JP2001061851A - 移植片固定装置 - Google Patents
移植片固定装置Info
- Publication number
- JP2001061851A JP2001061851A JP2000222738A JP2000222738A JP2001061851A JP 2001061851 A JP2001061851 A JP 2001061851A JP 2000222738 A JP2000222738 A JP 2000222738A JP 2000222738 A JP2000222738 A JP 2000222738A JP 2001061851 A JP2001061851 A JP 2001061851A
- Authority
- JP
- Japan
- Prior art keywords
- implant
- transplanting
- bone
- tissue
- substrate
- 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.)
- Granted
Links
- 239000007943 implant Substances 0.000 claims description 77
- 239000000463 material Substances 0.000 abstract description 22
- 230000000149 penetrating effect Effects 0.000 abstract 2
- 210000000988 bone and bone Anatomy 0.000 description 50
- 239000000758 substrate Substances 0.000 description 48
- 238000000034 method Methods 0.000 description 25
- 210000001519 tissue Anatomy 0.000 description 22
- 238000003780 insertion Methods 0.000 description 12
- 230000037431 insertion Effects 0.000 description 12
- 210000000845 cartilage Anatomy 0.000 description 11
- 230000007547 defect Effects 0.000 description 11
- 238000001356 surgical procedure Methods 0.000 description 7
- 210000000629 knee joint Anatomy 0.000 description 6
- 210000005065 subchondral bone plate Anatomy 0.000 description 5
- 241001494479 Pecora Species 0.000 description 4
- 238000010079 rubber tapping Methods 0.000 description 4
- 102000008186 Collagen Human genes 0.000 description 3
- 108010035532 Collagen Proteins 0.000 description 3
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 3
- 239000000560 biocompatible material Substances 0.000 description 3
- 210000004027 cell Anatomy 0.000 description 3
- 229920001436 collagen Polymers 0.000 description 3
- 239000002253 acid Substances 0.000 description 2
- 238000004873 anchoring Methods 0.000 description 2
- 239000000919 ceramic Substances 0.000 description 2
- 238000005553 drilling Methods 0.000 description 2
- 238000003306 harvesting Methods 0.000 description 2
- 229920002463 poly(p-dioxanone) polymer Polymers 0.000 description 2
- 239000000622 polydioxanone Substances 0.000 description 2
- 229920000642 polymer Polymers 0.000 description 2
- 230000000717 retained effect Effects 0.000 description 2
- LCSKNASZPVZHEG-UHFFFAOYSA-N 3,6-dimethyl-1,4-dioxane-2,5-dione;1,4-dioxane-2,5-dione Chemical group O=C1COC(=O)CO1.CC1OC(=O)C(C)OC1=O LCSKNASZPVZHEG-UHFFFAOYSA-N 0.000 description 1
- 206010002091 Anaesthesia Diseases 0.000 description 1
- 108010080379 Fibrin Tissue Adhesive Proteins 0.000 description 1
- 208000006735 Periostitis Diseases 0.000 description 1
- -1 Polyethylene Polymers 0.000 description 1
- 239000004698 Polyethylene Substances 0.000 description 1
- 229920000954 Polyglycolide Polymers 0.000 description 1
- 208000002847 Surgical Wound Diseases 0.000 description 1
- 239000004809 Teflon Substances 0.000 description 1
- 229920006362 Teflon® Polymers 0.000 description 1
- 206010052779 Transplant rejections Diseases 0.000 description 1
- 230000002745 absorbent Effects 0.000 description 1
- 239000002250 absorbent Substances 0.000 description 1
- 230000037005 anaesthesia Effects 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 230000015572 biosynthetic process Effects 0.000 description 1
- 230000012292 cell migration Effects 0.000 description 1
- 239000003795 chemical substances by application Substances 0.000 description 1
- 210000001612 chondrocyte Anatomy 0.000 description 1
- 239000002131 composite material Substances 0.000 description 1
- 238000010276 construction Methods 0.000 description 1
- 238000007796 conventional method Methods 0.000 description 1
- QTCANKDTWWSCMR-UHFFFAOYSA-N costic aldehyde Natural products C1CCC(=C)C2CC(C(=C)C=O)CCC21C QTCANKDTWWSCMR-UHFFFAOYSA-N 0.000 description 1
- 238000012258 culturing Methods 0.000 description 1
- 230000002950 deficient Effects 0.000 description 1
- 238000005516 engineering process Methods 0.000 description 1
- 230000007613 environmental effect Effects 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 238000000227 grinding Methods 0.000 description 1
- 239000001963 growth medium Substances 0.000 description 1
- 238000000338 in vitro Methods 0.000 description 1
- ISTFUJWTQAMRGA-UHFFFAOYSA-N iso-beta-costal Natural products C1C(C(=C)C=O)CCC2(C)CCCC(C)=C21 ISTFUJWTQAMRGA-UHFFFAOYSA-N 0.000 description 1
- 210000003127 knee Anatomy 0.000 description 1
- 230000014759 maintenance of location Effects 0.000 description 1
- 239000011159 matrix material Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- HLXZNVUGXRDIFK-UHFFFAOYSA-N nickel titanium Chemical compound [Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ti].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni].[Ni] HLXZNVUGXRDIFK-UHFFFAOYSA-N 0.000 description 1
- 229910001000 nickel titanium Inorganic materials 0.000 description 1
- 230000035515 penetration Effects 0.000 description 1
- 210000003460 periosteum Anatomy 0.000 description 1
- 229920000747 poly(lactic acid) Polymers 0.000 description 1
- 229920001610 polycaprolactone Polymers 0.000 description 1
- 239000004632 polycaprolactone Substances 0.000 description 1
- 229920000573 polyethylene Polymers 0.000 description 1
- 239000004633 polyglycolic acid Substances 0.000 description 1
- 239000004626 polylactic acid Substances 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 238000010298 pulverizing process Methods 0.000 description 1
- 229920006395 saturated elastomer Polymers 0.000 description 1
- 239000011780 sodium chloride Substances 0.000 description 1
- 239000007779 soft material Substances 0.000 description 1
- 210000004872 soft tissue Anatomy 0.000 description 1
- 229910001220 stainless steel Inorganic materials 0.000 description 1
- 239000010935 stainless steel Substances 0.000 description 1
- 230000000007 visual effect Effects 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0642—Surgical staples, i.e. penetrating the tissue for bones, e.g. for osteosynthesis or connecting tendon to bone
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00004—(bio)absorbable, (bio)resorbable or resorptive
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0409—Instruments for applying suture anchors
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0412—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from suture anchor body
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0419—H-fasteners
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0427—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from the anchor body
-
- 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
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0445—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors cannulated, e.g. with a longitudinal through-hole for passage of an instrument
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0646—Surgical staples, i.e. penetrating the tissue for insertion into cartillege, e.g. meniscus
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/28—Bones
- A61F2/2846—Support means for bone substitute or for bone graft implants, e.g. membranes or plates for covering bone defects
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Molecular Biology (AREA)
- General Health & Medical Sciences (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Rheumatology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Prostheses (AREA)
- Surgical Instruments (AREA)
Abstract
織移植片を固定するのに有用である。この移植片固定装
置は連接部材により連接される2個の移植部材により構
成されている。これらの移植部材は長手方向に貫通する
通路をそれぞれ有している。
Description
外科手術固定装置であり、特に、骨に移植片を固定する
ための外科手術固定装置である。
しい速さで進展している。特に、例えば、膝関節から軟
骨細胞および線維軟骨細胞を人間の身体から収集するこ
とが知られている。これらの自己細胞は生体吸収性の基
材上の実験室環境内において培養される。この基材は一
般に置換する必要のある組織部位とほぼ同一の形状をし
ている。適当な環境条件下における適当な培養媒地内で
十分な時間培養した後に、収集した細胞は基材上で成長
して患者において置換する必要のある組織部位とほぼ同
一の物理的形状を有する移植可能な組織部位を形成す
る。その後、このような基材上における細胞の(あるい
は、細胞を伴わない基材のみから成る)組織人工構造体
は縫合線、骨膜被覆材、フィブリン接着剤を含む従来に
おいて既知の外科手術固定装置により該当する骨の部位
に固定される。
日において生体の軟骨組織を人工の軟骨に置換すること
が可能である。加えて、インビトロで成長させた軟骨組
織が患者の自己軟骨組織と同一であるために、組織移植
片の拒絶の可能性を最少にできる。
しているが、それらの用途に伴う幾つかの不都合があ
る。まず、これらの固定装置は一般的な構成を有してい
て、骨や軟質組織に対して基材を固定するために特定的
に構成されているのではなく、種種の外科処理において
使用できるようになっている。また、他の不都合点とし
て、最少の侵襲性の関節鏡処理においてこれらの装置の
多くを使用する困難さがある。さらに別の不都合点とし
て、軟骨弁として使用するための軟骨片の採取における
困難さおよびその外科処理、当該採取に伴う患者の相当
な罹病率、および薄くて軟質な物質を周囲の組織に縫合
する困難さ等が挙げられる。
おいて組織が成長を続けて再生するように人工組織の基
材を骨や他の係留部位に効果的に固定することのできる
新規な固定装置がこの技術分野において要望されてい
る。
は組織人工化基材を骨や他の係留部位に効果的に固定す
ることにより移植した組織を保持して組織が成長し再生
し続けることのできる固定装置を提供することである。
により容易に備え付けることのできる基材を骨の部位に
固定するための装置を提供することである。
の結び目を形成する必要のない基材を骨の部位に固定す
るための装置を提供することである。
定の場所に上記の装置により基材を固定するための外科
手術方法を提供することである。
る。この移植片固定装置は第1の移植部材および第2の
移植部材を有している。これらの部材は細長い形状であ
って、円筒形状を有しているのが好ましい。また、これ
らの部材は先端部、基端部、および長手方向の軸を有し
ている。各移植部材の全長にわたって長手方向の通路が
貫通している。これらの部材は外表面を有している。さ
らに、これらの移植部材は第1の端部および第2の端部
および中央部位を有する棒状部材により互いに接続して
いる。この棒状部材の第1の端部は第1の移植部材の基
端部から延出しており、この棒状部材の第2の端部は第
2の移植部材の基端部から延出している。好ましくは、
この棒状部材は比較的剛体であり、例えば、逆「U」字
のような幾何学的な形状を有することができる。しかし
ながら、この棒状部材は柔軟性を有していてもよい。さ
らに、この棒状部材は移植部材を互いに相対的に固定し
た距離で維持する。また、棒状部材の中央部分は組織人
工化基材移植片における一定の部位に係合するように構
成されている。好ましい実施形態において、上記の移植
部材は当該移植部材の外表面部から延出して、移植部材
が既に形成した骨の穴の中に移植された後に、骨の部位
または他の係留部位からの当該移植部材の離脱阻止を補
助する一連の隆起部を有している。
材を骨に固定するために本発明の移植片固定装置を用い
る方法である。
点は以下の説明および図面によりさらに明らかとなる。
および非吸収性材料を含む従来の生体許容性の材料、な
らびに、従来の生体崩壊性の材料により形成できる。利
用できる非吸収性材料としては、ステンレススチール、
ポリエチレン、テフロン(登録商標)、ニチノール、非
吸収性ポリマー、他の生体許容性材料、セラミックス、
およびこれらの組合せ物等の従来の生体許容性の材料が
含まれる。また、本発明の移植片固定装置を製造するの
に使用できる吸収性材料としては、一般に、効果的に成
形処理または加工処理できるこの技術分野において既知
の従来の生体吸収性または生体再吸収性の材料が含まれ
る。さらに、これらの生体吸収性および生体再吸収性の
材料としては、ポリ乳酸、ポリジオキサノン、ポリカプ
ロラクトン、ポリグリコール酸、ポリガラクタン酸(po
lygalactic acid)、他の既知の生体許容性で生体吸収
性および生体再吸収性のポリマー、セラミック、複合
材、およびこれらの組合せ物および等価物等が含まれ
る。
固定装置10の好ましい実施形態が示されている。この
移植片固定装置10は移植部材20を有して示されてい
る。これらの移植部材20は細長い部材であって、ほぼ
円筒形状を有しているのが好ましい。さらに、これらの
部材20は円錐形、ピラミッド形、多角形、立方体、球
形等の他の幾何学的形状であってもよい。移植部材20
は先端部22および基端部24を有して示されている。
さらに、各移植部材20は外表面部28および長手軸2
9を有している。また、各部材20は貫通する長手方向
の通路35を有している。これらの移植部材20は円錐
台形の端部30と、基端側端面部32を有している。こ
の端面部32は平坦であるが、傾斜状、凹状、凸状など
であってもよい。端面部32は通路35に連通する中央
の円形開口部36を有している。好ましくは、この中央
開口部36は円形の断面を有しているが、楕円形、多角
形、正方形、長方形、およびこれらの組合せのような別
の幾何学的な断面を有していてもよい。また、部材20
は通路35に連通する円形開口部38を有する先端側端
面部37を備えている。選択的な円錐台形状の端部30
により示されるように、環状の端面部37は開口部38
の周りで最小になっているが、この厚さは円錐台形状の
端部の末端部まで増大している。さらに、部材20の表
面28から組織係合端部44を有する一連の選択的な突
出部40が延出している。これらの突出部40がなけれ
ば、部材20の表面28は滑らかになる。
する移植片保持部材50を備えている。この保持(連
接)部材50は第1の端部52、第2の端部54および
中央部分55を有する棒状部材として示されている。第
1の端部52は第1の部材20の基端側端面部32から
延出しており、第2の端部54は第2の部材20の基端
側端面部32から延出している。なお、これらの保持部
材50の端部52および54は、必要に応じて、外表面
部28の任意の部分から延出することができ、また当該
任意の部分に取り付けることができる。連接部材50は
上部セグメント55および足部セグメント56を含む3
個のセグメントに屈曲または形付けられているのが好ま
しい。上部セグメント55は足部セグメント56に対し
てほぼ直角になるように示されている。この連接部材5
0は逆「U」字形を有しているのが好ましいが、半円
形、円弧状、湾曲状、三角形、多角形、U字形およびこ
れらの組合せ等を含む別の幾何学形状を有していてもよ
い。また、連接部材50の各端部52および54は従来
様式において移植部材20に永久的に固定されていても
よく、また着脱自在に取り付けられていてもよい。部材
50は剛体または柔軟性のいずれでもよい。さらに、部
材50は骨または他の骨質表面上において組織人工化基
材を効果的に保持するのに十分な表面積を有している。
好ましくは、連接部材50は円形断面を有しているが、
楕円形、多角形、正方形、長方形、およびこれらの組合
せ等を含む別の幾何学的断面を有していてもよい。加え
て、部材50は剛体または柔軟性のいずれでもよく、単
一のフィラメント構造体または多数本の内部接続したフ
ィラメントまたは部材とすることができる。
ける本発明の移植片固定装置10の用法を説明する。ま
ず、最初の工程を示す図3において、本発明の移植片固
定装置10による人工組織を含有する基材の備え付けの
前に、例えば、膝関節における肋軟骨下骨等の骨210
に2個の(ボア)穴200をドリルまたは「タッピン
グ」により形成する。穴200は底部208、開口上部
202および側壁部205を有する円筒形の穴として示
されている。必要に応じて、これらの穴は骨の内部にお
いて連通していてそれぞれ底部を有していなくてもよ
く、また、開口した底部を有していてもよい。特に、図
10に示すような器具400を用いて骨に穴あけ(タッ
ピング)するのが好ましく、この器具400はこの技術
分野において「スラップハンマー(slap hammer)」部位
と従来称される基端側部位を有している。また、本明細
書において使用する用語の「タッピング」または「タッ
プ」は、器具400の軸部405の先端部415から延
出する先端側の尖ったプロング(熊手部)420を骨の
一定部位に配置して、器具400の基端部410を摺動
可能なハンマーハンドル450(「スラップハンマー」
の)によりたたくまたは打つ処理を意味する。なお、こ
のハンマーハンドル450は基端部410と基端側停止
部470との間の軸部460上を摺動して骨に穴200
を形成する。軸部460の先端部465は基端部411
に接続している。基端側停止部470は基端部467に
取り付けられている。また、ハンマーハンドル450は
把持部位451、カラー455および長手軸に沿う通路
457を備えている。なお、当該技術分野における熟練
者であれば、例えば、爪状の先端部を有する任意の器具
のような、骨に穴を「タッピング」により形成するため
に類似の先端の尖った器具を使用できることが理解され
ると考える。加えて、好ましいとは考えられないが、1
個の骨の穴を一度に「タップ処理」により形成できる。
また、外科医がドリルにより骨に穴を形成することを選
ぶ場合は、任意の従来的な外科ドリル処理装置が使用で
きる。穴200を骨210に形成した後に、外科医は図
4に示すように骨の表面201上に人工組織を含有する
基材220を配置する。次に、移植片固定装置10が挿
入器具250に取り付けられる。図11に示すような挿
入器具250は基端部262および先端部264を有す
る細長い棒状部材260として示されている。棒状部材
260の先端部264に深さ停止部またはプレート部材
290が取り付けられている。この深さ停止部290は
棒状部材260の長手軸251に垂直に取り付けられた
概ね長方形の部材として示されている。深さ停止部29
0は底部292を有している。さらに、一対の平行に離
間した取り付けプロング270がこのプレート部材29
0の底部292から先端側に延出している。これらの取
り付けプロング270は先端側に尖っている先端部27
7および基端部272を有する概ね棒状の部材として示
されている。さらに、これらのプロング270は第1の
部位273および先端部位275を有して示されてい
る。この第1の部位273は先端部位275よりも大き
な断面寸法を有していて、全体の部位275が部材20
の通路35の中に挿入可能であって、基端側部位273
がその中に挿入できないようになっている。この器具2
50もまた基端部262から延出している基端側の軸部
300から成る「スラップハンマー部位」、および基端
部262と基端側停止部330との間で軸部300上に
摺動可能な摺動ハンマーハンドル320(「スラップハ
ンマー」)を有して示されている。このハンマーハンド
ル部材320は把持部位325、端部カラー327およ
び長手軸通路329を有して示されている。移植片固定
装置10はプロング270上に移植部材20を摺動する
ことにより挿入器具250に取り付けられて、当該プロ
ング270の先端部位275が部材20の長手軸通路3
5の中に係合されて先端部277が先端側端面部37の
端部から突出する。その後、図5および図6に示される
ように、器具250を操作して、移植片固定装置10が
基材220を貫通して骨210の中に挿入されて、プロ
ング270上に取りつけた移植部材20が骨の穴200
の中に移動してこの骨の穴に部材剤20が係合すると共
に、保持部材50の組織係合部位55が基材220に係
合して基材220が骨210の表面201に固定され
る。所望に応じて、装置10の挿入の前に基材220の
中に穴を形成できる。その後、図7に示すように挿入器
具250を基端側に後退させて、プロング270を移植
部材20の通路35から後退させることにより、移植片
固定装置10を骨の穴の中に係合した状態で残留させ
て、基材220が骨210の表面201に係合した状態
で保持される。器具250の「スラップハンマー」部位
はプロングの取り外しを補助する。基材220を骨の表
面201上に保持した状態での骨210内に係合した装
置10の断面図を図8に示す。
付けた本発明の多数個の固定装置を有する骨210の骨
表面部201に取り付けた基材220を示している図で
ある。十分に有効な固定をするために必要な固定装置1
0の数、解剖構造学的位置および配向は移植片または基
材の寸法および種類、組織の種類、患者の年齢、患者の
欠陥部の寸法、固定装置の寸法、固定装置の構成材料、
治療部位において組織にかかる負荷等により変化する。
発明の固定装置の寸法は装置の特定の構成、構成材料、
装置の特定用途、および外科処理の種類等を含む多数の
変数により変化することが理解されると考える。さら
に、これらの装置により固定される基材の種類もまた同
様に変化する。なお、本明細書の一部分である図面は本
発明の装置および方法を単に概略的かつ例示的に説明す
るためのものであり、上記の装置および基材の実際の寸
法は実施において変更可能である。
態を例示するものであり、これらにより本発明を限定す
るわけではない。
の麻酔処理およびプロトコルを含む標準的な無菌外科技
法による外科処理用に6頭の羊を準備した。その後、外
科医はこれらの骨格的に成長した羊のそれぞれにおける
中央大腿骨顆の重量支持領域上および右後膝関節におけ
る滑車溝部内に7mm径の軟骨(全圧軟骨)欠損部を形
成した。欠損部は肋軟骨下部の骨の露出またはこれへの
穿通を防止するための深さ停止部を備える特別製のドリ
ルにより形成した。次に、全ての欠損部の底面を特別製
のマイクロピック用具により微小粉砕して細胞移動用の
接近路を形成した。その後、これらの被検体を以下のよ
うにそれぞれ2頭づつ3組に分けた。 グループ1:本発明の移植片固定装置により固定したコ
ラーゲン基材により充填された欠損部。 グループ2:9−0吸収性Vicryl(商標)縫合線(1個
の基材当たり約12本の中断ステッチ技法)により固定
したコラーゲン基材により充填された欠損部。 グループ3:充填処理しない欠損部(対照群)。
処理を受け、あるいは、同一の対照部として作用した。
形成して微小粉砕処理した後に、パンチ用具400を用
いて本発明の1個の移植片固定装置を受容するための2
個の必要な骨穴を肋軟骨下骨内に形成した。各基材を取
り付けるために1個のポリジオキサノン装置(4mmの
先端部間距離)のみを使用した。骨穴を形成するため
に、パンチ用具を欠損部の中心に配置して、矢状面内に
配向し、スラップハンマーにより打つか、叩いて肋軟骨
下骨内に数ミリメートル穿通させた。次に、塩類溶液
(saline)で飽和した7mm径の円形のコラーゲン基材
を欠損部内に入れてから余分な塩類溶液を吸い取って乾
燥した。挿入器具250に本発明の移植片固定装置10
を装填してから、この装置および挿入器具を基材の中心
上に配置して矢状面内に配向した。その後、外科医は予
め形成していた骨の穴の中に挿入器具の先端部を基材を
通して徐々に進入して位置決めした。挿入器具の先端部
と穴の位置決めが終わると、外科医はハンマーを使用し
て挿入器具(および固定装置10の移植部材20)を基
材を通して肋軟骨下骨内に完全に進入させた。この移植
器具は移植部材20が過剰に深く進入することを防止す
るための深さ停止部を備えているので、基材を通しての
移植部材の適正な配置が確実に行なえる。その後、2個
の移植部材の間の連接保持部材がコラーゲン基材を圧縮
して下部の肋軟骨下骨に固定されたことが示されること
によりこの挿入処理が完了する。任意の後膝関節におけ
る2個の欠損部をそれぞれ基材および固定装置により処
置した後に、この後膝関節部を縫合して羊を放置して回
復させた。この場合に、本発明の固定装置により基材を
取り付けるのに約1分(グループ1)かかり、縫合線の
みおよび必要な縫合線操作および結び目形成により基材
を取り付けるのに約15分(グループ2)かかった。
外科的に切開して検査した。この関節部の肉眼による評
価により、本発明の移植片固定装置により保持された4
個の全ての基材が完全な状態に保たれていることが分か
った。しかしながら、縫合線のみにより保持された4個
の全ての基材は部分的にのみ完全性が保たれていて、平
均で約30%の縫合線が任意の基材において破損してい
た。
置の別の実施形態を図9に示す。図9において、装置3
00は一対の移植部材310を有して示されている。こ
れらの移植部材310は長手軸311、先端部314お
よび基端部312をそれぞれ有する概ね円筒形の部材で
ある。各移植部材310は長手軸方向の通路320を有
している。この部材310は先端側の円錐台形状の端部
330、外表面部350、および当該外表面部350か
ら外方に延出している隆起部355を有している。各部
材310は第1の端部342および第2の端部344を
それぞれ有する一対の保持部材340により連接されて
いる。
0およびその方法は多くの利点を有する。これらの利点
には人工組織または他の組織の基材を固定するための迅
速で日常的な方法が提供できることが含まれる。すなわ
ち、この固定装置10は縫合線の結び目を形成する必要
がないので、必要な外科的切開が最小で患者の罹病率を
大幅に減少し得る関節鏡外科処理において利用できる。
加えて、この固定装置10は、周囲の組織を通過させる
(それゆえ損傷する)必要のある従来的な縫合線により
基材を軟骨欠損部に固定する従来的な方法とは異なっ
て、周囲の正常な軟骨組織を損傷することのない優れた
基材の固定方法を提供することが分かった。
て説明したが、当該技術分野における通常の熟練者にお
いて、本明細書に記載する特許請求の範囲およびその実
施態様に定められる本発明の趣旨および範囲に逸脱しな
い限りにおいて上記実施形態の種々の変形および変更が
可能であることが理解されると考える。
している一連の隆起部を有している請求項1に記載の装
置。 (2)前記連接部材が中央部分および棒状部材を有する
形状に形成されており、当該棒状部材が前記移植部材の
長手軸に対してほぼ平行であり、前記中央部分が棒状部
材に対してほぼ垂直である請求項1に記載の装置。 (3)前記連接部材が半円形の形状を有している請求項
1に記載の装置。 (4)さらに、前記第1の移植部材の先端部および前記
第2の移植部材の先端部から延出している円錐台形状の
端部から成る請求項1に記載の装置。 (5)前記移植部材が円筒形の形状を有している請求項
1に記載の装置。
て、移植片固定装置を備える工程から成り、当該装置
が、第1の移植部材から成り、当該第1の移植部材が長
手軸、基端部、先端部、外表面部、および長手方向に貫
通する通路を有しており、さらに、第2の移植部材から
成り、当該第2の移植部材が長手軸、基端部、先端部、
外表面部、および長手方向に貫通する通路を有してお
り、さらに、前記第1の移植部材および第2の移植部材
の各基端部に配置されて前記長手方向の通路を囲ってい
る基端側環状面部と、前記第1の移植部材および第2の
移植部材を連接する連接部材とから成り、当該連接部材
が中央部分、前記第1の部材から延出している第1の端
部、および前記第2の移植部材から延出している第2の
端部を有しており、さらに、前記方法が、骨に一対の離
間するボア穴を形成する工程と、一対の離間したプロン
グを有する挿入器具に前記装置を取り付ける工程とから
成り、当該プロングが先端部を有していて、これらのプ
ロングが前記移植部材の各通路の中に収容されて、それ
ぞれの先端部が当該移植部材の先端部から延出するよう
になっており、さらに、基材を前記ボア穴の上方の骨の
表面部上に配置する工程と、前記移植部材を前記基材を
通して前記ボア穴の中に挿入して、当該基材を骨に固定
する工程とから成る方法。 (7)前記移植部材が当該移植部材の外表面部から延出
している一連の隆起部を有している実施態様(6)に記
載の方法。 (8)前記連接部材が中央部分および棒状部材を有する
形状に形成されており、当該棒状部材が前記移植部材の
長手軸に対してほぼ平行であり、前記中央部分が棒状部
材に対してほぼ垂直である実施態様(6)に記載の方
法。 (9)前記連接部材が半円形の形状を有している実施態
様(6)に記載の方法。 (10)前記移植部材が、さらに、前記第1の移植部材
の先端部および前記第2の移植部材の先端部から延出し
ている円錐台形状の端部を備えている実施態様(6)に
記載の方法。
している実施態様(6)に記載の方法。 (12)前記各プロングがさらに前記先端部から延出し
ている尖った部分を備えている実施態様(6)に記載の
方法。 (13)前記各プロングが一定の断面を有する先端側部
分および一定の断面を有する基端側部分を備えており、
当該基端側部分の断面の面積が先端側部分の断面の面積
よりも大きい実施態様(6)に記載の方法。 (14)前記各プロングが円形の断面を有している実施
態様(6)に記載の方法。
おいて組織が成長を続けて再生するように人工組織の基
材を骨や他の係留部位に効果的に固定することのできる
新規な固定装置が提供できる。
断面図である。
するための外科処理の説明図である。
するための外科処理の説明図である。
するための外科処理の説明図である。
するための外科処理の説明図である。
移植片固定装置を示しており、当該装置が基材を骨の表
面に固定した状態を示している図である。
る線8−8に沿う断面図である。
定装置の別の実施形態を示す図である。
据え付けることのできる骨の穴を形成するのに有用な器
具の斜視図である。
るのに有用な器具の斜視図である。
固定した組織人工化基材の概略図である。
Claims (1)
- 【請求項1】 移植片固定装置において、 第1の移植部材から成り、当該第1の移植部材が長手
軸、基端部、先端部、外表面部、および長手方向に貫通
する通路を有しており、さらに、 第2の移植部材から成り、当該第2の移植部材が長手
軸、基端部、先端部、外表面部、および長手方向に貫通
する通路を有しており、さらに、 前記第1の移植部材および第2の移植部材の各基端部に
配置されて前記長手方向の通路を囲っている基端側環状
面部と、 前記第1の移植部材および第2の移植部材を連接する連
接部材とから成り、当該連接部材が中央部分、前記第1
の部材から延出している第1の端部、および前記第2の
移植部材から延出している第2の端部を有している装
置。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US360367 | 1999-07-23 | ||
US09/360,367 US6179840B1 (en) | 1999-07-23 | 1999-07-23 | Graft fixation device and method |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2001061851A true JP2001061851A (ja) | 2001-03-13 |
JP4152572B2 JP4152572B2 (ja) | 2008-09-17 |
Family
ID=23417689
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2000222738A Expired - Fee Related JP4152572B2 (ja) | 1999-07-23 | 2000-07-24 | 移植片固定装置 |
Country Status (6)
Country | Link |
---|---|
US (2) | US6179840B1 (ja) |
EP (1) | EP1070487B1 (ja) |
JP (1) | JP4152572B2 (ja) |
AU (1) | AU767246B2 (ja) |
CA (1) | CA2314448C (ja) |
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- 2000-07-21 CA CA002314448A patent/CA2314448C/en not_active Expired - Fee Related
- 2000-07-21 EP EP00306211A patent/EP1070487B1/en not_active Expired - Lifetime
- 2000-07-21 AU AU48762/00A patent/AU767246B2/en not_active Ceased
- 2000-07-21 DE DE60022590T patent/DE60022590T2/de not_active Expired - Lifetime
- 2000-07-24 JP JP2000222738A patent/JP4152572B2/ja not_active Expired - Fee Related
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2004
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JP2012526615A (ja) * | 2009-05-12 | 2012-11-01 | エシコン・インコーポレイテッド | 外科用締結具、アプリケータ器具、及び外科用締結具を展開する方法 |
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US10729433B2 (en) | 2009-05-12 | 2020-08-04 | Ethicon, Inc. | Applicator instruments for dispensing surgical fasteners having distal end caps with castling for engaging opposing surfaces |
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JP2012528699A (ja) * | 2009-06-04 | 2012-11-15 | ローテーション メディカル インコーポレイテッド | 目的の組織にシート状材料を固定するための装置 |
Also Published As
Publication number | Publication date |
---|---|
US8016867B2 (en) | 2011-09-13 |
CA2314448C (en) | 2007-11-27 |
JP4152572B2 (ja) | 2008-09-17 |
EP1070487A2 (en) | 2001-01-24 |
US20050059986A1 (en) | 2005-03-17 |
CA2314448A1 (en) | 2001-01-23 |
DE60022590D1 (de) | 2005-10-20 |
AU767246B2 (en) | 2003-11-06 |
EP1070487A3 (en) | 2001-09-12 |
AU4876200A (en) | 2001-01-25 |
US6179840B1 (en) | 2001-01-30 |
EP1070487B1 (en) | 2005-09-14 |
DE60022590T2 (de) | 2006-06-22 |
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