JP2003528648A - 自己ロック型縫合糸定着装置 - Google Patents
自己ロック型縫合糸定着装置Info
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- JP2003528648A JP2003528648A JP2001514841A JP2001514841A JP2003528648A JP 2003528648 A JP2003528648 A JP 2003528648A JP 2001514841 A JP2001514841 A JP 2001514841A JP 2001514841 A JP2001514841 A JP 2001514841A JP 2003528648 A JP2003528648 A JP 2003528648A
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- filament
- force threshold
- suture
- tissue
- bone
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- 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
- 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
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00862—Material properties elastic or resilient
-
- 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
- A61B2017/0403—Dowels
-
- 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
- A61B2017/0408—Rivets
-
- 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
- A61B2017/0414—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 a suture-receiving opening, e.g. lateral opening
-
- 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
- A61B2017/042—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors plastically deformed during insertion
- A61B2017/0422—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors plastically deformed during insertion by insertion of a separate member into the body of the anchor
- A61B2017/0424—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors plastically deformed during insertion by insertion of a separate member into the body of the anchor the separate member staying in the anchor after placement
-
- 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
- A61B2017/0438—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors slotted, i.e. having a longitudinal slot for enhancing their elasticity
-
- 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
- A61B2017/044—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws
-
- 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
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0448—Additional elements on or within the anchor
- A61B2017/045—Additional elements on or within the anchor snug fit within the anchor
-
- 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
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
-
- 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
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0459—Multiple holes in the anchor through which the suture extends and locking the suture when tension is applied
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
-
- 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
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0876—Position of anchor in respect to the bone
- A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
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- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Public Health (AREA)
- Surgery (AREA)
- Rheumatology (AREA)
- Molecular Biology (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Rehabilitation Therapy (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Vascular Medicine (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
Abstract
Description
装置、例えば定着装置に関する。さらに本発明は、結び目を使用せずに組織に縫
合糸を取り付ける縫合糸定着装置および一つ以上の定着装置とある程度の長さの
縫合糸を用いて組織を固定する方法に関する。
けることを要する。このことは、通常は、例えば、ネジ、ピンまたは他の骨定着
装置によって骨に縫合糸を定着させることと、軟組織にその縫合糸を巻き付ける
か縫い込むことによって行われる。この作業の完了後、一般的に外科医は組織を
固定するために縫合糸を結ぶ必要がある。この結び目形成工程は面倒でうんざり
させられるものであり、外科医が内視鏡管内に挿入された器具を用いて遠隔的に
縫合糸を操作するような、腹腔鏡または内視鏡を用いる処置においては特に面倒
でうんざりさせられる。さらに、一つの縫合糸を固定するには、6個も結び目を
形成しなければならないこともよくあることである。これらの結び目は、組織の
上方に盛り上がった状態になり、運動および治癒を阻害する。
,397号に開示されている。その装置は、縫合糸が通過する定着装置本体を備
えており、定着器本体はその内部に球状部材のようなクランプ機構を有する。縫
合糸が基端方向に引っ張られると、クランプが動かされて定着装置本体に接触さ
せられ、縫合糸を定位置に保持する。縫合糸が先端側に引っ張られると、クラン
プは解除され、縫合糸は自由に定着装置本体の内部を移動することができる。縫
合糸の少なくとも一つの端部は、軟組織に縫い付けられるか結ばれるか、縫い付
けられた上で結ばれる。
8,313号、同第5,665,112号および同第5,683,419号にお
いて、結び目のない縫合糸定着装置が提案されている。これらの特許には、一端
に小さいループを有するフィラメントを固定する縫合糸定着装置が記載されてい
る。ある実施の形態においては、他の長さを持つ縫合糸がその末端に小さな塊を
持っており、組織を固定するためにループの内部を通過させられる。確かにこれ
らの縫合糸は結び目なしで固定されるが、縫合糸を固定するのに使われる塊はそ
れ自体が組織の上方に盛り上がった状態になり、不快感の原因になって治癒を阻
害する。他の実施の形態では、定着装置自体が小さなループの内部を通過させら
れて、組織を固定するためのさらに大きなループを形成する。
ループを利用する縫合糸定着装置を開示し、この装置は同様な方式で組織を固定
する。他のThalの結び目のない定着装置と同様に、縫合糸の張力は、特別に与え
られた縫合糸の長さに依存しており、この縫合糸は調節することができない。従
って、これらの定着装置は、軟組織を固定するために縫合糸のループを堅く結ぶ
ことが必要とされる外科手術では使用できない。
例えば、運動選手の半月板に断裂が生ずることはよくあることである。かかる断
裂を治療する最も簡単な方法は、ある長さの縫合糸を組織に通して結ぶことによ
って、断裂を縫い合わせて閉じることである。しかし、かかる手術において使用
される針は、内視鏡手術で操作するのが非常に困難であり、縫合糸を固定する結
び目は上述のように治癒を阻害することがある。これらの困難性は、かかる傷害
の普通に起こる場所である膝の関節包の限られたスペースでは特に深刻である。
この目的のために、ダーツ(darts)およびクランプのような他の装置も提案さ
れてきている。例えば、米国特許第5,154,189号、同第5,269,7
83号および同第5,702,462号を参照されたい。縫合糸の結び目と同様
に、断裂の治癒の間、これらの装置は重大な不快感の原因になる。さらに、装置
が生体吸収性のない材料で製造されていた場合には、治癒の後に半月板から装置
を取り除くために二次的な手術を行わなければならない。
法が待望されている。さらに、縫合糸の位置を容易に調節することができる技術
および方法が待望されている。また、不快感を避けるために十分に小さく、生体
吸収性のある材料から製造されて構造になじみやすく、骨組織または軟組織のい
ずれにも使用されうる装置が待望されている。
織または軟組織に埋設されうる定着装置を提供し、この装置によれば縫合糸の長
さおよび/または張力を容易に調節することができ、結び目を使用することなく
固定することができる。
を有しており、この空洞はフィラメント(例えば縫合糸)を締まり嵌めによって
保持する。定着装置は、配備の後、例えば、縫合糸が取り付けられた骨および/
または軟組織の移動の間に縫合糸に与えられる「使用中の」力に縫合糸が抵抗で
きるように十分に強く縫合糸を保持する。しかし、このような締まり嵌めは十分
に弱いために、より強い力で空洞を通じて長手方向に縫合糸を引っ張ることが可
能である。
うる。縫合糸の両端の一つをより強い力で引っ張ることによって縫合糸は締め付
けられる。単に縫合糸のループまたは他端を引っ張ることによって、縫合糸の締
め付けが緩められることが本発明の利点である。ただし、縫合糸は通常の使用で
は緩められない。配備の間に縫合糸を移動させるのに要する力が、縫合糸が取り
付けられた骨および/または軟組織によって生ずる力よりも大きいからである。
。このループは組織の周囲に配置することができ、その後、縫合糸の一旦を引っ
張ることによって締め付けられて、組織を固定する。さらに、ループが非常に強
く締め付けるように引っ張られていても、強固に引っ張ることでループは緩める
ことができる。
上記のタイプの定着装置が骨に配置される。軟組織は、縫い付け、または組織の
一部を縫合糸のループの内部に捕捉してループを締め付けることによって、固定
される。縫合糸は、配備の間も必要に応じて締め付けたり緩めたりすることがで
き、結び目は必要としない。
される。
は定着要素10を備えており、この定着要素10は骨に形成された孔または軟組
織の内部に埋設するのに適しており、軸線方向の経路12を備えている。図示の
実施の形態では、定着要素10はその外面に一連の突起14を備えており、これ
らの突起14は例えば骨に形成された孔に定着要素10を固定するのを容易にす
る。突起14はこの定着装置の必須の要素ではなく、必要であれば省略すること
も可能であることが理解されよう。さらに定着要素10は挿入軸16を備える。
図1aに示される配備状態に定着装置がある場合には、挿入軸16は軸線方向の
経路12の内部に、例えば締まり嵌めの状態で保持されている。好ましい実施の
形態では、挿入軸16は軸線方向の経路12よりも僅かに大きく、このために挿
入軸16は定着要素10に挿入されると定着要素10を膨張させるように力を付
与し、定着装置を骨の孔に強固に固定させる。
ィラメント18は定着要素10と挿入軸16の間に配置されている。図1aおよ
び図1bに示された好ましい実施の形態では、この挿入部材(挿入軸16)は縫
合糸溝20を備える。この縫合糸溝20は、フィラメント(縫合糸)18を案内
して、定着要素10に対して圧縮された状態にフィラメント18を保持する。定
着要素10、挿入軸16およびフィラメント18の形状は、図1bに明瞭に示さ
れている。図1bは、図1aの矢印で示された位置における縫合糸定着装置の断
面図である。縫合糸溝20の内部で縫合糸18を緩く圧縮することによって、そ
の自由端22の一方に張力を与えたときに、縫合糸18の運動を妨げる摩擦抵抗
が生ずる。縫合糸18の一つの自由端に張力閾値を越える張力が与えられると、
この摩擦抵抗は打ち負かされる。その場合には、縫合糸18は長手方向に沿って
縫合糸溝20の内部を滑り、これによって自由端22の長さが調整されることに
なる。
施の形態の一つを示すに過ぎないことは理解されよう。特に、例えばループ状の
セグメントを形成するように、縫合糸が挿入軸16と定着要素10の間を複数回
通過する形態がときには好ましいこともある。本発明の他の実施の形態では、縫
合糸への圧縮力をさらに強力にし、縫合糸が移動するのに必要な張力閾値を、縫
合糸の破壊強度に近くまたはこれを越えるようにすることもできる。そのような
実施の形態では、縫合糸に一旦圧縮力が加わったなら、その自由端の長さを調整
することは不可能である。
ループが形成される。このループは、縫合糸を縫合糸定着装置に固定するのに使
用される。この実施の形態は、図2aおよび図2bに描かれている。図2aは縫
合糸定着装置をその対称軸線に沿って見た断面図であり、図2bは横断する断面
図である。縫合糸18の頭部は小さなループ28を有しており、このループ28
は縫合糸定着装置の先端に配置されている。縫合糸は挿入軸16と定着要素10
の間を通過し、ループ状のセグメント26を形成し、挿入軸16と定着要素10
の間を逆方向に通過する。そして、この縫合糸はループ28の内部を通過し、挿
入軸16と定着要素10の間を逆方向に上方に向けて通過して、自由端22で終
端する。ループ状のセグメント26は、自由端22を引っ張ることによって締め
付けられ、ループ状のセグメント26自体を引っ張ることによって緩められる。
縫合糸をループ状にすることによって奏される機械的な利点のために、ループ状
のセグメント26を引っ張って縫合糸を緩めるのに必要な力は、自由端22を引
っ張って縫合糸を締め付けるのに要する力の2倍になる。図示の実施の形態では
、縫合糸は挿入軸16の二つの通路23,25を通過する。ただし、これらの通
路の一つを排除し、縫合糸が縫合糸定着装置の頭部の周囲を通過するようにして
もよい。
の実施の形態では、縫合糸は、ループではなく小さな結び目27によって固定さ
れる。図3aは縫合糸定着装置の平面図であり、図3bは長手方向の断面図であ
る。
示す図である。図4a乃至図4cには、縫合糸の一部しか示されないが、縫合糸
は図2または図3に示される方式でループ状にされているのが好ましい。図4a
は、骨に形成された孔32に配置され、配備装置34に連結された縫合糸定着装
置を示す図である。図4bは、定着要素10の軸線方向の経路12の内部に向け
て引っ張られた挿入部材16を示す図である。挿入部材16の軸には、配備装置
34の集合的軸牽引部によって矢印Aで示される方向に張力が与えられる一方で
、定着要素10は配備装置34の定着器保持部によって骨の孔の内部でほとんど
不動に保持される。これらの力は、挿入部材16を矢印Aで示される方向に移動
させるように作用し、これによって挿入部材の大径部が定着要素10の軸線方向
の経路12の内部に向けて引っ張られる。この結果、定着要素10の壁が外側か
つ骨の孔32の壁に向けて膨張する。図4cに示されるように、挿入軸16のフ
ランジ36が定着要素10の先端部に接触して、さらなる移動が規制されるよう
になるまで、挿入軸16は軸線方向の経路12の内部において基端側に引っ張ら
れる。この位置で、配備装置34は挿入軸16に対して張力を加え続け、脆い部
分38を破断させる。これは、挿入軸16の余計な部分の除去を容易にするとと
もに、配備装置34を離脱させる。縫合糸18は、自由端22を強く引っ張るこ
とによって調整されうる。
ら提供されうる。例えば、成人の肩の回旋腱板の治療のために使用される、肩甲
骨に埋設される目的を持つ通常の定着装置は、8mm乃至15mmの範囲の長さ
と、3mm乃至6mmの範囲の直径を有する。かかる定着装置は、例えば2番の
縫合糸を25ポンド乃至35ポンド(11.34kg乃至15.88kg)の範
囲にある力の閾値で保持することが可能である。(ここで使用されるように、「
力の閾値」は、これを越えれば定着装置の内部でフィラメントを長手方向に移動
させることができ、これ未満ではフィラメントが定着装置の内部でほとんど動か
ないような引っ張り力である。)一般的には、定着装置は生体適合性のある材料
、例えば、インプラントに適する等級の高密度のポリエチレン、低密度のポリエ
チレン(PE6010およびPE2030)、ポリプロピレン(13R9Aおよ
び23M2、全てテキサス州、ダラスのRexeneで製造されている)または手術用
インプラントの等級の鋼からなることが望ましい。ある実施の形態では、定着装
置は、生体吸収性のある材料、例えば、ポリ−l−ラクチドまたはラクチド−グ
リコライドの組成物を含有する。
装置は、肩甲骨に回旋腱板を再取付することによって断裂した肩の回旋腱板を治
療するために使用されうる。図3aに示されるような定着装置は、縫合糸を締ま
り嵌めによって保持しており、例えば肩甲骨に穿孔された孔に埋設される。縫合
糸のループおよび縫合糸の自由端は、定着装置の基端において、肩甲骨から外側
に延び出す。
ループの内部に通される。それから、このループは力の閾値よりも大きな力で自
由端が引っ張られることによって締め付けられる。これによってループが締め付
けられ、ループは組織を定着装置に対して引き寄せ、縫合糸を結ばなくてもルー
プは組織を骨に固定する。その後、縫合糸の自由端は所望であれば切り取られる
。
される。特に、同時係属中の米国特許出願第08/813,914号、例えばそ
の図5および明細書に記載されたデザイン、ならびに同時係属中の米国特許出願
第08/814,149号の明細書に記載されたデザインに類似するデザインは
、本出願で開示した技術に従って縫合糸を保持するのに適合させることが可能で
ある。これらの米国特許出願は参照されることによって、本出願の開示の一部を
なす。
明の他の実施の形態を案出することは、当業者には自明であろう。例えば、本発
明は、骨に軟組織を固定することおよび軟組織の断裂を治療することに関連して
主に説明されているが、本発明は軟骨、靱帯または他の組織を固定して治療する
のにも使用されうる。この明細書および開示された例は例示のためのみに考慮さ
れるべきものであり、本発明の真の外延および趣旨は特許請求の範囲によって示
されている。
ある。
図である。
。
ある。
Claims (27)
- 【請求項1】 組織または骨にフィラメントを定着させる装置であって、 骨に埋設するのに適しており、内部に空洞を有する定着部材と、 前記空洞から延び出した第1の部分と第2の部分を有しており、締まり嵌めに
よって前記空洞に保持されるフィラメントとを備えており、 前記フィラメントは、力の閾値よりも小さい引っ張り力が前記第1の部分およ
び第2の部分のいずれかに与えられることに応じてはほとんど移動せず、 前記フィラメントは、前記力の閾値よりも大きい引っ張り力が前記第1の部分
および第2の部分のいずれかに与えられることに応じて長手方向に移動すること
を特徴とする装置。 - 【請求項2】 前記フィラメントは前記力の閾値よりも大きな破損張力を有
することを特徴とする請求項1に記載の装置。 - 【請求項3】 前記フィラメントは前記力の閾値よりも小さな破損張力を有
することを特徴とする請求項1に記載の装置。 - 【請求項4】 前記力の閾値は、25ポンド乃至35ポンド(11.34k
g乃至15.88kg)の範囲にあることを特徴とする請求項1に記載の装置。 - 【請求項5】 前記定着部材は、組織内の孔に挿入される定着要素を備えて
おり、前記定着要素はその基端と先端の間を延びる軸線方向の経路を有しており
、前記定着要素は挿入軸に摺動可能に取り付けられており、 前記挿入軸は前記軸線方向の経路の内径よりも大きな外径を持つ部分である大
径部を有しており、前記挿入軸は前記軸線方向の経路にて基端側に移動するよう
になされていることによって、前記大径部が前記軸線方向の経路の内部を少なく
とも部分的に移動して、前記組織内の孔に圧力嵌め状態になるように前記定着要
素を膨張させることを特徴とする請求項1に記載の装置。 - 【請求項6】 前記空洞は前記定着要素の表面と前記挿入軸の表面によって
形成され、これらの表遠の間に配置されていることを特徴とする請求項5に記載
の装置。 - 【請求項7】 前記第1の部分と前記第2の部分の間に位置する、前記フィ
ラメントの少なくとも二つの箇所が前記定着部材を通過し、前記箇所の間にルー
プ状のセグメントが形成されることを特徴とする請求項1に記載の装置。 - 【請求項8】 前記力の閾値よりも大きな引っ張り力で前記フィラメントの
前記第1の部分および前記第2の部分のいずれかを引っ張ることによって、前記
ループ状のセグメントは締め付け可能であることを特徴とする請求項7に記載の
装置。 - 【請求項9】 前記力の閾値の2倍より大きい引っ張り力で前記ループ状の
セグメントを引っ張ることによって、前記ループ状のセグメントは緩めることが
可能であることを特徴とする請求項7に記載の装置。 - 【請求項10】 前記定着部材は骨の孔に埋設するのに適することを特徴と
する請求項1に記載の装置。 - 【請求項11】 前記定着部材は、ポリエチレン、ポリプロピレン、鋼、ポ
リ−l−ラクチドおよびラクチド−グリコライドの組成物からなる群から選択さ
れる生体適合性のある材料を含有することを特徴とする請求項1に記載の装置。 - 【請求項12】 組織または骨にフィラメントを定着させる装置であって、 骨に埋設するのに適しており、内部に空洞を有する定着部材と、 前記空洞から延び出した第1の部分と第2の部分を有しており、締まり嵌めに
よって前記空洞に保持されるフィラメントとを備えており、 前記フィラメントは、力の閾値よりも小さい引っ張り力が前記第1の部分およ
び第2の部分のいずれかに与えられることに応じてはほとんど移動せず、 前記フィラメントは、前記力の閾値よりも大きい引っ張り力が前記第1の部分
および第2の部分のいずれかに与えられることに応じて長手方向に移動すること
によって、 前記フィラメントが軟組織を固定するのに使用されうることを特徴とする装置
。 - 【請求項13】 前記フィラメントは前記力の閾値よりも大きな破損張力を
有することを特徴とする請求項12に記載の装置。 - 【請求項14】 前記力の閾値は、25ポンド乃至35ポンド(11.34
kg乃至15.88kg)の範囲にあることを特徴とする請求項12に記載の装
置。 - 【請求項15】 前記定着部材は、組織内の孔に挿入される定着要素を備え
ており、前記定着要素はその基端と先端の間を延びる軸線方向の経路を有してお
り、前記定着要素は挿入軸に摺動可能に取り付けられており、 前記挿入軸は前記軸線方向の経路の内径よりも大きな外径を持つ部分である大
径部を有しており、前記挿入軸は前記軸線方向の経路にて基端側に移動するよう
になされていることによって、前記大径部が前記軸線方向の経路の内部を少なく
とも部分的に移動して、前記組織内の孔に圧力嵌め状態になるように前記定着要
素を膨張させることを特徴とする請求項12に記載の装置。 - 【請求項16】 前記空洞は前記定着要素の表面と前記挿入軸の表面によっ
て形成され、これらの表遠の間に配置されていることを特徴とする請求項15に
記載の装置。 - 【請求項17】 前記第1の部分と前記第2の部分の間に位置する、前記フ
ィラメントの少なくとも二つの箇所が前記定着部材を通過し、前記箇所の間にル
ープ状のセグメントが形成されることを特徴とする請求項12に記載の装置。 - 【請求項18】 前記力の閾値よりも大きな引っ張り力で前記フィラメント
の前記第1の部分および前記第2の部分のいずれかを引っ張ることによって、前
記ループ状のセグメントは締め付け可能であることを特徴とする請求項17に記
載の装置。 - 【請求項19】 前記ループ状のセグメント内を軟組織が通過させられ、前
記ループ状のセグメントを締め付けることによって、軟組織が固定されうること
を特徴とする請求項18に記載の装置。 - 【請求項20】 前記力の閾値の2倍より大きい引っ張り力で前記ループ状
のセグメントを引っ張ることによって、前記ループ状のセグメントは緩めること
が可能であることを特徴とする請求項17に記載の装置。 - 【請求項21】 前記定着部材は、ポリエチレン、ポリプロピレン、鋼、ポ
リ−l−ラクチドおよびラクチド−グリコライドの組成物からなる群から選択さ
れる生体適合性のある材料を含有することを特徴とする請求項12に記載の装置
。 - 【請求項22】 骨に軟組織を定着させる方法であって、 定着部材を骨の孔に埋設することと、 フィラメントを用いて軟組織を骨に取り付けることとを備えており、 前記定着部材は内部に空洞を有しており、前記フィラメントは前記空洞から延
び出した第1の部分と第2の部分を有しており、締まり嵌めによって前記空洞に
保持されており、 前記フィラメントは、力の閾値よりも小さい引っ張り力が前記第1の部分およ
び第2の部分のいずれかに与えられることに応じてはほとんど移動せず、 前記フィラメントは、前記力の閾値よりも大きい引っ張り力が前記第1の部分
および第2の部分のいずれかに与えられることに応じて長手方向に移動すること
を特徴とする方法。 - 【請求項23】 前記フィラメントを用いて軟組織を骨に取り付けることは
、 前記フィラメントの一部を軟組織の少なくとも一つの開口に通すことと、 前記力の閾値よりも大きい力を前記フィラメントの一部に与えることによって
前記フィラメントを締め付けて、前記フィラメントを長手方向に移動させること
とを備えることを特徴とする請求項22に記載の方法。 - 【請求項24】 前記フィラメントは前記力の閾値よりも大きな破損張力を
有することを特徴とする請求項22に記載の方法。 - 【請求項25】 前記力の閾値は、25ポンド乃至35ポンド(11.34
kg乃至15.88kg)の範囲にあることを特徴とする請求項22に記載の方
法。 - 【請求項26】 前記軟組織は、腱、靱帯、半月板および人工軟組織からな
る群から選択されることを特徴とする請求項22に記載の方法。 - 【請求項27】 前記定着部材は、組織内の孔に挿入される定着要素を備え
ており、前記定着要素はその基端と先端の間を延びる軸線方向の経路を有してお
り、前記定着要素は挿入軸に摺動可能に取り付けられており、 前記挿入軸は前記軸線方向の経路の内径よりも大きな外径を持つ部分である大
径部を有しており、 前記挿入軸は前記軸線方向の経路にて基端側に移動するようになされているこ
とによって、前記大径部が前記軸線方向の経路の内部を少なくとも部分的に移動
して、前記組織内の孔に圧力嵌め状態になるように前記定着要素を膨張させるこ
とを特徴とする請求項22に記載の方法。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/371,411 | 1999-08-10 | ||
US09/371,411 US6527794B1 (en) | 1999-08-10 | 1999-08-10 | Self-locking suture anchor |
PCT/US2000/021903 WO2001010312A1 (en) | 1999-08-10 | 2000-08-10 | Self-locking suture anchor |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2003528648A true JP2003528648A (ja) | 2003-09-30 |
JP4290365B2 JP4290365B2 (ja) | 2009-07-01 |
Family
ID=23463884
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2001514841A Expired - Lifetime JP4290365B2 (ja) | 1999-08-10 | 2000-08-10 | 自己ロック型縫合糸定着装置 |
Country Status (7)
Country | Link |
---|---|
US (5) | US6527794B1 (ja) |
EP (1) | EP1202672B1 (ja) |
JP (1) | JP4290365B2 (ja) |
AU (1) | AU771296B2 (ja) |
CA (1) | CA2378974C (ja) |
DE (1) | DE60008882T2 (ja) |
WO (1) | WO2001010312A1 (ja) |
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JP2007307379A (ja) * | 2006-05-18 | 2007-11-29 | Arthrex Inc | 組織の無結節固定に対するスウィベルアンカー |
JP2009544360A (ja) * | 2006-07-20 | 2009-12-17 | リー ディー カプラン | 手術器具 |
JP2010532207A (ja) * | 2007-06-29 | 2010-10-07 | スミス アンド ネフュー インコーポレーテッド | 軟部組織の固着法 |
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- 2000-08-10 WO PCT/US2000/021903 patent/WO2001010312A1/en active IP Right Grant
- 2000-08-10 AU AU66306/00A patent/AU771296B2/en not_active Expired
- 2000-08-10 CA CA002378974A patent/CA2378974C/en not_active Expired - Lifetime
- 2000-08-10 EP EP00953945A patent/EP1202672B1/en not_active Expired - Lifetime
- 2000-08-10 DE DE60008882T patent/DE60008882T2/de not_active Expired - Lifetime
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2003
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2005
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2008
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JP2018149292A (ja) * | 2017-03-13 | 2018-09-27 | メドス・インターナショナル・エスエイアールエルMedos International SARL | ノットレスな縫合糸固定のための方法及び装置 |
JP7175615B2 (ja) | 2017-03-13 | 2022-11-21 | メドス・インターナショナル・エスエイアールエル | ノットレスな縫合糸固定のための方法及び装置 |
Also Published As
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CA2378974A1 (en) | 2001-02-15 |
AU771296B2 (en) | 2004-03-18 |
JP4290365B2 (ja) | 2009-07-01 |
US20030130695A1 (en) | 2003-07-10 |
WO2001010312A1 (en) | 2001-02-15 |
US6660023B2 (en) | 2003-12-09 |
US20050090862A1 (en) | 2005-04-28 |
DE60008882D1 (de) | 2004-04-15 |
US7081126B2 (en) | 2006-07-25 |
EP1202672B1 (en) | 2004-03-10 |
US6527794B1 (en) | 2003-03-04 |
US20050149122A1 (en) | 2005-07-07 |
DE60008882T2 (de) | 2009-10-01 |
AU6630600A (en) | 2001-03-05 |
US20090099598A1 (en) | 2009-04-16 |
US9510816B2 (en) | 2016-12-06 |
EP1202672A1 (en) | 2002-05-08 |
CA2378974C (en) | 2006-08-01 |
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