JP2012506264A - ヒトまたは動物の関節を融合させるための融合装置およびツールセット - Google Patents
ヒトまたは動物の関節を融合させるための融合装置およびツールセット Download PDFInfo
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- JP2012506264A JP2012506264A JP2011532474A JP2011532474A JP2012506264A JP 2012506264 A JP2012506264 A JP 2012506264A JP 2011532474 A JP2011532474 A JP 2011532474A JP 2011532474 A JP2011532474 A JP 2011532474A JP 2012506264 A JP2012506264 A JP 2012506264A
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- fusion device
- joint
- energy
- bone
- tool
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Abstract
Description
固定ステップ:関節を所望の位置で固定する。関節面は、直に接するように位置決めされる(関節の空隙は閉じている)か、または、間に所望の距離を有する(固定ステップは関節包が固定機能を引継ぐのに十分堅固で緊張している状態であれば不要である)。
調製ステップおよび移植ステップ中、関節面は互いに固定されたままである。これは、融合装置が関節を伸張することを意図しておらず、固定ステップの前に、それ自体が公知の手段を用いて所望される適切な関節伸張を行なう必要があることを意味する。
・ドリルガイド22をガイドブッシュ21の軸方向のトンネル32内に配置しその遠位面が骨の表面に接触していることを確認する。
・カッタガイド24をガイドブッシュ21の軸方向のトンネル32内に配置し、その遠位面が骨の表面に接していることを確認する。
・関節調製の精度を、制御ツール26をガイドブッシュ21の軸方向のトンネルの中に導入し、導入深さを確認することによって制御し、制御ツールを除去する。
関節の調製を制御ツールを用いて制御するステップは必須のステップではない。
Claims (36)
- ヒトまたは動物の患者の関節を、融合装置を前記関節に移植することによって融合させる方法であって、前記関節は2つの関節面とその間にある隙間とを含む滑膜関節であり、前記方法は、
液化可能材料を含みエネルギを前記液化材料にその液化のために伝達することが可能な融合装置を与えるステップと、
前記融合装置を前記隙間にまたは前記隙間を横切るように移植するステップとを含み、移植中、エネルギを、前記液化可能材料に対して、前記液化可能材料の少なくとも一部を液化させ、かつ、前記液化可能材料を前記隙間の領域において骨組織に浸透させ再度凝固した際に前記骨組織との押込嵌合接続を形成するのに十分な時間、伝達する、方法。 - 前記エネルギは、振動もしくは回転エネルギであり、前記液化可能材料の中でもしくはその近傍で摩擦熱に変換され、または、前記エネルギは、可視もしくは赤外周波数範囲の電磁放射エネルギであり、吸収されて前記液化材料の中でもしくはその近傍で熱エネルギを生成する、請求項1に記載の方法。
- 前記滑膜関節は、ヒトの、椎間関節、手、指、足または爪先の関節、仙腸関節、胸鎖関節、胸肋関節、および肋椎関節のうちの1つである、請求項1または2に記載の方法。
- 前記関節面を予め定められた位置で互いに固定するステップと、前記関節面の固定を解除するステップとをさらに含み、前記固定するステップは前記移植するステップの前に実行され、前記解除するステップは前記移植するステップの後に実行される、請求項1から3のいずれか1つに記載の方法。
- 前記関節面および/または前記関節面に隣接する部分から組織を除去することによって前記関節を調製するステップをさらに含み、前記調製するステップは、前記移植するステップの前または前記固定するステップの後に行なわれる、請求項1から4のいずれか1つに記載の方法。
- 前記組織の除去は、前記関節面の軟骨層および/または軟骨層の直下もしくは前記軟骨層から離れた場所にある骨組織に関係する、請求項5に記載の方法。
- 前記融合装置は前記隙間に移植され、前記調製するステップは、溝(11)を前記関節面のうち少なくとも一方に設ける、もしくは1対の対向する溝(11)を1つの溝が前記関節面各々に存在するように設けることを含み、または、前記融合装置は前記隙間を横切るように移植され、前記調製するステップは、開口(13)を前記隙間の両側において骨組織に設けることを含む、請求項5に記載の方法。
- 前記融合装置は少なくとも1つの固定部分(1)を含み、前記液化可能材料は前記固定部分(1)の表面に配置され、前記移植するステップは、前記融合装置を、前記固定部分(1)の前記表面が前記溝(11)または開口(13)の中の骨組織と接触するように配置し、前記エネルギを前記固定部分(1)の近位端に結合することを含む、請求項7に記載の方法。
- 前記エネルギは振動エネルギであり、前記装置は、前記振動エネルギによって前記表面と前記骨組織との間に摩擦が生じるように配置される、請求項8に記載の方法。
- 前記エネルギは可視または赤外周波数範囲の電磁放射エネルギであり、前記装置は、前記電磁放射エネルギを吸収し吸収によって生じた熱エネルギを前記表面の液化可能材料に伝達する機能を有する、請求項8に記載の方法。
- 前記融合装置は少なくとも1つの固定部分(1)を含み、前記液化可能材料は前記固定部分(1)の一部を構成する有孔シース(52)の内側に配置され、前記移植するステップは、前記融合装置を、前記シース(52)の孔が前記溝(11)または開口(13)の中の骨組織と接触するように配置し、前記エネルギを前記有孔シース(52)の内側に配置された前記液化可能材料の近位面に結合することを含む、請求項7に記載の方法。
- 前記エネルギは、振動または回転エネルギであり、前記有孔シースと前記液化可能材料との間に摩擦を生じさせる、請求項11に記載の方法。
- 前記エネルギは、可視または赤外周波数範囲の電磁放射エネルギであり、前記装置は、前記電磁放射エネルギを吸収し吸収によって生じた熱エネルギを前記液化可能材料に伝達する機能を有する、請求項11に記載の方法。
- 前記融合装置はさらに少なくとも1つの安定化部分(2)を含み、前記固定部分および安定化部分は互いに固定され、前記移植するステップは1つのステップからなるプロセスであり、または、前記固定部分および安定化部分は別々の装置部品を構成し、前記移植するステップは2つまたは複数のステップからなるプロセスであり、前記少なくとも1つの固定部分(1)は、前記少なくとも1つの安定化部分(2)を前記関節面の間の隙間に配置する前またはその後に、前記骨組織に固定される、請求項8から13のいずれか1つに記載の方法。
- 前記移植するステップのために、前記融合装置は振動または押圧ツール(27)の遠位端で保持される、請求項1から14のいずれか1つに記載の方法。
- 固定部分および安定化部分のうち少なくとも一方は、全体が前記液化可能材料で構成され、前記移植するステップ中に変形される、請求項1から15のいずれか1つに記載の方法。
- ヒトまたは動物の患者の関節を融合させるための融合装置であって、前記関節は2つの関節面とその間にある隙間とを含む滑膜関節であり、前記融合装置は、
少なくとも1つの固定部分(1)と少なくとも1つの安定化部分(2)とを含み、
前記融合装置は、移植方向(I)に平行であり前記融合装置の近位面(4)から遠位端に至る全体の深さ(D)、全体の幅(W)、および前記移植方向(I)に垂直な厚みプロファイル(T1およびT2)を有し、
前記固定部分(1)および前記安定化部分(2)は前記幅(W)にわたって交互に配置されるまたは配置されることが可能であり、前記固定部分の厚み(T1)は前記安定化部分の厚み(T2)よりも大きい、融合装置。 - 前記安定化部分は、場合によって前記固定部分(1)とともに凹状の装置輪郭を形成しそれにより骨伝導領域(3)の範囲を定める、請求項17に記載の融合装置。
- 骨成長促進材料が前記骨伝導領域(3)に配置され、または、前記凹状の装置輪郭の装置表面がこの材料を保持するための手段を含む、請求項18に記載の融合装置。
- 前記骨成長促進材料は、同種移植片または自己移植片骨材料、骨代替材料、スポンジ、およびBMPキャリアのうち少なくとも1つである、請求項19に記載の融合装置。
- 前記少なくとも1つの固定部分(1)は、前記固定部分(1)の表面上または前記固定部分(1)の一部を構成する有孔シース(52)の内側に配置された液化可能材料を含み、前記固定部分(1)の前記表面または前記有孔シース(52)は、移植時に骨組織と接触するように前記融合装置に配置される、請求項17から20のいずれか1つに記載の融合装置。
- 前記液化可能材料または前記液化可能材料に隣接するさらなる装置領域は、可視または赤外周波数範囲の電磁放射エネルギを吸収することができる、請求項21に記載の融合装置。
- 前記融合装置全体は液化可能材料からなる、請求項20または21に記載の融合装置。
- 前記安定化部分(2)は、骨結合を促進することが可能なコーティングおよび/または表面構造を有する表面を含むことにより骨結合を促進する機能を有する、請求項17から23に記載の融合装置。
- 前記固定部分(1)の深さは、前記安定化部分(2)の深さよりも大きい、請求項17から24のいずれか1つに記載の融合装置。
- ピン形状の2つの固定部分(1)と1つの安定化部分(2)とを含み、前記安定化部分は前記固定部分(1)の間に配置される、または、前記固定部分および前記安定化部分は別々の装置部品を構成し前記安定化部分(2)は前記固定部分(1)の近位端に固定されてその間に延在するように設計され、または前記安定化部分(2)は前記固定部分(1)を収容するための貫通開口部(55)もしくは溝(60)を含む、請求項25に記載の融合装置。
- 装置近位面(4)は少なくとも1つの開口(5)または突起および/または凸状の湾曲を含む、請求項17から26のいずれか1つに記載の融合装置。
- 前記液化可能材料は、熱可塑特性、少なくとも0.5GPaである弾性係数、および350℃以下の溶融温度を有する材料である、請求項21から27のいずれか1つに記載の融合装置。
- ヒトまたは動物の患者の関節を融合させる方法であって、前記関節は2つの関節面とその間にある隙間とを含む滑膜関節であり、前記方法は、
請求項21から28のいずれか1つに記載の融合装置を与えるステップと、
前記関節面のうち少なくとも一方を調製するステップと、
前記融合装置を、少なくとも1つの固定部分が前記調整した少なくとも一方の関節面の領域で骨組織と接触している構成の中に押込むステップとを含み、
前記押込むステップは、エネルギを、前記融合装置の近位面(4)に、前記押込むステップ中または前記押込むステップの後に、前記エネルギを振動もしくは回転ドライブにまたは可視もしくは赤外周波数範囲の電磁放射エネルギ源に結合することによって、結合し、前記ドライブまたはエネルギ源を、前記液化可能材料の少なくとも一部を液化させ前記骨組織に浸透させ再凝固後に前記骨組織との押込嵌合接続を形成するのに十分な時間、作動させることを含む、方法。 - ヒトまたは動物の患者の関節を融合させる方法であって、前記関節は2つの関節面とその間にある隙間とを含む滑膜関節であり、前記方法は、
請求項17から28のいずれか1つに記載の融合装置を与えるステップと、
前記関節面のうち少なくとも一方を調製するステップと、
前記融合装置を、少なくとも1つの固定部分が前記少なくとも一方の調製された関節面の領域において骨組織と接触している構成の中に押込むステップとを含む、方法。 - ヒトまたは動物の患者の滑膜関節を融合させる方法であって、前記関節は2つの関節面とその間にある隙間とを含む滑膜関節であり、前記方法は、
請求項17から28のいずれか1つに記載の融合装置を与えるステップと、
前記関節面を予め定められた位置で互いに固定するステップと、
前記融合装置を前記固定された関節面の間に押込むステップと、
前記関節面の固定を解除するステップとを含む、方法。 - ヒトまたは動物の患者の滑膜関節を融合させるためのツールセットであって、前記ツールセットは、振動または押圧ツール(27)を含み、請求項17から28のいずれか1つに記載の融合装置は、前記振動または押圧ツール(27)の遠位端に装着されまたは装着可能である、ツールセット。
- 前記振動または押圧ツール(27)の遠位端および前記融合装置の近位面(4)は、前記融合装置を前記振動または押圧ツール(27)の遠位端に保持するために互いに適合するようにされた開口および突起を有する、請求項32に記載のツールセット。
- 前記融合装置の近位面(4)は凸状の湾曲を含み、前記振動または押圧ツール(27)の遠位面は対応する凹状の湾曲を含む、請求項32から33のいずれか1つに記載のツールセット。
- 軸方向のトンネル(32)、または振動もしくは押圧ツール(27)の断面に合わせた断面を有するガイドブッシュ(21)をさらに含み、前記ガイドブッシュ(21)の遠位面は、前記関節面を予め定められた位置で互いに固定するために、前記関節面の間の隙間の両側において骨の表面の中に押込まれることができるように配置された複数のスパイクを有する、請求項32から34のいずれか1つに記載のツールセット。
- 椎間関節探知機(20)、ドリルガイド(22)および対応するドリル(23)、ならびにカッタガイド(24)および対応するカッタ(25)のうち少なくとも1つをさらに含み、前記椎間関節探知機(20)、前記ドリルガイド(22)、および前記カッタガイド(24)の断面は前記ガイドブッシュ(21)の軸方向のトンネル(32)の断面に適合するようにされる、請求項35に記載のツールセット。
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JP2013540508A (ja) * | 2010-09-30 | 2013-11-07 | ウッドウェルディング・アクチェンゲゼルシャフト | 切断または骨折によって分離された2つの骨部分を固定するための方法およびインプラント |
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Cited By (7)
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JP2013540473A (ja) * | 2010-09-21 | 2013-11-07 | スパインウェルディング・アクチェンゲゼルシャフト | ヒトまたは動物の関節を修復するための装置 |
JP2013540508A (ja) * | 2010-09-30 | 2013-11-07 | ウッドウェルディング・アクチェンゲゼルシャフト | 切断または骨折によって分離された2つの骨部分を固定するための方法およびインプラント |
JP2014529311A (ja) * | 2011-07-18 | 2014-11-06 | ウッドウェルディング・アクチェンゲゼルシャフト | 分離された骨部分を互いに相対的に安定させるための方法およびインプラント |
JP2018501019A (ja) * | 2015-01-07 | 2018-01-18 | バイオメット シー.ブイ. | 骨固定のための整形外科インプラント |
JP2018509987A (ja) * | 2015-03-18 | 2018-04-12 | バイオメット シー.ブイ. | 槌状足指及び小寸骨組織の固定に対して構成されたインプラント |
US10729552B2 (en) | 2015-03-18 | 2020-08-04 | Biomet C.V. | Implant configured for hammertoe and small bone fixation |
JP7048318B2 (ja) | 2015-03-18 | 2022-04-05 | バイオメット シー.ブイ. | 槌状足指及び小寸骨組織の固定に対して構成されたインプラント |
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