JP2014519369A - 仙腸骨癒合システム - Google Patents
仙腸骨癒合システム Download PDFInfo
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Abstract
Description
ある種の人々は仙腸骨関節痛を経験する。この仙腸骨関節痛は種々の原因に由来し得るものであり、それらの例として負傷、出産前の発達における誤った脊椎骨癒合、妊娠の影響が挙げられる。
切断アセンブリは挿入装置に対して、収縮位置から伸張位置まで移動される。切断アセンブリは、腸骨と仙骨との間の関節内で操作される。アンダーカッティングシステムは開口から取り出される。
ハンドル部42は、長尺状シャフト40よりも大きな直径を有してもよい。ある実施態様において、ハンドル部42は約2センチメートルから20センチメートルの直径を有する。
挿入装置30はさらに、プローブアセンブリ32を伸張し、収縮するために用いられる制御ノブ46を含んでよい。挿入装置30の1つの構成において、制御ノブ46は挿入装置30に対して回転可能に取り付けられる。
制御ノブ46の外縁には複数の凹領域48を形成してもよい。凹領域48は、制御ノブ46を握り、挿入装置30を操作する能力を高める。
接続メカニズム66は、接続メカニズム66を第1の取り付けセクション62に取り付けるボールタイプのコネクタ80も含んでよい。ボールタイプのコネクタ80は、接続メカニズム66上にボール形状の延長部82と第1の取り付けセクション62の末端側端部に形成された窪み84から成ってもよい。窪み84は、ボール形状の延長部82の形状に対して略相補的な形状を有する。
プローブアセンブリ32は、第2の取り付けセクション64の末端側端部に取り付けられる。長さの異なる複数のプローブアセンブリ32の使用を受け入れるためには、アンダーカッティングシステム10に長さの異なる複数の第2の取り付けセクション64を設けてもよい。別法として、または加えて、アンダーカッティングシステム10は、異なる長さを有する複数の第1の取り付けセクション62を含んでよい。そのような構成を用いることによって、第1の取り付けセクション62と第2の取り付けセクション64のうちの一方をプローブアセンブリ32の長さに基づいて選択することを可能とする。
切断アセンブリ232の側縁は、腸骨14および仙骨16の間の組織を切り開くのに十分であろう。鋭くした縁のない切断アセンブリ232の使用は、切断アセンブリ232を回転させつつ腸骨14および仙骨16へと切り込む切断アセンブリ232の傾向を低下させうる。
切断エレメント234の末端側端部間の距離により、アンダーカッティングシステム10を用いて準備される腸骨14と仙骨16との間の領域の厚みを画定する。
切断エレメント334は、切断エレメント334が切断アセンブリ332の長さに対して略平行でないように、切断アセンブリ332に対して角度をもって配向してもよい。ある実施態様において、切断エレメント334は約0度から約60度の角度に配向してもよい。他の実施態様において、切断エレメント334と切断アセンブリ332との間の角度は約30度であってもよい。
切断アセンブリ532の側縁は、腸骨14と仙骨16との間の組織を切り開くには十分であろう。鋭くした縁のない切断アセンブリ532の使用は、切断アセンブリ532を回転しつつ腸骨14および仙骨16中へと切り込む切断アセンブリ532の傾向を低下させうる。
ハンドル部642は長尺状シャフト640よりも大きな直径を有してもよい。ある実施態様において、ハンドル部642は約2センチメートルから約20センチメートルまでの直径を有する。
挿入装置630は、さらに、プローブアセンブリ362を伸張および収縮するために用いる制御ノブ646を含んでもよい。挿入装置630の構成の1つにおいて、制御ノブ646は挿入装置630に対して回転可能に搭載される。
制御ノブ646の第1の方向の回転により、プローブアセンブリ632は挿入装置630の末端側端部から伸張される。第1の方向の反対である第2の方向への制御ノブ646の回転は、プローブアセンブリ632を挿入装置630の末端側端部内へと収縮させる。
切断アセンブリ633の外面を粗くするための切溝の別法として、またはそれに加えて、腸骨と仙骨との間の組織を切り開く、ならびに腸骨および仙骨中へと切り込む切断アセンブリ633の能力を高めるために他の技術を用いることは可能である。切断アセンブリ633の外面を粗くするために用いられうるそのような技術の一例は、切断アセンブリ633の外面の少なくとも一部に研磨剤を塗布することである。
上記の形状および特徴を有すれば、切断アセンブリ633は、種々の材料から形成してもよい。当業者であれば、切断アセンブリ633を製造するために用いる材料は人体中での使用に適当なものとすべきことは認識するであろう。切断アセンブリ633を製造するためのそのような材料の一例は、ニチノールである。ニチノールの有益な特質は、ニチノールが屈曲可能であるが、屈曲を引き起こした力が取り除かれると、屈曲していない構成に戻ることである。
同様に、主カッター部660の幅は、長尺状シャフト640の内径以下であってもよい。そのような構成に主カッター部660を形成することで、切断アセンブリ633が収縮配置にある場合には、切断アセンブリ633が実質的に長尺状シャフト640の輪郭内に位置することを可能とし、切断アセンブリ633は開口20を通って延在するアンダーカッティングシステム610の末端側端部の腸骨14への挿入に干渉しない。
主カッター部660は、上面650および下面654の少なくとも一部に沿って延在してもよい。ある実施態様において、主カッター部660は、実質的に切断アセンブリ633全体の周りに延在する。
患者の適切な準備および仙腸骨癒合のための位置の同定の後、少なくとも1つの開口20を腸骨14にドリルで貫通して開ける。この開口20は、図30に示されるように、仙骨16中へと少なくとも部分的に延在してもよい。ある実施態様では、3つのドリルで開けた開口がある。
ガイドピンの先端は、側面画像上の翼状骨の中央部分内に位置させることができる。腸仙骨通路は、仙腸骨癒合と組み合わせて用いる骨スクリューの通過のための最良な位置である。
該関節の関節部はより平坦であり、これは、仙腸骨関節の関節部における癒合を促すのに有利である。対照的に、該安全なゾーンに対して後方である該関節の骨間部分は、垂直から急勾配に角張っており、かつ非常に塊だらけであって、不規則である。
例えば、各側に2つずつのスクリュー720は、図34から38の骨盤領域の側面、インレットおよびアウトレット蛍光透視画像に示されるように、安全なゾーンに向けて集まる。骨スクリュー720のいずれも翼状範囲には進入していないことに注目すべきである。翼状範囲への侵入は、進入点が余りにも頭側であることによって引き起こされうる。そのような状況は、患者に合併症をもたらす場合もあり、早急な修正が求められるので、避けるべきである。
本発明の概念は、主として、仙腸骨癒合のための準備に関連して説明されているが、当業者であれば、該概念は身体中の他の関節に対しても適合するであろうことを認識するであろう。該概念は、骨の内部領域を準備するために用いてもよい。
Claims (22)
- 挿入装置と、
該挿入装置に動作可能に搭載されたプローブアセンブリであって、
収縮配置と伸張配置との間を該挿入装置に対して移動可能であり、
該伸張配置において、該プローブアセンブリの少なくとも一部は該挿入装置から側方に伸張するプローブアセンブリと、
該プローブアセンブリおよび該挿入装置に対して動作可能に取り付けられた切断アセンブリであって、
収縮配置と伸張配置との間を該挿入装置に対して移動可能であり、
伸張配置において、該切断アセンブリの少なくとも一部は該挿入装置から側方に伸張する切断アセンブリとを含む、
仙腸骨癒合のために腸骨と仙骨との間に領域を準備するためのアンダーカッティングシステム。 - 該挿入装置が、該プローブアセンブリを収縮位置から伸張位置へ移動させる機械的利点を供する、請求項1に記載のアンダーカッティングシステム。
- 該切断アセンブリが該挿入装置に対して回転可能に搭載された、請求項1に記載のアンダーカッティングシステム。
- 該切断アセンブリが該挿入装置に対して摺動可能に搭載された、請求項1に記載のアンダーカッティングシステム。
- 該挿入装置がその末端側端部近くにガイドチャネルを含む、請求項1に記載のアンダーカッティングシステム。
- 該ガイドチャネルが、
該挿入装置の中心軸に対して実質的に平行に整列した第1のチャネル部と、
該挿入装置の中心軸に対して実質的に横断方向である第2のチャネル部と、
該第1のチャネル部と該第2のチャネル部との間を延在する移行チャネル部と
を含む請求項5に記載のアンダーカッティングシステム。 - 該移行チャネル部が少なくとも1つのローラを含む、請求項6に記載のアンダーカッティングシステム。
- 該挿入装置の基部側端部近くに動作可能に取り付けられた第1の制御部をさらに含み、
該第1の制御部は、該プローブアセンブリを伸張配置と収縮配置との間で移動させるために該プローブアセンブリに動作可能に取り付けられた、
請求項1に記載のアンダーカッティングシステム。 - 該挿入装置の基部側端部近くに動作可能に取り付けられた第2の制御部をさらに含み、
該第2の制御部は、該切断アセンブリを伸張配置と収縮配置との間で移動させるために該切断アセンブリに動作可能に取り付けられ、
該第2の制御部は該第1の制御部とは別々に動作可能である、
請求項8に記載のアンダーカッティングシステム。 - 該プローブアセンブリおよび該切断アセンブリのうちの少なくとも1つが、クラッチメカニズムを備えた該挿入装置に動作可能に取り付けられた、請求項1に記載のアンダーカッティングシステム。
- 該プローブアセンブリが収縮配置にある場合には、該プローブアセンブリが該アンダーカッティングシステムの外周内にあり、
該切断アセンブリが収縮位置にある場合には、該切断アセンブリは該アンダーカッティングシステムの外周内にある、
請求項1に記載のアンダーカッティングシステム。 - 該挿入装置は、末端側端部近くでは、中心軸の周りに配向され、
該プローブアセンブリが伸張位置へ移動するにつれ、該プローブアセンブリの末端側端部が該中心軸から離れるように移動する、
請求項1に記載のアンダーカッティングシステム。 - 該切断アセンブリが、その少なくとも1つの縁に切断表面を有する、請求項1に記載のアンダーカッティングシステム。
- 該切断アセンブリが、その少なくとも1つの表面から延在する切断エレメントを含む請求項1に記載のアンダーカッティングシステム。
- 該切断アセンブリが、該プローブアセンブリの少なくとも一部の上に延在する請求項1に記載のアンダーカッティングシステム。
- 該切断アセンブリがその外面の少なくとも一部に粗面化部を有する請求項15に記載のアンダーカッティングシステム。
- 該切断アセンブリがその末端側端部近くに主カッター部を含み、
該主カッター部が該プローブアセンブリよりも大きな厚みを有する、請求項15に記載のアンダーカッティングシステム。 - さらに、該主カッター部から延在する少なくとも1つの延長部を含み、
該少なくとも1つの延長部上には少なくとも1つの切断表面が形成された、請求項17に記載のアンダーカッティングシステム。 - 該主カッター部の両側に2つの延長部が位置している、請求項18に記載のアンダーカッティングシステム。
- 該プローブアセンブリが該挿入装置に対して末端−基部方向の可撓性を呈し、
該挿入装置に対して径方向の移動に抵抗する、
請求項1に記載のアンダーカッティングシステム。 - 該切断アセンブリが、振動する形状に配向される可撓性材料から製造された、請求項1に記載のアンダーカッティングシステム。
- 切断アセンブリ・ロッキング・メカニズムをさらに含み、
該切断アセンブリ・ロッキング・メカニズムがロック配置とロック解除配置との間を移動可能であり、
該切断アセンブリ・ロッキング・メカニズムがロック配置にある場合、該切断アセンブリは該挿入装置に対して静止した位置に保持され、
該切断アセンブリ・ロッキング・メカニズムがロック解除配置にある場合、該切断アセンブリは該挿入装置に対して回転可能である、
請求項1に記載のアンダーカッティングシステム。
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2013
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2014
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2015
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US11737882B2 (en) | 2023-08-29 |
WO2012151573A1 (en) | 2012-11-08 |
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