JP2016511090A - 組織を骨に固定するシステムおよび方法 - Google Patents
組織を骨に固定するシステムおよび方法 Download PDFInfo
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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- 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
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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
- 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
- A61B2017/0429—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 the barbs being expanded by a mechanical mechanism which also locks them in the expanded state
- A61B2017/043—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 the barbs being expanded by a mechanical mechanism which also locks them in the expanded state by insertion of a separate spreading member into the anchor
- A61B2017/0432—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 the barbs being expanded by a mechanical mechanism which also locks them in the expanded state by insertion of a separate spreading member into the anchor the separate member staying in the anchor after placement
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- 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
- A61F2002/0817—Structure of the anchor
- A61F2002/0823—Modular anchors comprising a plurality of separate parts
- A61F2002/0835—Modular anchors comprising a plurality of separate parts with deformation of anchor parts, e.g. expansion of dowel by set screw
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- 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
- A61F2002/0847—Mode of fixation of anchor to tendon or ligament
- A61F2002/0852—Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
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- 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
- A61F2002/0847—Mode of fixation of anchor to tendon or ligament
- A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
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- 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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Abstract
Description
本願は、参照によりその全体を本明細書に組み込む、2013年3月15日出願の米国仮出願第61/801255号の利益および優先権を主張するものである。
200 アンカ本体
210 パネル
212 外側表面
213a 面
213b 面
213c 面
214 内側表面
215a 面
215b 面
215c 面
220 溝
224 遠位ピボット
225 ヒンジ要素
226 近位ピボット
260 遠位先端
262 リップ
265 中央内腔
266 その他の特徴
290 小孔
300 スプレッダ
310 管状本体
312 外側表面
314 内側表面
316 凹部
318 屈曲可能タブ
319 切れ込み
320 トラック
321 隆起部
322 凹み
323 バンプ
330 くさび状突起
380 開口
390 内側チャネル
1000 挿入器具
1100 組織固定デバイス
1200 アンカ本体
1205 最近位部分
1206 拡張スロット
1207 拡張可能セグメント
1210 管状壁
1215 内側表面
1220 圧縮可能タブ
1225 溝
1230 歯
1240 ヒンジ状縁部
1250 近位端部
1260 遠位先端
1265 中央内腔
1270 第1の列の圧縮可能タブ
1280 第2の列の圧縮可能タブ
1300 スプレッダ
1310 スプレッダの本体
1320 近位端部
1325 隆起部
1330 穴
1340 遠位端部
1400 滑動可能スリーブ
2100 組織固定デバイス
2200 アンカ本体
2206 拡張スロット
2207 拡張可能セグメント
2208 その他の突起
2210 管状壁
2220 拡張可能セグメント
2222 突起/タイン
2224 縁部
2260 遠位端部
2265 中央内腔
2270 近位端部
2290 小孔
2300 スプレッダ
2310 円錐状部分
2320 管状部分
2325 平坦な溝付き部分
2330 穴
3000 挿入器具
3100 組織固定デバイス
3300 スプレッダ
3500 内側ロッド/内側管
3510 遠位端部
3520 近位端部
3600 外側管
3605 近位端部
3610 遠位端部
3625 ねじ
3700 ハンドル本体
3710 ブラケット/ブレース
3725 ねじ
3740 開口
3770 遠位端部
3800 ねじ付きアクチュエータシャフト
3805 遠位端部
3810 ねじ穴
3820 近位端部
3825 第2のねじ部
3830 平坦領域
3900 配備ノブ
3905 ねじ
3910 中央穴
3930 溝
4000 縫合糸ループアンカ
5000 大腿骨アンカ
5106 遠位端部
5200 縫合糸ループ
6100 脛骨孔
6200 大腿骨孔
6300 組織移植片
Claims (38)
- 前十字靱帯(ACL)修復方法であって、
脛骨に骨孔を形成するステップであり、前記骨孔が、前記脛骨の一方の側の近位開口、および前記脛骨の反対側の遠位開口を備えるステップと、
前記骨孔に軟組織を通すステップと、
前記軟組織を大腿骨に固定するステップと、
前記骨孔の近位開口に、アンカの遠位端部が前記骨孔の遠位開口に隣接する位置までアンカを挿入するステップであり、前記アンカが、内部空洞を有する拡張可能なアンカ本体、およびスプレッダを備えるステップと、
エキスパンダを前記内部空洞中に滑動させることにより、前記アンカ本体の少なくとも一部分を外側に拡張させるステップであり、前記拡張が完了したときに、前記骨孔の前記遠位開口に隣接する前記アンカ本体の少なくとも一部分が拡張するステップと、
を含むことを特徴とする方法。 - 前記アンカが挿入されたとき、前記アンカが前記骨孔の実質的に全長にわたって延びる、請求項1に記載の方法。
- 前記アンカが拡張したときに、前記アンカの少なくとも一部分が外側に拡張しない、請求項1に記載の方法。
- 外側に拡張しない部分が、アンカ先端を備える、請求項3に記載の方法。
- 前記アンカが、約30mmを超える長さである、請求項1に記載の方法。
- 前記アンカが、約35mmを超える長さである、請求項1に記載の方法。
- 前記アンカが、約40mmを超える長さである、請求項1に記載の方法。
- 前十字靱帯(ACL)修復方法であって、
脛骨に骨孔を形成するステップであり、前記骨孔が、前記脛骨の一方の側の近位開口、および前記脛骨の反対側の遠位開口を備えるステップと、
前記骨孔に軟組織を通すステップと、
前記軟組織を大腿骨に固定するステップと、
前記骨孔の近位開口に、アンカの遠位端部が前記骨孔の遠位開口に隣接する位置までアンカを挿入するステップであり、前記アンカが、内部空洞を有する拡張可能なアンカ本体、およびスプレッダを備えるステップと、
エキスパンダを前記内部空洞中に挿入することにより、前記アンカ本体の少なくとも一部分を外側に拡張させるステップであり、前記拡張が完了したときに、前記アンカ本体の前記拡張した部分が、その長さに沿って実質的に一様に拡張するステップと、
を含むことを特徴とする方法。 - 前記アンカが挿入されたとき、前記アンカが前記骨孔の実質的に全長にわたって延びる、請求項8に記載の方法。
- 前記アンカが拡張したときに、前記アンカの少なくとも一部分が外側に拡張しない、請求項8に記載の方法。
- 外側に拡張しない前記部分が、アンカ先端を備える、請求項10に記載の方法。
- 前記アンカが、約30mmを超える長さである、請求項8に記載の方法。
- 前記アンカが、約35mmを超える長さである、請求項8に記載の方法。
- 前記アンカが、約40mmを超える長さである、請求項8に記載の方法。
- 前十字靱帯(ACL)修復方法であって、
脛骨に骨孔を形成するステップであり、前記骨孔が、前記脛骨の一方の側の近位開口、および前記脛骨の反対側の遠位開口を備えるステップと、
前記骨孔に軟組織を通すステップと、
前記軟組織を大腿骨に固定するステップと、
前記骨孔の長さを測定するステップと、
前記測定に基づいて、複数の可能なアンカからアンカを選択するステップと、
前記骨孔の近位開口に、前記アンカの遠位端部が前記骨孔の遠位開口に隣接する位置まで前記アンカを挿入するステップであり、前記アンカが、内部空洞を有する拡張可能なアンカ本体、およびスプレッダを備えるステップと、
前記スプレッダを前記内部空洞中に挿入することにより、前記アンカ本体の少なくとも一部分を外側に拡張させるステップであり、前記拡張が完了したときに、前記骨孔の前記遠位開口に隣接する前記アンカ本体の少なくとも一部分が拡張するステップと、
を含むことを特徴とする方法。 - 前記アンカを選択するステップが、複数の可能な長さからアンカの長さを選択するステップを含む、請求項15に記載の方法。
- 拡張可能骨アンカであって、
遠位先細なアンカ先端、および
ダブルヒンジを介してそれぞれ前記アンカ先端に結合される、前記アンカ先端から近位方向に延びる複数の剛性側面部分
を備えるアンカ本体と、
前記アンカ本体中へ遠位方向に前進することにより、前記剛性側面部分を外側に拡張させるように構成されたスプレッダと、
を備えることを特徴とする拡張可能骨アンカ。 - 前記スプレッダが、前記剛性側面部分に結合される、請求項17に記載のアンカ。
- 前記スプレッダが、前記剛性側面部分に滑動可能に結合される、請求項17に記載のアンカ。
- 前記スプレッダが、複数の長手方向トラックを備え、各側面部分が、前記側面部分が前記長手方向トラックに沿って長手方向に滑動することができるように、前記長手方向トラックのうちの1つに結合される、請求項19に記載のアンカ。
- 前記スプレッダが、遠位方向に先細になっている少なくとも一部分を備える、請求項17に記載のアンカ。
- 前記アンカ先端が、近位ロック部材を備え、前記スプレッダが、遠位ロック部材を備え、前記2つのロック部材が、前記スプレッダが遠位方向に最大限まで前進したときに互いにロックするように構成される、請求項17に記載のアンカ。
- 前記アンカ先端の前記近位ロック部材が、外側に突出する隆起部を有するポストを備え、前記スプレッダの前記遠位ロック部材が、前記ポストを受けるように構成された中空円筒を備える、請求項22に記載のアンカ。
- 前記中空円筒が、前記隆起部を受けるように構成された、内側表面上の溝を備える、請求項23に記載のアンカ。
- 前記中空円筒が、拡張可能タブを備える、請求項24に記載のアンカ。
- 最大限に拡張したときに、前記剛性側面部分が、その長さに沿って実質的に一様な程度に拡張する、請求項17に記載のアンカ。
- 拡張可能骨アンカであって、
遠位先細なアンカ先端、
アンカ本体の近位端部に位置決めされた複数の第1の拡張可能側面部分であり、遠位部分より近位部分でより大きく外側に延びるように外側に屈曲することによって拡張する第1の拡張可能側面部分、および
前記第1の拡張可能側面部分より遠位側に位置決めされた複数の第2の拡張可能側面部分であり、近位部分より遠位部分でより大きく外側に延びるように外側に屈曲することによって拡張する第2の拡張可能側面部分
を備えるアンカ本体と、
前記アンカ本体中へ遠位方向に前進することによって、前記第1の拡張可能側面部分および前記第2の拡張可能側面部分を外側に拡張させるように構成されたスプレッダと、
を備えることを特徴とする拡張可能骨アンカ。 - 前記第1の拡張可能側面部分および前記第2の拡張可能側面部分が、骨と係合する特徴を備える、請求項27に記載のアンカ。
- 前記骨と係合する特徴が、歯を備える、請求項28に記載のアンカ。
- 前記骨と係合する特徴が、隆起部を備える、請求項28に記載のアンカ。
- 前記第1の拡張可能側面部分および前記第2の拡張可能側面部分が、前記アンカ本体の側壁の切れ込みによって形成される、請求項27に記載のアンカ。
- 前記スプレッダが、遠位方向に先細になっている少なくとも一部分を備える、請求項27に記載のアンカ。
- 前記スプレッダが、その長さに沿って実質的に一定の直径を有する、請求項27に記載のアンカ。
- 前記スプレッダが、その近位端部に、またはその近位端部に隣接して位置決めされた円周方向隆起部を備える、請求項33に記載のアンカ。
- 前記アンカ本体が、実質的にその全長にわたって遠位方向に先細になっている、請求項31に記載のアンカ。
- 前記アンカ先端が、半球形状を有する、請求項31に記載のアンカ。
- 前記アンカ先端が、円錐形状を有する、請求項31に記載のアンカ。
- 前記第2の拡張可能側面部分が、前記アンカ本体内の中央空洞中に延びる突起を備え、前記スプレッダが前記中央空洞中へ前進することによって、前記スプレッダが前記突起と接触し、それにより前記第2の拡張可能側面部分を外側に拡張させる、請求項31に記載のアンカ。
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