JP5328763B2 - 形態変化整形外科用関節装置のための経皮的送達および回収システム - Google Patents
形態変化整形外科用関節装置のための経皮的送達および回収システム Download PDFInfo
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- JP5328763B2 JP5328763B2 JP2010503165A JP2010503165A JP5328763B2 JP 5328763 B2 JP5328763 B2 JP 5328763B2 JP 2010503165 A JP2010503165 A JP 2010503165A JP 2010503165 A JP2010503165 A JP 2010503165A JP 5328763 B2 JP5328763 B2 JP 5328763B2
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Description
本発明の種々の実施形態は、とりわけ、関節における骨対骨の接触を低減するための、低侵襲性の埋込型装置による、変形性関節症、関節リウマチ、および任意の他の変形性関節過程の治療に関する。
例えば、本発明は以下の項目を提供する。
(項目1)
患者の体内の送達部位の中への方向付けされた配向での整形外科用装置の低侵襲性の設置に好適な整形外科用装置送達システム(1000、1801、1901、2001、2210、2310、2800、3101、3401、3501、3701、3801、3901、4001、4101)であって、
自身を貫通して延在する管腔(1035、1235、2782、3142)を有する管状送達装置(1030、1110、1230、1830、2240、2350、2780、2900、3140、3440、3540、3740、3840、3940、4040、4140)と、
該管状送達装置の該管腔と連通しているチャネル(2110、2510、3122、3422)を備える装填装置(2100、2220、2310、2720、3120、3420、3520、3720、3820、3920、4120)であって、該チャネルは、第1の構成で少なくとも1つの整形外科用装置を格納するように構成され、該装填装置は、該第1の構成から第2の中間送達構成まで該少なくとも1つの整形外科用装置を移動させるように構成される、装填装置と
を備え、該整形外科用装置は、狭小化した構成で該管腔を通って移動可能であり、該少なくとも1つの整形外科用装置を確保する該装填装置は、設置されるときの該整形外科用装置の配置を向上させるために、実質的に体温において概して弓状の構成を備える第3の設置構成で、該管腔の遠位端から外に設置する、整形外科用装置送達システム。
(項目2)
上記第1の構成は、上記第3の設置構成と実質的に同じである、項目1に記載の整形外科用装置送達システム。
(項目3)
上記第2の中間送達構成は、狭小化した構成である、項目1に記載の整形外科用装置送達システム。
(項目4)
上記第2の中間送達構成は、実質的に直線化した構成である。項目1に記載の整形外科用装置送達システム。
(項目5)
近位端および遠位端を有する細長い芯を備える少なくとも1つの整形外科用装置(100a、100b、100c、300a、300b、300c、300d、300e、570d、570e、570f、1100、1200、1600、1700、1800、1900、2000、2120、2200、2600、2700、2700、3100、4000、4100)をさらに備え、該細長い芯は、設置されるときの該整形外科用装置の配置を向上させるために、実質的に体温において概して弓状の構成を備えており、該細長い芯は、送達を可能にするために、実質的に直線化した構成へと操作可能である、項目1に記載の整形外科用装置送達システム。
(項目6)
上記装填装置は、該装填装置の上記チャネルから上記管状送達装置の上記管腔の中へ整形外科用装置を移動させるように構成されるノブ(2230、3130)を備える、項目1に記載の整形外科用装置送達システム。
(項目7)
整形外科用装置を上記管状送達装置の上記管腔から外へ、そして上記患者の中へ前進させるプランジャ(1020、1120、1250、1950、2050、2410、2710、3110、3410、3510、3710、3810、3910、4010、4011、4110)をさらに備える、項目1に記載の整形外科用装置送達システム。
(項目8)
第1の構成から第2の構成まで整形外科用装置を移動させることと、
該第1の構成から該第2の構成まで該整形外科用装置を移動させることの後に、該第2の構成から第3の構成まで該整形外科用装置を移動させることであって、該第3の構成は、整形外科関節内の原位置に設置されるような該整形外科用装置の構成に対応し、該第2の構成は、該第3の構成での該整形外科用装置の適正な設置のために、該整形外科用装置の配向を制御する、ことと
を含む、患者の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目9)
上記第1の構成は、概して弓状である、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目10)
上記第2の構成は、狭小化構成である、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目11)
上記第2の構成は、実質的に直線化している、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目12)
上記第3の構成は、概して弓状である、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目13)
上記第3の構成は、上記第1の構成と実質的に同様である、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目14)
上記整形外科用装置は、近位端および遠位端を有する細長い芯を備え、該芯は、設置されるときの該整形外科用装置の配置を向上させるために、実質的に体温において概して弓状の構成を備えており、該芯は、送達を可能にするために、実質的に直線化した構成に操作可能であり、関節層は、該芯の少なくとも一部分を包囲する、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目15)
装填装置を備える整形外科用送達システムは、上記第1の構成で少なくとも1つの整形外科用装置を格納する、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目16)
上記患者における埋込中に、上記関節層を上記芯の少なくとも一部分に取り付けることをさらに含む、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目17)
上記患者における埋込後に、上記関節層を上記芯の少なくとも一部分に取り付けることをさらに含む、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目18)
上記芯の少なくとも一部分を除去するために、上記設置の原位置またはその近位に装置を挿入することをさらに含む、項目8に記載の整形外科関節の中へ整形外科用装置を低侵襲的に設置する方法。
(項目19)
管状送達装置を使用する低侵襲性の設置に好適な整形外科用装置であって、
生体適合性の外面と、
該外面の少なくとも一部の上に配置される被覆と、
近位端および遠位端を有する細長い芯であって、該芯は、設置されるときの該整形外科用装置の配置を向上させるために、実質的に体温において概して弓状の構成を備え、該芯は、送達を可能にするために、実質的に直線化した構成へと操作可能である、芯と
を備える、整形外科用装置。
(項目20)
上記生体適合性の外面は、生物学的な外被を備える、項目19に記載の整形外科用装置。
(項目21)
上記生体適合性の外面は、埋込後に、第1の寸法から第2のより大きい寸法まで増大するように構成される材料を備える、項目19に記載の整形外科用装置。
(項目22)
上記被覆は、多孔性である、項目19に記載の整形外科用装置。
(項目23)
上記被覆は、媒質を溶出する、項目19に記載の整形外科用装置。
(項目24)
上記媒質は、薬剤である、項目23に記載の整形外科用装置。
(項目25)
上記生体適合性の外面は、上記細長い芯の外面を備える、項目19に記載の整形外科用装置。
(項目26)
上記芯の少なくとも一部分を包囲する関節層をさらに備え、上記生体適合性の外面は、該関節層の外面を備える、項目19に記載の整形外科用装置。
(項目27)
上記装置はさらに、上記関節層内に空隙をもたらす、該関節層からの上記芯の少なくとも一部の少なくとも部分的な除去を可能にするように構成される、項目26に記載の整形外科用装置。
(項目28)
上記装置は、上記芯の少なくとも一部の除去によって生成される上記空隙の少なくとも一部がポリマー材料によって部分的に充填されるように、さらに構成される、項目27に記載の整形外科用装置。
種々の実施形態では、整形外科用装置は、いったん関節に埋め込まれると、弓状構成を有することができる。本明細書で使用されるように、「弓状」とは、曲線または円形の構成または形態を指してもよいが、また、曲線または円形の構成または形態を有する何らかの直線の側面または要素を有する、略弓状の構成および形態を含むこともできる。本明細書で使用されるように、弓状および略弓状の形態は、「C」字形、「O」字形、「S」字形、らせん、オウム貝形、「Q」字形、および平面または非平面的となり得る他の略弓状の形態を含むことができる。同様に、整形外科用装置のある実施形態は、三角形、正方形、長方形、ダイヤモンド形、菱形、五角形、六角形、八角形、および略直線の辺を有する他の形態を含むことができ、直線状形態の中にいくつかの曲線状の辺または角またはセグメントを有する略直線状である形態および構成をさらに含む、直線状構成を含んでもよい。本明細書で使用されるように、直線状および略直線状の形態は、「N」字形、「M」字形、「W」字形、「Z」字形、「T」字形、「Y」字形、「V」字形、「L」字形、「X」字形、および他の略直線状の形態を含むことができる。略弓状または略直線状の形態の種々の実施形態は、「P」字形、「R」字形、「B」字形、および「U」字形等の、直線状および弓状部分の両方を有する形態を含むことができる。整形外科用装置の実施形態は、第1の主要寸法、第2の主要寸法、および第3の主要寸法を含むことができる、3つの主要寸法を有する。一実施形態では、第1の主要寸法、第2の主要寸法、および第3の主要寸法は、幅、高さ、および厚さに対応する。整形外科用装置のある実施形態は、関節中の骨または軟骨等の組織の関節面の間の空間に嵌合するようにおおむね対応する、最小寸法に対応する厚さを有する。一実施形態では、幅および高さは、環状または正方形の整形外科用装置等と同様に同じになることができ、または、高さおよび幅は、卵形または長方形または一様でない高さおよび幅を有する他の形態と同様に異なってもよい。種々の実施形態では、整形外科用インプラントは、第1の主要寸法および第2の主要寸法がおよそ0.0394−4.0インチ(1.0−101.6mm)の範囲を有してもよく、第3の主要直径がおよそ0.001−0.50インチ(0.025−2.7mm)の範囲を有してもよい、様々なサイズの関節に埋め込むことができる。
本明細書で記載される整形外科用装置の種々の実施形態では、整形外科用装置は、関節内で弓状形態を有するように構成される。ある実施形態では、整形外科用装置は、整形外科用装置送達システムによる埋込のために、実質的に直線化したまたはあまり曲線状ではない構成に直線化することができる。例えば、一実施形態では、弓状整形外科用装置は、整形外科用装置の形態記憶材料を冷却または冷蔵し、次いで、特定設計の形態および断面の管、カニューレ、または皮下注射針に整形外科用装置を挿入することによって、直線化することができる。次いで、事前装填した皮下皮下注射針が、業界にとってのルアーロック標準または任意の他の取付手段等の連結またはインターフェースを介してハンドルに取付けられる。次いで、関節内に発生する空間または間隙を提供する力を付加することによって、医師は、指を真っ直ぐにする。例えば、力は、所望の関節を引張るか、伸張させるか、または広げるために手または道具を使用することによって、提供することができる。一実施形態では、関節組織を穿刺するために、外科用メスまたはトロカール等の鋭い道具を使用することができる。別の実施形態では、送達装置針が関節組織を穿刺することができる。針は、関節の後面と前面との間の中間点に配置される。針の先端は、関節包の完全に内側で、関節の中へ前進させられる。いったん挿入されると、医師は、ハンドルおよびプランジャ等の前進機構を使用して、装置を針の外へ前進させることによって、装置を解放する。本明細書で使用されるように、「プランジャ」はまた、押し棒、前進棒、または前進機構と呼ばれてもよい。いったん設置されると、針およびハンドルは、関節から除去することができる。指関節等の2つ以上の関節が治療される場合、設置した針は、ルアー型コネクタを介して除去することができ、第2の針を同じハンドルに取り付けることができ、必要に応じて手技を繰り返す。
Claims (17)
- 低侵襲性の設置に好適な整形外科用装置であって、該整形外科用装置は、近位端領域、遠位端領域およびその間の本体を含む細長い芯を備え、該芯は、該近位端領域と該遠位端領域との間の間隔にわたって、中心の開口部を囲む制限されていない概して弓状の構成を含み、該整形外科用装置は、該近位端領域および該遠位端領域に取り付けられた制限機構をさらに含み、該制限機構が、該弓状の構成が開閉し得る最大の範囲を提供するように構成される、整形外科用装置。
- 前記芯の少なくとも一部分を囲む関節層をさらに備える、請求項1に記載の整形外科用装置。
- 前記芯は形状記憶材料を含む、請求項1または2に記載の整形外科用装置。
- 前記概して弓状の構成は、実質的に平坦ではない、請求項1〜3のいずれかに記載の整形外科用装置。
- 前記制限機構はテザーを備え、前記芯の少なくとも一部が、該テザーを引くことによって前記関節層から除去され、その結果、該関節層内に空隙が生じる、請求項2に記載の整形外科用装置。
- 前記装置はさらにポリマー材料を含み、前記芯の少なくとも一部の除去によって生成される前記空隙の少なくとも一部が該ポリマー材料で部分的に充填される、請求項5に記載の整形外科用装置。
- 前記関節層は、ポリマー材料である、請求項2に記載の整形外科用装置。
- 前記装置の表面上に減摩高耐磨耗材料の被覆をさらに備える、請求項1〜7のいずれかに記載の整形外科用装置。
- 少なくとも1つの第2の芯をさらに備える、請求項1〜8のいずれかに記載の整形外科用装置。
- 前記制限機構は、紐、縫合糸またはワイヤを備える、請求項1〜9のいずれかに記載の整形外科用装置。
- 前記整形外科用装置は、テザーホールをさらに備える、請求項1〜10のいずれかに記載の整形外科用装置。
- 前記整形外科用装置は、手の関節に使用するように構成される、請求項1〜11のいずれかに記載の整形外科用装置。
- 前記整形外科用装置は、親指の関節に使用するように構成される、請求項12に記載の整形外科用装置。
- 前記整形外科用装置は、手根骨と中手骨との間で使用するように構成される、請求項12または13に記載の整形外科用装置。
- 前記整形外科用装置は、足の関節に使用するように構成される、請求項1〜11のいずれかに記載の整形外科用装置。
- 前記整形外科用装置は、つま先の関節に使用するように構成される、請求項15に記載の整形外科用装置。
- 前記整形外科用装置は、指骨と中足骨との間で使用するように構成される、請求項15または16に記載の整形外科用装置。
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US7527648B2 (en) * | 2004-12-21 | 2009-05-05 | Mitek Surgical Products Div Of Ethicon, Inc. | Method of replacing an anterior cruciate ligament in the knee |
US20060265077A1 (en) * | 2005-02-23 | 2006-11-23 | Zwirkoski Paul A | Spinal repair |
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US20070118218A1 (en) * | 2005-11-22 | 2007-05-24 | Hooper David M | Facet joint implant and procedure |
US20080027560A1 (en) * | 2006-06-13 | 2008-01-31 | Aspire Medical, Inc. | Glossal engagement system and method |
US20070293947A1 (en) * | 2006-06-19 | 2007-12-20 | Mansmann Kevin A | Multi-part implants for combined repair of hyaline and meniscal cartilage in joints |
US20080097606A1 (en) * | 2006-10-19 | 2008-04-24 | Cragg Andrew H | Knee joint prosthesis and hyaluronate compositions for treatment of osteoarthritis |
US20090012612A1 (en) * | 2007-04-10 | 2009-01-08 | David White | Devices and methods for push-delivery of implants |
US20080255664A1 (en) * | 2007-04-10 | 2008-10-16 | Mdesign International | Percutaneously deliverable orthopedic joint device |
EP2162095A4 (en) * | 2007-04-10 | 2013-08-07 | Articulinx Inc | SYSTEMS FOR PERCUTANEOUS PLACEMENT AND EXTRACTION OF SHAPE-CHANGING ORTHOPEDIC JOINT DEVICES |
AU2009291581A1 (en) * | 2008-09-12 | 2010-03-18 | Articulinx, Inc. | Tether-based orthopedic joint device delivery methods |
-
2008
- 2008-04-08 EP EP08745313.0A patent/EP2162095A4/en not_active Withdrawn
- 2008-04-08 US US12/099,296 patent/US20080255501A1/en not_active Abandoned
- 2008-04-08 WO PCT/US2008/059679 patent/WO2008124737A2/en active Application Filing
- 2008-04-08 JP JP2010503165A patent/JP5328763B2/ja not_active Expired - Fee Related
-
2010
- 2010-01-26 US US12/694,056 patent/US20110029094A1/en not_active Abandoned
Also Published As
Publication number | Publication date |
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EP2162095A4 (en) | 2013-08-07 |
WO2008124737A3 (en) | 2009-11-26 |
EP2162095A2 (en) | 2010-03-17 |
US20110029094A1 (en) | 2011-02-03 |
JP2010523277A (ja) | 2010-07-15 |
WO2008124737A2 (en) | 2008-10-16 |
US20080255501A1 (en) | 2008-10-16 |
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