JP5893407B2 - 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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- JP5893407B2 JP5893407B2 JP2011532474A JP2011532474A JP5893407B2 JP 5893407 B2 JP5893407 B2 JP 5893407B2 JP 2011532474 A JP2011532474 A JP 2011532474A JP 2011532474 A JP2011532474 A JP 2011532474A JP 5893407 B2 JP5893407 B2 JP 5893407B2
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- fusion device
- joint
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- bone
- vibration
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- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00389—The prosthesis being coated or covered with a particular material
- A61F2310/00592—Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
- A61F2310/00796—Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite
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 (19)
- 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2つのピン形状の固定部分(1)と少なくとも1つの安定化部分(2)とを含み、前記安定化部分は前記固定部分(1)の間に配置され、または配置可能であり、
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、
前記ピン形状の固定部分(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)よりも大きく、
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熱可塑性の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、
前記固定部分(1)の深さは、前記安定化部分(2)の深さよりも大きく、
前記安定化部分は、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、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1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2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1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1から3のいずれか1つに記載の融
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1から5のいずれか1つに記載の融合装置。
- 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1から6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1から7のいずれか1つに記載の融合装置。
- 前記近位面は、前記融合装置に機械的エネルギを結合するための振動ツールに結合するために設けられる、請求項1から8のいずれか1つに記載の融合装置。
- 前記近位面は、湾曲した接触面を形成する、請求項9に記載の融合装置。
- 前記近位面は、振動ツールの遠位面に設けられた対応する突起と協働する軸方向の開口またはボアを備える、請求項9または10に記載の融合装置。
- ヒトを除く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1から11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。 - ヒトを除く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1から11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。 - ヒトを除く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1から11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1から11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15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15から16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15から17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18に記載のツールセット。
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