JPH07503634A - device for pulling loops of wire or cable - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] Device for pulling loops of wires or cables The present invention is useful in surgical procedures, especially in surgical procedures. device used to pull loops formed in wires or cables when It is related to

Many surgeries involve tying loops of wire or thin flexible cables around bony structures Technologies have been developed over recent years. For example, some of those surgical techniques are Concerning the stabilization of various types of fractures, some also involve the use of various types of prostheses to the skeleton. or similar equipment. For such surgical procedures and An example of a device used is U.S. Pat. No. 4,604,995 (Stephens et al. ), U.S. Patent No. 2,501,978 (Wichman), and U.S. Patent No. 4.　 Seen in 790°303 (Stefee).

Traditionally, stiff stainless steel wire filaments are shaped around the bone. Shape, pull or push. By passing this stiff wire through the It can seriously and irreparably damage soft tissues and for this reason, e.g. A more flexible case made from polished titanium or stainless steel wire. Bull is preferred. This stiff wire can be looped and looped at the same time, e.g. U.S. Patent No. 2,455.609 (Scheib) and U.S. Patent No. ．． No. 304,620 (Steinkoenig) and U.S. Patent No. 914°182 Pull the free end of the wire as described in Pfeffer. We are connected by this. However, the use of prongs in surgical procedures is It's inconvenient. First, the entire procedure has to be repeated by going through an expensive process. Stress is applied to the wire, resulting in it breaking. Even worse, this This can weaken the wire and damage the surrounding tissue at the end of the surgical procedure. The sharp wire end should protrude and be held securely by the wire loop. The wound is closed, allowing the structure to move, and then the wire is will be broken. In any case, the process itself does not damage the tissue. This results in uncut portions of the protruding wire that can be cut off.

It is not possible to tie flexible wires or cables by the above means. Replaced Several forms of flexible cables can be used to appose bone fragments or bone to grafts. It becomes necessary to pull, and then this (Siebrandt) and U.S. Patent No. 4,966.600 (Songet It is secured in place by some form of crimping mechanism, such as the example of (and others).

However, these devices are relatively complex in structure and operation. These are made It is also expensive to manufacture and must be re-killed each time it is used for surgical procedures. Must be germinated. Supplied as a disposable part for one-time use It would be desirable to provide a tensioning tool of simple construction that can be produced reasonably cheaply. That is clear. .

According to the invention, the loop engages the cable or wire adjacent the closing position. The open body between the eels engages the open body between the cable or wire. an open body connected to an open body at a position spaced apart from the position; an adjustment member rotatable relative to the wire or cable; a hand for attaching the free end for rotation with at least one free end of the step, so that when the adjustment member is rotated relative to the open body, the width is Wrap the free end of the loop or cable around the adjustment member, thereby tightening the loop. Both the tensile, preferably open body and the adjustment member are molded plastic materials. A device is provided for pulling a loop formed in a cable or wire that is Ru.

In a preferred embodiment, the device has only two main parts and a molded plate. Since it is a plastic material, it is easy and inexpensive to manufacture, and can be used as a disposable part. provided. Since the plastic material used is radiolucent, this device This allows the surgeon to see an X-ray image of where the ring is forming. There is nothing to hinder it.

In a preferred embodiment, the device includes a first orientation of the open body and the adjustment member. an opposite second side of the body and the adjustment member with an open space between the body and the adjusting member; and a ratchet mechanism operable to resist relative rotation in the direction. the The ratchet mechanism allows the surgeon to insert one ratchet tooth at a time into the open body. The tension of the ring can be roughly adjusted by rotating the adjustment member. is allowed. In addition, the ratchet mechanism may e.g. If the surgeon moves another device under tension or removes the device for any reason. Even if you do, it will prevent the wheels from sliding.

Preferably, the open body has a deformed connecting tube through which the wire or cable passes. When in use, the device is not indirectly engaged with the cable or wire. match. In use, the open body bifurcates in the area where it engages the deformed connecting tube. a pair of deformed connecting tubes that are spaced apart from each other in the longitudinal direction. form the arms of the body, and thus the open body of the body can be opened without removing the body from the deformed connecting tube. caulking the deformed connecting tube in the area between the positions where the open bodies are engaged; is possible. This ensures that the ring is held strong and secure while being swaged.

The present invention also provides for cables or forming a closed loop through the wire, as claimed in any one of claims 1 to 17; a device for pulling a loop formed on a cable or wire on which the loop closes; engages the cable or wire adjacent to the device and equips the free end of the cable or wire. Attach the adjusting member of the device to the adjusting member of the device, and rotate the adjusting member of the device against the open body. to force (pull) the loop and tie the wire or cable to hold the loop closed. A method for forming a loop in a cable or wire is provided, comprising the steps of: forming a loop in a cable or wire;

The system of the invention will now be described in detail by way of example with reference to the drawings.

Figure 1 shows the wire being pulled around the fracture.

Figures 2a and 2b show a tool suitable for pulling wire around bone or other structures. It shows.

Figure 3 shows a modified connecting tube for forming a second modified connecting tube.

FIG. 4 is a partial cross-sectional view of a wire tensioning tool according to the invention.

5 is a side view of the tensioning tool of FIG. 4; FIG.

6 is a sectional view through the front part of the pulling tool of FIG. 4; FIG.

FIG. 7 is a partial cross-sectional view of an optional tensioning tool structure similar to FIG.

Figures 8a and 8b show the wire being threaded into the pulling tool of Figure 4.

FIG. 9 shows a torque driver for use with the pulling tool of FIG. 4.

FIG. 10 shows a tool for crimping the modified connecting tube of FIG.

As mentioned above, for example, a tie that has broken or split in the longitudinal direction of a long bone. One known technique for fixating bone fragments around a bone fracture involves threaded around the fractured fragment and holding it well while the bone heals. A wire hoop is used to hold the wire. In case of multiple fractures, securely hold the fracture To do this, several separate wire loops are passed around the bone in the fracture area. each ring is , causing the bone fragments to move and possibly heal without proper alignment. It must be tied together so that nothing happens.

FIG. 1 shows an external wire being passed under a fracture fragment 12 at a fracture site using a wire parasha 14. The wire 10 is shown over its entire length. Two preferred forms of wire parasha -14a and 14b are shown in Figures 2a and 2b.

Each wire parasha 14a, 14b has a specially shaped hook member 15a. , 15b can be seen to have long handles 13a, 13b holding them at one end. That flap The characteristic shape of the hook members 15a, 15b is that when the hook members 15a, 15b are used, determined by the characteristics of the body part being treated. However, each wire parasher 14 a, 14b are the openings 17a, 17b passing through the hook member 15aS 15b. Have it at the end.

When in use, a wire loop is formed around the tip of the wire parasha 14. It is moved smoothly under the bone or fracture fragment 12. Then that wire 10 hooks The wire used through the opening 17 at the tip of the member 15 is a single filament Rather than a case made of twisted stainless steel or titanium thread, It is bull.

The cable is consequently more flexible than a single wire and can be crimped to can be fixed more reliably than is possible with a single wire.

According to the invention, the end of the wire 1o is connected to a modified connecting tube, as shown in FIG. The free end of the wire 10 is passed through the two ends of the modified connecting tube. Extends from the end. By doing this, the wire 10 can be easily pulled as described later. In addition to being tensioned, when removing the free end of the wire 10 after crimping, the deformation It is advantageous that the tie tube 20 is substantially flush with the wire hoop. results and minimizes the risk of injury to surrounding tissue as protruding metal components almost disappears.

Before crimping, the tension of the wire 10 forming the loop must be adjusted. this This is accomplished using a tensioning tool 30 shown in FIGS. 4 to 6 of the drawings. Ru.

As can be seen from the drawing, the tensioning tool 3o (shown partially in section) is It includes an open body 32 and a rear adjustment member or knob 34. The gap between the holes Both the dial 32 and the adjustment knob 34 are preferably made of molded ABS plastic, for example. It is a molded plastic material. This makes it possible to manufacture tensile tools at a sufficiently low cost. The tension tool can now be used as a disposable component after only one use. provided. The materials used are ideally radiolucent and therefore allow for alignment of the fracture. The presence of one or more tensioning tools during recovery ensures that the fracture fragments are properly aligned. This does not prevent the surgeon from examining the patient with X-rays when the patient is being treated.

The open front portion of the body 32 is branched to form a pair of parallel arms 33; Each of its arms 33 includes a modified connecting tube, as best shown in FIG. The free end is provided with a partially circular recess 35 dimensioned to provide a secure fit around 2o. I can do it. The recessed ends of the arms 33 are spaced apart from each other and the tensioning tool The overall width of the forward end of 30 is approximately equal to the length of the modified connecting tube, so that the tension while snapping the recessed ends of the two arms 33 onto the two ends. By doing so, it is possible to firmly hold the deformed connecting tube 2o.

However, since there is sufficient space between the ends of the arms 33, the deformed connection tube The deformation held between the recesses 35 while holding the tab 20 with the tension tool 3° It is possible to caulk the central portion of the connecting tube 20 using a suitable tool. .

The arms 33 of the body 32 with an open space are connected at the rear, and a shape is formed in the center. forming a substantially tubular part with a cylindrical invisible hole 37 formed therein. the Hole 37 is provided with ring ratchet teeth 38 at its closed end. Opening of hole 37 Near the mouth end, the wall of the tubular portion extends outward to form an axis in the wall. forming a pair of diametrically opposed protrusions each having an opening 41 extending in the direction; do.

The rear adjustment knob 34 of the tensioning tool 30 slides into the rear hole 37 of the open body 32. There is a generally cylindrical hollow shaft 40 dimensioned for dynamic fit. that shaft The front end surface of the hole 40 has a ratchet formed at the innermost end of the invisible hole 37. Ratchet teeth 42 are formed to interengage with ratchet teeth 38.

At the end remote from the ratchet teeth 42, the shaft 4o is knurled. retains a knob 44 through which the rear adjustment knob component 34 adjusts the opening between. The body 32 is rotated relative to the body 32. The hollow shaft 40 has ratchet teeth 42 and serrations. A pair of diametrically opposed longitudinally extending knurled knobs 44 A groove 46 is provided. Each groove 46 has three different width sections along its length. , wires of different sizes are captured and held in the groove 46 as follows.

The adjustment knob 34 is spaced apart as shown in FIG. 4 by a resilient metal corrugated ring 48. It is attached to the body 32 that was previously installed. The corrugated ring 48 is attached to the hollow shaft 40. At the rear of the open body 32 projecting through the opening 49 formed and between the around an outwardly extending tab that engages a circumferential groove 50 formed in the wall of the invisible hole 37; space around the area. Accordingly, the corrugated ring 48 is This helps prevent the body from falling out through the open hole 37 in the body.

However, the corrugated ring 48 also allows the adjustment knob component 34 to In particular, it urges the ratchet tooth 3 toward the inside of the hole 37 in the body 32 It serves other important purposes such as disengaging two sets of 8 and 42 and engaging each other. . The two parts 32 and 34 of the pulling tool have 40 ratchet teeth 42 in the holes 37. Adjust the adjustment knob 34 with the open hole so that it rests on the ratchet teeth 38 formed in the end wall. relative to each other by a slight movement towards the outer edge of the hole 37 in the die 32. It only rotates. In one direction forward of the ratchet, the adjustment knob and associated The necessary axial movement with shaft 40 is achieved by two sets of ratchet teeth 38 and This is caused by the cam action of 42. However, in the rear direction, the adjustment knob structure The component 34 has a ratchet tooth 42 on the end of the shaft 40 of the adjustment knob 34 that fits into the hole 37. resists the biasing force of the corrugated ring 4B until it separates from these formed on the end wall of the must be actively pulled backwards.

Ratchet teeth 38 and 42 allow adjustment knob 34 to be rotated one tooth at a time. This is important because it allows the surgeon to gradually pull the wire loop. Change When the surgeon releases the tension tool, the ratchet teeth 38 and 42 The ratchet mechanism created by the This prevents the wire loop from loosening as a result. This allows several wire loops to be connected at the same time. It is particularly effective when the bone should be formed around a fracture. risk of slipping The final fixation is done so that the same pressure is applied around the fracture. It is possible to pull each ring a little at a time before pulling.

FIG. 7 shows a selectable pulling tool configuration with similar advantages to the device of FIG. .

The main components of the tensioning tool of FIG. 7, the open body 32 between the adjustment knob 34 and 4, but the two parts have a structure of inter-engaging regions. It's different. Instead of an invisible hole 37, the open body 32 between FIG. A hollow boss 70 is provided at the rear end. The main parts of the boss 70 are as follows: It is also connected to the seat of the open body 32 by a small diameter stem 72.

Its stem 72 provides there the necessary elastic force in place of the corrugated ring 48 of FIG. A thin outwardly extending annular spring flange 74 is formed.

The annular end surface of the boss 70 remote from the open body 32 is provided with ratchet teeth 76. I can do it.

In the structure shown in FIG. A sleeve 78 sized to fit on the dial 32 is attached to the sleeve 78 away from the knurl knob 44. It is provided at the end of the shaft 40. Ratchet teeth 80 are used in two sets of ratchet teeth. 4. Position such that chest teeth 76 and 80 cooperate in the same manner as described with respect to FIG. and is formed into an annular shoulder 82 extending inside the sleeve 78 . sleeve 7 8 has an inwardly directed flange 82 at its forward end. Adjustment knob component 34 sleeves 78 are snapped over the bosses 70 and are held together by the elasticity of the material. A flange 82 can be passed over the spring flange 74. Then the adjustment knob Disengagement of component 34 forces ratchet teeth 76 and 80 into engagement with each other. is blocked by a spring flange 74 which also serves to

In the construction shown in Figure 7, in addition to the two molded plastic components, It has the advantage of not requiring any metallic components. As a result, it is It's not very expensive to build and you can simply snap fit the two pieces together. Easy to assemble with.

As mentioned above, it may be necessary or necessary to place two or more wire loops on the fracture at the same time. desirable. For this reason, the front part of the body 32 with a small gap is shown in FIG. It has a roughly tapered triangular cross section, so that the tension tool used can It is preferred that they be located as closely as possible.

In use, the two free ends of the wire loop IO are connected from both sides of the deformed connecting tube 200. The modified connecting tube 20 is passed through. Then, the tensioning tool 30 is used to deform the connecting tube. 20 and the elasticity of the plastic material of the tensioning tool 30 Therefore, the arm 33 can be deformed in the region of the recess 35 at the end of the arm 33. Therefore, the deformed connecting tube 20 is held in the recess 35.

The free end of the wire 10 is then attached to the arm of the pulling tool 30 as shown in Figure 8a. and then an opening in the protrusion 40 at the rear end of the open body 32 between Each of the sections 41 is passed through. The two ends of wire IO are then shown in Figure 8b. Pass the wire end to the right of shaft 40 and press firmly into groove 46 so that They are passed together through diametrically opposed grooves 46 in shaft 40 so as to be aligned. hollow shell The shaft 40 passes between the grooves 46 against the inside of the wall of the hollow shaft 40 in use. Attach a tensionable transverse screw (not shown) to capture the wire IO. Be additionally prepared. This prevents the material from inadvertently coming off the groove 46 during tensioning. Prevent from turning. As can be seen in FIG. 8, the shaft of the tensioning tool 30 is In order to guide the end into the groove 46 to make it easier to thread the wire IO through the tensioning tool 30. It is provided with a lip 43 molded to suit the purpose.

Once threaded, the pulling tool 30 rotates the knurled knob 44. by rotating the adjustment knob component 34 relative to the open body 32. is used to adjust the tension of the wire hoop 10. Two configurations of tension tool 30 When the elements are rotated relative to each other, the wire lO is wound around the shaft 40, Generally pull hard on the wire loop. While pulling the wire IO, 30 is a modified connecting tube 20 rather than a bone fragment or any other biological structure. It is noteworthy that it is supported by Furthermore, the wire 10 is strongly pulled from both ends at the same time. tensioned to minimize friction between the wire lO and the bone or bone fragments around which the wire passes. limit.

When the final pull is near, the ratchet teeth 38 and 42 form a A ratchet mechanism allows the tensioning tool 30 to be adjusted in small increments. Now surgeons can avoid the real risk of wire slipping. The tool can be removed easily.

Adjustment knob 54 can be adjusted directly by the surgeon using knurled knob 44. or use a torque drino <-90 of the type shown in Figure 9. It is rotated by

The torque screwdriver 90 fits into the knurled knob 44 of the pulling tool 30. a hollow shaft having a sleeve 94 at one end dimensioned to matingly and frictionally engage; It has a foot 92. The torque driver 90 has a roughly disk shape with a relatively large diameter. It has a handle 96 at the other end. The large diameter of the handle 96 makes it difficult to handle the tension tool 30. The relatively large torque can be easily applied and also aids in slight adjustments.

Torque driver 90 also includes a torque meter, and wire 10 is is pulled by the specified value of torque. It also includes some forms of traditional one-pot It features a "pull-off" mechanism that allows the torque screwdriver to 90 is no longer operatively engaged with tension tool 30. This pulls the wire 10. This has the advantage of reducing the risk of being too tight.

Once the necessary tension is achieved, the deformed connecting tube 20 is shown in Figure 1O. It is crimped around the wire 10 using a crimping tool 100.

The crimping tool 100 includes a pair of opposing jaws 101 and 100 that are hinged together at a pivot 106. and 102. Each jaw 101 and 102 itself has a pivot 103 and 104 Each is hinged midway through its length. Rear part of each jaw 101 and 102 The portion extends rearward to form a handle 107 or 108, and the handles 107 and 108 are mutually connected. Engaging cam surfaces (not shown) are formed so that the handles 107 and 108 rotate around the pivot 106. After the jaws 101 and 102 which, when moved together, hold the pivots 103 and 104. The ends of the two halves move apart (indicated by dashed lines in Figure 10).

At the front end of the crimping tool 100, the jaws 101 and 102 are connected to a pivot 103 and and a front jaw member 111 and 104 connected to the rear portion of the jaw, respectively. 112. The anterior jaw members 111 and 112 themselves are located near their anterior ends. are hinged together to a pivot 110.

The forward ends of the two forward jaw members 111 and 112 have cooperating mold surfaces 113 and 114. is formed, and the deformed connecting tube 20 is placed between the mold surface 113 and l14, and the front When the jaw members 111 and 112 are moved together using the handles 107 and 108 Then, connect the wire IO so that the deformed connecting tube 20 firmly grasps the wire IO. It is designed to transform around it.

The front jaw members 111 and 112 are made sufficiently thin so that they can be pulled using the pulling tool 3. 0 can be located around the central portion of the modified connecting tube 20 between the arms 33 of the Wear. The deformed connecting tube 20 is then expanded with the tensioning tool in place. I can't stand it. Further, the front end surfaces of the front jaw members 111 and 112 are substantially in close contact with each other. The crimping tool 100 generally extends in the lateral direction of the crimping tool 100, so that it can be deformed using the tool. .

Once the caulking is completed, the caulking tool 100 and the tensioning tool 30 are removed. Then cut the end of the wire into the connecting tube using conventional surgical wire cutters. Cut near the end of the , the protruding ends that line up with the wire loops and damage the surrounding tissue are realistic. does not exist.

International search report Dr71 (HQoxtnn2r, +PCT/GO9310026 1 Continuation of front page (72) Inventor: Lugo, Brenda Massachusetts, United States 02368-1794. Randolph, Pasela Park Drive 41. Kotsuto Within Mann & Shurtleff Incorporated

Claims (22)

[Claims] 1. an opening between the rings to engage a cable or wire adjacent to the closed position; a position where the cable or wire engages the open body; connected to the open body at a position with a gap between them, and connected to the open body between the gap an adjusting member rotatable relative to the wire or cable; means for attaching the free end for rotation with at least one free end; , wherein the adjustment member is rotated relative to the open body between the adjustment members. and wrapping the free end of the wire or cable around the adjustment member; a loop formed in a cable or wire whereby the loop is pulled tight A device for pulling. 2. Allowing relative rotation between the open body and the adjustment member in a first direction. and a relative movement of the open body between the open body and the adjustment member in an opposite second direction. The device of claim 1, comprising a ratchet mechanism operable to resist rotation. . 3. The ratchet mechanism includes ratchet teeth formed in the open body. a first set, and a lug engageable with the first set and formed on the adjustment member. a second set of ratchet teeth and said first and second ratchets interengaging with each other; and resilient biasing means for pushing the teeth. 4. the resilient biasing means connect the intervening open body and the adjustment member together; 3. A device according to claim 2, which operates as follows. 5. said resilient biasing means permitting relative rotation but not relative axial movement; a groove or The device according to claim 3 or claim 4, comprising an elastic corrugated plate that engages the opening. Place. 6. the resilient biasing means being integral with the open body and one of the adjustment members; an open body formed between the body and another annular surface of the adjustment member; 5. A device according to claim 3 or claim 4, comprising an engageable resilient annular flange. 7. Either one or both of the open body and the adjustment member are molded plastics. A device according to the preceding claims, being a stick material. 8. Either or both of the open body and the adjustment member may be radiolucent. 10. A device according to the preceding claims, which is hyperactive. 9. the free end of the wire or cable between the wire or cable and the said self from a position where it engages with the open body of said self-adjusting member. Apparatus according to the preceding claim, including means for guiding the distal end. 10. the means for guiding includes at least one protruding protrusion; through the protrusion through which the free end of the wire or cable can pass. 10. The device of claim 9, having an axially extending opening formed therein. 11. means for attaching the free end of the wire or cable to the at least one groove having a width slightly greater than the width of the wire or cable; before the free end of the wire or cable is frictionally engaged by the wall of the groove. Apparatus according to the claims. 12. The or each groove may be different to accommodate wires or cables of different widths. 12. The device of claim 11, having a portion of width equal to or greater than . 13. means for attaching the free end of the wire or cable to the for gripping the free end of the wire or cable against the wall of the adjustment member; Apparatus according to the preceding claims, including a screw gripping member. 14. further comprising torque driver means, wherein the torque driver means engageable with the adjustment member for rotation with the member and with respect to the open body therebetween; a radially extending member of relatively large dimension to facilitate rotation of said adjustment member; A device according to the preceding claims, comprising a member. 15. The open body in between is a modified connecting tube through which the wire or cable passes. , wherein in use the open body between said deformed connecting tubes as claimed in the preceding claims, adapted to engage said cable or wire via equipment. 16. The open body therebetween is a region that engages the deformable connecting tube in use. When used in a position where there is a gap in the longitudinal direction, the forming a pair of arms for engaging the deformable coupling tube, wherein the deformable coupling The tube can be moved forward without removing the open body from the deformed connecting tube. the area between the positions where the deformed connecting tube is engaged by the open body of the recess; 16. The device according to claim 15, wherein the device is capable of being swaged in the area. 17. A cable or wire substantially as hereinbefore described with reference to Figures 3 to 9 of the drawings. A device for pulling the loop formed in the 18. The cable or wire is placed around the structure or structures to be surrounded by the hoop. forming a closed loop through the ear, according to any one of claims 1 to 17; said loop closes a device for pulling a loop formed on the cable or wire of engaging the cable or wire adjacent to the position; attaching the free end to the adjustment member of the device; Rotate against the open body and pull the ring tight to remove the wire or cable. tying a ring to hold said loop closed; A method for forming a ring. 19. The free end of the wire or cable is connected to the change to close the loop. A device for pulling the ring is threaded through the shaped connecting tube from its opposite ends. 19. The method of claim 18, wherein the method engages the deformed connecting tube. 20. The cable or wire is swaged around the deformed connecting tube. 19. The method of claim 18, wherein the loop is held closed by tying. 21. The deformed connecting tube, before removing the device for pulling the ring, 21. The method of claim 20, wherein the wire or cable is crimped. 22. Forming a loop in a wire or cable substantially as hereinbefore described with reference to the drawings method for.