JPH08206121A - 拡張式縫糸アンカー - Google Patents

拡張式縫糸アンカー

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Publication number
JPH08206121A
JPH08206121A JP7279858A JP27985895A JPH08206121A JP H08206121 A JPH08206121 A JP H08206121A JP 7279858 A JP7279858 A JP 7279858A JP 27985895 A JP27985895 A JP 27985895A JP H08206121 A JPH08206121 A JP H08206121A
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JP
Japan
Prior art keywords
suture anchor
follower
main body
expandable suture
hole
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Granted
Application number
JP7279858A
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Other versions
JP3693719B2 (ja
Inventor
Raymond L Curtis
エル．クルティス レイモンド
Urs Schlegel
シュレゲル ウルス
Thomas Heldstab
ヘルドスタブ トーマス
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AO Technology AG
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Synthes AG Chur
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Publication of JPH08206121A publication Critical patent/JPH08206121A/ja
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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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive
    • 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
    • A61B2017/0403—Dowels
    • 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
    • A61B2017/0414—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 a suture-receiving opening, e.g. lateral opening
    • 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
    • A61B2017/042—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors plastically deformed during insertion
    • 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
    • A61B2017/0438—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors slotted, i.e. having a longitudinal slot for enhancing their elasticity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
    • 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
    • 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
    • A61F2/30—Joints
    • A61F2/40—Joints for shoulders
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00—Surgery
    • Y10S606/907—Composed of particular material or coated
    • Y10S606/908—Bioabsorbable material

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Rheumatology (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Dowels (AREA)

Abstract

(57)【要約】 【課題】 主体と従体とから成る縫糸アンカー内で縫糸
を阻止することなく容易且つ安全に主体と従体とを組み
立てる。 【解決手段】 Ａ）処置しようとする体の部分に面して
いる前部（１）、後部（２）、縦軸（３）、曲面
（４）、前部（１）から後部（２）に延びる中心の貫通
孔（１９）、そして前部（１）と曲面（４）とにおいて
開いており、そして後部（２）で閉じている縦溝（１
２）を備える一般に円筒形の主体（１１）と、Ｂ）小さ
い基部（１５）、大きい基部（１６）、曲面（１７）、
そして縦軸（１３）を有する従体（１４）とを備え、こ
の従体（１４）の小さい基部（１５）を主体（１１）の
縦溝（１２）に同軸的に挿入できそれにより、主体（１
１）を拡大させ、そして従体（１４）は縦軸（１３）に
直交する貫通孔（６）を有する拡張式縫糸アンカーにお
いて、Ｃ）従体（１４）の曲面（１７）には２つの側溝
（７）を設け、これらの側溝は貫通孔（６）の開口（１
８）から小さい基部（１５）へ延びていることを特徴と
する拡張式縫糸アンカー。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】本発明は処置しようとする体
の部分に面している前部、後部、縦軸、曲面、前部から
後部に延びる中心の貫通孔、そして前部と曲面とにおい
て開いており、そして後部で閉じている縦溝を備える主
体と、小さい基部、大きい基部、曲面、そして縦軸を有
する従体とを備え、この従体の小さい基部を主体の縦溝
に同軸的に挿入でき、それにより主体を拡大させ、そし
て従体は主体の縦軸に直交する貫通孔を有する拡張式縫
糸アンカーに係るものである。
【０００２】柔軟な組織を骨に取り付けるため外科で縫
合術を利用する。骨からの組織の捻除の処置に、裂けた
腱、じん帯そして関節の被膜の骨への付けなおしを含む
再建処置に縫合術を利用する。その適用分野は肩の不安
定性と回旋筋カフの破損の処置、膝の不安定性の処置、
顎顔面の手術、手の手術そして足、足首そして手首のじ
ん帯治療にまで広がっている。
【０００３】肩が特に重要であるのは、この関節の外れ
が他の関節よりも頻繁に起こるからであり、それが起こ
ると総ての年齢にわたって運動選手でも運動選手でなく
ても運動が制限され、苦痛を生じる。
【０００４】
【従来技術】縫糸の係止は骨自体に直接行うか、もしく
は骨内へ移植するアンカーにより行うかのどちらかであ
る。
【０００５】古典的なバンカート（BANKART)法は、アン
カーなしでトランザス・トンネル（transosseous tunne
ls) を通して直接挿入される縫糸を利用して前下部の上
腕関節窩の不安定性を処置する方法として広く受け入れ
られている。手術のための患部露出に最小限の創傷と皮
膚の切開とは必要であり、そして報告によれば再発率
３．５％乃至４．０％という優れた臨床結果が出ている
が、裂けたじん帯もしくは腱を取り付けなおす処置は時
間もかかり、困難でもある。標準の回旋筋カフとバンカ
ート（Bankart)外傷の処置のための手術時間を低減する
改変方法があるけれども、これらの方法は技術を必要と
する。
【０００６】ステープルの使用は骨と腱を切ってしまう
傾向がある。
【０００７】ＥＰ−Ａ１ ０５０２５０９に示されてい
る拡張式縫糸アンカーでは、溝つき主体に別の円錐体を
同軸的に挿入して、それにより主体を拡張するようにな
っている。
【０００８】拡張式縫糸アンカーが組合わさるとき（主
体と円錐体との間に）縫糸は捕捉され、その縫糸は（主
体と円錐体との）組立体の上を自由に滑らなくなる。こ
の縫糸の捕捉によって縫糸の最大引っ張り強さは減少す
る。
【０００９】
【発明が解決しようとする課題】本発明の目的は、縫糸
アンカー内で縫糸を阻止することなく容易且つ安全に組
立てることができる縫糸アンカーを提供することによっ
て上述の問題を解決することである。拡張式縫糸アンカ
ーの組立て後の縫糸の滑動能力は、外科医が縫糸へ滑動
結び目をつけるため非常に重要である。
【００１０】
【課題を解決するための手段】本発明に従ってこの目的
を達成する拡張式縫糸アンカーは、それの主体に入り込
む従体の曲面に２つの側溝を設け、これらの側溝は主体
の縦軸に直交する従体の貫通孔の開口からそれの小さい
基部へ延びていることを特徴とする。
【実施例】
【００１１】本発明の種々の新規な特徴は特許請求の範
囲に記載されている。本発明の一層の理解のためそれの
作用効果と、それの使用によって達成される目的とを、
好ましい実施例を示す添付図を参照して以下に説明す
る。
【００１２】図１乃至図４に示す縫糸アンカーは基本的
に主体１１と従体である円錐体１４とから成る。
【００１３】主体１１は、前部分１、後部分２そして縦
軸３とを有する全体として円筒の形をしている。
【００１４】主体１１の曲面４に突起５を設けており、
これらの突起５は主体の全長にわたってかかりのように
分布していて皮質の骨部もしくは皮質と海綿状の骨部に
縫糸アンカーを保持し易くしている。
【００１５】取扱器具を受け入れるための中央孔の形の
接続手段９をその後部分２に設ける。中心の貫通孔１９
は前部分１から後部分２へ延びていて縫糸１０のループ
の両端を受ける。
【００１６】前部１と曲面４とで開いており、そして後
部２で閉じている縦溝１２によって主体１１は拡張でき
る。縦溝１２の閉じた端２３は丸められていて、２つの
脚２１と２２が広げられるときの応力を均一に分散させ
るようにしている。
【００１７】ほぼ円錐形の、従体１４は小さい基部１
５、大きい基部１６、曲面１７そして縦軸１３を有す
る。この第２の円錐体１４は楔の形をしていて、それの
小さい基部１５を主体１１の溝１２に同軸的に挿入で
き、それにより主体１１を拡張する。縫糸アンカーの拡
張は骨に対するアンカーの固定を改善することになる。
【００１８】円錐体１４の縦軸１３に直交して貫通孔６
があけられており、縫糸１０を受け入れるようになって
いる。従体１４の全長の５％乃至２５％に相当する距離
だけ大きな基部１６から貫通孔６は離れている。この位
置が縫糸の固定の強さを最大にしている。
【００１９】従体１４の曲面１７の２つの側溝７は貫通
孔６の開口１８から小さい基部１５に延びている。これ
らの側溝７の機能は図３と図４に示すように、貫通孔６
を通った後の縫糸１０を取り込むことであり、（アンカ
ーの組立て前に縫糸１０は貫通孔６を通っている）その
縫糸が主体１１と従体１４の曲面１７との間で詰まらな
いようにする。このためこれらの側溝７の深さは貫通孔
６の最小直径を越えるべきである。従体１４が円錐もし
くは楔状の形をしているため側溝７の深さは開口１８か
ら小さい方の基部１５へ減少している。
【００２０】貫通孔６はあけ易いように真っ直ぐにする
か、好ましくは彎曲させて、それの頂点が大きい基部１
６に向いているようにする。この彎曲によって貫通孔６
内で縫糸１０は滑らかに動き、そして縫糸１０を損傷さ
せることとなる鋭い縁はなくなる。
【００２１】主体１１と従体１４とは二個の別々に離し
た部品となっているか、又は図１乃至図４に示すよう
に、中間部分２０で同軸的に仮に接続されているかであ
って、この中間部分２０は縫糸１０にある引っ張り力が
加わると壊れて円錐体１４を図３、図４に示すように主
体１１と接合させる。
【００２２】接続手段９を使って適当な器具により主体
１１を保持することにより、そして貫通孔６と中心孔１
９とを通して縫糸１０のループの２つの端を引くことに
より引っ張り力を加える。
【００２３】中間部分２０の通路２４は主体１１と従体
１４との間に縫糸１０を通す空間となっている。
【００２４】図５に示すように、縫糸１０を更に引く
と、従体１４の小さい方の基部１５が縦溝１２に入り込
んできてこの縦溝１２により形成されている２つの脚２
１、２２を広げて、主体１１を拡張し、そして骨本体に
それを固定する。
【００２５】縫糸アンカーはステンレススチールやチタ
ンのような既知の移植材料からつくることができる。ポ
リラクチドのような分解吸収性の材料からつくられるの
が好ましい。人体内の酸素の存在の下でポリラクチドは
乳酸に分解し、それから二酸化炭素と水とになる。二酸
化炭素は呼吸器系から、水は腎臓を介してそれぞれ体外
へ排出される。
【００２６】分解吸収性の材料を使用することにより柔
らかい組織が金属腐食から刺激を受けることは回避され
る。またそれは、その局所近くでの磁気共鳴撮像のよう
な撮像診断もしくはある種の治療に対する支障を排除す
る。もしその局所に金属移植材などあればそのような撮
像診断をするには、先ずその金属移植材を外科的に除去
しなければならないからである。
【００２７】縫糸アンカー全長は骨に入れる前にはせい
ぜい２１ミリメートル（好ましくはせいぜい１８ミリメ
ートル）である。肩などの狭い場所では（従来のアンカ
ーでは２５ミリメートルもあったが、それと比較して）
この小さい寸法のお蔭で、臨床医は挿入場所をこれまで
よりも自由に選択できる。
【００２８】
【発明の効果】本発明の拡張式縫糸アンカーを用いれば
骨部に縫糸アンカーを保持し易くなり、骨に対するアン
カーの固定を改善できる。また分解吸収性の材料を使用
しているので、金属腐食からの柔らかい組織を刺激する
ことは回避でき、その局所近くでの撮像診断もしくはあ
る種の治療に対する支障もなくなる。さらに挿入場所も
自由に選択できる。
【図面の簡単な説明】
【図１】 縫糸を入れる前の本発明の拡張式縫糸アンカ
ーの斜視図である。
【図２】 縫糸を入れた後の本発明の拡張式縫糸アンカ
ーの斜視図である。
【図３】 図１の拡張式縫糸アンカーを９０°回転させ
た斜視図である。
【図４】 図２の拡張式縫糸アンカーを９０°回転させ
た斜視図である。
【図５】 主体を拡張させて、主体に円錐部品を挿入し
た後の拡張式縫糸アンカーの斜視図である。
【符号の説明】
１：主体の前部、２：主体の後部、３：主体の縦軸、
４：主体の曲面、５：主体の突起、６：従体の貫通孔、
７：従体の側溝、９：接続手段、１０：縫糸、１１：主
体、１２：主体の縦溝、１３：従体の縦軸、１４：従
体、１５：従体の小さい基部、１６：従体の大きい基
部、１７：従体の曲面、１８：従体の開口、１９：主体
の貫通孔、２０：中間部、２１：脚、２２：脚、２３：
主体の縦溝の閉じた端、２４：通路。
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ウルス シュレゲル スイス国、ツェーハー−7270 ダフォス プラッツ、オーバー アルベルティシュト ラーセ 10 (72)発明者 トーマス ヘルドスタブ スイス国、ツェーハー−7260 ダフォス ドルフ、スティッリ ５

Claims (13)

    【特許請求の範囲】
  1. 【請求項１】 Ａ）処置しようとする体の部分に面して
    いる前部（１）、後部（２）、縦軸（３）、曲面
    （４）、前部（１）から後部（２）に延びる中心の貫通
    孔（１９）、そして前部（１）と曲面（４）とにおいて
    開いており、そして後部（２）で閉じている縦溝（１
    ２）を備える一般に円筒形の主体（１１）と、 Ｂ）小さい基部（１５）、大きい基部（１６）、曲面
    （１７）、そして縦軸（１３）を有する従体（１４）と
    を備え、この従体（１４）の小さい基部（１５）を主体
    （１１）の縦溝（１２）に同軸的に挿入でき、それによ
    り、主体（１１）を拡大させ、そして従体（１４）は縦
    軸（１３）に直交する貫通孔（６）を有する拡張式縫糸
    アンカーにおいて、 Ｃ）従体（１４）の曲面（１７）には２つの側溝（７）
    を設け、これらの側溝は貫通孔（６）の開口（１８）か
    ら小さい基部（１５）へ延びていることを特徴とする拡
    張式縫糸アンカー。
  2. 【請求項２】 従体（１４）は円錐形もしくは楔の形を
    している請求項１に記載の拡張式縫糸アンカー。
  3. 【請求項３】 従体（１４）の貫通孔（６）は、従体
    （１４）の全長の５乃至２５％に相当する距離に大きい
    基部（１６）から離れて位置する請求項１もしくは２に
    記載の拡張式縫糸アンカー。
  4. 【請求項４】 従体（１４）の貫通孔（６）は、頂点を
    大きい基部（１６）に向けて縦に彎曲している請求項１
    乃至３のいずれかに記載の拡張式縫糸アンカー。
  5. 【請求項５】 従体（１４）の側溝（７）の深さは貫通
    孔（６）の最小直径を越えている請求項１乃至４のいず
    れかに記載の拡張式縫糸アンカー。
  6. 【請求項６】 従体（１４）の側溝（７）の深さは開口
    （１８）から小さい基部（１５）へ減少していく請求項
    １乃至５のいずれかに記載の拡張式縫糸アンカー。
  7. 【請求項７】 後部（２）に取扱器具を取り付けたり取
    り外したりできる接続手段（９）を設けた請求項１乃至
    ６のいずれかに記載の拡張式縫糸アンカー。
  8. 【請求項８】 分解吸収性の材料、好ましくはポリラク
    チドからできている請求項１乃至７のいずれかに記載の
    拡張式縫糸アンカー。
  9. 【請求項９】 曲面（４）に突起（５）、好ましくはね
    じ山もしくはかかりの形の突起（５）を設けている請求
    項１乃至８のいずれかに記載の拡張式縫糸アンカー。
  10. 【請求項１０】 主体（１１）と従体（１４）とが中間
    部（２０）により同軸的に仮に接続され、この中間部は
    軸方向に所定の力をかけると壊れて従体（１４）を主体
    （１１）と接合させる請求項１乃至９のいずれかに記載
    の拡張式縫糸アンカー。
  11. 【請求項１１】 縦溝（１２）の閉じた端（２３）は丸
    められている請求項１乃至１０のいずれかに記載の拡張
    式縫糸アンカー。
  12. 【請求項１２】 骨に挿入する前には全長がせいぜい２
    １ミリメートルである請求項１乃至１１のいずれかに記
    載の拡張式縫糸アンカー。
  13. 【請求項１３】 骨に挿入する前には全長がせいぜい１
    ８ミリメートルである請求項１乃至１２のいずれかに記
    載の拡張式縫糸アンカー。
JP27985895A 1994-10-04 1995-10-04 拡張式縫糸アンカー Expired - Fee Related JP3693719B2 (ja)

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Application Number Priority Date Filing Date Title
US08/317,396 1994-10-04
US08/317,396 US5464427A (en) 1994-10-04 1994-10-04 Expanding suture anchor

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JPH08206121A true JPH08206121A (ja) 1996-08-13
JP3693719B2 JP3693719B2 (ja) 2005-09-07

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EP (1) EP0705567B1 (ja)
JP (1) JP3693719B2 (ja)
CA (1) CA2146179C (ja)
DE (2) DE69525806D1 (ja)
ES (1) ES2172543T3 (ja)

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ES2172543T3 (es) 2002-10-01
JP3693719B2 (ja) 2005-09-07
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CA2146179A1 (en) 1996-04-05

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