KR20070022261A - Free hand drill guide - Google Patents

Abstract

The present invention relates to surgical drill guides having the use of a bone plate having locking holes located at a predetermined angle with respect to the plate, the surgical drill guide having a hole in a desired angle range permitted by the plate hole. It has at least one array of drill guide barrels arranged in respective lock holes in the bone plate for drilling holes.

Drill guide

Description

Free hand drill guide {FREE HAND DRILL GUIDE}

The present invention relates to surgical drill guides, and more particularly to drill guides associated with bone plates for providing an accurate arrangement of a device for forming holes with the bone screw holes of the plate. More particularly, the surgical drill guide assembly provides a soft tissue protection and accurate arrangement of at least one drill tube with bone screw holes in a bone plate, such as for example a vertebral bone plate.

The use of surgical fixation plates for various orthopedic applications is widely accepted. The plates are used by doctors for the purpose of stabilizing, altering and arranging the bones of the patients as well as changing the load on the bones of the patients and the bones are secured by a plurality of locking devices such as screws installed through the holes in the plates. Typically immobilized. Correct positioning and alignment of the locking device and safe surgical fixation of the plate relieve some potential complications after transplantation.

Immobilization of bone plates used in spine applications should be installed in special treatments such as intervertebral fixation, bone fragment fixation and anterior decompression of the spine such that they can be used for long periods of time. In particular, the margin of error is low in spinal surgery due to the sensitivity of the spinal cord and the risk of invasive processes around the spinal cord.

In addition, the dimensions of the spine in which the locking devices can be set are very limited.

The screws used to secure the plates to the bone must be properly aligned with the associated fixation plate holes for each screw to be correctly positioned in the plate. Misalignment of the screws in the plate holes is a risk of tissue injury. Incorrectly arranged screws can also lead to unstable or insecure connections of the plate to the bone material, potentially destroying the utility of the plate. In particular, the locking of the plates requires a precise locking arrangement.

Drill guides are often used to assist doctors in arranging screws in plate holes. Drill guides for locking plates that attach or abut to drill guide plates generally comprise a guide tube for hole forming devices such as a drill bite.

Summary of the Invention

The drill guide provides for including a guide barrel for a bone device that forms a hole in the bone and an alignment assembly associated with the guide barrel for arranging the bone device with a selected first or second locking device hole of the bone plate. The arrangement assembly may comprise a location post arranged to be at least partially received in a recess in the bone plate. The position post can also be pivoted against the bone plate recess in order to allow the guide barrel to be selectively arranged in the first or second holes. The position post may also be arranged to axially lock the drill guide to the bone plate.

The location post may further comprise a plurality of resilient finger elements arranged to frictionally engage the bone plate recess to axially lock the drill guide to the bone plate. The resilient finger elements may also have at least one ridge arranged for engaging the threads in the bone plate recess.

The arrangement assembly may further comprise a housing having a first axial bore arranged to slide at least a portion of the location post.

Each of the location posts and the housing may further have a distal end. The position post may have a retracted position whose position post distal end is located at a first distance from the distal end of the housing. The position post may have an extended position whose position post distal end is located a second distance from the distal end of the housing, the second length being greater than the first length. The arrangement assembly further includes a spring element disposed at least partially in a second axial hole in the housing to bias the position post in its extended position.

The guide barrel may further comprise a bore with a hole axis and an end plate engaging end, wherein the end plate engaging end is in the first or second lock hole to align the hole with the bone screw hole. It includes a nose portion arranged to be received.

The nose portion may comprise a conical shape. The housing first axial bore and guide barrel bore can form an acute angle therebetween.

The guide barrel distal end may thus be located at a first distance from the top position of the bone plate when the location post is received in the bone plate recess and the location post is in the extended position. The guide barrel distal end may contact the selected bone screw hole when the location post is received in the bone plate recess and the location post is in the retracted position. In another embodiment the location post is It can be axially fixed to the array assembly.

The guide barrel may further comprise a handle associated with the guide barrel, the handle may be arranged to selectively rotate relative to the guide barrel on the first side. The first face may be substantially perpendicular to the longitudinal axis of the guide barrel aperture. The handle swivel assembly may also be arranged to have a locked position that prevents the handle from rotating relative to the guide barrel, and an unlocked position to allow the handle to rotate freely with respect to the guide barrel. Can be arranged to have. The swivel assembly may comprise at least one nonmetal bearing and may comprise a drainage hole arranged to drain fluid from the assembly following sterilization of the drill guide.

A surgical drill guide may be provided that includes a handle, a guide barrel having a near end associated with the handle, and a distal end arranged to engage an inner surface of a fastener hole in the bone plate. The guide barrel may further comprise a bore arranged to receive the bone hole forming device. The arrangement assembly may be associated with the guide barrel for arranging the bone device in a selected first or second lock hole, the arrangement assembly arranged to be at least partially received in a recess in the bone plate. Includes location posts;

The position posts are selectively arranged with the guide barrel in the first and second lock holes so that the device can be extended through the guide barrel to form a hole in the bone below the selected lock hole. It may be pivoted into the recess in order to make it clear. The position post may be arranged to axially fix the drill guide to the bone plate. The location post may comprise a plurality of resilient finger elements arranged to frictionally engage the bone plate recess to axially secure the drill guide to the bone plate. The resilient finger elements may have at least one ridge arranged for engaging threads in the bone plate recess. The arrangement assembly may further comprise a housing having a first axial bore arranged to slide at least a portion of the location post.

The position post has an in position where the first length of the position post is received in the hole, and the second length of the position post can have an extended position accommodated in the hole, where the first length is greater than the second length. Bigger

The arrangement assembly further comprises a spring element disposed at least partially in a second axial bore in the housing to bias the position post in its extended position.

The guide barrel may further comprise a bore with a hole axis and an end plate engaging end, wherein the end plate engaging end is in the first or second lock hole to align the hole with the bone screw hole. It may include a nose portion arranged to be received. The nose portion may comprise a conical shape. The housing first axial bore and guide barrel bore can form an acute angle therebetween.

The guide barrel distal end is located at a first distance from the top surface of the bone plate when the location post is received in the bone plate recess and the location post is in the extended position. The guide barrel distal end may abut the screw hole when the location post is received in the bone plate recess and the location post is in the retracted position. In another embodiment the location post is in contact with the alignment assembly. It can be fixed by an axis.

The drill guide may further comprise a handle associated with the guide barrel, wherein the handle may be arranged to selectively rotate relative to the guide barrel on the first side. The first face may be substantially perpendicular to the longitudinal axis of the guide barrel aperture. The swivel assembly may also be arranged to have a locked position that does not allow the handle to rotate relative to the guide barrel, and to release the position to allow the handle to rotate freely with respect to the guide barrel. It can be arranged to have. The swivel assembly may comprise at least one nonmetal bearing and may comprise a drainage hole arranged to drain fluid from the assembly following sterilization of the drill guide.

A drill guide assembly is provided that includes a guide barrel having a device receiving portion including a longitudinal axis hole having a hole axis and an assembly portion to align. An array assembly is provided that includes a guide barrel engaging portion, a housing and a position post having a post axis. A bone plate may be further provided comprising at least two bone screw holes and a recessed portion for positioning, wherein the positioning recessed portion may be arranged to receive at least a portion of the location post, the recessed portion for positioning The center of is separated from the center of at least one of the bone screw holes by the first distance. The hole axis may be located at a second distance from the position post axis, the first and second distances being substantially equal such that the hole is substantially the same axis as the at least one securing hole when the position post engages in the bone plate recess. .

The drill guide may further comprise a handle member associated with the near end of the guide barrel, and the handle member may pivot with respect to the guide barrel.

At least one depth arranged in coordination with a corresponding stop surface of the device forming a bone cavity when the device is received in the hole to prevent the device from being completely passed through the guide barrel hole It can have a stationary surface of. The handle may have a locked position in which the handle is rotatably connected to the guide barrel and an unlocked position in which the handle can freely rotate with respect to the guide barrel. The handle may further comprise a locking button having an actuation end and a locking end, the locking end having at least one radial projection, the button being in an inoperative position and It also has an activated position.

The handle may include a hole arranged to slide at least a portion of the button, the hole may further include a radially concave portion arranged to receive the radial protrusion. The handle extension may be provided with a handle engagement end and a guide barrel engagement end, the handle engagement end having at least one radial groove arranged to receive the radial protrusion; Wherein when the handle is in the deactivated position, the radial protrusion engages in the radially concave portion of the handle opening and the handle extension to align the handle in the locked position. In addition, when the handle is in the actuated position, the radial protrusion may engage only one radial recess of the handle hole and the handle extension to align the handle in the unlocked position.

The location post may further comprise a plate engaging end having a plurality of resilient finger elements arranged to axially fix the drill guide to the bone plate when the location post engages in the recess. The location post plate engaging end may have at least one circumferential ridge arranged to engage the underside of the bone plate when the location post engages the recessed portion.

A drill guide assembly is provided that includes a guide barrel having a device receiving portion including a longitudinal axis hole having a hole axis and an assembly portion to align. An array assembly is provided that includes a guide barrel engaging portion, a housing and a position post having a post axis. A bone plate may further be provided having at least two locking device receiving holes and a drill guide positioning recess, the recess being arranged to receive at least a portion of the location post, the center of the recess being the first distance. By separating from at least one center of the bone screw holes. The bone axis may be located at a second distance from the position post axis when measured between the distal end and the position post of the guide barrel, wherein the first and second distances are not substantially equal such that the position post is a bone plate recess The hole is not substantially the same axis as the at least one fixing hole when engaged in.

The difference between the first and second distances can be between about 0 millimeters (mm) and about 0.8 mm. The second distance can also be about 0.5 mm longer than the first distance.

Providing a bone plate having at least a first pair of lock receiving holes and a drill guide arrangement recess; Applying the plate to the bone surface; Providing a drill guide comprising a positioning post having a close arrangement mechanism engaging end and a distal plate engaging end and having an alignment mechanism associated with the guide hole and a guide hole for receiving the device; Inserting the plate engaging end of the location post into a recess in the bone plate; Rotating the position post in a recessed portion of the bone plate to align the guide hole with the first selected pair of lock receiving holes; Inserting and pushing forward the device through the guide hole to contact the bone surface below the selected lock receiving hole; A method of drilling holes in a bone may be provided that includes applying rotational and / or axial forces to the device to drill the bone below the selected locking device receiving hole.

The alignment mechanism may further comprise a spring element for biasing the position post axially away from the alignment mechanism, the guide hole further comprising a distal end adjacent the distal end of the position post, the guide hole distal end Includes a conical nose portion arranged to engage an inner surface of the at least one pair of lock receiving holes, wherein arranging the guide hole with the selected pair of lock receiving holes Engaging said guide hole nose with an inner surface of at least one pair of locking device receiving holes.

The method includes rotating the location post in a hole, slot or indentation in a bone plate to align the guide hole with a second of the lock receiving holes of the pair; below the second lock receiving hole. Inserting and pushing forward the device through the guide hole to contact the bone surface at The method may further include applying rotational and / or axial forces to the device to puncture the bone below the second locking device receiving hole. The device may be an awl, a drill or a tap.

The method releases the position post from the recess in the plate to disassemble the drill guide from the bone plate and under the lock receiving hole through one of the first and second lock receiving holes. Securing the bone with the lock with the lock receiving hole to insert the bone lock into a hole in the bone and secure the plate to the bone.

The drill guide hole and the arrangement mechanism may be offset from each other such that the guide hole when rotating the position post into the bone plate recess to align the guide hole with a pair of first selected lock receiving holes. Is offset from the center of the lock receiving hole.

The method includes inserting and pushing forward the device through the guide hole to contact a bone surface below the selected lock receiving hole; Applying rotational and / or axial forces to the device to puncture the bone below the selected locking device receiving hole comprising creating a hole having an axis that is not collinear with the axis of the locking device receiving hole. It may further include.

desirable Example  details

Referring to FIG. 1, an exemplary drill guide assembly 10 is shown, which is employed for the use of a spinal fixation device such as, for example, spinal fixation plate 70. Exemplary spinal immobilization plates are described in US Application Serial No. 10 / 653,164 entitled "Bone Plate with Captive Clips," which is hereby filed on September 3, 2003 by Duong et al., All of which are incorporated herein. Was incorporated into the reference. However, it will be appreciated that the drill guide assembly may be used in conjunction with the bone plate used in any part of the human body when the drill guide assembly is known in connection with the spinal fixation plate. In some instances, the drill guide may be used without a bone plate. The drill guide assembly 10 generally includes a handle 20, an offset handle extension 30, a guide barrel 40, and a plate arrangement mechanism 50. In general, to operate the drill guide assembly 10, the doctors hold the handle 20 of the drill guide assembly 10 and arrange the plate arrangement mechanism 50 on the bone plate 70 (FIGS. 3A, 3B) so that the position post 52 of the plate arrangement mechanism 50 is Allow to be received in the slot end-hole 72 of the bone plate 70 (FIGS. 2A, 2C). When the position post 52 is received in the end hole 72, the drill guide barrel 40 pivots relative to the position post 52 so that the drill guide barrel 40 moves approximately in the bone plate 70 to the pair of bone screw holes 74R, L. (swivel) A downward force can then be applied to the handle 20 to push the nose portion 42 of the guide barrel 40 to engage the targeted threaded holes 74R, L. The fastening allows for the precise positioning of the guide barrel in the bone screw holes 74R, L so that the holes are mainly adjustable in the position of the screws located therein so that the holes can be drilled in the desired position and in the desired trajectory. .

With the nose portion 42 of the drill guide barrel 40 fixed to the targeted bone screw holes 74R, L, the awl, drill, and tap are inserted individually and successively to produce holes for the reception of the bone screws. Can be. Once the manufacture of the holes is complete, the guide barrel nose portion 42 is removed from the bone screw holes 74R, L, and the guide barrel 40 is a slot end-hole for arranging the barrel with the other "pair" of bone screw holes. Turn within 72 The second hole can then be made in the same form as the first. After the hole is completed, the drill guide can be lifted from the plate and similarly arranged in another pair of bone screw holes. Since the position posts do not remain asserted in the end holes, unwanted movement of the plate is minimized during removal of the drill guide from the plate.

Another embodiment is described in FIGS. 4 & 10 where plate arrangement mechanism 50 can have a location post 152 having a plate retention configuration comprising a plurality of axial slots 1152 that can form a plurality of resilient fingers 154. have. This arrangement allows the plate arrangement mechanism 50 to hold the bone plate axially which allows the surgeon to use the drill guide 10 as a platen holder. When the position post 152 is inserted into the slot end-hole 72 of the plate 70, the fingers 154 are compressed with each other to allow them to exert an elastic expansion force on the inner surface of the end-hole 72 in the bone plate and into the plate 70 Allow the drill guide 10 to be secured to the shaft. Although the inflation force may be sufficient to axially fix the drill guide to the plate, the position post can remain rotatable within the hole 72 such that the guide barrel 40 is a pair of bones as described in the previous embodiment. Rotate to align with screw holes 74R, L.

In order to increase the holding force of the position post 152 in the slot end-hole 72 of the bone plate 70, the resilient fingers 154 comprise one or more circumferential peaks 1154 that can be secured to the inner surface of the slot end-hole 72. can do. This arrangement is particularly effective when the circumferential peaks can secure a portion of the slot end-hole seal, especially when threaded in the slot end-hole 72. In addition, as shown in FIG. End portion 1155 of fingers 154 may include a circumferential peak that can secure the lower face (FIGS. 13 & 18) of bone plate 70 when the post is secured in slot end hole 72. FIG.

This fixation post arrangement of FIGS. 4 & 10 can obviate the need for a separate device to position and hold the bone plate in position within the surgical site. The configurations of the remaining drill guide of this embodiment are as described in the previous embodiment. Thus, once the fixing post 152 is fixed in the slot end hole 72, the guide barrel 40 of this embodiment can be arranged in the targeted screw hole 74R, L, and used as an auger, a tap and a drill in the form of the drill guide of FIG. Can be. However, after use, the drill guide may be detached from the plate by pulling the handle with sufficient force to separate the resilient fingers 154 from the plate slot end-hole 72.

Referring to FIG. 2A an exemplary bone plate 70 is described.

The plate 70 may have a plurality of pairs of bone screw holes 74R, L arranged in the longitudinal direction of the plate, each pair of bone screw holes corresponding to a pair of bone screws used to fix a single spine. Can be. The bone screw holes 74R, L may have at least one upper portion 174R, L (FIG. 2B) that is conical in cross section, the portion being arranged to receive a conical nose portion 42 of the guide barrel 40. Can be. The slot 76 may be provided between successive bone screw hole “pairs” and this slot may take the form of a “dog-bone” (ie it may include a slot with an inflated portion 72 located at each end). have). In the described embodiment the expanded portions are circular holes (FIG. 2C). Each hole 72 may be arranged to receive a position post 52 (FIGS. 3A, 3B) of the drill guide 10 to connect the drill guide and the bone plate. The slot 76 may have a longitudinal axis substantially parallel to the longitudinal axis “A-A” of the plate 70, and in the described embodiment the slot may be centered on the plate axis. The inner surface 172 of each end hole 72 is smooth, threaded, or jagged, and the counterbore 173 is formed to provide a flat surface for embodiments of plate 70 where the plate top surface 78 is curved. Can be provided on top. The end holes 74 have parallel sides or the holes are conical in cross section in whole or in part. The end-holes may be provided in any suitable arrangement or combination of arrangements known in the art.

As can be seen in FIG. 3A, the drill guide 10 can have a handle 20 having a grasping portion 22 and an expansion fixing portion 24. The gripping portion 22 provides an expanded ergonometric shape with a plurality of surface slots 26 that can infer proper placement and maximize the gripping by the user during operation in the described embodiment. The expansion-locking portion 24 may be arranged to receive a close extension 32 of the handle extension element 30, which may itself have a distal extension 34 which secures the drill guide barrel 40. The extension fixing portion 24 of the handle may further comprise a swivel assembly 28 that allows the handle 20 to rotate about the extension 30 and the guide barrel 40 during use. This rotation function allows the user to modify the rotational position of the handle 20 with respect to the guide tube 40 to provide the most convenient access of the device to the surgical site and bone plate 70. Once the plate 70 is positioned on the bone, the drill guide 10 When placed on the plate it causes the handle to rotate away from the working position. The swivel assembly 28 may further provide an optional securing configuration that allows the user to secure the handle in the desired rotational position relative to the handle extension 30 and the guide barrel 40.

5A-6B, the rotator assembly 28 will be described in more detail. Swivel assembly 28 may include a button cam 280 (FIG. 5B), a cam spring 284, a bearing 286, a fastening element 288, and a handle sleeve 290 that include a set of radial detents 282. The radial detent 282 may be arranged to secure the corresponding sets of detent grooves 292, 294 formed in each handle near extension 32 and the handle sleeve 290 (FIG. 5B). The handle sleeve 290 may have inner and outer surfaces 296, 298 having an outer surface 298 arranged to be received within the hole 200 at the expansion fixing portion 24 of the handle 20. The handle sleeve 290 can further include an upper shoulder region 300 arranged to abut the inner axial stop surface 202 of the handle 20. The upper shoulder area 300 may include a series of radially arranged detent grooves 294 arranged to receive the radial detents 282 of the button cam 280. The inner surface 296 of the handle sleeve 290 may be further arranged to receive a close handle extension 32 for its sliding rotational movement. Bearing 286 has a close handle extension 32 and handle sleeve inner surface to reduce the amount of force needed to rotate the handle relative to the handle extension and to facilitate smooth rotational movement between the pieces to reduce the wear of the components. May be provided between 296. The handle extension 32 close to the handle sleeve 290 can be axially fixed to each other via fastening elements 288 located in the relative radial grooves 306, 308 formed at the handle extension 32 close to the sleeve 290, respectively. In the embodiment of Figures 5A & 5B, the bearing 286 can include sleeve elements made from a polymer such as Teflon, polyether-ether-ketone (PEEK), or other suitable bearing material. The fastening element 288 can likewise comprise a C-shaped clip formed of Teflon, PEEK or other suitable material. The use of nonmetallic bearings and fastening elements 296,288, together with the other components of the drill guide 10, can increase the service life of the rotating ring assembly capable of performing hot steam sterilization after use. Exposure of this vapor can lead to corrosion of the assembly components with difficulty in completely drying the swivel assembly components after exposure. Where assembly components are made of different metals and not separated into non-metallic materials, this may cause electrical corrosion of each component, in particular.

Thus, nonmetal bearings and nonmetal retaining clips can be provided. The use of nonmetallic bearings and nonmetallic fastening clip materials can provide the effect of inhibiting electrical corrosion between the metal elements of the swivel assembly 28 when these components are exposed to the high humidity environment of the sterilization process. Such corrosion is undesirable because it can reduce the efficiency of the rotator assembly after only a few uses due to the presence of corrosion particles between the bearing surfaces.

Drain holes 1280, 1032 may be provided in the extension 32 close to the button cam 280, respectively, to facilitate drainage of any condensation remaining after sterilization of the drill guide 10 to minimize the chance of corrosion of the rotating ring assembly pieces. . Hole 1032 may exit handle extension 30 at port 1034 and thus provide a drainage path between the top portion of button cam 280 and handle extension 30. High pressure air may be applied at each end of the drainage path to blow out the remaining fluid.

In yet another embodiment shown in FIGS. 6A & 6B, the bearing can include a series of balls 306 arranged to move in the circumferential grooves 308, 310 corresponding to the handle extension 32 close to the handle sleeve 200, respectively. The handle sleeve 200 with the balls 306 in position in the grooves 308, 310 can further secure the near handle extension 32 axially. To facilitate insertion of the balls 306 into the grooves 308, 310, the handle 20 has a shaft hole 1312 in which the balls can be loaded between the grooves 308, 310 once the close handle extension 32 fits within the handle sleeve 200. Can have A set of screws 312 can be threaded into the holes 1312 to prevent balls 306 from escaping. The balls 306 are made of stainless steel, chrome plated steel, or other metal (coated or uncoated) suitable for use as bearing material. The balls 306 can also be made of a suitable nonmetallic material, such as a polymer (eg ultra-high molecular weight polyethylene). The swivel assembly of this embodiment may further insert a drainage hole arrangement similar to that described in FIGS. 5A and 5B to remove or reduce corrosion of the swivel assembly pieces.

Referring again to FIGS. 5A & 5B, the close extension 32 of the handle 30 can include first and second shaft holes 316, 318 arranged to receive the button cam 280 and the cam spring 284, respectively. When engaged, the cam spring 284 may be located in the second hole 316 and abut the bottom surface 291 of the button cam 280 to bias the button upwards over the top surface 204 of the handle 20. The handle 20 is coaxial with a hole formed by the circumferential inner surface 296 of the handle sleeve 290 so that the upper bias of the cam spring 284 can push the button portion 320 upward through the handle portion to protrude above the top surface 204 of the handle 20. It may have a second hole 206 located therein and arranged to receive the button portion 320 of the button cam 280 through it. The button cam 280 can thus be typically thumb operated by the user and the grip can be held in the drill guide handle 20.

In the non-operated neutral position, the handle 20 is axially and radially oriented to the handle extension 30 through the fixing of the radial detents 282 of the button cam 280 having the detent grooves 292, 294 of the respective close extension 32 and the handle sleeve 290. To lock. The button cam 280 is pressed downwards against the bias of the cam spring 284 to rotate the handle 20 from the handle extension 30 to allow the handle to rotate relative to the rest of the drill guide assembly. The downward axial movement of the button cam 280 within the first hole 316 of the close extension 32 causes the radial detents 282 to move out of the fixation in the detent grooves 294 of the handle sleeve 290 to drop the handle 20 from the handle extension 30. Allow handle member 20 to rotate relative to handle extension 30.

The reduction in pressure on the button cam 280 causes the cam spring 284 to rotate the detent 282 of the button cam 280 to engage the detent grooves 294 of the handle sleeve 290 to reinhibit the rotation of the handle member 20 relative to the handle extension 30. do.

As can be seen in FIG. 3A, the handle 20 can be offset from the drill guide barrel 40 by an offset handle extension 30, thus allowing greater visibility and access to the bone plate 70 and the spine. The distal extension 34 may be mechanically connected to the near portion 44 of the drill guide barrel 40 at the expansion receiving portion 144, for example welding, brazing, threaded connection, frictional joint or pin connection. The expansion receptacle 144 may include a hole into which the cylinder portion of the distal extension 34 may be inserted or the handle extension 30 may be associated with the guide barrel 40 in a suitable form. For example, the distal extension 34 may comprise a hole arranged fixedly in the portion 44 near the guide barrel of the at least one outer surface and may be attached by welding, soldering, threaded connection, or frictional joints.

The handle extension 30 can also be formed completely with the guide barrel 40.

Referring to FIG. 7, an exemplary guide barrel 40 is described. The drill guide barrel 40 may have a near handle fixing end 44 and a far plate fixing end 46. The guide barrel may further comprise a longitudinal axis hole having a hole axis "B-B". Guide barrel holes 48 may be arranged or dimensioned for sliding reception through a number of bone hole making devices such as awls, tabs and / or drills. The guide barrel hole 48 may comprise a near portion 148 having a first diameter "D1" and a far portion 149 having a second diameter "D2" and the first diameter "D1" may be larger than the second diameter "D2". When drill guide 10 is used with auger 90 (FIGS. 14A, B), "D1" can be sized to receive the near center portion of the awl and "D2" can be sized to receive the far barrel portion 94 of the auger. Can be. The guide barrel far end 46 may also have a conical inner surface 1252 arranged to receive the conical nose portion 96 of the auger barrel portion 94.

The close handle fixing end 44 of the barrel 40 can have an end face 150 which can act as a stop surface for the drill bite 80 and it can limit the total depth of the passage of the drill tip 88 to the bone so that the final bone hole is at a predetermined depth. To limit. In the described embodiment, end face 150 may incorporate shoulder 810 into drill bite 80 to perform this depth limiting function (FIG. 11).

Where drill guide 10 is used with tab 100 (FIG. 15), the guide barrel hole 48 may include a stop surface 1250 arranged to secure the corresponding shoulder 106 of tab 100. These corresponding stop surfaces cooperate to limit the distance that the threaded tapping surface 104 can pass into the bone hole.

The drill guide barrel far end 46 may further comprise a conical nose portion 42 arranged and dimensioned to be received within the conical bone screw holes 74R, L of the bone plate 70. In one embodiment the conical nose portion may have a taper angle arranged to substantially match the tapers of the corresponding conical portions 174R, L of the bone screw holes 74R, L. The tapper angle may also be somewhat larger or smaller than that of the bone screw hole conical portions 174R, L. Appropriate tapper angles may be provided as long as the tapper acts so that the guide barrel is centered within the bone screw hole in order to correctly align the barrel in the bone screw hole so that an angled hole is drilled in the bone below. Can be. In one embodiment, the taper angle of the cone nose portion was about 12 degrees.

The end surface 460 of the guide barrel far end 46 may not be perpendicular to the guide barrel hole axis “BB” and the bone plate 70 when the conical nose portion 42 of the guide barrel 40 is received within the bone screw hole 74R, L. It may be substantially parallel to the lower side of. In one embodiment, each gamma formed between the end surface 460 and the guide hole axis “B-B” may be about 85 degrees.

Providing an angled end surface 460 is possible even if the cone nose portion 42 is slightly off the hole and arrangement (ie where the axis “BB” of the drill guide barrel is not coaxial with the trajectory of the bone screw hole). The protruding side 462 of the drill guide conical nose portion 42 "grasps" (and thus arranges) at least one portion of the bone screw hole 74R, L. This happens when the doctor first attempts to arrange the guide barrel 40 into the bone screw hole 74R, L.

The angled end surface 460 can also cause the surgeon to minorly adjust the trajectory of the guide barrel 70 with respect to the bone screw hole 74R, L and the guide barrel 40 within the conical portion 74R, L of the hole raceway. Fix at least the protruding side 462 of the cone nose portion 42 of the still. This configuration allows the surgeon to customize the trajectory of the perforated hole to eventually position the bone screw in the portion of the vertebral body that is thick enough to reliably hold the bone screw. For example, one or more pairs of bone screw holes 74R, L can be located directly adjacent to the spinal end plate when the plate 70 is located in the targeted spine, depending on the anatomy of the particular patient. In such a case, the bone below the bone screw hole 74R, L will provide the safest long-term purchase of bone screws, since once the screws have been seated in the vertebral body there can be less bone thickness between the screw shank and the end plate. Can not.

Thus, doctors can modify the trajectory of the perforated hole to slightly shift the trajectory of the perforated hole (and ultimately its screw) towards the center of the vertebral body, thus providing more bone thickness between the screw body and the end plate. Can be.

Each end surface 460 may slightly modify the guide barrel trajectory so that it is arranged to be constrained within a predetermined range.

Such a restriction may be suitable, for example, where the drill guide is used with a bone screw and plate coupling having a fixed shape, where the trajectory of the screw with respect to the plate may affect the effect of the locking engagement of the screw and plate. . An example of such a locking screw / plate combination is described in US application serial number 10 / 653,164 entitled "Bone plate with Captive Clips", which is pending on September 3, 2003 by Duong et al. Such a system is described in FIG. 19 and includes a bone screw 740, a fixation plate 70 and a locking clip 750. The locking clip 750 is disposed in the groove 752 at the bone screw holes 74R, L of the plate 70. The bone screw head 742 has a circumferential groove 748 arranged to be fixed to at least one portion of the clip 750 when the bone screw 740 is secured to the plate 70. The fastening between the bone screw head 742 and the locking clip 750 thus prevents the screw 740 from being pushed out of the plate holes 74R, L during use.

In such a screw-lock arrangement the fastening interaction between the screw head 742 and the clip 750 may depend on the proper relative orientation of the screw 740 and the clip 750. Thus, in the described embodiment, if the screw 740 is positioned at an angle of about 12 degrees or less with respect to the screw hole trajectory, the screw groove 748 and the locking clip 750 will generally be sufficiently engaged to prevent screw detachment during use. will be.

Where the bone screw 740 is oriented at least about 12 degrees to the bone screw hole trajectory, the grooves 748 and the clip 750 will not be sufficient to allow proper engagement, and thus the locking form of the screw and plate will prevent screw release. May not be sufficient to suppress it.

Thus, it may be desirable to limit the maximum allowable modification to the guide barrel trajectories within the bone screw holes 74R, L to ensure that the bone screw head 742 can still be positively retained by the locking clip 750. Thus, each gamma is only between the conical portions 174R, L of the bone screw and the protruding face 462 of the guide barrel nose 42, unless the conclusive hole trajectory adversely affects the locking interaction between the screw head 742 and the locking clip 50. The physician may be selected to allow a positive "catch".

Thus, each gamma may only be selected to ensure a fixation between the guide barrel cone nose 42 and the screw holes 74R, L only where the guide barrel 40 axis and the screw hole trajectory are misaligned within a predetermined range. Can be. In the described embodiment this range is from about 0 degrees to about 5 degrees (complement of the angle between end surface 460 and axis “B-B”). Each end surface 460 configuration can thus provide immediate feedback to the physician by ensuring a bone screw arrangement within a predetermined range to ensure correct fixation of the screw to the plate. If the protruding surface 462 engages at least part of the bone screw holes 74R, L, the trajectory is within the permitted range. Likewise if the protruding surface 462 is not involved in a portion of the bone screw holes 74R, L then the hole arrangement is outside of that range and therefore needs to be corrected.

Corresponding to this conical nose portion 42, the guide array hole 48 has an inner diameter smaller than the diameter "D2" of the hole distant portion 149 and only slightly larger than the outer diameter of the grooved portion 84 of the drill bite 80 It may include part 1252 (FIG. 11). This reduced diameter portion 1252 of the hole 48 may also serve as a stationary surface of the device to inhibit the device from going deeper into the bone than desired. The reduced diameter portion 1252 may also act as a bearing surface for supporting and guiding the grooved portion 84 of the drill. It can also act to reduce the large amount of drilling debris that comes into the drill guide during use.

In another embodiment shown in FIG. 8, the guide barrel 40 can have a distant nose portion 142 having a non-conical end portion. With this alternative nose design, the guide barrel far end cannot be accommodated within the bone screw hole, so the surgeon cannot use the bone screw hole to operatively arrange the guide barrel into the bone screw hole. However, the surgeon can use one of the hole forming devices to precisely arrange the drill guide barrel with the targeted bone screw in the hole. 14A, B, for example, the auger barrel 94 can be positioned through the guide barrel 40 up to the conical nose portion 96 below the guide barrel far end 46, targeted bone screw holes 74R, L Secure the conical part of 74R, L. The rotational position of the drill guide barrel 40 can be adjusted to nest the tapered nose 96 of the awl within the conical portions 174R, L of the bone screw hole. The awl 98 can be used to form an inlet hole through the cortex of the bone at a desired location. Thereafter, the drill 80 (FIG. 11) and the tab 100 (FIG. 15) can simply be arranged in the inlet hole.

Since the flat-nose end 142 of the guide barrel is not secured to the bone screw holes 74R, L, the position post 52 can be secured to the guide barrel housing 156 rather than slipped and spring biased as in the embodiment described above. have. The post 52 may be secured in the barrel using a suitable connection method (eg welding, brazing, or gluing) or may be formed as an inner part of the housing.

Since the nose portion 142 of the guiding barrel of this embodiment does not have a reduced diameter conical nose portion (and thus the involved reduction in the internal hole diameter in the guide barrel nose), the guide barrel hole is the awl of the previous embodiment, In addition to tabs and drills, it is possible to position bone screws 740 and threaded drivers through them.

Referring again to FIG. 7, the distal end of the guide barrel 40 may further comprise a viewing slot 352 arranged in the barrel wall. This viewing slot can be used by the surgeon to visually confirm the position of the distant tip of the device inserted through the guide barrel (eg tip 88 of drill bite 80). In the described embodiment the viewing slot 352 comprises an elongated channel having an axis parallel to the axis of the guide barrel bore 48. However, the viewing slot may have any suitable shape, shape or orientation known in the art.

The far end of the guide barrel 40 may also include a housing 156 that includes a mechanism 50 that engages the plate. The housing 156 may be a separate piece formed completely with the guide barrel or joined by welding, brazing, attachment, or the like. The housing 156 may include a hole 158 arranged to slide to receive the position post 54 of the mechanism 50 that engages the plate. The hole may have an axis "C-C" which forms an acute beta with respect to the longitudinal axis "B-B" of the guide barrel. When the drill guide is mounted to the bone plate 70, the plate engaging mechanism 50 can be positioned with the axis “C-C” substantially perpendicular to the top surface 78 of the bone plate 70. Thus each beta is an angle at which the awl, tab and drill can be inserted into the bone and so may be the angle at which the bone screw is ultimately mounted to the bone. In order to ensure proper fixation between the bone screw 740 and the screw hole 74R, L, each beta may be selected to correspond to the trajectory of the associated bone screw hole 74R, L in the plate 70 and in an exemplary embodiment 4 degrees.

The housing 156 further includes a slot 160 arranged substantially parallel to the axis “C-C” and configured to receive a pin 162 used to hold the position post 54 within the housing 156. This structure will be described in more detail below.

Referring to FIG. 3B, the plate engaging mechanism 50 will be described in more detail. The plate engaging mechanism 50 is designed to stabilize the drill guide 10 in the bone plate 70 and to provide a pivot point for the guide that the guide barrel 40 can be rotated to move to the targeted pair of bone screw holes 74R, L. Thus, the two bone screw holes are drilled to have only a single position of the drill guide on the bone plate.

The plate engaging mechanism 50 may include a location post 52 arranged in cooperation with the slot-end hole 72 of the bone plate to stabilize the drill guide on the bone plate (FIG. 9). The location post 52 may have a close end 522 (FIG. 7) arranged to slide within the hole 158 of the guide barrel housing 156 and a far end 524 arranged to cooperate with the slot-end hole 72 of the bone plate 70. The spring element 502 may be arranged to secure the position post on its near end surface 526 to axially bias the position post 52 in a distant axial direction (ie, in the direction of the bone plate 70). The position post 54 can be moved axially through the hole 528 in the vicinity of the post 52 and held axially in the housing hole by a pin 504 that can be secured with the slot 162 of the guide barrel housing 156 (FIG. 7). ). Thus, when the plate engaging mechanism is engaged, the spring 502 can cause the position post to move in the axially distant direction until the pin 504 abuts the furthest end of the slot 162 in the housing 156 and as a result the larger of the post 52 Axis movement is hindered.

The far end of the location post 52 may include a nose portion 530 arranged to rest within the slot end-hole 72 of the bone plate 74. In the described embodiment, the nose portion 530 has a rounded surface 532 and a flat end 534. In this embodiment, the rounded face 532 is arranged to abut the inner surface 172 of the slot end-hole 72 so as to seat the post in the hole but not keep the post axially therein (ie lifting the drill Guide up off Lifting the drill guide from the bone plate will prevent the plate from moving above the drill guide).

The arrangement of the nose portion 530 and the slot end-hole 72 causes the position post 52 to "toggle" in the hole so that the surgeon still maintains the engagement between the position post 52 and the plate end-hole 72 while the target This allows the drill guide barrel 40 to be adjusted slightly within the bone screw holes 74R, L. This "toggling" configuration allows the surgeon to customize the trajectory of the hole to be drilled into the bone (ie bone screw). Change it from the trajectory of the hole screw hole 74R, L), and therefore the trajectory of the bone screw to be placed in the hole can be customized. As previously described, this form provides the surgeon with an important degree of flexibility in positioning the screws where the bone screw holes 74R, L are located very close to the end plate of one of the vertebral bodies. In such cases a minor adjustment of the guide barrel track (while still keeping the bone screw holes 74R, L a and nose 42 fixed) allows the doctor to select a hole adjacent to the center of the vertebral body (and thus a screw). can do.

This "toggling" form gives the doctor great flexibility in drilling holes in inaccessible vertebrae such as cervical spines C1 to C3 and C7. The forward access of these vertebrae may be partially obstructed by the jaw (C1-C3) or sternum (C7), allowing the surgeon to adjust the guide barrel trajectory to counteract the obstruction, while positioning with the plate slot end hole 72. Enables the selection to maintain contact between posts 54.

The nose portion can be used with slot end-holes having various internal surface arrangements (e.g., smooth, threaded, ribs, cones, etc.). This arrangement minimizes the chance that the bone plate on the bone will be affected when dismantling the drill guide from the plate (eg when the drill guide is repositioned in the bone plate to access the second pair of bone screw holes). ).

The spring-biased form of the location post 52 can take the drill guide barrel 40 in a neutral position relative to the bone plate 70 when the location post is received in the slot end-hole 72. In this neutral position, the nose portion of the guide barrel can be axially offset from the top surface of the bone plate 70 and under such conditions the barrel 40 is arranged in the right or left bone screw hole of the targeted bone screw hole pair 74R, L. It can be pivoted freely relative to the location post in order to be movable. The final arrangement / fixation of the guide barrel 40 with the bone screw holes 74R, L is then pressed downward against the drill guide hand 20 and compresses the position post spring 502 and the conical nose portion 42 of the guide barrel 40 is targeted bone screw hole 74 Is achieved by being accommodated within. The bone hole making devices can then be inserted through the guide barrel 40. Once bone hole preparation is completed for the first pair of bone screw holes 74R, L, the handle can be raised slightly with the aid of spring 502 to move up and away from plate 70. The guide barrel 40 can then pivot relative to the position post in order to move the barrel in the second pair of bone screw holes 74R, L.

The spring 502 may also not interfere with the contact between the cone nose portion 42 of the drill guide barrel 40 and the bone screw holes 74R, L despite the two relative trajectories. Thus, when the conical nose 42 holds the bone screw holes 74R, L while the guide barrel track is coaxial with the track of the bone screw hole, the spring 502 moves the position post 52 from the end of the housing 156 by a constant distance "D1". Will compress by the first volume expanding. By comparison the spring 502 retracts the position of the position post 52 into the housing 156 when the conical nose 42 holds the bone screw holes 74R, L while the guide barrel track is inclined out of alignment with the track of the bone screw holes. The guide barrel nose 42 can then be compressed by a second amount while keeping it fixed with the bone screw holes 74R, L. In this oblique arrangement the position post 52 can extend beyond the end of the housing 156 by a constant distance "D2" which is smaller than "D1".

The spring-biased position posts 52 can thus serve the additional purpose of ensuring the continuous fixing of the guide barrel 40 and the bone screw holes 74R, L, whereby the resulting holes in the bone support the bone screws in the desired trajectory with respect to the plate. I can guarantee to do it. As described previously, this may in particular be counterproductive by an angular offset between the screw and the hole, such as when the bone screw 740 is held axially by the plate 70 and its retaining form is used with the locking clip 750 described previously. This may be particularly important in the case.

An alternative location post design is described in FIG. 10, wherein the distant portion 524 includes a plate retaining form and is described as a plurality of resilient fingers 154 arranged to secure the slot-end hole 72 of the bone plate 70.

This arrangement may allow the plate arrangement mechanism 50 to hold the bone plate axially which may allow the surgeon to use the drill guide 10 as the plate holder.

When the position post 152 is inserted into the slot end-hole of plate 70, the fingers 154 are forced together, causing them to exert an elastic expansion force against the inner surface 172 of the slot end-hole 72 to guide the drill into the plate 70. Let 10 be fixed. Although the expansion force may be sufficient to axially fix the drill guide to the plate, the position post can rotate within the hole 72, so that the guide barrel 40 has a pair of bone screw holes 74R, L as described in the previous embodiment. To allow them to rotate.

In order to increase the holding force of the position post 152 in the slot end-hole 72 of the bone plate 70, the resilient finger 154 may include one or more circumferential ridges 1154 that may secure the inner surface of the slot end-hole 72. have. This arrangement is particularly effective where the slot end-hole 72 is a screw because the circumferential peak can hold a portion of the slot end-hole thread. As also shown in FIG. 18, the furthest circumferential peaks of each resilient finger 154 are arranged to secure the lower surface 79 of the plate 70 to provide an additional axial retention form between the plates in the drill guide 10.

As shown in FIG. 11, the drill bite 80 may include a near coupling end 802 and a far drilling end 804. The close coupling end 802 may be arranged to couple with a suitable source of rotational motion, such as hand or power, and contemplate a suitable arrangement known in the art. The distant drilling end 804 can likewise comprise a drilling flute 84 arranged to be drilled into the bone. The drill body 806 intermediate between the near and far end 802,804 is at least one arranged to cooperate with the inner shoulder 150 of the drill guide barrel bore 48 to adjust the maximum distance that the drill can advance below the nose portion 42 of the guide barrel 40. May include shoulder area 810. This maximum distance can correspond to the maximum desired drilling depth and can be appropriately adjusted by positioning the cooperating shoulder areas 810, 150 of the drill 80 and the guide barrel 40.

In another embodiment, the drill guide barrel 40 and the plate attachment mechanism 50 may be arranged such that a hole drilled in the bone may be slightly longitudinally offset from the center of the bone screw hole 74R, L located at one end of the bone plate 70. . Drilling a hole in the bone offset from the bone screw hole 74R, L of the bone plate 70 caught on one side 744 (FIG. 13) of the bone screw hole 74R, L when the screw was first inserted into the hole of the bone (FIG. 16). Head 742 of bone screw 740 (FIG. 12) may result. Thus, as the bone screw 740 enters the vertebrae, the lower surface 746 angled to the bone screw head 742 may contact the face 744 of the screw hole, and as the bone screw 740 further enters the spine, the screw head may be screwed into the bone screw. The plate 70 can be moved longitudinally with respect to the screw 740 until it is centered in the holes 74R, L. This arrangement can be used to move adjacent neighboring vertebrae to each other by simply tightening the bone screws drilled into the offset holes (i.e. achieving the compression of the intermediate disk space). The pair can be inserted through the first pair of bone screw holes 74R, L, and completely engage the underlying spine to secure the plate 70 to the first spine. The drill guide of this embodiment can then be used to make two bone screw holes that are longitudinally offset from the center of the adjacent pair of bone screw holes in plate 70. A second set of bone screws can then enter into the offset hole to perform the aforementioned longitudinal movement between the plate and the screws. In order to perform the desired offset, the distance between the guide barrel 40 and the guide barrel house 156 can be changed as appropriate.

As can be seen in FIG. 17, the exemplary offset bone insertion point is denoted by "X" and the center point of the bone screw hole 74R, L is denoted by "Y". The distance from the bone plate slot end-hole 72 to the center of the bone screw hole 74R, L is indicated by "L1" and the distance from the bone plate slot end-hole 72 to the offset bone insertion point "X" is indicated by "L2". The axis "D-D" formed by the points "X" and "Y" may be located substantially parallel to the longitudinal axis "A-A" of the bone plate 70. When pressed into the bone, the bone screw 740 (FIG. 12) inserted into the hole formed at the point "X" is the point "Y" due to the aforementioned interaction of the face 744 of the lock hole 74R, L and the bone screw head 742. "Will move in the direction. This movement of the bone screw 740 along the axis "DD" will cause the attached bone segment 2002 to move along the axis "DD" in the direction of the adjacent bone segment 2004, thus moving the two bone segments along the axis "DD". Will draw closer.

In the embodiment described in FIG. 16, the bone plate may be attached to adjacent vertebrae 2002, 2004 of the vertebra such that its plate axis “A-A” is substantially aligned with the longitudinal axis of the vertebrae. Thus, compression of disk space 2006 between adjacent vertebrae 2002 and 2004 can be substantially performed along the spinal axis. Compression of the disc space in a direction substantially along the longitudinal axis of the vertebra can be important for several reasons, including keeping the patient's postoperative conditions normal. In addition, where an intervertebral disc spacer (eg fusion spacer) is mounted between the spinal end plates, compression along the spinal axis contributes to providing proper initial seating and loading of the spacer between the end plates.

To carry out this press vector, the guide barrel 40 and the position post 52 are positioned with the center of the guide barrel 40 far end 44 to be arranged at an offset bone insertion point "X" when the drill guide barrel rotates with respect to the guide post 52. The center of the post 52 can be separated by a distance equal to the length "L2".

In one embodiment, the guide barrel 40 and barrel housing 156 may be arranged such that the distance between points “X” and “Y” along the axis “DD” is a longitudinal compression of adjacent bone segments of about 0.5 mm. have. In one embodiment, the drill guide barrel and the housing may have a distance between the points "X" and "Y" from about 0 mm to about 0.8 mm, so that the locks are about when they are pressed in the proper bone screw holes. Enables longitudinal compression of bone segments from 0 mm to about 0.8 mm.

If the bone plate, drill bite, and drill guide assembly are described for use in securing adjacent vertebrae of the vertebrae, the drill guide assembly may be a suitable bone plate or other structure capable of securing the bone firmly using a bone lock. Can be used. The drill guide can also be used without a bone plate to guide the drilling of the lock holes in a suitable position in the human body.

The method of perforating a hole in the spine with the system described above will now be described. The surgeon can insert bone plate 70 through the incision of the patient's skin and move the plate to a desired location on the patient's vertebrae. In an exemplary embodiment, the plate may have at least two pairs of bone screw holes 74R, L arranged to secure two adjacent vertebrae at the cervical spine of the vertebrae. After the plate is properly positioned in the vertebra, the drill guide 70 may be inserted through an incision and the location post 52 may be seated in a slot-end hole 72 associated with one of the two pairs of bone screw holes of the bone plate. . The drill guide 10 can then be pivoted relative to the position post 52 to arrange the guide barrel in the first bone screw hole of the targeted pair of bone screw holes 74. Once the guide barrel 40 is substantially arranged in the bone screw hole 74, downward pressure can be applied to the handle 20 to move the guide barrel nose 42 to secure it with the bone screw hole, thus precisely arranging the guide barrel in the bone screw hole 74. Can be. The surgeon can then continuously insert augers, tabs and / or drills and their combinations through the guide barrel to make holes in the bone for receiving bone screws. Making a hole in the bone using the drill guide 10 ensures that the hole is perforated in the spine at a suitable angle coaxial with the fixed hole.

After the first bone hole has been made, the drill guide can be rotated in a slot in the bone plate until the drill guide barrel is positioned over the second pair of bone screw holes. Thereafter, the process of applying pressure and inserting a drill bite to fix the fixing hole is repeated. The holes coaxial with the other pair of fastening holes in the plate 70 will then be drilled by lifting the drill guide from the plate and seating the location post 52 in the slot-end hole 72 adjacent to the next pair of targeted bone screw holes. .

In an embodiment of the drill guide 10 in which the position post 152 has an axial retaining form (eg, elastic fingers) for retaining the drill guide on the plate, the drill guide inserts the plate through the incision of the patient, It can be used to arrange the plate in the desired position. In addition, once a pair of bone screw holes are accessed and suitable holes are drilled, a separating force must be applied between the drill guide and the plate of this embodiment to overcome the holding force of the position post.

In addition, when using an embodiment of a drill guide having a guide barrel without a conical nose portion, the step of compressing the guide barrel into the bone screw hole is omitted and a suitable arrangement of the drill guide barrel and the targeted screw hole is arranged above the screw hole. This can be done by simply pivoting the guide barrel. The user can also use an awl 90 (FIG. 15A, B) to arrange the guide barrel 40 in the bone screw holes 74R, L. FIG. The awl 90 (FIG. 15A, B) shows the guide barrel 40 to allow the tapered nose portion 96 of the awl to extend below the far end 44 of the guide barrel and secure the tapered portion 174R, L of the targeted bone screw hole 74R, L. Can be inserted through. Once the auger tip 98 is used to break the cortex below the bone to form the initial inlet hole, the drill 80 can then be arranged in the initial inlet hole to maintain the proper drilling position. An exemplary awl is described by Christopher J., Rihanna on August 19, 2003, co-pending under the name US Patent Application No. 10 / 642,608, "Spring Loaded Awl," the entire disclosure of which is here. Inserted as a reference.

While the present invention has been shown and described herein with respect to particular embodiments, various forms, structures, arrangements, proportions, materials, etc. may be used in the embodiments described when used according to actual and specific circumstances and operational needs without departing from the spirit and scope of the invention. It is to be understood that additions, substitutions, or transformations of elements, elements, and the like are made. For example, various means can be used to attach a plate holder to the bone plate or drill guide assembly. The plates can also be of various thicknesses, shapes and contours and have various fixed hole shapes. It is therefore to be understood that the embodiments described herein are merely illustrative of the principles of the invention. Various other modifications may be made by those skilled in the art that will embody the principles of the invention within the spirit and scope of the invention.

Preferred configurations of the present invention are described in the accompanying drawings. Like reference characters represent like elements throughout the several views in which FIG. 1 is a perspective view of a free hand drill guide assembly, an exemplary bone plate and an exemplary drill bite of the first embodiment; 2A, 2B and 2C are respective top, side and end cross sections of the bone plate of FIG. 1; 3A and 3B are respective side and cross-sectional views of the drill guide of FIG. 1, respectively, and FIG. 3C is a cross-sectional view of the drill guide of FIG. 1 secured to the plate of FIG. 2A; 4 is a cross-sectional detail view of the embodiment of the drill guide of FIG. 1 incorporating an alternative plate-bearing configuration; 5A and 5B are cross-sectional detail and exploded views of each of the swivel handle mechanisms of the drill guide of FIG. 1; 6A and 6B are cross-sectional detail and exploded views, respectively, of the swivel handle mechanism of another embodiment of FIGS. 5A and 5B.

7 is a cross-sectional view of the guide barrel portion of the drill guide of FIG. 1; FIG. 8 is a side view of another embodiment of the guide barrel portion of FIG. 7; FIG. 9 is a side view of the position post of the drill guide of FIG. 1; FIG. 10 is a side view of another embodiment of the position post of FIG. 4; 11 is a side view of an exemplary drill bite for use as the drill guide of FIG. 1; 12 is a side view of an exemplary bone screw for use of the bone fixation plate of FIG. 2A; FIG. 13 is a side cross-sectional view of the bone fixation plate of FIG. 2A; 14A and 14B show side and cross-sectional details of each awl for use of the drill guide of FIG. 1; FIG. 15 shows a side view of a tap for use of the drill guide of FIG. 1; FIG. 16 shows two pairs of bone screws. A perspective view of a bone plate secured to an adjacent vertebrae in use, wherein the bone screws are located in perforated holes away from the center of the lock holes of the plate; FIG. 17 is a plan view of the FIG. 2A bone plate showing offset bone screw holes; FIG. 18 is a cross sectional view of the position post of FIG. 10 secured to the plate of FIG. 2A; FIG. Cutaway view of typical bone screw.

The surgical drill guide assembly of the present invention provides soft tissue protection and an accurate arrangement of at least one drill tube with bone screw holes in a bone plate, for example a spinal bone plate.

Claims (55)

A guide barrel for receiving a bone tool forming a hole in the bone; and An arrangement assembly associated with a guide barrel comprising a location post arranged to be at least partially received in a recess in the bone plate that arranges the bone device in a selected first or second locking device aperture of the bone plate, wherein the above And the position post can be pivoted against the bone plate recess to allow the guide barrel to be selectively arranged in the first or second holes. The drill guide of claim 1, wherein the location post is arranged to axially secure the drill guide to the bone plate. 3. The drill of claim 2, wherein the location post further comprises a plurality of resilient finger elements arranged to frictionally engage a bone plate recess to axially secure the drill guide to the bone plate. guide. 4. The drill guide of claim 3 wherein the resilient finger elements further comprise at least one ridge arranged for engaging threads in the bone plate recess. 2. The drill guide of claim 1 wherein the array assembly further comprises a housing having a first axial bore arranged to slide at least a portion of the location post. 6. The location post and housing may each further comprise a distal end, the location post having a location post distal end located at a first distance from the distal end of the housing. retracted position and the position post distal end may have an extended position located at a second distance from the distal end of the housing, the second length being greater than the first length. 7. The drill guide of claim 6 wherein the array assembly further comprises a spring element disposed at least partially in a second axial hole in the housing to bias the position post in its extended position. 8. The guide barrel of claim 7, wherein the guide barrel may further comprise a bore having a bore axis and an end plate engaging end, wherein the end plate engaging end is first or so as to align the hole with the bone screw hole. And a nose portion arranged to be received in the second locking hole. The drill guide of claim 8 wherein the nose portion comprises a conical shape. 9. A drill guide as set forth in claim 8 wherein said housing first axial bore and guide barrel bore can form an acute angle therebetween. 8. The guide barrel distal end of claim 7, wherein the position post is received in the bone plate recess and the position post is in the extended position, the guide barrel distal end is located at a first distance from the top position of the bone plate. Drill guide characterized in that. 8. The drill guide of claim 7, wherein the guide barrel distal end abuts the selected bone screw hole when the location post is received within the bone plate recess and the location post is in the retracted position.  The method of claim 1, wherein the guide barrel may further comprise a handle associated with the guide barrel, wherein the handle is arranged to selectively rotate relative to the guide barrel on a first plane. Drill guide. 14. The drill guide of claim 13, wherein the first face is substantially perpendicular to the longitudinal axis of the guide barrel hole. 14. The handle swivel assembly of claim 13 having a locked position that prevents the handle from rotating relative to the guide barrel and an unlocked position that allows the handle to rotate freely relative to the guide barrel. Drill guide comprising a.  16. The drill guide of claim 15 wherein the swivel assembly comprises at least one nonmetal bearing. 16. The drill guide of claim 15 wherein the swivel assembly comprises a drainage hole arranged to drain fluid from the assembly following sterilization of the drill guide. The drill guide of claim 1 wherein the position post is axially fixed to the array assembly. handle, A guide barrel having a near end associated with the handle and A distal end arranged to engage an inner surface of a fastener hole of the bone plate, The guide barrel further comprises a bore arranged to receive a bone hole forming apparatus; The arrangement assembly may be associated with the guide barrel for arranging the bone device in a selected first or second lock hole, the arrangement assembly arranged to be at least partially received in a recess in the bone plate. Characterized by including a location post, Wherein the position post allows the guide barrel to be selectively arranged with first and second lock holes so that the device can be extended through the guide barrel to form a hole in the bone below the selected lock hole. Surgical drill guide, characterized in that to be able to pivot (pivot) in the recess. 20. The drill guide of claim 19 wherein said location post is arranged to axially secure said drill guide to said bone plate. 21. The drill as recited in claim 20, wherein said position post further comprises a plurality of resilient finger elements arranged frictionally engaging said bone plate recess for axially securing said drill guide to said bone plate. guide. 22. The drill guide of claim 21 wherein the resilient finger elements have at least one ridge arranged to engage threads in the bone plate recess. 20. The drill guide of claim 19 wherein the array assembly further comprises a housing having a first axial bore arranged to slide at least a portion of the location post. The position post of claim 23, wherein the position post has an in position where the first length of the position post is received in the hole, and wherein the second length of the position post has an extended position received in the hole, wherein the first A drill guide, wherein the length is greater than the second length. 25. The drill guide of claim 24 wherein the arrangement assembly further comprises a spring element disposed at least partially in a second axial hole in the housing to bias the position post in its extended position. 26. The device of claim 25, wherein the guide barrel may further comprise a bore having a bore axis and an end plate engaging end, wherein the end plate engaging end is first or so as to arrange the hole in the bone screw hole. And a nose portion arranged to be received in a second locking hole. 27. The drill guide of claim 26 wherein the nose portion comprises a conical shape. 27. A drill guide as set forth in claim 26 wherein said housing first axial hole and guide barrel hole form an acute angle therebetween. 26. The guide barrel distal end of claim 25, wherein the location post is received in the bone plate recess and the location post is in the extended position, the guide barrel distal end at a first distance from the top surface of the bone plate. Drill guide, characterized in that located. 26. The drill guide of claim 25 wherein the guide barrel distal end abuts the screw hole when the location post is received within the bone plate recess and the location post is in the retracted position. 20. The drill guide of claim 19, wherein the drill guide may further comprise a handle associated with the guide barrel, the handle being arranged to selectively rotate relative to the guide barrel on a first side. 32. The drill guide of claim 31 wherein the first face is substantially perpendicular to the longitudinal axis of the guide barrel aperture. 32. The swivel assembly of claim 31, further comprising a swivel assembly having a locked position that prevents the handle from rotating relative to the guide barrel and an unlocked position that allows the handle to rotate freely relative to the guide barrel. Drill guide. 34. The drill guide of claim 33 wherein the swivel assembly comprises at least one nonmetal bearing. 34. The drill guide of claim 33 wherein the swivel assembly includes a drain hole arranged to drain fluid from the assembly following sterilization of the drill guide. 20. A drill guide as set forth in claim 19 wherein said position post is axially fixed to the array assembly. A guide barrel having a device receiving portion comprising a longitudinal axis hole having a bore axis and an arranging assembly portion; An array assembly comprising a guide barrel engaging portion, a position post having a housing and a post axis, A bone plate comprising at least two bone screw holes and a recessed portion for positioning The positioning recessed portion may be arranged to receive at least a portion of the location post, The center of the locating concave portion comprises being separated from the center of at least one of the bone screw holes by a first distance, Wherein the hole axis may be located at a second distance from the position post axis, the first and second distances being substantially equal such that the hole is substantially at least one fixing hole when the position post engages in the bone plate recess. Drill guide assembly, characterized in that the same axis. 38. The drill guide assembly of claim 37, wherein the drill guide assembly further comprises a handle member associated with the near end of the guide barrel. The surgical drill guide assembly of claim 38 wherein the handle member is pivotable relative to the guide barrel. 38. The device of claim 37, wherein the guide barrel corresponds to a device in which the guide barrel forms a bone cavity when the device is received in the hole to prevent the device from being completely passed through the guide barrel hole. And a stop surface of at least one depth arranged to cooperate with the stop surface. 40. The surgical drill guide assembly of claim 39, wherein the handle further has a locking position in which the handle is rotatably connected to the guide barrel and an unlocking position in which the handle can freely rotate relative to the guide barrel. 42. The locking button of claim 41, further comprising: a locking button and an locking end having an actuation end, the locking end having at least one radial projection, the button being in an inoperative position and in an actuated position. Further has; The handle includes a hole arranged to slidably receive at least a portion of the button, the hole further comprising a radially concave portion arranged to receive the radial protrusion; The handle extension having a handle engaging end and a guide barrel engaging end, the handle engaging end having at least one radial groove arranged to receive the radial protrusion; Wherein when the handle is in the inoperative position, the radial protrusion engages in the radially concave portion of the handle hole and the handle extension to align the handle in the locked position. 43. The device of claim 42, wherein when the handle is in the actuated position, the radial protrusion engages only one radial recess of the handle hole and the handle extension to align the handle in the unlocked position. Drill guide assembly. 43. The device of claim 42, wherein the location post further comprises a plate engaging end having a plurality of resilient finger elements arranged to axially fix the drill guide to the bone plate when the location post engages in the recess. Drill guide assembly, characterized in that. 45. The method of claim 44, wherein the location post plate engaging end has at least one circumferential ridge arranged to engage the underside of the bone plate when the location post engages in the recessed portion. Drill guide assembly. A guide barrel having a device receiving portion including a longitudinal axis hole having a hole axis and an arranging assembly portion; An array assembly comprising a guide barrel engaging portion, a position post having a housing and a post axis, A bone plate having at least two locking device receiving holes and a recess for positioning the drill guide,  The recessed portion is arranged to receive at least a portion of the position post, the center of the recessed portion being separated from the center of at least one of the bone screw holes by a first distance, Wherein the hole axis may be located at a second distance from the position post axis when measured between the distal end and the position post of the guide barrel, wherein the first and second distances are not substantially equal such that the position post is bone plate concave. And wherein the hole is not substantially coaxial with the at least one securing hole when engaging the portion. 47. The drill guide assembly of claim 46, wherein the difference between the first and second distances is between about 0 millimeters (mm) and about 0.8 mm. 47. The drill guide assembly of claim 46 wherein the second distance is about 0.5 mm longer than the first distance. Providing a bone plate having at least a first pair of lock receiving holes and a drill guide arrangement recess; Applying the plate to the bone surface; Providing a drill guide comprising a positioning post having a close arrangement mechanism engaging end and a distal plate engaging end and having an alignment mechanism associated with the guide hole and a guide hole for receiving the device; Inserting the plate engaging end of the location post into a recess in the bone plate; Rotating the position post in a recessed portion of the bone plate to align the guide hole with the first selected pair of lock receiving holes; Inserting and pushing forward the device through the guide hole to contact the bone surface below the selected lock receiving hole; And applying rotational and / or axial forces to the device to puncture the bone below the selected locking device receiving aperture. The apparatus of claim 49, wherein the alignment mechanism may further comprise a spring element for biasing the position post axially away from the alignment mechanism, the guide hole further comprising a distal end adjacent the distal end of the position post. The guide hole distal end further comprising a conical nose portion arranged to engage an inner surface of the at least one pair of locking device receiving holes, And arranging the guide hole with the selected pair of lock receiving holes further comprises engaging the guide hole nose with an inner surface of at least one pair of lock receiving holes. 50. The method of claim 49, further comprising rotating the location post in a hole, slot, or indentation in a bone plate to align the guide hole in the second pair of lock receiving holes; Inserting and pushing forward the device through the guide hole to contact the bone surface below the second lock receiving hole; And applying rotational and / or axial forces to the device to puncture the bone below the second locking device receiving hole. 53. The method of claim 51, wherein the device is an awl, a drill, or a tap. 52. The method of claim 51, wherein the method releases the position post from the recess in the plate to disassemble the drill guide from the bone plate, and through the one of the first and second lock receiving holes. Inserting a bone lock into a hole in the bone below the lock receiving hole, and securing the bone with the lock having the lock receiving hole to secure the plate to the bone. How to. 50. The method of claim 49, wherein the drill guide hole and the alignment mechanism can be offset from each other such that the location post is inserted into the bone plate recess to align the guide hole with a pair of lock receiving holes of the first selected. And the guide hole is offset from the center of the lock receiving hole when rotating. 55. The method of claim 54, wherein the method includes inserting and pushing forward the device through the guide hole to contact a bone surface below the selected lock receiving hole; Further applying steps of rotational and / or axial force to the device to puncture the bone below the selected locking device receiving hole comprising creating a hole having an axis that is not collinear with the axis of the locking device receiving hole. Method comprising a.

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