WO1999025262A1 - Instrument chirurgical pour manipulations osseuses - Google Patents

Instrument chirurgical pour manipulations osseuses Download PDF

Info

Publication number
WO1999025262A1
WO1999025262A1 PCT/US1998/024308 US9824308W WO9925262A1 WO 1999025262 A1 WO1999025262 A1 WO 1999025262A1 US 9824308 W US9824308 W US 9824308W WO 9925262 A1 WO9925262 A1 WO 9925262A1
Authority
WO
WIPO (PCT)
Prior art keywords
manipulation tool
tool according
handle
joint
locking device
Prior art date
Application number
PCT/US1998/024308
Other languages
English (en)
Inventor
Peter M. Simonson
Original Assignee
Simonson Peter M
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Simonson Peter M filed Critical Simonson Peter M
Priority to AU15866/99A priority Critical patent/AU1586699A/en
Publication of WO1999025262A1 publication Critical patent/WO1999025262A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A61B17/7077—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for moving bone anchors attached to vertebrae, thereby displacing the vertebrae
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws

Definitions

  • This invention relates to medical devices used in surgical procedures. More specifically, the invention relates to medical devices used in bone surgeries, especially as applied to techniques for reduction of Spondylolisthesis, manipulations of spinal vertebral bodies, or manipulations of bone.
  • Spondylolisthesis results from subluxation or slippage of a vertebral body anterior, or forward, to its normal anatomical position.
  • the fifth lumbar (L5) vertebral body, or vertebra can slide forward in relation to the first sacral (SI) vertebra, commonly termed an L5-S1 slippage, causing nerve impingement and instability.
  • SI first sacral
  • Spondylolisthesis is quantified by four levels of severity: grade 1, 25% forward slippage; grade 2, 50% forward slippage; grade 3, 75% forward slippage; and grade 4, 100 % forward slippage of the vertebral body.
  • spinal fixation devices and techniques have been used. Typically, these involve implantation of an implant, e.g., a screw or pin, into the vertebral bodies in order to fuse them in alignment. These implants can also serve as an anchor for an instrument used to place a force in the posterior direction in order to correct the anterior slippage of the vertebra.
  • an implant e.g., a screw or pin
  • the subject invention advantageously permits correction of the position of the bone by engaging only a single other contact spot on the body.
  • the subject invention does not require engaging body contact points superior and inferior to the bone being manipulated as in previously used devices, such as the threaded device described above.
  • a subluxated vertebral body for example, a fifth lumbar (L5) vertebra subluxated in relation to a first sacral (SI) vertebra, i.e. , an L5-S1 subluxation.
  • each of the handles can be arced, or substantially curvilinear in its longitudinal axis to provide a fulcrum point wherein the handles are adjoined , and the upper ends of the handles extend outwardly away from the fulcrum point and the other handle.
  • This configuration of the handles provides for inverse movement of one end relative to the other, i.e., moving the handles at the upper portion toward each other causes the lower portions to move away from each other.
  • the handles can have a spring means to bias the upper portions apart and the lower portions together.
  • the device can include a mechanism to lock the handles in a particular position.
  • the distal ends of the lower portion are provided with universally rotatable joints or mounts which can engage, at a wide variety of angles , an implant placed in the bone.
  • This allows the device to engage an implant positioned at an angle different from the angle of force, while applying the force as needed in an appropriate direction to manipulate the bone to its desired position.
  • the subject device in conjunction with implants, preferably an adjustable implant, in a cantilever fashion.
  • implants preferably an adjustable implant
  • the device would engage an implant on L5 and an implant on L4, and the device acts as a fulcrum pulling backwards the L5 vertebral body.
  • a force would be pushed anteriorly on L-4 and then by lever action, a posterior force is placed on L-5, pulling back the slipped vertebral body toward its normal anatomical position.
  • the anterior and posterior forces equal each other out, so that a net force is not placed on other parts of the body, thereby decreasing the risk of injury.
  • a further advantage is that the subject device can be handled easily by the surgeon such that appropriate and adequate force can be applied to position the bone, while providing tactile feedback to the surgeon so that such force or movement is not so excessive to cause other injury. This is especially useful in surgeries of the vertebrae where overmanipulation of the bone can cause injury to the spine.
  • FIG. 1 shows a plan view of one face of an embodiment of the subject invention.
  • FIG. 2 is a plan view of the subject invention showing a face opposite that to shown in Figure 1.
  • FIG. 3 shows an embodiment of the subject device having an extendible shaft operative end.
  • FIG. 4 shows a plan view of one face of a second embodiment of the subject invention .
  • FIG. 5 shows a plan view of one face of a third embodiment of the subject invention.
  • FIG. 6 shows a partial view of an attachment device.
  • FIG. 7 shows a partial view, partially in section, of an integrated attachment device.
  • the manipulation tool 1 comprises two substantially elongate handles 2 joined at a pivot joint 3.
  • the elongate handles extend upward from the pivot joint 3 to form upper portions 4a and 4b and extend downward to form lower portions 5a and 5b.
  • the upper portions 4a and 4b are preferably shaped to conform to the hand to facilitate manipulation of the device, although this limitation is not necessarily.
  • the upper portions 4a and 4b are preferably splayed at a greater distance than the lower portions 5a and 5b.
  • the handles 2a and 2b can be substantially mirror images of one another but are not identical.
  • the pivot joint 3 can be located anywhere along the length of the handles 2a and 2b.
  • Varying the position of the pivot joint along the handles 2a and 2b varies the relationship of the force exerted on the upper portions 4a and 4b versus the force exerted by the lower portions 5a and 5b. As the pivot joint moves upward the ratio of the force exerted on the upper portions 4a and 4b to that of the force exerted by the lower portions 5a and 5b decreases.
  • a substantially semi-circular protrusion 6 is preferably located along the length of one handle, shown as 2b in FIGS. 1 and 2, and which interengages with a substantially semi-circular protrusion (not shown) formed on the opposite handle, shown in FIGS. 1 and 2 as 2a.
  • the protrusion 6 has a slot formed therein, parallel to the longitudinal axis of the handle, for mating with the protrusion of the other handle.
  • the protrusions are preferably adjoined by a fastener, e.g., a screw 7, which holds together the handles 2a and 2b.
  • the handles 2a and 2b of the tool are preferably acted upon such that the upper portions 4a and 4b are biased away from each other.
  • This biasing can be achieved by a handle spring 8 which can be affixed to the upper portions 4a and 4b of the manipulation tool 1.
  • Many other spring or biasing mechanisms can be used to maintain the separation of the upper portions 4a and 4b, and this invention is not limited as to a particular type.
  • the invention is not limited as to the location of the biasing.
  • the biasing of the upper portions 4a and 4b away from each other could be accomplished with a spring (not shown) pushing against the lower portions 5a and 5b.
  • the invention is not limited to biasing of the upper portions 4a and 4b away from each other, but instead, the biasing of the upper portions 4a and 4b can be toward each other.
  • a locking device 9 is preferably provided for maintaining a particular position of the handles 2a and 2b relative to one another. Locking devices 9 for maintaining a particular position are commonly used in the tool field, and all are acceptable with this device.
  • One such locking device 9 is a bolt and thread assembly (not shown) that extends between the handles
  • the presently preferred locking device 9 is shown in FIGS. 1 and 2 and is a ratchet type latching mechanism 9 wherein the ratchet is provided with teeth 22 which engage the upper portion 4b at its tip 24.
  • the ratchet latching mechanism 9 can also be provided with a ratchet spring 10 to bias the ratchet device 9 against the tip 24 of the upper portion 4b.
  • the locking device 9 shown in FIGS. 1 and 2 prevents motion of the upper portion 4a in the direction away from the other upper portion 4b.
  • the locking device 9 can limit the motion of the upper portion 4a relative to the other upper portion 4b in either direction or both directions simultaneously .
  • the locking device 9 can also be provided with an adjustment device to change the orientation of the handles 2a and 2b relative to one another. Adjustment devices are common in the tool field and typically work in conjunction with a particular type of locking device 9. However, this invention is not limited as to the type of adjustment device and with which locking device 9 the adjustment device is used.
  • the presently preferred adjustment device is included with the ratchet type latching mechanism 9. The multiple teeth 22 in the ratchet allow different orientations of the handles 2a and 2b relative to one another. By squeezing the upper portions 4a and 4b towards each other, the orientation of the handles 2a and 2b relative to one another changes, and when the squeeze stops, the locking device 9 still maintains the changed orientation of the handles 2a and 2b relative to one another.
  • the construction includes a fulcrum 20 that provides inverse movement on each of the handles 2a and 2b on the opposite side of the fulcrum 20, for example, if the upper portions 4a and 4b come together, the lower portions 5a and 5b separate. Therefore, as the user squeezes, a separation action occurs at the lower portion 5a and 5b.
  • the invention is not so limited.
  • a criss-cross joint like a pair of pliers is used where squeezing on one portion closes the other portion.
  • variations or modifications of the device can be made to allow these two elongated handles 2a and 2b to be connected at any angle, at any point along the handles, passively (fixed) or actively (rotatable about the pivot point).
  • the device can be made linearly active by having a moveable fulcrum point or by having the handles 2a and 2b slide in and out at a particular point.
  • the fulcrum mechanism can also have an axial variability, for example, by having a moveable fulcrum or, alternatively, by having handles to which the attachment devices are connected that would move relative to the main body of the fulcrum member.
  • joints 11 which are connected to attachment devices 12 for engaging implants placed in bone.
  • the joints 11 are preferably positioned relative to the attachment devices such that a line passing through the joints 11 is parallel to a line passing through the attachment devices 12.
  • the joint 11 preferably enables the attachment device 12 to connect with an implant with at least one degree of freedom rotation between the implant relative to the handles 2a or 2b. Joints capable of providing such freedom of rotation are common in the tool field, and all are acceptable. However, the presently preferred joint 11 is an universal joint.
  • the universal joint 11 can alternatively, although not necessarily preferably, be constructed with other multi-directional connecting members, such as ball and socket connectors and flexible hose or rod arrangements. What is important according to the invention is that the attachment devices 12 are arranged relative to the lower portions 5a and 5b so as to approach and secure the implants in any of a wide range of directions.
  • FIG. 7 shows another example of an attachment device 12 in combination with a joint 11 that enables the attachment device 12 to connect to an implant and enables the implant at least one degree of freedom rotation relative to the handles 2a or 2b.
  • the presently preferred integrated attachment device 12 includes a cup 40 that is formed to fit over a protrusion 42 on the implant 44.
  • the invention is not limited to using a cup 40.
  • Attachment devices 12 capable of integrating the joint 11 are well known in the art, and all are acceptable.
  • the integrated attachment device 12 is advantageously used on an implant 44 that is attached to an article that is being pushed against. As force is directed downward from the handle 2 to the implant 44, the cup 40 is forced against protrusion 42 so to prevent the cup 40 and the implant 44 from disengaging; yet, the cup 40 is still capable of being rotated about the protrusion 42.
  • the cup 40 acts as both an attachment device 12 that connects the implant 44 to the attachment device 12 and as a joint 11 that allows the implant at least one degree of freedom rotation relative to the handle 2.
  • the attachment devices 12 can be provided with different fittings for engaging varying sizes of corresponding implants.
  • the engagement mounts are removable so that different sizes can be employed with a single device 1.
  • the angular position of each attachment devices 12 can be locked in any particular position as desired, and the angular positions can be adjusted before or during the procedure in which the tool is being used.
  • the attachment devices 12 can also selectively engage the implant such that the attachment devices 12 can either be detached from the implant or be incapable of movement relative to the implant.
  • the attachment devices 12 can also be in the shape of an implant such that the attachment device 12 and implant are integrated.
  • the presently preferred implant is a bone implant that inserted into a bone; however, the integrated attachment device 12 is not limited to bone implants. Any type of implant that can attach to an article is acceptable.
  • the integrated attachment device 12 can also be selectively detachable from the handles 2. This detachment can either be between the attachment device 12 and the joint 11 or between the joint 11 and the handle 2. Thus, the attachment device 12 can be first attached to the article to be manipulated and then the handle 2 can then be attached subsequently to the attachment device 12 or vice-versa.
  • the joint 11 on each of the lower portions allows the forces to be directed onto the implants at nearly any desirable direction.
  • the force can be pushed directly down, or at a similar angle, into the implant on L4 or SI to p rovide a very safe platform on which to place such force.
  • the manipulation tool 1 allows the force to be exerted either directly upward or downward because of the combination of the motion possible with the joints 11 and the pivot joint 3.
  • the manipulation tool 1 is pivoted about the joint 11 adjacent the implant on SI.
  • the lower portions 4a and 4b are spread apart which also increases the distance between the attachment devices 12.
  • the force can pull posteriorly on L5 in a direction, a spondial reduction, that is compatible with the screw's purchase or hold on the vertebral body.
  • this procedure using the subject invention can be done with any two vertebral bodies, whether or not adjacent.
  • the procedure can be carried out from the sacrum to any intralumbar levels, thoracic, even cervical levels.
  • the manipulation tool can allow linear translation, distraction, in the superior/inferior directions. This is often desired for disc degeneration resulting in the vertebral bodies becoming too close to each other, another factor in nerve impingement.
  • two pins could be put in a femur, and the tool could be used to translate the two bones together in a linear direction.
  • the length of extendable handles 29 can be varied according to surgeon preferences or clinical indications.
  • the extendable handle 29 can be lengthened (shown in phantom) as a telescopic extension or other similar extension mechanism which is known in the art.
  • the extension mechanism can be reversibly locked into a desired position, e.g. , by a twist and lock mechanism such as is used in other devices having extendable handles.
  • FIG. 4 is illustrative of another embodiment of the manipulation tool 28.
  • a handle 30 is provided with at least two joints 32 for connecting attachment devices 34 to the handle 30. Although two joints 32 and two attachment devices 34 are shown in FIG. 5, the invention is not limited in this regard.
  • Two attachment devices are advantageously used to provide greater flexibility with regards to the positioning of the attachment devices 34 relative to the implants.
  • Three or more attachment devices 34 can be used to provide a more stable base upon which to manipulate the bone; however, three or more attachment devices 34 provide less flexibility as to the motion available during the manipulation of the bone.
  • the handle 30 can optionally be divided into at least two portions 36 splaying away from each other. Three or more portions 36 are advantageously provided when three or more attachment devices 34 are also provided. Dividing the handle 30 into two or more portions 36 advantageously raises the handle 30 out of the wound.
  • the handle 30 can optionally include an arm 38 extending away from the handle 30.
  • the arm 38 advantageously allows the user to apply additional torque to the manipulation tool 28. Also, the arm 38 allows the user to grasp the manipulation tool 28 at a location away from the wound.
  • FIG. 5 Still another embodiment of a manipulation tool 40 is shown in FIG. 5.
  • the manipulation tool 40 includes at least two portions 42 with respective joints 44 for connecting respective attachment devices 34 to the portions 42.
  • a pivot joint 46 is also provided to allow the angular relationship between the portions 42 to vary.

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

Abstract

L'invention concerne un instrument (1) de manipulation comprenant une première et une seconde poignées (2a, 2b), une articulation à pivot (3) reliant les deux poignées et divisant chacune des poignées en une partie supérieure et une partie inférieure. Les parties inférieures (5a)(5b), qui possèdent chacune une extrémité distale (26a)(26b), entretiennent entre elles une relation angulaire variable. Un premier et un second joints (11) sont disposés au niveau de chacune des extrémités distales. Chacun des joints est relié pivotant à un dispositif de fixation (12). Un rochet (9) monté pivotant sur la première poignée, et pouvant sélectivement venir au contact de la seconde poignée peut également être prévu.
PCT/US1998/024308 1997-11-14 1998-11-13 Instrument chirurgical pour manipulations osseuses WO1999025262A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU15866/99A AU1586699A (en) 1997-11-14 1998-11-13 Surgical tool for bone manipulation

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US6600697P 1997-11-14 1997-11-14
US60/066,006 1997-11-14

Publications (1)

Publication Number Publication Date
WO1999025262A1 true WO1999025262A1 (fr) 1999-05-27

Family

ID=22066646

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1998/024308 WO1999025262A1 (fr) 1997-11-14 1998-11-13 Instrument chirurgical pour manipulations osseuses

Country Status (3)

Country Link
AU (1) AU1586699A (fr)
WO (1) WO1999025262A1 (fr)
ZA (1) ZA9810445B (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1534156A1 (fr) * 2002-06-24 2005-06-01 Endius Incorporated Instrument chirurgical permettant de bouger des vertebres
EP2689737A1 (fr) * 2012-07-25 2014-01-29 Stryker Leibinger GmbH & Co. KG Pince de réduction chirurgicale
CN108143480A (zh) * 2018-02-23 2018-06-12 南京市第医院 一种掌骨复位器
GB2561450A (en) * 2017-03-09 2018-10-17 Alphatec Spine Inc Osteotomy instrument
CN108937263A (zh) * 2018-08-07 2018-12-07 王逸妍 一种画板夹持及转动机构

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2002021A (en) * 1934-02-27 1935-05-21 Rouse Howard Surgical fracture extension appliance
US5281223A (en) * 1992-09-21 1994-01-25 Ray R Charles Tool and method for derotating scoliotic spine

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2002021A (en) * 1934-02-27 1935-05-21 Rouse Howard Surgical fracture extension appliance
US5281223A (en) * 1992-09-21 1994-01-25 Ray R Charles Tool and method for derotating scoliotic spine

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1534156A1 (fr) * 2002-06-24 2005-06-01 Endius Incorporated Instrument chirurgical permettant de bouger des vertebres
EP1534156A4 (fr) * 2002-06-24 2009-06-03 Endius Inc Instrument chirurgical permettant de bouger des vertebres
US7815650B2 (en) 2002-06-24 2010-10-19 Zimmer Spine, Inc. Surgical instrument for moving vertebrae
US7988700B2 (en) 2002-06-24 2011-08-02 Zimmer Spine, Inc. Surgical instrument for moving vertebrae
US9339319B2 (en) 2012-07-25 2016-05-17 Stryker European Holdings I, Llc Surgical reduction clamp
US20140031882A1 (en) * 2012-07-25 2014-01-30 Stryker Leibinger Gmbh & Co. Kg Surgical reduction clamp
EP2689737A1 (fr) * 2012-07-25 2014-01-29 Stryker Leibinger GmbH & Co. KG Pince de réduction chirurgicale
GB2561450A (en) * 2017-03-09 2018-10-17 Alphatec Spine Inc Osteotomy instrument
US10172653B2 (en) 2017-03-09 2019-01-08 Alphatec Spine, Inc. Osteotomy instrument
GB2561450B (en) * 2017-03-09 2020-07-08 Alphatec Spine Inc Osteotomy instrument
US11116552B2 (en) 2017-03-09 2021-09-14 Alphatec Spine, Inc. Osteotomy instrument
CN108143480A (zh) * 2018-02-23 2018-06-12 南京市第医院 一种掌骨复位器
CN108143480B (zh) * 2018-02-23 2022-06-24 南京市第一医院 一种掌骨复位器
CN108937263A (zh) * 2018-08-07 2018-12-07 王逸妍 一种画板夹持及转动机构

Also Published As

Publication number Publication date
ZA9810445B (en) 1999-07-01
AU1586699A (en) 1999-06-07

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