WO2009133539A1 - Hook for vertebral osteosynthesis device, and device including same - Google Patents
Hook for vertebral osteosynthesis device, and device including same Download PDFInfo
- Publication number
- WO2009133539A1 WO2009133539A1 PCT/IB2009/051819 IB2009051819W WO2009133539A1 WO 2009133539 A1 WO2009133539 A1 WO 2009133539A1 IB 2009051819 W IB2009051819 W IB 2009051819W WO 2009133539 A1 WO2009133539 A1 WO 2009133539A1
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- Prior art keywords
- hook
- rod
- vertebra
- isthmic
- hooks
- Prior art date
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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
- A61B17/68—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
- A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
-
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7041—Screws or hooks combined with longitudinal elements which do not contact vertebrae with single longitudinal rod offset laterally from single row of screws or hooks
-
- 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
- A61B17/7047—Clamps comprising opposed elements which grasp one vertebra between them
-
- 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
- A61B17/7056—Hooks with specially-designed bone-contacting part
Definitions
- Hook for vertebral osteosynthesis device and device comprising it.
- the invention relates to the field of prostheses intended to be implanted on the spine of a patient, called vertebral osteosynthesis devices.
- Different pathologies may require the implantation of such a device, such as damage to the vertebrae and / or disks separating them, following a degenerative disease, a tumor or trauma, or a misalignment of the vertebrae with respect to their positions. normal. They aim to secure two consecutive vertebrae or more in a specific relative position.
- longitudinal elements such as elongated rods or plates, extending along the vertebral column and attached to the vertebrae by various means are often used.
- the longitudinal elements may be attached to the column according to an anterior surgical approach or a posterior surgical approach. Both approaches have their advantages and disadvantages, and the surgeon's choice must be made according to the particular needs of the patient.
- the anterior approach may be particularly indicated when the vertebrae of the patient have a non-pathological internal structure, for example an absence of osteoporosis affecting the cancellous bone, which makes it possible to implant bone screws to which are connected (directly or through the intermediate connectors) the longitudinal elements.
- the posterior approach may be more appropriate in cases where osteoporosis weakens the spongy part of the vertebrae and makes it risky to implant bone screws in areas where the cancellous bone is particularly thick as is the case in the anterior part. vertebrae. In this case, we can take advantage of the vertebral processes to implant on the posterior vertebrae hooks engaging on these processes, these hooks themselves carrying elements for connecting a longitudinal element.
- the object of the invention is to provide a device for fixing a longitudinal element by the posterior route whose design is simple and easy to install, requiring only as little intervention time as possible.
- the subject of the invention is a hook, intended to be implanted on the isthmic part of a vertebra, and comprising a lower part and a part upper, connected by an intermediate portion substantially perpendicular to the lower and upper parts, and intended to extend, when the hook is attached to a vertebra, along the outer face of the isthmic portion of said vertebra, a clamping piece can to be secured to a rod inserted into an orifice and passing through the upper part of the body, non-return means being provided to prevent extraction of the rod from the orifice after insertion, and means for securing the a longitudinal member of a spinal osteosynthesis device to said rod.
- Said means for securing a longitudinal element of a spinal osteosynthesis device to said rod may comprise a connector fitted on the rod and means for clamping said connector on the upper part of the hook.
- Said rod and said connector can be oriented in relation to one another in a polyaxial manner.
- the connection between the rod and the clamping piece may be polyaxial.
- It may comprise means allowing the connection of two hooks located on the two isthmic parts of the same vertebra.
- Said means allowing the connection of two hooks located on the two isthmic parts of the same vertebra may comprise an appendage oriented substantially perpendicular to the upper part of the hook, and having an orifice to be traversed by a connecting rod and means of locking said connecting rod in said orifice.
- the rod may have a thread and the hole of the hook may have a thread corresponding to that of the rod, said threads constituting said non-return means.
- the subject of the invention is also a vertebral osteosynthesis device, comprising at least one longitudinal element and fastening elements of this longitudinal element on at least two consecutive vertebrae, characterized in that at least one of said fastening elements is a hook of the previous type. It may comprise at least two hooks intended to be implanted on the same vertebra and having means for their connection, and connection means to each other of said hooks.
- the invention is based on the use of a hook intended to be implanted laterally, on an isthmic part of a vertebra, by simply clamping said isthmic part between the upper and lower parts of the hook.
- FIG. 1 which shows in exploded perspective the main parts of an example of a vertebral osteosynthesis device hook according to FIG. invention
- FIG. 2 which shows exploded perspective the main parts of an exemplary vertebral osteosynthesis device according to the invention
- FIG. 5 which shows in perspective in the assembled state an example device according to the invention intended to be implanted on a vertebra and having two hooks according to the invention connected by a connecting rod;
- FIG. 6 which shows in perspective an example of vertebral osteosynthesis device according to the invention implanted on two vertebrae;
- Figure 7 shows another variant of the hook according to the invention, implanted on a vertebra.
- Figure 1 shows in exploded view a first example of isthmic hook used in the context of the invention. It contains the elements that we will enumerate.
- a body 1 forming a hook having a lower portion 2 and an upper portion 3, connected by an intermediate portion 4 intended to extend, when the hook is attached to a vertebra, along the outer face of the isthmic part of said vertebra.
- the lower part 2 is intended to be inserted against the lower face of the isthmic part, and the upper part 3 is intended to come above the upper face of the same. isthmic part, as seen in Figure 6. They are each substantially perpendicular to the intermediate portion 4.
- the tightening of the body 1 against the vertebra is provided by a clamping piece in the general form of disc 5 (in the example shown ) can be secured to a threaded rod 6 inserted in an orifice 7 having a corresponding thread and passing through the upper part 3 of the body 1, at a spherical dome 8 on which is intended to rest a connector 9 to connect the body 1 of the hook to a longitudinal rod 10.
- the fastening of the disc 5 and the threaded rod 6 is provided by two screws 11, 12 intended to be inserted into a groove 13 formed at the lower end of the threaded rod 6 , as can be seen in FIG. 4.
- the body 1 also comprises, in the example shown, an appendage 14 oriented substantially perpendicularly to the upper part 3 of the body 1 forming an eighth t.
- Appendix 14 has an orifice 15 to be traversed by a connecting rod 16 for connecting the body 1 to a body similar to him and disposed symmetrically to him on the other isthmic portion of the vertebra.
- a threaded orifice 17 makes it possible to introduce a clamping screw 18 to block the rod 16 in the orifice 15.
- Figure 2 shows an exploded view of the main parts of a complete device including the elements which have just been described, and intended to be implanted on both sides of the same vertebra. It shows in particular the configuration of the connector 9, which is of a type known in itself. It comprises an orifice 19 for insertion of the longitudinal rod 10 to be connected to the hook 1 and an orifice 20 for inserting the connector 9 on the rod 6.
- the lower face 21 of the connector 9 is shaped to rest on the dome spherical 8 of the body 1.
- the connector 9 also has a slot 22 putting in communication the two orifices 19, 20, so that, when the rod 10 is inserted into the orifice 19, a tightening nut 23 threaded onto the rod 6 causes a ruzement of the walls of the orifice 19, thus a clamping and locking of the longitudinal rod 10.
- FIG. 3 and 4 show the hook 1 and connector 9 assembled (without the rods 10, 16). It is seen, in particular, in the sectional view of FIG. 4 how the screws 11, 12 (not shown in FIG. 2) make it possible to secure the disc 5 and the threaded rod 6.
- Clamping of the hooks 1 against the isthmic parts of the vertebra is ensured by a rotation of the threaded rod 6 performed by the surgeon with the aid of a conventional tool engaging the upper end 24 of the rod 6, so as to bring the disk 5 in contact with the vertebra.
- the disc 5 is, in the example shown, in free rotation relative to the rod 6 and can easily come to take its best position on the vertebra.
- the disk shape of this clamping piece 5 shown in the drawings is in no way limiting and may be modified, in particular to better adapt its underside to the precise configuration of the part of the vertebra on which it is intended to 'to press.
- the connection between the rod 6 and the disk 5 could be of a type other than that shown in the figures, providing the same functionality, such as a ball joint. In general, it is preferable to provide a polyaxial connection between the rod 6 and the disk 5.
- FIG. 5 shows two hooks 1, each assembled with a connector 9 and a rod 6, and connected by a rod 16. It can also be seen that the upper parts of the threaded rods 6 and nuts 23 have been removed in order to limit the size of the device after his pose. This is also the case, preferably, for the upper part of the clamping screw 18 of the rod 16. This can be achieved, in a conventional manner, by providing on these different members areas of least resistance that break during their tightening as soon as a sufficient tightening torque is reached.
- FIG. 6 shows the implantation of this exemplary device according to the invention on a vertebra 24. The hooks 1 are tight on the isthmic parts 25 of the vertebra 24, and the connecting rod 16 passes behind the spinous process 26.
- the longitudinal rods 10 are fixed to the next vertebra 27 by passing through the head 28 of a pedicle screw 29 fixed in said vertebra 27 and locked by a clamping screw 30 of conventional type.
- a device similar to that of the invention or by any other suitable device could also extend, if necessary, to a larger number of vertebrae.
- a caudal hook 31 anchored in the caudal region of the vertebra is represented the case where the caudal hook 31 is substituted for the appendix 14 and, therefore, the hooks 1 located on the two isthmic parts of the same vertebra are not connected to each other.
- a caudal hook 31 is particularly useful if one wishes to install longitudinal rod 10 on one side of the spine, in that it improves the rigidity of the entire device.
- the rod 6 preferably has at least one flat 32 which, in cooperation with a corresponding form of the orifice 20 of the connector 9, prevents rotation of the connector 9 after its introduction.
- the threading of the rod 6 and the corresponding thread of the orifice 7 of the body 1 can be replaced by any non-return means making it possible to avoid the extraction of the rod 6 after it has been inserted into the orifice 7, for example teeth placed on the rod 6 and elastic strips placed in the orifice 7, the respective shapes would be adapted to obtain such a non-return effect.
- the longitudinal rod 10 may be replaced by another type of longitudinal element such as an elongate plate.
- any means could be used to secure the rod 6 and the longitudinal member 10, for example at the upper end of the threaded rod 6 a receptacle for the longitudinal member 10 and means, such as a threaded plug cooperating with a corresponding thread of the walls of the receptacle, for maintaining the longitudinal member in the receptacle.
- the assembly formed by the appendix 14 and the connecting rod 16 may be replaced by any functionally equivalent means allowing the connection of two hooks 1 located on the two isthmic parts of the same vertebra.
- the device according to the invention can be used in particular, but not exclusively, in the thoracic region of the spine.
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Abstract
The invention relates to a hook (1) to be implanted onto the isthmian portion of a vertebra and comprising: a lower portion (2) and an upper portion (3), connected by an intermediate portion (4) substantially perpendicular to the lower (2) and upper (3) portions, and intended to extend, when the hook is attached onto a vertebra, along the outer surface of the isthmian portion of said vertebra, one clamping part (5) capable of being secured to a rod (6) inserted into an opening (7) extending through the upper portion (3) of the body (1); a non-return means for preventing removal of said rod (6) from the opening (7); and a securing means for securing a longitudinal element (10) of a spinal osteosynthesis device to said rod (6). The invention relates to a vertebral osteosynthesis device comprising at least one such hook.
Description
Crochet pour dispositif d'ostéosynthèse vertébrale et dispositif le comprenant. Hook for vertebral osteosynthesis device and device comprising it.
L'invention concerne le domaine des prothèses destinées à être implantées sur la colonne vertébrale d'un patient, dites dispositifs d'ostéosynthèse vertébrale. Différentes pathologies peuvent nécessiter l'implantation d'un tel dispositif, tels que l'endommagement des vertèbres et/ou des disques les séparant, suite à une maladie dégénérative, une tumeur ou un traumatisme, ou un désalignement des vertèbres par rapport à leurs positions normales. Ils ont pour but de solidariser deux vertèbres consécutives ou davantage dans une position relative déterminée. A cet effet, on utilise souvent des éléments longitudinaux, tels que des tiges ou des plaques allongées, s'étendant le long de la colonne vertébrale et fixés sur les vertèbres par divers moyens.The invention relates to the field of prostheses intended to be implanted on the spine of a patient, called vertebral osteosynthesis devices. Different pathologies may require the implantation of such a device, such as damage to the vertebrae and / or disks separating them, following a degenerative disease, a tumor or trauma, or a misalignment of the vertebrae with respect to their positions. normal. They aim to secure two consecutive vertebrae or more in a specific relative position. For this purpose, longitudinal elements, such as elongated rods or plates, extending along the vertebral column and attached to the vertebrae by various means are often used.
Ces éléments longitudinaux peuvent être fixés à la colonne selon une approche chirurgicale antérieure ou une approche chirurgicale postérieure. Les deux approches ont leurs avantages et leurs inconvénients, et le choix du chirurgien doit être fait en fonction des besoins particuliers du patient. L'approche antérieure peut être particulièrement indiquée lorsque les vertèbres du patient présentent une structure interne non pathologique, par exemple une absence d'ostéoporose affectant l'os spongieux, qui rend possible l'implantation de vis osseuses auxquelles sont reliés (directement ou par l'intermédiaire de connecteurs) les éléments longitudinaux. L'approche postérieure peut être davantage indiquée dans les cas où une ostéoporose fragilise la partie spongieuse des vertèbres et rend risquée l'implantation de vis osseuses dans des régions où l'os spongieux est particulièrement épais comme c'est le cas dans la partie antérieure des vertèbres. Dans ce cas, on peut profiter des apophyses vertébrales pour implanter sur la partie postérieure des vertèbres des crochets venant en prise sur ces apophyses, ces crochets portant eux-mêmes des éléments permettant d'y connecter un élément longitudinal.These longitudinal elements may be attached to the column according to an anterior surgical approach or a posterior surgical approach. Both approaches have their advantages and disadvantages, and the surgeon's choice must be made according to the particular needs of the patient. The anterior approach may be particularly indicated when the vertebrae of the patient have a non-pathological internal structure, for example an absence of osteoporosis affecting the cancellous bone, which makes it possible to implant bone screws to which are connected (directly or through the intermediate connectors) the longitudinal elements. The posterior approach may be more appropriate in cases where osteoporosis weakens the spongy part of the vertebrae and makes it risky to implant bone screws in areas where the cancellous bone is particularly thick as is the case in the anterior part. vertebrae. In this case, we can take advantage of the vertebral processes to implant on the posterior vertebrae hooks engaging on these processes, these hooks themselves carrying elements for connecting a longitudinal element.
Le but de l'invention est de proposer un dispositif de fixation d'un élément longitudinal par la voie postérieure dont la conception est simple et la pose aisée, ne nécessitant qu'un temps d'intervention aussi réduit que possible.The object of the invention is to provide a device for fixing a longitudinal element by the posterior route whose design is simple and easy to install, requiring only as little intervention time as possible.
A cet effet, l'invention a pour objet un crochet, destiné à être implanté sur la partie isthmique d'une vertèbre, et comportant une partie inférieure et une partie
supérieure, reliées par une partie intermédiaire sensiblement perpendiculaire aux parties inférieure et supérieure, et destinée à s'étendre, lorsque le crochet est fixé sur une vertèbre, le long de la face externe de la partie isthmique de ladite vertèbre, une pièce de serrage pouvant être solidarisé à une tige s'insérant dans un orifice et traversant la partie supérieure du corps, des moyens anti-retour étant prévus pour éviter l'extraction de la tige hors de l'orifice après son insertion, et des moyens de solidarisation d'un élément longitudinal d'un dispositif d'ostéosynthèse rachidienne à ladite tige.For this purpose, the subject of the invention is a hook, intended to be implanted on the isthmic part of a vertebra, and comprising a lower part and a part upper, connected by an intermediate portion substantially perpendicular to the lower and upper parts, and intended to extend, when the hook is attached to a vertebra, along the outer face of the isthmic portion of said vertebra, a clamping piece can to be secured to a rod inserted into an orifice and passing through the upper part of the body, non-return means being provided to prevent extraction of the rod from the orifice after insertion, and means for securing the a longitudinal member of a spinal osteosynthesis device to said rod.
Lesdits moyens de solidarisation d'un élément longitudinal d'un dispositif d'ostéosynthèse rachidienne à ladite tige peuvent comporter un connecteur emmanché sur la tige et des moyens de serrage dudit connecteur sur la partie supérieure du crochet.Said means for securing a longitudinal element of a spinal osteosynthesis device to said rod may comprise a connector fitted on the rod and means for clamping said connector on the upper part of the hook.
Ladite tige et ledit connecteur peuvent être orientés l'un rapport à l'autre d'une façon polyaxiale. La liaison entre la tige et la pièce de serrage peut être polyaxiale.Said rod and said connector can be oriented in relation to one another in a polyaxial manner. The connection between the rod and the clamping piece may be polyaxial.
Il peut comporter des moyens permettant la connexion de deux crochets situés sur les deux parties isthmiques d'une même vertèbre.It may comprise means allowing the connection of two hooks located on the two isthmic parts of the same vertebra.
Lesdits moyens permettant la connexion de deux crochets situés sur les deux parties isthmiques d'une même vertèbre peuvent comporter un appendice orienté sensiblement perpendiculairement à la partie supérieure du crochet, et comportant un orifice destiné à être traversé par une tige de liaison et des moyens de blocage de ladite tige de liaison dans ledit orifice.Said means allowing the connection of two hooks located on the two isthmic parts of the same vertebra may comprise an appendage oriented substantially perpendicular to the upper part of the hook, and having an orifice to be traversed by a connecting rod and means of locking said connecting rod in said orifice.
Il peut comporter également un crochet caudal destiné à s'ancrer sur la partie caudale de la vertèbre. La tige peut présenter un filetage et l'orifice du crochet peut présenter un filetage correspondant à celui de la tige, lesdits filetages constituant lesdits moyens anti-retour.It may also include a caudal hook for anchoring on the caudal portion of the vertebra. The rod may have a thread and the hole of the hook may have a thread corresponding to that of the rod, said threads constituting said non-return means.
L'invention a également pour objet un dispositif d'ostéosynthèse vertébrale, comportant au moins un élément longitudinal et des éléments de fixation de cet élément longitudinal sur au moins deux vertèbres consécutives, caractérisé en ce qu'au moins un desdits éléments de fixation est un crochet du type précédent.
II peut comporter au moins deux crochets destinés à être implantés sur une même vertèbre et comportant des moyens permettant leur connexion, et des moyens de connexion l'un à l'autre desdits crochets.The subject of the invention is also a vertebral osteosynthesis device, comprising at least one longitudinal element and fastening elements of this longitudinal element on at least two consecutive vertebrae, characterized in that at least one of said fastening elements is a hook of the previous type. It may comprise at least two hooks intended to be implanted on the same vertebra and having means for their connection, and connection means to each other of said hooks.
Comme on l'aura compris, l'invention repose sur l'utilisation d'un crochet destiné à être implanté latéralement, sur une partie isthmique d'une vertèbre, par simple serrage de ladite partie isthmique entre les parties supérieure et inférieure du crochet.As will be understood, the invention is based on the use of a hook intended to be implanted laterally, on an isthmic part of a vertebra, by simply clamping said isthmic part between the upper and lower parts of the hook.
L'invention sera mieux comprise à la lecture de la description qui suit, donnée en référence aux figures annexées suivantes : - la figure 1 qui montre en perspective éclatée les principales pièces d'un exemple de crochet de dispositif d'ostéosynthèse vertébrale selon l'invention ;The invention will be better understood on reading the description which follows, given with reference to the following appended figures: FIG. 1 which shows in exploded perspective the main parts of an example of a vertebral osteosynthesis device hook according to FIG. invention;
- la figure 2 qui montre en perspective éclatée les principales pièces d'un exemple de dispositif d'ostéosynthèse vertébrale selon l'invention ;- Figure 2 which shows exploded perspective the main parts of an exemplary vertebral osteosynthesis device according to the invention;
- la figure 3 qui montre vu de profil à l'état assemblé ce même exemple de crochet et le connecteur qui lui est associé ;- Figure 3 which shows a profile in the assembled state this same hook example and the connector associated therewith;
- la figure 4 qui est une vue en section selon IV-IV du crochet et du connecteur de la figure 3 ;- Figure 4 which is a sectional view along IV-IV of the hook and the connector of Figure 3;
- la figure 5 qui montre en perspective à l'état assemblé un exemple de dispositif selon l'invention destiné à être implanté sur une vertèbre et comportant deux crochets selon l'invention connectés par une tige de liaison ;- Figure 5 which shows in perspective in the assembled state an example device according to the invention intended to be implanted on a vertebra and having two hooks according to the invention connected by a connecting rod;
- la figure 6 qui montre en perspective un exemple de dispositif d'ostéosynthèse vertébrale selon l'invention implanté sur deux vertèbres ;- Figure 6 which shows in perspective an example of vertebral osteosynthesis device according to the invention implanted on two vertebrae;
- la figure 7 qui montre une autre variante de crochet selon l'invention, implantée sur une vertèbre. La figure 1 montre en vue éclatée un premier exemple de crochet isthmique utilisable dans le cadre de l'invention. Il comporte les éléments que l'on va énumérer.- Figure 7 shows another variant of the hook according to the invention, implanted on a vertebra. Figure 1 shows in exploded view a first example of isthmic hook used in the context of the invention. It contains the elements that we will enumerate.
Il comporte d'abord un corps 1 formant crochet présentant une partie inférieure 2 et une partie supérieure 3, reliées par une partie intermédiaire 4 destinée à s'étendre, lorsque le crochet est fixé sur une vertèbre, le long de la face externe de la partie isthmique de ladite vertèbre. La partie inférieure 2 est destinée à venir s'insérer contre la face inférieure de la partie isthmique, et la partie supérieure 3 est destinée à venir au dessus de la face supérieure de cette même
partie isthmique, comme on le voit sur la figure 6. Elles sont chacune sensiblement perpendiculaires à la partie intermédiaire 4. Le serrage du corps 1 contre la vertèbre est assuré par une pièce de serrage en forme générale de disque 5 (dans l'exemple représenté) pouvant être solidarisé à une tige filetée 6 s'insérant dans un orifice 7 présentant un filetage correspondant et traversant la partie supérieure 3 du corps 1 , au niveau d'un dôme sphérique 8 sur lequel est destiné à reposer un connecteur 9 pour relier le corps 1 du crochet à une tige longitudinale 10. la solidarisation du disque 5 et de la tige filetée 6 est assurée par deux vis 11 , 12 destinée à venir s'insérer dans un sillon 13 ménagé à l'extrémité inférieure de la tige filetée 6, comme cela est visible sur la figure 4. Le corps 1 comporte également, dans l'exemple représenté, un appendice 14 orienté sensiblement perpendiculairement à la partie supérieure 3 du corps 1 formant crochet. L'appendice 14 comporte un orifice 15 destiné à être traversé par une tige de liaison 16 permettant de relier le corps 1 à un corps semblable à lui et disposé symétriquement à lui sur l'autre partie isthmique de la vertèbre. Un orifice fileté 17 permet d'introduire une vis de serrage 18 pour bloquer la tige 16 dans l'orifice 15.It comprises first a body 1 forming a hook having a lower portion 2 and an upper portion 3, connected by an intermediate portion 4 intended to extend, when the hook is attached to a vertebra, along the outer face of the isthmic part of said vertebra. The lower part 2 is intended to be inserted against the lower face of the isthmic part, and the upper part 3 is intended to come above the upper face of the same. isthmic part, as seen in Figure 6. They are each substantially perpendicular to the intermediate portion 4. The tightening of the body 1 against the vertebra is provided by a clamping piece in the general form of disc 5 (in the example shown ) can be secured to a threaded rod 6 inserted in an orifice 7 having a corresponding thread and passing through the upper part 3 of the body 1, at a spherical dome 8 on which is intended to rest a connector 9 to connect the body 1 of the hook to a longitudinal rod 10. the fastening of the disc 5 and the threaded rod 6 is provided by two screws 11, 12 intended to be inserted into a groove 13 formed at the lower end of the threaded rod 6 , as can be seen in FIG. 4. The body 1 also comprises, in the example shown, an appendage 14 oriented substantially perpendicularly to the upper part 3 of the body 1 forming an eighth t. Appendix 14 has an orifice 15 to be traversed by a connecting rod 16 for connecting the body 1 to a body similar to him and disposed symmetrically to him on the other isthmic portion of the vertebra. A threaded orifice 17 makes it possible to introduce a clamping screw 18 to block the rod 16 in the orifice 15.
La figure 2 montre en vue éclatée les principales pièces d'un dispositif complet incluant les éléments qui viennent d'être décrits, et destiné à être implanté des deux côtés d'une même vertèbre. On y voit en particulier la configuration du connecteur 9, qui est d'un type connu en lui-même. Il comporte un orifice 19 pour l'insertion de la tige longitudinale 10 à relier au crochet 1 et un orifice 20 permettant d'insérer le connecteur 9 sur la tige 6. La face inférieure 21 du connecteur 9 est conformée pour venir reposer sur le dôme sphérique 8 du corps 1. Le connecteur 9 présente également une fente 22 mettant en communication les deux orifices 19, 20, pour que, lorsque la tige 10 est insérée dans l'orifice 19, un écrou de serrage 23 enfilé sur la tige 6 provoque un rapprochement des parois de l'orifice 19, donc un serrage et un blocage de la tige longitudinale 10.Figure 2 shows an exploded view of the main parts of a complete device including the elements which have just been described, and intended to be implanted on both sides of the same vertebra. It shows in particular the configuration of the connector 9, which is of a type known in itself. It comprises an orifice 19 for insertion of the longitudinal rod 10 to be connected to the hook 1 and an orifice 20 for inserting the connector 9 on the rod 6. The lower face 21 of the connector 9 is shaped to rest on the dome spherical 8 of the body 1. The connector 9 also has a slot 22 putting in communication the two orifices 19, 20, so that, when the rod 10 is inserted into the orifice 19, a tightening nut 23 threaded onto the rod 6 causes a rapprochement of the walls of the orifice 19, thus a clamping and locking of the longitudinal rod 10.
Les figures 3 et 4 montrent le crochet 1 et le connecteur 9 assemblés (sans les tiges 10, 16). On y voit, en particulier, sur la vue en section de la figure 4 comment les vis 11 , 12 (absentes de la figure 2) permettent de solidariser le disque 5 et la tige filetée 6.Figures 3 and 4 show the hook 1 and connector 9 assembled (without the rods 10, 16). It is seen, in particular, in the sectional view of FIG. 4 how the screws 11, 12 (not shown in FIG. 2) make it possible to secure the disc 5 and the threaded rod 6.
Le serrage des crochets 1 contre les parties isthmiques de la vertèbre est assuré par une rotation de la tige filetée 6 effectuée par le chirurgien à l'aide d'un
outil classique venant en prise avec l'extrémité supérieure 24 de la tige 6, de manière à faire venir le disque 5 au contact de la vertèbre. Le disque 5 est, dans l'exemple représenté, en libre rotation par rapport à la tige 6 et peut facilement venir prendre sa meilleure position sur la vertèbre. Bien entendu la forme en disque de cette pièce de serrage 5 représentée sur les dessins n'est aucunement limitative et peut être modifiée, notamment pour mieux adapter sa face inférieure à la configuration précise de la partie de la vertèbre sur laquelle elle est destinée à s'appuyer. De même la liaison entre la tige 6 et le disque 5 pourrait être d'un autre type que celui représenté sur les figures, assurant les mêmes fonctionnalités, tel qu'une rotule. De façon générale, il est préférable de prévoir une liaison polyaxiale entre la tige 6 et le disque 5.Clamping of the hooks 1 against the isthmic parts of the vertebra is ensured by a rotation of the threaded rod 6 performed by the surgeon with the aid of a conventional tool engaging the upper end 24 of the rod 6, so as to bring the disk 5 in contact with the vertebra. The disc 5 is, in the example shown, in free rotation relative to the rod 6 and can easily come to take its best position on the vertebra. Of course, the disk shape of this clamping piece 5 shown in the drawings is in no way limiting and may be modified, in particular to better adapt its underside to the precise configuration of the part of the vertebra on which it is intended to 'to press. Similarly the connection between the rod 6 and the disk 5 could be of a type other than that shown in the figures, providing the same functionality, such as a ball joint. In general, it is preferable to provide a polyaxial connection between the rod 6 and the disk 5.
La figure 5 montre deux crochets 1 assemblés chacun avec un connecteur 9 et une tige 6, et connectés par une tige 16. On voit également que les parties supérieures des tiges filetées 6 et des écrous 23 ont été ôtées pour limiter l'encombrement du dispositif après sa pose. C'est également le cas, de préférence, pour la partie supérieure de la vis de serrage 18 de la tige 16. Cela peut être réalisé, de manière classique, en ménageant sur ces différents organes des zones de moindre résistance qui se brisent au cours de leur serrage dès qu'un couple de serrage suffisant est atteint. La figure 6 montre l'implantation de cet exemple de dispositif selon l'invention sur une vertèbre 24. Les crochets 1 sont serrés sur les parties isthmiques 25 de la vertèbre 24, et la tige de liaison 16 passe en arrière de l'apophyse épineuse 26. Dans l'exemple représenté, les tiges longitudinales 10 sont fixées sur la vertèbre 27 suivante par passage dans la tête 28 d'une vis pédiculaire 29 fixée dans ladite vertèbre 27 et blocage par une vis de serrage 30 de type classique. Mais il serait bien entendu possible d'assurer la fixation des tiges 10 sur la vertèbre 27 par un dispositif similaire à celui de l'invention ou par tout autre dispositif adéquat. Le dispositif pourrait aussi s'étendre, si nécessaire, sur un plus grand nombre de vertèbres. Egalement on pourrait envisager de n'installer un tel dispositif que sur un seul côté de la partie postérieure du rachis, si cela était suffisant pour soigner la pathologie du patient. Il serait alors superflu de prévoir sur les crochets 1 des appendices 14 pour la réception d'une tige de liaison 16 (ou de tout autre moyen
assurant la connexion de deux crochets 1 situés de part et d'autre d'une même vertèbre).FIG. 5 shows two hooks 1, each assembled with a connector 9 and a rod 6, and connected by a rod 16. It can also be seen that the upper parts of the threaded rods 6 and nuts 23 have been removed in order to limit the size of the device after his pose. This is also the case, preferably, for the upper part of the clamping screw 18 of the rod 16. This can be achieved, in a conventional manner, by providing on these different members areas of least resistance that break during their tightening as soon as a sufficient tightening torque is reached. FIG. 6 shows the implantation of this exemplary device according to the invention on a vertebra 24. The hooks 1 are tight on the isthmic parts 25 of the vertebra 24, and the connecting rod 16 passes behind the spinous process 26. In the example shown, the longitudinal rods 10 are fixed to the next vertebra 27 by passing through the head 28 of a pedicle screw 29 fixed in said vertebra 27 and locked by a clamping screw 30 of conventional type. But it would of course be possible to ensure the attachment of the rods 10 on the vertebra 27 by a device similar to that of the invention or by any other suitable device. The device could also extend, if necessary, to a larger number of vertebrae. Also we could consider installing such a device on only one side of the posterior part of the spine, if that was sufficient to treat the pathology of the patient. It would then be superfluous to provide on the hooks 1 appendices 14 for receiving a connecting rod 16 (or any other means ensuring the connection of two hooks 1 located on either side of the same vertebra).
On peut également envisager de compléter la fixation du crochet 1 en prévoyant, en plus ou à la place de l'appendice 14, un crochet caudal 31 s'ancrant dans la région caudale de la vertèbre, comme on le voit sur la figure 7 où est représenté le cas où le crochet caudal 31 est substitué à l'appendice 14 et, donc, les crochets 1 situés sur les deux parties isthmiques d'une même vertèbre ne sont pas connectés l'un à l'autre. Un tel crochet caudal 31 est particulièrement utile si on ne désire installer de tige longitudinale 10 que sur un côté du rachis, en ce qu'il permet d'améliorer la rigidité de l'ensemble du dispositif.It is also conceivable to complete the fixing of the hook 1 by providing, in addition to or in place of the appendix 14, a caudal hook 31 anchored in the caudal region of the vertebra, as seen in FIG. is represented the case where the caudal hook 31 is substituted for the appendix 14 and, therefore, the hooks 1 located on the two isthmic parts of the same vertebra are not connected to each other. Such a caudal hook 31 is particularly useful if one wishes to install longitudinal rod 10 on one side of the spine, in that it improves the rigidity of the entire device.
On pourrait aussi prévoir la possibilité, par des moyens classiques à cet effet, d'une orientation polyaxiale entre la tige 6 et le connecteur 9.One could also provide the possibility, by conventional means for this purpose, of a polyaxial orientation between the rod 6 and the connector 9.
Comme représenté, la tige 6 présente de préférence au moins un méplat 32 qui, en coopération avec une forme correspondante de l'orifice 20 du connecteur 9, permet d'éviter une rotation du connecteur 9 après sa mise en place.As shown, the rod 6 preferably has at least one flat 32 which, in cooperation with a corresponding form of the orifice 20 of the connector 9, prevents rotation of the connector 9 after its introduction.
Le filetage de la tige 6 et le filetage correspondant de l'orifice 7 du corps 1 peuvent être remplacés par tous moyens anti-retour permettant d'éviter l'extraction de la tige 6 après son insertion dans l'orifice 7, par exemple des dents placées sur la tige 6 et des lamelles élastiques placées dans l'orifice 7, dont les formes respectives seraient adaptées à l'obtention d'un tel effet anti-retour.The threading of the rod 6 and the corresponding thread of the orifice 7 of the body 1 can be replaced by any non-return means making it possible to avoid the extraction of the rod 6 after it has been inserted into the orifice 7, for example teeth placed on the rod 6 and elastic strips placed in the orifice 7, the respective shapes would be adapted to obtain such a non-return effect.
La tige longitudinale 10 peut être remplacée par un autre type d'élément longitudinal tel qu'une plaque allongée.The longitudinal rod 10 may be replaced by another type of longitudinal element such as an elongate plate.
De manière générale, à la place du connecteur 9 emmanché sur la tige filetée 6, on pourrait utiliser tout moyen permettant de solidariser la tige 6 et l'élément longitudinal 10, par exemple prévoir à l'extrémité supérieure de la tige filetée 6 un réceptacle pour l'élément longitudinal 10 et des moyens, tels qu'un bouchon fileté coopérant avec un filetage correspondant des parois du réceptacle, permettant de maintenir l'élément longitudinal dans le réceptacle.In general, instead of the connector 9 fitted on the threaded rod 6, any means could be used to secure the rod 6 and the longitudinal member 10, for example at the upper end of the threaded rod 6 a receptacle for the longitudinal member 10 and means, such as a threaded plug cooperating with a corresponding thread of the walls of the receptacle, for maintaining the longitudinal member in the receptacle.
De même l'ensemble formé par l'appendice 14 et la tige de liaison 16 peut être remplacé par tout moyen fonctionnellement équivalent permettant la connexion de deux crochets 1 situés sur les deux parties isthmiques d'une même vertèbre.
Un avantage du dispositif selon l'invention est de permettre une fixation très rapide de l'élément longitudinal 10 sur la vertèbre 25, de plus sans nécessiter la pose d'une ou plusieurs vis pédiculaires si la vertèbre est trop endommagée pour les supporter, et également de ne pas nécessiter de résection d'une partie de la vertèbre telle que l'apophyse épineuse, contrairement à ce que nécessitent d'autres dispositifs connus de fixation d'une ou deux tiges longitudinales par la voie postérieure.Similarly, the assembly formed by the appendix 14 and the connecting rod 16 may be replaced by any functionally equivalent means allowing the connection of two hooks 1 located on the two isthmic parts of the same vertebra. An advantage of the device according to the invention is to allow a very fast fixation of the longitudinal element 10 on the vertebra 25, moreover without requiring the installation of one or more pedicle screws if the vertebra is too damaged to bear, and also not to require resection of a portion of the vertebra such as the spinous process, contrary to what require other known devices for fixing one or two longitudinal rods by the posterior route.
Le dispositif selon l'invention peut être utilisé notamment, mais pas exclusivement, dans la région thoracique du rachis.
The device according to the invention can be used in particular, but not exclusively, in the thoracic region of the spine.
Claims
1. Crochet (1 ), destiné à être implanté sur la partie isthmique d'une vertèbre, et comportant une partie inférieure (2) et une partie supérieure (3), reliées par une partie intermédiaire (4) sensiblement perpendiculaire aux parties inférieure (2) et supérieure (3), et destinée à s'étendre, lorsque le crochet est fixé sur une vertèbre, le long de la face externe de la partie isthmique de ladite vertèbre, une pièce de serrage (5) pouvant être solidarisé à une tige (6) s'insérant dans un orifice (7) présentant un filetage correspondant et traversant la partie supérieure (3) du corps (1 ), des moyens anti-retour étant prévus pour éviter l'extraction de la tige (6) hors de l'orifice (7) après son insertion, et des moyens de solidarisation d'un élément longitudinal (10) d'un dispositif d'ostéosynthèse rachidienne à ladite tige (6).Hook (1), intended to be implanted on the isthmic part of a vertebra, and comprising a lower part (2) and an upper part (3), connected by an intermediate part (4) substantially perpendicular to the lower parts ( 2) and upper (3), and intended to extend, when the hook is fixed on a vertebra, along the outer face of the isthmic portion of said vertebra, a clamping piece (5) can be secured to a rod (6) inserted in a hole (7) having a corresponding thread and passing through the upper part (3) of the body (1), non-return means being provided to prevent extraction of the rod (6) out the orifice (7) after insertion, and means for securing a longitudinal member (10) of a spinal osteosynthesis device to said rod (6).
2. Crochet (1 ) selon la revendication 1 , caractérisé en ce que lesdits moyens de solidarisation d'un élément longitudinal (10) d'un dispositif d'ostéosynthèse rachidienne à ladite tige (6) comportent un connecteur (9) emmanché sur la tige (6) et des moyens de serrage (23) dudit connecteur (9) sur la partie supérieure (3) du crochet (1 ).2. Hook (1) according to claim 1, characterized in that said means for securing a longitudinal member (10) of a spinal osteosynthesis device to said rod (6) comprise a connector (9) fitted on the rod (6) and clamping means (23) of said connector (9) on the upper part (3) of the hook (1).
3. Crochet (1 ) selon la revendication 2, caractérisé en ce que ladite tige (6) et ledit connecteur (9) peuvent être orientés l'un par rapport à l'autre d'une façon polyaxiale.3. Hook (1) according to claim 2, characterized in that said rod (6) and said connector (9) can be oriented relative to each other in a polyaxial manner.
4. Crochet (1 ) selon l'une des revendications 1 à 3, caractérisé en ce que la liaison entre la tige (6) et la pièce de serrage (5) est polyaxiale.4. Hook (1) according to one of claims 1 to 3, characterized in that the connection between the rod (6) and the clamping piece (5) is polyaxial.
5. Crochet (1 ) selon l'une des revendications 1 à 4, caractérisé en ce qu'il comporte des moyens permettant la connexion de deux crochets (1 ) situés sur les deux parties isthmiques d'une même vertèbre.5. Hook (1) according to one of claims 1 to 4, characterized in that it comprises means for connecting two hooks (1) located on the two isthmic parts of the same vertebra.
6. Crochet (1 ) selon la revendication 5, caractérisé en ce que lesdits moyens permettant la connexion de deux crochets (1 ) situés sur les deux parties isthmiques d'une même vertèbre comportent un appendice (14) orienté sensiblement perpendiculairement à la partie supérieure (3) du crochet (1 ), et comportant un orifice (15) destiné à être traversé par une tige de liaison (16) et des moyens de blocage de ladite tige de liaison (16) dans ledit orifice (15). 6. Hook (1) according to claim 5, characterized in that said means for connecting two hooks (1) located on the two isthmic parts of the same vertebra comprise an appendix (14) oriented substantially perpendicular to the upper part. (3) the hook (1), and having an orifice (15) to be traversed by a connecting rod (16) and locking means of said connecting rod (16) in said orifice (15).
7. Crochet (1 ) selon l'une des revendications 1 à 6, caractérisé en ce qu'il comporte également un crochet caudal (31 ) destiné à s'ancrer sur la partie caudale de la vertèbre.7. Hook (1) according to one of claims 1 to 6, characterized in that it also comprises a caudal hook (31) for anchoring on the caudal portion of the vertebra.
8. Crochet (1 ) selon l'une des revendications 1 à 7, caractérisé en ce que la tige (6) présente un filetage et en ce que l'orifice (7) du crochet (1 ) présente un filetage correspondant à celui de la tige (6), lesdits filetages constituant lesdits moyens anti-retour.8. Hook (1) according to one of claims 1 to 7, characterized in that the rod (6) has a thread and in that the hole (7) of the hook (1) has a thread corresponding to that of the rod (6), said threads constituting said non-return means.
9. Dispositif d'ostéosynthèse vertébrale, comportant au moins un élément longitudinal (10) et des éléments de fixation de cet élément longitudinal sur au moins deux vertèbres consécutives, caractérisé en ce qu'au moins un desdits éléments de fixation est un crochet (1 ) selon l'une des revendications 1 à 8.9. A device for vertebral osteosynthesis, comprising at least one longitudinal element (10) and fastening elements of this longitudinal element on at least two consecutive vertebrae, characterized in that at least one of said fastening elements is a hook (1). ) according to one of claims 1 to 8.
10. Dispositif d'ostéosynthèse vertébrale selon la revendication 9, caractérisé en ce qu'il comporte au moins deux crochets (1 ) selon la revendication 5 ou 6 destinés à être implantés sur une même vertèbre, et des moyens de connexion l'un à l'autre desdits crochets (1 ). 10. A vertebral osteosynthesis device according to claim 9, characterized in that it comprises at least two hooks (1) according to claim 5 or 6 intended to be implanted on the same vertebra, and means of connection one to the other of said hooks (1).
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP09738552A EP2288302A1 (en) | 2008-05-02 | 2009-05-04 | Hook for vertebral osteosynthesis device, and device including same |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR0852966 | 2008-05-02 | ||
FR0852966A FR2930719B1 (en) | 2008-05-02 | 2008-05-02 | HOOK FOR VERTEBRAL OSTEOSYNTHESIS DEVICE AND DEVICE COMPRISING SAME |
Publications (1)
Publication Number | Publication Date |
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WO2009133539A1 true WO2009133539A1 (en) | 2009-11-05 |
Family
ID=40056124
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IB2009/051819 WO2009133539A1 (en) | 2008-05-02 | 2009-05-04 | Hook for vertebral osteosynthesis device, and device including same |
Country Status (3)
Country | Link |
---|---|
EP (1) | EP2288302A1 (en) |
FR (1) | FR2930719B1 (en) |
WO (1) | WO2009133539A1 (en) |
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US8585741B2 (en) | 2007-07-19 | 2013-11-19 | DePuy Synthes Products, LLC | Clamps used for interconnecting a bone anchor to a rod |
FR3026634A1 (en) * | 2014-10-07 | 2016-04-08 | Assist Publique - Hopitaux De Paris | VERTEBRAL ATTACHMENT |
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JP2017213262A (en) * | 2016-06-01 | 2017-12-07 | ミズホ株式会社 | Bone retainer |
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US10441325B2 (en) | 2006-04-11 | 2019-10-15 | DePuy Synthes Products, Inc. | Minimally invasive fixation system |
US10888360B2 (en) | 2010-04-23 | 2021-01-12 | DePuy Synthes Products, Inc. | Minimally invasive instrument set, devices, and related methods |
US20230073858A1 (en) * | 2021-09-09 | 2023-03-09 | Truspine Technologies Limited | Non-intrusive bone anchor for use on vertebral laminar processes |
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JPWO2019030902A1 (en) * | 2017-08-10 | 2020-08-20 | ミズホ株式会社 | Bone anchoring device |
US11344333B2 (en) | 2017-08-10 | 2022-05-31 | Mizuho Corporation | Bone fixation device |
US20230073858A1 (en) * | 2021-09-09 | 2023-03-09 | Truspine Technologies Limited | Non-intrusive bone anchor for use on vertebral laminar processes |
Also Published As
Publication number | Publication date |
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FR2930719A1 (en) | 2009-11-06 |
EP2288302A1 (en) | 2011-03-02 |
FR2930719B1 (en) | 2011-03-25 |
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