WO2015003284A2 - Guide chirurgical de perforation - Google Patents

Guide chirurgical de perforation Download PDF

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Publication number
WO2015003284A2
WO2015003284A2 PCT/CH2014/000102 CH2014000102W WO2015003284A2 WO 2015003284 A2 WO2015003284 A2 WO 2015003284A2 CH 2014000102 W CH2014000102 W CH 2014000102W WO 2015003284 A2 WO2015003284 A2 WO 2015003284A2
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WO
WIPO (PCT)
Prior art keywords
perforation guide
drill
surgical perforation
bone
surgical
Prior art date
Application number
PCT/CH2014/000102
Other languages
English (en)
Other versions
WO2015003284A3 (fr
Inventor
Paul Pavlov
Tom Overes
Original Assignee
RIOS Medical AG
IGNITE-concepts GmbH
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 RIOS Medical AG, IGNITE-concepts GmbH filed Critical RIOS Medical AG
Priority to CN201480002607.1A priority Critical patent/CN104869919A/zh
Priority to KR1020157011776A priority patent/KR101714285B1/ko
Priority to JP2015549910A priority patent/JP6095800B2/ja
Publication of WO2015003284A2 publication Critical patent/WO2015003284A2/fr
Publication of WO2015003284A3 publication Critical patent/WO2015003284A3/fr

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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
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/151—Guides therefor for corrective osteotomy
    • A61B17/152—Guides therefor for corrective osteotomy for removing a wedge-shaped piece of bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body

Definitions

  • the invention relates to a surgical perforation guide, in particular for performing open wedge and closing wedge osteotomies of the knee.
  • Knee osteotomy is a surgical method used to realign the Mikulicz-line of the large joints of the lower limb, namely the hip, knee and ankle. With normal axial alignment of the limb the centre of the hip, the inter-condylar eminence of the tibial plateau and the centre of the ankle joint are in one line, the so-called Mikulicz-line, the mechanical axis of the lower limb.
  • knee osteotomy surgical technique Due to, for example, arthritic damage on one side of the knee, born misalignment, or trauma injury, this alignment can be disturbed and cause excessive wear of the knee cartilage. This is also known as knee-arthrosis.
  • the purpose of the knee osteotomy surgical technique is to re-balance the forces in the knee away from a damaged area to an opposite, healthier area of the knee. This allows better distributing the forces generated by the patient's weight and muscles over the knee joint.
  • Two techniques are common clinical practice, namely the opening wedge osteotomy and the closing wedge osteotomy. Both techniques aim to partly or fully re-establish the aforementioned Mikulicz-line.
  • a wedge of bone is removed under the tibial plateau.
  • the tibial plateau is subsequently pulled down to close the gap and fixated with traumatology plates and screws.
  • a horizontal bone cut is made under the tibia plateau over about 80% of the surface area.
  • a wedge shaped spacer is then inserted.
  • the tibial plateau is therefore forced up on one side such as to correct the leg axis.
  • the wedge shaped spacer can be made of natural bone, artificial bone or other biocompatible or osteointegrative materials.
  • the spacer is usually fixated to the bone by means of plates and screws
  • US 7,185,645 discloses an apparatus providing guiding surfaces for a planar cutting tool, such as an oscillating bone saw.
  • the cutting tool is thereby guided by the tangential surfaces of a plurality of pin members located internally within the bone to be corrected. Two or more of the pin members define an intended plane of a resected surface to be created by the cutting tool.
  • US 2008/0262500 A1 (Howmedica Osteonics Corp.) describes a cutting guide for performing a bone osteotomy procedure having a first arm with a first guiding surface formed therein as well as a second arm with a second guiding surface formed therein.
  • the first and second arms are pivotably connected with each other.
  • the cutting guide surfaces may comprise rounded grooves forming a drill guide allowing the guidance of a drill into the bone when said two arms are in a closed position.
  • US 5,021 ,056 discloses a method and apparatus for performing osteotomy.
  • the apparatus comprises a first guide assembly with a pair of mirror clamp arm assemblies each including a clamp plate.
  • the clamp arms are freely slidable along the first guid assembly.
  • the clamp plates each feature a plurality of bores as well as a guide slot for a cutting tool.
  • a first cut is made in the bone through the guide slot, whereby the clamp plates are stabilized by bone fasteners inserted into said plurality of bores.
  • the first guide assembly is removed and a second guide assembly is arranged on said bone, wherein a flat blade element is inserted into the cut of the bone.
  • the second guide assembly comprises several guide slots allowing the formation of cuts with different angles to said first cut for creating an appropriate wedge in said bone.
  • the surgical perforation guide is intended to be fixated against a target bone and comprises at least one first elongated slot or at least one protrusion defining a first osteotomy plane.
  • the surgical perforation guide includes multiple drill guiding bores each with a diameter and a central axis, wherein the central axes of the multiple drill guiding bores lie parallel to the first osteotomy plane and the diameter of each of the multiple drill guiding bores intersect said first osteotomy plane.
  • each of the multiple drill guiding bores comprises a drill seat providing a stop surface for a drill, wherein each of said stop surfaces limits the drill depth to a specific required drilling depth for each of said multiple drill guiding bores.
  • the drill seats also allow to precisely control the depth of the holes drilled into the bone, such that the bone may be locally weakened sufficiently to increase its flexibility to avoid the occurrence of iatrogenic fractures when the surgeon opens or closes the wedge.
  • the surgical perforation guide preferably comprises a rigid body, more preferably configured as a block of biocompatible material, such as stainless steel, titanium or a biocompatible polymer, for example polyetheretherketone (PEEK) or polylactic acid (PLA).
  • PEEK polyetheretherketone
  • PPA polylactic acid
  • Said rigid body preferably is shaped generally in the form of a cuboid having one face adapted to be placed in contact with the target bone, e.g. having an appropriate curvature, wherein said bone contacting face has a length which approximately corresponds to the size of a lateral side of a tibia.
  • the at least one first elongated slot provides two guiding surfaces for a planar cutting tool, such as a saw blade for a reciprocating bone saw. Hence, the at least one first elongated slot allows to guide the planar cutting tool precisely along said first osteotomy plane.
  • the thickness of the at least one elongated slot is preferably selected to match the thickness of a saw blade.
  • the surgical perforation guide may comprise at least one protrusion, wherein said protrusion is preferably adapted to be insertable into a cut in a bone.
  • the at least one protrusion allows precisely aligning the surgical perforation guide into a cut, e.g. made by means of a bone saw.
  • each of said drill guiding bores includes said first osteotomy plane.
  • the multiple drill guiding bores are arranged on said surgical perforation guide such that their axes lie within said first osteotomy plane.
  • the axes of said multiple drill guiding bores may also be offset from said first osteotomy plane, however not more than half their diameter.
  • offset means a distance from the first osteotomy plane in a direction which is perpendicular to said first osteotomy plane.
  • the axes of all said drill guiding bores are not only parallel to said first osteotomy plane, but also all parallel to each other.
  • at least one of said drill guiding bores may have an axis which is at an angle to the axes of the remainder of said drill guiding bores.
  • all axes of said drill guiding bores are offset from said first osteotomy plane by the same distance.
  • at least one of said drill guiding bores may be offset by a distance which is smaller or larger than the distance the axes of the remaining drill guiding bores is offset from said first osteotomy plane.
  • all of the multiple drill guiding bores are evenly distributed over the length of the bone contacting face, i.e. all of the multiple drill guiding bores are spaced from each other by the same distance.
  • the distance between two neighbouring drill guiding bores may vary along the length of the bone contacting face.
  • the surgical perforation guide comprises from 2 to 20 drill guiding bores, more preferably from 4 to 10 drill guiding bores.
  • the drill guiding bores preferably have a diameter ranging from 1.2 to 4.0 mm.
  • any drills to be used in connection with the present surgical perforation guide have matching diameters.
  • the drill seats are preferably configured as surfaces cooperating with corresponding stop seats on a drill, hence physically blocking further advancement of the drill by a surgeon.
  • the specific required drilling depth for each drill guiding bore varies depending on the area of the target bone in which the osteotomy is carried out. Typically, the required drilling depth is smaller for drill guiding bores located towards the side of the surgical perforation guide, as these will concurrently be arranged on the sides of the target bone, while the required drilling depth is larger for drill guiding holes located at the centre of the surgical perforation guide.
  • the required drilling depth of the multiple drill guiding bores is dependent on the type of target bone and location of the osteotomy, e.g. proximal tibia, distal femur, proximal femur, etc.
  • the size of the patient to be treated and hence the individual size of her or his bones also influences the required drilling depth for each of the multiple drill guiding bores.
  • each drill seat is arranged on said perforation guide to limit the drill depth depending on patient specific data. More preferably, the required drilling depth of each of said multiple drill guiding bores corresponds to the distance to the cortex of the bone lying opposite of the fixation side of the surgical perforation guide.
  • the patient specific data preferably are imaging data gathered prior to the surgical procedure, e.g. by means of X-ray computed tomography (CT-scan), magnetic resonance imaging (MRI-scan) or 3D X-ray imaging. According to this patient specific imaging data, it is possible to determine the optimal required drilling depth for each of the multiple drill guiding bores.
  • the surgical perforation guide according to the present invention is custom made for each patient.
  • said surgical perforation guide further comprises a face for contacting the target bone, said bone contacting face having a shape matching the outer shape of said target bone.
  • the shape is preferably adapted according to patient specific data, preferentially imaging data gathered prior to the surgical procedure.
  • said bone contacting face is either machined to feature the right shape or that the surgical perforation guide is custom made for each patient.
  • Said surgical perforation guide preferably includes at least one elongated slot and an outer face providing a guiding surface for a saw blade to limit a resection depth of said saw blade within said bone.
  • the outer face is thereby arranged on the side opposite of said bone contacting face and configured to act as a stop surface for a blade seat located on a saw blade.
  • the shape is thereby chosen such as to impart an optimal geometry of a cut made with a saw blade in said target bone.
  • said outer face is concave. Such geometry of the outer face yields a cutting depth of a saw blade within the target bone which is less deep towards the sides of the bone and deeper towards the centre of the bone.
  • the shape of the outer face is configured such that the resection depth varies along said at least one elongated slot, preferably depending on patient specific data.
  • the shape of said outer surface is configured such that by cooperation with a blade seat of a bone saw blade, the geometry of a cut made by said bone saw blade is optimized for the target bone of the patient.
  • the shape of said outer surface is most preferably determined on the basis of patient specific data, preferably of patient specific imaging data.
  • the surgical perforation guide preferably comprises a first elongated slot and a second elongated slot, said second elongated slot defining a second osteotomy plane which is arranged at an angle to said first elongated slot, wherein the second elongated slot is configured such that said second osteotomy plane intersects said first osteotomy plane within said bone.
  • Provision of the second elongated slot allows the precise cutting of the target bone along said second osteotomy plane, hence yielding two cuts arranged in a wedge shape.
  • said angle of said second elongated slot as well as the position of said second elongated slot on said surgical perforation guide is chosen according to patient specific data, preferably of patient specific imaging data, such as to allow the precise cutting of a wedge which will result in an optimal re-alignment of the Mikulicz-line once the wedge is removed.
  • the surgical perforation guide comprises a multitude of protrusions, said protrusions being sized and shaped such as to be inserted into a resection cut of said target bone.
  • Such a configuration of the surgical perforation guide may be used when performing closing wedge osteotomies, as the placement of the multitude of protrusions into a cut allows precisely aligning the surgical perforation guide with said cut.
  • a surgeon may precisely place drill holes into the target bone, as the drill guiding bores will also be precisely placed at the right position.
  • the surgical perforation guide preferably further comprises at least one fastener receiving hole.
  • bone fasteners e.g. bone screws
  • the surgical perforation guide may be firmly attached to the target bone.
  • the present application further relates to a kit comprising at least one surgical perforation guide according to the present invention and at least one drill with a stop seat.
  • the stop seat of the drill is configured such as to cooperate with the drill seat of said drill guiding bores.
  • the stop seat is thereby arranged at a fixed distance from the drill tip.
  • said kit may comprise several drills, each drill having the stop seat arranged at a different distance from said drill tip.
  • said at least one drill may comprise at least one marking arranged at a defined distance from the drill tip. In this case a surgeon may determine whether the specific required drilling depth is reached once the marking is congruent with said drill seat.
  • said kit further comprises at least one saw blade having a protrusion defining a blade seat.
  • said kit further comprises at least one saw blade having a protrusion defining a blade seat.
  • the cooperation of the blade seat with said outer face shape yields a cut having a defined geometry mainly corresponding to the shape of the outer face in the first osteotomy plane.
  • the present application further relates to a method for producing of a surgical perforation guide, preferably according to the present invention.
  • a first step the position of and the required drilling depth for each of the multiple drill guiding holes is defined according to patient specific data. Said patient specific data preferably are patient specific imaging data.
  • the position of the drill seat for each of said multiple of drill guiding bores is determined according to the required drilling depth.
  • the surgical perforation guide is produced. The production is preferably carried out by a machining or additive manufacturing technique.
  • Additive manufacturing techniques comprise, amongst others, selective laser sintering, direct metal sintering, selective laser melting, selective heat sintering, electron beam freeform fabrication and fused deposition modelling.
  • a rigid body may be produced by an additive manufacturing technique and subsequently subjected to a machining process, e.g. to produce the drill guiding bores or the at least one first elongated slot.
  • said method further comprises the step of defining the shape of the face for contacting the target bone by determining the shape of the intended contact zone of the target bone from patient specific imaging data prior to said production step.
  • said method further comprises the step of defining the shape of the outer face according to the necessary resection depth from patient specific imaging data prior to said production step.
  • FIG. 1a, 1 b A closing wedge osteotomy of the knee-joint
  • Figs. 2a, 2b an opening wedge osteotomy of the knee-joint
  • Figs. 3a, 3b examples of iatrogenic fractures
  • FIGs. 4a - 4c different views of a first embodiment of a surgical perforation guide according to the present Invention
  • Figs, 0a, 6b alternative embodiments of a drill to be used in connection with a surgical perforation guide according to the present invention
  • Figs. 7a, 7b alternative embodiment of a saw blade to be used in connection with a surgical perforation guide according to the present invention
  • Ffg. 8 relevant anatomical landmarks for the design and dimensioning of a surgical perforation guide according to the present invention
  • Figs. 9a - 9c surgical steps for usage of the surgical perforation guide according to Fig. 4a;
  • FIG. 10a - 10c drilling steps with a surgical perforation guide according to the present invention
  • Fig. 1 1 a cut-away view of the drilling
  • Figs. 12a - 12b sawing steps with a surgical perforation guide according to the present invention
  • Fig. 13 a cross-sectional of the sawing
  • Fig. 14 a second embodiment of a surgical perforation guide according to the present invention.
  • Figs. 15a, 15b a third embodiment of a surgical perforation guide according to the present invention.
  • Figs. 16a, 16b an alternative embodiment of a surgical perforation guide.
  • the same components are given the same reference symbols.
  • Figs. 1 a and 1 b show a closing wedge osteotomy for the knee-joint.
  • the femur 100 and tibia 101 interact at the knee joint 102.
  • a first planar resection 104 is made below the joint 102, over approximately 60-90% of the cross-section surface area through the proximal tibia at a defined resection plane.
  • a second planar resection 107 is made at an angle to the first planar resection 104. Both said first planar resection 104 and said second planar resection 107 define a wedge 103.
  • This wedge 103 is subsequently removed and the proximal tibia plateau is pushed down distally to re-establish the mechanical axis 106 (Mikulicz-line) and fixated with e.g. a plate and screws (not shown).
  • Figs. 2a and 2b depict an opening wedge osteotomy.
  • a first planar resection 104 is made.
  • a bone wedge 105 is then inserted into the first planar resection 104.
  • the bone wedge 105 will lift the tibia plateau on the medial side and re-establish the correct mechanical axis 106 (Mikulicz-line).
  • the bone wedge 105 is fixated in place using e.g. plates and screws (not shown).
  • the uncut cortex adapts itself to the repositioning of the tibia plateau by natural flexibility such as elastic and plastic deformation. If the uncut cortex is not flexible enough and the stresses exerted thereon become too high, the tibial plateau may crack.
  • iatrogenic fractures 107 which may occur during osteotomies are shown.
  • Such iatrogenic fractures 107 may be the result of lifting or pulling down the proximal tibia plateau.
  • such iatrogenic fractures 107 are due to insufficient flexibility in the un-resected bone-area 108 due to material properties of the bone material (E-module & elasticity).
  • such iatrogenic fractures 107 may also result if the resection depth 1 10 of said first planar resection 104 is too short, such that the remaining un-resected bone-area 108 exhibits a strong resilience against any bending force.
  • Fig. 4a shows an exemplary embodiment of a surgical perforation guide 200 according to the present invention.
  • the surgical perforation guide 200 comprises a rigid body 210 which generally has a cuboid shape.
  • the rigid body has a bone contacting face 204 for contacting a target bone.
  • Said bone contacting face 204 preferably exhibits a shape corresponding to the outer shape of the area of the target bone where the osteotomy is to be carried out.
  • the surgical perforation guide 200 comprises a outer face 205.
  • the outer face 205 is the side of the surgical perforation guide 200 which faces a surgeon during a procedure.
  • An elongated first slot 201 spans from said outer face 205 to said bone contacting face 204 and provides two guiding surfaces for a planar cutting tool, such as a saw blade of a reciprocating bone saw.
  • the surgical perforation guide 200 includes seven drill guiding bores 202a - 202z.
  • the indexes a to z are used to identify multiple entities of the same feature, without implying any specific restriction on the number of said entities.
  • Each of said drill guiding bores 202a - 202z have a central axis X which is parallel to a first osteotomy plane A defined by said first elongated slot 201. For reasons of simplicity, only one central axis X is shown.
  • each of the drill guiding bores 202a - 202z are parallel to said first osteotomy plane A. Further, in this embodiment, the central axes X of all of the drill guiding bores 202a - 202z are congruent with said first osteotomy plane A. Further, each of the drill guiding bores 202a - 202z includes a drill seat 203a - 203z recessed from said outer face 205.
  • the drill seats 203a - 203z provide a stop surface for a drill inserted into said drill guiding bores 202a - 2Q2z, By varying the position of each of the drill seats 203a - 203z, it is possible to define a specific drilling depth for each of the multiple drill guiding bores 202a - 202z.
  • the surgical perforation guide comprises two fastener receiving holes 221a, 221 b.
  • the fastener receiving holes 221a, 221b are configured to receive bone fasteners to attach said surgical perforation guide 200 to a target bone.
  • Fig. 4b shows the surgical perforation guide 200 according to Fig. 4a from another perspective
  • Hg. 4c shows the surgical perforation guide 200 from the bone contacting face 204.
  • figures 5 to 15 Is made in relation to an opening wedge osteotomy, meaning the partial resection is made from the medial side of the tibia towards the lateral side.
  • the resection guide is thereby fixated to the antero-medial side of the proximal tibia, and the lateral cortex of the tibia is being perforated to weaken the cortical bone to allow lifting of the tibial plateau.
  • medial For the closing wedge technique, medial must be read as lateral, lateral as medial, forcing up as forcing down.
  • Fig. 5 shows the bone surface areas of the tibia 300 which are relevant for designing and manufacturing a surgical perforation guide 200, e.g. as shown in Figs. 4a to 4c.
  • the shape of the outer face 205 defines the resection depth 1 10, as described in greater detail later.
  • the relevant data of the bone surfaces may be gathered by CT-scan, MRI-scan or 3D X-ray imaging.
  • the shape of the bone contacting face 204 is configured as negative image of the antero medial side 301 of tibia 300 and therefore mates with the shape of the surface of said antero- medial side 301. As a person having skill in the art understands, this shaping of the bone contacting face 204 allows an exact positioning of the surgical perforation guide 200 during surgery based on pre-operative planning and patient specific data.
  • the lateral side of tibia 300 is documented to define the required drilling depth for each drill guiding bore 202a - 202z to perforate the lateral cortex 303 on the opposite side of the tibia 300.
  • the perforations ideally reach through the lateral cortex 303 but not much deeper as the outer cortex. A deeper penetration could cause damage to the soft tissue structures, such as for example muscles, arteries or nerves beside the lateral cortex 303.
  • a preferred embodiment of a drill 400 to be used in connection with a surgical perforation guide 200 according to the present invention is shown.
  • Said drill 400 has a calibrated drilling length 401 , defined by a stop seat 402.
  • the stop seat 402 will hit the drill seat 203a-203z of the drill guiding bore 202a - 202z into which the drill 400 is inserted, thus stopping any further advancement of the drill 400 into the bone, hence limiting the physically possible drill depth to the specific required drilling depth of said drill guiding bore 202a - 202z.
  • Fig. 6b shows an alternative embodiment of drill 400 with a calibrated drilling length 401 defined by a marking 403.
  • a surgeon has to optically determine when to stop drilling.
  • FIG. 7a shows a preferred embodiment of a saw blade 500 to be used in connection with an inventive surgical perforation guide 200.
  • the saw blade 500 has a calibrated sawing length 501 defined by a fix blade seat 502.
  • the blade seat 502 hits the outer face 205 of the surgical perforation guide 200, hence physically limiting the depth a surgeon may saw into the bone.
  • the saw blade 500 has a thickness 503 which corresponds to the thickness of the first elongated slot 201.
  • the saw blade 500 has saw teeth 504 at one end as well as a coupling structure 505 at an opposite end.
  • the coupling structure 505 allows attaching the saw blade 500 to a bone saw.
  • Figure 7b shows an alternative embodiment of the saw blade 500.
  • the saw blade 500 comprises a marking 503 which defines the calibrated sawing-length 501.
  • the surgeon has to optically determine when to stop sawing.
  • Fig. 8 shows the relevant anatomical landmarks for the design and dimensioning of the surgical perforation guide 200.
  • a partial resection 316 within the tibia 300 is planned for correcting the mechanical axis 106 as shown in Figs. 1 a and 1 b.
  • the interpretation of all anatomical variables and landmarks for defining a correct plane for partial resection 316 are part of the education taken and experience gained by surgeons performing these interventions, and therefore are not part of this description.
  • the necessary resection depth 1 10 of the preoperative ⁇ planned partial resection 316, the calibrated drill length 401 of drill 400 and the calibrated sawing length 501 of saw blade 500 define the design of the surgical perforation guide 200, specifically the placement of the seats 203a - 203z for controlling the required drilling depth, the shape of the outer face 205 for controlling the resection depth and the shape of the bone contacting face 204 for facilitating an unambiguous positioning.
  • Step 3 and 4 may also be executed in a reverse order. Steps 1 and 2 are depicted in Figs. 9a to 9c.
  • the surgical perforation guide 200 is placed by a surgeon onto the antero medial side 301 of the tibia 300, as shown in Fig. 9a.
  • the bone contacting face 204 has a shape which matches the shape of said antero medial side 301.
  • the shape of the bone contacting face 204 preferably has been formed using patient specific data.
  • the matching of the shape of the bone contacting face 204 with the outer shape of the antero medial side 301 of the tibia 300 helps to correctly place the surgical perforation guide 200 on the antero medial side 301 , as shown in Fig. 9b.
  • Fig. 9b the matching of the shape of the bone contacting face 204 with the outer shape of the antero medial side 301 of the tibia 300 helps to correctly place the surgical perforation guide 200 on the antero medial side 301 , as shown in Fig. 9b.
  • Fig. 9b the matching of the shape of the bone contacting face 204 with the outer
  • two bone fixation elements 220a, 220b are inserted through the two fastener receiving holes 221 a, 221 b and screwed into the bone material of the tibia 300, such as to securely anchor the surgical perforation guide 200 onto the tibia 300, as shown in Fig. 9d.
  • a drill 400 with the effective drilling length 401 and drills through the drill guiding bores 202a-202z until the stop seat 402 of the drill 400 collides with the respective drill seat 203a-203z, as shown in Fig. 10b.
  • the surgical perforation guide 200 especially in the case where the drill seats 203a - 203z have been arranged in said surgical perforation guide 200 according to patient specific data, the lateral cortex 303 is being perforated by the drill holes 310a - 310z, however without that any soft tissue neighbouring said lateral cortex 303 is being damaged.
  • the lateral cortex 303 is perforated, as shown in Fig. 10c, and hence weakened, which increases its flexibility.
  • the increased flexibility reduces the risk of iatrogenic fracture when the wedge is forced open by the surgeon.
  • the number of required perforations for preventing the occurrence of iatrogenic fractures depends mainly on the following variables: bone quality, size of tibial plateau, resection depth 1 10, diameter of the drill 400, and amount of correction of the mechanical axis 106.
  • Fig. 1 1 shows the situation according to Fig. 10c in a sectional view.
  • the drill seats 203a - 203z are all positioned differently in said surgical perforation guide, resulting in a somewhat steplike arrangement of the drill seats 203a - 203z relative to each other, as is emphasized by the broader line in Fig. 1 1.
  • the stop seat 402 of the drill 400 cooperates with the drill seats 203a - 203z to restrict the drill depth to the specific required drilling depth 312 for each of the multiple drill guiding bores 202a - 202z.
  • said restriction avoids any damage to soft tissue as the drill 400 may not be advanced further by the surgeon.
  • Fig. 12a shows the next step, in which a saw blade 500 is inserted into the elongated slot 201. By means of the saw blade 500, the surgeon may saw a cut 31 1 into the tibia 300, as shown in Fig. 12b. By cooperation of a blade seat 502 with the outer face 205 of the surgical perforation guide, the depth of the cut 31 1 is kept at a pre-operatively defined maximal desired depth within the tibia 300.
  • FIG. 13 shows a cross-sectional representation of the situation according to Fig. 12b.
  • the sectional plane is thereby located in the first osteotomy plane.
  • the geometry of the cut 31 1 in the tibia 300 corresponds essentially to the shape of the outer face 205, as the saw teeth 504 of the saw blade 500 may not be inserted deeper into the tibia 300 than the calibrated sawing length 501.
  • Fig. 14 shows another embodiment of a surgical perforation guide 200 according to the present invention.
  • the surgical perforation guide according to this embodiment comprises a second elongated slot 240 which defines a second osteotomy plane B.
  • the axes X of the drill guiding bores 202a - 202z are parallel to said first osteotomy plane A, while the second osteotomy plane B is arranged at an angle to said first osteotomy plane A.
  • Both osteotomy planes A, B intersect at a line 315 which is located within the target bone during surgery.
  • the surgical perforation guide 200 does not comprise an elongated slot 201 but instead a plurality of protrusions 250 arranged on the bone contacting face 204.
  • Protrusions 250 are arranged parallel to each other and define a first osteotomy plane A.
  • the multiple drill guiding bores 202a - 202z are arranged such that their axes are parallel to said first osteotomy plane A.
  • the thickness 251 of the protrusions 250 is chosen such that the protrusions 250 may be inserted into a resection cut 31 1.
  • FIGs. 16a and 16b show an alternative embodiment of a surgical perforation guide 200 which is not part of the present invention.
  • the elongated slot 201 defining the first osteotomy plane A is not parallel with the axes X of the drill guiding bores 202a - 202z (of which only one drill guiding bore 202 is shown).
  • the axes X as well as the elongated slot 201 are arranged such that they intersect at a line 315 which is located within the target bone during surgery.
  • the surgical perforation guide 200 also comprises a second elongated slot 240 which defines a second osteotomy plane B.
  • the second elongated slot 240 is arranged such that the second osteotomy plane B intersects with the first osteotomy plane A at line 315.
  • the second osteotomy plane B further intersects the axes X of the drill guiding bores 202a - 202z at line 315.
  • Fig. 16b shows the surgical perforation guide 200 according to the embodiment as shown in Fig. 16a from the bone contacting face 204.
  • the drill guiding bores 202a - 202z (of which only one drill guiding bore 202 is shown) are all arranged on a single line, which is spaced from the first elongated slot 201 and the second elongated slot 240.
  • the positions of the two fastener receiving holes 221 a, 221 b are also well recognizable in this figure.
  • Such a surgical perforation guide is specifically suited for a closing wedge osteotomy, as it allows cutting two cuts inclined to each other into the target bone, said cuts defining a wedge of bone to be subsequently removed from the target bone.

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  • Orthopedic Medicine & Surgery (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un guide (200) chirurgical de perforation à fixer contre un os cible. Ledit guide (200) chirurgical de perforation comprend au moins une première fente allongée (201) ou au moins une saillie (250) définissant un premier plan d'ostéotomie (A) et de multiples trous de guidage (202a à 202z) de foret. Les multiples trous de guidage (202a à 202z) de foret présentent un diamètre et un axe centrale (X), les axes centraux (X) des trous de guidage (202a à 202z) de foret s'étendant parallèlement audit premier plan d'ostéotomie (A). Le diamètre des multiples trous de guidage (202a à 202z) de foret coupe le plan d'ostéotomie (A). Chacun des multiples trous de guidage (202a à 202z) de foret comprend un siège (203a à 203z) de foret procurant une surface de butée pour un foret (400), ledit siège (203a à 203z) de foret limitant la profondeur de perçage à une profondeur de perçage (312) requise spécifique pour chacun des multiples trous de guidage (202a à 202z) de foret.
PCT/CH2014/000102 2013-07-12 2014-07-11 Guide chirurgical de perforation WO2015003284A2 (fr)

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CN201480002607.1A CN104869919A (zh) 2013-07-12 2014-07-11 外科手术穿孔导引件
KR1020157011776A KR101714285B1 (ko) 2013-07-12 2014-07-11 외과천공가이드
JP2015549910A JP6095800B2 (ja) 2013-07-12 2014-07-11 外科的穿孔ガイド

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CH1251/13 2013-07-12
CH12512013 2013-07-12

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WO2015003284A2 true WO2015003284A2 (fr) 2015-01-15
WO2015003284A3 WO2015003284A3 (fr) 2015-04-09

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WO (1) WO2015003284A2 (fr)

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JP2017047167A (ja) * 2015-09-02 2017-03-09 ライト メディカル テクノロジー インコーポレイテッドＷｒｉｇｈｔ Ｍｅｄｉｃａｌ Ｔｅｃｈｎｏｌｏｇｙ， Ｉｎｃ． 両面楔状骨切り術のための方法および切断ガイド
EP3488800A1 (fr) * 2017-11-22 2019-05-29 A Plus Biotechnology Company Limited Dispositif d'ostéotomie universel
CN110353760A (zh) * 2019-07-26 2019-10-22 盛珺 一种用于骨搬运胫骨截骨的引导板
TWI686166B (zh) * 2018-03-19 2020-03-01 愛派司生技股份有限公司 截骨手術限位裝置
USD943100S1 (en) 2020-02-18 2022-02-08 Laboratoires Bodycad Inc. Osteotomy plate
USD948719S1 (en) 2019-10-21 2022-04-12 Laboratoires Bodycad Inc. Posterior stabilizer for an osteotomy plate
US11517333B2 (en) 2018-08-24 2022-12-06 Laboratoires Bodycad Inc. Predrilling guide for knee osteotomy fixation plate
US11589876B2 (en) 2018-08-24 2023-02-28 Laboratoires Bodycad Inc. Surgical guide assembly for performing a knee osteotomy procedure
US11596421B2 (en) 2017-08-24 2023-03-07 Limacorporate S.P.A. Ankle arthroplasty system and methods
US11622801B2 (en) 2018-08-24 2023-04-11 Laboratoires Bodycad Inc. Patient-specific fixation plate with wedge member for knee osteotomies
US11701150B2 (en) 2018-08-24 2023-07-18 Laboratoires Bodycad Inc. Patient-specific fixation plate with spacing elements
US11819278B2 (en) 2018-08-24 2023-11-21 Laboratoires Bodycad Inc. Surgical kit for knee osteotomies and corresponding preoperative planning method
US11857206B2 (en) 2018-08-24 2024-01-02 Laboratoires Bodycad Inc. Patient-specific surgical tools
US11931106B2 (en) 2019-09-13 2024-03-19 Treace Medical Concepts, Inc. Patient-specific surgical methods and instrumentation
US11986251B2 (en) 2019-09-13 2024-05-21 Treace Medical Concepts, Inc. Patient-specific osteotomy instrumentation

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CN110477997A (zh) * 2019-09-17 2019-11-22 上海交通大学医学院附属第九人民医院 一种用于腓骨瓣塑形手术的可控制截骨深度的3d打印导板

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AU2016216179B2 (en) * 2015-02-05 2018-10-25 Ossability Limited A surgical guide
WO2016126168A1 (fr) * 2015-02-05 2016-08-11 Ossability Limited Guide chirurgical
US10682195B2 (en) 2015-02-05 2020-06-16 Ossability Limited Surgical guide
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JP2017047167A (ja) * 2015-09-02 2017-03-09 ライト メディカル テクノロジー インコーポレイテッドＷｒｉｇｈｔ Ｍｅｄｉｃａｌ Ｔｅｃｈｎｏｌｏｇｙ， Ｉｎｃ． 両面楔状骨切り術のための方法および切断ガイド
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US11712254B2 (en) 2015-09-02 2023-08-01 Wright Medical Technology, Inc. Method and cut guide for biplanar wedge osteotomy
US11596421B2 (en) 2017-08-24 2023-03-07 Limacorporate S.P.A. Ankle arthroplasty system and methods
EP3488800A1 (fr) * 2017-11-22 2019-05-29 A Plus Biotechnology Company Limited Dispositif d'ostéotomie universel
TWI686166B (zh) * 2018-03-19 2020-03-01 愛派司生技股份有限公司 截骨手術限位裝置
US11857206B2 (en) 2018-08-24 2024-01-02 Laboratoires Bodycad Inc. Patient-specific surgical tools
US11819278B2 (en) 2018-08-24 2023-11-21 Laboratoires Bodycad Inc. Surgical kit for knee osteotomies and corresponding preoperative planning method
US11517333B2 (en) 2018-08-24 2022-12-06 Laboratoires Bodycad Inc. Predrilling guide for knee osteotomy fixation plate
US11589876B2 (en) 2018-08-24 2023-02-28 Laboratoires Bodycad Inc. Surgical guide assembly for performing a knee osteotomy procedure
US11622801B2 (en) 2018-08-24 2023-04-11 Laboratoires Bodycad Inc. Patient-specific fixation plate with wedge member for knee osteotomies
US11701150B2 (en) 2018-08-24 2023-07-18 Laboratoires Bodycad Inc. Patient-specific fixation plate with spacing elements
CN110353760A (zh) * 2019-07-26 2019-10-22 盛珺 一种用于骨搬运胫骨截骨的引导板
CN110353760B (zh) * 2019-07-26 2023-12-22 中国人民解放军西部战区总医院 一种用于骨搬运胫骨截骨的引导板
US11931106B2 (en) 2019-09-13 2024-03-19 Treace Medical Concepts, Inc. Patient-specific surgical methods and instrumentation
US11986251B2 (en) 2019-09-13 2024-05-21 Treace Medical Concepts, Inc. Patient-specific osteotomy instrumentation
USD948719S1 (en) 2019-10-21 2022-04-12 Laboratoires Bodycad Inc. Posterior stabilizer for an osteotomy plate
USD943100S1 (en) 2020-02-18 2022-02-08 Laboratoires Bodycad Inc. Osteotomy plate

Also Published As

Publication number Publication date
JP6095800B2 (ja) 2017-03-15
WO2015003284A3 (fr) 2015-04-09
CN104869919A (zh) 2015-08-26
KR101714285B1 (ko) 2017-03-08
KR20150068432A (ko) 2015-06-19
JP2016501644A (ja) 2016-01-21

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