WO2016055958A1 - Instrument that can be used when fitting a shoulder prosthesis or a prosthetic element on a humerus - Google Patents
Instrument that can be used when fitting a shoulder prosthesis or a prosthetic element on a humerus Download PDFInfo
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- WO2016055958A1 WO2016055958A1 PCT/IB2015/057689 IB2015057689W WO2016055958A1 WO 2016055958 A1 WO2016055958 A1 WO 2016055958A1 IB 2015057689 W IB2015057689 W IB 2015057689W WO 2016055958 A1 WO2016055958 A1 WO 2016055958A1
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- Prior art keywords
- block
- instrument
- positioning piece
- pin
- positioning
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—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
- A61B17/1778—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the shoulder
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
Definitions
- the present invention relates to an instrument that can be used during the placement of a shoulder prosthesis or a prosthetic element on a humerus.
- shoulder prosthesis should be broadly understood to mean a set of elements including a piece intended to be anchored to the humerus, whether it is a medullary stem or a metaphyseal anchorage base, requiring a cut of the native humeral head.
- prosthetic element must be understood in the same way, as denoting any implantable element not constituting, strictly speaking, a prosthesis, and not requiring the cutting of the native humeral head. Such a prosthetic element is in particular a resurfacing part of this head.
- a shoulder prosthesis involves cutting the native humeral head at the boundary between the cartilage and the cortical bone, that is, in practice, at the level of the base the portion of the head substantially shaped spherical cap.
- the installation of a prosthetic resurfacing element does not generally involve cutting the humeral head but the establishment of a guide pin at the polar zone of the head, in order to drill a hole. allowing the anchoring position of said prosthetic element.
- a cutting guide positioned against the bone by means of proximal pins. This positioning is done using anatomical visual cues and involves the successive use of several instruments. The use of such a cutting guide is therefore relatively long and difficult, and the correct positioning of the cutting guide is largely based on the experience of the practitioner. The risk of making a cut whose inclination is not perfect in the sagittal plane and / or in the frontal plane is notable, with possible consequences on the quality of the restoration of the joint and the longevity of the joint. prosthetic joint.
- Another technique for making the cut of a humeral head is to set up a pin along the centromedullary axis of the humerus, for positioning a cutting guide. With such a guide, the inclination of the cut remains carried out judged, and the risk of making a non-perfect cut exists in the same way.
- a third existing technique is to set up a guide pin in the polar zone of said spherical cap and use a cutting guide including a hollow sphere portion of wall coming to marry said spherical cap, positioned by means of this pin.
- Such a cutting guide has the disadvantage of not allowing to guide perfectly the cutting blade during cutting and not be adapted to the different dimensions that can present the humeral heads according to gender or age of the patient.
- Patent Application No. WO 2014/1 10421 A1 describes an instrument that can be used when a shoulder prosthesis or a prosthetic element is placed on a humerus, comprising a positioning piece enabling positioning the instrument with respect to the head of the humerus, and a bone pin guide block pivotably connected to each other; the positioning piece including a curved branch extending over an arc; the guide block comprises pivoting connection means for assembling this positioning part and this block, and comprises two pin guide ducts adapted to receive bone pins in an adjusted manner.
- the present invention aims to remedy all of the aforementioned drawbacks of existing instruments. It therefore has the main objective of providing an instrument that allows a cut of the humeral head at a perfectly determined inclination both in the sagittal plane and in the frontal plane, and with perfect guidance of the cutting blade.
- Another object of the invention is to provide a single instrument, usable with different sizes of humeral heads that can meet according to the age and sex of the patient.
- a further object of the invention is to provide a versatile instrument, that is to say that can be used both for the introduction of a humeral implant involving a cut of the native bone head, and for the establishment of a prosthetic element not involving such a cut, in particular for the establishment of a resurfacing implant.
- the instrument concerned comprises the characteristics mentioned above, known from the aforementioned document No. WO 2014/1 10421 A1.
- the arc along which said curved branch extends is an arc of a circle of the order of 180 °
- this curved branch has a first end forming a positioning pin which projects radially towards the other end of this curved branch, and a second end forming a pivotally connecting means to said block, said connecting means extending radially relative to the curved branch, so that the pivoting it allows is done along a pivot axis coincides with the diametral axis of the curved branch, that is to say the axis going from one end of this branch to the other;
- the pivoting connection means that comprises the guide block is a connecting means complementary to that of the positioning piece, and said pin guide ducts are parallel to said pivot axis.
- the positioning piece is adapted to be engaged around a humeral head to be cut so that said pin is positioned, distally, at the plane of the cut to be operated (between the cartilage and the bone cortical) and that said block, or the end of the curved arm opposite said lug, is positioned proximally at the same cutting plane; these positions make it possible to place the ducts of the block in a correct inclination in the sagittal plane.
- the block is inclined in the frontal plane, around said axis, according to the optimum inclination that the cut to be operated in this frontal plane must have, then the pins are engaged through said ducts of the block and are inserted. in the bone.
- the instrument can then be slidably removed along these pins, and these pins can receive a cutting guide of the humeral head, by means of which the cut of this head is made.
- the instrument according to the invention thanks to the double positioning of the guide block, that it allows, both in the sagittal plane and in the frontal plane, ensures an optimal orientation of said pins relative to the humerus, and therefore a positioning perfect cutting block in these same plans.
- the guide block comprises a tube whose axis coincides with the axis of pivoting of this block relative to the positioning piece, this tube being able to receive a bone pin in a controlled manner but with the possibility of pivoting of the tube relative to this pin.
- the latter thus allows to position the block relative to the bone, with the possibility of pivoting about the axis that constitutes the spindle. As a result, the inclination of the block in the frontal plane can be performed accurately.
- This tube may be distinct from the two aforementioned pin guide ducts, or may itself be one of these ducts.
- said pivot connection means are arranged so as to allow not only a pivoting of the positioning piece and the guide block with respect to one another but also a sliding of the positioning piece with respect to the block of guidance along said pivot axis; and - the positioning piece is connected to the guide block at a location of this block set back from the end of the block facing said positioning pin.
- This lug relative to this end of the block is thus adjustable, to adapt the instrument to the different sizes of humeral heads that can meet according to the age and sex of the patient.
- said pivot connection means that comprises the guide block is a cylindrical element
- Said pivot connection means that comprises the positioning member is a sleeve open laterally adapted to be clipped on the cylindrical member.
- this tube and the cylindrical element mentioned above are one and the same piece.
- the instrument comprises means for angular positioning of the positioning piece with respect to the guide block so that the plane in which this positioning piece extends is perpendicular to the plane defined by the axes of two aforementioned guide ducts; pins; and
- the positioning part has in its middle portion at least one pin guide hole having an axis perpendicular to the axis of pivoting of the positioning member relative to the guide block.
- the instrument according to the invention thus makes it possible to position said guide hole so that the axis of this hole is perpendicular to the plane defined by the axes of the two aforementioned pin guide ducts, and thus makes it possible to set up said pin precisely perpendicular to the plane defined by these axes.
- This pin thus makes it possible to locate on the bone the perpendicular to the plane of section, and thus to be able to arrange in the bone, by guiding itself on this pin, the cavity of placing a piece of the prosthesis intended to be anchored to the humerus, in particular a metaphyseal anchoring base. This piece is thus perfectly positioned with respect to the humerus.
- the aforementioned hole is located substantially at the polar zone of the spherical cap that forms the humeral head, so that it allows to set up said pin at this polar zone, in a precisely radial direction to this head.
- the establishment of this pin allows to precisely guide the drilling of the bone so as to arranging a receiving hole of a fixation stud that comprises said prosthetic element.
- the instrument according to the invention is thus polyvalent, which can be used both for a procedure involving cutting of the humeral head and for a procedure not involving such a cut.
- the positioning piece when slidably moveable relative to the guide block as mentioned above, advantageously comprises a plurality of pin guide holes as mentioned above.
- one or other of these holes will be positioned substantially opposite the pole of the humeral head regardless of the size of the humeral head, and the practitioner may choose the hole having the best positioning to set up said pin .
- the positioning piece is slidably movable and comprises said plurality of guide holes:
- the positioning piece and the guiding block comprise marking means, providing, for each given sliding position of the positioning piece with respect to the guiding block, specific information relating to this position, for example a mark of a specific color;
- the positioning part comprises, next to each pinhole it comprises, specific information corresponding to the specific information provided by these locating means, for example a mark of the same color determined.
- the instrument according to the invention thus helps the practitioner to choose the pinhole which appears to be the most appropriate according to the sliding position of the curved branch relative to the block.
- the invention will be better understood, and other features and advantages thereof will appear, with reference to the accompanying drawing, showing, by way of non-limiting example, a preferred embodiment of the instrument concerned.
- Figure 1 is a view of the instrument in perspective, in the disassembled state
- Figure 2 is a perspective view in the disassembled state
- Figure 3 is a side view in median longitudinal section
- Figure 4 is a side view similar to Figure 3, in another position of a positioning member that comprises with respect to a guide block which it also comprises;
- Figure 5 is a perspective view from another angle, while it is set up on a humeral head in the sagittal plane;
- Figure 6 is a view similar to Figure 5, in the frontal plane.
- Figures 1 to 4 show an instrument 1 used during the introduction of a shoulder prosthesis or a prosthetic element such as a resurfacing part of the head of a humerus;
- Figures 5 and 6 show this instrument 1 set up on this head 101 of a humerus 100.
- the instrument 1 comprises a positioning piece 2 for positioning the instrument 1 with respect to the head 101, and a block 3 for guiding bone pins 50, 51, the positioning piece 2 and the guide block 3 being normally connected to each other as shown in Figures 2 to 6.
- the positioning piece 2 has a curved branch 4 extending over an arc of the order of 180 °.
- the branch 4 forms a positioning pin 5 projecting radially towards the other end of this branch 4.
- This other end forms a sleeve 6 open laterally, extending radially. relative to the branch 4, that is to say having its axis coincides with the diametrical axis A from the tip of the lug 5 to the axis of the sleeve 6.
- the lateral opening of the latter s' extends over the entire length of the sleeve, on the side thereof diametrically opposed to that connected to the branch 4.
- the piece 2 is made of a synthetic material or a metal having a degree of elastic flexibility, such that the sleeve 6 can be clipped onto a median tube 7 that includes the block 3, thereby forming the assembly of the part 2 and the block 3.
- This sleeve 6 is not only able to pivot around the tube 7 but also, as can be seen by comparing FIGS. 3 and 4, to slide along this tube. This sliding is possible between the position shown in Figure 3, usable for a head 101 of relatively large diameter D1, and a plurality of recoil positions of the part 2 vis-à-vis the block 3, the one shown in Figure 4, usable for a head 101 of diameter D2 comparatively smaller.
- the part 2 also comprises a block 8 located between the branch 4 and the sleeve 6, in which is arranged a threaded hole 9, of radial axis with respect to the sleeve 6.
- This hole 9 is intended to receive a pressure screw (no shown) which, when screwed into this hole 9, bears against the tube 7.
- the branch 4 also comprises, in its median portion, a series of holes 10 with axes perpendicular to the axis A, therefore parallel to each other.
- the block 3 has a body 15 in the form of a rectangular frame, whose length is parallel to the tube 7.
- the two longitudinal portions of this body 15 located on either side of the tube 7 form conduits 16 for guiding the bone pins 51, which open into the transverse portions of the frame 15 and which are adapted to receive these pins in an adjusted manner.
- the tube 7 also opens into these same transverse portions and is also adapted to internally receive a bone pin 50 in a controlled manner, so that it also constitutes a guide duct of this pin.
- the transverse portion of the frame 15 facing the pin 5 further comprises two pointed studs 17 bearing against the humerus 100.
- the positioning piece 2 is adapted to be engaged around a humeral head 101 to be cut so that the lug 5 is positioned, distally, at the plane of the cut to be operated, that is to say between the cartilage and the cortical bone, substantially along the line 102 shown in FIG. 6, and that the block 3 is positioned proximally at the same plane of chopped off.
- the spindle 50 is inserted into the duct formed by the tube 7, so as to position the block 3 vis-a-vis the humerus 100 in a fixed manner in the upper-inferior and anteroposterior directions. and so as to form a pivot axis of the block 3 around the pin 50.
- the block 3 is then inclined in the frontal plane, around said axis, according to the optimum inclination that must have the cut to be operated in the frontal plane, then the pins 51 are engaged through the ducts 16 and are inserted into the bone .
- the instrument 1 can then be removed by sliding along these pins 50, 51 (the relative flexibility of the branch 4 allows this branch does not make obstacle to this withdrawal).
- the pin 50 is removed and the pins 51 can then receive a cutting guide (not shown), by means of which the section of the humeral head 101 is made.
- the angular position of the part 2 can be stabilized or blocked by clamping the pressure screw engaged in the hole 9, which, by bearing against the tube 7, creates friction to reduce or eliminate the possibility of pivoting of the part 2 with respect to the block 3.
- one of the holes 10 will be more or less located opposite the pole of the head 101.
- This hole therefore makes it possible to set up a bone pin 52 in a manner precisely perpendicular to the plane defined by the axes of the ducts 16, which makes it possible to locate on the bone the perpendicular to the plane of section, and thus to be able to the bone, guided by this pin, the cavity for placing a part of the prosthesis intended to be anchored to the humerus 100, in particular a metaphyseal anchoring base. This piece is thus perfectly positioned with respect to the humerus.
- This hole 10 allows an additional use of the instrument 1 when it comes to implant a prosthetic element not involving a section of the humeral head 101, including a resurfacing element.
- the pin 52 implemented by means of this hole 10 can precisely guide the drilling of the bone so as to arrange a receiving hole of a fixing stud that includes said prosthetic element.
- the instrument 1 thus has the decisive advantage, compared to homologous instruments according to the prior art, by virtue of the double positioning of the guide block 3 that it allows, to ensure optimum orientation of the pins 50 to 52 with respect to the humerus 100, both in the sagittal plane and in the frontal plane, and thus to allow a perfect positioning of the cutting block in these plans.
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Abstract
This instrument (1) comprises a positioning component (2), for positioning the instrument (1) in relation to the head (101) of the humerus, and a guide block (3) for bone pins (51), said positioning component (2) and guide block (3) being connected to each other pivotably; the positioning component (2) includes a curved branch (4) extending over an arc; the guide block (3) comprises a pivotable connection means (7), allowing this positioning component (2) and this block to be joined together, and comprises two pin-guiding conduits (16) that are able to receive bone pins (51) with a tailored fit. According to the invention, the arc over which said branch (4) extends is an arc of a circle of the order of 180°, and this curved branch (4) has a first end forming a positioning lug (5) which protrudes radially in the direction of the other end of this curved branch, and a second end forming a means (6) for pivotable connection to said block (3), this connection means (6) extending radially with respect to the curved branch (4), in such a way that the pivoting that it permits takes place along a pivot axis coinciding with the diametric axis of the curved branch (4), that is to say the axis going from one end of this branch to the other; the pivotable connection means (7) that the guide block (3) comprises is a connection means matching that of the positioning component (2), and said pin-guiding conduits (16) are parallel to said pivot axis.
Description
INSTRUMENT UTILISABLE A L'OCCASION DE LA MISE EN PLACE D'UNE PROTHESE D'EPAULE OU D'UN ELEMENT PROTHETIQUE SUR UN HUMERUS INSTRUMENT USABLE ON THE PLACEMENT OF A PROSTHESIS OF SHOULDER OR A PROSTHETIC ELEMENT ON A HUMERUS
La présente invention concerne un instrument utilisable à l'occasion de la mise en place d'une prothèse d'épaule ou d'un élément prothétique sur un humérus. The present invention relates to an instrument that can be used during the placement of a shoulder prosthesis or a prosthetic element on a humerus.
L'expression "prothèse d'épaule" doit être comprise de façon large, comme désignant un ensemble d'éléments incluant une pièce destinée à être ancrée à l'humérus, qu'il s'agisse d'une tige médullaire ou d'une embase d'ancrage métaphysaire, nécessitant d'opérer une coupe de la tête humérale native. The term "shoulder prosthesis" should be broadly understood to mean a set of elements including a piece intended to be anchored to the humerus, whether it is a medullary stem or a metaphyseal anchorage base, requiring a cut of the native humeral head.
L'expression "élément prothétique" doit être comprise de la même façon, comme désignant tout élément implantable ne constituant pas à proprement parler une prothèse, et ne nécessitant pas d'opérer une coupe de la tête humérale native. Un tel élément prothétique est en particulier une pièce de resurfaçage de cette tête. The expression "prosthetic element" must be understood in the same way, as denoting any implantable element not constituting, strictly speaking, a prosthesis, and not requiring the cutting of the native humeral head. Such a prosthetic element is in particular a resurfacing part of this head.
La mise en place d'une prothèse d'épaule implique d'opérer une coupe de la tête humérale native à la limite séparant le cartilage et l'os cortical, c'est-à-dire, en pratique, au niveau de la base de la partie de la tête sensiblement en forme de calotte sphérique. La mise en place d'un élément prothétique de resurfaçage n'implique par contre généralement pas de coupe de la tête humérale mais la mise en place d'une broche de guidage au niveau de la zone polaire de la tête, afin de percer un trou permettant l'ancrage positionner dudit élément prothétique. The placement of a shoulder prosthesis involves cutting the native humeral head at the boundary between the cartilage and the cortical bone, that is, in practice, at the level of the base the portion of the head substantially shaped spherical cap. The installation of a prosthetic resurfacing element does not generally involve cutting the humeral head but the establishment of a guide pin at the polar zone of the head, in order to drill a hole. allowing the anchoring position of said prosthetic element.
Pour procéder à une coupe d'une tête humérale, il est connu d'utiliser un guide de coupe positionné contre l'os au moyen de broches proximales. Ce positionnement se fait à l'aide de repères visuels anatomiques et implique l'utilisation successive de plusieurs instruments. L'utilisation d'un tel guide de coupe est donc relativement longue et difficile, et le bon positionnement du guide de coupe fait largement appel à l'expérience du praticien. Le risque d'opérer une coupe dont l'inclinaison n'est pas parfaite dans le plan sagittal et/ou dans le plan frontal est notable, avec de possibles conséquences sur la qualité de la restauration de l'articulation et sur la longévité de l'articulation prothétique. To cut a humeral head, it is known to use a cutting guide positioned against the bone by means of proximal pins. This positioning is done using anatomical visual cues and involves the successive use of several instruments. The use of such a cutting guide is therefore relatively long and difficult, and the correct positioning of the cutting guide is largely based on the experience of the practitioner. The risk of making a cut whose inclination is not perfect in the sagittal plane and / or in the frontal plane is notable, with possible consequences on the quality of the restoration of the joint and the longevity of the joint. prosthetic joint.
Une autre technique pour réaliser la coupe d'une tête humérale consiste à mettre en place une broche selon l'axe centro-médullaire de l'humérus, permettant de positionner un guide de coupe. Avec un tel guide, l'inclinaison de la coupe reste réalisée au jugé, et le risque de réaliser une coupe non parfaite existe de la même façon.
Une troisième technique existante consiste à mettre en place une broche de guidage dans la zone polaire de ladite calotte sphérique et d'utiliser un guide de coupe incluant une paroi en portion de sphère creuse venant épouser ladite calotte sphérique, positionné au moyen de cette broche. Un tel guide de coupe a pour inconvénient de ne pas permettre de parfaitement guider la lame de coupe lors de la coupe et de ne pas être adapté aux différentes dimensions que peuvent présenter les têtes humérales selon le sexe ou l'âge du patient. Another technique for making the cut of a humeral head is to set up a pin along the centromedullary axis of the humerus, for positioning a cutting guide. With such a guide, the inclination of the cut remains carried out judged, and the risk of making a non-perfect cut exists in the same way. A third existing technique is to set up a guide pin in the polar zone of said spherical cap and use a cutting guide including a hollow sphere portion of wall coming to marry said spherical cap, positioned by means of this pin. Such a cutting guide has the disadvantage of not allowing to guide perfectly the cutting blade during cutting and not be adapted to the different dimensions that can present the humeral heads according to gender or age of the patient.
La publication de demande de brevet N° WO 2014/1 10421 A1 décrit un instrument utilisable à l'occasion de la mise en place d'une prothèse d'épaule ou d'un élément prothétique sur un humérus, comprenant une pièce de positionnement permettant de positionner l'instrument vis-à-vis de la tête de l'humérus, et un bloc de guidage de broches à os, reliés l'un à l'autre de manière pivotante ; la pièce de positionnement incluant une branche courbe s'étendant sur un arc ; le bloc de guidage comprend un moyen de liaison pivotante permettant l'assemblage de cette pièce de positionnement et de ce bloc, et comprend deux conduits de guidage de broches aptes à recevoir des broches à os de façon ajustée. The publication of Patent Application No. WO 2014/1 10421 A1 describes an instrument that can be used when a shoulder prosthesis or a prosthetic element is placed on a humerus, comprising a positioning piece enabling positioning the instrument with respect to the head of the humerus, and a bone pin guide block pivotably connected to each other; the positioning piece including a curved branch extending over an arc; the guide block comprises pivoting connection means for assembling this positioning part and this block, and comprises two pin guide ducts adapted to receive bone pins in an adjusted manner.
La présente invention a pour but de remédier à l'ensemble des inconvénients précités des instruments existants. Elle a donc pour objectif principal de fournir un instrument qui permette une coupe de la tête humérale selon une inclinaison parfaitement déterminée tant dans le plan sagittal que dans le plan frontal, et avec un parfait guidage de la lame de coupe. The present invention aims to remedy all of the aforementioned drawbacks of existing instruments. It therefore has the main objective of providing an instrument that allows a cut of the humeral head at a perfectly determined inclination both in the sagittal plane and in the frontal plane, and with perfect guidance of the cutting blade.
Un autre objectif de l'invention est de fournir un instrument unique, utilisable avec les différentes tailles de têtes humérales pouvant se rencontrer selon l'âge et le sexe du patient. Another object of the invention is to provide a single instrument, usable with different sizes of humeral heads that can meet according to the age and sex of the patient.
Un objectif supplémentaire de l'invention est de fournir un instrument polyvalent, c'est-à-dire pouvant être utilisé tant pour la mise en place d'un implant huméral impliquant une coupe de la tête osseuse native, que pour la mise en place d'un élément prothétique n'impliquant pas une telle coupe, en particulier pour la mise en place d'un implant de resurfaçage. A further object of the invention is to provide a versatile instrument, that is to say that can be used both for the introduction of a humeral implant involving a cut of the native bone head, and for the establishment of a prosthetic element not involving such a cut, in particular for the establishment of a resurfacing implant.
L'instrument concerné comprend les caractéristiques mentionnées plus haut, connues du document N° WO 2014/1 10421 A1 précité. The instrument concerned comprises the characteristics mentioned above, known from the aforementioned document No. WO 2014/1 10421 A1.
Selon l'invention, According to the invention,
- l'arc selon lequel s'étend ladite branche courbe est un arc de cercle de l'ordre de 180°, et cette branche courbe présente une première extrémité formant un ergot de positionnement qui fait saillie radialement en direction de l'autre extrémité de cette
branche courbe, et une deuxième extrémité formant un moyen de liaison pivotante audit bloc, ce moyen de liaison s'étendant radialement par rapport à la branche courbe, de telle sorte que le pivotement qu'il permet se fasse selon un axe de pivotement confondu avec l'axe diamétral de la branche courbe, c'est-à-dire l'axe allant d'une extrémité de cette branche à l'autre ; the arc along which said curved branch extends is an arc of a circle of the order of 180 °, and this curved branch has a first end forming a positioning pin which projects radially towards the other end of this curved branch, and a second end forming a pivotally connecting means to said block, said connecting means extending radially relative to the curved branch, so that the pivoting it allows is done along a pivot axis coincides with the diametral axis of the curved branch, that is to say the axis going from one end of this branch to the other;
- le moyen de liaison pivotante que comprend le bloc de guidage est un moyen de liaison complémentaire de celui de la pièce de positionnement, et lesdits conduits de guidage de broches sont parallèles audit axe de pivotement. - The pivoting connection means that comprises the guide block is a connecting means complementary to that of the positioning piece, and said pin guide ducts are parallel to said pivot axis.
En pratique, la pièce de positionnement est apte à être engagée autour d'une tête humérale à couper de telle sorte que ledit ergot soit positionné, de façon distale, au niveau du plan de la coupe à opérer (entre le cartilage et l'os cortical) et que ledit bloc, ou l'extrémité de la branche courbe opposée audit ergot, soit positionné de façon proximale au niveau de ce même plan de coupe ; ces positionnements permettent de placer les conduits du bloc selon une inclinaison correcte dans le plan sagittal. Une fois ces positionnements opérés, le bloc est incliné dans le plan frontal, autour dudit axe, selon l'inclinaison optimale que doit avoir la coupe à opérer dans ce plan frontal, puis les broches sont engagées aux travers desdits conduits du bloc et sont insérées dans l'os. L'instrument peut alors être retiré par coulissement le long de ces broches, et ces broches peuvent recevoir un guide de coupe de la tête humérale, au moyen duquel la coupe de cette tête est réalisée. In practice, the positioning piece is adapted to be engaged around a humeral head to be cut so that said pin is positioned, distally, at the plane of the cut to be operated (between the cartilage and the bone cortical) and that said block, or the end of the curved arm opposite said lug, is positioned proximally at the same cutting plane; these positions make it possible to place the ducts of the block in a correct inclination in the sagittal plane. Once these positions have been made, the block is inclined in the frontal plane, around said axis, according to the optimum inclination that the cut to be operated in this frontal plane must have, then the pins are engaged through said ducts of the block and are inserted. in the bone. The instrument can then be slidably removed along these pins, and these pins can receive a cutting guide of the humeral head, by means of which the cut of this head is made.
L'instrument selon l'invention, grâce au double positionnement du bloc de guidage, qu'il permet, tant dans le plan sagittal que dans le plan frontal, assure une orientation optimale desdites broches par rapport à l'humérus, et donc un positionnement parfait du bloc de coupe dans ces mêmes plans. The instrument according to the invention, thanks to the double positioning of the guide block, that it allows, both in the sagittal plane and in the frontal plane, ensures an optimal orientation of said pins relative to the humerus, and therefore a positioning perfect cutting block in these same plans.
De préférence, le bloc de guidage comprend un tube dont l'axe est confondu avec l'axe de pivotement de ce bloc par rapport à la pièce de positionnement, ce tube étant apte à recevoir une broche à os de manière ajustée mais avec possibilité de pivotement du tube par rapport à cette broche. Preferably, the guide block comprises a tube whose axis coincides with the axis of pivoting of this block relative to the positioning piece, this tube being able to receive a bone pin in a controlled manner but with the possibility of pivoting of the tube relative to this pin.
Cette dernière permet ainsi de positionner le bloc par rapport à l'os, avec possibilité de pivotement autour de l'axe que constitue la broche. Il en résulte que l'inclinaison du bloc dans le plan frontal peut être réalisée de manière précise. The latter thus allows to position the block relative to the bone, with the possibility of pivoting about the axis that constitutes the spindle. As a result, the inclination of the block in the frontal plane can be performed accurately.
Ce tube peut être distinct des deux conduits précités de guidage de broches, ou peut constituer lui-même l'un de ces conduits. This tube may be distinct from the two aforementioned pin guide ducts, or may itself be one of these ducts.
De préférence,
- lesdits moyens de liaison à pivotement sont aménagés de façon à permettre non seulement un pivotement de la pièce de positionnement et du bloc de guidage l'un par rapport à l'autre mais également un coulissement de la pièce de positionnement par rapport au bloc de guidage selon ledit axe de pivotement ; et - la pièce de positionnement est reliée au bloc de guidage en un emplacement de ce bloc situé en retrait de l'extrémité du bloc tournée vers ledit ergot de positionnement. Preferably, said pivot connection means are arranged so as to allow not only a pivoting of the positioning piece and the guide block with respect to one another but also a sliding of the positioning piece with respect to the block of guidance along said pivot axis; and - the positioning piece is connected to the guide block at a location of this block set back from the end of the block facing said positioning pin.
La position de cet ergot par rapport à cette extrémité du bloc est ainsi réglable, permettant d'adapter l'instrument aux différentes tailles de têtes humérales pouvant se rencontrer selon l'âge et le sexe du patient. The position of this lug relative to this end of the block is thus adjustable, to adapt the instrument to the different sizes of humeral heads that can meet according to the age and sex of the patient.
Dans un tel cas, c'est ladite extrémité du bloc de guidage qui vient au contact de la tête humérale ; cette extrémité est alors avantageusement pourvue d'au moins un moyen de prise d'appui sans glissement contre l'humérus, en particulier sous la forme d'au moins un plot pointu. In such a case, it is said end of the guide block which comes into contact with the humeral head; this end is then advantageously provided with at least one support means without sliding against the humerus, in particular in the form of at least one pointed pad.
Selon une forme de réalisation préférée de l'invention dans ce même cas, According to a preferred embodiment of the invention in this case,
- ledit moyen de liaison à pivotement que comprend le bloc de guidage est un élément cylindrique, et said pivot connection means that comprises the guide block is a cylindrical element, and
- ledit moyen de liaison à pivotement que comprend la pièce de positionnement est un manchon ouvert latéralement apte à être clipsé sur cet élément cylindrique. - Said pivot connection means that comprises the positioning member is a sleeve open laterally adapted to be clipped on the cylindrical member.
Lorsque l'instrument comprend le tube précité, ce tube et l'élément cylindrique mentionné ci-dessus sont une seule et même pièce. When the instrument comprises the aforesaid tube, this tube and the cylindrical element mentioned above are one and the same piece.
De préférence, Preferably,
- l'instrument comprend des moyens de positionnement angulaire de la pièce de positionnement par rapport au bloc de guidage de telle sorte que le plan dans lequel s'étend cette pièce de positionnement soit perpendiculaire au plan défini par les axes deux conduits précités de guidage de broches ; et the instrument comprises means for angular positioning of the positioning piece with respect to the guide block so that the plane in which this positioning piece extends is perpendicular to the plane defined by the axes of two aforementioned guide ducts; pins; and
- la pièce de positionnement présente dans sa portion médiane au moins un trou de guidage de broche ayant un axe perpendiculaire à l'axe de pivotement de la pièce de positionnement par rapport au bloc de guidage. - The positioning part has in its middle portion at least one pin guide hole having an axis perpendicular to the axis of pivoting of the positioning member relative to the guide block.
L'instrument selon l'invention permet ainsi de positionner ledit trou de guidage de telle sorte que l'axe de ce trou soit perpendiculaire au plan défini par les axes des deux conduits précités de guidage de broches, et permet donc de mettre en place ladite broche d'une façon précisément perpendiculaire au plan défini par ces axes. Cette broche permet ainsi de repérer sur l'os la perpendiculaire au plan de coupe, et donc de pouvoir aménager dans l'os, en se guidant sur cette broche, la cavité de
mise en place d'une pièce de la prothèse destinée à être ancrée à l'humérus, en particulier d'une embase d'ancrage métaphysaire. Cette pièce est ainsi parfaitement positionnée par rapport à l'humérus. The instrument according to the invention thus makes it possible to position said guide hole so that the axis of this hole is perpendicular to the plane defined by the axes of the two aforementioned pin guide ducts, and thus makes it possible to set up said pin precisely perpendicular to the plane defined by these axes. This pin thus makes it possible to locate on the bone the perpendicular to the plane of section, and thus to be able to arrange in the bone, by guiding itself on this pin, the cavity of placing a piece of the prosthesis intended to be anchored to the humerus, in particular a metaphyseal anchoring base. This piece is thus perfectly positioned with respect to the humerus.
De plus, le trou précité est situé sensiblement au niveau de la zone polaire de la calotte sphérique que forme la tête humérale, de sorte qu'il permet de mettre en place ladite broche au niveau de cette zone polaire, selon une direction précisément radiale à cette tête. Lorsqu'il s'agit d'implanter un élément prothétique n'impliquant pas une coupe de la tête humérale native, notamment un élément de resurfaçage, la mise en place de cette broche permet de guider précisément le perçage de l'os de manière à aménager un trou de réception d'un plot de fixation que comprend ledit élément prothétique. In addition, the aforementioned hole is located substantially at the polar zone of the spherical cap that forms the humeral head, so that it allows to set up said pin at this polar zone, in a precisely radial direction to this head. When it comes to implanting a prosthetic element not involving a cut of the native humeral head, including a resurfacing element, the establishment of this pin allows to precisely guide the drilling of the bone so as to arranging a receiving hole of a fixation stud that comprises said prosthetic element.
L'instrument selon l'invention est ainsi polyvalent, pouvant être utilisé tant pour une procédure impliquant une coupe de la tête humérale que pour une procédure n'impliquant pas une telle coupe. The instrument according to the invention is thus polyvalent, which can be used both for a procedure involving cutting of the humeral head and for a procedure not involving such a cut.
La pièce de positionnement, lorsqu'elle est déplaçable en coulissement par rapport au bloc de guidage comme mentionné ci-dessus, comprend avantageusement une pluralité de trous de guidage de broche tels que précités. The positioning piece, when slidably moveable relative to the guide block as mentioned above, advantageously comprises a plurality of pin guide holes as mentioned above.
Ainsi, l'un ou l'autre de ces trous sera positionné sensiblement en regard du pôle de la tête humérale quelle que soit la taille de cette tête humérale, et le praticien pourra choisir le trou ayant le meilleur positionnement pour mettre en place ladite broche. Thus, one or other of these holes will be positioned substantially opposite the pole of the humeral head regardless of the size of the humeral head, and the practitioner may choose the hole having the best positioning to set up said pin .
Avantageusement, dans ce cas où la pièce de positionnement est déplaçable en coulissement et qu'elle comprend ladite pluralité de trous de guidage : Advantageously, in this case where the positioning piece is slidably movable and comprises said plurality of guide holes:
- la pièce de positionnement et le bloc de guidage comprennent des moyens de repérage, fournissant, pour chaque position donnée de coulissement de la pièce de positionnement par rapport au bloc de guidage, une information spécifique relative à cette position, par exemple une marque d'une couleur déterminée ; et the positioning piece and the guiding block comprise marking means, providing, for each given sliding position of the positioning piece with respect to the guiding block, specific information relating to this position, for example a mark of a specific color; and
- la pièce de positionnement comprend, en regard de chaque trou à broche qu'elle comprend, une information spécifique correspondant à l'information spécifique fournie par ces moyens de repérage, par exemple une marque de la même couleur déterminée. - The positioning part comprises, next to each pinhole it comprises, specific information corresponding to the specific information provided by these locating means, for example a mark of the same color determined.
L'instrument selon l'invention aide ainsi le praticien à choisir le trou à broche qui apparaît être le plus approprié selon la position de coulissement de la branche courbe par rapport au bloc.
L'invention sera bien comprise, et d'autres caractéristiques et avantages de celle-ci apparaîtront, en référence au dessin schématique annexé, représentant, à titre d'exemple non limitatif, une forme de réalisation préférée de l'instrument concerné. The instrument according to the invention thus helps the practitioner to choose the pinhole which appears to be the most appropriate according to the sliding position of the curved branch relative to the block. The invention will be better understood, and other features and advantages thereof will appear, with reference to the accompanying drawing, showing, by way of non-limiting example, a preferred embodiment of the instrument concerned.
La figure 1 est une vue de l'instrument en perspective, à l'état démonté ; Figure 1 is a view of the instrument in perspective, in the disassembled state;
la figure 2 en est une vue en perspective à l'état démonté ; Figure 2 is a perspective view in the disassembled state;
la figure 3 en est une vue de côté, en coupe longitudinale médiane ; Figure 3 is a side view in median longitudinal section;
la figure 4 en est une vue de côté similaire à la figure 3, dans une autre position d'une pièce de positionnement qu'il comprend par rapport à un bloc de guidage qu'il comprend également ; Figure 4 is a side view similar to Figure 3, in another position of a positioning member that comprises with respect to a guide block which it also comprises;
la figure 5 en est une vue en perspective sous un autre angle, alors qu'il est mis en place sur une tête humérale, dans le plan sagittal ; et Figure 5 is a perspective view from another angle, while it is set up on a humeral head in the sagittal plane; and
la figure 6 en est une vue similaire à la figure 5, dans le plan frontal. Figure 6 is a view similar to Figure 5, in the frontal plane.
Les figures 1 à 4 représentent un instrument 1 utilisable lors de la mise en place d'une prothèse d'épaule ou d'un élément prothétique tel qu'une pièce de resurfaçage de la tête d'un l'humérus ; les figures 5 et 6 représentent cet instrument 1 mis en place sur cette tête 101 d'un humérus 100. Figures 1 to 4 show an instrument 1 used during the introduction of a shoulder prosthesis or a prosthetic element such as a resurfacing part of the head of a humerus; Figures 5 and 6 show this instrument 1 set up on this head 101 of a humerus 100.
L'instrument 1 comprend une pièce 2 de positionnement de l'instrument 1 vis-à-vis de la tête 101 , et un bloc 3 de guidage de broches à os 50, 51 , la pièce de positionnement 2 et le bloc de guidage 3 étant normalement reliés l'un à l'autre comme visible sur les figures 2 à 6. The instrument 1 comprises a positioning piece 2 for positioning the instrument 1 with respect to the head 101, and a block 3 for guiding bone pins 50, 51, the positioning piece 2 and the guide block 3 being normally connected to each other as shown in Figures 2 to 6.
La pièce de positionnement 2 présente une branche courbe 4 s'étendant sur un arc de l'ordre de 180°. A son extrémité non destinée à être reliée au bloc 3, la branche 4 forme un ergot de positionnement 5 faisant saillie radialement en direction de l'autre extrémité de cette branche 4. Cette autre extrémité forme un manchon 6 ouvert latéralement, s'étendant radialement par rapport à la branche 4, c'est-à-dire ayant son axe confondu avec l'axe diamétral A allant de la pointe de l'ergot 5 à l'axe du manchon 6. L'ouverture latérale de ce dernier s'étend sur l'ensemble de la longueur du manchon, sur le côté de celui-ci diamétralement opposé à celui raccordé à la branche 4. The positioning piece 2 has a curved branch 4 extending over an arc of the order of 180 °. At its end not intended to be connected to the block 3, the branch 4 forms a positioning pin 5 projecting radially towards the other end of this branch 4. This other end forms a sleeve 6 open laterally, extending radially. relative to the branch 4, that is to say having its axis coincides with the diametrical axis A from the tip of the lug 5 to the axis of the sleeve 6. The lateral opening of the latter s' extends over the entire length of the sleeve, on the side thereof diametrically opposed to that connected to the branch 4.
La pièce 2 est réalisée en une matière synthétique ou un métal présentant un degré de souplesse élastique, telle que le manchon 6 puisse être clipé sur un tube médian 7 que comprend le bloc 3, réalisant ainsi l'assemblage de la pièce 2 et du bloc 3. Ce manchon 6 est non seulement apte à pivoter autour du tube 7 mais également, comme visible par comparaison des figures 3 et 4, à coulisser le long de
ce tube. Ce coulissement est possible entre la position montrée sur la figure 3, utilisable pour une tête 101 de diamètre D1 relativement grand, et une pluralité de positions de recul de la pièce 2 vis-à-vis du bloc 3, dont celle montrée sur la figure 4, utilisable pour une tête 101 de diamètre D2 comparativement plus petit. The piece 2 is made of a synthetic material or a metal having a degree of elastic flexibility, such that the sleeve 6 can be clipped onto a median tube 7 that includes the block 3, thereby forming the assembly of the part 2 and the block 3. This sleeve 6 is not only able to pivot around the tube 7 but also, as can be seen by comparing FIGS. 3 and 4, to slide along this tube. This sliding is possible between the position shown in Figure 3, usable for a head 101 of relatively large diameter D1, and a plurality of recoil positions of the part 2 vis-à-vis the block 3, the one shown in Figure 4, usable for a head 101 of diameter D2 comparatively smaller.
La pièce 2 comprend également un bloc 8 situé entre la branche 4 et le manchon 6, dans lequel est aménagé un trou taraudé 9, d'axe radial par rapport au manchon 6. Ce trou 9 est destiné à recevoir une vis de pression (non représentée) qui, lorsqu'elle est vissée dans ce trou 9, vient porter contre le tube 7. The part 2 also comprises a block 8 located between the branch 4 and the sleeve 6, in which is arranged a threaded hole 9, of radial axis with respect to the sleeve 6. This hole 9 is intended to receive a pressure screw (no shown) which, when screwed into this hole 9, bears against the tube 7.
La branche 4 comprend aussi, dans sa portion médiane, une série de trous 10 d'axes perpendiculaires à l'axe A, donc parallèles entre eux. The branch 4 also comprises, in its median portion, a series of holes 10 with axes perpendicular to the axis A, therefore parallel to each other.
Le bloc 3 présente un corps 15 en forme de cadre rectangulaire, dont la longueur est parallèle au tube 7. Les deux portions longitudinales de ce corps 15 situées de part et d'autre du tube 7 forment des conduits 16 de guidage des broches à os 51 , qui débouchent dans les portions transversales du cadre 15 et qui sont aptes à recevoir ces broches de façon ajustée. Le tube 7 débouche également dans ces mêmes portions transversales et est également apte à recevoir intérieurement une broche à os 50 de façon ajustée, de sorte qu'il constitue également un conduit de guidage de cette broche. The block 3 has a body 15 in the form of a rectangular frame, whose length is parallel to the tube 7. The two longitudinal portions of this body 15 located on either side of the tube 7 form conduits 16 for guiding the bone pins 51, which open into the transverse portions of the frame 15 and which are adapted to receive these pins in an adjusted manner. The tube 7 also opens into these same transverse portions and is also adapted to internally receive a bone pin 50 in a controlled manner, so that it also constitutes a guide duct of this pin.
La portion transversale du cadre 15 tournée vers l'ergot 5 comprend en outre deux plots pointus 17 de prise d'appui contre l'humérus 100. The transverse portion of the frame 15 facing the pin 5 further comprises two pointed studs 17 bearing against the humerus 100.
En pratique, comme le montrent les figures 5 et 6, la pièce de positionnement 2 est apte à être engagée autour d'une tête humérale 101 à couper de telle sorte que l'ergot 5 soit positionné, de façon distale, au niveau du plan de la coupe à opérer, c'est à dire entre le cartilage et l'os cortical, sensiblement le long de la ligne 102 représentée sur la figure 6, et que le bloc 3 soit positionné de façon proximale au niveau de ce même plan de coupe. Une fois ce positionnement opéré, la broche 50 est insérée dans le conduit formé par le tube 7, de façon à positionner le bloc 3 vis-à- vis de l'humérus 100 de manière fixe dans les directions supérieure-inférieure et antéro-postérieure et de façon à former un axe de pivotement du bloc 3 autour de la broche 50. In practice, as shown in Figures 5 and 6, the positioning piece 2 is adapted to be engaged around a humeral head 101 to be cut so that the lug 5 is positioned, distally, at the plane of the cut to be operated, that is to say between the cartilage and the cortical bone, substantially along the line 102 shown in FIG. 6, and that the block 3 is positioned proximally at the same plane of chopped off. Once this positioning has been performed, the spindle 50 is inserted into the duct formed by the tube 7, so as to position the block 3 vis-a-vis the humerus 100 in a fixed manner in the upper-inferior and anteroposterior directions. and so as to form a pivot axis of the block 3 around the pin 50.
Le bloc 3 est alors incliné dans le plan frontal, autour dudit axe, selon l'inclinaison optimale que doit avoir la coupe à opérer dans le plan frontal, puis les broches 51 sont engagées aux travers des conduits 16 et sont insérées dans l'os. L'instrument 1 peut alors être retiré par coulissement le long de ces broches 50, 51 (la relative souplesse de la branche 4 permet que cette branche ne fasse pas
obstacle à ce retrait). La broche 50 est retirée et les broches 51 peuvent ensuite recevoir un guide de coupe (non représenté), au moyen duquel la coupe de la tête humérale 101 est réalisée. The block 3 is then inclined in the frontal plane, around said axis, according to the optimum inclination that must have the cut to be operated in the frontal plane, then the pins 51 are engaged through the ducts 16 and are inserted into the bone . The instrument 1 can then be removed by sliding along these pins 50, 51 (the relative flexibility of the branch 4 allows this branch does not make obstacle to this withdrawal). The pin 50 is removed and the pins 51 can then receive a cutting guide (not shown), by means of which the section of the humeral head 101 is made.
La possibilité précitée de coulissement de la pièce 2 par rapport au bloc 3 permet d'adapter l'instrument 1 aux différents diamètres de têtes 101 pouvant se rencontrer selon l'âge et le sexe du patient, comme visible sur les figures 3 et 4. The aforementioned possibility of sliding of the part 2 with respect to the block 3 makes it possible to adapt the instrument 1 to the different diameters of heads 101 that can be met according to the age and sex of the patient, as can be seen in FIGS. 3 and 4.
Si nécessaire, la position angulaire de la pièce 2 peut être stabilisée ou bloquée par serrage de la vis de pression engagée dans le trou 9, laquelle, en portant contre le tube 7, vient créer des frottements de nature à réduire, voire supprimer, la possibilité de pivotement de la pièce 2 par rapport au bloc 3. If necessary, the angular position of the part 2 can be stabilized or blocked by clamping the pressure screw engaged in the hole 9, which, by bearing against the tube 7, creates friction to reduce or eliminate the possibility of pivoting of the part 2 with respect to the block 3.
Quelle que soit la position de cette pièce 2 par rapport au bloc 3, l'un des trous 10 sera plus ou moins situé en regard du pôle de la tête 101 . Ce trou permet donc de mettre en place une broche à os 52 d'une façon précisément perpendiculaire au plan défini par les axes des conduits 16, qui permet de repérer sur l'os la perpendiculaire au plan de coupe, et donc de pouvoir aménager dans l'os, en se guidant sur cette broche, la cavité de mise en place d'une pièce de la prothèse destinée à être ancrée à l'humérus 100, en particulier d'une embase d'ancrage métaphysaire. Cette pièce est ainsi parfaitement positionnée par rapport à l'humérus. Whatever the position of this part 2 with respect to the block 3, one of the holes 10 will be more or less located opposite the pole of the head 101. This hole therefore makes it possible to set up a bone pin 52 in a manner precisely perpendicular to the plane defined by the axes of the ducts 16, which makes it possible to locate on the bone the perpendicular to the plane of section, and thus to be able to the bone, guided by this pin, the cavity for placing a part of the prosthesis intended to be anchored to the humerus 100, in particular a metaphyseal anchoring base. This piece is thus perfectly positioned with respect to the humerus.
Ce trou 10 permet une utilisation supplémentaire de l'instrument 1 lorsqu'il s'agit d'implanter un élément prothétique n'impliquant pas une coupe de la tête humérale 101 , notamment un élément de resurfaçage. En effet, la broche 52 mise en place au moyen de ce trou 10 permet de guider précisément le perçage de l'os de manière à aménager un trou de réception d'un plot de fixation que comprend ledit élément prothétique. This hole 10 allows an additional use of the instrument 1 when it comes to implant a prosthetic element not involving a section of the humeral head 101, including a resurfacing element. Indeed, the pin 52 implemented by means of this hole 10 can precisely guide the drilling of the bone so as to arrange a receiving hole of a fixing stud that includes said prosthetic element.
L'instrument 1 a ainsi pour avantage déterminant, par rapport aux instruments homologues selon la technique antérieure, grâce au double positionnement du bloc de guidage 3 qu'il permet, d'assurer une orientation optimale des broches 50 à 52 par rapport à l'humérus 100, tant dans le plan sagittal que dans le plan frontal, et donc de permettre un positionnement parfait du bloc de coupe dans ces plans. The instrument 1 thus has the decisive advantage, compared to homologous instruments according to the prior art, by virtue of the double positioning of the guide block 3 that it allows, to ensure optimum orientation of the pins 50 to 52 with respect to the humerus 100, both in the sagittal plane and in the frontal plane, and thus to allow a perfect positioning of the cutting block in these plans.
L'invention a été décrite ci-dessus en référence à une forme de réalisation fournie à titre d'exemple. Il va de soi qu'elle n'est pas limitée à cette forme de réalisation mais qu'elle s'étend à toutes les autres formes de réalisation couvertes par les revendications ci-annexées.
The invention has been described above with reference to an embodiment provided by way of example. It goes without saying that it is not limited to this embodiment but that it extends to all other embodiments covered by the appended claims.
Claims
REVENDICATIONS
1 - Instrument (1 ) utilisable à l'occasion de la mise en place d'une prothèse d'épaule ou d'un élément prothétique sur un humérus (100), comprenant une pièce de positionnement (2) permettant de positionner l'instrument (1 ) vis-à-vis de la tête (101 ) de l'humérus, et un bloc (3) de guidage de broches à os (51 ), reliés l'un à l'autre de manière pivotante ; la pièce de positionnement (2) inclut une branche courbe (4) s'étendant sur un arc ; le bloc de guidage (3) comprend un moyen (7) de liaison pivotante permettant l'assemblage de cette pièce de positionnement (2) et de ce bloc, et comprend deux conduits (16) de guidage de broches, aptes à recevoir des broches à os (51 ) de façon ajustée ; 1 - Instrument (1) usable during the placement of a shoulder prosthesis or a prosthetic element on a humerus (100), comprising a positioning piece (2) for positioning the instrument (1) vis-à-vis the head (101) of the humerus, and a block (3) for guiding bone pins (51), connected to each other pivotally; the positioning piece (2) includes a curved branch (4) extending over an arc; the guide block (3) comprises pivoting connection means (7) for assembling this positioning piece (2) and this block, and comprises two pin guide ducts (16) capable of receiving pins. bone (51) in an adjusted fashion;
caractérisé en ce que : characterized in that
- l'arc selon lequel s'étend ladite branche courbe (4) est un arc de cercle de l'ordre de 180°, et cette branche courbe (4) présente une première extrémité formant un ergot de positionnement (5) qui fait saillie radialement en direction de l'autre extrémité de cette branche courbe, et une deuxième extrémité formant un moyen (6) de liaison pivotante audit bloc (3), ce moyen de liaison (6) s'étendant radialement par rapport à la branche courbe (4), de telle sorte que le pivotement qu'il permet se fasse selon un axe de pivotement confondu avec l'axe diamétral de la branche courbe (4), c'est-à-dire l'axe allant d'une extrémité de cette branche à l'autre ; the arc along which said curved limb (4) extends is an arc of the order of 180 °, and this curved limb (4) has a first end forming a locating stud (5) which projects radially towards the other end of this curved branch, and a second end forming a means (6) pivotally connecting said block (3), the connecting means (6) extending radially relative to the curved branch ( 4), so that the pivoting that it allows is done along a pivot axis coincides with the diametral axis of the curved branch (4), that is to say the axis going from one end of this branch to the other;
- le moyen de liaison pivotante (7) que comprend le bloc de guidage (3) est un moyen de liaison complémentaire de celui de la pièce de positionnement (2), et lesdits conduits (16) de guidage de broches sont parallèles audit axe de pivotement. the pivoting connection means (7) that comprises the guide block (3) is a connecting means complementary to that of the positioning piece (2), and said pin guide ducts (16) are parallel to said axis of pivoting.
2 - Instrument (1 ) selon la revendication 1 , caractérisé en ce que le bloc de guidage (3) comprend un tube (7) dont l'axe est confondu avec l'axe de pivotement de ce bloc par rapport à la pièce de positionnement (2), ce tube (7) étant apte à recevoir une broche à os (51 ) de manière ajustée mais avec possibilité de pivotement du tube (7) par rapport à cette broche. 2 - Instrument (1) according to claim 1, characterized in that the guide block (3) comprises a tube (7) whose axis coincides with the axis of pivoting of said block relative to the positioning piece (2), this tube (7) being adapted to receive a bone pin (51) in a controlled manner but with possibility of pivoting of the tube (7) relative to this pin.
3 - Instrument (1 ) selon la revendication 2, caractérisé en ce que ledit tube constitue lui-même l'un des deux conduits de guidage de broches. 4 - Instrument (1 ) selon l'une des revendications 1 à 3, caractérisé en ce que :3 - Instrument (1) according to claim 2, characterized in that said tube itself constitutes one of the two pin guide ducts. 4 - Instrument (1) according to one of claims 1 to 3, characterized in that:
- lesdits moyens (6, 7) de liaison à pivotement sont aménagés de façon à permettre non seulement un pivotement de la pièce de positionnement (2) et du bloc
de guidage (3) l'un par rapport à l'autre mais également un coulissement de la pièce de positionnement (2) par rapport au bloc de guidage (3) selon ledit axe de pivotement ; et en ce que said pivot connection means (6, 7) are arranged so as to allow not only a pivoting of the positioning piece (2) and the block guiding (3) with respect to each other but also a sliding of the positioning piece (2) with respect to the guide block (3) along said pivot axis; and in that
- la pièce de positionnement (2) est reliée au bloc de guidage (3) en un emplacement de ce bloc situé en retrait de l'extrémité du bloc tournée vers ledit ergot de positionnement (5). - The positioning piece (2) is connected to the guide block (3) at a location of this block set back from the end of the block facing said positioning pin (5).
5 - Instrument (1 ) selon la revendication 4, caractérisé en ce que ladite extrémité du bloc de guidage (3) tournée vers ledit ergot de positionnement (5) est pourvue d'au moins un moyen de prise d'appui sans glissement contre l'humérus (100), en particulier sous la forme d'au moins un plot pointu (17). 5 - Instrument (1) according to claim 4, characterized in that said end of the guide block (3) facing said locating pin (5) is provided with at least one support means without sliding against the humerus (100), in particular in the form of at least one pointed pad (17).
6 - Instrument (1 ) selon la revendication 4 ou la revendication 5, caractérisé en ce que : 6 - Instrument (1) according to claim 4 or claim 5, characterized in that:
- ledit moyen de liaison à pivotement que comprend le bloc de guidage (3) est un élément cylindrique (7), et said pivotal connecting means which comprises the guide block (3) is a cylindrical element (7), and
- ledit moyen de liaison à pivotement que comprend la pièce de positionnement (2) est un manchon (6) ouvert latéralement apte à être clipsé sur cet élément cylindrique (7). - Said pivot connection means that comprises the positioning piece (2) is a sleeve (6) open laterally adapted to be clipped on the cylindrical member (7).
7 - Instrument (1 ) selon la revendication 2 et la revendication 6, caractérisé en ce que le tube précité et ledit élément cylindrique sont une seule et même pièce (7). 8 - Instrument (1 ) selon l'une des revendications 1 à 7, caractérisé en ce que :7 - Instrument (1) according to claim 2 and claim 6, characterized in that the aforesaid tube and said cylindrical member are a single piece (7). 8 - Instrument (1) according to one of claims 1 to 7, characterized in that:
- l'instrument (1 ) comprend des moyens (8, 9) de positionnement angulaire de la pièce de positionnement (2) par rapport au bloc de guidage (3) de telle sorte que le plan dans lequel s'étend cette pièce de positionnement (2) soit perpendiculaire au plan défini par les axes deux conduits (16) précités de guidage de broches ; et the instrument (1) comprises means (8, 9) for angular positioning of the positioning piece (2) with respect to the guiding block (3) so that the plane in which this positioning piece extends. (2) perpendicular to the plane defined by the axes two aforementioned guide ducts (16) pin; and
- la pièce de positionnement (2) présente dans sa portion médiane au moins un trou (10) de guidage de broche ayant un axe perpendiculaire à l'axe de pivotement de la pièce de positionnement (2) par rapport au bloc de guidage (3). the positioning piece (2) has in its middle portion at least one pin guide hole (10) having an axis perpendicular to the axis of pivoting of the positioning piece (2) with respect to the guide block (3). ).
9 - Instrument (1 ) selon la revendication 4 et la revendication 8, caractérisé en ce que la pièce de positionnement (2) comprend une pluralité de trous (10) de guidage de broche.
10 - Instrument (1 ) selon la revendication 4 et la revendication 9, caractérisé en ce que : 9 - Instrument (1) according to claim 4 and claim 8, characterized in that the positioning piece (2) comprises a plurality of pin guide holes (10). 10 - Instrument (1) according to claim 4 and claim 9, characterized in that:
- la pièce de positionnement et le bloc de guidage comprennent des moyens de repérage, fournissant, pour chaque position donnée de coulissement de la pièce de positionnement par rapport au bloc de guidage, une information spécifique relative à cette position, par exemple une marque d'une couleur déterminée ; et the positioning piece and the guiding block comprise marking means, providing, for each given sliding position of the positioning piece with respect to the guiding block, specific information relating to this position, for example a mark of a specific color; and
- la pièce de positionnement comprend, en regard de chaque trou à broche qu'elle comprend, une information spécifique correspondant à l'information spécifique fournie par ces moyens de repérage, par exemple une marque de la même couleur déterminée.
- The positioning part comprises, next to each pinhole it comprises, specific information corresponding to the specific information provided by these locating means, for example a mark of the same color determined.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
FR1459628A FR3026934B1 (en) | 2014-10-08 | 2014-10-08 | INSTRUMENT USABLE ON THE PLACEMENT OF A PROSTHESIS OF SHOULDER OR A PROSTHETIC ELEMENT ON A HUMERUS |
FR1459628 | 2014-10-08 |
Publications (1)
Publication Number | Publication Date |
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WO2016055958A1 true WO2016055958A1 (en) | 2016-04-14 |
Family
ID=52130419
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IB2015/057689 WO2016055958A1 (en) | 2014-10-08 | 2015-10-08 | Instrument that can be used when fitting a shoulder prosthesis or a prosthetic element on a humerus |
Country Status (2)
Country | Link |
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FR (1) | FR3026934B1 (en) |
WO (1) | WO2016055958A1 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN109549683A (en) * | 2018-12-03 | 2019-04-02 | 王爱香 | A kind of neurosurgery skull drilling device |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
FR3087105B1 (en) * | 2018-10-11 | 2021-07-16 | V I M S Video Interventionnelle Medicale Scient | ANCILLARY INSTRUMENT FOR ARTHROSCOPIC LATARJET OPERATION |
Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20120296339A1 (en) * | 2011-05-19 | 2012-11-22 | Iannotti Joseph P | Apparatus and method for providing a reference indication to a patient tissue |
US20130261629A1 (en) * | 2012-03-30 | 2013-10-03 | Sarah Anthony | Sizing instrument and punch for use in a surgical procedure to implant a stemless humeral component |
EP2724675A1 (en) * | 2012-10-26 | 2014-04-30 | Aston Medical | Template for installing an implant for articulating a shoulder prosthesis on a humeral head |
WO2014110421A1 (en) | 2013-01-11 | 2014-07-17 | The Uab Research Foundation | Apparatus for the fixation of proximal humerus fractures |
-
2014
- 2014-10-08 FR FR1459628A patent/FR3026934B1/en active Active
-
2015
- 2015-10-08 WO PCT/IB2015/057689 patent/WO2016055958A1/en active Application Filing
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20120296339A1 (en) * | 2011-05-19 | 2012-11-22 | Iannotti Joseph P | Apparatus and method for providing a reference indication to a patient tissue |
US20130261629A1 (en) * | 2012-03-30 | 2013-10-03 | Sarah Anthony | Sizing instrument and punch for use in a surgical procedure to implant a stemless humeral component |
EP2724675A1 (en) * | 2012-10-26 | 2014-04-30 | Aston Medical | Template for installing an implant for articulating a shoulder prosthesis on a humeral head |
WO2014110421A1 (en) | 2013-01-11 | 2014-07-17 | The Uab Research Foundation | Apparatus for the fixation of proximal humerus fractures |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN109549683A (en) * | 2018-12-03 | 2019-04-02 | 王爱香 | A kind of neurosurgery skull drilling device |
CN109549683B (en) * | 2018-12-03 | 2021-06-15 | 王爱香 | Skull drill for neurosurgery |
Also Published As
Publication number | Publication date |
---|---|
FR3026934A1 (en) | 2016-04-15 |
FR3026934B1 (en) | 2016-11-11 |
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