WO2018172660A1 - Set of elements comprising a joint prosthesis for small bones and an instrument allowing this prosthesis to be fitted - Google Patents

Set of elements comprising a joint prosthesis for small bones and an instrument allowing this prosthesis to be fitted Download PDF

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Publication number
WO2018172660A1
WO2018172660A1 PCT/FR2018/050596 FR2018050596W WO2018172660A1 WO 2018172660 A1 WO2018172660 A1 WO 2018172660A1 FR 2018050596 W FR2018050596 W FR 2018050596W WO 2018172660 A1 WO2018172660 A1 WO 2018172660A1
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WO
WIPO (PCT)
Prior art keywords
prosthesis
bone
instrument
piece
shape
Prior art date
Application number
PCT/FR2018/050596
Other languages
French (fr)
Inventor
Sophie CHALANDON
Yannick GALLIX
Philippe PENNUEN
Yann SAIN CAST
Renaud Duche
Original Assignee
Hands Up
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 Hands Up filed Critical Hands Up
Publication of WO2018172660A1 publication Critical patent/WO2018172660A1/en

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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
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1686—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hand or wrist
    • 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
    • A61B17/164—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans intramedullary
    • 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
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1682—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the foot or ankle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30159—Concave polygonal shapes
    • A61F2002/30168—L-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30159—Concave polygonal shapes
    • A61F2002/30172—T-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30159—Concave polygonal shapes
    • A61F2002/30181—Y-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30649—Ball-and-socket joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • A61F2002/30845—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes with cutting edges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • A61F2002/4256—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints
    • A61F2002/4258—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints for trapezo-metacarpal joints of thumbs

Definitions

  • the present invention relates to a set of elements comprising a joint prosthesis for small bones and an instrument for fitting this prosthesis.
  • “Small bones” means the bones of the joints of the hand or foot, as well as the bones of the wrist or ankle, provided that the joint to be treated comprises at least one long bone; the invention is particularly applicable to the constitution of a trapezio-metacarpal prosthesis.
  • a prosthetic articulation requires specific instrumentation, to arrange in the bones concerned receiving cavities of the two parts of the prosthesis which are articulated relative to each other and which constitute the prosthetic joint.
  • the part intended to be implanted in the trapezium has the shape of a cup, that is to say has a shape picked up, while the part intended to be implanted in the first metacarpal has an anchor rod conferring an elongated shape.
  • the instruments allowing the installation of such a prosthesis include a cutter for arranging a receiving cavity of the cup in the trapezium and a rasp for providing an enlargement of the medullary canal of the first metacarpal, allowing to develop a cavity receiving said anchor rod.
  • the instrumentation thus includes two "families" of instruments, one for the preparation of the trapezium and the other for the preparation of the first metacarp, which can be declined in several sizes, each having a structure adapted to the development of the cavity to be made.
  • the use of these instruments has the disadvantage of extending the time required for the installation of the prosthesis.
  • these instruments have significant manufacturing costs and are therefore designed to be reusable, so that they must be sterilized between two operations; as a result, the cost of manufacturing and using these instruments has a significant impact on the cost of setting up a joint prosthesis for small bones.
  • the present invention aims to remedy all of these disadvantages.
  • the document WO 2016/005684 A1 describes an assembly formed by a joint prosthesis for small bones and a single instrument allowing the installation of this prosthesis, this instrument allowing the development of a bone cavity for the placement of the prosthesis. prosthesis. This set does not overcome the aforementioned drawbacks.
  • the set of elements concerned comprises, in a manner known from the first document cited, a joint prosthesis for small bones and a single instrument for fitting this prosthesis, this instrument allowing the construction of a bone cavity for the placement of the prosthesis.
  • the set of elements comprises two prosthesis parts separated from one another and intended to be articulated to one another; a first piece of prosthesis intended to be implanted in a bone has totally or partially a shape corresponding to that of the envelope of the working part of said instrument; a second piece of prosthesis intended to be implanted in a bone has a metaphyseal portion and a diaphyseal portion.
  • the shape of the metaphyseal portion of said second prosthesis part corresponds to that of the envelope of the working part of said instrument, and the diaphyseal portion of this second prosthesis piece is in the form of an anchoring extension having a piercing and / or cutting shape in the direction of insertion of said second prosthesis part into a bone, this shape being such that said diaphyseal portion is adapted to be inserted into the spongy bone of the treated bone.
  • the set of elements according to the invention thus makes it possible to use said instrument to arrange, in the two bones concerned, proximal cavities of identical shapes, one of which is intended to receive said first piece of prosthesis and the other is intended to receive the metaphyseal portion of said second prosthesis part.
  • said first prosthesis piece has a shape corresponding as a whole to that of the envelope of the part of the said instrument and is intended to be implanted in the non-elongated bone by insertion into the cavity formed in this bone by means of this working part;
  • said second prosthesis part is intended to be implanted in the elongate bone, by force insertion of said diaphyseal part into the cancellous bone situated below the cavity formed in this elongated bone by means of said instrument and then by engagement of said part metaphyseal of this second piece of prosthesis in this cavity.
  • said first piece has, as said second piece, a metaphyseal portion and a diaphyseal portion; this metaphyseal portion of said first prosthesis part has a shape corresponding to that of the envelope of the working part of said instrument and this diaphyseal portion of said first prosthesis part has a piercing and / or cutting shape in the direction of insertion said first piece of prosthesis in a bone, this shape being such that said diaphyseal portion is adapted to be inserted into force in the cancellous bone of the treated bone.
  • said first piece of prosthesis and said second piece of prosthesis are respectively placed by insertion of their diaphyseal parts into the cancellous bone of the bones intended to receive them and then by engagement of their metaphyseal parts in the cavities arranged in these by means of said instrument, in the same way as described above about said second piece.
  • envelope of the working part of said instrument it must be understood that the space occupied globally by this part of work when it is animated by its movement of work.
  • shape of said first piece of prosthesis or of the metaphyseal part of one or the other said first and second prosthesis parts correspond either exactly to the shape of the envelope of said working part, or have a shape which is not exactly identical to that of this envelope but which is generally similar to this, for example example of shape slightly larger in diameter, for a fitting insertion, or even for a slightly forced insertion; the shape of said first prosthesis part or the metaphyseal part of one or the other of said first and second prosthesis parts may represent only a part of said envelope, and vice versa.
  • Said first prosthesis part or the metaphyseal part of one or the other of said first and second prosthesis parts may have a shape of revolution and the instrument then be rotatable, so that the envelope of said working part of this instrument presents a form of revolution when this instrument is animated by its movement of work.
  • Said anchoring extension of one or the other of said first or second prosthesis parts may be in the form of a tip or a blade, or at least one fin.
  • this anchorage extension is formed by three fins arranged at 120 ° from each other.
  • this same anchoring extension has the shape of a blade which can be either centered with respect to the axis of revolution of the metaphyseal part of the part, or decentered with respect to this axis; said anchoring extension may be in a single pan or in two or three panels giving it, in cross section, an L, T or Y shape.
  • the anchoring extension that comprises said first or second prosthesis piece is in two sections giving it, in cross section, a T-shape; a first pan is off-center and extends from one side of the metaphyseal portion of the prosthesis piece to the distal side of the anchor extension, the first pan being pointed on its distal portion; the second pan is connected to a bottom wall formed by the metaphyseal part of the prosthesis part, and has a longitudinal edge connected to said first pan and an opposite free longitudinal edge, the width of this second part going down in the direction of the distal end of the anchor extension.
  • the anchoring extension thus formed, allows a perfect anchoring of the prosthesis part in a long bone, especially in a first metacarpal.
  • the anchoring extension may be curved toward the axis of the prosthesis part at said distal portion, and said opposite free longitudinal edge may be curved in shape; the anchor extension can also be rectilinear.
  • Figure 1 is a side view of several of these elements, namely, on the left of the figure, four elements for the constitution of a trapezio-metacarpal joint prosthesis and, on the right of the figure, the strawberry that includes a bone milling instrument; the metacarpal prosthesis piece is according to a first embodiment;
  • Figure 2 is a perspective view of the cutter of the instrument
  • Figure 3 is a perspective view on an enlarged scale of the four aforementioned elements for the constitution of the articulation prosthesis
  • Figures 4 and 5 are other perspective views of said metacarpal piece, according to two other angles of view;
  • FIG. 6 is a view of the metacarpal piece according to another embodiment.
  • Figure 7 is a view of the metacarpal piece according to yet another embodiment.
  • FIG. 1 represents an assembly 1 of elements comprising elements 2, 3, 4, 5 allowing the constitution of a joint prosthesis for small bones, and the milling cutter 6 of a bone milling instrument 7, allowing the installation of this prosthesis.
  • the prosthesis in question is a trapezio-metacarpal prosthesis of a well-known type called "dual mobility", that is to say comprising a first piece of prosthesis 2 in the form of a cup, intended to be implanted. in the trapezium (hereinafter referred to as “trapezial piece”), a second piece of prosthesis 3 intended to be implanted in the first metacarpal (hereinafter referred to "metacarpal piece”), an intermediate piece 4 forming a spherical articulating head, and a slip insert 5.
  • dual mobility that is to say comprising a first piece of prosthesis 2 in the form of a cup, intended to be implanted. in the trapezium (hereinafter referred to as "trapezial piece”), a second piece of prosthesis 3 intended to be implanted in the first metacarpal (hereinafter referred to "metacarpal piece”), an intermediate piece 4 forming a spherical articulating head, and a slip insert 5.
  • the trapezial piece 2 has an outer collar 10 extending along its edge which defines the opening of the cavity 1 1 which it forms to receive the insert 5.
  • This collar 10 allows the support of this piece 2 against the trapezoid bone and is interrupted on two diametrically opposed sectors to allow its entry by a handling instrument.
  • the piece 2 also has a succession of circular grooves at its outer wall, promoting its insertion into the bone and retention on this bone due to growth of bone cells.
  • the trapezial piece 2 has as a whole a form of revolution whose generator corresponds to that of the envelope of the cutter 6, that is to say to the space that occupies globally this strawberry when it is rotated.
  • the metacarpal piece 3 has a metaphyseal portion 3a and a diaphyseal portion 3b.
  • the metaphyseal portion 3a has a general shape of revolution whose generator corresponds to that of the envelope of the cutter 6. It has on its proximal portion a flange 15 homologous to the flange 10 and has the conically shaped cavity 16 for receiving and retaining by wedging the corresponding connection piece 17 of the part 4.
  • the diaphyseal portion 3b is in the form of an anchoring extension 18 formed by two wall sections 20, 21 giving it, in cross-section, a T-shape.
  • a first panel 20 is off-center with respect to the metaphyseal part. 3a and extends from one side thereof, towards the distal side of the anchoring extension 18, this first panel 20 being pointed on its distal portion, and curving towards the axis of the part 3 at the same distal portion.
  • the second panel 21 is connected to a bottom wall formed by the metaphyseal portion 3a, and has a longitudinal edge connected to the first panel 20 and an opposite free longitudinal edge. The width of this second panel 21 is reduced in the direction of the distal end of the anchoring extension 18 and said opposite free longitudinal edge has a curved shape.
  • extension 18 to have a piercing and cutting shape in the direction of insertion of the metacarpal piece 3 in the first metacarpal, this shape being such that the diaphyseal portion 3b is able to be inserted by force into the cancellous bone of this first metacarpus.
  • the intermediate piece 4 in addition to the tip 17, forms the aforementioned spherical articulation head 25 and has a neck 26 of connection to this tip 17.
  • the slip insert 5 in particular made of polyethylene, forms a cavity 27 for receiving the head 25 with sliding, and has an outer wall in a portion of a sphere intended to be received with sliding in the cavity 1 1 arranged in the trapezium piece. 2.
  • the bone milling instrument 7 has a body 30 integral with the cutter 6, and is made of a piece of metal.
  • the instrument 7 is cannulated to allow its guidance in rotation around a pin previously placed on the bone to be treated.
  • the set of elements 1 thus makes it possible to use said instrument 7 for milling, in the two bones concerned, proximal cavities of identical shapes, one of which is intended to receive the trapezial piece 2 and the other is intended for receive the metaphyseal portion 3a of the metacarpal piece 3.
  • the piece 2 is implanted in the trapezium by insertion into the cavity formed in the latter, while the piece 3 is implanted in the first metacarp by force insertion of the diaphyseal portion 3b in the cancellous bone located below the cavity formed in this first metacarpus and then by engagement of the metaphyseal part 3a in the milled proximal cavity.
  • the set of elements then comprises a first piece of prosthesis having a metaphyseal portion of shape identical to the shape of the piece 2 described above and a diaphyseal portion connected to this metaphyseal portion, including an anchoring extension of piercing and / or cutting shape in the direction of insertion of said first prosthesis part into a bone, this shape being such that said portion diaphyseal is able to be inserted into force in the spongy bone of the treated bone.
  • the second prosthesis piece may be identical to the piece 3 described above or may be a piece of similar structure, having a metaphyseal portion and a diaphyseal portion formed by a piercing and / or cutting anchor extension.
  • Figure 6 shows another embodiment of the metacarpal piece 3, wherein said anchoring extension 18 is rectilinear and is formed by three wall panels 22 arranged at 120 ° from each other.
  • FIG. 7 shows yet another embodiment of the metacarpal piece 3 in which said anchoring extension 18 is also rectilinear and is formed by three fins 23 arranged at 120 ° from each other, but these fins are shorter than in the other two versions of the piece 3 and have rounded external edges.
  • the invention provides a set of elements 1 for using a single strawberry-type instrument 7 to arrange only cavities collected in the proximal portions of the bones to be treated, and to insert in force in the cancellous bone the one or more diaphyseal portions 3b of one and / or the other of the prosthesis parts to be implanted. It thus makes it possible to dispense with the use of rasps and sets of instruments, and thus significantly shorten the duration of the surgical procedure.
  • the uniqueness of the instrument 7 used eliminates the need to manufacture different instruments, and thus makes possible the fact that this instrument 7 is disposable.
  • the fact that this instrument 7 is designed to be disposable eliminates the need to resterilize the instrument, which has a significant impact on the cost of implantation of the prosthesis.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Dentistry (AREA)
  • Cardiology (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)

Abstract

This set (1) comprises a joint prosthesis for small bones and a single instrument (7) allowing this prosthesis to be fitted, this instrument (7) allowing a bone cavity to be formed in order to fit the prosthesis (2). According to the invention, - the set (1) of elements comprises two prosthesis pieces (2, 3) separated from each other and intended to be articulated with one another; a first prosthesis piece (2) intended to be implanted in a bone has a shape that corresponds completely or partially to that of the casing of the working part (6) of said instrument; a second prosthesis piece (3) intended to be implanted in a bone has a metaphyseal portion (3a) and a diaphyseal portion (3b); - the shape of the metaphyseal portion (3a) of said second prosthesis piece (3) corresponds to that of the casing of the working part (6) of said instrument (7), and the diaphyseal portion (3b) of this second prosthesis piece (3) is in the form of an anchoring extension (18) having a piercing and/or cutting shape so as to pierce and/or cut in the direction in which said second prosthesis piece (3) is inserted into a bone, this shape being such that said diaphyseal portion (3b) is suitable for being forcibly inserted into the cancellous bone of the treated bone.

Description

ENSEMBLE D'ÉLÉMENTS COMPRENANT UNE PROTHÈSE  ASSEMBLY OF ELEMENTS COMPRISING A PROSTHESIS
D'ARTICULATION POUR DE PETITS OS ET UN INSTRUMENT PERMETTANT JOINT FOR SMALL BONES AND A PERMITTING INSTRUMENT
LA POSE DE CETTE PROTHÈSE  THE INSTALLATION OF THIS PROSTHESIS
La présente invention concerne un ensemble d'éléments comprenant une prothèse d'articulation pour de petits os et un instrument permettant la pose de cette prothèse.  The present invention relates to a set of elements comprising a joint prosthesis for small bones and an instrument for fitting this prosthesis.
Par "petits os", il faut entendre les os des articulations de la main ou du pied, ainsi que les os du poignet ou de la cheville, dès lors que l'articulation à traiter comprend au moins un os long ; l'invention est en particulier applicable à la constitution d'une prothèse trapèzo-métacarpienne.  "Small bones" means the bones of the joints of the hand or foot, as well as the bones of the wrist or ankle, provided that the joint to be treated comprises at least one long bone; the invention is particularly applicable to the constitution of a trapezio-metacarpal prosthesis.
La mise en place d'une prothèse d'articulation requiert une instrumentation spécifique, permettant d'aménager dans les os concernés des cavités de réception des deux parties de la prothèse qui sont articulées l'une par rapport à l'autre et qui constituent l'articulation prothétique. Dans le cas d'une prothèse trapèzo-métacarpienne, la pièce destinée à être implantée dans le trapèze présente la forme d'une cupule, c'est-à-dire a une forme ramassée, tandis que la pièce destinée à être implantée dans le premier métacarpe présente une tige d'ancrage lui conférant une forme allongée. Les instruments permettant la pose d'une telle prothèse incluent une fraise permettant d'aménager une cavité de réception de la cupule dans le trapèze et une râpe d'aménagement d'un élargissement du canal médullaire du premier métacarpe, permettant d'aménager une cavité de réception de ladite tige d'ancrage.  The establishment of a prosthetic articulation requires specific instrumentation, to arrange in the bones concerned receiving cavities of the two parts of the prosthesis which are articulated relative to each other and which constitute the prosthetic joint. In the case of a trapezio-metacarpal prosthesis, the part intended to be implanted in the trapezium has the shape of a cup, that is to say has a shape picked up, while the part intended to be implanted in the first metacarpal has an anchor rod conferring an elongated shape. The instruments allowing the installation of such a prosthesis include a cutter for arranging a receiving cavity of the cup in the trapezium and a rasp for providing an enlargement of the medullary canal of the first metacarpal, allowing to develop a cavity receiving said anchor rod.
L'instrumentation inclut donc deux "familles" d'instruments, l'une pour la préparation du trapèze et l'autre pour la préparation du premier métacarpe, qui peuvent se décliner en plusieurs tailles, ayant chacun une structure adaptée à l'aménagement de la cavité à réaliser. L'utilisation de ces instruments a pour inconvénient d'allonger le temps nécessaire à la pose de la prothèse. De plus, ces instruments ont des coûts de fabrication non négligeables et sont donc conçus pour être réutilisables, de sorte qu'ils doivent être stérilisés entre deux opérations ; il en résulte que le coût de fabrication et d'utilisation de ces instruments a une incidence notable sur le coût de mise en place d'une prothèse d'articulation destinée à de petits os.  The instrumentation thus includes two "families" of instruments, one for the preparation of the trapezium and the other for the preparation of the first metacarp, which can be declined in several sizes, each having a structure adapted to the development of the cavity to be made. The use of these instruments has the disadvantage of extending the time required for the installation of the prosthesis. In addition, these instruments have significant manufacturing costs and are therefore designed to be reusable, so that they must be sterilized between two operations; as a result, the cost of manufacturing and using these instruments has a significant impact on the cost of setting up a joint prosthesis for small bones.
La présente invention a pour objectif de remédier à l'ensemble de ces inconvénients. Le document WO 2016/005684 A1 décrit un ensemble formé par une prothèse d'articulation pour de petits os et un instrument unique permettant la pose de cette prothèse, cet instrument permettant l'aménagement d'une cavité osseuse pour la mise en place de la prothèse. Cet ensemble ne permet pas de remédier aux inconvénients précités. The present invention aims to remedy all of these disadvantages. The document WO 2016/005684 A1 describes an assembly formed by a joint prosthesis for small bones and a single instrument allowing the installation of this prosthesis, this instrument allowing the development of a bone cavity for the placement of the prosthesis. prosthesis. This set does not overcome the aforementioned drawbacks.
Les documents FR 2 755 005 A1 et WO 2016/149635 A1 décrivent d'autres systèmes selon l'art antérieur, ne permettant pas non plus de remédier auxdits inconvénients.  The documents FR 2 755 005 A1 and WO 2016/149635 A1 describe other systems according to the prior art, also not making it possible to remedy said disadvantages.
L'ensemble d'éléments concerné comprend, de manière connue par le premier document cité, une prothèse d'articulation pour de petits os et un instrument unique permettant la pose de cette prothèse, cet instrument permettant l'aménagement d'une cavité osseuse pour la mise en place de la prothèse.  The set of elements concerned comprises, in a manner known from the first document cited, a joint prosthesis for small bones and a single instrument for fitting this prosthesis, this instrument allowing the construction of a bone cavity for the placement of the prosthesis.
Selon l'invention,  According to the invention,
- l'ensemble d'éléments comprend deux pièces de prothèse séparées l'une de l'autre et destinées à être articulées l'une à l'autre ; une première pièce de prothèse destinée à être implantée dans un os présente totalement ou partiellement une forme correspondant à celle de l'enveloppe de la partie de travail dudit instrument ; une deuxième pièce de prothèse destinée à être implantée dans un os présente une portion métaphysaire et une portion diaphysaire.  the set of elements comprises two prosthesis parts separated from one another and intended to be articulated to one another; a first piece of prosthesis intended to be implanted in a bone has totally or partially a shape corresponding to that of the envelope of the working part of said instrument; a second piece of prosthesis intended to be implanted in a bone has a metaphyseal portion and a diaphyseal portion.
- la forme que présente la portion métaphysaire de ladite deuxième pièce de prothèse correspond à celle de l'enveloppe de la partie de travail dudit instrument, et la portion diaphysaire de cette deuxième pièce de prothèse est sous la forme d'une extension d'ancrage présentant une forme perçante et / ou tranchante selon la direction d'insertion de ladite deuxième pièce de prothèse dans un os, cette forme étant telle que ladite portion diaphysaire est apte à être insérée en force dans l'os spongieux de l'os traité.  the shape of the metaphyseal portion of said second prosthesis part corresponds to that of the envelope of the working part of said instrument, and the diaphyseal portion of this second prosthesis piece is in the form of an anchoring extension having a piercing and / or cutting shape in the direction of insertion of said second prosthesis part into a bone, this shape being such that said diaphyseal portion is adapted to be inserted into the spongy bone of the treated bone.
L'ensemble d'éléments selon l'invention permet ainsi d'utiliser ledit instrument pour aménager, dans les deux os concernés, des cavités proximales de formes identiques, dont l'une est destinée à recevoir ladite première pièce de prothèse et l'autre est destinée à recevoir la portion métaphysaire de ladite deuxième pièce de prothèse.  The set of elements according to the invention thus makes it possible to use said instrument to arrange, in the two bones concerned, proximal cavities of identical shapes, one of which is intended to receive said first piece of prosthesis and the other is intended to receive the metaphyseal portion of said second prosthesis part.
Lorsque l'articulation à traiter comprend un os non allongé et un os allongé, comme cela est le cas d'une prothèse trapèzo-métacarpienne, ladite première pièce de prothèse présente une forme correspondant dans son ensemble à celle de l'enveloppe de la partie de travail dudit instrument et est destinée à être implantée dans l'os non allongé par insertion dans la cavité aménagée dans cet os au moyen de cette partie de travail ; ladite deuxième pièce de prothèse est destinée à être implantée dans l'os allongé, par insertion en force de ladite partie diaphysaire dans l'os spongieux situé en dessous de la cavité aménagée dans cet os allongé au moyen dudit instrument puis par engagement de ladite partie métaphysaire de cette deuxième pièce de prothèse dans cette cavité. When the joint to be treated comprises a non-elongated bone and an elongate bone, as is the case of a trapezio-metacarpal prosthesis, said first prosthesis piece has a shape corresponding as a whole to that of the envelope of the part of the said instrument and is intended to be implanted in the non-elongated bone by insertion into the cavity formed in this bone by means of this working part; said second prosthesis part is intended to be implanted in the elongate bone, by force insertion of said diaphyseal part into the cancellous bone situated below the cavity formed in this elongated bone by means of said instrument and then by engagement of said part metaphyseal of this second piece of prosthesis in this cavity.
Lorsque l'articulation à traiter comprend deux os allongés, par exemple dans le cas d'une prothèse interphalangienne, ladite première pièce présente, comme ladite deuxième pièce, une portion métaphysaire et une portion diaphysaire ; cette portion métaphysaire de ladite première pièce de prothèse présente une forme correspondant à celle de l'enveloppe de la partie de travail dudit instrument et cette portion diaphysaire de ladite première pièce de prothèse présente une forme perçante et / ou tranchante selon la direction d'insertion de ladite première pièce de prothèse dans un os, cette forme étant telle que ladite portion diaphysaire est apte à être insérée en force dans l'os spongieux de l'os traité. Dans ce cas, ladite première pièce de prothèse et ladite deuxième pièce de prothèse sont respectivement mises en place par insertion de leurs parties diaphysaires dans l'os spongieux des os destinés à les recevoir puis par engagement de leurs parties métaphysaires dans les cavités aménagées dans ces os au moyen dudit instrument, de la même façon que décrit plus haut à propos de ladite deuxième pièce.  When the joint to be treated comprises two elongate bones, for example in the case of an interphalangeal prosthesis, said first piece has, as said second piece, a metaphyseal portion and a diaphyseal portion; this metaphyseal portion of said first prosthesis part has a shape corresponding to that of the envelope of the working part of said instrument and this diaphyseal portion of said first prosthesis part has a piercing and / or cutting shape in the direction of insertion said first piece of prosthesis in a bone, this shape being such that said diaphyseal portion is adapted to be inserted into force in the cancellous bone of the treated bone. In this case, said first piece of prosthesis and said second piece of prosthesis are respectively placed by insertion of their diaphyseal parts into the cancellous bone of the bones intended to receive them and then by engagement of their metaphyseal parts in the cavities arranged in these by means of said instrument, in the same way as described above about said second piece.
Le fait d'utiliser un seul et même instrument pour aménager uniquement des cavités ramassées dans les portions proximales des os à traiter, et le fait d'insérer en force dans l'os spongieux la ou lesdites parties diaphysaires desdites première et deuxième pièces de prothèse, permet de s'affranchir de l'utilisation de râpes et d'outils de différentes tailles, et permet ainsi de raccourcir notablement, de ce fait, la durée de l'intervention chirurgicale. De plus, le caractère unique de l'instrument utilisé élimine la nécessité de fabriquer des séries d'instruments différents, et rend donc possible le fait que cet instrument soit à usage unique. Le fait que cet instrument soit conçu pour être à usage unique élimine toute nécessité de restériliser l'instrument, ce qui a une incidence importante sur le coût d'implantation de la prothèse.  The fact of using a single instrument to arrange only cavities collected in the proximal portions of the bones to be treated, and the fact of inserting force into the cancellous bone or said diaphyseal parts of said first and second prosthesis parts , avoids the use of rasps and tools of different sizes, and thus significantly shortens, therefore, the duration of the surgical procedure. In addition, the uniqueness of the instrument eliminates the need for different sets of instruments, making it possible for this instrument to be single-use. The fact that this instrument is designed to be disposable eliminates the need to resterilize the instrument, which has a significant impact on the cost of implantation of the prosthesis.
Il sera compris que par l'expression "enveloppe de la partie de travail dudit instrument", il doit être entendu que l'espace qu'occupe globalement cette partie de travail lorsqu'elle est animée de son mouvement de travail. Il sera également compris que par l'expression "correspond à l'enveloppe de la partie de travail dudit instrument", il doit être entendu que la forme de ladite première pièce de prothèse ou de la partie métaphysaire de l'une ou l'autre desdites première et deuxième pièces de prothèse correspond soit précisément à la forme de l'enveloppe de ladite partie de travail, soit présente une forme qui n'est pas exactement identique à celle de cette enveloppe mais qui est globalement similaire à celle-ci, par exemple de forme légèrement plus grande en diamètre, pour une insertion ajustée, voire pour une insertion légèrement forcée ; la forme de ladite première pièce de prothèse ou de la partie métaphysaire de l'une ou l'autre desdites première et deuxième pièces de prothèse peut ne représenter qu'une partie de ladite enveloppe, et inversement. It will be understood that by the expression "envelope of the working part of said instrument", it must be understood that the space occupied globally by this part of work when it is animated by its movement of work. It will also be understood that by the expression "corresponds to the envelope of the working part of said instrument", it is to be understood that the shape of said first piece of prosthesis or of the metaphyseal part of one or the other said first and second prosthesis parts correspond either exactly to the shape of the envelope of said working part, or have a shape which is not exactly identical to that of this envelope but which is generally similar to this, for example example of shape slightly larger in diameter, for a fitting insertion, or even for a slightly forced insertion; the shape of said first prosthesis part or the metaphyseal part of one or the other of said first and second prosthesis parts may represent only a part of said envelope, and vice versa.
Ladite première pièce de prothèse ou la partie métaphysaire de l'une ou l'autre desdites première et deuxième pièces de prothèse peut présenter une forme de révolution et l'instrument être alors rotatif, de sorte que l'enveloppe de ladite partie de travail de cet instrument présente une forme de révolution lorsque cet instrument est animé de son mouvement de travail.  Said first prosthesis part or the metaphyseal part of one or the other of said first and second prosthesis parts may have a shape of revolution and the instrument then be rotatable, so that the envelope of said working part of this instrument presents a form of revolution when this instrument is animated by its movement of work.
Ladite extension d'ancrage de l'une ou l'autre desdites première ou deuxième pièces de prothèse précitées peut présenter la forme d'une pointe ou d'une lame, ou d'au moins un aileron.  Said anchoring extension of one or the other of said first or second prosthesis parts may be in the form of a tip or a blade, or at least one fin.
Selon une possibilité, cette extension d'ancrage est formée par trois ailerons disposés à 120° les uns des autres.  According to one possibility, this anchorage extension is formed by three fins arranged at 120 ° from each other.
Selon une autre possibilité, cette même extension d'ancrage présente la forme d'une lame qui peut être soit centrée par rapport à l'axe de révolution de la partie métaphysaire de la pièce, soit décentrée par rapport à cet axe ; ladite extension d'ancrage peut être en un pan unique ou en deux ou trois pans lui donnant, vue en coupe transversale, une forme en L, T ou en Y.  According to another possibility, this same anchoring extension has the shape of a blade which can be either centered with respect to the axis of revolution of the metaphyseal part of the part, or decentered with respect to this axis; said anchoring extension may be in a single pan or in two or three panels giving it, in cross section, an L, T or Y shape.
Selon une forme de réalisation de l'invention, l'extension d'ancrage que comprend ladite première ou ladite deuxième pièce de prothèse est en deux pans lui donnant, vue en coupe transversale, une forme en T ; un premier pan est décentré et s'étend depuis un côté de la partie métaphysaire de la pièce de prothèse, vers le côté distal de l'extension d'ancrage, ce premier pan étant de forme pointue sur sa portion distale ; le deuxième pan est relié à une paroi de fond formée par la partie métaphysaire de la pièce de prothèse, et présente un bord longitudinal relié audit premier pan et un bord longitudinal libre opposé, la largeur de ce deuxième pan allant en se réduisant en direction de l'extrémité distale de l'extension d'ancrage. According to one embodiment of the invention, the anchoring extension that comprises said first or second prosthesis piece is in two sections giving it, in cross section, a T-shape; a first pan is off-center and extends from one side of the metaphyseal portion of the prosthesis piece to the distal side of the anchor extension, the first pan being pointed on its distal portion; the second pan is connected to a bottom wall formed by the metaphyseal part of the prosthesis part, and has a longitudinal edge connected to said first pan and an opposite free longitudinal edge, the width of this second part going down in the direction of the distal end of the anchor extension.
L'extension d'ancrage, ainsi constituée, permet un parfait ancrage de la pièce de prothèse dans un os long, en particulier dans un premier métacarpe.  The anchoring extension, thus formed, allows a perfect anchoring of the prosthesis part in a long bone, especially in a first metacarpal.
L'extension d'ancrage peut être courbée vers l'axe de la pièce de prothèse au niveau de ladite portion distale, et ledit bord longitudinal libre opposé peut présenter une forme courbe ; l'extension d'ancrage peut également être rectiligne.  The anchoring extension may be curved toward the axis of the prosthesis part at said distal portion, and said opposite free longitudinal edge may be curved in shape; the anchor extension can also be rectilinear.
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'exemples non limitatifs, plusieurs formes de réalisation d'éléments que comprend l'ensemble d'éléments qu'elle concerne.  The invention will be better understood, and other features and advantages thereof will appear, with reference to the appended schematic drawing, showing, by way of nonlimiting examples, several embodiments of elements that comprise the set of elements it concerns.
La figure 1 est une vue de côté de plusieurs de ces éléments, à savoir, sur la gauche de la figure, quatre éléments pour la constitution d'une prothèse d'articulation trapèzo-métacarpienne et, sur la droite de la figure, la fraise que comprend un instrument de fraisage d'os ; la pièce de prothèse métacarpienne est selon une première forme de réalisation ;  Figure 1 is a side view of several of these elements, namely, on the left of the figure, four elements for the constitution of a trapezio-metacarpal joint prosthesis and, on the right of the figure, the strawberry that includes a bone milling instrument; the metacarpal prosthesis piece is according to a first embodiment;
la figure 2 est une vue en perspective de la fraise de l'instrument ;  Figure 2 is a perspective view of the cutter of the instrument;
la figure 3 est une vue en perspective et à échelle agrandie des quatre éléments précités pour la constitution de la prothèse d'articulation ;  Figure 3 is a perspective view on an enlarged scale of the four aforementioned elements for the constitution of the articulation prosthesis;
les figures 4 et 5 sont d'autres vues en perspective de ladite pièce métacarpienne, selon deux autres angles de vue ;  Figures 4 and 5 are other perspective views of said metacarpal piece, according to two other angles of view;
la figure 6 est une vue de la pièce métacarpienne selon une autre forme de réalisation, et  FIG. 6 is a view of the metacarpal piece according to another embodiment, and
la figure 7 est une vue de la pièce métacarpienne selon encore une autre forme de réalisation.  Figure 7 is a view of the metacarpal piece according to yet another embodiment.
La figure 1 représente un ensemble 1 d'éléments comprenant des éléments 2, 3, 4, 5 permettant la constitution d'une prothèse d'articulation pour de petits os, et la fraise 6 d'un instrument 7 de fraisage d'os, permettant la pose de cette prothèse.  FIG. 1 represents an assembly 1 of elements comprising elements 2, 3, 4, 5 allowing the constitution of a joint prosthesis for small bones, and the milling cutter 6 of a bone milling instrument 7, allowing the installation of this prosthesis.
Dans l'exemple représenté, la prothèse en question est une prothèse trapèzo-métacarpienne de type bien connu dit "à double mobilité", c'est-à-dire comprenant une première pièce de prothèse 2 en forme de cupule, destinée à être implantée dans le trapèze (dite ci-après "pièce trapèzienne"), une deuxième pièce de prothèse 3, destinée à être implantée dans le premier métacarpe (dite ci-après "pièce métacarpienne"), une pièce intermédiaire 4 formant une tête sphérique d'articulation, et un insert de glissement 5. In the example shown, the prosthesis in question is a trapezio-metacarpal prosthesis of a well-known type called "dual mobility", that is to say comprising a first piece of prosthesis 2 in the form of a cup, intended to be implanted. in the trapezium (hereinafter referred to as "trapezial piece"), a second piece of prosthesis 3 intended to be implanted in the first metacarpal (hereinafter referred to "metacarpal piece"), an intermediate piece 4 forming a spherical articulating head, and a slip insert 5.
Ces pièces sont plus particulièrement visibles sur la figure 3, et sur les figures 3 à 5 s'agissant de la pièce métacarpienne 3.  These parts are more particularly visible in FIG. 3, and in FIGS. 3 to 5 with respect to the metacarpal piece 3.
En référence à la figure 3, il apparaît que la pièce trapèzienne 2 présente une collerette 10 externe s'étendant le long de son bord qui délimite l'ouverture de la cavité 1 1 qu'elle forme pour recevoir l'insert 5. Cette collerette 10 permet la prise d'appui de cette pièce 2 contre l'os du trapèze et est interrompue sur deux secteurs diamétralement opposés pour permettre sa saisie par un instrument de manipulation.  Referring to Figure 3, it appears that the trapezial piece 2 has an outer collar 10 extending along its edge which defines the opening of the cavity 1 1 which it forms to receive the insert 5. This collar 10 allows the support of this piece 2 against the trapezoid bone and is interrupted on two diametrically opposed sectors to allow its entry by a handling instrument.
La pièce 2 présente également une succession de cannelures circulaires au niveau de sa paroi extérieure, favorisant son insertion dans l'os et sa rétention sur cet os par suite de croissance de cellules osseuses.  The piece 2 also has a succession of circular grooves at its outer wall, promoting its insertion into the bone and retention on this bone due to growth of bone cells.
En considérant la figure 1 et la figure 3, il apparaît que la pièce trapèzienne 2 présente dans son ensemble une forme de révolution dont la génératrice correspond à celle de l'enveloppe de la fraise 6, c'est-à-dire à l'espace qu'occupe globalement cette fraise lorsqu'elle est entraînée en rotation.  By considering FIG. 1 and FIG. 3, it appears that the trapezial piece 2 has as a whole a form of revolution whose generator corresponds to that of the envelope of the cutter 6, that is to say to the space that occupies globally this strawberry when it is rotated.
En référence aux figures 3 à 5, il apparaît que la pièce métacarpienne 3 présente une portion métaphysaire 3a et une portion diaphysaire 3b.  With reference to FIGS. 3 to 5, it appears that the metacarpal piece 3 has a metaphyseal portion 3a and a diaphyseal portion 3b.
Comme visible sur les figures 1 , 3 et 5, la portion métaphysaire 3a a une forme générale de révolution dont la génératrice correspond à celle de l'enveloppe de la fraise 6. Elle présente sur sa partie proximale une collerette 15 homologue à la collerette 10, et présente la cavité 16 de forme conique destinée à recevoir, et à retenir par coincement, l'embout de connexion 17 correspondant de la pièce 4.  As shown in Figures 1, 3 and 5, the metaphyseal portion 3a has a general shape of revolution whose generator corresponds to that of the envelope of the cutter 6. It has on its proximal portion a flange 15 homologous to the flange 10 and has the conically shaped cavity 16 for receiving and retaining by wedging the corresponding connection piece 17 of the part 4.
La portion diaphysaire 3b est sous la forme d'une extension d'ancrage 18 formée par deux pans de paroi 20, 21 lui donnant, vue en coupe transversale, une forme en T. Un premier pan 20 est décentré par rapport à la partie métaphysaire 3a et s'étend depuis un côté de celle-ci, vers le côté distal de l'extension d'ancrage 18, ce premier pan 20 étant de forme pointue sur sa portion distale, et se courbant vers l'axe de la pièce 3 au niveau de cette même portion distale. Le deuxième pan 21 est relié à une paroi de fond formée par la partie métaphysaire 3a, et présente un bord longitudinal relié au premier pan 20 et un bord longitudinal libre opposé. La largeur de ce deuxième pan 21 va en se réduisant en direction de l'extrémité distale de l'extension d'ancrage 18 et ledit bord longitudinal libre opposé présente une forme courbe. Ces caractéristiques permettent à l'extension 18 de présenter une forme perçante et tranchante selon la direction d'insertion de la pièce métacarpienne 3 dans le premier métacarpe, cette forme étant telle que la portion diaphysaire 3b est apte à être insérée en force dans l'os spongieux de ce premier métacarpe. The diaphyseal portion 3b is in the form of an anchoring extension 18 formed by two wall sections 20, 21 giving it, in cross-section, a T-shape. A first panel 20 is off-center with respect to the metaphyseal part. 3a and extends from one side thereof, towards the distal side of the anchoring extension 18, this first panel 20 being pointed on its distal portion, and curving towards the axis of the part 3 at the same distal portion. The second panel 21 is connected to a bottom wall formed by the metaphyseal portion 3a, and has a longitudinal edge connected to the first panel 20 and an opposite free longitudinal edge. The width of this second panel 21 is reduced in the direction of the distal end of the anchoring extension 18 and said opposite free longitudinal edge has a curved shape. These characteristics allow the extension 18 to have a piercing and cutting shape in the direction of insertion of the metacarpal piece 3 in the first metacarpal, this shape being such that the diaphyseal portion 3b is able to be inserted by force into the cancellous bone of this first metacarpus.
La pièce intermédiaire 4, outre l'embout 17, forme la tête sphérique d'articulation 25 précitée et présente un cou 26 de liaison à cet embout 17.  The intermediate piece 4, in addition to the tip 17, forms the aforementioned spherical articulation head 25 and has a neck 26 of connection to this tip 17.
L'insert de glissement 5, notamment en polyéthylène, forme une cavité 27 de réception de la tête 25 avec glissement, et présente une paroi extérieure en portion de sphère, destinée à être reçue avec glissement dans la cavité 1 1 aménagée dans la pièce trapèzienne 2.  The slip insert 5, in particular made of polyethylene, forms a cavity 27 for receiving the head 25 with sliding, and has an outer wall in a portion of a sphere intended to be received with sliding in the cavity 1 1 arranged in the trapezium piece. 2.
L'instrument 7 de fraisage d'os présente un corps 30 solidaire de la fraise 6, et est réalisé en une pièce de métal. L'instrument 7 est canulé pour permettre son guidage en rotation autour d'une broche préalablement mise en place sur l'os à traiter.  The bone milling instrument 7 has a body 30 integral with the cutter 6, and is made of a piece of metal. The instrument 7 is cannulated to allow its guidance in rotation around a pin previously placed on the bone to be treated.
L'ensemble d'éléments 1 permet ainsi d'utiliser ledit instrument 7 pour fraiser, dans les deux os concernés, des cavités proximales de formes identiques, dont l'une est destinée à recevoir la pièce trapèzienne 2 et l'autre est destinée à recevoir la portion métaphysaire 3a de la pièce métacarpienne 3. La pièce 2 est implantée dans le trapèze par insertion dans la cavité aménagée dans ce dernier, tandis que la pièce 3 est implantée dans le premier métacarpe par insertion en force de la partie diaphysaire 3b dans l'os spongieux situé en dessous de la cavité aménagée dans ce premier métacarpe puis par engagement de la partie métaphysaire 3a dans la cavité proximale fraisée.  The set of elements 1 thus makes it possible to use said instrument 7 for milling, in the two bones concerned, proximal cavities of identical shapes, one of which is intended to receive the trapezial piece 2 and the other is intended for receive the metaphyseal portion 3a of the metacarpal piece 3. The piece 2 is implanted in the trapezium by insertion into the cavity formed in the latter, while the piece 3 is implanted in the first metacarp by force insertion of the diaphyseal portion 3b in the cancellous bone located below the cavity formed in this first metacarpus and then by engagement of the metaphyseal part 3a in the milled proximal cavity.
Lorsque l'articulation à traiter comprend deux os allongés, par exemple dans le cas d'une prothèse interphalangienne, l'ensemble d'éléments comprend alors une première pièce de prothèse présentant une portion métaphysaire de forme identique à la forme qu'a la pièce 2 décrite plus haut et une portion diaphysaire reliée à cette portion métaphysaire, incluant une extension d'ancrage de forme perçante et / ou tranchante selon la direction d'insertion de ladite première pièce de prothèse dans un os, cette forme étant telle que ladite portion diaphysaire est apte à être insérée en force dans l'os spongieux de l'os traité. La deuxième pièce de prothèse peut être identique à la pièce 3 décrite plus haut ou peut être une pièce de structure similaire, présentant une portion métaphysaire et une portion diaphysaire formée par une extension d'ancrage perçante et / ou tranchante. La figure 6 montre une autre forme de réalisation de la pièce métacarpienne 3, dans laquelle ladite extension d'ancrage 18 est rectiligne et est formée par trois pans de paroi 22 disposés à 120° les uns des autres. When the joint to be treated comprises two elongate bones, for example in the case of an interphalangeal prosthesis, the set of elements then comprises a first piece of prosthesis having a metaphyseal portion of shape identical to the shape of the piece 2 described above and a diaphyseal portion connected to this metaphyseal portion, including an anchoring extension of piercing and / or cutting shape in the direction of insertion of said first prosthesis part into a bone, this shape being such that said portion diaphyseal is able to be inserted into force in the spongy bone of the treated bone. The second prosthesis piece may be identical to the piece 3 described above or may be a piece of similar structure, having a metaphyseal portion and a diaphyseal portion formed by a piercing and / or cutting anchor extension. Figure 6 shows another embodiment of the metacarpal piece 3, wherein said anchoring extension 18 is rectilinear and is formed by three wall panels 22 arranged at 120 ° from each other.
La figure 7 montre encore une autre forme de réalisation de la pièce métacarpienne 3 dans laquelle ladite extension d'ancrage 18 est également rectiligne et est formée par trois ailerons 23 disposés à 120° les uns des autres, mais ces ailerons sont plus courts que dans les deux autres versions de la pièce 3 et présentent des bords externes arrondis.  FIG. 7 shows yet another embodiment of the metacarpal piece 3 in which said anchoring extension 18 is also rectilinear and is formed by three fins 23 arranged at 120 ° from each other, but these fins are shorter than in the other two versions of the piece 3 and have rounded external edges.
Il apparaît de ce qui précède que l'invention fournit un ensemble d'éléments 1 permettant d'utiliser un seul et même instrument 7 de type fraise pour aménager uniquement des cavités ramassées dans les portions proximales des os à traiter, et d'insérer en force dans l'os spongieux la ou lesdites parties diaphysaires 3b de l'une et/ou l'autre des pièces de prothèse à implanter. Il permet donc de s'affranchir de l'utilisation de râpes et de séries d'instruments, et de raccourcir ainsi notablement la durée de l'intervention chirurgicale. De plus, le caractère unique de l'instrument 7 utilisé élimine la nécessité de fabriquer des instruments différents, et rend donc possible le fait que cet instrument 7 soit à usage unique. Le fait que cet instrument 7 soit conçu pour être à usage unique élimine toute nécessité de restériliser l'instrument, ce qui a une incidence importante sur le coût d'implantation de la prothèse.  It appears from the foregoing that the invention provides a set of elements 1 for using a single strawberry-type instrument 7 to arrange only cavities collected in the proximal portions of the bones to be treated, and to insert in force in the cancellous bone the one or more diaphyseal portions 3b of one and / or the other of the prosthesis parts to be implanted. It thus makes it possible to dispense with the use of rasps and sets of instruments, and thus significantly shorten the duration of the surgical procedure. In addition, the uniqueness of the instrument 7 used eliminates the need to manufacture different instruments, and thus makes possible the fact that this instrument 7 is disposable. The fact that this instrument 7 is designed to be disposable eliminates the need to resterilize the instrument, which has a significant impact on the cost of implantation of the prosthesis.
L'invention a été décrite ci-dessus en référence à des formes de réalisation données uniquement à titre d'exemples. Il va de soi qu'elle s'étend à toutes les autres formes de réalisations couvertes par les revendications ci-annexées.  The invention has been described above with reference to embodiments given solely by way of example. It goes without saying that it extends to all other embodiments covered by the appended claims.

Claims

REVENDICATIONS
1 . Ensemble (1 ) d'éléments comprenant une prothèse d'articulation pour de petits os et un instrument (7) unique permettant la pose de cette prothèse, cet instrument (7) permettant l'aménagement d'une cavité osseuse pour la mise en place de la prothèse (2) ;  1. Set (1) of elements comprising a joint prosthesis for small bones and a single instrument (7) allowing the installation of this prosthesis, this instrument (7) allowing the development of a bone cavity for the establishment prosthesis (2);
caractérisé en ce que :  characterized in that
- l'ensemble (1 ) d'éléments comprend deux pièces de prothèse (2, 3) séparées l'une de l'autre et destinées à être articulées l'une à l'autre ; une première pièce de prothèse (2) destinée à être implantée dans un os présente totalement ou partiellement une forme correspondant à celle de l'enveloppe de la partie de travail (6) dudit instrument ; une deuxième pièce de prothèse (3) destinée à être implantée dans un os présente une portion métaphysaire (3a) et une portion diaphysaire (3b) ;  - The set (1) of elements comprises two parts of prosthesis (2, 3) separated from one another and intended to be articulated to one another; a first piece of prosthesis (2) intended to be implanted in a bone has totally or partially a shape corresponding to that of the envelope of the working part (6) of said instrument; a second piece of prosthesis (3) intended to be implanted in a bone has a metaphyseal portion (3a) and a diaphyseal portion (3b);
- la forme que présente la portion métaphysaire (3a) de ladite deuxième pièce de prothèse (3) correspond à celle de l'enveloppe de la partie de travail (6) dudit instrument (7), et la portion diaphysaire (3b) de cette deuxième pièce de prothèse (3) est sous la forme d'une extension d'ancrage (18) présentant une forme perçante et / ou tranchante selon la direction d'insertion de ladite deuxième pièce de prothèse (3) dans un os, cette forme étant telle que ladite portion diaphysaire (3b) est apte à être insérée en force dans l'os spongieux de l'os traité.  the shape of the metaphyseal portion (3a) of said second prosthesis part (3) corresponds to that of the envelope of the working part (6) of said instrument (7), and the diaphyseal portion (3b) of this second prosthesis part (3) is in the form of an anchoring extension (18) having a piercing and / or cutting shape in the direction of insertion of said second prosthesis part (3) into a bone, this form being such that said diaphyseal portion (3b) is adapted to be inserted into force in the cancellous bone of the treated bone.
2. Ensemble (1 ) d'éléments selon la revendication 1 , pour traiter une articulation comprenant un os non allongé et un os allongé, notamment une prothèse trapèzo-métacarpienne, caractérisé en ce que ladite première pièce de prothèse (2) présente une forme correspondant dans son ensemble à celle de l'enveloppe de la partie de travail (6) dudit instrument (7). 2. Set (1) of elements according to claim 1, for treating a joint comprising a non-elongated bone and an elongated bone, in particular a trapezio-metacarpal prosthesis, characterized in that said first prosthesis piece (2) has a shape corresponding as a whole to that of the envelope of the working part (6) of said instrument (7).
3. Ensemble (1 ) d'éléments selon la revendication 1 , pour traiter une articulation comprenant deux os allongés, caractérisé en ce que ladite première pièce de prothèse présente, comme ladite deuxième pièce de prothèse (3), une portion métaphysaire et une portion diaphysaire ; cette portion métaphysaire de ladite première pièce de prothèse présente une forme correspondant à celle de l'enveloppe de la partie de travail (6) dudit instrument (7) et cette portion diaphysaire de ladite première pièce de prothèse présente une forme perçante et / ou tranchante selon la direction d'insertion de ladite première pièce de prothèse dans un os, cette forme étant telle que ladite portion diaphysaire est apte à être insérée en force dans l'os spongieux de l'os traité. 3. Set (1) of elements according to claim 1, for treating a joint comprising two elongated bones, characterized in that said first prosthesis piece has, as said second piece of prosthesis (3), a metaphyseal portion and a portion diaphyseal; this metaphyseal portion of said first prosthesis part has a shape corresponding to that of the envelope of the working part (6) of said instrument (7) and this diaphyseal portion of said first prosthesis part has a piercing and / or cutting shape according to the insertion direction of said first piece of prosthesis in a bone, this shape being such that said diaphyseal portion is adapted to be inserted into force in the cancellous bone of the treated bone.
4. Ensemble (1 ) d'éléments selon l'une des revendications 1 à 3, caractérisé en ce que ladite première pièce de prothèse (2) ou la partie métaphysaire de l'une ou l'autre desdites première et deuxième pièces de prothèse (2, 3) présente une forme de révolution et en ce que l'instrument (7) est rotatif, de sorte que l'enveloppe de ladite partie de travail (6) de cet instrument présente une forme de révolution lorsque cet instrument est animé de son mouvement de travail. 4. Set (1) of elements according to one of claims 1 to 3, characterized in that said first piece of prosthesis (2) or the metaphyseal portion of one or other of said first and second prosthesis parts (2, 3) has a shape of revolution and that the instrument (7) is rotatable, so that the envelope of said working part (6) of this instrument has a form of revolution when this instrument is animated of his work movement.
5. Ensemble (1 ) d'éléments selon l'une des revendications 1 à 4, caractérisé en ce que ladite extension d'ancrage (18) de l'une ou l'autre desdites première ou deuxième pièces de prothèse (3) présente la forme d'une pointe ou d'une lame, ou d'au moins un aileron (22, 23). 5. Set (1) of elements according to one of claims 1 to 4, characterized in that said anchoring extension (18) of one or the other of said first or second parts of prosthesis (3) presents the shape of a tip or a blade, or at least one fin (22, 23).
6. Ensemble (1 ) d'éléments selon la revendication 5, caractérisé en ce que ladite extension d'ancrage (18) de l'une ou l'autre desdites première ou deuxième pièces de prothèse (3) est formée par trois ailerons (23) disposés à 120° les uns des autres. 6. Set (1) of elements according to claim 5, characterized in that said anchoring extension (18) of one or the other of said first or second prosthesis parts (3) is formed by three fins ( 23) arranged at 120 ° from each other.
7. Ensemble (1 ) d'éléments selon la revendication 5, caractérisé en ce que ladite extension d'ancrage de l'une ou l'autre desdites première ou deuxième pièces de prothèse présente la forme d'une lame centrée par rapport à l'axe de révolution de la partie métaphysaire de la pièce de prothèse. 7. assembly (1) of elements according to claim 5, characterized in that said anchoring extension of one or the other of said first or second prosthesis parts has the shape of a blade centered relative to the axis of revolution of the metaphyseal part of the prosthesis part.
8. Ensemble (1 ) d'éléments selon la revendication 5, caractérisé en ce que ladite extension d'ancrage de l'une ou l'autre desdites première ou deuxième pièces de prothèse présente la forme d'une lame décentrée par rapport à l'axe de révolution de la partie métaphysaire de la pièce de prothèse. 8. assembly (1) of elements according to claim 5, characterized in that said anchoring extension of one or the other of said first or second prosthesis parts has the shape of a blade off center relative to the axis of revolution of the metaphyseal part of the prosthesis part.
9. Ensemble (1 ) d'éléments selon l'une des revendications 1 à 8, caractérisé en ce que ladite extension d'ancrage est en un pan unique. 9. Set (1) of elements according to one of claims 1 to 8, characterized in that said anchoring extension is in a single pan.
10. Ensemble (1 ) d'éléments selon l'une des revendications 1 à 8, caractérisé en ce que ladite extension d'ancrage (18) est en deux ou trois pans (20, 21 ; 22) lui donnant, vue en coupe transversale, une forme en L, T ou en Y. 10. Set (1) of elements according to one of claims 1 to 8, characterized in that said anchoring extension (18) is in two or three sides (20, 21; 22) giving it, sectional view transverse, L-shaped, T-shaped or Y-shaped.
1 1. Ensemble (1 ) d'éléments selon la revendication 10, caractérisé en ce que les deux pans (20, 21 ) donnent à l'extension d'ancrage (18) une forme en T vue en coupe transversale ; un premier pan (20) est décentré et s'étend depuis un côté de la partie métaphysaire (3a) de la pièce de prothèse (3), vers le côté distal de l'extension d'ancrage (18), ce premier pan (20) étant de forme pointue sur sa portion distale, et se courbant vers l'axe de la pièce de prothèse (3) au niveau de cette même portion distale ; le deuxième pan (21 ) est relié à une paroi de fond formée par la partie métaphysaire (3a) de la pièce de prothèse (3), et présente un bord longitudinal relié audit premier pan (20) et un bord longitudinal libre opposé, la largeur de ce deuxième pan (21 ) allant en se réduisant en direction de l'extrémité distale de l'extension d'ancrage (18). 1. An assembly (1) of elements according to claim 10, characterized in that the two panels (20, 21) give the anchoring extension (18) a T-shape seen in cross-section; a first panel (20) is off-center and extends from one side of the metaphyseal part (3a) of the prosthesis part (3) towards the distal side of the anchoring extension (18), this first panel (18) 20) being pointed on its distal portion, and curving towards the axis of the prosthesis part (3) at the same distal portion; the second panel (21) is connected to a bottom wall formed by the metaphyseal part (3a) of the prosthesis part (3), and has a longitudinal edge connected to said first panel (20) and an opposite free longitudinal edge, the width of the second pan (21) being reduced towards the distal end of the anchor extension (18).
PCT/FR2018/050596 2017-03-20 2018-03-13 Set of elements comprising a joint prosthesis for small bones and an instrument allowing this prosthesis to be fitted WO2018172660A1 (en)

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FR1752292 2017-03-20
FR1752292A FR3063888A1 (en) 2017-03-20 2017-03-20 ASSEMBLY OF ELEMENTS COMPRISING ELEMENTS FOR THE CONSTITUTION OF A PROSTHESIS OF ARTICULATION FOR SMALL BONES AND AN INSTRUMENT FOR THE INSTALLATION OF THIS PROSTHESIS

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2755005A1 (en) 1996-10-24 1998-04-30 Provis Sa Selection and positioning device for trapeziometacarpal joint prosthesis
WO2016005684A1 (en) 2014-07-10 2016-01-14 Biotech Ortho Assemby for foot arthroplasty
WO2016149635A1 (en) 2015-03-19 2016-09-22 Wahl Rebecca H Sterile implant instruments and kits for flexible joint implants

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2755005A1 (en) 1996-10-24 1998-04-30 Provis Sa Selection and positioning device for trapeziometacarpal joint prosthesis
WO2016005684A1 (en) 2014-07-10 2016-01-14 Biotech Ortho Assemby for foot arthroplasty
WO2016149635A1 (en) 2015-03-19 2016-09-22 Wahl Rebecca H Sterile implant instruments and kits for flexible joint implants

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