WO1995024870A1 - Bone fragment transport device - Google Patents

Bone fragment transport device Download PDF

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Publication number
WO1995024870A1
WO1995024870A1 PCT/FR1995/000139 FR9500139W WO9524870A1 WO 1995024870 A1 WO1995024870 A1 WO 1995024870A1 FR 9500139 W FR9500139 W FR 9500139W WO 9524870 A1 WO9524870 A1 WO 9524870A1
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WO
WIPO (PCT)
Prior art keywords
axis
bone
sleeve
tube
bone fragment
Prior art date
Application number
PCT/FR1995/000139
Other languages
French (fr)
Inventor
Dror Paley
Original Assignee
Medinov S.A.
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 Medinov S.A. filed Critical Medinov S.A.
Publication of WO1995024870A1 publication Critical patent/WO1995024870A1/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
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7216—Intramedullary pins, nails or other devices for bone lengthening or compression
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones

Definitions

  • the invention relates to the technical sector of orthopedics, in particular the treatment of bone defects.
  • the surgeon obtains from a bone bank, a bone fragment necessary for performing a graft.
  • This technique is not entirely satisfactory, because there may appear risks of rejection of the bone substitute which, very often, is not tolerated by the body and requires several successive interventions, since we encounter phenomena of prenarthrosis.
  • bone transport is carried out, which consists in carrying out an osteotomy of one of the two healthy bone ends, above or below the absent part.
  • the aim is to activate the formation of a bone callus and to pull on this callus, to lengthen it by a length corresponding to the loss of bone substance. Indeed, at the end of elongation, the bone callus replaces the loss of substance.
  • This bone transport is carried out by means of an external fixator.
  • the object of the invention is to remedy these drawbacks in a simple, safe, effective and rational manner.
  • the problem which the invention proposes to solve is to ensure the transport of a bone fragment between the two parts of a bone, using a device which is completely internal to the body.
  • a device which comprises a series of tubular elements internal to the organism, shaped to be fixed to the two parts of bone, a part of said elements being arranged to be fixed. to the bone fragment, said elements being subject to means capable of ensuring the controlled movement in translation of the part receiving the bone fragment.
  • This movement can be carried out by various means and mechanisms, such as external movements applied to the members, motorizations or other devices of the hydraulic, mechanical, electronic type, etc.
  • the series of elements internal to the organization includes: - a tubular sheath fixed in the medullary canal of one of the bone parts,
  • the end of the axis, located inside the sheath being coupled to means capable of authorizing, when the bone part coupled to the tube is subjected to a rotary torque, in one direction, the translational movement of the axis carrying the bone fragment and, in the other direction, the blocking in translation of said axis.
  • the means are constituted by a threaded sleeve screwed into a threaded bore of the sheath , said bushing having at each of its ends, coupling arrangements cooperating with arrangements complementary to the end of the axis and the end of a support member, said arrangements being disengageable.
  • the arrangements of the threaded sleeve are constituted by ratchet systems disposed face to face at each end of said sleeve, each ratchet system being inverted.
  • the pressurization system is of the coaxial type and has a screw freely engaged inside the socket and a support member cooperating with the socket, being screwed at the end of the axis, said screw cooperating with an elastic member, mounted in combination with the 'support body.
  • the support member has rotation blocking arrangements, inside the threaded bore of the sleeve.
  • one of the ratchet systems of the sleeve cooperates with a complementary toothing formed facially at the end of the axis, to ensure, in a direction of rotation, the concomitant drive of the axis and of the sleeve.
  • the other ratchet system cooperates with a toothing formed facially at the end of the support member, to ensure, in the other direction of rotation, the free rotation of the axis relative to the socket.
  • the axis is equipped with a hole for the engagement of a screw. fixation of the bone fragment, through an oblong lumen, in which is mounted a key integral with the axis, in view, on the one hand, of the sliding of said axis in the tube and, on the other hand, of the angular drive of said axis, when a rotary torque is applied to the part of bone integral with said tube.
  • FIG. 1 is a perspective view before assembly of the main elements of the device.
  • FIGS. 2 and 3 are schematic views, showing the operation of the device according to the invention.
  • Figure 4 is a longitudinal sectional view of the device.
  • Figure 5 is a view corresponding to Figure 4, showing the displacement of the bone fragment.
  • Figures 6, 7, 8, 9, 10 and 11 are cross-sectional views considered respectively along lines 6.6, 7.7, 8.8, 9.9, 10.10, 11.11 in Figure 4.
  • the device comprises a sleeve (1) at the end of which is mounted with limited angular displacement capacity, a tube (2).
  • the tubes (1) and (2) are impacted inside the medullary canal of a bone (O).
  • the sheath (1) is fixed by means of a proximal screw (3), implanted through an oblique hole (1a), in a part of bone (01).
  • the tube (2) is fixed by a distal screw (4) implanted through a hole (2a), in a part of bone (02) ( Figure 2).
  • the sheath (1) and the tube (2) have a constant length.
  • the tube (2) is coupled at the end of the sleeve (1), by means of a ring (5) screwed at the end of the sleeve (1) and in which is rotatably mounted, a flange (2c) of the tube (2 ).
  • the tube (2) is hollow and internally receives a pin (6) mounted with sliding capacity and angular displacement.
  • the axis (6) is also engaged in the bore (1b) of the sleeve (1).
  • the axis (6) has a key (7) engaged in a groove (2d) of the tube (2), to allow the displacement of said axis relative to the tube and the concomitant drive in rotation, of the tube (2 ) and axis (6), as will be indicated in the following description.
  • the rotational movement of the assembly of the tube (2) and the axis (6), relative to the sleeve (1), is carried out in a limited manner.
  • the axis (6) has a key (8) cooperating with a groove profiled in an arc of a circle (1b1), formed on a part of the bore (1b) of the sleeve (1).
  • the key (8) moves in the groove (1b1), according to an arc of a circle of angle at the center ( ⁇ ).
  • the axis (6) is shaped to be fixed to the bone fragment (03) which should be transferred between the bone parts (01) and (02).
  • the axis (6) is equipped with a hole (6a) for the engagement of a screw (9) fixed in the bone fragment (03) and engaged through the lumen (2b) of the tube (2).
  • the axis (6) is coupled to means capable of authorizing, when the bone part (02) coupled to the tube (2), is subjected to a rotary torque, in one direction, the displacement in translation of said axis (6 ) and, in the other direction, blocking it in translation.
  • the axis (6) cooperates with, at its rear end, a threaded sleeve (10) screwed into a threaded part of the bore (1b) of the sleeve (1).
  • This socket (10) has, at one of its ends, coupling arrangements (10a), cooperating with complementary arrangements (6b) of the axis (6), these arrangements being disengageable.
  • these arrangements (10a) and (6b) are constituted respectively by ratchet systems disposed facially at the ends of the sleeve (10) and of the axis (6).
  • the end of the axis (6) has a face which is complementary to the ratchet system of the sleeve (10), this toothing (6b) being shaped to ensure, in a direction of rotation, the concomitant drive of the axis (6) and the socket (10).
  • the sleeve (10) has, at its other end, a ratchet system (10b), capable of cooperating with a complementary toothing (12b) formed facially at the end of a support member (12), in the form of a ring.
  • the sleeve (10) and the axis (6) are subject to a coaxial pressurization system.
  • this system comprises a screw (11) freely engaged inside the bush and the ring (12) cooperating in abutment on the bush (10), by the pawls (10b ) and the toothing (12b).
  • the screw is screwed into the end of the axle (6).
  • An elastic member of the spring type (13) is interposed between the screw head (11a) and the ring (12) to ensure the pressurization.
  • the latching system (10a) (6b) is in the free position, so that the rotation of the axis (2) will have no effect on the sleeve (10), whose ratchet system (10b) is engaged with the teeth (12b) of the support ring (12), blocked in rotation in the scabbard (1).
  • the ring (12) is locked in rotation in the threaded bore (1b1) of the sleeve (1), by means of a lug (12a) engaged in the groove (1c).
  • the practitioner will access the bone in question (O), using the usual route, remove the tumor, then ream the part of the spinal canal still available.
  • the cortical osteotomy will then be performed in the healthy part, so that the bone (O) will be fragmented into three distinct parts, namely, the proximal part (01), the distal part (02) and the middle part (03) corresponding to the bone fragment that is to be transferred.
  • the screw (3) is engaged in the hole (1a) of the sheath (1) to ensure its connection with the proximal part (01) of the bone.
  • the screw (4) is then engaged in the hole (2a) of the tube (2), to ensure its connection with the distal part (02) of the bone.
  • the screw (9) is engaged through the lumen (2b) of the tube (2) in the hole (6a) of the axis (6), to ensure the coupling of the bone fragment (03).
  • sheath (1) is closed by a plug (14).

Abstract

A device for transporting a bone fragment (O3) between two bone portions (O1 and O2), including a series of intracorporeal elements (1, 2, 6) shaped for attachment to the two bone portions (O1, O2), one part of said elements being attachable to said bone fragment (O3), and said elements (1, 2, 6) being controlled by an assembly for controllably translating the portion receiving the bone fragment.

Description

Dispositif de transport d'un fragment osseux Device for transporting a bone fragment
L'invention se rattache au secteur technique de l'orthopédie, notamment du traitement des défects osseux.The invention relates to the technical sector of orthopedics, in particular the treatment of bone defects.
Pour le traitement des pertes de substances osseuses (post- traumatiques, post-arthroplastie par prothèse), dans le cas de grandes reconstructions ou de sarcomes nécessitant l'ablation d'un foyer cancérigène, le chirurgien doit recourir à un apport de substitut osseux.For the treatment of losses of bone substances (post-traumatic, post-arthroplasty by prosthesis), in the case of large reconstructions or sarcomas requiring the removal of a carcinogen, the surgeon must resort to a supply of bone substitute.
Généralement, deux techniques opératoires sont actuellement utilisées.Generally, two operating techniques are currently used.
Selon une première technique, le chirurgien se procure auprès d'une banque d'os, un fragment osseux nécessaire pour réaliser une greffe. Cette technique ne donne pas entière satisfaction, car il peut apparaître des risques de rejet du substitut osseux qui, très souvent, n'est pas toléré par l'organisme et, nécessite plusieurs interventions successives, car l'on rencontre des phénomènes de prénarthroses .According to a first technique, the surgeon obtains from a bone bank, a bone fragment necessary for performing a graft. This technique is not entirely satisfactory, because there may appear risks of rejection of the bone substitute which, very often, is not tolerated by the body and requires several successive interventions, since we encounter phenomena of prenarthrosis.
Selon une seconde technique, on procède à un transport osseux, qui consiste à réaliser une ostéotomie d'une des deux extrémités osseuses saines, au dessus ou en dessous de la partie absente. Le but recherché est d'activer la formation d'un cal osseux et de tirer sur ce cal, pour l'allonger d'une longueur correspondant à la perte de substance osseuse. En effet, en fin d'allongement, le cal osseux remplace la perte de substance. Ce transport osseux est exécuté au moyen d'un fixateur externe.According to a second technique, bone transport is carried out, which consists in carrying out an osteotomy of one of the two healthy bone ends, above or below the absent part. The aim is to activate the formation of a bone callus and to pull on this callus, to lengthen it by a length corresponding to the loss of bone substance. Indeed, at the end of elongation, the bone callus replaces the loss of substance. This bone transport is carried out by means of an external fixator.
Si le principe de cette technique donne satisfaction, il n'en est pas de même, au niveau des moyens de mise en oeuvre. En effet, par définition, ce type de fixateur est situé à l'extérieur du corps, en utilisant un appareillage dont certaines parties traversent les tissus mous, pour atteindre l'os, en vue d'y être solidarisées. Il apparaît des problèmes d'esthétisme et des difficultés pour l'utilisateur, de supporter un tel appareillage. Enfin, les risques d'infections ne sont pas négligeables.If the principle of this technique gives satisfaction, it is not the same, at the level of the means of implementation. Indeed, by definition, this type of fixative is located outside the body, using an apparatus of which certain parts cross the soft tissues, to reach the bone, in order to be fixed there. There are aesthetic problems and difficulties for the user to support such equipment. Finally, the risks of infections are not negligible.
L'invention s'est fixée pour but de remédier à ces inconvénients, de manière simple, sûre, efficace et rationnelle.The object of the invention is to remedy these drawbacks in a simple, safe, effective and rational manner.
Le problème que se propose de résoudre l'invention, est d'assurer le transport d'un fragment osseux, entre les deux parties d'un os, en utilisant un dispositif qui soit totalement interne au corps.The problem which the invention proposes to solve is to ensure the transport of a bone fragment between the two parts of a bone, using a device which is completely internal to the body.
Pour résoudre un tel problème, il a été conçu et mis au point un dispositif qui comprend une série d'éléments tubulaires internes à l'organisme, conformés pour être fixés aux deux parties d'os, une partie desdits éléments étant agencée pour être fixée au fragment osseux, lesdits éléments étant assujettis à des moyens aptes à assurer le déplacement contrôlé en translation de la partie recevant le fragment osseux. Ce déplacement peut être effectué par différents moyens et mécanismes, tels que mouvements externes appliqués aux membres, motorisations ou autres dispositifs du type hydraulique, mécanique, électronique...To solve such a problem, a device has been designed and developed which comprises a series of tubular elements internal to the organism, shaped to be fixed to the two parts of bone, a part of said elements being arranged to be fixed. to the bone fragment, said elements being subject to means capable of ensuring the controlled movement in translation of the part receiving the bone fragment. This movement can be carried out by various means and mechanisms, such as external movements applied to the members, motorizations or other devices of the hydraulic, mechanical, electronic type, etc.
Pour résoudre le problème posé d'assurer le déplacement de l'élément accouplé au fragment osseux en vue de son transfert, il est apparu avantageux d'agir angulairement directement sur l'une des parties de l'os du patient.To solve the problem of ensuring the displacement of the element coupled to the bone fragment for its transfer, it appeared advantageous to act angularly directly on one of the parts of the patient's bone.
Dans ce but, la série d'éléments internes à l'organisme, comprend : - un fourreau tubulaire fixé dans le canal médullaire de l'une des parties d'os,For this purpose, the series of elements internal to the organization, includes: - a tubular sheath fixed in the medullary canal of one of the bone parts,
- un tube fixé dans le canal médullaire de l'autre partie d'os et monté en bout du fourreau avec capacité de déplacement angulaire limité, - un axe monté à coulissement à l'intérieur du tube et agencé pour être fixé au fragment osseux en étant apte à être entraîné angulairement lorsque la partie d'os où est fixé ledit tube est soumise à un couple rotatoire alternatif,- a tube fixed in the medullary canal of the other part of bone and mounted at the end of the sheath with limited angular displacement capacity, - an axis mounted to slide inside the tube and arranged to be fixed to the bone fragment in being able to be angularly driven when the part of bone where said tube is fixed is subjected to an alternating rotary torque,
- l'extrémité de l'axe, située à l'intérieur du fourreau étant accouplée à des moyens aptes à autoriser, lorsque la partie d'os accouplée au tube est soumise à un couple rotatoire, dans un sens, le déplacement en translation de l'axe portant le fragment osseux et, dans l'autre sens, le blocage en translation dudit axe.- The end of the axis, located inside the sheath being coupled to means capable of authorizing, when the bone part coupled to the tube is subjected to a rotary torque, in one direction, the translational movement of the axis carrying the bone fragment and, in the other direction, the blocking in translation of said axis.
Pour résoudre le problème posé d'assurer le déplacement du fragment osseux, sous l'effet d'un couple rotatoire, appliqué à l'une des parties d'os, les moyens sont constitués par une douille filetée vissée dans un alésage taraudé du fourreau, ladite douille présentant à chacune de ses extrémités, des agencements d'accouplement coopérant avec des agencements complémentaires de l'extrémité de l'axe et de l'extrémité d'un organe d'appui, lesdits agencements étant débrayables.To solve the problem of ensuring the displacement of the bone fragment, under the effect of a rotary torque, applied to one of the bone parts, the means are constituted by a threaded sleeve screwed into a threaded bore of the sheath , said bushing having at each of its ends, coupling arrangements cooperating with arrangements complementary to the end of the axis and the end of a support member, said arrangements being disengageable.
Les agencements de la douille filetée sont constitués par des systèmes à cliquets disposés facialement à chacune des extrémités de ladite douille, chaque système de cliquets étant inversé.The arrangements of the threaded sleeve are constituted by ratchet systems disposed face to face at each end of said sleeve, each ratchet system being inverted.
Pour résoudre le problème posé de permettre l'entrainement en rotation de la douille, seulement dans un sens de rotation, la douille filetée et l'axe sont assujettis à un système de mise en pression. Le système de mise en pression est du type coaxial et présente une vis engagée librement à l'intérieur de la douille et d'un organe d'appui coopérant avec la douille, en étant vissée à l'extrémité de l'axe, ladite vis coopérant avec un organe élastique, monté en combinaison avec l'organe d'appui. L'organe d'appui présente des agencements de blocage en rotation, à l'intérieur de l'alésage taraudé du fourreau.To solve the problem posed of allowing the drive in rotation of the sleeve, only in one direction of rotation, the threaded sleeve and the axis are subject to a pressurization system. The pressurization system is of the coaxial type and has a screw freely engaged inside the socket and a support member cooperating with the socket, being screwed at the end of the axis, said screw cooperating with an elastic member, mounted in combination with the 'support body. The support member has rotation blocking arrangements, inside the threaded bore of the sleeve.
Avantageusement, l'un des systèmes à cliquets de la douille, coopère avec une denture complémentaire formée facialement à l'extrémité de l'axe, pour assurer, dans un sens de rotation, l'entrainement concomitant de l'axe et de la douille, tandis que l'autre système à cliquets, coopère avec une denture formée facialement à l'extrémité de l'organe d'appui, pour assurer, dans l'autre sens de rotation, la libre rotation de l'axe par rapport à la douille.Advantageously, one of the ratchet systems of the sleeve cooperates with a complementary toothing formed facially at the end of the axis, to ensure, in a direction of rotation, the concomitant drive of the axis and of the sleeve. , while the other ratchet system cooperates with a toothing formed facially at the end of the support member, to ensure, in the other direction of rotation, the free rotation of the axis relative to the socket.
Pour résoudre le problème posé d'assurer le déplacement en translation du fragment osseux, lorsque l'une des parties d'os est soumise à un couple rotatoire, l'axe est équipé d'un trou pour l'engagement d'une vis de fixation du fragment osseux, au travers d'une lumière oblongue, dans laquelle est montée une clavette solidaire de l'axe, en vue, d'une part, du coulissement dudit axe dans le tube et, d'autre part, de l'entrainement angulaire dudit axe, lorsqu'un couple rotatoire est appliqué à la partie d'os solidaire dudit tube.To solve the problem posed of ensuring the translational movement of the bone fragment, when one of the bone parts is subjected to a rotary torque, the axis is equipped with a hole for the engagement of a screw. fixation of the bone fragment, through an oblong lumen, in which is mounted a key integral with the axis, in view, on the one hand, of the sliding of said axis in the tube and, on the other hand, of the angular drive of said axis, when a rotary torque is applied to the part of bone integral with said tube.
L'invention est exposée, ci-après plus en détail à l'aide des dessins annexés, dans lesquels :The invention is set out below in more detail using the appended drawings, in which:
La figure 1 est une vue en perspective avant montage des principaux éléments du dispositif Les figures 2 et 3 sont des vues à caractère schématique, montrant le fonctionnement du dispositif selon l'invention.FIG. 1 is a perspective view before assembly of the main elements of the device. FIGS. 2 and 3 are schematic views, showing the operation of the device according to the invention.
La figure 4 est une vue en coupe longitudinale du dispositif.Figure 4 is a longitudinal sectional view of the device.
La figure 5 est une vue correspondant à la figure 4, montrant le déplacement du fragment osseux.Figure 5 is a view corresponding to Figure 4, showing the displacement of the bone fragment.
Les figures 6, 7, 8, 9 , 10 et 11 sont des vues en coupe transversale considérées respectivement selon les lignes 6.6, 7.7, 8.8, 9.9, 10.10, 11.11 de la figure 4.Figures 6, 7, 8, 9, 10 and 11 are cross-sectional views considered respectively along lines 6.6, 7.7, 8.8, 9.9, 10.10, 11.11 in Figure 4.
Comme le montre la figure 1 , le dispositif comprend un fourreau (1) au bout duquel est monté avec capacité de déplacement angulaire limité, un tube (2). Les tubes (1) et (2) sont impactés à l'intérieur du canal médullaire d'un os (O). Notamment, le fourreau (1 ) est fixé au moyen d'une vis proximale (3), implantée à travers un trou oblique (1a), dans une partie d'os (01). Le tube (2) est fixé par une vis distale (4) implantée à travers un trou (2a), dans une partie d'os (02) (figure 2).As shown in Figure 1, the device comprises a sleeve (1) at the end of which is mounted with limited angular displacement capacity, a tube (2). The tubes (1) and (2) are impacted inside the medullary canal of a bone (O). In particular, the sheath (1) is fixed by means of a proximal screw (3), implanted through an oblique hole (1a), in a part of bone (01). The tube (2) is fixed by a distal screw (4) implanted through a hole (2a), in a part of bone (02) (Figure 2).
Le fourreau (1 ) et le tube (2) ont une longueur constante. Le tube (2) est accouplé en bout du fourreau (1 ), par l'intermédiaire d'une bague (5) vissée en bout du fourreau (1) et dans lequel est montée tournant, une colerette (2c) du tube (2).The sheath (1) and the tube (2) have a constant length. The tube (2) is coupled at the end of the sleeve (1), by means of a ring (5) screwed at the end of the sleeve (1) and in which is rotatably mounted, a flange (2c) of the tube (2 ).
Le tube (2) est creux et reçoit intérieurement, un axe (6) monté avec capacité de coulissement et de déplacement angulaire. L'axe (6) est par ailleurs engagé dans l'alésage (1b) du fourreau (1). En outre, l'axe (6) présente une clavette (7) engagée dans une rainure (2d) du tube (2), pour permettre le déplacement dudit axe par rapport au tube et l'entrainement concomitant en rotation, du tube (2) et de l'axe (6), comme il sera indiqué dans la suite de la description. Le déplacement en rotation de l'ensemble du tube (2) et de l'axe (6), par rapport au fourreau (1), s'effectue d'une manière limitée. Dans ce but, l'axe (6) présente une clavette (8) coopérant avec une rainure profilée en arc de cercle (1b1), formée sur une partie de l'alésage (1b) du fourreau (1). La clavette (8) se déplace dans la rainure (1b1), selon un arc de cercle d'angle au centre (α).The tube (2) is hollow and internally receives a pin (6) mounted with sliding capacity and angular displacement. The axis (6) is also engaged in the bore (1b) of the sleeve (1). In addition, the axis (6) has a key (7) engaged in a groove (2d) of the tube (2), to allow the displacement of said axis relative to the tube and the concomitant drive in rotation, of the tube (2 ) and axis (6), as will be indicated in the following description. The rotational movement of the assembly of the tube (2) and the axis (6), relative to the sleeve (1), is carried out in a limited manner. For this purpose, the axis (6) has a key (8) cooperating with a groove profiled in an arc of a circle (1b1), formed on a part of the bore (1b) of the sleeve (1). The key (8) moves in the groove (1b1), according to an arc of a circle of angle at the center (α).
L'axe (6) est conformé pour être fixé au fragment osseux (03) qu'il convient de transférer entre les parties d'os (01) et (02). Dans ce but, l'axe (6) est équipé d'un trou (6a) pour l'engagement d'une vis (9) fixée dans le fragment osseux (03) et engagée au travers de la lumière (2b) du tube (2).The axis (6) is shaped to be fixed to the bone fragment (03) which should be transferred between the bone parts (01) and (02). For this purpose, the axis (6) is equipped with a hole (6a) for the engagement of a screw (9) fixed in the bone fragment (03) and engaged through the lumen (2b) of the tube (2).
L'axe (6) est accouplé à des moyens aptes à autoriser, lorsque la partie d'os (02) accouplé au tube (2), est soumise à un couple rotatoire, dans un sens, le déplacement en translation dudit axe (6) et, dans l'autre sens, son blocage en translation.The axis (6) is coupled to means capable of authorizing, when the bone part (02) coupled to the tube (2), is subjected to a rotary torque, in one direction, the displacement in translation of said axis (6 ) and, in the other direction, blocking it in translation.
Dans ce but, l'axe (6) coopère avec, au niveau de son extrémité arrière, une douille filetée (10) vissée dans une partie taraudée de l'alésage (1b) du fourreau (1). Cette douille (10) présente, à l'une de ses extrémités, des agencements d'accouplement (10a), coopérant avec des agencements complémentaires (6b) de l'axe (6), ces agencements étant débrayables.For this purpose, the axis (6) cooperates with, at its rear end, a threaded sleeve (10) screwed into a threaded part of the bore (1b) of the sleeve (1). This socket (10) has, at one of its ends, coupling arrangements (10a), cooperating with complementary arrangements (6b) of the axis (6), these arrangements being disengageable.
Par exemple, comme le montre la figure 1 , ces agencements (10a) et (6b) sont constitués respectivement par des systèmes à cliquets disposés facialement aux extrémités de la douille (10) et de l'axe (6). L'extrémité de l'axe (6) présente facialement une denture complémentaire au système à cliquets de la douille (10), cette denture (6b) étant conformée pour assurer, dans un sens de rotation, l'entrainement concomitant de l'axe (6) et de la douille (10). La douille (10) présente facialement à son autre extrémité, un système à cliquets (10b), apte à coopérer avec une denture complémentaire (12b) formée facialement en bout d'un organe d'appui (12), sous forme d'une bague. Les sytèmes à cliquets (10a) et (10b) de la douille (10) sont inversés, de sorte que dans l'autre sens du couple de rotation exercé sur le tube (2), ce dernier sera sans effet sur la douille (10), interdisant par conséquent, le déplacement en translation inverse du précédent, de l'axe (6).For example, as shown in FIG. 1, these arrangements (10a) and (6b) are constituted respectively by ratchet systems disposed facially at the ends of the sleeve (10) and of the axis (6). The end of the axis (6) has a face which is complementary to the ratchet system of the sleeve (10), this toothing (6b) being shaped to ensure, in a direction of rotation, the concomitant drive of the axis (6) and the socket (10). The sleeve (10) has, at its other end, a ratchet system (10b), capable of cooperating with a complementary toothing (12b) formed facially at the end of a support member (12), in the form of a ring. The ratchet systems (10a) and (10b) of the socket (10) are reversed, so that in the other direction of the torque exerted on the tube (2), the latter will have no effect on the socket (10 ), consequently prohibiting the displacement in reverse translation of the previous one, of the axis (6).
La douille (10) et l'axe (6) sont assujettis à un système coaxial de mise en pression. Dans ce but, comme le montre la figure 4, ce système comprend une vis (11 ) engagée librement à l'intérieur de la douille et de la bague (12) coopérant en appui sur la douille (10), par les cliquets (10b) et la denture (12b). La vis est vissée dans l'extrémité de l'axe (6). Un organe élastique du type ressort (13) est interposé entre la tête de vis (11a) et la bague (12) pour assurer la mise en pression. Compte-tenu de ces dispositions, on conçoit que l'entrainement en rotation dans un certain sens de l'axe (6), par l'intermédiaire du tube (2), aura pour effet, compte-tenu du système à cliquets (10a) (6b), d'entraîner en rotation la douille (10) et, d'une manière concomitante, provoquer le déplacement linéaire en translation dudit axe, dont l'avance est fonction du pas de vis. Inversement, dans l'autre sens du couple de rotation, et compte-tenu de l'ensemble de mise en pression (12) (13), le système d'encliquetage (10a) (6b) se trouve en position libre, de sorte que la rotation de l'axe (2) sera sans effet sur la douille (10), dont le système à cliquets (10b) est en prise avec la denture (12b) de la bague d'appui (12), bloquée en rotation dans le fourreau (1).The sleeve (10) and the axis (6) are subject to a coaxial pressurization system. For this purpose, as shown in FIG. 4, this system comprises a screw (11) freely engaged inside the bush and the ring (12) cooperating in abutment on the bush (10), by the pawls (10b ) and the toothing (12b). The screw is screwed into the end of the axle (6). An elastic member of the spring type (13) is interposed between the screw head (11a) and the ring (12) to ensure the pressurization. In view of these provisions, it is understood that the rotational drive in a certain direction of the axis (6), via the tube (2), will have the effect, taking into account the ratchet system (10a ) (6b), to cause the sleeve (10) to rotate and, concomitantly, to cause the linear displacement in translation of said axis, the advance of which is a function of the pitch of the screw. Conversely, in the other direction of the torque, and taking into account the pressurizing assembly (12) (13), the latching system (10a) (6b) is in the free position, so that the rotation of the axis (2) will have no effect on the sleeve (10), whose ratchet system (10b) is engaged with the teeth (12b) of the support ring (12), blocked in rotation in the scabbard (1).
La bague (12) est bloquée en rotation dans l'alésage taraudé (1b1) du fourreau (1 ), au moyen d'un ergot (12a) engagé dans la rainure (1c).The ring (12) is locked in rotation in the threaded bore (1b1) of the sleeve (1), by means of a lug (12a) engaged in the groove (1c).
II convient d'analyser le fonctionnement du dispositif selon l'invention et indirectement le mode opératoire, en considérant le cas d'une perte de substance de corticale.It is necessary to analyze the operation of the device according to the invention and indirectly the procedure, considering the case of a loss of cortical substance.
Le praticien va accéder à l'os considéré (O), au moyen de la voie habituelle, retirer la tumeur, puis aléser la partie du canal médullaire encore disponible. Il sera ensuite procédé à l'ostéotomie de la corticale dans la partie saine, de sorte que l'os (O) sera fragmenté en trois parties distinctes, à savoir, la partie proximale (01), la partie distale (02) et la partie médiane (03) correspondant au fragment osseux que l'on veut transférer.The practitioner will access the bone in question (O), using the usual route, remove the tumor, then ream the part of the spinal canal still available. The cortical osteotomy will then be performed in the healthy part, so that the bone (O) will be fragmented into three distinct parts, namely, the proximal part (01), the distal part (02) and the middle part (03) corresponding to the bone fragment that is to be transferred.
L'opérateur impacte ensuite, l'ensemble du dispositif, la longueur du fourreau (1) et du tube (2) notamment, étant déterminée en fonction de la longueur du membre. Il est alors procédé, au moyen d'un viseur approprié, au perçage des deux corticales de l'os, pour réaliser les trous, au niveau de chacune des parties d'os (01) (02) et (03) en vue d'assurer le verrouillage de l'ensemble du dispositif.The operator then impacts, the entire device, the length of the sheath (1) and the tube (2) in particular, being determined as a function of the length of the member. It is then proceeded, by means of an appropriate sight, to the drilling of the two cortices of the bone, to make the holes, at the level of each of the bone parts (01) (02) and (03) in view of '' lock the entire device.
Dans ce but, la vis (3) est engagée dans le trou (1a) du fourreau (1) pour assurer sa liaison avec la partie proximale (01) de l'os. La vis (4) est ensuite engagée dans le trou (2a) du tube (2), pour assurer sa liaison avec la partie distale (02) de l'os. Enfin, la vis (9) est engagée au travers de la lumière (2b) du tube (2) dans le trou (6a) de l'axe (6), pour assurer l'accouplement du fragment osseux (03).For this purpose, the screw (3) is engaged in the hole (1a) of the sheath (1) to ensure its connection with the proximal part (01) of the bone. The screw (4) is then engaged in the hole (2a) of the tube (2), to ensure its connection with the distal part (02) of the bone. Finally, the screw (9) is engaged through the lumen (2b) of the tube (2) in the hole (6a) of the axis (6), to ensure the coupling of the bone fragment (03).
Le dispositif étant ainsi mis en place, l'opérateur applique un couple rotatoire externe à la partie inférieure (02) de l'os avec un angle (α1) correspondant au degré de liberté de la clavette (8), dans la rainure correspondante (1b1) (figure 7). Il en résulte l'entrainement en rotation de l'ensemble tube (2) - axe (6) lié par la clavette (7) et, par conséquent, l'entrainement en rotation de la douille (10) par le système à cliquets (6b) (10a). L'entrainement en rotation de la douille (10) provoque, d'une manière concomitante, le déplacement en translation de l'axe (6) et par conséquent, du fragment osseux (03). Au retour, correspondant à un couple rotatoire interne de la partie inférieure (02), la denture (6b) de l'axe (6), échappe le système à cliquets, de sorte que ledit axe est en position d'entraînement de la douille, lors de la prochaine rotation.The device being thus put in place, the operator applies an external rotary torque to the lower part (02) of the bone with an angle (α1) corresponding to the degree of freedom of the key (8), in the corresponding groove ( 1b1) (Figure 7). This results in the rotation drive of the tube (2) - pin (6) assembly connected by the key (7) and, consequently, the rotation drive of the sleeve (10) by the ratchet system ( 6b) (10a). The rotating drive of the sleeve (10) causes, in a concomitant manner, the displacement in translation of the axis (6) and therefore, of the bone fragment (03). On the return, corresponding to an internal rotary torque of the lower part (02), the toothing (6b) of the axis (6), escapes the ratchet system, so that said axis is in the position for driving the sleeve. , during the next rotation.
Comme indiqué, dans ce sens de rotation inverse, la douille, par son système à cliquets (10b) est bloquée par rapport à la denture (12b), de la bague d'appui (12).As indicated, in this reverse rotation direction, the bushing, by its pawl system (10b) is locked relative to the teeth (12b), of the support ring (12).
On conçoit que ces différents couples rotatoires transmis au niveau de la partie (02) de l'os, selon des fréquences d'intervalles déterminées par l'opérateur, auront pour effet de déplacer le fragment osseux (03) depuis la partie proximale (01) jusqu'au niveau de la partie distale (02), en provoquant, au fur et à mesure, l'allongement du cal osseux, afin de remplacer la perte de substance.It is understood that these different rotary couples transmitted at the level of the part (02) of the bone, according to intervals of intervals determined by the operator, will have the effect of displacing the bone fragment (03) from the proximal part (01 ) up to the level of the distal part (02), causing, as and when, the elongation of the bone callus, in order to replace the loss of substance.
Il est bien évident que le système d'entraînement en translation de l'axe (6) portant le fragment osseux (03) ne doit pas être considéré comme limitatif.It is obvious that the drive system in translation of the axis (6) carrying the bone fragment (03) should not be considered as limiting.
A noter que le fourreau (1) est obturé par un bouchon (14).Note that the sheath (1) is closed by a plug (14).
Les avantages ressortent bien de la description, en particulier on souligne et on rappelle la possibilité de procéder à un transport osseux, au moyen d'éléments internes à l'organisme, évitant ainsi l'emploi d'éléments externes, source d'infections et de désagréments pour le patient. The advantages clearly emerge from the description, in particular the possibility of carrying out bone transport is emphasized and recalled, by means of elements internal to the organism, thus avoiding the use of external elements, a source of infections and inconvenience to the patient.

Claims

R E V E N D I C AT I O N S R E V E N D I C AT I O N S
-1- Dispositif de transfert d'un fragment osseux (03) entre deux parties d'os(01) et (02), caractérisé en ce qu'il comprend une série d'éléments (1) (2) (6) internes à l'organisme, conformés pour être fixés aux deux parties d'os (01) (02), une partie desdits éléments étant agencée pour être fixée au fragment osseux (03), lesdits éléments (1 ) (2) (6) étant assujettis à des moyens aptes à assurer le déplacement contrôlé en translation de la partie recevant le fragment osseux.-1- Device for transferring a bone fragment (03) between two bone parts (01) and (02), characterized in that it comprises a series of internal elements (1) (2) (6) to the body, shaped to be fixed to the two parts of bone (01) (02), part of said elements being arranged to be fixed to the bone fragment (03), said elements (1) (2) (6) being subject to means capable of ensuring the controlled displacement in translation of the part receiving the bone fragment.
-2- Dispositif selon la revendication 1 , caractérisé en ce que la série d'éléments comprend :-2- Device according to claim 1, characterized in that the series of elements comprises:
- un fourreau tubulaire (1) fixé dans le canal médullaire de l'une des parties d'os (01), - un tube (2) fixé dans le canal médullaire de l'autre partie d'os (02) et monté en bout du fourreau (1) avec capacité de déplacement angulaire limité,- a tubular sheath (1) fixed in the medullary canal of one of the bone parts (01), - a tube (2) fixed in the medullary canal of the other bone part (02) and mounted in end of the sheath (1) with limited angular displacement capacity,
- un axe (6) monté à coulissement à l'intérieur du tube (2) et agencé pour être fixé au fragment osseux en étant apte à être entraîné angulairement lorsque la partie d'os (02) où est fixé ledit tube (2) est soumise à un couple rotatoire,- an axis (6) slidably mounted inside the tube (2) and arranged to be fixed to the bone fragment while being able to be angularly driven when the bone part (02) where said tube (2) is fixed is subjected to a rotary torque,
- l'extrémité de l'axe (6), située à l'intérieur du fourreau (1), étant assujettie aux moyens (10a) (6b) et (10b) (12b) aptes à autoriser, lorsque la partie d'os (02) accouplée au tube (2) est soumise à un couple rotatoire, dans un sens, le déplacement en translation de l'axe (6) portant le fragment osseux et, dans l'autre sens, le blocage en translation dudit axe.- the end of the axis (6), located inside the sheath (1), being subject to the means (10a) (6b) and (10b) (12b) capable of authorizing, when the bone part (02) coupled to the tube (2) is subjected to a rotary torque, in one direction, the translational movement of the axis (6) carrying the bone fragment and, in the other direction, the translational locking of said axis.
-3- Dispositif selon la revendication 1 , caractérisé en ce que les moyens sont constitués par une douille filetée (10) vissée dans un alésage taraudé (1b) du fourreau (1), ladite douille présentant, à chacune de ses extrémités, des agencements d'acouplement (10a) (10b) coopérant avec des agencements complémentaires (6b) (12b) de l'extrémité de l'axe (6a), et d'un organe d'appui (12), lesdits agencements étant débrayables.-3- Device according to claim 1, characterized in that the means consist of a threaded sleeve (10) screwed into a threaded bore (1b) of the sleeve (1), said sleeve having, at each of its ends, coupling arrangements (10a) (10b) cooperating with complementary arrangements (6b) (12b) of the end of the axis (6a), and a support member (12), said arrangements being disengageable .
-4- Dispositif selon la revendication 3, caractérisé en ce que les agencements de la douille filetée (10) sont constitués par des systèmes à cliquets (10a) (10b) disposés facialement à chacune des extrémités de ladite douille, chaque système de cliquets étant inversé.-4- Device according to claim 3, characterized in that the arrangements of the threaded sleeve (10) are constituted by ratchet systems (10a) (10b) disposed face to face at each end of said socket, each ratchet system being reversed.
-5- Dispositif selon la revendication 3, caractérisé en ce que la douille filetée (10) et l'axe (6) sont assujettis à un système de mise en pression.-5- Device according to claim 3, characterized in that the threaded sleeve (10) and the axis (6) are subject to a pressurization system.
-6- Dispositif selon la revendication 5, caractérisé en ce que le système de mise en pression est du type coaxial et présente une vis (11) engagée librement à l'intérieur de la douille (10) et d'un organe d'appui (12) coopérant avec ladite douille, en étant vissée à l'extrémité de l'axe (6), ladite vis coopérant avec un organe élastique (13), monté en combinaison avec l'organe d'appui.-6- Device according to claim 5, characterized in that the pressurizing system is of the coaxial type and has a screw (11) freely engaged inside the sleeve (10) and a support member (12) cooperating with said sleeve, being screwed to the end of the axis (6), said screw cooperating with an elastic member (13), mounted in combination with the support member.
-7- Dispositif selon la revendication 6, caractérisé en ce que l'organe d'appui (12) présente des agencements de blocage en rotation, à l'intérieur de l'alésage taraudé du fourreau (1).-7- Device according to claim 6, characterized in that the support member (12) has arrangements for locking in rotation, inside the threaded bore of the sleeve (1).
-8- Dispositif selon la revendication 3, caractérisé en ce que l'un des systèmes à cliquets (10a) de la douille (10), coopère avec une denture complémentaire (6b) formée facialement à l'extrémité de l'axe (6), pour assurer, dans un sens de rotation, l'entrainement concomitant de l'axe (6) et de la douille (10), tandis que l'autre système à cliquets (10b), coopère avec une denture (12b) formée facialement à l'extrémité de l'organe d'appui (12), pour assurer, dans l'autre sens de rotation, la libre rotation de l'axe par rapport à la douille.-8- Device according to claim 3, characterized in that one of the ratchet systems (10a) of the sleeve (10), cooperates with a complementary toothing (6b) formed face to the end of the axis (6 ), to ensure, in a direction of rotation, the concomitant drive of the axis (6) and the sleeve (10), while the other ratchet system (10b), cooperates with a toothing (12b) formed face to the end of the support member (12), to ensure, in the other direction of rotation, free rotation of the axis with respect to the sleeve.
-9- Dispositif selon la revendication 2, caractérisé en ce que l'axe (6) est équipé d'un trou (6a) pour l'engagement d'une vis de fixation du fragment osseux, au travers d'une lumière oblongue (2b), dans laquelle est montée une clavette (7) solidaire de l'axe, en vue, d'une part, du coulissement dudit axe dans le tube (2) et, d'autre part, de l'entrainement angulaire dudit axe, lorsqu'un couple rotatoire est appliqué à la partie d'os (02) solidaire dudit tube.-9- Device according to claim 2, characterized in that the axis (6) is equipped with a hole (6a) for the engagement of a screw for fixing the bone fragment, through an oblong lumen ( 2b), in which is mounted a key (7) integral with the axis, in view, on the one hand, of the sliding of said axis in the tube (2) and, on the other hand, of the angular drive of said axis , when a rotary torque is applied to the bone part (02) integral with said tube.
-10- Dispositif selon la revendication 2, caractérisé en ce que la partie de l'axe (6) engagée dans le fourreau (1), reçoit une clavette (8) coopérant avec une rainure (1b1) formée dans l'alésage du fourreau pour être déplacé selon un arc de cercle d'angle au centre (α) déterminé pour correspondre à la valeur d'une dent du système à cliquets, de la douille (10).-10- Device according to claim 2, characterized in that the part of the axis (6) engaged in the sheath (1), receives a key (8) cooperating with a groove (1b1) formed in the bore of the sheath to be moved according to an arc of a circle of angle at the center (α) determined to correspond to the value of a tooth of the ratchet system, of the socket (10).
-11- Dispositif selon la revendication 2, caractérisé en ce que le tube (2) est accouplé au fourreau (1 ), en combinaison avec une bague (5) permettant la rotation angulaire limitée et assurant la rigidité axiale de l'ensemble. -11- Device according to claim 2, characterized in that the tube (2) is coupled to the sleeve (1), in combination with a ring (5) allowing limited angular rotation and ensuring the axial rigidity of the assembly.
PCT/FR1995/000139 1994-03-17 1995-02-06 Bone fragment transport device WO1995024870A1 (en)

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FR9403437A FR2717371B1 (en) 1994-03-17 1994-03-17 Device for transporting a bone fragment between two parts of bone.
FR94/03437 1994-03-17

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US5725526A (en) * 1995-11-27 1998-03-10 Zimmer, Inc. Transport carriage for an external fixator
WO1997038641A1 (en) * 1996-04-17 1997-10-23 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Medullary nail
WO1997042896A1 (en) * 1996-05-09 1997-11-20 Uwe Horas Method of conveying a bone segment for bridging of bone damage, and device for carrying out said method
US7985222B2 (en) 2004-04-21 2011-07-26 Medshape Solutions, Inc. Osteosynthetic implants and methods of use and manufacture
US8118952B2 (en) 2004-04-21 2012-02-21 Medshape Solutions, Inc. Osteosynthetic implants and methods of use and manufacture
WO2009108194A1 (en) * 2008-02-27 2009-09-03 Medshape Solutions, Inc. Intramedullary medical device and methods of use and manufacture
US8992527B2 (en) 2009-06-24 2015-03-31 Jean-Marc Guichet Elongation nail for long bone or similar
WO2010149868A1 (en) * 2009-06-24 2010-12-29 Jean-Marc Guichet Elongation nail for long bone or similar
FR2947170A1 (en) * 2009-06-24 2010-12-31 Jean Marc Guichet ELONGATION NUTS FOR LONG OR SIMILAR BONES
WO2011030015A1 (en) 2009-09-09 2011-03-17 Arnaud Soubeiran Intracorporeal device for moving tissue
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US9113967B2 (en) 2009-09-09 2015-08-25 Arnaud Soubeiran Intracorporeal device for moving tissue
US8551106B2 (en) 2011-09-30 2013-10-08 Arthrocare Corporation Method and apparatus for installation of intramedullary medical device
WO2013126025A1 (en) * 2012-02-24 2013-08-29 Yuecel Irsadi Istemi Alp Prolonged nail
EP3437577A1 (en) * 2017-08-01 2019-02-06 Medizinische Hochschule Hannover Universal modular bone segment transport device

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Publication number Publication date
FR2717371B1 (en) 1996-05-31
FR2717371A1 (en) 1995-09-22

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