WO2005063135A1 - Surgical instrument that can be unclipped and is used for a spinal implant - Google Patents

Surgical instrument that can be unclipped and is used for a spinal implant Download PDF

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Publication number
WO2005063135A1
WO2005063135A1 PCT/FR2004/003358 FR2004003358W WO2005063135A1 WO 2005063135 A1 WO2005063135 A1 WO 2005063135A1 FR 2004003358 W FR2004003358 W FR 2004003358W WO 2005063135 A1 WO2005063135 A1 WO 2005063135A1
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WO
WIPO (PCT)
Prior art keywords
surgical instrument
tube
head
instrument according
profile
Prior art date
Application number
PCT/FR2004/003358
Other languages
French (fr)
Inventor
Tiphaine Leport
Jean-Yves Leroy
Pascal Rokegem
Guy Viart
Original Assignee
Eurosurgical
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
Priority claimed from FR0315251A external-priority patent/FR2863861B1/en
Application filed by Eurosurgical filed Critical Eurosurgical
Publication of WO2005063135A1 publication Critical patent/WO2005063135A1/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
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7091—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges

Definitions

  • the present invention relates to a surgical device of the unclipper type allowing the removal of a blocking element from the head of a previously anchored bone anchoring element belonging to a spinal implant.
  • the surgical instrument according to the present invention is more particularly intended for spinal implants consisting of bone anchoring element comprising a U-shaped head intended to cooperate with a blocking element allowing, by means of a screw tightening, immobilization in translation and in rotation of a connecting rod connecting each bone anchoring element to each other.
  • the surgical instrument according to the present invention is intended to improve and facilitate the removal of each blocking element of the U-shaped head from the corresponding bone anchoring element.
  • the surgical instrument according to the present invention consists of:
  • a main body comprising a guide tube integral with a fixed handle and comprising elastic means for attaching the surgical instrument to the head, • a sliding locking tube on the guide tube and comprising means for blocking the surgical instrument on the head,
  • a push tube sliding inside the guide tube via a movable handle connected to the fixed handle, said push tube comprising first means for spacing the walls of the head and second means for locking the connecting rod in the bottom of the head of the bone anchoring element,
  • the surgical instrument comprises a guide tube which is constituted, near the handle of a sleeve comprising on its external periphery a fixing stud carried by an elastic tongue, of a free end comprising an internal bore cylindrical which is extended by another bore having in section an internal profile that is substantially rectangular and of a shape complementary to that external to the head of the bone anchoring element.
  • the surgical instrument comprises a guide tube which has, at the level of its internal bore, an external profile of rectangular shape delimited by perpendicular walls so that each first wall has a U-shaped notch intended to cooperate with the connecting rod, while each second wall is pierced with a housing opening inside the bore and in that the guide tube comprises, on its external profile, flats allowing the fixing of elastic lamellae integral with a finger cooperating with the housing and penetrating inside the internal bore.
  • the surgical instrument comprises a locking tube which comprises a free end having notches with a truncated profile in order to delimit blades intended to press on the elastic lamellae to block the fingers in the head of the implant and to opposite the free end, a grip handle extended by a cylindrical sleeve which is pierced with a groove intended to cooperate with the stud of the guide tube allowing the guide of the locking tube during its drive in translation.
  • the surgical instrument comprises a push tube which comprises an internal bore and a free end having, in the extension of the bore, another internal bore with a substantially rectangular profile and of shape complementary to that external to the element of blocking and in that the push tube comprises opposite the end a sleeve having parallel housings with rectangular profile intended to receive respectively the branches of the fork of the movable handle and a groove arranged along the longitudinal axis of the push tube and between the housings.
  • the surgical instrument according to the present invention comprises a push tube whose free end is extended on the one hand by rectangular blades which are arranged in planes parallel to those containing the walls of the guide tube and on the other hand by fingers which are arranged in planes parallel to those containing the other two walls of the guide tube.
  • the surgical instrument according to the present invention comprises a push tube, each finger of which comprises an inclined external face so that the latter has a point-shaped profile.
  • the surgical instrument according to the present invention comprises a push tube whose housings are arranged in a plane parallel to that carrying the inclined fingers integral with the free end.
  • the surgical instrument according to the present invention comprises a gripping rod which comprises at one of its ends a handling handle and at the opposite end a gripping device, said gripping rod comprising between its handle and the gripping device two sleeves, the first sleeve of which has on its outer periphery a stud or a pin intended to cooperate with the groove of the sleeve of the push tube.
  • the surgical instrument according to the present invention comprises a gripping rod whose stud or pin is positioned so as to extend in a vertical direction when the manipulation handle is placed in a horizontal plane.
  • the surgical instrument comprises a gripping device which is formed at the end of the gripping rod with a square or rectangular profile secured on each of its first parallel faces with a tongue whose end has a profile in the form of a hook, while the other parallel faces of the profile are pierced with a slot opening into an internal bore and extending in the direction of the second sleeve and with a trigger cooperating with the slot and allowing, when the latter is actuated, to spread the tabs.
  • the surgical instrument comprises a movable handle provided with a head comprising on the one hand a first fork-shaped profile made up of branches each having a free end designed to cooperate with the push tube and on the other hand a second fork-shaped profile consisting of branches each having a free end intended to cooperate with the gripping rod.
  • the surgical instrument according to the present invention comprises a gripping rod comprising between the sleeve and the handling handle another sleeve provided with two parallel housings with rectangular profile.
  • FIG. 1 is a view in exploded perspective illustrating, for example, a bone anchoring element of a spinal implant for which the surgical instrument according to the present invention can be used.
  • Figures 2 and 3 are views showing in the rest position the surgical instrument according to the present invention.
  • Figure 4 is a view showing the main body and its operating handle of the surgical instrument according to the present invention.
  • Figure 5 is a view showing the main body of the surgical instrument according to the present invention.
  • Figure 6 is a perspective view illustrating the movable handle of the surgical instrument according to the present invention.
  • Figures 7 and 8 are perspective views showing the main body and more particularly its end opposite to the operating handle of the surgical instrument according to the present invention.
  • Figure 9 is a perspective view showing the locking tube of the surgical instrument according to the present invention.
  • Figures 10 to 12 are perspective views illustrating the spacer of the surgical instrument according to the present invention.
  • Figures 13 to 15 are perspective views showing the gripping rod of the surgical instrument according to the present invention.
  • Figures 16 to 20 are views showing the different stages of use of the surgical instrument according to the present invention.
  • Figures 21, 22 and 25 are views showing a variant allowing automation of the surgical instrument according to the present invention and more particularly translational movements of the gripping rod inside the push tube and the latter to the inside the guide tube of the main body.
  • Figure 23 is a perspective view illustrating the movable handle for the automation of the surgical instrument according to the present invention.
  • FIG. 1 shows an exemplary embodiment of a spinal implant 1 comprising a bone anchoring element 2 for blocking the rotation and translation of a connecting rod 3 at each instrumented vertebra of a column spinal.
  • the bone anchoring element 2 cooperates with a locking element 4 allowing, by means of a clamping screw 5, the fixing in rotation and in translation of the connecting rod 3.
  • the bone anchoring element 2 comprises an anchoring part 6 and a receiving part 7 which consists of a U-shaped head 8 open in its upper part to cooperate with the connecting rod 3 and the element blocking 4.
  • the anchoring part 6 may have either the shape of a hook, or a threaded profile which may or may not be integral with the receiving part 7 so as to be fixed on / or in the vertebral body of the vertebra to be instrumented.
  • the head 8 has two vertical walls 9, 10 arranged one opposite the other and in parallel planes in order to delimit a first central opening 11 in the shape of a U carried by the axis XX 'of the connecting rod 3 and the bottom 12 of which has a profile in the form of a cylinder portion.
  • Each vertical wall 9, 10 is separated, for example, from the bottom 12 of the central opening 11 by a vertical slot 13 giving a certain elasticity to each wall in the direction of the center of the head 8, along the geometric axis V V.
  • the vertical walls 9, 10 respectively comprise at each end a hooking part 14, 15 arranged one opposite the other and on either side of the central opening 11.
  • Each vertical wall 9, 10 has on its internal face and between the hooking parts 14, 15 a vertical housing 16 having a profile in portion of cylinder provided on each side with a groove 17 for guiding the locking element 4 when it is placed in the head 8 of the bone anchoring element 2.
  • Each vertical wall 9, 10 is pierced, between the attachment parts 14, 15, with a hole 18 opening out inside the central opening 11 and intended to cooperate with the corresponding surgical instrument.
  • the locking element 4 has a substantially parallelepipedal external profile comprising in a direction parallel to the axis XX 'and in its lower part a housing 19 having a profile in the portion of a cylinder in order to receive and cooperate with the connecting rod 3.
  • the locking element 4 has in its middle a clamping screw 5 which opens inside the housing 19 to come into contact by pressure against the connecting rod 3 to allow its immobilization in rotation and in translation.
  • the blocking element 4 comprises, in a plane parallel to the axis XX ', lugs 20, 21 in the form of a tooth separated by a vertical housing 22 bordered laterally by ribs 23 allowing the guiding of said blocking element during its introduction into the head 8 of the anchoring element 2.
  • FIGS. 2 to 6 show a surgical instrument 100 allowing the withdrawal of the locking element 4 from the U-shaped head 8 of the element anchor 2.
  • the surgical instrument 100 allows the disassembly in the surgical site of the locking elements 4 of each bone anchoring element 2 in order to be able to remove the connecting rod 3 and / or modify the spinal implant 1.
  • the surgical instrument 100 consists of a main body 101, a locking tube 102, a push tube 103 and a gripping rod 1 04.
  • the main body 101 comprises a horizontal guide tube 105 secured at one of its ends and in a direction parallel to the axis ZZ 'of a handle 106 called "fixed handle”.
  • the fixed handle 106 cooperates with another handle 107 known as a "movable handle” which is connected to the first by an axis of rotation 108 and a leaf spring 109 making it possible, under pressure, to move the thrust tube in translation 103 inside the guide tube 105 of the main body 101.
  • the movable handle 107 comprises above the axis of rotation 108 a head 110 having a fork-shaped profile 111, each branch 112 of which has a free end 113 intended to cooperate with the push tube 103 (FIG. 6).
  • the movement of the movable handle 107 is limited by a stopper 155 secured to said movable handle and abutting against the other fixed handle 106.
  • the stopper 155 can be turned angularly so as not to limit the movement stroke of the movable handle 107 .
  • the guide tube 105 consists, near the handle 106, of a sleeve 114 comprising on its outer periphery a fixing stud 115 intended for guiding in translation of the locking tube 102.
  • the fixing stud 115 is mounted on a elastic tongue 156.
  • FIGS. 7 and 8 show the free end 116 of the guide tube 105 lying opposite that which is integral with the handle 106 and intended to receive the head 8 of the anchoring element 2 of the 'spinal implant 1.
  • the guide tube 105 has a cylindrical internal bore 117 which is extended at its free end 116 by another bore 118 having in section an internal profile which is substantially rectangular and of shape complementary to that external to the head 8 of the bone anchoring element 2 of the spinal implant 1.
  • the guide tube 105 has, at its internal bore 118, an external profile of rectangular shape delimited by perpendicular walls 119, 120.
  • each parallel and opposite wall 119 has a U-shaped notch 121 intended to cooperate with the connecting rod 3 of the spinal implant 1, while each wall 120 is pierced by a T-shaped housing 122 opening out to the interior of bore 118.
  • the guide tube 105 has, on its external profile and in a plane perpendicular to that containing the walls 119 of the internal bore 118, flats 123 which extend on each wall 120.
  • Each flat 123 is integral, opposite the housing 122, with a stud 124 allowing the fixing of an elastic strip 125 comprising a finger 126 cooperating with the housing 122 and penetrating inside the internal bore 118.
  • FIG. 9 shows the locking tube 102 coming around the guide tube 105 and allowing, by translation, to come to bear against the elastic strips 125.
  • the locking tube 102 has a free end 127 having notches 128 with a truncated profile in order to delimit blades 129. The latter, by translation of the locking tube 102, gradually press on the lamellae 125 of the guide tube 105.
  • the locking tube 102 comprises, opposite the free end 127, a grip handle 130 whose external profile is grooved in order to facilitate the translation of said tube 102 on the tube 105 by the surgeon.
  • the grip handle 130 is extended by a cylindrical sleeve 131 which is pierced with a groove 132 along the longitudinal axis of the tube 102.
  • the groove 132 is intended to cooperate with the stud 115 of the elastic tongue 156 of the tube 105 allowing the guiding the locking tube 102 during its translation.
  • FIGS. 10 to 12 show the push tube 103 which slides inside the bore 117 of the guide tube 105 during a pressure force applied to the handles 106, 107 of the surgical instrument 100.
  • the push tube 103 has an internal bore 135 and a free end 134 having in the extension of the bore 135 another internal bore 136 with a substantially rectangular profile and of shape complementary to that external to the locking element 4 of the spinal implant 1.
  • the free end 134 of the push tube 103 is extended by rectangular blades 137 which are arranged in planes parallel to those containing the walls 119 of the guide tube 105.
  • the free end 134 of the push tube 103 is extended by fingers 138 which are arranged in planes parallel to those containing the walls 120 of the guide tube 105.
  • Each finger 138 has an inclined external face 139 so that the latter has a pointed profile.
  • the push tube 103 comprises, opposite the end 134, a sleeve 140 having an external diameter greater than that of said tube 103.
  • the sleeve 140 comprises two parallel housings 141 with rectangular profile intended to receive respectively the arms 112 of the fork 111 of the movable handle 107.
  • the housings 141 are arranged in a plane parallel to that carrying the inclined fingers 138 integral with the free end 134 of the push tube 103.
  • the sleeve 140 has a groove 142 arranged along the longitudinal axis of the push tube 103 and between the housing 141.
  • FIGS. 13 to 15 there is illustrated in FIGS. 13 to 15 the gripping rod 104 which slides inside the bore 135 of the push tube 103 of the surgical instrument 100.
  • the gripping rod 104 has at one of its ends a handling handle 143 and at the opposite end a gripping device 144.
  • the gripping rod 104 has between its handle 143 and the gripping device 144 two sleeves 145, 146 having an external diameter greater than that of said rod.
  • the first sleeve 145 comprises on its outer periphery a stud or a pin 147 cooperating with the groove 142 of the sleeve 140 of the push tube 103 during the introduction of the gripping rod 104 into the latter. This arrangement makes it possible to link in rotation the push tube 103 and the gripping rod 104 when using the surgical instrument 100.
  • the stud or pin 147 is positioned so as to extend in a vertical direction when the manipulation handle 143 is placed in a horizontal plane.
  • the gripping device 144 consists, at the end of the rod 104 and in the extension of the latter, of a square or rectangular profile 148 secured on each of its first parallel faces 149 with a tongue 150 whose end has a hook-shaped profile.
  • the profile 148 has other parallel faces 151 which are perpendicular to the first 149 and which each have a slot 152 opening into an internal bore 153.
  • Each slot 152 is extended in the direction of the sleeve 146 in order to receive a trigger 154 allowing, when the latter is actuated, to separate the tabs 150 from the gripping device 144.
  • FIGS. 16 to 20 show the different stages of use of the surgical instrument 100 for removal in situ, that is to say, in the surgical site, a 3.0 blocking element 4 of an anchoring element 2 in view, for example of the withdrawal of the connecting rod 3.
  • the surgeon loosens the clamping screw 5 35 of the locking element 4 so that the latter can move inside the head 8.
  • the surgical instrument 100 is positioned on the U-shaped head 8 of the anchoring element 2 so that on the one hand the connecting rod 3 is housed inside the notches 121 of the guide tube 105 and on the other hand that the head 8 of the bone anchoring element 2 is introduced into the internal bore 118 of said guide tube 105 (FIG. 16).
  • the positioning of the surgical instrument 100 on the head 8 also makes it possible to accommodate the fingers 126 of each elastic strip 125 of the guide tube 105 inside the holes 18 formed in each of the vertical walls 9, 10 of said head 8 (figure 16).
  • the surgical instrument 100 is fixed to the head 8 of the anchoring element 2 by means of the locking tube 102 which is driven in translation on the guide tube 105 so that the blades 129 are brought gradually against and above the elastic strips 125 to block the fingers 126 inside each hole 18 of said head 8.
  • the translation_du locking tube 102 on the guide tube 105 is guided through the stud 115 which cooperates with the groove 132 formed in the sleeve 131 of said tube 102 ( Figure 17).
  • the gripping rod 104 is inserted by the surgeon into the push tube 103 until the tongues 150 of the gripping device 144 cooperate respectively with the vertical housing 22 of the locking element 4 and come to hang below of the latter ( Figure 16).
  • the surgeon actuates the surgical instrument 100 by acting on the movable handle 107 by means of its branches 112 allowing the push tube 103 to move in translation inside the guide tube 105 and in the direction of l blocking element 4 ( Figures 17, 18).
  • the inclined fingers 138 are introduced respectively inside each vertical housing 16 formed in the walls 9, 10 of the head 8 of the bone anchoring element 2. This progressive introduction of fingers 138 makes it possible to separate the walls 9, 10 in the direction of the outside and to release the attachment parts 14, 15 from the head 8 of the lugs 20, 21 from the locking element 4 (FIG. 19).
  • the rectangular blades 137 come to bear on the connecting rod 3 in order to oppose any force that it could exert on the locking element 4 at the time of its removal.
  • the surgeon removes the gripping rod 104 using the handle 143 of the push tube 103 and therefore of the surgical instrument 100 by taking the locking element 4 retained in the gripping device 144 ( Figure 20) .
  • the surgeon exerts pressure on the trigger 154 of the gripping device 144 in order to spread the slots 152 and release the locking element 4 from the hooking tabs 150 .
  • the surgeon can remove the surgical instrument 100 by driving the tube 102 in translation in order to release the elastic strips 125 from the pressure exerted by the blades 129.
  • the elastic strips 125 return in their rest position freeing their fingers 126 from the holes 18 in the head 8 of the bone anchoring element 2.
  • the surgeon can, depending on the number of blocking element 4 to be removed, present the surgical instrument 100 on another head 8 of another anchoring element 2 and carry out the same steps as those described above.
  • the surgeon can then dismantle the surgical instrument 100 by acting on the stopper 155 in order to allow the movable handle 107 and more particularly to the branches 112 to be released from the housings 141 of the push tube 103.
  • the release of the movable handle 107 allows the withdrawal of the push tube 103 from the guide tube 105.
  • the locking tube 102 can also be removed by simple pressure on the elastic tongue 156, in order to release the stud 115 from the groove 132.
  • FIGS. 21 and 22 show a variant of the surgical instrument 100, described above, and allowing the withdrawal of the blocking element 4 from the U-shaped head 8 of the anchoring element 2.
  • the variant of the surgical instrument 100 will only be described with regard to the elements which have been modified, namely: the movable handle 107, and the gripping rod 104 and its drive in translation inside the push tube 103 , knowing that all the other parts are of identical structure and function.
  • the object of the variant described below consists in carrying out an automation of the surgical instrument 100 and more particularly the translational drive of the gripping rod 104 inside the push tube 103 by the movable handle 107.
  • the surgical instrument 100 allows the disassembly in the surgical site of the locking elements 4 of each bone anchoring element 2 in order to be able to remove the connecting rod 3 and / or modify the spinal implant 1.
  • the main body 101 of the surgical instrument 100 comprises a horizontal guide tube 105 secured at one of its ends and in a direction parallel to the axis Z Z 'of a handle 106 called "fixed handle".
  • the fixed handle 106 cooperates with another handle 107 called a “movable handle” which is connected to the first by an axis of rotation 108 and a leaf spring 109 allowing two simultaneous actions under pressure force, namely:
  • FIG. 23 shows the movable handle 107 which comprises above the axis of rotation 108 a head 110 having a first profile in the form of a fork 111 and laterally offset from the first profile a second profile in the form of a fork 157.
  • the first fork-shaped profile 111 of the movable handle 107 is formed of branches 112 each having a free end 113 provided to cooperate with the push tube 103.
  • the push tube 103 comprises, opposite the end 134, a sleeve 140 having an external diameter greater than that of said tube 103.
  • the sleeve 140 comprises two parallel housings 141 with rectangular profile intended to receive respectively the arms 112 of the fork 111 of the movable handle 107 ( Figure 22).
  • the housings 141 are arranged in a plane parallel to that carrying the inclined fingers 138 integral with the free end 134 of the push tube 103.
  • the sleeve 140 has a groove 142 arranged along the longitudinal axis of the push tube 103 and between the housings 141.
  • the second fork-shaped profile 157 of the movable handle 107 has branches 158 each having a free end 159 designed to cooperate with the gripping rod 104.
  • the branches 158 of the second fork 157 are arranged in a vertical direction and substantially parallel to that provided for the branches 112 of the first fork 111.
  • the branches 158 of the second fork 157 are provided larger than the branches 112 of the first fork 111 ( Figure 23).
  • FIG. 24 shows the gripping rod 104 which comprises at one of its ends a handling handle 143 and at the opposite end a gripping device 144.
  • the gripping rod 104 has between its handle 143 and the gripping device 144 sleeves 145, 146 and 161 having an external diameter greater than that of said rod.
  • the sleeves 145 and 146 are arranged on either side of the central sleeve 161 and at an equal distance from the latter.
  • the gripping rod 104 comprises between the sleeve 145 and the handling handle 143 another sleeve 160 having an external diameter greater than that of said gripping rod 104.
  • the sleeve 160 comprises two parallel housings 162 with rectangular profile intended to receive respectively the legs 158 of the fork 157 of the movable handle 107.
  • the housings 162 are arranged in a plane parallel to that containing the housings 141 of the sleeve 140 of the push tube 103.
  • FIGS. 16, 19, 20 and 25 show the different stages of using the surgical instrument 100 for removal in situ, that is to say, in the surgical, of a blocking element 4 of an anchoring element 2 in view, for example of the withdrawal of the connecting rod 3.
  • the surgeon Before placing and blocking the surgical instrument 100 on the head 8 of the anchoring element 2, the surgeon loosens the clamping screw 5 of the locking element 4 so that the latter can move inside the head 8.
  • the surgical instrument 100 is positioned on the U-shaped head 8 of the anchoring element 2 so that on the one hand the connecting rod 3 is housed inside the notches 121 of the guide tube 105 and on the other hand that the head 8 of the bone anchoring element 2 is introduced into the internal bore 118 of said guide tube 105 ( Figure 16).
  • the positioning of the surgical instrument 100 on the head 8 also makes it possible to accommodate the fingers 126 of each elastic strip 125 of the guide tube 105 inside the holes 18 formed in each of the vertical walls 9, 10 of said head 8 ( figure 16).
  • the surgical instrument 100 is fixed to the head 8 of the anchoring element 2 by means of the locking tube 102 which is driven in translation on the guide tube 105 so that the blades 129 are brought gradually against and above the elastic strips 125 to block the fingers 126 inside each hole 18 of said head 8.
  • the surgeon actuates the surgical instrument 100 by acting on the handle 107 allowing, by means of its branches 158, to move in translation the gripping rod 104 inside the push tube 103 in the direction of the locking element 4.
  • the tongues 150 of the gripping device 144 of the gripping rod .104 respectively cooperate with the vertical housing 22 of the locking element 4 and come to hang below the latter.
  • the continuous movement of the movable handle 107 also makes it possible, through the branches 112 of the first fork 111, to move the push tube 103 in translation inside the guide tube 105 in the direction of the locking element 4.
  • the inclined fingers 138 are introduced respectively inside each vertical housing 16 formed in the walls 9, 10 of the head 8 of the bone anchoring element 2 .
  • the following steps concerning the operation of the chiru rgical 100 instrument are identical to those described and illustrated in Figures 19 and 20.
  • the surgeon can then disassemble the surgical instrument 100 by acting on the stopper 155 in order to allow the movable handle 107 and more particularly to the branches 112 and 157 to free themselves respectively from the housings 141 and 162 of the push tube 103 and the rod. grip 104.

Abstract

The invention relates to a surgical instrument for withdrawing a blocking element (4), said instrument consisting of a main body (101) comprising a guiding tube (105) which is connected to a fixed handle (106) and provided with elastic means (125) for attaching the surgical instrument (100) to the head (8) of the osseous anchoring element, a locking tube (102) which slides along the guiding tube (105) and comprises means for blocking (129) the surgical instrument (100) on the head (8), a push tube (103) which slides inside the guiding tube (105) by means of a mobile handle (107) connected to the fixed handle (106), said push tube (103) comprising first means (138) for pushing apart the walls (9, 10) of the head (8) and second means (137) for blocking the connecting rod (3) in the bottom of the head (8) of the osseous anchoring element (2), and a grip rod (104) which slides inside the push tube (103) and comprises a gripping device for catching and withdrawing the element for blocking (104) the head (8) of the osseous anchoring element (2).

Description

INSTRUMENT CHIRURGICAL DE TYPE DECLIPSEUSE POUR IMPLANT RACHIDIEN CLIP-TYPE SURGICAL INSTRUMENT FOR A SPINAL IMPLANT
La présente invention est relative à un instrument chirurgical de type déclipseuse permettant le retrait d'un élément de blocage de la tête d'un élément d'ancrage osseux préalablement ancré appartenant à un implant rachidien. L'instrument chirurgical suivant la présente invention est plus particulièrement destiné pour les implants rachidiens constitués d'élément d'ancrage osseux comportant une tête en forme de U prévue pour coopérer avec un élément de blocage permettant, par l'intermédiaire d'une vis de serrage, l'immobilisation en translation et en rotation d'une tige de liaison reliant chaque élément d'ancrage osseux entre eux.The present invention relates to a surgical device of the unclipper type allowing the removal of a blocking element from the head of a previously anchored bone anchoring element belonging to a spinal implant. The surgical instrument according to the present invention is more particularly intended for spinal implants consisting of bone anchoring element comprising a U-shaped head intended to cooperate with a blocking element allowing, by means of a screw tightening, immobilization in translation and in rotation of a connecting rod connecting each bone anchoring element to each other.
L'instrument chirurgical suivant la présente invention est prévu pour améliorer et faciliter le retrait de chaque élément de blocage de la tête en forme de U de l'élément d'ancrage osseux correspondant.The surgical instrument according to the present invention is intended to improve and facilitate the removal of each blocking element of the U-shaped head from the corresponding bone anchoring element.
L'instrument chirurgical suivant la présente invention est constitué :The surgical instrument according to the present invention consists of:
• d'un corps principal comprenant un tube de guidage solidaire d'une poignée fixe et comportant des moyens élastiques pour l'accrochage de l'instrument chirurgical sur la tête, • d'un tube de verrouillage coulissant sur le tube de guidage et comportant des moyens de blocage de l'instrument chirurgical sur la tête,• a main body comprising a guide tube integral with a fixed handle and comprising elastic means for attaching the surgical instrument to the head, • a sliding locking tube on the guide tube and comprising means for blocking the surgical instrument on the head,
• d'un tube de poussée coulissant à l'intérieur du tube de guidage par l'intermédiaire d'une poignée mobile reliée à la poignée fixe, ledit tube de poussée comportant des premiers moyens d'écartement des parois de la tête et des seconds moyens de blocage de la tige de liaison dans le fond de la tête de l'élément d'ancrage osseux,• a push tube sliding inside the guide tube via a movable handle connected to the fixed handle, said push tube comprising first means for spacing the walls of the head and second means for locking the connecting rod in the bottom of the head of the bone anchoring element,
• et d'une tige de préhension coulissant à l'intérieur du tube de poussée et comprenant un dispositif de préhension pour l'accrochage et le retrait de l'élément de blocage de la tête de l'élément d'ancrage osseux.• and a gripping rod sliding inside the push tube and comprising a gripping device for hooking and removing the blocking element from the head of the bone anchoring element.
L'instrument chirurgical suivant la présente invention comporte un tube de guidage qui est constitué, à proximité de la poignée d'un manchon comportant sur sa périphérie externe un plot de fixation porté par une languette élastique, d'une extrémité libre comportant un alésage interne cylindrique qui se prolonge par un autre alésage présentant en section un profil interne sensiblement rectangulaire et de forme complémentaire à celle externe de la tête de l'élément d'ancrage osseux.The surgical instrument according to the present invention comprises a guide tube which is constituted, near the handle of a sleeve comprising on its external periphery a fixing stud carried by an elastic tongue, of a free end comprising an internal bore cylindrical which is extended by another bore having in section an internal profile that is substantially rectangular and of a shape complementary to that external to the head of the bone anchoring element.
L'instrument chirurgical suivant la présente invention comporte un tube de guidage qui présente, au niveau de son alésage interne, un profil externe de forme rectangulaire délimité par des parois perpendiculaires de manière que chaque première paroi comporte une échancrure en forme de U destinée à coopérer avec la tige de liaison, tandis que chaque seconde paroi est percée d'un logement débouchant à l'intérieur de l'alésage et en ce que le tube de guidage comporte, sur son profil externe, des méplats permettant la fixation de lamelles élastiques solidaires d'un doigt coopérant avec le logement et pénétrant à l'intérieur de l'alésage interne.The surgical instrument according to the present invention comprises a guide tube which has, at the level of its internal bore, an external profile of rectangular shape delimited by perpendicular walls so that each first wall has a U-shaped notch intended to cooperate with the connecting rod, while each second wall is pierced with a housing opening inside the bore and in that the guide tube comprises, on its external profile, flats allowing the fixing of elastic lamellae integral with a finger cooperating with the housing and penetrating inside the internal bore.
L'instrument chirurgical suivant la présente invention comporte un tube de verrouillage qui comprend une extrémité libre présentant des échancrures à profil tronqué afin de délimiter des lames destinées à faire pression sur les lamelles élastiques pour bloquer les doigts dans la tête de l'implant et à l'opposé de l'extrémité libre, une poignée de préhension se prolongeant par un manchon cylindrique qui est percé d'une rainure destinée à coopérer avec le plot du tube de guidage permettant le guidage du tube de verrouillage lors de son entraînement en translation. L'instrument chirurgical suivant la présente invention comporte un tube de poussée qui comprend un alésage interne et une extrémité libre présentant dans le prolongement de l'alésage un autre alésage interne à profil sensiblement rectangulaire et de forme complémentaire à celui externe de l'élément de blocage et en ce que le tube de poussée comporte à l'opposé de l'extrémité un manchon présentant des logements parallèles à profil rectangulaire destinés à recevoir respectivement les branches de la fourche de la poignée mobile et une rainure disposée suivant l'axe longitudinal du tube de poussée et entre les logements.The surgical instrument according to the present invention comprises a locking tube which comprises a free end having notches with a truncated profile in order to delimit blades intended to press on the elastic lamellae to block the fingers in the head of the implant and to opposite the free end, a grip handle extended by a cylindrical sleeve which is pierced with a groove intended to cooperate with the stud of the guide tube allowing the guide of the locking tube during its drive in translation. The surgical instrument according to the present invention comprises a push tube which comprises an internal bore and a free end having, in the extension of the bore, another internal bore with a substantially rectangular profile and of shape complementary to that external to the element of blocking and in that the push tube comprises opposite the end a sleeve having parallel housings with rectangular profile intended to receive respectively the branches of the fork of the movable handle and a groove arranged along the longitudinal axis of the push tube and between the housings.
L'instrument chirurgical suivant la présente invention comporte un tube de poussée dont l'extrémité libre se prolonge d'un part par des lames rectangulaires qui sont disposées dans des plans parallèles à ceux contenant les parois du tube de guidage et d'autre part par des doigts qui sont disposés dans des plans parallèles à ceux contenant les deux autres parois du tube de guidage. L'instrument chirurgical suivant la présente invention comporte un tube de poussée dont chaque doigt comprend une face externe inclinée afin que ce dernier présente un profil en forme de pointe.The surgical instrument according to the present invention comprises a push tube whose free end is extended on the one hand by rectangular blades which are arranged in planes parallel to those containing the walls of the guide tube and on the other hand by fingers which are arranged in planes parallel to those containing the other two walls of the guide tube. The surgical instrument according to the present invention comprises a push tube, each finger of which comprises an inclined external face so that the latter has a point-shaped profile.
L'instrument chirurgical suivant la présente invention comporte un tube de poussée dont les logements sont disposés dans un plan parallèle à celui portant les doigts inclinés solidaires de l'extrémité libre.The surgical instrument according to the present invention comprises a push tube whose housings are arranged in a plane parallel to that carrying the inclined fingers integral with the free end.
L'instrument chirurgical suivant la présente invention comporte une tige de préhension qui comprend à l'une de ses extrémités une poignée de manipulation et à l'extrémité opposée un dispositif de préhension, ladite tige de préhension comprenant entre sa poignée et le dispositif de préhension deux manchons dont le premier manchon comporte sur son pourtour externe un plot ou une goupille destiné(e) à coopérer avec la rainure du manchon du tube de poussée. L'instrument chirurgical suivant la présente invention comporte une tige de préhension dont le plot ou la goupille est positionné(e) de manière à s'étendre suivant une direction verticale lorsque la poignée de manipulation est placée dans un plan horizontal. L'instrument chirurgical suivant la présente invention comporte un dispositif de préhension qui est constitué à l'extrémité de la tige de préhension d'un profil carré ou rectangulaire solidaire sur chacune de ses premières faces parallèles d'une languette dont le bout présente un profil en forme de crochet, tandis que les autres faces parallèles du profil sont percées d'une fente débouchant dans un alésage interne et se prolongeant en direction du second manchon et d'une gâchette coopérant avec la fente et permettant, lorsque cette dernière est actionnée, d'écarter les languettes. L'instrument chirurgical suivant la présente invention comporte une poignée mobile pourvue d'une tête comprenant d'une part un premier profil en forme de fourche constitué de branches comportant chacune une extrémité libre prévue pour coopérer avec le tube de poussée et d'autre part un second profil en forme de fourche constitué de branches présentant chacune une extrémité libre prévue pour coopérer avec la tige de préhension.The surgical instrument according to the present invention comprises a gripping rod which comprises at one of its ends a handling handle and at the opposite end a gripping device, said gripping rod comprising between its handle and the gripping device two sleeves, the first sleeve of which has on its outer periphery a stud or a pin intended to cooperate with the groove of the sleeve of the push tube. The surgical instrument according to the present invention comprises a gripping rod whose stud or pin is positioned so as to extend in a vertical direction when the manipulation handle is placed in a horizontal plane. The surgical instrument according to the present invention comprises a gripping device which is formed at the end of the gripping rod with a square or rectangular profile secured on each of its first parallel faces with a tongue whose end has a profile in the form of a hook, while the other parallel faces of the profile are pierced with a slot opening into an internal bore and extending in the direction of the second sleeve and with a trigger cooperating with the slot and allowing, when the latter is actuated, to spread the tabs. The surgical instrument according to the present invention comprises a movable handle provided with a head comprising on the one hand a first fork-shaped profile made up of branches each having a free end designed to cooperate with the push tube and on the other hand a second fork-shaped profile consisting of branches each having a free end intended to cooperate with the gripping rod.
L'instrument chirurgical suivant la présente invention comporte une tige de préhension comprenant entre le manchon et la poignée de manipulation un autre manchon pourvu de deux logements parallèles à profil rectangulaire.The surgical instrument according to the present invention comprises a gripping rod comprising between the sleeve and the handling handle another sleeve provided with two parallel housings with rectangular profile.
L'instrument chirurgical suivant la présente invention comporte une tige de préhension dont les logements de l'autre manchon sont disposés dans un plan parallèle à celui contenant les logements du manchon du tube de poussée. La description qui va suivre en regard des dessins annexés, donnés à titre d'exemples non limitatifs, permettra de mieux comprendre l'invention, les caractéristiques qu'elle présente et les avantages qu'elle est susceptible de procurer : Figure 1 est une vue en perspective éclatée illustrant, par exemple, un élément d'ancrage osseux d'un implant rachidien pour lequel l'instrument chirurgical suivant la présente invention peut être utilisé.The surgical instrument according to the present invention comprises a gripping rod whose housings of the other sleeve are arranged in a plane parallel to that containing the housings of the sleeve of the push tube. The description which follows with reference to the appended drawings, given by way of nonlimiting examples, will allow a better understanding of the invention, the characteristics which it presents and the advantages which it is capable of providing: FIG. 1 is a view in exploded perspective illustrating, for example, a bone anchoring element of a spinal implant for which the surgical instrument according to the present invention can be used.
Figures 2 et 3 sont des vues représentant en position de repos l'instrument chirurgical suivant la présente invention.Figures 2 and 3 are views showing in the rest position the surgical instrument according to the present invention.
Figure 4 est une vue montrant le corps principal et sa poignée de manœuvre de l'instrument chirurgical suivant la présente invention. Figure 5 est une vue représentant le corps principal de l'instrument chirurgical suivant la présente invention.Figure 4 is a view showing the main body and its operating handle of the surgical instrument according to the present invention. Figure 5 is a view showing the main body of the surgical instrument according to the present invention.
Figure 6 est une vue en perspective illustrant la poignée mobile de l'instrument chirurgical suivant la présente invention.Figure 6 is a perspective view illustrating the movable handle of the surgical instrument according to the present invention.
Figures 7 et 8 sont des vues en perspective représentant le corps principal et plus particulièrement son extrémité opposée à la poignée de manœuvre de l'instrument chirurgical suivant la présente invention. Figure 9 est une vue en perspective montrant le tube de verrouillage de l'instrument chirurgical suivant la présente invention.Figures 7 and 8 are perspective views showing the main body and more particularly its end opposite to the operating handle of the surgical instrument according to the present invention. Figure 9 is a perspective view showing the locking tube of the surgical instrument according to the present invention.
Figures 10 à 12 sont des vues en perspective illustrant le tube d'écartement de l'instrument chirurgical suivant la présente invention.Figures 10 to 12 are perspective views illustrating the spacer of the surgical instrument according to the present invention.
Figures 13 à 15 sont des vues en perspective représentant la tige de préhension de l'instrument chirurgical suivant la présente invention. Figures 16 à 20 sont des vues montrant les différentes étapes d'utilisation de l'instrument chirurgical suivant la présente invention.Figures 13 to 15 are perspective views showing the gripping rod of the surgical instrument according to the present invention. Figures 16 to 20 are views showing the different stages of use of the surgical instrument according to the present invention.
Figures 21 , 22 et 25 sont des vues représentant une variante permettant une automatisation de l'instrument chirurgical suivant la présente invention et plus particulièrement des déplacements en translation de la tige de préhension à l'intérieur du tube de poussée et de ce dernier à l'intérieur du tube de guidage du corps principal.Figures 21, 22 and 25 are views showing a variant allowing automation of the surgical instrument according to the present invention and more particularly translational movements of the gripping rod inside the push tube and the latter to the inside the guide tube of the main body.
Figure 23 est une vue en perspective illustrant la poignée mobile pour l'automatisation de l'instrument chirurgical suivant la présente invention.Figure 23 is a perspective view illustrating the movable handle for the automation of the surgical instrument according to the present invention.
Figure 24 est une vue représentant la tige de préhension pour l'automatisation de l'instrument chirurgical suivant la présente invention. On a montré en figure 1 , un exemple de réalisation d'un implant rachidien 1 comportant un élément d'ancrage osseux 2 pour le blocage en rotation et en translation d'une tige de liaison 3 au niveau de chaque vertèbre instrumentée d'une colonne vertébrale. L'élément d'ancrage osseux 2 coopère avec un élément de blocage 4 permettant, par l'intermédiaire d'une vis de serrage 5, la fixation en rotation et en translation de la tige de liaison 3.Figure 24 is a view showing the gripping rod for the automation of the surgical instrument according to the present invention. FIG. 1 shows an exemplary embodiment of a spinal implant 1 comprising a bone anchoring element 2 for blocking the rotation and translation of a connecting rod 3 at each instrumented vertebra of a column spinal. The bone anchoring element 2 cooperates with a locking element 4 allowing, by means of a clamping screw 5, the fixing in rotation and in translation of the connecting rod 3.
L'élément d'ancrage osseux 2 comprend une partie d'ancrage 6 et une partie de réception 7 qui est constituée d'une tête 8 en forme de U ouverte dans sa partie supérieure pour coopérer avec la tige de liaison 3 et l'élément de blocage 4.The bone anchoring element 2 comprises an anchoring part 6 and a receiving part 7 which consists of a U-shaped head 8 open in its upper part to cooperate with the connecting rod 3 and the element blocking 4.
La partie d'ancrage 6 peut présenter soit la forme d'un crochet, soit un profil fileté solidaire ou non de la partie de réception 7 pour venir se fixer sur/ou dans le corps vertébral de la vertèbre à instrumenter.The anchoring part 6 may have either the shape of a hook, or a threaded profile which may or may not be integral with the receiving part 7 so as to be fixed on / or in the vertebral body of the vertebra to be instrumented.
La tête 8 comporte deux parois verticales 9, 10 disposées l'une en face de l'autre et dans des plans parallèles afin de délimiter une première ouverture centrale 11 en forme de U portée par l'axe XX' de la tige de liaison 3 et dont le fond 12 présente un profil en portion de cylindre.The head 8 has two vertical walls 9, 10 arranged one opposite the other and in parallel planes in order to delimit a first central opening 11 in the shape of a U carried by the axis XX 'of the connecting rod 3 and the bottom 12 of which has a profile in the form of a cylinder portion.
Chaque paroi verticale 9, 10 est séparée, par exemple, du fond 12 de l'ouverture centrale 11 par une fente verticale 13 donnant une certaine élasticité à chaque paroi en direction du centre de la tête 8, selon l'axe géométrique V V. Les parois verticales 9, 10 comportent respectivement à chaque extrémité une partie d'accrochage 14, 15 disposée l'une en face de l'autre et de part et d'autre de l'ouverture centrale 11.Each vertical wall 9, 10 is separated, for example, from the bottom 12 of the central opening 11 by a vertical slot 13 giving a certain elasticity to each wall in the direction of the center of the head 8, along the geometric axis V V. The vertical walls 9, 10 respectively comprise at each end a hooking part 14, 15 arranged one opposite the other and on either side of the central opening 11.
Chaque paroi verticale 9, 10 comporte sur sa face interne et entre les parties d'accrochage 14, 15 un logement vertical 16 présentant un profil en portion de cylindre pourvu de chaque côté d'une rainure 17 permettant de guider l'élément de blocage 4 lors de sa mise en place dans la tête 8 de l'élément d'ancrage osseux 2.Each vertical wall 9, 10 has on its internal face and between the hooking parts 14, 15 a vertical housing 16 having a profile in portion of cylinder provided on each side with a groove 17 for guiding the locking element 4 when it is placed in the head 8 of the bone anchoring element 2.
Chaque paroi verticale 9, 10 est percée, entre les parties d'accrochage 14, 15, d'un trou 18 débouchant à l'intérieur de l'ouverture centrale 11 et destiné à coopérer avec l'instrument chirurgical correspondant.Each vertical wall 9, 10 is pierced, between the attachment parts 14, 15, with a hole 18 opening out inside the central opening 11 and intended to cooperate with the corresponding surgical instrument.
L'élément de blocage 4 présente un profil externe sensiblement parallélépipédique comportant suivant une direction parallèle à l'axe XX' et dans sa partie inférieure un logement 19 présentant un profil en portion de cylindre afin de recevoir et coopérer avec la tige de liaison 3.The locking element 4 has a substantially parallelepipedal external profile comprising in a direction parallel to the axis XX 'and in its lower part a housing 19 having a profile in the portion of a cylinder in order to receive and cooperate with the connecting rod 3.
L'élément de blocage 4 comporte en son milieu une vis de serrage 5 qui débouche à l'intérieur du logement 19 pour venir en contact par pression contre la tige de liaison 3 pour permettre son immobilisation en rotation et en translation. L'élément de blocage 4 comporte, dans un plan parallèle à l'axe XX', des ergots 20, 21 en forme de dent séparés par un logement vertical 22 bordé latéralement par des nervures 23 permettant le guidage dudit élément de blocage lors de son introduction dans la tête 8 de l'élément d'ancrage 2. On a montré en figures 2 à 6 un instrument chirurgical 100 permettant le retrait de l'élément de blocage 4 de la tête 8 en forme de U de l'élément d'ancrage 2.The locking element 4 has in its middle a clamping screw 5 which opens inside the housing 19 to come into contact by pressure against the connecting rod 3 to allow its immobilization in rotation and in translation. The blocking element 4 comprises, in a plane parallel to the axis XX ', lugs 20, 21 in the form of a tooth separated by a vertical housing 22 bordered laterally by ribs 23 allowing the guiding of said blocking element during its introduction into the head 8 of the anchoring element 2. FIGS. 2 to 6 show a surgical instrument 100 allowing the withdrawal of the locking element 4 from the U-shaped head 8 of the element anchor 2.
L'instrument chirurgical 100 permet le démontage dans le site chirurgical des éléments de blocage 4 de chaque élément d'ancrage osseux 2 pour pouvoir retirer la tige de liaison 3 et/ou modifier l'implant rachidien 1.The surgical instrument 100 allows the disassembly in the surgical site of the locking elements 4 of each bone anchoring element 2 in order to be able to remove the connecting rod 3 and / or modify the spinal implant 1.
L'instrument chirurgical 100 est constitué d'un corps principal 101 , d'un tube de verrouillage 102, d'un tube de poussée 103 et d'une tige de préhension 1 04. Le corps principal 101 comporte un tube horizontal de guidage 105 solidaire à l'une de ses extrémités et suivant une direction parallèle à l'axe Z Z' d'une poignée 106 dite « poignée fixe ».The surgical instrument 100 consists of a main body 101, a locking tube 102, a push tube 103 and a gripping rod 1 04. The main body 101 comprises a horizontal guide tube 105 secured at one of its ends and in a direction parallel to the axis ZZ 'of a handle 106 called "fixed handle".
La poignée fixe 106 coopère avec une autre poignée 107 dite « poignée mobile » qui est reliée à la première par un axe de rotation 108 et un ressort à lame 109 permettant sous un effort d'une pression, de déplacer en translation le tube de poussée 103 à l'intérieur du tube de guidage 105 du corps principal 101. La poignée mobile 107 comporte au-dessus de l'axe de rotation 108 une tête 110 présentant un profil en forme de fourche 111 dont chaque branche 112 comporte une extrémité libre 113 prévue pour coopérer avec le tube de poussée 103 (figure 6).The fixed handle 106 cooperates with another handle 107 known as a "movable handle" which is connected to the first by an axis of rotation 108 and a leaf spring 109 making it possible, under pressure, to move the thrust tube in translation 103 inside the guide tube 105 of the main body 101. The movable handle 107 comprises above the axis of rotation 108 a head 110 having a fork-shaped profile 111, each branch 112 of which has a free end 113 intended to cooperate with the push tube 103 (FIG. 6).
Le mouvement de la poignée mobile 107 est limité par un stoppeur 155 solidaire de ladite poignée mobile et venant en butée contre l'autre poignée fixe 106. Le stoppeur 155 peut être tourné angulairement pour ne plus limiter la course de mouvement de la poignée mobile 107.The movement of the movable handle 107 is limited by a stopper 155 secured to said movable handle and abutting against the other fixed handle 106. The stopper 155 can be turned angularly so as not to limit the movement stroke of the movable handle 107 .
Le tube de guidage 105 est constitué, à proximité de la poignée 106, d'un manchon 114 comportant sur sa périphérie externe un plot de fixation 115 destiné au guidage en translation du tube de verrouillage 102. Le plot de fixation 115 est monté sur une languette élastique 156.The guide tube 105 consists, near the handle 106, of a sleeve 114 comprising on its outer periphery a fixing stud 115 intended for guiding in translation of the locking tube 102. The fixing stud 115 is mounted on a elastic tongue 156.
On a montré en figures 7 et 8 l'extrémité libre 116 du tube de guidage 105 se trouvant à l'opposé de celle, solidaire, de la poignée 106 et destinée à recevoir la tête 8 de l'élément d'ancrage 2 de l'implant rachidien 1. Le tube de guidage 105 comporte un alésage interne cylindrique 117 qui se prolonge au niveau de son extrémité libre 116 par un autre alésage 118 présentant en section un profil interne sensiblement rectangulaire et de forme complémentaire à celle externe de la tête 8 de l'élément d'ancrage osseux 2 de l'implant rachidien 1.FIGS. 7 and 8 show the free end 116 of the guide tube 105 lying opposite that which is integral with the handle 106 and intended to receive the head 8 of the anchoring element 2 of the 'spinal implant 1. The guide tube 105 has a cylindrical internal bore 117 which is extended at its free end 116 by another bore 118 having in section an internal profile which is substantially rectangular and of shape complementary to that external to the head 8 of the bone anchoring element 2 of the spinal implant 1.
Le tube de guidage 105 présente, au niveau de son alésage interne 118, un profil externe de forme rectangulaire délimité par des parois perpendiculaires 119, 120.The guide tube 105 has, at its internal bore 118, an external profile of rectangular shape delimited by perpendicular walls 119, 120.
Ainsi, chaque paroi 119 parallèle et opposée comporte une échancrure 121 en forme de U destinée à coopérer avec la tige de liaison 3 de l'implant rachidien 1 , tandis que chaque paroi 120 est percée d'un logement 122 en forme de T débouchant à l'intérieur de l'alésage 118.Thus, each parallel and opposite wall 119 has a U-shaped notch 121 intended to cooperate with the connecting rod 3 of the spinal implant 1, while each wall 120 is pierced by a T-shaped housing 122 opening out to the interior of bore 118.
Le tube de guidage 105 comporte sur son profil externe et dans un plan perpendiculaire à celui contenant les parois 119 de l'alésage interne 118 des méplats 123 qui se prolongent sur chaque paroi 120.The guide tube 105 has, on its external profile and in a plane perpendicular to that containing the walls 119 of the internal bore 118, flats 123 which extend on each wall 120.
Chaque méplat 123 est solidaire, à l'opposé du logement 122, d'un plot 124 permettant la fixation d'une lamelle élastique 125 comportant un doigt 126 coopérant avec le logement 122 et pénétrant à l'intérieur de l'alésage interne 118.Each flat 123 is integral, opposite the housing 122, with a stud 124 allowing the fixing of an elastic strip 125 comprising a finger 126 cooperating with the housing 122 and penetrating inside the internal bore 118.
On a représenté en figure 9 le tube de verrouillage 102 venant autour du tube de guidage 105 et permettant, par translation, de venir en appui contre les lamelles élastiques 125.FIG. 9 shows the locking tube 102 coming around the guide tube 105 and allowing, by translation, to come to bear against the elastic strips 125.
Le tube de verrouillage 102 comporte une extrémité libre 127 présentant des échancrures 128 à profil tronqué afin de délimiter des lames 129. Ces dernières, par translation du tube de verrouillage 102, viennent appuyer progressivement sur les lamelles 125 du tube de guidage 105.The locking tube 102 has a free end 127 having notches 128 with a truncated profile in order to delimit blades 129. The latter, by translation of the locking tube 102, gradually press on the lamellae 125 of the guide tube 105.
Le tube de verrouillage 102 comporte, à l'opposé de l'extrémité libre 127, une poignée de préhension 130 dont le profil externe est cannelé afin de faciliter la translation dudit tube 102 sur le tube 105 par le chirurgien.The locking tube 102 comprises, opposite the free end 127, a grip handle 130 whose external profile is grooved in order to facilitate the translation of said tube 102 on the tube 105 by the surgeon.
La poignée de préhension 130 se prolonge par un manchon cylindrique 131 qui est percé d'une rainure 132 suivant l'axe longitudinal du tube 102. La rainure 132 est destinée à coopérer avec le plot 115 de la languette élastique 156 du tube 105 permettant le guidage du tube de verrouillage 102 lors de sa translation.The grip handle 130 is extended by a cylindrical sleeve 131 which is pierced with a groove 132 along the longitudinal axis of the tube 102. The groove 132 is intended to cooperate with the stud 115 of the elastic tongue 156 of the tube 105 allowing the guiding the locking tube 102 during its translation.
On a montré en figures 10 à 12 le tube de poussée 103 qui coulisse à l'intérieur de l'alésage 117 du tube de guidage 105 lors d'un effort de pression appliqué sur les poignées 106, 107 de l'instrument chirurgical 100.FIGS. 10 to 12 show the push tube 103 which slides inside the bore 117 of the guide tube 105 during a pressure force applied to the handles 106, 107 of the surgical instrument 100.
Le tube de poussée 103 comporte un alésage interne 135 et une extrémité libre 134 présentant dans le prolongement de l'alésage 135 un autre alésage interne 136 à profil sensiblement rectangulaire et de forme complémentaire à celui externe de l'élément de blocage 4 de l'implant rachidien 1.The push tube 103 has an internal bore 135 and a free end 134 having in the extension of the bore 135 another internal bore 136 with a substantially rectangular profile and of shape complementary to that external to the locking element 4 of the spinal implant 1.
L'extrémité libre 134 du tube de poussée 103 se prolonge par des lames rectangulaires 137 qui sont disposées dans des plans parallèles à ceux contenant les parois 119 du tube de guidage 105.The free end 134 of the push tube 103 is extended by rectangular blades 137 which are arranged in planes parallel to those containing the walls 119 of the guide tube 105.
Egalement, l'extrémité libre 134 du tube de poussée 103 se prolonge par des doigts 138 qui sont disposés dans des plans parallèles à ceux contenant les parois 120 du tube de guidage 105. Chaque doigt 138 comporte une face externe inclinée 139 afin que ce dernier présente un profil en forme de pointe.Also, the free end 134 of the push tube 103 is extended by fingers 138 which are arranged in planes parallel to those containing the walls 120 of the guide tube 105. Each finger 138 has an inclined external face 139 so that the latter has a pointed profile.
Le tube de poussée 103 comporte, à l'opposé de l'extrémité 134, un manchon 140 présentant un diamètre externe supérieur à celui dudit tube 103. Le manchon 140 comprend deux logements parallèles 141 à profil rectangulaire destinés à recevoir respectivement les branches 112 de la fourche 111 de la poignée mobile 107.The push tube 103 comprises, opposite the end 134, a sleeve 140 having an external diameter greater than that of said tube 103. The sleeve 140 comprises two parallel housings 141 with rectangular profile intended to receive respectively the arms 112 of the fork 111 of the movable handle 107.
Les logements 141 sont disposés dans un plan parallèle à celui portant les doigts inclinés 138 solidaires de l'extrémité libre 134 du tube de poussée 103. Le manchon 140 comporte une rainure 142 disposée suivant l'axe longitudinal du tube de poussée 103 et entre les logements 141.The housings 141 are arranged in a plane parallel to that carrying the inclined fingers 138 integral with the free end 134 of the push tube 103. The sleeve 140 has a groove 142 arranged along the longitudinal axis of the push tube 103 and between the housing 141.
On a illustré en figures 13 à 15 la tige de préhension 104 qui coulisse à l'intérieur de l'alésage 135 du tube de poussée 103 de l'instrument chirurgical 100. La tige de préhension 104 comporte à l'une de ses extrémités une poignée de manipulation 143 et à l'extrémité opposée un dispositif de préhension 144. La tige de préhension 104 comporte entre sa poignée 143 et le dispositif de préhension 144 deux manchons 145, 146 présentant un diamètre externe supérieur à celui de ladite tige. Le premier manchon 145 comprend sur son pourtour externe un plot ou une goupille 147 coopérant avec la rainure 142 du manchon 140 du tube de poussée 103 lors de l'introduction de la tige de préhension 104 dans ce dernier. Cet agencement permet de lier en rotation le tube de poussée 103 et la tige de préhension 104 lors de l'utilisation de l'instrument chirurgical 100.There is illustrated in FIGS. 13 to 15 the gripping rod 104 which slides inside the bore 135 of the push tube 103 of the surgical instrument 100. The gripping rod 104 has at one of its ends a handling handle 143 and at the opposite end a gripping device 144. The gripping rod 104 has between its handle 143 and the gripping device 144 two sleeves 145, 146 having an external diameter greater than that of said rod. The first sleeve 145 comprises on its outer periphery a stud or a pin 147 cooperating with the groove 142 of the sleeve 140 of the push tube 103 during the introduction of the gripping rod 104 into the latter. This arrangement makes it possible to link in rotation the push tube 103 and the gripping rod 104 when using the surgical instrument 100.
10 Le plot ou la goupille 147 est positionné(e) de manière à s'étendre suivant une direction verticale lorsque la poignée de manipulation 143 est placée dans un plan horizontal.The stud or pin 147 is positioned so as to extend in a vertical direction when the manipulation handle 143 is placed in a horizontal plane.
15 Le dispositif de préhension 144 est constitué, à l'extrémité de la tige 104 et dans le prolongement de cette dernière, d'un profil carré ou rectangulaire 148 solidaire sur chacune de ses premières faces parallèles 149 d'une languette 150 dont le bout présente un profil en forme de crochet.15 The gripping device 144 consists, at the end of the rod 104 and in the extension of the latter, of a square or rectangular profile 148 secured on each of its first parallel faces 149 with a tongue 150 whose end has a hook-shaped profile.
20 Le profil 148 comporte d'autres faces parallèles 151 qui sont perpendiculaires aux premières 149 et qui présentent chacune une fente 152 débouchant dans un alésage interne 153. Chaque fente 152 se prolonge en direction du manchon 146 afin de recevoir une 25 gâchette 154 permettant, lorsque cette dernière est actionnée, d'écarter les languettes 150 du dispositif de préhension 144. On a montré en figures 16 à 20 les différentes étapes d'utilisation de l'instrument chirurgical 100 pour le retrait in situ, c'est à dire, dans le site chirurgical, d'un 3.0 élément de blocage 4 d'un élément d'ancrage 2 en vue, par exemple du retrait la tige de liaison 3. Avant la mise en place et le blocage de l'instrument chirurgical 100 sur la tête 8 de l'élément d'ancrage 2, le chirurgien procède au desserrage de la vis de serrage 5 35 de l'élément de blocage 4 afin que ce dernier puisse se déplacer à l'intérieur de la tête 8. L'instrument chirurgical 100 est positionné sur la tête 8 en forme de U de l'élément d'ancrage 2 de manière que d'une part la tige de liaison 3 soit logée à 40 l'intérieur des échancrures 121 du tube de guidage 105 et d'autre part que la tête 8 de l'élément d'ancrage osseux 2 soit introduit dans l'alésage interne 118 dudit tube de guidage 105 (figure 16). Le positionnement de l'instrument chirurgical 100 sur la tête 8 permet également 45 de loger les doigts 126 de chaque lamelle élastique 125 du tube de guidage 105 à l'intérieur des trous 18 ménagés dans chacune des parois verticales 9, 10 de ladite tête 8 (figure 16). L'instrument chirurgical 100 est fixé sur la tête 8 de l'élément d'ancrage 2 par l'intermédiaire du tube de verrouillage 102 qui est entraîné en translation sur le tube de guidage 105 de manière que les lames 129 soient amenées progressivement contre et au-dessus des lamelles élastiques 125 pour bloquer les doigts 126 à l'intérieur de chaque trou 18 de ladite tête 8.The profile 148 has other parallel faces 151 which are perpendicular to the first 149 and which each have a slot 152 opening into an internal bore 153. Each slot 152 is extended in the direction of the sleeve 146 in order to receive a trigger 154 allowing, when the latter is actuated, to separate the tabs 150 from the gripping device 144. FIGS. 16 to 20 show the different stages of use of the surgical instrument 100 for removal in situ, that is to say, in the surgical site, a 3.0 blocking element 4 of an anchoring element 2 in view, for example of the withdrawal of the connecting rod 3. Before the positioning and blocking of the surgical instrument 100 on the head 8 of the anchoring element 2, the surgeon loosens the clamping screw 5 35 of the locking element 4 so that the latter can move inside the head 8. The surgical instrument 100 is positioned on the U-shaped head 8 of the anchoring element 2 so that on the one hand the connecting rod 3 is housed inside the notches 121 of the guide tube 105 and on the other hand that the head 8 of the bone anchoring element 2 is introduced into the internal bore 118 of said guide tube 105 (FIG. 16). The positioning of the surgical instrument 100 on the head 8 also makes it possible to accommodate the fingers 126 of each elastic strip 125 of the guide tube 105 inside the holes 18 formed in each of the vertical walls 9, 10 of said head 8 (figure 16). The surgical instrument 100 is fixed to the head 8 of the anchoring element 2 by means of the locking tube 102 which is driven in translation on the guide tube 105 so that the blades 129 are brought gradually against and above the elastic strips 125 to block the fingers 126 inside each hole 18 of said head 8.
La translation_du tube de verrouillage 102 sur le tube de guidage 105 est guidée par l'intermédiaire du plot 115 qui coopère avec la rainure 132 ménagée dans le manchon 131 dudit tube 102 (figure 17).The translation_du locking tube 102 on the guide tube 105 is guided through the stud 115 which cooperates with the groove 132 formed in the sleeve 131 of said tube 102 (Figure 17).
La tige de préhension 104 est introduite par le chirurgien dans le tube de poussée 103 jusqu'à ce que les languettes 150 du dispositif de préhension 144 coopèrent respectivement avec le logement vertical 22 de l'élément de blocage 4 et viennent s'accrocher en dessous de ce dernier (figure 16).The gripping rod 104 is inserted by the surgeon into the push tube 103 until the tongues 150 of the gripping device 144 cooperate respectively with the vertical housing 22 of the locking element 4 and come to hang below of the latter (Figure 16).
Le chirurgien actionne l'instrument chirurgical 100 en agissant par une pression sur la poignée mobile 107 permettant par l'intermédiaire de ses branches 112 de déplacer en translation le tube de poussée 103 à l'intérieur du tube de guidage 105 et en direction de l'élément de blocage 4 (figures 17, 18).The surgeon actuates the surgical instrument 100 by acting on the movable handle 107 by means of its branches 112 allowing the push tube 103 to move in translation inside the guide tube 105 and in the direction of l blocking element 4 (Figures 17, 18).
Lors de ce déplacement en translation, les doigts inclinés 138 viennent s'introduire respectivement à l'intérieur de chaque logement vertical 16 ménagé dans les parois 9, 10 de la tête 8 de l'élément d'ancrage osseux 2. Cette introduction progressive des doigts 138 permet d'écarter les parois 9, 10 en direction de l'extérieur et de libérer les parties d'accrochage 14, 15 de la tête 8 des ergots 20, 21 de l'élément de blocage 4 (figure 19).During this displacement in translation, the inclined fingers 138 are introduced respectively inside each vertical housing 16 formed in the walls 9, 10 of the head 8 of the bone anchoring element 2. This progressive introduction of fingers 138 makes it possible to separate the walls 9, 10 in the direction of the outside and to release the attachment parts 14, 15 from the head 8 of the lugs 20, 21 from the locking element 4 (FIG. 19).
Simultanément à l'introduction des doigts 138, les lames rectangulaires 137 viennent prendre appui sur la tige de liaison 3 afin de s'opposer à tout effort qu'elle pourrait exercer sur l'élément de blocage 4 au moment de son retrait.Simultaneously with the introduction of the fingers 138, the rectangular blades 137 come to bear on the connecting rod 3 in order to oppose any force that it could exert on the locking element 4 at the time of its removal.
Dès que les parties d'accrochage 14, 15 de la tête 8 sont écartées des ergots 20, 21 de l'élément de blocage 4, ce dernier est libre et peut être retiré de l'élément d'ancrage osseux 2 (figure 20).As soon as the hooking parts 14, 15 of the head 8 are spaced from the lugs 20, 21 of the locking element 4, the latter is free and can be removed from the bone anchoring element 2 (FIG. 20) .
Ainsi, le chirurgien retire la tige de préhension 104 à l'aide de la poignée 143 du tube de poussée 103 et donc de l'instrument chirurgical 100 en emmenant l'élément de blocage 4 retenu dans le dispositif de préhension 144 (figure 20).Thus, the surgeon removes the gripping rod 104 using the handle 143 of the push tube 103 and therefore of the surgical instrument 100 by taking the locking element 4 retained in the gripping device 144 (Figure 20) .
Lorsque la tige de préhension 104 est extraite de l'instrument chirurgical 100, le chirurgien exerce une pression sur la gâchette 154 du dispositif de préhension 144 afin d'écarter les fentes 152 et libérer l'élément de blocage 4 des languettes d'accrochage 150.When the gripping rod 104 is extracted from the surgical instrument 100, the surgeon exerts pressure on the trigger 154 of the gripping device 144 in order to spread the slots 152 and release the locking element 4 from the hooking tabs 150 .
Ensuite, le chirurgien peut retirer l'instrument chirurgical 100 en entraînant en translation le tube 102 afin de dégager les lamelles élastiques 125 de la pression exercée par les lames 129. De ce fait, les lamelles élastiques 125 reviennent dans leur position de repos libérant leurs doigts 126 des trous 18 de la tête 8 de l'élément d'ancrage osseux 2.Then, the surgeon can remove the surgical instrument 100 by driving the tube 102 in translation in order to release the elastic strips 125 from the pressure exerted by the blades 129. As a result, the elastic strips 125 return in their rest position freeing their fingers 126 from the holes 18 in the head 8 of the bone anchoring element 2.
Le chirurgien peut, en fonction du nombre d'élément de blocage 4 à retirer, présenter l'instrument chirurgical 100 sur une autre tête 8 d'un autre élément d'ancrage 2 et procéder aux mêmes étapes que celles décrites ci dessus.The surgeon can, depending on the number of blocking element 4 to be removed, present the surgical instrument 100 on another head 8 of another anchoring element 2 and carry out the same steps as those described above.
Le chirurgien peut ensuite démonter l'instrument chirurgical 100 en agissant sur le stoppeur 155 afin de permettre à la poignée mobile 107 et plus particulièrement aux branches 112 de se libérer des logements 141 du tube de poussée 103.The surgeon can then dismantle the surgical instrument 100 by acting on the stopper 155 in order to allow the movable handle 107 and more particularly to the branches 112 to be released from the housings 141 of the push tube 103.
La libération de la poignée mobile 107 permet le retrait du tube de poussée 103 du tube de guidage 105. Le tube de verrouillage 102 peut être également démonté par simple pression sur la languette élastique 156, afin de libérer le plot 115 de la rainure 132.The release of the movable handle 107 allows the withdrawal of the push tube 103 from the guide tube 105. The locking tube 102 can also be removed by simple pressure on the elastic tongue 156, in order to release the stud 115 from the groove 132.
On a montré en figures 21 et 22 une variante de l'instrument chirurgical 100, décrit précédemment, et permettant le retrait de l'élément de blocage 4 de la tête 8 en forme de U de l'élément d'ancrage 2.FIGS. 21 and 22 show a variant of the surgical instrument 100, described above, and allowing the withdrawal of the blocking element 4 from the U-shaped head 8 of the anchoring element 2.
La variante de l'instrument chirurgical 100 sera uniquement décrite en ce qui concerne les éléments qui ont été modifiés, à savoir : la poignée mobile 107, et la tige de préhension 104 et son entraînement en translation à l'intérieur du tube de poussée 103, sachant que toutes les autres pièces sont de structure et de fonction identiques.The variant of the surgical instrument 100 will only be described with regard to the elements which have been modified, namely: the movable handle 107, and the gripping rod 104 and its drive in translation inside the push tube 103 , knowing that all the other parts are of identical structure and function.
L'objet de la variante décrite ci-après consiste à réaliser une automatisation de l'instrument chirurgicale 100 et plus particulièrement l'entraînement en translation de la tige de préhension 104 à l'intérieur du tube de poussée 103 par la poignée mobile 107.The object of the variant described below consists in carrying out an automation of the surgical instrument 100 and more particularly the translational drive of the gripping rod 104 inside the push tube 103 by the movable handle 107.
L'instrument chirurgical 100 permet le démontage dans le site chirurgical des éléments de blocage 4 de chaque élément d'ancrage osseux 2 pour pouvoir retirer la tige de liaison 3 et/ou modifier l'implant rachidien 1.The surgical instrument 100 allows the disassembly in the surgical site of the locking elements 4 of each bone anchoring element 2 in order to be able to remove the connecting rod 3 and / or modify the spinal implant 1.
Le corps principal 101 de l'instrument chirurgical 100 comporte un tube horizontal de guidage 105 solidaire à l'une de ses extrémités et suivant une direction parallèle à l'axe Z Z' d'une poignée 106 dite « poignée fixe ».The main body 101 of the surgical instrument 100 comprises a horizontal guide tube 105 secured at one of its ends and in a direction parallel to the axis Z Z 'of a handle 106 called "fixed handle".
La poignée fixe 106 coopère avec une autre poignée 107 dite « poignée mobile » qui est reliée à la première par un axe de rotation 108 et un ressort à lame 109 permettant sous un effort de pression deux actions simultanées à savoir :The fixed handle 106 cooperates with another handle 107 called a “movable handle” which is connected to the first by an axis of rotation 108 and a leaf spring 109 allowing two simultaneous actions under pressure force, namely:
• le déplacement en translation de la tige de préhension 104 à l'intérieur du tube de poussée 103,The displacement in translation of the gripping rod 104 inside the push tube 103,
• et le déplacement en translation du tube de poussée 103 à l'intérieur du tube de guidage 105 du corps principal 101. On a montré en figure 23, la poignée mobile 107 qui comporte au-dessus de l'axe de rotation 108 une tête 110 présentant un premier profil en forme de fourche 111 et décalé latéralement du premier profil un second profil en forme fourche 157. Le premier profil en forme de fourche 111 de la poignée mobile 107 est formé de branches 112 comportant chacune une extrémité libre 113 prévue pour coopérer avec le tube de poussée 103.• and the displacement in translation of the push tube 103 inside the guide tube 105 of the main body 101. FIG. 23 shows the movable handle 107 which comprises above the axis of rotation 108 a head 110 having a first profile in the form of a fork 111 and laterally offset from the first profile a second profile in the form of a fork 157. The first fork-shaped profile 111 of the movable handle 107 is formed of branches 112 each having a free end 113 provided to cooperate with the push tube 103.
Le tube de poussée 103 comporte, à l'opposé de l'extrémité 134, un manchon 140 présentant un diamètre externe supérieur à celui dudit tube 103. Le manchon 140 comprend deux logements parallèles 141 à profil rectangulaire destinés à recevoir respectivement les branches 112 de la fourche 111 de la poignée mobile 107 ( figure 22). Les logements 141 sont disposés dans un plan parallèle à celui portant les doigts inclinés 138 solidaires de l'extrémité libre 134 du tube de poussée 103. Le manchon 140 comporte une rainure 142 disposée suivant l'axe longitudinal du tube de poussée 103 et entre les logements 141. Egalement, le second profil en forme de fourche 157 de la poignée mobile 107, comporte des branches 158 présente chacune une extrémité libre 159 prévue pour coopérer avec la tige de préhension 104.The push tube 103 comprises, opposite the end 134, a sleeve 140 having an external diameter greater than that of said tube 103. The sleeve 140 comprises two parallel housings 141 with rectangular profile intended to receive respectively the arms 112 of the fork 111 of the movable handle 107 (Figure 22). The housings 141 are arranged in a plane parallel to that carrying the inclined fingers 138 integral with the free end 134 of the push tube 103. The sleeve 140 has a groove 142 arranged along the longitudinal axis of the push tube 103 and between the housings 141. Also, the second fork-shaped profile 157 of the movable handle 107, has branches 158 each having a free end 159 designed to cooperate with the gripping rod 104.
Les branches 158 de la seconde fourche 157 sont disposées suivant une direction verticale et sensiblement parallèle à celle prévue pour les branches 112 de la première fourche 111. Les branches 158 de la seconde fourche 157 sont prévues plus grandes que les branches 112 de la première fourche 111 (figure 23).The branches 158 of the second fork 157 are arranged in a vertical direction and substantially parallel to that provided for the branches 112 of the first fork 111. The branches 158 of the second fork 157 are provided larger than the branches 112 of the first fork 111 (Figure 23).
On a représenté en figure 24, la tige de préhension 104 qui comporte à l'une de ses extrémités une poignée de manipulation 143 et à l'extrémité opposée un dispositif de préhension 144.FIG. 24 shows the gripping rod 104 which comprises at one of its ends a handling handle 143 and at the opposite end a gripping device 144.
La tige de préhension 104 comporte entre sa poignée 143 et le dispositif de préhension 144 des manchons 145, 146 et 161 présentant un diamètre externe supérieur à celui de ladite tige. Les manchons 145 et 146 sont disposés de part et d'autre du manchon central 161 et à égale distance de ce dernier.The gripping rod 104 has between its handle 143 and the gripping device 144 sleeves 145, 146 and 161 having an external diameter greater than that of said rod. The sleeves 145 and 146 are arranged on either side of the central sleeve 161 and at an equal distance from the latter.
La tige de préhension 104 comporte entre le manchon 145 et la poignée de manipulation 143 un autre manchon 160 présentant un diamètre externe supérieur à celui de ladite tige de préhension 104. Le manchon 160 comprend deux logements parallèles 162 à profil rectangulaire destinés à recevoir respectivement les branches 158 de la fourche 157 de la poignée mobile 107.The gripping rod 104 comprises between the sleeve 145 and the handling handle 143 another sleeve 160 having an external diameter greater than that of said gripping rod 104. The sleeve 160 comprises two parallel housings 162 with rectangular profile intended to receive respectively the legs 158 of the fork 157 of the movable handle 107.
Les logements 162 sont disposés dans un plan parallèle à celui contenant les logements 141 du manchon 140 du tube de poussée 103.The housings 162 are arranged in a plane parallel to that containing the housings 141 of the sleeve 140 of the push tube 103.
On a montré en figures 16 19, 20 et 25 les différentes étapes d'utilisation de l'instrument chirurgical 100 pour le retrait in situ, c'est à dire, dans le site chirurgical, d'un élément de blocage 4 d'un élément d'ancrage 2 en vue, par exemple du retrait la tige de liaison 3.FIGS. 16, 19, 20 and 25 show the different stages of using the surgical instrument 100 for removal in situ, that is to say, in the surgical, of a blocking element 4 of an anchoring element 2 in view, for example of the withdrawal of the connecting rod 3.
Avant la mise en place et le blocage de l'instrument chirurgical 100 sur la tête 8 de l'élément d'ancrage 2, le chirurgien procède au desserrage de la vis de serrage 5 de l'élément de blocage 4 afin que ce dernier puisse se déplacer à l'intérieur de la tête 8.Before placing and blocking the surgical instrument 100 on the head 8 of the anchoring element 2, the surgeon loosens the clamping screw 5 of the locking element 4 so that the latter can move inside the head 8.
L'instrument chirurgical 100 est positionné sur la tête 8 en forme de U de l'élément d'ancrage 2 de manière que d'une part la tige de liaison 3 soit logée à l'intérieur des échancrures 121 du tube de guidage 105 et d'autre part que la tête 8 de l'élément d'ancrage osseux 2 soit introduit dans l'alésage interne 118 dudit tube de guidage 105 (figure 16). Le positionnement de l'instrument chirurgical 100 sur la tête 8 permet également de loger les doigts 126 de chaque lamelle élastique 125 du tube de guidage 105 à l'intérieur des trous 18 ménagés dans chacune des parois verticales 9, 10 de ladite tête 8 (figure 16). L'instrument chirurgical 100 est fixé sur la tête 8 de l'élément d'ancrage 2 par l'intermédiaire du tube de verrouillage 102 qui est entraîné en translation sur le tube de guidage 105 de manière que les lames 129 soient amenées progressivement contre et au-dessus des lamelles élastiques 125 pour bloquer les doigts 126 à l'intérieur de chaque trou 18 de ladite tête 8.The surgical instrument 100 is positioned on the U-shaped head 8 of the anchoring element 2 so that on the one hand the connecting rod 3 is housed inside the notches 121 of the guide tube 105 and on the other hand that the head 8 of the bone anchoring element 2 is introduced into the internal bore 118 of said guide tube 105 (Figure 16). The positioning of the surgical instrument 100 on the head 8 also makes it possible to accommodate the fingers 126 of each elastic strip 125 of the guide tube 105 inside the holes 18 formed in each of the vertical walls 9, 10 of said head 8 ( figure 16). The surgical instrument 100 is fixed to the head 8 of the anchoring element 2 by means of the locking tube 102 which is driven in translation on the guide tube 105 so that the blades 129 are brought gradually against and above the elastic strips 125 to block the fingers 126 inside each hole 18 of said head 8.
Ensuite le chirurgien actionne l'instrument chirurgical 100 en agissant par une pression sur la poignée 107 permettant par l'intermédiaire de ses branches 158 de déplacer en translation la tige de préhension 104 à l'intérieur du tube de poussée 103 en direction de l'élément de blocage 4. Les languettes 150 du dispositif de préhension 144 de la tige de préhension .104 coopère respectivement avec le logement vertical 22 de l'élément de blocage 4 et viennent s'accrocher en dessous de ce dernier.Then the surgeon actuates the surgical instrument 100 by acting on the handle 107 allowing, by means of its branches 158, to move in translation the gripping rod 104 inside the push tube 103 in the direction of the locking element 4. The tongues 150 of the gripping device 144 of the gripping rod .104 respectively cooperate with the vertical housing 22 of the locking element 4 and come to hang below the latter.
Le mouvement continu exercé par le chirurgien sur la poignée 107 permet de libérer les branches 158 de la seconde fourche 157 des logements 162 du manchon 160 de la tige de préhension 104 (figure 25).The continuous movement exerted by the surgeon on the handle 107 makes it possible to free the branches 158 of the second fork 157 from the housings 162 of the sleeve 160 of the gripping rod 104 (FIG. 25).
Le mouvement continu de la poignée mobile 107 permet également par l'intermédiaire des branches 112 de la première fourche 111 de déplacer en translation le tube de poussée 103 à l'intérieur du tube de guidage 105 en direction de l'élément de blocage 4.The continuous movement of the movable handle 107 also makes it possible, through the branches 112 of the first fork 111, to move the push tube 103 in translation inside the guide tube 105 in the direction of the locking element 4.
Lors de ce déplacement en translation du tube de poussée 103, les doigts inclinés 138 viennent s'introduire respectivement à l'intérieur de chaque logement vertical 16 ménagé dans les parois 9, 10 de la tête 8 de l'élément d'ancrage osseux 2.During this translational movement of the push tube 103, the inclined fingers 138 are introduced respectively inside each vertical housing 16 formed in the walls 9, 10 of the head 8 of the bone anchoring element 2 .
Les étapes suivantes concernant le fonctionnement de l'instrument chiru rgical 100 sont identiques à celles décrites et illustrés en figures 19 et 20. Le chirurgien peut ensuite démonter l'instrument chirurgical 100 en agissant sur le stoppeur 155 afin de permettre à la poignée mobile 107 et plus particulièrement aux branches 112 et 157 de se libérer respectivement des logements 141 et 162 du tube de poussée 103 et de la tige de préhension 104.The following steps concerning the operation of the chiru rgical 100 instrument are identical to those described and illustrated in Figures 19 and 20. The surgeon can then disassemble the surgical instrument 100 by acting on the stopper 155 in order to allow the movable handle 107 and more particularly to the branches 112 and 157 to free themselves respectively from the housings 141 and 162 of the push tube 103 and the rod. grip 104.
Il doit d'ailleurs être entendu que la description qui précède n'a été donnée qu'a titre d'exemple et qu'elle ne limite nullement le domaine de l'invention dont on ne sortirait pas en remplaçant les détails d'exécutions décrits par tout autre équivalent. It should moreover be understood that the foregoing description has been given only by way of example and that it in no way limits the field of the invention from which one would not depart by replacing the details of executions described by any other equivalent.

Claims

REVENDICATIONS
1. Instrument chirurgical pour le retrait d'un élément de blocage (4) de la tête (8) en forme de U d'un élément d'ancrage (2), préalablement ancré dans le corps osseux d'une vertèbre, d'un implant rachidien (1) pour la fixation en rotation et en translation d'une tige de liaison (3), caractérisé en ce qu'il est constitué d'un corps principal (101) comprenant un tube de guidage (105) solidaire d'une poignée fixe (106) et comportant des moyens élastiques (125) pour l'accrochage de l'instrument chirurgical (100) sur la tête (8), d'un tube de verrouillage (102) coulissant sur le tube de guidage (105) et comportant des moyens de blocage (129) de l'instrument chirurgical (100) sur la tête (8), d'un tube de poussée (103) coulissant à l'intérieur du tube de guidage (105) par l'intermédiaire d'une poignée mobile (107) reliée à la poignée fixe (106), ledit tube de poussée (103) comportant des premiers moyens d'écartement (138) des parois (9, 10) de la tête (8) et des seconds moyens de blocage (137) de la tige de liaison (3) dans le fond de la tête (8) de l'élément d'ancrage osseux (2) et d'une tige de préhension (104) coulissant à l'intérieur du tube de poussée (103) et comprenant un dispositif de préhension (144) pour l'accrochage et le retrait de l'élément de blocage (104) de la tête (8) de l'élément d'ancrage osseux (2).1. Surgical instrument for the removal of a blocking element (4) from the U-shaped head (8) of an anchoring element (2), previously anchored in the bone body of a vertebra, a spinal implant (1) for fixing in rotation and in translation a connecting rod (3), characterized in that it consists of a main body (101) comprising a guide tube (105) integral with '' a fixed handle (106) and comprising elastic means (125) for hooking the surgical instrument (100) on the head (8), of a locking tube (102) sliding on the guide tube ( 105) and comprising means (129) for locking the surgical instrument (100) on the head (8), of a push tube (103) sliding inside the guide tube (105) by the intermediate a movable handle (107) connected to the fixed handle (106), said push tube (103) comprising first means for spacing (138) the walls (9, 10) of the head (8) and himself conds locking means (137) of the connecting rod (3) in the bottom of the head (8) of the bone anchoring element (2) and of a gripping rod (104) sliding inside of the push tube (103) and comprising a gripping device (144) for hooking and removing the locking element (104) from the head (8) of the bone anchoring element (2).
2. Instrument chirurgical suivant la revendication 1 caractérisé en ce que le tube de guidage (105) est constitué, à proximité de la poignée (106), d'un manchon (114) comportant sur sa périphérie externe un plot de fixation (115) porté par une languette (156), d'une extrémité libre (116) comportant un alésage interne cylindrique (117) qui se prolonge par un autre alésage (118) présentant en section un profil interne sensiblement rectangulaire et de forme complémentaire à celui externe de la tête (8) de l'élément d'ancrage osseux (2).2. Surgical instrument according to claim 1 characterized in that the guide tube (105) consists, near the handle (106), of a sleeve (114) having on its outer periphery a fixing stud (115) carried by a tongue (156), of a free end (116) comprising a cylindrical internal bore (117) which is extended by another bore (118) having in section an internal profile which is substantially rectangular and of shape complementary to that external to the head (8) of the bone anchoring element (2).
3. Instrument chirurgical suivant la revendication 2 caractérisé en ce que le tube de guidage (105) présente, au niveau de son alésage interne (118), un profil externe de forme rectangulaire délimité par des parois perpendiculaires (119. 120), de manière que chaque paroi (119) comporte une échancrure (121) en forme de U destinée à coopérer avec la tige de liaison (3), tandis que chaque paroi (120) est percée d'un logement (122) débouchant à l'intérieur de l'alésage (118) et en ce que le tube de guidage (105) comporte sur son profil externe des méplats (123) permettant la fixation de lamelles élastiques (125) solidaire d'un doigt (126) coopérant avec le logement (122) et pénétrant à l'intérieur de l'alésage interne (118).3. Surgical instrument according to claim 2 characterized in that the guide tube (105) has, at its internal bore (118), an external profile of rectangular shape delimited by perpendicular walls (119. 120), so that each wall (119) has a U-shaped notch (121) intended to cooperate with the connecting rod (3), while each wall (120) is pierced by a housing (122) opening out inside the bore (118) and in that the guide tube (105) has on its external profile flats (123) allowing the fixing of elastic strips (125) integral with a finger (126) cooperating with the housing (122 ) and penetrating inside the internal bore (118).
4. Instrument chirurgical suivant la revendication 1 caractérisé en ce que le tube de verrouillage (102) comporte une extrémité libre (127) présentant des échancrures (128) à profil tronqué afin de délimiter des lames (129) destinées à faire pression sur les lamelles élastiques (125) pour bloquer les doigts (126) dans la tête de l'implant (8) et à l'opposé de l'extrémité libre (127) une poignée de préhension (130) se prolongeant par un manchon cylindrique (131) qui est percé d'une rainure (132) destinée à coopérer avec le plot (115) du tube (105) permettant le guidage du tube de verrouillage (102) lors de son entraînement en translation. 4. Surgical instrument according to claim 1 characterized in that the locking tube (102) has a free end (127) having notches (128) with a truncated profile in order to delimit blades (129) intended to put pressure on the lamellae elastic (125) to block the fingers (126) in the head of the implant (8) and opposite the free end (127) a grip handle (130) extended by a cylindrical sleeve (131) who is pierced with a groove (132) intended to cooperate with the stud (115) of the tube (105) allowing the guide of the locking tube (102) during its drive in translation.
5. Instrument chirurgical suivant la revendication 1 caractérisé en ce que le tube de poussée (103) comporte un alésage interne (135) et une extrémité libre (134) présentant dans le prolongement de l'alésage (135) un autre alésage interne (136) à profil sensiblement rectangulaire et de forme complémentaire à celui externe de l'élément de blocage (4) et en ce que le tube de poussée (103) comporte à l'opposé de l'extrémité (134) un manchon (140) présentant deux logements parallèles (141) à profil rectangulaire destinés à recevoir respectivement les branches (112) de la fourche (111) de la poignée mobile (107) et une rainure (142) disposée suivant l'axe longitudinal du tube de poussée (103) et entre les logements (141).5. Surgical instrument according to claim 1 characterized in that the push tube (103) has an internal bore (135) and a free end (134) having in the extension of the bore (135) another internal bore (136 ) with a substantially rectangular profile and a shape complementary to that of the external locking element (4) and in that the push tube (103) comprises, opposite the end (134), a sleeve (140) having two parallel housings (141) with rectangular profile intended to receive respectively the arms (112) of the fork (111) of the movable handle (107) and a groove (142) arranged along the longitudinal axis of the push tube (103) and between the housings (141).
6. Instrument chirurgical suivant la revendication 5 caractérisé en ce que l'extrémité libre (134) du tube de poussée (103) se prolonge d'une part par des lames rectangulaires (137) qui sont disposées dans des plans parallèles à ceux contenant les parois (119) du tube de guidage (105) et d'autre part par des doigts (138) qui sont disposés dans des plans parallèles à ceux contenant les deux autres parois (120) du tube de guidage (105).6. Surgical instrument according to claim 5 characterized in that the free end (134) of the push tube (103) is extended on the one hand by rectangular blades (137) which are arranged in planes parallel to those containing the walls (119) of the guide tube (105) and on the other hand by fingers (138) which are arranged in planes parallel to those containing the two other walls (120) of the guide tube (105).
7. Instrument chirurgical suivant la revendication 6 caractérisé en ce que chaque doigt (138) comporte une face externe inclinée (139) afin que ce dernier présente un profil en forme de pointe.7. Surgical instrument according to claim 6 characterized in that each finger (138) has an inclined external face (139) so that the latter has a point-shaped profile.
8. Instrument chirurgical suivant la revendication 6 caractérisé en ce que les logements (141) sont disposés dans un plan parallèle à celui portant les doigts inclinés (138) solidaires de l'extrémité libre (134) du tube de poussée (103).8. Surgical instrument according to claim 6 characterized in that the housings (141) are arranged in a plane parallel to that carrying the inclined fingers (138) integral with the free end (134) of the push tube (103).
9. Instrument chirurgical suivant la revendication 1 , caractérisé en ce que la tige de préhension (104) comporte à l'une de ses extrémités une poignée de manipulation (143) et à l'extrémité opposée un dispositif de préhension (144), ladite tige de préhension (104) comprenant entre sa poignée (143) et le dispositif de préhension (144) deux manchons (145, 146) dont le premier manchon (145) comporte sur son pourtour externe un plot ou une goupille (147) destiné(e) à coopérer avec la rainure (142) du manchon (140) du tube de poussée (103). 9. Surgical instrument according to claim 1, characterized in that the gripping rod (104) comprises at one of its ends a handling handle (143) and at the opposite end a gripping device (144), said gripping rod (104) comprising between its handle (143) and the gripping device (144) two sleeves (145, 146), the first sleeve (145) of which has a stud or pin (147) on its outer periphery ( e) cooperating with the groove (142) of the sleeve (140) of the push tube (103).
10. Instrument chirurgical suivant la revendication 9, caractérisé en ce que le plot ou la goupille (147) est positionné(e) de manière à s'étendre suivant une direction verticale lorsque la poignée de manipulation (143) est placée dans un plan horizontal. 10. Surgical instrument according to claim 9, characterized in that the stud or the pin (147) is positioned so as to extend in a vertical direction when the manipulation handle (143) is placed in a horizontal plane .
11. Instrument chirurgical suivant la revendication 9, caractérisé en ce que le dispositif de préhension (144) est constitué à l'extrémité de la tige (104) d'un profil carré ou rectangulaire (148) solidaire sur chacune de ses premières faces parallèles (149) d'une languette (150) dont le bout présente un profil en forme de crochet, tandis que les autres faces parallèles (151) du p rofil (148) sont percées d'une fente (152) débouchant dans un alésage interne (153) et se prolongeant en direction du second manchon (146) et d'une gâchette (154) coopérant avec la fente (152) et permettant lorsque cette dernière est actionnée d'écarter les languettes (150).11. Surgical instrument according to claim 9, characterized in that the gripping device (144) consists at the end of the rod (104) of a square or rectangular profile (148) integral on each of its first parallel faces (149) of a tongue (150) whose end has a hook-shaped profile, while the other parallel faces (151) of the profile (148) are pierced with a slot (152) opening into an internal bore (153) and extending towards the second sleeve (146) and a trigger (154) cooperating with the slot (152) and allowing when the latter is actuated spread the tabs (150).
12. Instrument chirurgical suivant la revendication 1 , caractérisé en ce que la poignée mobile (107) comporte une tête (110) présentant d'une part un premier profil en forme de fourche (111) constitué de branches (112) comportant chacune une extrémité libre (113) prévue pour coopérer avec le tube de poussée (103) et d'autre part un second profil en forme de fourche (157) constitué de branches (158) présentant chacune une extrémité libre (159) prévue pour coopérer avec la tige de préhension (104).12. Surgical instrument according to claim 1, characterized in that the movable handle (107) comprises a head (110) having on the one hand a first profile in the form of a fork (111) consisting of branches (112) each having one end free (113) provided to cooperate with the push tube (103) and on the other hand a second fork-shaped profile (157) consisting of branches (158) each having a free end (159) provided to cooperate with the rod gripping (104).
13. Instrument chirurgical suivant la revendication 9, caractérisé en ce que la tige de préhension (104) comporte entre le manchon (145) et la poignée de manipulation (143) un autre manchon (160) pourvu de deux logements parallèles (162) à profil rectangulaire.13. Surgical instrument according to claim 9, characterized in that the gripping rod (104) comprises between the sleeve (145) and the handling handle (143) another sleeve (160) provided with two parallel housings (162) with rectangular profile.
14. Instrument chirurgical suivant la revendication 13 caractérisé en ce que les logements (162) de l'autre manchon (160) de la tige de préhension (104) sont disposés dans un plan parallèle à celui contenant les logements (141) du manchon (140) du tube de poussée (103). 14. Surgical instrument according to claim 13 characterized in that the housings (162) of the other sleeve (160) of the gripping rod (104) are arranged in a plane parallel to that containing the housings (141) of the sleeve ( 140) of the push tube (103).
PCT/FR2004/003358 2003-12-23 2004-12-23 Surgical instrument that can be unclipped and is used for a spinal implant WO2005063135A1 (en)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
FR0315251A FR2863861B1 (en) 2003-12-23 2003-12-23 SURGICAL INSTRUMENT OF THE TYPE OF CLINKER FOR SPINAL IMPLANT.
FR0315251 2003-12-23
US10/899,026 2004-07-27
US10/899,026 US20050149048A1 (en) 2003-12-23 2004-07-27 Surgical instrument of the releaser type for a spinal implant

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US9486256B1 (en) 2013-03-15 2016-11-08 Nuvasive, Inc. Rod reduction assemblies and related methods
US10136927B1 (en) 2013-03-15 2018-11-27 Nuvasive, Inc. Rod reduction assemblies and related methods
CN112842415A (en) * 2015-10-09 2021-05-28 埃瓦尔维公司 Handle for a delivery catheter and method of using the same
US11051861B2 (en) 2018-06-13 2021-07-06 Nuvasive, Inc. Rod reduction assemblies and related methods

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WO1994010929A1 (en) * 1992-11-18 1994-05-26 Eurosurgical Rod attachment device for spinal orthopaedics
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Publication number Priority date Publication date Assignee Title
US9486256B1 (en) 2013-03-15 2016-11-08 Nuvasive, Inc. Rod reduction assemblies and related methods
US10136927B1 (en) 2013-03-15 2018-11-27 Nuvasive, Inc. Rod reduction assemblies and related methods
US10898241B2 (en) 2013-03-15 2021-01-26 Nuvasive, Inc. Rod reduction assemblies and related methods
US11660128B2 (en) 2013-03-15 2023-05-30 Nuvasive, Inc. Rod reduction assemblies and related methods
CN112842415A (en) * 2015-10-09 2021-05-28 埃瓦尔维公司 Handle for a delivery catheter and method of using the same
US11051861B2 (en) 2018-06-13 2021-07-06 Nuvasive, Inc. Rod reduction assemblies and related methods

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