surgical device

专利摘要:
CROSS-PINING DEVICES AND METHODS. The present invention provides methods and devices for implanting a transverse pin through a bone tunnel, such as in an arthroscopic surgical procedure. Generally speaking, methods and devices allow a hole in the transverse pin to be formed at a medial end of the knee bone. In one embodiment, a transverse pin guiding device is provided that can be configured to angularly position the transverse pin hole in relation to the bone tunnel to allow the transverse pin hole to cross the bone tunnel, without passing through the other side, by example, a lateral end, of the knee bone. The knee bone can be a femur or a tibia, so that the transverse hole in the pin and bone tunnel can each be entirely formed in the femur or tibia.
公开号:BR102012021435B1
申请号:R102012021435-0
申请日:2012-08-24
公开日:2021-01-12
发明作者:Jose E. Lizardi；Peter Reynaert；Stephen J. Orphanos；David Spenciner
申请人:Depuy Mitek, Inc.；
IPC主号:

专利说明:

[0001] [0001] The present invention relates generally to orthopedic methods and devices and, in particular, to methods and devices for use in arthroscopic repair of soft tissue injuries. BACKGROUND OF THE INVENTION
[0002] [0002] Joint injuries can usually result in total or partial rupture of ligaments, tendons and soft tissues of the bone. Tissue rupture can occur in many ways, for example, as a result of an accident, such as a fall, overexertion during work-related activities, during an athletic event, or in any of many other situations and / or activities. These types of injuries are usually the result of excessive stress or extraordinary forces that are exerted on the tissues.
[0003] [0003] In the case of a partial tear, commonly referred to by the general term "sprain", healing of the injury often happens without medical intervention, the patient rests and takes care not to expose the injury to undue strenuous activity during the healing process. If, however, the ligament or tendon is completely detached from its attachment site to an associated bone or bone, or if it is cut as a result of a traumatic injury, surgical intervention may be necessary to restore full function to the injured joint. Several conventional surgical procedures exist to fix these tendons and ligaments to the bone.
[0004] [0004] Such a procedure involves the formation of femoral and tibial tunnels aligned in a human knee, as in the repair of the damaged anterior cruciate ligament ("ACL" - anterior cruciate ligament). A bone block or anchor with a ligament graft attached to it is passed through the tunnels to a blind end of the femoral tunnel where the block or anchor is fixed in place. The ligament extends out of the tibial tunnel, and the end is attached to the tibial cortex by clamps or the like. Alternatively, the end of the ligament can be attached to the tibial tunnel by an anchor or by an interference screw. Various types of ligaments and / or suture anchors for fixing soft tissue to bone are well known in the art.
[0005] [0005] A method for anchoring bone blocks in bone tunnels is through transversal fixation, in which a transversal pin, such as a pin, screw, or nail is inserted in the bone, transversely to the bone tunnel, in order to cross the ligament graft and / or the bone block, to "cross-pin" the graft in the bone tunnel. The transverse pin is usually placed in a tunnel pre-drilled in the bone that is prepared using a drill guide.
[0006] [0006] Furthermore, considerations for transverse pinning of graft ligaments in the tibia differ from considerations for transverse pinning of graft ligaments in the femur. These considerations include differences in anatomical geometry, bone quality, and other considerations. These different needs usually result in the development and application of different transverse pinout guides for femoral and tibial transverse pinning, adding complexity and costs to performing tissue refixing surgeries, such as ACL replacement surgeries.
[0007] [0007] Consequently, there is a need for improved methods and devices for repairing ligaments and positioning and forming bone tunnels. SUMMARY OF THE INVENTION
[0008] [0008] In one embodiment, a transverse pinout guide device is provided that includes a structure that has a guide rod and a distal proximal arc spaced at a distance from the guide rod, a guide block slidably mounted on the arc distal proximal and having at least one orifice formed through it that is configured to receive a first surgical instrument, for example, a transverse pin, drill bit, etc., and a lateral medial arch having a first end with a locking mechanism coupling configured to detach the lateral medial arch to the guide block, and a second end having at least one orifice formed through it that is configured to receive a second surgical instrument, for example, a needle, a tunnel guide, etc.
[0009] [0009] The lateral medial arch and the guide block, and the respective holes formed through it, may have a variety of orientations in relation to each other when the lateral medial arch and the block are coupled together. For example, with the lateral medial arch attached to the guide block, the lateral medial arch can be positioned on a plane that is substantially perpendicular to the plane containing the distal proximal arch. In a further example, with the lateral medial arch coupled to the guide block, the at least one hole formed through the guide block can be coaxial with at least one hole formed through the second end of the lateral medial arch.
[0010] [00010] The at least one orifice formed through the guide block and the at least one orifice formed through the lateral medial arch can have a variety of configurations. In one embodiment, the at least one hole formed through the guide block can include first and second holes, and the at least one hole formed through the second end of the lateral medial arch can include third and fourth holes. With the lateral medial arch coupled to the guide block, the first hole can be coaxial to the third hole, and the second hole can be coaxial to the fourth hole. In another embodiment, the at least one orifice formed through the guide block can include first and second orifices, and the at least one orifice formed through the second end of the lateral medial arch can include a single orifice. With the lateral medial arch coupled to the guide block, a longitudinal axis of the single hole can be parallel and positioned between longitudinal axes of the first and second holes.
[0011] [00011] The engagement mechanism of the lateral medial arch can be coupled to the guide block in a first orientation in relation to the guide block and in a second orientation in relation to the guide block that differs from the first orientation. With the lateral medial arch coupled to the guide block, the lateral medial arch in the first orientation can be housed in a first hole formed in the guide block, and in the second orientation it can be housed in a second hole formed in the block.
[0012] [00012] In other respects, with the guide block in any sliding position along the distal proximal arc, a longitudinal axis of at least one hole formed through the guide block can extend through an opening formed in a distal portion of the guide rod. With the lateral medial arch coupled to the guide block, a longitudinal axis of at least one hole formed through the second end of the lateral medial arch can extend through the opening formed in the distal portion of the guide rod.
[0013] [00013] The structure can also have a variety of configurations. In an exemplary embodiment, the distal proximal arch can extend in a direction substantially parallel to the direction of the guide rod.
[0014] [00014] In another aspect, a method is provided for the implantation of a transverse pin through a bone tunnel that includes the positioning of a guide block of a transverse pinout guide device on a medial side of a knee bone, for example example, a femur or tibia, the placement of a needle guide of the transverse pinout device on a lateral side of the knee bone, and the adjustment of a hole path that extends through the guide block based on a depth of insertion of a needle inserted through a hole in the needle guide and into the tissue on the side of the knee bone.
[0015] [00015] The path of the hole that extends through the guide block can be adjusted in a variety of ways. For example, adjusting the path of the hole extending through the guide block may include rotating the transverse pinning guide device in relation to the knee bone about a longitudinal axis of a bone tunnel formed in the knee bone. In another example, the guide block can be coupled to the distal proximal structure of the transverse pinout guide device, and adjusting the path of the hole extending through the guide block may include sliding the guide block along the proximal structure. distal. In yet another example, the path can be adjusted based on a first distance between a mark on the needle positioned lateral to the hole in the needle guide and a side face of the needle guide. The first distance can be equal to or less than a second distance between a bony surface on the lateral side of the knee bone and a lateral terminal end of a lateral medial bone tunnel formed in the knee bone.
[0016] [00016] Before adjusting the path of the hole that extends through the guide block, the needle can be inserted through the hole in the needle guide and into the tissue on the side of the knee bone until a distal end of the needle is contiguous with an external surface of the knee bone. Before positioning the guide block and before adjusting the path of the hole extending through the guide block, a first end of a lateral medial arch of the cross-pin guide device can be attached to the guide block, a second end of the lateral medial arch includes the needle guide. After adjusting the path of the hole that extends through the guide block, a transverse pin can be advanced through the hole that extends through the guide block and into a lateral medial bone tunnel that extends into the side medial of the knee bone, so that the transverse pin crosses a near-distal bone tunnel formed in the knee bone.
[0017] [00017] The method can vary in any other number of ways. The method may include the insertion of a guide rod coupled to the guide block in a bone tunnel formed in the knee bone, and, with the guide rod inserted in the bone tunnel, rotating the transverse pin guide device about an axis longitudinal of the bone tunnel. The method may include determining the depth of insertion of the needle based on a position of a mark on the needle relative to the hole in the needle guide.
[0018] [00018] In another modality, a surgical method is provided that includes the preparation of a femoral tunnel using an anteromedial approach through an articular space between a femur and a tibia and into the femur, the insertion of a stem- femoral guide of a guide system into the femoral tunnel, the positioning of a structure that extends from the femoral guide rod on a medial side of the femur, the positioning of a needle guide in a measurement set coupled to the structure in a lateral side of the femur, the insertion of a needle through the needle guide and through the tissue to contact a lateral surface of the femur, the needle having a depth indicator that indicates a distance between the lateral surface of the femur and a location of destination of a distal end of a transverse pin to be implanted in the femur, the adjustment of a trajectory of at least one orifice that extends through a block mounted on an arch of the structure, the advance of and a drill through at least one hole in the guide block and to the medial side of the femur to form a pilot hole in the medial side of the femur that crosses the femoral tunnel, the placement of a ligament graft within the femoral tunnel, and application of a transverse pin through the pilot orifice in such a way that the transverse pin engages the ligament graft, to thereby secure the ligament graft within the femoral tunnel. BRIEF DESCRIPTION OF THE DRAWINGS
[0019] [00019] The attached drawings have been included in the present invention so that the characteristics, advantages and objects mentioned above will become clear and can be understood in detail. These drawings form a part of the specification. It should be noted, however, that the attached drawings illustrate exemplary modalities and should not be considered as limiting the scope.
[0020] [00020] Figure 1 is a perspective view of an embodiment of a transverse pinout guide device that includes a frame, a guide block attached to the frame, and a lateral medial arch attached to the guide block, with two needles inserted through one end of the lateral medial arch; figure 2 is a perspective view of the structure and guide block of figure 1; figure 3 is a top perspective view of another embodiment of a structure and the guide block, with an adapter coupled to the structure, and with drills and drill sleeves inserted through the guide block; Figure 4 is a bottom perspective view of the structure, guide block, adapter, drills, and drill gloves in Figure 3; figure 5 is a bottom perspective view of the structure and guide block of figure 1, with drills and drill sleeves inserted through the guide block; figure 6 is a top perspective view of the structure, guide block, and adapter of figure 5; Figure 7 is a side view of a drill sleeve embodiment and a drill embodiment configured to be inserted through the drill sleeve; figure 8 is a top proximal view of the drill sleeve in figure 7; figure 9 is a perspective view of another embodiment of a drill sleeve with the drill of figure 7 inserted through it; figure 10 is a side view of an additional embodiment of a drill sleeve; figure 11 is another side view of the drill sleeve in figure 10; figure 12 is a side view of a distal end of the drill sleeve of figures 10 and 11; figure 13 is a side view of an embodiment of an insertion tool and an embodiment of a cross pin configured to be inserted into a patient using the insertion tool; figure 14 is a perspective view of the lateral medial arch of figure 1; figure 15 is a perspective view of the structure and guide block of figure 1, and another embodiment of a lateral medial arch configured to couple with the guide block; figure 16 is a perspective view of another embodiment of a lateral medial arch; figure 17 is a perspective view of another guide block configured to be coupled to the lateral medial arch of figure 16, the guide block being coupled to a distal proximal arch of a structure; figure 18 is a perspective view of one of the needles of figure 1 inserted through the end of the lateral medial arch; figure 19 is a perspective view of another embodiment of an end of a lateral medial arch that has a single orifice formed through it; figure 20 is a perspective view of a guide rod of the structure of figure 1 inserted into a bone tunnel formed in a femur; figure 21 is a perspective view of a guide rod of figure 20 inserted into the bone tunnel and the lateral medial arch of figure 1, the lateral medial arch not being coupled to the guide block and no needles inserted through the same; figure 22 is a perspective view of another end of the lateral medial arch of figure 21 coupled to the guide block, which is coupled to the structure; figure 23 is a perspective view of the lateral medial arch, guide block, and structure of figure 22 with the needles of figure 1 inserted through the end of the lateral medial arch; figure 24 is a schematic view of one of the needles of figure 23 inserted through the lateral medial arch and inserted through the tissue of a patient to be in a borderline position with the lateral surface of the femur; figure 25 is another schematic view of one of the needles of figure 23 inserted through the lateral medial arch and inserted into a patient's tissue to be in a borderline position in relation to the lateral surface of the femur; figure 26 is a perspective view of the lateral medial arch, guide block, structure, and needles of figure 23 with the drill bits and gloves of figures 4 and 5 inserted through the guide block and into the femur; and figure 27 is a perspective view of a depth indicator in a claw configuration coupled to the insertion tools of figure 13 inserted through the guide block in figure 1. DETAILED DESCRIPTION
[0021] [00021] Certain exemplary modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods described here. One or more examples of three modalities are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described and illustrated in the accompanying drawings are exemplary non-limiting embodiments, and that the scope of the present invention is defined only by the claims. The aspects illustrated or described in connection with an exemplary modality can be combined with the aspects of other modalities. These modifications and variations are intended to be included in the scope of this application.
[0022] [00022] Various methods and exemplifying devices are presented in the present invention for implanting a transverse pin through a bone tunnel, such as in an arthroscopic surgical procedure. In general, the methods and devices allow a hole in the transverse pin to be formed on a medial side of the knee bone, such that it crosses a bony tunnel formed in the knee bone. In an exemplary embodiment, a transverse pin guiding device is provided that can be configured to position the transverse pin hole angled with respect to the bone tunnel to allow the transverse pin hole to cross the bone tunnel without passing through the other side, for example. example, a lateral side, thereby reducing knee trauma and facilitating healing. The knee bone can be either a femur or a tibia, so that the transverse hole in the pin and bone tunnel can each be entirely formed in the femur or tibia. The methods and devices can reduce the chances of damaging the bone during the surgical procedure, because there is no need to drill both the tibia and the femur to form a bone tunnel and / or a transverse pin hole in each of the tibia and the femur . Bearing in mind that the bone tunnel and the transverse pin hole can each be entirely formed in the knee bone itself, for example, in one of the femur and tibia, surgical instruments do not need to be passed through much, if any, cartilage located between the femur and the tibia, thus reducing the chances of damaging delicate cartilage during the surgical procedure.
[0023] [00023] Figure 1 illustrates an exemplary embodiment of a transverse pinout guiding device 100 configured to assist the transverse pinning of a ligament graft in a bone tunnel, for example, a femoral tunnel or a tibial tunnel. The device 100 may include a structure 102 having a guide rod 104 and a distal proximal arch 106, referred to in the present invention as "distal proximal arch" or "first arch," spaced at a distance from the guide rod 104. The device 100 can also include a guide block 108 and a lateral medial arch 110. The guide block 108 can be configured to slip-fit to frame 102, for example, to the first arch 106, as shown in Figure 1, in a way that the guide block 108 can slide in a way along the frame 102, for example, along the first arc 106, with respect to it. Guide block 108 can be configured to be locked in a selected position along the first arc 106, such as with a first thumbscrew 112, as will be discussed below. The lateral medial arch 110, hereinafter referred to as "lateral medial arch" or "second arch", can be configured to detachably engage the guide block 108 in such a way that the first arch 106 can be positioned in a foreground, and according to the arc 110 it can be positioned in a second plane substantially perpendicular to the first plane, as illustrated in figure 1 with the second arc 110 coupled to the structure 102. Figure 1 shows the second arc 110 coupled to the structure 102 in the guide block 108, which is shown in figure 1 slidably coupled and locked along the first arch 106 of structure 102. Figure 2 shows the guide block 108 slidably coupled and unlocked along structure 102 without the second arch 110 being coupled to structure 102.
[0024] [00024] Structure 102 can have a variety of configurations. As in the illustrated embodiment, structure 102 may include stalk 104, an L-shaped member that has a base portion 114, and an arm portion 116 that extends transversely, for example, substantially perpendicular to the base portion 114. The end end of the base portion 114 can be configured to mate with a terminal end of the guide rod 104, and the arm portion 16 can be configured to mate with the guide block 108.
[0025] [00025] As in the illustrated embodiment, the guide rod 104 may include a substantially cylindrical rod having an opening 118 formed in the distal portion thereof. Aperture 118 may, as in the illustrated embodiment, extend across opposite sides of stalk 104, although in some embodiments, aperture 118 may be formed as a blind hole partially formed through guide rod 104. Aperture 118 may be at shaped like an elongated slit and can have any longitudinal length along the longitudinal length of the guide rod. The guide rod 104 can be a solid member, or cannulate along its longitudinal length. The cannulation of the guide rod 104 may allow the placement of the guide rod 104 on a guide wire (not shown). Although a distal end 104d of the guide rod 104 is rounded in the illustrated embodiment, the distal end 104d can have a variety of shapes, for example, conical, flat or planar, chamfered, etc. A stalk 204 of figures 3 and 4, discussed in more detail below, includes a chamfered distal end.
[0026] [00026] The guide rod 104 can be configured to couple with the base portion 114 of the structure 102 so that, as shown in figure 1, the opening of the guide rod 118 is spaced a certain distance from the base portion 114 along the longitudinal length of the guide rod 104, the guide rod 104 is spaced at a distance from the arm portion 116 of the frame 102, and the first arc 106 extends in the direction substantially parallel to the direction of the guide rod 104. With the guide rod 104 coupled to the base portion 114, as shown in figure 1, the opening 118 can be oriented with respect to the base portion 114 so that an axis 118A that passes inwardly or through the opening 118 is substantially parallel to the base portion 114 and substantially perpendicular to the arm portion 114.
[0027] [00027] In an exemplary embodiment, the guide rod 104 can be configured to be detachably coupled to the base portion 114 of structure 102 by coupling a proximal end 104p of the guide rod 104 to an end of a portion of base 114, for example, by inserting the proximal end 104p of the guide rod 104 into the corresponding hole 122 formed in the base portion 114. The guide rod 104 can be configured to be locked in a coupled position with respect to the base portion 114, for example, by pressure fitting, attachable threads, a second thumbscrew 120 as shown, etc. The guide rod 104 and the base portion 114 can be configured to be attachable in a predetermined orientation in relation to the other, for example, through visual introduction, marking, etc., to facilitate the correct orientation of the bar opening guide 118 in relation to the arm portion 116, when the guide rod 104 is coupled to the base portion 114. Providing a detachable guide rod can facilitate cleaning of the guide rod 104 and frame 102. Frame 102 can be provided as part of a kit that includes detachable guide rod 104 as one of a plurality of guide rods, each configured to detachably couple to frame 102. The plurality of guide rods can have a variety of lengths longitudinal and diameters to accommodate various patient graft dimensions and anatomies. In some embodiments, the proximal end of the guide rod 104 can be non-removably attached to the end of the base portion 114. If the guide rod 104 is non-removably attached to the frame 102, the frame 102 can be supplied as part of a kit that includes a plurality of structures, each structure having guide rods of different sizes coupled in a non-removable way.
[0028] [00028] The guide rod 104 as illustrated in the embodiment of figure 1, is coupled to the base portion 114, as a femoral guide rod configured to be inserted into the bone tunnel formed in a femur, as discussed in more detail below. The guide rod 104 can also be coupled to the base portion 114 as a tibial stubble configured to be advanced into a bone tunnel formed in a tibia. However, due to differences in femoral and tibial anatomy, the coupling of the guide rod 104 directly to the base portion 114, as shown in figure 1, may present difficulties in orienting the structure 102 properly in relation to the tibia if the surgical procedure involves formation of a bone tunnel in the tibia into which the guide rod 104 is to be inserted. Figures 3 and 4 illustrate a guide rod 204 coupled to the base portion 214 of a structure 204, through an adapter 201. A proximal end of the adapter 201 can be configured to detachably engage with or be integrally formed with a end of the base portion 214, and a proximal end of the guide rod 204 can be configured to peel off or be integrally formed with a distal end of adapter 201. In this way, adapter 201 can allow the same portion of base 214 and the same guide rod 204 are used if a bone tunnel is being formed in the femur (without using the 201 adapter) or in the tibia (using the 201 adapter), which can reduce several stems and / or portions of base that need to be provided as part of a surgical kit.
[0029] [00029] Referring again to Figures 1 and 2, the arm portion 116 may include a proximal portion that extends from the base portion 114, and a distal portion that includes the first arch 106. The first arch 106 may have a arcuate shape that has a concave inner surface facing the guide rod 104, when the guide rod 104 is coupled to the base portion 114, such that the first arc 106 can arch at its terminal end in one direction D facing the guide rod 104. As in the illustrated embodiment, the first arc 106 may include a regulated scale, for example, a plurality of angle degree marks 126, over at least a portion of its longitudinal length. The marks 126 can facilitate the precise positioning of the guide block 108 along the first arc 106, as discussed in more detail below. Although the 126 marks in the illustrated modality are in five degree increments from -25 degrees to 25 degrees, the 126 marks can cover any range and can have any increment. The first arch 126 may include the marks 126 on opposite sides thereof, as shown in the embodiment of figures 1 and 2, which can facilitate the use of structure 102 with both the right and left knees.
[0030] [00030] The arm portion 116 may include one or more holes 116h formed therein, as in the illustrated embodiment. Orifices 116h can be used to optimize the visibility of a surgical site, assist in gripping structure 102, and / or help reduce the weight of structure 102, which can help make structure 102 easy to transport and use during surgical procedure. In addition or as an alternative to the arm holes 116h, the base portion 114 can include one or more holes formed therein.
[0031] [00031] As will be shown in figures 1 and 2, the first arch 124 can have a groove 128 formed therein, which can facilitate smooth sliding of the guide block 108 along the first arch 106. The groove 128 can be formed on one of the opposite sides of the first arc 106, for example, on one of the sides including the marks 126, although any side (s) of the first arc 106 may have a groove. In addition or as an alternative to the groove 128, the first arc 106 may include an opening or longitudinal slit 124 formed therein and extending through both opposite surfaces thereof. As in the illustrated embodiment, the slot 124 can be formed in a portion of the groove 128. The groove 128 and the slot 124 can be configured to facilitate the slide of the guide block 108 along the first arch 106 and lock the guide block 108 in relation to it, as discussed in more detail below.
[0032] [00032] Guide block 108 can have a variety of configurations. Guide block 108 can be configured to be slidably and detachable to frame 102, or, as in this illustrated embodiment, guide block 108 can be configured to be slidably and non-removable to frame 102, for example , to the first arc 106. Groove 128 and slot 124 can be configured as guide paths for guide block 108 along the first arc 106 to facilitate smooth sliding thereof. Guide block 108 can be configured to selectively slide near and distally along the first arch 106. As mentioned above, guide block 108 can be locked in a specific position along the first arch 106. The first thumbscrew 112 can be configured to move between a unscrewed configuration, in which the guide block 108 can slide along the first arc 106, and a screwed configuration, in which the guide block 108 is locked in the specific position along the first arc 106 and cannot slide along the first arc 106. In use, as will be discussed in more detail below, when the guide block 108 is in a desired position along the first arc 108, for example, at an angular orientation desired, as indicated by marks 126, the first screw 112 can be moved from the unscrewed configuration to the screwed configuration to lock the position of the guide block. The first screw 112 can move between unscrewed and screwed configurations any number of times during a surgical procedure. Similarly, the guide block 108 can be slid any number of times and any distance proximally and / or distally along the first arc 106.
[0033] [00033] Guide block 108 can have at least one hole formed through it that is configured to receive an instrument, for example, a cross pin, a drill, a drill sleeve, configured to receive a drill, etc. In an exemplary embodiment, the longitudinal axes of each of the one or more holes can be parallel to each other to allow instruments that are inserted through it to be parallel to each other. Each of the one or more holes can be formed longitudinally through the guide block 108 such that when the guide block 108 is coupled to the first arc 106, the longitudinal axes of each of the holes can be substantially perpendicular to a longitudinal axis of the arm portion 116. In the illustrated embodiment, the block 108 has first and second holes 130, 132 formed through it. As in the illustrated embodiment, the first and second holes 130, 132 can be spaced equidistant from a horizontal center H1 of the guide block 108. In another embodiment, the first and second holes 130, 132 can additionally or alternatively be vertically centered on the guide block. The illustrated holes 130, 132 are cylindrical, but the holes 130, 132 can be of any shape. As shown in figure 2, with the guide rod 104 coupled to the base portion 114, the first and second holes 130, 132 can have first and second longitudinal axis 130A, 132A, respectively, which are parallel to each other and which pass through opening 118 of the guide rod 104. In this way, the first and second instruments inserted through the first and second holes 130, 132, respectively, can be parallel to each other and can cross the opening of the guide rod 118, ensuring, d this way, that the instruments inserted through the holes 130, 132 towards the stent 104 can pass through the opening 118. Regardless of the location of the guide block 104 along the first arch 106, the guide block 108 can be configured that the first and second longitudinal axis 130A, 132A always pass through the opening 118 of the guide rod 104.
[0034] [00034] As shown, for example, in figures 5 and 6, the first and second drills 134, 136 can be inserted through the first and second holes 130, 132, respectively, to cross the opening of the guide rod 118. The first and second drills 134, 136 can have a variety of configurations. In general, the first and second drills 134, 136 can be substantially rigid members and can be configured to form bone tunnels in the bone when inserted into it. As illustrated, the first and second drills 134, 136 can have sharp points 134t, 136t to penetrate and / or cut the bone. As also shown in figure 7, the first and second drills 134, 136 can include first and second pins extending transversely 135, 137, respectively, extending from the rods thereof. The first and second pins 135, 137 can be positioned anywhere along the longitudinal lengths of drill bits 134, 136, but in an exemplary embodiment, pins 135, 137 are located in proximal portions of drill bits 134, 136 at a distal distance of the most proximal ends 134p, 136p of drill bits 134, 136, for example, a first distance 135D from the first drill 134 shown in figure 7. Although pins 135, 137 can extend in one direction from the sides of drill bits 134 , 136, in an exemplary embodiment, pins 135, 137 can extend from two sides of the bits 134, 136, as in the illustrated embodiment. Pins 135, 137 can be formed in any way, such as each including two pin extensions on opposite sides of the drills, or each including a single pin that extends through the drills from opposite sides of the drills.
[0035] [00035] The first and second drills 134, 136 are shown in figures 5 and 6 as being respectively arranged in the first and second drill sleeves 138, 140 inserted through the first and second holes 130, 132 of the guide block 108 before the arrangement of drills 134, 136 in sleeves 138, 140. However, one or both of the first and second drills 134, 136 can be inserted directly through the first and second holes 130, 132, respectively, for example, without drill sleeves. Additionally, although two drills 134, 136 are illustrated in figures 5 and 6 as being inserted through the guide block 108, in some embodiments, only one drill can be inserted through one of the holes 130, 132 of the guide block, so forming only a bone tunnel.
[0036] [00036] Drill sleeves 138, 140 can also have a variety of configurations. As in the illustrated embodiment, each of the drill sleeves 138, 140 may be substantially rigid members and may include cannulated rods configured to receive an instrument, for example, a drill, in them. Drill sleeves 138, 140 and drills 134, 136 can have any longitudinal lengths. In an exemplary embodiment, drills 134, 136 have longitudinal lengths greater than their respective drill sleeves 134, so that, as shown in figures 5 and 6, drills 134, 136 can be received within their respective drill sleeves 138 , 140 and have portions that extend beyond both ends of drill sleeve 138, 140. In other words, when drill bits 134, 136 are inserted through sleeves 138, 140, distal tips 134t, 136t can be positioned in distal position beyond the most distal ends of the gloves 138, 140, and the most proximal ends 134p, 136p of the drills can be positioned proximally beyond the most proximal ends of the gloves 138, 140. When inserted through the holes 134, 136, the drill 138, 140 can be configured to be axially and rotatably movable in their respective holes 134, 136.
[0037] [00037] As shown in figures 5 to 8, the first and second drill sleeves 138, 140 can include first and second proximal collar portions 142, 144, which respectively have the first and second grooves 145, 147 that extend, diametric and respectively, formed in it. The first and second grooves 145, 147 can be configured to receive the first and second drill bits 135, 137, respectively. When the first and second drills 134, 136 are inserted into drill sleeves 138, 140 respectively, the first and second drills 134, 136 can be advanced distally there, until the first and second pins 135, 137 are respectively housed in the first and second grooves 145, 147, as shown in figures 5 and 6. Thus, the axial movement of one or both drills 134, 136 in a distal direction can cause the corresponding axial movement in your drill sleeves 138, 140 related. Similarly, the rotational movement of one or both drills 134, 136 around its longitudinal axis can cause the corresponding rotational movement of its related drill sleeves 138, 140. Such a cooperative movement of drills 134, 136 and drill sleeves 138, 140 can facilitate the formation of bone tunnels. As discussed in more detail below, in an exemplary embodiment, at least drills 134, 136, and if not also drilling gloves 138, 140, can be drilled into the bone far enough to enter the opening of the guide rod 118 already positioned in a bone tunnel formed in the bone.
[0038] [00038] In another embodiment, a proximal collar portion of a drill sleeve can include at least one contact surface configured to fit a drill pin. In an exemplary embodiment illustrated in Figure 9, drill sleeve 138 'may include a proximal collar portion 142' that has two opposing contact surfaces 143, each configured to connect a pin extending from a drill, for example. For example, pin 135 extending from opposite sides of first drill 134. Thus, when drill 134 is inserted through drill sleeve 138 'so that pin 135 engages contact surfaces 143, axial movement of drill 134 in a distal direction can cause corresponding axial movement in drill sleeve 138 ', and rotation movement of drill 134 clockwise around its longitudinal axis can cause corresponding rotation movement of drill sleeve 138' in the direction time. The drill sleeve 138 'is configured to respond to the rotational movement of the drill 134 in a clockwise direction, the proximal collar portion 142' can be similarly configured to respond to the counterclockwise rotational movement.
[0039] [00039] The distal ends of the sleeves 138, 140 may include flat tips, as shown in figures 5 to 7. However, one or all drill sleeves 138, 140 may have other distal end configurations, such as round or tapered. In an exemplary embodiment, the drill sleeves inserted through the holes in the guide block 130, 132 can have distal ends that include one or more bead teeth. The cutting teeth can be configured to enhance the cutting performance of the drill sleeve and reduce the axial force required for cutting, such as when creating a bone tunnel. Figures 10 to 12 illustrate an embodiment of a drill sleeve 338 that includes a cutting tooth 339, although, as mentioned above, the drill sleeve 338 may include a plurality of teeth. The tooth 339 can extend distally from the drill sleeve 338, so that a more distal edge 338d of the drill sleeve 338 can be asymmetrical about its longitudinal axis 338A, as shown in Figure 12. distal 338d of drill sleeve 338 can be hinged at an angle α, for example, about 5 degrees, and can be sharpened all the way around, which can facilitate cutting.
[0040] [00040] One or all drill sleeves 138, 140 may have a lubricating coating on their outer surface, inner surface, and / or on any other portions of drill sleeves 138, 140. The lubricated coating may be formed on the drill gloves in any way, such as by fully immersing the drill gloves in a validated siliconization process. The lubricated coating can help facilitate the drilling of smooth bone holes, facilitate the removal of the bone glove, reduce heat generation during drilling, and / or reduce the potential for seizure between the bone and the glove, between the glove and an instrument inserted through the guide e, and between the sleeve and the guide block. The coating can include any lubricated biocompatible coating, but in an exemplary embodiment, the coating can include Dow Corning® 630 Fluid Medical, available from Dow Corning Corporation, of Midland, MI, USA.
[0041] [00041] As mentioned above, the first and second holes 130, 132 can be configured to receive instruments other than drills and drill sleeves, such as cross pins. The cross pins can have a variety of configurations, and can be inserted into the patient in any way. The transverse pins can be formed from one or more materials, such as a polymeric, a bioceramic, a composite, a non-absorbent material, etc. In an exemplary embodiment, the cross pins are formed from a bioabsorbent material, for example, poly (lactic acid) with calcium triphosphate and lactide and glycolide copolymer (poly (lactide-co-glycolide)) with calcium triphosphate. An exemplary embodiment of a cross pin 146 is illustrated in figure 13.
[0042] [00042] The cross pins can be inserted directly through holes 130, 132, but in an exemplary embodiment, the cross pins can be inserted through insertion tools inserted through holes 130, 132. The insertion tools can be directly inserted through holes 130, 132, or similar to drills 134, 136, can be inserted through gloves, for example drill bits 138, 140, inserted through holes 130, 132. Insertion tools can have a variety of settings. Figure 13 illustrates an exemplary embodiment of this insertion tool 148 configured to be inserted slidably through one of the holes 130, 132 and to have the transverse pin 146 advanced through them. The insertion tool 148 can have a cross pin insertion tip 148i, a handle 148h that can be hit with a hammer for insertion of the transverse pin 146 through it, and an inlet diameter 148s to control the depth of the pin insertion transversal 146.
[0043] [00043] Although figures 3 and 4 show drill sleeves 138, 140 and drills 134, 136 inserted through the holes in the block guides 130, 132, without the lateral medial arch or second arch 110 being attached to the guide block 108 (figures 5 and 6 similarly illustrate drill sleeves and drills inserted through holes in a guide block), drill sleeves 138, 140, drills 134, 136, and / or any other instruments can be inserted through the holes in the guide block 130, 132 with the second arch 110 attached to the guide block 108. In other words, when the second arch 110 is coupled to the guide block 108, the second arch 110 will not obstruct the holes 130, 132. In this way, the guide block 108 and the holes in the guide blocks 130, 132 can cooperate with the second arc 110 to facilitate transverse pinning.
[0044] [00044] The second arc 110 can have a variety of configurations. In the embodiment illustrated in figure 1, the second arc 110, also shown in figure 14, can include a first end 110a and a second end 110b with an arcuate portion 110c extending between them. The arcuate portion 110c can be a solid member, as shown in the embodiment of figure 1, or it can be at least partially hollow and / or include one or more holes formed therein. Figure 15 illustrates an embodiment of a lateral medial arch or second arch 410 that includes a first end 410a and a second end 410b with an arcuate portion 410c extending between them and having a plurality of holes 410h formed therein. Similar to the holes 116h of the arm portion 116 discussed above, the holes 410h of the arcuate portion 410 can be used to optimize the visibility of a surgical site, helping to grip the arcuate portion 410, and / or helping to reduce the weight of the arcuate portion 410.
[0045] [00045] Referring again to Figures 1 and 14, the first end 110a of the second arc 110 can be configured in a variety of ways to detachably couple to block 108. In general, the second arc 110 can include a locking mechanism hitch configured to detachably couple the second arc 110 to the guide block 108. As in the illustrated embodiment, the engagement mechanism of the second arch may include at least one track, for example, first, second, third, and fourth tracks 158a, 158b, 158c, 158d formed at the first end 110a, which is configured to slide guide guide 108 slidably. The at least one track can be configured to slide at least one guide block track 108, or, as in the illustrated embodiment, the four tracks 158a, 158b, 158c, 158d can be configured to seat the four corner edges of the substantially rectangular guide block 108, in order to seat the guide block 108 on tracks 158a, 158b, 158c, 158d. In another embodiment, the second arch can include at least one rail configured to fit at least one track of the guide block.
[0046] [00046] With the second coupling mechanism interconnected to the guide block 108, the second arch 110 can be configured to be locked in a fixed position in relation to it. The second arc 110 can lock the guide block 108 in a variety of ways, such as by press fit, plug-in threads, a pressable button, etc. As in the illustrated embodiment, the first end 110a of the second arc 110 can include a third screw 160 configured to be pushed and / or threaded into a corresponding hole 162 formed in the guide block 108, shown in figure 2, to lock the second arc 110 in a fixed non-sliding position in relation to block 108.
[0047] [00047] Another embodiment of a latching mechanism configured to detachably couple a lateral medial arch or second arch to the guide block includes a male member at the first end of the second arch. The male member can be configured to be received in a female member formed in the guide block. With the male member of the second arc housed in the female member of the guide block, the second arc can be configured to be locked in a fixed position in relation to it. The second arc can lock the guide block in a variety of ways, such as by press fit, plug-in threads, a pressable button, etc. Figure 16 shows an embodiment of a latching mechanism in the form of a male member 159 at a first end 110a 'of a lateral medial arch or a second arch 110'. The male member 159 can be configured to be received in the female member formed in a guide block. With the male member of the second arch 159 housed in a female member of the guide block, the second arch 110 'can be configured to be locked in a fixed position with respect to it, as by the use of a pressable protrusion 161 configured to be engaged , as by removable pressure fitting, a corresponding depression or hole formed in the guide block.
[0048] [00048] The guide block may include one or more female members, each configured to receive a male member from a second arc. In an exemplary embodiment, the guide block may include two female members, each coded to receive a male member from a correspondingly coded second arc. Coding can prevent the second arc from connecting to the guide block in an incorrect orientation. In addition or as an alternative to coding, the male and female members can be otherwise configured to be specifically related to each other, as by visual marking. In this way, a structure that has the guide block attached to it can be used for both the right and left knees, with a female member being configured to receive a male element from a second arch for use on the left knee, and the other member female being configured to receive another male element from a second arch for use on the right knee. Figure 17 illustrates an embodiment of a guide block 108 'coupled to a proximal-lateral arch or first arch 106' and which includes the first and second female members 161a, 161b. Each of the female members 161a, 161b can, as shown in this embodiment, be encoded. One of the female members 161a, 161b, for example, the first female member or female member on the left side 161a, can be inserted to receive a male member of a second arch configured for use on the left knee, and the other of the female members 161a, 161b, for example, the first female member or the left female member 161b, can be inserted to receive another male member from another second arch, for example, the second arch 110 'of figure 16 (its main feature is obscured in the wider concealed side of male member 159), configured for use on the right knee. Each of the female members 161a, 161b in this illustrated embodiment also includes a hole 163A, 163B formed in a wall of the guide block 108 ', which can be configured to receive a corresponding protrusion from a male member to release the male element releasably. inside.
[0049] [00049] Referring again to the embodiment of figure 1, a needle guide can be at the second end 110b of the second arc 110, also illustrated in figure 18, and with at least one hole, for example, first and second holes 150, 152 , formed through it. As in the illustrated embodiment, the first and second holes 150, 152 can be spaced equidistantly from a horizontal center of the H2 of the second end 110b and can be vertically centered V2 on the second end 110b. The illustrated holes 150, 152 are cylindrical, but the holes 150, 152 can be of any shape. As in the illustrated embodiment, with the guide rod 104 coupled to the base portion 114, the first and second holes 150, 152 can have first and second longitudinal axes 150A, 152A, respectively, which are parallel to each other and which pass through opening 118 of the guide rod 104. In this way, the first and second instruments, for example, the first and second needles 154, 156, inserted through the first and second holes 150, 152, respectively, can be parallel to each other and have longitudinal axes aligned with the axes of the holes 150A, 152A that cross the openings of the guide rod 118. Regardless of the location of the guide block 104 along the first arch 106, the second arch 110 can be configured in such a way that, when it is coupled to the guide block 108, the holes in the second arc 150, 152 can be coaxial with the holes in the guide block 130, 132, for example, first and second longitudinal axes of the holes in the first and second arches 150A, 1 52A can be the same as the first and second longitudinal axes of the guide block 130A, 132A. The first and second longitudinal axes of the holes in the second arc 150A, 152A can therefore also pass through the opening of the guide rod 118 when the second arc 110 is coupled to the guide block 108.
[0050] [00050] In another embodiment illustrated in figure 19, a lateral medial arch or second arch 510 may include a second end 510b that has only an orifice 550 formed through it. As in the illustrated embodiment, the single orifice 550 can be a central orifice centered at the second end horizontally H and vertically V of the second arc. Similar to the modality of figures 1 and 16, when the first end (not shown) of the second arc 510 is detachably coupled to the guide block (not shown), Regardless of a location of the guide block along a first arc of a structure (not shown), the second arc 510 can be configured so that a longitudinal axis 550A of the single orifice 550 can pass through the distal opening (not shown) of a guide rod of the structure. The longitudinal axis of the single orifice 550A can be aligned with respect to longitudinal axes of the first and second orifices formed through the guide block, so that the longitudinal axis of the single orifice 550A can be parallel to the longitudinal axes of the first and second orifices and be positioned between them.
[0051] [00051] As mentioned above, each of the holes 150, 152 of figures 1, 14, and of mode 18, as well as hole 550 of the mode of figure 19, can be configured to have an instrument like an advanced needle through it , for example, needles 154, 156. Needles 154, 156 can have a variety of configurations. In an exemplary embodiment, needles 154, 156 can each be substantially rigid members and include an elongated stem 154s, 156s extending distally from the proximal collar 154c, 156c. Each of the elongated rods 154s, 156s may include a depth indicator 154i, 156i in proximal portions thereof. The depth indicators 154i, 156i can have a variety of configurations, such as one or more marks on each of the 154s, 156s rods. The marks can be visual marks, for example, lines, colors, lights, etc., and / or tactile marks, for example, grooves, etc. Generally, because the distance between the ends 110a, 110b of the second arc 110 is fixed, because the longitudinal lengths of the 154 needles, 156 are fixed and because the longitudinal lengths of the bits 134, 136, respectively, are inserted through of the holes in the guide block 130, 132, are known and can be inserted in a predetermined position, for example, by inserting the bits 134, 136 through the holes 130, 132 until the proximal collar portions 142, 144 are in a borderline position with the guide block 108, the depth indicators 154i, 156i can be positioned along the respective longitudinal lengths of their needles, in order to be shown how deep the knee bone the drill bits 134, 136 would penetrate with guide block 108 in its current position along the first arc 106. In other words, depth indicators 154i, 156i can be configured to assist in inserting brocades the 134, 136, and subsequently, of the transverse pins on the medial side of the knee bone and having the distal ends of the same positioned on it, for example, without passing out of the lateral surface of the knee bone and with sufficient bone stock in the direction to the side of the knee bone to allow mechanical fixation of transverse pins there. The location of the depth indicators 154i, 156i along the longitudinal lengths of their respective needles 154, 156 can be the same for each of the depth indicators 154i, 156i, for example, each positioned on a quarter mark, from so that 25% of the longitudinal length of the needle is on one side of the depth indicator and 75% of the longitudinal length of the needle is on the other side of the depth indicator.
[0052] [00052] The elongated rods of needles 154s, 156s can have smaller diameters than holes 150, 152, while proximal collars 154c, 156c can have diameters, at least at the distal ends thereof, which are larger than the diameters of holes 150, 152. In this way, proximal collars 154c, 156c can be configured to prevent needles 154, 156 from being inserted too deeply into holes 150, 152 and become difficult to handle. The respective distal tips 154t, 156t of needles 154, 156 can be pointed, sharpened, and / or configured to penetrate through the fabric.
[0053] [00053] In use, as mentioned above, the transverse pinning guide devices presented in the present invention can be used in some minimally invasive surgical procedures for transverse pinning of a ligament graft in a bone tunnel. In general, the patient can first be prepared for surgery using standard techniques. An anterolateral (AL) arthroscopic visualization portal can be created on the patient's knee, as well as an anteromedial (AM) work portal. These standard surgical portals are not illustrated in the figures. Also not shown in the figures are the skin (s) incisions that can be used in performing various aspects of the procedure. A suitable graft can be provided, for example, by harvesting a semitendinosus graft from the patient, or by providing an allograft, although any type and origin of graft can be implanted using the methods of the present invention, including soft tissue grafts and bone grafts finished with rigid blocks or replacement materials.
[0054] [00054] In an exemplary embodiment illustrated in Figure 20, a surgical procedure of transverse pinning may include the preparation of a bone tunnel 170, also called in the present invention "femoral tunnel", in a femur 172 of a patient's knee, using an anteromedial approach through a joint space 174 between the femur 172 and a tibia 176 and into the femur 172. The femoral tunnel 170 can be prepared in a variety of ways, as will be understood by a person skilled in technical. In a non-limiting example, the femoral tunnel 170 can be formed by determining a position in the femoral notch that is suitable for the insertion of the graft and the drilling of a guide pin (not shown) in the femur 172 over a selected axis of the femoral tunnel, followed by boring to create the femoral tunnel 170 along the guide pin to a suitable depth and diameter to receive the graft. Although the femoral tunnel may have two open ends, the femoral tunnel 170 may, as in this illustrated embodiment, have only one open end, for example, be a blind tunnel. Although a femoral tunnel is formed in this illustrated modality, as mentioned above, a transverse pinning surgical procedure may include the formation of a tibial tunnel.
[0055] [00055] A guide rod, for example, the guide rod 104 of the device 100 of figure 1, can be inserted in the femoral tunnel 170. In an exemplary embodiment, the guide rod 104 is fixed to the base portion 114 when the guide rod 104 is inserted into the femoral tunnel 170, however, the guide rod 104 can be attached to the base portion 114 after the guide rod 104 has been inserted into the femoral tunnel 170. The device in figure 1 is used as an example non-limiting in this illustrated modality. A different guide rod, for example, a guide rod that has a different diameter and / or longitudinal length than the stem 104, can be coupled to the base portion 114 and could be inserted into the femoral tunnel 170, or a pinning guide device cross-sectional approach, as discussed in this document, could be used in the procedure.
[0056] [00056] With the guide rod 104 inserted in the femoral tunnel 170, the structure 102 can be positioned on a medial side 178 of the femur 172 with the first arch 106 being positioned on the medial side 178, as illustrated in figure 20. , with the guide rod 104 inserted in the femoral tunnel 170 and with the guide rod 104 coupled to the base portion 114 of the structure 102, the structure 102 can be rotated about a longitudinal axis A1 of the guide stem 104 and the tunnel to place the first arch 106 on the medial side 178 of the femur 172. In another embodiment, the guide rod 104 can be inserted into the femoral tunnel 104 before being attached to the base portion 114. Then, with the guide rod 104 extending from the femoral tunnel 170, the base portion 114 can be coupled to the guide rod 104, in order to position the first arch 106 on the medial side arch 178. Although structure 102 is shown in figure 20 without the second arch 110 coupled to it, the second arc 110 can be coupled to the gu-block ia 108 at any time during the surgical procedure. In an exemplary embodiment, the second arch 110 can be attached to block 108 after the first arch 106 that has guide block 108 attached to it is positioned on the medial side 178. If guide block 108 is configured to be detachable from the structure 102, guide block 108 can be attached to structure 102, for example, to the first arch 106, at any time during the procedure. In an exemplary embodiment, the guide block 108 can be coupled to the first arch 106 before the first arch 106 is positioned on the medial side 178 of the femur 172.
[0057] [00057] Figure 21 illustrates the first arch 106 on the medial side 178 of the femur 172 and the second arch 110 in a pre-fixed position that extends in a lateral medial direction. The first end 110a of the second arch 110 can be attached to the guide block 108, as discussed above, for example, by the sliding connection of four lanes 158a, 158b, 158c, 158d with the guide block 108. Once connected to the guide block 108, the second arc 110 can be locked in a fixed position with respect to it, as discussed above. The figures. 22 and 23 show the first end of the second arch 110a slidably connected to the guide block 108 and the third screw 160 advanced to the corresponding hole 162 formed in the guide block 108 to lock the second arch 110 in a fixed position in relation to the guide block 108. Consequently, the second arch 110 can be locked with respect to frame 102 when the guide block 108 is locked there by a first screw 112. Figures 22 and 23 show that, as mentioned above, the second arch 110 it can be configured to not obstruct or otherwise prevent access to the holes in the guide block 130, 132 when the second arch 110 is coupled to the guide block 108.
[0058] [00058] With the first arch 106 having the guide block 108 coupled there positioned on the medial side 178 of the femur 172, the guide block 108 can be slid along the first arch 106 to position the guide block 108 in an angular position selected to position the guide block 108 in relation to the femur 172, and / or the structure 102 can be rotated around the guide rod and the axis of the tunnel A1, to position the guide block 108 in relation to the femur 172. Thus, the path of the holes 130, 132 in the guide block 108 can be adjusted angularly in relation to the femur 172 and the bone tunnel 170. As discussed in this document, the selected angular position can be based on the insertion depth of the needles 154, 156 inserted through the holes in the second end 150, 152 and into the tissue on the side side 180 of the femur 172. In general, due to the general shape of the femur and due to the angle required for an anteromedial approach inside the femur 172 to intersect the tunic el osseo 170, there may be insufficient bone stock on one side of the bone tunnel 170, for example, between the bone tunnel 170 and the lateral surface of the femur 182. This insufficient bone stock may delay and / or prevent the mechanical fixation of transverse pins in the femur 172. Adjusting the trajectory of the holes 130, 132 based on the depths of the needles through the second arch 110 allows sufficient bone stock on the lateral side of the bone tunnel 170.
[0059] [00059] If the guide block 108 is in a locked configuration, for example, if the first screw is in the screwed configuration, the first screw 112 can be moved from the screwed configuration to the unscrewed configuration to allow block 108 to slide along the first arc 106. When the guide block 108 is in the selected angular position, for example, at the 20 degree mark, as shown in figure 20, the guide block 108 can be locked in position, as by moving the first screw 112 from the unscrewed configuration to the screwed configuration.
[0060] [00060] With the second arch 110 coupled to the guide block 108, with the guide block 108 and the first end of the second arch 110a positioned on the medial side 178 of the femur, and with the second end of the second arch 110b positioned on one side lateral view 180 of the femur, as shown in figure 23, the first and second needles 154, 156 can be inserted through the first and second holes 150, 152, formed, respectively, in the second arch 110. The first and second needles 154, 156 can be advanced through the first and second holes 150, 152, respectively, and through the tissue near the femur 172 until each of their respective distal tips 154t, 156t comes into contact with the lateral surface 182 of the femur 182. The contact of the tips distal 154t, 156t with the lateral surface of the femur 182 can be detected by tactile sensation and / or by sight, as with an endoscope or other visualization instrument placed on the patient. In an exemplary embodiment, the distal tips 154t, 156t extend through the tissue and do not form holes or otherwise enter the femur 172 through the lateral surface 182, although the distal tips 154t, 156t may negligently penetrate the lateral surface of the femur 182 Although both needles 154, 156 are shown in figure 23 as being inserted through the second end of the second arc 110b before either of the distal tips 154t, 156t are advanced to contact the lateral surface 182 of the femur 172, the needles 154, 156 can be inserted through the holes of the second arc 150, 152 simultaneously or in any sequential order. Although the use of needles 154, 156 inserted through both holes in the second end 150, 152 can help ensure that the paths of both holes in the guide block 130, 132 are desirably positioned, in some embodiments, only one of the needles 154, 156 can be used to check the positioning of the guide block, as if the patient's femur appears substantially dimensioned.
[0061] [00061] With the distal tips of needles 154t, 156t coming into contact with the lateral surface 182 of the femur, the depth indicators of the needles 154i, 156i can indicate distance between the lateral surface 182 of the femur 172 and the target location of one end distal of a transverse pin to be implanted inside the femur 172, for example, a location of the opening of the guide rod 118 positioned inside the femoral tunnel 170. In a first case, if all depth indicators 154i, 156i are positioned laterally to a side face 110L of the second end of the second arc 110b, for example, a lateral opening of the holes 150, 152, then the transverse pins inserted through each of the holes 130, 132 of the guide block can be inserted on the medial side 178 of the femur 172 and intersect the femoral tunnel 170 without passing through the lateral surface 182 of the femur, for example, they may be contained within the femur 172. Using the first needle 154 as an example, with reference to figure 24, the first needle 154 can be advanced through the first orifice of the second arch 150 until its distal tip 154t contacts the lateral surface of the femur 182. The depth indicator 154i is located at a distance D1 laterally from the side face of the second end 110L and a distance D2 laterally from the side surface of the femur 182. The distance D1 represents the distance that is equal to or less than the distance D3 between the side surface of the femur 182 and lateral terminal end of a lateral medial bone tunnel to be formed in the femur 172. Thus, the distance D1 indicates that a distance D3 exists, indicating that the bone to be drilled within the medial surface of the femur will not be pushed from the surface lateral of the femur 182. In other words, because a distance D4 between the first and second ends 110a, 110b of the second arch is fixed, because of the distance D2 between the distal tip of the needle 154t and the depth indicator 154i is fixed, and because the holes in the guide block 130, 132 are coaxial with the holes in the second end 150, 152, the depth indicator 154i which are located laterally in with respect to the lateral face of the second end 110L will indicate that a transverse pin inserted through one of the holes in the corresponding block 130 and inserted in the medial side 178 of the femur 172 will intersect the femoral tunnel 170 without passing through the lateral surface of the femur 182. The block Guide 108 can be considered to be in an acceptable position for inserting transverse pins through each of the holes in the guide block 130, 132.
[0062] [00062] Depth indicators 154i and 156i on needles 154, 156 can be located on them with a built-in safety distance so that if depth indicators 154i, 156i are aligned with the side face of the second end 110L, the distal tips 154t, 156t will have a predetermined distance, for example, the safety distance, medial in relation to the lateral surface of the femur 182. The safety distance can vary, being equal to about 2 mm or equal to about 4 mm.
[0063] [00063] On the other hand, in a second case, if one or both depth indicators 154i, 156i are positioned medial to the lateral face 110L of the second end of the second arch 110b, then the transverse pins inserted through one or both corresponding holes in the guide block 130, 132 and inserted in the medial side 178 of the femur 172 would pass through the lateral surface of the femur 182 (or would be within the safe distance of the lateral surface 182). This medial position (s) of the depth indicator (s) may indicate that the holes 130, 132 of the guide block 108 must be repositioned before the insertion of the transverse pins through it and inside the femur 172. Again, with the use of the first needle 154 as an example, with reference to figure 25, the first needle 154 can be advanced through the first orifice of the second arch 150 until its distal tip 154t contacts the lateral surface of the femur 182. The depth indicator 154i it is located at a negative distance D5, for example, medially, since it is positioned from the side face of the second end 110L and a distance D6 laterally from the side surface of the femur 182. The depth indicator 154i may not be visible , for example, can be arranged inside the hole 150 at the second end 110b or it can be arranged inside the fabric. The negative distance D5 is greater than a distance D7 between the lateral surface of the femur 182 and the lateral terminal end of a lateral medial bone tunnel that can be formed in the femur 172, as discussed below. Thus, because the distance D4 between the first and second ends 110a, 110b of the second arc is fixed, because the distance D2 between the distal tip of the needle 154t and the depth indicator 154i is fixed, and because of the holes of the guide block 130, 132 are coaxial with the holes of the second end 150, 152, the depth indicator 154i being located medial in relation to the lateral face of the second end 110L may indicate that a transverse pin inserted through one of the corresponding holes of block 130 and inserted in the medial side 178 of the femur 172 will intersect the femoral tunnel 170 and pass through the lateral surface of the femur 182. It can therefore be assumed that the guide block 108 may be in an unacceptable position for insertion of cross pins through each of the holes in the guide block 130, 132, any of the needles 154, 156 inserted in the patient can be removed, and the guide block 108 can be slidably replaced along the first arch 106. The sliding repositioning of guide block 108 also reposition the second end of the second arch 110b coupled to guide block 108. With the guide block repositioned, needles 154, 156 can be inserted back into the patient through holes in the second end 150, 152 to contact the lateral surface of the femur 182, and the location of the depth indicators can be judged to be desirably medial or undesirably lateral to the lateral face of the second end 110L. The repositioning of the guide block 108, the insertion of the needle and evaluation of the depth indicator can be repeated as many times as necessary to reach the first case in which the transverse pins can be inserted in the femur 172 without passing through the lateral side 182 of the same .
[0064] [00064] As mentioned above, the second end of the second arc can include only one hole formed through it, as in the embodiment illustrated in figure 19. In this case, only one needle can be inserted through the second end to determine whether the cross pins inserted through the holes in the guide block 130, 132 and inside the femur 172 would pass through the lateral surface of the femur 182. Because a hole in the second end can be centered between the holes in the guide block, as discussed above, the a single needle inserted through a hole can be used to assess whether the guide block 108 is positioned for the first case (transverse pins without passing through the lateral surface of the femur 182) or the second case (transverse pins passing through the lateral surface of the femur femur 182).
[0065] [00065] In another embodiment, needles 154, 156 can be used to indicate a distance, as discussed above, before the formation of the femoral tunnel 170. In this embodiment, the femoral guide rod coupled to the base portion 114 of structure 102 can be "beheaded" in such a way that it does not enter the bone, for example, in the femur 172, but is in a borderline position with an outer surface of the tissue, for example, skin, close to the bone. Alternatively, the guide rod coupled to the base portion 114 of the structure 102 can be truncated so that it forms a partial length of the femoral tunnel 170 to eventually be formed. The use of needles 154, 156 to check the distance before making a lot of bone drilling can help to ensure that the tunnels and holes that are created are formed in desired positions without the need for much, if any, readjustment.
[0066] [00066] With the guide block 108 in a selected position along the first arc 106, for example, after using needles 154, 156 to confirm the selected position of the guide block, as illustrated in figure 26, the first and the second drills 134, 136 and the first and second drill sleeves 138, 140 can be advanced through their respective holes in the guide block 130, 132 and into the medial side 178 of the femur 172 to form the first and second holes lateral medial pilot 184, 186 in the femur 172. As discussed above, pilot holes 184, 186 can be formed so as to be substantially perpendicular and intersect the femoral tunnel 170, for example, in the distal opening 118 of the guide rod 104. The pilot holes 184, 186 can be formed simultaneously, or can be formed sequentially in any order. Although needles 154, 156 are shown in figure 26 as being inserted through the holes in the second end 150, 152 when the first and second drill bits 134, 136 and the first and second drill sleeves 138, 140 can be advanced through their respective holes in guide block 130, 132, needles 154, 156 can be removed before using bits 134, 136 and / or drill sleeves 138, 140. After the formation of pilot holes 184, 186, at least bits 134 , 136 can be removed from there to prepare insertion of the cross pins.
[0067] [00067] A ligament graft (not shown) can be inserted and positioned in the femoral tunnel 170. The graft can be inserted there in a variety of ways. Methods for preparing a graft for implantation and for positioning a graft in a bone orifice are well known in the art. In a non-limiting example, the graft can be positioned in the femoral tunnel 170 using a through pin (not shown) placed through a guide hole (not shown) formed during the preparation of the femoral tunnel 170, to pull the graft in the femoral tunnel 170 through a suture fixed between the graft and the passing pin.
[0068] [00068] With the graft positioned in the femoral tunnel 170, the transverse pins, for example, like the transverse pin 146, can be inserted medially through the pilot holes 184, 186, for example, using the insertion tool 148, to wrap and fix the graft inside the femoral tunnel 170. The transverse pins can be inserted simultaneously or they can be inserted sequentially in any order. In a modality in which a graft ends in a bone block, for example, for the implantation of a bone-tendon-bone graft (BTB - bone-tendon-bone), an additional drilling step can be performed after the graft has been placed in the femoral tunnel 170. This additional drilling step can be performed by, in a non-limiting example, passing a scaled diameter trocar through the respective trocar sleeve positioned on the bone to receive a transverse pin, and through the graft, before insertion of the transverse pin.
[0069] [00069] The insertion of the transverse pins may include the transmission of an axial force directed laterally to penetrate the transverse pins through the graft and hold the pin securely in the graft, such as by hammering at a proximal end of the insertion instrument 148. A depth inserter can be configured to prevent too much lateral advancement of the cross pins, for example, through the lateral surface of the femur 182. Figure 27 illustrates a modality of a depth inserter 188. For clarity of the illustration, the femur 172 and the graft are not shown in figure 27. The depth inserter 188 can include at least one hole formed through it, for example, first and second holes 190, 192. The illustrated holes 190, 192 are cylindrical, but the holes 190 , 192 can have any shape. The depth inserter 188 can be configured to be movable between an unsecured position, in which the holes 190, 192 each have a first diameter, and a fixed position, in which each of the holes 190, 192 has a second smaller orifice. In this way, the instruments introduced through the holes 190, 192 can be prevented from moving, for example, being locked in them when the depth inserter 188 is in the fixed configuration, thereby holding or fixing the instruments in a fixed position. The depth inserter 188 can be configured to move between fixed and non-fixed configurations in a variety of ways, such as by actuating an actuator, for example, a push button, a lever, etc., coupled to the depth inserter 188. The actuator in the illustrated mode includes a movable lever 194, which is shown in figure 27 in a position corresponding to the depth inserter 188 which is in the fixed configuration. The depth inserter 188 can be formed in any way as well as from any one or more materials, such as a biocompatible metal molded into the shape.
[0070] [00070] As shown in figure 27, the depth inserter 188 can be positioned external to the patient between the guide block 108 and the medial side 178 of the femur 172. The depth inserter 188 can be positioned to be in a borderline position with the medial side 178 of the femur 172, for example, the medial surface (not shown) of the tissue close to the femur 172. In an exemplary embodiment, before fixing the depth insert 188 around the insertion tools 148, the insertion tools 148 with the transverse pins 146 at the distal ends of them, they can be inserted into the patient at any depth, as to position the transverse pins 146 next to the graft positioned in the opening 118 of the guide rod 104, which in figure 27, as mentioned above, does not show the graft positioned there. Then, the depth inserter 188 can be fixed around the insertion tools 188 to prevent axial movement thereof, when the transverse pins 146 are inserted through the graft. The depth inserter 188 can be disconnected from the insertion tools 148 before removing the insertion tools 148 from the patient, although if a distance between the insertion device 188 and the depth of the guide block 108 is of adequate size, the insertion tools insertion 148 may be able to be moved in a medial direction and out of the patient with the depth inserter attached to them 188.
[0071] [00071] Depth inserter 188 can be used additionally or alternatively when drilling pilot holes 184, 186.
[0072] [00072] With the graft pinning in the femoral tunnel 170, the stent 104 and any instruments inserted through any of the holes 130, 132, 150, 152 and that remain in the patient, for example, the insertion tool 148, the needles 154 , 156, etc., can be removed from the patient, leaving the transverse pins and the graft arranged on the patient. As mentioned above in an exemplary embodiment, the cross pins can be bioabsorbent, so that they do not need to be surgically removed from the patient.
[0073] [00073] Optionally, before the femoral tunnel 170 is drilled, a positioning guide can be used to help determine a placement of the femoral tunnel 170 and the lateral medial pilot holes 184, 186 before the formation of one or more femoral tunnels 170 and of the lateral medial pilot holes 184, 186. In general, the positioning guide can be configured to couple with the structure 102 and to help ensure, if the femoral tunnel 170 is drilled in a specific location of the femur 172, that the femur 172 has sufficient bone stock to allow femoral tunnel 170 and lateral medial pilot holes 184, 186 to be formed in femur 172. In this way, the sufficiency of bone stock can be confirmed before any instruments are drilled in femur 172 to form the tunnel 170 and / or before any instruments penetrate the skin around the femur 172. This confirmation may reduce the chances of a femoral tunnel needing to be drilled again and in another place where there is sufficient bone stock, thus improving safety, saving time, and / or reducing the chances of injury to the patient.
[0074] [00074] Figure 28 illustrates an exemplary embodiment of a positioning guide 196. As in the illustrated embodiment, positioning guide 196 may include a substantially cylindrical cannulated stem having an internal lumen 197 that extends along its longitudinal length between the proximal and distal ends 198p, 198d thereof. The cannulation of the positioning guides 196 may allow an instrument, for example, a guide wire, a drill pin, etc., to be inserted through the positioning guide 196, as will be discussed in more detail below. Although the distal end 198d of the positioning guide 196 is tapered to a truncated cone shape in the illustrated embodiment, the distal end 198d can have a variety of shapes, for example, tapered, flat or planar, chamfered, etc. The tapered distal end 198d can aid visualization when an instrument distally advanced through the inner lumen 197 will come out of the inner lumen 197.
[0075] [00075] The positioning guide 196 can be configured to couple with the base portion 114 of the structure 102 so that, as shown in figure 29, the distal end of the positioning guide 198d is spaced a certain distance from the portion base 114 along a longitudinal length of the positioning guide 196, the positioning guide 196 is spaced a distance from the arm portion 116 of the frame 102, and the first arch 106 extends in a direction substantially parallel to the direction guide. positioning 196. In an exemplary embodiment, the positioning guide 196 can be configured to couple with the base portion 114 in the same location as the guide rod 104, so that the positioning guide 196 and the guide rod 104 can be selectively and interchangeably coupled to the base portion 114. The positioning guide 196 can be configured to detachably couple base portion 114 of structure 102 by means of the action the proximal end 198p of the positioning guide 196 to the end of the base portion 114, for example, by inserting the proximal end 198p of the positioning guide 196 into the orifice 122 formed in the base portion 114. The positioning guide 196 can be configured to be locked in a coupled position in relation to the base portion 114, for example, by pressure fitting, as with a protrusion 199, as in the illustrated embodiment, attachable threads, second screw 120 as in the illustrated embodiment, etc. The provision of a detachable positioning guide can facilitate the cleaning of the positioning guide 196 and structure 102, as well as allowing structure 102 to be used in planning the positioning of femoral tunnel 170, as well as in the formation of femoral tunnel 170. A frame 102 can be provided as part of a kit that includes detachable positioning guide 196 as one of a plurality of positioning guides each configured to detachably engage structure 102. This kit may also include one or more rods -guides, as discussed above. The plurality of positioning guides can have a variety of longitudinal lengths and diameters to accommodate various dimensions of grafts and patient anatomies.
[0076] [00076] The positioning guide 196 can be configured to be used in connection with the formation of femoral bone tunnels and tibial bone tunnels. For use in connection with the formation of a tibial bone tunnel, the positioning guide 196 can be configured to mate with a base portion of a structure via an adapter, similar to the one discussed above with respect to the guide rod 204 of figures 3 and 4. The same adapter can be configured to couple the guide rod and the positioning guide to the base portion of a frame.
[0077] [00077] The longitudinal length of the positioning guide 196 may be less than the longitudinal length of the guide rod 104, so that when the guide rod 104 is coupled to the base portion 114, the guide rod 104 extends to a greater distance from the base portion 114 than when the positioning guide 196 is coupled to the base portion 114. In other words, when the guide rod 104 is coupled to the base portion 104, the first and second longitudinal axes 130A, 132A can pass through the opening 118 of the guide rod 104, as shown in figure 2. In contrast, when the positioning guide 196 is coupled to the base portion 114, as shown in figure 29, the first and second longitudinal axes 130A , 132A can be located distal to the distal end of the positioning guide 198d, so that the first and second longitudinal axes 130A, 132A do not cross the positioning guide 196. The positioning guide 196 can be shorter than the guide rod 104 and m any measure, for example, 30 mm. Because they have a longitudinal length less than the guide rod 104, the positioning guides 196 can be configured to not penetrate the femur 172 and / or the skin around the femur 172 when positioned in relation to it, as shown in figure 30 .
[0078] [00078] If the positioning guide 196 is used in a surgical procedure, as mentioned above, it can be used before the formation of the femoral tunnel 170. In other words, the positioning guide 196 can be coupled to the base portion 114 before of the guide rod 104 to be coupled thereto, and the guide rod 104 can subsequently be coupled to the base portion 104 after the positioning guide 196 is used to help determine the proper positioning of the femoral tunnel 170 to be drilled. As shown in the embodiment of figure 30, with the positioning guide 196 coupled to the base portion 114, the positioning guide 196 can be positioned in relation to the femur 172 with the distal end of the positioning guide 198d adjacent to the femur 172. In the embodiment illustrated, the distal end of the positioning guide is configured to penetrate the tissue and be in a boundary position with an external surface of the femur 172, and any residual ACL tissue, to help maintain the positioning of the positioning guide 196 in relation to the femur 172. The distal end of the positioning guide can be configured to penetrate tissue and / or bone, as by the inclusion of a penetrating element, for example, a thick textured surface, one or more teeth, etc. In some embodiments, the distal end of the positioning guide 198d may be configured to be in a position bordering the tissue, for example, the skin around the femur 172, without penetrating the tissue, for example, the distal end 198d is an end spent.
[0079] [00079] With the positioning guide 196 positioned in relation to the femur 172, the structure 102 coupled to the positioning guide 196 can be positioned on the medial side 178 of the femur 172 with the first arch 106 being positioned on the medial side 178, as shown in figure 30. Although structure 102 is shown in figure 30 without the second arch 110 attached to it, the second arch 110 can be attached to the guide block 108 at any time during the surgical procedure. In an exemplary embodiment, when positioning guide 196 is used, the second arch 110 can be coupled to the guide block 108 after the first arch 106 that has the guide block 108 attached to it is positioned on the medial side 178. Once engaged with the guide block 108, the second arch 110 can be locked in a fixed position with respect to it and used to angularly adjust the path of the holes 130, 132 in the guide block 108 with respect to the femur 172, as discussed above. In this way, the paths of the holes 130, 132 based on the depth of the depths of insertion of the needles through the second arc 110 can be adjusted before the femoral tunnel 170 is formed. However, even if the positioning guide 196 is used to help determine the placement of the femoral tunnel 170 and 170 before the femoral tunnel is formed in the femur 172, the second arch 110 can be used again after the formation of the femoral tunnel 170 as a check secondary.
[0080] [00080] In some embodiments, a pilot hole with a diameter smaller than the femoral tunnel 170 can be drilled in the femur 172 at a selected location in the femoral tunnel 170. Positioning guides 196 can be used to check for sufficient bone reserve before of the larger diameter femoral tunnel 170 be drilled at the pilot hole site. In a non-limiting example, a pin, for example, a drill pin can be positioned inside the pilot hole and extend out of the femur 172. Positioning guides 196 can be inserted over the drill bit so that the pins drilling holes extend through the inner lumen 197, and the placement of the hole can be verified using the second arc 110 similar to that discussed above.
[0081] [00081] The various methods and devices presented in the present invention can be used in a variety of surgical procedures, however, the methods and devices are particularly useful for repairing an ACL on a human knee. In an ACL repair, the torn ACL can be replaced with at least one ligament graft that is anchored to a knee bone, for example, a femur or a tibia. The "ligament graft," for use in the present invention, is intended to include natural materials, such as grafts, allografts and xenografts, including the ligaments and tendons produced, as well as synthetic materials. A ligament graft can also include an anchoring element attached to it for fixing the prosthesis to the knee bone. For example, the ligament graft may include a bone graft, tampon, or other member, attached to one or both terminal ends thereof. The term "bone graft", as used in the present invention, is intended to include natural materials, such as grafts, allografts and xenografts, as well as synthetic materials. Those skilled in the art will appreciate that the various methods and devices presented in the present invention can be used in a variety of surgical procedures, and that the specific configuration of ligament grafts can vary depending on the intended use, and virtually any ligament grafts known in the art. technique can be used with the devices and methods presented in the present invention.
[0082] [00082] Those skilled in the art will additionally appreciate that the present invention has applications in conventional open endoscopic and surgery instruments, as well as applications in robotic aid surgery.
[0083] [00083] The devices described here can also be designed to be discarded after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing particular parts and subsequent reassembly. In particular, the device can be disassembled, in any number of particular parts or parts of the device can be selectively replaced or removed, in any combination. When cleaning and / or replacing particular parts, the device can be reassembled for subsequent use in a reconditioning facility or by a surgical team immediately before a surgical procedure. Those skilled in the art will appreciate that the reconditioning of a device can use a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques and the resulting reconditioned device are all within the scope of the present patent application.
[0084] [00084] The person skilled in the art will observe additional features and advantages of the invention based on the modalities described above. Accordingly, the invention should not be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are hereby expressly incorporated, by reference, in their entirety.

权利要求:
Claims (9)
[0001]
Surgical device (100), characterized by the fact that it comprises: a structure (102) having a guide rod (104) and a distal proximal arch (106) spaced at a distance from the guide rod (104); a guide block (108) slidably mounted to the distal proximal arch (106) and which has at least one orifice (130) formed through it that is configured to receive a first surgical instrument; and a lateral medial arch (110) having a first end with a latching mechanism configured to detachably couple the lateral medial arch (110) to the guide block (108), and a second end having at least one hole (150 ) formed through it that is configured to receive a second surgical instrument.
[0002]
Device according to claim 1, characterized by the fact that, with the lateral medial arch (110) coupled to the guide block (108), the at least one hole (130) formed through the guide block (108) is coaxial with at least one orifice (150) formed through the second end of the lateral medial arch (110).
[0003]
Device according to claim 1, characterized by the fact that the coupling mechanism is attachable to the block (108) in a first orientation in relation to the guide block and in a second orientation in relation to the guide block that differs from the first guidance.
[0004]
Device according to claim 3, characterized by the fact that, with the lateral medial arch (110) coupled to the guide block (108), the lateral medial arch (110) in the first orientation is housed in a first hole formed in the guide block, and in the second orientation it is housed in a second hole formed in the guide block.
[0005]
Device according to claim 1, characterized in that the at least one hole formed through the guide block (108) comprises first and second holes (130, 132), the at least one hole formed through the second end of the lateral medial arch (110) comprises third and fourth holes (150, 152), and with the lateral medial arch (110) coupled to the guide block (108), the first orifice is coaxial to the third orifice and the second orifice is coaxial with the fourth hole.
[0006]
Device according to claim 1, characterized in that the at least one hole (130) formed through the guide block (108) comprises first and second holes (130, 132), the at least one hole (150) formed through the second end of the lateral medial arch (110) is a single orifice, and with the lateral medial arch (110) coupled to the guide block (108), a longitudinal axis of the single orifice is parallel and positioned between the longitudinal axes of the first and second holes (130, 132).
[0007]
Device according to claim 1, characterized by the fact that, with the lateral medial arch (110) coupled to the guide block (108), the lateral medial arch (110) is positioned on a plane that is perpendicular to the plane that contains the distal proximal arch (106).
[0008]
Device according to claim 1, characterized by the fact that, with the guide block (108) in any sliding position along the distal proximal arc (106), a longitudinal axis of at least one orifice (130) formed through The guide block (108) extends through an opening (118) formed in a distal portion of the guide rod (104).
[0009]
Device according to claim 8, characterized by the fact that, with the lateral medial arch (110) coupled to the guide block (108), a longitudinal axis of at least one hole (150) formed through the second end of the arch lateral medial (110) extends through the opening formed in the distal portion of the guide rod (104).

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EP2561815B1|2017-01-11|

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JP2013043093A|2013-03-04|

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AU2012213932A1|2013-03-14|

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CN102949216A|2013-03-06|

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US20130053959A1|2013-02-28|

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CA2787436A1|2013-02-24|

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JP6125173B2|2017-05-10|

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CN102949216B|2017-06-27|

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AU2012213932B2|2017-03-16|

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CN112168279B|2020-08-28|2021-07-13|中南大学湘雅医院|Intramedullary fixed drilling support for femoral head|

法律状态:
2014-12-02| B03A| Publication of an application: publication of a patent application or of a certificate of addition of invention|

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2018-12-11| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|

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2020-02-18| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|

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2020-11-03| B09A| Decision: intention to grant|

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2021-01-12| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 24/08/2012, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US13/216,947|US8617176B2|2011-08-24|2011-08-24|Cross pinning guide devices and methods|

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US13/216,947|2011-08-24|

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