intracorporeal device for the desolation of tissues.

专利摘要:
INTRACORPORAL DEVICE FOR DISPLACEMENT OF FABRICSDevice for displacing tissues inside the organism, notably bone tissue, that device comprising a first part, said reference part (C1); a second part, said transport part (C2), mounted sliding in relation to the reference part (C1); a threaded rod, mounted rotatable in relation to the reference piece (C1); a command tree; drive means connecting the counting tree to the threaded rod, a connecting nut, between the transport piece (C2) and the threaded rod, this connecting nut being mounted on the threaded rod and being oriented in rotation in relation to the reference (C1); means for transforming the displacement of the connecting nut along the threaded rod into a displacement of the transport piece (C2) in relation to the reference piece (C1), such a device being such that, to limit the longitudinal translation of that threaded rod in relation to to the reference piece (C1), a first stop (C11) and a second stop (C12) attached to the threaded rod cooperate respectively with a first support (A11) and a second support (A12), these supports being attached to the reference part (C1) and being placed along the threaded rod at a distance from each other between these stops (C11, C12), the connection nut being able to move along the threaded rod between the first support (A11) and the second support (A12).
公开号:BR112012005337A2
申请号:R112012005337-0
申请日:2010-09-07
公开日:2020-09-24
发明作者:Arnaud Soubeiran
申请人:Arnaud Soubeiran；
IPC主号:

专利说明:

Descriptive Report of the Invention Patent for: “INTRA-BODY DEVICE FOR THE DISPLACEMENT OF TISSUES”.
Technical field 5 The invention relates to a device for displacing tissues in the human or animal body.
The invention relates more particularly, but not exclusively, to devices that allow parts of bones to be displaced.
The invention notably finds an advantageous application in the following technical sectors: - distraction or compression rods for the correction of the spine or thorax, resting on the vertebrae, ribs and / or pelvis; - intramedullary nail or plate or bone lengthening for long, flat, mandible or skull bones; - growth prostheses.
Prior art Bone elongation by progressive distraction of the bone callus that naturally forms when a bone is fractured, before it calcifies was initially performed with the aid of external fixators, for example, as popularized by Ilizarov.
To try to correct the inconveniences of external fixators, such as infections or annoyances for daily life, fully implanted stretching nails have been proposed: Albizzia nail, through which the stretching is caused by an intentional rotation of the patient's leg, nail of Bliskunov, nail of Baumgart and Betz, or the nail ISKD (acronym of the English intramedullary Skeletal Kinetic Distractor, or intramedullary distractor of kinetic skeleton) of Cole.
The bone elongation speed, on the order of one millimeter per day, is adjusted according to clinical observations.
Bone transport makes it possible to reconstruct, for example, part of a bone shaft removed as a result of trauma, infection or a tumor, progressively stretching the bone callus that forms between a preserved piece of bone and a piece of bone that highlighted by osteotomy of this part, until a piece is supported against the second part of the preserved bone.
WO 02/071962 and WO 95/24870 show examples of bone transport nails. These two devices work by tongue systems, are bulky, contain a large number of parts and are hardly miniaturizable. The movements required for stretching are often painful.
Distraction by intracorporeal means for the surgical treatment of spinal deformations has also been proposed, in particular for the treatment of progressive scoliosis in 5 children. A functional presentation of the instruments for surgical treatment of spinal deformations is provided by Foster et al. (The Spine Journal, pages 652-694, 2005).
In children, it is necessary not only to correct the deformation as much as possible, but also to maintain the correction obtained during growth, limiting this as little as possible. This requires the geometry of the implanted distractor to evolve over time. For this, most known distractors need repeated surgeries, with the difficulties, costs and associated risks, notably infectious. This is the case for devices in WO 2006/010844, WO 2007/051924, FR 2900563, FR 2843538, FR 2891727, FR 2794357 and FR 2892617. This is also the case for VEPTR® (Vertical Expandable Prosthetic Titanium Rib, or vertical rib expandable titanium). In order to try to limit the number of surgical operations, several intracorporeal devices that can be stretched without further operation have been proposed. For example, the vertebral distractor described in WO 01/78614 comprises a magnet that drives the rotation of a gear wheel with two diametrically opposed wheels and each one provided with a complementary touching the line of two stretching rods.
5 The use of gears and lines on the stretching rods needs to make the device closed to environmental biological materials, which is technically very delicate and limits the possibilities of sterilization. In addition, the presence of a line on the stretching rods that are very stressed in fatigue, limiting the life of the implant or requires its oversizing, which then makes it too bulky to be reasonably implanted in a child.
WO 2007/144489, on behalf of the applicant, describes an intracorporeal stretching device, that prior device finding application as a bone lengthening nail, bone transport nail, spinal distraction nail or augmentation prosthesis. The device described in WO 2007/144489 comprises: - a first elongated part, - a second part telescopically mounted in relation to the first part; - first means of attachment to the organism, for example, by screwing, to a first end of the first part; - second means of attachment to the organism, for example, by screwing, to a first end of the second part; 5 - a rod comprising at least one line, whose rotation causes the displacement of the second part in relation to the first part; - means for controlling the rotation of the rod, for example, a permanent magnet, that rod being mounted between two approaching ends, when the device extends.
In the preferred embodiment described in that applicant's previous document, the rod comprises, in a first extreme part, a housing for a permanent magnet. A support tongue is fixed, for example, by welding, to the second end part of the rod. This support tongue is fixed to the first tubular part of the device, for example, by welding, and is oriented in longitudinal sliding in relation to the second part of the device. Between the permanent magnet housing and the support tongue, the thread rod is screwed into an adjustment of the second part of the device. A loaded rod length is thus defined between the adjustment of the second part and the support part rigidly connected to the first part of the device.
This prior device has numerous advantages. In particular, it is simple and inexpensive to manufacture in the light of the function performed, it has sufficient power 5 for its function in a reduced volume, it does not need a particular closure, it can be controlled manually and painlessly with the aid of a simple external permanent magnet , notably at home, by the patient or a person who assists him without any particular qualification. In addition, the length of the loaded rod decreases when the device stretches and the length of the loaded rod works in traction when the device stretches, which prevents any possibility of deformation.
The device described in WO 2007/144489, however, has a rigid straight length for the desired power and elongation potential that makes it impossible to place it in a location that is entirely curved (as in column and column applications). chest, for example), or in a location where the space lacks in length in the direction of the detachment that you want to perform gradually (as for important bone transports or stretches or those of the jaw, for example). In addition, this device is able to exert a distraction or a compression, but not indifferently both, as it will disconnect if an effort is applied in the opposite direction to that of the effort it is capable of producing. The invention aims particularly to eliminate these limitations, conserving the advantages of the device described in WO 2007/144489, proposing a new intra-corporal stretching device with screw, of adjustable length, notably, but not exclusively for an application to distraction or compression of the spine or bone transport.
Brief description of the invention For these purposes, the invention relates, according to a first aspect, to a device for displacing tissues within the organism, notably bone tissue, that device comprising a first piece, said reference piece; a second part, said transport part, mounted sliding in relation to the reference part; a rod comprising at least one line, said threaded rod, hinged in relation to the reference part; a camshaft, drive means connecting the camshaft to the threaded rod; a connection means, known as the connection nut, between the transport piece and the threaded rod, that connection nut being mounted on the threaded rod and being oriented in rotation with respect to the reference piece; means for transforming the displacement of the connecting nut along the threaded rod into a displacement of the transport piece in relation to the reference piece, that device comprising, in order to limit the longitudinal translation of that threaded rod in relation to the reference piece, a first pillar and a second pillar rigidly connected to the threaded rod, these pillars cooperating respectively with a first bearing and a second bearing rigidly connected to the reference part, these bearings being placed at a distance from each other between these pillars, the connection nut being able to move along the threaded rod between the first bearing and the second bearing.
The distance between the two pillars is advantageously greater than that between the bearings, in order to allow a translational play of the threaded rod in relation to the reference part.
In normal operation, the camshaft is rotated by any means known to a person skilled in the art. For example, the camshaft can be associated with a permanent magnet which, when subjected to a magnetic field, rotates to orient itself in the field and drives the camshaft. As a variant, the camshaft is connected to a motor, a motor gear or a key gear.
The device presents, according to several achievements,
the following characteristics, which can be combined.
The driving means comprise a flexible transmission shaft and / or at least a helical spring and / or a transmission joint, a transmission joint chain, a cardan joint or a cardan joint chain.
The actuating means comprise an intermittent device, notably a Geneva wheel mechanism, rigidly connected to the threaded rod and moved by the camshaft, this intermittent device being able to transform a continuous rotation motion of the camshaft into a movement flashing of the threaded rod.
The transformation means comprise a tongue or a rigid connection between the connection nut and the transport part or a bearing rigidly connected to the connection nut, that bearing cooperating with a pillar rigidly connected to the transport part.
The rotational orientation of the connection nut in relation to the reference part can be a linear orientation or a helical orientation, such that this connection nut rotates from an angle between 10 and 180º, when it moves from that first to that second bearing and vice versa.
Advantageously, the device comprises two conveying pieces and two threaded rods. Advantageously, the filleting of the two filleted rods has different diameter, direction or pitch characteristics. Each threaded rod is advantageously provided with an intermittent device moved by a camshaft, each intermittent device being able to transform a continuous rotation movement of the camshaft into an intermittent motion of each filmed rod, the two devices with intermittence being mounted in opposition, so that when one of the devices is in a state of activation, the other is in a state of blocking.
The diameter of the threaded rod (s) is less than four mm, notably between one and three millimeters.
When the device comprises two transport parts, they are advantageously driven by a common camshaft. The transport parts may or may not be substantially parallel to each other.
Advantageously, the transport parts are substantially cylindrical in shape and of a usual diameter for vertebral surgery, notably between three and seven millimeters.
In certain uses, the transport parts are provided with a substantially plate-shaped part,
comprising screw orifices usual in orthopedics for long bones or in maxillofacial surgery.
Advantageously, the camshaft comprises a permanent magnet, the direction of magnetization of which is substantially perpendicular to the camshaft rotation axis. The camshaft notably comprises a permanent magnet based on rare earths, more particularly neodymium iron boron.
The camshaft can be connected to a motor, motor gear or a key gear.
Advantageously, the camshaft comprises a hollow cylinder to which a magnet is attached by means of a silicone-based adhesive.
Advantageously, the device is at least in part made by an electromagnetic fabrication technique, notably the EFAB technique.
Advantageously, the reference part comprises a case in which a bone transport cart slides over which a transport part is mounted. The bone transport trolley is provided through perforation of the utilized longitudinal, distant from the axis of the case, this perforation being complementary to the filleting of the threaded rod. The bone transport cart is provided with a diametrical perforation that houses a bone screw, forming a transport part, that bone screw mounted sliding in two parallel longitudinal rails of the case.
In certain applications, the device comprises two transport parts mounted sliding in opposite directions from each other with respect to the reference part.
Advantageously, the device comprises a single threaded rod, the transformation means being able to transmit a movement of the connecting nut in a first direction of displacement, in a sliding of a first transport part in relation to the reference piece until in the direction in an extreme position, the device comprising means for locking the first transport part in that extreme position. The conversion means are able to transmit a movement of the connecting nut in a second direction of displacement opposite to that first direction, in a sliding of a second transport part in relation to the reference part.
Advantageously, the transformation and locking means comprise a tongue system.
The invention finds application as an intramedullary nail or elongation or bone transport plate, notably for long bones, planes and those of the mandible or skull.
The invention also finds application as a distraction or compression rod for the correction of the spine or thorax, or as an augmentation prosthesis.
The invention also finds application in the modification of soft tissues, notably elongation of a part of the intestine or gastric rings, or even in the modification of the sections of the conduits of the blood system, notably by placing arterial rings, valvuloplasty rings.
Brief description of the drawings Other objects and advantages of the invention will appear based on the description made below with reference to the attached drawings, in which: - figure 1 represents an exploded view in perspective of a tissue displacement device, according to a first mode of realization; figure 2 represents a perspective view of the connected device of figure 1; figure 3 represents a view similar to that of figure 2, in which the interior of the device is visible; figure 4 represents a sectional view of the device of figure 2 in a first position; figure 5 represents a sectional view of the device of figure 2 in a second position; - figure 6 represents an exploded perspective view of a tissue displacement device,
according to a second embodiment;
figure 7 represents a perspective view of the connected device of figure 6;
- figure 8 represents a view similar to that of
Figure 7 in which the interior of the device is visible;
figure 9 represents a sectional view of the device of figure 6 in a first position;
figure 10 represents a sectional view of the device of figure 6 in a second position;
figure 11 represents a perspective view of a tissue displacement device, according to a third embodiment;
figure 12 represents a sectional view of the device of figure 11 in a first position;
figure 13 represents a sectional view of the device of figure 11 in a second position;
figures 14 to 18 represent frontal views of a device that flashes in relation to a camshaft, in five different positions;
figure 19 represents a perspective view of a tissue displacement device according to a fourth embodiment;
figure 20 represents a view similar to figure 19 in which the interior of the device is visible;
figure 21 represents an exploded perspective view of the device shown in figures 19 and 20; figures 22 to 26 represent sectional views of the device of figure 19, in five different positions.
Detailed description of the invention Referring now to Figures 1 to 5, which represent a first embodiment, well adapted to bone transport or elongation.
The bone transport nail 1 comprises a threaded rod 2, a camshaft 3, a flexible transmission shaft 4 between the rod 2 and the camshaft 3.
The first part C1, referred to as a reference part, comprises a case 6, in which a bone transport cart 5 slides.
The threaded rod 2 comprises two end parts 21, 22 on either side of a threaded part 23, an end part 21 being smooth.
The camshaft 3 is in the form of a hollow cylinder, to which a magnet is attached, for example, by means of a silicone-based glue. At each of its ends, the camshaft 3 comprises an axial appendage 31, 32.
The flexible drive shaft 4 is placed between the edges of a U-shaped stirrup 7, the opposite flaps of which 71, 72 are perforated longitudinally. The perforation 73 of a first flap 71 of the stirrup 7 houses an axial appendage 32 of the camshaft 3. The perforation 74 of the second flap 72 of the stirrup 7 is parallel to and distant from the axis 5 of the case 6 and houses the smooth end part 21 of the stem 2.
In one application, the flexible transmission shaft 4 is of the type sold by the company SUHNER. The flexible transmission shaft is in the form of one or more helical springs wound around the same central axis. A flexible case can wrap around the flexible shaft to protect it.
In figures 1 to 5, a single spring is shown.
However, the flexible transmission shaft 4 can be formed of several layers of coil springs wound on top of each other, each layer being able to comprise several identical juxtaposed springs. Preferably, the coils of the springs of the same layer do not contact each other, in order to limit the deformations and friction that generate losses, and to allow a small radius of curvature of the flexible shaft.
Advantageously, the spring pitch is exactly greater than or equal to the desired smaller internal radius of the flexible transmission multiplied by Π and divided by the number of springs on the considered layer and the diameter of the wire that makes up these springs.
The carriage 5 is in the form of a cylinder truncated by a longitudinal plane. The carriage 5 is provided with a longitudinal perforation 51, distant from the axis of the case 6, this perforation 51 being complementary to the 5 filleting of the filleted part 23 of the stem 2.
The carriage 5 is provided with a diametrical perforation 52, housing a bone screw 53.
The case 6 is in the form of a hollow cylindrical piece, equipped with two parallel longitudinal rails 61, placed face to face, in which the bone screw 53 slides.
The carriage 5 forms a connection means, known as the connection nut, between the transport part C2 (bone screw 53) and the threaded rod 2, the car 5 being mounted on the threaded rod 2 and oriented in rotation to the case 6 belonging to the part reference C1.
The means of converting the movement of the connecting nut (the carriage 5) into a displacement of the transport part (bone screw 53) are formed by the rigid connection between the connecting nut and the transport part.
The axis of rotation of the rod 2 is defined by the perforation 74 of the second flap 72 of the stirrup 7 and a perforation 81 of a bearing block 8.
The case 6, closed at a distal end 62 by a distal fixture 9 in the form of a plug and at a proximal end 63 by a proximal fixture 10, forms a housing for the set of moving elements of the transport nail bone 1.
5 From its distal end 62, case 6 has an internal distal region 64 with a section complementary to that of the bearing block 8.
From its proximal end 63, case 6 has a proximal inner region 65 with a complementary section to that of flaps 71, 72 of the stirrup 7.
In an intermediate internal region 66, the interior of the case 6 has a substantially circular section, with a diameter smaller than that of the bearing block 8 and the flanges 71, 72 of the stirrup 7, so that the interior of the case 6 forms two pillars respectively between the distal region 64 and the intermediate region 66 and between the intermediate region 66 and the proximal region 65.
On its distal end part 62, case 6 comprises two distal diametrical perforations 67, and on its proximal end part 63, case 6 comprises a proximal diametrical perforation 68.
The distal fixation piece 9 is presented in the form of a cylindrical plug with a diameter approximately equal to that of the section of the distal inner region 64 of the case 6. This piece
9 of distal fixation is provided with two perforations 91 diameters.
The proximal fixation part 10 comprises two parts 101, 102. The first part 101 of the proximal fixation part 5 10 is cylindrical, with a diameter substantially equal to that of the proximal inner region section 65 of the case 6, and comprises a longitudinal perforation 103 and a diametrical perforation 104.
The second part 102 of the proximal fixation piece 10 is cylindrical, with a diameter greater than that of the first part 101, and is provided with three diametral perforations 105, longitudinally distributed and angularly 90º offset and able to receive bone screws.
The assembly of nail 1 can be obtained as follows.
The threaded rod 2 is inserted into the longitudinal perforation 51 of the bone transport carriage 5. The smooth terminal part 21 of the rod 2 is also inserted in the perforation 74 of the flap 72 of the stirrup 7. Thus, the axis of rotation of the threaded rod 2 is at a distance from the axis of symmetry of the bone transport cart 5.
A second nut 12, which forms a second axial stop C12, is screwed and locked in rotation, for example, by laser welding, on the terminal part 21 of the rod 2 and is placed against the second flap 72.
The tab 72 forms a second bearing A12, rigidly connected to the reference part C1, so that the rod 2 is blocked in longitudinal translation in a first direction, remaining free in rotation.
An appendix 32 at one end of the camshaft 3 is mounted by rotating in the perforation 73 of the first tab 71 of the stirrup 7.
The flexible shaft 4 is then mounted between the two flaps 71, 72 of the stirrup 7, the ends of the shaft 4 being welded respectively on the flat end 21 of the threaded rod 2 and in the appendix 32 of the camshaft 3.
The bearing shim 8 is then inserted at the distal end 62 of the case 6, until it struts at the limit of the intermediate inner region 66.
The set, namely the threaded rod 2, the transport carriage 5, the stirrup 7, the transmission shaft 4 and the camshaft 3, is then inserted into the case 6, the second end 22 of the threaded rod 2 being inserted at the perforation 81 of the bearing block 8. The stirrup 7 is placed to the bottom of the proximal inner region 65 of the case 6, while the threaded part 23 of the rod 2 and the carriage 5 are placed in the intermediate inner region 66 of the case 6.
A first nut 11, which forms a first axial abutment C11, is screwed and welded, for example, by laser, on the second end 22 of the threaded rod 2, against the bearing pad 8.
5 The shim 8 forms a first pillar A11, rigidly connected to the reference part C1 and the stem 2 is thus blocked in longitudinal translation, according to a second direction, remaining free in rotation.
The arrangement of bearings A11, 8 and A12, 72, placed between the pillars C11, 11 and C12, 12 allows that the threaded rod 2 can only be stressed in tension.
Then, the case 6 is closed at both ends by the fixing parts 9, 10.
For this, the plug 9 is inserted in the distal internal region 64 of the case 6, so that its two diametral perforations 91 are aligned with distal perforations 67 of the case 6 and can receive bone screws. The first cylindrical part 101 of the proximal connector 10 is inserted into the proximal inner region 65 of the case 6, the second appendix 31 of the control sheath 3 being inserted into the longitudinal perforation 103 of the proximal connector 10.
Then, the proximal perforation 68 of case 6 is aligned with the diametrical perforation 104 of the first cylindrical part
101. An appendix 106 secures the proximal fixation piece 10 in relation to the case 6. Laser welds reinforce these connections.
Thus, the case 6 and the fixing parts 9, 10 constitute a first part C1, said reference piece, 5 the bone screw 53, forming a second part C2, said of transport, the pillars C11 and C12 and the threaded rod 2 corresponding to the axial pillar nuts 11, 12 placed against the bearing block A11, 8 and against the second flap A12, 72 of the stirrup 7. The connecting nut is formed by the carriage 5 and the transmission of the displacement of that carriage 5 to the part transport is achieved by the rigid connection between the connecting nut and the transport part.
An example of how the bone nail 1 works is given below.
A bone, for example, as a result of ablation of a tumor, comprises a missing part between two healthy extreme parts. A healthy first part undergoes an osteotomy, in order to release a wedge between the two healthy extreme parts. The two parts and the shim are polished to allow the nail to pass 1.
The bone transport nail 1 is in an initial position, for example, as the transport carriage 5 is closer to the footboard 7 than the bearing blocks A11, 8, the bone callus stretch is made from the footboard 7 to the bearing chocks A11, 8. In addition, the carriage 5 is advantageously positioned so that its diametrical perforation 52 is in front of the longitudinal rails 61 of the case 6.
5 The proximal fixation piece 10 is fixed to the terminal portion of the first bone by means of 3 bone screws passed through the perforations 105 of the second cylindrical part 102 of the piece 10.
The distal part of the nail is fixed to the terminal portion of the second bone, by means of two bone screws passed through the distal perforations 67 of the case 6 and the perforations 91 of the distal connection piece 9.
A bone screw 53 makes it possible to connect the bone block to the carriage 5 through the diametrical perforation 52 of the carriage 5 and the rails 61 of the case 6.
The camshaft 3 is then rotated by a known value. Its rotation is transmitted to the threaded rod 2 via the flexible shaft 4, causing the carriage 5 to move to the bearing block A11, 8, the bone screw C2, 53 fixed to the bone plate by sliding along the tracks 61 of the case 6 and ensuring the translational orientation of the transport carriage 5, so that the bone pad is progressively removed from the terminal portion of the first bone.
Performing this operation regularly, the bone callus is formed between the bone block and the end of the first bone, until the missing part of bone is completed.
Once the junction between the bone pad and the end of the second bone and the bone callus has become solid, device 1 can be left on the bone or removed by surgical operation.
The flexible transmission shaft 4 advantageously allows to tilt the threading 51 of the transport carriage 5 in relation to the rest of the bone nail 1, so that the bone screw C2, 53 fixed on the bone block can be inserted along a diameter of the nail 1 .
The flexible transmission shaft 4 also allows a non-zero angle to be formed between the camshaft 3 and the threaded rod 2, in order to adapt the shape of the bone transport nail 1 to its use, for example, in the case of fixation on the jaw for transport or stretching.
An elongation can be obtained by not fixing the distal part of the nail, which in this case does not have a hole to do this.
A second embodiment is shown in figures 6 to 10.
This embodiment is more particularly adapted to the production of distraction or compression rods that can be attached to vertebrae, ribs or pelvis, to correct the spine or chest. It is the reason why, following this description, reference will be made essentially to that application.
The distraction rod 20 comprises a threaded rod 202, a camshaft 203, a flexible drive shaft 204 between the rod rod 202 and the camshaft 203, a movable rod 205 and a housing 206, housing the rod rod 202 and axes 203, 204.
Box 206 forms a first part C1, said reference part. A fixed rod 207 is mounted on the housing 206.
The movable box 205 forms the second part C2, said transport part.
The threaded rod 202 and camshaft 203 are not coaxial. In the illustrated embodiment, the axis of rotation of the threaded rod 202 is substantially parallel to the axis of rotation of the camshaft 203. The movable rod 205 is mounted sliding, inside the housing 206, the sliding axis of the movable rod 205 being sensibly positioned on the plane containing the axes of rotation of the threaded rod 202 and the camshaft 203.
In the illustrated embodiment, the sliding axis of the movable rod 205 extends between the axes of rotation of the threaded rod 202 and the camshaft 203.
The camshaft 203 is in the form of a hollow cylinder, to which a magnet is attached, for example, by means of a silicone-based glue. The camshaft 203 comprises at each of its ends, in alignment, an appendix 231, 232 placed on the camshaft 203.
The movable rod 205 comprises a proximal end part 251 and a distal end part 252. The terms "distal", "proximal" are used in the case with reference to box C1, 206.
The distal end part 252 of the mobile rod 205 is able to receive connection means (not shown), such as hooks, screws or straps, for connection to the bones (in particular vertebrae, ribs or pelvis) to which it is desired to attach over there.
The fixed rod 207 comprises a proximal end part 271 and a distal end part 272. The proximal end part 271 of the fixed rod 207 is fitted in housing C1, 206. The distal end part 272 of the fixed rod 207 is able to receive connection means (not shown), such as hooks, screws or straps, for connection to the bones (in particular vertebrae, ribs or pelvis) to which you want to attach it.
In the illustrated embodiment, the movable rod 205 and the fixed rod 207 are substantially straight and parallel, and can be cut and bent by the surgeon. In other embodiments, not shown, at least one of these elements 205, 207 is provided arched.
The threaded rod 202 is provided with two flat end parts 221, 222 on both sides, and a threaded part 223.
A lens 208 forms a connection means between the transport part C2, 205 and the threaded rod 202. This lens 208, or connecting nut, comprises a threading 281 complementary to the threaded part 223 of the rod 202. The proximal end 251 of the movable rod 205 is shaped to insert, for example, by force into a complementary aperture 282 of lens 208. Protrusions 291, 292 rigidly connected to this lens 208 and substantially symmetrical with respect to aperture 282 cooperate respectively with rails 293, 294 open inside the housing C1, 206 to ensure the rotating orientation of connection nut 208 in relation to reference part C1.
When, in addition to distraction or compression, it is desired to produce a torsion, these protrusions 291, 292 and these rails 293, 294 can advantageously be helical, forcing the progressive rotation of the movable rod 205 as it moves in relation to the box C1, 206 and thus the twisting of the treated spine. Similarly, a helical orientation of the connecting nut is interesting when, in addition to elongating a bone, it is desired to simultaneously correct a twisting deformation of that bone.
The flexible drive shaft 204 connects a first appendix 231 of the camshaft 203 to the smooth end 221 of the threaded rod 202.
Box C1, 206 comprises a cylindrical case 261 in which the camshaft 203 is housed, the second appendix 232 of camshaft 303 is inserted into a recess in the case
261.
The first appendix 231 of the camshaft 203 passes through a first opening 264 of a support part 265, fixed in the cylindrical case 261, for example, by fitting and welding.
A first end 221 of the threaded rod 202 is inserted into a second opening 266 of the support piece 265, so that it will emerge from the same side as the first appendix 231 of the drive shaft 203. The threaded part 223 of the rod 202 then extends, at least partially, on the opposite side of the support part 265.
A first nut 211 forms a first axial pillar C11 of the threaded rod 202. That nut 211, C11 is screwed and welded, for example, by laser welding, to the first end 221 of the threaded rod 202 against the support part 265.
The support part 265 forms a first bearing A11, 5 rigidly connected to the reference part C1, 206.
The flexible shaft 204 is fixed, for example, by welding, on the first appendix 231 of the camshaft 203 and on the first end 221 of the threaded rod
202. The flexible axis 204 then describes a curve, roughly in a circle or U shape.
The housing C1, 206 further comprises a hull 262, forming a housing for the flexible drive shaft 204 The shell 262 is fixed, in turn, to the support piece A11, 265.
The disc 208 is inserted into the case 267, preferably with a slight gap. The lens 208 cooperates with the threaded rod 202 via the thread 281, is fixed on the movable rod C2, 205 and is oriented in rotation through the protrusions 291, 292 cooperating with the rails 293, 294 of the case 267, part of the box C1 .
The case 267 is mounted at one of its ends against the support piece A11, 265. The other end of the case 267 is closed by a cover 268, comprising a first opening 269, leaving the passage for the movable rod 205.
The lid 268 further comprises a second opening 270, housing the second end portion 222 of the threaded rod 202.
5 The cover 268 forms a second bearing A12, rigidly connected to the reference part 206, C1.
An axial locking nut 212 forms a second stop C12 and is inserted over the second end 222 of the threaded rod 202 against the cap 268, A12.
The proximal terminal part 271 of the fixed rod 207 is rigidly connected to the cover A12, 268, for example, by forcibly inserting it into the third opening 273 of the cover A12, 268 and welding the end thereof.
The two cases 261, 267, the shell 262, the support part 265 and the cover A12, 268 forming the box C1, 206 are assembled, for example, by laser welding or gluing.
As shown in Figures 7 to 10, notably, the distraction rod 20 is generally J-shaped, the box C1, 206 forming the rigid and non-moldable part of the device that can be advantageously placed above or below the area referred to by surgical treatment.
The fixed rod 207 can also be attached to the cap 268 in the opposite direction to form an I-shaped rod 20 which is better adapted if it has to be fixed too high and too low on the column.
The housing 206 forms a first part C1, said reference part, the movable rod 205 forms a transport part C2, the pillars C11 and C12 of the threaded rod 202 are formed by the axial pillar nuts 211, 212 placed against the bearings A11 and A12 formed respectively by the support part 265 and the cover 268 of the housing C1, 206.
The lens 208, or connecting nut, forms the connection means between the transport part C2, 205 and threaded rod 202. The means for converting the movement of the connection nut 208 into a displacement of the transport part C2, 205 are formed by a rigid connection between the connection nut 208 and the transport part C2, 205, for example, by forcibly inserting the end part 251 of the transport part C2, 205 into the aperture 282 of the lens 208.
An example of how distractor 20 works is given below.
The distal end part 252 of the movable stem 205 is attached, for example, to a first vertebra, and the distal end part 272 of the fixed stem 207 is attached to a second vertebra, for example, located under the first vertebra. The fixations are made on the concave or convex side of a curvature, depending on the case and depending on whether you want to apply a distraction or compression to the part of the treated column respectively.
A magnetic field in which the magnet is oriented is applied: the rotating magnet drives the camshaft 203. The camshaft rotation 203 is transmitted to the threaded rod 5 via the flexible transmission shaft 204. The lens 208, in connection helical with the threaded rod 202, moves along the threaded part 223 of the rod 202 driving the movable rod C2, 205 in the direction of distraction or compression.
A display ring 220 is advantageously welded on the movable rod C2, 205 and allows to easily visualize the movement performed on an X-ray.
The two vertebrae are thus progressively separated or brought together, inducing a change in the curvature of the spine.
Advantageously, the ability of the stem 20 to evolve in both directions is used to periodically relax the effort applied to the spine, in order to temporarily give back a part of its mobility for a moment and thus delay the degeneration of the discs and the spontaneous fusion generally observed after a few years of maintenance with known fixed materials.
In the case where the variation in the length of the rod 20 is accompanied by a rotation, the distal end part 252 of the movable rod 205 is attached to a vertebra and the distal end part 272 of the fixed rod 207 is attached to the pelvis if it is necessary to correct a torsion of the spine in relation to the pelvis.
5 In the most frequent case of the treatment of scoliosis, they are advantageously combined on the spine to be treated in two opposite directions on both sides of the apex of the curve, whose extreme distal part 252 of the mobile stem 205 is connected to that apex , and the distal extreme part 272 of the fixed rod 207 is fixed respectively, for one, in a vertebra not or slightly turned above the apex and, for the other, in a vertebra not or slightly turned and located below the apex. In this way, it helps simultaneously in the correction and distortion of scoliosis.
In the shown embodiment, camshaft 203 is connected to a single movable rod 205.
In a variant of embodiment, not shown, the second appendix 232 of the 203 camshaft is also attached to a second flexible transmission shaft, which transmits the camshaft rotation to a second threaded rod, causing the displacement of a second rod mobile C2. In use, this second movable rod slides in the direction of travel of the first movable rod C2, 205 and in the opposite direction.
In another use. this second movable rod slides in one direction, forming an angle with the direction of travel of the first movable C2, 205.
The flexible transmission axis 204 thus allows the easy and economical realization of J-shaped or I-shaped rods, which can be indifferently elongated or shortened at any time and whose right part is not cut out and curved by the surgeon in a length compatible with the placement over the spine or the chest.
According to another preferred embodiment, the drive means connecting the camshaft to the threaded rod comprise an indexing device or an intermittent device.
This preferred embodiment will be presented, with reference to figures 11 to 18, in which a distraction or compression rod comprising two movable rods is shown.
The distraction rod 30 comprises two threaded rods 302, a camshaft 303, an intermittent device 304 between each threaded rod 302 and the single camshaft 303, two movable rods 305 and a box
306.
The threaded rods 302 and the camshaft 303 are not coaxial. In the illustrated embodiment, the axes of rotation of the threaded rods 302 are substantially parallel to the axis of rotation of the camshaft 303. The movable rods 305 are mounted sliding, inside the housing 306, the sliding axes of the movable rods 305 5 being substantially arranged on the plane containing the axes of rotation of the threaded rods 302 and the camshaft 303.
In the illustrated embodiment, the axis of rotation of the camshaft 303 is arranged at an equal distance from the axes of rotation of the threaded rods 302.
The camshaft 303 is in the form of a hollow cylinder, to which a magnet is attached, for example, by means of and a silicone-based glue. The camshaft 303 comprises at each end two appendages 331, 332.
A first appendix 331 presents a crescent section, placed substantially on the launch axis of the 303 camshaft. The first appendix comprises a concave peripheral surface 333 and a convex peripheral surface 334. The concave surface 333 crosses the launch axis of the camshaft 303, while the convex surface 334 is coaxial to the launch axis 335.
The second appendix 332 extends substantially parallel to the launch axis 335 of the command axis 303 and the distance from that axis 335.
Each movable rod 305 comprises a proximal end part 351 and a distal end part 352. The terms "proximal" and "distal" are used in the case with reference to box 306.
5 The distal end part 352 is able to receive connection means (not shown), such as screw hooks or straps, on the bones (in particular vertebrae, ribs or pelvis) to which it is desired to be attached.
In the illustrated embodiment, the movable rods 305 are substantially straight and parallel, and can be cut and curved by the surgeon. In other embodiments not shown, at least one of these movable rods 305 can be provided arched.
Each threaded rod 302 is provided with two flat ends 321, 322 on both sides of a threaded part 323.
As shown in figures 11, 12 and 13, the two movable rods 305 extend substantially symmetrically on both sides of the camshaft 303.
Each threaded rod 302 cooperates with a disc 308, provided with a complementary adjustment of the threaded part 323 of the rod 302. The proximal end 351 of each movable rod 305 is shaped to insert, for example, by force into a complementary opening of a disc 308.
Advantageously, disks 308 do not have any symmetry of revolution.
The illustrated box C1, 306 has central symmetry and comprises hulls 361, 362 connected, for example, by screwing.
The box 306 comprises two through holes for the movable rods 305.
The camshaft 303 is placed in a central housing of box 306, the appendices 331, 332 at each end ending in an extreme housing 365.
The assembly of a threaded rod 302 and a movable rod 305 with a disc 308 in housing C1, 306 is done as follows.
A first end 321 of the threaded rod 302 is inserted into an opening of a wall 367 in the box 308 so as to emerge in an extreme housing 365. The threaded part 323 of the stem 302 then extends at least partially on the opposite side of the wall 367. A longitudinal stop, described later, is carried out between the first end part 321 of a stem and the wall 367.
The second end portion 322 of the threaded rod 302 is placed in a reserve 368 of the case 306.
A first nut 311 forms a first stop C11, in reserve 368, forming support A11, to longitudinally lock the threaded rod 302.
The disc 308 cooperating with the rod 302 threaded via regulation 301 and attached to the movable rod 305 is inserted in a sliding connection in a housing in a substantially complementary manner and, preferably, leaving a slight gap.
As in the previous embodiment of the invention, a helical connection can be used in place of the slide connection to act simultaneously on the curvature and the twisting of a scoliosis, connecting each of the movable rods 305 on both sides of the apex of the curvature with vertebrae not or slightly rotated and box C1 at that apex.
When the rotation of the camshaft 303 is transmitted to the threaded rods 302, each disc 308 moves along a threaded rod 302, driving the movable rod 305 integral with the disc 308.
In each extreme housing 365 of box 306, an intermittent device 304 is placed to transmit the rotation of the control shaft 303 to each rod
305.
Each intermittent device 304 comprises means that, when the camshaft 303 performs a complete rotation, the threaded rod 302 with which it cooperates has rotated only in one direction (clockwise or counterclockwise) the corresponding movable rod 305 only being shifted in a single direction.
Each intermittent 304 device can assume two states.
In a first state of actuation, the device 304 with intermittence transmits the rotation of the camshaft 303 to the threaded rod 302, to cause the displacement of the movable rod 305.
In a second state of blocking, the intermittent device does not transmit the rotation of the camshaft 303 to the threaded rod 302, the movable rod 305 remaining immobile in the box 306.
Advantageously, each intermittent device 304 comprises a Geneva 310 wheel mechanism coaxial with the threaded rod 302 on which it is mounted integrally, for example, by forcibly inserting the first extreme end 321 of the threaded rod 302 emerging in the housing 365 end in a central opening of the Geneva 310 wheel mechanism.
The Geneva wheel mechanism also forms an axial stop C12 against the wall 367, forming support A12, so that each threaded rod 302 is blocked in longitudinal translation by the nut C11, 311 and the Geneva wheel mechanism C12 , 310 in support respectively against reserve A11,368 and wall A12, 367.
The Geneva 310 wheel mechanism is in the form of a toothed wheel, in which the teeth are formed by alternating two types of notches: - a short notch 313, in the shape of a semi-circle, with a radius of approximately 5 radius. that of the convex peripheral surface 334 of Appendix 331 in the form of a crescent of the command axis 303; - a long U-shaped notch 314, extending radially over a greater depth than the short notch 313, and of a width substantially equal to the diameter of appendix 332 removed from the camshaft 303.
The operation of the Geneva 310 wheel mechanism in cooperation with the camshaft 303 is detailed in the case, with reference to figures 14 to 18.
In a starting position, a crescent-shaped appendix 331 at a first end of the camshaft 303 is positioned in a first short notch 313 of the cross, the convex surface 334 being in contact with the bottom of the notch 313. The 303 axis control wheel rotates in the short notch 313, without turning the wheel 310: the device 304 with flashing is in the locked position. The camshaft 303 continues to rotate, the appendix 332 left on the first end of the camshaft 303 fits into the long notch 314 adjacent to the first short notch 313,
whereas the convex peripheral surface 334 of appendix 331 in crescent shape makes the notch 313 short and the concave surface 333 comes in front of the bottom of the short notch 313, releasing the short notch 313. The 5 appendix 332 left then drives the wheel 310 in rotation: the device 304 with flashing is in the actuation position.
The camshaft 303 continues to rotate, driving the cross 310, the appendix 332 left sliding along the long notch 314.
When the left appendix 332 leaves the long notch 314, the convex peripheral surface 334 of the crescent appends to the next short notch 313, again blocking the transmission.
In the illustrated embodiment, the two movable rods 305 move in two parallel directions and in two opposite directions. However, the movable rods 305 can move in the same direction. On the other hand, it is possible to form an angle between the movable rods 305 of each extension module, for example, interposing the flexible transmission axis between the device 304 with intermittence and the first extreme part 321 of the rod 302 threaded.
The two movable rods 305 can be of identical length and section or not.
The two intermittent devices are advantageously mounted in opposition. In other words, when one of the 304 intermittent devices is in the transmit state, the other 304 intermittent device is in the blocking state.
In particular, in the case where the intermittent 304 devices each comprise the Geneva 310 wheel mechanism, they are assembled, so that when the appendix 331 in the form of a crescent at one end of the camshaft 303 is positioned in a short notch 313 of the first Geneva 310 wheel mechanism, the appendix 332 removed from the other end is in a notch 314 long of the second Geneva 310 wheel mechanism and conversely.
Box 306 forms a first part C1, said reference part. Each movable rod 305 forms a second part C2 of said transport part.
The connection means, said connection nuts, between the transport parts C2, 305 and the threaded rods 303 are formed by the discs 308, mounted on the threaded rods 302 and oriented in rotation with respect to the reference part 306, C1.
The means for transforming the displacement of the connecting nuts into a displacement of the transport parts 305,
C2 are formed by a rigid connection between these connecting nuts and the transport parts, for example, by forcibly mounting the ends 351 of the rods 305 in an opening of the disks 308.
5 The first axial stop C11 and the second axial stop C12 of each threaded rod 302 are formed by the nut 311 and the Geneva wheel mechanism 310 placed against the supports A11, A12 formed respectively by the reserve 368 and the wall 367 of the box C1, 306.
The intermittent device 304 advantageously allows to introduce a reduction ratio between the control axis 303 and the threaded rods 302. For a complete revolution of the camshaft 303, the threaded rods 302 make only one part of the revolution, the value of which depends on the number of notches of the geneva wheel mechanism 310.
The distraction rod 30 with two movable rods 305 functions as follows.
The distal end portion 352 outside the case 306 of a first movable nail 305 is attached to a part of a patient's limb bone or to a bone. The distal end part 352 outside the housing 306 of the second movable rod 305 is in turn fixed to another part of the bone or another bone.
The patient's limb is then placed in a rotating magnetic field under the effect of which the magnet drives the rotating camshaft 303. A first half-turn of the camshaft 303 causes the displacement of a movable rod 305 5, then the second half-turn causes the displacement of the second movable rod 305.
This arrangement allows the entire torque of the camshaft 303 to be applied to each of the two threaded rods 302, each in turn.
The threaded rods 302 work exclusively in traction, which they work to compress or to cancel the spine or thorax.
Particularly, when the search for a minimum volume of the device has led to a device capable of producing only a small distraction or compression force, it is advantageous to leave a translation gap, either between the threaded rod 302 and the box C1, 306, either between this regulated part that cooperates with the threaded rod 302 and the disc
308. Thus, it will be possible to facilitate the stretching of the distraction rod, manipulating the patient externally, for example, holding him under the shoulders to manually stretch his spine, at the same time that a torque will be applied on the magnet, then relaxing the patient and so on. At each stretch, due to the translational gap, the threaded rod will be momentarily unloaded and will therefore spontaneously rotate under the effect of the torque applied to the magnet, displacing the disc 308, thus preventing the movable rod from resuming its initial position, when the 5 stretch will be relaxed. In this practice, stem 30 no longer produces distraction or compression, but maintains that obtained by external manipulation.
It then refers to figures 19 to 26, representing a fourth embodiment.
The distractor 40 shown in figures 16 to 26 comprises a threaded rod 402, a camshaft 403, a transmission joint 404 between the rod rod 402 and the camshaft 403.
The transmission joint 404 is, for example, formed by a chain of cardan joints.
The distractor 40 has two movable rods 405.
The threaded rod 402 and the camshaft 403 are not coaxial. In the illustrated embodiment, the axis of rotation of the threaded rod 402 is substantially parallel to the axis of rotation of the camshaft403. The movable rods 405 are mounted sliding, inside a box 406, the sliding axes of these movable rods 405 being substantially arranged in the plane containing the axes of rotation of the threaded rod 402 and the control shaft403.
In the illustrated embodiment, the threaded rod 402 extends between and about halfway between the sliding axes of the movable rods 405.
The threaded rod 402 comprises two flat end parts 421, 422 5 on both sides of a threaded part 423.
The camshaft403 is in the form of a hollow cylinder, to which a magnet is attached, for example, by means of a silicone-based glue. At each of its ends, the camshaft contains an axial appendage 431, 432.
The movable rods 504 each have an extreme proximal part and an extreme distal part. The terms "distal", "proximal" are used in the case with reference to box 406.
The distal end 452 of each movable rod 405 is able to receive connection means (not shown), such as hooks, screws, or straps, on the bones (in particular vertebrae, sides or pelvis) to which it is to be attached.
In the embodiment shown, the movable rods 405 are substantially straight and parallel, and can be cut and curved by the surgeon. In other embodiments not shown, at least one of these movable rods 405 can be provided arched.
As shown in the figures, the two movable rods 405 extend substantially symmetrically on both sides of the threaded rod 402.
A connection nut 408 is mounted on the threaded rod 5 402 and is oriented in rotation in relation to the reference part C1, 406. This connection nut 408 ensures the connection between the transport parts C2, 405 and the threaded rod 402. This connection nut 408 is provided with two reserves 409, 410 with opposite openings.
Box 406 forms a main hull 461, two plates 462, 463 and a hull 464.
The main hull 461 comprises a first conduit 465 substantially cylindrical, housing the camshaft403. The main hull 461 comprises a second conduit 466 with three openings. A first movable rod 405a is slidably mounted in a first opening 467.
A second movable rod 405b is slidably mounted in a second opening 468. Connecting nut 408 is slidably mounted in a third opening 469.
The first plate 462 is provided with a first opening 470 through an appendix 431 of the camshaft403. This appendix 431 thus passes through the first plate 462 and is connected to the transmission joint 404. The first plate 462 is provided with a second opening 471 through which the second moving part 405b slides in an F1 direction. The first plate 462 is furthermore provided with a third opening 472 for mounting an end portion 421 of the threaded rod 402. That end portion 421 passes through the first plate 462 and is connected to the transmission joint 404.
The second plate 463 is provided with a first opening 473 through an appendix 432 of the camshaft403. The second plate 463 is provided with a second opening 474 for mounting an end portion 422 of the threaded rod 402. The second plate 463 is further provided with a third opening 475 through which the first movable part 405a slides.
A first nut 411 forms a first stop C11 against the first plate 462, that first plate 462 forming a first support A11, to longitudinally lock the threaded rod 402.
A second nut 412 forms a second stop C12 against the second plate 463, that second plate 463 forming a second support A12 to longitudinally lock the threaded rod 402.
The first movable part 405a is provided, in its proximal extreme part 451, with a through hole 453 for the passage of a first mechanism with tongue 455.
The second movable part 405b is also provided, in its proximal extreme part 451, with a through hole 456 through a second mechanism with tongue 457.
The first mechanism with tongue 455 comprises a tongue 458 movable against an elastic means, such as a spring, not shown, that tongue being provided with a locking ramp 460.
The second tongue mechanism 457 comprises a tongue 459, that tongue 459 being movable against an elastic means, such as a spring, not shown.
On each of the two moving parts 405a, 405b, a ring 480 is advantageously welded, allowing to easily visualize the completed movement on an X-ray.
In a first extreme position, shown in figure 22, the second mechanism with tongue 457 is at a stop in a reserve 410 of the connecting nut 408.
The rotation of the camshaft 403 is transmitted to the threaded rod 402 by the transmission joint 404. The rotation of the threaded rod 402 causes the connection nut 408 to move.
The displacement of the connection nut 408 triggers the exit slide of the second moving part C2, 405b, according to the F1 direction, from the extreme entry position of this transport part C2, 405b, shown in figure 22, until its extreme exit position shown in the figure
25, two intermediate positions being represented in figures 23 and 24.
When the second transport part C2, 405b is in the extreme exit position, the tongue 459 of the second mechanism 5 with tongue 457 comes to be housed in a reserve, for example, a through hole 413, of the reference piece C1, 406. This state is represented in the figure
25. The exit movement of the tongue 459 is, for example, caused by a compression spring, not shown.
Advantageously, when the tongue 459 associated with the second transport part 405b is in an exit position and locked in relation to the reference part C1, 406, the tongue 458 associated with the first transport part 405a is housed in the reserve 409 of the connection nut 408 and the first transport part 405a is in the extreme entry position. The locking ramp 460 facilitates the entry of the tongue 458 in stop at the reserve 409 of the nut 408.
Thus, a rotating movement of the camshaft403 causes the first movement part 405a to move out, in the direction F2, from its extreme entry position, shown in figure 25, to its extreme exit position (not shown), an intermediate position being shown in figure 26. When the first transport part 405a moves out, the second transport part 405b remains in position by blocking the tongue 459 in the reserve 413 of the box 406.
The box 406 forms a first part C1, said reference piece, the movable rods 405a, 405b form two transport parts 5 C2, the stops C11 and C12 of the threaded rod 402 are formed by the nuts 411, 412 of axial stop placed against the supports A11 and A12 formed respectively by plates 462, 463 of box C1, 406.
The connection means between each transport part 405a, 405b and the threaded rod 402 is formed by a connection nut 408 mounted on the threaded rod 402 and oriented in rotation with respect to the reference piece 406, C1.
The means for transforming the displacement of that connecting nut 408 into a displacement of each transport part 405a, 405b comprises two tabs 458, 459 of advantageously similar structures.
This preferred embodiment of the invention offers an important elongation potential in a particularly compact volume and furthermore allows the successive control of the movable rods 405a, 405b.
In the described embodiments, the control is carried out thanks to a magnet integrated in the device.
Advantageously, this magnet is a neodymium magnet having an allowable operating temperature of approximately
150 ºC to allow sterilization of this device by all means and notably to steam superheated to 134 ºC, without risk of deterioration of this permanent magnet.
A rotation of the magnet can be easily achieved, 5 by bringing a magnetic dipole close to the magnet, which acts through the patient's body tissues. When the dipole has completed a complete revolution, the magnet will also have completed a complete revolution. Thus, no part of the device protrudes outside the patient's body.
Gear trains can be interposed between the camshaft and the driveshaft, and / or between the camshaft and the threaded rod, in order to achieve reduction ratios between the camshaft and the threaded rod. In the case where a single magnet controls two movable rods, different reduction ratios can advantageously allow different displacements, although proportional in one direction and another.
The devices shown allow the displacement of tissues, in the direction of distraction or compression, or alternating one and the other using a restricted number of pieces.
The use of a flexible transmission shaft, allowing to get rid of the alignment of the camshaft with the threaded rod, the general shape of the device can adapt as much as possible to the shape of the tissues in which it is implanted.
The flexible shaft also allows for a device with a double direction if it is attached to its two ends or use one of its ends as a friction spring that will allow the rotation of the threaded rod in one direction, which tends to tighten the spring, but not in the opposite direction in which the spring will slip.
Eventually, a complementary system for blocking rotation in one direction can be introduced, for example, by means of springs or bearings. Examples of such locking systems are given in the documents USER 5 505 733 and WO 2004/019796.
The use of threaded rod 2, 202, 302, 402 in traction allows to eliminate the influence of buckling on the sizing of the rod. It is therefore possible to reduce the diameter of the threaded rod in relation to devices working in compression.
The device, according to the invention, is advantageously made of mechanically resistant materials and well tolerated by the body, such as stainless steels such as 316L, titanium alloys, polymers such as Poly-Ether-Ketone (PEEK) or, preferably , as high performance alloys based on chromium and cobalt such as, for example, the austenitic alloy marketed by the company Arcelor Mittal under the name PHYNOX (AFNOR designation: K13C20N16Fe15D07) of Nickel and Cobalt, such as the VALLOY-120 specific to 5 EFAB process.
On the other hand, the surfaces subjected to friction of this device, in particular, the threaded rod, can advantageously receive an anti-wear surface treatment and / or decreasing its friction coefficient based on amorphous diamond or tungsten disulfide carbon, for example.
Thus, the combination of the small diameter of the threaded rod, allowed by its work in traction and the low coefficient of friction obtained, thanks to these surface treatments allows the activation of the threaded rod by a modest torque in relation to the applied load and the use of simple means for creating this torque, such as permanent magnet transmission of efforts applied directly to the hand.
The diameter of the threaded rod 2, 202, 302, 402 is commonly between one and three millimeters and does not exceed 4 millimeters for an adult patient prosthesis, for example.
The device, according to the invention, can advantageously be made without connection, for example, by the EFAB technique, proposed by the Microfabrica company, with the exception of a first trap door on the reference part and a second trap door on the structure that surrounds the magnet, trap doors 5 that allow the magnet to be inserted and glued. This embodiment will be particularly advantageous for maxillofacial, cardiac and hand surgery of the device, according to the invention, which require extreme compactness.
Possibilities for industrial application The device, according to the invention, is particularly useful for making nails for the correction of the spine or thorax, nails and elongation or bone transport plates and enlarged prostheses.
The devices, according to the invention, also find application in the stretching or extension and deformation of soft tissues, such as a part of the intestine, or even for arterial involvement, the valvuloplasty rings with evolutionary geometry, the gastric rings.

权利要求:
Claims (16)
[1]
1. Tissue displacement device within an organism, notably bone tissue, that device comprising: 5 - a first part (6, 206, 306, 406), said reference part (C1); - a second part (53, 205, 305, 405), said transport part (C2), mounted sliding in relation to the reference part (C1); - a rod (2, 202, 302, 402) comprising at least one fillet, said filleted rod, mounted rotatable in relation to the reference piece (C1); - a control tree (3, 203, 303, 403); - drive means (4, 202, 304, 404) connecting the control shaft to the threaded rod; - a connection means, said connection nut (5, 208, 308, 408), between the transport piece (C2) and the threaded rod, that connection nut being mounted on the threaded rod and being oriented in rotation with respect to the reference part (C1); - means of transforming the displacement of the connecting nut along the threaded rod into a displacement of the transport part (C2) in relation to the reference part (C1),
this device being characterized by the fact that, to limit the longitudinal translation of this threaded rod in relation to the reference piece (C1), a first stop (C11) and a second stop (C12) attached to the threaded rod 5 cooperate respectively with a first support (A11) and a second support (A12), these supports being solidary to the reference piece (C1) and being placed at a distance from each other between these stops (C11, C12), the connection nut being able to move to the along the threaded rod between the first support (A11) and the second support (A12).
[2]
2. Device according to claim 1, characterized in that the actuating means comprise at least one helical spring.
[3]
3. Device according to claim 1 or 2, characterized in that the actuation means comprise an intermittent device (304) attached to the threaded rod (302) and activated in motion by the control tree (303), this device with flashing (304) being able to transform a continuous rotation movement of the camshaft (303) into an intermittent movement of the threaded rod (302).
[4]
4. Device according to claim 3, characterized in that the actuation means include a Maltese cross (310) attached to the threaded rod (302).
[5]
Device according to any one of claims 1 to 4, characterized in that the transformation means include a rigid connection between the connecting nut and the transport piece.
[6]
6. Device, according to claim 5, characterized in that the rotating orientation of the connection nut in relation to the reference part is a helical orientation, such that this connection nut rotates from an angle between 10 and 180º, when moves from that first (A11) to that second support or vice versa (A12).
[7]
Device according to any one of claims 1 to 6, characterized in that it comprises two transport pieces (305) and two filleted rods (302).
[8]
8. Device according to claim 7, characterized in that the filleting of the two filleted rods has different diameter, direction, or pitch characteristics.
[9]
Device according to any one of claims 1 to 8, characterized in that the diameter of the threaded rod (s) (2, 202, 302, 402) is less than 4 mm.
[10]
10. Device according to any one of claims 7 to 9, characterized in that the transport parts (305, C2) are controlled by a common control tree (303).
[11]
11. Device according to any one of claims 1 to 00, characterized in that at least one transport piece (205, 305, 405) is provided with means of connection to the bones, such as hooks, screws or straps.
[12]
12. Device according to any one of claims 1 to 11, characterized in that the camshaft (3, 203, 303, 403) comprises a permanent magnet, the magnetization direction of which is substantially perpendicular to the axis of rotation of this command.
[13]
13. Device according to any one of claims 1 to 12, characterized in that the threaded rod (2) has its axis of rotation substantially parallel and distant to the axis of rotation of the camshaft (3), and the reference piece ( C1) comprising a case (6), in which a bone transport cart (5) slides on which a transport part (53) is mounted, and the bone transport cart (5) is provided with a perforation (51) longitudinal regulated through, far from the axis of the case (6), this perforation being complementary to the fillet of the threaded rod (2).
[14]
14. Device according to claim 13, characterized in that the bone transport carriage (5) 5 is provided with a diametrical perforation (52) that houses a bone screw (53) that forms a transport piece, this screw with bone (53) being mounted sliding on two longitudinal parallel rails (61) of the case (6).
[15]
Device according to any one of claims 1 to 12, or according to claim 14, characterized in that it comprises a single threaded rod (402), the transformation means being able to transmit a displacement of the connecting nut (408) in a first direction of displacement, in a slide of a first transport piece (405a, C2) in relation to the reference piece (406, C1) even to an extreme position, the device comprising means for locking the first piece (405a, C2) in that extreme position.
[16]
16. Device according to claim 15, characterized in that the transformation means are able to transmit a displacement of the connecting nut (408) in a second direction of displacement opposite to that first direction, in a slide of a second piece (405b, C2) in relation to the reference part (406,
C1).

类似技术:

---

公开号 | 公开日 | 专利标题

---

BR112012005337A2|2020-09-24|intracorporeal device for the desolation of tissues.

---

ES2449694T3|2014-03-20|Multifunctional external fixator

---

JP6073137B2|2017-02-01|Non-union scoliosis expandable spinal rod

---

JP6001551B2|2016-10-05|Non-union scoliosis expandable spinal rod

---

ES2529123T3|2015-02-17|External orthopedic fixator for elbow joint

---

ES2639014T3|2017-10-25|Skeleton handling system

---

US20100094302A1|2010-04-15|Spinal distraction system

---

BRPI1101077B1|2020-06-09|device for the displacement of tissues, especially bone tissues

---

US20200155201A1|2020-05-21|Magnetic implants with improved anatomical compatibility

---

US10925649B2|2021-02-23|Articulating rod inserter

---

BR112017013834A2|2019-11-19|distraction systems and methods

---

US11241257B2|2022-02-08|Spinal distraction system

---

WO2018130202A1|2018-07-19|Scoliosis correction system having single central rod

---

ES2875848T3|2021-11-11|Interspinous Process Implant with Pin Actuated Coupling Arms

---

CN208910451U|2019-05-31|Multi-functional wing external malleolus dissects lockplate

---

WO2009062522A2|2009-05-22|Bone lengthening plate

---

US20210346060A1|2021-11-11|Modular frame

---

US20210282995A1|2021-09-16|Scoliosis Correction Table

---

KR100501248B1|2005-07-18|Fixings with self-adjusting compression for structures of the spine

---

TWM459840U|2013-08-21|Bracket structure for external fixation

---

RU2252738C2|2005-05-27|Device for taking anti-schock measures

---

BR122012024666A2|2019-07-30|SPINAL SURGERY DEVICE AND METHOD

---

MX2012008572A|2014-01-23|Radiolucent wrist axial clamp.

同族专利:

---

公开号 | 公开日

---

JP2013504353A|2013-02-07|

---

FR2949662B1|2011-09-30|

---

CN102724926A|2012-10-10|

---

US9113967B2|2015-08-25|

---

KR101888573B1|2018-08-16|

---

JP5988162B2|2016-09-07|

---

EP2475315A1|2012-07-18|

---

EP2475315B1|2018-02-07|

---

CA2773041C|2014-05-13|

---

CN102724926B|2015-04-29|

---

AU2010294140A1|2012-05-03|

---

FR2949662A1|2011-03-11|

---

SG179058A1|2012-04-27|

---

WO2011030015A1|2011-03-17|

---

ES2663713T3|2018-04-16|

---

AU2010294140B2|2014-01-09|

---

KR20120099634A|2012-09-11|

---

US20120179215A1|2012-07-12|

---

MY159852A|2017-02-15|

---

IN2012DN02089A|2015-08-21|

---

CA2773041A1|2011-03-17|

引用文献:

---

公开号 | 申请日 | 公开日 | 申请人 | 专利标题

---

---

US2672861A|1952-12-30|1954-03-23|Jonas Salo|Self-retaining medullary extension splint|

---

CH581988A5|1974-04-09|1976-11-30|Messerschmitt Boelkow Blohm|

---

DE8515687U1|1985-05-29|1985-10-24|Aesculap-Werke Ag Vormals Jetter & Scheerer, 7200 Tuttlingen|Distraction device for extension osteotomy|

---

FR2632514B1|1988-06-09|1990-10-12|Medinov Sarl|PROGRESSIVE CENTRO-MEDULAR NAIL|

---

DE3921972C2|1989-07-04|1994-06-09|Rainer Dr Med Baumgart|Intramedullary nail|

---

US5112333A|1990-02-07|1992-05-12|Fixel Irving E|Intramedullary nail|

---

US5350379A|1993-02-18|1994-09-27|Genesis Orthopedics|Bone and tissue lengthening device|

---

EP0636346A1|1993-07-23|1995-02-01|Massimo Santangelo|Device for preventive support of the femur|

---

US5505733A|1993-10-22|1996-04-09|Justin; Daniel F.|Intramedullary skeletal distractor and method|

---

FR2717371B1|1994-03-17|1996-05-31|Medinov Sa|Device for transporting a bone fragment between two parts of bone.|

---

US6336929B1|1998-01-05|2002-01-08|Orthodyne, Inc.|Intramedullary skeletal distractor and method|

---

US5704939A|1996-04-09|1998-01-06|Justin; Daniel F.|Intramedullary skeletal distractor and method|

---

GB9806999D0|1998-04-02|1998-06-03|Univ Birmingham|Distraction device|

---

FR2794357B1|1999-06-01|2001-09-14|Frederic Fortin|DISTRACTION DEVICE FOR BONES OF CHILDREN HAVING HANGING AND ADJUSTMENT MEANS FOR TRACKING GROWTH|

---

FR2805451B1|2000-02-29|2002-04-19|Arnaud Andre Soubeiran|IMPROVED DEVICE FOR MOVING TWO BODIES IN RELATION TO ONE ANOTHER, PARTICULARLY FOR REALIZING IMPLANTABLE SYSTEMS IN THE HUMAN BODY|

---

GB0009107D0|2000-04-13|2000-05-31|Univ London|Surgical distraction device|

---

FR2822050B1|2001-03-13|2003-07-25|Arnaud Andre Soubeiran|DEVICE FOR MOVING IN ONE SENSE ON A DIRECTION DELTA A PORTION OF BONE IN RELATION TO ANOTHER|

---

JP4175899B2|2001-05-23|2008-11-05|オーソゴンテクノロジーズ２００３リミテッド|Magnetically driven intramedullary device|

---

FR2843538B1|2002-08-13|2005-08-12|Frederic Fortin|DEVICE FOR DISTRACTING AND DAMPING ADJUSTABLE TO THE GROWTH OF THE RACHIS|

---

FR2843875B1|2002-08-30|2004-10-08|Arnaud Andre Soubeiran|IMPLANTABLE DEVICE FOR TRANSFORMING ON DEMAND ALTERNATE COUPLES APPLIED BY MUSCLE FORCE BETWEEN TWO WORKPIECES IN A MOVEMENT OF TWO BODIES RELATIVELY TO ONE ANOTHER|

---

US20050261779A1|2003-11-17|2005-11-24|Meyer Rudolf X|Expansible rod-type prosthesis and external magnetic apparatus|

---

FR2872020B1|2004-06-29|2006-12-15|Frederic Fortin|SCOLIOTIC AUTOCORRECTION DEVICE REQUIRING MORE INTERVENTIONS AFTER IMPLANTATION|

---

US7481841B2|2004-06-30|2009-01-27|Depuy Products, Inc.|Adjustable orthopaedic prosthesis and associated method|

---

US7559951B2|2004-09-30|2009-07-14|Depuy Products, Inc.|Adjustable, remote-controllable orthopaedic prosthesis and associated method|

---

FR2891727B1|2005-10-06|2008-09-26|Frederic Fortin|PERFECTED AUTOBLOCATION DEVICE FOR COSTAL DISTRACTION DEVICE|

---

FR2892617B1|2005-11-02|2008-09-26|Frederic Fortin|DAMPING DISPLACEMENT DEVICE AND CORRECTION ADJUSTABLE TO THE GROWTH OF THE RACHIS|

---

FR2900563B1|2006-05-05|2008-08-08|Frederic Fortin|ADJUSTABLE SCOLIOSIS RECTIFIER DEVICE|

---

FR2901991B1|2006-06-13|2021-07-09|Arnaud Andre Soubeiran|INTRACORPAL EXTENSION DEVICE MOUNTED IN TENSILE SCREW|

---

FR2906453B1|2006-10-03|2009-03-06|Arnaud Andre Soubeiran|INTRA-BODY LIFTING DEVICE WITH PERMANENT MAGNET.|

---

FR2916622B1|2007-05-28|2009-09-04|Arnaud Andre Soubeiran|IMPLANTABLE DISTRACTOR WITH MODIFIABLE LENGTH WITHOUT REOPERATION IN J-SHAPE|

---

GB0915382D0|2009-09-03|2009-10-07|Dalmatic As|Expansion devices|

---

KR101740218B1|2009-09-04|2017-05-25|누베이시브 스페셜라이즈드 오소페딕스, 인크.|Bone growth device and method|

---

KR20120123298A|2009-12-01|2012-11-08|신세스 게엠바하|Non-fusion scoliosis expandable spinal rod|

---

FR2957776B1|2010-03-23|2013-02-15|Arnaud Andre Soubeiran|DEVICE FOR MOVING TISSUES INSIDE THE ORGANISM, ESPECIALLY BONE TISSUES, WITH FIXED TRACTION SCREWS AND ROTATING NUT|US7862502B2|2006-10-20|2011-01-04|Ellipse Technologies, Inc.|Method and apparatus for adjusting a gastrointestinal restriction device|

---

US20090112262A1|2007-10-30|2009-04-30|Scott Pool|Skeletal manipulation system|

---

US11202707B2|2008-03-25|2021-12-21|Nuvasive Specialized Orthopedics, Inc.|Adjustable implant system|

---

US8382756B2|2008-11-10|2013-02-26|Ellipse Technologies, Inc.|External adjustment device for distraction device|

---

US8197490B2|2009-02-23|2012-06-12|Ellipse Technologies, Inc.|Non-invasive adjustable distraction system|

---

US9622792B2|2009-04-29|2017-04-18|Nuvasive Specialized Orthopedics, Inc.|Interspinous process device and method|

---

KR101740218B1|2009-09-04|2017-05-25|누베이시브 스페셜라이즈드 오소페딕스, 인크.|Bone growth device and method|

---

KR20120123298A|2009-12-01|2012-11-08|신세스 게엠바하|Non-fusion scoliosis expandable spinal rod|

---

US8777947B2|2010-03-19|2014-07-15|Smith & Nephew, Inc.|Telescoping IM nail and actuating mechanism|

---

FR2957776B1|2010-03-23|2013-02-15|Arnaud Andre Soubeiran|DEVICE FOR MOVING TISSUES INSIDE THE ORGANISM, ESPECIALLY BONE TISSUES, WITH FIXED TRACTION SCREWS AND ROTATING NUT|

---

US9248043B2|2010-06-30|2016-02-02|Ellipse Technologies, Inc.|External adjustment device for distraction device|

---

US8734488B2|2010-08-09|2014-05-27|Ellipse Technologies, Inc.|Maintenance feature in magnetic implant|

---

WO2012071373A1|2010-11-22|2012-05-31|Synthes Usa, Llc|Non-fusion scoliosis expandable spinal rod|

---

US8715282B2|2011-02-14|2014-05-06|Ellipse Technologies, Inc.|System and method for altering rotational alignment of bone sections|

---

AU2012256356B2|2011-05-16|2016-11-17|Smith & Nephew, Inc.|Measuring skeletal distraction|

---

DE102011053638A1|2011-09-15|2013-03-21|Wittenstein Ag|Mark Nagel|

---

US10743794B2|2011-10-04|2020-08-18|Nuvasive Specialized Orthopedics, Inc.|Devices and methods for non-invasive implant length sensing|

---

WO2013066946A1|2011-11-01|2013-05-10|Ellipse Technologies, Inc.|Adjustable magnetic devices and methods of using same|

---

US10675064B2|2011-12-12|2020-06-09|Children's Hospital Medical Center Of Akron|Distraction Osteogenesis system|

---

TR201202107A2|2012-02-24|2012-12-21|İstemi̇ Alp Yücel İrşadi̇|Extending nails.|

---

US8808328B2|2012-04-05|2014-08-19|Tufts Medical Center, Inc.|Spring loaded mechanism for managing scoliosis|

---

US9044281B2|2012-10-18|2015-06-02|Ellipse Technologies, Inc.|Intramedullary implants for replacing lost bone|

---

CN104902854B|2012-10-29|2017-10-03|诺威适骨科专科公司|The adjustable apparatus scorching for treating knee endoprosthesis|

---

EP2916742B1|2012-11-12|2018-08-29|Ziran, Navid|Dynamic axial nail for intramedullary treatment of long bone fractures|

---

DE102012023042B3|2012-11-26|2013-11-28|Spontech Spine Intelligence Group Ag|Expandable cage for interbody fusion of lumbar vertebrae|

---

US10751094B2|2013-10-10|2020-08-25|Nuvasive Specialized Orthopedics, Inc.|Adjustable spinal implant|

---

JP5881922B2|2014-02-12|2016-03-09|オリンパス株式会社|Treatment tool|

---

WO2015168175A1|2014-04-28|2015-11-05|Ellipse Technologies, Inc.|System for informational magnetic feedback in adjustable implants|

---

DE102014112573A1|2014-09-01|2016-03-03|Wittenstein Ag|Mark Nagel|

---

CN104287874B|2014-10-22|2017-05-03|广州新诚生物科技有限公司|Extendable prosthesis for children|

---

BR112017013834A2|2014-12-26|2019-11-19|Nuvasive Specialized Orthopedics Inc|distraction systems and methods|

---

US10238427B2|2015-02-19|2019-03-26|Nuvasive Specialized Orthopedics, Inc.|Systems and methods for vertebral adjustment|

---

US20160256140A1|2015-03-03|2016-09-08|United States Endoscopy Group, Inc.|Microforceps|

---

DE102015109624A1|2015-06-16|2016-12-22|Wittenstein Se|Mechatronic implant|

---

CN113425401A|2015-10-16|2021-09-24|诺威适骨科专科公司|Adjustable device for treating gonitis|

---

FR3044888A1|2015-12-09|2017-06-16|Ecole Nat Superieure De Techniques Avancees|PLATE DISTRACTOR AND ASSEMBLY OF SUCH A PLATE DISTRACTOR AND AN ACTIVATION TOOL|

---

CN108601611B|2015-12-10|2021-11-02|诺威适骨科专科公司|External adjustment device for a tensioning device|

---

EP3407812B1|2016-01-28|2020-07-01|NuVasive Specialized Orthopedics, Inc.|Systems for bone transport|

---

US10888357B2|2016-02-29|2021-01-12|Warsaw Orthopedic, Inc.|Spinal implant system and method|

---

CN106308901B|2016-08-31|2019-06-07|山东威高骨科材料股份有限公司|A kind of growth period spinal orthosis|

---

WO2018125980A1|2016-12-30|2018-07-05|Smith & Nephew, Inc.|Bone transport nail|

---

CN106726011B|2017-03-28|2019-06-28|郭文来|Children's property metacarpal bone implantable prosthese|

法律状态:
2020-10-06| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

---

2020-10-13| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

---

2021-01-26| B11B| Dismissal acc. art. 36, par 1 of ipl - no reply within 90 days to fullfil the necessary requirements|

---

2021-11-23| B350| Update of information on the portal [chapter 15.35 patent gazette]|

优先权:

---

申请号 | 申请日 | 专利标题

---

FR0904306|2009-09-09|

---

FR0904306A|FR2949662B1|2009-09-09|2009-09-09|INTRA-BODY DEVICE FOR MOVING TISSUE|

---

PCT/FR2010/000608|WO2011030015A1|2009-09-09|2010-09-07|Intracorporeal device for moving tissue|

---