• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    BONE SCREW SET AND INSTRUMENTS FOR IMPLEMENTING THE SAME This is a bone screw that includes a screw rod extending longitudinally along a screw axis and a screw head extending from a proximal end of the screw rod and configured to be releasably coupled to a surgical tool. The bone screw also includes a through hole defined an axis intersects the screw axis at an acute angle, the through hole is adapted to receive a second screw and tapers from a first end of the screw head to a second end opening to a external surface of the screw head.
    公开号:BR112012028705B1
    申请号:R112012028705-2
    申请日:2011-05-09
    公开日:2020-10-13
    发明作者:Tom Overes；Silas Zurschmiede；Daniel Fluri
    申请人:Synthes Gmbh；
    IPC主号:
    专利说明:

    PRIORITY CLAIM
    [0001] The present invention claims priority for US Provisional Application. No. 61 / 334,234 filed on May 13, 2010 and entitled "Bone Screw Assembty and Implantation of the Same", the entire description of which is incorporated herein by reference. TECHNICAL FIELD OF THE INVENTION
    [0002] The present invention generally relates to sets of bone screws and instruments for implanting them, as well as an associated method for implanting the set of bone screws using the instruments. More particularly, the invention relates to a bone screw including second screw and insertion instruments for implanting them, as well as a method for implanting the bone screw and second screw using the insertion instruments. BACKGROUND OF THE INVENTION
    [0003] In the field of orthopedic surgery, bone fixation devices using bone screws are generally used. Such bone fixation devices include bone plates, intervertebral implants, or intramedullary nails through which two or more bones or bone fragments are fixed together. Typically, bone fixation devices comprise bone anchors mainly in the form of bone screws, pins or nails through which bones or bone fragments are attached to the bone plate, intervertebral implant or intramedullary nail and consequently fixed to each other. A problem that can arise in the case of the bone fixation devices mentioned above is that the bone screws, pins or nails can, for example, become dislodged in the bone or bone plate, intervertebral implant or intramedullary nail during normal patient movements.
    [0004] Thus, there remains a need for an improved bone anchor device for use in bone fixation that allows drilling a hole for a fixation screw in a bone at a particular angle with respect to the axis of a bone fixator and for inserting the bone screw. fixation in a guided manner. SUMMARY OF THE INVENTION
    [0005] The present invention relates to a bone screw with a screw head configured to be releasably coupled to an instrument or surgical tool so that the instrument or surgical tool is coaxially supported in a first position and can be articulated in a guided manner around an axis extending diametrically to the screw head in a second position.
    [0006] According to an exemplary embodiment of the present invention, the bone screw comprises a screw axis, a rod to be anchored in a bone and a screw head including a through hole with a through hole axis cutting through the bone screw axis at an acute angle and the through hole is adapted to receive a second screw that can be anchored to the bone as well. The screw head comprises a transverse channel with a channel axis that extends diametrically through the screw head and the transverse channel is open at the rear end of the bone screw. The screw head of the bone screw still includes a recess that has - in at least one cross section orthogonal to the channel axis - a circularly curved edge with a center located at the point where the through hole axis cuts the screw axis.
    [0007] One of the advantages of the bone screw according to the invention is that the configuration of the transverse channel and the recess allow an orientation guide with a tip complementarily configured to be coupled to the screw head and rotated around an axis of rotation from a first position aligned with the screw axis to a second position aligned with the through hole axis. Another advantage of the bone screw is the articulating joint of the screw head and the guidance guide. The guidance guide can be inserted into the incision coaxially to the screw axis of the bone screw using a tissue protection tube and wire guide and attached to the screw head. After removing the fabric protection tube and the guide wire, the orientation guide can be rotated around the axis of rotation. In addition, the guidance guide can then be rotated to a second position in which the longitudinal axis of the guidance guide is aligned with the through hole axis of the through hole in the screw head so that a hole for the second screw can be drilled into the bone that is exactly aligned with the through hole in the screw head; the hole for the second screw can be drilled in a completely guided manner and the second screw can be positioned in a guided manner by means of the guidance guide. Another advantage is that the transverse channel and the recess allow a complementary tip of a screwdriver to be attached to the bone screw in such a way that the screwdriver is positioned coaxially to the screw axis of the bone screw.
    [0008] In an exemplified bone screw embodiment, the through-hole axis cuts the screw axis at a depth T> O measured from the rear end of the bone screw towards the screw stem.
    [0009] In another exemplified embodiment of the bone screw, the recess has a constriction at the rear end of the bone screw. Thus, the recess forms a female connector for a plug-in connection with a respective male connector arranged on an instrument or surgical tool.
    [00010] In an additional exemplified embodiment of the bone screw, the through hole comprises an internal thread, preferably a conical internal thread. This allows for the advantage that the second screw can be firmly connected to the screw head of the bone screw.
    [00011] In another exemplified bone screw modality, the internal thread has a P thread spacing and an LT thread length and where the LT / P ratio is at least 2.0, preferably at least 2.3. This internal thread configuration allows rigid and angularly stable anchoring of the screw head of the second screw to the screw head of the bone screw.
    [00012] In yet another exemplified modality of the bone screw, the recess has a spherical shape with a radius of sphere R. This recess configuration allows an instrument or surgical tool to be articulated around an axis that extends through the point where the through hole axis and the screw axis intersect so that the instrument or tool can be pivoted from a first position aligned with the screw axis to a second position aligned with the through hole axis.
    [00013] In an additional exemplified embodiment, the bone screw still comprises a second screw that can be inserted into the through hole coaxially to the through hole axis.
    [00014] In another exemplified embodiment of the bone screw, the second screw has a conically threaded head that can be joined with the internal conical thread in the through hole.
    [00015] In yet another exemplified embodiment of the bone screw, the recess includes a depression crossing the constriction and forming a part of the wall in the form of a surface section of a cylinder, cone or prism whose axis coincides with the through-hole axis . By means of the depression, an interruption of the rotation of an instrument or tool inserted in the recess in the screw head of the bone screw is provided so that the instrument or tool can be exactly aligned with the through hole for the second screw.
    [00016] In another exemplified embodiment of the bone screw, angle a is at least 10 °, preferably at least 20 °.
    [00017] In yet another exemplified embodiment of the bone screw, angle a is a maximum of 70 °, preferably a maximum of 35 °
    [00018] In yet another exemplified embodiment of the bone screw, the transverse channel has a U-shape in a cross section orthogonal to the channel axis. The U-shaped channel may have a semicircular bottom with a radius of curvature rc, where the center of the semicircular edge of the transverse channel is located on the channel axis. The channel axis can be located at a depth Tc measured from the rear end of the bone screw towards the screw shank, where the depth Tc is equal to or greater than the depth T of the point where the through hole axis cuts the axis of screw. In a particular configuration of the transverse channel, the channel axis cuts the screw axis through the point where the through hole axis and the screw axis intersect, that is, Tc = T. In this case, the semicircular bottom defines a base coaxially to the recess to rotationally receive cylindrical pins of an orientation guide which have a pin diameter equal to twice the radius of curvature rc of the semicircular bottom of the transverse channel. In the case of a spherical recess, the rotatable movement of the guidance guide is limited to a uniaxial articulated movement due to the pins that engage the transverse channel.
    [00019] In an additional exemplified embodiment of the bone screw, the channel axis cuts the screw axis through the point at which the screw axis and through hole axis intersect.
    [00020] In yet another exemplified additional embodiment of the bone screw, the screw head of the bone screw comprises an external thread designed in such a way that the bone screw can be countersunk on a bone. The external thread on the screw head is preferably tapered so that the screw head can be countered in the bone. This configuration is particularly useful if the bone screw is used as a locking screw for an intramedullary nail.
    [00021] In another exemplified embodiment of the bone screw, the screw head of the bone screw has a longitudinal slit so that the screw head is radially elastically expandable. The screw head can be shaped like a segment of a sphere so that the bone screw can be inserted into a hole complementarily formed in a bone plate or other implant at an angle desired by the surgeon. Once the bone screw is correctly positioned, the second screw can be inserted until the head of the second screw expands the screw head of the bone screw in the hole allowing to hold the bone screw at an angle selected by the surgeon in relation to a bone plate or other implant.
    [00022] In accordance with another aspect of the present invention, a screwdriver is provided to screw the above bone screw into a bone. The screwdriver essentially comprises a male connector terminally disposed at the front end which is suitable to be coupled to the recess in the screw head of the bone screw. In addition, the connector includes a tip with constriction towards the front end of the screwdriver and two direction protrusions diametrically projecting over the tip in any direction and defining a central axis that extends orthogonal to the longitudinal axis of the screwdriver. The targeting protrusions fit into the transverse channel in the screw head of the bone screw. In at least one cross section orthogonal to the central axis, the tip has a circularly curved periphery with a radius R and a center located on the longitudinal axis. The targeting protrusions can be in the form of pins or blades. In the case of blade-shaped steering protrusions, the tips of the blades define the central axis. In the case of pin protrusions, the pin axes define the central axis.
    [00023] In an exemplified embodiment, the screwdriver further comprises a longitudinal slot extending parallel to the longitudinal axis and which is open at the front end so that the connector is radially elasticly compressible. In addition, the tip has a constriction towards the stem that forms at least in a cross section orthogonal to the central axis a curved contact support. Thus, the connector forms a male connector for a plug-in connection with a corresponding female connector disposed on the bone screw.
    [00024] In an additional exemplified mode of the screwdriver, the tip has a spherical shape with a radius of the sphere R and with a center located on the longitudinal axis.
    [00025] In an additional exemplified mode of the screwdriver, the two steering protrusions have a cylindrically circular shape where the central axis cuts orthogonally the longitudinal axis through the center of the spherical tip.
    [00026] In another exemplified form of the screwdriver, the male connector still comprises an axial stop located at a distance T measured from the central axis towards the nail so that the stop comes in contact with the rear end of the bone screw when the connector is coupled to the recess in the screw head. Thus, the screwdriver is held exactly coaxially to the screw axis of the bone screw when the stop touches the rear end of the bone screw.
    [00027] In yet another exemplified form of the screwdriver, the male connector still includes a nozzle projecting over the tip towards the front end and at an acute angle with respect to the longitudinal axis of the screwdriver. This configuration allows the advantage that the screwdriver can be inserted in an orientation at the base of the screw head of the bone screw.
    [00028] In yet another exemplified modality, the screwdriver still comprises a coaxial through hole penetrating through the rod and the male connector and having an internal thread to engage an external thread disposed in a locking pin that is insertable in the through hole of such that the locking pin can be advanced towards the front end of the screwdriver to prevent the tip from contracting radially.
    [00029] In accordance with an additional aspect of the present invention, an orientation guide is provided for drilling a hole in the bone whose axis coincides with the through hole axis of the through hole in the screw head of the bone screw. The guidance guide essentially comprises a guide sleeve, a coaxial through hole and a male connector terminally disposed at the front end which is suitable to be coupled to the recess in the screw head of the bone screw. The connector includes a tip whose width decreases in relation to the front end of the guidance guide and two pins diametrically projecting over the tip in any direction and coaxially arranged on a central axis that extends orthogonal to the longitudinal axis. In at least one cross section orthogonal to the central axis, the tip has a circularly curved periphery with a radius R and a center located on the longitudinal axis.
    [00030] In an exemplified embodiment, the guidance guide also comprises a longitudinal slot extending parallel to the longitudinal axis and which is open at the front end so that the connector is radially elasticly compressible. In addition, a curved contact support is formed at the proximal end of the tip. Specifically, the curved contact support is formed by a constriction at the proximal end of the tip (adjacent to the guide sleeve) where a transverse area of the tip in a plane orthogonal to the central axis of the tip is reduced in relation to a maximum diameter portion of the tip distal to that. This configuration allows the connector to operate as a male connector for a plug-in connection with a corresponding female connector disposed on the bone screw.
    [00031] In another exemplified form of the guidance guide, the tip has a spherical shape with a radius of the sphere R and with a center located on the longitudinal axis.
    [00032] In a further exemplified embodiment of the guidance guide, the two pins are cylindrically circular in shape and where the central axis cuts orthogonally the longitudinal axis through the center of the spherical tip. The cylindrically circular pivot pins are coaxial and rotationally insertable in the transverse channel.
    [00033] In yet another exemplified form of the guidance guide, a cylindrical or conical ring is disposed between the tip and the guide sleeve coaxially to the longitudinal axis of the guidance guide.
    [00034] In yet another example of the guidance guide, the ring has a radius R.
    [00035] In an additional exemplified embodiment, the guidance guide also comprises a drilling guide that can be inserted into the through hole.
    [00036] In another exemplified form of the guidance guide, the drilling guide has a conical tip. The conical tip is formed in such a way that it fits into the tapered through hole in the bone screw. This allows to lock the drilling guide in line with the through hole axis from the through hole to the second screw.
    [00037] In accordance with yet another aspect of the present invention, a set including a bone screw, a screwdriver and an orientation guide are provided. This set can be used if a standard locking screw that is generally available can be inserted into the through hole in the bone screw.
    [00038] In accordance with another aspect of the present invention, a set including a bone screw, a tissue protection tube, an orientation guide and a screwdriver is provided.
    [00039] In accordance with yet another aspect of the present invention, a method for bone fixation using an intramedullary nail including a number of proximal and distal locking holes and a number of bone screws with a second screw each is provided. The method essentially comprises the steps of: a) making an incision in the tissue surrounding a bone to be treated; b) placing an intramedullary nail on the bone; c) coupling a guidance device to the intramedullary nail; d) insert a fabric protection tube into a selected guide hole in the orientation device coaxially to one of the locking holes; e) drill a first hole in a bone to insert a bone screw using the orientation device, where the first hole is aligned with the selected proximal or distal locking hole; f) attach a bone screw to the screwdriver connector; g) advance the bone screw through the tissue protection tube; h) screw the bone screw into the bone using the screwdriver; i) remove the screwdriver; j) insert the guidance guide through the fabric protection tube; k) couple the guidance guide to the bone screw in such a way that the longitudinal axis of the guidance guide is aligned with the screw axis of the bone screw; l) remove the fabric protection tube; m) repeat steps (d) to (I) until the bone screw is inserted in all the holes or in the proximal and / or distal locking holes selected from the intramedullary nail; n) remove the intramedullary nail guidance device; o) articulate the guidance guide around the central axis until the guidance guide ring stops against a stop in the recess of the screw head of the bone screw so that the longitudinal axis of the guidance guide is aligned with the axis through hole from the through hole in the bone screw; p) insert the drilling guide into the through hole in the orientation guide; q) drill a second hole in the bone using the drill guide as a guide for the drill; r) remove the drill; s) insert the second screw through the through hole in the orientation guide; t) advance the second screw in the bone; u) remove the guidance guide; v) repeat steps (o) to (u) until a second screw is anchored in the bone passing through the through hole of each of the bone screws; and wjclose the incision.
    [00040] Rather than subsequently performing steps (d) to (I) for a bone screw and repeating the sequence for each bone screw to be inserted, each step can be repeated for all bone screws or for the bone screws selected for be inserted. Similarly, each step to insert the second screw can be repeated for all or for the selected number of bone screws instead of subsequently performing steps (o) to (u) for a bone screw and repeating the sequence for each bone screw to be inserted.
    [00041] In an exemplified embodiment, the stop is formed by the wall part of the depression in the recess in the screw head of the bone screw. BRIEF DESCRIPTION OF THE DRAWINGS
    [00042] An exemplified embodiment of the present invention will be described below by way of example and with reference to the attached drawings in which:
    [00043] FIG. 1 illustrates a longitudinal section of a bone screw embodiment according to the invention.
    [00044] FIG. 2 illustrates a side view of the bone screw embodiment of FIG. 1.
    [00045] FIG. 3 illustrates a perspective view of a screwdriver embodiment according to the invention.
    [00046] FIG. 4 illustrates a longitudinal section of the screwdriver embodiment of FIG. 3.
    [00047] FIG. 5 illustrates a side view of the screwdriver embodiment of FIG. 3.
    [00048] FIG. 6 illustrates a side view of the screwdriver embodiment of FIG. 3 which is orthogonal to the side view of FIG. 5.
    [00049] FIG. 7 illustrates a side view of another embodiment of the screwdriver according to the invention.
    [00050] FIG. 8 illustrates a side view of the screwdriver embodiment of FIG. 7 which is orthogonal to the side view of FIG. 7.
    [00051] FIG. 9 illustrates a partial section through the screwdriver mode of FIGS. 7 and 8 and a bone screw attached to it.
    [00052] FIG. 10 illustrates a perspective view of an embodiment of the guidance guide according to the invention.
    [00053] FIG. 11 illustrates a longitudinal section through the guideline embodiment of FIG. 10 and a bone screw coaxially attached to it.
    [00054] FIG. 12 illustrates a longitudinal section through the guideline embodiment of FIG. IO and a bone screw coaxially attached to it under angle a.
    [00055] FIG. 13 illustrates a longitudinal section through the guideline embodiment of FIG. 10 and a bone screw coupled to it under angle a and together with a drilling guide inserted in the guidance guide and a drill.
    [00056] FIG. 14 illustrates a section through the guidance device and the drilling guide of FIG. 13.
    [00057] FIG. 15 illustrates a longitudinal section through the guideline embodiment of FIG. 10 and a bone screw coupled to it under angle a and together with a second screw inserted in the guidance guide.
    [00058] FIG. 16 illustrates a longitudinal section through the guideline embodiment of FIG. 10 and a bone screw coupled to it under angle a and together with a second screw firmly fixed in the through hole in the screw head of the bone screw.
    [00059] FIG. 17 illustrates an intramedullary nail together with a bone screw and a second screw according to an embodiment of the method for bone fixation according to the invention.
    [00060] FIG. 18 illustrates a side view of a system according to an alternative embodiment of the present invention, in a first configuration. FIG. 19 illustrates a side view of the system of FIG. 18, in a second configuration.
    [00061] FIG. 20 illustrates a cross-sectional side view of the system of FIG. 18, in the second configuration.
    [00062] FIG. 21 illustrates an enlarged cross-sectional side view of a part of the system of FIG. 18. DETAILED DESCRIPTION
    [00063] The present invention can be further understood in relation to the following description and the attached drawings, where similar elements are identified with the same reference numbers. The present invention relates to sets of bone screws and instruments for implanting them, as well as an associated method for implanting the set of bone screws using the instruments. In particular, the invention relates to a system and method that facilitates the implantation of a first bone screw, including a through hole extending through a head portion thereof along a through hole axis, and a second screw inserted into the through hole along the through hole axis such that the first and second bone screws are implanted in a bone in a stable configuration.
    [00064] FIGS. 1 and 2 illustrate an embodiment of the bone screw 1 with a screw head 2 comprising a tapered external thread 29. The bone screw 1 includes a screw shaft 6, a threaded rod 10, a screw head 2 and a rear end 8 at a proximal end of that. The screw head 2 comprises a through hole 9 penetrating through the screw head 2 and having a through hole axis 7 cutting the screw axis 6 at an acute angle a. The through hole axis 7 cuts through the screw axis 2 at a depth T measured from the rear end 8 of the bone screw 1. The through hole 9 has a tapered internal thread 11. A second screw 50 (FIGS. 16 and 17) can be inserted into through hole 9 coaxially to the through hole axis 7. The second screw 50 has a conically threaded head 51 which is interlockable with the tapered internal thread 11 in the through hole 9. The screw head 2 includes a concave base 14 for releasably coupling a surgical instrument or tool to the bone screw 1. The concave base 14 comprises a transverse channel 5 and a centrally located recess 3. The transverse channel 5 comprises a channel axis 101 located at a depth Tc measured from the end back 8 of the bone screw 1 and extending diametrically through the screw head 2. The channel axis 101 cuts the screw axis 6 through the point where the through hole axis 7 cuts the screw axis 6. In addition, the transverse channel 5 is opened at the rear end 8 of the bone screw 1 and the transverse channel 5 has a U-shaped cross section with a semicircular bottom 100 orthogonal to the channel axis 101. The semicircular bottom 100 has a radius of curvature rc where a center of an edge of the semicircular bottom 100 of the transverse channel 5 is located on the channel axis 101. The depth Tc is equal to the depth T of the point where the through hole axis 7 cuts the screw axis 1. The semicircular bottom 100 defines a base coaxially to the recess 3 for rotationally receiving the cylindrical pins 25 of an orientation guide 23 (FIG. 10) which have a pin diameter equal to twice the radius of curvature rc of the semicircular bottom 100 of the transverse channel 5.
    [00065] The recess 3 has a spherical shape with a sphere radio Re a center 4 coinciding with the point at which the screw axis 6 and the through hole axis 7 intersect. The recess 3 forms a pivot bearing to rotationally support and guide a male connector complementarily spherical 232 of an orientation guide 23 (FIG. 10). Due to the fact that the channel axis 101 cuts the screw axis 6 at the point where the center 4 of the spherically shaped recess 3 is located on the screw axis 6 and that the pivot pins 25 of the guidance guide 23 fits into the channel transverse 5 rotationally about the channel axis 101, the poly-axial pivot bearing formed by the spheroidal joint is limited to a uniaxial pivot bearing. When the guide 23 is coupled to the bone screw 1, the guide 23 can only pivot about the channel axis 101 which is orthogonal to a plane defined by the screw axis 6 and the through hole axis 7 of the through hole 9 for the second screw 50. This allows to position the guide guide 23 in a first position coaxial to the screw axis 6 of the bone screw 1 and in a second position coaxial to the through hole axis 7 of the through hole 9 for the second screw 50 Thus, it is understood that the second screw 50 can be precisely inserted into the through hole 9 along the through hole axis 7, increasing the stability of the screws 1.50 in situ.
    [00066] Furthermore, the recess 3 has a constriction 31 at the rear end 8 of the bone screw 1 so that the recess 3 forms a female connector for a plug-in connection. In addition, the recess 3 includes a depression 12 that forms a wall part 121 in the form of a surface section of a circular cylinder with a radius R. The circular cylinder axis coincides with the through hole axis 7 of the through hole. 9. The depression 12 forms a stop for the rotation of an orientation guide 23 around the channel axis 101 when the orientation guide 23 is coupled to the screw head 2 of the bone screw 1. By means of the stop, the orientation guide orientation 23 can be exactly aligned with through hole 9.
    [00067] FIGS. 3 to 6 illustrate a screwdriver embodiment 13 to be used with the bone screw 1 according to FIGS. 1 and 2. The screwdriver 13 comprises a longitudinal axis 130, a rod 131, a front end 135 at a distal end thereof and a male connector 132 that can be coupled to the above modality of the bone screw 1. In order to the screwdriver 13 can be releasably attached to the bone screw 1, the connector 132 is essentially complementarily formed to the concave base 14 of the screw head 2 of the bone screw 1. The connector 132 includes a partially spherical tip 17 whose transverse area in a plane perpendicular to the longitudinal axis decreases towards stem 131 (i.e., towards the front end 135). Thus, a cross-sectional area of the ball point 17 at an end adjacent to the rod 131 and at the front end 135 is smaller than a cross-sectional area of an intermediate section of the ball point 17. The taper of the ball-point 17 towards the rod 131 forms a curved contact support 138 that abuts the recess 3 of the recess 3 at the rear end 8 of the bone screw 1. The screwdriver 13 still comprises a longitudinal slot 20 opened at the front end 135 to form the tip 17 as an elastic male connector for a snap connection between the tip 17 and the recess 3 in the screw head 2 of the bone screw 1. The longitudinal slot 20 is arranged orthogonal to a plane defined by the longitudinal axis 130 and the central axis 136 and penetrates through the stem 131. The connector 132 also includes two steering protrusions 18 extending laterally from the spherical tip 17 in any direction and which are coaxially arranged on a central axis 136. The protrusions directional elements 18 are cylindrically circular in shape with a cylinder axis coinciding with the central axis 136. The connector 132 further comprises an axial stop 21 which is located between the stem 131 and the connector 132 at a distance T measured from the central axis 136 towards rod 131. The axial stop 21 abuts the rear end 8 of the bone screw 1 allowing the screwdriver 13 to be kept exactly coaxial to the screw axis 6 of the bone screw 1. The stem 131 and the connector 132 comprise a coaxial through hole 134 with an internal thread 137 to engage an external thread arranged on a locking pin 35 (FIG. 4) which is insertable in the through hole 134 in such a way that the locking pin 35 can be advanced towards the front end 135 of the screwdriver 13 in order to prevent the tip 17 from contracting radially so that it can be held firmly in the recess 3 in the screw head 2 of the bone screw 1.
    [00068] The screwdriver mode 13 illustrated in FIGS. 7 to 9 differs from the embodiment of FIGS. 3 to 6 only because the male connector 132 still includes a nozzle 34 that extends from the end 17 towards the front end 135. The nozzle 34 has a nozzle axis 38 that extends under the angle a with respect to to the longitudinal axis 130 of the screwdriver 13. Thus, the screwdriver 13 can be coupled to the bone screw 1 in only one rotating position, that is, a position where the nozzle 34 engages the through hole 9 of the bone screw 1 in such a way so that the nozzle axis 38 coincides with the through hole axis 7.
    [00069] FIG. 10 illustrates an embodiment of the guidance guide 23 to be used with the bone screw 1 according to FIGS. 1 and 2. The guide 23 comprises a longitudinal axis 230, a coaxial through hole 28, a guide sleeve 26, a front end 235 and a male connector 232 terminally disposed at the front end 235. To releasably couple the guide orientation 23 to the bone screw 1, the connector 232 is essentially complementarily formed to the base 14 in the screw head 2 of the bone screw 1. The connector 232 includes a spherically shaped tip 231 that tapers towards the front end 235 and towards the sleeve guide 26 forming a spherical joint with the recess 3 of the modality described above of the bone screw 1. The spherical shaped tip 231 has a radius of the ball R and a center 233 located on the longitudinal axis 230. Additionally, the connector 232 includes two pins 25 protruding diametrically over the tip 231 in any direction and which are coaxially arranged on a central axis 234 that extends orthogonal to the longitudinal axis 230 and that cuts the longitudinal axis end 230 through the center 233 of the spherically shaped tip 231. The pins 25 are cylindrically circular in shape with a cylinder axis coinciding with the central axis 234 so as to form coaxial and rotationally insertable axes in the transverse channel 5 in the screw head 2 of the bone screw 1. The guide 23 further comprises a longitudinal slot 27 opened at the front end 235 to form the tip 231 as an elastic male connector for a snap connection between the guide 23 and the spherical recess 3 in the screw head 2 of the bone screw 1. The longitudinal slot 27 is arranged orthogonal to a plane defined by the longitudinal axis 230 and the central axis 234 and penetrates through the guide sleeve 26. Between the tip 231 and the guide sleeve 26, a cylindrical ring 33 is arranged coaxially to the longitudinal axis 230 and which has a radius r R.
    [00070] As illustrated in FIGS. 13 and 14, a drill guide 36 can be inserted into the through hole 28 in the guide guide 23. The drill guide 36 has a tapered tip 37 that fits into the tapered through hole 9 such that the drill guide 36 is exactly aligned with the through hole axis 7 of the through hole 9 in the bone screw 1.
    [00071] FIGS. 11 to 17 show a modality of the method for bone fixation using an intramedullary nail 300 and bone screws 1 together with second screws 50, which are briefly described in the following section. The intramedullary nail 300 comprises a nail shaft 303, a proximal end 305, a peripheral surface 304, a number of proximal locking holes 301 with a more proximal locking hole 302 and a number of distal locking holes 306. proximal and distal locking 301, 306 extend transversely to the shaft axis 303. The intramedullary nail 300 is inserted into the intramedullary canal of a long bone in such a way that the part of the intramedullary nail 300 containing the distal locking holes 306 is located in a distal bone fragment and the part containing the proximal locking holes 301 is located in the proximal bone fragment. In order to lock the intramedullary nail 300 in the bone, each bone screw 1 is directed through all the proximal and distal locking holes 301, 306 or a selected number of them. When using the bone screw 1 according to the invention, the bone screws 1 can be directed through all the proximal and distal locking holes 301, 306 or a selected number of them and the second screws 50 can be anchored in the bone. It should be appreciated that instead of directing the bone screws 1 to the proximal and distal locking holes 301, 306, the second screws 50 could be directed to the proximal and distal locking holes 301, 306 and the bone screws 1 could be anchored to the bone.
    [00072] The method for inserting the bone screws 1 in the nail 300 and anchoring the second screws 50 in the bone comprises the steps of making the incision in the tissue surrounding a bone to be treated and placing an intramedullary nail 300 in the bone. A guiding device (not shown) at the proximal end 305 of the intramedullary nail 300, the guiding device having guide holes for inserting the guide sleeves and fabric protection tubes 40 coaxially to each of all proximal locking holes and distal 301, 306 or a selected number of them. A fabric protection tube 40 (FIGS. 9 and 11) is inserted into a guide hole selected in the guiding device coaxially to one of the proximal and distal locking holes 301, 306 until the front end of the fabric protection tube 40 contact the bone surface. A first hole is then drilled into a bone for insertion of a bone screw 1 through the proximal or distal locking hole 301, 306 using the guiding device, the first hole being aligned with the proximal or distal locking hole 301,306. Furthermore, the hole extends on either side of the intramedullary nail 300 in such a way that the bone screw 1 can penetrate through the proximal or distal locking hole 301, 306 selected from the intramedullary nail 300 when the bone screw 1 is anchored in the bone. The bone screw 1 is attached to the connector 132 of the screwdriver 13 using the plug connection between the bone screw 1 and the screwdriver 13 and advancing the bone screw 1 through the tissue protection tube 40. The bone screw 1 is then screwed into the bone using the screwdriver 13. Once the bone screw 1 is screwed into the bone, the screwdriver 13 can be removed. The steps described above can be repeated until bone screw 1 has been inserted into all desired proximal and distal 301,306 locking holes.
    [00073] The guidance guide 23 is then inserted through the protection tube 40, as shown in FIG. 11, to couple the guidance guide 23 to the bone screw 1 using the plug connection between the tip 231 of the guidance device 23 and the recess 3 in the screw head 2 of the bone screw 1 so that the longitudinal axis 230 of the guidance guide orientation 23 is aligned with the screw axis 6 of the bone screw 1. The tissue protection tube 40 and the guidance device can be removed and the guidance guide 23 hinged around the central axis 234 defined by the pins 25 arranged in the connector 232 of the guide 23 until the ring 33 of the guide 23 rests against a stop in the recess 3 in the screw head 2 of the bone screw 1 such that the longitudinal axis 230 of the guide 23 is aligned with the axis through hole 7 of through hole 9 in bone screw 1 (FIG. 12). The stop is formed by the wall part 121 of the depression 12 in the recess 3 in the screw head 2 of the bone screw 1. The drill guide 36 is then inserted into the through hole 28 in the guide guide 23 (FIG. 13) and a second hole is drilled in the bone using drill guide 36 as a guide for drill 39. Once the second hole has been drilled, drill guide 36 is removed and the second screw 50 is inserted through through hole 28 in the drill guide orientation 23 (FIG. 15) and advanced through the second screw 50 in the bone (FIG. 16). The guidance guide 23 can then be removed and the steps described above repeated until a second screw 50 is anchored in the bone passing through the through hole 9 of each of the bone screws 1. Once all the desired bone screws 1 and the second screws 50 have been inserted into the bone, the incision can be closed.
    [00074] As shown in FIGS. 18 to 21, an alternative embodiment of the set of the present invention is substantially similar to the set described above with respect to FIGS. 1 to 17, comprising a first bone screw 1 ', a second bone screw 50' and a screwdriver 13 '. The screwdriver 13 ', however, combines elements of the screwdriver 13 and the guide guide 23, as described above, so that two separate devices are not required for insertion of the first bone screw T and for guidance the second bone screw 50 '. In addition, the screwdriver 13 'includes a connector 132' at a distal end 135 'thereof, which extends around a head 2' of the first bone screw 1 'rather than within a recess thereof.
    [00075] The first bone screw 1 'extends along a first axis 6' and includes a head 2 ', which has an external surface that is at least partially spherical. The outer surface can also include parts that are substantially flat allowing a pulling force to be applied to these via the screwdriver 13 '. Similar to bone screw 1, the first bone screw 1 'includes a through hole 9' that extends along a second axis 7 'to receive the second screw 50'. The second screw 50 'is substantially similar to the second screw 50' described above.
    [00076] The screwdriver 13 'includes a shank 131' which extends along a longitudinal axis 130 'with a connector 132' formed at the distal end 135 'thereof. The screwdriver 13 'also includes a channel 28' that extends through it along the longitudinal axis 130 'dimensioned and formed to allow the second bone screw 50' to be inserted through it. The connector 132 'includes a partially spherical inner surface 231' dimensioned and formed to receive the head 2 'of the first bone screw 1'. In one embodiment, the connector 132 'can be keyed (for example, it includes flat parts corresponding to the flat parts of the head 2') allowing the screwdriver 13 'to apply tensile forces to the bone screw 1' while also allowing the first bone screw 1 'articulate with respect to the screwdriver 13' via the partially spherical surfaces of the connector 132 'and the head 2'. The inner surface 231 'can receive the head 2' via, for example, a socket.
    [00077] In an alternative embodiment, the head 2 'may include pins extending radially outwardly from it, which are substantially similar to pins 25 of connector 232 of guidance guide 23, and connector 132' may include a channel transverse diametrically extending through it similarly to channel 5 of bone screw 1, as described above. It is understood then that a configuration also allows the first bone screw 1 'to be rotated via the screwdriver 13' while also allowing the first bone screw 1 'to be pivoted in relation thereto.
    [00078] The first and second bone screws 1 ', 50' and the screwdriver 13 'can be used in a substantially similar manner to the method described above. In particular, the first bone screw 1 'can be inserted into a desired hole between the proximal and distal locking holes 301,306 of an intramedullary nail 300 inserted into the bone. A first hole can be drilled through a desired hole between the first and second holes 301,306 to accommodate the first bone screw 1 '. As described above, the screwdriver 13 'is coupled to the first bone screw 1' receiving the head 2 'inside the connector 132'. In an initial configuration, the longitudinal axis 130 'of the screwdriver 13' is coaxially aligned with the first axis 6 'of the bone screw 1'. The first bone screw 1 'is screwed into the desired hole between holes 301, 306 and the first hole via screwdriver 13'. Once the first bone screw 1 'has been inserted, as desired, the screwdriver 13' is articulated with respect to the first screwdriver 1 'around the head 2' until its channel 28 'is coaxially aligned with the second axis 7 'of through hole 9. A second hole can be drilled into the bone through channel 28' and through hole 9 'to accommodate the second bone screw 50'. The second bone screw 50 'can then be guided through channel 28' and through the through hole 9 'to be advanced to the second hole in the bone. Those skilled in the art will understand that the steps described above can be repeated, as desired, until a desired number of first and second bone screws 1 ', 50' has been inserted into the bone.
    [00079] Although the invention and its advantages have been described in detail, it should be understood that various changes, substitutions, and changes can be made without abandoning the spirit and scope of the invention as defined by the appended claims. In addition, the scope of this application is not limited to the modalities of the process, machine, fabrication, material composition, devices, methods and steps described in the specification. As one skilled in the art will readily appreciate from the description of the present invention, processes, machines, manufacture, composition of matter, devices, methods or steps, which currently exist or will be developed in the future that perform substantially the same function or achieve substantially the same. same result of the corresponding modalities described here can be used in accordance with the present invention.
    [00080] Those skilled in the art appreciate that various modifications and alterations to the invention can be made without abandoning the broad scope of the appended claims. Some of these have been discussed above and others will be clear to those skilled in the art.
    权利要求:
    Claims (13)
    [0001]
    1. System, characterized by the fact that it comprises a bone screw (1) and an orientation guide (23) for drilling a hole in a bone; wherein the bone screw (1) comprises: a screw rod (10) extending longitudinally along a screw axis (6); a screw head (2) extending from a proximal end of the screw rod (10); and a through hole (9) that defines a through hole axis (7) and extends through the screw head (2), the through hole axis (7) intersects the screw axis (6) at an acute angle a, the through hole (9) is adapted to receive a second screw (50) therein and tapering from a first end at a proximal end of the screw head (2) to a second end open to an external surface of the bone screw (1); wherein the screw head (2) has a concave base (14) comprising a channel (5) and a centrally located recess (3), the channel (5) arranged at the first end of the through hole (9) and extending to from the outer surface of the bone screw (1) transversely through the screw head (2) along an axis of the channel (101) which is perpendicular to the axis of the screw (6), the channel (5) being opened at the proximal end the bone screw (1); wherein the guiding guide (23) is for drilling a hole having an axis that coincides with the axis of the through hole (7) of the through hole (9) in the screw head (2) of the bone screw (1); and wherein the guidance guide (23) comprises: a guide sleeve (26); a coaxial through hole (28); and a male connector (232) terminally disposed at a front end (235) of the guide (23) for coupling to the recess (3) in the screw head (2), the connector (232) including a tip (231 ) whose width decreases towards the front end (235) of the sighting guide (23) and two pins (25) that project diametrically on the tip (231) in any direction and coaxially arranged on a central axis (234 ) extending orthogonal to a longitudinal axis (230) of the guidance guide, where in at least one cross section orthogonal to the central axis (234) the tip (231) has a circularly curved periphery with a radius (R) and a center located on the longitudinal axis (230).
    [0002]
    2. System according to claim 1, characterized by the fact that the recess extends along the proximal end of the screw head (2), the recess (3) also configured to receive a portion of a surgical tool to be removably coupled to it and with a circular edge centered at an intersection of the through hole axis (7) and the screw axis (6).
    [0003]
    3. System according to claim 1, characterized by the fact that the through hole (9) comprises an internal thread.
    [0004]
    4. System according to claim 2, characterized by the fact that the recess (3) has a constriction (31) at the proximal end of the screw head (2) to facilitate a quick connection between the bone screw (1) and the surgical tool.
    [0005]
    5. System according to claim 4, characterized by the fact that the recess (3) includes a depression (12) through the constriction (31) and forming a part of the wall that forms a part of a cylinder, cone and prism whose axis coincides with the through hole axis.
    [0006]
    6. System according to claim 1, characterized by the fact that the channel axis intersects the screw axis at the point at which the screw axis and through hole axis intersect.
    [0007]
    System according to any one of claims 1 to 6, characterized by the fact that the bone screw (1) is a first bone screw, and in which the system comprises a second bone screw (50) dimensioned and configured to be inserted through the through hole (9) of the first bone screw (1) along the axis of the through hole (7).
    [0008]
    8. System according to claim 1, characterized by the fact that it still comprises a screwdriver for a bone screw, the screwdriver, including a rod that extends longitudinally from a distal end to a proximal end, the end distal including a male connector configured to be coupled to the recess in the screw head of the first bone screw, the connector including a tapering tip towards the distal end of the screwdriver and two guiding protrusions extending from opposite sides of the tip along a central axis that extends orthogonally to the longitudinal axis of the screwdriver, where the guiding protrusions engage the channel on the head of the screw of the first bone screw, and where the tip has a circular periphery centered on the longitudinal axis.
    [0009]
    9. System according to claim 8, characterized by the fact that the male connector still comprises an axial stop at a distance T from the central axis towards the rod so that the stop contacts the rear end of the first screw bone when the connector is coupled to the recess in the screw head.
    [0010]
    10. System, according to claim 8, characterized by the fact that the male connector still includes a nozzle that protrudes over the tip towards the distal end and at an acute angle with respect to the longitudinal axis of the screwdriver.
    [0011]
    11. System, according to claim 7, characterized by the fact that it still comprises a drill guide insertable in the through hole.
    [0012]
    12. System according to claim 11, characterized by the fact that it still comprises a screwdriver including a connector at a distal end thereof configured to receive the partially spherical screw head so that the first bone screw is articulated between a first position in which the screw axis is coaxial with a longitudinal axis of the screwdriver to a second position in which the through hole axis is coaxial with the longitudinal axis.
    [0013]
    13. System, according to claim 12, characterized by the fact that the screwdriver still includes a channel that extends through it along its longitudinal axis so that when the first bone screw is in the second position, the channel it is configured to guide the second bone screw through it and to the through hole of the first bone screw.
    类似技术:
    公开号 | 公开日 | 专利标题
    BR112012028705B1|2020-10-13|system for drilling a hole in a bone
    EP2353549B1|2016-06-15|Articulating humeral head prosthesis
    US9918743B2|2018-03-20|Facet interference cage
    JP6215339B2|2017-10-18|Interbody interference implants and instruments
    ES2281192T3|2007-09-16|TREATMENT OF FRACTURES.
    ES2400720T3|2013-04-11|System for stabilizing fractures of convex joint bone surfaces that include subcartilaginous support structures
    ES2733729T3|2019-12-02|Bone access device and cavity preparation
    ES2280253T3|2007-09-16|INSTRUMENT TO STABILIZE OSEAS STRUCTURES.
    EP1284662B1|2003-11-05|Radiolucent aiming guide
    AU2019222825A1|2019-09-19|Suprapatellar insertion system, kit and method
    US8758367B2|2014-06-24|Anchor delivery system
    CN101150991B|2010-09-15|Reference pin
    US10898210B2|2021-01-26|Separable guide instrument for anatomical implant
    US20130030478A1|2013-01-31|Anchor wire system and method
    US6695841B2|2004-02-24|Percutaneous scaphoid fixation method and guide wire alignment device
    ES2752456T3|2020-04-06|Tapered End Cap for Intramedullary Nail
    WO2009154229A1|2009-12-23|Intramedullary nail and intramedullary nail main body
    EP1779798B1|2009-02-18|Non-penetrating fixing device
    ES2608328T3|2017-04-07|Bone nail with soft back end
    EP3079606B1|2018-08-15|Aiming device for targeted drilling of bone
    同族专利:
    公开号 | 公开日
    WO2011143116A1|2011-11-17|
    TW201200099A|2012-01-01|
    EP2568899A1|2013-03-20|
    CO6660472A2|2013-04-30|
    JP2013526339A|2013-06-24|
    CA2797790A1|2011-11-17|
    CN102958462A|2013-03-06|
    KR20130108066A|2013-10-02|
    BR112012028705A2|2017-08-08|
    KR101885506B1|2018-08-07|
    CN102958462B|2015-08-19|
    US20110282398A1|2011-11-17|
    JP5784710B2|2015-09-24|
    EP2568899B1|2017-01-04|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    JP4145044B2|1999-09-08|2008-09-03|ジンテーズゲゼルシャフトミトベシュレンクテルハフツング|Bone screw|
    JP3383257B2|2000-03-10|2003-03-04|株式会社ロバート・リード商会|Rod fixing device|
    CN1652823A|2000-12-14|2005-08-10|控制释放系统公司|Device and method for treating conditions of a joint|
    US6681662B2|2002-03-01|2004-01-27|Bondhus Corporation|Tool with fastener engaging member|
    DE20314297U1|2003-09-12|2003-11-20|Allocon Gmbh|bone screw|
    DE102004009429A1|2004-02-24|2005-09-22|Biedermann Motech Gmbh|Bone anchoring element|
    US7909826B2|2005-03-24|2011-03-22|Depuy Spine, Inc.|Low profile spinal tethering methods|
    WO2008122446A1|2007-04-10|2008-10-16|Stryker Trauma Gmbh|Bone screw holding device|
    US9084646B2|2008-03-26|2015-07-21|DePuy Synthes Products, Inc.|Universal anchor for attaching objects to bone tissue|
    US9044282B2|2008-06-24|2015-06-02|Extremity Medical Llc|Intraosseous intramedullary fixation assembly and method of use|
    WO2010017357A1|2008-08-07|2010-02-11|K2M, Inc.|Bone screw assembly|
    CN102292043B|2008-12-05|2014-11-26|斯恩蒂斯有限公司|Anchor-in-anchor system for use in bone fixation|WO2006034436A2|2004-09-21|2006-03-30|Stout Medical Group, L.P.|Expandable support device and method of use|
    JP5542273B2|2006-05-01|2014-07-09|スタウトメディカルグループ，エル．ピー．|Expandable support device and method of use|
    US9084646B2|2008-03-26|2015-07-21|DePuy Synthes Products, Inc.|Universal anchor for attaching objects to bone tissue|
    US8882838B2|2008-06-05|2014-11-11|DePuy Synthes Products, LLC|Articulating disc implant|
    CA2726642A1|2008-06-05|2009-12-10|Synthes Usa, Llc|Articulating disc implant|
    US8303589B2|2008-06-24|2012-11-06|Extremity Medical Llc|Fixation system, an intramedullary fixation assembly and method of use|
    US20110230884A1|2008-06-24|2011-09-22|Adam Mantzaris|Hybrid intramedullary fixation assembly and method of use|
    US9017329B2|2008-06-24|2015-04-28|Extremity Medical, Llc|Intramedullary fixation assembly and method of use|
    US8343199B2|2008-06-24|2013-01-01|Extremity Medical, Llc|Intramedullary fixation screw, a fixation system, and method of fixation of the subtalar joint|
    US8328806B2|2008-06-24|2012-12-11|Extremity Medical, Llc|Fixation system, an intramedullary fixation assembly and method of use|
    US9044282B2|2008-06-24|2015-06-02|Extremity Medical Llc|Intraosseous intramedullary fixation assembly and method of use|
    US9289220B2|2008-06-24|2016-03-22|Extremity Medical Llc|Intramedullary fixation assembly and method of use|
    US8313487B2|2008-06-24|2012-11-20|Extremity Medical Llc|Fixation system, an intramedullary fixation assembly and method of use|
    US20100211176A1|2008-11-12|2010-08-19|Stout Medical Group, L.P.|Fixation device and method|
    US20100204795A1|2008-11-12|2010-08-12|Stout Medical Group, L.P.|Fixation device and method|
    US9060808B2|2008-12-05|2015-06-23|DePuy Synthes Products, Inc.|Anchor-in-anchor system for use in bone fixation|
    CN102292043B|2008-12-05|2014-11-26|斯恩蒂斯有限公司|Anchor-in-anchor system for use in bone fixation|
    CN101947139B|2010-10-21|2013-10-23|赵大国|Bionic dental implant and abutment and seminal root thereof|
    ES2552254T3|2010-11-17|2015-11-26|Hyprevention|Implantable device for the preventive or curative treatment of fractures of the femur, associated ancillary|
    EP2726002B1|2011-06-28|2019-04-17|Spinologics Inc.|Bone screw fixation system|
    WO2013043221A1|2011-09-21|2013-03-28|Flexmedex, LLC|Support device and method|
    WO2013074659A1|2011-11-18|2013-05-23|Synthes Usa, Llc|Femoral neck fracture implant|
    US20140343616A1|2013-04-22|2014-11-20|Daniel Sellers|Arthrodesis compression device|
    CN103692279A|2013-11-28|2014-04-02|黄勇|Slotted cylinder head shaft screw|
    EP2918238B1|2014-03-14|2017-11-15|Biedermann Technologies GmbH & Co. KG|Instrument for holding and inserting a bone anchor|
    US9649133B2|2014-11-11|2017-05-16|Intrepid Orthopedics|Supplemental fixation screw|
    US10136929B2|2015-07-13|2018-11-27|IntraFuse, LLC|Flexible bone implant|
    US10499960B2|2015-07-13|2019-12-10|IntraFuse, LLC|Method of bone fixation|
    US10154863B2|2015-07-13|2018-12-18|IntraFuse, LLC|Flexible bone screw|
    US10485595B2|2015-07-13|2019-11-26|IntraFuse, LLC|Flexible bone screw|
    US9918763B2|2015-07-24|2018-03-20|Warsaw Orthopedic, Inc.|Bone fixation element and methods of use|
    US10299847B2|2016-09-22|2019-05-28|Globus Medical, Inc.|Systems and methods for intramedullary nail implantation|
    US11026733B2|2019-02-28|2021-06-08|Warsaw Orthopedic, Inc.|Surgical system and method|
    KR102350764B1|2019-08-28|2022-01-14|오스테오닉|Device for inserting screws|
    WO2021068088A1|2019-10-09|2021-04-15|Kaj Klaue|Bone nail|
    法律状态:
    2017-08-15| B15I| Others concerning applications: loss of priority|
    2017-10-24| B12F| Appeal: other appeals [chapter 12.6 patent gazette]|
    2019-10-22| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-07-21| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2020-10-13| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 09/05/2011, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US33423410P| true| 2010-05-13|2010-05-13|
    US61/334,234|2010-05-13|
    PCT/US2011/035760|WO2011143116A1|2010-05-13|2011-05-09|Bone screw assembly and instruments for implantation of the same|
    [返回顶部]