• 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:
    chuck guide systems. the present invention relates to a mandrel guide system which can include a mandrel guide which is configured to guide a mandrel to at least two bones which must be drilled to form a countersunk hole. the chuck guide can be configured to temporarily attach to at least two bones that must be drilled so as to avoid substantial separation of the at least two bones during drilling. the chuck guide system may additionally include a positioner which is configured to receive a locating element. the locating element is configured to temporarily attach to a target location adjacent to the bones to be drilled. the mandrel is configured to receive the location element and advance along the location element to the target location.
    公开号:BR112013018833B1
    申请号:R112013018833-2
    申请日:2011-01-28
    公开日:2020-08-04
    发明作者:Mirko Rocci；Michael Jeffry Weber
    申请人:Synthes Gmbh；
    IPC主号:
    专利说明:

    BACKGROUND
    [0001] Arthrodesis is an operation to fuse two or more bones. This operation is performed to relieve pain caused by a fracture or arthritis. For example, many individuals suffer from wrist arthrosis, which may require the fusion of lunate, capitate, hamate, and triquetral bones.
    [0002] A method for fusing these four bones includes the step of milling and removing a part of each bone to implant a fusion plate. The fusion plate is configured to connect all four bones using screws, so that the four bones can be fused. However, during the milling step, the four bones have a tendency to separate elasticly from each other due to the force with which the milling mandrel is pushed towards the bone. The separation of the bones during milling can lead to a not exactly milled countersunk hole. When the fusion plate must be positioned inside the countersunk hole, the diameter of the plate can be larger than the countersunk hole since the bones move elastically towards each other.
    [0003] Furthermore, with current methods, it can be difficult to find an appropriate location where the bones should be drilled by the mandrel. This is because the countersunk hole is typically made freehand, without the use of guides or other aids. SUMMARY
    [0004] A chuck guide system may include a chuck guide that is configured to guide a chuck to at least two bones to thereby form a countersunk hole in at least two bones. The mandrel system can include a guide base that has a support body that is configured to be positioned adjacent to at least two bones. The guide base can define a guide opening that extends through the support body and is configured to receive a mandrel and direct the mandrel towards at least two bones when the base body is positioned adjacent to at least two bones. The guide base can also define at least two perforations that extend through the support body in one place, so that it is aligned with each of the at least two bones, respectively, when the support body is positioned adjacent to the first two bones. Each hole can be configured to receive temporary fasteners configured to hold at least two bones, respectively, in order to hold at least two bones relative to each other as the mandrel advances to at least two bones.
    [0005] The chuck guide system can also include a positioner alone or in combination with the chuck guide. Such a positioner can include a positioner base that has a positioner body configured to be positioned adjacent to at least two bones, a cable fixing element that extends from a positioner base, and a location perforation that extends through both elements and the positioner body. The locating hole can be configured to receive a temporary fastener. The positioner can also include at least two positioning openings that extend through the positioner body. Each positioning opening can be configured to receive a repositioning device capable of repositioning a respective bone from at least every two bones.
    [0006] The positioner can be supplied as a kit together with a mandrel. In this kit, the positioner can include a positioner base that is configured to be positioned adjacent to at least two bones, an element that extends from the positioner base, and a locating hole that extends through the positioner element and body. The locating orifice can be sized and configured to receive a locating element capable of engaging with a target location. The mandrel may include a mandrel body that is configured to mill the bone, and a hole that extends through the mandrel body. The orifice can be configured to receive the location element subsequent to the location element that engages the target location and with the removal of the positioner, so that the mandrel is guided along the location element towards the target location.
    [0007] A method of drilling a hole in at least two bones is also presented. In this case, a positioner can be placed initially on at least two bones. The positioner can include a positioner base, an element that extends from the positioner base, and a locating hole that extends through the positioner element and base. A locating element can be inserted through the locating hole and a distal end of the locating element can be temporarily coupled to an adjacent target location in at least one of the at least two bones. The positioner can be removed so that the location element remains attached to the target location. A mandrel can be positioned adjacent to at least two bones. The mandrel may include a mandrel body and a hole that extends through the mandrel body. The orifice can be configured to receive the locating element to thereby guide the mandrel to the target location. When positioned, the mandrel can drill a countersunk hole in at least two bones. BRIEF DESCRIPTION OF THE DRAWINGS
    [0008] The above mentioned summary, as well as the following detailed description of a preferred application modality, will be better understood when read in conjunction with the attached drawings. For purposes of illustration, the chuck guide systems and methods of the present application are shown in the drawings of a preferred embodiment. It must be understood, however, that the application is not limited to the exact provisions and means shown. In the drawings:
    [0009] Figure 1A is a perspective view of a chuck guide system constructed according to one embodiment, the chuck guide system including a chuck guide positioned against, and temporarily attached to, a lunate bone, capitate, hamate , and three-pulse of a pulse, and configured to receive a mandrel;
    [00010] Figure 1B is a perspective view of the pulse shown in figure 1A with the chuck and chuck guide system removed for clarity.
    [00011] Figure 2A is a perspective view of the mandrel guide shown in figure 1A, the mandrel guide having a guide base that defines a guide opening configured to receive the mandrel; Figure 2B is a top plan view of the chuck guide as shown in figure 2A; Figure 2C is a side elevation view of the chuck guide shown in Figure 2A; Figure 3A is a perspective view of the mandrel shown in figure 1A; Figure 3B is a sectional elevation view of the mandrel shown in Figure 3A; Figure 4A is a sectional side elevation view of the chuck guide shown in Figure 2A temporarily attached to two of the bones shown in Figure 1B; Figure 4B is a sectional side elevation view of the mandrel shown in figure 3A forming a countersunk hole in the bones through a mandrel guide opening shown in figure 4A; Figure 5A is a perspective view of a fusion plate that is configured to be positioned within a countersunk hole that is manufactured in at least two bones, the fusion plate having a plurality of fasteners that receive the holes; Figure 5B is a top plan view of the melting plate shown in Figure 5A; Figure 5C is a side elevation view of the melting plate shown in figure 5A; Figure 5D is a cross-sectional elevation view of the melting plate shown in Figure 5B through line 5D-5D; Figure 6A is a perspective view of the guide system shown in Figure 1A showing the mandrel guide temporarily attached to the lunate bone, the capitate, the hamate, and the triquet of the wrist shown in Figure 1B, and the mandrel positioned above the opening. chuck guide.
    [00012] Figure 6B is a perspective view of the guide system shown in figure 6A, showing the advanced mandrel in the opening of the mandrel guide to form a countersunk hole in the lunate bone, the capitate, the hamate, and the triquet of the wrist. ; Figure 6C is a sectional side elevation view of the guide system in Figure 6C, showing the melting plate placed in the countersunk hole through the mandrel guide opening; Figure 6D is a sectional side elevation view of the fusion plate shown in Figure 6D attached to the lunate, capitate, hamate, and triquet bone; Figure 7 is a perspective view of the chuck guide system constructed according to another embodiment, the chuck guide system including a drill guide system, and a positioner temporarily coupled to the drill guide system, and the positioner positioned against the lunato, the capitate, the hamate, and the triquet of the wrist, the positioner having a positioner base, a cable fixation element extending from the positioner base, a location hole configured to receive a temporary fixation element which provides a location element; Figure 8A is a perspective view of the positioner shown in Figure 7; Figure 8B is a top plan view of the bottom of the positioner of Figure 8A; Figure 8C is a sectional elevation view of the positioner shown in Figure 8B through line 8C-8C; Figure 9A is a perspective view of a drill guide system that has a drill guide configured to temporarily attach to the positioner cable fixing element, the drill guide defining a hole that is configured to receive the element locating and subsequently a part of the drill to drill the bone, the orifice configured to receive a fixing element that fixes the fusion plate to the bone; Figure 9B is a top plan view of the drill guide system shown in Figure 9A; Figure 9C is a side elevation view of the drill guide system shown in Figure 9B; Figure 10A is a perspective view of the guide system shown in Figure 7 showing the positioner temporarily attached to the drill guide of the drill guide system, and the positioner positioned adjacent to the lunate bone, capitate, hamate, and triquet of the wrist; Figure 10B is a perspective view of the guide system shown in Figure 10A, showing the location element positioned through the positioner location hole at the target location of the pulse that is to be drilled; Figure 10C is a perspective view of the guide system shown in Figure 10B with the positioner and drill guide system removed; Figure 10D is a perspective view of the guide system shown in Figure 10C with the locating element extending through the mandrel hole to guide the mandrel to the target location of the pulse; Figure 10E is a sectional side elevation view shown in Figure 10D, showing the mandrel forming a countersunk hole in the lunate, capitate, hamate, and triquet of the wrist; Figure 10F is a sectional side elevation view of the melting plate placed in the countersunk hole formed by the mandrel; Figure 10G is a sectional view of the melting plate shown in Figure 10F with the drill guide that extends into one of the fixing holes of the melting plate; Figure 10H is a sectional view of the melting plate shown in Figure 10G with a fastener securing the melting plate to the wrist; Figure 11A is a perspective view of a positioner constructed according to another embodiment, the positioner having a positioner base, an element extending from the positioner base, and a cable coupled to the element; Figure 11B is a side elevation view of the positioner shown in Figure 11A; Figure 11C is a sectional side elevation view of the positioner of Figure 11B; and Figure 12 is a perspective view of a guide system constructed according to another embodiment, the guide system including a mandrel guide that has a guide opening, and a positioner that has a positioner base that is configured to be received by the guide opening of the chuck guide. DETAILED DESCRIPTION
    [00013] Certain terminology is used in the following description for convenience only, and not for the purpose of limitation. The words "right", "left", "lower" and "upper" designate directions in the drawings to which reference is made. The words "inwardly" or "distally" and "externally" or "proximally" refer to directions in the direction of, and in the opposite direction of, respectively, the geometric center of the system and related parts thereof. The words, "anterior", "posterior", "upper," "lower" are related words and / or phrases that preferably designate positions and orientations in the human body to which reference is made and have no limiting intention. The terminology includes the words listed above, derived from them and words of similar importance.
    [00014] As shown in figure 1A, a chuck guide system 10 includes a chuck guide 14 which can be used to guide a chuck 18 towards one or more bones to thereby form a countersunk hole (such as countersunk hole 116 shown in figure 4B) in two or more bones. The chuck guide 14 is configured to be temporarily attached to two or more bones by a plurality of temporary fasteners 22 which are removed prior to the end of the surgical procedure, to avoid substantial separation of the bones as the chuck 18 is forced against the bones to form a countersunk hole. As shown in figure 1 A, mandrel 18 is elongated in a longitudinal direction L and is configured to be advanced in longitudinal direction L through mandrel guide 14. When the countersunk hole is formed by mandrel 18, a melting plate (such as the fusion plate 26 shown in figures 5A to 5D) can be inserted into countersink 116 and subsequently affixed to the bones to thereby fuse them. As shown in figure 1B, the chuck guide system 10 can be used to fuse a lunato 30, a capitate 34, a hamate 38, and a triquet 42 of a pulse 46. In this procedure, the chuck guide 14 can be placed so that the countersink is partially formed in each of lunato 30, capitate 34, hamate 38, and triquetal 42, or partially formed in any two of bones 30, 34, 38, and 42. Although the guide system of chuck 10 is illustrated as sized to form a countersink in the bones 30, 34, 38, and 42 of the wrist 46, it should be understood that the chuck guide system 10 can be sized to form a countersink in any two or more bones in the human body.
    [00015] As shown in figures 2A to 2C, the mandrel wire 14 includes a wire base 50 and a cable 54 that extends from a guide base 50. The cable 54 can be held by a user to place the base of guide 50 against the bones that must be drilled. The configuration of the cable 54 and the base guide 50 allows the mandrel to drill through the bones without user interference.
    [00016] As shown 2A, the guide base 50 includes a base body 56 and a guide opening 58 that extends through the base body 56. As shown, the base body 56 defines a substantially ring-shaped portion 60 which has a bottom bone in contact with the surface 62 which is configured to be in a borderline position with the bones that must be drilled when the chuck guide 14 is properly positioned. It should be understood, however, that the guide base 50 is not limited to the guide body 56 which defines a ring shaped portion 60, and that the guide base 50 can include alternately shaped bodies 56, such as a body 56 which defines a block shaped portion.
    [00017] As shown in figures 2A and 2B, the guide opening 58 includes a central axis that extends through the base body 56 so that the guide opening 58 provides a guide path along the longitudinal direction L for the bones that must be drilled by the mandrel 18. The opening of the guide 58 is cylindrical and can have an alternative diameter or dimension D of about 15 mm or about 17 mm. It should be understood, however, that the opening of the guide 58 can have any desired dimension D depending on the procedure to be performed and the bones to be drilled.
    [00018] As best shown in figure 2B, the base body of the guide 56 also defines four radial extensions 70 that extend radially from the ring-shaped portion 60. As shown, the extensions are spaced equidistant from each other around the portion ring shaped 60. Therefore, each extension 70 can extend from the ring shaped portion 60 so that each extension 70 is opposite to another extension 70 around the ring shaped portion 60. This configuration allows each extension 70 to be positioned in relation to a respective bone of the four bones that must be drilled, when the contact surface of the bone of the bottom 62 is in a borderline position with the bones. As shown in Figure 2B, each extension 70 defines two holes 74 that extend through the body of the base 56. Each extension 70 has two holes 74 so that at least one of the holes 74 but not necessarily all extend through one of the bones which must be drilled when the chuck guide 14 is properly positioned. The holes 74 can be spaced evenly and each hole 74 of the extensions 70 is configured to receive a respective temporary fixation element 22 so that the fixation elements 22 can extend through the holes 74 and to the bones that must be drilled. The fixing elements 22 can be a Kirschner wire (K wire), pin or other device capable of extending through the holes 74 and temporarily attaching to the bones. Therefore, holes 74 can define K wire holes that have a diameter that is substantially equal to the diameter of K threads. As shown, each hole has an alternative diameter or dimension that is less than the diameter of the guide opening, and each hole 74 has a central axis that is substantially parallel to the central axis of the guide opening. However, it should be understood that the central axes of the holes 74 can extend obliquely to the central axis of the guide opening 58.
    [00019] In use, the base of the guide 50 must be positioned on the bones so that an orifice 74 of the respective invention 70 is positioned on one of the bones to be drilled. When the temporary fasteners 22 are coupled to the respective bones through the holes 74, the bones will be held in place when the mandrel 18 is forced against the bones, thus preventing substantial separation of the bones during drilling.
    [00020] As shown in figure 2C, the cable 54 includes an angled portion 80 that extends from the base the guide 50 at a desired angle, and a portion of cable 84 that extends outwardly from a proximal end of the angled portion 80. As shown in figure 2C, the angled portion 80 extends out of the guide base 50, and the cable portion 84 extends from an angled portion 80 so that the guide base 50 will not be interfered with as the user holds and position the chuck guide 14.
    [00021] As shown in figures 3A and 3B, mandrel 18 includes a mandrel head 90 and a stem 94 that proximally extends from a proximal end of mandrel head 90. As shown in figure 3B, mandrel 18 includes additionally an orifice 98 that extends completely through the mandrel head 90 and the stem 94. As described in detail later, in certain embodiments, the orifice 98 is configured to receive a temporary fixing element that extends from a target location that must be drilled. Therefore, hole 98 may have a diameter that is substantially equal to the diameter of the temporary fastener.
    [00022] As shown in figure 3A, the chuck head 90 is substantially cylindrical in shape and has an external diameter or an alternative dimension DR that is substantially equal to the diameter D of the guide opening 58 of the chuck guide 14. As shown, the mandrel head 90 includes a plurality of radially extending blades 100. Each blade 100 includes a flat guide portion 104 and an angled cutting portion 108 that extends from a distal end of the flat guide portion 104 and radially inward at towards orifice 98. As shown, each of the cut angular portions 108 end at hole 98. Blades 100, and in particular angular cut portions 108, are configured to mill or otherwise bore bones as chuck 18 it is advanced into the bones to form a countersunk hole in the bones.
    [00023] As best shown in figure 3A, each blade 100 further defines a plurality of markings 106 in a proximal portion of the flat guide portion 104. Markings 106 illustrate to the operator how far away the mandrel 18 has pierced the bones. Each mark 106 can be spaced from an adjacent mark 106 by about 2 mm or another distance as desired. Markings 106 can be positioned so that they are at a specific distance from a proximal end of stem 94. Therefore, the operator will know the distance that mandrel 18 has drilled as mandrel 18 is advanced through guide opening 58 of the chuck guide 14.
    [00024] As shown in figure 3A, stem 94 is cylindrical and extends proximally to mandrel head 90. As shown, stem 94 includes a proximal coupling 109 that is configured to be received by a drive mechanism or other extension that is finally fixed to the drive mechanism. As shown, coupling 109 defines a recess or groove 112 that is configured to be engaged by a projection of the drive mechanism or extension to thereby lock the mandrel 18 to the drive mechanism. The drive mechanism can be a manually operated mechanism or a mechanism powered by a battery or alternative energy source.
    [00025] As shown in figures 4A and 4B, the chuck guide 14 can be positioned against and temporarily attached to at least two bones with temporary fasteners 22. As shown in figure 4B, chuck 18 can be advanced into the opening of the guide 58 of the mandrel guide 14 to thus form a countersunk hole 116 within the bones. As shown, mandrel 18 is configured to advance to the surfaces 118 of the bones along the longitudinal direction L and in a path that is substantially perpendicular to the surface 118 of the bones. The countersunk hole 116 formed is configured to receive the fusion plate 26 so that the fusion plate 26 is located below the upper surfaces 118 of the bones.
    [00026] As shown in figures 5A to 5D, the melting plate 26 includes a plate body 120 which is substantially circular and in a rounded shape. The body of the plate 120 has an alternative diameter or dimension Dp which is substantially equal to the diameter DR of the mandrel head 90. The plate 26 can be produced from a biocompatible material such as titanium. As shown in figure 5C, the body of the plate 120 defines a lower chamfered surface that has an angled portion 124 that ends in a substantially flat portion 128. The lower chamfered surface is substantially identical to the profile of the mandrel head 90. Therefore, the portion angle 124 extends at such an angle that the plate 26 can lie flushly within the countersunk hole 116 formed by the mandrel 18. As shown in figures 5A and 5B, plate 26 additionally includes a plurality of fasteners which they receive holes 132 which extend through the angled portion 124 of the plate body 120. Each hole 132 defines internal threads 136 which are configured to engage the external threads defined by a fastener 140 (as shown in figure 6D).
    [00027] As best shown in figure 5D, the holes 132 are tapered and configured to receive a head 144 from the fastener 140. The tapered shape can prevent the fastener 140 from retreating from the hole 132 after the fastener 140 have fixed plate 26 to the milled bones. In the illustrated embodiment, the plate 26 includes six holes 132, however it should be understood that more or less holes 132 can extend through the body of the plate 120 depending on the size of the plate 26. In addition, although the plate 26 is illustrated being circular and substantially rounded in shape, it should be understood that the plate 26 can have alternative designs, as desired.
    [00028] As shown in figure 5B, the fusion plate 26 may also include a central opening 150 that extends through the center of the body of the plate 120. The central opening 150 can assist an individual (i.e., surgeon) who needs or want to examine the process of bone fusion during the healing phase.
    [00029] In operation and with reference to figures 6A to 6D the mandrel guide system 10 can be used to form a countersunk hole 116 in lunato 30, capitate 34, hamate 38, and triquet 42 of a pulse 46. In such operation , the mandrel guide 14 can be positioned so that the contact surface of the bone 62 at the base of the guide 50 is in a boundary position with the four wrist bones 30, 34, 38, and 42 and at least one of the holes 74 of each extension 70 is positioned on one of the four respective bones 30, 34, 38, and 42. A temporary fixing element 22 can then be inserted through each hole 74 and coupled to one of the four bones. At this point, each bone is effectively coupled to a mandrel guide 14.
    [00030] As shown in figure 6B, the mandrel 18 can then be advanced through the opening of the guide 58 along the longitudinal direction L and in the four bones 30, 34, 38, and 42 to thus form the countersunk hole 116. As shown opening 58 guides mandrel 18 so that mandrel 18 is substantially perpendicular to the upper surfaces of the four bones being drilled. As the mandrel is being forced into the bones 30, 34, 38, and 42, the temporary fasteners 22 prevent the bones from separating substantially or otherwise moving in the opposite direction to each other. Therefore, when temporary fasteners 22 are removed, the diameter of countersunk hole 116 will remain substantially unmodified.
    [00031] As shown in figure 6C, once the countersunk hole 116 is formed, the melting plate 26 can be inserted through the opening of the guide 58 of the chuck guide 14 and into the countersunk hole 116. As shown, the countersinking plate 116 Fusion 26 is located inside countersunk hole 116 so that the fusion plate 26 is at least flush with the surfaces 118 of the bones 30, 34, 38, and 42 (that is, tissue that will be located on bone during the movement of the joint ). Because plate 26 does not protrude above the upper surfaces 118 of the bones, plate 26 will not interfere with or otherwise irritate the tissue above the bones 30, 34, 38, and 42. As shown in figure 6D , the fastening elements 140 can then be inserted through the respective holes 132 of the plate 26 and into the four bones 30, 34, 38, and 42 in order to fix the plate 26 to the bones and fuse them.
    [00032] In another embodiment and with reference to figure 7, the mandrel guide system 210 may include a positioner 214 that is configured to locate a target location 218 (see figure 1B) that is adjacent to two or more bones that they must be drilled by mandrel 18. In this sense, target site 218 may be a location in one of the bones to be drilled or it may be a location between the bones that are to be drilled. As shown in figure 7, positioner 214 can be temporarily attached to a first drill guide 220 of a drill guide system 221 which is used temporarily as a cable to properly position positioner 214 on the bones that are to be drilled. When positioner 214 is properly positioned, a temporary fastener 222 constructed substantially as described above with respect to fasteners 22 can be inserted or otherwise passed through the drill guide 220 and positioner 214 towards target location 218 The fixing element 222 can be temporarily coupled to the target location 218 in order to define a location element that is configured to guide the mandrel 18 along a guide path to the bones to be drilled.
    [00033] As shown in figures 8A to 8C, positioner 214 includes a positioner base 230 and a cable fixing element 234 that extends proximally at an angle other than zero (for example, substantially perpendicular) to an upper surface of the positioner base 230. In the illustrated embodiment, element 234 is tubular, although it should be understood that element 234 can include other configurations as desired. As shown, positioner 214 also includes a hole 238 that extends longitudinally through both the base of positioner 230 and element 234. Location hole 238 is dimensioned and configured at least partially to receive temporary fixation element 222 so that the location element 222 can extend through the location hole 238 and to target location 218.
    [00034] As shown in figures 8A and 8B, the base of the positioner 230 includes a base body 242 that defines a bottom surface 246 that is configured to face the underlying bone and contact the underlying bone as desired. The contact surface of bone 246 is configured to be in a position bordering the bones that are drilled by mandrel 18 when positioner 214 is properly positioned over target site 218. As shown in figures 8B and 8C, the base body 242 is cylindrical and defines a recess 250 that extends continuously around a lateral surface of the base body 242. As shown in figure 8C, the base of the positioner 230 additionally includes a metal ring 254 that extends substantially around the body of the base 242 within the recess 250. The base of the positioner 230 is produced from biocompatible material and can be transparent to radiation. The metal ring 254 is radiopaque and allows the positioner 214 to be positioned using an X-ray device. Therefore, the user can follow the positioner 214 on an X-ray machine to make sure that the positioner 214 is properly positioned on target site 218. In this way the positioner base 230 can be called a radiopaque. However, it should be understood that the base body 242 itself can be radiopaque so that the positioner 214 can be positioned under X-rays.
    [00035] As shown in figures 8A and 8C, the positioner base 230 additionally includes positioning openings 262 that extend through the positioner body 242. Each positioning opening 262 extends through body 242 so that each opening 262 is able to be positioned on a respective bone that must be drilled by mandrel 18. Once positioner 214 has been positioned on target location 218 so that each opening 262 is on a respective bone that must be drilled, openings 262 can (if necessary) each receive a repositioning device (such as a K pin or wire) that is configured to reposition one of the respective bones. That is, if one of the bones to be drilled is not positioned correctly, the repositioning device can be advanced through the opening 262 of the positioner 214 that is placed on the bone that needs repositioning to thus engage and reposition the bone. In the illustrated embodiment, the openings 262 are holes that extend through the positioner body 242 at an angle. It should be understood, however, that the openings 262 may include configurations other than holes. For example, openings 262 can define slots as shown in the embodiment described with reference to figures 11A to 11C.
    [00036] As shown in figure 8B, the positioner base 230 has an alternative diameter or dimension Dp that is substantially equal to the diameter D of the guide opening 58 defined by the mandrel guide 14. Therefore, in embodiments where the positioner 214 is used in conjunction with the mandrel guide 14, the positioner base 230 of the positioner 214 can fit within the opening of the guide 58 of the mandrel guide 14. It should be understood, however, that although the positioner base 230 is described being cylindrical, the base of the positioner 230 can have other configurations, as desired. For example, positioner base 230 can define a block.
    [00037] As shown in figure 8C, location hole 238 extends longitudinally through both the base of positioner 230 and element 234. As shown, location hole 238 includes a proximal portion 280 that extends at least partially through of the element 234, and a distal portion 284 that extends at least partially through the base of the positioner 230. The proximal portion 280 of the location hole 238 has an alternative diameter or dimension Di_i that is configured to receive a portion of the first drill guide 220 of the second drill system 221, and the distal portion 284 of the locating orifice 238 has an alternate diameter or direction DL2 which is configured to receive the locating element 222. For example, the locating element can be a K wire, and location hole 238 can define a hole in wire K that has a diameter that is substantially equal to the diameter of wire K. As shown in figure 8C, the Proximal connection 280 of location hole 238 defines a neck 290 near a distal end of the proximal portion 280. Neck 290 is configured to temporarily couple the first drill guide 220 to positioner 214.
    [00038] As shown in figures 9A to 9C, the drill guide system 221 includes a first drill guide 220 and a second drill guide 300 that are coupled together by a bridge 304. The first drill guide 220 is configured to receiving a first bit part to form a first type in an underlying structure, while the second bit guide 300 is configured to receive a second bit part to form a second type of hole in an underlying structure. The first drill guide 220 is also configured to couple the positioner 214 so that the drill guide system 221 can be used as a cable to position the positioner 214 over target location 218.
    [00039] As best shown in figure 9C, the first drill guide 220 includes a shank 308, the head 312 extending from a proximal end of the shank 308, and a location hole 316 that extends through both shank 308 as of the head 312. A distal end of the stem 308 includes a coupling 320 which is configured to engage the neck 290 defined by the proximal portion 280 of the locator orifice location 222 so as to temporarily couple the first drill guide 220 to the positioner 214. Again with reference to figure 7, when the first drill guide 220 is coupled to the positioner 214, the location hole 316 of the first drill guide 220 is configured to align with the distal portion 284 of the location hole 238 of the positioner 214. That is, when the rod 308 of the first drill guide 220 is disposed within the proximal portion 280 of the location hole 238, the location hole 316 of the first drill guide 220 aligns with the distal portion 284 of the locator orifice 238. The aligned locator orifices 238 and 316 provide a guide path 324 that guides the locator 222 to target location 218.
    [00040] In operation and with reference to figures 10A to 10H, the chuck guide system 210 can be used to form a countersunk hole 116 in lunate bone 30, capitate 34, hamate 38, and triquet 42 of a wrist 46. In this operation, the positioner 214 can initially be coupled to the first drill guide 220 of the drill guide system 221 for positioning on the target location 218. Because the metal ring 254 of the positioner base 230 is radiopaque, the appropriate location of the location target 218 can be determined with the assistance of an X-ray device. When target location 218 is determined, temporary fixing element 222 can be passed through the path of guide 324 defined by location holes 238 and 316 of positioner 214 and the first drill guide 220 respectively. The temporary fastening element 222 extends through the target location 218 and is temporarily coupled to the target location 218 by means of threads or other means.
    [00041] After the fastener 222 is coupled to the target location 218, the positioner 214 and the drill guide system 221 can be removed, leaving the temporary fastener 222 behind, as shown in figure 10C. As shown in figure 10D, the mandrel 18 can then be guided along the temporary fixation element 222 towards the target location 218 to drill the bones and form a countersunk hole 116. In particular, the temporary fixation element 222 is passed through from the hole 98 of the mandrel 18 and the mandrel is guided to the target location 218 along the temporary fixing element 222 in the longitudinal direction L. As shown in figure 10E, the temporary fixing element 222 guides the mandrel 18 so that it is substantially perpendicular to the upper surfaces of the four bones being drilled. In addition, mandrel 18 is configured to pierce the bones while temporary member 222 extends through its orifice 98 to thereby ensure that countersunk hole 116 is properly positioned.
    [00042] As shown in figure 10F, when countersunk hole 116 is formed, melting plate 26 can be inserted into countersunk hole 116. As shown, melting plate 26 is located within countersunk hole 116 so that the plate Fusion 26 is at least flush with the upper surfaces 118 of bones 30, 34, 38, and 42. Because plate 26 does not protrude above the upper surfaces 118 of bones, plate 26 will not interfere or otherwise irritate the tissue above the bones 30, 34, 38, and 42.
    [00043] As shown in figure 10G, the first drill guide 220 or at least shank 308 of the first drill guide 220 is inserted through each hole 132 of the melting plate 26 so that a screw must be inserted. A drill can then be advanced through the location hole 316 of the first drill guide 220 and into the bones to form a pre-drilled hole configured to receive a fastener 140. As shown in figure 10H, when the pre-drilled holes are formed in the bones, the fixing elements 140 can be inserted through the respective holes 132 of the plate 26 and in the pre-drilled holes formed in each of the four bones 30, 34, 38, and 42 in order to fix the plate 26 to the bones and merge them.
    [00044] In another embodiment and with reference to figures 11A to 11C, a guide system 410 can include a positioner 414 which is configured to have a cable 418. As shown, positioner 414 includes a positioner base 430, an element cable tie 434 extending upward from the positioner base 430, and a location hole 438 that extends completely through element 434 and the positioner base 430. As shown in figure 11C, location hole 438 has a alternative diameter or dimension that is substantially constant from start to finish and is configured to receive location element 222.
    [00045] As shown in figures 11A and 11B, the base of the positioner 430 includes a body 442 that defines a bottom or contact surface of the bone 446. The contact surface of the bone 446 is configured to be in a position bordering the bones that should be drilled by mandrel 18 when positioner 414 is properly positioned on target location 218. As shown in figures 11A and 11B, the base of positioner 430 additionally includes a pair of positioning openings 462 that extends through the positioner body 442. Each positioning opening 462 extends through the body 442 so that each opening 462 is capable of being positioned on a respective bone that must be drilled by mandrel 18. When positioner 414 has been positioned on target location 218 so that each opening 462 is on a respective bone that must be drilled, the openings 462 can (if necessary) each receive a repositioning device (such as a pi no or K wire) that is configured to reposition one of the respective bones. That is, if one of the bones that must be drilled is not positioned correctly, the repositioning device can be advanced through the opening 462 of the positioner 214 that is placed on the bone that needs repositioning in order to engage and reposition the bone. In the illustrated embodiment, the openings 462 define radial slits 466 that extend through the positioner body 442 and to the sides of the positioner body 442.
    [00046] As shown in figures 11A to 11C, element 434 includes a cable coupling 470 adjacent to its proximal end. As shown in figure 11C, coupling 470 defines a recess 474 that is configured to receive coupling 478 defined by cable 418. As shown in figures 11A and 11C, when the coupling of cable 478 is fitted with recess 474 defined by positioner 414 , a pin 482 can lock cable 418 to positioner 414.
    [00047] As shown in figure 11B, cable 418 includes an angular portion 484 that extends from element 434 to a desired angle, and a portion of cable 488 that extends from a proximal end of angular portion 484. As shown in figure 11B, the angled portion 484 extends from the element 434, and the cable portion 488 extends from the angled portion 484 so that the base of the positioner 430 and the element 434 will not be interfered as the user holds and positions the positioner 414.
    [00048] Although chuck guide 14 and positioners 214 or 414 have been described as being used in separate operations, it should be understood that chuck guide 14 and positioners 214 or 414 can be used together to locate a location target 218 and form a countersunk hole 116, as shown in figure 214 or 414, or can be used together to locate target place 218 and form a countersunk hole 116, as shown in figure 12. As shown, positioner 214 for example, can be used to locate target location 218 with the assistance of an X-ray apparatus. When location element 222 has been inserted through positioner 214 and coupled to target location 218, positioner 214 can be removed. The mandrel guide 14 can then be positioned so that the locating element 222 extends through the opening of the mandrel guide 14 guide 58, and the positioner 214 can be reinserted so that the positioner base 230 of the positioner 214 is in the center of the opening of the guide 58 of the chuck guide 14. At that point the chuck guide 14 will be properly positioned, and temporary fasteners can be inserted to temporarily couple the chuck guide 14 to the four bones. Once attached to the bones, the positioner 214 can be removed and the mandrel 18 can be advanced below the locating element 222 to thereby drill the bones to form a countersunk hole 116.
    [00049] It should be understood that each of the positioners 214 and 414, the mandrel guide 14, and the mandrel 18 can be supplied as a kit either alone or in combination with any of the other devices. In addition, the kit can be supplied with a locating element 222, temporary fasteners, and / or the drill guide system 221.
    [00050] It will be understood by those skilled in the art that changes can be made in the modalities described above without deviating from the broad concept of the invention. For example, temporary fasteners can be separated as part of a single unit. In addition, it should be understood that the structure, characteristics, and methods as described above with respect to any of the modalities described in the present invention can be incorporated into any of the other modalities described herein, except where otherwise indicated. It is understood, therefore, that this invention is not limited to the particular modalities presented, but aims to cover the changes within the spirit and scope of the present description.
    权利要求:
    Claims (15)
    [0001]
    1. Chuck guide system (10) comprising: a chuck guide (14) which includes: a guide base (50) having a base body (56) that is configured to be positioned adjacent to at least two bones (30, 34, 38, 42), in which at least two bones (30, 34, 38, 42) are selected from the group consisting of a lunato (30), a capitate (34), a hamate ( 38), and a tri-metal (42), the guide base (50) defining 1) a guide opening (58) that extends through the base body (56) and is configured to receive a mandrel (18) and directs the mandrel (18) towards at least two bones (30, 34, 38, 42) when the base body (56) is positioned adjacent to at least two bones (30, 34, 38, 42), and 2) at least two holes (74) that extend through the base body (56) in one place so that they are aligned with each of the at least two bones (30, 34, 38, 42), respectively, when the body of base (56) is positioned adjacent to at least two bones ( 30, 34, 38, 42), where the guide opening (58) extends along a central geometry axis, and the holes (74) extend along respective central geometry axes that extend parallel to the geometry axis center of the guide opening (58), where each hole (74) is configured to receive respective temporary fasteners (22) configured to attach to at least two bones (30, 34, 38, 42), respectively, in order to keep the at least two bones (30, 34, 38, 42) in relation to each other as the mandrel (18) advances to the at least two bones (30, 34, 38, 42) characterized by the fact that that the system still comprises a positioner (214; 414) which is configured to be received by the guide opening (58), the positioner (214; 414) including: a positioner base (230; 430) which is configured to be positioned adjacent to at least two bones (30, 34 , 38, 42); and a locating orifice (238; 438) extending through the positioner base (230; 240), wherein the locating orifice (238; 438) is configured to receive a temporary fastener (222).
    [0002]
    2. Chuck guide system (10), according to claim 1, characterized by the fact that the holes (74) have a smaller cross section than that of the guide opening (58), where preferably each cross section comprises a diameter, in which the holes preferably comprise holes of K wire.
    [0003]
    3. Chuck guide system (10) according to claim 1 or 2, characterized in that the holes (74) are spaced equidistant around the base body (56).
    [0004]
    Chuck guide system (10) according to any one of claims 1 to 3, characterized in that the chuck guide (14) includes four holes (74) that extend through the base body (56 ), such that each orifice (74) extends to one of four bones (30, 34, 38.42) when the base body (56) is positioned adjacent to the four bones (30, 34, 38, 42).
    [0005]
    5. Chuck guide system (10) according to any one of claims 1 to 4, characterized in that the base body (56) defines at least two radial extensions (70), and each hole (74) extends through a respective extension (70).
    [0006]
    6. Chuck guide system (10) according to any one of claims 1 to 5, characterized in that the chuck guide (14) further includes a handle (54) extending from the guide base (50).
    [0007]
    Chuck guide system (10) according to any one of claims 1 to 6, characterized in that it further comprises a cable fixing element (234; 434) extending from the positioner base (230; 430), where the locating hole (238; 248) still extends through the cable fixing element (234; 434), where preferably the positioner base (230; 430) defines a surface for engaging the bone ( 246; 446), and the cable fixing element (234; 434) extends at an angle other than zero with respect to the contact surface of the bone (246; 446).
    [0008]
    8. Chuck guide system (10) according to claim 7, characterized by the fact that the locating hole (238; 248) has a proximal portion (280) dimensioned to receive a cable.
    [0009]
    Chuck guide system (10) according to claim 8, characterized in that the locating hole (238; 248) still has a distal K wire hole portion (284) smaller than the portion proximal (280).
    [0010]
    10. Chuck guide system (10) according to any one of claims 1 to 9, characterized by the fact that it still comprises temporary fastening elements (22; 222).
    [0011]
    Chuck guide system (10) according to any one of claims 1 to 10, characterized in that the positioner base (230; 430) is radiopaque, in which the positioner base (230; 430 preferably) ) includes a base body transparent to radiation (242), and a radiopaque ring (254).
    [0012]
    Chuck guide system (10) according to any one of claims 1 to 11, characterized in that the positioner (214; 414) still defines at least one positioning opening (262; 462) that extends through the positioner base (230; 430) and is configured to receive a repositioning device that is capable of repositioning at least one of the at least two bones (30, 34, 38, 42), in which preferably at least one opening positioning (262; 462) is opened to a side wall of the positioner base (230; 430).
    [0013]
    13. Chuck guide system (10) according to claim 7, characterized by the fact that it also comprises a drill guide (221) configured to be separably coupled to the cable fixing element (234; 434) .
    [0014]
    14. Chuck guide system (10) according to claim 7, characterized by the fact that it still comprises a cable (418) that is coupled to the cable fixing element (434).
    [0015]
    Chuck guide system (10) according to any one of claims 1 to 14, characterized in that the positioner (214; 414) includes a cable fixing element (234; 434) extending from the positioner base (230; 430), where the locating hole (238; 438) extends through both the cable fixing element (234; 434) and the positioner base (230; 430); the system further comprises a mandrel (18) including a mandrel body defining a stem (94) and a head (90), the head (90) configured to mill into the bone, the mandrel (18) defining an orifice (98 ) that extends through the head (90) and the stem (94), where the hole (98) is dimensioned equal to the fixing element (222), such that the mandrel (18) can be guided along the fixation (222) for at least two bones (30, 34, 38, 42) after the positioner (214; 414) has been removed from at least two bones (30, 34, 38, 42), preferably in the hole (98) of the mandrel (18) defines a cross section equal to that of the locating orifice (238; 438).
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    同族专利:
    公开号 | 公开日
    CN103327912B|2017-07-11|
    KR20140005991A|2014-01-15|
    CA2973457C|2020-10-27|
    BR112013018833A2|2017-02-21|
    WO2012102726A1|2012-08-02|
    CN103327912A|2013-09-25|
    KR101805380B1|2017-12-06|
    CA2973457A1|2012-08-02|
    JP2014511207A|2014-05-15|
    CA2824962A1|2012-08-02|
    JP5774724B2|2015-09-09|
    EP2667798B1|2015-07-29|
    EP2667798A1|2013-12-04|
    CA2824962C|2018-12-11|
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    法律状态:
    2019-01-08| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2019-08-27| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2020-05-05| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2020-08-04| 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 28/01/2011, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    PCT/US2011/022842|WO2012102726A1|2011-01-28|2011-01-28|Reamer guide systems|
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