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  • 专利说明
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    • 专利摘要:
    This surgical implant (1) comprises: - a first anchoring part (10) comprising two first limbs (11, 12) movable between an insertion position and an anchoring position, where the first limbs (11, 12) are spaced apart for anchoring in a first bone, - a second anchoring portion (20) to be anchored in the second bone, - an intermediate portion (40) connecting the first anchoring portion (10) to the second portion of anchoring (20). The intermediate portion (40) comprises: a recess (48), a first connecting portion (42) and a second connecting portion (44) distant. A combination of the first (42) and the second connecting portions (44) moves the first legs (11, 12) from their introduction position to their anchoring position.
    公开号:FR3018441A1
    申请号:FR1451980
    申请日:2014-03-11
    公开日:2015-09-18
    发明作者:Loic Girod；Gregory Gledel；Gilles Audic；Marc Augoyard；Romain Augoyard；Tristan Meusnier；Stephanie Valentin
    申请人:Novastep SAS；
    IPC主号:
    专利说明:

    [0001] The present invention relates to a surgical implant for providing a fusion between a first portion of bone and a second portion of bone. In addition, the present invention relates to an ancillary clamp, configured to clamp a surgical implant. In a known manner, an ancillary is a manipulation instrument intended to assist the medical personnel. The present invention can be applied to the field of surgical implants used to perform intramedullary bone fusion arthrodesis in a joint. The present invention can also be applied to the field of surgical implants used for fusion osteosynthesis between two bone fragments. The indications are, for example: the correction of claw toes by arthrodesis of the proximal and / or distal interphalangeal joint of the foot, the surgical treatment of osteoarthritis or trauma by arthrodesis of the proximal and distal interphalangeal joints of the foot the surgical treatment of osteoarthritis or trauma by arthrodesis of the proximal and distal interphalangeal joints of the hand, bone osteosynthesis by fusion of two bone fragments, in particular of the foot or the hand, FR2846545A1 illustrates a surgical implant which is a shape memory alloy. This surgical implant comprises two anchor portions, configured to anchor respectively in a first bone and a second bone, and an intermediate portion connecting the anchor portions therebetween. The branches of each anchoring portion are movable between: - an insertion position, in which the branches are close and can be introduced into a respective bone, the surgical implant then having generally the shape of an "H", and - an anchoring position, in which the branches are further apart than in the insertion position, so that the branches anchor each anchoring part in a respective bone, the surgical implant then having generally the shape of 'an' X '. However, since the surgical implant of FR2846545A1 is composed of a shape memory alloy, it is necessary to refrigerate it for several hours in order to place it in the insertion position before implantation. Then, the surgeon has only a short time to implant this surgical implant before its branches return, by the effect of shape memory, anchoring position. Thus, this short time may affect the accuracy of the positioning of the surgical implant in the bones. In addition, the longer this period of time, the more the surgical implant gradually covers its final shape, which makes it difficult or impossible to insert the surgical implant at the bone site. The present invention is intended in particular to solve, in whole or in part, the problems mentioned above. For this purpose, the invention relates to a surgical implant intended to allow a fusion between a first portion of bone and a second portion of bone, the surgical implant comprising at least: a first anchoring portion configured to be anchored in the first bone portion, the first anchor portion having at least two first legs, the first legs being movable between: - an insertion position, wherein the respective ends of the first legs define a first insertion distance, so as to allow the introduction of the first branches within the first portion of bone, and 20 - an anchoring position, wherein the respective ends of the first branches define a first distance anchoring greater than the first insertion distance, so that the first legs are adapted to anchor the first anchoring portion therein of the first bone portion; a second anchor portion configured to be anchored in the second bone portion; an intermediate portion connecting the first anchor portion to the second anchor portion; the surgical implant being characterized in that: the intermediate portion comprises at least: a recess, a first connecting portion disposed between the first anchoring portion and the second anchoring portion, and a second portion. linkage disposed between the first anchoring portion and the second anchoring portion, the first connecting portion and the second connecting portion being arranged on either side of said at least one recess so that the first portion of link is remote from the second connecting portion, and the intermediate portion is shaped so that a bringing together of the first connecting portion and the second connecting portion moves the first branches from their introduction position to their position of anchor. In other words, the approximation of the first connecting portion and the second connecting portion reduces said at least one recess, displacing the first branches. Advantageously, said at least one recess has a closed contour. Alternatively, said at least one recess may have a partially closed contour; for example, said at least one recess may be open at 10 or 20% of its periphery. According to a variant of the invention, the first connecting portion 15 extends substantially between the first branch and the second anchoring portion, and the second connecting portion extends substantially between the second branch and the second portion of anchorage. According to a variant of the invention, the first insertion distance may be zero or negligible. According to one embodiment of the invention, the second anchoring portion comprises at least two second branches, the second branches being movable between: an insertion position, in which the respective ends of the second branches define a second distance; for introducing the second branches into the second bone portion, and - an anchoring position, wherein the respective ends of the second legs define a second anchorage distance. greater than the second insertion distance, so that the second branches are adapted to anchor the second anchoring portion within the second bone portion, and wherein the intermediate portion is shaped such that a bringing together of the first connecting portion and the second connecting portion moves the second branches from their introduction position. to their anchoring position.
    [0002] In other words, the surgical implant has at least four branches, at least two on each side of the intermediate portion. Thus, such a surgical implant allows a firm and simple anchoring not only in the first portion of bone, but also in the second portion of bone. According to a variant of the invention, the second insertion distance may be zero or negligible. Alternatively, the second anchoring portion has a single branch configured to be anchored in the second bone portion. This single branch may for example be formed by an anchor rod. According to a variant of the invention, the first branches are longer than the second branches. For example, the ratio between a length of the first limbs and a length of the second limbs is between 1.5 and 5. The length of each first limb may be between 5 mm and 20 mm. The length of each second branch can be between 3 mm and 10 mm. The intermediate portion may have a length, measured in the longitudinal direction of a first branch, between 3 mm and 10 mm. According to a variant of the invention, the intermediate portion, the first anchoring portion and the second anchoring portion have thicknesses of between 0.5 mm and 2 mm. According to a variant of the invention, the first anchoring portion comprises at least three first branches, for example four first branches. In this case, the intermediate portion has a plurality of respective connecting portions arranged to connect the first branches at least two by two. Thus, such a first anchoring portion allows a three-dimensional anchoring, which can have a very high mechanical strength and excellent stability. According to one embodiment of the invention, the intermediate portion 30 is plastically deformable so that a plastic deformation of the intermediate portion bringing the first connecting portion and the second connecting portion moves the first branches and / or the second branches. their position (s) of introduction to their anchorage position (s). In other words, a mechanical stress applied to the intermediate portion is determined so as to produce a permanent or irreversible deformation of the intermediate portion.
    [0003] Thus, this plastic deformation, which is by definition irreversible and permanent, allows a surgeon to easily place the first branches and / or the second branches in position (s) anchoring. In addition, the surgeon has all the time necessary to precisely position the surgical implant in the first portion of bone and in the second portion of bone, which guarantees the patient a durable and durable anchoring of the surgical implant. . Advantageously, the plastic deformation is performed in the field of homogeneous plastic deformation of the material constituting the intermediate portion. Thus, such a homogeneous plastic deformation avoids weakening in necking the intermediate portion, which thus retains a high mechanical strength. According to a variant of the invention, the intermediate portion is plastically deformable so that a plastic deformation of the intermediate portion bringing the first connecting portion into contact with the second connecting portion displaces the first branches of the insertion position. at the anchoring position. In other words, after the plastic deformation, the first connecting portion touches the second connecting portion. Thus, when tightening by a specific clamping device, the surgeon can feel when to stop clamping the intermediate portion. According to one embodiment of the invention, as an alternative to a plastic deformation, the intermediate portion is elastically deformable so that an elastic recess of the intermediate portion bringing the first connecting portion and the second connecting portion moves first. branches of their position (s) of introduction to their anchor position (s). In other words, a mechanical stress applied to the intermediate portion is determined so as to produce a reversible deformation of the intermediate portion. The intermediate portion is prestressed before the introduction of the surgical implant into the patient's body, and then this preload is released totally or partially to reach the anchoring position in the patient's body. Thus, the intermediate portion is elastically deformable between i) a position of large elastic deformation, in which the first branches and / or the second branches are in position (s) of introduction, and ii) a position of weak elastic deformation or zero, in which the first branches and / or the second branches are in position (s) anchoring. According to a variant of the invention, the surgical implant is configured to cooperate with movable retaining means between: - a retaining position, in which the retaining means retain the elastically deformed intermediate part, and - a release position, wherein the retaining means releases the intermediate portion so that said elastic expansion can occur.
    [0004] For example, the retaining means may comprise a stud which, in the retaining position, is inserted into the at least one recess. When the stud is withdrawn, the elastic expansion of the intermediate portion brings the first connecting portion of the second connecting portion together, which moves the first limbs and / or the second limbs towards their position (s). anchor. According to one embodiment of the invention, the first branches each have a generally elongate shape, and wherein the first branches are substantially parallel in their insertion position and substantially form a "V" in their anchoring position. In other words, the first branches form a "U" tightened in the insertion position and a "V" in the anchoring position. The "V" shape is defined by an angular sector which is advantageously between 20 degrees and 60 degrees.
    [0005] According to a variant of the invention, the second branches each have a generally elongate shape, the second branches are substantially parallel in their insertion position, and the second branches substantially form a "V" in their anchoring position. In other words, in this variant, the surgical implant generally has a shape of "H" tightened in the insertion positions and "X" in anchoring positions. Thus, such forms allow easy insertion and firm anchoring of the surgical implant into the first bone portion and the second bone portion.
    [0006] According to a variant of the invention, the first branches extend in a first longitudinal direction, the second branches extend in a second longitudinal direction, the first branches and the second branches forming an angle of between 150 degrees and 180 degrees in a plane containing the first longitudinal direction and the second longitudinal direction.
    [0007] According to one embodiment of the invention, the intermediate portion further comprises i) a first connecting portion connecting at least two first branches, and ii) a second connecting portion connecting at least two second branches, the first connecting portion and the second connecting portion being arranged respectively on either side of the first connection portion and on either side of the second connection portion. In this embodiment, the first connecting portion, the second connecting portion, the first connecting portion and the second connecting portion define said at least one recess. Thus, the intermediate portion may have a high mechanical strength and allow a high geometric accuracy of the deformation. According to a variant of the invention, the first connecting portion and the second connecting portion define at least one recess having a closed contour defined by the first connecting portion, by the second connecting portion, by the first connecting portion and by the second connecting portion. Thus, such a closed recess allows a high geometric accuracy of the deformation. Alternatively, the intermediate portion has a recess having an open contour towards the second anchoring portion.
    [0008] According to a variant of the invention, said at least one recess contains a more deformable element than the intermediate part. For this purpose, the limit of elastic or plastic deformation of the material composing this element is less than the limit of plastic deformation of the material constituting the intermediate part. Thus, the element does not prevent or slow the plastic deformation bringing the first connecting portion of the second connecting portion. This element may for example be composed of a polymeric material. According to one embodiment of the invention, at least one recess has an oblong shape, the length of which extends generally between the first anchoring portion and the second anchoring portion.
    [0009] Thus, such an oblong recess requires a small stroke plastic deformation, so a limited tightening on the part of the surgeon. According to one embodiment of the invention, at least one recess has a narrow zone and a wide zone which is wider than the narrow zone, the widths being measured between the first connecting portion and the second connecting portion. In particular, the widths are measured transversely to a longitudinal direction along which the first branches extend. For example, this recess may have approximately, in top view, a shape of a pear or saddle of a bicycle. Thus, such an asymmetrical shape allows a displacement of the first branches greater than the displacement of the second branches, so as to adapt the surgical implant to specific indications. According to one embodiment of the invention, the first connecting portion has a first face which is convex and which is oriented towards the second connecting portion, the first face having a profile formed by an arc of a circle whose radius is greater than 20 mm, preferably 40 mm, and the second connecting portion has a second face which is convex and which is oriented towards the first connecting portion, the second face having a profile formed by an arc of a circle whose radius is greater than 20 mm, preferably 40 mm. Thus, such circular arcs allow, during a plastic deformation, to obtain a high geometric precision in the movement of the first branches and, if necessary, the second branches. Advantageously, the radii of the circular profiles are equal. According to a variant of the invention, the first insertion distance is between 0 and 2 mm, and wherein the first anchoring distance is between 1 and 10 mm. Thus, such dimensions are particularly suitable for the interphalangeal joints of the feet or hands. According to a variant of the invention, the second insertion distance is between 0 and 2 mm, and wherein the second anchoring distance is between 1 and 10 mm. According to one embodiment of the invention, at least the intermediate portion is composed of a material selected from the group consisting of: - a titanium alloy, preferably of grade 1, 2, 3 or 4, depending on the ISO 5832-2 or ASTM F67, and - stainless steel according to ISO 5832-1. For example, the intermediate portion of such a titanium alloy has a plastic deformation range with a large breaking point and a relatively small yield strength, which makes it possible to obtain plastic deformation with a little compressive force. Student. According to a variant of the invention, at least one of the first branches and the second branches has, on a respective external face 10, notches configured for anchoring the surgical implant respectively in the first portion of bone and in the second portion of bone. Advantageously, on the or each end portion of a first or second respective branch, notches are spear-shaped. According to one embodiment of the invention, the intermediate portion further comprises at least two stops extending projecting on two opposite external faces of the intermediate portion. Thus, the stops make it possible to precisely position a clamping anchor on the intermediate part. According to a variant of the invention, in the case where the second anchoring portion comprises second branches, the intermediate portion comprises four stops, namely two stops located on the side of the first branches and two stops located on the side of the second branches. Advantageously, the stops located on the side of the first branches are larger than the stops located on the side of the second branches. Advantageously, external faces of the intermediate portion have, next to the abutments, friction means configured to grip by friction jaws of an ancillary clamping. For example, these friction means may include notches or roughnesses. Furthermore, the subject of the present invention is an ancillary clamping device, configured to clamp at least one surgical implant according to the invention, the clamping ancillary comprising at least two jaws and at least one articulation connecting said at least two jaws, clamping tool being characterized in that each jaw has a respective housing of complementary shape to a respective connecting portion so as to grip a respective outer face of the intermediate portion, and in that said at least one hinge is configured to so that a displacement of the jaws induces a rapprochement of the first connecting portion and the second connecting portion.
    [0010] Thus, such an ancillary clamping makes it possible to tighten the surgical implant until the aforementioned plastic deformation is obtained. According to one embodiment of the invention, said at least one hinge comprises a latch having at least one locking notch, the hinge being movable between: an open position, in which the jaws define a space allowing the installation of the hinge surgical implant, - a retaining position, in which the jaws grip the respective outer faces of the intermediate portion so that the clamping anchor retains the surgical implant, a clamping position, in which the jaws clamp the intermediate portion. to obtain said approximation. According to one embodiment of the invention, the latch is connected to one of the jaws by a pivot connection, and the latch has a handling portion, configured to allow a surgeon to manipulate the latch so as to move the latch. articulation between the open position, the retaining position and the clamping position. The embodiments and variants mentioned above may be taken individually or in any technically permissible combination.
    [0011] The present invention will be well understood and its advantages will also emerge in the light of the description which follows, given solely by way of nonlimiting example and with reference to the appended drawings, in which: FIG. 1 is a front view a surgical implant according to the invention, in the introduction configuration; FIG. 2 is a perspective view of the surgical implant of FIG. 1, in the introduction configuration; FIG. 3 is a front view of the surgical implant of FIG. 1, in anchoring configuration; FIG. 4 is an enlarged view of detail IV in FIG. 1; FIG. 5 is a view on a larger scale of detail V in FIG. 3; Figure 6 is a side view of the surgical implant of Figure 1; FIG. 7 is a view similar to FIG. 6 of a surgical implant according to a variant of the invention; FIG. 8 is a perspective view of a clamping anchor according to the invention and configured to hold and tighten the surgical implant of FIG. 1; FIG. 9 is a perspective view of the clamping anchor of FIG. 8 retaining the surgical implant of FIG. 1; FIG. 10 is an enlarged view of detail X in FIG. 9; - Figures 11A and 11B are schematic views and on a larger scale of the center of Figure 4; Figures 11A and 11B illustrate two different positions for clamping the surgical implant; Figure 12 is a side view of a portion of the clamping anchor of Figure 8 in an open position; - Figure 13 is a view similar to Figure 12 illustrating the clamping clamp of Figure 12 in a retaining position; - Figure 14 is a view similar to Figure 12 illustrating the clamping device of Figure 12 in a position according to the clamping position of Figure 13; - Figure 15 is a view similar to Figure 12 illustrating the clamping device of Figure 12 in a clamping position; FIG. 16 is a schematic view of the surgical implant of FIG. 1 in the introduction configuration; and FIG. 17 is a view similar to FIG. 16 illustrating the surgical implant of FIG. 1 in anchoring configuration. Figures 1, 2, 3, 4, 5 and 6 illustrate a surgical implant 1 35 for allowing fusion between a first bone portion and a second bone portion. In the example of FIGS. 16 and 17, the first bone portion and the second bone portion are respectively a proximal phalanx P1 and a middle phalanx P2 of a toe. The surgical implant 1 comprises a first anchoring portion 10 and a second anchoring portion 20, which are respectively configured to be anchored in the proximal phalanx P1 and in the middle phalanx P2. The first anchoring portion 10 comprises two first branches 11 and 12. The first branches 11 and 12 are movable between an insertion position (FIGS. 1, 2, 4, 16) and an anchoring position 10 (FIG. 5, 17). In the insertion position (FIGS. 1, 4, 16), the respective ends 11.1 and 12.1 of the first branches 11 and 12 define a first insertion distance D10.1. The first insertion distance D10.1 is relatively small, so as to allow the introduction of the first 15 branches 11 and 12 inside the proximal phalanx P1, as shown in Figure 16. In the example of the figures 1 to 6, the first insertion distance D10.1 is approximately equal to 0.4 mm and the first anchoring distance D10.2 is approximately equal to 6 mm. In the anchoring position (FIGS. 3, 5, 17), the respective ends 11.1 and 12.1 of the first branches 11 and 12 define a first anchoring distance D10.2 which is larger than the first insertion distance D10. 1. Since the first anchorage distance D10.2 is relatively large, the first legs 11 and 12 are adapted to anchor the first anchoring portion 10 within the proximal phalanx P1. The first legs 11 and 12 each have a generally elongate shape and are substantially parallel in their insertion position (Figures 1, 4, 16) and substantially form a "U" constricted in their insertion position (Figures 1, 4, 16). The first legs 11 and 12 form substantially a "V" in their anchoring position (Figures 3, 5, 17), in this case an angular sector A11.12 of about 30 degrees. In addition, the surgical implant 1 comprises an intermediate portion 40 which connects the first anchoring portion 10 to the second anchoring portion 20. The intermediate portion 40 extends between the first anchoring portion 10 and the second anchoring portion 10. anchoring part 20.
    [0012] The second anchoring portion 20 has two second branches 21 and 22. Thus the surgical implant 1 has four branches 11, 12, 21 and 22, two on each side of the intermediate portion 40. The second branches 21 and 22 are movable between an insertion position (FIGS. 1, 4, 16) and an anchoring position (FIGS. 3, 5, 17). The second branches 21 and 22 each have a generally elongate shape and are substantially parallel in their insertion position (FIGS. 1, 4, 16) and substantially form a "U" constricted in their insertion position (FIGS. 16). The second legs 21 and 22 substantially form a "V" in their anchoring position (Figures 3, 5, 17), in this case an angular sector A21.22 of about 40 degrees. Thus the surgical implant 1 generally has a shape of "H" tightened when the first branches 11 and 12 and the second branches 21 and 22 are in their insertion positions (Figures 1, 4, 16), then "X" When the first branches 11 and 12 and the second branches 21 and 22 are in their anchoring positions (FIGS. 3, 5, 17). In the insertion position (FIGS. 1, 4, 16), the respective ends 21.1 and 22.1 of the second branches 21 and 22 define a second insertion distance D20.1. The second insertion distance D20.1 is relatively small, so as to allow the introduction of the second branches 21 and 22 inside the middle phalanx P2. In the example of FIGS. 1 to 6, the second insertion distance D20.1 is approximately equal to 1.5 mm and the second anchoring distance D20.2 is approximately equal to 4.3 mm. In the anchoring position (FIGS. 3, 5, 17), the respective ends 21.1 and 22.1 of the second branches 21 and 22 define a second anchoring distance D20.2 which is larger than the second insertion distance D20.1. . Since the second anchorage distance D20.2 is relatively large, the second branches 21 and 22 are adapted to anchor the second anchoring portion 20 within the middle phalanx P2. The intermediate portion 40 comprises: a first connecting portion 41 which connects the two first 35 branches 11 and 12, - a first connecting portion 42, which is arranged between the first anchoring portion 10 and the second anchoring portion 20 and a second connecting portion 44, which is arranged between the first anchoring portion 10 and the second anchoring portion 20.
    [0013] The first connecting portion 42 and the second connecting portion 44 are arranged on either side of the recess 48 so that the first connecting portion 42 is distant from the second connecting portion 44. The first connecting portion 44 42 extends substantially between the first branch 11 and the second anchoring portion 20. The second connecting portion 44 extends substantially between the second branch 12 and the second anchoring portion 20. The intermediate portion 40 further comprises a recess 48 which here has a closed contour. In the example of FIGS. 1 to 6, the recess 48 has an oblong shape whose length L48 extends generally between the first anchoring part 10 and the second anchoring part 20. The intermediate part 40 comprises in addition a second connecting portion 46 which connects the second branches 21 and 22. The first connecting portion 42 and the second connecting portion 44 are arranged on either side of the recess 48. The first connecting portion 20 42 and the second connecting portion 44 are respectively arranged on either side of the first connecting portion 41 and on either side of the second connecting portion 46. As shown in FIGS. 1 and 4, the outline Closure of the recess 48 is defined by the first connecting portion 42, the second connecting portion 44, the first connecting portion 41 and the second connecting portion 46. The intermediate portion 40 is shaped as that a combination of the first connecting portion 42 and the second connecting portion 44 moves the first legs 11 and 12 from their introduction position 30 to their anchoring position. In the example of Figures 1 to 6, the intermediate portion 40 is plastically deformable so that a plastic deformation of the intermediate portion 40 bringing the first connecting portion 42 of the second connecting portion 44 moves the first branches 11 and 12 from their insertion position (FIGS. 1, 4, 16) to their anchoring position (FIGS. 3, 5, 17).
    [0014] In the example of FIGS. 1 to 5, the plastic deformation of the intermediate portion 40 puts the first connecting portion 42 into contact with the second connecting portion 44, which moves the first branches 11 and 12 of the insertion position. (Figures 1, 4, 16) at the anchoring position (Figures 3, 5, 17). As shown in Figures 3 and 5, after the plastic deformation, the first connecting portion 42 touches the second connecting portion 44. The intermediate portion 40 is composed of a grade 2 titanium alloy (titanium T40) according to the standard ISO 5832-2 or ASTM F67. The plastic deformation is here carried out in the region of homogeneous plastic deformation of the material constituting the intermediate portion 40. The comparison of FIGS. 4 and 5 shows the bringing together bringing into contact the first connecting portion 42 and the second connecting portion 44 resulting from the plastic deformation of the intermediate portion 40. Similar to the displacement of the first branches 11 and 12, the intermediate portion 40 is plastically deformable so that a plastic deformation of the intermediate portion 40 bringing the first connecting portion 42 of the second connecting portion 44 moves the second branches 21 and 22 from their insertion position (FIGS. 1, 4, 16) to their anchoring position (FIGS. 3, 5, 17). The first branches 11 and 12 are longer than the second branches 21 and 22. The ratio between a length of the first branches 11 and 12 and a length of the second branches 21 and 22 is here approximately equal to 3. The first branches 11 and 12 have the same length. The second branches 21 and 22 have the same length. The length of each first branch 11 or 12 is here approximately equal to 11 mm. The length of each second branch 21 or 22 is here approximately equal to 4 mm. The intermediate portion 40 here has a length, measured in the longitudinal direction of a first leg 11 or 12, approximately equal to 5 mm. The intermediate portion 40, the first anchoring portion 10 and the second anchoring portion 20 have a thickness El approximately equal to 1.5 mm. Each first branch 11 or 12 and each second branch 21 or 22 has, on a respective outer face, notches 11.5, 12.5 and 21.5, 22.5, which are configured for anchoring the surgical implant 1 respectively in the proximal phalanx. PI and in the middle phalanx P2. On each end portion of a first 11, 12 or second 21, 22 respective branch, notches 11.5, 12.5, 21.5 and 22.5 are shaped harpoons. In the example of FIGS. 1 to 6, the surgical implant 1 is in one piece. Thus, like the intermediate portion 40, the first branches 11 and 12 and the second branches 21 and 22 are composed of a grade 2 titanium alloy according to ISO 5832-2 or ASTM F67. As shown in FIGS. 3 and 5, after the plastic deformation, the first connecting portion 42 touches the second connecting portion 44, so that the recess 48 is very small or non-existent. The first connecting portion 42 has a first face 42.1 which is convex and which is oriented towards the second connecting portion 44. The first face 42.1 has a profile formed by an arc of a circle whose radius here is approximately equal to 35 mm. Similarly, the second connecting portion 44 has a second face 44.2 which is convex and which is oriented towards the first connecting portion 42. The second face 44.2 has a profile formed by an arc whose circle is here about equal at 35 mm. In addition, the intermediate portion 40 further includes four abutments 51, 52, 53 and 54 which protrude on two respective outer faces 55, 56 of the intermediate portion 40 which are opposed. The stops 51 and 52 protrude on the outer face 55, and stops 53 and 54 project on the outer face 56. The two stops 51 and 52 are located on the side of the first branches 11 and 12, while that the stops 53 and 54 are located on the side of the second branches 21 and 22. Each outer face 55 or 56 of the intermediate portion 40 has, next to the stops 51, 52, 53, 54, not shown friction means, notches or roughnesses, which are configured to grip the jaws of a clamping jig by friction. Figure 7 illustrates a surgical implant 101 according to a variant of the invention. The surgical implant 101 is similar to the surgical implant 1, except for the notable differences mentioned below. The surgical implant 101 includes a first anchoring portion 110, a second anchoring portion 120, and an intermediate portion 140. The first anchoring portion 110 has two first legs 111 and 112 similar to the first legs 11 and 12 of the the surgical implant 1. The second anchoring portion 120 has two second branches 121 and 122 similar to the second branches 11 and 12 of the surgical implant 1. The surgical implant 101 differs from the surgical implant 1 because the first branches 111 and 112 extend in a first longitudinal direction X1, while the second branches 121 and 122 extend in a second longitudinal direction X2. Thus, the first branches 111 and 112 and the second branches 121 and 122 form an angle A between them. The angle A is here approximately equal to 170 degrees in a plane 10 containing the first longitudinal direction X1 and the second longitudinal direction X2. The angle A is here represented in the plane of FIG. 7, which is parallel to the plane containing the first longitudinal direction X1 and the second longitudinal direction X2. Figures 8, 9, 10, 12, 13, 14 and 15 illustrate a clamping anvil 200 according to the invention, which is configured to clamp the surgical implant 1 or 101. The clamping anchor 200 comprises two jaws 201 and 202 and a hinge 204. The hinge 204 connects the jaws 201 and 202. The clamping ancillary 200 further comprises two gripping bars 205 and 206. Each gripping bar 205 or 206 is integral with a jaw 20 201 or 202. Each jaw 201 or 202 defines a respective housing 201.1 or 202.1 of complementary shape to a respective connecting portion 42 or 44, so that each jaw 201 or 202 can grip a respective outer face 55 or 56 of the part In the example of FIGS. 1 to 6, the first connecting portion 42 and the second connecting portion 44 each have a section with a rectangular profile. Thus, in the example of FIGS. 8 to 15, each respective housing 201.1 or 202.1 defined by the jaws 201 and 202 is generally parallelepipedic with a rectangular profile open on one side, as shown in FIG. 8. The hinge 204 is configured so that a displacement of the jaws 202 and 204 induces a plastic deformation of the intermediate portion 40 bringing the first connecting portion 42 of the second connecting portion 44. The hinge 204 comprises a latch 210 which has two locking notches 35 211 and 212. The jaw 205 has a lug 205.5 configured to cooperate with the locking notches 211 and 212 by complementarity of shapes. The latch 210 is connected to the jaw 206 by a pivot link 214. The latch 210 has a handling portion 210.1, which is configured to allow a surgeon to manipulate the latch 210 to move the hinge 204.
    [0015] The hinge 204 is movable between: an open position (FIGS. 8 and 12), in which the jaws 201 and 202 define a space 215 allowing the installation of the surgical implant 1; in the open position, the lug 205.5 does not yet cooperate with the locking notches 211 and 212; - A retaining position (Figures 9, 10 and 13), wherein the jaws 201 and 202 grip the respective outer faces 55 and 56 of the intermediate portion 40 so that the clamping ancillary 200 retains the surgical implant 1; in the retaining position, the lug 205.5 is engaged between the locking notches 211 and 212; a clamping position (Figure 15), in which the jaws 201 and 202 clamp the intermediate portion 40 so as to achieve the intended plastic deformation; in the clamping position, the lug 205.5 is disengaged from the locking notches 211 and 212, so that the lug 205.5 is under the locking notches 211 and 212.
    [0016] With the handling portion 210.1, the surgeon can manipulate the latch 210 to move the hinge 204 between the open position (FIGS. 8 and 12), the holding position (FIGS. 9, 10 and 13) and the position of the latch. tightening (Figure 15). The figure illustrates the clamping anchor 200 in a position following the clamping position (FIG. 13).
    [0017] FIG. 11A illustrates a first clamping position of the surgical implant 1 relative to the ancillary device 200. The resultant of the clamping forces exerted by the jaws 201 and 202 on the surgical implant 1 is generally carried by a resultant axis A. In this first clamping position, the resultant axis A 30 passes substantially through the middle of the recess 48, in a longitudinal direction generally defined by the first branches 11 and 12 in the insertion positions (FIGS. and 4). In this first clamping position, the clamping forces exerted by the jaws 201 and 202 on the surgical implant 1 are distributed uniformly over the intermediate portion 40. Thus, the plastic deformation of the first branches and the second branches could be symmetrical in the case where the first branches and the second branches are symmetrical. FIG. 11B illustrates a second clamping position of the surgical implant 1 relative to the ancillary device 200. The resultant of the clamping forces exerted by the jaws 201 and 202 on the surgical implant 1 is generally borne by the axis A. In this second clamping position, unlike the first clamping position illustrated in FIG. 11A, the resultant axis A does not pass through the middle of the recess 48, but closer to the second In this second clamping position, the clamping forces exerted by the jaws 201 and 202 on the surgical implant 1 are not uniformly distributed over the intermediate portion 40. Thus, the plastic deformation of the first branches and second branches is not symmetrical. The second branches would be wider than the first branches. FIGS. 16 and 17 illustrate the surgical implant 1 respectively before and after plastic deformation of the intermediate portion 40, and therefore respectively before and after separation of the first 20 branches 11 and 12 and second branches 21 and 22. FIG. first branches 11 and 12 and the second branches 21 and 22 in their insertion positions, while Figure 17 illustrates the first branches 11 and 12 and the second branches 21 and 22 in their anchoring positions.
    [0018] Of course, the present invention is not limited to the particular examples described in this application. Other embodiments within the reach of those skilled in the art can also be envisaged without departing from the scope of the present invention.
    权利要求:
    Claims (14)
    [0001]
    REVENDICATIONS1. Surgical implant (1), intended to allow a fusion between a first portion of bone (P1) and a second portion of bone (P2), the surgical implant (1) comprising at least: a first part of anchor (10) configured to be anchored in the first bone portion (P1), the first anchor portion (10) having at least two first legs (11, 12), the first legs (11, 12) being movable between: 10 - an insertion position, in which the respective ends of the first limbs (11, 12) define a first insertion distance (D10.1), so as to allow the introduction of the first limbs (11, 12 ) within the first bone portion (P1), and - an anchoring position, wherein the respective ends of the first legs (11, 12) define a first anchorage distance (D10.2) greater than the first insertion distance (D10.1), so that the first branches (11, 12 ) are adapted to anchor the first anchor portion (10) within the first bone portion (P1), - a second anchor portion (20) configured to be anchored in the second portion of the anchor portion (10). bone (P2), - an intermediate portion (40) connecting the first anchoring portion (10) to the second anchoring portion (20); the surgical implant (1) being characterized in that: the intermediate portion (40) comprises at least: - a recess (48), - a first connecting portion (42) disposed between the first anchoring portion ( 10) and the second anchoring portion (20), and - a second connecting portion (44) disposed between the first anchoring portion (10) and the second anchoring portion (20), the first portion of the anchoring portion (20) link (42) and the second connecting portion (44) being arranged on either side of said at least one recess (48) so that the first connecting portion (42) is distant from the second connecting portion (44). ), and - the intermediate portion (40) is shaped such that a combination of the first connecting portion (42) and the second connecting portion (44) moves the first legs (11, 12) of their position introduction to their anchoring position.
    [0002]
    2. Surgical implant (1) according to claim 1, wherein the second anchoring portion (20) comprises at least two second legs (21, 22), the second legs (21, 22) being movable between: - a position in which the respective ends of the second legs (21, 22) define a second insertion distance (D20.1), so as to allow the introduction of the second branches (21, 22) within the the second bone portion (P2), and - an anchoring position, wherein the respective ends of the second legs (21, 22) define a second anchorage distance (D20.2) greater than the second distance for introducing (D20.1), so that the second legs (21, 22) are adapted to anchor the second anchoring portion (20) within the second bone portion (P2), wherein the intermediate portion (40) is shaped so that a reconciliation of the first portion link (42) and the second connecting portion (44) moves the second legs (21, 22) from their insertion position to their anchoring position.
    [0003]
    The surgical implant (1) according to claim 1 or 2, wherein the intermediate portion (40) is plastically deformable such that plastic deformation of the intermediate portion (40) brings the first connecting portion (42) and the second connecting portion (44) moves the first limbs (11, 12) and / or the second limbs (21, 22) from their insertion position (s) to their position (s). anchor. 25
    [0004]
    4. Surgical implant according to claim 1 or 2, wherein the intermediate portion is elastically deformable so that an elastic recess of the intermediate portion approximating the first connecting portion and the second connecting portion moves the first branches and / or the 30 second branches of their (their) position (s) of introduction to their (their) position (s) anchoring.
    [0005]
    The surgical implant (1) according to any one of the preceding claims, wherein the first limbs (11, 12) each have a generally elongate shape, and wherein the first limbs (11, 12) are substantially parallel in their introduction position and substantially form a "V" in their anchoring position.
    [0006]
    6. The surgical implant (1) according to claim 2, wherein the intermediate portion (40) further comprises a first connecting portion (41) connecting at least two first limbs (11, 12), a second connecting portion ( 46) connecting at least two second branches (21, 22), the first connecting portion (42) and the second connecting portion (44) being arranged respectively on either side of the first connecting portion (41). and on either side of the second connecting portion (46).
    [0007]
    The surgical implant (1) according to any one of the preceding claims, wherein at least one recess (48) has an oblong shape, the length of which extends generally between the first anchor portion (10) and the second anchoring portion (20).
    [0008]
    The surgical implant of any preceding claim, wherein at least one recess has a narrow zone and a wide zone that is wider than the narrow zone, the widths being measured between the first link portion and the second link portion.
    [0009]
    The surgical implant (1) according to any one of the preceding claims, wherein the first connecting portion (42) has a first face (42.1) which is convex and which is oriented toward the second connecting portion (44). the first face (42.1) having a profile formed by an arc having a radius greater than 20 mm, preferably 40 mm, and wherein the second connecting portion (44) has a second face (44.2). which is convex and which is oriented towards the first connecting portion (42), the second face (44.2) having a profile formed by an arc having a radius greater than 20 mm, preferably 40 mm.
    [0010]
    The surgical implant (1) according to any one of the preceding claims, wherein at least the intermediate portion (40) is composed of a material selected from the group consisting of: - a titanium alloy, preferably a grade 1, 2, 3 or 4, according to ISO 5832-2 or ASTM F67, and - stainless steel according to ISO 5832-1.
    [0011]
    11. Surgical implant (1) according to any preceding claim, wherein the intermediate portion (40) further comprises at least two stops (51, 52, 53, 54) projecting on two outer faces ( 55, 56) opposite the intermediate portion (40).
    [0012]
    A clamping anchor (200,300) configured to clamp at least one surgical implant (1) according to any one of the preceding claims, the clamping fixture (200,300) comprising at least two jaws (201,202). 301, 302) and at least one articulation (204) connecting said at least two jaws (201, 202; 301, 302), the clamping ancillary (200) being characterized in that each jaw (201, 202; 301 , 302) has a respective housing (201.1, 202.1, 301.1, 301.2, 302.1, 302.2) of complementary shape to a respective connecting portion (40) so as to grip a respective outer face (55, 56) of the intermediate portion ( 40), and in that said at least one hinge (204) is configured so that a displacement of the jaws (201, 202; 301, 302) induces a bringing together of the first connecting portion (42) and the second connecting portion (44).
    [0013]
    The clamping anchor according to claim 12, wherein said at least one hinge (204) comprises a latch (210) having at least one locking catch, the hinge (204) being movable between: - an open position, wherein the jaws (201, 202, 301, 302) define a space (215) for the installation of the surgical implant (1), a holding position, wherein the jaws (201, 202; 302) grip the respective outer faces (55, 56) of the intermediate portion (40) so that the clamping anchor (200, 300) holds the surgical implant (1), - a clamping position, in which the jaws (201, 202; 301, 302) clamp the intermediate portion (40) to achieve said mating.
    [0014]
    The clamping anchor (200, 300) according to claim 13, wherein the latch is connected to one of the jaws (201, 202, 301, 302) by a pivot connection (214), and wherein the latch ( 210) has a handling portion (210.1) configured to allow a surgeon to manipulate the latch (210) to move the hinge (204) between the open position, the hold position, and the clamp position.
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    同族专利:
    公开号 | 公开日
    EP3116422B1|2018-01-03|
    JP2017512099A|2017-05-18|
    WO2015136212A1|2015-09-17|
    US20170065310A1|2017-03-09|
    US10098676B2|2018-10-16|
    FR3018441B1|2016-04-01|
    ES2664176T3|2018-04-18|
    EP3116422A1|2017-01-18|
    引用文献:
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    FR2901119A1|2006-05-19|2007-11-23|Memometal Technologies Soc Par|DEVICE FOR SUPPORTING A SURGICAL IMPLANT WITH SHAPE MEMORY|
    US20110301653A1|2010-06-02|2011-12-08|Wright Medical Technology, Inc.|Hammer toe implant with expansion portion for retrograde approach|
    US20120083791A1|2010-10-04|2012-04-05|Biomedical Enterprises, Inc.|Method and system for storing and inserting an implant|FR3051350A1|2016-05-19|2017-11-24|Fournitures Hospitalieres Ind|IMPLANT OF INTERPHALIAN ARTHRODESIS|
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    FR2935601B1|2008-09-09|2010-10-01|Memometal Technologies|INTRAMEDULLARY IMPLANT RESORBABLE BETWEEN TWO BONE OR TWO BONE FRAGMENTS|
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    法律状态:
    2015-01-30| PLFP| Fee payment|Year of fee payment: 2 |
    2016-02-12| PLFP| Fee payment|Year of fee payment: 3 |
    2017-01-19| PLFP| Fee payment|Year of fee payment: 4 |
    2018-01-19| PLFP| Fee payment|Year of fee payment: 5 |
    2019-11-29| ST| Notification of lapse|Effective date: 20191106 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1451980A|FR3018441B1|2014-03-11|2014-03-11|SURGICAL IMPLANT FOR MERGING BETWEEN TWO PORTIONS OF BONE AND ANCILLARY CLAMP FOR TIGHTENING SUCH A SURGICAL IMPLANT|FR1451980A| FR3018441B1|2014-03-11|2014-03-11|SURGICAL IMPLANT FOR MERGING BETWEEN TWO PORTIONS OF BONE AND ANCILLARY CLAMP FOR TIGHTENING SUCH A SURGICAL IMPLANT|
    US15/125,474| US10098676B2|2014-03-11|2015-03-10|Surgical implant for fusion between two bone portions and a clamping ancillary for clamping such a surgical implant|
    ES15717538.1T| ES2664176T3|2014-03-11|2015-03-10|Surgical implant for a fusion between two bone portions and tightening anchors to tighten such a surgical implant|
    EP15717538.1A| EP3116422B1|2014-03-11|2015-03-10|Surgical implant for merging two bone portions, and clamping aid for clamping such a surgical implant|
    JP2016555954A| JP2017512099A|2014-03-11|2015-03-10|Surgical implant for joining two bone parts and clamping device for clamping such a surgical implant|
    PCT/FR2015/050591| WO2015136212A1|2014-03-11|2015-03-10|Surgical implant for merging two bone portions, and clamping aid for clamping such a surgical implant|
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