• 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:
    The subject of the present invention is an ancillary for tensioning (5) an elongated element for fixing an implant on a bone element, at least partially surrounding said bone element, said ancillary device (5) comprising a body ( 6) having proximal (6a) and distal (6b) ends, the distal end (6a) being provided with a device for bearing on the implant, said body (6) extending along a longitudinal axis (L ). The ancillary (5) further comprises a carriage (7) movable along the longitudinal axis (L) and a fastening device (8) to the elongate element (2). The ancillary (5) also comprises a rotary shaft (9) around the longitudinal axis (L) of the body (6), this shaft (9) is configured to cooperate with the carriage (7) so that a rotation of the shaft (9) causes the translation movement of the carriage (7) along the longitudinal axis (L) and correspondingly the distance of the carriage (7) from the distal end (6b) of the body (6) and tensioning the elongate member.
    公开号:FR3026636A1
    申请号:FR1459366
    申请日:2014-10-01
    公开日:2016-04-08
    发明作者:Guy Deneuvillers；Jules Prandi
    申请人:Cousin Biotech SAS；
    IPC主号:
    专利说明:

    [0001] The present invention relates to the technical field of ancillaries for tensioning an elongated element, in particular a flat element, for attaching an implant to a bone element, in particular at least a portion of a vertebral body.
    [0002] BACKGROUND OF THE INVENTION It is known to correct abnormal spinal curvatures and / or pathological inclinations of the vertebrae to one another by the use of longitudinal bars arranged on either side of the vertebral column and secured to the vertebrae. via screws inserted into the vertebrae themselves or hooks, introduced for example along the spinal canal. However, these screws and hooks have the disadvantages of being aggressive for the spine.
    [0003] To overcome these drawbacks, it has been proposed a flexible elongate fixing element combined with an implant capable of being secured to a longitudinal bar, the elongate element being fixed to the implant and engaging with at least one vertebral portion in forming a loop around the latter.
    [0004] The longitudinal bars can be used in the treatment of scoliosis or the treatment of degenerative pathologies. Different levels of degeneration occur, for example on a vertebral level such as discopathy or on two vertebral levels such as spondylolisthesis or several levels such as scoliosis in C or S. In these treatments, the longitudinal bar can be put in connection with the vertebral level to be corrected by means of an elongated element, which passes around at least a portion of a vertebral body and around said bar and the ends of said elongate element can be maintained by means of a suture, a knot or using an implantable securing means. Said securing means may for example comprise a housing receiving the longitudinal bar and the elongated element in the wound state around the latter, and clamping means for locking the bar and said elongate member 5 in said housing. Generally, the clamping means comprise means for clamping said elongate element preventing any movement of the latter. One of the problems that the present invention seeks to solve is to tension the slender member when it forms a loop on at least a portion of a vertebral body, and is engaged with an implant and / or a longitudinal bar. EP 1 593 743 Bi relates to an ancillary for tensioning an elongated element comprising a movable cylindrical part able to move in translation about a rod, said rod comprising at its distal end means for pressing on a longitudinal bar. The movable cylindrical part also comprises a lug for fixing the elongate element. The dynamometric tightening system is operable via a handle. The tensioning of the elongated element is performed by the surgeon by pressing the handle 20 without limit of the voltage that can be applied. The surgeon can thus apply too much tension on the elongated element, which may affect the adjustment of the longitudinal bar or bars placed on the vertebral level (s) (s) to be corrected. see even moving vertebrae. In addition, the tension is applied to a loop in the extension of the two free ends of the elongate member secured with a passer. The applied voltage will therefore not be the same on each of the free ends since it is applied directly to a single free end of the elongate element in the extension of the other free end via the loop. The application of the tension 30 is therefore unbalanced on each free end of the elongate element and may cause erosion of the vertebral portion to which the tension is applied and / or sliding of the elongate element on said vertebral portion. FR 2.981.841 A1 relates to a tensioning ancillary seeking 5 to avoid compared to EP 1.933.743 Bi that the elongate member is twisted when it is tensioned. The ancillary thus comprises a return so that the elongated element forms an angle of 900. The ends of the elongate element provided with securing means are fixed to a compensation wheel according to two diametrically opposite points. The voltage applied to each of the ends of the elongate element is therefore not balanced. In addition, the return at an angle of 900 of the elongate member and the means for fixing an end in a groove generate significant friction on the elongate member may weaken it. In addition, because of the return member, the ancillary is bulky. However, during surgery, multiple implants and longitudinal bars are placed on the vertebral level (es) to be corrected so that it is important for the surgeon once an elongated element tensioned to be able to easily access to the implant to complete the tightening and fixation of the latter on the elongated element but also to be able to access the other implants and / or longitudinal bars. OBJECT AND SUMMARY OF THE INVENTION The subject of the present invention is therefore an ancillary for tensioning 25 making it possible to tension an elongated element forming a loop on at least a portion of a vertebral body without damaging said vertebral body, which is progressive and easily adjustable by the surgeon. The present invention also relates to a tensioning ancillary device for exerting an equal tension on each of the two ends of the elongate element.
    [0005] The present invention also relates to an ancillary tensioning allowing the surgeon to quickly release the tension exerted on the elongate member if necessary, and to apply a voltage on the elongated element controlled, in particular not exceeding a value determined.
    [0006] The subject of the present invention is, in a first aspect, an ancillary for tensioning an elongated element, in particular a flat element, for fixing an implant on a bone element, in particular at least a portion of a vertebral body, at least partially surrounding said bone element, said ancillary comprising a body having proximal and distal ends, the distal end being provided with a device for bearing on the implant, said body extending along a longitudinal axis, ancillary further comprises a carriage movable along the longitudinal axis and a fastening device to the elongate element. Typically, the ancillary comprises a rotating shaft about the longitudinal axis of the body, this shaft is configured to cooperate with the carriage so that a rotation of the shaft causes the displacement in translation of the carriage along the longitudinal axis of the body. longitudinal axis and correlatively the removal of the carriage from the distal end of the body and the tensioning of the elongate member. Advantageously, the elongated element is tensioned along the longitudinal axis of the body receiving the movable carriage which reduces the size of the ancillary operating and facilitates its tensioning. In particular, the elongated element is tensioned along a path parallel to the longitudinal axis extending between the support device and the fixing device. Preferably, the carriage comprises the device for fixing the elongate element. In addition, the carriage being mounted according to a rotary shaft, the ancillary according to the invention does not need a non-return system of the elongate element. Indeed, when the voltage applied to the elongated element is released, the carriage no longer moves and remains stationary because it is retained by the rotary shaft. The elongate element according to the invention is preferably a textile element, which can be braided, knitted or woven, preferably braided. More preferably, the elongate member is flat to generate significant frictional forces with the surfaces against which it is moving thus improving the clamping forces. The elongate element comprises first and second ends, optionally free (s).
    [0007] The support device bears on the implant, which may comprise a connector and / or an implantable fastening means for the elongate element to a longitudinal bar and / or a longitudinal bar and / or an ancillary device for pre-positioning the implant. tension of an elongate element, such as that described below with reference to a second aspect according to the invention.
    [0008] The support device of the tensioning ancillary may be the support device of the pre-tensioning ancillary device described below, independently of the other characteristics of the pre-tensioning ancillary. The connector may be that described in International Patent Application PCT / FR2014 / 051801 filed in the name of the Applicant. The implantable securing means may be that described in patents EP 2,555,698 B1 and EP 2,609,882 A1. Preferably, the carriage is configured to receive at least two superimposed segments of elongated element, which improves the distribution of the tension in the element lonliligne and avoids the risk of erosion and / or sliding of the elongate element around the portion of the vertebral body. Preferably, the rotating shaft is a threaded shaft, further preferably the shaft comprises a helical thread. In a variant, the shaft includes a portion extending beyond the proximal end of the body configured to couple with a dynamometric actuator. Advantageously, it is possible to choose precisely the torque 5 (newtons / cm) that it is desired to apply for the tensioning of the elongated element instead of exerting an approximate tension whose torque is unknown. safer for the patient. In a variant, the fixing device comprises a jaw assembly extending in two inclined planes relative to each other and inclined with respect to the longitudinal axis of the body. The surgeon does not need to have special means on the free ends of the elongate element to make them cooperate with a fastening system on the ancillary or form a loop as is the case in the state of the technique. It is thus sufficient simply to superimpose the first and / or second free end (s) of the elongate member in the jaw assembly after separating the jaws from each other with the aid of a gripping member described hereinafter. Preferably, the inclination of the jaw assembly makes it possible to apply a progressive tension to the elongated element, which improves the fixing force of the elongate element to the fixing device. More preferably, both planes converge towards the distal end of the body, which further enhances the aforementioned effects. The jaw assembly is also inclined with respect to the longitudinal axis of the body so that the elongated member adopts a corresponding inclination between said assembly and the distal end of the body. This arrangement also prevents the elongated element from de-actuating the anti-return blocker of the pre-tensioning ancillary device according to the invention which will be described below.
    [0009] Alternatively, the jaws are configured to be movable and operable by a gripper for the placement of the elongated member between said jaws. Preferably, the jaw assembly includes a locking member for locking said jaws in an open position. Still preferably, the locking member comprises two lugs vis-à-vis arranged in said gripping member, including a link, adapted to abut against the carriage to lock the jaw assembly in the open position.
    [0010] In a variant, the ancillary comprises a fast unlocking device for decoupling the carriage from the rotary shaft. This arrangement advantageously makes it possible to automatically release the tension on the elongated element, and thus forms a safety for the surgeon when adjusting the elongated element.
    [0011] In a variant, the carriage has a disengaged position in which the carriage is free to slide longitudinally with respect to the longitudinal axis of the rotary shaft and an engaged position in which the carriage is coupled with the rotary shaft. Preferably, the ancillary comprises a device for clutching and disengaging the carriage of the rotary shaft, further preferably the clutch and disengaging device comprises the quick release device for actuating the clutch and the clutch. of the carriage with the rotating shaft. Preferably, the clutch and disengagement device comprises a cam mounted on a return member in connection with the quick release device for moving the carriage from the engaged position to the disengaged position and vice versa. In a sub-variant, the clutch and disengagement device comprises a housing adapted to receive the rotary shaft, said housing having a window capable of allowing a fork to pass in connection with the carriage 8 to engage or disengage the forklift. rotating shaft under the effect of the cam mounted on said return member. In a variant, the body comprises a spring, in particular a cylindrical spring, mounted on the rotary shaft and extending longitudinally between the proximal end of the body and the carriage. The spring is supported at the proximal end of the body and against the carriage, which accelerates the release of the tension on the elongate member when the quick release device is actuated to decouple the carriage from the rotating shaft as the spring pushes the carriage 10 towards the distal end of the body. In a variant, the carriage comprises a longitudinal slot for receiving the elongated element, in particular two portions of said elongate element superimposed. Advantageously, the tension is homogeneously applied to the elongate member forming a loop around the portion of the vertebral body and the longitudinal bar. In a sub-variant, the slot is disposed above the jaw assembly. This arrangement facilitates access to the jaw assembly and thus the disposition of the elongate member in said assembly. In a variant, the quick release device comprises a lever which is configured when it is actuated to decouple the carriage from the rotary shaft. Alternatively, the proximal end of the body includes a coupling member adapted to be coupled with a removable handle and configured to allow pivoting of the handle about the longitudinal axis of the body. Preferably, the coupling member is also configured to lock the handle around the longitudinal axis of the body in a determined position. Advantageously, the surgeon can thus modify the position of the handle by rotating the latter around the body along the longitudinal axis of the body. Preferably, the removable handle comprises a ring having on its periphery at least one tooth capable of cooperating with a notch of a toothed ring mounted on the proximal end of the body. Still more preferably, the coupling member comprises a clamping ring that grips the ring comprising at least one tooth and the notched ring in order to block the coupling between said rings. In particular, the proximal end of the body comprises a threaded portion on which the clamping ring can be screwed. The subject of the present invention is, according to a second aspect, an assembly comprising a tensioning ancillary device according to any one of the preceding embodiments, and a pre-tensioning ancillary device comprising a support device on said implant. . In a variant, the ancillary for pre-tensioning the elongated element, in particular a flat element, for fixing the implant to a bone element, in particular at least a portion of a vertebral body, surrounding at least partially said bone element, comprises a shaft having proximal and distal ends, the distal end being provided with a bearing device on said implant, said shaft extending along a longitudinal axis. Advantageously, the rod comprises a device for guiding and locking the elongate element along the longitudinal axis and said guiding and locking device comprises a non-return stopper enabling the longitudinal displacement of the elongated element in said guiding device. and blocking toward the proximal end of the shaft and preventing longitudinal movement of the elongate member toward the distal end of the shaft. Advantageously, the anti-return blocker prevents any displacement of the elongated element towards the distal end of the rod when no tension is exerted on the elongated element which facilitates the work of the surgeon and allows him to leave on hold the elongated element to carry out other acts. The surgeon can resume the tensioning of the elongated element without having to exert other prior action on the pre-tensioning ancillary.
    [0012] Advantageously, the elongated element is tensioned in a path parallel to the longitudinal axis of the rod between the distal end of the rod and the non-return blocker. Advantageously, the elongated element is tensioned along a path parallel to the longitudinal axis of the stem of the pre-tensioning ancillary and to the longitudinal axis of the body of the tensioning ancillary, the longitudinal axes of the body and the rod being parallel. Preferably, the anti-return blocker is configured to receive at least two superimposed linear element portions, said portions being the extensions respectively of the first and second free ends of the elongated element. The support device bears on the implant which may comprise a connector and / or an implantable fastening means of the elongate element to an elongated bar and / or an elongated bar. In a variant, the anti-return blocker comprises an unlocking member allowing, when it is actuated, the longitudinal displacement of the elongated element towards the distal end of the rod. Advantageously, the unlocking member automatically releases the tension exerted on the elongate member which is a safety for the surgeon.
    [0013] Preferably, the anti-return blocker comprises a cam mounted on a return spring and engaging at least a portion of the elongate element, preferably at least two superimposed portions of the elongate element, against a bearing surface, in particular, in order to block the displacement of the elongate element towards the distal end of the rod.
    [0014] Preferably, the unlocking member is a lever which acts on the cam and the disengagement of the elongate member. In a variant, the anti-return blocker comprises a longitudinal passage having an upper bearing surface constituting a guide portion for the longitudinal displacement of the elongated element. Advantageously, when the elongated element is flat, the friction with the bearing surface is amplified and improves the guiding and locking of the elongate element against said upper bearing surface. Alternatively, the guiding and locking device further comprises a locking member configured to lock the elongated member against the upper bearing surface while preventing longitudinal movement of the elongate member toward the distal end of the elongated member. the stem. Preferably, the locking element comprises a return member in its initial position corresponding to its engagement and thus to the locking of the elongated element against said bearing surface. When the elongate element is put in tension causing its displacement towards the proximal end of the rod, the locking element under the effect of the elongated element, disengages from the latter and thus from the upper bearing surface . Preferably, this upper bearing surface is inclined with respect to the longitudinal axis of the rod to prevent the locking element, in particular a cam mounted on a return spring, from remaining in contact with the elongated element. and disengages said elongate member under the effect of the elongate member itself according to the angle of application of the voltage thereon. For example, the spring may be cylindrical or flat, and preferably cylindrical. In particular, the return member is mounted between the unlocking member comprising an actuating lever and the locking element, preferably around a rod connecting said lever and the locking element. In particular, the locking element blocks the elongate element against the bearing surface, thus when the elongate element comprises at least two superimposed portions (in particular in the extension of each of its first and second free ends), a first portion is disposed between the upper bearing surface and the second portion while the second portion is disposed between the first portion and the locking member.
    [0015] In a variant, the locking element is rotatably mounted about an axis transverse to the longitudinal direction of the rod. Preferably, the locking member has a curved contact portion with the elongate member to prevent abrasion damage thereof.
    [0016] In a variant, the guiding and locking device is configured to be traversed by two superimposed portions of the elongated element. Advantageously, each of the portions is in the extension of one of the two free ends of the elongate element so that the tension exerted on the elongate element is uniformly applied to the entire loop at least partially surrounding said vertebral body. which avoids any risk of sliding of said elongate member and therefore any risk of erosion of said vertebral body. Preferably, the guiding and locking device comprises a lateral opening facilitating the introduction of said superimposed portions of elongate element. In a variant, the unlocking member comprises a lever configured to actuate the locking element. Advantageously, the lever is in connection with the locking element and able to pivot said locking element towards the proximal end of the rod in order to allow the elongated element (of the two superimposed portions) to move towards said distal end of the stem. In a variant, the distal end of the stem comprises a head which comprises the support device, the head is provided with a housing configured to receive at least a portion of the implant, this housing comprises an opening for the passage and guidance of the elongated element. Preferably, the housing is configured to receive a connector or an implantable fastening means of the elongate element to a longitudinal bar. Preferably, the opening may be a conduit leading to a window or groove. In a variant, the opening comprises a bottom wall which is inclined with respect to the longitudinal axis of the rod, for guiding the elongated element towards the guiding and locking device. Advantageously, during the surgical procedure, the implant, in particular the connector or the implantable securing means is thus released and allows the surgeon to access the latter easily with a screwdriver for example to complete the fixation of the implant. elongated element without being disturbed by the thorny to access the implantation area. In a variant, the head is inclined relative to the longitudinal axis of the rod and forms a bearing zone on the implant inclined relative to a plane passing perpendicular to the longitudinal axis. We find the technical effect described above. In a variant, the opening forms a duct leading to a window, said duct having an inlet orifice and an outlet orifice of the elongated element spaced a distance apart. Advantageously, when the elongate member exits the connector or the implantable fastening means, it is guided by the window to be tensioned not directly so the implant but at the exit of the window so as not to hinder the setting implementation of the implant fixation member for fixing the elongate element to said implant. In a variant, the duct comprises upper and lower walls, the lower wall being the inclined bottom wall.
    [0017] In one variant, the opening comprises a coupling member, in particular a removable member, with the implant for removably securing the head to the implant. Preferably, the coupling member comprises weights mounted on a return member, for example a flat spring, adapted to cooperate with a corresponding coupling member on the implant, for example through lateral openings. Alternatively, the proximal end of the rod is provided with a coupling member with a tensioning ancillary. The proximal end can receive a handle. The present invention will be better understood on reading the exemplary embodiments described below, given by way of non-limiting example and illustrated by the drawings described hereinafter appended to this text. DETAILED DESCRIPTION OF THE DRAWINGS FIG. 1 is a diagrammatic and perspective representation of an implantable connector fixing an elongated element disposed around a portion of a vertebral body and a longitudinal bar; FIG. 2 is a diagrammatic and partially exploded perspective view of a first variant of a tensioning ancillary device according to the invention; FIG. 3 is a diagrammatic and perspective representation of the tensioning ancillary shown in FIG. 2; - Figure 4 is a side view of the ancillary 30 shown in Figures 2 and 3; - Figure 5 is a top view of the ancillary shown in Figures 2, 3 and 4; - Figure 6 is an exploded representation of the clutch device and clutch of the carriage on the rotary shaft of the ancillary shown in Figures 2 to 5; - Figure 7 is a schematic representation in perspective of the clutch device and clutch of the carriage on the rotary shaft of the ancillary shown in Figures 2 to 5; FIG. 8 is a diagrammatic representation in perspective of an example of pre-tensioning ancillary device according to the invention; and FIG. 9 is a schematic and perspective representation of an assembly according to the present invention comprising the tensioning ancillary shown in FIGS. 2 to 5 and the pre-tensioning ancillary shown in FIG. 8 in operation. .
    [0018] DETAILED DESCRIPTION OF THE EMBODIMENTS FIG. 1 represents an implantable connector 1 fixing an elongated element 2, in particular a flat element, arranged around a portion of a vertebral body 3 and a longitudinal bar 4. Said elongate element 2 prior to its fixation in its state wrapped around the portion of the vertebral body 3 has been tensioned using an ancillary tensioning according to the invention, possibly combined with an ancillary pre-tensioning according to the invention . Figures 2 to 5 show a first example of a tensioning ancillary device 5 according to the invention comprising a body 6 having proximal ends 6a and 6b and extending along a longitudinal axis L. The tensioning ancillary 5 further comprises a carriage 7 movable along the longitudinal axis L and a fastener 8 to the elongate member. The ancillary 5 also comprises a rotary shaft 9 about the longitudinal axis L of the body 6, this shaft 9 is configured to cooperate with the trolley 7 so that a rotation of the shaft 9 causes the displacement in translation of the carriage 7 along the longitudinal axis L and correspondingly the distance of the carriage 7 from the distal end 6b of the body 6. The shaft 9 comprises a portion 10 extending beyond the proximal end 6a of the Body 6 and configured to be coupled with a dynamometric actuator, such as the device 11 shown in FIG. 9. The fastening device 8 has a jaw assembly 12 extending in two inclined planes p1, p2. relative to each other and inclined relative to the longitudinal axis of the body L. The jaws 12 are configured to be movable and operable by a gripping member 13 for placement of the elongated member between said jaws 12 . In this particular example, the jaw assembly 12 includes a locking member 13a for locking said jaws 12 in the open position. The locking member 13a thus comprises two facing lugs arranged in the locking member. 13 and able to abut against the carriage 7 to lock the jaw assembly 12 in the open position. The tensioning ancillary device 5 comprises a quick release device 14 for decoupling the carriage 7 from the rotary shaft 9.
    [0019] The ancillary 5 comprises a clutch and disengagement device 15 for moving the carriage 7 to a disengaged position in which the carriage 7 is free to slide longitudinally with respect to the longitudinal axis I of the rotary shaft. 9 to an engaged position in which the carriage 7 is coupled with the rotary shaft 9, or vice versa via the quick release device 14. The clutch and disengagement device 15 comprises a support 16 housing a cam 17 in connection with an anvil 18 projecting from a fork 19 having a partially annular inner contact surface 19a comprising a thread corresponding to that of the rotary shaft 9. The device 15 also comprises a hollow tube-shaped part 20 comprising a window 21 adapted to receive in translation along the axis A the fork 19. Said piece 20 thus comprises a housing 22 adapted to receive a portion of the rotary shaft 9. The disposit if 15 also comprises two return members 23, in particular springs in the form of blades, arranged between the lower face of the anvil 18 and the upper face of the fork 19. The device 15 further comprises an actuating member 24 making fast unlocking device 14, such as a lever, rotatably mounted along a transverse axis T to the longitudinal axis L on the cylinder 25. The various parts of the device 15 are secured in particular by means of the fastening elements 27 The actuating member 24 is thus configured to, when actuated, decouple the carriage 7 from the rotary shaft 9. Moreover, the body 6 comprises a spring 28 mounted on the rotary shaft 9 and extending longitudinally between the proximal end 6a of the body 6 and the carriage 7. The carriage 7 comprises a longitudinal slot 30 for receiving the elongate element, in particular two portions of said elongate element superimposed. Preferably, the jaws 12 are serrated. The slot 30 is disposed above the jaw assembly 12. The proximal end 6b of the body 6 comprises a coupling member 31 adapted to be coupled with a removable handle 32 and configured so as to allow the pivoting of the handle 32 about the longitudinal axis L of the body 6. The removable handle 32 comprises a ring having on its periphery at least one tooth 33a adapted to cooperate with a notch of a toothed ring 34 mounted on the proximal end 6a of the body 6. Still preferably, the coupling member 31 comprises a clamping ring 35 which clamp the ring 33 comprising at least one tooth 33a and the toothed ring 34 to block the coupling between said rings 33,34. In particular, the proximal end 6a of the body 6 comprises a threaded portion on which the clamping ring 35 can be screwed.
    [0020] FIG. 8 represents a pre-tensioning anchor 36 used in an assembly 70 according to the invention also comprising the tensioning ancillary 5 and represented in operation in FIG. 36, shown in FIG. 8, comprises a rod 37 having proximal ends 37a and distal 37b, the distal end 37b being provided with a support device 38 on an implant, in this specific example on a connector implantable, such as the connector 1 shown in Figure 1. The rod 37 extends along a longitudinal axis L and comprises a device for guiding and locking 58 of an elongated element 10, such as the elongate element 2, according to the longitudinal axis L. The guiding and locking device 58 comprises a nonreturn blocker 39 allowing the longitudinal displacement along the longitudinal axis L of the elongate element in the guiding and locking device 58 towards the pro end ximal 37a of the rod 37 and preventing the longitudinal displacement along the longitudinal axis L of the elongate element towards the distal end 37b of the rod 37. In this specific example, the rod 37 is configured to be received in a housing 40 in the guiding and locking device 58 for securing the rod 37 to the guiding and locking device 58. The anti-return blocking device 39 comprises an unlocking member 41 allowing, when it is actuated, the displacement longitudinally of the elongated element towards the distal end 37b of the rod 37. The anti-return blocker 39 comprises a longitudinal passage 42 having an upper bearing surface 42a constituting a guide portion for the longitudinal displacement of the elongated element . The guiding and locking device 58 further comprises a blocking member 43 configured to lock the elongate member against the upper bearing surface 42a while preventing longitudinal movement of the elongated member toward the distal end 37b of the stem 37. The locking element 43 is rotatably mounted about an axis T transverse to the longitudinal direction L of the rod 37. The unlocking member 41 comprises a lever 44 configured to actuate the locking element 43. The guiding and locking device 58 is configured to be traversed by two superimposed portions of the elongated element, each of said portions being in the extension of a first or second free end of the elongate member. The locking element 43 is in this specific example a cam mounted on a return member, in particular a cylindrical spring. The distal end 37b of the stem 37 includes a head 45 which comprises the support device 38, the head 45 is provided with a housing 46 configured to receive at least a portion of the implant, in particular at least partially the connector 1. This housing 46 comprises an opening 47 for the passage and guiding of the elongated element. The opening 47 comprises a bottom wall 48 inclined with respect to the longitudinal axis L of the rod 37, for guiding the elongated element towards the guiding and locking device 58. The opening 47 forms a duct 15 opening 49 on a window 50, said duct 49 having an inlet 49a and an outlet 49b of the elongate member distant a predetermined distance d. The duct 49 comprises upper and lower walls, the bottom wall being the bottom wall 48 inclined. The opening 47 comprises a coupling member 51 with the implant, in particular the connector 1, for detachably securing the head 45 with the implant, here the connector 1. The proximal end 37a of the stem 37 is provided with a coupling member 52 with the distal end 6b of the body 6 of the tensioning ancillary 5. In Fig. 9, the tensioning ancillary 5 is illustrated in operation coupled with the ancillary pre-tensioning 36 for reasons of simplification. Nevertheless, on reading the present description, the person skilled in the art easily understands that the tensioning ancillary device 5 can tension an elongated element independently of the pre-tensioning ancillary device 36 provided that the The anchoring device 5 comprises a bearing device on the implant, in particular at the distal end 6b of the body 6. For example, the support device 38 comprising the head 45 of the pre-tensioning ancillary 36 may be provided at or in the extension of the distal end 6b of the body 6. In the assembly 70 shown in operation in Figure 9, the pre-tensioning ancillary 36 serves as a support device for the tensioning ancillary 5. When tensioning the elongate element 2, the first and second free ends of the elongate member output connector 1 and the head 45, in particular of the orifice 49b of the duct 49, are passed together in the guiding and locking device 58 and in the fixing device 8 of the carriage 7. The surgeon can then exert a first manual pulling to stretch the superposed portions of elongate element arranged in the devices 8 and 58 while opening the jaw assembly 12 with the gripping member 13. The surgeon 15 can also adjust the position of the handle 32 by rotating it about the longitudinal axis L of the body 6 to better access the implantation area. The surgeon then couples the dynamometric device 11 with the portion 10 projecting from the shaft 9 and actuates the device 11 which causes the carriage 7 to move towards the distal end 6a of the body 6 and correlatively the tensioning of the shaft. elongated element 2. The longitudinal displacement of the elongated element 2 in the guiding and locking device 58 is also observed. Advantageously, the elongate element 2 moves along the longitudinal axes of the body 6 and of the stem 37 which are parallel, especially confused. The dynamometer device 11 is preferably triggered, which makes it possible not to exceed a predetermined clamping force. If necessary, it is possible to release the tension immediately by means of the quick release device 14 comprising the lever 24 thus making it possible to disengage the carriage 7 from the rotary shaft 9. It is possible to re-engage the carriage 7 on the rotary shaft 9 by actuating the unlocking device 14. The tension 21 applied to the elongated element 2 is automatically released and this accelerated by the spring 28. Advantageously, even though the tension applied to the element The slender element 2 is released at the level of the carriage 7, the elongated element 2 remains in tension via the guiding and locking device 58 comprising a nonreturn device. It is also possible, if necessary, to release the tension at the guiding and locking device 58 by means of the unlocking member 41 comprising the lever 44. The window 39 makes it possible to shift by approximately the distance of , the output of the elongated element 2 of the connector 1. This arrangement allows to shift the application of the voltage on the window 50 and not to apply directly to the connector 1 thus limiting the risk of decoupling the connector 1 to the head 45. In addition, the inclination of the planes p1 and p2 of the jaw assembly 12 relative to the longitudinal axis L of the body 6 prevents the elongated element 2 when it is put into tension disengage the locking element 43 of the upper bearing surface 42a. In this specific example, the support device 38 bears on the connector 1 and not on the longitudinal bar 4.
    [0021] When the elongate member is properly tensioned and the vertebral level corrected, the surgeon actuates the elongated member fixing device to the implant, in this example the connector 1. The surgeon can also advantageously decouple the ancillary tensioning the ancillary device 36 and adjusting the voltage on other elongate members without actuating the elongate member attachment device to the connector to correct multiple vertebral levels as needed. 22
    权利要求:
    Claims (12)
    [0001]
    REVENDICATIONS1. Ancillary tensioning (5) of an elongate element (2) for fixing an implant (1) on a bone element, in particular at least a portion of a vertebral body (3), at least partially surrounding said bone element, said ancillary (5) comprising a body (6) having proximal (6a) and distal (6b) ends, the distal end (6a) being provided with a device for resting on the implant, said body (6) extending along a longitudinal axis (L), the ancillary (5) further comprises a carriage (7) movable along the longitudinal axis (L) and a fastening device (8) to the element longiline (2), characterized in that the ancillary (5) comprises a rotary shaft (9) around the longitudinal axis (L) of the body (6), this shaft (9) is configured to cooperate with the carriage ( 7) so that a rotation of the shaft (9) causes the displacement in translation of the carriage (7) along the longitudinal axis (L) and correspondingly the distance of the carriage (7). the distal end (6b) of the body (6) and the tensioning of the elongate element (2).
    [0002]
    2. Ancillary (5) according to claim 1, characterized in that the shaft (9) comprises a portion (10) extending beyond the proximal end (6a) 20 of the body (6) configured to be coupled with a dynamometric actuator (11).
    [0003]
    3. Ancillary (5) according to any one of claims 1 and 2, characterized in that the fastening device (8) comprises a jaw assembly (12), extending in two planes (p1, p2 ) inclined relative to each other and inclined with respect to the longitudinal axis of the body (L).
    [0004]
    4. Ancillary (5) according to claim 3, characterized in that the jaws (12) are configured to be movable and operable by a gripping member (13) for the placement of the elongated member (2) between said jaws ( 12). 23 3 0 2 6 6 3 6
    [0005]
    5. Ancillary (5) according to any one of claims 1 to 4, characterized in that the ancillary (5) comprises a quick release device (14) for decoupling the carriage (7) from the rotary shaft (9). ).
    [0006]
    6. Ancillary (5) according to claim 5, characterized in that the rapid unlocking device (14) comprises a lever (24) which is configured when actuated to decouple the carriage (7) from the rotary shaft (9).
    [0007]
    7. Ancillary (5) according to any one of claims 1 to 6, characterized in that the carriage (7) has a disengaged position in which the carriage (7) is free to slide longitudinally relative to the longitudinal axis 10 (I) of the rotary shaft (9) and an engaged position in which the carriage (7) is coupled with the rotary shaft (9).
    [0008]
    8. Ancillary (5) according to any one of claims 1 to 7, characterized in that the body (6) comprises a spring (28) mounted on the rotary shaft (9) and extending longitudinally between the end proximal 15 (6a) of the body (6) and the carriage (7).
    [0009]
    9. Ancillary (5) according to any one of claims 1 to 8, characterized in that the carriage (7) comprises a longitudinal slot (30) for receiving the elongate element (2), in particular two portions of said elongate element ( 2) superimposed.
    [0010]
    10. Ancillary (5) according to claim 9, characterized in that the slot (30) is disposed above the jaw assembly (12).
    [0011]
    11. Ancillary (5) according to any one of claims 1 to 10, characterized in that the proximal end (6a) of the body (6) comprises a coupling member (31) adapted to be coupled with a removable handle ( 32) and configured to allow pivoting of the handle (32) about the longitudinal axis (L) of the body (6).
    [0012]
    12. Assembly (70) comprising a tensioning ancillary (5) according to any one of claims 1 to 11, and a pre-tensioning ancillary (36) comprising a support device (38) on said implant (1) .30
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    同族专利:
    公开号 | 公开日
    FR3026636B1|2017-09-15|
    US20170354445A1|2017-12-14|
    EP3200710B1|2018-07-25|
    EP3200710A1|2017-08-09|
    US10278746B2|2019-05-07|
    ES2692329T3|2018-12-03|
    WO2016051088A1|2016-04-07|
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    法律状态:
    2015-09-29| PLFP| Fee payment|Year of fee payment: 2 |
    2016-04-08| PLSC| Search report ready|Effective date: 20160408 |
    2016-10-21| PLFP| Fee payment|Year of fee payment: 3 |
    2017-09-29| PLFP| Fee payment|Year of fee payment: 4 |
    2018-10-23| PLFP| Fee payment|Year of fee payment: 5 |
    2020-10-16| ST| Notification of lapse|Effective date: 20200914 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1459366A|FR3026636B1|2014-10-01|2014-10-01|ANCHORAGE FOR TENSIONING A LONGILINE ELEMENT FOR ATTACHING AN IMPLANT TO A BONE MEMBER|FR1459366A| FR3026636B1|2014-10-01|2014-10-01|ANCHORAGE FOR TENSIONING A LONGILINE ELEMENT FOR ATTACHING AN IMPLANT TO A BONE MEMBER|
    US15/516,033| US10278746B2|2014-10-01|2015-09-30|Accessory for tensioning an elongate element|
    EP15788118.6A| EP3200710B1|2014-10-01|2015-09-30|Accessory for tensioning an elongate element|
    ES15788118.6T| ES2692329T3|2014-10-01|2015-09-30|Auxiliary instrument for tensioning an elongated element|
    PCT/FR2015/052617| WO2016051088A1|2014-10-01|2015-09-30|Accessory for tensioning an elongate element|
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