• 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:
    This guiding instrument (1) comprises: - a support member (11) resting on a dorsal portion of the articulation, and - a guide member (12) connected to the support member (11) and having a passage (14) for guiding a guide pin (2). The passage (14) extends transversely to the joint (6), so that the guide pin (2) can pass through the first bone fragment and the second bone fragment in an oblique direction (O) relative to the support member (11). The passage (14) allows movements of the guide pin (2) in a guide plane including the oblique direction (O).
    公开号:FR3030221A1
    申请号:FR1462935
    申请日:2014-12-19
    公开日:2016-06-24
    发明作者:Olivier Boniface；Besque Remi Le；Loic Girod
    申请人:Novastep SAS；
    IPC主号:
    专利说明:

    [0001] The present invention relates to an instrument for guiding a guide pin of an implant compressing a joint present at one end of a limb. In addition, the present invention relates to a method for guiding a guide pin of an implant.
    [0002] The present invention can be applied to the field of arthrodesis of the extremity joints. In particular, the present invention can be applied to the arthrodesis of a metatarsophalangeal joint of the foot, to treat severe hallux valgus or hallux rigidus. WO2014105750A1 discloses a guiding instrument for guiding a guide pin for guiding a hollow screw. The guiding instrument comprises a fixing member and an alignment member connected to the fixing member. The fixation member is fixed on a dorsal portion of the metatarsophalangeal joint of the foot. The alignment member has an orifice through which is inserted a guide pin. The hole is oriented towards the metatarsophalangeal joint of the foot, so that the guide pin can be inserted accurately through the joint. However, the alignment member allows a single direction to insert the guide pin. So the surgeon can not optimize guiding the guide pin relative to the joint. But if the guide pin is incorrectly positioned, the hollow screw will be mis-oriented, which causes an inappropriate orientation between the phalanx and the metatarsal. Because of this inappropriate orientation, the bones may not be sufficiently compressed against each other, which slows the osteosynthesis. In addition, the positioning of the phalanx relative to the metatarsal can be found in an anatomically incorrect position. In addition, if the guide pin is incorrectly positioned, there is a risk of interference with the fixing screws used to fix an osteosynthesis plate on the joint. In addition, there is a risk that the guide pin or the hollow screw placed around the guide pin penetrates a cortical portion of one of the bones of the joint.
    [0003] 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 guiding instrument, for guiding at least one guide pin for guiding an implant, for example a hollow screw, for compressing a joint between a first bone fragment, for example. for example a phalanx, and a second bone fragment, for example a metatarsal, the guiding instrument comprising at least: a support member configured to be placed in abutment on a dorsal portion of the joint, and a guide which is connected to the support member and which has at least one passage configured to guide a guide pin; the guiding instrument being characterized in that the passage is configured to extend transversely to the joint when the support member is placed in abutment against the dorsal portion of the joint, so that said at least one a guide pin can pass through the first bone fragment, for example the phalanx, and the second bone fragment, for example the metatarsus in a direction oblique with respect to the support member, and the guiding instrument being further characterized in that the passage is configured to allow movements of the at least one guide pin in a guide plane including the oblique direction. Thus, such a guiding instrument, sometimes called "sight", allows precise positioning of a guide pin, so an implant, in the joint. The implant provides effective and reproducible interfragmentary compression of the first bone fragment against the second bone fragment, e.g. phalanx against metatarsal, while having an optimal orientation of the implant in the joint. In addition, the present invention decreases or even avoids orientation defects and the risk of perforation of the first and second bone fragments, for example cortical portions of the metatarsus and the phalanx, since the present invention allows reproducible positioning of the implant thanks to the movements of the guide pin in the guide plane itself defined in relation to the patient's anatomy. According to a variant of the invention, the implant comprises a hollow screw. In the present application, the term "hollow screw" designates a screw having a longitudinal channel which passes through the screw and which opens on each side of the screw, the longitudinal channel being able to have a cylindrical shape with a circular base. A hollow screw is sometimes referred to as "cannulated screw". Alternatively to the previous variant, the implant may comprise a cannulated drill. . In the present application, the term "phalanx" refers to the proximal phalanx of a toe. According to one embodiment of the invention, the passage is configured to allow movements only in the guide plane. Thus, such a passage allows a very precise positioning of a guide pin, so an implant, in the joint. According to one embodiment of the invention, the guide plane is defined by the oblique direction and by a planto-dorsal direction.
    [0004] In the present application, the term "planto-dorsal direction" designates a direction which connects a plantar surface and a dorsal surface of the articulation and which is vertical when the foot rests on a horizontal ground. Similarly, the guide plane is substantially vertical when the oblique direction is horizontal.
    [0005] In the present application, the term "plantar" refers to an element that is oriented substantially like the plant or the underside of the foot, while the term "dorsal" refers to an element that is oriented substantially like the back or top of the foot. Thus, such a guide plane allows the surgeon to insert the guide pin obliquely through the first and second bone fragments, for example through the phalanx and the metatarsus. According to one embodiment of the invention, the oblique direction is oriented towards a central region of the joint when the support member is placed in abutment against the dorsal portion of the joint. Thus, such an oblique direction allows the surgeon to insert the guide pin, thus the hollow implant, through the central region of the joint. According to one embodiment of the invention, the support member has on its dorsal side: a first mark, for example a first mark, intended to be substantially aligned with the longitudinal axis of the second bone fragment when the support member is placed in abutment against the dorsal portion of the joint, a second mark, for example a second line, intended to be substantially aligned with the longitudinal axis of the first bone fragment when the body of the support is placed in abutment against the dorsal portion of the joint, - a third mark, for example a third line, intended to be substantially aligned with the fusion line of the joint when the support member is placed in position. support against the dorsal portion of the joint, and - a fourth mark, for example a fourth line, aligned with the oblique direction. Thus, these first, second, third and fourth pins considerably reduce the risk of interference between the implant and fixing screws fixing an osteosynthesis plate on the joint, which allows easy positioning of the implant. guiding instrument, because it is sufficient to match the first, second, third and / or fourth pins with axes or anatomical planes. According to a variant of the invention, the first, second, third and fourth marks are derived from respective laser markings. According to one embodiment of the invention, the passage has generally the shape of a rectangle in section in the guide plane. Thus, such a passage is simple to machine. According to one embodiment of the invention, the passage has a depth, measured parallel to the oblique direction, of between 6 mm and 10 mm. Thus, such a passage avoids any deformation of the guide pin during its insertion into the joint. According to one embodiment of the invention, the passage has a height of between 10 mm and 20 mm, preferably between 10 mm and 15 mm. Thus, such a height gives the surgeon considerable latitude to optimize the orientation of the guide pin, therefore the implant, in the joint. According to a variant of the invention, the passage has a lower portion which is located lower than the support member. According to one embodiment of the invention, the passage has a width, measured perpendicularly to the guide plane, which is substantially constant along the oblique direction.
    [0006] Thus, such a passage allows precise lateral guidance of the guide pin. According to a variant of the invention, the passage has a width, measured perpendicularly to the guide plane, dimensioned so that the passage can receive, with a functional clearance, a guide pin having a determined width. Alternatively to this embodiment, the entrance of the passage may be wider than the exit of the passage. In this alternative, the passage may have a convergent shape from the inlet of the passage to the outlet 10 of the passage. In the present application, the terms "entrance of the passage" and "exit of the passage" respectively mean the opening of the passage through which the guide pin enters the passage and the opening of the passage through which the guide pin comes out of the passage. . In other words, the exit 15 of the passage is closer to the joint than the exit of the passage. According to one embodiment of the invention, the support member has at least: a proximal through hole configured for the insertion of a proximal pin for immobilizing the support member on the second bone fragment , for example metatarsal and - a distal through hole configured for the insertion of a distal pin for immobilizing the support member on the first bone fragment, for example the phalanx. Thus, this proximal hole and this distal hole allow the surgeon 25 to immobilize the support member, thus the guide instrument, relative to the joint, by means of fixation pins inserted respectively into the first bone fragment. and in the second bone fragment, for example in the metatarsus and in the phalanx. According to one embodiment of the invention, the support member 30 comprises a proximal plate and a distal plate, the proximal plate and the distal plate being arranged to extend respectively on a dorsal portion of the second bone fragment and on a dorsal portion of the first bone fragment.
    [0007] Thus, such a proximal plate and such a distal plate can form a bulky support member while being simple to place in abutment against the dorsal portion of the joint. According to one embodiment of the invention, the proximal plate generally has an elongate shape in a proximal direction which is parallel to the longitudinal axis of the second bone fragment, the distal plate generally has an elongated shape in a distal direction which is parallel to the longitudinal axis of the first bone fragment, the proximal direction and the distal direction forming an angle of between 160 degrees and 180 degrees, preferably between 167 degrees and 173 degrees. Thus, such proximal and distal plates provide good support respectively to the first bone fragment and the second bone fragment, for example to the metatarsal and phalanx, since the proximal and distal plates approximate the natural or physiological orientation. of the joint. In order for the guide pin to pass through the first bone fragment and the second bone fragment, for example the phalanx and the metatarsus, in the oblique direction, the surgeon places the support member on the joint so that the proximal direction and the distal direction are respectively parallel to the longitudinal axis of the first bone fragment (metatarsal) and to the longitudinal axis of the second bone fragment (phalanx). According to one embodiment of the invention, the oblique direction forms with the distal direction an angle of between 35 degrees and 70 degrees, preferably between 50 degrees and 60 degrees. Thus, such an oblique direction makes it possible to guide the guide pin precisely by minimizing the risks of interference with the fixing screws of an osteosynthesis plate and the risk of perforation of the first and second bone fragments, for example portions cortices of metatarsal and phalanx. According to a variant of the invention, the passage has a closed contour. Alternatively to the previous variant, the passage may have a partially open contour, for example open on the underside or plantar side of the guide member. According to one embodiment of the invention, the guiding instrument 35 further comprises a gripping member attached to the support member so that the gripping member allows an operator to place the body of support in support against the dorsal portion of the joint. Thus, such a gripping member allows the surgeon to easily hold the guide instrument, so to precisely guide the support member.
    [0008] According to a variant of the invention, the gripping member is composed of a handle, preferably substantially rectilinear. According to one embodiment of the invention, the guiding instrument further comprises fixing means configured to fix so as to make removable the gripping member on the support member.
    [0009] Thus, such fastening means make it possible to adapt a universal gripping member to the guiding instrument, which limits the material necessary for the operation. Alternatively to the previous embodiment, the gripping member is secured to the support member. In this variant, the guiding instrument 15 does not include fixing means. According to one embodiment of the invention, the fixing means comprise at least: - a generally cylindrical stud with circular base, and - a bore configured to receive the stud, and 20 - a friction element configured to generate friction between the stud and the bore when the gripping member is fixed on the support member, so that the gripping member can transmit a torque to the support member. Thus, such a stud and such a bore allow the surgeon to select the gripping position that suits him best. As the gripping member transmits a torque to the support member, the operator can rotate the support member relative to the dorsal portion of the joint, which allows him to set up the guiding instrument. According to a variant of the invention, the friction element comprises at least one O-ring. Said at least one O-ring may be disposed in a groove on the stud or in the bore. According to a variant of the invention, the stud extends over the support member and the bore extends over the gripping member. Alternatively to the previous variant, the stud extends over the gripping member and the bore 35 extends over the support member.
    [0010] According to one embodiment of the invention, a plantar portion of the support member has an abrasion. Thus, such an improvement makes it possible to optimize the ergonomics with respect to the implantation site and it prevents the support member from interfering with any bony overhangs which would be situated on the dorsal side and which would result from cuts. bone and positioning of the joint. According to a variant of the invention, the support member and the guide member are monobloc. Alternatively to the previous variant, the support member and the guide member are removable components. According to a variant of the invention, the support member and the guide member are composed of a surgical grade stainless steel, for example 316L steel or 17-4 PH steel. Furthermore, the present invention relates to a guide method, for guiding at least one guide pin for guiding an implant, for example a hollow screw, for compressing a joint between a first bone fragment, for example a phalanx, and a second bone fragment, for example a metatarsal, the guiding method comprising at least the steps of: - providing a guiding instrument according to the invention, - guiding the guiding instrument so that the organ support is placed in abutment on a dorsal portion of the articulation, - guiding a guide pin through said at least one passage of the guide member, - moving the guide pin in the guide plane so as to adjust the orientation of the guide pin with respect to the joint, - insert the guide pin in the oblique direction and through the first bone fragment, for example the phalanx, and the second bone fragment, for example the m étatarse. According to a variant of the invention, the implant comprises a hollow screw, the point of entry of the hollow screw, therefore of the guide pin, into the phalanx located on the medial side of the phalanx and near the plantar face of the phalanx. Then, the operative method may comprise the following steps: - placing the hollow screw around the guide pin, - screwing the hollow screw into the joint, - placing an osteosynthesis plate on the dorsal portion of the joint, - Fix the plate on the first bone fragment, for example on the metatarsal, and on the second bone fragment, for example on the phalanx, for example by means of fixing screws. The hollow screw is said to be interfragmentary because it is attached to bone fragments belonging to two bones, namely the phalanx and the metatarsus. The implantation of the hollow screw between the base of the phalanx and the head of the metatarsal allows: - to increase the mechanical stability of the metatarsophalangeal joint of the foot and the osteosynthesis plate, - to perform a primary assembly between the first bone fragment (phalanx) and the second bone fragment (metatarsal), which facilitates the placement of the osteosynthesis plate, - perform interfragmentary compression by bringing the base of the first bone fragment to the head of the second bone fragment, which promotes osteosynthesis. In such an operative method, the guiding instrument can be placed directly on the metatarsophalangeal joint of the foot, which eliminates the need to first fix the osteosynthesis plate, as taught WO2014105750A1. Indeed, the hollow screw performs a first compression of the bone fragments before the final stabilization of the bone fragments by assembling the osteosynthesis plate and the hollow screw. The embodiments and variants mentioned above may be taken individually or in any technically possible combination. 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 diagrammatic view in perspective of a guiding instrument according to the invention; FIG. 2 is a schematic view from above of the guiding instrument of FIG. 1; FIG. 3 is a schematic side view of the guiding instrument of FIG. 1; FIG. 4 is a diagrammatic front view of the guiding instrument of FIG. 1; - Figure 5 is a schematic sectional view along the plane P14 in Figure 4; FIG. 6 is a diagrammatic perspective view of the guiding instrument placed on a metatarsophalangeal joint of the foot; FIG. 7 is a flowchart illustrating a guidance method according to the invention; FIG. 8 is a diagrammatic perspective view illustrating a stage of osteotomy of the phalanx; FIG. 9 is a schematic perspective view illustrating a metatarsal osteotomy step; FIG. 10 is a schematic perspective view illustrating a step of insertion of a pin for stabilizing the metatarsophalangeal articulation of the foot; - Figure 11 is a schematic perspective view illustrating a verification step; - Figure 12 is a schematic perspective view illustrating a step of fixing the guide instrument on the metatarsophalangeal joint of the foot; - Figure 13 is a schematic perspective view illustrating a step of inserting a guide pin; FIG. 14 is a schematic perspective view illustrating a measurement step; - Figure 15 is a schematic perspective view illustrating a step of screwing a hollow screw; FIG. 16 is a schematic perspective view illustrating a final step; and FIG. 17 is a schematic perspective view illustrating an ultimate step after fixation of an osteosynthesis plate. Figures 1, 2, 3, 4, 5 and 6 illustrate a guide instrument 1, which is configured to guide a guide pin 2, visible in Figures 13, 14 and 15. The guide pin 2 serves to guide, during an arthrodesis operation, a hollow screw 4 sometimes referred to as a cannulated screw, visible in FIGS. 15 to 17. The hollow screw 4 has a longitudinal channel 4.1 which passes through the hollow screw 4 and which opens on either side of the hollow screw 4. The longitudinal channel 4.1 here has a cylindrical shape with a circular base for receiving the guide pin 2. The hollow screw 4, after implantation, compresses a hinge 6, which is here a metatarsophalangeal joint of the foot. The hinge 6 comprises a phalanx 7 and a metatarsal 8, which respectively form a first bone fragment and a second bone fragment. Alternatively, a hollow screw may compress another joint between two bone fragments, for example another joint present at one end of a limb. The guiding instrument 1 comprises a support member 11. As shown in FIG. 6, the support member 11 is configured to be placed in abutment on a dorsal portion 6.1 of the hinge 6. In addition, the guide instrument 1 comprises a guide member 12. The guide member 12 is connected to the support member 11. The guide member 12 has a passage 14 which is configured to guide the guide pin 2 during the arthrodesis operation. The support member 11 and the guide member 12 are composed of a stainless steel surgical grade, here 316L steel. In the example of Figures 1 to 6, the support member 11 and the guide member 12 are monobloc. Alternatively, the support member 11 and the guide member 12 may be connected by a connection allowing a mobility of the support member 11 relative to the guide member 12. The passage 14 is configured for s extend transversely to the hinge 6 when the support member 11 is placed in abutment against the dorsal portion 6.1 of the hinge 6, as shown in FIG. 6. Thus, the guide pin 2 can pass through the phalanx 7 and the metatarsus 8 of the articulation 6 in an oblique direction 0 with respect to the support member 11. In the example of FIGS. 1 to 6 and 8 to 17, the passage 14 is furthermore configured to allow displacements of the guide pin 2 only in a guide plane P14 which includes the oblique direction O. The oblique direction 0 is oriented towards a central region 6.0 of the articulation 6 when the support member 11 is placed in abutment against the dorsal portion 6.1 of the joint 6. As shown in Figure 4, the d Oblique irection 10 extends in a plantar plane which is substantially horizontal when the sole of the foot rests on a horizontal plane. As shown in Figure 5, the passage 14 has the overall shape of a rectangle in section in the guide plane P14. In the example of the figures, the passage 14 has a closed contour. Perpendicular to the oblique direction 0, the passage 14 extends in a planto-dorsal direction Y. The planto-dorsal direction Y is substantially orthogonal to a plantar surface and to a dorsal face of the hinge 6. The guide plane P14 is defined by the oblique direction 0 and by the planto-dorsal direction Y. The guide plane P14 (or OY) is a vertical plane 20 which is therefore perpendicular to the plantar plane. The passage 14 has a depth D14, measured parallel to the oblique direction 0, between 6 mm and 10 mm. The passage 14 has a width W14, measured perpendicularly to the guide plane P14, which is substantially constant along the oblique direction O. The width W14 is dimensioned so that the passage 14 can receive, with a functional clearance, the spindle. guide 2 which here has a diameter of about 1.4 mm. The passage 14 has a height H14, measured perpendicular to the depth D14 and the width W14, which is approximately equal to 12 mm. As shown in FIGS. 1 and 2, the support member 11 comprises a proximal plate 21 and a distal plate 22. The proximal plate 21 and the distal plate 22 are arranged to extend respectively on a dorsal portion 8.1 of the metatarsal 8 and on a dorsal portion 7.1 of the phalanx 7.
    [0011] The proximal plate 21 generally has an elongated shape in a proximal direction X21 which is parallel to the longitudinal axis X8 of the metatarsal 8. The distal plate 22 generally has an elongate shape in a distal direction X22 which is parallel to the longitudinal axis X7 of the phalanx 7. The longitudinal axis X8 of the metatarsal 8 and the longitudinal axis X7 of the phalanx 7 are visible in FIG. 10. In the example of the figures, the proximal direction X21 and the distal direction X22 form an angle A21. .22 approximately equal to 170 degrees. The oblique direction 0 forms with the distal direction X22 an angle A14.22 which is approximately equal to 55 degrees. The support member 11 has a proximal hole 23 and a distal hole 24. The proximal hole 23 is through and is configured for the insertion of a proximal pin 25, visible in Figures 6, 12 and 13. The spindle proximal 25 is intended to immobilize the support member 11 on the metatarsal 8. The distal hole 24 is through and it is configured for the insertion of a distal pin 26, visible in Figures 6, 12 and 13. The distal pin 26 is intended to immobilize the support member 11 on the phalanx 7. In addition, the support member 11 has on its dorsal side: - a first mark 11.1, here constituted by a first line, 20 intended to be substantially aligned with the longitudinal axis X8 of the metatarsus 8 when the support member 11 is placed in abutment against the dorsal portion 6.1 of the hinge 6, - a second mark 11.2, here constituted by a second line, intended to be substantially aligned with the longitudinal axis X7 of the phalanx 7 when the organ support 11 is placed in abutment against the dorsal portion 6.1 of the hinge 6, - a third mark 11.3, here constituted by a third line, intended to be substantially aligned with the merging line 6.5, visible in FIG. the hinge 6 when the support member 11 is placed in abutment against the dorsal portion 6.1 of the hinge 6, and a fourth mark 11.4, here constituted by a fourth line, aligned with the oblique direction O. The first, second, third and fourth pins 11.1, 11.2, 11.3 and 11.4 are derived from respective laser markings. The guiding instrument 1 further comprises a gripping member 31, visible in FIGS. 6, 12 and 13, which is fixed to the support member 11 so that the gripping member 31 allows an operator to place the support member 11 in abutment against the dorsal portion 6.1 of the hinge 6. The gripping member 31 is here composed of a substantially straight and flat handle.
    [0012] The guiding instrument further comprises fastening means 32, which are visible in FIGS. 6 and 13 and which are configured to removably attach the gripping member 31 to the support member 11. The organ The gripper 31 is of the universal or versatile type because it can be used for other stages of the arthrodesis operation or for other operations. In the example of the figures, the fastening means 32 comprise: - a stud 33 of generally cylindrical shape with a circular base, - a bore 34 configured to receive the stud 33, and 15 - a not shown friction element. The friction element is configured to generate friction between the stud 33 and the bore 34 when the gripping member 31 is fixed on the support member 11, so that the gripping member 31 can transmit a torque in the support member 11. In the example of the figures, the stud 33 extends on the support member 11 and the bore 34 extends on the gripping member 31. friction element here comprises an O-ring not shown. The O-ring may be arranged in a groove on the stud 33 or in the bore 34. As the gripping member 31 transmits a torque to the support member 11, the operator can rotate the organ 11 relative to the dorsal portion 6.1 of the hinge 6, which allows it to set up the guiding instrument 1. As shown in Figure 3, a plantar portion 11.6 of the support member 11 presents an attenuation 11.7, so as to limit or avoid the risk of interferences of the support member 11 with possible bony dorsal surges that result from the bone cuts and the positioning of the joint 6. The figures 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 and 17 illustrate a guide method 100, for guiding a guide pin 2 for guiding the hollow screw 4, so that the screw hollow 4 compresses the joint 6.
    [0013] The guiding method 100 may comprise a preparation step 101 to prepare the bone site of the hinge 6. The preparation step 101 is illustrated in FIGS. 8, 9, 10 and 11. The preparation step 101 includes the sub-steps 101. steps consisting in: (FIG. 8) machining the proximal portion of the phalanx 7 with the aid of a convex bur 91, so as to form a portion of a sphere, - (FIG. 9) machining the distal portion of the metatarsal 8 with the aid of a concave cutter 92, so as to form a portion of a sphere, - (FIG. 10) insert a stabilizing pin 93 through the metatarsus 8 and the phalanx 7, so as to temporarily fix the articulation 6, - (FIG. 11) check the stabilization of the articulation 6 with the stabilizing spindle 93; if necessary, adjust the stabilization of the hinge 6 using a support plate 94. The sub-step of machining the proximal portion of the phalanx 7 (Figure 8) may be to plan the distal portion of the phalanx 7, so as to form a concave sphere portion. The sub-step of machining the distal portion of the metatarsal 8 (FIG. 9) may consist in surfacing the distal portion of the metatarsus 8, so as to form a portion of a convex sphere. The guiding method 100 comprises the steps of: - 102) providing the guiding instrument 1, - 104) guiding the guiding instrument 1 so that the bearing member 11 is placed in abutment on a dorsal portion 6.1 the hinge 6, - 106) guide the guide pin 2 through the passage 14 of the guide member 12, - 108) move the guide pin 2 in the guide plane P14 so as to adjust the orientation of the guide pin 2 with respect to the articulation 6, 110) insert the guide pin 2 through the phalanx 7 and the metatarsus 8 in the oblique direction O. So that the guide pin 2 passes through the phalanx 7 and the metatarsal 8 in the oblique direction 0, the surgeon places the support member 11 on the hinge 6 so that the proximal direction X21 and the distal direction X22 are respectively parallel to the longitudinal axis X8 of the metatarsal 35 8 and to the longitudinal axis X7 of the phalanx 7.
    [0014] Then, the operating method can comprise the following steps: - (FIG. 14) measuring the length of the hollow screw 4 required using a measuring aid 95, - 112) placing the hollow screw 4 around the spindle of guide 2, - 114) screw the hollow screw 4 in the articulation 6 (FIG. 15), - 116) place an osteosynthesis plate 41 on the dorsal portion 6.1 of the articulation 6 (FIG. 17), - 118) fix the osteosynthesis plate 41 on the metatarsal 8 and 10 on the phalanx 7, by means of several fixing screws 42 (Figure 17). The point of entry of the hollow screw 4, therefore of the guide pin 2, into the phalanx 7 is located on the medial side of the phalanx 7 and near the plantar face of the phalanx 7. Of course, the present invention is not limited to the particular embodiments described in this patent application, nor to embodiments within the abilities of those skilled in the art. Other embodiments may be envisaged without departing from the scope of the invention, from any element structurally or functionally equivalent to an element indicated in the present patent application. 20
    权利要求:
    Claims (17)
    [0001]
    REVENDICATIONS1. A guiding instrument (1) for guiding at least one guide pin (2) for guiding an implant, for example a hollow screw (4), for compressing a joint (6) between a first bone fragment, for example a phalanx (7), and a second bone fragment, for example a metatarsal (8), the guiding instrument (1) comprising at least: - a support member (11) configtfré to be placed in abutment on a dorsal portion (6.1) of the hinge (6), and - a guide member (12) which is connected to the support member (11) and which has at least one passage (14) configured to guide a spindle guide (2); the guiding instrument (1) being characterized in that the passage (14) is configured to extend obliquely (0) with respect to the support member (11) so as to extend transversely to the articulation (6) when the support member (11) is placed in abutment against the dorsal portion (6.1) of the articulation (6), so that said at least one guide pin (2) may pass through the first bone fragment, for example the phalanx (7), and the second bone fragment, for example the metatarsus (8), in an oblique direction (0) with respect to the support member (11), and the passage (14) being further configured to allow movements of said at least one guide pin (2) in a guide plane (P14) including the oblique direction (0). 25
    [0002]
    2. Guiding instrument (1) according to claim 1, wherein the passage (14) is configured to allow displacements only in the guide plane (P14).
    [0003]
    3. A guiding instrument (1) according to any one of the preceding claims, wherein the guide plane (P14) is defined by the oblique direction (0) and a planto-dorsal direction (Y).
    [0004]
    The guiding instrument (1) according to any one of the preceding claims, wherein the oblique direction (0) is oriented towards a central region (6) of the articulation (6) when the support member (11) is placed in abutment against the dorsal portion (6.1) of the hinge (6).
    [0005]
    5. guiding instrument (1) according to any one of the preceding claims, wherein the support member (11) has on its dorsal side: a first mark (11.1), for example a first line, intended to be substantially aligned with the longitudinal axis (X8) of the second bone fragment when the support member (11) is placed in abutment with the dorsal portion (6.1) of the hinge (6), - a second mark (11.2) , for example a second line, intended to be substantially aligned with the longitudinal axis (X7) of the first bone fragment when the support member (11) is placed in abutment against the dorsal portion (6.1) of the joint (6), a third mark (11.3), for example a third line, intended to be substantially aligned with the melting line (6.5) of the hinge (6) when the support member (11) is placed resting against the dorsal portion (6.1) of the articulation (6), and a fourth marker (11.4), for example a fourth line, aligned with the oblique direction (0). 20
    [0006]
    6. guiding instrument (1) according to any one of the preceding claims, wherein the passage (14) has the overall shape of a rectangle in section in the guide plane (P14).
    [0007]
    7. A guiding instrument (1) according to any one of the preceding claims, wherein the passage (14) has a depth (D14), measured parallel to the oblique direction (0), between 6 mm and 10 mm.
    [0008]
    The guiding instrument (1) according to any one of the preceding claims, wherein the passage (14) has a height (H14) of between 10 mm and 20 mm, preferably of between 10 mm and 15 mm.
    [0009]
    The guiding instrument (1) according to any one of the preceding claims, wherein the passage (14) has a width (W14), measured perpendicularly to the guide plane (P14), which is substantially constant along the oblique direction (0).
    [0010]
    The guiding instrument (1) according to any one of the preceding claims, wherein the support member (11) has at least: - a proximal hole (23) therethrough configured for insertion of a spindle proximal (25) for immobilizing the support member (11) on the second bone fragment, for example the metatarsus (8), and 10 - a distal hole (24) therethrough configured for the insertion of a distal pin (26) for immobilizing the support member (11) on the first bone fragment, for example the phalanx (7).
    [0011]
    The guiding instrument (1) according to any one of the preceding claims, wherein the support member (11) comprises a proximal plate (21) and a distal plate (22), the proximal plate (21). and the distal plate (22) being arranged to extend respectively on a dorsal portion (8.1) of the second bone fragment and on a dorsal portion (7.1) of the first bone fragment. 20
    [0012]
    The guide instrument (1) according to claim 11, wherein the proximal plate (21) has a generally elongate shape in a proximal direction (X21) which is parallel to the longitudinal axis (X8) of the second bone fragment, the The distal plate (22) is generally elongate in a distal direction (X22) which is parallel to the longitudinal axis (X7) of the first bone fragment, the proximal direction (X21) and the distal direction (X22) forming an angle (A21.22) between 160 degrees and 180 degrees, preferably between 167 degrees and 173 degrees. 30
    [0013]
    13. A guiding instrument (1) according to any one of claims 11 to 12, wherein the oblique direction (0) forms with the distal direction (X22) an angle (A14.22) of between 35 degrees and 70 degrees, preferably between 50 degrees and 60 degrees. 35
    [0014]
    14. guiding instrument (1) according to any one of the preceding claims, further comprising a gripping member (31) fixed to the support member (11) so that the gripping member (31) allows an operator to place the support member (11) bearing against the dorsal portion (6.1) of the hinge (6).
    [0015]
    15. Guiding instrument (1) according to claim further comprising fixing means (32) configured to releasably fix the gripping member (31) on the support member (11).
    [0016]
    16. The guiding instrument (1) according to claim 15, wherein the fastening means (32) comprise at least: a stud 3) of globally cylindrical shape with a circular base, a bore (34) configured to receive the stud ( 33), and a friction element configured to generate friction between the stud (33) and the bore (34) when the grip member (31) is attached to the support member (11), so that the gripping member (31) can transmit a torque to the support member (11),
    [0017]
    The guiding instrument (1) according to any one of the preceding claims, wherein a plantar portion (11.6) of the support member (11) has an edging (11.7).
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    EP3585278A4|2017-02-27|2021-04-07|Paragon 28, Inc.|Targeting instruments, systems and methods of use|
    US11123120B2|2018-07-11|2021-09-21|Paragon 28, Inc.|Implants, alignment guides, systems and methods of use|
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    法律状态:
    2015-10-15| PLFP| Fee payment|Year of fee payment: 2 |
    2016-06-24| PLSC| Publication of the preliminary search report|Effective date: 20160624 |
    2016-11-10| PLFP| Fee payment|Year of fee payment: 3 |
    2017-11-09| PLFP| Fee payment|Year of fee payment: 4 |
    2018-10-26| PLFP| Fee payment|Year of fee payment: 5 |
    2019-11-14| PLFP| Fee payment|Year of fee payment: 6 |
    2020-10-30| PLFP| Fee payment|Year of fee payment: 7 |
    2021-10-29| PLFP| Fee payment|Year of fee payment: 8 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1462935A|FR3030221B1|2014-12-19|2014-12-19|INSTRUMENT AND METHOD FOR GUIDING A GUIDE PIN|
    FR1462935|2014-12-19|FR1462935A| FR3030221B1|2014-12-19|2014-12-19|INSTRUMENT AND METHOD FOR GUIDING A GUIDE PIN|
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