CN102551824A - 外科手术细丝圈套组件 - Google Patents
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Abstract
本发明提供了一种外科手术细丝圈套组件,所述外科手术细丝圈套组件包括能够固定于骨骼中并具有细丝接合特征的锚钉。第一细丝在至少第一延伸段的第一部分上有套索,并且具有连接到锚钉的细丝接合特征的第二部分。优选地,至少一个自由细丝延伸段能够穿过要修复的组织,并有至少一端可穿过套索以在锚钉固定在骨骼中之后能够逐渐拉紧组织,其中,在一些实施例中所述自由细丝延伸段是一段第一细丝,而在其它实施例中,所述自由细丝延伸段为一段第二细丝。当拉力被加到自由细丝延伸段和所述套索中至少一者上时,所述套索勒住所述自由细丝延伸段。
Description
背景技术
1.技术领域
本发明涉及用于将组织固定到骨骼上的细丝组件,更具体地讲,涉及不依赖于锚钉固定而可调节地拉紧组织的细丝组件。
2.背景技术
肌腱、韧带或其它软组织从骨骼上完全或部分分离是一种普通损伤,在运动员当中尤为常见。组织分离会在摔倒过程中因用力过猛而发生,或出于各种其它原因。尤其是当组织完全从其相关的骨骼上分离时,通常需要外科手术干预。当前可用的组织附着器件包括螺钉、缝钉、缝线锚钉和平头钉。
关节镜式系结方法通常在肩袖和不稳定手术中实施。通常,先将载有缝线的锚钉固定到骨骼上。缝线正常情况下通过孔眼或绕着柱可滑动地附着到锚钉上,使得单段缝线具有两个自由延伸段。缝线的一个延伸段穿过待修复的软组织,诸如肌腱或盂唇。缝线的两端随后彼此系上,从而与锚钉一起将软组织获取于套环中。当收紧套环时,软组织就通过锚钉靠近骨骼。
外科医生通常先放置诸如Tennessee滑结或Duncan结之类的滑结来系住缝线端。在收紧套环后,系上多个附加的半结或其它结。之所以需要附加的结,是因为常规的滑结不具有必要的防松或防滑功能,尤其在拉力主要作用于套环的延伸段上时。通常认可的做法是,在滑结之后在交替布置的缝线柱上打至少三个反向半结。
然而,在可将一个或多个半结或其它结加到滑结上之前,存在滑结滑动的可能性,也就是说,套环会因为组织对其施加的拉力而扩大。这被称为“套环安全性”,据报道甚至在富有经验的外科医生手中也可能发生。有时,甚至完全系住的结也会滑动。此外,常规结的总体大小会具有阻碍或侵入性,尤其在紧密关节中,由于受到结的摩擦,可损坏软骨或其它组织。
用于修复撕裂或损伤的组织的具有滑结和锁结的缝线锚钉系统包括Wenstrom,Jr的美国专利No.6,767,037所公开的系统。尤其适合半月板修复的其它缝线锚钉系统在Selvitelli等人的美国专利No.7,390,332中公开,被用于购自DePuy Mitek Inc.,325 Paramount Drive,Raynham,Massachusetts02767的OmniSpanTM半月板修复系统。
存在许多声称为“无结”的缝线植入系统,所谓“无结”即无需外科医生在手术中系结。许多这种系统通过锚钉被驱动进入骨骼的深度来控制作用于组织的拉力。Lizardi的美国专利No.5,782,864和No.7,381,213公开了特定类型的缝线锚钉,其获取固定长度的缝线环。利用插入套管中的锚钉元件的可调套环无结锚钉组件被Thal在美国专利No.5,569,306和No.6,045,574以及美国专利申请公布No.2009/0138042中公开。包括夹具或其它锁紧装置的其它系统公开于Goble等人的美国专利No.5,702,397和Schwartz等人的美国专利申请公布No.2008/0091237。
因此,理想的是实现稳固然而可调节的组织固定,同时最小化外科医生尤其在关节镜式修复手术中将要系缚的结的数量和大小。
发明内容
本发明的一个目的是满足或超出对组织张力控制的需求,并保持当前可用的缝线锚钉组件用于组织修复手术的能力,同时减少将通过外科医生系缚的半结或其它结的数量。
本发明的另一目的是减小用于组件的已成结的尺寸。
又一个目的是为外科医生简化整体的系结过程,同时增强套环安全性和结安全性。
本发明的再一个目的是增加锚钉固定之后的拉紧力。
本发明的特色在于一种外科手术细丝圈套组件,所述外科手术细丝圈套组件包括能够固定于骨骼中并具有细丝接合特征的锚钉。第一细丝在至少第一延伸段的第一部分上有套索,并且具有连接(包括滑动连接或固定连接)到锚钉的细丝接合特征的第二部分。套索(如一个或多个半结或绞索式套索)能够接纳自由细丝延伸段的至少一端,并当张力加到自由细丝延伸段和套索中至少一者上时,所述套索勒住所述自由细丝延伸段。
在一个优选实施例中,至少第一自由细丝延伸段(在一些实施例中所述自由细丝延伸段是一段第一细丝,而在其它实施例中所述自由细丝延伸段为一段第二细丝)能够穿过要修复的组织,并有至少一端可穿过套索以在锚钉固定在骨骼中之后能够逐渐拉紧组织。在一些实施例中,所述套索可朝着所述锚钉缩进。可包括至少一个管,以帮助将自由细丝延伸段穿过所述套索。
在其中所述套索有至少一个半结形成的特定实施例中,所述组件包括至少两个管,所述管能够可拆卸地插入到所述半结的不同套环中,以提供用于自由细丝延伸段两端的通道。在一些实施例中,所述管连接在一起,并具有用于操作所述管的至少一个手柄。优选地,各个管开有槽,以便从管中取出所述自由细丝延伸段。
本发明的特色还在于一种外科缝线圈套组件,所述外科缝线圈套组件具有锚钉,所述锚钉能够固定在骨骼中,并具有至少一个通道以及缝线接合特征。第一缝线在至少第一延伸段的第一部分上有套索,并且具有穿过所述通道并连接到锚钉的缝线接合特征的第二部分。第二缝线具有至少一个第一自由缝线延伸段,所述第一自由缝线延伸段能够穿过要修复的组织,并有至少一端能穿过所述套索,以使得在锚钉被固定在骨骼中之后能够逐步拉紧组织,当拉力被加到自由缝线延伸段和套索中至少一者上时,所述套索勒住所述自由缝线延伸段。
本发明的又一特色在于一种外科缝线圈套组件,所述外科缝线圈套组件具有锚钉,所述锚钉能够固定在骨骼中,并具有至少一个通道以及缝线接合特征。第一缝线在至少第一延伸段的第一部分上有套索,并且具有穿过所述通道并连接到锚钉的缝线接合特征的第二部分。第一缝线还具有至少一个第一自由缝线延伸段,所述第一自由缝线延伸段能够穿过要修复的组织,并有至少一端能穿过所述套索,以使得在锚钉被固定在骨骼中之后能够逐步拉紧组织,当拉力被加到自由缝线延伸段和套索中至少一者上时,所述套索勒住所述自由缝线延伸段。
本发明的另一特色是一种通过外科手术修复组织的方法,所述方法包括:选择能够固定在骨骼中的锚钉,并具有细丝接合特征。选择第一细丝,所述第一细丝在至少第一延伸段的第一部分上有套索,并且具有连接(包括滑动连接或固定连接)在锚钉的细丝接合特征上的第二部分。所述方法还包括将锚钉固定到骨骼中,选择至少第一自由细丝延伸段并将其穿过要修复的组织。自由细丝的至少一端穿过所述套索,并且在锚钉被固定到骨骼中之后,根据需要拉紧所述组织,当拉力被加到自由细丝延伸段和套索中至少一者上时,所述套索勒住所述自由细丝延伸段。
在一些实施例中,所述自由细丝延伸段选自一段第二细丝。在一个实施例中,所述第二细丝包括还穿过所述套索的第二自由细丝延伸段,使得组织在所述第一自由细丝延伸段和第二自由细丝延伸段之间被获取。在某些实施例中,通过将所述套索朝着所述锚钉收缩,张力也被施加到所述套索上。
在其它实施例中,所述方法还包括在自由细丝延伸段穿过所述套索之后将止挡件置于所述自由细丝延伸段的步骤,以阻止所述自由细丝延伸段从所述套索中退出。在一些实施例中,系结并将其朝所述套索滑动,以用作所述止挡件。至少一个管可以可拆卸地插入到所述套索中,以有助于自由细丝端穿过所述套索。在某些实施例中,所述套索由具有至少三个开口的至少一个半结形成。至少两个管可拆卸地插入到所述半结的不同开口中,以提供用于自由细丝延伸段的至少两端的通道。至少两个自由细丝端穿过所述半结中的不同开口。
附图说明
下文结合附图更详细地解释了本发明的优选实施例,其中:
图1是具有锚钉和套索的根据本发明的外科手术细丝圈套组件的示意性侧视图;
图1A是绞索式套索的示意性侧视图,图1B是根据本发明的待用的半结套索的示图;
图2是可拆卸地连接于插管装拆器的图1的组件的示意性侧视图,所述插管装拆器用来将载有穿过套索的穿线套环的锚钉初始固定;
图3-10是示意性侧视图,说明将组织获取并拉紧到根据本发明的外科手术细丝圈套组件中的过程,图8A提供图8、9和10中示出的止挡结的实例;
图11和图12是替代形式的半结套索的透视图,其中使用多个开口来勒住两根或多根自由细丝延伸段;
图13是用于帮助自由细丝延伸段穿过图11的套索开口的管的透视图;
图14A是双筒带槽装置的透视图;
图14B示出了使用图14A的装置穿套索;
图15-19示出了具有根据本发明的可收缩套索构造的不同的圈套组件;
图20是穿过根据本发明的圈套组件的单个套索的多根细丝的示意性俯视图;
图21是图18所示布置的一个结构的放大图;
图22-27是用于布置为穿过要修复的组织的另一锚钉的图18的圈套组件的示意性侧视图。以及
图28是具有插管缝线锚钉的根据本发明的圈套组件的透视图。
具体实施方式
本发明可通过外科手术细丝圈套组件来实现,所述外科手术细丝圈套组件包括能够固定于骨骼中并具有细丝接合特征的锚钉。第一细丝在至少第一延伸段的第一近端部分具有套索,并且具有连接(包括滑动连接或固定连接)到锚钉的细丝接合特征的第二部分。套索(如一个或多个半结或绞索式套索)能够接纳自由细丝延伸段的至少一端。拉力被加到所述套索、加到自由细丝延伸段或加到这二者上时,套索勒住所述自由细丝延伸段。
在优选结构中,至少第一自由细丝延伸段(在一些结构中是一段第一细丝,而在其它结构中,为一段第二细丝)穿过要修复的组织,并有至少一端可穿过套索以在锚钉固定在骨骼中之后能够逐渐拉紧组织。
图1的外科手术细丝圈套组件10具有锚钉12和第一细丝14。在该结构中,锚钉12通过在其远端20的狭窄开口18限定内部通道16,所述狭窄开口是细丝接合特征。诸如外部棱纹或螺纹之类的至少一个骨接合特征22布置在远端20和近端24之间的锚钉12的外表面上。
第一细丝14具有在其近端的套索30和在细丝的柱或茎15的远端的固定结32,所述固定结与狭窄开口18相互作用以将细丝14夹持在固定、永久附着的位置。这种构造可称作与细丝接合特征18连接的第一细丝14,其包括穿过细丝接合特征18的部分(phrase)。诸如桑葚结的许多常规结可用作固定结32,前提是结32足够大以防在加于套索30的临床所需拉力作用下穿过。以下描述多个其它类型的细丝接合结构。茎15保持得足够短,即使套索如下所述被拉扁后,也将套索30保持为靠近锚钉12。
公知的套索结33示于图1A中,其中第一细丝14a具有在其近端的绞索式套索30a和在茎15a的远端的固定结32a。套索30a具有滑动套索结33,并限定开口34。通过在细丝14a的近端形成扁平的“S”或“Z”形来系成套索结33,从而形成用作套索开口的大的近端套环和与大套环隔离开的小套环。双细丝延伸段被末端(也被称作工作端)缠绕。在通常四至八圈缠绕后,所述末端被塞入小套环并通过拉动合拢于小套环的大套环的任一延伸段捕获。
图1B示出了第一细丝14b的替代形式的更简单的套索,其具有半结35(也被称作简单结或反手结),所述半结系缚成在细丝延伸段36和38的中间形成套索30b。通过半结35的套环形成多个开口,如以下更详细描述,尽管在图1B中,中央开口37被示出为大的单个开口。第一细丝延伸段36和38绕半结35折叠,以形成双茎布置,并且第一细丝延伸段36和38的远端在穿过锚钉上的合适细丝接合特征之后在结32b中连接。
在本文中将套索效率定义为基于施加到套索上的每单位拉力的勒力强度,所述拉力通过拉动系缚有套索或以另一种方式带有套索的细丝来实现,或通过拉动穿过套索的一条或多条股线或细丝的延伸段产生。在套索结中具有低内摩擦的套索将趋于具有更高的套索效率。
用于将锚钉12插入在骨骼中钻的孔中的一种器械示于图2中。打入器40具有可拆卸地插入到通道16中的远端42。打入器40以具有腔44的管插入这种结构中,带有穿过套索30的可选穿线细丝46。使用穿引细丝是选择性的,但是当套索30与细丝接合特征18仅相隔很短的距离时,换句话说,当套索30被初始布置为靠近锚钉12或在锚钉内时,使用穿引细丝可能是理想的。
在根据本发明的一个手术中,锚钉12如图3所示固定在骨骼B中,在打入器40被取下后,锚钉位于与要修复的组织T相距所需距离的孔50中。套索30位于初始开口构造中。穿引细丝46具有足够的长度,以在第一延伸段上具有穿引细丝套环52,并且在第二延伸段54上具有可抓握部分,在穿引细丝46的中部与套索30可滑动地相连的同时,第二延伸段54在皮肤S上方朝近端延伸。
继续参照该示例性手术,在图4中,第二细丝60利用缝线穿过器械、针或外科医生选择的其它组织穿刺技术穿过组织T。两个自由细丝延伸段62和64通常在皮肤S之上或至少在连接空间之外被带到一起,并穿过穿引细丝套环52,见图5。穿引细丝延伸段54随后被拉动,以将两个细丝延伸段62和64穿过套索30,如图6所示,同时套索30位于初始开口构造中。作为另外一种选择,自由细丝延伸段62和64直接穿过套索30,而不利用穿引细丝。
当具有高套索效率时,轻拉就足以将套索30在细丝延伸段62和64上拉扁,如图7所示,以在外科手术细丝圈套组件10上提供初始拉伸。一般来说,当一个或多个自由细丝延伸段不利用穿引细丝而直接穿过套索30时,或者利用以下图13-14B所示的管或穿线器装置穿过时,可获得更高的套索效率。
在自由细丝延伸段62和64(见图7)的初始拉伸或预拉伸之后,张力在延伸段62和64上释放,由外科医生在皮肤S上方的延伸段62和64上系出可滑动止挡结70(见图8)。用于止挡结70a的一个结构的放大示图(图8A)示出了具有多一拐或一圈的半结,也被称作双反手结。诸如单个半结或反手结的简单结在一些情况下可能已足够。具有更高负载能力的其它合适的更稳固的外科手术可滑动结包括在关节镜式结系缚方法手册(2005)中描述的Tennessee滑结以及在美国专利No.6,767,037中Wenstrom,Jr的可滑可锁结。作为另外一种选择,在并不严格要求总体轮廓,尤其远离关节或其它关节连接表面的情况下,可利用机械锁定机构。
止挡结70通过利用结推进器前进直至其接触套索30为止,见图9。在组织T和锚钉12之间产生的张力单独或与作用于细丝延伸段62或64之一上的拉力一起使得套索30进一步拉扁(图10),并勒住细丝。止挡结上所有的组织产生的张力被传递到套索30上并且细丝延伸段62、64被防止滑入套索结中,止挡结70从而增强了勒紧作用。因此,形成自系紧机构,其阻止细丝的松散。通过将止挡结再向前推进或拉动细丝延伸段62、64之一,在类似于棘轮的作用方式下张力可被逐步增大。
一旦达到满意的组织张力,则可将一个或多个半结添加到止挡结70上,以增强止挡结的负载能力,并降低在不利条件下松散的风险。作为对照,常规滑结通常通过设置在交错的柱上的至少两三个反向半结来加强。由于本发明的自系紧效应,达到或超过与常规结系统相当的负载性能,止挡结70需要较少的全结(overall hitch)或其它结。因此,本发明实现了以更小的总体结轮廓来应对给定负载。延伸段62、64根据需要剪除。止挡结还使得细丝端头随时间推移而出现的磨散最少。
细丝14和60的优选材料包括各种外科手术缝线,通常为0至5号缝线,例如购自DePuy Mitek的OrthocordTM缝线以及购自Ethicon的EthibondTM缝线。OrthocordTM缝线包含接近百分之五十五至六十五的PDSTM聚对二氧环己酮,它是生物可吸收的,并且剩余的百分比含量为超高分子量聚乙烯,而EthibondTM缝线主要是高强度聚酯。在第一或第二细丝中使用的生物可吸收材料的量和类型(如果有的话),主要取决于外科医生针对要进行的外科手术的选择。
尽管第一套索细丝14和第二组织细丝60都可使用同一类甚至同样的缝线,但是其表面具有较低摩擦特性的缝线可被一些外科医生优选用作第二细丝60。较低摩擦特性可通过更大的直径、更软的组分、更软的编织、打辫或股线形式或这些特征的组合来实现。
以上图1-6中示出的套索被描述为具有单个开口,一个或多个自由细丝延伸段穿过所述开口。简单半结或反手型“扭曲”状结示于图11中,作为套索30c,其具有多个可用的开口80、82和84。侧开口80和84在第一细丝延伸段36c、38c上通过半结的次要套环81和83形成,而中间开口82通过主要套环形成。自由细丝延伸段62c和64c示于图12中,它们分别延伸穿过侧开口80和中间开口82,然而其它的排列、组合(例如利用侧开口80和84或中间开口82和侧开口84)也是有效的。利用套索结的不同区域或部位可显著增大有效的勒紧作用和对自由细丝延伸段的抓握。期望的是,利用套索结中的多个开口也最小化了负荷承载能力对细丝柔顺特性的依赖。简单的单个半结止挡结70c也示于图12中。
虽然两个或更多个穿引细丝或外科医生的小心的、可能单调的操作可被用于实现图12所示的构造,但是避免非故意造成的套索拉扁的替代形式的技术示于图13中。管90和92具有适于滑入由套环81和83形成的侧开口中的外径。细丝延伸段36、38c被示为与锚钉12c接合。管90和92分别限定通道94和96,自由细丝延伸段62c和64c穿过所述通道94和96。管90和92随后从套索30c上脱离,并沿着细丝延伸段62c和64c拉动直至它们能够合适地取出和丢弃。
图14A的双筒穿线器装置100具有两个穿线管102、104,其通过手柄106连在一起,并提供了更容易的方法。在一个结构中,装置100被利用聚合物材料模制成整体单元。管102、104分别具有分别在两端具有开口的内腔108、110以及槽112、114,槽同样延伸管102、104的整个长度。在使用中,管102、104被布置穿过图14B的由第一细丝延伸段36d、38d形成的环81d、83d,并且自由细丝延伸段62d、64d插入并穿过腔108、110。然后,延伸段62d、64d被简单地通过槽112、114拉出,以将完全穿过的细丝从装置100取出。根据需要,可形成和使用一个或多个这种附加的管。另外,管102、104在横截面上看可形成为“C”或“U”形,这样可获得比图示更宽的槽。
存在根据本发明的圈套组件的多个其它构造,其具有一个或多个使得套索可根据需要朝锚钉退缩成为可能的可调节长度的套索支持茎或延伸段。这些构造提供对最终细丝位置和张力的附加层面的控制。图15的圈套组件120具有形成在第一细丝122的一端的套索124,其中茎段126伸进锚钉130以穿过棘轮状单向闸或夹持机构132。细丝122的其余部分用作延伸段128,也称作茎尾。单向机构的一些示例通过Goble等人在美国专利No.5,702,397中公开,例如,该机构让细丝仅沿一个方向移动。
如图15所示,锚钉130固定在骨骼B中。第二细丝134穿过组织T,并且其自由延伸段136和138穿过套索124,自由延伸段一开始位于周围组织T的连接空间之外。同样位于所述连接空间之外的延伸段128被拉动以将套索124朝着机构132退缩。通常,套索124被拉扁,延伸段128被剪除,然后利用与以上图7-10示出的相似的工序。
图16的圈套组件140具有第一细丝140,第一细丝具有通过延伸到锚钉150中的两个茎延伸段146和148系成的套索144。在该结构中,锚钉柱152用作将细丝140可滑动地附连在锚钉150上的细丝接合特征。细丝茎尾延伸段154、156延伸到连接空间之外,与套索144一起形成初始构造。第二细丝160穿过组织T,然后自由延伸段162、164穿过在连接空间之外的套索144。
在图16A所示的工序中,第一细丝142的延伸段154和156也穿过套索144,然后被拉动,然后将套索144围绕所有四个延伸段154、156、162和164拉扁,并将套索144朝着细丝接合柱152退缩。一个或多个滑结系在茎尾的延伸段对154、156上,以调节套索144接近锚钉150的程度,然后在自由延伸段162、164上系缚简单结,以调节组织T上的最终张力,但是在本发明的范围内可采用上述方式的其他组合与排列。通常,滑结通过一个或多个半结结束,以“系紧”或完成固定。
图17所示的圈套组件170中,单根细丝172既用来将套索174固定到锚钉180,又用来拉紧组织T。当锚钉180固定在骨骼B中时,茎延伸段176、178穿进锚钉12并且可滑动地绕过细丝接合柱182,作为尾延伸段184、186从锚钉180中伸出,所述尾延伸段184、186一开始与套索174一起保持在连接空间之外。在一些结构中,锚钉柱182是金属圈或滑轮销。自由尾延伸段184、186在相同或不同的位置或部位穿过组织T,然后穿过套索174。将轻的拉力加到尾延伸段184、186之一或优选地加到二者上,套索174被拉扁并被拉入连接空间中。在尾延伸段184、186之间系上简单止挡结,并在将延伸段184、186拉紧的同时压向套索174,以对组织T施加所需量的张力。通过在套索174处对着止挡结设置一个或多个半结,完成固定。
图18的圈套组件190与图15的圈套组件120功能相似,不同之处在于不用单向闸或夹持机构实现类似棘轮的套索缩进。图18的细丝192具有套索194,止挡结196位于其终端,以防止拉动穿过并抵抗磨散。滑结198使得当柱延伸段206被拉动时使具有套环延伸段202和204的套环200朝着锚钉205缩短。套环200绕过锚鞍或柱207。参照图21-27更详细地描述所述和其它可调套环、滑结的构造。
图19的圈套组件310包括具有套索304和套环306的第一细丝302,其长度固定,细丝302的总长度以套索304被完全拉扁为准。第二细丝316具有终端318、保持在锚钉312远端的滑结322、柱延伸段320和通过延伸段326、328形成的可调套环324。以下参照图28更详细地描述该构造。
虽然本文已经关于固定穿过组织T中的单个位置或部位的一个或多个细丝延伸段描述了多个实施例,但是这并不限制本发明。图20的圈套组件210具有第一细丝211,第一细丝具有套索212,第二和第三细丝222和224的自由延伸段214、216和218、220分别穿过所述套索。套索212通过茎213与锚钉215接合。细丝222和224分别穿过组织部位R1和R2。因此利用根据本发明的单个圈套组件可将组织的多个部位和可能的多种类型的缝线或其它细丝加以固定。
图18的圈套组件190的细丝192的一种布置,示于表示圈套组件190a的图21中。仅通过在细丝192a的区域230中形成开口232并将细丝192a穿过开口形成套索194a。套环200a和滑结198a随后形成在柱延伸段206a上。在该布置中,例如通过拉动柱延伸段206a施加到茎234上的任何张力不仅拉扁套索194a以勒住穿过套索194a的物体,而且也绑住穿过开口232的细丝192a的一部分。在其它布置中,半结或其它简单结系缚在细丝区域230中,并且细丝192a随后成圈地穿过所述简单结。诸如简单半结的止挡结196a将防止终端被磨损或散开,尤其当诸如OrthocordTM缝线的编织细丝用作细丝192a时。
利用缝线作为细丝192的用于制造图18的圈套组件190的步骤的示例如下。系上止挡结196并剪除终端的末尾。使缝线成环并在非常靠近止挡结196的位置将缝线从该环中穿过,以实现图21所示的套索布置,或者在非常靠近止挡结的位置系第二半结,并将缝线穿过所述半结以形成图18的套索194。细的心轴或其它物体例如销可设置成穿过套索194,以保持其开放。滑结198(如帆脚索半结式结)系缚在非常靠近套索194的位置,并且缝线布置为与锚钉205的特征207滑动接合。滑结198随后按需要整理或最终确定。
传统上,肩袖侧列固定涉及从内侧锚钉拉缝线桥。通过在所述侧列处用带结或无结锚钉固定缝线。锚钉被拉出时,未穿线的锚钉比穿线的锚钉更难以拉出,并且不论锚钉类型如何,在许多传统手术中在相对低的负载下会发生缝线滑动。
用于利用图18的圈套组件进行肩袖双列修复的当前优选的技术示于图22-27中。图22的内侧列锚钉240示出为已经埋入骨骼B中,肩袖组织T通过缝线242固定在所述内侧列中。优选地,利用穿线锚钉作为锚钉240,并可以是与锚钉205相同类型的锚钉。自由缝线延伸段244和246被拉出连接空间之外,图22中示出为延伸到皮肤S外。图23的穿线锚钉205随后布置在独立于所述内侧列固定的孔H中作为内侧列锚钉。在这个阶段,可拉扁套环200足够长以使得滑结198和套索环194能够延伸到连接空间之外。
来自内侧列的缝线延伸段244、246随后优选利用上述的穿线器装置之一穿过图24的套索194。缝线延伸段244、246上的任何拉力会拉扁它们周围的套索194。穿线管的尺寸被选择为可限制套索194从滑结198中移出。参照图25,随后沿着通过箭头250指示的近侧方向拉紧柱延伸段206,以将滑结198缩进到锚钉205内或锚钉205附近的位置,并对缝线桥258设置初始张力。
随后在缝线延伸段244、246之间系缚如半结这样的简单结,并对着套索194作为滑结206下推,见图26,同时延伸段244和246被拉动以进一步根据需要拉紧缝线桥258。参照图27,在缝线桥258已经被合适地张紧之后,随着添加第二或更多半结262,以永久性地锁定该修复,并且缝线延伸段244和246的端部被剪除。根据以上参照图20的描述,因为单个套索可应付多对缝线,所以可根据需要从多个内侧锚钉固定额外的缝线桥。
图28的可调节缝线圈套组件310具有缝线锚钉312和第一材料302的封闭的固定长度的套环306,其一端系有套索304。半结“扭曲”状结305示于该结构中。套环306被第二细丝316捕获即被连接到第二细丝316,第二细丝具有终端318、柱延伸段320、滑动帆脚索半结式结322以及具有套环延伸段326和328的可调套环324。第二细丝316可被认为是锚钉12的可调节细丝接合特征的一部分,因为细丝316将套索304连接到锚钉12。在一个结构中,缝线锚钉312类似于Cauldwell等人在美国专利申请公布No.2008/0147063中公开的插管缝线锚钉,该申请以引用方式并入本文。但是,在利用根据本发明的该滑结构造的锚钉系统中,不一定需要柱状缝线接合构件或其它堵塞件,一个或多个缝线或缝线延伸段穿过所述柱状缝线接合构件或其它堵塞件以用作对朝近端运动的限制;在许多结构中,狭窄开口346足以防止结322的抽回。
缝线锚钉312具有近端330和远端332,相对的远端臂334和336在它们之间限定切口338。通道340是从近端330延伸至远端切口338的内腔。虽然结322在图28中为了举例说明被示为延伸到切口338之外,但是在圈套组件310插入到患者体内的过程中,结322优选相对于臂334和336之间的狭窄开口346密封,或者以其它方式通过洞或其它特征保持在远端332,以最小化结322对骨骼接合特征342或锚钉312的其它外表面以及固定有缝线锚钉312的骨骼的干扰。
诸如图28所示的螺纹的一个或多个骨骼接合特征342,或诸如齿、脊或其它突起的其它特征形成在锚钉312的外部,以增强在骨骼中的固定。螺纹是理想的特征,例如得自DePuy Mitek Inc.的HealixTM锚钉上的螺纹。在其它结构中,缝线锚钉旋转以通过其近端拧入骨骼,从而最小化抽出的力。在许多结构中,在锚钉插入前在骨骼中形成孔;在其他结构中,缝线锚钉被直接插入骨骼。此外,可在缝线锚钉的外部形成一个或多个通道或其它沟道,诸如在图28中以虚线示出的穿过骨骼接合特征342的沟道344。
终端318是被保持为足以靠在至少一个骨骼接合特征342外部的长度以在插入过程中被与骨骼相抵地被截获,还是剪除至较短长度是外科医生的喜好问题。此外,当锚钉312固定在骨骼中时,如受限开口这样的限制可通过与骨骼的接合至少部分地确定,从而当拉力施加到柱延伸段320上时防止结322与柱延伸段320一起移动。
可提供一个或多个这种远端延伸部分或其它突出部分,在一些结构上与上面提到的Cauldwell等人的相似,或与Lizardi的美国专利No.7,381,213相似,所述专利以引用方式并入本文。在另一结构中,在锚钉的远端提供筒形或其它圆周形腔、杯或埋头孔特征,以在插入和固定过程中安置结322。
在一些结构中,将可滑动结322描述为帆脚索半结式结,但是在阅览本发明之后,其它合适的结对于缝线系缚领域的普通技术人员将是容易理解的。如本文所用,术语“可滑动”旨在涵盖可滑可锁结和可滑动结,诸如在可从DePuy Mitek获得的关节镜式结系缚方法手册(2005)中描述的那些,以及Wenstrom,Jr.在美国专利No.6,767,037中的所述可滑可锁结。
因此,尽管已经示出、描述和指出了应用于其优选实施例的本发明的基本新颖特征,应该理解,在不脱离本发明的精神和范围的情况下,本领域技术人员可对所示装置及其操作进行形式和细节上的各种省略、替换和改变。例如,明确预期的是以基本上相同的方式执行基本上相同的功能以实现相同结果的那些元件和/或步骤的所有组合均在本发明的范围内。元件从一个描述的实施例替换到另一实施例也是完全可以预期和想到的。还应当理解,附图未必按比例绘制,它们本质上仅仅是概念上的。因此,只意图如所附权利要求书中的范围所指出的那样进行限制。
本文引用的每一公布的专利、待审的专利申请、专利公开、期刊文章、书籍或任何其他参考文献均全文以引用方式并入。
Claims (31)
1.一种外科手术细丝圈套组件,所述外科手术细丝圈套组件包括:
锚钉,所述锚钉能够被固定在骨骼中并具有细丝接合特征;以及
第一细丝,所述第一细丝在至少第一延伸段的第一部分上有套索,并具有连接到锚钉的细丝接合特征的第二部分,所述套索能够接纳自由细丝延伸段的至少一端,并当拉力被加到所述自由细丝延伸段和所述套索中至少一者上时,所述套索勒住所述至少一端。
2.根据权利要求1所述的组件,其中所述套索可朝着所述锚钉缩进。
3.根据权利要求1所述的组件,其中所述套索由至少一个半结形成。
4.根据权利要求1所述的组件,其中所述套索包括绞索结。
5.根据权利要求1所述的组件,还包括至少一个管,所述管能够可拆卸地插入到所述套索中,以提供用于所述至少一个自由细丝延伸段的端部的通道。
6.根据权利要求5所述的组件,其中各个管被开槽,以便于将所述自由细丝延伸段从所述管取出。
7.根据权利要求3所述的组件,还包括至少两个管,所述管能够可拆卸地插入到所述半结的不同套环中,以提供用于自由细丝延伸段的两端的通道。
8.根据权利要求7所述的组件,其中所述管连接在一起,并具有用于操作所述管的至少一个手柄。
9.根据权利要求8所述的组件,其中各个管被开槽,以便于将所述自由细丝延伸段从所述管取出。
10.一种外科手术细丝圈套组件,所述外科手术细丝圈套组件包括:
锚钉,所述锚钉能够被固定在骨骼中并具有细丝接合特征;
第一细丝,所述第一细丝在至少第一延伸段的第一部分上有套索,并且具有连接到锚钉的细丝接合特征的第二部分;以及
至少一个第一自由细丝延伸段,所述第一自由细丝延伸段能够穿过要修复的组织,并有至少一端能穿过所述套索,以使得在锚钉被固定在骨骼中之后能够逐步拉紧组织,当拉力被加到所述自由细丝延伸段和所述套索中至少一者上时,所述套索勒住所述自由细丝延伸段。
11.根据权利要求10所述的组件,其中所述第一自由细丝延伸段是一段第二细丝。
12.根据权利要求11所述的组件,其中所述第二细丝包括第二自由细丝延伸段,所述第二自由细丝延伸段也能够穿过所述套索,使得组织在所述第一自由细丝延伸段和第二自由细丝延伸段之间被获取。
13.根据权利要求10所述的组件,其中所述第一自由细丝延伸段是一段第一细丝。
14.根据权利要求13所述的组件,其中所述第一细丝包括第二自由细丝延伸段,所述第二自由细丝延伸段也能够穿过所述套索,使得组织在所述第一自由细丝延伸段和第二自由细丝延伸段之间被获取。
15.根据权利要求10所述的组件,其中所述套索由至少一个半结形成。
16.根据权利要求10所述的组件,其中所述套索可朝着所述锚钉缩进。
17.一种外科缝线圈套组件,所述外科缝线圈套组件包括:
锚钉,所述锚钉能够被固定在骨骼中并具有至少一个通道和缝线接合特征;
第一缝线,所述第一缝线在至少第一延伸段的第一部分上有套索,并且具有穿过所述通道并连接到锚钉的缝线接合特征的第二部分;以及
第二缝线,所述第二缝线具有至少一个第一自由缝线延伸段,所述第一自由缝线延伸段能够穿过要修复的组织,并有至少一端能穿过所述套索,以使得在锚钉被固定在骨骼中之后能够逐步拉紧组织,当拉力被加到自由缝线延伸段和套索中至少一者上时,所述套索勒住所述缝线细丝延伸段。
18.一种外科缝线圈套组件,所述外科缝线圈套组件包括:
锚钉,所述锚钉能够被固定在骨骼中并具有至少一个通道和缝线接合特征;
第一缝线,所述第一缝线在至少第一延伸段的第一部分上有套索,并且具有穿过所述通道并连接到锚钉的缝线接合特征的第二部分;以及
所述第一缝线具有至少一个第一自由缝线延伸段,所述第一自由缝线延伸段能够穿过要修复的组织,并有至少一端能穿过所述套索,以使得在锚钉被固定在骨骼中之后能够逐步拉紧组织,当拉力被加到自由缝线延伸段和套索中至少一者上时,所述套索勒住所述自由缝线延伸段。
19.一种通过外科手术修复组织的方法,所述方法包括:
选择锚钉,所述锚钉能够被固定在骨骼中并具有细丝接合特征;
选择第一细丝,所述第一细丝在至少第一延伸段的第一部分上有套索,并且具有连接到锚钉的细丝接合特征的第二部分;
将所述锚钉固定到骨骼中;
选择至少第一自由细丝延伸段并将其穿过要修复的组织;
将所述自由细丝的至少一个端部穿过所述套索;以及
在锚钉被固定到骨骼中之后,根据需要拉紧所述组织,当张力被施加到所述自由细丝延伸段和所述套索中至少一者上时,所述套索勒住所述自由细丝延伸段。
20.根据权利要求19所述的方法,其中所述自由细丝延伸段选自一段第二细丝。
21.根据权利要求20所述的方法,其中所述第二细丝包括第二自由细丝延伸段,所述第二自由细丝延伸段也穿过所述套索,使得组织在所述第一自由细丝延伸段和第二自由细丝延伸段之间被获取。
22.根据权利要求19所述的方法,其中所述自由细丝延伸段选自一段第一细丝。
23.根据权利要求22所述的方法,其中所述第一细丝包括第二自由细丝延伸段,所述第二自由细丝延伸段也穿过所述套索,使得组织在所述第一自由细丝延伸段和第二自由细丝延伸段之间被获取。
24.根据权利要求19所述的方法,其中拉紧所述组织的步骤包括将所述套索朝所述锚钉缩进。
25.根据权利要求19所述的方法,还包括在自由细丝延伸段穿过所述套索之后将止挡件置于所述自由细丝延伸段的步骤,以阻止所述自由细丝延伸段从所述套索中抽出。
26.根据权利要求25所述的方法,其中系结并将其朝所述套索滑动,以用作所述止挡件。
27.根据权利要求19所述的方法,其中将所述自由细丝延伸段的所述至少一端穿过的步骤包括将至少一个管可拆卸地插入到所述套索中,将所述自由细丝延伸段的至少一端穿过所述管,然后将所述管从所述套索中取出。
28.根据权利要求19所述的方法,其中所述套索由具有至少三个开口的至少一个半结形成。
29.根据权利要求28所述的方法,其中至少两个自由细丝端穿过所述半结中的不同开口。
30.根据权利要求29所述的方法,还包括:将至少两个管可拆卸地插入到所述半结的不同开口中以为自由细丝延伸段的至少两端提供通道;将所述自由细丝延伸段之一的至少一端穿过所述管之一并将所述自由细丝延伸段的另一个的至少一端穿过另一个管;以及随后将所述管从所述套索中取出。
31.根据权利要求30所述的方法,其中所述管合并在一起,并且各个管被开槽,以便于将所述自由细丝延伸段从所述管取出。
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CN109044516A (zh) * | 2018-09-10 | 2018-12-21 | 西南医科大学附属中医医院 | 一种无绑接可调节带袢钢板组件 |
CN109044516B (zh) * | 2018-09-10 | 2020-08-07 | 西南医科大学附属中医医院 | 一种无绑接可调节带袢钢板组件 |
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BRPI1105520B1 (pt) | 2020-06-09 |
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EP2455004A2 (en) | 2012-05-23 |
US20140343607A1 (en) | 2014-11-20 |
BRPI1105520A2 (pt) | 2013-03-19 |
CN102551824B (zh) | 2016-09-21 |
JP6026099B2 (ja) | 2016-11-16 |
US20170000479A1 (en) | 2017-01-05 |
EP3228256A3 (en) | 2018-01-24 |
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