CN1010657B - 韧带的手术替换的改进 - Google Patents

韧带的手术替换的改进

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CN1010657B
CN1010657B CN86107059A CN86107059A CN1010657B CN 1010657 B CN1010657 B CN 1010657B CN 86107059 A CN86107059 A CN 86107059A CN 86107059 A CN86107059 A CN 86107059A CN 1010657 B CN1010657 B CN 1010657B
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replacing
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pipeline
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巴哈·博特罗斯·西德霍姆
基奥苏基·富吉卡瓦
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4601—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/28—Bones
    • A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
    • A61F2002/2839—Bone plugs or bone graft dowels

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  • Health & Medical Sciences (AREA)
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Abstract

一种用于在至少两块骨5、6之间移植的替换韧带1，韧带形状为由柔韧物质编织而成的管状体，移植后组织可经其向内生长，系在韧带1一端的带3a穿过骨内的管道，并拉动韧带通过该管道，当韧带被拉过管道后，保护性的、系在韧带上以便于韧带移植的可分离的鞘膜2马上脱离韧带。使用骨栓导引器(8到12)把骨栓嵌入骨管道内的韧带的一端，由此固定韧带末端，使其处于适当位置。

Description

本发明涉及一种在至少两块骨之间移入的替换韧带。
欧洲专利EP-A-0126520中揭示了一种可在至少两块骨之间移入的替换韧带，包括一由多孔材料制成的柔韧拉长体和该拉长体的牵引装置被系在拉长体一端以将韧带穿过骨内管道并拉动韧带通过该管道。
欧洲专利EP-A-0051954中揭示了一种沿韧带体的整个长度延伸的，用柔韧材料制造的、可分开的鞘膜，所述的鞘膜包附在韧带上，并与韧带一起运动，通过骨内的管道，然后与韧带分开，使鞘膜在韧带移入后可马上被除去。
然而EP-0051954中所揭示的替换韧带没有提供牵引装置以使韧带穿过骨内管道并被拉动通过该管道，另外，鞘膜包附在韧带周围只能通过纵向切割的方法将其去除，在韧带和鞘膜植入骨内的管道后通过该方法要将鞘膜彻底去除是一项困难的工作。
本发明的目的在于提供一种可方便植入的替换韧带和一在植入过程中保护韧带的鞘膜，以及使鞘膜植入和在植入过程结束后容易地被去除的装置。
本发明提供一种替换的韧带，该韧带包括一适合在至少二块骨之间植入的柔韧拉长体，系在拉长体一端上的用于将韧带穿过在骨骼中形成的管道并拉动韧带通过该管道的牵引装置，还包括一用柔韧材料制作的鞘膜，该鞘膜沿韧带体的整个长度方向延伸，且其一端包附在牵引装置上与韧带一起运动通过骨内管道，所述的鞘膜通过在韧带上的滑移运动从韧带上移去，即在韧带和鞘膜植入后牵引装置与鞘膜的 一端分离，并拉动鞘膜的另一端使其移去。
这样，本发明的替换韧带可通过牵引装置方便地穿过骨内的通道，且在韧带植入的过程中，鞘膜保护韧带免予与管道内壁的接触，以防止韧带（纺织材料制成）由于骨内管道粗糙的内表面引起的障碍而损坏，以及韧带的变形和阻塞管内韧带的通道。另外，鞘膜还为其端部和牵引装置的分离连接带来优点，在韧带植入后可方便地从韧带上的保持位置将其移去，即通过在鞘膜的端部施加一拉力使其与牵引装置离开。
特别地，牵引装置包括一通过打结而系在所述鞘膜一端的带子。
另外，鞘膜的一端在带子与韧带体的结点之外延伸，并且，在鞘膜内带子再打了一个结，鞘膜就可通过割断鞘膜的一端和在第一与第二个带结之间的带子而相对韧带体滑动。
提供一可方便操作的夹持部分，使鞘膜移去，特别是鞘膜的另一端延伸至从牵引装置上分离开来的韧带体一端之外。
鞘膜可以呈管状，或由多数个可分离材料组成。
下面结合附图，对本发明替换韧带的一个实施例进行详细描述：
图1所示的是韧带的一实施方案的闭合末端，该韧带带有固定的鞘膜;
图2所示的是韧带的开口端，该韧带的四周被鞘膜环绕着;
如图3所示，带有鞘膜的韧带被穿过胫骨和股骨内的管道;
如图4所示，鞘膜和带子被切断;
如图5所示，韧带被拉紧，同时鞘膜被拨离韧带;
如图6所示，骨栓被安置在韧带的凹陷内;
如图7所示，韧带被拉，以便固定股骨的骨栓，使其处于股骨内的适当位置;
如图8所示，被移植的韧带与鞘膜完全脱离;
参见图1，本发明的韧带1采用把开口的编织聚脂纤维制成管状的长带形式，该韧带1的一个可能结构的例子详细地记载在已公开的欧洲专利第0153831A号上，该结构的一端形成穿孔管的开口，在其相反端上有一凹陷。
韧带1设有由聚乙烯片制作的呈管状的鞘膜2，鞘膜2沿韧带1的整个长度方向将韧带的四周全部围住，并借助于系在韧带的闭合端上的带子3a里的带结3使其固定在韧带的闭合端。带结3是被绕着鞘膜2的外部打的，以便固定鞘膜2，使其处于适当位置，并防止鞘膜2相对于韧带1滑动。带3a还在鞘膜的内部打了一个结4。
参见图2，鞘膜的相反的末端是开口的，并在韧带的开口端之外延伸一小段距离。
参见图3，在从股骨5和胫骨6中取出骨栓并在关节窝的每个底部钻孔直通各自骨的相对一侧的外科手术进行以后，将带有鞘膜的韧带穿过所钻的孔，拉动带3a，首先使韧带穿过胫骨，然后穿过股骨。鞘膜2适宜于在韧带被拉着通过骨中的管道时保护韧带1，还使韧带能容易地穿过骨骼而不受韧带材料的影响。
参见图4，一俟韧带穿过骨孔，位于带结4上部的鞘膜2和带3a就被切断，从而使鞘膜能相对于韧带自由滑动。
现在参见图5，韧带通过夹住带3a而被拉紧，同时，在韧带的开口端处继续拉鞘膜2。
参见图6，鞘膜被部分拔离韧带，暴露凹陷，股骨的骨栓被安置在韧带的闭合端凹陷内。
参见图7，然后，将韧带拉至开口端处，从而导至凹陷里的骨栓被拉进股骨关节窝的凹陷内。
如图8所示，韧带原有的鞘膜完全被拨离韧带，同时，股骨的骨栓复位。

Claims (6)

1、一种替换韧带，包括适用于在至少两块骨5、6之间植入的柔韧的拉长体1，该拉长体的牵引装置3a被系在拉长体1一端以将韧带穿过骨内管道并拉动韧带通过该管道；其特征在于还包括一沿韧带体的整个长度延伸的，用柔韧材料制造的鞘膜2，所述的鞘膜2一端包附在牵引装置3a上，并与韧带1一起运动，通过骨内的管道，所述鞘膜2在韧带和鞘膜植入后通过在韧带1上的滑移运动使牵引装置3a与鞘膜2的一端分离，拉动鞘膜另一端从韧带上移去。
2、根据权利要求1所述的替换韧带，其特征在于所述的牵引装置包括一根带子3a。
3、根据权利要求2所述的替换韧带，其特征在于在所述的带子3a通过一带结3系在所述鞘膜2的一端。
4、如权利要求3所述的替换韧带，其特征在于所述鞘膜2的一端在带子3a与韧带体1的结点之外延伸，且在鞘膜内带子再打了一个结4，鞘膜通过割断其一端和在第一个带结3与第二个带结4之间的带子而相对韧带体滑动。
5、根据权利要求1至4中任一项所述的替换韧带，其特征在于所述的鞘膜2的另一端在远离牵引装置3a的韧带1的末端处延长。
6、根据权利要求1至4中任一项所述的替换韧带，其特征在于所述的鞘膜2是呈管状的，或者由许多单块的材料组成。
CN86107059A 1985-10-17 1986-10-19 韧带的手术替换的改进 Expired CN1010657B (zh)

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GB8525565 1985-10-17
GB858525565A GB8525565D0 (en) 1985-10-17 1985-10-17 Surgical replacement of ligaments

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CN1010657B true CN1010657B (zh) 1990-12-05

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EP (1) EP0223370B1 (zh)
JP (1) JPH08118B2 (zh)
CN (1) CN1010657B (zh)
AT (1) ATE63050T1 (zh)
AU (1) AU597275B2 (zh)
DE (1) DE3679034D1 (zh)
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GB8525565D0 (en) 1985-11-20
EP0223370B1 (en) 1991-05-02
JPS62161359A (ja) 1987-07-17
DE3679034D1 (en) 1991-06-06
EP0223370A2 (en) 1987-05-27
GB2181653B (en) 1990-01-10
GB2181653A (en) 1987-04-29
CN86107059A (zh) 1987-09-16
AU597275B2 (en) 1990-05-31
US4775380A (en) 1988-10-04
GB8623345D0 (en) 1986-11-05
AU6351386A (en) 1987-04-30
ES2021591B3 (es) 1991-11-16
JPH08118B2 (ja) 1996-01-10
ATE63050T1 (de) 1991-05-15

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