Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
  • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
  • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
  • A61B17/7037—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other wherein pivoting is blocked when the rod is clamped
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
  • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
  • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
  • A61B17/7034—Screws or hooks with U-shaped head or back through which longitudinal rods pass characterised by a lateral opening
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
  • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
  • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
  • A61B17/7038—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other to a different extent in different directions, e.g. within one plane only
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/86—Pins or screws or threaded wires; nuts therefor
  • A61B17/8605—Heads, i.e. proximal ends projecting from bone

Definitions

• the invention relates to a vertebral anchoring device comprising a bone anchoring screw having a screw body and a screw head movably mounted on the screw body.
• the bone anchoring device according to the invention is intended in particular, but not exclusively, to the treatment of deviations of vertebral columns such as scoliosis.
• Scoliosis is a deviation of the spine in which the vertebrae define a curvature conventionally shaped "S". It is the consequence of a rotation of vertebrae. More specifically, the spine has an inclination in the frontal plane, the vertebrae affected by the deviation may also have a rotation in the horizontal plane.
• the latter is performed using bone anchoring screws in the vertebrae concerned and connecting rods mounted on the bone anchoring screws. These are implanted substantially perpendicular to the vertebra on which they are attached while the connecting rod is to be placed substantially parallel to the spine. A tightening nut is then placed on each head, immobilizing the connecting rod while allowing a rotational movement and translation of the latter on the head so as to allow reduction manipulations before the final tightening of the nut and thus the complete immobilization of the connecting rod on the head.
• the rectification (derotation) vertebrae is performed either directly during the final tightening of the nut when the anchor screws implemented are fixed head screws or single-planar screws, or before the final tightening when the anchoring screws used are multiaxial screws.
• the straightening is carried out by progressively carrying out tractions or compressions on each of the bone anchoring screws implanted on the vertebrae to be straightened with the help of adapted instruments or with a rotation of the stems of the bone. link.
• Multiaxial head anchoring screws make it possible to overcome the drawbacks of anchor screws with fixed heads, the multiaxial heads being able to be oriented in all directions of space to receive the connecting rods.
• the anchoring screws with multiaxial head have the disadvantage of not allowing to directly straighten the vertebrae, the latter remaining in place during the final tightening of the nut. It is therefore necessary, once the bone anchoring elements, the connecting rod and the clamping nuts in place, to reduce the vertebrae by derotation techniques vertebrae and bending the connecting rod.
• the operation of straightening vertebrae with multiaxial screws is therefore a separate operation as opposed to achieved with fixed head screws which is performed together with the tightening operation of the nuts.
• the mono-planar anchoring screws materialize for their part by a movement in a single plane.
• Such screws allow, as the fixed head screws, a recovery of the vertebrae during the tightening operation of the nuts, they offer however a limited movement between the head and the body of screws (movement in a single plane) of so that when the vertebral length to be corrected is important and it is necessary to use several anchor screws, the movement in the plane is generally insufficient to allow establishment of the connecting rods. It is then necessary, as for the fixed head screws, to adapt the curvatures of the connecting rods.
• the invention aims to remedy these problems by providing a bone anchoring device and an associated spinal recovery system combining the features of the fixed head screws / mono-planar and multiaxial head screws.
• the object of the invention is to propose a bone anchoring device allowing easy placement of the connecting rods on the bone anchoring device as well as rectification in a frontal plane of the vertebra in which the device is implanted while allowing angulation in the sagittal plane.
• the invention also aims to provide a small footprint anchor device.
• the invention relates to a vertebral anchoring device comprising a bone anchoring screw comprising a screw body and a screw head for coupling a connecting element to the device.
• screw body the screw head being mounted movably on the screw body, the screw body comprising a threaded rod of longitudinal axis AA for anchoring in a vertebra provided at one of its ends with a coupling head with the screw head, the screw head comprising a head body longitudinal axis BB traversed longitudinally by a channel, said channel being adapted to receive the lower part of the coupling head.
• the device is remarkable in that it comprises means for assembling the coupling head with the screw head arranged to allow, after assembly of the screw body and the screw head but before immobilization of the connecting element on the screw head a translation movement of the screw body relative to the screw head parallel to the longitudinal axis BB of the screw body and any rotational movement of the screw body relative to the screw head excluding a rotational movement about the longitudinal axis BB of the screw body, the coupling head having a cylindrical portion of axis perpendicular to the threaded rod.
• the coupling head is traversed longitudinally by a key of circular section, the ends of the key being received respectively in an associated oblong hole formed in the screw head, each of the oblong holes extending in a parallel direction. to the longitudinal axis BB of the head body, the key and the oblong holes forming said connecting means.
• At least one of the holes is through.
• the key is secured to the coupling head.
• the coupling head and the key are formed in one piece.
• the cylindrical portion of the coupling head is connected to the threaded rod by a portion of spherical shape.
• the device comprises a part forming a cradle having a lower surface comprising a bore of complementary shape with the head of coupling and an upper surface of concave shape adapted to receive the connecting element and extending in a direction perpendicular to that of the bore of the lower surface.
• the screw head has longitudinal internal grooves dimensioned to allow axial displacement of the part forming a cradle.
• the screw head has two longitudinal internal grooves arranged to allow an axial displacement of the cradle piece between a position allowing the movement of the screw head relative to the screw body and a locking position of the screw head on the screw body.
• the device comprises means for locking the cradle in the channel in a predetermined longitudinal position.
• the cylindrical portion of the coupling head is extended on either side by a rounded end portion, each end portion being adapted to be received in each case. longitudinal internal groove formed in the screw head, said internal groove being of complementary shape with the associated end portion.
• the cradle advantageously constitutes the assembly means.
• the invention also relates to a spinal recovery system comprising bone anchoring devices intended to be implanted in a vertebra and arranged to receive a connecting rod, at least one of the bone anchoring devices being a device. as described above, at least one connecting rod and clamping nuts adapted to fix and immobilize the connecting rod on each of the anchoring devices.
• FIG. 1 shows a schematic perspective view of the vertebral anchoring device according to a first embodiment of the invention
• FIG. 2 represents an exploded view of the vertebral anchoring device of FIG. 1;
• FIG. 3 shows a sectional view in the frontal plane of the anchoring device of Figure 1 before recovery of the vertebra;
• FIG. 4 shows the anchoring device of Figure 3 after recovery of the vertebra and immobilization of the connecting element by tightening the nut;
• FIG. 5 shows a sectional view in the sagittal plane of the anchoring device of Figure 4;
• FIG. 6 represents an exploded view of a vertebral anchoring device according to a second embodiment of the invention
• - Figure 7 shows a longitudinal sectional view of the anchoring device of Figure 6;
• FIG. 8 and 9 show a sectional view in the plane respectively front and sagittal of an anchoring device according to a third embodiment of the invention, before recovery of the vertebra;
• FIG. 10 and 11 show the anchoring device respectively of Figures 8 and 9 after rectification of the vertebra and immobilization of the connecting element by tightening a nut;
• FIG. 12 represents a view of the screw head of the anchoring device of FIG. 9;
• FIG. 13 represents a side perspective view of the screw head of FIG. 12;
• FIG. 14 represents a sectional view of the screw head of FIG. 12 along the axis XIV-XIV.
• FIG. 1 In connection with Figures 1 to 5, there is described a vertebral anchoring device 1 intended to be connected to other anchoring devices by connecting elements, the connecting rods type 7, said devices vertebral anchorage being respectively fixed on a vertebra of the spinal part concerned by the deformation. The whole thus forms a system of spinal recovery.
• the anchoring device comprises a bone anchoring screw 2 having a screw body 3 provided at one of its ends with a screw head 4 for the coupling of the connecting rod 7 to the screw body 3.
• the screw body 3 comprises a threaded rod 9 of longitudinal axis AA intended to be implanted in the vertebra to straighten.
• Said threaded rod 9 is provided at one of its ends 10 with a head 11 configured to allow the coupling of the threaded rod 9 with the screw head 4.
• the coupling head 11 has a cylindrical outer profile portion 112 of axis CC perpendicular to the axis AA of the threaded rod 9.
• the coupling head 11 comprises an axial bore 12 extending from one end to the other of the head and traversed by a key 5 of cylindrical shape complementary to that of the bore 12.
• the key 5 is advantageously arranged coaxially with the cylindrical portion 112 of the coupling head 11.
• the key 5 which has a length greater than the length of the coupling head 11, is disposed in the bore 12 so as to have ends 50, 51 extending beyond the ends 110, 111 of the coupling head 11 to to reach re spectively oblong holes 13, 15 formed in the screw head.
• the key 5 thus configured provides the connection between the coupling head 11 and the screw head 4.
• the cylindrical portion 112 of the coupling head 11 is connected to the threaded rod 9 by a spherical outer profile portion 113.
• the advantage of providing such a spherical portion 113 is to improve the character multiaxial screw head 4.
• the screw head 4 has, in known manner, a head body 14 of longitudinal axis BB, tulip-shaped.
• the head body 14 is traversed longitudinally by a channel 16 extending between the lower and upper ends 140, 141 of the head body 14.
• the terms “lower” and “upper” are defined with respect to the position of the bone anchoring device 1 in the figures.
• the channel 16 comprises in the upper part a tapping for receiving a clamping nut 8 and in the lower part a receiving cavity 17 of the coupling head 11. As will be understood later, the receiving cavity 17 forms a clearance chamber for the coupling head 11.
• the head body 14 further comprises two lateral arms 18, 20 arranged to define a U-shaped transverse channel for receiving the connecting rod 7.
• each lateral arm 18, 20 is provided with a notch 180, 200 for the attachment of a specific instrument, such as for example a guide tube used in the context of minimally invasive procedures.
• each of the lateral arms 18, 20 has a longitudinal extension 19, 21.
• Each arm 18, 20 is connected to one of the extensions 19, 21 by a rupture zone 22, 24 allowing the withdrawal. extension after the intervention is completed.
• These rupture zones 22, 24 are constituted by notches whose depth and geometry are determined to allow a clean break when exerting, on one of the extensions, a lateral force exceeding a threshold value with a specific instrument.
• the portion of the channel 16 delimited by these arms is advantageously threaded.
• each extension 19, 21 advantageously comprises a notch 190, 210 for the attachment of a specific instrument, such as a guide tube used in the context of minimally invasive procedures.
• Such a screw head 4 is intended in particular for the treatment of large reductions. It is of course obvious that the anchoring screw 1 according to the invention is not limited to such an application, and that the screw head 4 may have a conventional shape (ie not having an extension).
• the arms 18, 20 of the screw head 4 are connected by a base 23 having two holes 13, 15 oblong formed in the alignment of said arms and extending in a direction parallel to the longitudinal axis BB of the body 14.
• the holes 13, 15 are sized to receive respectively the ends 50, 51 of the key 5.
• the key 5 and the oblong holes 13, 15 are arranged to allow, before the immobilization of the connecting rod 7 on the screw body 3 under the action of the clamping nut 8, a single translational movement of the screw head relative to the screw body 3 parallel to the longitudinal axis BB of the channel 16 and any rotational movement excluding a rotational movement about the longitudinal axis BB of the screw body 3.
• the translational movement is limited, the lower surfaces and upper holes 13, 15 constituting abutment surfaces s lower 130, 150 and above 131, 151 on which the coupling head 11 equipped with the key 5 abuts as it moves in the receiving cavity 17.
• the lateral surfaces of the holes 13, 15, for their part, constitute stop surfaces preventing any rotational movement about the axis BB of the head body 14.
• the holes 13, 15 must have a length sufficient to allow a displacement of the screw body 3 about an axis perpendicular to the axes BB and DC before tightening the nut on the connecting rod.
• the translational movement may constitute a simple axial clearance between the screw head 4 and the screw body 3.
• the assembly of the screw body 3 with the screw head 4 is carried out by loading the screw body 3 from the top of the screw head 4.
• the screw body 3 is placed in the screw head 4 so as to position the bore 12 of the coupling head 11 opposite the holes 13, 15 of the head body 14.
• the coupling head 11 of the screw body 3 is advantageously sized to allow a rotational movement of the head body 14 around the body.
• the key 5 is then inserted into the bore 12 by one of the holes 13, 15 and pushed into it until the end opposite the inlet hole comes to be placed in the other hole 15, 13.
• the mounting of the key 5 in the bore 12 of the coupling head 11 is made in force in order to make the two parts integral with each other and thus to limit any risk of removal of the key 5. It is obviously obvious that the two parts can be made integral with each other by the implementation of any other means of attachment (glue, welding, etc.). without departing from the scope of the invention.
• the vertebral anchoring device 1 further comprises a cradle member 6.
• the cradle part 6, hereinafter referred to as a cradle has a lower surface and an upper surface shaped to respectively receive the head of the cradle. coupling 11 of the screw body 3 and a connecting rod 7.
• the cradle 6 has a lower surface 60 comprising a cylindrical bore 62 adapted to cooperate with the coupling head 11 and an upper surface 64 of concave shape adapted to receive the connecting element. 7 and extending in a direction perpendicular to that of the cylindrical shape of the lower surface.
• the terms “upper” and “lower” are defined with respect to the position of the cradle when placed in the screw head 4.
• the cradle 6 is housed in a receiving cavity 26 formed in the head body 14, at the bottom of the U-shaped arms 18, 20.
• the receiving cavity 26 opens in the receiving cavity 17 of the coupling head 11.
• the receiving cavity 26 advantageously comprises two longitudinal internal grooves 40, 41 sized to allow an axial displacement of the cradle 6 between a position allowing the movement of the screw head 4 with respect to the screw body 3 (high position of the cradle) and a locking position of the screw head 4 on the screw body 3 following the immobilization of the connecting rod 7 by the clamping nut (low position of the cradle).
• the grooves are formed respectively in alignment with the oblong holes 13, 15 of the head body 14.
• the outer surface of the coupling head 11 and the lower surface 60 of the cradle 6 comprise ridges or a notch. This thus prevents any movement of the screw head 4 on the screw body 3 after tightening the nut.
• Figures 3 to 5 illustrate the position of the constituent elements of the bone anchoring device 1 relative to each other before and after tightening the nut.
• Figure 3 shows an example of positioning of the device 1 on the vertebra to straighten.
• the screw head 4 and the screw body 3 are inclined with respect to the frontal and sagittal plane.
• the end 50 abuts against the abutment surface 130 of the lower hole 13 while the end 51 abuts against the upper abutment surface 151 of the hole 15.
• the cradle 6 moves in translation along the grooves 40, 41, towards the lower opening of the head body 14. During its displacement, the cradle 6 enters the receiving cavity 17 of the coupling head 11, to come into contact with the upper part of the coupling head 11 and to exert on it a force of support to bring the screw head 4 into a position in which the ends 50, 51 rest on the lower abutment surfaces 130, 150 of the holes 13, 15 ( Figures 4 and 5).
• the coupling head 11, and thus the threaded rod 9 fixed in the vertebra is subjected to a rotational movement such that the screw body 3 is realigned in the frontal plane, while maintaining the inclination of the screw head 4 previously given in the sagittal plane.
• the holes 13, 15 of the screw head 4 for cooperating with the ends of the key 5 are through. It is of course obvious that the invention is not limited to this configuration of the screw head 4 and that a configuration can be provided in which only one of the holes is through to allow insertion of the key 5 in the axial bore of the coupling head 11, the other being blind.
• the key 5 and the coupling head 11 consist of two independent parts. It can be provided according to an advantageous embodiment, that the coupling head 11 and the key 5 are formed in one piece.
• the screw head 4 will be arranged to allow lateral assembly of the screw body 3 and the screw head 4. According to this configuration, one of the holes will lead to the lower end 140 of the head body 4 Similarly, it may be provided that the screw head comprises only a through oblong hole opening on the lower end 140 of the head body 4, the other hole may be a blind oblong hole.
• Figures 6 and 7 illustrate an anchoring device 10, the assembly of the constituent elements (screw head, threaded rod and cradle) is formed by the base of the screw head.
• the anchoring device 10 essentially incorporates all the characteristics of the anchoring device 1 described above. Only the additional or modified features related to the anchoring device 10 and its assembly are described below.
• the cradle 6 have lower extensions 65 delimiting, with the lower surface 60, the cylindrical bore 62. Said extensions 65 respectively have at the end a retaining tab 66 extending outwardly. .
• outwardly extending is meant a tab extending in the opposite direction to the cylindrical bore 62.
• the channel 16 comprises, upstream of the receiving cavity 17 receiving the coupling head 11, two longitudinal grooves 42, 43 symmetrical extending to the lower end 140 of the screw head 4.
• Each groove 42, 43 defines with the receiving cavity 17 of the coupling head 11 a shoulder 44 on which abuts one of the retaining tabs 66 of the cradle 6 when the screw body 3 and the cradle 6 are loaded into the screw head 4 by its lower end.
• the shoulders 44 and the retaining tabs 66 thus form means for locking the cradle 6 in the channel 16 in a given longitudinal position, thus avoiding any inadvertent withdrawal of the cradle during assembly of the screw head 4 on the screw body 3 as may be the case in the embodiment described above.
• This configuration also offers the advantage of ensuring the retention of the screw head 4 on the screw body 3 even before mounting the key 5 in the coupling head 11, thus making the assembly of the screw head 4 with the screw body 3 easier.
• Figures 8 to 14 illustrate an anchoring device 500 according to another embodiment of the invention.
• the assembly of the coupling head with the screw head is carried out by means of either a key mounted through the coupling head and oblong holes of the screw head 4, but by means of a cradle and a particular configuration of the coupling head and the screw head.
• the coupling head (referenced 511) comprises a cylindrical portion 511B extended on either side by a rounded end portion 511A. 511C.
• the cradle 6 implemented in the anchoring device 500 comprises a lower bore having a complementary shape with the cylindrical portion 511B of the coupling head 511.
• the cradle 6 has lower extensions 65 which delimit the lower bore respectively provided with an outer retaining tab 66.
• the upper extensions which delimit the bore for receiving the connecting rod 7 are in turn preferably without tab.
• the screw head includes all the characteristics of the screw head 4 of the previously described embodiments.
• the screw head 504 has two internal grooves 506 of complementary shape to the end portions 511 A, 511C of the coupling head 511. Said grooves extend longitudinally from the upper end of the arms side 18, 20 into the receiving cavity 17 of the coupling head 511 ( Figure 12).
• the grooves 506 have a depth such that the distance separating the bottom of each of them is slightly greater than the length of the coupling head (length between the apex of the two end portions).
• distance “slightly greater” is meant a distance sufficient to give a slight clearance of the coupling head 511 when the latter is housed in the receiving cavity 17.
• the two internal grooves 506 allow the passage of the head of the coupling 511 when loading the screw body 503 from the top of the screw head 504 while blocking the rotational movement of the screw body 503 about the axis BB (movement blocked by the abutting of the end portions 511A, 511C against the side edges 506A, 506B of the grooves 506).
• the grooves 507, 508 thus have an angular spacing of about 90 degrees with the longitudinal grooves 506 (FIG. 14).
• the grooves 507, 508 are sized to receive the lower extensions 65 of the cradle 6 and allow axial displacement of the latter in the receiving cavity 17.
• the grooves 507, 508 are each delimited by an upper shoulder 507A, 508A and a lower shoulder 507B, 508B against which the retaining lugs 66 of the cradle 6 abut.
• the respectively upper shoulder 507A, 508A and lower 507B, 508B delimit a high position and a low position of the cradle 6.
• the rotational movement of the screw body 503 with respect to the screw head, apart from the rotational movement of the screw head 504, is furthermore authorized not only because of the mobility of the cradle 6, but also because of the arrangement end portions 511A, 511C of the coupling head 511 in the internal grooves 506 of the cavity 17 in which the coupling head 511 is housed.
• Figures 8 and 9 show the anchoring device 500 in which the cradle 6 is free to move in translation between the low position and the high position. When tightening the nut on the connecting rod 7 until complete tightening, the cradle 6 is driven to its lower position to be blocked after complete tightening of the nut.
• Figures 10 and 11 show the cradle 6 locked in the low position after final tightening of the clamping nut (clamping nut not shown in this embodiment but illustrated in Figures 1 to 5).

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• Health & Medical Sciences (AREA)
• Orthopedic Medicine & Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
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• Heart & Thoracic Surgery (AREA)
• Engineering & Computer Science (AREA)
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• 2014
  • 2014-10-20 FR FR1460059A patent/FR3027209B1/fr not_active Expired - Fee Related
• 2015
  • 2015-10-20 EP EP15791696.6A patent/EP3209228A1/de not_active Withdrawn
  • 2015-10-20 US US15/520,436 patent/US10610264B2/en not_active Expired - Fee Related
  • 2015-10-20 WO PCT/FR2015/052817 patent/WO2016062963A1/fr active Application Filing

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