JP2009517093A - カニューレ - Google Patents
カニューレ Download PDFInfo
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- JP2009517093A JP2009517093A JP2008532910A JP2008532910A JP2009517093A JP 2009517093 A JP2009517093 A JP 2009517093A JP 2008532910 A JP2008532910 A JP 2008532910A JP 2008532910 A JP2008532910 A JP 2008532910A JP 2009517093 A JP2009517093 A JP 2009517093A
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- cannula
- exemplary embodiment
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- cement
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
- A61L24/04—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials
- A61L24/06—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials obtained by reactions only involving carbon-to-carbon unsaturated bonds
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/34—Trocars; Puncturing needles
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
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- 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
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
- A61B17/8811—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by the introducer tip, i.e. the part inserted into or onto the bone
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- 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
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
- A61B17/8816—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by the conduit, e.g. tube, along which fluid flows into the body or by conduit connections
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- 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
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
- A61B17/8822—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by means facilitating expulsion of fluid from the introducer, e.g. a screw pump plunger, hydraulic force transmissions, application of vibrations or a vacuum
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- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8833—Osteosynthesis tools specially adapted for handling bone cement or fluid fillers; Means for supplying bone cement or fluid fillers to introducing tools, e.g. cartridge handling means
- A61B17/8836—Osteosynthesis tools specially adapted for handling bone cement or fluid fillers; Means for supplying bone cement or fluid fillers to introducing tools, e.g. cartridge handling means for heating, cooling or curing of bone cement or fluid fillers
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- A—HUMAN NECESSITIES
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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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- A61F2/4601—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
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- A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
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- A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
- A61L27/14—Macromolecular materials
- A61L27/26—Mixtures of macromolecular compounds
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F27/00—Mixers with rotary stirring devices in fixed receptacles; Kneaders
- B01F27/80—Mixers with rotary stirring devices in fixed receptacles; Kneaders with stirrers rotating about a substantially vertical axis
- B01F27/95—Mixers with rotary stirring devices in fixed receptacles; Kneaders with stirrers rotating about a substantially vertical axis with stirrers having planetary motion, i.e. rotating about their own axis and about a sun axis
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F35/00—Accessories for mixers; Auxiliary operations or auxiliary devices; Parts or details of general application
- B01F35/30—Driving arrangements; Transmissions; Couplings; Brakes
- B01F35/32—Driving arrangements
- B01F35/32005—Type of drive
- B01F35/3202—Hand driven
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F35/00—Accessories for mixers; Auxiliary operations or auxiliary devices; Parts or details of general application
- B01F35/50—Mixing receptacles
- B01F35/53—Mixing receptacles characterised by the configuration of the interior, e.g. baffles for facilitating the mixing of components
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F35/00—Accessories for mixers; Auxiliary operations or auxiliary devices; Parts or details of general application
- B01F35/75—Discharge mechanisms
- B01F35/754—Discharge mechanisms characterised by the means for discharging the components from the mixer
- B01F35/75425—Discharge mechanisms characterised by the means for discharging the components from the mixer using pistons or plungers
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
- B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
- B01F35/00—Accessories for mixers; Auxiliary operations or auxiliary devices; Parts or details of general application
- B01F35/75—Discharge mechanisms
- B01F35/754—Discharge mechanisms characterised by the means for discharging the components from the mixer
- B01F35/75425—Discharge mechanisms characterised by the means for discharging the components from the mixer using pistons or plungers
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-
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- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
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- A61B17/29—Forceps for use in minimally invasive surgery
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- A61B2017/2905—Details of shaft flexible
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3937—Visible markers
-
- 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
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- A—HUMAN NECESSITIES
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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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- A61F2002/4692—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor having operating or control means fluid
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- Dentistry (AREA)
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- Surgical Instruments (AREA)
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Abstract
【解決手段】 このカニューレは、塑性変形のための部分(224)を含む管(212)、及び少なくとも100気圧の圧力でこの管を通して推進される粘性物質の力に抵抗することができる管内の内腔を含む。代替的に、複数の物質のためのまたはスタイレットの導入のための少なくとも二つの入口(730)、(740)を持つ骨セメントカニューレ(1002)が提供される。
【選択図】 図4A−B
Description
本願は、2006年1月26日に出願した「Cannula」と称し、かつ出願番号60/763003を持つ米国特許仮出願の米国特許法第119号(e)項に基づく特典を主張し、その開示内容は参照までにここに組込まれる。
本発明は、器官中への物質の送達のための装置と方法に関し、例えば整形外科手術時の骨セメントの送達のためのカニューレに関する。
(a)塑性変形のために適合した部分を含む管;
(b)管内の内腔であって、少なくとも100気圧の圧力で粘性物質がそれを通して推進されるときの粘性物質の力に耐えることができる内腔;
を含む。
(a)塑性変形のために適合した部分を含む管;
(b)管内の内腔であって、骨充填物質により少なくとも部分的に充填されている内腔;
を含む。
(a)少なくとも一つの注入口と連結体の間の流体連通の通路を提供する管内腔を含む管;及び
(b)前記管内に構成された少なくとも二つの入口;
を含む。
(a)加工物に希望の変形性を与える切込みのパターンを決定すること;
(b)外科手術器具を作るために加工物にその切込みのパターンを刻むことにより加工物に希望の塑性変形性を与えること;及び
(c)前記加工物を骨セメント注入のために適したカニューレに形成すること;
を含む。
(a)側面出口を含むカニューレに、カニューレの軸方向穴を通して出る軸方向案内ワイヤーを与えること;
(b)前記カニューレを骨中に挿入すること;
(c)前記スタイレットを除去すること;及び
(d)軸方向穴を通して出るセメントが20%未満になるように前記カニューレを通してセメントを注入すること;
を含む。
(a)カニューレを患者に挿入すること;
(b)前記カニューレを少なくとも20mmの長さに渡って曲げること;及び
(c)粘性物質を前記カニューレを通して注入すること;
を含む。
図面において、複数の図に表れる同一の構造、要素または部品は、一般的にそれらが表れる全ての図面において同じ番号で表示される。図面に示される要素及び特徴の寸法は便宜のため及び表示の明解さのために選ばれ、必ずしも縮尺どおりで示されていない。図面は以下に列挙される。
図1は本発明の例示的実施態様によるセメント提供の方法100を示す流れ図である。102で、任意選択的にスタイレットの補助有りまたは無しのカニューレが挿入される。かかるスタイレットは例えば硬いかまたは柔軟であり、真直ぐかまたは曲がったものであることができる。任意選択的に、挿入102は例えば透視機械または通常のX線カメラのような医療用撮像装置を介して監視104される。もし任意のスタイレットが採用されたなら、それはこの段階で除去106されることができる。
本発明の例示的実施態様によるカニューレは柔軟とは対照的に、塑性変形可能である。ここで使用される“塑性変形”は、実施するために入力エネルギーを必要とし、かつ逆転するために例えば同様の程度の別のエネルギー入力を必要とする形状の変化を言う。本発明の例示的実施態様において、塑性変形のために必要な入力エネルギーは、それが手動で、任意選択的に片手で付与されることができるように十分に小さい。任意選択的に、いったん変形されたら、カニューレはそれを通してセメントを注入することによりそれに付与される力では及び/または外部的力なしでは変形しないであろう。
図2は本発明の例示的実施態様による組立てられたカニューレ/スタイレット装置200の正面図であり、そのハンドルの部分断面図を示す。本発明の例示的実施態様において、ハンドル方向はスリット方向(下述する)に合致しており、従って典型的な使用では、カニューレを挿入するために医者により付与された力はカニューレを曲げるために使用される力と同じ方向ではないであろう。任意選択的に、ハンドル方向は希望の変形方向を示すために使用される。
図6はカニューレを通して注入されたセメントの洩れを防ぐために套管238を取付けられたカニューレ212の透視図である。套管238はスリットを覆うように配置される。套管はカニューレの外側に描かれているが、それは任意選択的に内部被覆として与えられることができる。代替的にまたは追加的に、外部被覆が洩れを減らすためにカニューレ212に付与されることができる。本発明の例示的実施態様において、套管238は100〜300(または50〜200)気圧の範囲内の圧力で注入されている骨セメントの洩れを防ぐまたは減らすために十分な力でカニューレ212に接着する。任意選択的に、套管238はスリットされているカニューレの部分を越えて延びる。本発明の例示的実施態様において、套管238はしなやかでなく、従って高圧でのセメント注入時に、套管直径は同じままである。任意選択的に、套管238は関連した注入圧力下で安定性のために十分な壁厚を持つポリマーから作られる。任意選択的に、套管238は使用時に(例えばカニューレの挿入後、またはその前)カニューレ212上に置かれる。任意選択的に、カニューレ212は套管238を所定場所に備えている。
本発明の例示的実施態様において、カニューレ212上に配置された一連のスリット224はそれらが使用時に患者の身体の外側に実質的にまたは全体的に位置するように、例えば変形可能領域の少なくとも60%、少なくとも75%またはそれより多くが患者の外側にあるように設計される。任意選択的に、カニューレ212の塑性変形は、セメント貯蔵器の取付けが便利であるようにカニューレを外科医に向けて曲げる。本発明の例示的実施態様において、カニューレ212上のマーキング(図示せず)は好適な変形方向を示す(例えばより大きな切込み230,232に向けて)。
図7は半径方向注入穴710と貫入先端720を持つカニューレ712の例示的実施態様を示す。貫入先端720は任意選択的に上述したスタイレット先端218の代わりの役目をする。カニューレ712が挿入時に曲がらないことを確実にするために別個のスタイレットが設けられることができる。幾つかの実施態様ではスタイレットは使用されない。
図4Cは本発明の例示的実施態様による例示的スリット設計の詳細を示す。示された詳細には、二つのスリット228(外部曲げから)と232(内部曲げから)がある。スリット228はベース切込み246とビーム切込み248を含む。図5に示されるように、第二ベース切込みがカニューレの他の側に設けられることができる。スリット232はベース切込み236とビーム切込み244を含む。
カニューレ212はカニューレ本体自体がカニューレの変形された形状のための支持体を提供するカニューレの一例である。代替実施態様では、これは該当しない。
図9Aは柔軟部分900を含むカニューレ912の断面側面図である。任意選択的に、柔軟部分はカニューレの残りより厚いが、身体の外側にあり、これは容認できる。任意選択的に、例えば硬いリングとしてまたは可動リングとして組織停止具902が設けられ、それは部分900の身体中への貫入を防ぐ。部分900は例えば上述のように変形可能な部分であることができる。
図11は本発明の例示的実施態様による変形可能なカニューレの製造の例示的方法1100のフローチャートである。
図12は本発明の例示的実施態様によるスタイレット1204のための軸方向穴1202を持つ封止先端カニューレ1200の概略側面断面図である。第二側面出口1206がセメントの排出のために示されている。
本発明の例示的実施態様において、カニューレは多数の充填口を備える。これは非変形カニューレのために有用であることができ、そこでは軸方向充填口はスタイレットの導入のために使用され、側面充填口は医者及び/または撮像システムの視線をふさぐセメント送達システムなしに、及び/または患者へトルクを付与することなしにセメントを注入するために設けられている。典型的には、セメントはスタイレットが除去された後に注入される。
上記用途は脊椎に重点を置いたが、他の組織、例えば圧縮脛骨板および圧迫骨折のある他の骨も治療することができ、緩んでしまったインプラント、あるいは埋込み中のインプラント、例えば股関節インプラントまたは他の骨インプラントを締め付けるためにも使用することができる。任意選択的に、既存のインプラントを締め付けるために、骨の空隙のある場所に小さい穴が開けられ、空隙内に材料が押し出される。
Claims (21)
- 以下のものを含むことを特徴とする骨セメントカニューレ:
(a)塑性変形のために適合した部分を含む管;及び
(b)管内の内腔であって、少なくとも100気圧の圧力で粘性物質がそれを通して推進されるときの粘性物質の力に耐えることができる内腔。 - 塑性変形のために適合した前記部分がカニューレの外壁内に形成された一連の別個のジョイント部を含むことを特徴とする請求項1に記載のカニューレ。
- 前記ジョイント部の少なくとも一つが少なくとも一つの切込みにより形成されることを特徴とする請求項2に記載のカニューレ。
- 前記切込みの少なくとも一つがカニューレが変形するときに閉じるような形状をしていることを特徴とする請求項3に記載のカニューレ。
- 前記ジョイント部の少なくとも一つがカニューレ壁の貫通しない弱化により形成されることを特徴とする請求項2〜4のいずれかに記載のカニューレ。
- 前記ジョイント部がカニューレの希望の変形形状を容易にすることを特徴とする請求項2〜5のいずれかに記載のカニューレ。
- 前記ジョイント部がシールされていることを特徴とする請求項2〜6のいずれかに記載のカニューレ。
- 外部シール層を含むことを特徴とする請求項1〜7のいずれかに記載のカニューレ。
- 内部シール層を含むことを特徴とする請求項1〜8のいずれかに記載のカニューレ。
- 前記部分が身体の外側に残るように適合されていることを特徴とする請求項1〜9のいずれかに記載のカニューレ。
- 塑性変形のために適合した前記部分が変形可能な套管を含むことを特徴とする請求項1〜10のいずれかに記載のカニューレ。
- 塑性変形のために適合した前記部分が柔軟な管と前記管のための形状支持体とを含むことを特徴とする請求項1〜11のいずれかに記載のカニューレ。
- 以下のものを含むことを特徴とするカニューレ:
(a)塑性変形のために適合した部分を含む管;及び
(b)管内の内腔であって、骨充填物質により少なくとも部分的に充填されている内腔。 - 以下のものを含むことを特徴とする骨セメントカニューレ:
(a)少なくとも一つの注入口と連結体の間の流体連通の通路を提供する管内腔を含む管;及び
(b)前記管内に構成された少なくとも二つの入口。 - 前記入口の一つが軸方向に配向されていることを特徴とする請求項14に記載のカニューレ。
- 前記入口の少なくとも一つが横断軸方向に配向されていることを特徴とする請求項14または15に記載のカニューレ。
- 前記入口の一つからの流れを選択的に可能にするのに適合した入口経路セレクタを含むことを特徴とする請求項14〜16のいずれかに記載のカニューレ。
- 前記入口の一つからの逆流を選択的に防ぐのを可能にするのに適合した入口経路ブロッカーを含むことを特徴とする請求項14〜17のいずれかに記載のカニューレ。
- 以下のことを含むことを特徴とする外科手術器具の製造方法:
(a)加工物に希望の変形性を与える切込みのパターンを決定すること;
(b)外科手術器具を作るために加工物にその切込みのパターンを刻むことにより加工物に希望の塑性変形性を与えること;及び
(c)前記加工物を骨セメント注入のために適したカニューレに形成すること。 - 以下のことを含むことを特徴とするセメントを送達する方法:
(a)側面出口を含むカニューレに、カニューレの軸方向穴を通して出る軸方向案内ワイヤーを与えること;
(b)前記カニューレを骨中に挿入すること;
(c)前記スタイレットを除去すること;及び
(d)軸方向穴を通して出るセメントが20%未満になるように前記カニューレを通してセメントを注入すること。 - 以下のことを含むことを特徴とする粘性物質を患者に注入する方法:
(a)カニューレを患者に挿入すること;
(b)前記カニューレを少なくとも20mmの長さに渡って曲げること;及び
(c)粘性物質を前記カニューレを通して注入すること。
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WO2007036815A2 (en) | 2007-04-05 |
CA2624101A1 (en) | 2007-04-05 |
US8809418B2 (en) | 2014-08-19 |
US20130123791A1 (en) | 2013-05-16 |
AU2006296291A1 (en) | 2007-04-05 |
US9750840B2 (en) | 2017-09-05 |
WO2007036815A3 (en) | 2007-09-13 |
US20130261217A1 (en) | 2013-10-03 |
US20080228192A1 (en) | 2008-09-18 |
EP1928335A2 (en) | 2008-06-11 |
KR20080060250A (ko) | 2008-07-01 |
US8415407B2 (en) | 2013-04-09 |
US20070027230A1 (en) | 2007-02-01 |
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