JP4493629B2 - 膨張可能本体を用いて折れた骨または罹病した骨を治療するシステム - Google Patents
膨張可能本体を用いて折れた骨または罹病した骨を治療するシステム Download PDFInfo
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- JP4493629B2 JP4493629B2 JP2006215128A JP2006215128A JP4493629B2 JP 4493629 B2 JP4493629 B2 JP 4493629B2 JP 2006215128 A JP2006215128 A JP 2006215128A JP 2006215128 A JP2006215128 A JP 2006215128A JP 4493629 B2 JP4493629 B2 JP 4493629B2
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- inflatable body
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Description
本発明は、1つまたはそれを超える膨張可能本体を用いて、椎体を含め、他の骨のタイプにおいても同様に、骨を治療する改良型システムを提供する。
カテーテル管が自然な軸と非整列状態である時でさえ、標的化された内部人体領域の自然な軸に関して対称の様式で膨張可能な構造の配置を許容する。
キットは、使用まで無菌状態に装置を維持する封鎖状態の無菌封入体を規定するうわ包装を備える。キットは、その内部に実装された装置が無菌で、それ以前の使用を受けていないことを、医者またはユーザーに証明する。それにより、医者またはユーザーは、膨張可能構造が確立した性能と無菌状態の仕様に適合することを確証し、使用について膨張された場合に、所望の形状を得る。
この明細書は、膨張可能本体を利用して骨を治療するための新規なシステムおよび方法を解説する。骨を治療するための膨張可能本体の使用は、米国特許第4,969,888号および第5,108,404号に開示されるが、これらは引用により本明細書中に援用される。この観点における改良は、1994年1月26日に出願された米国特許第08/188,244号、1995年6月7日に出願された米国特許第08/485,394号、1996年6月5日に出願された米国特許第08/659,678号に開示されており、これらは各々が、参考として本明細書に援用される。
図1が示すように、脊柱10は、椎骨12と称される多数の固有形状の骨、仙骨14、および、尾骨16(テールボーンとも称される)を備える。脊柱10を構築する椎骨12の数は動物の種で決まる。人体には(図1が示す)24の椎骨12が存在し、それには、7つの頚椎18、12の胸椎20、および、5つの腰椎22が含まれる。
図4は、膨張可能本体を用いた椎体の圧縮骨折または崩壊を防止または治療するための
機材48を示す。
ガイド鞘部72の遠位端74は、同様に、椎茎42へと軽く叩き入れられる。医者は套管針68を除去し、図5Gが示すように、ガイドピン66および外側ガイド鞘部72を適所に残す。代替例として、套管針68およびガイド鞘部72は一緒に一段階で導入され得る。
本体壁58の材料は、その使用を取り巻く治療目的にしたがって選択され得る。例えば、ビニール、ナイロン、ポリエチレン、アイオノマー、ポリウレタン、およびポリエチレンテレフタレート(tetraphthalate)(PET)を含む材料が使用され得る。本体壁58の厚さは2/1000インチから25/1000インチの範囲にあるか、または、例えば、250psiから500psiまでの圧力に耐え得る他の厚さであるのが、典型的である。
後でまた提示されるように、比較的非弾性材料が本体壁58について使用された場合、
または、本体壁58が他に外的に抑制されて、壁破損の前にその膨張を制限した場合は、本体が実質的に膨張された時に、所定の形状および寸法が本体56に付与され得る。この形状および寸法は、包囲する皮質骨28および隣接する内部構造の形状および寸法に従って、または、海綿質32に形成されるのが望ましい空洞84の寸法および形状により、予め決定され得る。
膨張可能本体56を利用して海綿質32に所望の空洞形状を形成することは、所望の治療効果を達成するために、広範な方法で達成可能である。先の開示は、海綿質32を圧縮し、かつ、それ自体で、充填材料96を受容するのに望ましい形状および寸法を有する空洞84を形成するための、単一膨張可能本体56の配置を予見する。
(i.抑制式ドーナッツ型形状)
図20は膨張可能本体の代表的実施態様を示し、これは、参照番号210により大まかに示される。本体210は、PETまたはKevlarなどの可撓性材料からなる、1対の中空の膨張可能非膨張可能部分212および214を備える。部分212および214は、それらの間に吸引管216を備え、遠隔廃棄処理場所までの輸送のための管216内への吸引により、脂肪および他の細片を抽出する。カテーテル管216は、吸引が吸引源
(図示せず)から管216の開口端部に付与され得るように、1つ以上の吸引孔を備える。
図23は、膨張可能本体230の別な代表的実施態様を示し、これは、腎臓型形状を有する。本体230は1対の対向する腎臓型側壁232および連続する端部壁234を有する。管238は液体を本体内に方向付け、それを椎体内部で膨張させる。
標的となった椎体26を治療するための、特定の膨張可能本体(単数および複数)の寸
法および形状の最終的選択は、幾つかの要因に基づく。複数の膨張可能本体が使用された場合、配置された全ての膨張可能本体の全組み合わせ寸法は、実質的に膨張された時には、考慮に入れられるべきである。
椎骨と同様に、海綿質により実質的に占有される長骨の内部領域は、1つ以上の膨張可
能本体の使用で治療され得る。図43は人体骨格600の代表的領域を例示し、ここでは、長骨の海綿質領域は、膨張可能本体を利用して治療され得る。各領域は、遠位橈骨(領域602)、近位脛骨平坦部(領域604)、近位上腕骨(領域606)、近位大腿骨頭部(領域608)、および、踵骨(領域610)を含む。
遠位部橈骨(図43の領域602)の骨折を治療するための適切な膨張可能本体の選択は、遠位橈骨の放射線学的寸法および骨折の位置で決まる。
所与の近位上腕骨骨折(図43の領域606)を治療するための適切な膨張可能本体266の選択は、近位上腕骨の放射線学的寸法および骨折の位置で決まる。
所与の脛骨平坦域骨折(図43における領域604)を治療するための膨張可能本体の選択は、近位脛骨の放射線学的寸法および骨折の位置で決まる。
大腿骨頭部(図43の領域608)において使用するための膨張可能本体の寸法は、大腿骨の頭部のX線透視的寸法またはCTスキャン寸法と、虚血壊死状態の骨の位置および寸法とに基づいて、選択される。
か球面の形状(図34が示すように)を有し得る。半球面形状は、図35では、プリーツ300bを設作っている本体300の重畳部分を結合することにより維持される。
閾値を下回る臀部(図43の領域612)の骨密度を有する患者は、股関節骨折の危険性が高く、より低い密度は危険性を増大させる。患者の選択は、骨密度スキャンにより行われる。
踵骨(図43における領域610)の骨折を治療する際に使用するための膨張可能本体の寸法は、踵骨の放射線透視的寸法またはCTスキャン寸法と、骨折の位置および寸法とに基づいて選択される。
面458の領域を占有するより小さい二次寸法を有する。
膨張可能本体の異なる寸法および/または形状は、顎骨、腕骨および脚骨の中央シャフト、頚部の椎体、足および足首の骨、骨盤、肋骨などの、先に指定されていない場所で使用され得る。
するために、相当な圧縮の犠牲とされることがある。この応用例では、膨張可能本体の寸法は、送達されるよう求められた治療物質の所望量によって、選択される。この場合、内部に薬物を有する骨が支持される間に、薬物が作用し、骨は外部鋳型、または現行の内部固定装置または外部固定装置により、癒される。
(A.従来型対称的構造)
図50は機材848を示し、これは、それぞれ参照番号52および54を付した、近位端および遠位端を有するカテーテル管850を備える。カテーテル管850はハンドル851を備えて、管850の把持と操作を容易にする。ハンドル851は、カテーテル管850の周囲に固着された発泡材から作成されるのが、好ましい。
図56Aは改良型骨治療機材814を示し、これは、遠位端818に膨張可能構造820を搬送するカテーテル管816を備える。カテーテル管816は、その近位端で、図50に示される管850のように構成され得て、ハンドル851は、発泡材などから作成される。
可能構造820の形状とは異なる、オフセットされた非対称的形状を有する、膨張可能構造1200を示す。図56Aおよび図56Bにおいては、円筒型軸822とカテーテル管軸824の間のオフセット角Aは、鋭角である。その結果として、構造820の軸822は、カテーテル管軸824に相対して非平行な次元または平面でオフセットされる。図58Aおよび図58Bでは、円筒部1210の軸1220がカテーテル管軸1240から或る距離で、かつ、それに相対してほぼ平行な次元または平面でオフセットされると、円筒部軸1220とカテーテル管軸1240の間のオフセット角Aはゼロになる。カテーテル管1160は、その近位端では、図50に示される管50のように構成されて、ハンドル51は発泡材などから作成され得る。
図51に戻って参照すると、図51に示される従来型の管状構造856が実質的に膨張された場合は、構造の材料は、カテーテル管850に結合された端部858付近で円錐型セクション862内へ伸張される。図59は、膨張状態の管状構造856の形状をより詳細に示す。円錐型部分862は結合端部858から円錐角度αで延在する。それゆえ、膨張された構造856は、構造856の最大直径(BODYDIA)が存在するほぼ円筒型の中央領域864と、カテーテル管の直径(TUBEDIA)に達するまで中央領域864からの距離と共に減少する直径の領域を備える、円錐型部分862とを提示する。
ここでは、所与の円錐型領域の長さ(Lc)は、以下のように表現される。
BODYDIAは、実質的に膨張状態にある場合の、中央領域864の最大直径であり、
TUBEDIAは、カテーテル管850の直径であり、
αは円錐型部分の角度である。
テル管1302への装着により、過剰膨張しないように抑制される。
血管系における配置
図66は、血管系領域1400を示す。領域1400は第1の血管1402を含み、これは、第1軸1404に沿って延在する。領域1400はまた第2の血管1406を含み、これは、第1軸1404からオフセットされた第2軸1408に沿って、第1血管1402から分岐する。
上述の実施態様の全てについて、ある長さの関連カテーテル管は膨張可能構造内部に延在する。図51、図56A、図56B、図58A、図58B、および、図59から図62に示される実施態様では、封入されたカテーテル管は、主要カテーテル管の延長からなる。図63から図65に示される実施態様では、封入されたカテーテル管は、主要カテーテル管により搬送される別個のカテーテル管を備える。
標的の人体領域における最初の使用期間の、本明細書に記載された膨張可能構造のうちのいずれかの膨張は、構造を構成する材料(単数または複数)に応力を発生する。標的の人体領域における最初に使用期間中に作動上の負荷により生じた材料の応力は、構造の成形による形態学的形状を相当変更して、構造の将来的性能を予測不能にすることがある。
(A.二元式段階充填処理)
図39Aから図39Dは、海綿質において膨張可能本体により形成された空洞内に充填材料を導入するための、複数段工程を例示する。この工程は、椎体を治療する処理に関連して例示される。これは、例示を目的としている。この工程は、あらゆる骨のタイプの治療で使用され得ることが、理解されるべきである。
採用が指示される。破損した皮質性壁28は空隙と割れ目(図39AでGと指定される)を設ける。典型例では、破損した皮質骨28の残遺屑500は、皮質性壁破損が発生した領域の海綿質32に存することがある。充填材料は、上記空隙または割れ目Cを通って、骨の内部体積の外側へ流出または漏出する可能性がある。
図40および図41は、海綿質において膨張可能本体により形成された空洞に充填材料を導入することに関連する、内部網510の使用を例示する。網510は、椎体を治療することに関連して例示されるが、同工程は、全ての骨のタイプの治療について使用され得ると、理解されるべきである。
した皮質骨領域に存在する未充填の空隙または割れ目(図41においてGで示される)を経由して、流出または漏出する可能性がある。
上述の膨張可能本体のいずれかにより海綿質に設けられた空洞には、医学的に適切な処方の薬物または成長因子が充填され得る。
レキセート(methotrexate)、タキソール(taxol)、および、タモキシフェン(tamoxifen)などの化合物が挙げられる。骨粗しょう症薬剤としては、エストロゲン(estrogen)、カルシトニン(calcitonin)、ジフォスフォナート類(diphosphonates)、および、上皮小体ホルモン拮抗体が挙げられる。
上述の膨張可能本体のいずれかにより海綿質に設けられた空洞には、生体用材料も充填され得る。
上述の膨張可能本体のいずれもが、例えば、複数骨髄腫の診断において、または、骨髄移植を利用した進行性癌の治療において、診断目的または治療目的で骨髄を収穫する際に使用され得る。
おいて、本体728は大きな面積を圧縮するが、海綿質728のかなりの深さまでは圧縮しない形状にされる。
Claims (12)
- 骨に挿入し膨張させる装置において、
遠位端を有する外側カテーテル管と、
少なくとも一部において前記外側カテーテル管内に延在し、かつ少なくとも一部が前記外側カテーテル管の前記遠位端を越えて延在している遠位端領域を有した内側カテーテル管と、
近位端において前記外側カテーテル管に結合され、遠位端において前記内側カテーテル管に結合される膨張可能本体であって、前記外側カテーテル管の外側でかつそれを超えて延在し前記内側カテーテル管を少なくとも部分的に包囲している該膨張可能本体と、
外側カテーテル管と内側カテーテル管との間の空間により規定され,前記膨張可能本体と連通して該膨張可能本体に膨張媒体を搬送し該膨張可能本体を膨張させる流れ通路と、
を備えた、骨に挿入し膨張させる装置。 - 請求項1に記載の装置において、前記外側カテーテル管は軸線を有し、また前記膨張可能本体の膨張は該軸線に関して非対称に行われるようになっている、骨に挿入し膨張させる装置。
- 請求項1に記載の装置において、前記膨張可能本体は前記骨の中で膨張すると海綿質を圧縮するよう形成されている、骨に挿入し膨張させる装置。
- 請求項1に記載の装置において、前記内側カテーテル管は前記外側カテーテル管に対して変位可能である、骨に挿入し膨張させる装置。
- 骨に挿入し膨張させる装置において、
遠位端を有する外側カテーテル管と、
少なくとも一部において前記外側カテーテル管内に延在し、かつ少なくとも一部が前記外側カテーテル管の前記遠位端を越えて延在している遠位端領域を有した内側カテーテル管と、
近位端において前記外側カテーテル管に結合され、遠位端において前記内側カテーテル管に結合される膨張可能本体であって、前記外側カテーテル管の外側でかつそれを超えて延在し前記内側カテーテル管を少なくとも部分的に包囲している該膨張可能本体と、
外側カテーテル管と内側カテーテル管との間の空間により規定され,前記膨張可能本体と連通して該膨張可能本体に膨張媒体を搬送し該膨張可能本体を膨張させる流れ通路と、
を備え、前記膨張可能本体はそれが崩壊した状態にあるときガイド管内を骨の内部まで通過できるような形状及び寸法を有する、骨に挿入し膨張させる装置。 - 請求項5に記載の装置において、前記外側カテーテル管は軸線を有し、また前記膨張可能本体の膨張は該軸線に関して非対称に行われるようになっている、骨に挿入し膨張させる装置。
- 請求項5に記載の装置において、前記膨張可能本体は前記骨の中で膨張すると海綿質を圧縮するよう形成されている、骨に挿入し膨張させる装置。
- 請求項5に記載の装置において、前記内側カテーテル管は前記外側カテーテル管に対して変位可能である、骨に挿入し膨張させる装置。
- 骨を処理する装置において、
ガイド管と、
遠位端を有する外側カテーテル管と、
少なくとも一部において前記外側カテーテル管内に延在し、かつ少なくとも一部が前記外側カテーテル管の前記遠位端を越えて延在している遠位端領域を有した内側カテーテル管と、
近位端において前記外側カテーテル管に結合され、遠位端において前記内側カテーテル管に結合される膨張可能本体であって、前記外側カテーテル管の外側でかつそれを超えて延在し前記内側カテーテル管を少なくとも部分的に包囲している該膨張可能本体と、
外側カテーテル管と内側カテーテル管との間の空間により規定され,前記膨張可能本体と連通して該膨張可能本体に膨張媒体を搬送し該膨張可能本体を膨張させる流れ通路と、
を備え、前記膨張可能本体はそれが前記ガイド管内を骨の内部まで通過できるような形状及び寸法を有する、骨を処理する装置。 - 請求項9に記載の装置において、前記外側カテーテル管は軸線を有し、また前記膨張可能本体の膨張は該軸線に関して非対称に行われるようになっている、骨を処理する装置。
- 請求項9に記載の装置において、前記膨張可能本体は前記骨の中で膨張すると海綿質を圧縮するよう形成されている、骨を処理する装置。
- 請求項9に記載の装置において、前記内側カテーテル管は前記外側カテーテル管に対して変位可能である、骨を処理する装置。
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