WO2017156601A1 - Système de réalignement osseux à contrôle élevée - Google Patents

Système de réalignement osseux à contrôle élevée Download PDF

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Publication number
WO2017156601A1
WO2017156601A1 PCT/BR2016/050054 BR2016050054W WO2017156601A1 WO 2017156601 A1 WO2017156601 A1 WO 2017156601A1 BR 2016050054 W BR2016050054 W BR 2016050054W WO 2017156601 A1 WO2017156601 A1 WO 2017156601A1
Authority
WO
WIPO (PCT)
Prior art keywords
bone
plate
opening device
opening
single plate
Prior art date
Application number
PCT/BR2016/050054
Other languages
English (en)
Portuguese (pt)
Inventor
Cristiano Hossri Ribeiro
Mauricio Sante Bettio MOD
Daniel Ernst
Original Assignee
Cristiano Hossri Ribeiro
Mod Mauricio Sante Bettio
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Cristiano Hossri Ribeiro, Mod Mauricio Sante Bettio filed Critical Cristiano Hossri Ribeiro
Priority to PCT/BR2016/050054 priority Critical patent/WO2017156601A1/fr
Publication of WO2017156601A1 publication Critical patent/WO2017156601A1/fr

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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
    • 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
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • 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
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices

Definitions

  • This system consists of a single plate with proximal shims and a continuous linear sliding mechanism device that engages the plate.
  • the system works together at the osteotomy site allowing its opening and closing according to the desired angular correction in the opening wedge osteotomy surgeries.
  • This system allows a millimeter correction of bone deformity, facilitating the surgical procedure, reducing the time of corrective surgery and reducing the risks of inaccurate correction.
  • the plate is contoured in its proximal head portion to more closely resemble the structure of the tibial bone segment that is cut and rotated during the procedure.
  • the plate also preferably has screw holes in the proximal head portion, which are machined through the pre-contoured proximal head portion, and are configured to form an angle of the screw in a target screw path with respect to osteotomy;
  • Document MU 8900220-2, FIBERAL AND FEMORAL FIXING SYSTEM WITH ADDITION OSTEOTOMY which describes a device used especially for the fixation of corrective addition osteotomy of the valgus and knee varus angular deviations, which comprises a structure T-shaped bone plate (1) has rounded profiles and an anatomical shape for both the Tibia (2) and the Femur (3), with a defined thickness where a series of holes, and in the horizontal projection there are holes (4), which promote the fixation of the cancellous screw (5); In the central vertical region there is an oblong hole (6) where it is fixed by screw (6A) of the adjustable shim (7), followed by other distal holes (8) with thread that promote the fixation of the cortical locking screw (9).
  • Document BR 1 12012000387-9 (WO201 1005327) OSTEOTOMY BOARD, CONDUCTING BOARD AND METHOD FOR USE, which describes an orthopedic plate configured specifically for use in osteotomies, where part of the plate extends to a portion of A first bone segment and part is external to the cortical surface of an adjacent bone segment to secure the segments to allow them to fuse together.
  • the plate has a first end and a second end where the end that is inserted into the bone has a bevel and a through hole having a hole axis, optionally at an angle to the longitudinal axis of the plate, and which may receive a screw. , handle or pin.
  • the second end of the plate includes a locking screw hole and optionally including a compression slot extending in one direction to a screw hole at the opposite end.
  • a plate controller having a recess holding the plate is used to insert the plate into the bone; and
  • Document BR 1 1 2012 010733 0 (WO201 1055353), MULTI-ADJUSTABLE OSTEOTOMY PLATE, where the invention relates to a mechanical device for correcting a malformation of the bones of the body.
  • the device is continuously adjustable, making the surgeon's job easier and reducing surgery time, thereby reducing the risk of infection and, above all, ensuring the desired precision for surgery.
  • the device comprises a top plate (1) suitable for sliding over a bottom plate (2) by means of a guide (7).
  • the plates of said device may be screwed to either side of an angular notch made in the bone.
  • the plates respectively comprise: top (5) and bottom (6) bone notch bearings.
  • Said bearings form an acute angle chamfer which substantially corresponds to the notch surfaces.
  • One of the plates is provided with a set screw (4) for continuous adjustment of relative positions of the plates.
  • the device also comprises a lock screw (3) suitable for maintaining the open position of the device and, consequently, the final angle of the bone notch in the desired position.
  • the upper bearing of the angled bone adjustment notch is suitable for correcting the angle of the beveled surface of the bearing, in particular the inclination of the tibia, by means of a tapered screw (8) adjusting an angular space of the bearing.
  • a device comprising an upper plate that slides vertically on a lower plate, the two plates having orthogonal wedges that take up the notch made in the tibia.
  • the lower plate has side guides that allow the upper plate to slide, which is effected by an adjusting screw that derives from the lower plate.
  • a second locking bolt holds the plates in the chosen opening. for that procedure.
  • the surgical procedure consists of making the tibial notch, positioning and fixing the upper plate and the lower plate on both sides of the bone and then retract with the adjustment screw.
  • the coupling system of the two parts of the first plate is more unstable and more difficult to fix. This increases the risk of loss of the desired correction for the operated limb; since two components must be well fixed to each other and also to the bone.
  • the multi-adjustable plate, object of the present invention has only one plate, solving all the above mentioned drawbacks.
  • the plate of the present invention only one component is fixed and remains in the bone. Opening is performed by an opening and closing instrument that engages with the fixed plate. But, after setting the desired (opening) wedge, this equipment is removed; and only one material (plaque) remains attached to the bone; eliminating the point of instability that existed in the coupling for both parts of the plate.
  • Figure 1 shows the schematic view of the high control bone realignment system, showing its use in two different situations
  • Figure 2 shows the perspective view of the high control bone realignment system in the assembled situation, highlighting all its configuration details
  • Figure 3 shows the front view of the high control bone realignment system showing its use with minimal adjustment, highlighting a tibial osteotomy as an example of utilization;
  • Figure 4 shows the frontal view of the high control bone realignment system, showing its use with intermediate adjustment, highlighting a tibial osteotomy as an example of use.
  • the high control bone realignment system is a set consisting of a single plate (1) and an opening device (5), with the plate showing proximal shims (2), and a central slot (3) to be traversed by the wedges (4) of the wedging opening device (5) (4), and which functions as a vise, applying an axial force to the bone to open a bone wedge, having the set screw (6) engaged promotes movement between the shims (2 and 4) to the desired angle in the notch made in the bone.
  • the high control bone realignment system object of the present patent, is a multi-adjustable plate assembly by means of an opening device (5), with the osteotomy plate configured by a single plate.
  • a sliding force is applied by applying a force to the wedges which can be adjusted by means of a millimeter ruler (7) running through a guide (8) located on the body (9) of the opening device (5), which also includes a fastening means.
  • the l allows a range of openings according to bonesize and / or medical indication, ranging from at least 0 to 20 mm.
  • the single plate (1) forms a joint splint, and has at least two proximal wedge shims (2) in its upper third, in addition to the central tear (3) and holes for permanent fixation (11) to the bone. the most extreme upper hole also serves for connecting the movable fastening means (10) of the opening device (5).
  • bone screws (10,12) with or without locking mechanism may be applied to the movable side of the plate in the final alignment position according to planning, navigation or control surgery.
  • the opening device (5) has the same principle of operation of a vise, being formed by a body (9) with a guide (8) traversed by a millimeter ruler (7), at whose end is located by at least one movable wedge bracket (4) which can be moved by actuating the adjusting screw (6) through the body (9), from which the fastening means (10) to the plate (1), consisting of a pin, is derived. (12) with thread compatible with the upper hole of the plate.
  • the procedure for the placement of the multi-adjustable plate comprises, in the femur / tibial direction, the previous fixation of the upper side of the single plate (1) in the notch made in the tibia by the wedge shims (2) attached to the bone, and connecting the opening device (5) with the shims (4) inserted into the central groove (3) in a dimension that provides alignment with the shims (2), allowing an axial force to be applied to the bone to open a bone wedge.
  • the adjusting screw (6) is turned to move the wedge movable wedges (4) from the wedge fixed wedges (2) to the desired opening limit by moving the wedges so as to apply a force on them. they move them away by the desired distance.
  • the opening device (5) is removed and the fixing is completed by placing and tightening the screws in the holes (11) to the bones, where the bone screws can be applied without removing the opening device.
  • the high control bone realignment system provides for the use of a single plate (1) associated with a sliding opening device (5) in a central slot of said single plate, which presents proximal wedges such as the wedges of the opening device which, as already commented, slide in the central groove thereof, such that, by turning the adjusting screw (6) of said opening device, there is a gap between the wedges (2 , 4) until reaching the desired final angle in the bone notch.
  • the opening device has the principle of a vise, but with only one jaw represented by a millimeter sliding bracket with millimeter or inch markings indicating the distance between the wedges and which is equivalent to the opening of the wedges and can be used to measure alignment , since the distance is equivalent to the bone correction angle.
  • the millimeter ruler slide bracket is positioned in a guide in the body of the opening device, which also includes the adjusting screw, and the means of attachment to the single plate.
  • the plate (1) and opening device (5) unite via positive / non-positive connection before surgery, and disconnect after performing the procedure. opening and fixing the plate. Both components have one or two shims on each component depending on where they are used. The shims on the plate are fixed while those on the opening device are movable. These shims adhere to the bone and allow axial force to be applied against the bone to promote bone opening, thereby establishing a wedge in the bone whose angular opening will promote bone alignment.
  • the system is an active part of bone realignment.
  • the sliding opening mechanism may be on the plate, in one plane, or on a different plane of the plate to meet different technical needs and access routes.
  • the opening device has a safety lock that prevents unintentional closing of the wedge during the opening maneuver. However, the wedge can be closed (decreased) voluntarily by operating the sliding opening mechanism in the opposite direction.
  • the opening device has graduation in millimeters or inches to indicate the distance of the spacers, which equals x opening wedge. Shim opening can be used to measure alignment since the distance equals x bone correction.
  • the system allows for a correction interval appropriate to the size of the bone and the need for medical indication, eg 0 to 20 mm for knee osteotomies.
  • the plate should be fixed above and below the bone cut.
  • the number of holes available for mounting depends on where the card is used. THE Fixation of the plate to the bone can be done with screws with or without locking mechanism, because their holes can be threaded or not. One end of the plate can be clamped before the opening of the wedge is initiated, which provides greater security for this step. For this purpose, it is not necessary to disconnect the instrument from the board.
  • the other end of the plate is fixed. Once the plate has been secured, the opening device can be disconnected without changing the position of the plate and the alignment achieved.
  • the fixed part of the system may be proximal or distal to the bone according to medical need, and there is no impediment on the part of the system to limit its orientation ( Figure 1).
  • the system not only allows the use of navigation, but also allows its full operability and efficiency, since the opening of the bone is continuous and millimeter.
  • the high control bone realignment system object of the present patent, as described above, presents a new and unique configuration that gives it great advantages over the osteotomy devices, plates and elements currently used and found in the present study. market.
  • These advantages include: greater stability to perform bone correction during the opening of the wedge, and fixation after the completion of the procedure; the fact that it has only one component that is fixed and remains in the bone, which eliminates the point of instability existing at the interface of the pieces when using two plates or other devices; the fact that, after defining the wedge (desired end angle), the opening device is immediately removed with only the plate remaining; provide reduction of surgical procedure time; and provide greater accuracy with the millimeter aperture system.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Medical Informatics (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Neurology (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un nouveau système de réalignement osseux à contrôle élevé, constitué par une plaque et un dispositif d'ouverture de plaque, à utiliser dans des chirurgies de corrections angulaires osseuses, humaines ou vétérinaires, également appelées ostéotomies. Ce système présente un mécanisme mécanique millimétrique pour corrections angulaires nécessitant des cales d'ouverture, et peut être utilisé dans divers os. Ledit système permet la correction continue et millimétrée de la déformation osseuse, supprimant les étapes du procédé classique et améliorant la sécurité et la précision pour l'opération chirurgicale. Outre le fait d'être moins invasif que le système classique, il permet en outre la réalisation d'autres opérations dans la même plage chirurgicale, telles que la reconstruction ligamentaire et les traitements de cartilage et de lésions méniscales dans le cas de l'articulation du genou.
PCT/BR2016/050054 2016-03-14 2016-03-14 Système de réalignement osseux à contrôle élevée WO2017156601A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/BR2016/050054 WO2017156601A1 (fr) 2016-03-14 2016-03-14 Système de réalignement osseux à contrôle élevée

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/BR2016/050054 WO2017156601A1 (fr) 2016-03-14 2016-03-14 Système de réalignement osseux à contrôle élevée

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WO2017156601A1 true WO2017156601A1 (fr) 2017-09-21

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5645548A (en) * 1996-02-15 1997-07-08 Augsburger; Samuel F. Osteotomy frame
EP0784454B1 (fr) * 1994-11-10 1999-06-23 Georges Kehyayan Dispositif de blocage temporaire de deux parties d'une piece osseuse
US6796986B2 (en) * 2001-03-29 2004-09-28 David W. Duffner Adjustable tibial osteotomy jig and method
US20090318924A1 (en) * 2008-06-19 2009-12-24 Helenbolt Kenneth T Amz tibial tuberosity transfer system
CN104546087A (zh) * 2015-01-07 2015-04-29 北京爱康宜诚医疗器材股份有限公司 前髁截骨器
BR112012010733A2 (pt) * 2009-11-05 2016-08-16 Cristiano Hossri Ribeiro placa mult-ajustável para osteotomia

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0784454B1 (fr) * 1994-11-10 1999-06-23 Georges Kehyayan Dispositif de blocage temporaire de deux parties d'une piece osseuse
US5645548A (en) * 1996-02-15 1997-07-08 Augsburger; Samuel F. Osteotomy frame
US6796986B2 (en) * 2001-03-29 2004-09-28 David W. Duffner Adjustable tibial osteotomy jig and method
US20090318924A1 (en) * 2008-06-19 2009-12-24 Helenbolt Kenneth T Amz tibial tuberosity transfer system
BR112012010733A2 (pt) * 2009-11-05 2016-08-16 Cristiano Hossri Ribeiro placa mult-ajustável para osteotomia
CN104546087A (zh) * 2015-01-07 2015-04-29 北京爱康宜诚医疗器材股份有限公司 前髁截骨器

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