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WO2008089019A2 - Système et procédé de formation d'un matériau de remplissage d'os poreux - Google Patents

Système et procédé de formation d'un matériau de remplissage d'os poreux Download PDF

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Publication number
WO2008089019A2
WO2008089019A2 PCT/US2008/050702 US2008050702W WO2008089019A2 WO 2008089019 A2 WO2008089019 A2 WO 2008089019A2 US 2008050702 W US2008050702 W US 2008050702W WO 2008089019 A2 WO2008089019 A2 WO 2008089019A2
Authority
WO
WIPO (PCT)
Prior art keywords
bone
gaseous substance
filling material
bone augmentation
augmentation
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/US2008/050702
Other languages
English (en)
Other versions
WO2008089019A3 (fr
Inventor
Hai H. Trieu
Aashiish Agnihotri
Joseph J. Saladino
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Warsaw Orthopedic Inc
Original Assignee
Warsaw Orthopedic Inc
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
Priority claimed from US11/622,570 external-priority patent/US8926623B2/en
Application filed by Warsaw Orthopedic Inc filed Critical Warsaw Orthopedic Inc
Publication of WO2008089019A2 publication Critical patent/WO2008089019A2/fr
Anticipated expiration legal-status Critical
Publication of WO2008089019A3 publication Critical patent/WO2008089019A3/fr
Ceased legal-status Critical Current

Links

Classifications

    • 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
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L27/56—Porous materials, e.g. foams or sponges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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, e.g. stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
    • B01F—MIXING, e.g. DISSOLVING, EMULSIFYING OR DISPERSING
    • B01F25/00—Flow mixers; Mixers for falling materials, e.g. solid particles
    • B01F25/40—Static mixers
    • B01F25/42—Static mixers in which the mixing is affected by moving the components jointly in changing directions, e.g. in tubes provided with baffles or obstructions
    • B01F25/43—Mixing tubes, e.g. wherein the material is moved in a radial or partly reversed direction
    • B01F25/431—Straight mixing tubes with baffles or obstructions that do not cause substantial pressure drop; Baffles therefor
    • B01F25/43197—Straight mixing tubes with baffles or obstructions that do not cause substantial pressure drop; Baffles therefor characterised by the mounting of the baffles or obstructions
    • B01F25/431971—Mounted on the wall
    • 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
    • A61L2400/00—Materials characterised by their function or physical properties
    • A61L2400/06—Flowable or injectable implant compositions
    • 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
    • A61L2430/00—Materials or treatment for tissue regeneration
    • A61L2430/38—Materials or treatment for tissue regeneration for reconstruction of the spine, vertebrae or intervertebral discs

Definitions

  • Bone cements and other bone filling materials are currently used throughout the skeletal system to augment or replace bone weakened or lost to disease or injury.
  • a treatment that includes the administration of bone filling material is vertebroplasty.
  • the cancellous bone of a vertebral body is supplemented with bone filling material.
  • the available bone filling materials do not possess material properties similar to the native bone. Materials, systems, and methods are needed to form and deliver bone filling materials that may be selectively matched to the natural bone undergoing treatment.
  • a method for treating a vertebral bone comprises providing a gaseous substance and providing a flowable and settable bone filling material. The method further comprises introducing the gaseous substance into the bone filling material to form a porous bone augmentation material and inserting a material delivery device into the vertebral bone. The method further comprises injecting the porous bone augmentation material from the material delivery device and into the vertebral bone.
  • a bone augmentation system comprises a first vessel at least partially filled with a gaseous substance and a second vessel at least partially filled with a flowable and settable bone filling material.
  • the system further comprises a mixing vessel in fluid communication with both the first and second vessels to receive the gaseous substance and the flowable and settable bone filling material.
  • the mixing vessel includes a mixing mechanism for mixing the gaseous substance and the bone filling material to form a bone augmentation material.
  • the system also includes a dispensing instrument comprising a dispensing reservoir for receiving the bone augmentation material and comprising a cannulated member adapted to deliver the bone augmentation material into a body region adjacent cancellous bone.
  • a method of augmenting a bone comprises pressurizing a gaseous substance, mixing the gaseous substance and a flowable bone filling material to form a bone augmentation material, injecting the bone augmentation material into the bone, and allowing the bone augmentation material to set to a hardened and porous condition within the bone.
  • FIG. 1 is a flowchart for a process of forming a modulated bone augmentation material according to one embodiment of the disclosure.
  • FIG. 2 is a cross-sectional view of a material preparation system according to one embodiment of the present disclosure.
  • FIG. 3 is a cross-sectional view of a material preparation system according to another embodiment of the present disclosure.
  • FIG. 4 is a sagittal view of a section of a vertebral column.
  • FIG. 5 is a sagittal view of a section of a vertebral column undergoing a vertebroplasty procedure using a porous bone augmentation material.
  • FIGS. 6-7 are detailed views of the procedure of FIG. 5.
  • FIG. 8 is a sagittal view of a section of a vertebral column with an intervertebral disc treated with porous bone filling material.
  • the present disclosure relates generally to devices, methods and apparatus for augmenting bone, and more particularly, to methods and instruments for augmenting bone with a porous material.
  • the reference numeral 10 refers to a method for forming a modified or modulated bone augmentation material that may better correspond to the material properties, including the modulus of elasticity, of a target bone region as compared to unmodulated bone filling material such as bone cement.
  • a gaseous substance may be provided to a material preparation system 20 as shown in FIG. 2.
  • a vessel 22 may be filled with a gaseous substance 24 such as air.
  • the vessel 22 may be connected, either releasably or fixedly, to connective tubing 26.
  • the vessel 22 has a syringe-like configuration, comprising a reservoir 28 which contains the gaseous substance 24 and a plunger 30 which may be moved through the reservoir 28 to pressurize the gaseous substance and to dispense the gaseous substance through the connective tubing 26.
  • the contents of the vessel may be pressurized by any known means or alternatively, the gaseous substance may be provided in prepackaged, pressurized form such as a compressed gas, such as carbon dioxide, nitrogen, or oxygen (as will be described below).
  • an appropriate bone filling material may be selected.
  • suitable bone filling materials may include polymethylmethacrylate (PMMA) bone cement, calcium phosphate bone cement, calcium sulfate compounds, calcium aluminate compounds, aluminum silicate compounds, hydroxyapatite compounds, in situ curable ceramics or polymers, or other flowable materials that become more rigid after delivery.
  • PMMA polymethylmethacrylate
  • the bone filling material may have a higher modulus of elasticity than the target bone region.
  • the bone filling material may be provided as multiple components such as, a PMMA powder and a PMMA monomer.
  • the order in which the gaseous substance and the bone filling material are introduced is merely exemplary, and it is understood that the bone filling material may be introduced first or contemporaneously with the introduction of the gaseous material.
  • a bone filling material 32 which in this embodiment is a bone cement, may be provided to the material preparation system 20.
  • a vessel 34 may be filled with the bone filling material 32.
  • the vessel 34 may be connected, either releasably or fixedly, to the connective tubing 26.
  • the vessel 34 has a syringe-like configuration, comprising a reservoir 36 which contains the bone filling material 32 and a plunger 38 which may be moved through the reservoir 36 to dispense the bone filling material 32 through the connective tubing 26.
  • the contents of the vessel may be pressurized by any known means or alternatively, the gaseous substance may be provided in prepackaged, pressurized form.
  • the gaseous substance 24 may flow through the connective tubing 26 and into a mixing vessel 40 where it becomes introduced into the liquid bone filling material 32 which has traveled through the tubing 26 from the vessel 34.
  • the mixing vessel 40 may be a static mixer comprising fixed mixing elements 42. As the two flow streams of gas 24 and bone filling material 32 move through the static mixer 40, buffeted by the mixing elements 42, bubbles of the gaseous substance 24 may form within and become dispersed throughout the bone filling material 32 to form a porous modulated bone augmentation material 43.
  • the gaseous substance 24 may be added until the concentration of bubbles in the liquid bone augmentation material 43 is sufficient to lower the overall modulus of elasticity of the final cured or hardened modulated bone augmentation material to a level that more closely matches the modulus of the target bone region or that at least reduces the risk of damage to the adjacent bone that could otherwise be caused by the unmodulated bone cement.
  • it may be desirable to reduce the modulus of elasticity to a level lower than natural cancellous bone.
  • a modulus of elasticity for hardened bone augmentation material that is less than five times that of cancellous bone may be suitable for some patients.
  • the mixing vessel may comprise an agitator for mixing the gaseous substance and the bone filling material.
  • a gas diffuser or aerator may be used to disperse the gaseous substance throughout the bone filling material.
  • the material preparation system 20 may further include a control mechanism 44, such as a valve, to control the flow of the gaseous substance 24 into the mixing vessel 40.
  • a control mechanism 44 such as a valve
  • the valve 44 With the valve 44 in an open position, a continuous flow of gaseous substance 24 may be dispensed from the vessel 22 into the mixing vessel 40.
  • the valve 44 may also be toggled between open and closed positions to provide intermittent bursts of gas flow. Further, the valve 44 may be used to control the velocity of the flowing gaseous substance 24 and the pressure within the vessel 22.
  • control valve 44 may be used to control the size and density of the bubbles that form in the fluid modulated bone augmentation material, and ultimately the size and density of the pores that are formed in the hardened modulated bone augmentation material.
  • larger pores may impart a lower modulus than the same quantity of smaller pores.
  • a higher density of pores may impart a lower modulus to the bone filling material than would a less dense array of pores of the same size and material properties.
  • the desired size and density of the pores may be dependent upon the size of the target bone region and characteristics of the patient including the age, bone density, body mass index, or health of the patient.
  • an elderly osteoporotic vertebroplasty patient may require a more reduced modulus bone augmentation material than would a young healthy trauma victim undergoing a similar procedure.
  • the size of the pores may be selected based upon the patient and controlled by pressurization, flow rate, a pattern of intermittent introduction of the gaseous substance, or other means. For example, 90% of the pores may be in the range of 1 to 2000 microns in diameter. Other suitable pore sizes may range from 10 to 1000 microns.
  • additives may be added to the bone filling material during the preparation of the bone filling material or during the mixing of the gaseous substance.
  • Additives that include radiocontrast media may be added to the bone filling material to aid in visualizing the bone augmentation material with imaging equipment.
  • Suitable radiocontrast materials may include barium sulfate, tungsten, tantalum, or titanium.
  • Osteoconductive or osteoinductive materials may be added to promote bone growth into the hardened bone augmentation material.
  • Suitable osteoconductive materials may include hydroxyapatite (HA), tricalcium phosphate (TCP), HA-TCP, calcium phosphate, calcium sulfate, calcium carbonate, and/or bioactive glasses.
  • Suitable osteoinductive materials may include proteins from transforming growth factor (TGF) beta superfamily, or bone-morphogenic proteins, such as BMP2 or BMP7.
  • Pharmacological agents may be added to promote healing and prevent or fight infection.
  • Suitable pharmacological additives may include antibiotics, anti-inflammatory drugs, or analgesics.
  • the modulated bone augmentation material may be delivered into a target bone region in a patient's anatomy.
  • the modulated bone augmentation material may be transferred to a delivery system, such as a syringe or a threaded material dispensing system prior to delivery into the target bone region.
  • a delivery system such as a syringe or a threaded material dispensing system
  • the bone filling material and the gaseous substance may be mixed in the same container that will be used to dispense the mixture such that a material transfer becomes unnecessary.
  • a gas cartridge can be directly attached to the delivery nozzle of a known bone cement delivery instrument.
  • target bone region will often be in a bone
  • other bone regions such as joints, may receive the modulated bone augmentation material to, for example, promote fusion.
  • target bone regions may be fractured cortical or cancellous bone, osteoporotic cancellous bone, or degenerated intervertebral discs.
  • a material preparation system 50 may be substantially similar to the system 20 with the differences to be described.
  • a vessel 52 may be filled with a compressed gaseous substance 53 such as carbon dioxide.
  • the gaseous substance 53 may flow into a mixing vessel 56 where it may be dispersed throughout a bone filling material 54 from a vessel 55.
  • the vessel 52 may be removable from connective tubing 58 through the use of quick- connect fasteners, threaded fasteners, clamp fasteners, or other suitable fasteners.
  • the gaseous substance 53 may be provided in a pre-measured, pre-filled, pre-pressurized interchangeable cartridge format that may simplify the bone augmentation material preparation process.
  • a modulated bone augmentation material formed by method 10 may be used to augment or replace portions of a vertebral column.
  • the reference numeral 60 refers to a healthy vertebral joint section of a vertebral column.
  • the joint section 60 includes adjacent vertebrae 62, 64 having vertebral bodies 66, 68, respectively.
  • An intervertebral disc 70 extends between the vertebral bodies 66, 68.
  • FIG. 4 generally depicts a lumbar region of the spine, it is understood that the systems, materials, and methods of this disclosure may be used in other regions of the vertebral column including the thoracic or cervical regions.
  • vertebral body portion 68 of the vertebra 64 may begin to collapse, causing pain and loss of bone height.
  • One procedure for restoring the vertebral height, reducing pain, and/ or building mass is known as vertebroplasty.
  • a stylet or other sharpened instrument (not shown) may be inserted into an injection instrument such as a cannula 72 and arranged so that a sharpened tip protrudes through the end of the cannula.
  • the assembled stylet and cannula 72 may then be inserted through a pedicle of the vertebra 64 and into the cancellous bone of the vertebral body 68. This insertion may be guided through the use of fluoroscopy or other imaging modalities. With the cannula 72 in place in the vertebral body 68, the stylet may be withdrawn leaving the cannula in place to serve as a pathway for delivering instruments or materials into the bone. In alternative embodiments, a surgical needle having a cannulated body and a pointed tip may be used to access the vertebral body.
  • a modulated bone augmentation material 74 comprised of bone cement 76 and bubbles of gaseous substance 78 may be formed and transferred to a delivery system 80.
  • the delivery system 80 may be a conventional syringe, having a material reservoir and a plunger mechanism movable therethrough, or a more sophisticated threaded injection system such as the type covered by, for example, U.S. Patent No. 6,348,055 which is incorporated by reference herein. Other types of material delivery systems may also be suitable.
  • the delivery system 80 may be actuated, such as by moving the plunger mechanism into the material reservoir, to move the bone augmentation material 74 through the cannula 72 and into the vertebra 64 where the mixture may flow into the interstices of the cancellous bone of the vertebral body 68 as shown in FIG. 7.
  • the bubbles of gaseous substance 78 shown in FIG. 7 are not necessarily to scale but rather are merely exemplary of the random disbursement of the bubbles of gaseous substance which will later form pores within the hardened bone augmentation material.
  • the pores may have different sizes and/or properties. Further, the density of pores may be determined based upon the amount the original bone filling material must be modified to achieve an acceptable modulated bone augmentation material.
  • the modulated bone augmentation material 74 may be cured or otherwise allowed to harden within the vertebral body 68.
  • the bubbles of gaseous substance 78 may remain suspended in the hardened bone cement 76, forming pores which reduce the overall stiffness of the modulated bone augmentation material 74.
  • the modulus of elasticity of the hardened modulated bone augmentation material 74 may be lower than that of the unmodulated hardened bone filling material 76, alone, and closer to the modulus of elasticity of the cancellous bone of the vertebral body 68 than that of the hardened bone filling material alone.
  • the material 74 creates a more uniform stiffness in the vertebral body 68, avoiding the significant alterations in stress distribution that would be associated with the use of bone cement alone.
  • the more uniform stiffness in the vertebral body 68 may lower the risk for fracture in the adjacent vertebrae.
  • modulated bone augmentation material 74 has been described for use in a vertebroplasty procedure, it is understood that in alternative treatments, channels or voids may be formed in the vertebral body using probes, balloons, drills, cutting blades or other devices. In these embodiments, the mixture of gaseous bubbles and bone filling material may be used to fill the preformed voids or channels. The resulting reduced modulus material may be particularly effective in these embodiments as the otherwise unmodulated, large concentrations of bone cement accumulating in the preformed voids may give rise to significant alteration is the stress distribution.
  • modulated bone augmentation material has been described primarily for vertebral body applications, it is understood that the same modulated material may be used for other procedures where reduced modulus bone cement may be desirable.
  • the modulated material may be useful for fracture repair.
  • a modulated bone augmentation material 81 may be created using the method 10 and may be used to fuse the joint section 60.
  • the fusion of the joint 60 may be accomplished using conventional fusion techniques including transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), or anterior lumbar interbody fusion (ALIF) procedures.
  • TLIF transforaminal lumbar interbody fusion
  • PLIF posterior lumbar interbody fusion
  • ALIF anterior lumbar interbody fusion
  • Such techniques may involve the use of cages or other intervertebral spacers to maintain the height of the disc space.
  • the modulated material 81 may be injected into the disc 70 or the disc space remaining after the removal of disc 70.
  • the modulated material 81 may flow into crevices, voids, or prepared areas of the adjacent vertebral endplates. After hardening, the material 81 may have a modulus of elasticity similar to that of the adjacent endplates of the vertebrae 62, 64, or at least lower than unmodulated bone cement. Use of the modulated material 81 may reduce the risk of the hardened material subsiding into the endplates of the adjacent vertebrae 62, 64.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Medical Informatics (AREA)
  • Dispersion Chemistry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Neurology (AREA)
  • Biomedical Technology (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Dermatology (AREA)
  • Medicinal Chemistry (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Epidemiology (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)

Abstract

L'invention concerne un procédé de traitement d'un os vertébral qui comprend la fourniture d'une substance gazeuse et d'un matériau de remplissage d'os fluide et durcissable. Le procédé comprend en outre l'introduction de la substance gazeuse dans le matériau de remplissage d'os pour former un matériau d'augmentation osseuse poreux et l'insertion d'un dispositif d'administration de matériau dans l'os vertébral. Le procédé comprend en outre l'injection du matériau d'augmentation osseuse poreux à partir du dispositif d'administration de matériau et dans l'os vertébral.
PCT/US2008/050702 2007-01-12 2008-01-10 Système et procédé de formation d'un matériau de remplissage d'os poreux Ceased WO2008089019A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US11/622,570 2007-01-12
US11/622,570 US8926623B2 (en) 2007-01-12 2007-01-12 System and method for forming porous bone filling material

Publications (2)

Publication Number Publication Date
WO2008089019A2 true WO2008089019A2 (fr) 2008-07-24
WO2008089019A3 WO2008089019A3 (fr) 2009-08-27

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PCT/US2008/050702 Ceased WO2008089019A2 (fr) 2007-01-12 2008-01-10 Système et procédé de formation d'un matériau de remplissage d'os poreux

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Family Cites Families (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AU7324394A (en) * 1993-07-06 1995-02-06 Michael L. Earle Bone cement delivery gun
DE50009584D1 (de) * 2000-01-18 2005-03-31 Zimmer Gmbh Winterthur Pistole zum Auspressen von Knochenzement mit einer aufsetzbaren Zementspritze
US6547866B1 (en) * 2000-10-30 2003-04-15 Howmedica Osteonics Corp. Porous calcium phosphate cement
US7029163B2 (en) * 2002-10-07 2006-04-18 Advanced Biomaterial Systems, Inc. Apparatus for mixing and dispensing components
ITBO20020650A1 (it) * 2002-10-15 2004-04-16 Fin Ceramica Faenza Srl Ora Fin Ceramica Faenza Procedimento per la realizzazione di articoli porosi calcio fosfatici per la rigenerazione ossea e come supporto per cellule e gli articoli porosi stessi.
US8038682B2 (en) * 2004-08-17 2011-10-18 Boston Scientific Scimed, Inc. Apparatus and methods for delivering compounds into vertebrae for vertebroplasty
EP1786344B1 (fr) * 2004-09-10 2010-12-01 Kieran P. Murphy Aiguille à ciment
US8840618B2 (en) * 2007-01-12 2014-09-23 Warsaw Orthopedic, Inc. System and method for pressure mixing bone filling material

Also Published As

Publication number Publication date
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