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WO2020187463A1 - Dispositif de liaison pour relier deux parties d'os - Google Patents

Dispositif de liaison pour relier deux parties d'os Download PDF

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Publication number
WO2020187463A1
WO2020187463A1 PCT/EP2020/051423 EP2020051423W WO2020187463A1 WO 2020187463 A1 WO2020187463 A1 WO 2020187463A1 EP 2020051423 W EP2020051423 W EP 2020051423W WO 2020187463 A1 WO2020187463 A1 WO 2020187463A1
Authority
WO
WIPO (PCT)
Prior art keywords
rod
connecting device
end section
drive
threaded element
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/EP2020/051423
Other languages
German (de)
English (en)
Inventor
Augustin Betz
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.)
Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Priority to EP20701581.9A priority Critical patent/EP3937808A1/fr
Publication of WO2020187463A1 publication Critical patent/WO2020187463A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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
    • 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
    • A61B17/72—Intramedullary devices, e.g. pins or nails
    • A61B17/7216—Intramedullary devices, e.g. pins or nails for bone lengthening or compression

Definitions

  • the invention relates to a connecting device for connecting two bone parts, in particular for bridging a gap in the bone, for lengthening or shortening the bone, which extends from a first end section connectable to the first bone part to a second end section connectable to the second bone part and which has an adjustment mechanism, wherein the distance between the first end section and the second end section can be changed by repeatedly actuating the adjustment mechanism in each case by a predefined or predefinable adjustment path.
  • Such connecting devices can in particular be designed as intramedullary distraction nails, which are state of the art medical technology and, inter alia, from the publications DE19700225A1, DE3921972A1, US9179938B2 and
  • CA2917676A1 are known. Such devices are used to lengthen long bones, e.g. to be able to restore the original bone length after tumor removal or after bone inflammation.
  • Distraction intramedullary nails have significant advantages over external distraction devices in which the bone parts are connected to the outside through the skin with an adjustable frame, which on the one hand results in an unfavorable application of force and on the other hand there is a constant risk of infection through the penetration of germs.
  • Distraction medullary nails of this type can have an adjustment mechanism, each actuation of the adjustment mechanism distancing the two bone parts from one another by a step or a provided adjustment path.
  • a bone lengthening by means of a distraction marrow nail a shortening of bones, in particular tubular bones, is indicated in certain medical or cosmetic cases, in which the use of gradually shortening implants, referred to here as contraction marrow nails, can be advantageous.
  • All known intramedullary distraction nails solve the task at hand, the adjustment of the length of a bone, through various compromises with regard to size, strength, technical complexity, reliability, patient comfort and production costs. All known systems perform a straight bone lengthening that does not take into account the physiological curvature of the bones.
  • a connecting device with the features of claim 1 and in particular in that the actuation of the adjustment mechanism comprises at least one translational, manually executable relative movement between the two end sections, in particular a manual pulling on the second end section away from the first end section and / or manual pulling on the first end section away from the second end section.
  • connection device With such a construction, a technically simple and robust connection device can be realized which is highly reliable due to its low complexity.
  • the possibility of manual actuation of the adjustment mechanism can initially replace implant types that use expensive and complex electromechanical, hydraulic or memory metal drives and are often error-prone, low-drive and only have a low load capacity, so that the connection device can withstand high loads low manufacturing costs can be achieved.
  • Such a resilient connection device can in particular enable the patient a high level of everyday comfort and ensure continuous mobilization, whereby the healing process can be significantly accelerated.
  • the construction according to the invention can also replace implant types that involve a rotating actuation that is often painful for the patient an adjustment mechanism work. Furthermore, such a translational movement, in particular for lengthening or shortening bones, can be perceived by a patient as more logical or more natural and, regardless of the pain sensation, less unpleasant than a rotational movement because the movement corresponds to the desired effect. The process of learning how to operate the adjustment mechanism by the patient can thus be accelerated due to the less overcoming.
  • the simple manual actuation also enables the patient to comfortably and independently bring about a continuous lengthening or shortening of the distance between the connected bone parts during the lengthening or shortening process, without there being a relevant risk of incorrect actuation.
  • the distance between the two end sections By changing the distance between the two end sections by a predetermined travel each time the adjustment mechanism is actuated, the current distance or the already achieved lengthening or shortening of the bone can also be easily checked and documented.
  • the speed at which a bone is to be lengthened can also be coordinated with a treating doctor and carried out in an uncomplicated manner by using a Patient carries out an agreed number of actuations of the adjustment mechanism per day or time unit.
  • connection device particularly due to the simple design of the adjustment mechanism, highly corrosion-resistant materials can be used for all components and sealing elements can be dispensed with, which are usually intended to protect the internal corrosion-prone mechanism from the effects of aggressive body fluids.
  • the connection device can be made permeable to body fluid by eliminating the sealing elements, so that a gas-filled space within the connection device can be avoided.
  • a change in air pressure prevents gas and possibly aged body fluid influenced by corrosion from escaping, which can lead to extreme pain at greater geodetic heights, such as during a flight or when staying in the mountains.
  • avoiding corrosion can mean that the implant does not necessarily have to be removed immediately after the end of the treatment, so that in medically indicated cases the intramedullary nail can remain in the patient for an unlimited period of time.
  • the actuation of the adjustment mechanism can result in an increase in the distance between the first end section and the second end section by the adjustment path, while in other embodiments the actuation of the adjustment mechanism results in a reduction in the distance between the first end section and the second end portion can result around the travel.
  • a connecting device can thus be provided to the distance between the respective connected bone parts can be increased or decreased continuously by repeatedly operating the adjustment mechanism.
  • such a connecting device can thus be used, for example, as a distraction intramedullary nail in order to be able, for example, to enlarge a thigh bone. Equally, it is also possible to design it as a contraction medullary nail in order to continuously bring the respective bone parts closer together by reducing the distance between the two end sections.
  • the actuation of the adjustment mechanism can exclusively comprise translational relative movements between the second end section and the first end section.
  • all of these relative movements can be carried out manually and can be generated by pulling on a respective end section or by pressing on a respective end section.
  • minimal, in particular production-related, rotational components during such translational relative movements for example during a pulling of an end section, can in principle also occur and be tolerated in such embodiments.
  • the actuation of the adjustment mechanism can comprise at least two oppositely directed, directly successive manual actuation steps, in particular manual pulling followed by manual pushing.
  • the setting mechanism can be returned to an initial state by the second, opposite movement and the actuation of the setting mechanism can be completed, so that the distance between the two end sections has changed by the setting path after this movement has been completed.
  • the adjustment mechanism can then, starting from the initial state, be actuated again in order to again change the distance between the first end section and the second end section around the adjustment path and to adjust this distance step by step.
  • the actuation of the adjustment mechanism can be started by manually pulling the second end section away from the first end section and / or by manually pulling the first end section away from the second end section.
  • Such a manual pulling can consequently initiate or initiate the actuation of the adjustment mechanism, wherein in particular a first part of the adjustment path can already be covered during or as a result of the pulling.
  • an unlocking process in the adjustment mechanism can be triggered by pulling, for example, in order to enable the adjustment path to be covered in a further step of actuating the adjustment mechanism.
  • the adjustment mechanism can be operated by manually pressing the second end section in the direction of the first end section following the manual pulling on the second end section or by pressing the first end section towards the second end section following the manual pulling on the first end section be.
  • the travel or part of the travel can be covered during or as a result of the manual pressing.
  • the setting mechanism can be reset to an initial state from which actuation can take place again.
  • the second end section can be arranged on a rod and the first end section can be arranged on a tube, the rod being partially arranged inside the tube and a length of a section of the rod being changeable by actuating the adjustment mechanism protrudes from the pipe.
  • the end sections can in particular be formed by the rod or the tube, so that the rod or the tube can be connected to the associated bone parts at their respective end sections.
  • one or more bores can be provided on the end sections through which the respective end section or the rod or the tube can be connected to the associated bone parts by means of screws.
  • the rod and the tube can have a circular cross section, and the tube can in particular be designed as a hollow cylinder. In principle, however, other cross-sectional shapes are also possible, for example rectangular or polygonal or polygonal designs are possible.
  • the cross-sections of the rod and the tube can correspond or be of the same type, or different cross-sections can be provided for the two parts. In this case, for example, an insert element can be arranged within the tube which matches an inner wall of the tube to the cross section of the rod guided inside the tube.
  • the tube and / or the rod can be curved.
  • the tube and the rod can be straight.
  • a straight design can enable simple manufacture and assembly with high load capacity of the connecting device and can be used in particular to lengthen or shorten straight bones, to bridge only short distances or, for example, as a spinal distraction or contraction system for the surgical treatment of curvatures of the spine .
  • a curved design of the tube and / or the rod can be provided, in particular in the case of a connecting device used as an intramedullary nail, wherein the curvature can correspond in particular to the physiological curvature of the bone to be lengthened or shortened.
  • the rod can be guided inside the tube in a manner secure against rotation, wherein the rod can in particular have a feather key which is guided along the extension of the connecting device in a groove formed inside the tube.
  • the groove can run in a straight line or curved, in particular on an inner surface of the pipe and accordingly, depending on the design of the pipe.
  • the rod can also have the groove and the tube the feather key in order to achieve a torsion-proof guidance of the rod.
  • relative rotational movements between the rod and the tube can be excluded or at least limited, taking into account possible manufacturing tolerances. Such movements of the two connected bone parts relative to one another, which may be painful for the patient, can accordingly be avoided.
  • the adjustment mechanism can be arranged between the first end section and the second end section.
  • the adjustment mechanism can be arranged inside the tube.
  • the adjustment mechanism can interact with an end of the rod opposite the second end section and, when the adjustment mechanism is actuated, push the rod out of the tube or enable it to be moved into the tube.
  • the connection device can be protected against impacts, for example, by arranging the adjustment mechanism inside the pipe, while conversely no components arranged outside the pipe which could possibly impair the healing process need to be provided.
  • the tube can have an internal thread and the adjustment mechanism can have a threaded element with an external thread, which is rotatably guided in the internal thread. Due to the thread pitch, a rotation of the thread element can result in a translational movement Component comprise, wherein the threaded element can move away from the first end section or towards the first end section depending on the thread pitch or the direction of rotation. As a result of the interaction of the thread element with the rod, this translational movement component can consequently also be transmitted to the rod in order to reduce the distance between the first end section arranged on the tube or formed by the tube and the end section arranged on the rod or from the To change rod formed second end portion.
  • the threaded element can have a locking toothing on the rod side and the rod can have a locking toothing opposite the second end section, which in a locked position of the rod engages with the locking toothing of the threaded element on the rod side, the engagement being able to block a rotation of the threaded element .
  • the blocking position of the rod relates in particular to a position along the extension of the connecting device, so that the rod can be guided out of the blocking position by translational movements.
  • the blocking position can in particular represent a starting point from which, in principle, the adjustment mechanism can be actuated in order to adjust the distance between the two end sections.
  • the blocking position can represent an end point of the actuation of the adjustment mechanism, at which the rod is positioned at the end of the actuation in order to enable a renewed actuation.
  • connection device Since a rotation of the threaded element is blocked in this blocking position, an undesired change in the distance between the actuations of the adjustment mechanism can be avoided. In this way, in particular, the load-bearing capacity of the connection device can be guaranteed between deliberately executed distance adjustments, so that a patient can, for example, use the Connection device connected leg bones can be easily mobilized and walk or stand.
  • the rod-side locking toothing of the threaded element and the rod locking toothing can be designed symmetrically.
  • the respective blocking teeth can be designed with tooth flanks that correspond to one another and in such a way that they can be brought into exact engagement with one another. Such an exact engagement can achieve a reliable blocking effect of the threaded element when the rod is in the blocking position.
  • the rod can be transferred by manual pulling from the blocking position into a release position in which the rod blocking toothing releases the rod-side blocking toothing of the threaded element. In this release position, the rod blocking toothing can consequently be out of engagement with the rod-side blocking toothing and release the threaded element for rotation.
  • This pulling which can take place in particular on the bone part connected to the second end section, for example a lower leg, can correspondingly represent a start of the actuation of the adjustment mechanism in order to rotate the threaded element and the associated translational displacement of the same enable or initiate.
  • a relative pulling movement between the two end sections can be achieved by pulling the second bone part in this way, in order to be able to move the rod relative to the tube and thereby to be able to operate the adjustment mechanism.
  • the adjustment mechanism can have a drive element which has a drive toothing on the thread element side, via which the drive element with a drive toothing facing away from the rod tion of the threaded element can be connected, wherein the drive toothing of the threaded element facing away from the rod can be offset by a deflection distance with respect to the threaded element-side drive toothing of the drive element with respect to a direction of rotation of the threaded element.
  • This offset between the drive toothing of the threaded element facing away from the rod and the threaded element-side drive toothing of the drive element can in particular be provided in a starting position from which the adjustment mechanism can be actuated.
  • the rod can in particular be in the blocking position mentioned.
  • a further element which is coupled to the threaded element in a rotationally fixed manner can also be provided, which has a toothing that faces the drive element and is offset with respect to the drive toothing on the threaded element side.
  • a torque can be transmitted to the threaded element by a translational movement of the drive element in the direction of the threaded element or the second end section. This can be done, for example, by manually pulling the rod, which can be coupled or connected to the drive element in order to be able to transmit the translational movement.
  • the rod can be brought into a release position which enables the threaded element to rotate. Due to the offset of the respective drive toothings with respect to one another, rotation can be transmitted to the threaded element during or as a result of pulling on the rod and at least part of the travel can be covered.
  • the drive element can be guided within the tube in a manner secure against rotation, wherein the drive element can in particular have a feather key, which is guided along the extension of the connecting device in a groove running inside the tube.
  • this can be the drive element-guiding groove correspond to the groove already mentioned for guiding the rod inside the tube.
  • the drive element can also have the groove, while the feather key is formed on an inside of the tube.
  • the non-rotating guidance of the drive element can clearly define and specify the deflection distance by which the drive gears are offset from one another, especially in an initial state for actuating the setting mechanism, and it can be ensured that the drive gears are always activated after the setting mechanism are again just offset from one another by the specified deflection distance.
  • the drive teeth of the drive element and the threaded element can be biased into engagement with one another by biasing the drive element in the direction of the threaded element. Due to the drive toothing of the drive element on the thread element side, a pretensioning-related axial force can thus be exerted on the threaded element, which results in a torque acting on the threaded element as a result of the offset of the drive toothings with respect to one another. While the rod is in the blocking position, this torque can be absorbed by the interlocking blocking teeth of the rod and the threaded element and the non-rotating guidance of the rod and undesired rotation of the threaded element can be prevented.
  • the threaded element By moving the rod into the release position in which the blocking teeth are out of engagement with one another, the threaded element can, on the other hand, execute a rotational movement, the drive teeth being able to come into complete engagement with one another by overcoming the mutual offset.
  • the rod can be connected to the drive element by a connecting element, in particular a screw screwed into the rod, with manual pulling on the first end section or on the second end section exerting a force in the direction of the second end section Drive element is transferable.
  • a torque can be transmitted to the threaded element through this force and the offset of the drive gears with respect to one another.
  • a further force can be transmitted to the drive element in order to increase the torque on the threaded element.
  • the force necessary to generate a torque can be applied exclusively by manual pulling, without pretensioning by a spring element.
  • the connecting element can extend inside the tube from a side of the drive element facing away from the rod, through the drive element and the threaded element, and can be anchored to the rod.
  • Such an anchoring allows, in particular, a translational movement of the rod relative to the tube, for example by manual pulling or pushing, to be transmitted directly to the connecting element and from this to the drive element.
  • the connecting element can have a stop which limits a movement of the connecting element in the direction of the second end section relative to the drive element, wherein the connecting element can in particular be designed as a screw with a stepped shaft which forms the stop.
  • this distance can be the distance between a blocking position of the rod in which the respective blocking Locking teeth of the rod and the threaded element are in engagement and block rotation of the threaded element, corresponding to a release position in which the blocking teeth are out of engagement and the threaded element is released for a rotary movement.
  • the connecting element can comprise a spring element which, as a result of manual pulling on the first end section or on the second end section, exerts a force on the drive element in the direction of the second end section.
  • the spring element can be effective between the connecting element, in particular a head of a screw forming the connecting element, and the drive element.
  • a spring element can be compressed or compressed, for example, by pulling on the rod in order to transmit a force to the drive element in the direction of the second end section arranged on the rod.
  • the spring can be pre-tensioned, so that the force already exerted on the drive element by the pre-tension can be further increased by the manual pulling.
  • the spring element can be in a basic state before the adjustment mechanism is actuated, so that the spring element is only deflected or compressed by the manual pulling and exerts a force on the drive element.
  • the connecting element can have a have written stop to prevent overloading of the spring as a result of pulling on the rod.
  • the drive element can be connected to the threaded element by a connecting element, in particular by a screw screwed into the threaded element, wherein the connecting element can have a pretensioned spring element which exerts a force on the drive element in the direction of the second end portion exercises.
  • the connecting element can have a pretensioned spring element which exerts a force on the drive element in the direction of the second end portion exercises.
  • only the threaded element and drive element are consequently connected to one another, while the rod or the rod blocking toothing can be kept in engagement with the rod-side blocking toothing of the threaded element by the soft tissue tension when the connecting device is inserted.
  • the spring element can permanently exert a force on the drive element, so that a torque acts on the threaded element due to the offset of the drive teeth with respect to one another.
  • the drive element can be moved in the direction of the second end section as a result of the rod being moved into the release position and the force transmitted to the drive element by the connecting element, the threaded element being moved by the movement of the drive element due to the offset of the drive teeth a first circumferential section is rotatable.
  • a first part of the translational adjustment path can be covered which, depending on the direction of rotation of the threaded element and the thread pitch of the internal thread of the pipe, can run towards or away from the first end section arranged on the pipe.
  • the distance between the first end section and the second end section can consequently be reduced in order to achieve a contraction or shortening of the bone, while the opposite direction enables a distraction or bone lengthening.
  • the first circumferential distance can correspond to the deflection distance by which the drive gears are offset from one another.
  • the drive toothing of the drive element on the thread element side can be brought into full engagement with the drive toothing of the threaded element facing away from the rod by rotating the threaded element around the first circumferential distance while eliminating the deflection path.
  • the deflection path or the offset of the drive toothings with respect to one another can be overcome and the drive toothings can be brought into full engagement with one another.
  • the first circumferential section can accordingly correspond precisely to the deflection section.
  • the drive toothing facing away from the rod and the rod-side drive toothing can in particular be designed symmetrically in order to be able to achieve complete engagement.
  • Covering the first circumferential distance and / or reaching full engagement of the drive gears can be audible to the human ear.
  • the force required to rotate the threaded element can be transmitted to the drive element via a connecting element and a spring, with the snapback of the spring being audible as a result of the twisting of the threaded element and the achievement of complete engagement of the drive teeth.
  • a patient can thus twist the threaded element and cover the first circumferential distance perceive immediately, so that the success of this operating step can be registered and, for example, documented.
  • the change in the distance between the first end section and the second end section that occurred up to a respective point in time of the treatment or the healing process can always be traced and checked.
  • the rod-side blocking toothing of the threaded element can be displaced by the rotation of the threaded element by the first circumferential distance with respect to the rod blocking toothing of the rod by the first circumferential distance. Since the blocking teeth are disengaged from one another in the release position of the rod, the threaded element can rotate around the first circumferential distance. If the distance between two teeth of at least one of the blocking teeth does not correspond to the circumferential path, the blocking teeth can subsequently be offset from one another, while the drive teeth come into mutual engagement.
  • the threaded element can be rotated by a second circumferential distance by returning the rod from the release position to the blocking position, in particular by manually pressing the rod, due to the rod-side blocking toothing of the threaded element being offset with respect to the rod blocking toothing.
  • the sum of the translational movements of the threaded element during the rotation around the first circumferential distance and the second circumferential distance can correspond to the adjustment path by which the distance between the first end section and the second end section can be changed by actuating the adjustment mechanism.
  • the actuation of the adjustment mechanism can thus in particular comprise two steps or consist of two steps, with manual pulling on the rod followed by manual pressing on the rod.
  • a first part of the travel range can be covered during or as a result of the manual pulling and a second part of the travel range can be covered during or as a result of the manual pushing.
  • the travel is correspondingly predetermined by the thread pitch and the sum of the two circumferential distances or, in particular, predetermined during the construction of the connecting device.
  • a force can also be transmitted to a spring element, which is coupled to a connecting element, while pressing the rod and transferring the rod from the release position to the blocking position, the spring element snapping back when the blocking position is reached and an audible one Can generate noise.
  • the skipping of a tooth of the drive toothing can thus be audible, through which the rod can return to the blocking position.
  • the completion of an actuation of the adjustment mechanism can thus be acoustically perceptible, so that the success of the change in distance around the adjustment path can be determined and documented.
  • the direction of rotation around the second circumferential path can be the same as the direction of rotation around the first circumferential path.
  • the threaded element can consequently rotate in the same direction.
  • the distance between the two end sections increases or decreases accordingly, depending on the thread pitch and the direction of rotation as a result of both rotations.
  • a rotation of the thread element in the direction of rotation can result in an increase in the distance between the thread element and the first end section due to the thread pitch of the internal thread of the pipe, or a rotation of the thread element in the direction of rotation can result in a reduction in the size of the thread due to the pitch of the internal thread of the pipe Distance between the threaded element and the first end portion result.
  • Connecting Generation devices for enlarging bones and for reducing bones can thus basically have similar adjustment mechanisms, the desired effect for example by setting the thread pitch or by changing the direction of rotation, in particular by changing the offset of the drive teeth with respect to one another or the Direction of the deflection can be achieved.
  • the second circumferential distance can be greater than the first circumferential distance. Consequently, when the rod is transferred from the release position to the blocking position, a greater part of the travel can be covered than when the rod was previously transferred from the blocking position to the release position.
  • the drive toothing of the threaded element facing away from the rod can skip at least one tooth compared to the threaded element-side drive toothing of the drive element due to the twisting of the threaded element about the second circumferential distance.
  • the direction of rotation of the threaded element can consequently correspond to a freewheeling direction of the drive toothing, so that it is possible to rotate the threaded element about the second circumferential distance despite the engagement of the drive toothing.
  • the drive element can be movable relative to the threaded element in the direction of the first end section in order to jump over a tooth while the threaded element is being rotated by the second circumferential distance.
  • the drive element can be connected to the threaded element via a spring-loaded connecting element, in particular a screw with a spring acting between the head of the screw and the drive element, so that the spring is compressed as a result of the relative movement between the drive element and the threaded element.
  • a spring-loaded connecting element in particular a screw with a spring acting between the head of the screw and the drive element, so that the spring is compressed as a result of the relative movement between the drive element and the threaded element.
  • the return of the rod to the blocking position and the turning of the threaded element around the second circumferential distance can complete the actuation of the adjustment mechanism.
  • the adjustment path can consequently have been covered by the threaded element and thereby transferred to the rod, so that the distance between the first end section and the second end section has changed by this adjustment path.
  • the connecting device can act as a distraction marrow nail for lengthening bones, in particular long bones. be educated.
  • the thread pitch or the direction of rotation of the thread element can be selected in such a way that actuating the adjustment mechanism and covering the adjustment path results in an increase in the distance between the first end section and the second end section.
  • the connecting device can also be designed as a contraction medullary nail for shortening bones, in particular long bones. This can be achieved, for example, by a thread pitch that is reversed compared to a distraction intramedullary nail or a reversed direction of rotation of the thread element with the same thread pitch.
  • the intramedullary nails can in particular be designed with a curvature corresponding to the physiological curvature of a bone to be changed, whereby the introduction into the bone is made considerably easier for the surgeon, the medullary canal can be optimally used and the bone substance can be spared.
  • the invention also relates to the use of a connecting device as disclosed herein for a spinal distraction system or a spinal contraction system, in particular for treating spinal curvatures by gradually stretching and straightening the spine.
  • a connecting device as disclosed herein for a spinal distraction system or a spinal contraction system, in particular for treating spinal curvatures by gradually stretching and straightening the spine.
  • Such a system can be used to surgically treat curvatures of the spine, for example scolioses, whereby after the insertion of the connecting device, a step-by-step stretching and straightening of the spine is made possible without further surgical interventions during the correction.
  • Complex and, in particular, non-MRT-compatible systems can thus be replaced.
  • such connecting devices can be suitable for use in scoliosis in children, which require stick technology that grows with them.
  • the invention also relates to the use of a connecting device as disclosed herein as a component or supplement for a prosthesis that grows with the patient, in particular for use after a tumor resection, in particular on a child's skeleton.
  • a connecting device as disclosed herein as a component or supplement for a prosthesis that grows with the patient, in particular for use after a tumor resection, in particular on a child's skeleton.
  • the bony defect is usually bridged by a prosthesis after the tumor resection, but this can lead to considerable length deficits in the course of growth in the growing skeleton.
  • the invention also relates to a spinal distraction system or spinal contraction system, in particular for the treatment of curvatures of the spine by gradually stretching and straightening the spine, with at least one connecting device as disclosed herein.
  • the invention also relates to a prosthesis, in particular a prosthesis that grows with the patient, in particular for use after a tumor resection, in particular on a child's skeleton, with at least one connecting device as disclosed herein, in particular as a component or as a supplement to the prosthesis.
  • FIG. 1 shows a schematic representation of a connecting device designed as an intramedullary nail
  • FIG. 1 shows a connecting device 31 which is designed as a distraction intramedullary nail.
  • the connecting device 31 has a rod 1 with bores 2 in a second end section 35 formed by the rod 1, so that the rod 1 can be fastened to a first part of the bone by screws (not shown).
  • This second end section 35 is formed on a section 39 of the rod 1 which protrudes from a tube 5 within which the rod 1 is arranged.
  • the rod 1 is guided with a feather key 7 in a groove 6 within the tube 5 so as to be axially movable and free of rotation (see also section AA).
  • a nut 3 screwed into the tube 5 guides the rod 1 radially at the front end of the tube 5.
  • the tube 5 has a plurality of bores 13 through which a first end section 33 formed by the tube 5 can be fastened to a second part of the long bone.
  • the connecting device 31 has an adjustment mechanism 37 on.
  • the adjustment mechanism 37 By actuating the adjustment mechanism 37, the mentioned distance or length L can be changed by an adjustment path S (cf. also FIGS. 2A to 2D).
  • the adjustment mechanism 37 initially comprises a threaded element 8 which is screwed into an internal thread 4 of the tube 5 and in which the rod 1 engages with a blocking toothing 17 (see also section BB).
  • the rod 1 has a rod blocking toothing 17a which engages in a rod-side blocking toothing 17b of the threaded element 8 and together with this forms the blocking toothing 17.
  • the threaded element 8 is also in contact with a drive element 9 on a side facing away from the rod 1 via a drive toothing 16.
  • the drive toothing 16 is formed by a drive toothing 16a of the threaded element 8 facing away from the rod and a threaded element-side drive toothing 16b of the drive element 9.
  • the drive element 9 can also be moved axially by a feather key 10 in the tube 5, but is non-rotatably guided (see also section CC).
  • the rod 1, the threaded element 8 and the drive element 9 are braced in the direction of the extension E of the connecting device 31 by means of a connecting element 12 anchored in the rod 1, which is designed as a screw 12, and a spring element 11.
  • the spring element 11 can exert a pretension on the toothings 16 and 17, although this does not necessarily have to be provided.
  • the shoulder 41 resulting from the two different diameters 14 and 15 of the shaft 43 of the screw 12 serves as an axial stop 41 or a stop 41 acting in the direction of the second end section 35 and running against the drive element 9. This stop 41 can overload the Prevent the spring element 11 by a relative movement between the screw 12 or its head 45, to which the spring element 11 is connected, and the drive element 9 is limited by the stop 41.
  • the rod 1 In the initial state shown in FIG. 2A for actuating the adjustment mechanism 37, the rod 1 is in a blocking position Q in which the blocking teeth 17 are completely closed and the drive teeth 16 are offset by the deflection distance b.
  • the axial spring force or spring force acting in the direction of the second end section 35 exerts a torque on the threaded element 8 via the drive toothing 16, which in turn is prevented from rotating by the interlocking locking teeth 17a and 17b
  • the rod 1 By pulling on the rod 1 in direction a, the rod 1 can be brought into a release position F, in which the blocking toothing 17 is out of engagement (cf. FIG. 2B).
  • the threaded element 8 can then rotate by the torque acting via the tooth flanks of the drive toothing 16 along a direction of rotation R by a first circumferential distance U, the drive toothing 16 being completely closed and the blocking toothing 17 being offset by the first circumferential distance U, see Figure 2B. Pulling on the rod 1 or on the second end section 35 away from the first end section 33 can thus represent a first step in the actuation of the adjustment mechanism 37.
  • the threaded element 8 When the rod 1 is pushed back or pressed in the direction d, the threaded element 8 is rotated further in the direction of rotation R by the tooth flanks 18 of the blocking teeth 17 by a second circumferential distance e (see FIGS. 2C and 2D).
  • the drive toothing 16 skips over a tooth, the position of a tooth 47 being marked in FIGS. 2C and 2D before and after the pressing to illustrate this skipping.
  • the drive toothing 16 In order to enable this skipping or turning of the threaded element 8 by the second circumferential distance e, the drive toothing 16 has an axial degree of freedom f, so that the drive element 9 moves relative to the threaded element 8 in the direction of the first end section 33 during the rotation can.
  • the spring element 11 Since the spring element 11 is tensioned during this relative movement, the spring element 11 snaps back when the locking position Q of the rod 11 is reached, as a result of which a noise audible to the human ear is generated. As a result, the success of the actuation of the adjustment mechanism 37 can be immediately traced and for example can be easily documented by the patient. In the same way, such a noise can also be achieved during the previous pulling on the rod when the drive toothings 16a and 16b come into engagement with one another.
  • FIG. 2D shows, the initial state of the adjustment mechanism 37 is restored after pressing and the threaded element 8 and the rod 1 are advanced by an increment resulting from the thread pitch and the tooth pitch, the adjustment path S.
  • pressing the rod 1 or transferring the rod 1 from the release position F into the blocking position Q can complete the actuation of the adjustment mechanism 37.
  • the drive toothing 16 is again offset by the deflection distance b so that the intramedullary distraction nail can be gradually extended to the desired length by repeating the process or actuating the adjustment mechanism 37.
  • the distance between the first end section 33 and the second end section 35 or the length L of the section 39 of the rod 1 protruding from the tube 5 can be increased by the travel S.
  • the function of the adjustment mechanism 37 can also be given without the spring element 11, but without the intended acoustically clearly perceptible click when the adjustment mechanism 37 is actuated, which is considered to be a helpful control of every successful extension step. If such an acoustic control is not required, the spring element 11 can be omitted. In this case, the force required to rotate the threaded element 8 on the drive element 9 is achieved at the end of the pulling movement of the rod 1 by the shaft section 14 abutting the drive element 9 or the stop 41 of the screw 12.
  • each actuation of the setting mechanism 37 results in an increase in the distance between the first end section 33 and the second end section 35 by the travel S
  • a connecting device 31 for shortening bones in particular a contraction medullary nail
  • the thread pitch of the internal thread 4 can be reversed, so that a rotation of the thread element 8 in the direction of rotation R results in a translational movement component towards the first end section 33.
  • the direction of rotation R of the threaded element 8 can be reversed, for which purpose, in particular, the offset of the drive toothing 16 or the direction of the deflection path b can be adapted.
  • a connecting device 31 can in particular be used as a spinal

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
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  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif de liaison pour relier deux parties d'os, en particulier pour ponter une rupture entre des parties d'os, pour prolonger un os ou pour raccourcir un os. Ledit dispositif de liaison s'étend d'une première section d'extrémité pouvant être reliée à la première partie d'os, à une seconde section d'extrémité pouvant être reliée à la seconde partie d'os, et comprend un organe mécanique de réglage. La distance entre la première section d'extrémité et la seconde section d'extrémité peut être modifiée à chaque fois, par un actionnement répété de l'organe mécanique de réglage, selon un trajet de réglage prédéfini ou pouvant être prédéfini, et l'actionnement de l'organe mécanique de réglage comporte au moins un mouvement relatif, translatoire, s'étendant le long de l'étendue du dispositif de liaison et exécutable manuellement, entre les deux sections d'extrémité.
PCT/EP2020/051423 2019-03-15 2020-01-21 Dispositif de liaison pour relier deux parties d'os Ceased WO2020187463A1 (fr)

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DE102019001835.4 2019-03-15
DE102019001835 2019-03-15
DE102019003633.6 2019-05-23
DE102019003633 2019-05-23

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Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102020116489A1 (de) 2020-06-23 2021-12-23 Augustin Betz Verlängerungsvorrichtung für kleine Röhrenknochen
CN113974809A (zh) * 2021-12-15 2022-01-28 河北医科大学第三医院 胫骨髓内钉
CN115813522A (zh) * 2022-12-05 2023-03-21 无锡市第九人民医院 一种胫骨平台骨折复位固定导向设备
DE102021127020A1 (de) 2021-10-19 2023-04-20 Augustin Betz Gekrümmter Marknagel
DE102022000228A1 (de) 2022-01-22 2023-07-27 Trauma-Stiftung gemeinnützige Gesellschaft für Klinik - Forschung - Lehre mbH Rotationsadaptiver Knochenmarknagel
CN118078405A (zh) * 2024-04-18 2024-05-28 北京爱康宜诚医疗器材有限公司 可调节的髓内钉
CN118512254A (zh) * 2024-07-23 2024-08-20 北京爱康宜诚医疗器材有限公司 捆扎拧线工具及捆扎组件

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US5074882A (en) * 1988-06-09 1991-12-24 Medinov Sarl Progressive elongation centro-medullar nail
US5516335A (en) * 1993-03-24 1996-05-14 Hospital For Joint Diseases Orthopaedic Institute Intramedullary nail for femoral lengthening
DE19700225A1 (de) 1997-01-07 1998-07-09 Augustin Prof Dr Betz Distraktionsvorrichtung zum Auseinanderbewegen zweier Teile eines Knochens
WO2007117571A2 (fr) * 2006-04-06 2007-10-18 Lotus Medical, Llc UTILISATION de la compression active pour favoriser la guerison osseuse
US20140135769A1 (en) * 2012-11-12 2014-05-15 Navid Ziran Dynamic axial nail for intramedullary treatment of long bone fractures
US9179938B2 (en) 2013-03-08 2015-11-10 Ellipse Technologies, Inc. Distraction devices and method of assembling the same
CA2917676A1 (fr) 2015-01-13 2016-07-13 Stryker European Holdings I, Llc Croissances de tiges vertebrales et methodes d'utilisation
WO2018049232A1 (fr) * 2016-09-08 2018-03-15 Meduloc, Llc Implant et méthode de fixation d'os longs
CN108143477A (zh) * 2017-12-18 2018-06-12 武汉大学 应用记忆合金弹簧电磁加热的髓内骨延长装置

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5074882A (en) * 1988-06-09 1991-12-24 Medinov Sarl Progressive elongation centro-medullar nail
DE3921972A1 (de) 1989-07-04 1991-01-17 Rainer Dr Baumgart Marknagel
US5516335A (en) * 1993-03-24 1996-05-14 Hospital For Joint Diseases Orthopaedic Institute Intramedullary nail for femoral lengthening
DE19700225A1 (de) 1997-01-07 1998-07-09 Augustin Prof Dr Betz Distraktionsvorrichtung zum Auseinanderbewegen zweier Teile eines Knochens
WO2007117571A2 (fr) * 2006-04-06 2007-10-18 Lotus Medical, Llc UTILISATION de la compression active pour favoriser la guerison osseuse
US20140135769A1 (en) * 2012-11-12 2014-05-15 Navid Ziran Dynamic axial nail for intramedullary treatment of long bone fractures
US9179938B2 (en) 2013-03-08 2015-11-10 Ellipse Technologies, Inc. Distraction devices and method of assembling the same
CA2917676A1 (fr) 2015-01-13 2016-07-13 Stryker European Holdings I, Llc Croissances de tiges vertebrales et methodes d'utilisation
WO2018049232A1 (fr) * 2016-09-08 2018-03-15 Meduloc, Llc Implant et méthode de fixation d'os longs
CN108143477A (zh) * 2017-12-18 2018-06-12 武汉大学 应用记忆合金弹簧电磁加热的髓内骨延长装置

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102020116489A1 (de) 2020-06-23 2021-12-23 Augustin Betz Verlängerungsvorrichtung für kleine Röhrenknochen
DE102021127020A1 (de) 2021-10-19 2023-04-20 Augustin Betz Gekrümmter Marknagel
WO2023066909A1 (fr) * 2021-10-19 2023-04-27 Augustin Betz Clou médullaire incurvé
CN113974809A (zh) * 2021-12-15 2022-01-28 河北医科大学第三医院 胫骨髓内钉
CN113974809B (zh) * 2021-12-15 2023-07-18 河北医科大学第三医院 胫骨髓内钉
DE102022000228A1 (de) 2022-01-22 2023-07-27 Trauma-Stiftung gemeinnützige Gesellschaft für Klinik - Forschung - Lehre mbH Rotationsadaptiver Knochenmarknagel
CN115813522A (zh) * 2022-12-05 2023-03-21 无锡市第九人民医院 一种胫骨平台骨折复位固定导向设备
CN115813522B (zh) * 2022-12-05 2023-05-16 无锡市第九人民医院 一种胫骨平台骨折复位固定导向设备
CN118078405A (zh) * 2024-04-18 2024-05-28 北京爱康宜诚医疗器材有限公司 可调节的髓内钉
CN118512254A (zh) * 2024-07-23 2024-08-20 北京爱康宜诚医疗器材有限公司 捆扎拧线工具及捆扎组件

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