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WO1994026192A1 - Linking device for an osteosynthesis strip, especially for insertion in the spine - Google Patents

Linking device for an osteosynthesis strip, especially for insertion in the spine Download PDF

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Publication number
WO1994026192A1
WO1994026192A1 PCT/FR1994/000540 FR9400540W WO9426192A1 WO 1994026192 A1 WO1994026192 A1 WO 1994026192A1 FR 9400540 W FR9400540 W FR 9400540W WO 9426192 A1 WO9426192 A1 WO 9426192A1
Authority
WO
WIPO (PCT)
Prior art keywords
ligament
cam
engagement
plate
sliding
Prior art date
Application number
PCT/FR1994/000540
Other languages
French (fr)
Inventor
Jean-Gilbert Paccagnella
Jean Taylor
Original Assignee
Paccagnella Jean Gilbert
Jean Taylor
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 Paccagnella Jean Gilbert, Jean Taylor filed Critical Paccagnella Jean Gilbert
Priority to AU67245/94A priority Critical patent/AU6724594A/en
Publication of WO1994026192A1 publication Critical patent/WO1994026192A1/en

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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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/842—Flexible wires, bands or straps
    • 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
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • 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
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8085—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with pliable or malleable elements or having a mesh-like structure, e.g. small strips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/132—Tourniquets
    • A61B17/1322—Tourniquets comprising a flexible encircling member
    • A61B17/1327—Tensioning clamps
    • 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
    • A61B17/82—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin for bone cerclage
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30138—Convex polygonal shapes
    • A61F2002/30153—Convex polygonal shapes rectangular
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30261—Three-dimensional shapes parallelepipedal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30777—Oblong apertures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30784—Plurality of holes
    • A61F2002/30785—Plurality of holes parallel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017—Angular shapes
    • A61F2230/0019—Angular shapes rectangular
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0082—Three-dimensional shapes parallelepipedal

Definitions

  • the present invention relates to a device for connecting the ends of an osteosynthesis ligament, in particular of vertebral osteosynthesis.
  • This technique has the disadvantage of stiffening the spine at the treated joint, which causes significant discomfort for the patient and can be the cause of a resumption of the degenerative process above the treated joint.
  • this kind of technique is relatively complex to implement.
  • an inter-vertebral wedge can be inserted between the spinous processes of at least two successive vertebrae, to prevent any mutual contact of the vertebrae at the level of their rear part, which can cause the spinal nerves to be crushed.
  • the present aims to remedy all of these drawbacks.
  • the device which it relates comprises a plate of resistant and malleable material, capable of being fixed to one of the ends of the ligament, and means, integral with the plate, for engaging and retaining the other end of the ligament, said plate being capable of being engaged, with the ligament, behind the spinous process of one of the two vertebrae delimiting the joint to be treated and to be folded back on either side thereof to form a hook for holding in position said engagement and retention means, and the latter being capable of receiving the other end of the ligament after engagement around the other spinous process, by allowing this end to slide in its direction engagement and preventing this sliding in the opposite direction.
  • the malleable plate makes it possible to securely fix to the ligament the means of engagement and blocking of the end of the ligament which bypasses the second spinous process, this fixation being able to resist over time the tension imparted to the ligament and the repeated stresses exerted on him. It also allows precise and stable positioning of these means with respect to the spinous process, laterally with respect thereto.
  • the means for engaging and retaining the end of the ligament which bypasses the second spinous process are constituted by a tubular element integral with the plate, delimiting a conduit, and by a cam arranged transversely to the interior of this element, this cam being able to pivot on itself between a retracted position, where it allows the engagement and the sliding of the end of the ligament between it and the wall of the tubular element, and an active position, where it wedges said end between it and this wall.
  • the surfaces of the cam and of the tubular element coming, in this active position, in contact with the end of the ligament comprise asperities favoring the pivoting of the cam towards its active position and eliminating the risk of sliding of the end of the ligament when it is blocked.
  • the ligament is tubular and the plate is designed to be able to be engaged inside the ligament and to be sewn to the two opposite walls of the ligament by means of holes which it comprises.
  • the bond thus obtained is very resistant.
  • Figure 1 is an exploded perspective view of this device and the ligament with which it is intended to be associated;
  • Figure 2 is a longitudinal sectional view, while it is attached to the ligament; and
  • Figures 3 and 4 are views respectively in perspective and in longitudinal section after placement on two successive vertebrae of a spine.
  • the figures represent from different angles a tubular ligament 2 for vertebral osteosynthesis and a device 3, intended to be fixed to one end 2a of the ligament 2 and making it possible to ensure the connection of the ends 2a, 2b thereof, with maintenance of its tensioning.
  • the device 3 comprises a plate 4 of resistant and malleable material, for example of titanium alloy, and a tubular element 5, fixed to one of the ends of the plate 4 and housing a cam 6, made of the same material.
  • the plate 4 is intended to be engaged in the end 2a of the ligament 2, and to be sewn to it thanks to seams 7 passing through pairs of holes 8 which it comprises.
  • the tubular element 5 defines a conduit 9 in which the cam 6 is arranged transversely, the ends of the latter being cylindrical and engaged in two bores arranged coaxially in the side walls of the element 5.
  • the cam 6 can pivot on itself between a retracted position, where it allows the engagement and sliding of the end 2b of the ligament 2 between it and the wall of the element 5, and an active position, where it wedges said end 2b between it and this wall, the cam 6 being engaged in this position when the ligament 2 undergoes a steering force opposite to that of its engagement through the element 5, that is to say when the ligament 2 is energized.
  • the surfaces of the cam 6 and of the tubular element 5 coming, in this active position, into contact with the end 2b of the ligament 2 have asperities promoting the pivoting of the cam 6 towards its active position and eliminating the risk of slipping of the end 2b of the ligament 2, when the latter is blocked.
  • the plate 4 makes it possible to securely fix to the ligament 2 the means of engagement and blocking of the end 2b of the ligament 2 which constitutes the element 5 and the cam 6. Thanks to its folding around the thorny process, the plate 4 also allows precise and stable positioning of the element 5 and of the cam 6 with respect to the vertebra, laterally with respect thereto, during the time of placing the ligament 2.
  • To place the ligament 2 under tension it suffices to operate, in particular using an appropriate instrument allowing the control of the tension exerted, a displacement of this end 2b of the ligament 2 relative to the tubular element 5 until obtaining the desired tension.
  • the cam 6 pivots in its active position or it wedges the end 2b of the ligament 2 between it and the wall of the tubular element 5.
  • the ligament 2 thus remains subject to the desired tension. This tension can be adjusted extremely precisely, using the aforementioned appropriate instrument.
  • the fixation thus produced is perfectly resistant over time, to the tension imparted to the ligament, and to the repeated stresses exerted on the ligament.
  • the ligament can pass through an intervertebral wedge 15, forming a spacer between the spinous processes of the vertebrae.

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

Abstract

The device according to the invention comprises a strip of a tough and ductile material, which can be secured to one (2a) of the ends (2a, 2b) of the ligament (2), and means (5, 6) integral with the strip (4), for inserting and retaining the other end (2b) of the ligament (2). The strip (4) can be inserted together with the ligament (2), behind the spinous process of one of the two vertebrae delimiting the joint to be treated and can be folded on either side of said joint to form a loop which holds in place the inserting and retaining means (5, 6). The latter means are capable of receiving the other end (2b) of the ligament (2) after fitting about the other spinous process, while allowing sliding of this end (2b) in its insertion direction and while preventing it from sliding in the opposite direction.

Description

DISPOSITIF DE LIAISON POUR BANDE D1OSTEOSYNTHESE, NOTAMMENT INTER-EPINEUSECONNECTION DEVICE FOR A BAND OF 1 OSTEOSYNTHESIS, ESPECIALLY INTER-SPINOUS
La présente invention concerne un dispositif de liaison des extrémités d'un ligament d'osteosynthese, notamment d'osteosynthese vertébrale.The present invention relates to a device for connecting the ends of an osteosynthesis ligament, in particular of vertebral osteosynthesis.
L'instabilité de la colonne vertébrale liée à la dégénérescence des articulations inter-vertébrales a longtemps été traitée par arthrodèse, avec ou sans fixation interne.Instability of the spine linked to degeneration of the inter-vertebral joints has long been treated by arthrodesis, with or without internal fixation.
Cette technique présente 1 ' inconvénient de rigidifier la colonne vertébrale au niveau de l'articulation traitée, ce qui occasionne une gêne importante pour le patient et peut être la cause d'une reprise du processus dégénératif au-dessus de l'articulation traitée. De plus, ce genre de technique est relativement complexe à mettre en oeuvre.This technique has the disadvantage of stiffening the spine at the treated joint, which causes significant discomfort for the patient and can be the cause of a resumption of the degenerative process above the treated joint. In addition, this kind of technique is relatively complex to implement.
Pour remédier à ces inconvénients, il est connu d'entrelacer un ligament autour des apophyses épineuses des vertèbres situées de part et d'autre de l'articulation affectée, et de coudre les extrémités du ligament l'une à l'autre ou au ligament lui-même, après mise en tension contrôlée de celui-ci. Cette technique permet de stabiliser l'articulation affectée tout en lui conservant une certaine mobilité. Dans certains cas, une cale inter-vertébrale peut être insérée entre les apophyses épineuses d'au moins deux vertèbres successives, pour interdire tout contact mutuel des vertèbres au niveau de leur partie arrière, pouvant causer l'écrasement des nerfs rachidiens.To overcome these drawbacks, it is known to intertwine a ligament around the spinous processes of the vertebrae located on either side of the affected joint, and to sew the ends of the ligament together or to the ligament itself, after controlled tensioning thereof. This technique stabilizes the affected joint while retaining some mobility. In some cases, an inter-vertebral wedge can be inserted between the spinous processes of at least two successive vertebrae, to prevent any mutual contact of the vertebrae at the level of their rear part, which can cause the spinal nerves to be crushed.
La ou les coutures précitées présentent l'inconvénient d'être longues et difficiles à réaliser. Elles requièrent en effet l'emploi d'une aiguille courbe, qui est d'une utilisation difficile compte tenu du peu d'espace disponible, d'autant plus que le ligament doit être maintenu en tension le temps que soit réalisée la couture. De plus, sous l'effet des contraintes que subit le ligament, le fil constituant ces coutures peut plus ou moins se distendre et recréer un certain jeu.The above-mentioned seam (s) have the drawback of being long and difficult to produce. They indeed require the use of a curved needle, which is difficult to use given the limited space available, especially since the ligament must be kept in tension while the sewing. In addition, under the effect of the stresses on the ligament, the thread constituting these seams can more or less stretch and recreate a certain play.
La présente vise à remédier à 1 'ensemble de ces inconvénients.The present aims to remedy all of these drawbacks.
A cette fin, le dispositif qu'elle concerne comprend une plaque de matériau résistant et malléable, apte à être fixée à l'une des extrémités du ligament, et des moyens, solidaires de la plaque, pour l'engagement et la rétention de l'autre extrémité du ligament, ladite plaque étant apte à être engagée, avec le ligament, derrière l'apophyse épineuse de l'une des deux vertèbres délimitant l'articulation à traiter et à être repliée de part et d'autre de celle-ci pour former un crochet de maintien en position desdits moyens d'engagement et de rétention, et ces derniers étant aptes à recevoir l'autre extrémité du ligament après engagement autour de l'autre apophyse épineuse, en permettant le coulissement de cette extrémité dans son sens d'engagement et en empêchant ce coulissement dans le sens inverse.To this end, the device which it relates comprises a plate of resistant and malleable material, capable of being fixed to one of the ends of the ligament, and means, integral with the plate, for engaging and retaining the other end of the ligament, said plate being capable of being engaged, with the ligament, behind the spinous process of one of the two vertebrae delimiting the joint to be treated and to be folded back on either side thereof to form a hook for holding in position said engagement and retention means, and the latter being capable of receiving the other end of the ligament after engagement around the other spinous process, by allowing this end to slide in its direction engagement and preventing this sliding in the opposite direction.
Pour mettre le ligament en place, il suffit de l'engager derrière l'apophyse épineuse de l'une des deux vertèbres, par exemple la vertèbre supérieure, jusqu'à ce que sensiblement la partie médiane de la plaque soit en regard du bord d'extrémité de l'apophyse, de replier ensuite la plaque de part et d'autre de l'apophyse, d'engager le ligament autour de l'apophyse épineuse de l'autre vertèbre et d'engager l'extrémité du ligament au travers desdits moyens. Pour mettre le ligament sous tension, il suffit alors d'opérer, notamment à l'aide d'un instrument approprié permettant le contrôle de la tension exercée, un déplacement de cette extrémité du ligament par rapport auxdits moyens jusqu'à obtention de la tension recherchée. Lorsque ce déplacement s'interrompt, les moyens précités bloquent l'extrémité du ligament en empêchant son déplacement en sens inverse, de sorte que le ligament reste soumis à la tension désirée.To put the ligament in place, it is enough to engage it behind the spinous process of one of the two vertebrae, for example the upper vertebra, until substantially the middle part of the plate is opposite the edge d end of the process, then fold the plate on either side of the process, engage the ligament around the spinous process of the other vertebra and engage the end of the ligament through said means. To put the ligament under tension, it then suffices to operate, in particular using an appropriate instrument allowing the control of the tension exerted, a displacement of this end of the ligament relative to said means until tension is obtained. wanted. When this movement is interrupted, the aforementioned means block the end of the ligament by preventing its reverse movement, so that the ligament remains under the desired tension.
La plaque malléable permet de fixer solidement au ligament les moyens d'engagement et de blocage de l'extrémité du ligament qui contourne la deuxième apophyse épineuse, cette fixation étant apte à résister dans le temps à la tension conférée au ligament et aux contraintes répétées exercées sur lui. Elle permet également un positionnement précis et stable de ces moyens par rapport à l'apophyse épineuse, latéralement par rapport à celle-ci.The malleable plate makes it possible to securely fix to the ligament the means of engagement and blocking of the end of the ligament which bypasses the second spinous process, this fixation being able to resist over time the tension imparted to the ligament and the repeated stresses exerted on him. It also allows precise and stable positioning of these means with respect to the spinous process, laterally with respect thereto.
De préférence, les moyens pour l'engagement et la rétention de l'extrémité du ligament qui contourne la deuxième apophyse épineuse sont constitués par un élément tubulaire solidaire de la plaque, délimitant un conduit, et par une came disposée transversalement à 1 ' intérieur de cet élément, cette came pouvant pivoter sur elle-même entre une position effacée, où elle permet l'engagement et le coulissement de l'extrémité du ligament entre elle et la paroi de l'élément tubulaire, et une position active, où elle coince ladite extrémité entre elle et cette paroi. Avantageusement, les surfaces de la came et de l'élément tubulaire venant, dans cette position active, en contact avec l'extrémité du ligament, comportent des aspérités favorisant le pivotement de la came vers sa position active et éliminant le risque de glissement de l'extrémité du ligament lorsque celle-ci est bloquée.Preferably, the means for engaging and retaining the end of the ligament which bypasses the second spinous process are constituted by a tubular element integral with the plate, delimiting a conduit, and by a cam arranged transversely to the interior of this element, this cam being able to pivot on itself between a retracted position, where it allows the engagement and the sliding of the end of the ligament between it and the wall of the tubular element, and an active position, where it wedges said end between it and this wall. Advantageously, the surfaces of the cam and of the tubular element coming, in this active position, in contact with the end of the ligament, comprise asperities favoring the pivoting of the cam towards its active position and eliminating the risk of sliding of the end of the ligament when it is blocked.
Selon une forme de réalisation préférée de l'invention, le ligament est tubulaire et la plaque est prévue pour pouvoir être engagée à l'intérieur du ligament et être cousue aux deux parois opposées du ligament grâce à des trous qu'elle comprend. La liaison ainsi obtenue est très résistante.According to a preferred embodiment of the invention, the ligament is tubular and the plate is designed to be able to be engaged inside the ligament and to be sewn to the two opposite walls of the ligament by means of holes which it comprises. The bond thus obtained is very resistant.
De toute façon, l'invention sera bien comprise à l'aide de la description qui suit, en référence au dessin schématique annexé représentant, à titre d'exemple non limitatif, une forme de réalisation préférée du ligament du dispositif qu'elle concerne.Anyway, the invention will be well understood with the aid of the description which follows, with reference to the appended schematic drawing representing, by way of example not limiting, a preferred embodiment of the ligament of the device it relates to.
La figure 1 est une vue en perspective éclatée de ce dispositif et du ligament auquel il est destiné à être associé ; la figure 2 en est une vue en coupe longitudinale, alors qu'il est fixé au ligament ; et les figures 3 et 4 en sont des vues respectivement en perspective et en coupe longitudinale après mise en place sur deux vertèbres successives d'une colonne vertébrale.Figure 1 is an exploded perspective view of this device and the ligament with which it is intended to be associated; Figure 2 is a longitudinal sectional view, while it is attached to the ligament; and Figures 3 and 4 are views respectively in perspective and in longitudinal section after placement on two successive vertebrae of a spine.
Les figures représentent sous différents angles un ligament tubulaire 2 pour osteosynthese vertébrale et un dispositif 3, destiné à être fixé à une extrémité 2a du ligament 2 et permettant d'assurer la liaison des extrémités 2a, 2b de celui-ci, avec maintien de sa mise en tension.The figures represent from different angles a tubular ligament 2 for vertebral osteosynthesis and a device 3, intended to be fixed to one end 2a of the ligament 2 and making it possible to ensure the connection of the ends 2a, 2b thereof, with maintenance of its tensioning.
Le dispositif 3 comprend une plaque 4 en matériau résistant et malléable, par exemple en alliage de titane, et un élément tubulaire 5, fixé à une des extrémités de la plaque 4 et logeant une came 6, réalisés dans le même matériau.The device 3 comprises a plate 4 of resistant and malleable material, for example of titanium alloy, and a tubular element 5, fixed to one of the ends of the plate 4 and housing a cam 6, made of the same material.
La plaque 4 est destinée à être engagée dans l'extrémité 2a du ligament 2, et a être cousue à elle grâce à des coutures 7 traversant des paires de trous 8 qu'elle comprend.The plate 4 is intended to be engaged in the end 2a of the ligament 2, and to be sewn to it thanks to seams 7 passing through pairs of holes 8 which it comprises.
L'élément tubulaire 5 délimite un conduit 9 dans lequel est disposée transversalement la came 6, les extrémités de cette dernière étant cylindriques et engagées dans deux alésages aménagés coaxialement dans les parois latérales de l'élément 5.The tubular element 5 defines a conduit 9 in which the cam 6 is arranged transversely, the ends of the latter being cylindrical and engaged in two bores arranged coaxially in the side walls of the element 5.
Ainsi, la came 6 peut pivoter sur elle-même entre une position effacée, où elle permet l'engagement et le coulissement de l'extrémité 2b du ligament 2 entre elle et la paroi de l'élément 5, et une position active, où elle coince ladite extrémité 2b entre elle et cette paroi, la came 6 étant engagée dans cette position lorsque le ligament 2 subit une force de direction opposée à celle de son engagement au travers de 1 'élément 5, c'est-à-dire lorsque le ligament 2 est mis sous tension. Les surfaces de la came 6 et de 1 'élément tubulaire 5 venant, dans cette position active, en contact avec l'extrémité 2b du ligament 2 comportent des aspérités favorisant le pivotement de la came 6 vers sa position active et éliminant le risque de glissement de l'extrémité 2b du ligament 2, lorsque celle-ci est bloquée.Thus, the cam 6 can pivot on itself between a retracted position, where it allows the engagement and sliding of the end 2b of the ligament 2 between it and the wall of the element 5, and an active position, where it wedges said end 2b between it and this wall, the cam 6 being engaged in this position when the ligament 2 undergoes a steering force opposite to that of its engagement through the element 5, that is to say when the ligament 2 is energized. The surfaces of the cam 6 and of the tubular element 5 coming, in this active position, into contact with the end 2b of the ligament 2 have asperities promoting the pivoting of the cam 6 towards its active position and eliminating the risk of slipping of the end 2b of the ligament 2, when the latter is blocked.
Ainsi que le montrent les figures 3 et 4, pour mettre le ligament 2 en place, il suffit de l'engager derrière l'apophyse épineuse de l'une des deux vertèbres, par exemple l'apophyse de la vertèbre supérieure, jusqu'à ce que sensiblement la partie médiane de la plaque 4 soit en regard du bord de l'extrémité de l'apophyse, de replier ensuite la plaque 4 de part et d'autre de l'apophyse, d'engager le ligament 2 autour de l'apophyse épineuse de l'autre vertèbre, inférieure en l'occurence, et d'engager l'extrémité 2b du ligament au travers dudit conduit 9, entre la came 6 et la paroi de l'élément 5.As shown in Figures 3 and 4, to put ligament 2 in place, simply engage it behind the spinous process of one of the two vertebrae, for example the process of the upper vertebra, until that substantially the middle part of the plate 4 is opposite the edge of the end of the process, then fold the plate 4 on either side of the process, engage the ligament 2 around the the spinous process of the other vertebra, lower in this case, and engaging the end 2b of the ligament through said conduit 9, between the cam 6 and the wall of the element 5.
La plaque 4 permet de fixer solidement au ligament 2 les moyens d'engagement et de blocage de 1 'extrémité 2b du ligament 2 que constitue l'élément 5 et la came 6. Grâce à son repliage autour de l'apophyse épineuse, la plaque 4 permet, en outre, un positionnement précis et stable de 1 'élément 5 et de la came 6 par rapport à la vertèbre, latéralement par rapport à celle-ci, le temps de la mise en place du ligament 2. Pour mettre le ligament 2 sous tension, il suffit d'opérer, notamment à l'aide d'un instrument approprié permettant le contrôle de la tension exercée, un déplacement de cette extrémité 2b du ligament 2 par rapport à l'élément tubulaire 5 jusqu'à obtention de la tension recherchée. Lorsque ce déplacement s'interrompt, la came 6 pivote dans sa position active ou elle coince l'extrémité 2b du ligament 2 entre elle et la paroi de l'élément tubulaire 5. Le ligament 2 reste ainsi soumis à la tension désirée. Cette tension peut être réglée de manière extrêmement précise, grâce à l'instrument approprié précité. La fixation ainsi réalisée est parfaitement résistante dans le temps, à la tension conférée au ligament, et aux contraintes répétées exercées sur le ligament.The plate 4 makes it possible to securely fix to the ligament 2 the means of engagement and blocking of the end 2b of the ligament 2 which constitutes the element 5 and the cam 6. Thanks to its folding around the thorny process, the plate 4 also allows precise and stable positioning of the element 5 and of the cam 6 with respect to the vertebra, laterally with respect thereto, during the time of placing the ligament 2. To place the ligament 2 under tension, it suffices to operate, in particular using an appropriate instrument allowing the control of the tension exerted, a displacement of this end 2b of the ligament 2 relative to the tubular element 5 until obtaining the desired tension. When this movement is interrupted, the cam 6 pivots in its active position or it wedges the end 2b of the ligament 2 between it and the wall of the tubular element 5. The ligament 2 thus remains subject to the desired tension. This tension can be adjusted extremely precisely, using the aforementioned appropriate instrument. The fixation thus produced is perfectly resistant over time, to the tension imparted to the ligament, and to the repeated stresses exerted on the ligament.
Comme montré aux figures 3 et 4, le ligament peut traverser une cale intervertébrale 15, formant une entretoise entre les apophyses épineuses des vertèbres. As shown in Figures 3 and 4, the ligament can pass through an intervertebral wedge 15, forming a spacer between the spinous processes of the vertebrae.

Claims

REVENDICATIONS
1. Dispositif de liaison des extrémités d'un ligament d'osteosynthese, notamment d'osteosynthese vertébrale, caractérisé en ce qu'il comprend une plaque (4) de matériau résistant et malléable, apte à être fixée à l'une (2a) des extrémités (2a,2b) du ligament (2), et des moyens (5,6), solidaires de la plaque (4), pour l'engagement et la rétention de l'autre extrémité (2b) du ligament (2) , ladite plaque (4) étant apte à être engagée, avec le ligament (2), derrière l'apophyse épineuse de l'une des deux vertèbres délimitant l'articulation à traiter et à être repliée de part et d'autre de celle-ci pour former un crochet de maintien en position desdits moyens d'engagement et de rétention (5,6), et ces derniers étant aptes à recevoir l'autre extrémité (2b) du ligament (2) après engagement autour de l'autre apophyse épineuse, en permettant le coulissement de cette extrémité (2b) dans son sens d'engagement et en empêchant ce coulissement dans le sens inverse. 1. Device for connecting the ends of an osteosynthesis ligament, in particular a vertebral osteosynthesis, characterized in that it comprises a plate (4) of resistant and malleable material, capable of being fixed to one (2a) ends (2a, 2b) of the ligament (2), and means (5,6), integral with the plate (4), for the engagement and retention of the other end (2b) of the ligament (2) , said plate (4) being able to be engaged, with the ligament (2), behind the spinous process of one of the two vertebrae delimiting the joint to be treated and to be folded back on either side of it ci to form a hook for holding in position said engagement and retention means (5,6), and the latter being able to receive the other end (2b) of the ligament (2) after engagement around the other process prickly, by allowing this end (2b) to slide in its direction of engagement and preventing this sliding in the inve direction rse.
2. Dispositif selon la revendication 1, caractérisé en ce que les moyens pour 1 'engagement et la rétention de l'extrémité (2b) du ligament (2) qui contourne la deuxième apophyse épineuse sont constitués par un élément tubulaire (5) solidaire de la plaque (4) , délimitant un conduit (9) , et par une came (6) disposée transversalement à l'intérieur de cet élément (5), cette came (6) pouvant pivoter sur elle-même entre une position effacée où elle permet l'engagement et le coulissement de l'extrémité (2b) du ligament (2) entre elle et la paroi de l'élément tubulaire (5), une position active, où elle coince ladite extrémité (2b) entre elle et cette paroi.2. Device according to claim 1, characterized in that the means for 1 engagement and retention of the end (2b) of the ligament (2) which bypasses the second spinous process are constituted by a tubular element (5) integral with the plate (4), delimiting a conduit (9), and by a cam (6) disposed transversely inside this element (5), this cam (6) being able to pivot on itself between a retracted position where it allows the engagement and sliding of the end (2b) of the ligament (2) between it and the wall of the tubular element (5), an active position, where it wedges said end (2b) between it and this wall .
3. Dispositif selon la revendication 2, caractérisé en ce que les surfaces de la came (6) et de l'élément tubulaire (5) venant, dans cette position active de la came (6), en contact avec l'extrémité (2b) du ligament (2) , comporte des aspérités favorisant le pivotement de la came (6) vers sa position active et éliminant le risque de glissement de l'extrémité (2b) du ligament (2) lorsque celle-ci est bloquée.3. Device according to claim 2, characterized in that the surfaces of the cam (6) and of the tubular element (5) coming, in this active position of the cam (6), into contact with the end (2b ) of the ligament (2), has asperities promoting the pivoting of the cam (6) towards its active position and eliminating the risk of sliding of the end (2b) of the ligament (2) when the latter is blocked.
4. Dispositif selon l'une des revendications l à 3, caractérisé en ce que, le ligament (2) étant tubulaire, la plaque (4) est prévue pour pouvoir être engagée à l'intérieur du ligament (2) et être cousue aux deux parois opposées de celui-ci grâce à des trous qu'elle comprend.4. Device according to one of claims l to 3, characterized in that, the ligament (2) being tubular, the plate (4) is provided to be able to be engaged inside the ligament (2) and be sewn to two opposite walls thereof thanks to the holes it includes.
5. Dispositif selon l'une des revendications 1 à 4, caractérisé en ce qu'il est réalisé en alliage de titane. 5. Device according to one of claims 1 to 4, characterized in that it is made of titanium alloy.
PCT/FR1994/000540 1993-05-07 1994-05-06 Linking device for an osteosynthesis strip, especially for insertion in the spine WO1994026192A1 (en)

Priority Applications (1)

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AU67245/94A AU6724594A (en) 1993-05-07 1994-05-06 Linking device for an osteosynthesis strip, especially for insertion in the spine

Applications Claiming Priority (2)

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FR93/05742 1993-05-07
FR9305742A FR2704745B1 (en) 1993-05-07 1993-05-07 Device for connecting the ends of a ligament for osteosynthesis, in particular for vertebral osteosynthesis.

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