JP2010504771A - 低侵襲開創器および使用方法 - Google Patents
低侵襲開創器および使用方法 Download PDFInfo
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Abstract
【選択図】図1
Description
本願は、2005年9月26日に出願された米国仮特許出願第60/720,670号に基づく優先権および利益を主張し、その全内容を参照により本明細書に援用する。
本発明は、概して、整形外科的脊椎手術に関し、特に、低侵襲外科的処置に使用される低侵襲開創器および使用方法に関する。
低侵襲処置での使用に適した開創器および開創器システムは飛躍的に進展してきている。最近の進展の多くは、開放処置用の従来型の外科用開創器、主に、さまざまな設計のテーブル設置型のデバイスに基づく。これらのデバイスは扱いにくいことが多く、小切開に使用するにはあまり適していない。標準的な手持ち式の外科用開創器は、先行技術において周知であり、このような小切開の輪郭に合うように変更することができるが、所望の位置を保つためには手動操作が必要であり、このため、処置中に、医師の片方の手が塞がれ、あるいは医師を補助する他の人が必要となる。また、典型的な開創器は、軟組織に配置され、創傷を開いた状態に保持するために拡げられ、位置が移動したり、医師の視界を遮ったり、あるいは、手術部位へのアクセスを妨げてしまう場合には、頻繁に再配置する必要がある。
fusion)などの脊椎手術に応用されている。患部が体の狭い部位に限定されている関節鏡膝手術や胆嚢手術などの低侵襲処置とは異なり、脊椎固定術は、通常、患者の体のかなり広い部位を網羅する。また、関節鏡手術および腹腔鏡手術では、組織を膨張させて、外科医の作業空間を作り出すために、流体(すなわち、液体や気体)の導入が可能である。脊椎手術では、このように膨張させることができる嚢や空間がなく、その代わりに、軟組織、骨、靭帯および神経の複数の層が関わっている。このような理由から、脊椎に対して低侵襲処置を行うという考えは、最近になってようやく取り組みがなされたに過ぎない。
hinge)」を有する。ブレード長の任意の部分で屈曲が可能となるように、複数のリンビングヒンジを組み込むことができる。
degree procedures)において特に有用であろう。別の実施形態として、外科医が、隣接する開創器間を選択的に切開してもよい。後者のアプローチにより、隣接するスクリューの切開部を通してロッドを挿入することが可能となる。ロッド3を、一対の椎弓根スクリュー40の間に、より詳細には、各ロッド受容通路44を通して配置したら、上述のように、セットスクリューを使用して、ロッド3を適所に固定する。
Claims (21)
- 外科用開創器であって、
少なくとも1つの長尺状部材と、
前記外科用開創器の一端に配された連結領域であって、該連結領域の遠位端に設けられた開口および少なくとも1つのリリーフ領域を有する連結領域と、
前記長尺状部材を前記連結領域に連結するフレキシブルジョイントと、
を有する開創器。 - 前記開口は、スクリューのシャンクの外径よりも大きい直径を有する、
請求項1に記載の開創器。 - 前記開口の前記直径は、前記スクリューのヘッドの外径よりも小さい、
請求項2に記載の開創器。 - 前記連結領域は、前記遠位端から近位に延びる第1および第2の弓状アームを有し、
該弓状アームは、放射状に離間され、一対の縦方向に延びるスロットを画定する、
請求項1に記載の開創器。 - 少なくとも2つの長尺状の弓状部材を更に有し、
前記長尺状の弓状部材は、放射状に離間され、一対の縦方向に延びる通路を画定する、
請求項1に記載の開創器。 - 少なくとも2つの長尺状の弓状部材を更に有し、
前記長尺状の弓状部材は、放射状に離間され、一対の縦方向に延びる通路を画定し、
前記一対の縦方向に延びる通路は、前記縦方向に延びるスロットと実質的に位置合わせされている、
請求項5に記載の開創器。 - スクリューのヘッドと前記少なくとも1つのリリーフ領域との間の相対移動により、前記リリーフ領域が前記連結領域から切り離され、前記開創器を前記スクリューの前記ヘッドから切り離すことを可能にする、
請求項1に記載の開創器。 - 以下の各ステップを有する脊椎手術の実施方法。
a)少なくとも2つの開創器アセンブリを提供するステップ。各開創器アセンブリは、前記開創器の連結領域に可撓的に取り付けられた少なくとも1つの長尺状部材および前記連結領域の遠位端の開口を通って延びるスクリューを有する。
b)第1の椎体の一部に第1のスクリューを固定するステップ。
c)第1の開創器の前記少なくとも1つの長尺状部材を使用して組織を牽引するステップ。
d)第2の椎体の一部に第2のスクリューを固定するステップ。
e)第2の開創器の前記少なくとも1つの長尺状部材を使用して組織を牽引するステップ。
f)前記第1のスクリューと前記第2のスクリューの間にロッドを挿入するステップ。
g)前記第1スクリューおよび前記第2のスクリューに前記ロッドを固定するステップ。
h)前記第1の開創器および前記第2の開創器を取り外すステップ。 - 以下の各ステップを有する手術の実施方法。
a)骨構造にガイドワイヤを経皮的に挿入するステップ。
b)前記ガイドワイヤを介して、キャニュレイテッドボーンスクリューおよび関連する開創器を標的部位に挿入するステップ。
c)骨に前記ボーンスクリューを埋め込むステップ。
d)前記ボーンスクリューに隣接する回転軸から前記開創器を拡張させ、軟組織を牽引し前記部位へのアクセスを提供するステップ。
e)前記開創器を介して、前記標的部位において外科的処置を実施するステップ。
f)前記ボーンスクリューから前記開創器を取り外すステップ。 - 外科用開創器であって、
少なくとも1つの長尺状の牽引部材と、
前記外科用開創器の一端に配された連結領域であって、該連結領域の遠位端に設けられ、外科用インプラントと係合するように構成され寸法が定められた開口および少なくとも1つのリリーフ領域を有する連結領域と、
前記長尺状の部材を前記連結領域に連結するフレキシブルジョイントと、
を有する外科用開創器。 - 前記開口は、スクリューのシャンクの外径よりも大きい直径を有する、請求項10に記載の開創器。
- 前記開口の前記直径は、前記スクリューのヘッドの外径よりも小さい、請求項11に記載の開創器。
- 前記連結領域は、前記遠位端から近位に延びる第1および第2の弓状アームを有し、
前記弓状アームは、放射状に離間され、一対の縦方向に延びるスロットを画定する、
請求項10に記載の開創器。 - 少なくとも2つの対向する長尺状の牽引部材を更に有する、請求項10に記載の開創器。
- 前記少なくとも1つのリリーフ領域は、前記開創器と関連するスクリューのヘッドから前記開創器を切り離すのに十分な所定の力を加えると、前記開創器を前記スクリューの前記ヘッドから切り離すことができるように構成され寸法が定められている、請求項10に記載の開創器。
- 外科用開創器を含む滅菌筐体を含むキットであって、
前記外科用開創器は、
少なくとも1つの長尺状の牽引部材と、
前記外科用開創器の一端に配された連結領域であって、該連結領域の遠位端に設けられ、外科用インプラントと係合するように構成され寸法が定められた開口および少なくとも1つのリリーフ領域を有する連結領域と、
前記長尺状部材を前記連結領域に連結している可撓ジョイントと、
を有するキット。 - 複数の外科用開創器を更に有する、請求項16に記載のキット。
- キャニュレイテッドメスを更に有する、請求項17に記載のキット。
- 少なくとも1つの拡張器を更に有する、請求項17に記載のキット。
- 少なくとも1つの生検ニードルを更に有する、請求項17に記載のキット。
- 少なくとも一本のガイドワイヤを更に有する、請求項17に記載のキット。
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ES2599835T3 (es) | 2017-02-03 |
US20130041228A1 (en) | 2013-02-14 |
PT2066223E (pt) | 2012-01-03 |
ES2378576T3 (es) | 2012-04-16 |
US9510858B2 (en) | 2016-12-06 |
US8734338B2 (en) | 2014-05-27 |
US20140243605A1 (en) | 2014-08-28 |
DK2066223T3 (da) | 2012-02-06 |
EP2384690B1 (en) | 2016-08-10 |
EP2066223A2 (en) | 2009-06-10 |
US9161779B2 (en) | 2015-10-20 |
AU2007300727B2 (en) | 2013-08-29 |
US8298138B2 (en) | 2012-10-30 |
US20110054259A1 (en) | 2011-03-03 |
US20070106123A1 (en) | 2007-05-10 |
EP2066223A4 (en) | 2010-03-17 |
EP2384690A1 (en) | 2011-11-09 |
ATE536136T1 (de) | 2011-12-15 |
WO2008039247A2 (en) | 2008-04-03 |
US7846093B2 (en) | 2010-12-07 |
WO2008039247A3 (en) | 2008-06-05 |
CA2664731C (en) | 2015-07-07 |
PL2066223T3 (pl) | 2012-04-30 |
JP5249229B2 (ja) | 2013-07-31 |
CA2664731A1 (en) | 2008-04-03 |
JP2013078644A (ja) | 2013-05-02 |
US20160038182A1 (en) | 2016-02-11 |
AU2007300727A1 (en) | 2008-04-03 |
JP5486076B2 (ja) | 2014-05-07 |
EP2066223B1 (en) | 2011-12-07 |
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