CN104023649A

CN104023649A - Method and apparatus for repairing a tendon or ligament

Info

Publication number: CN104023649A
Application number: CN201280038702.8A
Authority: CN
Inventors: L·戈登; R·T·布里根蒂; D·J·齐莫曼
Original assignee: Core Essence Orthopaedics LLC
Current assignee: Core Essence Orthopaedics LLC; Core Essence Orthopaedics Inc
Priority date: 2011-06-06
Filing date: 2012-06-06
Publication date: 2014-09-03
Also published as: JP2014523763A; AU2012275965A1; CA2838509A1; EP2717785A1

Abstract

An apparatus for reattaching a longitudinal anatomical feature to an not other anatomical feature comprising: a first repair device (1710) hav not ing at least first (1711) and second (1712) filaments, each having a first longitudinal end and a second longitudinal end, a first needle (1715) attached to the first ends of the first and second filaments and a second needle (1716) attached to the second ends of the first and second filaments; a catheter (101) comprising a tube having a lumen; a funnel member (103) having a smaller longitudinal end for place not ment adjacent an entry to an anatomical passageway and a larger longitudinal end.

Description

Repair the method and apparatus of tendon or ligament

The cross reference of related application

The U.S. non-temporary patent application case No.12/716 that the application submitted to as on March 3rd, 2010,724 continuation-in-part application and require preference, whole disclosures of the non-temporary patent application case of the described U.S. at this by reference to being incorporated to, it is the temporary patent application case No.61/304 submitting on February 12nd, 2010,003 non-provisional application case, whole disclosures of this temporary patent application case at this by reference to being incorporated to.The application also requires the temporary patent application case No.61/493 submitting on June 6th, 2011,702, the temporary patent application case No.61/505 submitting on July 7th, 2011,348, the temporary patent application case No.61/506 submitting on July 13rd, 2011,819, the temporary patent application case No.61/535 of JIUYUE in 2011 submission on the 16th, 648 preference, whole disclosures of these temporary patent application cases are by reference to being incorporated herein.

Technical field

The present invention relates to repair the method and apparatus of tendon, ligament etc.More particularly, the present invention relates to for repairing fracture or the tendon of damage and surgery implant and the technology of ligament.It is particularly useful in the situation that the destruction minimum of surrounding tissue is repaired to tendon and the ligament of extremity.

Background technology

The medical care standard of current reparation hands Fracture tendon is only with stitching thread, two of tendon separated ends to be connected again.During healing process of tendons, two ends of this of tendon are kept together by stitching thread.The surgical repair of tendon and ligament (especially musculus flexor tendon) has accurately been described as technology-intensive surgical tasks.

Reparation must have enough intensity to prevent occurring gap in the opposed end of repaired member, thereby member can again be connected and heal, and allow the member of repairing can carry out postoperative rehabilitation operation.Towards developing various suturing skills, be put to very large effort for this reason.Main two-wire thigh (two strand), four line thighs and the six line thigh suturing skills of locking-type stitch (locking stitch) of adopting are used widely.Many kinds of sewing patterns have been developed to attempt to improve the hot strength in surgical repair place during agglutination.Nearly section known a kind of general suturing skill of time is that Kessler repairs, and it uses stitching thread with specific structure or pattern, to cross over the relative broken ends of tendon (or ligament).The article that Evans and Thompson deliver on periodical " The Journal of Hand Therapy " " The Application of Force to the Healing Tendon " (issuing 266-282 page for 1993 the 10-12 month) is investigated the various suturing skills that adopt in operation tendon repair.In addition, two pieces of articles " Flexor Tendon Injuries:I.Foundations of Treatment " that Strickland delivers in periodical " The Journal of American Academy of Orthopaedic Surgeons " and " Flexor Tendon Injuries:II.Operative Technique " (distribution in January nineteen ninety-five/February, roll up 3 part 1s, 44-62 page) describe and set forth various suturing skills.

In general, the hot strength at tendon repair place improves along with the increase of the scheme of stitching complexity.As the article of Evans and Thompson is mentioned, the load when sewing up the generation inefficacy of connecting portion place can be at about 1000 gram forces to changing between about 8000 gram forces (or about 10 to 80 newton).At least there are two kinds of potential failure modes, comprise that sutures breaks or stitching thread tear out from tendon.Kessler recovery technique and improvement type Kessler recovery technique trend towards occurring losing efficacy towards the scope lower end between for example about 1500 to 4000 gram forces (or about 15 to 40 newton), this a little less than than original tendon many, need patient during agglutination, to carry out limit medical care to can not disturb tendon repair.

For example, the normal bending of finger without any load in the situation that produces approximately 40 newton's (N) power on tendon.With the stressed bending of grasped thing, conventionally the power of about 60N-100N will be applied on tendon.The brute force that finally, for example may relate in sports or in lifting heavy grasps object can apply 140N or the larger power of being approximately on the tendon of hands.

These various suturing skills are also quite complicated, are therefore difficult to reproduce and grasp as technology, say nothing of on the little tendon in hands and realize.In addition, because they have adopted locking-type stitch, must in whole process, two tendon ends be relative to each other placed in and remain on correct position (, allow the contact of two ends) because locking-type stitch does not allow repair place further to adjust (as do not used some previous technology of locking-type stitch).

Repairing and in hands, especially pointing another remarkable difficulty that the tendon of Fracture and avulsion encounters is to reboot by the tackle system (pulley system) of finger-joint the tendon (the normally nearside tendon broken ends of fractured bone) of fracture.Specifically, when tendon rupture or avulsion, the nearside tendon broken ends of fractured bone (proximal tendon stump) is tending towards bouncing back towards carpal joint away from fracture location.Therefore, often need to form longitudinal cut at the nearside of fracture location, to give the portions of proximal of fracture tendon for change, the tackle system by it by finger draws gets back to fracture location, thereby again connects with the distally tendon broken ends of fractured bone.

As the article institute of Evans and Thompson descriptively, at least one researcher adopted its diameter to be a bit larger tham the Mersilene net of tendon, this net is sewn on opposed two tendon ends subsequently.Report is used the test failure load of this net up to 10000 gram forces (100N).But Mersilene is non-degradable polyester (making the sutural common used material of using in plastic operation), its shortcoming is that tissue will stand local organization reaction, cause polyester to be sticky in and repair position tissue around.This phenomenon is less desirable in tendon and ligament, because the coaster freely slippage of tendon in must for example pointing with respect to surrounding tissue.Although net can be suitable for using together with ligament with columniform tendon substantially, more difficult for thering is the tendon of flat or avette cross section.And now, increasing any volume (bulk) will be debatable to tendon outside, because this reparation must be walked the tackle system of finger.

U.S. Patent No. 6102947 has disclosed another kind of for repairing the method and apparatus of tendon, and it comprises the implant that can be sewn on tendon, and the clamping plate that stretch out between two tendon ends (splint) are provided.Implant consists essentially of metal wire, this metal wire carries most advanced and sophisticated first pair of wedge-shaped part back to mid point in metal wire mid point one side, and on metal wire mid point opposite side, carries tip also back to second pair of wedge-shaped part of mid point (in the face of and first pair of direction that wedge-shaped part is contrary).First pair of wedge-shaped part is pushed (or pulling) in a broken ends of tendon, and another is pushed (or being drawn to) in another broken ends of tendon to wedge-shaped part.These wedge-shaped parts are sewn on tendon, and are fixed in tendon.This system provides high hot strength for repair place.

In addition, the Ortheon Medical of Winter Park of Fla. exploitation and sale, for the implant of musculus flexor tendon repair, are called Teno Fix.Su, B. wait people in " the A Device for Zone-IIFlexor Tendor Repair:Surgical Technique " of periodical " The Journal of Bone and Joint Surgery " (in March, 2006 distribution, volume 88-A-supplementary issue 1, part 1) in, Teno Fix implant has been carried out to basic description.The implant assembling comprises the stainless anchoring piece (form that is the coil being wound around around a core) in two tendons that engaged by single multifilament (multi-filament) rustless steel cable.While consigning to surgeon, this implant is unassembled state, comprise one end be fixed with the rustless steel cable of block bead (stop-bead), with two separated anchoring pieces of the through hole passing through for cable and with another block bead of the through hole passing through for cable.

During use, anchoring piece advances in longitudinal tendon of making in the nearside tendon broken ends of fractured bone in breach (tendon disconnecting unit (tenotomy)), thereby this anchoring piece is positioned at tendon disconnecting unit longitudinally, and by being stuck in, tendon fiber between core and anchoring piece, engages tendon material.Another anchoring piece is placed in the tendon broken ends of fractured bone of distally according to identical mode.Then, the staight needle of attached rustless steel cable penetrates the through hole of this anchoring piece from the small end of distal anchors, and the central authorities that are pulled the cutting surfaces by the distally tendon broken ends of fractured bone are until the block bead contact distal anchors of the end relative with pin of cable.Then, the rustless steel cable that is attached with pin is directed in the cutting tip of the nearside broken ends of fractured bone, and the through hole that the large end of the anchoring piece from the nearside broken ends of fractured bone passes through anchoring piece is to small end.Then, by stretching cable, make the nearside broken ends of fractured bone of tendon contact with the distally broken ends of fractured bone, and the second block bead is held in place above the rustless steel cable at nearside place of proximal anchors.Then, clamp (crimp) second block bead to be locked on cable, cut away unnecessary cable cable and damper ends is flushed with the second block bead.

Therefore the defect of Teno Fix is that the size of tendon anchoring piece is larger, has increased the resistance to tendon at tendon during by tackle system.Another defect of Teno Fix is to implant the invasive of this device, the whole piece skin route on tendon path all must be cut to this device is implanted.What the 3rd defect was anchoring piece to tendon is attached quite slim and frahile, reports that hot strength is only approximately 46 newton.These shortcomings are overcome by theme described in the invention and method.

The prior art overwhelming majority discussed above all has the defect of high infection rate.

Summary of the invention

The present invention includes the method and apparatus again connecting for dissecting member (such as tendon, ligament or bone), between the preparation of described member and healing stage, adopted surgical repair device, this prosthetic device can be attached to described member firmly, then is guided through safely crooked anatomical structure to realize the operation that again connects and repair.This prosthetic device also comprises structure devices, and the relative end that is used for fixing described member between healing stage prevents its separation.Device for surgical repair device described in auxiliary positioning is also provided, for example clamp adapter retaining tool, this retaining tool is used for two stitching thread that are attached to two tendon broken ends of fractured bone maintaining cramping adapter through clamping when adapter passes, thereby is with two broken ends of fractured bone enter butt state and clamped in place.

Accompanying drawing explanation

Fig. 1 demonstrates the various building blocks that can be used to repair the fracture member such as tendon or ligament according to apparatus of the present invention the first embodiment.

Fig. 2 A-Fig. 2 L demonstrated according to each stage of the operative procedure of the inventive method the first embodiment.

Fig. 2 M is the perspective view of both crimps retaining tool in accordance with the principles of the present invention.

Fig. 2 N is the zoomed-in view of clamp of the cramping retaining tool of Fig. 2 M.

Figure 20 is the perspective view of alternative clip casting die retaining tool in accordance with the principles of the present invention.

Fig. 3 is according to the photo of the tendon repair completing of the first embodiment.

Fig. 4 A-Fig. 4 D demonstrates each stage according to the operative procedure of another embodiment of the inventive method.

Fig. 5 demonstrates the device for member is connected again in accordance with another embodiment of the present invention.

Fig. 6 A demonstrates in accordance with the principles of the present invention for by two interconnective alternative connectors of tendon repair device.

Fig. 6 B demonstrates the operative procedure that locks the cable of two tendon repair devices for the connector at Fig. 7 A.

Fig. 7 demonstrates the tackle system of finger.

Fig. 8 A demonstrates the alternative of tendon repair device in accordance with the principles of the present invention.

Fig. 8 B demonstrates the tendon repair device of Fig. 9 A when preferably being delivered to operative site.

Fig. 9 A to 9C demonstrates another embodiment of tendon repair device and technology in accordance with the principles of the present invention.

Figure 10 A demonstrates another alternative of tendon repair device in accordance with the principles of the present invention.

Figure 10 B demonstrates for repairing two devices of device of Figure 10 A of tendon.

Figure 11 A demonstrates according to alternative means of the present invention.

Figure 11 B-Figure 11 D demonstrates the another kind of alternative technique of the device that has adopted Figure 11 A.

Figure 11 E shows the alternative according to guiding elements of the present invention.

Figure 11 F shows another alternative according to guiding elements of the present invention.

Figure 11 G shows the another alternative according to guiding elements of the present invention.

Figure 12 A demonstrates according to alternative means of the present invention.

Figure 12 B-Figure 12 C demonstrates the another kind of alternative technique of the device that has adopted Figure 12 A.

Figure 13 A is according to the perspective view of an embodiment of the single formula dilating catheter of another embodiment.

Figure 13 B is according to the perspective view of an embodiment of the multi-piece type dilating catheter of another embodiment.

Figure 13 C is the perspective view for an embodiment of the guiding elements of the dilating catheter of Figure 13 A and Figure 13 B.

Figure 14 A-Figure 14 G demonstrates the another kind of alternative technique of the device that has adopted Figure 13 A or Figure 13 B.

Figure 15 demonstrates and is sewed with modification cross and repairs sutural tendon.

Figure 16 is the perspective view of tendon keeper in accordance with another embodiment of the present invention.

Figure 17 A shows another alternative of tendon repair device in accordance with the principles of the present invention.

Figure 17 B shows another alternative of tendon repair device in accordance with the principles of the present invention.

Figure 18 A-Figure 18 H shows according to the suturing skill of embodiment of the present invention principle.

Figure 19 shows the bone reparation of merging the prosthetic device of (bone fusing) for bone of having used according to first embodiment of the invention principle.

Figure 20 shows the bone reparation of having used according to the prosthetic device merging for bone of second embodiment of the invention principle.

Figure 21 shows the bone reparation of having used according to the prosthetic device merging for bone of third embodiment of the invention principle.

Figure 22 shows the bone reparation of having used according to the prosthetic device merging for bone of fourth embodiment of the invention principle.

Figure 23 shows the bone reparation of having used according to the prosthetic device merging for bone of fifth embodiment of the invention principle.

Figure 24 shows the bone reparation of having used according to the prosthetic device merging for bone of sixth embodiment of the invention principle.

Figure 25 is the perspective view of guiding piece of holing in accordance with the principles of the present invention.

Figure 26 is the side view of guide pin in accordance with the principles of the present invention.

Figure 27 is the cross-sectional side view of bone anchor in accordance with the principles of the present invention;

Figure 28 A-Figure 28 L shows a part of in accordance with the principles of the present invention bone integration technology.

The specific embodiment

According to the present invention, disclosed in tendon, ligament and analog fracture, the surgery implant of after bone avulsion etc., it being repaired and the technology being associated.The present invention is particularly suited for repairing the musculus flexor tendon of fracture or avulsion, for example flexor digitorum profundus of distal phalanx and/or the flexor digitorum superficialis of middle phalanx.

First set exemplary embodiment

Fig. 1 demonstrates the building block according to first embodiment of the invention.As will be explained below, in each operative procedure, not every building block will be used to.Described building block comprises coaster conduit 101, and it will be used to guide together with the tendon broken ends of fractured bone, the ligament broken ends of fractured bone or the similar anatomical features part of tendon repair device of the present invention and fracture by one or more dissection limiting structures (for example, by the tackle system of finger) when needed to repairing position.Building block also comprises flanged pin conduit 103, and it arrives by dissection limiting structure the tendon broken ends of fractured bone that is used to where necessary guiding fracture repair position.Pipe joint element 105 can be used for coaster conduit 101 together with 103 end-to-end links of flanged pin conduit, the same as will be described in detail below.Pipe joint element 105 can be metal pin.If desired, tendon keeper instrument 107 can be used for keeping tendon during surgical repair operative procedure.

One or more tendon repair devices 109 are the actual device that affect the reparation by two tendon broken ends of fractured bone are connected again.Each tendon anchoring piece 109 comprises multifilament rustless steel cable 110.From an end 141 of cable, to the intermediate point 143 of cable, each rhizoid of cable is wound around to form single cable part 144 in normal way.Staight needle 111 is attached to the first end 141 of cable.From intermediate point 143, along the direction contrary with end 141, each rhizoid of cable is untied to be wound around take and is formed many (being seven in this specific embodiment) separated stitching thread 147a-147g.On the end of each the cable part in these seven separated cable part 147a-147g, be attached with pin, be preferably crooked pin 114a-114g.The accessory that is attached at intermediate point 143 places prevents that cable part 144 from untiing winding.This accessory can be for example sleeve 149.In a preferred embodiment of the invention, rustless steel cable is entwined with seven groups by 343 independent line thighs.Therefore, from sleeve 149 to first end 141, cable 144 comprises that 343 independent line thighs form seven intermediate line thighs, and every intermediate line thigh consists of seven windings, less line thighs, every less line thigh has 49 rhizoids, each root in these less line thighs consists of seven independent line thighs again, and every independent line thigh has 7 rhizoids.Leaving in another direction of sleeve 149, each root in seven independent line thigh 147a-147g comprises seven those less line thighs that are intertwined (wherein each root in those less line thighs comprises seven independent line thighs that are intertwined).

The embodiment described above of tendon repair device 109 is preferred, because it is for example highly susceptible to, from widely available material manufacture (, 343 line thigh rustless steels are sewed up cable and both crimps).These materials can be selected from the implantable family of metal and alloy, comprise rustless steel, cochrome, titanium and alloy thereof and Ni-Ti alloy (NiTinol).But this tendon repair device 109 can be formed by other material such as polymer fiber, and to assemble such as braiding, welding or molded alternate manner.For example, it can be welded together and be formed by independent silk, fiber or yarn.

In ensuing discussion, in order more clearly to distinguish them, the single-ended part 144 of tendon repair device 109 will be called as cable part 144, and line thigh 147a-147g will be called as stitching thread.But the use that it being understood that these terms is not for showing that they are formed by different materials because for example here in described exemplary embodiment wired strand of institute all by stainless steel metal line, formed.

Connector 112 is for interfixing two tendon repair devices 109, the same as will be described in detail below.In this illustrated embodiment, connector 112 comprises the piece of the material that is preferably deformable metal (such as rustless steel), has interior diameter and is a bit larger tham two of cable part 144 through holes 151,152 side by side.The same as will be described in more detail below, approach the operative procedure ending that tendon is connected again, each cable 144 part is inserted through the direction by along contrary each through hole 151 and 152 of connector 112, and (connector will deform, clamped), thus cable part 144 is locked in wherein.

Finally, can tendon from bone avulsion or extremely near the place fracture of bone so that use bone anchor 400 or 450 operative procedure that can not provide enough tendon length to carry out fixing tendon repair device 109.In the first embodiment, bone anchor 400 has threaded distal end 401, is used for being screwed in bone firmly.Proximal end 403 comprises the eyelet 402 that stitching thread can be passed through.The same as will be described in more detail below, stitching thread can tie up in eyelet.Alternative, proximal end 403 can be formed by the deformable material such as thin-wall metal, thereby can eyelet be flattened suture clamp therein by cramping instrument.In a second embodiment, bone anchor 450 can be made so that one or a plurality of stitching thread 451 stretch out from proximal end 455, such as four stitching thread 451a, 451b, 451c, 451d.These sutural ends are provided with sewing needle 452a, 452b, 452c, 452d.

Tendon repair device, operation tool and method are described in reparation below in conjunction with the flexor digitorum profundus of the fracture at middle phalanx level height place.But, it should be understood that this just exemplifies explanation.Each stage of operative procedure is illustrated by Fig. 2 A-Fig. 2 L.

First, if can get at the proximal end of tendon separately from wound site, it is given for change gently by site of injury, with tendon keeper 107, clamp.

Tendon keeper 107 comprises handle 201, at cross bar 203 and the first pin 205 distad stretching out from cross bar 203 respectively and second pin 207 at handle 201 distal end places.The pin 205 and 207 respectively slit in cross bar 203 209 and 211 inside laterally slides.Specifically, the proximal end of these pins comprises the internal thread hole that shoulder block 213 and the proximal end from shoulder block 213 to pin are stretched out.Screw 217 can be screwed in the proximal end of each pin 205,207, to cross bar 203 is trapped between the head of screw 217 and the shoulder block 213 of pin 205,207, thereby the slit 209,211 along it is fixed in any given position by each pin.

The length of stretching out in wound outside according to tendon, surgeon can pierce through tendon tendon is remained on to site of injury outside with one or two in the pin 205,207 of tendon keeper 107.For example, referring to Fig. 2 C, the figure illustrates the tendon keeper 107 that maintains tendon broken ends of fractured bone 153a.Preferably, surgeon pierces through tendon from the position of the about 1cm of broken ends of tendon.

But, if can not easily tendon be given for change from site of injury, and must touch tendon by another otch, being brought back to again wound site, tendon keeper 107 still can use, but first must give tendon for change wound site.In this case, give tendon for change with coaster conduit 101 and flanged pin conduit 103.Specifically, coaster conduit 101 is the hollow plastic pipes that formed by biocompatible polymeric, and the composition of this pipe and/or wall thickness make it relatively hard, but can be crooked.For example, it can roughly have the flexibility of typical case's operation vessel catheter.The relative rigidity of coaster conduit by enabling to be pushed through narrow anatomical passageway, for example, is pointed coaster.But its flexibility will allow again some bendings to adapt to integrally bending path.Preferably, the material friction coefficient that forms coaster conduit is lower, to allow the coaster conduit can be easily through around the bodily tissue such as tendon tackle system.Suitable biocompatible polymeric comprises homopolymer, copolymer and the mixture of silicones, polyurethane, polyethylene, polypropylene, polyamide, polyaromatic, fluoropolymer, or any other biocompatible polymeric system that meets above mechanical property.Except simple tubular structure, also can adopt the various shape of cross sections of coaster conduit, for example will provide the solid construction of above mechanical property, multiple chamber or complicated geometry.The coefficient of friction of coaster catheter surface can be intrinsic for building the material of this device, or can by the mechanical alteration such as surperficial (for example longitudinal fluting) or lubricious surface treatment improved.

The length-specific of coaster conduit 101, material, wall thickness, interior diameter, overall diameter and hardness can alter a great deal according to specific tendon or the ligament situation that will use this conduit.Length can be determined by the extreme length that will need it to walk certainly.Interior diameter must be enough large, to easily hold the cable part 144 of tendon repair device 109.Overall diameter must be enough little, so that through needing the anatomical structure of its process.The certain material of coaster conduit and cross-sectional geometry (for example wall thickness) will determine the hardness of conduit to a great extent, and the rigidity that should be selected to as described above provide enough makes it possible to be pushed through narrow path, but there is enough flexibilities to bend to adapt to the knee in path.In the exemplary case of the flexor digitorum profundus at middle phalanx level height place, coaster conduit can be formed by silicones, and length is 120 millimeters, and wall thickness is 0.5 millimeter, and overall diameter is 2 millimeters.For coaster conduit, can adopt Shao Shi A type hardness tester instrumentation to obtain the silicones that hardness is 50-80.

Flanged pin conduit 103 is also the hollow pipe being formed by biocompatible material (being preferably polymer).But flanged pin conduit is preferably softer than coaster conduit.Flanged pin conduit has first end 157, and the diameter of this end is substantially equal to the diameter of coaster conduit 103, thus it can with the end-to-end link of coaster conduit, the same as will be described in more detail below.It also has flanged end 159, and this end is convergent, to substantially form the end that a funnel-form body is received the tendon broken ends of fractured bone, this is the same as will be described in more detail below.As in subsequent discussion, become clearer, when flanged pin conduit when walking substantially the same path as coaster conduit, coaster conduit is by guiding or pull flanged pin conduit to enter into anatomical path together with the tendon repair device being attached on the tendon broken ends of fractured bone of flanged pin part 159 inside of flanged pin conduit.Therefore, flanged pin conduit is without being rigidity.In fact, flanged pin conduit should be relative flexibility, because it can be bent to tortuous shape to adapt to cable part 144 processes of tendon repair device 109.In addition, the flanged pin part 159 of flanged pin conduit 103 especially should be able to easily be collapsed, to around collapsing and pass through the narrow anatomical passageway such as pointing coaster at the tendon broken ends of fractured bone containing the tendon broken ends of fractured bone and tendon repair device being housed in the situation that, equally will be mounted in it as will be described in more detail below.

Flanged pin conduit 103 should have the length mutually suitable with its purposes, wall thickness, interior diameter, overall diameter and material and form.Its purposes is to allow the single-ended part 144 of tendon repair device 109 pass through through it, follows in addition coaster conduit through anatomical path, as by more fully describing below.Therefore, flanged pin conduit has narrow end 157 and wide end 158.Wide end ends at bullet or flange 159, to more easily the staight needle 111 of the end of the cable part 144 of tendon repair device 109 is inserted into wherein, and more easily comprises the tendon broken ends of fractured bone.The narrow end 157 of flanged pin conduit 109 is narrow, to match with the end of coaster conduit.

Preferably, the material that forms flanged pin conduit 103 also has low coefficient of friction, to allow flanged pin conduit easily to pass through around the bodily tissue such as tendon tackle system.This biocompatible polymeric can be selected from homopolymer, copolymer and the mixture of silicones, polyurethane, polyethylene, polypropylene, polyamide, polyaromatic, fluoropolymer, or any other biocompatible polymeric system that meets above mechanical property.Except simple tubular structure, also can adopt the various shape of cross sections of flanged pin conduit, for example will provide the solid construction of above mechanical property, multiple chamber or complicated geometry.The coefficient of friction of flanged pin catheter surface can be intrinsic for building the material of this device, or can by the mechanical alteration such as surperficial (for example longitudinal fluting) or lubricious surface treatment improved.

In the exemplary case of the flexor digitorum profundus at middle phalanx level height place, flanged pin conduit can be formed by silicones, and length is 120 millimeters, and wall thickness is 0.5 millimeter, and overall diameter is 2 millimeters.Yet preferably, the flanged pin part 159 of conduit can thinner by cross section (for example 0.25 millimeter or less) material manufacture, make the flange portion 159 of flanged pin conduit can encase the tendon broken ends of fractured bone, and collapse when the tendon broken ends of fractured bone is reorientated at the anatomical passageway of advancing through the tackle system such as finger.Flanged pin conduit is for example preferably adopted to by Shore durometer, to record hardness be 20 to 40 softer silicones.

Referring now to Fig. 2 A, in use, if tendon has bounced back and must give for change and enter the second otch (or site of injury) 160 from the first otch 161 as tendon rupture typical case in hands, typically in palm, form the otch 161 that can give tendon 153 for change.On the other hand, if the nearside tendon broken ends of fractured bone in the distally of A2 coaster, tendon will expose by the otch in the distally of A2 coaster just.For the sake of clarity, in Fig. 7, demonstrate the pinkie tackle system departing from surrounding tissue.As shown in the figure, it comprises five annular coasters that mark with A1 to A5, and three criss-cross coasters marking of C1, C2 and C3.Unclear in order not make the present invention thicken, this tackle system does not demonstrate in other accompanying drawing of great majority.

Coaster conduit 101 is passed in the site of injury or otch 160 at fracture location place, and new otch 161 proximads towards A3 coaster below promote lentamente by the tackle system of finger by this conduit.If the resistance of encountering makes coaster conduit 101 proximads to be promoted to pass through, can form the otch (not shown) of one 1/2 centimetres to 1 centimetre at a crease in the skin of nearside interphalangeal joints of hand and the place, the centre position between a crease in the skin at finger root place of finger.This otch is at the A2 coaster of finger and the level height place between A3 coaster.Dissect downwards lightly to musculus flexor flesh sheath, will find coaster conduit there.Then, pull coaster conduit to surmount obstacles or resistance by this otch.Then, by promoting gently to make coaster conduit can continue proximad, advance by the tackle system of finger, until coaster conduit arrives tendon, give otch 161 for change, and proximad exposes.

Then, as shown in Figure 2 B, the narrow end 157 of flanged pin conduit 103 is connected with the proximal end of coaster conduit 101.If building block is enough large and/or surgeon is enough skilled, the narrow end of flanged pin conduit directly can be inserted in the proximal end of coaster conduit.Otherwise, use the pipe joint element (for example hook) of metal pin 105 or other form to complete connection.Specifically, pipe joint element 105 is rigidity, the narrow end 157 of flanged pin conduit 103 can be inserted on an end of pipe joint element.Then, another end of pipe joint element 105 can be inserted in the proximal end of coaster conduit 101 with tight friction fit, thereby coaster conduit 101 and flanged pin conduit 103 are interconnected.

Then, with reference to Fig. 2 C, the nearside broken ends of fractured bone 153a of tendon is sent by the otch 161 in palm, thereby the tendon of about 2cm is exposed in otch 161 outsides to (a bit of distance and be positioned at nearside phalanges level height place if the nearside tendon broken ends of fractured bone just bounces back, according to circumstances can send tendon by the otch in A2 coaster distally or the otch between A1 coaster and A2 coaster).Preferably, flexible block piece 165 is placed on below tendon keeper 107 and nearside tendon broken ends of fractured bone 153a, to be formed for implementing the work " platform " of this technology.After coaster conduit 101 and flanged pin conduit 103 connect, from otch 160, distad pull coaster, to flanged pin conduit 103 is drawn in and passed through the tackle system between otch 160 and otch 161.When the front end 157 of flanged pin conduit 103 is when by otch 160, out thereby flanged pin conduit 103 stretches out between two otch 160,161, coaster conduit 101 and connector 105 are removed, the same as shown in Figure 2 C.

Turn to now Fig. 2 D, next, the staight needle 111 of the end of the cable part 144 of tendon repair device 109 is placed in tendon broken ends of fractured bone 153a to the about 1cm of end 168a from broken ends of fractured bone 153a, and the cut end 168a by tendon broken ends of fractured bone 153a draws by pin 111.Pull pin 111 by until sleeve 149 from the about 1/2cm of cut end 168a.If tendon exposes very little, sleeve 149 can be arranged to obtain to more close a little cut end 168a.

Next, in tendon, make little tendon disconnecting unit, thereby both crimps can be imbedded in tendon.Fig. 2 D demonstrates tendon and the situation of tendon repair device when this moment of operative procedure.

At tendon repair device 109, in this position in the situation that, with seven free line thigh 147a-147g of tendon repair device, tendon repair device 109 is sewn on tendon broken ends of fractured bone 153a.More particularly, for example, with two stitching thread (147a and 147g) that looper 114a and 114g promote in stitching thread, pass through tendon, and they are tied up in node 185 mutually.In a preferred embodiment, use locking-type intersection stitch or cruciform pattern that two stitching thread are sewn on tendon 153a.In this case, load will disperse along repairing length between a plurality of fixing points.In addition, due to cross method, be repaired tendon and under stretching action, diameter diminished, this will be conducive to walk and pass through tackle system.Distal side at node cuts off to remove the excess stock outside node by stitching thread 147a, 147g.Yet in order not allow the present invention smudgy, these stitching thread illustrate with " X " in comprising most of accompanying drawings of Fig. 2 E-2J.Only for example, in thering is the accompanying drawing of proper ratio (Fig. 2 L), or in having provided the corresponding contents of some discussion of stitch (stitch), just can represent more exactly stitch operation.

Then, use looper 114b and 114f that other two stitching thread (for example 147b and 147f) are sewn on tendon, and they are tied in another node 187.Preferably, the cross locking-type stitch that this node 187Wei Liangge branch proximad is advanced.These stitching thread are being to cut off after node.In a preferred embodiment of the invention, as shown in Figure 2 E, along tendon broken ends of fractured bone 153a length, at different level height places, be the first node 185 and the second node 187.Finally, other two stitching thread (for example 147c and 147e) tied up on the opposite side of tendon broken ends of fractured bone 153a in similar cross node (not shown) and cut off.

Finally, remaining single stitching thread 147d can be cut away, or can engage any (before pruning) in other free end to form again another node with it.Preferably, have a plurality of fixing points that tendon repair device are fixed to the tendon broken ends of fractured bone.

In one embodiment of the invention, stitching thread can have different length, and forms rightly, makes each the root length in two paired stitching thread identical, and every pair of suture length difference.When stitching thread is sewn on tendon, every pair of identical stitching thread of length is sewn on tendon and knotting mutually.The advantage of this embodiment is, it provides vision indication easily to surgeon, indicates during operative procedure which will be hitched to (stitching thread of equal length) mutually to stitching thread, has simplified thus operative procedure.

With reference to Fig. 2 F, upper since tendon repair device 109 is fixed on nearside tendon broken ends of fractured bone 153a firmly, so tendon is removed from tendon keeper, and the staight needle 111 of cable part 144 ends is inserted in the flange 159 of flanged pin conduit 103.Tendon repair device 109 is advanced by flanged pin conduit, until the end of tendon broken ends of fractured bone 153a (this end is sewn on the rear end of tendon repair device 109) is in the flange portion 159 of flanged pin conduit 103.Cable part 144 is enough rigidity preferably, make it possible to the cable to promote the tackle system by finger together with flanged pin conduit and make cable along with flanged pin conduit 103 from site of injury 160 out.Now, surgeon can clamp pin 111 and pull pin 111, cable part 114, flanged pin conduit 103 and this broken ends of fractured bone of tendon broken ends of fractured bone 153a(to be comprised in the inside of the collapsed flange 159 of flanged pin conduit 103 through flanged pin conduit 103 with clip) by finger tackle system from site of injury 160 out.Alternative is, if pin 111 stretches out from the distal end 157 of flanged pin conduit, surgeon can directly catch pin 111 or cable part 144 with hands or with clip, pulls pin 111, cable part 114, flanged pin conduit 103 and this broken ends of fractured bone of tendon broken ends of fractured bone 153a(to be comprised in the inside of the collapsed flange 159 of flanged pin conduit 103) by finger tackle system from site of injury 160 out.If encounter resistance, can check by the path of tackle system by separated otch.

The flange 159 of flanged pin conduit 103 will around be collapsed at the tendon broken ends of fractured bone when needed, so that the tackle system through pointing.

With reference to Fig. 2 G, once tendon broken ends of fractured bone 153a has arrived site of injury 160, flanged pin conduit 103 can be removed from tendon repair device 109 and tendon broken ends of fractured bone 153a, expose thus tendon repair device 109 and tendon broken ends of fractured bone 153a by site of injury 160.The pin of tendon keeper 107 205 can be crossed to nearside tendon broken ends of fractured bone 153a and place, to tendon broken ends of fractured bone 153a is remained in reliable position.

In Fig. 2 G and accompanying drawing subsequently, the length of the tendon broken ends of fractured bone can be amplified to help to set forth repair process by exaggeration.But, once it should be understood that and tendon given for change or near primary trauma position (as in Fig. 2 G), only had few or do not have unnecessary tendon can expose outside skin, the in the situation that of especially opening (there is no bending) at finger.In fact, if finger does not have bending, surgeon may mainly perform the operation to tendon in skin.But in some drawings, unclear in order not set forth the method and apparatus of describing in conjunction with these accompanying drawings, the length of the tendon broken ends of fractured bone can be amplified by exaggeration.In addition, in some drawings, in the situation that stitching thread and the feature described in conjunction with these accompanying drawings there is no contact, stitching thread and/or node represent by simple cruciform pattern, makes these accompanying drawings can be too complicated.In other accompanying drawing, in the situation that stitching thread or node and those feature close relation of being described can be expressed suitable node/stitching thread more accurately.

Should also be noted that such as diameter or the further feature length of stitching thread, both crimps, cramping connector and pin and all needn't draw in proportion in institute's drawings attached.

Next with reference to Fig. 2 H, for the distally tendon broken ends of fractured bone, carry out very similarly operation process.Specifically, according to the mode that is similar to above combination nearside tendon broken ends of fractured bone 153a description, distally tendon broken ends of fractured bone 153b is delivered in site of injury 160.That is to say, if can not realize, expose that fully distally tendon broken ends of fractured bone 153b is directly fetched from site of injury 160, can be just in the distally of the wrinkle at distal interphalangeal joint place, cut out the otch 174 of 1 centimetre, and dissect to the distal region of A5 coaster downwards, distally tendon broken ends of fractured bone 153b can be exposed by this new otch.Leading block conduit 101 between otch 160 and otch 174, and flanged pin conduit 103 is inserted in the distal end of coaster conduit 101.Then, pull coaster conduit 101 to allow flanged pin conduit 103 thereupon together by tackle system, until flanged pin conduit 103 locates by tackle system and stretches out in relative end with otch 174 from otch 160, shown in Fig. 2 H.Then, by another tendon repair device 109 according to the attached finger of the same way distally tendon broken ends of fractured bone 153b with describing in conjunction with the nearside tendon broken ends of fractured bone above.Fig. 2 H demonstrates the operative procedure when this stage.

Next with reference to Fig. 2 I, then as above in conjunction with nearside tendon broken ends of fractured bone 153a, describe, with coaster conduit 101 and flanged pin conduit 103, the distally tendon broken ends of fractured bone is guided to former wound site 160.The second pin 207 of tendon keeper 107 can be placed through distally tendon broken ends of fractured bone 153b, as described in conjunction with the nearside tendon broken ends of fractured bone tendon that exposes about 1 centimetre above.In Fig. 2 I, demonstrate this stage of operative procedure.

Next, with reference to Fig. 2 J, take connector 112 to wound site, the staight needle 111 of cable part 144 ends is inserted through to the hole 151,152 in connector 112.More particularly, by the staight needle 111 of tendon repair device 109 that is attached to nearside tendon broken ends of fractured bone 153a through along a hole 151 of being advanced by nearside to distal direction, and by the staight needle 111 of tendon repair device 109 that is attached to distally tendon broken ends of fractured bone 153b through (by distally to proximal direction) advances in the opposite direction in connector another hole 152.

Referring now to Fig. 2 K, nearly pleural muscle tendon broken ends of fractured bone 153a and distally tendon broken ends of fractured bone 153b from they separately tendon keeper pin remove (and tendon keeper is put aside), applying pulling force pulls distally tendon broken ends of fractured bone 153b proximad, and nearly pleural muscle tendon broken ends of fractured bone 153a distad pulls until make these two tendon broken ends of fractured bone have about 1 millimeter overlapping, and connector 112 is embedded in the tendon between tendon end 168a, 168b substantially.

Then with cramping instrument 113, clamp connector 112, thus the cable part 144 of two tendon repair devices is fixed in connector 112 firmly.More particularly, with reference to Fig. 2 K, can by tendon broken ends of fractured bone 153a, 153b, inflection be to expose connector 112 a little, a cramping instrument 113 that makes it possible to is placed on and clamps above connector and can not contact or damage tendon.

Alternative is, can use tendon keeper 107 if desired, by towards center adjustment two pins 205,207 position in the slit 209,211 of tendon keeper 107 so that they each other very near and use respectively each tendon broken ends of fractured bone of needle-penetration, help the tendon broken ends of fractured bone to take to or remain to together.

Then the edge that is positioned as close to cramping connector cuts off cable part 144 extra lengths that stretch out connector 112 throw away.Then, connector 112 will retract in tendon material when released, and tendon end is not folding, and tendon end will be drawn over to one's side together admirably, as shown in Fig. 2 L.Fig. 2 L demonstrates four cross-stitch 185,187,185 ' and 187 ' that utilize tendon repair device to make.Although it is effective especially that cross-stitch is considered to, also can adopt the stitch of other type.If need, (epitendonous) stitch 183 on one or more 6-0 nylon tendon can be placed in around tendon end, thereby to guarantee tendon end to draw over to one's side preferably together the edge of " putting in order " repair place.

Fig. 2 M shows both crimps retaining tool, and this instrument can be for linking and grip and handle adapter 112 with the action that adapter 112 is brought to reparation position and stitching thread is passed through adapter mutually.Fig. 2 N is the enlarged drawing of the clamp part 971 of this instrument.

According to the size of specific tendon or other anatomical structure being just repaired, adapter 112 can be very little, and be therefore very difficult to grip with hands.In the particular example of discussing herein, for example, when repairing the flexor digitorum profundus of finger, adapter 112 can be very little and be difficult to grip.In addition, owing to clamping adapter 112, be soft yielding, with traditional operation pincers or analog, grip this adapter and can allow surgeon inadvertently by adapter distortion, if this adapter is in situation about gripping with pincers or other traditional operation instrument.Therefore, clamp the instrument of controlling for example the instrument 970 shown in Fig. 2 M and Fig. 2 N be useful.Fig. 2 M is the perspective view of instrument 970 and Fig. 2 N is the enlarged drawing of the clamp part 972 of instrument 970.Instrument 970 can be formed by the elastomeric material 971 of rod, line, bar, dowel (dowel) or other elongate form, and this elastomeric material can be for example thin specification rustless steel, titanium or polymer to have the attribute (as will be described) of spring-like.Microscler material (being below line) forms ring 971 as shown in the figure, to present the clamp 972 that opposed end 971a, the 971b of circle or oval shape and line roughly meet to form instrument.Particularly, two end 971a, 971b cross each other, and from ring 971, extend laterally abreast, thereby line by ring 971 biasing with the elasticity of directly stretching out at least in part make clamp 972 naturally setover (that is, two end 971a and 971b court being offset with respect to each).Preferably, ring 971 is sized to comfortable and is engaged in staff.For example, it can be avette, has the normal axis of about 2 inches and the minor axis of about 1 inch.The length of the formation clamp of end 971a, 971b will be subject at least in part by the size domination of the specific adapter 112 therewith using, but can be in the magnitude of about 0.5 inch.

Two finger hold item 973a, 973b can or be attached to ring 971 with relation welding respect to one another, and the centre of the length L in ring 971 preferably, thereby two finger hold item 973a, 973b will be opened to clamp 972 while pushing toward each other.Finger hold item 973a, 973b are designed to provide a pair of relative planar surface through size and dimension, and this surperficial size is enough to provide the stability of instrument in surgeon's hands.They are shape or oval shape in the form of a substantially rectangular, and its length along the long dimensional directions 975b of ring 971 is approximately 0.5 inch, along the width of the short dimensional directions 975c of ring, be about 0.25 inch.The outside apparent surface of finger hold item 973a, 973b can be through annular knurl disposal or treated to have high frictional property.

In the alternative 970 ' shown in Figure 20, finger hold item 973a ' and 973b ' can directly be incorporated into loop materials 971 '.

In one embodiment, the path 974 providing along with respect to the horizontal direction 975a of ring 971 plane that limits is provided clamp, to maintain adapter 112, is orientated to its longitudinal axis and is positioned on aforementioned lateral direction 975a.When linking with exemplary adapter 112, path is cylindricality, so that the cylindrical shape of matching connector 112.The cross sectional dimensions of path 974 can be enough greatly to receive the adapter of number of sizes.Path 974 can be designed so that when the adapter of minimum dimension is arranged in path through size and dimension, this path still keeps clamp (to be for example engaged with each other, planar surface 976a, 976b do not meet), thus the elastic bias force of clamp will closely keep minimum adapter in path.The spring force of ring 971 should be enough to closely keep adapter in this situation and can not make its distortion.

Oblique section 979 on each end of path 974 makes easily to touch both crimps so that stitch is loaded through it, thereby realizes light effect of visualization.

Adapter can be passed surgeon in the situation that being preloaded in both crimps keeper.Or, adapter can be sent discretely with both crimps keeper, and surgeon can use hand grip adapter, or grasp adapter with fixture or other strap clamp utensil, then two finger hold item 973a, 973b are pushed toward each other to open clamp 972, adapter 112 is placed in path 972, then in release, be applied to the pressure on finger hold item 973a, 973b, adapter 112 be locked in clamp 972.Thereby surgeon should grasp adapter can unexpectedly not crushed at the longitudinal end place of adapter, and make adapter can in the situation that fixture or surgical finger are not arranged in clamp 972, be placed on path.

Then, stitching thread passes through path as mentioned before in adapter.The matched shape of path 974 and adapter prevents that adapter from deflection (pitching), rolling, sideslip, translation or motion occurring when surgeon attempts stitching thread to pass adapter.Once stitching thread is through adapter 112, surgeon can be by pushing finger hold item 973a, 973b to open clamp and unclamping adapter 112 from instrument 970 toward each other.Adapter 112 steadily supports by the stitching thread passing through it.Surgeon then will apply the traction force of expectation, and adapter is clamped by the cramping instrument of describing before to stitching thread.

The actual tendon repair photo of Fig. 3 for carrying out according to first embodiment of the invention.Can see respectively the first node 185 and the second node 187 in nearside tendon broken ends of fractured bone 153a.Can see similar node 185 ' and node 187 ' in the tendon broken ends of fractured bone 153b of distally.Can also see stitch 183 on four tendons.

Can as usual sew up one or more skin traumas place, and operative procedure finishes.

Although describe this operation process and device in connection with repairing a relevant particular procedure process in the flexor digitorum profundus fracture at middle phalanx place to musculus flexor tendon above, this is only exemplary purposes.The present invention can be applied to reconnect tendon, ligament or other similar carrying soft tissue of other type.

The second cover exemplary embodiment

Fig. 4 A-Fig. 4 D demonstrates another device and operative procedure in accordance with the principles of the present invention, and they can be used in tendon (or ligament) from the situation of bone avulsion or separated rather than fracture.Thereby the device of describing in conjunction with Fig. 4 A-4D and operative procedure also can be used in tendon or ligament and tendon repair device 109 be effectively attached in the situation of the broken ends of fractured bone very not leaving enough tendon length near the position fracture of bone.

In this type of situation, for example, for thering is the broken ends of fractured bone (the normally nearside broken ends of fractured bone) of sufficient length (at least 2 centimetres), still according to the mode of describing in conjunction with Fig. 2 A-2H above, use tendon repair device (all devices of tendon repair as previously described 109).But, for bone or the short tendon broken ends of fractured bone, directly by one or more cable attaching to bone anchor 400, and do not use the second tendon repair device.

Bone anchor can be any bone anchor, can be attached to bone at its distal end place, and can allow stitching thread or cable attaching to its proximal end.For example in the PCT of international publication patent application WO2008/054814, disclosed suitable bone anchor, the document is used as with reference in being incorporated herein.But, also can use bone anchor simply too much.

In the simple embodiment of suitable bone anchor, for example as shown in Figure 1, bone anchor can comprise for be screwed into the threaded distal part 401 of bone and be formed in the portions of proximal of bone anchor main body, for receiving the eyelet 402 of the cable of tendon repair device.In other embodiments, can produce in advance bone anchor, this bone anchor is with one or more stitching thread that forms therein and stretch out from its proximal end.

In connection with flexor digitorum profundus, the exemplary injury situation in the position avulsion of very close distally phalanges describes the operative procedure according to this embodiment now.But, it should be understood that for from bone avulsion or some modification that can use substantially this operative procedure at any tendon or the ligament of the position fracture near bone.

Fig. 4 A-4D demonstrates each stage of repairing the exemplary procedure program of (i.e. this reparation will have four stitching thread line thighs that stretch out between two tendon broken ends of fractured bone) for realizing four line thighs.This embodiment has utilized the tendon repair device 1001 different from tendon repair device 109 shown in Fig. 1-2 L.This tendon anchoring piece is shown in Figure 10 A, and it will discuss in more detail below in conjunction with another exemplary procedure program.With reference to Figure 10 A, it comprises two line thighs or silk 1047a, 1047b, and every line thigh has pin in each end.In the embodiment shown, looper 1014a and 1014b are located at respectively the first end place of line thigh 1047a, 1047b, and staight needle 1011a, 1011b are located at respectively the second end place of line thigh 1047a, 1047b.These two line thighs that form tendon repair device 1001 for example by fixing or slidably both crimps 1049 in they end inter-engagement.Both crimps 1049 can not clamped at first, so it can slide along this device, and the suitable stage in operative procedure is clamped the in the situation that of needs.As shown in Figure 10 A, the state that tendon repair device 1001 can be loaded in sheath 1011 with staight needle 1011a, 1011b on a part of stitching thread and end 1001a is delivered to surgeon, conveniently that end of tendon repair device 1001 is passed into the process in coaster conduit 101 and/or flanged pin conduit 103.

The long tendon broken ends of fractured bone 501 is operated in mode basic as that above describe in conjunction with the first embodiment.Specifically, with reference to Fig. 4 A, by the position formation at needs, give otch 531 for change if desired the tendon broken ends of fractured bone 501 is given for change, expose the tendon broken ends of fractured bone 501, and use looper that the end 1001b of tendon repair device 1001 is sewn on the tendon broken ends of fractured bone.In only having this exemplary case of two stitching thread 1047a, 1047b, preferably adopt a cross-stitch.In employing, for example have, in the embodiment of more sutural tendon repair devices (the tendon repair device with seven sutural Fig. 1-2 L), for example can use and as multiple cross-stitch or other stitch described with the above embodiment in conjunction with Fig. 1-2 L, tendon repair device is sewn on the tendon broken ends of fractured bone.Then, can equally use as described earlier coaster conduit 101, flanged pin conduit 103 and pipe joint element 105(in the situation that of needs) tendon repair device 1001 and the tendon broken ends of fractured bone 501 are led back to damage location 533.If any being provided with narrow sheath 1011, can be convenient to the end 1001a of tendon repair device 1001 is screwed into and pass through these conduits.

Then, when being ready to the distally tendon broken ends of fractured bone 501, the tendon broken ends of fractured bone is placed in tendon keeper 107.Fig. 4 A demonstrates the situation of the operative site after having carried out these steps, and wherein, tendon 501 is in tendon keeper 107, and tendon repair device 1001 is sewn on this tendon.

Then, with reference to Fig. 4 B, for bone 503(and the distally broken ends of fractured bone 505, if present), make this otch of otch 532(and can comprise original wound 532), and dissect to expose the bone 503 of distally phalanges downwards.Then, by being screwed into bone 503 firmly, bone anchor (example is bone anchor 450 as shown in Figure 1) secures it to this bone.

Then with reference to Fig. 4 C, because this exemplary embodiment is four line thigh reparations, can be at bone anchor place or in the position near it as far as possible, two stitching thread 451c, 451d of bone anchor 450 are cut away.Other two stitching thread 451a, 451b are passed through the distally broken ends of fractured bone 505.Referring now to Fig. 4 D, a small amount of the tendon broken ends of fractured bone is put together overlapping in the situation that having, and two stitching thread 451a, 451b knottings of bone anchor 450 are sewn on the nearside broken ends of fractured bone 501.It has been sewn on the nearside tendon broken ends of fractured bone 501 an end similarly, then by tendon repair device 1001() in another end, be sewn on the distally broken ends of fractured bone 505.Fig. 4 D demonstrates the reparation completing according to this embodiment.

Certainly, the strand count amount on bone anchor 450 and the strand count amount on tendon repair device 1001 can increase the reparation that provides firmer, for example if necessary can for six, eight, ten or even 12 line thighs repair.

For that tendon injury that leaves the short distally tendon broken ends of fractured bone (or there is no the distally tendon broken ends of fractured bone) as shown in Fig. 4 A-4D at all, also for example can adopt tendon repair device 109 and other bone anchor 400 as shown in Figure 1 as shown in Fig. 2 A-2L to repair this tendon injury, wherein the long tendon broken ends of fractured bone 501 be operated in the mode as with above describing in conjunction with the first embodiment of Fig. 2 A-2L.Specifically, by the place formation at needs, give otch for change if desired and give the tendon broken ends of fractured bone 501 for change, expose the tendon broken ends of fractured bone 501, tendon repair device 109 is attached to this tendon broken ends of fractured bone, and uses as described above coaster conduit 101, flanged pin conduit 103 and pipe joint element 105(if necessary) the tendon broken ends of fractured bone is led back to damage location.

Next, make otch, and bone anchor 400 is fixed to bone in the mode of substantially as above describing in conjunction with Fig. 4 A-4D, so difference is at bone anchor 400 rather than bone anchor 450.

Then, for example, if the distally broken ends of fractured bone of musculus flexor still exists (broken ends of fractured bone in Fig. 4 A-4D 505), the pin of tendon repair device 109 111 and cable 144 are stretched out by the broken ends of fractured bone 505, and enter the eyelet 402 by bone anchor 400.Specifically, the staight needle 111 of cable part 144 ends is brought in the short distally tendon broken ends of fractured bone 505 by the broken ends of the tendon broken ends of fractured bone 505, and by near that side tendon broken ends of fractured bone, the broken ends of fractured bone 505 is still connected to the place on bone 503 out, be then passed in the eyelet 402 of bone anchor 400.

Then, to cable 144, apply pulling force and distad pull with the pleural muscle tendon broken ends of fractured bone 501 nearly, until the nearside tendon broken ends of fractured bone 501 and the distally tendon broken ends of fractured bone 505 have 1 millimeter overlapping.

Then, cable 144 is fixed to the eyelet of bone anchor 503.This can complete by stitching thread or cable being tied to the eyelet 402 of bone anchor.But in preferred embodiment, the proximal end of bone anchor 503 is clamped so that the eyelet of bone anchor 400 402 is flattened, and thus cable 144 is stuck in wherein.

Finally, substantially as above in conjunction with Fig. 2 A-2L or Fig. 4 A-4D, describe and complete this operative procedure.

If do not have on the other hand the distally tendon broken ends of fractured bone to stay or in fact not have the distally tendon broken ends of fractured bone to stay for carrying out attached, alternatively can utilize bone anchor that the nearside broken ends of fractured bone is directly attached to bone.Preferably, in the situation that not using the second stitching thread or cable 509, the cable part 144 that is attached to the tendon repair device of the tendon broken ends of fractured bone is directly attached to bone anchor, and the pleural muscle tendon broken ends of fractured bone distad pulls and makes this broken ends of fractured bone encase bone anchor and contact bone anchor bone around nearly.Conventionally, surgeon can do roughening to the bone in bone anchor peripheral region and process, beats counterbore or passage to tendon is attached to bone.

In another alternative, only use the bone anchor 450 with the many line thighs (end at these line thighs has pin) that stretched out from bone anchor.Do not use any independent tendon repair device 109 or 1001.But the stitching thread stretching out from bone anchor 450 is directly sewn to the nearside tendon broken ends of fractured bone.This embodiment is best suited for such damage, and wherein (1) nearside tendon broken ends of fractured bone is not obviously retracted, and therefore appears at and approach the incision of the distally broken ends of fractured bone and needn't give for change by another otch; And (2) do not contain any distally tendon broken ends of fractured bone in reparation.Specifically, for the first situation, if need to give the nearside tendon broken ends of fractured bone for change, actual is to adopt the technology of describing in conjunction with Fig. 4 A-4D.More particularly, if must take out the nearside tendon broken ends of fractured bone, in any case all may be by the attached independent tendon repair device of having to the nearside tendon broken ends of fractured bone to give for change this broken ends of fractured bone.In this case, be more simply that the tendon repair device being sewn on the nearside tendon broken ends of fractured bone is attached to bone anchor, rather than increase another group stitching thread.

For the second situation, if there is the distally tendon broken ends of fractured bone, preferably contain the stitching thread of drawing from the nearside broken ends of fractured bone and apply the active force that the distally tendon broken ends of fractured bone is pulled towards the nearside tendon broken ends of fractured bone.Do not have proximal end tendon repair device just not have any stitching thread that applies this active force, what therefore can expect is that the distally tendon broken ends of fractured bone can slip off from the end-to-end contact position of two tendon broken ends of fractured bone before the healing of the tendon broken ends of fractured bone.

According in the reparation of bone anchor embodiment, the load in distal end is born by bone and bone anchor completely.

Preliminary test shows, the failure intensity that the tendon of carrying out according to the principle of the invention connects is again approximately 70-100 newton.Therefore, tendon and ligament repair have realized than the stronger reparation of current medical care standard in accordance with the principles of the present invention.

In addition, compare with current medical care standard, operative procedure is simplified widely.

The 3rd cover exemplary embodiment

Fig. 5 demonstrates another embodiment in accordance with the principles of the present invention.Fig. 5 has amplified the nearside tendon broken ends of fractured bone 153a of this embodiment according to the present invention in stage after tendon repair device 109 being sewn to the tendon broken ends of fractured bone.It is substantially similar to the stage shown in Fig. 2 E, but demonstrates the good stitch of different mode cloth, rather than they are tied up in node in couples.

Simpler than in above-described embodiment of the related operative procedure of this embodiment, because will not need surgeon to go out any node.But as illustrated in fig. 5, not that it is node that stitching thread 147a-147g is sewn to later on tendon in these stitching thread, but can allow both crimps 603 facing to stitch, advance until the place that it can reach on each stitching thread, then with cramping instrument, clamp so that both crimps is locked on stitching thread, thus stitch is locked on tendon.According to the concrete structure of looper 114a-114g and both crimps 603, both crimps can slide on stitching thread 147a-147g around pin on pin.If can not can pin 114a-114g be cut away from stitching thread 147a-147g after hitching corresponding stitch like this, to both crimps can be placed on stitching thread.In this embodiment, do not need surgeon by stitching linear system, to take the post as what node, therefore simplified operative procedure.The stitch that surgeon can freely use these stitching thread to plant any expectation but will not tied a knot in end by these stitching thread.

Quadruplet exemplary embodiment

Fig. 6 A and 6B demonstrate for by two tendon repair device 109(or tendon repair device 109 and bone anchor 115) alternative of the cramping connector 115 that is attached to one another.In this embodiment, connector 701 comprises the connector main body 711 with two parallel longitudinal holes 713,715.Main body 711 can be cylindrical, rectangle or any other rational shape.In main body 711, be provided with another hole 717 transverse to the direction of longitudinal hole 713,715, this hole and two longitudinal holes 713,715 intersect.The pin with the form of piece 719 is assemblied in transverse holes 717.Therefore,, when inserting as shown in Figure 6B in transverse holes 717 for described, it also laterally passes through part longitudinal hole 713,715.Piece 719, transverse holes as shown in Figure 6B 717, longitudinal hole 713 and 715 and cable part 144(its by through longitudinal hole 713,715) size so select, while making it possible to allow piece 719 in being inserted into transverse holes 717, between the sidewall of piece 719 and the sidewall of longitudinal hole 713,715, push the cable in longitudinal hole 713,715, thus these cables are stuck in connector 701.

Therefore, in this embodiment, not to flatten cramping connector with cramping instrument, but act on piece 719 and connector 701 with pliers or fixture, the resistance of the cable part 144 in piece 719 antagonism longitudinal holes 713,715 is pushed in connector 701, cable is blocked thus as described above.

Some advantages of this connector embodiment comprise: lock required active force much lower, because plastic deformation needn't occur piece 719.On the contrary, this mechanism locks by the cable 144 part 701 inwall wedges that are connected.

Those suturing skills as described above have many possible alternative suturing skills.The present invention can adapt to any desired suturing skill and adopt for surgeon.In alternative, tendon repair device can only have four stitching thread, if or tendon repair device there are four above stitching thread, surgeon can determine that those stitching thread that he/her can not be used cut away.For example, two stitching thread of the tendon repair device 109 of Fig. 1-2 L (for example stitching thread 147a and 147g) can be sewn on tendon with cross-stitch, and as before in conjunction with the embodiment of Fig. 2 A-2L, describe and tie a knot together, difference is now the residue distal part of the stitching thread 147a, the 148g that stretch out from these nodes not to be cut away.Then, in conjunction with the embodiment of Fig. 2 A-2L, describe ground for another example, at the level height place different from two stitching thread, other two stitching thread (for example 147b, 147f) are sewn on tendon and are tied a knot.Then, stitching thread 147a and 147b are tied up in a node, and stitching thread 147g and 147f are tied up in another node.Now, the sutural distal end of each root in stitching thread 147a, 147g, 147b and 147f can be cut away.Other 3 stitching thread 147c, 147d, 147e can cut away need not, or can be used for forming other node.The sutural interdependency of two couples in this technology has guaranteed that stitching thread can not tear from tendon more.

In other embodiments, also the 3rd pair of stitching thread and two pairs of stitching thread can be tied.Suturing skill and the various variations that these stitching thread are tied are actually endless.

The 6th cover exemplary embodiment

Fig. 8 A demonstrates the alternative of tendon repair device.This alternative is particularly useful for but is not limited to such operative procedure,, without give one or any tendon broken ends of fractured bone for change from independent otch, and is led back to wound site that is.This embodiment also has advantages of that can desired in the situation that, only use single tendon repair device to realize repairs.

As seen in this embodiment, be not as Fig. 1-2 L and Fig. 4 A-E illustrated embodiment a side of anchoring piece is consisted of many stitching thread and its opposite side is consisted of single line cable, but allow this tendon repair device all there are many stitching thread on the both sides of tendon repair device 901 901a, 901b.More particularly, this tendon repair device can be formed by four stitching thread 947a-947d, and these stitching thread are attached together at one or more intermediate points along their length.In manufacturing particularly easily an embodiment, tendon repair device 901 comprises four stitching thread 947a-947d, in these sutural mid-length, has at least one both crimps 949 to hold them in together.This both crimps is not being clamped at first, so it can slide along sutural length during operative procedure.Can during operative procedure, clamp this both crimps, to it is locked in to any some place with respect to stitching thread.In some operative procedure, it can not used and be clamped.

In this embodiment, tendon repair device 901 is preferably being delivered to operative site in situation shown in Fig. 8 B, at least one sidepiece 901a of this tendon repair device be accommodated in can be easily through the narrow sheath 911(of flanged pin conduit plastic tube for example) in.But, the material that also has flanged pin conduit according to sutural quantity in the diameter of pin, stitching thread and flanged pin conduit, device, sheath can be dispensable, or can just cover a part (for example just covering the needle point of pin 913a-913d) of end 901a.In this embodiment, the pin 913a-913d that will be attached to suture end will being placed into of both crimps 949 on the sidepiece 901a in sheath 911 should be staight needle, thereby is more easily assembled in sheath 911 and/or through conduit 101,103.The pin that is attached to the other end of stitching thread 947a-947d can be for looper 914a-914d so that sew up.But they can be also staight needle.

The first half of this operative procedure is with substantially the same in conjunction with the operative procedure that shown in Fig. 2 A to 2L, the first embodiment describes above.More particularly, operative procedure and the first embodiment are basic identical until the stage shown in Fig. 2 F, unique difference is, is holding four separated stitching thread (or cable) in sheath 911, rather than the single cable 144 of stretching out from the distally of middle both crimps 949.

This device is being sewn to after a tendon broken ends of fractured bone, is accommodating four staight needles and sutural sheath 911 and walk by tackle system and arrive wound site as described above.Then, remove sheath 911 for protection; Thus, four stitching thread 947a-947d and staight needle 913a-914d are discharged.

In one embodiment, with knife or shears, cut away sheath 911.In another embodiment, can be torn by hand sheath.In yet another embodiment and especially in the embodiment shown, sheath 911 comprises that integral type longitudinal band 911a(is such as the rope being embedded in the material of sheath), " afterbody " 911b of this band stretches out at least one end of crossing sheath, make surgeon can catch and pull this afterbody to tear sheath, emit pin thus to be attached to the tendon broken ends of fractured bone.Alternative, this band can be included in the radially weak fragment of the sheath stretching out on the whole longitudinal length of sheath.This weakness fragment can form the sheath band that the remainder with sheath is integrally formed, but the remainder of wall ratio sheath is thinner.

Can clamp both crimps 949 in this stage of this operative procedure, thereby lock the position of this both crimps on device 901.For example, can clamp this both crimps at the place, place that is close to the end of tendon broken ends of fractured bone 902a, now both crimps has been stitched to that end of tendon broken ends of fractured bone 902a.

When adopting this embodiment, preferably, another tendon broken ends of fractured bone 902b exposes and needn't be given for change at wound site place.But, if it must be given for change by different otch, can adopt any rational technology that it is given for change, comprise for giving the conventional art of tendon for change, or adopt as described above coaster conduit and the flanged pin conduit of this description.For example, little stitching thread can be sewn on tendon temporarily, and can be as above described and utilize coaster conduit 101 and flanged pin conduit 103 that this stitching thread is advanced by the tackle system of finger in conjunction with the first embodiment.

No matter any, when another tendon broken ends of fractured bone 902b is when site of injury exposes, the end that two broken ends of fractured bone 902a, 902b are positioned to them toward each other, and can according to in conjunction with the first embodiment, describe similar identical mode above the second end 901a of this tendon repair device be sewn to distally tendon broken ends of fractured bone 902b.Should carefully guarantee these two tendon end 902a, 902b to put toward each other, even if can not will be also not difficult because remove again to adjust the relative position of the end of the tendon broken ends of fractured bone after completing and lock first stitch.Can use tendon keeper 107 as previously described, to tendon end is held in opposed each other.Stitching thread can be sewn on tendon as described above in pairs.Can with stitch on tendon, between two broken ends of fractured bone, complete reparation as described above.

The advantage of this embodiment is, it does not need to clamp connector or cramping instrument, and parts still less.For example, only relate to a tendon repair device in this operative procedure, this tendon repair device is double end, the same as shown in Figure 8 A.

The 7th cover exemplary embodiment

Fig. 9 A-9C helps to have set forth such tendon repair device and technology, that is, this tendon repair device and technology are particularly useful for but are not limited to that two tendon broken ends of fractured bone must be followed by the anatomical structure between two otch being repaired such repair place, position to give for change.Fig. 9 A demonstrates the tendon repair device 951 according to this embodiment.In this embodiment, used two tendon repair devices 951, each comprises two line thighs or silk 953a, 953b, and every line thigh has pin in each end.In an illustrated embodiment, at the first end place of every line thigh, be provided with looper 954, and be provided with staight needle 955 at the second end place.As above described in conjunction with other embodiment, these two line thighs that form single tendon repair device for example pass through slidably both crimps 956 and engage in the middle of its end.Both crimps 956 can not clamped to can slide along device at first, and the suitable stage in this operative procedure is clamped the in the situation that of expectation.

As shown in Figure 9 B, utilize two line thighs of this end to be sewn on corresponding tendon broken ends of fractured bone 961a, 961b an end 951 of each tendon repair device 951-1,951-2.With the embodiment of Fig. 8 A and 8B similarly, another end 951b of each tendon repair device can be in being installed in sheath 968, to use coaster conduit and the anatomical structure of flanged pin conduit process such as the coaster of finger of describing in conjunction with other embodiment above at first.But, as pointed in conjunction with the embodiment of Fig. 8 A and 8B, also can not need sheath above.

Then, can use coaster conduit as above and flanged pin conduit that tendon repair device and the tendon broken ends of fractured bone that is sewed with these tendon repair devices are guided through anatomical structure to repairing otch.In Fig. 9 B, demonstrate the situation of the tendon repair device of at this moment waiting.Referring now to Fig. 9 C, two tendon broken ends of fractured bone 961a, 961b are taken to together.If desired, tendon keeper 107 can be used to tendon broken ends of fractured bone 961a, 961b to be held in place, and in each tendon broken ends of fractured bone, respectively have a pin 205,207(is not shown).

Then, preferably, at the different level height place of the stitch from the second tendon repair device 951-2, other end 951a of first this device of tendon repair device 951-1(has been sewn on the first tendon broken ends of fractured bone 961a) the free end 951b of two line thighs be sewn on the second tendon broken ends of fractured bone 961b.Similarly, other end 951a of second this device of tendon repair device 951-2(has been sewn on the second tendon broken ends of fractured bone 961b) the free end 951b of two line thighs be sewn on the first tendon broken ends of fractured bone 961b.The repair place having demonstrated in Fig. 9 D.If desired, can adopt as described above and on tendon, sew up reparation.

As the embodiment of Fig. 8 A-Fig. 8 B, this embodiment provides two stitch at four line thighs that extend between two tendon broken ends of fractured bone and the differentiated levels place in each tendon broken ends of fractured bone, and very firm reparation is provided thus.

The 8th cover exemplary embodiment

Figure 10 A demonstrates the tendon repair device of another embodiment according to the present invention.This device 1001 is basic identical with the device of Fig. 9 A, but as will be below described in more detail, a side of this device is in sheath.In these embodiments, as shown in Fig. 1 and Fig. 2 A-2L, will use two tendon repair devices the first embodiment.But, as Fig. 8 A-8B and Fig. 9 A-9D illustrated embodiment, these two tendon repair devices 1001 have many line thighs in each end.More particularly, each tendon repair device 1001 comprises two stitching thread 1047a, 1047b.These two stitching thread are such as passing through both crimps 1049 or sliding sleeve in their end inter-engagement together.Alternative, these two stitching thread can be separate.

In addition, this tendon repair device 1001 can comprise single cable or stitching thread in its most of length, and just near the opposed end of anchoring piece, is divided into two stitching thread.Also have, this tendon repair device can be formed by two stitching thread, these two lines are twisted with the fingers around together in its most of length, and at opposed end place separately, and now the both crimps such as both crimps 956 will be twisted with the fingers around part and keep together being twisted with the fingers around each end of part.Tendon repair device embodiment as shown in Fig. 8 A-8B and Fig. 9 A-9D preferably adopts staight needle 1013a, 1013b, and adopt looper 1014a, 1014b on the 1001b of another end at least one end 1001a of device 1001.The state that tendon repair device can be installed in sheath 1011 with the stitching thread on the 1001a of end and staight needle 1011a, 1011b as shown in the figure, is delivered to surgeon.Adopt this embodiment of tendon repair device repair the operative procedure of tendon and device and be combined those operative procedure that the first and second embodiment describe and install very similar above.Specifically, if desired, can, as with describing one or two tendon broken ends of fractured bone in the tendon broken ends of fractured bone is given for change by the tackle system of finger in conjunction with first embodiment of the invention shown in Fig. 1 and Fig. 2 A-2L, distinguish and be only two stitching thread to be sewn on each tendon broken ends of fractured bone at a side 1001b place of tendon repair device 1001.

In this embodiment, two tendon repair device 1001-1 and 1001-2 have been used.A side 1001a in each tendon repair device 1001-1 and 1001-2 is sewn to the tendon broken ends of fractured bone on one of them.

How Figure 10 B helps to demonstrate by two fixtures 1001 of this embodiment according to the present invention are utilized this two fixtures to realize to repair around forming each other ring.Substantially, a tendon repair device 1001-1 can be folded to form to ring 1091, and be sewn on the first tendon broken ends of fractured bone 1087a, again another tendon repair device 1001-2 is folded to form to another ring 1092, and embedded in another tendon broken ends of fractured bone 1087b, these rings engage at middle part as will hereinafter be described in detail.

Specifically, substantially as embodiment before combination describes, two stitching thread 1047a, 1047b and looper 1014a, 1014b on a side 1001b of the first tendon repair device 1001-1 will be sewn on the first tendon broken ends of fractured bone 1087a, and the opposite side 1001a of this device stretches out from the end of the corresponding tendon broken ends of fractured bone.

Then, with reference to Figure 10 B, the opposite side 1001a of the first tendon repair device 1001-1 turns back in this tendon broken ends of fractured bone by the end of the same tendon broken ends of fractured bone, thereby tendon repair device 1001-1 forms the ring 1091 stretching out from the end of tendon broken ends of fractured bone 1087a.This can be by returning to each the root stitching thread in two stitching thread and staight needle 1014a, 1014b and staight needle alone through the end of tendon broken ends of fractured bone 1087a and they out realized by this layback of the tendon broken ends of fractured bone.These stitching thread should so be pulled by, make ring 1091 can stretch out from the end of tendon broken ends of fractured bone 1087a 1 millimeter or still less.Preferably, stitching thread so pulled by, ring 1091 can not stretched out, but substantially in the material of tendon broken ends of fractured bone 1087a.Then, as described in combination before above, embodiment describes substantially, and these two stitching thread 1047a, 1047b are sewn on tendon.Now, it is upper that two end 1001a, the 1001b of tendon repair device 1001-1 are sewn to tendon broken ends of fractured bone 1087a, and ring 1091 is positioned in the fracture end place of tendon broken ends of fractured bone 1087a.

Then, according to the same way that the first tendon repair device 1001-1 is attached to the first tendon broken ends of fractured bone 1001a, the second tendon repair device 1001-2 being attached to the second tendon broken ends of fractured bone 1087b, difference is: by two pin 1013a at the first end 1001a place of the second tendon repair device 1001-2, after 1013b is sewn on tendon, by other two pin 1014a, 1014b and stitching thread 1047a, 1047b is guided through the ring 1091 being formed by the first tendon repair device 1001-1, to formed the second ring 1092 before being sewn on the second tendon broken ends of fractured bone 1087b.If the ring 1091 of the first tendon repair device 1001-1 is positioned at the material of the first tendon broken ends of fractured bone 1087, need with suitable retraction tool, the material of the first tendon broken ends of fractured bone 1087 to be retracted at once to expose ring, allow the pin of the second tendon repair device and stitching thread pass through this ring.Alternative, surgeon can pierce through tendon material to enter ring 1091 with the second tendon repair device 1001-2 simply.Then, two stitching thread and pin 1014a, the 1014b that are positioned at the second end 1001b place of the second tendon repair device 1001-2 are sewn on the second tendon broken ends of fractured bone.This embodiment provides the another kind of technology of repairing for form four line thighs between two tendon broken ends of fractured bone.

The 9th cover exemplary embodiment

The correlation technique that Figure 11 A-Figure 11 E demonstrates alternative and uses therewith, these technology can be used with the feature of many other embodiment of the method and apparatus of disclosure and some or all combinations in aspect herein.Figure 11 A is according to the perspective view of the device of this alternative.Specifically, in this embodiment, with the guiding elements with the form of funnel-form body 1101, replace flanged pin conduit.

In a preferred embodiment, funnel-form body 1101 is formed by relatively firm biocompatible material (such as bio-compatibility plastics), thereby it can easily not collapsed.Funnel-form body 1101 comprises the little opening 1102 that is positioned at an end and the large opening that is positioned at another 1103 places, end.Funnel-form body 1101 limits fi-ustoconical surface in not biased situation time, but split off along its whole length, it can radially expand at breach 1104 places and make the distortion of funnel-form body elasticity thus, thereby form sideshake (lateral gap) at breach 1104 places, tendon, ligament etc. can be inserted in funnel-form body by this gap.Alternative, funnel-form body can be overlapping a little at breach place, as long as it can radially expand formation lateral openings.

Little opening 1102 should be less than the entrance of anatomical passageway to be combined for guiding tendon therefrom to pass through with this entrance, and large opening 1103 is greater than anatomical passageway.For example, in each embodiment of the present invention above describing in conjunction with finger tendon reparation, the size of little opening should be set as contributing to enter into the coaster of finger.Large opening at 1103 places, the other end of funnel-form body 1101 should be enough large, to easily receive the end of the tendon broken ends of fractured bone that is sewed with tendon repair device.Handle 1197 can be configured to stretch out so that operated by surgeon from the side of funnel-form body 1101.

Figure 11 B-Figure 11 D demonstrates the surgical technic that has used funnel-form body 1101.With reference to Figure 11 B, as described before, tackle system by coaster conduit 101 by finger is placed between two otch 1112,1113, and can be attached to for the tendon repair device 1114 of any tendon repair device of description before this paper the end of the nearside tendon broken ends of fractured bone 1116.In addition, also substantially as before describe the front end 1114a of tendon repair device 1114 is passed in coaster conduit 101, difference is not use flanged pin conduit 103, but with funnel-form body 1101, substantially replaces as described in detail the function of flanged pin conduit.

In this embodiment, the front end 1114a of tendon repair device 1114 is promoted by coaster conduit 101 close but do not contact the position of the tail end 101b of coaster conduit 101 to the end of the tendon broken ends of fractured bone 1116.Then, coaster conduit 101 and tendon repair device 1114 are distad pulled to the position of the entrance of the first coaster 1121 that must be walked to the tail end 101b process of coaster conduit 101 by the tackle system of finger from distally otch 1113, but the tendon broken ends of fractured bone 1116 but also there is no through it near the entrance of the first coaster 1121.Specifically, the same as previously noted, the end of the tendon broken ends of fractured bone 1116 deforms and becomes large, in the situation that be not used for pushing and guiding its structure to be not easy through coaster 1121.In the embodiment discussing before, described structure is flanged pin conduit 103.And in this embodiment, it will be funnel-form body 1101.

Therefore, with reference to Figure 11 C, funnel-form body 1101 expands, and slides on the tendon broken ends of fractured bone 1116, and the little end 1102 of funnel-form body is facing to the entrance of coaster 1121, and large end 1103 is back to the entrance of coaster.More particularly, surgeon is positioned at funnel-form body 1101 in the entrance of coaster 1121, so that expansion coaster 1121 facilitates tendon to enter and passes through this coaster, the same as shown in Figure 11 C.Can be provided as the funnel-form body of different size of the part of suite, to adapt to the different size part of anatomical structure and/or the patient of different body sizes, also be convenient to make coaster (or other anatomical structure) expansion.

When funnel-form body is in position shown in Figure 11 C, surgeon just can pull on the front end 1114a of tendon repair device 1114, to the end of the tendon broken ends of fractured bone 1116 is drawn into and passes through funnel-form body 1101 and coaster 1121.

Will be seen that, by funnel-form body 1101(and in conjunction with the flange portion 159 of the disclosed flanged pin conduit 103 of embodiment above) even if the Main Tissues occupying is not conventionally but often yet: the end that is attached with the tendon broken ends of fractured bone of tendon repair device tail end bunches up to become and is greater than the passage by coaster, and is therefore difficult to be inserted through coaster.The end that funnel-form body (and as described above the flange portion 159 of flanged pin conduit 103) holds the tendon broken ends of fractured bone gradually, so that insert and through coaster (or according to circumstances and other fixed narrow anatomical passageway).It is current to further facilitate that the funnel-form body 1101 of this embodiment is also used for expanding the entrance of coaster.

The embodiment of flanged pin conduit 103 is different from having utilized, and in this embodiment, funnel-form body 1101 does not pass through coaster.As shown in Figure 11 C, it stays the position that is just in time arranged in coaster entrance inside, and the tendon broken ends of fractured bone 1116 slides through funnel-form body 1101 and pass through coaster 1121.Once coaster 1121 has been passed through in the end of the tendon broken ends of fractured bone 1116, remove funnel-form body 1101.Specifically, it can expand and skid off from tendon.Alternative, funnel-form body can be cut away.Figure 11 D demonstrate operative procedure this time repair place.

If the tendon broken ends of fractured bone 1116 must be guided through second or coaster subsequently, for the second coaster, substantially repeat identical process.For example, if tendon must pass the second coaster, can above this coaster, form another otch (in the corresponding fold of finger), and can adopt identical or different funnel-form body to repeat process as described above.But first surgeon should attempt to pull tendon to pass through in the situation that not using funnel-form body, because tendon often can be followed by second or coaster subsequently under the help that there is no funnel-form body.

U.S. Provisional Patent Application No.61/506, whole disclosures that 809(the application has required its priority and this application at this by reference to being incorporated herein) disclosed position for locating coaster and therefore determining any otch for example to pass through coaster by funnel-form body and other guiding elements guiding tendon disclosing herein.The content of this application is comprised in and is positioned at herein under adnexa A.

According to circumstances, then can adopt any as described above in tendon repair device and/or technology by the tendon broken ends of fractured bone: (1) is directly attached to the distally tendon broken ends of fractured bone; (2) attached with another tendon repair device that is attached to the distally tendon broken ends of fractured bone; Or (3) be attached to bone anchor.

Figure 11 E demonstrates the alternative of guiding elements.This guiding elements 1140 is in this embodiment the hollow frusto-conical shape of splitting, and have less diameter end 1143 and larger diameter end 1144, and a part for fi-ustoconical surface is removed.By surface to be removed lateral openings 1142 that part limits should be enough wide so that will be applied to its specific tendon, ligament or other anatomical structure and insert, but also want enough narrow to can not allow tendon skid off from member 1140 accidents.Therefore, preferably opening is not more than 50% of conical surface.This opening for example can, for about 5%-35% of conical surface, be preferably 1/3.In this embodiment, because guiding elements 1140 needn't be out of shape, allow tendon insert wherein, so it is preferably essentially rigidity, and can not deform under normal load effect.It can be formed by biocompatible material (such as rustless steel or titanium).Also have, handle 1198 can be set so that surgeon handles this guiding elements 1140.

The guiding elements 1140 of this embodiment substantially completely as above in conjunction with before use the funnel-form body 1101 described of embodiment, difference is, this member 1140 can not expand to allow tendon insert wherein.Can by lateral openings 1142, tendon be placed on to member 1201 inside simply.As at embodiment before, handle 1198 can be set and facilitate surgeon to handle.

The advantage of this embodiment is, more easily tendon is inserted in member.In addition, guiding elements is rigidity, therefore anatomical structure can more effectively be expanded.

Figure 11 F demonstrates another alternative of guiding elements.Different from the embodiment of Figure 11 A, guiding elements in this embodiment 1150 is for having the funnel-form body 1151 of little opening 1152 and large opening 1153.It splits along its whole length, and it can radially expand at breach 1154 places so that funnel-form body generation strain thus, thereby forms sideshakes at breach 1154 places, by this gap, tendon, ligament etc. can be inserted in funnel-form body.

In large end, be provided with lip 1156, be used for preventing that funnel-form body from being pulled because of carelessness passes through coaster.Little handle 1157 provides the place that grasps guiding elements 1150 for surgeon.Use has little handle or only has lip and without any the funnel-form body of handle, be convenient to surgeon and allow guiding elements around the rotation of its longitudinal axis.Specifically, rotation contributes to the little end 1152 of guiding elements to guide in coaster sometimes.Longer handle may hinder the ability that allows guiding elements rotate freely, because handle is longer, more easily encounters barrier (for example another part of patient's hands or another operating theater instruments).

In also having other embodiment, guiding elements can form the cone of splitting at breach place with overlapping portion, thereby has spiral shape.This overlapping portion should be relatively little, for example, have about 5 ° to 90 ° radially overlapping, and when not being subject to stress, preferably have about 70 ° radially overlapping.Specifically, radially overlapping can making is too much difficult to allow guiding elements fully expand to open the gap that must allow tendon pass through.

At breach place, there is overlapping embodiment and there are several advantages.First, once remove the expansion pressure for opening clearance, this overlapping portion by make tendon substantially carefully the gap from guiding elements skid off.The second, some adjustings can be carried out to the radial dimension of guiding elements in this overlapping portion.That is to say, if desired, by apply inside radial effect power on the outer wall of guiding elements, the radius that can temporarily reduce guiding elements is assembled to the little opening of guiding elements in coaster with help.On the contrary, can temporarily increase if desired the radius of guiding elements so that tendon can but need not be opened the gap in sidewall by the opening of the little end at guiding elements, otherwise this can make the tendon broken ends of fractured bone by gap, surprisingly to deviate from from guiding elements.More particularly, if guide the tendon broken ends of fractured bone through tackle system to be less than the opening in the little end of guiding elements by guiding elements, the pulling force being applied on tendon repair device and the tendon broken ends of fractured bone also will apply radially outer active force simultaneously on the inwall of guiding elements.This radially outer active force will force guiding elements radially to expand, and the opening diameter of the end little is increased the tendon broken ends of fractured bone can be passed through.

Figure 11 G shows the another embodiment of guiding elements.It is the flanged pin conduit 10 of embodiment of Fig. 1-Fig. 2 L and the mixture of the guiding elements of Figure 11 A, Figure 11 E and Figure 11 F that this guiding elements 1160 can be construed to.Particularly, with flanged pin conduit 103 similarly, guiding elements 1160 is suitable for passing through tackle system with the tendon broken ends of fractured bone together with prosthetic device.Its protection tendon, when tendon need to be by coaster, help to compress equably tendon and coaster is presented to smooth surface and pass through helping.Yet, with the guiding elements of Figure 11 A, Figure 11 E and Figure 11 F similarly, it is relatively short and is funnel shaped member.

Guiding elements 1160 is frustoconical shape elements, have its leading edge 1171 places compared with duck eye 1165 with at the larger opening of its tail end 1172.The leading edge of this member should be less than coaster conduit (leading edge will insert in this conduit), and tail end should be greater than coaster conduit.As the guiding elements of Figure 11 A, Figure 11 E, Figure 11 F, guiding elements 1160 can split, thereby tendon and prosthetic device can laterally be introduced in this guiding elements.Yet illustrated embodiment is not split, thereby tendon and prosthetic device must longitudinally be guided in guiding elements.

The leading edge 1161 of member 1160 is firm (solid).Tail end 1162 comprises that a plurality of leaf lobe 1166(of portion that longitudinally extend back and separated by gap 1168 are 4 in this embodiment).Preferably, member 1160 by complete firm frustum member being started then to removing materials (for example, by cutting) thus formation gap 1168 forms.Gap can have roughly V-arrangement shape, has the angle of 15 °.The diameter that gap 1168 helps this tail end of tail end 1162(that allows guiding elements 1160 is greater than tackle system and coaster conduit 101) be crimped to minor diameter more and coordinate and pass through tackle system to contain therein in the situation of the tendon broken ends of fractured bone.

The design in leaf lobe portion and gap has prevented that leaf lobe portion 1166 from collapsing with superimposed each other when the coaster at guiding elements self substantially, thereby allows the tail end 1162 of guiding elements 1160 to be collapsed into as far as possible little diameter.The front end in gap 1168 is preferably cut to form curved edge 1164, thereby helps prevent member 1160 to tear.Especially, if gap 1168b is directly cut and ends at a bit, member 1160(is used for passing through tackle system so) distortion can cause otch inadvertently to extend forward.Curved surfaces at the front end place of otch contributes to stop this situation to occur.

The tapering of guiding elements can be 15 °.The overall diameter in hole 1165 should be less than its coaster conduit that will insert (or its other conduit that will insert, the dilator conduit 1301 of for example discussing together with another alternative hereinafter) interior diameter, thereby and the after-opening that extends back on diameter be greater than coaster conduit.By this way, the tail end of coaster conduit 101 can be inserted in the front portion 1160 of guiding elements, thereby and hole 1165 can also be less than the tendon broken ends of fractured bone tendon broken ends of fractured bone and can not pass through through it.Preferably, after-opening is greater than coaster conduit and the tendon broken ends of fractured bone substantially, because at least part of object of the after-opening of guiding elements 1160 is to make easily prosthetic device and the tendon broken ends of fractured bone to be inserted wherein.In one embodiment, the diameter in hole 1165 is approximately 1mm, and the diameter of tail end is approximately 8mm.In one embodiment, the widest part of the firm part 1161 of guiding elements is less than system by the minimum coaster passing through, thereby the firm part 1161 of guiding elements is without shrinkage or collapse.Only leaf lobe portion 1166 collapses and is inwardly folding.At an embodiment for flexor digitorum profundus, the maximum gauge of firm part (that is, at its rear portion) is about 4mm.

Guiding elements can be made by diaphragm material, and this material is flexible, thus can self shrinkage to be contained in the tendon broken ends of fractured bone wherein by tackle system compressed package, but when power discharges, be tending towards being back to its original-shape.In one embodiment, guiding elements is formed by the thick polyethylene terephthalate of 0.02mm (PET) diaphragm.The type if guiding elements splits, so tendon can be in office when marquis inserts wherein along lateral.Yet if guiding elements is not to split (embodiment as shown) of type, prosthetic device and the tendon broken ends of fractured bone must or be inserted in guiding elements 1160 before prosthetic device is inserted to coaster conduit so simultaneously.

Guiding elements 1160 is similarly for the flanged pin conduit 103 of Fig. 1-Fig. 2 L, and wherein, it passes through tackle system with prosthetic device together with the tendon broken ends of fractured bone.Especially, at coaster conduit as previously said through tackle system and in appropriate location and after prosthetic device has been attached to the tendon broken ends of fractured bone, the leading edge 1171 of guiding elements 1160 inserts in the proximal end of coaster conduits 101.Next, prosthetic device longitudinally inserts in the after-opening of guiding elements 1160, and advance by guiding elements 1160 enter coaster conduit 101 until the end of the tendon broken ends of fractured bone in guiding elements 1160.Then, surgeon can pull prosthetic device, coaster conduit, guiding elements and the tendon broken ends of fractured bone (it is comprised in the guiding elements 1160 that can collapse) through tackle system, substantially as linked Fig. 2 A-Fig. 2 L, describes ground.Guiding elements 1160 will be collapsed around the tendon broken ends of fractured bone, and compress if desired the tendon broken ends of fractured bone to pass through the tackle system of finger.

Then, operating remainder can complete in any mode described herein.

The tenth cover exemplary embodiment

Although describe the present invention in conjunction with the situation that two tendon broken ends of fractured bone and/or tendon broken ends of fractured bone are directly attached to bone above, but for it will be appreciated by one skilled in the art that it also can be in conjunction with adopting the reparation of tendon graft to use.In these cases, adopt said apparatus and technology that tendon graft is attached to a tendon broken ends of fractured bone, and another end of tendon graft is attached to another tendon broken ends of fractured bone or is directly attached to bone.Tendon graft can be taken from another part of patient body, patient's foot for example, or can be allograft (allograft).

According to another aspect of the present invention, the light-wall pipe as anti part can be held in place on the tendon of repairing position, so that tendon art skating is by the tackle system of finger.More particularly, along with impaired tendon, ligament or other longitudinally dissection member healing, repair position and formed scar tissue around.During agglutination, scar tissue can hinder tendon freely-movable to pass through tackle system.Also need other surgeon to remove these scar tissues.

For the ease of tendon freely-movable, through tackle system, can be contained in the anti part of the form with light-wall pipe repairing position.This anti part can comprise for example light-wall pipe 1201 shown in Figure 12 A.Figure 12 B demonstrates a specific embodiment for the anti part of tendon repair, and this anti part is not being got involved in the situation of graft and used together in conjunction with the tendon repair that two tendon broken ends of fractured bone are connected again.As shown in the figure, before repairing, can allow pipe 1201 on the end of a fracture tendon broken ends of fractured bone 1203a, slide therein, and slide away during repair process.Then, with reference to Figure 12 C, while having repaired, pipe 1201 can slide into along repaired tendon reparation position 1204(and comprise stitch, tendon repair device and two tendon broken ends of fractured bone 1203a, 1203b).Preferably, now with at least one stitch 1221, pipe 1201 is sewn on tendon, in each end of pipe, there is at least one suture 1221.

This pipe will provide anti part to allow healing carry out along tendon length (in pipe), rather than outwards make scar tissue will interfere tendon freely-movable to pass through tackle system.Pipe can also be provided for the guiding of growth on pipe diameter outside, take and supports the structure that the final tissue being repaired in pipe is provided to passage.The outer surface of pipe and inner surface should be smooth, and have lower coefficient of friction, thereby pipe (having tendon in pipe) can freely slide through tackle system, and pipe can remove after healing.

The wall thickness of pipe should be thin as far as possible, to make the volume that increases to the tissue in repairing minimum.In musculus flexor tendon repair case, expect that wall thickness is less than 0.25 millimeter.But the optimum wall thickness of pipe will be depending on the operation applicable cases of reparation, and the tissue that should compare in reparation is thin pro rata.The length of pipe and diameter will mainly be determined by concrete reparation certainly.In addition, pipe should be by bio-inert material (such as being selected from Teflon ^tM, PET, PTFE and EPTFE the material and so on of fluoropolymer Zu Huo silicon resin copolymer family) form.Preferably, this pipe is porous, to can carry out fluid communication by it, keeps tendon healthy.It can have hole or other opening carries out this fluid transmission to facilitate.Preferably, these holes are enough little to can not make tissue inwardly grow by it.It also can be coated with lubricant, to slide through tackle system (or any other dissected limiting structure).Between the healing stage of tendon, the active exercise of finger is also attached to by the hole in pipe the scar tissue that prevents tendon in surrounding tissue.

This pipe should be repaired position to cover completely by long enough.In the situation that utilizing graft to repair, according to the length of graft, passing into property (accessibility) and other factors, can adopt single longer pipe to cover two ends of graft, or can adopt two separated, less pipes.

This pipe will be held in place during agglutination reach several weeks to for some months.Last in this process, can be by making one or more little otch near an end at pipe with it patient, more carefully pipe is pulled out from otch when surgeon cuts pipe, thus it removed.In alternative, pipe can be by the bioabsorbable material of dissolving along with the time is formed, as long as this bioabsorbable material can not promote bonding or local organization reaction when absorbing.The example of bioabsorbable material has crosslinked formula hyaluronic acid or other biologically inert polymer.In yet another embodiment, anti part can be provided with longitudinal breach in its whole length, thereby when it is removed, does not need to cut, but only need to expand it so that it is removed from tendon.This embodiment is also convenient to anti part to expand to be arranged on repair on position and allow its such selection of sliding after repairing completing on tendon, without after making the longitudinal sliding motion on the end of the tendon broken ends of fractured bone of anti part complete before repairing to repair, anti part is slided on reparation position thus again.Repairing position length available deficiency long and/or the tendon broken ends of fractured bone, to make anti part be favourable in the situation that cannot sliding away during repair procedure for this.

The tenth a set of exemplary embodiment

The correlation technique that Figure 13 A-Figure 13 C and Figure 14 A-Figure 14 C demonstrate other alternative and adopt, each feature of many other embodiment of the method and apparatus that these technology can be disclosed with this paper and some or all in aspect are combined with.Figure 13 A is according to the perspective view of an embodiment of the single formula dilating catheter of this group embodiment.Figure 13 B is according to the perspective view of an embodiment of the multi-piece type dilating catheter of this group embodiment.Dilating catheter is designed to assembling for example, must be pulled by longitudinal anatomical structure (tendon) passage passing through, and makes passage expansion.The same as will be described in detail below, it is by basic as use and carry out identical function in conjunction with the coaster conduit 101 of first group of embodiment of Fig. 1 and Fig. 2 A-Fig. 2 L description is the same above.But it also will be used for making passage expansion.Figure 13 C is for being combined with dilating catheter for making the perspective view of the guiding elements of passage expansion.Specifically, as will be described in more detail below, it as seal wire, is used for dilating catheter to be inserted through tackle system substantially.But, think that this guiding elements will be unnecessary in major applications occasion.

Dilating catheter 1301 comprises the pipe of elongation, in the pipe of this elongation, has tube chamber.This pipe comprises a series of continue, longitudinal pipeline sections 1302,1303,1304,1305 with stepped diameter, and each pipeline section continuing is greater than previous pipeline section.It is only exemplary adopting in the embodiment shown four stage portion.Can adopt any amount of stage portion.The anatomical passageway that the overall diameter of the pipeline section that diameter is different and quantity should will be passed through according to dilating catheter 1301 or the size of opening decide.We will continue to use the example of hands Fracture tendon in below discussing.The pipeline section of diameter minimum should be less than the diameter of the tackle system of the most reasonable little hands size that it must pass through, and makes the pipeline section of diameter minimum should be able to relatively easily pass through any tackle system.The pipeline section that each diameter is larger should be designed to gently and with the mode of stepping gradually expand tackle system to larger size to prepare to allow tendon broken ends of fractured bone process.Subsequently, the pipeline section of the diameter maximum of dilating catheter should at least with the tackle system of hands size be equally large by the maximum gauge being rationally expanded to the most greatly.

From following discussion, can find out, according to an exemplary techniques, any pipeline section with the diameter larger than the diameter that need to pass through particular patient tackle system will can not pass coaster.Therefore, in fact the pipeline section of the diameter maximum of dilating catheter can have any diameter.Be applicable to make tendon through pointing in an embodiment of coaster, each pipeline section of dilating catheter has from the minimum diameter of about 10French to the such scope of the maximum gauge of 18French.In one embodiment, with nine pipeline sections that diameter is 10F, 11F, 12F, 13F, 14F, 15F, 16F, 17F and 18F, realize.The length of each pipeline section is approximately 10cm.

In an example embodiment as shown in FIG. 13A, dilating catheter 1301 can be single formula.If before operative procedure or during, surgeon determines that pipeline section that any diameter is less is than needed significantly little, and/or determine that the pipeline section that any diameter is larger is larger than needed, surgeon can be before operative procedure or during simply they are cut away.Therefore, can provide single dilating catheter, it can be used in a large amount of different anatomical passageway with for the different patient of many body sizes, thereby reduced the quantity of the different model that needs the dilating catheter manufactured.

In example, as shown in Figure 13 B in another embodiment of dilating catheter 1310, each diameter pipeline section 1311,1312,1314 etc. can be separated from each other.For example, in a simple embodiment, each conduit section has cervical region 1315 near its nearside longitudinal end, and the distal end that this neck size is set to the pipeline section less with next diameter is mated with interference engagement.Preferably, the part of constriction is sized to be assemblied in the distal end of next less pipeline section, thereby the edge of the longitudinal end of each pipeline section will can not be exposed at the outside of dilating catheter 1310.

The same with coaster conduit 101, this dilating catheter is preferably formed by low friction biocompatible material, its wall thickness is enough to make whole conduit to have enough rigidity to be pushed through tackle system and to be used for making coaster to overcome its natural size expansion (staying open), but enough soft and flexible to follow the bending section in the anatomical passageway that must pass through by it.For example it has the flexibility that is approximately general surgery vessel catheter.The interior diameter of all pipeline sections should be enough large easily to hold the tendon repair device using together with this dilating catheter.

In other embodiments, dilating catheter is without having the different discrete pipeline section of a plurality of diameters, but can be in its whole length convergent continuously.With the same in stagewise embodiment, the explaining aobvious unwanted any part for surgeon and can cut away before inserting of conduit, and conduit after inserting, unwanted any part can be after dilating catheter be in place in anatomical passageway.

Figure 13 C demonstrates alternative guiding elements 1320.As shown in the same, this guiding elements comprises the member of elongation, and its overall diameter is less than the interior diameter of the tube chamber in the minimum pipeline section of diameter of dilating catheter, thereby dilating catheter can easily pass through on guiding elements.In other words, the whole tube chamber of dilating catheter has enough large size and dimension to receive guiding elements 1320 therefrom to pass through.Guiding elements 1320 can be for hollow tubular.Alternative, it can be solid (being for example essentially seal wire).According to disclosed here technology, guiding elements should be relatively firm its can be promoted by tackle system in the situation that not there is kinking, will be according to the bending section in the anatomical passageway of disclosed herein technology process by it to follow but have again enough flexibilities.The overall diameter of guiding elements should be less than the anatomical passageway that it must pass through substantially.

In most realistic embodiment, guiding elements and dilating catheter both will be for cylindrical.But not necessarily, the specific anatomical passage that will pass through according to guiding elements and dilating catheter, also can preferably adopt the cross section of other shape to cylindrical cross section.Term " diameter " is used in nonrestrictive mode in this application, and does not mean that cross section must be columniform.

Preferably, each the pipeline section long enough in the different pipeline section of the diameter of dilating catheter so that can each walk the whole length of the anatomical passageway that it will pass through, and fully stretch out in its each end passing into of providing convenience to surgeon.Specifically, the same as will be described in more detail below, dilating catheter being placed by after relevant anatomical passageway, except assembling can be cut off or remove by all pipeline sections the maximum pipeline section of passage.For staff, the length of 10cm should be just enough.

This dilating catheter (and optional guiding elements) is used for expanding tackle system, to guarantee that best the tendon broken ends of fractured bone can be through tackle system in abandoned situation.Guiding elements and dilating catheter as hollow pipe are both formed by the biocompatible polymeric with such component and/or wall thickness, that is, this polymer can be crooked, but enough firm to be pushed through tackle system.The relative stiffness of dilating catheter and guiding elements will enable to be pushed through narrow anatomical passageway, such as finger coaster.But its flexibility will enable again to carry out some bendings to adapt to integrally bending path.Preferably, dilating catheter is formed by the lower material of coefficient of friction, and this dilating catheter can easily around be passed through at the bodily tissue such as tendon tackle system.Suitable biocompatible polymeric comprises homopolymer, copolymer and the mixture of silicones, polyurethane, polyethylene, polypropylene, polyamide, polyaromatic, fluoropolymer, or any other biocompatible polymeric system that meets above mechanical property (can adopt PELLETHANE for this device ^tM---DOW Polyurethane Thermoplastic Elastomer (TPU), it is normally used for other dilating catheter).

The desired low surface friction coefficient coefficient of friction of dilating catheter can be intrinsic for building the material of this device, or can by the mechanical alteration such as surperficial (for example longitudinal fluting) or lubricious surface treatment improved.

The length-specific of dilating catheter, material, wall thickness, interior diameter, overall diameter and hardness can change according to specific tendon or the ligament that will use this dilating catheter.

Interior diameter should be enough large, to can easily hold cable part and the staight needle of tendon repair device.The certain material of dilating catheter and cross-sectional geometry (for example wall thickness) will determine the hardness of conduit to a great extent, and the rigidity that should be selected to as described above provide enough makes it possible to be pushed through narrow path, but there is enough flexibilities to bend to adapt to the knee in path.In the exemplary case of the flexor digitorum profundus at the level height place of middle phalanx, coaster conduit can be formed by silicones, and length is 120 millimeters, and wall thickness is 0.5 millimeter, and overall diameter is 2 millimeters.For dilating catheter, can adopt Shao Shi A type hardness tester instrumentation to obtain the bio-compatibility elastomer that hardness is 50-90.

Similar with the coaster conduit 101 of Fig. 1, dilating catheter can be repaired in conjunction with using to the tendon that has in fact utilized any tendon repair device of describing in this article and relevant equipment to carry out or other in the situation that being with or without guiding elements, and can be for any surgical technic of describing in fact in this article.

Figure 14 A-Figure 14 G demonstrates each stage in the exemplary procedure process that the tendon of fracture is connected again.If the tendon broken ends of fractured bone has bounced back and must give for change and enter the second otch (or site of injury) from the first otch as tendon rupture typical case in hands, typically in palm, form the otch 1361 that can give the nearside tendon broken ends of fractured bone 1370 for change.On the other hand, if the nearside tendon broken ends of fractured bone in the distally of A2 coaster, tendon will expose by the otch in the distally of A2 coaster just.First with reference to Figure 14 A, if used guiding elements, guiding elements 1320 is passed through and entered in site of injury or otch 1360 at fracture location place, and this guiding elements is promoted by the tackle system of finger lentamente towards another otch 1361 proximads below A3 coaster.If the resistance of encountering makes coaster conduit proximad to be promoted to pass through, can form the otch (not shown) of one 1/2 centimetres to 1 centimetre at a crease in the skin of nearside interphalangeal joints of hand and the place, the centre position between a crease in the skin at finger root place of finger.This otch is at the A2 coaster of finger and the level height place between A3 coaster.Dissect downwards lightly to musculus flexor flesh sheath, will find coaster conduit there.Then, pull dilating catheter 1301 to surmount obstacles or resistance by this otch.If used guiding elements 1320, this guiding elements should long enough, so that completely through tackle system and stretch out two ends.If guiding elements is obviously longer than desired length, can before or after inserting, it be switched to suitable length.

With reference to Figure 14 B, once guiding elements 1320 is in place, allow dilating catheter 1301(or 1310) on guiding elements 1320, from distally proximad, slide through tackle system.Specifically, the part 1302 of diameter minimum is slided on guiding elements 1320, and this part is promoted on guiding elements by tackle system until it from another otch out.In there is no the embodiment of guiding elements 1320, as describing ground for guiding elements above, just the pipeline section of the diameter minimum of dilating catheter 1301 is inserted through to tackle system.

In any case, the pipeline section of the diameter minimum of dilating catheter is slidably reciprocated to about 10cm to expand annular distance (annular ring).Then, similarly, the larger conduit section of the next one is pulled by and makes its slip.Continuation is carried out such operation to each longitudinal pipeline section of dilating catheter, until surgeon determines the annular distance in tackle system, is sufficiently amplified to receive the current of the tendon broken ends of fractured bone.Substantially, for most hands, this will be that diameter is 14,16 or 18French.This maximum ducts size is centered between two operation wound places 1360,1361.In this embodiment, pipeline section 1304 is for passing through the maximum pipeline section of tackle system.

With reference to Figure 14 C, once dilating catheter 1301 is in place, the guiding elements 1320 that may be used can be removed.

With reference to Figure 14 D, at this moment, all pipeline sections except crossing tackle system of dilating catheter can be removed.As mentioned above, if dilating catheter is single formula, other diameter pipeline section of dilating catheter can be cut away.On the other hand, if dilating catheter comprises a plurality of separable pipeline sections, can only other pipeline section be pulled off.In addition, if it is longer than needed, surgeon can also partly cut away residue pipeline section.

At this moment, the operation process tendon broken ends of fractured bone being connected again can with tendon repair device and the tendon broken ends of fractured bone by the situation of dilating catheter rather than coaster conduit substantially as according to before any embodiment of discussing herein carry out with being described.

Therefore, for example,, referring to Figure 14 E, flexible block piece 1376 is placed on below tendon keeper to be formed for sewing up the work " platform " of repairing, and can pierces through the tendon broken ends of fractured bone to keep the tendon broken ends of fractured bone for sewing up with tendon keeper.Then, can be by the end of the attached tendon broken ends of fractured bone 1370 processed of tendon repair device (it can be any tendon repair device of discussing before herein).Figure 14 A-14G demonstrates and utilizes the embodiment repairing with the single stitching thread 1401 of pin 1402,1403 in each end.In this embodiment, pin can be crooked and another is staight needle, or two pins are all staight needle.In fact, can repair with the pin on a sutural only end; But it is favourable all having pin in each end, can sew up soon, because surgeon can sew up from sutural two ends much.In any case, stitching thread is sewn on the nearside tendon broken ends of fractured bone with pin.As below in conjunction with Figure 15 in greater detail, improved cross is sewed up technology owing to being that locking-type stitch provides particularly advantageous stitching.

Once tendon repair device 1350 is fixed on the nearside tendon broken ends of fractured bone 1370 firmly, the tendon broken ends of fractured bone be removed from tendon keeper (if use).Then, by the loose end 1350a of stitching thread 1350,1350b mono-direct line another end by dilating catheter 1301 out (substantially as describing in conjunction with coaster conduit 101 before).Rustless steel stitching thread typically has enough rigidity, makes them can be pushed through dilating catheter pipeline section.In fact, for example as in conjunction with the described multifilament rustless steel of the embodiment stitching thread before of sewing up prosthetic device be especially suitable for, because they are firm, show shape memory function (if any) a little, and can reasonably well keep node.Exemplary stitching thread is can be from Fort Wayne Metals of Fort Wayne, IN, the multifilament rustless steel 4-0(MFSS that USA has bought) stitching thread.The long filament of 49 windings that the 316L stainless steel silk that it is 0.023 inch that this MFSS stitching thread comprises by diameter forms.Have seven groups of seven stainless steel silks that are intertwined each other, each group comprises seven stainless steel silks that are intertwined each other.

No matter adopt any stitching thread, all preferably put into a smaller diameter rods to the needle point of the pin on the sutural end of major general, make before they pass dilating catheter 1301, the diameter of this bar is less than the interior diameter of dilating catheter.This contributes to prevent in the tube chamber side of acupuncture p-adic extension p conduit 1301 and blocks.In one embodiment, this bar can be pipe small-sized, that have double lumen, and every pin 1351,1352 can be inserted into respectively in one of them tube chamber.The size of these tube chambers is so set, and these pin 1351,1352 modes with frictional fit are assemblied in corresponding tube chamber.Alternative, this bar can be solid (not being the hollow pipe with tube chamber), and is made so that by needle-penetration by enough soft material, thereby pin can be pushed in the end of the bar as needlebook (pin cushion).Figure 14 E demonstrates another embodiment, wherein manages 1368 and has single tube chamber, and this official jargon is sized to receive two pins 1351,1352 together in the mode of frictional fit.Managing 1368 needs long enough to hold needle point, and on these pins, provides enough length to make Guan Buhui allow pin come off to form rational frictional fit.

In other embodiments, if wherein a pin is looper, can after sewing up, pin be cut off, and exposed suture end can be inserted into and manage 1368 together with being arranged in the pin at sutural another end place.In also having other embodiment, only a sutural end is through dilating catheter 1301.Therefore, sutural another end can have the looper being cut away easily after sewing up, or at all without any pin.

In any case, Figure 14 F demonstrates another possible embodiment.In this embodiment, much longer pipe or the bar 1380 of pipe 1368 use of Figure 14 E replaces.Pipe or bar 1380 long enoughs pass through dilating catheter and stretch out from two ends of dilating catheter with the direction along from distally to nearside.By stitching thread 1350(or other tendon repair device) be sewn on the tendon broken ends of fractured bone 1370 after, pin 1351,1352 can be inserted into the end 1380a towards nearside of pipe 1380, and surgeon can catch this end of end 1380b(towards distally of pipe or bar to stretch out from the distal end of dilating catheter 1301), and stitching thread/tendon repair device 1350 is pulled through dilating catheter rather than by it and promotes to pass through.The advantage of this embodiment is, it makes those can not have enough hardness can in reparation, use to be pushed through other type stitching thread (such as nylon suture) of dilating catheter.Alternative is, can be can temporarily fix (such as by thrusting, bonding, adhesive tape etc.) short tube, bar or the pieces etc. of pin are attached to any longitudinal member (another root stitching thread for example, narrow operating theater instruments) end, this end is enough thin, to can be assemblied in dilating catheter, stitching thread is pulled and passes through dilating catheter.

In any case, at tendon repair device/stitching thread 1350 by dilating catheter and from its distal end 1301a stretches out, if fully little the making in the end being sewn of the tendon broken ends of fractured bone 1370 can not oneself be passed in dilating catheter, can only it be drawn in the proximal end 1301a of dilating catheter 1301, then as described in conjunction with the coaster conduit 101 of Fig. 1 above, dilating catheter 1301, tendon repair device/stitching thread 1350 and the tendon broken ends of fractured bone 1370 can be pulled through tackle system as an assembly.

But referring now to Figure 14 G, most probable ground, because the tendon broken ends of fractured bone 1370 is out of shape and has too much volume because of stitching, therefore will be not easy to be assemblied in dilating catheter 1301.In these cases, tendon repair device 1350 is promoted or pulled by dilating catheter 1301 to such position, in this position, the end of the tendon broken ends of fractured bone 1370 near but do not contact the tail end 1301b of dilating catheter 1301, as seen in Figure 14 G.

Then, using dilating catheter 1301, tendon repair device 1350 and the tendon broken ends of fractured bone 1370 as an assembly, pull by tackle system to such position, in this position, the tail end 1301b of dilating catheter 1301 has passed the entrance of the first coaster 1321 that must be walked, and the end tendon broken ends of fractured bone 1370 is positioned near the entrance of coaster 1321, shown in Figure 14 G.If existing otch is not adjacent with coaster entrance, need the end of contiguous coaster to make other otch 1333.In fact, can find out, this extra otch is can be necessary for each the separated coaster that must be walked.For example 1140 of Figure 11 E funnel-form body slides on the tendon broken ends of fractured bone 1370, and to be placed on slightly the entrance of coaster 1121 inner in the little end 1143 of this funnel-form body, and large end 1144 is back to the entrance of coaster.

In the situation that funnel-form body 1140 is in position shown in Figure 14 G, surgeon can apply pulling force on the front end of tendon repair device 1350 and dilating catheter 1301, to the end of the tendon broken ends of fractured bone 1370 is drawn into and passes through funnel-form body 1140 and coaster 1321.

Make funnel-form 1140 little by little accommodate the end of the tendon broken ends of fractured bone 1370 so that insert and pass through coaster 1321.The tendon broken ends of fractured bone 1370 slides through funnel-form body 1140 and passes through coaster 1321.Once the end of the tendon broken ends of fractured bone 1370, through coaster 1321, removes funnel-form 1140, shown in Figure 14 G.

Dilating catheter 1301 can be provided with mm scale in its surface, to help to determine exactly where have hiding tamper (and must do there the otch making new advances) when pulling tendon by tackle system with dilating catheter.Specifically, pulling tendon to write down specific mm labelling by the skin place in otch before pointing.If encounter resistance, at the same position place of skin, write down mm labelling.By determining the difference between two labellings of observing and measure the accurate location that the distance being equal to calculates tamper in patient skin surface.

If the tendon broken ends of fractured bone 1370 must be guided through to second or coaster subsequently, for second or coaster subsequently repeatedly utilize the identical process of funnel-form 1140.

If the distally tendon broken ends of fractured bone has been retracted and must be along contrary direction the different piece through tackle system, can utilize the technology just now described and device but operate in the opposite direction.

Then according to circumstances can adopt any in above-mentioned technology by tendon broken ends of fractured bone 1370(1) be directly attached to the tendon broken ends of fractured bone that another matches; (2) attached with another tendon repair device that is attached to another tendon broken ends of fractured bone matching; Or (3) be attached to bone anchor.Specifically, two tendon broken ends of fractured bone are taken to and are together adjacency state, and the pin stretching out from the nearside tendon broken ends of fractured bone and stitching thread are sewn to the tendon broken ends of fractured bone of distally.Can use tendon keeper, by towards center, adjust the position of the pin of tendon keeper make they each other very near and use respectively in tendon broken ends of fractured bone of a needle-penetration help the tendon broken ends of fractured bone to take to or remain to together.If any, those are attached in advance the distally tendon broken ends of fractured bone the pin stretching out from this broken ends of fractured bone and stitching thread and also can be sewn to the nearside tendon broken ends of fractured bone so that Repair strength doubles.Also have, can adopt improved cross-stitch.

The above-mentioned improved cross that Figure 15 demonstrates in the exemplary repair procedure that is used in Figure 14 A-Figure 14 G is repaired stitch.Time sequencing in Figure 15, show stitching step in more sutural line segment sides and near 1 to 14 help of numeral node.Dotted line represents that stitching thread is in tendon material, and solid line represents that stitching thread is on tendon surface.

According to time sequencing, (1) is used improved cross-stitch as shown in the figure that the first stitching thread 1350 is sewn on the nearside tendon broken ends of fractured bone 1370 (step 1-3); (2) also adopt improved cross-stitch as shown in the figure that the second stitching thread 1380 is sewn on the distally tendon broken ends of fractured bone 1390 (step 4-6); (3) after being kept together, two tendon broken ends of fractured bone (can use tendon keeper, by towards center, adjust the position of the pin of tendon keeper make they each other very near and respectively with pin or in tendon broken ends of fractured bone of a needle-penetration help the tendon broken ends of fractured bone to take to or remain to together), adopt another kind of improved cross-stitch that the first stitching thread is sewn on the tendon broken ends of fractured bone of distally (step 7-9); (4) first sutural two ends are tied up to (step 10) in node together; (5) adopt another kind of improved cross-stitch that the second stitching thread is sewn on the nearside tendon broken ends of fractured bone (step 11-13); And (6) second sutural two ends are tied up to (step 14) in node together.Finally, can repair joint along circumferentially applying (the employing 6-0Ethibond of stitch on tendon ^tM), but smudgy in order not make the diagram of improved cross-stitch, on tendon, stitch does not have shown in Figure 15.

On a few end, be attached with knob, to allow the surgeon can rotation screw button.Needle holder piece 815 screw threads are arranged on each half 812a of, 812b.Therefore, when buckle 812 rotates along a direction, these two needle holder pieces 815 (that is, their medially motions towards each other on buckle 812) closer to each other.When buckle 812 rotates along another direction, two needle holder piece 815 laterally motions away from each other on cross bar 803.The cylindrical part 812 threadless, that diameter is larger that is just in time positioned at buckle middle part of buckle 812 can be provided for preventing that two pin maintainance blocks 815 from colliding mutually.Back-up block 822 can remain on threadless cylindrical part 821 wherein rotationally, to provide support for buckle 812 in the middle of its two ends.

Each needle holder piece can keep several different pins with different structures.Specifically, each needle holder piece 815 comprises for receiving the horizontal thread hole 825 of needle holder 823.Needle holder 823 comprises the double-screw bolt 826 with the screw thread coordinating with horizontal thread hole, and at the head 827 at its proximal end place to be used for double-screw bolt 826 manual rotations to enter the transverse holes 825 of needle holder piece 815.One or more pin 828 stretches out to keep tendon from the distal end of double-screw bolt 826.Can provide the different needle holder of the pin with varying number and structure to solve different operative status.

Each needle holder piece 815 also comprises one or more extra holes 818, by this hole, can insert pin or K line (K-wire).Each hole 818 can be with different angular orientation, so that the angle of stretching out from pin maintainance block for these pins or K line provides multiple choices.Specifically, adopting device of the present invention and technology when the tendon of avulsion rather than fracture or ligament connect again from bone, can use needle holder piece one of them by tendon keeper be attached to bone rather than the tendon broken ends of fractured bone one of them.Then, tendon keeper can allow the tendon broken ends of fractured bone approach bone.For example, one or more K line can be through one or more holes 818 of a needle holder piece 816, and (for example, by any one technology of above describing in conjunction with Fig. 4 A-4D) penetrates in the bone that will again connect with the tendon broken ends of fractured bone of avulsion.By being needled in the tendon broken ends of fractured bone of another needle holder piece 816, and rotation screw button approaches bone by the tendon broken ends of fractured bone.

In use, can rotation screw button so that with before the pin puncture tendon broken ends of fractured bone by these pins the spacing location with expectation relative to each other.Alternative, can be respectively with two tendon broken ends of fractured bone that wherein a pin (or many pins) puncture will be re-engaged, then can rotation screw button so that these pin pieces are pulled toward centre towards each other, thereby these broken ends of fractured bone are entered in abutting connection with contact.

Stabilizer bar 831 can be set for tendon keeper, the needle point of pin 828 can operation before and during be inserted in this bar.Stabiliser bar 831 can be cylinder, the cylinder 832 of being made by relatively soft material, pin can relatively easily pierce through forms, this cylinder is partly surrounded the second ring set 833 of being made by harder material, have gap 834, by this gap, can get at soft internal material 832 to stick a needle into wherein.Much more difficult with the exterior material 833 that needle-penetration is harder, thus can prevent that pin from disclosing always wears stabiliser bar 831 and again exposes.Alternative, stabiliser bar can be for example unitarily formed by two extruding-out process by the material with two kinds of different hardness.

Operation before and during, stabiliser bar 831 can have several functions.First, it is protecting needle point, thereby has prevented that surgeon from using acupuncture own or other thing because of carelessness.The second, it is supporting pin, thereby form, helps prevent the careless diastrophic rectangular configuration of pin.Finally, at intra-operative, it can prevent that the tendon broken ends of fractured bone from deviating from from pin because of carelessness.

The 12 cover exemplary embodiment

Figure 17 A shows another specific embodiment of prosthetic device 1400, and this prosthetic device is included in each end with the single stitching thread 1701 of needle bent 1702,1703.This prosthetic device can utilize one or two pins to be seamed to the tendon broken ends of fractured bone.The rustless steel stitching thread that stitching thread 1701 is mentioned before can being, thus its there is enough rigidity can substantially as the embodiment describing before linking be pushed into mentionedly and/or for example, through conduit (any conduit in conduit 1301,1310 or 103).Also as mentioned about the embodiment that describes before, needle bent is staight needle preferably conventionally, because can more easily sew up with it.Also as mentioned about the embodiment that describes before, staight needle has advantages of and more easily passes into and pass conduit.Although in any embodiment, needle bent can be used in two ends of prosthetic device, there is a sutural the present embodiment and be particularly useful for thering is needle bent two ends.Particularly, the stitching thread of supposing to be seamed to a tendon broken ends of fractured bone is not seamed to an operative procedure of another tendon broken ends of fractured bone, and right needle bent can be arranged on two ends of prosthetic device 1400.This be because, after being seamed to a tendon broken ends of fractured bone, no longer need pin, and therefore, this pin can be after prosthetic device be seamed to the first tendon broken ends of fractured bone and be cut before it passes into and pass through conduit 1301,1310,103.

This prosthetic device can be mostly used in operative procedure to link mutually with other embodiment as discussed above any mode of describing above.For example, two this devices 1700 can be attached to the relative tendon broken ends of fractured bone, then use to clamp adapter for example adapter 112 in the situation that of two broken ends of fractured bone butts, be connected to each other, as mentioned before.

In an exemplary procedure program, prosthetic device is seamed to tendon, two ends of prosthetic device are all stretched out from the front portion of the tendon broken ends of fractured bone, and two free ends all passes through conduit simultaneously.Therefore, four stitching thread line thighs will be by adapter 112(, sutural two ends of the first prosthetic device along a direction and two ends of the second prosthetic device along another direction).Adapter 112 can have two holes, the hole 151,152 in exemplary adapter 112 as shown in Figure 1 for example, and wherein sufficiently to receive two stitching thread line stock-traders' know-hows, it passes greatly in each hole.Or adapter can have single macropore, to receive four all stitching thread line thighs to pass simultaneously.In other embodiments, adapter can have four holes, and every stitching thread has a hole.

Figure 17 B shows the another embodiment of prosthetic device 1710, and this prosthetic device comprises that 1711,1712 and two needle bent 1715 of two stitching thread, 1716(have one in each end of device 1710).Particularly, two sutural first ends are attached to a pin 1715, and two sutural the other end are attached to another pin 1716.This embodiment is very similar to the embodiment shown in Figure 17 A, except it is because having two stitching thread rather than a stitching thread has better Repair strength but keeps similar flexibility.In this way, eight independent stitching thread line thighs are connected to each other two tendon broken ends of fractured bone, and extend past cramping adapter, thereby very strong reparation is provided.As mentioned before, clamp adapter and can there is a macropore to receive all eight line thighs.

In one embodiment, sutural whole length can be wrapped in sheath.Yet, in the embodiment shown, near two short sheaths 1717,1718 that are two shrink wrapped pipe fittings (shrink wrap tubing) form, two stitching thread 1711,1712 of for example only wrapping two stitching thread 1711,1712 opposed end adjacent with pin 1715,1716.Most of length between stitching thread opposed end of stitching thread 1711,1712 is not wrapped.Sheath 1717,1718 at least plays two kinds of effects.First, it has simplified stitching thread by conduit and by clamping adapter, because it keeps together two sutural ends, thereby allows two stitching thread can once pass through conduit and/or clamp adapter.In addition,, after pin is cut, it keeps suture end can not untie or wear and tear.Therefore, this sheath can also be attached in the single strand embodiment shown in Figure 17 A.

Figure 18 A-Figure 18 H shows another kind of suturing skill, it provides prosthetic device has been arrived to the extremely strong attached effectively of the tendon broken ends of fractured bone, and be particularly useful for the prosthetic device shown in Figure 14 and Figure 15, this prosthetic device has a stitching thread (or substantially have for sewing up object make sutural two stitching thread) substantially, and wherein the end from the tendon broken ends of fractured bone is extended in sutural two ends.Suturing skill by stop stitching thread under the tensile pressures of tendon from tendon avulsion.

Referring to Figure 18 A, first surgeon should isolate the tendon 1801 that exposes 0.5cm in each side at position.This requires proximal end to pull out nearside coaster.Distally tendon can be sent by deflection radioulnar joint.Surgeon uses suitable marking tool, and for example methylene blue or marker pen can be made nearly seven place's labellings 1802,1803,1804,1805,1806,1807,1808 on the tendon broken ends of fractured bone, to be used as the visual reference of stitching, indicates.According to surgical preference, some labellings can be omitted (for example 1805,1807, thereby because other labellings for example 1804,1808 enough closely also can be as the reference sign of those labellings).Some surgeon can preferably not use any labelling.Although Figure 18 A only illustrates a broken ends of fractured bone, should on two tendon broken ends of fractured bone, carry out.

Referring now to Figure 18 B,, first using stitching thread 1810 compared with fingers and palms side, come the place of more close back surface (posterios surface) and the longitudinal axis of tendon 1801 vertically through (use two backmost labelling 1802,1808 as inlet point and the reference sign that goes out to give me a little) thus and pull stitching thread to pass the sutural end of tendon 1801 to flush each other.

Next referring to Figure 18 C, obtain stitching thread 1810 an end, by stitching thread crossed tendon, by pin (not shown) be approximately labeled as 1804 some place again with the long axis of tendon just in time vertically through tendon and pull pin to pass through through it.Obtain sutural another end and crossed tendon so that pin at about labelling 1808 places but preferably enters tendon compared with sutural another end from the place of the farther 1mm of cut end 1801a.Labelling 1808 can be compared with labelling 1802 from the farther about 1mm of cut end 1801a.Or, if labelling 1802 and 1808 flushes surgeon along tendon length, also can from the place of cut end 1801 farther 1mm, enter tendon compared with labelling 1808.Suture end is strained.

Next referring to Figure 18 D, by sutural two ends respectively point 1805 and point 1807 places return penetrate tendon in and from the cut end of tendon, exit.Should attempt as far as possible that (that is, near labelling 1806) from the end 1801a of tendon 1801 out medially near cut end.Should also be noted that at point 1805,1807 places, reentering tendon (it is than going out to give me a little 1804,1806 more close a little cut end 1801a) will contribute to prevent stitching to lock.Pin can excise from sutural end at this some place, especially in the situation that prosthetic device has, can not pass the needle bent that clamps adapter.Not so, can be at stitching thread through any time excision pin after both crimps.

Next, should on another tendon broken ends of fractured bone 1821, repeat with the stitching thread 1820 of another prosthetic device described above in steps.

Next, referring to Figure 18 E, adapter 1812 is passed through to clamp along a direction in two ends of every stitching thread 1810,1820.Then, preferably in the situation that for example by keeping these stitching thread line thighs not block passage in these stitching thread line thighs space that outwards biasing clamps in connector passage with increase, sutural two ends of another root are passed and are clamped adapter 1812 along contrary direction.

Referring now to Figure 18 F,, be in the lateral edge place of repairing position and arrange and fasten stitch 1825 on the first tendon leaving surgical point.On this tendon, stitch will be controlled desirable rotation.Suggestion when completing on tendon stitch around tendon always by the long enough that on this tendon, stitch stays for future use.

Next as shown in Figure 18 G, the every independent stitching thread line thigh that pulls the line thigh of stitching thread 1810 and 1820 and guarantee as far as possible equally to stretch in each direction along contrary direction, maximizes to make to repair the intensity of position when rotating tendon.This rotation is towards permission cramping instrument 1830 is entered from lateral angles rather than backward angle of the past, to both crimps is flattened.Now can be repaired any unnecessary tendon.With cramping instrument 1830, clamp about 10 seconds to guarantee the suitable distortion of both crimps 1812.

Finally, referring to Figure 18 H, the palm surface that crosses reparation position completes stitch 1815 on tendon, to both crimps 1812 is imbedded in tendon material.Surgeon can use the stitching stitch of stitching continuously or some interruptions in each side of both crimps at the place, axis of tendon.

It is optional that stitch on the tendon of rear wall is sewed up, and determines according to outward appearance.On tendon in rear wall, sew up stitch and can interfere repairing the blood supply at position, even and the two perfect combination, test also illustrates intensity without increase.

As implied above completing after reparation, surgeon should experience tendon five or six excursions to guarantee the good action by coaster.Can need to observe coaster by the horizontal little otch on the nearside of original otch.

The 13 cover illustrative examples

As mentioned before, one or more disclosed prosthetic device can be for merging bone herein, comprise to the reparation of fractured bone or for following other objects bone merged: (a) the boat moon ligament repair, include the scapholunatum gap widened, have vertical scapholunatum and with static state or dynamic instability (SLR), (b) other joint of wrist, (c) palm refers to (MP) joint; (d) thumb and finger, (e) palmar plate, (f) fusions associate member, (g) between PIP and DIP distally and nearside dactylus) joint, and (h) fragment in wrist and palm reduces.

Figure 19 shows the repair of bone in palm, and it uses two bone anchors, and for example bone anchor 400 and/or 450 and cramping adapters shown in Fig. 1 and Fig. 4 B-Fig. 4 D for example clamp adapter 112.Each bone anchor has respectively the stitching thread 1903,1904 stretching out from it.Particularly, can in every bone (or GUSUIPIAN) 1901,1902, implant respectively a bone anchor (for example anchoring piece 400), and one or more stitching thread 1905 that stretch out from each bone anchor with substantially as the mode described of contact Fig. 2 J-Fig. 2 L or Figure 18 E-Figure 18 G walked and clamped adapter 112.More specifically, at the stitching thread stretching out from two bone anchors 400, along contrary direction, walked adapter 112, along contrary direction, applied traction force until bone contacts with each other.Then, adapter 112 can be clamped for good and all to keep two bone photos to contact.

If thereby being restricted them from anatomy together, Synostosis can not under the active force of prosthetic device, be folded relative to each other, can only in a side of bone 1901,1902, place the bone anchor 400 of a pair of Colaesce so, for example, shown in the SLR of Figure 19.Yet, if bone can be folded relative to each other (or relative to each other moving along any degree of freedom) when only a pair of bone anchor 400 restriction being only subject in bone one side by adapter 112 Colaesces, can use so the extra a pair of or more multipair bone adapter by adapter 112 Colaesces, so as at additional positions place by Synostosis.For example, in Figure 19, nut bone and lunar be by two bone anchor Colaesces, these two bone anchors from top (or palm of the hand) side of palm implant and that stitching thread extends along bone top by single adapter Colaesce.In order to ensure the active force applying at stitching thread, can not cause these two bones to be folded relative to each other, another can be implanted two bones from the end (or the back of the hand) side bone anchor, thereby the stitching thread extending extends along the dorsal part of bone, and offset the sutural active force in the palmar extension of bone between these two bone anchors.

Referring to Figure 20, in order to repair cracked tubular bone for example ulna or fibula, three pairs of bone anchors (stitching thread 2002 of every pair of bone anchor is by adapter 112 Colaesces) are shown as with the interval of 120 ° arranges to realize reparation rotationally around the longitudinal axis of bone 2000.Can also use the bone anchor pair of other quantity.

In yet another embodiment, for example as shown in figure 20, three or more bone anchors 400 can be repaired to realize by one or more stitching thread 2001 Colaesces.As shown in the figure, each bone anchor can be implanted in independent bone (or GUSUIPIAN) 2002,2003,2004.In addition, also as shown in the figure, single stitching thread 2005 can be walked the eyelet of three bone anchors 400, and single sutural two ends are in the opposite direction through adapter 112.Yet in other operative procedure, two or more bone anchor 400 can be implanted in monolithic GUSUIPIAN, and Colaesce to piece or the 3rd or other bone anchor in other bones of polylith (or GUSUIPIAN) more.In fact can use bone anchor, adapter and sutural any combination to repair to realize.For example, can use different stitching thread through different adapter 112 by the Colaesce each other of the bone anchor of different grouping.

Figure 22 shows and utilizes the principle of the invention to carry out exemplary reparation to bone 2201, and this bone 2201 is broken into two 2201a, 2201b at fracture location 2202 places.In this example, an anchoring piece 400 can be implanted in a GUSUIPIAN 2201a, and single stitching thread 2203 can be as shown in figure wound around around bone 2201, and its relative two end 2203a, 2203b are in opposite direction through adapter 112.

Prothesis shown in Figure 22 can otherwise carry out, for example, use two bone anchors 400, both crimps 112 and a stitching thread 2203, as shown in figure 23.The second anchoring piece 400 is controlled the path of stitching thread 2203 better, thereby makes stitching thread pass the eyelet of the second anchoring piece, and guarantees that stitching thread 2203 is passed in time and will at least can not slip away from the position of the second bone anchor.

According to another embodiment, as shown in figure 24, can similarly repair, wherein there is no adapter 112 completely.Especially, implantable bone anchoring piece 400 in a GUSUIPIAN 2201a, and a stitching thread 2203 is wound around around bone 2201, and this sutural opposed end 2203a, 2203b return the eyelet through bone anchor 400.In latched position, arrange that eyelet pin is to be locked in two end 2203a, 2203b of stitching thread 2203 in eyelet.In addition, the second anchoring piece 400(is shown in broken lines in Figure 24) can implant in the second GUSUIPIAN 2201b, and stitching thread 2203 can be through the eyelet of this anchoring piece to control better the path of stitching thread 2203 and guarantee stitching thread can not pass in time and skid off from its position.

Some is repaired for example scapholunatum reparation meeting mentioned above, because surrounding tissue has hindered, the visual field of bone is difficult to execution, especially from palmar.Particularly, visual field is being had in the reparation of obstruction, can be difficult to bone anchor to insert in bone.In boat moon ligament repair, nut bone and lunar be connected together (although this is not the naturalness of two bones).Use technology of the present invention, preferably in dorsal part and the lunar side of bone, implant anchoring piece and it is interconnected, to prevent that as mentioned before bone is folded relative to each other.

Figure 25, Figure 26, Figure 27 and Figure 28 A-Figure 28 L show for overcoming operative procedure and the relevant apparatus of this difficulty.The present invention will link and be described with typical scapholunatum fusion.Yet, should be understood that, this is only schematically, and this technology can be applied to many other bones fusion and other reparations with device.

Summarize it, Figure 25 shows boring guiding piece 2501, this guiding piece be used for boring two (or more) holes in case by bone anchor relative to each other and with respect to the exact relationship of bone to receive.Use boring guiding piece, two or more polylith bone can be crept into and be drilled through bone completely to each hole on each end is opened wide, and can receive any or two anchoring pieces,, on an end of bone, there is a bone anchor (, anchoring piece at the dorsal part of bone and anchoring piece at the palmar of bone), or in every side, have a bone anchor.By drilling through bone completely, each hole can be for bone anchor on palmar and another anchoring piece on dorsal part, thereby the hole number that need to get out in bone in some cases reduces by half.As shown in figure 26, the pin 2525 with sufficient length inserts each hole and passes completely through bone to fully surmount obstruction tissue above bone from two ends in hole, thereby can easily be seen.The diameter dimension of pin is configured to be closely engaged in still can in hole, slide (for example, pin can have the nominal diameter identical with drill bit) in the hole in.Pin comprises the post 2526 that longitudinally stretch out at least one end from its end, and it has the most diameter that is less than pin.

The bone anchor 2505 being shown as in Figure 27 on the end that is arranged on insertion tool 2507 has the coupling groove 2515 at its distal end place, so that bond post 2526.Visible, except the distal recesses 2525 of the post in acceptance pin, in bone anchor, be also useful on two parallel holes 2513,2514 of maintenance stitching thread 2517, described stitching thread is as previously mentioned for connecting bone photo.

Once pin 2525 is placed in position, surgeon just can easily see that the end (it is with the post 2526 from its extension) of pin is above bone and other any tissues.Then, surgeon can be by the distal recesses of bone anchor 2,505 2515 being inserted on post 2526 and bone anchor 2505 is rested on pin.Then, surgeon can push and plug instrument 2507 below to force anchoring piece 2505 and pin 2525 to be passed down through hole until the acra of bone anchor is arranged in hole, and pin directly guides bone anchor to enter in hole.Then, during bone anchor 2505 screws and bones by insertion tool 2507.Then, pin 2525 can be pulled out from bone at the opposite side of bone.

The present invention will be particularly useful for scapholunatum reparation, because (1) anchoring piece will need to be implanted in palmar and the dorsal part of bone conventionally; (2) both sides of bone can be by the palmar of hands and the counteropening on dorsal part and available; (3) one sides (dorsal part) are with respect to because hindering tissue, very heavy handled opposite side (palmar) is relatively not interrupted.

Figure 28 A-Figure 28 L shows operative procedure.For the purpose of clearness, the dorsal part of the D indication bone in figure, and V indication palmar.In addition, bone anchor conventionally before implanting preloaded have stitching thread.Yet in order not allow the present invention fuzzy, stitching thread omits from Figure 28 A-Figure 28 L.

Referring to Figure 28 A, boring guiding piece 2501 is used for retouching multiple type by specialized designs, and this guiding piece is provided with guiding hole 2502a and 2502b, for piercing nut bone 2520 and lunar 2522 two with accurate angle relative to each other and position, gets into the cave.In order to describe briefly basic sides of the present invention, shown in the guiding piece 2501 of holing there are two parallel borings guiding hole 2502a and 2502b.Yet some scapholunatums merge meeting need to be at a side of bone or three anchoring pieces in the more anchoring pieces on both sides.In addition, not all these holes all must be parallel to each other.

Under any circumstance, in one embodiment, the bottom side 2503 of boring guiding piece 2501 is shaped to bone 2520,2522(boring guiding piece will be used to this bone) surface configuration complementary, thereby boring guiding piece 2501 can directly be placed on bone, and boring the bottom side profile of guiding piece and the coupling complementary contours of bone surface are accurately aimed at partly to lock engagement state.Certainly, boring guiding piece 2501 can be lifted from bone surface simply, but when it is pressed down on bone, boring guiding piece laterally locks mating (as jigsaw puzzle pieces) with bone because of the complementation of profile.This is only possible with regard to some bone because the shape of many bones and/or size all vary with each individual, therefore can not be as described above supporting member reasonably.Yet nut bone and lunar are relatively unified for most people, therefore few boring guiding piece (for the patient of different size) to three kinds of sizes should be enough to be used in most people.

According to first step of operative procedure as shown in Figure 28 A, after the palmar of hands and dorsal part have been carried out otch, boring guiding piece 2501 is placed on the dorsal part of bone, and the profile of the bottom side 2503 of the guiding piece 2501 of simultaneously holing is respectively against the coupling profile of the dorsal part of nut bone 2520 and lunar 2522.Then, each boring that suitable drill bit inserts on boring guiding piece guides in hole 2502a and 2502b and for piercing and drill through bone completely.

Referring to Figure 28 B, after getting out each hole 2530,2531, pin 2525 inserts in holes, thereby and pass completely through bone pin on the both sides of bone above bone.First the sidepiece with guide post 2526 of pin is inserted, thereby the end with guide post of pin will be stretched out from the palmar of bone.Figure 28 C has stretched out 2525 states after having inserted of selling.

One or more pins can insert in hole by means of boring guiding piece as you were, to simplify, pin are entered to the manipulation in hole, and not so this will be difficult to see clearly because hindering tissue.Boring guiding piece can be left on original place and as by pin relative to each other parallel any two or more boring guide hole to be inserted into the guiding piece in hole.In this embodiment, two guiding hole 2502a, 2502b in guiding piece are parallel to each other in boring, and therefore two pins 2525 can be inserted and wear in the hole of these two guiding holes in going forward side by side to the marrow.Yet, in other boring guiding pieces, when if any boring guiding hole does not have with other boring guiding cavity parallel, the guiding piece of holing so should be removed before pin inserts nonparallel hole, because the nonparallel pin in guiding piece will stop boring guiding piece to be recalled the pin bent not in the situation that in boring.

Under any circumstance, next, as shown in Figure 28 D, hands is turned over to approach palmar.Surgeon can dispose on palmar and organize in around some of pin, so that: (1) improves visual; (2) while preventing from introducing bone anchor, clamp or catch tissue; (3) arrange on the whole operative site.

Next, as shown in Figure 27 and Figure 28 E, surgeon then prepare bone anchor 2505 for screw hand-hole 2530 one of them.In one embodiment, bone anchor is preloaded on implanting instrument 2507 and this bone anchor preloaded has in sutural situation and sends at it.As Figure 27 the best illustrates, the distal end of bone anchor 2505 is perforated to be formed for receiving in the groove 2515(Figure 27 of the post 2526 on guide pin end not shown).The proximal end of anchoring piece 2505 comprises for receiving the proximal aperture 2509 of the acra 2506 of insertion tool 2507.Acra 2506 and proximal aperture 2509 have the profile of coupling, make during anchoring piece 2505 rotates to screw to the marrow around its longitudinal axis thereby instrument 2507 can reverse.

Because pin 2526 is above bone and around organizing (not shown), surgeon can easily see that pin 2525 and post 2526 are to be placed on bone anchor 2505 on post 2526.Therefore, surgeon inserts the aperture, distally of bone anchor 2,505 2515 to get on the post 2526 of pin 2525 to bone anchor 2505 is rested on pin 2526.

Referring now to Figure 28 F,, now under surgeon, push away insertion tool 2507 to force pin 2525 along with anchoring piece 2505 is by pin guiding hand-hole 2530 and exit the dorsal part of bone 2520.Groove 2515 in the distal end of bone anchor 2505 and the post 2526 on the end at pin 2525 can have the profile (the same with the acra 2506 of bone anchor and proximal aperture 2509 and instrument 2507) of coupling, thereby thereby by instrument 2507, bone anchor 2505 are reversed and will also make pin 2525 reverse surgeon instrument, anchoring piece and pin can be integral and to reverse to contribute to make pin 2525 to advance through hole 2530.When the distal end of bone anchor 2505 arrives bone 2530, surgeon screws in hand-hole 2530 bone anchor 2505 until the proximal end of bone anchor flushes with bone surface, as Figure 28 G the best illustrates.

Referring to Figure 28 H, by repeating above process before making bone anchor 2505 and pin 2525 and then to another pin 2525 and hole 2531, until anchoring piece is screwed in hole 2532 and its top flushes with bone surface.

Referring to Figure 28 I, hands is overturn again to touch the dorsal part of bone.

Referring to Figure 28 J, from dorsal part, by the first pin 2525, from a hole, (for example 2530) pulls out.Referring to Figure 28 K, use as described earlier insertion tool 2507 another bone anchor 2505 to be screwed in the dorsal part in hole 2530 of exposure.On dorsal part, hinder to observe the tissue in hole and want much less, and hole should easily see from dorsal part, even in the situation that pin is removed.However, under any circumstance, if surgeon pulls out one at every turn, sell and be screwed into bone anchor (with to pull out all pins before being screwed into any anchoring piece contrary), the residue pin that can easily see will contribute to surgeon directed and find the hole of no longer containing pin.

Above process is repeated in another hole 2531, make each hole 2530,2531 there to be the form of a bone anchor to contain two bone anchors 2505 on every one end in hole.

Implanted after anchoring piece, will between one or more stitching thread each bone anchor on dorsal part, extend and will between one or more stitching thread bone anchor on palmar, extend as described earlier and can complete operative procedure.

Conclusion

Preliminary test illustrate the tendon carried out according to the principle of the invention again attached failure intensity be approximately 70-100 newton.Therefore, tendon and ligament repair have produced compared with the much higher intensity of current nursing standard in accordance with the principles of the present invention.In addition, operative procedure is compared greatly and is simplified with respect to current nursing standard.

The invention provides safe, simple, the easy and strong reparation for tendon, ligament etc.In preliminary test, observed the failure intensity up to 100N.

Should be understood that, with the stitching thread/cable of all parts and the quantity of pin of the formation tendon repair device that herein each embodiment describes be explicitly only exemplary, and can provide still less or more stitching thread/cables (and pin) according to expectation strength, the particular organization being just repaired, the strength of materials that produces tendon repair device and the other factors repaired.

Although the description of various embodiment practicalities is only limited to the musculus flexor tendon of hands, it must be understood that many parenchima reparations can be undertaken by described device partially or entirely.The example of this anatomical structure comprises that the tendon of health and ligament and any other require the structure being fixed at a plurality of points.

Described thus specific embodiment of the present invention, various alternative, modification and improvement will easily be expected for a person skilled in the art.These become significantly alternative, modification and improvement even without at large being described the part being intended to also as this description because of present disclosure, and are intended within the spirit and scope of the present invention.Therefore, describing and be merely given as examples before, is not restrictive.The present invention is only limited by following claims and equivalents thereof.

Adnexa A

Palm and the musculus flexor tendon in finger and the surface anatomy of tackle system about little transverse miniature otch

Foreword

Verdan had once utilized middle lateral incision for musculus flexor tendon repair, axial cut-outs (Verdan) during Bunnell was once used (Boyes, Surgery of the Hand).In 1967, Bruner described the zigzag otch on the palm surface of palm and finger to the easy exposure to musculus flexor tendon and tackle system (Bruner, Zig-zag volar-digital incision1967) is provided.This expansion cut is popular between hands surgeon, and it is used to other operation degree on the palm surface of musculus flexor operation on tendon and finger, and is still commonly used so far.Yet portion is dissectd in the extension of dissecing flap that it need to be set up along finger length.

The detailed structure of the tackle system of thumb and finger and function are by cropping (Doyle) well.When using these expansion cut, coaster is broadly exposed (Bruner).In order to use less expansion cut restriction to dissect the total amount of portion, to the detailed understanding of the surface anatomy of fabric, be necessary.We dissect and have measured a lot of corpse with cropping tendon and coaster surface anatomy.In this article, we describe the relation between finger fold and fabric, and by this surface anatomy with can correctly expose the horizontal little otch that the intrasystem ad hoc structure of musculus flexor tendon but maintains the globality of tackle system simultaneously and connect.

In recent years, the surgeon in many fields was partial to less intrusion type method from the exposure of large-scale otch and extended pattern.The development that this causes arthroscope and endoscope field, makes open type operation completely overshadowed.Proved well the sickness rate, the swelling that reduce, bleed and recovered faster, and clinical experience has been realized these benefits.In hands surgical field, endoscopic technique has been applied to radius and ulna joint, carpometacarpal joints and carpal tunnel release art (Vasiliadis).

We have dissected 8 palms and 32 fingers in 8 corpse handss.Palm fold and finger fold were used methylene blue labelling before dissecing.2 millimeters of bar portions of every a crease in the skin are held in place, and remaining skin of palm of hand, finger skin and subcutaneous tissue are removed downwards to musculus flexor tendon sheath.All coasters are protected carefully.

With milimeter scale, measure each coaster with respect to nearside extension distance and the distal extension portion distance of the finger of nearside more fold, and record.According to Fiorini method, measure the desired locations of the proximal end of A-1 coaster.The proximal end of the proximal of A1 and distal side edge and A2 is from this point measurement and record.The far and near side end of the distal end of A-2 and C1 coaster and the proximal end of A-3 coaster are recorded with respect to palmar-nearside finger fold.The far and near side end of the distal side edge of A3, A4 and the proximal end of A-5 are measured with respect to middle finger fold.Finally, the proximal end of the dry end of the distal side edge of A5 and distally phalanges is measured from distally finger fold.

The distal extension portion that the position of the decussation portion of FDS tendon and finger tendon intersect is measured with respect to tackle system and is recorded as inserting the position of FDS and FDP tendon.Central longitudinal axis along finger is measured.

We do not measure intensity or the thickness of each coaster with quantization method or Histological method, the observed and given rank of each coaster be weak, in or strong.

By proximal position and the distal position of each coaster, the cross sections position of crossing finger is designed strategically, makes otch by the exposure that provides ring to the musculus flexor sheath between shape coaster.In order to eliminate the multiformity of finger size, the location tables of these horizontal " tiny incisions " is reached a fingers and palms side or is pointed fold to the percent of next fingers and palms or finger fold.

Finally, we have analyzed apart from usining distance as the guiding with the intrasystem specific part of exposure musculus flexor tendon for small design otch.

Result

Coaster thickness:

On the whole, A-1, A-2, A-4 coaster are strong and complete.A-1 coaster is divided into two or three sections conventionally.Because these functions become integral body, so they make one-shot measurement.Between A-1 coaster and A-2 coaster, have sometimes thin section, this section can be assessed as the separation between these two coasters, or evaluated by the weak distal section of A-1 when measuring as a part of A-1.A-3 coaster and A-5 coaster always exist, but usually narrow and thin.

C-1 physically well develops conventionally, and it is by thicker a branch of and thinner a branch of composition, and it is derived from the place about 1 millimeter of the nearside of the distal extension portion of A-2 coaster conventionally.C-2 and C-3 are thinner, and are difficult to cropping in some specimen.

Fascial strip:

There is the fascia that crosses tendon in the palm, in the place of A-1 nearside 3-4mm.These are derived from palmar fascia and are absolutely in most cases being located immediately at below the fingers and palms side fold of distally.But they are not coaster strictly speaking can be used as coaster.

The surface anatomy of coaster and position:

Nearside extension and the distal extension portion of coaster go on record.According to Fiorini desired locations measuring distance from the nearside extension of A-1 in palm.All all the other distances apart from fingers and palms side finger fold, nearside finger fold and distally finger fold in distally middle phalanx and distally phalanges are recorded.Average for each each coaster of finger calculating.For opponent's size is proofreaied and correct, also distance table is shown as to the percent of the distance from a fold to next fold.

The position that the decussation of FDS and finger tendon intersect:

FDS anatomy is consistent for all specimen and finger.At the proximal end place of A2, find the decussation of FDS.All the time in the distal end of A2 and the proximal end place of A3, find respectively the nearside extension and the distal extension portion that refer to that tendon intersects.

Tendon inserts:

For our all eight specimen, we have found the two consistent insertion in all fingers of FDP and FDS.FDS is inserted in the centre 1/3rd of middle phalanx all the time under A4 coaster.FDP is inserted in the nearside of distal phalanx and middle 1/3rd.

Anatomy place of safety for labelling otch:

There are 6 crucial globalities that allow horizontal little otch is set and do not interfere important coaster of measuring.They are:

The distally starting point of 1-A-1 coaster and A-2 coaster;

The nearside of 2-C-1 coaster and distal extension portion;

The nearside of 3-A-4 coaster and distal extension portion;

4-refers to the position of tendon intersection and the division portion of FDS tendon;

5-FDS inserts the region in middle phalanx;

The dry end position of 6-distal phalanx and FDP insert the position of distal phalanx;

Result based on us, we have built the safe incision tract chart of the globality that maintains A-1, A-2, A-3, A-4 and A-5 coaster.

Clinical quoting and tiny incisions

The surface anatomy of tendon and coaster and sheath system can be for providing the guiding to tendon surgical incision.Relation between these structures and finger fold is proposed to arrange otch and easily locates fabric.We propose design the reparation of musculus flexor tendon and tendon is passed to tackle system by this surface anatomy.

Surface anatomy is also necessary to the insertion in middle phalanx to repair for locating reliably FDS, to a slippage portion of tendon is carried out to excision or for example exposes and refer to that tendon intersects in the situation that tendon dangles in finger tendon intersection region.For this reason, about the finger tendon crossover location of coaster and at tendon in the surface anatomy at split point place that becomes two slipped tendon portions with measured.

Advocated the method that the excision of a slippage portion of FDS is rubbed in reducing A-1 coaster and A-2 coaster region.This has also been avoided the slype of walking crosswise for FDP when FDP extends through the tearing part in FDS tendon potentially.We describe this anatomical accurate location, even so that a slippage portion of FDS can be by excision in the situation that of horizontal little otch.

In order to remove slippage portion, expose in this slippage portion can be in the nearside extension of A-4 coaster and be deep to this coaster place in the insertion section, distally of FDS.It can separate along distally, then refers to that tendon intersects the nearside place that can just in time point fold at A-3 coaster and the nearside between A-2 coaster below C-1 coaster and separates.Then, slippage portion is delivered by the horizontal little otch between A-1 coaster and A-2 coaster and is finally sent, and the nearside place of the nearside starting point of the A-1 of this slippage portion in palm is from all the other FDS excisions.

According to these measurements, we make the guide that does not injure important structure for approaching musculus flexor system, and we claim that this guide is three minutes laws (Rule of Thirds), because it mainly comprises the various distances in fracture palm, and be divided into trisection, then in the trisection of safety, do otch.More specifically, can do the safe otch in palm and finger (digit) according to following rule.

Reference is with figure below A, wherein the indication of blue area is unsafe region for otch, for being made at distal palm, is positioned at the nearside of the intrinsic fold 113 of fingers and palms side in the safety zone of the otch between A1 coaster and A2 coaster to point 1/3rd of the nearside extension of 117 A-1 coaster and the distance between the intrinsic fold 113 of fingers and palms side.More specifically, if the nearside fold 107 of finger and the distance between the intrinsic fold 113 of fingers and palms side are A, the proximal end of A1 coaster is positioned at the nearside of the intrinsic fold of this fingers and palms side with this identical distance A so.Therefore, in region 115 the distance A of intrinsic fold 113 nearsides of fingers and palms side 1/3rd in to do otch be unsafe because this is the place that A2 coaster is stationed.

For the A2 coaster in nearside phalanges and the otch between A3 coaster, safety zone is in the nearside fold 107 of finger and 2/3rds distance of the distance between the intrinsic fold 113 of fingers and palms side.Nearside three/1 of this distance are dangerous, because it comprises A2 coaster.

In middle phalanx, the nearside 1/3rd of the distance between distally finger fold 103 and nearside finger fold 107 is safe for do otch between A3 coaster and A4 coaster, and the distally 1/3rd of the same distance between distally finger fold 103 and nearside finger fold 107 is safe for do otch between A4 coaster and A5 coaster.Centre three/1 of the distance between distally finger fold 103 and nearside finger fold 107 are unsafe for doing otch, because it comprises A4 coaster.

Finally, in the phalanges of distally, the distally 2nd/3rd of the distance between distally finger fold 103 and the end of finger 111, the safety zone of doing otch.Between distally finger fold 103 and the end of finger 111, the region 101 of the nearside 1/3rd of distance is occupied by A5 coaster and DIP joint, and is unsafe.

Discuss

The anatomical knowledge of musculus flexor system is made to locate after easily all fabrics.This allows horizontal little otch or other relatively gentle otch, dissecing and exposed amount when this performs the operation restriction.

We have measured as the nearside extension of the A-1 of Wilhelmi and Fiorini description.Wilihelmi and Fiorini independently confirm that nearside finger fold is identical to the distance of the proximal of A-1 coaster with nearside finger fold with the distance between PIP finger fold in research at two.This makes it possible to locate easily and reliably this coaster.From practical term, because difference is only 2 to 4mm, therefore the horizontal little otch in this region will be sufficiently near coaster source to it is easily exposed.

The coaster position of discovery in other position also has the variation of 2-4mm, but the region of A-1, A-2, A-3 and A-4 is consistent, because these coasters are

Separation between A-1 coaster and A-2 coaster may be clearly, or may be fuzzy and be difficult to distinguish.Research before finds that 95% specimen does not have separation between A-1 and A-2.We find that our specimen is like this.In this case, we according between two coasters, deposit separative other specimen conclude the end of A-1 coaster and the beginning of A-2 coaster between the beginning of A-1 and the intrinsic fold of fingers and palms side distance 1/3rd.

We have found to cross the fascial strip of A-1 coaster nearside tendon in some specimen.These fascial strips can hinder and lead to the entrance (Fiorini) of A-1 coaster and can effectively be used as coaster.

Fiorini JHS2011 March

No. the 6th, 7,8,10,12,13, Fiorini biblio.

Claims

1. one kind for being again attached to a longitudinal anatomic components device of another anatomic components, comprise: the first prosthetic device, this first prosthetic device has at least the first and second, each has the first longitudinal end and the second longitudinal end, be attached to described first and described second described the first longitudinal end the first pin and be attached to the second pin of described the second longitudinal end of described first and described second; Conduit, this conduit comprises the pipe with tube chamber; Funnel shaped member, this funnel shaped member has larger longitudinal end and for the less longitudinal end with leading to the entrance placed adjacent of anatomical passageway.