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FR2894454A1 - Implant for realizing arthrodesis, has median hole receiving pedicle screw along convergent angle with respect to sagittal plane, and lateral hole receiving ilio-sacral screw, where latter screw is fixed on implant by locking screw - Google Patents

Implant for realizing arthrodesis, has median hole receiving pedicle screw along convergent angle with respect to sagittal plane, and lateral hole receiving ilio-sacral screw, where latter screw is fixed on implant by locking screw Download PDF

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Publication number
FR2894454A1
FR2894454A1 FR0512598A FR0512598A FR2894454A1 FR 2894454 A1 FR2894454 A1 FR 2894454A1 FR 0512598 A FR0512598 A FR 0512598A FR 0512598 A FR0512598 A FR 0512598A FR 2894454 A1 FR2894454 A1 FR 2894454A1
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Prior art keywords
screw
implant
plate
sacral
ilio
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FR0512598A
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French (fr)
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FR2894454B1 (en
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Maurice Bergoin
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7055—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant connected to sacrum, pelvis or skull
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A61B17/8066—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for pelvic reconstruction

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

Abstract

The implant has a horizontal sacral plate comprising median and lateral fixation holes, where the median hole receives an S1-pedicle screw (3) along a convergent angle with respect to a sagittal plane. A base in centered on the median hole and receives a cylindrical bar which connects the sacrum to other vertebral implants. The lateral hole receives an ilio-sacral screw (2) with a convergence axis greater than 30 degrees with respect to a convergence axis of the pedicle screw, where the screw (2) is fixed on the plate by a locking screw (4). An independent claim is also included for an aiming device for installing an implant.

Description

La présente invention concerne un dispositif destiné à améliorer laThe present invention relates to a device for improving the

fixation sacrée par une plaque et des vis lorsque une instrumentation vertébrale nécessite de prendre appui sur le sacrum pour réaliser une arthrodèse . Actuellement il existe 3 types de fixation sacrée : -La première consiste à se fixer uniquement sur le sacrum à l'aide d'une première vis introduite dans le pédicule de S1 et une deuxième vis introduite soit dans le pédicule de S2 soit latéralement dans l'aileron sacré . -La deuxième consiste à ajouter à ces deux premières vis une troisième introduite latéralement dans l'os iliaque -La troisième consiste à introduire une seule vis ilio-sacrée et à fixer sur cette vis un connecteur mobile sur lequel sera verrouillé la barre du montage définitif. Ces 3 solutions ne sont pas satisfaisantes la première et la deuxième résistent mal dans les longs montages aux forces d'arrachement lors de la flexion antérieure du tronc. La troisième résiste bien aux forces d'arrachement mais la fixation de la tige sur le connecteur n'est pas satisfaisante en raison de la persistance de mouvements de cisaillement sur la vis unique ilio-sacrée Le dispositif que nous proposons est une combinaison de la première et de la troisième solution de fixation .Cette fixation est réellement nouvelle car elle nécessite un nouvel implant de fixation sur le sacrum (un implant pour le côté droit et un implant pour le côté gauche) et un dispositif original de visée mécanique pour introduire la vis ilio-sacrée.  Sacral fixation by a plate and screws when a vertebral instrumentation requires to be supported on the sacrum to perform arthrodesis. Currently there are 3 types of fixation sacred: -The first is to attach only on the sacrum with a first screw introduced into the pedicle of S1 and a second screw introduced either into the pedicle of S2 or laterally in the sacred fin. -The second is to add to these first two screws a third introduced laterally into the iliac bone -The third is to introduce a single ilio-sacral screw and to fix on this screw a movable connector on which will be locked the bar of the final assembly . These 3 solutions are not satisfactory. The first and the second resist badly in the long assemblies with pulling forces during the anterior flexion of the trunk. The third is resistant to tearing forces but the fixation of the rod on the connector is not satisfactory due to the persistence of shear movements on the ilio-sacral single screw The device we propose is a combination of the first and the third fixation solution. This fixation is really new because it requires a new fixation implant on the sacrum (an implant for the right side and an implant for the left side) and an original mechanical sighting device to introduce the screw iliac-sacral.

Le nouvel implant est dessiné sur les figures 1 et 2, sur le côté droit du sacrum est dessiné l'implant droit (1) en vue postérieure , l'implant droit (1) en coupe horizontale se voit sur la figure 2. Sur le côté gauche de la figure 2 est dessiné le viseur nécessaire pour mettre en place correctement les deux vis (A B P) Description du nouvel implant sacré (côté droit). Il s'agit d'une plaque sacrée horizontale légèrement concave en avant (1) comportant 2 trous de fixation (la distance entre le centre des 2 trous est d'environ 10 mm) . Le trou médial est destiné à recevoir la vis qui se fixera dans le pédicule de S1, l'axe du canal dans la plaque est de 10 à 15 convergent par rapport au plan sagittal (3). Le trou médial se trouve au centre de l'embase qui recevra la barre de liaison avec les autres implants vertébraux. Le trou latéral est destiné à recevoir la vis ilio- sacrée (2).Cette vis est plus convergente par rapport par rapport au plan sagittal (30 de plus que la vis pédiculaire de S l). Les 2 vis : pédiculaire de S1 et iliosacrée vont fixer la plaque sacrée mais pour verrouiller la vis ilio-sacrée sur la plaque il est nécessaire d'ajouter sur la plaque une petite vis de blocage (4) Pour réaliser avec le plus de sécurité possible l'insertion de ces 2 vis il est nécessaire de disposer d'un viseur original, un viseur pour le côté droit et un pour le côté gauche. Le viseur comprend une plaque (P) qui a la forme exacte de la base de la plaque sacrée sur laquelle est soudé un tube de visée (A) destiné à forer le trajet que suivra la vis pédiculaire de S1. L'orifice de la plaque correspondant à la vis ilio-sacrée comporte seulement un canal long d'environ 5 mm dans lequel s'engagera le forêt venant du tube de visée B Le tube de visée B est solidarisé au tube de visée A par une lame métallique (C) , il est interrompu sur les 6 premiers centimètres pour pouvoir enjamber le rebord de l'os iliaque. L'angle que fait le tube B par rapport au tube A est de 30 dans le plan horizontal et de 10 dans le plan vertical de façon à ce que la vis ilio- sacrée soit à la fois convergente par rapport à la vis pédiculaire de S1 mais aussi légèrement divergente pour passer au-dessous d'elle (2,3). Sans modifier le procédé de la visée, cette visée pourra être améliorée après essais sur différents sujets de laboratoire d'anatomie en modifiant l'ancrage temporaire du viseur soit à l'aide d'un tube télescopique en B soit à l'aide de petits pointeaux surla face de la plaque en regard du sacrumLa fixation de l'implant sacré par 2 vis, une pédiculaire en S1 et une ilio-sacrée devrait être très robuste, les 2 vis résisteront bien aux forces de cisaillement en inclinaison latérale droite et gauche du tronc. Dans les mouvements de flexion antérieure ou de torsion du tronc la vis pédiculaire en S1 sera très sollicitée en arrachement mais la vis ilio-sacrée ne subira pas cette contrainte et l'implant sacré restera stable. La fixation que nous avons décrite pourra être utilisée en première intention dans les longs montages, elle sera aussi d'un grand secours dans les échecs des montages classiques que nous avons rapportés au début de notre présentation Si l'implant sacré de base ne comporte que 2 trous il est naturellement possible de prolonger la plaque vers le bas (Ibis) pour mettre en place une troisième vis sacrée latérale dans l'aileron sacré (pas de visée nécessaire) (5) On pourra également prolonger la plaque latéralement (lier) ce prolongement est alors perpendiculaire à l'implant de la figure 1bis.Dans ce prolongement de la plaque on pourra placer une quatrième vis dans l'os iliaque (pas de visée nécessaire) (6) Ces différents montages peuvent être nécessaires lorsque la qualité de l'os est précaire par déminéralisation osseuse 3  The new implant is drawn in Figures 1 and 2, on the right side of the sacrum is drawn the right implant (1) in posterior view, the right implant (1) in horizontal section is shown in Figure 2. On the left side of Figure 2 is drawn the viewfinder needed to properly set up the two screws (ABP) Description of the new sacred implant (right side). It is a concave horizontal plate slightly concave forward (1) with 2 fixing holes (the distance between the center of the 2 holes is about 10 mm). The medial hole is intended to receive the screw which will be fixed in the pedicle of S1, the axis of the channel in the plate is from 10 to 15 convergent with respect to the sagittal plane (3). The medial hole is at the center of the base that will receive the connecting bar with the other vertebral implants. The lateral hole is intended to receive the iliac-sacral screw (2) .This screw is more convergent relative to the sagittal plane (30 more than the pedicle screw S 1). The 2 screws: pedicle of S1 and iliosacrée will fix the sacred plate but to lock the ilio-sacred screw on the plate it is necessary to add on the plate a small locking screw (4) To achieve with the most security possible the insertion of these 2 screws is necessary to have an original viewfinder, a viewfinder for the right side and one for the left side. The viewfinder comprises a plate (P) which has the exact shape of the base of the sacred plate on which is welded a sighting tube (A) for drilling the path that will follow the pedicle screw of S1. The orifice of the plate corresponding to the ilio-sacral screw has only a channel about 5 mm long in which will engage the forest coming from the sighting tube B The sighting tube B is secured to the sighting tube A by a metal blade (C), it is interrupted on the first 6 centimeters to be able to span the edge of the iliac bone. The angle made by the tube B with respect to the tube A is 30 in the horizontal plane and 10 in the vertical plane so that the iliac sacral screw is at the same time convergent with respect to the pedicle screw of S1 but also slightly divergent to pass below it (2,3). Without modifying the aiming process, this aim can be improved after tests on various subjects of anatomy laboratory by modifying the temporary anchoring of the viewfinder either with a telescopic tube in B or with the help of small Needles on the face of the plate next to the sacrum The fixation of the sacred implant by 2 screws, a pedicle in S1 and ilio-sacral should be very robust, the 2 screws will withstand shear forces in right and left lateral inclination trunk. In the movements of anterior flexion or torsion of the trunk the pedicle screw in S1 will be very stressed in tearing but the ilio-sacral screw will not undergo this constraint and the sacred implant will remain stable. The fixation that we have described may be used as a first aid in long montages, it will also be of great help in the failures of the classic montages that we reported at the beginning of our presentation. If the basic sacred implant contains only 2 holes it is naturally possible to extend the plate down (Ibis) to set up a third lateral sacred screw in the sacred fin (no sighting required) (5) It can also extend the plate laterally (link) this extension is then perpendicular to the implant of Figure 1bis.In this extension of the plate can be placed a fourth screw in the pelvic bone (no aim necessary) (6) These different montages may be necessary when the quality of the bone is precarious by bone demineralization 3

Claims (5)

REVENDICATIONS 1) Implant destiné à améliorer la fixation sacrée à l'aide d'une plaque et de vis lorsque l'instrumentation vertébrale nécessite l'appui sur le sacrum pour réaliser une arthrodèse,caractérisé en ce qu'il est constitué d'une plaque horizontale comportant 2 trous distants et convergents, un trou médial étant destiné à recevoir une vis pédiculaire en S1 suivant un angle convergent de 10 à 15 par rapport au plan sagittal ,centrée sur ce premier trou se trouve l'embase qui permettra la fixation de la barre cylindrique de connexion entre les implants vertébraux et le sacrum,le trou latéral étant destiné à recevoir une vis ilio-sacrée (2) avec un axe de convergence supérieur à 30 par rapport à celui de la vis pédiculaire de S1(3), la fixation de la vis ilio-sacrée sur la plaque nécessite une vis de verrouillage (4).  1) Implant intended to improve the sacred fixation using a plate and screws when the vertebral instrumentation requires support on the sacrum to perform arthrodesis, characterized in that it consists of a horizontal plate having 2 remote and convergent holes, a medial hole being adapted to receive a pedicle screw S1 at a convergent angle of 10 to 15 with respect to the sagittal plane, centered on this first hole is the base which will allow the fixing of the bar cylindrical connection between the vertebral implants and the sacrum, the lateral hole being intended to receive an ilio-sacral screw (2) with an axis of convergence greater than 30 relative to that of the pedicle screw of S1 (3), the fixation the ilio-sacral screw on the plate requires a locking screw (4). 2) Implant selon la revendication 1 caractérisé en ce que la plaque présente un prolongement vers le bas pour ajouter une vis dans l'aileron sacré (Ibis) et un allongement latéral pour ajouter une vis dans l'épaisseur de l'os iliaque (lier)  2) Implant according to claim 1 characterized in that the plate has a downward extension to add a screw in the sacral fin (Ibis) and a lateral elongation to add a screw in the thickness of the iliac bone (link ) 3)Viseur destiné à la pose d'un implant selon la revendication 1 ou 2 caractérisé en qui comporte une plaque de même forme que la plaque de l'implant sur laquelle sont soudés 2 tubes de visée, un tube complet pour le forage de la vis pédiculaire de S1 et un deuxième tube incomplet , relié au premier tube par une connexion rigide, pour permettre le forage de la vis iliosacrée, l'angle que forme les 2 tubes par rapport à la plaque devra respectant la convergence différente que doivent avoir les 2 vis dans le plan horizontal et la divergence nécessaire pour que la vis ilio-sacrée passe légèrement au-dessous de la vis pédiculaire de S1  3) Viewfinder for implanting an implant according to claim 1 or 2 characterized in that comprises a plate of the same shape as the plate of the implant on which are welded 2 sighting tubes, a complete tube for drilling the Pedicle screw of S1 and a second incomplete tube, connected to the first tube by a rigid connection, to allow the drilling of the iliosacral screw, the angle formed by the two tubes with respect to the plate must respect the different convergence that must have the 2 screws in the horizontal plane and the divergence necessary for the ilio-sacral screw to pass slightly below the pedicle screw of S1 4)Viseur selon revendication 3 caractérisé en ce que le tube (B) est un tube télescopique  4) Viewfinder according to claim 3 characterized in that the tube (B) is a telescopic tube 5)Viseur selon la revendication 3 caractérisé en ce que la face de la plaque,destinée à être dirigée vers le sacrum, est munie de petits pointeaux30  5) A viewfinder according to claim 3 characterized in that the face of the plate, intended to be directed towards the sacrum, is provided with small needles30
FR0512598A 2005-12-13 2005-12-13 ORIGINAL PLATE OF SACRED ATTACHMENT LOCKED BY A S1 SCREWDRIVER SCREW AND AN ILIO-SACRED SCREW USING A VERY ORIGINAL VIEWING DEVICE Expired - Fee Related FR2894454B1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
FR0512598A FR2894454B1 (en) 2005-12-13 2005-12-13 ORIGINAL PLATE OF SACRED ATTACHMENT LOCKED BY A S1 SCREWDRIVER SCREW AND AN ILIO-SACRED SCREW USING A VERY ORIGINAL VIEWING DEVICE

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
FR0512598A FR2894454B1 (en) 2005-12-13 2005-12-13 ORIGINAL PLATE OF SACRED ATTACHMENT LOCKED BY A S1 SCREWDRIVER SCREW AND AN ILIO-SACRED SCREW USING A VERY ORIGINAL VIEWING DEVICE

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FR2894454A1 true FR2894454A1 (en) 2007-06-15
FR2894454B1 FR2894454B1 (en) 2008-08-08

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN107174326A (en) * 2017-06-15 2017-09-19 邹伟 A kind of interlocking formula pedicle screw system
US10179014B1 (en) 2012-06-01 2019-01-15 Nuvasive, Inc. Systems and methods for promoting sacroiliac joint fusion
CN117653427A (en) * 2024-01-30 2024-03-08 首都医科大学宣武医院 Asymmetric self-stabilizing ALIF fusion cage for fifth lumbar vertebra and first sacral vertebra

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1996005778A1 (en) * 1994-08-23 1996-02-29 Spinetech, Inc. Cervical spine stabilization system
WO2000076412A1 (en) * 1999-06-15 2000-12-21 Euros Backbone implant with lateral linkage by anterior path
US20050177167A1 (en) * 2001-06-21 2005-08-11 Karl-Heinz Hildinger & Helmut Muckter Implantable screw for stabilization of a joint or a bone fracture

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1996005778A1 (en) * 1994-08-23 1996-02-29 Spinetech, Inc. Cervical spine stabilization system
WO2000076412A1 (en) * 1999-06-15 2000-12-21 Euros Backbone implant with lateral linkage by anterior path
US20050177167A1 (en) * 2001-06-21 2005-08-11 Karl-Heinz Hildinger & Helmut Muckter Implantable screw for stabilization of a joint or a bone fracture

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10179014B1 (en) 2012-06-01 2019-01-15 Nuvasive, Inc. Systems and methods for promoting sacroiliac joint fusion
US11253302B2 (en) 2012-06-01 2022-02-22 Nuvasive, Inc. Systems and methods for promoting sacroiliac joint fusion
US12156684B2 (en) 2012-06-01 2024-12-03 Nuvasive, Inc. Systems and methods for promoting sacroiliac joint fusion
CN107174326A (en) * 2017-06-15 2017-09-19 邹伟 A kind of interlocking formula pedicle screw system
CN107174326B (en) * 2017-06-15 2023-12-12 邹伟 Interlocking pedicle screw system
CN117653427A (en) * 2024-01-30 2024-03-08 首都医科大学宣武医院 Asymmetric self-stabilizing ALIF fusion cage for fifth lumbar vertebra and first sacral vertebra

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