Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
  • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/86—Pins or screws or threaded wires; nuts therefor
  • A61B17/8605—Heads, i.e. proximal ends projecting from bone
  • A61B17/861—Heads, i.e. proximal ends projecting from bone specially shaped for gripping driver
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/86—Pins or screws or threaded wires; nuts therefor
  • A61B17/8625—Shanks, i.e. parts contacting bone tissue
  • A61B17/8635—Tips of screws
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/00831—Material properties
  • A61B2017/00902—Material properties transparent or translucent
  • A61B2017/00911—Material properties transparent or translucent for fields applied by a magnetic resonance imaging system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/03—Automatic limiting or abutting means, e.g. for safety
  • A61B2090/031—Automatic limiting or abutting means, e.g. for safety torque limiting

Definitions

• the present invention relates to a stereotaxic framework for investigations in the cranial box of a patient.
• complementary exploration techniques such as computed tomography, angiography, ventriculography or nuclear magnetic resonance are known.
• the interest of these complementary investigation techniques is to be superimposed during their exploitation in order to combine the recovered information.
• the millimetric repositioning of the brain in the same space is each time indispensable.
• a millimetric repositioning of the brain in space is also necessary for the implementation of certain therapeutic techniques such as surgery under stereotaxic conditions, radio-surgery or fractional treatment by stereotactic radiotherapy.
• a stereotactic frame fixed in the external table of the bones of the skull of the patient.
• the attachment of the frame in the external table of the bones of the skull is carried out for example by means of four percutaneous bone screws, that is to say screws whose head projects outside the skin of the patient.
• These percutaneous bone screws are placed during the entire investigation and / or treatment of the patient.
• These percutaneous bone screws constitute a positioning reference for the stereotactic frame which is made to be placed, deposited, rested several times according to the investigative and / or therapeutic techniques.
• the object of the invention is therefore to overcome the disadvantages of the prior art by proposing a new stereotaxic framework, lightweight and compact and has the advantage of being deposited and reinstalled several times, on the bone screws percutaneous while maintaining the precision required.
• the object of the invention relates to a stereotactic frame for investigations in a cranial box, said frame having a closed ring-shaped base from which rise from four corners, pillars of mounting and support for bone fixation systems.
• each pillar comprises in a direction transverse to its direction of extension, a tapped hole of longitudinal axis, the pillars being mounted so that the longitudinal axes of the tapped holes extend in a plane along the diagonals of the quadrilateral formed by the pillars, the four pillars being interconnected by a connecting ring fixed to the pillars by temporary assembly means.
• the connecting ring is open or closed.
• the pillars comprise fastening means on the base of the stereotaxic frame, each pillar having a bearing face for the connecting ring.
• the temporary assembly means comprise screws passing right through the connecting ring to be anchored in a tapped hole made from the transverse face of the pillars, forming the face of the 'support.
• each tapped hole has a calibrated diameter to form a guide barrel of a tool or to ensure the screwing of a guide barrel or a connecting strut with a bone fixation system.
• each tapped hole has a calibrated diameter greater than the largest diameter of the bone fixation system to allow the passage of the latter through the tapped hole.
• each bone fixation system is a percutaneous bone screw comprising a head in which is arranged an axial well consisting of a bore for receiving a tip formed at the end of the connecting spacer, the bore being extended by a receiving housing of a screwing tool.
• the housing has a prismatic shape complementary to that of the screwing tool, this housing being deformable beyond a given screwing torque to allow the free rotation of the screwing tool to the inside the housing to prevent rupture of the percutaneous bone target.
• each percutaneous bone screw is made of a thermoplastic material.
• each percutaneous bone screw and / or bonding spacer comprises an imaging marker.
• each percutaneous bone screw has a threaded self-tapping portion extending between a smooth portion connecting to the head and a frustoconical portion extending to a distal transverse face of the bone screw. percutaneous.
• Another subject of the invention concerns a stereotactic frame equipped with an adaptation device according to the invention
• Figures 1 to 3 are schematic perspective views of the stereotactic frame according to the invention, illustrated in various configurations of use.
• Figure 4 is an elevational sectional view taken substantially along lines AA of Figure 3.
• FIG. 5 is a view similar to Figure 4 on a larger scale showing another feature of the subject of the invention.
• Figs. 1 to 3 describe an adaptation device I for a stereotactic frame 1 allowing investigations in a not shown cranial box.
• a stereotactic frame 1 comprises a closed ring-shaped base 2 from which four corners, mounting and supporting pillars 4 for fastening systems such as percutaneous bone screws 6 are mounted.
• the ring 2 has a generally rectangular closed shape delimited by four straight sides 2i mounted in pairs parallel to each other. The straight sides 2i are interconnected by connecting portions 2 2 extending substantially at 45 ° between each right side 2 ⁇ with which they are connected.
• the stereotactic frame 1 thus comprises in each corner, an oblique connection portion 2 2 from which a mounting pillar 4 rises.
• Each mounting pillar 4 thus rises in a direction X substantially perpendicular to the plane formed by the metric ring 2.
• Each pillar 4 comprises a series of tapped holes 7 arranged in a direction substantially perpendicular to the extension direction X of the pillars 4.
• Each pillar 4 is mounted on the ring 2 with the aid of fastening means 8 such for example a screw 8 passing through a bore 9 formed in the connecting portion 2 2 of the ring 2 to be screwed into a threaded hole 7 ( Figure 4).
• Such a stereotactic frame 1 which conventionally comprises graduations on the sides 2 ⁇ and the pillars 4 is able to constitute a stereotactic frame or a frame known as the Leksell frame.
• such a stereotactic frame 1 comprises at least one connecting ring 11 for connecting the four pillars 4 to each other.
• This connecting ring 11 contributes to stiffening the pillars 4.
• the connecting ring 11 has a closed shape.
• the connecting ring 11 can be opened.
• the connecting ring 11 has a generally U-shaped to connect the four pillars 4 between them considering that the ring does not exist between two adjacent pillars.
• This connecting ring 11 is made in any appropriate manner, such as by bars, profiles, cables or other to ensure the stiffening of the pillars.
• This connecting ring 11 is removably attached to the pillars 4 by means of temporary assembly means 13.
• the connecting ring 11 has a generally rectangular general shape, substantially homologous to that of the In a more precise manner, this connecting ring 11 has four main sides Hi extending in pairs parallel to one another. The main sides Hi are connected to one another via connection portions H 2 .
• this connecting ring 11 is made in one piece.
• this connecting ring 11 comes to rest or is in contact with a bearing face 4i presented by each pillar 4.
• the bearing face 4i of the pillar is formed by the transverse face 4i of the pillar delimiting the distal portion or the free end of the pillars 4.
• the temporary assembly means 13 comprise screws passing through from one side to the other. connecting ring 11 to come each anchored in a tapped hole 16 arranged from the transverse face 4i of the pillars 4.
• the screws 13 preferably comprise a knurled gripping portion 17 facilitating the assembly and disassembly operations of this ring 11.
• the connecting ring 11 can be fixed on the pillars 4 by means of temporary assembly means 13 of different nature.
• the connecting ring 11 is fixed on the pillars 4 by means of interlocking or latching assembly.
• the stereotactic frame 1 is provided with such a connecting ring 11, there is created around the skull, a cube completely closed by its twelve edges.
• Such a stereotactic frame 1 thus has a very good rigidity providing increased precision during the drilling and screwing phases of the percutaneous bone screws 6, as will be described in the following description.
• each pillar 4 comprises in a transverse direction perpendicular to the direction X extension of the pillars, a threaded hole 21 extending along a longitudinal axis L.
• the threaded holes 21 are arranged so that in the mounted position of the pillars 4 on the ring 2, the Longitudinal axes L of the four threaded holes 21 extend in the same plane.
• the axes of the tapped holes 21 converge towards a central point so that the longitudinal axes extend along the diagonals of the quadrilateral formed by the four pillars 4.
• each threaded hole 21 ensuring the screwing of a connecting spacer 23 with a percutaneous bone screw 6.
• Each threaded hole 21 has a calibrated diameter to form a guide barrel for a tool 24 such as a drill for example. It should be noted that each tapped hole 21 is adapted to ensure, as illustrated in FIG. 1, the screwing of a guide barrel 25 for a tool 24.
• each tapped hole 21 has a calibrated diameter greater than the largest diameter of the percutaneous bone screw 6 to allow the latter, as appears more specifically in FIG. 5, to pass through the Tapped hole 21.
• Each percutaneous bone screw 6 comprises a head 26 in which is arranged an axial well 27 opening on a transverse face 28 delimiting the end of the percutaneous bone screw 6.
• the axial well 27 consists of a bore 29 for receiving a tip 30 arranged at the end of the connecting spacer 23.
• the bore 29 is extended by a housing 31 for receiving a screwing tool 32 such as a screwdriver illustrated in FIG. Figure 2
• the housing 31 has a prismatic shape, for example hexagonal, complementary to the shape of the screwing tool so as to ensure the rotational drive of the percutaneous bone screw 6.
• this housing 31 is deformable beyond a given torque screw to allow free rotation of the screwing tool inside the housing. There is thus a matting of the housing avoiding breakage or breakage of the bone screw 6, beyond a given screwdriving torque exerted by the screwdriver.
• each percutaneous bone screw 6 is made of a thermoplastic material such as PEEK.
• Each percutaneous bone screw 6 comprises an imaging marker integrated in the thermoplastic material or integrated in a complementary part attached to the percutaneous bone screw 6. It should be noted that this imaging marker can be attached to or integrated into the spacer of connection 23 only or be part of the percutaneous bone screw 6 and the connecting strut 23.
• Each percutaneous bone screw 6 has a threaded portion 34 extending between one side, a smooth portion 35 connecting to the head 28 and on the other side, a frustoconical portion 36 extending to the transverse face. distal 37 of the percutaneous bone screw 6.
• the threaded portion 34 is self-tapping.
• the implementation of the adaptation system I according to the invention on a stereotactic frame 1 follows directly from the foregoing description.
• the connecting ring 11 is mounted using the temporary assembly screws 13 on the pillars 4.
• the frame of stereotaxis 1 has a high rigidity.
• the establishment of the stereotactic frame 1 on the cranial box of the patient is carried out using four screwable percutaneous tips 40 as illustrated in Figure 1. Each percutaneous tip 40 is screwed advantageously into the threaded hole 21. percutaneous tip 40 is removed so as to allow a drilling operation of the cranial box of the patient with the aid of a drill 24.
• the drill 24 is guided either by the threaded hole 21 or by a guide bush 25 screwed In the threaded hole 21.
• a screwdriver 32 with a percutaneous bone screw 6 is used to screw the percutaneous bone screw into the skull (Fig. 2).
• the screwdriver 32 equipped with the percutaneous bone screw 6 is inserted through the threaded hole 21 which serves as a guide for the screwdriver 32 during the screwing operation.
• the pillar 4 is held rigidly in position by means of the connecting ring 11.
• the screwdriver 32 is removed, and the connection between the screw to percutaneous bone 6 and the stereotactic frame 1 is made using a spacer of link 23 which is screwed into the threaded hole 21 until its tip 30 comes to cooperate with the bore 29 of the percutaneous bone screw 6.
• the mounting of the other percutaneous bone screws 6 is carried out successively according to the process described above. As illustrated in FIG. 3, the connecting ring 11 can be removed if necessary after the operation of placing the four percutaneous bone screws 6.
• a stereotactic frame equipped with an adaptation device according to the invention was developed with the active collaboration of Dr. NATAF of the Hospital Sainte-Anne Paris XIv * TM and successfully tested on corpses and dry skulls .

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

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• 2007
  • 2007-06-22 FR FR0755977A patent/FR2917599B1/fr not_active Expired - Fee Related
• 2008
  • 2008-06-19 WO PCT/FR2008/051116 patent/WO2009007574A2/fr not_active Ceased
  • 2008-06-19 EP EP08806048A patent/EP2170207A2/de not_active Withdrawn

Non-Patent Citations (1)

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