Source: http://www.google.com/patents/US20040230197?dq=5685792
Timestamp: 2016-10-25 02:39:37
Document Index: 625288203

Matched Legal Cases: ['art 62', 'art 64', 'art 66', 'art 64', 'art 66', 'art 81', 'art 83', 'art 66']

Patent US20040230197 - Ancillary tool for positioning a glenoid implant - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsThis ancillary tool (1) comprises a plate (4) which defines a convex surface (12) intended to bear against the glenoid cavity of a patient's scapula (2) and which forms a directional guide for a drilling, fashioning or like member. To allow the surgeon to apply this member in a chosen direction (C—C),...http://www.google.com/patents/US20040230197?utm_source=gb-gplus-sharePatent US20040230197 - Ancillary tool for positioning a glenoid implantAdvanced Patent SearchTry the new Google Patents, with machine-classified Google Scholar results, and Japanese and South Korean patents.Publication numberUS20040230197 A1Publication typeApplicationApplication numberUS 10/793,947Publication dateNov 18, 2004Filing dateMar 8, 2004Priority dateMar 10, 2003Also published asUS7887544, US8187282, US20070250174Publication number10793947, 793947, US 2004/0230197 A1, US 2004/230197 A1, US 20040230197 A1, US 20040230197A1, US 2004230197 A1, US 2004230197A1, US-A1-20040230197, US-A1-2004230197, US2004/0230197A1, US2004/230197A1, US20040230197 A1, US20040230197A1, US2004230197 A1, US2004230197A1InventorsAlain Tornier, Anders EkelundOriginal AssigneeAlain Tornier, Anders EkelundExport CitationBiBTeX, EndNote, RefManPatent Citations (99), Referenced by (78), Classifications (5), Legal Events (3) External Links: USPTO, USPTO Assignment, EspacenetAncillary tool for positioning a glenoid implant
[0048] [0048]FIG. 1 shows an ancillary tool 1 for positioning a glenoid implant, adapted to directionally guide the bit of a surgical drill (not shown). When positioning a glenoid implant on a patient's scapula, with a view to forming a shoulder prosthesis, the surgeon must hollow out in the glenoid cavity of the scapula a canal for receiving a keel of the glenoid implant. As a function of the patient's morphology, the geometry of this keel, the pathology having motivated the positioning of the implant, etc . . . , the direction in which this canal is to be formed is different. In order to determine the optimal direction of this canal, the term “optimal” here meaning “preferential” considering all the medical parameters brought to his knowledge, the surgeon has available for example a series of scanner images of the scapula on which it is provided to position the implant and he determines this privileged direction. The exact localization of the point of application of the drilling member is secondary with respect to the privileged direction, it being understood that this point of application lies in a central zone of the glenoid cavity. FIG. 2 shows in dotted lines a patient's scapula 2 as it appears to the surgeon by a scanner image. Axis C-C indicates the privileged direction chosen by the surgeon as being the direction in which the drilling member should be applied. [0049] To that end, the ancillary tool 1 essentially comprises a plate 4 on which are added means 6 for adjusting the direction of a drilling guide with respect to the plate. [0050] More precisely, as shown in FIGS. 1 to 5, the plate 4 is formed by a metal body 10 presenting, in a direction noted Z-Z, a smaller dimension than in the two remaining orthogonal directions, indicated by axes X-X and Y-Y. In the following description, the terms lower and upper will be oriented with respect to axis X-X, with the result that, for example with reference to FIG. 3, the term upper corresponds to the top part of this Figure, while the term lower corresponds to the bottom part. [0051] The body 10 of the plate 4 defines a convex surface 12 intended to come into surface abutment against the scapula 2, as shown in FIG. 2. The surface 12 is advantageously provided with projecting barbs 16 intended to facilitate retention of the plate with respect to the scapula as will be explained hereinafter. [0052] The body 10 defines a surface 18 opposite the surface 12, which is substantially planar and from which bevelled surfaces 20 are made at the four corners of the body 10. In these surfaces 20 there are formed tapped recesses 21 adapted to receive means (not shown) for removably fixing a handle for manipulating the plate, known per se. [0053] The body 10 internally defines a through opening 22, of central axis Z-Z and of cruciform profile in cross-section. More precisely, the opening 22 comprises two pairs of diametrically opposite lobes, the lobes of the same pair being respectively aligned in directions X-X and Y-Y. [0054] The adjusting means 6 are formed by a barrel 30 shown in greater detail in FIGS. 3 to 5. This barrel comprises a tubular body 32 of axis Z-Z and whose outer profile is substantially complementary of the profile of the through opening 22 of the body 10. The body 32 is closed at one of its ends by a substantially hemispherical bottom 34 which, with the outer surface of the body 32, forms a planar shoulder 35 radially projecting with respect to axis Z-Z. [0055] Inside this bottom 34 are formed rectilinear through holes 36 of which the respective axes are substantially concurrent at a point noted P belonging to axis Z-Z. These holes 36 are distributed in a first series 38 of holes which extend in a first plane containing the axes X-X and Z-Z and corresponding substantially to the plane of section of FIG. 4, and a second series 40 of holes which extend in a second plane containing axes Y-Y and Z-Z and corresponding to the plane of section of FIG. 5. [0056] In each series 38, 40 of holes 36, the value of the angular deviation between two adjacent holes located on the same side of axis Z-Z is substantially 10�. The value of the angular deviation between axis Z-Z and one of the two holes 36 of the series 38 located nearest the centre of the cover 34 is about 5�, while the value of the same angular deviation for the two holes nearest the centre of series 40 is about 10�. [0057] By cooperation of the tubular body 32 with the through opening 22 of the plate 10, the barrel 30 is able to be received and immobilized with respect to the plate 4, the shoulder 35 in that case being positioned in abutment against the substantially planar surface 18 of the plate, as shown in FIG. 2. Point P is then inscribed substantially in the geometric extension of the face 12 intended to come into abutment against the scapula 2. [0058] In the upper part of the plate 4, a screw 42 is housed in a complementary bore extending in direction X-X and opening out, on one side, on the edge of the body 10 and, on the other side, in the opening 22. [0059] This screw makes it possible to retain the barrel 30 in the opening 22 along axis Z-Z. [0060] The use of the ancillary tool 1 when positioning a glenoid implant for shoulder prosthesis is as follows: [0061] When the surgeon has determined, for example by means of scanner images of a patient's shoulder, the privileged direction C-C in which he desires to anchor the glenoid implant in the scapula and therefore to apply a drill bit, he applies the ancillary tool 1 against the scapula. More precisely, the surface 12 of the plate 4 is applied against the osseous glenoid cavity of the scapula 2, as shown in FIG. 2. To that end, the ancillary tool 1 is advantageously manipulated by a handle connected to the plate 10 at the level of the bevelled surfaces 20. The barbs 16 facilitate attachment of the plate with respect to the scapula. [0062] While the barrel 30 is being received and immobilized in the opening 22 of the plate, the surgeon selects, from all the holes 36 of the barrel, the one whose longitudinal axis is the closest to the preferential direction C-C which he has chosen. If necessary, the surgeon disengages the barrel 30 from the plate, pivots it through a quarter turn then replaces it in the cruciform opening 22, which makes it possible to have available drilling directions adjustable with a pitch of 5� in the two planes containing axes X-X and Z-Z and axes Y-Y and Z-Z, respectively. [0063] In FIG. 2, the chosen direction C-C forms, in a plane containing axes Y-Y and Z-Z, an angular deviation of about 15� with respect to the central axis of the glenoid cavity, with the result that the surgeon will use one of the holes of the series 38 of the barrel only. [0064] He then introduces the bit of a drill into this hole in order to make a bore or at least an incipient bore in the direction imposed by the hole. If necessary, after having disengaged the ancillary tool 1, the surgeon may widen the orifice bored in the scapula by a bit of larger diameter or another fashioning member. He may also use a milling tool which, wedged in the bored orifice, enables a glenoid resection plane orthogonal to direction C-C to be made. [0065] The ancillary tool 1 is thus easy to use and rapidly provides the surgeon with a guide for application of a member, particularly a drill, whose direction is adjusted in the preferential direction that the surgeon has chosen. [0066] [0066]FIGS. 6 and 7 show a variant embodiment of the ancillary tool 1 which differs from the tool of the preceding Figures by the number and arrangement of the guiding holes 36 made in the barrel 30. In addition to the series of holes 38 and 40, series of holes 42, 44, 46 and 48 are respectively located in the four quadrants defined by the series of holes 38 and 40, forming a grid layout of the bottom 34 of the barrel. This variant offers the surgeon more guiding directions than the tool of FIGS. 1 to 5. [0067] FIGS. 8 to 14 show a second ancillary tool 50 according to the invention. This tool is intended to be used within the same framework as the tool 1 of the preceding Figures, i.e. to guide the rod of a member, particularly the bit of a surgical drill, when positioning a glenoid implant of a shoulder prosthesis. [0068] As shown in detail in FIGS. 8 to 11, this tool 50 comprises a plate 52 formed by a metal body 54 having substantially the same shape as the body 10 of the plate 4 and oriented with respect to axes X-X, Y-Y and Z-Z defined in the same way as in FIG. 3. [0069] The body 54 defines a convex surface 56 intended to abut against a patient's osseous glenoid cavity, advantageously provided with catching barbs 58 substantially similar to barbs 16 of the plate 10, as well as an opposite planar surface 59. The body 54 is also adapted to be removably fixed to a handle for manipulation (not shown). [0070] In the body 54 of the plate 52 there is formed a through opening 60 of axis of revolution Z-Z. As shown in FIG. 9, this opening comprises, successively from the face 56 of the body 54, a truncated part 62 which diverges towards the face 56, a part 64 in the form of a frustum of sphere with centre 0, and a tapped cylindrical part 66. [0071] The tool 50 also comprises means 70 for adjusting the direction of a bore guide with respect to the plate 52, comprising, on the one hand, a sphere 72 pierced right through along one of its diameters, forming a single cylindrical bore 74 of axis Z′-Z′, and, on the other hand, a nut 76. [0072] More precisely, the sphere 72 presents an outer surface 72 a substantially complementary of the hemispherical part 64 of the opening 60. The nut 76 is formed by a tubular body 78, of axis Z-Z and threaded in manner substantially complementary of the tapped cylindrical part 66 of the opening 60, and by a hexagonal head 80 which forms with the tubular body 78 a shoulder 82 radially projecting with respect to the axis of the body 78. The nut 76 internally forms a bore 84 formed, on the tubular body 78 side, by a part 81 substantially in the form of a frustum of sphere complementary of the outer surface of the sphere 72, and, on the head 80 side, by a flared part 83. [0073] By cooperation of the outer surface 72 a of the sphere 72 with the surface 64 of the opening 60, the sphere 72 is mobile with respect to the plate 52 in the manner of a ball-joint of centre O. Moreover, by engagement and cooperation of the threads of the body 78 of the nut 76 and of the tapped part 66 of the opening 60, the nut is able to immobilize the sphere 72 with respect to the plate. The planar face 59 of the plate forms a stop surface for the shoulder 82, thus avoiding excessive tightening, and even the deterioration of the sphere by the tightened nut. [0074] In order to make it possible to apply a considerable tightening torque on the nut 76, the ancillary tool 50 advantageously comprises a spanner 86, shown in FIG. 12, provided with a hollowed head for driving the hexagonal head of the nut. [0075] The sphere 72 being mobile with respect to the plate 52 when the nut 76 is not tightened, this sphere is adapted to be displaced so that the axis Z′-Z′ of its bore 74 is adjusted in the privileged direction C-C previously chosen by the surgeon. [0076] The ancillary tool 50 further comprises means 88 for displacing and positioning the sphere 72 with respect to the plate 52, shown in FIGS. 8, 13 and 14. These means comprise a rigid support 90, on the one hand, and a rod 92 for driving the sphere 72, on the other hand, connected to the support 88. [0077] More precisely, the rod 92 is adapted, at one of its ends, to be fitted inside the bore 74 of the sphere 72, and comprises at its other end a knurled knob 94 for manipulating the rod, removably connected on this rod in the manner of a nut. [0078] As for the rigid support 90, it comprises: [0079] a lower support for bearing on a substantially planar surface, only shown in FIG. 13 under reference 98, formed for example by a table or other like work surface; this lower support is constituted for example by a foot 96A and a heel 96B; [0080] a base 100 for receiving and immobilizing the plate 52, provided with a U of which the parallel arms each bear a longitudinal rib 102 adapted to be received in a corresponding groove 104 formed in the lateral edges of the body 54 of the plate, as shown in FIG. 14, so as to position the plane Q of the plate, containing point O and the axes X-X and Y-Y, substantially perpendicularly to the planar surface 98; [0081] a so-called horizontal protractor 106 in the form of a plate substantially parallel to the planar surface 98; this horizontal protractor 106 is, on the one hand, joined to the base 100 and, on the other hand, fixedly connected to the heel 96B of the lower bearing support by fastening studs 110; [0082] a so-called vertical protractor 112 constituted by a flat bar 114 interposed between the heel 96B and the plate of the horizontal protractor 106, and by a pair of arms 116 [0083] parallel to each other, which extend transversely from the bar 114 and between which the rod 92 is retained. [0084] The bar 114 is mounted to pivot with respect to the rest of the support 90, about a pivot axis 118 perpendicular to the surface 98 and formed for example by a cylindrical stud guided in rotation in a corresponding recess formed in the plate of the horizontal protractor 106 and the base 100. [0085] Depending on its length, each arm 116 presents an essentially semi-circular profile of centre O and bears corresponding angle graduations, referenced 120 in FIGS. 8 and 13. The graduation zero corresponds to the position of the rod 92 perpendicular to the plane Q. At the level of their ends connected to the pivoting plate 114, the arms 116 are received in a groove 122 of the horizontal protractor 106, which is semi-circular and centred on the pivot axis 118. The periphery of the groove 122 bears angular graduations referenced 124. The graduation zero corresponds to the position of the rod 92 perpendicular to the plane Q. At their opposite ends, the arms 116 are connected by a joining bridge 126. [0086] Use of the ancillary tool 50 when positioning a glenoid implant for a shoulder prosthesis is as follows: [0087] In the same way as for the ancillary tool 1 of FIGS. 1 to 5, the surgeon determines the privileged direction C—C in which he wishes to proceed with hollowing out the canal for receiving a keel of the glenoid implant. [0088] Starting from the configuration of the tool 50 shown in FIGS. 8, 13 and 14, in which the plate 52 is immobilized in the base 100 of the support 90, the surgeon, after having, if necessary, slightly loosened the nut 76, drives the sphere 72 by means of the [0089] rod 92. By displacing the knurled knob 94 upwardly or downwardly with respect to the planar surface 98, the inclination of the rod in a plane perpendicular to axis Y-Y is adjusted. By displacing the knob 94 to the left or to the right in a plane parallel to the planar surface 98, the whole of the vertical protractor 112 pivots about the axis 118 and the angular orientation of the rod in a plane perpendicular to axis X-X of the plate is adjusted. The surgeon verifies that the rod is correctly positioned angularly by directly reading on the corresponding angular references 120 and 124. [0090] Once the rod 92 is directed in the chosen direction, the surgeon uses the spanner 86 to tighten the nut 76 firmly and thus immobilize the sphere 72 with respect to the plate 52. To that end, the head of the spanner 86 is provided with a sufficiently wide slot to enable the spanner to engage on the head 80 of the nut without being hindered by the rod 92. [0091] He then disengages the plate 52 from the base 100, by removing for example the plate, the sphere 72, the tightened nut 76 and the rod 92, by previously unscrewing the knob 94. The rod 92 is then withdrawn from the hole 74 without difficulty. [0092] In the same way as for the ancillary tool 1 of FIGS. 1 to 5, the surgeon then places the plate 52 in surface abutment against the patient's osseous glenoid cavity and introduces a drill bit inside the hole 74. [0093] The second form of embodiment of the ancillary tool 50 presents the advantage over the tool 1 of FIGS. 1 to 5, of allowing the surgeon to continuously adjust the direction of the drill guide in all anatomically conceivable directions, and not only in a discrete series of these directions. [0094] Various arrangements and variants of the two forms of embodiment of the ancillary tool described hereinabove may, furthermore, be envisaged. By way of example, the bearing face 12 or 56 is planar. Moreover, the positions of points P and O mentioned above may diverge somewhat from those described hereinabove. By way of variant, the adjusting means 70 employing a sphere are replaced by a system employing a slideway allowing directional adjustment in a single plane. [0095] Similarly, the ancillary tool according to the invention is able to directionally guide any drilling, fashioning or like member other than a drill bit, for example an impact pin or a marking pin. 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