Instruments and instrument kit for Latarjet procedure and adapted method

Abstract

Disclosed is a positioning instrument that includes: two branches equipped at the proximal end thereof with an opposite jaw between which the graft is positioned, the two branches moving closer to one another by a translation movement; and a drill bush including a first hole and a second hole, separated by a distance and sized for the passage and guidance of a bone drill bit. Also disclosed are an instrument kit as well as a method for attaching a graft.

Claims

1. A method for attaching a bone graft to a scapula, the method comprising: providing a bone graft free of any holes; producing a first hole at the same time in the bone graft and in the scapula; producing a second hole at the same time through the bone graft and the scapula; and screwing screws passing through the graft in said holes to attach the bone graft to the scapula.

2. The method for attaching the bone graft to the scapula according to claim 1, further comprising providing a clamp configured to remove and prepare the bone graft free of any holes.

3. The method for attaching the bone graft to the scapula according to claim 1, further comprising providing a graft positioning clamp configured to position against the scapula and bone graft free of any holes.

4. The method for attaching the bone graft to the scapula according to claim 3, further comprising positioning an extension of the graft positioning clamp against the glenoid surface.

5. The method for attaching the bone graft to the scapula according to claim 4, further comprising drilling the first hole at the same time in said bone graft and in the scapula with the aid of a drill bush borne by the graft positioning clamp.

6. The method for attaching the bone graft to the scapula according to claim 1, further comprising: positioning the first hole at the same time in the bone graft and in the scapula by a drill bush borne by a graft positioning instrument; and positioning and drilling the second hole in the bone graft at the same time as the scapula with the aid of the drill bush borne by the graft positioning instrument.

7. The method for attaching the bone graft to the scapula according to claim 1, further comprising, based on preoperative planning, selecting a graft positioning instrument from a plurality of prefabricated instruments including a variety of sizes and shapes of one or more of: (i) graft-holding jaws, and (ii) glenoid extension surfaces.

8. The method for attaching the bone graft to the scapula according to claim 1, further comprising, prior to using an instrument kit: acquiring imaging of a shoulder of the patient; three-dimensionally reconstructing the shoulder blade; modeling at least a part of a clamp configured to remove and prepare the bone graft or a graft positioning instrument; and manufacturing at least a part of the clamp or the graft positioning instrument.

9. The method for attaching the bone graft to the scapula according to claim 1, further comprising, using, based on preoperative planning, an intraoperative guidance solution including providing, by virtual visual elements overlaid on real visual elements, position and orientation data of at least one step of an operation from cutting to separate the bone graft from a bone to which the bone graft is attached, baring the surface of the bone graft to come in contact with the scapula, and positioning the bone graft on the scapula and drilling the graft and the scapula.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 is a schematic drawing of a perspective view of an embodiment of a positioning instrument according to the invention;

(2) FIG. 2 is a schematic drawing of an exploded perspective view of the positioning instrument in FIG. 1;

(3) FIG. 3 is a schematic drawing of a perspective view of a removal and/or preparation instrument according to the invention;

(4) FIG. 4 is a schematic drawing illustrating the removal of the coracoid by means of the instrument in FIG. 3;

(5) FIG. 5 is a schematic drawing illustrating the instrument in FIG. 3 receiving the bone graft from the removal illustrated by FIG. 4 and positioned for baring of the surface required to be in contact with the scapula;

(6) FIG. 6 is a schematic drawing of a perspective view illustrating the positioning of the bone graft on the scapula by means of the instrument in FIG. 1;

(7) FIG. 7 is a schematic drawing of a front view illustrating the positioning of the bone graft on the scapula by means of the instrument in FIG. 1;

(8) FIG. 8 is a schematic drawing illustrating a kit according to the invention including the positioning instrument in FIG. 1 and the removal and/or preparation instrument in FIG. 3;

(9) FIG. 9 is a schematic drawing of a perspective view of a further embodiment according to the invention of a removal and/or preparation instrument provided with a central drill bush;

(10) FIG. 10 is a schematic drawing of a perspective view of a further embodiment of a positioning instrument provided with a drill bush and a bearing surface;

(11) FIG. 11 is a schematic drawing illustrating a kit according to the invention including the positioning instrument in FIG. 10 and the removal and/or preparation instrument in FIG. 9;

(12) FIG. 12 is a diagram of the main phases of the process leading to the creation of an instrumental system and/or an attachment method according to the invention specific to a patient.

(13) FIG. 13 is a schematic drawing of a perspective view of an embodiment of a positioning instrument with jaws and a bearing surface formed according to the patient's bone according to the invention;

(14) FIG. 14 is a schematic drawing of a perspective view of an embodiment of a removal and/or preparation instrument with jaws formed according to the patient's bone according to the invention;

DESCRIPTION OF PREFERRED EMBODIMENTS

(15) As illustrated by FIGS. 1 and 2, the positioning instrument referenced 100 as a whole includes two branches 110 and 120 arranged facing one another and having two ends 111 and 112 for the branch 110 and 121 and 122 for the branch 120.

(16) The proximal ends 112 and 122 arranged facing one another are each preformed with a jaw 113 and 123 between which the graft G is positioned (see FIGS. 7 and 8). This instrument 100 is designed such that the two branches 110 and 120 move toward or away from one another by a translation movement represented by the double arrow F1.

(17) The positioning instrument 100 further comprises a drill bush 130 including a first hole 131 and a second hole 132 substantially parallel and separated by a distance between 8 mm and 16 mm and sized for the passage and guidance of bone drill bits.

(18) The branch 110 extends beyond the performed jaw portion 113 with an extension 140 preformed with a bearing surface 141 against the glenoid surface so as to position the bone graft G on the scapula S prior to the simultaneous drilling thereof with the scapula.

(19) In order to use the slide allowing the translation movement along the double arrow F1, the instrument 100 comprises two parallel transversal connecting rods 150 and 160. A first end of said rods 150 and 160 is attached to a first branch 110 and the second branch 120 is preformed with guide sleeves to enable the sliding thereof along the rods 150 and 160 and thus separate or approach the jaws 113 and 123.

(20) As illustrated, said drill bush 130 is positioned between said branches 110 and 120 such that the axes of the holes 131 and 132 are arranged respectively on either side of the plane defined by the axes of the parallel rods 150 and 160.

(21) So as not to form an obstacle to this sliding but also so as to enable the correct systematic positioning of the drill bush 130 the latter is drilled with two transversal holes 133 and 134 to be traversed by said two connecting rods 150 and 160. The drill bush 130 is therefore also in a slide link along said rods.

(22) There is further provided a longitudinal slot 135 wherein the shaft 138 connected rigidly to one of the two ends and pivotally to the other second ends of two tie rods 136 and 137, of identical length, moves, the first end being pivotally connected, respectively, to a different branch 110 or 120. These hinged tie rods 136 and 137 carry out the positioning of the drill bush 130 such that the axes of the holes 131 and 132 are the median plane separating the two branches 110 and 120 and therefore the two jaws 113 and 123 regardless of the spacing of the branches 110 and 120.

(23) According to the embodiment illustrated, the approach or separation of the two branches 110 and 120 is carried out manually.

(24) According to a further embodiment not illustrated, the movement may be carried out by means of a third rod including two threaded portions each engaged in a different branch.

(25) Once the graft has been received between the jaws 113 and 123, it is necessary to lock the position. To do this, said two branches 110 and 120 include at the distal end 111 and 121 thereof, a locking and tensioning means connecting same. According to the preferred and non-limiting embodiment illustrated, this consists of a rack lock 170.

(26) According to a further embodiment not illustrated, the locking may be carried out by means of a wheel engaging with a threaded portion of one of the transversal rods.

(27) As illustrated by FIG. 3, the instrument for removing and preparing a graft referenced 200 as a whole takes on the same configuration as the positioning instrument i.e. it forms forceps wherein the branches move toward or away from each other according to a translation movement along the double arrow F2.

(28) To do this, the instrument 200 includes two branches 210 and 220 arranged facing one another and having two ends 211 and 212 for the branch 210 and 221 and 222 for the branch 220.

(29) The proximal ends 212 and 222 arranged facing one another are each preformed with a jaw 213 and 223 between which the graft G (to be removed or removed) is positioned (see FIGS. 5 and 6).

(30) The ends 212 and 222 arranged facing one another are further each preformed on at least one different face from that supporting the jaws 213 and 223 but in the vicinity thereof, with notches 214 and 224. These notches 214 and 224 serve as positioning marker of the graft G between the jaws 213 and 223.

(31) Said proximal ends 212 and 222 are further preformed: with a first planar surface 215 and 225 to define a first cutting plane for the purposes of separating the graft from the bone to which it is attached. a second planar surface 216 and 226 to define a second cutting plane or indeed a referencing plane perpendicular to the first cutting plane for the purposes of surfacing the graft portion coming into contact with the bone portion to receive said graft.

(32) To carry out the translation along the double arrow F2, the instrument 200 comprises two parallel transversal connecting rods 250 and 260. A first end of said rods 250 and 260 is attached to a first branch 210 and the second branch 220 is preformed with guide sleeves to enable the sliding thereof along the rods 250 and 260 and thus separate or approach the jaws 213 and 223.

(33) Once the graft has been received between the jaws 213 and 223, it is necessary to lock the position. To do this, said two branches 210 and 220 include at the distal end 211 and 221 thereof, a locking and tensioning means connecting same. According to the preferred but non-limiting embodiment illustrated, this consists of a rack lock 270.

(34) FIGS. 4, 5, 6 and 7 illustrate a plurality of steps of a so-called Latarjet procedure carried out by the instruments 100 and 200 described above. As explained above, one benefit of the novel features of the instruments is that of carrying out a method which is remarkable in that it consists of positioning by means of the positioning instrument 100 a bone graft G on the scapula S and drilling said bone graft G at the same time as the scapula S with the aid of the drill bushes 130 borne by the same positioning instrument 100. FIGS. 4 to 7 illustrate such a method with beforehand the removal of the coracoid in order to have a bone graft G to be attached as illustrated in FIGS. 4 and 5. The jaws 213 and 223 take the coracoid or bone graft G in the length thereof to fasten same in the width thereof.

(35) Once the removal instrument 200 is in place as illustrated in FIG. 4, the practitioner may use the surfaces 215 and 225 as a cutting plane.

(36) FIG. 5 illustrates the position of coracoid or bone graft G during resurfacing. To do this, the coracoid is turned in the forceps. In other words, after the resection of the coracoid, the removal instrument is unfastened and the graft removed from the coracoid is turned therein (the bottom face becomes the top face and the resected face is inserted first into the jaws) to have access more readily to the surface to be freshened.

(37) As illustrated by FIGS. 6 and 7, for the positioning means 100, the coracoid or bone graft G is taken in the thickness thereof to be fastened in the width thereof. Once the graft G has been locked between the jaws 113 and 123, the positioning means is positioned bearing against the scapula using the extension 140 thereof. The simultaneous drilling of the graft G and the scapula S can then start leaving for each bore the bit used in place. After producing two bores, the positioning instrument 100 is removed while leaving the drill bits in place. Successively, the drill bits are removed and replaced by compression screws or a further attachment means.

(38) FIG. 8 illustrates an instrument kit according to the invention which comprises the positioning instrument referenced 100, the instrument for removing and preparing a graft referenced 200 and a drilling kit 190. The drilling kit 190 includes at least two drill bits 191 and 192 suitable for being inserted into the holes 131 and 132 of the drill bush 130 and provided at the distal end 1911 and 1921 thereof with a means for engaging with a drive tool 193 such that the engagement means does not impede the sliding of the drill bits 191 and 192 in the holes 131 and 132.

(39) FIG. 9 illustrates a different embodiment of the instrument for removing and preparing the coracoid or a graft G. The instrument 300 with the branches 310 and 320 and the jaws 313 and 323 uses the removal and/or preparation instrument. As a whole, it adopts the same configuration as the positioning instrument 100 i.e. it forms forceps wherein the branches move closer or apart according to a translation movement along the double arrow F3.

(40) The instrument 300 further includes a central body 330 traversed by the two connecting rods 350 and 360 so as to form a transversal axis slide link. Similarly to the drill bush 130, the central body 330 is provided with a longitudinal slot wherein the shaft of the two ends of two tie rods of identical length moves, the first end of each tie rods being connected pivotally, respectively, to a different branch such that the central body is substantially in the median plane separating the two branches.

(41) Said central body 330 further includes a means for guidance in translation 331 and a fastening means 332 both capable of engaging with a drill bush 340 including a first hole 341 sized for the passage and guidance of a pin and a second hole 342 sized for the passage and guidance of bone drill bits. The drill bush 340 is free to translate along an axis represented by the double arrow F4 and perpendicular to the double arrow F3. The fastening means 332 is suitable for locking the drill bush in a desired position relative to the graft G.

(42) These features make it possible to position systematically the central body 330, the bush 340 and the guide axis of the holes 341 and 342 in the median plane defined by the two jaws. A pin inserted into the hole 341 makes it possible to identify the distal end of the graft while being flush therewith. The axis of the hole 342 is thus systematically correctly positioned. The removal and preparation instrument 300 makes it possible to carry out the distal drilling of the graft with the removal and/or preparation instrument.

(43) FIG. 10 illustrates a different embodiment of the instrument for positioning the graft G on the scapula S. The positioning instrument referenced 400 as a whole includes a handle 410 and a drill bush 420 including a hole 430 sized for the passage and guidance of bone drill bits.

(44) The drill bush 420 extends beyond the proximal end of the hole 430 with an extension 440 preformed with a bearing surface 441 against the glenoid surface so as, in a first phase, to position the drill bush on the scapula S then, in a second phase, to position the bone graft G on the scapula S.

(45) According to an embodiment not illustrated, the drill bush 420 may be inserted into the handle 410 in two mirror positions relative to one another suitable for being adapted to the laterality of the operated shoulder.

(46) FIG. 11 illustrates an instrument kit according to the invention which comprises the instrument for removing and preparing a graft referenced 300, the positioning instrument referenced 400 and at least one drill bit 490 suitable for being inserted into the holes 342 and 430 of the drill bushes 340 and 420.

(47) FIG. 12 illustrates the method comprising prior to the selection or manufacture of all or part of the instruments, preoperative planning.

(48) Prior to the surgical procedure, during the data collection phase 510, the preoperative imaging of the patient to be operated on is acquired in various ways. By way of example, X-rays and/or sonographies and/or CT scan and/or MRI images of the shoulder are used.

(49) Based on the preoperative imaging of the patient to be operated on, during a modeling and identification phase 520, at least one segmentation and processing algorithm makes it possible to model the patient's joint and identify at least one anatomical structure. This phase may include the measurement of at least one specific characteristic of the patient's joint.

(50) During the planning phase 530, the surgeon carries out preoperative planning by means of a computer interface suitable for viewing the modeling of the joint and carrying out at least one of the following operations: sizing the graft, positioning the graft on the host bone and positioning and selecting the devices for attaching the graft onto the host bone.

(51) This method may further include the formation, manufacture and provision for the surgical procedure of a patient-specific instrument kit produced based on the data previously collected and, in particularly, the planning output data.

(52) FIG. 13 illustrates a positioning instrument of FIG. 1 wherein the jaws 113P and 123P and the bearing surface 141P are preformed according to preoperative planning as described above. Such a structure of the jaws has the advantage of ensuring unique positioning of the graft between the jaws and relative to the drill bush. Furthermore, the structure of the bearing surface on the glenoid surface ensures unique positioning of the graft on the scapula.

(53) FIG. 14 illustrates an instrument for removing and preparing a graft of FIG. 3 wherein the jaws 213P and 223P are preformed according to preoperative planning as described above. Such a structure of the jaws has the advantage of ensuring unique positioning of the graft between the jaws.

(54) It is understood that the instrumental system and the adapted methods described and represented above have been described and represented with a view to disclosure rather than limitation. Obviously, various adaptations, modifications and improvements may be made to the above examples, without leaving the scope of the invention.