|Publication number||USRE39995 E1|
|Application number||US 09/951,983|
|Publication date||Jan 1, 2008|
|Filing date||Sep 13, 2001|
|Priority date||Jun 30, 1998|
|Also published as||CA2335838A1, CA2335838C, DE69943267D1, EP1091698A1, EP1091698B1, US5951561, WO2000000094A1|
|Publication number||09951983, 951983, US RE39995 E1, US RE39995E1, US-E1-RE39995, USRE39995 E1, USRE39995E1|
|Inventors||John Pepper, Thomas A. Russell, Roy Sanders, Christopher E. Johnson|
|Original Assignee||Smith & Nephew, Inc.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (14), Non-Patent Citations (2), Referenced by (15), Classifications (11), Legal Events (1)|
|External Links: USPTO, USPTO Assignment, Espacenet|
The present invention relates to a surgical tool and method for accessing the intramedullary canal of a bone and more particularly to a minimally invasive reaming assembly and method for creating an entry portal into the canal of a bone and providing a working channel for reaming the canal of the bone to receive an intramedullary fracture reduction device.
Bone fractures are repaired by inserting bone fracture reduction rods or intramedullary nails into the intramedullary canal of a bone in order to stay the fracture. In performing this type of surgery for femoral fractures for example, it is conventional to make an incision near the tip of the greater trochanter extending proximally in line with the fibers of the gluteus in order to create an entry portal through the bone and into the canal. However, it has been found to be difficult to correctly position the entry portal to the intramedullary canal from the greater trochanter and to ream the canal to the desired size without damaging the surrounding soft tissue, displacing the previously reduced fracture, or making extremely large incisions. This is especially true if the patient is obese or if flexion or abduction of the proximal fragment causes a portion of the greater trochanter to lie against the ilium.
In this type of surgery, after the entry portal has been established, the canal is progressively reamed to a larger diameter from a smaller diameter in increments of about 0.5 mm, from generally about 8 mm, up to generally about 12.5 mm. Typically, the surgeon starts with a small reamer, reams the bone, removes the reamer and then inserts a second reamer, 0.5 mm larger in diameter than the previous reamer. The surgeon repeats this process until he has reached the required canal diameter for the intramedullary nail that has been selected for the patient.
Additionally, this type of surgery can be particularly bloody which presents other problems. Excess blood can obstruct the surgeon's view of the site being reamed and excessive blood flowing from the surgical site can create problems for the surgical staff particularly if the patient has a blood or bone disease. Thus, it is important that the surgical instrumentation provide for suctioning of the blood created by the surgery from the surgical site.
Several other problems are encountered during the process of repeatedly inserting the different sized reamers in and out of the bone. First, the surgeon can lose the entry portal, even though there may be a guide rod in place, as the soft tissues close around the slender guide rod, eliminating from view the entry portal opening. Further, as the reamers are slid over the guide rod and into the soft tissues, the sharp edges of each reamer rub against the soft tissues. Because this process is repeated a number of times during the reaming process, the soft tissues become very irritated and torn. Additionally, the guide rod can be pulled out of the bone when a reamer is being withdrawn.
A second problem has to do with the actual entry of the reamer into the intramedullary canal of the bone after it has passed through the soft tissues. Since the guide rod is so much smaller than the reamer (3 mm compared to at least 8 mm), the guide rod frequently will not stay centered in the opening created by the previous reamer, which results in the next reamer getting caught on the edge of the opening created by the previous reamer. Since the next reamer is larger in size, it will not fit smoothly into the opening created by the previous smaller reamer. This situation prevents the surgeon from being able to determine if the next larger reamer is correctly centered before he or she starts reaming the canal. In order for the surgeon to locate the opening with the present instrumentation, he typically has to make a larger incision in order to locate the entry portal and determine the correct centering of the reamers.
There have been a number of attempts to solve these problems. One attempt is found in U.S. Pat. No. 5,624,447 which describes a surgical tool guide and entry portal positioner that provides a cannulated sleeve with a handle and a C-shaped soft tissue protector secured to the sleeve. U.S. Pat. No. 5,569,262 describes a guide tool for surgical devices that is used for directing a surgical device into attachment with a bone segment and is used to protect a surgeon's fingers from the surgical device and from the jagged surface of the bone segment. U.S. Pat. No. 5,443,469 describes a tubular tissue protection guard that is inserted into an incision or wound in order to accommodate reaming devices.
While these devices provide protection to the soft tissues, none of them provide a working channel within the bone canal in which to progressively ream out the intramedullary canal of the bone. It would be advantageous to have a device that can be used to both open the entry portal into the canal of a bone and to provide a working channel in which to ream the canal of the bone in a minimally invasive mannor manner. It also would be advantageous to be able to use the subject invention in combination with an entry portal tool that can be used to locate the most desirable placement of the entry portal into the bone.
The present invention consists of a minimally invasive reaming assembly and method for creating an entry portal into the canal of a bone and for providing a working channel in which to ream the canal of a bone. The assembly includes a sleeve, a housing and an inner reamer. The sleeve is an elongated cylindrically-shaped hollow sleeve that has a proximal and a distal end, with the distal end having a plurality of cutting blades. The housing is adjacent to the sleeve and has a top portion, a bottom portion and a through bore. The top portion includes a releasable locking mechanism for engaging the inner reamer within the housing.
The inner reamer has an elongated body and proximal and distal ends. The distal end has a rotatable reaming head and the proximal end has a drill shaft and connecting means for connection to a drill. A portion of the body includes an annular collar with a tab for engaging a notch in the housing. The inner reamer is sized and shaped for insertion through the bore of the housing and the sleeve. The reaming assembly allows for the passage of reamers of graduated sizes for progressively reaming the canal of a bone through the sleeve. In a preferred embodiment, the reaming assembly is used in combination with an entry portal tool for use in correctly placing the entry portal in the bone
A better understanding of the invention can be obtained when the detailed description of exemplary embodiments set forth below is reviewed in conjunction with the accompanying drawings, in which:
The present invention, as shown in
Entry portal tool 20 is an elongated, cylindrically-shaped hollow sheath 22 having a proximal end 24, a beveled distal end 26 and an upper and lower portion 28, 30 (FIG. 2). The upper portion 28 includes at least one generally circular opening 32 in the sheath 22, and in a preferred embodiment has three openings. In one embodiment the openings 32 of the sheath 22 can be threaded. As shown in
In one embodiment of the handle 34, as shown in
A third embodiment of the entry portal tool 20B is shown in
Entry portal tools 20, 20A and B also include a cannulated obturator or elongated cylindrically-shaped tube 50 having a proximal and distal end 52, 54 and a central longitudinal axis LA (FIG. 3). The distal end 54 has a conical tip 56 that includes a plurality of openings 58. Preferably, the plurality of openings 58 have a circular center opening surrounded by five circular openings all of the same size, as shown in FIG. 4. The proximal end 52 includes an annular collar 60 having a diameter greater than tube 50 and sheath 22. Tube 50 includes a cylindrical hub 62 at its proximal end 52 with the hub 62 including a plurality of openings 64 identical in configuration to the openings 58 of the conical tip 56. Tube 50 also can include a number of cylindrical hubs 66, each having a plurality of openings 64, placed longitudinally in tube 50 between the proximal and distal ends 52, 54 of tube 50 (FIG. 3). The plurality of openings 64 of the hubs 62, 66, and the openings 58 of the conical tip 56 are aligned along parallel lines that are parallel with the central longitudinal axis LA of tube 50. Obturator 50 is sized and shaped for removably inserting into the hollow sheath 22 with the hollow sheath 22 being sized and shaped for removable insertion of the reaming sleeve 14 into the sheath 22 (FIG. 2).
Additionally, the entry portal tools 20, 20 A-B are configured to allow for the suctioning of blood out of the intramedullary canal into the reaming sleeve 12 and out the sheath 22 and through handle 34, 34A and B into a collection device.
As described above, the minimally invasive reaming assembly 10 includes reaming sleeve 12, housing 14 and inner reamer 16 (FIG. 10). Reaming sleeve 12, as shown in
As illustrated in
As shown in
As illustrated in
The inner reamer 16 of the reaming assembly 10 has an elongated cannulated body 144 and proximal and distal ends 146, 148 (FIGS. 10 and 22). However, elongated body 144 can also formed from a solid rod that is not cannulated. Distal end 148 has a rotatable reaming head 150 of a type known to one skilled in the art of orthopaedic surgery (FIG. 22). The rotatable reaming head 150 includes a plurality of cutting blades 152 suitable for cutting through the intramedullary canal of a bone. The proximal end 146 of inner reamer 16 includes a connection mechanism 154 configured in the shape of a drive shaft 156 of a type known to one skilled in the art of orthopaedic surgery (FIG. 23). Any suitable connection mechanism 154 can be employed to interconnect or detachably connect the drive shaft 156 to a rotational driver, such as that found in a conventional reaming drill or other suitable device. In a preferred embodiment, inner reamer 16 can include a flexible center section 147 that allows the reamer 16 to also be used to ream the proximal tibia, thus eliminating the need for a separate instrument. The flexible center section 147 of inner reamer 16 can be formed by cutting concentric helical cuts in opposite directions in a metal tube so that torque can be applied. The concentric helical cuts will provide both rigidity and flexibility to the center section 147 of the inner reamer 16.
A portion of inner reamer 16 includes an annular collar 158 that is of a slightly larger diameter than the diameter of cannulated body 144 of inner reamer 16 (FIGS. 22 and 23). Collar 158 includes a tab 160 that is sized and shaped to mate with notch 94 of housing 14 in order to secure inner reamer 16 in the housing 14. As shown in
In a preferred embodiment, a plurality of reamers (not shown) of graduated sizes are used with the reaming apparatus 10 for progressively reaming the canal of a bone after the initial reaming has been performed with the inner reamer 16. The reamers are typically graduated in 0.5 mm increments, however, other graduated dimensions are contemplated.
In a preferred embodiment of the invention, the reaming assembly 10 and the entry portal tool 20 are used in combination to ream in a minimally invasive manner an intramedullary canal (FIGS. 1 and 8). Preferably, a surgeon first uses the entry portal tool 20 to locate the most desirable location for the entry portal in the proximal femur or other long or flat bones. The multiple openings 58 and 64 (
The surgeon makes an appropriate minimally invasive incision in the patient and using the entry portal tool handle 34, he or she inserts the entry portal sheath 22, with the obturator 50 inserted in the sheath 22, into the incision. The surgeon then places one or more guide pins (not shown) through a selected one of the plurality of openings 58, 64 in the obturator 50, and using fluoroscopy, evaluates the position of the guide pins. If the surgeon desires to change the position of the guide pins, he or she can place one or more of the pins into another opening, or can rotate the obturator 50 within the sheath 22 of the entry portal tool 20. Once the surgeon has selected the best position for the entry portal, he will insert the guide pin into the bone. With the pin firmly imbedded in the bone, the obturator 50 is removed from the sheath 22 of the entry portal tool 20.
The surgeon next inserts the reaming sleeve assembly 10 into sheath 22 and over the guide pin that is firmly imbedded in the bone (FIG. 8). The pin will act as a guide as the reamer assembly 10 reams an entry portal into the canal of the bone (FIG. 9). With the entry portal tool 20 and reamer assembly 10 still in place, the surgeon removes the inner reamer 16 from the assembly 10 by depressing the release button 122 on the housing 14. The one or more guide pins are also removed with the inner reamer 16, however, the reaming sleeve 12 remains in place in the canal of the bone. At this point, the reaming sleeve 12 becomes a working channel through which the intramedullary canal can be opened up to the appropriate diameter using progressively larger sized reamers as described above. A suction device attached to handle 34, 34A-B of the entry portal tool 20, 20A-B allows for the blood produced from the reaming to be suctioned up through holes 71 in the sleeve 12, into the sheath 22 of the entry portal tool 20, 20A-B and out its handle 34, 34A-B in to a collection container. Upon completion of the canal preparation, entry portal tool 20 and the reaming sleeve 12 are removed and an intramedullary nail (pin or rod) is inserted into the canal.
Thus, with the minimally invasive reaming assembly 10 of the present invention, an entry portal into the canal of a bone can be created by a surgeon, who then uses the same assembly to provide a working channel in which to progressively ream the canal of the bone without damaging the soft tissues or losing the entry portal into the bone.
Although the present invention has been described with reference to its preferred embodiments, those skilled in the art will recognize changes that may be made in form and structure that do not depart from the spirit of the invention already described in the specification and embodied in the claims that follow.
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|U.S. Classification||606/80, 606/79, 606/86.00R|
|International Classification||A61B17/00, A61B17/58, A61F5/00, A61B17/17, A61B17/16|
|Cooperative Classification||A61B17/1717, A61B17/8897|