CA1069796A - Surgical instrument - Google Patents

Surgical instrument

Info

Publication number
CA1069796A
CA1069796A CA250,885A CA250885A CA1069796A CA 1069796 A CA1069796 A CA 1069796A CA 250885 A CA250885 A CA 250885A CA 1069796 A CA1069796 A CA 1069796A
Authority
CA
Canada
Prior art keywords
instrument
hinge
jaws
handle
jaw
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
CA250,885A
Other languages
French (fr)
Inventor
John E. Hall
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Smiths Healthcare Ltd
Original Assignee
Downs Surgical Ltd Micham
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Downs Surgical Ltd Micham filed Critical Downs Surgical Ltd Micham
Application granted granted Critical
Publication of CA1069796A publication Critical patent/CA1069796A/en
Expired legal-status Critical Current

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8869Tensioning devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • A61B2017/0256Joint distractors for the spine
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10TTECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00Metal working
    • Y10T29/53Means to assemble or disassemble
    • Y10T29/53796Puller or pusher means, contained force multiplying operator
    • Y10T29/53896Puller or pusher means, contained force multiplying operator having lever operator
    • Y10T29/539Plier type means

Abstract

ABSTRACT

Surgical instrument for applying tension to a metal cable secured to the spine in an operation for the correction of scoliosis.

Description

7~6 This invention relates to a sur~ical instrument for use in the correction of curvature of the spinal column.
One technique that is used for the correction of spinal curvatures is the Dwyer technique of anterior instrumentation of the spine; (c.f. A.F. Dwyer, "Anterior approach to scoliosis", Journal of the Western Pacific Orthopaedic Association, Vol. VI, No. 1, March 1969; A. F. Dwyer et al, "Anterior approach to scoliosis", Clinical Orthopaedics and Related Research, No. 62, pp. 192 - 202, 1969; and A. F. Dwyer, "Anterior approach to scoliosis", ibid, No. 93, July 1973). This technique involves operation on the fron~ of the spine, with access to the spine being gained by the removal of one rib, or possibly of two ribs. This method may be used for the correction of scoliosis (lateral curvature of the spinal column) when posterior elements are absent, such as in myelomeningocele or after an extensive laminectomy. It is particu-larly useful when lordosis (curvature of the spinal column with a forward convexity) is associated with scoliosis, and can often be used as a supplementary means of fixation in very long paralytic curves, especially those associated with lordosis in the lumbar region.
The technique involves the application of compression on the convex side of the spinal curve, after the contents of the discs have been excised, so as to straighten the curve. The compression is applied by means of a metal cable threaded through the heads of screws, one of which is anchored through a metal staple in each vertebra.
A staple or "saddle" of such a size as to fit snugly over the vertebra is first selected and driven into place over the vertebra.
A screw is then passed through a hole in the staple and into the
- 2 -106~7~f~

vertebra until only the head of the screw protrudes above the staple. A metal cable is passed through a hole in the head of the screw. The procedure is repeated on successive vertebrae with a single cable being passed through all screw heads. Tension is applied to the cable, to ob~ain the necessary corrective force. The tension may be applied one stage at a time, after the cable has been passed through each respective screw~head~ or it may be applied after the cable has been passed through several or all of the screw-heads.
When the correct tension has been obtained, the screw-head is crimped over the cable so as to maintain the cable at the necessary tension.
The present invention relates to a surgical instrument, which is a tensioner designed specifically for applying the necessary tension to the metal cable to straighten the spinal column.
The present invention provides a surgical instrument for applying tension to a cable for straightening a spinal column, said instrument having first and second handles hinged together at a main hinge, each handle having an extension beyond the hinge so arranged that movement about the hinge of the two handles toward one another causes the two extensions to move away from one another, wherein the first extension has, at the end remote from the hinge, cable-receiving means consisting essentially of a bifurcated arm defining a slot open at one end to receive a cable, and wherein the second extension has, at the end remote from the hinge, two jaws between which a metal cable can be gripped, the instrument having means to ensure that movement together of the two handles causes the jaws, if open, to close and movement away from one another of the two handles causes the jaws, if closed, to open prior to causing any movement of the two extensions relative to one another.
The second extension may terminate in a first member provided, at the end remote from the main hinge, with one of the jaws, and the second extension also includes a second member which is slidable with respect to the 1~979~i said first member and is provided, at the end remote from the main hinge, with the second jaw, wherein the said second member is coupled to the second handle, which has a pivot at a point along its length between the main hinge and the point of coupling of the said second member.
Advantageously, the axis of the pivot and the axis of the main hinge are substantially parallel. Advantageously, also, the plane in which the first jaw lies is parallel to that in which the second jaw lies irrespective of whether the jaws are open or closed. Moreover, advantageously, the said two planes are parallel to the axis of the pivot and to the axis of the main hinge irrespective of the positions of the jaws and of the relative positions of the handles.
The second extension preferably terminates in a hollow cylinder (the said first member) the end of which remote from the main hinge serves as the first jaw, with the second jaw attached tc the end of a shaft (the said second member) which is moveably contained within the cylinder and is coupled to the second handle. When the handles are moved apart, the shaft is caused to move in the direction of the end of the cylinder remote from the main hinge, thus pushing the second jaw away from the first jaw. When the handles are moved together, the shaft is pulled in the opposite direction and the jaws close.
The first jaw faces in a direction away from the second handle, and the second jaw faces in the opposite direction.
Preferably, when the jaws are apart, the shaft can be rotated with-in the cylinder thus moving the first jaw in relation to the second jaw.
In this way the tensioner can be adapted for either - ~9'7~
.
right-hand or left-hand use.
The cylinder is preferably, at the end remote from the main hinge, bifurcated, with the end surfaces of the two branches serving as the first jaw. Preferably also, a lug is secured to the shaft, which lug is accommodated in a slot between the two branches of the bifurcated cylinder, when the two jaws are closed. If the shaft can be rotated as described above, this lug can advantageously be accommodated in either slot between the two branches of the cylinder.
The end of the shaft or other second member nearer the main hinge is advantageously pivotably joined to one end of a coupling member, the other end of which is pivotably joined to the second handle or, preferably, to a short side arm provided on the second handle. Preferably, the axes of the two pivots of the coupling member are parallel to one another, and preferably also parallel to the axis of the main hinge.
A screw-threaded shaft may be attached to the end of one handle ~ remote from the main hinge and passed through the end of the other handle - remote from the main hinge, with a nut, preferably a knurled nut, provided on the shaft such that it can be screwed along the shaft so as to apply pressure to push the handles together.
Various forms of tensioners according to the invention will now be described, by way of example only, with reference to the accompanying drawings, in which:
Fig. 1 is a perspective view of one form of tensioner according to the invention;
Fig. 2 is a perspective view of a slightly modified form of the second extension of the tensioner shown in Fig. l;
Fig. 3 is a perspective view of the extension shown in Fig. 2.

10697~6 but from the oppos:ite side;
Figure 4 is a cros~-section through the extension shown in Figures 2 and 3 with the jaws apart;
Figure 5 is a similar view to that of Figure 4 but with the jaws closed; and Figure 6 is a perspective view showing the screw-threaded shaft and the ends of the two handles J in a form slightly different from that of Figure 1.
The tensioner is made of stainless steel. It has two handles 11,12 which are hinged together at a main hinge 13. Each handle has an extension 14,15 respectively beyond the hinge 13. The first extension 14 has at its end an open-ended slot 16 to receive a cable and a surface 17 to operate against a surface from which the - cable protrudes. The second extension 15 terminates in a cylinder - 18, the end of which remote from the hinge 13 serves as a first ~ jaw 19. A second jaw 20 is attached to a shaft 21 contained within : ~ the cylinder 18 and coupled via coupling members 22,23 and pivots 24,25 to a short side arm provided on the handle 12. The handle 12 is pivoted at 26 between pivot 25 and hinge 13. When the 2 handles 11,12 are moved together as shown by arrows 27, 27', the handle 12 moves about the hinge 26 thus pulling the coupling members 22,23 and the shaft 21 in the direction 28 and closing the jaws 19,20 against one another. When the two jaws 19,20 are closed no further rotational movement is possible about the hinge 26, and the handle 12 rotates relative to the handle 11 about the hinge 13 thus moving the two extensions 14,15 away from one another : as shown by the arrows 29,29'. With the surface 17 abutting the surface from which a cable protrudes, and with the cable passing .' , ' .
'~ . : ' : .

- ~ ~

through the slot 16 and being gripped between the jaws 19,20, tension can be applied to the cable by moving the handles 11,12 together.
Normally, the surface against which the surface 17 operates will be the head of a spinal screw. The screw will have been secured through a spinal staple into a vertebra, and a metal cable will have been passed through a hole in the screw-head.
Tension is applied to the cable as described above, and then the head of the screw can be crimped over the cable so as to maintain it at the desired tension. The process can be repeated with screws in subsequent vertebrae one at a time; alternatively tension can be applied over several vertebrae at once.
A partially screw-threaded shaft 30 of rectangular cross-section is hinged at the end 31 of the handle 11 about hinge 32.
This shaft 30 passes through a slot 33 in the end of the handle 12. A knurled nut 34 is provided on the shaft and this can be screwed along the shaft to operate against a spring 35 (not visible in Figure l; see Figure 6), which in turn operates against the inside of a partially dome-shaped hollow collar 36. This collar 36 in turn operates against the handle 12 to move it in the direction 27'. The handles 11,12 can alternatively be moved together by manual pressure.
Figures 2 to 5 show a slightly modified form of the extension 15 of Figure 1. As in Figure 1, the extension terminates in a cylinder 18, the end remote from the hinge 13 of which serves as a jaw 19.
The second jaw 20 is attached to a shaft 21 contained within the cylinder and this shaft 21 is attached to a coupling member 22.
he end of the cylinder 18 is birurcated and there are two opposed ~ .

~069~9~

slots 37,38 each capable of receiving a lug 39 secured to the shaft 21.
When the two jaws 19,20 are wide apart, as shown in Figs. 2 to 4, the shaft 21 can be rotated within the cylinder 18 and relative to the coupling member 22, so as to align the lug 39 either with the slot 37 or with the opposed slot 38. When the jaws 19,20 are closed, as shown in Fig. 5, the lug 39 is retracted into one of the slots 37,38 (slot 38 in Fig. 5) and thus the shaft 21 is prevented from rotating. This rotational movement of the shaft 21 permits a choice of direction for the opening between the jaws 19,20 and thus the tensioner can be adapted for either right-hand or left-hand use. The 10 jaws 19,20 are provided Wit}l respective slots 40,41 for receiving the cable.
Various surgical implants for use in the Dwyer technique of anterior instrumentation of the spine are described and claimed in my concurrently filed Canadian Patent Applications Nos. 250,948; 250,947 and 250,946.

' .

. .
: :

Claims (12)

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A surgical instrument for applying tension to a cable for straighten-ing a spinal column, said instrument having first and second handles hinged together at a main hinge, each handle having an extension beyond the hinge so arranged that movement about the hinge of the two handles toward one another causes the two extensions to move away from one another, wherein the first extension has, at the end remote from the hinge, cable-receiving means con-sisting essentially of a bifurcated arm defining a slot open at one end to receive a cable, and wherein the second extension has, at the end remote from the hinge, two jaws between which a metal cable can be gripped, the instrument having means to ensure that movement together of the two handles causes the jaws, if open, to close and movement away from one another of the two handles causes the jaws, if closed, to open prior to causing any movement of the two extensions relative to one another.
2. An instrument as claimed in claim 1, wherein the second extension terminates in a first member provided, at the end remote from the main hinge, with one of the jaws, and the second extension also includes a second member which is slidable with respect to the said first member and is provided, at the end remote from the main hinge, with the second jaw, wherein the said second member is coupled to the second handle, which has a pivot at a point along its length between the main hinge and the point of coupling of the said second member.
3. An instrument as claimed in claim 2, wherein the axis of the pivot and the axis of the main hinge are substantially parallel.
4. An instrument as claimed in claim 2, wherein the plane in which the first jaw lies is parallel to that in which the second jaw lies irrespective of whether the jaws are open or closed.
5. An instrument as claimed in claim 4, wherein the said two planes are parallel to the axis of the pivot and to the axis of the main hinge irrespective of the positions of the jaw and of the relative positions of the handles.
6. An instrument as claimed in claim 2 wherein the second extension terminates in a hollow cylinder, which constitutes the said first member, and wherein the end of the cylinder remote from the main hinge serves as the first jaw with the second jaw attached to the end of a shaft, which constitutes the said second member, moveably contained within the cylinder and coupled to the second handle.
7. An instrument as claimed in claim 6, wherein, when the jaws are apart, the shaft can be rotated within the cylinder.
8. An instrument as claimed in claim 6, wherein the cylinder is, at the end remote from the main hinge, bifurcated, with the end surfaces of the two branches of the bifurcated cylinder serving as the first jaw.
9. An instrument as claimed in claim 8, wherein a lug is secured to the shaft, which lug, when the jaws are closed, is accommodated in a slot between the two branches of the bifurcated cylinder.
10. An instrument as claimed in claim 2 wherein the end of the second member nearer the main hinge is pivotably joined to one end of a coupling member, the other end of which is pivotably joined to the second handle or to a short side arm provided on the second handle.
11. An instrument as claimed in claim 10, wherein the axes of the said two pivots are parallel to one another and to the axis of the main hinge.
12. An instrument as claimed in any one of claims 1 to 3, wherein a screw-threaded shaft is attached to the end of one handle and can be passed through the end of the other handle, with a nut so arranged on the shaft that it can be screwed along the shaft so as to apply pressure to push the handles together.
CA250,885A 1975-04-28 1976-04-23 Surgical instrument Expired CA1069796A (en)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
GB17613/75A GB1551707A (en) 1975-04-28 1975-04-28 Surgical instrument

Publications (1)

Publication Number Publication Date
CA1069796A true CA1069796A (en) 1980-01-15

Family

ID=10098207

Family Applications (1)

Application Number Title Priority Date Filing Date
CA250,885A Expired CA1069796A (en) 1975-04-28 1976-04-23 Surgical instrument

Country Status (7)

Country Link
US (1) US4050464A (en)
JP (1) JPS51131193A (en)
AU (1) AU500598B2 (en)
CA (1) CA1069796A (en)
DE (1) DE2618375A1 (en)
FR (1) FR2309201A1 (en)
GB (1) GB1551707A (en)

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Also Published As

Publication number Publication date
AU500598B2 (en) 1979-05-24
FR2309201A1 (en) 1976-11-26
AU1344876A (en) 1977-11-03
DE2618375A1 (en) 1976-11-11
US4050464A (en) 1977-09-27
JPS51131193A (en) 1976-11-15
GB1551707A (en) 1979-08-30

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