WO1993012724A1 - Optical fibre device intended to the repair of damaged nerve fibres - Google Patents

Optical fibre device intended to the repair of damaged nerve fibres Download PDF

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Publication number
WO1993012724A1
WO1993012724A1 PCT/FR1992/001244 FR9201244W WO9312724A1 WO 1993012724 A1 WO1993012724 A1 WO 1993012724A1 FR 9201244 W FR9201244 W FR 9201244W WO 9312724 A1 WO9312724 A1 WO 9312724A1
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Prior art keywords
nerve
optical fiber
sleeve
fiber
fibers
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PCT/FR1992/001244
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French (fr)
Inventor
Jean Berque
Original Assignee
Jean Berque
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Publication date
Application filed by Jean Berque filed Critical Jean Berque
Priority to EP93911659A priority Critical patent/EP0619721A1/en
Publication of WO1993012724A1 publication Critical patent/WO1993012724A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1128—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of nerves

Definitions

  • Fiber optic device for repairing damaged nerve fibers
  • the present invention relates to a fiber optic device (s) intended for the repair of damaged nerve fibers in human organisms.
  • the intervention must be very early.
  • the nerve fiber lesions are older or of a different nature than the blunt-tearing, crushing section - attempts at suturing are often unsuccessful.
  • this electrical stimulation cannot recreate the junction between the nervous centers and the periphery because it can in no way correspond to a physiological message.
  • the solution consists in restoring the relationships and messages between the nerve centers or the brain and the periphery. It suffices to insert a simple mechanism at the level of the damaged nerve fibers in order to reinstate a physiological conduction which is mainly motor and probably also sensitive.
  • the restoration of the physiological conduction of the nerve impulse can be carried out by a method of connection or even an exogenous neurological bypass thanks to the interposition of a simple conducting mechanism, in place of the injured part of the nerve fiber in the cases of unitary, radicular or trunk lesions, or of nerve fibers in the case of plurifocal lesions of a nervous plexus and especially of the fibers of the spinal cord.
  • This photosynthetic theory concerns all the cells and tissues of the organism, both on the physiology and cell biology scale.
  • this theory leads to two particularly important conclusions: the first relates to the birth of nerve impulses; this nerve impulse propagating along the nerve fibers, relayed by the spinal ganglia and reaching the upper nervous centers and the brain is clearly demonstrated by electrophysiology experiments. All books on physiology and medical biophysics are Agree to conclude that the nerve impulses are transmitted electrically along the nerve fibers, but the problem of the birth of this nerve impulse remains a mystery.
  • the birth of nerve impulses can be explained by a mechanism of photoelectricity and photoconductivity.
  • the nerve fiber is the perfect analog of an optical fiber.
  • the nervous system by its complexity and its extreme degree of performance has often been compared to a telephone system. It would in fact be a cable telecommunications network, the cabling consisting of optical fibers which we know can carry, in particular when they correspond to the wavelength of the infrared, thousands or even millions. information simultaneously.
  • the comparative anatomy of the nerve fiber and an optical fiber therefore leads to the notion of an almost perfect structural equivalence, a simple reminder of the physics of light then allows to broaden the notion of nerve impulse in its informative component.
  • Light whether wave or corpuscular, decomposes in the direction of its propagation according to a triple field equivalent to a trihedron: a light field accompanied by an electric field and a magnetic field, these three fields propagating along of three perpendicular plants to one another .
  • the perfect complementarity of these three energy components leads to formulate the hypothesis according to which these three fields are inseparable. It is well known that an electric field induces a magnetic field and vice versa. It is also known that electronic agitation generates photons.
  • the nerve impulse would not be a purely electrical conduction but makes it an optoelectronic and incidentally magnetic conduction.
  • the present invention provides a solution to this problem and proposes to reconstitute the light of the nerve fiber by interposition, at the level of the lesion, of an optical fiber.
  • fiber optic device at the level of the nerve fibers makes it possible to hope not only for the rehabilitation of motor function, even sensitivity, but also in the direction of physiological continuity by allowing information to be taken up. between the brain or nerve centers and the periphery.
  • the device according to the invention intended for neurological bypass comprises two versions depending on whether the bypass involves a nerve fiber or the spinal cord.
  • the description which follows concerns first of all the first version which aims at bridging a single nerve fiber.
  • the device consists of a cylindrical sleeve inside which is the fiber optics to be inserted at the proximal and distal ends of the injured nerve fiber; this optical fiber, of length greater than that of the sleeve, is held in place inside the sleeve by means of two removable solid plugs, pierced in their center with a hole intended to receive and protect the ends of the fiber optical.
  • the cylindrical sleeve further comprises at each of its ends two open articulated arms, semi-cylindrical, the articulation being ensured by an area of lesser thickness.
  • These two articulated arms - semicylindrical - can be closed at the end of the intervention in order to sheath on both sides the terminal parts of the bridged nerve fiber, the central cylindrical sleeve covering the bridging itself, ie optical fiber.
  • the closure of the two articulated arms can be ensured by an asynchronous oppositional toothing system, the final compression being able to be obtained by a gluing system.
  • the optical fiber carried by the apparatus will advantageously have a diameter just smaller than that of the nerve fiber into which it will be introduced.
  • the cylindrical sleeve will advantageously have a diameter slightly greater than the nerve fiber to be bridged. In this way as soon as the two ends of the optical fiber are inserted into the two ends of the nerve fiber, the sleeve can slide along the latter so that a possible fascial suture joins the ends of the fibers around the optical fiber. nervous that might break apart due to their retractability. Once the suture has been performed, the sleeve covers the optical fiber and the articulated arms are closed at each end in order to cover the distal and proximal parts of the nerve fiber.
  • the variant of the device described uses the same apparatus which, instead of a single optical fiber, will comprise between the two plugs several tens of these same fibers.
  • the same process can thus be applied to the spinal cord with the only difference being the reinsertion of multiple optical fibers.
  • the diameter of the cylindrical sleeve is slightly greater than the diameter of the cord.
  • Figure 1 shows, in section, the device according to the invention in its first version with an optical fiber.
  • Figures 2 and 3 show, in section, the main bridging times.
  • the optical fiber is fixed in the two ends of the nerve fiber and the cylindrical sleeve has been moved laterally on the nerve fiber in order to practice a possible suture of the two ends.
  • FIG. 4 shows the coaptative toothing closure of the two articulated arms. a collage can permanently secure these two articulated arms which will thus reconstitute a sheathing tunnel.
  • FIG. 5 represents, in section, the variant of the device of FIG. 1. its only difference is to include several tens of optical fibers.
  • the device represented in FIG. 1 comprises a cylindrical sleeve (1) the lumen of which is closed at both ends by a removable plug (2) and (2 *), carrying a hole (3) and (3 ') now in places the optical fiber (4), the free ends of the cylindrical sleeve (1) comprise on both sides two articulated arms (5, 5 ') and (6, 6') whose lower right part is toothed (7) .
  • each end of the optical fiber 4 will be inserted into each of the two ends of the nerve fiber 9 and 9 ′ as shown in FIGS. 2 and 3.
  • the device shown in FIG. 5 is a variant with several optical fibers of the device shown in FIG. 1. The main difference will therefore lie in the removable plugs holding the optical fibers in place and which must have several holes in this variant.
  • All of the component parts of the unitary device or its variant can be produced on an industrial scale.
  • the ends of the optical fiber may also be butted at each end of the nerve fiber, that is to say without there being insertion of the optical fiber into the nerve fiber. such a possibility could thus be implemented according to the diagram in FIG. 6.
  • a sleeve provided with articulated and toothed arms, as described above can advantageously be used to hold together the optical fiber-nerve fiber assembly and ensure the abutment.
  • the main part of the device which includes the sleeve and the four articulated arms can be made in .dacron in a single molding operation.
  • the removable caps can also be made of dacron.
  • the optical fiber it will preferably be made of flexible material. It will operate preferentially in the range of 1 • infrared.
  • the material composing it can be any material having the physical characteristics of optical and biocompatible fibers. It is preferably flexible glass.
  • the preferred optical fibers are fibers made of silica dioxide, fibers monocrystalline based on sodium chloride and polycrystalline fibers based on silver halides or thallium halides.
  • the diameter of the optical fibers will depend on that of the nerve fibers which one wishes to bridge.
  • optical fibers will advantageously be full but may also be in the form of a hollow cylinder.

Abstract

The invention relates to a device based on optical fibre(s) allowing to make a neurological exogenous brigde to the damaged nerve fibres of a human body. Said bridge may be used for bridging an isolated nerve or multiple fibres of the spinal cord by using an alternative embodiment with multiple optical fibres. The device is comprised of a cylindrical handle (1) whose port is obturated at both ends by a removable plug (2) and (2') with a passage (3) and (3') for setting in place the optical fibre (4). The free ends of the handle (1) have on either side two articulated arms (5, 5') and (6, 6') whose lower straight portion is provided with teeth (7). The articulation (8) of the two hinged arms is made possible by providing an area of reduced thickness.

Description

Dispositif à fibre optique destiné à la réparation des fibres nerveuses léséesFiber optic device for repairing damaged nerve fibers
La présente invention concerne un dispositif à fibre(s) optique(s) destiné à la réparation des fibres nerveuses lésées au niveau des organismes humains.The present invention relates to a fiber optic device (s) intended for the repair of damaged nerve fibers in human organisms.
Les lésions au niveau des nerfs périphériques ou de la moelle épinière sont fréquentes chez l'homme; très souvent accidentelles elles peuvent aussi avoir une origine congénitale ou dégénérative à la suite de pathologies diverses.Lesions in the peripheral nerves or spinal cord are common in humans; very often accidental they can also have a congenital or degenerative origin following various pathologies.
Ces lésions neurologiques sont dans la grande majorité des cas irréversibles et aboutissent à des troubles distaux plus ou moins invalidants de la motricité, la sensibilité et la trophicité des territoires concernés.These neurological lesions are in the vast majority of irreversible cases and lead to more or less disabling distal disorders of motor skills, sensitivity and trophicity of the territories concerned.
Les progrès constants de la chirurgie et de la micro chirurgie permettent parfois la réalisation de sutures performantes . C'est ainsi que des membres amputés à coupe franche ont pu être recousus. Mais ces cas de section franche sont assez rares et en général la suture neurologique est loin d'être toujours possible.The constant progress of surgery and microsurgery sometimes allows the performance of efficient sutures. This was how amputated limbs with a clean cut could be stitched up. But these cases of frank section are quite rare and in general the neurological suture is far from being always possible.
En outre, pour assurer un bon pourcentage de réussite, l'intervention doit être très précoce. Lorsque les lésions des fibres nerveuses sont plus anciennes ou d'une autre nature que la section franche-arrachement , écrasement - les tentatives de suture sont souvent des échecs .In addition, to ensure a good percentage of success, the intervention must be very early. When the nerve fiber lesions are older or of a different nature than the blunt-tearing, crushing section - attempts at suturing are often unsuccessful.
Il faut signaler enfin que toutes les interventions tentées jusqu'ici pour réparer une moelle épinière sectionnée ont échoué. Certains procédés médicamenteux phaπnacologi- ques sont à l'étude et ont pu apporter quelques résultats encourageants dans la régénération neurologique après traumatisme, à condition bien entendu que les lésions neurologiques initiales ne soient pas trop délabrantes.Finally, it should be noted that all of the procedures attempted so far to repair a severed spinal cord have failed. Certain phanacologic drug processes are being studied and have been able to bring some encouraging results in neurological regeneration after trauma, provided of course that the initial neurological lesions are not too decaying.
Des cultures de nerfs avec greffes différées sont- d'un domaine envisageable, mais de nombreux paramètres sont encore loin d'être résolus. Des expériences d'électrostimulation ont pu être réalisées chez les paraplégiques et ont donné quelques résultats encourageants; un appareillage implant ble est à l'étude mais , comme il sera exposé plus loin, l'électricité n'est peut être pas le seul mode de transmission de l'Influx Nerveux.Cultures of nerves with delayed grafts are of a possible domain, but many parameters are still far from being resolved. Electrostimulation experiments have been carried out in paraplegics and have given some encouraging results; an implantable device is being studied but, as will be explained below, electricity may not be the only mode of transmission of Nervous Influx.
En outre , cette stimulation électrique , soit externe, soit par appareil i plantable , ne peut recréer la jonction entre les centres nerveux et la périphérie car elle ne peut en rien correspondre à un message physiologique.In addition, this electrical stimulation, either external or by plantable device, cannot recreate the junction between the nervous centers and the periphery because it can in no way correspond to a physiological message.
Il faut donc s'attendre avec le procédé d'êlectrostimulation à une certaine reprise de force, de trophicitê, voire de motricité des segments paralysés périphériques mais elle ne sera qu'un pis- aller et restera fort éloignée de la réhabilitation de mouvements harmonieux et commandés volontairement.We must therefore expect with the electrostimulation process a certain recovery in strength, trophicity, or even motor skills of the peripheral paralyzed segments, but it will only be a last resort and will remain very far from the rehabilitation of harmonious movements and ordered voluntarily.
Comme il a été vu précédemment, hormis l'exceptionnelle suture immédiate après section franche, tous les procédés actuellement existants ou en cours de recherche sont loin de ramener le malade à un état proche de l'état physiologique parfait .As has been seen above, apart from the exceptional immediate suturing after a free section, all the procedures currently existing or under research are far from bringing the patient back to a state close to the perfect physiological state.
Four arriver à cette perfection para- physiologique la solution consiste à rétablir les relations et messages entre les centres nerveux ou le cerveau et la périphérie . Il suffit pour cela d'insérer un mécanisme simple au niveau des fibres nerveuses lésées afin de réinstaurer une conduction physiologique principalement motrice et vraisemblablement aussi sensitive.In order to reach this para- physiological perfection, the solution consists in restoring the relationships and messages between the nerve centers or the brain and the periphery. It suffices to insert a simple mechanism at the level of the damaged nerve fibers in order to reinstate a physiological conduction which is mainly motor and probably also sensitive.
Ainsi la restauration de la conduction physiologique de l'influx nerveux peut être effectuée par un procédé de raccordement ou encore un pontage neurologique exogène grâce à l'interposition d'un mécanisme conducteur simple, en place de la partie lésée de la fibre nerveuse dans le cas de lésions unitaires, radiculaires ou tronculaires, ou des fibres nerveuses dans le cas de lésions plurifocales d'un plexus nerveux et surtout des fibres de la moelle épinière.Thus the restoration of the physiological conduction of the nerve impulse can be carried out by a method of connection or even an exogenous neurological bypass thanks to the interposition of a simple conducting mechanism, in place of the injured part of the nerve fiber in the cases of unitary, radicular or trunk lesions, or of nerve fibers in the case of plurifocal lesions of a nervous plexus and especially of the fibers of the spinal cord.
Les moyens de cette solution dépendent essentiellement des recherches du demandeur concernant le corps humain et la lumière, l'ayant amené à la démonstration de la photosynthèse protéique à l'échelle humaine et animale.The means of this solution depend essentially on the applicant's research concerning the human body and light, having led him to demonstrate protein photosynthesis on a human and animal scale.
Cette théorie photosynthétique intéresse toutes les cellules et tissus de l'organisme tant à l'échelle de la physiologie que de la biologie cellulaire. En ce qui concerne le tissu .nerveux cette théorie aboutit à deux conclusions particulièrement importantes : la première est relative à la naissance de l'influx nerveux; cet influx nerveux se propageant le long des fibres nerveuses, relayé par les ganglions rachidiens et atteignant les centres nerveux supérieurs et le cerveau est bien mis en évidence par des expériences d'électrophysiologie . Tous les livres de physiologie et de biophysique médicale sont d'accord pour conclure à une transmission électrique de l'influx nerveux le long des fibres nerveuses, mais le problème de la naissance de cet influx nerveux demeure un mystère. Selon la théorie photosynthetique la naissance de l'influx nerveux peut s'expliquer selon un mécanisme de photo-électricité et photo- conductivitê.This photosynthetic theory concerns all the cells and tissues of the organism, both on the physiology and cell biology scale. With regard to the nervous tissue, this theory leads to two particularly important conclusions: the first relates to the birth of nerve impulses; this nerve impulse propagating along the nerve fibers, relayed by the spinal ganglia and reaching the upper nervous centers and the brain is clearly demonstrated by electrophysiology experiments. All books on physiology and medical biophysics are Agree to conclude that the nerve impulses are transmitted electrically along the nerve fibers, but the problem of the birth of this nerve impulse remains a mystery. According to photosynthetic theory, the birth of nerve impulses can be explained by a mechanism of photoelectricity and photoconductivity.
La deuxième conclusion essentielle de la théorie photosynthétique appliquée au tissu nerveux est particulièrement importante puisqu'elle permet d'-aboutir à la notion de pontage neurologique exogène. Selon cette conclusion le principe suivant peut être énoncé: la fibre nerveuse est l'analogue parfait d'une fibre optique. Le système nerveux par sa complexité et son extrême degré de performance a souvent été comparé à un système de téléphonie. Il serait en fait un réseau câblé de télécommunication, le câblage étant constitué de fibres optiques dont on sait qu'elles peuvent véhiculer, en particulier lorsqu'elles correspondent à la longueur d'onde de l'infr -rouge, des milliers voire des millions d'informations et ce de façon simultanée.The second essential conclusion of photosynthetic theory applied to nervous tissue is particularly important since it allows us to arrive at the concept of exogenous neurological bypass. According to this conclusion the following principle can be stated: the nerve fiber is the perfect analog of an optical fiber. The nervous system by its complexity and its extreme degree of performance has often been compared to a telephone system. It would in fact be a cable telecommunications network, the cabling consisting of optical fibers which we know can carry, in particular when they correspond to the wavelength of the infrared, thousands or even millions. information simultaneously.
L'anatomie comparée de la fibre nerveuse et d'une fibre optique aboutit donc à la notion d'une équivalence structurale quasi parfaite, un rappel simple de la physique de la lumière permet alors d'élargir la notion de l'influx nerveux dans sa composante informative. La lumière, qu'elle soit ondulatoire ou corpusculaire se décompose dans le sens de sa propagation selon un triple champ équivalent à un trièdre: un champ lumineux accompagné d'un champ électrique et d'un champ magnétique, ces trois champs se propageant le long de trois plants perpendiculaires l'un à l'autre . La parfaite complémentarité de ces trois composantes énergétiques amène à formuler l'hypothèse selon laquelle ces trois champs sont indissociables. II est fort connu qu'un champ électrique induit un champ magnétique et inversement. Il est connu aussi qu'une agitation électronique est génératrice de photons. De même l'étincelle électrique produite entre deux électrodes est parfois visible à l'oeil nu . Si donc les trois champs énergétiques précités sont indissociables, il paraît évident que la conduction électrique parfaitement démontrée au niveau de la gaine des fibres nerveuses ne peut se concevoir qu'en synergie avec un champ lumineux qui, bien entendu, se propagerait dans la lumière de la fibre.The comparative anatomy of the nerve fiber and an optical fiber therefore leads to the notion of an almost perfect structural equivalence, a simple reminder of the physics of light then allows to broaden the notion of nerve impulse in its informative component. Light, whether wave or corpuscular, decomposes in the direction of its propagation according to a triple field equivalent to a trihedron: a light field accompanied by an electric field and a magnetic field, these three fields propagating along of three perpendicular plants to one another . The perfect complementarity of these three energy components leads to formulate the hypothesis according to which these three fields are inseparable. It is well known that an electric field induces a magnetic field and vice versa. It is also known that electronic agitation generates photons. Likewise, the electrical spark produced between two electrodes is sometimes visible to the naked eye. If therefore the three aforementioned energy fields are inseparable, it seems obvious that the perfectly demonstrated electrical conduction at the level of the sheath of nerve fibers can only be conceived in synergy with a light field which, of course, would propagate in the light of the fiber.
Cette notion nouvelle de la transmission optique par les fibres nerveuses permet de mieux expliquer un phénomène qui n'aurait aucune raison d'être si la transmission était purement électrique. C'est le phénomène de l'écrasement ou de la compression nerveuse. On sait que celle-ci lorsqu'elle est prononcée aboutit à une paralysie des segments distaux innervés . Or un fil électrique reste un fil électrique et, sauf en cas de section, le courant passe toujours.This new notion of optical transmission by nerve fibers makes it possible to better explain a phenomenon which would have no reason to exist if the transmission was purely electrical. It is the phenomenon of crushing or nerve compression. We know that when pronounced it leads to paralysis of the innervated distal segments. However an electric wire remains an electric wire and, except in the event of section, the current always passes.
Ce n'est pas du tout le cas des fibres optiques dont l'écrasement interrompt la conduction sinusoïdale de la lumière ; un appareil à fibres optiques est inutilisable dès lors que la fibre conductrice est détériorée.This is not at all the case with optical fibers whose crushing interrupts the sinusoidal conduction of light; a fiber optic device cannot be used as soon as the conductive fiber is damaged.
En résumé, en fonction des deux notions précédemment exposées il apparaît que l'influx nerveux ne serait pas une conduction purement électrique mais en fait une conduction optoélectronique et accessoirement magnétique.In summary, according to the two notions previously exposed it appears that the nerve impulse would not be a purely electrical conduction but makes it an optoelectronic and incidentally magnetic conduction.
La présente invention apporte une solution à ce problème et propose de reconstituer la lumière de la fibre nerveuse par interposition, au niveau de la lésion , d'une fibre optique.The present invention provides a solution to this problem and proposes to reconstitute the light of the nerve fiber by interposition, at the level of the lesion, of an optical fiber.
L'inclusion de dispositif à fibre(s) optique(s) au niveau des fibres nerveuses permet d'espérer non seulement la réhabilitation de la fonction motrice, voire la sensibilité mais encore dans le sens de la continuité physiologique en permettant une reprise des informations entre le cerveau ou les centres nerveux et la périphérie.The inclusion of fiber optic device (s) at the level of the nerve fibers makes it possible to hope not only for the rehabilitation of motor function, even sensitivity, but also in the direction of physiological continuity by allowing information to be taken up. between the brain or nerve centers and the periphery.
Il serait ainsi permis d'espérer entre autre une récupération après lésion d'un nerf périphériqueIt would thus be possible to hope, among other things, for recovery after injury to a peripheral nerve.
(sciatique, cubital, plexus brachial) , une reprise de la motricité chez les paraplégiques voire les tétraplégiques.(sciatica, ulnar, brachial plexus), a resumption of motor skills in paraplegics or even quadriplegics.
Enfin , les progrès de l'informatique et de l'optoélectronique à l'échelle de la miniaturisation et des nanotechnologies permet aussi d'espérer un jour de voir fonctionner une prothèse de main ou de pied commandée par le cerveau.Finally, advances in computer science and optoelectronics at the scale of miniaturization and nanotechnologies also allow us to hope one day to see a hand or foot prosthesis controlled by the brain.
Le dispositif selon l'invention destiné au pontage neurologique comporte deux versions selon que le pontage intéresse une fibre nerveuse ou la moelle épinière.The device according to the invention intended for neurological bypass comprises two versions depending on whether the bypass involves a nerve fiber or the spinal cord.
La description qui va suivre intéresse tout d'abord la première version qui a pour but le pontage d'une seule fibre nerveuse.The description which follows concerns first of all the first version which aims at bridging a single nerve fiber.
Le dispositif est constitué d'un manchon cylindrique à l'intérieur duquel se trouve la fibre optique à insérer au niveau des extrémités proximales et distales de la fibre nerveuse lésée; cette fibre optique , de longueur supérieure à celle du manchon, est maintenue en place à l'intérieur du manchon par l'intermédiaire de deux bouchons pleins amovibles, percés en leur centre d'un pertuis destiné à recevoir et protéger les extrémités de la fibre optique.The device consists of a cylindrical sleeve inside which is the fiber optics to be inserted at the proximal and distal ends of the injured nerve fiber; this optical fiber, of length greater than that of the sleeve, is held in place inside the sleeve by means of two removable solid plugs, pierced in their center with a hole intended to receive and protect the ends of the fiber optical.
Ces deux bouchons s'insèrent aux extrémités du manchon cylindrique dont ils obturent ainsi la lumière. Ils permettent une protection de la fibre optique durant la manutention du dispositif et son maintien à l'intérieur du manchon. Ils seront otés lors de l'intervention de pontage des fibres nerveuses. Le manchon cylindrique comporte en outre à chacune de ses extrémités deux bras articulés ouverts, hémicylindriques, l'articulation étant assurée par une zone de moindre épaisseur.These two plugs are inserted at the ends of the cylindrical sleeve, thereby closing off the lumen. They allow protection of the optical fiber during the handling of the device and its maintenance inside the sleeve. They will be removed during the nerve fiber bypass intervention. The cylindrical sleeve further comprises at each of its ends two open articulated arms, semi-cylindrical, the articulation being ensured by an area of lesser thickness.
Ces deux bras articulés -hêmicylindriques - pourront être refermés en fin d'intervention afin d'engainer de part et d'autre les parties terminales de la fibre nerveuse pontée, le manchon cylindrique central recouvrant quant à lui le pontage proprement dit, c'est-à-dire la fibre optique. La fermeture des deux bras articulés peut être assurée par un système de denture oppositionnelle asynchrone, la contention définitive pouvant être obtenue par un système de collage .These two articulated arms - semicylindrical - can be closed at the end of the intervention in order to sheath on both sides the terminal parts of the bridged nerve fiber, the central cylindrical sleeve covering the bridging itself, ie optical fiber. The closure of the two articulated arms can be ensured by an asynchronous oppositional toothing system, the final compression being able to be obtained by a gluing system.
La fibre optique portée par l'appareillage sera avantageusement d'un diamètre juste inférieur à celui de la fibre nerveuse dans laquelle elle sera introduite. Le manchon cylindrique quant à lui sera avantageusement d'un diamètre légèrement supérieur à la fibre nerveuse à ponter. De cette manière dès lors que les deux extrémités de la fibre optique seront insérées dans les deux extrémités de la fibre nerveuse, le manchon pourra coulisser le long de cette dernière afin qu'une éventuelle suture aponévrotique joigne autour de la fibre optique les extrémités des fibres nerveuses qui risqueraient de se désinsêrer en raison de leur rétractilité. une fois la suture effectuée, le manchon vient recouvrir la fibre optique et les bras articulés sont refermés à chaque extrémité afin d'engainer les parties distales et proximales de la fibre nerveuse.The optical fiber carried by the apparatus will advantageously have a diameter just smaller than that of the nerve fiber into which it will be introduced. The cylindrical sleeve will advantageously have a diameter slightly greater than the nerve fiber to be bridged. In this way as soon as the two ends of the optical fiber are inserted into the two ends of the nerve fiber, the sleeve can slide along the latter so that a possible fascial suture joins the ends of the fibers around the optical fiber. nervous that might break apart due to their retractability. once the suture has been performed, the sleeve covers the optical fiber and the articulated arms are closed at each end in order to cover the distal and proximal parts of the nerve fiber.
La variante du dispositif décrit fait appel au même appareillage qui, au lieu d'une fibre optique unique, comportera entre les deux bouchons plusieurs dizaines de ces mêmes fibres.The variant of the device described uses the same apparatus which, instead of a single optical fiber, will comprise between the two plugs several tens of these same fibers.
Le même procédé peut être ainsi appliqué au niveau de la moelle épinière avec pour seule différence la réinsertion de fibres optiques multiples. Dans cette variante il est bien entendu que le diamètre du manchon cylindrique est légèrement supérieur au diamètre de la moelle.The same process can thus be applied to the spinal cord with the only difference being the reinsertion of multiple optical fibers. In this variant, it is understood that the diameter of the cylindrical sleeve is slightly greater than the diameter of the cord.
La figure 1 représente, en coupe, le dispositif selon l'invention dans sa première version à une fibre optique.Figure 1 shows, in section, the device according to the invention in its first version with an optical fiber.
Les figures 2 et 3 représentent, en coupe, les temps principaux du pontage.Figures 2 and 3 show, in section, the main bridging times.
Au niveau de la figure 2 , la fibre optique est fixée dans les deux extrémités de la fibre nerveuse et le manchon cylindrique a été déplacé latéralement sur la fibre nerveuse afin de pratiquer une suture éventuelle des deux extrémités.In FIG. 2, the optical fiber is fixed in the two ends of the nerve fiber and the cylindrical sleeve has been moved laterally on the nerve fiber in order to practice a possible suture of the two ends.
Au niveau de la figure 3 , le manchon a été remis à sa place. Il recouvre ainsi la fibre optique pontée. Les deux bras articulés sont refermés sur les deux extrémités terminales de fibre nerveuse afin d'éviter la rétractilité de ceux-ci et d'assurer la bonne contention du pontage.In Figure 3, the sleeve has been put back in its place. It thus covers the bridged optical fiber. The two articulated arms are closed on the two end ends of nerve fiber in order to avoid their retractability and to ensure the correct bridging containment.
La figure 4 montre la fermeture coaptative à denture des deux bras articulés . un collage pourra solidariser définitivement ces deux bras articulés qui reconstitueront ainsi un tunnel engainant. La figure 5 représente, en coupe, la variante du dispositif de la figure 1 . sa seule différence est de comporter plusieurs dizaines de fibres optiques.Figure 4 shows the coaptative toothing closure of the two articulated arms. a collage can permanently secure these two articulated arms which will thus reconstitute a sheathing tunnel. FIG. 5 represents, in section, the variant of the device of FIG. 1. its only difference is to include several tens of optical fibers.
Elle est destinée aux pontages de la moelle épinière.It is intended for bypass surgery of the spinal cord.
Le dispositif représenté sur la figure 1 comporte un manchon cylindrique (1) dont la lumière est obturée aux deux extrémités par un bouchon amovible (2) et (2*), porteur d'un pertuis (3) et (3') maintenant en place la fibre optique (4), les extrémités libres du manchon cylindrique (1) comportent de part et d'autre deux bras articulés (5, 5') et (6, 6') dont la partie droite inférieure est dentée (7) .The device represented in FIG. 1 comprises a cylindrical sleeve (1) the lumen of which is closed at both ends by a removable plug (2) and (2 *), carrying a hole (3) and (3 ') now in places the optical fiber (4), the free ends of the cylindrical sleeve (1) comprise on both sides two articulated arms (5, 5 ') and (6, 6') whose lower right part is toothed (7) .
L'articulation (8) des deux bras articulés est permise par une zone de moindre épaisseur. Il faut signaler enfin que les bouchons amovibles (2) et (2') doivent être suffisamment longs afin que la fibre optique (4) insérée dans leur pertuis soit d'une longueur supérieure à celle du manchon (1) .The articulation (8) of the two articulated arms is permitted by a zone of reduced thickness. Finally, it should be noted that the removable plugs (2) and (2 ') must be long enough so that the optical fiber (4) inserted in their hole is of a length greater than that of the sleeve (1).
Lors du pontage , chaque extrémité de la fibre optique 4 va être insérée dans chacun des deux extrémités de la fibre nerveuse 9 et 9' comme le montrent les figures 2 et 3. Le dispositif représenté sur la figure 5 est une variante à plusieurs fibres optiques du dispositif représenté sur la figure 1 . La différence principale résidera donc au niveau des bouchons amovibles maintenant les fibres optiques en place et qui doivent comporter plusieurs pertuis dans cette variante.During the bridging, each end of the optical fiber 4 will be inserted into each of the two ends of the nerve fiber 9 and 9 ′ as shown in FIGS. 2 and 3. The device shown in FIG. 5 is a variant with several optical fibers of the device shown in FIG. 1. The main difference will therefore lie in the removable plugs holding the optical fibers in place and which must have several holes in this variant.
L'ensemble des pièces constitutives du dispositif unitaire ou de sa variante pourra être réalisé à l'échelle industrielle. Les extrémités de la fibre optique pourront aussi être aboutêes à chaque extrémité de fibre nerveuse, c'est-à-dire sans qu'il y ait insertion de la fibre optique dans la fibre nerveuse. une telle possibilité pourra ainsi être mise en oeuvre selon le schéma de la figure 6.All of the component parts of the unitary device or its variant can be produced on an industrial scale. The ends of the optical fiber may also be butted at each end of the nerve fiber, that is to say without there being insertion of the optical fiber into the nerve fiber. such a possibility could thus be implemented according to the diagram in FIG. 6.
Un manchon muni de bras articulés et dentés, tel que décrit ci-dessus peut être avantageusement utilisé pour maintenir solidaire l'ensemble fibre optique-fibres nerveuses et assurer l'aboutement. La partie principale du dispositif qui comporte le manchon et les quatre bras articulés pourra être réalisée en .dacron en une seule opération de moulage. Les bouchons amovibles pourront également être réalisés en dacron. Quant à la fibre optique elle sera réalisée en matériau souple de préférence . Elle fonctionnera prêférentiellement dans la gamme de 1•infra-rouge.A sleeve provided with articulated and toothed arms, as described above can advantageously be used to hold together the optical fiber-nerve fiber assembly and ensure the abutment. The main part of the device which includes the sleeve and the four articulated arms can be made in .dacron in a single molding operation. The removable caps can also be made of dacron. As for the optical fiber, it will preferably be made of flexible material. It will operate preferentially in the range of 1 • infrared.
Le matériau la composant peut être tout matériau présentant les caractéristiques physiques des fibres optiques et biocompatibles . Il est prêférentiellement du verre souple.The material composing it can be any material having the physical characteristics of optical and biocompatible fibers. It is preferably flexible glass.
Ainsi les fibres optiques préférentielles sont les fibres en dioxyde de silice, les fibres monocristallines à base de chlorure de sodium et les fibres polycristallines à base d'halogénures d'argent ou d'halogénures de thallium.Thus, the preferred optical fibers are fibers made of silica dioxide, fibers monocrystalline based on sodium chloride and polycrystalline fibers based on silver halides or thallium halides.
Le diamètre des fibres optiques sera fonction de celui des fibres nerveuses que l'on souhaitera ponter.The diameter of the optical fibers will depend on that of the nerve fibers which one wishes to bridge.
Il sera généralement compris entre environ lμm et 100 μm mais pourra s'écarter de ces valeurs dans le cas de fibres nerveuses plus fines ou plus épaisses. II devra être légèrement inférieur au diamètre des fibres nerveuses en cas de pontage par insertion et sera avantageusement équivalent en cas d'abboutement.It will generally be between approximately lμm and 100 μm but may deviate from these values in the case of thinner or thicker nerve fibers. It should be slightly less than the diameter of the nerve fibers in the event of insertion bypass and will advantageously be equivalent in the event of abutment.
Les fibres optiques seront avantageusement pleines mais pourront aussi être sous la forme d'un cylindre creux. The optical fibers will advantageously be full but may also be in the form of a hollow cylinder.

Claims

REVENDICATIONS
1. Dispositif destiné au pontage d'une ou de plusieurs fibres nerveuses , caractérisé en ce qu'il comporte un manchon cylindrique central (1) contenant une ou plusieurs fibre(s) optique(s) (4) .1. Device for bridging one or more nerve fibers, characterized in that it comprises a central cylindrical sleeve (1) containing one or more optical fiber (s) (4).
2. Dispositif selon la revendication 1, caractérisé en ce que le manchon est prolongé à chacune de ses extrémités par deux bras articulés hémicylindriques (5, 5') et (6, 6') .2. Device according to claim 1, characterized in that the sleeve is extended at each of its ends by two articulated semi-cylindrical arms (5, 5 ') and (6, 6').
3. Dispositif selon les revendications 1 et 2, caractérisé par le fait qu'il comporte deux bouchons amovibles (2) et (2') munis d'un ou plusieurs pertuis (3) et (3•) destinés à maintenir et protéger les extrémités de la ou les fibre(s) optique(s) (4) contenue(s) dans le manchon.3. Device according to claims 1 and 2, characterized in that it comprises two removable plugs (2) and (2 ') provided with one or more vents (3) and (3 •) intended to maintain and protect the ends of the optical fiber (s) (4) contained in the sleeve.
4. Dispositif selon les revendications 1 à 3, caractérisé par le fait que les extrémités des deux bouchons (2) et (2') obturant la lumière du manchon cylindrique central (1) débordent du manchon .4. Device according to claims 1 to 3, characterized in that the ends of the two plugs (2) and (2 ') closing the lumen of the central cylindrical sleeve (1) project from the sleeve.
5. Dispositif selon les revendications 1 à 4, caractérisé par le fait que la ou les fibre(s) optique(s) incluse(s) dans le manchon cylindrique central (1) sont d'une longueur supérieure à celui-ci.5. Device according to claims 1 to 4, characterized in that the one or more optical fiber (s) included (s) in the central cylindrical sleeve (1) are of a length greater than this.
6. Dispositif selon l'une des revendications 1 à 5, caractérisé par le fait que l'articulation des bras (5, 5') et ( 6, 6') prolongeant le manchon central (1) à chaque extrémité est délimitée par une zone de moindre épaisseur (8) .6. Device according to one of claims 1 to 5, characterized in that the articulation of the arms (5, 5 ') and (6, 6') extending the central sleeve (1) at each end is delimited by a thinner area (8).
7.Dispositif selon les revendications l à 6, caractérisé par le fait que les deux bras articulés (5, 5') et (6, 6') comportent un système de fermeture dentée asynchrone et oppositionnelle (7) . 7. Device according to claims l to 6, characterized in that the two articulated arms (5, 5 ') and (6, 6') comprise an asynchronous and oppositional toothed closure system (7).
8. Dispositif selon l'une quelconque des revendications précédentes, caractérisé en ce que le manchon (1) est réalisé en dacron.8. Device according to any one of the preceding claims, characterized in that the sleeve (1) is made of dacron.
9. utilisation du dispositif selon l'une des revendications 1 à 8 pour le pontage de fibres nerveuses, caractérisée en ce que les deux extrémités de la fibre optique sont insérées dans les deux extrémités des fibres nerveuses à ponter.9. use of the device according to one of claims 1 to 8 for bridging nerve fibers, characterized in that the two ends of the optical fiber are inserted into the two ends of the nerve fibers to be bridged.
10. Utilisation du dispositif selon l'une des revendications 1 à 8 pour le pontage de fibres nerveuses , caractérisée en ce que les deux extrémités de la fibre optique sont aboutées aux deux extrémités des fibres nerveuses à ponter.10. Use of the device according to one of claims 1 to 8 for bridging nerve fibers, characterized in that the two ends of the optical fiber are joined at the two ends of the nerve fibers to be bridged.
11.Utilisation selon l'une des revendications 9 et 10, caractérisé en ce que les deux extrémités des fibres nerveuses et la fibre optique sont maintenues solidaires à l'aide du système de fermeture selon la revendication 7. 11.Use according to one of claims 9 and 10, characterized in that the two ends of the nerve fibers and the optical fiber are held together by means of the closure system according to claim 7.
PCT/FR1992/001244 1991-12-30 1992-12-30 Optical fibre device intended to the repair of damaged nerve fibres WO1993012724A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP93911659A EP0619721A1 (en) 1991-12-30 1992-12-30 Optical fibre device intended to the repair of damaged nerve fibres

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR9116465A FR2685628B1 (en) 1991-12-30 1991-12-30 OPTICAL FIBER (S) DEVICE FOR THE REPAIR OF LESED NERVOUS FIBERS.
FR91/16465 1991-12-30

Publications (1)

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WO1993012724A1 true WO1993012724A1 (en) 1993-07-08

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PCT/FR1992/001244 WO1993012724A1 (en) 1991-12-30 1992-12-30 Optical fibre device intended to the repair of damaged nerve fibres

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EP (1) EP0619721A1 (en)
AU (1) AU3455193A (en)
CA (1) CA2127118A1 (en)
FR (1) FR2685628B1 (en)
WO (1) WO1993012724A1 (en)

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US7076292B2 (en) 2002-04-25 2006-07-11 Medtronic, Inc. Optical communication of neurostimulation-system information
US7147647B2 (en) 2002-04-26 2006-12-12 Medtronic, Inc. Sintered titanium tube for the management of spinal cord injury
JP2015061604A (en) * 2009-03-10 2015-04-02 ザ ジョーンズ ホプキンズ ユニバーシティＴｈｅ Ｊｏｈｎｓ Ｈｏｐｋｉｎｓ Ｕｎｉｖｅｒｓｉｔｙ Biological tissue connection and repair device and method of using the same

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US3833002A (en) * 1973-09-10 1974-09-03 J Palma Apparatus for aiding severed nerves to join
US4412825A (en) * 1981-09-17 1983-11-01 Tokarz Richard D Medical entry connector for teeth bearing animals
US4432363A (en) * 1980-01-31 1984-02-21 Tokyo Shibaura Denki Kabushiki Kaisha Apparatus for transmitting energy to a device implanted in a living body
US4534349A (en) * 1983-02-02 1985-08-13 Minnesota Mining And Manufacturing Company Absorbable sutureless nerve repair device
US4863668A (en) * 1988-09-22 1989-09-05 University Of Utah Method of forming fibrin-collagen nerve and body tissue repair material

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Publication number Priority date Publication date Assignee Title
US3833002A (en) * 1973-09-10 1974-09-03 J Palma Apparatus for aiding severed nerves to join
US4432363A (en) * 1980-01-31 1984-02-21 Tokyo Shibaura Denki Kabushiki Kaisha Apparatus for transmitting energy to a device implanted in a living body
US4412825A (en) * 1981-09-17 1983-11-01 Tokarz Richard D Medical entry connector for teeth bearing animals
US4534349A (en) * 1983-02-02 1985-08-13 Minnesota Mining And Manufacturing Company Absorbable sutureless nerve repair device
US4863668A (en) * 1988-09-22 1989-09-05 University Of Utah Method of forming fibrin-collagen nerve and body tissue repair material

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7076292B2 (en) 2002-04-25 2006-07-11 Medtronic, Inc. Optical communication of neurostimulation-system information
US7865246B2 (en) 2002-04-25 2011-01-04 Medtronic, Inc. Optical communication of neurostimulation-system information
US7147647B2 (en) 2002-04-26 2006-12-12 Medtronic, Inc. Sintered titanium tube for the management of spinal cord injury
JP2015061604A (en) * 2009-03-10 2015-04-02 ザ ジョーンズ ホプキンズ ユニバーシティＴｈｅ Ｊｏｈｎｓ Ｈｏｐｋｉｎｓ Ｕｎｉｖｅｒｓｉｔｙ Biological tissue connection and repair device and method of using the same
US9539009B2 (en) 2009-03-10 2017-01-10 The Johns Hopkins University Biological tissue connection and repair devices and methods of using same

Also Published As

Publication number Publication date
EP0619721A1 (en) 1994-10-19
CA2127118A1 (en) 1993-07-08
AU3455193A (en) 1993-07-28
FR2685628A1 (en) 1993-07-02
FR2685628B1 (en) 1994-02-11

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