US20010010008A1 - Protective sheath for transvaginal anchor implantation device - Google Patents
Protective sheath for transvaginal anchor implantation device Download PDFInfo
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- US20010010008A1 US20010010008A1 US09/804,500 US80450001A US2001010008A1 US 20010010008 A1 US20010010008 A1 US 20010010008A1 US 80450001 A US80450001 A US 80450001A US 2001010008 A1 US2001010008 A1 US 2001010008A1
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- Prior art keywords
- bone anchor
- bone
- balloon
- inches
- shaft
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- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04L—TRANSMISSION OF DIGITAL INFORMATION, e.g. TELEGRAPHIC COMMUNICATION
- H04L12/00—Data switching networks
- H04L12/28—Data switching networks characterised by path configuration, e.g. LAN [Local Area Networks] or WAN [Wide Area Networks]
- H04L12/40—Bus networks
- H04L12/407—Bus networks with decentralised control
- H04L12/413—Bus networks with decentralised control with random access, e.g. carrier-sense multiple-access with collision detection (CSMA-CD)
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04L—TRANSMISSION OF DIGITAL INFORMATION, e.g. TELEGRAPHIC COMMUNICATION
- H04L12/00—Data switching networks
- H04L12/28—Data switching networks characterised by path configuration, e.g. LAN [Local Area Networks] or WAN [Wide Area Networks]
- H04L12/40—Bus networks
- H04L12/40006—Architecture of a communication node
- H04L12/40032—Details regarding a bus interface enhancer
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0493—Protective devices for suturing, i.e. for protecting the patient's organs or the operator
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00805—Treatment of female stress urinary incontinence
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0409—Instruments for applying suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0801—Prevention of accidental cutting or pricking
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- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04M—TELEPHONIC COMMUNICATION
- H04M11/00—Telephonic communication systems specially adapted for combination with other electrical systems
- H04M11/06—Simultaneous speech and data transmission, e.g. telegraphic transmission over the same conductors
- H04M11/062—Simultaneous speech and data transmission, e.g. telegraphic transmission over the same conductors using different frequency bands for speech and other data
Definitions
- This invention relates to a protective sheath or cap for a bone anchor implantation device.
- the bone anchor implantation device is used in maintaining or improving urinary continence.
- Urinary incontinence the inability to control urination from the bladder, is a widespread problem in the United States and throughout the world. Urinary incontinence affects people of all ages and can severely impact a patient both physiologically and psychologically.
- incontinence is caused by intrinsic sphincter deficiency (ISD), a condition in which the valves of the urethral sphincter do not properly coapt.
- incontinence is caused by hypermobility, a condition in which the muscles around the bladder relax, causing the bladder neck and proximal urethra to rotate and descend in response to increases in intraabdominal pressure. Hypermobility may be the result of child delivery or other conditions which weaken, stretch or tear the muscles.
- the condition is caused by a combination of ISD and hypermobility.
- urinary incontinence may be the consequence of post radical prostatectomy, which can destroy the valves of the urethral sphincter.
- urinary incontinence has a number of other causes, including birth defects, disease, injury, aging, and urinary tract infection.
- bladder neck stabilization sutures are placed around the muscles on either side of the urethra and affixed to the rectus fascia or pubic bone and tensioned to treat hypermobility.
- Other procedures which treat both hypermobility and intrinsic sphincter deficiency (ISD) involve the placement of a sling under the urethra/bladder which compresses the sphincter while simultaneously acting as a stabilizer of the bladderneck (preventing excessive downward mobility).
- the bone anchors which support the sling sutures may be inserted into rectus fascia or various locations on the pubis bone to provide a non-moveable anchoring method.
- the present invention generally relates to devices and methods for inserting anchors, such as bone anchors, into a bone or tissue and more particularly to a protective sheath or cap for isolating the bone anchor to prevent both accidents with the sharp bone anchor before it is inserted into a target site and contamination of the target site by insertion of the bone anchor therethrough.
- Bone anchors are often attached into bones in order to provide support for a “sling” useful in improving or maintaining a patient's urinary incontinence.
- a suture-carrying anchor is driven through the vaginal wall and into the posterior portion of the pubic bone or symphysis pubic, and the suture(s) attached to the bone anchor(s) extend through the vaginal wall and may be attached to the endopelvic fascia, the vaginal wall, a sling, or other material to stabilize and/or slightly compress the urethra thereby improving the patient's urinary incontinence.
- the present invention effectively addresses concerns in affixing an anchor to bone or tissue.
- the present invention is directed to a protective sheath for the bone anchor.
- the protective sheath prevents accidents with the sharp bone anchor tip before insertion into the target site, and it prevents infection of the pubic bone.
- the protective sheath prevents exposure and accidental puncture of the surgeon's gloves as well as premature insertion into unintended tissue in the patient. It also provides a sterile barrier around the bone anchor.
- the protective sheath shields the bone anchor from contacting microorganisms in the vagina and area surrounding the implantation site during insertion.
- the protective sheath of the present invention ensures that the bone anchor implants into the bone implantation site free from contamination and thus prevents the occurrence of biological complications.
- One aspect of the present invention is a bone anchor implantation device comprising an elongated member having a first end and a second end, and a related method.
- a bone anchor is releasably engaged to the elongated member in the vicinity of the first end.
- a protective sheath is mounted over the bone anchor.
- the protective sheath can be axially movable relative to the bone anchor such that the bone anchor is exposed from the sheath as the bone anchor is pressed into a bone by the elongated member.
- the protective sheath can be a balloon, gelatin structure, or other covering that encapsulates or covers the bone anchor prior to implantation.
- the balloon or thin film can be hermetically sealed around the bone anchor, but in any case the balloon isolates the bone anchor from contact with tissue and prevents contamination prior to implantation of the bone anchor.
- the balloon is perforated by the bone anchor as the bone anchor is pressed into the bone by the elongated member or shaft.
- the balloon may be made of a variety of materials such as plastic, thermoplastic, elastromers, PET, PETG, rubber, vinyl, latex, or silicone.
- the balloon is made of latex.
- the balloon can also be made of a biodegradable material.
- the balloon comprises a polymer such as a synthetic polymer.
- Nonlimiting examples of useful polymers include the following: polyglycolic acid (PGA), polyactic acid(PLA), poly (dioxanone)(PDO), poly (l-lactide) (LPLA), poly (dl-lactide)(DLPLA), poly (glycolide-co-trimethylene carbonate)(PGA-TMC), poly (l-lactide-co-glycolide)(PGA-LPLA), poly (dl-lactide-co-glycolide) (PGA-DLPLA), poly(l-lactide-co-dl-lactide)(LPLA-DLPLA), poly(glycolide-co-trimethylene carbonate-co-dioxanone)(PDO-PGA-TMC), poly( ⁇ -caprolactone), poly(dioxanone)(a polyether-ester), poly(lactide-co-glycotide), poly(SA-HDA anhydride), poly(orthoester), and polyglyconate.
- the protective sheath (e.g. balloon or gelatin structure) can contain an antibiotic which is released when the sheath is perforated by the bone anchor.
- the antibiotic prevents infection at the site where the bone anchor is pressed into the bone.
- antibiotics which can be used include the following: nafcillin, aminogylcoside, ciprofloxin, clindamcin, piperacillin/tazobactum, ampicillin/sulbactum, aminoglcoside, vancomycin, cephalosporin, TMP/SMX, ampicillin, gentaminicin, tobramycin, and ciprofloxacin.
- the bone anchor implantation device has a port which extends from the first end to the second end of the shaft into the balloon or gelatin structure.
- Antibiotics can be inserted into the protective sheath through a port.
- the invention features a bone anchor implantation device which has a spring attached to the sheath within the balloon which retracts when the sheath is pressed against the bone by the shaft, thereby causing the bone anchor to perforate the balloon and implant into the bone.
- the spring element may be an open-coiled helical spring which surrounds the bone anchor. The spring element retracts when pressure is applied to the sheath causing the bone anchor to puncture the balloon.
- the shaft of the bone anchor implantation device can have a hollow section which accommodates one or more sutures coupled to the releasably engaged bone anchor. Also, the shaft preferably is hook shaped.
- a method for inserting such a bone anchor that is releasably engaged to such a bone anchor implantation device can include the steps of locating a bone anchor implantation site on the bone and applying a retrograde force to the bone anchor to implant the bone anchor into the bone or to retract the spring to cause the bone anchor to perforate the sheath and implant into the bone.
- FIG. 1 is a plan view of the bone anchor implantation device.
- FIG. 2 is an exploded view of the anchor implantation device.
- FIG. 3 is a cross-sectional view of the distal end of the cannula showing the protective cap therein taken along line 3 - 3 of FIG. 2.
- FIG. 4 is a cross-sectional view of the bone anchor implantation device of FIG. 1 taken along line 4 - 4 of FIG. 1.
- FIG. 5 is a cross-sectional view of the bone anchor implantation in its locked configuration.
- FIG. 6 is a plan view of an alternate embodiment of the bone anchor implantation device having a keyhole-shaped bore in the second handle.
- FIG. 7 is a cross-sectional view taken along line 7 - 7 of the alternate embodiment shown in FIG. 6 locked in the position in which the inserter shaft is fully extended from the cannula.
- FIG. 8 is a cross-sectional view of the alternate embodiment of FIG. 6 locked in the position in which the inserter shaft is fully retracted within the cannula.
- FIG. 9 is a cross-sectional view of the distal end of the inserter shaft in the cannula showing location of the bone anchor implantation site by sliding the cannula along the endopelvic fascia.
- FIG. 10 is a cross-sectional view of the distal end of the inserter shaft and the cannula showing the inserter shaft penetrating the protective cap near the distal end of the cannula.
- FIG. 11 is a cross-sectional view of the distal ends of the inserter shaft in the cannula showing the bone anchor being drive into the bone.
- FIG. 12 shows the bone anchor with sutures extending therefrom after implantation into the bone.
- FIG. 13 is a side view of a bone anchor implantation device having a hooked shaft.
- FIG. 14 is an enlarged side view of a distal portion of the bone anchor implantation device taken along line 14 - 14 of FIG. 13 showing the internal structure of the bone anchor mount.
- FIG. 15 is a perspective view of the bone anchor mount.
- FIG. 16 is a cross sectional view of the bone anchor mount of FIG. 15 taken along line 16 - 16 .
- FIG. 17 is a schematic view showing the interior structure of the handle an alternate embodiment of the bone anchor implantation device inserted into the vagina with the proximal end of the second telescoping cylinder contacting the pubic bone.
- FIG. 18 is an enlarged view of the shaft of the alternate embodiment of the bone anchor implantation device illustrated in FIG. 17.
- FIG. 19 is a cross sectional view of the shaft of the bone anchor implantation device shown in FIG. 18 taken along line 19 - 19 of FIG. 18.
- FIG. 20 is a schematic view showing the interior structure of the handle of an alternate embodiment of the bone anchor implantation device illustrated in FIG. 17 inserted into the vagina showing the implantation of a bone anchor into the pubic bone and the compression of the spring.
- FIG. 21 is a side view of the bone anchor implantation device of FIG. 13 showing a protective sheath contacting the pubic bone.
- FIG. 22 is a side view of the bone anchor implantation device of FIG. 13 showing the bone anchor implanted into the pubic bone.
- FIG. 23 is a cross sectional view of the bone anchor mount and protective sheath when the protective sheath is containing the pubic bone.
- FIG. 24 is a cross sectional view of the bone anchor mount and the protective sheath when the bone anchor is being implanted into the pubic bone.
- FIG. 25 is a side view of a bone anchor implantation device having a hooked-shaped shaft and a balloon.
- FIG. 26 a is a perspective view of the bone anchor and a balloon.
- FIG. 26 b is a perspective view of a bone anchor and a gelatin structure.
- FIG. 27 is a schematic view showing the interior structure of the handle of an alternate embodiment of the bone anchor implantation device with balloon inserted into the vagina with the proximal end of the second telescoping cylinder contacting the pubic bone.
- FIG. 28 is a side view of the bone anchor implantation device of FIG. 25 showing a balloon contacting the pubic bone.
- FIG. 29 is a side view of the bone anchor implantation device of FIG. 25 showing the bone anchor implanted into the pubic bone.
- FIG. 30 is a side elevational view of a bone anchor.
- FIG. 31 is a side elevational view of the spear member of bone anchor shown in FIG. 30.
- FIG. 32 is a rear elevational view of the spear member of the bone anchor shown in FIG. 30.
- FIG. 33 is an enlarged sectional view of a shaft of the spear member of the bone anchor taken along the lines 4 - 4 of FIG. 31.
- FIG. 34 is a side elevational view of a collar member of the bone anchor shown in FIG. 30.
- FIG. 35 is a rear elevational view of the collar member of the bone anchor shown in FIG. 30.
- FIG. 36 is a side elevational view of the collar member of the bone anchor taken along the direction of the lines 7 - 7 of FIG. 35.
- FIG. 37 is a sectional view of the collar member of the bone anchor taken along the lines 8 - 8 of FIG. 35.
- FIG. 38 is a perspective view of the bone anchor tip on a bone anchor implantation device having a balloon with a spring element.
- FIG. 39 is a side view of a bone anchor implantation device with a telescoping sheath.
- FIG. 40 a is an enlarged view of the telescoping sheath of FIG. 39 with the telescoping sheath in an expanded position.
- FIG. 40 b is an enlarged view of the telescoping sheath of FIG. 39 with the telescoping sheath in a retracted position.
- FIG. 41 a is a view of a bone anchor implantation device with a balloon sheath.
- FIG. 41 b is an enlarged view of the balloon sheath on bone anchor implantation device of FIG. 41 a.
- FIG. 42 a is a view of a bone anchor implantation device with a latex sheath and a spring element.
- FIG. 42 b is another view of the bone anchor implantation with a latex sheath and a spring element.
- FIG. 43 is a view of a bone anchor implantation device with a caplet sheath.
- FIG. 44 is a view of a bone anchor implantation device that has a lumen that can hold one or more sutures.
- FIG. 45 is a view of a bone anchor implantation device of FIG. 39 inserted into the vagina showing the implantation of a bone anchor into the pubic bone.
- the present invention relates to a device for affixing a bone anchor to a bone. More particularly, the invention relates to a protective sheath for protecting the bone anchor from contacting tissue during implantation and thereby preventing contamination of the bone anchor. It also relates to methods for improving or maintaining a patient's urinary continence in which bone anchors are inserted transvaginally into the posterior portion of the pubic bone or symphysis pubis and devices for use in such methods.
- transvaginally or “transvaginal access” refer to access through the vaginal introitus or from within the vagina, as opposed to access from the patient's abdominal side.
- the methods and devices of the present invention drive a bone anchor through the vaginal wall and into the posterior portion of the pubic bone or symphysis pubis.
- the public bone may also be accessed through a suprapublic bone incision.
- at least one bone anchor is driven into the pubic bone on either side of the urethra.
- a single bone anchor may also be used.
- the sutures attached to the bone anchors extend through the vaginal wall and may then be attached to the endopelvic fascia, the vaginal wall, a sling, or other material to stabilize and/or slightly compress the urethra, thereby improving or maintaining the patient's urinary continence.
- the anchor implantation device has a first handle having an inserter shaft attached thereto.
- the inserter shaft is adapted to releasably engage or attach to a bone anchor.
- a second handle is hingedly attached to the first handle and has a cannula attached thereto.
- the cannula has a central bore extending therethrough.
- the cannula is aligned with the inserter shaft such that the inserter shaft is inside the central bore of the cannula and is extendible from and retractable in the cannula.
- a biasing member is disposed between the first handle and the second and biases the first handle and the second handle apart.
- FIGS. 1 and 2 provide a plan view and an exploded view of an anchor implantation device 10 for introducing a bone anchor 22 transvaginally and driving it into the pubic bone or symphysis pubis.
- the device comprises a first handle 12 having a proximal end 14 , a central region 16 , and a distal end 18 .
- the first handle 12 may be made of any relatively firm material, including plastic or metal.
- the first handle 12 is made of plastic, aluminum, stainless steel, or titanium.
- those skilled in the art will appreciate that a wide range of other material may also be employed.
- the first handle 12 may be configured in any of a variety of shapes compatible with vaginal insertion.
- the first handle 12 is rectangular.
- a variety of configurations may be employed, such as a handle which tapers towards the distal end, and the present invention contemplates the use of any handle configuration compatible with vaginal insertion.
- the dimensions of the first handle 12 are also compatible with vaginal insertion.
- the first handle 12 may be from about 4 inches to about 8 inches in length, about 0.25 inches to about 1.25 inches in width, and about 0.05 inches to about 0.5 inches in height.
- the first handle 12 is about 5 inches to about 7 inches in length, about 0.5 inches to about 1 inch in width, and about 0.1 inches to about 0.3 inches in height. More preferably, the first handle 12 is has a length of 6 inches, a width of 0.75 inches and a height of 0.2 inches.
- An inserter shaft 20 adapted for releasably engaging a bone anchor 22 is located near the distal end 18 of the first handle 12 .
- a variety of bone anchors 22 can be used.
- the bone anchor comprises a spear member 112 which is able to pierce and securely engage the bone.
- the spear member 112 has a generally cone shaped head portion 114 which is used to pierce the bone to which the and a shaft portion 116 with an oval eyelet 118 therethrough for receiving and holding a suture strand(s).
- the bone anchor 122 further comprises a collar member 120 .
- the collar member is used for retaining the bone anchor 122 in place, once it has been driven into the bone, by lodging within the bone in a manner to resist removal of the bone anchor 122 .
- the bone anchor 122 and its component parts are more fully described below.
- the spear member 112 of the bone anchor 122 will now be described with additional reference to FIGS. 31 - 33 .
- the shaft portion 116 of the spear member 112 is generally cylindrical in shape and has the eyelet 118 , or bore, formed radially therethrough proximate one of its ends.
- the eyelet 118 may be oval, round or other suitable shapes and is of a sufficient size to permit suture strand or strands to pass therethrough.
- the circumference of each outer end of the eyelet 118 is chamfered or grounded to provide a bevel portion 122 .
- the bevel portion 122 provides a generally smooth surface for contacting suture strand which has been passed through the eyelet 118 .
- the eyelet 118 is located on the shaft portion 116 of the spear member 112 such that the transverse axis of the eyelet 118 intersect the longitudinal axis of the spear member 112 .
- the generally cone-shaped head portion 114 of the spear member 112 is located at an end of the shaft portion 116 opposite the end having the eyelet 118 .
- the apex of the cone-shaped head portion is a point 124 which is suitable for piercing and being driven into bone.
- the diameter of the cone-shaped head portion 114 increases, when viewed along a longitudinal direction rearwardly from the point 124 towards the shaft portion 116 .
- the cone angle along this region is preferably about 30 degrees.
- the diameter of the cone-shaped head portion 114 increases at a greater rate along approximately the rearward half thereof, when viewed along the same longitudinal direction.
- the rearward half of the cone-shaped head portion 114 arcs outwardly from the central longitudinal axis of the spear member 112 .
- the base 126 of the cone-shaped head portion 114 is a ring-shaped planar surface which is oriented substantially perpendicular to the longitudinal axis of the shaft portion 116 .
- the cone-shaped head portion 114 is formed integrally with the shaft portion 116 of the spear member 112 .
- the cone-shaped head portion 114 and the shaft portion 116 may initially be formed separately and then subsequently attached to one another by any suitable means.
- the collar member 120 of the bone anchor 122 will now be described with particular reference to FIG. 30 and FIGS. 34 - 37 .
- the collar member 120 is provided with a ring-shaped generally planar forward surface 130 which is adapted to bear against, and mate with the base 126 of the cone-shaped head portion 114 of the spear member 112 .
- a circular bore 132 is located centrally through the planar forward surface 130 and is adapted to receive the shaft portion 116 of the spear member 112 therethrough.
- the circumference of the planar forward surface 130 may be, but is not necessarily, chamfered to formed a beveled outer rim portion 133 .
- flanges 134 extend rearwardly from the planar forward surface 130 of the collar member 120 as shown in FIGS. 34 - 39 .
- the flanges 134 are separated from one another by longitudinally extending slots 136 .
- the portions of the flanges 134 which are proximate to the planar forward surface 130 run generally parallel to the central longitudinal axis of the collar member 120 .
- Each of the flanges 134 arcs generally outward from the central longitudinal axis as the flange 134 extends in a direction away from the planar forward surface 130 .
- the lateral width of each of the flanges 134 increases as the flange 134 extends in a direction away from the planar forward surface 130 .
- the extreme rearward end of each of the flanges 134 curves away from the planar forward surface 130 in the form a shallow C-shape, thereby providing two trailing tips 140 for each flange 134 .
- the collar member 120 is rotatably fitted over the shaft portion 116 of the spear member 112 to form the assembled bone anchor 122 as shown in FIG. 1. While there is no need to permanently secure the collar member 120 to the spear member 112 , the planar forward surface 130 may nevertheless be securely attached to the base 126 of the cone-shaped head member 114 of the spear member 112 by any suitable means. It will be appreciated, however, that by permitting the spear member 112 to freely rotate with respect to collar member 120 , the suture strand 150 can be rotated by the surgeon after implantation to a position where the forces acting on the suture strand 150 by the bone anchor 122 are more evenly distributed around the region of the shaft portion 116 adjacent to the eyelet 118 . Such a position of the suture strand 150 is shown in FIG. 33.
- the two-piece construction of the bone anchor 122 affords machining advantages over a single-piece bone anchor. That is, it is easier to machine each of these components separately and to subsequently assemble them together, as opposed to machining the same basic structural features from a single piece of material.
- Any known materials suitable for orthopedic anchor devices may be employed to construct the bone anchor 122 of the present invention.
- the bone anchor 122 is formed from a metallic material possessing sufficient strength to penetrate the bone. Such materials include titanium 316 LVM stainless steel, CoCrMo alloy, Nitinol alloy, or other suitable materials.
- the bone anchor is made of titanium.
- the inserter shaft 20 has a distal end 24 , a central region 26 , and a proximal end 28 .
- the inserter shaft extends at an angle of about 90° from the first handle 12 .
- the inserter shaft 20 may be made of any of a variety of materials, including steel, stainless steel, aluminum, titanium, and plastic, but is preferably made of stainless steel. Additionally, the inserter shaft 20 may have a variety of cross sectional shapes including rectangular, hexagonal, or triangular but preferably the inserter shaft 20 has a circular cross section.
- the inserter shaft 20 maybe located from about 0.05 inches to about 0.5 inches from the distal end 18 of the first handle 12 . preferably, the inserter shaft 20 is located from about 0.1 inches to about 0.3 inches from the distal end 18 . More preferably, the inserter shaft 20 is located 0.2 inches from the distal end 18 of the handle.
- the length of the inserter shaft 20 is consistent with transvaginal delivery of the releasable bone anchor 22 .
- the inserter shaft 20 maybe from about 0.5 inches to about 1.5 inches long.
- the inserter shaft 20 is from about 0.75 inches to about 1.25 inches in length. More preferably, the inserter shaft 20 is 1 inch in length.
- the proximal end 28 and the central region 26 of the inserter shaft 20 have an equal cross sectional area, which is larger than the cross sectional area of the bone anchor 22 and distal end 24 .
- a shoulder 17 is formed at the junction between the central region 25 of the inserter shaft and the distal region of the inserter shaft. The shoulder 17 acts as a stop which will not penetrate the cortical shell of the bone.
- the diameter of the inserter shaft is dependent upon the size of the bone anchor.
- the diameter of the proximal end 28 and central region 26 of the inserter shaft is from about 0.1 inches to about 0.3 inches, and that of the distal end 24 is from about 0.04 inches to about 0.2 inches.
- the diameter of the proximal end 28 and central region 26 of the inserter shaft is from about 0.15 inches to about 0.25 inches, and that of the distal end 24 is from about 0.07 inches to about 0.11 inches. More preferably, the diameter of the proximal end 28 and central region 26 of the inserter shaft is 0.2 inches and that of the distal end 24 is 0.09 inches.
- the inserter shaft 20 is curved as shown in FIGS. 1 and 2.
- the inserter shaft 20 may also be straight.
- the radius of curvature of the inserter shaft 20 is the distance between the pivot point of the hinge and the center of the inserter shaft.
- the radius of curvature of the inserter shaft 20 may be from about 3.5 inches to about 7.9 inches.
- the radius of curvature of the inserter shaft 20 is from about 4.7 inches to about 6.9 inches. More preferably, the radius of curvature of the inserter shaft 20 is 5.8 inches.
- the distal end 24 of the inserter shaft 20 is adapted to releasably engage a bone anchor 22 .
- the bone anchor 22 is housed within a notch 30 at the distal end 24 of the inserter shaft, and frictionally engages the inner wall of the distal end 24 of the inserter shaft.
- the inserter shaft 20 may releasably engage the bone anchor 22 through a variety of means other than that described above, and such means are specifically contemplated by the present invention.
- the distal end 24 of the inserter shaft maybe hollow or solid and has a complementary shape to the proximal end of the bone anchor 22 to permit the bone anchor 22 to frictionally engage the distal end 24 of the inserter shaft.
- the distal end 24 of the inserter shaft and the proximal end of the bone anchor may be square, rectangular, pentagonal, triangular or hexagonal in cross section.
- the distal end 24 of the inserter shaft and the proximal end of the bone anchor are cylindrical.
- numerous shapes may be employed, and the present invention specifically contemplates any such shape.
- the central region 26 of the inserter shaft has a pair of grooves 32 therein for receiving a suture 54 attached to the bone anchor as illustrated in FIGS. 1 and 2.
- the grooves 32 in the inserter shaft are coextensive with slots 34 in the outer cannula and are aligned with the slots 34 .
- the device also comprises a second handle 36 hingedly connected to the first handle 12 and having a proximal end 38 , a central region 40 , and a distal end 42 .
- the second handle 36 may be fabricated from any of the materials discussed above with regard to the first handle 12 . Additionally, the second handle 36 may have any of the dimensions and shapes discussed above with regard to the first handle 12 . The preferred materials, dimensions, and shapes for the second handle 36 are the same as those discussed above with regard to the first handle 12 .
- the second handle 36 has a cannula 44 positioned near its distal end 42 and fixed within a bore 11 in the second handle by screws 13 .
- the cannula 44 has a proximal end 46 , a central region 48 , and a distal end 50 , with a central bore 52 running through its entire length.
- the cannula 44 extends at an angle of about 90° from the second handle 36 .
- the cannula 44 may be fabricated from any of the materials described above with regard to the inserter shaft 20 .
- the cannula 44 is made of stainless steel.
- the cannula 44 may have any of the shapes discussed above with regard to the inserter shaft 20 .
- the shape of the cannula 44 is the same as that of the inserter shaft 20 .
- the cannula 44 is located approximately the same distance from the distal end 42 of the second handle as the inserter shaft 20 is from the distal end 18 of the first handle and the central bore 52 of the cannula has an inner diameter larger than the outer diameter of the inserter shaft 20 . In this way, the inserter shaft 20 extends into the central bore in the cannula as depicted in FIG. 1. The inserter shaft 20 is extendible and retractable relative to the cannula 44 .
- the cannula 44 has two oppositely disposed slots 34 therein through which the suture 54 attached to the bone anchor passes. These slots reduce the possibility of the suture 54 becoming tangled.
- the slots 34 in the cannula are aligned with and coextensive with the grooves 32 in the inserter shaft.
- the sutures can be contained within the cannula and extend out another portion of the device such as the first handle 12 .
- the distal end 50 of the cannula has a sharp tip 56 to facilitate its use in piercing tissue.
- the cannula 44 is preferably also curved in the same arc as the inserter shaft 20 .
- the diameter of the cannula 44 can be reduced in comparison with embodiments in which the inserter shaft and the cannula are not curved.
- the inner diameter of the cannula 44 is from about 0.1 inches to about 0.25 inches and the outer diameter of the cannula 44 is from about 0.14 inches to about 0.31 inches.
- the inner diameter of the cannula 44 is from about 0.15 inches to about 0.2 inches.
- the inner diameter of the cannula is 0.170 inches, the wall is about 0.02 inches, and the outer diameter is about 0.210 inches. These dimensions also apply to the devices in FIGS. 5 and 6 in which the inserter shaft and the cannula are also curved.
- the cannula 44 has a protective cap 58 inside the central bore 52 and located at the distal end 50 of the cannula, as shown in FIGS. 2, 3 and 5 .
- the protective cap 58 may be made of a variety of materials, such as plastic, thermoplastic elastomers, PET, PETG, rubber material, vinyl, gelatin, latex, thermoset rubbers and silicone.
- the protective cap 58 is made of silicone or plastic.
- the internal protective cap 58 acts to shield the bone anchor 22 from contamination, e.g., from contact with microorganisms in the vagina which could cause infection if introduced into the pubic bone during implantation of the bone anchor.
- the protective cap 58 has a vertical slit 60 and a horizontal slit 62 therein which intersect to form a cross.
- the protective cap 58 has slits three slits which intersect to form a Y.
- the slits 60 and 62 penetrate entirely through the material of the protective cap 58 , thereby dividing the protective cap into discrete segments.
- the slits 60 and 62 are scored in the material of the protective cap 58 but do not extend entirely therethrough.
- the slits 60 and 62 permit the bone anchor 22 to move through the protective cap 58 during implantation.
- the bone anchor 22 forces the segments of the protective cap 58 to separate as the bone anchor 22 is extended through the protective cap 58 .
- the protective cap 58 remains in contact with the external surface of the bone anchor 22 as it is inserted into the bone, thereby shielding the bone anchor from contact with potentially infectious microorganisms in the vaginal wall.
- first and second handles, 14 and 38 respectively are hingedly connected to permit them to move towards and away from one another.
- Any suitable type of hinge can be used, for example, this can be accomplished using a hinge 64 similar to that commonly found on doors as shown in FIGS. 1 and 2.
- a piece of rubber may be interposed between the first and second handles at their proximal ends 14 and 38 and secured thereto by bolts extending into holes in each of the handles.
- Those skilled in the art will appreciate that other means of hingedly connecting the first and second handles may be employed, and the present invention specifically contemplates embodiments in which such other hinging mechanisms are employed.
- the first handle 12 and the second handle 36 are biased apart.
- the biasing force is provided by a spring 66 , as discussed below.
- the spring 66 can be metal, resilient polymer, pneumatically driven, or of any other suitable design.
- those skilled in the art will appreciate that a number of other structures can be employed to achieve the same biasing effect.
- the present invention specifically contemplates such other means of biasing the handles apart.
- the length of the inserter shaft 20 extending from the cannula 44 is from about 0.05 inches to about 0.8 inches.
- the length of the inserter shaft 20 extending from the cannula 44 is about 0.1 inches to about 0.5 inches. More preferably, the length of the inserter shaft 20 extending from the cannula 44 at the position of maximum extension is 0.2 inches.
- the bone anchor 22 is inserted in the bone by manually moving the inserter shaft 20 axially through the bore 52 in the cannula until the inserter shaft and bone anchor 22 thereon extend from the cannula 44 .
- the bone anchor 22 can be forced into the bone by applying sufficient pneumatic pressure through the inserter shaft to eject the bone anchor from the inserter shaft with sufficient force to implant the bone anchor in the bone.
- the bone anchor may be driven into the bone by a spring mechanism.
- the device further comprises a locking mechanism for locking the device in the position in which the inserter shaft is fully retracted within the cannula in order to avoid accidental insertion of the bone anchor into tissue.
- a locking mechanism for locking the device in the position in which the inserter shaft is fully retracted within the cannula in order to avoid accidental insertion of the bone anchor into tissue.
- a variety of locking structures may be used to achieve such locking.
- the locking mechanism comprises a locking plate 15 slidably mounted over the first handle 12 and having a bore 68 therein.
- the locking plate 15 is separated from the first handle 12 by a spacer 70 having an internally threaded bore 72 therein which is aligned with the bore 68 in the locking plate.
- the first handle 12 has an elongate hole 74 herein having a proximal end 75 and a distal end 77 .
- a locking screw 76 extends through the elongate hole 74 in the first handle and the bores 72 . 68 in the spacer 70 and locking plate 15 .
- the locking screw 76 is secured to the locking plate 15 by a nut 78 .
- the second handle 36 has a bore 80 therethrough having a diameter larger than that of the head of the locking screw 76 .
- the bore 80 can be aligned with the locking screw 76 as shown in FIG. 4 thereby permitting the first handle 12 and the second handle 36 to be squeezed together such that the inserter shaft 20 extends from the cannula 44 .
- the locking plate 15 in the locked position, is positioned at the proximal end 75 of the elongate hold 74 in the first handle.
- the locking screw 76 is disposed between the first and second handles such that the head of the screw abuts the inner side of the second handle 36 , thereby preventing the first handle 12 and the second handle 36 form being squeezed together.
- the bone anchor implantation device 110 may have a dual position lock permitting the device to be locked in a position in which the inserter shaft 120 is fully retracted within the cannula 144 or in a position in which the inserter shaft 120 is fully extended from the cannula 144 .
- the bore 180 of the second handle 136 is keyhole shaped.
- the narrower part 121 of the keyhole shaped bore is sufficiently narrow to prevent the head of the locking screw 176 from passing therethrough. As illustrated in FIG.
- the head of locking screw 176 is aligned with the wide portion 123 of the keyhole shaped bore.
- the locking plate 115 can then be returned to the proximal end 175 of the elongate hole, such that the head of the locking screw 176 is disposed between the first handle 112 and the second handle 136 and the head of the locking screw 176 abuts the inner side of the second handle 136 , as shown in FIG. 8. In this position the inserter shaft 120 is fully retracted and the first handle 112 and the second handle 136 cannot be squeezed together.
- the force biasing the two handles apart is preferably provided by a spring 66 disposed between two depressions 82 and 84 in the first handle 12 and the second handle 36 .
- the spring 66 is located in the central regions 16 and 40 of the first and second handles.
- biasing members other than a spring may be employed to bias the handles apart.
- the bone anchor is transvaginally introduced into the pubic bone as follows.
- the endopelvic fascia is accessed using techniques well known to those of skill in the art, such as with a conventional retractor.
- a Foley catheter may be introduced to assist in locating the bladder neck.
- the bone anchor implantation device is inserted into the vaginal introitus and the first desired site for bone anchor implantation is located by digital palpation of the urethra, pubic symphysis or other anatomical landmark or other techniques known to those of ordinary skill in the art.
- the device is locked in the position in which the inserter shaft is fully retracted during this procedure.
- the sharp tip 56 on the distal end of the cannula is driven through the endopelvic fascia 17 .
- the pointed end of the cannula can also be employed to locate the desired implantation site by inserting the device into the vaginal introitus and through the incision, piercing the endopelvic fascia, and moving the cannula along the pubic bone 19 to the desired implantation site, as shown in FIG. 9.
- the device is then unlocked from the position in which the inserter shaft 20 is fully retracted.
- the first and second handles 12 and 36
- the device is locked in the position in which the inserter shaft 120 is fully extended from the cannula 144 and the manual pressure is applied to drive the bone anchor 122 into the posterior portion of the pubic bone 19 .
- the inserter shaft moves towards the bone 19 .
- the bone anchor 22 pierces the protective cap 58 which separates as the bone anchor 22 passes therethrough.
- the protective cap 58 shields the bone anchor 22 from contact with the vaginal tissue.
- the inserter shaft 20 is then retracted into the cannula 44 , leaving the bone anchor 22 implanted in the bone 19 with the attached suture 54 extending through the wound in the vaginal wall and the endopelvic fascia as shown in FIG. 12.
- the sutures are attached to a needle, looped back through the vaginal wall, and attached to tissue such as the endopelvic fascia or the vaginal wall so as to bias the tissue surrounding the urethra towards the urethra.
- the biasing force compresses or stabilizes the bladder neck thereby maintaining or improving urinary continence.
- the sutures attached to the bone anchors can be attached to a sling which compresses or stabilizes the bladder neck.
- an incision is made midline to the urethra.
- An opening or pocket for receiving the sling is created in the tissue between the urethra and the upper vaginal wall.
- the bone anchor implantation device is inserted through the incision, into the pocket, and through the endopelvic fascia to contact the pubic bone.
- At least one bone anchor is inserted into the pubic bone on each side of the urethra.
- the sling is introduced into the opening or pocket and attached to the sutures. The tension on the sling provided by the sutures is adjusted to provide the appropriate biasing force to the urethra.
- Example 1 describes one method of using the present bone anchor implantation device to compress or stabilize the bladder neck with sutures. It will be appreciated that the bone anchor implantation device can be used with other methods in which sutures compress or stabilize the bladder neck.
- the bone anchor implantation device can be used in incontinence treatments in which the bladder neck is compressed or stabilized with sutures.
- a Foley catheter is inserted into the urethra to indicate its location.
- An incision is then made through the anterior vaginal wall, preferably approximately 1 cm lateral to midline and adjacent to the bladder neck.
- the vaginal wall is retracted to allow access to the endopelvic fascia.
- the bone anchor implantation device having a bone anchor with sutures attached thereto releasably engaged with the inserter shaft, is introduced through the opening in the vaginal wall with the device locked in the position in which the inserter shaft is fully retracted within the cannula, and the sharp point is pressed through the fascia to contact the posterior pubic bone.
- the anchor implantation site is located lateral to the symphysis pubis and cephalad to the inferior edge of the pubic bone.
- the anchor implantation site is located by palpating the inferior rim of the pubic bone and the symphysis pubis, moving laterally until the lower border of the obturator foramen is located.
- the anchor is located from about 0.5 to 4 cm lateral to the symphysis pubis and from about 0.5 to 3 cm cephalad to the inferior edge. More preferably, the anchor implantation site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone.
- the anchor implantation site can be located on the pubic ramus.
- the bone anchor implantation device is withdrawn, leaving the two free ends of the anchored suture exiting the endopelvic fascia 17 .
- a device such as a Mayo needle is then attached to one free end of the anchored suture and a “bite of fascia” is taken adjacent to the bladder neck.
- the entry and exit points of the suture are adjacent to the bladder neck approximately 0.5 cm lateral to the urethra. This step is then repeated with the other free end of the suture, and the two ends are tied together.
- the vaginal wall incision is then closed.
- the entry and exit points of the suture can be made as illustrated in FIG. 13 a of U.S. Pat. No. 5,611,515 to Benderev, the disclosure of which is incorporated herein by reference.
- Example 2 describes use of the bone anchor implantation device in a procedure in which the bladder neck is compressed or stabilized with a sling. However, it will be appreciated that the bone anchor implantation device can be used with other methods in which the bladder neck is compressed or stabilized with a sling.
- Double Anchor Placement For Sling or Bolster Procedure
- the bone anchor implantation device can also be used in incontinence treatments in which the bladder neck is compressed or stabilized using a sling.
- two bone anchors are placed on either side of the urethra.
- one or more than two bone anchors per side can be used. The procedure is performed as follows.
- a Foley catheter is inserted into the urethra to indicate its location. Starting adjacent to the bladder neck on either side of the urethra, a 1 cm incision is made through the anterior vaginal wall approximately 1 cm lateral to and parallel to the midline of the urethra. The vaginal wall is retracted to allow access to the endopelvic fascia 17 . Blunt dissection is used to tunnel under the urethra and form a pocket for the sling.
- the bone anchor implantation device is introduced through the opening in the vaginal wall with the device locked in position in which the inserter shaft is fully retracted within the cannula, and the sharp point of the cannula is pressed through the fascia 17 near the distal end of the vaginal wall incision closer to the bladder neck, to contact the posterior aspect of the pubic bone.
- the first anchor implant site is located lateral to the symphysis pubis and cephalad to the inferior edge of the pubic bone. More preferably, the first anchor implant site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone.
- the locking mechanism of the bone anchor implantation device is then placed in the unlocked position, and the two handles are squeezed together to expose the anchor.
- the bone anchor may be exposed by locking the device in the position in which the inserter shaft is fully extended from the cannula.
- the anchor is driven into the pubic bone using manual pressure and opposing thumb pressure on the external pubic region if necessary.
- the bone anchor implantation device is withdrawn leaving the two free ends of suture exiting the endopelvic fascia.
- the above bone anchor implantation procedure is repeated to introduce a second anchor on the same side of the urethra as the first anchor.
- the second anchor implant site is located by palpating the obturator foramen in the pelvis just cephalad to the ramus.
- the fascial tissue near the proximal end of the vaginal wall incision farther from the bladder neck is pierced.
- the second anchor is implanted on the superior (cephalad) aspect of the ramus.
- the bone anchor implantation device is removed as before trailing the two free ends of each suture from the vaginal wall incision.
- the sling is then positioned in the pocket under the urethra.
- the free ends of suture from the two anchors on each side of the urethra are then tied to the corresponding corners of the sling.
- the sutures are then tied off with the appropriate amount of tension to suspend or stabilize the bladder neck.
- the vaginal wall incisions are then closed on each side.
- the above procedure can also be utilized in techniques in which only a single bone anchor is inserted on either side of the urethra.
- the anchor implantation site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone. More preferably, the anchor implantation site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone.
- the anchor implantation device of the present invention has a hooked shaft with a bone anchor mount for releasably engaging a bone anchor on the distal end of the shaft. This embodiment reduces the amount of force required to drive the bone anchor into the bone by utilizing the patient's body weight to provide an opposing force.
- the anchor implantation device comprises a handle, a hooked shaft secured to the handle and a bone anchor mount adapted to releasably engage a bone anchor attached to the distal end of the shaft.
- the bone anchor mount generally points toward the handle, such that the user can drive the bone anchor into the bone by simply pulling back on the handle and using the patient's body weight to provide an opposing force.
- the longitudinal axis of the bone anchor mount is aligned with the longitudinal axis of the handle.
- a protective sheath is attached to the bone anchor mount such that the bone anchor releasably engaged to the bone anchor mount is enclosed within the protective sheath and isolated from tissue contact during placement of the device. More preferably, the protective sheath is a telescoping sheath or a balloon.
- FIG. 13 A representative anchor implantation device having a hooked shaft is shown in FIG. 13.
- the anchor implantation device 210 has a handle 212 having a proximal end 214 and a distal end 216 .
- the handle 212 may be made of a variety of materials, such as plastic or metal.
- the shaft 220 may be made of a variety of materials such as stainless steel engineering plastics, fiber-bearing components, or other materials.
- the shaft is made of stainless steel.
- shaft 220 comprises a straight proximal section 222 , a first generally curved section 224 distal to the straight proximal section, a second generally curved section 226 distal to the first curved section, a third generally curved section 228 distal to the second curved section, and a fourth generally curved section 230 distal to the third curved section.
- the shaft could also comprise a series of straight segments angled relative to one another to form a hook.
- the straight proximal section 222 of the shaft 220 has an annular shoulder 232 which abuts the distal end 216 of the handle.
- the straight proximal section 222 passes through a lumen (not shown) extending through the handle.
- the proximal end of the straight proximal section 222 has a threaded bore which is adapted to receive a screw 236 which secures the shaft 220 to the handle.
- a washer (not shown) may be placed between the proximal end 214 of the handle and the screw 236 .
- the straight proximal section 222 of the shaft 220 may be from about 3 inches to about 6 inches in length. Preferably, the straight proximal section 222 is from about 4 inches to about 5 inches in length. More preferably, the straight proximal section 222 is about 4.5 inches in length.
- the handle 212 defines an axis at the proximal end of the anchor implantation device 210 , and ten moving distally from the handle 212 the shaft 220 first curves away from the axis of the handle and then back toward the axis of the handle 212 .
- the distal end of the shaft 220 preferably is located in the vicinity of the axis of the handle 212 .
- the shaft 220 at the distal end can be generally perpendicular to the axis of the handle or can actually be curving back toward the handle 212 .
- the distance from the distal end of the handle 212 to the tip of the tapered bone anchor receptacle 246 measured along the longitudinal axis of the handle 212 is about 33 ⁇ 8 inches.
- the distance from the distal end of the handle 212 to the distal end of the bone anchor mount 238 is about 4 inches.
- the distance of a line perpendicular to the longitudinal axis of the handle 212 extending from the bottom of the third curved section 228 is about 2 inches.
- a bone anchor mount 238 is attached to the distal end 240 of the fourth curved section 230 of the shaft 220 .
- the bone anchor mount 238 may be oriented at an angle from about 60° to about 120° relative to the distal end 240 of the fourth curved section.
- the bone anchor mount 238 is oriented at an angle from about 80° to about 100° relative to the distal end 240 of the fourth curved section. More preferably, the bone anchor mount 238 is oriented at an angle of approximately 90° relative to the distal end 240 of the fourth curved section, as illustrated in FIG. 13.
- the bone anchor mount comprises an outer cylinder 242 , an inner cylinder 244 , and a tapered bone anchor receptacle 246 for releasably engaging a bone anchor 248 .
- a variety of bone anchors can also be used with the bone anchor implantation device having a hooked shaft.
- the bone anchor used with the hooked shaft device is the bone anchor discussed above with respect to the two handle bone anchor implantation device.
- the bone anchor mount 238 and the bone anchor receptacle 246 are oriented so that the bone anchor 248 is pointed in the general direction of the handle 212 .
- the axis of the bone anchor 248 is generally aligned with the axis of the handle 212 , with the bone anchor pointed toward the handle 212 .
- the bone anchor mount 238 may be fabricated from the same materials as the shaft 220 and may be attached to the shaft 220 by a variety of methods known to those skilled in the art, such as brazing. As best shown in FIG. 15 the distal end 250 of the outer cylinder 242 has a pair of holes 252 therein sized to accommodate a suture 254 .
- the outer cylinder 242 may have a diameter from about 0.18 inches to about 0.6 inches. Preferably, the outer cylinder 242 has a diameter from about 0.25 inches to about 0.5 inches. More preferably, the outer cylinder 242 has a diameter of about 0.375 inches.
- the outer cylinder 242 has a cavity 258 formed therein, creating a cup in the proximal region of the outer cylinder 242 .
- the proximal end 260 of the outer cylinder 242 has an annular shoulder 262 thereon.
- the inner cylinder 244 is connected to the outer cylinder 242 and extends into the cavity 258 as best shown in FIG. 16.
- the inner cylinder 244 may be connected to the outer cylinder 242 in a variety of ways known to those skilled in the art.
- the inner cylinder 244 may be fused to the outer cylinder 242 .
- the inner cylinder 244 has grooves 264 therein adapted to accommodate the suture 254 .
- a tapered bone anchor receptacle 246 extends from the proximal end 266 of the inner cylinder 244 .
- the tapered bone anchor receptacle 246 has grooves 268 therein adapted to accommodate the suture 254 .
- the tapered bone anchor receptacle 246 may extend from the proximal end 266 of the inner cylinder 244 by a distance of from about 0.3 inches to about 0.7 inches. Preferably, the tapered bone anchor receptacle 246 extends from the proximal end 266 of the inner cylinder 244 by a distance of from about 0.4 inches to about 0.6 inches. More preferably, the tapered bone anchor receptacle 246 extends from the proximal end 266 of the inner cylinder 244 by a distance of about 0.5 inches.
- the distal end 270 of the tapered bone anchor receptacle 246 preferably has a width smaller than that of the proximal end 266 of the inner cylinder 244 .
- This configuration produces a shoulder 272 which may serve as a depth stop to ensure that the bone anchor 248 is driven into the bone to the desired depth.
- the distal end 270 of the tapered bone anchor receptacle 246 may be from about 0.08 inches to about 0.12 inches in width. Preferably, the distal end 270 of the tapered bone anchor receptacle 246 is from about 0.09 inches to about 0.110 inches in width. More preferably, the distal end of the tapered bone anchor receptacle 246 is 0.1 inches in width.
- the proximal end 274 of the tapered bone anchor receptacle 246 may be from about 0.110 inches to about 0.15 inches in width.
- the proximal end 274 of the tapered bone anchor receptacle 246 is from about 0.12 inches to about 0.14 inches in width. More preferably, the proximal end 274 of the tapered bone anchor receptacle 246 is 0.13 inches in width.
- the proximal end 274 of the tapered bone anchor receptacle 246 may have a variety of cross sectional shapes adapted to releasably engage the bone anchor 248 .
- the proximal end 274 of the tapered bone anchor receptacle 246 may be square, rectangular, pentagonal, triangular or hexagonal in cross section.
- the tapered bone anchor receptacle 246 may have a notch 276 therein in which the bone anchor 248 is releasably seated.
- the outer cylinder, inner cylinder, and tapered bone anchor receptacle may be a single integral component.
- the bone anchor implantation device has a protective sheath connected to the bone anchor mount which protects the point of the bone anchor from tissue contact during placement of the device and also protects the bone anchor from contacting potentially infectious microorganisms.
- the protective sheath 278 comprises a first telescoping cylinder 280 and a second telescoping cylinder 282 .
- a spring 284 biases the first telescoping cylinder 280 and the second telescoping cylinder 282 to a position in which they extend from the outer cylinder 242 and cover the bone anchor 248 .
- the first and second telescoping cylinders 280 , 282 may be made of a variety of materials such as stainless steel or plastic. Preferably, the first and second telescoping cylinders 280 , 282 are made of stainless steel.
- the first telescoping cylinder 280 has a lumen 286 extending therethrough.
- the first telescoping 280 cylinder has a first shoulder 288 which engages shoulder 262 on the outer cylinder 242 and a second shoulder 290 which engages a first shoulder 292 on the second telescoping cylinder 282 .
- the second telescoping cylinder 282 has a first shoulder 292 which engages the second shoulder 290 on the first telescoping cylinder 280 as described above.
- a second shoulder 294 is located at the proximal end of the second telescoping cylinder 282 and engages the spring 284 .
- the second telescoping cylinder 282 also has a lumen 296 extending therethrough which is in fluid communication with the lumen 286 of the first telescoping cylinder 280 and the cavity 258 in the outer cylinder 242 .
- the inner diameter of the first telescoping cylinder 280 is slightly larger than the outer diameter of the second telescoping cylinder 282 such that the second telescoping cylinder 282 can retract inside the first telescoping cylinder 280 .
- the first telescoping cylinder 280 and the second telescoping 282 can retract inside the cavity 258 of the outer cylinder 242 .
- the first telescoping cylinder 280 may be from about 0.2 inches to about 0.3 inches in length, with an inner diameter of from about 0.27 inches to about 0.33 inches and an outer diameter of about 0.3 inches to about 0.36 inches.
- the first telescoping cylinder 280 is from about 0.23 inches to about 0.27 inches in length, with an inner diameter of from about 0.29 inches to about 0.31 inches and an outer diameter of about 0.32 inches to about 0.34 inches. More preferably, the first telescoping cylinder 280 is about 0.25 inches in length, with an inner diameter of about 0.3 inches and an outer diameter of about 0.33 inches.
- the second telescoping cylinder 282 may be from about 0.2 inches to about 0.3 inches in length, with an inner diameter of from about 0.22 inches to about 0.31 inches and an outer diameter of about 0.25 inches to about 0.35 inches.
- the second telescoping cylinder 282 is from about 0.23 inches to about 0.27 inches in length, with an inner diameter of from about 0.24 inches to about 0.29 inches and an outer diameter of about 0.27 inches to about 0.33 inches. More preferably, the second telescoping cylinder 282 is about 0.25 inches in length, with an inner diameter of about 0.27 inches and an outer diameter of about 0.3 inches.
- a spring 284 biases the first and second telescoping cylinders 280 and 282 towards a position in which the first telescoping cylinder 280 and the second telescoping cylinder 282 are extended from the outer cylinder 242 .
- FIGS. 25 and 26 a Another embodiment of the protective sheath is depicted in FIGS. 25 and 26 a .
- the bone anchor implantation device as described above with respect to FIGS. 14 - 17 has a balloon which encapsulates the bone anchor.
- the bone anchor implantation device 210 has a balloon 279 which is coupled to the bone anchor mount 238 and which covers the bone anchor 279 .
- the balloon 279 protects the bone anchor from contacting potentially infections microorganisms prior to implantation.
- the balloon 279 may be made of any material which exhibits a strength that allows it to be punctured by the bone anchor. Examples of suitable materials include plastic, thermoplastic, elastromers, PET, PETG, rubber, vinyl, latex, gelatin or silicone. In a preferred embodiment, the balloon is made of latex.
- the balloon 279 can be made of a biodegradable material.
- a suitable biodegradable material dissolves within the patient after a predetermined period of time. Following implantation of the bone anchor the punctured sheath remains are simply metabolized by natural biological processes.
- the balloon comprises a biodegradable polymer.
- the polymer may be either natural or synthetic. Synthetic polymers offer greater advantages that natural materials in that they can be tailored to give a wider range of properties and are more uniform than materials from natural sources. Synthetic polymers also offer a more reliable source of raw materials which reduce the risks of invoking an immunogenic response.
- Biodegradable polymers are synthesized from chemical functional groups such as, for example, esters, anhydrides, orthoesters and amides, which have hydrolytically unstable linkages in the backbone.
- the balloon is made of a biodegradable materials such as polyglycotic acid (PGA), polylactic acid (PLA), poly (dioxanone)(PDO), poly (l-lactide)(LPLA), poly (dl-lactide)(DLPLA), poly (glycolide-co-trimethylene carbonate) (PGA-TMC), poly (l-lactide-co-glycolide) (PGA-LPLA), poly (dl-lactide-co-glycolide) (PGA-DLPLA), poly (l-lactide-co-dl-lactide) (LPLA-DLPLA), poly(glycolide-co-trimethylene carbonate-co-dioxanone) (PDO-PGA-TMC), poly( ⁇ -caprolact
- PGA poly
- the balloon or structure can be filled with air, water, antibiotic or any substance which inflates the balloon so as to prevent the bone anchor from puncturing the balloon prior to implantation.
- the device may further include a spring which is attached to the shaft within the balloon to maintains the shape of the balloon and prevent the bone anchor from puncturing the balloon prematurely.
- the balloon 278 contains an antibiotic that is released when the sheath is perforated by the bone anchor during implantation.
- the balloon may contain several antibiotics that have complementary activity. The antibiotic prevents infection at the site where the bone anchor is pressed into the bone.
- Non-limiting examples of suitable antibiotics for use in the invention include nafcillin, aminogylcoside, ciprofloxin, clindamcin, piperacillin/tazobactum, ampicillin/sulbactum, aminoglcoside, vancomycin, cephalosporin, TMP/SMX, ampicillin, gentaminicin, tobramycin and ciprofloxacin.
- the bone anchor implantation device further comprises an port 280 which allows antibiotics to be inserted into the balloon.
- the port 280 extends from the balloon 279 into a lumen which extends from one end of the shaft to the other.
- the port 280 has an opening 282 at the distal end of the shaft. Antibiotics inserted into the opening 282 travel through the port 280 into the balloon 279 .
- the port extends from the balloon into a lumen which extends from one end of the shaft to the other end and through the handle to an opening.
- the invention features a bone anchor implantation 210 device that has a spring element attached to the shaft within the balloon which retracts when the balloon contacts the bone anchor implantation site causing the bone anchor to perforate the balloon and implant in the bone.
- the spring element reduces the amount of force required to perforate the sheath and implant the bone anchor in the bone.
- the spring element 285 can be any type of spring which is elastically or plastically deformable.
- the spring element 285 has a first end 286 which is attached or grounded to the bone anchor mount 238 and a second floating end 287 which contacts the balloon.
- the spring is a compression spring which is normally in an open position.
- a compression spring retracts when pressure is applied causing the point to puncture the balloon.
- the spring element 285 can be an open-coiled helical spring which surrounds the bone anchor 248 .
- the spring mechanism 285 must have some minimum deflection strength so as to prevent the bone anchor from puncturing the balloon prematurely during insertion but must have enough deflection strength to puncture the balloon when force is applied to the bone anchor implantation device at the desired location.
- the balloon 279 which covers the spring and the bone anchor has the same attributes as the balloon discussed above with respect to FIGS. 25 - 26 a.
- FIG. 26 b Another embodiment of the protective sheath is illustrated in FIG. 26 b .
- the bone anchor implantation device 210 as described above with respect to FIGS. 14 - 17 has a gelatin structure 290 which covers the bone anchor.
- the bone anchor implantation device 210 has a gelatin structure or caplet which is coupled to the bone anchor mount 238 and which encapsulates the bone anchor 248 .
- the gelatin structure 290 protects the bone anchor 248 from contamination.
- the gelatin structure may be filled with an antibiotic.
- the device may also include a port for inserting antibiotic into the gelatin structure.
- FIGS. 17 - 20 and FIG. 27 An alternative embodiment of the bone anchor implantation device 310 is shown in FIGS. 17 - 20 and FIG. 27.
- the shaft 320 has a generally straight proximal section 399 , a first generally bent section 397 , a generally straight median section 395 , a second bent section 393 , a generally curved section 391 , and a distal generally straight section 389 .
- the straight proximal section 399 may be from about 3.0 inches to about 6.0 inches in length. Preferably, the straight proximal section 399 is from about 4.0 inches to about 5.0 inches in length. More preferably, the straight proximal section 399 is about 4.5 inches in length.
- the first bent section 397 may be from about 1.0 inches to about 3.0 inches in length. Preferably, the first bent section 397 is from about 1.5 inches to about 2.5 inches in length. More preferably, the first bent section 397 is about 2 inches in length.
- the first bent section 397 may bend at an angle of from about 35° to about 55° relative to the straight proximal section 399 .
- the first bent section 397 bends at an angle of from about 40° to about 50° relative to the straight proximal section 399 . More preferably, the first bent section 397 bends at an angle of about 45° relative to the straight proximal section 399 .
- the straight median section 395 may be from about 2 inches to about 4 inches in length. Preferably, the straight median section 395 is from about 2.5 inches to about 3.5 inches in length. More preferably, the straight median section 395 is about 3 inches in length.
- the second bent section 393 may be from about 0.5 inches to about 2.5 inches in length. Preferably, the second bent section 393 is from about 1.0 inches to about 2.0 inches in length. More preferably, the second bent section 393 is about 1.5 inches in length.
- the second bent section 393 may bend at an angle of from about 125° to about 145° relative to the straight median section 395 .
- the second bent section 393 bends at an angle of from about 130° to about 140° relative to the straight median section 395 . More preferably, the second bent section 393 bends at an angle of about 135° relative to the straight median section 395 .
- the curved section 391 may curve through an arc of from about 700 to about 110° with a radius from about 0.2 inches to about 0.6 inches.
- the curved section curves 391 through an arc of from about 80° to about 100° with a radius from about 0.3 inches to about 0.5 inches. More preferably, the curved section 391 curves through an arc of about 90° with a radius of 0.4 inches.
- the distal straight section 389 may be from about 0.5 inches to about 0.9 inches in length. Preferably, the distal straight section 389 is from about 0.6 inches to about 0.8 inches in length. More preferably, the distal straight section 389 is about 0.7 inches in length.
- the shaft 320 has a lumen extending therethrough.
- the lumen may have a diameter from about 0.03 inches to about 0.07 inches and the shaft 320 may have an outer diameter from about 0.2 inches to about 0.3 inches.
- the lumen has a diameter from about 0.04 inches to about 0.06 inches and the shaft 320 has an outer diameter from about 0.24 inches to about 0.26 inches. More preferably, the lumen has a diameter of about 0.05 inches and the shaft 320 has an outer diameter of about 0.250 inches.
- the shaft 320 has an insert 387 therein with a lumen 385 extending therethrough as best illustrated in the cross section of FIG. 19.
- the insert 387 may be made of a variety of materials such as stainless steel or plastic.
- the insert 387 has an outer diameter approximately that of the diameter of the lumen in the shaft such that the insert 387 fits snugly within the lumen of the shaft.
- the insert 387 may have an outer diameter from about 0.2 inches to about 0.3 inches.
- the insert 387 has an outer diameter from about 0.21 inches to about 0.27 inches. More preferably, the insert 387 has an outer diameter of about 0.23 inches.
- the insert 387 has a lumen 385 extending therethrough having a diameter large enough to accommodate a suture 354 .
- the diameter of the lumen 385 may be from about 0.02 inches to about 0.100 inches.
- the diameter of the lumen 385 is from about 0.04 inches to about 0.08 inches. More preferably, the diameter of the lumen 385 is about 0.06 inches.
- the shaft 320 has a bore therein which is large enough to permit the suture 354 to exit from the shaft 320 .
- the bore is located in the straight median section 395 at a position in which it is located outside of the patient's body when the bone anchor 348 has been inserted into the patient's bone.
- the bore may be located in other locations such as the first bent section 397 .
- the shaft 320 extends through a lumen 383 in the handle 312 .
- the lumen 383 has a narrow distal section 381 having a diameter slightly larger than the outer diameter of the shaft 320 and a wide proximal section 373 adapted to receive a spring 371 .
- the shaft 320 passes through the interior of the spring 371 as depicted in FIGS. 17 and 20.
- the distal end of the spring 371 contacts the distal end of the wider proximal section 373 of the lumen.
- the proximal end of the spring contacts a plug 369 .
- the plug 369 has a lumen through which the shaft 320 passes and a bore adapted to receive a screw 367 .
- the screw 367 passes through the bore in the plug 369 and a bore in the shaft 320 which is aligned with the bore in the plug, thereby securing the shaft 320 to the plug 369 .
- the resistance of the spring 371 is selected to be equal to the force with which the bone anchor 348 is to be driven into the bone. For example, where the bone anchor 348 is to be driven into the bone by applying 20 pounds of force, the spring 371 is a 20 pound spring. The spring indicates when the desired amount of force has been applied because the user can sense when the spring has been completely compressed.
- the spring 371 may have a resistance of from about 5 to about 35 pounds. Preferably, the spring 371 has a resistance from about 15 to 25 pounds. More preferably, the spring 371 has a resistance of 20 pounds.
- anchor implantation device shown in FIGS. 13 - 16 may also be adapted to include a force indicating spring in the handle.
- a bone anchor mount 338 and a protective sheath 378 as described above with respect to the embodiment of FIGS. 13 - 16 are attached to the end of the distal straight section 389 .
- the protective sheath on the bone anchor implantation device 310 is a balloon 279 as described above with respect to the embodiments of FIGS. 25 and 26 a .
- the balloon is attached to the distal straight section 389 of the bone anchor implantation device 310 as described above with respect to the embodiment of FIGS. 24 and 25.
- the device may further comprise a spring element as discussed above with respect to FIG. 38.
- the hooked bone anchor implantation devices 210 , 310 are used as follows. An incision in the anterior vaginal wall is made as described above. The site for bone anchor implantation is located by palpation as described above.
- the hooked bone anchor implantation device 210 , 310 is inserted into the vagina as shown in FIGS. 17 and 21 with the patient in the lithotomy position and the surgeon located between the patient's legs.
- the shaft 220 , 320 is inserted through the incision and the protective sheath 278 , 378 is positioned such that the proximal end of the second telescoping cylinder 282 , 382 contacts the pubic bone 219 , 319 as shown in FIGS. 17, 21 and 23 .
- the first and second telescoping cylinders 280 , 380 , 282 , 382 are biased to a position in which they extend from the outer cylinder 242 , 342 to cover the bone anchor.
- the bone anchor is inserted into the bone by applying a retrograde force to the bone anchor.
- the retrograde force can be applied in a number of ways as will be apparent to one of skill in the art.
- the bone anchor is implanted by pulling the handle.
- the handle may be pulled in a retrograde direction (toward the user) to implant the anchor as shown in FIGS. 20 and 22.
- the first and second telescoping cylinders 280 , 282 , 380 , 382 retract inside the cavity 258 , 358 of the outer cylinder as shown in FIGS. 20, 22 and 24 and the bone anchor 248 , 348 is driven into the pubic bone 219 , 319 .
- the user need only apply a small amount of force, such as 10-20 pounds, in order to drive the bone anchor 248 , 348 into the bone 219 , 319 .
- the device 210 , 310 is then pushed away from the implanted anchor to disengage the device from the anchor.
- the device is then removed from the vagina, leaving the bone anchor 248 , 319 in the bone 219 , 319 with the suture extending therefrom.
- the bladder neck is then compressed, suspended or stabilized using the suture(s) extending from the bone anchor(s) as described above.
- the spring 371 is compressed when the handle is pulled in a retrograde direction to drive the bone anchor into the bone.
- the user can detect when the spring 371 has been completely compressed, or compressed by a predetermined amount, indicating that the desired amount of force for driving the bone anchor into the bone has been applied.
- the hooked bone anchor implantation device with balloon illustrated in FIGS. 25 - 27 is used as follows. An incision in the anterior vaginal wall is made as described above. The site for bone anchor implantation is located by palpation of the urethra, pubic symphsis or other anatomical landmark or other techniques known by those skilled in the art.
- the hooked bone anchor implantation device with a balloon or gelatin structure 210 , 310 is inserted into the vagina as shown in FIGS. 27 and 28 with the patient in the lithotomy position and the surgeon located between the patient's legs.
- the shaft 220 , 320 is inserted through the incision and the balloon or gelatin structure 279 , 379 is positioned such that the balloon or gelatin structure 279 contacts the pubic bone 219 , 319 as shown in FIGS. 27 and 28.
- the bone anchor is inserted into the bone by applying a retrograde force to the bone anchor 238 , 348 .
- the force is transmitted through the bone anchor implantation device 210 , 310 to the bone anchor 279 , 379 and causes the balloon or gelatin structure 279 , 379 to press against the pubic bone 279 , 379 .
- the application of additional force causes the bone anchor point to puncture the balloon or gelatin structure 279 , 379 and drives the bone anchor 248 , 348 into the pubic bone 219 , 319 . Because the patient's body weight provides an opposing force, the user need only apply a small amount of force, such as 10-20 pounds, in order to drive the bone anchor 248 , 348 into the bone 219 , 319 .
- the retrograde force retracts a spring element attached to the shaft within the balloon which causes the bone anchor to perforate the sheath and implant into the bone.
- an antibiotic is inserted into the balloon or gelatin structure and is released when the sheath is punctured.
- the antibiotic may be inserted into the balloon or gelatin structure via a port which extends from one end of the shaft to the other end of the shaft into the balloon.
- the device 210 , 310 is then pushed away from the implanted anchor to disengage the device from the anchor.
- the device is then removed from the vagina, leaving the bone anchor 248 , 319 in the bone 219 , 319 with the suture extending therefrom.
- the bladder neck is then compressed, suspended or stabilized using the suture(s) extending from the bone anchor(s) as described above.
- FIGS. 39 - 45 Other embodiments of the invention, particularly various types of protective sheaths which prevent premature insertion, are illustrated in FIGS. 39 - 45 .
- FIGS. 39 - 40 b illustrate a bone anchor implantation device with a telescoping sheath which retracts upon insertion.
- the bone anchor implantation device with telescoping sheath comprises a handle 512 , a hooked shaped shaft 520 secured to the handle 212 , a bone anchor mount 538 adapted to releasably engage a bone anchor 548 and attached at the distal end of the shaft 520 , and a telescoping sheath 550 which attaches to the bone anchor mount 538 and covers the bone anchor 548 .
- FIG. 40 a depicts the telescoping sheath 550 in an extended or open position covering the bone anchor 548 .
- FIG. 40B illustrates the telescoping sheath 550 in a retracted position. Details regarding the telescoping sheath are discussed above with reference to FIGS. 13 - 16 .
- a spring biases the telescoping sheath 550 between extended and retracted positions.
- the bone anchor implantation device with telescoping sheath shown in FIG. 39 is inserted into the vagina 908 and positioned so that the telescoping sheath 950 contacts the pubic bone 918 .
- the bone anchor 948 is then inserted by applying a retrograde force to the bone anchor 948 by pulling the handle 912 of the device in a retrograde direction.
- FIGS. 41 a and 41 b illustrate a hooked-shaped bone anchor implantation device which a balloon 650 covering the bone anchor 648 .
- the device comprises a handle 612 , a hooked-shaped shaft secured to the handle 612 , a bone anchor mount 638 attached to the distal end of the shaft and adapted to releasably engage a bone anchor 648 , and a balloon 650 which covers the bone anchor 648 .
- the balloon 650 may be filled with one or more antibiotics to combat infection at he implantation site.
- the device may also comprise a port 680 for inserting antibiotics into the balloon. The balloon is perfed away upon implantation.
- FIGS. 42 a and 42 b illustrate a bone anchor implantation device having a latex sheath 750 with a spring element 779 which covers the bone anchor 748 .
- the spring element can be any type of spring which is elastically or plastically deformable.
- the spring is a compression spring such as a coiled helical spring which surrounds the bone anchor and which retracts when pressure is applied.
- the latex sheath can be hermetically sealed to the bone anchor implantation device.
- the sheath may also be filled with one or more antibiotics to prevent infection at the implantation site.
- the latex sheath perfs away upon implantation.
- FIG. 43 illustrates a bone anchor implantation device with gelatin structure or a capsule 890 that covers the bone anchor 888
- the capsule 890 can be coupled to the bone anchor mount 838 .
- the capsule 890 can be made of biodegradable materials such as those described above with reference to the balloon sheath illustrated in FIGS. 25 and 26 a .
- the caplet is made of gelatin.
- the bone anchor 888 perfs the capsule 890 and any remaining capsule particles are absorbed or metabolized.
- FIG. 44 illustrates a bone anchor implantation device that has a sheath 802 with a lumen 805 that a diameter large enough to accommodate one or more sutures 808 which are preattached to the bone anchor 848 .
- the sheath 802 protect the sutures 808 from contamination. Further details regarding a shaft with a lumen that accommodates one or more sutures are discussed above with respect to FIGS. 17 - 20 .
- the bone anchor 848 with attached sutures 808 has a screw or locking device 804 which secures the bone anchor 848 to the bone anchor implantation device.
- the locking mechanism 804 prevents accidental insertion of the bone anchor 848 into tissue.
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Abstract
Bone anchor implantation devices and methods for their use are disclosed. The bone anchor implantation devices and methods find particular application in maintaining or improving urinary continence by suspending or stabilizing the bladder neck. Protective sheaths for covering a bone anchor on a bone anchor implantation device are disclosed. The protective sheaths protect the bone anchor from contacting tissue during insertion and prevent contamination of the bone anchor.
Description
- This is a continuation-in-part of U.S. patent application Ser. No. 08/744,438 filed Nov. 8, 1996. This also is based on and claims priority to and the benefit of U.S. Provisional Patent Application Ser. No. 60/072,641 filed Jan. 27, 1998. The entirety of these two priority documents are hereby incorporated herein by reference.
- This invention relates to a protective sheath or cap for a bone anchor implantation device. The bone anchor implantation device is used in maintaining or improving urinary continence.
- Urinary incontinence, the inability to control urination from the bladder, is a widespread problem in the United States and throughout the world. Urinary incontinence affects people of all ages and can severely impact a patient both physiologically and psychologically.
- In approximately 30% of the women suffering from urinary incontinence, incontinence is caused by intrinsic sphincter deficiency (ISD), a condition in which the valves of the urethral sphincter do not properly coapt. In approximately another 30% of incontinent women, incontinence is caused by hypermobility, a condition in which the muscles around the bladder relax, causing the bladder neck and proximal urethra to rotate and descend in response to increases in intraabdominal pressure. Hypermobility may be the result of child delivery or other conditions which weaken, stretch or tear the muscles. In an additional group of women with urinary incontinence, the condition is caused by a combination of ISD and hypermobility.
- In males, urinary incontinence may be the consequence of post radical prostatectomy, which can destroy the valves of the urethral sphincter.
- In addition to the conditions described above, urinary incontinence has a number of other causes, including birth defects, disease, injury, aging, and urinary tract infection.
- Numerous approaches for treating urinary incontinence are available. In one procedure, referred to as bladder neck stabilization (BNS), sutures are placed around the muscles on either side of the urethra and affixed to the rectus fascia or pubic bone and tensioned to treat hypermobility. Other procedures which treat both hypermobility and intrinsic sphincter deficiency (ISD) involve the placement of a sling under the urethra/bladder which compresses the sphincter while simultaneously acting as a stabilizer of the bladderneck (preventing excessive downward mobility). The bone anchors which support the sling sutures may be inserted into rectus fascia or various locations on the pubis bone to provide a non-moveable anchoring method.
- The present invention generally relates to devices and methods for inserting anchors, such as bone anchors, into a bone or tissue and more particularly to a protective sheath or cap for isolating the bone anchor to prevent both accidents with the sharp bone anchor before it is inserted into a target site and contamination of the target site by insertion of the bone anchor therethrough.
- Bone anchors are often attached into bones in order to provide support for a “sling” useful in improving or maintaining a patient's urinary incontinence. In one procedure, a suture-carrying anchor is driven through the vaginal wall and into the posterior portion of the pubic bone or symphysis pubic, and the suture(s) attached to the bone anchor(s) extend through the vaginal wall and may be attached to the endopelvic fascia, the vaginal wall, a sling, or other material to stabilize and/or slightly compress the urethra thereby improving the patient's urinary incontinence. The present invention effectively addresses concerns in affixing an anchor to bone or tissue.
- The present invention is directed to a protective sheath for the bone anchor. The protective sheath prevents accidents with the sharp bone anchor tip before insertion into the target site, and it prevents infection of the pubic bone. The protective sheath prevents exposure and accidental puncture of the surgeon's gloves as well as premature insertion into unintended tissue in the patient. It also provides a sterile barrier around the bone anchor. The protective sheath shields the bone anchor from contacting microorganisms in the vagina and area surrounding the implantation site during insertion. The protective sheath of the present invention ensures that the bone anchor implants into the bone implantation site free from contamination and thus prevents the occurrence of biological complications.
- One aspect of the present invention is a bone anchor implantation device comprising an elongated member having a first end and a second end, and a related method. A bone anchor is releasably engaged to the elongated member in the vicinity of the first end. A protective sheath is mounted over the bone anchor. The protective sheath can be axially movable relative to the bone anchor such that the bone anchor is exposed from the sheath as the bone anchor is pressed into a bone by the elongated member. Alternatively, the protective sheath can be a balloon, gelatin structure, or other covering that encapsulates or covers the bone anchor prior to implantation. The balloon or thin film can be hermetically sealed around the bone anchor, but in any case the balloon isolates the bone anchor from contact with tissue and prevents contamination prior to implantation of the bone anchor. The balloon is perforated by the bone anchor as the bone anchor is pressed into the bone by the elongated member or shaft. The balloon may be made of a variety of materials such as plastic, thermoplastic, elastromers, PET, PETG, rubber, vinyl, latex, or silicone. In one preferred embodiment, the balloon is made of latex. The balloon can also be made of a biodegradable material. In another preferred embodiment, the balloon comprises a polymer such as a synthetic polymer. Nonlimiting examples of useful polymers include the following: polyglycolic acid (PGA), polyactic acid(PLA), poly (dioxanone)(PDO), poly (l-lactide) (LPLA), poly (dl-lactide)(DLPLA), poly (glycolide-co-trimethylene carbonate)(PGA-TMC), poly (l-lactide-co-glycolide)(PGA-LPLA), poly (dl-lactide-co-glycolide) (PGA-DLPLA), poly(l-lactide-co-dl-lactide)(LPLA-DLPLA), poly(glycolide-co-trimethylene carbonate-co-dioxanone)(PDO-PGA-TMC), poly(ε-caprolactone), poly(dioxanone)(a polyether-ester), poly(lactide-co-glycotide), poly(SA-HDA anhydride), poly(orthoester), and polyglyconate. The protective sheath can also take the form of a gelatin structure (similar to a pill capsule).
- In some embodiments, the protective sheath (e.g. balloon or gelatin structure) can contain an antibiotic which is released when the sheath is perforated by the bone anchor. The antibiotic prevents infection at the site where the bone anchor is pressed into the bone. Nonlimiting examples of antibiotics which can be used include the following: nafcillin, aminogylcoside, ciprofloxin, clindamcin, piperacillin/tazobactum, ampicillin/sulbactum, aminoglcoside, vancomycin, cephalosporin, TMP/SMX, ampicillin, gentaminicin, tobramycin, and ciprofloxacin. Those skilled in the art will appreciate that there are numerous ways to insert the antibiotic into the balloon or the gelatin structure. In one embodiment, the bone anchor implantation device has a port which extends from the first end to the second end of the shaft into the balloon or gelatin structure. Antibiotics can be inserted into the protective sheath through a port.
- In general, in another aspect, the invention features a bone anchor implantation device which has a spring attached to the sheath within the balloon which retracts when the sheath is pressed against the bone by the shaft, thereby causing the bone anchor to perforate the balloon and implant into the bone. The spring element may be an open-coiled helical spring which surrounds the bone anchor. The spring element retracts when pressure is applied to the sheath causing the bone anchor to puncture the balloon.
- In some embodiments, the shaft of the bone anchor implantation device can have a hollow section which accommodates one or more sutures coupled to the releasably engaged bone anchor. Also, the shaft preferably is hook shaped.
- A method for inserting such a bone anchor that is releasably engaged to such a bone anchor implantation device can include the steps of locating a bone anchor implantation site on the bone and applying a retrograde force to the bone anchor to implant the bone anchor into the bone or to retract the spring to cause the bone anchor to perforate the sheath and implant into the bone.
- The foregoing and other objects, aspects, features, and advantages of the invention will become more apparent from the following description and from the claims.
- In the drawings, like reference characters generally refer to the same parts throughout the different views. Also, the drawings are not necessarily to scale, emphasis instead generally being placed upon illustrating the principles of the invention.
- FIG. 1 is a plan view of the bone anchor implantation device.
- FIG. 2 is an exploded view of the anchor implantation device.
- FIG. 3 is a cross-sectional view of the distal end of the cannula showing the protective cap therein taken along line3-3 of FIG. 2.
- FIG. 4 is a cross-sectional view of the bone anchor implantation device of FIG. 1 taken along line4-4 of FIG. 1.
- FIG. 5 is a cross-sectional view of the bone anchor implantation in its locked configuration.
- FIG. 6 is a plan view of an alternate embodiment of the bone anchor implantation device having a keyhole-shaped bore in the second handle.
- FIG. 7 is a cross-sectional view taken along line7-7 of the alternate embodiment shown in FIG. 6 locked in the position in which the inserter shaft is fully extended from the cannula.
- FIG. 8 is a cross-sectional view of the alternate embodiment of FIG. 6 locked in the position in which the inserter shaft is fully retracted within the cannula.
- FIG. 9 is a cross-sectional view of the distal end of the inserter shaft in the cannula showing location of the bone anchor implantation site by sliding the cannula along the endopelvic fascia.
- FIG. 10 is a cross-sectional view of the distal end of the inserter shaft and the cannula showing the inserter shaft penetrating the protective cap near the distal end of the cannula.
- FIG. 11 is a cross-sectional view of the distal ends of the inserter shaft in the cannula showing the bone anchor being drive into the bone.
- FIG. 12 shows the bone anchor with sutures extending therefrom after implantation into the bone.
- FIG. 13 is a side view of a bone anchor implantation device having a hooked shaft.
- FIG. 14 is an enlarged side view of a distal portion of the bone anchor implantation device taken along line14-14 of FIG. 13 showing the internal structure of the bone anchor mount.
- FIG. 15 is a perspective view of the bone anchor mount.
- FIG. 16 is a cross sectional view of the bone anchor mount of FIG. 15 taken along line16-16.
- FIG. 17 is a schematic view showing the interior structure of the handle an alternate embodiment of the bone anchor implantation device inserted into the vagina with the proximal end of the second telescoping cylinder contacting the pubic bone.
- FIG. 18 is an enlarged view of the shaft of the alternate embodiment of the bone anchor implantation device illustrated in FIG. 17.
- FIG. 19 is a cross sectional view of the shaft of the bone anchor implantation device shown in FIG. 18 taken along line19-19 of FIG. 18.
- FIG. 20 is a schematic view showing the interior structure of the handle of an alternate embodiment of the bone anchor implantation device illustrated in FIG. 17 inserted into the vagina showing the implantation of a bone anchor into the pubic bone and the compression of the spring.
- FIG. 21 is a side view of the bone anchor implantation device of FIG. 13 showing a protective sheath contacting the pubic bone.
- FIG. 22 is a side view of the bone anchor implantation device of FIG. 13 showing the bone anchor implanted into the pubic bone.
- FIG. 23 is a cross sectional view of the bone anchor mount and protective sheath when the protective sheath is containing the pubic bone.
- FIG. 24 is a cross sectional view of the bone anchor mount and the protective sheath when the bone anchor is being implanted into the pubic bone.
- FIG. 25 is a side view of a bone anchor implantation device having a hooked-shaped shaft and a balloon.
- FIG. 26a is a perspective view of the bone anchor and a balloon.
- FIG. 26b is a perspective view of a bone anchor and a gelatin structure.
- FIG. 27 is a schematic view showing the interior structure of the handle of an alternate embodiment of the bone anchor implantation device with balloon inserted into the vagina with the proximal end of the second telescoping cylinder contacting the pubic bone.
- FIG. 28 is a side view of the bone anchor implantation device of FIG. 25 showing a balloon contacting the pubic bone.
- FIG. 29 is a side view of the bone anchor implantation device of FIG. 25 showing the bone anchor implanted into the pubic bone.
- FIG. 30 is a side elevational view of a bone anchor.
- FIG. 31 is a side elevational view of the spear member of bone anchor shown in FIG. 30.
- FIG. 32 is a rear elevational view of the spear member of the bone anchor shown in FIG. 30.
- FIG. 33 is an enlarged sectional view of a shaft of the spear member of the bone anchor taken along the lines4-4 of FIG. 31.
- FIG. 34 is a side elevational view of a collar member of the bone anchor shown in FIG. 30.
- FIG. 35 is a rear elevational view of the collar member of the bone anchor shown in FIG. 30.
- FIG. 36 is a side elevational view of the collar member of the bone anchor taken along the direction of the lines7-7 of FIG. 35.
- FIG. 37 is a sectional view of the collar member of the bone anchor taken along the lines8-8 of FIG. 35.
- FIG. 38 is a perspective view of the bone anchor tip on a bone anchor implantation device having a balloon with a spring element.
- FIG. 39 is a side view of a bone anchor implantation device with a telescoping sheath.
- FIG. 40a is an enlarged view of the telescoping sheath of FIG. 39 with the telescoping sheath in an expanded position.
- FIG. 40b is an enlarged view of the telescoping sheath of FIG. 39 with the telescoping sheath in a retracted position.
- FIG. 41 a is a view of a bone anchor implantation device with a balloon sheath.
- FIG. 41b is an enlarged view of the balloon sheath on bone anchor implantation device of FIG. 41a.
- FIG. 42a is a view of a bone anchor implantation device with a latex sheath and a spring element.
- FIG. 42b is another view of the bone anchor implantation with a latex sheath and a spring element.
- FIG. 43 is a view of a bone anchor implantation device with a caplet sheath.
- FIG. 44 is a view of a bone anchor implantation device that has a lumen that can hold one or more sutures.
- FIG. 45 is a view of a bone anchor implantation device of FIG. 39 inserted into the vagina showing the implantation of a bone anchor into the pubic bone.
- The present invention relates to a device for affixing a bone anchor to a bone. More particularly, the invention relates to a protective sheath for protecting the bone anchor from contacting tissue during implantation and thereby preventing contamination of the bone anchor. It also relates to methods for improving or maintaining a patient's urinary continence in which bone anchors are inserted transvaginally into the posterior portion of the pubic bone or symphysis pubis and devices for use in such methods. As used herein, the terms “transvaginally” or “transvaginal access” refer to access through the vaginal introitus or from within the vagina, as opposed to access from the patient's abdominal side.
- As will be described in more detail below, the methods and devices of the present invention drive a bone anchor through the vaginal wall and into the posterior portion of the pubic bone or symphysis pubis. The public bone may also be accessed through a suprapublic bone incision. Preferably, at least one bone anchor is driven into the pubic bone on either side of the urethra. However, one of skill in the art will appreciate that a single bone anchor may also be used. The sutures attached to the bone anchors extend through the vaginal wall and may then be attached to the endopelvic fascia, the vaginal wall, a sling, or other material to stabilize and/or slightly compress the urethra, thereby improving or maintaining the patient's urinary continence.
- Two Handle Bone Anchor Implantation Device
- In one embodiment, the anchor implantation device has a first handle having an inserter shaft attached thereto. The inserter shaft is adapted to releasably engage or attach to a bone anchor. A second handle is hingedly attached to the first handle and has a cannula attached thereto. The cannula has a central bore extending therethrough. The cannula is aligned with the inserter shaft such that the inserter shaft is inside the central bore of the cannula and is extendible from and retractable in the cannula. Preferably, a biasing member is disposed between the first handle and the second and biases the first handle and the second handle apart.
- FIGS. 1 and 2 provide a plan view and an exploded view of an
anchor implantation device 10 for introducing abone anchor 22 transvaginally and driving it into the pubic bone or symphysis pubis. The device comprises afirst handle 12 having aproximal end 14, acentral region 16, and adistal end 18. Thefirst handle 12 may be made of any relatively firm material, including plastic or metal. Preferably, thefirst handle 12 is made of plastic, aluminum, stainless steel, or titanium. However, those skilled in the art will appreciate that a wide range of other material may also be employed. - The
first handle 12 may be configured in any of a variety of shapes compatible with vaginal insertion. Preferably, thefirst handle 12 is rectangular. However, those skilled in the art will appreciate that a variety of configurations may be employed, such as a handle which tapers towards the distal end, and the present invention contemplates the use of any handle configuration compatible with vaginal insertion. - The dimensions of the
first handle 12 are also compatible with vaginal insertion. Thefirst handle 12 may be from about 4 inches to about 8 inches in length, about 0.25 inches to about 1.25 inches in width, and about 0.05 inches to about 0.5 inches in height. Preferably, thefirst handle 12 is about 5 inches to about 7 inches in length, about 0.5 inches to about 1 inch in width, and about 0.1 inches to about 0.3 inches in height. More preferably, thefirst handle 12 is has a length of 6 inches, a width of 0.75 inches and a height of 0.2 inches. - An
inserter shaft 20 adapted for releasably engaging abone anchor 22 is located near thedistal end 18 of thefirst handle 12. A variety of bone anchors 22 can be used. In a preferred embodiment, illustrated in FIG. 30 the bone anchor comprises aspear member 112 which is able to pierce and securely engage the bone. Thespear member 112 has a generally cone shapedhead portion 114 which is used to pierce the bone to which the and ashaft portion 116 with anoval eyelet 118 therethrough for receiving and holding a suture strand(s). To provide means for retaining thespear member 112 within the bone, thebone anchor 122 further comprises acollar member 120. The collar member is used for retaining thebone anchor 122 in place, once it has been driven into the bone, by lodging within the bone in a manner to resist removal of thebone anchor 122. Thebone anchor 122 and its component parts are more fully described below. - The
spear member 112 of thebone anchor 122 will now be described with additional reference to FIGS. 31-33. Theshaft portion 116 of thespear member 112 is generally cylindrical in shape and has theeyelet 118, or bore, formed radially therethrough proximate one of its ends. Theeyelet 118 may be oval, round or other suitable shapes and is of a sufficient size to permit suture strand or strands to pass therethrough. The circumference of each outer end of theeyelet 118 is chamfered or grounded to provide abevel portion 122. It should be appreciated that thebevel portion 122 provides a generally smooth surface for contacting suture strand which has been passed through theeyelet 118. Theeyelet 118 is located on theshaft portion 116 of thespear member 112 such that the transverse axis of theeyelet 118 intersect the longitudinal axis of thespear member 112. - The generally cone-shaped
head portion 114 of thespear member 112 is located at an end of theshaft portion 116 opposite the end having theeyelet 118. As best shown in FIGS. 30 and 31, the apex of the cone-shaped head portion is apoint 124 which is suitable for piercing and being driven into bone. The diameter of the cone-shapedhead portion 114 increases, when viewed along a longitudinal direction rearwardly from thepoint 124 towards theshaft portion 116. The cone angle along this region is preferably about 30 degrees. The diameter of the cone-shapedhead portion 114 increases at a greater rate along approximately the rearward half thereof, when viewed along the same longitudinal direction. Thus, the rearward half of the cone-shapedhead portion 114 arcs outwardly from the central longitudinal axis of thespear member 112. As show in FIGS. 31 and 32, thebase 126 of the cone-shapedhead portion 114 is a ring-shaped planar surface which is oriented substantially perpendicular to the longitudinal axis of theshaft portion 116. - Preferably, the cone-shaped
head portion 114 is formed integrally with theshaft portion 116 of thespear member 112. Alternatively, the cone-shapedhead portion 114 and theshaft portion 116 may initially be formed separately and then subsequently attached to one another by any suitable means. - The
collar member 120 of thebone anchor 122 will now be described with particular reference to FIG. 30 and FIGS. 34-37. Thecollar member 120 is provided with a ring-shaped generally planarforward surface 130 which is adapted to bear against, and mate with thebase 126 of the cone-shapedhead portion 114 of thespear member 112. Acircular bore 132 is located centrally through the planarforward surface 130 and is adapted to receive theshaft portion 116 of thespear member 112 therethrough. The circumference of the planarforward surface 130 may be, but is not necessarily, chamfered to formed a beveledouter rim portion 133. - Four
separate flanges 134 extend rearwardly from the planarforward surface 130 of thecollar member 120 as shown in FIGS. 34-39. Theflanges 134 are separated from one another by longitudinally extendingslots 136. The portions of theflanges 134 which are proximate to the planarforward surface 130 run generally parallel to the central longitudinal axis of thecollar member 120. Each of theflanges 134 arcs generally outward from the central longitudinal axis as theflange 134 extends in a direction away from the planarforward surface 130. The lateral width of each of theflanges 134 increases as theflange 134 extends in a direction away from the planarforward surface 130. The extreme rearward end of each of theflanges 134 curves away from the planarforward surface 130 in the form a shallow C-shape, thereby providing two trailingtips 140 for eachflange 134. - As set forth above, the
collar member 120 is rotatably fitted over theshaft portion 116 of thespear member 112 to form the assembledbone anchor 122 as shown in FIG. 1. While there is no need to permanently secure thecollar member 120 to thespear member 112, the planarforward surface 130 may nevertheless be securely attached to thebase 126 of the cone-shapedhead member 114 of thespear member 112 by any suitable means. It will be appreciated, however, that by permitting thespear member 112 to freely rotate with respect tocollar member 120, thesuture strand 150 can be rotated by the surgeon after implantation to a position where the forces acting on thesuture strand 150 by thebone anchor 122 are more evenly distributed around the region of theshaft portion 116 adjacent to theeyelet 118. Such a position of thesuture strand 150 is shown in FIG. 33. - In addition, it should also be appreciated that the two-piece construction of the
bone anchor 122, affords machining advantages over a single-piece bone anchor. That is, it is easier to machine each of these components separately and to subsequently assemble them together, as opposed to machining the same basic structural features from a single piece of material. Any known materials suitable for orthopedic anchor devices may be employed to construct thebone anchor 122 of the present invention. Preferably, thebone anchor 122 is formed from a metallic material possessing sufficient strength to penetrate the bone. Such materials include titanium 316 LVM stainless steel, CoCrMo alloy, Nitinol alloy, or other suitable materials. Preferably, the bone anchor is made of titanium. - Referring now back to FIGS. 1 and 2, the
inserter shaft 20 has adistal end 24, a central region 26, and aproximal end 28. Preferably, the inserter shaft extends at an angle of about 90° from thefirst handle 12. - The
inserter shaft 20 may be made of any of a variety of materials, including steel, stainless steel, aluminum, titanium, and plastic, but is preferably made of stainless steel. Additionally, theinserter shaft 20 may have a variety of cross sectional shapes including rectangular, hexagonal, or triangular but preferably theinserter shaft 20 has a circular cross section. - The
inserter shaft 20 maybe located from about 0.05 inches to about 0.5 inches from thedistal end 18 of thefirst handle 12. preferably, theinserter shaft 20 is located from about 0.1 inches to about 0.3 inches from thedistal end 18. More preferably, theinserter shaft 20 is located 0.2 inches from thedistal end 18 of the handle. - The length of the
inserter shaft 20 is consistent with transvaginal delivery of thereleasable bone anchor 22. Thus, theinserter shaft 20 maybe from about 0.5 inches to about 1.5 inches long. Preferably, theinserter shaft 20 is from about 0.75 inches to about 1.25 inches in length. More preferably, theinserter shaft 20 is 1 inch in length. - Preferably, the
proximal end 28 and the central region 26 of theinserter shaft 20 have an equal cross sectional area, which is larger than the cross sectional area of thebone anchor 22 anddistal end 24. Thus, ashoulder 17 is formed at the junction between the central region 25 of the inserter shaft and the distal region of the inserter shaft. Theshoulder 17 acts as a stop which will not penetrate the cortical shell of the bone. - The diameter of the inserter shaft is dependent upon the size of the bone anchor. In embodiments in which the
inserter shaft 20 is cylindrical, the diameter of theproximal end 28 and central region 26 of the inserter shaft is from about 0.1 inches to about 0.3 inches, and that of thedistal end 24 is from about 0.04 inches to about 0.2 inches. Preferably, the diameter of theproximal end 28 and central region 26 of the inserter shaft is from about 0.15 inches to about 0.25 inches, and that of thedistal end 24 is from about 0.07 inches to about 0.11 inches. More preferably, the diameter of theproximal end 28 and central region 26 of the inserter shaft is 0.2 inches and that of thedistal end 24 is 0.09 inches. - Preferably, the
inserter shaft 20 is curved as shown in FIGS. 1 and 2. As will be appreciated by those of skill in the art, theinserter shaft 20 may also be straight. In those embodiments in which theinserter shaft 20 is curved, the radius of curvature of theinserter shaft 20 is the distance between the pivot point of the hinge and the center of the inserter shaft. The radius of curvature of theinserter shaft 20 may be from about 3.5 inches to about 7.9 inches. Preferably, the radius of curvature of theinserter shaft 20 is from about 4.7 inches to about 6.9 inches. More preferably, the radius of curvature of theinserter shaft 20 is 5.8 inches. - The
distal end 24 of theinserter shaft 20 is adapted to releasably engage abone anchor 22. In one embodiment, thebone anchor 22 is housed within anotch 30 at thedistal end 24 of the inserter shaft, and frictionally engages the inner wall of thedistal end 24 of the inserter shaft. However, it will be appreciated by those of skill in the art that theinserter shaft 20 may releasably engage thebone anchor 22 through a variety of means other than that described above, and such means are specifically contemplated by the present invention. - The
distal end 24 of the inserter shaft maybe hollow or solid and has a complementary shape to the proximal end of thebone anchor 22 to permit thebone anchor 22 to frictionally engage thedistal end 24 of the inserter shaft. For example, thedistal end 24 of the inserter shaft and the proximal end of the bone anchor may be square, rectangular, pentagonal, triangular or hexagonal in cross section. Preferably, thedistal end 24 of the inserter shaft and the proximal end of the bone anchor are cylindrical. However, those skilled in the art will appreciate that numerous shapes may be employed, and the present invention specifically contemplates any such shape. - The central region26 of the inserter shaft has a pair of
grooves 32 therein for receiving asuture 54 attached to the bone anchor as illustrated in FIGS. 1 and 2. Preferably, thegrooves 32 in the inserter shaft are coextensive withslots 34 in the outer cannula and are aligned with theslots 34. - The device also comprises a
second handle 36 hingedly connected to thefirst handle 12 and having aproximal end 38, acentral region 40, and adistal end 42. Thesecond handle 36 may be fabricated from any of the materials discussed above with regard to thefirst handle 12. Additionally, thesecond handle 36 may have any of the dimensions and shapes discussed above with regard to thefirst handle 12. The preferred materials, dimensions, and shapes for thesecond handle 36 are the same as those discussed above with regard to thefirst handle 12. - The
second handle 36 has acannula 44 positioned near itsdistal end 42 and fixed within abore 11 in the second handle byscrews 13. Thecannula 44 has aproximal end 46, acentral region 48, and adistal end 50, with acentral bore 52 running through its entire length. Preferably, thecannula 44 extends at an angle of about 90° from thesecond handle 36. - The
cannula 44 may be fabricated from any of the materials described above with regard to theinserter shaft 20. Preferably, thecannula 44 is made of stainless steel. - The
cannula 44 may have any of the shapes discussed above with regard to theinserter shaft 20. Preferably, the shape of thecannula 44 is the same as that of theinserter shaft 20. - The
cannula 44 is located approximately the same distance from thedistal end 42 of the second handle as theinserter shaft 20 is from thedistal end 18 of the first handle and thecentral bore 52 of the cannula has an inner diameter larger than the outer diameter of theinserter shaft 20. In this way, theinserter shaft 20 extends into the central bore in the cannula as depicted in FIG. 1. Theinserter shaft 20 is extendible and retractable relative to thecannula 44. - Preferably, the
cannula 44 has two oppositely disposedslots 34 therein through which thesuture 54 attached to the bone anchor passes. These slots reduce the possibility of thesuture 54 becoming tangled. Preferably, theslots 34 in the cannula are aligned with and coextensive with thegrooves 32 in the inserter shaft. - Alternatively, the sutures can be contained within the cannula and extend out another portion of the device such as the
first handle 12. - Preferably, the
distal end 50 of the cannula has asharp tip 56 to facilitate its use in piercing tissue. - As illustrated in FIGS. 1 and 2, in the embodiments in which the
inserter shaft 20 is curved, thecannula 44 is preferably also curved in the same arc as theinserter shaft 20. By curving thecannula 44, the diameter of thecannula 44 can be reduced in comparison with embodiments in which the inserter shaft and the cannula are not curved. Thus, in the embodiments in which theinserter shaft 20 andcannula 44 are curved, the inner diameter of thecannula 44 is from about 0.1 inches to about 0.25 inches and the outer diameter of thecannula 44 is from about 0.14 inches to about 0.31 inches. Preferably the inner diameter of thecannula 44 is from about 0.15 inches to about 0.2 inches. In a highly preferred embodiment, the inner diameter of the cannula is 0.170 inches, the wall is about 0.02 inches, and the outer diameter is about 0.210 inches. These dimensions also apply to the devices in FIGS. 5 and 6 in which the inserter shaft and the cannula are also curved. - In a preferred embodiment, the
cannula 44 has aprotective cap 58 inside thecentral bore 52 and located at thedistal end 50 of the cannula, as shown in FIGS. 2, 3 and 5. Theprotective cap 58 may be made of a variety of materials, such as plastic, thermoplastic elastomers, PET, PETG, rubber material, vinyl, gelatin, latex, thermoset rubbers and silicone. Preferably, theprotective cap 58 is made of silicone or plastic. - The internal
protective cap 58 acts to shield thebone anchor 22 from contamination, e.g., from contact with microorganisms in the vagina which could cause infection if introduced into the pubic bone during implantation of the bone anchor. In one embodiment, theprotective cap 58 has avertical slit 60 and ahorizontal slit 62 therein which intersect to form a cross. Alternatively, theprotective cap 58 has slits three slits which intersect to form a Y. - In one embodiment, the
slits protective cap 58, thereby dividing the protective cap into discrete segments. Preferably, theslits protective cap 58 but do not extend entirely therethrough. - The
slits bone anchor 22 to move through theprotective cap 58 during implantation. In embodiments in which theslits protective cap 58, thebone anchor 22 forces the segments of theprotective cap 58 to separate as thebone anchor 22 is extended through theprotective cap 58. Theprotective cap 58 remains in contact with the external surface of thebone anchor 22 as it is inserted into the bone, thereby shielding the bone anchor from contact with potentially infectious microorganisms in the vaginal wall. - The operation of the
protective cap 58 in embodiments in which theslits bone anchor 22 pierces the material of theprotective cap 58 as thebone anchor 22 is extended, thereby causing theprotective cap 58 to separate into segments along the scores. - The proximal ends of the first and second handles,14 and 38 respectively, are hingedly connected to permit them to move towards and away from one another. Any suitable type of hinge can be used, for example, this can be accomplished using a
hinge 64 similar to that commonly found on doors as shown in FIGS. 1 and 2. Alternatively, a piece of rubber may be interposed between the first and second handles at their proximal ends 14 and 38 and secured thereto by bolts extending into holes in each of the handles. Those skilled in the art will appreciate that other means of hingedly connecting the first and second handles may be employed, and the present invention specifically contemplates embodiments in which such other hinging mechanisms are employed. - The
first handle 12 and thesecond handle 36 are biased apart. In one embodiment, the biasing force is provided by aspring 66, as discussed below. Thespring 66 can be metal, resilient polymer, pneumatically driven, or of any other suitable design. However, those skilled in the art will appreciate that a number of other structures can be employed to achieve the same biasing effect. The present invention specifically contemplates such other means of biasing the handles apart. - When sufficient force is applied to the distal ends of the first and second handles (18 and 42) to overcome the resistance of the spring, the distal ends (18 and 42) of the first and second handles move closer together. In the position in which the distal ends of the first and second handles are maximally separated, the
inserter shaft 20 andbone anchor 22 thereon are fully retracted inside thecannula 44. As increasing force is applied to the handles and the distal ends approach one another, theinserter shaft 20 andbone anchor 22 thereon emerge from thedistal end 50 of the cannula. At the point where the distal ends (18 and 42) of the first and second handles are touching, theinserter shaft 20 andbone anchor 22 thereon are maximally extended from thedistal end 50 of the cannula. - At the point of maximum extension, the length of the
inserter shaft 20 extending from thecannula 44 is from about 0.05 inches to about 0.8 inches. Preferably, at the position of maximum extension, the length of theinserter shaft 20 extending from thecannula 44 is about 0.1 inches to about 0.5 inches. More preferably, the length of theinserter shaft 20 extending from thecannula 44 at the position of maximum extension is 0.2 inches. - In the above embodiment, the
bone anchor 22 is inserted in the bone by manually moving theinserter shaft 20 axially through thebore 52 in the cannula until the inserter shaft andbone anchor 22 thereon extend from thecannula 44. However, the those skilled in the art will appreciate that approaches other than manually moving the inserter shaft may also be used to implant the bone anchor into the bone. For example, thebone anchor 22 can be forced into the bone by applying sufficient pneumatic pressure through the inserter shaft to eject the bone anchor from the inserter shaft with sufficient force to implant the bone anchor in the bone. Alternatively, the bone anchor may be driven into the bone by a spring mechanism. - Preferably, the device further comprises a locking mechanism for locking the device in the position in which the inserter shaft is fully retracted within the cannula in order to avoid accidental insertion of the bone anchor into tissue. As those skilled in the art will appreciate, a variety of locking structures may be used to achieve such locking.
- One exemplary locking mechanism is shown in FIG. 2. The locking mechanism comprises a locking
plate 15 slidably mounted over thefirst handle 12 and having abore 68 therein. The lockingplate 15 is separated from thefirst handle 12 by aspacer 70 having an internally threaded bore 72 therein which is aligned with thebore 68 in the locking plate. Thefirst handle 12 has anelongate hole 74 herein having aproximal end 75 and a distal end 77. A lockingscrew 76 extends through theelongate hole 74 in the first handle and the bores 72.68 in thespacer 70 and lockingplate 15. The lockingscrew 76 is secured to the lockingplate 15 by anut 78. - The
second handle 36 has abore 80 therethrough having a diameter larger than that of the head of the lockingscrew 76. In the unlocked position, thebore 80 can be aligned with the lockingscrew 76 as shown in FIG. 4 thereby permitting thefirst handle 12 and thesecond handle 36 to be squeezed together such that theinserter shaft 20 extends from thecannula 44. - As illustrated in FIG. 5, in the locked position, the locking
plate 15 is positioned at theproximal end 75 of theelongate hold 74 in the first handle. In this position, the lockingscrew 76 is disposed between the first and second handles such that the head of the screw abuts the inner side of thesecond handle 36, thereby preventing thefirst handle 12 and thesecond handle 36 form being squeezed together. - In an alternate embodiment, the bone
anchor implantation device 110 may have a dual position lock permitting the device to be locked in a position in which theinserter shaft 120 is fully retracted within thecannula 144 or in a position in which theinserter shaft 120 is fully extended from thecannula 144. In this embodiment, illustrated in FIG. 6 thebore 180 of thesecond handle 136 is keyhole shaped. Thenarrower part 121 of the keyhole shaped bore is sufficiently narrow to prevent the head of the lockingscrew 176 from passing therethrough. As illustrated in FIG. 7, when the lockingplate 115 is positioned at theproximal end 175 of the elongate bore in the first handle, the head of the lockingscrew 176 is over thenarrow part 121 of the keyhole shapedaperture 180. As shown in FIG. 7, in this position the inner side of the head of lockingscrew 176 contacts the outer side of the second handle. The device is locked in the position in which the inserter shaft and bone anchor thereon are fully extended. - When the
locking plate 115 is positioned at the distal end 177 of the elongate bore in the first handle, the head of lockingscrew 176 is aligned with thewide portion 123 of the keyhole shaped bore. The lockingplate 115 can then be returned to theproximal end 175 of the elongate hole, such that the head of the lockingscrew 176 is disposed between thefirst handle 112 and thesecond handle 136 and the head of the lockingscrew 176 abuts the inner side of thesecond handle 136, as shown in FIG. 8. In this position theinserter shaft 120 is fully retracted and thefirst handle 112 and thesecond handle 136 cannot be squeezed together. - The above locking mechanisms may be used in the embodiments where the inserter shaft and cannula are straight. As those skilled in the art will appreciate, a variety of other locking structures may be used to achieve such dual position locking. Such other locking mechanisms are specifically contemplated by the present invention.
- In the embodiments described above, the force biasing the two handles apart is preferably provided by a
spring 66 disposed between twodepressions first handle 12 and thesecond handle 36. In the embodiments described above, thespring 66 is located in thecentral regions - Using the present bone anchor implantation device, the bone anchor is transvaginally introduced into the pubic bone as follows.
- After making an incision in the anterior vaginal wall, the endopelvic fascia is accessed using techniques well known to those of skill in the art, such as with a conventional retractor. A Foley catheter may be introduced to assist in locating the bladder neck. The bone anchor implantation device is inserted into the vaginal introitus and the first desired site for bone anchor implantation is located by digital palpation of the urethra, pubic symphysis or other anatomical landmark or other techniques known to those of ordinary skill in the art. The device is locked in the position in which the inserter shaft is fully retracted during this procedure.
- Once the desired site for bone anchor implantation is located, the
sharp tip 56 on the distal end of the cannula is driven through theendopelvic fascia 17. The pointed end of the cannula can also be employed to locate the desired implantation site by inserting the device into the vaginal introitus and through the incision, piercing the endopelvic fascia, and moving the cannula along thepubic bone 19 to the desired implantation site, as shown in FIG. 9. - The device is then unlocked from the position in which the
inserter shaft 20 is fully retracted. In the embodiment having a single position lock, the first and second handles (12 and 36) are pressed together with enough pressure to extend theinserter shaft 20 out of thecannula 44 and drive thebone anchor 22 into the posterior portion of thebone 19. Alternatively, in the embodiment having a dual position lock, the device is locked in the position in which theinserter shaft 120 is fully extended from thecannula 144 and the manual pressure is applied to drive thebone anchor 122 into the posterior portion of thepubic bone 19. - As shown in FIG. 10, when the first and second handles are squeezed towards one another, the inserter shaft moves towards the
bone 19. Thebone anchor 22 pierces theprotective cap 58 which separates as thebone anchor 22 passes therethrough. Theprotective cap 58 shields thebone anchor 22 from contact with the vaginal tissue. - As shown in FIG. 11, when the
inserter shaft 20 is extended beyond the distal tip of thecannula 56, the bone anchor contacts thebone 19 and is driven therein. - The
inserter shaft 20 is then retracted into thecannula 44, leaving thebone anchor 22 implanted in thebone 19 with the attachedsuture 54 extending through the wound in the vaginal wall and the endopelvic fascia as shown in FIG. 12. - The above site location and bone anchor implantation procedure is repeated to implant a second bone anchor on the opposite side of the urethra from the first bone anchor.
- In one embodiment, the sutures are attached to a needle, looped back through the vaginal wall, and attached to tissue such as the endopelvic fascia or the vaginal wall so as to bias the tissue surrounding the urethra towards the urethra. The biasing force compresses or stabilizes the bladder neck thereby maintaining or improving urinary continence.
- Alternatively, the sutures attached to the bone anchors can be attached to a sling which compresses or stabilizes the bladder neck. In such procedures, an incision is made midline to the urethra. An opening or pocket for receiving the sling is created in the tissue between the urethra and the upper vaginal wall. The bone anchor implantation device is inserted through the incision, into the pocket, and through the endopelvic fascia to contact the pubic bone. At least one bone anchor is inserted into the pubic bone on each side of the urethra. The sling is introduced into the opening or pocket and attached to the sutures. The tension on the sling provided by the sutures is adjusted to provide the appropriate biasing force to the urethra.
- Example 1 describes one method of using the present bone anchor implantation device to compress or stabilize the bladder neck with sutures. it will be appreciated that the bone anchor implantation device can be used with other methods in which sutures compress or stabilize the bladder neck.
- Compression or Stabilization of the Bladder Neck with Sutures
- The bone anchor implantation device can be used in incontinence treatments in which the bladder neck is compressed or stabilized with sutures. A Foley catheter is inserted into the urethra to indicate its location. An incision is then made through the anterior vaginal wall, preferably approximately 1 cm lateral to midline and adjacent to the bladder neck. The vaginal wall is retracted to allow access to the endopelvic fascia. The bone anchor implantation device, having a bone anchor with sutures attached thereto releasably engaged with the inserter shaft, is introduced through the opening in the vaginal wall with the device locked in the position in which the inserter shaft is fully retracted within the cannula, and the sharp point is pressed through the fascia to contact the posterior pubic bone. Preferably, the anchor implantation site is located lateral to the symphysis pubis and cephalad to the inferior edge of the pubic bone. The anchor implantation site is located by palpating the inferior rim of the pubic bone and the symphysis pubis, moving laterally until the lower border of the obturator foramen is located. Preferably, the anchor is located from about 0.5 to 4 cm lateral to the symphysis pubis and from about 0.5 to 3 cm cephalad to the inferior edge. More preferably, the anchor implantation site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone. In addition, the anchor implantation site can be located on the pubic ramus.
- The locking mechanism of the bone anchor implantation device is then placed in the unlocked position, and the two handles are squeezed together such that the inserter shaft is in the extended position. Alternatively, for devices having a dual position locking mechanism, the bone anchor may be exposed by locking the device in the position in which the inserter shaft is fully extended from the cannula. In either case, the anchor is driven into the pubic bone using manual pressure and opposing thumb pressure on the external pubic section if necessary.
- The bone anchor implantation device is withdrawn, leaving the two free ends of the anchored suture exiting the
endopelvic fascia 17. A device such as a Mayo needle is then attached to one free end of the anchored suture and a “bite of fascia” is taken adjacent to the bladder neck. Preferably, the entry and exit points of the suture are adjacent to the bladder neck approximately 0.5 cm lateral to the urethra. This step is then repeated with the other free end of the suture, and the two ends are tied together. The vaginal wall incision is then closed. - Alternatively, the entry and exit points of the suture can be made as illustrated in FIG. 13a of U.S. Pat. No. 5,611,515 to Benderev, the disclosure of which is incorporated herein by reference.
- The above procedure is then repeated on the opposite side of the urethra to complete the bladder neck suspension. The sutures are then appropriately tensioned. Appropriate tension is confirmed using well known means such as cystoscopy or a standard Q tip test.
- Example 2 describes use of the bone anchor implantation device in a procedure in which the bladder neck is compressed or stabilized with a sling. However, it will be appreciated that the bone anchor implantation device can be used with other methods in which the bladder neck is compressed or stabilized with a sling.
- Double Anchor Placement: For Sling or Bolster Procedure
- The bone anchor implantation device can also be used in incontinence treatments in which the bladder neck is compressed or stabilized using a sling. Preferably, in such procedures two bone anchors are placed on either side of the urethra. However, one of ordinary skill in the art will appreciate that one or more than two bone anchors per side can be used. The procedure is performed as follows.
- A Foley catheter is inserted into the urethra to indicate its location. Starting adjacent to the bladder neck on either side of the urethra, a 1 cm incision is made through the anterior vaginal wall approximately 1 cm lateral to and parallel to the midline of the urethra. The vaginal wall is retracted to allow access to the
endopelvic fascia 17. Blunt dissection is used to tunnel under the urethra and form a pocket for the sling. - The bone anchor implantation device is introduced through the opening in the vaginal wall with the device locked in position in which the inserter shaft is fully retracted within the cannula, and the sharp point of the cannula is pressed through the
fascia 17 near the distal end of the vaginal wall incision closer to the bladder neck, to contact the posterior aspect of the pubic bone. Preferably, the first anchor implant site is located lateral to the symphysis pubis and cephalad to the inferior edge of the pubic bone. More preferably, the first anchor implant site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone. - The locking mechanism of the bone anchor implantation device is then placed in the unlocked position, and the two handles are squeezed together to expose the anchor. Alternatively, for devices having a dual position locking mechanism, the bone anchor may be exposed by locking the device in the position in which the inserter shaft is fully extended from the cannula. The anchor is driven into the pubic bone using manual pressure and opposing thumb pressure on the external pubic region if necessary.
- The bone anchor implantation device is withdrawn leaving the two free ends of suture exiting the endopelvic fascia.
- The above bone anchor implantation procedure is repeated to introduce a second anchor on the same side of the urethra as the first anchor. The second anchor implant site is located by palpating the obturator foramen in the pelvis just cephalad to the ramus. For implantation of the second anchor, the fascial tissue near the proximal end of the vaginal wall incision farther from the bladder neck is pierced. The second anchor is implanted on the superior (cephalad) aspect of the ramus.
- The bone anchor implantation device is removed as before trailing the two free ends of each suture from the vaginal wall incision.
- The above procedures for implantation of the first and second anchors are repeated on the opposite side of the urethra.
- The sling is then positioned in the pocket under the urethra. The free ends of suture from the two anchors on each side of the urethra are then tied to the corresponding corners of the sling. The sutures are then tied off with the appropriate amount of tension to suspend or stabilize the bladder neck. The vaginal wall incisions are then closed on each side.
- Alternatively, the above procedure can also be utilized in techniques in which only a single bone anchor is inserted on either side of the urethra. Preferably, in such procedures the anchor implantation site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone. More preferably, the anchor implantation site is located approximately 1 cm lateral to the symphysis pubis and 1 cm cephalad to the inferior edge of the pubic bone.
- Bone Anchor Implantation Device with Hooked Shaft
- In another embodiment, the anchor implantation device of the present invention has a hooked shaft with a bone anchor mount for releasably engaging a bone anchor on the distal end of the shaft. This embodiment reduces the amount of force required to drive the bone anchor into the bone by utilizing the patient's body weight to provide an opposing force.
- In this embodiment, the anchor implantation device comprises a handle, a hooked shaft secured to the handle and a bone anchor mount adapted to releasably engage a bone anchor attached to the distal end of the shaft. The bone anchor mount generally points toward the handle, such that the user can drive the bone anchor into the bone by simply pulling back on the handle and using the patient's body weight to provide an opposing force. Preferably, the longitudinal axis of the bone anchor mount is aligned with the longitudinal axis of the handle. Preferably, a protective sheath is attached to the bone anchor mount such that the bone anchor releasably engaged to the bone anchor mount is enclosed within the protective sheath and isolated from tissue contact during placement of the device. More preferably, the protective sheath is a telescoping sheath or a balloon.
- A representative anchor implantation device having a hooked shaft is shown in FIG. 13. As illustrated in FIG. 13, the
anchor implantation device 210 has ahandle 212 having aproximal end 214 and adistal end 216. Thehandle 212 may be made of a variety of materials, such as plastic or metal. - The
shaft 220 may be made of a variety of materials such as stainless steel engineering plastics, fiber-bearing components, or other materials. Preferably, the shaft is made of stainless steel. - In the embodiment of the bone anchor implantation device shown in FIG. 13,
shaft 220 comprises a straightproximal section 222, a first generallycurved section 224 distal to the straight proximal section, a second generallycurved section 226 distal to the first curved section, a third generallycurved section 228 distal to the second curved section, and a fourth generallycurved section 230 distal to the third curved section. However, one skill in the art would appreciate that the shaft could also comprise a series of straight segments angled relative to one another to form a hook. - The straight
proximal section 222 of theshaft 220 has anannular shoulder 232 which abuts thedistal end 216 of the handle. The straightproximal section 222 passes through a lumen (not shown) extending through the handle. The proximal end of the straightproximal section 222 has a threaded bore which is adapted to receive ascrew 236 which secures theshaft 220 to the handle. If desired, a washer (not shown) may be placed between theproximal end 214 of the handle and thescrew 236. - While one means of securing the
shaft 220 to thehandle 212 was described above, those skilled in the art will appreciate that a variety of other means may be employed. For example, a plastic handle may be formed over the shaft such that the shaft is integral with the handle. - The straight
proximal section 222 of theshaft 220 may be from about 3 inches to about 6 inches in length. Preferably, the straightproximal section 222 is from about 4 inches to about 5 inches in length. More preferably, the straightproximal section 222 is about 4.5 inches in length. - The
handle 212 defines an axis at the proximal end of theanchor implantation device 210, and ten moving distally from thehandle 212 theshaft 220 first curves away from the axis of the handle and then back toward the axis of thehandle 212. The distal end of theshaft 220 preferably is located in the vicinity of the axis of thehandle 212. In some preferred embodiments, theshaft 220 at the distal end can be generally perpendicular to the axis of the handle or can actually be curving back toward thehandle 212. Preferably the distance from the distal end of thehandle 212 to the tip of the taperedbone anchor receptacle 246 measured along the longitudinal axis of thehandle 212 is about 3⅜ inches. Preferably, the distance from the distal end of thehandle 212 to the distal end of thebone anchor mount 238 is about 4 inches. Preferably, the distance of a line perpendicular to the longitudinal axis of thehandle 212 extending from the bottom of the thirdcurved section 228 is about 2 inches. - Referring to FIGS.13-16, a
bone anchor mount 238 is attached to thedistal end 240 of the fourthcurved section 230 of theshaft 220. Thebone anchor mount 238 may be oriented at an angle from about 60° to about 120° relative to thedistal end 240 of the fourth curved section. Preferably, thebone anchor mount 238 is oriented at an angle from about 80° to about 100° relative to thedistal end 240 of the fourth curved section. More preferably, thebone anchor mount 238 is oriented at an angle of approximately 90° relative to thedistal end 240 of the fourth curved section, as illustrated in FIG. 13. - The bone anchor mount comprises an
outer cylinder 242, aninner cylinder 244, and a taperedbone anchor receptacle 246 for releasably engaging abone anchor 248. As was the case with the two handle bone anchor implantation device discussed above, a variety of bone anchors can also be used with the bone anchor implantation device having a hooked shaft. Preferably, the bone anchor used with the hooked shaft device is the bone anchor discussed above with respect to the two handle bone anchor implantation device. - In any event, it is preferred that the
bone anchor mount 238 and thebone anchor receptacle 246 are oriented so that thebone anchor 248 is pointed in the general direction of thehandle 212. In one preferred embodiment, the axis of thebone anchor 248 is generally aligned with the axis of thehandle 212, with the bone anchor pointed toward thehandle 212. - The
bone anchor mount 238 may be fabricated from the same materials as theshaft 220 and may be attached to theshaft 220 by a variety of methods known to those skilled in the art, such as brazing. As best shown in FIG. 15 thedistal end 250 of theouter cylinder 242 has a pair ofholes 252 therein sized to accommodate asuture 254. - The
outer cylinder 242 may have a diameter from about 0.18 inches to about 0.6 inches. Preferably, theouter cylinder 242 has a diameter from about 0.25 inches to about 0.5 inches. More preferably, theouter cylinder 242 has a diameter of about 0.375 inches. - As best shown in the cross section of FIG. 16, the
outer cylinder 242 has acavity 258 formed therein, creating a cup in the proximal region of theouter cylinder 242. Theproximal end 260 of theouter cylinder 242 has an annular shoulder 262 thereon. - The
inner cylinder 244 is connected to theouter cylinder 242 and extends into thecavity 258 as best shown in FIG. 16. Theinner cylinder 244 may be connected to theouter cylinder 242 in a variety of ways known to those skilled in the art. For example, theinner cylinder 244 may be fused to theouter cylinder 242. As best shown in FIG. 15, theinner cylinder 244 hasgrooves 264 therein adapted to accommodate thesuture 254. - A tapered
bone anchor receptacle 246 extends from theproximal end 266 of theinner cylinder 244. The taperedbone anchor receptacle 246 has grooves 268 therein adapted to accommodate thesuture 254. - The tapered
bone anchor receptacle 246 may extend from theproximal end 266 of theinner cylinder 244 by a distance of from about 0.3 inches to about 0.7 inches. Preferably, the taperedbone anchor receptacle 246 extends from theproximal end 266 of theinner cylinder 244 by a distance of from about 0.4 inches to about 0.6 inches. More preferably, the taperedbone anchor receptacle 246 extends from theproximal end 266 of theinner cylinder 244 by a distance of about 0.5 inches. - The
distal end 270 of the taperedbone anchor receptacle 246 preferably has a width smaller than that of theproximal end 266 of theinner cylinder 244. This configuration produces ashoulder 272 which may serve as a depth stop to ensure that thebone anchor 248 is driven into the bone to the desired depth. - The
distal end 270 of the taperedbone anchor receptacle 246 may be from about 0.08 inches to about 0.12 inches in width. Preferably, thedistal end 270 of the taperedbone anchor receptacle 246 is from about 0.09 inches to about 0.110 inches in width. More preferably, the distal end of the taperedbone anchor receptacle 246 is 0.1 inches in width. - The
proximal end 274 of the taperedbone anchor receptacle 246 may be from about 0.110 inches to about 0.15 inches in width. Preferably, theproximal end 274 of the taperedbone anchor receptacle 246 is from about 0.12 inches to about 0.14 inches in width. More preferably, theproximal end 274 of the taperedbone anchor receptacle 246 is 0.13 inches in width. - The
proximal end 274 of the taperedbone anchor receptacle 246 may have a variety of cross sectional shapes adapted to releasably engage thebone anchor 248. For example, theproximal end 274 of the taperedbone anchor receptacle 246 may be square, rectangular, pentagonal, triangular or hexagonal in cross section. - As depicted in FIGS.14-16, the tapered
bone anchor receptacle 246 may have anotch 276 therein in which thebone anchor 248 is releasably seated. - Alternatively, the outer cylinder, inner cylinder, and tapered bone anchor receptacle may be a single integral component.
- Preferably, the bone anchor implantation device has a protective sheath connected to the bone anchor mount which protects the point of the bone anchor from tissue contact during placement of the device and also protects the bone anchor from contacting potentially infectious microorganisms.
- One embodiment of the
protective sheath 278 is shown in FIGS. 13-16. In this embodiment, theprotective sheath 278 comprises afirst telescoping cylinder 280 and asecond telescoping cylinder 282. Aspring 284 biases thefirst telescoping cylinder 280 and thesecond telescoping cylinder 282 to a position in which they extend from theouter cylinder 242 and cover thebone anchor 248. - The first and
second telescoping cylinders second telescoping cylinders - The
first telescoping cylinder 280 has alumen 286 extending therethrough. - The
first telescoping 280 cylinder has afirst shoulder 288 which engages shoulder 262 on theouter cylinder 242 and asecond shoulder 290 which engages afirst shoulder 292 on thesecond telescoping cylinder 282. - The
second telescoping cylinder 282 has afirst shoulder 292 which engages thesecond shoulder 290 on thefirst telescoping cylinder 280 as described above. Asecond shoulder 294 is located at the proximal end of thesecond telescoping cylinder 282 and engages thespring 284. Thesecond telescoping cylinder 282 also has alumen 296 extending therethrough which is in fluid communication with thelumen 286 of thefirst telescoping cylinder 280 and thecavity 258 in theouter cylinder 242. - The inner diameter of the
first telescoping cylinder 280 is slightly larger than the outer diameter of thesecond telescoping cylinder 282 such that thesecond telescoping cylinder 282 can retract inside thefirst telescoping cylinder 280. Thefirst telescoping cylinder 280 and thesecond telescoping 282 can retract inside thecavity 258 of theouter cylinder 242. - The
first telescoping cylinder 280 may be from about 0.2 inches to about 0.3 inches in length, with an inner diameter of from about 0.27 inches to about 0.33 inches and an outer diameter of about 0.3 inches to about 0.36 inches. Preferably, thefirst telescoping cylinder 280 is from about 0.23 inches to about 0.27 inches in length, with an inner diameter of from about 0.29 inches to about 0.31 inches and an outer diameter of about 0.32 inches to about 0.34 inches. More preferably, thefirst telescoping cylinder 280 is about 0.25 inches in length, with an inner diameter of about 0.3 inches and an outer diameter of about 0.33 inches. - The
second telescoping cylinder 282 may be from about 0.2 inches to about 0.3 inches in length, with an inner diameter of from about 0.22 inches to about 0.31 inches and an outer diameter of about 0.25 inches to about 0.35 inches. Preferably, thesecond telescoping cylinder 282 is from about 0.23 inches to about 0.27 inches in length, with an inner diameter of from about 0.24 inches to about 0.29 inches and an outer diameter of about 0.27 inches to about 0.33 inches. More preferably, thesecond telescoping cylinder 282 is about 0.25 inches in length, with an inner diameter of about 0.27 inches and an outer diameter of about 0.3 inches. - As illustrated in FIGS.13-16, a
spring 284 biases the first andsecond telescoping cylinders first telescoping cylinder 280 and thesecond telescoping cylinder 282 are extended from theouter cylinder 242. - Another embodiment of the protective sheath is depicted in FIGS. 25 and 26a. The bone anchor implantation device as described above with respect to FIGS. 14-17 has a balloon which encapsulates the bone anchor. The bone
anchor implantation device 210 has aballoon 279 which is coupled to thebone anchor mount 238 and which covers thebone anchor 279. Theballoon 279 protects the bone anchor from contacting potentially infections microorganisms prior to implantation. - The
balloon 279 may be made of any material which exhibits a strength that allows it to be punctured by the bone anchor. Examples of suitable materials include plastic, thermoplastic, elastromers, PET, PETG, rubber, vinyl, latex, gelatin or silicone. In a preferred embodiment, the balloon is made of latex. - Alternatively, the
balloon 279 can be made of a biodegradable material. A suitable biodegradable material dissolves within the patient after a predetermined period of time. Following implantation of the bone anchor the punctured sheath remains are simply metabolized by natural biological processes. - In a preferred embodiment, the balloon comprises a biodegradable polymer.
- The polymer may be either natural or synthetic. Synthetic polymers offer greater advantages that natural materials in that they can be tailored to give a wider range of properties and are more uniform than materials from natural sources. Synthetic polymers also offer a more reliable source of raw materials which reduce the risks of invoking an immunogenic response.
- Biodegradable polymers are synthesized from chemical functional groups such as, for example, esters, anhydrides, orthoesters and amides, which have hydrolytically unstable linkages in the backbone. Preferably, the balloon is made of a biodegradable materials such as polyglycotic acid (PGA), polylactic acid (PLA), poly (dioxanone)(PDO), poly (l-lactide)(LPLA), poly (dl-lactide)(DLPLA), poly (glycolide-co-trimethylene carbonate) (PGA-TMC), poly (l-lactide-co-glycolide) (PGA-LPLA), poly (dl-lactide-co-glycolide) (PGA-DLPLA), poly (l-lactide-co-dl-lactide) (LPLA-DLPLA), poly(glycolide-co-trimethylene carbonate-co-dioxanone) (PDO-PGA-TMC), poly(ε-caprolactone), poly(dioxanone)(a polyether-ester), poly (lactide-co-glycotide), poly(SA-HDA anhydride), poly(orthoester), polyglyconate.
- The balloon or structure can be filled with air, water, antibiotic or any substance which inflates the balloon so as to prevent the bone anchor from puncturing the balloon prior to implantation. Alternatively, as illustrated in FIG. 38 and discussed below, the device may further include a spring which is attached to the shaft within the balloon to maintains the shape of the balloon and prevent the bone anchor from puncturing the balloon prematurely. In a preferred embodiment, the
balloon 278 contains an antibiotic that is released when the sheath is perforated by the bone anchor during implantation. The balloon may contain several antibiotics that have complementary activity. The antibiotic prevents infection at the site where the bone anchor is pressed into the bone. Non-limiting examples of suitable antibiotics for use in the invention include nafcillin, aminogylcoside, ciprofloxin, clindamcin, piperacillin/tazobactum, ampicillin/sulbactum, aminoglcoside, vancomycin, cephalosporin, TMP/SMX, ampicillin, gentaminicin, tobramycin and ciprofloxacin. - There are numerous ways to insert an antibiotic or other desired substance into the balloon. In one embodiment, the bone anchor implantation device further comprises an
port 280 which allows antibiotics to be inserted into the balloon. As shown in FIG. 25, theport 280 extends from theballoon 279 into a lumen which extends from one end of the shaft to the other. Theport 280 has anopening 282 at the distal end of the shaft. Antibiotics inserted into theopening 282 travel through theport 280 into theballoon 279. In an alternate embodiment (not shown), the port extends from the balloon into a lumen which extends from one end of the shaft to the other end and through the handle to an opening. Those skilled in the art will appreciate other ways of inserting the antibiotic into the balloon. - In general, in another aspect illustrated in FIG. 38, the invention features a
bone anchor implantation 210 device that has a spring element attached to the shaft within the balloon which retracts when the balloon contacts the bone anchor implantation site causing the bone anchor to perforate the balloon and implant in the bone. The spring element reduces the amount of force required to perforate the sheath and implant the bone anchor in the bone. Thespring element 285 can be any type of spring which is elastically or plastically deformable. Thespring element 285 has afirst end 286 which is attached or grounded to thebone anchor mount 238 and a second floatingend 287 which contacts the balloon. Preferably, the spring is a compression spring which is normally in an open position. A compression spring retracts when pressure is applied causing the point to puncture the balloon. As illustrated in FIG. 38, thespring element 285 can be an open-coiled helical spring which surrounds thebone anchor 248. Thespring mechanism 285 must have some minimum deflection strength so as to prevent the bone anchor from puncturing the balloon prematurely during insertion but must have enough deflection strength to puncture the balloon when force is applied to the bone anchor implantation device at the desired location. Theballoon 279 which covers the spring and the bone anchor has the same attributes as the balloon discussed above with respect to FIGS. 25-26 a. - Another embodiment of the protective sheath is illustrated in FIG. 26b. The bone
anchor implantation device 210 as described above with respect to FIGS. 14-17 has agelatin structure 290 which covers the bone anchor. The boneanchor implantation device 210 has a gelatin structure or caplet which is coupled to thebone anchor mount 238 and which encapsulates thebone anchor 248. Thegelatin structure 290 protects thebone anchor 248 from contamination. As discussed above with reference to FIGS. 25-26 a, the gelatin structure may be filled with an antibiotic. The device may also include a port for inserting antibiotic into the gelatin structure. - An alternative embodiment of the bone
anchor implantation device 310 is shown in FIGS. 17-20 and FIG. 27. - As illustrated in FIGS. 17 and 18, the
shaft 320 has a generally straightproximal section 399, a first generallybent section 397, a generally straightmedian section 395, a secondbent section 393, a generallycurved section 391, and a distal generallystraight section 389. - The straight
proximal section 399 may be from about 3.0 inches to about 6.0 inches in length. Preferably, the straightproximal section 399 is from about 4.0 inches to about 5.0 inches in length. More preferably, the straightproximal section 399 is about 4.5 inches in length. - The first
bent section 397 may be from about 1.0 inches to about 3.0 inches in length. Preferably, the firstbent section 397 is from about 1.5 inches to about 2.5 inches in length. More preferably, the firstbent section 397 is about 2 inches in length. - The first
bent section 397 may bend at an angle of from about 35° to about 55° relative to the straightproximal section 399. Preferably, the firstbent section 397 bends at an angle of from about 40° to about 50° relative to the straightproximal section 399. More preferably, the firstbent section 397 bends at an angle of about 45° relative to the straightproximal section 399. - The straight
median section 395 may be from about 2 inches to about 4 inches in length. Preferably, the straightmedian section 395 is from about 2.5 inches to about 3.5 inches in length. More preferably, the straightmedian section 395 is about 3 inches in length. - The second
bent section 393 may be from about 0.5 inches to about 2.5 inches in length. Preferably, the secondbent section 393 is from about 1.0 inches to about 2.0 inches in length. More preferably, the secondbent section 393 is about 1.5 inches in length. - The second
bent section 393 may bend at an angle of from about 125° to about 145° relative to the straightmedian section 395. Preferably, the secondbent section 393 bends at an angle of from about 130° to about 140° relative to the straightmedian section 395. More preferably, the secondbent section 393 bends at an angle of about 135° relative to the straightmedian section 395. - The
curved section 391 may curve through an arc of from about 700 to about 110° with a radius from about 0.2 inches to about 0.6 inches. Preferably, the curved section curves 391 through an arc of from about 80° to about 100° with a radius from about 0.3 inches to about 0.5 inches. More preferably, thecurved section 391 curves through an arc of about 90° with a radius of 0.4 inches. - The distal
straight section 389 may be from about 0.5 inches to about 0.9 inches in length. Preferably, the distalstraight section 389 is from about 0.6 inches to about 0.8 inches in length. More preferably, the distalstraight section 389 is about 0.7 inches in length. - The
shaft 320 has a lumen extending therethrough. The lumen may have a diameter from about 0.03 inches to about 0.07 inches and theshaft 320 may have an outer diameter from about 0.2 inches to about 0.3 inches. Preferably, the lumen has a diameter from about 0.04 inches to about 0.06 inches and theshaft 320 has an outer diameter from about 0.24 inches to about 0.26 inches. More preferably, the lumen has a diameter of about 0.05 inches and theshaft 320 has an outer diameter of about 0.250 inches. - Preferably, the
shaft 320 has aninsert 387 therein with alumen 385 extending therethrough as best illustrated in the cross section of FIG. 19. Theinsert 387 may be made of a variety of materials such as stainless steel or plastic. - The
insert 387 has an outer diameter approximately that of the diameter of the lumen in the shaft such that theinsert 387 fits snugly within the lumen of the shaft. Theinsert 387 may have an outer diameter from about 0.2 inches to about 0.3 inches. Preferably, theinsert 387 has an outer diameter from about 0.21 inches to about 0.27 inches. More preferably, theinsert 387 has an outer diameter of about 0.23 inches. - The
insert 387 has alumen 385 extending therethrough having a diameter large enough to accommodate asuture 354. The diameter of thelumen 385 may be from about 0.02 inches to about 0.100 inches. Preferably, the diameter of thelumen 385 is from about 0.04 inches to about 0.08 inches. More preferably, the diameter of thelumen 385 is about 0.06 inches. - As illustrated in FIGS. 17, 18 and20, the
shaft 320 has a bore therein which is large enough to permit thesuture 354 to exit from theshaft 320. In the embodiment shown in FIGS. 17, 18 and 20, the bore is located in the straightmedian section 395 at a position in which it is located outside of the patient's body when the bone anchor 348 has been inserted into the patient's bone. However, those skilled in the art will appreciate that the bore may be located in other locations such as the firstbent section 397. - As illustrated in FIGS. 17 and 20, the
shaft 320 extends through alumen 383 in thehandle 312. Thelumen 383 has a narrowdistal section 381 having a diameter slightly larger than the outer diameter of theshaft 320 and a wideproximal section 373 adapted to receive aspring 371. - The
shaft 320 passes through the interior of thespring 371 as depicted in FIGS. 17 and 20. The distal end of thespring 371 contacts the distal end of the widerproximal section 373 of the lumen. The proximal end of the spring contacts aplug 369. Theplug 369 has a lumen through which theshaft 320 passes and a bore adapted to receive ascrew 367. Thescrew 367 passes through the bore in theplug 369 and a bore in theshaft 320 which is aligned with the bore in the plug, thereby securing theshaft 320 to theplug 369. - The resistance of the
spring 371 is selected to be equal to the force with which the bone anchor 348 is to be driven into the bone. For example, where the bone anchor 348 is to be driven into the bone by applying 20 pounds of force, thespring 371 is a 20 pound spring. The spring indicates when the desired amount of force has been applied because the user can sense when the spring has been completely compressed. - The
spring 371 may have a resistance of from about 5 to about 35 pounds. Preferably, thespring 371 has a resistance from about 15 to 25 pounds. More preferably, thespring 371 has a resistance of 20 pounds. - Those skilled in the art will appreciate that the anchor implantation device shown in FIGS.13-16 may also be adapted to include a force indicating spring in the handle.
- As illustrated in FIGS. 17, 18 and20, a
bone anchor mount 338 and aprotective sheath 378 as described above with respect to the embodiment of FIGS. 13-16 are attached to the end of the distalstraight section 389. - In an alternate embodiment, illustrated in FIG. 27, the protective sheath on the bone
anchor implantation device 310 is aballoon 279 as described above with respect to the embodiments of FIGS. 25 and 26a. The balloon is attached to the distalstraight section 389 of the boneanchor implantation device 310 as described above with respect to the embodiment of FIGS. 24 and 25. The device may further comprise a spring element as discussed above with respect to FIG. 38. - The hooked bone
anchor implantation devices - The hooked bone
anchor implantation device shaft protective sheath second telescoping cylinder pubic bone second telescoping cylinders outer cylinder second telescoping cylinders cavity 258, 358 of the outer cylinder as shown in FIGS. 20, 22 and 24 and thebone anchor 248, 348 is driven into thepubic bone bone anchor 248,348 into thebone device bone anchor bone - As shown in FIG. 20, in the
device 310 having aspring 371 inside thehandle 312, thespring 371 is compressed when the handle is pulled in a retrograde direction to drive the bone anchor into the bone. In this embodiment, the user can detect when thespring 371 has been completely compressed, or compressed by a predetermined amount, indicating that the desired amount of force for driving the bone anchor into the bone has been applied. - The hooked bone anchor implantation device with balloon illustrated in FIGS.25-27 is used as follows. An incision in the anterior vaginal wall is made as described above. The site for bone anchor implantation is located by palpation of the urethra, pubic symphsis or other anatomical landmark or other techniques known by those skilled in the art.
- The hooked bone anchor implantation device with a balloon or
gelatin structure shaft gelatin structure 279, 379 is positioned such that the balloon orgelatin structure 279 contacts thepubic bone bone anchor 238,348. The force is transmitted through the boneanchor implantation device bone anchor 279, 379 and causes the balloon orgelatin structure 279, 379 to press against thepubic bone 279, 379. The application of additional force causes the bone anchor point to puncture the balloon orgelatin structure 279, 379 and drives thebone anchor 248, 348 into thepubic bone bone anchor 248, 348 into thebone device bone anchor bone - Other embodiments of the invention, particularly various types of protective sheaths which prevent premature insertion, are illustrated in FIGS.39-45.
- FIGS.39-40 b illustrate a bone anchor implantation device with a telescoping sheath which retracts upon insertion. As discussed above with reference to FIGS. 13-16, the bone anchor implantation device with telescoping sheath comprises a
handle 512, a hooked shapedshaft 520 secured to thehandle 212, abone anchor mount 538 adapted to releasably engage abone anchor 548 and attached at the distal end of theshaft 520, and atelescoping sheath 550 which attaches to thebone anchor mount 538 and covers thebone anchor 548. FIG. 40a depicts thetelescoping sheath 550 in an extended or open position covering thebone anchor 548. FIG. 40B illustrates thetelescoping sheath 550 in a retracted position. Details regarding the telescoping sheath are discussed above with reference to FIGS. 13-16. A spring biases thetelescoping sheath 550 between extended and retracted positions. - As illustrated in FIG. 45 the bone anchor implantation device with telescoping sheath shown in FIG. 39 is inserted into the
vagina 908 and positioned so that thetelescoping sheath 950 contacts thepubic bone 918. Thebone anchor 948 is then inserted by applying a retrograde force to thebone anchor 948 by pulling the handle 912 of the device in a retrograde direction. There is anannular shoulder 910 on thebone anchor 948 which acts as a depth stop to ensure adequate penetration. Further details regarding the method of inserting the bone anchor are described above with reference to FIGS. 17 and 21. - FIGS. 41a and 41 b illustrate a hooked-shaped bone anchor implantation device which a
balloon 650 covering thebone anchor 648. The device comprises ahandle 612, a hooked-shaped shaft secured to thehandle 612, abone anchor mount 638 attached to the distal end of the shaft and adapted to releasably engage abone anchor 648, and aballoon 650 which covers thebone anchor 648. Features of the balloon sheath are discussed above with reference to FIGS. 25 and 26a. Theballoon 650 may be filled with one or more antibiotics to combat infection at he implantation site. The device may also comprise aport 680 for inserting antibiotics into the balloon. The balloon is perfed away upon implantation. - FIGS. 42a and 42 b illustrate a bone anchor implantation device having a
latex sheath 750 with aspring element 779 which covers thebone anchor 748. As described above with reference to FIG. 38, the spring element can be any type of spring which is elastically or plastically deformable. Preferably the spring is a compression spring such as a coiled helical spring which surrounds the bone anchor and which retracts when pressure is applied. The latex sheath can be hermetically sealed to the bone anchor implantation device. The sheath may also be filled with one or more antibiotics to prevent infection at the implantation site. The latex sheath perfs away upon implantation. - FIG. 43 illustrates a bone anchor implantation device with gelatin structure or a
capsule 890 that covers thebone anchor 888 Thecapsule 890 can be coupled to thebone anchor mount 838. Thecapsule 890 can be made of biodegradable materials such as those described above with reference to the balloon sheath illustrated in FIGS. 25 and 26a. Preferably the caplet is made of gelatin. Thebone anchor 888 perfs thecapsule 890 and any remaining capsule particles are absorbed or metabolized. - FIG. 44 illustrates a bone anchor implantation device that has a
sheath 802 with alumen 805 that a diameter large enough to accommodate one ormore sutures 808 which are preattached to thebone anchor 848. Thesheath 802 protect thesutures 808 from contamination. Further details regarding a shaft with a lumen that accommodates one or more sutures are discussed above with respect to FIGS. 17-20. Thebone anchor 848 with attachedsutures 808 has a screw or lockingdevice 804 which secures thebone anchor 848 to the bone anchor implantation device. Thelocking mechanism 804 prevents accidental insertion of thebone anchor 848 into tissue. - Although this invention has been described in terms of certain preferred embodiments, other embodiments which will be apparent to those of ordinary skills in the art in view of the disclosure herein are also within the scope of this invention. Accordingly, the scope of the invention is intended to be defined only by reference to the appended claims.
Claims (26)
1. A bone anchor implantation device, comprising:
a hook-shaped shaft having a first end and a second end;
a bone anchor releasably engaged to one end of the shaft; and
a protective sheath for encapsulating the bone anchor prior to implantation.
2. The device of , wherein said protective sheath comprises:
claim 1
at least one telescoping cylinder
a first telescoping cylinder having a proximal end, a distal end and a lumen extending therethrough, a first shoulder at said distal end of said first telescoping cylinder and a second shoulder at said proximal end of said first telescoping cylinder.
a second telescoping cylinder having a proximal end, a distal end and a lumen extending therethrough, a first shoulder at said distal end of said second telescoping cylinder and a second shoulder at said proximal end of said second telescoping cylinder; and
a spring, wherein said first shoulder of said first telescoping cylinder engages said shoulder of said outer cylinder, said second shoulder of said first telescoping cylinder engaged said first shoulder of said second telescoping cylinder, and said spring is disposed between said second shoulder of said second telescoping cylinder and said outer cylinder, whereby said first and second telescoping cylinders are movable between a first position in which they are extended from said outer cylinder to cover said bone anchor and a second position in which they are retracted in said cavity of said outer cylinder to expose said bone anchor.
3. The device of wherein the protective sheath comprises a balloon.
claim 1
4. The device of wherein the protective sheath comprises a gelatin structure.
claim 1
5. The device of wherein said balloon is perforatable by the bone anchor as the bone anchor is pressed into a bone.
claim 3
6. The device of wherein said balloon is hermetically sealed around the bone anchor.
claim 3
7. The device of wherein said balloon comprises a material selected from the group consisting of plastic, thermoplastic, elastromers, PET, PETG, rubber, vinyl, latex, and silicone.
claim 3
8. The device of wherein said balloon comprises latex.
claim 3
9. The device of wherein said balloon comprises a biodegradable material.
claim 3
10. The device of wherein said biodegradable material comprises a polymer.
claim 9
11. The device of wherein said polymer comprises a synthetic polymer.
claim 10
12. The device of wherein said polymer is selected from the group consisting of polyglycolic acid (PGA), polylactic acid (PLA), poly (dioxanone) (PDO), poly (l-lactide) (LPLA), poly (dl-lactide) (DLPLA), poly (glycolide-co-trimethylene carbonate) (PGA-TMC), poly (l-lactide-co-glycolide) (PGA-LPLA), poly (dl-lactide-co-glycolide) (PGA-DLPLA), poly (l-lactide-co-dl-lactide) (LPLA-DLPLA), poly(glycolide-co-trimethylene carbonate-co-dioxanone) (PDO-PGA-TMC), poly(ε-caprolactone), poly(dioxanone)(a polyether-ester), poly (lactide-co-glycotide), poly(SA-HDA anhydride), poly(orthoester), polyglyconate.
claim 9
13. The device of wherein said balloon contains an antibiotic.
claim 3
14. The device of wherein said gelatin structure contains an antibiotic.
claim 4
15. The device of further comprising a port which extends from the first end to the second end of said shaft into the balloon.
claim 3
16. The device of further comprising a port which extends from the first end to the second end of said shaft into the gelatin structure.
claim 4
17. The device of wherein said antibiotic is released when the balloon is perforated.
claim 13
18. The device of wherein said antibiotic is release when the gelatin structure is perforated.
claim 14
19. The device of or wherein said antibiotic is selected from the group consisting of nafcillin, aminogylcoside, ciprofloxin, clindamcin, piperacillin/tazobactum, ampicillin/sulbactum, aminoglcoside, vancomycin, cephalosporin, TMP/SMX, ampicillin, gentaminicin, tobramycin and ciprofloxacin.
claim 13
14
20. The device of further comprising a spring element attached to the shaft within to the balloon which retracts when the balloon is pressed against the bone by the shaft causing the bone anchor to perforate the sheath.
claim 3
21. The device of wherein the spring element comprises an open-coiled helical spring which surrounds the bone anchor.
claim 20
22. The device of wherein one or more sutures are coupled to the bone anchor and wherein the shaft includes a hollow section in which the sutures are disposed.
claim 1
23. A method of inserting into a bone a bone anchor that is releasably engaged to a bone anchor implantation device and covered by a sheath, comprising:
(1) locating a bone anchor implantation site on the bone,
(2) applying a retrograde force to said bone anchor to perforate said sheath and implant said bone anchor into said bone.
24. The method of wherein said sheath comprises a balloon and step (2) includes perforating the balloon.
claim 23
25. The method of further comprising the step of inserting an antibiotic into the balloon which is released when the sheath is perforated.
claim 24
26. The method of wherein said bone anchor implantation device further comprises a spring element attached to the end of the shaft within the balloon and step (2) further comprises retracting the spring element.
claim 24
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US09/804,500 US6440154B2 (en) | 1996-11-08 | 2001-03-12 | Protective sheath for transvaginal anchor implantation device |
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US09/804,500 Expired - Fee Related US6440154B2 (en) | 1996-11-08 | 2001-03-12 | Protective sheath for transvaginal anchor implantation device |
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US09/238,654 Expired - Lifetime US6264676B1 (en) | 1996-11-08 | 1999-01-26 | Protective sheath for transvaginal anchor implantation devices |
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