U.S. patent application number 10/742629 was filed with the patent office on 2004-11-04 for bone instruments and methods.
This patent application is currently assigned to Sulzer Spine-Tech, Inc.. Invention is credited to Bagga, Charanpreet S., Brady, Dale L., Hanson, David A..
Application Number | 20040220578 10/742629 |
Document ID | / |
Family ID | 29783169 |
Filed Date | 2004-11-04 |
United States Patent
Application |
20040220578 |
Kind Code |
A1 |
Bagga, Charanpreet S. ; et
al. |
November 4, 2004 |
Bone instruments and methods
Abstract
Bone guides for sizing or shaping bone are disclosed. The guides
can be configured and sized for placement on a surgery table,
instrument table or similar structure in an operating room. The
guides provide for real time preparation of a bone graft during a
surgical procedure.
Inventors: |
Bagga, Charanpreet S.;
(Phoenixville, PA) ; Hanson, David A.;
(Minneapolis, MN) ; Brady, Dale L.; (Richfield,
MN) |
Correspondence
Address: |
Attention Karen A. Fitzsimmons
MERCHANT & GOULD P.C.
P.O. Box 2903
Minneapolis
MN
55402-0903
US
|
Assignee: |
Sulzer Spine-Tech, Inc.
Minneapolis
MN
|
Family ID: |
29783169 |
Appl. No.: |
10/742629 |
Filed: |
December 19, 2003 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
10742629 |
Dec 19, 2003 |
|
|
|
09692512 |
Oct 19, 2000 |
|
|
|
6676662 |
|
|
|
|
60160484 |
Oct 20, 1999 |
|
|
|
60197040 |
Apr 14, 2000 |
|
|
|
Current U.S.
Class: |
606/87 |
Current CPC
Class: |
A61F 2002/30617
20130101; A61F 2/4644 20130101; A61F 2002/2839 20130101; A61F
2250/0097 20130101; A61B 17/15 20130101; A61F 2002/30948 20130101;
A61F 2002/4649 20130101; A61F 2002/4658 20130101 |
Class at
Publication: |
606/087 |
International
Class: |
A61F 005/00 |
Claims
1-20. (Cancelled)
21. A guide device for use in sizing and shaping bone, the device
comprising: a base; a bone holding arrangement; and a cutting guide
configured to translate and pivot relative to the base.
22. The device of claim 21, wherein the cutting guide is configured
to translate in a first direction, and a second direction
perpendicular to the first direction.
23. The device of claim 21, wherein the cutting guide is configured
to translate in at least one of a horizontal direction relative to
the base and a vertical direction relative to the base.
24. The device of claim 21, wherein the cutting guide is configured
to translate in a first horizontal direction relative to the base
and a second vertical direction relative to the base.
25. The device of claim 21, wherein the cutting guide is a first
cutting guide, the guide device further including a second cutting
guide configured to translate and pivot relative to the base.
26. A guide device for use in configuring a bone piece, the device
comprising: a base; a bone holding arrangement; and a bone cutting
arrangement including a first cutting guide and a second cutting
guide, each of the first and second cutting guides being configured
move relative to a bone piece positioned in the bone holding
arrangement.
27. The device of claim 26, wherein at least one of the first and
second cutting guides is configured to pivot relative to the bone
piece.
28. The device of claim 26, wherein each of the first and second
cutting guides is configured to pivot relative to the bone
piece.
29. The device of claim 26, wherein each of the first and second
cutting guides is configured to move in a first direction, and a
second direction perpendicular to the first direction.
30. The guide of claim 26, wherein each of the first and second
cutting guides is configured to move in at least one of a
horizontal direction relative to the bone piece and a vertical
direction relative to the bone piece.
31. The guide of claim 26, wherein each of the first and second
cutting guides is configured to move in a first horizontal
direction relative to the bone piece and a second vertical
direction relative to the bone piece.
32. A method of modifying the configuration of a bone piece, the
method comprising the steps of: providing a bone device, the bone
device including a bone holding arrangement and a bone cutting
arrangement; selecting a piece of bone to be modified; positioning
the bone piece in the bone holding arrangement; translating the
bone cutting arrangement to a selected position relative to the
bone piece; pivoting the bone cutting arrangement to a selected
orientation relative to the bone piece; and modifying the bone
piece to a desired configuration.
33. The method of claim 32, wherein the step of modifying the bone
piece includes cutting the bone piece with a cutting element.
34. The method of claim 32, wherein the step of modifying the bone
piece includes shaping the bone piece with a shaping element.
35. The method of claim 32, wherein the step of translating the
bone cutting arrangement includes moving a cutting guide of the
cutting arrangement in at least one of a first horizontal direction
relative to the bone piece and a second vertical direction relative
to the bone piece.
36. A method of modifying the configuration of a bone piece, the
method comprising the steps of: providing a bone device, the bone
device including a bone holding arrangement and a bone cutting
arrangement, the bone cutting arrangement including first and
second cutting guides; selecting a piece of bone to be modified;
positioning the bone piece in the bone holding arrangement; moving
the first and second cutting guides of the bone cutting arrangement
to selected positions relative to the bone piece; and modifying the
bone piece to a desired configuration.
37. The method of claim 36, wherein the step of moving the first
and second cutting guides of the bone cutting arrangement includes
translating the first and second cutting guides in at least one of
a horizontal direction relative to the bone piece and a vertical
direction relative to the bone piece.
38. The method of claim 37, wherein the step of moving the first
and second cutting guides of the bone cutting arrangement further
includes pivoting at least one of the first and second cutting
guides relative to the bone piece.
39. The method of claim 37, wherein the step of moving the first
and second cutting guides of the bone cutting arrangement includes
pivoting the first and second cutting guides relative to the bone
piece.
40. The method of claim 36, wherein the step of modifying the bone
piece includes cutting the bone piece with a cutting element.
41. The method of claim 36, wherein the step of modifying the bone
piece includes shaping the bone piece with a shaping element.
Description
RELATED APPLICATIONS
[0001] The present application claims priority to U.S. applications
Ser. Nos. 60/160,484 filed Oct. 20, 1999, and 60/197,040 filed Apr.
14, 2000, the entire disclosures of each application being
incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention is directed to the field of surgery.
Specifically, the invention is directed to instruments and methods
for cutting and shaping bone. The invention is particularly
advantageous for cutting and shaping bone for use in bone
grafting.
BACKGROUND OF THE INVENTION
[0003] Bone grafts are used in many types of bone surgery. Often
times, bone used as a bone graft has been prepared according to
generic size and shape specifications. However, preparing a bone
graft during surgery can provide precisely configured bone at
significantly reduced costs. Having instruments for sizing or
shaping bone in the operating room can enhance the overall success
of the surgical procedure by enabling the surgeon to fine tune the
configuration of the graft for a particular site.
[0004] Accordingly, there is a need for instruments and methods to
size and shape bone for a particular application. The present
invention is directed to this need.
SUMMARY OF THE INVENTION
[0005] The present invention is directed to guides and methods for
cutting or shaping bone. A guide (or jig) provides for maintaining
a selected positional relationship between herein disclosed cutting
or shaping instruments and bone that can be held by the jig. The
guide can be configured and sized for placement on a surgery table,
instrument table or similar structure for use in an operating room.
In preferred embodiments, the jig is portable and manufactured from
a material such as stainless steel (or other materials suitable for
surgical use) which permits sanitization or sterilization using
known procedures. The jigs provide real time preparation of a bone
graft from heterologous, homologous, or autologous sources (i.e.,
xenograph, allograft, autograft).
[0006] Throughout the specification, guidance may be provided
through lists of examples. In each instance, the recited list
serves only as a representative group. It is not meant, however,
that the list is exclusive.
[0007] Unlike many prior systems, the invention provides the
surgeon with the flexibility to cut and shape a bone graft to any
size or shape needed at the time of surgery. In some embodiments,
the guides disclosed include a surface for cooperative fit with an
inanimate object in the operating room. If necessary, the guides
can be stabilized during use by one or more c-clamps or a similar
fixating device or by a surgical assistant or other person holding
the guide in a stable position during graft preparation.
[0008] The guides of the invention are suitable for use with any
type of bone that is used for grafting in any location. In some
embodiments, the guides are particularly advantageous for use in
spinal surgery applications. Examples of bones which can be used
for spinal applications include, without limitation, femur, tibia,
patella and fibula. In the case of vertebral fusion procedures
(e.g., intradiscal graft implant), femoral and tibial bone can
typically be used as grafts for fusion of lumbar and thoracic
vertebrae and fibular bone for cervical vertebrae.
[0009] In one embodiment, a guide according to the invention can
include a base, bone holding arrangement, bone cutting arrangement
having at least one cutting guide and a bone shaping arrangement.
The bone holding arrangement can include a first and second bone
holding member. A bone holding member typically includes a gripping
end for contacting the bone. The gripping end can have any of
various surface contours to facilitate secure engagement of the
bone.
[0010] In an alternative embodiment, the bone cutting guide can
include a base, a bone holding arrangement and a bone cutting
arrangement including a first cutting block and a second cutting
block. Each of the first and second cutting blocks can include a
slot for passing a saw blade therethrough for cutting bone.
[0011] In another embodiment, a guide according to the invention
can include a base, a bone holding arrangement and a bone cutting
arrangement wherein the bone cutting arrangement includes at least
one cutting guide. The cutting guide can include a slot for passing
a saw therethrough and is arranged such that when bone is fixed in
a first position by the bone holding arrangement, a saw passed
through the slot in the first cutting guide can make a first cut in
the bone at a first location. The cutting guide can then be
repositioned and a second cut made with the saw at a second
location in the bone.
[0012] The invention also provides methods for bone cutting and
shaping.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1 is a side perspective view of one embodiment of a
bone guide according to the invention;
[0014] FIG. 2 is a top perspective view of the bone guide of FIG.
1;
[0015] FIG. 3 is a top perspective view of an embodiment of a body
of a jig of the invention;
[0016] FIG. 4 is a front view of the body of FIG. 3;
[0017] FIG. 5 is a side view of the body of FIG. 3;
[0018] FIG. 6 is a top view of the body of FIG. 3;
[0019] FIG. 7 is a perspective view of one embodiment of a bone
holding member;
[0020] FIG. 8 is a top plan view of the bone holding member of FIG.
7;
[0021] FIG. 9 is a view of the bone holding member of FIG. 8
rotated 90.degree.;
[0022] FIG. 10 is a view of an alternative embodiment of a bone
holding member within a portion of the body of a jig according to
the invention;
[0023] FIG. 11 is a perspective view of one embodiment of a
horizontal track, carriage and shaping track;
[0024] FIG. 12 is a side view of the horizontal track and carriage
of FIG. 11;
[0025] FIG. 13 is a front view of the carriage of FIG. 11;
[0026] FIG. 14 is a top view of the horizontal track, carriage and
shaping track of FIG. 11;
[0027] FIG. 15 is a perspective view of one embodiment of a cutting
block;
[0028] FIG. 16 is a top view of the cutting block of FIG. 15;
[0029] FIG. 17 is a front view of the cutting block of FIG. 15;
[0030] FIG. 18 is a side view of the cutting block of FIG. 15;
[0031] FIG. 19 is a diagrammatic representation of a side view of
an alternative embodiment of a bone cutting arrangement of the
invention;
[0032] FIG. 20 is a perspective view of one embodiment of a shaping
block according to the invention;
[0033] FIG. 21 is a side view of the shaping block of FIG. 20;
[0034] FIG. 22 is a top view of the shaping block of FIG. 20;
[0035] FIG. 23 is a back view of the shaping block of FIG. 20;
[0036] FIG. 24 is a perspective view of an alternative embodiment
of a shaping block according to the invention;
[0037] FIG. 25 is a side view of the shaping block of FIG. 24;
[0038] FIG. 26 is a back view of the shaping block of FIG. 24;
[0039] FIG. 27 is a top view of the shaping block of FIG. 24;
[0040] FIG. 28 is a perspective view of an alternative embodiment
of a shaping block according to the invention;
[0041] FIG. 29 is a side view of the shaping block of FIG. 28;
[0042] FIG. 30 is a back view of the shaping block of FIG. 28;
[0043] FIG. 31 is a top view of the shaping block of FIG. 28;
[0044] FIG. 32 is a perspective view of one embodiment of a bone
guide according to the invention;
[0045] FIG. 33 is a perspective view of the bone guide of FIG. 32
rotated 180.degree.;
[0046] FIG. 34 is a front end view of a portion of the bone guide
shown in FIG. 32;
[0047] FIG. 35 is an example of graduated markings for use
according to the invention;
[0048] FIG. 36 is an example of graduated markings for use
according to the invention;
[0049] FIG. 37 is an end on view of bone holding members of one
embodiment of a bone holding arrangement for a bone guide such as
that of FIG. 32, and related components;
[0050] FIG. 38 is an alternative embodiment of engaging surfaces of
a bone holding arrangement of the invention;
[0051] FIG. 39 is an exploded view of a shaping assembly according
to the invention;
[0052] FIG. 40 is a perspective view of a cover guide of a shaping
assembly according to the invention;
[0053] FIG. 41 is a view of a concave cutting surface for a shaping
member according to the invention;
[0054] FIG. 42 is a perspective view of a bone holding arrangement
according to the invention; and
[0055] FIG. 43 is a top plan view of the bone holding arrangement
of FIG. 42.
DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS
[0056] The bone guides of the invention will be described by
reference to the several drawing figures. The illustrated
embodiments are provided only for descriptive purposes and are not
intended to limit the guides that are within the scope of the
invention.
[0057] In general, a guide of the invention functions to hold a
bone or section of bone in a fixed position during cutting, shaping
or other preparational procedure performed on the bone.
Advantageously, in some embodiments, the guides disclosed herein
provide a stereotaxic approach for precision sizing and shaping of
bone for use in bone grafting.
[0058] FIG. 1 is a side perspective view and FIG. 2 a top
perspective view of one embodiment of a guide 10 according to the
invention. In this embodiment, guide 10 includes a body 1, a base 2
and a bone holding arrangement 150 including a first bone holding
member 3 and a second bone holding member 4 which pass through body
1. Bone holding members 3 and 4 do not need to pass through body 1
to provide their herein disclosed functions.
[0059] A bone cutting arrangement 160 including a vertical track 5
mounted to body 1 and a cutting guide such as cutting block 7 is
illustrated. Horizontal track 6 can be mounted to vertical track 5.
However, it will be appreciated that horizontal track 6 could
alternatively be mounted to body 1. Moreover, while referred to as
vertical and horizontal tracks, it will be appreciated that the
tracks of a jig of the invention need not be limited to vertical or
horizontal. Rather, the horizontal and vertical tracks are used for
explanatory purposes of the illustrated embodiment. Tracks
configured at various degrees of angulation from vertical and
horizontal are within the scope of the invention.
[0060] Referring to FIGS. 1, 2 and 15, cutting block 7 can be
mounted to vertical track 5 for vertical movement of cutting block
7 along the track, relative to first and second holding members 3,
4, respectively. It will be appreciated that cutting block 7 could
alternatively be adjustably mounted directly to body 1.
[0061] Referring to FIGS. 1, 2, 11-14 and 20-31, one embodiment of
a bone shaping arrangement 170 is illustrated. In this embodiment,
bone shaping arrangement 170 includes a shaping block 8 mounted to
shaping track 9 which is mounted to horizontal track 6. While the
specific components of a bone shaping arrangement may vary, a bone
shaping arrangement of the invention typically includes a cutting,
grinding, rasping, or other surface to shape or provide a contour
to a piece of bone. In the illustrated embodiment, shaping block 8
can be moved in a vertical direction along vertical track 5. In
addition to vertical movement, shaping block 8 can also move in a
first horizontal plane along shaping track 9 and in a second
horizontal plane via horizontal track 6. Shaping block 8 can also
include a portion of tracking mechanism 11 to maintain shaping
block 8 in a selected orientation on shaping track 9 as will be
discussed below.
[0062] Body 1 also includes a first stabilizing arrangement 12 and
a second stabilizing arrangement 13 for fixing guide 10 in a
particular location. For example, first and second stabilizing
arrangements 12, 13 can be holes 14, 15, threaded or unthreaded,
for mounting horizontally oriented handles (not shown). By exerting
a downward force on such handles, guide 10 can be stabilized while
in use. Alternatively, a c-clamp can be used to clamp base 2 to a
stationary object, for example, a surgery table or instrument
table. In another alternative, the jig may be used without the need
for c-clamps or other ancillary stabilizing system.
[0063] FIGS. 3-6 illustrate an embodiment of body 1 of jig 10 with
certain components removed for easier visualization. FIG. 3 is a
top perspective view, FIG. 4 is a front view, FIG. 5 is a side view
and FIG. 6 is a top view. In the illustrated embodiment, vertical
track 5 comprises a first vertical member 20 and a second vertical
member 21. However, in some embodiments, vertical track 5 may have
only a single track member. Whether a single track member or
multiple track members, in some embodiments, vertical track 5 can
also include a rack which meshes with a pinion located, for
example, on cutting block 7, for incremental movement of cutting
block 7 along vertical track 5. Vertical track 5 can also include
graduated markings to indicate relative positions of cutting block
7 along vertical track 5. Body 1 can also include a rotation
limiter 23 such as first holder opening 24 and second holder
opening (not visible) through which holding members 3 and 4 are
passed. The bone holder openings can be configured, such as having
a "D" shape, to limit rotational movement of the bone holding
members.
[0064] FIG. 7 is a perspective view of one embodiment of a first
bone holding member 3. The second bone holding member 4 may be
identical in appearance. FIG. 8 is a top view of the bone holding
member of FIG. 7 and FIG. 9 is a top view of the holding member of
FIG. 8 rotated 90.degree. about the longitudinal axis of bone
holding member 3. As illustrated, bone holding member 3 includes an
operating end 30 and a gripping end 31. Gripping end 31 directly
contacts bone that is prepared in guide 10 and preferably includes
an engaging surface 31 a for frictional gripping of the bone.
Suitable engaging surfaces are known and include, for example,
serrations, grooves, ridges, knurls, etc. A shaft 32 extends
between operating end 30 and gripping end 31. Shaft 32 is
preferably configured to limit rotational movement of bone holding
member 3 when within body 1. For example, in the illustrated
embodiment, bone holding member 3 includes a groove 34 which can
cooperate with a rotation limiter 23, such as a pin mounted onto
body 1 (not illustrated) which maintains groove 34, and the entire
bone holding member, in a fixed rotational position.
[0065] FIG. 10 is a top view of an alternative embodiment of a bone
holding member 50 passing through body 1. According to this
embodiment, bone holding member 50 includes an operating end 51 and
a gripping end 52. Threads 53 of adjustment knob 54 at operating
end 51 cooperate with threads 55 of bone holding member 50 when
adjustment knob 54 is rotated. Rotation of adjustment knob 54 can
advance or retract bone holding member 50 relative to an opposing
bone holding member. Arm 56 is mounted to body 1 and includes a
slot 57 that receives guide ring 58 of adjustment knob 54 to
maintain adjustment knob 54 in position as holding member 50 is
advanced or retracted.
[0066] Referring to FIG. 11, a perspective view of horizontal track
6 and shaping track 9 of a bone shaping arrangement is shown. In
the illustrated embodiment, horizontal track 6 comprises a first
horizontal member 61 and a second horizontal member 62 which extend
from carriage 63. It will be appreciated that horizontal tracks
could alternatively comprise only a single horizontal track
member.
[0067] Carriage 63 includes a first opening 64 and a second opening
65 for passing along first vertical member 20 and second vertical
member 21 of body 1. Carriage 63 also includes a releasable locking
arrangement 66 (such as a threaded screw with knob 66a) for
releasably locking carriage 63 at a selected position along the
length of vertical track 5.
[0068] FIG. 12 is a side view of horizontal track 6 and carriage
63. FIG. 13 is a front view of carriage 63 and FIG. 14 is a top
view of horizontal track 6, shaping track 9 and carriage 63.
Referring to FIG. 14, shaping track 9 includes a first end
including first tracking coupler 71 and a second end including a
second tracking coupler 72. Thus, shaping track 9 can move back and
forth along horizontal members 61, 62 in a plane horizontal to
vertical track 5. As will be discussed below, shaping track 9
includes a portion of tracking mechanism 11, a shaping slot 70, for
receiving a cooperating portion of tracking mechanism 11 on shaping
block 8.
[0069] FIG. 15 is a perspective view of a cutting guide, cutting
block 7, of a bone cutting arrangement. Cutting block 7 includes a
first opening 80 and a second opening 81 for passage along first
vertical member 20 and second vertical member 21. Cutting block 7
also includes a releasable locking arrangement 82 such as a
threaded screw and knob 83 for locking cutting block 7 in a
selected position along vertical track 5. Cutting block 7 also
includes a cutting slot 84 for receiving the blade of a saw which
can be passed through slot 84 from the front 85 of cutting block 7
through the back 86 to a position for cutting bone positioned
between first and second holding members 3, 4. In the illustrated
embodiment, slot 84 is parallel to the horizontal plane. However,
cutting block 7 can include a slot which extends from front 85 to
back 86 and which has an angle relative to horizontal of up to
.+-.90.degree., typically about 0.degree. to 60.degree.. Slot 84
maintains the saw blade (not shown) at the selected angle during
cutting. It will be appreciated, however, that rather than passing
through slot 84, a saw blade can be positioned against the top 88
or bottom 89 of cutting block 7 to maintain the position of the saw
blade relative to a piece of bone. The positioning of the slot
permits cutting bone such that the cut edges are parallel or angled
relative to one another.
[0070] In an alternative embodiment, a saw blade can be maintained
in a selected position using a bone cutting arrangement 160 such as
saw stabilizing arrangement 100. According to this embodiment, a
first saw guide member 101 is positioned a selected distance above
or below a second saw guide member 102 such that when a saw blade
103 is passed between first saw guide member 101 and second saw
guide member 102, the saw blade 103 is maintained at the selected
angle for cutting a piece of bone. The saw guide members 101, 102
can be selectively positioned, for example, along vertical track 5
and spaced apart the appropriate distance between the first and
second saw guides 101, 102 to form a desired angle using known
releasable locking arrangements.
[0071] FIGS. 20-23, 24-27 and 28-30 are each alternative
embodiments of a shaping block 8 according to the invention.
Referring to FIGS. 20-23, rounding block 110 can round an outer
surface of bone and includes a cutting surface 111 having a first
curved side 112 and a second curved side 113. When rounding block
110 is in position on shaping track 9, and pin 114 of tracking
mechanism 11 is positioned in shaping slot 70 (FIG. 11), rounding
block 110 can be moved back and forth over a piece of bone in at
least two horizontal directions, one along horizontal track 6 and
the second along shaping track 9.
[0072] FIGS. 24-27 illustrate an alternative embodiment of a
shaping block 8. According to this embodiment, ribbed block 120
includes a cutting surface 121 having a ridge 122 which can create
a groove in a bone when passed back and forth over the bone. FIG.
25 is a side view of ribbed block 120, FIG. 26 is a back view of
ribbed block 120 and FIG. 27 is a top view of ribbed block 120.
Ribbed block 120 also includes a pin 123 of tracking mechanism 11
as described above for rounding block 110.
[0073] FIGS. 28-31 illustrate another embodiment of a shaping block
8. According to this embodiment, serrated block 130 includes a
cutting surface 131 having serrations 132 which can shave bone when
passed back and forth over the bone. FIG. 29 is a side view of
serrated block 130, FIG. 30 is a back view of serrated block 130
and FIG. 31 is a top view of serrated block 130. Serrated block 130
also includes a pin 133 of tracking mechanism 11 as discussed above
for rounding block 110.
[0074] During use of guide 10, a surgeon can determine an initial
size and shape of bone to be used, for example, for a bone graft,
in vivo or using x-rays, MRI, CT-scans, etc. Once the bone source
is selected, it can be placed within the bone holding arrangement,
such as between the gripping ends of a pair of bone holding members
and the members are advanced towards one another to secure the bone
in place.
[0075] An appropriate bone cutting arrangement, such as a cutting
block, saw stabilizing arrangement, etc., and bone shaping
arrangement are selected. The cutting block can be mounted to the
jig and a saw such as an oscillating saw, can then be used to make
a first cut of bone. The cutting block can then be repositioned if
a second cut is needed to obtain a desired width dimension of the
bone. If a different cutting block providing a different slot angle
is desired, it can also be put onto the vertical track before
making the second cut. The first or second cut can be made to
achieve a flat or lordotic (angled) piece of bone of a desired
width.
[0076] For shaping, the bone can be repositioned in the gripping
end of the bone holding members. A bone shaping block can then be
mounted onto the horizontal track at a selected position. The
shaping block can then be passed back and forth over the bone, each
pass removing an incremental amount of bone until the desired shape
is cut into the piece of bone. Different shaping blocks can be used
as necessary.
[0077] In an alternative embodiment, body 1 can be modular.
Referring to FIG. 5 for description purposes, according to this
alternative, body 1 could include a removable upper portion 180
separable from a lower portion 181 at a distance below rotational
limiter 23. This configuration provides a height dimension H.sub.1
below the rotational limiter that is greater (as illustrated) or
less than the distance H.sub.2 between rotational limiter 23 and
the top edge of the upper portion. Thus after making a first cut
through the bone with the removable upper portion oriented as in
FIG. 5, the removable portion 180 (including the bone holding
member and bone) can be rotated 180.degree. and reset on the lower
portion 181 of the body 1. The bone is then in a new position for
making the second cut with the cutting block position
unchanged.
[0078] The base of the jig can include one or more legs, typically
four, which rest on a stationary object. The legs can be
telescoping or modular for increasing or decreasing the height of
the jig relative to the table as desired.
[0079] FIGS. 32 to 34 illustrate an alternative embodiment of a
bone guide 210 according to the invention. FIG. 32 is a perspective
view of bone guide 210. FIG. 33 is a perspective view of the bone
guide 210 of FIG. 32 rotated 180.degree.. Bone guide 210 includes a
body 201, a base 202, a bone holding arrangement 150 comprising
first bone holding member 203 and a second bone holding member 204.
A first support member 206 has a first pair of support arms 206a,
206b and a second support member 207 has a second pair of support
arms 207a, 207b. The first support member 206 and second support
member 207 can be opposed to each other and in slidable
relationship relative to one another and to body 201.
[0080] A bone cutting arrangement 208, comprising a bone cutting
guide such as first cutting block 211 mounted to a first pivot arm
212 and a second pivot arm 214 which can rotate around pivot points
213a (not visible) and 213b of first support member 206. Second
cutting block 215 can be mounted to a third pivot arm 216 and a
fourth pivot arm 217 which can rotate around pivot points 218a,
218b (not visible) of second support member 207. Thus, first
cutting block 211 can be pivoted on first pivot arm 212 and second
pivot arm 214 relative to first support member 206 and second
cutting block 215. Second cutting block 215, in combination with
third pivot arm 216, fourth pivot arm 217 and pivot points 218a and
218b, have a similar relationship to second support member 207 and
first cutting block 211.
[0081] FIG. 34 is a front view of bone guide 210 as shown in FIG.
32. Portions of bone cutting arrangement 208 have been removed to
visualize pivot point 213a. As illustrated in FIGS. 32 and 33,
pivot point 213a and 213b (and 218a and 218b) can be located along
an axis that passes through bone holding members 203 and 204.
However, in alternative embodiments, pivot points such as
illustrated pivot point 213d (213c on the opposite side not shown
for this description) can be located above the bone holding members
203 and 204.
[0082] Referring again to FIGS. 32 and 33, first cutting block 211
includes a first cutting slot 220 extending from proximal edge 221
to distal edge 222. Second cutting block 215 includes a second
cutting slot 223 extending from proximal edge 224 to distal edge
225 of cutting block 215.
[0083] The foregoing components are arranged such that when a piece
of bone is secured within the bone holding arrangement 150, such as
between first bone holding member 203 and second bone holding
member 204, a bone saw, such as an oscillating bone saw, can be
passed into first cutting slot 220 to make a first cut into the
bone and subsequently into second cutting slot 223 to make a second
cut into the bone.
[0084] The relative position of first cutting block 211 to second
cutting block 215 determines the spacing between cuts made into the
bone. In one embodiment, when first cutting block 211 is in direct
contact with second cutting block 215, the spacing between first
cutting slot 220 and second cutting slot 223 is approximately 6 mm.
This also being the approximate thickness of a section of bone that
can be cut when the first and second cutting blocks are in this
position. Thus, the position of first cutting block 211 and second
cutting block 215 during cutting can determine whether the cut
edges of the bone are parallel or angled relative to one
another.
[0085] In another embodiment, it will be appreciated that only a
single cut may be necessary to provide a piece of bone having a
particular thickness. For example, referring to FIG. 32, an
affirmative stop (not shown), such as a flat sheet of stainless
steel, can be inserted into first cutting slot 220 extending from
proximal edge 221, beyond distal edge 222 and distally beyond bone
holding arrangement 150 to contact the top surface of base 202. A
length of bone can then be inserted into bone holding arrangement
150 with one end of the bone abutting against the affirmative stop.
Second cutting block 215 can then be positioned at a selected
distance from first cutting block 211 and a saw passed into second
cutting slot 223 and the bone cut. Thus, according to this example,
the end of the bone abutting against the affirmative stop is not
cut at this time.
[0086] In the illustrated embodiment, first support member 206 and
second support member 207 can be selectively moved relative to one
another by sliding back and forth along first linear track guide
230 and second linear track guide 231. Referring to FIG. 33 when
first support member 206 is positioned at a selected location it
can be fixed into position by a first locking arrangement 233. In
the illustrated embodiment, first locking arrangement 233 includes
a first compression plate 234 which secures the first support
member 206 in position when first securing knob 235 is rotated to
threadedly compress compression plate 234 against first support
member 206. A similar arrangement for locking second support member
207 includes a second locking arrangement 236 comprising second
compression plate 237 and second securing knob 238.
[0087] In an alternative embodiment, body 201 can include a rack,
for example along each of edges 239 and 240, which meshes with a
pinion located on each of support members 206 and 207, for
incremental movement of support member 206 and support member 207
relative to one another. The rack could alternatively be located on
the support arms 206, 207 and the pinion on body 201. An indicator
including markings such as shown in FIG. 35 can be mounted along
edge 239 or 240 for measuring the distance between support arms 206
and 207.
[0088] Referring again to FIGS. 32 and 33, in this embodiment,
pivot arms 212 and 214 can be secured in a selected position by
threading first set screw 250 into a selected one of receptacles
251 located along first support member 206. Likewise, pivot arms
216 and 217 can be secured in a selected position by threading
second set screw 252 into a selected one of receptacles 253 mounted
along second support member 207. Securing pivot arms at a selected
location can alternatively be accomplished using other arrangements
known in the art including, for example, compression securing
arrangements, etc., or, a rack and pinion system for incrementally
adjusting the relative position of the pivot arm pairs relative to
one another.
[0089] An indicator arrangement such as apexes 260 and 261, located
on pivot arms 212 and 214, respectively, can be present to assist
the surgeon in confirming the spacing between cutting blocks. That
is, apices 260 and 261 can be used in conjunction with graduated
markings, for example as shown in FIG. 36, to indicate the amount
of spacing or angle between the cutting blocks or cutting slots. As
stated earlier, markings to indicate the spacing between the
cutting blocks could also be located, for example, on edges 239 or
240.
[0090] Referring now to FIG. 37, there is illustrated an end on
view of a bone holding arrangement 150 (viewed from the end shown
nearest the reader in FIG. 32) of bone holding members 203 and 204
relative to body 201 with omission of first and second support
members and other components for easier viewing. First bone holding
member 203 includes a gripping end 270 and an operating end 271
including a securing knob 272 for varying the position of bone
holding member 203 relative to bone holding member 204. In the
illustrated embodiment, bone holding member 203 includes a threaded
bore 273 for receiving threaded shaft 274 which is attached to
securing knob 272. Rotation of securing knob 272 rotates threaded
shaft 274 within threaded bore 273 to move gripping end 270 to and
fro relative to gripping member 204. Housing assembly 275 includes
coaptating pieces 276 and 277 which function using known technology
to cause gripping end 270 to move to and fro when securing knob 272
is rotated rather than permitting shaft 278 to move to and fro.
[0091] Bone holding member 204 also includes a gripping end 280.
Opposite the gripping end 280, bone holding member 204 can be
fixedly attached to body 201 or, alternatively, can include an
operating end similar to that of bone holding member 203 for moving
gripping end 280 to and fro relative to gripping end 270.
[0092] Gripping ends 270 and 280 directly contact bone that is to
be prepared in guide 210 and preferably include an engaging surface
281 and 282, respectively, for engaging the bone. Suitable engaging
surfaces are known and include, for example, serrations, grooves,
ridges, knurls, or other textured surfaces.
[0093] In the illustrated embodiment, gripping end 270 is rigidly
fixed to bone holding member 203 and gripping end 280 is pivotably
mounted to bone holding member 204 via gripping pin 283. It will be
appreciated that either or both of the gripping ends can be rigidly
or pivotably mounted. In addition, the gripping ends or bone
holding members can be modular for selective removal from guide 210
and interchangeability with any one of an array of different
gripping ends or bone holding members for use as needed for a
particular piece of bone.
[0094] As shown in FIG. 38, in one embodiment, engaging surfaces
270 and 280 can include engaging surfaces 281 and 282 configured
for providing four-point contact with a piece of bone (B).
[0095] As described earlier, in use, a surgeon can determine an
initial size of bone to be used for a bone graft in vivo or using
x-rays, MRI, CT-scans, etc. Once a bone source is selected, it can
be placed between the gripping ends of the bone holding members and
one or both of the gripping members advanced towards one another to
secure the bone in place. A saw can then be passed through, for
example, first cutting slot 220 to make a first cut and through
second cutting slot 223 to make a second cut. Alternatively, it is
foreseen that the saw can be passed through cutting slot 220 (or
223) to make a first cut, and the bone then moved to a second
location and a second cut made using the same slot as used for the
first cut. In any embodiment, the first and/or second cut can be
made to provide a cut surface of the bone that is in a plane which
0.degree.-90.degree. relative to a side surface of the bone. In
fact, the guide provides for repositioning the bone in any
orientation to make a cut on any surface and provide any dimension
or degree of angulation.
[0096] FIG. 39 illustrates an alternative embodiment of a bone
shaping assembly 300 according to the invention. Shaping assembly
300 includes a frame 301, table surface 302 and cover guide 303. A
shaping member 304 is rotatably mounted in frame 301. At a first
end 305 shaping member 304 includes a coupler 306 for coupling a
driver (not shown) for rotatably driving shaping member 304.
Examples of suitable sources which can couple to coupler 305 for
driving shaping member 304 include, for example, drills, hand
crank, motors, or any other device which can rotate the shaping
member 304.
[0097] In the illustrated embodiment, shaping member 304 comprises
a shaping cylinder 310 having a shaping surface 311 configured to
provide a particular shape to the bone. In the illustrated
embodiment, two shaping surfaces 311 are present. A first shaping
surface 312 includes a plurality of rows of raised cutting teeth
313 for cutting serrations into the bone when shaping cylinder 310
is rotated. A second shaping surface 314 includes a plurality of
cutting teeth 315 positioned in a single plane which is
perpendicular to the long axis of shaping cylinder 310. Second
shaping surface 314 can be used for cutting a notch into either
side of a piece of bone. Such a notch would, for example, permit
gripping of the piece of bone on two sides when placing the shaped
bone into a surgical site.
[0098] Table surface 302 provides a flat surface along which a
piece of bone can be passed when shaping. Table surface 302
includes an aperture 320 through which the teeth 313, 315 protrude
above table surface 302. Each of screws 322a-d have heads 323a-d,
respectively. When screws 322a-d are passed through holes 324a-d,
respectively, to secure table surface 302 to frame 301, heads
323a-d are configured to protrude an appropriate distance to
maintain the bottom surface 325 of cover guide 303 above table
surface 302. In one embodiment, the distance will be about the
height that cutting teeth (or other shaping surface) protrude above
table surface 302. Cover guide 303 provides for guiding a piece of
bone along the table surface 302 and shaping surfaces 311 when in
use. FIG. 40 illustrates cover guide 303 rotated 180.degree. from
the view in FIG. 39 illustrating an opening 326 for receiving a
piece of bone to be shaped by the assembly 300.
[0099] FIG. 41 is a profile view of an alternative embodiment of a
shaping member 304 having a concave cutting surface 330 which
includes, for example, cutting flutes 331 for forming a rounded
edge on a piece of bone.
[0100] FIGS. 42 and 43 illustrate an embodiment bone holding
assembly 400 according to the invention. In use, the bone holding
assembly 400 can be used to safely hold a piece of bone when
cutting serrations, grooves, rounding edges, or forming other
shapes when using a bone shaping assembly such as that shown in
FIG. 39. In the illustrated embodiment, bone holding assembly 400
includes two different bone vices for securing a piece of bone. In
a first bone vice 401, a single mobile compression plate 402 can
selectively apply a compression force to secure the piece of bone.
Mobile compression plate 402 can be moved towards vertical edge 403
by rotating knob 404 mounted to threaded shaft 405. The male
threads 406 on threaded shaft 405 cooperate with female threads
(not visible) present in a bore (not visible) passing through shaft
guide 407.
[0101] In use, once the bone is in place, the planar bottom surface
410 of bone holding assembly 400 can be slid along table surface
402 of bone shaping assembly 300 to pass the bone over one or both
of rotating shaping surfaces 311 as needed.
[0102] Bone holding assembly 400 also includes a second bone vice
420. In this arrangement, two mobile compression plates 421, 422
are arranged such that when moved toward one another, the bone is
fixed in position between the plates by compression force. In the
illustrated embodiment, first mobile compression plate 421 and/or
second bone compression plate 422 can freely move relative to one
another along a threadless shaft 423 when knob 424 is rotated. Knob
425 is attached to counter-threaded shaft 425. The counter-thread
configuration 426 is best appreciated in the top plan view of FIG.
43.
[0103] Once a piece of bone is in place in second bone vice 420,
the bone holding arrangement can be slid along table surface 302 of
bone shaping assembly 300 as described for first bone vice 401. It
will be appreciated that one, two, or more bone vices can be
present on a single bone holding arrangement.
[0104] From the foregoing detailed description, it will be evident
that modifications and variations can be made in the devices and
methods of the invention without departing from the spirit or scope
of the invention. Therefore, it is intended that all modifications
and variations not departing from the spirit of the invention come
within the scope of the claims and their equivalents.
* * * * *