CN102325505B - 用于将移植韧带附连到骨上的螺旋圈干涉固定系统 - Google Patents

用于将移植韧带附连到骨上的螺旋圈干涉固定系统 Download PDF

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CN102325505B
CN102325505B CN200980155954.7A CN200980155954A CN102325505B CN 102325505 B CN102325505 B CN 102325505B CN 200980155954 A CN200980155954 A CN 200980155954A CN 102325505 B CN102325505 B CN 102325505B
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spiral coil
inserter
spirillum
ligament
spiral
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CN102325505A (zh
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D·麦克德维特
V·诺瓦克
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Smith and Nephew Medical Shanghai Ltd
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HELICOIL Inc
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    • A61F2210/0004—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof bioabsorbable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • A—HUMAN NECESSITIES
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Abstract

一种螺旋圈干涉固定系统，包括螺旋圈(10)、至少一个内部支柱(45)以及用于使螺旋圈旋转的插入器(5)，螺旋圈(10)包括螺旋体(20)，螺旋体(20)包括多个螺圈，螺圈之间被间隔分开，该至少一个内部支柱(45)在螺旋体的至少两个螺圈之间延伸，插入器(5)包括至少一个槽(70)以用于接收该至少一个支柱；螺旋圈被安装在插入器上，以便使螺旋圈的该至少一个支柱被安装在插入器的该至少一个槽中，从而使插入器的旋转造成螺旋圈的旋转。

Description

用于将移植韧带附连到骨上的螺旋圈干涉固定系统
对待决的现有专利申请的引用
本专利申请是对2009年2月25日提交的美国专利申请序号12/392,804和2008年11月26日提交的美国专利申请序号61/200,285申明优先权的PCT国际专利申请。
上面提到的两项专利申请通过引用而全部被包括在本文中。
发明领域
本发明大体上涉及医疗器械和疗法，并且更具体而言涉及用于重建韧带的医疗器械和疗法。
发明背景
韧带是坚韧的组织带，其用于连接骨的关节末端，和/或用以支撑和/或保持器官处于身体中的合适位置。韧带通常由粗糙的稠密的纤维组织束组成，这些纤维组织束以平行或紧密交错的方式而布置，其中纤维组织是可弯曲并且柔韧的，但不是可显著延伸的。
在许多情况下，韧带由于意外被破坏或撕裂。因此，已经开发了多种疗法来修补或替换这样的受损的韧带。
例如，在人体膝盖中，前十字韧带和后十字韧带(即，“ACL”和“PCL”)在胫骨的顶端和股骨的底端之间延伸。ACL和PCL用于与其它韧带和软组织一起为膝盖提供静态和动态稳定性。通常，前十字韧带(即ACL)由于例如运动相关的损伤而被撕裂或破坏。因此，已经开发了许多外科疗法以用于重建ACL，以便使膝盖恢复基本正常的功能。
在许多情况下，可通过用移植韧带替换被破坏的ACL来重建ACL。更具体地说，在这样的疗法中，通常在胫骨的顶部和股骨的底部形成骨隧道，使移植韧带的一端定位在股骨隧道中，并且移植韧带的另一端定位在胫骨隧道中，并使移植韧带的中间部分跨越股骨的底部和胫骨的顶部之间的距离。移植韧带的两端以本领域中众所周知的各种方式锚定在其相应的骨隧道中，从而使移植韧带在股骨的底端和胫骨的顶端之间以与原来的ACL基本相同的方式延伸，并且带有基本相同的功能。这种移植韧带然后与周围解剖结构协作，从而使膝盖恢复基本正常的功能。
在某些情况下，移植韧带可为从病人身体内的其它地方获取的韧带或腱，例如附连有骨块或未附连骨块的膝盖骨腱、半腱肌腱和/或股薄肌腱。在其它情况下，移植韧带可从尸体获取。在还有其它情况下，移植韧带可为人造装置。出于本发明的目的，所有前述的那些可在本文中总称为“移植韧带”。
如上面提到的那样，用于将移植韧带的两端锚定在股骨道和胫骨隧道中的许多途径在本领域中是众所周知的。
在一种众所周知的可应用于股骨固定、胫骨固定或这两者的疗法中，移植韧带的末端被放置在骨隧道中，并且然后使用无头矫形螺钉(在本领域中通常被称为“干涉”螺钉)将移植韧带固定在合适位置。更具体地说，利用这种途径，移植韧带的末端被放置在骨隧道中，并且然后使干涉螺钉前进到骨隧道中，从而使干涉螺钉平行于骨隧道而延伸，并且同时接合移植韧带以及骨隧道的侧壁。在这种设置下，干涉螺钉基本上横向地驱动移植韧带，使其与骨隧道的相对的侧壁接合，从而利用所谓的“干涉配合”将移植韧带固定到宿主骨上。之后，随着时间(例如几个月)过去，移植韧带和宿主骨在其接触点长到一起，从而在韧带和骨之间提供一种强健的自然的连接。
干涉螺钉已被证明是一种用于将移植韧带固定在骨隧道中的有效装置。然而，干涉螺钉本身通常在骨隧道内占用相当大量的空间，其可限制在移植韧带以及骨隧道的侧壁之间建立的表面面接触。这又限制骨到韧带的内生长的区域，并因此可影响连接的强度。作为示例，但非限制，已估计典型的干涉螺钉阻塞潜在的骨到韧带结合区域的大约50％。
出于这个原因，已经作出大量努力以提供由可吸收材料制成的干涉螺钉，从而使干涉螺钉可最终随时间消失，并且可围绕骨隧道的整个周边而发生骨到韧带的内生长。为此，已经开发出多种由生物相容、生物可吸收的聚合物(例如聚乳酸(PLA)、聚乙醇酸(PGA)等)制成的可吸收的干涉螺钉。这些聚合物通常提供所需的大的机械强度以使干涉螺钉前进到合适位置，并且之后在发生骨到韧带的内生长时将移植韧带保持在合适位置，而不用保持于永久基底上的位置。
大体上，由这样的生物相容、生物可吸收的聚合物制成的干涉螺钉已在临床上证明是成功的。然而，这些可吸收的干涉螺钉仍然遭受若干缺点。第一，临床证据表明骨到韧带的内生长的质量与自然的骨到韧带的内生长略微不同，在这样的意义上，前述的生物可吸收的聚合物倾向于被纤维质而非良序的组织基质替代。第二，临床证据表明吸收通常占用相当长的时间段，例如大约三年左右。因此，在该吸收时间期间，骨到韧带的内生长仍然会由于干涉螺钉的存在而受到显著限制。第三，临床证据表明，对于许多病人，吸收决不是完全的，从而使相当多的外部物质保留在身体内。由于可吸收的干涉螺钉通常相当大以便给其提供足够的强度，这个问题被加剧了几分，例如干涉螺钉具有8mm至12mm的直径(即，外径)以及20mm至25mm的长度是常见的。
因而，具有对于一种新的并且改进的干涉固定系统的需求，其(i)具有在骨到韧带的内生长发生时使移植韧带保持在合适位置所需的强度，并且(ii)促进优良的骨到韧带的内生长。
本发明的概述
这些和其它目的通过提供和使用新颖的螺旋圈干涉固定系统以用于将移植韧带附连到骨上得以实现。
在本发明的一个方面，提供了一种新颖的螺旋圈干涉固定系统，其包括：
螺旋圈，其包括螺旋体以及至少一个内部支柱，该螺旋体包括多个螺圈，螺圈之间被间隔分开，螺旋体终止于近端和远端，并且该至少一个内部支柱在螺旋体的至少两个螺圈之间延伸；以及
用于使螺旋圈旋转的插入器，该插入器包括至少一个槽，以用于接收该至少一个支柱；
螺旋圈被安装在插入器上，以便使螺旋圈的该至少一个支柱被安装在插入器的该至少一个槽中，从而使插入器的旋转造成螺旋圈的旋转。
在本发明的另一方面，提供了一种用于将移植韧带附连到骨上的新颖的方法，该方法包括：
提供螺旋圈干涉固定系统，其包括：
螺旋圈，其包括螺旋体以及至少一个内部支柱，该螺旋体包括多个螺圈，螺圈之间被间隔分开，螺旋体终止于近端和远端，并且该至少一个内部支柱在螺旋体的至少两个螺圈之间延伸；以及
用于使螺旋圈旋转的插入器，该插入器包括至少一个槽，以用于接收该至少一个支柱；
螺旋圈被安装在插入器上，以便使螺旋圈的该至少一个支柱被安装在插入器的该至少一个槽中，从而使插入器的旋转造成螺旋圈的旋转；
在骨中形成骨隧道，并提供移植韧带；
将移植韧带插入到骨隧道中；以及
使用插入器来使螺旋圈旋入骨隧道中，从而使用干涉配合将移植韧带固定到骨上。
在本发明的还有另一方面，提供了一种新颖的螺旋圈，其包括螺旋体以及至少一个内部支柱，螺旋体包括多个螺圈，螺圈之间被间隔分开，螺旋体终止于近端和远端，并且该至少一个内部支柱在螺旋体的至少两个螺圈之间延伸，其中，该至少一个内部支柱包括螺旋结构。
附图的简要描述
本发明的这些和其它目的与特征将通过下面对本发明的优选实施例的详细描述而更完全地公开或变得显而易见，其应当与附图一起进行考虑，在附图中相似的标号表示相似的部件，并且，其中：
图1至图7是显示了根据本发明形成的第一螺旋圈干涉固定系统的示意图；
图8至图13是显示了根据本发明形成的第二螺旋圈干涉固定系统的示意图；
图14至图20是显示了使用图8至图13的第二螺旋圈干涉固定系统进行股骨固定的示意图；
图21至图25是显示了使用图8至图13的第二螺旋圈干涉固定系统进行完整的ACL重建的示意图；
图26至图28是显示了使用图8至图13的第二螺旋圈干涉固定系统进行软组织ACL固定的示意图；
图29至图31是显示了根据本发明形成的第三螺旋圈干涉固定系统的示意图；
图32是显示了根据本发明形成的第四螺旋圈干涉固定系统的示意图；
图33是显示了根据本发明形成的第五螺旋圈干涉固定系统的示意图；
图34至图36是显示了根据本发明形成的第六螺旋圈干涉固定系统的示意图；
图37是显示了根据本发明形成的第七螺旋圈干涉固定系统的示意图；
图38是显示了根据本发明形成的第八螺旋圈干涉固定系统的示意图；以及
图39是显示了根据本发明形成的第九螺旋圈干涉固定系统的示意图。
优选实施例的详细说明
本发明包括提供和使用新颖的螺旋圈干涉固定系统以用于将移植韧带附连到骨或其它组织上。
出于方便起见，本发明将在后文中结合其用于ACL胫骨和/或股骨固定的用途进行论述；然而，应当理解，本发明还可用于将其它移植韧带固定到胫骨和/或股骨上；和/或将其它移植韧带固定到其它骨或到其它组织(例如器官)上。
首先参见图1至图7，其显示了一种用于将移植韧带固定到骨上的新颖的螺旋圈干涉固定系统5。螺旋圈干涉固定系统5通常包括用于布置在骨隧道中的螺旋圈10，从而在发生骨到韧带的内生长时将移植韧带保持在合适位置。螺旋圈干涉固定系统5还包括用于将螺旋圈10部署在骨隧道中的插入器15。
更具体地说，并且现在参见图1至图6，并且尤其参见图5，螺旋圈10通常包括螺旋体20，其终止于远端25和近端30。螺旋体20构造成使得在螺旋体的螺圈40之间具有相当大的间隔或间隙35。间隔或间隙35有助于骨到韧带的内生长，即，通过提供穿过螺旋体的大的开口。这些大的开口有助于承载细胞与营养的流体流过螺旋圈，并允许组织的内生长跨过螺旋圈，从而增强骨到韧带的内生长。
一个或多个支柱45布置在螺旋体20的内部，其中该一个或多个支柱45被固定到螺旋体20的内表面50上。该一个或多个支柱45提供用于使螺旋圈10在部署在身体内期间旋转的装置，如将在下文进一步详细论述的那样。另外，该一个或多个支柱45可给螺旋体20的螺圈40提供结构支撑。该一个或多个支柱45可与螺旋体20整体形成(例如通过模制工艺)，或者其可单独于螺旋体20而形成，并且然后在单独的制造工艺中附连到螺旋体20上(例如通过焊接)。在该一个或多个支柱45与螺旋体20是整体形成的情况下，该一个或多个支柱45可用于帮助流融合至合适位置。
在本发明的一种优选形式中，该一个或多个支柱45包括螺旋结构。并且在本发明的一种特别优选的形式中，该一个或多个支柱45包括螺旋结构，其沿着与螺旋体20的螺旋相反的方向盘旋，并且该一个或多个支柱45具有比螺旋体20的螺距大得多的螺距。参见图5。
优选地，支柱45的数量和其大小被选择为用以封闭螺旋体20的螺圈40之间的很小部分的间隔或间隙35，由此基本上不会阻碍流体和组织穿过螺旋圈。然而，同时，支柱45的数量、其大小和组分被选择为用以提供一种用于使螺旋圈10在部署期间旋转的合适装置，并为螺旋体20的螺圈40提供任何必要的支撑。
在本发明的一种优选形式中，提供了一个支柱45。
在本发明的另一优选形式中，提供了多个支柱45(例如两个、三个、四个或更多支柱)。
并且在本发明的一种优选形式中，支柱45总共封闭螺旋体20的螺圈40之间的间隔或间隙35的不到百分之五十(50％)。
并且在本发明的一种特别优选的形式中，支柱45总共封闭螺旋体20的螺圈40之间的间隔或间隙35的不到百分之二十(20％)。
螺旋圈10由一种或多种生物相容的材料形成。这些生物相容的材料可为不可吸收的(例如不锈钢或塑料)或可吸收的(例如生物可吸收的聚合物)。在本发明的一种优选形式中，螺旋圈10优选地包括生物可吸收的聚合物，例如聚乳酸(PLA)、聚乙醇酸(PGA)等等。然而，在任何情况下，螺旋圈10都包括这样的材料，其能够提供将固定装置设于合适位置并在骨到韧带内生长发生时将移植韧带保持在合适位置所需的强度。
图1至图4以及图7中显示了插入器15。插入器15通常包括轴55，其具有远端60和近端65。在轴55的远端形成一个或多个槽70。槽70接收螺旋圈10的一个或多个支柱45，从而可将螺旋圈10安装在轴55的远端上，并通过轴55的旋转而旋转。在轴55中远离槽70形成了渐缩的形成承座的螺纹75(例如渐缩的切螺纹、渐缩的开口或扩展螺纹等)。渐缩的形成承座的螺纹75用于先于螺旋圈10进入移植韧带和骨隧道的壁之间的间隔，并且然后在移植韧带和骨隧道的壁中形成引入部或开口以用于接收螺旋体20的螺圈40，其方式与丝锥产生螺纹的形式大致相同，这将在后文进一步详细地论述。手柄80安装在轴55的近端，从而有助于由外科医生旋转轴55。
应当理解，渐缩的形成承座的螺纹75与螺旋圈10相匹配，从而使得当螺旋圈10安装在插入器15上时，渐缩的形成承座的螺纹75为螺旋圈10提供合适的引入。
优选地，螺旋体20的内表面50和插入器15的远端60是渐缩的，在近侧方向上向外扩展，以便使螺旋圈10和插入器15形成主动承座，从而使螺旋圈的内表面与插入器的渐缩体直径处于直接接触。
因此可以看出，当螺旋圈10安装在轴55的远端上时，插入器15可用于使螺旋圈前进至外科手术位置，并且经由手柄80的旋转将螺旋圈10旋入到移植韧带和骨隧道的壁之间的间隙中，由此在骨隧道中创建移植韧带的干涉固定。重要的是，由于插入器15在螺旋圈10前面具有形成于其远端的渐缩的形成承座的螺纹75，所以该渐缩的形成承座的螺纹可形成承座到螺旋圈10前面的组织中，由此允许螺旋圈容易前进到组织中，并创建所需的干涉固定。因此，螺旋圈10不需要在其远端具有任何穿透点以穿透组织。
如果需要，可将插入器15插入，从而使得插入器和螺旋圈10可通过引导线而部署，如将在下文论述的那样。
图8至图13显示了另一螺旋圈干涉固定系统5，其中，螺旋圈10包括两个支柱45，并且插入器15包括两个槽70。使用两个支柱45而非一个支柱45可以是有利的，因为其可将旋转期间施加的负载分布在更大的表面区域上。这在螺旋圈10由生物可吸收的聚合物形成的情况下可能是重要的。
可在与传统的干涉螺钉系统基本相似的方式下利用螺旋圈干涉固定系统5，以便将移植韧带附连到骨上。
更具体地说，并且现在参见图14至图25，其中显示了使用螺旋圈干涉固定系统5实现ACL重建的各个方面。
图14显示了典型的膝关节205，其中该关节已经准备用于ACL重建，即，其中已经移除了自然的ACL，并且其中已经在胫骨215中形成了胫骨隧道210，并且其中已经在股骨225中形成了股骨隧道220。
图15是与图14的视图相似的视图，除了移植韧带230已经根据本领域中众所周知的方式而定位在股骨隧道220和胫骨隧道210中之外。作为示例，使用牵引缝线235可使移植韧带230被“牵引”通过胫骨隧道210并进入股骨隧道220中。
图16和图17显示了使用螺旋圈干涉固定系统5将移植韧带230固定在股骨隧道220中。更具体地说，根据本发明，通过将螺旋圈10的支柱45适配到插入器的槽70中，螺旋圈10被安装在插入器15的远端。然后使用插入器来使螺旋圈10前进通过胫骨隧道210，跨过膝关节205的内部，并达到股骨隧道220中。如果需要，可将插入器15插入，从而使插入器和螺旋圈通过本领域中众所周知类型的引导线而前进。当插入器的远端前进时，渐缩的形成承座的螺纹75首先找到其进入移植韧带230和股骨隧道220的侧壁之间的间隔的途径。然后，当插入器旋转时，渐缩的形成承座的螺纹75在螺旋圈10前面形成承座到组织中，并且使螺旋圈10前进到组织中，从而使螺旋体20的螺圈自身承座在由形成承座的螺纹75形成的承座中。当这发生时，移植韧带被横向驱动，与骨隧道的相对的侧壁接合。该动作将螺旋圈10设置在股骨隧道220的侧壁和移植韧带230之间，因而确保移植韧带230以及骨隧道的侧壁之间的干涉配合，从而将移植韧带230固定到骨上。
随后，并且现在参见图18和图19，插入器15被收回，留下螺旋圈10卡在移植韧带和骨隧道的侧壁之间的位置。如图20中看到的那样，螺旋圈10保持移植韧带220以及骨隧道的侧壁之间建立的干涉配合，从而将移植韧带固定到骨上。
如果需要，可然后以相似的方式使用螺旋圈干涉固定系统5来形成胫骨固定。参见图21至图25。
重要的是，以开放的螺旋圈的形式形成固定装置已被证明是特别有利的，因为开放的螺旋圈提供将固定装置设置在合适位置并在发生骨到韧带内生长时将移植韧带保持在合适位置所需的强度，同时仍提供穿过固定装置的实体的特别的通路。因而，承载细胞与营养的流体可基本上无阻碍地穿过螺旋圈10的实体，并且组织的内生长可跨过螺旋圈10的实体而发生。
此外，已经发现当移植韧带随后施加轴向负载在干涉配合上时，支柱45有助于保持螺旋体20的螺圈40的结构完整性，由此确保干涉配合的完整性。
在图16至图24中，移植韧带230被显示为在韧带的端部包括骨块，例如，移植韧带10可以是附连有骨块的膝盖骨腱。然而，如图26至图28中看到的那样，移植韧带230还可仅由软组织组成，例如，移植韧带230可包括半腱肌腱和/或股薄肌腱，和/或人造装置。
在图5和图11中，一个或多个支柱45被显示为具有螺旋结构。然而，该一个或多个支柱45还可形成为带有直的构造。例如参见图29至图30以及图31，图29至图30显示了带有单个直的支柱45的螺旋圈10，并且图31显示了带有多个直的支柱45的螺旋圈10。
此外，如图32中看到的那样，一个或多个支柱45可在螺圈40之间中断，或者，如图33中看到的那样，一个或多个支柱45可在螺圈40之间选择性地中断。
还应当理解，可使用多个螺旋圈10形成干涉配合。因而，如图34至图36中看到的那样，可将多个螺旋圈10装载到插入器15上并使用，以用于总的干涉配合。
如果需要，并且现在参见图37，可用凹部45A替代一个或多个支柱45。在这种情况下，插入器15上的槽70被相应的肋条(未显示)替代，由此允许插入器15可旋转地驱动螺旋圈10。
如图38中看到的那样，螺圈40的周期可沿着螺旋圈10的长度变化。
另外，如果需要，螺旋圈10可在其远端25与其近端30之间成渐缩形。
变型
对本领域技术人员而言，应当理解，本发明的更进一步的实施例将是显而易见的。应当理解，本发明决不限于本文公开的和/或附图中显示的特定结构和方法步骤，而是还包括落在本发明的范围内的任何变型或等同物。

Claims (20)

1. 一种螺旋圈干涉固定系统，包括：
螺旋圈，所述螺旋圈包括螺旋体以及至少一个内部支柱，所述螺旋体包括多个螺圈，所述多个螺圈之间被间隔分开，所述螺旋体终止于近端和远端，并且所述至少一个内部支柱在所述螺旋体的至少两个螺圈之间延伸；以及
用于使所述螺旋圈旋转的插入器，所述插入器包括用于接收所述至少一个支柱的至少一个槽；
所述螺旋圈被安装在所述插入器上，以便使所述螺旋圈的所述至少一个支柱安装在所述插入器的所述至少一个槽中，从而使所述插入器的旋转造成所述螺旋圈的旋转。
2. 根据权利要求1所述的系统，其特征在于，所述至少一个支柱包括螺旋结构。
3. 根据权利要求2所述的系统，其特征在于，所述至少一个支柱的所述螺旋结构沿着与所述螺旋体相反的方向旋转。
4. 根据权利要求2所述的系统，其特征在于，所述至少一个支柱的所述螺旋结构比所述螺旋体具有更长的周期。
5. 根据权利要求1所述的系统，其特征在于，所述螺旋圈包括至少两个支柱。
6. 根据权利要求1所述的系统，其特征在于，所述螺旋体的远端是钝的。
7. 根据权利要求1所述的系统，其特征在于，具有至少两个螺旋圈。
8. 根据权利要求1所述的系统，其特征在于，所述螺旋圈由不能吸收的材料制成。
9. 根据权利要求1所述的系统，其特征在于，所述螺旋圈由能吸收的材料制成。
10. 根据权利要求1所述的系统，其特征在于，所述插入器包括远离所述至少一个槽的渐缩的形成承座的螺纹，并且，其中，所述渐缩的形成承座的螺纹还设置为用以在组织中形成承座以用于接收所述螺旋体的螺圈。
11. 根据权利要求1所述的系统，其特征在于，所述螺旋圈包括渐缩的内表面，并且所述插入器包括渐缩的外表面，从而使得当所述螺旋圈安装在所述插入器上时，所述螺旋圈和所述插入器形成主动承座，以便使所述螺旋圈的内表面与所述插入器的渐缩体直径处于直接接触。
12. 根据权利要求10所述的系统，其特征在于，所述渐缩的形成承座的螺纹与所述螺旋圈相匹配，从而使得当所述螺旋圈安装在所述插入器上时，所述渐缩的形成承座的螺纹为所述螺旋圈提供合适的引入。
13. 一种螺旋圈，所述螺旋圈包括螺旋体以及至少一个内部支柱，所述螺旋体包括多个螺圈，所述多个螺圈之间被间隔分开，所述螺旋体终止于近端和远端，并且所述至少一个内部支柱在所述螺旋体的至少两个螺圈之间延伸，其中，所述至少一个内部支柱包括螺旋结构。
14. 根据权利要求13所述的螺旋圈，其特征在于，所述至少一个支柱的所述螺旋结构沿着与所述螺旋体相反的方向旋转。
15. 根据权利要求14所述的螺旋圈，其特征在于，所述至少一个支柱的所述螺旋结构比所述螺旋体具有更长的周期。
16. 根据权利要求13所述的螺旋圈，其特征在于，所述螺旋圈包括至少两个支柱。
17. 根据权利要求13所述的螺旋圈，其特征在于，所述螺旋体的远端是钝的。
18. 根据权利要求13所述的螺旋圈，其特征在于，具有至少两个螺旋圈。
19. 根据权利要求13所述的螺旋圈，其特征在于，所述螺旋圈由不能吸收的材料制成。
20. 根据权利要求13所述的螺旋圈，其特征在于，所述螺旋圈由能吸收的材料制成。
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AU2009319879B2 (en) 2015-11-26
US9579189B2 (en) 2017-02-28
EP2385801B1 (en) 2020-03-25
US20160374794A1 (en) 2016-12-29
US10820983B2 (en) 2020-11-03
US20190099256A1 (en) 2019-04-04
US8992612B2 (en) 2015-03-31
US11628058B2 (en) 2023-04-18
EP2385801A1 (en) 2011-11-16
JP2012509744A (ja) 2012-04-26
JP5851840B2 (ja) 2016-02-03
US20130325125A1 (en) 2013-12-05
US20150081020A1 (en) 2015-03-19
US20190099255A1 (en) 2019-04-04
WO2010062833A1 (en) 2010-06-03
US8894661B2 (en) 2014-11-25
AU2009319879A1 (en) 2010-06-03
US20180214260A9 (en) 2018-08-02
US20190099257A1 (en) 2019-04-04
US20090319043A1 (en) 2009-12-24

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