CN100400015C - 具有可倾斜的关节部分的椎间植入物 - Google Patents

具有可倾斜的关节部分的椎间植入物 Download PDF

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Publication number
CN100400015C
CN100400015C CNB028300610A CN02830061A CN100400015C CN 100400015 C CN100400015 C CN 100400015C CN B028300610 A CNB028300610 A CN B028300610A CN 02830061 A CN02830061 A CN 02830061A CN 100400015 C CN100400015 C CN 100400015C
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CN
China
Prior art keywords
joint component
joint
intervertebral implant
described intervertebral
jut
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Fee Related
Application number
CNB028300610A
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English (en)
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CN1713867A (zh
Inventor
M·埃比
D·伯卡德
R·弗里格
B·莱西曼
小R·马蒂斯
P·帕夫洛夫
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AO Technology AG
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Synthes USA LLC
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Publication of CN1713867A publication Critical patent/CN1713867A/zh
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit

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Abstract

本发明涉及一种椎间植入物(1)、特别是人造的椎间盘，包括一条中心轴线(2)、一个上面的部分(10)和一个下面的部分(20)，所述上面的部分适于贴靠到一个位于其上面的椎骨体的底板上，所述下面的部分适于贴靠到一个位于其下面的椎骨体的盖板上，其中：A)上面的部分(10)具有一个前侧的侧面(11)、一个背侧的侧面(12)、两个侧向的侧面(13、14)、一个上面的对合表面(15)和一个下面的表面(16)；B)下面的部分(20)具有一个前侧的侧面(21)，一背侧的侧面(22)、两个侧向的侧面(23、24)、一个下面的对合表面(25)和一个上面的表面(26)；C)两个部分(10、20)可通过两个在两个部分(10、20)之间设置的关节(38、39)相互相对运动，其中D)每一关节(38、39)具有一条转动轴线(3、4)并且两条转动轴线(3、4)相互垂直设置，以及E)两关节(38、39)包括一个上面的、一个中间的和一个下面的关节部分(31、32、33)；其特征在于，F)每一关节(38、39)包括一个第一关节部分(31、32、33)，所述第一关节部分包括一个具有一个棱边(51、53)的突起部分(49、50)，用于一个第二关节部分(31、32、33)的可绕转动轴线(3、4)倾斜的支承。

Description

具有可倾斜的关节部分的椎间植入物
技术领域
本发明涉及一种椎间植入物和一种由一椎间植入物置换一缺损的天然的椎间盘的方法。
背景技术
在去掉一损伤的天然椎间盘或一椎间盘的损伤的髓核以后将植入物或假体插入两个邻接的椎骨体的椎间空隙内。其目的是，尽可能重新恢复天然的状态，亦即特别是恢复原来的椎间盘高度并从而恢复两邻接的椎骨体之间的原来的间距。此外，应该可尽可能无妨碍地以其天然的方式实现邻接的椎骨体相互相对的运动。对此重要的是，在向前/向后倾斜，亦即椎骨体的屈曲和伸展时以及在椎骨体的侧向弯曲时，在天然限度内保持运动可能性。天然的韧带和肌肉沿脊椎柱基本上保持无伤的，从而它们进一步稳定一机械的椎间盘代用件的运动。
由DE-A 35 29 761
Figure C0283006100061
已知一同一种的椎间盘内假体。该已知的椎间盘内假体基本上包括两个对称的具有相互面对的凹的滑动面的端接板并且各具有一个外表面用以贴靠到邻接的椎骨体的底板或盖板上以及一在两端接板之间定位的隔板，其具有各个互补于端接板上的凹的滑动面构成的凸的滑动面。各滑动面在一实施形式中构成为一圆柱体外表面的部分表面，其中在两端接板上设置的滑动面构成为分别互补于一个邻接的在隔板上的滑动面并且各两个互补的滑动面构成一可绕一转动轴线转动的关节部分的可相互移动的骨关节表面。该关节包括一上关节部分和一下关节部分，各具有一个转动轴线。两转动轴线相互位错90°。该已知的椎间盘内假体的缺点是：
a)椎间盘内假体只具有一个转动中心的构造没有考虑到通过天然的椎间盘可传递的重叠的特别是在前后的和侧向的屈曲的情况下的转动运动，其在天然的椎间盘中彼此是独立的；
b)由于剪切运动，特别在沿前后的方向移动的情况下，椎骨关节(小面关节)受负荷，因此可能引起病人的疼痛；
c)在两可相互滑动的骨关节表面上产生不利的摩擦力。此外在表面上产生磨损，亦即其中还在关节部分的运动中产生磨损和阻力。并且具有“粘滞-滑动(stick-slip)”效应的危险；
d)机械的椎间盘代用件几乎不可能阻止涉及的运动节段的继续的变性。原来的运动状况的恢复大大减小疼痛并且提高病人的生活质量。但在重新出现疼痛时必须进行护理的修正。在这种情况下通常完全去掉按传统的结构形式的椎间盘假体并且加固运动节段。这样的手术特别使病人受痛苦，以及
e)一般没有考虑对各邻接的椎骨体的接触表面的形状。传统的结构形式的椎间盘假体植入物具有平面的(平坦的)接触表面，其常常还补充有许多龙骨状突起部分。
发明内容
在这里本发明将消除这种弊端。本发明的目的在于，提供一种椎间植入物，其包括一关节，其关节轴线具有最小摩擦的轴承结构。
根据本发明，提出一种椎间植入物，具有一条中心轴线、一个上面的部分和一个下面的部分，所述上面的部分适于贴靠到一个位于其上面的椎骨体的底板上，所述下面的部分适于贴靠到一个位于其下面的椎骨体的盖板上，其中，A)上面的部分具有一个前侧的侧面、一个背侧的侧面、两个侧向的侧面、一个上面的对合表面和一个下面的表面；B)下面的部分具有一个前侧的侧面、一个背侧的侧面、两个侧向的侧面、一个下面的对合表面和一个上面的表面；C)上面的部分和下面的部分可通过两个在上面的部分和下面的部分之间设置的关节相互相对运动，其中D)每一关节具有一条转动轴线并且两条转动轴线相互横向设置；以及E)两个关节包括一个连接于上面的部分的上面的关节部分、一个中间的关节部分和一个连接于下面的部分的下面的关节部分；其特征在于，F)每一关节包括一个第一关节部分，所述第一关节部分包括一个具有一个棱边的突起部分，用于一个第二关节部分的可绕转动轴线倾斜的支承。
可看出通过本发明取得的优点基本上在于，由于本发明的椎间植入物，使
-向前后方向和向侧向的转动运动是独立的；
-刃状装置上的运动的摩擦表面减到一最小值；以及
-通过各关节部分之间的线接触代替滑动表面在关节中产生较小的摩擦力并因此不妨碍椎骨体间的相对运动，特别是脊椎柱的侧向弯曲和屈曲/伸展运动。
由于天然的转动轴线在沿脊椎柱不同的椎间盘空隙中的不同的位置，各转动轴线的设置可以是歪斜的或相交的。
通过各刃的长度使各关节面对两部分绕一中心轴线的偏转稳定。各突起部分的侧面角优选为在1°与30°之间而各凹槽的侧面角优选为在6°与70°之间。
在本发明的椎间植入物的一优选的实施形式中其包括两个关节。各具有一第一和一第二关节部分，其中第二关节部分各具有一凹槽用以可绕传动轴线倾斜地容纳第一关节部分上的一突出部分。借此可取得的优点是，不允许邻接植入物的各椎骨体的任何的移动运动，因此使各小面关节不过度操劳。
在本发明的椎间植入物的另一实施形式中，从前侧的侧面在两部分上可安装装置，借助该装置可以在前侧按一规定的间距相互相对固定该两部分。借此可取得的优点是，两部分为插入椎间空隙中可处于具有保持不变的高度的位置并且在插入椎间空隙中以后可绕关节运动并可贴靠到邻接的椎骨体的底板或盖板上。
在本发明的椎间植入物的另一实施形式中，所述装置使两部分绕关节的活动性可以暂时锁定。借此可取得的优点是，借助一最小的侵入手术就可锁定结合于椎间空隙中的关节。这对于以下情况是特别有利的，即在出现手术后的疼痛时，亦即在那里继续所涉及的脊椎柱节段的变性并且使外科医生考虑所涉及的椎骨的融合术。优选该装置可安装到两部分的两前侧的侧面上。通过两部分绕关节的活动性的以后的二次的锁定，加固椎间植入物并将其转为一关节固定术植入物(融合架)。
在本发明的椎间植入物的又一实施形式中，该装置包括一插件，其可插入上面的和下面的部分的相互面对的表面上的各一个凹槽中。优选这些凹槽构成为燕尾槽导轨，其在前侧的侧面是敞开的，从而互补于燕尾槽导轨构成的插件的各端可从前侧插入各燕尾槽导轨中。借此可取得的优点是，通过插件的插入可锁定两部分绕关节的活动性。当将各燕尾槽导轨构成使其向椎间植入物的中心轴线的方向逐渐缩小，从而插件可附加楔入燕尾槽导轨中时，可以提高锁定的刚性。
在本发明的椎间植入物的又一实施形式中，两部分设有多个钻孔用以容纳骨固定装置、特别是骨螺钉，其中各钻孔具有纵轴线，其倾斜于中心轴线定位。优选两部分之一的各两个钻孔从前侧的侧面穿过对合表面。其中各纵轴线，如果只设有椎间植入物的一个轴向固定，只从侧面看倾斜于中心轴线定位，或如果设有椎间植入物的一角稳定的固定，从前侧看也从两部的内表面向对合表面的方向岔开。
各钻孔的纵轴线与中心轴线之间包含一角度γ。角度γ在20°至65°的范围内。
在本发明的椎间植入物的另一实施形式中，用于容纳骨固定装置的各钻孔设有内螺纹，借此可达到骨固定装置在两部分中的附加的刚性固定。优选各钻孔圆锥形地构成，从而通过内螺纹与骨固定装置头部上的外螺纹之间的圆锥形螺纹连接可达到骨固定装置在两部分的任一个上的加强的固定。
各对合表面优选构成凸面的并且设有优选以棱锥形突起部分的形式的三维结构。通过对合表面的这种构造考虑到椎骨体端板的解剖学。
本发明的方法基本上用来由一椎间植入物置换一缺损的天然的椎间盘并且包括下列步骤：
A)将一椎间植入物的所述关节借助为其设定的装置锁定在所述关节的规定的位置；
B)将该椎间植入物插入待治疗的椎间空隙中；
C)脱开和去掉为所述关节的锁定插入椎间植入物中的装置，通过关节的锁定可取得的优点是，带有外部的对合表面的各活动的部分可更容易地插入待治疗的椎间空隙中。
在本发明的方法的另一应用中，其包括借助为锁定所述关节设定的装置对所述关节在植入的椎间植入物上的事后的锁定。借此可取得的优点是，在病人出现手术后的疼痛或在涉及的运动节段继续变性的情况下，可将所述关节在手术后通过插入为此设定的装置锁定在椎间植入物上。该事后的锁定利用一最小的侵入手术、优选腔镜外科的(lapraskopischen)手术是可能的。椎间植入物然后承担一架的任务，从而可以加固涉及的脊柱的运动节段。
附图说明
以下借助多个实施例的局部示意图还要更详细地说明本发明和本发明的进一步构成。其中：
图1  本发明的椎间植入物的一实施形式的分解图；
图2  图1中所示的本发明的椎间植入物的实施形式在组合状态下的透视图；
图3  本发明的椎间植入物的另一实施形式的侧视图；
图4  按图3的实施形式的从前侧的透视图；
图5  沿图1中线A-A截取的侧剖视图；及
图6  沿图1中线B-B截取的背侧剖视图。
具体实施方式
图1和2中示出本发明的椎间植入物1的一种实施形式，其包括一上面的部分10和一下面的部分20以及两个关节38、39，所述上面的部分具有一上面的横向于中心轴线2设置的对合表面15用以贴靠到一邻接的椎骨体的底板上；所述下面的部分具有一下面的横向于中心轴线2设置的对合表面25用以贴靠到邻接的椎骨体的盖板上。上面的部分10和下面的部分20经由关节38、39可相互相对活动地连接，其中上面的部分10相对于下面的部分20绕横向于中心轴线2设置的第一转动轴线3的活动性限制在+10°至-6°的角度范围内而绕横向于中心轴线2和垂直于第一转动轴线3设置的第二转动轴线4的活动性限制在±7°的角度范围内。
关节38、39由三个关节部分31、32、33构成，其中下面的关节部分33和上面的关节部分31各构成一个与中间的关节部分32配合作用的关节38、39。两关节38、39构成为摇臂并且各具有一转动轴线3、4，其中两转动轴线相互垂直并垂直于中心轴线2定位。下面的关节39包括一构成下面的关节部分33的、连接于下面的部分20的突起部分50和一在中间的关节部分32中设置的、容纳突起部分50的凹槽52，该突起部分构成有一形成转动轴线4的棱边51，其支承于凹槽52中使两关节部分32、33构成一在棱边51上可绕转动轴线4倾斜的关节39。类似地上面的关节38由一在上面的关节部分31上设置的、平行于转动轴线3的突起部分49和一在中间的关节部分32上设置的、容纳突起部分49的凹槽54组合而成。突起部分49构成有一形成转动轴线3的棱边53，其支承于凹槽54中使两关节部分31、32构成一在棱边53上可绕转动轴线3倾斜的关节38。
两部分10、20的相互相对活动性可由装置40可拆式锁定。在图中所示的实施形式中，装置40包括一可从两部分10、20的前侧的侧面11、21横向于中心轴线2和平行于两部分10、20的侧向的侧面13、14、23、24插入的插件41。插件41插入构成为燕尾槽导轨的两凹槽42、43中。插件41从两部分10、20的前侧的侧面11、21插入到构成为燕尾槽导轨的凹槽42、43中并且借助一螺钉44固定在下面的部分20上。并且插件41在终点状态时构成互补于凹槽42、43，从而两部分10、20在插入插件41以后平行于中心轴线2相互相对固定。
此外在中间的关节部分32上设有第一锁定装置100，其与下面的关节部分33上的第二锁定装置105可进入嵌接并且在固定元件110固定在中间的关节部分32上以后防止中间的关节部分32脱离下面的关节部分33。借助各螺钉111固定固定装置110，螺钉拧紧入在中间的关节部分32中的凹槽52的旁边的各螺纹孔112中。第一锁定装置100包括在中间的关节部分32上的凹槽101，其与第二锁定装置105的凸耳106可进入形锁合嵌接。借此防止两关节部分32、33可能彼此分离。在上面的关节部分31与中间的关节部分32之间还设有各个铰链120(图5和6)，借其平行于中心轴线2连接两关节部分31、32，而不因此限制两关节部分31、32相互相对绕第一转动轴线3的转动运动。
图3中示出本发明的椎间植入物1的一种实施形式，其不同于图1和2中所示的实施形式的只在于，两部分10、20包括用于容纳骨固定装置81的钻孔80，其中骨固定装置81在这里构成为骨螺钉。各钻孔80具有纵轴线83，其与中心轴线2之间包含一角度γ。此外两部分10、20之一的各两个钻孔80(图4)从前侧的侧面11、21穿过对合表面15、25。各钻孔80的纵轴线83从侧面看(图3)和从前侧看(图4)均倾斜于中心轴线2定位。此外各钻孔80成圆锥形向对合表面15、25方向逐渐缩小地构成并且设有内螺纹82，其用于可旋紧地容纳构成为骨螺钉的骨固定装置81的设有互补的外螺纹的螺钉头部84。
图5和6中详细地示出上面的关节部分31与中间的关节部分32之间的两个铰链120。各铰链120允许两关节部分31、32绕由第二突起部分49上的棱边53和凹槽54构成的第一转动轴线3(图2)的相对转动运动并且包括在中间的关节部分32上侧面端部安装的各凸块121，其向椎间植入物1的前侧的侧面11、21的方向是倒圆角的，以及包括在上面的关节部分31上安装的各外壳122，其从前侧的侧面11、21成圆弧形以约90°的角度围绕凸块121的倒圆角的侧面。通过这些外壳122将上面的关节部分31平行于中心轴线2(图1)固定在中间的关节部分32上。

Claims (22)

1.椎间植入物(1)，具有一条中心轴线(2)、一个上面的部分(10)和一个下面的部分(20)，所述上面的部分适于贴靠到一个位于其上面的椎骨体的底板上，所述下面的部分适于贴靠到一个位于其下面的椎骨体的盖板上，其中，
A)上面的部分(10)具有一个前侧的侧面(11)、一个背侧的侧面(12)、两个侧向的侧面(13、14)、一个上面的对合表面(15)和一个下面的表面(16)；
B)下面的部分(20)具有一个前侧的侧面(21)、一个背侧的侧面(22)、两个侧向的侧面(23、24)、一个下面的对合表面(25)和一个上面的表面(26)；
C)上面的部分(10)和下面的部分(20)可通过两个在上面的部分(10)和下面的部分(20)之间设置的关节(38、39)相互相对运动，其中
D)每一关节(38、39)具有一条转动轴线(3、4)并且两条转动轴线(3、4)相互横向设置；以及
E)两个关节(38、39)包括一个连接于上面的部分(10)的上面的关节部分(31)、一个中间的关节部分(32)和一个连接于下面的部分(20)的下面的关节部分(33)；其特征在于，
F)每一关节(38、39)包括一个第一关节部分，所述第一关节部分包括一个具有一个棱边(51、53)的突起部分(49、50)，用于一个第二关节部分的可绕转动轴线(3、4)倾斜的支承。
2.按照权利要求1所述的椎间植入物(1)，其特征在于，下面的关节部分(33)包括一个具有棱边(51)的突起部分(50)，用于中间的关节部分(32)的可绕转动轴线(4)倾斜的支承。
3.按照权利要求1或2所述的椎间植入物(1)，其特征在于，上面的关节部分(31)包括一个具有棱边(53)的突起部分(49)，用于中间的关节部分(32)的可绕转动轴线(3)倾斜的支承。
4.按照权利要求1或2所述的椎间植入物(1)，其特征在于，第二关节部分包括一个凹槽(52、54)，用以容纳第一关节部分上的突起部分(49、50)。
5.按照权利要求4所述的椎间植入物(1)，其特征在于，下面的关节部分(33)包括一个具有一构成转动轴线(4)的棱边(51)的、平行于转动轴线(4)的突起部分(50)并且突起部分(50)支承于中间的关节部分(32)上的凹槽(52)中。
6.按照权利要求4所述的椎间植入物(1)，其特征在于，上面的关节部分(31)包括一个具有一构成转动轴线(3)的棱边(53)的、平行于转动轴线(3)的突起部分(49)并且突起部分(49)支承于中间的关节部分(32)上的凹槽(54)中。
7.按照权利要求1或2所述的椎间植入物(1)，其特征在于，转动轴线(3、4)相互歪斜地定位。
8.按照权利要求1所述的椎间植入物(1)，其特征在于，设有一些装置(40)，这些装置将上面的部分(10)和下面的部分(20)彼此保持一个固定的间距，该间距是在上面的部分(10)和下面的部分(20)的前侧的侧面(11、21)测量的。
9.按照权利要求1所述的椎间植入物(1)，其特征在于，设有一些装置(40)，这些装置适合暂时锁定上面的部分(10)和下面的部分(20)的绕关节(38、39)的活动性。
10.按照权利要求8或9所述的椎间植入物(1)，其特征在于，装置(40)可在两个前侧的侧面(11、21)上安装到上面的部分(10)和下面的部分(20)上。
11.按照权利要求9所述的椎间植入物(1)，其特征在于，装置(40)包括一个具有一个下端部和一个上端部的插件(41)并且在上面的部分(10)和下面的部分(20)上各包括一个在表面(16、26)中的凹槽(42、43)，所述凹槽在前侧的侧面(11、21)上是敞开的，并且插件(41)的上下两端部可以各插入一个凹槽(42、43)中。
12.按照权利要求11所述的椎间植入物(1)，其特征在于，凹槽(42、43)是燕尾槽导轨并且插件(41)上的端部互补于该燕尾槽导轨构成。
13.按照权利要求12所述的椎间植入物(1)，其特征在于，各燕尾槽导轨从前侧的侧面(11、21)向背侧的侧面(12、22)方向逐渐缩小。
14.按照权利要求1或2所述的椎间植入物(1)，其特征在于，上面的和下面的部分(10、20)各包括至少两个从前侧的侧面(11、21)向对合表面(15、25)穿过的、具有纵轴线(83)的钻孔(80)，用以容纳骨固定装置(81)。
15.按照权利要求14所述的椎间植入物(1)，其特征在于，各钻孔(80)的纵轴线(83)与中心轴线(2)之间包含一角度γ。
16.按照权利要求15所述的椎间植入物(1)，其特征在于，角度γ在20°至65°的范围内。
17.按照权利要求14所述的椎间植入物(1)，其特征在于，从前侧的侧面(11、21)看，各钻孔(80)的纵轴线(83)从内表面(16、26)向对合表面(15、25)的方向岔开。
18.按照权利要求14所述的椎间植入物(1)，其特征在于，各钻孔(80)向对合表面(15、25)的方向圆锥形地逐渐缩小。
19.按照权利要求14所述的椎间植入物(1)，其特征在于，各钻孔(80)具有内螺纹(82)。
20.按照权利要求1或2所述的椎间植入物(1)，其特征在于，中间的关节部分(32)包括第一锁定装置(100)，而下面的关节部分(33)包括第二锁定装置(105)，并且第一和第二锁定装置(100、105)可相互进入嵌接。
21.按照权利要求1或2所述的椎间植入物(1)，其特征在于，在上面的关节部分(31)与中间的关节部分(32)之间设有一些铰链(120)，借其平行于中心轴线(2)连接两个关节部分(31、32)，而不因此限制两个关节部分(31、32)相对彼此绕第一转动轴线(3)的转动运动。
22.按照权利要求1或2所述的椎间植入物(1)，其特征在于，每一关节(38、39)具有一条转动轴线(3、4)并且两条转动轴线(3、4)相互垂直设置。
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CA2510244A1 (en) 2004-07-01
AU2002347117A1 (en) 2004-07-09
JP2006509561A (ja) 2006-03-23
HUP0500746A2 (en) 2006-04-28
EP1572037B1 (de) 2008-05-07
CN1713867A (zh) 2005-12-28
DE50212249D1 (de) 2008-06-19
US8388686B2 (en) 2013-03-05
JP4210652B2 (ja) 2009-01-21
ES2306798T3 (es) 2008-11-16
KR101004374B1 (ko) 2010-12-27
CA2510244C (en) 2011-03-22
AR042504A1 (es) 2005-06-22
EP1572037A1 (de) 2005-09-14
TW200422031A (en) 2004-11-01
WO2004054476A1 (de) 2004-07-01
ATE394085T1 (de) 2008-05-15
AU2002347117B2 (en) 2006-10-26
KR20050092720A (ko) 2005-09-22
TWI303168B (zh) 2008-11-21
US20070276498A1 (en) 2007-11-29
BR0215969A (pt) 2005-09-27

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