CN100457062C - 椎间植入物 - Google Patents

椎间植入物 Download PDF

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Publication number
CN100457062C
CN100457062C CNB028300599A CN02830059A CN100457062C CN 100457062 C CN100457062 C CN 100457062C CN B028300599 A CNB028300599 A CN B028300599A CN 02830059 A CN02830059 A CN 02830059A CN 100457062 C CN100457062 C CN 100457062C
Authority
CN
China
Prior art keywords
intervertebral implant
joint
joint component
parts
plug
Prior art date
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
CNB028300599A
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English (en)
Other versions
CN1713865A (zh
Inventor
M·埃比
D·布卡德
R·弗里格
B·莱希曼
小罗伯特·马蒂斯
P·帕夫洛夫
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
AO Technology AG
Original Assignee
Synthes AG Chur
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Publication date
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Publication of CN1713865A publication Critical patent/CN1713865A/zh
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Publication of CN100457062C publication Critical patent/CN100457062C/zh
Anticipated expiration legal-status Critical
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    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • 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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    • 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
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    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
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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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Abstract

一种椎间植入物(1)、特别是人造的椎间盘，其包括一中心轴线(2)、一上面的部分(10)，其适于贴靠到一位于上面的椎骨体的底板上；和一下面的部分(20)，其适于贴靠到一位于下面的椎骨体的盖板上；其中A)上面的部分(10)具有一前侧的侧面(11)、一背侧的侧面(12)、两侧向的侧面(13、14)、一上面的对合表面(15)和一下面的表面(16)；B)下面的部分(20)具有一前侧的侧面(21)、一背侧的侧面(22)、两侧向的侧面(23、24)、一下面的对合表面(25)和一上面的表面(26)；C)两部分(10、20)可借助一在两部分(10、20)之间设置的关节部件(30)相互相对运动，其中D)关节部件(30)为一具有两相互横向的转动轴线(3、4)的万向节。

Description

椎间植入物
技术领域
本发明涉及一种椎间植入物。
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核髓质以后将植入物或假体插入两相邻的椎骨体的椎间空隙中。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相邻的椎骨体之间的原来的间距。此外，应该尽可能无妨碍地以其天然的方式实现相邻的椎骨体相互相对的运动。对此重要的是，保持在向前/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的活动自由。使天然的韧带和肌肉沿脊柱基本上是无损伤的，从而它们进一步稳定一机械的椎间盘假体的活动。
由DE-A 35 29 761
Figure C0283005900051
已知一同类型的椎间盘内假体。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用于贴靠到邻接的椎骨体的底板上或盖板上的外表面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互补于各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转动运动特别是在前后的和侧向的屈曲的情况下，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)机械的椎间盘假体几乎不可能阻止所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负担；以及
e)一般没有考虑对各相邻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，其具有各个最小摩擦面积的关节。
本发明达到提出的目的是利用一种以下特征的椎间植入物和一种用于由一椎间植入物置换一缺损的天然的椎间盘的方法，其包括以下的步骤。
按本发明的椎间植入物，包括一中心轴线、一上面的部分和一下面的部分，所述上面的部分适于贴靠到一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位于其下面的椎骨体的盖板上；其中
A)上面的部分具有一前侧的侧面、一背侧的侧面、两侧向的侧面、一上面的对合表面和一下面的表面；
B)下面的部分具有一前侧的侧面、一背侧的侧面、两侧向的侧面、一下面的对合表面和一上面的表面；
C)所述两个部分可通过在两个部分之间设置的第一关节和第二关节相互相对运动，
D)第一关节和第二关节分别具有一转动轴线并且两个转动轴线相互成横向地设置；
E)第一关节和第二关节由一与上面的部分连接的上面的关节部分、一中间的关节部分和一与下面的部分连接的下面的关节部分实现；
F)中间的关节部分借助至少一个同轴于一转动轴线的轴可绕该转动轴线转动地连接于下面的关节部分而借助至少一个同轴于另一转动轴线的轴可绕该另一转动轴线转动地连接于上面的关节部分；其特征在于，
G)设有装置，所述装置适合于暂时锁定两部分绕关节部件的活动性；
H)所述装置包括一具有下端部和上端部的插件并且在两个部分上包括各一个在表面中的凹槽，所述凹槽在前侧的侧面上是敞开的；以及
I)插件可以其两端部各插入一个凹槽中。
按本发明的用于由一椎间植入物置换一缺损的天然的椎间盘的方法，其特征在于下列步骤：
A)借助为其设置的装置将一椎间植入物的所述关节锁定在所述关节的规定的位置上；
B)将该椎间植入物插入待治疗的椎间空隙中；
C)脱开和去掉用于锁定所述关节的插入椎间植入物中的装置。
可以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
—在前后方向和向侧面的转动运动彼此是独立的；
—不允许邻接的椎骨体的任何平移运动；以及
—运动的元件的摩擦面积限制在小的圆柱形的或多边形的转动体上并因此保持一最小值。
在本发明的椎间植入物的一优选的实施形式中，两关节包括三个关节部分，其中中间的关节部分构成为框架并且该框架一方面借助两个同轴于第一转动轴线设置的轴可绕第一转动轴线转动地连接于下面的关节部分，而另一方面借助另一同轴于第二转动轴线设置的轴可绕第二转动轴线转动地连接于上面的关节部分。其中各转动轴线可以设置成歪斜的或在一平面内且相交的。
在本发明的椎间植入物的另一实施形式中，中间的关节部分构成十字形的。
在本发明的椎间植入物的又一实施形式中，中间的关节部分构成角形的。借此每一关节只需要一个同轴于相应的转动轴线的轴，因此可取得的优点是，可由少量的构件实现两关节。
在本发明的椎间植入物的另一实施形式中，可从前侧的侧面在两部分上安装装置，借助该装置可以在前侧以一相互相对不变的间距固定该两部分。借此可取得的优点是，用于插入椎间空隙中的两部分可处于具有保持不变的高度的位置，并且在插入椎间植入物中以后可绕关节运动并可贴靠到相邻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集成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，亦即在那里所涉及的脊柱节段的变性继续进行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锁定而加固椎间植入物并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另一实施形式中，包括用于锁定关节的装置，其包括两个插件。所述两插件可借助螺钉平行于第二转动轴线固定到下面的关节部分上。在插入插件的情况下上面的部分和下面的部分被相互支承，而消除一部分相对于另一部分绕两转动轴线的转动运动。
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部可从前侧插入各燕尾槽导槽中。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。当各燕尾槽导轨这样地构成，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另一实施形式中所述装置包括两个平行的插件，其可平行于各侧向的侧面插入到两部分之间并且贴靠到两部分的相互面对的表面上。两插件可借助各一螺钉固定在下面的部分上。
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用于容纳骨固定装置、特别是骨螺钉的钻孔，其中各钻孔具有纵轴线，其倾斜于中心轴线。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，如果只设有椎间植入物的一个轴向固定，只从侧面看各纵轴线倾斜于中心轴线，或如果设有椎间植入物的一角度稳定的固定，也从前侧看各纵轴线从两部分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°与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。优选各钻孔成圆锥形构成，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固的固定。
本发明的方法主要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)借助为其设定的装置将一椎间植入物的一个或各个关节锁定在一个或各个关节的规定的位置上；
B)将该椎间植入物插入待治疗的椎间空隙中；
C)脱开和去掉用于锁定一个或各个关节的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，各活动的部分可由外部的对合表面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，其包括借助用于锁定一个或各个关节设定的装置在植入的椎间植入物上事后地锁定一个或各个关节。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，可以在手术后通过插入为此设定的装置在椎间植入物上锁定一个或各个关节。这种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功能，从而可以加固涉及的脊柱的运动节段。
附图说明
以下借助一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的实施形式的前侧的透视图。
具体实施方式
图1中示出本发明的椎间植入物1的一个实施形式，其包括一上面的部分10，其具有一上面的横向于中心轴线2设置的对合表面15用于贴靠到一邻接的椎骨体的底板上；一下面的部分20，其具有一下面的横向于中心轴线2设置的对合表面25用于贴靠到邻接的椎骨体的盖板上；以及一个关节部件30。上面的部分10和下面的部分20经由关节部件30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。
关节部件30构成为万向节并且包括一构成为框架的中间的关节部分32，该关节部分具有两个同轴于第一转动轴线3设置的轴62，所述轴可绕第一转动轴线3转动地支承于在下面的关节部分33上的两个与其互补的钻孔65中。另一同轴于第二转动轴线4设置的轴61安装在中间的关节部分32上并且可绕第二转动轴线4转动地支承于在上面的关节部分31上的一个与其互补的钻孔(未示出的)中。轴61、62在垂直于转动轴线3、4观察的横截面中具有圆形的或多边形的横截面表面。在图中所示的实施形式中由装置40实现关节部件30的锁定。其包括两个插件63，其可借助螺钉64平行于第二转动轴线4固定在下面的关节部分33上。在插入插件63的情况下上面的部分10和下面的部分20被相互支承，而使部分10、20之一相对于另一部分绕第一转动轴线3的转动运动和部分10、20之一相对于另一部分绕第二转动轴线4的转动运动均是不可能的。
两部分10、20和中间的关节部分32通过在中间的关节部分32中固定的轴61、62组合在一起，轴61、62可绕转动轴线3、4转动地支承于在下面的关节部分33上的各钻孔65和在上面的关节部分31上的一钻孔(未示出)中。
图2中所示的本发明的椎间植入物的实施形式与图1中所示的实施形式的不同只在于，装置40不同地构成。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且平行于两部分10、20的侧面13、14、23、24插入的插件41。插件41插入两凹槽42、43中，所述凹槽构成为燕尾槽导轨。插件41从两部分10、20的前侧的侧面11、21插入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在端部构成互补于凹槽42、43，从而两部分10、20在插入插件41的情况下平行于中心轴线2相互相对固定。
图3中示出本发明的椎间植入物1的一个实施形式，其与图1和2中所示的实施形式的不同只在于，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。

Claims (17)

1.一种椎间植入物(1)，包括一中心轴线(2)、一上面的部分(10)和一下面的部分(20)，所述上面的部分(10)适于贴靠到一位于其上面的椎骨体的底板上，所述下面的部分(20)适于贴靠到一位于其下面的椎骨体的盖板上；其中
A)上面的部分(10)具有一前侧的侧面(11)、一背侧的侧面(12)、两侧向的侧面(13、14)、一上面的对合表面(15)和一下面的表面(16)；
B)下面的部分(20)具有一前侧的侧面(21)、一背侧的侧面(22)、两侧向的侧面(23、24)、一下面的对合表面(25)和一上面的表面(26)；
C)所述两个部分(10、20)可通过在两个部分(10、20)之间设置的第一关节(38)和第二关节(39)相互相对运动，
D)第一关节(38)和第二关节(39)分别具有一转动轴线(3、4)并且这两个转动轴线(3、4)相互成横向地设置；
E)所述第一关节(38)和第二关节(39)由一与上面的部分(10)连接的上面的关节部分(31)、一中间的关节部分(32)和一与下面的部分(20)连接的下面的关节部分(33)实现；
F)所述中间的关节部分(32)借助至少一个同轴于一转动轴线(3)的轴(62)可绕该转动轴线(3)转动地连接于下面的关节部分(33)而借助至少一个同轴于另一转动轴线(4)的轴(61)可绕该另一转动轴线(4)转动地连接于上面的关节部分(31)；
其特征在于，
G)设有装置(40)，所述装置适合于暂时锁定所述两个部分(10、20)绕关节部件(30)的活动性；
H)所述装置(40)包括一具有下端部(45)和上端部(46)的插件(41)并且在所述两个部分(10、20)上包括各一个在表面(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；以及
I)所述插件(41)的下端部(45)和上端部(46)可以各插入一个凹槽(42、43)中。
2.按照权利要求1所述的椎间植入物(1)，其特征在于，中间的关节部分(32)构成为框架。
3.按照权利要求1所述的椎间植入物(1)，其特征在于，中间的关节部分(32)构成为十字形的。
4.按照权利要求1所述的椎间植入物(1)，其特征在于，中间的关节部分(32)构成为角形的。
5.按照权利要求1至4之一项所述的椎间植入物(1)，其特征在于，设有装置(40)，这些装置使所述两个部分(10、20)彼此保持在一个在其前侧的侧面(11、21)测量的不变的间距上。
6.按照权利要求5所述的椎间植入物(1)，其特征在于，所述装置(40)可安装到所述两个部分(10、20)的两个前侧的侧面(11、21)上。
7.按照权利要求1至4之一项所述的椎间植入物(1)，其特征在于，在所述两个部分(10、20)上的凹槽(42、43)是燕尾槽导轨并且插件(41)上的两端部(45、46)设计为互补于该燕尾槽导轨。
8.按照权利要求7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)开始向背侧的侧面(12、22)方向逐渐缩小。
9.按照权利要求1至4之一项所述的椎间植入物(1)，其特征在于，所述装置(40)包括两个平行于侧向的侧面(13、14、23、24)的插件(63)，这些插件可贴靠在相互面对的表面(16、26)上。
10.按照权利要求1至4之一项所述的椎间植入物(1)，其特征在于，所述插件(41可借助一个螺钉(44)可拆式固定在所述两个部分(10、20)之一上。
11.按照权利要求1至4之一项所述的椎间植入物(1)，其特征在于，所述上面的部分(10)和下面的部分(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)。
12.按照权利要求11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。
13.按照权利要求12所述的椎间植入物(1)，其特征在于，角度γ在20°与65°的范围内。
14.按照权利要求13所述的椎间植入物(1)，其特征在于，各钻孔(80)的纵轴线(83)从前侧的侧面(11、21)看从内表面(16、26)向对合表面(15、25)的方向岔开。
15.按照权利要求11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)的方向呈圆锥形地逐渐缩小。
16.按照权利要求11所述的椎间植入物(1)，其特征在于，各钻孔(80)具有内螺纹(82)。
17.按照权利要求1所述的椎间植入物(1)，其特征在于，所述两个转动轴线(3、4)相互垂直地设置。
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NZ540228A (en) 2006-04-28
BR0215968B1 (pt) 2012-08-21
KR20050109459A (ko) 2005-11-21
EP1572038A1 (de) 2005-09-14
US20080119933A1 (en) 2008-05-22
JP4276625B2 (ja) 2009-06-10
US7887591B2 (en) 2011-02-15
EP1572038B1 (de) 2008-03-05
CA2510245C (en) 2011-02-22
JP2006509562A (ja) 2006-03-23
CA2510245A1 (en) 2004-07-01
ATE387896T1 (de) 2008-03-15
CN1713865A (zh) 2005-12-28
WO2004054477A1 (de) 2004-07-01
HUP0500738A2 (en) 2006-04-28
KR100975379B1 (ko) 2010-08-12
AU2002347118A1 (en) 2004-07-09
BR0215968A (pt) 2005-09-27
ES2301687T3 (es) 2008-07-01
TWI317277B (zh) 2009-11-21
AU2002347118B2 (en) 2006-12-21
AR042505A1 (es) 2005-06-22
TW200422032A (en) 2004-11-01
US20110093077A1 (en) 2011-04-21

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