CN100591306C - 颈部的椎间假体 - Google Patents

颈部的椎间假体 Download PDF

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CN100591306C
CN100591306C CN200580047305A CN200580047305A CN100591306C CN 100591306 C CN100591306 C CN 100591306C CN 200580047305 A CN200580047305 A CN 200580047305A CN 200580047305 A CN200580047305 A CN 200580047305A CN 100591306 C CN100591306 C CN 100591306C
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joint core
dimple
joint
articular surface
connecting plate
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CN101111206A (zh
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A·凯勒
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Waldemar Link GmbH and Co KG
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Abstract

颈部的椎间假体，具有两个用于各自连接到相邻脊椎体之一上的连接板(1，5)，并且具有关节芯(20)。该关节芯与一个连接板(1)形成关节，该关节在关节芯(20)上具有凹下的关节面(11)并在所述连接板(1)上具有互补地凸起的关节面。并且所述关节芯通过基本平行于另一连接板(5)的方向延伸的滑动面(17)而支撑在该另一连接板(5)上，该滑动面允许在该方向上有相对运动，并被界定该相对运动的边缘(15)所围绕。所述凹下的关节面(11)以至少90°的空间角度(28)将凸起的关节面包围，并且该凹下的关节面(11)的位于该空间角度内的部分位于被边缘(15)所围出的凹座(16)内。由此改善了假体相对于侧面作用的力的稳定性。

Description

颈部的椎间假体
已知有一种颈部的椎间假体(US 6368350)，它由用于连接相邻脊椎体的上连接板和下连接板以及关节芯(Gelenkkern)组成，关节芯与一个连接板形成关节，该关节由在上连接板的底面上的凸起关节面和在关节芯的顶面上的凹下关节面所组成。关节芯通过滑动面支撑在另一连接板上，该滑动面平行于连接板的尺度方向而延伸，并允许关节芯在这个方向上相对于下连接板有平移的相对运动。该相对运动这样地进行限制：滑动面被垂直向上的边缘限制住。关节芯的关节面在已知的假体中构造成扁平的壳罩状。这是常用的，因为这样可以实现小的特定表面载荷。但也带来以下危险，即当将相关的脊椎体连接的韧带太弱或伸长时，假体零部件就相互脱开。虽然已知(US-A-5895428)，通过中间地通过关节面的螺钉将假体零部件相互连接起来，但这不能与关节芯的上面所述的、平行于连接板尺度的平移活动自由性相连系起来，并且此外对于颈部假体，由于受限的空间也是不可能的。
因而本发明的任务是提供一种开头所述类型的假体，它即使在韧带较弱时也有充足的稳定性。解决方案在于独立权利要求的特征之中以及优选在从属权利要求的特征中。
由此规定：凹下的关节面以至少90°的空间角度包围住凸起的关节面。因此确保：倾斜地从侧面作用的力可以使凸起的关节面不会从凹下的关节面里滑出去。因为所述的角度确定了凹下的关节面包围住凸起的关节面的区域，因此该角度在以下称为包围角。该包围角适宜地是至少110°，进一步优选为135°。如果它按照本发明的另一特征超过180°，那么凸起的关节面就完全固定在凹下的关节面里。包围角或者空间角度被作为半径之间的圆锥的中心角被测量，这些半径从凹下关节面的边缘的相互对峙的点出发。
因为在关节面区域内对假体的稳定是徒劳的，如果关节芯与其他连接板的连接并不稳定，因此本发明还规定：凹下的关节面的处在至少90°的空间角度内的部分被放置在由边缘所围成的凹座里。这就是说，关节面的这个部分位于由边缘的上棱边所撑开的平面之下。因此使关节芯对于侧面作用的力以足够的概率不会从所相关的连接板的凹座里抬升出来。正如上面有利地所述的那样，如果选择超过90°的包围角，那么凹下关节面的超出90°的部分也不是必须位于凹座里。然而，这样是有利的。
凸起的关节面在凹座内的定位，不仅用于使关节芯保持在固定的连接板上，并且也用于减小假体的结构高度。凸起关节面的半径相对于关节芯的横截面构造得如此地小，使得关节面的较大部分都位于关节芯的、被下连接板的凹座所包围住的那个部分之内。关节芯可以这样来构造，使得它基本上全部都位于凹座内。然而可以设置有凸缘，该凸缘在上面置于凹座的边缘上，以便在关节弯曲时避免上连接板和下连接板的金属部分发生直接接触。
凹座应该至少达到三分之一、优选达到大约关节芯的关节面半径的一半来接纳关节芯。特别优选一种实施形式，其中凹座基本上达到关节芯的关节面的中点高度来接纳关节芯。包围着凹座的边缘在滑动面之上的最小高度应该至少达到凹座的Ap尺度的四分之一、优选至少达到三分之一。缩写Ap表示前后方向(antero-posterior)。
通过关节芯与凹座边缘的共同作用，可以所希望的方式预先确定关节芯的运动自由度。在一种有利的实施方式中，凹座界定为矩形，并优选为正方形，并且其边界平行于和横交于Ap方向。这具有以下优点：最大可能尺寸的凹座可以被放置在下连接板里。在该实施方式的第一种变型方案中，可以使用界定为矩形的关节芯，该关节芯在一个方向上具有比凹座更短的侧边长度，而关节芯的其他侧边长度与凹座的侧边长度基本上一致。因此实现了根据关节芯在凹座里的取向，可以将关节芯的运动自由度限制于Ap方向上(这是最经常的情况)或者限制在垂直于Ap方向的方向上。如果在另一变型方案中要完全避免关节芯的平移运动，那么使用正方形的与凹座具有相同的尺寸的关节芯。相反，如果希望在所有方向上有运动自由度，那就选择关节芯在所有方向上的尺寸都小于凹座的尺寸。
以下根据附图对本发明进行详细说明。附图示出：
图1第一实施方式的纵向剖视图；
图2第二实施方式的纵向剖视图；
图3两个连接板连同其间的不同形式的关节芯的分解透视图。
第一连接板1具有表面2，它用于与第一脊椎体的盖板连接。连接板可以设置有齿或其它装置，用于与骨组织紧密地连接。腹部的法兰3包含螺纹孔4，用于骨螺钉。不言而喻，假体的这些结构细节可以构造成不同的。第二盖板5具有表面6，用于与第二脊椎体连接，第二盖板5还具有带着螺纹孔8的腹部法兰7。第一连接板1在上面示出，并且也大多应用在上面。因此以下它被称为上连接板，而另一个则称为下连接板。但也可以反过来布置。
上连接板的底面有关节头10，该关节头形成凸起的带有中点12的关节面11。下连接板5具有围绕的边缘15，它在平滑动面17上包围住一个正方形的凹座16。边缘15的内表面垂直于形成了凹座16的底部的滑动面17、并且平行于或者垂直于Ap方向而延伸。拐角18是倒圆的，在Ap方向上的或者垂直于Ap方向的尺寸26、27是相同的。连接板1、5适宜地由有耐久的材料制成，如金属。
关节芯20位于凹座16内，该关节芯20适宜地由聚乙烯、陶瓷或其它有利于滑动的材料制成。该关节芯具有平整的底面，该底面尽可能大面积地支撑在滑动面17上，并与该滑动面17形成用于平移运动的滑动轴承。关节芯在Ap方向上延伸的侧面21和与之横交的侧面22形成矩形的边界，该边界互补地类似于凹座16的边缘15的内表面。
关节芯20在上边缘有凸缘25，它设置在边缘15的上棱边上。在弯曲运动时，该凸缘防止上连接板1的底面直接碰撞到下连接板5的部分上。在连接板1、5之间的侧面区域24里，留有足够空间用于相对的弯曲运动。
关节芯20包括有球形的凹坑，该凹坑互补地与凸起的关节面11相同，并构成附属的凹下的关节面。该凹坑的中点12与凸起的关节面11的中点重合。凹坑在大于180°的包围角内将凸起的关节面11包围。在中点12之上，凹坑稍微变窄，使得关节头10只有在弹性变形时才可以离开该凹坑，并由此在正常的力作用下被牢固保持在该凹坑内。
由于关节芯20的凹下的关节面11大部分地将关节头10包围，因此即使在侧面出现力时，弯曲关节也具有高度的稳定性。关节芯20同样也以高度的稳定性通过边缘15保持凹座16内。这是由于关节芯20近乎完全地被边缘15所包围，至少在相当大的高度上被边缘15所包围。关节芯的上棱边和由该上棱边所撑开的平面23高于凹下的关节面11的中点12。边缘15在滑动面17之上的高度29略大于凹座16的Ap尺寸26的五分之二。即使关节芯由于未预见到的力而要微微抬起，关节芯也总是通过边缘15返回到示出的位置上。
连接板1、5可以与具有不同侧边长度的关节芯组合。这在图3中示出。关节芯“a”的侧面的尺寸与边缘15的内表面相同(有适当的间隙)。如果关节芯装入到下连接板的凹座16里，那么关节芯相对于下连接板5就没有平移的相对活动可能性。因此如果假体必须承担椎间关节的稳定，那就在韧带削弱时应用这种关节芯。
关节芯“c”在Ap方向上和横交于Ap方向上小于凹座16，因此在所有方向上，运动可能性都受到限制。这种关节芯在期望关节有一定的平移运动距离的情况下得以应用，但在该运动距离之后仍期望达到稳定。
关节芯“b”是在上述方案之间的一种折衷方案，因为关节芯的侧面21的侧边长度与凹座16的侧边长度26、27相等，而横交于该侧面延伸的成对侧面22较短。这意味着，关节芯b相对于所属的下连接板5在侧面21的方向上是不可活动的，但在侧面22的方向上则可以有限制地运动。如果在不同方向上的稳定性需要不同，那么应用这种关节芯。活动性大多设置在Ap方向上，而在横向方向上的连接则是固定的。然而也可以实现相反的方案。
图2示出一个实施例，它与图1中的实施例的不同在于：更扁平结构的关节面11’和更低的关节芯20’。包围角28’只有大约110°。关节面11’的由该包围角所确定的区域完全在凹座16’内，也就是说不高于上边界面23’。关节面的半径30以其部段31，超过三分之一在边界面23’之下位于凹座16’内。凹座16’的高度29’大致等于凹座的Ap尺寸的三分之一。假体的总高度略小于第一实施例中的总高度。同样它有高的侧向稳定性。

Claims (11)

1.颈部的椎间假体，具有两个用于各自连接到相邻脊椎体之一上的连接板(1，5)，并且具有关节芯(20，20’)，该关节芯与一个连接板(1)形成关节，该关节在关节芯(20，20’)上具有凹下的关节面(11，11’)并在所述连接板(1)上具有互补地凸起的关节面，并且所述关节芯通过基本平行于另一连接板(5)的方向延伸的滑动面(17)而支撑在该另一连接板(5)上，该滑动面允许在该方向上有相对运动，并被界定了该相对运动的边缘(15)所围绕，其特征在于，所述凹下的关节面(11，11’)以至少90°的空间角度(28，28’)将凸起的关节面包围，并且该凹下的关节面(11，11’)的位于该空间角度内的部分位于被边缘(15)所围成的凹座(16，16’)内。
2.按照权利要求1所述的椎间假体，其特征在于，所述凹下的关节面(11)以至少180°的空间角度(28)将凸起的关节面包围。
3.按照权利要求1或2所述的椎间假体，其特征在于，所述凹座(16，16’)至少达到关节面半径(30)的三分之一高度将关节芯(20，20’)接纳。
4.按照权利要求3所述的椎间假体，其特征在于，所述凹座(16)基本达到该关节芯的关节面(11)的中点(12)的高度将关节芯(20)接纳。
5.按照权利要求1或2所述的椎间假体，其特征在于，所述围绕着凹座(16)的边缘的高度(29)至少为该边缘在前后方向上的尺度(26)的四分之一。
6.按照权利要求1或2所述的椎间假体，其特征在于，所述关节芯(20)基本上完全位于凹座(16)内。
7.按照权利要求6所述的椎间假体，其特征在于，所述关节芯(20)具有在弯曲时阻止连接板(1，5)直接接触的凸缘(25)。
8.按照权利要求1或2所述的椎间假体，其特征在于，所述凹座(16)是矩形的，并且该凹座的侧面平行于或者垂直于前后方向而延伸。
9.按照权利要求8所述的椎间假体，其特征在于，所述凹座(16)是正方形的，并且可以使用界定为矩形的关节芯(b)，该矩形的关节芯的一对侧面(21)具有与凹座(16)的侧边长度(26，27)基本一致的侧边长度，而该关节芯的另一对侧面(22)具有较短的侧边长度。
10.按照权利要求8所述的椎间假体，其特征在于，可以使用具有如凹座(16)那样基本相同尺寸的关节芯(a)。
11.按照权利要求8所述的椎间假体，其特征在于，所述凹座(16)界定为正方形，并且可以使用界定为矩形的关节芯(b)，该矩形的关节芯在两个方向上具有比凹座(16)更小的侧边长度。
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