CN101083947B - 椎间稳固系统 - Google Patents

椎间稳固系统 Download PDF

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CN101083947B
CN101083947B CN2005800391606A CN200580039160A CN101083947B CN 101083947 B CN101083947 B CN 101083947B CN 2005800391606 A CN2005800391606 A CN 2005800391606A CN 200580039160 A CN200580039160 A CN 200580039160A CN 101083947 B CN101083947 B CN 101083947B
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band
bar
cavity
stabilisation system
pedicle screw
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CN101083947A (zh
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托马斯·埃利
埃马纽埃尔·日尔博
米夏埃多·欧仁·朗夏尔
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Zimmer GmbH
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Abstract

本发明涉及一种用于至少三块椎骨的椎间稳固系统，包括可紧固于椎骨上的椎弓根螺钉(67)；至少一个杆(11)，用于将至少两个椎弓根螺钉与刚性加强系统相连；以及至少一个带(33)，其可以被张紧，而且当植入所述稳固系统时，所述带由至少一个可压缩的挤压体(77)包围，所述挤压体(77)位于两个相邻的椎弓根螺钉之间，所述带将所述椎弓根螺钉与一弹性支撑系统相连。根据本发明，一公共椎弓根螺钉既与所述加强系统相关联，又与所述支撑系统相关联，且所述带可通过紧固元件与所述杆相连或通过紧固元件与所述杆相连。

Description

椎间稳固系统
技术领域
本发明涉及一种用于至少三块椎骨的椎间稳固系统。
背景技术
由于脊柱的变形或变性改变，个别受损的不稳定脊柱节段可能必须通过手术加以稳固。
在此方面，受损脊柱节段的加强众所周知。通过这种局部脊柱的加强，椎间盘至少部分地被去除；在待加强的椎骨之间植入骨组织；而且待加强的椎骨通过螺钉和至少一个杆彼此刚性连接。然而，脊柱节段的加强使相邻椎骨随着脊柱的弯曲和伸展运动而比加强前承受更大应力。
作为选择，对于“较轻的病例”，特别是在椎间盘也出现问题之前，最近更多地使用一种植入物，该植入物在背部支撑受损的脊柱节段而不是对其进行加强，从而在较大范围内保持受损椎骨的活动性。因此，在固定于椎骨上的螺钉之间使用一种具有柔韧垫片的弹性带。该弹性带限制弯曲运动，而该垫片限制伸展运动。
发明内容
本发明的问题是提出一种前面提及类型的装置，该装置被设计成用于以使脊柱随弯曲和伸展运动承受尽可能小的应力的方式加强不稳定的脊柱节段，尤其用于防止进一步的手术或至少尽可能地延迟手术。
该问题的解决方案特别在于可紧固(或固定)于椎骨上的椎弓根螺钉(pedicle screw)、将至少两个椎弓根螺钉与一刚性加强系统相连的杆以及带，当拉动该带时，该带可被预加应力(或预受力)，并且当植入稳固系统时，该带由至少一个可压缩的挤压体(pressure body)包围，该挤压体位于两个相邻的椎弓根螺钉之间，并用于将椎弓根螺钉与弹性支撑系统相连，其中，一公共椎弓根螺钉既与加强系统相关联，又与支撑系统相关联，所述带通过带紧固件与所述杆相连或可通过带紧固件与所述杆相连。
特别是，根据本发明的一个方面，提出一种用于至少三块椎骨的椎间稳固系统，包括：
-可紧固于椎骨上的第一、第二和第三椎弓根螺钉；
-在所述第一和第二椎弓根螺钉之间连接刚性加强系统的杆；以及
-带，当拉动该带时，该带可被预加应力，并且当植入所述稳固系统时，该带由至少一个可压缩的挤压体包围，所述挤压体位于两个相邻的椎弓根螺钉之间，以用于连接所述椎弓根螺钉，从而在所述第二椎弓根螺钉和所述第三椎弓根螺钉之间形成弹性支撑系统，
其中，所述第二椎弓根螺钉既与所述刚性加强系统相关联，又与所述弹性支撑系统相关联；
所述杆的端部具有空腔，所述带的端部通过所述杆的端部的开口插入所述空腔中并通过带紧固件与所述杆相连。
因此，本发明的特征在于，所述刚性加强系统将包括杆的已知现有技术与包括带和挤压体且同样由现有技术可知的弹性支撑系统结合。根据本发明，以前用作替代已知刚性加强系统的弹性支撑系统与刚性加强系统一起使用，以用于稳固不稳定的脊柱节段。
所述加强系统的杆被设计成用于加强包括至少两块椎骨的不稳定脊柱节段。当植入稳固系统时与所述杆相连以及当未植入稳固系统时与所述杆相连或可与所述杆相连的带用于支撑与加强脊柱节段相邻的至少一块椎骨。所述杆与带通过椎弓根螺钉紧固于待稳固椎骨上。
优选地，当实施稳固系统时，在位于受损椎骨销延伸部的左侧和右侧处设有至少两个加强系统、特别是两个杆，其中，优选地，所述两个加强系统彼此相连或可彼此相连。此外，可以设置多个支撑系统。特别是，对于每个系统或多个系统而言，可为加强系统设置连接在加强系统的一端的两个支撑系统。本质上，还可设置有多个加强系统和支撑系统，其在植入状态下交替地彼此相连。
在稳固系统的植入状态下，当拉动所述支撑系统的带时，该带被预加应力。另一方面，所述挤压体处于压缩状态，也就是说，该挤压体在压力下被预加应力。因此，所述杆和带通过带紧固件彼此相连，也就是说，所述带紧固件于所述杆上或反之亦然。公共椎弓根螺钉由刚性加强系统和弹性支撑系统同等地使用，其中在所述稳固系统的植入状态下，所述带与杆的连接通常设计在所述公共椎弓根螺钉上或所述公共椎弓根螺钉附近。如果带紧固件位于两个椎弓根螺钉的大约中间位置，两个椎弓根螺钉中的任意一个可以视为公共椎弓根螺钉。
通过在刚性加强系统后作为其延伸的弹性支撑系统，或通过位于刚性加强系统的两侧的弹性支撑系统，在通过加强系统彼此刚性连接的椎骨后的椎骨被支撑，因此这些相邻椎骨不会随脊柱的弯曲和伸展运动而受到增大的应力。
在说明书以及附图中还给出了本发明的有利实施例。
优选地，带紧固件被设计为夹紧装置，以用于夹紧所述带。通过设计为夹紧装置的带紧固件的夹紧力，可以保持带，该带以特别安全可靠的方式在稳固系统的植入状态下受到牵引。
优选地，所述带紧固件还包括所述杆的端部、分离部件和/或公共椎弓根螺钉。
附图说明
下面参考附图以示例方式对本发明进行说明，其中包括不同实施例，这些实施例的各特征可以彼此在有意义的程度上彼此进行任意组合，附图中：
图1-图7示出了根据本发明的稳固系统的带紧固件，该带紧固件包绕所述杆的端部；
图8-图10示出了根据本发明的稳固系统的带紧固件，该带紧固件包绕分离部件；以及
图11-图15示出了根据本发明的稳固系统的带紧固件，该带紧固件包绕公共椎弓根螺钉。
具体实施方式
下面描述的实施例仅仅示出了用于描述加强系统的杆与支撑系统的带之间的连接所需的稳固系统的一部分。本发明的不同实施例的相同部件或彼此对应的部件用相同的附图标记表示。
图1示出了具有刚性加强系统的刚性金属杆11的根据本发明第一实施例的稳固系统，所述刚性加强系统的其他方面未示出，其中，杆11具有端部13，端部13的直径大于杆11的中间部分15的直径。同时，被指示为头部13并可用作未示出的挤压体的止挡件的杆11的端部为带紧固件的至少一部分，并具有基本圆柱形中空空间17。其他方面未示出的弹性支撑系统的弹性带23(例如由塑料制成)的一端通过带进入开口19插入或可插入所述中空空间17中。
带紧固件还包括套筒状夹紧元件27，该夹紧元件27沿带23的端部21的插入方向25插入(图1c)或可插入(图1a)空腔17中，并在圆周方向上封闭；该夹紧元件被推至带23的端部21，并被设计成利用杆11的头部13将插入杆11的空腔17中的带23的端部21夹紧。该套筒状夹紧元件27还可以被指定为夹紧套筒或夹紧环。
夹紧套筒27被设计成当其未插入杆11的空腔17中时其外部呈锥形渐缩，其中，夹紧套筒27的壁厚向着具有较大外径的端部增大。根据图1d，沿圆周布置的突出部29向内指向，并使夹紧套筒27的内径收缩，该突出部29可设计在夹紧套筒27的具有较大外径的一端的内部。根据图1e，特别是，夹紧套筒27可在两个相反侧开口。本质上，夹紧套筒可具有突出部并且也可开口。
图1a至图1c示出了杆11与带23的连接。首先，通过使具有较大外径的圆锥形夹紧套筒27的一端面向带23的中部(图1a)的方式，将夹紧套筒27推至将插入空腔17或杆11中的带23的端部21上。然后，利用适宜的工具，沿插入方向25(图1b)将设有夹紧套筒25[原文如此；27]的带23的端部21压入杆11的头部13的空腔17中。
具有较大外径的夹紧套筒27的端部压在杆11的圆柱形空腔17的内径上，圆柱形空腔17的内径至少基本上对应于夹紧套筒27的另一端的较小外径。当组装时(图1c)，夹紧套筒27的内径向着最初具有较大外径的一端减小，因为夹紧套筒27的壁厚在该方向上增大，也就是说，夹紧套筒27的通道限制在杆11的头部13的空腔17的带进入开口19的方向上，因此带23被有效夹紧。
带紧固件的夹紧力可以通过图1d所示的突出部29附加地加强。开口夹紧套筒27(图1e)的优点在于，当夹紧套筒27插入杆11的头部13的空腔17中时，为材料的变形提供了额外的空间，这样，压入过程在花费较小的力的情况下便可实施。
图2示出了根据本发明的第二实施例的稳固系统。与图1中的实施例相比，根据图2的带紧固件包括两个彼此支撑的夹紧套筒27、31。
与图1类似，通过使具有较大外径的圆锥形第一夹紧套筒27的一端面向带23的中部(图2a)的方式，将第一夹紧套筒27推至带23的端部21上，其中带23将插入根据图2a和图2b的实施例中的杆11的空腔17中。用作圆锥形压紧环的第二夹紧套筒31压入杆11的头部13的空腔17中(图2a)，其中第二夹紧套筒31与第一夹紧套筒27关于垂直于插入方向25的平面呈镜像关系。为连接带23和杆11，第一夹紧套筒27沿插入方向25压入杆11的头部23的空腔17中，其中第一夹紧套筒27由第二夹紧套筒31支撑。第一夹紧套筒27以使带23有效夹紧于其内的方式变形(图2b)。本质上，也可设置多个锥形压紧环。
在根据图2c和图2d的实施例中，与根据图2a和图2b的实施例相比，两个夹紧套筒27、31交换了彼此的方位，其中，第一夹紧套筒27压紧于处于未插入状态的带23的端部21(图2c)上。当组装时，设有第一夹紧套筒27的带23的端部21沿插入方向25插入杆11的头部13的空腔17中。随后，第二夹紧套筒31沿插入方向压入所述空腔中(图2d)。
图3示出了根据本发明的第三实施例的稳固系统。
根据图3a至图3c的实施例的带紧固件包括夹紧销33，所述夹紧销33可横向于带23的端部21的插入方向25以压入配合方式插入空腔17中；所述销被设计成将所述带的端部与所述杆11的头部13夹紧，所述带的端部可插入杆11的空腔17中。穿过开口35插入空腔17中的夹紧销33的末端可以设计为圆形(图3a)或楔形(图3b)，该末端相对于带23的纵向延伸部将径向压力作用于带23的插入端部21上。利用楔形夹紧销33，可在夹紧的带23上获得更大的接触压力。
与夹紧销33插入空腔17中所穿过的开口35径向相对，空腔17形成在限定空腔17的杆11的头部13的内部；压入的夹紧销33压紧进入所述中空空间中。由此产生的带23的偏离可以附加地增大带23上的夹紧力。为了便于带23的插入，设计为套筒39的插入辅助件可以粘附在将插入的带23的端部21上(图3a和图3b)。如图3c所示，可以设置一个、两个、三个或任何数目的夹紧销33、41、43。
在根据图3d的实施例中，带紧固件包括加压元件(pressure element)，例如夹紧螺钉137，夹紧螺钉137可横向于插入方向25通过开口133插入杆11的头部13的空腔中，并被设计成用于将带23的端部21夹紧于杆11的头部13中。此外，设有比带进入开口19更深且与带进入开口19相对的带退出开口135，通过该带退出开口135，带23的端部21又可以向外移动或退出杆11的空腔之外。带23中未插入头部13的部分由挤压体75包围，挤压体75也可以被指定为衬垫。在组装状态下，杆11置于或可置于公共椎弓根螺钉67的凹槽139中，公共椎弓根螺钉67在其上端形成为音叉状，并且通过夹紧螺钉141，杆11紧固于或可紧固于公共椎弓根螺钉67上。然而，公共椎弓根螺钉67的上端也可以被设计为通道。
图4示出了根据本发明的第四实施例的稳固系统，其中，空腔17向着杆11的头部13的带进入开口19收缩。因此，通过杆11的头部13的再成形，该收缩或收缩部由插入空腔17的带23的端部21形成。通过该收缩部，带23被有效夹紧(图4b、图4f和图4h)。类似于图3，在根据图4的实施例中，也可以将套筒39用作带23的端部21的插入辅助件，如图4a和图4b所示。
在根据图4a和图4b的实施例中，杆11的头部13显示有凸出部45，该凸出部45沿与插入方向25相反的方向凸出，并沿杆11的圆周布置。例如，通过辊轧(图4c)或通过使用两个半壳(图4d)，可以实现凸出部45从图4a所示的位置至其中凸出部45的方位旋转了90°的图4b所示的位置的再成形。
在根据图4e和图4f的实施例中，在再成形之前，杆11的头部13不具有凸出部。相反，当压入带23的插入端21的末端时，杆11的头部13形成带进入开口19的边界的区域以特别是向内压紧的方式利用冲头131变形，因此，空腔17向着杆11的头部13的带进入开口19收缩。
根据图4g和图4h的实施例的特征在于，在变形之前，杆11的头部13的外径以及头部13在空腔17区域中的相关壁厚沿着与带23的插入方向25相反的方向增大。通过杆11的头部13的再成形，压紧环47沿与插入方向25相反的方向移动，其中该压紧环47具有基本对应于杆11的中间部分15的外径的内径。因此，杆11的头部13压缩至压紧环47的内径，这样，由于头部13的厚度在该方向上增大，空腔17向着头部13的带进入开口18收缩。
图5示出了根据本发明的第五实施例的稳固系统，其中，带23与杆11的连接通过杆11的头部13的再成形实现。至少在再成形之前，杆11的头部13以及该头部13内的空腔17为球形，其中，所述带进入开口19的直径小于形成于头部13中的空腔17。因此，在再成形之前，空腔17已经向着带进入开口19收缩。
为了实现带23与杆11的连接，首先在带23的端部21上挤入环49(图5a)，特别是锥形环49’。然后，将带23的具有环49、49’的头部插入杆11的头部13的空腔17内，在该空腔17内，杆11的头部13被压缩，因而环49、49’也被压缩，从而将带23有效地夹紧(图5b)。可以通过使环49’一端变细而附加地增大施加在带23上的压紧力。
图6示出了根据本发明的第六实施例的稳固系统。根据图6的实施例本质上与根据图1的实施例相同，其区别在于，所述带紧固件还包括特别是由金属或塑料制成的嵌入件51，该嵌入件51插进带23的端部21中，特别在中心插进，带23的端部21可插入(图6a)或插入(图6b)杆11的空腔中，嵌入件51沿带23的插入方向25延伸。
嵌入件51被设计为销形，并包括头部53和轴55，其中，头部53的直径大于轴55的直径。头部53从带23的端部21部分突出。利用嵌入件51，可以增大施加在夹紧带23上的压紧压力，从而可以增大由所述带紧固件产生的所述带23和杆11之间连接的保持力。
图7示出了根据本发明的第七实施例的稳固系统。在图7中，带23被扩宽，以形成大量的力承受部(strength carrier)，特别是带23的纤维，而且通过插入件57，将带23可以压入(图7b)或压入(图7c)杆11的头部13的空腔17中。为了实现扩宽，可以使用刷子工具59(图7a)向上刷拭带23的端部21。
为了压入，图7中设计为环状插入件的插入件57以螺纹方式拧接在带23上，并插入头部13的空腔17中，这样，在所有朝向插入方向25径向伸出的各纤维夹紧在环状插入件57的前侧面和空腔17的边界之间。为了增大带23和杆11之间的这种连接的保持力，可以设置居中定位的长钉61和凸耳63(图7d)，长钉61沿插入方向25的相反方向突出至空腔17中，凸耳63围绕长钉61布置且沿插入方向25的相反方向突出至空腔17中。
根据本发明的未图示的第八实施例，所述带可插入空腔的端部可以特别是通过胶水或粘合剂粘住。这样，带的纤维彼此结合在一起，从而防止各纤维彼此之间的滑动，而且可以获得所述带和杆之间的连接的更大保持力。
根据本发明的未图示的第九实施例，所述带可插入或插入所述空腔中的端部通过熔融、模制成型以及随后的硬化而形成。特别是，其形状可以设计为在硬化或固化后所述带的端部呈钩状。
图8示出了根据本发明的第十实施例的稳固系统，其中，所述带紧固件包括分离部件65，其中，杆11紧固于或可紧固于所述带紧固件上，也就是说，特别是紧固于分离部件65上，也可紧固于公共椎弓根螺钉67上。特别是，分离部件65没有或不能直接紧固于公共椎弓根螺钉67上。
图8a和图8b示出了植入时的稳固系统。杆11连接包括公共椎弓根螺钉67的两个椎弓根螺钉67、69，每个椎弓根螺钉紧固在脊柱的椎骨上，以形成刚性加强系统。拉动时被预加应力的带23连接包括公共椎弓根螺钉67的三个椎弓根螺钉67、71、73，其中，椎弓根螺钉71、73中的每一个也紧固于椎骨上，以形成弹性支撑系统。压缩的挤压体75、77位于椎弓根螺钉67和71之间，并位于椎弓根螺钉71和73之间；它们沿圆周方向完全包围带23。公共椎弓根螺钉67与所述刚性加强系统相互关联，也与所述支撑系统相互关联。
带23和杆11通过分离部件65彼此相连。分离部件65基本上垂直于带23的纵向伸展方向而延伸，或垂直于杆11的纵向伸展方向而延伸，带23和杆11基本上彼此平行且中间/侧向交错延伸，而至少在根据图1至图7的实施例中，所述带的纵向延伸部和所述杆的纵向延伸部彼此平行，至少没有中间/侧向交错。根据图8，分离部件65相对于公共椎弓根螺钉67既可以位于支撑系统侧(图8a)，也可以位于加强系统侧(图8b)。
根据图8c所述的实施例示出了分离部件65，该分离部件65具有两个管状通道79、81，以用于带23的紧固和杆11的紧固。用于紧固杆11的通道79具有上半壳83和下半壳85，二者可以通过固定螺钉87彼此相对移动，以用于夹紧杆11。垂直于用于紧固带23的通道81，在公共椎弓根螺钉67上具有开口89，在该开口89中可插入或插入加压元件91，例如用于夹紧带23的夹紧螺钉。
分离部件65可以构造为多个部分，其中，特别是，可以实现分离部件65的部分的彼此不同的相对位置。这种部件65图示在根据图8d、图8e和图8f的实施例中。分离部件65具有用于带23的管状通路或通道81，带23可以通过插入穿过开口89的夹紧螺钉91紧固。当植入时，杆11可插入扇形开放通道79。与带23类似，杆11也可以通过插入开口95的夹紧螺钉93紧固于所述分离部件65上。分离部件65中形成有通道，分离部件65设有位于其中形成通路或通道81的一部分与其中形成通道79的另一部分之间的旋转轴97，这样，分离部件65的部分可以彼此相对旋转。通过锁定螺钉99可以锁定两个部分彼此相对的调整过的相对位置。
分离部件65的其他实施例图示在图8g和图8h中，其以透视图(图8g)或顶视图或侧视图(图8h)示出。特别是，显然，在以一定角度构造的单件式分离部件65或多部分的分离部件65中，该分离部件65的各部分的彼此相对位置可以通过线性位移进行变化。
根据图8i的实施例示出了分离部件65，未示出的杆可以从一侧插入该分离部件65中，未示出的带可以从相对的另一侧插入该分离部件65中。分离部件65在一定程度上被设计为双套筒，其具有两个管状通路79、81。而且，设有开口89、95，以通过未示出的夹紧螺钉将杆和带与分离部件65相连。
图9示出了根本发明的第十一实施例的稳固系统，其中，所述带紧固件包括分离部件65，未示出的杆紧固于或可紧固于该带紧固件65上，而且所述带紧固件65紧固于或可紧固于公共椎弓根螺钉上。特别是，该杆未直接紧固于或不能直接紧固于所述公共椎弓根螺钉上。
在根据图9a和图9b的实施例中，分离部件65具有中心通道101，该中心通道101被设置用于使分离部件65紧固于公共椎弓根螺钉上。此外，在分离部件65中垂直于中心通道101延伸并彼此平行的两个通道或通路79、81被设计用于所述带和杆的紧固。为夹紧杆，设有开口89，未示出的夹紧螺钉可插入开口89中。通道79为狭缝，并可以通过公共椎弓根螺钉收缩限制，这样该杆可以被有效地夹紧。
图10示出了根据本发明的第十二实施例的稳固系统，其中，所述带紧固件包括分离部件65，其中，所述带紧固件和杆紧固于或可紧固于公共椎弓根螺钉67上。特别是，所述杆11未直接紧固于或不能直接紧固于所述分离部件65上。
根据图10a的分离部件65具有用于紧固带23的套筒或通路和用于紧固于公共椎弓根螺钉67上的紧固环103，其中，套筒81的纵向轴线和紧固环103的中央轴线基本上彼此垂直。紧固环103也可具有用于杆11的凹槽105(图10b)。
图11示出了根据本发明的第十三实施例的稳固系统，其中，所述带紧固件包括公共椎弓根螺钉67，其中杆11可紧固于或紧固于分离部件107上，分离部件107紧固于或可紧固于所述公共椎弓根螺钉67上。特别是，杆11未紧固于或不能紧固于所述公共椎弓根螺钉67上。
根据图11的分离部件107具有两个横向布置的夹臂109，利用该夹臂109，根据夹紧闭合类型，分离部件107紧固于或可紧固于公共椎弓根螺钉67上。夹臂109锁定于公共椎弓根螺钉67的横向凹部111中，以用于紧固。而且，分离部件107具有未示出的通路和开口95，杆11插入或可插入所述通路中，用于杆11的紧固的未示出的夹紧螺钉可插入该开口95中。此外，设有开口113，未示出的紧固螺钉可插入或插入该开口113，以用于将分离部件107附加地紧固于公共椎弓根螺钉67上。
图12示出了根据本发明的第十四实施例的稳固系统，其中，所述带紧固件包括公共椎弓根螺钉67，其中杆11通过横杆115紧固于或可紧固于公共椎弓根螺钉67上，当植入时，横杆115基本上垂直于带23的纵向伸展方向延伸。
图12中所示的稳固系统示出了一加强系统，在该加强系统的两端为支撑系统，也就是说，具有两个公共椎弓根螺钉67和两个横杆115。形状基本上为S形的横杆115可以具有与杆11或周向封闭的通道79相关联的通道79，通道79在端部呈打开的扇形。为了将横杆115紧固于公共椎弓根螺钉67上，在与该公共椎弓根螺钉67相关联的端部形成有长孔117，这样，可以实现在公共椎弓根螺钉67与杆11之间的各种相对位置。杆11的纵向延伸部以及带23的纵向延伸部平行延伸，而且彼此相对地中间/侧向交错。
图13示出了根据本发明的第十五实施例的稳固系统，其中，所述带紧固件包括公共椎弓根螺钉67，其中，杆11紧固于或可紧固于该公共椎弓根螺钉67上，而且该公共椎弓根螺钉67具有带23和杆11的公共通道119。
在根据图13的实施例中，带23和杆11在所述公共椎弓根螺钉67的公共通道119中彼此紧邻设置，或彼此层叠设置。带23和杆11一同由未示出的夹紧螺钉压紧，该夹紧螺钉插入或可插入形成在所述公共椎弓根螺钉67中的开口121中。这样，带和杆均被有效地夹紧。
图14示出了根据本发明的第十六实施例的稳固系统。类似于根据图13的实施例，根据图14的实施例具有带23和杆11的公共通道119以及插入夹紧螺钉的开口121。
在根据图14a的实施例中，与根据图13的实施例相比，带23在杆11上或可以在杆11上拉动。而且，套筒123推入或可以推入公共通道119中，公共通道119反过来又包围带23。否则，类似于图13中的实施例，可以将带23和杆11夹紧。在图14b所示的实施例中，带23的端部21插入或可以插入杆11中，类似于图1-图7所示，其中，通过穿过开口143插入或可插入所述公共椎弓根螺钉67的夹紧螺钉141，带23和杆11可以被夹紧。
在根据图14c的实施例中，公共椎弓根螺钉67的上端被设计为音叉状，这样，在两个叉子149之间形成凹槽139，杆置入或可以置入该凹槽中。通过夹紧螺钉141实现将杆安装在公共椎弓根螺钉67上，夹紧螺钉141插入或可插入两个叉子149的孔部分143中，其中，该孔部分具有内螺纹。杆11的端部13被设计为用于连接带23的端部21，该端部13可以具有大于杆11的中间部分15的直径的直径(图14d)。带23通过夹紧螺钉137连接于或可连接于杆11上，夹紧螺钉137穿过开口133插入或可插入杆11中。
为了导向杆11与公共椎弓根螺钉67的装配或为了将杆11相对于所述公共椎弓根螺钉67准确定位，在杆11的头部13上形成有导向装置，例如一个或多个圆形或角形桩145(图14d、图14e、图14g)，该导向装置可以与公共椎弓根螺钉67的导向装置(图14c、图14f)啮合，该公共椎弓根螺钉67的导向装置例如为一个或多个凹槽、狭槽或开槽147，特别是对应于两个叉子149的孔部分143(图14c)。
而且，可以设置垂直于杆11的纵向轴线的至少一个特别是呈盘形的凸缘151(图14e、图14g、图14h)，该凸缘151与杆11相连，并允许杆11相对于公共椎弓根螺钉67的准确定位，或者当装配稳固系统时提供导向。如果凸缘151被设计为杆11的端部13的封闭或截止，该凸缘还可以同时用作稳固系统的支撑系统的挤压体75的止挡件151。
图15示出了根据本发明的第十七实施例的稳固系统，其中，所述带紧固件包括公共椎弓根螺钉67，其中未示出的杆紧固于或可紧固于公共椎弓根螺钉67上，且带23夹紧于或可以夹紧于加压机构(特别是螺母125)和公共椎弓根螺钉67之间，其中，该公共椎弓根螺钉67具有所述杆的通道127。
通过螺纹销129，插入通道127的杆被有效地夹紧，螺纹销129具有连续的外螺纹，而且穿过开口121的螺纹销129插入或可插入公共椎弓根螺钉67中。螺母125位于螺纹销129的端部上，以将带23夹紧于公共椎弓根螺钉67和螺母125之间，螺纹销129的端部从公共椎弓根螺钉67突出。为此，将被夹紧的带23的端部21被制成环状，螺纹销129啮合在该环内。
附图标记列表
11杆
13头部
15中间部分
17空腔
19带进入开口
21端部
23带
25插入方向
27夹紧套筒
29突出部
31夹紧套筒
33夹紧杆
35开口
37中空空间
39插入辅助件
41夹紧杆
43夹紧杆
45凸出部
47压紧环
49，49’环、锥形环
51嵌入件
53头部
55轴
57插入件
59刷子工具
61长钉
63凸耳
65分离部件
67公共椎弓根螺钉
69椎弓根螺钉
71椎弓根螺钉
73椎弓根螺钉
75挤压体
77挤压体
79通道、通路
81通道、通路、套筒
83上半壳
85下半壳
87固定螺钉
89开口
91夹紧螺钉
93夹紧螺钉
95开口
97旋转轴
99锁定螺钉
101中心通道
103紧固环
105凹槽
107分离部件
109夹臂
111凹部
113开口
115横杆
117长孔
119公共通道
121开口
123套筒
125螺母
127通道
129螺纹杆
131冲头
133开口
135带退出开口
137夹紧螺钉
139凹槽
141夹紧螺钉
143开口、孔部分
145桩
147凹槽
149叉子
151凸缘、止挡件

Claims (18)

1.用于至少三块椎骨的椎间稳固系统，包括：
-可紧固于椎骨上的第一、第二和第三椎弓根螺钉；
-在所述第一和第二椎弓根螺钉之间连接刚性加强系统的杆(11)；以及
-带，当拉动该带时，该带可被预加应力，并且当植入所述稳固系统时，该带由至少一个可压缩的挤压体包围，所述挤压体位于两个相邻的椎弓根螺钉之间，以用于连接所述椎弓根螺钉，从而在所述第二椎弓根螺钉和所述第三椎弓根螺钉之间形成弹性支撑系统，
其中，所述第二椎弓根螺钉既与所述刚性加强系统相关联，又与所述弹性支撑系统相关联；
所述杆的端部具有空腔，所述带的端部通过所述杆的端部的开口插入所述空腔中并通过带紧固件与所述杆相连。
2.根据权利要求1所述的稳固系统，其特征在于，所述带紧固件被设计为用于夹紧所述带的夹紧装置。
3.根据权利要求1所述的稳固系统，其特征在于，所述带紧固件包括所述杆的端部。
4.根据权利要求3所述的稳固系统，其特征在于，所述杆能够与所述第二椎弓根螺钉相连。
5.根据权利要求1所述的稳固系统，其特征在于，所述杆的端部具有大于至少所述杆的中间部分的直径的直径。
6.根据权利要求1所述的稳固系统，其特征在于，所述带紧固件包括至少一个夹紧元件，该夹紧元件沿所述带的端部的插入方向插入所述空腔中，所述夹紧元件被设计成用于将插入所述空腔中的带的端部与所述杆的端部夹紧。
7.根据权利要求6所述的稳固系统，其特征在于，所述至少一个夹紧元件呈环形或套筒形。
8.根据权利要求1所述的稳固系统，其特征在于，所述带紧固件包括至少一个夹紧元件，该夹紧元件在压入配合的作用下能够横向于所述带的端部的插入方向插入所述空腔中，所述夹紧元件被设计成用于将插入所述空腔中的带的端部与所述杆的端部夹紧。
9.根据权利要求8所述的稳固系统，其特征在于，所述至少一个夹紧元件为呈销形的夹紧元件。
10.根据权利要求1所述的稳固系统，其特征在于，所述空腔向着所述开口收缩。
11.根据权利要求10所述的稳固系统，其特征在于，插入所述空腔中的带的端部的收缩部通过所述杆的端部的再成形或挤压而形成。
12.根据权利要求1所述的稳固系统，其特征在于，所述带紧固件包括嵌入件，所述嵌入件能够插进带的端部中，所述带的端部插入所述杆的空腔中。
13.根据权利要求12所述的稳固系统，其特征在于，所述嵌入件由金属或塑料制成。
14.根据权利要求1所述的稳固系统，其特征在于，所述带的端部被扩宽，以形成所述带的大量力承受部，并且通过插入件，所述带的端部压入所述杆的空腔中。
15.根据权利要求14所述的稳固系统，其特征在于，所述带的端部被向上刷拭。
16.根据权利要求1所述的稳固系统，其特征在于，插入所述杆的空腔中的所述带的端部被粘住。
17.根据权利要求1所述的稳固系统，其特征在于，插入所述杆的空腔中的所述带的端部具有由熔融、模制成型以及随后的硬化所产生的形状。
18.根据权利要求1所述的稳固系统，其特征在于，所述带紧固件包括分离部件。
CN2005800391606A 2004-12-17 2005-11-24 椎间稳固系统 Expired - Fee Related CN101083947B (zh)

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US20080294196A1 (en) 2008-11-27
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US20090228043A9 (en) 2009-09-10
US8523905B2 (en) 2013-09-03
ES2468541T3 (es) 2014-06-16
US20080294197A1 (en) 2008-11-27
JP4778000B2 (ja) 2011-09-21
BRPI0514905A (pt) 2008-08-05
CA2577436A1 (en) 2006-06-29
US8518080B2 (en) 2013-08-27
EP1719468A1 (de) 2006-11-08
ZA200703281B (en) 2008-05-28
US20080294195A1 (en) 2008-11-27
EP2599457A1 (de) 2013-06-05
EP1809192A1 (de) 2007-07-25
US20090036924A1 (en) 2009-02-05
US8608778B2 (en) 2013-12-17

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