CN101180011A - 人造椎体 - Google Patents
人造椎体 Download PDFInfo
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- CN101180011A CN101180011A CNA2006800151537A CN200680015153A CN101180011A CN 101180011 A CN101180011 A CN 101180011A CN A2006800151537 A CNA2006800151537 A CN A2006800151537A CN 200680015153 A CN200680015153 A CN 200680015153A CN 101180011 A CN101180011 A CN 101180011A
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- vertebral body
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- artificial
- wing member
- artificial vertebral
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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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Abstract
一种人造椎体,包括上部分和下部分,其中所述部分能够形状接合。上部分和下部分关于矢状面的相对位置能够改变。所述人造椎体也包括用于接合相邻脊柱结构以将椎体定位在脊柱内的一个或多个装置。
Description
技术领域
本发明总体涉及治疗各种类型的脊柱病症的设备和外科方法。更具体而言,本发明涉及椎体置换和用于实施此种置换的程序。
背景技术
脊柱具有四个自然弯曲;两个是脊柱前凸的,两个是脊柱后凸的。颈弯曲部和腰弯曲部是脊柱前凸的,而胸弯曲部和骶弯曲部是脊柱后凸的。尽管当身体运动时脊柱的这些弯曲部帮助分布机械应力,但是在有极限曲率的地方仍会出现病况。例如,尽管脊柱的上部或胸部区域通常向前弯曲,但如果弯曲超过50°,则它被认为是异常的或“脊柱后凸的”。脊柱前凸是腰部脊柱的正常脊柱前凸曲率的异常增加;过度脊柱前凸会导致下背极度向内弯曲。
用于治疗脊柱病况或异常的技术、器械和移植适合解决可由于外伤、疾病或先天性影响而发生的许多形式的脊柱损伤和畸形。脊柱畸形的一种类型是驼背,其涉及脊柱朝着身体的前部脱垂,这常常是由椎体自身的破坏所导致。
几种事例可扭曲脊柱,导致例如增强性驼背或过度脊柱前凸这样的病况。由于脊柱的自然倾向是弯曲,因此其任何组成部分或支撑结构中的脆弱部位均可导致此类病况。例如,病变胸椎通常首先是破碎其向前的边缘,从而增加了脊柱后凸弯曲。可以造成这样状况的疾病包括癌症、结核病、脊柱骨软骨病(Scheuermann’s disease)、以及一些种类的关节炎。健康椎骨可因为例如在撞车中的快速减速性损伤,而造成向前骨折。骨质疏松也可以导致这样的病况。由于这些病况和它们的潜在病因之一,可能必须考虑椎体置换。
在由于上述原因而必需对椎体的至少一部分进行置换时,现有技术涉及用可聚合糊剂或骨移植物重建椎体的所述部分,所述可聚合糊剂或骨移植物经常被模制以使它形成完整椎体的形状。经常使用例如从髂骨抽出的自体骨来桥接空间。可聚合糊剂可包括PMMA骨接合剂。也开发出了各种人造装置以解决脊柱的各个部分的结构损坏。
尽管存在置换受损和/或病变的椎体的需要,所述受损和/或病变椎体导致各种脊柱疾病或者是各种脊柱疾病的结果,但是现有装置和技术具有若干种缺陷。它们通过在整个病变区段产生融合而形成以提供相邻椎体之间的支撑,由此消除脊柱的移动。除了减小脊柱的运动范围之外,这也会导致融合部位之上和之下的脊柱关节的早衰。它们也需要在脊柱的前面或后面附加器械以将它们固定就位。
在一个方面,本发明提供了一种人造椎体,其消除或减轻了现有装置和技术的至少一些缺陷。
发明内容
在一个方面,本发明提供一种用于置换脊柱内自然生长的椎体的椎体。
因而,在一个方面,本发明提供了一种人造椎体,其包括:
-上部分和下部分,所述上部分和下部分均具有上表面和下表面以及侧面;
-所述下部分的上表面与所述上部分的下表面接触并且形状接合;
-所述上部分的上表面和所述下部分的下表面具有一个或多个接合装置以接合相邻的脊柱结构。
附图说明
当结合附图考虑时将更全面地理解和更好地领悟本发明的各种目标、特征及其它优点,在附图中相似的参考符号在所有几个视图中标示相同或类似的部件。
图1(a)-(g)示出了本发明的实施方式的各种视图。
图2示出了本发明的一个实施方式的侧视图。
图3示出了本发明的一个实施方式的立体图。
图4(a)-(d)示出了本发明的实施方式的各种视图。
[15]图5(a)-(c)示出了本发明的实施方式的各种视图。
[16]图6(a)-(c)示出了本发明的实施方式的各种视图。
[17]图7示出了本发明的一个实施方式的侧视图。
[18]图8示出了本发明的一个实施方式的侧视图。
[19]图9示出了本发明的一个实施方式的侧视图。
具体实施方式
[20]为了更全面地理解本发明,现在将通过例子并参考附图对其进行描述,其中图1-9示出了本发明的实施方式。
[21]在本文的描述和图中,除非另外注释,当讨论视图的剖面时,可以理解的是,术语“前”和“后”应当用于表示冠状面或正面图的前和后。术语“左”和“右”应当用于表示矢状面或侧平面的左和右。术语“上”和“下”应当用于表示轴向横断面中的上和下。可以理解的是,对“中间”的引用应当是指朝着身体的中线。可以理解的是,对“侧面”的引用应当是指远离身体的中线。可以理解的是,对“下”的引用应当是指下部、下方或向下,“上”应当是指上部、上方或向上。可以进一步理解的是,对“前”的引用应当是指前部,“后”应当表示后部或背后。
[22]本发明提供了一种人造椎体,其可以用于置换脊柱的不同区域内的椎体的至少一部分,或替代地,可以置换整个椎体(例如,位于椎骨前端的鼓状结构)。具体而言,根据本发明的椎体的不同实施方式可以用在腰部、胸部和颈部脊柱区域内。
[23]图1(a)示出了根据本发明的实施方式的人造椎体10。椎体10具有上部分12和下部分12’。如图1(e)所示,部分12和12’具有大体楔形的梯形形状以与前凸脊柱内的正常椎体的配置相近似。如图1(a)所示,上元件12包括上部或上表面16、下部的下表面21、相应的前表面20和后表面18、以及相应的左侧表面19和右侧表面17。类似的表面设在部分12’上,如图1和3中所示,区别在于标识为16’、17’、18’、19’、20’和21’的部分。部分12的前表面20可延伸超过部分12’的前表面20’,其功能将在下面进行描述。
部分12和12’由至少一个紧固件附接在一起。如图1(b)和(e)中所示,存在三个螺钉22、24和26形式的紧固件。
前表面20通常是凸形的,而下表面21通常是凹形的。后表面18也是凹形的。在插入到脊柱内之后,前表面或前侧面20通常面向前,即面朝着身体的前部,而后侧面18被定位成朝着容纳在脊柱内的脊髓(朝着身体的后部)。椎体上表面16的尺寸可以小于下表面21的尺寸。类似地,上表面16’的尺寸可以小于下表面21’的尺寸,使得上表面和下表面之间不对称,从而与颈部脊柱中的正常解剖关系更近似。在本发明用于胸部或腰部脊柱区域的情况下,该不对称可能较不显著或相反。
部分12设置有凸表面20相对于椎体各侧面的悬突28。椎体的前(或前部)弯曲表面的侧面上的悬突产生与椎体的实际侧壁成大约90度的边缘。部分12’形状类似。当将部分12插入到外科椎骨切除缺损内时,悬突28就防止部分12向后移动到脊髓内。通过减小植入物和后咽壁之间的附着力,平滑前表面也可减小术后吞咽困难。
部分12和12’通过齿状或织构化弯曲状锁定机构接合。此种机构形成具有互补齿状表面的部分12的下表面和部分12’的上表面。以此方式,当部分12和12’被定位在一起时,所述齿状表面接合以防止这两个表面之间进一步移动。该锁定机构由将部分12和12’附接在一起的紧固件中的至少一个紧固。在本发明的一个实施方式中,如图1(b)和(e)中所示提供了凹入部分12的上表面的中线内的螺钉22,24和26。锁定机构的松开允许调节椎体10的上部分12与下部分12’的角关系。以此方式,可以使椎体10的上表面16平行于下表面21’,或者这两个表面可以相对于彼此成角度或偏移。图1(f)示出了表面可怎样偏移。另外,图7至图9示出了所述部分可怎样偏移。这样适应脊柱的不同区域中的脊柱前凸和脊柱后凸的角变化和不同人的脊柱的变化。
在一个实施方式中,锁定机构由调节紧固件22、24和26组成,所述调节紧固件通常设置在部分12的中线内并且凹入部分12的上表面16内。如图1(e)中可见,锁定板25设置在部分12和12’之间,并且定位在邻近椎体的下部分12’的凸曲线处。螺钉22、24和26的末端接合锁定板25。锁定板25接收螺钉22、24和26并且起类似“盲孔螺母”的作用,锁定板25接收螺钉,所述螺钉随后可无需旋转螺母就被紧固。螺钉22、24和/或26紧固到锁定板25内,将锁定板25固定抵住12’的内部,所述内部又抵接部分12的齿状或织构化弯曲状表面21的齿27。在图4(a)中较详细地示出了齿27。螺钉头22、24和25与其抵住的部分12之间的压力、和锁定板抵住部分12’而产生的压力,保持部分12和12’之间的齿接合,从而防止椎体改变形状。锁定板25可足够宽或足够长以配合在部分12’内。锁定板25设置成抵住齿状或织构化弯曲状表面21,以允许部分12在成角度的后位置和前位置之间的角运动,所述角运动允许调节椎体10的上部分12与下部分12’的角关系。可以理解,所述调节通过松开螺钉22、24和26,拆离部分12和12’的齿状表面并相对于彼此移动这两个部分进行,以实现所期望的定位。
如图1(e)中所示,下部分12’的上表面16’适合与上部分12的弯曲状下表面21配合。表面16和表面21的配合提供了界面,该界面将椎体10的上部分12与下部分12’隔离。角度的变化需要人造椎体的上半部分相对于下半部分有一定的平移度。
在本发明的进一步实施方式中,如图1(f)中所示,本发明的人造椎体可包括第三部分30,该第三部分设置在部分12和12’之间以产生对椎体10’的部分12的纯平移调节。如图1(f)中所示,第三部分30提供部分12和12’之间的附加界面。如图1(f)和图7中所示,可以理解的是添加部分30使得允许在椎体植入物内产生更脊柱后凸的角,而无需“双部件”型式中所需的大程度偏移。如图1(f)中所示,在包括三个部分12、12’和30的实施方式中的曲率半径较小,使得曲线比双部件设计中的陡峭。然而可以理解的是,所述半径可依据应用而变化。类似地10’中所示的三个部件(图1(f))——即部分12,12’和30——的长度、宽度和高度也可以变化。
第三部分30具有分别与表面21和16’接合的上部或上表面30’和下部或下表面30”。上表面30’通常是平坦的,而下表面30”通常是弯曲状的,以与部分12’的上表面16’配合。可以理解的是,在这样的实施方式中部分12的下表面21将需要配置成与表面30’配合。这允许人造椎体呈现更偏斜和脊柱更后凸的形状以治疗较严重的排列不齐的病况。在该实施方式中,椎体10’由三个元件或部分12、12’和30组成。这些元件由类似于上述的两组锁定机构通过相互作用以形成两个界面的齿状或织构化表面附接。椎体10的一个部分在中间部分上向后或向前平移。当设置在图1(e)中时,部分12可如箭头A所示地向前或向后移动。椎体10的另一部分也在中间部分上向后和向前地角移动。当设置在图1(e)中时,部分30可如箭头B所示地移动。调节螺钉从椎体的外露上表面和下表面凹入,并且将所述零件以它们的预期配置锁定在一起。
[32]如图1(e)和2中所示,本发明的人造椎体可与人造椎间盘,例如在本申请人的共同未决申请No.60/594,732(通过引用将其全部内容纳入本申请)中描述的椎间盘,一体地形成或与其配合。如该申请中所述,人造椎间盘在其外表面的至少一个上设置有一个或多个“稳定龙骨”。如图1(a)、1(b),和1(d)所示,在表面16上提供了开口35和36以及在下表面16’上提供了开口35’和36’。开口25、36以及35’和36’包括紧固件开口,从人造椎间盘的端板或类似物延伸的螺钉可通过所述紧固件开口被固定,从而将椎间盘的端板紧紧地固定到椎体。人造椎间盘端板的龙骨配合进所述开口内以对准螺钉通道。
[33]图1(c)和1(d)图示了椎间盘端板(参见图1(c))与人造椎体(参见图1(d))的相邻或一体形成的表面。设置在人造椎间盘端板上的龙骨70插入到椎体的狭槽35和36(或35’和36’)内。螺钉孔允许插入螺钉,从而在多级椎间盘和椎体重建中将端板22a和22b附接到人造椎体。在人造椎体示图中以及在人造椎间盘的龙骨70上示出了螺钉插孔23。图1(c)是人造椎间盘端板的表面的示图,该端板的表面“翻转”过来并与1(d)中所示的椎体一体形成。椎间盘端板的龙骨70配合进人造椎体的沟槽35、35’、36和36’内。在一个实施方式中,螺钉将上端板22b固定到椎体的下表面16’,并且将椎间盘的下端板22a固定到椎体的上表面16。螺钉从椎间盘端板的内侧表面插入,即,椎间盘必须被拆解以将端板附接到人造椎体。
[34]如图1(a)和1(d)以及图3中所示,提供了两组位于椎体的部分12和14的每个侧表面上的稳定翼件40和40’。翼件40和40’借助于翼件定位螺钉,例如图1(g)中所示的翼件定位螺钉41,从凹入位置移动到延伸位置。当椎体10插入到外科椎骨切除缺损中时翼件40和40’处于凹入位置。当椎体10插入到正确位置时,例如翼件定位螺钉41的翼件定位螺钉可被紧固,从而使得翼件组40和40’的单独翼件从它们位于人造椎体10内的凹入位置突出,以接合周围骨并且使椎体10抵住患者体内的其余自然生长的骨而固定就位。
[35]翼件组40和40’的单独翼件设计成用于防止椎体挤出。它们朝它们后方和人造椎体的后方逐渐变细,但是沿它们前表面与椎体成垂直角度。它们用于防止人造椎体的弯曲状前表面的悬突,这防止了向后迁移。
如图3所示,部分12’的多孔容器45’和46’以及部分12的多孔容器45和46(未示出)沿着部分12的侧表面19和21以及部分12’的侧表面19’和21’分别位于弯曲状表面20或20’之后。容器45、46、45’和46’作用为外壁上具有小穿孔的中空室。所述室在其上端和下端敞开以允许插入物质,从而促进骨的生长。多孔容器容纳该骨生长物质,以便有助于以受控方式局部地释放骨生长物质,从而促使骨主动生长进穿孔内并抵住患者受体的脊柱内部的正常骨稳定人造椎体。多孔容器可搁置在位于人造椎间盘端板内的类似容器附近。可以理解的是人造椎体10或10’的外表面也可以包括促进骨向内生长的各种物理特征,例如微孔或带凹痕的表面、多个销,肋等,从而将假体锚固在脊柱内的合适位置。各种其他这样的锚固装置对于本领域的技术人员来说是已知的。
在另一实施方式中,在椎体10的一个部分中的成组的稳定翼件40和40’和/或容器45、46、45’及46’可部分地或完全地由凹陷或凹槽代替,如图4、5和6中所示。这些凹陷用作适于接收在所述凹陷内的人造椎弓根的插入点。椎弓根是椎骨的神经弓的每一侧的一部分。它将层状体和椎体连接起来。在本发明的一个实施方式中,人造椎弓根可以是中空的,以允许在其内部放置钻孔器,所述钻孔器用于钻穿凹陷进入人造椎体内。然后螺钉可插入穿过椎弓根,从而紧固到人造椎体内并且将椎弓根固定地抵靠住人造椎体。如图6(a)所示,提供一种位于人造椎弓根61内的椎弓根紧固件60,所述人造椎弓根搁置在椎体70的凹槽或开孔65内(也参见图6(b)和6(c))。从图6(a)中还可以看出,钻头61推进到椎体70的侧表面内。
在又一实施方式中,如图5所示,开孔或凹陷可以进一步延伸到形成椎弓根紧固件插孔或套管的椎体的一部分内,所述插孔或套管并不需要如图6所示地被钻孔。如图5(a)、5(b)和5(c)中所示,插孔80的角度被确定成与椎体85的侧面相切以大体从一个侧表面朝着人造椎体的前表面或朝着前部的中线交叉。插孔80可在其壁上具有螺纹以接收适合尺寸的螺纹紧固件。插孔或椎弓根螺钉套管可实施为椎体的挖空部分,或者可制造成如图5所示组装到人造椎体内的独立部件。
如图4(a)-4(d)所示,插孔或椎弓根螺钉套管100可制造为独立部件并且被组装到人造椎体内。从套管的上表面和下表面隆突的柱102和104可作用为凹入人造椎体内部的枢轴(如图1(d)中所示),使得椎弓根套管100可绕柱旋转。这允许椎弓根螺钉套管100从不同角度容纳椎弓根螺钉(如图1(d)所示)。椎弓根螺钉插孔的外端部扩大,以便人造椎弓根可以插入其内,从而相对于插孔和人造椎体将其锁定就位。
从椎弓根螺钉插孔的上表面和下表面隆突的柱可嵌入到在人造椎体内从前到后延伸的凹槽内。所述凹槽提供了一个轨道,椎弓根套管可沿着该轨道相对于人造椎体向前或向后移动,同时维持绕柱的角运动。
所述凹槽可向内或向外(从前到后)倾斜一定角度,从而当人造椎弓根被固定到人造椎体时就可防止它们向前或向后移动。可以设想到除了将人造椎弓根连接到人造椎体之外,它们也可直接地或间接地从后面彼此连接。该附加连接防止人造椎弓根沿着它们的、位于椎体任一侧上并指向相反方向的凹槽内部的柱滑动。
另外,构建在人造椎体的壁内的独立矩形隔室可容纳包含椎弓根螺钉套管的凹槽。该矩形壳体可通过两个在每一端突进其内的侧轨道连接到人造椎体。侧轨道(凹槽内的突舌)防止壳体突伸到人造椎体的外部或内部,但是允许壳体在人造椎体的壁内向上和向下移动。这在图4b和4d中示出。
侧轨道可朝着人造椎体的中间向内或朝着侧面向外(从上向下)倾斜一定角度,从而当人造椎弓根被固定到人造椎体时就可防止矩形隔室移动。可以设想到除了人造椎弓根连接到人造椎体之外,它们可直接地或间接地从后面彼此连接。该附加连接防止人造椎弓根和它们的相应矩形壳体在位于人造椎体任一侧的、指向相反的轨道上向上或向下滑动。
人造椎体可与人造椎间盘一起使用以重建脊柱中的多级。它可被制造成各种宽度、高度和深度。
尽管参考某些特定实施方式描述了本发明,但在不脱离本文所述的本发明的目的和范围的情况下,本领域的普通技术人员会清楚其各种改型。在此通过引用方式将上述所有参考文献的全部公开内容纳入本申请。
Claims (14)
1.一种人造椎体,其包括:
-上部分和下部分,所述上部分和所述下部分各自均具有上表面和下表面以及侧面;
-所述下部分的上表面与所述上部分的下表面接触并且形状接合;
-所述上部分的上表面和所述下部分的下表面具有一个或多个接合装置以接合相邻的脊柱结构。
2.根据权利要求1所述的椎体,其中所述形状接合由一个或多个接合装置提供。
3.根据权利要求2所述的椎体,其中所述接合装置包括具有齿状配合表面的所述下部分的上表面和所述上部分的下表面。
4.根据权利要求3所述的椎体,其中所述接合装置进一步包括从所述部分之一延伸到另一个所述部分的一个或多个螺钉。
5.根据权利要求4所述的椎体,其中所述上部分和下部分关于矢状面的相对位置能够通过释放和重新接合所述接合装置而改变。
6.根据权利要求5所述的椎体,其中所述椎体的前表面关于冠状面是凸形弯曲的。
7.根据权利要求6所述的椎体,其中所述椎体的后表面大体是平坦的。
8.根据权利要求7所述的椎体,其中所述上部分的上表面或所述下部分的下表面中的至少一个包括接合相邻人造表面的装置。
9.根据权利要求1-8中任一项所述的椎体,其中所述椎体包括向外延伸的翼件以接合相邻的骨结构。
10.根据权利要求9所述的椎体,其中所述翼件是可延伸的。
11.根据权利要求10所述的椎体,其中所述椎体包括一个或多个调节螺钉以延伸所述翼件。
12.根据权利要求11所述的椎体,其中所述翼件设置在所述椎体的侧面上。
13.根据权利要求12所述的椎体,其中所述椎体的一个或多个外表面包括一种或多种物理和/或化学的骨生长促进剂。
14.根据权利要求13所述的椎体,其中所述一个或多个外表面包括用于容纳和释放一种或多种骨生长促进化合物的容器。
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PCT/CA2006/000675 WO2006116850A1 (en) | 2005-05-02 | 2006-05-02 | Artificial vertebral body |
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EP (1) | EP1879527A4 (zh) |
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CN (1) | CN101180011B (zh) |
AU (1) | AU2006243711B2 (zh) |
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MX (1) | MX2007013294A (zh) |
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- 2006-05-02 MX MX2007013294A patent/MX2007013294A/es unknown
- 2006-05-02 KR KR1020077028165A patent/KR20080029961A/ko not_active Application Discontinuation
- 2006-05-02 BR BRPI0609297-7A patent/BRPI0609297A2/pt not_active IP Right Cessation
- 2006-05-02 WO PCT/CA2006/000675 patent/WO2006116850A1/en active Application Filing
- 2006-05-02 AU AU2006243711A patent/AU2006243711B2/en not_active Expired - Fee Related
- 2006-05-02 RU RU2007144590/14A patent/RU2430704C2/ru not_active IP Right Cessation
- 2006-05-02 CN CN2006800151537A patent/CN101180011B/zh not_active Expired - Fee Related
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Also Published As
Publication number | Publication date |
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RU2430704C2 (ru) | 2011-10-10 |
JP2008539828A (ja) | 2008-11-20 |
KR20080029961A (ko) | 2008-04-03 |
MX2007013294A (es) | 2008-03-07 |
WO2006116850A1 (en) | 2006-11-09 |
AU2006243711B2 (en) | 2012-03-22 |
RU2007144590A (ru) | 2009-06-10 |
EP1879527A1 (en) | 2008-01-23 |
CA2607313A1 (en) | 2006-11-09 |
AU2006243711A1 (en) | 2006-11-09 |
US20080065217A1 (en) | 2008-03-13 |
BRPI0609297A2 (pt) | 2010-03-23 |
EP1879527A4 (en) | 2009-08-26 |
WO2006116850A8 (en) | 2007-12-13 |
CN101180011B (zh) | 2011-12-14 |
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