CN101288609A - Instrument for the insertion of an intervertebral articular prosthesis - Google Patents

Instrument for the insertion of an intervertebral articular prosthesis Download PDF

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Publication number
CN101288609A
CN101288609A CNA2008100879511A CN200810087951A CN101288609A CN 101288609 A CN101288609 A CN 101288609A CN A2008100879511 A CNA2008100879511 A CN A2008100879511A CN 200810087951 A CN200810087951 A CN 200810087951A CN 101288609 A CN101288609 A CN 101288609A
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CN
China
Prior art keywords
intervertebral
prosthese
instrument
shape
bone file
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.)
Pending
Application number
CNA2008100879511A
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Chinese (zh)
Inventor
H·D·林克
A·克勒
P·C·麦卡菲
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.)
Waldemar Link GmbH and Co KG
Cervitech Inc
Original Assignee
Waldemar Link GmbH and Co KG
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Filing date
Publication date
Priority claimed from US10/731,432 external-priority patent/US7527629B2/en
Application filed by Waldemar Link GmbH and Co KG filed Critical Waldemar Link GmbH and Co KG
Publication of CN101288609A publication Critical patent/CN101288609A/en
Pending legal-status Critical Current

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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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • 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
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1659—Surgical rasps, files, planes, or scrapers
    • A—HUMAN NECESSITIES
    • 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
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059—Cortical plates
    • A—HUMAN NECESSITIES
    • 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
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00261—Discectomy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine
    • 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
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • 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
    • A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684—Trial or dummy prostheses
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30593—Special structural features of bone or joint prostheses not otherwise provided for hollow

Abstract

The invention provides an apparatus for implanting a prosthetic appliance of intervertebral joint into space between bodies of two vertebras in an intervertebral cavity, wherein the apparatus comprises a material removal tool for fitting the shape of the intervertebral cavity to the shape of prosthetic appliance, wherein the shape of each prosthetic appliance is disposed with a group of material removal tools, wherein the largest tool is substantially same as the prosthetic appliance in shape, and the other tools are diminished by degrees.

Description

Be used for intervertebral prostheses is encased in the equipment of two intervertebral intracavity between the vertebral body
Technical field
The present invention relates to a kind of being used for is enclosed in two equipment in the intervertebral chamber between the vertebral body with an intervertebral prostheses.
Background technology
When the articuli intervertebrales prosthese of packing into substituted intervertebral disc, operative doctor carried out work being directly adjacent in important nerve and the vascular site in a kind of very chaotic field of operation.This is like this for cervical spine especially, because the vertebra overall dimensions is very little there, and the spacing of the responsive adjacent regions that arrives is especially little.Therefore people will have special dangerous tendency or the freedom of motion of the instrument that must use with special precision is restricted in the necessary scope with regard to making great efforts by suitable instrument.It is passable that yet visual inspection should be still largely.
Known with intervertebral prostheses pack into instrument in the lumbar vertebra post (DE-U-299 16 078, and EP-A-0 333990, FR-A-2737656), in the intervertebral chamber of in these instruments, at first the cover plate of prosthese being packed into, strut and then make the prosthese core to move in the centre.Generally can abandon the vertebra surface is processed.The instrument of packing into is big comparatively speaking, but this is tolerable in lumbar vertebra post position.The intervertebral chamber is very narrow in the cervical vertebra position, therefore must provide the position for prosthese is installed by processing adjacent vertebral body.Enter simultaneously the chamber so narrow and also since near have for the important internal organs of existence and so responsive, to such an extent as to the big instrument of can not packing into.
Summary of the invention
Task of the present invention is that a kind of equipment of design proposition is used for processing and/or separates cervical vertebra being used for inserting the articuli intervertebrales prosthese, and it can realize high precision and visual inspection largely.
According to solution of the present invention, the equipment that is used for intervertebral prostheses is encased in two intervertebral intracavity between the vertebral body is provided, it is characterized in that, described equipment comprises and is used for making the form fit in intervertebral chamber in the worn instrument of the material of prosthese shape, wherein each prosthese shape is furnished with one group of worn instrument of material, wherein Zui Da instrument is substantially the same with the shape of prosthese, and other instrument then is classified to diminish.
When using equipment, after intervertebral disc and the outside of belly edge wedge angle of going up vertebral body are in case of necessity removed, the intervertebral disk of at first packing into.It has just pointed out the position on vertebral body surface exactly after the intervertebral disk location, should place prosthese between these surfaces.It also is used for making vertebral body to have the spacing of predesignating each other.Select it more aptly like this, it is had as the roughly same shape and size in the intervertebral chamber of nature, its size just is slightly less than the size in intervertebral chamber in other words.This just makes the intervertebral disk location be more prone to, and is the position of intermediary and same sensing because it automatically occupies one owing to its shape with respect to the intervertebral chamber.Intervertebral disk also can be provided with the X-ray examination labelling and be used for locating more accurately.Intervertebral disk remains on the position of regulation by the tension force that ligament produced by the nature between the vertebral body.This tension force depends on the thickness of intervertebral disk.If this thickness is selected roughly greatly as the prosthese thickness of regulation, so always have enough tensile.For its position can also follow-uply be proofreaied and correct additionally, its surface is level and smooth basically, that is to say not protuberance, and this protuberance is owing to making the relative motion that is parallel to surface direction difficult more in nip bone or the cartilage surface.
Guider is supported by an adjusting rod, and the adjusting rod front is outstanding from the intervertebral disk.Because the position of adjusting rod has been predesignated by intervertebral disk, so people have just obtained the size of guider position.This device that is to say can be by means of adjusting apparatus accurately, just to locate as the identical precision of adjusting apparatus itself.The inverted orientation of vertebral body is then equally also guaranteed as machining tool is located by intervertebral disk.The processing of vertebral body is carried out by means of guider, as long as this device also is connected with adjusting apparatus and remains on accurate locational words by this adjusting apparatus.
Guider preferably can be passed on this adjusting rod from the free end of adjusting rod with a sleeve.This can make operative doctor the coefficient adjusting range of bar and guider is placed on together field of operation a front, in the open-and-shut part, and needn't be placed on the unclear degree of depth.Guider is then led on the degree of depth of field of operation along adjusting rod.
Adjusting rod and guider cannot not have rotatablely the common use face that complementary fit forms more aptly, so that guider can not rotated with respect to adjusting rod.Guider more practicably has a guiding mechanism, be used for two be parallel in the mid-plane that adjusting rod is arranged on the bar and under the axis of guide.For example respectively be provided with under the sleeve that surrounds adjusting rod that a bushing plate can be arranged in guider and on.
Advantageously following this embodiment is wherein only arranged a guiding mechanism and is made sleeve and the cooperation together on the position of 180 ° of two mutual deflections of the common use face of adjusting rod on the sleeve that surrounds adjusting rod.Therefore make the instrument observation of littler and corresponding improvement that become to field of operation.First vertebral body of using guider to process in two vertebral bodys on the primary importance in these two positions also is anchored at a stop mechanism (preferably pin) wherein where necessary.Make guider be returned to its circular cross section part then on adjusting rod, Rotate 180 ° and reach again are so that can carry out same processing to other vertebral body always.
Can install a drafting tool additional then on stop mechanism, it makes stop mechanism keep direction to fix when traction, and stop mechanism is connected with drafting tool in other words, makes stop mechanism and makes vertebral body keep mutual direction setting with it.The guidance axis of guiding mechanism and corresponding with it stop mechanism or pin of packing into preferably are parallel to each other.The hole seat that is used for stop mechanism or pin that correspondingly also will be located on the draft gauge is arranged to be parallel to each other then.
Reducing natural kyphosis (bending) in some cases with cervical vertebra post of the axis of bending that is positioned at the back.Suitable is not only to draw vertebral body before the intervertebral prostheses of packing in these cases, and rebulids the spinal column back of nature.This according to the present invention by following realization: intervertebral disk is a wedge shape, that is to say that the edge towards its back reduces its thickness from the edge of its abdominal part.Can in equipment, prepare intervertebral disk ready with different angles of wedge.
The present invention can realize a kind of method, be used for an intervertebral prostheses is enclosed in two intervertebral chambeies between the vertebral body, in the first step of this method, intervertebral disc is removed, second step located also the intervertebral disk of an adjusting apparatus and clamps therein in the intervertebral chamber, in the 3rd step, the sleeve of guider passed one from the outstanding adjusting rod of intervertebral disk, make it in the mid-plane on the adjusting rod and under limit two guidance axis, in the 4th step, pack on the direction of pin in the vertebra at guidance axis, in the 5th step, a traction clamp is connected with pin, so that they keep being parallel to each other.And the mutual spacing of adjustment vertebral body is got rid of guider and adjusting apparatus in following steps, if want to process the intervertebral chamber, and intervertebral prostheses is packed into.
The precision according to equipment of the present invention that can use depends on intervertebral disk accurate in locating in the intervertebral chamber.Therefore importantly: the intervertebral chamber has a kind of planform that is matched with intervertebral disk.This generally also is the planform of the prosthese that will pack into after adapting to.In order to satisfy this prerequisite, replenish by one group of bone file according to equipment of the present invention, its maximum bone file always has the shape of intervertebral disk or prosthese basically, and another standby bone file is more smaller at least.If be provided with a plurality of less bone files, their size is then mutually by classification so.
Description of drawings
The present invention is described in detail below with reference to accompanying drawing.Accompanying drawing is depicted as:
Fig. 1: be enclosed in an adjusting apparatus in the intervertebral chamber;
Fig. 2: the corresponding diagram when shifting onto guider on the adjusting rod;
Fig. 3 and 4: the cutaway view of guider and front view;
Fig. 5 a: partial side view of adjusting apparatus;
Fig. 6: the drilling tool that will use by guider;
Fig. 7: the spiral spanner with spiral pin that will use by guider;
Fig. 8: the view when in vertebra, packing the spiral pin into corresponding to Fig. 1;
Fig. 9: add the view that struts instrument corresponding to Fig. 8;
Figure 10-18: be used for a kind of bone file tool drawing of definite prosthese, that is to say
Figure 10-15: one group of three kinds of different bone files;
Figure 16: the comparison diagram of bone file profile;
Figure 17 and 18: prosthese, bone file designs for it.
The specific embodiment
Comprise an adjusting apparatus 30 at the equipment shown in Fig. 1-9, it has an intervertebral disk 11.Its area occupied only is slightly less than the area occupied in intervertebral chamber, thereby it automatically is positioned between the lateral edge wedge angle of projection therein.The size of the prosthese that will pack into after it approximately has.Its size of (in the middle of the LM=side, just perpendicular to mid-plane) on AP-and LM direction is little a lot of unlike this size in intervertebral chamber.It should reach 70% of clear distance between the lateral edge wedge angle of bottom vertebral body at least in the size on the LM direction, and preferably at least 80%.Therefore intervertebral disk just occupies a roughly position intermediate when inserting.Can check that with a kind of X-light instrument that has the AP-light path at least wherein the position of the outer surface of adjusting rod 32 and direction are crucial to position in the middle of it and its situation in alignment with mid-plane.They have constituted the X-ray labelling that is used for this inspection of instrument.It is opaque that adjusting rod is designed to X-ray for this purpose, for example is made of metal.Equally also can in a side direction light path, check, see whether intervertebral disk has reached correct degree of depth adjustment on the AP-direction.The seamed edge of the intervertebral disk on the LM-direction or a kind of special labelling just are used as the X-labelling in this case.
The thickness of intervertebral disk 11 roughly is equivalent to the thickness of the intervertebral disk prosthese that will pack into.If have the prosthese of different sizes selective, various intervertebral disk so also correspondingly be provided in equipment.It is always big like that, to such an extent as to it after removing intervertebral disc, can be pushed in the intervertebral chamber and there the tough tensile force of belt by nature be fixed.Intervertebral disk can be regarded wedgewise as in side view, as represented among Fig. 5.If intervertebral disk has reached the position of its regulation, it just has a position that accurately limits to the vertebral body surface that comprises it so.
Therefore just guaranteed: even also have a position that accurately limits with respect to vertebral body from the outstanding forward adjusting rod 32 of intervertebral disk 11.This adjusting rod has a square cross section for 31 li at its position near intervertebral disk 11 at least, and other then has circular cross section away from portion's section 33.Adjusting rod 32 is pipes, so that can be as the X-ray labelling of the X-ray light path of arranging on the AP-direction.But tubular form is dispensable, even because the outline of adjusting rod also is used as the X-ray labelling.
Adjusting rod 32 is used for regulating (location) guider 34.As seen, this device has a hole 35 with square cross section in Fig. 3 and 4, and it makes with portion's section 31 of adjusting rod 32 and cooperates.This part of guider has constituted a sleeve, by this sleeve guider is fixed on the adjusting rod.It also comprises a hole with circle cross-section 36 that is parallel to hole 35.The guiding that this hole 36 is used as bushing plate or more normally is used for machining tool.If guider 34 has been shifted onto on portion's section 31 of adjusting rod, it just can have location status shown in Figure 2 so, and the axis of guide 37 that limited by hole 36 this moment has just been aimed at the centre of hypocentrum 2. Axis 37 and 38 is positioned in the same mid-plane as adjusting rod 32.Also can select another kind of non-circular shape at 31 li instead of squared cross sections of portion's section, this just allows can combined effect on the position of 180 ° of two mutual deflections of guider 34.
Guider 34 is used like this, to such an extent as to make it at first be used to process a vertebra, then, after it is pulled back on the circular cross section portion section 33 of adjusting rod 32, changes 180 ° and is used to process the another one vertebra.
Processing is: at first by means of a drilling tool 39, its handle and hole 36 couplings process a hole in a vertebra, then by means of the spiral spanner 40 spiral pin 41 of in this hole, packing into, the handle of spiral spanner equally also with hole 36 couplings.Pin 41 is engaged in the hole of being located at 40 li of spiral spanners exactly, has therefore guaranteed: pin and spiral spanner 40 centerings and so also with axis 37,38 centerings and be parallel to adjusting rod 32 and be screwed in separately the vertebra.After on two vertebras, carrying out like this, be exactly situation shown in Figure 8.Spiral pin 41 because guider and by the adjusting of regulating instrument exactly in mid-plane and in parallel to each other from two vertebras 2 at the ventral direction upper process.
A draft gauge can be contained on the pin 41, this draft gauge respectively has a hole seat 43 that is used for pin 41 on two arms 42, and wherein arm 42 can draw on the direction of arrow 45 on an instrument body 44 and locate in parallel to each other.Such draft gauge is well-known, therefore just no longer has been illustrated here.
Vertebra 2 can also be pulled a little by means of this instrument (if must), so that intervertebral disk 11 can be taken out.The words that need can be proceeded processing to be ready to receive intervertebral prostheses under the state that vertebra maintains by instrument 42 to 44 and pin 41.At last prosthese is packed in the intervertebral chamber and cancellation makes the traction of vertebra 2 with instrument 42 to 44, thereby reach its final position.
Described equipment also comprises one group of bone file, and they are repaired the surface configuration of vertebra and are used to lay prosthese.These bone files have been represented among Figure 10 to 16.Shown embodiment cooperates consistent with the embodiment of the prosthese shown in Figure 17 and 18.It has a kind of ellipse to orthogonal profile, and this is used for making full use of as much as possible the size in intervertebral chamber.Bone file is flat, so it can carry out just insertion of milling completely to the vertebral body cover plate.It is towards vertebral body cover plate outer surface, and 50 li at its maximum position on this surface is flat substantially and tooth is arranged.Its 51 one-tenth inclined-planes of side dorsal horn portion are returned the surface with respect to the plane of surface portion 50 in this position.
A kind of complementary shape in intervertebral chamber prepares by one group of bone file 52,53 and 54, and they are shown among Figure 10 to 15.Figure 16 has represented the size relation of fractionated bone file.At first insert in the intervertebral chamber, to open path by means of the bone file 52 of a handle of not expressing in detail with minimum.Then be to have trapezoid bone file 53, roughly be equivalent to the trapezoidal shape of the flat surfaces part of prosthetic surface.Last bone file 54 shaping intervertebral chambeies, it is basic consistent with the shape of the prosthese of will packing into.The height of all bone files is all identical with the prosthese height.All bone files are not made tooth in that face corresponding to the planar section 50 of prosthese.This means that they mainly grind off cartilage and make bone to restore to the original state with its preceding arris 55, and the vertebral body surface of not wearing and tearing substantially.All bone files all are provided with a block 56, and it is used to make bone file can only insert in the intervertebral chamber until the degree of depth of regulation.

Claims (6)

1. be used for intervertebral prostheses is encased in the equipment of two intervertebral intracavity between the vertebral body, it is characterized in that, described equipment comprises and is used for making the form fit in intervertebral chamber in the worn instrument (52 of the material of prosthese shape, 53,54), wherein each prosthese shape is furnished with one group of worn instrument of material, and wherein Zui Da instrument is substantially the same with the shape of prosthese, and other instrument then is classified to diminish.
2. equipment according to claim 1, it is characterized in that, the worn instrument of described material forms by the bone file of being operated by handle, wherein Zui Da bone file and minimum bone file are anodontia on those surfaces corresponding to the planar section (50) of prosthese, and maximum bone file and minimum bone file all have by the height that vertical dimension limited between its anodontia plane surface, and this highly equals the height of prosthese.
3. equipment according to claim 1 and 2, it is characterized in that, described equipment is attached troops to a unit in the prosthese of outer surface towards the vertebral body cover plate, described outer surface is generally flat in its maximum position (50) and tooth is arranged, and the side dorsal horn portion (51) of described outer surface becomes the inclined-plane, make described surface in this position, with respect to the plane of surface portion (50), return, and the bone file of described maximum is shaped to and make it intervertebral chamber can be configured as the shape of prosthese.
4. equipment according to claim 1 and 2 is characterized in that, the preceding arris (55) of described no tooth surface has abrasiveness.
5. equipment according to claim 1 and 2 is characterized in that, second largest bone file (53) has the corresponding trapezoidal shape of trapezoidal shape with the plane surface of prosthetic surface part (50).
6. equipment according to claim 1 and 2 is characterized in that, all bone files (52,53,54) are equipped with the block (56) that is used for limiting its insertion depth.
CNA2008100879511A 2003-12-10 2004-11-24 Instrument for the insertion of an intervertebral articular prosthesis Pending CN101288609A (en)

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JP6445704B2 (en) * 2014-09-12 2018-12-26 イノビジョン，インコーポレイティド Bone drill guide and method of using the same
EP3210550B1 (en) * 2016-01-27 2018-10-10 Biedermann Technologies GmbH & Co. KG Instrument guide assembly for a bone plate and kit of a bone plate with such an instrument guide assembly
EP4017424A4 (en) 2019-08-21 2023-09-20 Flospine, LLC Interspinous-interlaminar stabilization systems and methods
RU200909U1 (en) * 2020-04-24 2020-11-18 федеральное государственное бюджетное образовательное учреждение высшего образования "Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова" Министерства здравоохранения Российской Федерации INDIVIDUAL NAVIGATION GUIDE FOR FORMING THE ROUTE IN THE CALL FOR FURTHER INTRODUCTION OF THE SCREWS
CN113663293B (en) * 2021-08-24 2022-06-10 郑州铁路职业技术学院 Wrist joint loosening operation training instrument

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IL175854A (en) 2010-05-17
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RU2322212C1 (en) 2008-04-20
JP4728964B2 (en) 2011-07-20

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