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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CN101288609A
CN101288609A CN 200810087951 CN200810087951A CN101288609A CN 101288609 A CN101288609 A CN 101288609A CN 200810087951 CN200810087951 CN 200810087951 CN 200810087951 A CN200810087951 A CN 200810087951A CN 101288609 A CN101288609 A CN 101288609A
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prosthesis
intervertebral
shape
surface
bone
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CN 200810087951
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Chinese (zh)
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H·D·林克
A·克勒
P·C·麦卡菲
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颈椎修复技术公司
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671Bone 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special 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
    • A61F2/4611Special 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1659Surgical rasps, files, planes, or scrapers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059Cortical plates
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875Screwdrivers, spanners or wrenches
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00261Discectomy
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors
    • A61B2017/0256Joint distractors for the spine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657Measuring instruments used for implanting artificial joints
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684Trial or dummy prostheses
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2002/4475Joints for the spine, e.g. vertebrae, spinal discs 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

用于将椎间假体装入到两个椎体之间的椎间腔内的设备 The intervertebral prosthesis for an intervertebral cavity loaded into the device between two vertebral bodies

[0001] 技术领域 [0001] Technical Field

[0002] 本发明涉及一种用于将一个椎间假体装入在两个椎体之间的椎间腔里的设备。 [0002] The present invention relates to an intervertebral prosthesis for a loading in the intervertebral space between two vertebral bodies in the device.

[0003] 背景技术 [0003] BACKGROUND OF THE INVENTION

[0004] 当装入一个椎间关节假体来替代椎间盘时,手术医生在直接靠近重要的神经和血管部位里在一种很混乱的手术区里进行工作。 [0004] When loading a intervertebral disc prosthesis to replace the surgeon to work in a very messy operation zone in direct proximity to the important nerves and blood vessels in the site. 这尤其对于脊柱颈段来说是这样,因为在那里椎骨外形尺寸很小,而至敏感的相邻部位的间距特别小。 This is especially so for the cervical spine is, because the small dimensions where the vertebrae, and to an adjacent portion of the sensitive particularly small pitch. 因此人们就努力通过合适的仪器将具有特别的危险倾向或者必须以特殊的精度而使用的仪器的运动自由度限制到必要的范围内。 Freedom of movement so people can work through a suitable instrument having a particular instrument or a dangerous tendency to be used in a special accuracy is limited to the extent necessary. 然而目检应该在极大程度上仍是可以的。 However, visual inspection should to a large extent still is possible.

[0005] 已知将椎间假体装入腰椎柱里的仪器(DE-U-299 16 078,EP-A-0 333990,FR-A-2737656),在这些仪器中首先将假体的盖板装入椎间腔里、撑开并接着使假体芯在中间移动。 [0005] It is known to mount the lumbar intervertebral prosthesis in the instrument column (DE-U-299 16 078, EP-A-0 333990, FR-A-2737656), in these instruments the first prosthesis cover plate into the intervertebral space, the softened and then move the prosthesis core in the middle. 一般可以放弃对椎表面进行加工。 Generally possible to dispense with processing of the vertebral surfaces. 装入的仪器是相对来说大的,但这在腰椎柱部位里是可容忍的。 Loaded instrument is relatively large, but in the lumbar column in the site is tolerable. 在颈椎部位里椎间腔很窄小,因此必须通过加工相邻的椎体为安装假体提供位置。 In the cervical spine in the intervertebral space is very narrow, it is necessary to provide for the installation position of the prosthesis by processing the adjacent vertebral bodies. 同时进入腔如此窄而且由于附近有对于生存重要的脏器而如此敏感,以至于不能装入大的仪器。 At the same time into the chamber so narrow and because there are important to the survival of nearby organs and so sensitive that it can not mount a large instrument.

[0006] 发明内容 [0006] SUMMARY OF THE INVENTION

[0007] 本发明的任务是设计提出一种设备用于加工和/或分离开颈椎用来插入椎间关节假体,它可以实现高的精度和极大程度上的目检。 Task [0007] The proposed design of the present invention is an apparatus for processing and / or separated for inserting the cervical intervertebral joint prosthesis, it can achieve the visual inspection with high precision and great extent.

[0008] 按照本发明的解决方案,提供了用于将椎间假体装入到两个椎体之间的椎间腔内的设备,其特征在于,所述设备包括用来使椎间腔的形状配合于假体形状的材料磨除工具,其中每一种假体形状配有一组材料磨除工具,其中最大的工具与假体的形状基本上相同,而其它的工具则分级地变小。 [0008] The solution according to the present invention, there is provided an intervertebral prosthesis for an intervertebral cavity loaded into the device between two vertebral bodies, characterized in that said apparatus comprises a chamber for intervertebral shape fitted to the shape of the prosthesis material removal tool, wherein each of the prosthesis with the shape of a set of material removal tool, wherein the shape of the prosthesis largest tool is substantially the same, while other tools are stepwise smaller .

[0009] 当使用设备时,在将椎间盘和必要时上椎体的腹面边缘尖角去掉之后,首先装入椎间板。 [0009] When using the device, after the intervertebral disc and the vertebral body necessary to remove sharp edges of the ventral surface, initially charged intervertebral disk. 在椎间板定位之后它就准确地指出了椎体表面的位置,在这些表面之间应该可以放置假体。 After the intervertebral disk positioning it accurately indicates the location of the surface of the vertebral body, between the surface of the prosthesis should be placed. 它也用来使椎体相互之间具有预先规定的间距。 It is also used a vertebral body having a predetermined spacing between each other. 更为适宜地这样来选择它,使它具有如同自然的椎间腔那样大致同样的形状和尺寸,或者说其大小只是略小于椎间腔的大小。 More suitably chosen such that it, it has substantially the same shape and size as the natural intervertebral space as its size or only slightly smaller than the size of the intervertebral cavity. 这就使椎间板定位更加容易,因为它由于其形状而自动地占有一个相对于椎间腔来说为中间的和同样指向的位置。 This makes it easier positioning intervertebral disk, due to its shape since it automatically occupies a relative intervertebral cavity is the same as the intermediate point and the location. 椎间板也可以设有X射线检查标记用于更准确的定位。 The intervertebral plate may be provided with an X-ray inspection mark for more accurate positioning. 椎间板通过由椎体之间的自然的韧带所产生的张力保持在规定的位置上。 Intervertebral disk held in a predetermined position by the tension of the ligament between the vertebral bodies naturally generated. 这种张力取决于椎间板的厚度。 This tension depends on the thickness of the intervertebral disk. 如果此厚度选择得大致如规定的假体厚度那样大,那么总是有足够的张力的。 If the thickness is selected to be substantially as large as the prosthesis predetermined thickness, then there is always enough tension. 为了使其位置还可以后续补充地进行校正,其表面基本上是平滑的,也就是说没有隆起,这种隆起由于咬入骨头或软骨表面里而使平行于表面方向的相对运动更加困难。 In order to position it can be added subsequent correction, which surface is substantially smooth, i.e. not raised, since such a ridge to bite into the bone or cartilage surface in a direction parallel to the surface more difficult relative movement.

[0010] 导向装置被一根调节杆支承住,调节杆前面从椎间板上突出来。 [0010] The guide is supported by an adjusting lever live adjusting lever projecting from the front of the intervertebral plate. 因为调节杆的位置由椎间板预先规定了,因此人们就得到了导向装置位置的尺寸。 Since the position of the adjusting lever by a predetermined intervertebral disk, so that people get the size of the guide position. 这种装置也就是说可以借助于调节仪精确地,也就是以如同调节仪本身相同的精度来定位。 Such a device can be accurately That is, it is the same as the regulator itself is positioned by means of precision regulator. 椎体的反向定位则通过椎间板同样也如同通过导向装置使加工工具定位那样来确保。 Reverse positioning of the vertebral body through the intervertebral disk as the processing tool is also positioned by the guide means to ensure that. 椎体的加工借助于导向装置来进行,只要该装置还与调节仪相连接并由该调节仪保持在准确位置上的话。 Guide means by means of a vertebral body to perform the processing, as long as the apparatus is also connected to the regulator by the regulator held at a precise location on words.

[0011] 导向装置优选用一个套筒可以从调节杆的自由端起推移到该调节杆上。 [0011] The guide means may preferably reach with a sleeve from the free passage of the adjusting lever to the adjustment rod. 这可以使手术医生将杆和导向装置的共同作用的调节面一起放在手术区的一个前面的、一目了然的部分里,而不必放在不清楚的深度上。 This allows a surgeon will be placed in front of the operation zone of interaction with the regulation surface and the guide rod means, clear sections, rather than on the depth unclear. 导向装置则沿着调节杆被通向手术区的深度上。 The guide means are adjustable along the rod leading to the surgical field depth.

[0012] 调节杆和导向装置更为适宜地具有不可转动互补配合形成的共同使用面,以便使导向装置不会相对于调节杆转动。 [0012] The adjusting lever and the guide means having more suitably used in common mating surface formed in complementary non-rotatable, guide means so as not to rotate relative to the adjustment lever. 导向装置更为实用地具有一个导向机构,用于两个在中间平面里平行于调节杆布置在杆之上和之下的导向轴。 More practical guide means having a guide means for the adjusting lever is arranged parallel to the two guide rods above and below the axis in the plane of the middle. 例如各设有一个钻模板可以布置在导向装置的包围住调节杆的套筒之下和之上。 Each template is provided with a drill, for example, it may be arranged under the guide means surrounding the sleeve and stay on the adjustment lever.

[0013] 更为有利的是以下这种实施方式,其中在包围调节杆的套筒上只布置一个导向机构并使套筒和调节杆的共同使用面在两个相互偏转180°的位置上一起配合。 [0013] The following is a more advantageous embodiment of this embodiment, wherein the sleeve surrounding the adjusting lever is disposed and only a guide surface of the sleeve and commonly used together with the adjusting lever in a position in two mutually deflected by 180 ° on the cooperation. 因此使仪器变得更小并相应改善对手术区的观察。 Thus making the instrument smaller and observation of the surgical field corresponding improvement. 在这两个位置中的第一位置上使用导向装置来加工两个椎体中的第一椎体并在必要时将一个止动机构(最好是一个销钉)锚固在其中。 Guide means used in these two positions a first position to a first machining two vertebral bodies in the vertebral body if necessary, and a stopper mechanism (preferably a pin) anchored therein. 然后使导向装置在调节杆上一直拉回至其圆形横截面部分,旋转180°并且再前移,以便能够对其它的椎体进行同样的加工。 Then adjusting the guide rod has been retracted to its circular cross-section, rotated by 180 ° and then moved forward, so that the same processing can be performed on the other vertebrae.

[0014] 然后可以在止动机构上加装一个牵引工具,它使止动机构在牵引时保持方向固定,这就是说止动机构与牵引工具相连接,使止动机构和用它使椎体保持相互的方向设定。 [0014] may then be installed on a traction tool stopper mechanism, the stopper mechanism that remains fixed during pulling direction, that is to say pulling means and the stopper means is connected to the stopper and the means by which a vertebral body maintaining mutual direction setting. 导向机构的导向轴线以及与之对应装入的止动机构或者销钉最好相互平行。 And guide means with the axis of the guide means corresponding to the stopper pins mounted or preferably mutually parallel. 然后相应地也将设于牵引仪上的用于止动机构或者销钉的孔座布置成相互平行。 Then correspondingly also provided the boss stopper mechanism for a traction device or pins arranged parallel to each other.

[0015] 在有些情况下减小了自然的脊柱后凸(具有位于背部的弯曲轴线的颈椎柱的弯曲)。 [0015] natural kyphosis reduced in some cases (cervical column having a curved bending axis located at the back). 在这些情况下适宜的是不仅在装入椎间假体之前牵引椎体,而且重新建立自然的脊柱后面。 Suitable is not only pulling the vertebral body before loading the intervertebral prosthesis in these cases, and to re-establish a natural behind the spine. 这按照本发明按如下实现:椎间板为楔形的,也就是说其厚度从其腹部的边缘向着其背部的边缘减小。 This is achieved according to the present invention is as follows: intervertebral plate is wedge-shaped, that its thickness is reduced towards the edge of the back from the edge of the abdomen. 可以将具有不同楔角的椎间板在设备里准备停当。 The intervertebral disk may have a different wedge angle inside the device was ready.

[0016] 本发明可以实现一种方法,用于将一个椎间假体装入在两个椎体之间的椎间腔里,在该方法的第一步中将椎间盘除去,第二步使一个调节仪的椎间板在椎间腔里定位并在其中夹住,在第三步中将导向装置的套筒推移到一个从椎间板上突出的调节杆上,使它在中间平面里在调节杆之上和之下限定两个导向轴线,在第四步中将销钉在导向轴线的方向上装入椎骨里,在第五步中使一个牵引夹钳与销钉连接,以使它们保持相互平行。 [0016] The present invention may be a method for a charged intervertebral prosthesis in the intervertebral space between two vertebral bodies, the intervertebral disc is removed in a first step of the process, the second step so that a regulator of the intervertebral plate is positioned in the intervertebral space in and clamped therein, in a third step the sleeve is pushed onto a guide means projecting from the intervertebral plate adjusting lever, in the middle of it to the plane of defined above and below the two adjustment rod guide axis, the pin will be loaded in the fourth step in the vertebra in the direction of the axis of the guide, in a fifth step manipulation and traction clamp pin connection, to keep them parallel to each other. 并在以下步骤中调整椎体的相互间距将导向装置和调节仪去除掉,如果想要的话加工椎间腔,并将椎间假体装入。 And adjust the vertebral body in the steps of the guide means and the mutual spacing regulator removed, if desired, processing the intervertebral space, and loads the intervertebral prosthesis.

[0017] 能够使用的按照本发明的设备的精度取决于椎间板在椎间腔里准确的定位。 [0017] depends on the accuracy of the device according to the present invention can be used in intervertebral disk accurate positioning in the intervertebral space inside. 因此重要的是:椎间腔具有一种配合于椎间板的结构形状。 It is therefore important: an intervertebral cavity having a shape of a complex structure on the intervertebral plate. 这一般也是适配于以后要装入的假体的结构形状。 It is also generally adapted to the shape of the structure to be loaded after the prosthesis. 为了满足这种先决条件,按照本发明的设备通过一组骨锉来补充,其最大的骨锉总是基本上具有椎间板或假体的形状,而至少另一个备用的骨锉略小些。 To meet this prerequisite, the device according to the present invention is supplemented by a set of bone file, the maximum file always substantially the shape of a bone plate or the intervertebral prosthesis, and at least one other backup file bone slightly smaller . 如果设有多个较小的骨锉的话,那么它们的大小则相互被分级。 If a plurality of smaller bone file, then their size is graded with each other.

[0018] 附图说明 [0018] BRIEF DESCRIPTION OF DRAWINGS

[0019] 以下参考附图对本发明进行详细说明。 [0019] below with reference to the accompanying drawings of the present invention will be described in detail. 附图所示为: As shown in the drawings is:

[0020] 图1:装入在一个椎间腔里的调节仪; [0020] FIG. 1: Load a cavity in the intervertebral regulator;

[0021] 图2:将导向装置推到调节杆上时的对应图; [0021] FIG. 2: corresponding to the guide unit to the adjusting rod view;

[0022] 图3和4:导向装置的剖视图和正面视图; [0022] FIGS. 3 and 4: cross-sectional view and a front view of the guide means;

[0023] 图5:调节仪的一个局部侧视图; [0023] Figure 5: a partial side view of the adjusting instrument;

[0024] 图6:一个通过导向装置要使用的钻具; [0024] Figure 6: a drill guide to be used by;

[0025] 图7:一个通过导向装置所要使用的具有螺旋销钉的螺旋搬手; [0025] Figure 7: a helical coil having a pin guide to be used by the wrench means;

[0026] 图8:在椎骨里装入螺旋销钉时的对应于图1的视图; [0026] FIG. 8: a view corresponding to FIG. 1 when the helical pin charged in vertebrae;

[0027] 图9:加装有撑开仪器的对应于图8的视图; [0027] Figure 9: the installation of the expansion there is a corresponding view of the apparatus in Figure 8;

[0028] 图10-18:用于一种确定的假体的骨锉工具图,也就是说 [0028] Figure 10-18: bone file for the tool of FIG prosthesis a defined, i.e.

[0029] 图10-15:一组三种不同的骨锉; [0029] FIGS 10-15: A set of three different bone file;

[0030] 图16:骨锉轮廓的比较图; [0030] Figure 16: Comparison of view of the bone contour file;

[0031] 图17和18:假体,骨锉为其而设计。 [0031] FIGS. 17 and 18: the prosthesis, bone file for the design.

[0032] 具体实施方式 [0032] DETAILED DESCRIPTION

[0033] 在图1-9中所示的设备包括一个调节仪30,它有一个椎间板11。 [0033] In the apparatus shown in Figures 1-9 comprises a regulating device 30, which has an intervertebral plate 11. 其占用面积只略小于椎间腔的占用面积,从而使它自动地在其中定位在突起的侧面的边缘尖角之间。 Which is only slightly smaller than the area occupied by the footprint of the intervertebral cavity, so that it is automatically positioned therein between the sharp edges of the side projections. 它大约具有以后要装入的假体的大小。 It is about the size of the future has to be loaded prosthesis. 其在AP-和LM方向上(LM=侧面中间,也就是垂直于中间平面)的尺寸并不比椎间腔的这个尺寸小很多。 In which the direction of AP- and LM (LM = intermediate side, i.e. perpendicular to the median plane) size is not much smaller than the size of the intervertebral cavity. 其在LM方向上的尺寸至少应达到下部椎体的侧面边缘尖角之间的净距离的70%,最好至少80%。 Its size in the direction of the LM should reach at least 70% of the clear distance between the side edges of the lower vertebral body corners, preferably at least 80%. 因此在插入时椎间板就占有一个大致中间的位置。 Therefore, when inserted into the intervertebral disk will occupy a substantially intermediate position. 用一种至少具有AP-光路的X-光仪器可以对其中间位置和其对准于中间平面的情况进行检查,其中调节杆32的外表面的位置和方向是关键。 X- ray device with an optical path having at least AP- may check its intermediate position where it is aligned and the intermediate plane, wherein the outer surface of the adjusting lever 32 is a position and orientation of the key. 它们构成了仪器的用于这种检查的X光标记。 They constitute a marker for X-ray examination apparatus of this kind. 调节杆为此目的设计成X光不透明的,例如由金属制成。 For this purpose the adjusting lever designed to X-ray opaque, for example made of metal. 同样也可以在一个侧向光路里检查,看椎间板是否在AP-方向上达到了正确的深度调整。 Also can check a lateral light path, the intervertebral disk to see whether the correct depth adjustment in the AP- direction. 在这种情况下在LM-方向上的椎间板的棱边或者一种特殊的标记就用作为X-标记。 In this case, an edge or a particular marker in the intervertebral disk to use as LM- X- direction marker.

[0034] 椎间板11的厚度大致相当于所要装入的椎间板假体的厚度。 [0034] The thickness of the intervertebral disk 11 substantially corresponds to the thickness of the plate to be loaded intervertebral prosthesis. 若有不同大小的假体供选择的话,那么也相应地在设备中提供各种不同的椎间板。 If the prosthesis of different sizes for selection, then accordingly provided in a variety of intervertebral disk apparatus. 它总是那样大,以至于它在去除椎间盘之后可以推入到椎间腔里并且在那里通过自然的韧带拉力被固定住。 It is always so great that it after removing the intervertebral disc can be pushed into the cavity where the ligament and is fixed by a natural tension there. 椎间板可以在侧视图中看作成楔形的,如在图5中所表示的那样。 Intervertebral disk can be made wedge-shaped as seen in side view, as in FIG. 5 as indicated. 如果椎间板达到了其规定的位置,那么它至包括它的椎体表面就有一个准确限定的位置。 If the intervertebral disk has reached its predetermined position, it includes its vertebral surface to have a precise defined position.

[0035] 因此就确保了:即使是从椎间板11向前突出的调节杆32相对于椎体也具有一个准确限定的位置。 [0035] The thus ensures that: even intervertebral disk 11 protruding forward from the adjusting lever 32 with respect to the vertebral body also has a precise defined position. 该调节杆至少在其靠近椎间板11的部位31里有一方形横截面,而其它远离部段33则具有圆形横截面。 The adjusting lever at least in its portion close to the intervertebral disk 11 is 31, there are a square cross-section, away from the other section 33 having a circular cross section. 调节杆32是管子,以便能够用作在AP-方向上布置的X光光路的X光标记。 Adjusting rod 32 is a tube, so that X can be used as an X-ray beam path indicia on AP- direction arrangement. 但管状形状不是必要的,因为即使是调节杆的外轮廓也用作为X光标记。 But the tubular shape is not necessary, because even the outer contour adjustment rod also serves as an X-ray marker.

[0036] 调节杆32用于调节(定位)导向装置34。 [0036] The adjusting lever 32 for regulating (positioning) the guide means 34. 在图3和4中可见,该装置有一个具有方形横截面的孔35,它作成与调节杆32的部段31配合。 Visible in FIGS. 3 and 4, the apparatus has a bore 35 having a square cross section, which mating portion 31 creating section 32 and the adjusting lever. 导向装置的这个部分构成了一个套筒,通过该套筒使导向装置固定在调节杆上。 This portion of the guide sleeve constitutes a means by which the guide sleeve means fixed to the adjusting rod. 它还包含一个平行于孔35的具有圆横截面的孔36。 It also contains pores having a round cross-section 36 is parallel to the hole 35. 这个孔36用作钻模板或者更为通常地用于加工工具的导向。 This hole is used as drilling template 36 or, more generally, for guiding the processing tool. 如果将导向装置34推到了调节杆的部段31上的话,那么它就可以具有图2所示的位置状态,此时被孔36所限定的导向轴37就对准了下椎体2的中间。 If the guide section 34 pushed to the adjustment lever 31, then it may have a position state shown in Figure 2, this time being defined by the aperture 36 is aligned on the guide shaft 37 at the intermediate vertebral bodies 2 . 轴线37和38位于如同调节杆32的同一个中间平面里。 Axes 37 and 38 are located the same as the adjustment lever 32 in an intermediate plane. 也可以在部段31里替代方形横截面而选择另一种非圆形的形状,这就允许在导向装置34的两个相互偏转180°的位置上可以共同作用。 May be used instead of a square cross-section in section 31 selects another non-circular shape, which allows the deflection can cooperate on the 180 ° position of the guide means 34 in two mutually.

[0037] 导向装置34这样被使用,以至于使它首先用于加工一个椎骨,然后,在它被拉回到调节杆32的圆形横截面部段33上之后,转180°用于加工另外一个椎骨。 [0037] The guide means 34 is used so that it is first processed to a vertebra, and then, after it is pulled back adjusting lever on a circular portion cross section 32 and 33, turn 180 ° for further processing a vertebra.

[0038] 加工在于:首先借助于一个钻具39,其柄与孔36匹配,在一个椎骨里加工出一个孔,接着借助于螺旋搬手40在该孔里装入一个螺旋销钉41,螺旋搬手的柄同样也与孔36匹配。 [0038] Processing: first by means of a drill 39, the shank aperture 36 which matches a machined hole in a vertebra, and then charged by means of a helical coil transfer hand 40 of the pin 41 in the hole, the spiral transport hand handle also match the hole 36. 销钉41准确地配合在一个设于螺旋搬手40里的孔里,因此保证了:销钉与螺旋搬手40对中并因此也与轴线37,38对中并平行于调节杆32拧入到各自的椎骨里。 Pin 41 accurately fits in a hole provided in the transfer hand 40 in the spiral in, thus ensuring: pin 40 of the helical wrenches and thus also with the axis 37, 38 and parallel to the adjusting rod 32 is screwed into the respective vertebrae in. 在两个椎骨上这样进行之后,就是图8所示的情况。 After the two vertebrae so that the case is shown in FIG. 8. 螺旋销钉41由于导向装置及其通过调节仪器的调节而准确地在中间平面中并相互平行地从两个椎骨2在腹部方向上突起。 Helical guide means and since the pin 41 accurately parallel to each other and the projections 2 in the ventral direction from the mid-plane by modulating two vertebrae instrument.

[0039] 可以将一个牵引仪装在销钉41上,该牵引仪在两个臂42上各有一个用于销钉41的孔座43,其中臂42可以在一个仪器体44上相互平行地在箭头45的方向上进行牵引和定位。 [0039] a traction device may be mounted on the pin 41, the traction device 42 on two arms each have a hole for the pin 41 seat 43, wherein the arm 42 may be parallel to one another in an arrow on the instrument body 44 towing and positioning in the direction 45. 这样的牵引仪是众所周知的,因此这里就不再加以说明了。 Such a traction device is well known and therefore will not be explained here.

[0040] 椎骨2可以借助于这种仪器(如果必需要的话)还被牵引少许,以便能将椎间板11取出。 [0040] 2 vertebra by means of this instrument (necessary if necessary) is further pulled a little to be able to remove the intervertebral disk 11. 需要的话可以在椎骨通过仪器42至44和销钉41而保持住的状态下继续进行加工以准备好接收椎间假体。 Processing continues at desired vertebrae by the instrument may be 42 to 44 and 41 to hold the pin in a state ready to receive an intervertebral prosthesis. 最后将假体装入椎间腔里并取消用仪器42至44使椎骨2的牵引,从而达到其最终的位置。 Finally, the cavity in the intervertebral prosthesis is loaded and removed with the traction device 42 to 44 of the vertebra 2, to achieve its final position.

[0041] 所述设备也包括一组骨锉,它们对椎骨的表面形状进行修整用于安放假体。 [0041] The apparatus also includes a set of bone file, they are trimmed to leave safety body surface shape of the vertebrae. 图10至16中表示了这些骨锉。 10 to 16 shows the bone file. 所示的实施例与图17和18所示的假体的实施例配合一致。 The illustrated embodiment and the embodiment of Figure 17 the prosthesis 18 shown with the same. 它具有一种椭圆至矩形的轮廓,这用于尽可能地充分利用椎间腔的大小。 It has one elliptical to rectangular contour, which take advantage of the size of the intervertebral cavity for as much as possible. 骨锉是扁平的,因此它可以不必对椎体盖板进行彻底的铣削就插入。 Bone is a flat file, it may not be necessary to thoroughly cover the vertebral body milling is inserted. 它面向椎体盖板外表面,该表面在其最大的部位50里大体是平的和有齿的。 It is the outer surface of the vertebral body facing the cover, the largest part of its surface 50 in a generally flat and toothed. 其侧背角部51成斜面,使表面在该部位里相对于表面部分50的平面来说退回去。 Its dorsal beveled corners 51, in the portion where the surface with respect to the planar surface portion 50 is returned to.

[0042] 椎间腔的一种互补形状通过一组骨锉52,53和54来制备,它们表示于图10至15中。 [0042] 54 to prepare a complementary shape of the intervertebral space by a set of 52, 53 and bone file, which are shown in FIGS. 10 to 15. 图16表示了分级的骨锉的大小比例关系。 16 shows the relationship between the size ratio of the fractionated bone file. 首先借助于一个未详细表示出的把手将最小的骨锉52插入椎间腔里,以打开通路。 First, by means of a not further shown the handle of the smallest bone file 52 inserted in the intervertebral space, in order to open the passage. 接着是具有梯形的骨锉53,大致相当于假体表面的平坦表面部分的梯形形状。 Followed by a bone file 53 has a trapezoidal, a substantially trapezoidal shape corresponding to the flat surface portion of the surface of the prosthesis. 最后骨锉54成形椎间腔,它基本与所要装入假体的形状相一致。 Finally intervertebral bone file forming chamber 54, which substantially coincides with the shape of the prosthesis to be loaded. 所有骨锉的高度都与假体高度相同。 All the height of bone file are the same height as the prosthesis. 所有骨锉在对应于假体的平面部分50的那个面里没有制齿。 All teeth bone file system that does not correspond to a face plane portion 50 of the prosthesis in. 这意味着,它们主要用其前边棱55将软骨磨掉并使骨头恢复原状,而基本并不磨损椎体表面。 This means that they mainly use their front edge 55 will wear off cartilage and bone restitution, but basically do not wear the vertebral body surface. 所有骨锉都设有一个挡块56,它用于使骨锉只能插入椎间腔里一直到规定的深度。 All bone file has a stopper 56, which is used to insert bone file only in the depth of the intervertebral space until a predetermined.

Claims (6)

  1. 1.用于将椎间假体装入到两个椎体之间的椎间腔内的设备,其特征在于,所述设备包括用来使椎间腔的形状配合于假体形状的材料磨除工具(52,53,54),其中每一种假体形状配有一组材料磨除工具,其中最大的工具与假体的形状基本上相同,而其它的工具则分级地变小。 1. The intervertebral prosthesis for an intervertebral cavity loaded into the device between two vertebral bodies, characterized in that said apparatus comprises a grinding material for the shape of the intervertebral cavity with the prosthesis in the shape of the in addition to the tool (52,53,54), wherein each prosthesis shape with a set of material removal tool, wherein the shape of the prosthesis largest tool is substantially the same, while other tools are stepwise smaller.
  2. 2.根据权利要求1所述的设备,其特征在于,所述材料磨除工具通过由手柄来操作的骨锉形成,其中最大的骨锉和最小的骨锉在相应于假体的平面部分(50)的那些表面上是无齿的,并且最大的骨锉和最小的骨锉都具有由其无齿的平表面之间的垂直距离所限定的高度,该高度等于假体的高度。 2. The apparatus according to claim 1, characterized in that the material removal tool is formed by a handle operated by a bone file, the file in which the maximum and minimum bone bone file corresponding to the planar portion of the prosthesis ( 50) that the surface is toothless, and the maximum and minimum file bone having bone file by the vertical distance between the flat surface of the toothless defined height, the height equal to the height of the prosthesis.
  3. 3.根据权利要求1或2所述的设备,其特征在于,所述设备配属于外表面面向椎体盖板的假体,所述外表面在其最大的部位(50)内是大致平的和有齿的,并且所述外表面的侧背角部(51)成斜面,使得所述表面在该部位内相对于表面部分(50)的平面来说退回,并且所述最大的骨锉成型为使其能够将椎间腔成形为假体的形状。 3. The apparatus of claim 1 or claim 2, characterized in that the device associated with the outer surface of the cover plate facing the vertebral body prosthesis, the outer surface in the largest part of which (50) is substantially flat and toothed, and the dorsal surface of the outer corner portion (51) beveled, such that the inner surface of this portion is planar with respect to the surface portion (50) is retracted, and the maximum bone forming file the intervertebral space that it can be molded into the shape of the prosthesis.
  4. 4.根据权利要求1或2所述的设备,其特征在于,所述无齿表面的前边棱(55)是有研磨性的。 4. The apparatus of claim 1 or claim 2, wherein said front edge surface of the non-tooth (55) is abrasive.
  5. 5.根据权利要求1或2所述的设备,其特征在于,第二大的骨锉(53)具有与假体表面的平表面部分(50)的梯形形状相对应的梯形形状。 5. The apparatus of claim 1 or claim 2, wherein the second largest bone file (53) has a trapezoidal shape trapezoidal flat surface portion (50) of the prosthesis surface corresponds.
  6. 6.根据权利要求1或2所述的设备,其特征在于,所有的骨锉(52,53,54)均设有用来限制其插入深度的挡块(56)。 6. The apparatus of claim 1 or claim 2, wherein all bone file (52,53,54) are provided for limiting the depth of insertion of its stop (56).
CN 200810087951 2002-03-12 2004-11-24 Instrument for the insertion of an intervertebral articular prosthesis CN101288609A (en)

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KR101096381B1 (en) 2011-12-20 grant
CN1889889A (en) 2007-01-03 application
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KR20070015112A (en) 2007-02-01 application
JP2007513657A (en) 2007-05-31 application

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