CN101330878A - Apparatus and methods for vertebral augmentation - Google Patents
Apparatus and methods for vertebral augmentation Download PDFInfo
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- CN101330878A CN101330878A CNA2006800467648A CN200680046764A CN101330878A CN 101330878 A CN101330878 A CN 101330878A CN A2006800467648 A CNA2006800467648 A CN A2006800467648A CN 200680046764 A CN200680046764 A CN 200680046764A CN 101330878 A CN101330878 A CN 101330878A
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Abstract
The apparatus comprises elongated members (2200) which are inserted into vertebrae and secured to an arcuate fixation rod (2300) by clamps (2400) which when moved along the rod cause the elongated members and attached vertebrae to pivot. The method may further include passing through a cannula (2100) and into the damaged vertebra a disruption tool for fracturing the damaged vertebral body. Once the cortical bone is broken or otherwise disrupted, the height of the damaged vertebral body may be restored, for example by removing the disruption tool and inserting through the cannula another tool, implant, device and/or material to restore the height of the vertebral body and to restore normal spinal curvature in the affected area. Grafting material or filler may be added with or without an implanted device to augment the damaged vertebral body.
Description
Technical field
The present invention relates to surgical implant, and the microinvasion formula (minimally invasive) equipment and the method that in particular, the present invention relates to be used to strengthen vertebra and lordosis is resetted.
Background technology
Vertebral compression fractures, as shown in Figure 1, there is the situation of vertebrae injry usually in expression and may causes long term disability.These fracture relate to subsiding that one or more vertebral bodys 12 in the spinal column 10 produce.The compression fracture of spinal column appears in the thoracispinal down vertebra or in the epipyramis of lumbar spine usually.They are usually directed to the fracture of the anterior part 18 (relative with rear lateral portion 16) of affected vertebrae 12.Compression fracture of spine can cause normal aligned condition of the vertebral body in the involved area of spinal column or curvature to produce distortion, lordosis for example occurs.Compression fracture of spine and/or relevant deformity of spine may be for example by the metastatic disease of spinal column, cause by wound or may be relevant with osteoporosis.Up to date, how the doctor is still puzzled can treat this compression fracture and the deformity that is associated in them.The pharmacotherapy of pain, lie up, pillar is fixed or the formula spinal surgery of invasion and attack is only available at present possibility.
More recently, develop microinvasion formula surgical procedures and treated vertebral compression fractures.These processes are usually directed to insert inflexible sleeve pipe, pin or the trocar, described inflexible sleeve pipe, pin or the trocar be inserted into subside or damaged vertebral body inside otherwise.Sleeve pipe can comprise cavity or center channel, another instrument, implant or implant material can be by described cavity or center channel so that vertebral body is reorientated and/or strengthens.The surgical operation approach of arrival vertebral body inside commonly used arrives from rear lateral portion, for example is that one or two pedicle of vertebral arch by as shown in Figure 2 arrives.
The most basic process is a vertebroplasty in these processes, and from literal understanding, vertebroplasty means fixedly vertebral body, and can realize described vertebroplasty under situation about need not at first reorientate bone.In brief, sleeve pipe or the special-purpose spicule soft tissue by the back lentamente.Image-guided x ray is with the feasible position that whenever can both see pin of a spot of x ray dyestuff.A spot of polymethyl methacrylate (PMMA) or other plastic surgery's bone cement are pushed through pin and enter in the vertebral body.Polymethyl methacrylate is other material of medical grade, is used to for many years in the multiple plastic surgery operations process.Generally, cement can mix with antibiotic so that reduce the risk that infects and mix mutually with the powder that comprises barium, tantalum or iodine solution, and described powder makes can see this cement under X ray.
Vertebroplasty can reduce or eliminate effectively fracture pain, prevent to produce and further subside and make patient recover motility.Therefore yet this process can't reorientate and can't solve because fracture causes the problem of the deformity of spine that produces the bone of fracture.Usually only just can implement this process under less than 10 situation at the kyphosis between the adjacent vertebral bodies in involved area.In addition, this process need utilizes low viscosity cement to carry out the high pressure cement injection, and in the light of recent researches, this process can cause occurring cement and leak in the process of 30-80%.What in most of the cases, cement leaked is harmless really.Yet under few situation, polymethyl methacrylate or the leakage of other cement enter in spinal canal or the other Venous system of vertebra and cause occurring pulmonary embolisms, thereby cause patient death.
The method of multiple more advanced treatment vertebral compression fractures is known, and is usually directed to two stages: (1) is reorientated vertebral body or is restored the original height of described vertebral body and therefore spinal curvature will is carried out lordosis and correct; (2) increase or interpolation material are so that the bone of supporting or reinforcement fracture.For vertebroplasty, this process is usually directed to use sleeve pipe, conduit, pin, the trocar or other conductor so that the inside of approaching influenced vertebral body.
For example, Fig. 3 A-Fig. 3 D shows so a kind of therapeutic process, and sacculus kyphoplasty art (Kyphon, Inc.).Conduit with expandable balloon tip is planted to be entered in the core of fractured vertebral body by sleeve pipe, sheath or other conductor, and described fractured vertebral body comprises the relative softer spongy bone (Fig. 3 A) that is centered on by the fracture cortical bone.By making inflation realize re-constructing or realize normal curvature to lordotic, described sacculus makes it restore its original height (Fig. 3 B) at the vertebral body intramedullary expansion to the kyphoplasty art subsequently.Sacculus is removed, and stays the space in vertebral body, and polymethyl methacrylate or other implant material for example bone cement entered (Fig. 3 C) in the space by injection by sleeve pipe subsequently, as above at vertebroplasty describe.Sleeve pipe is removed and cement produces curing so that bone is strengthened, fills or fixing (Fig. 3 D).
The shortcoming of this process comprises that cost is higher, remove lost vertebral height after the foley's tube, need high pressure to apply to be enough to separate vertebral endplate or keep the isolating power of vertebral endplate and in this process vertebral endplate may bore a hole.For vertebroplasty, though probability is minimum, but still the most frightening complication that relates to the kyphoplasty art that is associated with the leakage of bone cement may appear.For example, bone cement leaks to enter and can cause occurring neurological deficit in the spinal canal.The leakage of this cement may take place by the lower resistance blood vessel of vertebral body or by the former and unwitnessed crackle in the bone.Other complication comprises: the vertebral fracture of additional contiguous level, infection and cement embolism.The genesis mechanism of cement embolism is leaked similar to cement.Cement is force-applied to be entered in the lower resistance Venous system and marches to pulmonary or brain and cause occurring pulmonary embolisms or apoplexy.The additional detail relevant with sacculus kyphoplasty art can for example see the United States Patent(USP) Nos. 6,423,083,6,248,110 and 6,235 that licenses to Riley etc., and in 043, the whole content of each described United States Patent (USP) is cited as a reference at this.
Another process that is used for the treatment of vertebral compression fractures is the (Spineology of Optimesh system, Inc., Stillwater, MN), this system utilizes distensible mesh bag or sealing device to transmit cement or allograft or homogeneous allogenic bone in the microinvasion mode in related vertebral body.This bag or graft keep being in vertebral body inside after it produces expansion, and this has prevented to impair reorientating of carrying out when carrying out surgical operation, for example as the situation that may occur when withdrawing from sacculus in the process of implementing the kyphoplasty art.The Optimesh system also can prevent to be caught by this bag or the cement that comprises or bony material produce and leak.Yet a shortcoming of this system is that mesh implant is not incorporated in the vertebral body well.This can cause relative motion occurring between implant and vertebral body, and therefore causes impairing reorientating of carrying out after operation.This system is still complicated and relatively costly.It is that the whole content of this US patent application publication is cited as a reference at this in 20040073308 the US patent application publication that the additional detail relevant with this process can for example see publication number.
Another process of utilizing in the treatment of vertebral compression fractures is the swellable polymer enhancing substance, and this material is known as SKy Bone Expander (bone dilator) knownly.This device can be expanded in a controlled manner pre-design size and cube or trapezoidal configuration.With the Kyphon sacculus similarly, in case realized vertebral levels and the space optimized, then SKy Bone Expander is removed and polymethyl methacrylate cement or other implant are injected in the space.Therefore this process has a plurality of same top shortcoming and defect of describing at the kyphoplasty art.
Therefore, be used for the common drawback that impaired vertebra is reorientated with enhanced great majority known system and process is that they have all related to the equipment that utilizes the relative complex that is conducted through inflexible conductor.This inflexible conductor can damage pedicle of vertebral arch and/or tissue on every side in the process of plant and/or manipulation enhancing equipment.Therefore, still needing to provide safe and efficient equipment and method in the art reorientates and carries out the enhancing of osteopathy aspect so that lordosis is resetted so that vertebral body is carried out the microinvasion formula.
Yet, no matter use the implant or the Enhancement Method of which kind of type, any this to subsiding or otherwise the treatment of the vertebral body of fracture usually all must enforcement in injured about six weeks.Otherwise, the bone of fracture may tend to heal with its collapsed mode, if thereby make the fractures at first do not make inappropriate healing wreck or cracked situation under, be difficult to maybe can not reorientate and/or make lordosis to reset to affected vertebral body.In addition, the next-door neighbour is neural because spinal column is in usually, the position of blood vessel and other responsive soft tissue, and therefore, being used for making subside any method that the involved area of vertebral body wrecks should be microinvasion and controlled so that avoid making tissue damaged around this.Therefore, still need to provide proper implements or method in the art so that the bone of this inappropriate healing securely and effectively wrecks in the microinvasion mode.
Summary of the invention
The invention provides and be used to carry out equipment and the method that microinvasion formula vertebra strengthens and lordosis is resetted.In one embodiment, a kind of sleeve pipe comprises the rigid member with rigid member cavity and has the flexible member of flexible member cavity that described rigid member cavity is made into certain size so that pass through utensil.Described flexible member is attached to described rigid member, so that the described cavity of the described cavity of described rigid member and described flexible member has formed path, utensil can pass through described path.
In another embodiment, a kind ofly be used for that spinal column is carried out corrigent utensil and comprise at least two body sections, each body section has far-end and near-end, the described far-end of at least one first body section of naming a person for a particular job is connected to the described near-end of adjacent body section, and it relative to each other is that the joint links to each other that described point allows described body section.Described utensil further comprises the elongated flexible element on the described far-end that is attached to a body section, and described elongated member has extended the length of at least two body sections.When described elongated member towards the described near-end of described body section when pulled, described far-end body section is that the joint links to each other with respect to adjacent body section.
In another embodiment, a kind of being used for comprises at least one slender member to the equipment that vertebra is reorientated, each slender member in the described slender member has first end and second end, and wherein described first end of each slender member is configured to insert in the vertebral body.Described equipment further comprises fixed bar and at least one anchor clamps with bowed shape, and described at least one anchor clamps are configured to the described second end adjustable ground of a slender member in the described slender member is fastened on the described fixed bar.Thereby described anchor clamps are configured to move so that described slender member pivots that vertebral body is reorientated along described fixed bar.
The present invention also provides crooked utensil and implant, and described crooked utensil and implant can be gone forward side by side bone or other body part for example in the damaged vertebra by sleeve pipe of the present invention.This implant can for example be used for vertebral body is reorientated and/or be used for strengthening to the end plate of damaged vertebral body.
Described sleeve pipe of the present invention and/or crooked utensil can use in combination with miscellaneous equipment and method.For example, utilization be applied in come by telescopic crooked utensil vertebral body reorientated with partially flexible after, one or more implants can be inserted in the described vertebral body so that further strengthen described vertebral body.Also can utilize one or more other utensils or equipment, thereby for example external fixation device is helped to reorientating the compression stress that for example reduces on the vertebra with the vertebra of the vertebrae adjacent of subsiding.
Described sleeve pipe of the present invention and/or reorientate bar and can comprise any biocompatible materials, biological example compatible polymer, metal, pottery, Nitinol (Ultimum Ti), PEEK (polyether-ether-ketone), complex or its arbitrary composition with desirable characteristics.In certain embodiments, described sleeve pipe and/or reorientate bar or other implant or utensil can be can be resorbent.
In certain embodiments, the step that comprises of a kind of method that is used for the treatment of damaged vertebral body has: make the lordosis in the damaged vertebral body zone reset, make described damaged vertebral body fracture, restore the height of described damaged vertebral body and strengthen described vertebral body.
In another embodiment, a kind of external member comprises the various combinations of assembly and parts.A kind of external member for example can comprise according to sleeve pipe of the present invention and be used to restore vertebral levels and/or be used to strengthen one or more utensils and/or the implant of vertebral body.For example, a kind of external member can comprise sleeve pipe and be used to restore the curved utensil of vertebral height, the flexible member that described sleeve pipe has rigid member and links with rigid member.Other external member can comprise that another implant replaces described curved utensil or also comprise described another implant except described crooked utensil.In other embodiments, a kind of external member can comprise that sleeve pipe, external drum are fixed or tensile member and/or vertical fixed component.This embodiment also can comprise and be used for cement or other implant are injected Intrapyramidal syringe or miscellaneous equipment.
Description of drawings
In the exemplary drawings below even illustrate in greater detail the present invention and further improvement of the present invention and feature.Can understand the present invention better in conjunction with following accompanying drawing, wherein use similar Reference numeral to represent similar element.Only to be exemplary should not be limited to illustrated embodiment so that the special characteristic and the present invention that can use separately or be used in combination with further feature be shown with this accompanying drawing.
Fig. 1 shows has the spinal column that is in a vertical compression fracture in the vertebral body;
Fig. 2 shows spinal column, there is shown the rear portion surgical operation approach by pedicle of vertebral arch;
Fig. 3 A-Fig. 3 D shows the method that is used for the treatment of vertical compression fracture of the prior art;
Fig. 4 is the flow chart that lordosis resetted and be used to strengthen the method for vertebral body of being used to according to an embodiment of the invention;
Fig. 5 is the perspective view that is used for the external fixation device of spinal column according to an embodiment of the invention;
Fig. 6 is the side view of external fixation device shown in Figure 5;
Fig. 7 shows a method according to the present present invention and is inserted into Intrapyramidal telescopic schematic side elevation;
Fig. 8 shows and is used for shown in Figure 7 telescopic schematic side elevation that vertebral body is reorientated;
Fig. 9 is the perspective view for the external fixator of model spinal column use;
Figure 10 is the near-sighted perspective view of fixed bar according to an embodiment of the invention;
Figure 11 is the side view that is secured to the anchor clamps on the fixed bar according to an embodiment of the invention;
Figure 12 is the sectional view of anchor clamps shown in Figure 11;
Figure 13 A and Figure 13 B show the schematic side elevation of the operation of anchor clamps shown in Figure 11 and fixed bar;
Figure 14 is the perspective view that comprises the fixture of anchor clamps shown in Figure 11 and fixed bar;
Figure 15 is the perspective view with fixture of slender member intersected with each other;
Figure 16 is the perspective view that has from the fixture of the angle that is different from angle shown in Figure 15 slender member intersected with each other;
Figure 17 shows adjustable slide mechanism;
Figure 18 shows another embodiment of scalable slide mechanism;
Figure 19 shows another option means that is used for vertebra is reorientated;
Figure 20 is the side view that is inserted into the device that wrecks in the vertebra according to an embodiment of the invention;
Figure 21 is the top view that is inserted into two devices that wreck in the vertebra according to an embodiment of the invention;
Figure 22 A is the near-sighted top view of wreck device and vertebra shown in Figure 16;
Figure 22 B is the close-up side view of wreck device and vertebra shown in Figure 21;
Figure 23 shows the perspective view that sleeve pipe is inserted this operation in the vertebra from the back side of spinal column;
Figure 24 is equipment and the telescopic side schematic sectional view of wrecking according to an embodiment of the invention;
Figure 25 is the side view that is inserted into the device that wrecks in the vertebra according to an embodiment of the invention;
Figure 26 is the top view that is inserted into the device that wrecks in the vertebra according to an embodiment of the invention;
Figure 27 is the side view that is inserted into the device that wrecks in the vertebra according to an embodiment of the invention;
Figure 28 is the schematic side elevation that knocks utensil and two devices that wreck in the vertebra of being inserted into according to a plurality of embodiment of the present invention;
Figure 29 is the side view that is inserted into the device that wrecks in the vertebra, there is shown kinematic axis according to an embodiment of the invention;
Figure 30 is the top view that schematically shows according to the device tip of wrecking of each embodiment of the present invention;
Figure 31 A and Figure 31 B are the top views at different device according to an embodiment of the invention tip;
Figure 32 A and Figure 32 B are two end perspective view that device is most advanced and sophisticated according to an embodiment of the invention;
Figure 33 shows the schematic side elevation that is used to make the apparatus and method that fractured vertebral body wrecks;
Figure 34 shows the schematic side elevation of fractured vertebral body;
Figure 35 A-Figure 35 D shows the schematic side elevation of the method for the height that restores fractured vertebral body;
Figure 36 is the telescopic top view that is inserted in the vertebra according to an embodiment of the invention;
Figure 37 is a telescopic near-sighted top view shown in Figure 36;
Figure 38 is a telescopic side schematic sectional view according to an embodiment of the invention;
Figure 39 is a telescopic sectional view according to another embodiment of the present invention;
Figure 40 shows the top view of telescopic rigid member according to an embodiment of the invention;
Figure 41 A and Figure 41 B are the side schematic sectional view of telescopic rigid member according to an embodiment of the invention and bar;
Figure 42 A and Figure 42 B are the side schematic sectional view that is used for the sleeve pipe and the bar of vertebra according to an embodiment of the invention;
Figure 43 shows the perspective view according to the different shape of the spendable utensil of a plurality of embodiment of the present invention or implant;
Figure 44 shows the schematic side elevation according to the various curvature of the spendable utensil of a plurality of embodiment of the present invention or implant;
Figure 45 shows sleeve pipe according to another embodiment of the present invention and strengthens the sectional view of bar;
Figure 46 shows the sectional view that is oriented to by telescopic pin and conduit according to of the present invention;
Figure 47 A-Figure 47 C shows the perspective view that is suitable for transmitting the equipment of vertebral body implant material according to an embodiment of the invention;
Figure 48 shows the schematic side elevation that is used for strengthening by the implant material equipment of vertebral body;
Figure 49 is the perspective view of an embodiment of utensil of the present invention;
Figure 50 telescopic perspective view of the pedicle of vertebral arch by fractured vertebral body of being planted;
Figure 51 is the perspective view that is inserted into the utensil shown in Figure 49 in the sleeve pipe shown in Figure 50;
Figure 52 is the perspective view of utensil shown in Figure 49, and the front end of described utensil is raised;
Figure 53 is the perspective view of vertebral body, and described vertebral body has restored its original height;
Figure 54 is the perspective view that is used for spurring the mechanism wiry of utensil shown in Figure 49;
Figure 55 is the perspective view of another exemplary embodiments that is used for spurring the mechanism wiry of utensil shown in Figure 49;
Figure 56 is the perspective view of another exemplary embodiments that is used for spurring the mechanism wiry of utensil shown in Figure 49;
Figure 57 A-Figure 57 C is the perspective view of other exemplary embodiments of utensil of the present invention;
Figure 58 A and Figure 58 B are the perspective views of exemplary embodiments of the globe joint of utensil shown in Figure 49;
Figure 59 is the perspective view of another exemplary embodiments of utensil of the present invention; With
Figure 60 is another perspective view of the exemplary embodiments of utensil of the present invention.
The specific embodiment
To be described (referring to Fig. 4) so that for example treat the method 1000 of vertebral compression fractures to lordosis being resetted and strengthening vertebral body below.Generally speaking, method 1000 can comprise the one or more steps in the following step: step 1100, and in the vertebral body that one or more sleeve pipes insert in the damaged vertebral body and/or insertion is adjacent with described damaged vertebral body.Step 1100 can be implemented from posterior approach.Step 1200 relates to utilizes sleeve pipe that vertebra is reorientated.Step 1200 can be implemented in combination with external fixation device.Step 1300 wrecks the fractured bones in the damaged vertebra.Step 1400 is restored vertebral height; With step 1500, restorative vertebral body is strengthened, this for example utilizes implant or implant material to realize.Some or all of steps in the step 1100 of method 1000,1200,1300,1400 and/or 1500 can be shown in Figure 4 order or any other be implemented in proper order and use in combination with other method.To additional detail and the example relevant with each step in the step 1100,1200,1300,1400 and 1500 of method 1000 be explained in more detail below.
Insert sleeve pipe (step 1100)
Fig. 7 shows the operation that sleeve pipe 2100 is inserted in the damaged vertebra 12b.For example in step 1100 shown in Figure 4, can utilize and the sleeve pipe 100 same or analogous different slender members of describing after a while 2200.For example, sleeve pipe 2100 can be inserted into fracture or otherwise in the damaged vertebral body 12b, and one or more members 2200 can be inserted in vertebra 12a and the 12c or otherwise be attached on described vertebra 12a and the 12c, described vertebra 12a and 12c can be positioned at the top of damaged vertebral body 12b and/or below.One or more slender members in the slender member 2200 can be sleeve pipes.
The size of one or more members 2200 and/or sleeve pipe 2100 can be identical or different, and can have for example diameter between about 2mm and 10mm.Slender member 2200 and/or sleeve pipe 2100 can be made into certain size so that extend to vertebra and soft tissue on every side outside and can have any Len req, for example between about 10cm and about 30cm or longer.Slender member 2200 can comprise rustless steel, metal, metal alloy, polymer, complex, pottery or its compositions.
Slender member 2200 and sleeve pipe 2100 can be configured and be made into certain size so that insert in the vertebra, for example are inserted in the core 50 of vertebral body 12 by pedicle of vertebral arch 24 from posterior approach.When being planted, slender member 2200 and sleeve pipe 2100 extend outside vertebra 12, the soft tissue and arrival patient body by covering spinal column 10.In certain embodiments, each slender member 2200 and/or sleeve pipe 2100 can be inserted in the vertebral body by the hole, and described hole can be the exodermis bone by vertebra 12, for example by pedicle of vertebral arch 24, the hole that forms, this for example realizes by brill, the trocar or other utensil.In certain embodiments, slender member 2200 can comprise the external screw thread (not shown) that is positioned on the outer surface, and described outer surface engages so that slender member 2200 is fastened in the described vertebral body with vertebral body 12a and 12c.External screw thread can extend along the distal portions 2210 of slender member 2200, extends or extend along any required part of slender member 2200 along the whole length of slender member 2200.The shank (not shown) can be attached on the near-end 2220 of slender member 2200 and be used to control member 2200 and/or member 2200 is planted by pedicle of vertebral arch 24.
With reference to the additional detail of the discussion that sleeve pipe 100 is carried out with acquisition sleeve pipe 2100 and/or slender member 2200.
Vertebra is reorientated (step 1200)
In step 1200, fixture can be used to help vertebra is reorientated.Fig. 5 and Fig. 6 show and are used for bone, and for example the vertebra 12 of spinal column 10 positions, fixes and/or stable fixture 3000.Device 3000 can for example be used to power is applied on the vertebral body 12 so that vertebral body 12 is reorientated and the lordosis of spinal column 10 is corrected, and described lordosis for example is in the zone of fractured vertebral body 12.Fixture 3000 can be applicable in other zone of skeletal structure so that the bone of impaired or pathological changes is reorientated.
Alternatively, one or more sleeve pipes 2100 can be included in the device 3000, be attached on the described device or with described device and use in combination.For example, sleeve pipe 2100 can be inserted into fracture or otherwise in the damaged vertebral body 12, and one or more member 2200 can be inserted into the top and/or following vertebra 12 that is positioned at damaged vertebral body 12 or otherwise is attached on the described vertebra.Therefore member 2200 can be used as the cement injection cannula so that and/or prophylactically implement vertebroplasty in the following vertebra and the vertebra bony structure is strengthened in the above.In addition, when utilizing external force to implement to reorientate after a while, cement injected be positioned at above the damaged vertebral body 12 and/or engineering properties that the cement of following vertebral body and sleeve pipe can enhancing portion section.
One or more anchor clamps 2400 can be fastened to each slender member 2200 on the longitudinal member 2300.Each anchor clamps 2400 can be adjustable with respect to slender member 2200 and/or longitudinal member 2300, thereby for example along any required orientation member 2200 is fastened on the longitudinal member 2300.Be inserted in the vertebral body 12 or otherwise be attached on the described vertebral body and the other end of each member 2200 is secured to by anchor clamps 2400 under the situation on the longitudinal member 2300 at an end of each slender member 2200, the position of member 2200 can relative to each other be stable or fixed.
Fig. 7 shows member 2200, and described member can be sleeve pipe or can not be that sleeve pipe, described member are inserted in vertebral body 12a and the 12c.The far-end 2210 of each member 2200 can for example be inserted in the core 50 of vertebral body 12a and 12c.Member 2200 can have cavity 2230, and cement, skeletal grain or other implant can for example be inserted in vertebral body 12a and the 12c by described cavity.This cement, skeletal grain or other implant can be for example be fastened on member 2200 in vertebral body 12a and the 12c with helping.
Fig. 7 also shows sleeve pipe 2100, and described sleeve pipe has the far-end 2120 that is inserted in the vertebral body 12b that subsides.Sleeve pipe can comprise cavity 2110, and instrument, implant, cement, skeletal grain or other implant can and be inserted in the vertebral body 12b by described cavity, thereby for example strengthens and/or stable damaged vertebral body.Slender member 2200 can be inserted in one or more vertebra 12a and the 12c, and described one or more vertebras can be adjacent with damaged vertebra 12b, as shown in Figure 7.
Fig. 8 show a kind of strengthen or stable fracture vertebral body 12b before vertebral body 12a-12c is reorientated, thereby for example restore normal curvature in the zone of damaged vertebra 12b or the method that the lordosis in the described damaged vertebra zone is resetted.The far-end 2220 of member 2200 can engage with fixed component 2300 adjustable grounds, and described adjustable ground engages and for example utilizes anchor clamps 2400 to realize, makes member 2200 relative to each other to be fixed thus or can be relocated.The end 2130 of sleeve pipe 2100 also can be attached on the fixed component 2300, and is described attached for example by anchor clamps 2400 realizations, thereby stablizes the also position of vertebrae immobiles 12b in the process that vertebra 12a is reorientated.Be secured to the end 2220 of the slender member 2200 on the vertebra 12a can be for example along the direction shown in the arrow 2700 longitudinally member 2300 carry out translation.This translation can cause slender member 2200 to pivot and moment or moment of torsion are applied on the vertebral body around center of rotation 2600, and this can tend to vertebral body 12a is reorientated, thereby the normal lordotic of spinal column 10 is resetted.
For example adjacent with fractured vertebral body 12b vertebral body 12a or 12c are reorientated the compression stress that can reduce on the vertebra 12b and for example utilize help enhancing or recovery vertebral levels such as instrument, implant, implant.In other embodiments, can utilize one or more members 2200 that different revolving forces or translational force are applied on the vertebral body.For example, thereby member 2200 can for example replace the rotation carried out around pivot 2600 or except carrying out horizontal promotion in described edge or pulling around described pivot is rotated along laterally being pushed or spurring with respect to spinal column 10, thereby one or more vertebral bodys 12 are orientated or locate so that form required aligned condition.In certain embodiments, sleeve pipe 2100 is not fastened on the fixed component 2300.Figure 14 shows the perspective view of the fixture that comprises anchor clamps shown in Figure 11 and fixed bar, thereby this moment, power helped resetting of vertebra 12b so that temporarily restore the aligned condition of vertebra on fixed bar is applied to slender member among vertebra 12a, the 12c in different directions.
Fig. 9 shows the embodiment of device 3000, there is shown in the vertebra 12 that is inserted into spinal column 10 and is secured to member 2200 on one or more fixed components 2300, and described one or more fixed components can have bowed shape.Member 2200 can utilize anchor clamps 2400 to be secured on the fixed component 2300, and described anchor clamps can for example be the known standard fixed anchor clamps in this area.Shank 2500 on each member 2200 can be used to plant and/or control member 2200.
Figure 10 shows the side view of bar 900, and described bar can be used as longitudinal member 2400, for example so that member 2200 and/or sleeve pipe 2100 are fastened on the desired location place.Bar 900 can comprise spine or otch 910, and described spine or otch can be crenations or jaggy, thereby for example allows anchor clamps or other device (anchor clamps 4000 for example shown in Figure 11) to move along a direction 920 rather than along opposite direction 930.
Figure 11 and Figure 12 show the side view of the pieceable anchor clamps 4000 of selectivity, and described anchor clamps can use in combination with bar 900, thereby for example replace anchor clamps 2400.Anchor clamps 4000 can comprise and are configured to the first 4100 that optionally engages with bar 900, and the second portion 4200 that links and be configured to engage with sleeve pipe or other slender member adjustable ground with part 4100, described sleeve pipe or other slender member can be fixed on the vertebral body.The pieceable first 4100 of selectivity can comprise housing 4110 and the inside body 4112 that for example has opening 4111, and described inside body can partly be placed in the housing 4110 and from opening 4111 to extend.Biasing member 4120 can be set in the space 4150 in the housing 4110, for example between the member 4211 of the bolt 4210 of inside body 4112 and part 4200.Biasing member 4120 can provide and can tend to make the stressed and biasing force that leave by opening 4111 of inside body 4112.
One or more holes 4113 in the housing 4110 can be made into certain size so that sell 4130 and pass through, described pin can for example pass through the elongated open 4114 of internals 4112, thereby make inside body to move, but can be remained in the housing 4110 by pin 4130 with respect to housing 4110.Being oriented to the recess that be arranged in housing 4,110 4115 relative with hole 4113 or hole or further feature as shown in figure 12 can be configured to engage and fastening described pin with pin 4113.
The part 4200 of anchor clamps 4000 can be configured to and member engages and fastening described member, described member for example for slender member 2200 or sleeve pipe, bar, the trocar, conductor, tinsel, sell or be applicable to and insert in the vertebral body 12 or otherwise be attached to described epicentral any other slender member.Part 4200 can comprise bolt 4210 or screw, one or more vise plate 4220,4230 that engages with bolt 4210 of linking with housing 4110, can tend to holding plate 4220,4230 is in the biasing member 4240 of closed condition and can tends to relative with biasing member 4240 and tend to nut 4250 around the fastening vise plate 4220,4230 of member 2200 (not shown).Bolt 4210 can comprise and is positioned at housing 4110 and is attached to the member 4211 of axle on 4212.The end 4213 of axle 4212 can be threaded 4214.
Vise plate (vise plate) 4220,4230 can have opening 4221,4231 respectively, and bolt 4210 can pass through described opening.In this way, vise plate 4220,4230 can be on bolt 4210, and is for example between nut 4250 and housing 4110, fastened.Every vise plate 4220,4230 also can have receiving unit 4222,4232 respectively, so that engage with member 2200 or other slender member and keep described member 2200 or other slender member.
Biasing member 4240 (for example disc spring, wave washer, radial spring) can be set between first vise plate 4230 and the housing 4110.In this way, when nut 4250 is attached to bottom 4210 but is not fastened on the described bottom fully, the bone Connection Element can be held or snap-on between vise plate 4220 and 4230, this for example realizes by will the bone Connection Element inserting in the receiving unit.This structure can allow the bone Connection Element for example to be remained between vise plate 4220 and 4230 in nut 4250 fronts temporarily.
In addition, vise plate 4220,4230 has the feature that helps making the suitable alignment of vise plate.For example, second vise plate 4230 can have at least one the protuberance (not shown) that is extended out by it, and described at least one protuberance can be received at least one recess (not shown) in first vise plate 4220.In this way, thus vise plate 4220,4230 can all rotate together receiving unit 4222,4232 is orientated.Those skilled in the art is to be appreciated that and can utilizes various other pins, protuberance, recess, coupling or other alignment feature.
For clamp nut 4250, nut 4250 can have grip portions 4251 (for example zigzag part or knurled portion), and described grip portions can help with hand-tight solid nut 4250.Another kind of optional mode is or in addition, can be provided with the further feature that is beneficial to spanner or other tool engagement by nut 4250.Those skilled in the art will recognize: for as shown in the figure with the external fixation system of describing for, also can utilize other anchor clamps.
Figure 13 A and Figure 13 B show the sketch map of bar 900, and described bar has the otch 910 or the further feature that can engage with one or more anchor clamps 4000.Anchor clamps 4000 can connect with cut-out feature 910 and be incorporated in specific direction upper edge bar 900 and move, and described specific direction for example depends on the direction of cut-out feature 910.
Two bars 900 can be attached at together by adapter 950, thus make the direction of otch 910-1 and 910-2 be in rightabout.Therefore, the reorientating of anchor clamps, promptly moving of anchor clamps can be carried out in opposite direction, shown in the arrow 2710 and 2720 in Figure 14.
Further strut/mobile spinal column in order to utilize as Fig. 5, Fig. 6 and fixture 3000 shown in Figure 14, have necessity and make slender member 2200 (Figure 15 and Figure 16) intersected with each other, this for example utilizes adjustable slide mechanism 3500 (Figure 17 and Figure 18) to realize.Figure 15 and Figure 16 show the scalable slide mechanism 3500 that is connected to slender member 2200.
Figure 17 and Figure 18 show two embodiment of scalable slide mechanism 3500, and these two embodiment have similar function.Scalable slide construction 3500 shown in Figure 17 comprises slidably member 3510, described slidably member can have " I shape bar " configuration, and wherein vertical member 3511 has the otch 3512 that is positioned on the both sides so that allow align member 3520,3530 to move along the length of member 3510 slidably.Align member 3520,3530 is engaged between the horizontal member 3513 and 3514 of member 3510 slidably and with vertical member 3511 and is complementary.Each align member 3520,3530 can have and is positioned at protuberance or other device 3524 of coupling on the sidepiece 3523,3533, and described protuberance or other device are corresponding to the otch 3512 on the member 3510 slidably.Align member 3520,3530 also can comprise release-push 3522,3532, and when when for example depressing this button and start described release-push, align member 3520,3530 can move along member 3510 slidably.That is, for example, protuberance 3524 and cut 3512 and be disengaged and align member 3520,3530 can slide between horizontal member 3513,3514 along the length of member 3510 slidably.Align member 3520,3530 can be maintained between the horizontal member 3513,3514, and this for example is to realize by the antelabium (not shown) that extends out from each horizontal member.Each align member 3520,3530 can have attaching unit 3521,3531, so that allow slender member 2200 to be attached on the align member 3520,3530.Attaching unit 3521,3531 can be rotated so that regulate the angle of slender member 2200, thereby for example makes that they can be relative to each other cross-shaped.
Figure 18 shows another optional embodiment of the slidably member 3550 of scalable slide mechanism 3500.In this embodiment, slidably member 3550 has two tracks 3551,3552 parallel to each other.Every track 3551,3552 can have and is used for allowing align member 3520,3530 to carry out tooth portion 3553 or other device of incremental motion.Have the function of align member 3520,3530 of attaching unit 3521,3531 and release- push 3522,3532 and the functional similarity in the previous embodiment.
Figure 19 shows another option means that is used for vertebra is reorientated.Replace foregoing fixture 3000 ground, can have Velcro (Velcro) securing member 3600 that is attached on its near-end 2220 from the extended slender member 2200 of vertebra., can stick together by the slender member 2200 that will be equipped with Velcro securing member 3600 and carry out fastening by manual control and control slender member 2200 and slender member 2200 handled so that after lordosis resets for example the relative to each other residing position of slender member 2200.Velcro securing member 3600 can directly be attached on the shank 2500 of slender member 2200 or additional lid (not shown) can slippage on shank 2500.Be used for Velcro securing member 3600 is attached to other optional method on the shank 2500 also in the imagination scope.
In case the vertebral part section is decompressed and reorientates, then can carry out surgical operation therapy to fractured vertebral body.
Make healing fracture site wreck (step 1300)
Before or after the vertebra 12a in the zone of fractured vertebral body 12b and/or 12c are reorientated, have necessity and make the anterior part 22 of the vertebral body 12b that subsides and particularly make cortex shell 14 fracture again, dissociate or otherwise wreck.For example at the bone of fracture during one period for example under the situation of six weeks or healing of longer times or part healing, this process can be used for vertebral body is prepared for use in vertebral endplate 20 and 30 being reorientated and/or strengthening especially.Various types of devices that wreck can be used to make impaired cortical bone 14 fracture, for example chisel 800 as shown in figure 20, laser instrument 900 or another kind of utensils.
Figure 20 shows wreck device or cutter shape device 5000, and described device or the cutter shape device of wrecking can comprise slender member 5410, and described slender member has proximal tips 5420, and described proximal tips can be constructed such that bone or other rigid structure separately.Slender member 5410 can be approximately cylindrical, but other shape is also in intended scope.Most advanced and sophisticated 5420 can have multiple shape as herein described, and for example most advanced and sophisticated 5420 can be gradually thin shape, as shown in figure 20, are used for cutter shape tip that bone is wrecked so that provide.Most advanced and sophisticated 5420 at least in part rust so that help to make damage to minimize to surrounding tissue.Shank 5430 can be attached on the far-end 5432 of slender member 5410, and described far-end is for example relative with most advanced and sophisticated 5420.
As shown in figure 20, the device 5000 that wrecks can be inserted in the vertebra, this for example is to realize by the sleeve pipe 5440 that utilizes posterior approach to plant, thus make tip 5420 by vertebral body 12 core 50 and contact with cortical bone 14 on the front side 22 that is positioned at vertebra 12.Sleeve pipe 5440 can be similar to aforementioned sleeve pipe or can be dissimilar.
In certain embodiments, sleeve pipe 5440 comprises the rigid member 5442 in the hole that can be screwed in the pedicle of vertebral arch 24 and comprises slender member 5444, thus described slender member can be cylindrical and be made into certain size so as to extend vertebra and soft tissue on every side make device 5000 with the microinvasion mode near and enter in the vertebral body.Slender member 5444 can be flexible and can link at connector 5446 places and rigid member 5442 that this linking for example is forever to link or releasable linking.Rigid member 5442 can be configured and be made into certain size so that insert in the vertebra, for example is inserted in the core of vertebral body 12 by pedicle of vertebral arch 24 from posterior approach.In certain embodiments, can form exodermis bone by vertebra 12, for example by pedicle of vertebral arch 24, the hole, this for example realizes by brill, the trocar or other utensil.Connector 5446 can be positioned at the inside or the outside position of the pedicle of vertebral arch 24 of vertebra 12, and at described connector place, rigid member 5442 links with member 5444.In other embodiments, can utilize sleeve pipe, the trocar or other conductor of another kind of type so that the device 5000 that wrecks near vertebra 12 or other bone.
The diameter of the member 5410 of device 5000 can be for example between about 2mm and 10mm.The member 5410 of this device can have any Len req, for example between about 20cm and 70cm.Shank 5430 also can have any Len req, for example between about 4cm and 20cm.Device 5000 can comprise rustless steel, metal, metal alloy, polymer, complex, pottery or its compositions.
As shown in figure 21, one, two or more devices that wreck, for example 5000-1 and 5000-2 can for example be inserted in the vertebral body 12 in conjunction with one or more sleeve pipes 5440 shown in Figure 20 by top.Sleeve pipe 5440 can have rigid member 5442, and rigid member 5442 can comprise screw thread 5443 so that the pedicle of vertebral arch 24 for example by as shown in the figure is secured on the vertebra.In certain embodiments, rigid member 5442 can comprise nut feature 5447, described nut feature has flat substantially surface or other is surperficial, and described surface can be configured to and be used for rigid member 5442 screwed togather and/or otherwise fit into spanner or other tool engagement in the bone 12.Connector 5446 can be for example provides releasable and connects between member 5444 and rigid member 5442.
Figure 22 A and Figure 22 B show most advanced and sophisticated 5420 close-up view, and described tip for example is most advanced and sophisticated 5420-1 and 5420-2.Most advanced and sophisticated 5420 can have any required configuration, thereby for example the cortical bone 14 of cutting by vertebra 12, make described cortical bone cracked or otherwise wreck, this for example at bone 14 for example because vertebral compression fractures and under collapsed mode, carrying out after the healing after injured.Most advanced and sophisticated 5420 can be gradually thin on one or more sizes, for example carries out gradually thin so that provide the cutter shape shown in most advanced and sophisticated 5420-1 most advanced and sophisticated or cutter shape tip.In other embodiments, most advanced and sophisticated 5420 can have another kind of configuration, the oar shape configuration shown in for example most advanced and sophisticated 5420-2, the wherein most advanced and sophisticated width that can have greater than the diameter of member 5410-2.In the other places of this paper,, the additional detail relevant with the configuration of tip 5420 and/or member 5410 is described for example in conjunction with Figure 28-Figure 30.
Figure 23 shows the perspective view of spinal column, and sleeve pipe 5440 or other conductor be inserted in the back side of vertebra 12, and this for example is to utilize the instrument 5700 with shank 5710 to realize, described instrument is used to sleeve pipe 5440 is planted by pedicle of vertebral arch 24.Can utilize applicable to making device 5400 enter various types of sleeve pipes in the vertebra 12.
Figure 24 shows the cutaway view of the device 5000 that wrecks, and the described device that wrecks can use in combination or also can not use in combination with it with aforesaid sleeve pipe 5440.The device 5000 that wrecks can comprise slender member 5410, and described slender member is made into certain size so that by sleeve pipe 5440, for example by rigid member 5442 and member 5444.Sleeve 5422 or other member can be set at around the member 5410 and can be made into certain size and/or be located such that when device 5000 and advance vertically when entering in vertebral body or other bone, and the end 5512 of sleeve 5422 can contact with the near-end 5510 of the coupling 5446 of rigid member 5442.Sleeve 5422 can be attached on the member 5410 and/or can be slidably or adjustable on described member, thereby for example generator 5000 moves into required range of movement in the vertebra.
The near-end 5432 of member 5410 can be configured and be made into certain size as required so that engage with shank 5430, as for example in conjunction with Figure 26 describe in more detail ground.
Figure 25 is the opposite side view of the device 5000 that wrecks of use in vertebra 12.Slender member 5410, tip 5420 and sleeve pipe 5440 can be aforesaid forms.In this example, sleeve 5422 can be made into certain size so that be engaged in sleeve pipe 5410 inside.Sleeve 5422 can comprise teat 5433, and described teat can stretch out and extend longitudinally along the longitudinal axis of member 5410.This teat 5433 can be used to be provided for the limit stop device of device 5000, and this for example is to realize by described teat is contacted with the far-end of the rigid element 5442 of implant 5440 when bone 14 is pushed through the space 50 of sleeve pipe 5440 and vertebra 12 at device 5410.
Figure 26 is the top view of device 5000 of wrecking, and it is most advanced and sophisticated 5420 that the described device that wrecks has, and is describedly most advanced and sophisticatedly planted by sleeve pipe 5440 and is inserted in the vertebra 12 so that contact with bone 14 and described bone is wrecked.Device 5000 can comprise that sleeve 5422 or other mechanism are so that restriction or control most advanced and sophisticated 5420 penetrate the penetration depth (shown in " T ") of the cortical bone 14 on the anterior part that is positioned at vertebra 12.The far-end 5432 of slender member 5410 can for example carry out fastening with shank 5430 in recess 5434 or otherwise link.In certain embodiments, sleeve 5422 can contact with end 5432 at recess 5434 places.Recess 5434 and end 5432 can be configured and be made into certain size so as to carry out releasedly each other, adjustable ground or connect regularly.For example, recess 5434 can be threaded and end 5432 can have respective threads, thereby makes, can regulate for example penetration depth " T " of device by the amounts that adjustment end 5432 is set in the recess 5434 of shank 5430.
Figure 27 is being used for to carry out the side view of the dissociative device 5000 that wrecks at the bone of collapse position or the healing of fracture place of using in vertebral body 12.Device 5000 comprises aforesaid sleeve 5422, and sleeve can be used to limit tip 5410 moving by bone 14.For example under the situation that will may be had fragility or sensitive organization on every side, can wish to carry out this restriction by the disassociation zone.Arrow 1 expresses possibility impaired and can utilize method described herein to wreck and the zone of the bone 14 that may repair after a while.
As shown in figure 28, thereby can for example utilize hammer 2 that device 5000 is entered to install in the anterior part of vertebra 12 in 5000 the end insertion vertebra 12, describedly make device enter operational example in the anterior part of vertebra to utilize most advanced and sophisticated 5420 to realize in this way, described most advanced and sophisticated 5420 are configured to have sharp-pointed, half sharp-pointed or blunt tip so that contact with bone.That is, can for example utilize hammer 2 that device 5000 is impacted on bone.In other embodiments, vibrator or other device for example are attached on shank 5430 and/or the slender member 5410, and are used for making slender member 5410 for example longitudinally, move along moving in the vertebra 12 and towards impaired bone 14 laterally and/or along other direction.
Figure 29 shows the close-up side view of vertebra 12 and the device 5000 with slender member 5410 and most advanced and sophisticated 5420 and shows can be by means of the motions of device 5000 realizations, for example transverse movement 3 and lengthwise movement 4.
Figure 30 shows the sketch map that can be used to make multiple most advanced and sophisticated 1512,1522,1532 the example that bone wrecks.Figure 31 shows the top close-up view of member 5420-2 and most advanced and sophisticated 5420-2.Figure 31 shows the top view of the device 5410-2 that uses in vertebral body.Figure 32 A and Figure 32 B are dissimilar tip 1720 and 1722 close-up view.
As shown in figure 33, be used for cutting bone make the laser instrument 9000 of bone fracture or other instrument can replace chisel or the device 5000 that wrecks is used to or the impaired cortical bone 14 that except the described chisel or the device that wrecks, is used to make vertebral body 12b separately or otherwise wreck (Figure 34).Laser instrument 9000 can be made into certain size so that by sleeve pipe 2100 and enter in the interior section 50 of vertebra 12b.
Figure 35 shows has the sketch map of the vertebral body 12b of the cortical bone 14 of fracture again, and described fracture again for example is to utilize wreck device 5000 or laser instrument 9000 realizations.Thereby wreck device 5000 or laser instrument 9000 for example are removed from sleeve pipe 2100 being prepared so that end plate 20 and 30 reorientated in the process of the height that restores vertebral body 12b.
Restore vertebral height (step 1400)
Make in the step 1300 of Fig. 4 after the cortical bone 14 of vertebral body 12b fractures again or otherwise wreck, the distance between the height of vertebral body 12b or end plate 20 and 30 can increase towards the direction of normal height (for example height of the vertebral body 12b before injured).
In Figure 35 A-Figure 35 D, show an example of the method for restoring vertebral height in more detail.For example, Figure 35 A shows the sleeve pipe with partially flexible 6000 that is inserted in the vertebral body 12b.Sleeve pipe 6000 can comprise for example proximal structure 6100 and distal end members 6200, and described sleeve pipe and described after a while sleeve pipe 100 are same or similar.Can utilize rigid casing, pin, the trocar or other conductor 6500 so that help laying sleeve pipe 6000.For example, as those skilled in the art knownly, conductor 6500 can at first be inserted in the vertebral body by pedicle of vertebral arch, and described conductor can be made into certain size so that be engaged in the cavity 6300 of sleeve pipe 6000.Sleeve pipe 6000 can be subsequently slides on conductor 6500 and slides into the appropriate location, thereby makes distal end members 6200 by pedicle of vertebral arch 24 and enter in the core 50 of vertebral body 12b.
After inserting sleeve pipe 6000, conductor 6500 can be removed, shown in the step among Figure 35 B, thereby for example open the cavity 6300 of sleeve pipe 6000 so that be provided for the path in the core 50 of bent stick 6700 or another utensil, implant or implant insertion vertebral body.
Shown in Figure 35 C, the utensil that is used for the end plate that subsides of damaged vertebral body is reorientated can be planted by sleeve pipe 6000 subsequently.For example, bar 6700 can be planted by cavity 6300 and can be used to be pushed against on the upper end plate 20, and described bar can be crooked and have head 6750.Shown in Figure 35 C, bar 1130 can be advanced in the core 50 that enters vertebral body 12b, and thereby crooked bar 6700 can promote end plate 20 and 30 and make them separate the height of recovery vertebra 12b, for example restores to the height h2 shown in Figure 35 D from the height h1 shown in Figure 35 C.Bar 6700 can have and is different from Figure 35 C and the structure of constructing shown in Figure 35 D and can comprises more than one parts or element and can comprise the parts that the joint links to each other.
An embodiment who is used to strengthen the device of vertebra provides sleeve pipe in more detail.Figure 36 shows the sleeve pipe 100 with partially flexible, and described sleeve pipe can comprise rigid member 110 and flexible member 120.Flexible member 120 can link at connector/joint 130 places and rigid member 110, and this linking for example is forever to link or releasable linking.Rigid member 110 can be configured and be made into certain size so that insert in the vertebra, for example inserts in the core 50 of vertebral body 12 by pedicle of vertebral arch 24 from posterior approach.In certain embodiments, can form exodermis bone by vertebra 12, for example by pedicle of vertebral arch 24, hole 60, this for example realizes by brill, the trocar or other utensil.Joint 130 can be positioned at the inside or the outside position of the pedicle of vertebral arch 24 of vertebra 12, and in described joint, rigid member 110 links with flexible member 120.
As shown in figure 36, one, two or more sleeve pipes 100 can be inserted into or implant in the vertebral body 12.Utilizing under two telescopic situations, these two sleeve pipes 100 can all be used to instrument, implant and/or bone filler are introduced in the inside 50 of vertebra 12.The external diameter of sleeve pipe 100 can be for example between about 3mm and 12mm, and internal diameter can be between about 2mm and 10mm.Sleeve pipe 100 can have any Len req, for example between about 10 and 30cm between.The rigid member 110 of sleeve pipe 100 can have the length between about 20mm and 70mm, and can with or can be approximately not corresponding with the length of pedicle of vertebral arch 24 yet.Sleeve pipe 100 can comprise any material in rustless steel, metal, metal alloy, polymer, complex, pottery or its compositions.
Figure 37 provides in the sleeve pipe 100 shown in Figure 36 telescopic near-sighted top view, the described sleeve pipe pedicle of vertebral arch 24 by vertebra 12 of being planted.Especially, rigid member 110 is illustrated the pedicle of vertebral arch 24 of planting by vertebra 12.Rigid member 110 can link at connector 130 places and flexible member 120, and described connector just is positioned at the outside, the back side of vertebra 12.Rigid member 110 can comprise screw thread 112 or spine or further feature, and described screw thread or spine or further feature can help rigid member 110 is for example planted by vertebra 12.Rigid member 110 can further comprise by that point, jagged and/or toothed end (near-end) 111, thus described end can with or can be not do not work in combination yet and help carrying out boring and bore and pass through bone with screw thread 112.
Figure 38 and Figure 39 show the additional detail of sleeve pipe 100.In certain embodiments, rigid member 110 can have shaft portion 113, described shaft portion has and the about equal lengths of the width of pedicle of vertebral arch 24, thereby make rigid member 110 to be implanted fully in the pedicle of vertebral arch 24, for example making only has a fraction of rigid member to extend out from the pedicle of vertebral arch rear portion.Shown in the cutaway view of Figure 38, rigid member 110 and flexible member 120 can comprise columniform substantially wall portion 114 and 124 respectively, and described wall portion has internal diameter and external diameter and limits cavity 115 and 125 respectively.Cavity 115 and 125 can for example connect at connector 130 places, and forms the cavity 130 by whole sleeve pipe 100.
Referring to Figure 39, another embodiment of sleeve pipe 100 can comprise rigid member 110 and member 120.Yet, this mode that replacement connects by the connector 130 that allows member 120 and rigid member 110 disengagements to be connected, rigid member 110 and member 120 can be shaped as single type sleeve pipe 200.In such an embodiment, connector or joint 210 can comprise spine 215 or the further feature that telescopic flexibility or controlled bending are provided.More particularly, member 120 can similarly also have rigidity with rigid member 110, but has flexible joint 210 between rigid member 110 and 120.Member 120 also can present relative flexibility with respect to rigid member 110, the situation about being provided in other embodiment.
Figure 40 shows and is planted by access hole, the hole 60 in the pedicle of vertebral arch 24 for example, rigid member 110 parts of sleeve pipe 100.The length of rigid member 110 can be substantially corresponding to the length of pedicle of vertebral arch 24, and rigid member 110 will be planted by described pedicle of vertebral arch.One or more utensils 810,820 can be inserted in the interior section 50 of vertebral body 12 by sleeve pipe 100.Utensil can be as being straight substantially the utensil 810 or being curved as utensil 820.The flexible portion 120 of sleeve 100 (not being shown among Figure 40 for being convenient to see the purpose of utensil 810 and 820) allows crooked or curved implant or utensil plant are entered in the interior section 50 of vertebral body 12 by sleeve pipe 100 and pedicle of vertebral arch 24.Quilt is planted can be greater than straight implant or utensil 810 by the opereating specification 830 of the crooked implant of sleeve pipe 100 or utensil 820.
Figure 41 A and Figure 41 B show the example that curved utensil 300 and 302 is used in combination with rigid member 310 and 312 respectively. Rigid member 310 and 312 can be similar to above-mentioned rigid member 110 and have labelling independently herein so as the length of rigid member to be shown and the curvature of can be planted utensil by rigid member or bar between relation. Rigid member 310 and 312 can link with aforesaid flexible member 120, but for the purpose of illustrating briefly this flexible member 120 is not shown in the drawings.Rigid member 312 shown in Figure 41 B is obviously shorter than the rigid member shown in Figure 41 A 310.As shown in the figure, rigid member 312 can receive the rigid member 302 that rigid member that the rigid member that has and can more be grown 310 receives is compared bigger curvature.Therefore, can depend on the diameter of rigid member 310,312 length of (with 110), rigid member and the diameter of utensil or implant axle at least in part with the utensil of sleeve pipe 100 uses or the degree of curvature of implant.
Turn to Figure 42 A and Figure 42 B now, bent stick 500 can be configured to have required diameter and curvature so that cooperate sleeve pipe 100 by having partially flexible, and can for example be used for restoring the vertebral levels of subsiding in the vertebra 12.When bar 500 was planted in sleeve pipe 100, flexible member 120 can be crooked with bar 500, and rigid element 110 is used for retraining and the translation of limit rod 500 in vertebra 12.In certain embodiments, the near-end of bar can comprise sphere or spheroplast 510, and described sphere or spheroplast can enter the core 50 of vertebral body 12 and engage with the upper end plate 20 of vertebral body 12.Sphere 510 can be used to make bar 500 to have blunt end and pressure is dispersed on the bigger zone.When bar 500 was advanced, shown in Figure 42 B, the end 510 of bar 500 was pushed against on the end plate 20 and can increases vertebral height between upper end plate 20 and lower end plate 30.The end that has or do not have the bar 500 of sphere 510 also can compress the spongy bone in the vertebral body so that form space, space or cavity.
Therefore in certain embodiments, bar 500, or the part of bar 500 are having restored vertebral levels and having made lordosis remain on the appropriate position after resetting, so that the enhancing vertebral body.For example, one or more parts of bar 500, for example 510, can optionally separate with the remainder of bar 500, and as keeping being in the implants in the core 50 so that strengthen vertebral body 12.In other embodiments, additional utensil, implant, skeletal grain, bone cement and/or other implant material can use with bar 500 and/or sleeve pipe 100 in combination so that strengthen and/or cooperate vertebral height.
Utilizing after 500 pairs of vertebral bodys of sleeve pipe 100 and utensil such as bar reorientate, the some or all of sleeve pipes in the sleeve pipe 100 can remain on the appropriate position.For example, flexible member 120 can separate with rigid member 110, and rigid member 110 can remain on Intrapyramidal appropriate position.
As Figure 43 and shown in Figure 44, can utilize the multiple configuration of utensil and implant.For example, bar or other utensil can have any required form, and for example shape 610,620,630,640 or 650.Similarly, can have any required curvature with bar or other utensil that this sleeve pipe with partially flexible uses in combination, for example bar 710,720,730 as shown in the figure and 740 curvature that had.Each bar 740 can comprise spheroplast 741.
Strengthen vertebral body (step 1500)
Figure 45 shows bent stick 6800, and described bent stick can be used in aforesaid mode vertebra 12b be reorientated, and its king-rod 6800 can comprise and be positioned at proximal cover or spheroplast 6820, far-end for example, one or more holes 6810 of position.Hole 6810 can be used to remove bone material or bone cement or other bone filler are introduced in the space 50 from vertebra, thus vertebral body for example fixing or that enhancing resets.For example, hole 6820 can be communicated with the hollow cavity 6830 of bar 6800, and bone filler, cement, skeletal grain etc. can be by injection by described hollow cavities.Situation about being envisioned is, bone filler, bone cement, skeletal grain etc. can be inserted into bar 6800 simultaneously so that the end plate of vertebra is reorientated, and also Yu Xiang situation is, bone filler, bone cement, implant and skeletal grain etc. can not be applied to any power on the bar so that be inserted in the damaged vertebra under the situation that end plate is reorientated.
In other embodiments, as shown in figure 46, curved utensil, for example curved rod can be removed from vertebra 12b.Pin 6900 and/or conduit or sleeve pipe can be planted by sleeve pipe 2100 subsequently, thereby for example bone filler, skeletal grain, bone cement or homologue are injected in the vertebra.Bone filler, skeletal grain, bone cement, implant or other intensifier can be inserted in the vertebra under not carrying out described situation of reorientating under the situation of at first end plate of damaged vertebra being reorientated or also, and can be inserted under the effect of sufficient force so that at utensil that need not be other or install under the situation of help vertebral endplate is reorientated.
In certain embodiments, to such an extent as to required implant material may be too thick or comprise the bar 6800 that can't be transmitted through too greatly as shown in figure 45 or the granule of syringe needle as shown in figure 46 6900.In this case, granule or other nonfluid implant material can install by means of other, for example utilize auger conveyor or are used for transmitting other device of implant material, and be inserted in the vertebral body 12b.
Figure 47 shows the example of device 10000 and 10100, described device comprises can be from auger conveyor 10200 (the MEVA Shaftless Screw Conveyor (not having the axle auger conveyor) of commercial acquisition, VoR Environmental, Botany, NSW is Australia) with 10300 (Spiroflow Flexible Screw Conveyor (flexible auger conveyor), SpiroflowInc., Monroe is NC) so that transmission granular materials 10400.The screw feature of this helical feed apparatus can be suitable for or be used to transmit the implant material so that strengthen vertebral body 12.Compare with for example injecting by syringe, this auger conveyor mechanism is transmission implant material under lower pressure for example.The fracture vertebra is being carried out utilizing in the enhanced process lower pressure can help avoid the leakage of implant material.
Figure 48 shows the example of the helical feed apparatus 11000 that is used to strengthen vertebral body 12.Hopper 11100 can be suitable for keeping and will for example be inserted into Intrapyramidal implant material by sleeve pipe 2100, and described sleeve pipe is inserted in the vertebral body in aforesaid mode.Hopper 11100 can for example be communicated with the cavity 2110 of sleeve pipe 2100 by valve 11200.Screw 11500 can be from valve 11200 by sleeve pipe 2200 and enter in the core 50 of vertebral body 12.Can be for example with manual mode or utilize the motor (not shown) that crank 11300 or other mechanism are rotated so that rotating screw 11500.In rotary course, can enter the space between the screw thread 11510 of screw 11500 and be transmitted and be transmitted from the implant material 11400 of hopper 11100 and enter in the space 50 along the length of screw 11500.
Those skilled in the art will recognize: each step in step as herein described, the method and apparatus, every kind of method, every kind of equipment can various compound modes and/or are used in combination with various other method and apparatus.For example, the external member that is used for implementing one or more steps of method as herein described or part can comprise the assembly described herein that is in one or more packaging parts and the various combinations of parts.A kind of external member can comprise, for example one or more sleeve pipe, the device that wrecks, external fixator and the implant or the implant material that are used for strengthening bone.This embodiment also can comprise and be used for fluid, quasi-viscous fluid or nonfluid implant material are injected Intrapyramidal one or more syringe, carrier or miscellaneous equipment.
At another embodiment that is used for strengthening vertebral body, utensil 13000 as shown in figure 49 can be used to that spinal column is carried out microinvasion formula lordosis and corrects.Utensil 13000 can comprise at least two body sections 13100, and described at least two body sections are joined together by joint 13200.Joint between the body section is the joint of globe joint, universal joint or some other types preferably.Joint preferably allows the body section relative to each other to carry out the multiaxial type rotation, or provides at least around a rotation or the pivot that axis carries out.Body section 13100 can have cylinder form.Another kind of optional mode is that the body section can be flat or have other section shape.The body section is preferably inflexible so that the thrust that is applied on the near-end 13001 of utensil 13000 will be transferred into far-end 13002.Elongated member 13300 can be made by metal, polymer pottery, composite or its compositions.
In addition, those skilled in the art is to be appreciated that the length of body section can change.Tinsel, filament or other elongated member, preferred flexible elongated member 13300 can be connected to foremost or the body section 13100a of far-end.Utensil 13000 foremost or this term of the part of far-end refer to the utensil end 13002 that is positioned at away from the position of the part that grips by the surgeon.Yet the tail end of utensil 13000, rear end or far-end 13001 refer to the utensil end that is not arranged in the vertebral body that is gripped by the surgeon.
Normal position or static position in the body section, when not applying power on elongated member 13300, body section 13100 and joint 13200 are constructed such that preferably body section 13100 aligns along the longitudinal axis 13003 of straight line or utensil 13000.When slender member 13300 when pulled, the body section 13100 that is positioned at far-end 13002 places no longer overlaps with longitudinal axis 13003, thereby makes bending section 13004 occurred in utensil, elongated member 13300 is attached at described far-end.
For using appliance 13000, sleeve pipe 2100 is planted passes through the pedicle of vertebral arch (Figure 50) of fracture vertebral body 12.Utensil 13000 is planted by sleeve pipe 2100, thereby makes the far-end 13002 of utensil 13000 be positioned in the body interior (Figure 51) of the vertebra 12 that subsides.By applied thrust on near-end 13001 along sleeve pipe 2100 plant utensils 13000.Utensil 13000 has enough hardness, is transmitted so that described utensil is moved in sleeve pipe 2100 and enter in the vertebral body along utensil 13000 thereby exert all one's strength.Can be subsequently by spurring far-end 13002 bendings that make utensil 13000/be raised along direction towards the near-end 13001 of utensil 13000 at elongated member 13300 places (Figure 52).If apply enough power, thereby therefore the end plate 20,30 of the vertebral body 12 of then subsiding can be pushed separately owing to body section 13100 is applied to power on the end plate 20,30, and vertebral body can restore its original height (Figure 48).In addition, around the far-end 13002 of utensil 13000 or compacted around the bone that is arranged in vertebral body 12 of distal-most end body section 13100a, this can reduce the risk that cement leaks.Mobile end plate 20,30 and/or compress bone and can in vertebra, form cavity 51.
Figure 54-Figure 56 shows the different institutions of the elongated member 13300 that is used to spur utensil 13000.The part that these different institutions can form utensil 13000 maybe can be the stand-alone assembly that uses in combination with utensil 13000.
Figure 54 shows a kind of roll 14000 that can be used to spur elongated member 13300.Roll 14000 can comprise two supporting members 14300 that are attached on the platform 14200, and axostylus axostyle 14400 is attached on two supporting members 14300.Knob 14100 is attached on this axostylus axostyle and can be used to make this axostylus axostyle rotation, thereby spurs elongated member 13300, and promotes the far-end 13002 of utensil 13000 thus.
Figure 55 shows screw nut assembly 15000.Screw nut assembly 15000 can form the afterbody part of utensil 13000 or be attached on the near-end 13001 of utensil 13000.Screw nut assembly 15000 can comprise threaded axle 15100, nut 15200 and sheath body 15300.Elongated member 13300 can be connected to threaded axle 15100.By the rotating screw nut assembly, owing to moving with respect to nut 15200 and sheath body 15300, threaded axle 15100 makes that elongated member 13300 is back spurred, promoted the far-end 13002 of utensil 13000 thus.Along with distal end sections 13100a is bent and promotes,, joint 13200 makes that body section 13100 relative to each other is that the joint links to each other owing to allowing to move.Can apply biasing force by joint 13200 by means of for example spring member, thereby keep the body section to bias to normal resting position, in described normal static position, body section 13100 is on straight line or axis 13003 alignment longitudinally.Although longitudinal axis 13003 is illustrated as straight line in the drawings, should be appreciated that longitudinal axis 13003 can also be a curve.
Similarly, Figure 56 shows screw assembly 16000.Screw assembly 16000 can comprise screw 16100 and sheath body 16200.One end of elongated member 13300 is connected to screw 16100.When screw 16100 was rotated, elongated member 13300 was correspondingly back spurred, and promoted the far-end 13002 of utensil 13000 thus.
Figure 57 A-Figure 57 C shows other configuration of utensil 13000.According to applicable cases, the quantity of body section 13100 and joint 13200 can change.Figure 57 A shows the utensil 13000 with three body sections 13100 and two joints 13200.Figure 57 B shows the utensil 13000 with two body sections 13100 and a joint 13200, and Figure 57 C shows the utensil 13000 with five body sections 13100 and four joints 13200.
Figure 58 A and Figure 58 B show spendable two kinds of dissimilar joints 13200.Figure 58 A shows universal joint 13201, and Figure 58 B shows globe joint 13202.Yet, should be contemplated to: the joint that can utilize other type and configuration.Those skilled in the art is to be appreciated that joint 13200 can be made into certain size and be configured so that to be rotated around x, y and/or z axis.
In another optional embodiment of the present invention, the utensil 1700 except one or more joints can be made of polymer, or described utensil 1700 can constitute (Figure 59) by memorial alloy (for example Nitinol (Ultimum Ti)).When elongated member 17200 when pulled, the far-end of portion's section 17100 of utensil 17000 is bent upwards, so that far-end produces lateral shift from the home position along the longitudinal axis of utensil, thereby the end plate of the vertebral body that promotes thus to subside makes it separately and make vertebral body restore its original height.
In another embodiment of the present invention, the utensil 18000 shown in Figure 60 can comprise main body section 18100, at least one adjustable section 18200 (Figure 60 shows two adjustable section) and elongated member 18300.Utensil 18000 also can comprise mechanism 18400 so that pulling elongated member 18300 promotes adjustable section 18200 thus.
Although the present invention and advantage thereof are described in detail, should dissociate, can under the situation that does not depart from the spirit and scope of the present invention that limit by appended claims, make various changes, equivalent substitution and other optional mode to the present invention.In addition, the application's scope is not intended to be limited to the specific embodiment of the technology described in the description, machine, manufacture process, material composition, device, method and step.Those skilled in the art will be easy to recognize by disclosure content of the present invention: can utilize the present existence or the technology that will develop after a while, machine, manufacture process, material composition, device, method or the step that have realized identical functions substantially with corresponding embodiment as herein described or obtained identical substantially result according to the present invention.Therefore, appended claims is intended to comprise this technology, machine, manufacture process, material composition, device, method or step in its scope.
Although up to the present under the background that makes vertebra be relocated, wreck and be enhanced under the situation that the distortion of vertebral compression fractures and spinal curvature will occurred, equipment as herein described and method are described, but also envisioned various other purposes and method, for example long bone, rib and other framing structure have been reorientated and strengthen.Further, in certain embodiments, can utilize conduit to insert implant, the one or more flexible chain link of the body that for example links with partially flexible.Bone cement, skeletal grain or other implant also can be used for helping to strengthen.In other embodiments, can insert another implant 3430.
In certain embodiments, implant as herein described and method can be used so that lordosis resets and strengthens vertebral body in combination with miscellaneous equipment and method.For example, one or more sleeve pipes 100 with partially flexible can with other known process, for example vertebroplasty or sacculus kyphoplasty art, use in combination, described other known process can be used to start the space of reorientating and/or be formed for implant in vertebral body that vertebral body is carried out.
In other embodiments, various microinvasion formula implants and the method that is used for alleviating the discomfort relevant with spinal column can adopt anchoring piece as herein described and other implant.For example, comprise the implant of one or more bodies that link can the spinous process of implanted adjacent vertebrae between so that strut this spinous process and alleviating pain and for example cause the other problem that occurs by spinal canal stenosis, joint of lumbar vertebra disease and similar conditions, described implant for example is positioned at the expandable container (not shown).For example, enhancing as herein described system can replace in U.S. Patent Publication No. 2004/018128 and license to the U.S. Patent application 6 of Zucherman etc., 419, expansible intervertebral spinous process equipment and the method described in 676 are used, and perhaps use enhancing as herein described system except described equipment and method.
Although the description of front and accompanying drawing have shown a plurality of preferred embodiment of the present invention, be appreciated that and under the situation of the spirit and scope of the present invention that do not depart from the appended claims qualification, make various append modes, modification and alternative.Especially, it will be apparent to those skilled in the art: under the situation that does not depart from spirit of the present invention or essential characteristics, the present invention can other particular form, structure, layout, ratio and implement by other element, material and parts.At present the embodiment that discloses therefore all be considered to exemplary in all respects and and nonrestrictive, scope of the present invention is limited by appended claims, and is not limited to top description.
Claims (20)
1, a kind of equipment that vertebra is reorientated of being used for, described equipment comprises:
At least one slender member, each slender member in the described slender member has first end and second end, and wherein described first end of each slender member is configured in order to insert in the vertebral body;
Fixed bar with bowed shape; With
At least one anchor clamps, described at least one anchor clamps are configured in order to the described second end adjustable ground with a slender member in the described slender member and are fastened on the described fixed bar,
Wherein, described slender member pivots thereby described anchor clamps are configured in order to move along described fixed bar reorientates vertebral body.
2, equipment according to claim 1 further comprises the shank that closes with described second termination of described slender member.
3, equipment according to claim 1, wherein two or more slender members are tubular body, described tubular body has the cavity along its length.
4, equipment according to claim 1, wherein:
Described fixed bar comprises a plurality of surface character of arranging along the longitudinal axis of described fixed bar; And
Described anchor clamps have first configuration, in described first configuration, described anchor clamps can move up in first party along the described longitudinal axis of described fixed bar, and engage so that prevent with described surface character and to move up in second party along the described longitudinal axis of described fixed bar.
5, equipment according to claim 4, wherein said anchor clamps comprise button and have second configuration that wherein said button makes the described surface character of described anchor clamps and described fixed bar be disengaged and allow described anchor clamps to move along described second direction.
6, equipment according to claim 1, further comprise sleeve pipe, described sleeve pipe has first end, second end and provides from described first end and arrives the cavity of the path of described second end by described sleeve pipe, and described first end is configured to insert in the fractured vertebral body.
7, equipment according to claim 1, wherein said slender member comprise at least a in the following material group, and described material group comprises rustless steel, metal, metal alloy, polymer, complex, pottery or its compositions.
8, a kind of method that is used for the treatment of damaged vertebral body said method comprising the steps of:
In the zone, apply power so that the lordosis in the damaged vertebral body zone resets;
Make described damaged vertebral body fracture;
Restore the height of described damaged vertebral body; And
Strengthen described vertebral body.
9, method according to claim 8, the wherein said step that lordosis is resetted comprises:
First slender member is inserted in first vertebral body, and first end of wherein said first vertebral body and described damaged vertebral body is adjacent;
Second slender member is inserted in second vertebral body wherein said second vertebral body and described damaged vertebral body adjacent with the described first end second opposed end;
Move described first slender member so that change the position of described first vertebral body with respect to described damaged vertebral body; And
First slender member is positioned on the fixed bar.
10, method according to claim 9 wherein was positioned at described slender member on the described fixed bar before moving described first slender member with respect to described damaged vertebral body.
11, method according to claim 9, wherein said mobile step comprise with respect to described damaged vertebral body described first slender member are positioned.
12, method according to claim 9, wherein said positioning step comprise by first anchor clamps described first slender member are fastened on the arc fixed bar.
13, method according to claim 12, wherein said mobile step comprises:
Described first anchor clamps and described fixed bar are disengaged;
Described slender member is pivoted; And
Described first anchor clamps are engaged again so that the position of fixing described first vertebral body with described fixed bar.
14, method according to claim 12, wherein said mobile step comprises the position of moving the described anchor clamps that are connected to described slender member along the described longitudinal axis of described fixed bar.
15, method according to claim 12, the wherein said step that lordosis is resetted further comprise sleeve pipe inserted in the described damaged vertebral body and with described sleeve pipe and are fixed on the described fixed bar.
16, method according to claim 8, the wherein said step of described damaged vertebral body fracture that makes comprises:
By means of posterior approach sleeve pipe is inserted in the described damaged vertebral body, described sleeve pipe has cavity, and described cavity is made into certain size and enters described Intrapyramidal path so that provide;
The device that will wreck is planted by described sleeve pipe; And
Utilize the described device that wrecks to make described damaged vertebral body fracture.
17, method according to claim 8, the step of the height of the described damaged vertebral body of wherein said recovery comprises:
Sleeve pipe is inserted in the described damaged vertebral body, and described sleeve pipe has cavity, and described cavity is made into certain size and enters described Intrapyramidal path so that provide;
Plant instrument by described sleeve pipe and insert in the described vertebral body; And
Move the end plate of described damaged vertebral body so that restore the height of described damaged vertebral body by described instrument.
18, method according to claim 17, wherein:
The instrument of coming in and going out comprises the curved rod with longitudinal axis and the far-end that is configured to contact with bone; And
The described step that moves described end plate comprises that described curved rod is advanced makes described end plate contact with the far-end generation of described curved rod by described sleeve pipe, and by the described longitudinal axis along described curved rod apply power move described end plate make its away from the relative end plate of described vertebra so that described vertebral endplate is reorientated.
19, method according to claim 8 further is included in and implements before the described reconstitution steps sleeve pipe to be inserted in the described damaged vertebral body, and described sleeve pipe has cavity, and described cavity is made into certain size and enters described Intrapyramidal path so that provide.
20, method according to claim 8 was wherein implemented described fracture step before the described step that lordosis is resetted.
Applications Claiming Priority (9)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US72577305P | 2005-10-12 | 2005-10-12 | |
| US60/725,773 | 2005-10-12 | ||
| US60/726,835 | 2005-10-13 | ||
| US60/728,442 | 2005-10-19 | ||
| US60/730,909 | 2005-10-27 | ||
| US60/733,026 | 2005-11-03 | ||
| US11/471,169 | 2006-06-19 | ||
| US11/523,202 | 2006-09-18 | ||
| US11/527,280 | 2006-09-25 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN101330878A true CN101330878A (en) | 2008-12-24 |
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ID=40206345
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CNA2006800467648A Pending CN101330878A (en) | 2005-10-12 | 2006-10-11 | Apparatus and methods for vertebral augmentation |
Country Status (2)
| Country | Link |
|---|---|
| CN (1) | CN101330878A (en) |
| ZA (1) | ZA200803706B (en) |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN108814658A (en) * | 2018-06-27 | 2018-11-16 | 中国人民解放军陆军军医大学第三附属医院（野战外科研究所） | One kind opening cranium device and opens cranium method |
| CN110680423A (en) * | 2014-03-19 | 2020-01-14 | 华沙整形外科股份有限公司 | Surgical instruments and methods |
-
2006
- 2006-10-11 ZA ZA200803706A patent/ZA200803706B/en unknown
- 2006-10-11 CN CNA2006800467648A patent/CN101330878A/en active Pending
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110680423A (en) * | 2014-03-19 | 2020-01-14 | 华沙整形外科股份有限公司 | Surgical instruments and methods |
| CN108814658A (en) * | 2018-06-27 | 2018-11-16 | 中国人民解放军陆军军医大学第三附属医院（野战外科研究所） | One kind opening cranium device and opens cranium method |
| CN108814658B (en) * | 2018-06-27 | 2021-10-01 | 中国人民解放军陆军军医大学第三附属医院（野战外科研究所） | Craniotomy device and craniotomy method |
Also Published As
| Publication number | Publication date |
|---|---|
| ZA200803706B (en) | 2009-03-25 |
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Open date: 20081224 |