CN101404957B - 后路关节置换装置 - Google Patents
后路关节置换装置 Download PDFInfo
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- CN101404957B CN101404957B CN200780010039XA CN200780010039A CN101404957B CN 101404957 B CN101404957 B CN 101404957B CN 200780010039X A CN200780010039X A CN 200780010039XA CN 200780010039 A CN200780010039 A CN 200780010039A CN 101404957 B CN101404957 B CN 101404957B
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- Prior art keywords
- pole
- articular portion
- prosthetic appliance
- section
- joint
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Abstract
一种从后路植入上椎骨和下椎骨之间所限定的椎间隙内的假体装置(20)，所述装置包括：上关节部分(22)，它被构造成至少部分地设置在椎间隙内；以及，下关节部分(24)，它被构造成至少部分地设置在所述上关节部分下方的椎间隙内，所述上下关节部分被构造成提供所述上下椎骨的关节运动。上下关节部分可各自包括后侧区段(28)，所述后侧区段被构造成设置在所述椎间隙后侧的位置中。所述上下关节部分中的一个的后侧区段可包括支杆(SO)，所述上下关节部分中的另一个可包括接纳部(70)，接纳部被构造成在关节运动期间与所述支杆相互作用。
Description
技术背景
盘关节成形术是治疗受损、退化或患病脊柱盘的一种方法。一些盘关节成形术治疗包括用保留运动的脊柱盘替换受损的盘关节，这样的脊柱盘允许脊柱关节一定程度的关节连接或运动。虽然插入的盘可为患者提供关节连接，但插入脊柱盘的过程是侵入性的强力手术疗法。例如，前路手术常常需要将诸如大动脉和静脉之类的器官移位，必须非常小心地进行。而且，因为外科手术部位周围可能生长瘢痕组织，任何必需的二次处理都将更加困难，并且可能导致患者额外的痛苦。
需要的是能够从后侧位置安装的用于插入椎间隙的假体装置。本文所述的后路关节置换装置克服了现有技术的一种或多种问题。
发明内容
在一个示例性的方面，所述内容涉及一种假体装置，该装置用于从后路放置到上椎骨和下椎骨所限定的椎间隙内以提供上下椎骨的关节运动。所述装置可包括上关节部分，它被构造成能至少部分地设置在椎间隙内。它还包括下关节部分，它被构造成能至少部分地设置在上关节部分下方的椎间隙内。
上下关节部分可被构造成能为上下椎骨提供的关节运动。
一方面，上下关节部分各自包括后侧区段，所述后侧区段被构造成能设置在所述椎间隙后侧的位置中。所述上下关节部分之一的后侧区段可包括支杆，所述上下关节部分中另一个的后侧区段可包括接纳部，所述接纳部被构造成能在关节运动期间与所述支杆相互作用。
另一方面，所述上下关节部分中至少一个可结合有至少一个连接孔。所述上下关节部分中的所述至少一个可限定纵向中线，所述至少一个连接孔沿所述中线对齐。
在另一个示例性的方面，描述了一种用于放置到上椎骨和下椎骨之间所限定的椎间隙内以提供上下椎骨关节运动的关节置换装置。该关节置换装置可包括第一关节置换装置和第二关节置换装置。所述第一和第二关节置换装置可各自包括：上关节装置，它被构造成能至少部分地设置在椎间隙中；下关节装置，它被构造成能至少部分地设置在椎间隙中。所述上下关节部分被构造成能为上下椎骨提供关节运动。所述上下关节装置各自具有中线以及沿所述中线对齐的螺钉孔。
在又一个示例性的方面，描述了一种用于放置到上椎骨和下椎骨之间所限定的椎间隙内以提供上下椎骨关节运动的关节置换装置。该关节置换装置可包括：第一关节置换装置，它被构造成能至少部分地植入所述椎间盘间隙内；和第二关节置换装置，它被构造成能至少部分地植入邻近所述第一关节置换装置的椎间盘间隙内。所述第一和第二关节置换装置可大致相同，从而每一个都可植入椎间盘间隙的右侧或左侧中的任一个。
在一些示例性的方面，本文所述的关节置换装置可包括以下现有专利申请中所述的一个或多个特征，这些申请的内容以参考的方式结合于此：
2005年1月7日提交的题为“脊柱关节成形装置和方法(Spinal ArthroplastyDevice and Method)”的美国专利申请11/031,602；
2005年1月7日提交的题为“双重关节运动脊柱装置和方法(DualArticulating Spinal Device and Method)”的美国专利申请11/031,603；
2005年1月7日提交的题为“裂口脊柱装置和方法(Split Spinal Device andMethod)”的美国专利申请11/031,780；
2005年1月7日提交的题为“互联脊柱装置和方法(Interconnected SpinalDevice Method)”的美国专利申请11/031,904；
2005年1月7日提交的题为“支持结构装置和方法(Support StructureDevice and Method)”的美国专利申请11/031,700；
2005年1月7日提交的题为“活动承重脊柱装置和方法(Mobile BearingSpinal Device and Method)”的美国专利申请11/031,783；
2005年1月7日提交的题为“中央关节运动脊柱装置和方法(CentrallyArticulating Spinal Device and Method)的美国专利申请11/031,781；和
2005年1月7日提交的题为“后路脊柱装置和方法”的美国实用新型专利申请11/031,903。
附图说明
图1是一部分脊柱的侧视图。
图2是限定椎间隙的一对相邻椎体的侧视图。
图3是设置在相邻椎体之间的椎间假体装置的视图。
图4是下椎体上的椎间假体装置的俯视图。
图5是显示椎体之间的椎间假体装置的内部特征的视图。
图6、7和8a-8c是椎间假体装置的视图。
图9是包括偏置构件的椎间假体装置的视图。
图10-12是根据另一方面的椎间假体装置的视图。
图13-15是设置在椎体之间的图10-12所示椎间假体装置的视图。
图16是根据图10-12所示装置的另一方面的椎间假体装置的视图。
具体实施方式
本发明一般涉及脊椎重建装置，更具体地涉及用于植入的椎间假体装置。为了促进对本发明原理的理解，现在将参考附图所示实施方式或实施例并用具体语言来描述这些实施方式或实施例。然而应理解，这不是对本发明范围的限制。对所述实施方式的任何改变或进一步改进，以及本文所述本发明原理的任何其他应用都是本领域所属领域的技术人员通常所明白的。
图1示出了脊柱10的一部分的侧视图，显示被天然椎间盘D1、D2、D3隔离的一组相邻的上下椎骨V、V2、V3、V4。显示四个椎骨仅仅是示例性的。其他的例子也可以是骶骨和一个椎骨。
为了进一步的示例，现在将参考图2讨论两个椎骨。两个椎骨形成脊柱节段12，包括上椎骨14和下椎骨16。一些类型的盘关节成形术需要通过关节切除术或类似的外科手术去除一些或所有位于两个椎骨14、16之间的天然盘。切除患病或退化的盘可导致上下椎骨14、16间形成椎间隙S。虽然图2将椎骨关节12大致描绘成腰椎关节形式，但应理解，所述装置、系统和方法可应用于脊柱的所有区域，包括颈区和胸区。
一些常规的脊柱假体装置使用前路手术方法安装，需要医师采用令人痛苦的有时甚至是创伤性的手术以到达脊柱。一旦采用前路手术安装假体，敏感管路上可能形成瘢痕组织。如果需要第二次手术，医师可能需要切除瘢痕组织以到达先前设置的假体。该敏感性手术可能导致患者额外的痛苦。本文所述的椎间假体装置优于现有技术的装置，因为它可采用后路手术进行安装。因此，医师无需接触和扰乱位于脊柱前侧的关键导管。而且，如果需要第二次的手术，医师能够容易地到达先前设置的假体而不需要切除敏感管路上的瘢痕组织。因而简化了手术过程，并且患者痛苦程度较小。后路植入手术常常包括切除小平面关节或棘突。因为关节和棘突起韧带和肌肉的连接位置的作用，所以切除它们可能限制了关节在控制关节运动的程度或范围方面的能力。因此，通过后路手术植入的常规假体装置能提供关节运动，但在很大程度上不受控制。切除肌肉和韧带后，修复的关节可能变得松软。本文所述的椎间假体装置能够限制关节范围，从而为脊柱提供更大的稳定性和更多的控制。
图3显示了椎骨14、16的侧视图，椎间假体装置18位于盘间隙S中。盘18允许椎骨14相对于椎骨16关节运动，以提供脊柱关节的运动。以类似于天然椎间盘(例如盘D1-D4)的方式尺寸匹配盘间隙高度，假体盘18为椎骨提供支撑和稳定性。
图4-8是显示假体盘18的至少一部分的一组视图。图4显示了位于椎骨16上的假体盘18的俯视图。图5显示了位于椎骨14、16上的假体盘18的视图，不过，椎骨被分开以显示假体盘18的内部特征。参考图4，假体盘18可包括一对假体装置，包括左侧假体装置20和右侧假体装置21，它们协同作用以取代天然盘。虽然认识到假体盘18可包括一个以上的假体装置，但以下的描述主要针对左侧假体装置20。容易明白，假体盘18的右侧假体装置21在结构和功能上基本类似于左侧假体装置20，因此不再详细描述。
参考图4-8，假体装置20包括上关节部分22和下关节部分24。上关节部分22包括盘间区段26、后侧区段28以及在盘间区段26和后侧区段28间延伸的桥接件30。类似地，下关节部分24包括盘间区段32、后侧区段34以及在盘间区段32和后侧区段34间延伸的桥接件36。
上下关节部分22、24可由任何合适的生物相容性材料构成，包括如钴-铬合金、钛合金、镍钛合金和/或不锈钢合金之类的金属。陶瓷材料如铝氧化物或氧化铝、锆氧化物或氧化锆、金刚石微粒压实物和/或热解碳也是可以的。也可使用聚合物材料，包括聚芳基醚酮(PAEK)家族中的任一种，例如聚醚醚酮(PEEK)、碳增强型PEEK、或聚醚酮酮(PEKK)；聚砜；聚醚酰亚胺；聚酰亚胺；超高分子量聚乙烯(UHMWPE)；和/或交联的UHMWPE。构成上关节部分22和下关节部分24的各个区段可由不同的材料构成，从而形成金属在金属上，金属在陶瓷上，金属在聚合物上，陶瓷在陶瓷上，陶瓷在聚合物上，或聚合物在聚合物上的结构。
在所示示例性的实施方式中，所述上下关节部分22、24分别由单一片材一体成形或铸型。在其他实施方式中，所述上关节部分22或下关节部分24中的盘间区段、后侧区段和桥接件中的一个或多个可分别成形并附连于一个或多个其他部分。这些实施方式中的附连可采用本领域已知的任何紧固机构来实现，包括例如螺纹连接、螺栓连接、或掣子连接。在这些实施方式中，盘间区段、后侧区段和桥接件也可由不同的材料形成。
上关节部分22的盘间区段26可包括骨接触表面38和在骨接触表面38对侧的内表面44。第一关节表面42可形成内表面44的一部分。在所示实施方式中，第一关节表面为凹面。类似地，下关节部分24可包括在内表面48对侧的骨接触表面40，第二关节表面46形成内表面48的一部分并被构造成与第一关节表面42相匹配。在所示实施方式中，第二关节表面46是凸面。第一和第二关节表面42、46一起形成允许上下关节部分22、24相互关节运动的联接关节。这种关节运动又能实现上椎骨14相对于下椎骨16的关节运动，并且在一些实施方式中，能实现类似于天然脊柱盘所提供的运动。在所示实施方式中，第二关节表面46是能够在第一关节表面42内旋转或平移的部分球形，形成松散约束的球窝型接头。虽然所示为球窝型接头，第一和第二关节表面42、46也可以是允许上下关节部分22、24之一相对于上下关节表面22、24中的另一个发生运动的任何形状或设计。例如，第一和第二关节表面42、46可包括沟槽和凹槽，球和球托，或其他形状特征。
如图5所示，一旦植入，盘间区段26可沿上椎骨14下表面定位，而盘间区段32则在下椎骨16上表面上方定位。然而，本领域普通技术人员应理解，两个盘间区段26、32并不限于这种排列，它们也可以采取与所示形式不同的位置取向和/或不同的形状。
上下关节部分22、24的骨接触表面38、40可包括能加强所植入的假体装置20的固定的特征或涂层。例如，表面38、40可通过化学蚀刻、小珠冲击、砂纸打磨、研磨、锯齿化和/或金刚石切割等方法进行粗糙化处理。还可用生物相容性的骨诱导材料如羟基磷灰石(HA)、磷酸三钙(TCP)和/或碳酸钙涂覆上下关节部分22、24骨接触表面28、40的所有部分或其一部分，以促进骨生长和固定。或者，可使用以下物质作为骨诱导性涂层：来自转化生长因子(TGF)β超家族的蛋白质，或骨形态发生蛋白如BMP2或BMP7。其他合适的特征可包括道钉、突脊和/或其他表面构造。
在所示示例性的实施方式中，在骨接触表面38、40上分别形成任选的上下骨连接件50、52。这些骨连接件50、52以有助于上下关节部分22、24设置到位的方式朝上下椎骨14、16延伸。在所示实施例中，骨连接件50、52是龙骨，它们被构造成能延伸到椎骨终板中所形成的凹口或开槽内。虽然显示为沿上下关节部分的大部分长度延伸，骨连接件50、52也可以是任意长度，比所示更长或更短，此外也可具有除所示之外的一些其他取向或特征。例如，在一些实施方式中，骨连接件是一系列的突脊、凸起或有助于使假体装置20固定到位的其他表面特征。
在所示实施方式中，上关节部分22还包括用于附连于椎骨14的附加特征。例如，上关节部分22包括连接孔54(最佳地如图6和7所示)，它被构造成够接纳骨紧固件56(如图3和4所示)，例如螺钉。连接孔54可被设置在盘间区段26后部附近，使骨紧固件56可穿过孔54而进入椎骨14的椎体后部。在其他实施方式中，连接孔54可位于其它位置，只要孔54中的骨紧固件56有助于使假体装置20保持到位即可。在所示实施方式中，下关节部分24不包括连接孔。然而，在其他实施方式中，可包括一个或多个连接孔。
桥接区段30、36分别从盘间区段26、32向后延伸。在所示实施方式中，桥接区段30、36基本沿假体装置20的纵向中线58(图7)延伸。在其他实施方式中，桥接区段不与盘间区段的纵向中线对齐，而是弯曲或倾斜以偏离所示纵向中线。
后侧区段28、34可位于桥接区段30、36的末端，它们被构造成能够匹配到椎骨14、16的棘突附近。下关节部分24的后侧区段34可包括支杆60，支杆60具有桥接端62和尾端64。支杆60可被构造成大致沿脊柱的方向延伸。
支杆60的桥接端62可连接于桥接区段36。在所示实施方式中，支杆60的桥接端62由桥接区段36的一段弯曲形成，包括陷到桥接区段36水平下方的凹陷65。支杆60可向上延伸，使得支杆60的尾端64被设置在比桥接区段36高的位置。尾端64包括止动件66，它被构造成能够限制上下关节部分22、24之间的关节运动范围。在所示实施方式中，止动件66是支杆60中的一段弯曲，其长度被构造成能够与上关节部分22一起作用以限制上下关节部分22、24的关节旋转所能实现的范围。应该注意的是，支杆60可包括在桥接端62和尾端64间延伸的直线段。在一个示例性的实施方式中，支杆60可包括与凸起的关节表面46的曲率同中心的曲线。
上关节部分22的后侧区段28包括翼片68，翼片68中形成孔70，孔70被构造成接纳下关节部分24的支杆60。在所示实施方式中，孔70是矩形孔，其宽度w(图7)比尾端64的长度小。翼片68的一部分形成止动件69，它被构造成与支杆60上的止动件66协同作用。因此，当上下关节部分22、24如图6所示组装后，止动件66和止动件69协同作用以限制假体装置20的关节运动范围。此外，孔70被构造成当关节表面42、46相匹配时，支杆60可延伸穿过孔70，其延伸方式为在所述范围内仍然能够自由进行关节运动。
因为尾端64中形成止动件66的弯曲，上下关节部分22、24可被构造成能够在图2所示盘间隙S外部进行组装。例如，可在上下关节部分22、24处于盘间隙S外部时将上关节部分22设置到下关节部分24上。并且，上下关节部分22、24在盘间隙S难以发生解离。因此，实际上消除了植入后上下关节部分22、24发生错开的可能。而且，支杆60和孔70可减少上下关节部分中的一个22、24绕上下关节部分22、24中另一个的轴向旋转。因此，虽然形成球窝型接头，但是上下关节部分22、24仍被束缚在一起，从而轴向旋转受到孔70和支杆60大小的限制。
图4和7是假体装置20的俯视图。如图所示，支杆60和孔70虽然仍沿纵向中线58排列，但也是可以旋转的。因此，尾端64可沿偏离纵向中线58的方向转动到位。类似地，矩形或方形孔70发生倾斜以适应尾端64的角度。在所示实施方式中，角度形成在下关节部分24的后侧区段34中，而不是下关节部分24的桥接区段36中。如图4所最清楚地示出的，该角度通过使尾端大致向后延伸但桥接区段和椎间盘区段以一定角度延伸到椎间隙S内，从而有助于使假体装置20匹配到椎间隙S内。如图4所示，右侧假体装置21包括类似的倾斜后端，但倾斜的方向与左侧假体装置20相反。在一些实施方式中，后侧区段根本不倾斜，但在其他实施方式中，桥接区段发生倾斜或转动。
图8a-8c显示了关节假体装置20的关节运动范围的一个例子。图8a显示关节运动至第一限位的假体装置20，图8b显示了关节运动至中间位置的假体装置20，图8c显示关节运动至第二限位的假体装置20。在图8a所示的第一限位中，上关节部分22后侧区段34上的止动件69与下关节部分24的止动件相接触。因此，假体装置20的屈曲/延展和/或扭曲关节运动范围被限制在止动件66和69所允许的范围内。图8b显示关节运动至大致中间位置的假体装置20，孔70位于支杆60的中间区域周围。图8c显示关节运动至第二限位的假体装置20。在该第二限位处，桥接区段30、36起止动件的作用以限制上下关节部分22、24间的关节运动。在所示实施例中，图8a-8c所代表的总的运动范围约为45度。然而，运动范围也可以更大或更小，这受止动件的控制。
图9显示了另一实施方式的关节装置。在图9中，支杆60周围设置有偏置构件72。如上所述，在后路手术中，可从小平面关节切断支撑椎骨的肌肉和韧带，并切除小平面关节。因此，植入关节装置将允许在运动范围内不受限制地运动。为了限制不希望的运动范围，图9所示的偏置构件72可将假体装置20偏置到所需的位置，例如中间位置。因此，虽然切除了一些或所有控制健康脊柱盘的关节运动的肌肉和韧带，偏置构件72可提供控制关节运动的稳定力。在一个实施例中，偏置构件72是位于上关节部分22的后侧区段28上方和下方并围绕支杆60设置的一个或多个弹簧。这可提供屈曲和伸展两个方向上的缓冲。在另一个实施方式中，偏置构件是弹性构件。在又一个实施方式中，偏置构件可以是例如摩擦元件、可延展的带、或缓冲器如氨基甲酸酯缓冲器。在一些实施方式中，偏置构件72仅仅设置在上关节部分22后侧区段28的上面或下面，而不是在上关节部分22后侧区段28的上面和下面都设置。在其他实施方式中，偏置构件可设置在其它位置，例如桥接区段30、36上。在又一些实施方式中，偏置构件可为关节装置提供一定的扭转阻力。
另一实施方式的关节假体装置100如图10-16所示。关节假体装置100可具有许多类似于上述关节假体装置20的特征。这些特征的描述将不再重复。关节假体装置100包括上关节部分102和下关节部分104，它们每一个都分别具有盘间区段106、108。盘间区段106、108限定纵向中线109。上关节部分102上的第一连接孔110被构造成允许沿着与关节假体装置100的纵向中线109(图12)基本上对齐的方向引入骨紧固件112，例如螺钉，从而使紧固件112和纵向中线109基本上位于相同的平面内。类似地，下关节部分104上的第二连接孔114被构造成允许沿着与关节假体装置100的纵向中线109基本上对齐的方向引入骨紧固件116，使紧固件116和纵向中线109基本上位于相同的平面内。
在常规假体盘中，任何的螺钉都偏离纵向中线一定角度地引入骨中。随着螺钉的紧固，牵拉装置以抵靠骨，装置可能位移或从其初始设定位置移开。位移通常发生在螺钉方向上。因此，如果螺钉的方向偏离装置的纵向中线，那么一旦被引入骨中，螺钉常常导致装置沿偏离纵向中线的方向发生位移。这种移动可导致上下关节部分间的对准差异。
为了有助于固定就位，关节假体装置100被构造成第一和第二连接孔110、114分别与各个紧固件112、116对齐，使得纵向中线109和紧固件112、116基本上位于相同的平面内。因此，当紧固件112、116使假体装置100紧靠骨时，假体装置100从其位置开始的任何移动或位移都沿着纵向中线的方向。因此，假体装置100可更好地对齐，并可更加接近实际期望的位置。
也可将关节假体装置100设计成通用型，可匹配到椎间隙S的右侧或左侧。这样，医师不再需要确定假体装置10是左侧装置还是右侧装置。这就简化了外科手术过程并降低了错误的可能。而且，同时适用于左侧和左侧的单一假体装置可降低和简化制造成本，因为只需要一种设计而不是两种。然而应理解，所揭示的特征可结合到对称的装置上，例如设计用于左侧或右侧位置的装置，或者结合到不对称的装置上，例如设计用于左侧和右侧位置之一的装置。
类似于上述的假体装置20，图10-15的假体装置100包括下关节部分104的后侧区段118，后侧区段118上具有向上延伸的支杆120。支杆120沿中线109设置，包括止动件122，止动件122与上关节部分102的后侧区段124协同作用以限制关节运动范围。在该实施方式中，支杆120包括延伸穿过其中孔126，提供通往上关节部分102的第一连接孔110的通路。如图15所示，第二连接孔114位于支杆120的下部，因而可容易地从后侧进入。
上关节部分102的后侧区段124包括第一延伸臂128和第二延伸臂130。臂128、130围绕支杆120延伸，从而限制支杆侧向移动和沿中线109的位移。在邻近支杆120处，臂128、130包括止动件132，它被构造成接触支杆120上的止动件122。与上述假体装置20不同，假体装置100的臂128、130不互连以形成支杆延伸穿过其中的闭合孔。而是，带有止动件132的臂132不相连，留出中央定位的间隙134。假体装置100上关节部分102的后侧区段中的间隙134与支杆120中的孔126对齐，提供通往假体装置100上关节部分102连接孔110的通路，如图15所示。参考图11，第二连接孔114可形成在下关节部分104中，并可位于支杆120的第一端。因此，第一和第二连接孔110、114不是水平对齐，而是水平偏离。上连接孔110被设置成紧固件112进入椎骨14前弓后部。下连接孔114被设置成紧固件116进入椎弓根并穿过下椎骨16的前弓。应理解，在其他实施方式中，连接孔110、114可水平对齐，此外，在其他实施方式中，连接孔114可被设置在邻近支杆或在支杆120和关节部分之间的任何位置。一个例子如图16的人造椎间关节100’所示。关于人造椎间关节100的所有特征都适用于人造椎间关节100’。人造椎间关节100可安装在椎骨14、16之间，如下所述。虽然参照左侧假体装置20描述安装过程，但应理解，右侧假体装置21可以类似的方式安装。并且，应理解，假体装置100也可以类似的方式安装。一般地，如上所述，可采用类似于已知的经椎孔腰部椎体间融合术(TLIF)或后路腰部椎体间融合术(PLIF)的后路经椎孔方法将人造椎间假体装置20植入体内。PLIF方法一般较居中，依赖于更多地回缩横向根和硬膜以到达椎间隙。TLIF方法通常较偏斜，所需的根部回缩较少，且横向结构的回缩较少而使硬膜外出血较少。还可采用远外侧方法进入椎间隙。在一些情况下，可以通过远外侧进入椎间隙而无需切除小平面。
并且，已知通过腰肌的直接侧路方法。该方法完全避开后侧神经元件。预计假体20、100的实施方式可采用这些常见方法中的任一种。
根据这些方法中的至少一种，可在患者背部制造切口，例如中线切口，并可经椎孔去除一些或所有受患盘和周围组织。椎骨14的上终板表面可经辗磨、粗锉或其他方式切割以匹配上关节表面22的骨接触表面38的外形，以使椎骨14上终板表面上的应力分布正常化，和/或在骨向内生长之前提供最初的固定。椎骨14终板的制备过程可形成平坦表面或形成窝陷、凹槽或与骨接触表面38上的对应特征相匹配的其他外形的表面形状。椎骨16的下终板可以类似方式制备以接纳下关节部分24到现有神经根和背根神经节所允许的程度。在一些手术中，可修整或切除椎骨14、16的天然小平面关节，为后侧元件120腾出空间。
假体装置20的上下关节部分22、24的取向能使支杆60延伸穿过孔70。或者，参照假体装置100，能使支杆120在两个臂128、130之间延伸。然后，可将上下关节部分同时引入椎孔开口中并设置到上下椎骨间的适当椎间盘间隙内。在一些手术中，因为支杆和孔(或支杆和臂)的紧凑性，上下关节部分可通过插管引入。如果元件为标准件，则可一次植入多个元件，其中，最后植入上下关节部分的后侧区段。桥接区段30、36可沿后路方向从盘间区段26、32延伸和沿后路方向从椎间盘间隙S延伸。后侧区段28、34可沿椎间盘间隙的后路方向定位以代替或补充天然小平面关节的功能。
参考假体装置20，紧固件56可通过连接孔58插入上椎骨14。参考假体装置100，紧固件112可通过后侧区段中的间隙134和孔126引入，通过孔110而进入上椎骨14。类似地，紧固件116可穿过下关节部分104后侧区段118中的连接孔114而被插入，并进入相邻的骨，如椎骨16的椎弓根。
安装后，关节表面42、46所形成的球窝型接头相对稳定且自定中心。这种前侧接头和后侧连接(由支杆和孔的连接所形成)使假体装置20耐受剪切力，尤其是前-后的力。而且，绕椎体14、16所限定的纵向中线的旋转运动也受到支杆和孔的连接中的约束以及两个假体装置20、21所提供的组合约束的限制。
前侧接头以及支杆和孔的连接的强效宽大结构允许在假体装置20、21设置过程中的错位和稍许不准确。例如，关节接头的球窝结构耐受两个元件间一定程度的错位。支杆和孔的相互作用也容许假体装置20、21间的平行错位和/或前-后错位。在一些实施方式中，可植入一个单侧假体装置，而在其他实施方式中，可植入两个装置，这两个装置形成左侧和右侧装置。在另一些实施方式中，代替仅提供关节运动的上下关节部分，使用三件式关节盘。在该实施方式中，第三关节元件可位于上下关节部分之间以提供关节运动。
虽然上文仅详细描述了一些示例性的实施方式，本领域技术人员容易理解，示例性实施方式的许多改进都是可能的，而不会事实偏离本说明书的新的公开内容和优点。因此，所有这种改进和可选方式都包括在所附权利要求书所限定的本发明的范围内。本领域技术人员还应认识到，这些改进和等价结构或方法并不背离本发明的精神和范围，并且它们可进行各种变化、替代和改变而不背离本发明的精神和范围。应理解，所有空间术语，例如“水平”、“垂直”、“顶部”、“上部”、“下部”、“底部”、“左侧”、“右侧”、“头侧”、“尾侧”、“上侧”、“下侧”仅仅是阐述的目的，可在本发明的范围内变化。在权利要求书中，方法加功能语句旨在覆盖执行所述功能的本文所述的元件，不仅包括结构等价物而且包括等价元件。
Claims (13)
1.一种布置在上椎骨和下椎骨之间所限定的椎间隙内以提供上下椎骨关节运动的假体装置，所述装置包括：
上关节部分，它被构造成至少部分地设置在椎间隙内；
下关节部分，它被构造成至少部分地设置在所述上关节部分下方的椎间隙内，所述上下关节部分被构造成能提供所述上下椎骨的关节运动，
上下关节部分各自包括后侧区段，所述后侧区段被构造成设置在所述椎间隙后侧的位置中，
其中，所述上下关节部分中的一个的后侧区段包括支杆，所述上下关节部分中的另一个的后侧区段包括接纳部，所述接纳部被构造成能在关节运动期间与所述支杆相互作用，所述接纳部是孔，所述支杆延伸穿过所述孔。
2.如权利要求1所述的假体装置，其特征在于，所述支杆被构造成沿脊柱方向延伸。
3.如权利要求1所述的假体装置，其特征在于，所述支杆包括限制所述上下关节部分的关节运动范围的止动件。
4.如权利要求3所述的假体装置，其特征在于，所述止动件位于所述支杆的一端。
5.如权利要求1所述的假体装置，其特征在于，所述上下关节部分各自包括：
盘间区段，它被构造成设置在所述椎间隙内；和
将所述盘间区段连接至所述后侧区段的桥接区段，
其中，所述支杆是从所述上下关节部分中的所述一个的桥接区段延伸的一体式延伸件。
6.如权利要求1所述的假体装置，其特征在于，所述支杆包括第一端和第二端，所述第一端被弯曲偏离所述假体装置的中线。
7.一种植入上椎骨和下椎骨之间所限定的椎间隙内以提供上下椎骨关节运动的假体装置，所述装置包括：
上关节部分，它被构造成至少部分地设置在椎间隙内；
下关节部分，它被构造成至少部分地设置在所述上关节部分下方的椎间隙内，所述上下关节部分被构造成提供所述上下椎骨的关节运动，和
与所述上下关节部分中至少一个相联的至少一个连接孔，所述上下关节部分中的所述至少一个限定纵向中线，所述至少一个连接孔沿所述中线对齐。
8.如权利要求7所述的假体装置，其特征在于，所述装置包括分别与所述上下关节部分相联的至少一个连接孔，所述上下关节部分限定纵向中线，所述至少一个连接孔沿所述中线对齐。
9.如权利要求8所述的假体装置，其特征在于，与所述上关节部分相联的所述至少一个连接孔水平偏离于与所述下关节部分相联的所述至少一个连接孔。
10.如权利要求7所述的假体装置，其特征在于，所述上下关节部分各自包括：
盘间区段，它被构造成设置在椎间隙中；和
后侧区段，它被构造成设置在上椎骨或下椎骨后侧的位置。
11.如权利要求10所述的假体装置，其特征在于，所述上下关节部分中的一个的后侧区段包括支杆，所述上下关节部分中的另一个的后侧区段包括接纳部，接纳部被构造成在关节运动期间与所述支杆相互作用。
12.如权利要求11所述的假体装置，其特征在于，所述支杆沿所述纵向中线对齐。
13.如权利要求12所述的假体装置，其特征在于，所述支杆包括形成于其中的孔，所述孔被构造成提供通往所述至少一个连接孔的通路。
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
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| US11/343,159 | 2006-01-30 | ||
| US11/343,159 US7811326B2 (en) | 2006-01-30 | 2006-01-30 | Posterior joint replacement device |
| PCT/US2007/060549 WO2007089972A2 (en) | 2006-01-30 | 2007-01-16 | Posterior joint replacement device |
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| CN101404957A CN101404957A (zh) | 2009-04-08 |
| CN101404957B true CN101404957B (zh) | 2012-06-20 |
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| CN200780010039XA Active CN101404957B (zh) | 2006-01-30 | 2007-01-16 | 后路关节置换装置 |
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| US (1) | US7811326B2 (zh) |
| EP (1) | EP1978898B1 (zh) |
| JP (1) | JP2009525148A (zh) |
| KR (1) | KR20080093143A (zh) |
| CN (1) | CN101404957B (zh) |
| AT (1) | ATE499080T1 (zh) |
| AU (1) | AU2007211165B2 (zh) |
| DE (1) | DE602007012659D1 (zh) |
| WO (1) | WO2007089972A2 (zh) |
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- 2007-01-16 JP JP2008553436A patent/JP2009525148A/ja not_active Ceased
- 2007-01-16 WO PCT/US2007/060549 patent/WO2007089972A2/en active Application Filing
- 2007-01-16 DE DE602007012659T patent/DE602007012659D1/de active Active
- 2007-01-16 AU AU2007211165A patent/AU2007211165B2/en active Active
- 2007-01-16 KR KR1020087021348A patent/KR20080093143A/ko active IP Right Grant
- 2007-01-16 EP EP07701237A patent/EP1978898B1/en active Active
Patent Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN2333369Y (zh) * | 1998-05-29 | 1999-08-18 | 中山医科大学孙逸仙纪念医院 | 人工腰椎间盘 |
Also Published As
| Publication number | Publication date |
|---|---|
| US20070179616A1 (en) | 2007-08-02 |
| EP1978898B1 (en) | 2011-02-23 |
| AU2007211165B2 (en) | 2012-07-05 |
| DE602007012659D1 (de) | 2011-04-07 |
| JP2009525148A (ja) | 2009-07-09 |
| WO2007089972A2 (en) | 2007-08-09 |
| ATE499080T1 (de) | 2011-03-15 |
| KR20080093143A (ko) | 2008-10-20 |
| CN101404957A (zh) | 2009-04-08 |
| WO2007089972A3 (en) | 2007-11-22 |
| AU2007211165A1 (en) | 2007-08-09 |
| EP1978898A2 (en) | 2008-10-15 |
| US7811326B2 (en) | 2010-10-12 |
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