CN101431955A - 开口轴手术植入物 - Google Patents

开口轴手术植入物 Download PDF

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CN101431955A
CN101431955A CNA2007800153109A CN200780015310A CN101431955A CN 101431955 A CN101431955 A CN 101431955A CN A2007800153109 A CNA2007800153109 A CN A2007800153109A CN 200780015310 A CN200780015310 A CN 200780015310A CN 101431955 A CN101431955 A CN 101431955A
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recess
vertical surface
implant
surgery implant
projection
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M·M·莫里森
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Warsaw Orthopedic Inc
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Warsaw Orthopedic Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Neurology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • General Health & Medical Sciences (AREA)
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  • Heart & Thoracic Surgery (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Abstract

提供了一种手术植入物，其可通过具有面向内的管状突起的分隔的钳口的手术工具接合。所述植入物包括用于与骨结构交界的体部。所述植入物还包括与所述体部连接的头部，所述头部具有由稳定元件接收区域并置的间隔柱。每个柱具有向外的侧面，该向外的侧面包括与大体指向内的下表面交叉的上部大体垂直的表面，所述下表面又与下部大体垂直的表面交叉。该侧面具有大体管状圆柱形的凹口，该凹口与上部垂直表面和指向内的下表面交叉。

Description

开口轴手术植入物
发明领域
本发明提供了手术植入物，其可与脊柱稳定元件，如缆绳(cable)、棒或盘连接。
发明背景
脊柱外科医生通常采用以诸如盘或细长的脊柱棒之类的稳定元件增强的脊柱融合来处理脊柱异常。所述稳定元件使用诸如椎弓根螺钉(pediclescrew)或椎板钩(lamina hook)之类的植入物连接到脊柱。这样的“稳定组件”通常包括一个或两个脊柱棒或盘以及多个植入物，以接合它们各自椎体的椎弓根。植入物具有U形的头部，该U型头部可以被加盖(capped)以将稳定元件连接到植入物。植入物的头部相对小并且在手术过程中通常被隐埋在患者的肌肉中。期望的是提供和植入一种容易用手术工具扭转或操纵的植入物，而不会使植入物的头部过大。
发明内容
要表明上面提到的和其它的各种期望，产生了本发明的公开。在优选的实施方式中，本发明提供了带有“开口轴凹槽(open axle recess)”的外科植入物。所述植入物可以通过具有内向管状突起的间隔的钳口(jaws)来接合。所述植入物包括用于与骨结构交界的体部。所述植入物还包括与体部连接的头部，所述头部具有由稳定元件接收区域并置的间隔柱。每个柱具有向外的侧面，该向外的侧面包括与大体指向内的下表面交叉的上部大体垂直的表面，所述下表面又与下部大体垂直的表面交叉。侧面具有大体圆柱形的凹槽或凹口(indention)，凹槽或凹口与上部垂直表面和指向内的下表面交叉，从而形成开口轴(open axle)。
本发明的其它特征随着本发明在附图和发明详述中的进一步阐明而对本领域普通技术人员变得明显。
附图说明
图1是本发明优选的实施方式椎板钩植入物的透视图。
图2是本发明优选的实施方式椎弓根螺钉植入物的透视图。
图2A是本发明优选的实施方式多轴椎弓根螺钉植入物的前视图。
图3是图1所示植入物的前视图。
图4是图1所示植入物的俯视图。
图5A-5C是图1所示植入物的部分侧视图。
图6是本发明可替换优选实施方式植入物的部分透视图。
图7是图6所示植入物的俯视图。
图8是图1所示植入物的前视图。
图8A是本发明另一可替换优选实施方式植入物的部分前视图。
图8B是手术工具和附随的突起的部分透视图，该突起可以被用于本发明特定的方法，并且在工具以及图5C和9C所示的植入物间提供锁定。
图9A-9C是图6所示植入物的部分侧视图。
图10和11是与图4的视图相似的本发明其它可替换优选实施方式植入物的视图。
发明详述
参考图1、3和4，提供了本发明的椎板钩植入物7。该植入物7具有用于与患者的骨结构交界的体部10。体部10与头部12连接。头部12具有间隔的柱14。稳定元件或棒接收区域16与柱14并列。每个柱14均具有向外的侧面18。向外的侧面18具有上部大体垂直的表面20。表面20与大体指向内的下表面22交叉。下表面22与下部大体垂直的表面24交叉。
侧面18具有穿透上部垂直表面20和下表面22的大体圆柱形的凹槽或凹口26。凹口26被可扭转地接合到手术工具的面向内的管状突起28(图8)。
如图4所示，垂直表面20具有大体圆锥形的曲线形状。图10是具有圆柱形凹口26的可选实施方式植入物30的附视图，其中上部大体垂直的表面32是平的。植入物30的体部与前述体部10基本相同。
图5A-5C示出了图1所示植入物7的三种可能的部分侧视图。在图5A中，凹口26在表面20上投影180°。在图5B和5C中，凹口26在表面20上投影分别小于180°或大于180°。通常优选的是凹口在表面20上投影在80°到240°之间。
参考图6、7、8、9A-9C，提供了可替换实施例植入物57。该植入物57与植入物7本质相同，除了表面20的凹口62进一步延伸到终止于封闭端(blind end)64的下部垂直表面24内。图9A-9C显示了在表面20上投影180°、小于180°和大于180°的凹口62。通常优选的是凹口在表面20上投影在80°到240°之间。
参考图8，两个表面24之间的距离为D1。两个表面20之间的距离为D2。两个表面64之间的距离为D3。通常在手术操作过程中，植入物57被包埋于患者的肌肉下。稳定元件，如缆绳、盘或细长棒延伸穿过棒接收区域16。外科医生使用稳定元件来辅助定位植入物57。手术工具(仅部分示出)在非常接近D1的分离距离处设置有突起28。外科医生随后沿下部垂直表面24对齐突起28。手术工具被向上拉而不将突起28分开明显超过D1的距离。突起28随后被拉起以接触下表面24。突起28随后被转动直到它们放入凹口62。如果凹口62的投影等于或小于180°(图9A和9B)，则突起28滑进凹口62而不需要突起向外延伸到距离D2。在突起28与凹口62对齐以后，突起28可以被向内移动以便与封闭端64接触。突起28到封闭端64的向内延伸作为给外科医生的确认指示，用于指示突起28现在已经可以用于与凹口62扭转接合。突起与凹口的扭转接触在距离D2-D3之间发生。
在手术操作中，通常棒非常接近植入物57，并且需要相对小的力使棒缩进棒接收区域16。在这样的情况下，可以使用Burel等人(下文称为Burel)共同转让的美国专利6,036,692中所描述的棒引入钳(rod introductionforceps)。在这个案例中，该钳子的突起只需要在D1到D2之间与凹口62的弓形部分接合。在一些棒缩进应用中，如Beale等人的美国专利6,790,290(下文称为Beale)所述的棒缩进器械更合适。Beale的器械在植入物的头部施加了大的夹持力。Beale的突起可以被修改以便开始时仅在与Burel相同的区域接合凹口。随后在Burel的执行器组件的臂进一步合拢时，突起将向内移动以在D2和D3间装在凹口的区域。
如图8A所示，可以对植入物67做进一步修改，以便凹口62具有圆锥形末端69，从而和与Beale中所述相似的突起71的圆锥形末端71配对。
图5C、9C和8B示出了本发明进一步的优势。可以为手术工具96提供突起92(仅示出一个)，突起92具有非常接近凹口62半径的半径93。突起92具有平面94。突起具有高度H1。H1在长度上可以小于半径93。凹口62的投影具有宽度为D4的窗口97(凹口62在下表面22与上部垂直表面20交叉处的宽度)。平面94的宽度比D4宽。为了将突起92放置进凹口，突起92具有平坦的接触表面95。接触表面95与表面24以与前述有关突起28相似的方式配对。手术工具96被成角度(倾斜)，以允许突起92进入凹口窗口97。在手术工具96被提回到竖直位置后，突起92本质上被锁定进凹口62，因为平面的宽度比D4宽。为了从植入物76中移去工具96，工具96被倾斜并且突起92被向下推出窗口97。突起92之间的间隔距离保持恒定。因此，突起92可以通过连接刚性非折叠刚性结构元件(未示出)被提供。
图2是本发明椎弓根螺钉107的实施方式，其具有用于通过螺纹插入物与患者的椎弓根交界的体部109。图2A是具有体部129的多轴线椎弓根螺钉127的本发明实施方式。图11示出了本发明的植入物147，其在每个侧面18上具有多个凹口62。
尽管本发明的优选实施方式已经被公开，应该理解其仅通过实施例的形式被描述，并且可以做各种修改而不悖离本发明的精神和范围，因为其被包括在权利要求书中。
权利要求书(按照条约第19条的修改)
1.一种可连接到稳定元件的手术植入物，该手术植入物通过具有面向内的管状突起的分隔钳口的手术工具接合，所述植入物包括：
用于与骨结构交界的体部；和
连接到所述体部的头部，所述头部具有由稳定元件接收区域并置的间隔的柱，每个所述柱具有向外的侧面，所述向外的侧面具有上部大体垂直的表面，该上部大体垂直的表面与大体指向内的下表面交叉，所述下表面与下部大体垂直的表面交叉，所述侧面具有大体管状圆柱形的凹口，所述凹口与所述上部垂直表面和所述指向内的下表面交叉。
2.如权利要求1所述的手术植入物，其中所述体部是螺钉。
3.如权利要求1所述的手术植入物，其中所述体部是多轴线螺钉。
4.如权利要求1所述的手术植入物，其中所述体部是钩状物。
5.如权利要求1所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影约为180°。
6.如权利要求1所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影小于180°。
7.如权利要求6所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影至少180°。
8.如权利要求1所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影大于180°。
9.如权利要求8所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影为240°或更小。
10.如权利要求1所述的手术植入物，其中所述上部垂直的表面是大体平坦的。
11.如权利要求1所述的手术植入物，其中所述上部垂直的表面是大体曲线的。
12.如权利要求1所述的手术植入物，其中所述凹口穿透所述下部大体垂直的表面。
13.如权利要求12所述的手术植入物，其中所述凹口具有封闭末端。
14.如权利要求12所述的手术植入物，其中所述凹口具有圆锥形末端。
15.如权利要求1所述的手术植入物，其中每个所述柱的侧面具有多个凹口。
16.一种可连接到细长稳定元件的手术植入物，该手术植入物通过具有面向内的管状突起的间隔钳口的手术工具接合，所述植入物包括：
用于与骨结构交界的体部；和
连接到所述体部的头部，所述头部具有由稳定元件接收区域并置的间隔的柱，每个所述柱具有向外的侧面，所述向外的侧面具有上部大体垂直的表面，该上部大体垂直的表面与大体指向内的下表面交叉，所述下表面与下部大体垂直的表面交叉，所述侧面具有大体圆柱形的凹口，所述凹口与所述上部和下部垂直的表面以及所述指向内的下表面交叉，所述凹口具有封闭末端并且所述凹口在所述上部大体垂直的表面上投影180°或更小。

Claims (20)

1.一种可连接到稳定元件的手术植入物，该手术植入物通过具有面向内的管状突起的分隔钳口的手术工具接合，所述植入物包括：
用于与骨结构交界的体部；和
连接到所述体部的头部，所述头部具有由稳定元件接收区域并置的间隔的柱，每个所述柱具有向外的侧面，所述向外的侧面具有上部大体垂直的表面，该上部大体垂直的表面与大体指向内的下表面交叉，所述下表面与下部大体垂直的表面交叉，所述侧面具有大体管状圆柱形的凹口，所述凹口与所述上部垂直表面和所述指向内的下表面交叉。
2.如权利要求1所述的手术植入物，其中所述体部是螺钉。
3.如权利要求1所述的手术植入物，其中所述体部是多轴线螺钉。
4.如权利要求1所述的手术植入物，其中所述体部是钩状物。
5.如权利要求1所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影约为180°。
6.如权利要求1所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影小于180°。
7.如权利要求6所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影至少180°。
8.如权利要求1所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影大于180°。
9.如权利要求8所述的手术植入物，其中所述凹口在所述上部大体垂直的表面上投影为240°或更小。
10.如权利要求1所述的手术植入物，其中所述上部垂直的表面是大体平坦的。
11.如权利要求1所述的手术植入物，其中所述上部垂直的表面是大体曲线的。
12.如权利要求1所述的手术植入物，其中所述凹口穿透所述下部大体垂直的表面。
13.如权利要求12所述的手术植入物，其中所述凹口具有封闭末端。
14.如权利要求12所述的手术植入物，其中所述凹口具有圆锥形末端。
15.如权利要求1所述的手术植入物，其中每个所述柱的侧面具有多个凹口。
16.一种可连接到细长稳定元件的手术植入物，该手术植入物通过具有面向内的管状突起的间隔钳口的手术工具接合，所述植入物包括：
用于与骨结构交界的体部；和
连接到所述体部的头部，所述头部具有由稳定元件接收区域并置的间隔的柱，每个所述柱具有向外的侧面，所述向外的侧面具有上部大体垂直的表面，该上部大体垂直的表面与大体指向内的下表面交叉，所述下表面与下部大体垂直的表面交叉，所述侧面具有大体圆柱形的凹口，所述凹口与所述上部和下部垂直的表面以及所述指向内的下表面交叉，所述凹口具有封闭末端并且所述凹口在所述上部大体垂直的表面上投影180°或更小。
17.一种用于接合具有面向内的管状突起的分隔钳口的手术工具与可连接到稳定元件的骨交界植入物的方法，所述方法包括：
向所述具有由稳定元件接收区域并置的间隔的柱的体部提供头部，每个所述柱具有向外的侧面，所述向外的侧面具有上部大体垂直的表面，该上部大体垂直的表面与大体指向内的下表面交叉，所述下表面与下部大体垂直的表面交叉，所述侧面具有大体圆柱形的凹口，所述凹口与所述上部垂直的表面和所述指向内的下表面交叉，所述柱的所述侧面下部大体垂直的表面间隔距离D1，并且所述上部大体垂直的表面间隔更大的距离D2；
将所述管状突起分开非常接近D1的距离；
将所述管状突起与所述植入物头部的所述大体下部垂直的表面对齐；
将所述管状突起推进所述凹口而不使所述管状突起分开明显超过D1的距离；和
以距离D2在所述圆柱形的凹口中扭转地接合所述管状突起。
18.如权利要求16所述的方法，进一步包括以小于D2的距离D3在每个所述侧面提供所述圆柱形凹口，并且通过允许所述突起达到非常接近D3的间隔距离而提供所述管状突起进入所述圆柱形凹口的确认。
19.如权利要求16所述的方法，进一步包括向投影于带有上部垂直表面的侧面上超过180°的所述凹口提供D4的窗口宽度；向所述管状突起提供与所述凹口的所述半径非常接近的半径，所述突起具有宽度大于所述D4的平面；倾斜所述手术工具以允许所述突起进入所述凹口窗；以及使所述手术工具成一线，以在所述凹口内锁定所述突起。
20.一种用于接合具有面向内的管状突起的分隔钳口的手术工具与可连接到稳定元件的骨交界植入物的方法，所述方法包括：
向所述具有由稳定元件接收区域并置的间隔的柱的体部提供头部，每个所述柱具有向外的侧面，所述向外的侧面具有上部大体垂直的表面，该上部大体垂直的表面与大体指向内的下表面交叉，所述下表面与下部大体垂直的表面交叉，所述侧面具有大体圆柱形的凹口，所述凹口与所述上部垂直表面交叉并穿透所述下部垂直表面，所述柱的所述侧面下部大体垂直表面间隔距离D1并且所述上部大体垂直表面间隔更大的距离D2，并且所述圆柱形的凹口穿透所述下部垂直表面到距离D3；
在距离D1-D2间在所述圆柱形凹口内接合所述管状突起；和
在距离D2-D3间在所述圆柱形凹口内接合所述管状突起。
CNA2007800153109A 2006-04-28 2007-04-09 开口轴手术植入物 Pending CN101431955A (zh)

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