CN101453962A - 外科拔出器 - Google Patents

外科拔出器 Download PDF

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CN101453962A
CN101453962A CNA2007800193958A CN200780019395A CN101453962A CN 101453962 A CN101453962 A CN 101453962A CN A2007800193958 A CNA2007800193958 A CN A2007800193958A CN 200780019395 A CN200780019395 A CN 200780019395A CN 101453962 A CN101453962 A CN 101453962A
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extractor
arm
locking element
intervertebral disk
surgical extractor
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弗朗茨·小科弗
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
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    • 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
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4619—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof for extraction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4628—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about an axis transverse to the instrument axis or to the implantation direction, e.g. clamping
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0091—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements connected by a hinged linkage mechanism, e.g. of the single-bar or multi-bar linkage type
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • A61F2230/0052—T-shaped

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Abstract

本发明涉及一种用于通过手术取出人工椎间盘(10)的外科拔出器(20)，该人工椎间盘包括两个托板(3、4)，所述托板分别带有一关节部分(5、6)。拔出器(20)具有以叉形相互连接的两条臂(21、21’)，所述臂可插入到两个托板(3、4)之间的间隙内，所述臂在自由端部上分别带有至少一个锁止元件(22、22’)，所述锁止元件在第一位置处允许插入到两个托板(3、4)之间的间隙内，而在锁止的第二位置处，在竖直高度上超过所述间隙。所述臂(21、21’)与在纵向方向上将拉力传递到所述臂(21、21’)上的公共的拔出装置(24、25、26)相连接。

Description

外科拔出器
技术领域
本发明涉及一种用于通过手术取出人工椎间盘的外科拔出器，该人工椎间盘包括两个托板，所述托板分别带有一个关节部分。
背景技术
在应用中已知一种包括两个分件的人工椎间盘，所述分件分别包括一个托板。各托板在其向外的一侧上具有一支承面，托板以该支承面支承在与椎间盘间隙相邻的椎骨上。在各托板的内侧上设置关节部分，该关节部分对于一个托板由截球形关节窝构成，而对于另一个托板由截球形关节头构成。在联接状态下，关节窝和关节头共同构成一球窝关节，使两个托板可以在所有空间方向上相对倾斜。
因为这种球窝关节由于作用在它上面的力而经受很大的磨损，所以可能需要整体更新人工椎间盘。如果相邻的椎骨病态变形，使人工椎间盘不再最佳地匹配于身体状况，也需要进行更换。
本发明的目的是，提供一种开头所述类型的、用于通过手术取出人工椎间盘的外科拔出器。
发明内容
所述目的通过一种外科拔出器实现，该外科拔出器具有以叉形相互连接的两条臂，所述臂可插入到待拔出的人工椎间盘的两个托板之间的间隙内，所述臂在其自由端部上分别带有至少一个锁止元件，所述锁止元件在第一位置处允许插入到人工椎间盘的两托板之间的间隙内，而在锁止的第二位置处，在竖直高度上超过所述间隙。所述两个臂连接到用于在臂的纵向方向上将拉力传递到所述臂上的公共拔出装置。
为进行拔出，将臂穿过人工椎间盘托板之间的间隙，接着锁止。然后可使用拔出装置将人工椎间盘从椎间盘间隙中拔出。
如果臂与拔出装置可拆卸地连接，则可以分别在人工椎间盘球窝关节的两侧分开地插入所述臂，只有在插入状态下才为了拔出而(使所述臂)相互间并与公共的拔出装置间相连接。这简化了臂的插入。
锁止元件可以设计成，使其在第一横向方向上比在第二横向方向上宽。因此可以将两条臂分别以一个取向插入，在该取向中锁止元件以其较窄的横向方向穿过托板之间的间隙，然后转动90°到达锁止位置，并相互连接。
所述臂在其可插入的长度上优选具有基本为圆形的轮廓，锁止元件分别设计成形成于所述臂的端部上的、刚性T形延伸部。
锁止元件应该适合于成型成，使该锁止元件在锁止位置处不能传递使所述托板张开/相互分开的力分量，所述力分量加大将人工椎间盘从椎间盘间隙中拔出的难度。
所述拔出装置有利地包括带止挡部的杆/柄和可沿杆一直运动到止挡部的回击重物/反冲重物。然后，通过由外科医生移动回击重物而使之敲击止挡部，可以将人工椎间盘小心地以很小地幅度拔出。这样外科医生可很好地控制施加在人工椎间盘上的冲击力。
在另一种有利的实施形式中所述臂具有不同的长度。所述实施形式使得可以通过侧向通路将人工椎间盘从椎间盘间隙中拔出。
附图说明
由以下借助于附图对实施例的说明得到本发明的其它特征和优点，其中：
图1示出处于安装在两椎骨之间的状态下的人工椎间盘的侧视图；
图2示出根据本发明的拔出器和设置在该拔出器下面的人工椎间盘托板的俯视图；
图3示出图2中的拔出器的一个臂的侧视图；
图4示出图1中的人工椎间盘，其中一拔出器从不可见的一侧插入；
图5示出在图2至4所示的拔出器的分解视图；
图6示出根据本发明另一个实施例的拔出器的与图2相似的俯视图。
具体实施方式
图1示出一人工椎间盘10，该椎间盘被装入在上椎骨1与下椎骨2之间的椎间盘间隙内。人工椎间盘具有一上托板3和一下托板4。
在各托板3、4的内侧设置有带关节部分的延伸部，下托板的关节部分由截球形的关节窝5形成，上托板3的关节部分由一相应的截球形的关节头6构成。关节窝5和关节头6共同构成一球窝关节，使人工椎间盘10的两个托板3、4可以在所有空间方向上相对倾斜。
如果为了更换而需要通过手术取出这种人工椎间盘10，则需要一种称为拔出器的外科器械。在图2中以在人工椎间盘10的下托板4的上方观察的俯视图示意性地示出根据本发明的拔出器20，在图5中以一分解视图示出该拔出器。
拔出器20具有两个结构相同的臂21、21’，所述臂分别在一端部上刚性形成有T形延伸部22、22’，而在另一端部上分别支承有一侧向偏置的固定突板23、23’。在图3中从侧面示出臂21。臂21和T形延伸部22具有圆形轮廓。用虚线示出在固定突板23中的、用于接纳销子27的孔28。T形延伸部22垂直于固定突板23安装，因此该延伸部在拔出器20的装配状态下垂直于由臂21、21’确定的平面。
借助于销子27可以使两条臂22、22’与一公共的杆24可拆卸地连接，在该杆上引导一可动的回击重物25，该回击重物可运动到止挡部26上。当然也可以选择螺钉、螺栓或类似的固定结构代替销子27。
两条臂22、22’在连接状态下共同形成一叉，该叉夹持人工椎间盘10的由关节部分5、6构成的球窝关节。由于在固定突板23、23’与臂21、21’之间的弯曲段，臂21、21’在通过销子27相互连接的情况下设置在一个平面内。
拔出器20的可拆卸性使得臂21、21’能够被插入到待取出的人工椎间盘7的托板3、4之间间隙中。此外，这样拔出器20的所有零件可以单独地清洗和消毒。
优选地，拔出器20由外科用不锈钢(316L)制成。可选地，当然也可以采用其它惰性足够的抗断裂材料，例如钛或钛合金。
为取出人工椎间盘10，两条臂21、21’单独地、优选通过正面或侧面的通道，插入两个托板3、4之间的缝隙状间隙中。为此，这样转动臂21、21’，使T形延伸部22、22’处于缝隙方向上。一旦两条臂21、21’向人工椎间盘10的关节间隙中插入到使T形延伸部22、22’在相对侧上伸入到椎管(wirbelkanal)内的程度，则使臂21、21’转动90°，由杆23配合在一起，并通过销子27连接在一起。
现在如图4中所示，两个延伸部22、22’垂直于托板3、4之间间隙的缝隙方向并从后面夹持所述托板。现在外科医生开始通过以回击重物25敲击止挡部26而将人工椎间盘10从椎间盘间隙中拔出。
T形延伸部22、22’设计成，使其基本以平面靠在两个托板3、4的端面上，因此不会传递使托板3、4张开的、垂直作用的力分量。
可选地，托板3、4的端面也可以略微向其外侧倾斜。如果延伸部22、22’设计成分别与臂21、21’形成一略小于90°的角，则在敲出人工椎间盘10时便传递一力分量，该力分量使托板3、4在朝向椎管的一侧并拢，而在相对的正面的一侧相应地张开。因此托板形成了一略呈楔形的姿态，使人工椎间盘10更容易从椎间盘间隙中滑出。
应该指出，所示的拔出器仅仅是一非限制性的实施例。本专业的读者显然知道，对所述拔出器可以做出许多修改和补充。
例如，可采用任何其它类型的、适用于沿臂21、21’的纵向方向传递拉力的拔出结构代替回击机构。例如，可以在杆24上设置侧向突出部代替用于回击重物25的止挡部26，利用该突出部外科医生可使用锤子敲出人工椎间盘10。可选地，也可以设置在相邻的椎骨上的螺纹机构，从而通过抵靠椎骨旋入一个或多个拔出螺纹杆将人工椎间盘10从椎间盘间隙中拔出。
作为锁止臂21、21’的T形延伸部22、22’的替代方案，也可以设置例如可立起的倒钩或可旋转地支承在臂端部上的锁止元件，该锁止元件可在臂插入后通过在臂的前端的适当机构致动。也不是必须使臂21、21’在人工椎间盘10整个宽度上一直插入到椎管中。可选地，例如可在托板上设置凹部，在拔出器臂的端部上的合适锁止元件可接合到所述凹部内。
图6示出一总体用20表示的、根据本发明的另一实施例的拔出器的与图2相似的俯视图。拔出器120与上述拔出器20的区别仅在于，臂121、121’的长度不同。另外，T形延伸部122、122’朝外的短边具有半圆形轮廓，托板3、4在其背侧的端部上具有半圆形凹部130、130’，该凹部设计成与延伸部122、122’的轮廓互补。
长度不同的臂122、122’以及使延伸部122、122’形锁合地接合到凹部130、130’中实现了，通过侧向作用的力将托板3、4从椎间盘间隙中拔出，而不使延伸部122、122’相对于托板3、4滑动。此外，通过半圆形状保证了，延伸部122、122’不突出到托板3、4的背侧端部之外，以这种方式避免相邻的敏感组织在拔出过程中受伤。

Claims (7)

1.用于通过手术取出人工椎间盘(10)的外科拔出器(20)，该人工椎间盘包括两个托板(3、4)，所述托板分别带有一关节部分(5、6)，其中外科拔出器(20)具有以叉形相互连接的两条臂(21、21’)，所述臂可插入到两个托板(3、4)之间的间隙内，所述臂在自由端部上分别带有至少一个锁止元件(22、22’)，所述锁止元件在第一位置处允许插入到人工椎间盘(10)的两个托板(3、4)之间的间隙内，而在锁止的第二位置处，在竖直高度上超过所述间隙，拔出器还具有用于在臂(21、21’)的纵向方向上将拉力传递到所述臂上的公共的拔出装置(24、25、26)。
2.按权利要求1的外科拔出器，其特征在于，所述臂(21、21’)与拔出装置(24)可拆卸地连接。
3.按权利要求2的外科拔出器，其特征在于，锁止元件(22、22’)在第一横向方向上比在第二横向方向上宽。
4.按权利要求3的外科拔出器，其特征在于，所述臂(21、21’)在其可插入的长度上具有基本为圆形的轮廓，所述锁止元件(22、22’)分别设计成在所述臂(21、21’)的端部上形成的、刚性的、T形延伸部。
5.按上述权利要求之任一项的外科拔出器，其特征在于，所述锁止元件(22、22，)成型成，使该锁止元件在锁止位置处不能传递使托板(3、4)张开的力分量。
6.按上述权利要求之任一项的外科拔出器，其特征在于，所述拔出装置包括带止挡部(26)的杆(24)和可沿杆(24)一直运动到止挡部(26)的回击重物(25)。
7.按上述权利要求之任一项的外科拔出器，其特征在于，所述臂(121、121’)的长度不同。
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