CN101502436A - Device for expanding and fusing bone - Google Patents
Device for expanding and fusing bone Download PDFInfo
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- CN101502436A CN101502436A CNA2009100258667A CN200910025866A CN101502436A CN 101502436 A CN101502436 A CN 101502436A CN A2009100258667 A CNA2009100258667 A CN A2009100258667A CN 200910025866 A CN200910025866 A CN 200910025866A CN 101502436 A CN101502436 A CN 101502436A
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Abstract
A bone expansion fusion cage relates to a fixed apparatus in minimal invasion surgery, which mainly treats cancellous bone fracture and comprises a head, a neck, a waist, a connector pipe, a handle and a swing handle; wherein, the head, neck, waist, connector pipe and handle are hollow and the hollow body is internally provided with tension rods; a central tension bolt of the swing handle is connected with the tension rods; the tension rods are provided with locking pins; both sides of the front end of the tension rod are provided brace rods; both ends of the brace rod are movably connected with the tension rod and the head; the far end of the waist props against but is not connected with the near end of the neck; the swing handle is movably connected with a handle pad at the near end of the handle; the head employs different shapes of appearance; the neck and the brace rod are respectively of two diamond shapes; the head and the brace rod are provided with a plurality of bone graft windows; the neck is provided with a bone graft window; the fusion cage is completely folded; the far ends of the tension rods are wholly housed in the head, the neck and the groove at the inner side of the brace rod and are completely strutted; the head and two necks as well as the head and two brace rods are all fixed into right angles; straight lines are formed between the two necks and the two brace rods by fixation, at the moment, the head forms a cuboid with the two necks and the inner sides of the two brace rods.
Description
Technical field
The present invention relates to a kind of medical science minimally invasive spinal surgery operation internal fixation device, particularly a kind of device for expanding and fusing bone, be mainly used in treatment osteoporotic vertebral compression fracture, also can be used for treating traumatic or some pathologic vertebral compression fracture of fracture, the part of other position spongy bone etc.
Background technology
Osteoporosis is the common disease that threatens the senior health and fitness.Compression fracture of spine is one of osteoporosis important complication, and it has increased old people's disability rate and mortality rate greatly.The Minimally Invasive Surgery method of treatment osteoporotic vertebral fracture mainly contains two kinds at present:
1.1984 a year French Deramond at first uses injection bone cement (polymethylmethacrylate) in the percutaneous vertebral body, is called for short PMMA, is called percutaneous vertebroplasty (percutaneous vertebroplasty), is called for short PVP.But PVP is applied to pain relieving of osteoporosis centrum compression fracture and stable vertebral body, but can not increase the compression vertebral height, can not correct the kyphosis deformity of spinal column, and higher bone cement percolation ratio is arranged, and can reach more than 30%.
2.1994 year U.S. Reiley etc. has designed the technology of correcting the vertebral body kyphosis deformity by balloon expandable, is called balloon expandable kyphoplasty art (balloon-kyphoplasty), is called for short BKP.Its operation is to insert balloon-expandable in percutaneous cervical arc root or the pedicle of vertebral arch lateral vertebral body, forms cavity in the vertebral body that resets after the inflation, vertebral body, injects bone cement again in the vertebral body cavity behind the taking-up sacculus.Obtained United States Patent (USP) in 1996, patent No. US5827289 obtained the FDA approval and is applied to clinical in 1998.Show to lose a clinical research result who adopts BKP to treat 70 vertebral bodys of 30 routine patients and highly on average recover 2.9mm, promptly recovered 33.1% the height of losing.8.6% the bone cement seepage occurs in the sick vertebra of full group, and the bone cement percolation ratio of fracturing than PVP treatment osteoporosis centrum slightly descends.Most literature has also been reported vertebral height recovery rate and the bone cement percolation ratio that BKP is identical.
In PVP and BKP operation, use bone cement in vertebral body, to play fixation as implant.But the PMMA bone cement has a lot of shortcomings, and its application prospect is unsatisfactory, and the problem of existence mainly contains:
1, polymerization exotherm, temperature can reach 40 ℃-100 ℃, soft tissue, especially spinal cord and nerve root near can burning, and the Intrapyramidal osteocyte of also can burning simultaneously influences final union of fracture.
2, can cause hypotension or blood vessel embolism in the process of setting.If generation lung, cerebral embolism can cause death.
3, the PMMA viscosity is low, easily leaks in the adjacent anatomical structures, can reach percolation ratio more than 30% at PVP, still has an appointment 8.6% at BKP.Can cause paralysis if leak into canalis spinalis compressing spinal cord.
4, the vertebral body after the PMMA injection is different with the vertebral body mechanical strength of adjacent not injection, and stress is concentrated the fracture that easily causes adjacent vertebral bodies.
5, PMMA discharges certain toxic monomer.
6, immunogenicity, PMMA can not combine by chemical bond with sclerotin on every side, and occurs foreign body reaction around it, and inflammatory cell is assembled, and giant cell is engulfed, and the later stage bone produces with the bone cement interface and becomes flexible.
7, PMMA does not have bone conduction effect, and is not biodegradable, finally can not be replaced from the body bone.
At the above shortcoming of bone cement PMMA, many scholar's research several different methods, as use polyester webs, can absorb sacculus etc. the PMMA bone cement is wrapped up, use injectable artificial bone such as calcium sulfate, calcium phosphate, hydroxyapatite, chitin etc. to replace PMMA, or the like, but such or such problem is all arranged, still can not replace PMMA fully.
Summary of the invention
The objective of the invention is many deficiencies, carrying out percutaneous bone dilator kyphoplasty art (dilator-kyphoplasty), be called for short in the DKP operation, a kind of inside-fixture device for expanding and fusing bone is provided at implant bone cement PMMA.Earlier recover vertebral height with bone dilator, correct kyphosis deformity, behind the taking-up bone dilator, vertebral body is inserted device for expanding and fusing bone; Also can expand without bone dilator, vertebral body is directly inserted device for expanding and fusing bone, and the expansion back is retained in the vertebral body as inside-fixture fully, by bone grafting, finally rebuilds healing from the body osteogenesis, to replace bone cement.This invention also can be used for treating traumatic or some pathologic vertebral compression fracture of fracture, part of other position spongy bone.
Device for expanding and fusing bone of the present invention takes following scheme to realize: device for expanding and fusing bone has head, cervical region, waist, connecting leg, handle and swing handle; Between described head and the cervical region and as a whole between the two cervical region proximal end by being hinged to, described head, cervical region, waist, connecting leg, handle is ducted body, one pull bar runs through described ducted body, described swing handle connects a turnbuckle, described turnbuckle links to each other with an end of described pull bar, there is strut the other end both sides of described pull bar, described strut two ends flexibly connect by connecting pin with described pull bar and described head respectively, described waist far-end contacts mutually with the near-end of described cervical region, the near-end of described connecting leg is fixedlyed connected with described handles distal, the far-end of one handle holder is arranged on described handle proximal lateral, and the proximal lateral of described swing handle and described handle holder flexibly connects.
Head is made up of two parts up and down, and its profile can take different shapes at different parts according to use, can be ellipse, rectangle, racket shape, circle or semicircle etc., and a plurality of bone grafting windows are arranged on the head, can fill broken bone piece.Head is applied to its width and aspect ratio when closing up of breast waist section pedicle approach and is about 2:1, and is consistent for the major diameter of oval working column and minor axis are about 2:1 with the cross section of using at the pedicle of vertebral arch pipe.
Cervical region is two box-shaped up and down.Waist is a tubular, and its diameter height of head when closing up equates that the waist far-end can be provided with the device of tightening nuts.
Between head and the cervical region, between head and the strut, up and down between the two cervical region near-ends and flexibly connect by connecting pin respectively between two strut distal end up and down.There is a bone grafting window in the box-shaped central authorities of cervical region, and plant bone mass is in this inserts fusion device.Cervical region near-end inboard is the articulated section, and protrude in the outside, meets at right angles with the cervical region longitudinal axis.When two cervical regions strutted into 180 ° fully, the two cervical region near-ends outside was protruded the plane and is stopped mutually.When cervical region strutted fully, cervical region and head met at right angles simultaneously, and described inner portion is provided with protrudes the limit, in order to keep this square position; And this moment, head covered the top of cervical region hinged place fully.The far-end of strut flexibly connects with pull bar by connecting pin and interaction is connected, and its near-end flexibly connects by the inboard or the both sides of connecting pin and head.Strut is two box-shaped, and a plurality of bone grafting windows are arranged on it, can fill broken bone piece.The outstanding limit in the hinged and outside of the outstanding limit in the hinged and outside of the far-end inboard of two struts and the near-end inboard of two cervical regions is just the same, and just direction is opposite; The near-end of two struts and last head portion hinged place structure and two cervical region far-ends and last head portion hinged place structure are just the same, and just direction is opposite.Pull bar distal ports cross section is square, and the proximal segment cross section is circular, is provided with locking pin or screw thread between two sections.When two cervical regions strut into 180 ° fully, form a circle hole in articulated section, both sides central authorities between two cervical regions, the rounded portions of pull bar from then on circle was pierced.When fusion device struts fully, by the waist far-end withstand the cervical region near-end until or the locking of the locking pin of pull bar, or the nut on the pull bar is tightened by waist.The near-end of pull bar distal ports projected square part withstands on the medial surface outside the round hole that is mutually between 180 two cervical regions of spending at this moment, keeps cuboid of the inner formation of two heads, two cervical regions and two struts.Head, cervical region and strut inboard are provided with groove, and when head, cervical region and strut closed up fully, the far-end of pull bar all was embedded in the groove of head, cervical region and strut inboard.Connecting leg is a long mini diameter tube, and its external diameter is less than the external diameter of waist, and waist can be enclosed within the outside of connecting leg.The connecting leg far-end is connected with the far-end inboard of waist, allows the rotation of waist original position, and the waist near-end can have swing handle.The connecting leg near-end is fixedlyed connected with the far-end of handle by pin.
The periphery of handle holder proximal lateral is provided with annular groove, the far-end of swing handle is fastened on the proximal lateral of handle holder, the sidewall of swing handle is provided with fixture, and the head of fixture is entrenched in the annular groove on the handle holder periphery, makes the swing handle can only the original position rotation and can not move to near-end or distal direction.
The distal side of the proximal lateral of handle and handle holder is respectively arranged with a corresponding vertical fluting, and vertical fluting and turnbuckle that a pointer passes handle and handle holder fix, when swing handle clockwise or when being rotated counterclockwise, pointer can move to proximal lateral or distal side.The outstanding vertically outside of fluting of pointer is provided with graduation apparatus on the fluting limit, can read head portion by pointer and whether be fully expanded to the position.Graduation apparatus also available sensors connects the LED display replacement.
Advantage and characteristics that device for expanding and fusing bone of the present invention possesses compared with prior art are:
1, device for expanding and fusing bone of the present invention can be easily from way of escape percutaneous from pedicle of vertebral arch or the pedicle of vertebral arch outside enter vertebral body, the soleplate up and down of disease vertebra is kept near parallel or be parallel to each other.Basic recover or recover the height that vertebral body is lost fully, correct the kyphosis deformity of spinal column substantially.After measured, device for expanding and fusing bone bears compressive stress and can reach 1000 pounds/square inch.
2, adopt device for expanding and fusing bone of the present invention to be retained in the bone,, the complication of bone cement seepage just can not take place yet owing to do not use bone cement in the operation as inside-fixture.
3, bone grafting in the device for expanding and fusing bone art of the present invention, finally from the body osteogenesis, bone is rebuild healing, does not have stress concentration, and the adjacent vertebral bodies fracture does not take place, and does not produce the interface and becomes flexible.Device for expanding and fusing bone of the present invention also can be used for treating traumatic or some pathologic vertebral compression fracture of fracture, the part of other position spongy bone etc.
Description of drawings
The invention will be further described below with reference to the accompanying drawing that with the head ovalize is embodiment.
Fig. 1 is that the structure master of device for expanding and fusing bone of the present invention looks sketch map;
Fig. 2 is the structure schematic top plan view of device for expanding and fusing bone of the present invention;
Fig. 3 is the local enlarged diagram at I place among Fig. 2;
Fig. 4 is front portion when expansion cross-sectional schematic of device for expanding and fusing bone of the present invention.
The specific embodiment
For ease of understanding, the right side among Fig. 1,2 is called far-end or front end, the left side is called near-end or rear end.
Referring now to accompanying drawing 1～4, describe the device for expanding and fusing bone specific embodiment of the present invention in detail, device for expanding and fusing bone structure of the present invention has head 1, cervical region 2, waist 3, connecting leg 4, handle 5 and swing handle 6; Between described head 1 and the cervical region 2 and as a whole between the two cervical region proximal end by being hinged to, described head 1, cervical region 2, waist 3, connecting leg 4, handle 5 is ducted body, one pull bar 7 runs through described ducted body, described swing handle 6 connects a turnbuckle 8, described turnbuckle 8 links to each other with an end of described pull bar 7, there is strut 9 other end both sides of described pull bar 7, described strut 9 two ends flexibly connect by connecting pin 10 with described pull bar 7 and described head 1 respectively, described waist 3 far-ends contact mutually with the near-end of described cervical region 2, the near-end of described connecting leg 4 is fixedlyed connected with described handle 5 far-ends, the far-end of one handle holder 14 is arranged on described handle 5 proximal laterals, and described swing handle 6 flexibly connects with the proximal lateral of described handle holder 14.
Below concrete structure of the present invention, operation principle are described in detail.
Between described head 1 and the cervical region 2, between head 1 and the strut 9, flexibly connect by connecting pin 10 respectively between two cervical regions, 2 near-ends and between two struts, 9 far-ends, there is a bone grafting window in the box-shaped central authorities of cervical region 2, and plant bone mass is in this inserts fusion device.Cervical region 2 near-ends inboard is the articulated section, and protrude in the outside, with cervical region 2 longitudinal axis at an angle of 90.When two cervical regions 2 strutted into 180 ° fully, two cervical regions, the 2 near-ends outside was protruded the plane and is stopped mutually.Simultaneously when cervical region 2 struts fully, cervical region 2 and head 1 at an angle of 90, head 1 inboard is provided with protrudes the limit, is used to keep this square position; And this moment, head 1 covered the top of cervical region 2 hinged places fully.The far-end both sides of described pull bar 7 are provided with at least one pair of strut 9, as shown in Figure 4, in the present embodiment, be provided with a pair of strut 9 in the far-end both sides of pull bar 7, the far-end of this a pair of strut 9 flexibly connects with pull bar 7 by connecting pin 10 and interaction is connected, and its near-end flexibly connects by the inboard or the both sides of connecting pin 10 with head 1.Strut 9 is two box-shaped, and a plurality of bone grafting windows are arranged on it, can fill broken bone piece, and the later stage grows into from here from the body bone trabecula.The outstanding limit in the hinged and outside of the near-end inboard of the outstanding limit in the hinged and outside of the far-end inboard of two struts 9 and two cervical regions 2 is just the same, and just direction is opposite; Two struts, 9 near-ends and last head portion 1 hinged place structure and two cervical regions, 2 far-ends and last head portion 1 hinged place structure are just the same, and just direction is opposite.Pull bar 7 distal ports cross sections are square, and the proximal segment cross section is circular, is provided with locking pin or screw thread between two sections.When two cervical regions 2 strut into 180 ° fully, form a circle hole in articulated section, both sides central authorities between two cervical regions 2, the rounded portions of pull bar 7 proximal segment from then on circle was pierced.When fusion device struts fully, withstand of the locking pin locking of cervical region 2 near-ends by waist 3 far-ends, or the nut on the pull bar 7 17 is tightened by waist 3 until pull bar 7.This moment, the near-end of pull bar 7 square distal ports withstood on the outer medial surface in round hole between two cervical regions 2, kept two heads 1, two cervical regions 2 and cuboid of two struts, 9 inside formation.Stretch into the antagonism torque tube, rotating rod 7 proximal end firmly, then pull bar 7 is at the near-end of locking pin, or at the near-end of nut 17, or twists into two parts in arbitrary place of autotomying at pull bar 7 near-ends, and device for expanding and fusing bone just is retained in the bone as an inside-fixture at this moment.Head 1, cervical region 2 and strut 9 inboards are provided with groove, and when head 1, cervical region 2 and strut 9 closed up fully, the far-end of pull bar 7 all was embedded in the groove of head 1, cervical region 2 and strut 9 inboards.Connecting leg 4 is a long mini diameter tube, and its external diameter is less than the external diameter of waist 3, and waist 3 can be enclosed within the outside of connecting leg 4.Connecting leg 4 far-ends are connected with the far-end inboard of waist 3, allow the rotation of waist 3 original positions, and waist 3 near-ends can have swing handle.Connecting leg 4 near-ends fix by the far-end of pin 12 with handle 5.
The far-end of one handle holder 14 is contained in the proximal lateral of described handle 5, by holding screw 13 distal side of handle holder 14 and the proximal lateral of handle 5 is fixed.In the present embodiment, have a step-like storage tank 51 in the proximal lateral of described handle 5, the distal side of described handle holder 14 is contained in this storage tank 51.On the periphery of handle holder 14 proximal laterals, be provided with an annular groove 142, the far-end of described swing handle 6 has the caulking groove 61 of an indent, be fastened on the proximal lateral of described handle holder 14 by the far-end of these caulking groove 61 described swing handles 6, the sidewall of described swing handle 6 is provided with at least one fixture 15, the head of described fixture 15 is entrenched in the described annular groove 142 on described handle holder 14 peripheries, makes the swing handle 6 can only the original position rotation and can not move to near-end or distal direction.Described swing handle 6 and turnbuckle 8 are connected by screw thread.When swing handle 6 clockwise or when being rotated counterclockwise, turnbuckle 8 and pull bar 7 are just axially moving to proximal lateral or distal side.
Be respectively arranged with a corresponding vertical fluting 51,141 in the proximal lateral of described handle 5 and the distal side of described handle holder 14, one pointer 16 passes vertical fluting 51,141 of described handle 5 and handle holder 14 and described turnbuckle 8 or pull bar 7 and fixes, in the present embodiment, shown in Fig. 2,3, described pointer 16 fixes with turnbuckle 8.When described swing handle 6 clockwise or when being rotated counterclockwise, described pointer 16 can move to proximal lateral or distal side.The outside of described pointer 16 outstanding described vertical flutings 51,141 is provided with graduation apparatus 17 on described fluting limit, can read device for expanding and fusing bone by pointer 16 and whether be fully expanded to the position.Graduation apparatus 17 also available sensors connects the LED display replacement.
Device for expanding and fusing bone operation principle of the present invention is as follows:
Device for expanding and fusing bone is made up of the rear portion of front portion that produces expansionary force and generation pulling force.
1, the front portion of device for expanding and fusing bone comprises head 1, cervical region 2 and strut 9, between these three parts be connected through the hinge into as a whole.Head 1 is made up of two parts up and down.According to the difference of using the position, its profile adopts difformity, use ellipse, rectangle or racket shape as breast waist section vertebral fracture through posterior approach, breast waist section vertebral fracture adopts oval or semicircle through anterior approach, and fracture of the tibial plateau uses semicircle etc.All each is made up of two box-shaped for cervical region 2 and strut 9.There is pull bar 7 to pass through at the forward center of device for expanding and fusing bone.There is strut 9 pull bar 7 front end both sides, and strut 9 is movably connected with pull bar 7 and head 1 respectively with connecting pin 10.Cervical region 2 and strut 9 play and draw or strut effect in.When pull bar 7 when the distal side moves to head 1 and closes up fully, pull bar 7 all is stowed in the groove of head 1, cervical region 2 and strut 9 inboards.On the contrary, when pulling force with pull bar 7 when the proximal lateral spurs, waist 3 far-ends prop up the near-end of cervical region 2, cervical region 2 and strut 9 strut head 1; Until all being stuck when being mutually 180 ° of angles separately between two cervical regions, 2 near-ends and between two struts, 9 far-ends, the near-end of pull bar 7 square distal ports withstands on the medial surface outside the round hole that is mutually between two cervical regions 2 of 180 ° of angles at this moment.All be mutually 90 ° of angles between head 1, two cervical regions 2 in line and two struts 9 in line like this, cuboid of the inboard formation of three.The compressive stress that device for expanding and fusing bone bears directly is passed to lower head 1 through the outer surface of two cervical regions 2 and two struts 9 by upside head 1, and transmit, thereby avoid pin portion 10 to produce fatigue fractures without the pin portion between the pin portion 10 and two cervical regions 2 between head 1 and the cervical region 2, between head 1 and the strut 9, between two struts 9 10.
2, the rear portion of device for expanding and fusing bone is made up of waist 3, connecting leg 4, handle 5 and swing handle 6.Connecting leg 4 is a mini diameter tube, and it links to each other with waist 3 respectively and links to each other with handle 5 by pin 12.Waist 3 contacts mutually with cervical region 2 but is not connected, and waist 3 can be enclosed within outside the connecting leg 4, can the original position rotation.Pull bar 7 is passed at waist 3, connecting leg 4 and handle 5 centers.There is turnbuckle 8 at swing handle 6 centers, and turnbuckle 8 is connecting pull bar 7.When swing handle 6 turned clockwise, pull bar 7 moved to the proximal lateral; When swing handle 6 was rotated counterclockwise, pull bar 7 can move to the distal side.Between swing handle 6 and handle 5, be provided with a handle holder 14, the three linked to each other by fixture 15 and holding screw 13.There is a graduation apparatus 17 at handle 5 rear portions, and intermediary pointer 16 links to each other with pull bar 7 or turnbuckle 8, can read device for expanding and fusing bone from the position of pointer 16 on graduation apparatus 17 and whether be fully expanded to the position.
The device for expanding and fusing bone operative indication:
Device for expanding and fusing bone mainly is applicable to treatment osteoporotic vertebral compression fracture as the bone inside-fixture, also can be used for treating the fracture of other position spongy bone, as fracture of the tibial plateau, distal tibial fracture, fracture of the surgical neek of the humerus, radius far-end fracture, fractured near end of thighbone, Methods for Distal Femoral Fractures, fracture of calcaneus or fracture of rib etc., and part is traumatic or some pathologic vertebral compression fracture etc.
Operation method:
With the modal breast waist of osteoporosis section vertebral compression fracture posterior approach is example.At this moment, the device for expanding and fusing bone that will be used for vertebral body is called the vertebral body device for expanding and fusing.The characteristics of vertebral body device for expanding and fusing head 1 are: head about 1 footpaths were with the footpath is than being about 2:1 up and down when fusion device closed up, and head 1 special shape is according to the breast waist section pedicle of vertebral arch radius vector of state stranger and Chinese's measurement and (the seeing Table 1) that transverse diameter is set than the characteristics that on average are about 2 to 1.Therefore, setting up the pedicle of vertebral arch plumber when making passage, inserting major diameter is oval-shaped working column with minor axis than the cross section that is about 2:1, and also available long limit is rectangular working column with minor face than the cross section that is about 2:1.Footpath and footpath up and down are than the vertebral body device for expanding and fusing that is about 2:1 about when vertically putting into head 1 and close up by this oval pedicle of vertebral arch tube passage, arrive behind the vertebral body 1/2, vertebral body device for expanding and fusing half-twist, again head 1 is laterally put into vertebral body, strut fully, with the vertebral body contact area of soleplate up and down, reduce pressure when increasing expansion, avoid vertebral body sclerotin generation dissection.
External and Chinese's lower breast of table 1 and waist section pedicle of vertebral arch radius vector and transverse diameter measurement (mm) (x ± s)
VD: pedicle of vertebral arch radius vector TD: pedicle of vertebral arch transverse diameter R: pedicle of vertebral arch radius vector transverse diameter ratio
The operation approach has two kinds:
1, pedicle approach
This approach is applicable to T10 to L5 vertebral fracture.Under C arm machine perspective, the patient is prostrate in operating-table, gives the perspective location earlier, and adjusts C arm machine to showing that the disease vertebra does not have " bilateral shadow ", and promptly this terminal plate of vertebral body and X line are complete parallel and make its soleplate be imaged as a line shadow; The shape of both sides pedicle of vertebral arch must be symmetrical and identical with the spacing of spinous process simultaneously, and this moment, pedicle of vertebral arch was the most clear in the normotopia demonstration.Local anaesthesia, but also general anesthesia.It is 9 o'clock location that the puncture needle needle point places the outer rim left side of pedicle of vertebral arch shadow, and the right side is 3 o'clock location.C arm machine is transferred to the side position, pierces the belt carcass puncture needle, when needle point to pedicle of vertebral arch 1/2 the time, the perspective normotopia, this moment, needle point should be positioned at the midline of " eyes shape " pedicle of vertebral arch shadow.When the side position showed that needle point arrives the vertebral body rear wall, normotopia should show that needle point is positioned at the medial border of pedicle of vertebral arch shadow.Extract the inner core of puncture needle out, insert guide pin.Extract the puncture needle sleeve pipe, insert the cross section for circular expanded casing and working column along guide pin according to the order of sequence, make the front end of working column be positioned at 2mm place, vertebral body trailing edge cortex the place ahead.Bone drill is slowly pierced through the strength of working column with finger.When the side position showed that drill bit arrives vertebral body 1/2 place, normotopia should show that drill bit is positioned at pedicle of vertebral arch shadow and spinous process line 1/2 place; When the side position showed that drill bit arrives apart from anterior margin of vertebral body 5mm, normotopia should show that drill bit is near the spinous process edge.Adopt direction of rotation limit rotating side taking-up bone drill identical when piercing.Changing major diameter and minor axis is oval-shaped expanded casing and working column than the cross section that is about 2:1, will stretch into the big or small solid open circuit device identical with shape of vertebral body device for expanding and fusing and make passage in the vertebral body, takes out solid open circuit device.At this moment, can be earlier with the expansion of vertebral body dilator, the vertebral body dilator is vertically put into pedicle of vertebral arch to the vertebral body 1/2 along oval-shaped work pipe box, and half-twist is put into vertebral body along last soleplate lower edge fully with its head, be positioned at apart from sick vertebra leading edge 5mm place to its front end, enlarge the vertebral body dilator, to sick vertebra up and down soleplate draw the vertebral body dilator near parallel or be parallel to each other, half-twist takes out, and selected vertebral body device for expanding and fusing is vertically put into vertebral body along oval-shaped working column; Also can directly the vertebral body device for expanding and fusing vertically be put into vertebral body along oval-shaped working column without vertebral body dilator expansion, half-twist, head 1 wider part is to soleplate up and down.This moment, head 1 and cervical region 2 were all in vertebral body.The swing handle 6 that turns clockwise, enlarged head 1 gradually, until strutting fully.Locking pin locking on the available pull bar 7 at this moment, or with tightening in the screw thread of waist 3 with nut 17 screw-in pull bars 7.The vertebral body device for expanding and fusing is expanded fully and can be read the present position on graduation apparatus 17 from pointer 16.Simultaneously C arm machine monitor the disease vertebra up and down soleplate near parallel or be parallel to each other.Stretch into the antagonism torque tube, rotating rod 7 proximal laterals firmly, then pull bar 7 can be at the near-end of locking pin, or at the near-end of nut 17, or twist into two parts in the place of autotomying of pedicle of vertebral arch collar extension at pull bar 7 near-ends, latter's hollow pedicle screw is inserted in pull bar 7 stump sections and is fixed on the pedicle of vertebral arch, prevents that the vertebral body device for expanding and fusing from moving in vertebral body.The vertebral body device for expanding and fusing was retained in to keep in the vertebral body as inside-fixture and resetted this moment.Push pipe through bone grafting the bone grafting window of broken bone piece from cervical region 2 central authorities pushed in the fusion device, until filling up.The same simultaneously operation of offside pedicle operation.Can carry out Wicresoft's short-segment pedicle instrument internal fixation this moment simultaneously.
2, the outer approach of pedicle
This approach is applicable to T5 to T12 vertebral fracture.The gradient inside because of thoracic vertebral pedicle is very little, as adopting the puncture of pedicle approach, then may be broken in the outside by vertebral body side cortex too partially because of the vertebral body device for expanding and fusing bone of inserting, and it is too thin to go up thoracic vertebral pedicle, is easily cracked in the art.Adopt between outer approach puncture needle pedicle of pedicle and the rib and enter vertebral body, can make puncture needle that enough gradients are to the inside arranged, thereby make the vertebral body device for expanding and fusing insert comparatively ideal position.The operation of this approach only needs carry out from a side, and vertebral body device for expanding and fusing head 1 adopts oval or semicircle, and enters vertebral body and need surpass center line to offside.All the other operations are identical with the pedicle approach.
Claims (9)
1, a kind of device for expanding and fusing bone is characterized in that: have head, cervical region, waist, connecting leg, handle and swing handle; Between described head and the cervical region, as a whole between cervical region and the cervical region by being hinged to, described head, cervical region, waist, connecting leg, handle is ducted body, one pull bar runs through described ducted body, described swing handle connects a turnbuckle, described turnbuckle links to each other with an end of described pull bar, there is strut the other end both sides of described pull bar, described strut two ends flexibly connect by pin with described pull bar and described head respectively, described waist far-end contacts mutually with described cervical region near-end, the near-end of described connecting leg is fixedlyed connected with described handles distal, the far-end of one handle holder is arranged on described handle proximal lateral, and the proximal lateral of described swing handle and described handle holder flexibly connects.
2, device for expanding and fusing bone according to claim 1, it is characterized in that: described head is made up of two parts up and down, described head adopts ellipse, rectangle, racket shape, circle or semicircle, described head is provided with the bone grafting window, and its width that closes up and aspect ratio were 2:1 when described head was applied to breast waist section pedicle approach.
3, device for expanding and fusing bone according to claim 1 is characterized in that: described cervical region is two box-shaped, and there is a bone grafting window in the central authorities of box-shaped; Cervical region near-end inboard is the articulated section, and the outside is for becoming the protrusion of 90 ° of angles with the cervical region longitudinal axis, and when two cervical regions strut when being mutually 180 ° fully, the protuberance plane stops mutually; When cervical region strutted fully, cervical region and head met at right angles, and inner portion is provided with outstanding limit, and to keep this position, right angle, head covers the top of cervical region hinged place fully.
4, device for expanding and fusing bone according to claim 1 is characterized in that: described strut is two box-shaped, and a plurality of bone grafting windows are arranged on the described strut; Described strut is provided with a pair of at least, and the far-end of strut is movably connected by connecting pin and described pull bar and interaction is connected, and near-end flexibly connects by the inboard or the both sides of connecting pin and described head; Described strut distal end inboard is the articulated section, and the outside, is protruded the limit and stopped mutually when two struts strut into 180 ° fully for become the protrusion of 90 ° of angles with the strut longitudinal axis; When strut strutted fully, strut and head met at right angles, and inner portion is provided with outstanding limit, and in order to keep this position, right angle, head covers the top of cervical region hinged place fully.
5, according to each described device for expanding and fusing bone in the claim 1-4, it is characterized in that: the inboard formation of described head, described cervical region and described strut one groove.
6, device for expanding and fusing bone according to claim 1 is characterized in that: described pull bar distal ports cross section is square, and the proximal segment cross section is circular, is provided with locking pin or screw thread between two sections; The far-end of pull bar flexibly connects by connecting pin and described strut distal end, and the pull bar near-end is fixedlyed connected with described turnbuckle.
7, device for expanding and fusing bone according to claim 1, it is characterized in that: the near-end of described connecting leg is fixedlyed connected with the far-end of described handle, the far-end of described connecting leg is connected with the near-end of described waist is inboard, and the far-end of described waist and the near-end of described cervical region contact mutually; Described connecting leg and described waist are mini diameter tube, and the external diameter of described connecting leg can be inserted in the described waist pipe less than the external diameter of described waist, and waist can rotate in position, the height the when diameter of waist equals head and closes up.
8, device for expanding and fusing bone according to claim 1, it is characterized in that: in described handle holder, be provided with an annular groove, the far-end of described swing handle is fastened on the proximal lateral of described handle holder, the sidewall of described swing handle is provided with at least one fixture, and the head of described fixture is entrenched in the described annular groove on the described handle holder periphery.
9, device for expanding and fusing bone according to claim 1, it is characterized in that: be respectively arranged with a corresponding vertical fluting in the distal side of described handle proximal lateral and described handle holder, one pointer passes vertical fluting of described handle and described handle holder and described turnbuckle or described pull bar and fixes, outside the outstanding described vertical fluting of described pointer, be provided with graduation apparatus on described fluting limit.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN2009100258667A CN101502436B (en) | 2009-03-11 | 2009-03-11 | Device for expanding and fusing bone |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN2009100258667A CN101502436B (en) | 2009-03-11 | 2009-03-11 | Device for expanding and fusing bone |
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| Publication Number | Publication Date |
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| CN101502436A true CN101502436A (en) | 2009-08-12 |
| CN101502436B CN101502436B (en) | 2012-01-25 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN2009100258667A Expired - Fee Related CN101502436B (en) | 2009-03-11 | 2009-03-11 | Device for expanding and fusing bone |
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| CN103830023A (en) * | 2012-11-26 | 2014-06-04 | 思邦科技脊柱智慧公司 | Expandable cage for intracorporeal fusion of lumbar vertebrae |
| CN104921849A (en) * | 2015-07-15 | 2015-09-23 | 王洪伟 | Interbody fusion cage |
| CN105310804A (en) * | 2014-07-25 | 2016-02-10 | 陈桂蓉 | Automatic elastic expansion vertebral body implant |
| CN105943205A (en) * | 2016-05-24 | 2016-09-21 | 中山市世医堂医疗器械有限公司 | A force application device for an expandable spinal fusion cage |
| CN108403200A (en) * | 2018-03-14 | 2018-08-17 | 张龙君 | Thoracolumbar fracture resets the soleplate bone block percutaneous reduction by leverage device of bone grafting operation |
| CN109172057A (en) * | 2018-10-16 | 2019-01-11 | 北京东鸿致远医疗科技有限公司 | Invasive lumbar fusion device and its installation tool |
| US10973650B2 (en) | 2015-12-30 | 2021-04-13 | Nuvasive, Inc. | Lordotic expandable fusion implant |
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| CN201356642Y (en) * | 2009-03-11 | 2009-12-09 | 吴乃庆 | Centrum expanding fusion cage |
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| CN103830023A (en) * | 2012-11-26 | 2014-06-04 | 思邦科技脊柱智慧公司 | Expandable cage for intracorporeal fusion of lumbar vertebrae |
| US11957602B2 (en) | 2013-05-22 | 2024-04-16 | Nuvasive Inc. | Expandable fusion implant and related methods |
| US11679000B2 (en) | 2013-05-22 | 2023-06-20 | Nuvasive, Inc. | Expandable fusion implant and related methods |
| CN105310804A (en) * | 2014-07-25 | 2016-02-10 | 陈桂蓉 | Automatic elastic expansion vertebral body implant |
| US11234833B2 (en) | 2015-05-12 | 2022-02-01 | Nuvasive, Inc. | Expandable lordosis intervertebral implants |
| US11938040B2 (en) | 2015-05-12 | 2024-03-26 | Nuvasive, Inc. | Expandable lordosis intervertebral implants |
| CN104921849A (en) * | 2015-07-15 | 2015-09-23 | 王洪伟 | Interbody fusion cage |
| US11690730B2 (en) | 2015-12-30 | 2023-07-04 | Nuvasive, Inc. | Lordotic expandable fusion implant |
| US10973650B2 (en) | 2015-12-30 | 2021-04-13 | Nuvasive, Inc. | Lordotic expandable fusion implant |
| CN105943205A (en) * | 2016-05-24 | 2016-09-21 | 中山市世医堂医疗器械有限公司 | A force application device for an expandable spinal fusion cage |
| CN105943205B (en) * | 2016-05-24 | 2018-05-29 | 中山市世医堂医疗器械有限公司 | A kind of force application apparatus for being used to may expand spinal fusion device |
| US11273047B2 (en) | 2017-12-18 | 2022-03-15 | Nuvasive, Inc. | Expandable implant device |
| CN108403200A (en) * | 2018-03-14 | 2018-08-17 | 张龙君 | Thoracolumbar fracture resets the soleplate bone block percutaneous reduction by leverage device of bone grafting operation |
| CN109172057A (en) * | 2018-10-16 | 2019-01-11 | 北京东鸿致远医疗科技有限公司 | Invasive lumbar fusion device and its installation tool |
| CN113509253A (en) * | 2021-07-19 | 2021-10-19 | 常熟市第二人民医院 | Spine acantha strutting device |
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| CN101502436B (en) | 2012-01-25 |
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