CN101631516A - 可调节椎间植入物 - Google Patents

可调节椎间植入物 Download PDF

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Publication number
CN101631516A
CN101631516A CN200880008347A CN200880008347A CN101631516A CN 101631516 A CN101631516 A CN 101631516A CN 200880008347 A CN200880008347 A CN 200880008347A CN 200880008347 A CN200880008347 A CN 200880008347A CN 101631516 A CN101631516 A CN 101631516A
Authority
CN
China
Prior art keywords
body part
ratchet
ring
implant
body member
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
CN200880008347A
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English (en)
Inventor
W·伍德伯恩
D·埃文斯
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Synthes GmbH
Synthes USA LLC
Original Assignee
Synthes GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Synthes GmbH filed Critical Synthes GmbH
Publication of CN101631516A publication Critical patent/CN101631516A/zh
Pending legal-status Critical Current

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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • 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
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Abstract

本发明涉及可调节椎间植入物，其中一种可扩张椎间植入物(10)包括第一部件(20)、第二部件(40)，和以可操作方式与第一和第二部件相关联的卡环，其中卡环包括螺纹机构从而述卡环的旋转引起第二部件相对于第一部件轴向移动。植入物包括棘轮机构(50，80)从而当施加至少预定量值的作用力时，第二部件以轴向棘轮类型方式相对于第一部件移动。卡环优选地包括被以可旋转方式联结到第一部件的驱动环(50)和以可操作方式与驱动环相关联的棘轮环(50)。棘轮环包括具有用于与在所述第二部件上所形成的棘轮螺纹齿型接合的、在其上形成的至少一个相应棘轮螺纹齿型的内孔。

Description

可调节椎间植入物
相关申请的交叉引用
[0001]该申请主张2007年3月13日提交的美国临时专利申请序列号No.60/894,568的优先权，其全部内容由此通过引用而被整体并入。
技术领域
[0002]本发明涉及一种椎间植入物，并且更加具体地涉及一种可调节高度的椎间植入物，该植入物优选地使得使用者能够运用棘轮类型调节和螺杆类型调节来调节植入物的高度。
背景技术
[0003]退变性腰椎间盘疾病(degenerative disc disease)或者椎体退化经常导致椎间盘高度损失，而椎间盘高度损失继而能够引起的后果特别是对小面关节(facet)和神经的冲击。一种护理标准是利用椎间植入物替代受损椎间盘或者利用椎间植入物替代受损部分或者全部椎体。即，在移除受损椎间盘、受损椎间盘髓核或者受损部分或者全部椎体之后，椎间植入物被插入两个相邻椎体的椎间空间中、或者通过移除部分或者全部椎体所产生的空间中。优选地，椎间植入物将脊骨尽可能地恢复至自然状态，即恢复椎间盘的初始高度并且因此恢复处于不同脊骨水平的椎体之间或者两个相邻椎体之间的初始距离。
发明内容
[0004]本发明针对一种用于在第一和第二部件之间插入的可扩张椎间植入物。该植入物可以包括第一部件、第二部件，和以可操作方式与第一和第二部件相关联的卡环，该卡环可以包括螺纹机构和棘轮机构，该螺纹机构从而使得卡环的旋转引起第二部件相对于第一部件轴向移动，该棘轮机构从而使得当至少预定量值的作用力被施加到第一和第二部件之一或这两者时，第二部件以轴向棘轮类型方式相对于第一部件移动。第二部件可以稍微小于第一部件从而第二部件至少部分地被接收于第一部件内。
[0005]在另一示例性实施例中，椎间植入物可以包括具有第一端部和第二端部的第一本体部件，其中该第一端部能够与第一椎骨的终板的至少一个部分接合。该植入物可以还包括具有第一端部和第二端部的第二本体部件，其中该第一端部能够与第二椎骨的终板的至少一个部分接合。该第二本体部件优选地包括在其上形成的至少一个棘轮螺纹齿型。驱动环被以可旋转方式联结到第一本体部件并且优选地包括用于接收第二本体部件的内孔。棘轮环以可操作方式与驱动环相关联并且优选地包括内孔，该内孔具有用于与在第二本体部件上形成的棘轮螺纹齿型相接合的、在其上形成的至少一个相应的棘轮螺纹齿型。在使用中，驱动环的旋转优选地引起棘轮环旋转，而这继而优选地引起第二本体部件相对于第一本体部件轴向移动。棘轮环优选地沿着径向是柔性的从而使得在棘轮环上形成的棘轮螺纹齿型能够移动到与在第二本体部件上形成的棘轮螺纹齿型相分离从而使得第二本体部件相对于第一本体部件轴向移动的位置。
[0006]在本发明的另一个方面中，一种对用于植入位于第一与第二骨头部件之间的椎间盘空间中的可调节高度椎间植入物确定尺寸的示例性方法可以包括：(i)提供植入物，该植入物具有第一本体部件、第二本体部件，和以可操作方式与第一和第二本体部件相关联的卡环；(ii)向第一和第二本体部件中的至少一个施加至少预定量值的作用力从而使得第二本体部件以轴向棘轮类型方式相对于第一本体部件移动以接近在第一与第二骨头部件之间的空间；和(iii)相对于第二本体部件旋转该卡环从而使得第二本体部件相对于第一本体部件轴向移动以精调所述植入物到第一和第二骨头部件之间的椎间盘空间的总体高度。
附图简要说明
[0007]当与附图相结合地阅读时，可以更好地理解本申请的前述简介，以及以下优选实施例的详细说明。为了示意的目的，在图和优选实施例中示出本申请的可调节椎间植入物。然而，应该理解，本申请并不限于所示的精确布置和手段，并且权利要求不应该受限于所示实施例。在图中：
[0008]图1是根据本申请第一优选实施例的、并且布置为处于扩大位置中的可调节椎间植入物的顶部透视图；
[0009]图2是为清楚起见终板已被移除的、并且布置为处于收折位置中的、图1所示椎间植入物的一个部分的顶部透视图；
[00010]图3是沿着图2的线3-3截取的、并且布置为处于收折位置中的图1所示椎间植入物的一个部分的截面视图；
[00011]图3A是取自图3的圆3A内的并且布置为处于扩大位置中的图1所示椎间植入物的一个部分的放大截面视图；
[00012]图4是图1所示椎间植入物的第一或者外部本体部件的顶部透视图；
[00013]图5是图1所示椎间植入物的第二或者内部本体部件的顶部透视图；
[00014]图6是图5所示第二或者内部本体部件的后部立视图；
[00015]图7是沿着图5的线7-7截取的、图5所示第二或者内部本体部件的截面视图；
[00016]图8A是图1所示椎间植入物的驱动环的顶部透视图；
[00017]图8B是图8A所示驱动环的底部透视图；
[00018]图9是图8A所示驱动环的侧部立视图；
[00019]图10是图1所示椎间植入物的棘轮环的顶部平面视图；
[00020]图11是沿着图10的线11-11截取的、图10所示棘轮环的截面视图；
[00021]图12是取自图11的圆12内的、图10所示棘轮环的放大截面视图；
[00022]图13是沿着图1的线13-13截取的、图1所示的椎间植入物的截面视图；
[00023]图14是图1所示的椎间植入物的终板的顶部平面视图；并且
[00024]图15是根据本申请第二优选实施例的可调节椎间植入物的侧部立视图。
具体实施方式
[00025]特定术语在以下说明中仅仅为了方便起见而使用的并且不是限制性的。单词“右”、“左”、“下”和“上”指定在图中所参考的方向。单词“向内”和“向外”指的是分别地朝向和远离可调节椎间植入物及其指定部件的几何中心的方向。单词“前面的”、“后面的”、“上级的”、“下级的”以及相关单词和/或短语指定所参考的人体中的优选位置和定向而非旨在是限制性的。术语包括以上列出的单词、其派生词以及具有类似含义的单词。
[00026]现在将参考附图描述特定的示例性实施例。通常，这种实施例涉及一种椎间植入物，作为一个非限制实例，用于在第一和第二邻近或者相邻椎骨中间植入患者脊骨内的一种可扩张椎间植入物。如果用作切除(corpectomy)器件，则椎间植入物将能够执行单或者多节段操作，即，移除一个或者多于一个的椎骨和/或椎骨部分。植入物可以被插入椎骨之间或者椎骨内，例如，一个或者多个椎骨的部分可以被移除并且植入物可以接触椎骨的内部部分。
[00027]椎间植入物可以具有对本文中所描述那些植入物的可替代的应用和使用，并且不应该限于所被描述和图示的结构或者使用。即，虽然椎间植入物将被描述成并且可以基本上在脊骨中使用(例如，在腰椎、胸廓或者颈部区域中)，但是本领域技术人员将会意识到椎间植入物还可以在其它身体部位中使用，并且可以具有在医疗器械领域以外的其它应用。
[00028]参考图1至3和15，第一和第二优选实施例的椎间植入物10、210可以由在本技术领域中已知的任何生物适合材料或者任何生物适合材料的组合构造，包括但是不限于不锈钢、钛、钛合金、陶瓷、聚合物，所述聚合物包括但是不限于聚四氟乙烯(“PTFE”)等。优选地，椎间植入物10、210由聚醚醚酮(“PEEK”)构造。椎间植入物10、210可以具有辐射不透性从而使得植入物的安置和定位能够被可视化。
[00029]植入物10、210的全部构件可以由相同材料制成，或者，如果优选的话，能够使用不同的材料，例如，用以增强耐久性和强度并且减小摩擦和磨损。另外，一个或者多个涂层可以被涂覆到一个或者多个构件。
[00030]参考图1至3，第一优选实施例的椎间植入物10可以包括第一本体部件20和第二本体部件40。在使用中，第二本体部件40优选地尺寸被确定并且被配置为稍微小于第一本体部件20从而第二本体部件40能够被以可移动方式置于第一本体部件20内。这样，第一本体部件20将通常被表征为内部本体部件20，而第二本体部件40将通常被表征为外部本体部件40。然而，应该指出，考虑了以可移动方式关联第一本体部件和第二本体部件的其它布置。例如，第一和第二本体部件可以各自包括从端部部件或者环延伸的多个支腿，第一部件的支腿可以是相对于第二部件的支腿能够以可移动方式移位的。
[00031]如最佳地在图4中所示，外部本体部件20优选地是基本中空的柱形部件，该部件具有第一端部22、第二端部24、外表面26和基本从第一端部22到第二端部24延伸的内孔28。外部本体部件20不限于柱形形状并且可以例如可替代地被成形为诸如正方形、矩形、椭圆形、卵形或者任何其它形状。外部本体部件20可以还包括形成于其外表面26中的一个或者更多个开口30、31。在第一优选实施例中，外部本体部件20包括比较大的骨头包装开口30，骨头包装开口30优选地提供通往内孔28的进口从而外科医生能够通常在植入配置中将骨头碎片或者可替代的移植材料插入植入物10中。外部本体部件20还优选地包括若干较小的向内生长(in-growth)开口31，向内生长开口31允许骨头在植入配置中向内生长以促进邻近椎骨200、202的愈合。椎间植入物10不限于包括骨头包装开口30或者向内生长开口31并且可以不在其中包括开口30、31或者可以包括另外的以不同形式成形的开口，这取决于植入物10的具体应用或者配置。
[00032]如最佳地在图5至7中所示，内部本体部件40优选地形式为柱形部件，该部件具有第一端部42、第二端部44、外表面46和中空内部空腔48。如所示那样，内部本体部件40的外表面46优选地并不限定360度从而使得内部本体部件40优选地具有局部柱形部件的形式。内部本体部件40不限于形成仅仅局部柱形形状并且可以采取全柱体的形式或者可以被以可替代的形式成形，诸如正方形、椭圆形或者允许与外部本体部件20相配合的几乎任何的其它形状。如将在下面更加详细描述地，内部本体部件40可以具有能够承受正常操作条件并且执行内部本体部件40的优选功能的几乎任何形状。
[00033]参考图1至7，在第一优选实施例中，在植入配置中，内部本体部件40的第一端部42邻近上级椎骨200定位并且外部本体部件20的第二端部24邻近下级椎骨202定位。内部本体部件40的第一端部42和外部本体部件20的第二端部24不一定与椎骨200、202形成面对式接合，而是优选地在植入配置中邻近椎骨200、202定位。例如，第一端部42和第二端部24可以利用终板120、122而在植入配置中与椎骨200、202间隔开，所述终板被分别地联结到第一端部42和第二端部24，并且将在下面更加详细地描述。
[00034]参考图2和3，在收折位置中，第一或者外部本体部件20的第一端部22邻近第二或者内部本体部件40的第一端部42定位。另外，在收折位置中，外部本体部件20的第二端部24邻近内部本体部件40的第二端部44定位。第一优选实施例的植入物10优选地在这个收折位置中具有其最小高度并且可以在这个配置中被插入或者被植入患者体内以限制植入所需空间。当植入物10被推进到扩大位置(图1和3A)时，外部本体部件20的第一端部22从内部本体部件40的第一端部42移开。在扩大位置中，植入物10的高度大于植入物在收折位置中的高度。植入物10可以在扩大位置中采取各种高度以适应在邻近椎骨200、202或者椎骨200、202部分之间的各种距离。
[00035]参考图1至7，外部和内部本体部件20、40优选地沿着公共纵向轴线12被共轴地置放并且优选地相对于彼此以可滑动方式置放(例如，伸缩的)从而使得相对于外部本体部件20而言内部本体部件40的轴向位置是可调节的。外部和内部本体部件20、40不限于相对于彼此以伸缩方式和/或以可滑动方式置放，并且可以按照允许外部和内部本体部件20、40相对于彼此移动从而允许内部部件40的第一端部42相对于外部部件20的第二端部24运动的几乎任何方式配置。
[00036]内部本体部件40的外表面46优选地包括形成于其上的棘轮螺纹齿型50。棘轮螺纹齿型50指的是这样一种结构，该结构当内部本体部件40相对于棘轮环80旋转时允许内部本体部件40相对于棘轮环80用作螺杆类型部件(如下面更加详细描述)，并且还包括当在内部本体部件40和外部本体部件20之间沿着轴向方向施加充分的轴向作用力时允许内部本体部件40相对于棘轮环80以平移方式移动的截面轮廓。将会理解，如将在下面更加详细描述地，可以通过内部本体部件40和/或棘轮环80中的至少一个的弹性压缩来促成轴向运动。棘轮螺纹齿型可具有任何形式，只要其允许轴向移动和旋转这两种运动。
[00037]棘轮齿型50可以是例如允许内部本体部件40相对于棘轮环80、外部本体部件20或这两者发生旋转并且还允许内部本体部件40相对于棘轮环80、外部本体部件20或这两者发生平移的螺旋槽、凸起或者螺纹。虽然附图将内部本体部件40图示为具有单一连续长度的棘轮螺纹齿型50，但是植入物10并不受到如此限制。作为实例，可以提供棘轮螺纹齿型50的、由非螺纹区域分离开的离散的部段，并且棘轮螺纹齿型50还可以被平行于植入物10的纵向轴线12而延伸的一个或者更多个凹槽所中断。
[00038]将会进一步理解的是，棘轮螺纹齿型50的齿距、轮廓和尺寸优选地被选择为当内部本体部件40优选地无旋转地相对于外部本体部件20移动时促成植入物10的棘轮作用。作为非限制实例，如本领域普通技术人员可以理解地，使用“锯齿”螺纹轮廓可以产生“单向”棘轮，而使用更为呈三角形的螺纹轮廓可以允许实现“双向”棘轮。当经历棘轮类型作用时，棘轮螺纹齿型50可以优选地在形成于棘轮环80上的相应棘轮螺纹齿型90或者在外部本体部件20之上滑过，以允许轴向运动。当植入物10经历棘轮类型运动时，棘轮螺纹齿型可以相对于棘轮环80或者外部本体部件20沿着径向移动，并且棘轮螺纹齿型的径向运动可以促成棘轮运动。棘轮螺纹齿型的径向运动可以由棘轮螺纹齿型、或者由棘轮螺纹齿型被紧固到的或者形成于其中的部件的弹性挠度提供。可替代地，棘轮螺纹齿型可以被弹簧偏压以相对于棘轮环80沿着径向移动或者沿着径向枢转。如最佳地在图3a中所示，棘轮螺纹齿型50可以包括根切或者负螺纹角度，例如大致7度，从而使得一旦植入物10被植入，则所产生的压缩作用力便趋向于引起在内部本体部件20上所形成的棘轮螺纹齿型与在棘轮环80上形成的棘轮螺纹齿型相锁定。
[00039]参考图8A至13，椎间植入物10可以还包括被置于外部与内部本体部件20、40之间的驱动环60、以及与驱动环60相关联的并且优选地被包含于驱动环60内的棘轮环80。虽然驱动环60和棘轮环80将大体上被描述成两个分离并且独立的构件，但是可以设想，取决于植入物10的操作和/或优选的用法，驱动环60和棘轮环80可以被一体地形成为单一构件或者可以被构造成若干构件的组件。驱动环60和棘轮环80优选地与外部和内部本体部件20、40互相作用以允许通过螺杆类型调节和棘轮类型调节而对植入物10的高度进行轴向操纵或者修正，这将在下面更加详细地描述。
[00040]如最佳地在图8A和8B中所示，驱动环60可以包括内孔62，该内孔62在组装配置中接收了内部本体部件40。驱动环60还优选地被以可移动方式联接到、更加优选地被以可旋转方式联结到外部本体部件20。驱动环60可以利用使得驱动环60能够被以可移动方式联接到、优选地被以可旋转方式联结到外部本体部件20的任何手段而被连接到外部本体部件20，所述手段包括但是不限于卡扣配合连接、挤压配合连接等。驱动环60优选地包括用于与形成于外部本体部件20上的周向凹槽23相接合的一个或者更多个凸起64。在第一优选实施例中，驱动环60包括围绕着环60的圆周被基本上均匀地、沿着径向地间隔开的五个(5)凸起64。外部本体部件20还优选地包括对准凸出23，该对准凸出23与内部本体部件40相互作用，用以当构件相对于彼此轴向移动时基本上沿着轴向将内部本体部件40与外部本体部件20对准。
[00041]驱动环60可以还包括在其表面上形成的环齿轮66。如所示那样，环齿轮66可以沿着驱动环60的外表面68形成。环齿轮66优选地被配置为与相应的工具例如小齿轮(未示出)相配合，从而使得可被连接至手动工具、电动工具等的小齿轮的旋转导致驱动环60旋转。以此方式，环齿轮66有助于促成驱动环60的旋转。可替代地和/或另外地，驱动环60可以被以人工方式旋转而不借助于环齿轮66和小齿轮，或者被现在已知的或此后已知的任何其它装置旋转。
[00042]如最佳地在图10至13中所示，棘轮环80可以包括第一端部82、第二端部84、外表面86、从第一端部82延伸到第二端部84的内孔88，和在内孔88的内表面上形成的用以与在内部本体部件40的外表面46上形成的棘轮螺纹齿型50相接合的至少一个螺纹机构或者棘轮螺纹齿型90。棘轮环80优选地被包含在驱动环60内并且被联接到驱动环60从而驱动环60的旋转同时地引起棘轮环80的旋转。
[00043]如将在下面更加详细地描述地，棘轮环80还优选地包括至少一个狭槽92从而棘轮环80是柔性的，使得当棘轮环80经受至少预定数量的轴向作用力例如受到旨在沿着轴向分离开外部和内部本体部件20、40的作用力时，棘轮环80能够沿着径向扩张以允许内部本体部件40相对于棘轮环80沿着轴向平移。虽然设想到棘轮环可以采取其它形式，例如，棘轮环可以是连续可扩张环，但是该环能够由于例如它的材料和/或它的配置从而是可扩张的。优选地，棘轮环80是弹性的或者被配置为一旦轴向作用力已被移除便基本上恢复它的初始尺寸和/或形状，从而使得在棘轮环80的内孔88上形成的棘轮螺纹齿型90与在内部本体部件40的外表面46上形成的棘轮螺纹齿型50再次接合以相对于外部本体部件40基本上固定内部本体部件20的轴向位置。
[00044]参考图3A、8B、10和13，在第一优选实施例中，棘轮环80被安装于由外部本体部件20的第一端部22、内部本体部件40的棘轮螺纹齿型50和驱动环60的内表面所限定出的空腔81中。棘轮环80优选地包括了凸耳91，该凸耳91在狭槽92处从棘轮环80沿着径向向外延伸、并且被定位于在驱动环60的悬垂支腿72之间所限定出的棘轮对准间隙63中。第一优选实施例的驱动环60包括五个(5)悬垂支腿72，由此限定五个(5)对准间隙63从而使得凸耳91在组装配置中可以位于任何对准间隙63中。棘轮环80不限于被安装于空腔81中从而凸耳91被定位于对准间隙63中，并且可以利用允许棘轮环80与棘轮齿型50相互接合的任何数目的机械结构而被联接到驱动环60并且在植入物10中联接。
[00045]参考图1至13，在使用中，如将在下面更加详细描述地，外部本体部件20、驱动环60和棘轮环80优选地被配置为相对于彼此保留在同一相对轴向位置中，而驱动环60和棘轮环80这两者都是基本上自由地相对于外部本体部件20旋转的。即，驱动环60和棘轮环80优选地被如此配置，使得它们基本上沿着轴向被固定但是能够相对于外部本体部件20以旋转方式移动。同时，内部本体部件40优选地被配置为基于由使用者对于植入物10的操纵而相对于外部本体部件20、驱动环60和棘轮环80发生轴向平移。另外，内部本体部件40优选地被配置为沿着轴向移动，但是相对于外部本体部件20基本上并不旋转。以此方式，如本领域普通技术人员基本上可以理解地，驱动环60的旋转、以及因此优选地被与此联接的棘轮环80的旋转引起内部本体部件40相对于驱动环60和棘轮环80、并且因此相对于外部本体部件20轴向移动。
[00046]防止内部本体部件40相对于外部本体部件20的有关旋转可以利用在本技术领域中当前或此后已知的任何手段实现，包括但是不限于例如在外部本体部件20的内表面上形成一个或者更多个引导狭槽34(图4)。引导狭槽34优选地平行于纵向轴线12延伸，同时内部本体部件40可以包括一个或者更多个销或者肋条(未示出)，用以与在外部本体部件20中所形成的一个或者更多个引导狭槽34协同工作从而防止或者基本上限制内部本体部件40相对于外部本体部件20旋转。该一个或者更多个销或者肋条可以与内部本体部件40一体地形成，或者可以是分离的构件并且被与其结合。可替代地，内部本体部件40可以包括一个或者更多个引导狭槽并且外部本体部件20可以包括一个或者更多个销或者肋条。可替代地，可以使用用于防止或者基本上限制在外部和内部本体部件20、40之间的相对旋转的任何其它机构，包括但是不限于相应的非圆形形状，例如正方形、卵形、椭圆形等。
[00047]驱动环60的旋转、以及因此与其联接的棘轮环80的旋转优选地致动在椎间植入物10上所形成的螺纹特征。即，由于相对于内部和外部本体部件40、20而旋转所述驱动环60，棘轮环80优选地被同时旋转，而继而由于在内部本体部件40的外表面46上形成的相应的棘轮螺纹齿型50与在棘轮环80的内表面上形成的棘轮螺纹齿型90的相互作用，这引起内部本体部件40相对于驱动环60和棘轮环80并且因此相对于外部本体部件20发生轴向移动。特别地参考图13，当起初旋转驱动环60时，棘轮环80并不旋转直至凸耳91之一冲击邻近的悬垂支腿72。当凸耳91之一与悬垂支腿72之一形成接触时，由于悬垂支腿72沿着旋转方向推动凸耳91和棘轮环80，驱动环60和棘轮环80一起地旋转。如果使用者相对于棘轮环80反向旋转驱动环60，则棘轮环80将不随着驱动环60旋转，直至在空腔63的相对侧上的相对的悬垂支腿72冲击邻近凸耳91，由此通过在悬垂支腿72与凸耳91之间的接触而推动棘轮环80旋转。据此，在初始旋转期间，可能在驱动环60与棘轮环80之间的相对旋转中存在一定的“蹿动(play)”，直至凸耳91之一与悬垂支腿72之一形成接触。优选地，螺纹机构使得驱动环60能够沿着任一方向而以可旋转方式被驱动，从而椎间植入物10能够被扩大或者收缩。因此，在使用中，外部和内部本体部件20、40能够经由驱动环60和棘轮环80的旋转而被扩大和/或收缩。
[00048]另外，如本领域普通技术人员可以理解地，椎间植入物10还优选地为使用者提供了例如以人工方式或者借助于外科手术工具向椎间植入物10施加轴向或者分离载荷的能力，以经由棘轮特征来扩张和/或收缩椎间植入物10。即，通过施加轴向作用力而能够经由棘轮类型机构来扩大和/或收缩外部和内部本体部件20、40。通过向椎间植入物10施加充分的轴向分离作用力，例如，向内部本体部件40施加轴向作用力并且向外部本体部件20施加相等并且反向的轴向作用力，棘轮环80将挠曲和/或偏转向外，以使得在内部本体部件40的外表面46上形成的棘轮螺纹齿型50能够在形成于棘轮环80的内表面上的相应的棘轮螺纹齿型90之上移过和/或跨过其而移动，从而内部本体部件40能够相对于驱动环60和棘轮环80、并且因此相对于外部本体部件20沿着轴向平移或者伸缩。由于在棘轮类型调节期间，棘轮环80扩大，用以适应棘轮齿型50、90的顶部的接合、或者用以允许顶部在彼此交叠地滑动，所以允许凸耳91在空腔63内扩张，至少直至凸耳91与邻近的悬垂支腿72形成接触。
[00049]在第一优选实施例中，如上所述，植入物10的棘轮环80提供主要的挠曲以适应植入物的棘轮类型调节。然而，植入物并不受到如此限制并且棘轮环80和/或内部本体部件40这两者中的每一个或其组合可以在棘轮操作期间发生挠曲，以允许棘轮螺纹齿型90、50的齿彼此交叠地滑动、并且当内部和外部本体部件40、20利用棘轮类型运动而相对于彼此轴向移动时发生挠曲以恢复接合。
[00050]因此，根据使用者的偏好，能够通过棘轮类型调节或者螺杆类型调节实现内部和外部本体部件40、20的轴向调节。例如，外部本体部件20相对于内部本体部件40的粗略间隔可以通过棘轮类型调节而实现，而对于外部本体部件20相对于内部本体部件40的轴向偏移的精调可以通过上述螺杆类型调节而得以实现。
[00051]在棘轮模式中使用椎间植入物10通常使得椎间植入物10能够更加快速地、基本上粗略地扩张/收缩。另外，在棘轮模式中使用植入物10优选地允许在宏观上或者大规模地改变椎间植入物10的总体尺寸。相反，在螺纹或者螺杆类型模式中使用植入物10可以为使用者提供无限地或者以比较精细的方式调节椎间植入物10的尺寸的能力。另外，通过旋转所述驱动环60而进行的扩张/收缩可以是较为精确的，并且因此使得使用者能够精调植入物10的总体高度。植入物10优选地使得使用者能够根据使用者偏好在任何时间在棘轮类型与螺杆类型调节模式之间进行切换。
[00052]在内部本体部件40上形成的棘轮螺纹齿型50和在棘轮环80的内表面上形成的相应的棘轮螺纹齿型90可以被构造成是自锁的，从而能够相对于外部本体部件20来固定内部本体部件40的位置而不需要任何另外的锁定机构。可替代地，椎间植入物10可以还包括锁定机构，用于在一旦已由使用者使用棘轮类型或者螺杆类型调节而实现了所期植入物高度的情况下便固定住外部本体部件20相对于内部本体部件40的位置。例如，如最佳地在图1至3中所示，驱动环60可以包括形成于悬垂支腿72上的一个或者更多个螺纹孔70，其用于以螺纹方式接收一个或者更多个定位螺丝100。为了相对于棘轮环80而固定驱动环60并且基本上相对于外部本体部件20而固定内部本体部件40，定位螺丝100中的一个或者更多个被驱动进入螺纹孔70之一中直至定位螺丝100的尖端接触并且朝向内部本体部件40推进棘轮环80的外表面86，这基本上通过将棘轮环80的棘轮螺纹齿型90推进成与内部本体部件40的棘轮螺纹齿型46相接合而稳固了棘轮环80相对于驱动环60的运动。这种接合基本上防止了使用者旋转驱动环60和棘轮环80，这是因为棘轮螺纹齿型90、50的接合。另外，定位螺丝100在螺纹孔70中的旋转接合基本上限制了棘轮环80扩张的能力并且因此，基本上防止了内部本体部件40经由棘轮类型调节而相对于外部本体部件20移动。
[00053]一个或者更多个定位螺丝100可以在组装配置中被紧固到螺纹孔70中以基本上相对于内部本体部件40锁定外部本体部件20，然而，在优选实施例中，外科医生通常只紧固住在介于椎骨200、202之间的植入位置中布置植入物10之后面向着外科医生的定位螺丝100之一。可替代地，可以使用任何其它锁定机构，例如定位螺丝100可以接触内部或者外部本体部件40、20，而这继而将会基本上防止驱动环60和棘轮环80旋转以及内部和外部本体部件40、20相对于彼此轴向移动，或者可以利用限制了外部和内部本体部件20、40相对于彼此运动的几乎任何其它的锁定机构，例如外部夹持、紧固、粘结剂粘结或者相关机构和方法。
[00054]如最佳地在图1和14中所示，外部和内部本体部件20、40可以包括被分别地安装到此的终板120、122，它们用于接触邻近椎骨的终板的至少一个部分。终板120、122可以被形成为分离的和独特的构件，并且可以通过在本技术领域中已知的任何手段而被连接到外部和内部本体部件20、40，包括但是不限于过盈配合、挤压配合、穿引(threading)、拧紧、粘结、定位螺丝等。以此方式，能够在成套工具中提供椎间植入物10，该成套工具具有多个不同的终板120、122，因此使得使用者能够选择最好地符合患者椎骨终板的轮廓的理想终板120、122。例如，可以提供包括不同形状的各种终板120、122，所述形状包括但是不限于圆形、正方形、矩形、卵形、腰形、等，和/或以下特征中的一个或者多个：基本楔形的表面、弯曲表面、平坦表面等。可替代地，上和下终板120、122可以与外部和内部本体部件20、40成一体地形成。在第一优选实施例中，终板120、122起初分别地与在外部和内部本体部件20、40的端部42、24处的八边形凸起41、25相接合，并且使用与在外部和内部本体部件20、40上的内螺纹121、123相接合的锁定螺杆(未示出)而被固紧到外部和内部本体部件20、40。可替代地，凸起41、25能够具有外螺纹，并且终板能够具有定位螺丝以及在凸起之上装配的孔洞或者空腔，该定位螺丝具有内螺纹用于与在凸起上所形成的螺纹相接合以固定终板相对于外部和内部本体部件20、20的位置。八边形凸起41、25允许终板120、122相对于外部和内部本体部件20、40的至少八种(8)定向。虽然已经示出并且描述了八边形凸起，但是可以理解，可以使用圆形、椭圆形、正方形或者任何其它形状。
[00055]终板120、122优选地包括用于接触和/或接合邻近椎骨200、202的终板的一个或者更多个固定部件124。固定部件124可以具有任何已知形式，包括但是不限于多个突起、多个波状结构、多个凸起、多个凸脊、多个齿、一个或者更多个龙骨等。终板120、122还可以被配置为接收用于将终板120、122紧固到患者椎骨的一个或者更多个骨头固定元件，诸如，以螺杆、销钉等为例。
[00056]如前所述，外部本体部件20可以包括一个或者更多个开口30、31。内部本体部件40可以具有局部柱形表面的形式(例如，内部本体部件40的壁优选地并不限定360度)从而使得由骨头包装开口30以及内部本体部件40中的局部开口所构成的窗口125被形成于椎间植入物10中，以用于将骨头碎片或者其它类似的材料输送到内部本体部件40的空腔48中。另外，外部和内部本体部件20、40和终板120、122优选地在它们的邻近与椎骨200、202的接合处的端部处打开，从而使得骨头碎片或者其它材料可以与椎骨200、202形成面对式接合或者通过植入物10中的孔而以物理方式与椎骨200、202相连通。
[00057]在第一优选实施例中，驱动环60和棘轮环80包括以可旋转方式安装到外部本体部件20的卡环。棘轮环80包括与内部本体部件40的外表面46上的棘轮螺纹齿型50相接合着的棘轮螺纹齿型90。棘轮环80的棘轮螺纹齿型90与内部本体部件40的棘轮螺纹齿型50的接合允许通过以螺杆类型方式或者调节来相对于外部和内部本体部件20、40旋转所述卡环，从而实现内部本体部件40相对于外部本体部件20的轴向运动。在第一优选实施例中，该卡环还包括由棘轮环80和内部本体部件40的相互作用构成的棘轮机构。具体地，棘轮环80借助于施加在外部与内部本体部件20、40之间的预定轴向作用力而沿着径向扩张从而使棘轮螺纹齿型90的顶部能够沿着轴向移动经过内部本体部件40的棘轮螺纹齿型50的能力，允许了外部和内部本体部件20、40以轴向棘轮类型方式相对于彼此地移动。
[00058]参考图15，在本申请的第二优选实施例中，椎间植入物210基本类似于第一优选实施例的植入物10并且在本文中将基本上不再描述类似的构件和特征。椎间植入物210可以包括外部本体部件220、内部本体部件240和悬臂梁弹簧齿轮260。可替代地，设想到外部本体部件220可以与悬臂梁弹簧齿轮260一体地形成。类似于植入物10的第一优选实施例的内部本体部件40，内部本体部件240优选地包括了在其外表面上形成的棘轮螺纹齿型250。
[00059]外部本体部件220和悬臂梁弹簧齿轮260优选地被以如下方式配置，即，保持它们的相对轴向位置但是使得悬臂梁弹簧齿轮260能够相对于、并且优选地围绕着外部本体部件220的轴线而旋转。悬臂梁弹簧齿轮260优选地包括了在内表面中所形成的棘轮螺纹齿型(未示出)，该棘轮螺纹齿型被配置为基本对应于或者匹配着在内部本体部件240的外表面上所形成的棘轮螺纹齿型250，从而使得悬臂梁弹簧齿轮260的旋转引起内部本体部件240相对于悬臂梁弹簧齿轮260并且因此相对于外部本体部件220沿着轴向移动。棘轮螺纹齿型可以具有在悬臂梁弹簧齿轮260的尖端262处形成的凸部或者凸起的形式。
[00060]在使用中，悬臂梁弹簧齿轮260相对于外部本体部件220的旋转致动了在椎间植入物210上所形成的螺纹特征，而这继而导致内部本体部件240相对于悬臂梁弹簧齿轮260并且因此外部本体部件220沿着轴向移动。即，能够通过旋转悬臂梁弹簧齿轮260而使用在内部本体部件240的外表面上所形成的棘轮螺纹齿型250来扩大或者收缩椎间植入物210。当悬臂梁弹簧齿轮260旋转时，悬臂梁弹簧的尖端接合着在内部本体部件240上所形成的棘轮螺纹齿型250并且沿着螺纹行进以驱动植入物210发生扩张或者收缩。
[00061]另外，如本领域普通技术人员可以基本上理解地，椎间植入物210还优选地为使用者提供向椎间植入物210施加轴向分离载荷以便经由棘轮特征扩张和/或收缩所述椎间植入物210的能力。即，能够通过施加轴向作用力而经由棘轮类型机构来扩大和/或收缩外部和内部本体部件220、240。通过向椎间植入物210施加充分的轴向作用力，随着悬臂梁弹簧齿轮260相对于形成于内部本体部件240的外表面上所形成的棘轮螺纹齿型250并且在其之上移动，内部本体部件240将轴向平移，并且向外偏转以提供用于内部本体部件240的棘轮螺纹齿型250沿着轴向经过的空间。悬臂梁弹簧齿轮260优选地被配置为在一旦轴向作用力已被移除的情况下便恢复它的初始几何形状，从而悬臂梁弹簧齿轮260在不同位置处与在内部本体部件240的外表面上所形成的棘轮螺纹齿型250再次接合。
[00062]虽然前面的说明和附图代表本发明的优选实施例，但可以理解，可在其中作出各种添加、修改、组合和/或替代而不偏离如由所附权利要求限定的本发明的精神和范围。具体地，对本领域技术人员而言明显的是，本发明可以以其它特殊形式、结构、布置、比例，并利用其它元件、材料和构件体现，而不偏离其精神或基本特征。本领域技术人员将意识到，可以利用特别适于特殊环境和操作要求的、对于结构、布置、比例、材料和构件的很多修改而使用本发明但不偏离本发明原理。另外，在本文描述的特征可以被单独地或与其它特征组合地使用。目前披露的实施例因此在所有方面均被视为示意性的而非限制性的，本发明的范围由所附权利要求示意，而不限于前面的说明。

Claims (20)

1.一种用于在第一与第二椎骨之间植入的可扩张椎间植入物，所述植入物包括：
具有第一端部和第二端部的第一本体部件；
具有第一端部和第二端部的第二本体部件，在收折位置中，第一本体部件的第一端部邻近着第二本体部件的第一端部定位，第二本体部件包括在其上形成的至少一个棘轮螺纹齿型；和
以可操作方式与第一和第二本体部件相关联的卡环，所述卡环包括螺纹机构和棘轮机构，所述螺纹机构能够以可操作方式与至少一个棘轮螺纹齿型相接合从而卡环的旋转引起第二本体部件相对于第一本体部件发生轴向移动；所述棘轮机构使得当至少预定量值的作用力被沿着轴向施加到第一和第二本体部件中的至少一个时，第二本体部件以轴向棘轮类型方式相对于第一本体部件移动。
2.根据权利要求1所述的植入物，其中第二本体部件小于第一本体部件从而第二本体部件被接收在第一本体部件内。
3.根据权利要求1所述的植入物，其中第一本体部件是具有内孔的、基本柱形的部件并且第二本体部件是具有外表面的、基本柱形的部件，第二本体部件的外表面能够被接收在第一本体部件的内孔内。
4.根据权利要求3所述的植入物，其中第二本体部件的外表面包括在其上形成的棘轮螺纹齿型，所述棘轮螺纹齿型使得第二本体部件能够相对于卡环旋转并且使第二本体部件能够相对于卡环发生渐进。
5.根据权利要求1所述的植入物，其中卡环包括被以可旋转方式联结到第一本体部件的驱动环，所述驱动环包括用于接收第二本体部件的内孔、以及以可操作方式与所述驱动环相关联的棘轮环，所述棘轮环包括具有用于与在所述第二本体部件上所形成的所述棘轮螺纹齿型相接合的、在其上形成的至少一个相应棘轮螺纹齿型的内孔。
6.根据权利要求5所述的植入物，其中驱动环包括用于与在第一本体部件的外表面上所形成的周向凹槽相匹配的多个凸起。
7.根据权利要求5所述的植入物，其中棘轮环被联接到驱动环，从而驱动环的旋转引起棘轮环的旋转。
8.根据权利要求5所述的植入物，其中棘轮环包括至少一个狭槽从而棘轮环能够沿着径向扩张，当第二本体部件以棘轮类型方式相对于第一本体部件移动时，棘轮环沿着径向扩张从而使得相应的棘轮螺纹齿型的齿能够沿着轴向移动经过在第二本体部件上所形成的棘轮螺纹齿型的齿。
9.根据权利要求5所述的植入物，其中驱动环和棘轮环被基本上沿着轴向固定但是能够相对于第一本体部件以旋转方式移动。
10.根据权利要求1所述的植入物，其还包括：
用于固定第一本体部件相对于第二本体部件的位置的锁定机构，所述锁定机构包括被安装到卡环的多个定位螺丝。
11.根据权利要求1所述的植入物，其还包括：
用于与第一椎骨的终板相接触的第一终板；和
用于与第二椎骨的终板相接触的第二终板，所述第一和第二终板被分别地以可移除方式联接到第一和第二本体部件。
12.一种用于在第一和第二椎骨之间植入的可扩张椎间植入物，所述植入物包括：
具有第一端部和第二端部的第一本体部件；
具有第一端部和第二端部的第二本体部件，在收折位置中，第一本体部件的第一端部邻近第二本体部件的第一端部而定位，第二本体部件包括在其上形成的至少一个棘轮螺纹齿型；
被以可旋转方式联结到第一本体部件的驱动环，所述驱动环包括用于接收第二本体部件的至少一个部分的内孔；和
以可操作方式与驱动环相关联的棘轮环，所述棘轮环包括具有用于与所述第二本体部件的所述棘轮螺纹齿型相接合的、在其上形成的至少一个相应棘轮螺纹齿型的内孔，其中驱动环的旋转引起棘轮环的旋转，而棘轮环的旋转继而引起第二本体部件以螺杆类型方式相对于第一本体部件轴向移动，棘轮环沿着径向是柔性的从而使得在棘轮环与第二本体部件之间施加预定的作用力引起第二本体部件以棘轮类型方式相对于第一本体部件发生轴向移动。
13.根据权利要求12所述的植入物，其中第二本体部件稍微小于第一本体部件，从而第二本体部件被至少部分地接收在第一本体部件内。
14.根据权利要求12所述的植入物，其中第一本体部件是基本柱形的并且包括内部空腔，第二本体部件是基本柱形的并且包括外表面，第二本体部件的外表面包括用于与棘轮环相接合的棘轮螺纹齿型，第二本体部件的外表面能够被以可滑动方式接收在第一本体部件的内部空腔内。
15.根据权利要求12的所述植入物，其中驱动环包括用于与邻近着第一端部在所述第一本体部件的外表面上形成的周向凹槽匹配的多个凸起。
16.根据权利要求12所述的植入物，其中棘轮环包括至少一个狭槽和邻近着狭槽定位的一对凸耳。
17.根据权利要求12所述的植入物，其中第一本体部件包括用于与第一椎骨相接触的第一终板并且第二本体部件包括用于与第二椎骨相接触的第二终板，第一和第二终板分别地被以可移除方式联接到第一和第二本体部件。
18.一种对用于在第一和第二椎骨之间植入的可调节高度椎间植入物确定尺寸的方法，所述椎间植入物包括第一本体部件、第二本体部件和以可操作方式与所述第一本体部件相关联的卡环，所述方法包括：
a)向第一和第二本体部件施加至少预定的轴向作用力，使得第二本体部件以轴向棘轮类型方式相对于第一本体部件移动，从而接近介于第一和第二椎骨之间的空间；并且
b)相对于第二本体部件旋转卡环从而使得第二本体部件相对于第一本体部件沿着轴向移动。
19.根据权利要求18所述的方法，其还包括：
c)在步骤(a)和(b)之前在第一和第二椎骨之间植入所述椎间植入物。
20.根据权利要求18所述的方法，其还包括：
c)在步骤(b)中使用工具向在卡环上所形成的环齿轮施加旋转作用力；和
d)通过窗口将骨头碎片插入到在所述植入物中所形成的空腔中，以促进骨头生长以及第一和第二椎骨的愈合。
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