CN102573705B - 用于椎骨的外科手术移位的装置 - Google Patents

用于椎骨的外科手术移位的装置 Download PDF

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CN102573705B
CN102573705B CN201080042893.6A CN201080042893A CN102573705B CN 102573705 B CN102573705 B CN 102573705B CN 201080042893 A CN201080042893 A CN 201080042893A CN 102573705 B CN102573705 B CN 102573705B
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L.F.丘皮克
M.斯帕尔斯基
R.冈兹伯格
D.扎齐克基
J.皮尼亚泽克
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Abstract

用于椎骨的外科手术移位的装置，其包括以滑动方式合作的两个部分：具有内螺纹的滑动部分(1)和载体部分(3)，并且包括位于这两个部分之间具有外螺纹的驱动元件(4)。驱动元件(4)设置有头部(5)。装置的滑动部分(1)配备有与驱动元件(4)协作的螺纹引导件(2)以及直径与头部(5)的直径相对应而长度大于头部(5)的长度的底座。装置的载体部分(3)具有直径和长度与头部(5)的直径和长度相对应的圆筒形底座(12)。滑动部分(1)和载体部分(3)设置有彼此协作的：至少一个有形元件(8)和有形元件(9)，它们形成防止所述两个部分沿垂直于装置纵向轴线的方向发生分离的锁定器。

Description

用于椎骨的外科手术移位的装置
技术领域
本发明涉及椎骨的外科手术移位，其应用于椎骨脱位的外科手术治疗。文献数据显示由于背疼而接受治疗的病人中平均10％会出现椎骨的滑动。该病变可能在少年和成人中引起显著的残疾。当神经学上的症状和/或疼痛出现时，或者甚至增大时，即使先前进行了保守治疗，也需要进行椎骨脱位的外科手术治疗。迄今为止，在医疗实践中，最常用的治疗涉及通过滑动水平上的骨融合使脊柱达到脊柱固定。椎骨融合术本身并非总是充分的手段，在以下形式中并未带来正面结果：椎间盘空间的高度中的比例的复原，从而正确几何结构的重建，姿势变形的降低，疼痛不适的去除，生物力学平衡的复原。要获得所有上述好处，神经结构的减压和移位椎骨的复位是根本的。
背景技术
用于椎骨脱位复位的装置是已知的；它们中的大部分都是基于不同种类的牵引螺钉或者特殊的复位构造，其主要特征是相当大量的元件和由去除该病变的系统的复杂性引起的外科手术困难。
它们的应用经常涉及大量的外科手术动作，这显著地增加病人的负担，并且可能导致术中和术后并发症。
从专利申请WO96/40016中已知用于椎骨脱位矫正的植入物、设备和方法。植入物呈单元件保持架的形式，用于阻止椎骨的错位，而矫正本身是以引入椎骨间空间中的特殊设计的设备来进行的，该设备包括由两个元件构成的纵向本体，这两个元件沿彼此移动，使错位椎骨对齐。该解决方案的缺点是可能在以锁定用保持架更换矫正设备期间发生复位损失。
从专利申请US2008/0319481中已知一种用于使相邻椎骨重新对齐和稳定的设备和方法。植入物具有两个半部，它们是互锁的，使得它们能够相对于彼此水平地滑动。植入物半部的移动以及它们各自的位置受控于植入物内的螺钉组。植入物包括装配到设置于错位椎骨中的对齐切口中的径向锚定器。植入物中的螺钉组用于使植入物的半部前进，其进而将错位椎骨移动回到正确位置。该解决方案只借助于使用前路外科手术途径来矫正椎骨脱位，这由于有可能会干扰位于那里的重要解剖结构，而严重地妨碍并且有时防止外科手术活动，并且可能特别是在长时间外科手术时对病人造成可观的风险。该解决方案的另一缺点是同样需要通过使用特殊器具来进行切割，以在椎骨体中开出用于锚定器的切口。又一缺点是复杂，并且难以控制向椎间空间中引入植入物的程序，需要使其位置适配于在先准备好的切口。所采用的螺旋齿轮只允许沿一个方向的移动，即沿错位椎骨的复位方向。由于不存在逆向机构，术中矫正和植入物的去除被防止，引起病人的风险。以燕尾形式被采用的引导件没有任何保护措施来防止偏移的锁定，因为相互协作的植入物半部由于螺钉的肘推动作而变得彼此远离。椎骨位置的固定以及植入物本身的锁定需要使用呈螺母形式的附加手段和附加的固定板，而这使植入物元件的数量增加，此外还刺激组织。
从旨在用于椎骨脱位的外科手术治疗的专利申请US 2007/0123989中已知一种椎间分隔物。分隔物由两个半部和锁定螺旋齿轮构成，在两个椎骨之间使用前路途径得到安装，并在与减薄板相关的变型中以接骨螺钉锚定在椎骨体中。在所公开的实施例中，用使第一半部和另一半部沿彼此移动从而对齐椎骨的方式操作调节机构，来进行椎骨脱位的矫正。锁定螺旋齿轮可以具有中心螺钉，其在旋转时能够使一个半部前向或者向后移动。在螺旋齿轮的一个实施例中，可以是中心导轨允许两个半部前后移动，而所述机构可以通过横向阻挡得到确保。所采用的调节机构不提供使各半部在相反方向上沿彼此移动的可能性。该解决方案的另一缺点是在椎骨体中锚定椎间分隔物的机构，其不能提供在复位期间的牢固固定，使分隔物的元件在病状减退后从椎骨缘突出，从而危及位于该区域中的生物学结构。
发明内容
没有上述不便的是这样一种装置，其包括用于椎骨的外科手术移位的植入物，所述装置包括以滑动方式合作的两个部分：具有内螺纹的滑动部分和载体部分，并且包括位于这两个部分之间具有外螺纹的驱动元件。根据本发明，所述驱动元件设置有头部，而装置的滑动部分配备有与驱动元件协作的螺纹引导件(guideline)以及直径与头部的直径相对应而长度大于头部长度的底座，并且载体部分具有直径和长度与头部的直径和长度相对应的底座。此外，滑动部分和载体部分设置有彼此协作的有形元件，它们形成防止所述两个部分在矫正动作的进行期间沿垂直于装置纵向轴线的方向发生分离的锁定器。所述锁定器由位于滑动部分中的至少一个元件和位于载体部分中的一个元件形成。在本装置的一个实施例中，位于装置的滑动部分中的锁定器的元件呈圆筒的形式。在另一实施例中，所述有形元件呈长方体的一部分的形式。
滑动部分和载体部分中的螺纹引导件呈套筒的形式。优选地，该套筒可以是纵向开放式的。
滑动部分和载体部分的外表面设置有驱动锚定元件(drive-anchoringelement)，它们呈设置有阻力表面和至少一个有形切割刀的搁板(shelf)的形式。在本装置的一个实施例中，所述驱动锚定元件设置有间隙。在另一实施例中，至少一个搁板与装置的外表面上的有形底座铰接。优选地，可移动的搁板设置有阻力突起。构成装置的滑动部分的外侧部分的外围(outfit)的驱动锚定元件以0到100°的角度定位，并且载体部分的驱动锚定元件相对于外表面以0到100°的角度定位。
本发明的用于通过椎骨的外科手术移位来治疗椎骨脱位的装置的特征在于，它具有简单和紧凑的构造，限制了外科手术介入的面积，从而减小了过程的侵袭力。它允许外科手术通过后路和前路途径来进行，这取决于医疗需求和建议。同时，它确保了被压迫神经结构的减压，正确解剖学比例的复原和全体系统的最终阻挡，在没有任何附加伴随元件的情况下防止了二次滑脱，而这进而减小了与稳定系统的所有元件的协作的必要性有关的风险。
本发明的动态驱动元件的螺纹引导件的构造确保了克服阻挡的驱动-复位系统，从而增加了所进行的椎骨移位的安全性。
植入物在椎间空间中的简单且安全的就位缩短了外科手术的持续时间，并且使病人的负担最小化，增加了他的安全性。植入物的构造满足了用于稳定的生物力学需求，并且适配于椎间空间的解剖学形状，这确保了治疗任何年龄的病人的有效性。
附图说明
本发明以附图中的实施方式的示例来公开，其中：
图1示出了这样一个部分的装置，该部分具有可见驱动元件和呈配备有有形切割刀的搁板形式的驱动锚定元件，并且具有锁定器；
图2示出了螺纹引导件呈套筒形状并且驱动锚定元件呈均匀搁板形式的配置的装置；
图3示出了螺纹引导件呈开放式套筒形式并且搁板设置有间隙的滑动部分；
图4示出了滑动部分和运载部分上驱动锚定元件呈可移动搁板形式的装置的一个实施例。
具体实施方式
图1中示出的装置由具有螺纹引导件2的滑动部分1、载体部分3以及设置有头部5的具有外螺纹的驱动元件4构成。装置的滑动部分1和运载部分3在外表面上设置有驱动锚定元件6。装置的滑动部分1上的驱动锚定元件6呈设置有阻力表面的搁板和有形切割刀7的形式。滑动部分1还设置有至少两个有形元件8，所述至少两个有形元件8呈圆筒的一部分的形式，与装置的载体部分3中的有形元件9一起构成锁定器，防止它们沿与装置的纵向轴线正交的方向发生分离。驱动元件4的头部5设置有被指派为与安装器具协作的操纵元件10。
以图2中的配置示出的装置在外表面上设置有呈均匀搁板形式的驱动锚定元件6。装置的载体部分3设置有圆筒形底座11，有形元件9是锁定器的元件，而纵向间隙12通过形状与和它协作的螺纹引导件2相对应。与驱动元件4的头部5协作的圆筒形底座11具有与头部5的直径和长度相对应的直径和长度。装置的滑动部分1设置有圆筒形底座13和有形元件8，所述圆筒形底座13的直径与头部5的直径相对应，而长度长于头部5的长度，所述有形元件8是呈长方体一部分的形式的锁定器的元件。螺纹引导件2呈套筒的形式。
在图3所示的另一实施例中，滑动部分1中的螺纹引导件2呈纵向开放式套筒的形式，有形突起8呈圆筒的一部分的形式，并且滑动部分1的外表面设置有具有间隙14的驱动锚定元件6。
在图4所示实施例中，装置具有在装置的载体部分3和滑动部分1的外表面上与有形底座15铰接的两个驱动锚定元件6。驱动锚定元件6之一设置有阻力突起16，防止搁板的不受控旋转。

Claims (10)

1.一种用于椎骨的外科手术移位的装置，包含以滑动方式协作的两个部分：具有内螺纹的滑动部分和载体部分，并且包含位于它们之间具有外螺纹的驱动元件，其中：驱动元件(4)设置有头部(5)，装置的滑动部分(1)设置有与所述驱动元件(4)协作的螺纹引导件(2)，以及直径与头部(5)的直径相对应而长度大于头部(5)的长度的底座(13)，而装置的载体部分(3)具有直径和长度与头部(5)的直径和长度相对应的圆筒形底座(11)，此外所述滑动部分(1)和载体部分(3)设置有相互协作的元件：至少一个有形元件(8)和有形元件(9)，它们构成防止所述两部分(1、3)沿与装置的纵向轴线正交的方向发生分离的锁定器。
2.如权利要求1所述的装置，其特征在于，装置的滑动部分(1)中的螺纹引导件(2)呈套筒的形式。
3.如权利要求2所述的装置，其特征在于，装置的滑动部分(1)中的螺纹引导件(2)呈纵向开放式套筒的形式。
4.如权利要求1所述的装置，其特征在于，所述有形元件(8)呈圆筒的一部分的形式。
5.如权利要求1所述的装置，其特征在于，所述有形元件(8)呈长方体的一部分的形式。
6.如权利要求1所述的装置，其特征在于，所述载体部分(3)和滑动部分(1)在外表面上设置有驱动锚定元件(6)。
7.如权利要求6所述的装置，其特征在于，所述驱动锚定元件(6)呈搁板的形式，设置有阻力区域和至少一个有形切割刀(7)。
8.如权利要求6所述的装置，其特征在于，所述驱动锚定元件(6)包含间隙(14)。
9.如权利要求7或8所述的装置，其特征在于，至少一个驱动锚定元件(6)在装置的外表面上与有形底座(15)铰接，此外它还设置有阻力突起(16)。
10.如权利要求7所述的装置，其特征在于，构成装置的滑动部分(1)的外表面的外围的驱动锚定元件(6)以0°到110°的角度(α)定位，并且装置的载体部分(3)的驱动锚定元件(6)相对于外表面以0°到110°的角度(β)配置。
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