CN102599968A - 用于保持和/或引导接骨固定装置的接收部件的工具 - Google Patents

用于保持和/或引导接骨固定装置的接收部件的工具 Download PDF

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CN102599968A
CN102599968A CN2012100803311A CN201210080331A CN102599968A CN 102599968 A CN102599968 A CN 102599968A CN 2012100803311 A CN2012100803311 A CN 2012100803311A CN 201210080331 A CN201210080331 A CN 201210080331A CN 102599968 A CN102599968 A CN 102599968A
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W·马蒂斯
L·比德曼
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Biedermann Technologies GmbH and Co KG
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7091Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A61B17/7037Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other wherein pivoting is blocked when the rod is clamped
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86Pins or screws or threaded wires; nuts therefor
    • A61B17/8605Heads, i.e. proximal ends projecting from bone
    • A61B17/861Heads, i.e. proximal ends projecting from bone specially shaped for gripping driver

Abstract

本发明提供了一种用于保持和/或引导接骨固定装置的接收部件(1)的工具,接收部件(1)将接骨固定元件的柄部(50)连接到杆件(7)上,接收部件(1)包括:第一端部(2)和第二端部(3);具有U形横截面的凹槽(4),凹槽(4)从第一端部(2)在向着第二端部(3)的方向上延伸,从而形成在第一端部(2)处隔开的两个支柱(5,6),凹槽(4)限定一沟槽以接收所述杆件,沟槽具有纵轴(L),支柱(5,6)具有内螺纹(9)以接收紧固元件(10),该紧固元件(10)具有与内螺纹配合的外螺纹,其中:所述工具包括具有方形轮廓的保持或引导部分(40),该保持或引导部分和接收部件(1)以形状配合的连接方式配合。

Description

用于保持和/或引导接骨固定装置的接收部件的工具
本申请是2006年5月11日提交的、申请号为200610081770.9、名称为“用于将接骨固定件的柄部连接到杆件上的接收部件以及带有该接收部件的接骨固定装置”的申请的分案申请。
技术领域
本发明涉及一种用在脊柱外科和创伤外科中、用来将接骨固定件的柄部连接到杆件上的接收部件以及带有该接收部件的接骨固定装置。
背景技术
在图11中示出了一种已知的多轴型接骨螺钉100。它包括用于把螺钉元件102连接到杆件103上的接收部件101,该接收部件的外壁基本呈圆柱形。接收部件101带有一基本为U形截面的凹槽104,如此形成了两个间隔开的支柱105,106,从而限定出用于插入杆件103的沟槽。在所述支柱上设有内螺纹107,用来接收紧固螺钉108,以便将所述杆件固定在沟槽内。该内螺纹107为公制螺纹。
当如图13所示把紧固螺钉108拧入时,由箭头A所指示的沿径向向外的作用力作用在所述内螺纹上,这样使得所述支柱105,106张开。这有可能使得对杆件的固定变松。
迄今为止,已经实施了一些方法来解决支柱张开的问题。其中一种解决方案是提供管形反向保持工具。另一种解决方案是提供一种外部螺母,其拧在所述支柱的外螺纹上,如EP0614649A中所公开的那样。此外,外部环形紧固装置也是众所周知的。但是,这种紧固装置如外部螺母或外部环扩大了接骨螺钉的尺寸,因此限制了其在临床上的应用。
另一种方法是对于内螺纹107和紧固螺钉上的相应螺纹来说,采用一特定类型的螺纹形状。已知可采用如US5005562中公开的锯齿形螺纹,或者是US6296642B1或US2002/0138076A1中公开的倒角螺纹,以消除作用在所述支柱上的指向外部的径向力。一种特别有利的螺纹形状是方螺纹,如US2003/0100896A1中所公开的,它完全消除了这种径向力,并且便于制造。采用这些特定的螺纹形状使得可以在不需要使用另外的外部紧固装置,如外部螺母或外部环的情况下使用接骨螺钉。
不过,尽管具有上述措施,但在最后拧紧紧固螺钉时仍然存在支柱斜向张开的问题。这种张开主要是由最后拧紧时作用在所述支柱105,106上的扭矩导致的,在拧紧时由于螺纹侧面之间的摩擦,使得支柱产生了沿对角线的横向变形。这种变形如图14所示,其中为了更好的图示,图中并未示出紧固螺钉。支柱张开的问题不仅仅局限在多轴型接骨螺钉中,还发生在所有所谓顶部分开的接骨固定装置中,包括单轴型螺钉,这种单轴型螺钉带有两个间隔开的支柱和位于所述支柱之间用于插入杆件的狭缝。
如图12所示,在接收部件侧面朝向沟槽的横向设置平的表面109并不能解决上述问题,只是有助于使接骨螺钉在杆件纵向上的尺寸最小化。
本发明的一个目的是提供一种特别用于多轴型接骨固定装置的接收部件,以及一种连接在杆件上的接骨固定装置,该装置在使用中是安全的,同时具有紧凑的结构。本发明的另一个目的是提供一种用于保持和/或引导这种接骨固定装置的工具。
通过按照权利要求1所述的接收部件、按照权利要求16所述的接骨固定装置以及按照权利要求17所述的工具可解决上述问题。其他的改进出现在从属权利要求中。
按照本发明的接收部件具有的优势在于它能够在不采用任何外部紧固装置的情况下防止支柱张开。而且在平行于所述杆件纵轴的方向上具有减小了的尺寸。因此比已知的螺钉具有更紧凑的结构。当把它设计成在平行于杆件纵轴的方向上具有与传统螺钉相同的尺寸时,可以使用与传统螺钉所采用的杆件相比具有更大直径的杆件。
附图说明
本发明进一步的特征和优点将从结合附图对实施方案的描述中变得更加直观。
图1示出了按照本发明第一实施方案的接收部件的透视图。
图2示出了按照第一实施方案的接收部件的顶视图。
图3a示出了带有第一实施方案中接收部件的接骨固定装置的截面图。
图3b示出了带有第一实施方案中接收部件的接骨固定装置的透视图。
图4a和4b示意性地示出了按照接收部件第一实施方案的设置加强结构的原理。
图5a示出了按照本发明第二实施方案中接收部件的间隔开的支柱的横截面示意图。
图5b示出了按照第二实施方案的接收部件的透视图。
图6a示出了按照本发明第三实施方案中接收部件的间隔开的支柱的横截面示意图。
图6b示出了按照第三实施方案的接收部件的透视图。
图7示出了反向保持工具的侧视图。
图8示出了按照本发明的反向保持工具的保持部分的透视图。
图9示出了传统套针工具的透视图。
图10示出了按照本发明的套针工具的透视图。
图11示出了传统多轴型接骨螺钉的透视图。
图12示出了经过改进的传统多轴型接骨螺钉的透视图。
图13为一示意性截面图,示出了传统接收部件出现的问题。
图14为一示意性截面图,示出了传统接收部件出现的又一问题。
具体实施方式
如图1-3b所示,按照本发明所述的用于将接骨固定件51的柄部50连接到杆件上的接收部件1包括第一端部2和第二端部3、中心轴M以及带有基本为U形截面的凹槽4。凹槽4从第一端部2处向着第二端部3处延伸,由此在第一端部2处形成了间隔开的两个支柱5,6。凹槽限定出一具有纵轴L的沟槽,以用于杆件7的插入。当插入杆件时,纵轴L与杆件的纵轴相对应。凹槽4的宽度正好使得杆件能够放入其内并且与凹槽的底部8相配合,同时还能够在未被固定时在凹槽内产生滑动。插入杆件后,支柱5,6突出于杆件之上,而且都带有内螺纹9,所述内螺纹9在第二端部3的方向上从靠近第一端部2的位置开始延伸一个预定长度,以便将紧固螺栓10拧入其内以固定杆件。内螺纹9和紧固螺栓上与其相配合的外螺纹优选为方螺纹,每个方螺纹的上侧和下侧都具有相对螺钉轴呈90度的角度。在支柱5,6的外壁表面上,设置两个彼此相对的平面11,12,这两个平面在平行于沟槽纵轴L的方向并平行于接收部件中心轴M的方向延伸。两个平面11,12彼此相互平行,并且从靠近第一端部2的第一位置处向朝着第二端部3并位于凹槽4底部8之下的第二位置延伸。由此,平面11,12沿着所述支柱的部分延伸,该支柱从两侧包围杆件。接收部件1在其横向于凹槽纵轴L的侧面上还包括两个彼此相对的平面13,14,这两个平面都从与第一端部2间隔一定距离的位置处向凹槽底部8之下的位置延伸。平面13,14都平行于中心轴M,而且还彼此相互平行。这样,平面11,12和平面13,14就分别包括一90°的角度。在图示的实施方案中,平面11,12,13,14在垂直于中心轴M方向上的宽度W都是相同的,从而在接收部件的圆周方向上靠近凹槽底部8的包络面E基本上为正方形。
在支柱5,6的侧向边缘上提供相对于支柱在平面11,12区域上的壁厚具有增强壁厚的几个部分15,16,17,18。这些部分形成了加强结构,能够防止由于沿对角线张开而导致的支柱弯曲。这些具有增强壁厚的部分15,16,17,18可以具有如图1和2所示平坦的外表面,也可以具有圆形的表面。它们可以沿着平面11,12,13或14的整个长度延伸,或者如图1和2所示,转变成在向着第一端部2的方向上壁厚逐渐减少的倾斜部分19。
图3a和3b示出了按照本发明的接收部件连同接骨螺钉51一起形成了多轴型接骨固定装置。在该情形下,如图3a所示,接收部件1还包括延伸穿过沟槽底部8并朝着第二端部3在区段21上逐渐变细的同轴孔20,从而在第二端部3上形成了比孔20的直径小的开孔22。所述孔20的直径要大于螺钉元件51头部52的直径,以便能够将接骨固定螺钉51的柄部50和螺钉头部52引导穿过所述孔。开孔21的直径要小于螺钉头部52的直径而大于柄部50的直径。因此,渐细的区段21和螺钉头部52共同形成了球窝接头,以便能够柔性地连接接骨固定螺钉和接收部件。
还设置有压力元件25,当把压力元件压在螺钉头部上时,该压力元件可在孔20内滑动,而且可用来向螺钉头部施加压力,以便将螺钉元件固定在相对于接收部件的一个角度位置上。压力元件基本为圆盘形,并且可以带有用来包围螺钉头部上部的凹槽和用来容纳杆件7下侧的凹槽。压力元件还可以具有用于使拧入工具受引导通过的开孔。
从图3b中能够看到,当把杆件插入到接收部件中,具有增强壁厚的接收部件的部分15大致位于杆件纵轴所在的高度,而平面由支柱5,6从两侧包围杆件的整个区域内延伸。
在操作中,螺钉元件和压力元件插入到接收部件中。然后放入杆件并通过紧固螺钉将其固定。在图示的实施方案中,拧紧内螺钉时杆件就会压在压力元件上,同时螺钉头部和杆件被固定。
如图2中箭头B所示,作用在支柱上的扭矩分布更加均匀,从而能够基本上完全防止支柱的斜向张开。
图4a和4b示意性地示出了按照本发明的增强支柱5、6的刚度的原理。在图4a所示的传统接收部件中,支柱在横向于中心轴M的方向上具有与圆柱体的截面形状类似的横截面形状。在平行于凹槽4的纵轴L的方向上使支柱的外壁变平以产生平面11、12,使得最靠近中心轴M的位置处壁厚减小为值d。壁厚d小于支柱侧向边缘区域的壁厚。进一步使垂直于凹槽4的纵轴L的表面变平以形成平面13,14,这就消除了陡边30,并且在支柱的侧向边缘处产生了具有增强壁厚D的部分15。如此形成了加强结构以防止支柱的斜向张开。下面的实施例示出了采用按照本发明的接收部件达到的效果。采用直径d杆件为5.5mm的杆件并且内螺纹部分的内径为7mm,按照本发明的接收部件在横向于杆件方向上的横向宽度Wmax与传统接收部件的13mm相比,减小到11.5mm。作为侧面刚度的一种度量,按照本发明的接收部件的几何惯性矩与传统情形下的240mm4相比,提高到380mm4
被减小的横向宽度Wmax能够构造出更具有解剖学形状的接骨固定装置的下侧,这有助于减小作用在小面关节(facet joints)上的载荷和/或与小面关节的接触。
相反,如果按照本发明的接收部件具有与传统圆柱形接收部件相同的横向宽度Wmax,那么在不减小刚度的情形下,按照本发明的接收部件将具有较大的凹槽4以使用具有较大直径的杆件。
可通过形成圆柱形部件并通过磨削(mill)出平面来生产接收部件1。
本发明并不限于将接收部件用在如图3a和3b所示的接骨固定装置上。也可以应用在其它多轴型连接装置上,如头部和杆件可以分别固定。在该情形下,设置有彼此分离的杆件固定装置和螺钉头部固定装置。另外,在所示的实施方案中螺钉头部和渐细的区段为球形,但是它们也可以是其它任何形状,只要接骨固定螺钉的头部和渐细的区段能够起到球窝接头的作用。例如,所述渐细的区段可以为锥形。
进一步,本发明不限于多轴型接骨固定装置,还可以应用在单轴型接骨固定装置上。在此情形下,接收部件的第二端部3固定连接在将要被锚定到骨骼里的柄部上。
该柄部可以是如图所示带有螺纹的柄部,也可以是销或钩或其他易于锚定在骨骼里的装置。
内螺纹可以是任何形状,不过优选能够使指向径向外部的作用力减小的形状。
图5a和5b示出了接收部件的第二实施方案。该第二实施方案与图1至3b所示第一实施方案的不同之处在于与平面11,12相对应的表面11’,12’不是平坦的,而是呈凹形,部分15’具有增强的壁厚,即沿着支柱的整个长度一直延伸到第一端部2的凹面11’,12’的外缘。尽管相对于第一实施方案,其刚度有所减小,但利用该第二实施方案中的接收部件,依然能够很大程度上减小支柱的张开。第二实施方案的接收部件所具有的优势在于所述凹面便于外科医生夹持该接收部件。
图6a和6b中示出了接收部件的第三实施方案。该第三实施方案与图1至3b所示第一实施方案的不同之处在于平面11,12带有纵向肋115,这些肋115在横向于沟槽的纵轴L并平行于接收部件的中心轴M的方向上在所述平面的整个表面延伸。这些纵向肋便于接收部件的夹持。
也可以是其它实施方案。这些肋不需要在支柱的整个外表面上延伸。此外,在第二实施方案的凹面11’,12’上也可以带有这种纵向肋。甚至能够想象到,可以在传统的、现有接收部件的凸形外表面上设置上述肋。
在另一实施方案中,通过向用来形成接收部件的基本材料中增加一种或多种附加材料来增强基本材料,从而实现这种加强结构。例如,可通过加入纤维例如碳纤维,或通过加入玻璃珠来实现。
图7示出了与多轴型螺钉的接收部件一起使用的传统反向保持工具。该反向保持工具具有握持部分30、能够使拧入工具引导通过的中空轴32,以及圆形的、与传统圆柱形接收部件一起使用的保持部分33。保持部分具有相对的狭缝34,以便装在杆件上,从而当旋紧内螺钉时能够反向保持接收部件。
按照本发明,反向保持工具的保持部分应当与接收部件的形状相适合。图8示出了按照本发明的用于反向保持工具的保持部分40。该保持部分40具有一基本呈方形的轮廓和一中空的内部,该中空内部带有与反向保持工具的中空轴相连的开口43,以及位于相对侧上的两个凹槽41,以便当插入杆件后,将其安装到接收部件上。该保持部分40还包括两个彼此相对的平行表面42,这两个平行表面42与接收部件的平面11,12配合以形成形状配合的连接(form-fit connection)。这种反向保持工具特别适合微创外科手术中的经皮应用。通过在保持部分和接收部件之间的形状配合连接,可以实现对接收部件的精确对准。
图9示出了用于微创外科的套针的传统管形部件,该管形部件具有圆形的横截面。图10示出了按照本发明的套针的管形部件,该管形部件具有与基本为方形的接收部件相适合的形状。由于接收部件和管形部件之间的形状配合连接,采用按照图10所示的管形部件可以通过经皮引入将接骨固定装置精确地引入并对准。

Claims (3)

1.一种用于保持和/或引导接骨固定装置的接收部件(1)的工具,所述接收部件(1)将接骨固定元件的柄部(50)连接到杆件(7)上,所述接收部件(1)包括:第一端部(2)和第二端部(3);具有U形横截面的凹槽(4),所述凹槽(4)从第一端部(2)在向着第二端部(3)的方向上延伸,从而形成在第一端部(2)处隔开的两个支柱(5,6),所述凹槽(4)限定一沟槽以接收所述杆件(7),所述沟槽具有纵轴(L),所述支柱(5,6)具有内螺纹(9)以接收紧固元件(10),该紧固元件(10)具有与所述内螺纹配合的外螺纹,其中:
所述工具包括具有方形轮廓的保持或引导部分(40),该保持或引导部分(40)和接收部件(1)以形状配合的连接方式配合。
2.根据权利要求1的工具,其中,所述保持或引导部分(40)具有位于相对两侧上的两个凹槽(41),以在所述杆件被插入时安装在所述接收部件(1)上。
3.根据权利要求1或2的工具,其中,所述保持或引导部分(40)还具有两个相对的平行表面,所述平行表面与所述接收部件(1)的平坦表面(11,12)配合以提供所述形状配合的连接。
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EP2085040A1 (en) 2009-08-05
EP1726264A1 (en) 2006-11-29
TWI428114B (zh) 2014-03-01
EP2085040B1 (en) 2012-05-23
DE602005014545D1 (de) 2009-07-02
US9585696B2 (en) 2017-03-07
TW200642654A (en) 2006-12-16

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