CN103099662B - The monolateral fixed system of a kind of anterior cervical vertebrae - Google Patents
The monolateral fixed system of a kind of anterior cervical vertebrae Download PDFInfo
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- CN103099662B CN103099662B CN201310000941.0A CN201310000941A CN103099662B CN 103099662 B CN103099662 B CN 103099662B CN 201310000941 A CN201310000941 A CN 201310000941A CN 103099662 B CN103099662 B CN 103099662B
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Abstract
The monolateral fixed system of a kind of anterior cervical vertebrae, treats cervical facet joint interlocking for being fixed on by the Invasive lumbar fusion device containing autologous bone or artificial bone implanting intervertebral space on the next vertebral body be adjacent; The monolateral fixed system of described anterior cervical vertebrae is constructed as follows: front road fixing head (1), bone screw (2), Invasive lumbar fusion device screw (3); Wherein: Invasive lumbar fusion device screw (3) is for being fixed together the Invasive lumbar fusion device containing autologous bone or artificial bone and front road fixing head (1) of implanting intervertebral space; Bone screw (2) to be arranged between front road fixing head (1) and vertebral body and by as a whole for the two connection; Described bone screw (2) has 2.The present invention can treat cervical facet joint interlocking better, and make cervical vertebra recover normal physiological curvature, reduce the generation of complication, it has long service life, without advantages such as rejections simultaneously; There is fabulous application prospect in the art.
Description
Technical field
The present invention relates to structural design and the applied technical field of the monolateral fixed system of anterior cervical vertebrae, specifically provide the monolateral fixed system of a kind of anterior cervical vertebrae being mainly used to treat cervical facet joint interlocking.
Background technology
Cervical facet joint interlocking is the damage of a kind of serious cervical vertebra three post; it accounts for 6.7% in all cervical spine injuries; be more common in high falling and injure car accident; wherein the most often involve (see list of references Payer M, Tessitore E.Delayed surgical management of atraumatic bilateral cervical facet dislocation by an anterior – posterior – anteriorapproach.JClin Neurosci2007 with C5/6, C6/7 two sections; 14:782 – 6.).Say from pathogenesis; cervical facet joint interlocking is a kind of flexing-stretching type or flexing-rotary-type damage; wherein flexing is that the most basic pathogenesis is (see list of references Crawford NR; Duggal N; Chamberlain RH; Park SC, SonntagVK, Dickman CA.Unilateral cervical facet dislocation:injury mechanism andbiomechanical consequences.Spine2002; 27:1858 – 64.Kalayci M, Cagavi F, Acikgoz B.Unilateral cervical facet fracture:presentation of two cases andliterature review.Spinal Cord2004; 42:466 – 72.Ivancic PC, Pearson AM, Tominaga Y, et al.Biomechanics of cervical facet dislocation.Traffic Inj Prev2008; 9:606-11.).From the angle of dissecting, wound violence makes the inferior articular process of upper vertebral body move forward to the front of the superior articular process of the next vertebral body, this can occur over just prominent also can the dashing forward at bilateral facet joint of unilateral facet joint and all occur, therefore, cervical facet joint interlocking can be divided into one-sided interlocking and bilateral interlocking two kinds (see list of references Vaccaro AR, Madigan L, Schweitzer ME, et al.Magneticresonance imaging analysis of soft tissue disruption after flexion-distractioninjuries of the subaxial cervical spine.Spine2001, 26:1866 – 72.Carrino JA, Manton GL, Morrison WB, et al.Posterior longitudinal ligament status incervical spine bilateral facet dislocations.Skeletal Radiol2006, 35:510 – 4.).
Clinically, cervical facet joint interlocking is usually associated with the combined injuries such as intercalated disc is outstanding, Minor articulus fracture, fracture of the vertebral lamina, ligament complex damage.It is reported, the probability wherein merging prolapse of cervical intervertebral disc is on average about 40%.(see list of references Vaccaro AR; Falatyn SP; Flanders AE; et al.Magnetic resonance evaluation of the intervertebral disc; spinal ligaments, andspinal cord before and after closed traction reduction of cervical spinedislocations.Spine1999; 24:1210 – 17.)
The main purpose of cervical facet joint interlocking treatment is the dissection order recovering cervical vertebra, recaptures cervical stability, recovers remaining function of nervous system as much as possible.The simple expectant treatment method using skull traction or neck neck to fix is rejected at present, doctor's many opinions operative treatment, but the operative treatment of cervical facet joint interlocking is by the impact of many factors, function of nervous system's state of such as patient; Whether be associated with intercalated disc, bone block etc. and cause laminate; One-sided or bilateral interlocking, whether Minor articulus fractures; Posterior ligament complex degree of impairment; The selection of reset mode and reset success or not; The experience of patient and custom etc.Many influence factors make the operative treatment mode of cervical facet joint interlocking varied, road combined etc. before comprising simple front road, the simple way of escape, facet locking, rear front road combined and front and back.In these modus operandis, facet locking is one of modus operandi the most often used; According to reports, in the patient of cervical bilateral Facet looking its with 44% utilization rate rank first.(see list of references Nassr A, LeeJY, Dvorak MF, et al.Variations in surgical treatment of cervical facetdislocations.Spine2008; 33:E188-93.) usual, completing anterior-posterior approach cervical facet joint interlocking has two kinds of methods: 1. Posterior fixation, fusion before row after closed reduction; 2. front road resets, fixes and merges rear row Posterior fixation fusion.But, often series of problems is there is in patient's actual mechanical process, closed reduction and front road reset and may increase the weight of nervous function damage degree and occur resetting unsuccessfully to make patient have to adopt road combined modus operandi (front road disc excision before numerous and diverse front and back, upset patients underwent way of escape Minor articulus unlocks, Posterior fixation merges, and the upset front road of patients underwent is fixing again merges).We have invented a kind of front and back road modus operandi newly, it is after front road disc excision, Invasive lumbar fusion device implantation, using the fixing fusion of the monolateral fixed system of anterior cervical vertebrae, adopt the way of escape to reset and solve the problems referred to above, thus road combined modus operandi before avoiding numerous and diverse front and back, save operating time and anesthesia duration, decrease potential operation and anesthesia related complication, be conducive to Rehabilitation.
By using front road fixing head 1 and 1 bone screw, 2,1 Invasive lumbar fusion device screw 3 jointly to coordinate the case (see accompanying drawing 1, Fig. 2, Fig. 3) forming the monolateral fixed system of anterior cervical vertebrae in prior art, but it is by double-side fastening system improvement by us, find that himself intensity is lower in actual use, Invasive lumbar fusion device is fixed not good enough, bad with the constant intensity of vertebral body.
People urgently wish to obtain the monolateral fixed system of the excellent anterior cervical vertebrae of a kind of clinical effectiveness.
Summary of the invention
The object of this invention is to provide the monolateral fixed system of the excellent anterior cervical vertebrae of a kind of clinical effectiveness.
The invention provides the monolateral fixed system of a kind of anterior cervical vertebrae, treating cervical facet joint interlocking for being fixed on by the Invasive lumbar fusion device containing autologous bone or artificial bone implanting intervertebral space on the next vertebral body be adjacent; It is characterized in that: it is constructed as follows: front road fixing head 1, bone screw 2, Invasive lumbar fusion device screw 3; Front road fixing head 1 is provided with the counter structure for fixed bone screw 2 and Invasive lumbar fusion device screw 3; Wherein:
Invasive lumbar fusion device screw 3 is for being fixed together the Invasive lumbar fusion device containing autologous bone or artificial bone and front road fixing head 1 of implanting intervertebral space; Bone screw 2 to be arranged between front road fixing head 1 and vertebral body and by as a whole for the two connection;
Described bone screw 2 has 2.
The monolateral fixed system of described anterior cervical vertebrae, also comprises following content and requires:
What front road fixing head 1 was arranged is hole (i.e. Invasive lumbar fusion device screw hole 31) for the Invasive lumbar fusion device containing autologous bone or artificial bone that will implant intervertebral space by the counter structure that Invasive lumbar fusion device screw 3 is fixed thereon;
What front road fixing head 1 was arranged is bone screw 22 or bone screw wide aperture 21 for being fixed in the counter structure of epicentral bone screw 2, wherein: the length of bone screw wide aperture 21 and width ratio≤1.5;
Described " wide aperture " specifically refers to the overall structure that two semicircular structures and a rectangular configuration three splice and combine, the straight line of its two semicircular structures overlaps with two non-conterminous corresponding limits arranged of rectangle respectively (widen on the basis in hole its width) in some directions, is appreciated that related content see accompanying drawing 4,7,8.
What front road fixing head 1 was arranged is bone screw wide aperture 21 for being fixed in the counter structure of epicentral bone screw 2, wherein: the arranged direction of bone screw wide aperture 21 is be 22 °-30 ° with the angle p of spinal column vertical axes.The explanation at p angle: p angle is excessive, bone screw 2 is near vertebral rim, and screw bone passage is shorter, and hold is not enough, and implants stability is not good enough; P angle is too small, and 2 pieces of bone screw 2 spacing too closely make stress too concentrated, is easy to implants related complication occurs.
Described Invasive lumbar fusion device screw 3 has 1, and bone screw 2 has 2, and bone screw 2 and Invasive lumbar fusion device screw 3 are triangularly arranged; The relative position that 1 the Invasive lumbar fusion device screw hole 31 Ji Qian road fixing head 1 being installed Invasive lumbar fusion device screw 3 and 2 bone screw wide aperture 21 of installing bone screw 2 or bone screw 22 are total to three is triangularly arranged; Bone screw wide aperture 21 meets the requirement of " wide aperture ", it is also that two semicircular structures and a rectangular configuration combine, " wide aperture " of (widen on the basis in hole its width) in some directions and the straight line of two semicircular structures overlaps with two narrow limits of rectangle respectively;
Also be provided with locking or/and locking mechanism between bone screw 2 and bone screw wide aperture 21 or bone screw 22.
The relative position in 1 the Invasive lumbar fusion device screw 3 on front road fixing head 1 and 2 bone screw 22 or bone screw wide aperture 21 totally three holes is that isosceles triangle is arranged.
Bone screw wide aperture 21 be combined by two semicircular structures and rectangular configuration on the basis in hole, widen its pass groove at the width in some directions.
In addition, the aperture of Invasive lumbar fusion device screw hole 31 and bone screw wide aperture 21 can also be provided with countersunk head groove so that arrange head and the nut of screw.
Further preferably: the relative position in 1 the Invasive lumbar fusion device screw hole 3 on front road fixing head 1 and 2 bone screw wide aperture 21 holes totally three holes be isosceles triangle layout.
Front road fixing head 1 is in two sub-sections: the top tie plate 101 being provided with the hole for arranging Invasive lumbar fusion device screw 3; Be provided with the lower tie plate 102 for the bone screw wide aperture 21 or bone screw 22 of arranging bone screw 2; This two part forms a continuous print plate profile structure;
Lower tie plate 101 and the main part space angle both top tie plate 102 are α, and meet 160 °≤α≤180 °.
Lower tie plate 102 is provided with the two parts be connected for respectively with 2 bone screw 2: lower left quarter fixing head 1021, right lower quadrant fixing head 1022; The main part space angle of said two devices is β, and meets 140 °≤β≤180 °.
Be in order to the monolateral fixed system of described anterior cervical vertebrae and conical surface docile are good to defining of α, β angle, be conducive to the physiological camber recovering and maintain cervical vertebra.Because conical surface curvature there are differences between vertebral body and vertebral body and between individuality and individuality, patient can regulate according to concrete condition in art.
Preferred further: lower tie plate 101 and the main part space angle both top tie plate 102 are α, and meet 170 °≤α≤180 °;
Lower left quarter fixing head 1021 on lower tie plate 102, the main part space angle of both right lower quadrant fixing heads 1022 are β, and meet 150 °≤β≤170 °.
The material of front road fixing head 1, bone screw 2, Invasive lumbar fusion device screw 3 is medical titanium alloy;
Front road fixing head 1 meets following requirement: length 12-25mm, thickness 1.2-4.0mm, width 15-22mm; Bone screw 2 meets following requirement: length 12-26mm, diameter 2.0-3.5mm, the long 1.2-4.0mm of the head of a nail; Invasive lumbar fusion device screw 3 meets following requirement: length 8-15mm, threaded portion external diameter 1.5-2.0mm, the long 1.2-4.0mm of the head of a nail;
Having that described anterior cervical vertebrae monolateral fixed system Zhong Qian road fixing head 1 is arranged is smooth for fixed bone screw 2 and the bone screw wide aperture 21 of Invasive lumbar fusion device screw 3 or the inner surface of bone screw 22 or arranges threaded.Arranging of screw hole can help to realize the relative lock in place of front road fixing head 1 relative to vertebral body 4.
Top tie plate 101 meets following requirement: length 6-9mm width 6-10mm; Lower tie plate 102 meets following requirement: length 6-16mm width 15-22mm.
The height of top tie plate 101 is suitable for highly mutually with the Invasive lumbar fusion device 6 implanting intervertebral space, and it can stop that Invasive lumbar fusion device 6 forwards moves, and is connected as a single entity simultaneously, prevents Invasive lumbar fusion device 6 from rearward moving by Invasive lumbar fusion device screw 3 and Invasive lumbar fusion device 6.Like this, guarantee in way of escape reseting procedure when upper vertebral body rearward mobile Invasive lumbar fusion device 6 is extruded time, Invasive lumbar fusion device 6 there will not be and is shifted forward or backward and causes the generation of the severe complication such as Internal implant failure and/or spinal cord injury.
Key technology of the present invention is: the structural design of front road fixing head 1 and the global design scheme of the monolateral fixed system of described anterior cervical vertebrae.
In the clinical practice research that the present invention is correlated with, 8 cervical facet joint interlockings merge intercalated disc to be given prominence to patient's (Frankel marks: 3 A levels, 4 D levels, 1 E level) have employed new Surgical treatment in treatment, all adopts skull traction (trailing weight 4-6Kg) with stable cervical vertebra and the neural secondary damage that prevents the unsuitable activity of cervical vertebra from causing before operation in patients.After peri-operation period is made adequate preparation, in the descending operative treatment of general anesthesia, operation method: dorsal position Hang Qian road dislocation sections disc excision, abundant decompression, then the peek(polyether-ether-ketone of autologous bone or artificial bone a centre being equipped with) cage implants intervertebral space, again with the next vertebral body that the cage of implantation intervertebral space is fixed on dislocation by the monolateral fixing head that a peek makes, close front road otch; Upset patient, row posterior cervical median incision, appear the Minor articulus of rear interlocking, unlock Minor articulus under direct-view, lift resets, fix with lateral mass screw or pedicle screw again, titanium rod is installed, clap c spine ap & lat picture in art and judge reset case, outside bone grafting after last line, closed way of escape otch (see Fig. 1-3).Adopt 8 patients of above-mentioned new Surgical treatment treatment all to obtain anatomical reduction, recover cervical curvature.Postoperatively die from except pulmonary infarction except 1 patient's postmortem, all the other 7 patients all obtain and follow up a case by regular visits to, follow up time 7-12 month, average 10 months, the routine patient of postoperative nothing 1 occurs that nervous symptoms worsens and inside-fixture failure, wherein 2 patient Frankel scorings rise to E level from D level, and 1 patient Frankel scoring rises to B level from A level, remain 2 A level patients, 1 D level patient and 1 E level patient Frankel scoring and remain unchanged.Preliminary result of study confirms that the Strategy of Surgical Treatment that this new cervical facet joint interlocking merges intercalated disc outstanding is safe and effective.
In this new Surgical treatment, it is crucial that the use of the monolateral fixed system of anterior cervical vertebrae, it is fixed on the next vertebral body by monolateral for cage, cage and upper vertebral body is made to be in transitory state, thus ensure the upper vertebral body of dislocating in way of escape reseting procedure can after move to anatomical position, recover the normal physiological curvature of cervical vertebra.Thus, the use of the monolateral fixed system of anterior cervical vertebrae, the success that the way of escape resets can not only be guaranteed, eliminate and use way of escape reset to cause the possibility of patient's spinal cord secondary damage under having intercalated disc to give prominence to situation, and avoid numerous and diverse front and back anterior approach, save operating time, decrease operation related complication, be conducive to the postoperative rehabilitation of patient.
The planform of the monolateral fixed system of the anterior cervical vertebrae related in the present invention more meets practicality, itself and respective screws coordinate can better fix corresponding vertebral body and Invasive lumbar fusion device, be conducive to the way of escape to reset, cervical facet joint interlocking can be treated better, cervical vertebra is made to recover normal physiological curvature, reduce the generation of complication, it has long service life, without advantages such as rejections simultaneously.It has obvious novelty and performance advantage in structural design and Material selec-tion, has fabulous application prospect in the art.
Accompanying drawing explanation
Below in conjunction with drawings and the embodiments, the present invention is further detailed explanation:
Fig. 1 is case accompanying drawing operation principle simplified schematic diagram (anterior approach completes, not yet row way of escape reset mode) using front road fixing head 1 and 1 bone screw, 2,1 Invasive lumbar fusion device screw 3 jointly to coordinate the monolateral fixed system of composition anterior cervical vertebrae;
Fig. 2 uses front road fixing head 1 and 1 bone screw, 2,1 Invasive lumbar fusion device screw 3 jointly to coordinate the case accompanying drawing front view of the monolateral fixed system of composition anterior cervical vertebrae (having completed the way of escape to reset and stationary state schematic diagram);
Fig. 3 is the left view corresponding with Fig. 2;
Fig. 4 is the front road fixing head 1 structural representation sketch front view of the monolateral fixed system of anterior cervical vertebrae of the present invention;
Fig. 5 is the left view corresponding with Fig. 4;
Fig. 6 is the upward view corresponding with Fig. 4;
Fig. 7 is the front road fixing head 1 structural representation sketch two of the monolateral fixed system of anterior cervical vertebrae;
Fig. 8 is the front road fixing head 1 structural representation sketch three of the monolateral fixed system of anterior cervical vertebrae;
Fig. 9 is the front road fixing head 1 structural representation sketch four of the monolateral fixed system of anterior cervical vertebrae;
Figure 10 is the front road fixing head 1 structural representation sketch five of the monolateral fixed system of anterior cervical vertebrae; Use bone screw 22 replacement bone screw wide aperture 21; Front road fixing head 1 centre is provided with observation window 5;
Figure 11 is the front road fixing head 1 structural representation sketch six of vertebra front road double-side fastening system; Front road fixing head 1 main body in " T " character form structure stood upside down, uses bone screw 22 to substitute the bone screw wide aperture 21 of channel-shaped on its frontal plane of projection;
Figure 12 is the front road fixing head 1 structural representation sketch seven of the monolateral fixed system of anterior cervical vertebrae;
Figure 13 is the front road fixing head 1 structural representation sketch eight of the monolateral fixed system of anterior cervical vertebrae.
Detailed description of the invention
Reference numeral implication is as follows:
Front road fixing head 1, bone screw 2, Invasive lumbar fusion device screw 3, bone screw wide aperture 21, bone screw 22, Invasive lumbar fusion device screw hole 31, top tie plate 101, lower tie plate 102, lower left quarter fixing head 1021, right lower quadrant fixing head 1022, vertebral body 4, observation window 5(cross section are special-shaped through hole, be conducive to carrying out auxiliary observation in operation process, be conducive to post-operative recovery simultaneously), Invasive lumbar fusion device 6(includes autologous bone or artificial bone).
Embodiment 1
1 cervical facet joint interlocking merges intercalated disc and gives prominence to patient, treatment have employed the Surgical treatment of the present embodiment, before operation in patients, all adopt skull traction (trailing weight 4-6Kg) with stable cervical vertebra and the neural secondary damage that prevents the unsuitable activity of cervical vertebra from causing.After peri-operation period is made adequate preparation, in the descending operative treatment of general anesthesia, operation method: dorsal position Hang Qian road dislocation sections disc excision, abundant decompression, then the peek(polyether-ether-ketone of autologous bone or artificial bone a centre is equipped with) Invasive lumbar fusion device implantation intervertebral space, with the monolateral fixed system of anterior cervical vertebrae, the Invasive lumbar fusion device implanting intervertebral space is fixed on the next vertebral body of dislocation again, closed front road otch; Upset patient, row posterior cervical median incision, appears the Minor articulus of rear interlocking, unlock Minor articulus under direct-view, lift resets, then fix with lateral mass screw or pedicle screw, titanium rod is installed, clap c spine ap & lat picture in art and judge reset case, outside bone grafting after last line, closed way of escape otch.
The monolateral fixed system of a kind of anterior cervical vertebrae (see accompanying drawing 4-6) described in the present embodiment; Cervical facet joint interlocking is treated for being fixed on by the Invasive lumbar fusion device containing autologous bone or artificial bone implanting intervertebral space on the next vertebral body be adjacent; It is constructed as follows:
Front road fixing head 1, bone screw 2, Invasive lumbar fusion device screw 3; Front road fixing head 1 is provided with the hole for fixed bone screw 2 and Invasive lumbar fusion device screw 3 or wide aperture; Wherein:
Invasive lumbar fusion device screw 3 is for being fixed together the Invasive lumbar fusion device containing autologous bone or artificial bone and front road fixing head 1 of implanting intervertebral space; Bone screw 2 to be arranged between front road fixing head 1 and vertebral body and by as a whole for the two connection;
Described bone screw 2 has 2.
The monolateral fixed system of described anterior cervical vertebrae, also comprises following content and requires:
What front road fixing head 1 was arranged is hole for the Invasive lumbar fusion device containing autologous bone or artificial bone that will implant intervertebral space by the counter structure that Invasive lumbar fusion device screw 3 is fixed thereon;
What front road fixing head 1 was arranged is wide aperture for being fixed in the counter structure of epicentral bone screw 2, and the length of wide aperture and width ratio are 1.5;
And the arranged direction of groove is be 25 ° (as shown in Figure 4) with spine stretching direction (the main bearing of trend of Ji Qian road fixing head 1) angle p.The explanation at p angle: p angle is excessive, bone screw 2 is near vertebral rim, and screw bone passage is shorter, and hold is not enough, and implants stability is not good enough; P angle is too small, and 2 pieces of bone screw 2 spacing too closely make stress too concentrated, is easy to implants related complication occurs.
The monolateral fixed system of described anterior cervical vertebrae, also comprises following content and requires:
Described Invasive lumbar fusion device screw 3 has 1, and bone screw 2 has 2, and bone screw 2 and Invasive lumbar fusion device screw 3 are triangularly arranged; Relative position Ji Qian road fixing head 1 being installed 1 Invasive lumbar fusion device screw hole 31 of Invasive lumbar fusion device screw 3 and 2 bone screw wide aperture 21 threes of installation bone screw 2 is triangularly arranged; Bone screw wide aperture 21 be two semicircular structures and rectangular configuration combine on the basis in hole, widen its pass groove at the width in some directions.The aperture of Invasive lumbar fusion device screw hole 31 and bone screw wide aperture 21 can also be provided with countersunk head groove so that arrange head and the nut of screw.
Specifically, the relative position in 1 the Invasive lumbar fusion device screw 3 on front road fixing head 1 and 2 bone screw wide aperture 21 holes totally three holes is that isosceles triangle is arranged.
Front road fixing head 1 is in two sub-sections: the top tie plate 101 being provided with the hole for arranging Invasive lumbar fusion device screw 3; Be provided with the lower tie plate 102 of hole for arranging bone screw 2 or wide aperture; This two part forms a continuous print plate profile structure; Lower tie plate 101 and the main part space angle α both top tie plate 102 are 175 °.Lower tie plate 102 is provided with the two parts be connected for respectively with 2 bone screw 2: lower left quarter fixing head 1021, right lower quadrant fixing head 1022; The main part space angle β of said two devices is 155 ° (as shown in accompanying drawings 5,6).
Be in order to the monolateral fixed system of described anterior cervical vertebrae and conical surface docile are good to defining of α, β angle, be conducive to the physiological camber recovering and maintain cervical vertebra.Because conical surface curvature there are differences between vertebral body and vertebral body and between individuality and individuality, patient can regulate according to concrete condition in art.
The lateral edges place of fixing head 102 junction, top tie plate 101 up and down portion can be provided with outwardly open arcuate structure, to be beneficial to observation region of interest in operation process, ensures surgical effect.
The material of front road fixing head 1, bone screw 2, Invasive lumbar fusion device screw 3 is medical titanium alloy;
Front road fixing head 1 meets following requirement: length 14mm, thickness 2.0mm, width 18mm; Bone screw 2 meets following requirement: length 18mm, diameter 2.5mm, the long 2.0mm of the head of a nail; Invasive lumbar fusion device screw 3 meets following requirement: length 12mm, threaded portion external diameter 1.7mm, the long 2.0mm of the head of a nail;
Top tie plate 101 meets following requirement: length 7.5mm width 8mm; Lower tie plate 102 meets following requirement: length 10mm width 18mm.
Described anterior cervical vertebrae monolateral fixed system Zhong Qian road fixing head 1 is arranged to have for fixed bone screw 2 and the hole of Invasive lumbar fusion device screw 3 or the inner surface of wide aperture be smooth or be provided with screw thread (be locked better effects if).
The height of top tie plate 101 is suitable for highly mutually with the Invasive lumbar fusion device 6 implanting intervertebral space, and it can stop that Invasive lumbar fusion device 6 forwards moves, and is connected as a single entity simultaneously, prevents Invasive lumbar fusion device 6 from rearward moving by Invasive lumbar fusion device screw 3 and Invasive lumbar fusion device 6.Like this, guarantee in way of escape reseting procedure when upper vertebral body rearward mobile Invasive lumbar fusion device 6 is extruded time, Invasive lumbar fusion device 6 there will not be and is shifted forward or backward and causes the generation of the severe complication such as Internal implant failure and/or spinal cord injury.
The key technology of the present embodiment is: the structural design of front road fixing head 1 and the global design scheme of the monolateral fixed system of described anterior cervical vertebrae.
In the clinical practice research that the present embodiment is relevant, 8 cervical facet joint interlockings merge intercalated disc to be given prominence to patient's (Frankel marks: 3 A levels, 4 D levels, 1 E level) have employed new Surgical treatment in treatment, all adopts skull traction (trailing weight 4-6Kg) with stable cervical vertebra and the neural secondary damage that prevents the unsuitable activity of cervical vertebra from causing before operation in patients.After peri-operation period is made adequate preparation, in the descending operative treatment of general anesthesia, operation method: dorsal position Hang Qian road dislocation sections disc excision, abundant decompression, then the peek(polyether-ether-ketone of autologous bone or artificial bone a centre being equipped with) cage implants intervertebral space, again with the next vertebral body that the cage of implantation intervertebral space is fixed on dislocation by the monolateral fixing head that a peek makes, close front road otch; Upset patient, row posterior cervical median incision, appear the Minor articulus of rear interlocking, unlock Minor articulus under direct-view, lift resets, fix with lateral mass screw or pedicle screw again, titanium rod is installed, clap c spine ap & lat picture in art and judge reset case, outside bone grafting after last line, closed way of escape otch (see Fig. 1-3).Adopt 8 patients of above-mentioned new Surgical treatment treatment all to obtain anatomical reduction, recover cervical curvature.Postoperatively die from except pulmonary infarction except 1 patient's postmortem, all the other 7 patients all obtain and follow up a case by regular visits to, follow up time 7-12 month, average 10 months, the routine patient of postoperative nothing 1 occurs that nervous symptoms worsens and inside-fixture failure, wherein 2 patient Frankel scorings rise to E level from D level, and 1 patient Frankel scoring rises to B level from A level, remain 2 A level patients, 1 D level patient and 1 E level patient Frankel scoring and remain unchanged.Preliminary result of study confirms that the Strategy of Surgical Treatment that this new cervical facet joint interlocking merges intercalated disc outstanding is safe and effective.
In this new Surgical treatment, it is crucial that the use of the monolateral fixed system of anterior cervical vertebrae, it is fixed on the next vertebral body by monolateral for cage, cage and upper vertebral body is made to be in transitory state, thus ensure the upper vertebral body of dislocating in way of escape reseting procedure can after move to anatomical position, recover the normal physiological curvature of cervical vertebra.Thus, the use of the monolateral fixed system of anterior cervical vertebrae, the success that the way of escape resets can not only be guaranteed, eliminate and use way of escape reset to cause the possibility of patient's spinal cord secondary damage under having intercalated disc to give prominence to situation, and avoid numerous and diverse front and back anterior approach, save operating time, decrease operation related complication, be conducive to the postoperative rehabilitation of patient.
Embodiment 2
The present embodiment is substantially the same manner as Example 1, and its difference is mainly described as follows:
What front road fixing head 1 was arranged is grooves for being fixed in the counter structure of epicentral bone screw 2, and the length of groove and width ratio are 1.3; And the arranged direction of groove is be 22 ° with spine stretching direction (the main bearing of trend of Ji Qian road fixing head 1) angle p.
Front road fixing head 1 is in two sub-sections: the top tie plate 101 being provided with the hole for arranging Invasive lumbar fusion device screw 3; Be provided with the lower tie plate 102 of hole for arranging bone screw 2 or wide aperture; This two part forms a continuous print plate profile structure; Lower tie plate 101 and the main part space angle α both top tie plate 102 are 160 °.Lower tie plate 102 is provided with the two parts be connected for respectively with 2 bone screw 2: lower left quarter fixing head 1021, right lower quadrant fixing head 1022; The main part space angle β of said two devices is 140 °.
Front road fixing head 1 meets following requirement: length 12mm, thickness 1.2mm, width 15mm; Bone screw 2 meets following requirement: length 12mm, diameter 2.0mm, the long 1.2mm of the head of a nail; Invasive lumbar fusion device screw 3 meets following requirement: length 8mm, threaded portion external diameter 1.5mm, the long 1.2mm of the head of a nail;
Top tie plate 101 meets following requirement: length 6mm width 6mm; Lower tie plate 102 meets following requirement: length 6mm width 15mm.
Having that described anterior cervical vertebrae monolateral fixed system Zhong Qian road fixing head 1 is arranged is smooth for fixed bone screw 2 and the hole of Invasive lumbar fusion device screw 3 or the inner surface of wide aperture or arranges threaded.
Embodiment 3
The present embodiment is substantially the same manner as Example 1, and its difference is mainly described as follows:
What front road fixing head 1 was arranged is hole for the Invasive lumbar fusion device containing autologous bone or artificial bone that will implant intervertebral space by the counter structure that Invasive lumbar fusion device screw 3 is fixed thereon; What front road fixing head 1 was arranged is wide aperture for being fixed in the counter structure of epicentral bone screw 2, and the length of wide aperture and width ratio are 1.15; And the arranged direction of groove is be 30 ° with spine stretching direction (the main bearing of trend of Ji Qian road fixing head 1) angle p.
Front road fixing head 1 is in two sub-sections: the top tie plate 101 being provided with the hole for arranging Invasive lumbar fusion device screw 3; Be provided with the lower tie plate 102 of hole for arranging bone screw 2 or groove; This two part forms a continuous print plate profile structure; Lower tie plate 101 and the main part space angle α both top tie plate 102 are 170 °.Lower tie plate 102 is provided with the two parts be connected for respectively with 2 bone screw 2: lower left quarter fixing head 1021, right lower quadrant fixing head 1022; The main part space angle β of said two devices is 170 °.
Front road fixing head 1 meets following requirement: length 25mm, thickness 4.0mm, width 22mm; Bone screw 2 meets following requirement: length 26mm, diameter 3.5mm, the long 4.0mm of the head of a nail; Invasive lumbar fusion device screw 3 meets following requirement: length 15mm, threaded portion external diameter 2.0mm, the long 4.0mm of the head of a nail;
Top tie plate 101 meets following requirement: length 9mm width 10mm; Lower tie plate 102 meets following requirement: length 16mm width 22mm.
Described anterior cervical vertebrae monolateral fixed system Zhong Qian road fixing head 1 is arranged have for fixed bone screw 2 and the hole of Invasive lumbar fusion device screw 3 or the inner surface of wide aperture be provided with screw thread in case with carry out better be locked (fine setting of can pressurizeing in locking process realizes better technique effect).
Embodiment 4
The present embodiment is substantially the same manner as Example 1, and its difference is main to be understood with reference to accompanying drawing 7 or Fig. 8 or Fig. 9, and correspondence is described as follows respectively:
Bone screw wide aperture 21(on front road fixing head 1 is with reference to accompanying drawing 7 or Fig. 8) or bone screw 22(with reference to Fig. 9) and Invasive lumbar fusion device screw hole 31 be triangularly arranged on the frontal plane of projection of front road fixing head 1.Also be provided with locking or/and locking mechanism is for use in lock operation between bone screw 2 and bone screw wide aperture 21 or bone screw 22.
Embodiment 5
The present embodiment is substantially the same manner as Example 1, and its difference is mainly as follows:
See accompanying drawing 10, correspondence is described as follows: front road fixing head 1 main body is triangular in shape on its frontal plane of projection, uses bone screw 22 to substitute the bone screw wide aperture 21 of channel-shaped; And observation window 5 is provided with between bone screw 22 and Invasive lumbar fusion device screw hole 31, observation window 5 is cross sections is special-shaped through hole, is conducive to carrying out auxiliary observation in operation process, is conducive to post-operative recovery simultaneously.
Embodiment 6
The present embodiment is substantially the same manner as Example 1, and its difference is mainly as follows:
See accompanying drawing 11, correspondence is described as follows: front road fixing head 1 main body in " T " character form structure stood upside down, uses bone screw 22 to substitute the bone screw wide aperture 21 of channel-shaped on its frontal plane of projection.
Embodiment 7
The present embodiment is substantially the same manner as Example 1, and its difference is mainly as follows:
See accompanying drawing 12, front road fixing head 1 main body is triangular in shape on its frontal plane of projection, uses bone screw 22 to substitute the bone screw wide aperture 21 of channel-shaped; And observation window 5 is provided with between bone screw 22 and Invasive lumbar fusion device screw hole 31, observation window 5 is cross sections is special-shaped through hole, is conducive to carrying out auxiliary observation in operation process, is conducive to post-operative recovery simultaneously.
Bone screw 22 is provided with countersunk head groove, and bone screw 22 is inwalls is provided with the screwed hole (not drawing in Figure 12) of helicitic texture.The lateral edges place of fixing head 102 junction, top tie plate 101 up and down portion can be provided with outwardly open arcuate structure, to be beneficial to observation region of interest in operation process, ensures surgical effect.
Embodiment 8
The present embodiment is substantially the same manner as Example 1, and its difference is mainly as follows:
See accompanying drawing 13, correspondence is described as follows: front road fixing head 1 main body in " T " character form structure stood upside down, uses bone screw 22 to substitute the bone screw wide aperture 21 of channel-shaped on its frontal plane of projection.
Bone screw 22 is provided with countersunk head groove, and bone screw 22 is inwalls is provided with the screwed hole (not drawing in Figure 13) of helicitic texture.The lateral edges place of fixing head 102 junction, top tie plate 101 up and down portion can be provided with outwardly open arcuate structure, to be beneficial to observation region of interest in operation process, ensures surgical effect.
Embodiment 9
One of them is substantially identical for the present embodiment and embodiment 5-8, and its difference is mainly as follows: lower tie plate 101 and the main part space angle α both top tie plate 102 are 180 °.The main part space angle β of lower left quarter fixing head 1021, both right lower quadrant fixing heads 1022 is 180 °.
Claims (7)
1. the monolateral fixed system of anterior cervical vertebrae, treats cervical facet joint interlocking for being fixed on by the Invasive lumbar fusion device containing autologous bone or artificial bone implanting intervertebral space on the next vertebral body be adjacent; It is constructed as follows: front road fixing head (1), bone screw (2), Invasive lumbar fusion device screw (3); Front road fixing head (1) is provided with the counter structure for fixed bone screw (2) and Invasive lumbar fusion device screw (3); Wherein:
Invasive lumbar fusion device screw (3) is for being fixed together the Invasive lumbar fusion device containing autologous bone or artificial bone and front road fixing head (1) of implanting intervertebral space; Bone screw (2) to be arranged between front road fixing head (1) and vertebral body and by as a whole for the two connection;
Front road fixing head (1) is upper, and what arrange is hole for the Invasive lumbar fusion device containing autologous bone or artificial bone that will implant intervertebral space by the counter structure that Invasive lumbar fusion device screw (3) is fixed thereon;
What front road fixing head (1) was above arranged is bone screw wide aperture (21) for being fixed in the counter structure of epicentral bone screw (2), wherein: the length of bone screw wide aperture (21) and width ratio≤1.5;
Described " wide aperture " specifically refers to the overall structure that two semicircular structures and a rectangular configuration three splice and combine, and the straight line of its two semicircular structures overlaps with two non-conterminous corresponding limits arranged of rectangle respectively; It is characterized in that:
What front road fixing head (1) was above arranged is bone screw wide aperture (21) for being fixed in the counter structure of epicentral bone screw (2), wherein: the arranged direction of bone screw wide aperture (21) is be 22 °-30 ° with the angle p of spinal column vertical axes;
Described Invasive lumbar fusion device screw (3) has 1, and bone screw (2) has 2, and bone screw (2) and Invasive lumbar fusion device screw (3) are triangularly arranged; The relative position that 1 Invasive lumbar fusion device screw hole (31) on Ji Qian road fixing head (1) upper installation Invasive lumbar fusion device screw (3) and 2 bone screw wide aperture (21) of installation bone screw (2) are total to three is triangularly arranged; Bone screw wide aperture (21) meets the requirement of " wide aperture ";
Also be provided with locking or/and locking mechanism between bone screw (2) and bone screw wide aperture (21).
2. according to the monolateral fixed system of anterior cervical vertebrae described in claim 1, it is characterized in that: the relative position in 1 Invasive lumbar fusion device screw (3) on front road fixing head (1) and 2 bone screw wide aperture (21) totally three holes is that isosceles triangle is arranged.
3., according to the monolateral fixed system of anterior cervical vertebrae described in claim 1, it is characterized in that:
Front road fixing head (1) is in two sub-sections: the top tie plate (101) being provided with the hole for arranging Invasive lumbar fusion device screw (3); Be provided with the lower tie plate (102) of the bone screw wide aperture (21) for arranging bone screw (2); This two part forms a continuous print plate profile structure;
The two main part space angle of lower tie plate (101) and top tie plate (102) is α, and meets 160 °≤α≤180 °.
4., according to the monolateral fixed system of anterior cervical vertebrae described in claim 3, it is characterized in that:
Lower tie plate (102) is provided with the two parts be connected for respectively with 2 bone screw (2): lower left quarter fixing head (1021), right lower quadrant fixing head (1022); The main part space angle of said two devices is β, and meets 140 °≤β≤180 °.
5., according to the monolateral fixed system of anterior cervical vertebrae described in claim 4, it is characterized in that:
The two main part space angle of lower tie plate (101) and top tie plate (102) is α, and meets 170 °≤α≤180 °;
The two main part space angle of lower left quarter fixing head (1021) on lower tie plate (102), right lower quadrant fixing head (1022) is β, and meets 150 °≤β≤170 °.
6., according to claim 1-5 monolateral fixed system of anterior cervical vertebrae described in one of them, it is characterized in that:
The material of front road fixing head (1), bone screw (2), Invasive lumbar fusion device screw (3) is medical titanium alloy;
Front road fixing head (1) meets following requirement: length 12-25mm, thickness 1.2-4.0mm, width 15-22mm; Bone screw (2) meets following requirement: length 12-26mm, diameter 2.0-3.5mm, the long 1.2-4.0mm of the head of a nail; Invasive lumbar fusion device screw (3) meets following requirement: length 8-15mm, threaded portion external diameter 1.5-2.0mm, the long 1.2-4.0mm of the head of a nail;
Described anterior cervical vertebrae monolateral fixed system Zhong Qian road fixing head (1) is upper having of arranging is smooth for the inner surface of the bone screw wide aperture (21) of fixed bone screw (2) and Invasive lumbar fusion device screw (3) or arranges threaded.
7., according to the monolateral fixed system of anterior cervical vertebrae described in claim 6, it is characterized in that:
Top tie plate (101) meets following requirement: length 6-9mm, width 6-10mm; Lower tie plate (102) meets following requirement: length 6-16mm width 15-22mm.
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| CN201310000941.0A CN103099662B (en) | 2013-01-04 | 2013-01-04 | The monolateral fixed system of a kind of anterior cervical vertebrae |
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| CN201310000941.0A CN103099662B (en) | 2013-01-04 | 2013-01-04 | The monolateral fixed system of a kind of anterior cervical vertebrae |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US8940030B1 (en) | 2011-01-28 | 2015-01-27 | Nuvasive, Inc. | Spinal fixation system and related methods |
| CN109288614A (en) | 2018-11-09 | 2019-02-01 | 中国人民解放军第二军医大学第二附属医院 | A kind of fixed emerging system in the preceding road of cervical vertebra natural height |
| CN111588521B (en) * | 2020-05-29 | 2023-02-03 | 四川大学华西医院 | Cervical vertebra side front approach double-cortical fixation uncinate vertebra joint fusion cage |
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| CN2607962Y (en) * | 2003-03-18 | 2004-03-31 | 尹庆水 | Reset fixing titanium plate for atlantean centrum through throat |
| CN1527688A (en) * | 2001-07-13 | 2004-09-08 | LDRҽѧ��˾ | Vertebral cage device with modular fixation |
| CN203195754U (en) * | 2013-01-04 | 2013-09-18 | 朱悦 | Anterior cervical unilateral fixing system |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US8216312B2 (en) * | 2007-05-31 | 2012-07-10 | Zimmer Spine, Inc. | Spinal interbody system and method |
| US8551144B2 (en) * | 2008-04-22 | 2013-10-08 | Collab Comlo, LLC | Bone plate system configurable as static or dynamic implant |
| US8425514B2 (en) * | 2008-06-25 | 2013-04-23 | Westmark Medical, Llc. | Spinal fixation device |
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Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN1527688A (en) * | 2001-07-13 | 2004-09-08 | LDRҽѧ��˾ | Vertebral cage device with modular fixation |
| CN2607962Y (en) * | 2003-03-18 | 2004-03-31 | 尹庆水 | Reset fixing titanium plate for atlantean centrum through throat |
| CN203195754U (en) * | 2013-01-04 | 2013-09-18 | 朱悦 | Anterior cervical unilateral fixing system |
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Effective date of registration: 20210209 Address after: 110000 No. 155 North Nanjing street, Heping District, Liaoning, Shenyang Patentee after: THE FIRST HOSPITAL OF CHINA MEDICIAL University Address before: 110001 2-301, 42-1 Haikou street, Heping District, Shenyang City, Liaoning Province Patentee before: Zhu Yue |