CN103750891A - 用于将杆锚固到骨或椎骨中的锚固装置 - Google Patents
用于将杆锚固到骨或椎骨中的锚固装置 Download PDFInfo
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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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
- A61B17/7037—Screws 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/60—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 for external osteosynthesis, e.g. distractors, contractors
- A61B2017/603—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 for external osteosynthesis, e.g. distractors, contractors with three points of contact, e.g. tripod
Abstract
提供了一种锚固装置,用于将杆锚固到骨或椎骨中,并且用于与具有不同直径的至少两根杆一起使用,所述锚固装置(1;20)具有锚杆(2;22)和用于连接到所述杆(10)之一的头部(4;25),所述头部(4;25)连接到所述锚杆(2;22)并且具有凹槽(5;31),所述凹槽具有基部(11;40)和两个基本竖直延伸的支腿(6,7;32,33;38,39),所述支腿限定通道以用于在所述通道中接收所述杆,和用于将所述杆(10)夹紧在所述通道中的固定元件(52;70),其中所述固定元件和所述基部均具有接触所述杆的接触表面(11;40;53;73),所述接触表面成形为能够夹紧任何不同的杆。
Description
本申请是2008年12月9日申请的、申请号为200810179590.3、发明名称为“用于将杆锚固到骨或椎骨中的锚固装置”的申请的分案申请。
技术领域
本发明涉及一种用于将杆锚固到骨或椎骨中的锚固装置,所述锚固装置可以用于与具有不同直径的至少两根杆一起使用。
背景技术
为了稳固脊柱,包括待锚固到骨中的锚杆和待连接到杆的头部的骨锚固装置是已知的。通常,杆连接几个骨锚固装置。根据内科适应症和需要稳固的脊柱的区域,需要具有不同直径的杆。杆的直径范围从3mm至6mm以上。一般而言,用于脊柱的下部分中的杆的直径大于用于脊柱的上部分中的杆的直径。例如如图1中所示,在脊柱的颈胸区域中杆的直径为3mm至3.5mm,在颈胸和胸腰区域之间的过渡区域中杆的直径为3.5mm至4.5mm,在胸腰区域中杆的直径通常为4.5mm至5.5mm,并且在腰骶区域中杆的直径为5mm至6.35mm。
对于杆的每个直径,需要特定的骨锚固装置(诸如椎弓根螺钉)。这些骨锚固装置特别在杆插入其中的凹槽的尺寸方面彼此不同。提供不同骨锚固装置增加了成本并且对于外科医生来说使脊柱手术更复杂。
US5,873,878公开了一种锚固元件,所述锚固元件用于附连到椎骨并用于与具有第一直径的第一杆和具有第二更小直径的第二杆一起使用。所述锚固元件包括插入元件,所述插入元件可以插入锚固元件的头部中以允许直径更小的杆插入。
发明内容
本发明的目的是提供一种锚固装置,所述锚固装置可以用于与具有不同直径的几根杆一起使用。
根据权利要求1的锚固装置解决了所述目的。在从属权利要求中给出了进一步的改进。
所述锚固装置具有的优点在于:提供了具有不同直径的任何杆的安全夹紧。夹紧力不取决于杆的直径。
此外,所述锚固装置构造成最小化了部件的数量。因此不需要附加部件以允许不同杆的固定。
所述锚固装置可以特别用于儿童脊柱侧凸的矫正。当儿童成长时,必须采用脊柱侧凸矫正装置。例如,必须使用具有更大直径的其它杆作为最初插入的那些杆。使用根据本发明的骨锚固装置可以在二次手术中用保持锚固在椎骨中的骨锚固器替换最初使用的杆。
附图说明
通过参考以下结合附图进行的实施例的详细描述将显而易见和将最好地理解本发明的其它特征和优点。
图1示出脊柱的示意图,在脊柱的不同区域具有使用不同直径的杆的脊柱稳固装置。
图2示出根据第一实施例的锚固装置的透视分解图。
图3示出处于组装状态的图2的骨锚固装置的透视图。
图4示出处于组装状态的图3的锚固装置的截面图,所述截面垂直于杆的轴线截取。
图5示出根据第二实施例的锚固装置的透视分解图。
图6示出处于组装状态的图5的锚固装置的透视图。
图7示出图6的锚固装置的部分截面图,所述截面在垂直于杆的轴线并且通过锚固装置的中心的平面中截取。
图8a)示出图7的锚固装置的压力元件的侧视图。
图8b)示出图7的锚固装置的压力元件的截面图,所述截面在垂直于杆的轴线的平面中截取。
图8c)示出图7的锚固装置的压力元件的顶视图。
图8d)示出图7的锚固装置的压力元件的透视图。
图9a)-d)示意性地示出杆在图8a)-8d)中所示的压力元件中的夹紧,其中使用了具有不同直径的不同杆。
图10a)-10d)示意性地示出具有不同直径的杆在修改实施例的压力元件中的夹紧。
图11a)-11b)示出杆的基座的修改实施例。
具体实施方式
参考图2-4描述根据本发明第一实施例的锚固装置。所述锚固装置1包括锚杆2,所述锚杆在一端具有尖端3并且在另一端具有头部4。所述锚杆在其至少一部分中包括骨螺纹。
头部4在其与尖端相对的一侧上具有凹槽5,借助于所述凹槽形成两个自由支腿6、7,所述支腿限定用于接收杆10的通道。内螺纹8设置在支腿6、7处以用于接收内螺钉9,以便将杆10固定在通道中。所述杆具有圆形或基本为圆形的横截面。
在图4中可以最清楚地看到,通过凹槽5形成两个相对的基本竖直的平坦侧壁12、13。侧壁12、13的距离稍大于待容纳在凹槽中的杆的最大直径,因此凹槽5的宽度稍大于待容纳在凹槽中的杆的最大直径,从而杆可以插入并且在其中沿杆的轴线的方向被引导。特别如在图4中可以看到的,凹槽5的基部11具有基本为V形的横截面。基部11的底部是圆形的。基部11的V形的夹角α使得直径为d的杆10在两个相对的接触线P1、P2处接触基部,所述接触线沿平行于杆的轴线的方向延伸。
如图2中所示的轴向孔14设置在通道的中心,从而凹槽5的V形基部11设置在支腿6、7的两侧上。由轴向孔14形成的内孔允许获得多点接触,这意味着左和右接触。对于预弯曲的成型杆来说这是特别重要的。设置在支腿6、7上的内螺纹8从头部4的自由端延伸过一个预定长度。邻近内螺纹8沿朝着基部11的方向设置有底切(undercut)15。在图2-4所示的实施例中,内螺钉9是可以拧在支腿之间的定位螺钉。当杆10插入并且内螺钉9拧入时,内螺钉在被紧固时压在杆上并且其下侧面对杆。因此,内螺钉9沿接触线P3接触杆10。
凹槽5和V形基部11的宽度w以及杆10的直径d和内螺钉9的长度这些尺寸使得能够沿三条接触线P1、P2和P3夹紧所述杆10。当杆这样被夹紧时它处于稳定位置,类似于观察截面中的三点固定。这样获得了沿杆的可靠的多条接触线。应当理解的是,接触线不是无穷细的线,而是根据宏观产生的接触具有一定粗细的线。这提供了与杆的直径无关的安全固定。
可以与锚固装置一起使用的杆的直径可以在最大直径和最小直径之间变化,所述直径在几何上被限定成使得杆在任何情况下都具有与基部11的两条接触线。内螺钉9的长度使得当内螺钉完全拧入时,内螺钉在接触线P3处触碰杆。
所述锚固装置和杆由生物相容材料制成,例如由诸如钛之类的金属或诸如呈现超弹性性质的合金之类的金属合金制成。所述杆是刚性的,从而当内螺钉被紧固时,所述杆通过摩擦力保持就位。
在使用中,首先锚固至少两个锚固装置,使得它们的锚杆位于骨中,例如位于椎骨的椎弓根中。然后,选择用于脊柱稳固的杆,所述杆具有适合于临床应用的特定直径。将所述杆插入凹槽中并且通过紧固内螺钉固定所述杆。
参考图5-8描述第二实施例。锚固装置20是包括螺钉元件21的多轴骨螺钉,所述螺钉元件具有带骨螺纹的锚杆22和球形头部23。球形头部23在其自由端具有用于与拧紧工具接合的凹槽24。
所述锚固装置进一步包括接收部分25,所述接收部分具有第一端26、与第一端相对的第二端27和中心轴线C。与中心轴线C同轴地设置有孔29,所述孔从第一端延伸到距离第二端一定距离处。在第二端设置有一开口,所述开口的直径小于孔29的直径。头部23可枢转地保持在接收部分中,并且锚杆延伸穿过开口30。
所述接收部分进一步具有始于第一端并且沿第二端的方向延伸的基本为U形的凹槽31。借助于U形凹槽31形成两个自由支腿32、33。在支腿上设置内螺纹34。
设置压力元件35,所述压力元件具有基本为圆柱形的构造,并且所具有的外径仅仅稍小于孔29的内径,以允许压力元件引入孔中并在其中沿轴向方向移动。压力元件35在其面向螺钉元件21的头部23的下侧包括球形凹槽36,所述球形凹槽的半径对应于螺钉元件的球形头部23的半径。压力元件在相对侧上包括凹槽37,所述凹槽37形成具有平坦侧壁38′、39′的两个支腿38、39和基部40。基部40为类似于第一实施例的基部11的基本V形。所述基部40可以在其最深点处和在其与平坦侧壁的过渡处是圆形的。基部40的侧壁的夹角α′的大小制成为使得可以插入具有最大直径的杆和具有最小直径的杆,从而这些杆分别在平行于杆的轴线L的两条接触线P1、P2处接触基部40。凹槽37的深度使得对于具有的直径在最小和最大直径之间的所有杆,支腿38、39在插入的杆的上表面上方延伸。压力元件进一步包括同轴孔41,所述同轴孔用于通过拧紧工具接近头部23的凹槽24。
为了固定杆10和螺钉元件21的头部23,设置固定元件50。固定元件50是两件式固定元件并且包括第一外螺钉51,所述第一外螺钉与接收部分25的内螺纹34配合并且具有同轴螺纹孔,第二内螺钉52插入所述同轴螺纹孔中。第一外螺钉51在其背离接收部分的一端包括环形突出部51a,所述环形突出部51a具有便于夹持固定元件的结构。如图7中所示,当第一外螺钉51被紧固时,第一外螺钉51用其下侧压在压力元件的支腿38、39上,而不会接触插入的杆。因此,第一外螺钉可以通过将压力元件35压在头部23上而固定头部23的枢转位置。
第二内螺钉52作用在杆10上。为了能够与不同直径的杆形成接触,第二内螺钉在其面对杆的下侧包括突出部53,所述突出部例如是圆柱形的并且具有的直径小于压力元件的凹槽37的宽度。因此,突出部53触碰杆而不是压力元件35。突出部53是用于平衡不同杆直径的结构。通过紧固第二内螺钉52,可以与头部23无关地固定杆10。
在如图6和7中所示的组装和固定状态下,压力元件的基部40稍稍突出于接收部分的凹槽31的基部上方,从而杆10仍然置于压力元件的基部40中。
所述装置的使用类似于第一实施例,唯一的区别在于螺钉元件的枢转位置可以通过第一外螺钉和压力元件固定。压力元件的基部则用作预期直径在最大和最小可能直径之间的杆的基座。
图9a)-9c)示意性地示出直径递增的杆10、10′、10′′和10′′′的固定。在每种情况下杆在两个点上,或者当通过三维观察时在两条接触线上置于基部上。所述杆从上面被固定元件的内螺钉夹紧,所述内螺钉通过突出部53接触杆。因此,每根杆处于类似于三点夹紧的稳定夹紧位置。这允许使用在最大和最小可能直径之间的任何直径的杆。
图10a)-10c)示意性地示出直径递增的杆10、10′、10′′和10′′′的固定,其与第二实施例的区别在于压力元件和固定元件。压力元件60具有未延伸超出插入的杆的上表面的支腿61、62。固定元件70是采用定位螺钉形式的单件式固定元件,所述定位螺钉与根据第二实施例的接收部分25的内螺纹34配合。固定元件具有作用在杆上的突出部75。通过该实施例,头部23和杆10被同时固定。
图11a)和11b)分别示出基部11或40的形状的修改实施例。形成V形的侧壁不是平坦的而是弯曲的(curved)。在图11a中基部具有凹弯曲侧壁,在图11b)中基部具有凸弯曲侧壁。另外在该修改实施例中,杆沿两条接触线置于基部中。
可以对所述实施例进行修改。例如,在杆置于其中的基部和杆插入其中的凹槽的侧壁之间可以具有像台阶或倾斜表面之类的区域。
所述多轴螺钉示出为顶装螺钉,即螺钉元件从接收部分的第一端或顶部插入,但是所述多轴螺钉也可以被设计成底装螺钉,即螺钉元件可以从第二端即底部插入为此设计的接收部分中。
还可以想到颠倒的三条线固定,即两条线形成于固定元件的下侧,一个接触点或一条接触线形成于基部。还可以组合不同实施例的特征。
Claims (12)
1.一种锚固装置,用于将杆锚固到骨或椎骨中,并且用于与具有不同直径的至少两根杆一起使用,
所述锚固装置(1;20)具有锚杆(2;22)和用于连接到所述杆(10)之一的头部(4;25),
所述头部(4;25)连接到所述锚杆(2;22)并且具有凹槽(5;31),所述凹槽具有基部(11;40)和两个基本竖直延伸的支腿(6,7;32,33;38,39),所述支腿限定通道以用于在所述通道中接收所述杆,
和用于将所述杆(10)夹紧在所述通道中的固定元件(52;70),
其中所述固定元件和所述基部均具有接触所述杆的接触表面(11;40;53;73),所述接触表面成形为能够夹紧任何不同的杆。
2.根据权利要求1所述的锚固装置,其中所述接触表面(11;40;53;73)成形为使得能够沿三条接触线(P1;P2;P3)夹紧所述杆。
3.根据权利要求2所述的锚固装置,其中所述三条接触线中的两条接触线(P1;P2)位于所述基部中,而一条接触线(P3)位于所述固定元件处。
4.根据权利要求1-3之一所述的锚固装置,其中所述固定元件(52;70)在其面对杆的一侧具有突出部(53;73),所述突出部的尺寸制成为使得能够接触不同直径的杆。
5.根据权利要求1-4之一所述的锚固装置,其中所述基部(11;40)的横截面基本为V形。
6.根据权利要求5所述的锚固装置,其中形成V形的所述基部的侧壁是弯曲的。
7.根据权利要求1-6之一所述的锚固装置,其中所述接触表面(11;40;53;73)成形为使得能够以无级的方式夹紧具有不同直径的多根杆。
8.根据权利要求1-7之一所述的锚固装置,其中所述头部(4)和所述锚杆(2)单轴地连接。
9.根据权利要求1-7之一所述的锚固装置,其中所述锚杆(22)可枢转地连接到所述头部(25),并且设置压力元件(35),所述压力元件锁定所述锚杆相对于所述头部的角位置并且包括用于所述杆的基部(40)。
10.根据权利要求1-9之一所述的锚固装置,其中所述杆(10)具有基本为圆形的横截面。
11.根据权利要求1-10之一所述的锚固装置,其中所述元件由生物相容材料制成,所述生物相容材料例如生物相容金属或金属合金。
12.根据权利要求1-11之一所述的锚固装置,其中所述基部(11;40)包括用于在分别位于所述支腿两侧的两个区域中提供接触表面的内孔(14)。
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US1361807P | 2007-12-13 | 2007-12-13 | |
EP07024221.9 | 2007-12-13 | ||
EP07024221A EP2070485B1 (en) | 2007-12-13 | 2007-12-13 | Anchoring device for anchoring a rod in bones or vertebrae |
US61/013,618 | 2007-12-13 |
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CNA2008101795903A Division CN101455580A (zh) | 2007-12-13 | 2008-12-09 | 用于将杆锚固到骨或椎骨中的锚固装置 |
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CN201310697913.9A Pending CN103750891A (zh) | 2007-12-13 | 2008-12-09 | 用于将杆锚固到骨或椎骨中的锚固装置 |
CNA2008101795903A Pending CN101455580A (zh) | 2007-12-13 | 2008-12-09 | 用于将杆锚固到骨或椎骨中的锚固装置 |
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US (1) | US8257399B2 (zh) |
EP (1) | EP2070485B1 (zh) |
JP (1) | JP5220575B2 (zh) |
KR (1) | KR101197729B1 (zh) |
CN (3) | CN104605923B (zh) |
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CN104605923B (zh) | 2017-10-27 |
CN101455580A (zh) | 2009-06-17 |
JP5220575B2 (ja) | 2013-06-26 |
KR20090063112A (ko) | 2009-06-17 |
EP2070485A1 (en) | 2009-06-17 |
TW200924700A (en) | 2009-06-16 |
US8257399B2 (en) | 2012-09-04 |
CN104605923A (zh) | 2015-05-13 |
KR101197729B1 (ko) | 2012-11-05 |
TWI451857B (zh) | 2014-09-11 |
EP2070485B1 (en) | 2011-09-14 |
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Application publication date: 20140430 |