CN104271079B - 制逆脊椎装置 - Google Patents

制逆脊椎装置 Download PDF

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CN104271079B
CN104271079B CN201380005023.5A CN201380005023A CN104271079B CN 104271079 B CN104271079 B CN 104271079B CN 201380005023 A CN201380005023 A CN 201380005023A CN 104271079 B CN104271079 B CN 104271079B
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U·阿尔宁
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    • 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
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    • 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
    • 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
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages

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Abstract

一种脊椎装置(10)包括可变长度构件(12)，该可变长度构件包括制逆机构(14)，该制逆机构具有如下操作构造，所述操作构造允许可变长度构件(12)的长度在一个方向上发生变化，并且防止可变长度构件(12)的长度在相反方向上发生变化，其中所述可变长度构件(12)包括用于附接到骨的多轴接头附接构件(32)，这允许所述附接构件(32)绕一个以上的枢转轴线进行枢转运动，其特征在于，该脊椎装置还包括力施加器(40)，该力施加器操作为调整或推进所述制逆机构(14)。

Description

制逆脊椎装置
技术领域
本发明总体上涉及一种脊椎植入物和假体，并且尤其涉及一种具有制逆机构的脊椎植入物，例如具有允许以不同的自由度移动的接头的脊椎植入物，或具有用于控制制逆机构的力施加器的脊椎植入物。
背景技术
脊柱侧凸是一种影响很多人的脊柱畸形。当前的手术治疗包括通过椎弓根螺钉将长的融合杆加接至脊椎。杆系统的目的在于将变形的脊椎强制推到更为健康的位置。通常通过融合治疗的其他脊椎错位包括脊柱后凸过度和脊柱前凸过度。
作为融合的一种可替代方式，同一发明人的PCT专利申请PCT/US2011/035278描述了一种能够利用制逆机构被伸长或缩短的改进型脊椎装置。该装置具有可变长度构件，该构件能够利用合适的连接器连接至标准椎弓根螺钉以及连接至其它脊椎杆。
发明内容
本发明旨在提供一种进一步改进的脊椎装置。
在一个实施方式中，脊椎装置是能够利用制逆机构被伸长或缩短的脊椎杆的形式(术语杆或杆组件指的是一个或多个能共同起杆的作用的伸长部件，而并非必须具有圆柱形状但也可以是棒状或其他形状)。杆是一可变长度构件，其能够利用合适的连接器连接至标准椎弓根螺钉以及连接至其它的脊椎杆。可变长度构件还可直接连接至脊椎的骨元件或由该骨元件支撑。
在本发明的一个实施方式中，该装置可设定为三种不同的构造：
a.制逆机构发生作用，并且可变长度构件(杆)能够在一个方向上改变长度(伸长或缩短)。
b.制逆机构不发生作用，并且可变长度构件能够在与伸长和缩短方向对应的相反方向上移动。
c.锁定位置，其中可变长度构件的长度固定。
在本发明一实施方式中，对这些构造的选择可通过旋转组件的内部元件来完成。例如，内部元件的旋转可利用蜗轮机构来完成。该蜗轮可通过经皮手术由杆触发，或由诸如电动马达、磁体装置或本领域技术人员公知的其它手段之类的可植入机构来触发。
在本发明的另一实施方式中，可变长度构件可以具有刚度不同的两个部分。例如，可变长度构件可具有柔韧部(例如，当棘齿被构造成使得杆仅能缩短时)，例如柔性线缆、绳索、柔性机械接头和本领域技术人员公知的其它手段。
在本发明的另一实施方式中，有用的是在杆直接由脊椎的骨结构支撑时，靠着骨保持的钩可具有第二钩，以将所述钩固定到最优位置。
附图说明
结合附图，根据下面的详细描述可以更充分理解和领会本发明，其中：
图1是根据本发明的非限制性实施方式构造和操作的制逆脊椎装置的简化视图；
图2是图1所示的制逆脊椎装置的制逆机构的简化视图；
图3是可调整或推时图1的制逆脊椎装置的制逆机构的力施加器的简化视图；
图4是根据本发明的非限制性实施方式构造和操作的脊椎装置的简化视图，该脊椎装置包括用三个骨螺钉连接在三段椎骨之间的两个杆组件，其中具有允许多自由度移动的连接组件；
图5是根据本发明的实施方式的连接组件的一个优选实施方式的简化俯视图；
图6A是图5实施方式的简化剖视图；以及
图6B是图5实施方式的改进型式的简化剖视图。
具体实施方式
现在参考图1至图3，它们示出了根据本发明的非限制性实施方式构造和操作的制逆脊椎装置10。
制逆脊椎装置10包括可变长度构件12。在所示意的实施方式中，可变长度构件12为杆。术语“杆”包含任意尺寸和横截面形状的任何细长元件，诸如但不限于杆、棒、线等。
如PCT专利申请PCT/US2011/035278中类似描述的，脊椎装置10包括制逆机构14(图2)，该制逆机构14具有如下操作构造：该构造允许可变长度构件12的长度在一个方向上发生变化，并且防止可变长度构件12的长度在相反方向上发生变化。制逆机构14具有：沿着可变长度构件12的轴向部分形成的制逆齿16(图3；也称为棘条16)；以及掣爪18(图2和图3)，该掣爪布置成卡合在所述制逆齿16中的一个齿上。掣爪18从绕枢轴22(图2)安装并设有偏心凸轮24(图2和图3)的控制元件20(图2)延伸。偏心凸轮24的旋转使掣爪18移向三个位置中的一个位置：a)与齿16制逆接合使得可变长度构件12能够在一个方向上增量移动；b)与齿16锁定接合使得可变长度构件12完全不能移动；以及c)脱出与齿16的接合使得可变长度构件12能够在两个方向上自由移动。
如图1可见的，可变长度构件12的一端23布置成沿线性移动穿过形成在外壳30中的孔28。可变长度构件12包括两个多轴接头附接构件32。使用两个多轴接头附接构件32将装置10附接到脊椎的可用骨结构上。
与PCT专利申请PCT/US2011/035278不同的是，在本发明中，脊椎装置10包括一力施加器40来控制制逆机构14。力施加器40包括但不限于具有齿44的凸轮42(图3)。图2中示出了凸轮42的头部46(例如六角头)；为简便起见，图3中未示出头部46。通过利用合适工具(例如扳手(未示出))沿图3的顺时针方向转动头部46，凸轮42的齿44强有力地移动棘条16(图3的情况下向上)，使得供掣爪18接合的齿从脱出与掣爪18的接合，并且棘条16的下一个较低齿移动成与掣爪18接合。由此，力施加器40调整或推进制逆机构14。
现在参照图4，其示出了根据本发明的一实施方式的脊椎装置50。
在所示的实施方式中，脊椎装置50包括两个杆组件52，这两个杆组件52利用三个骨螺钉54连接在三段椎骨49之间。杆组件52可以被构造成但不限于制逆脊椎装置10或其他脊椎装置。连接器组件56形成杆组件52之间的接头连接。如以下将描述的，连接器组件56允许杆组件52(例如可变长度构件12)的多自由度移动。
要注意的是，由于该系统的设计是模块化的，因此可以选择任意数量的椎骨。也要注意的是，两个杆组件52的中间接头连接不必连接到任何椎骨，意味着根据使用可以跳过一个或多个椎骨。在画出的图中，骨螺钉54插入到椎弓根中，但可采用其他插入位置。
现在参见图5和图6A，它们示出了根据本发明一实施方式的连接器组件56的优选实施方式。
连接器组件56包括具有头部60的栓件58(例如中央螺栓)，其穿过形成于第一铰链构件62和第二铰链构件64中的孔，第二铰链构件可以位于第一铰链构件62的顶部或与其相邻。每个铰链构件都形成有接收器66(图6A)，该接收器用于在其中接收枢轴销68(图5)。其中一个枢轴销68以枢转的方式接收于其中一个杆组件52的端部70中，另一个枢轴销68以枢转的方式接收于另一个杆组件52的端部72中(图5)。因此相邻的杆组件52可以通过连接器组件56相对于彼此枢转。锁定元件74(例如螺母)确保销68就位(图6A)。另一个锁定元件76(例如螺母)旋于螺栓58的一端上以完成组件(图6A)。
图6B示出了图6A实施方式的变型。相同的元件用相同的数字标记。主要不同是锁定元件74的形状，并且第一铰链构件62的接收器66具有一闭合孔而不是图6A所示的开口孔。在发明范围内的其他变化也是可能的。
连接器组件56允许杆组件52的多自由度移动。绕中央螺栓58的纵轴以及独立地绕每个销68的纵轴(其垂直于中央螺栓58的纵轴)的旋转都是允许的。

Claims (4)

1.一种脊椎装置(10)，该脊椎装置包括：
可变长度构件(12)，该可变长度构件包括制逆机构(14)，该制逆机构具有如下操作构造，该操作构造允许所述可变长度构件(12)的长度在一个方向上发生变化，并且防止所述可变长度构件(12)的长度在相反方向上发生变化，其中，所述可变长度构件(12)包括用于附接到骨的多轴接头附接构件(32)，所述附接构件(32)允许所述附接构件(32)绕一个以上的枢转轴线进行枢转运动，
其特征在于，该脊椎装置还包括力施加器(40)，该力施加器操作为推进所述制逆机构(14)，其中，所述力施加器(40)包括具有齿(44)的凸轮(42)，所述齿与所述制逆机构(14)的棘条(16)接合。
2.一种脊椎装置(50)，该脊椎装置包括：
一对杆组件(52)，每个杆组件包括：
可变长度构件(12)，该可变长度构件包括制逆机构(14)，该制逆机构具有如下操作构造，该操作构造允许所述可变长度构件(12)的长度在一个方向上发生变化，并且防止所述可变长度构件(12)的长度在相反方向上发生变化，其中，所述可变长度构件(12)包括用于附接到骨的多轴接头附接构件(32)，所述附接构件(32)允许所述附接构件(32)绕一个以上的枢转轴线进行枢转运动；以及
力施加器(40)，该力施加器操作为推进所述制逆机构(14)，其中，所述力施加器(40)包括具有齿(44)的凸轮(42)，所述齿与所述制逆机构(14)的棘条(16)接合；和
一个连接器组件(56)，该连接器组件在所述杆组件(52)之间形成接头连接，以允许所述杆组件(52)进行多自由度移动。
3.根据权利要求2所述的脊椎装置(50)，其中，所述连接器组件(56)包括：栓件(58)，该栓件穿过第一铰链构件(62)和与所述第一铰链构件(62)相邻的第二铰链构件(64)；以及枢轴销(68)，该枢轴销将所述杆组件(52)以枢转的方式连接于所述第一铰链构件(62)和所述第二铰链构件(64)。
4.根据权利要求3所述的脊椎装置(50)，其中，所述连接器组件(56)允许绕所述栓件(58)的纵轴以及独立地绕每个枢轴销(68)的纵轴进行旋转，所述枢轴销(68)的纵轴垂直于所述栓件(58)的纵轴。
CN201380005023.5A 2012-01-09 2013-01-07 制逆脊椎装置 Active CN104271079B (zh)

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US201261631667P 2012-01-09 2012-01-09
US61/631,667 2012-01-09
US201261690835P 2012-07-06 2012-07-06
US61/690,835 2012-07-06
US201261743418P 2012-09-04 2012-09-04
US61/743,418 2012-09-04
PCT/US2013/020453 WO2013106262A2 (en) 2012-01-09 2013-01-07 Ratcheted spinal devices

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US20140330387A1 (en) 2014-11-06
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CN104271079A (zh) 2015-01-07
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