CN105208975A - 椎骨植入物、植入物的椎骨紧固装置和植入物器械 - Google Patents

椎骨植入物、植入物的椎骨紧固装置和植入物器械 Download PDF

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Publication number
CN105208975A
CN105208975A CN201480028167.7A CN201480028167A CN105208975A CN 105208975 A CN105208975 A CN 105208975A CN 201480028167 A CN201480028167 A CN 201480028167A CN 105208975 A CN105208975 A CN 105208975A
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China
Prior art keywords
implant
vertebral
plate
clamp device
vertical axis
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CN201480028167.7A
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Inventor
H·丹维尔
S·勒奎特
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LDR Medical SAS
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LDR Medical SAS
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Publication of CN105208975A publication Critical patent/CN105208975A/zh
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Abstract

本公开提供椎骨植入物、用于椎骨植入物的紧固装置和植入物器械以及其各种结合。在一些实施例中,植入物包括根据竖直轴线在该植入物的上表面与下表面之间延伸的外围壁,其中每个这样的表面被配置为在由该植入物替代的椎骨节段的顶部和底部处分别置于与椎骨结构接触。一些实施例包括紧固装置,其部署将植入物锚固在下椎骨结构和上椎骨结构中。一些紧固装置可以通过平行于植入物的竖直轴线滑动来部署、并且可以包括具有在部署时保持与植入物的外围壁接触的至少一个部分的板以及从植入物的上表面和下表面之一突出以在部署完成时进入椎骨结构的尖端末端。

Description

椎骨植入物、植入物的椎骨紧固装置和植入物器械
本申请要求2013年5月16日在法国提交的法国专利申请号FR13/54421的优先权,该申请通过引用被并入本文。
技术领域
本公开涉及被设计为替代椎骨节段、也就是说替代至少一个椎骨体和/或至少一个椎间盘的全部或部分的椎骨植入物,具体而言是椎体切除保持架(corpectomycage)或躯干重建保持架(intersomaticcage)的领域。本公开更具体地涉及椎骨植入物(具体是椎体切除)、这种植入物的至少一种椎骨紧固装置和植入物器械。
背景技术
在椎骨植入物的领域和尤其是椎体切除保持架的领域中的问题涉及能够替代椎骨节段的植入物的部署(deployment)对于椎体切除保持架而言有时在尺寸上、至少在高度上太大,由于椎骨节段能够对应于至少一个椎骨体/或至少一个椎间盘的任何或部分。事实上,一些病症,尤其是癌症情况导致(部分或整体的)椎骨体和/或椎间盘的恶化。有必要通过可观高度的植入物来替代受损的(一个或多个)椎骨节段。而且,经常优选的是,能够在外科手术的过程中调整植入物的高度,由于受损结构的切除总体上需要将椎骨撑开牵引以对被治疗的椎骨节段重建生理上(或至少病理上)的高度并且这种高度随着损伤程度的变化而变化(以将植入物插入在健康组织之间)。
与植入物的高度的问题相关的问题涉及植入物相对于在其被插入的椎骨结构之间的椎骨结构的稳定性。必要的撑开牵引经常与很多稳定性技术方案不相容,例如在植入物的接触表面上的槽口,这是由于这些槽口需要对植入物的插入制造附加的撑开牵引。而且,锚固注入物对简单的槽口通常是优选的,这些简单的槽口通常仅限制运动的风险但不能保证可靠的固定。
从现有技术中已知的尤其是对于原位椎体切除(如可膨胀保持架)的解决方案通常包括主体,该主体包括提供椎骨接触表面并且一旦植入物被插入椎骨之间就促进植入物的高度的移动元件。这些解决方案的缺点是基于往往使植入物和/或椎骨变脆的通常复杂且昂贵的机构,由于由植入物在其膨胀过程中实现的撑开牵引经常没有测试施加的作用力(使得植入物有时凹陷在椎骨中)。而且,它们经常提供减小的移植物空间,不允许附加的骨移植或适当替代件。而且,这些解决方案具有较低的膨胀比(1/3)并且因此通常需要经压缩的植入物已经具有足够大的尺寸,使得当它膨胀时其尺寸是令人满意的,并且这些保持器的设计经常意味着释放撑开牵引以允许它们被插入到椎骨节段中。最终,这种类型的可膨胀保持器经常与用于稳定性的槽口或齿状物不相容(由于后者减少了实际撑开牵引、损伤定位和脆化相邻椎骨结构的风险的能力)和/或与锚固不相容(由于保持器通常不提供使锚固装置固位的足够宽的结构)。而且,要将经由螺钉来锚固到位能够证明是难以得到的并且需要一种过度侵入的方法。
经常联系至现有技术解决方案的缺点的最后的问题涉及通常是不可能或困难的植入物的切除。
在此背景下,感兴趣的是提出了植入物的各种实施例,该植入物可以是容易植入的、稳健且可靠的、可适于不同的尺寸、限制脆化相邻椎骨结构的风险、在椎骨主体中提供了方便的切除和锚固而不损害最终定位并且无需撑开牵引,这些优于插入植入物所要求的。
发明内容
本公开的各种实施例被配置为通过提出一种椎骨植入物(具体是椎体切除)来消除或减少在上文中所公开的现有技术或在领域本身的至少一个缺点,该椎骨植入物容易植入且可靠地固定到与替代椎骨节段相邻的椎骨结构。
这个目标由一种椎骨植入物(例如,用于椎体切除)来实现,该椎骨植入物包括其尺寸适于替代至少一个椎骨节段的至少一个主体,该植入物包括外围壁并且根据竖直轴线在该植入物的上表面与下表面之间延伸,该上表面和该下表面各自被设计为在由该植入物替代的椎骨节段的顶部和底部处分别置于与椎骨结构接触,并且包括紧固装置,其部署能够将该植入物锚固在所述下椎骨结构和上椎骨结构中,所述紧固装置中每个通过平行于该植入物的竖直轴线滑动来部署并且包括:一方面,至少一个板,该至少一个板的至少一个部分在部署完成时保持与该植入物的外围壁接触;以及在另一方面,至少一个尖端末端,该至少一个尖端末端从该植入物的上表面和下表面之一突出以在部署完成时进入所述椎骨结构之一。
这个目标还由一种椎骨植入物(具体用于椎体切除)来实现,该椎骨植入物包括具有尺寸适于替代至少一个椎骨节段的至少一个主体,该植入物包括外围壁并且根据竖直轴线在该植入物的上表面与下表面之间延伸,该上表面和该下表面各自被设计为在由该植入物替代的椎骨节段的顶部和底部处分别置于与椎骨结构接触,进一步包括紧固装置,其部署确保了该植入物锚固在所述下椎骨结构和上椎骨结构中,所述紧固装置中的每个通过在该植入物里面根据曲线轨迹通过在该外围壁的外部与该植入物的上表面或下表面之一之间的通道滑动来部署,并且包括:一方面,至少一个弧形板,该至少一个弧形板的至少一个后部在部署完成时保持在该通道里面;以及在另一方面,至少一个尖端末端,该至少一个尖端末端从该植入物的上表面和下表面之一突出以在部署完成时进入所述椎骨结构之一。
而且,一些实施例的目标之一是提出一种可靠并且易于使用的紧固装置。
这个目标可以由一种用于椎骨植入物的椎骨紧固装置来实现,该装置被设计为通过在该植入物的外围壁的外部与该植入物与椎骨结构接触的上表面或下表面之一之间的通道从脊椎的周边插入,该装置包括主体,该主体包括至少一个弧形板,其是刚性的并且根据纵轴线在前端与后端之间延伸成细长的,该板被配置为使得其前端借助于至少一个尖端末端进入椎骨结构而其后端保持在该植入物的该通道中,其中,该板一方面在该板的平面中是弧形的并且具有凸侧向边缘、凹侧向边缘和两个大体平坦面,并且在另一面被配备有多个槽口,这些槽口被安排为在该植入物的通道的壁中与自身接合并且当所述尖端末端进入所述椎骨结构时使该紧固装置固定在该植入物中。
本公开的各个实施例的其他特定特征和优点在以下说明书中详细描述。
附图说明
本公开的各个实施例的其他特定特征和优点将通过参考附图给出的、在本文以下描述表现得更加清楚,在附图中:
-图1A示出了根据一些实施例配备有紧固装置的植入物的透视图,图1B、图1C和图1D分别示出了图1A的紧固装置的轮廓图、前视图和透视图,
-图2A和图2B分别示出了根据一些实施例配备有紧固装置的植入物的前视图和透视图,图2C和图2D分别示出了这个相同植入物在组装有模块式主体之前和单独(不带模块式主体)的透视图,
-图3A和图3B分别示出了根据一些实施例配备有紧固装置的植入物的前视图和透视图,图3C示出了这个相同植入物在组装有多个椎骨接触板之前的透视图,
-图4A和图4B分别示出了根据一些实施例配备有紧固装置的植入物的前视图和透视图,图4C示出了这个相同植入物在组装有两个模块式主体之前的透视图,
-图5A和图5B分别示出了根据一些实施例配备有紧固装置的植入物的前视图和透视图,图5C示出了这个相同植入物在组装有两个模块式主体之前的透视图并且图5D示出了被单独组装的两个模块式主体透视图,
-图6A、图6B、图6C、图6D和图6E示出了根据不同实施例配备有紧固装置的植入物的透视图,
-图7A和图7C分别示出了根据一些实施例配备有紧固装置的植入物的前视图和透视图,图7D和图7F分别示出了根据另一些实施例配备有紧固装置的植入物的前视图和透视图,并且图7B和图7E分别示出了在图7A和图7C或者图7D和图7F中的植入物的紧固装置的轮廓图和透视图,
-图8A和图8B分别示出了根据一些实施例的植入物在插入紧固装置之后和之前的一方面的剖视图,图8C和图8D分别示出了根据另一些实施例的植入物在插入紧固装置之后和之前的另一方面的剖视图,
-图9A、图9B、图9C和图9D示出了根据不同实施例的紧固装置的轮廓图,
-图10A和图10B分别示出了根据一些实施例的紧固装置的轮廓图和植入物在这些紧固装置的预组装之后的一方面的剖视图,图10C和图10D分别示出了根据另一些实施例的紧固装置的轮廓图和植入物在这些紧固装置的预组装之后的另一方面的剖视图,
-图11A和图11B分别示出了根据一些实施例的紧固装置的轮廓图和前视图,图11C、图11D和图11E分别示出了根据另一些实施例的紧固装置的仰视图、轮廓图和透视图,
-图12A和图12B分别示出了根据一些实施例的紧固装置的轮廓图和透视图,图12C、图12D和图12E分别示出了根据另一些实施例的紧固装置的仰视图、轮廓图和透视图,
-图13A、图13B和图13C分别示出了根据一些实施例的紧固装置的轮廓图、前视图和透视图,
-图14A、图14B和图14C分别示出了根据一些实施例的紧固装置的轮廓图、透视图和平面图,
-图15A示出了根据一些实施例配备有紧固装置的植入物的透视图,图15B和图15C分别示出了在这个相同植入物配备有紧固装置的一方面的根据图15B的截面平面15C-15C的前视图和剖视图,图15D和图15E分别示出了根据这些实施例的紧固装置的仰视图和透视图,
-图16A示出了根据一些实施例配备有紧固装置的植入物的透视图,图15B和图15C分别示出了根据这些实施例的紧固装置的轮廓图和透视图,
-图17A和图17B分别示出了配备有紧固装置的植入物的透视图和仅紧固装置的透视图,图17C示出了根据一些实施例的这些紧固装置的轮廓图,并且图17D和图17E分别示出了根据另一些实施例的紧固装置的平面图和透视图,
-图18A和图18B分别示出了根据一些实施例的紧固装置的轮廓图和透视图,图18C、图18D和图18E分别示出了根据另一些实施例的紧固装置的轮廓图、平面图和透视图,
-图19A、图19B、图19C和图19D分别示出了根据一些实施例配备有紧固装置的植入物的透视图和仅紧固装置的透视图,图19E示出了这些紧固装置的变体的透视图,
-图20A、图20B、图20C和图20D分别示出了根据一些实施例的植入物和在部署之后、在借助于间隔物完成部署时、在借助于触针(stylus)部署之前和在借助于紧固装置的触针完成部署时部署该植入物的紧固装置的透视图,
-图21A、图21B、图21C和图21D分别示出了根据一些实施例的植入物和在部署之后、在借助于触针完成部署时、在借助于间隔物部署之前和在借助于间隔物完成部署时部署该植入物的紧固装置的透视图,
-图22A、图22B、图22C和图22D分别示出了根据一些实施例的植入物和在部署之后、在组装之前、在借助于双触针部署之前和在借助于双触针完成部署时部署该植入物的紧固装置的透视图,
-图23A、图23B、图23C和图23D分别示出了根据一些实施例的植入物和在部署之后、在组装之前、在借助于间隔物部署的过程中和在借助于间隔物完成部署时部署该植入物的紧固装置的透视图,
-图24A和24B分别示出了根据一些实施例配备有紧固装置的植入物的前视图和透视图,图24C示出了在部署该相同植入物的紧固装置的过程中的这个相同植入物,图24D和图24E分别示出了图24A、图24B和图24C的紧固装置的前视图和透视图,
-图25A、图25B和图25C分别示出了根据一些实施例的植入物和在分别利用双间隔物、双触针和撞击器部署紧固装置的过程中部署该植入物的紧固装置的透视图,图25D示出了图25C的实施例的仅紧固装置,
-图26A和图26E示出了根据一些实施例的植入物和插入这些植入物的间隔物的透视图,图26B示出了图26A的植入物的透视图并且图26C和图26D分别示出了图26A和图26B的植入物的插入间隔物的轮廓图和透视图,
-图27A、图27B、图27C和图27D分别示出了根据一些实施例的植入物和在插入紧固装置之后、在由植入物夹持器夹持植入物的过程中部署之前、在由撞击器部署的过程中和在部署之后部署该植入物的紧固装置的透视图,
-图28A、图28B、图28C、图28D和图28E示出了根据不同实施例配备有其紧固装置和椎骨接触板的植入物的透视图,
-图29A、图29B和图29C示出了根据不同实施例配备有其紧固装置、椎骨接触板和椎骨适配支架(tray)的植入物的透视图,
-图30A和图30B分别示出了根据一些实施例的植入物和在部署之后和部署过程中部署该植入物的紧固装置的透视图,图30C和图30D分别示出了植入物和在部署之后和部署过程中部署该植入物的紧固装置的透视图,
-图31A示出了根据一些实施例配备有紧固装置的植入物的透视图,图31B、图31C和图31D分别示出了图31A的植入物的紧固装置的透视图、轮廓图和前视图,
-图32A示出了图31B、图31C和图31D中由切除钳夹持的固定装置的平面图,图32B是由图32A的圆圈指示的部分32B的放大图。
具体实施方式
本公开涉及椎骨植入物,尤其用于执行椎体切除,也就是说切除椎骨节段并且插入植入物以替代被移除的组织。本公开还涉及植入物的至少一种紧固装置,该至少一种紧固装置总体上并且尤其是(尽管并不只是)在本申请中所指定的类型。这些固定装置在本申请中还由术语“锚固”或“锚定”或甚至“紧固装置”来指定。本公开还涉及用于插入植入物(可以包括在本申请中所描述的类型)的植入物器械以及用于由例如那些在本申请中所公开的紧固装置来固定植入物的器械。术语“椎骨节段”在本说明书中以其可接受的形式用于代表“脊椎的一部分”,因为它能够对应于至少一个椎骨体和/或至少一个椎间盘的全部或部分。事实上,椎体切除能够涉及至少一个完整椎骨体,或甚至整个椎骨及其邻近椎间盘,但还能够涉及椎骨体的仅一部分或若干椎骨体的全部或部分,以及邻近椎间盘中的至少一个的至少一部分。例如,尤其在癌性病症的情况下,仅能够部分地触及椎骨体并且能够通过保存健康部分以容纳植入物而有利。所以,本说明书的各个实施例被配置为将植入物固定在“椎骨结构”中并且这个术语在本说明书中以其可接受的方式用于代表“组成脊椎的至少一个元件的至少一部分”,因为它能够对应于至少一个椎骨体和/或至少一个椎间盘的全部或部分。在上文中所规定的术语和在本说明书中使用的所有术语因此必须不能被解释为限制,并且很明显本申请总体上是赋予所描述的元件和特点的功能性定义。例如,术语“椎骨植入物”被用于表示该植入物能够涉及椎骨节段的事实,也就是说至少一个椎骨体和/或至少一个椎间盘。因此植入物能够对应于椎体切除保持架还对应于例如躯干重建保持架。而且,用于固定在“椎骨结构”中的椎骨固定装置能够被用于固定各种类型的椎骨植入物,尤其是椎体切除保持架、躯干重建保持架、椎间盘假体或接骨板等。
一些实施例的植入物优选地由PEEK(聚醚醚酮)制成,PEEK具有接近骨组织的那些物理性质的物理性质(尤其是刚度)并且改善了手术后放射位置追踪(与由钛或其他金属或可能产生MRI闪光的合金制成的植入物相对,这种植入物由用于关节融合术的植入物经常伴随有接骨板的事实而恶化)。然而,固定装置优选地由金属或生物相容的合金(例如钛)制成以确保实质的阻力,但是其他材料也是可能的。
关于植入,用于放置植入物的各种途径方法都是可能的,甚至用于各个脊柱阶段的每个的给定方法通常是优选的。例如(非限制性的),用于颈椎的前正中微创术(MIS,针对微创脊柱手术)和用于胸部或腰椎的侧向或前外侧微创术方法可以是优选的。
优选地,具体在躯干重建保持架或椎体切除的情况下,借助于从所述上表面延伸远至所述下表面的至少一个开口,植入物是中空的,如具体在非限制性地展示了椎体切除保持架的大多数附图中是可见的。这种植入物在其表面之间的开口与邻近于替代椎骨节段的椎骨结构接触确保了在植入物(1)里面的粘固剂的插入和/或骨质生长并且为了加入骨移植物或替代件的连续移植物提供了宽的空间以将在其上手术的椎骨节段固结。粘固剂的插入还能够锁定组成植入物的各个主体。因此,在一些实施例中,如在多数附图中所示的,外围壁包括至少一个导管(15)以允许插入移植物和/或在植入物中的骨质替代件,以用于通过植入物的开口使骨质更容易生长。而且,通常提供的是,植入物的不同元件和紧固装置也提供这种开口。例如,在图21的实施例中,紧固装置板(52)配备有至少一个孔(53),从而就椎骨结构而言确保了植入物(1)的开口的连续性。
通常,一些实施例优选地包括至少一个椎骨植入物(1),裤头是椎体切除,该至少一个椎骨植入物包括至少一个主体(10、11、3、3m、3f),该至少一个主体(10、11、3、3m、3f)具有适于替代至少一个椎骨节段的尺寸。这个植入物(1)通常包括外围壁并且根据竖直轴线在植入物(1)的上表面和下表面之间延伸,该上表面和该下表面各自被设计为在由植入物(1)替代的椎骨节段的顶部和底部处分别置于与椎骨结构接触。该外围壁优选的包括用于植入物器械的挂接装置(14、34)。借助于优点,植入物(1)包括紧固装置(2、2a、5、8)或与紧固装置(2、2a、5、8)关联,该紧固装置的部署确保了该植入物锚固在所述下椎骨结构和上椎骨结构中。为了消除现有技术中的至少一个缺点,所述紧固装置(2、2a、5、8)中的每个通过沿植入物(1)的至少一部分滑动来部署。在各种实施例中,这些紧固装置(2、2a、5、8)通过在该植入物里面或围绕该植入物的外围滑动来部署。而且,在下文中详细描述及展示了其各自优点的各个实施例中,这些紧固装置(2、2a、5、8)根据平行于竖直轴线的直线轨迹(进而当植入物被放置在被治疗的椎骨节段中时大体平行于脊椎的轴线)或根据曲线轨迹来滑动,优选的通过在外围壁的外部与植入物(1)的上表面或下表面之一之间的通道(12)。最后,如在下文中详细描述的各个有利实施例中,这些紧固装置(2、2a、5、8)优选地包括至少一个板(20、52、82),其至少一个部分在部署完成时保持与植入物(1)接触以确保适当的固定稳定性。而且,如在下文中详细描述的各个有利实施例中,这些紧固装置(2、2a、5、8)通常包括从植入物(1)的上表面和下表面之一突出的至少一个尖端末端(21、51、81),从而在部署完成时进入所述椎骨结构之一。优选地,提供了若干尖端末端,以借助于若干固定尖端来确保更好的稳定性。最后,在一些实施例中,紧固装置穿透椎骨结构的那些部分优选地包括板的多个部分,其宽度提供运动(患者的运动可能会对植入物具有冲击)的阻力,从而确保了在脊椎中的良好稳定性(优于由具有较少实质范围的部分所允许的稳定性,例如尖端或钉状物)。总体上对在被治疗的椎骨节段上的上椎骨结构和下椎骨结构中的每个提供了至少一个固定装置(2、2a、5、8),如在多数附图中所示的,但有可能仅在这些椎骨结构之一上固定植入物。而且,清楚的是,能够根据本申请的实施例提供的紧固装置对于这两个椎骨结构而言可以是不同的或者甚至至少一个固定装置与本申请的那些固定装置不同。明显的是,紧固装置大体上是刚性的,例如由金属或合金制成以获得良好的稳定性,即使在一些实施例中提供了锚定件的一部分是弯曲的可能性(在这种情况中,这是允许限制弯曲而非材料的具体安排)。
植入物
植入物包括具有适于替代被治疗的椎骨节段的尺寸的至少一个主体(10、11、3、3m、3f)。植入物的大体形式能够根据各种构型的变化而变化并且因此不必要详细描述它,除非它限定竖直轴线(在这里为了更简便表示为平行于脊椎的轴线)。而且,主体可以具有借助于非平行上表面和下表面强加或矫正脊柱弯曲的形式。
在一些实施例中,植入物(1)包括若干主体(10、11、3、3m、3f),所述若干主体彼此互补并且沿竖直轴线可堆叠以使植入物(1)的高度适于待替代的椎骨节段的尺寸;这还使覆盖可能整个范围的高度所必须的植入物的数目最小化。这些主体能够被叠套在一起,或甚至被锁定以确保组件的适当凝聚力。这些主体还能够包括用于器械的挂接装置(14、34)。各种形式的螺栓连接是可能的,例如燕尾榫、螺纹和攻丝、直齿或与互补壳体配合的凸出部等,但是如果凸凹嵌套被提供在足够的高度上,则不强制将这些主体锁定在一起,以便它们在(具体来自病人的)运动过程中不分离。事实上,在椎骨水平下具有非常小范围的运动并且由于凸凹元件而使两个主体适配在一起的凸凹元件必须只具有大于用来确保组件的良好稳定性的这个幅度的尺寸(在竖直方向上)。
在一些实施例中(其说明性且非限制性的示例在图2A至图2D中示出),植入物(1)包括主要主体(10),该主要主体能够单独使用或者与和主要主体(10)的上表面或下表面中至少一个互补的附加主体(11)结合使用,所述附加主体(11)包括用于与主要主体(10)适配的装置(110、111)和相对于该附加主体滑动以进入所述椎骨结构之一的紧固装置(2、2a、5、8)。
在一些实施例中(其说明性且非限制性的示例在图3A至图3C、图4A至图4C和图5A至图5D中示出),植入物(1)包括两个附加主体(3、3m、3f)。在这些实施例的一些中,附加主体(3)形成被安排在植入物的上表面和下表面上的支架(平顶或末端构件),例如在图3(A至C)中所示的。在这些示例中,植入物的主体在其下表面和上表面包括用于承载(takeup)这些支架的装配装置(13),所述装配装置包括互补型装配装置(33)(在图3C中所示的凸凹(male-female)构型很明显地能够颠倒)。这种支架能够用作解剖适配元件以采取椎骨结构和/或强加或矫正脊椎弯曲的形式,例如在图28(A至E)中所示的矫正支架(C)。一些支架(C)还增大椎骨接触表面,例如在图28E中明显看出的。这些支架能够例如包括配备有唇缘(C1)的板(C3),该唇缘具有适于容纳植入物的外围的尺寸,但是也能够提供上文或下文中所描述的那些类型的装配装置(类似地,附加主体的装配装置能够与这些唇缘具有相同类型)。在这些支架(C)的一些实施例中,孔(C2)被提供用于紧固装置的通道,使得通过抵靠椎骨结构而被锁定的支架(C)来实现椎骨锚固。能够在紧固装置上可选地提供足够长的尖端末端(51、21)以穿过支架甚至其最厚的部分。这种附加主体(3)能够包括用于植入物的紧固装置(2、2a、5、8)的至少一个通道(32),诸如例如在图3C中非限制性地展示的,或能够包括用于承载紧固装置的结构(例如壳体(32)或通道),例如在图4和图5中非限制性地展示的。在一些实施例中,例如在图4C中,两个附加主体(3)是完全相同的(这提供了限制产品成本的优点),并且(经由装配装置)与主要主体互补。以此方式,附加主体(3)的凹形装配装置(31)例如接收主要主体(10)的凸形装配装置(13),或反之亦然。明显的是,能够提供互补混合型(凸形和凹形)装配装置以可置换地使若干主体彼此堆叠。而且,除了装配装置,通常提供了足够的支撑表面(133)使得主体稳定地彼此依靠放置。还明显的是,主体尤其在其装配装置上的主体能够包括切口(130、335)使得不影响植入物的其他装置的功能,如例如在图4C中所明显显示的。在一些植入物的高度适于被治疗的椎骨节段的尺寸的具体有利的实施例中,提供附加主体(3m、3f),所述附加主体中的每个能够用于与植入物(1)的主要主体(10)结合使用和/或彼此互补并在主要主体(10)不存在的情况下彼此结合地单独使用,诸如例如在图5D中所展示的。在这种模式下,如在图5C中尤其明显的,主要主体(10)包括例如在其下表面或上表面之一上的凸形装配装置(13)和在另一个表面上的凹形装配装置。所以,具有凸形装配装置(33)的附加主体(3m)与主要主体(10)或其他附加主体(3f)的凹形装配装置配合,其凹形装配装置也能够与主要主体(10)的凸形装配装置(13)配合。因此,可能的是,使用单一附加主体(3f)与主要主体(10)结合、或者两个附加主体(3m、3f)一起、或者两个附加主体(3m、3f)与主要主体(10)结合。明显的是,在图2至图5中所展示的主要主体和附加主体展示了在一些紧固装置的情况下的各种可能性,但是清楚的是,这些展示并非限制性的并且各种实施例可以使用不同或附加的主体。事实上,主要主体能够在其上表面与下表面之间、具体在接收紧固装置的元件之间被分离(或可分离)为两部分,因此一个或更多个附加主体能够例如借助于在图5C中所示的那些类型的装配装置被叠套在这两个分离部分之间。
在一些实施例中,具体有利的是,在椎骨结构展现出强的不规律性时(例如因为在外科手术过程中没有移除整个椎骨体),植入物能够包括例如在图29(A至C)中所展示的附加适配元件(D、E)。例如,能够将覆盖椎骨接触表面一半的楔形(D)或覆盖椎骨接触表面四分之一的楔形(E)或覆盖接触表面任何值的任何楔形添加到植入物上,直接添加到其下表面或上表面、或添加到(如图29A至图29C中的)适配或矫正支架(C)、或添加到附加主体。
锚固
一些实施例(其说明性且非限制性的示例在图20至图25中示出)涉及一种椎骨植入物(1),具体是用于椎体切除,包括具有适于替代至少一个椎骨节段的尺寸的至少一个主体(10、11、3、3m、3f),植入物(1)包括外围壁并且根据竖直轴线在植入物(1)的上表面与下表面之间延伸,该上表面与该下表面各自被设计为在由植入物(1)替代的椎骨节段的顶部和底部处分别置于与一个椎骨结构接触。这种类型的植入物包括紧固装置(5、8),该紧固装置的部署确保将植入物锚固在所述下椎骨结构和上椎骨结构中,所述紧固装置(5、8)中的每个通过平行于植入物(1)的竖直轴线滑动来部署。这些紧固装置(5、8)包括:一方面,至少一个板(52、82),该至少一个板的至少一个部分在部署完成时保持与植入物(1)接触;以及另一方面,至少一个尖端末端(51、81),该至少一个尖端末端从植入物(1)的上表面和下表面之一突出以在部署完成时进入所述椎骨结构之一。
在这些实施例的一些中(其说明性且非限制性的示例在图20和图21中示出),紧固装置(5)平行于竖直轴线滑动到植入物(1)的外围壁里面。例如,在图20(A至D)中所示的一些实施例中,紧固装置(5)的所述板(52)被安排在植入物里面、垂直于竖直轴线的平面中,并且配备有根据竖直轴线定向的至少一个尖端(51)。这种类型的锚固例如经由在植入物(1)的外围壁中的至少一个壳体(56)垂直于竖直轴线被插入在植入物(1)中,所述壳体(56)具有与板(52)的宽度互补的宽度以及与紧固装置(5)的高度至少相等的高度。这个壳体(56)经由接收所述尖端(51)的至少一个孔而终止在植入物(1)的下表面或上表面中的一个处,使得该尖端(51)通过在该下表面或该上表面中的这个孔穿透所述椎骨结构之一。总体上,提供若干尖端(51),例如在图20(A、B和D)中所示的四个尖端。板(52)具有大体矩形的形式例如尖端(51)垂直于板(52)的平面安排在该大体矩形的形式上。该板在部署期间被竖直引导平移到壳体(56)里面。总体上为在被治疗的椎骨节段上的上椎骨结构和下椎骨结构中每个提供了至少一个固定装置(5)。如例如借助于在图20B中的图示所示出的,能够借助于间隔物(6)来实施这种部署,该间隔物的支部(65)被各自插入到植入物(1)的两个上壳体和下壳体(56)之一中以同时推动这两个紧固装置。如例如借助于在图20C和图20D中的图示所示出的,能够借助于至少一个触针(7)来实施这种部署,该至少一个触针的末端(75)逐渐变尖,使得当它被进一步插入到壳体(56)中时,它将板(52)在椎骨结构朝向紧固装置(5)的尖端末端(51)指向的方向上推动。对间隔物(6)和触针(7)的这种类型的使用与紧固装置的许多实施例是相同的并且将不再对其他模式详细描述,因为清楚的是本领域普通技术人员将理解在本申请所描述的各个实施例中的这些工具或器械的操作和使用。在另一示例中,尤其例如在图21(A至D)所示的一些实施例,紧固装置(5)的所述板(52)被安排在垂直于竖直轴线的平面中、配备有根据竖直轴线定向并且平行于竖直轴线经由在植入物(1)的上表面和下表面之一的至少一个壳体插入在植入物(1)中的至少一个尖端(51)。当所述尖端(51)进入所述椎骨结构之一时,所述板(52)的外围保持与这个壳体的壁接触以使组件、板(52)和具有互补形状的植入物(1)的壳体稳定,如在图21A中尤其明显示出的。当然,明显的是所展示的形式是说明性的并且能够选择各种形式。如果需要的话,板(52)优选地包括孔(53),该孔(53)为穿过植入物的开口提供连续性用于骨质生长。可以提供紧固件或锁以便在部署时避免固定/紧固装置(5)的任何运动。这种紧固件或锁可以包括各种机构,例如卡扣配合螺栓、滑动销、榫舌和榫孔等。
在一些实施例中(其说明性且非限制性的示例在图22至图25中示出),紧固装置(5、8)平行于竖直轴线围绕植入物(1)的外围壁滑动。例如,紧固装置(5、8)的所述板(52、82)包括至少一个孔(53),该至少一个孔(53)具有与植入物(1)的外围的尺寸至少相等的尺寸并且形成冠部,该冠部被安排在垂直于竖直轴线的平面中并且平行于这个竖直轴线围绕植入物(1)的外围壁滑动。通常提供限制所述板(52、82)的滑动的阻挡装置(16、17、18、54),使得板(52、82)在所述尖端末端(51、81)穿透所述椎骨结构之一时保持与植入物(1)的外围壁接触。在这些实施例的一些中,其说明性且非限制性的示例在图22(A至D)、图23(A至D)和图30(C和D)中示出,限制所述板(52)的滑动的阻挡装置(16、17、54)包括:一方面,所述板(52)的孔(53)的壁中的凹槽(54)和在植入物(1)的下表面和上表面的至少一个的区域中、在该外围壁中的凹槽(16);以及在另一方面,开缝环(17),该开缝环被适配到两个凹槽(16、54)中(类似于夹紧的夹子)以在所述尖端末端(51)穿透所述椎骨结构之一时相对于植入物(1)来阻挡板(52)。明显的是,开缝环能够包括指形件或孔眼以将其更容易地放置在植入物的凹槽(16)中。还能够在板(52)中提供通向该环(尤其是其指形件或孔眼)的入口壳体(54)以便于切除。在另一些实施例中,其说明性且非限制性的示例在图24(A至E)、图25(A至D)和图30(A和B)中示出,限制所述板(52、82)的滑动的所述阻挡装置(18)包括被安装至植入物(1)的下表面和上表面中的至少一个的区域中的冠部(18),从而当所述尖端末端(51、81)通过在所述冠部(18)中的至少一个孔(195、188)而穿透所述椎骨结构之一时相对于植入物(1)来阻挡板(52、82)。
在一些实施例中,其说明性且非限制性的示例在图22(A至D)、图23(A至D)和图30(A至D)中示出,围绕植入物滑动的所述板(52)配备有形成穿透所述椎骨结构之一的所述尖端末端的至少一个直且竖直的尖端(51)。在另一些实施例中,其说明性且非限制性的示例在图24(A至E)和图25(A至D)中示出,滑动的板(82)配备有至少一个螺旋板(80),该至少一个螺旋板配备有至少一个尖端(81),根据螺旋运动经由伴随旋转的竖直滑动来形成穿透所述椎骨结构之一的所述尖端末端。为了简便,配备有至少一个尖端(81)的螺旋板(80)通常在下文中由术语“螺旋尖端(81)”来表示,但清楚的是,这优选是尖端板,虽然它能够被简化为尖端杆。在这些实施例的一些中,能够借助于如先前描述的间隔物(6)来实施紧固装置(5、8)的部署,优选的是具有双支部的间隔物(6),该间隔物的两个支部(66、68)经过外围壁的任一侧,例如如图23C、图23D或图25A中的。在这些实施例的一些中,能够借助于如之前描述的触针(7)来实施紧固装置(5、8)的部署,优选地借助于具有双支部的触针(7),该触针的两个支部(76、78)经过外围壁的任一侧并且在凸缘(bead)(19)上被支撑例如以推动所述滑动的板(52、82),该凸缘在上表面与下表面之间(例如中间)的外围壁的外围上突出,例如如图22C、图22D或图25B中的。明显的是,这种凸缘事实上能够是被插入在支承紧固装置的两个部分之间的额外主体,类似于之前在本申请中所解释的。在一些实施例中,其说明性且非限制性的示例在图25C和图25D中示出,具有螺旋尖端(81)的滑动的板(82)在其配备有尖端的相对面上包括槽口、齿状物或锯齿状物(83),所述槽口、齿状物或锯齿状物被配置为使得包括与这些槽口(83)的形式互补的端部的工具(88)能够被用于在椎骨结构中锚固螺旋尖端。事实上,在骨质结构的情况下,经常有必要通过“冲击”来进行,也就是说,通过在工具上的打击来将振动传递至紧固装置。以此方式,通过成功使用板(82)的各种槽口(83),有可能有助于板的平移且尤其是旋转,对于将螺旋尖端穿透在椎骨结构中而言是必要的。
在上文中描述的实施例中明显的是,尖端(51、81)(即使通常由尖锐的圆柱形元件(类似于钉子)来表示)优选的由尖锐的板来形成,这在骨骼中提供了更好的稳定性。优选地,当呈板的形式的若干尖端(51、81)被用于相同椎骨结构时,这些板的平面将不相对于彼此平行定向(例如垂直地)使得椎骨固定最佳地与若干方向上的运动相反。
同样明显的是,为了在外科手术期间更容易的准备植入,各个实施例允许紧固装置被预安装在植入物上。
如先前在本申请中详细描述的,一些实施例涉及根据曲线轨迹插入的紧固装置和/或包括这种紧固装置的植入物。这种轨迹是有利的,因为它通过使用与用于将植入物插入在被治疗的椎骨节段中并且因此允许更轻易地获得紧固装置在脊椎中的撞击,尤其根据(至少接近)垂直于脊椎的轴的接近轴线的接近方法相同的方法来锚固植入物。所以,一些实施例涉及一种椎骨植入物(1),具体用于椎体切除,包括具有适于替代至少一个椎骨节段的尺寸的至少一个主体(10、11、3、3m、3f),植入物(1)包括外围壁并且根据竖直轴线在植入物(1)的上表面与下表面之间延伸,该上表面与该下表面各自被设计为在由植入物(1)替代的椎骨节段的顶部和底部处分别置于与一个椎骨结构接触。这个植入物包括紧固装置(2、2a、2d),其部署确保将植入物锚固在所述上椎骨结构和下椎骨结构中,所述紧固装置(2、2a、2d)中的每个通过在植入物(1)里面根据曲线轨迹经由在外围壁的外部与植入物(1)的上表面或下表面之一之间的导管或通道(12)来部署。这些紧固装置(2、2a、2d)包括:一方面,至少一个弧形板(20),该至少一个弧形板的至少一个后部在部署完成时保持在通道(12)里面;以及另一方面,至少一个尖端末端(21),该至少一个尖端末端从植入物(1)的上表面和下表面之一突出以在部署完成时进入所述椎骨结构之一。这个弧形板(20)优选地在由板限定的平面中弯曲并且因此大体具有凸侧向边缘、凹侧向边缘和两个大体平坦面,如在大多数图中大体可见的。同样的,在一些实施例中,其说明性且非限制性的示例在图17、图18和图19中示出,该板的弧形不在由该板限定的平面中,因为它不限定平面,但相反,该板是拱形的并且因此具有凹面、凸面和两个直的侧向边缘。而且,在一些实施例中,其说明性且非限制性的示例在图7B和图7E中示出,该板在两个方向上同时弯曲并且因此具有凹边缘、凹面(24)、凸边缘和凸面(25)。这种双弧形根据需要在各个方向上使锚固定向,如具体能够在图7A和图7C或者在图7D和图7F中看见。
在这些实施例中,因此植入物被链接至在插入植入物之后所使用的紧固装置,与上文所描述的实施例相反。形成拱形板的这种紧固装置仅需要植入物具有例如描述的一个通道(12)。以此方式,本公开还涉及调整紧固装置。在一些实施例中,本公开因此涉及一种用于椎骨植入物(1)的椎骨固定的装置(2、2a、2d),该装置被设计为通过在该植入物的外围壁的外部与植入物(1)与椎骨结构接触的上表面或下表面之一之间的导管或通道(12)从脊椎的周边插入,装置(2、2a、2d)包括主体,该主体包括至少一个弧形的板(20),其是刚性的并且根据纵轴线在前端与后端(23、23a、23d)之间延伸成细长的,板(20)被配置为使得其前端借助于至少一个尖端末端(21)进入椎骨结构而其后端(23、23a、23d)保持在植入物(1)的通道(12)中。这个固定装置(2、2a、2d)优选地被配置有板(20),该板在该板的平面中弯曲并且具有凸侧向边缘、凹侧向边缘和两个大体平坦面。而且,这个装置(2、2a、2d)的板(20)优选地配备有被安排为适配在植入物(1)的通道(12)的壁中的多个槽口(27)并且当所述尖端末端进入所述椎骨结构中时使紧固装置(2、2a、2d)在植入物(1)固定。
下文中所描述的实施例还涉及包括锚定件的植入物,该锚定件本身呈弧形板形式,下文中有时由术语“拱形板”来表示。拱形板的后部保持在植入物中并且这个部分必须足以在植入物中良好的适配。后端(23、23a、23d)优选地在植入物中还与通道的入口平齐或至少不超过外围壁太多,这会有损伤外围组织的风险。在一些实施例中,所述弧形板(20)被安排在植入物(1)的通道(12)里面的竖直平面中并且板(20)的弧形在这个竖直平面中定向。因此,通道具有大体矩形截面(可选地具有倒圆的边缘),其宽度至少等于拱形板(20)的厚度并且长度(或高度,由于它是竖直的)至少近似等于拱形板(20)的宽度。拱形板在其被设计为保持在植入物中的整个后部上具有近似不变的宽度,但在其后端会轻微的更宽以允许堵塞在通道中。这种堵塞还能够通过板在其后端的加厚或通过止挡件来达到。拱形板(20)在其后端和其前尖端末端(“前”和“后”参照板插入植入物中的方向来限定)之间的长度取决于通道的长度,通道(12)的定位和/或取向相对于植入物(诸如例如在图6A、图6B、图6C、图6D和图6E中展示的各个变体中明显的)和具有曲率半径板的上表面或下表面,该板适于由通道限定的轨迹,但是这个长度还可以随着尖端末端进入椎骨结构的深度和可选地托架(3、C)或其他解剖适配元件的存在而改变。以此方式,在一些实施例中,所述板(20)的长度和所述尖端(21)的长度被配置为通道的函数,使得仅两个尖端从该植入物突出并且穿透椎骨结构。而且,这考虑到曲率半径并且清楚的是板的边缘或弧形面描述曲率的一个或更多个半径。最后,通道(12)将曲线轨迹强加给锚定件(2、2a、2d),但它进而能够是弯曲的(如例如在图8C和图8D中展示的)或直线的。当通道是直线时,它优选地包括具有不同取向(与板跟随的曲率半径相切)的至少两个直线部分,如例如在图8A和图8B中展示的。在两个直线部分中的这种类型的通道使得更易于通过直线孔来制造(一个从通道入口并且一个从出口)植入物,并且有利于锚定件的通道。
在一些实施例中,弧形板(20)的至少一个后部包括多个槽口(27),所述多个槽口接合在植入物(1)的通道(12)的壁中以在部署完成时使紧固装置(2、2a、2d)固定。这种槽口或齿状物(27)在通道中阻挡拱形板。在一些实施例中,这些槽口(27)变为锚固在通道的壁中,尤其在PEEK植入物的情况下,并且确保板在植入物中的固定(在锚定件移除的方向上并且还可选地在穿透椎骨结构的方向上)。这些槽口能够提供在凹形边缘上但优选地在提供更好支撑的凸形边缘上(如例如在图11(A至E)、图12(A、C和D)和图8C中所展示的)和/或提供在平坦面的至少一个上(如例如在其中所述槽口在两面上的图13(A至C)、图14(A至C)以及图15(B至E)中所展示的)。在另一些实施例中,这些槽口(27)能够被提供在凹面、但优选地凸面的至少一部分上,如例如在图17(B至E)、图18(A至E)或图19C和图19D中所展示的。在一些实施例中,所述弧形板(20)在至少一个后部上包括穿过其整个厚度用于在紧固装置(2、2a、2d)的移除期间脱离接合所述槽口(27)的槽缝(29)。这种类型的安排具有促进切除的优点。根据槽口(27)的位置,槽缝将被定位为允许由槽缝(29)分开的支部的至少一个的弯曲以使槽口(27)脱离接合。图11D、图11E、图12A、图12B、图12D和图12E示出这种槽缝的示例。图13A和图13C示出了其他示例,其中这两个由槽缝分开的支部不在同一平面中:支承槽口的支部在槽口的方向上弯曲,用于更好地在植入物的通道(12)的壁中卡住槽口(27)。从相反方向推动这个支部有利于移除。图15(A至E)还示出了一种变体,其中没有提供槽缝,但是在该变体中,在槽口的方向上弯曲的板的一部分上存在槽口(27)。推动(扭曲)板的这个后部,例如借助于为此目的提供的穿透壳体(290)的工具经由提供在通道(12)的壁中的入口(129)有助于切除。注意到的是,这种类型的切除壳体(290)能够根据槽口的位置被提供在各种位置中,如例如在图12C中所展示的。类似地,图12A和图12B示出了这种类型的两个壳体(290),可选地允许其被钳子夹紧以使这两个支部朝向彼此。图17D和图17E示出了非共面支部的另一种变体,其作用于支部的至少一个上以使锚定件脱离接合。图18D和图18E还示出了另一种变体,其中槽缝(29)横跨板的厚度但不是在垂直于板的平面中,使得槽缝在植入物的厚度中倾斜。以此方式,通过夹紧这两个支部(使它们面朝彼此),槽口(27)将被提供在其上的其中之一可以跨坐在另一个上并且将槽口(27)空出。图31(A至D)和图32(A和B)还示出了另一种变体,其中槽缝(29)将弧形板(20)分离为两个支部,所述支部将槽口(27)支承在其外部直线侧向边缘上(位于槽缝的相对侧)。这种类型的安排通过使两个支部朝向彼此而使槽口(27)脱离接合,例如借助于卡住被安排在后端处的麦角(ergot)水平处的锚定件的支墩(pier),例如在图32A和图32B中所示的。
在一些实施例中,所述弧形板(20)在其后端的区域中包括至少一个止挡表面(28),该至少一个止挡表面不平行于该板的表面以限制紧固装置(2、2a、2d)穿透在植入物(1)中。图11(C至E)、图12(A至E)、图17和图18示出了这种止挡件的说明性示例。
在一些实施例中,所述尖端末端(21)包括由至少一个尖锐部分(22)(例如,切割部分)分开的两个尖端(21),从而有助于穿透在椎骨结构中。这种尖锐部分还能够被提供在锚定件的各个边缘上,优选地仅在被设计为穿透椎骨结构的部分上。例如,图9A和图9B示出了在板(20)的若干边缘上的尖锐部分(22)。类似地,在锚定件仅具有一个尖端(21)的图9C和图9D中,尖锐边缘(22)有助于锚定件的插入。明显的是,相同板(20)的尖端不可能具有相同的长度,例如尖端之一在另一个从植入物中退出之前从植物中退出,例如如在图10C和图10D中所展示的(通过与图10A和图10B进行对比)。
在一些实施例中,所述弧形板(20)在被设计为穿透椎骨结构的前部上包括多个齿状物(26)、槽口或缺口以改善锚定件在穿透组织中的固位。图9D、图19E、图31B、图31C和图31D示出了这种齿状物(26)的说明性且非限制性的示例。
在一些实施例中,其说明性且非限制性的示例在图19(A至E)和图16(A至C)中示出,具有弧形板的紧固装置(2a、2d)事实上包括由链节(23a、23d)接合的若干弧形板,例如诸如垂直于弧形板的平面的板或棍,可选地具有在形式(234)上与植入物的其他元件匹配的不规则性。这种类型的安排增强了锚固尖端并且受益于通过与较窄结构相比由板的形式提供更好的稳定性而给出的优点。在图中明显的是,这两个弧形板彼此平行但它们可以不被提供为彼此平行,即,甚至相互垂直,从而一旦植入椎骨结构中则最优化对运动的阻力。
以上示出的各个实施例,具体对于具有拱形板的锚定件,允许许多变体并且所提供的示例仅是说明性的并且用于限定特征的术语不必被理解为限制而是以其功能来定义。而且,本公开不仅详述了紧固装置或锚固装置的若干实施例,而且考虑到其任何结合。具体地,在一些实施例中,对在将植入物预期插入在其间的椎骨结构中的每个,都使用至少两个紧固装置是有帮助的。本公开因此还考虑到用于包括至少两个紧固装置的植入物的紧固系统。更具体地,在椎体切除的情况下,通过多于一个紧固装置或锚固装置来获得这种固定是有帮助的,因为已经从患者身上移除了若干生理结构并且优选地必须实现更好的稳定性。通过如在本公开中所描述的对每个椎骨结构使用至少两个紧固装置的结合来获得这种稳定性。应该注意的是,本公开的一个紧固装置可以与任何其他已知紧固装置(例如螺钉或其他任何装置)来结合,尽管优选地是将如本公开中的两个锚固装置结合。图30A和图30C示出了这种结合的两个说明性且非限制性的示例。此外,这(至少)两个紧固装置能够彼此相同或彼此不同,并且可以具有彼此平行或不平行的取向。非平行取向总体上有益于更好的稳定性并且紧固装置还能够具有不同长度使得紧固装置的从植入物突出且穿透椎骨结构的部分彼此偏移,以便进一步地改善稳定性。
器械
本公开还涉及用于插入植入物和/或撞击紧固装置的器械。
在一些实施例中,其说明性且非限制性的示例在图27(A至D)中示出,器械包括植入物夹持器(P),该植入物夹持器优选地与提供在植入物上的挂接装置(14)配合。这些装置能够是壳体或用于由器械保持的植入物的任何结构类型。另一方面,器械能够包括用于用弧形板穿透椎骨结构来得到锚定件的至少一个撞击器(I)。有利的是,植入物夹持器(P)和撞击器(I)彼此互补使得夹持植入物的植入物夹持器(P)允许、或甚至引导撞击器的滑动,例如如在图27C和图27D中所示的。例如,植入物夹持器可以包括由至少一个翼板(P1)界定的头部(P2),在其上能够放置撞击器以这种方式朝植入物引导的至少一个支部。有利的是,撞击器(I)能够包括用于例如在植入物夹持器(P)的头部(P2)的任一侧上同时将至少两个锚定件撞击穿过植入物的至少两个支部(I2),这提供了可靠的导轨。
根据各个实施例,器械能够包括至少一个牵张器(或牵引夹具),一方面至少保持或甚至扩大(即使一般优选具有大接触表面的牵张器)由移除的椎骨节段留下的空间,并且另一方面有助于放置植入物(1)。图26A、图26C和图26D示出了牵张器(9b)的示例,该牵张器包括具有被配置为将植入物接收并引导至(在椎骨结构之间的)植入物空间的表面(900)的板(90),例如借助于支撑椎骨结构并且形成导轨的支部(91),植入物的肩台(19b)沿所述导轨被引导,例如如在图26B中所示的。图26E示出了牵张器(9b)的另一个示例,该牵张器包括支撑椎骨结构并且形成导轨的支部,植入物沿该导轨例如借助于在其上表面和下表面上的凹槽(19b)而被引导。这些类型的间隔物有助于植入物的植入并且确保了植入物的插入,特别是具有植入物夹持器(P)的植入物,具体是在本申请中所描述的那些类型的植入物,以及甚至使用如本申请中所描述的撞击器(I)、间隔物(6)或触针(7)。本公开因此还涉及包括这些各种工具或器械的全部或部分的器械。
至少在本申请中所描述的一些实施例中,明显的是,紧固装置、植入物和器械的安排借助于在由植入物替代的(脊椎中的)椎骨节段之上和之下定位的椎骨结构中的至少两个紧固装置来固定植入物。事实上,借助于在植入物夹持器(P)之上和之下滑动的双撞击器或两个撞击器(I),可能尤其经由本申请的锚定件的各个实施例的构型来使至少两个锚定件同时锚固在相同椎骨结构中或者各自锚固在被治疗的椎骨节段上的上结构和下结构之一中,因为这些锚定件的轨迹甚至在它们是曲线时也没有交叉并且植入物的构型(尤其是封装)与这两个锚定件的这种同时锚固是相容的。
本申请参照附图和/或实施例描述了各种技术特点和优点。专家将了解到给定实施例的技术特点事实上能够与另一实施例的特点相结合,除非另外规定或者这些特点明显不相容或其结合明显没有为在本申请中提出的技术问题中的至少一个问题提供解决方案。而且,在给定实施例中所描述的技术特点能够与这种模式的其他特点分离,除非另外规定。以此方式,例如,图30A、图30B、图30C和图30D示出了在相同植入物上的各个实施例的紧固装置的结合。图30A和图30B示出了例如围绕植入物滑动并且包括尖端(51)的板(52),所述尖端穿过滑动的且拱形的板(20)的锁定的冠部(18)的孔(195),所述板然后被插入并且优选地从植入物的外围壁突出以将滑动的板(52)抵靠冠部(18)锁定,从而确保尖端(52)完全堵塞在椎骨结构中。图30C和图30D示出了结合的其他示例,其中,(由夹紧夹锁定的)滑动的板(52)实际上形成包括被安排用于承载拱形板(20)的通道的厚冠部。一旦滑动的板(52)的尖端(51)被植入在椎骨结构中,则添加拱形板以增强固定。
对本领域的技术人员必须明显的是,本公开允许了呈许多其他特定形式的实施例,而不脱离本公开的申请领域。因此,本实施例必须通过图示的方式来考虑,但能够在由所附权利要求书的范围所定义的领域中来修改,并且基于本公开的权利要求书不应局限于上文给出的细节。

Claims (25)

1.一种用于椎骨植入物(1)的椎骨固定的装置(2,2a,2d),所述装置被设计为通过在所述植入物的外围壁的外部与所述植入物(1)与椎骨结构接触的上表面或下表面之一之间的通道(12)从脊椎的周边插入,所述装置(2,2a,2d)包括主体,所述主体包括至少一个板(20),所述板是弧形的、刚性的并且根据纵轴线在前端与后端之间延伸成细长的,所述板(20)被配置为使得所述前端借助于至少一个尖端末端(21)进入椎骨结构而其后端保持在所述植入物(1)的所述通道(12)中,所述装置(2,2a,2d)的特征在于,所述板(20)一方面在所述板的平面中是弧形的并且具有凸侧向边缘、凹侧向边缘和两个大体平坦面并且在另一方面被配备有多个槽口(27),所述多个槽口被安排为接合在所述植入物(1)的所述通道(12)的壁中并且当所述尖端末端进入所述椎骨结构时使所述紧固装置(2,2a,2d)固定在所述植入物(1)中。
2.根据权利要求1所述的装置,其特征在于,所述弧形板(20)被安排在所述植入物(1)的所述通道(12)里面的竖直平面中,并且所述板(20)的弧形在这个竖直平面中被定向。
3.根据权利要求1和2中任一项所述的装置,其特征在于,所述弧形板(20)的至少一个后部包括多个槽口(27),所述多个槽口接合在所述植入物(1)的所述通道(12)的壁中以在完成部署所述紧固装置(2,2a,2d)时使所述紧固装置(2,2a,2d)固定。
4.根据权利要求3所述的装置,其特征在于,所述弧形板(20)在至少一个后部上包括穿过其整个厚度以在所述紧固装置(2,2a,2d)的移除过程中脱离接合所述槽口(27)的槽缝(29)。
5.根据权利要求1至4中任一项所述的装置,其特征在于,所述弧形板(20)在其后端的区域中包括至少一个止挡表面(28),所述至少一个止挡表面不平行于所述板的表面以限制所述紧固装置(2,2a,2d)穿透在所述植入物(1)中。
6.根据权利要求1至5中任一项所述的装置,其特征在于,所述尖端末端(21)包括两个尖端(21),所述两个尖端由有助于穿透在所述椎骨结构中的至少一个尖锐部分(22)分开。
7.根据权利要求6所述的装置,其特征在于,所述板(20)的长度和所述尖端(21)的长度被配置为所述通道(12)的函数,使得仅两个尖端从所述植入物突出并且穿透所述椎骨结构。
8.一种用于将椎骨植入物(1)固定在椎骨结构中的系统,其特征在于,所述系统对于每个椎骨结构包括至少两个根据权利要求1至7中任一项所述的装置,所述植入物预期被插入在至少两个所述装置之间。
9.一种椎骨植入物(1),具体是椎体的椎骨植入物,包括具有被适于替代至少一个椎骨节段的尺寸的至少一个主体(10,11,3,3m,3f),所述植入物(1)包括外围壁并且根据竖直轴线在所述植入物(1)的上表面与下表面之间延伸,所述上表面与所述下表面各自被设计为在由所述植入物(1)替代的所述椎骨节段的顶部和底部处分别被置于与椎骨结构接触,其特征在于,所述椎骨植入物包括紧固装置(2,2a,2d),其部署确保所述植入物锚固在所述下椎骨结构和上椎骨结构中,所述紧固装置(2,2a,2d)中的每个通过在所述植入物(1)里面根据曲线轨迹通过在所述外围壁的外部与所述植入物(1)的上表面或下表面之一之间的通道(12)滑动来部署,并且一方面包括至少一个弧形板(20),所述至少一个弧形板的至少一个后部在部署完成时保持在所述通道(12)里面;以及在另一方面包括至少一个尖端末端(21),所述至少一个尖端末端从所述植入物(1)的上表面和下表面之一突出以在部署完成时进入所述椎骨结构之一。
10.根据权利要求9所述的椎骨植入物,其特征在于,所述紧固装置是由至少一个根据权利要求1至7中任一项所述的装置来形成的。
11.一种椎骨植入物(1),具体是椎体的椎骨植入物,包括具有适于替代至少一个椎骨节段的尺寸的至少一个主体(10,11,3,3m,3f),所述植入物(1)包括外围壁并且根据竖直轴线在所述植入物(1)的上表面与下表面之间延伸,所述上表面与所述下表面各自被设计为在由所述植入物(1)替代的所述椎骨节段的顶部和底部处分别置于与椎骨结构接触,其特征在于,所述椎骨植入物包括紧固装置(5,8),其部署将所述植入物锚固在所述下椎骨结构和上椎骨结构中,所述紧固装置(5,8)中的每个通过平行于所述植入物(1)的竖直轴线滑动来部署并且一方面包括至少一个板(52,82),所述至少一个板的至少一个部分在部署完成时保持与所述植入物(1)的外围壁接触;以及在另一方面包括至少一个尖端末端(51,81),所述至少一个尖端末端从所述植入物(1)的上表面和下表面之一突出以在部署完成时进入所述椎骨结构之一,其中,所述紧固装置(5,8)围绕所述植入物(1)的外围壁、平行于所述竖直轴线来滑动。
12.根据权利要求11所述的植入物,其特征在于,所述紧固装置(5,8)的所述板(52,82)包括具有尺寸至少等于所述植入物(1)的外围的尺寸的至少一个孔(53)并且形成冠部,所述冠部被安排在垂直于所述竖直轴线的平面中并且围绕所述植入物(1)的所述外围壁、平行于所述竖直轴线来滑动,阻挡装置(16,17,18,54)限制所述板(52,82)的滑动,使得当所述尖端末端(51,81)穿透所述椎骨结构之一时所述阻挡装置保持与所述植入物(1)的所述外围壁接触。
13.根据权利要求12所述的植入物,其特征在于,限制所述板(52,82)的滑动的所述阻挡装置(16,17,54)一方面包括所述板(52)的孔(53)的壁中的凹槽(54)和在所述外围壁中、在所述植入物(1)的下表面和上表面的至少一个的区域中的凹槽(16);以及在另一方面包括开缝环(17),所述开缝环被适配在两个凹槽(16,54)中以在所述尖端末端(51)穿透所述椎骨结构之一时相对于所述植入物(1)来阻挡所述板。
14.根据权利要求12所述的植入物,其特征在于,限制所述板(52,82)的滑动的所述阻挡装置(18)包括被安装至所述植入物(1)的下表面和上表面中的至少一个的区域中的冠部(18),从而当所述尖端末端(51,81)通过在所述冠部(18)中的至少一个孔(195,188)而穿透所述椎骨结构之一时相对于所述植入物(1)来阻挡所述板(52,82)。
15.根据权利要求11至14中任一项所述的植入物,其特征在于,所述板(52)被适配有至少一个直且竖直的尖端(51),其形成穿透所述椎骨结构之一的所述尖端末端。
16.根据权利要求11至14中任一项所述的植入物,其特征在于,所述板(82)被适配有至少一个螺旋尖端(81),其根据螺旋运动借由旋转伴随的竖直滑动而形成穿透所述椎骨结构之一的所述尖端末端。
17.一种椎骨植入物(1),具体是椎体的椎骨植入物,包括具有适于替代至少一个椎骨节段的尺寸的至少一个主体(10,11,3,3m,3f),所述植入物(1)包括外围壁并且根据竖直轴线在所述植入物(1)的上表面与下表面之间延伸,所述上表面与所述下表面各自被设计为在由所述植入物(1)替代的椎骨节段的顶部和底部处分别置于与椎骨结构接触,其特征在于,所述椎骨植入物包括紧固装置(5,8),其部署将所述植入物锚固在所述下椎骨结构和上椎骨结构中,所述紧固装置(5,8)中的每个通过平行于所述植入物(1)的竖直轴线滑动来部署并且一方面包括至少一个板(52,82),所述至少一个板的至少一个部分在部署完成时保持与所述植入物(1)的外围壁接触;以及在另一方面包括至少一个尖端末端(51,81),所述至少一个尖端末端从所述植入物(1)的上表面和下表面之一突出以在部署完成时进入所述椎骨结构之一,其中,所述紧固装置(5)在所述植入物(1)的外围壁里面、平行于所述竖直轴线滑动。
18.根据权利要求17所述的植入物,其特征在于,所述紧固装置(5)的所述板(52)被安排在垂直于所述竖直轴线的平面中、被适配有根据所述竖直轴线定向并且经由在所述植入物(1)的外围壁中的至少一个壳体(56)垂直于所述竖直轴线被插入所述植入物(1)中的至少一个尖端(51),所述壳体(56)具有与所述板(52)的宽度互补的宽度和与所述紧固装置(5)的高度至少相等的高度,所述壳体(56)由接收所述尖端(51)的至少一个孔终止在所述植入物(1)的下表面或上表面之一上,使得所述尖端通过在所述下表面或所述上表面中的这个孔来穿透所述椎骨结构之一。
19.根据权利要求17所述的植入物,其特征在于,所述紧固装置(5,8)的所述板(52)被安排在垂直于所述竖直轴线的平面中、适配有根据所述竖直轴线定向并且经由在所述植入物(1)的上表面和下表面之一中的至少一个壳体平行于所述竖直轴线被插入所述植入物(1)中的至少一个尖端(51),所述板(52)的外围在所述尖端(51)进入所述椎骨结构之一时保持与这个壳体的壁接触。
20.根据权利要求9至19中任一项所述的植入物,其特征在于,所述植入物包括若干主体(10,11,3,3m,3f),所述若干主体彼此互补并且能够沿所述竖直轴线堆叠以使所述植入物(1)的高度适于有待被替代的所述椎骨节段的尺寸。
21.根据权利要求20所述的植入物,其特征在于,所述植入物包括主要主体(10),所述主要主体能够单独使用或者与和所述主要主体(10)的上表面或下表面中至少一个互补的附加主体(11)结合使用,所述附加主体(11)包括用于与所述主要主体(10)适配的装置(110,111)和通过相对于所述附加主体(11)的滑动以进入所述椎骨结构之一的紧固装置(2,2a,5,8)。
22.根据权利要求20所述的植入物,其特征在于,所述植入物包括两个附加主体(3,3m,3f),所述附加主体能够彼此结合和/或与所述植入物(1)的所述主要主体(10)结合使用。
23.根据权利要求9至22中任一项所述的植入物,其特征在于,所述外围壁包括用于植入物器械的挂接装置(14,34)。
24.根据权利要求9至23中任一项所述的植入物,其特征在于,所述植入物借助于从所述上表面延伸至所述下表面的至少一个开口是中空的。
25.根据权利要求9至24中任一项所述的植入物,其特征在于,所述外围壁包括至少一个导管(15)以允许插入移植物和/或骨替代件。
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US9937050B2 (en) 2018-04-10
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US9974661B2 (en) 2018-05-22
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AU2014267237A1 (en) 2015-11-19
FR3005569B1 (fr) 2021-09-03
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US11633288B2 (en) 2023-04-25
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US20150045893A1 (en) 2015-02-12
US10779953B2 (en) 2020-09-22

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