CN108135641A - 脊椎植入物、用于放置这种植入物的方法和用于放置植入物的工具 - Google Patents
脊椎植入物、用于放置这种植入物的方法和用于放置植入物的工具 Download PDFInfo
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Abstract
本发明涉及一种椎板切除术后放置的脊椎植入物,其通过沿经椎板方向布置的经关节螺钉固定。本发明还涉及一种放置器械和一种用于放置植入物的方法。
Description
技术领域
本发明涉及脊柱外科植入物领域,例如腰椎关节融合术。本发明更具体地涉及通过后路放置到位的植入物。
背景技术
关节融合术是一种外科手术,旨在稳定关节以使关节减轻疼痛。
在脊柱的应用中,关节融合术用于相对于彼此阻塞两个椎骨。稳定通常通过两个椎骨的融合获得,这要求它们先前借助脊椎植入物保持彼此固定。
基本上,椎骨在前部包括具有后部的锥体,两个椎弓根从后部延伸,各自通过椎板连接到棘突。椎弓根和椎板限定了脊髓或马尾神经根延伸的管。从椎弓根延伸出关节小面,用于与相邻椎骨的小面协配,以便在椎骨的相对运动期间相对于彼此引导椎骨。
有几种类型的植入物用于进行关节融合术。
举例来说,已知通过使用由椎弓根螺钉(即尺寸被设计成接合在椎骨椎弓根中的螺钉)紧固到每个椎骨的若干杆,将两个椎骨连接在一起。由于椎弓根靠近沿脊柱行进的神经,椎弓根螺钉的正确放置是棘手的,并且不正确的定位可能是并发症的来源。
在另一种关节融合方法中,使用利用Boucher技术接合在小面中的经关节螺钉。然而,当它们被放置到位时,这些经关节螺钉可能难以定位,并且它们在顶小面中的锚固可能有缺陷(骨保持不充分)。
为了改善骨保持,Magerl开发了另一种“经椎板关节突”技术。该技术具有改进螺钉锚固的优点。然而,实现所需的优点是复杂的。
发明内容
本发明的一个目的是提供便于将脊椎植入物放置到位并包括经关节螺钉的装置。
为此,本发明提供了一种脊椎植入物,包括彼此铰接的第一主体和第二主体,以及两个经关节连接螺钉,经关节连接螺钉各自具有设置有部分球形头部的螺纹柄部。每个主体包括用于连接到另一主体的部分和具有底板的基部,底板被布置成面向已通过椎板切除术暴露的椎骨部分。基部设置有孔,孔具有开口到底板中的第一端和开口到相对端的第二端,并且第二端设置有用于接纳螺钉头部的凹部,基部还设置有沿着孔延伸的槽,槽在侧向开口到孔内以允许将螺钉在侧向插入到孔内。
经关节连接螺钉的尺寸设置成穿过第一椎骨的一部分并容纳在与第一椎骨相邻的第二椎骨的小面中,并且试图将第一椎骨紧固到小面。每个经关节螺钉穿入的部分通过椎板切除术暴露,这有助于将螺钉放置到位。植入物的主体在插入螺钉之后被放置就位,这对医师来说更舒适。植入物的主体确保螺钉机械地连接在一起,并且它们加强椎骨,同时还保护神经结构。
本发明还提供了一种用于在椎板切除术后将螺钉放置就位在椎骨中的器械,器械包括钳子,钳子具有第一钳夹和第二钳夹,第一钳夹与引导管协配。引导管具有开口的第一端和开口的第二端,开口的第一端被布置成支承在由椎板切除术露出的椎骨部分上,开口的第二端被布置成使得钻孔构件能够插入到引导管中。第二钳夹具有基本上面向引导管的第一端延伸的端部。
这种器械能够以准确、可靠和可重复的方式进行钻孔。特别地,第二钳夹的自由端位于引导管的轴线附近,因此钻头的自由端位于引导管的轴线附近,这一事实使得医师能够观察将要形成的孔的最终位置。
最后,本发明提供了一种将至少一个植入物放置就位在患者的至少第一椎骨和第二椎骨上的方法,第二椎骨在第一椎骨的紧邻下方延伸,植入物包括经关节螺钉。该方法包括以下步骤:
·进行椎板切除以露出第一椎骨的两个部分;
·通过穿过第一椎骨的底小面直到其穿入第二椎骨的顶小面沿着经椎板瞄准线在露出部分中的每一个中接合经关节螺钉,使得每个螺钉固定第一椎骨的底小面和第二椎骨的顶小面。
瞄准线优选为Magerl类型,并且定向成确保两个面对的小面的钻孔不干扰位于下方的椎骨的棘突。
本发明的其它特征和优点在阅读以下对本发明的特定非限制性实施例的描述时是显然的。
附图说明
参考附图,其中:
·图1是植入物的第一主体的前视图;
·图2是从植入物的第一主体的上方观察的视图;
·图3是从植入物的第一主体下方观察的视图;
·图4是从植入物的第一主体后方观察的视图;
·图5是植入物的第一主体的侧视图;
·图6是从植入物的第二主体的上方观察的视图;
·图7是植入物的第二主体的前视图;
·图8是第一实施例中植入物的螺钉的视图;
·图9是第二实施例中植入物的螺钉的视图;
·图10是组装好的植入物的前视图;
·图11是从组装好的植入物上方观看的视图;
·图12是从组装好的植入物上方观看的视图,是在包含螺钉之一的中心轴线的平面上的局部截面图;
·图13是组装好的植入物的侧视图;
·图14是从组装好的植入物后方观察的视图;
·图15是组装好的植入物的透视图,和沿着包含连接螺栓的轴线的中平面的截面;
·图16是用于将植入物的螺钉放置到位的器械的分解透视图;
·图17是器械的透视图;
·图18是图17的区域XVIII的较大比例细节图,器械处于其打开状态;
·图19是与处于其闭合状态的器械的图18所示相似的视图;
·图20至29是示出植入物被放置就位在脊柱的腰部区域中的透视图;和
·图30是类似于图29所示的视图,示出了两个植入物放置就位在脊柱的腰部区域中并联接在一起。
具体实施方式
参照图1至15,本发明的脊椎植入物包括总体上以附图标记100给出的第一主体、总体上以附图标记200给出的第二主体和以附图标记1给出的两个螺钉。
每个螺钉1包括螺纹柄部2,螺纹柄部2设置有头部3,头部3具有基本上球形的外表面4,并且设置有承窝5,在该示例中为六边形承窝,以便与螺丝刀工具协配。螺钉1的尺寸设置成提供经关节连接。
在图8所示的螺钉的第一实施例中,螺纹柄部包括位于螺纹柄部2的自由端附近的单螺纹段6。螺纹段6的外径大于螺纹柄部2的在螺纹段6与头部2之间的其余部分的直径。
在图9所示的螺钉的第二实施例中,螺钉1的螺纹柄部2包括间隔开的两个螺纹段:一个螺纹段7位于螺钉1的头部3附近,另一个螺纹段6位于螺纹柄部2的自由端附近。螺纹段6、7的外径大于在螺纹段7与头部3之间延伸的非螺纹段的直径,并且大于在螺纹段6、7之间延伸的非螺纹段的直径。螺纹段7的螺距大于螺纹段6的螺距。螺纹段7的直径大于螺纹段6的直径。这使得能够将螺钉接合在其中的骨部分压在一起。
第一主体100包括用于连接到主体200的部分110和基部150(具体参见图1至5)。
基部150包括底板151,底板151布置成面对由椎板切除术暴露的椎骨部分。基部150设置有孔152,用于接纳在螺钉1的头部3附近延伸的柄部2的非螺纹段。孔152具有向底板151开口的第一端和在基部150的表面153中在相对端开口的第二端。管状套环154围绕孔152的第二端的出口从表面153突出,以限定与孔152连通的凹部155,凹部155的直径足以接纳螺钉1的头部3。凹部155具有形状基本上为截头圆锥形的端壁156,该端壁156被设计成通过提供球窝接头连接而与头部3的外表面4接触(在一变型中,端壁156可以是球体的一部分)。套环154外部设置有螺纹157,用于通过螺纹紧固与覆盖物160协配,覆盖物160包括由带螺纹的环形边缘围绕的端壁。覆盖物160的边缘在外部设置有与承窝5相同的承窝161,以便能够与相同的螺丝刀工具协配。覆盖物160的端壁在内部设置有块体162,块体162朝向覆盖物160的内侧突出并且具有横向尺寸大于承窝5的横向尺寸的球形帽形式的凹自由表面,使得当覆盖物160拧紧在套环154上时,块体162抵靠头部3的外表面4并且将头部压靠于形成基部150的肩部的截头圆锥形表面156。因此,头部3被夹持在截头圆锥形表面156与块体162之间。
基部150还设置有沿着孔152和沿着凹部155延伸并侧向开口到孔152和凹部155中的槽158,以使得柄部2的非螺纹段能够侧向插入到孔152中并且头部3能够侧向插入到凹部155中。
连接部分110从基部150向侧向突出,并且包括用于供螺栓300穿过的长圆形贯通开口111。长圆形开口111具有平行于侧向的长轴。连接部分110具有凹入的后表面112,该后表面112围绕侧向弯曲并且包括沿着长圆形开口111的长轴分布的半球形凹陷113。
第二主体200包括用于连接到主体100的部分210和基部250(具体参见图6和7)。
基部250包括底板251,底板251被布置成面对由椎板切除术暴露的椎骨部分。基部250设置有孔252,用于接纳在螺钉1的头部3附近延伸的柄部2的非螺纹段。孔252具有向底板251内开口的第一端和在基部250的表面253中在相对端开口的第二端。管状套环254围绕孔252的第二端的出口从表面253突出,以限定与孔252连通的凹部255,凹部255具有足以接纳螺钉1的头部3的直径。凹部255具有形状基本上为截头圆锥形的端壁256,并被设计成通过提供球窝接头连接而与头部3的外表面4接触。套环254在外部设置有螺纹257,用于通过螺纹紧固与覆盖物160协配,覆盖物160包括由带螺纹的环形边缘围绕的端壁。覆盖物160的边缘在外部设置有与承窝5相同的承窝161,以便能够与相同的螺丝刀工具协配。覆盖物160的端壁在内部设置有块体162,块体162朝向覆盖物160的内侧突出并且具有横向尺寸大于承窝5的横向尺寸的球形帽形式的凹自由表面,使得当覆盖物160被拧紧在套环254上时,块体162抵靠头部3的外表面4并且将头部压靠于形成基部250的肩部的截头圆锥形表面256。因此,头部3被夹持在截头圆锥形表面256与块体162之间。
基部250还设置有沿着孔252和沿着凹部255延伸并在侧向开口到孔252和凹部255中的槽258,以使得柄部2的非螺纹段能够侧向地插入孔252中并且头部3能够侧向地插入凹部255中。
连接部分210从基部250在侧向突出,并且包括用于供螺栓300穿过的圆柱形贯通开口211。圆柱形开口211的一端在从连接部分210的前表面212突出的杯状物213的中心敞开。
当组装植入物时(具体参见图10至15)。应该观察到,为了说明的目的,在植入物中使用两种类型的螺钉。自然地,在实践中优选使用单一类型,杯状物213接纳在半球形凹陷113之一中,使得主体100、200的连接部分110、210布置成在它们之间形成基本上球窝接头连接。多个半球形凹陷113使得能够在连接部分210相对于连接部分110就位时调节连接部分210。螺栓300通常包括抵靠连接部分110的螺钉、螺母和垫圈。垫圈具有圆柱形后表面,其具有基本上穿过杯状物213的几何中心的中心轴线。
参照图16至19,本发明的器械布置成用于在椎板切除术后将螺钉放置就位在椎骨中。
该器械包括钳子500,钳子500具有第一杆件600和第二杆件700,第一杆件600具有固定于其上的第一钳夹610,第二杆件700具有固定于其上的第二钳夹710,第二钳夹700在其中心铰接于第一杆件600。
第一钳夹610与引导管800协配,引导管800具有第一开口端801和第二开口端802,第一开口端801布置成支承在由椎板切除术露出的椎骨部分上,第二开口端802布置成使得钻头和螺钉1能够插入引导管800中。端部801设置有两个轴向缺口803,并且具有锯齿状的前表面804,用于咬入骨骼中。引导管800安装在固定到第二杆件700的壳体720中,以沿着引导管800的中心轴线滑动,并且第一杆件600铰接到引导管800,使得将杆件600、700移动得更靠近在一起使得引导管800在第二钳夹710的方向上滑动。引导管800在外部设置有接合在壳体720的凹槽721中的两个对称凸耳805,以便形成卡口型连接。第一钳夹610包括两个臂,各自设置有缺口,缺口以能够在钳500闭合期间推动引导管800的方式枢转地接纳凸耳805中的一个。
引导管800具有足够大的直径以可移除的方式接纳钻套900(见图23),并且一旦钻套900被移除,引导管800用于使螺钉1和适于转动螺钉1的螺丝刀1000(见图24)中的一个穿过。
第二钳夹710具有基本上与引导管800的中心轴线重合的端部。在一变型中,第二钳夹710可相对于中心轴线偏移,主要关注的是,第二钳夹710基本上面向前表面804定位,以便能够将骨部分夹紧在一起(因此,第二钳夹710也可相对于前表面804稍微偏移)。
杆件600、700通过互补形状的元件之间的相互作用彼此铰接,在该实施例中,凸耳730固定到第二杆件700并且接合在第一杆件600的凹槽630中。
应当注意,杆件600、700以与第一杆件600从引导管800可分离和引导管800从壳体720可分离相同的方式容易地彼此分离。这使得拆卸和因此清洁和消毒器械更为容易。
下面参照图20至29描述将植入物放置就位在患者的至少第一椎骨和第二椎骨上的方法。
手术前患者脊柱的腰部区域如图20所示。
它示出了第一椎骨V1和在第一椎骨V1的紧邻下方延伸的第二椎骨V2的顶部、椎骨V1的底小面F1、椎骨V2的顶小面F2和椎骨V1的棘突E1。
该方法开始于进行椎板切除术,以便基本对称地露出第一椎骨的两个部分P1(图21)。
然后将器械放置就位以限定瞄准线,第一孔将沿着瞄准线延伸,并且因此在稍后阶段,螺钉1之一将沿着瞄准线延伸(在该实施例中,当脊柱被认为处于竖直位置时,螺钉位于左侧),该螺钉还将紧固植入物的主体100。
应当观察到,钳夹710的端部进入小面F2后方的位置,而引导管800的前表面804抵靠于通过椎板切除术在左侧露出的部分。引导管800和壳体720在位于椎骨V1上方的椎骨棘突下方通过。
瞄准线是经椎板的(但椎板的中间部分已经被移除)并且是Magerl型的。
钻套900被放置就位在引导管800中,并且钻头插入其中。因此,沿着瞄准线形成孔,并穿过第一椎骨V1的底小面F1,直到其穿入第二椎骨V2的顶小面F2。
为了将螺钉1拧紧在形成于小面F1、F2中的孔中,移除钻套并利用螺丝刀1000的端部将螺钉1插入引导管800中。
然后可以移除螺丝刀和器械。
螺钉没有完全拧入,从而植入物的主体可以在侧向接合在螺钉从由椎板切除术露出的椎骨部分突出的部分(头段)上(图25)。在植入体接合之后,螺钉1的拧紧完成(图26)。
然后将覆盖物160放置就位(图27和28)。
该器械被定位在椎骨V1的通过椎板切除术在右侧露出的部分上。然后执行与上述相同的操作,以便将螺钉1紧固在右侧的小面F1、F2中。
因此,第一主体100安装在左螺钉1上,第二主体200安装在右螺钉1上。
连接部分210被带到连接部分110后方,并且半球形凸起213接合在凹陷113之一中,并且螺栓300被放置到位而不被拧紧。
覆盖物160和螺栓300被逐渐拧紧(图29)。
在一种变型中,对于某些病症,能够联接安装在相邻椎骨上的一个或多个植入物。
举例来说,这包括执行第二椎骨V2的椎板切除,并且以与在椎骨V1和V2上相同的方式将植入物紧固在第二椎骨V2上及其下方的椎骨上。
可以在所有相邻椎骨上执行相同的过程,并且根据外科医生设想的组装重复该过程。
然后使用螺栓300将杆400紧固到两个或更多个植入物(图30)。杆400包括多个开口,用于使螺栓300穿过从而能够可调整地定位它们。此外,在多级组装中,杆400由外科医生成形以匹配装配有植入物的脊柱的曲率。
当然,应该提供几种尺寸的植入物和螺钉,以便能够适应不同的形态。
当然,本发明不限于所描述的实施例,而是包括属于由权利要求限定的本发明范围内的任何变型。
特别地,植入物可以具有不同于所描述和示出的形状。
覆盖物可以以不同的方式紧固在基部上。边缘154可以带螺纹以接纳螺纹覆盖物。覆盖物可以通过螺钉紧固以外的方式紧固,并且例如它们可以通过卡口连接来紧固。
钻孔构件可以是用于在每个经关节螺钉放置就位之前形成孔的钻头,或者当经关节螺钉布置为自钻孔螺钉时,钻孔构件可以是螺钉本身。
Claims (20)
1.一种脊椎植入物,包括彼此铰接的第一主体和第二主体,以及两个经关节连接螺钉,经关节连接螺钉各自具有设置有部分球形头部的螺纹柄部,每个主体包括用于连接到另一主体的部分和具有底板的基部,所述底板被布置成面向已通过椎板切除术暴露的椎骨部分,所述基部设置有孔,所述孔具有向底板开口的第一端和在相对端开口的第二端,并且所述第二端设置有用于接纳螺钉头部的凹部,所述基部还设置有沿着孔延伸的槽,所述槽在侧向向孔内开口以允许将所述螺钉在侧向插入到所述孔内。
2.根据权利要求1所述的植入物,其特征在于,覆盖物与所述基部协配,以便抵靠所述基部的肩部紧固所述螺钉的头部。
3.根据权利要求1所述的植入物,其特征在于,所述覆盖物通过螺钉紧固与所述基部协配。
4.根据权利要求3所述的植入物,其特征在于,所述孔的所述第二端由从所述主体突出的套环限定,所述套环在外部设置有螺纹以便与所述覆盖物协配。
5.根据权利要求1所述的植入物,其特征在于,所述主体的连接部分布置成在它们之间基本形成球窝接头连接,并且通过螺栓彼此连接。
6.根据权利要求5所述的植入物,其特征在于,所述第一主体的连接部分包括用于使所述螺栓穿过的长圆形开口,并且所述第二主体的连接部分包括用于使所述螺栓穿过的圆柱形开口。
7.根据权利要求6所述的植入物,其特征在于,除了所述第二主体的连接部分之外,所述第一主体的连接部分还包括沿所述长圆形孔分布的半球形凹陷,以便部分容纳所述第二主体的连接部分的球形杯状部分。
8.根据权利要求1所述的植入物,其特征在于,所述螺钉的螺纹柄部包括两个间隔开的螺纹段:一个螺纹段靠近所述螺钉的头部,另一个螺纹段靠近所述柄部的自由端。
9.根据权利要求8所述的植入物,其特征在于,靠近所述螺钉头部的螺纹段的螺距比靠近所述柄部的自由端的螺纹段的螺距更大。
10.根据权利要求8所述的植入物,其特征在于,靠近所述螺钉头部的螺纹段的直径大于靠近所述柄部自由端的螺纹段的直径。
11.一种用于在椎板切除术后将螺钉放置就位在椎骨中的器械,所述器械包括钳子,所述钳子具有第一钳夹和第二钳夹,所述第一钳夹与引导管协配,所述引导管具有开口的第一端和开口的第二端,所述开口的第一端被布置成支承在由所述椎板切除术露出的椎骨部分上,所述开口的第二端被布置成使得钻孔构件能够插入到所述引导管中,所述第二钳夹具有基本上面向所述引导管的第一端延伸的端部。
12.根据权利要求11所述的器械,其特征在于,所述引导管具有足够大的直径以可移除的方式接纳钻套,并且一旦所述钻套被移除,所述引导管使得螺钉和适于拧紧所述螺钉的螺丝刀之一能够通过。
13.根据权利要求11所述的器械,其特征在于,包括固定到所述第一钳夹的第一杆件和铰接到所述第一杆件并固定到所述第二钳夹的第二杆件,所述引导管安装到固定于所述第二钳夹的壳体中,以便沿着所述引导管的中心轴线滑动,并且所述第一钳夹铰接到所述引导管,使得所述杆件更靠近地移动到一起使得所述引导管在所述第二钳夹的方向上滑动。
14.根据权利要求13所述的器械,其特征在于,所述杆件通过互补形状的相互接合元件彼此铰接,并且所述第一钳夹通过互补形状的相互接合元件铰接到所述引导管。
15.根据权利要求13所述的器械,其特征在于,所述引导管外部设置有两个对称的凸耳,所述凸耳接合在所述壳体的凹槽中,以便形成卡口型连接。
16.一种在患者的至少第一椎骨和第二椎骨上放置就位至少一个植入物的方法,所述第二椎骨在所述第一椎骨的紧邻下方延伸,所述植入物包括经关节螺钉,所述方法包括以下步骤:
·进行椎板切除术以露出所述第一椎骨的两个部分;
·通过穿过所述第一椎骨的底小面直到其穿入所述第二椎骨的顶小面,沿着经椎板瞄准线在露出部分中的每一个中接合经关节螺钉,使得每个螺钉固定所述第一椎骨的底小面和所述第二椎骨的顶小面。
17.根据权利要求16所述的方法,其特征在于,所述植入物包括两个主体,每个主体借助螺钉紧固到所述椎骨部分之一并且彼此连接。
18.根据权利要求17所述的方法,其特征在于,所述螺钉部分地接合在所述露出部分中,使得头段从所述露出部分突出,并且所述植入体包括侧向槽,所述侧向槽使得能够将所述植入体侧向地接合在所述螺钉上,以便将它们紧固在所述螺钉上。
19.根据权利要求16所述的方法,其特征在于,包括以下步骤:在与所述第一椎骨和/或所述第二椎骨相邻的一个或多个椎骨上执行椎板切除;以及以与在所述第一椎骨上相同的方式将植入物紧固在所述相邻椎骨上;以及将所述相邻植入物与杆连接。
20.根据权利要求16所述的方法,其特征在于,在每个经关节螺钉放置就位之前沿着瞄准线形成孔。
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FR1558077A FR3040285B1 (fr) | 2015-08-31 | 2015-08-31 | Implant vertebral, procede de mise en place d'un tel implant et outil pour la mise en place de l'implant |
FR1558077 | 2015-08-31 | ||
PCT/EP2016/068472 WO2017036709A1 (fr) | 2015-08-31 | 2016-08-02 | Implant vertebral, procede de mise en place d'un tel implant et outil pour la mise en place de l'implant |
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US9962192B2 (en) | 2016-03-17 | 2018-05-08 | Medos International Sarl | Multipoint fixation implants |
US10898232B2 (en) | 2018-03-20 | 2021-01-26 | Medos International Sàrl | Multipoint fixation implants and related methods |
US11426210B2 (en) | 2019-09-25 | 2022-08-30 | Medos International Sàrl | Multipoint angled fixation implants for multiple screws and related methods |
AU2021220225A1 (en) | 2020-02-14 | 2022-10-06 | Medos International Sarl | Integrated multipoint fixation screw |
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WO2017036709A1 (fr) | 2017-03-09 |
US10987141B2 (en) | 2021-04-27 |
FR3040285B1 (fr) | 2017-09-15 |
CN108135641B (zh) | 2019-07-12 |
EP3344171A1 (fr) | 2018-07-11 |
FR3040285A1 (fr) | 2017-03-03 |
US20190038323A1 (en) | 2019-02-07 |
CN110123411A (zh) | 2019-08-16 |
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