CN108697512A - 齿轮传动凸轮可扩展的椎间植入物和植入方法 - Google Patents

齿轮传动凸轮可扩展的椎间植入物和植入方法 Download PDF

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Publication number
CN108697512A
CN108697512A CN201780008241.2A CN201780008241A CN108697512A CN 108697512 A CN108697512 A CN 108697512A CN 201780008241 A CN201780008241 A CN 201780008241A CN 108697512 A CN108697512 A CN 108697512A
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CN
China
Prior art keywords
end plate
distal end
expansible
spur gear
projection
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Granted
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CN201780008241.2A
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CN108697512B (zh
Inventor
J·M·德威利
W·D·阿姆斯特朗
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Warsaw Orthopedic Inc
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Warsaw Orthopedic Inc
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Priority to CN202010381959.XA priority Critical patent/CN111419488B/zh
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    • A61F2/447—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 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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    • 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
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4627—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
    • 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
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4629—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof connected to the endoprosthesis or implant via a threaded connection

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Abstract

一种齿轮传动凸轮可扩展的脊柱植入物。旋转部分的旋转运动被转换成轭架的线性运动，所述轭架使齿轮传动凸轮在所述植入物的远端移动以与相应的齿条的齿配合并且沿着所述齿行走。齿轮凸轮齿沿着所述齿条齿的行走创建了植入物扩展的正常速率，减小了施加到所述植入物的最初过大的扩展力，并且提供了所述扩展速率和力的精细调整。

Description

齿轮传动凸轮可扩展的椎间植入物和植入方法
技术领域
本发明涉及一种脊柱植入物以及一种用于将所述植入物植入患者的两个邻近椎体之间的椎间隙中的方法。更具体地，本发明涉及一种包含齿轮传动凸轮的可扩展的脊柱植入物，所述可扩展的脊柱植入物被配置成在患者的椎间隙内从叠缩位置扩展到扩展位置。
相关技术说明
可扩展的脊柱植入物是已知的。现有可扩展的脊柱植入物使用常规的“4杆”和“曲柄滑块”扩展机构。随后在叠缩位置中时插入通过外科手术方式增强的椎间隙中，使现有可扩展的脊柱植入物扩展。已知现有可扩展的植入物至少用于：(1)向准间隙施加不期望的过大最初扩展力，(2)向椎间隙施加不规则的扩展力，并且(3)缺乏精细调整的可靠能力。现有可扩展的植入物在植入物的远端尖端处还缺乏不同配置，所述不同配置通常可能有利于例如确保远端尖端与邻近椎体之间的接合。
发明内容
本发明的一个目的是提供一种消除相关领域的缺点中一个或多个的可扩展的脊柱植入物。
本发明的另一个目的是提供一种用于插入患者的上椎体与下椎体之间的椎间隙中的可扩展的脊柱植入物。所述植入物具有在其间限定中间纵向轴线的近端和远端并且在叠缩位置、部分扩展位置和完全扩展位置之间可扩展。
所述植入物包含上部端板。所述上部端板具有近端、远端、外表面、至少一个侧表面和内表面。所述内表面的一部分包含上部齿条部分。所述上部齿条部分包含处于所述上部端板的所述近端与所述远端中间的向下突伸的齿以及靠近所述上部端板的所述远端的至少一个最远端向下突伸的齿。所述植入物进一步包含下部端板。所述下部端板具有近端、远端、外表面、至少一个侧表面和内表面。所述内表面的一部分包含下部齿条部分。所述下部齿条部分包含处于所述下部端板的所述近端与所述远端中间的向上突伸的齿以及靠近所述下部端板的所述远端的至少一个最远端向上突伸的齿。所述下部端板的所述近端枢转地连接到所述上部端板的所述近端。
底架部分被安装在所述植入物内、处于所述上部端板与所述下部端板之间。所述底架部分具有近端和远端。所述近端具有在其中限定的开口。
轭架可移动地安装在所述底架部分内。所述轭架具有近端和远端。所述轭架由第一和第二平行的间隔开的壁限定，所述第一和第二平行的间隔开的壁从所述近端延伸到所述远端。横向于所述纵向轴线的远端横向件连接所述轭架的所述第一和第二壁的所述远端。
旋转部分可旋转地安装在所述底架部分内。所述旋转部分具有近端和远端。所述远端被配置成接触所述轭架的所述远端横向件。所述近端具有在其中限定的开口，所述开口被配置成收容植入物扩展工具的远端。
至少一个第一正齿轮可旋转地安装在所述轭架的所述第一和第二壁之一的远端上。所述至少一个第一正齿轮具有齿，所述齿被配置成接合所述上部齿条部分的所述向下突伸的齿。至少一个第二正齿轮可旋转地安装在所述轭架的所述第一和第二壁之一的远端上。所述至少一个第二正齿轮具有齿，所述齿被配置成接合所述下部齿条部分的所述向上突伸的齿。
所述旋转部分被配置成将其旋转运动转换成所述轭架的线性运动。所述轭架将所述线性运动转换成所述正齿轮相对于所述轭架的旋转，从而使所述正齿轮朝着所述植入物的所述远端分别沿着所述上部齿条齿轮齿和所述下部齿条齿轮齿行走，由此使所述植入物移动穿过所述部分扩展位置。当所述正齿轮齿分别顶靠所述上部齿条或所述下部齿条的所述最远端齿时，所述植入物已经到达所述完全扩展位置。
本发明的另一目的是提供一种将如上所述的可扩展的脊柱植入物植入患者的上椎体与下椎体之间的椎间隙中的方法。所述方法包含：使用植入物插入工具将处于叠缩位置中的所述植入物插入通过外科手术方式准备的椎间隙中；旋转所述旋转部分；限定旋转运动；将所述旋转部分的所述旋转运动转换成所述轭架朝着所述植入物的所述远端的线性运动；相对于所述轭架旋转所述正齿轮，由此使所述正齿轮沿着对应的上部和下部齿条的所述突伸的齿行走；并且使所述植入物扩展通过所述部分扩展位置到达所述完全扩展位置。所述插入工具包含中空外轴、中空内轴和长形传动器，所述中空内轴被配置成穿过所述外轴，所述长形传动器被配置成穿过所述中空内轴。所述长形传动器具有钝头远端，所述钝头远端被配置成接触所述植入物的一部分。施加到所述长形传动器的移动被转移到所述植入物，从而迫使所述植入物进入所述椎间隙中。在移除所述长形传动器之后，骨生长材料可以路由通过所述内轴并且进入所述植入物中。
通过回顾以下说明书和附图，本发明的这些和其它目的将是显而易见的。
附图说明
图1是处于叠缩位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图2是处于部分扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图3是处于部分扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图4是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图5是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图6是根据本发明的齿轮传动凸轮可扩展的脊柱植入物的分解零件视图；
图7是根据本发明的齿轮传动凸轮可扩展的脊柱植入物的下部端板、底架部分、轭架、旋转部分和正齿轮的上部透视图；
图8是处于叠缩位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的横截面侧视图；
图9是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的横截面侧视图；
图10到图16是根据本发明的齿轮传动凸轮可扩展的脊柱植入物的一个优选实施例中使用的多阶段扩展机构的示意侧视图；
图17是处于叠缩位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图18是处于完全打开位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图19是处于部分扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图20是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图21是处于部分扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；
图22是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；
图23是处于叠缩位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的另一个实施例的上部透视图；
图24是处于完全扩展位置中的图23的实施例的上部透视图；
图25是根据本发明的齿轮传动凸轮可扩展的植入物的分解零件视图；
图26是处于叠缩位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；
图27是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；
图28和图29是根据本发明的齿轮传动凸轮可扩展的脊柱植入物的后视图；
图30是处于叠缩位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；
图31是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；
图32到图34是一阶段扩展机构的正齿轮和齿条的示意侧视图；
图35是处于叠缩位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图36是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图37是处于完全扩展位置中的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图38是连接到根据本发明的齿轮传动凸轮可扩展的脊柱植入物的根据本发明的植入物插入工具的上部透视截面图；
图39是连接到根据本发明的齿轮传动凸轮可扩展的脊柱植入物的根据本发明的植入物插入工具的上部透视图，描绘了将植入物插入到椎间隙中；
图40是连接到根据本发明的齿轮传动凸轮可扩展的脊柱植入物的根据本发明的植入物插入工具的上部透视截面图；
图41是附接到根据本发明的植入物插入工具的齿轮传动凸轮可扩展的植入物的上部透视截面图；
图42是根据本发明的齿轮传动凸轮可扩展的植入物的上部透视截面图，所述齿轮传动凸轮可扩展的植入物通过根据本发明的植入物插入工具插入到椎间隙中；
图43是根据本发明的齿轮传动凸轮可扩展的植入物的上部透视截面图，所述齿轮传动凸轮可扩展的植入物通过根据本发明的植入物插入工具插入到椎间隙中；
图44是插入到椎间隙中的齿轮传动凸轮可扩展的植入物的上部透视截面图，随后移除植入物插入工具；
图45是由下椎体支撑的根据本发明的齿轮传动凸轮可扩展的脊柱植入物的上部透视图；
图46是描绘了根据本发明的齿轮传动凸轮可扩展的植入物与根据本发明的植入物插入工具之间的附接点的上部透视图。
图47是根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；
图48是根据本发明的齿轮传动凸轮可扩展的脊柱植入物的截面侧视图；并且
图49是描绘了下部端板、底架、轭架、下部正齿轮和具有周向棘轮齿的圆柱体的局部上部透视图。
具体实施方式
齿轮传动凸轮可扩展的脊柱植入物10被配置成插入上椎体与邻近的下椎体之间的通过外科手术方式增强的椎间隙中。植入物10包含在其间限定中间纵向轴线L-L的近端12和远端14。
在一个实施例中，植入物10包含上部端板16。如图6、图8和图9中所描绘的，上部端板16包含近端18、远端20、侧表面22和内表面24。内表面24包含上部齿条部分26，所述上部齿条部分包含向下突伸的齿28和最远端向下突伸的齿29。
在一个实施例中，植入物10包含下部端板30。下部端板30包含近端32、远端34、侧表面36和内表面38。内表面38包含下部齿条部分40，所述下部齿条部分包含向上突伸的齿42和最远端向上突伸的齿43。
在一个实施例中，植入物10包含安装在植入物内、处于上部端板16与下部端板30之间的底架部分44。底架部分44包含近端46和远端48。如图7到图9、图21、图22和图46中所描绘的，底架部分44的近端46是垂直于中间纵向轴线L-L的壁，所述壁具有通过壁限定的开口50和在靠近开口50的壁中限定的一个或多个凹陷52。底架部分44进一步包含在近端46的开口50中限定的第一组内螺纹54。
在一个实施例中，如图1到图7中所描绘的，底架部分44包含近端46与远端48中间的拱形部分56。第二组内螺纹58被限定在拱形部分56的内表面上。
在一个实施例中，轭架60可移动地安装在底架部分44内。轭架60由第一壁62和与第一壁62间隔开的平行的第二壁64限定。第一壁62具有近端66和远端68。第二壁64具有近端70和远端72。如图6、图7和图41到图43中所描绘的，第一壁62和第二壁64的远端68和72可以通过远端横向件71连接。如图5中所描绘的，轭架60包含在第一壁62和第二壁64中的至少一个中限定的槽缝74。每个槽缝74被配置成在其中收容从下部端板30的内侧表面突伸的销76。将销76插入槽缝74中帮助避免植入物10分离。
在一个实施例中，旋转部分78可旋转地安装在底架部分44内。旋转部分78包含近端80、远端82以及外表面84，其中在外表面84上限定外螺纹86。在一个实施例中，如图6、图8、图9、图20到图22、图25到图27、图30和图31中所描绘的，远端82包含T形突伸部88。然而，本发明不限于具有旋转部分78的远端82处的T形突伸部。在一个实施例中，旋转部分的近端80包含开口89，所述开口被配置成在其中收容植入物扩展工具(未示出)的远端。只要旋转部分78可以通过植入物扩展工具旋转，本发明就不限于开口89的任何特定配置。如图8和图9中所描绘的，开口89具有用于收容植入物扩展工具的多边形形状的远端的多边形形状。作为另一个实例但非限制性地，开口89可以是带螺纹的，以收容植入物扩展工具的带螺纹的远端。
在一个实施例中，如图47到图49中所描述的，带螺纹的旋转部分78已经由具有周向棘轮齿166的圆柱体164代替，并且拱形部分56上的匹配螺纹54已经由整体棘爪168代替。棘轮齿166通过凹槽170分开。因为棘爪168与附接到底架部分44的“活动”弹簧172成一体，所以允许所述棘爪挠曲。在此实施例中，随着肋状圆柱体164前进，每个棘爪168前进到下一个对应凹槽170。以此方式，圆柱体164的远端推动轭架60，从而使正齿轮90和94朝着植入物10的远端14行走，使植入物扩展，同时棘爪168保持在棘轮齿166之间的对应凹槽170中，从而将植入物10保持在其当前扩展位置中。
在一个实施例中，一对第一正齿轮90被可旋转地分别安装到轭架60的第一壁62的远端68和轭架60的第二壁64的远端72。每个第一正齿轮90包含突伸的第一正齿轮齿92，所述第一正齿轮齿被配置成接合上部齿条部分26的向下突伸的齿28。
在一个实施例中，如图5到图7、图18、图24、图36和图37中所描绘的，第二正齿轮94被可旋转地分别安装在轭架60的第一壁62的远端68与轭架60的第二壁64的远端72之间。如图6中所描绘的，用销98将正齿轮90和94可旋转地附接到轭架60。第二正齿轮94包含突伸的第二正齿轮齿96，所述第二正齿轮齿被配置成接合下部齿条部分40的向上突伸的齿42。本发明不限于具有两个第一正齿轮90和一个第二正齿轮96。例如，如图20中所描绘的，本发明可以包含两个第一正齿轮90和两个第二正齿轮96。还落入本发明的范围内的是具有一个第一正齿轮90和两个第二正齿轮96。
在一个实施例中，如图19和图20中所描绘的，槽缝160被限定在靠近下部端板30的远端34的侧表面36中，并且销162被限定成从第二正齿轮96突伸。销162被配置成接合槽缝160以帮助防止上部端板和下部端板分离。
在一个实施例中，旋转部分78在底架部分44内旋转，旋转部分78的外螺纹86接合底架部分44的带螺纹的部分58，直到旋转部分78的远端82接触轭架60的远端横向件71。旋转部分78的旋转被转换成轭架60朝着植入物10的远端14的线性运动。轭架60的线性运动使第一正齿轮90和第二正齿轮94旋转。对应的第一正齿轮齿92和第二正齿轮齿96沿着上部齿条部分26的对应的向下突伸的齿28和下部齿条部分40的向上突伸的齿42朝着植入物10的远端14“行走”。随着齿“行走”，上部端板16远离下部端板30移动，由此使植入物10移动到部分扩展位置中并且通过所述部分扩展位置。当对应的正齿轮齿92和96到达对应的最远端向下突伸的齿29或替代性地最远端向上突伸的齿43时，它们可能不朝着植入物10的远端再往前“行走”，并且植入物已经到达完全扩展位置。完全扩展位置中的扩展量与正齿轮的长度相关。如图6中所描绘的，正齿轮具有长度S1，而取决于个体患者的要求，不同的正齿轮长度是有可能的。例如图4、图5、图9、图20和图22中描绘了与正齿轮长度相关的不同量的完全扩展。
在一个实施例中，如图32到图34中所描绘的，正齿轮92和94在一阶段扩展移动中沿着对应的齿条26和40“行走”，对应的直齿简单地沿着对应的齿条滚动。
在一个实施例中，如图10到图16中所描绘的，正齿轮90和94在多阶段扩展移动中沿着对应的齿条26和40“行走”，所述多阶段扩展移动包含如图10和图11中所描绘的对应的直齿最初沿着对应的齿条滚动以及如图12和图13中所描绘的随后以球窝方式枢转。如图14到图16中所描绘的，随着齿轮前进，节圆直径的圆周沿着彼此平移。这种平移允许与固定长度连杆机构相比装置的起点处的较高的入射角。入射角/机构优点开始较高并且随着齿轮前进减小，随着齿轮进一步前进而增大。多阶段扩展模式允许齿轮与齿条的迎角恒定。
在一个实施例中，如图1和图2中所描绘的，上部端板16包含突伸部100，所述突伸部被配置成接合上椎体(未示出)的端板的表面。上部端板16进一步包含在其中限定的开口102，所述开口被配置成允许来自植入物10中负载的骨生成材料的骨生长穿过开口102并且与上椎体融合。上部端板16进一步包含平滑表面104，所述平滑表面被配置成分配椎体端板负载。平滑表面104可以被配置成如图1和图2中所描绘的沿着上部端板16的上部表面的大部分长度或用于上部表面的仅一部分长度以仅接触脱离上椎体端板的较软松质骨。
在一个实施例中，如图8和图9中所描绘的，下部端板30包含用于接合(图45中描绘的)下椎体的端板的突伸部106以及开口108，所述开口被配置成允许来自植入物10中的骨移植材料的骨生长穿过开口108并且与下椎体融合。
在一个实施例中，上部端板16的远端20和下部端板30的远端34限定尖端110。尖端110可以是如图45中所描绘的有斜面的；如图23和图24中所描绘的平坦的；或如图26中所描绘的来到中心点。
在一个实施例中，尖端110可以包含骨接合突伸部112。根据另一个实施例，尖端110可以不具有突伸部。骨接合突伸部112被配置成防止植入物随着植入物10扩展而迁移。
在一个实施例中，如图35和图36中所描绘的，接合销114从至少一个正齿轮90或94延伸并且接合到上部端板16的一侧中的槽缝116中。接合销114接合到槽缝116中帮助防止端板16和30在植入物10的扩展过程中解除联接。
在一个实施例中，如图35和图36中所描绘的，在上部端板16的近端18处限定的上部齿轮118与在下部端板30的近端32处限定的下部齿轮120接合。上部近端齿轮118与下部近端齿轮120的分别接合帮助防止端板16和30在植入物10的扩展过程中解除联接。
在一个实施例中，独立的近端扩展机构122被限定在植入物10的近端12处。如图28到图31、图35和图36中所描绘的，近端扩展机构122包含附接到旋转部分78的近端80的近端多边形形状的肘节124。一对近端枢转销126从近端肘节124突伸。在一个实施例中，肘节124可以具有一个撑开牵引位置，而在另一个实施例中，肘节124可以具有渐进的撑开牵引位置。在一个实施例中，肘节124可以被旋转，而在另一个实施例中，肘节124可以被平移。在旋转肘节124的实施例中，使用凸轮状动作撑开牵引枢转销126。在平移肘节124的实施例中，通过沿着近端斜坡件128滑动来撑开牵引枢转销126。
在一个实施例中，如图38到图44和图46中所描绘的，插入工具130包含近端132和远端134。圆柱形中空外轴136在近端132与远端134之间延伸。圆柱形中空内轴138延伸穿过外轴136。内轴138具有近端140和远端142。
在一个实施例中，如图38中所描绘的，T形手柄158被限定在内轴138的近端140处。T形手柄158附接到长形传动器143，所述长形传动器延伸穿过内轴138。
在一个实施例中，如图42和图43中所描绘的，长形传动器143具有钝头远端154。
在一个实施例中，如图39中所描绘的，丝锥盖144被限定在附接到传动器143的内轴138的近端140处。
在一个实施例中，如图40中所描绘的，丝锥盖144可移除地配合到在内轴138的近端140处限定的漏斗146中。
在一个实施例中，提供了夹持外轴136的外表面的手柄148。手柄148被配置成在使用插入工具130时由外科医生握持。
在一个实施例中，如图46中所描绘的，外轴136的远端134包含突伸指状物150，所述突伸指状物被配置成配合到靠近底架部分44的近端46中的开口50的凹陷52中。
在一个实施例中，如图40和图46中所描绘的，内轴138的远端142包含外螺纹152，所述外螺纹被配置成接合底架部分44的开口50中的第一组内螺纹54。
在一个实施例中，如图38、图39和图42中所描绘的，通过向T形手柄158施加力或通过向丝锥盖144施加力来移动长形传动器143，长形传动器143移动穿过内轴138、穿过底架部分44的近端46中的开口50、并且穿过底架部分44，直到旋转部分78中的钝头近端开口89。将长形传动器143的运动转换到旋转部分78推动植入物10进入椎间隙。随后从植入物10和内轴138移除长形传动器143，如图44中所描绘的，骨生长材料可以通过内轴138插入并且进入植入物10中。
通过考虑本文中所公开的本发明的说明书和实践，本发明的其它实施例对本领域技术人员将是显而易见的。说明书和实例旨在被认为仅是示例性的，而本发明的真正范围和精神由所附权利要求书来指示。

Claims (30)

1.一种用于插入患者的上椎体与下椎体之间的椎间隙中的可扩展的脊柱植入物，所述植入物具有在其间限定中间纵向轴线的近端和远端并且在叠缩位置、部分扩展位置和完全扩展位置之间可扩展，所述植入物包括：
上部端板，所述上部端板包含近端、远端、外表面、至少一个侧表面和内表面，所述内表面的一部分包含上部齿条部分，所述上部齿条部分包含处于所述上部端板的所述近端与所述远端中间的至少一个向下突伸的齿以及靠近所述上部端板的所述远端的至少一个最远端向下突伸的齿；
下部端板，所述下部端板包含近端、远端、外表面、至少一个侧表面和内表面，所述内表面的一部分包含下部齿条部分，所述下部齿条部分包含处于所述下部端板的所述近端与所述远端中间的至少一个向上突伸的齿以及靠近所述下部端板的所述远端的至少一个最远端向上突伸的齿，所述下部端板的所述近端枢转地连接到所述上部端板的所述近端；
底架部分，所述底架部分被安装在所述植入物内、处于所述上部端板与所述下部端板之间，所述底架部分具有近端和远端，所述近端具有在其中限定的开口、靠近所述开口在其中限定的至少一个凹陷、在所述开口中限定的第一组内螺纹以及在所述底架部分的所述近端与所述远端中间限定的第二组内螺纹；
轭架，所述轭架可移动地安装在所述底架部分内，所述轭架具有近端和远端并且由第一和第二基本上平行的间隔开的壁限定，所述第一和第二间隔开的壁中的每一个具有近端和远端；
旋转部分，所述旋转部分可旋转地安装在所述底架部分内，所述旋转部分具有外表面、近端和远端以及在所述外表面的至少一部分上限定的螺纹，所述近端具有在其中限定的开口，所述远端被定位成靠近所述轭架的所述远端，所述螺纹与所述底架部分中的所述第二组内螺纹可接合；
至少一个第一正齿轮，所述至少一个第一正齿轮可旋转地安装到所述轭架的所述第一和第二间隔开的壁中的至少一个的所述远端中的至少一个，所述至少一个第一正齿轮具有至少一个突伸的第一正齿轮齿，所述至少一个突伸的第一正齿轮齿被配置成可移动地接合所述上部齿条部分上的所述向下悬垂的齿；以及
至少一个第二正齿轮，所述至少一个第二正齿轮可旋转地安装到所述轭架的所述第一和第二间隔开的壁中的至少一个的所述远端中的至少一个，所述至少一个第二正齿轮具有至少一个突伸的第二正齿轮齿，所述至少一个突伸的第二正齿轮齿被配置成接合所述下部齿条部分上的所述向上突伸的齿；
其中所述旋转部分被进一步配置成将其旋转运动转换成所述轭架的线性运动，所述轭架将所述线性运动转换成至少所述至少一个第一正齿轮的旋转运动，由此使所述至少一个第一正齿轮相对于所述轭架旋转；并且
其中所述至少一个第一正齿轮相对于所述轭架的所述旋转限定所述至少一个突伸的第一正齿轮齿朝着所述植入物的所述远端沿着所述向下悬垂的上部齿条齿轮齿的第一线性行走运动，由此使所述上部端板枢转到至少所述部分扩展位置。
2.根据权利要求1所述的可扩展的脊柱植入物，其中所述旋转部分的所述近端中的所述开口被配置成收容凸轮扩展工具的远端。
3.根据权利要求1所述的可扩展的脊柱植入物，其中所述上部端板和所述下部端板中的至少一个包含从其所述外表面突伸的至少一个突伸部，所述至少一个突伸部被配置成接合所述对应的上椎体和下椎体的相应端板。
4.根据权利要求1所述的可扩展的脊柱植入物，其中所述轭架进一步包含至少一个侧表面，所述至少一个侧表面具有在其中限定的轨道，所述轨道被配置成在其中收容从所述下部端板和所述上部端板之一的所述至少一个侧表面突伸的销钉，由此防止所述上部端板与所述下部端板脱离接合。
5.根据权利要求1所述的可扩展的脊柱植入物，其中所述旋转部分的所述旋转进一步将运动转换到至少所述至少一个第二正齿轮以使所述至少一个第二正齿轮相对于所述轭架旋转，所述至少所述至少一个第二正齿轮至少相对于所述轭架的所述旋转限定所述至少一个突伸的第二正齿轮齿朝着所述植入物的所述远端沿着所述向上突伸的下部齿条齿轮齿的第二线性行走运动，从而使所述下部端板至少枢转到所述部分扩展位置。
6.根据权利要求1所述的可扩展的脊柱植入物，其中所述上部端板的所述远端和所述下部端板的所述远端协作以形成尖端。
7.根据权利要求6所述的可扩展的脊柱植入物，其中所述尖端限定相对于所述中间纵向轴线基本上垂直的角和相对于所述纵向轴线基本上倾斜的角之一。
8.根据权利要求6所述的可扩展的脊柱植入物，其中所述上部端板的所述远端和所述下部端板的所述远端协作以限定斜面边缘、尖头边缘和平面边缘之一。
9.根据权利要求6所述的可扩展的脊柱植入物，其中所述尖端包含至少一个突伸部，所述至少一个突伸部被配置成与所述对应的上椎体和下椎体的相应端板接合。
10.根据权利要求1所述的可扩展的脊柱植入物，其中所述旋转部分是大致圆柱形的并且包含在其外周表面上限定的一组外螺纹。
11.根据权利要求1所述的可扩展的脊柱植入物，其中所述上部端板和所述下部端板中的至少一个包含在其所述外表面中限定的孔口，所述孔口被配置成允许穿过其的骨生长。
12.根据权利要求1所述的可扩展的脊柱植入物，其进一步包括至少一个接合销，所述至少一个接合销从至少一个正齿轮延伸，所述至少一个接合销被配置成接合在所述上部端板和所述下部端板中的至少一个的所述至少一个侧表面中限定的至少一个槽缝，所述至少一个接合销与所述至少一个槽缝的接合防止所述上部端板与所述下部端板脱离接合。
13.根据权利要求1所述的可扩展的脊柱植入物，其进一步包括靠近所述上部端板的近端部分安装的上部齿轮和靠近所述下部端板的近端部分安装的下部齿轮，所述下部齿轮枢转地接合所述上部齿轮，所述上部齿轮与所述下部齿轮的所述接合防止所述上部端板与所述下部端板脱离接合。
14.根据权利要求1所述的可扩展的脊柱植入物，其中至少所述上部齿条部分包含最远端向下悬垂的上部齿条齿轮齿，所述最远端向下悬垂的上部齿条齿轮齿被配置成至少停止所述至少一个第一正齿轮朝着所述植入物的所述远端沿着所述向下悬垂的上部齿条齿轮齿的所述行走运动，由此使所述上部端板朝着所述完全扩展位置远离所述下部端板移动。
15.根据权利要求1所述的可扩展的脊柱植入物，其中至少所述下部齿条部分包含最远端向上突伸的下部齿条齿轮齿，所述最远端向上突伸的下部齿条齿轮齿被配置成至少停止所述至少一个第二正齿轮朝着所述植入物的所述远端沿着所述向上突伸的下部齿条齿轮齿的所述行走运动，由此使所述上部端板朝着所述完全扩展位置远离所述下部端板移动。
16.根据权利要求1所述的可扩展的脊柱植入物，其中所述旋转部分包括带螺纹的螺钉。
17.根据权利要求1所述的可扩展的脊柱植入物，其中所述旋转部分包括圆柱体，所述圆柱体具有安装在其外圆周上的多个棘轮齿。
18.根据权利要求1所述的可扩展的脊柱植入物，其中所述底架部分进一步包含一系列棘爪，所述一系列棘爪被配置成接合所述旋转部分上的所述棘轮齿。
19.根据权利要求18所述的可扩展的脊柱植入物，其中所述棘爪与所述棘轮齿的所述接合被配置成至少维持所述植入物处于所述部分扩展位置和所述完全扩展位置之一。
20.根据权利要求1所述的可扩展的脊柱植入物，其中所述旋转部分包含在其所述远端处限定的基本上T形的突伸部，所述基本上T形的突伸部被适配成接触所述轭架。
21.根据权利要求1所述的可扩展的脊柱植入物，其进一步包括在所述植入物的所述近端处限定的近端扩展机构，所述近端扩展机构包含连接到所述旋转部分的所述近端的肘节和至少一个后部枢转销，所述至少一个后部枢转销被定位成靠近至少一个后部斜坡件，其中所述肘节被配置成在旋转和平移所述肘节之一发生时使所述至少一个枢转销沿着所述至少一个后部斜坡件滑动。
22.根据权利要求1所述的可扩展的脊柱植入物，其中所述底架部分进一步包含处于所述近端与所述远端中间的拱形部分，所述拱形部分具有内表面和外表面，所述内表面包括在其上限定的螺纹。
23.根据权利要求1所述的可扩展的脊柱植入物，其中所述轭架的所述远端进一步包括基本上横向于所述纵向轴线的远端横向件，所述远端横向件连接所述轭架的所述第一和第二壁的所述远端。
24.根据权利要求1所述的可扩展的脊柱植入物，其中所述至少一个第一正齿轮和所述至少一个第二正齿轮中的至少一个具有长度，处于所述完全扩展位置中的植入物扩展量与所述长度相关。
25.一种用于将可扩展的脊柱植入物插入患者的上椎体与下椎体之间的椎间隙中的套件，所述套件包括：
所述植入物，所述植入物包括：
上部端板，所述上部端板包含近端、远端、外表面、至少一个侧表面和内表面，所述内表面的一部分包含上部齿条部分，所述上部齿条部分包含处于所述上部端板的所述近端与所述远端中间的至少一个向下突伸的齿以及靠近所述上部端板的所述远端的至少一个最远端向下突伸的齿；
下部端板，所述下部端板包含近端、远端、外表面、至少一个侧表面和内表面，所述内表面的一部分包含下部齿条部分，所述下部齿条部分包含处于所述下部端板的所述近端与所述远端中间的至少一个向上突伸的齿以及靠近所述下部端板的所述远端的至少一个最远端向上突伸的齿，所述下部端板的所述近端枢转地连接到所述上部端板的所述近端；
底架部分，所述底架部分被安装在所述植入物内、处于所述上部端板与所述下部端板之间，所述底架部分具有近端和远端，所述近端具有在其中限定的开口、靠近所述开口在其中限定的至少一个凹陷、在所述开口中限定的第一组内螺纹以及在所述底架部分的所述近端与所述远端中间限定的第二组内螺纹；
轭架，所述轭架可移动地安装在所述底架部分内，所述轭架具有近端和远端并且由第一和第二基本上平行的间隔开的壁限定，所述第一和第二间隔开的壁中的每一个具有近端和远端；
旋转部分，所述旋转部分可旋转地安装在所述底架部分内，所述旋转部分具有外表面、近端和远端以及在所述外表面的至少一部分上限定的螺纹，所述近端具有在其中限定的开口，所述远端被定位成靠近所述轭架的所述远端，所述螺纹与所述底架部分中的所述第二组内螺纹可接合；
至少一个第一正齿轮，所述至少一个第一正齿轮可旋转地安装到所述轭架的所述第一和第二间隔开的壁中的至少一个的所述远端中的至少一个，所述至少一个第一正齿轮具有至少一个突伸的第一正齿轮齿，所述至少一个突伸的第一正齿轮齿被配置成可移动地接合所述上部齿条部分上的所述向下悬垂的齿；以及
至少一个第二正齿轮，所述至少一个第二正齿轮可旋转地安装到所述轭架的所述第一和第二间隔开的壁中的至少一个的所述远端中的至少一个，所述至少一个第二正齿轮具有至少一个突伸的第二正齿轮齿，所述至少一个突伸的第二正齿轮齿被配置成接合所述下部齿条部分上的所述向上突伸的齿；
其中所述旋转部分被进一步配置成将其旋转运动转换成所述轭架的线性运动，所述轭架将所述线性运动转换成至少所述至少一个第一正齿轮的旋转运动，由此使所述至少一个第一正齿轮相对于所述轭架旋转；并且
其中所述至少一个第一正齿轮至少相对于所述轭架的所述旋转限定所述至少一个突伸的第一正齿轮齿朝着所述植入物的所述远端沿着所述向下悬垂的上部齿条齿轮齿的第一线性行走运动，由此使所述上部端板至少枢转到所述部分扩展位置；以及
插入工具，所述插入工具可附接到所述植入物的所述近端。
26.根据权利要求25所述的套件，其中所述插入工具包含近端和远端并且包括：
至少一个基本上圆柱形的中空外轴，所述至少一个外轴具有近端和远端，所述远端包含至少一个突伸的指状物部分，所述至少一个突伸的指状物部分被配置成接合在所述底架部分的后壁中限定的所述至少一个凹陷；
基本上圆柱形的内轴，所述基本上圆柱形的内轴被配置成穿过所述至少一个外轴，所述内轴具有近端和远端，所述远端包含在其外周表面上限定的一组外螺纹，所述一组外螺纹被配置成接合所述底架部分中的所述第一组内螺纹。
27.根据权利要求26所述的套件，其中所述内轴的所述近端进一步包括在所述近端处限定的漏斗部分，所述漏斗部分被配置成将骨移植材料插入所述外轴中。
28.根据权利要求27所述的套件，其中所述外轴被适配成将所述骨移植材料从所述漏斗部分转移到所述植入物的所述底架部分。
29.根据权利要求25所述的套件，其进一步包括延伸穿过所述内轴的长形传动器杆。
30.根据权利要求29所述的套件，其进一步包括T形手柄和附接到所述传动器杆的近端的丝锥盖。
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