CN1088421A - 脊柱胸腰段前部固定装置 - Google Patents

脊柱胸腰段前部固定装置 Download PDF

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CN1088421A
CN1088421A CN93119848A CN93119848A CN1088421A CN 1088421 A CN1088421 A CN 1088421A CN 93119848 A CN93119848 A CN 93119848A CN 93119848 A CN93119848 A CN 93119848A CN 1088421 A CN1088421 A CN 1088421A
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T·A·兹迪布力克
M·C·舍曼
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Medtronic Sofamor Danek Inc
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Abstract

一个治疗脊椎突发性骨折的体内前部固定系统 (10)，包括一个细长的板(11)，板(11)由上部(12)、下 部(20)和桥部(25)构成。上部(12)包括一对互相平 行的贯通该部分的细长槽(15)，每个槽有用于接收骨 固定螺钉的(22)的扇形凹口(40、42)。下部(20)包括 一对孔(21)，固定螺钉或螺栓可穿过所述的孔。上部 (12)中的槽(15)可使中间的脊椎部分加压和内脱 位。下部(20)的孔(21)同板的轴线形成斜角(A)，从 而提供一个四边形结构。桥部(25)的宽度(W)比上、 下固定部分的宽度小得多。

Description

本发明涉及前部固定脊骨的装置，更具体地说，本发明涉及用于固定胸椎或腰椎的平板。本发明的固定板尤其适于治疗脊椎Corpectomies例如具有明显脊髓管损伤或脊椎肿瘤的突发性骨折。
脊骨折断一般发生在胸腰关节，尤其是在T-11，T-12，L-1或L-2脊椎上。过去对突发性骨折的治疗是通过用石膏或绷带将驱体固定后长时间卧床休息的方法。哈林顿杆是第一个在治疗脊椎突发性骨折时可进行体内固定的非常成功的装置。哈林顿杆适于脊骨的后部内脱位术而且通过内脱位使脊椎高度复位。然而，哈林顿杆不能使驼背减轻或完全清理脊髓，这是该装置的主要缺陷。
为了改进复位术，可用成形杆、杆的套管、改进的夹子和次层流金属丝改善后部内脱位系统。然而对这些后部内脱位系统，通常被建议用于脊骨融合包括向尾侧的骨折的2个脊椎骨水平面和向头侧的骨折的2或3个脊椎水平面。然而，对于后部的方案即使改进到这种程度仍不是解决胸腰段突发性骨折治疗中问题的最优的方案。
80年代初一个前部装置被开发用于治疗突发性骨折。利用改进的扫描技术可以观察突发性骨折中存在的骨碎片，以便可以把注意力集中到使骨髓管的压力完全降低，作为神经的康复提供的最佳环境。从那时起，根据突发性骨折的体内前部治疗理论，研制了很多类型的固定装置。可是，前部装置在某些情况下可以引起手术后发病率增高。这是由于这个方法操作起来非常困难。除了对脊椎网有危害外，脊髓管的完全清理也是许多前固定方法所存在的问题，以前大部分体内前体系统系具有过于复杂的缺点。
这种系统之一是Acromed，Inc.of        Cleveland，Ohio出售的Kanada杆。该装置利用了脊椎体的主要部分，使固定螺丝穿过这个主要部分固定在脊椎体内部。然后将杆拧在上、下脊椎中的那两个螺丝之间。通常在每个脊椎体内部安放两个螺丝，因此上、下脊椎之间需要有两个杆。将这两个杆端部的螺纹拧紧以便进行加压和内脱位。
由Zimmer出售的另一装置也提供了用于治疗肿瘤或突发性骨折的前部脊骨固定装置。1981年9月15日公布的Drnn，no        4289123号专利描述了这种装置。该装置与Kanada装置的相似之处在于都将杆配置在上、下脊椎之间。一对成形的脊椎的大固定板通过许多螺丝来安装。
业已研究出几种用于脊椎前部固定的平板装置。其中之一是Syracuse        I-板具有各种不同尺寸的I形板。它们跨越突发性骨折部位固定。然而，Syracuse        I形板不允许对上、下脊椎之间的骨接合加压和内脱位。
Acromed Inc出售一种用于治疗突发性骨折和肿瘤的成形前部脊骨固定板（CASETM板）。该固定板上有若干个穿过成形板的螺丝孔。这些孔只提供了将骨螺丝拧到脊椎上的不同位置，并不对骨接合进行加压和内脱位。Duma International of Taipai提供了包括一个平板的Stafix板系统，该固定板具有许多螺丝孔和唯一的一个螺纹槽。Stafix板允许在四角安置骨螺丝，但难于适合加压和内脱位。而且，此板同前面提到的前部固定板一样，不能用骨螺钉或骨螺栓进行刚性或半刚性的固定。
即使利用了这些早期的前部固定系统，仍然需要用于有效治疗胸腰段突发性骨折和肿瘤的固定板和螺纹系统。需要这样一个可使前部负荷平均分配以及加压和内脱位的系统。该系统还必须容易植入以便减少术后发病率。
图1是根据本发明固定在上、下脊椎之间用于治疗突发性骨折的体内前部胸腰段固定板的侧视图。
图2是沿图1中线2-2剖开，从箭头所示方向看去的前部胸腰段固定板一端的横截面视图。
图3是与图1所示板相似，但长度较短的前部胸腰段固定板的顶视图。
图4是沿线4-4剖开并从箭头所示方向看去的图3所示板的侧横截面视图。特别显示出板的切成扇形的槽和螺纹孔的结构。
为了有助于理解本发明的原理，将参考附图中所示出的实施例并用专业术语描述本发明。不难理解，这决不是对本发明范围的限制，关于对所示装置的等同物替代和进一步的改型以及根据本发明原理的进一步应用等对于本发明相关技术领域中的普通技术人员来说都是显而易见的。
首先参照图1，图中示出了根据本发明制造的前部胸腰固定板系统10。系统10包括安装在上脊椎V1和下脊椎V2之间的特殊成形的板11。板11跨越了有突发性骨折F的脊椎V3。脊椎V3属于脊椎Corpectomy，例如用于肿瘤切除。另外本发明适合应用于跨越上、下脊椎之间的脊椎骨接合的场合。
板11包括3个不同部分。第一部分是上部12，包括一对加工在上面的槽15。每一个槽15的结构适合接收一个通过的骨固定元件16。在板的相反一部是下部20，它包括一个用于接收连接脊椎V2的固定元件（例如骨螺栓或骨螺钉）的孔21，上部12和下部20分别通过桥部25互连，桥部25的结构适合于跨越突发性骨折脊椎V3。通过比较图1和图3所示的固定板可以发现，可以通过改变桥部分25的长度改变上、下部分12和20之间的距离。
不难理解，桥部25可根据特定脊椎结构所要求的板11的总长度而延长或缩短。板11必须足够长以使固定部分12和20分别在上、下脊椎上获得可靠的固定支撑区。本发明的胸腰段固定板的总长度可以根据脊骨结构和板所跨越的脊椎数目在2.5-5.0时范围内以半英寸递增。
本发明的前部胸腰固定板的特殊结构是本发明的主要特征。例如板的所有角都是倒圆的。具体地说，上部12的拐角30和下部20的端头32被倒圆。另外，上部12和桥部25之间的过渡部分34具有光滑的轮廓，下部20和桥25之间的过渡部分36也是这样。板11的这个“倒圆的”的轮廓在植入板时减少了对周围的组织损伤。
另一个重要方面是桥25的横向宽度比板11的固定部分12和20的宽度小。与先前的前部固定板不同，本发明的固定板的较宽的部分仅限于直接同脊椎面接的那些部分。业已发现减小尺寸的桥部有利于板的插入并且尽可能地减少了对周围组织的损伤，并且不损害板保持平稳固定区域的能力，桥25的宽度W最好比固定板上部12中的两个槽16之间的中心线CL之间的距离稍长。在一个具体的实施例中，这个宽度为1.5英寸。
为了便于板11固定到脊椎上，板11的下边11b被弯曲以与图2所示的脊椎V2的椎体外曲面相匹配。板下边以半径R变曲，一个具体的实施例中R根据板所固定的脊椎结构在1.0-1.5英寸的范围内选择。
参照图3，图4示出了本发明的前部胸腰段固定板的其它重要特征。图3所示固定板与图1所示固定板相同，但桥部25较短。如图3所示，板11′包括一对细长的平行槽15，固定元件穿过这二个槽被拧紧。每个槽包括将一些扇形凹口40限定在槽中的上表面11b′。另外，也可以将一些扇形凹口40成形在板的下边11a′上。
扇形凹口40和42适于通过骨螺钉和骨螺栓例如图2所示的骨螺钉22的倒圆啮合表面，只有合适轮廓的板啮合表面的骨固定元件是本技术领域的普通专业人员所熟知的。满足这些需求的骨螺丝是由Danek        Medical        Inc出售的小齿形骨螺丝，其部分系列号为803-370到803-384。不难理解，也可以利用骨螺栓，该骨螺栓包括一个同板11最佳部分的下侧11a′的扇形凹口42啮合的合适形状的上表面。这样以骨螺栓包括一啮合到脊椎骨上的下部分带螺纹部分，一个同下侧扇形凹口42配合的中间部分和一个穿过板的开口伸出的上部带螺纹的部分。一个也具有适合形面的螺帽通过螺纹拧到螺栓的上部带螺纹的部分上并且向下拧紧到板的顶表面11b′上，以便使板夹紧骨螺栓，Heining等人的美国专利No        4887595和Sma比等人的美国专利No        5129889公开了适合的骨螺钉结构。骨螺钉或骨螺栓二者最好都包括六角驱动凹槽以便允许元件“顶部加载”和“拧紧”固定元件。
本发明的前部固定板的一个重要方面是槽15和孔21允许用骨螺钉或骨螺栓或两者共同将板固定到脊椎上，用骨螺钉还是用螺栓取决于所要求的固紧程度。骨螺钉（例如螺钉22）比可以从两端螺纹拧紧的螺栓刚性固定要弱，由于在螺栓的情况下是其中间部分接触板的下边11a′。突发性骨折F的性质往往能决定在操作中所需要的固定程度。在先前的体内前部固定装置中不可能获得固定装置的这个灵活性。
如图1和图3所示，细长的槽15沿轴线平行延伸到板11和11′的纵轴上，除了扇形凹口40和42之外，槽的长度也应适合骨螺钉16安装脊椎内以后进行加压和内脱位。在典型的操作中，可以用穿过槽15的骨螺钉16安装板，但开始时并不需要将螺钉牢牢地拧在脊椎上。在完成了加压或内脱位之后，就立即向下拧骨螺钉，以便使板夹紧到脊椎上，形成了可靠的固定。而且，加工有扇形和槽可以使螺钉根据在骨折的位置上所需要保持的适当的内脱位的加压程度在手术后重新定位。通过调整上、下脊椎骨之间距离使螺钉在手术后重新固定，这一特点也是先前的装置所没有的。通过消除被固定的脊锥骨之间间隙达到对脊椎间的骨接合加压的主要目的。
板的另一端即下部20上有一对孔21。当采用细长的槽时，孔21包括上面的埋头部分45和下面的埋头部分47，以便接收穿过的骨螺钉或螺栓的螺帽。从图中可以看到通过这两个孔21的中心所述的线同板11、11′的纵轴线之间构成的斜角A。这个特定角度的方位提供了一个稳固的四边形结构，又使连接的脊椎之间的前部负荷获得最佳分配。如图1所示，在典型的操作中，上部12的螺钉16也按同板的纵轴线的夹角进行安装，以便形成四边形结构。
板11和11′是由生物相容材料（例如316LVM不锈钢）。制成的，其它的材料例如钛合金也可考虑使用，条件是这些材料具有生物相容性和脊椎前部固定所需的刚性。
本发明的体内前部固定系统10，尤其是前部板11提供了脊椎骨的稳定的前部固定结构，特别是在胸腰段接合处。板11的成形形状适合于固定数目尽可能少的活动段。固定板还提供了调节固定螺钉或螺栓的手段，以便进行加压和内脱位。板的外形有利于减少对组织的损伤，并且便于插入。本发明的板11具有上述的所有功能并提供一个四边形结构和可改变固定刚性的大小。
虽然上面是通过结合附图和文字描述详细说明了本发明的，但是附图和上面的描述只是作为发明的举例解释而不是对发明特征的限制，显然，只要示出和描述了这些优选的实施例，在本发明的方案范围内的所有的改变和改型也在本发明的保护范围内。

Claims (7)

1、一种用于治疗脊椎突发性骨折的体内前部固定系统，其特征在于包括：
一个具有纵向轴线的细长板，该板包括一个上部、一个下部以及整体地跨越该上部和下部之间的桥部，该上部具有一对穿通的细长槽，每个槽具有一个基本上平行于该板的纵向轴线的纵向轴线，该下部分具有一对穿通的孔；以及，
一些包括一个骨连接部分和一个板的固定部分的脊锥固定元件，该板的固定部分适合于穿过该板上的槽或孔以便固定该板。
2、如权利要求1所述的体内前部固定系统，其特征在于，该下部上的一对孔中的每个孔包括在两孔之间确定一条直线的形心，这条直线同该板的纵轴线成一个斜角。
3、如权利要求1所述的体内前部固定系统，其特征在于该上部和该下部都具有一个宽度，而该桥部的宽度基本上小于该上部和该下部的那个宽度。
4、如权利要求1所述的体内前部固定系统，其特征在于该一对细长槽的配置应满足使这两个槽的纵向轴线互相平行的要求。
5、如权利要求4所述的体内前部固定系统，其特征在于，该桥部的宽度小于该上部和该下部的那个宽度，并且基本等于那两个槽之间的纵轴线之间的距离。
6、如权利要求1所述的体内前部固定系统，其特征在于，该板包括一些扇形凹口，这些扇形凹口被限定在每个细长槽的边界线周围的该板的上表面中。
7、如权利要求6所述的体内前部固定系统，其特征在于，该板包括一些扇形凹口，这些扇形凹口被限定在每个细长槽的边界线周围的该板的下表面中。
CN93119848A 1992-09-24 1993-09-23 脊柱胸腰段前部固定装置 Pending CN1088421A (zh)

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Cited By (1)

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Publication number Priority date Publication date Assignee Title
CN100423699C (zh) * 2003-09-03 2008-10-08 斯恩蒂斯有限公司 带有束缚夹的骨板

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AU4851093A (en) 1994-04-12
US5324290A (en) 1994-06-28
FI942379A (fi) 1994-05-23
FI942379A0 (fi) 1994-05-23
NO941902D0 (no) 1994-05-20
NZ256231A (en) 1995-07-26
MX9305869A (es) 1994-03-31
ZA937090B (en) 1994-04-22
EP0618785A1 (en) 1994-10-12
WO1994006360A1 (en) 1994-03-31
EP0618785A4 (en) 1995-04-19
JPH07501257A (ja) 1995-02-09
CA2123687A1 (en) 1994-03-31
KR100308588B1 (ko) 2001-12-28
TW314465B (zh) 1997-09-01
AU669387B2 (en) 1996-06-06
BR9305643A (pt) 1996-01-09

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