CN109906061A - 弯曲的可膨胀保持架 - Google Patents
弯曲的可膨胀保持架 Download PDFInfo
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Abstract
本发明提供了一种可膨胀椎间植入物,该可膨胀椎间植入物包括第一端板和第二端板、第一楔形构件和与第一楔形构件间隔开的第二楔形构件,第一楔形构件和第二楔形构件将第一端板和第二端板联接在一起。第一楔形构件和第二楔形构件被构造成沿容纳在第一端板和第二端板之间的致动构件平移,以使植入物从第一塌缩构型膨胀到第二膨胀构型。致动构件具有与第二螺纹节段间隔开的第一螺纹节段,其中第一螺纹节段和第二螺纹节段彼此成角度。在致动构件上的第一螺纹节段和第二螺纹节段之间存在允许第一螺纹节段和第二螺纹节段在相同旋转方向上旋转的节段。致动构件被构造成将第一楔形构件和第二楔形构件从第一塌缩构型移动到第二膨胀构型,使得第一端板和第二端板彼此分离以接触并接合相邻椎体的端板。
Description
技术领域
本发明涉及可膨胀椎间植入物、系统、套件和方法。
背景技术
人的脊柱由被椎间盘分离的一系列椎体构成。天然椎间盘包含由纤维状的纤维环围绕的胶状髓核。在轴向载荷下,髓核压缩并将该载荷径向传递至纤维环。纤维环的层状性质为其提供了高抗拉强度,因此允许其响应于该传递的载荷而径向膨胀。
在健康椎间盘中,髓核内的细胞产生包含高百分比蛋白聚糖的细胞外基质(ECM)。这些蛋白聚糖包含保持水的硫酸化官能团,从而为髓核提供了其缓冲特性。这些髓核细胞还可分泌少量细胞因子,诸如白细胞介素-1β和TNF-α以及基质金属蛋白酶(“MMP”)。这些细胞因子和MMP有助于调节髓核细胞的代谢。
在椎间盘退变性疾病(DDD)的一些情况下,椎间盘的逐渐退变由脊柱的其他部分中的机械不稳定性引起。在这些情况下,增大对髓核的载荷和压力会造成椎间盘内的细胞(或侵入巨噬细胞)释放高于正常量的上述细胞因子。在DDD的其他情况下,遗传因子或细胞凋亡也可导致髓核内的细胞释放毒性量的这些细胞因子和MMP。在某些情况下,椎间盘的泵送作用可发生故障(例如,由于髓核内蛋白多糖浓度的降低),从而阻碍营养物质流入椎间盘以及废物流出椎间盘。这种降低的消除废物的能力可导致高水平的毒素积累,这可导致神经刺激和疼痛。
随着DDD的进展,存在于髓核中的细胞因子和MMP的毒性水平开始降解细胞外基质,具体地,MMP(由细胞因子介导)开始裂解蛋白聚糖的保水部分,从而降低其保水能力。该降解导致髓核柔性减小,因此改变了椎间盘内的载荷模式,从而可导致纤维环分层。这些变化造成更大的机械不稳定性,可使细胞释放甚至更多细胞因子,从而使MMP上调。随着该破坏级联继续且DDD进一步发展,椎间盘开始凸出(“椎间盘突出”),然后最终破裂,这可导致髓核接触脊髓并引起疼痛。
一种提出的管理这些问题的方法是去除有问题的椎间盘并用恢复椎间盘高度且允许相邻椎骨之间骨骼生长的装置替换它。这些装置通常称为融合装置或“椎间融合装置”。目前的脊柱融合手术包括经椎间孔腰椎间融合术(TLIF)、后路腰椎间融合术(PLIF)和极限侧向椎间融合术(XLIF)。
发明内容
本发明涉及可膨胀椎间植入物。可膨胀椎间植入物优选地是用于融合脊柱中的两个相邻椎体的融合植入物。
在一个优选的实施方案中,植入物被构造成具有致动构件,该致动构件可被旋转以膨胀和收缩植入物的两个相对的端板。致动构件具有第一螺纹节段和第二螺纹节段,其中每个螺纹节段沿致动构件的直的中心纵向部分延伸。第一螺纹节段与第二螺纹节段成角度地偏移,该角度偏移优选地在15°和55°之间。沿第一螺纹节段和第二螺纹节段之间的致动构件是可柔性地旋转的节段,使得第一螺纹节段在第一旋转方向上的旋转引起第二螺纹节段也在第一旋转方向上旋转。第一螺纹节段和第二螺纹节段上的螺纹优选地相反。楔形构件定位在第一螺纹节段和第二螺纹节段上,并且楔形构件沿螺纹节段平移,以使植入物能够从塌缩构型膨胀到膨胀构型。
根据本发明的一个实施方案,可膨胀植入物被设计用于插入到上椎体和相邻下椎体之间的椎间空间中。可膨胀植入物包括上端板,该上端板具有用于接触上椎体的上外表面和沿横向方向与上外表面相对的上内表面。植入物还包括下端板,该下端板具有用于接触下椎体的下外表面和沿横向方向与下外表面相对的下内表面。上端板可移动地联接到下端板,使得上端板可沿横向方向相对于下端板平移。植入物包括插入端部部分和与插入端部部分相对的后端部部分,以及第一侧表面和沿垂直于横向方向的侧向方向与第一侧表面相对的第二侧表面。致动构件至少部分地容纳在下端板和上端板之间,致动构件具有沿致动构件的第一中心纵向轴线延伸的第一螺纹节段和沿致动构件的第二中心纵向轴线延伸的第二螺纹节段,其中第一中心纵向轴线和第二中心纵向轴线形成在约15°和约75°之间的角度。第一楔形构件与第一螺纹节段通过螺纹配合,并且第二楔形构件与第二螺纹节段通过螺纹配合。当致动构件围绕第一中心纵向轴线和第二中心纵向轴线旋转时,第一楔形件沿第一螺纹节段平移,第二楔形件沿第二螺纹节段平移,以使上端板从塌缩植入物构型到膨胀植入物构型在横向方向上从下端板移开。
附图说明
结合附图阅读将更好地理解上述发明内容以及以下对本申请的椎间植入物的说明性实施方案的详细说明。出于说明本申请的可膨胀椎间植入物的目的,附图中示出示例性实施方案。然而,应当理解,本专利申请并不局限于所示出的精确的布置方式和机构。在附图中:
图1示出根据本公开的实施方案的定位在椎体之间的植入物;
图2为处于塌缩构型的图1中所示的植入物的透视图;
图3为处于膨胀构型的图1中所示的植入物的透视图;
图4为图1中所示的植入物的分解透视图;
图5为图1中所示的植入物的下端板的透视图;
图6为图5中所示的植入物的端板的侧视图;
图7为图5中所示的植入物的端板的顶部平面图;
图8为图7中所示的植入物的端板的底部平面图;
图9为图1中所示的植入物的上端板的透视图;
图10为图9中所示的植入物的端板的侧视图;
图11为图9中所示的植入物的端板的底部平面图;
图12为图1中所示的植入物的端板的顶部平面图;
图13为图1中所示的植入物的楔形构件的透视图;
图14为图13中所示的楔形构件的侧视图;
图15为图13中所示的楔形构件的端视图;
图16为图13中所示的楔形构件的另一端视图;
图17为图1中所示的植入物的致动构件的透视图;
图18为图1中所示的植入物的致动构件的透视图;
图19为图1中所示的植入物的致动构件的顶视图;
图20为图1中所示的植入物的致动构件的侧视图;
图21为图20中所示的植入物的致动构件的剖视图;
图22为图21中所示的植入物的致动构件的剖视图;
图23为图2的植入物的顶视图,其示出处于塌缩构型的植入物;
图24为沿线24-24截取的图23的植入物的剖视图,其示出处于塌缩构型的植入物;
图25为图2的植入物的顶视图,其示出处于膨胀构型的植入物;
图26为沿线26-26截取的图25的植入物的剖视图,其示出处于膨胀构型的植入物;
图27为图1中所示的植入物的致动构件的另一实施方案的透视图;
图28为图27中所示的致动构件的分解图;
图29为图27中所示的致动构件的顶视图;
图30为图27中所示的致动构件的侧视图;
图31E为图30中所示的致动构件的剖视图;
图32为图1中所示的植入物的致动构件的另一实施方案的透视图;
图33为图32中所示的致动构件的分解图;
图34为图32中所示的致动构件的顶视图;
图35为图32中所示的致动构件的侧视图;
图36为图35中所示的致动构件的剖视图;
图37为图1中所示的植入物的致动构件的另一实施方案的透视图;
图38为图37中所示的致动构件的分解图;
图39为图37中所示的致动构件的顶视图;
图40为图37中所示的致动构件的侧视图;
图41为图40中所示的致动构件的剖视图;
图42为图1中所示的植入物的致动构件的另一实施方案的透视图;
图43为图42中所示的致动构件的顶视图;
图44为图42中所示的致动构件的侧视图;
图45为图42中所示的致动构件的剖视图。
具体实施方式
参见图1,上椎体2和相邻下椎体4限定在椎体2和4之间延伸的椎间间隙9。上椎体2限定上椎骨表面6,并且相邻的下椎体4限定下椎骨表面8(椎骨表面通常为外科准备用于接受植入物的椎骨终板)。椎体2和椎体4通常是解剖学上相邻的,但可以是从椎体2和椎体4之间的位置移除中间椎体之后的剩余椎体。在图1中示出椎间盘切除术之后的椎间空间9,由此已经移除或至少部分地移除椎间盘材料以准备椎间空间9来接收如图2-3所示的椎间植入物或植入物10(植入物在技术社区中也可称为“间隔物”或“融合间隔物”)。插入和膨胀的植入物10设计成实现椎间空间9的适当高度恢复。椎间空间9可根据需要设置在沿脊柱的任何位置,包括在脊柱的腰椎、胸腔和颈椎区域处。
参见图2-3,本发明的实施方案示出为TLIF植入物10。可膨胀的椎间植入物或植入物10限定植入物主体13,该植入物主体13限定远侧端部或插入端部12以及与插入端部12间隔开并与插入端部12相对的近侧端部或后端部14。植入物10被设计和构造成在从后端部14朝向插入端12(在本文中也称为插入方向)的方向上插入椎间空间中。TLIF植入物的插入方向通常不是直线,而是可沿或大致沿植入物轴线取向的弯曲路径,植入物轴线沿植入物10的中心宽度线。后端部14被构造成与一个或多个插入器械连接,所述插入器械被构造成支撑植入物10并将其携带到椎间空间9中,以及/或者将植入物10从图2中所示的塌缩构型C致动到图3中所示的膨胀构型E。
植入物10具有上端板或外壳18和下端板或外壳20,它们保持在一起并且可以在横向方向T上相对于彼此膨胀和收缩,以改变植入物10在椎间空间9内的高度。上端板或外壳18具有上骨接触表面或外部/上部骨接触表面32,并且下端板或外壳20具有沿横向方向T与上骨接触表面32间隔开的下骨接触表面或外部/下部或第二骨接触表面132。上骨接触表面32和下骨接触表面132被构造成分别在相应的椎骨表面6、8处接合上椎体2和下椎体4。上骨接触表面32和下骨接触表面132中的每个可为凸形或部分凸形的,例如,表面的一部分为凸形的,而另一部分可为平坦的;这些表面可沿植入物10的长度为凸形并且还在侧向方向A上沿宽度为凸形。骨接触表面32和骨接触表面132还可限定纹理41,诸如尖刺、脊、金字塔形状、锥体、倒钩、凹口或滚花,它们被构造成当植入物10插入到椎间空间9中时分别接合上椎骨表面6和下椎骨表面8。骨接触表面32和骨接触表面132可为部分纹理化的。例如,骨接触表面32和骨接触表面132可包括纹理化部分和非纹理化部分的特定图案。对于如图所示的TLIF植入物10,纹理41可呈平行的弯曲脊43的形式,所述脊为图2-3中所示的金字塔形状纹理的峰,并且在插入路径方向上弯曲。
如本文所用,术语“近侧”及其衍生词是指从远侧端部或插入端部12朝向近侧端部14的方向。如本文所用,术语“远侧”及其衍生词是指从近侧端部14朝向插入端部12的方向。如本文所用,术语“上”及其衍生词是指从下骨接触表面132朝向上骨接触表面32的方向。如本文所用,术语“下”及其衍生词是指从上骨接触表面32朝向下骨接触表面132的方向。
继续参考图2-4,植入物10包括一对联接至致动构件26的楔形构件。该对楔形构件包括第一楔形构件22和第二楔形构件24,在优选的设计中,它们用于将上端板18联接到下端板20。第一楔形构件22和第二楔形构件24可沿致动构件26平移,以便使上端板18沿横向方向T相对于下端板20移动,以改变植入物10的高度;即,如下所述,致动构件可被旋转以沿致动构件26移动楔形构件22、24,从而升高和降低植入物10的高度(上骨接触表面32和下骨接触表面132之间的横向距离)。在该实施方案中,致动构件26具有相对窄的凸缘28,该凸缘28从致动构件26沿横向方向T朝上端板18和下端板20延伸。在优选的设计中,上端板18具有上内表面33,并且下端板20具有共同地限定通道135的下内表面133。植入物10被构造成使得当植入物10处于图2中所示的塌缩构型C时,致动构件26的绝大部分、第一楔形构件22的至少一部分和第二楔形构件24的至少一部分设置在通道135内;即,优选地,在塌缩构型C中,仅致动构件26的近侧端部部分26p在通道135之外,并且楔形构件22、24的后部在通道135之外。植入物端板和/或楔形构件可由聚醚醚酮(PEEK)或任何其他合适的生物相容性聚合材料或金属合金形成。致动构件26可由生物相容性聚合物材料或金属合金诸如钛或钢形成。应当理解,可使用任何合适的材料来形成如本文所述的植入物部件。例如,整个植入物可由钛合金制成。例如,整个植入物可由钛铝铌(TAN)合金制成。
参见图4-8,下端板20被构造成与第一楔构件22、第二楔形构件24和凸缘28的至少一部分联接。下端板20可限定腔体42,该腔体42被构造成部分地容纳第一楔形构件22和第二楔形构件24,以及致动构件26。下端板20具有下内表面133,该下内表面133包括优选平坦的表面35a,该优选平坦的表面35a形成两个侧向侧壁36i和40i的顶表面,两个侧向侧壁36i和40i可优选地设计成与上端板18上的类似角度的相对表面,以及形成通道135的一部分的多轮廓表面35b匹配。下端板20还限定第一斜坡表面44和第二斜坡表面46。下端板20还限定第一侧表面33a和与第一侧表面33a相对的第二侧表面33b。第一侧表面33a和第二侧表面33b沿横向方向T在骨接触表面132和顶部平坦表面35a之间延伸。下端板20因此限定第一侧壁36i和沿侧向方向A与第一侧壁36i间隔开的第二侧壁40i。如图所示,通道135沿下端板20的长度并在相对的第一侧壁36i和第二侧壁40i之间沿侧向方向A延伸。在所示的实施方案中,第一侧壁36i和第二侧壁40i与下骨接触表面132会聚以形成锥形插入端部16(图2)。
继续参考图4-8,第一侧壁36i和第二侧壁40i被构造成接收凸缘28。第一侧壁36i可限定至少一个狭槽,例如第一狭槽52,用于接收位于致动构件26上的凸缘28的一部分。第一狭槽52在下端板20的插入端部12与后端部14之间的位置处设置在侧壁40i中。侧壁36i可限定至少一个或第二狭槽54,用于接收凸缘28的另一部分。第二狭槽54在插入端部12与后端部14之间的位置处设置在侧壁36i中。第二狭槽54与相对的第一狭槽52对齐,例如侧向对齐,使得每个狭槽52和54被定位成接收凸缘28的一部分。狭槽52和狭槽54也被构造成与凸缘28的结构配合。例如,狭槽52、狭槽54具有曲线形的内轮廓并且对应于凸缘28的曲线轮廓。在其他另选实施方案中,狭槽52和狭槽54可具有直线形状。应当理解,狭槽52和54可具有可滑动地接收凸缘28的一部分的任何期望的形状。例如,如果凸缘28具有正方形轮廓,则狭槽52和狭槽54可被构造成与正方形凸缘配合。在另选实施方案中,壁36i和壁40i可包括沿植入物10的长度间隔开并设置在侧壁36i和侧壁40i上的多个间隔开的狭槽,以接收从致动构件26延伸的对应数量的凸缘或凸缘部分。
下端板20的内表面133还设计成具有将楔形构件22、24与端板联接的特征件。在一个实施方案中,沟槽37i分别沿侧壁36i和40i的内壁39i、45i在侧向方向A上切入内壁39i、45i。沟槽37i被构造成接合第一楔形构件22和第二楔形构件24的对应突片部分,如下文进一步详述。下端板20具有成两组的四个沟槽37i。沟槽37i沿植入物10的长度以平行方式延伸到斜坡表面44、46。下端板20的第一侧3上的一对沟槽37i从与后端部14相邻的点朝向植入物10的中间节段7和平行斜坡表面46在朝向下表面132的方向上在横向方向T上延伸。以类似的方式,在植入物的相对的第二侧5上,一对沟槽37i从与插入端部12相邻的点朝向植入物10的中间节段7和平行的斜坡表面44在朝向下表面132的方向上在横向方向T上延伸。沟槽37i朝向中间节段7延伸并终止于植入物10的纵向中心或靠近纵向中心的点处,或者如果存在凸缘28,则优选地终止于狭槽52、54之前。虽然示出的每个侧面3、5具有一对沟槽37i,但每个侧面3、5可具有单个沟槽,或多于两个沟槽或其他形式的凹槽以捕获楔形构件22、24。
继续参考图4-8,下端板20限定斜坡表面44和46,例如第一斜坡表面44和第二斜坡表面46,它们被构造成与第一楔形构件22和第二楔形构件24配合并且沿其一部分滑动。第一斜坡表面44以朝向下骨接触表面132的角度从靠近插入端部12的点朝向中间节段7延伸一个角度。斜坡表面44下倾以抵接并滑动地接收第二楔形构件24的一部分。第二斜坡表面46以朝向下骨接触表面132的角度从靠近后端部14的点朝向中间节段7延伸,并且下倾以抵接并滑动地接收第一楔形构件22的一部分。斜坡表面44和46还沿相对的第一壁36i和第二壁40i之间的侧向方向A侧向地延伸。每个斜坡表面44和46可限定相对于平坦表面35a限定的斜坡角度β(未示出)。应当理解,角度β可根据需要变化,并且优选地在约10°和约65°之间。下端板20还可限定设置在后端部14处的曲线部分48,该曲线部分48被切入第二斜坡表面46。曲线部分48被构造成与上端板18上的对应曲线部分对齐。当端板18和20处于如图2中所示的塌缩构型时,曲线部分限定提供进入致动构件26的通路的进入开口50,如下文进一步详述。
如图9-12所示,上短板18被构造成类似于下端板20。因此,上端板18包括类似的结构特征,所述结构特征对应于上文相对于下端板20所述的结构特征。这两个端板设计成彼此抵靠并且容纳致动构件26,其中楔形构件22、24连接到致动构件26。上端板18被构造成与第一楔构件22、第二楔形构件24和凸缘28的至少一部分联接。上端板18可限定腔体42,该腔体42被构造成部分地容纳第一楔形构件22和第二楔形构件24,以及致动构件26。上端板18具有下内表面33,该下内表面133包括优选平坦的表面35a,该优选平坦的表面35a形成两个侧向侧壁36s和40s的顶表面,两个侧向侧壁36s和40s可优选地设计成与下端板20上的类似角度的相对表面,以及形成通道135的一部分的多轮廓表面35b匹配。上端板18还限定第一斜坡表面44和第二斜坡表面46。上端板18还限定第一侧表面33a和与第一侧表面33a相对的第二侧表面33b。第一侧表面33a和第二侧表面33b沿横向方向T在骨接触表面32和顶部平坦表面35a之间延伸。上端板18因此限定第一侧壁36s和沿侧向方向A与第一侧壁36s间隔开的第二侧壁40s。如图所示,通道135沿上端板18的长度并在相对的第一侧壁36s和第二侧壁40s之间沿侧向方向A延伸。在所示的实施方案中,第一侧壁36s和第二侧壁40s与下骨接触表面32会聚以形成锥形插入端部16(图2)。
继续参考图9-12,第一侧壁36s和第二侧壁40s被构造成接收凸缘28。第一侧壁36s可限定至少一个狭槽,例如第一狭槽52,用于接收位于致动构件26上的凸缘28的一部分。第一狭槽52在上端板18的插入端部12与后端部14之间的位置处设置在侧壁40s中。侧壁36s可限定至少一个狭槽或第二狭槽54,用于接收凸缘28的另一部分。第二狭槽54在插入端部12与后端部14之间的位置处设置在侧壁36s中。狭槽54与相对的狭槽52对齐,例如侧向对齐,使得每个狭槽52和54被定位成接收凸缘28的一部分。狭槽52和54也被构造成与凸缘28的结构配合。例如,狭槽52、54具有曲线形的内轮廓并且对应于凸缘28的曲线轮廓。在其他另选实施方案中,狭槽52和54可具有直线形状。应当理解,狭槽52和54可具有可滑动地接收凸缘28的一部分的任何期望的形状。例如,如果凸缘28具有正方形轮廓,则狭槽52和54可被构造成与正方形凸缘配合。在另选实施方案中,壁36s和40s可包括沿植入物10的长度间隔开并设置在侧壁36s和40s上的多个间隔开的狭槽,以接收从致动构件26延伸的对应数量的凸缘或凸缘部分。
上端板18的内表面33还设计成具有将楔形构件22、24与端板联接的特征件。在一个实施方案中,沟槽37s分别沿侧壁36s和40s的内壁39s、45s在侧向方向A上切入内壁39s、45s。沟槽37s被构造成接合第一楔形构件22和第二楔形构件24的对应突片部分,如下文进一步详述。上端板18具有成两组的四个沟槽37s。沟槽37s沿植入物10的长度以平行方式延伸到斜坡表面44、46。上端板18的第一侧3上的一对沟槽37s从与后端部14相邻的点朝向植入物10的中间节段7和平行斜坡表面46在朝向上表面32的方向上在横向方向T上延伸。以类似的方式,在植入物的相对的第二侧5上,一对沟槽37s从与插入端部12相邻的点朝向植入物10的中间节段7和平行的斜坡表面44在朝向上表面32的方向上在横向方向T上延伸。沟槽37s朝向中间节段7延伸并终止于靠近植入物10的纵向中心的点处,或者如果在设计中存在凸缘28,则优选地终止于狭槽52、54之前。虽然示出的每个侧面3、5具有一对沟槽37s,但每个侧面3、5可具有单个沟槽,或多于两个沟槽或其他形式的凹槽以捕获楔形构件22、24。
继续参考图9-12,下端板18限定斜坡表面44和46,例如第一斜坡表面44和第二斜坡表面46,它们被构造成与第一楔形构件22和第二楔形构件24配合并且沿其一部分滑动。第一斜坡表面44以朝向上骨接触表面32的角度从靠近插入端部12的点朝向中间节段7延伸。第一斜坡表面44下倾以抵接并滑动地接收第二楔形构件24的一部分。第二斜坡表面46以朝向上骨接触表面32的角度从靠近后端部14的点朝向中间节段7延伸,并且下倾以抵接并滑动地接收第一楔形构件22的一部分。斜坡表面44和46还沿相对的第一壁36s和第二壁40s之间的侧向方向A侧向地延伸。每个斜坡表面44和46可限定相对于平坦表面35a限定的斜坡角度β(未示出)。应当理解,角度β可根据需要变化,并且优选地在约10°和约65°之间。上端板18还可限定设置在后端部14处的曲线部分48,该曲线部分48被切入斜坡表面46。曲线部分48被构造成与下端板20上的对应曲线部分对齐。当端板18和20处于如图2中所示的塌缩构型时,曲线部分限定提供进入致动构件26的通路的进入开口50,如下文进一步详述。
上端板18和下端板20设计成配合在一起。在一个优选的实施方案中,通过在沟槽37内行进的楔形构件22、24将两个端板配合在一起。上端板18和下端板20的平坦表面35a设计成当植入物处于其塌缩位置(图2)时彼此接触或接近接触。上端板18和下端板20可在植入物10的后端部14处限定相对的凹口98。凹口98被构造成接收插入工具(未示出)的一部分。
上端板18和下端板20也可限定相应的开口或通孔30。每个开口或通孔30已被构造成接收第一楔形构件22和第二楔形构件24的至少一部分,以使植入物10的紧凑设计和膨胀特性最大化。当植入物10处于塌缩构型C(图2)时,开口30部分地接收第一楔形构件22和第二楔形构件24的一部分,这允许第一楔形构件22和第二楔形构件24的尺寸相比用于不具有开口30的植入物中的楔形构件增加,其中开口30被构造成允许楔形构件的一部分延伸穿过其中。因此,植入物10具有紧凑和侵入性较低的塌缩构型,以及尺寸上稳定的膨胀构型。当植入椎间空间9中时,开口30具有促进骨生长的附加有益效果。开口30延伸穿过上端板18并且类似地穿过下端板。
参见图4和图13-16,第一楔形构件22和第二楔形构件24被构造为可滑动地联接到上端板18和下端板20。第一楔形构件22和第二楔形构件24类似地构造,并且出于说明的目的,下面仅描述第一楔形构件22。第一楔形构件22限定楔形主体74,该楔形主体74沿中心楔形轴线CL在窄的外端部75和较宽的内端76之间延伸,较宽的内端76沿中心楔形轴线CL与外端部75间隔开。楔形轴线CL优选地与致动构件26的中心轴线对齐并且沿楔形件的长度延伸(在所示的实施方案中,植入物10设计成在上下方向上均匀地膨胀,因为楔形件设计以对称的方式设计;楔形件可设计成具有不同角度的楔形面(甚至一侧可以设计成具有平坦面),使得在上下方向上的膨胀可以是不均匀的)。如图4和图24所示,第一楔形窄端75定位成面向植入物10的外端部或后端部14,而内宽端76定位成面向植入物10的中间部分7(和开口30)。另外,第二楔形构件24具有楔形主体,其中窄的外端部75定位成面向植入物10的远侧端部或插入端部12,并且内宽端76定位成面向植入物的中间部分7(和开口30)。
楔形主体74沿致动构件26并且在致动构件26上行进,以提供机械装置来分离上端板18和下端板20从而使植入物10膨胀。楔形主体74具有上表面77和相对的下表面78。上表面77从窄端75到宽端76成角度,并且下表面78在相反方向上类似地成角度。该角度相对于上表面77的中心轴线CL优选地在约10°和约65°之间(并且对于相对表面78成相反的角度)。该角度优选地与斜坡表面44、46的角度以及沟槽37的角度匹配。楔形主体74具有沿侧面79、80延伸的突起、突片或舌状部82;突起82设计成适配在沟槽37内并且在沟槽37内行进,使得当楔形主体74沿致动构件26行进,楔形构件22、24沿致动构件26远离中间部分7平移时,楔形构件22、24迫使上端板18和下端板20彼此相对远离,以使植入物10从其塌缩位置移动到其膨胀位置。楔形主体74具有上边缘76s和限定楔形件高度H1的下边缘76i。楔形主体74具有中心孔81,该中心孔81优选地内部带螺纹以与致动构件26上的外螺纹配合。
现在参见图17-22,出于描述目的描绘了致动构件26的实施方案。致动构件26被构造成将第一楔形构件22和第二楔形构件24联接在一起,同时还在植入物膨胀期间为上端板18和下端板20提供稳定性。致动构件26在其中间节段90处成角度或弯曲,所述中间节段将第二螺纹节段91和第一螺纹节段92分离,螺纹节段91、92具有螺纹99。第二螺纹节段91优选地构造成使得存在一定长度的具有中心纵向轴线CL1的螺纹直杆,并且类似地,第一螺纹节段92优选地构造成使得存在一定长度的具有中心纵向轴线CL2的螺纹直杆(参见图21)。两条中心纵向轴线CL1和CL2在它们之间形成角度α,其中角度α优选地在约15°和约75°之间;更优选地在约15°和约55°之间;更优选地在约20°和约50°之间;更优选地在约25°和约45°之间;更优选地在30°和40°之间,并且在一些实施方案中在33°和37°之间。优选的是,第一螺纹节段92和第二螺纹节段91各自沿致动构件的相应的直的纵向部分延伸;然而,第一螺纹节段92和第二螺纹节段91可为非直的。在该后者构型中,可以在第一螺纹节段92和第二螺纹节段91中的每个上的螺纹99的开始和结束处在致动构件26的中心中的点之间绘制线。然后这两条线之间的角度将形成角度α。第一螺纹节段92和第二螺纹节段91优选地由钢、钛合金、钴铬合金、镍钛合金、聚合物或前述材料的组合形成。
在所示的实施方案中,致动构件26的中间节段90可构造成包括柔性杆,该柔性杆在该实例中为缆线93的形式,缆线93由多个导线段94构成。因此,中间节段90是柔性的并且能够使致动构件26在一个端部处通过致动工具旋转,并且对于第一螺纹节段92和第二螺纹节段91两者,旋转将保持均匀。第一螺纹节段92上的螺纹99的螺距优选地与第二螺纹节段91上的螺纹99上的螺距相同,除了第一螺纹节段92和第二螺纹节段91之间的螺距反向。就这一点而言,第一楔形构件22和第二楔形构件24的孔81内的内螺纹设计成与相应的第一螺纹节段92和第二螺纹部分91的相应螺纹配合,因此也是反向的,使得当致动构件26旋转时,第一楔形构件22和第二楔形构件24沿致动构件26朝向彼此或远离彼此平移,这取决于致动构件26的旋转方向。每个螺纹节段91、92上的螺纹图案可具有相同的螺距,使得第一楔形构件22和第二楔形构件24可沿致动构件26以相同的速率平移。如果在膨胀构型中需要不同的牵引轮廓(例如,脊柱后凸或脊柱前凸)时,螺距可以是不同的。致动构件26的近侧端部26p可限定被构造成接收或支撑插入器械的一部分的承窝26e,如下文进一步详述。承窝26e可根据需要具有接收器械的任何构型,诸如六角形、菲利普形、扁平形、星形、正方形等。
因此,致动构件26的轴95沿其长度弯曲并且限定相对于凸缘28朝远侧设置的第二螺纹节段91(或在靠近插入端部12的第二侧5中设置),以及从凸缘28朝近侧设置的第一螺纹节段92(或在靠近后端部14的第一侧3中设置)。轴95可具有沿中心轴线CA从远侧端部96延伸到近侧端部97的长度L1,中心轴线CA沿轴的中心延伸(参见图17),其中长度L1可在约24mm至约32mm之间延伸。第一螺纹节段92和第二螺纹节段91中的每个的长度优选地相等,但可不同,并且优选地在约6mm至约12mm之间,更优选地在约8mm至约9mm之间。在第一螺纹节段92和第二螺纹节段91之间延伸的中间节段90的长度优选地在约8mm至约13mm之间,更优选地在约9mm至约11mm之间。如图17-21所示,中间节段90构造有在第二螺纹节段91和凸缘28之间延伸的第一缆线节段93a和在第一螺纹节段92和凸缘28之间延伸的第二缆线节段93b。第一缆线节段93a和第二缆线节段93b中的每个的长度优选地大约相等,但可不同,并且优选地各自沿中心轴线CA(参见图17)从约4mm至约7mm长,并且更优选地为从约4.5mm至约5.5mm长。凸缘28在面28a、28b之间沿中心轴线CA优选地约2mm至约5mm长,并且优选地在面28c、28d(参见图21)之间的约2mm至约3mm高。
如图2-3和图23-26所示,植入物10可具有初始尺寸和膨胀尺寸。例如,当植入物处于其塌缩位置C时,植入物可具有在相对的第一骨接触表面32和第二骨接触表面132之间限定的第一植入物高度D1,并且当植入物处于其膨胀位置E时,植入物可具有在相对的第一骨接触表面32和第二骨接触表面132之间限定的第二植入物高度D2。该距离从表面32、132测量,而不是从通常与这些表面一起使用的任何纹理41(牙齿等)的顶部测量。在一个实施方案中,第一植入物高度D1可在约7mm和15mm之间,优选地在约7mm和10mm之间,并且第二膨胀植入物高度D2可在约10mm和20mm之间的范围内,优选地在约10mm和13mm之间。在膨胀位置E中,在塌缩位置C优选地彼此抵接的相对的上和下内平坦表面35a可根据需要在所述范围内间隔开任何距离,诸如在约3mm和约5mm之间。例如,在一个实施方案中,第一高度D1可以为7mm,而膨胀的第二高度D2可以为10mm。在另一个实施方案中,第一高度D1可以为9mm,并且膨胀的第二高度D2可以为13mm。其他尺寸也是可能的。例如,第一高度可为至多7mm、9mm或更大。植入物10还具有宽度,并且在一个实施方案中,第一骨接触表面32和第二骨接触表面132可根据需要在侧向方向A上限定尺寸,诸如在8mm和12mm之间。
整个系统包括一个或多个插入工具。插入工具可包括柄部和从柄部朝向植入物支撑端延伸的轴。植入物支撑端可被构造成支撑例如承载或接合植入物10的一部分。植入物支撑端可包括间隔开的突片,所述突片被构造成和尺寸设计成接收在植入物凹口98中。当植入物突片接合凹口98时,工具可将植入物10定位和/或插入到椎间空间9中。可使用另外的工具将植入物10从塌缩构型C膨胀到膨胀构型E。该工具可包括柄部和从柄部朝向工作端延伸的轴,该工作端被构造成接合致动构件26的近侧端部26p,使得工具的旋转可引起致动构件26的旋转。
参见图23-26,植入物10被构造成从塌缩构型C(图24)膨胀至膨胀构型E(图26)。当处于第一或塌缩构型C时,第一楔形构件22和第二楔形构件24设置在植入物中,使得内端76面向彼此并且彼此间隔开以在它们之间限定在中间节段90上延伸的间隙。第一楔形构件22和第二楔形构件24拧到致动构件26上,使得第一螺纹节段92设置在第一楔形构件22的孔81内,第二螺纹节段91设置在第二楔形构件24的孔81内。在塌缩位置C中,楔形构件22、24优选地位于螺纹节段91、92的内端61附近或其中,并且与凸缘的侧面28a、28b间隔开。楔形构件22、24的倾斜表面77和78与相应的下端板20和上端板18的相对的斜坡表面44和46相邻。在一个实施方案中,内端上边缘76s和下边缘76i延伸到开口30中并且可位于包含骨接触表面32、132的平面内或上方/下方。设置在开口30中的第一楔形构件22和第二楔形构件24的部分例如边缘76s、76i允许楔形轮廓,该楔形轮廓有助于使用第一楔形构件22和第二楔形构件24沿致动构件26的相对较小的推进分离端板18和20。
当致动构件26经由接合在近侧端部26p处的工具旋转时,致动构件26的第一螺纹部分92使第一楔形构件22朝向植入物10的后端部14平移。倾斜表面77和78承靠斜坡表面44和46,以沿横向方向将上端板18与下端板20分离,从而使植入物10从塌缩位置C移动到膨胀位置E。第一楔形构件22的突起或突片82以受控方式沿沟槽37i、37s滑动。结合在一起,因为致动构件26的中间部分90是柔性缆线,同时当第一楔形构件22朝向植入物后端部14平移时,致动构件26的第二螺纹部分91接合第二楔形构件24的孔81,并且使第二楔形构件24朝向植入物10的插入端部12平移。同样,第二楔形构件24的倾斜表面77和78沿斜坡表面44和46滑动,以便沿横向方向T将上端板18与下端板20分离。再次,第二楔形构件24的突起或图片82沿相应的沟槽37s、37i滑动。在植入物10的致动期间,凸缘28保持设置在狭槽52、54中,并且当植入物10膨胀时提供附加的抗剪切稳定性。图23-26中所示的实施方案示出上端板18沿横向方向T与下端板20分离,同时保持大致彼此平行。在其他另选实施方案中,植入物可被构造成使得实现脊柱前凸或后凸牵引。例如,致动构件的螺纹部分可被构造成使得一个楔形构件与另一个楔形构件相比以更快的速率平移。在此类实施方案中,当植入物10膨胀时,上端板18将与下端板20成角度地偏移。
植入物10可用于TLIF外科手术中。一般来讲,椎间盘空间9通过根据外科医生的偏好移除适当量的天然椎间盘材料并制备用于接收植入物10的端板椎骨表面6、8来制备。植入物10插入到限定在上椎体2和下椎体4之间的椎间空间9中。优选地,椎间植入物10以完全塌缩构型插入到椎间空间9中,但植入物10可以略微膨胀。该方法还包括将椎间植入物10从塌缩构型膨胀到最终膨胀构型的步骤。当植入物10处于塌缩构型时,第一骨接触表面32和第二骨接触表面132在横向方向T上彼此间隔开第一距离。
如上所述,致动构件26可围绕其中心轴线CA旋转,以使植入物10从塌缩构型膨胀至膨胀构型。如上所述,工具用于使致动构件26旋转,以使第一楔形构件22和第二楔形构件24沿致动构件26平移并且彼此远离移动以使植入物10膨胀。致动构件26可旋转,直到第一楔形构件22抵接止动构件63,这阻止致动构件26在膨胀方向上的进一步旋转。止动构件63可以是具有螺纹内孔的环,并且在第一楔形构件22组装到植入物10上之后放置在第一螺纹节段92上。致动构件26可在与膨胀方向相反的收缩方向上旋转,以使楔形构件22和24朝向彼此移动,从而使端板18和20在从膨胀位置朝向塌缩构型的方向上朝向彼此移动。因此,植入物10可在颅尾或上下方向(横向方向T)上膨胀,以与相邻的椎体2、4接合。
在本发明中可以使用其他机械部件来提供致动构件26的第一螺纹节段92和第二螺纹节段91的同时旋转,以通过在致动构件26的近侧端部26p处施加旋转力使第一楔形构件22和第二楔形构件24同时使植入物10膨胀。例如,在图27-31,示出了用于致动构件26的双万向接头实施方案。双万向接头102位于致动构件26的中间区段90中。双万向接头102构造有第一万向接头组件107和第二万向接头组件108。第一万向接头组件107具有联接到第一螺纹节段92,优选地与第一螺纹节段92一体地形成的叉103a。叉103a通过销106a联接到中心块(或球)104a,销106a延伸穿过叉103a中的相对开口109a。中心块104a还通过延伸穿过开口109a的销106a联接到中心叉105a。第二万向接头组件108具有联接到第二螺纹节段91,优选地与第二螺纹节段91一体地形成的叉103b。叉103b通过销106b联接到中心块104b,销106a延伸穿过叉103b中的相对开口109b。中心块104b还通过延伸穿过开口109b的销106b联接到中心叉105b。在该实施方案中,双万向接头102连同第一螺纹节段92和第二螺纹节段91形成用于植入物10的致动构件26。除允许两个螺纹节段91、92同时旋转的机械机构在图2-26中的该双万向接头102实施方案和柔性缆线93实施方案之间不同之外,植入物的其余部分和功能相同。就这一点而言,当在植入物中使用具有双万向接头102的致动构件26时,第一螺纹节段91和第二螺纹节段92之间的角度与上述柔性缆线93实施方案中的角度相同。
致动构件26的另一个实施方案示于图32-36中,一种螺旋扣实施方案。螺旋扣112位于致动构件26的中间节段90中。螺旋扣112构造有第一内端113a,该第一内端113a联接到第一螺纹节段92,优选地与第一螺纹节段92一体形成。第一内端113a部分地带有螺纹99,但沿其两侧116a切割以形成减小轮廓的环节段,并且侧面116a具有孔口119a。内轴114a还具有带有孔口115a的环节段。内端113a的孔口119a接收内轴114a的环节段,并且内轴114a的孔口115a接收内端113a的环节段,以在致动构件26的第一螺纹节段92上形成螺旋扣112的部分。螺旋扣112还构造有第二内端113b,该第二内端113a联接到第二螺纹节段91,优选地与第二螺纹节段91一体形成。第二内端113b部分地带有螺纹99,但沿其两侧116b切割以形成减小轮廓的环节段,并且侧面116b具有孔口119b。内轴114b还具有带有孔口115b的环节段。内端113b的孔口119b接收内轴114b的环节段,并且内轴114b的孔口115b接收内端113b的环节段,以在致动构件26的第二螺纹节段91上形成螺旋扣112的部分。在该实施方案中,螺旋扣112连同第一螺纹节段92和第二螺纹节段91形成用于植入物10的致动构件26。除允许两个螺纹节段91、92同时旋转的机械机构在图2-26中的该螺旋扣112实施方案和柔性缆线93实施方案之间不同之外,植入物的其余部分和功能相同。就这一点而言,当在植入物中使用具有螺旋扣112的致动构件26时,第一螺纹节段91和第二螺纹节段92之间的角度与上述柔性缆线93实施方案中的角度相同。
致动构件26的另一个实施方案示于图37-41中,一种万向接头实施方案。万向接头122位于致动构件26的中间区段90中。万向接头122构造有叉123a,该叉123a联接到第一螺纹节段92,优选地与第一螺纹节段92一体形成。叉123a通过销126联接到中心块(或球)124,销126延伸穿过叉123a中的相对开口129a。中心块124还通过延伸穿过开口129b的销126联接到相对的叉123b。叉123b联接到第二螺纹节段91,优选地与第二螺纹节段91一体地形成。在该实施方案中,万向接头122连同第一螺纹节段92和第二螺纹节段91形成用于植入物10的致动构件26。除允许两个螺纹节段91、92同时旋转的机械机构在图2-26中的该万向接头122实施方案和柔性缆线93实施方案之间不同之外,植入物的其余部分和功能相同,除了在如图所示的实施方案中不存在凸缘28。就这一点而言,当在植入物中使用具有万向接头122的致动构件26时,第一螺纹节段91和第二螺纹节段92之间的角度与上述柔性缆线93实施方案中的角度相同。
另一种可形成致动构件26的另一个实施方案的基础的驱动机构示于图42-45中,一种双接线圆柱体实施方案。双接线圆柱体142也是类似于缆线93实施方案的柔性杆,并且位于致动构件26的中间节段90中。双接线圆柱体142构造有第一接线圆柱体143a,该第一接线圆柱体143a联接到第一螺纹节段92,优选地与第一螺纹节段92一体形成。第一线接线圆柱体143a优选地由手术级金属合金诸如钛合金形成,该金属合金作为被转动以形成圆柱体形状的线。在其相对端处,第一接线圆柱体143a连接到第二接线圆柱体143b,该第二接线圆柱体143b在其相对端处连接到第二螺纹节段91。如图所示,凸缘28可任选地形成在第一接线圆柱体143a和第二接线圆柱体143b之间。在该实施方案中,双接线圆柱体142连同第一螺纹节段92和第二螺纹节段91形成用于植入物10的致动构件26。除允许两个螺纹节段91、92同时旋转的机械机构在图2-26中的该双接线圆柱体142实施方案和柔性缆线93实施方案之间不同之外,植入物的其余部分和功能相同。就这一点而言,当在植入物中使用具有双接线圆柱体142的致动构件26时,第一螺纹节段91和第二螺纹节段92之间的角度与上述柔性电缆93实施方案中的角度相同。
上端板18和下端板20中的每个可包括一个或多个射线照相标记。植入物10可限定一个或多个孔(未示出),孔的大小和尺寸被设计成在其中接收射线照相标记。例如,射线照相标记可设置在上端板18或下端板20或两者中的突出的部分16附近。因此,标记可识别植入物的突出的部分16的位置以及当标记物位于每个端板中时植入物10的膨胀程度。例如,当植入物10插入到椎间空间9中,并且植入物10从第一构型C膨胀到膨胀构型E时,标记可沿横向方向T分离。使用图像分析,可通过观察设置在上端板18中的标记相比于设置在下端板20中的标记之间的分离程度确定或指示板分离的程度。
尽管已详细描述了本公开,然而应当理解,在不背离如随附权利要求书所限定的本发明的精神和范围的条件下,可对本文作出各种改变、替代和更改。此外,本公开的范围并非旨在仅限于本说明书中所述的具体实施方案。本领域的普通技术人员将容易理解可根据本公开采用与本文所述的相应实施方案执行基本上相同的功能或实现基本上相同结果的现有或以后将开发出的工艺、机器、制造、物质的组成、装置、方法或步骤。
Claims (21)
1.一种用于插入到上椎体和相邻下椎体之间的椎间空间中的可膨胀植入物,所述可膨胀植入物包括:
上端板,所述上端板具有被构造成接触所述上椎体的上外表面;
下端板,所述下端板具有被构造成接触所述下椎体的下外表面;
致动构件,所述致动构件至少部分地设置在所述上端板和所述下端板之间,所述致动构件具有沿所述致动构件的第一中心纵向轴线延伸的第一螺纹节段和接合到所述第一螺纹节段并且沿所述致动构件的第二中心纵向轴线延伸的第二螺纹节段,其中所述第一中心纵向轴线和所述第二中心纵向轴线形成在约15°和约75°之间的角度;
第一楔形构件和第二楔形构件,所述第一楔形构件与所述第一螺纹节段通过螺纹配合,所述第二楔形构件与所述第二螺纹节段通过螺纹配合;
其中所述致动构件被构造成围绕所述第一中心纵向轴线和所述第二中心纵向轴线旋转,从而驱动所述第一楔形构件沿所述第一螺纹节段平移,并且驱动所述第二楔形构件沿所述第二螺纹节段平移,使得所述下端板和所述上端板中的至少一个被迫从塌缩植入物构型到膨胀植入物构型移动远离所述下端板和所述上端板中的另一个。
2.根据权利要求1所述的可膨胀植入物,其中所述致动构件包括邻近所述可膨胀植入物的插入端部部分并邻近所述第二螺纹节段定位的远侧端部,邻近所述第一螺纹节段定位的近侧端部,以及用于响应于所述第一螺纹节段在第一旋转方向上旋转而使所述第二螺纹节段在所述第一旋转方向上旋转的装置。
3.根据权利要求1所述的可膨胀植入物,其中所述致动构件包括位于所述第一螺纹节段和所述第二螺纹节段之间的万向接头。
4.根据权利要求1所述的可膨胀植入物,其中所述致动构件包括位于所述第一螺纹节段和所述第二螺纹节段之间的双万向接头。
5.根据权利要求1所述的可膨胀植入物,其中所述致动构件包括位于所述第一螺纹节段和所述第二螺纹节段之间的螺旋扣组件。
6.根据权利要求1所述的可膨胀植入物,其中所述致动构件包括柔性杆,所述柔性杆位于所述第一螺纹节段和所述第二螺纹节段之间并且连接到所述第一螺纹节段和所述第二螺纹节段。
7.根据权利要求6所述的可膨胀植入物,其中所述柔性杆包括接线圆柱体。
8.根据权利要求6所述的可膨胀植入物,其中所述柔性杆包括缆线。
9.根据权利要求1所述的可膨胀植入物,其中所述第一螺纹节段与所述第二螺纹节段具有相反的螺纹。
10.根据权利要求1所述的可膨胀植入物,其中所述第一楔形构件具有在所述上内表面上接触第一上斜坡表面的上倾斜表面。
11.根据权利要求10所述的可膨胀植入物,其中所述第一楔形构件具有在所述下内表面上接触第一下斜坡表面的下倾斜表面。
12.根据权利要求1所述的可膨胀植入物,其中所述第一中心纵向轴线和所述第二中心纵向轴线形成在约15°和约55°之间的角度。
13.根据权利要求1所述的可膨胀植入物,其中所述第一中心纵向轴线和所述第二中心纵向轴线形成在30°和40°之间的角度。
14.一种用于将椎间植入物插入到上椎体和相邻下椎体之间的椎间空间中的方法,所述方法包括:
将处于塌缩构型的可膨胀植入物插入到所述椎间空间中,其中所述可膨胀植入物包括具有面向所述上椎体的上外表面的上端板和具有面向所述下椎体的下外表面的下端板;
使至少部分地设置在所述下端板和所述上端板之间的致动构件旋转,从而使所述可膨胀植入物从所述塌缩构型变化至膨胀构型,其中所述下端板和所述上端板中的至少一个在颅尾方向上与所述下端板和所述上端板中的另一个分开;
其中所述致动构件包括第一楔形构件和第二楔形构件,所述第一楔形构件与所述致动构件的第一螺纹节段通过螺纹配合,所述第一螺纹节段沿第一中心纵向轴线延伸,所述第二楔形构件与所述致动构件的第二螺纹节段通过螺纹配合,所述第二螺纹节段与所述第一螺纹节段接合,所述第二螺纹节段沿所述致动构件的第二中心纵向轴线延伸,其中所述第一中心纵向轴线和所述第二中心纵向轴线形成在15°和75°之间的角度。
15. 根据权利要求14所述的方法,其中:
所述致动构件包括1)远侧端部,所述远侧端部邻近所述椎间植入物的插入端部部分并邻近所述第二螺纹节段定位,和2)近侧端部,所述近侧端部邻近所述第一螺纹节段定位,以及
在第一旋转方向上旋转所述第一螺纹节段使得所述第二螺纹节段在所述第一旋转方向上旋转。
16.根据权利要求15所述的方法,其中所述致动构件包括位于所述第一螺纹节段和所述第二螺纹节段之间的万向接头。
17.根据权利要求15所述的方法,其中所述致动构件包括位于所述第一螺纹节段和所述第二螺纹节段之间的双万向接头。
18.根据权利要求15所述的方法,其中所述致动构件包括位于所述第一螺纹节段和所述第二螺纹节段之间的螺旋扣组件。
19.根据权利要求15所述的方法,其中所述致动构件包括柔性杆,所述柔性杆位于所述第一螺纹节段和所述第二螺纹节段之间并且连接到所述第一螺纹节段和所述第二螺纹节段。
20.根据权利要求15所述的方法,其中所述第一螺纹节段与所述第二螺纹节段具有相反的螺纹。
21.根据权利要求15所述的方法,其中使所述第一螺纹节段在所述第一旋转方向上旋转使得所述第一楔形构件和所述第二楔形构件在所述颅尾方向上不均匀地移开所述下端板和所述上端板,从而引起所述上椎体和所述下椎体之间的脊柱前凸膨胀和脊柱后凸膨胀中的一个。
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- 2017-10-30 CN CN201780067983.2A patent/CN109906061B/zh active Active
- 2017-10-30 MA MA046719A patent/MA46719A/fr unknown
- 2017-10-30 JP JP2019523064A patent/JP2019532771A/ja active Pending
- 2017-10-30 EP EP17866574.1A patent/EP3534811A4/en active Pending
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AU2017353899A1 (en) | 2019-05-02 |
CN109906061B (zh) | 2022-07-05 |
MA46719A (fr) | 2019-09-11 |
AU2017353899B2 (en) | 2023-02-02 |
WO2018085189A1 (en) | 2018-05-11 |
EP3534811A4 (en) | 2020-07-08 |
EP3534811A1 (en) | 2019-09-11 |
US20180116819A1 (en) | 2018-05-03 |
US10537436B2 (en) | 2020-01-21 |
JP2019532771A (ja) | 2019-11-14 |
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