CN110612070B - 可伸展保持架 - Google Patents
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Abstract
本发明公开了一种椎间植入物,该椎间植入物在塌缩构型和伸展构型之间迭代,该椎间植入物包括第一板和第二板,该第一板和第二板沿着第一方向彼此间隔开并且限定沿着第一方向背向彼此的骨接触表面。伸展组件相对于第一方向定位在板之间并且包括第一支撑楔形件,该第一支撑楔形件支撑第一板并限定第一坡道;以及第二支撑楔形件,该第二支撑楔形件支撑第二板并限定第二坡道和第三坡道。伸展组件包括限定第四坡道的伸展楔形件。第一坡道、第二坡道、第三坡道和第四坡道各自相对于第二方向倾斜,该第二方向基本上垂直于第一方向。第一支撑楔形件和第二支撑楔形件中的至少一个能够沿着相应的被支撑的第一板或第二板滑动。植入物包括致动器,该致动器被构造为向伸展楔形件施加驱动力,以便致使1)第四坡道沿着第三坡道行进,以便沿着第一方向增加骨接触表面之间的距离,并且2)第二坡道沿着第一坡道行进,从而进一步增加所述距离,从而将植入物从塌缩构型迭代到伸展构型。
Description
技术领域
本发明涉及可伸展椎间植入物,具体地讲,涉及具有一对端板的植入物,以及相关的方法,该对端板中的至少一个相对于另一个能够独立地伸展和旋转。
背景技术
如果椎间盘退化,则通常期望移除椎间盘。脊柱融合术可用于治疗这样的病症,并涉及用诸如保持架或其它垫片之类的装置代替退化椎间盘,该装置恢复椎间隙的高度并允许骨生长通过该装置以融合相邻的椎骨。脊柱融合术试图恢复正常的脊柱排列,稳定脊柱节段以进行适当的融合,创建最佳的融合环境,并通过使对脊柱脉管系统、硬脑膜和神经元的损害最小化来允许早期主动活动。当脊柱融合术满足这些目标时,愈合加快,并且患者功能、舒适度和活动性得到改善。压紧到椎间隙中并允许骨从相邻椎体穿过植入物的上表面和下表面生长的垫片装置在本领域中是已知的。然而,仍然需要使过程侵入性最小化但稳定脊柱节段并创建用于脊柱融合术的最佳空间的装置。
发明内容
根据本公开的一个实施方案,被构造为在塌缩构型和伸展构型之间迭代的椎间植入物包括沿着第一方向彼此间隔开的第一板和第二板。第一板限定第一骨接触表面,并且第二板限定沿着第一方向背向第一骨接触表面的第二骨接触表面。植入物包括相对于第一方向设置在第一板和第二板之间的伸展组件。伸展组件包括第一支撑楔形件,该第一支撑楔形件支撑第一板并限定第一坡道;以及第二支撑楔形件,该第二支撑楔形件支撑第二板并限定第二坡道和第三坡道。伸展组件包括伸展楔形件,该伸展楔形件限定第四坡道,其中第一坡道、第二坡道、第三坡道和第四坡道中的每个相对于基本上垂直于第一方向的第二方向倾斜。第一支撑楔形件和第二支撑楔形件中的至少一个能够沿着相应的被支撑的第一板或第二板滑动。植入物包括致动器,该致动器被构造为向伸展楔形件施加驱动力,以便使得1)第四坡道沿着第三坡道行进以便沿着第一方向增加第一骨接触表面和第二骨接触表面之间的距离,并且2)第二坡道沿着第一坡道行进,从而进一步增加距离,从而将植入物从塌缩构型迭代到伸展构型。
根据本公开的另一个实施方案,用于侧向插入椎间间隙的植入物包括相对于竖直方向设置在第一端板和第二端板之间的伸展机构。第一端板限定第一骨接触表面,并且第二端板限定沿着竖直方向背向第一骨接触表面的第二骨接触表面。伸展机构包括沿着第一轴线布置的前致动组件和沿着第二轴线布置的后致动组件。第一轴线和第二轴线各自沿着基本上垂直于竖直方向的纵向方向取向。第一轴线和第二轴线沿着基本上垂直于竖直方向和纵向方向的横向方向彼此间隔开。沿着竖直方向在第一骨接触表面和第二骨接触表面之间的第一距离与第一轴线相交,并且沿着竖直方向在第一骨接触表面和第二骨接触表面之间的第二距离与第二轴线相交。前致动组件和后致动组件各自包括第一支撑楔形件,该第一支撑楔形件支撑第一端板;以及第二支撑楔形件,该第二支撑楔形件支撑第二端板并且能够相对于第一支撑楔形件滑动。致动组件各自还包括伸展楔形件,该伸展楔形件能够相对于第二支撑楔形件滑动;以及驱动轴,该驱动轴联接到伸展楔形件并且可围绕相应的第一轴线或第二轴线旋转,以便致使1)伸展楔形件沿着第二支撑楔形件行进,并且2)第二支撑楔形件沿着第一支撑楔形件行进,从而改变相应的第一距离或第二距离。前致动组件和后致动组件的驱动轴能够彼此独立地旋转以便提供第一距离和第二距离之间的差值。
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是根据本公开的第一示例性实施方案的定位在相邻椎体之间的植入物的端视图,其中植入物处于塌缩构型;
图2是被示为处于塌缩构型的图1的植入物的透视图;
图3是被示为处于塌缩构型的图1的植入物的端视图;
图4是被示为处于塌缩构型的图1的植入物的纵向截面图;
图5是图1的植入物的局部分解透视图,其中以将植入物的内部伸展机构示为处于塌缩构型的方式分离植入物的骨板;
图6是图1的植入物的分解图;
图7是示于图6中的骨板中的一个的端部部分的放大图;
图8是示于图6中的另一个骨板的端部部分的反向透视图;
图9是示于图5和图6中的伸展机构的致动构件的纵向侧视图;
图10是示于图5和图6中的伸展组件的第一伸展楔形件的透视图;
图11是图10的第一伸展楔形件的另一个透视图;
图12是图10的第一伸展楔形件的侧视图;
图13是示于图10至图12中的第一伸展楔形件的变型形式的透视图;
图14是图13的第一伸展楔形件的变型形式的另一个透视图;
图15是图13的第一伸展楔形件的变型形式的侧视图;
图16是示于图5和图6中的伸展组件的第二伸展楔形件的透视图;
图17是图16的第二伸展楔形件的另一个透视图;
图18是图16的第二伸展楔形件的侧视图;
图19是示于图5和图6中的伸展组件的第三伸展楔形件的透视图;
图20是图19的第三伸展楔形件的另一个透视图;
图21是图19的第三伸展楔形件的侧视图;
图22是示于图5和图6中的伸展组件的第四伸展楔形件的透视图;
图23是图22的第四伸展楔形件的另一个透视图;
图24是图22的第四伸展楔形件的侧视图;
图25是图22的第四伸展楔形件的前端视图;
图26是在示于图5和图6中的伸展组件的第一伸展阶段期间第一楔形件和第四楔形件的侧面局部截面图;
图27是在伸展组件的第一伸展阶段和第二伸展阶段之间图26的第一楔形件和第四楔形件的侧面局部截面图;
图28是在伸展组件的第二伸展阶段期间第一楔形件和第四楔形件的侧面局部截面图;
图29是图5和图6的伸展组件的内端的透视图,其中伸展组件被示为处于伸展和前凸构型;
图30是示于图5和图6中的致动组件的侧视图,其中为了比较,近侧伸展组件被示为处于塌缩构型,并且远侧伸展组件被示为处于完全伸展构型;
图31是图4的纵向截面图的放大图,将植入物示为处于塌缩构型;
图32是处于部分伸展构型的图1的植入物的透视图;
图33是示于图32中的植入物的端视图;
图34是沿着图33的剖面线34-34截取的示于图32和图33中的植入物的纵向截面图;
图35是被示为处于完全伸展构型的图1的植入物的纵向截面图;
图36是示于图35中的植入物的透视图;
图37是示于图36中的植入物的端视图;
图38是被示为处于部分伸展的前凸构型的图1的植入物的透视图;
图39是图38的植入物的透视图,为了说明目的移除骨板而示出;
图40是图38的植入物的端视图;
图41是示于图5和图6中的致动组件的一对楔形构件的端视图,示出了楔形构件中的一个相对于另一个的旋转;
图42是根据本公开的第二示例性实施方案的处于塌缩构型的植入物的透视图;
图43是图42的植入物的另一个透视图,其中示出以将植入物的内部伸展机构示为处于塌缩构型的方式分离植入物的骨板,另外,其中骨板中的顶部一者以书状形式展开,示出了骨板的内面;
图44是沿着伸展机构的驱动轴定位的图43的伸展机构的一对楔形构件的透视图;
图45是图44的楔形构件的另一个透视图,其中示出楔形构件中的一个相对于另一个楔形构件围绕驱动轴旋转;
图46是图44的楔形构件的分解透视图;
图47是被示为处于完全伸展构型的图42的植入物的透视图,其中为了说明目的移除骨板中的一个;
图48是处于前凸构型的图42的植入物的端视图;
图49是图48的植入物的局部分解透视图;并且
图50是被构造为使示于图38中的植入物的伸展的驱动工具的透视图。
具体实施方式
参考下列结合对构成本公开的一部分的附图和实例的详细说明可更易于理解本公开。应当理解,本公开不限于本文所述和/或所示的具体装置、方法、应用、条件或参数,并且本文所用的术语仅用于以举例的方式描述具体实施方案的目的,并非旨在限制本公开的范围。此外,除非上下文另外明确地指出,否则如本说明书(包括随附权利要求书)中所用,单数形式“一个”和“所述”包括复数,并且提到特定数值时至少包括此特定值。
本文所用的术语“多个”意指多于一个。当表示值的范围时,另一个实施例包括从一个具体的值和/或到其他具体的值。相似地,当前面用“约”将值表示为近似值时,应当理解,该值的具体值构成了另一个实施例。所有范围均包括端值在内并且可组合。
参见图1,上椎体2和相邻下椎体4限定在椎体2、4之间延伸的椎间间隙5。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。椎体2、4可以是在解剖学上相邻的,或者可以是从椎体2、4之间的位置移除中间椎体之后的剩余椎体。图1中示出了椎间盘切除术之后的椎间间隙5,由此已经移除或至少部分地移除了椎间盘材料,以准备用于接纳可伸展椎间植入物10的椎间间隙5。植入物10被示为处于塌缩构型,在该构型中,植入物10可被构造用于侧向插入(即,沿着内侧-外侧轨迹)在椎间间隙5内。
一旦插入椎间间隙5中,植入物10便可沿头尾(即,竖直)方向伸展,或者以其它方式在塌缩构型和完全伸展构型之间迭代,以实现适当的高度恢复。另外,植入物10的侧面中的一个可以比相对侧竖直地伸展更大程度,以实现脊柱前凸或后凸,如下文更详细地公开。
椎间间隙5可根据需要沿着脊柱设置在任何位置,包括在脊柱的腰椎、胸腔和颈椎区域处。应当理解,植入物10的某些特征可以类似于在2014年8月28日以Mi l ler的名义发布的美国专利公布2014/0243982A1中阐述的那些特征,该专利的整个公开内容以引用方式并入本文。
下述说明所使用的某些术语仅为了方便起见且并非限制性的。词汇“右”、“左”、“下”和“上”指定附图中的方向,以此作为参照。词汇“内”、“内部的”和“内部”是指朝向植入物10的几何中心的方向,而词汇“外”、“外部的”和“外部”是指远离植入物的几何中心的方向。词汇“前”、“后”、“上”、“下”、“内侧”、“外侧”和相关词汇和/或短语用于指示所参照的人体内的各种位置和取向。当关于植入物10或其部件使用这些词汇时,应将它们理解为是指在植入体内时植入物10的相对位置,如图1所示。术语包括以上列举的词汇、它们的派生词以及具有类似含义的词汇。
植入物10在本文中被描述为沿着纵向方向“L”和横向方向“T”水平延伸,并且沿着竖直方向“V”竖直延伸。纵向方向L可至少基本上垂直于横向方向T和竖直方向V中的每个。横向方向T可至少基本上垂直于纵向方向L和竖直方向V中的每个。竖直方向V可至少基本上垂直于纵向方向L和横向方向T中的每个。除非本文另有说明,否则术语“纵向”、“横向”和“竖直”用于参考植入物10被构造为定位在椎间间隙5中的取向来描述各种植入物部件和植入物部件轴线的正交方向部件;然而,无论植入物的实际取向如何,都可以相对于植入物一致地使用此类方向术语。另外,应当理解,虽然纵向方向L和横向方向V被示出为沿着水平平面(在本文中也称为“纵向-横向平面”)延伸并且限定该水平平面,并且竖直方向被示出为沿着竖直平面(诸如在本文中分别称为“垂直-纵向平面”或“垂直-横向平面”)延伸,但涵盖各个方向的平面在使用期间可能会有所不同。例如,当将植入物10插入椎间间隙5中时,竖直方向V大致沿着上-下(或尾-头)方向延伸,纵向方向L大致沿着内侧-外侧方向延伸,而横向方向L大致沿着前-后方向延伸。因此,水平平面通常位于由前-后方向和内侧-外侧方向限定的解剖平面中。因此,方向术语“竖直”、“纵向”、“横向”和“水平”和此类术语可用于描述植入物10及其部件,仅出于清楚和说明的目的而示出。考虑到前述,在参考植入物10使用时,术语“扩展”和“伸展”是指沿着竖直方向V的伸展。
现在参见图2,根据第一实施方案的植入物10可限定沿着纵向方向L彼此间隔开的近侧端部12和远侧端部14。具体地讲,远侧端部14可沿远侧方向与近侧端部12间隔开,并且近侧端部12可沿与远侧方向相反的近侧方向与远侧端部14间隔开。因此,如本文所用,术语“纵向方向L”是双向的,并且由单方向的远侧方向和相对的近侧方向限定。另外,植入物10可限定沿横向方向T彼此间隔开的前侧16和后侧18。具体地讲,前侧16可沿前方向与后侧18间隔开,并且后侧18可沿与前方向相反的后方向与前侧16间隔开。因此,如本文所用,术语“横向方向T”是双向的,并且由单方向的前方向和相对的后方向限定。
植入物10可包括沿着竖直方向V彼此间隔开的第一或下板20以及第二或上板22。下板20和上板22可称为“端板”。下板20可限定第一或下板主体24,并且上板22可限定第二或上板主体26。下板主体24可在其外部上限定第一或下骨接触表面28。上板主体26可在其外部上限定第二或上骨接触表面30,如图3所示。下骨接触表面28和上骨接触表面30可背向彼此。具体地讲,上骨接触表面30可面向上椎骨2的上椎骨表面6,而下骨接触表面28可面向下椎体4的下椎骨表面8。下骨接触表面28和上骨接触表面30可各自是基本上平面的;然而,在其它实施方案中,每个骨接触表面28、30例如可至少部分地凸出,并且可至少部分地限定纹理(未示出),诸如尖峰、脊、锥、倒钩、凹痕或滚纹,其被构造为当将植入物10插入到椎间间隙5中时接合相应的椎体2、4。
当植入物10处于塌缩构型时,下骨接触表面28和上骨接触表面30可沿着竖直方向V彼此间隔开距离D,通过非限制性示例,该距离在约5mm和约20mm的范围内,但是其它尺寸也在本公开的范围内。另外,当植入物10处于塌缩构型时,下骨接触表面28和上骨接触表面30均可相对于横向方向T彼此平行,并且因此可具有中立(即,既不是脊柱前凸也不是脊柱后凸)塌缩轮廓。如本文所用,术语“脊柱前凸”、“脊柱后凸”及其相应的派生词可互换使用,每个术语是指植入物10的任何构型,其中下骨接触表面28和上骨接触表面30在竖直横向平面中相对于彼此成角度。
应当理解,下板主体24和上板主体26可彼此重叠,使得植入物10的近侧端部12和远侧端部14可被表征为每个板20、22或板主体24、26的近侧端部12和远侧端部14。类似地,植入物10的前侧16和后侧18也可被表征为每个板20、22或板主体24、26的前侧16和后侧18。
如图2和图3所示,植入物10的近侧端部12可包括联接特征,诸如联接孔32,用于接纳被构造为将植入物10插入椎间间隙中的插入器械。联接孔32可由下板主体24和上板主体26共同限定。植入物10还可以限定一个或多个竖直孔34(图2),其沿着竖直方向V延伸穿过下板主体24和上板主体26。竖直孔34可彼此连通并且与联接孔32连通,并且可被构造为在植入物10伸展之后接纳骨生长材料以便与上椎体2和下椎体4融合。
继续参考图2,植入物10通常可限定前部部分36和后部部分38,其各自沿着纵向方向L伸长并且相对于横向方向T位于竖直孔34的相对侧上。植入物10通常还可限定沿远侧方向与竖直孔34间隔开的远侧部分40。植入物10的远侧端部14也可称为植入物10的“插入端部”。为了便于插入,上板主体12和下板主体18可各自邻近远侧端部14限定锥形表面42,其中每个锥形表面42沿远侧方向倾斜,如图2和图4所示。
现在参见图5和图6,下板主体24和上板主体26中的每个可限定相对于竖直方向V与相应的骨接触表面28、30相对的内面44。另外,下板主体24和上板主体26的内面44可各自限定一个或多个内部接触表面46。当植入物10处于塌缩构型时,上板主体26的内部接触表面46可邻接下板主体24的内部接触表面46。下板主体24和上板主体26的内面44可联接到伸展机构48,并且被构造为与该伸展机构接合,该伸展机构被构造为使伸展构件(诸如楔形件51、52、53、54)相对于彼此以沿竖直方向V使植入物10伸展的方式移动,如下面更详细地讨论的。
每个板主体24、26的内面44还可限定各自沿着纵向方向L伸长的前通道56和后通道58。每个板20、22的前通道56和后通道58可沿着竖直方向V从其内部接触表面46朝向相应的骨接触表面28、30延伸到相应的板主体24、26中。板12、18的前通道56可位于植入物10的前部部分36内,并且板12、18的后通道58可位于植入物10的后部部分38内。板12、18的前通道56可彼此重叠,以便至少部分地限定植入物10的第一或前隔室60,同时板12、18的后通道58可彼此重叠,以便至少部分地限定植入物10的第二或后隔室62(图3)。前隔室60和后隔室62可被构造为容纳伸展机构48的部件。因此,隔室60、62可被称为“伸展隔室”。
如图7的放大图更清除地示出,前通道56和后通道58可各自在沿着横向方向T间隔开的相对的前侧壁64和后侧壁66之间延伸。每个通道56、58还可以沿着竖直方向V从内部接触表面46延伸到通道56、58的基部表面68。因此,每个通道56、58的基部表面68可被表征为在板主体24、26内从相应的内部接触表面46朝向相应的骨接触表面28、30竖直地凹陷。每个通道的基部表面68可沿着纵向方向L和横向方向T延伸,并且可任选地是基本上平面的。
每个通道56、58还可包括引导特征结构,诸如导槽70,其从基部表面68朝向骨接触表面28、30凹陷。通道56、58的每个导槽70也可称为“板导槽”70。板导槽70可具有被构造为引导伸展机构48的一个或多个部件在通道56、58内沿着纵向方向L移动的几何形状。任选地,板导槽70还可被构造为在竖直方向V上朝向相关联板20、22的内部接触表面46提供与此类部件的机械干涉。换句话讲,板导槽70可任选地具有几何形状,使得板主体24、26以防止部件与板导槽70(以及通过延伸而与通道56、58)脱开的方式与伸展机构48的所述部件互锁。因此,板导槽70还可被表征为保持特征结构。例如,板导槽70可在竖直横向平面中具有燕尾形轮廓,如图所示。然而,应当理解,板导槽70的其它轮廓和几何形状也在本公开的范围内。
下板主体24和上板主体26的内面44也可限定一个或多个联接特征结构,用于将下板主体24和上板主体26联接在一起,特别是在塌缩构型中。板主体14、20的联接特征结构可被构造为以在整个操作的各个阶段稳定植入物10的方式彼此嵌套。例如,如图5和图6所示,在下板主体24的远侧部分40处,内面44可限定第一横向狭槽72,沿远侧方向与第一横向狭槽72间隔开的第二横向狭槽74,以及定位在第一横向狭槽72和第二横向狭槽74之间的横向壁76。横向壁76可沿着横向方向T在前壁端部78和后壁端部80之间延伸。
如图8所示,在上板主体26的远侧部分40处,内面44可限定第一横向突起82,以及沿远侧方向与第一横向突起82间隔开的第二横向突起84。第一横向突起82和第二横向突起84中的每个可从上板主体26朝向下板主体24突出超过其内部接触表面46。第一横向突起82和第二横向突起84可各自在前端部86和后端部88之间沿着横向方向T延伸,并且可在近侧面90与远侧面92之间沿着纵向方向L延伸。当植入物10处于塌缩构型时,上板主体26的第一横向突起82和第二横向突起84可分别嵌套在下板主体24的第一横向狭槽72和第二横向狭槽74内(图4)。当植入物10从塌缩构型伸展时,横向突起82、84和横向狭槽72、74可有效地稳定植入物并且抑制沿着纵向方向L在下板主体24和上板主体26之间的相对运动。
再次参见图5和图6,伸展机构48可定位在下板20和上板22之间。在所示实施方案中,伸展机构48可被构造为将医师施加的一个或多个旋转输入力转换成沿着竖直方向V的一个或多个对应的线性伸展力。伸展机构48可包括一个或多个致动组件94、96,其各自被构造为将旋转输入力转换成沿着竖直方向V的线性伸展力。如图所示,伸展机构48可包括沿着横向方向T彼此间隔开的第一或前致动组件94和第二或后致动组件96。前致动组件94可被构造为将第一旋转输入力R1转换成沿着竖直方向V的多个线性伸展力Z1、Z2、Z3、Z4,以便沿着竖直方向V伸展植入物10的前部分36。类似地,后致动组件96可被构造为将第二旋转输入力R2转换成沿着竖直方向V的多个线性伸展力Z1、Z2、Z3、Z4,以便沿着竖直方向V伸展植入物10的后部分38。
可以驱动前致动组件94和后致动组件96以便如医师所期望,提供植入物10沿着竖直方向的一致或不一致的伸展或收缩。例如,致动组件94、96中的任一个都可彼此独立地被驱动。当独立驱动时,前致动组件94和后致动组件96可将植入物10的前部部分36和后部部分38沿着竖直方向V伸展到不同的伸展高度,从而为植入物10在椎间间隙5中提供脊柱前凸轮廓,如下面更详细地讨论的。因此,植入物10允许椎间间隙内的竖直伸展以及彼此独立地调节植入物10的脊柱前凸角。
前致动组件94和后致动组件96可被基本上类似地构造;因此,将相对于致动组件94、96的对应部件和特征结构在本文中使用相同的附图标记。每个致动组件94、96可包括致动器,诸如驱动轴98,同样如图9所示。驱动轴98可限定沿着纵向方向L延伸的中心轴轴线X1,并且还可限定沿着中心轴轴线X1彼此间隔开的近侧端部100和远侧端部102。
继续参考图9,驱动轴98可包括一个或多个螺纹部分104、106,其被构造为沿着纵向方向L传递一个或多个线性驱动力F1、F2。例如,驱动轴98可包括第一或近侧螺纹部分104以及沿着中心轴轴线X1沿远侧方向与近侧螺纹部分104间隔开的第二或远侧螺纹部分106。近侧螺纹部分104和远侧螺纹部分106的螺纹可以具有不同的螺纹质量。例如,在所示实施方案中,近侧螺纹部分104限定沿与远侧螺纹部分106相反的方向取向的螺纹图案。以这种方式,在驱动轴98旋转时,近侧螺纹部分104可提供第一线性驱动力F1,远侧螺纹部分106可提供第二线性驱动力F2,并且第一线性驱动力F1和第二线性驱动力F2可彼此相反。
驱动轴98可包括定位在近侧螺纹部分104和远侧螺纹部分106之间的中间部分108。近侧螺纹部分104的螺纹可与远侧螺纹部分106的螺纹在中间部分108处基本上接续。因此,中间部分108可限定螺纹部分104、106之间的边界。在所示实施方案中,中间部分108可被表征为近侧螺纹部分104和远侧螺纹部分106中的每个的内端,而驱动轴98的近侧端部100可限定近侧螺纹部分104的外端,并且驱动轴98的远侧端部102可限定远侧螺纹部分106的外端。此外,在所示实施方案中,前和后驱动轴98的中间部分108可限定植入物10相对于纵向方向L的中心或中点。因此,相对于驱动轴98的每个螺纹部分104、106(以及位于其上的任何部件),外部纵向方向LE从内端108延伸到外端100、102,内部纵向方向LI从外端100、102延伸到内端108。
头部110可位于驱动轴98的远侧端部102处,并且可以与远侧螺纹部分106接续。头部110可与驱动轴98成整体,或者可以是单独部件,诸如螺纹联接到远侧螺纹部分106的螺母。头部110可限定近侧端部112以及沿着纵向方向L与近侧端部112间隔开的远侧端部114。诸如螺母插座116之类的驱动联接件可螺纹连接至驱动轴98的近侧端部100,并且可与近侧螺纹部分104接续。螺母插座116可限定从螺母插座116的近侧端部120朝向其远侧端部122延伸的插座孔118。如图所示,插座孔118可限定六角形插座,但是可采用其它插座构型来连接到由医师操作的驱动工具。
再次参加图5和图6,每个致动组件94、96可包括沿着竖直方向V伸展的一个或多个伸展组件124、126(也称为“楔形件组件”)。例如,第一或近侧楔形件组件124可与驱动轴98的近侧螺纹部分104接合,并且第二或远侧楔形件组件126可与驱动轴98的远侧螺纹部分106接合。在图6中,后致动组件96的近侧楔形件组件124以虚线表示,并且前致动组件94的远侧楔形件组件126以虚线表示。近侧楔形件组件124和远侧楔形件组件126可被表征为相应的前致动组件94和后致动组件96的子组件。另外,在每个致动组件94、96内,近侧楔形件组件124和远侧楔形件组件126可围绕定位在驱动轴98的中间部分108处的竖直横向平面任选地为彼此的大致镜像。换句话讲,远侧楔形件组件126可被构造为实际上与近侧楔形件组件126相同(或至少基本上相似),主要区别在于远侧楔形件组件126相对于纵向方向L翻转。近侧楔形件组件124和远侧楔形件组件126中的一些微小变化将在下面更充分地阐述。
每个近侧楔形件组件124和远侧楔形件组件126可包括多个伸展构件或楔形件51、52、53、54,其可相对于彼此移动,以便沿着竖直方向V增加其共同的高度。例如,伸展构件可包括第一楔形件51、第二楔形件52、第三楔形件53和第四楔形件54。楔形件51、52、53、54中的一个或多个可接合驱动轴98的相应螺纹部分104、106。
参考图4,当植入物10处于塌缩构型时,第一楔形件51可被定位成邻近驱动轴98的相应螺纹部分104、106的外端;第二楔形件52可沿内部纵向方向LI与第一楔形件51间隔开;第三楔形件53可沿内部纵向方向LI与第二楔形件52间隔开;并且第四楔形件54可沿内部纵向方向LI与第三楔形件53间隔开。因此,第一楔形件51可被表征为“最外部”楔形件,而第四楔形件54可被表征为“最内部”楔形件,但是其它构型也是可能的。另外,楔形件51、52、53、54可限定几何形状,该几何形状为每个楔形件组件124、126提供沿纵向方向L和竖直方向V的伸缩运动。换句话讲,楔形件51、52、53、54可被成形为使得当楔形件51、52、53、54彼此接合时,其共同的高度可增加,而器共同的长度减小,反之亦然,如下面更详细地阐述的。
现在参见图10至图12,第一楔形件51可具有第一楔形件主体128,该第一楔形件主体限定内端130以及沿着纵向方向L与内端130间隔开的外端132。第一楔形件主体128还可限定沿着横向方向T彼此间隔开的前侧表面134和后侧表面136。第一楔形件主体128的外端132可限定沿着竖直方向V在主体128的向上顶点140和底部或基部表面142之间延伸的外面138。外面138可以是基本上平面的,但是其它几何形状也在本公开的范围内。外面138可被构造为以在患者体内的植入物10的操作期间限制或防止第一楔形件主体128沿外部纵向方向LE的运动的方式邻接植入物10的另一个部件。例如,通过非限制性示例,在近侧楔形件组件124中,第一楔形件51的外面138可被构造为邻接螺母插座116的远侧端部122。
向上顶点140可位于第一楔形件主体128的外端132处。第一楔形件主体128的基部表面142可被构造为接合下板主体24的相应前通道56或后通道58的基部表面68。第一楔形件主体128的基部表面142的至少一部分可以是基本上平面的,并且可被构造为例如至少在植入物10的组装期间至少部分地跨过相应通道56、58的底表面68平移。在其它实施方案中,一旦在相应的通道56、58内就位,第一楔形件51可诸如通过焊接、钎焊、粘合剂或机械紧固件固定到下板主体24。在另外的实施方案中,第一楔形件51可与下板主体24成整体。因为第一楔形件51可被表征为“支撑”下板主体24,所以第一楔形件51在本文中可被称为“支撑构件”或“支撑楔形件”。
在所示实施方案中,第一楔形件51还可包括第一或下引导元件,诸如引导突起144,其被构造为例如在植入物10的组装期间在相关联通道56、58的板导槽70内平移。引导突起144可从第一引导主体128的基部表面142延伸。引导突起144的底部表面146可限定第一楔形件51和相应的楔形件组件124、126的最底部部分。引导突起144可具有被构造为引导第一楔形件主体128在相应通道56、58内沿着纵向方向L的移动的几何形状。另外,第一楔形件主体128的引导突起144和下板主体24的相应导槽70可协作地成形以使得第一楔形件主体128以防止第一楔形件主体128和下板主体24沿着竖直方向V脱离的方式与下板主体24互锁。例如,如图所示,引导突起144和板导槽70可在竖直横向平面中具有对应燕尾形轮廓,但其它几何形状也在本公开的范围内。以这种方式,第一楔形件51能够在下板主体24的相应的通道56、58内纵向地移动,但是基本上竖直地不能够移动。因此,引导突起144还可被表征为第一楔形件51的保持特征结构。另外,引导突起144和板导槽70的轮廓可允许第一楔形件51和下板主体24彼此旋转地互锁,使得例如第一楔形件51和下板主体24可在伸展期间以及任选地在脊柱前凸期间保持围绕中心轴轴线X1的相同角度位置。在其它实施方案中,第一楔形件51和下板主体24的旋转互锁可允许第一楔形件51围绕中心轴轴线X1的旋转,从而引起下板主体24围绕中心轴轴线X1的基本上相似程度的旋转,反之亦然。
第一楔形件主体128还可包括接合元件,该接合元件被构造为接合相应楔形件组件124、126的一个或多个其它楔形件(诸如第二楔形件52和第四楔形件54)的一部分。接合元件可包括在第一楔形件主体128的内端130和向上顶点140之间延伸的第一倾斜表面或坡道148。当定位在相应致动组件94、96内时,第一楔形件51可被取向为使得第一坡道148沿外部纵向方向LE倾斜。在所示实施方案中,第一坡道148可相对于纵向方向L(图12)以在约10度和约60度范围内的第一倾斜角度α1取向。在其它实施方案中,第一倾斜角度α1相对于纵向方向L可在约20度和约40度的范围内。在另外的实施方案中,第一倾斜角度α1相对于纵向方向L可在约25度和约35度的范围内。在附加实施方案中,第一倾斜角度α1相对于纵向方向L可小于10度或大于60度。
第一楔形件主体128还可限定第二或上引导特征结构,诸如导槽150,其被构造为引导第一楔形件51与相关联楔形件组件124、126的另一个楔形件(诸如第四楔形件54)之间的相对运动。导槽150可从第一坡道148凹陷到第一楔形件主体128中。导槽150可相对于纵向方向L从第一楔形件主体128的内端130处的导槽开口152延伸到第一引导主体128的外面138。导槽150可平行于第一坡道148延伸并且可具有被构造为引导第四楔形件54的相关联引导元件在其中的移动的几何形状。任选地,导槽150还可被构造为以至少沿与第一坡道148正交的方向防止第四楔形件54与第一楔形件51脱离的方式与相关联的引导元件互锁。如图所示,导槽150可在竖直横向平面上具有燕尾形轮廓,但其它几何形状也在本公开的范围内。导槽150可横穿第一坡道148的整个长度,如图所示,或者可任选地横穿小于整个长度。另外,导槽150可将第一坡道148分成前部部分154和后部部分156,其可被表征为“导轨”。
第一楔形件主体128可限定通道158,该通道沿着纵向方向L延伸穿过主体128。通道158可以是U形的,并且第一楔形件主体128的位于通道158的相对横向侧上的部分可被表征为第一楔形件主体128的前臂160和后臂162(图10)。通道158的尺寸、形状可被设计成并且/或者以其它方式构造为驱动轴98的相应螺纹部分104、106提供空间,以至少部分地延伸穿过主体128(即,在臂160、162之间)而不会机械地干扰主体128。因此,第一楔形件主体128可在竖直横向平面中具有U形轮廓。通道158还能够以将导槽150的一部分有效地分成分别限定在前臂160和后臂162中的前狭槽164和后狭槽166的方式与导槽150相交。
现在参见图13至图15,示出了第一楔形件51'的变型。具体地讲,变体51'可用于后致动组件96中。变体51'可基本上类似于图10至图12中示出的第一楔形件51;因此,可以使用类似的附图标记,其中变型第一楔形件51'的对应特征结构用“撇号”标记表示。变型第一楔形件51'的主要区别在于,第一楔形件主体128'的外面138'是由前臂160'和后臂162'中的横向外部臂限定的第一外面138'。另外,臂160'、162'中的相对(即,横向内部)臂可限定第二外面139',该第二外面从第一外面138'沿内部纵向方向LI凹陷。
第一楔形件51'的第一外面138'可邻接头部110的近侧侧面112,并且第二外面139'可邻接上板主体26的第一横向突起82的近侧面90(图30)。因此,第一横向突起82的近侧面90可以称为上板主体26的邻接表面。这样的构型可至少在植入物10的伸展、收缩和/或成脊柱前凸角期间增加植入物10的稳定性。然而,在其它实施方案中,远侧楔形件组件126的第一楔形件51实际上可与近侧楔形件组件124的第一楔形件51相同。与第一楔形件51一样,变体51'可被表征为“支撑构件”或“支撑楔形件”,并且能够任选地通过焊接、钎焊、粘合剂或机械紧固件而牢固地固定到下板主体24。应当理解,前致动组件94的变型第一楔形件51'可以是后致动组件96中的其对应物围绕定位在致动组件94、96之间的竖直纵向平面的大致镜像。
现在参见图16至图18,第二楔形件52可具有第二楔形件主体168,该第二楔形件主体限定内端170以及沿着纵向方向L与外端172间隔开的外端172。第二楔形件主体168还可限定沿着横向方向T彼此间隔开的前侧表面174和后侧表面176。第二楔形件主体168还可在外端172处限定外面178。第二楔形件主体168的外面178可沿着竖直方向V和横向方向T延伸,并且可以基本上是平面的,但其它几何形状也在本公开的范围内。第二楔形件主体168还可限定上基部表面180和沿着竖直方向V与上基部表面180间隔开的相对的向下顶点182。上基部表面180可沿着纵向方向L在主体168的内端170和外端172之间延伸。向下顶点182可相对于纵向方向L位于第二楔形件主体168的内端170和外端172之间。
上基部表面180可被构造为接合上板主体26的相应前通道56或后通道58的基部表面68。因此,第二楔形件52可被表征为“支撑”上板主体26,并且在本文中可被称为“支撑构件”或“支撑楔形件”。上基部表面180的至少一部分可以是基本上平面的,并且可被构造为在植入物10的伸展期间至少部分地跨过相应通道56、58的基部表面68平移。因此,第二楔形件52还可称为“滑块”。
第二楔形件主体168可限定第三或上引导元件,诸如引导突起184,其沿着竖直方向V从上基部表面180延伸。引导突起184的顶部表面186可限定第二楔形件52的最顶部部分。顶部表面186还可限定相应楔形件组件124、126的最顶部部分。引导突起184可被构造为在上板主体26的相关联通道56、58的导槽70内平移。第二楔形件主体168的引导突起184可具有与以上阐述的第一楔形件主体128的引导突起144的那些设计和功能大致相似的设计和功能。通过非限制性示例,第二楔形件主体168的引导突起184和上板主体26的相关联通道56、58的导槽70可具有对应燕尾形轮廓,该燕尾形轮廓将第二楔形件52互锁到上板主体26。以这种方式,引导突起184(其也可被表征为“保持”特征结构)可在上板主体26的相应的通道56、58内纵向地移动,但是基本上竖直地不可移动。另外,引导突起184和板导槽70的轮廓可允许第二楔形件52和上板主体26彼此旋转地互锁,使得例如第二楔形件52围绕驱动轴98的中心轴轴线X1的旋转导致上板主体26围绕中心轴轴线X1的基本上相似程度的旋转,反之亦然。
第二楔形件52可包括一个或多个接合元件,其被构造为接合相关联楔形件组件124、126的其它楔形件中的一个或多个的部分。通过非限制性示例,第二楔形件主体168可限定从外面178延伸到向下顶点182的第二倾斜表面或坡道188,以及从向下顶点182延伸到第二楔形件主体168的内端170的第三倾斜表面或坡道190。第二楔形件主体168的内端170可限定上基部表面180和第三坡道190之间的共享边缘。第二楔形件52可在每个致动组件94、96中取向,使得第二坡道188沿外部纵向方向LE倾斜,并且第三坡道190沿外部纵向方向LE下降(并且因此沿内部纵向方向LI倾斜)。第二坡道188可被构造为在植入物10的伸展期间接合第一楔形件主体128的第一坡道148。第三坡道190可被构造为接合相应楔形件组件124、126的另一个楔形件(诸如第三楔形件53)的一部分。
第二坡道188可任选地基本上平行于第一楔形件主体128的第一坡道148。第二坡道188可相对于纵向方向L(图18)以在约10度和约60度范围内的第二倾斜角度α2取向。在其它实施方案中,第二倾斜角度α2相对于纵向方向L可在约20度和约40度的范围内。在另外的实施方案中,第二倾斜角度α2相对于纵向方向L可在约25度和约35度的范围内。在附加实施方案中,第二倾斜角度α2相对于纵向方向L可小于10度或大于60度。
第三坡道190可相对于纵向方向L以在约10度和约60度范围内的第三倾斜角度α3取向。在其它实施方案中,第三倾斜角度α3相对于纵向方向L可在约20度和约40度的范围内。在另外的实施方案中,第三倾斜角度α3相对于纵向方向L可在约25度和约35度的范围内。在附加实施方案中,第三倾斜角度α3相对于纵向方向L可小于10度或大于60度。
第二楔形件52可包括第四引导特征结构,诸如导槽192,其被构造为引导第二楔形件52与相关联楔形件组件124、126的另一个楔形件(诸如第三楔形件53)之间的相对运动。导槽192可从第三坡道190凹陷到第二楔形件主体168中,并且可将第三坡道190分成前部部分194和后部部分196,其可被表征为“导轨”。导槽192可平行于第三坡道190延伸,并且可具有被构造为引导第三楔形件53的相关联引导元件的移动并且任选地与该引导元件互锁的几何形状。如图所示,导槽192可具有燕尾形轮廓并且可类似于第一楔形件主体128的导槽150构造,如上所阐述,但是其它几何形状也在本公开的范围内。导槽192可从上基部表面180处的导槽开口198延伸到止动特征结构200,该止动特征结构被构造为防止第三楔形件53的引导元件沿着外部纵向方向LE移动超过止动特征结构200。止动特征结构200可沿内部纵向方向LI与向下顶点182间隔开。因此,导槽192可延伸小于第三坡道190的整个长度。
第二楔形件主体168可限定202,该通道沿着纵向方向L延伸穿过其中。第二楔形件主体168的通道202可类似于上文阐述的第一楔形件主体128通道158构造。因此,第二楔形件主体168可在竖直横向平面中具有U形轮廓,并且可以包括在通道202的相对横向侧上的前臂204和后臂206。另外,通道202可将第二坡道188分成前部部分208和后部部分210,其可被表征为“导轨”。通道202还能够以将导槽192的一部分有效地转换成分别限定在前臂204和后臂206中的前狭槽212和后狭槽214的方式与导槽192相交。
现在参见图19至图21,第二楔形件53可具有第三楔形件主体216,该第三楔形件主体限定内端218以及沿着纵向方向L与内端218间隔开的外端220。第三楔形件主体216还可限定沿着横向方向T彼此间隔开的前侧表面222和后侧表面224。第三楔形件主体216还可在其内端218处限定内面226,并且在外端220处限定外面228。第三楔形件主体216的内面226和外面228可各自沿着竖直方向V和横向方向T延伸,并且可以各自基本上是平面的,但其它几何形状也在本公开的范围内。第三楔形件主体216可限定沿着中心孔轴线X2延伸的中心孔230。中心孔230可以是通孔,并且中心孔轴线X2可沿着纵向方向L延伸。中心孔230可限定螺纹232,该螺纹被构造为接合驱动轴98的近侧螺纹部分104和远侧螺纹部分106中至少一个,使得驱动轴98的旋转使第三楔形件53沿着纵向方向L螺纹地平移。因此,中心孔轴线X2可与中心轴轴线X1共同延伸。第三楔形件主体216还可被构造为围绕中心孔轴线X2旋转,如下更详细地所阐述。
第三楔形件53可包括一个或多个接合元件,其被构造为接合相关联楔形件组件124、126的其它楔形件(诸如第二楔形件52和第四楔形件54)中的一个或多个的部分。例如,第三楔形件53的内面226可被构造为接合(诸如通过邻接)第四楔形件54的一部分。另外,第三楔形件主体216可限定位于主体216的上侧处的第四倾斜表面或坡道234。第四坡道234可沿着纵向方向L在内面226和外面228之间延伸。第四坡道234可沿外部纵向方向LE下降(并且因此沿内部纵向方向LI倾斜)。
第四坡道234可被构造为接合第二楔形件主体168的第三坡道188,包括在植入物10的伸展期间。第四坡道234可任选地基本上平行于第二楔形件主体168的第三坡道190。第四坡道234可相对于纵向方向L(图21)以在约10度和约60度范围内的第四倾斜角度α4取向。在其它实施方案中,第四倾斜角度α4相对于纵向方向L可在约20度和约40度的范围内。在另外的实施方案中,第四倾斜角度α4相对于纵向方向L可在约25度和约35度的范围内。在附加实施方案中,第四倾斜角度α4相对于纵向方向L可小于10度或大于60度。
第三楔形件53可包括第五引导元件,诸如引导突起236,其被构造为引导第三楔形件53和第二楔形件52之间的运动。例如,第三楔形件53的引导突起236可从第四坡道234竖直地延伸,并且可被构造为在第二楔形件52的导槽192内平移。引导突起236能够以至少沿与第三坡道190正交的方向防止引导突起236离开导槽192的方式与导槽192协作地成形。例如,引导突起236和导槽192可在竖直横向平面中具有对应燕尾形轮廓,如图所示。在这样的实施方案中,引导突起236可仅通过导槽开口198进出导槽192。另外,导槽192和引导突起236的轮廓还可允许第二楔形件52和第三楔形件53彼此旋转地互锁,使得例如第三楔形件53围绕中心孔轴线X2的旋转导致第二楔形件52围绕中心孔轴线X2的基本上相似程度的旋转。
第三楔形件53可具有被构造为避免在第一楔形件51与第三楔形件53之间的相对移动期间与第一楔形件51接触的几何形状。例如,第三楔形件主体216可具有倒圆下侧238,该倒圆下侧被构造为在第三楔形件主体216在第一楔形件主体128上方的平移和旋转移动期间不与第一坡道148或第一楔形件主体128的前臂160和后臂162接触或以其它方式直接接合或干涉。另外,下侧238可限定第五倾斜表面或坡道240,该第五倾斜表面或坡道以与第一坡道148的第一倾斜角度α1基本上平行的第五倾斜角度α5取向。第五坡道240可被构造为不与第一坡道148接触。例如,第五坡道240可包括定位在倒圆部分244的相对横向侧上的一对平面部分242。倒圆部分244可被构造为在第三楔形件主体216在第一楔形件主体128上方的平移和旋转移动期间在第一楔形件主体128的导槽150内延伸,而不接触第一坡道148或第一楔形件主体128的任何其它部分。另外,在第三楔形件主体216在第一楔形件主体128上方的移动期间,第五坡道240的平面部分242可远离第一坡道148或第一楔形件主体128的任何其它部分。
现在参见图22至图25,第四楔形件54可具有第四楔形件主体246,该第四楔形件主体限定内端248以及沿着纵向方向L与内端248间隔开的外端250。第四楔形件主体246还可限定沿着横向方向T彼此间隔开的前侧表面252和后侧表面254。第四楔形件主体246还可在其内端248处限定内面256,并且在外端250处限定外面258。第四楔形件主体246的内面256和外面258可各自沿着竖直方向V和横向方向T延伸,并且可以各自基本上是平面的,但其它几何形状也在本公开的范围内。第四楔形件主体246可包括顶部表面260以及相对于竖直方向V与顶部表面260相对的底部表面262。底部表面262还可称为第四楔形件54的“基部”表面,并且可沿着纵向方向L和横向方向T延伸。底部表面262可任选地为平面的。例如,第四楔形件主体246可在顶部表面260和侧表面252、254之间倒圆或倒角,以避免在第四楔形件主体246在第二楔形件主体168下方的平移和旋转移动期间与第三坡道190或第二楔形件主体168的任何其它部分接触或以其它方式直接接合或干涉。
第四楔形件主体246可限定沿着中心孔轴线X3延伸的中心孔264。中心孔264可以是通孔并且可沿着纵向方向L延伸。第四楔形件主体246的中心孔轴线X3可与驱动轴98的中心轴轴线X1以及与第三楔形件主体216的中心孔轴线X2共同延伸。第四楔形件主体246的中心孔264可限定螺纹266,该螺纹被构造为接合近侧螺纹部分104和远侧螺纹部分106一者中的与第三楔形件主体216的螺纹232相同的螺纹。在所示实施方案中,驱动轴98的旋转可以使第三楔形件53和第四楔形件54沿着纵向方向L以相同的速率一起螺纹平移。然而,在其它实施方案中,每个楔形件组件124、126的第三楔形件53和第四楔形件54可沿着驱动轴98以不同的速率和/或沿相反的方向移动。
第四楔形件54可包括一个或多个接合元件,其被构造为接合相关联楔形件组件124、126的其它楔形件(诸如第三楔形件53)中的至少一个的部分。例如,第四楔形件主体246的外面258可被表征为接合元件,因为它可被构造为邻接第三楔形件主体216的内面226。第四楔形主体54的外面258可被任选地构造为以确保第三楔形件主体216和第四楔形件主体158沿着驱动轴98的相应螺纹部分104、106以相同速率平移的方式邻接第三楔形件主体216的内面226。以这种方式,第四楔形件54可被表征为有效地沿外部纵向方向LE推动第三楔形件53的“推动器”或“推动器构件”。另外,应当理解,第三楔形件53和第四楔形件54可共同地称为“伸展楔形件”,其中第三楔形件53被称为伸展楔形件的“第一构件”或“第一部分”,并且第四楔形件54被称为伸展楔形件的“第二构件”或“第二部分”。另外,第三楔形件53和第四楔形件54中的每个可被单独称为“伸展楔形件”。
第四楔形件主体246还可在主体246的底部表面262附近限定第六倾斜表面或坡道268。第六坡道268可相对于纵向方向L在第四楔形件主体246的底部表面262和外面256之间延伸。第六坡道268可沿外部纵向方向LE倾斜(并且因此沿内部纵向方向LI下降)。第六坡道268可被构造为在植入物10的伸展期间接合第一楔形件主体128的第一坡道148。第六坡道268可任选地基本上平行于第一坡道148。第六坡道268可相对于纵向方向L(图24)以在约10度和约60度范围内的第六倾斜角度α6取向。在其它实施方案中,第六倾斜角度α6相对于纵向方向L可在约20度和约40度的范围内。在另外的实施方案中,第六倾斜角度α6相对于纵向方向L可在约25度和约35度的范围内。在附加实施方案中,第六倾斜角度α6相对于纵向方向L可小于10度或大于60度。
第四楔形件54可包括第六引导元件,诸如引导突起270,其被构造为引导第四楔形件54与内板12和第一楔形件51中的每个之间的运动。引导突起270可从底部表面262和第六坡道268中的每个延伸。引导突起270可被构造为使得在植入物10的一个伸展阶段中,突起270可在下板主体24的相应通道68的导槽70内平移,并且在另一个伸展阶段期间,突起270可在第一楔形件51的导槽150内平移。
第四楔形件主体246的引导突起270可包括被构造为选择性地接合下板主体24的引导特征结构和第一楔形件51的引导特征结构的一个或多个部分。例如,在图22至图24中示出的非限制性示例中,引导突起270可包括第一部分271、第二部分272、第三部分273和第四部分274。第一部分271可从第六坡道268延伸。第四部分274可从底部表面262延伸。第二部分272可位于第一部分271下面。第三部分273通常可位于第四部分274下面。第一部分271和第四部分274可各自在竖直横向平面中具有矩形轮廓。第二部分272和第三部分273可各自在竖直横向平面中具有燕尾形轮廓。在第四楔形件主体246的前侧252和后侧254中的每个上,第一部分271和第二部分272之间的边缘276可平行于底部表面262。另外在每一侧252、254上,第三部分273和第四部分274之间的边缘278可平行于第六坡道268。第二部分272可从第二部分272和第三部分273之间的边缘280朝向第一部分271横向向内渐缩。第三部分273可从第二部分272和第三部分273之间的边缘280朝向第四部分274横向向内渐缩。
如图26所示,在植入物10的第一伸展阶段期间,第四楔形件54的引导突起270的第二部分272、第三部分273和第四部分274可定位在相应板导槽70内,而第一部分271定位在板导槽70的外部。如图27所示,在第一阶段的结束(其也可被认为是第二伸展阶段的开始)时,突起270可同时定位在板导槽70和第一楔形件51的导槽150中。突起270的几何形状允许其从板导槽70转移到第一楔形件导槽150,并在第二伸展阶段期间保持在第一楔形件导槽150内,如图28所示。在第二阶段期间,引导突起270的第一部分271、第二部分272和第三部分273可被定位在第一楔形件51的导槽150内,而第四部分274可以在导槽150的外部。
应当理解,引导突起270的燕尾形轮廓,特别是在第二部分272和第三部分273之间的边缘280处,可以基本上匹配每个通道62、64的导槽70的燕尾形轮廓以及第一楔形件51的导槽102。引导突起270的第二部分272可被构造为允许引导突起270在第一阶段和第二阶段期间从下板主体24的导槽70转移到第一楔形件51的导槽150。引导突起270的第三部分273可被构造为允许引导突起270在植入物10的任选反向伸展过程期间(即,在塌缩或“收缩”过程期间)从第一楔形件51的导槽150转移到下板主体24的导槽70,如下更详细地所阐述。
引导突起270的第三部分273,特别是在第二部分272和第三部分273之间的边缘280处,能够以至少沿正交于第一坡道148的方向以及任选地沿除平行于第一坡道148的方向之外的任何方向防止引导突起270离开导槽150的方式与第一楔形件51的导槽150协作地成形。在所示实施方案中,引导突起270可仅在内端130处(通过导槽开口198),或任选地在第一楔形件主体128的外端132处进出导槽150。
另外,引导突起270的第二部分272,特别是在第二部分272和第三部分273之间的边缘280处,能够以至少沿正交于通道基部表面68的方向以及任选地沿除纵向方向L或平行于第一坡道148的方向之外的任何方向防止引导突起270离开导槽70的方式与下板主体24的相应通道62、64的导槽70协作地成形。另外,当引导突起270位于板导槽70(图26)内时,引导突起270和板导槽70的轮廓可允许下板主体24与第四楔形件54旋转互锁,使得例如第四楔形件54和下板主体24可围绕中心轴轴线X1保持相同的角度位置。因为第一楔形件51可与下板主体24(图40)旋转互锁,并且第四楔形件54可与下板主体24或与第一楔形件51(图26至图28)旋转互锁,由此下板主体24可在所有伸展阶段期间与第一楔形件51和第四楔形件54两者旋转互锁。
应当理解,在所示实施方案中,近侧楔形件组件124的第二楔形件52、第三楔形件53和第四楔形件54可与其在远侧楔形件组件126中的相应对应物基本上相似,或者甚至实际上相同。然而,在其它实施方案中,近侧楔形件组件124的第二楔形件52、第三楔形件53和第四楔形件54中的一个或多个可与其在远侧楔形件组件126中的相应对应物不同地构造。
现在参见图29,示出了在第二伸展阶段期间的远侧楔形件组件126。在第三楔形件53相对于第四楔形件54围绕驱动轴98的轴线X1旋转时,第二楔形件52的导槽192和第三楔形件的引导突起236的轮廓可允许第二楔形件52与第三楔形件53旋转互锁,如上所阐述。另外,同样如上所阐述,当引导突起270在导槽150内时,第一楔形件51的导槽150和第四楔形件54的引导突起270的轮廓可允许第一楔形件51和第四楔形件54彼此旋转互锁,使得例如第一楔形件51和第四楔形件54围绕中心轴轴线X1保持相同的角度位置,或者在其它实施方案中,使得第一楔形件51和第四楔形件54在植入物10的操作期间围绕中心轴轴线X1旋转相同的程度。
现在参见图30,每个楔形件组件124、126的楔形件51、52、53、54可沿纵向方向L和竖直方向V具有伸缩移动性。应当理解,当植入物10处于塌缩构型时,前致动组件94和后致动组件96中的每个,以及近侧楔形件组件124和远侧楔形件组件126中的每个也可被认为处于其相应的塌缩构型。为了比较的目的,图30描绘了处于塌缩构型的近侧楔形件组件124,同时以完全伸展构型描绘了远侧楔形件组件124。每个楔形件组件124、126可限定沿着纵向方向L从第一楔形件51的外面138到第四楔形件54的内面256测量的长度,以及沿着竖直方向V从第一楔形件51的引导突起144的底部表面146到第二楔形件122的引导突起184的顶部表面186测量的高度。在塌缩构型中,每个楔形件组件124、126可限定塌缩长度L1和塌缩高度H1。在完全伸展构型中,每个楔形件组件124、126可限定小于塌缩长度L1的伸展长度L2,以及大于塌缩高度H1的伸展高度H2。换句话讲,每个楔形件组件124、126可以随着高度的增加而减小长度。通过非限制性示例,伸展高度H2与塌缩高度H1的比率可以在约1.5:1至3.5:1的范围内。因此,在植入物10的伸展期间,骨接触表面28、30(图31)之间的竖直距离D也可增加类似的余量。例如,通过非限制性示例,从塌缩构型到完全伸展构型,竖直距离D可增加约1.05和约3.0范围内的倍数。
现在将参考图31至图41讨论植入物10的操作,包括伸展和前凸,从处于塌缩构型的植入物开始,如图31所示。
现在参见图31,虽然描绘了后致动组件96,但应当理解,以下描述也可适用于前致动组件94的对应部件。当植入物10处于塌缩构型时,下板主体24和上板主体26的内部接触表面46可彼此邻接。另外,当塌缩时,每个致动组件94、96可基本上完全设置在由板12、18的上覆通道56、58限定的相关联隔室60、62(图2)内。螺母插座116的近侧端部120可沿着横向方向T与植入物10的近侧端部12大致对准。驱动轴98可沿着纵向方向L延伸穿过通道56、58。头部110的远侧端部114和驱动轴98的远侧端部102中的一个或两个可邻接或邻近上板主体26的第二横向突起84的近侧面90。头部110的近侧端部112可邻接或邻近上板主体26的第一横向突起82的远侧面92。以这种方式,头部110可沿着横向方向T与下板主体24的横向壁76对准。
相对于处于塌缩构型的近侧楔形件组件124,第一楔形件51的外面138可邻接或邻近螺母插座116的远侧端部122。第一楔形件51的底部基部表面142可邻接下板主体24的后通道58的基部表面68,并且第一楔形件51的引导突起144可被接纳在下板主体24的后通道58的导槽70内。驱动轴98的近侧螺纹部分104可延伸穿过第一楔形件51的U形通道158。
第二楔形件52可被定位成使得第二坡道188在邻近第一楔形件51的内端130的位置处邻接第一坡道148。第二楔形件52的上基部表面180可邻接上板主体26的后通道58的基部表面68,并且第二楔形件52的引导突起184可被接纳在上板主体26的后通道58的导槽70内。驱动轴98的近侧螺纹部分104可延伸穿过第二楔形件52的U形通道202。
第三楔形件53可被定位成使得其第四坡道234在邻近其内端170的位置处邻接第二楔形件52的第三坡道190。第三楔形件53的引导突起236可被接纳在第二楔形件52的导槽192内。驱动轴98可延伸穿过第三楔形件53的中心孔230,其中其螺纹232与驱动轴98的近侧螺纹部分104接合。
第四楔形件54可被定位成使得其外面258邻接或邻近第三楔形件53的内面226。第四楔形件54的内面256可被定位在驱动轴98的中间部分108(即,近侧螺纹部分104的内端处或附近)。第四楔形件54的底部表面262可邻接下板主体24的后通道58的基部表面68,并且第四楔形件54的引导突起270可被接纳在下板主体24的后通道58的导槽70内。驱动轴98可延伸穿过第四楔形件53的中心孔264,其中其螺纹266与驱动轴98的近侧螺纹部分104接合。
应当理解,如上所阐述,远侧楔形件组件126可以有效地是近侧楔形件组件124围绕定位在驱动轴98的中间部分108处的竖直横向平面的大致镜像。因此,远侧楔形件组件126的楔形件51'、52、53、54和驱动轴98的远侧螺纹部分106的相对位置可与近侧楔形件组件124和驱动轴的近侧螺纹部分104的相对位置基本上相似。关于第一楔形件51'的变体,其第一外面138'可邻接或邻近头部110的近侧端部112(图5),而第一楔形件51'的第二外面139'可邻接或邻近上板主体26的第一横向突起82的近侧面90(图4)。
现在将根据示例性伸展模式讨论如图32至图34所示的植入物10在塌缩构型和第一部分伸展构型之间的伸展。应当理解,虽然图32至图34描绘了同时致动前致动组件94和后致动组件96以一致地伸展植入物10,但是前致动组件94和后致动组件96中的每个可独立地操作以提供植入物10的不一致伸展或收缩(即,脊柱前凸)。
在第一伸展阶段期间,驱动轴98可围绕其中心轴轴线X1沿第一旋转方向(诸如顺时针)旋转,使得近侧螺纹部分104沿其外部纵向方向LE(即,近侧方向)提供第一或近侧驱动力F1,并且远侧螺纹部分106沿其外部纵向方向LE(即,远侧方向)提供第二或远侧驱动力F2。第三楔形件53和第四楔形件54的中心孔146、176的螺纹232、178可分别以以下方式接合驱动轴98的相关联螺纹部分104、106:将相应驱动力F1、F2传递到第三楔形件53和第四楔形件54,从而使第三楔形件53和第四楔形件54沿外部纵向方向LE平移。
参见图34,在第三楔形件53和第四楔形件54平移时,可发生以下各项中的每一项:第四楔形件54的底部表面262沿着下板20的相应前通道56、58的基部表面68行进;第四楔形件54的引导突起270在相应通道56、58的导槽70内行进;第三楔形件53的第四坡道234沿着第二楔形件52的第三坡道190行进;以及第三楔形件53的引导突起236在第二楔形件52的导槽192内行进。由于第四坡道234沿着第三坡道190行进,下骨接触表面28和上骨接触表面30之间的竖直距离D可增加约0.2和约1.0范围内的倍数。在第四坡道234沿着第三坡道190行进时,第一驱动力F1可被至少传送到第二楔形件52,使得第二坡道188(在图34中不可见)沿着第一楔形件51的第一坡道148行进,从而进一步将骨接触表面28、30之间的距离D沿着竖直方向V增加约0.2至1.0范围内的倍数(相对于塌缩距离D)。
在第四坡道234沿着第三坡道190行进时以及在第二坡道188沿着第一坡道148行进时,第四楔形件54的第六坡道268可接近第一楔形件51的第一坡道148。在本示例中,当第六坡道268邻接第一坡道148时,第一伸展阶段可完成,此时第四楔形件54的突起270可进入第一楔形件51的导槽150的开口152(图28)。如上所阐述,第四楔形件54的引导突起270的几何形状可允许在第一伸展阶段结束时(以及在第二伸展阶段开始时)将突起270同时定位在板导槽70和第一楔形件51的导槽150内。
在第一阶段结束以及第二伸展阶段开始时,第二楔形件52的外端172以及整个第二坡道188可相对于纵向方向L定位在第一楔形件51的内端130和外端132中间。此外,整个第四坡道234可定位在第二楔形件52的向下顶点182和内端170中间,而第三楔形件53的突起236可定位在第二楔形件52的止动特征结构200和导槽192的开口198中间,各自相对于纵向方向L。应当理解,虽然第一楔形件51的内端90、以及第二楔形件52的向下顶点182和止动特征结构200的视图各自在图34中被阻挡,但此类特征结构在图31中是可见的。
现在将根据示例性伸展模式讨论植入物10在如图32至图34所示的第一部分伸展构型与如图35至图37所示的完全伸展构型之间的伸展。
现在参见图35至图37,植入物10被示为在第二伸展阶段结束时一致地伸展,这可与完全伸展构型相称。如上所述,应当理解,前致动组件94和后致动组件96可各自独立地操作以在第一部分伸展构型和完全伸展构型之间提供植入物10的不一致伸展或收缩(即,脊柱前凸)。
参见图35至图37,在第二伸展阶段期间,驱动轴98可进一步沿第一旋转方向围绕其中心轴轴线X1旋转。第三楔形件53和第四楔形件54的螺纹232、178可分别以使第三楔形件53和第四楔形件54进一步沿外部纵向方向LE平移的方式继续接合驱动轴98的相关联螺纹部分104、106。第二伸展阶段可被表征为当第六坡道268沿着第一坡道148行进时,这还进一步增加下骨接触表面28和上骨接触表面30之间的距离D。
随着第四楔形件54在第二伸展阶段开始时平移,突起270可从下板主体24的通道56、58的导槽70转移到第一楔形件51的导槽150。具体地讲,突起270的第一部分271、第二部分272、第三部分273和第四部分274的几何形状可接合第一楔形件51的导槽150,使得突起270离开板导槽70并被完全接纳在第一楔形件51的导槽150内。另外,第三楔形件53的第五坡道240可在第一楔形件51的导槽150内延伸而不接触第一楔形件主体128。
在第二伸展阶段的至少一部分期间,第六坡道268可沿着第一坡道148行进,而第四坡道234沿着第三坡道190行进,从而导致沿着纵向方向L和竖直方向V在第二楔形件52和第三楔形件53和第四楔形件54中的每个之间的相对运动。在第二阶段期间第二楔形件52与第三楔形件53和第四楔形件54之间的相对运动可以使第二坡道188相对于竖直方向V与第一坡道148分离,或以其它方式变得远离该第一坡道。另外,第二楔形件52与第三楔形件53和第四楔形件54之间的这样的相对运动可由施加到第二楔形件52、第三楔形件53和第四楔形件54中的至少一个的反作用力来引发。例如,当植入物10的部件(诸如通道56、58中的止动特征结构、导槽70、或板主体24、26的其它部分)阻碍第二楔形件52沿外部纵向方向LE的运动时,可发生反作用力。在另一个非限制性示例中,第二坡道124和第六坡道180可沿着第一坡道148以相同速率或接近相同速率行进,直到在近侧楔形件组件124中,第二楔形件52的外面178邻接螺母插座116的远侧端部122,而在远侧楔形件组件126中,第二楔形件52的外面178邻接第一横向突起82的近侧面90。在近侧楔形件组件124和远侧楔形件组件126中的每个中,前述邻接可阻碍第二楔形件52沿着外部纵向方向LE的进一步移动,而第四坡道234继续沿着第三坡道190行进并且第六坡道268继续沿着第一坡道148行进,从而相对于第一楔形件51向上驱动第二楔形件52。
在另一个非限制性示例中,反作用力可在第二伸展阶段开始时发生,从而致使一旦第六坡道268沿着第一坡道148行进,第四坡道234就沿着第三坡道190行进。在这样的示例中,在近侧楔形件组件124和远侧楔形件组件126中的每个中,第四坡道234可沿着第三坡道190行进,直到第三楔形件53的引导突起236邻接第二楔形件52的导槽192的止动特征结构200,此后第六坡道268可继续沿着第一坡道148行进而没有沿着纵向方向L和竖直方向V在第二楔形件52与第三楔形件53和第四楔形件54之间的任何相对运动。因此,在两个前述非限制性示例中的每个中,第二伸展阶段可包括至少一个部分或子阶段(其涉及相对于纵向方向L和竖直方向V在第二楔形件52与第三楔形件53和第四楔形件54中的每个之间的相对运动),以及至少另一个部分或子阶段(在该部分或子阶段期间,第二楔形件52、第三楔形件53和第四楔形件54沿着纵向方向L和竖直方向V被驱动到一起,而在其间没有任何相对运动)。
在又一个非限制性示例中,相对运动可在基本上整个第二伸展阶段期间沿着纵向方向L和竖直方向V在第二楔形件52与第三楔形件53和第四楔形件54中的每个之间发生。在该示例中,在近侧楔形件组件124和远侧楔形件组件126中的每个中,反作用力可发生在第二伸展阶段开始时,从而致使一旦第六坡道268沿着第一坡道148行进,第四坡道234就沿着第三坡道190行进,并且第三楔形件53的引导突起236同时在导槽192内行进。此外,在该示例中,第三楔形件53的引导突起236可邻接第二楔形件52的止动特征结构200,基本上同时第二楔形件52的外面178邻接螺母插座116的远侧端部122。
在第二伸展阶段结束时,在近侧楔形件组件124中,第二楔形件52的外端172可沿着竖直方向V与第一楔形件51的外端132基本上对准,并且在远侧楔形件组件中,第二楔形件52的外端172可与第一楔形件51'的第二外面139'基本上对准。另外,在每个楔形件组件124、126中,第三楔形件53和第四楔形件54可各自完全在第一楔形件51的内端130和外端132以及第二楔形件52的内端170和外端172中间。类似地,在第二伸展阶段结束时,第二楔形件52的向下顶点182可与第一楔形件51的向上顶点140向上间隔开。
在植入物10的整个伸展中,近侧楔形件组件124和远侧楔形件组件126的相应第一楔形件51、51'可保持邻近驱动轴98的近侧螺纹部分104和远侧螺纹部分106的外端。另外,每个楔形件组件124、126的第二楔形件52、第三楔形件53和第四楔形件54可在伸展期间沿外部纵向方向LE移动。因此,楔形件组件124、126与上板12和下板28之间的接触点最初位于植入物10的近侧端部12和远侧端部14附近(如在第一楔形件51、51'联接到下板20的情况下),或者在伸展期间朝向植入物10的近侧端部12和远侧端部14移动(如在第二楔形件52联接到上板22的情况下)。这样的布置在伸展期间对植入物10提供了增强的支撑和稳定性,特别是相对于在椎间间隙5内沿着竖直方向V施加到植入物10的反作用力,诸如内体力。然而,应当理解,在其它实施方案(未示出)中,近侧楔形件组件124和远侧楔形件组件126的相应第一楔形件51、51'可位于驱动轴98的螺纹部分104、106的内端附近,并且每个楔形件组件124、126的第二楔形件52、第三楔形件53和第四楔形件54可在伸展期间沿内部纵向方向LI移动。
现在将讨论用以实现脊柱前凸的植入物10的操作。
现在参见图38至图40,前致动组件94和后致动组件96能够以为植入物10提供脊柱前凸轮廓的方式独立地被驱动,如上所阐述。换句话讲,前致动组件94和后致动组件96可以以使得下板20和上板22中的至少一个相对于另一个板20、22相对于横向方向T倾斜的方式操作。在一些实施方案中,板20、22中的至少一个可以相对于另一个板20、22围绕第一和第二中心轴轴线X1中的至少一个倾斜。这可通过将前致动组件94和后致动组件96中的一个的楔形件组件124、126以不同于另一个致动组件94、96的楔形件组件124、126的伸展程度放置来实现。在图38至图40的示例性前凸构型中,在后致动组件96中,其近侧楔形件组件124和远侧楔形件组件126可大致处于塌缩构型(图39),而在前致动组件94中,其楔形件组件124、126可伸展到接近第一部分伸展构型,从而致使上板22相对于下板20相对于横向方向T以脊柱前凸角β倾斜(图40)。
当板20、22中的至少一个相对于彼此前凸地倾斜时,下骨接触表面28和上骨接触表面30之间的第一距离D1(其沿着竖直方向L测量并且与前致动组件94的中心轴轴线X1相交)可短于或长于下骨接触表面28和上骨接触表面30之间的第二距离D2(其沿着竖直方向L测量并且与后致动组件96的中心轴轴线X1相交)。另外,当板20'、22'中的至少一个相对于另一个前凸地倾斜时,在植入物10'的前侧16'处在下板20'和上板22'之间的竖直距离D3短于或长于在植入物10的后侧18'处在板20'、22'之间的竖直距离D4。如图40所示,D3和D4中的一个可以小到零,此时植入物10的相应侧面16、18处的内部接触表面46可限定支点。在一些实施方案中,下板主体24和上板主体26的内面44可以是弯曲的、倾斜的、或者可以以其它方式在前侧16和后侧18中的一个或两个处在其间限定间隙,使得当前致动组件94和后致动组件96中的一个处于塌缩构型时,板20、22中的至少一个可前凸地倾斜(即,可从塌缩构型引起脊柱前凸)。
应当理解,示于图38至图40中的脊柱前凸轮廓仅表示本公开的植入物10可实现的许多脊柱前凸轮廓之一。例如,医师可将前致动组件94致动到第一伸展构型,并且将后致动组件96致动到第二伸展构型,以提供第一距离D1与第二距离D2之间的差值。具体地讲,医师可将前致动组件94和后致动组件96中的一个致动到完全伸展构型,而另一个致动组件96、94保持在完全塌缩构型附近,以向植入物10提供在约0度和约45度范围内的最大脊柱前凸角β。应当理解,医师可将致动组件94、96中的每个独立地置于塌缩构型、完全伸展构型或其间的任何位置,以为植入物10提供期望的脊柱前凸角β。还应当理解,可将初始脊柱前凸角β构建到植入物10中。在此类实施方案中,下骨板20和上骨板22可被构造为使得当植入物10处于塌缩构型时,其骨接触表面28、30以脊柱前凸角β取向。
至少因为下板20与第一楔形件51旋转互锁,上板22与第二楔形件52旋转互锁,第二楔形件52与第三楔形件53旋转互锁,第三楔形件53能够围绕相应中心轴轴线X1相对于第四楔形件54旋转(如图41所示),并且第四楔形件54与下板20旋转互锁(直接旋转互锁,如在第一伸展阶段中,或者经由与第一楔形件51的旋转互锁而旋转互锁,该第一楔形件与下板20旋转互锁),所以可以使倾斜成为可能。应当理解,第四楔形件54用作植入物10的铰链,其促进板20、22中的至少一个的脊柱前凸倾斜。通过将驱动轴98用作铰链的“通销”,可以提高铰链的强度,并减少完成铰链所需的零件数量。另外,通道56、58的基部表面68、每个楔形件组件124、126的基部表面142、180、262以及每个楔形件组件124、126的坡道表面148、188、190、234、268协作地为植入物10提供增加的稳定性和强度,以承受植入期间和植入后的内体力。
还应当理解,植入物10在实现植入物10的期望伸展和/或脊柱前凸的排序方面为医师提供了增强的自由度。具体地讲,在预定植入物10在椎间间隙5中的伸展和/或脊柱前凸的期望量之后,医师可以将处于塌缩构型的植入物10沿着内侧-外侧方向插入椎间间隙5中,如图1所示。如果伸展和脊柱前凸均是期望的,则医师可将植入物10一致地伸展到部分伸展构型,然后以不一致的方式伸展或收缩植入物10以实现植入物10的期望脊柱前凸角β。植入物10能够以各种方式不一致地伸展或收缩,包括例如:独立地操作致动组件94、96中的一个;同时但以不同速率操作致动组件94、96两者;同时但沿不同旋转方向操作致动组件94、96两者;或前述的任何组合。如本文所公开,植入物10的设计允许医师利用前述的伸展、收缩和/或脊柱前凸的模式中的任一种来实现最终的期望构型,并根据需要调整植入物10的构型,包括在对患者进行随后的物理手术期间。处于塌缩构型的植入物10的紧凑性质允许植入物10装配在标准腰椎间盘空间内。另外,因为可以调整植入物10以实现最大30mm或更大的伸展以及最大45度或更大的脊柱前凸,所以医师可以在脊柱内的许多不同位置中并出于许多不同目的使用植入物10。
现在参见图42,示出了植入物10'的第二实施方案。应当理解,第二实施方案可类似于示于图1至图41中的植入物的第一实施方案。因此,上面相对于第一实施方案使用的相同附图标记也可相对于第二实施方案以“撇号”标记使用。还应当理解,除非下面另有说明,否则第二实施方案的植入物10'的部件(及其特征结构)可以与第一实施方案的相似。
第二实施方案的下板20'和上板22'可限定沿着竖直方向V延伸穿过植入物10'的单个竖直孔34'。植入物10的前部部分36'和后部部分38'可位于竖直孔34'的相对侧上。植入物10'的远侧部分40'可沿远侧方向与竖直孔34'间隔开。
现在参见图43,下板主体24'和上板主体26'中的每个的前通道56'和后通道58'可包括近侧通道部分55',其轮廓被成形为与螺母插座116'的外轮廓匹配。在每个近侧通道部分55'的远侧端部处,每个板主体24'、26'可限定肩部57'。下板主体24'的肩部57'可被构造为邻接前致动组件94'和后致动组件96'的第一楔形件51'的外面138'。上板主体22'的肩部57'可被构造为当致动组件94'、96'处于完全伸展构型时邻接或至少邻近致动组件94'、96'的第二楔形件52'的外面178'。
下板主体24'的通道56'、58'中的每个可限定沿着纵向方向L彼此间隔开的第一对切口59'和第二对切口61'。在每个通道56'、58'中,第一对切口59'可沿着横向方向T彼此相对,并且第二对切口61'可沿着横向方向T彼此相对。虽然图43的视图仅示出了每对的前切口61',但应当理解,每对的后切口61'可以是相关联前切口61'的镜像。第一对切口59'和第二对切口61'可各自与下板主体24'的板导槽70'连通,并且其尺寸可被设计成允许第一楔形件51'的基部突起142'在植入物10'的组装期间被插入板导槽70'中。
上板主体26'的通道56'、58'中的每个可限定相对于纵向方向L大致居中的一对切口63'。在每个通道56'、58'中,每对的中心切口63'可沿着横向方向T彼此相对。虽然图43的视图仅示出了每对的后中心切口63',但应当理解,每对的前中心切口63'可以是相关联后中心切口63'的镜像。中心切口63'可各自与上板主体26'的板导槽70'连通,并且其尺寸可被设计成允许每个致动组件94'、96'的第四楔形件54'的底部突起270'(图44至图46)在植入物10'的组装期间被插入板导槽70'中。
继续参考图43,板导槽70'中的每个可限定近侧端部70a'和远侧端部70b'。在下板主体24'中,板导槽70'的近侧端部70a'可任选地被构造为邻接近侧楔形件组件124'的第一楔形件51”的基部突起,并且板导槽70'的远侧端部70b'可任选地被构造为邻接远侧楔形件组件126'的第一楔形件51”'的基部突起。虽然本实施方案的第一楔形件51”、51”'的基部突起在图43中不可见,但应当理解,这些基部突起可类似于图10至图15中所示的基部突起144、144'构造。在上板主体26'中,板导槽70'的近侧端部70a'可被任选地构造为在植入物的操作期间,诸如当每个相应致动组件94'、96'处于完全伸展构型时邻接近侧楔形件组件124'的第二楔形件52'的基部突起184'。类似地,板导槽70'的远侧端部70b'可被任选地构造为在植入物10'的操作期间,诸如当每个相应致动组件94'、96'处于完全伸展构型时邻接远侧楔形件组件126'的第二楔形件52'的基部突起184'。应当理解,在植入物10伸展期间,上板22的导槽70'的近侧端部70a'和远侧端部70b'可阻止第二楔形件52'沿外部纵向方向LE的运动。
在下板主体24'的远侧部分40'处,内面44'可限定沿着横向方向T伸长的单个横向狭槽73'。上板主体26'的远侧部分40'可限定突出超过上板主体26'的内部接触表面46'的单个横向突起83'。当植入物10'处于塌缩构型时,上板主体26'的横向突起83'可嵌套在下板主体24'的横向狭槽73'内。横向突起83'可以限定一对相对的凹陷部85',该对凹陷部沿着横向方向T延伸到突起83'中。凹陷部85'可被构造为至少在植入物10'处于塌缩构型时在其中接纳前致动组件94'和后致动组件96'的驱动轴98'的头部110'的部分。
应当理解,第二实施方案的致动组件94'、96'中的每个的第三楔形件53'和第四楔形件54'可不同于其在第一实施方案中的对应物。参见图44至图46,第三楔形件主体216'可限定上表面231',该上表面沿着纵向方向L在内面226'和第四坡道234'之间延伸。第三楔形件主体216'可限定延伸穿过第四坡道234'和引导突起236'的竖直孔233',并且还可限定从内面226'延伸到外面228'的一对臂235'、237'。竖直孔233'可与第三楔形件53'的中心孔230'连通。中心孔230'的螺纹232'的一部分可被限定在臂235'、237'的内侧上。该对臂235'、237'中的每个可限定下表面239'(图46),该下表面朝向第三楔形件53'的中心孔230'的轴线X2倾斜。第三楔形件53'的倒圆部分244'可以从臂235'、237'的下表面239'向下延伸,并且可在竖直横向平面中具有大致半圆形轮廓。本实施方案的倒圆部分244'可任选地相对于纵向方向L不倾斜。倒圆部分244'可包围第三楔形件主体216'的中心孔230'的至少一部分。
第四楔形件主体246'可限定从外面258'沿着外部纵向方向LE延伸的前篮253'。前篮253'可为第四楔形件主体246'的底部基部表面262'提供增加的长度,并因此在底部基部表面262'沿着通道基部表面68邻接和/或平移时增加稳定性。第四楔形件主体246'的外面258'可以是其第一外面,并且前篮253'可限定第二外面255',该第二外面沿着外部纵向方向LE与第一外面256'间隔开。第二外面255'可定位在第四楔形件主体246'的外端250'处。第四楔形件主体246'的底部表面262'可沿着纵向方向L从内面256'延伸到第六坡道268',并且可沿着篮253'的一部分延伸。第六坡道268'可从底部表面262'延伸到第四楔形件主体246'的第二外面255'。第二实施方案的第四楔形件主体246'的引导突起270'可与第一实施方案的引导突起270'类似地构造。
篮253'可限定沿着纵向方向L延伸的中心凹陷部257'。中心凹陷部257'可被表征为沿着篮253'的第四楔形件主体246'的中心孔264'的延伸部。中心凹陷部257'可将篮253'的上部部分分成一对臂259'、261',其各自大致沿着纵向方向L延伸并且各自具有上表面263',该上表面朝向第四楔形件54'的中心孔轴线X3倾斜。篮253'还可限定槽265',该槽被构造为接纳第三楔形件主体216'的倒圆部分244'。槽265'可具有对应于第三楔形件主体216'的倒圆部分244'的倒圆轮廓,并且可允许第三楔形件主体216'的倒圆部分244'围绕第三楔形件主体216'的中心孔轴线X3在槽265内旋转。中心凹陷部257'还可限定第四楔形件主体246'的中心孔264'的螺纹266'的一部分。第四楔形件主体216'可在其外端250'处限定延伸穿过篮253'的竖直孔267'。第三楔形件216'和第四楔形件246'的竖直孔233'、267'可沿着竖直方向V彼此对准。
如图44和图45所示,第三楔形件主体216'可联接到第四楔形件主体54',使得:第三楔形件主体216'的倒圆部分244'被接纳在第四楔形件主体246'的槽265'内;第三楔形件主体216'的内面226'邻接或邻近第四楔形件主体的第一外面256';并且第三楔形件主体216'的外面228'沿着竖直方向V基本上与第四楔形件主体246'的第二外面255'对准。当板20'、22'处于中立(即,非脊柱前凸)构型时,在第三楔形件主体216'的臂235'、237'的下表面239'与第四楔形件主体246'的臂259'、261'的上表面263'之间限定间隙275'。间隙275'和倾斜的臂表面239'、263'可被构造为允许第三楔形件主体216'相对于第四楔形件主体246'旋转,如图45所示。另外,第三楔形件主体216'的倒圆部分244'和第四楔形件主体246'的槽265'可被协作地构造为相对于沿着驱动轴98'的平移将第三楔形件53'和第四楔形54'平移地附连在一起。
现在参见图47,示出了植入物10'的第二实施方案,其中每个楔形件组件124'、126'处于完全伸展构型(为了可视化目的而移除了上板22')。应当理解,第二实施方案的致动组件94'、96'和楔形件组件124'、126'可如上相对于第一实施方案所阐述的那样操作。
现在参见图48和图49,植入物10'的致动组件94'、96'可独立地操作,使得上板22'相对于下板20'相对于横向方向T倾斜,以便为植入物10'提供脊柱前凸轮廓,如上所阐述。如图48所示,下骨接触表面28'和上骨接触表面30'能够以在约0度和约25度的范围内的脊柱前凸角β取向。如上所阐述,当板20'、22'中的至少一个相对于另一个前凸地倾斜时,下骨接触表面28'和上骨接触表面30'之间的与相关联的中心轴轴线X1相交的第一竖直距离D1可短于或长于骨接触表面28'、30'之间的与相关联的中心轴轴线X1相交的第二竖直距离D2。另外,当板20'、22'中的至少一个相对于另一个前凸地倾斜时,在植入物10'的前侧16'处在下板20'和上板22'之间的竖直距离D3短于或长于在植入物10的后侧18'处在板20'、22'之间的竖直距离D4,如上所阐述。
如图49的示例性前凸构型中所示,在前致动组件94'中,其近侧楔形件组件124'和远侧楔形件组件126'可靠近塌缩构型,而在后致动组件96'中,其楔形件组件124'、126'可在完全伸展构型附近或其处伸展,从而致使上板22'的前凸倾斜。应当理解,虽然图49示出竖直地分离以提供致动组件94'、96'的无阻挡视图的下板20'和上板22',但板20'、22'以与图48中所示相同的脊柱前凸角β示出。
应当理解,尽管所示实施方案描绘了具有一对致动组件94、96的植入物10,但是在其它实施方案(未示出)中,植入物10可具有单个致动组件94以使植入物10沿着竖直方向V伸展。在一个这样的实施方案中,板20、22可被构造为在前侧16和后侧18中的一个处以铰链状的方式保持彼此接触,使得单个致动组件94的操作使植入物10竖直地伸展,并且同时提供脊柱前凸。
现在参见图50,驱动工具300可被构造为接合植入物10的前致动组件94和后致动组件96。例如,驱动工具300可包括联接到沿着横向方向T彼此间隔开的第一驱动器304和第二驱动器306的柄部302。第一驱动器304可携带被构造为接合前致动组件94的驱动联接件的第一钻头308,而第二驱动器306可携带被构造为接合后致动组件96的驱动联接件的第二钻头310。例如,在所示实施方案中,第一钻头308和第二钻头310可各自限定六角形轮廓,该六角形轮廓被构造为接合对应致动组件94、96的插座孔118的对应的六角形轮廓。
驱动工具300可包括一个或多个选择器开关,其允许医师在工具300的各种操作模式之间进行选择。例如,第一选择器开关312可在第一驱动模式A、第二驱动模式B和第三驱动模式C之间切换。在第一驱动模式A下,工具300可被设为仅操作第一驱动器304。在第二驱动模式B下,工具300可被设为同时操作第一驱动器304和第二驱动器306。在第三模式C下,工具300可被设为仅操作第二驱动器306。
第二选择器开关314可与第一驱动器304通信。例如,第二选择器开关314可在第一位置E和第二位置F之间切换,在该第一位置E中,工具300被设置为沿顺时针方向旋转第一驱动器304;在该第二位置F中,工具300被设置为沿逆时针方向旋转第一驱动器304。类似地,第三选择器开关316可与第二驱动器306连通。例如,第三选择器开关316可在第一位置G和第二位置H之间切换,在该第一位置G中,工具300被设置为沿顺时针方向旋转第二驱动器306;在该第二位置H中,工具300被设置为沿逆时针方向旋转第二驱动器306。
第四选择器开关318可允许医师选择第一驱动器304的扭矩和/或速度设置。第五选择器开关320可允许医师选择第二驱动器306的扭矩和/或速度设置。因此,第一选择器开关312、第二选择器开关314、第三选择器开关316、第四选择器开关318和第五选择器开关320允许医师根据需要使用工具300来一致地或独立地操作前致动组件94和后致动组件96。另外,选择器开关还可允许医师独立地调整致动组件94、96中的每个的旋转方向、速度和/或扭矩。
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。另外,本文公开的实施方案中的任一个可以结合相对于本文公开的其它实施方案中的任一个公开的特征。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)
1.一种椎间植入物,所述椎间植入物被构造为在塌缩构型和伸展构型之间迭代,所述植入物包括:
第一板和第二板,所述第一板和所述第二板沿着第一方向彼此间隔开,所述第一板限定第一骨接触表面,所述第二板限定沿着所述第一方向背向所述第一骨接触表面的第二骨接触表面;
伸展组件,所述伸展组件相对于所述第一方向设置在所述第一板和所述第二板之间,所述伸展组件包括:
第一支撑楔形件,所述第一支撑楔形件支撑所述第一板,所述一支撑楔形件限定第一坡道;
第二支撑楔形件,所述第二支撑楔形件支撑所述第二板,所述第二支撑楔形件限定第二坡道和第三坡道;和
伸展楔形件,所述伸展楔形件限定第四坡道,
其中所述第一坡道、所述第二坡道、所述第三坡道和所述第四坡道中的每个相对于基本上垂直于所述第一方向的第二方向倾斜,并且所述第一支撑楔形件和所述第二支撑楔形件中的至少一个能够沿着相应的被支撑的所述第一板或所述第二板滑动;和
致动器,所述致动器被构造为向所述伸展楔形件施加驱动力,以便致使1)所述第四坡道沿着所述第三坡道行进,以便沿着所述第一方向增加所述第一骨接触表面和所述第二骨接触表面之间的距离,并且2)所述第二坡道沿着所述第一坡道行进,从而进一步增加所述距离,从而将所述植入物从所述塌缩构型迭代到所述伸展构型,
其中第一和第二支撑楔形件与伸展楔形件可相对于彼此平移。
2.根据权利要求1所述的植入物,其中所述距离在所述塌缩构型和所述伸展构型之间至少增加2.0倍。
3.根据权利要求1所述的植入物,其中所述第一坡道、所述第二坡道、所述第三坡道和所述第四坡道中的每个以10度和60度范围内的倾斜角度倾斜。
4.根据权利要求3所述的植入物,其中所述伸展楔形件限定附加坡道,所述附加坡道被构造为响应于所述驱动力而沿着所述第一坡道行进,并且所述附加坡道以20度和50度范围内的角度倾斜。
5.根据权利要求1所述的植入物,其中所述致动器能够围绕沿着所述第二方向取向的轴线旋转,并且当所述第四坡道沿着所述第三坡道行进时,所述致动器驱动所述伸展楔形件以沿着所述第二方向平移。
6.根据权利要求5所述的植入物,其中所述致动器螺纹联接到所述伸展楔形件,使得所述致动器围绕所述轴线的旋转致使所述伸展楔形件沿着所述致动器螺纹平移。
7.根据权利要求1所述的植入物,其中:
所述伸展组件是第一伸展组件;并且
所述植入物还包括相对于所述第一方向设置在所述第一板和所述第二板之间的第二伸展组件,所述第二伸展组件沿着所述第二方向与所述第一伸展组件间隔开,所述第二伸展组件包括:
第三支撑楔形件,所述第三支撑楔形件支撑所述第一板,所述三支撑楔形件限定第五坡道;
第四支撑楔形件,所述第四支撑楔形件支撑所述第二板,所述第二支撑楔形件限定第六坡道和第七坡道;和
第二伸展楔形件,所述第二伸展楔形件限定第八坡道,
其中所述第五坡道、所述第六坡道、所述第七坡道和所述第八坡道中的每个相对于所述第二方向倾斜,并且所述第三支撑楔形件和所述第四支撑楔形件中的至少一个能够沿着相应的被支撑的所述第一板或所述第二板滑动,并且
所述致动器被构造为向所述第二伸展楔形件施加第二驱动力,以便致使1)当所述第四坡道沿着所述第三坡道行进时,所述第八坡道沿着所述第七坡道行进,以便沿着所述第一方向共同地增加所述第一板和所述第二板之间的距离,并且2)当所述第二坡道沿着所述第一坡道行进时,所述第六坡道沿着所述第五坡道行进,以便沿着所述第一方向共同地进一步增加所述第一板和所述第二板之间的距离,从而将所述植入物从所述塌缩构型迭代到所述伸展构型。
8.根据权利要求1所述的植入物,其中所述伸展构型是第一伸展构型,伸展组件是第一伸展组件,所述距离是第一距离,并且所述植入物还包括:
第一侧和第二侧,所述第二侧沿着第三方向与所述第一侧间隔开,所述第三方向基本上垂直于所述第一方向和所述第二方向,其中所述第一距离在所述植入物的所述第一侧处能够测量;
第二伸展组件,所述第二伸展组件相对于所述第一方向设置在所述第一板和所述第二板之间,所述第二伸展组件沿着所述第三方向与所述第一伸展组件间隔开,所述第二伸展组件包括:
第三支撑楔形件,所述第三支撑楔形件支撑所述第一板,所述第三支撑楔形件限定第五坡道;
第四支撑楔形件,所述第四支撑楔形件支撑所述第二板,所述第二支撑楔形件限定第六坡道和第七坡道;和
第二伸展楔形件,所述第二伸展楔形件限定第八坡道,
其中所述第五坡道、所述第六坡道、所述第七坡道和所述第八坡道中的每个相对于所述第二方向倾斜,并且所述第三支撑楔形件和所述第四支撑楔形件中的至少一个能够沿着由所述第三支撑楔形件和所述第四支撑楔形件中的所述一个支撑的所述相应板滑动;和
第二致动器,所述第二致动器被构造为将第二驱动力施加到所述第二伸展楔形件,以便致使1)所述第八坡道沿着所述第七坡道行进,以便沿着所述第一方向增加所述第一板和所述第二板之间的第二距离,其中所述第二距离在所述第二侧处能够测量,并且2)所述第六坡道沿着所述第五坡道行进,以便沿着所述第一方向进一步增加所述第一板和所述第二板之间的所述第二距离,从而使所述植入物从所述塌缩构型迭代到所述第二伸展构型,其中,在所述第二伸展构型中,所述第二距离不同于所述第一距离,使得所述第一板和所述第二板中的一个相对于所述第一板和所述第二板中的另一个倾斜。
9.一种椎间植入物,所述椎间植入物被构造为在塌缩构型和伸展构型之间迭代,所述植入物包括:
第一板和第二板,所述第一板和所述第二板沿着第一方向彼此间隔开,所述第一板限定第一骨接触表面,所述第二板限定沿着所述第一方向背向所述第一骨接触表面的第二骨接触表面;
伸展组件,所述伸展组件相对于所述第一方向设置在所述第一板和所述第二板之间,所述伸展组件包括:
第一支撑楔形件,所述第一支撑楔形件支撑所述第一板,所述一支撑楔形件限定第一坡道;
第二支撑楔形件,所述第二支撑楔形件支撑所述第二板,所述第二支撑楔形件限定第二坡道和第三坡道;和
伸展楔形件,所述伸展楔形件限定第四坡道,
其中所述第一坡道、所述第二坡道、所述第三坡道和所述第四坡道中的每个相对于基本上垂直于所述第一方向的第二方向倾斜,并且所述第一支撑楔形件和所述第二支撑楔形件中的至少一个能够沿着相应的被支撑的所述第一板或所述第二板滑动;和
致动器,所述致动器被构造为向所述伸展楔形件施加驱动力,以便致使1)所述第四坡道沿着所述第三坡道行进,以便沿着所述第一方向增加所述第一骨接触表面和所述第二骨接触表面之间的距离,并且2)所述第二坡道沿着所述第一坡道行进,从而进一步增加所述距离,从而将所述植入物从所述塌缩构型迭代到所述伸展构型,
其中:
当所述植入物处于所述塌缩构型时,整个所述第一支撑楔形件相对于所述第二方向与整个所述伸展楔形件间隔开,并且所述第二支撑楔形件的至少一部分相对于所述第二方向设置在所述第一支撑楔形件和所述伸展楔形件之间;并且
当所述植入物处于所述伸展构型时,所述第一支撑楔形件相对于所述第一方向位于整个所述伸展楔形件之下,并且整个所述第二支撑楔形件相对于所述第一方向与整个所述第一支撑楔形件间隔开。
10.根据权利要求9所述的植入物,其中所述第一板限定沿着所述第二方向伸长的第一通道,所述第二板限定沿着所述第二方向伸长的第二通道,所述第一通道和所述第二通道朝向彼此开放并且彼此重叠以便限定隔室,并且当所述植入物处于所述塌缩构型时,所述楔形件中的每个容纳在所述隔室内。
11.根据权利要求10所述的植入物,其中:
所述第一通道限定沿着所述第二方向和第三方向延伸的第一基部表面,所述第三方向垂直于所述第一方向和所述第二方向;
所述第二通道限定沿着所述第二方向和所述第三方向延伸的第二基部表面,并且所述第一基部表面和所述第二基部表面面向彼此;
所述第二支撑楔形件限定楔形件基部表面,所述楔形件基部表面被构造为在所述植入物在所述塌缩构型和所述伸展构型之间的伸展期间沿着所述第二基部表面滑动,并且
所述伸展楔形件限定另一个楔形件基部表面,所述另一个楔形件基部表面被构造为在所述植入物的伸展期间沿着所述第一基部表面行进。
12.根据权利要求11所述的植入物,其中所述伸展楔形件进一步限定附加坡道,所述附加坡道相对于所述第二方向倾斜,并且所述植入物被构造为使得在所述植入物的第一伸展阶段期间:
所述附加坡道相对于所述第二方向远离所述第一坡道,而所述第二坡道沿着所述第一坡道行进,并且;
所述第四坡道沿着所述第三坡道行进;并且
所述另一个楔形件基部表面沿着所述第一基部表面行进。
13.根据权利要求12所述的植入物,其中所述植入物被构造为使得在所述植入物的第二伸展阶段,1)所述附加坡道沿着所述第一坡道行进,并且2)所述第二坡道远离所述第一坡道。
14.一种用于侧向插入椎间间隙中的植入物,所述植入物包括:
伸展机构,所述伸展机构相对于竖直方向设置在第一端板和第二端板之间,所述第一端板限定第一骨接触表面,所述第二端板限定沿着所述竖直方向背向所述第一骨接触表面的第二骨接触表面,所述伸展机构包括:
前致动组件,所述前致动组件沿着第一轴线布置;和
后致动组件,所述后致动组件沿着第二轴线布置,所述第一轴线和所述第二轴线各自沿着基本上垂直于所述竖直方向的纵向方向取向,所述第一轴线和所述第二轴线沿着基本上垂直于所述竖直方向和所述纵向方向的横向方向彼此间隔开,其中沿着所述竖直方向在所述第一骨接触表面和所述第二骨接触表面之间的第一距离与所述第一轴线相交,并且沿着所述竖直方向在所述第一骨接触表面和所述第二骨接触表面之间的第二距离与所述第二轴线相交,所述前致动组件和所述后致动组件各自包括:
第一支撑楔形件,所述第一支撑楔形件支撑所述第一端板;
第二支撑楔形件,所述第二支撑楔形件支撑所述第二端板,所述第二支撑楔形件能够相对于所述第一支撑楔形件滑动;和
伸展楔形件,所述伸展楔形件能够相对于所述第二支撑楔形件滑动;和
驱动轴,所述驱动轴联接到所述伸展楔形件,所述驱动轴能够围绕相应的所述第一轴线或所述第二轴线旋转,以便致使1)所述伸展楔形件沿着所述第二支撑楔形件行进,并且2)所述第二支撑楔形件沿着所述第一支撑楔形件行进,从而改变相应的所述第一距离或所述第二距离;
其中所述前致动组件和所述后致动组件的所述驱动轴可彼此独立地旋转,以便提供所述第一距离和所述第二距离之间的差值。
15.根据权利要求14所述的植入物,其中每个伸展楔形件包括第一构件和第二构件,所述第一构件能够相对于所述第二构件围绕相应的所述第一轴线或所述第二轴线旋转,并且所述第一构件被构造为响应于所述相应驱动轴的旋转而沿着所述相应第二支撑楔形件行进,并且所述第二构件被构造为响应于所述相应驱动轴的旋转而沿着所述相应第一支撑楔形件行进。
16.根据权利要求15所述的植入物,其中:
每个端板限定前引导特征结构和后引导特征结构,所述前引导特征结构和所述后引导特征结构中的每个沿着所述纵向方向延伸,
每个第二支撑楔形件包括引导元件,所述引导元件被构造为沿着所述第二端板的相应的所述前引导特征结构或所述后引导特征结构行进;并且
每个伸展楔形件的所述第二构件包括引导元件,所述引导元件被构造为沿着所述第一端板的相应的所述前引导特征结构或所述后引导特征结构行进。
17.根据权利要求16所述的植入物,其中每个第二支撑楔形件还包括引导特征结构,并且每个伸展楔形件的所述第一构件限定引导元件,所述引导元件被构造为在所述相应第二支撑楔形件的所述引导特征结构内行进。
18.根据权利要求17所述的植入物,其中每个第一支撑楔形件限定引导特征结构,并且所述相应第二构件的所述引导元件进一步被构造为沿着所述相应第一支撑楔形件的所述引导特征结构行进。
19.根据权利要求18所述的植入物,其中所述引导特征结构中的每个是导槽,并且所述引导元件中的每个是引导突起,所述引导突起被构造为在所述相关联导槽内延伸并且沿着所述相关联导槽行进。
20.根据权利要求19所述的植入物,其中:
所述第二端板的所述导槽和所述第二支撑楔形件的所述相应引导突起协作成形以便相对于围绕相应的所述第一轴线或所述第二轴线的旋转将所述第二端板旋转地互锁到所述第二支撑楔形件中的每个;并且
所述第二支撑楔形件的所述导槽和所述第一构件的所述相应引导突起协作成形以便相对于围绕相应的所述第一轴线或所述第二轴线的旋转将所述第二支撑楔形件旋转地互锁到所述相应第一构件。
21.根据权利要求20所述的植入物,其中,
每个第一支撑楔形件相对于围绕相应的所述第一轴线或所述第二轴线的旋转固定到所述第一端板;
每个第二构件的所述引导突起和所述第一端板的所述相应导槽协作成形以便在所述相关联第二构件的所述引导突起在所述相应导槽内延伸时将所述第一端板旋转地互锁到所述相关联第二构件;并且
每个第二构件的所述引导突起和所述相应第一支撑楔形件的所述导槽协作成形,以便在所述相关联第二构件的所述引导突起在所述相关联第一支撑楔形件的所述导槽内延伸时将每个第一支撑楔形件旋转地互锁到所述相关联第二构件。
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WO2018208583A1 (en) | 2018-11-15 |
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