CN1273087C - 器械去除成套工具 - Google Patents

器械去除成套工具 Download PDF

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Publication number
CN1273087C
CN1273087C CNB991073789A CN99107378A CN1273087C CN 1273087 C CN1273087 C CN 1273087C CN B991073789 A CNB991073789 A CN B991073789A CN 99107378 A CN99107378 A CN 99107378A CN 1273087 C CN1273087 C CN 1273087C
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CN
China
Prior art keywords
keeper
vertebral body
body keeper
trepan
handle
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Fee Related
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CNB991073789A
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English (en)
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CN1237403A (zh
Inventor
D·J·乌尔巴恩斯
T·S·卡米诺
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
DePuy Spine LLC
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DePuy Acromed Inc
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Publication of CN1237403A publication Critical patent/CN1237403A/zh
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    • 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
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    • 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
    • A61F2/4611—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 of spinal prostheses
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    • A61B17/1604—Chisels; Rongeurs; Punches; Stamps
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    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
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  • Oral & Maxillofacial Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Dentistry (AREA)
  • Neurology (AREA)
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Abstract

一种用于从脊柱(14)中去除定位件(12)的成套工具(100)，所述的定位件(12)具有外表面(22)和末端(24、26)。该成套工具(100)包括骨刀(10)、螺纹拔除器(54)和环锯(70)，每个工具均可使定位件(12)从脊柱(14)中分开。骨刀(10)包括切削部(46)，该切削部(46)具有与定位件(12)的外表面(22)配合的表面(48)，骨刀(10)还包括切削定位件(12)四周的物质尖部(52)。螺纹拔除器(54)包括形成有螺纹(66)的侧壁(64)，该螺纹可以在侧壁(64)相对于定位件(12)转动时，切入到定位件(12)的端部(24、26)中的一个，并使定位件(12)从脊柱中拉出。环锯(74)包括具有限定了通道(80)的套筒(76)的锯片(74)，环锯还包括用于切削定位件(12)的表面(22)周围的物质的边缘(64)。

Description

器械去除成套工具
技术领域
本发明涉及从骨骼中对器械的去除，更具体地说，涉及从脊柱中对植入的器械的去除。进一步具体地说，本发明涉及用于从脊柱中对植入器械去除的成套工具。
背景技术
现有技术CN1128944A披露了一种插入脊椎植入物的装置，相对于病人身体插入或取出植入物。该植入物具有大体柱形的结构，在其外周边上具有螺纹且还具有一中央螺纹部，该装置包括第一管件，此管件具有与植入物的中央螺纹部相对应的螺纹和外径，此外还具有用来啮合植入物一部分的啮合装置。该啮合装置固定于植入物之上，且相对于第一管件成可转动的关系。
发明内容
本发明提供一种用于从脊柱中去除椎体定位件的成套工具，所述椎体定位件具有预定的长度并且具有外表面和相对的末端，该成套工具包括骨刀、螺纹拔除器和环锯，该骨刀包括手柄部和从手柄部延伸的切削部，该切削部具有与椎体定位件的外表面配合的表面，还包括与手柄部分开的尖部，该尖部具有足够的长度以切削椎体定位件外表面的大体整个长度四周的物质，以使椎体定位件从脊柱分开；该螺纹拔除器包括手柄和与手柄连接的端部，该端部包括形成有螺纹的侧壁，以在侧壁相对于椎体定位件转动时，该螺纹切入到椎体定位件的其中一端，并使椎体定位件朝手柄拉出，从而使椎体定位件从脊柱分开；该环锯包括锯片，该锯片具有带内表面的套筒，该内表面限定了一通道，该通道的尺寸被设计成用以接收位于其内的椎体定位件，该环锯还包括一外表面和一位于通道内开口的周边的边缘，该边缘用于切削椎体定位件的外表面周围的物质。本发明的方法包括成套工具及其部件的使用，该方法通过在定位件的外表面切削骨骼而从脊柱上去除定位件。
在参照下面的最佳实施例的详细描述后，对于本领域的技术人员来说，本发明其他的特征将更明显，该最佳实施例表示了目前获得的实现本发明的最佳模式。
附图说明
图1为脊柱的前部的透视图，其中脊柱的一个椎间盘的部分被去除以形成空腔，定位件设置平放在椎体之间的该空腔内，并且骨刀包括形成用以沿定位件切削的切削端；
图2为沿图1中的2-2线的视图，该图示出了包括具有顺时针螺纹的外表面和穿过该外表面形成的孔腔的融合架，以及骨刀的切削端伸入到一个椎体和融合架之间，从而可使融合架从骨骼中分离出来；
图3为反向螺纹拔除器和融合架的透视图，同时示出的融合架包括限定了通道的内表面，反向螺纹拔除器包括手柄和具有逆时针螺纹的斜末端；
图4为与图3近似的视图，该图示出了反向螺纹拔除器的螺纹切入到定位件的边缘，该手柄的逆时针转动产生使定位件从空腔内移出的运动；
图5为环锯的透视图，该环锯包括手柄和切削端，切削端具有限定了通道的套筒，其尺寸用以接收其中的融合架，同时示出了沿开口的四周延伸到通道中的切削齿；及
图6为与图2近似的图，示出了延伸到环锯的通道中的融合架，以及切削齿沿融合架的外端进行切削以使融合架从骨骼中分离开。
具体实施方式
本发明提供一种用于例如在椎间盘替换外科手术中，从脊柱14中去除椎体定位件12的成套修正工具100及方法。如图1、3和5所示，成套工具100可使外科大夫从脊柱14的外部18去除定位件12，而此时仅切削定位件12周围有限量的骨骼。进行这种去除可替换内椎间盘20。成套修正工具100包括骨刀10、容易拔除或者是反螺纹的拔除器50以及环锯110。
定位件12包括由金属制成的并可水平地植入到脊柱14中的螺纹融合架。参见图1-2，每个定位件12中容有堆积的骨骼或其它需要的物质(未示出)，于是定位件12可与脊柱14融合，同时可避免两个脊椎40间的移动，以减小患者的痛苦。可以理解，成套修正工具100可与各种不同尺寸和不同材料的定位件一起使用，这些材料例如为纤维组织、骨骼、合成物或其它类似的设计成可植入到脊柱14中的作为脊柱定位件的材料。
参见图1、2和3，示出的定位件12通常包括圆筒外表面22、两个相对端面24、26以及在相对端面24、26之间延伸的限定通道30的内表面28，其尺寸可设计成接收堆积的骨骼。形成的每个端面24、26包括限定了孔腔34的的边缘32，孔腔34具有比通道30的直径稍小的直径。另外，定位件12包括形成在外表面22上的螺纹36和各种尺寸的孔38，该孔在外表面22和内表面38之间延伸。可以理解的是定位件12可包括顺时针或逆时针方向延伸的螺纹，同时也可不带孔38。
脊柱14包括前部18和后部16。参见图1和图2，另外，脊柱14包括颈部的、胸部的和腰部的椎体40。成套修正工具100的工具10、54、70的结构设计成可从脊柱14的前部18和后部16的椎间盘20中去除示出的定位件12，而无论该脊柱是颈部的、胸部的或是腰部的。在去除定位件12后，外科大夫去除所有的坏死的椎间盘或其中的一部分，并刮掉椎间盘20的两端的骨骼。新的定位件12送入到形成的空腔42内，以代替椎间盘20并挖入附近的椎体40内。参见图1，定位件12在空腔42内是并排平着放置。
提供的成套修正工具的骨刀10以最小的侵损把定位件从脊柱上去除下来。参见图1-2，骨刀10包括手柄部44和切削部46。切削部46包括基本上凹陷的内表面48和外表面50。切削部46还包括尖部52。无论什么原因要使定位件12从脊柱14上去除，尖部52均可围绕定位件12的外表面22进行铲削，使定位件12从椎体30上分离开来。在示出并描述了骨刀10后，可以理解在本发明中可以使用各种可购买到的骨刀，这些骨刀具有形成的内表面，于是该表面可与各种形状的定位件相对应，尖部在尺寸和形状上可以变化，手柄带有预定的角度，或者手柄设计成可运动到不同角度。
当从脊柱14上去除定位件12需要比骨刀10有较大的侵损时，可使用成套修正工具100的反向螺纹拔除器54。虽然使用拔除器5的侵损的程度要比使用骨刀10的要大，但是用拔除器4去除定位件12的侵损还是受限制。拔除器54的形状设计成把定位件12从脊柱14的或者是前部18或者是后部16拉出来。拔除器54包括手柄56和端部58。端部58包括基体60、尖部62和从基体60向尖部62会聚的侧壁64。侧壁64包括形成在其中的螺纹66。拔除器54是由高级不锈钢制成的。然而，可以理解，拔除器54可由各种医疗用的金属制成，于是螺纹66可比制成定位件12的材料相对要硬，并在形成在定位件12外表面22上的螺纹36相对方向上延伸。根据本发明，螺纹可沿侧壁64以顺时针或逆时针方式延伸。
当定位件融合到脊柱14上，这样从脊柱14上去除定位件12需要比拔除器54有较大的侵损时可使用成套修正工具的环锯70。在图5-6示出了环锯70。环锯70沿定位件12周围切削，使脊柱14分开，于是根据本发明的方法定位件12很容易地去除掉。环锯70由不锈钢制成，然而根据本发明可使用其它材料。
环锯70包括手柄72和锯片74。从图5中可清楚地看出，锯片74包括套筒76、相对的外表面82和边缘，该套筒76具有限定了通道80的内表面78，其尺寸设计成用以接收其中的定位件12，边缘沿开口86的四周延伸到通道80中。边缘最好由分开的齿84来形成。每个齿84包括第一侧边85，该侧边可基本上与锯片80的外表面82对齐延伸，该齿还包括第二侧边87，该侧边与第一侧边85有一个角度的偏离，于是第二侧边87可在齿峰处与第一侧边85相交。锯齿84的第一侧边85和第二侧边87的位置设计成逆时针方向，于是定位件12周围的骨骼可在手柄72如图箭头88的方向，即在切削骨骼的顺时针方向而被切削掉。可以理解，锯齿的第一侧边85和第二侧边87可根据手柄72的转动方向而变化。
另外，环锯70的内表面78的尺寸设计成可与定位件12的外表面22的螺纹36配合。参见图6，环锯70和定位件12之间的配合减少了定位件12周围分布的骨骼量。在锯片74上的内表面78和外表面82之间还形成有槽孔90。可以理解，根据本发明，可以使用各种具有不同长度手柄、不同长度和直径锯片以及没有分离齿而带尖端的锯片的环锯。
这样，本发明可以提供用以从脊柱14上去除植入定位件12的成套修正工具100。使用者可使用包括骨刀10、拔除器54和环锯70的成套工具100。一旦使用者确定了要去除的定位件12的相对尺寸，根据使用环境可选择适当的成套工具100。可以考虑将组成成套工具100的骨刀10、拔除器54和环锯70具有与已知定位件12的尺寸相对应的相近尺寸。
在使用中，使用者可选择其部件的形状和尺寸与植入的定位件12的对应的成套工具100。根据定位件12和椎体40之间的融合量，使用者可选择使用一个或更多的骨刀10、拔除器54或环锯70，以使定位件12从脊柱14上去除掉。而且，可以理解使用者可用骨刀10、拔除器5或环锯70其中之一开始进行去除，可用骨刀10、拔除器5或环锯70其中之一或多个完成去除。
现在来参照图1，骨刀10的尖部52首先沿椎体40和定位件12之间的定位件12的外表面22而处于箭头92的位置。此时切削部46的内表面48正对着定位件12，同时切削部46的外表面50正对着附近的椎体40。参见图2，骨刀10的切削部46沿定位件12的外表面22运动，以铲削周围软的和硬的骨骼或其它纤维组织。一旦切削部46铲掉融合在定位件12上的骨骼，定位件可从脊柱14上的空腔42中拉出来。可以理解的是，通过迅速地只铲掉定位件12周围骨骼，提供了用于从脊柱14上去除定位件12的相对有限侵损的方法。
如果从脊柱14上去除定位件12需要比骨刀10较大侵损，那么使用者可从成套工具100中选择拔除器54。使用拔除器54以从脊柱14中去除定位件12，尖部62可插入到空腔34中。于是手柄56可如箭头94所示方向转动，于是螺纹66与定位件12的边缘32配合。当手柄56转动时，螺纹66挖入到定位件12的边缘32中，并使拔除器54和定位件联在一起。因为螺纹66的材料比定位件12的材料较硬，于是螺纹66可挖入到边缘32中。当使用者在箭头94的方向上连续转动手柄56时，定位件12开始从椎体之间如箭头96所示的方向基本上水平地移动，从而与脊柱14分离开来。
如果从脊柱14上去除定位件12还需要比拔除器54较大侵损，那么使用者可从成套工具100中选择环锯70。使用根据本发明的环锯以使定位件12从脊柱14中去除，锯片74首先平放于附近的定位件12上。参见图5和6，使用者于是如箭头88方向转动手柄72。当手柄72在箭头88方向上转动手柄72时，边缘挖入到骨骼40中并使定位件12从脊柱14中分开，以使定位件12去除。图6可清楚地示出，当手柄转动时，定位件12延伸到环锯70的通道80中，锯齿84绕外表面22切削，使定位件12从椎体40间分开。此时，定位件12可利用环锯70从脊柱14中被拉出来，或定位件12可本身从脊柱14中拉出来。
虽然参照了最佳实施例对本发明进行了详细的描述，在描述的和下面权利要求书中限定的本发明的范围和精神内可进行变化和改型。

Claims (5)

1、一种用于从脊柱中去除椎体定位件的成套工具，所述椎体定位件具有预定的长度并且具有外表面和相对的末端，该成套工具包括骨刀、螺纹拔除器和环锯，
该骨刀包括手柄部和从手柄部延伸的切削部，该切削部具有与椎体定位件的外表面配合的表面，还包括与手柄部分开的尖部，该尖部具有足够的长度以切削椎体定位件外表面的大体整个长度四周的物质，以使椎体定位件从脊柱分开；
该螺纹拔除器包括手柄和与手柄连接的端部，该端部包括形成有螺纹的侧壁，以便在侧壁相对于椎体定位件转动时，该螺纹切入到椎体定位件的其中一端，并使椎体定位件朝手柄拉出，从而使椎体定位件从脊柱分开；
该环锯包括锯片，该锯片具有带内表面的套筒，该内表面限定了一通道，该通道的尺寸被设计成用以接收位于其内的椎体定位件，该环锯还包括一外表面和一位于通道内开口的周边的边缘，该边缘用于切削椎体定位件的外表面周围的物质。
2、根据权利要求1所述的成套工具，其特征在于：所述环锯的边缘具有锯齿。
3、根据权利要求1所述的成套工具，其特征在于：所述环锯包括与锯片连接的手柄。
4、根据权利要求1所述的成套工具，其特征在于：所述拔除器的端部包括基体、尖部和在基体和尖部之间延伸的侧壁。
5、根据权利要求4所述的成套工具，其特征在于：所述侧壁从基体向尖部会聚。
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DE69923727D1 (de) 2005-03-24
EP0951872A3 (en) 2001-03-07
CA2269269A1 (en) 1999-10-21
ATE289183T1 (de) 2005-03-15
ES2237885T3 (es) 2005-08-01
AU754555B2 (en) 2002-11-21
CA2269269C (en) 2007-01-09
DE69923727T2 (de) 2006-04-06
KR19990083369A (ko) 1999-11-25
US6264657B1 (en) 2001-07-24
CN1237403A (zh) 1999-12-08
EP0951872A2 (en) 1999-10-27
AU2386199A (en) 1999-10-28
KR100587201B1 (ko) 2006-06-08
EP0951872B1 (en) 2005-02-16

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