CN1602171A - 具有多轴头部的骨锚固植入体 - Google Patents

具有多轴头部的骨锚固植入体 Download PDF

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CN1602171A
CN1602171A CNA028247949A CN02824794A CN1602171A CN 1602171 A CN1602171 A CN 1602171A CN A028247949 A CNA028247949 A CN A028247949A CN 02824794 A CN02824794 A CN 02824794A CN 1602171 A CN1602171 A CN 1602171A
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rod
implant
axis
passage
fixing head
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雅克·博兰
若埃尔·德莱克兰
埃尔韦·沙泰涅
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LDR Medical SAS
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • A61B17/7034—Screws or hooks with U-shaped head or back through which longitudinal rods pass characterised by a lateral opening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6466—Devices extending alongside the bones to be positioned with pin-clamps movable along a solid connecting rod
    • A61B17/6483—Devices extending alongside the bones to be positioned with pin-clamps movable along a solid connecting rod the connecting rod having a non-circular section
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A—HUMAN NECESSITIES
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A61B17/7037—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other wherein pivoting is blocked when the rod is clamped
    • A—HUMAN NECESSITIES
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7056—Hooks with specially-designed bone-contacting part

Abstract

本发明涉及一种骨固定植入体，其包括能接纳并固定至少一根杆棒(2)的固定装置，该杆棒尤其是属于人造骨上的部件，植入体(1)在一方面包括骨锚固装置(10)，在另一方面，还包括支撑着所述固定装置的一固定头(11)，至少有一条接纳着杆棒(2)的通道(12)横穿所述固定头，固定头包括夹持装置(4)，其能将杆棒抵接着一个被称为支撑壁(32)的内侧壁而对其进行夹持，所述植入体(1)的特征在于：在将固定装置(4)锁定之前，固定装置(4)与所述支撑壁(32)具有绕至少一第一轴线(d3)进行转动的预定容隙，该第一轴线不与杆棒的纵向轴线平行；特征还在于夹持装置在与杆棒接触处包括一表面，该表面被称为活动夹持面(420)，夹持装置(4)的移动夹持面(420)被一个利用球窝连接机构铰接在夹持装置(4)端部的支撑头(42)支承着；特征还在于所述通道(12)为开口通道的形式，其具有一个位于固定头(11)某一侧面上的开口隙口(120)，所述隙口的一个边缘(124)支承着夹持装置(4)，因而，通道的隙口(120)与夹持装置的位置使得杆棒可从侧面穿入。

Description

具有多轴头部的骨锚固植入体
技术领域
本发明涉及一种用于骨锚固的植入体，其例如用在脊椎骨上固定一人造骨装置。该植入体包括一头部，所述头部能接纳一根杆棒，该杆棒将处于不同角位置的多个植入体联接起来。
背景技术
如所公知的那样，为了将植入到人体或动物体内的装置连接到骨骼上，将一个或多个植入体固定到一块或多块骨上。然后，利用所述植入体来紧固所述装置的某些元件。尤其是为了维持和矫正脊椎，公知的措施是采用一种人造骨假体，其包括一根或多根沿脊柱定位的支撑杆棒或支撑板，且利用植入体将这些杆棒或板件固定到某些脊椎骨上。在一方面，这些植入体被固定到杆棒上，在另一方面，其还利用骨锚固装置固定到脊椎骨上，其中的骨锚固装置是由一钩体或一螺纹部件构成的，钩体将其自身支撑在脊椎骨上，而螺纹部件则旋入到脊椎骨中—例如在脊椎骨的椎弓根处。自然地，在安装人工末端椎骨的情况下，可将一个或多个植入体固定到相邻的骨头—例如骶骨上。
为此目的，第FR 0104717号专利公开了一种植入体，其包括一骨锚固部件和一固定头，一通道横穿所述的固定头，支撑杆棒可被夹持在该通道中。该专利文件描述了一种植入体，其头部包括一横向孔，该横向孔允许一带有平面的杆棒穿入到其中，而夹紧螺钉则被预先安装在所述固定头的顶部中。为了确保夹紧螺钉在所述平面上具有理想的接触状况—而不论所述平面绕销体的轴线处于什么样的角位置上，在夹紧螺钉上设置了一个可倾转的支撑表面，其被安装在一球窝接头上。
在夹紧力的作用下，杆棒通过将其自身支撑在通道的内部形状上，其位置就由植入体的总体位置确定了。在将杆棒安装到已固定于脊椎中的植入体上时，如果杆棒所处位置不对应于通道的位置，则用于将其插入的作用力会在杆棒中产生一定的应力。
一方面，所述应力会使杆棒穿入植入体的操作变得困难、或者使其夹紧作用变得不是非常精确。当杆棒已被接合到第一植入体中、且正在被穿入到第二植入体中时，这一问题确实会非常突出。为了减小这一应力，可以考虑根据杆棒的位置来对植入体进行固定，但这样作并非是始终可行的，或者并不易于预测其效果。还可考虑将杆棒变形的方案，但在那些需要刚性杆棒、以确保有效支撑的场合和条件下，这样的方案也存在问题。因而，杆棒中的应力会导致操作难于进行，尤其是在小切口外科手术的执行过程中，其中的小切口手术例如是窥镜手术或腹腔镜手术。
在另一方面，即使夹持作用能将杆棒强制变形为具有与植入体相对应的位置和形状，在手术之后的很长时间内，所述应力也将长期存在。杆棒长期处于张力状态下的事实会带来这样的风险：对脊椎产生了直接的机械作用，例如会造成疼痛，或者改变或影响了采用人造骨假体所追求的矫正或支撑作用。
发明内容
本发明的目的是消除现有技术中的至少一方面缺陷，其方式是通过提供一种能适应所述杆棒的一定范围的不同取向的骨锚固植入体，尽管该植入体在事前已被固定到了骨中。
实现本目的的方式是通过一种用于骨锚固的植入体，所述植入体包括能接纳并固定至少一杆棒的固定装置，所述杆棒尤其是属于人造骨上的部件，所述植入体在一方面包括骨锚固装置，在另一方面还包括一固定头，所述固定头支撑着所述固定装置，至少有一通道横穿所述固定头，该通道接纳着所述杆棒，并且所述固定头包括夹持装置，所述夹持装置能将所述杆棒抵接着一个被称为支撑壁的内侧壁而对其进行夹持，所述植入体的特征在于：在固定锁紧之前，所述固定装置与所述支撑壁能够得到一绕至少一第一轴线转动用的确定容隙，该第一轴线不与所述杆棒的纵向轴线平行；所述夹持装置在与所述杆棒接触处包括一表面，该表面被称为活动夹持面，所述夹持装置的活动夹持面被一利用球窝连接机构铰接在所述夹持装置端部的支撑头支承着；并且所述通道为开口通道的形式，其具有一隙口，所述隙口开口于所述固定头某一侧面上，所述隙口的一边缘支承着所述夹持装置，因而，所述通道的隙口与所述夹持装置的位置使得所述杆棒可从侧路导入。
根据另一个特征，在固定锁紧之前，所述固定装置与所述支撑壁能够获得一确定容隙，以利于绕至少一第二轴线进行转动，该第二轴线既不与第一轴线平行、也不与所述杆棒的纵向轴线平行。
根据另一个特征，所述通道借助于隙口而开口在所述固定头的每一侧上，这些隙口的布置位置和尺寸使得所述杆棒在所述通道内获得一确定容隙，以利于至少绕一轴线转动，该轴线基本上垂直于所述通道的轴线、以及所述夹持装置的支撑方向。
根据另一特征，所述支撑壁包括一被称为活动基座的元件，所述活动基座具有一利于至少绕一轴线转动的容隙，该轴线既不与所述通道的轴线平行、也不与所述杆棒上的所述夹持装置的支撑方向平行，所述活动夹持面具有一利于绕一轴线转动的确定容隙，该轴线基本上平行于所述活动基座的转动轴线。
根据本发明的另一特征，所述活动基座具有一球体的形式的部件，该部件通过一互补的接触方式倚靠在一形成在所述固定头中的容壳内。
根据本发明的另一特征，所述活动基座通过一支撑面与所述杆棒保持接触，所述支撑面的形状与所述杆棒的外形基本上互补，所述活动基座具有至少一形式不规则体，所述形式不规则体与所述固定头上所带的一形式不规则体相配合，从而形成了一止挡，用于支撑转向所述杆棒侧的所述基座的支撑面。
根据本发明的另一特征，所述形式不规则体是一制在所述活动基座下侧、后面或前面上的销体，其与一尺寸较大的凹腔相配合，该凹腔设置在所述固定头上。
根据本发明的另一特征，所述形式不规则体是一钻制在所述活动基座前面上的圆柱孔，其与一销体的圆柱形头部相配合，该销体被安装在所述固定头上制出的钻孔中。
根据本发明的另一特征，所述夹持装置包括一夹紧螺钉，其被旋入到一钻孔中，并与所述钻孔相配合，从而在所述杆棒上形成了一支撑体，其中的钻孔横穿所述通道开口的一边缘。
根据本发明的另一特征，所述骨锚固装置或者包括一螺纹部件，其能锚固到一骨元件中——方式是通过与所述骨元件的骨材料相配合；或者包括一突伸部件，其能锚固到一骨元件的所述表面处——其方式是通过与所述同一表面的至少一个形式不规则体相配合。
根据本发明的另一特征，所述骨锚固装置是由一纵长的螺纹部件制成，所述通道的轴线基本上垂直于所述骨锚固装置的纵向轴线。
根据本发明的另一特征，所述通道的形状包括两个首尾相接的截顶锥体，它们以各自较小的基座相互面对着，且直接或借助于一圆筒形的部分相互接合起来。
根据本发明的另一特征，所述杆棒的外表面上带有一个或多个平面，从而供给所述支撑头一平的接触平面。
附图说明
提高参照附图阅读下文的描述，可更清楚地理解本发明及其特征和优点，在附图中：
图1、2和3表示了一种带有活动头部和骨锚固件的植入体，三个视图分别是沿杆棒纵轴所在纸面方向所作的剖视图、沿杆棒的轴线所作的侧视图、以及俯视图；
图4是沿杆棒的横断方向对一带有固定头部的植入体所作的局部侧视剖面图，图中表示了该植入体在穿入杆棒过程中的状态；
图5和图6分别是沿杆棒的轴线、以及杆棒的横向对一带有固定头部和骨锚固件的植入体所作的轴测图，两轴测图中都表示出了作为骨锚固件的螺钉的纵向剖面结构；
图7是沿杆棒的轴线的纵向剖面所作的轴测图，表示了带有骨锚固件和固定头的植入体，其中的骨锚固件是由钩形体构成的；
图8和图9分别是根据第二实施方式的、带有固定头的植入体的轴测图和剖视图；
图10和图11分别是根据第三实施方式的、带有固定头的植入体的轴测图和剖视图；以及
图12和图13分别是根据第四实施方式的、带有固定头的植入体的轴测图和剖视图。
具体实施方式
本文所描述的发明涉及一种植入体，其一方面具有用于固定一杆棒的装置，另一方面还具有用于锚固到骨上的装置。
一般来讲，在外科学上，植入体被定义为一个要被植入到人体或动物体内、且在外科手术后至少要在体内停留一段时间的物体。更确切来讲，人们将能完成一定功能(例如具有运动功能或关节的功能)的装置称之为假体。尽管本文所述的植入体自身并不能构成假体，但必须要认识到这些植入体可构成一假体装置的组成部件、或者可被用来固定此类装置。
举例来讲，根据本发明的假体在本文中被定义为包含在人造骨装置中的植入体，例如用于保持、支护、或撑直脊柱。因而，其功能是由一根或多根杆棒或类似元件实现的，杆棒或类似元件将多块脊椎骨相互连接起来，其中的脊椎骨例如是骶骨、椎骨或椎骨的组成部分。在同样意义上，显然这样的杆棒还可被用来将其它的植入体或假体连接到骨骼上，其中的骨骼例如是人工脊柱、关节固定术所用支架、或人工椎间盘。
由于其部件被一个或多个植入体附接到了骨头上，所述杆棒就被锚固到所述骨头上，其中的植入体包括骨锚固装置，骨锚固装置例如是螺钉或一个/多个钩体。因而，植入体包括能在外科手术之前或过程中接纳杆棒的固定装置，这样就可以将所述杆棒与植入体固定起来。
在图1到图6所示的实施方式中，所述锚固装置是由一纵长的部件构成的，该纵长部件上制有螺纹，并能被旋入到骨材料中—例如可被旋入到椎骨上椎弓根或本体处的材料中、或者被旋拧到骶骨中。
在图7所示的实施方式中，所述骨锚固装置包括一钩体，该钩体将与骨头上的一形式不规则体相接合，其中的不规则体例如是椎弓根、椎骨棘突、骶骨突、或横向骨突。
在外科手术的过程中，当一植入体被锚固到某块骨中、且杆棒要被固定到该植入体上时，植入体所处位置并不能始终与杆棒的穿入位置相对应，如与该位置对正，则能将杆棒最容易地装配到植入体的固定装置。但例如是受解剖环境的限制、或者是由于所述杆棒已被装配到了另一个植入体中，所述的对正位置受到了限制。
另外，当杆棒被插入到固定装置中时，如果固定装置未能与杆棒的轴线正确地对正，则接触面或固定面的格局可能会成为固定不良的原因，从而无足够的刚度或无法进行紧固。
具体来讲，如果在进行固定时必须要向杆棒施力，以便于使其能适应于植入体的相对位置，则所述作用力会导致在人造骨装置的结构中产生残余应力。因此，这种持续存在的应力会影响患者日常的舒适性或干扰/改变假体装置的预期效果。
为了使固定装置能更好地适应于杆棒的位置，根据本发明的固定装置包括至少一个具有一定活动性的元件。可通过绕一条或多条轴线进行旋转来调节所述元件，这些轴线并不与杆棒的纵向轴线重合，例如可与所述纵向轴线垂直。可根据预定的容隙或预定的角位置来执行所述的转动，或者也可以不受限制地进行转动—即完全自由地转动，其中的预定容隙允许实现一最大的转角位置。根据本发明的实施方式，所述固定装置可包括一个沿一条或多条轴线移动的元件，或可包括多个自身能沿一条或多条轴线运动的元件。
因而，可相对于骨锚固装置或骨块将杆棒装配到多个不同的角位置上。具体来讲，角位置的这种变化包括：在植入体的锚固处相对于骨表面可调地倾斜、或绕一条从所述骨表面延伸出的轴线转动、或者这两种运动的组合。
在文中所述的实施方式中，利用固定装置将植入体1刚性地连接到杆棒2上，固定装置包括一通道12，该通道是在植入体的一个部件中形成，所述部件被称为固定头11。通道12的形状表现为一条两端和一侧均开口的通道。因而，这样的侧面开口120使得可从通道的侧面导入杆棒2(见图4)，而无需从将杆棒从其一端旋入到通道中。
杆棒一旦被插入到通道12中之后，就可由夹持装置4来保证杆棒的固定，夹持装置被所述杆棒的至少一侧支撑着，从而与杆棒的一侧相接触，并将杆棒顶抵在通道12的一个壁面上，该壁面被称为支撑壁。所述夹持装置例如包括一夹紧螺钉41，其被安装到固定头11一部分上制出的一个钻孔14中，固定头的这一部分构成了通道12侧面开口的一个边缘。所述夹紧螺钉41具有一外螺纹，其与所述钻孔14中的内螺纹相配合，由此可使螺钉41沿夹紧轴线d4移动，从而与杆棒相抵接，进而实现了夹持，夹紧螺钉41可包括外形上的不规则结构，例如可包括一内部标卡体(internal mark)，从而能使用夹持工具将杆棒2锁固紧。杆棒的外表面上最好具有一个或多个平面，以便于形成与夹紧螺钉41平面接触的接触面，这样，相比于点接触或线接触，能使锁固作用更为可靠。
在图4到图13所示的实施方式中，通道12具有一支撑壁，其提供了一个被称为活动基座3的元件，所述基座3具有一个局部球体形式的部件31，其由一互补的接触体抵靠着，该接触体位于一个形成于通道12壁面上的容壳内。借助于所述球面接触，活动基座3提供了绕其球形部分31的球心在一定程度上进行转动的自由度。具体而言，所述活动基座3具有绕一轴线d3进行转动的一定容隙a3，轴线d3基本上垂直于通道的纵向轴线d12、以及夹持装置的支撑方向。活动基座上与杆棒相接触的所述支撑面32具有与所述杆棒的外表面互补的形状，例如为圆柱面的形式，从而当进行夹紧时能实现良好的接触。
在活动基座3的球形部件31上，可制有一个或多个形式不规则体310，其与制在固定头11容壳上的一个或多个形式不规则体相配合，从而形成了一个止挡，以限制活动基座的转动容隙。所述形式不规则体310例如可以是一个从活动基座上突起的销体，其与一个制在互补接触面上的、尺寸较大的凹腔相配合。所述止挡例如能防止活动基座的转动过度，并能确保其能将支撑面正确地面对着杆棒。因而，在图4到图7所示的实施方式中，形式不规则体310是一个制在活动基座3球形部件31下方的销体，在图8和图9所示的实施方式中，形式不规则体310是一个制在活动基座3后部的销体。类似地，在图12和图13所示的实施方式中，形式不规则体310是一个制在活动基座前部的、横截面为长方形的销体。至少在沿活动基座3转动轴线d3的方向上，与销体形式的形式不规则体310相配合的凹腔的尺寸比所述形式不规则体310的尺寸至少大20到30mm，从而能为活动基座留有一定的转角容隙，且不会使其完全转动。
在图10和图11所示的实施方式中，形式不规则体310是一个制在活动基座3前部中的圆筒形钻孔，其与一个销体的圆柱形头部相配合，该销体被保持在固定头上制出的一个钻孔中，至少在沿活动基座3转动轴线d3的方向上，圆筒形钻孔的尺寸比销体头部的尺寸至少大20到30mm。按照这样的设计形式，销体使得活动基座3可绕所述轴线d3旋转，同时还能将销体保持在通道12壁面上形成的互补凹腔中。
相对于杆棒2，通道12的内表面具有足够的尺寸，以使得杆棒具有绕一条或多条轴线进行转动的一定容隙a2，这些轴线不与杆棒的纵向轴线相平行，尤其是垂直于该纵向轴线。
在其位于杆棒一侧的端部处，夹紧螺钉41带有一个活动元件，其被称为支撑头42，其通过一球窝连接机构与夹紧螺钉铰接着。夹紧螺钉41的旋拧促使所述支撑头42通过该活动夹持系统的一个活动夹持面420抵靠在杆棒2的平面上。所述球窝连接机构使得支撑体42能相对于夹紧螺钉41绕该机构的中心进行转动。这样，通过绕至少一条平行于活动基座3转动轴线d3的轴线进行转动，可将活动支撑面420恒定地适应杆棒和活动基座的位置。此外，球窝连接结构还使得支撑面420能保持与杆棒的接触，而不会在杆棒上滑动，这样就能防止接触表面的损坏，确保了位置锁定，并降低了出现残余应力的可能性。
因而，可以理解：杆棒可按照不同的角位置插入并锁定在通道12内，并借助于活动基座3由夹持装置和通道的壁面形成了平面的接触面。这样，所述的多轴转角容隙使得杆棒能更容易地插入，并实现了相对于植入体以最自然的姿态对杆棒进行夹持，这将降低或消除夹紧后残留在假体装置中的应力。另外，夹紧力直接促进锁止作用，而不需抵抗杆棒的刚性，这样就能提高锁止的可靠性。
在图1到图3所示的实施方式中，固定头11按照一种铰接关系而相对于骨锚固部件10活动，该铰接关系实现了绕至少两条轴线进行转动的自由度，这两条轴线均不于杆棒的纵向轴线重合。
该铰接关系是由固定头11与骨锚固部件10一端之间互补的球形接触面构成的，骨锚固部件的这一端是指远离骨体的那一端，该端部被称为转动头101。转动头包括一半球形的部件1011，在固定头11的方向上，该部件是展宽的，也就是说，通过远离骨体而扩宽。利用所述固定头中所形成容壳内的互补接触面、以及在朝向骨锚固部件的方向将所述半球形部分1011缩窄，可将半球形部分1011保持在固定头11的内部。在通道12上与夹持装置相反的开口部分处，所述容壳与通道12相连通。因而，这些接触面的球面特性允许固定头与骨锚固部件能产生相对转动、并可绕所述半球形表面部分1011的球心转动。
具体来讲，所述转动使固定头具有相对于骨锚固部件绕一轴线d11进行旋转的不受限制的容隙a1，其中的轴线被称为固定头的转动轴线，其不与杆棒或通道的纵向轴线平行，甚至于垂直于该轴线，而且穿过转动头101上半球部分1011的球心。
这些转动形式还使固定头具有相对于骨锚固部件绕一轴线转动一定程度的容隙a4，该轴线基本上垂直于固定头的转动轴线d11，而且也穿过转动头101上的半球部分1011的球心。
在该实施方式中，转动头3上带有一个与上述活动基座相类似的活动基座3，转动头位于背对杆棒的表面上形成的一个容壳内。
在对夹持装置进行夹紧时，夹紧螺钉41通过其螺纹与固定头11的钻孔14相配合，从而抵靠到杆棒2上。杆棒抵靠在活动基座3上。活动基座则抵靠在转动头101上，转动头被固定头11的容壳保持着。将这些表面中的某些表面夹持住，就能将那些部件相互锁固起来。
不难理解：按照本发明的方式就可获得一种植入体，在将夹持装置锁定之前，该植入体的固定头可相对于骨锚固部件移动，而在执行了所述的锁定之后，则被固定到杆棒上。因而，固定头11可根据一定的容隙相对于骨块的外表面倾斜，并能绕一条从所述骨表面延伸出的轴线自由的枢转。
在植入体被锚固到骨块中之后，仍然能对固定头的位置进行调整，以便于使杆棒能保持或恢复其形状，这将减低出现残余应力的可能性，并使杆棒易于进入到该杆棒和植入体所处的各个不同位置。在杆棒被穿入、且整个装置已被组装完成后，就可以借助于夹持装置将所述位置锁定。由于可在销体处于最为自然的状态下执行夹紧，所以，夹紧力的作用至多只集中于提高锁定的可靠性。具体来讲，这些夹紧力不存在使装置出现残余应力、或相对于外科医生选定的位置发生移动的可能性，或者可能性极小。
在该实施方式中，尤其是：如果固定头11倾角与杆棒2倾角的接近程度足以确保夹紧螺钉41与杆棒的平面之间形成平面接触，则夹持装置4不必在球窝连接机构处设置支撑头42。
在附图所示的实施方式中，植入体1上固定头11的外截面为方形，该形状使植入体易于借助于合适的工具植入到椎骨中。在另一方面，固定头是跨在通道12的上方，从而还可在杆棒被穿入到通道12中之后对椎骨中植入体1的位置重新进行调整。
对本领域工程人员来讲，很显然地是：在不悖离本发明由权利要求书所限定的应用范围的前提下，本发明具有很多种具体的实施方式。因而，必须要将本文的实施方式看作是示例性的，在由所附权利要求书的意义所限定的范围内，可对这些实施方式进行修改，本发明不应受限于上文所述的细节特征。

Claims (13)

1.一种用于骨固定的植入体(1)，其包括能接纳并固定至少一根杆棒(2)的固定装置，该植入体尤其是属于人造骨上的部件，植入体(1)在一方面包括骨锚固装置(10)，在另一方面，还包括一固定头(11)，其支撑着所述固定装置，至少有一条通道(12)横穿所述固定头，该通道接纳着杆棒(2)，固定头包括夹持装置(4)，其能将杆棒抵接着一个被称为支撑壁(32)的内侧壁而对其进行夹持，所述植入体(1)的特征在于：在将固定装置(4)锁定之前，固定装置(4)与所述支撑壁(32)具有绕至少一第一轴线(d3)进行转动的预定容隙，该第一轴线不与杆棒的纵向轴线平行；特征还在于夹持装置在与杆棒接触处包括一表面，该表面被称为活动夹持面(420)，夹持装置(4)的移动夹持面(420)被一个利用球窝连接机构铰接在夹持装置(4)端部的支撑头(42)支承着；特征还在于所述通道(12)为开口通道的形式，其具有一个位于固定头(11)某一侧面上的开口隙口(120)，所述隙口的一个边缘(124)支承着夹持装置(4)，因而，通道的隙口(120)与夹持装置的位置使得杆棒可从侧面穿入。
2.根据权利要求1所述的植入体，其特征在于：在将固定装置(4)锁定之前，固定装置(4)与所述支撑壁(32)具有绕至少一第二轴线(d4)进行转动的预定容隙，该第二轴线既不与第一轴线(d3)平行、也不与杆棒的纵向轴线平行。
3.根据权利要求1或2所述的植入体，其特征在于：通道(12)借助于一些隙口而开口在固定头(11)的侧面上，这些隙口的布置位置和尺寸使得杆棒在通道(12)内具有绕至少一轴线转动的预定容隙(a2)，该轴线基本上垂直于通道的轴线(d12)、以及夹持装置的支撑方向(d4)。
4.根据权利要求1到3之一所述的植入体，其特征在于：支撑壁包括一个被称为活动基座(3)的元件，其具有绕至少一轴线(d3)进行转动的自由容隙(a3)，该轴线既不与通道(12)的轴线(d12)平行、也不与杆棒(2)上夹持装置的支撑方向(d4)平行，活动夹持面(420)具有绕一轴线进行转动的预定容隙，该轴线基本上平行于活动基座的转动轴线(d3)。
5.根据权利要求4所述的植入体，其特征在于：活动基座(3)具有一个部件(31)，该部件为球体的形式，该部件抵靠着一个互补的接触部，该接触部位于固定头(11)中形成的一个容壳内。
6.根据权利要求4或5所述的植入体，其特征在于：活动基座(3)通过一支撑面(32)与杆棒(2)保持接触，支撑面的形状与杆棒的外形基本上互补，活动基座具有至少一个形式不规则体(310)，其固定头(11)上所带的一个形式不规则体相配合，从而形成了一个止挡，用于防止基座的支撑面(32)转向杆棒(2)的侧面。
7.根据权利要求6所述的植入体，其特征在于：形式不规则体(310)是一个制在活动基座(3)下侧、后面或前面上的销体，其与一个尺寸较大的凹腔相配合，该凹腔设置在固定头上。
8.根据权利要求6所述的植入体，其特征在于：形式不规则体(310)是一个钻制在活动基座(3)前面上的圆筒孔，其与一销体的圆柱形头部相配合，该销体被安装在固定头(11)上制出的钻孔中。
9.根据权利要求1到8之一所述的植入体，其特征在于：夹持装置(4)包括一夹紧螺钉(41)，其被旋入到一钻孔(14)中，并与所述钻孔相配合，从而在杆棒(2)上形成了一个支撑体，其中的钻孔横穿通道开口的一个边缘(124)。
10.根据权利要求1到9之一所述的植入体，其特征在于：骨锚固装置或者包括一螺纹部件(102)，其能通过与一块骨的骨材料相配合而锚固到所述骨中；或者包括一突伸部件(103)，其能通过与骨表面上的至少一个形式不规则体相配合而锚固到所述表面上。
11.根据权利要求10所述的植入体，其特征在于：骨锚固装置是由一纵长的螺纹部件构成的，所述通道(12)的轴线(d12)基本上垂直于骨锚固装置的纵向轴线。
12.根据权利要求1到11之一所述的植入体，其特征在于：通道(d12)的形状包括两个首尾相接的截顶锥体，它们以各自较小的基座相互面对着，且直接或借助于一圆筒形的部分相互接合起来。
13.根据权利要求1到12之一所述的植入体，其特征在于：杆棒(2)的外表面上带有一个或多个平面，从而形成了一个与支撑头(42)相接触的接触平面。
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CN1931105B (zh) * 2005-09-13 2012-09-05 伯德比德尔曼股份公司 用于脊柱植入物的动态夹紧装置
CN102988105A (zh) * 2011-09-15 2013-03-27 比德尔曼技术有限责任两合公司 具有增大枢转角的多轴骨锚固装置
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CN103083098B (zh) * 2012-12-31 2015-03-25 成都博硕科技有限责任公司 一种种植固位系统
CN103230287A (zh) * 2013-04-16 2013-08-07 创生医疗器械（中国）有限公司 一种锚钉缝合系统
CN106388921A (zh) * 2016-11-21 2017-02-15 上海市同仁医院 一种用于脊柱侧凸矫形的栓系绳器械
CN109381250A (zh) * 2017-08-03 2019-02-26 比德尔曼技术有限责任两合公司 用于骨或椎骨的稳定装置

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FR2833151A1 (fr) 2003-06-13
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US20160317190A1 (en) 2016-11-03
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FR2833151B1 (fr) 2004-09-17
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Granted publication date: 20061206

Termination date: 20181212