CN1652727A - 用于固定棘突的装置 - Google Patents

用于固定棘突的装置 Download PDF

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CN1652727A
CN1652727A CNA038109638A CN03810963A CN1652727A CN 1652727 A CN1652727 A CN 1652727A CN A038109638 A CNA038109638 A CN A038109638A CN 03810963 A CN03810963 A CN 03810963A CN 1652727 A CN1652727 A CN 1652727A
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P·J·维森斯基
J·E·布拉克维尔
W·B·奴尔
J·C·鲁滨逊
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Abstract

一种与ALIF手术相关地使用的固定装置，该装置包括一对间隔开的板，所述板在其面对的表面上形成有整体的骨钉，用于压入相邻椎骨的棘突。两板之一设有一球形承座，该承座捕获一柱的一球形顶端，该柱的另一端穿过另一板中的一孔而被接纳。承座的安装设置成使柱能在其中有限程度地枢转至少两个自由度，使两板之间能改变角度，以适应相邻椎骨的棘突的不同厚度和定向。柱在第二板中的接纳能调节板之间的间隙，以提供组件通过压缩器械在棘突上的有效安装、以及在去除压缩器械之后该间隙永久可靠的保持。柱的横截面形状和板中的接纳孔阻止板相对柱绕柱轴线转动，并且在带孔板中的一紧定螺钉接合在柱上的一平直部，以固定所调节的板间间隙。

Description

用于固定棘突的装置
技术领域
本发明总的涉及脊柱外科手术领域，更具体地说是涉及有关放置用于体内融合或类似功能的一体内结构的、用于稳固脊柱的装置。
背景技术
随着局部或全部的椎间盘切除手术的施行，人们广泛地使用各种体内融合装置，用以在所涉及的部位处稳固脊柱。一些稳固装置锚固在茎蒂上。对于一些系统，使用茎蒂要求占据较大空间的螺钉或其它的锚固装置，且这些装置还包括剖开肌肉的操作和用以进行植入的相关工作时间。我们相信，在许多情况下是不需要这样精细的设备和手术的。
于1991年4月30日授权的、Breard等人的专利第5,011,484号揭示了一种适用细长插入物的人造韧带。在1998年3月10日授权给Bevan等人的美国专利第5,725,582号中，作为背景技术提到了两个类型的系统，一个包括杆而另一个包括不可拉伸的条带或不可拉伸的带子。所提及的一个这种系统是将不可拉伸件直接环套在棘突上。Bevan等人的专利揭示一种建议得以环套手术的简化形式，简化形式通过简单地将围绕相邻椎骨的棘突缠绕带子(如该专利的图1和2所示)，然后再张紧和卷曲它们来实现。Bevan等人示出了采用茎蒂螺钉和钩子的其它形式。Howland等人的专利第5,496,318号使用一安装在棘突上的结构，并有一定位带124。Lumb等人的专利第3,648,691号使用夹紧在棘突相对侧上的柔性的多孔带28。氟乙烯作为带材料的一个例子给出，并据说优于机加工的金属带。Kapp等人的专利第4,554,914号揭示了一对细长板28和30，它们通过穿过钻在棘突中的孔的螺栓来夹紧到棘突上。Samani专利第5,645,599号采用一U形体，它较佳的是用铸造成一件零件的钛制成，并具有其中带有孔的、大体呈U形的上和下托架。托架可接纳在相邻椎骨的棘突上，且在其中设有孔，以接纳接合在棘突中的接骨螺钉或骨钉，并在孔中卷曲以将植入物固定于其上。
在我们看来，这些系统在不同程度上存在一个或多个各种缺点，比如与前前腰体内融合(ALIF)手术相关的诸问题：如尺寸、必需有大的切口、难于操纵、难于或过度地钻骨或凿骨以及固定的耐久性和可靠性。本发明致力于克服目前进行这样的手术的固定装置和系统所遇到的一个或多个缺点。
发明内容
简要地描述，根据本发明的一个典型的实施例，一种与ALIF手术相关地使用的固定装置包括一对间隔开的板，所述板在其面对的表面上形成有整体的骨钉，用于压入相邻椎骨的棘突。两板之一设有一承座，该承座捕获一柱的一端，该柱穿过另一板中的一孔而被接纳。承座的安装设置成使柱能在其中有限程度地枢转至少两个自由度，使两板之间能改变角度，以适应相邻椎骨的棘突的不同厚度和定向。柱在第二板中的接纳能调节板之间的间隙，以提供组件通过压缩器械在棘突上的有效安装，以及在去除压缩器械之后该间隙永久可靠的保持。柱的横截面形状和板中的接纳孔阻止板相对柱绕柱轴线转动。
附图说明
图1是脊柱的一部分的后视图，且本发明的装置在前腰体内融合手术之后固定在位。
图2是图1所示器械的侧视图。
图3是在安装之前该装置自身的立体图。
图4是在横柱固定在其中的承座中的情况下的顶板内表面图，且该图为沿着横柱的纵轴线所见的该组件。
图5是没有横柱、以致柱头承座是空的顶板的内表面图。
图6是穿过顶板沿着图5中的线6-6截取的、并沿着箭头方向所见的剖视图。
图7是横柱的视图。
图8是横柱沿着图7中的线8-8截取的、并沿着箭头方向所见的端视图。
图9是穿过图3组件在横柱的轴线上截取的、在包含横柱轴线和紧定螺钉的一平面中且沿着箭头9-9的方向所见的剖视图。
图10是折断下来的紧定螺钉的放大的正视图。
图11是沿着横柱接纳孔的轴线方向所见的锁定板内表面的视图。
具体实施方式
为了促进对本发明原理的理解，现将参照附图中所示的实施例，并将用具体的语言来对其加以描述。但仍应予以理解的是，并不因此而对本发明的保护范围加以限制，这样的所述装置的替换形式和进一步的修改以及这样的对如这里所述的本发明原理的进一步应用被认为是熟悉本本发明所涉及的技术领域的人员所能想到的。
现详细参见附图，特别是图3和9，根据本发明所示实施例的装置11被夹紧到L4和L5椎骨的棘突上。该装置包括一顶板12、一锁定板13以及一横柱14，该横柱有一接纳在顶板中的承座17中的头部16和一穿过锁定板中的孔19而被接纳的末端18。板12的面对板13的内部或内侧面13A的内侧或内部表面12A设有多个骨钉19，它们面对板13的内部面13A上的类似骨钉21。当该装置被压缩在位时，这些骨钉刺入棘突中，从而夹紧相邻的椎骨。
横柱呈圆柱形的横截面形状，但带有一延伸柱14的长度的平直表面14F。一紧定螺钉22旋入锁定板。在通过一压缩工具将板固定到棘突上之后，锁定板的内端支承在柱的平直部14F上，以将板锁定到柱上。可以使用市场上可购得的各种棘突压缩工具。在顶板12的外侧或背面上设有半球形的凹进部26(图6)。在锁定板的外侧或背面上设有类似的半球形凹进部27(图3)。在将板压缩到棘突上的过程中，这些凹进部便利于放置压缩工具的尖端和便于将工具定位在板上。
现请参见图7和8，横柱14是圆柱形的，并在一端有一球形头部16，且末端18是弄圆的。尽管平直部14F对着柱圆柱形表面的一个十分狭窄的弧度，但它在头部16中设有一相对较深的凹槽或凹口14N。例如，当柱头部的直径为7.14毫米且柱直径为4.49毫米时，在平面14P中平分平直部和凹槽14N的一直径线上的尺寸14H(图8)为4.29毫米，且槽、凹槽或凹口14N在柱头部中的宽度14W(图7)是2.353毫米。
图11是锁定板内侧面13A的视图，且是沿着孔19的轴线所见。在孔的顶部处示出了一平直部19F。因而该孔19的形状就形成为提供在板与横柱之间的滑动、无转动的配合。柱上的和孔19中的平直部是柱和孔的圆形形式的中断部分。柱和孔可以具有提供滑移但防止锁定板相对柱转动的其它一些横截面形状。例如，可以使用多边形或键和键槽的形状。
请回过来参见图4、以及图6和9，系面对内侧表面12A且沿着横柱14的轴线14A来看顶板12的。柱头部16表示为接纳在承座17中。一卡环31接纳在承座17入口处的一凹槽12G中，并将柱头部16定位在承座中。上面提到过，横柱的配合表面和锁定板中的柱接纳孔19防止板相对柱转动。在横柱顶板端处，一圆柱形销32压配合在顶板的孔33(图6和9)中，并凸伸入横柱头部的凹槽14N中。如图4所示，在凹槽的各侧面与销32的壁之间允许有一狭窄的空间。这就允许顶板相对横柱绕横柱轴线14A可有一十分狭窄的转动角度(最大为总共五度)。
在横柱的相对端部处，一盲孔13B从锁定板的顶缘延伸穿过板中的孔19。孔13B上部的直径较大，并攻有内螺纹，以接纳紧定螺钉22的外螺纹22T。螺钉在图9中所示为紧密地接合横柱的平直表面14F。如图3和9所示，紧定螺钉有一上或外侧头部22U，且在螺钉的上端处外露有多条槽22F，以接纳螺钉安装工具。在紧定螺钉的内侧端处也设有一组槽22K(图9)。两组槽中的每一条可容纳一六槽工具，但当然是不同直径的六槽工具。在紧定螺钉的颈缩部分22N的下端处设有一环形凹口22B，藉由该环形凹口，头部可以在安装和充分地旋紧紧定螺钉之后从螺纹部分上折断，以使板13外侧边缘13C处的体积最小。
现请参见图9，应予理解的是，在本较佳实施例中，承座的球形部分的半径与横柱上的球形头部的半径相同。在图9中，看起来在承座与横柱头部之间在顶部处有空隙。这是因为在设置槽14N的柱头部中的切口所造成的。
应予注意的是，在图9中，卡环31在穿过其的孔处有两个腔室31A和31B，且两腔室从卡环的各面向内延伸。腔室可以是平直的，但较佳的是凹入的，并与柱头部有相同的半径。以这种方式，在该装置的预组装中在柱头部插入承座中之后，卡环以何种形式安装在凹槽12G中是无关紧要的。还有，该腔室具有与柱头部相同的稍微凹度，从而使柱头可贴合地安置在卡环上，以抵抗板在安置和压缩在棘突上、并且用紧定螺钉将锁定板13锁定在位之后发生分离的任何趋势。
如上所述，在顶板12中设置承座，且使柱头部可转动地安装在承座中，使板可相对柱的轴线14A发生一些运动。槽14N的宽度稍稍大于防转销32，使板能相对柱绕柱轴线转动十分有限的量(小于五度的角度)。因此，它保持板在将植入物插入病人背部的过程中、将骨钉压缩入棘突的过程中以及将紧定螺钉夹紧到柱的平直表面14F上的过程中彼此平行。但顶板还具有相对锁定板在一轴向(水平)平面、例如为包含柱的轴线14A和销32的轴线32A的平面内改变角度的能力。图9的纸张平面是一个例子。换言之，考虑图5中的线6-6为板12的纵向轴线。板可绕该轴线在承座17的中心的各侧转动或旋转最多二十五度、或者总共最大五十度。顶板12还可相对锁定板12在一冠状(垂直)平面、例如包括柱的轴线14A并垂直于销32的轴线的平面内改变角度。图1、6和9的纸张平面是一个例子。换言之，考虑穿过承座17中心的线，诸如平面9-9中的32A，垂直于平面6-6，以及为板12的横向轴线。板12可绕其横向轴线在承座中心的各侧上旋转或转动最多二十五度。
在前腰体内融合手术之后可适用根据本发明的装置来进行稳固。在将一结构放置在体内部位中相关的适当时候或之后，在病人的背部形成一小的切口。该切口具有足够的尺寸以接纳装置和器械。尽管顶板相对柱可在某些程度上成一角度，但板相对柱的转动是十分有限的。锁定板既不可以相对柱改变角度也不可以相对柱转动。在切开之后，如果需要或者按照需要移动肌肉以放置板。为了在进入前使体积最小，可以将两板如外科医生所需要的那样靠近在一起，并贴近紧定螺钉。如果已安装了板，且其上的骨钉彼此接触，则可拧松紧定螺钉，以张开板从而安装在与椎间结构部位相邻的椎骨的棘突上。然后，应用压缩器械，以将板压向彼此，因而使骨钉进入棘突。继续进行压缩，直至骨钉完全安置好。顶板相对柱的角度改变是足够的(如上所述，在中心线的任一侧上最多可为二十五度)，以能使板足够适应相邻椎骨的棘突的不同厚度和形状，从而能使骨钉完全安置在相邻椎骨的棘突中。为了在接纳柱头部16时使顶板在承座17处的厚度最小，在顶板中设置开口12E(图5和6)。在柱头部与承座的球形凹腔之间几乎没有间隙，从而提供紧密但可滑动的配合。开口12E加强了在病人体外组装零件之后以及在植入之前的、用于清洁柱头部和承座的高压釜效果。尽管不太可能会需要，但在将板安置在棘突上之后，如果需要的话，可将露出在开口12E中的柱头部16E沿箭头41的方向(图9)稍稍推向卡环。
在将板完全安置在棘突上之后，利用带有与外面一组槽相配的槽的螺丝起子，将紧固螺钉拧紧到横柱的平直部14F上。当达到外科医生的要求时，固定完成，就施加额外的转矩，以将紧定螺钉的头部从螺纹部分上折断，并丢弃紧固螺钉。然后使该部位闭合，完成稳固手术。紧定螺钉可靠地保持板在棘突上的夹紧力。在任何时候，如果决定拆除该装置，则诸内槽可接纳一较小的、头部开槽的螺丝起子，以拧松紧定螺钉。
在压缩过程中，并保证柱正确地放置，顶板12能在柱14上倾斜并相对锁定板13改变角度的能力帮助保证在两棘突的两侧上完全地安置骨钉。顶板相对柱倾斜的能力受到头部的颈部抵靠在卡环31的内边缘上的接合的限制。板相对柱在任一平面中的角度改变由卡环边缘限制在柱轴线14A各向约二十五度。
对卡环是否如图4中所示地定位还是在图4中的柱轴线的相对侧上、或者水平之上或之下四十五度处的选择可取决于外科医生的观念什么才是所应集中注意的角度改变的严格限制之处所在。
尽管所示的装置的例子是施加于L-4和L-5的，但该装置可植入在其它级处的棘突上。高至T-3级可以是合适的部位。还有，也可考虑桥跨多于一级的板。板的形状可以在不同的级处是不同的。所示板12和13的、实质上相同的周缘一面凹一面凸的形状和尺寸大体与腰区域的脊柱前凸的曲线相一致。在本例子中，凹状的边缘1 2C和凸状的边缘12X具有共同的中心，且该中心远离板并位于板的面12A的平面中。这个公共的中心位于板的一横向轴线上，该横向轴线诸如上面已提及的，且位于承座17的中心至边缘12C和12X的公共曲率中心的半径上。可以使用非平直的板面。可以使用除了所示的香蕉形外形之外的边缘形状。可以使用各种生物适合的材料。钛-6A-4V ASTMF-136是板、销、柱、锁定环以及螺钉材料的一个例子。也可以使用其它的材料。
由于整个装置可在植入之前在体外进行组装，且没有阻止植入的过大体积，所以在避免需要在体内进行组装的多零件装置的方面是很有帮助的。这种整体式的方法减小了植入所需的切口的尺寸。即使该装置是预组装的，但它仍可使板相对彼此在两个平面中改变角度，使该装置能适应棘突厚度和几何形状方面的变化。使用整体的骨钉、而非螺钉或者需要对棘突进行刻槽或其它处理的形状，简化了在ALIF之后稳固棘突的操作。在一板中以固定的方式接合横柱，可无需使用独立的螺栓和缆线来连接诸板。
尽管已在附图和前述的说明中详细地描述了本发明，但这些附图和说明应被认为是用来作说明的而不是在特征方面作限制的。应予理解的是，仅示出并说明了较佳的实施例，而要求保护落入本发明保护范围内的所有变化和修改。

Claims (34)

1.一种用于棘突固定的可植入装置，该装置包括：
第一和第二间隔开的板，所述第一板的一表面具有面对所述第二板的一表面；
连接至各所述板的一柱，且所述柱从所述第一板的面对表面延伸到所述第二板的所述面对表面；
所述柱至所述第一板的连接是可枢转的，以能改变所述第一板相对所述第二板的空间方位角；并且
所述柱至所述第二板的连接是可调节的，以能改变所述第一板与所述第二板之间的间隙。
2.如权利要求1所述的装置，其特征在于，
所述第二板中有一孔，
所述柱的一部分可滑动地接纳在所述孔中；并且
一紧定螺钉接纳在所述第二板中，并与所述柱接合以将柱固定至所述第二板。
3.如权利要求2所述的装置，其特征在于，
所述柱部分和所述孔具有相互配合的表面，所述表面的形状成形为用于防止所述第二板相对所述柱转动。
4.如权利要求3所述的装置，其特征在于，
相互配合的表面是在所述上的一平直表面和在所述孔中的一平直表面。
5.如权利要求1所述的装置，其特征在于，
所述第二板中有一孔；
所述柱有一部分可滑动地接纳在所述孔中；并且
所述可滑动地接纳的柱部分是不可转动地接纳在所述孔中的，以防止所述第二板相对所述柱转动。
6.如权利要求5所述的装置，其特征在于，
所述可滑动地接纳的诸部分是细长的，具有大体呈圆柱形的外表面，该外表面在圆筒形形状中有一纵向延伸的中断部分；并且
所述孔具有大体呈圆柱形的孔膛，该孔膛带有与柱部分上的中断部分相配、防止第二板在柱上转动的一轴向延伸的中断部分。
7.如权利要求5所述的装置，其特征在于，
所述柱部分是细长的，并具有一实心的、大体呈圆形横截面的形状，但缺少一个弓形；并且
所述装置设有用于防止转动的装置，所述装置包括在缺少弓形之处在所述柱部分上纵向延伸的一平直表面，且该平直表面配合地接合所述孔的一平直表面。
8.如权利要求6所述的装置，其特征在于，还包括：
在所述第二板上的、用于将所述柱锁定在所述第二板上以在所述板之间固定一选定间隙的装置。
9.如权利要求8所述的装置，其特征在于，所述用于锁定的装置包括：
旋入所述第二板并可与所述柱部分的一平直表面足够紧密地接合以防止所述柱部分在所述第二板中滑动的装置。
10.如权利要求1所述的装置，其特征在于，
所述面对表面设有骨钉组，所述骨钉从所述表面上凸伸，以在所述板之间的空间中刺入棘突，从而实现所述板之间对棘突的固定。
11.如权利要求10所述的装置，其特征在于，
所述面对表面是平直的。
12.如权利要求1所述的装置，其特征在于，
第一板有一带有一中心的承座；
所述柱有一纵向轴线以及接纳在所述承座中的一头部，且所述头部可在所述承座中枢转，藉此，所述柱可在彼此垂直的两个平面中相对所述第一板的所述面对表面枢转；
所述柱在所述头部中有一凹槽；并且
所述第一板有凸伸入所述承座中的一导销，所述导销接纳在所述凹槽中以阻止所述第一板相对所述柱在垂直于所述柱的轴线的平面中转动。
13.如权利要求12所述的装置，其特征在于，
所述柱在一端具有所述头部，并具有从所述头部朝向所述柱的另一端延伸的一导向表面；
所述第二板具有一孔，并穿过该孔接纳所述柱；并且
所述孔有与所述柱上的导向表面接合的一导向跟从表面，以防止所述第二板相对所述柱在垂直于柱轴线的平面中转动。
14.如权利要求13所述的装置，其特征在于，
导向表面是平直的；并且
所述第二板中的孔被旋紧入所述第二板的一紧定螺钉拦截，并与所述平直的导向表面端接合，防止第二板沿着所述柱平移，并防止所述第二板相对所述柱转动。
15.如权利要求13所述的装置，其特征在于，
所述第二板是细长的，具有位于所述两平面中的一第一平面中的一纵向轴线，并且第二板具有位于所述两平面中的一第二平面中的一横向轴线；
所述第二平面垂直于所述第一平面；并且
所述第一板是细长的，具有位于所述第一平面中并可在所述第一平面中枢转的一纵向轴线，并且所述第一板具有位于所述第二平面中并可在所述第二平面中枢转的一横向轴线
16.如权利要求15所述的装置，其特征在于，还包括：
在所述承座中的一定位环，所述定位环的尺寸和位置构造成在所述第一平面和所述第二平面中枢转时接合所述柱，以将所述第一板的所述轴线在所述第一和第二平面中的最大角度改变限制在小于从承座的中心为二十五度。
17.如权利要求16所述的装置，其特征在于，
所述第一板和所述第二板排列成大体平行地间隔开的关系，且所述柱横跨所述板之间的间隙；
所述第一板的一表面面对所述第二板的一表面；并且
所述面对的表面设有骨钉组，所述骨钉从所述表面上凸伸，以在所述板之间的空间中刺入棘突。
18.如权利要求17所述的装置，其特征在于，
所述面对的表面是平直的。
19.如权利要求18所述的装置，其特征在于，
所述板呈香蕉形的外形。
20.如权利要求19所述的装置，其特征在于，
所述第二板的横向轴线与是围绕远离所述第二板的空间中的一中心的同心圆的、所述板的凹状和凸状同心边缘的半径共线，藉此，所述边缘在所述第二板的所述面对表面的平面中形成所述第二板的一面凹一面凸的形状。
21.如权利要求20所述的装置，其特征在于，还包括：
从所述凹状边缘朝向所述中心凸伸的一紧定螺钉。
22.如权利要求21所述的装置，其特征在于，
所述紧定螺钉上有一工具接纳部。
23.如权利要求22所述的装置，其特征在于，
所述紧定螺钉有在所述接合端处开始的一第一螺纹部分，所述第一螺纹部分中具有一第一工具接纳部开口，所述第一工具接纳部开口面向离开所述凹状边缘朝向中心的一方向；
所述紧定螺钉具有一第二工具接纳部开口，所述第二工具接纳部开口面向离开所述凹状边缘朝向所述中心；并且
所述紧定螺钉具有厚度减小的一个部分，用以便于在安装在治疗部位之后从螺纹部分上分离头部。
24.如权利要求1所述的装置，其特征在于，
所述第一板有一承座；
所述承座在所述第一板的所述面对表面中开口；
所述柱有接纳在所述承座中的一头部，且所述柱凸伸到所述第一板的面对表面之外，并可在所述承座中枢转，藉此，所述柱可在两个平面中相对所述第一板枢转；
所述第一板的背表面中带有一承座接近开口；并且
所述柱头部的一部分暴露在所述开口中。
25.如权利要求24所述的装置，其特征在于，还包括：
在所述承座中的一定位环，用以将所述头部保持在所述承座中。
26.一种固定患者的棘突的方法，该方法包括：
将诸零件组装成一植入组件，所述植入组件包括第一和第二板，且一柱的一端枢转地安装在第一板中的一承座中，柱的相对端可滑动地接纳在第二板中；
在患者身上开出一条切口
插入该组件以定位在棘突附近；
在柱上滑动第二板，从而在第一和第二板之间提供空隙，以在第一和第二板之间接纳棘突；
将板压缩到棘突上；并且
保持板压缩在棘突上，并且用一紧定螺钉将所述第二板夹紧到柱上。
27.如权利要求26所述的方法，其特征在于，还包括：
在将所述板压缩到所述棘突上的过程中，在至少一个平面中使第一板相对第二板改变角度。
28.如权利要求27所述的方法，其特征在于，还包括：
在将所述板压缩到所述棘突上的过程中，在两个平面中使第一板相对第二板改变角度。
29.如权利要求28所述的方法，其特征在于，还包括：
在将所述板压缩到所述棘突上的过程中，将所述板上的骨钉压入棘突。
30.如权利要求28所述的方法，其特征在于，
在冠状和轴向平面内使第一板相对第二板改变角度。
31.如权利要求26所述的方法，其特征在于，还包括：在插入该组件以定位在棘突附近之前，
使第二板靠拢到第一板上；
用将第二板夹紧到柱上的一紧定螺钉锁定靠拢的第二板；
在患者的背部开出一切口；
然后插入该组件以定位在棘突附近；
插入一螺丝起子并松开紧定螺钉；
在柱上滑动第二板，从而增加所述板之间的间隔；
移动到棘突附近要固定的想要位置处；并且
然后将板压缩到所述棘突上。
32.如权利要求31所述的方法，其特征在于，还包括：
将所述板的面对表面的固定与所述棘突接合；并且
在将板压缩到棘突上的过程中，迫使骨钉进入所接合的棘突。
33.如权利要求32所述的方法，其特征在于，还包括：
在将骨钉压缩入所接合的棘突中的同时，使用一螺丝起子来将第二板锁定在柱上
34.如权利要求33所述的方法，其特征在于，还包括
折断紧定螺钉的头部；并且
闭合所述切口。
CNB038109638A 2002-05-17 2003-05-01 用于固定棘突的装置 Expired - Fee Related CN100337600C (zh)

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