CN1917833A - 脊椎关节造形装置和方法 - Google Patents

脊椎关节造形装置和方法 Download PDF

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Publication number
CN1917833A
CN1917833A CNA2005800048283A CN200580004828A CN1917833A CN 1917833 A CN1917833 A CN 1917833A CN A2005800048283 A CNA2005800048283 A CN A2005800048283A CN 200580004828 A CN200580004828 A CN 200580004828A CN 1917833 A CN1917833 A CN 1917833A
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CN
China
Prior art keywords
joint
artificial spinal
artificial
spinal joint
implant
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Granted
Application number
CNA2005800048283A
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English (en)
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CN1917833B (zh
Inventor
S·C·翰普瑞斯
S·D·豪杰斯
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Three Spine Co.
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SDGI Holdings Inc
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Priority claimed from PCT/US2005/000706 external-priority patent/WO2005070354A2/en
Publication of CN1917833A publication Critical patent/CN1917833A/zh
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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
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Abstract

提供一种人造脊椎关节和用来代替自然椎间盘的至少一部分的方法。在一些实施例中，小面关节的至少部分与椎间盘一起被代替。

Description

脊椎关节造形装置和方法
交叉参考
本申请要求2004年1月9日提交的、名称为“背侧腰椎关节造形术”的美国临时专利申请第60/534,960号的优先权，下列申请也要求上面提到的临时申请的优先权并与本申请相关联。它们被援引于此以供参考。
系列号(代理人案号P21769)的美国实用专利申请，提交于2005年1月7日，题为“Dual Articulating Spinal Device and Method”；
系列号(代理人案号P21756)的美国实用专利申请，提交于2005年1月7日，题为“Split Spinal Device and Method”；
系列号(代理人案号P21752)的美国实用专利申请，提交于2005年1月7日，题为“Interconnected Spinal Device and Method”；
系列号(代理人案号P21745)的美国实用专利申请，提交于2005年1月7日，题为“Mobile Bearing Spinal Device and Method”；
系列号(代理人案号P21743)的美国实用专利申请，提交于2005年1月7日，题为“Support Structure Device and Method”；
系列号(代理人案号P21765)的美国实用专利申请，提交于2005年1月7日，题为“Centrally Articulating Spinal Device and Method”；以及
系列号(代理人案号P21751)的美国实用专利申请，提交于2005年1月7日，题为“Posterior Spinal Device and Method”。
技术领域
本发明诸实施例总地涉及用于完成脊椎手术的装置和方法，尤其在一些实施例中涉及能从背侧放置到脊椎盘空间中的脊椎关节成形装置。
已预见到本发明的各种实现方法，包括藉由背侧靠近而用于整个脊椎关节成形替换，不管是椎间盘还是自然脊椎关节的小面功能。
背景技术
如业内公知地那样，在人的解剖体系中，脊椎是总体上可弯曲的柱状体，它能承受拉伸和挤压负载，能够作弯曲运动并提供对肋骨、肌肉和韧带的连接空间。一般来说，脊椎被分成三个部分：颈脊椎、胸脊椎和腰脊椎。图1示意性地示出健康的人的脊柱的腰脊椎1和骶骨区域3。脊椎部分由被称为椎骨的单独的骨头构成并且椎骨由位于它们之间的椎间盘分开。
图2示出具有位于两相邻的椎骨7、9之间的健康的椎间盘5的腰椎区域的右侧部分。在任何给出的关节处，顶椎骨可被称为上椎骨而底椎骨被称为下椎骨。每块椎骨总体上包括作为承受重量的主要区域的圆柱体7a、9a以及三个骨突，即7b、7c、7d(其中两个在图2中可见)。如图7A所示，其中可看到所有的骨突，骨突7b、7c、7d从椎骨体7在沿圆周隔开的位置上向外延伸。作为其它功能，骨突提供对肌肉和韧带连接的区域。相邻的椎骨可藉由多个小面部分7e(图2)彼此相对移动，这些小面部分7e从椎骨的圆柱体延伸并在弯曲时能一个在另一个上滑动，以引导脊椎的移动。存在两个小面关节，每个小面关节由上、下小面部分界定并与附近的椎骨相关。图3示出了健康的椎间盘。如图3所示，椎间盘具有4个区域：髓核11、过渡区13、内环纤维区15和外环纤维区17。一般来说，内环纤维区15和外环纤维区17由牢固地粘结于其上和其下的椎骨体的软骨纤维材料层构成。髓核11典型地从本质上说更具水合性。
这些椎间盘用作吸震结构和关节。它们被设计成吸收脊柱可能受到的挤压和拉伸负载并同时允许相邻的椎骨体彼此相对地移动一有限量，尤其是在脊椎弯曲(屈曲)时。因此，椎间盘处于恒定的肌肉和/或重力压迫下并且一般作为腰椎的首要部分以表现出“磨损和撕裂”的迹象。
由于小面关节几乎随脊椎而持续地运动，因此小面关节退化是常见的。事实上，小面关节退化和椎间盘退化经常一起发生。总地来说，尽管一个可能是脊椎改变的结构造成的主要问题而另一个是次要问题，在考虑选择手术前，一般小面关节退化和椎间盘退化均已发生。例如，小面关节和/或椎间盘改变的结构可能造成脊椎收缩、退化性脊椎前移以及退化性脊柱侧凸。
治疗这些症状的一个手术过程是脊椎关节固定术(即脊椎融合术)，这可以从前侧和/或从背侧进行。背侧过程包括原位融合、背侧横向器械融合、变形腰椎体间融合(“TLIF”)以及背侧腰椎体间融合(“PLIF”)。
将脊椎部分紧密地融合以消除该层上任何运动能够缓解即刻的症状，但对于某些患者而言保持运动可能是有利的。另外通过手术将退化性椎间盘或小面关节分别替换以人造椎间盘或人造小面关节也是已知的。然而，没有一种已知的装置或方法提供本公开实施例的优点。
因此，前述内容表现出一种需要，即提供能避免已知植入和外科技术的缺陷和缺点的经改进的脊椎关节成形术。
发明内容
本公开的第一实施例提供用于在一上椎骨和下椎骨之间造成至少一部分连接的人造脊椎关节。该人造脊椎关节可包括：一前侧关节代替部分和与前侧关节代替部分连接并从前侧关节代替部分向背侧延伸的桥。此外，一背侧关节代替部分可作为人造脊椎关节的部分连接桥。
在另外一实施例里，人造脊椎关节包括一带有左上构件的前侧关节代替部分，与左上构件关节连接的左下构件，一右上构件，以及与右上构件关节连接的右下构件。在该实施例里，左下构件和右下构件各配置成互相连接。
在还有一个实施例里，本公开描述了一种植入人造脊椎关节的方法。该方法包括在病人背部切割一切口，从椎间盘中移去至少一部分椎间盘材料，该移去包括通过切口接近椎间盘材料，以及通过切口插入植入物。在该实施例里，插入更换椎间盘和小面关节的至少一部分的植入物。
该公开的实施例可有用于腰椎、外伤后、椎间盘、小面疼痛或脊椎前移的退化性变化和/或保持腰椎在多个高度上的运动。
其它和额外的特征、优点、用途和实施例在后面的说明书、附图和权利要求中被展开并且变得明显。
附图的简要说明
图1是健康人脊柱的腰椎和骶骨区的侧视示意图。
图2是示出图1的腰椎骨的右侧的一部分的详细立体图，其中一健康椎间盘位于两椎骨之间。
图3是图2所示的椎间盘的顶部立体图，示出椎间盘主要部分。
图4是显示根据本公开原理构造的人造椎间关节的第一实施例的腰椎的一部分的分解侧视图。
图5是表示根据本公开的第一实施例构造的经组装的人造椎间关节的左右半部的上部、椎间盘和下部的腰椎的一部分的前侧视图。
图6是图5所示的人造椎间关节的右半部的侧视图。
图7A是显示图4所示的人造椎间关节的上部的腰椎的一部分的横贯的、自下至上的视图。
图7B是显示图4所示的人造椎间关节的下部的腰椎的一部分的横贯的、自上至下的视图。
图8是显示人造椎间关节的上部的第二实施例的腰椎的一部分的横贯的、自下至上的视图，其中蒂螺钉被用来协助植入。
图9是显示人造椎间关节的下部的第二实施例的腰椎的一部分的横贯的、自上至下的视图，其中蒂螺钉被用来协助植入。
图10是显示图8所示的人造椎间关节的上部的腰椎的一部分的侧视图，其中的一个蒂螺钉是可见的。
图11是显示图9所示的人造一体椎间关节的下部和一体的椎间盘部分的腰椎的一部分的侧视图，其中的一个蒂螺钉是可见的。
图12是显示图8所示的人造椎间关节的上部的腰椎的一部分的背侧视图，其中的两个蒂螺钉是可见的。
图13是显示图9所示的人造椎间关节的下部的腰椎的一部分的背侧视图，其中的两个蒂螺钉是可见的。
图14是显示第二实施例的腰椎的一部分的侧视图，其中蒂螺钉处于组装位置。
图15是显示人造椎间关节的下部、椎间盘和上部的第三实施例的腰椎的一部分的背侧视图，其中使用张紧带。
图16是显示第三实施例的腰椎的一部分的侧视图，其中张紧带被用于组装位置。
图17是显示根据本公开原理构造的人造椎间关节的第四实施例的上部的腰椎的一部分的横贯的、从下至上的视图，其中未更换小面关节。
图18是显示人造椎间关节的第四实施例的下部的腰椎的一部分的横贯的、从上至下的视图。
具体的实施方式
附图示出用于替换椎间盘或椎间盘和至少一个相应小面关节的组合的人造椎间关节的各实施例。根据本公开原理的人造椎间关节的各种实施例可用于解决将它们用于关节更换的任何问题，尤其是例如腰椎、外伤后、椎间盘、小面疼痛或脊椎前移的退化性变化和/或保持腰椎的多个高度上的运动。
图4-图7示出人造椎间关节的第一范例性实施例。如图4和图5所示，每个关节由两个关节造形半部构成，每个关节造形半部具有间隔物或椎间盘19以及保持部分21。保持部分21包括第一保持部分21a和第二保持部分21b。在图4所示例子中，第一保持部分21a高于第二保持部分21b(在它之上)并且椎间盘19位于保持部分21a、21b之间。尽管根据该范例性实施例的人造椎间关节具有用于第一保持部分和第二保持部分的两个半部，但要理解可实施一个代替性实施例，其中人造椎问关节具有单个的第一保持部分，单个的第二保持部分和单个的间隔物。
要理解代替性实施例可实现具有第一保持部分、第二保持部分和/或椎间盘的关节造形，第一保持部分、第二保持部分和/或椎间盘均由不等尺寸的半部或两个以上部分形成。
此外，如图4所示，第一保持部分21a和第二保持部分21b位于两相邻椎骨之间。更具体地说，第一保持部分沿两相邻椎骨的上面一个的下表面定位而第二保持部分被定位在两相邻椎骨的下面一个的上表面上。然而，本领域内技术人员应当理解第一保持部分和第二保持部分不局限于这种配置，第一保持部分和第二保持部分可位于与本文中所述的不同位置和/或不同地构形。
接触椎骨其余终板的关节造形的保持部分21a、21b的表面可涂覆以粒状材料或被等离子喷溅以促进骨增长和它们之间的牢固连接。特别地，增进骨增长的表面可是具有钛/钙/磷双覆层的钴铬钼合金、啮合面或任何其它有效的面精加工。作为代替或组合，诸如聚甲基丙烯酸甲酯(PMMA)的粘合剂或胶泥可用来将植入物的全部或一部分固定于一个或两个终板。
如下面将要更详细说明的那样，外环部分17的大部分(在某些实施例中大约300度)(例如参阅图4、7B)可被保持在终板的下部，它作为止动结构而在发生骨增长之前将下保持部分固定在位，从而牢固地使保持部分结合于它们各自的椎骨(图4仅示出外环17被保持的那一部分)。相反地，在传统的前侧关节造形中，大约270度的外环区17被去除。此外，蒂螺钉也可用于即刻固定，正如结合下面讨论的其它实施例而更详细说明的那样。
在本公开的各实施例中，第一保持部分21a和第二保持部分21b被构造成将椎间盘19保持在它们之间。
例如，在椎间盘19具有两凸面19a的情况下，第一保持部分21a和第二保持部分21b的每一个具有凹面21c，它界定其中可保持椎间盘19的空间。例如，在图4所示的范例性实施例中，椎间盘19的上凸面19a配合入由第一保持部分21a的凹面21c界定的凹陷内，而椎间盘19的下凸面19b配合入由第二保持部分21b的凹面21c界定的凹陷内。
图5示出两关节造形半部在位的范例性组装的人造椎间关节的前侧视图，而图6示出图5所示的组装的人造椎间关节的侧视图。如图5和图6所示，椎间盘19被保持在第一保持部分21a和第二保持部分21b之间。要注意尽管椎间盘19可被保持在第一保持部分21a和第二保持部分21b之间，但椎间盘19可在由第一保持部分21a和第二保持部分21b的相应表面21a界定的空间内自由滑动。由此提供在相邻椎骨之间的有限移动。
在图4、图5和图6所示的范例性实施例中，椎间盘19是被插入到第一保持部分21a和第二保持部分21b之间的独立部分。然而，正如下面所讨论的那样，要理解间隔物或椎间盘19可与第一保持部分21a和第二保持部分21b中的一个或两个一体地形成或形成在它们中间。
在本公开的范例性实施例中，如图4、6、7A和7B所示，人造椎间关节的每个保持部分包括第一人造小面部分23a和第二人造小面部分23b。如图7A和图7B所示，第一人造小面部分23a具有表面25a，而相应的第二人造小面部分23b具有表面25b，表面25a与表面25b匹配以稳定相邻的椎骨，同时保留和引导每块椎骨相对于另一椎骨的运动。
每组上/下保持部分21a、21b可以具有一对小面部分23a、23b，它们一起界定一个小面关节。对用根据本实施例的小面代替整个关节，当从背侧观察时，左右关节造形界定两个相邻小面关节。
不管是否提供人造小面关节，与关节造形的左右半部相关的各上下保持部分可完全彼此独立。即，如图7A所示，例如与每个半部相关的第一保持部分21a彼此不直接接触。对图7B所示的第二保持部分21b亦然如此。然而，本领域内技术人员应当理解即使在包括人造小面关节的本公开的实施例中，每个半部的第一保持部分21a的至少一部分和/或每个半部的第二保持部分21b的至少一部分可直接接触和/或彼此连接，如结合图17-18更详细说明的那样。
此外，在本公开的各实施例中，椎间盘19、第一保持部分21a和第二保持部分21b可由任何合适材料制成，这些材料有利于在提供各相邻表面间大致沿横向的上述的滑动的同时传递挤压和拉伸力的连接。例如，在第一实施例中，第一保持部分21a和第二保持部分21b典型地由适用于手术植入的任何金属或金属合金制成，例如不锈钢、钛和钴铬或诸如碳纤维的的复合材料、或诸如聚醚醚酮(PEEK)的塑料材料或任何其它合适材料。椎间盘可由诸如高分子量聚乙烯或PEEK的塑料或陶瓷、金属和例如(但不局限于)碳纤维、橡胶之类的天然或合成纤维，或其它合适材料制成。一般来说，为有助于保持表面的滑动特性，这些表面被抛光和/或涂层以提供光滑表面。例如，如果表面由金属制成，则金属表面可以是抛光金属。
图8-14示出人造椎间关节的第二实施例。仅有与第一实施例的不同特征将在下面进行讨论。在第二范例性实施例中，设有例如蒂螺钉27的固定部分以提供各第一保持部分21a和/或第二保持部分21b至相应椎骨之间的更安全和快速的连接。此外，该实施例示出与其中一个保持部分(在这里是下保持部分21b)形成一体的椎间盘19。椎间盘19可用与其保持部分相同材料一体地形成，但也能用相同或不同材料独立地形成并永久地连接于此以形成整体单元。在该实施例中，椎间盘19和保持部分可均由金属形成。
图15和16示出人造椎间关节的第三实施例。在第三示范性实施例中，提供例如张紧带31的额外固定部分以补充或代替背侧韧带的功能，以通过将第一保持部分21a固定于第二保持部分21b而限制相邻椎骨之间的移动。如图15-16所示，可通过将其缠绕在相应蒂螺钉27或其它传统接合点周围而提供背侧张紧带31。
图17和图18示出人造椎间关节的第四实施例。在图17和图18所示的范例性实施例中，人造椎间关节可具有除人造小面部分外的上述所有特征。在该实施例中，自然小面关节保留。韧带张紧带在某些实施例中也可保存完好。另外，本实施例包括在各上/下保持部分之间的前侧中线连接的一个特定实例，它有助于保持第一保持部分21a和第二保持部分21b的定位。
图17和图18示出可提供具有锁和钥匙型图案的第一保持部分21a，这些图案由设置在第二保持部分21b上的相应匹配部分互补。更具体地，第一保持部分21a的一半部具有带U形部分35a的外边界而相应的第一保持部分21a的另一半部具有带凸起部分35b的外边界，凸起部分35b能嵌入U形部分35a。结果，第一保持部分21a、21b的各半部可保持在预设位置。
然而，上或下保持部分可便于植入和/或有助于提供和/或保持关节在大致稳定、对称的结构的方式配合在一起和/或连接于例如靠近它们中线前侧部分的体间空间中。更重要的是由于由图18所示下终板上保留的外环17提供的向内的力而在下保持部分之间提供这样的连接。在各下保持部分之间的中线连接将抵抗外环使保持部分向中线37移动的力。
如各范例性实施例所示，除了象锁和钥匙那样可配合在一起以保持彼此相对定位的第一和/或第二保持部分，人造椎间关节的每个半部基本关于椎骨的中线37对称。
再者，这些范例性实施例仅为示例性的并且不旨在成为本发明所有可能的设计、实现、修正以及使用的穷举性罗列。此外，结合本公开的一个实施例描述的特征可与其它实施例结合使用，即使在上面没有直接说明也是如此。
尽管上述说明对本领域内技术人员而言已经很明白，不过下面还是提供了对可用来植入人造关节的合适手术过程的简单说明。如上所述，人造椎间关节一般可使用与TLIF或PLIF过程相似的背侧穿孔方法被植入到人体内。根据该方法，可在患者的背部形成诸如中线切口的切口并且经由孔将一些或全部受影响的椎间盘以及周围组织去除。根据是否更换任何小面关节，可修剪自然小面关节以形成容纳人造小面关节的空间。然后，人造椎间关节的半部通过左/右穿孔开口被逐块地插入。即包括上下保持部分(具有或不具有小面部分和人造椎间盘，如果单独提供的话)的人造椎间关节块配合在通孔中并位于适当的椎间空间中。人造关节块可以是完全独立的或者在插入通孔前，用纱布或其它业内公知的材料将两个以上的人造关节块捆绑或包裹在一起。在自然椎间盘的外环的至少一部分可被保留的情况下，人造椎间关节的每侧的下保持部分被插入以使它们毗邻环的相应部分。如果提供中线前侧连接，则保持部分的左、右半部配合在一起并由外环保持在位。这样，环的保持部分可位于与手术过程前大致相同的位置。
此外，在必须完全去除自然椎间盘的环或只有不多的环保留的情况下，例如可使用本公开的实施例，其中采用蒂螺钉以确保人造椎间关节块保持在位。本领域内的技术人员能够理解，虽然背侧过程的优点是有限的，但人造关节可经由前侧方法或结合前侧方法和背侧方法植入。例如，某些人造椎间关节的块将通过前侧方法插入而其它关节块则通过背侧方法插入。前侧和背侧定位的部分可与图17和图18所示实施例相同的方式彼此配合。
尽管上面仅详细地描述了一些范例性实施例，但本领域内的技术人员很容易理解在实质上不脱离本公开的新颖性理念和优点的前提下可在示范的实施例中作出多种修正。因此，所有这些修正和替换均由下列权利要求所定义的本发明范围所包括。本领域内技术人员还认识到这样的修正和等效结构或方法不脱离本公开精神和范围，并且它们不脱离本公开精神和范围地作出各种改变、代替和选择。要理解所有空间基准，例如“水平”、“垂直”、“顶”、“上”、“下”、“底”、“左”、“右”仅为示例性的目的并且能在本公开范围内变化。在权利要求书中，装置加功能的条款旨在覆盖文本中所述结构以实现所述功能，并且不仅是结构等效物，而且包括等效结构。

Claims (69)

1.用于更换椎间盘和脊椎小面关节的至少部分的人造脊椎关节，所述人造关节的部分适合于从脊椎背侧植入，包括：
一间隔物；一上保持部分，具有适合于附连在自然骨表面的第一表面，形状能接纳和保持所述间隔物的一部分的第二表面，以及一上小面构件；以及一下保持部分，具有适合于附连在自然骨表面的第一表面，形状能接纳和保持所述间隔物的一部分的第二表面，以及一下小面构件；其中，在体内植入后，所述间隔物相对于所述上和下保持部分至少一个可滑动地安装，以及所述上和下小面构件可在脊椎弯曲运动过程中一个在另一个上面滑动，从而形成人造小面关节，至少部分地代替自然小面关节的导向运动。
2.如权利要求1所述的设备，其特征在于，所述间隔物与所述上和下保持部分的一个一体地形成。
3.如权利要求1所述的设备，其特征在于，所述上和下保持部分各包括段部分，以及所述间隔物设置在所述人造关节的段部分之间。
4.如权利要求3所述的设备，其特征在于，所述上和下保持部分的所述段部分连接在一起。
5.如权利要求4所述的设备，其特征在于，所述上和下保持部分的所述段部分具有在体间空间内配合在一起的外部。
6.如权利要求1所述的设备，其特征在于，自然椎间盘的一部分保持上和下保持部分的至少一个在体间空间内。
7.如权利要求1所述的设备，其特征在于，还包括用来固定上和下保持部分的至少一个到自然骨材料的至少一个蒂螺钉。
8.如权利要求1所述的设备，其特征在于，还包括在所述上和下保持部分之间延伸的张紧带，以便补充或代替一个以上的自然韧带的功能。
9.如权利要求1所述的设备，其特征在于，所述间隔物包括人造椎间盘。
10.如权利要求3所述的设备，其特征在于，所述段部分在体间空间内接合在一起。
11.如权利要求1所述的设备，其特征在于，上保持部分包括左和右部分，而下保持部分包括各自与上保持部分的左和右部分对齐的左和右部分。
12.如权利要求1所述的设备，其特征在于，所述间隔物与所述上和下保持部分一体地形成。
13.用于在一上椎骨和下椎骨之间造成至少一部分连接的人造脊椎关节，包括：一前侧关节代替部分；与所述前侧关节代替部分连接并从所述前侧关节代替部分向背侧延伸超过所述上椎骨和下椎骨的一个或两个的大致圆柱体部分的桥；以及连接所述桥的背侧关节代替部分。
14.如权利要求13所述的人造脊椎关节，其特征在于，在所述前侧关节代替部分和桥之间的连接是刚性连接。
15.如权利要求13所述的人造脊椎关节，其特征在于，在所述背侧关节代替部分和桥之间的连接是刚性连接。
16.如权利要求13所述的人造脊椎关节，其特征在于，所述人造脊椎关节包括用于接受紧固件、以将人造脊椎关节固定于上椎骨的连接。
17.如权利要求16所述的人造脊椎关节，其特征在于，用于接受紧固件的连接是用于蒂螺钉的连接。
18.如权利要求16所述的人造脊椎关节，其特征在于，用于接受紧固件的连接与前侧关节代替部分是一体的。
19.如权利要求16所述的人造脊椎关节，其特征在于，用于接受紧固件的连接与背侧关节代替部分是一体的。
20.如权利要求19所述的人造脊椎关节，其特征在于，用于接受紧固件的连接是用于蒂螺钉的连接。
21.如权利要求13所述的人造脊椎关节，其特征在于，人造脊椎关节包括用于接受紧固件、以将人造脊椎关节固定于下椎骨的连接。
22.如权利要求21所述的人造脊椎关节，其特征在于，用于接受紧固件的连接是用于蒂螺钉的连接。
23.如权利要求21所述的人造脊椎关节，其特征在于，用于接受紧固件的连接与前侧关节代替部分是一体的。
24.如权利要求21所述的人造脊椎关节，其特征在于，用于接受紧固件的连接与背侧关节代替部分是一体的。
25.如权利要求24所述的人造脊椎关节，其特征在于，用于接受紧固件的连接是用于蒂螺钉的连接。
26.如权利要求13所述的人造脊椎关节，其特征在于，还包括蒂螺钉。
27.如权利要求13所述的人造脊椎关节，其特征在于，在人造脊椎关节和上椎骨或下椎骨之间的表面的一部分包括设计成促进骨生长的材料。
28.如权利要求27所述的人造脊椎关节，其特征在于，设计成促进骨生长的材料包括珠子形状的材料。
29.如权利要求27所述的人造脊椎关节，其特征在于，设计成促进骨生长的材料包括等离子喷涂的材料。
30.如权利要求13所述的人造脊椎关节，其特征在于，人造脊椎关节至少包括：上构件，具有上前侧关节代替部分，连接至上前侧关节代替部分的上桥，以及连接至上桥的上背侧关节代替部分；以及下构件，包括下前侧关节代替部分，连接至下前侧关节代替部分的下桥，以及连接至下桥的下背侧关节代替部分。
31.如权利要求30所述的人造脊椎关节，其特征在于，上构件配置成与下构件连接。
32.如权利要求30所述的人造脊椎关节，其特征在于，上前侧关节代替部分配置成与下前侧关节代替部分连接。
33.如权利要求30所述的人造脊椎关节，其特征在于，上背侧关节代替部分配置成与下背侧关节代替部分连接。
34.如权利要求33所述的人造脊椎关节，其特征在于，用张紧带将上背侧关节代替部分连接至下背侧关节代替部分。
35.如权利要求13所述的人造脊椎关节，其特征在于，所述桥至少是人造蒂的一部分。
36.一种在上椎骨和下椎骨之间产生至少一部分连接的人造脊椎关节，包括：一前侧关节代替部分，其至少包括：一左上构件，一与左上构件关节连接的左下构件，一右上构件，以及一与右上构件关节连接的右下构件；其中，左上构件和右上构件各配置成互相连接，以及左下构件和右下构件各配置成互相连接。
37.如权利要求36所述的人造脊椎关节，其特征在于，所述左下构件和右下构件配置成通过锁和钥匙图案互相连接。
38.如权利要求36所述的人造脊椎关节，其特征在于，所述左上构件和右上构件配置成通过锁和钥匙图案互相连接。
39.一种在上椎骨和下椎骨之间产生至少一部分连接的人造脊椎关节，包括：一前侧关节代替部分，其至少包括：一左上构件，一与所述左上构件关节连接的左下构件，一右上构件，以及一与所述右上构件关节连接的右下构件；其中所述左下构件和右下构件各配置成互相连接。
40.如权利要求36所述的人造脊椎关节，其特征在于，所述左下构件和右配置成通过锁和钥匙图案互相连接。
41.一种植入人造脊椎关节的方法，包括以下步骤：在病人背部切割一切口；从椎间盘中移去至少一部分椎间盘材料，所述移去包括：通过切口接近椎间盘材料；以及通过切口插入一植入物；其中，插入植入物的动作包括插入取代椎间盘和小面关节的至少一部分的植入物。
42.如权利要求41所述的方法，其特征在于，还包括修整小面关节的至少一部分，以提供至少放置人造脊椎关节的一部分的空间。
43.如权利要求41所述的方法，其特征在于，插入植入物的动作顺序地包括：植入植入物的第一上部分；以及植入植入物的第一下部分。
44.如权利要求41所述的方法，其特征在于，插入植入物的动作包括：植入至少包括植入物的第一上部分和植入物的第一下部分的单元。
45.如权利要求44所述的方法，其特征在于，插入植入物的动作包括植入通过在第一上部分和第一下部分之间的系带成一体的单元。
46.如权利要求44所述的方法，其特征在于，插入植入物的动作包括植入通过包装的材料成一体的单元。
47.如权利要求44所述的方法，其特征在于，插入植入物的动作包括植入通过外科器械成一体的单元。
48.如权利要求44所述的方法，其特征在于，插入植入物的动作包括植入一体形成的、但保留通过在上部分和下部分施力而可变形的单元。
49.如权利要求41所述的方法，其特征在于，所述插入动作是通过一变化的脊椎开口实现。
50.如权利要求49所述的方法，其特征在于，所述变化的开口是左变化的开口。
51.如权利要求49所述的方法，其特征在于，所述变化的开口是右变化的开口。
52.如权利要求41所述的方法，其特征在于，还包括将一附加的植入物部分通过在与先前插入的植入物相反的一侧上的开口插入盘空间的至少一部分。
53.如权利要求52所述的方法，其特征在于，插入附加的植入物部分的动作包括插入基本上执行与先前插入的植入物功能相同的植入物。
54.一种在上椎骨和下椎骨之间产生连接的系统，所述系统包括：用于代替在椎间盘空间里的椎间盘的一部分的第一装置；用于代替至少一个小面关节的一部分的第二装置；以及刚性地连接第一装置和第二装置的第三装置。
55.如权利要求54所述的系统，其特征在于，刚性地连接第一装置和第二装置包括一体地连接第一装置和第二装置。
56.如权利要求54所述的系统，其特征在于，第三装置从第一装置向背侧延伸和从椎间盘空间向外延伸。
57.如权利要求54所述的系统，其特征在于，第一装置包括一上部分和一下部分，其中，上部分可相当于下部分移动。
58.如权利要求54所述的系统，其特征在于，第一装置包括：一用于固定在上椎骨的左上部分；一用于固定在上椎骨的右上部分；一用于固定在下椎骨的左下部分；以及一用于固定在下椎骨的右下部分。
59.如权利要求58所述的系统，其特征在于，第二装置包括：一左上小面构件和一左下小面构件，其中，左上和左下小面构件可相对彼此滑动；以及一右上小面构件和一右下小面构件，其中，右上和右下小面构件可相对彼此滑动。
60.如权利要求59所述的系统，其特征在于，第三装置包括：用于将左上部分连接至左上小面构件的左上连接装置；用于将左下部分连接至左下小面构件的左下连接装置；用于将右上部分连接至右上小面构件的右上连接装置；以及用于将右下部分连接至右下小面部分的右下连接装置。
61.如权利要求54所述的系统，其特征在于，还包括用于将第二装置固定于上或下椎骨的第四装置。
62.一种将人造脊椎关节植入上和下椎骨终板之间的方法，所述方法包括：在病人背部切割一切口；接近椎间盘，所述椎间盘包括外环区域；通过切口移去椎间盘的至少一部分；保留附连在椎骨终板的一个上的外环区域的一部分；以及，通过切口插入一植入物，以邻接外环区域的保留部分，其中，所述植入物代替椎间盘和小面关节的至少一部分。
63.如权利要求62所述的方法，其特征在于，所述外环区域的该部分附连在下椎骨终板。
64.如权利要求62所述的方法，其特征在于，保留外环区域的一部分包括保留外环区域的约300度。
65.如权利要求62所述的方法，其特征在于，保留外环区域的一部分包括保留外环区域的前侧部分。
66.如权利要求62所述的方法，其特征在于，所述植入物包括第一和第二保留部分，其中插入一植入物包括限制第一和第二保留部分在椎骨终板之间移动。
67.如权利要求66所述的方法，其特征在于，连接第一和第二保留部分。
68.如权利要求67所述的方法，其特征在于，所述第一和第二保持部分在大致前侧中线位置处连接。
69.如权利要求67所述的方法，其特征在于，所述第一和第二保持部分通过互连特征连接。
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