CN1921808A - 替代小平面关节功能的方法和装置 - Google Patents

替代小平面关节功能的方法和装置 Download PDF

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CN1921808A
CN1921808A CNA2004800408566A CN200480040856A CN1921808A CN 1921808 A CN1921808 A CN 1921808A CN A2004800408566 A CNA2004800408566 A CN A2004800408566A CN 200480040856 A CN200480040856 A CN 200480040856A CN 1921808 A CN1921808 A CN 1921808A
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joint
posterior means
posterior
facet
facet joint
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M·C·舍曼
F·J·莫兹四世
J·R·贾斯蒂斯
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Warsaw Orthopedic Inc
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SDGI Holdings Inc
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Abstract

本发明提供了一种用来替代一上椎骨和一下椎骨之间的一小平面关节功能而不需要解剖性植入物的系统和方法。该方法包括：设置一个或多个柔性后部装置以替代小平面关节的主要功能，该柔性装置在椎骨之间施加一分离力；以及采用一个或多个后部装置的第一个以用于与一第一茎部的第一处连接和与一第二茎部的第二处连接。还揭示出包括两个后部装置的装置，这两个装置一个抗压缩，一个抗扩张。还揭示出用于前部脊柱稳定器的一杆子，它包括两个柔性构件，该杆子由一接头相连以替代小平面关节的功能。

Description

替代小平面关节功能的方法和装置
技术领域
本发明涉及脊柱装置及其方法，尤其涉及一种用来替代上椎骨和下椎骨之间的小平面关节功能而不必然需要解剖性植入物的系统和方法。
背景技术
椎骨包括椎骨体和包括茎部、薄板、关节突和棘突在内的向后延伸结构。关节突包括上突和下突，它们连接起来以形成相邻椎骨的椎骨关节突或小平面关节。小平面关节由相邻椎骨的关节突所形成，即一椎骨的下关节突与在下方的椎骨的关节突联接。小平面关节执行数个功能，包括稳定脊柱并承担脊柱上大约20％的压缩负荷。因此，它们的解剖位置和朝向影响每个脊柱区域的机动性。例如，在颈部区域，小平面关节朝向冠状平面并可以在六个自由度上在较大范围内运动。在腰部区域，小平面朝向旁矢状面并由此限制旋转。
较重的外伤或反复发生的轻外伤会使小平面关节受损或退化。结果，将关节排成一行的透明软骨就会失去其水分并最终磨损。当这一情况发生时，关节突就开始随着关节囊伸长而互相骑跨，导致关节不再对准且运动部分的生物机械功能不正常。
现在对于退化或损坏的小平面关节的处理是提供假体小平面关节。假体小平面关节的形状和位置被设置成类似于原始的小平面关节，并且必须被构造成可承受执行原始小平面关节的功能所需的运动和重量。在同时又要达到可靠性和稳定性的情况下，这样的要求很难达到。所需要的是一种用来减少和/或消除对解剖性假体小平面关节的需求的系统和方法。
发明内容
本发明提供了一种用来替代一上椎骨和一下椎骨之间的一小平面关节功能而不需要解剖性植入物的系统和方法。
在一个实施例中提供了一种用于替代相邻的椎骨之间的一小平面关节功能的外科植入物。该外科植入物包括连接于一上椎骨的一第一茎部的一第一生物相容连接装置和连接于一下椎骨的一第二茎部的一第二生物相容连接装置。该外科植入物还包括连接于第一和第二生物相容连接装置的一柔性构件。第一和第二生物相容连接装置被定位、且采用柔性构件，从而使外科植入物在上、下椎骨之间施加一个足以选择性地将保持第一和第二茎部保持一预定距离的分离力。
在另一个实施例中，提供有一种小平面替代系统。该小平面替代系统包括：一第一后部装置，该第一后部装置具有第一和第二连接机构以及连接在这两个连接机构之间的一抗压缩构件；以及一第二后部装置，该后部装置具有第一和第二连接机构以及连接在这两个连接机构之间的一抗扩张构件。第一连接机构适于与一上棘突的各个部分相连，而第二连接机构适于与一下棘突的各个部分相连。
在另一个实施例中提供了一种替代相邻的椎骨之间的一小平面关节的功能的方法。该方法包括：提供一个或多个柔性后部装置以替代小平面关节的主要功能；以及采用一个或多个后部装置的第一个以用于与一第一茎部的第一处连接和与一第二茎部的第二处连接。
在另一个实施例中，一种替代相邻的椎骨之间的一小平面关节的功能的假体装置包括：用于设置一个或多个后部装置以替代小平面关节的主要功能的装置；以及用于采用一个或多个后部装置的第一个作为与一第一横突(transverse process)的第一处连接以及与一第二横突的第二处连接的装置。
在另一个实施例中，一种用来替代相邻的椎骨之间的一小平面关节的功能的方法包括：设置一个或多个柔性后部装置以替代小平面关节的主要功能；以及采用一个或多个后部装置的第一个作为与一第一关节突的第一处连接以及与一第二关节突的第二处连接。
在另一个实施例中，一种用来替代相邻的椎骨之间的一小平面关节的功能的方法包括：设置一个或多个后部装置以替代小平面关节的主要功能；以及采用一个或多个后部装置的第一个作为与一第一棘突的第一处连接以及与一第二棘突的第二处连接。
在另一个实施例中，一种用来替代相邻的椎骨之间的一小平面关节的功能的方法包括：设置一个或多个后部装置以替代小平面关节的主要功能；以及采用一个或多个后部装置的第一个作为与一第一茎部的第一处连接以及与一第二茎部的第二处连接。
在另一个实施例中，一种用来替代相邻的椎骨之间的一小平面关节的功能的方法包括：将一个或多个后部装置与相邻的椎骨相连以替换小平面关节的主要功能而不需要采用任何解剖性的小平面关节植入物。
在另一个实施例中一种用于替代一小平面关节的功能的后部装置包括：一第一构件，该第一构件包括一伸长的主体和一第一接头，该第一接头具有一第一孔，其中该第一孔中容纳有一弹性材料；一第二构件，该第二构件包括一伸长的主体和一第二接头，该第二接头具有一第二孔，其中第二接头与第一接头联结于该第二孔中，且第二孔容纳该弹性材料；以及一连接器，该连接器将第一接头和第二接头覆盖，其中该连接器中包括该弹性材料。
附图说明
图1示出了根据本发明的一个实施例、用来替代小平面功能的一后部装置和一前部装置。
图2A示出了根据本发明的一个实施例、用来替代小平面功能的一后部装置和一前部装置。
图2B和2C示出了示例性的后部装置。
图3示出了根据本发明的一个实施例、用来替代小平面功能的一后部装置和一前部装置。
图4示出了根据本发明的一个实施例、用来替代小平面功能的一后部装置的诸构件。
图5示出了组装好的图4所示后部装置。
图6-8示出了图5所示后部装置的示例性使用方法。
具体实施方式
为了促进对本发明的原理的理解，现在将参照附图所示的实施例或例子，并将使用具体的语言来描述这些实例。应该理解的是，并不因此就对本发明的范围进行了限制。另外，为了简化而重复使用标号，且这些标号本身并不表示不同的实施例中所讨论的任何元件组合。应该认为，那些熟悉本领域技术的人员可以对此处所描述的实施例作任何的改变和进一步的修改，并且对所描述的本发明的原理作任何进一步的应用。
现在参见图1，出于举例的目的，显示出带有受损或退化的小平面关节110的相邻椎骨V1和V2。本实施例试图复制小平面关节110的功能(或一些功能)而不需要诸如假体小平面关节装置之类的解剖植入物。然而，可以理解的是，根据需要，解剖植入物也可用于某些实施例中。为了替代小平面关节110的功能，采用一后部装置100和/或一前部装置120。后部装置100可以单独使用或与前部装置120结合使用以复制小平面关节110的功能。相反，也可采用单独的一个前部装置(没有后部装置)来复制小平面关节的功能。
为了在后部装置100和/或前部装置120中实现小平面关节110的功能可以采用许多方法来评定小平面关节110的功能要求。例如，可以确定小平面关节110所承受的脊柱负荷。作为替代或附加的方案，可以采用运动分析方法，该方法利用设计装置来重现小平面关节110的运动。
一旦评定了小平面关节110的功能要求，可选择后部装置100的组成以满足这些要求。其例子包括生物相容装置，比如由形状记忆合金、缆索或弹簧构成的装置。在图1所示出的中，后部装置100是柔性缆索。在本实施例中，后部装置100可居于各种物理位置处，从而可将该装置的尺寸设置成可满足功能要求而非满足小平面关节110的空间和形状要求。在对图1的这一说明中，后部装置100通过诸如茎螺丝之类的生物相容的连接装置102和104连接于椎骨V1和V2的茎部。连接装置的其它例子包括钉子、铆钉和形成在椎骨中用于接纳后部装置100的固定部分的锁定槽。设想后部装置100还可连接于椎骨V1和V2的其它部分，比如关节突、横突、棘突或薄板。还设想可以使用系绳、钉子和其它的固定装置。
后部装置100可为形状记忆材料制成的柔性缆索，该材料可为聚合体基材料或镍钛金属互化物。例如，后部装置100可包括大约一半镍和一半钛，并可在热空气中、随后在冷水中对其进行处理以生成低于人体温度范围的奥氏体形成温度。在这个例子中，后部装置100可具有大约34℃的奥氏体形成温度。因此，在34℃以上时，后部装置100变得超弹性。
在将后部装置100植入人体之前，可将该后部装置冷却到34℃以下以保持易于插入的预定形状。或者，它可以保持在34℃以上，从而其超弹性可以帮助进行插入。可将前部装置120插入椎骨V1和V2之间的椎间盘空间中。在图1所示的中，前部装置120是一椎间盘替换装置，比如美国专利6,402,785中所揭示的(该专利让与SDGI Holding，Inc.，结合于此作为参照)。前部装置120的其它例子包括柔性的生物相容装置，比如、缆索、弹簧或由形状记忆合金制成的装置。
根据小平面关节110的状况，可以通过手术将其取下或不取下。例如，如果小平面关节110造成了很严重的疼痛，则可以准许将其取下。或者，可将小平面关节110留下并在一限定的范围内使用。
现在参见图2A，在另一个实施例中，椎骨V3和V4之间的小平面关节204会受损或退化。结果，后部装置200可替代小平面关节204的功能(或主要功能)，该后部装置可单独使用或与前部装置202结合使用。
现在参见图2B，在一个实施例中，后部装置200可为生物相容的弹簧，该弹簧包括一对连接装置206和208、偏置构件210和壳体装置212。
连接装置206和208可包括任何传统的连接装置，比如销钉、连接器、销栓、铆钉、长钉、键、联结器或衬套。在这个图中，连接装置206和208是可插入椎骨V3和V4中以固定后部装置200的生物相容的螺丝。
偏置构件210可响应脊柱的运动而重新定形。类似于传统的弹簧，偏置构件210通过复制小平面关节204的功能而响应脊柱运动。例如，当在脊柱上施加负荷时可压缩偏置构件210，但在弯曲运动时偏置构件210会伸长。设想偏置构件210可在由其所选择的材料和结构确定的弹性范围内工作。还设想偏置构件210可包括任意一种生物相容材料，比如钛、碳纤维、聚合体或形状记忆合金。
壳体装置212可用于保护偏置构件210不受周围组织的影响，从而这些组织不会意外地阻碍偏置构件210并妨碍其适当的功能。设想壳体装置212可包括任意生物相容材料，比如橡胶或形状记忆合金。
设想后部装置200及其组件可包括多种形状，比如图2C中所示的那种。还构想后部装置200可包括多个偏置构件或者只有一根传统的弹簧。还设想后部装置200可为任意一种柔性的生物相容装置，比如一根缆索、或一个形状记忆合金制成的装置。
后部装置200可由诸如销钉、连接器、销栓、铆钉、长钉、键、联结器、衬套、垫圈或其它固定装置之类的任何一种传统的生物相容连接装置连接于椎骨V3和V4的横突。还设想后部装置200可连接于椎骨V3和V4的茎部、关节突、棘突或薄板。
前部装置202可插入椎骨V1和V2之间的椎间盘空间并与后部装置200一起工作以替代小平面关节204的功能，前部装置202可为核心装置(nucleus device)。前部装置202可包括任何传统的核心替代装置。或者，它可包括任何柔性的生物相容装置，比如一根缆索、一根弹簧或由一个形状记忆合金制成的装置。可以理解的是，传统的核心替代装置在本领域中是已知的，在这里就不再进一步进行描述了。
根据小平面关节204的状况，可以通过手术将其取下或不取下。例如，如果小平面关节204造成了很严重的疼痛，则可以将其取下。或者，可将小平面关节204留在人体中而不再主要依靠其功能。
现在参见图3，在再一个实施例中，可采用后部装置302和后部装置304的组合来替代椎骨V5和V6之间受损的小平面关节(未示出)的功能(或主要功能)。还可以构想的是，前部构件310可与后部装置302和304一起起作用以替代小平面关节的功能，前部构件310可类似于先前所描述的装置108或202。
在复制小平面关节的功能时后部装置302和后部装置304可互相促进。例如，后部装置302可为调整被替换的小平面关节的功能的生物相容弹簧，而后部装置304可为调整被替换的小平面关节的功能的阻尼器。后部装置302可为在先所述的后部装置100或200、或者生物相容的阻尼器。同样，后部装置304可为以上所述的后部装置100或200的任意一种。在一个例子中，后部装置304可为与标题为“吸震装置”的美国专利2,235,488所揭示的实施例相同或相类似的阻尼器，该文件结合于此作为参照。
在这个例子中，后部装置302通过茎螺丝连接于茎部，同时后部装置304连接于椎骨V5和V6的横突。或者，后部装置302和304的每一个都可连接于椎骨V5和V6的关节突、横突、棘突、薄板或茎部的任意一个。设想可将一个或多个附加的后部装置添加到后部装置302和304之中，所有的这些后部装置都可一起工作以替代小平面关节的功能。
即使以上的实施例都旨在替代单个小平面关节的功能，设想该发明也可用于替代多个小平面关节的功能。例如，可采用侧向进入的方法来替换椎间盘两侧的受损小平面关节。
现在参见图4，在另一个实施例中，后部装置400可包括连接器418、第一组件420和第二组件422。后部装置400可单独使用，或者可与前述的一个或多个附加的后部和/或前部装置结合使用，从而替代小平面关节的功能而不需要任何解剖性小平面关节植入物。设想可使用后部装置400来替代先前所描述的实施例中的后部装置100、200、302或304中的任意一种。
连接器418为后部装置400提供弹性，从而可进行模仿小平面关节的功能的运动。连接器418可包括任意一种弹性的生物相容材料，比如橡胶、硅或形状记忆合金。它可包括任意合适的形状，其中可有空心的橄榄形或部分球形。
第一组件420可包括末端408、加长的主体406和接头402，主体406可为杆子或轴。末端408可为尖端的，并适于通过皮肤将后部装置400插入，这就需要推动后部装置400，使之穿过动物体的组织。接头402包括孔402，该孔可容纳任何生物相容弹性材料，比如橡胶、硅或形状记忆合金，从而便于后部装置400的运动。
第二组件422可具有与第一组件420相同或类似的结构。在这幅图中，第二组件422可包括末端416、加长的主体414和接头410，主体414可为杆子或轴。末端416可为尖端的，并适于通过皮肤将后部装置400插入，这就需要推动后部装置400，使之穿过动物体的组织。接头410包括孔412，该孔可容纳任何生物相容弹性材料，比如橡胶、硅或形状记忆合金，从而便于后部装置400的运动。孔412可与孔404相连，从而弹性材料可以穿过孔404和412以便于实现后部装置400的功能。还设想第二组件422可具有与第一组件420不同的结构。
第一和第二组件420和422可由传统的装置互相联结，比如经过它们各自的接头402和410模制或用螺丝旋在一起，从而形成一个单元。另外，它们可以不同的角度相联结以模仿小平面关节的自然解剖特性。例如，为了替代颈部区域中的小平面关节的功能，第一和第二组件420和422可相对于水平呈大约45°的角度地联结以模仿自然的小平面关节的朝向。在另一个实施例中，为了替代胸部区域的小平面关节的功能，第一和第二组件420和422可以相对于人体的轴向平面呈60°、相对于其正面呈20°的角度地联结。在腰部区域，第一和第二组件420和422可以相对于人体的轴向平面呈90°、相对于其正面呈45°的角度地联结。
第一和第二组件420和422每个都可包括任何生物相容的材料，比如不锈钢、钛、形状记忆合金、聚合体、碳纤维以及多孔材料。设想后部装置400可连接于椎骨的茎部、关节突、横突、棘突或薄板的任意一部分。
现在参见图5，可以诸如后向或侧向方法之类的传统方法将后部装置400以一个整体插入脊柱区域。还设想可以美国专利6,530,925(该专利让与SDGI Holdings，Inc)所揭示的方法将后部装置400插入脊柱区域。
现在将描述对后部装置100、200、302、304和400的使用。可用诸如后向或侧向进入方法之类的任何传统的方法将后部装置插入脊柱区域。例如，可用于后向进入方法的程序和器械在美国专利6,241,729(该专利让与SDGI Holdings，Inc)以及Sofamor Danek1996所出版的题为“使用骨钉器械用于后向进入法的手术技术(Surgical Technique using Bone DowelInstrumentation for Posterior Approach)”一文中有所揭示，这两份文件全文结合于此作为参照。还设想可用美国专利6,530,929(该专利让与SDGIHoldings，Inc，并结合于此作为参照)中所揭示的方法将后部装置100、200、302、304和400的任意一个插入脊柱区域中。
可通过任何传统的方法将前部装置120、202和303插入脊柱区域中，比如用前向、后向或侧向进入法。例如，可用于前向进入法的程序和器械在美国专利6,248,541以及Sofamor Danek1996所出版的题为“使用骨钉器械用于后向进入法的手术技术(Surgical Technique using Bone DowelInstrumentation for Posterior Approach)”一文中有所揭示。这两份文件全文结合于此作为参照。
图6-8以示例性的方式示出了后部装置400连接于动物体的椎骨上时的使用。例如，现在参见图6，其中示出了根据本发明的一个实施例的用两个多轴线螺丝602和604定位于椎骨V7和V8之间的后部装置400。可以使用的连接机构的其余例子在美国专利6,280,442、5,891,145、6,485,491和6,520,963中有所揭示，这些文件结合于此作为参照。图7和8示出了从不同角度看的图6的立体图，以显示出根据本发明的一个实施例的后部装置400的应用。
虽然以上只是详细描述了本发明的数个示例性实施例，但那些熟悉本领域技术的人员会知道有可能对示例性的实施例进行许多修改而不会实质上背离本发明的新颖性内容和优点。同样，以上关于某些实施例描述和讨论的特征可与以上关于其它的实施例所描述和讨论的特征相结合。例如，固定于脊柱突的连接机构也可根据需要固定于茎部或薄板。因此，所有的这些实施例和替代方案都应包括在所要求保护的本发明的范围中。

Claims (22)

1.一种用于替代相邻的椎骨之间的一小平面关节的功能的外科植入物，该外科植入物包括：
连接于一上椎骨的一第一茎部的一第一生物相容连接装置；
连接于一下椎骨的一第二茎部的一第二生物相容连接装置；
连接于第一和第二生物相容连接装置的一柔性构件；
其中，第一和第二生物相容连接装置被定位成并且柔性构件被适配成：使外科植入物在上、下椎骨之间施加一个足以选择性地将第一和第二茎部保持在一预定距离的分离力。
2.如权利要求1所述的外科植入物，其特征在于，该柔性构件还适于响应超出分离力的一第二力而受到压缩。
3.如权利要求1所述的外科植入物，其特征在于，该柔性构件包括位于第一和第二生物相容连接装置之间的一接头构件。
4.如权利要求3所述的外科植入物，其特征在于，该柔性构件还包括：一第一柔性构件，该第一柔性构件连接在第一生物相容连接装置和接头构件之间；以及一第二柔性构件，该第二柔性构件连接在第二生物相容连接装置和接头构件之间，其中，第一和第二柔性构件在接头构件处连接在一起并适于在接头构件处互相相对地旋转。
5.一种小平面替代系统，包括：
一第一后部装置，该第一后部装置具有第一和第二连接机构以及连接在这两个连接机构之间的一抗压缩构件；
一第二后部装置，该第二后部装置具有第一和第二连接机构以及连接在这两个连接机构之间的一抗扩张构件；
第一连接机构适于与一上棘突的各个部分相连；以及
第二连接机构适于与一下棘突的各个部分相连。
6.如权利要求5所述的小平面替代系统，其特征在于，第一连接机构连接于同一个棘突。
7.如权利要求5所述的小平面替代系统，其特征在于，第二连接机构连接于同一个椎骨上的不同的棘突。
8.一种替代相邻的椎骨之间的一小平面关节的功能的假体装置，包括：
用于设置一个或多个柔性后部装置以替代小平面关节的主要功能的装置；以及
用于使一个或多个后部装置中的第一个用于与一第一横突的第一处连接以及与一第二横突的第二处连接的装置。
9.如权利要求8所述的假体装置，其特征在于，它还包括：
用于将小平面关节的至少一部分去除的装置。
10.如权利要求8所述的假体装置，其特征在于，它还包括：
用于使一个或多个后部装置中的第二个与关节突相连的装置。
11.如权利要求8所述的假体装置，其特征在于，它还包括：
用于使一个或多个后部装置中的第二个与棘突相连的装置。
12.如权利要求8所述的假体装置，其特征在于，它还包括：
用于使一个或多个后部装置中的第二个与茎部相连的装置。
13.一种用于替代一小平面关节的功能的后部装置包括：
一第一构件，该第一构件包括：
一伸长的主体；和
一第一接头，该第一接头具有一第一孔，其中该第一孔中容纳有一弹性材料；
一第二构件，该第二构件包括：
一伸长的主体；和
一第二接头，该第二接头具有一第二孔，其中第二接头与第一接头联结于该第二孔中，且第二孔容纳该弹性材料；以及
一连接器，该连接器将第一接头和第二接头覆盖，其中该连接器中包括弹性材料。
14.如权利要求13所述的后部装置，其特征在于，该第一构件还包括一削尖的末端，该末端适于从皮肤插入后部装置。
15.如权利要求13所述的后部装置，其特征在于，该第二构件还包括一削尖的末端，该末端适于从皮肤插入后部装置。
16.如权利要求13所述的后部装置，其特征在于，该连接器为椭圆形。
17.如权利要求13所述的后部装置，其特征在于，该第一构件和第二构件与水平方向呈大约45°的角度地联结以模拟小平面关节的取向。
18.如权利要求13所述的后部装置，其特征在于，该第一构件和第二构件大约相对于人体的轴向平面呈60°、相对于其正面呈20°的角度而联结。
19.如权利要求13所述的后部装置，其特征在于，该第一构件和第二构件大约相对于人体的轴向平面呈90°、相对于其正面呈45°的角度而联结。
20.一种用来替代相邻椎骨之间的一小平面关节的功能的前部假体装置系统，该前部假体装置系统包括：
用于设置一个或多个柔性前部装置以替代小平面关节的主要功能的装置；以及
用于使一个或多个前部装置的第一个插在相邻的椎骨体之间的装置。
21.如权利要求20所述的前部假体装置系统，其特征在于，该系统还包括：
用于将小平面关节的至少一部分去除的装置。
22.如权利要求20所述的前部假体装置系统，其特征在于，该系统还包括：
用于使一个或多个前部装置的第二个插在相邻的椎骨体之间的装置。
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