CN1985771A - 用于骨头或椎骨的动态稳定装置 - Google Patents

用于骨头或椎骨的动态稳定装置 Download PDF

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CN1985771A
CN1985771A CNA2006101684511A CN200610168451A CN1985771A CN 1985771 A CN1985771 A CN 1985771A CN A2006101684511 A CNA2006101684511 A CN A2006101684511A CN 200610168451 A CN200610168451 A CN 200610168451A CN 1985771 A CN1985771 A CN 1985771A
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dynamic stabilization
stabilization device
recess
pressure elements
ring
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CN1985771B (zh
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L·比德曼
W·马蒂斯
H·拉普
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Biedermann Motech GmbH and Co KG
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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
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7022—Tethers, i.e. longitudinal elements capable of transmitting tension only, e.g. straps, sutures or cables
    • A—HUMAN NECESSITIES
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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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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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
    • 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
    • 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
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • 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

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Abstract

一种用于骨头或椎骨的动态稳定装置，包括：至少两个骨锚固元件(1；1′；1″)；至少一个连接元件(5；50；51)，其连接所述骨锚固元件，所述骨锚固元件具有要锚固在骨头或椎骨中的茎秆部(2)和要与所述连接元件(5；50；51)相连的头部部分(3；3′)，其中，所述连接元件(5；50；51)至少部分地是弹性的并具有至少一个环部分，并且所述头部部分(3；3′)包括具有用于插入所述环部分的开口的凹部(4；40)，并且固定元件(6)被设置用于将所述环部分固定在所述凹部中；所述连接元件优选地为由弹性体材料制成的环形环的形式。

Description

用于骨头或椎骨的动态稳定装置
技术领域
本发明涉及一种用于骨头或椎骨的动态稳定装置，包括通过弹性环连接的至少两个骨锚固元件。该弹性环允许两个骨锚固元件之间有限的运动，从而提供两个骨头或椎骨的动态稳定。
背景技术
EP0669109B1公开了一种稳定装置，包括锚固在相邻椎骨中并通过带连接以传递相应椎骨之间的张力的至少两个单轴线骨螺钉。抗压缩的支撑体围绕骨螺钉之间的带以传递压缩力。带以预加应力的方式扣紧到骨螺钉上。如果要连接不止两个螺钉，则这种稳定装置在手术期间不易操作，并且调节该装置的可能性也受到限制。
包括骨螺钉和由弹性体材料制成的挠性杆的另一种动态稳定装置可以从EP1 3646 22A2中获知。可以在相邻椎骨间获得的系统的弹性性能由杆的材料的形状和特性决定。如果要使多个椎骨相互连接，则在操作部位难以使弹性性能根据实际需要适合于整个连接长度。此外，骨螺钉的接纳部和轴单轴线地连接。这限制了相对于杆调节轴的位置的可能性。
US 2002/0133155A1公开了一种脊骨稳定系统，其带有能限制脊骨运动的交叉连接的稳定装置。该交叉连接元件可以采用不同形式，其中包括弹性带形式。
US 6,616,669B2公开了一种用于拴住脊骨的装置，其是形成在一组块体中带人造绞合螺纹的穿透通道的组合，所述块体在脊骨凸侧上连接至椎骨主体。该装置用于通过选择性抑制脊骨凸侧的一部分的生长来治疗畸形。
发明内容
本发明的目的是提供一种用于骨头特别是椎骨的动态稳定装置，其允许根据实际临床需要很容易地进行调节，并且在手术过程中安装简单、安全。
该目的通过根据权利要求1的动态稳定装置实现。进一步的实施方式在从属权利要求中给出。
该动态稳定装置的优点在于，通过提供包括多个具有不同长度和/或弹性的环形环，可以使系统通过简单地选择尺寸和刚性适当的弹性环而适应于手术期间操作部位处的实际需要。如果要使多个弹性环相互连接，则可以根据稳定相邻运动部分的需要使用不同的弹性环。如果骨锚固元件为多轴线螺钉，则允许相对于茎秆更好地调节螺钉的取向。结合将装置的动态性能调节至实际临床需要的可能性，可以使作用在骨锚固元件的茎秆上的力最小。从而，该动态稳定装置具有改进的寿命和更加平衡的性能。
附图说明
本发明的其它特征和优点通过参考下面结合附图的实施例的详细描述将变得更加清楚和更易理解。
图1示出根据第一实施例的动态稳定装置的透视图；
图2示出根据第一实施例的动态稳定装置的骨锚固元件的剖视图，其中插入有弹性环；
图3示出根据图2的骨锚固元件的分解透视图；
图4示出根据第二实施例的动态稳定装置；
图5示出根据第二实施例的动态稳定装置的骨锚固元件的剖视图，其中插入有弹性环；
图6示出根据第二实施例的动态稳定装置的骨锚固元件的分解视图，其中不带弹性环；
图7示出弹性环的变型；
图8以透视图的形式示出弹性环的第二实施例；
图9以透视图的形式示出弹性环的第二实施例的变型；
图10示出图9的弹性环沿线A-A在垂直于环的纵向轴线L的方向上延伸的平面内的剖视图。
具体实施方式
图1所示的动态稳定装置的第一实施例包括至少两个骨锚固元件1、1′。每个骨锚固元件1、1′具有带有骨螺纹用于锚固在骨头中的茎秆部2和连接至茎秆部2的接纳部3。接纳部3具有凹部4，环形弹性环5插入在该凹部中以连接两个骨锚固元件1、1′。固定元件6被设置用于将环形弹性环5固定在骨锚固元件1、1′的接纳部3中。
如图1-3所示，骨锚固元件1在茎秆部2一端具有头部7，其在本实施例中被定形成球缺。在茎秆2的相反侧，球形头部7具有用于与拧入工具接合的凹部8。
接纳部3包括第一端9和与第一端相反的第二端10以及横贯第一端和第二端的平面的纵向轴线11。与纵向轴线11共轴线地设有孔12，其从第一端9延伸至离第二端10预定距离。开口13设在第二端10处，其直径小于孔12的直径。球形部分14邻近开口13设置，从而形成用于球形头部7的座部。部分14不必为球形部分，也可以具有其它形状，例如锥形渐缩形状。
接纳部3中的凹部4为U形，起始于第一端9并沿第二端10的方向延伸至离第二端预定距离。借助于U形凹部4，形成了两个朝向第一端9延伸的自由支腿15、16。邻近第一端9，接纳部3在支腿15、16上包括内螺纹17。
骨锚固元件还包括第一压力元件18，其具有圆柱形构造，且其外直径稍小于孔12的内直径以允许将第一压力元件18引入到接纳部3的孔12中并使之沿轴向方向运动。在其面向第二端的下侧，第一压力元件18包括球形凹部19，其半径对应于骨螺钉的球形头部7的半径。在另一侧，第一压力元件18具有圆柱形凹部20，其横向于纵向轴线11延伸。该凹部20的横向直径被选择成使得具有圆形横截面的环5可以插入到凹部20中。该圆柱形凹部20的深度被选择成使得在组装状态当环沿U形凹部4的底部的方向被插入并挤压时，第一压力元件18将压力施加到头部7上。优选地，圆柱形凹部20的深度为环5的直径的大约一半。
第一压力元件18还包括共轴线孔21，用于引导拧入工具通过。
骨锚固元件还包括第二压力元件22，其具有圆柱形构造，并且其外直径对应于第一压力元件的外直径，从而可以在孔12中滑动。第二压力元件22在其面向第一压力元件18的一侧上具有圆柱形凹部23。圆柱形凹部23的直径使得环5可以装配到其中并且其深度为环5的直径的一半或少于一半。此外，第二压力元件22也包括共轴线孔24。在组装状态中，如图2所示，第一压力元件18和第二压力元件22包住环5。特别是从图2和图3可以看出，第一压力元件18和第二压力元件22以这样一种方式插入到接纳部3中，即圆柱形凹部20和23的取向与U形凹部5的取向一致。第一压力元件的上边缘20a抵靠第二压力元件的下边缘23a。从而，环5被夹紧在第一压力元件18和第二压力元件22之间。
在本实施例中，固定元件6被形成为可以拧入到支腿15、16之间的内螺钉。在其面向接纳部3的一侧，内螺钉6具有突起25，该突起装配到第二压力元件22的轴向孔24中。在图2所示的组装状态中，突起25与环5接触。内螺纹17和内螺钉16的配合螺纹可以具有任何已知的螺纹形状。但是，平螺纹或阴角螺纹提供了这样的优点：防止支腿15、16外张。
接纳部3和压力元件18可以通过分别设在接纳部3和第一压力元件18上的相对两侧上的压接孔32、33松散地预组装。
骨锚固元件由不会引起排斥的材料如不锈钢或钛或适合于骨螺钉的任何其它材料制成。
从图1和7可以看出，环5为环形并具有大体矩形外形，其具有两相对的长边35、35′和两相对的短边36、36′。短边的长度稍大于接纳部3的直径，使得短边可以被插入到接纳部3的U形凹部4中。长边的长度对应于操作部位上两个锚固元件的接纳部之间的距离。环5优选地由弹性材料制成，如不会引起排斥的塑料材料，例如基于聚亚安酯、有机硅聚合物或PEEK的聚合物。一种特别合适的材料是聚碳酸脂聚氨酯。它是完全或部分挠性的。特别地，长边35、35′是挠性的。为了避免磨损，环5可以在短边或长边上具有加强或防护结构37。环5优选地具有圆形横截面。
可以提供尺寸变化如长度变化和/或直径变化的多个环。它们也可以在其弹性性能上变化。
使用中，至少两个骨锚固装置被锚固在要动态稳定的两个骨头碎片或两个椎骨中。骨锚固装置由预组装的骨螺钉、接纳部和第一压力元件构成。然后，将环插入到骨锚固元件的接纳部3中以连接接纳部3。接着，将第二压力元件22插入到每个接纳部中以保住环5。此后，将内螺钉6拧入到接纳部的支腿之间。在这种情况下，内螺钉6防止第二压力元件22掉落，同时接纳部3仍然可以相对于茎秆2枢转。当紧固内螺钉6时，它挤压第二压力元件22，该第二压力元件自己又挤压第一压力元件18，以在骨螺钉的头部7上施加压力，从而将骨螺钉的头部锁定在其角位置中。环5通常在未施加应力的条件下插入。
该装置所需的动态性能可以通过选择具有适当尺寸和刚性的环5很容易地调整。如果环被选择成挠性很高，则它可以只传递张力。如果环5被选择成刚性很高，则它也能够传递压缩力和弯曲力。
环也可以以预加应力的方式插入。
图4-6示出了第二实施例。第二实施例与第一实施例不同之处在于它允许插入两个或更多个环以便连接两个以上的锚固元件。在图4所示的例子中，三个锚固元件1、1′、1″通过例如两个环形弹性环50、51相连，以稳定脊柱的两个运动段。
第二实施例与第一实施例相同的那些部分用相同的附图标记表征。其描述也不再重复。接纳部3具有与结合在一起的两个U形凹部相似的凹部40。因此，凹部40的底部41具有两个部分圆柱形部分41a、41b，这两个部分彼此邻近使得两个环50、51可以分离地容纳在部分41a、41b中。第一压力元件18′与第一实施例的第一压力元件18的不同之处在于，在第二实施例中有两个相邻的圆柱形凹部20a、20b而不是单个圆柱形凹部20来接纳两个分离的环50、51。因此，第二压力元件22′在其面向第一压力元件的一侧上具有两个分离的圆柱形凹部23a、23b而不是单个圆柱形凹部，以便覆盖和包住两个环50、51。
使用中，锚固骨锚固元件以及插入环的步骤与第一实施例相同。但是在本实施例中，可以连接不止两个骨锚固装置，如图4所示。如果要连接三个骨锚固装置，则中心骨锚固装置1′接纳两个环。这样，可以通过使用每个运动段所需的合适的环来连接脊柱的多个运动段。如果要稳定不止两个相邻的椎骨，则可以使定位在链的相应端处的骨螺钉的接纳部适合于容纳仅一个环，如图1-3所示。该模块系统允许使动态稳定装置正好适合于相应的运动段。该系统易于操作，原因是外科医生只需要选择适当的环并将其插入到接纳部并固定它。甚至可以使用常规的多轴线骨螺钉。除了常规装置外，仅需要提供适于接纳环的第一和第二压力元件和环自身。
在另一实施例中，可以增加弹性阻尼器(未示出)，其围绕环的至少一条长边以在环可以更大程度地挠曲的情况下维持接纳部3之间的距离。
本发明可以有变型。环不必具有圆形横截面。它可以是卵形、矩形或方形横截面或其它形状的横截面。环也可以具有在边的长度上特别是长边的长度上变化的横截面。另外，外形不必为如图所示的矩形，也可以是卵形，或者可以具有其它形状。环可以是高度挠性的或者几乎不可挠曲。表面不必是光滑的，它可以是织地粗糙的或结构化的。
图8示出了环形弹性环的第二实施例。环500包括第一闭合环部分501和第二闭合环部分502，它们通过直线部分503相连。环500通过第一和第二闭合环部分501和502与骨螺钉的相应的接纳部相连。它由弹性材料制成。在变型中，仅直线部分503为弹性的，而闭合环部分501和502为刚性的。环500还可以具有加强结构以防止磨损。
图9和图10示出了图1-4所示的环5、50、51的另一变型。环550包括两个末端部分551和552和中心部分553，该中心部分由通过套筒554画在一起的两条长边形成。因此，环550类似于图8所示的具有两个闭合环末端部分501和502的环500。套筒554可以由弹性材料制成。
环不必紧紧地夹在第一和第二压力元件之间，环可以松散地保持在第一和第二压力元件之间。在另一变型中，第一和/或第二压力元件的圆柱形凹部可以具有突起，该突起优选地横向于圆柱轴线延伸。突起可以挤压到环的表面上，使得环的材料流动，从而产生强制结合连接。对于内螺钉，所有已知的变型都可以使用。这也包括使用外环或螺母。
在上述实施例中，螺钉从顶部引入到接纳部3中。但是，如果接纳部被构造成允许螺钉也可以从接纳部的底部引入。
在另一变型中，接纳部3和茎秆2刚性地连接，从而呈现出单轴线螺钉。在这种情况下，第一压力元件可以省略。在另一变型中，第二压力元件也可以省略。在另一变型中，凹部4、40可以不开在接纳部的顶部而是开在侧边。
本发明不限于螺钉作为骨锚固元件，而是可以利用骨钩或任何其它骨锚固元件实现。

Claims (17)

1.一种用于骨头或椎骨的动态稳定装置，包括：
至少两个骨锚固元件(1；1′；1″)，
至少一个连接元件(5；50；51)，其连接所述骨锚固元件，
所述骨锚固元件具有要锚固在骨头或椎骨中的茎秆部(2)和要与所述连接元件(5；50；51)相连的头部部分(3；3′)，其中，所述连接元件(5；50；51)至少部分地是弹性的并具有至少一个环部分，并且所述头部部分(3；3′)包括具有用于插入所述环部分的开口的凹部(4；40)，并且固定元件(6)被设置用于将所述环部分固定在所述凹部中。
2.根据权利要求1所述的动态稳定装置，其特征在于，所述连接元件(5；50；51)为优选地由弹性体材料制成的环形环。
3.根据权利要求1或2所述的动态稳定装置，其特征在于，所述凹部(4；40)具有包括内螺纹(17)的内壁，所述固定元件(6)为拧入到所述凹部(4；40)中的螺钉。
4.根据权利要求1-3之一所述的动态稳定装置，其特征在于，在所述固定元件(6)和所述环部分(5；50；51)之间设置有压力元件(22；22′)，以通过固定元件(6)的作用将压力施加到环部分(5；50；51)上。
5.根据权利要求1-4之一所述的动态稳定装置，其特征在于，所述凹部(4)被定形而用于容纳单个环部分(5)。
6.根据权利要求1-4之一所述的动态稳定装置，其特征在于，所述凹部(40)被定形而用于容纳至少两个环部分(50；51)。
7.根据权利要求1-6之一所述的动态稳定装置，其特征在于，所述茎秆部(2)和所述头部部分刚性地相连。
8.根据权利要求1-6之一所述的动态稳定装置，其特征在于，所述茎秆部(2)和所述头部部分(3；3′)可枢转地相连。
9.根据权利要求8所述的动态稳定装置，其特征在于，所述茎秆部(2)具有被可枢转地保持在所述头部部分(3；3′)中的球形头部(7)。
10.根据权利要求8或9所述的动态稳定装置，其特征在于，设有第一压力元件(18；18′)和第二压力元件(22；22′)，所述第一压力元件和第二压力元件包住凹部(4；40)中的环部分(5；50；51)并且可在凹部中滑动，使得当通过固定元件(6)施加压力时，茎秆的角位置被锁定。
11.根据权利要求9或10所述的动态稳定装置，其特征在于，所述第一压力元件(18；18′)将压力施加在球形头部(7)上。
12.根据权利要求1-11之一所述的动态稳定装置，其特征在于，所述环部分的横截面大体为圆形。
13.根据权利要求1-12之一所述的动态稳定装置，其特征在于，所述连接元件(5；50；51)在未加应力的条件下连接至两个骨锚固元件(1；1′；1″)。
14.根据权利要求1-13之一所述的动态稳定装置，其特征在于，所述凹部(4；40)为大体U形。
15.根据权利要求1-14之一所述的动态稳定装置，其特征在于，所述头部部分(3；3′)穿透环部分的内部空间。
16.根据权利要求1-15之一所述的动态稳定装置，其特征在于，所述连接元件为单个环(5；50；51)。
17.根据权利要求1-15之一所述的动态稳定装置，其特征在于，所述连接元件为具有两个闭合环部分(501，502；551，552)和位于其间的中心部分(503；553)的双环(500；550)。
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KR101277771B1 (ko) 2013-06-24
US20070225708A1 (en) 2007-09-27
EP1800614B1 (en) 2009-02-25
US8979902B2 (en) 2015-03-17
KR20070066892A (ko) 2007-06-27
DE602005012980D1 (de) 2009-04-09
EP1800614A1 (en) 2007-06-27
US20120283779A1 (en) 2012-11-08
ES2323008T3 (es) 2009-07-03
TW200726430A (en) 2007-07-16
ES2371701T3 (es) 2012-01-09
CN1985771B (zh) 2013-10-02
EP2055251A1 (en) 2009-05-06
US8192468B2 (en) 2012-06-05
JP2007167658A (ja) 2007-07-05
JP5260869B2 (ja) 2013-08-14
TWI379660B (en) 2012-12-21
EP2055251B1 (en) 2011-08-17

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