DE19816832C1 - Surgical vertebral implant - Google Patents
Surgical vertebral implantInfo
- Publication number
- DE19816832C1 DE19816832C1 DE19816832A DE19816832A DE19816832C1 DE 19816832 C1 DE19816832 C1 DE 19816832C1 DE 19816832 A DE19816832 A DE 19816832A DE 19816832 A DE19816832 A DE 19816832A DE 19816832 C1 DE19816832 C1 DE 19816832C1
- Authority
- DE
- Germany
- Prior art keywords
- bearing
- implant according
- bearing body
- core
- implant
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
- A61F2/446—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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-
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
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- A61F2/02—Prostheses implantable into the body
- A61F2/28—Bones
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2002/30199—Three-dimensional shapes
- A61F2002/30224—Three-dimensional shapes cylindrical
- A61F2002/30225—Flat cylinders, i.e. discs
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- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30354—Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
- A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
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- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
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Abstract
Description
Die Erfindung betrifft ein in den Zwischenwirbelraum einführbares Wirbelkörperfusionsimplantat mit Anlage flächen für benachbarte Wirbelkörper.The invention relates to an in the intervertebral space insertable vertebral body fusion implant with attachment surfaces for neighboring vertebral bodies.
Derartige Implantate sind beispielsweise in der EP 260 044 B1, in der WO 92/14423, in der WO 97/0054 oder in der DE 43 23 956 C1 beschrieben. All diesen Implan taten ist gemein, daß sie nach Entfernung der geschä digten Bandscheibe in den Zwischenwirbelraum eingeführt werden können und dann durch Entfernung der Anlageflä chen voneinander die benachbarten Wirbelkörper ausein anderdrücken. Dabei liegen die Anlageflächen im wesent lichen flächig an den Wirbelkörperflächen an, jede Be wegung der Anlageflächen des Implantates führt damit auch zu einer Verschiebung der Wirbelkörper gegeneinan der und zu einer Aufweitung des Zwischenwirbelraumes.Such implants are for example in the EP 260 044 B1, in WO 92/14423, in WO 97/0054 or described in DE 43 23 956 C1. All this implan acts is common that after the removal of the business inserted intervertebral disc in the intervertebral space can be and then by removing the investment separate the neighboring vertebrae press on. The contact areas are essentially lichen flat on the vertebral body surfaces, each Be movement of the contact surfaces of the implant also to shift the vertebrae towards each other and to widen the intervertebral space.
In der WO 97/15246 ist ein Zwischenwirbelimplantat be schrieben, das aus einem Käfig und einem Rotationskör per besteht. Der Rotationskörper ist mit einem Schrau bengewinde versehen und dient dazu, das gesamte Implan tat durch Verdrehung gegenüber dem Käfig in den Zwi schenwirbelraum einzuschrauben. Die Anlageflächen haben bei diesem Implantat immer einen konstanten Abstand voneinander, so daß der Zwischenwirbelraum aufgeweitet werden muß, um das Implantat einschieben zu können.In WO 97/15246 an intervertebral implant is wrote that from a cage and a rotating body per exists. The rotating body is with a screw threaded and serves the entire implan did by twisting the cage in the twos screw in vertebrae. The contact areas have with this implant always a constant distance from each other, so that the intervertebral space widens must be in order to insert the implant.
Es ist Aufgabe der Erfindung, ein gattungsgemäßes Wir belkörperfusionsimplantat zu schaffen, das in einfacher Weise in den Zwischenwirbelraum einschiebbar und dort festlegbar ist.It is an object of the invention, a generic We belbody fusion implant to create that in easier Insertable in the intervertebral space and there is definable.
Diese Aufgabe wird bei einem Wirbelkörperfusionsimplan tat der eingangs beschriebenen Art erfindungsgemäß da durch gelöst, daß an einem Rahmen des Wirbelkörperfu sionsimplantates mindestens ein Lagerkörper drehbar ge lagert ist, der mindestens eine exzentrisch zu seiner Drehachse verlaufende Stützrippe trägt, und daß die Stützrippe in einer Einschubstellung des Lagerkörpers minimal nach außen aus dem Wirbelkörperfusionsimplantat hervorsteht und in einer Stützstellung maximal aus die sem hervortritt.This task is done with a vertebral fusion implant did the type described above according to the invention solved by that on a frame of the vertebral body sionsimplantates at least one bearing body rotatable ge is at least one who is eccentric to his Supporting axis extending support rib, and that the Support rib in an inserted position of the bearing body minimally outwards from the vertebral body fusion implant protrudes and in a support position from the maximum this emerges.
Durch eine solche Ausgestaltung ist es möglich, das Wirbelkörperfusionsimplantat in einer Stellung des oder der Lagerkörper in den Zwischenwirbelraum einzuschie ben, in denen Stützrippen nur allenfalls minimal aus dem Implantat hervorstehen, so daß der Zwischenwirbel raum beim Einschieben nicht besonders aufgeweitet oder gar ausweitend bearbeitet werden müßte. Nach dem Ein schieben des Implantates werden die Stützrippen durch Verdrehung des entsprechenden Lagerkörpers aus dem Im plantat ausgefahren, wobei sie sich durch ihre Ausbil dung als Rippe in das Material der benachbarten Wirbel körper eingraben können. Dieses Eingraben wird insbe sondere dadurch gefördert, daß die schmalen Stützrippen beim Verdrehen der Lagerkörper nicht nur in der Verbin dungsrichtung der benachbarten Wirbelkörper bewegt wer den, sondern auch in Umfangsrichtung der Rippen, so daß sie sich durch diese Bewegung stetig in das Knochenma terial der Wirbelkörper eingraben können.With such a configuration, it is possible Vertebral fusion implant in one position of the or insert the bearing body into the intervertebral space ben, in which support ribs are minimal at best protrude from the implant so that the intervertebral vertebra not particularly widened when inserted or would even have to be expanded. After the one the support ribs are pushed through Rotation of the corresponding bearing body from the Im extended plantat, whereby it stands out through its training as a rib in the material of the neighboring vertebrae can bury bodies. This burial is particularly promoted in particular that the narrow support ribs when rotating the bearing body not only in the connector direction of movement of the neighboring vertebral body the, but also in the circumferential direction of the ribs, so that through this movement they are steadily into the bone dimension material of the vertebral body can dig.
Sobald die Lagerkörper in der Stützstellung stehen, sind die Rippen vollständig in die benachbarten Wirbel körper eingedrungen, so daß einerseits eine Stützfunk tion in Wirbelsäulenlängsrichtung gegeben ist, anderer seits ist das Implantat gegen eine Verschiebung quer zur Wirbelsäulenlängsrichtung optimal gesichert. As soon as the bearing bodies are in the support position, the ribs are completely in the adjacent vertebrae body penetrated, so that on the one hand a support radio is given in the longitudinal direction of the spine, others on the one hand, the implant is transverse against displacement optimally secured to the longitudinal direction of the spine.
Grundsätzlich würde es genügen, wenn ein Lagerkörper nur eine derartige Stützrippe trägt, es ist jedoch bei einer bevorzugten Ausführungsform vorgesehen, daß der Lagerkörper nebeneinander im Abstand zueinander mehrere Stützrippen trägt, die in gleicher Weise exzentrisch zur Drehachse des Lagerkörpers verlaufen. Diese Viel zahl von Stützrippen wirkt insgesamt als Anlage- oder Stützfläche, so daß durch die Stützrippen nicht nur die Festlegung in axialer Richtung gesichert wird, sondern auch eine Stützfunktion übernommen wird, wobei diese Stützfläche durch das Ausfahren der Stützrippen in ih rer wirksamen Lage gegenüber dem Implantat verschiebbar ist.Basically, it would be sufficient if a bearing body only carries such a support rib, but it is a preferred embodiment provided that the Bearing bodies next to each other at a distance from each other Support ribs that are eccentric in the same way run to the axis of rotation of the bearing body. This much Total number of support ribs acts as an investment or Support surface, so that not only the Fixing is secured in the axial direction, but a support function is also assumed, this Support surface by extending the support ribs in ih rer effective position relative to the implant is.
Bei einer bevorzugten Ausführungsform kann vorgesehen sein, daß jede Stützrippe durch die Außenkante einer Scheibe gebildet wird, die drehfest mit dem Lagerkörper verbunden ist.In a preferred embodiment can be provided be that each support rib through the outer edge of a Washer is formed, which rotatably with the bearing body connected is.
Insbesondere kann diese Scheibe kreisförmig ausgebildet und exzentrisch mit dem Lagerkörper verbunden sein.In particular, this disc can be circular and be connected eccentrically to the bearing body.
Während üblicherweise alle Stützrippen eines Lagerkör pers in ihrer Dimensionierung und Anordnung gleich aus gebildet sind, kann bei einer abgewandelten Ausfüh rungsform eines Lagerkörpers mit mehreren Stützrippen vorgesehen sein, daß der maximale Abstand der Stützrip pen von der Drehachse des Lagerkörpers über die Länge des Lagerkörpers verschieden ist, beispielsweise kann der maximale Abstand der Stützrippen von der Drehachse von der Mitte des Lagerkörpers zu seinen Enden hin ab nehmen. Dadurch ist es möglich, die Kontur der durch die Stützrippen gebildeten Stützfläche an die anatomi schen Gegebenheiten anzupassen, beispielsweise an die geometrische Form der Wirbelkörperendfläche.While usually all the support ribs of a bearing block pers equal in their dimensioning and arrangement are formed, with a modified version tion form of a bearing body with several support ribs be provided that the maximum distance of the support rip pen from the axis of rotation of the bearing body over the length of the bearing body is different, for example the maximum distance of the support ribs from the axis of rotation from the center of the bearing body towards its ends to take. This makes it possible to trace the contour through the support ribs formed support surface to the anatomi adapt to the circumstances, for example to the geometric shape of the vertebral end surface.
Die Stützrippen können grundsätzlich durch Scheiben gleicher Dicke gebildet werden, bei einer bevorzugten Ausführungsform ist jedoch vorgesehen, daß die Stütz rippen nach außen hin schmaler werden.The support ribs can in principle by discs same thickness are formed, with a preferred However, embodiment is provided that the support ribs become narrower towards the outside.
Die Stützrippen können in einer stumpfen Kante enden, so daß hier eine maximale Tragfunktion gewährleistet ist. In diesem Falle ist es vorteilhaft, wenn der be nachbarte Wirbelkörper für die Aufnahme einer solchen Stützrippe vorbereitet wird, beispielsweise durch eine Ausfräsung mit einem exzentrischen Fräser.The support ribs can end in a blunt edge, so that a maximum carrying function is guaranteed here is. In this case it is advantageous if the be neighboring vertebral bodies for the inclusion of such Support rib is prepared, for example by a Milling with an eccentric cutter.
Es kann aber bei einer anderen Ausführungsform auch vorgesehen sein, daß die Stützrippen eine scharfe Kante ausbilden, dadurch wird das Eingraben der Rippen in das Knochenmaterial der Wirbelkörper gefördert, die Stütz rippen schneiden sich somit selbst beim Verdrehen der Lagerkörper in das Knochenmaterial ein, so daß gegebe nenfalls eine Vorbereitung der Wirbelkörperendfläche entfallen kann.But it can also in another embodiment be provided that the support ribs have a sharp edge train, this will dig the ribs into the Bone material of the vertebral body encourages the support ribs cut themselves even when twisting the Bearing body in the bone material, so that given if necessary, prepare the end of the vertebral body can be omitted.
Bei einer besonders einfachen Ausgestaltung trägt ein Implantat lediglich einen einzigen Lagerkörper, so daß im eingesetzten Zustand das Implantat auf der einen Seite durch den Rahmen an einem Wirbelkörper abgestützt wird, auf der gegenüberliegenden Seite dagegen durch die ausgefahrenen Stützrippen. In a particularly simple embodiment, a Implant only a single bearing body, so that the implant on one side when inserted Side supported by the frame on a vertebral body on the opposite side the extended support ribs.
Bei einem abgewandelten Ausführungsbeispiel kann aber auch vorgesehen sein, daß an dem Rahmen diametral ge genüberliegend zwei Lagerkörper mit jeweils mindestens einer Stützrippe gelagert sind, diese Stützrippen kön nen dann nach diametral gegenüberliegenden Seiten aus gefahren werden.In a modified embodiment, however also be provided that on the frame diametrically ge opposite two bearing bodies with at least one each a support rib are mounted, these support ribs can then from diametrically opposite sides be driven.
Besonders vorteilhaft ist eine Ausführungsform, bei der vorgesehen ist, daß an dem Rahmen in Umfangsrichtung verteilt drei Lagerkörper mit jeweils mindestens einer Stützrippe gelagert sind. Bei einer solchen Ausgestal tung wird das Implantat im eingesetzten Zustand zusätz lich gegen eine seitliche Verkippung gesichert, da sich dann die Stützrippen von zwei Lagerkörpern an einem Wirbelkörper abstützen, die Stützrippen des dritten La gerkörpers am benachbarten Wirbelkörper.An embodiment in which it is provided that on the frame in the circumferential direction distributes three bearing bodies with at least one each Support rib are stored. With such a configuration tion, the implant becomes additional when inserted secured against lateral tilting because then the support ribs of two bearing bodies on one Support the vertebrae, the support ribs of the third La body on the adjacent vertebral body.
Bei einem Implantat mit mehreren Lagerkörpern kann je der Lagerkörper für sich verdrehbar sein, es kann bei einer bevorzugten Ausführungsform aber auch eine Kopp lung der Lagerkörper vorgesehen sein, durch die die La gerkörper gemeinsam verdrehbar sind. Dies ließe sich beispielsweise durch ein Zahnradgetriebe am Implantat realisieren.In the case of an implant with several bearing bodies, each the bearing body can be rotated by itself, it can be a preferred embodiment but also a Kopp ment of the bearing body through which the La body can be rotated together. This could be done for example by a gear mechanism on the implant realize.
Eine besonders kompakte Konstruktion eines Implantates mit mindestens zwei Lagerkörpern ergibt sich, wenn die Stützrippen eines Lagerkörpers in der Einschubstellung der Lagerkörper in Zwischenräume zwischen den Stützrip pen der anderen Lagerkörper eintauchen. Durch die in axialer Richtung versetzten Stützrippen der Lagerkörper können die Drehachsen der Lagerkörper relativ dicht einander angenähert werden, so daß ein Implantat mit geringer Bauhöhe herstellbar ist, das ohne Probleme in den Zwischenwirbelraum eingeführt werden kann.A particularly compact design of an implant with at least two bearing bodies results if the Support ribs of a bearing body in the inserted position the bearing body in spaces between the support rib Immerse the pen of the other bearing bodies. By in Support ribs of the bearing bodies offset in the axial direction the axes of rotation of the bearing body can be relatively tight are brought closer together so that an implant with low height can be produced, which without problems in the intervertebral space can be introduced.
Der Lagerkörper kann insbesondere eine Welle sein.The bearing body can in particular be a shaft.
Bei einer bevorzugten Ausführungsform ist vorgesehen, daß der Rahmen durch zwei voneinander unabhängige La gerelemente gebildet wird, von denen jedes Lageröffnun gen zur drehbaren Lagerung mindestens eines Lagerkör pers aufweist, und daß die Lagerkörper an ihren beiden Enden jeweils in einem der Lagerelemente um ihre Längs achse drehbar und axial unverschieblich gelagert sind. Die Lagerelemente können dabei eine relativ geringe axiale Ausdehnung haben, beispielsweise können sie auch scheibenförmig ausgebildet sein. Der gesamte Bereich zwischen den Lagerelementen bleibt also ausschließlich den Lagerkörpern mit den von ihnen getragenen Stützrip pen vorbehalten, in diesem Bereich sind keine störenden Verbindungselemente zwischen den Lagerelementen vorge sehen.In a preferred embodiment, that the frame by two independent La is formed, each of which bearing openings conditions for the rotatable mounting of at least one storage unit pers has, and that the bearing body on their two Each ends in one of the bearing elements around its length axis rotatable and axially immovable. The bearing elements can be relatively small have axial extension, for example they can also be disc-shaped. The whole area between the bearing elements thus remains exclusively the bearing bodies with the support rip worn by them pen reserved, in this area there are no disturbing Pre-connecting elements between the bearing elements see.
Bei einer bevorzugten Ausführungsform ist vorgesehen, daß an einem der Lagerelemente die Lageröffnungen zum Außenrand der Lagerelemente hin derart offen sind, daß der in ihnen gelagerte Lagerkörper radial nach außen verschiebbar ist. Dadurch wird einerseits die Fertigung vereinfacht, andererseits ergibt sich durch eine ge ringfügige radiale Verschiebung der Lagerkörper die Möglichkeit, Rastelemente zwischen die Lagerkörper ein zuschieben.In a preferred embodiment, that on one of the bearing elements, the bearing openings for The outer edge of the bearing elements are open in such a way that the bearing body stored in them radially outwards is movable. On the one hand, this means manufacturing simplified, on the other hand results from a ge slight radial displacement of the bearing body Possibility to insert locking elements between the bearing body push on.
Es ist vorteilhaft, wenn die Lagerelemente eine Durch brechung aufweisen, die einen Zugang in den Raum zwi schen den Lagerelementen freigibt. Durch diese Durch brechungen kann gegebenenfalls Knochenmaterial zur För derung der Durchwachsung eingefüllt werden.It is advantageous if the bearing elements have a through have refraction that gives access to the space between releases the bearing elements. Through this through If necessary, refractions can result in bone material change in the growth.
Bei einer besonders bevorzugten Ausführungsform ist vorgesehen, daß in den Zwischenraum durch die Durchbre chung hindurch ein Kern einschiebbar ist, wenn der oder die Lagerkörper in der Stützstellung stehen, wenn also zwischen den benachbarten Lagerkörpern durch die maxi mal ausgefahrenen Stützrippen Platz geschaffen wird.In a particularly preferred embodiment provided that in the space through the breakthrough a core can be inserted if the or the bearing bodies are in the support position, if so between the adjacent bearing bodies by the maxi times extended support ribs space is created.
Dabei kann vorgesehen sein, daß der Kern an den Stütz rippen des in der Stützstellung stehenden Lagerkörpers derart anliegt, daß ein Zurückdrehen des Lagerkörpers in die Einschubstellung verhindert wird. Der Kern bil det also einen Anschlag für die beiden Lagerkörper und fixiert diese in der ausgefahrenen Stützstellung.It can be provided that the core on the support rib the bearing body in the support position so that a turning back of the bearing body is prevented in the insertion position. The core bil det a stop for the two bearing bodies and fixes this in the extended support position.
Dabei kann sich der Kern insbesondere über einen Teil umfangsbereich der Stützrippen an diese anschließen.The core can in particular over a part Connect the circumferential area of the support ribs to them.
Günstig ist es, wenn der Kern in der Durchbrechung un verdrehbar gehalten ist. Dies ist beispielsweise durch eine entsprechende unrunde Form der Durchbrechung und des Kerns in diesem Bereich erreichbar.It is favorable if the core is in the opening is held rotatable. This is for example by a corresponding non-circular shape of the opening and of the core in this area.
Es ist weiterhin vorteilhaft, wenn an dem Kern Mittel zur axialen Festlegung des Kerns relativ zu den Lager körpern und den Lagerelementen vorgesehen sind, so daß sich der Kern nicht unbeabsichtigt in axialer Richtung verschieben kann. It is also advantageous if means are on the core for axially fixing the core relative to the bearing bodies and the bearing elements are provided so that the core does not accidentally move in the axial direction can move.
Beispielsweise können diese Mittel zur axialen Fest legung Vorsprünge sein, die in eine Vertiefung ein schnappen.For example, these means for axial fixation Projection be projections that are in a recess snap.
Besonders vorteilhaft ist es dabei, wenn die Mittel an dem Kern und an den Lagerkörpern derart angeordnet sind, daß sie den Kern relativ zu den Lagerkörpern nur festlegen, wenn die Lagerkörper in der Stützstellung stehen.It is particularly advantageous if the funds are on the core and arranged on the bearing bodies in this way are that they only have the core relative to the bearing bodies set when the bearing body in the support position stand.
Dies gilt insbesondere dann, wenn die Mittel die Lager körper gegenüber dem Kern auch gegen eine Drehung des Lagerkörpers sichern. Man erhält dann eine gegenseitige Verriegelung des Kerns und der Lagerkörper sowohl gegen eine axiale Verschiebung als auch gegen eine Verdrehung der Lagerkörper, und diese Verriegelung ist nur dann wirksam, wenn die Lagerkörper in der maximal ausgefah renen Stützstellung stehen.This is especially true when the funds are the stock body against the core also against rotation of the Secure the bearing body. You then get a mutual one Locking the core and the bearing body against both an axial displacement as well as against rotation the bearing body, and this lock is only there effective when the bearing body is in the maximum standing support position.
Der Kern kann einen die Einschubtiefe begrenzenden An schlag aufweisen, beispielsweise in Form eines seitlich abstehenden Flanschabschnittes.The core can have a type limiting the insertion depth have impact, for example in the form of a side projecting flange section.
Bei einer bevorzugten Ausführungsform ist vorgesehen, daß der Kern in seinem mittleren, zwischen die Stütz rippen eingeschobenen Abschnitt mindestens eine Durch brechung aufweist, insbesondere kann diese Durchbre chung ein sich in Längsrichtung des Kerns über den größten Teil seiner Länge erstreckendes Langloch sein. Diese Durchbrechung oder diese Durchbrechungen dienen der Aufnahme von Knochenmaterial und fördern die Durch wachsung des Implantates, der Kern kann nach Art einer Schublade mit Knochenmaterial gefüllt in den Zwischen raum zwischen die Lagerkörper eingeschoben werden.In a preferred embodiment, that the core in its middle, between the supports rib inserted section at least one through has refraction, in particular this breakthrough chung in the longitudinal direction of the core over the be an elongated hole for most of its length. This opening or these openings serve the absorption of bone material and promote the through growth of the implant, the core can be of the type Drawer filled with bone material in between be inserted between the bearing body.
Es ist vorteilhaft, wenn der Kern eine bei eingeschobe nem Kern außerhalb des Lagerelements angeordnete seit liche Vertiefung aufweist, beispielsweise in Form einer Umfangsnut. Diese Vertiefung dient dem Ansetzen eines Werkzeuges, mit dessen Hilfe der Kern aus dem Implantat herausgezogen werden kann.It is advantageous if the core is inserted at Nem arranged outside of the bearing element since Liche depression, for example in the form of a Circumferential groove. This deepening is used to start one Tool, with the help of which the core from the implant can be pulled out.
Weiterhin kann vorgesehen sein, daß die Lagerkörper stirnseitige Anlageflächen für ein die Lagerkörper ver drehendes Werkzeug aufweisen, beispielsweise können die Anlageflächen durch eine konzentrisch angeordnete, un runde Einstecköffnung für ein Werkzeug gebildet werden, etwa eine Sechskantöffnung.Furthermore, it can be provided that the bearing body frontal contact surfaces for a ver the bearing body have rotating tool, for example Contact surfaces by a concentrically arranged, un round insertion opening can be formed for a tool, about a hexagon opening.
Die nachfolgende Beschreibung bevorzugter Ausführungs formen der Erfindung dient im Zusammenhang mit der Zeichnung der näheren Erläuterung. Es zeigen:The following description of preferred embodiment forms of the invention is used in connection with the Drawing of the detailed explanation. Show it:
Fig. 1: eine perspektivische Ansicht eines Wir belkörperfusionsimplantates mit den La gerkörpern in Einschubstellung ohne eingeschobenen Kern; Fig. 1: a perspective view of a We belkörperfusionsimplantates with the La gerkörpern in insertion position without inserted core;
Fig. 2: eine Längsschnittansicht des Implantats der Fig. 1 mit den Lagerkörpern in Ein schubstellung; FIG. 2: a longitudinal sectional view of the implant of FIG. 1 with the bearing bodies in a push position;
Fig. 3: eine Ansicht des Implantats der Fig. 2 in Richtung des Pfeiles A; Fig. 3 is a view of the implant of Figure 2 in the direction of arrow A;.
Fig. 4: eine Schnittansicht längs Linie 4-4 in Fig. 2; Fig. 4 is a sectional view taken along line 4-4 in Fig. 2;
Fig. 5: eine perspektivische Ansicht des Im plantats der Fig. 1 mit den Lagerkör pern in Stützstellung und mit einem teilweise eingeschobenen Kern; Fig. 5: A perspective view of the implant of Figure 1 with the Lagerkör pern in support position and with a partially inserted core.
Fig. 6: eine perspektivische Ansicht des Kerns; Fig. 6 is a perspective view of the core;
Fig. 7: eine Ansicht ähnlich Fig. 2 mit den La gerkörpern in Stützstellung und mit eingeschobenem Kern; . Fig. 7 is a view similar to Figure 2 with the La gerkörpern in the support position and with inserted core;
Fig. 8: eine vergrößerte Detailansicht des Be reiches C in Fig. 7 bei einem Ausfüh rungsbeispiel mit scharfkantigen Rip pen; Fig. 8: an enlarged detail view of the loading area C in Figure 7 in an embodiment with sharp-edged ribs;
Fig. 9: eine Schnittansicht längs Linie 9-9 in Fig. 7; Fig. 9 is a sectional view taken along line 9-9 in Fig. 7;
Fig. 10: eine Ansicht des Implantats der Fig. 7 in Richtung des Pfeiles B; Fig. 10 is a view of the implant of Figure 7 in the direction of arrow B;.
Fig. 11: eine Ansicht ähnlich Fig. 7 bei einem Ausführungsbeispiel mit über die Länge des Lagerkörpers unterschiedlich ausge bildeten Stützrippen; Fig. 11 is a view similar to Figure 7, in one embodiment with the length of the bearing body differently formed support ribs;.
Fig. 12: eine Vorderansicht des Implantates der Fig. 11 im eingesetzten Zustand; FIG. 12: a front view of the implant of FIG. 11 in the inserted state;
Fig. 13: eine Ansicht ähnlich Fig. 11 bei einem Implantat mit nur einem Lagerkörper mit gleichartigen Stützrippen; FIG. 13: a view similar to FIG. 11 for an implant with only one bearing body with supporting ribs of the same type;
Fig. 14: eine Vorderansicht des Implantates der Fig. 13 im eingesetzten Zustand; FIG. 14: a front view of the implant of FIG. 13 in the inserted state;
Fig. 15: eine Seitenansicht eines abgewandelten Ausführungsbeispiels eines Implantates mit drei mit Stützrippen versehenen La gerkörpern und Fig. 15: a side view of a modified embodiment of an implant with three gerkörpern provided with support ribs and La
Fig. 16: eine Vorderansicht des Implantates der Fig. 15 im eingesetzten Zustand. FIG. 16: a front view of the implant of FIG. 15 in the inserted state.
Das in den Fig. 1 bis 10 dargestellte Wirbelkörper fusionsimplantat 1 weist zwei parallel zueinander ver laufende Lagerwellen 2 auf, die zwischen zwei Lagerele menten 3, 4 um ihre Längsachse verdrehbar gelagert sind.The vertebral body shown in Figs. 1 to 10 fusion implant 1 has two mutually parallel running ver bearing shafts 2, the elements between two Lagerele 3 are mounted to rotate about its longitudinal axis 4.
Das Lagerelement 3 ist scheibenförmig ausgebildet und weist zwei außermittig und bezüglich einer Radialebene des Lagerelementes 4 symmetrisch angeordnete Lageröff nungen 5 auf, die auf ihren einander abgewandten Seiten bis zum Außenrand 6 des Lagerelementes 3 hin offen sind, d. h. von den Lageröffnungen 5 geht jeweils ein von der anderen Lageröffnungen 5 weggerichteter radia ler Schlitz 7 aus (Fig. 3).The bearing element 3 is disc-shaped and has two eccentrically and with respect to a radial plane of the bearing element 4 symmetrically arranged bearing openings 5 , which are open on their sides facing away from one another up to the outer edge 6 of the bearing element 3 , that is, each of the bearing openings 5 goes from the other bearing openings 5 directed radia ler slot 7 from ( Fig. 3).
Im anderen Lagerelement 4, das ebenfalls scheibenförmig ausgebildet ist, sind entsprechend außermittig und sym metrisch zu einer Radialebene der Scheibe angeordnet zwei Lageröffnungen 8 vorgesehen, die jedoch geschlos sen sind.In the other bearing element 4 , which is also disc-shaped, two bearing openings 8 are provided eccentrically and symmetrically to a radial plane of the disc, but are closed.
Die Lagerwellen 2 durchsetzen diese Lageröffnungen 8 und sind an ihrem aus dem Lagerelement 4 hervorstehen den Ende 9 aufgeweitet, so daß das Lagerelement 4 auf den beiden Lagerwellen 2 unverlierbar festgelegt ist.The bearing shafts 2 pass through these bearing openings 8 and are extended at their end 9 protruding from the bearing element 4 , so that the bearing element 4 is captively fixed on the two bearing shafts 2 .
An ihrem gegenüberliegenden Ende 10 stehen beide Lager wellen 2 aus dem Lagerelement 3 hervor und tragen dort eine kopfförmige Verdickung 11, in die konzentrisch zur Drehachse der Lagerwellen 2 ein Innensechskant 12 ein gearbeitet ist, der zum Ende 10 hin offen ist. In die sen Innensechskant 12 kann ein Werkzeug eingesetzt wer den, so daß mittels dieses Werkzeuges die Lagerwellen 2 in den beiden Lagerelementen 3, 4 unabhängig voneinan der verdrehbar sind.At their opposite end 10 , both bearing shafts 2 protrude from the bearing element 3 and carry there a head-shaped thickening 11 , in which a hexagon socket 12 is worked concentrically to the axis of rotation of the bearing shafts 2 , which is open towards the end 10 . In the sen hexagon 12 a tool can be used who, so that by means of this tool, the bearing shafts 2 in the two bearing elements 3 , 4 can be rotated independently of one another.
Beide Lagerwellen 2 tragen eine Vielzahl von im gegen seitigen Abstand zueinander angeordneten, quer zur Drehachse der Lagerwellen 2 verlaufenden kreisförmigen Scheiben 13, wobei alle Scheiben 13 einer Lagerwelle 2 in gleicher Weise relativ zur Drehachse dieser Lager welle 2 exzentrisch angeordnet sind. Die Außenkanten 14 dieser Scheiben 13 bilden Stützrippen aus. Die Scheiben 13 haben relativ zur Ausdehnung der Lagerwelle 2 eine geringe axiale Erstreckung, so daß sich relativ schmale Außenkanten 14 ergeben. Diese können beispielsweise im Querschnitt rechteckförmig sein (Fig. 7), bei abgewan delten Ausführungsbeispielen kann sich die Dicke der Scheibe aber auch nach außen hin verringern, so daß scharfe Außenkanten 14 entstehen (Fig. 8). Both bearing shafts 2 carry a plurality of mutually spaced, transverse to the axis of rotation of the bearing shafts 2 extending circular discs 13 , all discs 13 of a bearing shaft 2 in the same way relative to the axis of rotation of this bearing shaft 2 are arranged eccentrically. The outer edges 14 of these disks 13 form support ribs. The disks 13 have a small axial extension relative to the extension of the bearing shaft 2 , so that relatively narrow outer edges 14 result. These can, for example, be rectangular in cross section ( FIG. 7), but in the case of modified embodiments, the thickness of the disk can also decrease towards the outside, so that sharp outer edges 14 are formed ( FIG. 8).
Die Scheiben 13 der beiden Lagerwellen 2 sind in axia ler Richtung so gegeneinander versetzt, daß die Schei ben der einen Lagerwelle 2 in die Zwischenräume 15 der Scheiben 13 der anderen Lagerwelle 2 eintauchen können.The discs 13 of the two bearing shafts 2 are offset from each other in axia ler direction that the ticket ben of a support shaft 2 in the spaces 15 of the discs 13 of the other bearing shaft 2 can plunge.
In einer ersten Winkelstellung der beiden Lagerwellen 2, bei der die Scheiben 13 mit ihrem in radialer Rich tung am weitesten vorstehenden Bereich in Richtung auf die jeweilige andere Lagerwelle 2 gerichtet sind, be finden sich die Lagerwellen 2 in einer sogenannten Ein schubstellung (Fig. 1 bis 4), in dieser Stellung weist das Wirbelkörperfusionsimplantat 1 eine minimale Bauhöhe auf. Die Scheiben 13 der beiden Lagerwellen 2 tauchen in die Zwischenräume 15 ein und können bis dicht an die jeweils andere Lagerwelle 2 heranreichen.In a first angular position of the two bearing shafts 2 , in which the disks 13 are directed with their most protruding region in the radial direction in the direction of the respective other bearing shaft 2 , the bearing shafts 2 are in a so-called an insert position ( FIG. 1 to 4), in this position the vertebral body fusion implant 1 has a minimal overall height. The disks 13 of the two bearing shafts 2 dip into the intermediate spaces 15 and can reach as close as possible to the other bearing shaft 2 .
Werden die Lagerwellen 2 um jeweils 180° verdreht, ra gen die Scheiben 13 mit ihren exzentrischen Außenkanten 14 maximal in radialer Richtung aus dem Wirbelkörper fusionsimplantat 1 hervor, so daß eine maximale Bauhöhe erzielt wird (Fig. 7 bis 10). Die nebeneinander an geordneten Außenkanten 14 bilden gemeinsam jeweils eine Anlagefläche für einen benachbarten Wirbelkörper, diese Anlagefläche besteht aus parallel zueinander verlaufen den Stützrippen.If the bearing shafts 2 are rotated by 180 ° in each case, ra discs 13 with their eccentric outer edges 14 protrude maximally in the radial direction from the vertebral fusion implant 1 , so that a maximum overall height is achieved ( FIGS. 7 to 10). The side edges 14 arranged side by side together each form a contact surface for an adjacent vertebral body, this contact surface consists of the support ribs running parallel to one another.
In beiden Lagerelementen 3, 4 ist zwischen den jeweili gen Lageröffnungen 5 bzw. 8 eine Durchbrechung 16 bzw. 17 angeordnet, diese Öffnungen haben bei dem darge stellten Ausführungsbeispiel die Form einer Hantel. Wenn die Lagerwellen 2 in ihrer Stützstellung stehen, kann durch die Durchbrechung 16 des Lagerelementes 3 ein Kern 18 zwischen die beiden Lagerwellen 2 einge schoben werden. Dieser Kern 18 weist einen Querschnitt auf, der dem der Durchbrechungen 16 und 17 entspricht, so daß der Kern 18 im eingeschobenen Zustand drehfest in den beiden Durchbrechungen 16 und 17 gehalten ist. Die Einschubtiefe wird durch seitlich vom Kern 18 ab stehende Flanschabschnitte 19 begrenzt, die am Lager element 3 zur Anlage kommen, und der Kern 18 wird in der eingeschobenen Lage in axialer Richtung dadurch festgelegt, daß radiale Vorsprünge 20 am Kern 18 in ra diale Vertiefungen 21 an der kopfförmigen Verdickung 11 der beiden Lagerwellen 12 eintauchen (Fig. 7). Die Vor sprünge 20 werden beispielsweise durch einen Stift 22 ausgebildet, der eine Querbohrung 23 im Kern 18 durch setzt, in dieser axial festgelegt ist und geringfügig über den Umfang des Kernes 18 hervorsteht. Die Vertie fungen 21 in der Verdickung 11 werden durch seitliche Bohrungen 24 gebildet, die in Umfangsrichtung so ange ordnet sind, daß die Vorsprünge 20 dann in die Vertie fungen 21 einrasten, wenn die Lagerwellen 2 in der voll ausgefahrenen Stützstellung stehen und wenn der Kern 18 vollständig eingeschoben ist.In both bearing elements 3 , 4 an opening 16 and 17 is arranged between the respective gene bearing openings 5 and 8 , these openings have the shape of a dumbbell in the Darge presented embodiment. When the bearing shafts 2 are in their supporting position, a core 18 can be inserted between the two bearing shafts 2 through the opening 16 of the bearing element 3 . This core 18 has a cross section which corresponds to that of the openings 16 and 17 , so that the core 18 is held in the inserted state in a rotationally fixed manner in the two openings 16 and 17 . The insertion depth is limited by laterally from the core 18 from standing flange sections 19 , which come to rest on the bearing element 3 , and the core 18 is fixed in the inserted position in the axial direction by radial projections 20 on the core 18 in ra diale recesses 21st immerse in the head-shaped thickening 11 of the two bearing shafts 12 ( FIG. 7). Before the jumps 20 are formed, for example, by a pin 22 which sets a transverse bore 23 in the core 18 , is axially fixed in this and protrudes slightly over the circumference of the core 18 . The recesses 21 in the thickening 11 are formed by lateral bores 24 which are arranged in the circumferential direction so that the projections 20 then engage in the recesses 21 when the bearing shafts 2 are in the fully extended support position and when the core 18th is fully inserted.
Durch den Eingriff der Vorsprünge 20 in die Vertiefun gen 21 wird nicht nur der Kern 18 in axialer Richtung festgelegt, sondern auch die beiden Lagerwellen 2 wer den gegen eine Drehung aus der Stützstellung heraus ge sichert.Through the engagement of the projections 20 in the recesses 21 not only the core 18 is fixed in the axial direction, but also the two bearing shafts 2 who secures the ge against rotation out of the support position.
Das Einschieben des Kernes 18 und das Einschnappen der Vorsprünge 20 in die Vertiefungen 21 wird im übrigen dadurch erleichtert, daß die Lagerwellen 2 im Bereich des Lagerelementes 3 durch die seitlich offenen Lager öffnungen 5 geringfügig in radialer Richtung ausweichen können.The insertion of the core 18 and the snapping of the projections 20 into the recesses 21 is further facilitated by the fact that the bearing shafts 2 in the bearing element 3 through the laterally open bearing openings 5 can dodge slightly in the radial direction.
Der Kern 18 legt sich im eingeschobenen Zustand mit seiner Oberseite 25 und seiner Unterseite 26 an die Außenkanten 14 der Scheiben 13 an und verhindert auch dadurch eine Verdrehung der beiden Lagerwellen 2 gegen einander. Die Oberseiten 25 und 26 sind dabei bogenför mig ausgebildet und in ihrem Radius an den Radius der Außenkante 14 angepaßt.The core 18 lies in the inserted state with its upper side 25 and its lower side 26 against the outer edges 14 of the disks 13 and thereby also prevents the two bearing shafts 2 from rotating against one another. The tops 25 and 26 are formed bogenför shaped and adapted in radius to the radius of the outer edge 14 .
Im Bereich zwischen den beiden Lagerelementen 3 und 4 weist der Kern 18 eine durchgehende, längliche Durch brechung 27 auf, die eine Verbindung zwischen den bei den Lagerwellen 2 und den von ihnen getragenen Schrei ben 13 ausbildet. Diese Durchbrechung 27 ist großflä chig ausgebildet und bildet somit eine Aufnahmekammer für Knochenmaterial.In the area between the two bearing elements 3 and 4 , the core 18 has a continuous, elongated opening 27 , which forms a connection between the ben 13 at the bearing shafts 2 and the cry carried by them. This opening 27 is large and thus forms a receiving chamber for bone material.
An die Flanschabschnitte 19 schließt sich zum Ende des Kerns 18 hin eine Umfangsnut 32 an, in die ein Werkzeug eingesetzt werden kann, mit dessen Hilfe der Kern 18 aus dem Wirbelkörperfusionsimplantat 1 herausgezogen werden kann.A peripheral groove 32 adjoins the flange sections 19 towards the end of the core 18 , into which a tool can be inserted, with the aid of which the core 18 can be pulled out of the vertebral body fusion implant 1 .
Das beschriebene Wirbelkörperfusionsimplantat 1 besteht vorzugsweise aus einem körperverträglichen Metall, bei spielsweise aus Titan oder aus einer Titan-Aluminium legierung.The described vertebral body fusion implant 1 preferably consists of a body-compatible metal, for example made of titanium or a titanium-aluminum alloy.
Dieses Implantat wird in einen Zwischenwirbelraum 28 eingesetzt, aus dem vorher die Bandscheibe entfernt worden ist. Diese Entfernung kann beispielsweise mit der Methode der perkutanen Bandscheibenchirurgie erfol gen (H. Leu und A. Schreiber, Diskoskopie in Arthrosko pie, 1993/6:, Seiten 3-9). Bei dieser Operations methode wird die Bandscheibe durch eine dorso-lateral eingeführte Arbeitshülse entfernt, und diese Arbeits hülse kann auch zum Einsetzen des beschriebenen Implan tates Verwendung finden. Dies ist möglich, weil das Im plantat bei in Einschubstellung stehenden Lagerkörpern sehr geringe Außenabmessungen hat, beispielsweise einen Außendurchmesser unter 10 mm, so daß das Implantat in Längsrichtung durch die Arbeitshülse bis in den Zwi schenwirbelraum vorgeschoben werden kann, der im übri gen dazu auch nicht oder nur geringfügig aufgeweitet werden muß.This implant is inserted into an intervertebral space 28 from which the intervertebral disc has previously been removed. This removal can take place, for example, with the method of percutaneous intervertebral disc surgery (H. Leu and A. Schreiber, Discoskopie in Arthrosko pie, 1993/6 :, pages 3-9). In this method of operation, the intervertebral disc is removed through a dorso-laterally inserted working sleeve, and this working sleeve can also be used to insert the described implant. This is possible because the implant has very small external dimensions when the bearing bodies are in the inserted position, for example an outer diameter of less than 10 mm, so that the implant can be advanced in the longitudinal direction through the working sleeve into the intervertebral space, which also does not apply to the rest or only needs to be expanded slightly.
Nach dem Einführen des Implantates in den Zwischenwir belraum 28 werden die beiden Lagerwellen 2 durch ein ebenfalls durch eine solche Arbeitshülse hindurch ein geführtes Werkzeug, das in den Innensechskant 12 einge setzt wird, verdreht. Bei dieser Verdrehung gelangen die Stützrippen bildenden Außenkanten 14 der Scheiben 13 an den dem Zwischenwirbelraum 28 benachbarten Wir belkörpern 29, 30 zur Anlage und graben sich bei weite rer Verdrehung in diese Wirbelkörper 29 und 30 ein, wo bei das Eingraben einmal durch die Ausbildung der Aus senkanten 14 als schmale Rippe oder gar scharfe Kante unterstützt wird, zum anderen aber auch durch die Bewe gung dieser Außenkante 14 in Umfangsrichtung. Die Aus senkanten 14 schneiden sich dadurch in das Knochenmate rial ein, ohne daß die Wirbelkörper 29 und 30 in ihrem Abstand wesentlich verschoben werden. After insertion of the implant into the intermediate space 28 , the two bearing shafts 2 are rotated by a tool which is also guided through such a working sleeve and which is inserted into the hexagon socket 12 . During this rotation, the outer ribs 14 of the disks 13 forming the supporting ribs come to rest on the vertebral space 28 adjacent to the vertebral bodies 29 , 30 and dig into wider vertebral bodies 29 and 30 , where the digging occurs once through the formation of the off vertical edges 14 is supported as a narrow rib or even a sharp edge, but also by moving this outer edge 14 in the circumferential direction. From the cut edges 14 cut into the bone material rial without the vertebral bodies 29 and 30 being significantly displaced in their distance.
Sobald die Lagerwellen 2 in ihrer Stützstellung stehen, also gegenüber der Einschubstellung um 180° verdreht, wird ebenfalls durch die Arbeitshülse hindurch der Kern 18 in das Implantat eingeschoben, bis die Vorsprünge 20 in die Vertiefungen 21 einrasten. Der Kern 18 wird vor dem Einschieben im Bereich seiner Durchbrechung 27 mit Knochenmaterial gefüllt, so daß der Kern 18 wie eine mit Knochenmaterial gefüllte Schublade in den Zwischen raum zwischen die Lagerwellen 2 eingeschoben wird.As soon as the bearing shafts 2 are in their supporting position, that is to say rotated by 180 ° with respect to the insertion position, the core 18 is likewise inserted through the working sleeve into the implant until the projections 20 snap into the recesses 21 . The core 18 is filled with bone material before insertion in the area of its opening 27 , so that the core 18 is inserted like a drawer filled with bone material into the space between the bearing shafts 2 .
Es ist durchaus möglich, in einen Zwischenwirbelraum 28 zwei derartige Implantate 1 einzusetzen, wobei diese Implantate dann insbesondere bei dem Einbringen durch eine dorso-lateral verlaufende Arbeitshülse im Zwi schenwirbelraum im Winkel zueinander angeordnet sind.It is entirely possible to use two such implants 1 in an intervertebral space 28 , these implants then being arranged at an angle to one another, in particular when introduced through a dorso-lateral working sleeve in the intervertebral space.
Grundsätzlich ist es nicht notwendig, die Wirbelkörper 29 und 30 für die Aufnahme des beschriebenen Implanta tes besonders vorzubereiten. Es kann aber durchaus vor gesehen werden, daß die Wirbelkörper 29 und 30 im Anla gebereich der Außenkanten 14 vor dem Einsetzen des Im plantates geringfügig bearbeitet werden, beispielsweise mit Hilfe eines Fräskopfes, wie er in der angegebenen Literaturstelle H. Leu und A. Schreiber in Abb. 4 dargestellt ist. Es handelt sich dabei um einen exzen trisch abrasiven Fräser, mit dem in die einander zuge wandten Endflächen der Wirbelkörper 29 und 30 vor dem Einbringen des Implantates 1 im Querschnitt bogenförmi ge Kanäle eingefräst werden, deren Durchmesser vorzugs weise geringer ist als die Bewegungsbahn 31 der am wei testen von der Drehachse der Lagerwelle 2 entfernten Abschnitte der Außenkante 14 der Scheiben 13 (Fig. 10), so daß sichergestellt ist, daß bei eingesetztem Implan tat die Außenkanten 14 weiterhin in das Material der Wirbelkörper 29 und 30 eindringen.Basically, it is not necessary to prepare the vertebral bodies 29 and 30 especially for the inclusion of the described implant. But it can be seen before that the vertebral bodies 29 and 30 in the bearing area of the outer edges 14 are slightly processed before the implantation is inserted, for example with the aid of a milling head, as described in the literature reference H. Leu and A. Schreiber in Fig. 4 is shown. It is an eccentrically abrasive milling cutter, with which in the mutually facing end faces of the vertebral bodies 29 and 30 before the implant 1 is milled in cross-section bogenformi channels, the diameter of which is preferably less than the path of motion 31 of the White test portions of the outer edge 14 of the disks 13 ( FIG. 10) removed from the axis of rotation of the bearing shaft 2 , so that it is ensured that when the implant was inserted the outer edges 14 continued to penetrate into the material of the vertebral bodies 29 and 30 .
Im Ausführungsbeispiel der Fig. 11 und 12 ist ein ähnliches Implantat dargestellt wie in den Fig. 1 bis 10, einander entsprechende Teile tragen daher die selben Bezugszeichen. Während bei dem Ausführungsbei spiel der Fig. 1 bis 10 die auf einem Lagerkörper getragenen Scheiben 13 gleich ausgebildet sind, so daß die Außenkanten 14 der Scheiben 13 gemeinsam eine kreiszylindrische Außenfläche definieren, sind die Durchmesser der Scheiben 13 beim Ausführungsbeispiel der Fig. 11 und 12 bei jeder Lagerwelle 2 über deren Länge unterschiedlich, und zwar in diesem Falle in der Form, daß der Durchmesser der Scheiben 13 in der Mitte des Lagerkörpers am größten ist und zu beiden Enden hin abnimmt. Es ergibt sich damit eine durch die Außenkan ten 14 aufgespannte Hüllfläche, die in der Mitte des Implantates weiter vom Implantat entfernt ist als an dessen Enden. Damit ist es möglich, diese Hüllkurve an die anatomischen Gegebenheiten anzupassen, beispiels weise an die geometrische Form der Wirbelkörperendflä chen.In the exemplary embodiment in FIGS. 11 and 12, an implant similar to that in FIGS. 1 to 10 is shown, parts which correspond to one another therefore have the same reference symbols. While in the Ausführungsbei of Figure 1 play. To 10, supported on a bearing body disks 13 of the same design, so that the outer edges 14 of the discs 13 together define a circular cylindrical outer surface, the diameter of the discs 13 in the embodiment of Figs. 11 and 12 with each bearing shaft 2 over its length, in this case in the form that the diameter of the disks 13 is largest in the center of the bearing body and decreases towards both ends. This results in an envelope surface spanned by the outer edges 14 , which is further away from the implant in the middle of the implant than at its ends. This makes it possible to adapt this envelope to the anatomical conditions, for example to the geometric shape of the vertebral end surfaces.
Bei dem Ausführungsbeispiel der Fig. 13 und 14 ist wieder ein ähnlicher Gesamtaufbau des Implantates ge wählt wie beim Ausführungsbeispiel der Fig. 1 bis 10, entsprechende Teile tragen daher auch hier diesel ben Bezugszeichen.In the embodiment of FIGS. 13 and 14, a similar overall structure of the implant is again selected as in the embodiment of FIGS. 1 to 10, corresponding parts therefore have the same reference numerals here as well.
Im Unterschied zu dem Ausführungsbeispiel der Fig. 1 bis 10 ist bei diesem Implantat lediglich eine einzige Lagerwelle 2 mit entsprechenden Scheiben 13 vorgesehen, so daß die Außenkanten 14 nur nach einer Seite aus dem Implantat ausgefahren werden können. Um hier eine flä chige Abstützung des Implantates auf der der Lagerwelle 2 gegenüberliegenden Seite zu ermöglichen, sind die La gerelemente 3 und 4 dort abgeflacht (Fig. 14).In contrast to the exemplary embodiment of FIGS. 1 to 10, only a single bearing shaft 2 with corresponding disks 13 is provided in this implant, so that the outer edges 14 can only be extended out of the implant on one side. In order to enable a flat support of the implant on the side opposite the bearing shaft 2 , the bearing elements 3 and 4 are flattened there ( FIG. 14).
Im Gegensatz dazu weist das Implantat der Fig. 15 und 16, das bei im wesentlichen ähnlichem Aufbau auch hier mit den gleichen Bezugszeichen gekennzeichnet ist, im Implantat drei Lagerwellen 2 mit entsprechenden Scheiben 13 auf, die in Umfangsrichtung jeweils um 120° gegeneinander versetzt an den Lagerelementen 3 und 4 gelagert sind. Es ist daher möglich, beim Ausfahren der Scheiben 13 an einem Wirbelkörper das Implantat über zwei Anlagebereiche abzustützen, so daß eine Verdrehung oder Verkippung des Implantates im Zwischenwirbelraum mit Sicherheit vermieden wird. Selbstverständlich wird bei einer solchen Ausführungsform der zwischen die La gerelemente 3 und 4 eingeschobene Kern 18 in seiner Querschnittsform daran angepaßt, daß in diesem Implan tat drei Lagerwellen 2 gelagert sind, beispielsweise kann dieser Kern einen sternförmigen Querschnitt erhal ten, wie dies in Fig. 16 dargestellt ist.In contrast to this, the implant of FIGS. 15 and 16, which is also identified by the same reference numerals in the case of a substantially similar structure, has three bearing shafts 2 with corresponding disks 13 in the implant, each of which is offset in the circumferential direction by 120 ° relative to the Bearing elements 3 and 4 are stored. It is therefore possible, when the disks 13 are extended on a vertebral body, to support the implant via two contact areas, so that twisting or tilting of the implant in the intervertebral space is avoided with certainty. Of course, will be adapted in such an embodiment the gerelemente between the La 3 and 4 inserted core 18 in its cross-sectional shape thereto, that in this Implan did three bearing shafts 2 stored are, for example, this core may th a star-shaped cross-section sustainer as shown in Fig. 16 is shown.
Claims (32)
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DE29806833U DE29806833U1 (en) | 1998-04-16 | 1998-04-16 | Vertebral fusion implant |
DE19816832A DE19816832C1 (en) | 1998-04-16 | 1998-04-16 | Surgical vertebral implant |
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DE29806833U DE29806833U1 (en) | 1998-04-16 | 1998-04-16 | Vertebral fusion implant |
DE19816832A DE19816832C1 (en) | 1998-04-16 | 1998-04-16 | Surgical vertebral implant |
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DE29806833U Expired - Lifetime DE29806833U1 (en) | 1998-04-16 | 1998-04-16 | Vertebral fusion implant |
DE19816832A Expired - Fee Related DE19816832C1 (en) | 1998-04-16 | 1998-04-16 | Surgical vertebral implant |
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DE29806833U Expired - Lifetime DE29806833U1 (en) | 1998-04-16 | 1998-04-16 | Vertebral fusion implant |
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EP1210920A1 (en) * | 2000-02-02 | 2002-06-05 | Chih-I Lin | Spinal fixation and retrieval device having side pieces |
FR2846876A1 (en) * | 2002-11-12 | 2004-05-14 | Hassan Razian | Intervertebral cage with median anchoring strip comprises block and pivot with two fins rotating in drilling and groove in block |
WO2004062535A2 (en) * | 2003-01-14 | 2004-07-29 | Michael Lococo | Bone implant and device for forming a socket for same |
WO2004103226A2 (en) * | 2003-05-21 | 2004-12-02 | Aesculap Ag & Co. Kg | Vertebral column implant |
DE10361166A1 (en) * | 2003-12-22 | 2005-07-28 | Meisel, Jörg, Dr. | Component for a prosthesis, especially a cervica vertebra, comprises two base parts coupled together by a hinge |
US7655045B2 (en) | 2003-05-06 | 2010-02-02 | Aesculap Implant Systems, Llc | Artificial intervertebral disc |
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US9233011B2 (en) | 2006-09-15 | 2016-01-12 | Pioneer Surgical Technology, Inc. | Systems and apparatuses for inserting an implant in intervertebral space |
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