DE3922044A1 - Treatment of fractured vertebra - by instrument which avoids any force on intact adjacent to vertebrae - Google Patents

Treatment of fractured vertebra - by instrument which avoids any force on intact adjacent to vertebrae

Info

Publication number
DE3922044A1
DE3922044A1 DE19893922044 DE3922044A DE3922044A1 DE 3922044 A1 DE3922044 A1 DE 3922044A1 DE 19893922044 DE19893922044 DE 19893922044 DE 3922044 A DE3922044 A DE 3922044A DE 3922044 A1 DE3922044 A1 DE 3922044A1
Authority
DE
Germany
Prior art keywords
characterized
instrumentation according
tube
threaded rod
fractured vertebra
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.)
Granted
Application number
DE19893922044
Other languages
German (de)
Other versions
DE3922044C2 (en
Inventor
Matthias Dr Richter-Turtur
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
RICHTER TURTUR MATTHIAS DR
Original Assignee
RICHTER TURTUR MATTHIAS DR
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by RICHTER TURTUR MATTHIAS DR filed Critical RICHTER TURTUR MATTHIAS DR
Priority to DE19893922044 priority Critical patent/DE3922044C2/de
Publication of DE3922044A1 publication Critical patent/DE3922044A1/en
Application granted granted Critical
Publication of DE3922044C2 publication Critical patent/DE3922044C2/de
Anticipated expiration legal-status Critical
Application status is Expired - Fee Related legal-status Critical

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/885Tools for expanding or compacting bones or discs or cavities therein
    • A61B17/8852Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc
    • A61B17/8858Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc laterally or radially expansible
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025Joint distractors

Abstract

The surgical instrument for treating a fractured vertebra consists of a spreader tube (2) with longitudinal slots. This spreader tube (2) is supported in an outer tube (1) which has an internal screw thread (4) at one end. A screwed spindle (3) with a knob (7) at its outer end engages the screw thread (4). The inner end of the screwed spindle is fitted with a cone. As the spindle (3) is rotated the cone is moved axially and expands the spreader tube which acts on the fractured vertebra (10). USE/ADVANTAGE - The surgical instrument for treating a fractured vertebra does not impose any force on the intact adjacent vertebrae.

Description

Die bisherigen Verfahren zur Behandlung von gebrochenen Wirbelkörpern beziehen die benachbarten Wirbelkörper mit ein. The previous method for the treatment of broken vertebrae relate the adjacent vertebral bodies with a. Die benutzten Instrumentarien sind auf diese Vorgehensweise abgestellt. The instruments used are geared to this approach. Die Einbeziehung von intakten Nachbarwirbeln ist jedoch nachteilig, da eine Schädigung derselben zu befürchten ist. However, the inclusion of the intact neighboring vertebrae is disadvantageous since damage to them is to be feared.

Aufgabe der vorliegenden Erfindung ist es, mit einem einfachen Instrumentarium eine Wiederaufrichtung gebrochener Wirbelkörper von dorsal zu erreichen, ohne dabei die intakten benachbarten Wirbelkörper einzubeziehen. Object of the present invention is to achieve a simple instrument, a restoration of broken vertebrae from the dorsal side, without including the intact adjacent vertebral bodies.

Gelöst wird diese Aufgabe durch ein Instrumentarium wie es in Anspruch 1 gekennzeichnet ist. This object is achieved by an instrument as characterized in claim. 1 Vorteilhafte Ausbildungen der Erfindung sind in Ansprüchen 2-19 angegeben. Advantageous embodiments of the invention are specified in claims 2-19.

Als Mittel zur Spreizung des inneren Endes des Spreizrohres kann eine Gewindestange dienen. As a means for spreading of the inner end of the Spreizrohres a threaded rod may be used. Das Gewinde kann auch entfallen, wenn durch andere Mittel, z. The thread can also be omitted if by other means, eg. B. am äußeren Ende, eine Arretierung gewährleistet ist. B. is ensured at the outer end, a detent. Es sind jedoch auch andere Mittel zur Spreizung, wie Druck-Zug-Stangen, an einem Seil geführter konischer Kopf etc. möglich, die eine Aufspreizung des Spreizrohres bewirken. However, other means for spreading such as pressure-train-rods, guided on a rope conical head etc., it is possible to cause a spreading of the Spreizrohres.

Mit dem erfindungsgemäßen Instrumentarium wird eine operative Aufrichtung gebrochener Wirbelkörper von dorsal möglich. The inventive surgical instruments erection broken vertebrae from the dorsal side is possible.

Nach transcutaner oder nach operativer Freilegung des Wirbelbogens des verletzten Wirbels von dorsal werden die Bogenwurzeln des Wirbels unter Röntgenkontrolle aufgebohrt. After transcutaneous or after surgical exposure of the vertebral arch of the injured vertebra from the posterior side the pedicles of the vertebra to be drilled under fluoroscopy. Sodann wird das Instrumentarium in Form eines Arbeitsrohres beidseits bis in den Wirbelkörper plaziert. Then, placing the instrument in the form of a working tube either side up in the vertebral body. Durch den Arbeitskanal wird dann das erfindungsgemäße Instrumentarium vorgeschoben, bis es ausreichend weit im Wirbelkörper steckt. Instruments to the invention is then advanced until it lies sufficiently far in the vertebral body through the working channel. Die Arme des Spreizers können dann je nach Bruchform nach vorn, zur Mitte oder nach hinten geöffnet werden, um so die komprimierte Berstung wieder aufzurichten. The arms of the spreader can then, depending on the form of a fraction forward, toward the center or open to the rear to raise the compressed so rupture again.

Unter endoskopischer oder offener Kontrolle kann dann zusätzlich transspinal ein Arbeitsrohr in den Bandscheibenraum eingebracht werden. Under endoscopic or open control, a working tube can then be introduced into the disc space in addition transspinal. Mit feinen Biopsiezangen wird das restliche zerstörte Bandscheibengewebe, das durch die Verletzung nicht in den Wirbel körper eingedrungen ist, entfernt. With fine biopsy forceps destroyed the remaining disc tissue that has not penetrated the body into the vortex by the injury is removed. Der geleerte Bandscheibenraum wird schließlich über die Arbeitsrohre mit Spongiosamehl aufgefül lt. The disc space is finally emptied lt aufgefül on the working tubes with Spongiosamehl.

Mit dem erfindungsgemäßen Instrumentarium läßt sich die endoskopische Operation von Bandscheiben ebenfalls durchführen. With the invention of instruments, the endoscopic surgery of intervertebral discs can also perform.

Weitere Einzelheiten und Vorteile der Erfindung werden im folgenden an einem Ausführungsbeispiel näher erläutert. Further details and advantages of the invention will be explained below using an exemplary embodiment. Es zeigt It shows

Fig. 1 ein erfindungsgemäßes Arbeitsrohr, Fig. 1 shows an inventive working tube,

Fig. 2 eine erste Variante des erfindungsgemäßen Instrumentes, das in einen aufzurichtenden Wirbelkörper eingeführt ist, Fig. 2 shows a first variant of the instrument according to the invention, which is inserted into a vertebral body righted,

Fig. 3 eine zweite Variante des erfindungsgemäßen Instrumentariums und Fig. 3 shows a second variant of the instrument according to the invention and

Fig. 4 eine weitere Variante des erfindungsgemäßen Instrumentariums. Fig. 4 shows another variant of the instrument according to the invention.

In Fig. 2 ist ein erfindungsgemäßes Instrumentarium in einem aufzurichtenden Wirbelkörper 10 dargestellt. In FIG. 2, an inventive instrument is illustrated in a righted vertebral body 10. Die anliegenden Wirbelkörper 9 werden zur Wiederaufrichtung nicht benötigt. The adjacent vertebrae 9 are not required for restoration. Das "äußere" Rohrende ist mit einem Gewinde 4 versehen, auf das ein Trichter 5 oder ein Schlagschutzring ( Fig. 1) aufgeschraubt werden kann. The "outer" end of the pipe is provided with a thread 4 to which a hopper 5 or an impact protection ring (Fig. 1) can be screwed. Das Arbeitsrohr weist eine Dichte von 4-12 mm, bevorzugt 8 mm auf. The working tube has a density of 4-12 mm, preferably 8 mm.

Der Wirbelspreizer Typ 1 gemäß Fig. 2 weist eine ca. 20 cm lange Gewindestange 3 , deren "inneres" Ende einen konischen Kopf 11 trägt. The vortex type spreader 1 according to Fig. 2 comprises an approximately 20 cm long threaded rod 3, the "inner" end carries a conical head 11. Die Gewindestange 3 ist eingedreht in ein mit Innengewin de ausgestattetem Spreizrohr 2 , dessen Außendurchmesser bündig dem Innendurchmesser des Arbeitsrohres 1 entspricht, so daß es durch dieses hindurchgeschoben werden kann. The threaded rod 3 is screwed into a threaded inner equipped with de spreading tube 2, whose outer diameter corresponds to flush the inside diameter of the working tube 1, so that it can be pushed through this. Das "innere" Ende des Spreiz rohres 2 ist auf einer Länge von 2,5 cm geschlitzt, um aufgespreizt werden zu können. The "inner" end of the expanding tube 2 is slotted on a length of 2.5 cm to be spread to. Das "innere" Ende der Gewindestange 3 trägt einen nach außen konisch erweiterten Kopf 11 (bis auf den Innendurchmesser des Arbeitsrohres). The "inner" end of the threaded rod 3 carries an outwardly flared head 11 (except for the inner diameter of the working tube). Bei Rückdrehung der Gewindestange 3 paßt sich die ser in das Spreizrohr 2 und drängt die Repositionsschenkel 12 auseinan der ( Fig. 2). At reverse rotation of the threaded rod 3, the ser fit into the spreader tube 2 and urges the Repositionsschenkel auseinan 12 of (Fig. 2).

Der Wirbelspreizer Typ 2 gemäß Fig. 3 weist im wesentlichen das Bauprinzip des Wirbelspreizers Typ 1 auf. The vortex type spreader 2 of FIG. 3 has essentially the building principle of the vertebral spreader type 1. Im Gegensatz zum Typ 1 ist die Schlitzung des "inneren" Endes jedoch nicht durchgezogen, sondern endet ca. 2 mm vor dem Ende. In contrast to type 1, the slitting of the "inner" end is not solid, but ends approximately 2 mm before the end. Bei Rückdrehung der Gewindestange 3 wird dadurch eine in etwa rautenförmige oder bauchige Aufspreizung bewirkt, die zur Reposition der Deck- und Grundplatte im mittleren Bereich führt ( Fig. 3). At reverse rotation of the threaded rod 3 causes thereby a roughly diamond-shaped or bulbous spreading, which leads to the reduction of the cover and base plate in the central region (Fig. 3). Dabei kann ein Gelenk 8 angeordnet sein. In this case, 8 can be arranged a joint. Die Aufspreizung kann jedoch auch durch elastisches Ausbiegen der Gewindestange 3 erfolgen. However, the spread can also occur through elastic bending out of the threaded rod. 3

Fig. 3 zeigt den Wirbelspreizer Typ 3 mit einer Gewindestange 3 mit Innengewinde. Fig. 3 shows the vertebral spreader type 3 with a threaded rod 3 with female thread. Die Gewindestange 3 liegt bündig dem Arbeitsrohr 1 an. The threaded rod 3 lies flush with the working tube. 1 In die Gewindestange 3 ist ein Spreizrohr 2 mit Außengewinde geführt, welches an seinem inneren Ende gelenkig verbundene Abspreizschenkel 6 trägt. In the threaded rod 3, a spreader tube 2 is guided with an external thread, which carries at its inner end hinged Abspreizschenkel. 6 Die nach hinten öffnenden Abspreizschenkel 6 weisen eine Länge von 0,5 bis 4 cm, bevorzugt 2,5 cm auf und liegen in nicht abgespreiztem Zustand auf der Gewindestange auf. The rearwardly opening Abspreizschenkel 6 have a length of 0.5 to 4 cm, preferably 2.5 cm and are present in not abgespreiztem state on the threaded rod. Durch Drehen der Gewindestange werden die Abspreizschenkel dorsal abgespreizt, wodurch die dorsale Aufrichtung der Deck- und Grundplatte sowie der Hinterkante des Wirbelkörpers bewirkt wird ( Fig. 4). By rotating the threaded rod, the dorsal Abspreizschenkel are spread apart, whereby the dorsal erection of the cover and base plate, and the rear edge of the vertebral body is caused (Fig. 4).

Die Erfindung ist keineswegs auf das dargestellte Ausführungsbeispiel beschränkt. The invention is by no means limited to the illustrated embodiment. Vielseitige Anwendungen sind im Rahmen der Erfindung, wie sie in den Ansprüchen gekennzeichnet ist, möglich. Versatile applications are within the scope of the invention as it is characterized in the claims, possible.

Claims (19)

1. Instrumentarium zur Wirbelbruchbehandlung, dadurch gekennzeichnet, daß es ein Arbeitsrohr ( 1 ), ein in diesem geführtes Spreizrohr ( 2 ) und Mittel ( 3 ) aufweist, die eine Spreizung des inneren Endes des Spreizrohres bewirken. 1. instruments for vertebral fracture treatment, characterized in that it comprises a working tube (1), a spreading tube guided in this (2) and means (3) which cause a spreading of the inner end of the Spreizrohres.
2. Instrumentarium nach Anspruch 1, dadurch gekennzeichnet, daß die Mittel ( 3 ) eine Gewindestange aufweisen. 2. Instrumentation according to claim 1, characterized in that the means (3) comprise a threaded rod.
3. Instrumentarium nach Anspruch 2, dadurch gekennzeichnet, daß die Gewindestange ( 3 ) an ihrem inneren Ende einen konischen Kopf ( 11 ) trägt. 3. Instrumentation according to claim 2, characterized in that the threaded rod (3) at its inner end a conical head (11).
4. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß das Spreizrohr ( 2 ) ein Innengewinde aufweist. 4. Instrumentation according to any of the preceding claims, characterized in that the spreader tube (2) has an internal thread.
5. Instrumentarium nach Anspruch 4, dadurch gekennzeichnet, daß das Innengewinde des Spreizrohres ( 2 ) mit der Gewindestange kämmt. 5. An instrument according to claim 4, characterized in that the internal thread of Spreizrohres (2) meshes with the threaded rod.
6. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß die Gewindestange ( 3 ) in einem Spreizrohr geführt ist. 6. Instrumentation according to any of the preceding claims, characterized in that the threaded rod (3) is guided in a spreader tube.
7. Instrumentarium nach einem der gekennzeichneten Ansprüche, dadurch gekennzeichnet, daß das Arbeitsrohr an einem Ende ein Gewinde ( 4 ) aufweist. Includes 7. Instrumentation according to any of claims marked, characterized in that the working tube at one end a thread (4).
8. Instrumentarium nach Anspruch 6, dadurch gekennzeichnet, daß auf das Gewinde ein Trichter ( 5 ) oder ein Schlagschutzring aufschraubbar ist. 8. Instrumentation according to claim 6, characterized in that on the thread, a hopper (5) or an impact protection ring is screwed.
9. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß in das Arbeitsrohr ( 1 ) ein mit scharfer Spitze versehener Trokar einführbar ist. 9. Instrumentation according to any of the preceding claims, characterized in that in the working tube (1) is insertable provided with a sharp tip trocar.
10. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß das Spreizrohr ( 2 ) am inneren Ende zur Bildung von Repositionsschenkeln ( 12 ) geschlitzt ist. 10. Instrumentation according to one of the preceding claims, characterized in that the spreader tube (2) is slotted to form Repositionsschenkeln at the inner end (12).
11. Instrumentarium nach Anspruch 10, dadurch gekennzeichnet, daß die Schlitzung 0,5 bis 5 cm, bevorzugt 2,5 cm beträgt. 11. Instrumentation according to claim 10, characterized in that the slit is preferably 0.5 to 5 cm, 2.5 cm.
12. Instrumentarium nach Anspruch 10 oder 11, dadurch gekennzeichnet, daß die Schlitzung am inneren Ende des Spreizrohres ( 2 ) beginnt. 12. Instrumentation according to claim 10 or 11, characterized in that the slit at the inner end of the Spreizrohres (2) begins.
13. Instrumentarium nach Anspruch 10 oder 11, dadurch gekennzeichnet, daß die Schlitzung ca. 1-15 mm, bevorzugt 2 mm von inneren Ende des Spreizrohres beginnt. 13. Instrumentation according to claim 10 or 11, characterized in that the slit about 1-15 mm, preferably 2 mm starts from the inner end of Spreizrohres.
14. Instrumentarium nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß das Spreizrohr ( 2 ) ein Außengewinde aufweist. 14. Instrumentation according to claim 1 or 2, characterized in that the spreader tube (2) has an external thread.
15. Instrumentarium nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß die Gewindestange 3 im Arbeitsrohr ( 1 ) geführt ist und ein Innengewinde aufweist. 15. Instrumentation according to claim 1 or 2, characterized in that the threaded rod 3 in the working tube (1) is guided and has an internal thread.
16. Instrumentarium nach Anspruch 14 und 15, dadurch gekennzeichnet, daß die Gewinde von Spreizrohr und Gewindestange miteinander kämmen. 16. Instrumentation according to claim 14 and 15, characterized in that the threads of the spreader tube and threaded rod mesh with each other.
17. Instrumentarium nach einem der Ansprüche 1, 2, 14, 15 oder 16, dadurch gekennzeichnet, daß das Spreizrohr ( 2 ) an dessen innerem Ende über ein Gelenk mit diesem verbundene Abspreizschenkel ( 6 ) trägt, die durch die Gewindestange abspreizbar sind. 17. Instrumentation according to one of claims 1, 2, 14, 15 or 16, characterized in that the spreader tube (2) bears via a hinge connected thereto Abspreizschenkel at its inner end (6), which are spreadable by the threaded rod.
18. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß die Gewindestange ( 3 ) eine Betätigungsvorrichtung ( 7 ) trägt. 18. Instrumentation according to one of the preceding claims, characterized in that the threaded rod (3) carries an actuator (7).
19. Instrumentarium nach Anspruch 13, dadurch gekennzeichnet, daß das Spreizrohr ( 2 ) im geschlitzten Bereich ein Gelenk ( 8 ) aufweist. 19. Instrumentation according to claim 13, characterized in that the spreader tube (2) in the slotted region has a joint (8).
DE19893922044 1989-07-05 1989-07-05 Expired - Fee Related DE3922044C2 (en)

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DE3922044C2 DE3922044C2 (en) 1991-05-29

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