EP0999795A1 - Device for stiffening and/or correcting a vertebral column or such like - Google Patents

Device for stiffening and/or correcting a vertebral column or such like

Info

Publication number
EP0999795A1
EP0999795A1 EP98939650A EP98939650A EP0999795A1 EP 0999795 A1 EP0999795 A1 EP 0999795A1 EP 98939650 A EP98939650 A EP 98939650A EP 98939650 A EP98939650 A EP 98939650A EP 0999795 A1 EP0999795 A1 EP 0999795A1
Authority
EP
European Patent Office
Prior art keywords
anchoring element
anchoring
clamping means
passage
spacer sleeves
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.)
Withdrawn
Application number
EP98939650A
Other languages
German (de)
French (fr)
Inventor
Hans Schmotzer
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.)
Smith and Nephew Orthopaedics AG
Original Assignee
Plus Endoprothetik AG
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
Priority claimed from DE19738968A external-priority patent/DE19738968B4/en
Application filed by Plus Endoprothetik AG filed Critical Plus Endoprothetik AG
Publication of EP0999795A1 publication Critical patent/EP0999795A1/en
Withdrawn legal-status Critical Current

Links

Classifications

    • 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
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7008—Longitudinal elements, e.g. rods with a cross-section which varies along its length with parts of, or attached to, the longitudinal elements, bearing against an outside of the screw or hook heads, e.g. nuts on threaded rods
    • 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
    • A61B17/7011—Longitudinal element being non-straight, e.g. curved, angled or branched
    • 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
    • A61B17/702—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other having a core or insert, and a sleeve, whereby a screw or hook can move along the core or in the sleeve
    • 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
    • A61B17/7034—Screws or hooks with U-shaped head or back through which longitudinal rods pass characterised by a lateral opening

Definitions

  • the invention relates to a device for stiffening and / or correcting a bone framework or section consisting of at least two bones or bone fragments or a spinal column section consisting of at least two vertebrae, with at least two anchoring elements for a connecting element which can be fastened to a bone or vertebra on the anchoring element fixable, cable, wire or rod-shaped tensioning means as well as spacer sleeves which can be pushed over them and which hold adjacent anchoring elements at a predetermined distance when tension is exerted on the tensioning means.
  • Such a device is known from WO 94/17745 in connection with the correction of a spinal column section.
  • This known device is characterized by a high degree of flexibility with permanent functional reliability. It is also simple from an operational point of view and permits subsequent position corrections.
  • the present invention has for its object to improve the known device in terms of flexibility.
  • each spacer sleeve facing the anchoring elements are preferably complementary to the corresponding support surface on the anchoring element, i. H. spherically concave or convex. This ensures a flat support of the spacer sleeves on the convex or concave arched support surfaces of the anchoring elements.
  • a particularly preferred embodiment of the device according to the invention is characterized in that the head of the anchoring element protruding from the bone or vertebra is spherical, it being mentioned at this point that the anchoring element can either be a pedicle screw or a pedicle hook. In the former case, the head of the pedicle screw is a spherical head.
  • these or their heads each have a passage, in particular a through hole with conical or trumpet-like outlets or outlets for the tensioning means.
  • the clamping means can thus enter or exit the anchoring element without constraint within a predetermined solid angle of up to 15 to 25 degrees.
  • the passage or the through hole is accessible or evident over its or its entire length through a gap, so that the clamping means can be inserted into the passage in the direction transverse to the longitudinal direction of the passage.
  • the anchoring tion element are first attached to the associated bone or vertebral bone. Only then is the fixation device, including the clamping sleeves, fixed to the anchoring elements. In this embodiment, the anchoring elements do not therefore have to be threaded onto the clamping device beforehand.
  • a particularly simple embodiment is the first-mentioned alternative, which has a gap for inserting the tensioning means, which extends over the length of the passage in the anchoring element.
  • the anchoring element is formed in two or more parts in such a way that the passage in the anchoring element can be opened over its entire length for inserting the clamping means. Then the passage is “capped” again, so that a radially closed passage is created.
  • the passages in the spacer sleeves preferably have conical or trumpet-like outwardly widening inlet or outlet openings in order to ensure that the tensioning means passes freely from the spacer sleeve into the passage of the anchoring element or vice versa in the area of the support of the spacer sleeves on the associated anchoring element .
  • the device comprises support balls which can be placed on the clamping means, in particular split balls (with a continuous longitudinal gap), which can each be inserted between two spacer sleeves in order to change or adapt the distance length by lining up two or more spacer sleeves of the same or different lengths.
  • the support balls mentioned each have a passage corresponding to the passage on the anchoring elements for the cable, wire or rod-shaped tensioning means. The support balls are thus threaded onto the clamping means, in each case between two successive spacer sleeves.
  • clamping means anchoring part of each anchoring Rungselements, in particular the ball head of a ball-head pedicle screw to rotatably support an axis extending transversely to the longitudinal extension of the clamping means or about the longitudinal axis of the pedicle screw.
  • the anchoring part of a z. B. marked in a vertebral screw pedicle screw is spherical.
  • the top of the ball head 11 is flattened.
  • an internal hexagon (not shown here) is formed, into which a complementary screwing tool can be inserted. This will screw the pedicle screw into the vertebra.
  • the head 11 of the pedicle screw 10 has a passage in the form of a through hole 12, each with conically widening inlet and outlet openings 13, 14.
  • a cable or wire-like clamping means 15 is placed, which after implantation Train stands.
  • Spacer sleeves 16 are pushed over the clamping means 15, by means of which adjacent anchoring elements, here pedicle screws 10, are held at a predetermined distance when tension is exerted on the cable-like or wire-like clamping means 15.
  • the spacer sleeves 16 are supported on the spherical surface of the screw head 11.
  • the end faces 17 of the spacer sleeves 16 facing the spherical head 11 of the pedicle screw 10 are complementary to that, ie spherically concave, in accordance with the spherical support surface. This is a flat support of the spacer sleeves on the ball head 11 of the pedicle screw 10 possible at different angles, as indicated by the double bow arrows 18 in the attached drawing.
  • the angle at which the spacer sleeves 16 are supported on the ball head 11 of the pedicle screw 10 corresponds to the entry or exit angle of the cable-like or wire-like clamping means 15 from the through bore 12 in the ball head 11.
  • the maximum clamping device out or Entry angle is defined by the cone of the entry or exit opening 13, 14.
  • the passages 19 in the spacer sleeves 16 also have conical or trumpet-like outwardly widening inlet and outlet openings 20 in order to provide a non-constrained passage of the cable or to ensure wire-like clamping means 15 from the spacer sleeve 16 into the passage 12 of the anchoring element or here ball head 11 of the pedicle screw 10 or vice versa.
  • This constraint-free transition can be seen very clearly in the attached drawing.
  • a pedicle hook can also serve as anchoring element.
  • the ball head 10 is rotatably mounted about the pedicle screw longitudinal axis 21. This gives the surgeon even more degrees of freedom with regard to the alignment of clamping devices and spacer sleeves.
  • support balls are to be arranged between two adjacent spacer sleeves, these are designed in accordance with the ball head 11 of the pedicle screw 10.
  • the ball head 11 is formed in one piece and is an integral part of the pedicle screw 10. This is first screwed into the vertebral bone during implantation and aligned with respect to the passage 12. Then the threading of the cable or wire like clamping means 15, on which the spacer sleeves 16 are then pushed in each case.
  • the clamping means 15 has a thickening which is supported in the passage 12 of the anchoring element located at one end of the spinal column section to be stiffened, while the other end comprises a threaded section onto which a clamping nut can be screwed.
  • the clamping nut is supported either directly or indirectly via a short spacer sleeve on the anchoring element assigned to the other end of the spinal column section to be stiffened.
  • a threaded rod can also be used as the clamping means 15, i. H. a rod with an external thread extending over the entire length.
  • This embodiment has the advantage that the threaded rod can be cut to length according to the needs at the site of the implantation.
  • the ball head 11 of the pedicle screw 10 In order to avoid the aforementioned threading of the clamping means into the passage 12 of the anchoring part, here the ball head 11 of the pedicle screw 10, it can be provided that the ball head 11 is formed in two parts, so that the passage 11 can be opened over its entire length for inserting the clamping means 15 , or to provide a longitudinal gap in the ball head 11, via which the clamping means 15 can also be inserted into the passage 12. In this embodiment, the clamping means 15 is virtually hooked or suspended in the passage 12.
  • the tensioning means 15 can be designed as a flexible cable, in particular a cable-like braided cable.
  • the clamping means 15 is - as already mentioned above - under tension, while the spacer sleeves 16 are under pressure.
  • the described device is suitable not only for stiffening and / or correcting a spinal column section, but also for stiffening or correcting the bone structure or a bone fracture in general, in particular also as part of an external fixator or an intramedullary nail. However, the system described is particularly suitable for the correction and / or stiffening of a spinal column section.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Neurology (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Abstract

The invention relates to a device for stiffening and/or correcting a bone structure or bone section consisting of at least two bones or bone fragments, or a section of vertebral column consisting of at least two vertebrae. Said device comprises at least two anchoring elements (10), which can each be fixed to a vertebra of the vertebral column, for a connecting element. Said connecting element consists of a cable-, wire- or rod-shaped tensioning means (15) which can be attached to the anchoring element (10) and spacer sleeves (16) which can be slid over said tensioning means. The spacer sleeves keep neighbouring anchoring elements (10) at a predetermined distance when traction is applied to the tensioning means (15). The surfaces of the anchoring element (10) on which the spacer sleeves (16) are supported are spherically convex or concave.

Description

Vorrichtung zur Versteifung und/oder Korrektur einer Device for stiffening and / or correcting a
Wirbelsäule od. dgl .Spine or the like
B e s c h r e i b u n gDescription
Die Erfindung betrifft eine Vorrichtung zur Versteifung und/oder Korrektur eines aus wenigstens zwei Knochen oder Knochenfragmenten bestehenden Knochengerüstes oder -abschnitts oder eines aus wenigstens zwei Wirbeln bestehenden Wirbelsäulenabschnitts, mit mindestens zwei jeweils an einem Knochen bzw. Wirbel befestigbaren Verankerungεelementen für ein Verbindungselement, welches ein am Verankerungselement festlegbares, kabel-, draht- oder stabförmiges Spannmittel sowie über dieses schiebbare Distanzhülsen umfaßt, die benachbarte Verankerungselemente bei Ausübung von Zug auf das Spannmittel auf vorbestimmte Distanz halten.The invention relates to a device for stiffening and / or correcting a bone framework or section consisting of at least two bones or bone fragments or a spinal column section consisting of at least two vertebrae, with at least two anchoring elements for a connecting element which can be fastened to a bone or vertebra on the anchoring element fixable, cable, wire or rod-shaped tensioning means as well as spacer sleeves which can be pushed over them and which hold adjacent anchoring elements at a predetermined distance when tension is exerted on the tensioning means.
Eine derartige Vorrichtung ist in Verbindung mit der Korrektur eines Wirbelsäulenabschnitts aus der WO 94/17745 bekannt. Diese bekannte Vorrichtung zeichnet sich durch eine hohe Flexibilität bei dauerhafter Funktionssicherheit aus. Sie ist auch operationstechnisch einfach und läßt nachträgliche Positionskorrekturen zu.Such a device is known from WO 94/17745 in connection with the correction of a spinal column section. This known device is characterized by a high degree of flexibility with permanent functional reliability. It is also simple from an operational point of view and permits subsequent position corrections.
Der vorliegenden Erfindung liegt die Aufgabe zugrunde, die bekannte Vorrichtung hinsichtlich der Flexibilität zu verbessern.The present invention has for its object to improve the known device in terms of flexibility.
Diese Aufgabe wird erfindungsgemäß durch die kennzeichnenden Merkmale des Anspruches l gelöst, wonach die Flächen des Verankerungselements, an denen sich die Distanzhülsen abstützen, sphärisch konvex oder konkav gewölbt sind. Damit ist es mόg- lieh, die Abstützung der Distanzhülsen an den zugeordneten Verankerungselementen anzupassen an die Richtung des Spannmittels zwischen zwei benachbarten Verankerungselementen. Es ist dementsprechend nicht zwingend notwendig, daß sich die Spannmittel in einem vorbestimmten Winkel zum Verankerungselement erstrecken. Vielmehr kann dieser Winkel vom Operateur individuell eingestellt werden, ohne daß er von den Distanzhulsen und deren Abstützung an den Verankerungselementen behindert wird.This object is achieved according to the invention by the characterizing features of claim 1, according to which the surfaces of the anchoring element on which the spacer sleeves are supported are spherically convex or concave. So it is possible lent to adjust the support of the spacer sleeves on the associated anchoring elements to the direction of the clamping means between two adjacent anchoring elements. Accordingly, it is not absolutely necessary for the tensioning means to extend at a predetermined angle to the anchoring element. Rather, this angle can be individually adjusted by the surgeon without being hampered by the spacer sleeves and their support on the anchoring elements.
Vorzugsweise sind die den Verankerungselementen zugewandten Stirnseiten einer jeden Distanzhülse entsprechend der zugeordneten Stützfläche am Verankerungselement komplementär dazu, d. h. sphärisch konkav bzw. konvex ausgebildet. Damit ist eine flächige Abstützung der Distanzhulsen an den konvex oder konkav gewölbten Stützflächen der Verankerungselemente sichergestellt.The end faces of each spacer sleeve facing the anchoring elements are preferably complementary to the corresponding support surface on the anchoring element, i. H. spherically concave or convex. This ensures a flat support of the spacer sleeves on the convex or concave arched support surfaces of the anchoring elements.
Eine besonders bevorzugte Ausfuhrungsform der erfindungsgemäßen Vorrichtung zeichnet sich dadurch aus, daß der aus dem Knochen oder Wirbel herausragende Kopf des Verankerungselements kugelartig ausgebildet ist, wobei an dieser Stelle erwähnt sei, daß das Verankerungselement entweder eine Pedikelschraube oder ein Pedikelhaken sein kann. Im erstgenannten Fall ist der Kopf der Pedikelschraube eine Kugelkopf.A particularly preferred embodiment of the device according to the invention is characterized in that the head of the anchoring element protruding from the bone or vertebra is spherical, it being mentioned at this point that the anchoring element can either be a pedicle screw or a pedicle hook. In the former case, the head of the pedicle screw is a spherical head.
Zur Festlegung der Spannmittel an den Verankerungselementen weisen diese bzw. deren Köpfe jeweils einen Durchgang auf, insbesondere eine Durchgangsbohrung mit sich jeweils konisch oder trompetenartig nach außen erweiternden Ein- bzw. Austrittsöffnungen für das Spannmittel . Damit kann das Spannmittel zwän- gungsfrei innerhalb eines vorgegebenen Raumwinkels von bis zu 15 bis 25 Grad in das Verankerungselement eintreten bzw. aus diesem austreten.To fix the tensioning means on the anchoring elements, these or their heads each have a passage, in particular a through hole with conical or trumpet-like outlets or outlets for the tensioning means. The clamping means can thus enter or exit the anchoring element without constraint within a predetermined solid angle of up to 15 to 25 degrees.
Bei einer vorteilhaften Ausfuhrungsform ist der Durchgang bzw. die Durchgangsbohrung über seine bzw. ihre gesamte Länge durch einen Spalt zugänglich oder offenbar, so daß das Spannmittel in Richtung quer zur Durchgangslängsrichtung in den Durchgang einführbar ist. Bei beiden Ausführungsformen kann das Veranke- rungselement zunächst am zugeordneten Knochen bzw. Wirbelknochen befestigt werden. Erst dann erfolgt die Festlegung des Spannmittels samt Spannhülsen an den Verankerungselementen. Die Verankerungselemente müssen bei dieser Ausfuhrungsform also nicht vorher auf das Spannmittel aufgefädelt werden. Eine besonders einfache Ausfuhrungsform ist die erstgenannte Alternative, die durch einen sich über die Länge des Durchgangs im Verankerungselement erstreckenden Spalt zum Einführen des Spannmittels aufweist. Alternativ ist das Verankerungselement zwei- oder mehrteilig ausgebildet derart, daß der Durchgang im Verankerungselement über seine gesamte Länge geöffnet werden kann zum Einlegen des Spannmittels. Anschließend wird der Durchgang wieder "gedeckelt", so daß ein radial allseitig geschlossener Durchgang ensteht.In an advantageous embodiment, the passage or the through hole is accessible or evident over its or its entire length through a gap, so that the clamping means can be inserted into the passage in the direction transverse to the longitudinal direction of the passage. In both embodiments, the anchoring tion element are first attached to the associated bone or vertebral bone. Only then is the fixation device, including the clamping sleeves, fixed to the anchoring elements. In this embodiment, the anchoring elements do not therefore have to be threaded onto the clamping device beforehand. A particularly simple embodiment is the first-mentioned alternative, which has a gap for inserting the tensioning means, which extends over the length of the passage in the anchoring element. Alternatively, the anchoring element is formed in two or more parts in such a way that the passage in the anchoring element can be opened over its entire length for inserting the clamping means. Then the passage is "capped" again, so that a radially closed passage is created.
Die Durchgänge in den Distanzhülsen weisen vorzugsweise sich konisch oder trompetenartig nach außen erweiternde Ein- bzw. Austrittsöffnungen auf, um im Bereich der Abstützung der Distanzhülsen am zugeordneten Verankerungselement einen zwän- gungsfreien Übertritt des Spannmittels von der Distanzhülse in den Durchgang des Verankerungselements bzw. umgekehrt sicherzustellen.The passages in the spacer sleeves preferably have conical or trumpet-like outwardly widening inlet or outlet openings in order to ensure that the tensioning means passes freely from the spacer sleeve into the passage of the anchoring element or vice versa in the area of the support of the spacer sleeves on the associated anchoring element .
Bei einer weiteren Variante der erfindungsgemäßen Vorrichtung kann noch vorgesehen sein, daß diese auf dem Spannmittel plazierbare Stützkugeln, insbesondere Spaltkugeln (mit durchgehendem Längsspalt) umfaßt, die jeweils zwischen zwei Distanzhulsen einfügbar sind, um eine Änderung oder Anpassung der Distanz- länge durch Aneinanderreihung von zwei oder mehr Distanzhülsen gleicher oder unterschiedlicher Länge zu ermöglichen. Die erwähnten Stützkugeln weisen jeweils einen Durchgang entsprechend dem Durchgang an den Verankerungselementen für das kabel-, draht- oder stabförmige Spannmittel auf. Die Stützkugeln werden also auf die Spannmittel aufgefädelt, und zwar jeweils zwischen zwei aufeinanderfolgenden Distanzhülsen.In a further variant of the device according to the invention it can also be provided that it comprises support balls which can be placed on the clamping means, in particular split balls (with a continuous longitudinal gap), which can each be inserted between two spacer sleeves in order to change or adapt the distance length by lining up two or more spacer sleeves of the same or different lengths. The support balls mentioned each have a passage corresponding to the passage on the anchoring elements for the cable, wire or rod-shaped tensioning means. The support balls are thus threaded onto the clamping means, in each case between two successive spacer sleeves.
Um die Variationsmδglichkeiten noch weiter zu erhöhen, ist es denkbar, den Spannmittel-Verankerαngsteil eines jeden Veranke- rungselements , insbesondere den Kugelkopf einer Kugelkopf-Pedikelschraube, um eine sich quer zur Längserstreckung des Spannmittels erstreckende Achse bzw. um die Pedikelschrauben- Längsachse drehbar zu lagern. Damit hat der Operateur die Möglichkeit, das Spannmittel und die zugeordneten Distanzhülsen in drei Dimensionen einzustellen nach den jeweils gegebenen Erfordernissen.In order to increase the possible variations even further, it is conceivable that the clamping means anchoring part of each anchoring Rungselements, in particular the ball head of a ball-head pedicle screw to rotatably support an axis extending transversely to the longitudinal extension of the clamping means or about the longitudinal axis of the pedicle screw. This gives the surgeon the option of adjusting the clamping device and the associated spacer sleeves in three dimensions according to the respective requirements.
Nachstehend wird eine bevorzugte Ausfuhrungsform einer erfindungsgemäßen Vorrichtung anhand der beigefügten Zeichnung näher erläutert. Diese zeigt in der einzigen Figur das Zusammenspiel zwischen Verankerungselement, Spannmittel und Distanzhulsen im Schnitt.A preferred embodiment of a device according to the invention is explained in more detail below with reference to the accompanying drawing. In the single figure, this shows the interplay between the anchoring element, tensioning means and spacer sleeves on average.
Mit der Bezugsziffer 10 ist der Verankerungsteil einer z. B. in einen Wirbelknochen einschraubbaren Pedikelschraube gekennzeichnet. Der aus dem Wirbelknochen herausragende Kopf 11 dieser Schraube ist kugelförmig ausgebildet. Die Oberseite des Kugelkopfes 11 ist abgeflacht. In diesem Bereich ist ein hier nicht dargestellter Innnensechskant ausgebildet, in den ein komplementäres Schraubwerkzeug einfügbar ist. Damit wird die Pedikelschraube in den Wirbel eingeschraubt.With the reference number 10, the anchoring part of a z. B. marked in a vertebral screw pedicle screw. The head 11 of this screw protruding from the vertebral bone is spherical. The top of the ball head 11 is flattened. In this area, an internal hexagon (not shown here) is formed, into which a complementary screwing tool can be inserted. This will screw the pedicle screw into the vertebra.
Der Kopf 11 der Pedikelschraube 10 weist einen Durchgang in Form einer Durchgangsbohrung 12 auf mit sich jeweils konisch nach außen erweiternden Ein- und Austrittsöffnungen 13, 14. Innerhalb der Durchgangsbohrung 12 ist ein kabel- bzw. drahtartiges Spannmittel 15 plaziert, welches nach der Implantation auf Zug steht. Über das Spannmittel 15 sind Distanzhülsen 16 geschoben, mittels denen benachbarte Verankerungselemente, hier Pedikelschrauben 10 bei Ausübung von Zug auf das kabel- bzw. drahtartige Spannmittel 15 auf vorbestimmte Distanz gehalten werden. Die Distanzhulsen 16 stützen sich an der kugelförmigen Oberfläche des Schraubenkopfes 11 ab. Die dem Kugelkopf 11 der Pedikelschraube 10 zugewandten Stirnseiten 17 der Distanzhülsen 16 sind entsprechend der kugelförmigen Stützfläche komplementär dazu, d. h. sphärisch konkav ausgebildet. Damit ist eine flächige Abstützung der Distanzhülsen am Kugelkopf 11 der Pedikel- schraube 10 unter unterschiedlichen Winkeln möglich, wie in der anliegenden Zeichnung durch die Doppel-Bogenpfeile 18 angedeutet ist.The head 11 of the pedicle screw 10 has a passage in the form of a through hole 12, each with conically widening inlet and outlet openings 13, 14. Inside the through hole 12, a cable or wire-like clamping means 15 is placed, which after implantation Train stands. Spacer sleeves 16 are pushed over the clamping means 15, by means of which adjacent anchoring elements, here pedicle screws 10, are held at a predetermined distance when tension is exerted on the cable-like or wire-like clamping means 15. The spacer sleeves 16 are supported on the spherical surface of the screw head 11. The end faces 17 of the spacer sleeves 16 facing the spherical head 11 of the pedicle screw 10 are complementary to that, ie spherically concave, in accordance with the spherical support surface. This is a flat support of the spacer sleeves on the ball head 11 of the pedicle screw 10 possible at different angles, as indicated by the double bow arrows 18 in the attached drawing.
Der Winkel, unter dem sich die Distanzhülsen 16 am Kugelkopf 11 der Pedikelschraube 10 abstützen, entspricht dem Ein- bzw. Aus- trittswinkel des kabel- bzw. drahtartigen Spannmittels 15 aus der Durchgangsbohrung 12 im Kugelkopf 11. Der maximale Spannmittel-Aus- bzw. Eintrittswinkel ist definiert durch den Konus der Ein- bzw. Austrittsöffnung 13, 14.The angle at which the spacer sleeves 16 are supported on the ball head 11 of the pedicle screw 10 corresponds to the entry or exit angle of the cable-like or wire-like clamping means 15 from the through bore 12 in the ball head 11. The maximum clamping device out or Entry angle is defined by the cone of the entry or exit opening 13, 14.
Die Durchgänge 19 in den Distanzhülsen 16 weisen ebenfalls sich konisch oder trompetenartig nach außen erweiternde Ein- bzw. Austrittsöffnungen 20 auf, um im Bereich der Abstützung der Distanzhülsen 16 am zugeordneten Verankerungselement, hier am Kugelkopf 11 der Pedikelschraube 10 einen zwängungsfreien Übertritt des kabel- bzw. drahtartigen Spannmittels 15 von der Distanzhülse 16 in den Durchgang 12 des Verankerungselements bzw. hier Kugelkopfes 11 der Pedikelschraube 10 oder umgekehrt sicherzustellen. Dieser zwängungsfreie Übertritt ist in der anliegenden Zeichnung sehr deutlich erkennbar. Statt der dargestellten Pedikelschraube 10 kann auch ein Pedikelhaken als Verankerungselement dienen.The passages 19 in the spacer sleeves 16 also have conical or trumpet-like outwardly widening inlet and outlet openings 20 in order to provide a non-constrained passage of the cable or to ensure wire-like clamping means 15 from the spacer sleeve 16 into the passage 12 of the anchoring element or here ball head 11 of the pedicle screw 10 or vice versa. This constraint-free transition can be seen very clearly in the attached drawing. Instead of the illustrated pedicle screw 10, a pedicle hook can also serve as anchoring element.
Es kann auch noch vorgesehen sein, daß der Kugelkopf 10 um die Pedikelschrauben-Längsachse 21 drehbar gelagert ist. Damit hat der Operateur noch mehr Freiheitsgrade bezüglich der Ausrichtung von Spannmittel und Distanzhülsen.It can also be provided that the ball head 10 is rotatably mounted about the pedicle screw longitudinal axis 21. This gives the surgeon even more degrees of freedom with regard to the alignment of clamping devices and spacer sleeves.
Sofern zwischen zwei benachbarten Distanzhülsen Sützkugeln angeordnet sein sollen, sind diese entsprechend dem Kugelkopf 11 der Pedikelschraube 10 ausgebildet.If support balls are to be arranged between two adjacent spacer sleeves, these are designed in accordance with the ball head 11 of the pedicle screw 10.
Bei der dargestellten Ausfuhrungsform ist der Kugelkopf 11 einteilig ausgebildet und integraler Bestandteil der Pedikelschraube 10. Diese wird bei der Implantation zunächst in den Wirbelknochen eingeschraubt und hinsichtlich des Durchgangs 12 ausgerichtet. Dann erfolgt das Einfädeln des kabel- oder draht- artigen Spannmittels 15, auf welches dann auch jeweils die Distanzhülsen 16 aufgeschoben werden. An einem Ende weist das Spannmittel 15 eine Verdickung auf, die sich im Durchgang 12 des an einem Ende des zu versteifenden Wirbelsäulenabschnitts befindlichen Verankerungselements abstützt, während das andere Ende einen Gewindeabschnitt umfaßt, auf den eine Spannmutter aufschraubbar ist. Dabei stützt sich die Spannmutter entweder unmittelbar oder mittelbar über eine kurze Distanzhülse an dem dem anderen Ende des zu versteifenden Wirbelsäulenabschnitts zugeordneten Verankerungselement ab.In the embodiment shown, the ball head 11 is formed in one piece and is an integral part of the pedicle screw 10. This is first screwed into the vertebral bone during implantation and aligned with respect to the passage 12. Then the threading of the cable or wire like clamping means 15, on which the spacer sleeves 16 are then pushed in each case. At one end, the clamping means 15 has a thickening which is supported in the passage 12 of the anchoring element located at one end of the spinal column section to be stiffened, while the other end comprises a threaded section onto which a clamping nut can be screwed. The clamping nut is supported either directly or indirectly via a short spacer sleeve on the anchoring element assigned to the other end of the spinal column section to be stiffened.
Als Spannmittel 15 kann auch ein Gewindestab verwendet werden, d. h. ein Stab mit einem sich über die gesamte Länge erstreckenden Außengewinde. Diese Ausfuhrungsform hat den Vorteil, daß der Gewindestab individuell abgelängt werden kann entsprechend den Bedürfnissen am Ort der Implantation.A threaded rod can also be used as the clamping means 15, i. H. a rod with an external thread extending over the entire length. This embodiment has the advantage that the threaded rod can be cut to length according to the needs at the site of the implantation.
Um das erwähnte Einfädeln des Spannmittels in den Durchgang 12 des Verankerungsteils, hier Kugelkopfes 11 der Pedikelschraube 10 zu vermeiden, kann vorgesehen sein, den Kugelkopf 11 entweder zweiteilig auszubilden, so daß der Durchgang 11 über seine gesamte Länge zum Einlegen des Spannmittels 15 geöffnet werden kann, oder im Kugelkopf 11 einen Längsspalt vorzusehen, über den das Spannmittel 15 ebenfalls in den Durchgang 12 eingeführt werden kann. Das Spannmittel 15 wird bei dieser Ausfuhrungsform im Durchgang 12 quasi eingehakt bzw. eingehängt.In order to avoid the aforementioned threading of the clamping means into the passage 12 of the anchoring part, here the ball head 11 of the pedicle screw 10, it can be provided that the ball head 11 is formed in two parts, so that the passage 11 can be opened over its entire length for inserting the clamping means 15 , or to provide a longitudinal gap in the ball head 11, via which the clamping means 15 can also be inserted into the passage 12. In this embodiment, the clamping means 15 is virtually hooked or suspended in the passage 12.
Sämtliche Bauteile bestehen aus humanverträglichem Material, insbesondere Titan oder einer Titanlegierung. Das Spannmittel 15 kann bei einer besonderen Ausfuhrungsform als flexibles Kabel ausgebildet sein, insbesondere seilartig geflochtenes Kabel.All components are made of human-compatible material, especially titanium or a titanium alloy. In a special embodiment, the tensioning means 15 can be designed as a flexible cable, in particular a cable-like braided cable.
Im implantierten Zustand steht das Spannmittel 15 - wie bereits oben erwähnt - unter Zug, während die Distanzhülsen 16 unter Druck stehen. Die beschriebene Vorrichtung eignet sich nicht nur zur Versteifung und/oder Korrektur eines Wirbelsäulenabschnitts, sondern zur Versteifung oder Korrektur des Knochengerüstes oder einer Knochenfraktur ganz allgemein, insbesondere auch als Teil eines Fixateurs externe oder eines intramedullären Nagels. Besonders geeignet ist das beschriebene System jedoch für die Korrektur und/oder Versteifung eines Wirbelsäulenabschnitts.In the implanted state, the clamping means 15 is - as already mentioned above - under tension, while the spacer sleeves 16 are under pressure. The described device is suitable not only for stiffening and / or correcting a spinal column section, but also for stiffening or correcting the bone structure or a bone fracture in general, in particular also as part of an external fixator or an intramedullary nail. However, the system described is particularly suitable for the correction and / or stiffening of a spinal column section.
Sämtliche in den Anmeldungsunterlagen offenbarten Merkmale werden als erfindungswesentlich beansprucht, soweit sie einzeln oder in Kombination gegenüber dem Stand der Technik neu sind. All features disclosed in the application documents are claimed as essential to the invention, insofar as they are new compared to the prior art, individually or in combination.
B e z u g s z e i c h e n l i s t eB e z u g s z e i c h e n l i s t e
10 Pedikelschraube10 pedicle screw
11 Schraubenkopf11 screw head
12 Durchgangsbohrung12 through hole
13 Eintrittsöffnung13 inlet opening
14 Austrittsöffnung14 outlet opening
15 Spannmittel15 clamping devices
16 Distanzhülse16 spacer sleeve
17 Stirnseite17 end face
18 Doppel-Bogenpfeil18 double bow arrow
19 Durchgang19 round
20 Ein- bzw. Austrittsöffnung20 inlet or outlet opening
21 Pedikelschrauben-Langsachse 21 pedicle screw longitudinal axis

Claims

A n s p r ü c h e Expectations
1. Vorrichtung zur Versteifung und/oder Korrektur eines aus wenigstens zwei Knochen oder Knochenfragmenten bestehenden Knochengerüstes oder -abschnitts, oder eines aus wenigstens zwei Wirbeln bestehenden Wirbelsäulenabschnitts, mit wenigstens zwei jeweils an einem Knochen bzw. Wirbel befestigbaren Verankerungselementen (10) für ein Verbindungselement, welches ein am Verankerungselement (10) festlegbares, kabel-, draht- oder stabförmiges Spannmittel (15) sowie über dieses schiebbare Distanzhulsen1. Device for stiffening and / or correcting a bone structure or section consisting of at least two bones or bone fragments, or a spinal column section consisting of at least two vertebrae, with at least two anchoring elements (10), each of which can be fastened to a bone or vertebra, for a connecting element, which has a cable, wire or rod-shaped clamping means (15) which can be fixed on the anchoring element (10) and spacer sleeves which can be pushed over this
(16) umfaßt, die benachbarte Verankerungsele ente (10) bei Ausübung von Zug auf das Spannmittel (15) auf vorbestimmte Distanz halten, d a d u r c h g e k e n n z e i c h n e t , daß die Flächen des Verankerungselements (10) , an denen sich die Distanzhülsen (16) abstützen, sphärisch konvex oder konkav gewölbt sind.(16), the adjacent anchoring element duck (10) when exerting tension on the tensioning means (15) at a predetermined distance, characterized in that the surfaces of the anchoring element (10) on which the spacer sleeves (16) are supported are spherically convex or are concave.
2. Vorrichtung nach Anspruch 1, d a d u r c h g e k e n n z e i c h n e t , daß die den Verankerungselementen (10) zugewandten Stirnseiten2. Device according to claim 1, d a d u r c h g e k e n n z e i c h n e t that the end faces facing the anchoring elements (10)
(17) einer jeden Distanzhülse (16) entsprechend der zugeordneten Stützfläche am Verankerungselement (10) komplementär gestaltet, d. h. sphärisch konkav bzw. konvex ausgebildet sind.(17) of each spacer sleeve (16) is designed to be complementary in accordance with the associated support surface on the anchoring element (10), d. H. are spherically concave or convex.
3. Vorrichtung nach Anspruch 1 oder 2, d a d u r c h g e k e n n z e i c h n e t , daß der aus dem Knochen oder Wirbel herausragende Kopf (11) des Verankerungselements (10) kugelartig ausgebildet ist.3. Apparatus according to claim 1 or 2, so that the head (11) of the anchoring element (10) protruding from the bone or vertebra is spherical.
4. Vorrichtung nach einem der Ansprüche 1 bis 3, d a d u r c h g e k e n n z e i c h n e t , daß das Verankerungselement (10) bzw. dessen Kopf (11) einen Durchgang für das Spannmittel (15) aufweist, insbesondere eine Durchgangsbohrung (12) mit sich jeweils konisch oder trompetenartig nach außen erweiternden Ein- bzw. Aus- trittsöffnungen (13, 14).4. Device according to one of claims 1 to 3, characterized in that the anchoring element (10) or its head (11) has a passage for the clamping means (15), in particular a through hole (12) with each conical or Inlet and outlet openings (13, 14) widening like a trumpet.
5. Vorrichtung nach Anspruch 4, d a d u r c h g e k e n n z e i c h n e t , daß der Durchgang bzw. die Durchgangsbohrung (12) über seine bzw. ihre gesamte Länge durch einen Spalt hindurch zugänglich oder alterntiv offenbar ist, so daß das Spannmittel (15) in Richtung quer zur Durchgangslängsrichtung in den Durchgang bzw. Durchgangsbohrung (12) einführbar ist.5. The device according to claim 4, characterized in that the passage or the through bore (12) is accessible over its or its entire length through a gap or alternatively apparent, so that the clamping means (15) in the direction transverse to the longitudinal direction in the Passage or through hole (12) is insertable.
6. Vorrichtung nach Anspruch 5, d a d u r c h g e k e n n z e i c h n e t , daß das Verankerungselement, insbesondere dessen Kopf (11) im Bereich des Durchgangs bzw. der Durchgangsbohrung (12) für das Spannmittel (15) teilbar ausgebildet ist.6. The device according to claim 5, d a d u r c h g e k e n n z e i c h n e t that the anchoring element, in particular its head (11) in the region of the passage or the through bore (12) for the clamping means (15) is divisible.
7. Vorrichtung nach einem der Ansprüche 1 bis 6, d a d u r c h g e k e n n z e i c h n e t , daß die Durchgänge (19) in den Distanzhülsen (16) sich konisch oder trompetenartig nach außen erweiternde Ein- bzw. Aus- trittsöffnungen (20) aufweisen, um im Bereich der Abstützung der Distanzhulsen (16) am zugeordneten. Verankerungselement (10) bzw. dessen Verankerungsteil (11) einen zwän- gungsfreien Übertritt des Spannmittels (15) von der Distanzhülse (16) in den Durchgang bzw. die Durchgangsbohrung (12) des Verankerungselements (10) bzw. umgekehrt sicherzustellen.7. Device according to one of claims 1 to 6, characterized in that the passages (19) in the spacer sleeves (16) have conical or trumpet-like outwardly widening inlet and outlet openings (20) in order to support the Spacer sleeves (16) on the assigned. Anchoring element (10) or its anchoring part (11) to ensure that the tensioning means (15) passes freely from the spacer sleeve (16) into the passage or the through bore (12) of the anchoring element (10) or vice versa.
8. Vorrichtung nach einem der Ansprüche 1 bis 7, d a d u r c h g e k e n n z e i c h n e t , daß sie auf dem Spannmittel (15) plazierbare Stützkugeln, insbesondere Spaltkugeln umfaßt, die jeweils zwischen zwei Distanzhülsen (16) einfügbar sind, um eine Änderung oder Anpassung der Distanzlänge durch Aneinanderreihung von zwei oder mehr Distanzhulsen gleicher oder unterschiedlicher Länge zu ermöglichen.8. Device according to one of claims 1 to 7, characterized in that it comprises on the clamping means (15) placeable support balls, in particular split balls, each of which can be inserted between two spacer sleeves (16) in order to change or adjust the distance length by stringing together to enable two or more spacer sleeves of the same or different length.
9. Vorrichtung nach einem der Ansprüche 1 bis 8, d a d u r c h g e k e n n z e i c h n e t , daß als Verankerungselemente Pedikelhaken oder Pedikelschrau- ben (10) dienen.9. Device according to one of claims 1 to 8, d a d u r c h g e k e n n z e i c h n e t that serve as anchoring elements pedicle hook or pedicle screws (10).
10. Vorrichtung nach Anspruch 9, d a d u r c h g e k e n n z e i c h n e t , daß bei Verwendung von Pedikelschrauben als Verankerungselement Kugelkopf-Schrauben dienen, in deren Kugelkopf (11) ein sich quer zur Schraubenlängsachse (21) erstreckender Durchgang, insbesondere Durchgangsbohrung (12) für das Spannmittel (15) ausgebildet ist.10. The device according to claim 9, characterized in that when using pedicle screws serve as anchoring element ball screws, in the ball head (11) a transverse to the longitudinal axis of the screw (21) extending passage, in particular through hole (12) for the clamping means (15) is.
11. Vorrichtung nach einem der Ansprüche 1 bis 10, d a d u r c h g e k e n n z e i c h n e t , daß der Spannmittel-Verankerungsteil des Verankerungselements, insbesondere der Kugelkopf (11) einer Kugelkopf-Pedikelschraube (10) um eine sich quer zur Längserstreckung des Spannmittels (15) erstreckende Achse bzw. um die Pedikelschrauben-Langsachse (21) drehbar gelagert ist. 11. Device according to one of claims 1 to 10, characterized in that the clamping means anchoring part of the anchoring element, in particular the ball head (11) of a ball head pedicle screw (10) about an axis extending transversely to the longitudinal extension of the clamping means (15) or around the pedicle screw longitudinal axis (21) is rotatably mounted.
EP98939650A 1997-07-31 1998-07-31 Device for stiffening and/or correcting a vertebral column or such like Withdrawn EP0999795A1 (en)

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DE19733160 1997-07-31
DE19733160 1997-07-31
DE19738968 1997-09-05
DE19738968A DE19738968B4 (en) 1997-07-31 1997-09-05 Device for stiffening and / or correcting a spinal column or the like
PCT/EP1998/004812 WO1999005980A1 (en) 1997-07-31 1998-07-31 Device for stiffening and/or correcting a vertebral column or such like

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