ES2211039T3 - Protesis interespinosa. - Google Patents

Protesis interespinosa.

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Publication number
ES2211039T3
ES2211039T3 ES99904916T ES99904916T ES2211039T3 ES 2211039 T3 ES2211039 T3 ES 2211039T3 ES 99904916 T ES99904916 T ES 99904916T ES 99904916 T ES99904916 T ES 99904916T ES 2211039 T3 ES2211039 T3 ES 2211039T3
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Prior art keywords
prosthesis
ears
interspinous
prosthesis according
ligature
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Jean Taylor
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • 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
    • A61B17/7053—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant with parts attached to bones or to each other by flexible wires, straps, sutures or cables
    • 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
    • A61B17/82—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin for bone cerclage
    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/842—Flexible wires, bands or straps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06052—Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2/30721—Accessories
    • A61F2/30724—Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30159—Concave polygonal shapes
    • A61F2002/30166—H-shaped or I-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30563—Special structural features of bone or joint prostheses not otherwise provided for having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30777—Oblong apertures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30784—Plurality of holes
    • A61F2002/30785—Plurality of holes parallel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00—Surgery
    • Y10S606/907—Composed of particular material or coated
    • Y10S606/91—Polymer

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Neurology (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)
  • Prostheses (AREA)

Abstract

Prótesis interespinosa, realizada en un material multidireccionalmente flexible y elástico, y que comprende una porción interespinosa (5) que tiene un espesor ligeramente superior al espacio interespinoso anatómico cuando el raquis está en lordosis, de tal manera que esta poción (5) está ligeramente comprimida cuando la prótesis (2) está colocada entre las apófisis espinosas (3) de dos vértebras (4), caracterizada porque presenta dos pares de orejas (6) que forman resalte longitudinalmente a uno y otro lado de su porción interespinosa (5), teniendo estas orejas (6) unas alturas importantes con respecto a la altura total de la prótesis (2), del orden, para cada par de orejas (6), del 30 al 45% de esta altura total; cada par de orejas (6) forma un cuerpo con dicha porción interespinosa (5) y delimita un vaciado profundo (9) apto para recibir sin juego la apófisis espinosa (3) correspondiente, con una amplia superficie de contacto de estas orejas (6) y de esta apófisis (3).

Description

Prótesis interespinosa.
La presente invención se refiere a una prótesis interespinosa, destinada a producir una asistencia discal y a amortiguar los movimientos relativos de dos vértebras adyacentes cuando tienen lugar movimientos de flexión o de extensión del raquis.
La patente francesa nº 2 717 675 presentada a nombre del solicitante, describe una prótesis que comprende un cuerpo de material flexible y dos inserciones rígidas en forma de V. El cuerpo está destinado a ser insertado entre las apófisis espinosas de dos vértebras para mantener una separación anatómica flexible entre éstas, permitiendo al mismo tiempo su movimiento relativo. Las inserciones permiten delimitar unas ranuras para recibir las apófisis espinosas de las dos vértebras y comprenden un medio para fijar la prótesis a estas apófisis.
La prótesis según esta patente anterior es satisfactoria en la práctica, pero ha resultado que podía ser mejorada, en particular en lo que concierne a su estructura y a su resistencia a los esfuerzos repetidos que sufre. Las uniones entre el cuerpo de la prótesis y las inserciones son en efecto muy solicitadas.
La solicitud de patente francesa nº 2 623 085 describe una cala con estructura en forma de H que presenta, sobre solamente una de sus dos caras extremas, o sobre las dos, una garganta dimensionada para recibir, con un ligero juego lateral, una apófisis espinosa respectiva. Cada garganta está delimitada por unos labios de pequeña altura que, vistos de lado, tienen una forma en arco de círculo.
La presente invención tiene por objeto proporcionar una prótesis interespinosa que asegura un perfecto sostenimiento de las dos vértebras interesadas, y permitiendo por consiguiente una perfecta asistencia discal, debiendo esta prótesis poder resistir los esfuerzos repetidos ejercidos sobre ella por las apófisis, debiendo estar conformada de manera que sufra sólo un pequeño desgaste y debiendo presentar una estabilidad importante en todas las direcciones, en particular con respecto a los movimientos de "báscula lateral", es decir unos movimientos provocados por la torsión del raquis según su eje.
La prótesis objeto de la presente solicitud de patente está, de forma conocida, realizada en un material multidireccionalmente flexible y elástico, y comprende una porción interespinosa que tiene un espesor ligeramente superior al espacio interespinoso anatómico cuando el raquis está en lordosis, de tal manera que esta porción está ligeramente comprimida cuando la prótesis es colocada entre las apófisis espinosas de dos vértebras.
Según la invención, la prótesis presenta dos pares de orejas que forman resalte longitudinalmente a uno y otro lado de su porción interespinosa, y que tienen unas alturas importantes con respecto a la altura total de la prótesis, del orden, para cada par de orejas de 30 al 45% de esta altura total, formando cada par de orejas un cuerpo con dicha porción interespinosa y delimitando un vaciado profundo apto para recibir sin juego la apófisis espinosa correspondiente, con una amplia superficie de contacto de estas orejas y de esta apófisis.
Estos vaciados profundos aseguran un perfecto mantenimiento de la prótesis en posición entre las apófisis espinosas de las vértebras, en todas las direcciones, y en particular con respecto a los movimientos que resultan de una torsión del raquis según su eje, que tienden a crear una báscula lateral de la prótesis.
Además y sobre todo, la combinación de esta estructura de material multidireccionalmente flexible y elástico, por una parte, y de estos dos pares de orejas de longitud importante y que forman cuerpo con la porción interespinosa de la prótesis, por otra parte, permite, cuando esta porción interespinosa es puesta a compresión, llevar las orejas al apoyo contra las caras laterales de las apófisis espinosas, por un efecto de "autoapriete".
Este mantenimiento de la prótesis, aliado a la flexibilidad de esta prótesis, permite reducir notablemente los rozamientos entre la prótesis y las apófisis, lo que hace inútiles las inserciones de material rígido de la prótesis según la técnica anterior. La prótesis según la invención es por tanto monobloque, lo que resuelve además los problemas ligados a la fabricación y sobre todo a la resistencia en el tiempo de la prótesis según la técnica anterior.
La prótesis según la invención conjuga un efecto de supresión de los contactos nuevamente creados entre las facetas a consecuencia de apoyos intensos y un efecto de reducción de la presión interdiscal, que permite una ralentización del envejecimiento discal.
Las indicaciones principales de esta prótesis son:
-
artropatía de las facetas;
-
prevención de la degenerescencia discal que se produce consecutivamente a una artrodesis;
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"alivio" del anulus discal subsistente después del tratamiento quirúrgico de una hernia discal.
Las caras internas de dos orejas de un mismo par de orejas están preferentemente inclinadas de manera que converjan una hacia la otra en dirección al fondo del vaciado que delimitan.
Se obtiene así un relativo acuñado de la apófisis por ligera deformación elástica de las orejas, que contribuye al mantenimiento de la prótesis con respecto a las apófisis.
Las orejas tienen ventajosamente un espesor medio relativamente importante con respecto a la anchura media de la prótesis, del orden, para cada oreja, del 25 al 35% de esta anchura media.
Estas orejas forman así perfectamente un cuerpo con la porción interespinosa de la prótesis, lo que asegura su resistencia a los esfuerzos repetidos sufridos por ésta.
Preferentemente, la cara anterior de la prótesis se une respectivamente a las caras superior e inferior de la prótesis por unas zonas talladas al bies y/o redondeadas, que permiten el borrado total de los ángulos que formarían sino estas caras dos a dos.
La prótesis puede así ser colocada al nivel de la base de las apófisis espinosas, en la unión lámina-espinosa de las vértebras, lo que reduce la amplitud de los esfuerzos en torsión que las apófisis son susceptibles de ejercer sobre ella.
Ventajosamente, la prótesis está perforada por lo menos por un conducto transversal practicado al nivel de su porción interespinosa, permitiendo este conducto el acoplamiento de una unión destinada a unir estrechamente la prótesis a por lo menos una de las apófisis espinosas.
Estas uniones tienen simplemente por objeto asegurar la colocación de la prótesis, estando ésta, por su estructura citada, autoapretada entre las apófisis.
Preferentemente, la pared de la porción interespinosa que delimita este conducto está ensanchada a nivel de los extremos de este conducto, para eliminar cualquier arista susceptible de crear un punto de desgaste de dicha unión.
Según una forma de realización preferida de la invención, en este caso, la prótesis comprende dos conductos transversales que reciben cada uno una ligadura para unirla a la apófisis espinosa de la vértebra correspondiente.
La prótesis según la invención está ventajosamente dispuesta en una vaina textil que encaja con su forma.
Esta vaina evita el contacto directo del material sintético que la constituye, en particular silicona, con los tejidos circundantes, y facilita la integración de la prótesis con estos tejidos. Además, la misma constituye un medio de limitación del estiramiento de la prótesis, que elimina cualquier riesgo de rotura de ésta en caso de carga excepcionalmente elevada.
Ventajosamente, esta vaina comprende una bandeleta cosida a ella en el lado posterior de la prótesis, que puede servir de punto de anclaje para una ligadura protésica de sustitución del ligamento inter y supraespinoso.
Para su mejor comprensión, la invención se describe de nuevo a continuación con referencia al plano esquemático anexo que representa, a título de ejemplo no limitativo, una forma de realización preferida de la prótesis interespinosa a la que se refiere.
La figura 1 es una vista en perspectiva de una pieza de silicona que comprende esta prótesis;
las figuras 2 y 3 son unas vistas en sección de esta pieza según respectivamente las líneas II-II y III-III de la figura 1, y
las figuras 4 y 5 son vistas en perspectiva de la prótesis en el curso de dos fases de implantación sobre unas vértebras.
Las figuras 1 a 3 representan, bajo diferentes ángulos, una pieza 1 de silicona que constituye el núcleo de una prótesis interespinosa 2. Como aparece en las figuras 4 y 5, esta prótesis 2 está destinada a ser dispuesta entre las apófisis espinosas 3 de dos vértebras adyacentes 4 para amortiguar los movimientos relativos de estas vértebras 4 cuando tienen lugar movimientos de flexión o de extensión del raquis.
La pieza 1 comprende una porción interespinosa 5 y dos pares de orejas laterales 6 que forman resalte longitudinalmente a uno y otro lado de esta porción 5.
La porción 5 tiene un espesor ligeramente superior al espacio interespinoso anatómico cuando el raquis está en lordosis; la misma está por tanto ligeramente comprimida cuando la prótesis 2 está dispuesta entre las apófisis 3.
Esta porción 5 está perforada por dos conductos transversales 7 que permiten, como muestran las figuras 4 y 5, la introducción de dos ligaduras 8 que sirven para unir estrechamente la prótesis 2 con cada una de las apófisis 3. La pared 5a de la porción 5 que delimita cada uno de estos conductos 7 por el lado de las orejas 6 correspondientes está ensanchado al nivel de los extremos del conducto 7, para eliminar cualquier arista susceptible de crear un punto de desgaste de la ligadura 8.
Las orejas 6 tienen unas alturas importantes con respecto a la altura total de la prótesis 2, del orden, para las orejas superiores e inferiores, del 33% y 40% de esta altura total, respectivamente.
Las caras internas de dos orejas 6 de un mismo par de orejas están inclinadas de forma que converjan una hacia la otra en dirección al fondo del vaciado 9 que ellas delimitan entre sí; en el ejemplo representado en el plano, el ángulo formado por las dos paredes de las orejas superiores es del orden de 27º, mientras que el ángulo formado por las dos paredes de las orejas inferiores es del orden de 43º.
Las orejas 6 tienen además un espesor medio relativamente importante con respecto a la anchura media de la prótesis 2, del orden, para las orejas superiores e inferiores, del 27% y del 30% de esta anchura media, respectivamente.
Aparece además en las figuras 1 y 2 que la cara anterior de la pieza 1 se une respectivamente a las caras superior e inferior de ésta por las zonas 10 talladas al bies o redondeadas, que permiten el borrado total de los ángulos que formarían sino estas caras anterior y superior o inferior entre ellas.
La pieza 1 está dispuesta en una vaina textil 11, de poliester, que encaja con su forma y que está perforada por orificios en correspondencia con las aberturas de los conductos 7.
Esta vaina 11 comprende una bandeleta 12 cosida a ella en el lado posterior de la prótesis 2, destinada a servir de punto de anclaje para una ligadura protésica de sustitución del ligamento inter y supraespinoso.
Aparece en las figuras 4 y 5 que cada ligadura 8 está constituida por una trenza de la que un extremo está engarzado sobre el extremo de una aguja curva 15 y cuyo otro extremo presenta un aro 16.
En la práctica, la prótesis 2 está insertada en el espacio interespinoso destinado a recibirla. Gracias a sus zonas 10, la misma puede ser insertada en el fondo de este espacio, hasta la unión entre las láminas y las espinosas de las vértebras 4.
Cada ligadura 8 es introducida en el conducto 7 que le corresponde, y después es acoplada, gracias a la aguja 15, alrededor de la apófisis espinosa 3 correspondiente, y después a través del aro 16. Después del tensado adecuado de la ligadura 8, una pieza de tope (no representada) que comprende un collarín de tope y un manguito susceptible de ser engarzado alrededor de la ligadura 8, es acoplada sobre esta ligadura 8 hasta que dicho collarín queda apoyado contra el aro 16. Dicho manguito es entonces engarzado sobre la ligadura 8 para asegurar la fijación de esta ligadura, y el extremo libre inutilizado de la ligadura 8 es cortado a ras de este manguito.
Desde luego la invención no está limitada a la forma de realización descrita anteriormente a título de ejemplo sino que abarca, por el contrario, todas las variantes de realización. Así, la pieza 1 podría ser utilizada sola, sin la vaina 11, constituyendo esta pieza 1 entonces ella misma la prótesis según la invención.

Claims (9)

1. Prótesis interespinosa, realizada en un material multidireccionalmente flexible y elástico, y que comprende una porción interespinosa (5) que tiene un espesor ligeramente superior al espacio interespinoso anatómico cuando el raquis está en lordosis, de tal manera que esta poción (5) está ligeramente comprimida cuando la prótesis (2) está colocada entre las apófisis espinosas (3) de dos vértebras (4), caracterizada porque presenta dos pares de orejas (6) que forman resalte longitudinalmente a uno y otro lado de su porción interespinosa (5), teniendo estas orejas (6) unas alturas importantes con respecto a la altura total de la prótesis (2), del orden, para cada par de orejas (6), del 30 al 45% de esta altura total; cada par de orejas (6) forma un cuerpo con dicha porción interespinosa (5) y delimita un vaciado profundo (9) apto para recibir sin juego la apófisis espinosa (3) correspondiente, con una amplia superficie de contacto de estas orejas (6) y de esta apófisis (3).
2. Prótesis según la reivindicación 1, caracterizada porque las caras internas de dos orejas (6) de un mismo par de orejas están inclinadas de manera que converjan una hacia la otra en dirección al fondo del vaciado (9) que delimitan.
3. Prótesis según la reivindicación 1 o la reivindicación 2, caracterizada porque las orejas (6) tienen un espesor medio relativamente importante con respecto a la anchura media de la prótesis (2), del orden, para cada oreja (6), del 25 al 35% de esta anchura media.
4. Prótesis según una de las reivindicaciones 1 a 3, caracterizada porque su cara anterior se une respectivamente a sus caras superior e inferior por unas zonas (10) talladas al bies y/o redondeadas, que permiten el borrado total de los ángulos que formarían sino estas caras dos a dos.
5. Prótesis según una de las reivindicaciones 1 a 4, caracterizada porque está perforada por lo menos por un conducto transversal (7) practicado a nivel de su porción interespinosa (5), permitiendo este conducto (7) la introducción de una ligadura (8) destinada a unir estrechamente la prótesis (2) a por lo menos una de las apófisis espinosas (3).
6. Prótesis según la reivindicación 5, caracterizada porque la pared (5a) de la porción interespinosa (5) que delimita dicho conducto (7) está ensanchada a nivel de los extremos de este conducto (7), para eliminar cualquier arista susceptible de crear un punto de desgaste de dicha ligadura (8).
7. Prótesis según la reivindicación 5 o la reivindicación 6, caracterizada porque comprende dos conductos transversales (7) que reciben cada uno una ligadura (8) para unirla a la apófisis espinosa (3) de la vértebra (4) correspondiente.
8. Prótesis según una de las reivindicaciones 1 a 7, caracterizada porque está colocada en una vaina textil (11) que encaja con su forma.
9. Prótesis según la reivindicación 8, caracterizada porque la vaina (11) comprende una bandeleta (12) cosida a ella en el lado posterior de la prótesis, destinada a servir de punto de anclaje a una ligadura protésica de sustitución del ligamento inter- y supraespinoso.
ES99904916T 1998-02-20 1999-02-19 Protesis interespinosa. Expired - Lifetime ES2211039T3 (es)

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EP1056408B1 (fr) 2003-12-17
FR2775183A1 (fr) 1999-08-27
US6626944B1 (en) 2003-09-30
DE69913659T2 (de) 2004-06-09
DE69913659D1 (de) 2004-01-29
EP1056408A1 (fr) 2000-12-06
FR2775183B1 (fr) 2000-08-04

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