FR2718635A1 - Prothèse cervicale. - Google Patents
Prothèse cervicale. Download PDFInfo
- Publication number
- FR2718635A1 FR2718635A1 FR9404832A FR9404832A FR2718635A1 FR 2718635 A1 FR2718635 A1 FR 2718635A1 FR 9404832 A FR9404832 A FR 9404832A FR 9404832 A FR9404832 A FR 9404832A FR 2718635 A1 FR2718635 A1 FR 2718635A1
- Authority
- FR
- France
- Prior art keywords
- core
- prosthesis according
- lower plate
- cervical prosthesis
- grooves
- 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
Links
Classifications
-
- 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
- A61F2/442—Intervertebral or spinal discs, e.g. resilient
- A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
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- 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
- A61B17/86—Pins or screws or threaded wires; nuts therefor
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Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Neurology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
Prothèse cervicale, caractérisée en ce qu'elle comprend: - un plateau supérieur (1) dans la face inférieure duquel est ménagée une surface concave (4); - un plateau inférieur (2) dont la face supérieure est pourvue de rainures espacées de guidage (9); - un noyau d'articulation (3) comportant une surface supérieure convexe (15) destinée à s'emboîter dans ladite surface concave du plateau supérieur( (1) et dont la base est munie d'ailettes latérales (16) conformées pour pouvoir glisser dans lesdites rainures de guidage (9) et permettant le positionnement dudit noyau (3) sur la face supérieure du plateau inférieur (2) par un mouvement de coulissement dans un plan parallèle à ladite face supérieure.
Description
Prothèse cervicale.
La presente invention concerne une prothèse cervicale visant au remplacement du disque intervertébral cervical détérioré.
Afin de pallier aux handicaps découlant de la discectomie discale ou de l'arthrodèse, on a déjà proposé (WO-A-91/13598), une prothèse pour disques intervertébraux constituée, principalement, de deux plateaux munis, chacun, d'ailerons d'ancrage, séparés par un organe d'articulation constituée d'une calotte sphérique à base cylindrique implantée dans une cavité cylindrique de meme diamètre, réalisée dans la face supérieure du plateau inférieur, chacun des plateaux comportant, sur l'arrière, des orifices filetés disposes symétriquement de part et d'autre de la cavité cylindrique et parallèlement aux ailerons d'ancrage.
L'implantation de cette prothèse intervertébrale prévue pour l'étage lombaire et qui nécessite l'exécution de mortaises d'ancrage dans les vertèbres adjacentes au moyen de gabarits d1 d'ecartement et de mortaisage et d'un ciseau ostéotome, est une intervention difficile à exécuter et cette prothèse lombaire et sa méthode d'implantation, sont inapplicables à la restauration de la hauteur discale et de la mobilité de l'espace intersomatique des vertèbres cervicales. La nécessité de procéder à quatre ostéotomies et surtout l'impaction de la prothèse qui se fait en force, rendraient délicate une intervention au niveau cervical, en raison du risque d'ébranlement médullaire, et donc de paralysie.
On connait aussi (EP-A-0.566.810), un disque intervertébral artificiel comprenant un support supérieur et un support inférieur destinés à etre fixés à deux vertèbres contiguës et entre lesquels est engagé un insert composite constitué d'un corps central élastique solidaire de deux plaques rigidesdébordantes de liaison permettant l'insertion, par coulissement, de cet insert dans des gLissières ménagées dans les faces en regard desdits supports ; un dispositif de blocage élastique assurant le maintien dudit insert en position opérante.
Outre le fait que l'insert composite est une pièce difficile à réaliser, compte tenu de la nature des matériaux envisageables, le corps central élastique subit, lorsqu'il est implanté en position fonctionnelle, des forces d'écrasement et de torsion qui laissent craindre une altération rapide de ses qualités initiales et des riques sérieux de luxation. Cette prothèse intervertébrale est également inapplicable à la restauration de la hauteur discale et de ta mobilité de l'espace intersomatique des vertèbres cervicales. Effectivement, elle présente un ancrage tout à fait insuffisant sur les vertebres adjacentes et la migration éventuelle dans le canal pourrait également provoquer une paralysie médullaire, donc gravissime.
L'éjection du noyau ou de la prothèse dans les parties molles cervicales, serait responsable de problèmes laryngés et oesophagiens, voire de problèmes graves au niveau des gros vaisseaux du cou.
L'invention a notamment pour but de remédier aux inconvénients ou insuffisances des prothèses intervertébrales proposées à ce jour et notamment à leur totale inadéquation au domaine des vertèbres cervicales.
Selon l'invention, cet objectif est atteint grace à une prothèse cervicale comprenant principalement un plateau supérieur dans la face inférieure duquel est ménagée une surface concave ; un plateau inférieur dont la face supérieure est pourvue de rainures espacées de guidage, - un noyau d'articulation ou rotule comportant une surface supérieure convexe et dont la base est munie d'ai lettes latérales conformées pour pouvoir glisser dans lesdites rainures de guidage et permettant le positionnement dudit noyau sur la face supérieure du plateau inférieur, par un mouvement de coulissement dans un plan parallèle à ladite face supérieure.
Dans l'application au remplacement du disque intervertébral cervical, la prothèse de disque cervicale selon l'invention permet - une fixation parfaitement stable sans impaction en force; - de restaurer la hauteur de l'espace intersomatique ; - de restaurer la mobilité de cet espace ; - de procurer un effet antalgique lié à la résection du tissu discal pathologique et à l'ouverture des trous de conjugaison, occasionnant ainsi une décompression radiculaire ; - d'obtenir également un effet antalgique par restauration d'une congruence correcte des articulaires postérieures liée à la restauration de la hauteur discale.
Les buts, caractéristiques et avantages ci-dessus, et d'autres encore, ressortiront mieux de la description qui suit et des dessins annexés dans lesquels :
La figure 1 -est une vue de dessous du plateau supérieur de la prothèse.
La figure 1 -est une vue de dessous du plateau supérieur de la prothèse.
La figure 2 est une vue en coupe selon la ligne 2-2 de la figure 1.
La figure 3 est une vue de face de ce plateau supérieur.
La figure 4 est une vue de dessous du noyau d'articulation.
La figure 5 est une vue en coupe suivant la ligne 5-5 de la figure 4.
La figure 6 est une vue du côté arrière ou coté d'introduction du noyau d'articulation.
La figure 7 est une vue en plan du plateau inférieur.
La figure 8 est une vue en coupe selon la ligne 8-8 de la figure 7.
La figure 9 est une vue de face du plateau inférieur.
La figure 10 est une vue de face de la prothèse montrée en place entre deux vertèbres adjacentes.
La figure il est une vue en coupe selon la ligne 11-11 de la figure 10,
On se reporte auxdits dessins pour décrire un exemple avantageux, bien que nullement limitatif, de réalisation de la prothèse de disque cervicale selon l'invention.
On se reporte auxdits dessins pour décrire un exemple avantageux, bien que nullement limitatif, de réalisation de la prothèse de disque cervicale selon l'invention.
Cette prothèse comporte principalement - un plateau supérieur 1, - un plateau inférieur 2, - un noyau d'articulation ou rotule 3, intercalé entre les deux plateaux 1, 2.
Les trois parties composantes précitées ont une forme générale circulaire et il parait suffisant de prévoir leur exécution en seulement deux largeurs ou diamètres, par exemple de l'ordre de 13 mm et de 16 mm seulement.
Les plateaux 1 et 2 peuvent etre exécutés avec une hauteur unique, ce qui simplifie les références de matériel, mais le noyau prothétique 3 peut être réalisé en différentes hauteurs, ce qui permet de modifier la hauteur de l'espace distal.
Les plateaux prothétiques 1 et 2 peuvent avantageusement être exécutés en titane, tandis que le noyau d'articulation est de préférence exécuté en polyéthylène haute densité.
Le plateau supérieur 1 comporte, dans sa face inférieure, une surface concave 4, constituée par une cavité ayant avantageusement la forme d'une calotte sphérique. Ce plateau présente une plaque console antérieure 5 s'étendant vers le haut dans une direction parallèle ou sensiblement parallèle a l'axe dudit plateau. Dans cette plaque console de forme courbe, est ménagé un trou 6 pourvu d'une fraisure, pour le passage d'une vis de fixation.
Le plateau inférieur 2 comporte également une plaque console antérieure' 7 simiLaire, s'étendant vers le bas, et dans laquelle est aussi prévu un trou 8 pourvu d'une fraisure, pour le passage d'une vis de fixation.
La face supérieure du plateau inférieur est évidée, de manière à présenter deux rainures de guidage 9 espacées et parallèles. Selon une disposition caractérisque de l'invention, ces rainures 9 sont orientées parallèlement à l'axe du trou 8, comme le montre la figure 7. Elles sont ouvertes à leur extrémité antérieure et fermées à leur extrémité postérieure.
En outre, selon une autre disposition caractéristique de l'invention, une rampe de guidage 10 est ménagée entre les portions postérieures des rainures 9. Cette rampe de guidage comporte une extrémité antérieure courbe 10a et des bords parallèles lOb constituant les surfaces de guidage, ces bords 10b étant parallèles aux rainures 9.
La face supérieure du plateau 2 est ainsi constituée par des surfaces planes étagées 2a, 2b.
En avant et à distance de l'extrémité libre arrondie 10a de la rampe 10, la surface inférieure 2a du plateau 2, est munie d'un petit ergot 11 orienté vers le haut.
De manière avantageuse, les surfaces extérieures des plateaux 1 et 2 destinées à se trouver en contact avec les vertèbres adjacentes, sont pourvues de rainures 12, 13, respectivement, afin que les parties en contact avec l'os soient réhabitables par ostéogenèse. Ces rainures sont orientées perpendiculairement à l'axe des trous 6, 8, respectivement. ElLes sont délimitées par des nervures de section triangulaire dont la face pentée est orientée en direction du bord d'introduction des plateaux 1 et 2, c'est-à-dire en direction de leur bord opposé à la plaque console antérieure 5 et 7, respectivement.
Le noyau d'articulation 3 est, comme indiqué précédemment, avantageusement réalisé en polyéthylène haute densité ou en tout autre matériau biocompatible présentant les caractéristiques mécaniques souhaitables.
Par exemple, ce noyau pourrait être exécuté en polyéthylène recouvert de céramique permettant d'éviter tout fluage et de diminuer l'usure.
Ce noyau comporte un corps cylindrique 14 qui peut être réalisé avec des hauteurs différentes, selon les besoins. Il présente une surface supérieure convexe 15 laquelle peut avoir la forme d'une calotte sphérique ayant un rayon sensiblement identique à celui de la concavité 4 du plateau supérieur 1.
Dans sa partie inférieure, le noyau prothétique comporte latéralement, des ailettes parallèles 16 dirigées vers l'extérieur.
En outre, dans sa partie postérieure ou partie d'introduction, la face inférieure du noyau 3 présente un évidement pour le logement des parties saillantes de la face supérieure du plateau inférieur 2. Notamment, la face inférieure du noyau 3 comporte une gorge de guidage 17 coopérant avec la rampe de guidage double 10 du plateau 2, pour s'opposer à tout effet de coincement, lors de l'introduction, ou du retrait, par coulissement, dudit noyau entre les plateaux prothétiques. Cette gorge de guidage présente des bords 17b parallèles et un fond courbe 17a.
La face inférieure du noyau 3 présente des surfaces planes étagées 3a, 3b destinées à se trouver en contact avec les surfaces planes étagées 2a, 2b du plateau inférieur 2 et coopérant avec ces dernières lors de son engagement entre les plateaux 1 et 2 ou lors de son retrait.
En avant et à distance de la gorge de guidage 17, la face inférieure du noyau 3 présente un petit trou borgne 18 destiné à coopérer avec l'ergot 11 du plateau inférieur 2, lequel vient s'enclaver dans ledit trou, lorsque ledit noyau se trouve en position opérante.
Les surfaces de la prothèse cervicale décrite ci-dessus et notamment ses surfaces en contact avec les vertèbres cervicales contiguës, sont avantageusement couverte d'un plasma d'hydroxy apatite, afin d'améliorer l'interface entre la prothèse et ITOS adjacent. La prothèse pourrait également être recouverte d'un plasma de titane.
On décrit ci-apres le mode de pose de la prothèse cervicale selon l'invention.
1. - La conformation de l'espace récepteur est d'abord adaptée à la taille de la prothèse, à l'aide d'un matériel ancillaire adapté connu en.soi, ce matériel consistant en un gabarit permettant une découpe osseuse franche et de dimension exacte.
En effet, il existe de grandes variabilités de l'anatomie des structures ostéodiscales au niveau cervical, tant en forme qu'en dimension, ce qui nécessiterait, le cas échéant, de multiples tailles et formes des plateaux prothétiques, voire la fabrication d'une prothèse sur mesure. Il apparait plus simple d'adapter l'os avoisinant à la prothèse, ce qui procure par ailleurs une meilleure stabilité des plateaux prothétiques.
Par ailleurs, cela évite une impaction en force de la prothèse, ce qui provoquerait un important risque de souffrance médullaire par ébranlement, voire par choc direct.
2. - Les plateaux prothétiques supérieur 1 et inférieur 2 sont ensuite fixés aux corps vertébraux adjacents C1, C2 par l'intermédiaire de leur plaque console antérieure 5, 7, respectivement, et au moyen d'une vis cortico-spongieuse 19, lesdites plaques consoles antérieures étant appliquées contre la surface antérieure desdits corps vertébraux.
3. - Le noyau prothétique ou rotule 3 est ensuite engage, par coulissement, à la manière d'un tiroir, entre les plateaux 1 et 2, les ailettes latérales 16 du noyau 3 glissant dans les rainures 9 du plateau inférieur 2 lors de l'engagement dudit noyau. En fin de course, l'extrémité libre de la rampe double de guidage 10 vient buter contre le fond de la gorge 17, tandis que - d'une part, la partie 15 formant rotule du noyau vient s'emboiter dans la concavité 4 du plateau supérieur 1, et que, - d'autre part, l'ergot 11 vient s'enclaver dans le trou 18 du noyau, ce qui empêche toute mobilisation secondaire dudit noyau.
On conçoit que le noyau 3 est ainsi positionné sur le plateau inférieur 2 au moyen d'un système anti-rotatoire sur l'axe de la prothèse, constitué par les surfaces de guidage parallèles de ces derniers et d'un système anti-exclusion constitué par le fond de la gorge 17 et par le dispositif de verrouillage 11-18.
D'autre part, les surfaces en contact du plateau superieur et de la rotule permettent un débattement angulaire égal ou inférieur à 10 degrés.
On observe qu'en position opérante, il n'existe qu'une seule surface de glissement, située entre le plateau supérieur 1 et le noyau 3, alors que la fixation rigide desdits noyau au plateau inférieur 2 empêche tout risque de luxation.
D'autre part, le noyau 3 est mis en place dans un système de tiroir, ce qui permet de le fixer rigidement au plateau inférieur 2 après avoir fixé les deux plateaux prothétiques seulement, et non pas dans le même temps opératoire.
En outre, le remplacement de la rotule en cas de nécessité peut s'opérer dans les meilleures conditions de facilité et de rapidité.
Claims (10)
1. - Prothèse cervicale, caractérisée en ce qu'elle comprend : - un plateau supérieur (1) dans la face inférieure duquel est ménagée une surface concave (4) ; - un plateau inférieur (2) dont la face supérieure est pourvue de rainures espacées de guidage (9) ; - un noyau d'articulation (3) comportant une surface supérieure convexe (15) destinée à s'emboiter dans ladite surface concave du plateau supérieur( (1) et dont la base est munie d'ailettes latérales (16) conformées pour pouvoir glisser dans lesdites rainures de guidage (9) et permettant le positionnement dudit noyau (3) sur la face supérieure du plateau inférieur (2) par un mouvement de coulissement dans un plan parallèle à ladite face supérieure.
2. - Prothèse cervicale selon la revendication 1, caractérisée en ce que le plateau inférieur (2) comporte sur sa face supérieure, entre la portion postérieure des rainures de guidage (9) et à distance de ces dernières, une rampe de guidage double (10) dont les bords latéraux (10b) sont parallèles auxdites rainures (9), et en ce que le noyau d'articulation (3) comporte une gorge de guidage (17) dont les bords parallèles (17b) coopèrent avec les bords opposés de la rampe double (10) pour réaliser un guidage complémentaire dudit noyau d'articulation, lors de son engagement entre les plateaux supérieur (1) et inférieur (2).
3. - Prothèse 'cervicale suivant l'une quelconque des revendications 1 à 3, caractérisée en ce que les plateaux supérieur (1) et inférieur (2) comportent, chacun, une plaque console antérieure de fixation (5, 7), respectivement dirigée vers le haut et vers le bas, ces plaques consoles antérieures étant pourvues d'un trou (6, 8) pour le passage d'une vis de fixation (19).
4. - Prothèse cervicale selon la revendication 3, caractérisée en ce que l'axe du trou (8) de la plaque console antérieure de fixation (7) du plateau inférieur, est parallèle aux rainures (9) dudit plateau inférieur.
5. - Prothèse cervicale suivant l'une quelconque des revendications 2 à 4, caractérisée en ce que le plateau inférieur (2) comporte, en avant et dans l'alignement de sa rampe de guidage double (10), un petit ergot (11), et en ce que la face inférieure du noyau d'articulation (3) est pourvue d'un petit trou (18) dans lequel est enclavé ledit petit ergot lorsque ledit noyau est positionné de façon opérante sur ledit plateau inférieur (2).
6. - Prothèse cervicale selon l'une quelconque des revendications 2 à 5, caractérisée en ce que la rampe de guidage double (10) comporte une extrémité libre courbe (10a) tandis que la gorge (17) du noyau (3) dans laquelle peut coulisser ladite rampe de guidage, comporte un fond courbe (17a).
7. - Prothèse cervicale selon l'une quelconque des revendications 1 à 6, caractérisée en ce que la base du noyau d'articulation (3) et la face supérieure du plateau inférieur (2) comportent des surfaces planes étagées (3a, 3b ; 2a, 2b) glissant les unes sur les autres, lors de l'engagement ou du retrait dudit noyau d'articulation.
8. - Prothèse cervicale suivant l'une quelconque des revendications 3 à 7, caractérisée en ce que les surfaces extérieures des plateaux prothétiques (1, 2) destinées à se trouver en contact avec les vertèbres adjacentes, sont pourvues de rainures (12, 13) orientées perpendiculairement aux trous (6, 8) des plaques consoles antérieures de fixation (5, 7).
9. - Prothèse cervicale selon la revendication 8, caractérisée en ce que les rainures (12, 13) sont délimitées par des filets saillants ou nervures ayant un profil triangulaire dont la face pentée est orientée en direction du bord d'introduction des plateaux (1, 2).
10. - Prothèse cervicale suivant l'une quelconque des revendications 1 à 9, caractérisée en ce que ses surfaces destinées à entre placées en contact avec le corps osseux de deux vertèbres contigus, sont recouvertes d'hydroxy-apatite.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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FR9404832A FR2718635B1 (fr) | 1994-04-15 | 1994-04-15 | Prothèse cervicale. |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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FR9404832A FR2718635B1 (fr) | 1994-04-15 | 1994-04-15 | Prothèse cervicale. |
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FR2718635A1 true FR2718635A1 (fr) | 1995-10-20 |
FR2718635B1 FR2718635B1 (fr) | 1996-07-05 |
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FR9404832A Expired - Lifetime FR2718635B1 (fr) | 1994-04-15 | 1994-04-15 | Prothèse cervicale. |
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