JP2008525130A - 全脊椎円板の置換のための装置及び方法 - Google Patents
全脊椎円板の置換のための装置及び方法 Download PDFInfo
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- JP2008525130A JP2008525130A JP2007548663A JP2007548663A JP2008525130A JP 2008525130 A JP2008525130 A JP 2008525130A JP 2007548663 A JP2007548663 A JP 2007548663A JP 2007548663 A JP2007548663 A JP 2007548663A JP 2008525130 A JP2008525130 A JP 2008525130A
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Abstract
Description
・ 真後方又は経椎間孔刺入法に比べて椎間腔に対して幅広い開口が達成でき;
・ 外科医は神経構造を通過し、面関節を切開する必要はなく;
・ 正確な軌道の検出が横突起の可視化により可能となり;
・ 患者は背部固定治療であるかのように腹臥位であり;
・ 外科医は患者の位置決めと切開に慣れている。
A)外側、内方の背部切開を行う。すなわち、腰背筋膜をターゲットにすることで中央縦断面から離れる。
B)キルシュナー鋼線を用いて罹患した椎間板に近づく。
C)キルシュナー鋼線に沿ってトロカールとプロテクションスリーブを椎間板に挿入する。
D)切削工具を用いて、繊維軟骨椎間板に、幅がWである刺入口と面積を削り取る。
E)円板材を除去する。
F)手術用具を使用して椎体に隣接する上下脊椎端板を洗浄する。
G)デストラクトールを使用して椎間腔を分離又は拡大させる。
H)インプラントホルダーを使用して、人工椎間板を刺入口に挿入する。
・ 第一及び第二の人工成分は外側端方向の一端に小幅ながら、関節部が設置される中間面に隣接するのに適切な幅を有する。前記の小幅は椎間孔外刺入法による挿入を可能にし、前記の適切な幅は中間面に隣接し、関節部は自然の椎間円板に適合できる構造をしている。
・ 人工椎間板の退化による椎体の骨端板の形態変化、即ち、時間と共とする更に変動のため特別な注意を払い、第一及び第二の人工成分における不必要な部材(プレートに連結する骨)が除去される。
・ 脊椎端板の後部周辺上の骨棘を除去しないという外科医の決定が考慮可能である。即ち、人工椎間板が凹凸部の周辺で操作可能であるから人工椎間板の設置が簡単になる。
a)ポリエチレン・グリコール、好ましくはポリエチレン・グリコールアクリレート;
b)N−ビニルピロリドン;
c)ビニル、好ましくはビニル・アルコール;
d)スチレン
・ 二つの成分はモジュール様式に配置していて、回転の中心の位置の高さが調整可能である。
・ 成分の球状キャップの半径もさらに異なり、人工椎間板の回転中心に調整可能である。
・ 回転の中心の位置、角状、人工椎間板の並進運動部分が相対的に広範囲で自由に選択可能であり、人工成分は互いに横中央軸に沿って一部並進運動を行う。
・ 異なる半径を有する球状キャップを含むことが出来るという点で人工成分は球状キャップの半径が大きくなればなるほど偏位中の並進運動の部分は大きくなり、患者の脊柱の湾曲の際に面関節に過度の圧力がかかり、その変質を加速させる。
・ 人工成分の高さと対応する人工椎間板の関節球状キャップの半径は変化することができ、違う椎間腔の大きさに適応可能である。
1. 背部の外側中部におよそ7cmの切開12を行う。すなわち、筋肉の損傷を最小限にするため、中央縦断面2から離れた腰背筋膜をターゲットにする。(図3)
2. 罹患した椎間板3に横突起6に向かう椎間孔進路23内へ、キルシュナー鋼線14を近付ける。画像増強などのX線制御の使用は必須である。(図5)
3. 肋骨突起17を通ってキルシュナー鋼線14に沿ってトロカール(trockar)15とプロテクションスリーブ16を罹患した椎間板3に差し込む。(図6)
4. 切削工具19(図7)を使用して、前縦靱帯5(図1)と後縦靱帯4(図1)を離れて繊維軟骨椎間板18に、幅がWで高さがHである刺入口9を削る。
5. プロテクションスリーブ16を貫通する掻爬、骨鉗子、スプーンを使用して円板材を移動させる。好ましくは内視鏡を使用する。
6. 隣接する上下脊椎体10;11の端板を洗浄する。とくに、水ジェット若しくは超音波装置のような特定の道具を使用する。好ましくは内視鏡を使用する。
7. 若干曲げられたデストラクトール(distractor)20を使用して罹患した椎間円板3を移動させ、外科医に位置が自由に見えるようにする。分離はプロテクションスリーブ16(図6)又は軟組織開創器(図9)を使用して行われる。
8. インプラントホルダー23を使用して、人工椎間板30を刺入口9に挿入する。例えば、イメージ増強管などのX線制御を使用して人工椎間板30の位置をコントロールすることは必須となる。(図10)
「腰部と腰仙椎の脊椎の後側方固定術」
J Bone Joint Surg Am. 1953年10月 35−A(4):1014−8
ワトキンス メルビン B
「偽関節および腰仙椎の背部要素欠陥に関する後側方固定術」
Clin Orthop Relat Res. 1964年7〜8月 35:80−5
Claims (40)
- 背部刺入法による罹患した椎間板の全置換方法であって、罹患した椎間板(3)の円板物質を除去するステップ及び椎間孔外刺入進路(23)に沿って人工椎間板(30)を椎間腔に挿入するステップから構成される方法。
- 椎間孔外刺入進路(23)は横突起(6)の正面内を通る請求項1に記載の方法。
- 更に以下のステップ、
A)外中部の背部切開(12)を実施し、即ち、腰背筋膜をターゲットにすることで中央縦断面(2)から離れ、
B)キルシュナー鋼線(14)を使用して罹患した椎間板(3)に接近し、
C)キルシュナー鋼線(14)に沿ってトロカール(15)とプロテクションスリーブ(16)を椎間板(3)に挿入し、
D)切削工具(19)を使用して、繊維軟骨椎間板(18)に、幅がWで高さがHである刺入口(9)を削り、
E)医療道具を使用して円板材を除去し、
F)医療道具を使用して椎体に隣接する上下脊椎端板(10;11)を洗浄し、
G)デストラクトール(20)を使用して椎間腔を分離又は拡大させ、
H)インプラントホルダー(22)を使用して、人工椎間板(30)を刺入口(9)に挿入するステップから構成される請求項1又は2に記載の方法 - 医療道具であるプロテクションスリーブ(16)を使用して円板材を除去する請求項3に記載の方法。
- 刺入口(9)は前縦靱帯と後縦靱帯からの間隔X>0である処に削る請求項3又は4に記載の方法。
- 間隔Xの数値が2mmから38mmである請求項5に記載の方法。
- 刺入口(9)の幅Wの数値が8mmから36mmである請求項3〜6のいずれか一項に記載の方法。
- 刺入口(9)の面積が24mm2から684mm2である(高さは3mmから19mmである)請求項3〜7のいずれか一項に記載の方法。
- プロテクションスリーブ(16)を使用して、処理される円板腔に隣接する椎体間の分離を行う請求項3〜8のいずれか一項に記載の方法。
- 外科医が位置を自由に見えるよう処理される円板腔に隣接する椎体の分離作業が若干湾曲したデストラクトール(20)を使用して行われる請求項3〜9のいずれか一項に記載の方法。
- 全円板置換治療が面関節の切開無しで行われる請求項1〜10のいずれか一項に記載の方法。
- 全円板置換治療が横突起の切開無しで行われる請求項1〜11のいずれか一項に記載の方法。
- 治療される椎間腔に対する接近は基本的に真直である請求項1〜12のいずれか一項に記載の方法。
- チューブにより切開が減少される請求項1〜13のいずれか一項に記載の方法。
- 脊髄をパスしたり、神経根を固定、移動、印付けをすることで神経構造に対する損傷を削減する請求項1〜14のいずれか一項に記載の方法。
- 人工椎間板(100)、特に人工椎間円板であって、
A)椎柱に隣接する第一端板を連結するため中央軸(103)に横に設置された第一接合表面(107)を有する第一人工成分(101)と、
B)椎柱に連接する第二端板を連結するため中央軸(103)に横に設置された第二接合表面(108)を有する第二人工成分(102)で構成され、
C)前記の第一及び第二の人工成分(101;102)は関節部(106)により連接され、これにより
D)前記の中央軸(103)に平行して見る場合、前記の第一及び第二の人工成分(101;102)は長軸(127)と横短軸(128)を有する細長の形状をしていて、
E)前記の中央軸(103)、長軸(127)と横短軸(128)が互いに交差し、前記の中央軸(103)と横短軸(128)は中間面(126)を形成し、
F)前記の第一及び第二の人工成分(101;102)が、前記の中央軸(103)に垂直する断面領域を有し、
G)前記の断面領域は、前記中間面(126)の反対側及び長軸(127)の同じ側に位置する少なくとも二つの凹面(125)で構成される人工椎間板。 - 前記の第一および第二人工成分(101;102)の前記の断面領域は細長の腎臓形であり、基本的に前記の中間面(126)に対称的に配置される請求項16に記載の人工椎間板(100)。
- 前記の少なくとも二つの凹面(125)が基本的に半楕円又は半卵形の形状をする請求項16又は17に記載の人工椎間板(100)。
- 前記の少なくとも二つの凹面(125)が基本的に前記の中間面(126)に対称的に配置される請求項16〜18のいずれか一項に記載の人工椎間板(100)。
- 前記の第一および第二人工成分(101;102)は前記の長軸(127)に平行して測定される長さHを有し、前記の少なくとも二つの凹面(125)は長軸(127)に平行して測定される幅Wを有し、前記の幅Wは前記の長さHの15%から35%の範囲内である請求項16〜19のいずれか一項に記載の人工椎間板(100)。
- 前記の第一及び第二の人工成分(101;102)は前記の横短軸(128)に平行して測定される最大幅Bを有し、前記の少なくとも二つの凹面(125)は前記の横短軸(128)に平行して測定される深さTを有し、前記の深さTは前記の最大幅Bの3%から25%の範囲内である請求項16〜20のいずれか一項に記載の人工椎間板(100)。
- 前記の第一及び第二人工成分(101;102)の断面領域が基本的に楕円であって、第一従属頂点における湾曲半径が第二の従属頂点における湾曲半径より小さい外周(129)を有する請求項16〜21のいずれか一項に記載の人工椎間板(100)。
- 前記の第一従属頂点が前記の少なくとも二つの凹面(125)と同様に前記の長軸(127)の同側にある請求項22に記載の人工椎間板(100)。
- 前記の第一及び第二人工成分(101;102)は長軸(127)に平行して測定される長さHと横短軸(128)に平行して測定される最大幅Bを有し、長さHと最大幅Bとの比例の範囲が3:1から5:1である請求項16〜24のいずれか一項に記載の人工椎間板(100)。
- 前記の関節部(106)は球体関節機構から成り、第一及び第二人工成分(101;102)の一方に連結される球状キャップ(112)と前記の第一及び第二人工成分(101;102)のもう一方に連結され、前記の球状キャップ(112)に合致する球形嚢陥凹(111)により構成される請求項16〜24のいずれか一項に記載の人工椎間板(100)。
- 第一及び第二人工成分(101:102)の一方と球状キャップ(112)が一枚構造である請求項25に記載の人工椎間板(100)。
- 前記の人工椎間板(100)が少なくとも三枚構造からなり、球状キャップ(112)が三枚目の成分として前記の第一及び第二人工成分(101;102)の一方に連接可能である請求項25に記載の人工椎間板(100)。
- 前記の人工椎間板(100)は少なくとも三枚構造からなり、三枚目の成分として前記の第一および第二人工成分(101;102)の一方に取り付けられ、凹所(111)を有する関節殻を含む請求項25〜27のいずれか一項に記載の人工椎間板(100)。
- 球状キャップ(112)と関節殻が金属とプラスチックから成る請求項28に記載の人工椎間板(100)。
- 球状キャップ(112)と関節殻がセラミック対セラミック構成からなる請求項28に記載の人工椎間板(100)。
- 球状キャップ(112)と凹所(111)の表面が炭化チタン又は非晶質炭素(ADLC)でコーティングされる請求項16〜30のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップ(112)が形状記憶合金素材で作成される請求項16〜31のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップ(112)が膨張可能な素材で作成される請求項16〜31のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップが流動性、熱硬化性がある素材で作成される請求項25〜31のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップがモノマー、コモノマー、ホモポリマー、オリゴマー又は流動性、熱硬化性がある素材の混合物で作成される請求項34に記載の人工椎間板(100)。
- 熱硬化性、流動性を有する素材が、
a)ポリエチレン・グリコール、好ましくはポリエチレン・グリコール(ジ)アクリレート;
b)N−ビニルピロリドン;
c)ビニル、好ましくはビニル・アルコール;
d)スチレン
のグループから適切に選択される請求項35に記載の人工椎間板(100)。 - 前記の第一人工成分(101)は少なくともM≧2の第一人工成分(101)の第一キットから選択される請求項16〜36のいずれか一項に記載の人工椎間板(100)。
- 前記の第二人工成分(102)は少なくともN≧2の第二人工成分(102)の第二キットから選択される請求項16〜37のいずれか一項に記載の人工椎間板(100)。
- 前記の第一及び第二人工成分(101;102)は、各自の中間面(109;110)を含み、前記の第一及び第二の中間面(109;110)は互いに面していて少なくとも第一中間面(109)は第一及び第二人工成分の第一又は/及び第二の外側端(133;134)に位置し、インプラントホルダー(22)の定着部材(141)の収容に適するアンダーカット(132)を有する少なくとも一つの穴を備える請求項16〜38のいずれか一項に記載の人工椎間板(100)。
- 請求項16〜39のいずれか一項に基づいてスリーブ(140)と定着部材(141)を備えてスリーブ(140)の中央ボアに可動的に設置され、更に人工椎間板(100)の第一及び/又は第二人工成分(101;102)の外側端(133;134)に適する前部(143)を備える前端(142)を有するインプラントホルダー(22)。
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