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Description
本発明は脊柱の脊椎間の結合を確実にする線維軟骨円盤(fibrocartilaginous discs)の代用とされるように意図された椎間板プロテーゼに関する。
異なる種類の椎間板プロテーゼが、従来技術において公知である。例えばPCT国際公開WO02089701及びPCT国際公開WO2004/041129に公開されたような多数のプロテーゼは、中心コア部の周りに関節結合されたケージを形成する下方プレート及び上方プレートからなる。例えば、米国特許第5676701号及びPCT国際公開WO03/059212A1に開示されたような他のプロテーゼは、関節結合面により互いに関節結合した下方プレートと上方プレートとだけを含んでいる。これらの関節結合したプロテーゼは、プレートが互いに対して傾斜すること及び/又は回転することを可能にすることにより、かかるプロテーゼを具備する患者に動作の自由を提供するという利点を有する。プレート同士の間において可動である中心コア部を含むプロテーゼは、プロテーゼに付与される荷重を吸収する理想的な位置への中心コア部の自発的な位置決めを可能にするという更なる利点を有する。従来技術において公知であるこれらのプロテーゼにおいては、プレートの前方、後方、及び側方エッジは、別のプレートの対応するエッジと同一の鉛直軸に配置される。かかるプロテーゼのこの形状は、同一のサイズであるプレートのためであり、関節結合の各軸は、患者の動作を容易にし、起こり得る位置欠陥を修正することが可能なように(同軸に)結合される。しかしながら、これらのプロテーゼは、脊柱の形態に完全に適合していないという不利益を有する。さらに、2つの隣接する脊椎の後方エッジは、たいてい互いにわずかにオフセットされている。よって、従来技術において公知のプロテーゼは、正確に移植することが困難である。さらに、椎骨の天然のオフセット及び椎骨におけるプレートの固着のために、荷重がプロテーゼの異なる部分の動作の自由度を制限するので、プロテーゼの異なる部分は望ましくない位置における荷重の下にある。この不都合は、プレート同士の間に可動コア部を使用することにより低減されるが、コア部の可能な動作は制限され、プロテーゼに付与される荷重を吸収するようにコア部を位置決めする能力は低減される。
これは、特許出願EP1250898A1のような従来技術において公知であり、椎間板プロテーゼは、中心コア部の周りに関節結合した2つのプレートを含んでいる。プレートの一方の寸法は、少なくとも1つのかかるプレートのエッジにおいて、別のプレートの寸法よりも大きい。プレートの寸法のこの差は、プレートのエッジのオフセットを生ずるけれども、プレートの関節結合の軸のオフセットを生ずるという不都合を有する。さらに、この種類のプロテーゼは、かかるプロテーゼのプレートの1つが椎骨プレートと比較して大きいか、反対に、別のプレートが椎骨プレートより小さく、椎骨プレートの周囲に寄りかからず、わずかな剛性部分に寄りかかるので、プロテーゼは椎骨プレートを損傷するリスクを有するという不都合を有する。
これに関連して、脊柱の形状に効率的にフィットし、関節結合の表面を提供する目標を十分に達成することが可能であるプロテーゼを提案することは有益である。
本発明の目的は、2つのプレートを少なくとも含む椎間板プロテーゼを提案することにより、従来技術の不都合の幾つかを解消することである。かかる2つのプレートは、他方のプレートの同一のエッジに対してオフセットされた少なくとも1つのエッジを具備している。
この目標は、脊柱の椎骨同士の間に移植する椎間板プロテーゼにより達成される。かかる椎間板プロテーゼは、少なくとも2つのプレート、すなわち第1プレート及び第2プレートを含み、かかる少なくとも2つのプレートは、すくなくとも1つのプレートの少なくとも1つの曲面部、すなわち関節結合部により互いに関節結合されており、プレートの平面に実質的に垂直な軸及び実質的にプレートの平面における軸の周りの回転を介して、互いに対して枢動すること及び/又は傾斜することが可能である。前記湾曲した関節結合はプロテーゼの関節結合の中心部に鉛直方向に整列された頂部を有する。各プレートは、エッジ及びプロテーゼが移植される椎骨の1つの椎骨プレートと接触する接触面として公知である表面を含んでいる。各プレートのためのこの接触面は、プレートの周囲に配置された少なくとも2つの直径方向に対向する点から等距離の幾何学的中心部を含んでおり、以下のように特徴付けられる。
プロテーゼの関節結合の中心部はプレートの幾何学的中心部の1つと鉛直方向に整列され、
プレートの幾何学的中心部同士は、鉛直方向に整列されず、脊柱の鉛直軸に垂直な少なくとも一方向へオフセットされ、
2つのプレートの接触面は実質的に同一の寸法を有し、プレートのエッジは、脊柱の鉛直軸に垂直な少なくとも一方向へオフセットされている。
プレートの幾何学的中心部同士は、鉛直方向に整列されず、脊柱の鉛直軸に垂直な少なくとも一方向へオフセットされ、
2つのプレートの接触面は実質的に同一の寸法を有し、プレートのエッジは、脊柱の鉛直軸に垂直な少なくとも一方向へオフセットされている。
別の特徴によれば、第2プレートは関節結合の曲面部を含み、かかる曲面部の少なくとも一部が、相補的である第1プレートの関節結合の曲面部と協働し、互いに対するプレートの枢動及び/又は傾斜により関節結合を可能にし、第2プレートの関節結合の曲面部の頂部と鉛直方向に整列された関節結合の中心部は、第2プレートに対する第1プレートの曲面部の中心部の中央位置に対応する。
別の特徴によれば、第1プレートの曲面部は凹面であり且つ第2プレートの関節結合の曲面部は凸面である。
別の特徴によれば、第1プレートの曲面部は凸面であり且つ第2プレートの関節結合の曲面部は凹面である。
別の特徴によれば、椎間板プロテーゼは、関節結合の平面部と曲面部とを含むコア部を含み、第1プレートだけが、相補的であるコア部の曲面部の少なくとも一部と協働する関節結合の曲面部を含み、互いに対してプレートを枢動すること及び/又は傾斜することを可能にする。コア部の平面部は、第2プレートの平面部の少なくとも一部と協働し、脊柱の鉛直軸に垂直な少なくとも一方向への第2プレートに対するコア部の移動及び/又は回転を可能にし、第2プレートは、コア部の協働手段と相補的な協働手段を含み、これら協働手段は、第2プレートに対するコア部の少なくともこの移動を制限するか、又は防止し、コア部の関節結合の曲面部の頂部に鉛直方向に整列された関節結合の中心部は、第2プレートの協働手段同士の間のコア部の中央位置、及びコア部に対する第1プレートの曲面部の中心部の中央位置に対応する。
別の特徴によれば、第1プレートの曲面部は凹面であり且つコア部の曲面部は凸面である。
別の特徴によれば、第1プレートの曲面部は凸面であり且つコア部の曲面部は凹面である。
別の特徴によれば、第2プレートの協働手段は、かかる第2プレートのエッジ近傍に配置された雌手段であり、コア部の雄手段と協働する。
別の特徴によれば、各雄協働手段の寸法は、雌協働手段の寸法よりわずかに小さく、コア部と第2プレートとの間のわずかな移動を関節結合の中心部の鉛直方向投影(vertical projection)に対応する位置の周りにおいて可能にする。
別の特徴によれば、各雄協働手段の寸法は、各雌協働手段の寸法と実質的に同一であり、コア部と第2プレートとの間のわずかな移動をも防止し、関節結合の中心部の鉛直方向投影に対応する位置にコア部を保持する。
別の特徴によれば、第2プレートの協働手段は、第2プレートのエッジ近傍に配置された雄手段であり、コア部の雌手段と協働する。
別の特徴によれば、各雄協働手段の寸法は、各雌協働手段の寸法よりわずかに小さく、コア部と第2プレートとの間のわずかな移動を関節結合の中心部の鉛直方向投影に対応する位置の周りにおいて可能にする。
別の特徴によれば、各雄協働手段の寸法は各雌協働手段の寸法と実質的に同一であり、コア部と第2プレートとの間のどのような移動をも防止し、関節結合の中心部の鉛直方向投影に対応する位置にコア部を保持する。
別の特徴によれば、コア部の雄協働手段は、2つのスタッドであり、かかる2つのスタッドはコア部の2つのサイドエッジに配置され、第2プレートの雌協働手段は、4つの壁部であり、かかる4つの壁部はそれぞれ対になり、それぞれ第2プレートの2つのサイドエッジに配置されている。
別の特徴によれば、第2プレートの雌協働手段は、プレートの中心に向かう皿状(dish shaped)に形成された部分を含み、コア部の雄協働手段を部分的に被覆し、コア部が持ち上がることを防止する。
別の特徴によれば、プレートの接触面を示す正中面同士(median planes)は、実質的に平行であるか、鋭角を形成し、このような角度により得られた傾斜は、プロテーゼの全体的な形状を脊柱の解剖学的な形状に適合することを可能にするか、又はプロテーゼが挿入される患者の椎骨のどのような傾斜欠陥をも可能な限り矯正することを可能にする。
別の特徴によれば、プレートは、少なくとも下方エッジにおいて、椎骨間へのプロテーゼの挿入を容易にする少なくとも傾斜を含んでいる。
別の特徴によれば、同一のプレートは、異なる厚さ及び/又は寸法及び/又は形状のコア部と共に組み立てられ得る。
別の特徴によれば、プレートは可動式骨固着手段を含んでいる。
別の特徴によれば、骨固着手段及び/又はプレートは、プレートに骨固着手段を拘束する固定手段を含んでいる。
別の特徴によれば、プレートの可動式骨固着手段は、ノッチを設けられた少なくとも1つのプレートを含み、かかるノッチは、一旦かかるノッチプレートが椎骨に挿入されると、落下することを防止するように向けられており、かかるプレートの一端は、内側湾曲部を有し、プレートの周囲近傍に配置された開口部の少なくとも1つのエッジに固定される。
別の特徴によれば、ノッチプレートの内側湾曲部を伴う端部の反対の端部は、椎骨へのノッチプレートの挿入を容易にする傾斜を有する。
別の特徴によれば、プレートの周囲近傍に配置された開口部は、傾斜部を含み、骨固着要素の湾曲部がこの開口部のエッジに固定されると、ノッチプレートはかかる傾斜部に寄りかかるので、この傾斜部は、プレートに対する骨固着手段の角度を設定することを可能にし、骨固定手段が開口部に挿入されると、骨固定手段をガイドする。
別の特徴によれば、固定手段は、骨固着手段の湾曲部の方に向けられた可撓性タブからなり、骨固着手段をプレートにおける開口部に挿入すると、かかる可撓性タブは、プレートのエッジに重なり、その後、プレートにおける開口部のエッジへの湾曲部の固定の間、プレートにおける開口部の壁部に配置された制限停止部に寄りかかるようにはね返り(spring back)、骨固着手段が落下することを防止する。
別の特徴によれば、可動式骨固着手段のノッチプレートの内側湾曲部は、ノッチを設けられた第2プレートにより伸長し、かかるノッチは、一旦プレートが椎骨に挿入されると、かかるプレートが落下することを防止するように向けられている。
別の特徴によれば、プレートの可動式骨固着手段は、ノッチを設けられた少なくとも1つの翼状部からなり、かかるノッチは、一旦翼状部が椎骨に形成された溝部に挿入されると、翼状部が落下することを防止するように向けられている。翼状部の一端は、内側湾曲部を有し、プレートの周囲近傍における開口部の少なくとも1つのエッジに固定される。
別の特徴によれば、翼状部の固定手段は、翼状部の下面に配置された少なくとも1つのスタッドからなり、プレートの接触面における少なくとも1つの穴部に固定される。かかるスタッド及び穴部は、プレートの所定位置翼状部を固定するような相補的な形状およびサイズである。
本発明の他の特徴及び利点は、添付図面を参照しつつ以下における説明を読むことにより理解されるであろう。
本発明は、脊柱の解剖学的構造に効率的に従うように、互いにオフセットされた少なくとも2つのプレート(1、2)を含んでいる椎間板プロテーゼに関する。本明細書の冒頭において説明したように、椎骨同士は通常互いにわずかにオフセットされており、かかる椎骨のエッジ、例えば後方エッジは鉛直方向に整列されていない。よって、本発明によるプロテーゼは、プレート(1、2)のエッジが、鉛直方向に整列されず且つかかるプロテーゼが挿入される椎骨のエッジ同士の間のオフセットに対応するわずかなオフセットを有するようにデザインされる。椎骨のオフセットは、プレート(1、2)のオフセットがかかる椎骨のオフセットに完全に一致するプロテーゼを選択するために、事前に正確に測定され得る。
本発明によるプロテーゼのプレート(1及び2)は、一般的に、かかるプレート(1、2)の周囲に配置された2つの対向する点から等距離の点により画定され得る幾何学的中心部(G1及びG2)を含んでいる。通常、椎間板プロテーゼのプレートは、比較的単純な(straightforward)形状を有し、かかるプレートの幾何学的中心部は、かかるプレートの周囲に配置された全ての点から等距離であり得る。プロテーゼにかかわらず、幾何学的中心部はプレートのエッジから等距離に配置された点又は面により画定され得る。本発明によるプロテーゼのプレート(1、2)の幾何学的中心部(G1、G2)は、鉛直方向に整列されておらず、少なくとも一方向、例えば脊柱の鉛直軸に垂直な前方−後方へ互いにオフセットされている。1つの椎間板プロテーゼの2つのプレート(1及び2)は、通常、実質的に同一のサイズであり、かかるプレートの幾何学的中心部(G1、G2)のこのオフセット(D)は、かかるプレート(1、2)のエッジのオフセットを生ずる。プレートが同じサイズでないプロテーゼの場合においては、プレート(1及び2)のエッジをオフセットすることが予想され、幾何学的中心部(G1、G2)は互いに、よりオフセットされる。
以下において説明される異なる実施例においては、プロテーゼは、少なくとも2つのプレート(1及び2)、すなわち第1プレート(1)と第2プレート(2)とを含み、かかるプレートは、少なくとも一方のプレートの曲面部(11、31)、すなわち関節結合により互いに関節結合されている。関節結合のこの曲面部(11、31)は、プレートの平面に実質的に垂直な軸の周りの回転を介して、プレート(1、2)を互いに枢動すること、及び/又はプレート(1,2)の平面に実質的に沿った軸の周りの回転を介して、プレート(1、2)を互いに傾斜することを可能にする。各プレート(1,2)は、接触面として公知な表面(14、24)を含み、かかる表面(14、24)は、プロテーゼが挿入される椎骨間の1つの椎骨プレートと接触する。幾何学的中心部は、これ以降、簡易性のためにこの接触面に関して画定されるが、本発明の原理において重要であることは、幾何学的中心部を貫通する鉛直軸であり、プレートの幅における幾何学的中心部の正確な位置は直接関係ないことを理解されたい。以下において説明される異なる実施例においては、各プレート(1、2)は、プレート(1、2)の周囲に配置された少なくとも2つの直径方向に対向する点から等距離の幾何学的中心部(G1、G2)を含んでいる。プレート(1、2)の幾何学的中心部(G1、G2)は鉛直方向に整列されておらず、プレートの幾何学的中心部(G1、G2)のこのオフセット(D)は、脊柱の鉛直軸に垂直な少なくとも1つの方向へのプレート(1、2)のエッジのオフセットを生ずる。
図2A、図2B、図2C、図3C、及び図3Dに示した実施例においては、プロテーゼは、2つの要素、すなわち2つのプレート(1、2)を含んでいるだけである。この場合においては、第2プレート(2)が関節結合の曲面部(31)を含み、かかる曲面部(31)の少なくとも一部が、相補関係である第1プレート(1)の関節結合の曲面部(11)と協働する。関節結合のこれらの曲面部(11、31)の協働は、互いに対してプレート(1、2)を枢動すること及び/又は傾斜することを可能にする。第2プレート(2)の関節結合の曲面部(31)の頂部と鉛直方向に整列された関節結合の中心部(C)が画定され得る。関節結合のかかる中心部(C)は、第2プレート(2)と比較して、第1プレート(1)の曲面部(11)の中心部の中央位置に相当する。図面に示した実施例においては、第1プレート(1)の曲面部(11)は凹面であり且つ第2プレート(2)の関節結合の曲面部(31)は凸面であるが、第1プレート(1)の曲面部(11)が凸面であり且つ第2プレート(2)の関節結合の曲面部(31)が凹面である場合もあり得る。
図1A乃至図1C、図3A、図3B、及び図5A乃至図5Cに示した実施例においては、プロテーゼは、関節結合の平面部(33)と曲面部(31)とを含むコア部(3)を含んでいる。3つの要素を伴うプロテーゼの場合においては、第1プレートだけが関節結合の曲面部(11)を含み、かかる曲面部が、相補的であるコア部(3)の曲面部(31)の少なくとも一部と協働し、互いにプレート(1、2)を枢動及び/又は傾斜することを可能にする。コア部(3)の平面部(33)は、第2プレート(2)の平面部(23)の少なくとも一部と協働し、第2プレート(2)に対するコア部(3)の脊柱の鉛直軸に垂直な少なくとも一方向への移動及び/又はかかる平面部の面に実質的に垂直な軸の周りの回転を介して、第2プレート(2)に対するコア部(3)の回転を可能にする。第2プレート(2)は、コア部(3)の協働手段(32)と相補的である協働手段(22)を含み、第2プレート(2)に対するコア部(3)の少なくともこの移動を制限するか、又は防止する。図面に示した実施例においては、第2プレート(2)の協働手段(22)は、第2プレート(2)のエッジ近傍に配置された雌手段であり、コア部(3)の雄手段と協働する。図面に示した実施例においては、コア部のこれらの雄協働手段(32)は2つのスタッドであり、かかる2つのスタッドは、かかるコア部(3)の2つのサイドエッジに配置され、第2プレート(2)の雌協働手段(22)は、4つの壁部であり、かかる4つの壁部は、対になり、第2プレート(2)の2つのサイドエッジにそれぞれ配置されている。これらの壁部は、プレートの中心に向かう内側湾曲部を含み、コア部(3)の雄協働手段(32)を部分的に被覆し、コア部(3)が持ち上がることを防止する。本発明の別の実施例においては、第2プレート(2)の協働手段(22)は、第2プレート(2)のエッジ近傍に配置された雄手段であり、コア部(3)の雌手段(32)と協働する。本発明の実施例においては、各雄協働手段(32、22)の寸法は、雌協働手段(22、32)の寸法よりわずかに小さく、コア部(3)と第2プレート(2)との間のわずかな移動を関節結合の中心部(C)の鉛直方向投影に対応する位置の周りにおいて可能にする。別の実施例においては、各雄協働手段(32、22)の寸法は、各雌協働手段(22、32)の寸法と実質的に同一であり、コア部(3)と第2プレート(2)との間のどのような移動をも防止し、関節結合の中心部(C)の鉛直方向投影に対応する位置にコア部(3)を保持する。
3つの要素を伴うプロテーゼのこの場合においては、関節結合の中心部(C)は、コア部(3)の関節結合の曲面部(31)の頂部と鉛直方向に整列され、第2プレート(2)の協働手段(22)同士の間のコア部(3)の中央位置及びコア部(3)に対する第1プレート(1)の曲面部(11)の中心部の中央位置に対応する。図面に示した実施例においては、第1プレート(1)の曲面部(11)は凹面であり且つコア部(3)の曲面部(31)は凸面であるが、第1プレート(1)の曲面部(11)は凸面であり且つコア部(3)の曲面部(31)は凹面であり得る。
本発明の実施例においては、関節結合の中心部(C)は、第1プレート(1)の幾何学的中心部(G1)に鉛直方向に整列されているが、少なくとも脊柱の鉛直軸に垂直な方向へ、第2プレート(2)の幾何学的中心部(G2)に対してオフセットされている。プレートの幾何学的中心部(G1、G2)のオフセット(D)は、脊柱の鉛直軸に垂直な少なくとも一方向へのプレート(1、2)のエッジのオフセットを生ずる。本発明の別の実施例においては、関節結合の中心部(C)は、第1プレート(1)の幾何学的中心部(G1)に対してオフセットされ得る。第1プレート(1)の幾何学的中心部(G1)に対する関節結合の中心部のこのオフセットは、第2プレート(2)の幾何学的中心部(G2)に対する関節結合の中心部(C)のオフセット(D)の向きと反対であり、関節結合の中心部(C)の鉛直方向投影は、プレート(1、2)の幾何学的中心部(G1、G2)の鉛直方向投影同士の間に存在し、関節結合の中心部(C)に対する幾何学的中心部(G1、G2)のオフセットが、重なり、脊柱の鉛直軸に垂直な少なくとも一方向への、プレート(1,2)のエッジのオフセットを生ずる。第1プレート(1)の幾何学的中心部(G1)に対する関節結合の中心部(C)のオフセットは、第2プレート(2)の幾何学的中心部(G2)に対する関節結合の中心部(C)のオフセット(D)と同一の方向であってもよいが、より小さな距離であり、これらのオフセットは、互いを部分的に補償し、脊柱の鉛直軸に垂直な少なくとも一方向への、プレート同士の間にプレート(1、2)のエッジのオフセットを生ずる。
本発明によるプロテーゼが、かかるプロテーゼが挿入される椎骨の傾斜欠陥を良くすることは有益である。プレート(1、2)の接触面(14、24)を示す正中面(median planes)同士は、実質的に平行であるか、又は鋭角を形成する。このような角度により得られる傾斜は、プロテーゼの全体的な形状を脊柱の解剖学的形状に適合することを可能にするか、又はプロテーゼが移植される患者の椎骨の起こり得る傾斜欠陥を修正することを可能にする。同一のプレート(1、2)は、異なる厚み及び/又は寸法及び/又は形状のコア部(3)と共に組み立てられ得る。プレート(1、2)は、少なくともかかるプレート(1、2)の前方エッジにおいて、椎骨間へのプロテーゼの挿入を容易にする少なくとも1つの傾斜部(12)を含み得る。
本発明の実施例によるプロテーゼは、椎骨にプレート(1、2)を固着することを可能にする取り外し自在な(すなわち可動式の)骨固着手段(4A、4B)を含んでいる。これらの骨固着手段(4A、4B)及び/又はプレート(1、2)は、骨固着手段(4A、4B)をプレート(1、2)に拘束する固定手段(43及び/又は211、212)を含んでいる。
可動式骨固着手段(4B)の第1実施例においては、ノッチ(42)を設けられた少なくとも1つのプレート(40)が、内側湾曲部(41)により、プレート(1、2)の周囲近傍における開口部の少なくとも1つのエッジ(21)に固定される。かかるノッチ(42)は、一旦かかるプレート(40)が椎骨に挿入されると、このノッチプレート(40)が落下することを防止するように向けられている。よって、これらの可動式骨固着手段(4B)は、脊柱に挿入され、一旦後部が椎骨同士の間に挿入されるとプロテーゼのプレートに固定される。可動式骨固着手段(4B)のこの実施例は、最終的な固定の前に、椎骨同士の間のプロテーゼの位置の調整を可能にする。ノッチプレート(40)の内側湾曲部(41)を伴う端部の反対の端部は、椎骨へのかかるノッチプレート(40)の挿入を容易にする傾斜を含んでいる。プレート(1、2)の周囲近傍における開口部は傾斜部(210)を含み、骨固着手段(4B)の湾曲部(41)がこの開口部のエッジ(21)に固定されると、ノッチプレート(40)はかかる傾斜部(210)に寄りかかる。この傾斜部(210)は、プレートに対する骨固着手段(4B)の角度を設定することを可能にし、かかる骨固着手段(4B)が開口部に挿入されると、かかる骨固着手段(4B)をガイドする。固定手段(43)は、骨固着手段(4B)の湾曲部(41)の方に向けられた可撓性タブ(43)からなり、プレート(1、2)における開口部へ骨固着手段(4B)を挿入すると、プレート(40)のエッジに対して折り重なる。プレート(1、2)における開口部のエッジへの湾曲部(41)の固定の間、これらの可撓性タブ(43)は、プレート(1、2)における開口部の壁部に配置された制限停止部(211)に寄りかかるように分かれ、骨固着手段(4B)が落下することを防止する。別の実施例においては、可動式骨固着手段(4)のノッチプレート(40)の内側湾曲部(41)は、一旦プレート(40)が椎骨に挿入されると、プレート(40)が落ちることを防止するように向けられたノッチ(42)を設けられた第2プレート(40)を介して伸長する。
プレート(1、2)の可動式骨固着手段(4A、4B)の第2実施例においては、少なくとも1つの翼状部(4A)にはノッチ(42)が設けられ、かかるノッチ(42)は、一旦翼状部(4A)が椎骨に形成された溝へ挿入されると、翼状部(4A)が落下することを防止するように向けられている。翼状部(4A)の一端は、内側湾曲部(41)を有し、プレート(1、2)の周囲近傍における開口部の少なくとも1つのエッジ(21)に固定される。翼状部(4A)の固定手段(43)は、少なくとも翼状部(4A)の下面に配置されたスタッド(43)からなり、プレート(1、2)の接触面(14、24)における少なくとも1つの穴部(210)に固定される。スタッド(43)及び穴部(210)は、翼状部(4A)をプレート(1、2)に固定するような相補的な形状およびサイズである。この実施例においては、プロテーゼが挿入される椎骨は、椎骨プレートにおいて、翼状部(4A)の形状及びサイズと相補的な形状及びサイズの溝をくり抜く(hollowing out)ことにより外科医により前もって処置されている。
本発明は特許請求の範囲に記載されたような本発明の範囲を残しつつ、多数の他の特定の形態の実施例が可能であることは当業者には明らかである。よって、実施例は、単なる例示目的として考慮されるべきであり、従属請求項の影響により画定される範囲において変更され、本発明は前述した記述に制限されるべきではない。
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PCT/IB2006/002632 WO2007034310A1 (en) | 2005-09-23 | 2006-09-23 | Intervertebral disc prosthesis |
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