JP2021013756A - 椎間関節インプラント - Google Patents
椎間関節インプラント Download PDFInfo
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- 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
- A61F2/4405—Joints for the spine, e.g. vertebrae, spinal discs for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes
-
- 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
- A61F2002/30199—Three-dimensional shapes
- A61F2002/302—Three-dimensional shapes toroidal, e.g. rings
-
- 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
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30471—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements connected by a hinged linkage mechanism, e.g. of the single-bar or multi-bar linkage type
-
- 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
- A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
- A61F2002/30578—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
-
- 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
- A61F2002/30754—Implants for interposition between two natural articular surfaces
Abstract
Description
本出願は、参照によってその全体が本明細書に援用される、2015年1月27日出願の米国特許仮出願第62/108,451号に対する優先的利益を主張する。
図1に示すように、脊柱2は、体の上側部分に軸方向支持および移動をもたらす一連の交互の椎骨4および線維性円板6を備える。脊柱2は、通常、7つの頸椎(C1〜C7)、12個の胸椎(T1〜T12)、5つの腰椎(L1〜L5)、5つの癒合した仙椎(S1〜S5)、4つの癒合した尾椎を備えた33個の椎骨4を備える。図2Aおよび図2Bは、典型的な胸椎を示す。各椎骨は、後弓10を備えた前方体8を含む。後弓10は、2つの椎弓根12および2つの椎弓板14を備え、これらは後方で接合されて棘突起16を形成する。後弓10の各側からの突出するのは、横関節突起18、上関節突起20および下関節突起22である。上関節突起20および下関節突起22の小関節面24、26は、隣接する椎骨の関節突起と共に椎間関節28を形成する(図3Aおよび3Bを参照)。椎間関節は、軟骨性表面および関節包を備えた真の滑膜性関節である。
図7は、椎間関節インプラント100の実施形態を示す。図7に示すように、インプラント100は、固定プレート102と、スペーサ114とを備えることができる。スペーサ114は、上関節突起および下関節突起20、22の小関節面間に置かれ得る。スペーサ114の配向は、椎間関節に応じて決まり得る。スペーサ114は、脊柱の任意のレベルに位置する椎間関節内に置かれ得る。たとえば、スペーサ114は、C1とC3椎骨間の椎間関節内に位置する場合、横平面に対して平行であることができる。スペーサ114は、平行、ほぼ平行、垂直、ほぼ垂直、0度、15度、30度、45度、60度、75度、90度などを含む、横平面に対する任意の角度で置かれ得る。スペーサ114は、平行、ほぼ平行、垂直、ほぼ垂直、0度、15度、30度、45度、60度、75度、90度などを含む、前平面に対する任意の角度で置かれ得る。一部の実施形態では、固定プレート102は、椎間関節28の一部分を覆う。固定プレート102は、上関節突起20、下関節突起22、または上関節突起および下関節突起20、22の両方に固定され得る。固定プレート102は、スペーサ114の椎間関節28からの移動を防止することができる。固定プレート102は、関節突起20、22の癒合を容易にすることができる。一部の実施形態では、固定プレート102は、スペーサ114に接合または結合される。他の実施形態では、固定プレート102およびスペーサ114は、別個の構成要素である。
一部の実施形態では、椎間関節28の2つの小関節面24、26間に間隔を取り戻す、または維持するためのスペーサ114が、提供される。図8Aから8Bに示すように、インプラント100は、少なくとも2つの面、すなわち椎間関節28の1つの小関節面の関節面と接触するように適合された上面118と、椎間関節28の他の小関節面の関節面と接触するように適合された下面120とを備えたスペーサ114を備えることができる。たとえば、一部の実施形態では、上面118は、上関節突起20と接触するように成形され、下面120は、下関節突起22と接触するように成形される。
一部の実施形態では、固定プレート102は、上側部分104と、下側部分106とを有することができる。使用においては、上側部分104を上関節突起20に隣接させることができ、下側部分106を下関節突起22に隣接させることができる。上側部分104および下側部分106は、椎間関節28に広がることができる。他の構成が企図される。
一部の実施形態では、スペーサ114および固定プレート102は、互いの間にいくらかの相対運動をもたらすように構成することができる。スペーサ114と固定プレート102の間にいくらかの相対運動をもたらすことにより、インプラント100は、移植部位における既存の生体構造への適合を改善しながら、骨構造への固定を改善することができる。図9Aから図9Dは、スペーサ114に対する固定プレート102の枢動を可能にするように配向されたヒンジ継手128を備える実施形態を示す。例示する実施形態では、ヒンジ継手128は、後方側116に対する固定プレート102の枢動を可能にするように配向される。他の実施形態では、ヒンジ継手128は、上面118、下面120、および側方部122、124を含む、スペーサ114の他の部分に対する枢動を可能にするように配向することができる。ヒンジ継手128は、矢状面、横面、前頭面、または3つの平面間の任意の平面を含む、任意の平面内の移動を可能にし得る。
図10Aから図10Dは、スペーサ214および固定プレート202を備えるインプラント200を例示する。スペーサ214は、スペーサ114に対して上記で説明した特徴の任意のものを有することができる。固定プレート202は、固定プレート102に対して上記で説明した特徴の任意のものを有することができる。一部の実施形態では、スペーサ214と固定プレート202の間の複数の継手は、追加の運動角度をもたらすように構成することができる。スペーサに対する複数の運動角度において固定プレート202の調整を行うことにより、骨構造への固定を改善しながら、移植部位における既存の生体構造への適合を改善することもできる。
図11Aから図11Dは、スペーサ414を備えるインプラント400を例示する。スペーサ414は、スペーサ114または214に対して上記で説明した特徴の任意のものを有することができる。インプラント400は、2つ以上の固定プレート470、472を備える。固定プレート470、472は、固定プレート102または202に対して上記で説明した特徴の任意のものを有することができる。一部の実施形態では、インプラント400は、独立した運動継手を備えた2つ以上の固定プレート470、472を備えることができ、この場合各固定プレート470、472は、既存の生体構造へのさらなる適合をもたらすように独立的に移動または枢動することができる別個の運動継手に結合される。
一部の実施形態では、スペーサ514は、図12の例示する実施形態のように、表面間に1つまたは複数の固定穴550を含む。固定穴550は、第1の表面から別の表面までの貫通管腔とすることができる。スペーサ514は、上記で説明したインプラントと同様に、上面および下面と、後方側および前方側と、側方部とを有することができる。固定穴550は、後方側からスペーサ514の任意の他の表面まで延びることができる。スペーサ514は、後方側から前方側まで延びる軸(たとえば長手方向軸)を含むことができる。固定穴550は、スペーサ514の幅と平行な平面内の軸と共に第1の角度を形成することができる。第1の角度は、固定デバイスを、スペーサ514の中央に向かって、またはそこから離れるように向けることができる。一部の実施形態では、第1の角度は、約15°であり、このとき固定穴550は、スペーサ514の中央に向かって延びている。一部の実施形態では、第1の角度は、固定穴550が軸に対して平行に延びる0°から、固定穴550がスペーサ514の中央に向かって延びる45°までの範囲を有する。一部の実施形態では、第1の角度は、(たとえば、固定穴550がスペーサ514の中央から30°離れるように延びる)-30°から、(たとえば、固定穴550がスペーサ514の中央に60°向かうように延びる)60°までの範囲を有する。
一部の実施形態では、スペーサ114は、図13に例示するように、同種移植片または脱灰骨マトリクス600と組み合わせて利用される。スペーサ114は、脱灰骨マトリクス600を配置する前に椎間関節28に挿入され得る。脱灰骨マトリクス600は、本明細書において説明する固定プレート102の代わりに利用され得る。他の実施形態では、脱灰骨マトリクスは、1つまたは複数の固定プレート102、202、470、472、570と、1つまたは複数の関節突起20、22との間に置かれる。一部の実施形態では、脱灰骨マトリクス600は、椎間関節28に広がることができる。脱灰骨マトリクス600は、1つまたは複数の関節突起20、22と当接することができる。
図7に示すように、インプラント100は、隣接する椎骨を、第1の椎骨V1の下関節突起22および第2の椎骨V2の上関節突起20を介して安定させるために使用され得る。一部の実施形態では、椎骨V1および椎骨V2は、1つの椎間関節内(たとえば右の椎間関節)内に置かれた1つだけのインプラント100を使用して安定される。一部の実施形態では、1つのインプラント100は、椎骨V1および椎骨V2を、椎骨V1の下関節突起IAP1Aおよび椎骨V2の上関節突起SAP2Aを介して、または椎骨V1の下関節突起IAP1Bおよび椎骨V2の上関節突起SAP2Bを介して安定させるために使用され得る。他の実施形態では、椎骨V1および椎骨V2は、各椎間関節(たとえば右および左両方の椎間関節)内に1つずつ置かれた2つのインプラント100を使用して安定される。一部のそのような実施形態では、1つのインプラント100は、椎骨V1の下関節突起IAP1Aおよび椎骨V2の上関節突起SAP2Aを介して椎骨V1および骨V2を安定させるために使用することができ、別のインプラント100は、椎骨V1の下関節突起IAP1Bおよび椎骨V2の上関節突起SAP2Bを介して椎骨V1および椎骨V2を安定させるために使用することができる。インプラント200、400、500は、インプラント100と同じようにして送達され得る。
本発明をさまざまな例示的な実施形態に関連して説明してきたが、説明する実施形態に対するさまざまな追加の実施形態および変更が、本発明の範囲内で企図される。したがって、前述の説明のいずれの部分も特許請求の範囲において記載する本発明の範囲を限定するように解釈されてはならない。上記で説明した実施形態のすべてに関して、方法のステップを順序通りに実行する必要はない。
4 椎骨
6 線維性円板
8 前方体
10 後弓
12 椎弓根
14 椎弓板
16 棘突起
18 横関節突起
20 上関節突起(上突起)
22 下関節突起(下突起)
24、26 小関節面
28 椎間関節
30 横平面
32 前平面
100 椎間関節インプラント
102 固定プレート
104 上側部分
106 下側部分
108 骨対向面
110 アクセス面
112 穴
114 スペーサ
116 後方側
118 上面
120 下面
122、124 側方
126 前方側
128 ヒンジ継手
130 ピボット点
132 バレル
152 穴
200 インプラント
202 固定プレート
204 上側部分
206 下側部分
212 穴
214 スペーサ
260 二重ヒンジ継手
262 単一ヒンジ継手
400 インプラント
412 穴
414 スペーサ
418 上面
420 下面
430 ピボット
432 バレル
434 止め具
440 固定穴
464、466 ヒンジ継手
470、472 固定プレート
500 インプラント
514 スペーサ
550 傾斜型固定穴
570 固定プレート
600 脱灰骨マトリクス
IAP1A、IAP1B 下関節突起
SAP2A、SAP2B 上関節突起
V1、V2 椎骨
Claims (17)
- 椎間関節を治療するためのインプラントであって、
アクセス面および骨対向面を有する固定プレートと、
前記椎間関節に挿入されるように構成されたスペーサであって、前記スペーサは円形のディスクを含み、前記円形のディスクは、上面と、下面と、前記上面から前記下面に向けて延びる少なくとも一つの開口と、を含む、スペーサと、
前記スペーサと前記固定プレートの骨対向面との間の少なくとも1つのヒンジと、
を備え、
前記スペーサは、第1の表面と、第2の表面と、を有し、
前記第1の表面は、粗面化され、または多孔性であり、
前記第2の表面は、高度に研磨されている
インプラント。 - 前記固定プレートが、複数の穴を有する、請求項1に記載のインプラント。
- 前記スペーサが、複数の穴を有する、請求項1に記載のインプラント。
- 前記複数の穴のうちの少なくとも1つが、移植片材料を含む、請求項3に記載のインプラント。
- 前記少なくとも1つのヒンジが、前記スペーサと前記固定プレートとの間の枢動式の関節および運動を提供する、請求項1に記載のインプラント。
- 前記固定プレートが、通過する固定デバイスを受け入れるように構成された少なくとも1つの穴を含む上側部分を含む、請求項1に記載のインプラント。
- 前記固定プレートが、通過する固定デバイスを受け入れるように構成された少なくも1つの穴を含む下側部分を含む、請求項6に記載のインプラント。
- 前記少なくとも1つのヒンジが、ヒンジの対を備える、請求項1に記載のインプラント。
- 前記インプラントが、前記固定プレートが前記スペーサの前記下面に対してほぼ平行である低プロファイル構成を含む、請求項1に記載のインプラント。
- 前記固定プレートが、前記スペーサの前記上面に対してほぼ垂直である第2の構成になるまで回転するように構成された、請求項9に記載のインプラント。
- 前記スペーサが、通過する固定デバイスを受け入れるように構成された少なくとも1つの穴を含む、請求項1に記載のインプラント。
- 前記固定プレートが、上関節突起に固定されるように構成され、かつ、前記スペーサ内の少なくとも1つの穴が、下関節突起に固定するための固定デバイスを受け入れるように構成された、請求項11に記載のインプラント。
- 前記固定プレートが、下関節突起に固定されるように構成され、かつ、前記スペーサ内の少なくとも1つの穴が、上関節突起に固定するための固定デバイスを受け入れるように構成された、請求項11に記載のインプラント。
- アクセス面および骨対向面を有する第2固定プレートを更に備える
請求項1に記載のインプラント。 - 前記スペーサと前記第2固定プレートの前記骨対向面との間の少なくとも1つのヒンジを更に備える、
請求項14に記載のインプラント。 - 前記第1の表面は、凹状である
請求項1に記載のインプラント。 - 前記第2の表面は、凸状である
請求項1に記載のインプラント。
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US201562108451P | 2015-01-27 | 2015-01-27 | |
US62/108,451 | 2015-01-27 |
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JP2017557269A Division JP2018502693A (ja) | 2015-01-27 | 2016-01-12 | 椎間関節インプラント |
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JP2021013756A true JP2021013756A (ja) | 2021-02-12 |
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JP2017557269A Pending JP2018502693A (ja) | 2015-01-27 | 2016-01-12 | 椎間関節インプラント |
JP2020181320A Pending JP2021013756A (ja) | 2015-01-27 | 2020-10-29 | 椎間関節インプラント |
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JP2017557269A Pending JP2018502693A (ja) | 2015-01-27 | 2016-01-12 | 椎間関節インプラント |
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EP (1) | EP3250155A4 (ja) |
JP (2) | JP2018502693A (ja) |
AU (3) | AU2016212009C1 (ja) |
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WO (1) | WO2016122868A1 (ja) |
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