JP2796544B2 - 人工脊椎融合挿入材 - Google Patents

人工脊椎融合挿入材

Info

Publication number
JP2796544B2
JP2796544B2 JP1507651A JP50765189A JP2796544B2 JP 2796544 B2 JP2796544 B2 JP 2796544B2 JP 1507651 A JP1507651 A JP 1507651A JP 50765189 A JP50765189 A JP 50765189A JP 2796544 B2 JP2796544 B2 JP 2796544B2
Authority
JP
Japan
Prior art keywords
insert
spinal fusion
wall
artificial spinal
adjacent vertebrae
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.)
Expired - Lifetime
Application number
JP1507651A
Other languages
English (en)
Other versions
JPH03505416A (ja
Inventor
マイケルスン、ガーリー、カーリン
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=22791197&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=JP2796544(B2) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Application filed by Individual filed Critical Individual
Publication of JPH03505416A publication Critical patent/JPH03505416A/ja
Application granted granted Critical
Publication of JP2796544B2 publication Critical patent/JP2796544B2/ja
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

Links

Classifications

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    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
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    • 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
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    • A61F2/447—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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    • A61F2/02—Prostheses implantable into the body
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    • 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
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006—Properties of materials and coating materials
    • A61F2002/30062—(bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
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    • 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
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    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0004—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof bioabsorbable
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • A—HUMAN NECESSITIES
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
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    • A—HUMAN NECESSITIES
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    • 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
    • A61F2230/0017—Angular shapes
    • A61F2230/0019—Angular shapes rectangular
    • 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
    • A61F2230/0017—Angular shapes
    • A61F2230/0026—Angular shapes trapezoidal
    • 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
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0082—Three-dimensional shapes parallelepipedal
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0009—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting thickness
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/006—Additional features; Implant or prostheses properties not otherwise provided for modular
    • A61F2250/0063—Nested prosthetic parts
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00592—Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
    • A61F2310/00796—Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite
    • 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

Description

【発明の詳細な説明】 背景技術 本発明は、損傷した椎間板を削除したる後、椎骨間空
内に設けられる人工脊椎に関する。
本発明の目的は、椎間板空内に設けられる挿入材を具
備し、前記位置における凡ての移動の永久終結を行わし
めるものである。このために、装置としては、椎間板間
空内を占有すべく配設され、剛性を有し、切除に対抗す
るための自己安定性、局所移動を終結せしめる隣接脊椎
椎骨の安定化ならびに椎骨における本質的関与を融合椎
骨になさしめて、永久的結果を確実に得ようとするもの
である。
また、損傷した椎間板を除去した後、除去された前記
間空には骨が設けられるか、または設けられないのいず
れかである。前記間空に何も設けられない場合には、該
間空は破損されて神経に損傷をもたらすことがある。ま
たは、間空に破壊組織にて充填されてしまい、結果的に
再ヘルニア形成をもたらすものである。骨の使用は最適
なものでなく、患者から得られた骨は付加的な手術を要
するのみならず、最も有効な形状を得るための有用性が
限定される。何処からでも入手しうる場合、生存骨細胞
が不足して感染の危険性がもたらされ、そして、一般的
に若年事故被害者から得られている供給が限定されてし
まう。さらに、骨の発生源にかかわらず、構造的に限界
的なものであり、切除に対して自体を安定化し、または
隣接椎骨を安定化するためのいずれかの手段をも具備さ
れていない。
参照した従来技術についてなしえた展望は、本発明の
新規性を実証するものである。
容認される椎間板（人工椎間板）の開発に関する試み
がなされており、かかる設計の装置により、損傷した椎
間板の交換のために用いられ、前記間空相互の高さが回
復されるとともに、前記脊椎関節の正規運動が回復され
る。
医学的に容認されるかかる装置は見出されず、本発明
と相異する脊椎運動を維持することを求める人工椎間板
交換の一群は下記を包含している。
米国特許第3,867,728号明細書は、伸縮可能な椎間板
挿入材を記載している。
特許第4,349,921号明細書は、装置転位を抑制するた
めのロープ状または筋状の表面突起を有する伸縮可能な
椎間板挿入材交換体について記載している。
特許第4,309,777号明細書は、転位に対抗するための
スパイク状表面を有し、相互から離間される椎骨を支持
するためのスプリング列を有している運動維持挿入材に
ついて記載している。
特許第3,875,595号明細書は、転位に対抗するための
２つの対向スタッド状突起物を有する運動維持袋状椎間
板交換体について記載している。
特許第2,372,622号明細書は、相互補完対向凹凸面か
らなる運動維持挿入材について記載している。
前記について要約すると、幾多の類似する装置は、本
発明のみが損傷した脊椎椎間板を切除した後に椎骨間空
内に設けられていることに関し類似している。
そして前記装置が脊椎運動を維持することを求めるさ
いに、本発明は、前記脊椎分割材における凡ゆる移動の
永久終結を求めているが、両者は全く異るものである。
第二の参照した従来技術は、本質的に完全に切除した
脊椎を交換するために用いられる装置が包含されてい
る。かかる切除は一般的に烈しい脊椎破壊、または腫張
によって必要とされ、椎間板疾患の治療に伴って必要さ
れるものではなく、本発明に関連するものである。
本発明は、椎間板間空に設けられているのに対し、従
来技術は椎間板間空に設けられず、少くとも一つの椎骨
がすでに切除されて、もはや“椎間板間空”を止めてい
ない。
さらに、凡ゆる前記装置は、切除された椎骨（切除さ
れた椎間板ではない）を機械的に交換する一時的構造体
として求めることについて制約され、そして、断面椎骨
融合を行うための骨形材料を供給するさいに本質的関与
がなされない。かくして、再び本発明が骨形成源を具備
していることにおいて異なり、前記装置からなるグルー
プの使用は、公知技術を用いた骨融合法からなる処置が
さらに付加されねばならない。
前記装置群は、椎間板交換よりも椎骨ストラットから
なるもので、下記を包含している。
特許第4,553,273号明細書は、ターンバックル状椎骨
ストラットについて記載している。
特許第4,401,112号明細書は、椎骨体を欠損した間空
のための長尺安定化ステープルを付加したターンバック
ル状椎骨ストラットについて記載している。
特許第4,554,914号明細書は、全体の椎骨が除去され
て残った間隙を拡大し、欠損せる骨（椎骨）を交換する
場合に使用されるアクリルセメントのための留め金とし
て用いるためのねじ機構により伸延を行う大型延伸延ス
パイクについて記載している。
特許第4,636,217号明細書は、少くとも１つの椎骨を
切除した後、挿入できて、切除した下位の椎骨を上位の
椎骨にねじ接合を行わせる機構からなる装置である椎骨
ストラット機構について記載している。
前記について要約すると、前記装置群は、椎骨交換ス
トラットからなり、骨融合において本質的関与がなされ
ず、全体の椎骨が前方から切除される限定された環境に
おいてのみ挿入できて、椎間板疾患の処置に用いるべく
設計されてなく、または意図されていないことにおい
て、本発明と相異している。
本発明に関し、第三の参照した従来技術は、脊椎の一
つの表面に用いられるべく設計された凡ゆる装置が包含
されている。前記装置は、フック、線およびねじに接続
される各種の板、ストラットおよび棒類が包含されてい
る。
前記装置は、椎間板間空に挿入されることなく、さら
に、融合のための骨形成材料を供給するさいに本質的関
与がなされないことにおいて、本発明と重要な相違をな
している。
かくして、前記装置による永久脊椎固定化は、公知手
段によるか、または、補助的なメチルメタアクリレート
セメントの使用を必要とする脊椎融合からなる付加的処
置が行われる。前記装置は脊椎に応用されるが椎間板間
空には応用されず、下記を包含している。
特許第4,604,995号明細書は、多数の分割片をもつ脊
椎を安定化させるために線材にて脊椎の後方要素に接合
するための“U"字状金属棒について記載している。
特許第2,677,369号明細書は、金属製柱装置が腰椎に
沿って、形状にしたがい位置決めされるように、後方に
配設されるとともに、患者の椎間板への最大重量を移行
させて屈曲するさいに脊椎を固着させて脊椎柱の後方部
に作用する圧力が閉塞されることについて記載してい
る。
その他の諸装置は、棒類（例えば、ハーリントン、リ
ューブ、コトレルーデュボス、チールケ）、線材または
ケーブル（ダイワー）、板およびねじ類（ステフィー）
またはストラット（ダン、ナウル）などを用いるさいの
単なる変形である。
前記について要約すると、前記装置は、椎間板間空用
として設計され、または使用され得るものであるが、損
傷した椎間板を変換することができないとともに、椎骨
融合の創成について本質的関与がなされていない。
本発明に関し、その他の参照可能な従来技術は、“骨
の内部成長”に関するものと思われる。前記の特徴に関
連した諸特許は、前記を達成するための材料または装置
を製造する方法について記載している。前記特許は下記
のものを包含している。
特許第4,636,526号明細書、第4,634,720号明細書、第
4,542,539号明細書、第4,405,319号明細書、第4,439,15
2号明細書、第4,168,328号明細書、第4,535,485号明細
書、第3,987,499号明細書、第3,605,123号明細書、第4,
655,777号明細書、第4,645,503号明細書、第4,547,390
号明細書、第4,608,052号明細書、第4,698,375号明細
書、第4,661,536号明細書、第3,952,334号明細書、第3,
905,047号明細書、第4,693,721号明細書、第4,070,514
号明細書。しかしながら、本発明が骨の内部成長技術を
用いるさいには、公知技術を用いて行われるであろう。
最後の参照した従来技術は、装置は損傷した椎間板を
切除した後、椎骨間空に設けられるとともに、前記位置
における移動を終結させることを求めるように設計され
たものと考えられる。
かかる装置は、特許第4,501,262号明細書に包含され
ており、挿入可能な装置にして、限定された計装および
方法について記載しており、前記明細書によれば、孔が
関節を横切って穿孔され、大径の中空金属製バスケット
か前記孔部に打込まれ、穿孔により発生した骨くずによ
り充填される。
本発明は、下記の点について従来技術の装置と相異す
るものである。
1.椎骨間空の輪郭無しでの一般的応用性 本発明による装置は、すべての患者に適合できて、凡
ゆる部位の脊椎、凡ての椎間板において、そして、本来
の寸法または形状に関係なく間空の代替なしに適合しう
る。
2.間空の回復および保護 本発明は、椎骨間空を病前の寸法までに回復させると
ともに、間空を修正するよりも挿入に適合するように椎
骨から骨を切除して椎骨間空に適合する挿入により行わ
せている。
3.端板保護 高度に特定した重要支持皮質骨の保護が許容され、端
板の多孔部は高度に網状の骨髄に接合されて、関連する
出血が回避される。かかる出血が発生した場合、血液喪
失の危険性（例えば、低血糖障害、肝炎および後天性免
疫不全症候群などのごとき輸血伝染疾患）、および生体
組織（例えば、神経、血管およびかかる出血による器
官）の結果的な損傷の可視化から現われている凡ての合
併症を示す。
4.技術 前記の挿入物の挿入のための技術は、椎間板除去の確
立されている方法と一致しており、特別な計装も特殊な
外科技術も必要としない。
5.椎間板除去の範囲 椎間板除去の範囲は、外科手術の時点において外科医
によって決定されるとともに、患者ごとに個別化され
る。
6.無穿孔 本発明の利用にさいして穿孔を伴わない。
7.不正確な挿入寸法選定の回避 穿孔が用いられ、特定の骨が切除される前記挿入シス
テムでは、挿入寸法の推定が最初に行われて、適合に関
係なく穿孔によって形成された間空は少くとも大きくし
て挿入されねばならないので適合の品質とは無関係であ
る。
本発明によれば、特定の骨は除去されず、正確な寸法
を有する挿入物が間空に直接に取付けられ、事実の前に
正確な挿入物寸法を推定することが回避できる。
8.モジュール設計 本発明による挿入物は、中央部から外側への間空の深
さの変化に対応して、長さを変化させている。前記装置
は高さを可変とすることができ、または生理学的範囲内
で高さを無限に調整することができて、各種の実施例は
凡ゆる組合せにより用いることができる（例えば、腰部
脊椎では二つの自動伸延挿入物が間空を完全に充填する
ために二つの留め金を配設した挿入物と接合して用いら
れる）。
9.寸法制限の回避 一実施例ではシステムがモジュールであるので、構成
部品は、大きな寸法の挿入物が利用できる間空を完全に
充填して復元されるまで非常に小さな開口に、挿入する
ことができる。しかし、構成モジュール部が導入された
開口よりも組込んだ場合はより大きい。例えば、腰部脊
椎において、その時の巾の測定値が8mmである４個の挿
入物が導入されて、間空内にて復元されたときは、巾32
mmの挿入物となっている。
腰部脊椎において後方進入からの前記寸法の単一挿入
物の挿入は、複数の膜および脊椎神経が存在しているの
で不可能である。
10.間空破壊の回避 本発明の装置は、骨よりも数倍強固であり、破損する
ことはない。
前記装置の挿入は、極めて強固な椎骨皮質の保護が得
られて、椎骨への挿入材の移動を防止するための圧縮力
に抵抗するものである。組立られたモジュール挿入材の
大きな表面積は、単位面積当りの荷重を低減せしめてい
る。例えば、修復された腰椎挿入物は、４個のモジュー
ル成分から形成されているが、椎骨表面積当り約8cm2以
上の荷重分布がなされている。
11.除去性 本発明は間空挿入材であって、間空挿入材と交差する
“貫通椎骨”ではなく、挿入材の切除が必要となるが隣
接椎骨の医原性の破壊をきたすことがない。
12.自己安定性 本発明の挿入材はねじを用いることなく、自己安定性
を有しており、凡ての挿入材は局所移動に対抗するため
の表面構造を具備していて、好適な実施例は、永久固着
を確実にするための活動的、機械手段を包含している。
長期間安定性は上述したように始まり、さらに骨の内部
成長（公知の従来手段による）や挿入材の骨形成荷重へ
の挿入材の表面処理によって促進される。
13.脊椎整復 本発明の各種の実施例の一例として180゜対抗歯面を
有する自動伸延形は、椎骨障害（一椎骨が他椎骨へ前進
または後退する）から整復させることが可能である。
14.脊椎安定性 前記挿入材は、椎間板切除後に脊椎分割材を安定化で
きる効果を有するとともに、その際にねじの使用を省略
しうるものである（ねじは椎骨が広範囲に乱れるため設
計を必要としている）。
15.安定性 本発明によれば、処置はすべて直接視のもとで行われ
るとともに、隣接する生体組織（例えば、器官、神経組
織および血管）の完全な可視化のもとで行われる。
要約すれば、本発明は損傷した脊椎椎間板を交換する
ために用いられる間空挿入材であり、人工円板と異な
り、脊椎運動を保護するよりも永久終結させ、骨融合に
よって行わせるものである。
本発明は、明らかな従来技術の改良であって、骨融合
法において本質的関与をする間空挿入材であって、自己
安定化、脊椎分割片の安定化が行われ、従来の椎間板切
除法と調和し、隣接椎骨との統合性の保護について格別
な調和が行われる。
発明の簡単な要約 本発明は、人工挿入材に関し、その目的とするところ
は、損傷した椎間板を切除した後、椎骨間空に性して直
接的な骨融合を行うものである。前記挿入材は荷重支持
装置に構成され、骨よりも強固にして、椎骨間空内に発
生する強力な力に対抗しうるものである。前記装置は、
複数の巨視的細胞と１〜3mmの開口を有し、自原性骨の
ごとき融合促進材を用いて結合し、骨と挿入材との結合
および相互の結合を行わせるために隣接椎骨に材料的に
影響を与えるようにされている。
挿入材の皮部は表面組織からなり、または、多数の公
知技術のいずれかによって挿入材の安定性および融合促
進のため“骨内部成長表面”を用いて行われる。さら
に、前記装置は、局所移動に抵抗するために椎骨間空内
の固有の安定性を促進するように配設され、設計されて
おり、加えて、隣接椎骨を安定させるようにしている。
本発明による挿入材を用いるために、従来の椎間板切
除が行われ、椎骨端板は不要となるが、多孔部は必要で
ある。概略寸法の挿入材は自原性骨が取付けられ、間空
内に挿入される。
前方勁部装置挿入法の例として、短い横切開が勁の前
面にてなされ、そして損傷した椎間板上を直接的に正中
線の石まで切開される。
広勁筋が開裂され、胸鎖乳突筋とともに開裂され、勁
動脈鞘を有する胸鎖乳突筋は外部に対する保護と後退が
行われる。
食道、気管および関連正中線組織は医学的な保護と後
退が行われて、勁部脊椎の前面が露出される。損傷した
椎間板が識別され、従来の手術方法により切除され、隣
接の椎骨端板は、あらゆる残存軟骨を静かに除去して、
微細な拡散が中断されるまで皮質除去が試みられる。
間空の寸法は、静かな伸延のもとで測定され、適切な
挿入材が選定される網状骨は、患者の腸骨稜、または相
当品から得られ、挿入材に取付けられる。安全を考慮し
て椎骨の前方唇の裏側に挿入材が挿入される。
創傷は規則的方法により終結される。
発明の目的 本発明の目的は、従来法による椎間板切除に調和した
手段による単一処置として、間空融合および安定化を行
うための手段を提供するものである。
本発明の他の目的は、いかなる他の公知手段よりも迅
速、安全および少い血液喪失のもとで、間空融合および
安定化を行うための手段を提供するものである。
本発明の他の目的は、隣接椎骨の有意な妨害または切
除などに一段間空融合および安定化を行うための手段を
提供するものである。
本発明の他の目的は、処置がすべて直接視のもとで行
われて安全性を促進する椎骨間関接固定術および安定化
方法を提供するものである。
本発明の他の目的は、従来の手段による処置をするこ
とにより極めて簡易にしてまだ保有していない特殊計装
または技術の最低の必要のもとで椎骨間関節固定術およ
び安定化方法を提供するものである。
本発明の他の目的は、相補性補助具が少開口を貫通し
て個別的に挿入されて、間空内に再組立てされ、挿入可
能とされる以上に大形である挿入材が占有する間空を復
元するようにしたモジュール構造人工装具を提供するも
のである。
本発明の他の目的は、人工装具に順応するためにいか
なる椎骨をも犠牲とする必要もになしに、凡ゆる間空内
の輪郭に正確に適合することができるモジュール構造挿
入材を提供するものである。
本発明の目的は下記の明細書および添付した図面から
明らかである。
図面の簡単な説明 第１図は、挿入材（頚型）の上部右斜視図、第1a図
は、第１図に示す挿入材の正面図、第1bは、第１図に示
す挿入材の背面図、第1c図は、第１図に示す挿入材の平
面図、第1d図は、第１図に示す挿入材の側面図、第1e図
は、第１図に示す挿入材の底面図である。
第２図は、第1dの線２−２に沿って視た挿入材の側面
断面図である。
第３図は、操作手段への取付けおよび操作手段を示す
第１図の挿入材である。
第４図は、椎間板間空へ運動されている挿入材を示す
正面斜視図である。
第５図は、脊椎に位置されている挿入材の側面図、第
5a図は挿入材および操作手段の拡大部分断面図である。
第６図は、勁部椎骨間空に付設される挿入材の配列の
斜視図、第6a図は矩形固体挿入材の実施態様である。
第７図は、第６図の線７−７に沿って視た椎骨および
挿入材の側断面図、第7a図は、矩形固体挿入材が付設さ
れる第三の実施例を示す椎骨構造の側断面図である。
第８図は、本発明の他の実施例の拡大斜視図である。
第９図は、第８図の線９−９に沿って視た椎骨構造お
よび挿入材の側断面図である。
第10図は、対称の位置における第８図の挿入材の側断
面図である。
第11図は、伸延した位置における第10図の挿入材の側
断面図である。
第12図は、第９図の挿入材の実施態様の斜視図であ
る。
第13図は、中空矩形固形挿入材の実施態様である。
第14図は、第13図の線14−14に沿って視た第13図の中
空矩形固体挿入材の側断面図である。
第15図は、伸延した位置における伸延可能挿入材の実
施態様である。
第16図は、対称の位置における第15図の伸延可能挿入
材である。
第17図は、椎間板間空に付設された第16図の挿入材で
ある。
発明の詳細な説明 第１図〜第５図において、椎間板間空に用いられる挿
入材および挿入材10を挿入するために用いられる付属装
置が示される。
挿入材10は、実質上、中空矩形状のものが示され、テ
ーパー状の前方部を有している。また、上面12と平行を
なす下面14を有し、２側面16,18は相互に平行であり、
前記側面16,18には１〜3mmの細孔からなる開口20が列設
されている。
前壁22は、僅かな凸面を呈し、中央部にねじ孔26を有
する受面24が具備され、操作部材30の取付端28が受入れ
られる。
上面12には、孔33が貫通して設けられたねじ込み式キ
ャップ32が取付けられ、中央部にはアレンレンチ孔34が
設けられ、第３図のアレンレンチＡが嵌入される。
キャップ32は、中空矩形状の挿入材10を嵌挿させる開
口部を被覆し、挿入材10の中央部には自原性骨の挿入が
行われるように形成されている。キャップ32は、上面12
に設けられた１〜3mmの細孔からなる複数の開口36の配
列によって包囲されており、挿入材10の中央中空部を指
向して開口されている。
後壁38は、凸状を呈しており、椎間板間空の後部に適
合するように形成されている。
第３図に示すごとく、操作部部材30は、実質上、長い
芯棒42を有する中空管材40からなり、芯棒42の一端は回
転ノブ44が取付けられ、他端は挿入材10のねじ孔26にね
じ込むためのねじ部46が設けられている。
操作部材30の取付端28は、僅かな凸面を呈しており、
前壁22の僅かな凸面と補完して一体化される。
取付端28は、挿入材10の前壁22における凸面と締結さ
せるための拡大部48を具備しており、また、取付端28に
は操作部材30の差込み深さを制限するための制限具47,4
9が設けられている。
前記挿入材10を用いるにさいし、キャップ32が挿入材
10から取外されるとともに、自原性骨が挿入材10の中空
部内に挿入された後、キャップ32は再び取付けられる。
自原性骨材料による挿入材10への各種の充填方法が充分
な充填を行った挿入材10を得るためのに用いられる。
第４図，第4a図および第５図，第5a図において、挿入
材10を挿入する方法が示されている。操作部材30の芯棒
42のねじ部46は、回転ノブ44を回転させて挿入材10のね
じ孔26にねじ込まれ、取付端28が定置されて、前記拡大
部48は前壁22における凸面と締結されるとともに受面24
と当接されて操作部材30に関連して挿入材10の移動が防
止される。
次いで、挿入材10は、２個の隣接する椎骨Ｖとの間空
に進入が開始される。椎間板間空への挿入材10の挿入操
作のためにハンマＨにより充分かつ堅固に叩いた後、回
転ノブ44によりねじ込まれる。制限具47,49の寸法は、
椎間板間空よりも大きくなっているので、挿入材10の過
大差込みが防止される。
挿入材10の寸法、処置される椎間板間空と実質上同一
寸法を有しており、使用される椎間板間空に対応して、
大形または小形のものが用いられる。
好適な実施例においては、挿入材10はほぼ32mの巾を
有している。
第4A図および第５図において、挿入材10は、所定の位
置に進入されて操作部材3cが切除された後に、椎間板間
空に定置されていることが示されている。
自原性骨材料は挿入材10の中空部材に充填されてお
り、挿入材10と隣接椎骨との間において内部成長を促進
するために用いられている。
骨の内部成長が発生すると、挿入材10は挿入材10の局
所移動を防止する永久装具となり、隣接椎骨間の凡ゆる
運動をも防止するようになる。
第６図において、挿入材の実施態様が開示されてい
る。挿入材61は、上面および下面に、それぞれ線状の隆
起62の列が形成された実質上、矩形状部からなってい
る。
単数または複数の溝64が上面および下面に同様に設け
られる。
第６図にしめすごとく、前記挿入材61列は、椎体間脊
椎挿入材として用いられ、各々は相互に密接に配列され
て切除された椎間板の寸法に近似して配設される。微細
寸法からなる細孔63の組は挿入材61を多孔質なものにし
て骨の内部成長を促進させている。
第６図の挿入材は次のように挿入される。
椎間板は、本質的に従来手段によって切除され、そし
て挿入材61は２個の椎骨の間の椎骨間空に挿入される。
第６図の挿入材61の寸法は、椎骨が融合することによっ
て異なるが、概略、長さ26mmで巾は４個をもって実質
上、椎骨間空を充足させている。
第6a図において、前方開口部69を有し、挿入材69の挿
入を容易にするための“弾頭”型挿入材67が示されてい
る。
第７図および第7a図においては、第６図の挿入材の実
施態様が示され、２個の椎間Ｖの間に設けられる。
第７図において、挿入材70は、前方に面した歯状に示
された隆起62を有していることが示されている。
前記隆起62は、挿入材70が椎骨間空を“歩き”出して
しまうことを防止するようにされている。
第7a図において、第６図の挿入材７の実施例が示され
ており、対抗する隆起72および74を有しており、２つの
椎骨が不正確に配設される場合、椎骨の芯出しを維持る
ようにされている。
第８図において、挿入材の巾を調整可能とする手段を
持つ調整式挿入材81が示されており、前記挿入材81は、
下部材82および上部材84からなり、組立てられたさい
に、本質的に矩形挿入材が形成されるようにされてい
る。上部材84および下部材82は中空部を有しており、相
互に傾斜楔材86および88と対面して受入れ、上部材84お
よび下部材82の中空部の内側に取付けられる。楔部82,8
4は広大部においては上部材84および下部材82との間の
組立中空部よりも高くされているとともに、他端におい
ては浅くされている。
楔部82,84は中央部にねじ孔90,90が設けられ、ねじ棒
94がねじ込まれる。ねじ棒94の頭部98の上部には可撓止
め具95が取付けられ、ねじ込まれるさいの緩み止めに用
いられる。
挿入材は挿入材の本体を貫通する複数の穴100列が設
けられて内部成長プロセスが支援される。
第９〜11図において、伸延可能挿入材81が２個の椎骨
Ｖの間に位置しているのが示されている。
第10図において、伸延可能挿入材81は対称位置におい
て示されている。楔部86,88は、上部材および下部材82
および84の内側傾斜面104に隣接している。
第11図に示すごとく、ねじ棒94が回動されると楔部86
および88は一緒に引張られ、楔部の傾斜部は上部材82を
下部材84から離間させる。ねじ棒94が充分に回動された
時、頭部98は打たれ、可撓止め具95を折曲げてねじ棒94
を逆転することを回避している。
第12図において、伸延可能挿入材81の他の実施態様が
示され、上部材および下部材の表面に突起材106が配設
されて、椎骨内に食い込ませ、確実に付設されることが
支援される。
伸延可能挿入材81を用いるさいし、椎間板が切除され
て、前記挿入材81は椎骨間に置かれ、ねじ棒94を回動さ
せて挿入材81が伸延される。好適な実施例では、前記挿
入材81の巾は、８乃至18mmである。
第13図および第14図において、本発明の他の実施例が
示され、挿入材200は、僅かに傾斜した前進部材202を有
する矩形中空材からなり、第14図に示すごとく前記断面
形状は、挿入材の矩形構造が示されている。
挿入材200を用いるにさいし、挿入材200の内側は、自
原材骨からなるペースト材が充填され、椎間板の場所に
挿入される。挿入材200を形成するために用いる材料の
強度は、実質上、中空構造であっても挿入材200を圧縮
する椎骨の力に抵抗しうる充分な強度を有している。
第15〜17図において、他の実施態様が示されており、
挿入材は、可動部を備えており、挿入材の内側における
第一の位置から挿入材の外側における第二の位置まで移
動させることができる。
挿入材300は、一般的に、矩形構造であり、挿入材の
頂面302および底面304には、それぞれスリット306を有
しており、突起部308をもった移動片307が前記スリット
306内を移動することができる。移動片307の他端は挿入
材300に設けられたピン310によって支持される。
中心部にねじ孔316を持った対向する楔部312および31
4は、頭部320およびスリット322を有するねじ棒318がね
じ込まれている。
楔部312および314は、相互に対向されており、ねじ棒
318が回動されると両楔部312,314は、一緒に引張られ
て、突起部308はピン310を中心に回転して間隙306内を
移動し、挿入材300の外側に位置される。
複数の孔324の列は、挿入材300内における骨の内部成
長および融合を行わせる。
挿入材300を用いるにさいし、椎間板が切除された
後、突起材308が収納された状態の挿入材300が椎骨間空
内に挿入される。そして、第17図に示すごとく、突起材
308が椎間部に食い込まれるまでねじ棒318は回動され
る。かくして、挿入材300は強固に位置される。
上述した挿入材300は、挿入材を通じて骨の内部成長
が誘起される表面構造を有しており、そして、椎骨の壁
部内に持続され、椎骨Ｖ関節の一方から他方への融合を
誘起させる効果をもたらし、挿入材自体は骨が作用する
以上に過剰に作用し得るものである。
挿入材自体は、骨よりも強固な材料によって製作され
ているので、骨の内部成長が待望されている間、両椎骨
にとって構造的支持材をなしている。しかし乍ら、骨の
内部成長が発生されると挿入材は、強固に、かつ、永久
に前記位置に固定される。
本発明は、好適な実施例と多数の実施態様に関し記載
されているので、本発明の他の実施例は、本発明の範囲
から逸脱せずに変形を施すことができることを理解すべ
きである。

Claims (54)

    (57)【特許請求の範囲】
  1. 【請求項１】脊椎挿入材において、２つの隣接する椎骨
    の融合のための挿入材にして、前記挿入材は前記隣接す
    る椎骨の端面間に挿入されており、前記挿入材は、ほぼ
    矩形状部材からなり、前記部材は上部壁および下部壁
    と、前縁壁および後縁壁と、側壁とを備え、前記上部壁
    および下部壁の両表面は前記前縁壁および後縁壁と側壁
    との間に前記隣接する椎骨の端面を支持するための支持
    構造を形成するとともに、前記部材は、前記上部壁およ
    び下部壁に複数の開口を備えており、前記複数の開口は
    前記挿入材を介した骨の内部成長ならびに前記椎骨の融
    合を促進させるための融合促進材を収容しうるととも
    に、少なくとも前記上部壁および下部壁部分は前記椎骨
    の端面の後部および側部に位置決めできて、２つの隣接
    する椎骨の端面間に、前記挿入材が挿入された後、隣接
    する椎骨を支持するとともに、前記椎骨の融合を促進さ
    せることを特徴とする人工脊椎融合挿入材。
  2. 【請求項２】前記ほぼ矩形状部材は、隣接椎骨の端面と
    のかみ合のために、前記ほぼ矩形状部材の上部壁および
    下部壁にあって同一方向に面して複数の鋸歯状部材を備
    えたことを特徴とする請求項第１項に記載の人工脊椎融
    合挿入材。
  3. 【請求項３】前記鋸歯状部材は、前記挿入材が隣接する
    椎骨との間にて移動することを防止するために、第１の
    方向にて上部壁面にある鋸歯状部材と前記第１の方向と
    異った第２の方向にて下部壁面にある鋸歯状部材とから
    なることを特徴とする請求項第２項に記載の人工脊椎融
    合挿入材。
  4. 【請求項４】前記挿入材は、前記前縁壁に傾斜部を有し
    ていることを特徴とする請求項第１項に記載の人工脊椎
    融合挿入材。
  5. 【請求項５】前記ほぼ矩形状部材は、少くとも部材とな
    る上部材と下部材とに少くとも分離され、上部材と下部
    材との間に配設された手段は上部材と下部材との離間を
    強制させることを特徴とする請求項第１項に記載の人工
    脊椎融合挿入材。
  6. 【請求項６】前記手段は、一対からなり中央部にねじ孔
    が設けられ、２つの楔部を接合するねじ棒が嵌装され
    て、ねじ棒の回動により楔部は一緒に引張られて上部材
    と下部材との離間を強制させることを特徴とする請求項
    第５項に記載の人工脊椎融合挿入材。
  7. 【請求項７】前記挿入材は、挿入材の上部壁および下部
    壁には前記隣接する椎骨を接合するための突起材が配設
    されていることを特徴とする請求項第６項記載の人工脊
    椎融合挿入材。
  8. 【請求項８】前記挿入材は、上部壁および下部壁には複
    数のスリットが設けられるとともに、挿入材の内側にお
    ける第１の移動位置から挿入材の外側における第２の移
    動位置の間まで前記複数のスリット内を通過して移動し
    得る移動片が配設され、前記移動片とともに前記椎骨と
    接合させるため２つの隣接する椎骨の端面間に前記挿入
    材が挿入された後、前記複数の移動片は第１の移動位置
    から第２の移動位置まで移動されることを特徴とする請
    求項第１項に記載の人工脊椎融合挿入材。
  9. 【請求項９】２つの椎骨の融合のため脊椎融合挿入材に
    して、前記挿入材は前記隣接する椎骨の端面間に挿入さ
    れており、前記挿入材は、上部壁および下部壁と前縁壁
    および後縁壁と側壁とを備え、前記上部壁および下部壁
    の両表面は前記前縁壁および後縁壁と側壁の間に前記隣
    接する椎骨の端面を支持するための支持構造を形成する
    とともに、少くとも前記上部壁および下部壁に複数の開
    口を備えており、内部中空部は融合促進材を収容しうる
    とともに、前記内部中空部は前記複数の開口の１つの断
    面積よりも大きい断面積を有しており、少くとも１つの
    前記複数の開口は前記内部中空部と連通されており、前
    記隣接する椎骨からの骨の成長は前記内部中空部への前
    記複数の開口を通じて生成できて、少くとも前記上部壁
    および下部壁の前記内部中空部において２つの隣接する
    椎骨の間に前記挿入材が挿入された後、隣接する椎骨の
    後部および側部に位置決めできて隣接する椎骨を支持す
    るとともに椎骨間との融合を可能とすることを特徴とす
    る脊椎融合挿入材。
  10. 【請求項１０】前記隣接する椎骨間に存在する椎間板材
    は、巾、深さおよび高さを有し、前記挿入材は前記椎間
    板材の実質部分の除去により形成された空間と実質上、
    同一の形状および寸法からなり、前記実質部分は椎間板
    の全高さを備えていることを特徴とする請求項第９項に
    記載の脊椎融合挿入材。
  11. 【請求項１１】前記挿入材は、操作接合部が設けられて
    いることを特徴とする請求項第９項に記載の人工脊椎融
    合挿入材。
  12. 【請求項１２】前記挿入材は、前記操作接合部はねじ操
    作部材と接合するねじ孔が設けられていることを特徴と
    する請求項第11項に記載の人工脊椎融合挿入材。
  13. 【請求項１３】前記挿入材の操作接合部は、前記後縁壁
    に受面が設けられていることを特徴とする請求項第12項
    に記載の人工脊椎融合挿入材。
  14. 【請求項１４】前記挿入材は、前記側壁は少くとも１つ
    の前記複数の開口を含んでいることを特徴とする請求項
    第９項記載の人工脊椎融合挿入材。
  15. 【請求項１５】脊椎における２つの隣接する椎骨の融合
    のための人工脊椎融合挿入材を操作するための操作部材
    にして、前記操作部材は、挿入材の壁の外面に適合させ
    るための形状からなる端部を備えるとともに、挿入材の
    補助部と接合するための挿入材接合部であり、かつ、挿
    入材の前記操作部材とかみ合って接合するための手段で
    あることを特徴とする人工脊椎融合挿入材の操作部材。
  16. 【請求項１６】脊椎挿入材において、２つの隣接する椎
    骨の融合のための挿入材にして、前記挿入材は前記隣接
    する椎骨の端面間に挿入されており、前記挿入材は、ほ
    ぼ矩形状部材からなり、前記部材は上部壁および下部壁
    と、前縁壁および後縁壁と、側壁とを備え、前記上部壁
    および下部壁の両表面は前記前縁壁および後縁壁と側壁
    との間に前記隣接する椎骨の端面を支持するための支持
    構造を形成するとともに、複数の挿入材は第１の挿入材
    の側壁と少なくともその他の挿入材の側壁と直接に隣接
    して側部相互が位置せられて融合される２つの隣接する
    椎骨の中間にある椎間板の全高さを除去し、かつ椎間板
    の巾および深さの少なくとも実質的部分を除去して形成
    された空間と実質上同等な組立て巾を有するようにされ
    たことを特徴とする人工脊椎融合挿入材。
  17. 【請求項１７】脊椎挿入材において、２つの隣接する椎
    骨の融合のための複数の挿入材にして、前記挿入材は前
    記隣接する椎骨の端面間に挿入されており、前記挿入材
    の各々は、ほぼ矩形状部材からなり、前記挿入材の組立
    て巾は融合される２つの隣接する椎骨の中間にある椎間
    板の全高さを除去し、かつ椎間板の巾および深さの少な
    くとも実質的部分を除去して形成された空間の巾寸法に
    近似していることを特徴とする人工脊椎融合挿入材。
  18. 【請求項１８】前記内部中空部は、前記内部中空部に近
    接し、かつ融合促進材を前記内部中空部に収容するため
    の近接開口を含んでおり、前記近接開口は前記複数の開
    口のうちの最大寸法よりも大きい寸法からなることを特
    徴とする請求項第９項に記載の人工脊椎融合挿入材。
  19. 【請求項１９】前記挿入材は、前記近接開口を閉鎖する
    手段を備えたことを特徴とする請求項第18項に記載の人
    工脊椎融合挿入材。
  20. 【請求項２０】前記挿入材は、融合される２つの隣接す
    る椎骨の中間にある椎間板の全高さを除去して形成さ
    れ、かつ椎間板の巾および深さの少なくとも実質的部分
    を除去して形成された空間と実質上同一の形状および寸
    法からなることを特徴とする請求項第１項に記載の人工
    脊椎融合挿入材。
  21. 【請求項２１】前記上部材と下部材との間に配設された
    手段は、少なくとも１つの前記部材について前記上部材
    と下部材とに関連する前記部材を移動させるための移動
    手段を有し、移動手段は上部材と下部材との離間を制御
    させることを特徴とする請求項第５項に記載の人工脊椎
    融合挿入材。
  22. 【請求項２２】前記側壁は、複数の開口の少なくとも１
    つを含んでいることを特徴とする請求項第１項に記載の
    人工脊椎融合挿入材。
  23. 【請求項２３】前記挿入材の近接開口を閉鎖する手段
    は、着脱自在のキャップであることを特徴とする請求項
    第19項記載の人工脊椎融合挿入材。
  24. 【請求項２４】前記挿入材は、挿入材の側壁が少なくと
    も他の複数の挿入材の側壁と直接に隣接して側部相互が
    位置せられていることを特徴とする請求項第16項に記載
    の人工脊椎融合挿入材。
  25. 【請求項２５】脊椎挿入材において、２つの隣接する椎
    骨の融合のための挿入材にして、前記挿入材は、前記隣
    接する椎骨の端面間に挿入されており、夫々の端面は後
    部、前部および側部を有しており、椎骨の端面の４隅を
    形成する接合部を備えていて、上部壁および下部壁と、
    前縁壁および後縁壁と、側壁とを備え、前記上部壁およ
    び下部壁の両表面は前記前縁壁および後縁壁と側壁との
    間に前記隣接する椎骨の端面を支持するための支持構造
    を形成するとともに、前記挿入材は２つの隣接する椎骨
    の端面間に前記挿入材が挿入された後、前記端面の後部
    および側部との接合により形成される２つの後部隅部と
    挿入できる構成を有し、複数の開口は少なくとも前記上
    部壁および後部壁に備えられており、前記複数の開口は
    前記挿入材を介した骨の内部成長ならびに前記椎骨の融
    合を促進させるための融合促進材を収容しうることを特
    徴とする人工脊椎融合挿入材。
  26. 【請求項２６】前記挿入材は、前記上部壁および下部壁
    が外表面を有しており、上部外表面は２つの隣接する椎
    骨の端面間に前記挿入材が挿入された後、椎骨の端面の
    主要部と接触することを特徴とする請求項第25項に記載
    の人工脊椎融合挿入材。
  27. 【請求項２７】前記挿入材は、ほぼ矩形状形態を有する
    ことを特徴とする請求項第25項に記載の人工脊椎融合挿
    入材。
  28. 【請求項２８】前記挿入材は、２つの隣接する椎骨の端
    面間に前記挿入材が挿入された後、椎骨の端面の側部と
    後部および前部とのかみ合により形成された４隅と接触
    することができることを特徴とする請求項第25項に記載
    の人工脊椎融合挿入材。
  29. 【請求項２９】前記挿入材は、椎骨の端面に平行な面に
    て非円形断面を有していることを特徴とする請求項第25
    項に記載の人工脊椎融合挿入材。
  30. 【請求項３０】前記挿入材は、椎骨の端面に平行な面に
    て非円形断面を有していることを特徴とする請求項第１
    項に記載の人工脊椎融合挿入材。
  31. 【請求項３１】前記挿入材は、椎骨の端面に平行な面に
    て非円形断面を有していることを特徴とする請求項第９
    項に記載の人工脊椎融合挿入材。
  32. 【請求項３２】前記挿入材は、前記前縁壁の少なくとも
    一部は湾曲していることを特徴とする請求項第９項に記
    載の人工脊椎融合挿入材。
  33. 【請求項３３】前記挿入材は、前記前縁壁の少なくとも
    一部は湾曲していることを特徴とする請求項第25項に記
    載の人工脊椎融合挿入材。
  34. 【請求項３４】前記挿入材は、前記後縁壁の少なくとも
    一部は湾曲していることを特徴とする請求項第１項に記
    載の人工脊椎融合挿入材。
  35. 【請求項３５】前記挿入材は、前記後縁壁の少なくとも
    一部は湾曲していることを特徴とする請求項第９項に記
    載の人工脊椎融合挿入材。
  36. 【請求項３６】前記挿入材は、前記後縁壁の少なくとも
    一部は湾曲していることを特徴とする請求項第25項に記
    載の人工脊椎融合挿入材。
  37. 【請求項３７】前記挿入材のほぼ矩形状部材は、隣接す
    る椎骨の端面とのかみ合のために、前記矩形状部材の上
    部壁および下部壁にあって同一方向に面して複数の鋸歯
    状部材を備えたことを特徴とする請求項第９項に記載の
    人工脊椎融合挿入材。
  38. 【請求項３８】前記鋸歯状部材は、前記挿入材が隣接す
    る椎骨との間にて移動することを防止するために、第１
    の方向にて上部壁面にある鋸歯状部材と前記第１の方向
    と異なった第２の方向にて下部壁面にある鋸歯状部材と
    からなることを特徴とする請求項第37項に記載の人工脊
    椎融合挿入材。
  39. 【請求項３９】前記挿入材は、少なくとも部材となる上
    部材と下部材とに少なくとも分離され、上部材と下部材
    との間に配設された手段は上部材と下部材との離間を強
    制させることを特徴とする請求項第９項に記載の人工脊
    椎融合挿入材。
  40. 【請求項４０】前記手段は、中央部にねじ孔が設けら
    れ、２つの楔部を接合するねじ棒が嵌装されて、ねじ棒
    の回動により楔部は一緒に引張られて上部材と下部材と
    の相互の離間を強制させることを特徴とする請求項第39
    項に記載の人工脊椎融合挿入材。
  41. 【請求項４１】前記挿入材は、挿入材の上部壁および下
    部壁には前記隣接する椎骨の接合するための突起材が配
    設されていることを特徴とする請求項第９項に記載の人
    工脊椎融合挿入材。
  42. 【請求項４２】前記挿入材は、挿入材の上部壁および下
    部壁には複数のスリットが設けられるとともに、挿入材
    の内側における第１の移動位置から挿入材の外側におけ
    る第２の移動位置の間まで前記スリット内を通過して移
    動しうる複数の移動片が配設され、前記移動片とともに
    前記椎骨と接合させるため２つの隣接する椎骨の間に前
    記挿入材が挿入された後、前記複数の移動片は第１の移
    動位置から第２の移動位置まで移動できることを特徴と
    する請求項第９項に記載の人工脊椎融合挿入材。
  43. 【請求項４３】前記挿入材は、挿入材の上部壁および下
    部壁には前記隣接する椎骨を接合するための突起材が配
    設されていることを特徴とする請求項第25項に記載の人
    工脊椎融合挿入材。
  44. 【請求項４４】前記挿入材の上部壁および下部壁には複
    数のスリットが設けられるとともに、挿入材の内側にお
    ける第１の移動位置から挿入材の外側における第２の移
    動位置の間まで前記スリット内を通過して移動しうる複
    数の移動片が配設され、前記移動片とともに前記椎骨と
    接合させるための２つの隣接する椎骨の間に前記挿入材
    が挿入された後、前記複数の移動片は第１の移動位置か
    ら第２の移動位置まで移動できることを特徴とする請求
    項第25項に記載の人工脊椎融合挿入材。
  45. 【請求項４５】前記挿入材は、融合される２つの隣接さ
    れる椎骨の中間にある椎間板の全高さを除去して形成さ
    れ、かつ椎間板の巾および深さの少なくとも実質的部分
    を除去して形成された空間と実質上同一の形状および寸
    法からなることを特徴とする請求項第１項に記載の人工
    脊椎融合挿入材。
  46. 【請求項４６】前記挿入材は、操作接合部を有すること
    を特徴とする請求項第１項に記載の人工脊椎融合挿入
    材。
  47. 【請求項４７】前記操作接合部はねじ操作部材と接合す
    るねじ孔が設けられていることを特徴とする請求項第46
    項に記載の人工脊椎融合挿入材。
  48. 【請求項４８】前記挿入材は、融合される２つの隣接す
    る椎骨の中間にある椎間板の全高さを除去して形成さ
    れ、かつ椎間板の巾および深さの少なくとも実質的部分
    を除去して形成された空間と実質上同一の形状および寸
    法からなることを特徴とする請求項第25項に記載の人工
    脊椎融合挿入材。
  49. 【請求項４９】前記挿入材は、操作接合部を有すること
    を特徴とする請求項第25項に記載の人工脊椎融合挿入
    材。
  50. 【請求項５０】前記操作接合部は、ねじ操作部材と接合
    するねじ孔が設けられていることを特徴とする請求項第
    49項に記載の人工脊椎融合挿入材。
  51. 【請求項５１】前記挿入材は、複数のモジュール下位構
    造からなり、各々のモジュール下位構造は椎間板の巾寸
    法よりも少ない巾寸法を有しており、複数の前記下位構
    造は第１の前記下位構造の側壁と少なくともその他の下
    位構造の側壁と直接に隣接して位置せられて融合される
    ２つの隣接する椎骨の中間にある椎間板の全高さを除去
    し、かつ椎間板の巾および深さの少なくとも実質的部分
    を除去して形成された空間と実質上同等な組立て巾を有
    するようになされたことを特徴とする請求項第１項に記
    載の人工脊椎融合挿入材。
  52. 【請求項５２】前記挿入材は、複数のモジュール下位構
    造からなり、各々のモジュール下位構造は椎間板の巾寸
    法よりも少ない巾寸法を有しており、複数の前記下位構
    造は第１の前記下位構造の側壁と少なくともその他の下
    位構造の側壁と直接に隣接して位置せられて融合される
    ２つの隣接する椎骨の中間にある椎間板の全高さを除去
    し、かつ椎間板の巾および深さの少なくとも実質的部分
    を除去して形成された空間と実質上同等な組立て巾を有
    するようにされたことを特徴とする請求項第25項に記載
    の人工脊椎融合挿入材。
  53. 【請求項５３】前記挿入材は、複数のモジュール下位構
    造からなり、各々のモジュール下位構造は椎間板の巾寸
    法よりも少ない巾寸法を有しており、複数の前記下位構
    造は第１の前記下位構造の側壁と少なくともその他の下
    位構造の側壁と直接に隣接して位置せられて融合される
    ２つの隣接する椎骨の中間にある椎間板の全高さを除去
    し、かつ椎間板の巾および深さの少なくとも実質的部分
    を除去して形成された空間と実質上同等な組立て巾を有
    するようにされたことを特徴とする請求項第９項に記載
    の人工脊椎融合挿入材。
  54. 【請求項５４】前記挿入材は、前記前縁壁の少なくとも
    一部は湾曲していることを特徴とする請求項第１項に記
    載の人工脊椎融合挿入材。
JP1507651A 1988-06-28 1989-06-28 人工脊椎融合挿入材 Expired - Lifetime JP2796544B2 (ja)

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US212,480 1988-06-28

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US6733535B2 (en) 2004-05-11
WO1990000037A1 (en) 1990-01-11
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US5522899A (en) 1996-06-04
US5776199A (en) 1998-07-07
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ATE119015T1 (de) 1995-03-15
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US20060241764A1 (en) 2006-10-26
US20030149482A1 (en) 2003-08-07
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US20030065396A1 (en) 2003-04-03
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