JP3955632B2 - 体幹間融合固定装置 - Google Patents
体幹間融合固定装置 Download PDFInfo
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- JP3955632B2 JP3955632B2 JP53590197A JP53590197A JP3955632B2 JP 3955632 B2 JP3955632 B2 JP 3955632B2 JP 53590197 A JP53590197 A JP 53590197A JP 53590197 A JP53590197 A JP 53590197A JP 3955632 B2 JP3955632 B2 JP 3955632B2
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- outer plate
- cancellous bone
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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
- A61F2/4455—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
- 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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- A61F2/00—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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- 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
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7059—Cortical plates
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- A61F2002/30428—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by inserting a protrusion into a slot
- A61F2002/30431—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by inserting a protrusion into a slot made by first pushing a necked button longitudinally and then sliding it laterally within a keyhole slot
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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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- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
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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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- A61F2002/30535—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
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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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- 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
- A61F2002/30316—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
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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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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Neurology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- General Health & Medical Sciences (AREA)
- Transplantation (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Cardiology (AREA)
- Animal Behavior & Ethology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
- Tents Or Canopies (AREA)
- Lining Or Joining Of Plastics Or The Like (AREA)
- Ultra Sonic Daignosis Equipment (AREA)
- Peptides Or Proteins (AREA)
- Surgical Instruments (AREA)
Description
かかるケージは例えば次の特許出願から既知である。即ち、FR2 703 580,EP493 698,EP599 419,FR2 124 815,EP307 241,EP615 428。
それらのケージは概ね卵形または平行六面体である。それらは金属または生物適合材料により剛性に形成され、かつ開放上下面を介して海綿状骨を受ける設計である。
上記タイプのケージは概ね良好な結果を得るが、実際には、ケージのいかなる移動の可能性または第2変位の危険をも回避するためにそのケージを確実に位置決めして移動しないようにする必要がある場合がある。
海綿状骨または骨代替物を受けるように形成された開放内部ケージを形成する移植片から成るプロテーゼはEP0179695から既知である。このケージは、ケージの挿入面に実質的に垂直の平面内に延在しかつ相互に固定されるべき2つの隣接椎骨の各々に固定するためにそれぞれのねじを通過させる孔を両側に有するプレートに取り付けられている。この移植片は長手がシリンダの形態になっていて椎骨本体部分が除去された2つの隣接椎骨間へ挿入できる設計である。かかるプロテーゼは固定ねじに関する欠点を有し、この固定ねじは、少なくとも一部で椎骨からそのねじを分離させてケージの相対的移動の原因となる大きな力を必要とする。
本発明の課題は椎骨用の体幹間融合固定装置を提供することにより従来技術の欠点を解消することにある。本発明による装置は次の構成から成るタイプに属する。
−海綿状骨または骨代替物を受けかつ円板除去時に2つの椎骨間に設置されるように設計された少なくとも1つの開放内部ケージ、および
−前記ケージの挿入面に実質的に垂直の平面内でそのケージのいずれかの側に延在しかつ前記ケージにより相互に対して固定されるべき少なくとも2つの隣接椎骨へ固定するための固定手段を有する外部プレート。
本発明によれば、前記装置は剛性平行六面体(parallepiped)で構成され、2つの隣接する椎骨により形成される体幹間スペースもしくは椎骨腔(intervertebral space)に適合する形状および断面を形成する前壁、後壁、および側壁を有することを特徴とする。
前記ケージは剛性であり、金属または生物適合材料により形成され、概ね平行六面体であり、体幹間スペースに適合し、かつ海綿状骨または骨代替物を上下開放面かつ/または前開口部を介して受ける設計である。
必要により、本発明の装置は単一片の形態のケージ−プレートユニットの形態、またはプレートとゲージとを組立てるための手段を含む内部ケージおよび外部プレートの形態に構成される。
本発明は、また、次の説明から理解されかつ独立または技術的に可能な組合せにより考えられる特徴に関する。
本発明の実施方法のより良い理解のために添付図面を参照して非制限例を説明する。
図面において、図1は本発明の第1形態の固定装置に分解斜視図である。
図2は本発明の第2形態の固定装置の分解斜視図である。
図3はワンピース固定装置例を示す。
非制限例によれば、図1に示されたケージ1は、概ね、海綿状骨または骨代替物を保持固定する設計の側壁2,3,4および5を有する剛性平行六面体に構成される。その上下壁8および9は2つの連続椎骨方向に開放している。
前後面5および3は適宜椎骨間の間隔を保持するために決定された高さを有する。
本実施例において、ケージ1の側壁2および4は対応する側壁2および4に類似の形態の大きな貫通孔10および11を有する。
ケージ1は、このように、4つの側壁面を貫通する開口部を有する。ケージは、また、前面5上でケージ1の挿入面に対して実質的垂直の平面内でそのケージの両側に延在しかつその両端部にケージ1を介して共に連結するための少なくとも2つの隣接椎骨へ固定するための固定手段13および14を有する外部ストラップ形成要素12(以下「プレート」と言う)を担持する。
当然ながら、外部ストラップまたはプレート12は、例えばケージ−プレートユニットとしてモールディングまたはキャスティングにより内部ケージ1と一体成形されてよい。
ただし、本実施例においてプレート12および内部ケージ1は分離して形成されかつ組立手段により相互に連続的に固定されることが好ましい。
図1の形態において、ケージ1上にプレート12を組立てる手段はケージ1の垂直前面5上に形成された円筒スタッド15およびこのスタッド15の円形頭部16下に形成された周辺溝17により構成されている。頭部16はプレート12に形成されたキーホール形態の長円形孔19の対応する拡大部18への挿入に適したものであり、溝17はキーホールの狭域20に側縁部間を慴動してスタッド15の頭部16がプレート12の外側面21と共働して軸係止できる寸法である。
スタッド15のキーホールへの係合は狭域へスタッド15を付勢することにより行われる設計であってよい。
当然ながら、上記ケージは種々の高さ、幅および深さに設計されてよい。
次の実施例は好適な解剖学的形態が付与されている。
海綿状骨または他の骨代替物はケージ1を椎骨間へ位置決めする前後のいずれかに適所へ設置されると仮定できる。
図2の形態は先の形態と次の点で事実上相違する。即ち、ケージ1Aへプレート12Aを組立てる手段は鳩尾形慴動路により構成され、その柄穴形成部30は垂直方向へ慴動するようにプレート12Aの内側面31上に形成され、他方、対応する柄形成部32はケージ1Aの外側前面5A上に形成されている。柄穴形成部31と柄形成部32はこれと逆の位置関係で形成されてよい。
本実施形態において、ケージ1Aは先の実施例と異なり側開口部を有しない。
更に、図1のケージの上壁8に対応する図2のケージ1Aの上面は、凸面に形成されている。
ケージ1Aの外側前面5Aおよびこれと共働するプレート12Aの対応面31はそれぞれ同一長円形孔33および34を有し、長円形孔33,34はプレート12Aがケージ1A上へ組立てられるときに合致し、ケージ1Aを適所に設置した後に海綿状骨を前方から挿入できる設計になっている。
図2の実施例において特定断面形態のケージ1Aは体幹間スペースへ完全に適合するようになっている。
図3の実施形態は単一片として形成されている点が図2の形態と相違する。
ケージとプレートのユニットの前面5Aは長円形孔33を有していて、そのユニットが適所へ設置された後にそのケージ部へ海綿状骨の前方から挿入できる構成である。
図1、2および3の実施形態に共通する方法において、ケージ1,1Aを固定した後に、プレート12,12Aを椎骨上へ固定するための固定手段には、ストラップ12,12Aの両端部へ形成された孔13および14を通過する支持(pedicular)ねじ(図示せず)が使用される。
本発明の他の特徴によれば、プレート12,12Aの固定孔13および14は組立体の中心垂直軸X,X’の両側に形成される対角線Y,Y’上の形成される。
1実施形態(図示せず)において、本固定装置は2つ以上の内部ケージ1,1Aを具備し、ケージ1,1Aは、相互に対すると共に3つ以上の連続的椎骨に対して、ケージ1,1Aと共に2つの組立体手段15,18または30,32を構成し、2つの端部固定孔13,14を有し、かつ同様に椎骨内に固定するための3つ以上の支持ねじと共働する中間固定孔を有するプレート12,12Aにより固定される。
上記プレートは1つの椎骨に対して1つの固定ねじを有するものとして示されているが、これらは2またはそれ以上であってよい。
当然ながら、本固定装置は図1,2または3の実施例で説明したように2またはそれ以上のケージ−プレートユニットにより構成でき、プレートは選択的に重合されて相互に対に連結されてよい。
本発明の固定装置はチタン合金または同等金属またはその他の生物適合性プラスチック材料により形成される。
Claims (9)
- −海綿状骨または骨代替物を受けかつ円板除去時に2つの椎骨間に設置されるように設計された少なくとも1つの開放内部ケージ(1A)、および
−前記ケージ(1A)の挿入面に実質的に垂直の平面内でそのケージの両側に延在しかつ前記ケージ(1A)により共に固定されるべき少なくとも2つの隣接椎骨へ固定するための固定手段(13,14)を有する外部プレート(12A)から成るタイプの椎骨用体幹間融合固定装置において、
前記外部プレートは前記ケージに選択的に取り付けられることのできる構成であり、かつ
前記ケージ(1A)は剛性平行六面体を形成すると共に2つの隣接する体幹間の椎間腔(intervertebral space)に適合する断面を構成する前壁(5A)、後壁)(3)および2側壁(2,4)を有することを特徴とする椎骨用体幹間融合固定装置。 - 前記ケージ(1A)の前壁(5)は海綿状骨の前記ケージへの前方からの挿入を可能にする開口部(33)を有することを特徴とする、請求項1の装置。
- 前記固定手段は、対面する椎骨に係合する設計のねじの通過を可能にする単一孔(13,14)により構成され、前記孔(13,14)はその組立体の中心垂直軸(x−x’)の両側に対角線(y−y’)上に形成されていることを特徴とする、請求項1の装置。
- 前記外部プレート(12A)と内部ケージ(1A)は単一片として形成されることを特徴とする、請求項1の装置。
- 前記外部プレート(12A)および内部ケージ(1A)は分離形成されて相互に対して固定されていることを特徴とする、請求項1の装置。
- 前記外部プレート(12A)は、柄穴形成部(30)を有する鳩尾形慴動路により前記ケージ(1A)上に固定され、前記柄穴形成部(30)は前記外部プレート(12A)の内側面(31)上で垂直慴動方向に形成され、かつそれに対応する柄部(32)は前記ケージ(1A)の外側前面(5A)上に形成されるか、または柄穴形成部(30)および柄部(32)はそれぞれ前記と逆の側面上に形成されていることを特徴とする、請求項5の装置。
- 前記ケージ(1A)の外側前面(5A)およびそれと共働する前記外部プレート(12A)の相応する内面(31)は、前記外部プレート(12A)が前記ケージ(1A)へ組立てられるときに合致するように設計された同一の長円形孔(33,34)をそれぞれ有し、それにより前記ケージ(1A)が隣接する椎骨間の適所への設置後に海綿状骨の前方からの挿入を可能にすることを特徴とする、請求項6の装置。
- 前記ケージ(1A)は、開放上下面を含み、前記上面は凸面に構成され、かつ側壁(2,4)は海綿状骨を挿入できる構成の挿入孔(10,11)を有することを特徴とする、請求項1の装置。
- 2つまたはそれ以上の前記内部ケージは相互に対して固定されかつ前記外部プレート(12A)によって3つまたはそれ以上の連続椎骨に対して位置決めされ、かつ前記外部プレートは前記ケージ(1A)へ組立てるための少なくとも2つの組立手段(30,32)、そして少なくとも2つの端部固定孔(13,14)、および椎骨へ固定するための3つまたはそれ以上の支持ねじと共働する中間固定孔を有することを特徴とする、請求項1の装置。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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FR9604196A FR2747034B1 (fr) | 1996-04-03 | 1996-04-03 | Systeme de contention et de fusion intersomatique |
FR96/04196 | 1996-04-03 | ||
PCT/FR1997/000591 WO1997037620A1 (fr) | 1996-04-03 | 1997-04-02 | Systeme de contention et de fusion intersomatique |
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JP2000508187A JP2000508187A (ja) | 2000-07-04 |
JP3955632B2 true JP3955632B2 (ja) | 2007-08-08 |
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Application Number | Title | Priority Date | Filing Date |
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JP53590197A Expired - Lifetime JP3955632B2 (ja) | 1996-04-03 | 1997-04-02 | 体幹間融合固定装置 |
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US (1) | US6235059B1 (ja) |
EP (1) | EP0891169B1 (ja) |
JP (1) | JP3955632B2 (ja) |
AT (1) | ATE314029T1 (ja) |
BR (1) | BR9710703A (ja) |
DE (1) | DE69734977T2 (ja) |
ES (1) | ES2256884T3 (ja) |
FR (1) | FR2747034B1 (ja) |
PT (1) | PT891169E (ja) |
WO (1) | WO1997037620A1 (ja) |
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-
1996
- 1996-04-03 FR FR9604196A patent/FR2747034B1/fr not_active Expired - Lifetime
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1997
- 1997-04-02 WO PCT/FR1997/000591 patent/WO1997037620A1/fr active IP Right Grant
- 1997-04-02 PT PT97919466T patent/PT891169E/pt unknown
- 1997-04-02 ES ES97919466T patent/ES2256884T3/es not_active Expired - Lifetime
- 1997-04-02 US US09/147,083 patent/US6235059B1/en not_active Expired - Lifetime
- 1997-04-02 EP EP97919466A patent/EP0891169B1/fr not_active Expired - Lifetime
- 1997-04-02 BR BR9710703A patent/BR9710703A/pt not_active IP Right Cessation
- 1997-04-02 JP JP53590197A patent/JP3955632B2/ja not_active Expired - Lifetime
- 1997-04-02 AT AT97919466T patent/ATE314029T1/de active
- 1997-04-02 DE DE69734977T patent/DE69734977T2/de not_active Expired - Lifetime
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ES2256884T3 (es) | 2006-07-16 |
WO1997037620A1 (fr) | 1997-10-16 |
BR9710703A (pt) | 1999-08-17 |
US6235059B1 (en) | 2001-05-22 |
FR2747034B1 (fr) | 1998-06-19 |
FR2747034A1 (fr) | 1997-10-10 |
EP0891169A1 (fr) | 1999-01-20 |
JP2000508187A (ja) | 2000-07-04 |
EP0891169B1 (fr) | 2005-12-28 |
ATE314029T1 (de) | 2006-01-15 |
PT891169E (pt) | 2006-05-31 |
DE69734977T2 (de) | 2006-08-31 |
DE69734977D1 (de) | 2006-02-02 |
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