JP4547135B2 - 骨の動的安定化装置 - Google Patents
骨の動的安定化装置 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
- A61B17/7008—Longitudinal elements, e.g. rods with a cross-section which varies along its length with parts of, or attached to, the longitudinal elements, bearing against an outside of the screw or hook heads, e.g. nuts on threaded rods
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
- A61B17/702—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other having a core or insert, and a sleeve, whereby a screw or hook can move along the core or in the sleeve
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/0084—Material properties low friction
- A61B2017/00845—Material properties low friction of moving parts with respect to each other
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Description
この発明は、骨の、特に椎骨の動的安定化装置に関する。
【0002】
椎間板の欠陥を治療するための既知の方法では、手術によって欠陥のある椎間板を除去し、椎骨板の空間を2つの椎骨体で補強するか、欠陥のある椎骨板を除去した後で、続いて人工的な椎骨板を挿入する。第1の場合において、補強した部分に隣接した脊柱の部分は不自然に圧迫され、第2の場合において、本来の椎骨板の特性のシミュレーションは依然として満足のゆくものではない。
【0003】
EP 0 669 109 B1から、隣接した胸椎を安定させるための装置が既知であり、それによって、損傷を受けた椎間板および椎間関節の圧迫を、後に、部分的に和らげることができる。この装置は2つの茎ねじを有し、これらのねじは、各々、弾性合成素材からなるバンドに固く接合され、付勢されたバンドを介して互いに接合される。圧縮力を伝達するのに、弾性バンドに押付けられた耐圧縮体が2つのねじ頭の間にさらに与えられる。しかしながら、この種類のバンドを使用すると、脊柱の動く部分のいかなる誘導安定性も得られない。隣接する椎骨の互いに対する位置付けの調整も不可能であり、これはバンドおよび骨ねじを介した圧縮要素の力伝達作用が特定ではないためである。
【0004】
EP 0 516 567 B1から、隣接した椎骨を安定化するための装置が既知であり、この装置は、椎骨にねじ込まれた2つの単軸ねじの間に与えられたエラストマからなる減衰要素を有する。この減衰要素の端部はそれぞれ上記ねじに接合され、その端部には、骨ねじの1つの受け部分に各々差込んで固定することが可能な球状ヘッドがある。したがって、減衰要素の長手軸に対する骨ねじの角度の最小の調整が可能である。しかしながら、各々の対になった椎骨を互いに接合するには、正確な長さおよび正確な断面を備えた個々に一致する減衰要素を作らなければならない。さらに、減衰要素の力伝達作用は不確定であり、これは力伝達作用が軸力だけでなく曲げ力およびねじり力にも屈するためである。
【0005】
脊柱または脊柱の部分を固定するために、ロッドおよびロッドに固く接合され、対応する椎骨にねじ込まれた少なくとも2つの茎ねじからなるインプラントシステムを与えることがさらに既知である。しかしながら、これでは、椎間板の動的な動きを制御すること、または椎間板への圧迫を動的に引き継いでその圧迫を和らげることは、不可能である。
【0006】
この発明の目的は、骨の、特に隣接する椎骨のために動的に作用する安定化装置を提供することであり、それによって、骨または椎骨および椎間関節を互いに対して位置付けることと、同時に、定められた方法で、椎間板および間に接合された椎間関節への圧迫を、伝達される力に対して支持し、部分的に和らげることとの双方が可能である。
【0007】
この目的は、請求項1に従う安定化装置によって達成される。この発明のさらなる発展は従属クレームに記載されている。
【0008】
さらなる特徴および利点が図を用いた実施例の説明から明らかになる。
特に図1〜図4からわかるように、この安定化装置は、2つの多軸茎ねじ1、2およびこれらのねじを接合して隣接した2つの椎骨100、101を安定化させるためのロッド3を有する。茎ねじ1、2は、好ましくは図3および4に示されるように構成される。茎ねじ1、2は、骨ねじを備えたねじ込みシャンク4を有するねじ要素と、受け部分6に接合され球の部分のような形をしたヘッド5とを有する。この受け部分6は、端部の1つにおいて、軸に対称に整列した第1のボア7を有し、その直径はシャンク(4)のねじ込み部分の直径よりも大きく、ヘッド(5)の直径よりも小さい。受け部分6はさらに、第1のボア7と反対側の端部で開いている同軸の第2のボア(8)を有し、その直径は、ねじ要素が開いた端部を通して案内され、ねじ込み部分が第1のボア7を通り、ヘッド5が第2のボアの床に届くのに、十分な大きさである。受け部分の床は、ねじ要素が挿入されかつ圧迫されていない状態で受け部分6内で旋回可能であるように構成される。この受け部分はさらに、中心に対して対称的に配置されたU字形のリセスを有し、その床は第1のボア7に向けられており、それにより2つの開いた脚10、11が形成される。開いた端部と境を接する領域において、脚10、11は内ねじ12を有する。
【0009】
茎ねじはさらに、圧縮要素13を含み、この圧縮要素は、受け部分6に押込まれることができるように、適切な外径を有するように構成されている。その端部の1つで、リセス14が与えられ、これは球の部分のような形をしており、受け部分6の第1のボア7に向かって広がっており、その球の半径は、受け部分に挿入された状態でねじ要素のヘッド5を囲むように選択される。脚10、11の開いた端部の方向では、圧縮要素13はU字形のリセス15を有し、その寸法はロッド3をそれにより形成される溝に置くことができるような寸法にされる。このU字形のリセス15の深さは、受け部分6の円筒軸の方向で見ると、受けるロッド3の直径よりも大きいため、圧縮要素13は、横方向の脚16がロッド3の位置より上にある状態で、上方に突出する。圧縮要素13はさらに、それを通して延在し、ねじ道具をヘッド5に与えられた対応するリセス18と係合するようにする中央のボア17を有する。
【0010】
受け部分でねじ要素を固定するために、ブッシングタイプまたはナットタイプの固定要素20が与えられ、この要素は脚10、11の間にねじ込むことができ、脚の内ねじ12と協働する外ねじ21を有し、さらに内ねじ22を有する。ねじ込むために、固定要素20はその端の1つにおいて半径方向に延びるリセス23を有する。受け部分の軸方向における固定要素20の寸法、受け部分の開いた脚10、11の寸法および協働するねじの寸法または圧縮要素の開いた脚16の高さは、ねじ込まれた状態で、固定要素20が圧縮要素の脚16に力を及ぼし、それが受け部分6でヘッド5を塞ぐような寸法にされる。
【0011】
さらに、固定要素20にねじ込むことのできる内ねじ、締付ねじまたは設定ねじ25が与えられ、その外ねじ26は固定要素20の内ねじ22と協働する。内ねじ25、固定要素20および圧縮要素13の寸法は、ねじ込まれた状態で、内ねじ25が配置されたロッド3を押すように選択される。
【0012】
図4は、図1および2に従った茎ねじ1の断面を示している。茎ねじ1は、内ねじの構成が茎ねじ2とは異なる。図4からわかるように、茎ねじ1の内ねじ25′は、ロッドが動作中に摩擦が小さい状態で滑動できるようにするために、ロッドに面する側に、滑動素材で作られた滑動床26を有する。たとえば、滑動素材として高分子ポリエチレンが使用される。
【0013】
図1および2からわかるように、この安定化装置はさらに、ロッドを介して互いに接合された2つの茎ねじ1、2の間に与えられるばね要素30を含む。このばね要素30は、コイルばねとして構成されており、直径はロッド3の直径よりもわずかに大きいため、このコイルばねはロッド3に押付けることができる。軸方向でのコイルばねの長さは、2つの茎ねじの間のロッドで架橋される隣接する椎骨間の距離の大きさと一致する。さらに、コイルばねの長さおよびばねの力は、椎間板の既存の機能的欠陥に対して拡張または圧縮効果がこのばねで達成できるような大きさにされている。このばねは好ましくは耐摩耗素材、たとえば耐摩耗合成素材で覆われる。
【0014】
ロッド3は、その端の1つに、たとえば環状のショルダーの形をした止め具31を有し、その直径は受け部分6のU字形のリセスおよび圧縮要素13の直径よりも大きいため、組立てられた状態で止め具31に隣接した茎ねじ1は、これに関する限りのみ置換え可能である。好ましくは、ロッドは、ある素材で覆われる、特に受け部分6におけるまたは受け部分に設けられた圧縮要素13におけるロッドの滑動を容易にする適切な素材で覆われる。好ましくは、茎ねじのうちの少なくとも1つの圧縮要素13はまた、滑動力を増大させる素材たとえば合成素材で覆われる。
【0015】
動作において、図5からわかるように、まず受け部分6に挿入された茎ねじ1、2のねじ要素が、外科医によって、圧縮されていない状態の欠陥の椎間板200に隣接した患者の椎骨にねじ込まれ、受け部分6はロッド3を挿入できるように位置合わせされる。圧縮要素13は既に受け部分に挿入されている。次に、図6に示されるように、ロッド3は、ばね30が押付けられた状態で受け部分6に挿入される。ロッド3はその中で、止め具31が患者の頭の方向に向くように方向付けられる。さらに、ばね30は、付勢された状態で2つの受け部分6の間に置くために、道具によって予め圧縮される。次の段階では、図7に示されるように、外科医は、茎ねじ1、2各々について、受け部分またはロッドに対するねじ要素の最適角度を設定する。この角度は、次に固定要素20を受け部分にねじ込むことによって固定される。図3および4からわかるように、角度が固定されると、固定要素20が圧縮要素13に力を及ぼし、固定要素が受け部分におけるその位置でヘッド5を固定する。圧縮要素の脚16は、配置されたロッド3を超えて突出するため、ロッド3は固定要素20にねじ込んでも接触されず、各々において受け部分6で依然として自由に置換え可能である。
【0016】
ねじ要素および受け部分の互いの角度によって、間に位置する椎間板が再びその自然の形を採ることができるようにするために、隣接する椎骨の反対側の表面の間で所望の楔角度を調節できる。図2に示されるように各々において2つの安定化装置を使用することによって、角度はその中で、側面および正面図において互いに独立して設定可能である。このようにして、互いの椎間関節の位置もまた規定できる。
【0017】
図7からさらにわかるように、付勢された状態で挿入されたばね30は、挿入の後に拡張して、受け部分6を押し離す。この拡張は、一方側で止め具31によって制限される。拡張によって、椎間空間および椎間関節の広がりが生じ、それにより椎間板200は、椎間空間から流体を吸収するため拡張することができ、椎間関節は図7の矢印が示すように圧縮から解放される。損傷した椎間板はしたがって再びその自然の形を採ることができる。
【0018】
図8に示されるように、ばねは次に、再び付勢された状態にするために、受け部分6を互いに対して移動することによりわずかに圧縮される。それにより、椎間空間も減じられ、椎間板もともに再びわずかに圧迫され、または縮められ、椎間関節は図8の矢印が示すように圧迫される。所望の端の位置において、ロッド3は最後に、止め具の反対側の端に位置付けられた茎ねじの受け部分6に固く接合される。ロッドは内ねじ25にねじ込むことによって固定される。ロッドの止め具31に隣接して与えられる茎ねじ1において、受け部分6およびロッド3は互いに対して可動のままである。滑動床26を有する内ねじ25′によって摩擦の少ない状態でのロッドの滑動が可能になる。
【0019】
図1および2に示される最終的な位置において、このシステムは力伝達システムおよび減衰システムとして作用する。患者が直立した位置にあるときに脊柱に作用する力は、茎ねじ、ばねおよびロッドからなるシステムを介して部分的に伝達され、椎間板は圧力から解放される。このばねはさらに、静止しているまたは圧迫されていない状態で、すなわち横になっている間に椎間空間を広げるための拡張要素として、および、たとえば歩いているときといった圧迫中に激しい上下動を減衰するための減衰装置としての双方として作用する。
【0020】
このシステムには、組立中に骨ねじおよびロッドの最適の調整が可能であるという利点がある。ロッドを介して固く接合されているため、軸力を伝達して椎間板への圧迫を軽減することが可能である。しかしながら、このシステムは屈曲およびねじれに対して剛性が高く、椎間板へ正確に力を伝達するという点でさらなる利点を含む。
【0021】
この発明は、ロッドによる2つの多軸茎ねじのみの接合に限定されない。必要であれば、いくつかの椎骨を互いに接合することもでき、その場合対応する数の多軸骨ねじが用いられる。所望の可動性次第で、止め具がロッドの適切な点に与えられ、対応する隣接した骨ねじがロッドに対して置換え可能な状態で保持される。
【0022】
説明した実施例では、多軸骨ねじが使用されたが、この発明はこれらに限定されない。脊柱の対応する部分の解剖学的構造で、単軸骨ねじを使用することができれば、この発明に従って、ロッドに固く接合された1つの単軸骨ねじおよびロッドに可動に接合された1つの単軸骨ねじを使用することが可能である。単軸骨ねじと多軸骨ねじとの組合せでも使用できる。
【0023】
ばね要素30も異なった構成であってもよい。たとえば、ばね要素30をコイルねじとして構成し、ロッドの内側で与えることができる。この目的のために、ロッドは互いに挿入された2つのスリーブからの2つの部分で形成され、各々のスリーブはスリーブ床を有し、スリーブ床に対してコイルばねの端がある。このばね要素をさらにポリマー製の弾性管として構成することもできる。
【図面の簡単な説明】
【図1】 この発明に従った組立てられた状態の装置の概略側面図を示す。
【図2】 図1に示すこの発明に従った装置の水平投影図を示す。
【図3】 図1に示す装置で使用される多軸ねじの、線A−Aに沿う断面を示す図である。
【図4】 図1に示す装置で使用される多軸ねじの、図2の線に沿う部分的な断面を示す図である。
【図5】 安定化装置の組立ての一連のステップを示す図である。
【図6】 安定化装置の組立ての一連のステップを示す図である。
【図7】 安定化装置の組立ての一連のステップを示す図である。
【図8】 安定化装置の組立ての一連のステップを示す図である。
【符号の説明】
1 茎ねじ、3 ロッド、4 ねじ込みシャンク、6 受け部分、7 第1のボア、8 第2のボア、10 開いた脚、12 内ねじ、13 圧縮要素、14リセス、15 U字形のリセス、16 横方向の脚、17 中央のボア、20固定要素、25 設定ねじ、26 滑動床、30 ばね要素、31 止め具。
Claims (11)
- 骨の動的安定化装置であって、
第1の骨固定要素(1)と、
第2の骨固定要素(2)と、
これら2つの骨固定要素を接続する長手軸を有するロッド(3)と、
前記第1と第2の骨固定要素の間にあってそれら第1と第2の骨固定要素に対して前記長手軸の方向に力を及ぼす弾性要素(30)とを備え、
各骨固定要素は骨内に固定される第1の部分(4)と前記ロッドに接続される第2の部分(6)を有し、
前記骨固定要素の少なくとも1つは多軸骨ねじを含み、前記多軸骨ねじの第1部分は骨内に固定されるシャンクを含み、前記多軸骨ねじの第2部分は受け部を含み、この受け部は前記ロッドを受け入れるためにシャンクに関節的態様で接続されており、前記シャンクと前記受け部は任意の角度で互いに固定され得ることを特徴とする、動的安定化装置。 - 前記骨固定要素(1)のうちの1つが、置換え可能に前記ロッドに接合され、止め具(31)が与えられて、前記置換え可能な骨固定要素の動きを制限することを特徴とする、請求項1に記載の動的安定化装置。
- 少なくとも1つの骨固定要素(1,2)は前記ロッド(3)に多軸で接合できることを特徴とする、請求項1または2に記載の動的安定化装置。
- 前記骨固定要素は、骨における固定のためのシャンク(4)と、関節の態様でシャンクに接合されて前記ロッドを受けるための受け部分(6)とを有し、前記シャンク(4)および前記受け部分(6)は、互いに対し、ロッドを固定する角度から独立した角度で固定できることを特徴とする、請求項3に記載の動的安定化装置。
- 前記ロッドに接合され、前記止め具に隣接する多軸で接合された前記骨固定要素(1)が、置換え可能に配置されることを特徴とする、請求項4に記載の動的安定化装置。
- 前記骨固定要素(2)のうちの1つは、前記ロッド(3)に固く接合されることを特徴とする、請求項1から5のうちの1つに記載の動的安定化装置。
- 前記ロッド(3)および/または前記骨固定要素(1,2)のうちの1つの一部は、滑動素材で覆われていることを特徴とする、請求項1から6のうちの1つに記載の動的安定化装置。
- 弾性要素(30)はばねとして構成されることを特徴とする、請求項1から7のうちの1つに記載の動的安定化装置。
- 前記ばね(30)は前記ロッドを囲むコイルばねとして構成されることを特徴とする、請求項8に記載の動的安定化装置。
- 前記ロッド(3)は2つの部分でスリーブ形状で構成され、前記ばねは前記ロッドの内側で与えられることを特徴とする、請求項8に記載の動的安定化装置。
- 前記骨固定要素は骨ねじまたは骨フックとして構成されることを特徴とする、請求項1から10のうちの1つに記載の動的安定化装置。
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DE10236691A DE10236691B4 (de) | 2002-08-09 | 2002-08-09 | Dynamische Stabilisierungseinrichtung für Knochen, insbesondere für Wirbel |
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EP (1) | EP1388323B1 (ja) |
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Also Published As
Publication number | Publication date |
---|---|
JP2004073855A (ja) | 2004-03-11 |
KR20040014202A (ko) | 2004-02-14 |
EP1388323A1 (de) | 2004-02-11 |
EP1388323B1 (de) | 2007-01-10 |
DE10236691B4 (de) | 2005-12-01 |
US7722649B2 (en) | 2010-05-25 |
DE10236691A1 (de) | 2004-02-26 |
US20040049190A1 (en) | 2004-03-11 |
KR100780852B1 (ko) | 2007-11-29 |
DE50306246D1 (de) | 2007-02-22 |
US20100204736A1 (en) | 2010-08-12 |
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