JP5028273B2 - 全脊椎円板の置換のための装置及び方法 - Google Patents
全脊椎円板の置換のための装置及び方法 Download PDFInfo
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- JP5028273B2 JP5028273B2 JP2007548663A JP2007548663A JP5028273B2 JP 5028273 B2 JP5028273 B2 JP 5028273B2 JP 2007548663 A JP2007548663 A JP 2007548663A JP 2007548663 A JP2007548663 A JP 2007548663A JP 5028273 B2 JP5028273 B2 JP 5028273B2
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- artificial
- disc
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- intervertebral disc
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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
- 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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Description
・ 真後方又は経椎間孔刺入法に比べて椎間腔に対して幅広い開口が達成でき;
・ 外科医は神経構造を通過し、面関節を切開する必要はなく;
・ 正確な軌道の検出が横突起の可視化により可能となり;
・ 患者は背部固定治療であるかのように腹臥位であり;
・ 外科医は患者の位置決めと切開に慣れている。
A)外側、内方の背部切開を行う。すなわち、腰背筋膜をターゲットにすることで中央縦断面から離れる。
B)キルシュナー鋼線を用いて罹患した椎間板に近づく。
C)キルシュナー鋼線に沿ってトロカールとプロテクションスリーブを椎間板に挿入する。
D)切削工具を用いて、繊維軟骨椎間板に、幅がWである刺入口と面積を削り取る。
E)円板材を除去する。
F)手術用具を使用して椎体に隣接する上下脊椎端板を洗浄する。
G)デストラクトールを使用して椎間腔を分離又は拡大させる。
H)インプラントホルダーを使用して、人工椎間板を刺入口に挿入する。
・ 第一及び第二の人工成分は外側端方向の一端に小幅ながら、関節部が設置される中間面に隣接するのに適切な幅を有する。前記の小幅は椎間孔外刺入法による挿入を可能にし、前記の適切な幅は中間面に隣接し、関節部は自然の椎間円板に適合できる構造をしている。
・ 人工椎間板の退化による椎体の骨端板の形態変化、即ち、時間と共とする更に変動のため特別な注意を払い、第一及び第二の人工成分における不必要な部材(プレートに連結する骨)が除去される。
・ 脊椎端板の後部周辺上の骨棘を除去しないという外科医の決定が考慮可能である。即ち、人工椎間板が凹凸部の周辺で操作可能であるから人工椎間板の設置が簡単になる。
a)ポリエチレン・グリコール、好ましくはポリエチレン・グリコールアクリレート;
b)N−ビニルピロリドン;
c)ビニル、好ましくはビニル・アルコール;
d)スチレン
・ 二つの成分はモジュール様式に配置していて、回転の中心の位置の高さが調整可能である。
・ 成分の球状キャップの半径もさらに異なり、人工椎間板の回転中心に調整可能である。
・ 回転の中心の位置、角状、人工椎間板の並進運動部分が相対的に広範囲で自由に選択可能であり、人工成分は互いに横中央軸に沿って一部並進運動を行う。
・ 異なる半径を有する球状キャップを含むことが出来るという点で人工成分は球状キャップの半径が大きくなればなるほど偏位中の並進運動の部分は大きくなり、患者の脊柱の湾曲の際に面関節に過度の圧力がかかり、その変質を加速させる。
・ 人工成分の高さと対応する人工椎間板の関節球状キャップの半径は変化することができ、違う椎間腔の大きさに適応可能である。
1. 背部の外側中部におよそ7cmの切開12を行う。すなわち、筋肉の損傷を最小限にするため、中央縦断面2から離れた腰背筋膜をターゲットにする。(図3)
2. 罹患した椎間板3に横突起6に向かう椎間孔進路23内へ、キルシュナー鋼線14を近付ける。画像増強などのX線制御の使用は必須である。(図5)
3. 肋骨突起17を通ってキルシュナー鋼線14に沿ってトロカール(trockar)15とプロテクションスリーブ16を罹患した椎間板3に差し込む。(図6)
4. 切削工具19(図7)を使用して、前縦靱帯5(図1)と後縦靱帯4(図1)を離れて繊維軟骨椎間板18に、幅がWで高さがHである刺入口9を削る。
5. プロテクションスリーブ16を貫通する掻爬、骨鉗子、スプーンを使用して円板材を移動させる。好ましくは内視鏡を使用する。
6. 隣接する上下脊椎体10;11の端板を洗浄する。とくに、水ジェット若しくは超音波装置のような特定の道具を使用する。好ましくは内視鏡を使用する。
7. 若干曲げられたデストラクトール(distractor)20を使用して罹患した椎間円板3を移動させ、外科医に位置が自由に見えるようにする。分離はプロテクションスリーブ16(図6)又は軟組織開創器(図9)を使用して行われる。
8. インプラントホルダー23を使用して、人工椎間板30を刺入口9に挿入する。例えば、イメージ増強管などのX線制御を使用して人工椎間板30の位置をコントロールすることは必須となる。(図10)
「腰部と腰仙椎の脊椎の後側方固定術」
J Bone Joint Surg Am. 1953年10月 35−A(4):1014−8
ワトキンス メルビン B
「偽関節および腰仙椎の背部要素欠陥に関する後側方固定術」
Clin Orthop Relat Res. 1964年7〜8月 35:80−5
Claims (23)
- 人工椎間板(100)であって、
A)隣接する第一椎柱の端板を連結するための中央軸(103)に横に設置される第一接合表面(107)を有する第一人工成分(101)と、
B)隣接する第二椎柱の端板を連結するための中央軸(103)に横に設置される第二接合表面(108)を有する第二人工成分(102)で構成され、
C)前記第一及び第二人工成分(101;102)は関節部(106)により連接され、これにより
D)前記中央軸(103)に平行して見る場合、前記第一及び第二の人工成分(101;102)は長軸(127)と横短軸(128)を有する細長の形状をし、
E)前記中央軸(103)、長軸(127)と横短軸(128)は互いに交差し、前記中央軸(103)と横短軸(128)は中間面(126)を形成し、
F)前記第一及び第二人工成分(101;102)は前記中央軸(103)に垂直する断面領域(201;202)をそれぞれ有し、前記断面領域(201;202)は長円形若しくは楕円形であり、
G)前記断面領域(201;202)は、片側が凹面形状であり、前記中間面(126)の反対側及び長軸(127)の同じ側に位置する少なくとも二つの凹面(125)で構成され、
H)前記少なくとも二つの凹面(125)が基本的に半楕円又は半卵形の形状を有してなる人工椎間板。 - 前記第一及び第二人工成分(101;102)の前記断面領域(201;202)は、第一及び第二接合表面(107;108)をさらに備える請求項1に記載の人工椎間板(100)。
- 前記少なくとも二つの凹面(125)が基本的に前記中間面(126)に対称的に配置される請求項1または2に記載の人工椎間板(100)。
- 前記第一及び第二人工成分(101;102)は前記長軸(127)に平行して測定される長さHを有し、前記少なくとも二つの凹面(125)は長軸(127)に平行して測定される幅Wを有し、前記幅Wは前記長さHの15%から35%の範囲内である請求項1から3のいずれか一項に記載の人工椎間板(100)。
- 前記第一及び第二の人工成分(101;102)は前記横短軸(128)に平行して測定される最大幅Bを有し、前記少なくとも二つの凹面(125)は前記横短軸(128)に平行して測定される深さTを有し、前記深さTは前記最大幅Bの3%から25%の範囲内である請求項1から4のいずれか一項に記載の人工椎間板(100)。
- 前記第一及び第二人工成分(101;102)の断面領域(201;202)が基本的に楕円であって、第一従属頂点における湾曲半径が第二の従属頂点における湾曲半径より小さい外周(129)を有する請求項1から5のいずれか一項に記載の人工椎間板(100)。
- 前記第一従属頂点が前記少なくとも二つの凹面(125)と同様に前記長軸(127)の同じサイドにある請求項6に記載の人工椎間板(100)。
- 前記第一及び第二人工成分(101;102)は長軸(127)に平行して測定される長さHと横短軸(128)に平行して測定される最大幅Bを有し、長さHと最大幅Bとの比例の範囲が3:1から5:1である請求項1から7のいずれか一項に記載の人工椎間板(100)。
- 前記関節部(106)は球体関節機構から成り、第一及び第二人工成分(101;102)の一方に連結される球状キャップ(112)と上述の第一及び第二人工成分(101;102)のもう一方に連結されて上述の球状キャップ(112)に合致する球形嚢陥凹(111)により構成される請求項1から8のいずれか一項に記載の人工椎間板(100)。
- 第一及び第二人工部品(101:102)の一方と球状キャップ(112)が一枚構造である請求項9に記載の人工椎間板(100)。
- 前記人工椎間板(100)が少なくとも三枚構造からなり、球状キャップ(112)が第三部品として前記第一及び第二人工成分(101;102)の一方と連接可能である請求項9に記載の人工椎間板(100)。
- 前記人工椎間板(100)は少なくとも三枚構造からなり、第三部品として前記第一及び第二人工成分(101;102)の一方に取り付けられ、凹所(111)を有する関節殻を含む請求項9から11のいずれか一項に記載の人工椎間板(100)。
- 球状キャップ(112)と関節殻が金属とプラスチックから成る請求項12に記載の人工椎間板(100)。
- 球状キャップ(112)と関節殻がセラミック対セラミック構成からなる請求項12に記載の人工椎間板(100)。
- 球状キャップ(112)と凹所(111)の表面が炭化チタン又は非晶質炭素(ADLC)でコーティングされる請求項1から14のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップ(112)が形状記憶合金素材で作成される請求項1から15のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップ(112)が膨張可能な素材で作成される請求項9から15のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップが流動性、熱硬化性がある素材で作成される請求項9から15のいずれか一項に記載の人工椎間板(100)。
- 少なくとも球状キャップがモノマー、コモノマー、ホモポリマー、オリゴマー又は流動性、熱硬化性がある素材の混合物で作成される請求項18に記載の人工椎間板(100)。
- 熱硬化性、流動性を有する素材が、
a)ポリエチレン・グリコール;
b)N−ビニルピロリドン;
c)ビニル、好ましくはビニル・アルコール;
d)スチレン
のグループから選択される請求項19に記載の人工椎間板(100)。 - 前記第一人工成分(101)は少なくとも2つの第一人工成分(101)の第一キットから選択される請求項1から20のいずれか一項に記載の人工椎間板(100)。
- 前記第二人工成分(102)は少なくとも2つの第二人工成分(102)の第二キットから選択される請求項1から21のいずれか一項に記載の人工椎間板(100)。
- 前記第一及び第二人工成分(101;102)は、各自の中間面(109;110)を含み、前記第一及び第二の中間面(109;110)は互いに面していて、少なくとも第一中間面(109)は第一及び第二人工部品の第一又は/及び第二の外側端(133;134)に位置し、インプラントホルダー(22)の定着部材(141)の収容に適するアンダーカット(132)を有する少なくとも一つの穴を備える請求項1から22のいずれか一項に記載の人工椎間板(100)。
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