201125533 六、發明說明： 【發明所屬之技術領域】 本發明與脊椎手術的器具有關，更詳而言之，係一種可導弓丨_椎間裝 置進入椎間盤的手術工具，所述的椎間裝置包括了假體及融合器。 【先前技術】 人體椎間盤退化為中高年齡層所常見之退化性疾病之一，椎間融合手 術(spinal interbody fusion)可使這類型疾病獲得改善。其係在退化的椎間盤 之間置入一融合器，以撐開椎體，達到減輕對神經根的壓迫、消減疼痛以 及使椎間節融合等效果。 椎間融合手術一般分為前（anterior)、後（posterj〇r)、與側後 採側後入路方向之手術方式，於美國第2007/009385〇號(以下簡稱85〇 案）、第2006/0229627號(以下簡稱627案)等專利公開文獻中有初步的揭 露。醫師於患者的椎間侧設—個空腔，並以如各文獻中所揭露的器具或 類似器具’將-假體置人該空腔巾，_試空㈣尺寸是賴融合器相符 合’假體會在測試的過程巾被反覆的置人或移出紐。在確認空腔尺寸適 足以融合11置人時’將假體移出空腔，並將融合器植人空腔中。 850案所揭露的係將假體置人空腔中的器具。該器具的前端具有一夾 持器’以螺紋手段與假體組合。操作者以旋轉—指輪的方式，使夹持器改 文角度’以隨應側後入路的手術方向將假體導入椎間空間中。85〇案之結 構6又计’使轉H及其觸作的假體為分段式或乡段式的改變肖度，而假 體4在頓點位置定位。85Q案無法做無段式的角度變化，亦無法做微角 201125533 度之定位及微調’這使得假體的置入路徑受到了限制。此外，夾持器係以 螺紋與假體組合，故僅適用於假體之導入及導出，不適用於融合器的植入。 因為融合器的植入更進一步涉及了手術器具與融合器在椎間盤空腔中分離 的技術。 627案所揭露的亦為將假體置入椎間盤空腔中的器具，其技術手段係 在饭體與器具外管對應端的棘齒結構。―個旋轉單元可控制外管沿著内管 移動’當彼此的棘齒分離時，.。相對穿樞的崎及外管，得以與假體 連接的軸心為心點而擺動，無段式的改變與假體的㈣。當外管需與假體 連結以導引假體移動時，同樣赠轉單元控做外管沿著崎移動，使棘 齒結合。基於棘_配位，在定位肢方面也麵_，這也會影響假體 的導入路徑。料，基於細^具的結合方式，使此、適用於假 體之導入及導出’不適驗融合器的植人。賴如上段所述。 【發明内容】 T w 的你在提供一種可導引 _ 工具’所述的椎間裝置包括了假體及融合器。 本發明之目祕在提供_鮮椎手術卫具， 椎間裝r—嫌，爾—ζτ _—=::=::^;:_4可— 本發明更進戈攸雜m空腔觸假體導出。且 衔工録 一融合器導入椎間盤空腔中，並在該空腔中物 術工具與融合器分離的方案。 便°亥’ 本發明達成上述目的之主要技術手段’細_固定桿提供—滑動桿與 201125533 之雜鷄郎，騎__翻知雜 _桿於赚謝_峨；，^=== 的外部，其往復的移動可控制該操縱桿的角度。該 …月干 部分別以卡槽構造連接—椎間裝置的第_梢和第二梢，二套=杯的端 拘束該操縱桿的位置時，操作者可以該控制立移至 位移’改__裝置_度。當絲管觀==縱桿往復 該操縱桿_彈簧之釋能而脫__裝置。 ㈣位置時， 【實施方式】 為便於·核於上述發_容—攔巾所絲的中·增，—、 實施酬。實w各細物件係按_明之比二寸纽= 或位移量而導而非按實際元件的崎以繪製，合先敘明。且以= 說明中’類似的元件是帅同的編絲表示。 ’ 請參閱第—圖、第二圖和第三圖，本發明導錄間裝置之手術工具， 固疋才干1〇、_滑動桿20、一操縱桿3〇、一控制組4〇、—套管5〇、 以及-握柄60。各部件的組合及位置_，詳述如下： —該固定桿1Q的第—端Ή穿套於該握柄叫兩者以螺紋川組合固 ^相仏10的第二端12為椎間裝置7〇之操作端，利用卡槽構造與 _間裝置70的第二梢72連接。該固定桿以第二端12為基點以平行於 軸心的方向開設-線性移動空間13，供該滑動桿2〇及該操_〇容納其 中。該固定桿10於近接該第一端11的桿身上設有—外螺紋段14，供該控 201125533 J'” 0 ’’且&於。亥處。上述套管5〇係樞套拘束於該固定桿1〇、滑動桿 組合結構的外部。 以下’描述各部件詳細的、細部的結構及彼此的連接關係。 4 ’月動杯20與該固定桿]〇之間具有梢，5和長孔2，的連接關係，使 ⑺動杯20可在違長孔21所定義的距離内於該固定桿1〇的線性移動空間 13中移動，且無脫離該線性移動空間13之虞。 物縱杯3Q的第—端31與該滑動桿2Q的第—端22係以—旋轉枢轴 32連接，並配置_雜移動㈣13中。該㈣樞軸力可使該操縱桿 ”該口疋#1〇保持平仃，或與該固定桿彳〇相交―預定角度(約5度）。 該操縱桿3Q的第二端33為轉置7〇的操作端，_卡槽構造與該椎 間裝置70的第一梢71連接。當該操縱桿3〇與該固定桿扣相交一預定角 糾’該第二端32與該椎間裝置7〇的第—梢Μ分離；反之，當該操縱 杯3〇與顧如〇呈平行時’該操縱桿3◦的第二端33與該椎間裝置7〇 的第-㈣連接。—彈簧34設於該線性移動空間13中，其彈力作用於 錄縱桿30 ’使鋪縱桿3Q常態保持外擴之預定角度。 該套管5〇被用來控制該操縱桿3〇的角度。該套管5〇與該固定桿1〇 之間具有梢16和長孔51的連接關係，使該套管5〇於該長孔51所定義的 Ζ1 ΓΓ"^# 10' 20 30 =，且無脫離之虞。當套f5Q被推動而往_置7。的方向位移時 (如第四圖和_)，其_對該操縱桿3G造成拘束 縱桿3〇使其與該固定桿1〇平行，該彈簧3 下雜 與嶋—~卿— 201125533 反之，當套管50被推動而往握柄6〇的方向位移時，釋除對該操縱桿加 的拘束’该彈簧34釋能’推抵該操縱桿3〇使之復回至與該固定桿1〇呈 預疋的相交角度，而致與該椎間裝置7G的第-梢71分離。 »亥控制組40包括-線性傳動件41以及一旋轉操作件42,兩者於各自 的端部分別設置環槽421與· 411結合(描述於第三圖），使兩者之間具 =向的連接_及旋⑽自由性。該旋轉操作件似以内螺紋結合於該固 疋桿1〇的外螺紋段14,該線性傳動件41則以梢412連接於該滑動桿如。 如第五圖和第六圖，該旋轉操作件42被旋轉時，可依其旋轉方向而於 該固定桿1G的外螺紋段14移動。往糊裝置7Q或往該握柄6〇的方向 移動時，該線性傳動件41帶動該滑動桿2〇及操縱桿％做同步同方向位 移’以致該操縱桿3q推動該椎間謝◦，使其以第二梢72為中心點而旋 轉’無段改變該椎間裝置7〇與該固定桿1〇所形成的内_角度，並且 Z在任何-個角度定位。實現以旋轉操作件&改變該椎間裝置角度的 别科必需鳴管5◦拘束該操縱桿3〇，以確保該操縱㈣與固定桿 平行以維持與3亥椎間裝置7〇的連接關係。 第一圖至第六圖之實施例，都是以假體73來描述該椎間裝置7〇，藉 2本發明之轉，體73 __彳认路方向進人射聽預設空腔 空腔中導出。過程中，本發明的器具使椎間裝置可做無段之角 遇及疋位’將使導入和導出之進行更為順利。如上所述，使套管50往 =柄60的料移動，操縱桿％細至與該㈣桿π呈_預定的相交角 :，將導輪轉3Q鱗贼置7Q錄。此—機織本封顧於將融 ⑽(如第七圖所示)導入椎間盤空腔中。該融合器Μ與該假體π的基 201125533 本形狀和尺寸相同，並同樣具有第—梢71和第二梢72，以便分別與該固 定才干10和操縱杯30連接。以外科手術預設之椎間盤空腔尺寸藉由該假體 73而獲付確認，因此可將融合器75植場隨空腔巾。本剌以相同於 上述的方式及路徑操作該融合器75，至進入椎間盤空腔後，將套管印往 握柄60的方向移動，使操縱桿3〇復回至與該固定桿呈一預定的相交 角度而與《合S 75的第-梢71分離，而稍微調變本發㈣具的角度並 位移距離’即可使固定桿1Q脫離該融合器75的第二梢72，此時即可將 本發明器具退離_盤空腔’將融合器留置於空腔中，完舰入手術。 雖然本案以—個最佳實_做觸，但精於此技藝者能在不脫離本 案精神與鱗下做各種不同形式的改變。以上所舉實關制以說明本案 非用以限制本案之範圍。舉凡不違本案精神所從事的種種修改或變 化，俱屬本案申請專利範圍。 【圖式簡單說明】 第-圖為本案之手術工具與假體之立體外觀圖。 第-圖為本案之手術卫具與假體之立體分解圖。 第二圖為本f之手術卫具與假體之組合剖視圖。 第四圖為本案之手術卫具欲操作假體改Μ度之立斷觀圖。 第五圖為本案之手術工具操作假财變角度之組合剖關之一。 第六圖為本案之手術工具操作假體改㈣度之組合剖關之二。 第七圖為本案之外科與融合器之立體外觀圖。 【主要元件符號說明】 10-固定桿 201125533 11- 第一端 111-螺紋 12- 第二端 13- 線性移動空間 14- 外螺紋段 15- 梢 16- 梢 20- 滑動桿 21- 長孔 22- 第一端 30- 操縱桿 31- 第一端 32- 旋轉樞轴 33- 第二端 34- 彈簧 40- 控制組 41- 線性傳動件 411-環簷 412梢 42- 旋轉操作件 421-環槽 50-套管 201125533 51-長孔 60-握柄 70- 椎間裝置 71- 第一梢 72- 第二梢 73- 假體 75-融合器201125533 VI. Description of the Invention: [Technical Field] The present invention relates to a device for spinal surgery, and more particularly to a surgical tool for guiding a sacral intervertebral device into an intervertebral disc, the intervertebral device Includes prostheses and cages. [Prior Art] Degeneration of the human intervertebral disc is one of the degenerative diseases commonly found in the middle and high age groups, and spinal interbody fusion can improve this type of disease. It is equipped with a cage between the degenerated discs to expand the vertebral body to reduce the compression of the nerve roots, reduce pain and fuse the intervertebral segments. Intervertebral fusion surgery is generally divided into anterior, posterior (posterj〇r), and lateral posterior approach lateral approach to the surgical approach, in the United States 2007/009385 nickname (hereinafter referred to as 85 cases), the 2006 There is a preliminary disclosure in the patent publications such as No. 0229627 (hereinafter referred to as the 627 case). The physician sets a cavity on the intervertebral side of the patient, and places the prosthesis on the cavity towel with an appliance or the like as disclosed in various documents. The size of the test space (four) is the conformation of the cage. The prosthesis will be placed or removed from the test during the test process. The prosthesis is removed from the cavity and the cage is implanted into the cavity while confirming that the cavity is of sufficient size to be fused. The 850 case reveals that the prosthesis is placed in the cavity. The front end of the appliance has a gripper 'combined with the prosthesis by means of a thread. The operator uses the rotation-finger wheel to cause the gripper to change the angle 'to introduce the prosthesis into the intervertebral space in accordance with the surgical direction of the posterior approach. The structure of the 85 case is again calculated to make the rotation H and its prosthesis a segmented or township change, and the prosthesis 4 is positioned at the point. In the 85Q case, it is impossible to make a paragraphless angle change, and it is impossible to make a micro angle. The positioning and fine adjustment of the 201125533 degree makes the placement path of the prosthesis limited. In addition, the gripper is threaded and combined with the prosthesis, so it is only suitable for the introduction and export of the prosthesis, and is not suitable for the implantation of the cage. Because the implantation of the cage further involves the separation of the surgical instrument from the cage in the cavity of the disc. Also disclosed in the 627 case is an instrument for placing a prosthesis into the cavity of the intervertebral disc, the technical means of which is a ratchet structure at the corresponding end of the outer tube of the rice body and the appliance. "One rotating unit can control the movement of the outer tube along the inner tube" when the ratchets of each other are separated. Relative to the shaft and the outer tube of the shaft, the axis connected to the prosthesis is oscillated as a heart point, with no segmental changes and (4) of the prosthesis. When the outer tube needs to be connected with the prosthesis to guide the movement of the prosthesis, the same unit is controlled to move the outer tube along the strip to make the ratchets. Based on the spine _ coordination, it is also in the position of the positioning limb, which also affects the introduction path of the prosthesis. According to the combination of the fine tools, this is suitable for the introduction and export of the prosthesis. Lai is as described in the above paragraph. SUMMARY OF THE INVENTION The intervertebral device of Tw that provides a steerable tool includes a prosthesis and a cage. The secret of the present invention is to provide a fresh vertebra surgery aid, intervertebral device r-suspect, er-ζτ _-=::=::^;:_4 can - the invention is more in the dormant m cavity Body export. And the work of recording a cage into the cavity of the intervertebral disc and separating the physical tool from the cage in the cavity.便°海' The main technical means for achieving the above objectives of the invention 'fine _ fixed rod provides - sliding rod and 201125533 miscellaneous chicken lang, riding __ 翻知杂 _ _ _ _ _ _ 峨;, ^ = = = external Its reciprocating movement controls the angle of the joystick. The ... monthly cadres are respectively connected by a card slot structure - the first tip and the second tip of the intervertebral device, and the two sets = the end of the cup restrains the position of the joystick, the operator can control the vertical shift to the displacement 'change __ Device _ degrees. When the wire tube view == longitudinal rod reciprocating the joystick _ spring release energy can be off __ device. (4) When the position is made, [Embodiment] In order to facilitate and nucleate the above-mentioned hair-filling--------------------------- The actual parts of the real w are drawn according to the ratio of _ Ming ratio 2 inch New Zealand or displacement, rather than the actual component of the Qi, to be described first. And the similar components in the = description are similar to the braided representation. 'Please refer to the first, second and third figures. The surgical tools of the inter-recording device of the present invention are 1 〇, _ sliding rod 20, a joystick 3 〇, a control group 4 〇, a sleeve Tube 5〇, and - grip 60. The combination and position of each component is detailed as follows: - the first end of the fixed rod 1Q is threaded over the handle, and the second end 12 of the threaded combination is the intervertebral device 7 The operating end of the crucible is connected to the second end 72 of the inter-device 70 by a card slot structure. The fixing rod is opened at a position parallel to the axis center with the second end 12 as a base point for the sliding rod 2 and the operation to be accommodated therein. The fixing rod 10 is provided on the rod adjacent to the first end 11 with an external thread section 14 for the control 201125533 J'" 0 '' and & at the sea. The sleeve 5 is pivotally restrained The fixing rod 1〇, the outer portion of the sliding rod assembly structure. The following 'describes the detailed, detailed structure of each component and the connection relationship between them. 4 'The moon moving cup 20 and the fixing rod 〇 have a tip, 5 and length The connection relationship of the holes 2 allows (7) the movable cup 20 to move in the linear movement space 13 of the fixed rod 1〇 within the distance defined by the obstruction hole 21 without detachment from the linear movement space 13. The first end 31 of the cup 3Q and the first end 22 of the sliding rod 2Q are connected by a rotating pivot 32 and configured with a miscellaneous movement (four) 13. The (four) pivoting force enables the lever "the mouth" #1 〇 Keep it flat or intersect with the fixed rod ― a predetermined angle (about 5 degrees). The second end 33 of the lever 3Q is an operation end that is transposed 7 ,, and the _ card slot structure is coupled to the first tip 71 of the intervertebrate device 70. When the joystick 3 is intersected with the fixed lever buckle by a predetermined angle, the second end 32 is separated from the first tip of the intervertebral device 7〇; conversely, when the manipulation cup 3 is parallel to the Guru The second end 33 of the lever 3 is coupled to the first (fourth) of the intervertebral device 7A. - A spring 34 is provided in the linear movement space 13, and its elastic force acts on the recording rod 30' to keep the vertical rod 3Q normally extended by a predetermined angle. The sleeve 5〇 is used to control the angle of the lever 3〇. The sleeve 5 〇 has a connection relationship between the tip 16 and the long hole 51 between the fixing rod 1〇, so that the sleeve 5 is Ζ1 ΓΓ"^# 10' 20 30 = defined by the long hole 51, and There is no detachment. When the set f5Q is pushed, it is set to 7. When the direction is displaced (such as the fourth figure and _), the _ the lever 3G is restrained by the longitudinal rod 3 〇 so that it is parallel with the fixed rod 1 ,, the spring 3 is mixed with 嶋—~卿—201125533 When the sleeve 50 is pushed and displaced in the direction of the grip 6〇, the restraining of the lever “release of the spring 34” is pushed against the lever 3 to return it to the fixed rod 1 The 〇 is at an early angle of intersection and is separated from the first tip 71 of the intervertebral device 7G. The leeway control group 40 includes a linear transmission member 41 and a rotary operation member 42 which are respectively provided with ring grooves 421 and 411 at respective ends (described in the third figure) so as to have a = direction therebetween Connection _ and spin (10) freedom. The rotary operating member is adapted to be internally threaded to the externally threaded section 14 of the retaining rod 1 , and the linear drive member 41 is coupled to the sliding rod by a tip 412. As shown in the fifth and sixth figures, when the rotary operating member 42 is rotated, it can be moved in the external thread section 14 of the fixed rod 1G in accordance with the direction of rotation thereof. When moving to the paste device 7Q or moving in the direction of the handle 6〇, the linear transmission member 41 drives the slide bar 2〇 and the joystick % to perform the same direction displacement so that the joystick 3q pushes the intervertebral thank-you It rotates 'with the second tip 72 as a center point' without changing the inner angle formed by the intervertebral device 7〇 and the fixed rod 1〇, and Z is positioned at any angle. Implementing a rotation control member & changing the angle of the intervertebral device must be squeezing the control rod 3〇 to ensure that the manipulation (4) is parallel with the fixed rod to maintain the connection relationship with the 3H intervertebral device 7〇 . In the embodiments of the first to sixth embodiments, the intervertebral device 7 is described by the prosthesis 73. By the rotation of the present invention, the body 73 __彳 recognizes the direction of the road and enters the preset cavity. Exported in the cavity. In the process, the device of the present invention allows the intervertebral device to be subjected to a segmental encounter and a squatting position, which will make the introduction and delivery more smoothly. As described above, the sleeve 50 is moved toward the material of the shank 60, and the lever % is as thin as the predetermined angle of intersection with the (4) rod π: the guide wheel is turned to the 3Q scale to set the 7Q record. This—the woven booklet is introduced into the intervertebral disc cavity by the fusion (10) (as shown in Figure 7). The cage Μ is the same shape and size as the base 201125533 of the prosthesis π, and also has a first tip 71 and a second tip 72 for connection with the fixed stem 10 and the manipulation cup 30, respectively. The size of the intervertebral disc cavity presupposed by surgery is confirmed by the prosthesis 73, so that the cage 75 can be planted with the cavity. The crucible operates the cage 75 in the same manner and manner as described above, and after entering the intervertebral disc cavity, the sleeve is printed in the direction of the handle 60, so that the joystick 3 is returned to the predetermined position with the fixed rod. The angle of intersection is separated from the first tip 71 of the S 75, and the angle of the hair (4) is slightly adjusted and the distance is shifted to make the fixed rod 1Q out of the second tip 72 of the cage 75. The device of the present invention can be removed from the cavity of the disk to leave the cage in the cavity and complete the operation. Although the case is based on a best-practice, it is true that those skilled in the art can make various forms of change without departing from the spirit and scale of the case. The above system is used to illustrate that the case is not intended to limit the scope of the case. All kinds of modifications or changes that are not in violation of the spirit of this case are the scope of patent application in this case. [Simple description of the diagram] The first figure is a three-dimensional appearance of the surgical tool and the prosthesis of the present case. The first figure is an exploded view of the surgical aid and prosthesis of the case. The second figure is a sectional view of the combination of the surgical aid and the prosthesis of the f. The fourth picture is the view of the surgical aid of the case to be manipulated. The fifth picture is one of the combination of the operation and the fake financial change angle of the surgical tools in this case. The sixth picture is the second part of the combination of the surgical tool operation prosthesis (four degrees) of this case. The seventh picture shows the stereoscopic appearance of the external department and the cage. [Main component symbol description] 10-fixing rod 201125533 11- first end 111-thread 12- second end 13- linear moving space 14- external thread segment 15--tip 16-tip 20- sliding rod 21-long hole 22- First End 30 - Joystick 31 - First End 32 - Rotation Pivot 33 - Second End 34 - Spring 40 - Control Set 41 - Linear Drive 411 - Loop 412 Tip 42 - Rotary Operator 421 - Ring Groove 50 - cannula 201125533 51 - long hole 60 - grip 70 - intervertebral device 71 - first tip 72 - second tip 73 - prosthesis 75 - cage