TW201912118A - Device for surgery of stabilizing bone segments and extending assembly thereof - Google Patents

Abstract

The present invention discloses a device for surgery of stabilizing bone segments and an extending assembly thereof. The device includes a screw assembly, two supporting members and two extending members. The screw assembly includes a receiver and an anchoring member. The receiver has a retainer and two opposite arms extending along the longitudinal axis of the device from the positions adjacent to the retainer. The anchoring member connects to the retainer. The supporting members connect to the arms respectively, and extend along the longitudinal axis of the device as well. The extending members have a through hole respectively, and the extending members connect to the arms with that the supporting members pass through the through holes respectively.

Description

Device for stabilizing bone segment surgery and its extension assembly

The present invention relates to a device for stabilizing bone segment surgery and an extension assembly thereof, and more particularly to a device for stabilizing a minimally invasive procedure for a bone segment and an extension assembly therefor.

The spine is one of the most important parts of the body's ability to determine the activity of the human body. When the spinal cord occurs, especially in the lumbar region, it often has a considerable impact on the patient, including pain, numbness, and powerlessness. Even symptoms such as incontinence or difficulty. Most of the causes of spinal lesions are the displacement of the vertebral body (bone segment), which causes the nerve or spinal cord to be compressed. It is clinically diagnosed as disc herniation, spondylolisthesis, spinal canal stenosis or Degenerative scoliosis, etc. When the condition is serious, the patient often cannot correct the discomfort by correcting it, and must rely on the spinal surgery for the reduction treatment. As for how to effectively fix the vertebral body after the reduction to avoid the displacement again, it is an important key for the success of the treatment.

The most stable and widely used treatment is the Pedicle screw fixation system. The pedicle screw internal fixator system can be used for spinal fusion surgery such as vertebral fixation and reduction after conventional discectomy, cervical degeneration treatment and scoliosis correction. The pedicle screw internal fixator system has a plurality of vertebral arch screws (also referred to as screw assemblies). Taking a multi-axial vertebral arch screw as an example, reference may be made first to FIG. 1 , and each vertebral arch screw 9 can be roughly divided into a shank 91 (Screw shaft) and the receiver 92 (Receiver, also known as Tulip), plus a locking screw (also known as nut, Nut, unillustrated). The common pedicle screw internal fixator system is used in the course of spinal surgery. The vertebral arch screws are firstly implanted into the vertebral body by the vertebral arch position on both sides of the spinal process, and the connecting rod (Rod) is adjusted to After conforming to the spine curve, the locking screw and the connecting rod are pressed into the receiving member 92 by using other surgical tools to complete the restoration or stabilization of the front and rear vertebral bodies.

Traditional spinal surgery is open, which is made by making a midline incision on the back of the patient. The muscle tissue is cut open to the outside of the vertebra, and the periosteum is peeled off to expose the vertebrae. Then the above-mentioned pedicle screw internal fixator system is installed. . The problem of this procedure is not only the large wound, the high blood loss, but also the slow recovery of the wound caused by the destruction of the anatomical structure. Furthermore, because postoperative muscle elasticity is reduced or fibrosis is hardened, it also causes severe pain, pain, and high risk of infection. These problems have led to an increase in the average length of hospital stay and an increase in overall medical expenses, which is a problem that has to be resolved for public health policy. Therefore, Minimally Invasive Surgery (MIS), which can significantly reduce wounds in recent years, is gradually favored by surgeons and patients, and its clinical importance is also increasing.

In general, minimally invasive surgery is defined as a wound that must be less than 3 cm, and anatomical damage should be avoided as much as possible. However, when the operation is performed, the surgical field is often insufficient due to the tightness of the muscles around the incision. The problem of hindrance. Referring to Figures 1 and 2, in spinal minimally invasive surgery, an extension or sleeve is usually provided to maintain the surgical path. Specifically, after the surgery is performed on the back of the patient to make a small incision corresponding to the position of the vertebral arch of the spine, the vertebral screw 9 (9a) equipped with the extension 7 or the sleeve 8 is implanted into the vertebral body. The surgical path is maintained by the extension 7 or the sleeve 8, after which the surgical tool, the fitting, and the pedicle screw internal fixation system can be operated on the pedicle screw 9 (9a) with sufficient surgical field or surgery. Erection.

1 is a schematic view of a conventional pedicle screw having an extension member. As shown in FIG. 1, a vertebral screw 9 of this type includes a shank 91 and a receiving member 92, and the extension member 7 is coupled to the top end of the accommodating member 92. . The receiving member 92 is U-shaped and has two side walls 921. The vertebral arch screw 9 is formed on the top end of the two side walls 921 of the accommodating member 92 to form the engaging structure 93, and the two extending members 7 are inserted into the engaging structure 93. After the vertebral arch screw 9 having the extension member 7 is fixed on the vertebral body of the patient, the muscle tissue can be supported by the extension member 7 on both sides, thereby forming a passage for maintaining the surgical field and the surgical tool to approach the vertebral screw 9. .

2 is a schematic view of a conventional pedicle screw having a sleeve. As shown in FIG. 2, the vertebral screw 9a of this type also includes a shank 91a and a accommodating member 92a, and the front end of the sleeve 8 has a clamping portion 81. It is directly clamped or sleeved outside the side wall 921a of the receiving member 92a. Similarly, after the vertebral arch screw 9a having the sleeve 8 is implanted into the vertebral body of the patient, the muscle tissue can be supported by the sleeve 8.

However, the extension member 7 is only connected to the accommodating member 92 by the engaging structure 93, and the sleeve 8 is directly clamped or sleeved on the outside of the accommodating member 92a. The stability of the connection manner is not good as long as When the external force is encountered, it is very easy to cause the extension member 7 or the sleeve 8 to be skewed, slid, or even loose. Although the manufacturer attempts to improve the connection stability of the extension member 7 and the side wall 921 by enlarging, deepening the engagement structure 93 or other designs, the extension member 7 having a large size or a special structure is also clamped or sleeved from the outside. The sleeve 8 will increase the overall outer diameter of the vertebral arch screws 9, 9a after installation, and expand the wound, which runs counter to the original minimally invasive surgery.

In detail, since the upper edge space of the side wall 921 of the pedicle screw 9 is rather limited, in order to open the engaging structure 93, it is necessary to increase the wall thickness of the side wall 921, thereby increasing the outer diameter of the accommodating member 92. As for the sleeve 8 having a tubular shape, when directly clamped or engaged with the outside of the accommodating member 92a, the outer diameter of the joint of the upper edge of the accommodating member 92a and the sleeve 8 is inevitably greatly increased.

Therefore, how to make the extension (or sleeve) and the implanted screw have a stable connection and effectively limit the enlargement of the outer diameter of the joint at the joint is a very important subject for minimally invasive surgery of the spine.

In view of the above problems, the main object of the present invention is to provide a device and an extension assembly for stabilizing bone segment surgery, the device comprising a screw assembly, two support members and two extension members, and the support member is coupled to the screw assembly. And the extension member can pass through the support member to be connected to the accommodating member, and the connection relationship between the extension member and the screw assembly is more stable by the arrangement of the support member, and the outer diameter of the joint portion is substantially not increased. .

To achieve the above objects, the present invention provides an apparatus for stabilizing bone segment surgery comprising a screw assembly, two support members, and two extension members. The screw assembly includes a receiving member and a fixing member. The accommodating member has a limiting portion and two opposite side walls, and the two side walls extend toward the longitudinal axis of the device near the limiting portion. The fixing member is connected to the limiting portion. The two support members are respectively connected to the two side walls and extend in the longitudinal direction. The two extensions each have a perforation, wherein the extension member is perforated through the support member and connected to the two side walls.

In order to achieve the above object, the present invention further provides an extension assembly for use in a device for stabilizing bone segment surgery, the device comprising a screw assembly and two support members, the screw assembly comprising a receiving member. The accommodating member has a limiting portion and two opposite side walls. The two side walls extend toward the longitudinal axis of the device near the limiting portion. The two supporting members are respectively connected to the two side walls and extend in the longitudinal axis direction. The extension assembly includes two extension members each having a perforation, wherein the extension member is perforated through the support member and coupled to the two side walls.

According to an embodiment of the invention, the support member has an external thread at one end of the connection, the top surface of the side wall has a recess, the recess has an internal thread fitted to one of the external threads, and the support member is connected to the side wall in a screw-lock manner.

According to an embodiment of the invention, the extension member has a recess at one end of the connecting side wall, and the recess engages the portion of the side wall at the outer side.

According to an embodiment of the invention, the through hole is located at the bottom of the groove, and after the support member passes through the through hole, the extension member is sleeved on the outer side portion of the side wall to achieve the connection with the side wall.

According to an embodiment of the invention, the recess is externally communicated with the bottom end of the extension member and one of the sides of the connection bottom end.

According to an embodiment of the invention, the extension member has a support member limiting structure disposed on the extension member to restrict movement of the support member relative to the extension member.

According to an embodiment of the invention, the extension member has a limiting hole that communicates with the through hole and the outer space. The support member limiting structure is adjacent to the limiting hole and has an abutting top through the limiting hole abutting support member.

According to an embodiment of the invention, the support member limiting structure is pivotally connected to the extension member, and has a flat surface on the top portion. After the support member limiting structure is rotated, the flat surface abuts the support member.

According to an embodiment of the invention, the side wall has a first thickness, and after the extension member is connected to the side wall, there is a second thickness at the joint, and the difference between the first thickness and the second thickness is between 0.25 mm and 1 mm.

According to an embodiment of the invention, the side wall has a first thickness, and after the extension member is connected to the side wall, the connection has a second thickness, and the difference between the first thickness and the second thickness is between 0.2 mm and 0.5 mm.

According to an embodiment of the invention, the difference between the first thickness and the second thickness is substantially the thickness of the extension at one end of the connecting sidewall.

According to an embodiment of the invention, the extension member includes a fastener having an engagement groove while engaging one of the top ends of the two extension members.

According to an embodiment of the present invention, the fastener has two grooves, which are respectively communicated with the engaging grooves, and the two supporting members are respectively disposed through the two grooves.

According to an embodiment of the invention, the minimally invasive spinal surgery of the bone segment surgery system is stabilized.

According to the present invention, there is provided a device for stabilizing bone segment surgery and an extension assembly thereof, the device comprising a screw assembly and two support members, and the support member is coupled to the two side walls of the receptacle of the screw assembly. The extension assembly has two extensions each having a perforation. The support member passes through the perforations of the extension member, and the bottom end of the extension member is coupled to the side wall of the container. Therefore, the support member can be used as the support backbone of the extension member to achieve the effect of similar ground piles, stabilize the position of the extension member to avoid swaying and displacement, improve the connection stability of the extension member and the side wall, and avoid the extension of the two sides during the operation operation. It is affected by external force and is skewed or even detached from the side wall. Through this structural design, under the same stability requirement, the space requirement of the extension piece and the side wall at the joint can be reduced, for example, if the upper edge of the side wall is not required to be additionally thickened to set a large engaging groove, thereby causing the screw The size is enlarged to expand the surgical wound.

In addition, in an embodiment of the invention, the extension member is designed to be perforated through the support member to be connected to the side wall, so that the extension member can be unloaded directly along the fixed direction (such as the longitudinal axis direction of the device for stabilizing the bone segment surgery). Down and reassemble. Since the spine has a specific bending angle, in particular, the five vertebral bodies of the lumbar vertebrae form a convexity to the abdomen. When treating, for example, the vertebral bodies L5 and S1, the conventional minimally invasive surgery sometimes causes the problem of the interleaving of the elongate members. With the implementation of the present invention, if a conflict occurs, one of the extension members can be easily removed in a fixed direction, which not only avoids the angle of implantation of the screw, but must be compromised due to the conflict of the extension member, and is removed and reassembled. In the case of surgery, it is also possible to avoid expanding or pulling the wound, and at the same time, when the extension member is removed, the support member can partially temporarily extend the length of the incision to ensure the clear function of the surgical field.

In order to enable the reviewing committee to better understand the technical contents of the present invention, the preferred embodiments are described below.

First, the device for stabilizing bone segment surgery of the present invention is a pedicle screw for a minimally invasive spinal surgery pedicle screw internal fixator system. The technical features and application modes of the device are described as an example. However, it should be understood by those of ordinary skill in the art to which the present invention pertains, and the present invention is not limited to vertebral screws.

3 is a schematic view of an embodiment of a device for stabilizing bone segment surgery according to the present invention, and FIG. 4 is an exploded view of the device for stabilizing bone segment surgery shown in FIG. 3, please refer to FIG. 3 and FIG. Show. In the present embodiment, the device 1 for stabilizing the bone segment surgery (hereinafter referred to as the device 1) includes a screw assembly 10, two support members 20, and two extension members 30. The screw assembly 10 of the present embodiment is one of the vertebral arch screws (also referred to as pedicle screws) of the pedicle screw internal fixation system, and the support member 20 and the extension member 30 are mounted on the screw assembly 10.

In general, most patients who require vertebral screw internal fixation system surgery are Lumbar lesions, usually located between the lumbar vertebrae L4 and L5. The operator uses an open-circuit drill (Awl) and other instruments to enter from the insertion point on the lumbar vertebrae, and pass through the pedicle to reach the cancellous bone of the vertebral body to form a nail passage. The operator can then choose whether to expand or tap the access channel to facilitate screw placement. After the nail channel preparation is completed, the operator assembles the device 1 of the present embodiment before the patient. For example, after the assembly of the screw assembly 10 is completed, the support member 20 and the extension member 30 are attached to the screw assembly 10. After the assembly of the device 1 is completed, the vertebral body is implanted, that is, the support member 20 and the extension member 30 are implanted together with the screw assembly 10 into the vertebral body. The details of the screw assembly 10, the support member 20, and the extension member 30, as well as the connection relationship and assembly sequence and manner, will be described below.

The screw assembly 10 of the embodiment includes a receiving member 11 and a fixing member 12. The receiving member 11 is generally U-shaped, so it may also be referred to as a U-shaped head or a U-shaped head. The receiving member 11 has a limiting portion 111 and two opposite sidewalls 112. The limiting portion 111 is located at a recess of the receiving member 11 , and the opposite sidewalls 112 extend toward the longitudinal axis direction Y of the device 1 adjacent to both sides of the limiting portion 111 . The limiting portion 111 and the side wall 112 together form an accommodating space 113 for accommodating a spinal surgery accessory, such as a connecting rod of the pedicle screw internal fixator system and a locking screw for fixing the connecting rod. In addition to accommodating the connecting rod and the locking screw, the accommodating space 113 also provides space for various spinal surgical tools to operate.

The fixing member 12 of the embodiment is a nail rod, and the fixing member 12 is connected to the limiting portion 111. The fixing member 12 and the receiving member 11 may be integrally formed or connected by a ball joint (refer to FIG. 6A or FIG. 6B). In terms of the instrument name, the former is a monoaxial screw, and the latter is Multi-axial or Polyaxial screw. This embodiment is an example of a universal joint that is connected by a ball joint. The assembly of the screw assembly 10 will be briefly described below.

The fixing member 12 of the embodiment has a spherical head portion, and the limiting portion 111 is a through hole, and the spherical portion of the fixing member 12 is received in the limiting portion 111. When the screw assembly 10 is assembled, the fixing member 12 is first passed through the accommodating space 113 and the limiting portion 111. However, the diameter of the spherical head of the fixing member 12 is larger than the inner diameter of the limiting portion 111, so that it is stuck in the limit. Bit portion 111. Preferably, the screw assembly 10 further has an inner cover 13, and the inner cover 13 is first placed on the spherical head of the fixing member 12, and then the spherical head and the inner cover 13 of the fixing member 12 are forcefully combined by the jig. The pressure is applied to the limiting portion 111 to be fixed to the limiting portion 111. In addition, the thread on the fixing member 12 can be designed differently depending on the implantation position, wherein one of the evenly distributed threads is a pedicle screw implanted by the vertebral arch, and the other is a screw. A loose cortical nail, but the invention is not limited to any one. In addition, the general definition of minimally invasive spinal surgery refers to a single surgical incision of no more than three centimeters, so whether it is a pedicle screw or a cortical nail can be used in minimally invasive spinal surgery.

FIG. 5A is a schematic view of the support member shown in FIG. 4 assembled in front of the screw assembly, as shown in FIG. 5A. After the assembly of the screw assembly 10 is completed, the two support members 20 are respectively connected to the two side walls 112, and the support member 20 and the side wall 112 extend in the direction of the longitudinal axis Y. In the present embodiment, the support member 20 is assembled on the top surface of the side wall 112 of the receiving member 11, thereby extending the support member 20 in the longitudinal direction Y, that is, in a direction away from the fixing member 12. Moreover, the support member 20 and the accommodating member 11 may be integrally formed or may be connected in other detachable manners. This embodiment is exemplified by a screw lock. Preferably, the support member 20 has an external thread 21 at one end of the connection, and the top surface of the side wall 112 has a recess 114, preferably located in the middle of the top surface of the side wall 112, and the recess 114 has a fitting in the external thread 21 The internal thread allows the support member 20 to be screwed to the side wall 112. Preferably, the support member 20 may be of a long rod structure having a length of about 7 to 20 cm, preferably 10 to 15 cm, and a diameter of about 0.2 cm or less, preferably 0.1 to 0.2 cm. Further, the support member 20 can be made of various materials that are biocompatible and rigid, such as titanium alloy.

5B is a schematic view of the extension member shown in FIG. 4 assembled to the screw assembly, and FIG. 5C is a schematic view of the extension member shown in FIG. 4 assembled to the screw assembly, as shown in FIG. 5B and FIG. 5C. After the support member 20 is screwed into the side wall 112 of the receiving member 11, as shown in FIG. 5B, the extension member 30 is then assembled to the screw assembly 10. In the present embodiment, the two extension members 30 each have a through hole 31, and the operator can pass the two support members 20 through the through holes 31 of the extension member 30, the extension member 30 through the support member 20, and the extension member 30. The bottom end is connected to the side wall 112 as shown in Fig. 5C. The shape of the support member 20 of the present embodiment cooperates with the side wall 112, for example, an arc-shaped structure, and the through hole 31 can be positioned in the middle of the extension member 30. When the extension member 30 passes through the support member 20 with its through hole 31, It is connected to the top surface of the side wall 112.

As described above, the operating end of the surgical tool is operated in the accommodating space 113 formed by the limiting portion 111 and the side wall 112, so that when the device 1 is assembled and implanted into the vertebral body, the extension 30 connected to the side wall 112 is negative. The muscle tissue is opened to establish a function of a passage (surgical path) that communicates with the accommodation space 113. The operator can use different surgical tools to perform the surgical operation to the accommodation space 113 through the passage formed by the extension member 30.

In the above structure, it can be seen that the support member 20 is the support backbone of the extension member 30, providing similar pile effects, effectively improving the stability of the connection between the extension member 30 and the side wall 112. Since the device 1 is a small implant, in general, the joint structure of the extension member 30 and the side wall 112 cannot be too complicated or large. Please refer to FIG. 1 , so the raft structure or the extension member 30 is often used. The side wall 112, or the side wall 112, is sleeved with the extension member 30. However, since the available space is limited, the raft or the arranging structure is usually shallow at the time of design, and the effort is very limited. As long as the upper end of the extension member 30 is subjected to an external force, the extension member 30 is liable to cause the extension member 30 to be skewed or detached. However, in the present embodiment, since the support member 20 provides the supporting force, the extension member 30 and the side wall 112 need only a simple snap or snap structure (even if the depth of the structure is shallow), and the extension member 30 can be stabilized. It is fixed to the side wall 112 of the accommodating member 11 to avoid the situation of being skewed or falling off due to an external force during the surgical operation. Specifically, the top surface of the side wall 112 may be provided with a convex portion, and the bottom surface of the extension member 30 (referring to the surface connected to the end of the side wall 112) may be provided with a concave portion; conversely, a concave portion may be provided on the top surface of the side wall 112 and extended. The bottom surface of the member 30 is correspondingly provided with a convex portion.

Preferably, the extension member 30 of the embodiment is connected to the side wall 112 by the groove 32. In detail, the extension member 30 has a recess 32 at one end of the connecting side wall 112, that is, the bottom end of the extension member 30 has a recess 32. In this embodiment, the end of the extension member 30 adjacent to the receiving member 11 is referred to as a bottom end; otherwise, the end away from the receiving member 11 is referred to as a top end. The groove 32 of the embodiment is externally connected to the bottom end of the extension member 30 and one side of the connection bottom end. In other words, the groove 32 has two sides which are open faces and can communicate with each other, and the groove 32 is the bottom of the extension member 30. The end surface, the other side that connects the bottom end, and the side that faces the side of the other extension member 30, allows the recess 32 to engage the outer side portion of the side wall 112. The groove 32 is engaged with the side wall 112 and is engaged with the portion outside the side wall 112 to achieve the connection with the side wall 112.

6A is a schematic cross-sectional view of the device for stabilizing bone segment surgery shown in FIG. 5C, and FIG. 6B is an enlarged schematic view of the circled region shown in FIG. 6A. Please refer to FIG. 5B, FIG. 6A and FIG. 6B simultaneously. The perforation 31 has a long passage shape, one end is located at the top end of the extension member 30, and the other end is located at the bottom end of the extension member 30. This embodiment is located at the bottom portion 321 of the recess 32, as shown in Fig. 6B. After the extension member 30 is sleeved on the support member 20, the extension member 30 moves along the longitudinal axis direction Y toward the side wall 112 with the support member 20 as the axis, and finally the groove 32 is sleeved on the outer side of the side wall 112. The connection of the extension member 30 to the side wall 112 is achieved. It should be noted that since the support member 20 is received in the through hole 31, the through hole 31 of FIG. 6B is indicated between the inner wall of the through hole 31 and the support member 20. In this embodiment, the extension member 30 can be connected to the side wall 112 by the groove 32, and the groove 32 is designed to be externally connected to the bottom end of the extension member 30 and one side of the connection bottom end, that is, at the bottom of the extension member 30. It is an open groove, not a hole with a bottom opening (see the drawing), because the support member 20 in the extension member 30 provides a supporting effect, and the extension member 30 is prevented from being stressed on the outside. The horizontal axis direction X is displaced or rotated. The advantage of the extension member 30 utilizing the recess 32 instead of the recess to connect the side wall 112 is that the thickness T of the bottom end of the extension member 30 can be reduced, reducing the problem of expanding or pulling the surgical incision during use. Specifically, since the space at the bottom end of the extension member 30 is limited, if a cavity for accommodating the side wall 112 is formed therein, it is necessary to use the extension member 30 having a large thickness at the bottom end.

As shown in FIG. 6B, the side wall 112 of the receiving member 11 of the present embodiment has a first thickness T1. When the recess 32 of the extension member 30 is sleeved on the outer side portion of the side wall 112, there is a second thickness T2 at the junction of the two members, that is, the thickness T of the extension member 30 protruding from the portion outside the side wall 112 and the side wall 112. The first thickness T1 is added to the second thickness T2. Wherein, the difference between the first thickness T1 and the second thickness T2 is substantially between 0.25 mm and 1 mm, more preferably between 0.2 mm and 0.5 mm. In other words, in the present embodiment, the thickness T of the portion of the extension member 30 that protrudes beyond the side wall 112 is preferably between 0.25 mm and 1 mm, more preferably between 0.2 mm and 0.5 mm.

Since the support member 20 passes through the through hole 31 of the extension member 30, the extension member 30 can be connected to the side wall 112 as the backbone of the support member 20, so that the structure of the stable extension member 30 is the support member 20, and the groove of the extension member 30. 32 is biased toward the auxiliary effect of the limit, so that the thickness T of the portion of the extension member 30 that protrudes beyond the side wall 112 can be greatly reduced. In one embodiment, the thickness T of the extension member 30 at the recess 32 is 0.2 mm to achieve the effect of firmly extending the extension member 30 to the side wall 112. Compared with the extension member 7 and the sleeve 8 of the prior art, the present embodiment can simplify the structure of the joint (the position at which the extension member 30 connects the side wall 112 of the container 11) and reduce the thickness thereof, and can reduce the surgical wound.

Please refer to FIG. 3 , FIG. 4 and FIG. 6A . Preferably, the extension member 30 of the embodiment has a support member limiting structure 33 disposed on the extension member 30 to limit the occurrence of the support member 20 relative to the extension member 30 . Movement in the direction of the longitudinal axis Y, or the extension 30 is pivoted about the support member 20, thereby causing the recess 32 of the extension member 30 to be separated from the side wall 112 or otherwise loose. In other words, the extension member 30 of the present embodiment engages the outer portion of the side wall 112 by the recess 32 to prevent the extension member 30 from rotating relative to the side wall 112, and limits the extension member 30 relative to the support by the support member limiting structure 33. The movement of the piece 20, or the displacement of the support 20 within the perforation 31, increases the likelihood that the extension 30 will be released from the side wall 112.

7A is a schematic cross-sectional view taken along line A-A of FIG. 3, and please refer to FIG. 4 and FIG. 7A at the same time. The extension member 30 of this embodiment has a limiting hole 34 that communicates with the through hole 31 and the external space. It should be noted that, since the limiting hole 34 communicates with the through hole 31, the limiting hole 34 shown in FIG. 7A is marked on the curved surface adjacent to the limiting hole 34. Moreover, the support member limiting structure 33 of the embodiment is adjacent to the limiting hole 34, and the supporting member limiting structure 33 has an abutting top portion 331 which can pass through the limiting hole 34 against the supporting member 20, thereby fixing the support. The relative positional relationship of the member 20 with the extension member 30 prevents movement of the support member 20 relative to the extension member 30.

Preferably, the support limiting structure 33 is pivotally connected to the extension member 30, and the abutting top portion 331 has a flat surface 331a. The peripheral edge of the limiting hole 34 of the embodiment is a curved surface to accommodate the top portion 331. After the support member limiting structure 33 is rotated, the plane 331a can abut the supporting member 20, as shown in FIG. 7B, FIG. 7B is FIG. 7A is a schematic view showing the support member limit structure rotated. In this embodiment, the design of the plane 331a can interfere with the support member 20, so that when the support member limiting structure 33 is rotated, the plane 331a can further interfere with the support member 20 in addition to the top support member 20 to support The member 20 is forced into the perforation 31 to fix the relative position of the support member 20 and the extension member 30.

In other embodiments of the invention, the support limit structure 33 can also be a nut or similar nut configuration. By providing a thread on the upper end of the support member 20, when the extension member 30 passes through the support member 20, the position of the thread is higher than that of the extension member 30, so that the support member limiting structure 33 can press the extension member by screwing downward. 30 is closely engaged with the side wall 112 to avoid displacement or sway, and the effect of fixing the relative position of the support member 20 and the extension member 30 can also be achieved.

Please refer to FIG. 3 and FIG. 4 . Preferably, the extension member 30 of the embodiment includes a fastening member 35 . The fastening member 35 has at least one engaging groove 351 and is engaged with the top ends of the two extending members 30 . The fastener 35 of the present embodiment has a C-shape and has two engaging grooves 351 corresponding to the opposite two extension members 30. Preferably, the top end of the extension member 30 has an engaging portion 36 that cooperates with the engaging groove 351, and the engaging groove 351 is sleeved on the engaging portion 36, so that the fastening member 35 is engaged with the two extending members 30. top. In other embodiments, the fastener 35 can also have an engaging groove 351 and a C-shaped engaging groove, and can also be engaged with the top ends of the two extending members 30 at the same time. Since the fasteners 35 are simultaneously engaged with the top ends of the two extension members 30, the extension member 30 can be further prevented from being inwardly tilted or outwardly expanded in the horizontal axis direction X during the operation due to an external force, and can be maintained. The size of the passage (surgical path) formed by the extensions 30 on the opposite sides.

Preferably, the fastener 35 of the embodiment further has two grooves 352 respectively communicating with the engaging grooves 351. When the engaging grooves 351 are engaged with the top ends of the two extending members 30, the through holes 31 of the self-extending member 30 The two opposite support members 20 can be respectively disposed through the two grooves 352, as shown in FIG. In operation, the fastener 35 can be placed above the device 1, the groove 352 is corresponding to the support member 20, and moved downward along the support member 20 to the top end of the extension member 30, and then the engagement groove 351 is sleeved. The engaging portion 36 is provided as shown in FIG. 3 to complete the assembly of the fastener 35.

In general, the operator first screws the support member 20 to the side wall 112 of the receiving member 11, as shown in FIGS. 5A and 5B. Then, the extension member 30 is passed through the support member 20 with the through hole 31, and the groove 32 is engaged with the side wall 112 of the receiving member 11, as shown in FIG. 5C, and can be rotated by the support member limiting structure 33. The support member 20 is forced into the perforation 31 as shown in Fig. 7B. Finally, the fastener 35 is again engaged with the top ends of the two extension members 30 to complete the assembly of the device 1. Once assembled, the operator can use the instrument to implant the device 1 into the patient's vertebral body. While the device 1 of the present embodiment is a minimally invasive spinal surgery using a pedicle screw internal fixator system, the number of devices 1 is usually in pairs and there are a plurality of pairs, such as six or eight, and is caused by the patient. The vertebral arch site on both sides of the spine is implanted into the vertebral body.

In other embodiments of the present invention, the two extension members 30 and the fasteners 35 may be combined into one unit in advance, or integrally formed, and become a sleeve-like or ㄇ-shaped structure, which is convenient for the operator to perform surgery. The step of assembling the extension member 30 and the fastener 35 is reduced.

If there is a mutual interference between the adjacent devices 1, as shown in Fig. 8A, Fig. 8A is a schematic view in which the devices 1 shown in Fig. 3 are respectively implanted into the vertebral bodies L5, S1. In addition, Figure 8A shows two of the adjacent devices 1, one of which has been forced to pass between the two extensions 30 of the other device 1, in which case the surgical instrument is inaccessible. The screw assembly 10 is a case in which one interferes with each other. However, this result is not necessarily seen clinically on the operating table because the operator has pre-emptive practices or adjustment screws when the operator is judged by professional or empirical reasons that interference should occur between the extensions 30. The angle of the assembly 10 is to prevent the situation shown in Figure 8A from occurring. As for other interference modes, there may be one of the extension members 30 that are excessively tightly attached to the extension member 30 of the other group, and both are forced to be pulled by an external force and fixed to a position that does not pass through each other (Fig. 8A). . However, all of the above two methods are referred to herein as interference. If the extensions 30 of the adjacent two devices 1 interfere with each other, one or two extensions 30 of one of the devices 1 can be removed, as shown in FIG. 8B, and FIG. 8B is an extension of the vertebral body S1 of FIG. 8A. Schematic diagram of the piece. At the time of removal, only the fastener 35 needs to be taken out, and the support member limiting structure 33 is loosened (ie, reversely reversed from FIG. 7B as shown in FIG. 7A), and the extension member 30 can be directly along the longitudinal axis. Y is taken up (please be shown in Fig. 5B), and the support member 20 is detached from the through hole 31 to remove the extension member 30. Since the device 1 of the embodiment has the design of the support member 20, even during the operation, the operator can directly align the through hole 31 with the support member 20, and the support member 20 can be easily extended after passing through the through hole 31. The member 30 is assembled to the side wall 112 of the container 11. Compared with the prior art, since the connecting structure of the extension member 7 or the sleeve 8 and the vertebral screw 9 (9a) is complicated, and the connection position is located under the skin and muscle tissue, the extension member 7 is removed. After the sleeve 8 or the sleeve 8, it is difficult to reassemble the extension 7 or the sleeve 8 in the case of a small minimally invasive surgical wound and a poor surgical field. In addition, it is conventional to remove the extension member 7, or the sleeve 8, because it may be necessary to pull the outside, requiring additional working space, which may cause the wound to expand or pull. The extension member 30 of the present embodiment can be taken straight up along the longitudinal axis direction Y to avoid a situation in which the wound is enlarged or pulled.

In addition, the present invention further provides an extension assembly for use in a device for stabilizing bone segment surgery. The device includes a screw assembly and two support members. The screw assembly includes a receiving member having a limiting portion and a relative portion. The two side walls are respectively connected to the two side walls. For the detailed structure of the screw assembly and the support member and the connection relationship thereof, the screw assembly 10 and the support member 20 of the foregoing embodiment can be directly referred to, and no further details are provided herein. Moreover, the extension assembly includes two extension members each having a through hole, and the two support members are respectively connected to the two side walls through the through holes of the two extension members. For the two extensions of the extension assembly, the two extensions 30 of the device 1 of the previous embodiment can also be directly referred to, and the details are not described herein.

In summary, the device for stabilizing the bone segment surgery and the extension assembly thereof according to the present invention comprise a screw assembly and two support members, and the support member is coupled to the two side walls of the housing of the screw assembly. The extension assembly has two extensions each having a perforation. The support member passes through the perforations of the extension member, and the bottom end of the extension member is coupled to the side wall of the container. Therefore, the support member can be used as the support backbone of the extension member to achieve the effect of similar ground piles, stabilize the position of the extension member to avoid swaying and displacement, improve the connection stability of the extension member and the side wall, and avoid the extension of the two sides during the operation operation. It is affected by external force and is skewed or even detached from the side wall. Through this structural design, the space requirement of the extension member and the side wall at the joint can be reduced. Specifically, the upper edge of the side wall is not required to be additionally thickened to provide a larger engagement groove, so that the screw size is enlarged to expand the surgical wound.

In addition, in an embodiment of the invention, the extension member is designed to be perforated through the support member to be connected to the side wall, so that the extension member can be unloaded directly along the fixed direction (such as the longitudinal axis direction of the device for stabilizing the joint operation). Down and reassemble. Due to the specific bending angle of the spine, especially the five vertebral bodies of the lumbar vertebrae form a convex curvature to the abdomen. When treating, for example, the vertebral bodies L5 and S1, the traditional minimally invasive surgery sometimes occurs with the extension of the L5 and S1 extensions. The problem of conflict. With the implementation of the present invention, if a conflict occurs, one of the extension members can be easily removed in a fixed direction, which not only avoids the screw implantation angle, but must be compromised due to the extension member conflict, and is unloaded and reassembled (is surgery) In the case of demand, it is also possible to avoid expanding or pulling the wound, and at the same time, when the extension member is removed, the support member can partially temporarily extend the length of the incision to ensure the clear function of the surgical field.

Regardless of the purpose, means and efficacy of the present invention, it is shown that it is different from the characteristics of the prior art, and the reviewing committee is required to express the patent and grant the patent as soon as possible. It should be noted that the above-described embodiments are exemplified for the convenience of the description, and the scope of the claims is intended to be limited to the above embodiments.

1‧‧‧ device

10‧‧‧ screw assembly

11‧‧‧ 容 容

111‧‧‧Limited

112‧‧‧ side wall

113‧‧‧ accommodating space

114‧‧‧ recess

12‧‧‧Fixed parts

13‧‧‧ Inner cover

20‧‧‧Support

21‧‧‧ external thread

30‧‧‧Extensions

31‧‧‧Perforation

32‧‧‧ Groove

321‧‧‧ bottom

33‧‧‧Support member limit structure

331‧‧‧ arrived at the top

331a‧‧ plane

34‧‧‧Limited holes

35‧‧‧fasteners

351‧‧‧ snap groove

352‧‧‧ trench

36‧‧‧Clock Department

7‧‧‧Extensions

8‧‧‧ sleeve

81‧‧‧ gripping department

9, 9a‧‧ ‧ vertebral arch screws

91, 91a‧‧‧ nail rod

92, 92a‧‧‧ 容 容

921, 921a‧‧‧ side wall

93‧‧‧Clamping structure

L4, L5‧‧‧ vertebral body

T‧‧‧ thickness

T1‧‧‧first thickness

T2‧‧‧second thickness

X‧‧‧ horizontal axis direction

Y‧‧‧ vertical axis direction

Figure 1 is a schematic illustration of a conventional pedicle screw with an extension. 2 is a schematic view of a conventional pedicle screw having a sleeve. 3 is a schematic illustration of one embodiment of an apparatus for stabilizing a bone segmental procedure of the present invention. 4 is an exploded perspective view of the surgical device for stabilizing a bone segment shown in FIG. 3. Figure 5A is a schematic view of the support member of Figure 4 assembled in front of the screw assembly. Figure 5B is a schematic view of the extension shown in Figure 4 assembled in front of the screw assembly. FIG. 5C is a schematic view of the extension shown in FIG. 4 assembled to the screw assembly. Fig. 6A is a schematic cross-sectional view showing the entire apparatus for stabilizing a bone segment operation shown in Fig. 5C. Fig. 6B is an enlarged schematic view showing the circled area shown in Fig. 6A. Fig. 7A is a schematic cross-sectional view taken along line A-A of Fig. 3. FIG. 7B is a schematic view showing the support member limit structure shown in FIG. 7A rotated. Fig. 8A is a schematic view showing the implantation of the vertebral bodies L5, S1 by the two devices shown in Fig. 3, respectively. Figure 8B is a schematic illustration of the extension of the vertebral body S1 of Figure 8A.

Claims (20)

An apparatus for stabilizing a bone segment operation, comprising: a screw assembly, comprising: a receiving member having a limiting portion and two opposite side walls, the two side walls being longitudinally adjacent to the limiting portion And a fixing member connected to the limiting portion; two supporting members respectively connected to the two side walls and extending toward the longitudinal axis; and two extending members respectively having a through hole, wherein the extending member has a through hole The perforation passes through the support and is coupled to the two side walls. The device for stabilizing a segmental bone segment according to claim 1, wherein the support member has an external thread at one end of the connecting portion, and the top surface of the side wall has a concave portion, the concave portion having a fitting therein One of the threads is internally threaded and the support is threadedly connected to the side wall. The device for stabilizing a segmental bone segment according to claim 1, wherein the extension member has a groove at one end of the connecting side wall, and the groove engages the portion of the side wall at the outer side. The device for stabilizing a segmental bone segment according to claim 3, wherein the perforation is located at a bottom of the groove, and after the support member passes through the perforation, the extension member is sleeved with the groove The side of the side wall is connected to the side wall. The device for stabilizing a segmental bone segment according to claim 3, wherein the groove is externally connected to a bottom end of the extension member and a side surface connected to the bottom end. The device for stabilizing a segmental bone segment according to claim 1, wherein the side wall has a first thickness, and the extension member is connected to the side wall and has a second thickness at the joint, the first thickness The difference from the second thickness is between 0.25 mm and 1 mm. The device for stabilizing a segmental bone segment according to claim 1, wherein the side wall has a first thickness, and the extension member is connected to the side wall and has a second thickness at the joint, the first thickness The difference from the second thickness is between 0.2 mm and 0.5 mm. The device for stabilizing a segmental bone segment according to any one of claims 7 to 8, wherein the difference between the first thickness and the second thickness is substantially the extension of the extension member at one end of the side wall. thickness of. The device for stabilizing a segmental bone segment according to claim 1, wherein the extension member comprises a fastening member having an engaging groove while engaging one of the top ends of the two extension members. The device for stabilizing the segmental bone segment according to claim 9, wherein the fastener further has two grooves respectively communicating with the engaging groove, and the two supporting members are respectively disposed on the two grooves. . A device for stabilizing a segmental bone surgery as described in claim 1, wherein the surgery is a minimally invasive spinal surgery. An extension assembly for use in a device for stabilizing bone segment surgery, the device comprising a screw assembly and two support members, the screw assembly comprising a receiving member having a limiting portion and opposite side walls The two side walls extend toward the longitudinal axis of the device, and the two supporting members are respectively connected to the two side walls and extend toward the longitudinal axis. The extension assembly comprises: two extension members, respectively There is a perforation, wherein the extension member passes through the support member and is connected to the two side walls. The extension assembly of claim 12, wherein the extension has a recess at one end of the side wall and the recess engages the outer side portion of the side wall. The extension assembly of claim 13, wherein the through hole is located at a bottom of the groove, and after the support member passes through the through hole, the extension member is sleeved on the outer side of the side wall. A connection to the side wall is achieved. The extension assembly of claim 13, wherein the groove is externally connected to a bottom end of the extension member and a side surface connected to the bottom end. The extension assembly of claim 12, wherein the sidewall has a first thickness, and the extension has a second thickness at the junction after the sidewall is joined, the difference between the first thickness and the second thickness The value is between 0.25 mm and 1 mm. The extension assembly of claim 12, wherein the two side walls have a first thickness, the extension member is connected to the side wall, and has a second thickness at the joint, the first thickness and the second thickness The difference is between 0.2 mm and 0.5 mm. The extension assembly of any one of claims 16 or 17, wherein the difference between the first thickness and the second thickness is substantially the thickness of the extension member at one end of the side wall. The extension assembly of claim 12, wherein the extension member comprises a fastener having an engagement groove while engaging one of the top ends of the two extension members. The extension assembly of claim 19, wherein the fastener further has two grooves, respectively communicating with the engagement groove, and the two support members are respectively disposed through the two grooves.