WO2010010259A1 - Articulated prosthesis for posterior total lumbar arthroplatsy - Google Patents

Articulated prosthesis for posterior total lumbar arthroplatsy Download PDF

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Publication number
WO2010010259A1
WO2010010259A1 PCT/FR2009/000919 FR2009000919W WO2010010259A1 WO 2010010259 A1 WO2010010259 A1 WO 2010010259A1 FR 2009000919 W FR2009000919 W FR 2009000919W WO 2010010259 A1 WO2010010259 A1 WO 2010010259A1
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WO
WIPO (PCT)
Prior art keywords
connectors
guiding
prosthesis according
joint prosthesis
connecting element
Prior art date
Application number
PCT/FR2009/000919
Other languages
French (fr)
Inventor
Alain Tornier
Original Assignee
Clariance
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Clariance filed Critical Clariance
Priority to EP09784297A priority Critical patent/EP2317945A1/en
Publication of WO2010010259A1 publication Critical patent/WO2010010259A1/en

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Classifications

    • 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
    • A61B17/7043—Screws or hooks combined with longitudinal elements which do not contact vertebrae with a longitudinal element fixed to one or more transverse elements which connect multiple screws or hooks

Definitions

  • the present invention relates to a total arthroplasty joint prosthesis for reconstructing guide elements of the upper and lower lumbar vertebrae of a spinal segment with a center of rotation and movement limitation means ensuring a necessary stability of said vertebrae .
  • the articular prosthesis of total arthroplasty according to the present invention has, when destabilization of the spine was created, to be able to stabilize the spinal segment Sr concerned while at the same time preserving the risk of degradation of the other vertebral stages.
  • the total arthroplasty joint prosthesis according to the present invention comprises connectors fixed in the pedicles Vp of the vertebral stages by anchoring screws, upper and lower connection elements connecting the connectors to each other, and guide means and damping connecting said upper and lower link members, said guide and damping means and said upper and lower link members being arranged relative to each other so as to define at least one axis of rotation and sliding C located at level of the superior vertebral overlying Va of the instrumented segment Sr in order to limit the efforts on the anchoring screws ensuring the attachment of the connectors in said vertebra Va.
  • the total arthroplasty joint prosthesis according to the present invention comprises limiting means which connect the connectors together and which make it possible to limit the flexion extension and lateral inflection movements around the axis of rotation and sliding C.
  • the total arthroplasty joint prosthesis according to the present invention comprises limiting means which consist of a cable connecting the connectors to each other.
  • the total arthroplasty joint prosthesis according to the present invention comprises guiding and damping means which consist of a connecting support having an oblong groove inside which is housed a guiding element cooperating with the element. connecting and elastomeric stops whose elastic deformations make it possible to limit, without constraint, the displacements of said guide element inside said oblong groove and guiding and fixing means cooperating with the lower connecting element.
  • the total arthroplasty joint prosthesis comprises a guide element which consists of a first plate secured to a hollow sleeve on which a second plate comes, said guide element being connected to the first upper connecting element by by means of a clamping screw passing through the hollow sleeve to cooperate with a nut, said hollow sleeve passing through the oblong groove of the connecting support so that its displacements are limited by the elastic deformation of the elastomeric stops.
  • the total arthroplasty joint prosthesis according to the present invention comprises a connecting support which is connected to the second lower connecting element on the one hand by means of a guiding device and on the other hand by means of a locking device .
  • the total arthroplasty joint prosthesis according to the present invention comprises a first upper connecting element which consists of a central body extending at each end by rods on which slide respectively a split ring with a spherical profile intended to cooperate with each first connector, said central body being pierced with an oblong hole for cooperation with the guiding and damping means.
  • the total arthroplasty joint prosthesis according to the present invention comprises a second lower connecting element which consists of a central part having laterally extensions each having a fork-shaped end provided to come around the corresponding anchor screw, said central portion comprising a guiding device and threaded bores for the establishment and immobilization of guiding and damping means.
  • the total arthroplasty joint prosthesis comprises first connectors which each consist of a body having a bore for the passage of the pedicle screw, a housing for receiving the first upper connecting element, a threaded bore opening perpendicularly in a hole and cooperating with a clamping screw for immobilizing the limiting means when the latter are introduced into the through hole, and a slot passing through the hole and the bore to open into the housing so as to allow said housing to deform under a pressure force generated by a clamping nut during immobilization of said first connector on the corresponding pedicle screw.
  • the total arthroplasty joint prosthesis according to the present invention comprises second connectors which each consist on the one hand of a connecting element forming a rod comprising in a horizontal direction a fork having an oblong opening for its passage around the screw. pedicle, and extending in a direction perpendicular by an anchor rod provided with a blade-shaped end and secondly a connecting ring pierced in the middle of a hole for its establishment around the same anchoring screw, said connecting ring is pierced with through holes for the introduction and immobilization of the limiting means.
  • the total arthroplasty joint prosthesis according to the present invention comprises a connecting ring comprising lower side edges cooperating with the fork so that said ring can not rotate in relation to the anchor screw during tightening of the nut. .
  • the total arthroplasty joint prosthesis according to the present invention comprises a connecting ring comprising upper lateral edges which are arranged in a direction perpendicular to that of the lower side edges for guiding the second lower connecting element.
  • Figures 1 and 2 are views illustrating a spinal segment of a vertebral column on which was mounted on vertebral stage joint prosthesis total arthroplasty according to the present invention.
  • Figure 3 is an exploded perspective view showing the various elements constituting the total arthroplasty joint prosthesis according to the present invention.
  • Figure 4 is a perspective view showing the assembly of the various elements constituting the total arthroplasty joint prosthesis according to the present invention.
  • Figure 5 is a view illustrating a spinal segment of a spine on which has been mounted on at least two vertebral stages, the total arthroplasty joint prosthesis according to the present invention.
  • Figure 6 is an exploded perspective view showing the various elements constituting the total arthroplasty joint prosthesis for connecting at least two vertebral stages according to the present invention.
  • Figure 7 is a perspective view showing the assembly of the various elements constituting the total arthroplasty joint prosthesis for connecting at least two vertebral stages according to the present invention.
  • FIGS. 1 to 4 show an instrumented spinal segment Sr of a vertebral column, some vertebrae of which, and more particularly, the supravoidal lumbar vertebrae Va and underlying Vb are interconnected by a total arthroplasty articular prosthesis 1.
  • the articular prosthesis 1 comprises on the one hand first connectors 2 coming via an anchor screw 3 to be fixed in the pedicles Vp of the overlying lumbar vertebra Va and on the other hand the second connectors 4 coming through by means of other anchoring screws 3 to be fixed in the pedicles Vp of the underlying lumbar vertebra Vb.
  • the articular prosthesis 1 comprises a first upper connecting element 5 for interconnecting the first connectors 2 integral pedic Vp of the lumbar vertebra overlying Va.
  • the articular prosthesis 1 comprises a second lower connecting element 6 for interconnecting the second connectors 4 integral pedic Vp of the underlying lumbar vertebra Vb.
  • the articular prosthesis 1 comprises guiding and damping means 7 connecting the first upper connecting element 5 with the second lower connecting element 6 and ensuring controlled movements of flexion extension and lateral inflection of the overlying lumbar vertebrae Va and underlying Vb.
  • the guiding and damping means 7 and the upper and lower connecting elements 5, 6 are arranged relative to each other so as to define at least one axis of rotation and sliding C located at the level of the upper vertebra above. jacente Va of the instrumented segment Sr to limit the forces on the anchoring screws 3 ensuring the attachment of the connectors 2 in said overlying vertebra Va.
  • the articular prosthesis 1 comprises limiting means 8 connecting the first connectors 2 with the corresponding second connectors 4 and providing a limitation of the flexion extension and lateral inflection of the overlying lumbar vertebrae Va and underlying Vb.
  • the limiting means 8 connecting the connectors 2, 4 to each other make it possible to limit the flexion extension and lateral inflection movements around the axis of rotation and sliding C of the joint prosthesis 1.
  • the articular prosthesis 1 comprises pedicular anchoring screws 3 double threading known per se and consisting of a longitudinal body 30 having a threaded portion 31 for anchoring said screw in the bone body of the pedicles Vp of each lumbar vertebra above and underlying Va, Vb of the spinal segment Sr to instrument.
  • the longitudinal body 30 comprises, in the extension of the threaded portion 31, a clamping head 32 integral with a threaded cylindrical profile 33 enabling the insertion of a clamping nut 34.
  • the pedicle screws 3 can be cannulated with lateral orifices 35 for injecting a biological cement intended to improve the anchoring in each upper and lower lumbar vertebra Va, Vb of the spinal segment Sr to be instrumented.
  • the first connectors 2 each consist of a body 20 having a bore 21 for the passage of the threaded cylindrical profile 33 of the pedicle screw 3 and in a perpendicular direction and, laterally offset to said bore a housing 22 having a spherical profile cooperating with the first upper connecting element 5.
  • the first upper connecting element 5 consists of a central body 51 extending at each end by rods 52 on which slide respectively a split ring with a spherical profile 53 intended to cooperate with the housing 22 of each connector 2 and allow the angular positioning of said upper connecting member 5 with respect to said connector.
  • the central body 51 of the first upper connecting element 5 is pierced with an oblong hole 54 whose longitudinal axis is perpendicular to that of the rods 52.
  • each first connector 2 is pierced vertically with a threaded bore 24 opening perpendicularly into a hole 25 passing through said body.
  • the threaded bore 24 cooperates with a clamping screw 27 for immobilizing the limiting means 8 when the latter are introduced into the through hole 25.
  • the limitation means 8 of the flexion extension and lateral inflection movements consist of a cable 80 formed for example of a central strand around which six other strands are twisted.
  • each first connector 2 has a slot 26 passing through the hole 25 and the bore 21 to open into the housing 22 so as to allow said housing to deform under a pressure force generated by the nut of tightening 34 during the immobilization of said connector on the pedicle screw 3 corresponding.
  • the second connectors 4 each consist of a connecting element forming a rod 40_comprising in a horizontal direction a fork 41 extending in a perpendicular direction by a support rod 42.
  • the fork 41 has an oblong opening 43 which cooperates with the threaded cylindrical profile 33 of each anchoring screw 3, while the support rod 42 has a blade-shaped end which bears against the external bone part of the corresponding vertebra in a direction substantially parallel to that of the part threaded 31 of the anchoring screw 3 to strengthen the pedicle anchorage and to withstand the cantilever.
  • the oblong opening 43 of the fork 41 has a profile that fits around the clamping head 32 of the anchoring screw 3 so that the connecting element 40 forming a rod can not be rotated during clamping. nut 34.
  • the second connectors 4 each comprise a connecting ring 45 pierced in the middle with a hole 46 for its implementation around the threaded cylindrical profile 33 of the anchoring screw 3.
  • the connecting ring 45 has a lower face coming into position. support on the fork 41.
  • the lower face has lateral edges 47 cooperating with the outer edges of each leg constituting the fork 41 so that the ring 45 can not rotate in relation to the anchoring screw 3 when tightening the nut 34 .
  • each connecting ring 45 The lateral edges 47 of the lower face of each connecting ring 45 are respectively pierced by a through hole 49 allowing the introduction and the immobilization of the cable 80 of the limiting means 8.
  • the connecting ring 45 has an upper face provided with lateral edges 48 which are arranged in a direction perpendicular to that of the lateral edges 47 of the lower face.
  • the upper face of the connecting ring 45 of each connecting element 40 forming a rod is provided to cooperate, before tightening the nut 34 with the second lower connecting element 6.
  • the second lower connecting element 6 consists of a central portion 60 having laterally extensions 61 each having a fork-shaped end 62.
  • the branches of the fork 62 of each extension 61 are provided to come around the threaded cylindrical profile 33 of the corresponding anchoring screw 3 while being guided laterally, before the tightening of the nut 34, by the lateral edges 48 of the upper face of the connecting ring 45.
  • the central portion 60 of the second lower connecting element 6 comprises laterally and in a direction perpendicular to that of the extensions 61 a guide device 63 whose profile may be, for example, dovetail.
  • the central portion 60 is pierced between the lateral edges of the guiding device 63 of two threaded bores 65 cooperating respectively with a clamping screw 66 for immobilization in translation of a connecting support 70 belonging to the guiding and damping means. 7 for connecting the first upper connecting element 5 with the second lower connecting element 6.
  • connection support 70 comprises in its middle an oblong groove 71 inside which is accommodated a guide element 72 and on each side of the latter elastomeric stops 73 whose elastic deformations make it possible to limit without restraint the movements of said guiding element 72 within said oblong groove 71.
  • the guide element 72 is constituted below the connecting support 70 of a first plate 74 integral with a hollow sleeve 75 passing through the oblong groove 71 and on which is fitted above said connection support 70 a second platinum 76.
  • the guide element 72 is connected to the central body 51 of the first upper connecting element 5 by means of a clamping screw 77 passing through the hollow sleeve 75 and the oblong hole 54 to cooperate with a nut 78.
  • the connecting support 70 is connected to the central portion 60 of the second lower connecting element 6 by a guiding device 79 whose profile complementary to that of the guiding device 63 allows the sliding of said connecting support 70 in the central part 60 of the second lower connecting element 6.
  • the connecting support 70 is pierced with two holes 9 each traversed by a clamping screw 66 cooperating with the threaded bores 65 for fixing said connecting support 70 on the central portion 60 of the second lower connecting element 6.
  • FIGS. 5 to 7 show the assembly and assembly of the total arthroplasty joint prosthesis 1, for example, on two vertebral stages Va, Vb and Vc of a spinal segment Sr to be corrected.
  • the vertebrae Va and Vb are the extreme vertebrae of the spinal segment Sr to be instrumented, while the vertebra Vc is located between said vertebrae Va and Vb.
  • the pedicles Vp of the vertebrae Va, Vb are respectively fixed by means of the anchoring screws 3, the first and second connectors 2, 4 each connected by the upper and lower connecting elements 5, 6 of the total arthroplasty joint prosthesis 1.
  • the connectors 4 of the vertebra Vc are interconnected by a median connecting element 6 similar in part to that connecting the connectors 4 of the vertebrae Vb.
  • the medial connecting element 6 of the vertebra Vc stands out mainly from that described above in that the central portion 60 has between the extensions 61 a side skirt 64 pierced in the middle of an oblong hole 67.
  • This side skirt 64 has the same characteristics and advantages as the central body 51 of the first element upper link 5 to allow the fixing of the guide member 72 guiding and damping means 7 by means of a clamping screw 77 through the hollow sleeve 75 and the oblong hole 67 to cooperate with the nut 78.
  • This lateral skirt 64 of the medial connecting element 6 allows the introduction and retention of another guiding and damping means 7 identical to that described above but between the vertebral stages Vc, Vb.
  • the upper connecting element 5 fixed on the vertebra Va is connected to the median connecting element 6 of the vertebra Vc by guide and damping means 7 similar to those described above, while the element of median connection 6 is connected to the lower connecting element 6 of the vertebra Vb by other guiding and damping means 7.
  • first and second cables 80 constituting the limiting means 8 of the flexion extension and lateral inflection movements.
  • the articular prosthesis total arthroplasty 1 integral supra and underlying vertebrae Va and Vb or vertebrae Va, Vc, Vb allows when a destabilization of the spine was created to be able to stabilize the spinal segment Sr while preserving the degradations other vertebral stages.
  • the articular prosthesis of total arthroplasty 1 allows, by its structure and its various elements, the component of reconstructing the guiding elements of the lumbar vertebrae overlying Va and subjacent Vb of a spinal segment Sr of a vertebral column.

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Abstract

The articulated prosthesis for total arthroplasty of the present invention comprises connectors (2, 4) attached in the pedicles Vp of the upper vertebral stages by anchoring screws (3), upper and lower linking members (5, 6) linking the connectors (2, 4) therebetween, and guiding and a damping means (7) linking said upper and lower linking members (5, 6), wherein said guiding and damping means (7) and said upper and lower linking members (5, 6) are arranged relative to each other so as to define at least one rotation and sliding axis C located at the upper vertebra Va underlying the instrumented segment Sr in order to limit stresses on the anchoring screws (3) for attaching said connectors (2) in said underlying vertebra (Va).

Description

PROTHESE ARTICULAIRE D'ARTHROPLASTIE TOTALE LOMBAIRE PAR JOINT PROSTHESIS OF TOTAL LUMBAR ARTHROPLASTY BY
VOIE POSTERIEUREPOSTERIOR
La présente invention est relative à une prothèse articulaire d'arthroplastie totale permettant de reconstruire des éléments de guidage des vertèbres lombaires sus et sous jacentes d'un segment rachidien avec un centre de rotation et des moyens de limitation des mouvements assurant une stabilité nécessaire desdites vertèbres.The present invention relates to a total arthroplasty joint prosthesis for reconstructing guide elements of the upper and lower lumbar vertebrae of a spinal segment with a center of rotation and movement limitation means ensuring a necessary stability of said vertebrae .
Dans certains cas de patient atteint de pathologies dégénératives du rachis lombaire comme les sténoses ou l'arthroses articulaires, il est prévu de réaliser des fusions complètes des vertèbres lombaires sus et sous jacentes du segment rachidien.In some cases of patients suffering from degenerative pathologies of the lumbar spine such as joint stenosis or arthrosis, it is planned to perform complete fusions of the upper and lower lumbar vertebrae of the spinal segment.
Dans les cas de patients jeunes où les dégradations des vertèbres lombaires peuvent être réversibles, il est prévu désormais d'utiliser des dispositifs de stabilisation dynamique surtout en première intention.In the case of young patients where degradations of the lumbar vertebrae can be reversible, it is now planned to use dynamic stabilization devices especially in the first line.
Dans les cas de patients âgés où les dégradations des vertèbres lombaires sont plus sévères et surtout non réversibles, il est prévu de réaliser une décompression de la moelle épinière et des racines nerveuses nécessitant l'élimination de certains éléments osseux hypertrophiés. Cette technique conduit généralement à une déstabilisation du segment rachidien obligeant à réaliser une fusion des vertèbres lombaires sus et sous jacentes entre elles.In the case of elderly patients where the deterioration of the lumbar vertebrae is more severe and especially non-reversible, it is planned to perform decompression of the spinal cord and nerve roots requiring the removal of some hypertrophied bone elements. This technique generally leads to a destabilization of the spinal segment forcing to merge the above and underlying lumbar vertebrae together.
Il a été constaté que la fusion des vertèbres lombaires sus et sous jacentes entre elles peut, dans certains cas, présenter des complications entraînant la dégénérescence des étages vertébraux adjacents qui sont sur-sollicités du fait de ladite fusion.It has been found that the fusion of the above-mentioned and underlying lumbar vertebrae may, in certain cases, present complications leading to the degeneration of the adjacent vertebral stages which are over-stretched as a result of said fusion.
La prothèse articulaire d'arthroplastie totale suivant la présente invention a pour objet, lorsqu'une déstabilisation du rachis a été créée, de pouvoir stabiliser le segment rachidien Sr concerné tout en préservant à terme les risques de dégradation des autres étages vertébraux.The articular prosthesis of total arthroplasty according to the present invention has, when destabilization of the spine was created, to be able to stabilize the spinal segment Sr concerned while at the same time preserving the risk of degradation of the other vertebral stages.
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte des connecteurs fixés dans les pédicules Vp des étages vertébraux par des vis d'ancrage, des éléments de liaison supérieure et inférieure reliant les connecteurs entre eux, et des moyens de guidage et d'amortissement reliant lesdits éléments de liaison supérieure et inférieure, lesdits moyens de guidage et d'amortissement et lesdits éléments de liaison supérieure et inférieure étant agencés les uns par rapport aux autres de manière à définir au moins un axe de rotation et de glissement C situé au niveau de la vertèbre supérieure sus jacente Va du segment instrumenté Sr afin de limiter les efforts sur les vis d'ancrage assurant la fixation des connecteurs dans ladite vertèbre sus jacente Va. La prothèse articulaire d'arthroplastie totale suivant Ia présente invention comporte des moyens de limitation qui relient les connecteurs entre eux et qui permettent de limiter les mouvements de flexion extension et d'inflexion latérale autour de l'axe de rotation et de glissement C.The total arthroplasty joint prosthesis according to the present invention comprises connectors fixed in the pedicles Vp of the vertebral stages by anchoring screws, upper and lower connection elements connecting the connectors to each other, and guide means and damping connecting said upper and lower link members, said guide and damping means and said upper and lower link members being arranged relative to each other so as to define at least one axis of rotation and sliding C located at level of the superior vertebral overlying Va of the instrumented segment Sr in order to limit the efforts on the anchoring screws ensuring the attachment of the connectors in said vertebra Va. The total arthroplasty joint prosthesis according to the present invention comprises limiting means which connect the connectors together and which make it possible to limit the flexion extension and lateral inflection movements around the axis of rotation and sliding C.
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte des moyens de limitation qui sont constitués d'un câble reliant les connecteurs entre eux.The total arthroplasty joint prosthesis according to the present invention comprises limiting means which consist of a cable connecting the connectors to each other.
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte des moyens de guidage et d'amortissement qui sont constitués d'un support de liaison comportant une rainure oblongue à l'intérieur de laquelle est logée un élément de guidage coopérant avec l'élément de liaison et des butées en élastomère dont les déformations élastiques permettent de limiter sans contrainte les déplacements dudit élément de guidage à l'intérieur de ladite rainure oblongue et des moyens de guidage et de fixation coopérant avec l'élément de liaison inférieure. La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte un élément de guidage qui est constitué d'une première platine solidaire d'un manchon creux sur lequel vient une seconde platine, ledit élément de guidage étant relié au premier élément de liaison supérieure par l'intermédiaire d'une vis de serrage traversant le manchon creux pour coopérer avec un écrou, ledit manchon creux traversant la rainure oblongue du support de liaison de sorte que ses déplacements sont limités par la déformation élastique des butées en élastomère.The total arthroplasty joint prosthesis according to the present invention comprises guiding and damping means which consist of a connecting support having an oblong groove inside which is housed a guiding element cooperating with the element. connecting and elastomeric stops whose elastic deformations make it possible to limit, without constraint, the displacements of said guide element inside said oblong groove and guiding and fixing means cooperating with the lower connecting element. The total arthroplasty joint prosthesis according to the present invention comprises a guide element which consists of a first plate secured to a hollow sleeve on which a second plate comes, said guide element being connected to the first upper connecting element by by means of a clamping screw passing through the hollow sleeve to cooperate with a nut, said hollow sleeve passing through the oblong groove of the connecting support so that its displacements are limited by the elastic deformation of the elastomeric stops.
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte un support de liaison qui est relié au second élément de liaison inférieure d'une part au moyen d'un dispositif de guidage et d'autre part au moyen d'un dispositif de blocage.The total arthroplasty joint prosthesis according to the present invention comprises a connecting support which is connected to the second lower connecting element on the one hand by means of a guiding device and on the other hand by means of a locking device .
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte un premier élément de liaison supérieure qui est constitué d'un corps central se prolongeant à chaque extrémité par des tiges sur lesquelles coulissent respectivement une bague fendue à profil sphérique destinée à venir coopérer avec chaque premier connecteur, ledit corps central étant percé d'un trou oblong pour la coopération avec les moyens de guidage et d'amortissement.The total arthroplasty joint prosthesis according to the present invention comprises a first upper connecting element which consists of a central body extending at each end by rods on which slide respectively a split ring with a spherical profile intended to cooperate with each first connector, said central body being pierced with an oblong hole for cooperation with the guiding and damping means.
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte un second élément de liaison inférieure qui est constitué d'une partie centrale comportant latéralement des prolongements présentant chacun une extrémité en forme de fourche prévue pour venir autour de la vis d'ancrage correspondante, ladite partie centrale comportant un dispositif de guidage et des alésages filetés pour la mise en place et l'immobilisation des moyens de guidage et d'amortissement. La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte des premiers connecteurs qui sont constitués chacun d'un corps présentant un alésage pour le passage de la vis pédiculaire, un logement pour la réception du premier élément de liaison supérieure, un alésage fileté débouchant perpendiculairement dans un trou et coopérant avec une vis de serrage pour l'immobilisation des moyens de limitation lorsque ces derniers sont introduits dans le trou traversant, et une fente traversant le trou et l'alésage pour déboucher à l'intérieur du logement de manière à permettre audit logement de se déformer sous un effort de pression engendré par un écrou de serrage lors de l'immobilisation dudit premier connecteur sur la vis pédiculaire correspondante.The total arthroplasty joint prosthesis according to the present invention comprises a second lower connecting element which consists of a central part having laterally extensions each having a fork-shaped end provided to come around the corresponding anchor screw, said central portion comprising a guiding device and threaded bores for the establishment and immobilization of guiding and damping means. The total arthroplasty joint prosthesis according to the present invention comprises first connectors which each consist of a body having a bore for the passage of the pedicle screw, a housing for receiving the first upper connecting element, a threaded bore opening perpendicularly in a hole and cooperating with a clamping screw for immobilizing the limiting means when the latter are introduced into the through hole, and a slot passing through the hole and the bore to open into the housing so as to allow said housing to deform under a pressure force generated by a clamping nut during immobilization of said first connector on the corresponding pedicle screw.
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte des seconds connecteurs qui sont constitués chacun d'une part d'un élément de connexion formant une canne comprenant suivant une direction horizontale une fourche présentant une ouverture oblongue pour son passage autour de la vis pédiculaire, et se prolongeant suivant une direction perpendiculaire par une tige d'ancrage pourvue d'une extrémité en forme de lame et d'autre part d'une bague de liaison percée en son milieu d'un trou pour sa mise en place autour de la même vis d'ancrage, ladite bague de liaison est percée de trous débouchants permettant la mise en place et l'immobilisation des moyens de limitation.The total arthroplasty joint prosthesis according to the present invention comprises second connectors which each consist on the one hand of a connecting element forming a rod comprising in a horizontal direction a fork having an oblong opening for its passage around the screw. pedicle, and extending in a direction perpendicular by an anchor rod provided with a blade-shaped end and secondly a connecting ring pierced in the middle of a hole for its establishment around the same anchoring screw, said connecting ring is pierced with through holes for the introduction and immobilization of the limiting means.
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte une bague de liaison comprenant des bords latéraux inférieurs coopérant avec la fourche de manière que ladite bague ne puisse pivoter en rotation par rapport à la vis d'ancrage lors du serrage de l'écrou.The total arthroplasty joint prosthesis according to the present invention comprises a connecting ring comprising lower side edges cooperating with the fork so that said ring can not rotate in relation to the anchor screw during tightening of the nut. .
La prothèse articulaire d'arthroplastie totale suivant la présente invention comporte une bague de liaison comprenant des bords latéraux supérieurs qui sont disposés suivant une direction perpendiculaire à celle des bords latéraux inférieurs pour le guidage du second élément de liaison inférieure.The total arthroplasty joint prosthesis according to the present invention comprises a connecting ring comprising upper lateral edges which are arranged in a direction perpendicular to that of the lower side edges for guiding the second lower connecting element.
Les dessins annexés, donnés à titre d'exemple, permettront de mieux comprendre l'invention, les caractéristiques qu'elle présente et les avantages qu'elle est susceptible de procurer :The accompanying drawings, given by way of example, will provide a better understanding of the invention, the characteristics that it presents and the advantages that it is likely to provide:
Figures 1 et 2 sont des vues illustrant un segment rachidien d'une colonne vertébrale sur lequel a été montée sur étage vertébral la prothèse articulaire d'arthroplastie totale suivant la présente invention.Figures 1 and 2 are views illustrating a spinal segment of a vertebral column on which was mounted on vertebral stage joint prosthesis total arthroplasty according to the present invention.
Figure 3 est une vue en perspective éclatée représentant les différents éléments constituant la prothèse articulaire d'arthroplastie totale suivant la présente invention. Figure 4 est une vue en perspective montrant l'assemblage des différents éléments constituant la prothèse articulaire d'arthroplastie totale suivant la présente invention. Figure 5 est une vue illustrant un segment rachidien d'une colonne vertébrale sur lequel a été montée, sur au moins deux étages vertébraux, la prothèse articulaire d'arthroplastie totale suivant la présente invention. Figure 6 est une vue en perspective éclatée représentant les différents éléments constituant la prothèse articulaire d'arthroplastie totale pour relier au moins deux étages vertébraux suivant la présente invention.Figure 3 is an exploded perspective view showing the various elements constituting the total arthroplasty joint prosthesis according to the present invention. Figure 4 is a perspective view showing the assembly of the various elements constituting the total arthroplasty joint prosthesis according to the present invention. Figure 5 is a view illustrating a spinal segment of a spine on which has been mounted on at least two vertebral stages, the total arthroplasty joint prosthesis according to the present invention. Figure 6 is an exploded perspective view showing the various elements constituting the total arthroplasty joint prosthesis for connecting at least two vertebral stages according to the present invention.
Figure 7 est une vue en perspective montrant l'assemblage des différents éléments constituant la prothèse articulaire d'arthroplastie totale pour relier au moins deux étages vertébraux suivant la présente invention.Figure 7 is a perspective view showing the assembly of the various elements constituting the total arthroplasty joint prosthesis for connecting at least two vertebral stages according to the present invention.
On a montré en figures 1 à 4 un segment rachidien instrumenté Sr d'une colonne vertébrale dont certaines vertèbres et plus particulièrement les vertèbres lombaires sus jacentes Va et sous jacentes Vb sont reliées entre elles par une prothèse articulaire d'arthroplastie totale 1.FIGS. 1 to 4 show an instrumented spinal segment Sr of a vertebral column, some vertebrae of which, and more particularly, the supravoidal lumbar vertebrae Va and underlying Vb are interconnected by a total arthroplasty articular prosthesis 1.
La prothèse articulaire 1 comporte d'une part des premiers connecteurs 2 venant par l'intermédiaire d'une vis d'ancrage 3 se fixer dans les pédicules Vp de la vertèbre lombaire sus jacente Va et d'autre part des seconds connecteurs 4 venant par l'intermédiaire d'autres vis d'ancrage 3 se fixer dans les pédicules Vp de la vertèbre lombaire sous jacente Vb.The articular prosthesis 1 comprises on the one hand first connectors 2 coming via an anchor screw 3 to be fixed in the pedicles Vp of the overlying lumbar vertebra Va and on the other hand the second connectors 4 coming through by means of other anchoring screws 3 to be fixed in the pedicles Vp of the underlying lumbar vertebra Vb.
La prothèse articulaire 1 comporte un premier élément de liaison supérieure 5 permettant de relier entre eux les premiers connecteurs 2 solidaires des pédicules Vp de la vertèbre lombaire sus jacente Va.The articular prosthesis 1 comprises a first upper connecting element 5 for interconnecting the first connectors 2 integral pedic Vp of the lumbar vertebra overlying Va.
La prothèse articulaire 1 comporte un second élément de liaison inférieure 6 permettant de relier entre eux les seconds connecteurs 4 solidaires des pédicules Vp de la vertèbre lombaire sous jacente Vb.The articular prosthesis 1 comprises a second lower connecting element 6 for interconnecting the second connectors 4 integral pedic Vp of the underlying lumbar vertebra Vb.
La prothèse articulaire 1 comporte des moyens de guidage et d'amortissement 7 reliant le premier élément de liaison supérieure 5 avec le second élément de liaison inférieure 6 et assurant des mouvements contrôlés de flexion extension et d'inflexion latérale des vertèbres lombaires sus jacentes Va et sous jacentes Vb.The articular prosthesis 1 comprises guiding and damping means 7 connecting the first upper connecting element 5 with the second lower connecting element 6 and ensuring controlled movements of flexion extension and lateral inflection of the overlying lumbar vertebrae Va and underlying Vb.
Les moyens de guidage et d'amortissement 7 et les éléments de liaison supérieure et inférieure 5, 6 sont agencés les uns par rapport aux autres de manière à définir au moins un axe de rotation et de glissement C situé au niveau de la vertèbre supérieure sus jacente Va du segment instrumenté Sr afin de limiter les efforts sur les vis d'ancrage 3 assurant la fixation des connecteurs 2 dans ladite vertèbre sus jacente Va.The guiding and damping means 7 and the upper and lower connecting elements 5, 6 are arranged relative to each other so as to define at least one axis of rotation and sliding C located at the level of the upper vertebra above. jacente Va of the instrumented segment Sr to limit the forces on the anchoring screws 3 ensuring the attachment of the connectors 2 in said overlying vertebra Va.
La prothèse articulaire 1 comprend des moyens de limitation 8 reliant les premiers connecteurs 2 avec les seconds connecteurs 4 correspondant et assurant une limitation des mouvements de flexion extension et d'inflexion latérale des vertèbres lombaires sus jacentes Va et sous jacentes Vb. Les moyens de limitation 8 reliant les connecteurs 2, 4 entre eux permettent de limiter les mouvements de flexion extension et d'inflexion latérale autour de l'axe de rotation et de glissement C de la prothèse articulaire 1.The articular prosthesis 1 comprises limiting means 8 connecting the first connectors 2 with the corresponding second connectors 4 and providing a limitation of the flexion extension and lateral inflection of the overlying lumbar vertebrae Va and underlying Vb. The limiting means 8 connecting the connectors 2, 4 to each other make it possible to limit the flexion extension and lateral inflection movements around the axis of rotation and sliding C of the joint prosthesis 1.
La prothèse articulaire 1 comporte des vis d'ancrage pédiculaire 3 double filetage connues en soi et constituées d'un corps longitudinal 30 présentant une partie filetée 31 destinée à l'ancrage de ladite vis dans le corps osseux des pédicules Vp de chaque vertèbre lombaire sus et sous jacentes Va, Vb du segment rachidien Sr à instrumenter. Le corps longitudinal 30 comprend dans le prolongement de la partie filetée 31 une tête de serrage 32 solidaire d'un profil cylindrique fileté 33 permettant la mise en place d'un écrou de serrage 34.The articular prosthesis 1 comprises pedicular anchoring screws 3 double threading known per se and consisting of a longitudinal body 30 having a threaded portion 31 for anchoring said screw in the bone body of the pedicles Vp of each lumbar vertebra above and underlying Va, Vb of the spinal segment Sr to instrument. The longitudinal body 30 comprises, in the extension of the threaded portion 31, a clamping head 32 integral with a threaded cylindrical profile 33 enabling the insertion of a clamping nut 34.
Egalement, les vis pédiculaires 3 peuvent être canulées avec des orifices latéraux 35 permettant l'injection d'un ciment biologique destiné à améliorer l'ancrage dans chaque vertèbre lombaire sus et sous jacente Va, Vb du segment rachidien Sr à instrumenter.Also, the pedicle screws 3 can be cannulated with lateral orifices 35 for injecting a biological cement intended to improve the anchoring in each upper and lower lumbar vertebra Va, Vb of the spinal segment Sr to be instrumented.
Les premiers connecteurs 2 sont constitués chacun d'un corps 20 présentant un alésage 21 pour le passage du profil cylindrique fileté 33 de la vis pédiculaire 3 et suivant une direction perpendiculaire et, décalés latéralement audit alésage un logement 22 à profil sphérique coopérant avec le premier élément de liaison supérieure 5. Le premier élément de liaison supérieure 5 est constitué d'un corps central 51 se prolongeant à chaque extrémité par des tiges 52 sur lesquelles coulissent respectivement une bague fendue à profil sphérique 53 destinée à venir coopérer avec le logement 22 de chaque connecteur 2 et permettre le positionnement angulaire dudit élément de liaison supérieure 5 par rapport audit connecteur. Le corps central 51 du premier élément de liaison supérieure 5 est percé d'un trou oblong 54 dont l'axe longitudinal est perpendiculaire à celui des tiges 52.The first connectors 2 each consist of a body 20 having a bore 21 for the passage of the threaded cylindrical profile 33 of the pedicle screw 3 and in a perpendicular direction and, laterally offset to said bore a housing 22 having a spherical profile cooperating with the first upper connecting element 5. The first upper connecting element 5 consists of a central body 51 extending at each end by rods 52 on which slide respectively a split ring with a spherical profile 53 intended to cooperate with the housing 22 of each connector 2 and allow the angular positioning of said upper connecting member 5 with respect to said connector. The central body 51 of the first upper connecting element 5 is pierced with an oblong hole 54 whose longitudinal axis is perpendicular to that of the rods 52.
Le corps 20 de chaque premier connecteur 2 est percé verticalement d'un alésage fileté 24 débouchant perpendiculairement dans un trou 25 traversant ledit corps. L'alésage fileté 24 coopère avec une vis de serrage 27 permettant l'immobilisation des moyens de limitation 8 lorsque ces derniers sont introduits dans le trou traversant 25.The body 20 of each first connector 2 is pierced vertically with a threaded bore 24 opening perpendicularly into a hole 25 passing through said body. The threaded bore 24 cooperates with a clamping screw 27 for immobilizing the limiting means 8 when the latter are introduced into the through hole 25.
Les moyens de limitation 8 des mouvements de flexion extension et d'inflexion latérale sont constitués d'un câble 80 formé par exemple d'un brin central autour duquel sont torsadés six autres brins.The limitation means 8 of the flexion extension and lateral inflection movements consist of a cable 80 formed for example of a central strand around which six other strands are twisted.
Le corps 20 de chaque premier connecteur 2 présente une fente 26 traversant le trou 25 et l'alésage 21 pour déboucher à l'intérieur du logement 22 de manière à permettre audit logement de se déformer sous un effort de pression engendré par l'écrou de serrage 34 lors de l'immobilisation dudit connecteur sur la vis pédiculaire 3 correspondante. Les seconds connecteurs 4 sont constitués chacun d'un élément de connexion formant une canne 40_comprenant suivant une direction horizontale une fourche 41 se prolongeant suivant une direction perpendiculaire par une tige d'appui 42. La fourche 41 présente une ouverture oblongue 43 qui coopère avec le profil cylindrique fileté 33 de chaque vis d'ancrage 3, tandis que la tige d'appui 42 présente une extrémité en forme de lame qui vient prendre appui contre la partie osseuse externe de la vertèbre correspondante suivant une direction sensiblement parallèle à celle de la partie filetée 31 de la vis d'ancrage 3 afin de renforcer l'ancrage pédiculaire et de résister au porte-à-faux.The body 20 of each first connector 2 has a slot 26 passing through the hole 25 and the bore 21 to open into the housing 22 so as to allow said housing to deform under a pressure force generated by the nut of tightening 34 during the immobilization of said connector on the pedicle screw 3 corresponding. The second connectors 4 each consist of a connecting element forming a rod 40_comprising in a horizontal direction a fork 41 extending in a perpendicular direction by a support rod 42. The fork 41 has an oblong opening 43 which cooperates with the threaded cylindrical profile 33 of each anchoring screw 3, while the support rod 42 has a blade-shaped end which bears against the external bone part of the corresponding vertebra in a direction substantially parallel to that of the part threaded 31 of the anchoring screw 3 to strengthen the pedicle anchorage and to withstand the cantilever.
L'ouverture oblongue 43 de la fourche 41 présente un profil venant s'adapter autour de la tête de serrage 32 de la vis d'ancrage 3 afin que l'élément de connexion 40 formant une canne ne puisse être entraîné en rotation lors du serrage de l'écrou 34.The oblong opening 43 of the fork 41 has a profile that fits around the clamping head 32 of the anchoring screw 3 so that the connecting element 40 forming a rod can not be rotated during clamping. nut 34.
Les seconds connecteurs 4 comportent chacun une bague de liaison 45 percée en son milieu d'un trou 46 pour sa mise en place autour du profil cylindrique fileté 33 de la vis d'ancrage 3. La bague de liaison 45 comporte une face inférieure venant en appui sur la fourche 41.The second connectors 4 each comprise a connecting ring 45 pierced in the middle with a hole 46 for its implementation around the threaded cylindrical profile 33 of the anchoring screw 3. The connecting ring 45 has a lower face coming into position. support on the fork 41.
La face inférieure comporte des bords latéraux 47 coopérant avec les bords externes de chaque branche constituant la fourche 41 de manière à ce que la bague 45 ne puisse pivoter en rotation par rapport à la vis d'ancrage 3 lors du serrage de l'écrou 34.The lower face has lateral edges 47 cooperating with the outer edges of each leg constituting the fork 41 so that the ring 45 can not rotate in relation to the anchoring screw 3 when tightening the nut 34 .
Les bords latéraux 47 de la face inférieure de chaque bague de liaison 45 sont respectivement percés d'un trou débouchant 49 permettant la mise en place et l'immobilisation du câble 80 des moyens de limitation 8.The lateral edges 47 of the lower face of each connecting ring 45 are respectively pierced by a through hole 49 allowing the introduction and the immobilization of the cable 80 of the limiting means 8.
La bague de liaison 45 comporte une face supérieure pourvue de bords latéraux 48 qui sont disposés suivant une direction perpendiculaire à celle des bords latéraux 47 de la face inférieure. La face supérieure de la bague de liaison 45 de chaque élément de connexion 40 formant une canne est prévue pour coopérer, avant le serrage de l'écrou 34 avec le second élément de liaison inférieure 6.The connecting ring 45 has an upper face provided with lateral edges 48 which are arranged in a direction perpendicular to that of the lateral edges 47 of the lower face. The upper face of the connecting ring 45 of each connecting element 40 forming a rod is provided to cooperate, before tightening the nut 34 with the second lower connecting element 6.
Le second élément de liaison inférieure 6 est constitué d'une partie centrale 60 comportant latéralement des prolongements 61 présentant chacun une extrémité en forme de fourche 62. Les branches de la fourche 62 de chaque prolongement 61 sont prévues pour venir autour du profil cylindrique fileté 33 de la vis d'ancrage correspondante 3 tout en étant guidées latéralement, avant le serrage de l'écrou 34, par les bords latéraux 48 de la face supérieure de la bague de liaison 45.The second lower connecting element 6 consists of a central portion 60 having laterally extensions 61 each having a fork-shaped end 62. The branches of the fork 62 of each extension 61 are provided to come around the threaded cylindrical profile 33 of the corresponding anchoring screw 3 while being guided laterally, before the tightening of the nut 34, by the lateral edges 48 of the upper face of the connecting ring 45.
La partie centrale 60 du second élément de liaison inférieure 6 comporte latéralement et suivant une direction perpendiculaire à celle des prolongements 61 un dispositif de guidage 63 dont le profil peut être, par exemple, en queue d'aronde. La partie centrale 60 est percée entre les bords latéraux du dispositif de guidage 63 de deux alésages filetés 65 coopérant respectivement avec une vis de serrage 66 pour l'immobilisation en translation d'un support de liaison 70 appartenant aux moyens de guidage et d'amortissement 7 permettant de relier le premier élément de liaison supérieure 5 avec le second élément de liaison inférieure 6.The central portion 60 of the second lower connecting element 6 comprises laterally and in a direction perpendicular to that of the extensions 61 a guide device 63 whose profile may be, for example, dovetail. The central portion 60 is pierced between the lateral edges of the guiding device 63 of two threaded bores 65 cooperating respectively with a clamping screw 66 for immobilization in translation of a connecting support 70 belonging to the guiding and damping means. 7 for connecting the first upper connecting element 5 with the second lower connecting element 6.
Le support de liaison 70 comporte en son milieu une rainure oblongue 71 à l'intérieur de laquelle est logée un élément de guidage 72 et de chaque coté de ce dernier des butées en élastomère 73 dont les déformations élastiques permettent de limiter sans contrainte les déplacements dudit élément de guidage 72 à l'intérieur de ladite rainure oblongue 71.The connection support 70 comprises in its middle an oblong groove 71 inside which is accommodated a guide element 72 and on each side of the latter elastomeric stops 73 whose elastic deformations make it possible to limit without restraint the movements of said guiding element 72 within said oblong groove 71.
L'élément de guidage 72 est constitué en dessous du support de liaison 70 d'une première platine 74 solidaire d'un manchon creux 75 traversant la rainure oblongue 71 et sur lequel vient s'emboîter au-dessus dudit support de liaison 70 une seconde platine 76.The guide element 72 is constituted below the connecting support 70 of a first plate 74 integral with a hollow sleeve 75 passing through the oblong groove 71 and on which is fitted above said connection support 70 a second platinum 76.
L'élément de guidage 72 est relié au corps central 51 du premier élément de liaison supérieure 5 par l'intermédiaire d'une vis de serrage 77 traversant le manchon creux 75 et le trou oblong 54 pour coopérer avec un écrou 78.The guide element 72 is connected to the central body 51 of the first upper connecting element 5 by means of a clamping screw 77 passing through the hollow sleeve 75 and the oblong hole 54 to cooperate with a nut 78.
Le support de liaison 70 est relié à la partie centrale 60 du second élément de liaison inférieure 6 par un dispositif de guidage 79 dont le profil complémentaire à celui du dispositif de guidage 63 permet le coulissement dudit support de liaison 70 dans la partie centrale 60 du second élément de liaison inférieure 6.The connecting support 70 is connected to the central portion 60 of the second lower connecting element 6 by a guiding device 79 whose profile complementary to that of the guiding device 63 allows the sliding of said connecting support 70 in the central part 60 of the second lower connecting element 6.
Le support de liaison 70 est percé de deux trous 9 traversés chacun par une vis de serrage 66 coopérant avec les alésages filetés 65 pour la fixation dudit support de liaison 70 sur la partie centrale 60 du second élément de liaison inférieure 6.The connecting support 70 is pierced with two holes 9 each traversed by a clamping screw 66 cooperating with the threaded bores 65 for fixing said connecting support 70 on the central portion 60 of the second lower connecting element 6.
On a montré en figures 5 à 7 l'assemblage et le montage de la prothèse articulaire d'arthroplastie totale 1 , par exemple, sur deux étages vertébraux Va, Vb et Vc d'un segment rachidien Sr à corriger. Les vertèbres Va et Vb sont les vertèbres extrêmes du segment rachidien Sr à instrumenter, tandis que la vertèbre Vc se trouve entre lesdites vertèbres Va et Vb.FIGS. 5 to 7 show the assembly and assembly of the total arthroplasty joint prosthesis 1, for example, on two vertebral stages Va, Vb and Vc of a spinal segment Sr to be corrected. The vertebrae Va and Vb are the extreme vertebrae of the spinal segment Sr to be instrumented, while the vertebra Vc is located between said vertebrae Va and Vb.
De la même manière que précédemment, sont fixés respectivement sur les pédicules Vp des vertèbres Va, Vb par l'intermédiaire des vis d'ancrage 3 les premiers et seconds connecteurs 2, 4 reliés chacun par les éléments de liaison supérieures et inférieures 5, 6 de la prothèse articulaire d'arthroplastie totale 1.In the same way as above, the pedicles Vp of the vertebrae Va, Vb are respectively fixed by means of the anchoring screws 3, the first and second connectors 2, 4 each connected by the upper and lower connecting elements 5, 6 of the total arthroplasty joint prosthesis 1.
Au niveau des pédicules Vp de la vertèbre intermédiaire Vc sont fixés au moyen des vis d'ancrage 3 d'autres connecteurs 4 identiques à ceux fixés dans les pédicules de la vertèbre Vb.At the level of the pedicles Vp of the intermediate vertebra Vc are fixed by means of the anchoring screws 3 of other connectors 4 identical to those fixed in the pedicles of the vertebra Vb.
Les connecteurs 4 de la vertèbre Vc sont reliés entre eux par un élément de liaison médian 6 semblable en partie à celui reliant les connecteurs 4 de Ia vertèbres Vb. L'élément de liaison médian 6 de la vertèbre Vc se distingue principalement de celui décrit précédemment en ce que la partie centrale 60 comporte entre les prolongements 61 une jupe latérale 64 percée en son milieu d'un trou oblong 67. Cette jupe latérale 64 présente les mêmes caractéristiques et avantages que le corps central 51 du premier élément de liaison supérieure 5 afin de permettre la fixation de l'élément de guidage 72 des moyens de guidage et d'amortissement 7 par l'intermédiaire d'une vis de serrage 77 traversant le manchon creux 75 et le trou oblong 67 pour coopérer avec l'écrou 78.The connectors 4 of the vertebra Vc are interconnected by a median connecting element 6 similar in part to that connecting the connectors 4 of the vertebrae Vb. The medial connecting element 6 of the vertebra Vc stands out mainly from that described above in that the central portion 60 has between the extensions 61 a side skirt 64 pierced in the middle of an oblong hole 67. This side skirt 64 has the same characteristics and advantages as the central body 51 of the first element upper link 5 to allow the fixing of the guide member 72 guiding and damping means 7 by means of a clamping screw 77 through the hollow sleeve 75 and the oblong hole 67 to cooperate with the nut 78.
Cette jupe latérale 64 de l'élément de liaison médian 6 permet la mise en place et la retenue d'un autre moyen de guidage et d'amortissement 7 identique à celui décrit précédemment mais entre les étages vertébraux Vc, Vb. Ainsi, l'élément de liaison supérieure 5 fixé sur la vertèbre Va est relié à l'élément de liaison médian 6 de la vertèbre Vc par des moyens de guidage et d'amortissement 7 semblables à ceux décrits précédemment, tandis que l'élément de liaison médian 6 est relié à l'élément de liaison inférieure 6 de la vertèbre Vb par d'autres moyens de guidage et d'amortissement 7.This lateral skirt 64 of the medial connecting element 6 allows the introduction and retention of another guiding and damping means 7 identical to that described above but between the vertebral stages Vc, Vb. Thus, the upper connecting element 5 fixed on the vertebra Va is connected to the median connecting element 6 of the vertebra Vc by guide and damping means 7 similar to those described above, while the element of median connection 6 is connected to the lower connecting element 6 of the vertebra Vb by other guiding and damping means 7.
Egalement, les connecteurs 2 et 4 des étages vertébraux Va, Vc et les connecteurs 4 des étage vertébraux Vc , Vb sont reliés respectivement par des premiers et seconds câbles 80 constituant les moyens de limitation 8 des mouvements de flexion extension et d'inflexion latérale.Also, the connectors 2 and 4 of the vertebral stages Va, Vc and the connectors 4 of the vertebral stages Vc, Vb are respectively connected by first and second cables 80 constituting the limiting means 8 of the flexion extension and lateral inflection movements.
Ainsi, la prothèse articulaire d'arthroplastie totale 1 solidaire des vertèbres sus et sous jacentes Va et Vb ou des vertèbres Va, Vc, Vb permet lorsqu'une déstabilisation du rachis a été créée de pouvoir stabiliser le segment rachidien Sr tout en préservant les dégradations des autres étages vertébraux.Thus, the articular prosthesis total arthroplasty 1 integral supra and underlying vertebrae Va and Vb or vertebrae Va, Vc, Vb allows when a destabilization of the spine was created to be able to stabilize the spinal segment Sr while preserving the degradations other vertebral stages.
En effet la prothèse articulaire d'arthroplastie totale 1 permet par sa structure et ses différents éléments la composant de reconstruire les éléments de guidage des vertèbres lombaires sus jacente Va et sous jacente Vb d'un segment rachidien Sr d'une colonne vertébrale.In fact, the articular prosthesis of total arthroplasty 1 allows, by its structure and its various elements, the component of reconstructing the guiding elements of the lumbar vertebrae overlying Va and subjacent Vb of a spinal segment Sr of a vertebral column.
II doit d'ailleurs être entendu que la description qui précède n'a été donnée qu'a titre d'exemple et qu'elle ne limite nullement le domaine de l'invention dont on ne sortirait pas en remplaçant les détails d'exécution décrits par tous autres équivalents. It must also be understood that the foregoing description has been given by way of example only and that it does not limit the scope of the invention which could not be overcome by replacing the described details of execution. by all other equivalents.

Claims

REVENDICATIONS
1. Prothèse articulaire d'arthroplastie totale permettant de reconstruire les éléments de guidage des vertèbres lombaires sus jacente Va et sous jacente Vb d'un segment rachidien Sr d'une colonne vertébrale, caractérisée en ce qu'elle comporte des connecteurs (2, 4) fixés dans les pédicules Vp des étages vertébraux par des vis d'ancrage (3), des éléments de liaison supérieure et inférieure (5, 6) reliant les connecteurs (2, 4) entre eux, et des moyens de guidage et d'amortissement (7) reliant lesdits éléments de liaison supérieure et inférieure (5, 6), lesdits moyens de guidage et d'amortissement (7) et lesdits éléments de liaison supérieure et inférieure (5, 6) étant agencés les uns par rapport aux autres de manière à définir au moins un axe de rotation et de glissement C situé au niveau de la vertèbre supérieure sus jacente Va du segment instrumenté Sr afin de limiter les efforts sur les vis d'ancrage (3) assurant la fixation des connecteurs (2) dans ladite vertèbre sus jacente (Va). 1. Articular prosthesis of total arthroplasty for reconstructing the guide elements of the lumbar vertebrae overlying Va and underlying Vb of a spinal segment Sr of a vertebral column, characterized in that it comprises connectors (2, 4 ) fixed in the pedicles Vp of the vertebral stages by anchoring screws (3), upper and lower connection elements (5, 6) connecting the connectors (2, 4) between them, and guide means and damping (7) connecting said upper and lower connecting members (5, 6), said guiding and damping means (7) and said upper and lower connecting members (5, 6) being arranged with respect to one another in such a way as to define at least one axis of rotation and sliding C located at the level of the upper supra-vertebra Va of the instrumented segment Sr in order to limit the forces on the anchoring screws (3) ensuring the fixing of the connectors (2) in L adite vertebra above (Va).
2. Prothèse articulaire d'arthroplastie totale suivant la revendication 1 , caractérisée en ce qu'elle comporte des moyens de limitation (8) reliant les connecteurs (2, 4) entre eux et permettant de limiter les mouvements de flexion extension et d'inflexion latérale autour de l'axe de rotation et de glissement C.2. Total arthroplasty joint prosthesis according to claim 1, characterized in that it comprises limiting means (8) connecting the connectors (2, 4) between them and for limiting the flexion extension and inflection movements. lateral around the axis of rotation and sliding C.
3. Prothèse articulaire d'arthroplastie totale suivant la revendication 2, caractérisée en ce que les moyens de limitation (8) sont constitués d'un câble (80) reliant les connecteurs (2, 4) entre eux. 3. Total arthroplasty joint prosthesis according to claim 2, characterized in that the limiting means (8) consist of a cable (80) connecting the connectors (2, 4) between them.
4. Prothèse articulaire d'arthroplastie totale suivant la revendication 1 , caractérisée en ce que les moyens de guidage et d'amortissement (7) sont constitués d'un support de liaison (70) comportant une rainure oblongue (71 ) à l'intérieur de laquelle est logée un élément de guidage (72) coopérant avec l'élément de liaison (5, 6) et des butées en élastomère (73) dont les déformations élastiques permettent de limiter sans contrainte les déplacements dudit élément de guidage (72) à l'intérieur de ladite rainure oblongue (71 ) et des moyens de guidage et de fixation coopérant avec l'élément de liaison inférieure (6). Joint arthroplasty joint prosthesis according to Claim 1, characterized in that the guiding and damping means (7) consist of a connecting support (70) having an oblong groove (71) on the inside. of which is housed a guide element (72) cooperating with the connecting element (5, 6) and elastomeric stops (73) whose elastic deformations make it possible to limit without restraint the displacements of said guide element (72) to the inside of said oblong groove (71) and guiding and fixing means cooperating with the lower connecting element (6).
5. Prothèse articulaire d'arthroplastie totale suivant la revendication 4, caractérisée en ce que l'élément de guidage (72) est constitué d'une première platine (74) solidaire d'un manchon creux (75) sur lequel vient une seconde platine (76), ledit élément de guidage (72) étant relié au premier élément de liaison supérieure (5) par l'intermédiaire d'une vis de serrage (77) traversant le manchon creux (75) pour coopérer avec un écrou (78), ledit manchon creux (75) traversant la rainure oblongue (71 ) du support de liaison (70) de sorte que ses déplacements sont limités par la déformation élastique des butées en élastomère (73). Joint arthroplasty joint prosthesis according to claim 4, characterized in that the guide element (72) consists of a first plate (74) integral with a hollow sleeve (75) on which a second platinum (76), said guide member (72) being connected to the first upper connecting member (5) via a clamping screw (77) passing through the hollow sleeve (75) to cooperate with a nut (78) , said hollow sleeve (75) passing through the oblong groove (71) of the connecting support (70) so that its displacements are limited by the elastic deformation of the elastomeric stops (73).
6. Prothèse articulaire d'arthroplastie totale suivant la revendication 4, caractérisée en ce que le support de liaison (70) est relié au second élément de liaison inférieure (6) d'une part au moyen d'un dispositif de guidage (79, 63) et d'autre part au moyen d'un dispositif de blocage (66, 65, 9).Joint arthroplasty joint prosthesis according to Claim 4, characterized in that the connecting support (70) is connected to the second lower connecting element (6) on the one hand by means of a guiding device (79, 63) and on the other hand by means of a locking device (66, 65, 9).
7. Prothèse articulaire d'arthroplastie totale suivant la revendication 1 , caractérisée en ce que le premier élément de liaison supérieure (5) est constitué d'un corps central (51 ) se prolongeant à chaque extrémité par des tiges (52) sur lesquelles coulissent respectivement une bague fendue à profil sphérique (53) destinée à venir coopérer avec chaque premier connecteur (2), ledit corps central (51 ) étant percé d'un trou oblong (54) pour la coopération avec les moyens de guidage et d'amortissement (7).Joint arthroplasty joint prosthesis according to claim 1, characterized in that the first upper connecting element (5) consists of a central body (51) extending at each end by rods (52) on which slide respectively a split ring spherical profile (53) intended to cooperate with each first connector (2), said central body (51) being pierced with an oblong hole (54) for cooperation with the guiding and damping means (7).
8. Prothèse articulaire d'arthroplastie totale suivant les revendications 1 et 6, caractérisée en ce que le second élément de liaison inférieure (6) est constitué d'une partie centrale (60) comportant latéralement des prolongements (61 ) présentant chacun une extrémité en forme de fourche (62) prévue pour venir autour de la vis d'ancrage correspondante (3), ladite partie centrale (60) comportant un dispositif de guidage (63) et des alésages filetés (65) pour la mise en place et l'immobilisation des moyens de guidage et d'amortissement (7). Joint arthroplasty joint prosthesis according to claims 1 and 6, characterized in that the second lower connecting element (6) consists of a central part (60) having laterally extensions (61) each having an end fork form (62) provided to fit around the corresponding anchor screw (3), said central portion (60) having a guide means (63) and threaded bores (65) for positioning and immobilization of the guiding and damping means (7).
9. Prothèse articulaire d'arthroplastie totale suivant les revendications 1 et 2, caractérisée en ce que les premiers connecteurs (2) sont constitués chacun d'un corps (20) présentant un alésage (21) pour le passage de la vis pédiculaire (3), un logement (22) pour la réception du premier élément de liaison supérieure (5), un alésage fileté (24) débouchant perpendiculairement dans un trou (25) et coopérant avec une vis de serrage (27) pour l'immobilisation des moyens de limitation (8) lorsque ces derniers sont introduits dans le trou traversant (25), et une fente (26) traversant le trou (25) et l'alésage (21) pour déboucher à l'intérieur du logement (22) de manière à permettre audit logement de se déformer sous un effort de pression engendré par un écrou de serrage (34) lors de l'immobilisation dudit premier connecteur9. Joint arthroplasty joint prosthesis according to claims 1 and 2, characterized in that the first connectors (2) each consist of a body (20) having a bore (21) for the passage of the pedicle screw (3). ), a housing (22) for receiving the first upper connecting element (5), a threaded bore (24) opening perpendicularly into a hole (25) and cooperating with a clamping screw (27) for the immobilization of the means (8) when the latter are introduced into the through hole (25), and a slot (26) passing through the hole (25) and the bore (21) to open into the housing (22) to allow said housing to deform under a pressure force generated by a clamping nut (34) during the immobilization of said first connector
(2) sur la vis pédiculaire (3) correspondante.(2) on the corresponding pedicle screw (3).
10. Prothèse articulaire d'arthroplastie totale suivant les revendications 1 et 2, caractérisée en ce que les seconds connecteurs (4) sont constitués chacun d'une part d'un élément de connexion (40) formant une canne comprenant suivant une direction horizontale une fourche (41 ) présentant une ouverture oblongue (43) pour son passage autour de la vis pédiculaire (3), et se prolongeant suivant une direction perpendiculaire par une tige d'ancrage (42) pourvue d'une extrémité en forme de lame et d'autre part d'une bague de liaison (45) percée en son milieu d'un trou (46) pour sa mise en place autour de la même vis d'ancrage (3), ladite bague de liaison (45) est percée de trous débouchants (49) permettant la mise en place et l'immobilisation des moyens de limitation (8). Articular prosthesis of total arthroplasty according to claims 1 and 2, characterized in that the second connectors (4) each consist on the one hand of a connecting element (40) forming a rod comprising in a horizontal direction a fork (41) having an oblong opening (43) for its passage around the pedicle screw (3), and extending in a perpendicular direction by an anchor rod (42) provided with a blade-shaped end and on the other hand a connecting ring (45) pierced in the middle of a hole (46) for its establishment around the same anchoring screw (3), said connecting ring (45) is pierced with through holes (49) for placing and immobilizing the limiting means (8).
11. Prothèse articulaire d'arthroplastie totale suivant la revendication 7, caractérisée en ce que la bague de liaison (45) comportant des bords latéraux inférieurs (47) coopérant avec la fourche (41) de manière que la bague (45) ne puisse pivoter en rotation par rapport à la vis d'ancrage (3) lors du serrage de l'écrou (34).Joint arthroplasty joint prosthesis according to Claim 7, characterized in that the connecting ring (45) has lower lateral edges (47) cooperating with the fork (41) so that the ring (45) can not pivot. in rotation relative to the anchoring screw (3) when tightening the nut (34).
12. Prothèse articulaire d'arthroplastie totale suivant la revendication 8, caractérisée en ce que la bague de liaison (45) comporte des bords latéraux supérieurs (48) qui sont disposés suivant une direction perpendiculaire à celle des bords latéraux inférieurs (47) pour le guidage du second élément de liaison inférieure (6). Articular arthroplasty joint prosthesis according to claim 8, characterized in that the connecting ring (45) has upper lateral edges (48) which are arranged in a direction perpendicular to that of the lower lateral edges (47) for the guiding the second lower link member (6).
PCT/FR2009/000919 2008-07-25 2009-07-24 Articulated prosthesis for posterior total lumbar arthroplatsy WO2010010259A1 (en)

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EP09784297A EP2317945A1 (en) 2008-07-25 2009-07-24 Articulated prosthesis for posterior total lumbar arthroplatsy

Applications Claiming Priority (2)

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FR0804234A FR2934146B1 (en) 2008-07-25 2008-07-25 JOINT PROSTHESIS OF TOTAL LUMBAR ARTHROPLASTY THROUGH POSTERIOR
FR08/04234 2008-07-25

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US20060149230A1 (en) * 2004-12-30 2006-07-06 Kwak Seungkyu Daniel Posterior stabilization system
WO2006073593A2 (en) * 2004-12-30 2006-07-13 Depuy Spine, Inc. Facet joint replacement
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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8920475B1 (en) 2011-01-07 2014-12-30 Lanx, Inc. Vertebral fixation system including torque mitigation

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FR2934146A1 (en) 2010-01-29
FR2934146B1 (en) 2010-09-10

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