WO2010092893A1 - Système d'intervention chirurgicale pour fusion lombaire intervertébrale et dispositif pour maintenir l'espace intervertébral lombaire s'utilisant dans une intervention chirurgicale de fusion lombaire intervertébrale - Google Patents

Système d'intervention chirurgicale pour fusion lombaire intervertébrale et dispositif pour maintenir l'espace intervertébral lombaire s'utilisant dans une intervention chirurgicale de fusion lombaire intervertébrale Download PDF

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Publication number
WO2010092893A1
WO2010092893A1 PCT/JP2010/051558 JP2010051558W WO2010092893A1 WO 2010092893 A1 WO2010092893 A1 WO 2010092893A1 JP 2010051558 W JP2010051558 W JP 2010051558W WO 2010092893 A1 WO2010092893 A1 WO 2010092893A1
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WIPO (PCT)
Prior art keywords
interbody fusion
main body
rear end
vertebral bodies
interbody
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PCT/JP2010/051558
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English (en)
Japanese (ja)
Inventor
哲雄 佐藤
孝 五十嵐
憲正 瀬尾
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学校法人自治医科大学
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Priority to JP2010550492A priority Critical patent/JP5553268B2/ja
Publication of WO2010092893A1 publication Critical patent/WO2010092893A1/fr

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    • A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A61F2/446—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
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Definitions

  • the present invention relates to an interbody fusion surgery in which an interbody fusion device is inserted into an intervertebral disc space modified at an appropriate interval between two adjacent vertebral bodies (vertebrae) to fix the vertebral bodies.
  • An interbody fusion surgery in which an interbody fusion device is inserted into an intervertebral disc space modified at an appropriate interval between two adjacent vertebral bodies (vertebrae) to fix the vertebral bodies.
  • plates or rods are filled with bone material as a support between the vertebral bodies to facilitate the fixation of the two adjacent vertebral bodies and stably connect and fix the damaged vertebral bodies Is used.
  • a fixing member such as a plate or a rod fixed to the vertebral body to maintain the stability of the vertebral body is no longer an obstacle.
  • the surgical procedure for implanting and fixing these rods or plates is performed from behind the spinal column by general anesthesia, and the muscles and nerves that extend along the spinal column are complicatedly complicated behind the spinal column, and these muscles can be peeled off. This is a major operation that takes a long time because it is troublesome to prevent the nerve from being damaged, and the surgical invasion is excessive.
  • FIG. 48 is a perspective view of the conventional interbody fusion device of the first example
  • FIG. 49 is a longitudinal sectional view (main part cross section) of the conventional interbody fusion device of the second example fixed between the vertebral bodies. It is.
  • the interbody fusion device 100 of the first example has male threads 118 and 119 formed on the outer surface of a tapered hollow frustoconical shape with the front end 113 opened or closed and the rear end 112 opened, It consists of a main body 111 formed with parallel truncated side walls 122 and is screwed in between adjacent vertebral bodies (not shown) via male screws 118 and 119. (See Patent Document 1).
  • male threads 258 and 259 are formed on the outer surface of a tapered hollow frustoconical shape in which the front end 253 is open or closed and the rear end 256 is partially open.
  • a pair of screw holes 267 and 267 provided so as to incline in a divergent shape toward the upper and lower vertebral bodies L4 and L5 adjacent to the rear end 256, respectively.
  • the interbody fusion devices of the first example and the second example are both of a small size that can be inserted between the upper and lower vertebral bodies to which the main bodies 111 and 251 are adjacent, particularly the conventional rod. Or it can be transplanted and fixed between vertebral bodies in a relatively short time using a laparoscope from the abdominal side compared with the large-scale surgical operation from the back side of transplanting and fixing plates, etc. Can be expected to significantly reduce.
  • a vertebra for maintaining an intervertebral disc space by correcting an appropriate interval between two adjacent vertebral bodies (vertebrae) required in advance when implanting and fixing these interbody fusion devices between vertebral bodies.
  • vertebrae a vertebra for maintaining an intervertebral disc space by correcting an appropriate interval between two adjacent vertebral bodies (vertebrae) required in advance when implanting and fixing these interbody fusion devices between vertebral bodies.
  • interbody space holding device There is a typical example of the recently proposed interbody space holding device.
  • FIG. 50 is a perspective view of a conventional typical interbody space holding device (ventral ventral lordosis extending external sleeve), and FIG. 51 is a side view of the interbody space holding device of FIG. 50 inserted between the vertebral bodies.
  • FIG. 50 is a perspective view of a conventional typical interbody space holding device (ventral ventral lordosis extending external sleeve)
  • FIG. 51 is a side view of the interbody space holding device of FIG. 50 inserted between the vertebral bodies.
  • a conventional typical interbody space holding device (ventral anterior lordosis extending outer sleeve) 300 is a long hollow tubular member provided with a cylindrical outer end 330 at the rear end.
  • 302 is connected to the distal end 310 of 302, and a plurality of teeth 312 respectively engaged with front surfaces of adjacent vertebral bodies L6 and L7, and a height that restores the height of the disc space between the vertebral bodies L6 and L7.
  • a pair of extension portions 320 and 322 are provided so as to face each other and extend at a 180-degree relationship. (See FIGS. 31 and 32 of Patent Document 3).
  • JP 2007-75632 A (priority claim number: US08 / 603, 674)
  • JP-T-2002-501784 (priority claim number: US09 / 014,901)
  • JP 2004-267786 A (priority claim number: US08 / 396,414)
  • the interbody fusion device described in Patent Document 1 (first example) is configured such that the main body 111 is simply screwed between the adjacent upper and lower vertebral bodies via male screws 118 and 119. After insertion between vertebral bodies, there is a problem that the proper spacing between the vertebral bodies tends to be lost by retreating or rotating from an appropriate position between the vertebral bodies.
  • the main body 251 is screwed between the adjacent vertebral bodies L4 and L5 via the male screws 258 and 259, and then the main body 251. Since the pair of bone screws 280 and 280 inserted through the rear end 256 is obliquely screwed into the vertebral bodies L4 and L5, the appropriateness between the vertebral bodies of the main body 251 as in Patent Document 1 is described. It has been improved to prevent retraction and rotation from position.
  • a pair of screw holes 267, 267, a bone screw 280, 280, and a pair of bone screws 280, 280 which are provided so as to incline toward the upper and lower vertebral bodies L4, L5 adjacent to the rear end 256, respectively.
  • the structure of the setscrew 282 for retaining the screw and the processing thereof are complicated, and further, a so-called triaxial screwing operation of the main body 251 and the setscrew 282 and a pair of bone screws 280, 280 intersecting with these main shafts.
  • the interbody space holding device (ventricular lordosis extension external sleeve) 300 described in Patent Document 3 is a cannula in the abdominal part for endoscope formed from the human abdomen to the front surface of the adjacent vertebral bodies L6 and L7.
  • the height of the disc space is restored and a plurality of teeth 312 is restored via a pair of extensions 320 and 322 provided at the distal end 310 of the hollow tubular member 302, respectively.
  • the interbody fusion device is relatively fixed when transplanting and fixing the vertebral bodies L6 and L7.
  • the vertebral bodies L6 and L7 to which a large external force is applied have a drawback in that the engagement with the plurality of teeth 312 is disengaged and the vertebral bodies L6 and L7 are liable to shift backward or left and right.
  • the present invention has been made in view of the above-mentioned problems of the prior art, and an object of the present invention is to simplify and reduce the overall structure with a simple configuration, and to improve operability, reliability and Necessary for interbody fusion surgery system with an interbody fusion device that is highly economical and easily reduces the burden on the patient and surgical invasion by performing the interbody fusion treatment easily in a short time. It is an object of the present invention to provide an interbody space holding device for interbody fusion surgery with improved reliability.
  • the interbody fusion surgical system is a generally hollow body with a front end that is formed so as to maintain an appropriate distance between two adjacent vertebral bodies (vertebrae).
  • An outer surface engaging portion that engages with the opposing surface portions of the two vertebral bodies is formed on the outer surface of the cylindrical or tapered hollow truncated cone, and a female screw of an appropriate depth is formed on the hollow inner surface on the rear end side.
  • a main body in which one or a plurality of bent or straight guide holes are formed so as to incline in the radial direction from the hollow inner surface of the distal end toward the opposing surface of the vertebral body and penetrate to the outer surface;
  • One or a plurality of bent or straight pins inserted into the guide holes along the guide holes and screwed into the female screw of the main body, and the axial propulsive force of the rear ends of the pins.
  • a pressing screw for pressing the end After the main body is inserted and fixed in the intervertebral disc space via the outer surface engaging portion, the rear end is pressed by the axial thrust of the pressing screw screwed into the female screw of the main body.
  • an intervertebral body fixing device in which the distal end side is sequentially guided along the guide hole and inserted into the vertebral body.
  • the invention according to claim 2 is the interbody fusion surgical system according to claim 1, characterized in that the outer diameter of the central part of the substantially hollow cylindrical body is formed in a slightly thick drum shape. To do.
  • a third aspect of the present invention is the interbody fusion surgical system according to the first aspect, wherein the pin is a solid or hollow rod-shaped body having an arbitrary cross-sectional shape including a circle or a polygon, or at least the distal end side or the entire length. It consists of a rod-shaped laminated body with an arbitrary cross-sectional shape including a round or polygonal shape laminated with a plurality of thin plate materials or a wire having an arbitrary cross-sectional shape including circles and various flat shapes, and the tip thereof is sharp It is formed.
  • the invention according to claim 4 is the interbody fusion surgical system according to any one of claims 1 to 3, wherein the one or more pins are provided with a female screw hole at a rear end. Proximal end portions are individually or integrally formed and continuously provided, and the pressing screw is rotated from within the main body by a rotation operation in a direction opposite to the screwing direction into the main body, and the main body is moved between the vertebral bodies. Can be removed from between the vertebral bodies by being rotated in the direction opposite to the insertion direction and / or withdrawing operation, and removed from the body.
  • the pin After the pin is inserted into the vertebral body, The pin is pulled out from the main body, and the pin is pulled out from between the vertebral bodies by a pull-out driver having a male threaded portion that engages with a female threaded hole at the base end, and is taken out of the body together with the main body. It is characterized by being.
  • a fifth aspect of the present invention is the interbody fusion surgical system according to the fourth aspect, wherein a blind plug having an engaged portion at the rear end is normally inserted into the female screw hole of the pin base end. Prior to the pulling-out operation of the pin, the blind plug can be removed from the female screw hole and taken out of the body by a screwdriver having an engaging portion that engages the engaged portion at the tip. It is characterized by that.
  • a sixth aspect of the invention is the interbody fusion surgical system according to the first aspect, wherein the outer surface engaging portion is formed in a male screw shape.
  • the invention according to claim 7 is the interbody fusion surgical system according to claim 1, wherein the outer surface engaging portion is formed in a plurality of spline teeth parallel to the main axis. .
  • the invention according to claim 8 is the interbody fusion surgical system according to claim 1, wherein the outer surface engaging portion is formed in a plurality of sawtooth shapes parallel to the main axis.
  • the invention according to claim 9 is the interbody fusion surgical system according to any one of claims 1, 6 to 8, wherein the distal end in the axial direction and the outer radial head of the outer surface engaging portion are provided.
  • the top is formed in the shape of a sharp blade.
  • a tenth aspect of the invention is the interbody fusion surgical system according to any one of the first to ninth aspects, wherein the main body has an angiogenesis opening communicating with the upper, lower, left, and right sides of the outer surface. And a plurality of openings for bone ingrowth.
  • the invention of claim 11 is the interbody fusion surgical system according to any one of claims 1 to 10, wherein the whole or part of the rear end surface of the main body is attached to the rear end of the pressing screw. A covering cap is formed.
  • the invention according to claim 12 is the interbody fusion surgical system according to claim 11, wherein the boss is loosely fitted to the pressing screw, and is erected on the outer surface of the boss so as to be axially symmetrical. It further comprises a fixing reinforcing tool comprising a pair of arms whose rear end surface is pressed against the cap portion and whose front end portion is engaged and fixed to the abdomen front surface of the adjacent vertebral body.
  • a thirteenth aspect of the invention is the interbody fusion surgical system according to any one of the first to twelfth aspects, wherein the interbody fusion surgical system is loosely accommodated in the female screw of the main body, and is attached to the rear end portion of the pin. It is further characterized by further including a friction plate disposed in contact therewith.
  • the invention according to claim 14 is the interbody fusion surgical system according to claim 13, wherein the rear end portion of the pin is engaged with the friction plate so as to be restrained from moving at least in the left-right direction. It is fixed.
  • the invention of claim 15 is the interbody fusion surgery system according to any one of claims 1 to 14, wherein the interbody fusion device is a vertebral body using a laparoscope in combination from the abdominal side. It is fixed between the vertebral bodies by interstitial surgery.
  • a sixteenth aspect of the present invention is the interbody fusion surgical system according to any one of the first to fifteenth aspects, wherein the distal end of a hollow long shaft portion having a grip portion at the rear end is provided.
  • a front end engaging portion that engages with a rear end engaging portion formed at a rear end portion of the main body of the interbody fusion device, and the front end engaging portion is engaged with the rear end engaging portion of the main body;
  • the interbody space holding device is inserted into a cannula in the abdominal cavity for endoscope formed from the living body abdomen to the front surface of the vertebral body to maintain an appropriate distance between the two adjacent vertebral bodies.
  • a main body insertion driver for inserting the main body between the vertebral bodies by pressing or / and rotating the main body.
  • the invention according to claim 17 is the interbody fusion surgery system according to claim 16, wherein the main body insertion driver has a tip engaging portion made of metal and a shaft portion made of a polymer material. To do.
  • the invention of claim 18 is the interbody fusion surgery system according to claim 16 or claim 17, wherein the interbody fusion device is attached to the distal end of a long shaft portion provided with a grip portion at the rear end.
  • a front end engaging portion that engages with a rear end engaging portion formed at a rear end portion of the pressing screw, and the front end engaging portion is engaged with the rear end engaging portion of the pressing screw in the state where the front end engaging portion is engaged.
  • the invention according to claim 19 is the interbody fusion surgical system according to claim 18, wherein the pressing screw driver has a tip engaging portion made of metal and a shaft portion made of a polymer material. To do.
  • the interbody space holding device for interbody fusion surgery corrects an appropriate interval between two adjacent vertebral bodies (vertebrae) during a body interbody fusion surgery.
  • a device for holding the intervertebral disc space having a gripping portion at the rear end and being inserted to the vicinity of the front surface of the vertebral body via a cannula in the abdominal portion for endoscope provided on the living body abdominal portion side
  • a hollow long first shaft portion and a fixing claw extending in the axial direction at the distal end portion of the first shaft portion and holding and fixing the left and right side surfaces of the adjacent vertebral bodies at the distal end
  • a vertebral body clamping mechanism having at least one pair of clamp arms connected to each other and capable of opening and closing in an orthogonal plane of the vertebral body.
  • the invention of claim 21 is the interbody space holding device for interbody fusion surgery according to claim 20, wherein the vertebral body clamp mechanism has each of the fixing claws connected to the tip, and the rear end Each having an elastic support portion that is elastically supported by being bent so as to open and expand the fixed claw in the orthogonal plane of the vertebral body in a free state.
  • a pair of clamp arms and a front end portion of a hollow long second shaft portion which is externally fitted to the first shaft portion so as to be movable forward / backward, and provided with a gripping portion at the rear end are advanced to the elasticity. Clamps that open the pair of clamp arms in the diameter increasing direction by closing the pair of clamp arms in the diameter reducing direction by pressing the support parts from the outside and retreating the tip parts from the elastic support parts.
  • An arm opening and closing tube is provided.
  • the invention of claim 22 is the interbody space holding device for interbody fusion surgery according to claim 20, wherein the vertebral body clamping mechanism has the respective fixing claws connected to the tip, and the rear end portion.
  • a pair of clamp arms pivotally attached to the distal end portion of the first shaft portion via a first support shaft in an orthogonal plane of the vertebral body, and the first shaft portion
  • a hollow long second shaft portion that is externally fitted so as to be able to move forward / backward and a grip portion is provided at the rear end, and an intermediate portion of each of the pair of clamp arms via a second support shaft.
  • Each pair of link members is pivotably attached to each other, and each other end thereof is pivotally attached to the tip of the second shaft portion via a third support shaft.
  • each of the pair of link members is moved in the first shaft by the second shaft portion moving forward or backward.
  • the pair of clamp arms are closed or expanded in the diameter-reducing direction with the first support shaft as a fulcrum within the orthogonal plane of the vertebral body by swinging counterclockwise or clockwise around the support shaft as a fulcrum.
  • a toggle mechanism that opens in a direction is configured.
  • the invention of claim 23 is the interbody space holding device for interbody fusion surgery according to any one of claims 20 to 22, wherein the vertebral body is provided on the vertebral body clamping surface of the fixation claw. It has a plurality of sharp protrusions that can be pierced on the side surface.
  • the interbody space holding device for interbody fusion surgery corrects an appropriate distance between two adjacent vertebral bodies (vertebrae) during a body interbody fusion surgery.
  • a device for holding the intervertebral disc space having a gripping portion at the rear end and being inserted to the vicinity of the front surface of the vertebral body via a cannula in the abdominal portion for endoscope provided on the living body abdominal portion side
  • a hollow elongate first shaft portion and a threaded portion that extends in the axial direction on the outer surface of the first shaft portion so as to be rotatable in the axial direction, are formed on one or both of the adjacent vertebral bodies.
  • a long fixing screw member that is inserted into and fixed to the front surface portion, and one or a plurality that can project into the front surface portion of one or both of the adjacent vertebral bodies protruding from the distal end portion of the first shaft portion A needle-like protrusion.
  • a twenty-fifth aspect of the invention is the interbody space holding device for interbody fusion surgery according to any one of the twenty-second to twenty-fourth aspects, wherein the vertebra is provided at a distal end portion of the first shaft portion.
  • the adjacent vertebral bodies are properly connected to each other by extending into the intervertebral space at an interval slightly narrower than the outer diameter of the body and facing the intervertebral space in the axial direction. It is further characterized by further comprising at least one pair of spacers formed in an outer shape so as to be corrected and held at intervals.
  • the interbody fusion device is a small size having an outer shape adapted to an appropriate distance between adjacent vertebral bodies, and after the main body is inserted and fixed between the vertebral bodies, the pressing screw is attached to the main body. Since the tip side of the pin that is pressed just by screwing into the female screw is guided along the guide hole and is inserted into the vertebral body and fixed, all from the main axis direction using the laparoscope The interbody fusion treatment can be easily performed in a short time by only pressing or / and screwing by one axis.
  • the operation scale can be greatly reduced as compared to conventional interbody fusion surgery, and the operation time and recovery period can be greatly reduced, so that the physical and mental burden of medical staff including patients and doctors, The surgical invasion and even the economic burden on the patient can be significantly reduced.
  • the pin inserted and fixed in the vertebral body can prevent the intervertebral body fixing device body from retreating or rotating from the appropriate position between the vertebral bodies.
  • the vertebral body is secured, and the interbody fixing structure and the operation of only pressing or / and screwing by one axis in the main body axis direction are greatly simplified and compacted as described above, and the operability and economy are further excellent. It is possible to provide an interbody fusion surgical system having an interbody fusion device, and so on.
  • the outer diameter of the central part of the substantially hollow cylindrical main body is formed in a slightly thick drum shape. There is an effect that is firmly fixed between the bodies.
  • the pin in addition to having the same effect as that of the invention of claim 1, since the tip of the pin is formed sharply, the pin can be easily inserted into the vertebral body. Further, a pin made of a hollow rod-like body or a rod-like laminated body is relatively easy to bend and deform, and the tip side is smoothly guided along the guide hole of the main body. Such a pin can be easily formed into an arbitrary shape, and the design flexibility is improved.
  • the interbody fusion device is fixed between the vertebral bodies via the pins.
  • the pin is pulled out from between the vertebral bodies by a pulling screwdriver that is screwed into the female screw hole at the proximal end, and is taken out of the body together with the main body.
  • the interbody fusion device can be re-fixed between the vertebral bodies again after a treatment such as filling with an antibiotic or an aggregate if necessary.
  • the intervertebral body is inserted into the female screw hole by the blind plug that is removably inserted into the female screw hole of the pin base end portion.
  • the blind plug removes the blind plug from the female screw hole before pulling out the pin, and make it easy to quickly and easily screw the extraction screwdriver into the female screw hole at the base end of the pin. Therefore, the operability of removing the interbody fusion device can be improved.
  • the outer surface engaging portion is formed in a male screw shape, the main body can be easily screwed and fixed between the vertebral bodies. There is an effect that can.
  • the outer surface engaging portion is formed in a plurality of spline teeth parallel to the main shaft, so that the main body is pressed. It is possible to insert and fix between vertebral bodies in a short time just by doing so, and there is an effect of improving operability.
  • the outer surface engaging portion is formed in a plurality of sawtooth shapes parallel to the main shaft, so that the main body is pressed. It has the effect of being able to easily fit between vertebral bodies in a short time and to secure the fixing reliability by retaining.
  • a plurality of angiogenesis openings and bones are provided on the upper, lower, left and right sides of the outer surface of the main body. Due to the presence of ingrowth openings, these openings contact the highly vascularized tissue surrounding the vertebral body to provide a path for promoting angiogenesis and adjacent vertebral body facing surfaces
  • the bleeding from the vertebrae serves as a passage for facilitating bone internal tissue growth and has an effect of promoting interbody fusion.
  • the interbody fixing device itself becomes a kind of fixed body of the bone mass.
  • the cap formed at the rear end of the pressing screw is provided at the rear end of the main body.
  • the cap By covering the entire surface or a part thereof, there is an effect of preventing the outflow of the bone-forming material or the like that contains the bone morphogenic protein that promotes fixation in the liquid carrier and is filled in the hollow body.
  • the screw screw since the cap finally comes into contact with the rear end surface of the main body or the front surface of the vertebral body, the screw screw is allowed to be screwed into the main body, and the reverse rotational frictional force of the press screw is increased. This also has the effect of preventing the reverse rotation of the pin and preventing the pin from coming off.
  • a pair of arm tip portions of the fixing reinforcement loosely fitted to the press screw are bosses on the cap portion of the press screw.
  • the pin rear end pressing of the pressing screw is performed via the friction plate. Therefore, the frictional force between the pressing screw and the pin rear end surface is reduced and the pin rear end surface is not directly subjected to the rotational force of the pressing screw. There is an effect that the pressing screw can be screwed with a small torque and the pin can be smoothly pushed forward without almost receiving the force to be sent.
  • the rear end portion of the pin is engaged or fixed to the friction plate so that the movement in the left-right direction is restricted at least. Therefore, the push screw is screwed into the female screw with a small torque and the pin is not subjected to almost any force that tends to be pushed in the left-right direction with a large gap with the inner surface of the female screw part. There is an effect of improving reliability that can be pushed in smoothly.
  • the interbody fusion device is a vertebra using a laparoscope in combination from the abdomen side. Because it is fixed between vertebral bodies by interbody fusion surgery, the operation scale is greatly reduced and the operation time and recovery period are also greatly reduced compared to the conventional interbody fusion surgery from the back side. Therefore, the physical and mental burden of the medical staff including the patient and the doctor, the surgical invasion of the patient, and the economic burden can be remarkably reduced.
  • the main body insertion driver has a tip engaging portion made of hard metal and the shaft portion is made of a lightweight resin or the like. Since it can be composed of a molecular material, the whole is reduced in weight and has the effect of improving operability.
  • the rear end grip portion of the press screw driver is gripped and the tip engagement portion is placed behind the press screw. Inserted into the hollow part of the main body insertion driver with the end engaged, and inserted into the female screw part of the main body of the interbody fusion device and rotated while rotating, and screwed into the female screw.
  • the pin can be inserted into the vertebral body while sequentially guiding the tip side of the pin along the guide hole by the direction propulsive force, and there is an effect of facilitating the pin insertion fixing operation by one axis in the main body main axis direction.
  • the main body insertion driver has a tip engaging portion made of a hard metal, and the shaft portion is a lightweight polymer such as a resin. Since it can be comprised from a material, the whole is reduced in weight and there exists an effect which improves operativity.
  • an interbody fusion surgical interbody space holding device that corrects an appropriate distance between two adjacent vertebral bodies to maintain an intervertebral disc space. Since the left and right side surfaces of adjacent vertebral bodies are sandwiched and fixed by the claws, the vertebral bodies to which a relatively large external force is applied when the interbody fusion device is subsequently implanted and fixed between the vertebral bodies are posterior or left and right Therefore, there is an effect that the reliability of the interbody space retention in the interbody fusion surgery is ensured.
  • each of the elastic support portions is provided by advancing or retreating the clamp arm opening / closing pipe fitted on the first shaft portion. Since a pair of clamp arms are closed in the diameter-reducing direction or opened in the diameter-enlarging direction, the structure and operation of the interbody space holding device that clamps and fixes the left and right side surfaces of adjacent vertebral bodies are simplified. There is.
  • the plurality of sharp protrusions of the fixed claw can be easily pierced on the side surface of the vertebral body.
  • an interbody fusion space holding device for interbody fusion surgery that corrects an appropriate distance between two adjacent vertebral bodies and holds an intervertebral disc space is provided on the first shaft portion. From a long fixing screw member and a needle-like projection provided on the outer surface and the distal end, respectively, one or both front surfaces of the adjacent vertebral bodies are respectively screwed and pierced to be fixed with a retaining effect.
  • the structure and operation of the interbody space holding device is simple and the vertebral body to which a relatively large external force is applied when the interbody fusion device is subsequently implanted and fixed between the vertebral bodies is located on the posterior or left and right sides. Therefore, the reliability of the interbody space retention in the interbody fusion surgery is ensured.
  • a vertebral body clamping mechanism or a long length is provided in one interbody space holding device.
  • Intervertebral body fixation because it combines a fixed screw member / needle-like process and a pair of spacers having an outer shape that holds the adjacent vertebral bodies at appropriate intervals by being inserted into the intervertebral disc space.
  • Correction and fixation / holding can be performed simultaneously in a short time at an appropriate interval between adjacent vertebral bodies in a surgical operation.
  • the operation time can be shortened as compared with the conventional interbody fusion surgery, thereby reducing the physical and mental burden of medical staff including patients and doctors, the surgical invasion of the patient, and the economic burden. .
  • FIG. 3 is an AA arrow view of FIG. 2.
  • A is a cross-sectional view taken along the line BB in FIG. 2
  • (b) is a cross-sectional view taken along the line CC in FIG. (A), (b), (c), (d), (e), (f) is a partial sectional view showing a concept of a pin of another modified embodiment of the present invention.
  • FIG. 3 is a sectional view taken along the line DD in FIG.
  • FIG. 3 is a plan view of FIG. 2. It is a longitudinal cross-sectional view (main part cross section) which shows the insertion state between the vertebral bodies of the interbody fixing device main body of FIG.
  • FIG. 3 is a longitudinal sectional view (main section) showing a state of fixation between vertebral bodies of the interbody fusion device of FIG. 2.
  • FIG. 10 is an EE arrow view of FIG. 9. It is a longitudinal cross-sectional view (main part cross section) which shows the fixation completion state between the vertebral bodies of the interbody fixing device of another embodiment (Example 2) of this invention.
  • FIG. 12 is an FF arrow view of FIG. 11.
  • FIG. 15A is a cross-sectional view taken along the line GG of the friction plate portion of FIG. 15, and FIG. 15B is a cross-sectional view taken along the line HH of FIG.
  • FIG. 15B is a cross-sectional view taken along the line HH of FIG.
  • FIG. 15B is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 5) of this invention.
  • FIG. 21 is an RR arrow view of FIG. 20. It is a top view of FIG. It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 7) of this invention.
  • (A) is the longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 8) of this invention,
  • (b) is II arrow view required of (a).
  • FIG. 28 is a view taken from the direction of the arrows U-U in FIG. 27.
  • FIG. 32 is a view on arrow VV of FIG. 31.
  • FIG. 34 is a plan view (upper half section) of the interbody space holding device of FIG. 33.
  • FIG. 35 is a view on arrow WW in FIG. 34.
  • FIG. 34 is a longitudinal cross-sectional view (upper half part cross section) which shows the concept of the main body insertion driver of one Embodiment of this invention.
  • FIG. 37 is a view taken along the line SS of FIG. 36. It is a side view which shows the concept of the press screw driver of one Embodiment of this invention.
  • FIG. 39 is a view on arrow TT in FIG. 38. It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fusion surgery system of the deformation
  • (A) is a side view conceptually showing a patient's lithotripsy state in the interbody fusion surgery of one embodiment of the present invention, and
  • (b) is a conceptual view of a patient's Trendelenburg position following (a).
  • FIG. 45 is a view on arrow XX in FIG. 44. It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 12) of this invention.
  • FIG. 45 is a view on arrow XX in FIG. 44.
  • FIG. 47 is a view on arrow YY in FIG. 46. It is a perspective view of the conventional interbody fusion device of the first example. It is a longitudinal cross-sectional view (main part cross section) of the state by which the conventional interbody fixing device of the 2nd example was fixed between vertebral bodies. It is a perspective view of the conventional typical interbody space holding
  • FIG. 52 is a side view showing a state in which the interbody space holding device (ventral ventral lordosis extending external sleeve) of FIG. 50 is inserted between vertebral bodies.
  • FIG. 1 is a longitudinal sectional view (main section) showing a main configuration concept of an interbody fusion surgical system according to an embodiment (Example 1) of the present invention
  • FIG. 2 is an intervertebral body of Example 1 of the present invention
  • FIG. 3 is a sectional view taken along the line AA in FIG. 2
  • FIGS. 4A and 4B are sectional views taken along the line BB in FIG.
  • FIGS. 5A, 5B, 5C, 5C, 5D, 5E, 5F, and 5F are cross-sectional views taken along arrows CC, respectively.
  • 6 is a cross-sectional view taken along the line DD of FIG. 2
  • FIG. 7 is a plan view of FIG. 2
  • FIG. 8 is a diagram showing a state where the interbody fusion device 10 is inserted between the vertebral bodies L1 and L2.
  • 9 is a longitudinal sectional view (cross section of the main part)
  • FIG. 9 is a longitudinal sectional view (cross section of the main part) showing a state of fixation between the vertebral bodies L1 and L2 of the interbody fusion device 10
  • Each drawing attached here is a conceptual diagram showing the main structural concept expressed in knot scale by enlarging the radial direction compared to the axial direction in order to make the internal structure easy to understand.
  • the interbody fusion surgical system is a male screw shape that is engaged and fitted between vertebral bodies L1 and L2 on a substantially hollow cylindrical outer surface having a front end.
  • Outer surface engaging portions 14 and 15 are formed, and one or a plurality of guide holes 17 and 18 penetrating from the inner surface of the female screw 16 provided on the rear end side hollow inner surface 16a to the outer surface so as to extend toward the vertebral body are formed.
  • the main body 11, one or a plurality of pins 30 loosely accommodated in the guide hole, and the female screw 16 are screwed together and the rear end of the pin is pressed so that the distal end side of the pin is inserted into the vertebral body along the guide hole.
  • An intervertebral body fixing device 10 that has a pressing screw 40 to be inserted and fits into an intervertebral disc space M between two adjacent vertebral bodies (vertebrae) L1 and L2, and fixes the vertebral bodies L1 and L2.
  • a cannula K inserted into the endoscope port Ma drilled from the side of the part MN1 toward the center between the vertebral bodies L1 and L2, and inserted into the cannula K, and an appropriate distance between the vertebral bodies L1 and L2
  • the interbody fixing device 10 is inserted into the hollow portion of the interbody space holding device 70, the main body 11 is pressed and rotated to be inserted between the vertebral bodies L1 and L2, and the intervertebral body fixing device 10 is inserted into the distal end engaging portion 93.
  • a press screw driver 90 is inserted into the hollow of the main body insertion driver 80 in a state of being engaged with the rear end engaging portion 44 of the press screw 40, and the press screw 40 is inserted into the female screw portion 16 of the main body 11 and screwed while being pressed. And.
  • an endoscope or a laparoscope or a main body is inserted through a plurality of endoscope abdominal cavity (not shown). It is desirable to provide a capsule endoscope or the like housed in the hollow of the driver 80.
  • the interbody fusion device 10 is formed in a substantially hollow cylindrical shape with a front end that fits an appropriate distance between the vertebral bodies L1 and L2, and the opposing surface of the vertebral bodies L1 and L2 on the outer surface.
  • the pin 3 is screwed into the female screw 16 and its axial propulsive force
  • the press screw 40 that presses the rear ends 31 and 31 of 0 and 30 is schematically configured.
  • the main body 11 has an outer shape formed so as to maintain an appropriate distance between the vertebral bodies L1 and L2, and the opposing surfaces L1a and L2a of the two vertebral bodies L1 and L2 are substantially parallel or dorsal.
  • a drum with a substantially hollow cylinder as shown in FIG. 1 whose outer diameter is slightly thicker, for example, on the order of 0.1 mm, so as to correspond to the case of an inclined surface shape of about 9 ° with respect to a horizontal plane. It is formed in a shape.
  • the main body 11 is accommodated between the vertebral bodies L1 and L2, for example, having an outer diameter of approximately 18 to 22 mm and a total length of approximately 25 to 45 mm, depending on the size of the vertebral bodies L1 and L2.
  • the front end surface 12 of the main body 11 is formed in a convex curved surface or a substantially conical surface not shown, and is disposed between the vertebral bodies L1 and L2 sufficiently in front of the nerve portion so as not to touch the nerve portion behind the spinal column. It is necessary.
  • the main body 11 is formed of a material having sufficient strength and biological compatibility to withstand a strong compressive force between the vertebral bodies L1 and L2, for example, on the order of 1000 kg, or an inert material.
  • these materials include porous materials such as medical grade stainless steel (SUS), titanium (Ti), and a porous tantalum composite material. Ti is particularly preferable from the viewpoint of strength and light weight.
  • External threads 14 and 15 are formed on the outer surface of the main body 11 as outer surface engaging portions in which the outer surface crown portion bites into and engages the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2. It is desirable that the valley diameter of the male screws 14 and 15 is substantially in contact with the distance between the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2.
  • the thread height of the male screws 14 and 15 is, for example, about 3 to 4 mm.
  • the male screws 14 and 15 are desirably sufficiently engaged in the vertebral bodies L1 and L2 so that the main body 11 is not pushed out between the vertebral bodies L1 and L2 due to a high load applied to the spine.
  • the pitch of the male screws 14 and 15 is, for example, about 2 to 3 mm, depending on the amount of screw engagement required to hold the interbody fusion device 10 at a predetermined position between the vertebral bodies L1 and L2. Needless to say, the thread height and pitch of the male threads 14, 15 can be formed to a value smaller than the above as required.
  • the main body 11 is a substantially parallel cut side surface in which the tops on both the left and right sides of the rear outer surface are cut with an appropriate width, leaving the front end face 12 side. 19 and 19 are formed. Therefore, the male screw 15 on the front end face 12 side is a full screw, but the male screw 14 formed on the upper and lower outer surfaces of the cross-section partial cylinder in which the cut side faces 19 and 19 on the rear side are formed is a partial screw.
  • the axial front ends (screw ends) and the radial outer surface crests of the male screws 14 and 15 are formed in a sharp blade shape, and the male screw 15 which is a complete screw on the front end surface 12 side uses the main body 11 as a vertebral body L1. , L2 can be easily screwed in.
  • the main body 11 When the cut side surfaces 19 and 19 are formed over the entire length of the main body 11, the main body 11 can be easily inserted between the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2 without screwing the main body 11 if the main body 11 is turned 90 ° in the figure. You can also In this case, the main body 11 is rotated 90 ° after being inserted between the vertebral bodies L1 and L2, and is held vertically so that the main body 11 maintains an appropriate distance between the vertebral bodies L1 and L2, as shown in FIG. Fixed.
  • the cut side surfaces 19 and 19 are suitable for providing a region for bone-like fixation by bone ingrowth between the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2.
  • the rear end portions of the cut side surfaces 19 and 19 of the main body 11 are provided at the tip of the shaft of the transplant driver (not shown) when the interbody fusion device 10 is inserted and fixed between the vertebral bodies L1 and L2. It can also be held by a (holding tool).
  • a main body insertion driver according to an embodiment of the present invention in which the main body 11 is inserted between the vertebral bodies L1 and L2 will be described later.
  • a hollow inner surface 16a drilled from the rear end surface 13 side of the main body 11 is formed with a female screw 16 having an appropriate depth, and is substantially axisymmetric in the vertebral body L1 and L2 directions from the hollow inner surface 16a of the depth portion of the female screw 16.
  • a pair of upper and lower guide holes 17 and 18 penetrating to the outer surface along the inclined axes C2 and C3 of the inclination angles ⁇ 1 and ⁇ 2 with respect to the main axis C1 are formed at the end.
  • the inclination angles ⁇ 1 and ⁇ 2 are appropriately determined according to the arrangement state of the vertebral bodies L1 and L2 and the situation such as the thickness and flexibility of the pin 30, and both may be set to be substantially equal or slightly different inclination angles. Under the same conditions, the pushing force of the pin 30 tends to be substantially proportional to the inclination angles ⁇ 1 and ⁇ 2.
  • the inclined axes C2 and C3 are arranged in any direction and asymmetrically with respect to the main axis C1 as long as the distal end 32 of the pin 30 is not pushed and protrudes from the outer surface of the vertebral bodies L1 and L2.
  • it may be eccentric with respect to the main axis C1 and arranged in a plane in any direction.
  • the main body 11 has a plurality of openings such as side openings 21, 22, 23 and upper and lower openings 24, 25, 26.
  • a small hole 28 communicating with the side surface opening 21 and the upper and lower surface openings 24 is formed in the distal end surface of the hollow inner surface 16a.
  • the side openings 21, 22, 23 contact the highly vascularized tissue surrounding the vertebral bodies L1, L2 to promote angiogenesis, and the upper and lower surface openings 24, 25, 26 are opposite surfaces of the vertebral bodies L1, L2. Bone-like fixation by bone ingrowth is promoted between L1a and L2a. For this reason, it is desirable to drill a large number of openings in the main body 11 so as to communicate with each other as much as possible unless the strength is impaired.
  • the rear end surface 13 of the main body 11 has a pair of rear end openings 27 and 27 and a plurality of, for example, six partial arc-shaped openings formed along the circumferential portion.
  • This partial arc-shaped opening is a rear end engaging portion 29 in which a front end engaging portion of a main body insertion driver described later for fitting the main body 11 between the vertebral bodies L1 and L2 is engaged and engaged.
  • the rear end engaging portion 29 is provided with, for example, a hexagonal concave groove (not shown) on the rear end surface 13 in place of such a partial arc-shaped opening to engage the hexagonal front end engaging portion of the main body insertion driver. You may make it match.
  • the main body 11 is made of a porous tantalum-carbon composite material, for example, a porous material such as “HEDROCEL” (trade name of US Implex Co., Ltd.), the side openings 21, 22, 23 and the upper and lower surfaces as described above are used.
  • the openings 24, 25, and 26 may not be provided, and the interconnected porous portions may promote bone ingrowth and angiogenesis.
  • This porous material resembles the structure of a porous bone and has an elastic modulus close to that of a human bone, so it can be said to be optimal for the interbody fusion device of the present invention.
  • the pair of pins 30, 30 are loosely accommodated in the female screw 16 in parallel in the direction of the main axis C ⁇ b> 1, the rear end 31 side extends along the main axis C ⁇ b> 1 of the main body 11, and the front end 32 side is a pair each. It is guided along the guide holes 17 and 18, bent and inserted. Each tip 32 is appropriately sharpened, and in the initial state before the main body 11 is inserted between the vertebral bodies L1 and L2, the guide holes 17 and so on do not protrude from the valley diameter of the male screw 14, that is, from the valley diameter. It is accommodated in 18 outlets.
  • the pin 30 of this embodiment is formed of a solid or hollow rod-like body having an arbitrary cross-sectional shape such as a circle or a polygon. For example, as shown in FIGS. It is softer than the main body and is made of, for example, medical grade SUS having appropriate flexibility and strength.
  • the pin 30 which consists of a solid or hollow integrated rod-shaped body of this Example, and is a partial sectional view of the pin in the same direction as in FIG. 4A or FIG. )
  • a plurality of thin plate materials 30An, 30Dn or wire rods 30Bn, 30En, 30Cn, 30Fn having an arbitrary cross-sectional shape such as a round shape or various flat cross-sections are laminated and integrated at least over the tip side or the entire length.
  • the pins 30A, 30B, 30C, 30D, 30E, and 30F may be different from each other in the form of a rod-like laminate having an arbitrary cross-sectional shape such as a round shape or a polygonal shape.
  • the deformed pins 30A, 30B, and 30C each include a plurality of thin plate materials 30An, a round wire 30Bn, and an oval shape at least on the distal end side or the entire length.
  • the flat wire rods 30Cn are laminated to form a rod-like laminate having an integral substantially square cross section.
  • the deformed pins 30D, 30E, and 30F include a plurality of thin plate materials 30Dn and round wire rods 30En having different widths at least on the tip side or the entire length, respectively.
  • the oblong flat wire 30Fn is laminated to form a rod-like laminated body having a substantially rhombic cross section.
  • the deformed pins 30A, 30B, 30C, 30D, 30E, and 30F made of such a laminate are mutually connected to the thin plate members 30An and 30Dn or the wire rods 30Bn, 30En, 30Cn, and 30Fn at the base portion in order to maintain the shape. It is desirable to be integrally formed by bonding or welding to each other. As a result, since the thin plate members 30An, 30Dn or the wire rods 30Bn, 30En, 30Cn, 30Fn are in a free state, the distal end side is guided along the guide holes 17 and 18 of the main body 11 and can be bent relatively easily. Thus, the operability of being smoothly guided along the guide hole of the main body is improved. Further, the pins 30A to 30F made of these laminates can be easily laminated and formed in an arbitrary shape, and the degree of design freedom is improved.
  • the inner diameters of the female screw 16 and the hollow inner surface 16a are appropriately determined from the balance of the thickness of the pin 30 or 30A to 30F, the outer diameter of the main body 11, the strength of both, and the like.
  • the hollow inner surface 16a also serves as a pilot hole for the female screw 16.
  • the pressing screw 40 is a substantially disc flange having a size that covers the whole or part of the rear end surface 13 of the main body 11 at the rear end of the male screw portion 41 that is screwed into the female screw 16 of the main body 11.
  • a cap 42 is continuously provided.
  • the length of the male screw portion 41 from the surface where the cap 42 is provided corresponds to the pin 30 pressing stroke corresponding to the length of inserting the pin 30 into the vertebral bodies L1 and L2, and the pressing screw 40 is connected to the female screw 16 with the stroke screw. It is desirable to set so that the continuous surface of the cap 42 is in contact with the rear end surface 13 of the main body 11 when it is inserted.
  • the size of the cap 42 can be set so as to cover between the vertebral bodies L1 and L2 as necessary.
  • the material of the pressing screw 40 there are porous materials such as medical grade SUS, Ti, porous tantalum composite material, etc., as in the case of the main body 11.
  • Ti is a bone ingrowth in terms of strength and light weight.
  • a porous tantalum composite material or the like is preferable.
  • a cross groove 44 is formed on the rear end surface of the cap 42 as a rear end engaging portion that engages with a tip engaging portion of the transplant driver or a press screw driver described later.
  • the rear end engaging portion 44 may be formed with a hexagonal hole that engages with a distal end engaging portion formed in, for example, a hexagon wrench shape of a transplant driver or a pressure screw driver (not shown) instead of the cross groove. .
  • FIG. 27 is a longitudinal sectional view (upper half section) showing a concept of an interbody space holding device 70 for interbody fusion surgery according to an embodiment of the present invention
  • FIG. 28 is an interbody space holding device of FIG. 70 is a plan view (upper half section)
  • FIG. 29 is a view taken in the direction of arrows U-U in FIG.
  • An intervertebral body space holding device 70 includes a cannula K in an abdominal part Ma for endoscope provided on a living body abdominal part MN1 side with a grip 72 at a rear end (see FIG. 1).
  • the hollow long first shaft portion 71 inserted to the vicinity of the front surface of the vertebral bodies L1 and L2 via the vertebral body and the distal end portion 71a of the first shaft portion 71 are extended along the axial direction and are adjacent to the vertebrae.
  • a holding device having at least one pair of clamp arms 74 and 74 that can be opened and closed in the orthogonal planes of the vertebral bodies L1 and L2 with fixing claws 74b that clamp and fix the left and right side surfaces of the bodies L1 and L2 respectively. It consists of a main body 70a and a hollow long second shaft portion 76 which is fitted to the first shaft portion 71 so as to be movable forward / backward and provided with a gripping portion 77 at the rear end. A pair of clamp arms 74, 74 A clamp arm closing pipe 70b open to closed or expanded direction direction of reducing the diameter, made of.
  • a vertebral body clamping mechanism is constituted by the holding device main body 70a and the clamp arm opening / closing tube 70b.
  • the holding device main body 70a of this embodiment has the fixed claws 74b connected to the tip, the rear end connected to the tip 71a of the first shaft portion 71, and in the free state.
  • a pair of clamp arms 74 and 74 each having an elastic support portion 74a that is bent and elastically supported so as to expand and open the fixing claws 74b in the orthogonal planes of the vertebral bodies L1 and L2, respectively.
  • the clamp arm opening / closing pipe 70b is a contraction of the pair of clamp arms 74, 74 indicated by a two-dot chain line by the distal end portion 76a of the second shaft portion 76 moving forward and pressing the elastic support portion 74a from the outside.
  • the pair of clamp arms 74 and 74 are opened in a diameter increasing direction indicated by a two-dot chain line by closing in the radial direction and retreating the distal end portion 76a from the elastic support portion 74a.
  • Each of the pair of clamp arms 74, 74 is closed to the minimum when the position of the distal end portion 76a of the second shaft portion 76 in the C1 axis direction is X1 (fully closed position), and is X2 (vertebral body grasping / fixing position). Sometimes the left and right lateral surfaces of the vertebral bodies L1 and L2 are gripped / fixed, and open to the maximum at X3 (fully open position).
  • the vertebral body clamping surface of the fixed claw 74b has a plurality of sharp protrusions 74c that can be pierced on the left and right side surfaces of the vertebral bodies L1 and L2.
  • the holding device body 70a of this embodiment is opposed to the intervertebral space M along the axial direction at a slightly narrower distance than the outer diameter of the vertebral bodies L1 and L2 to the distal end portion 71a of the first shaft portion 71.
  • At least one pair of spacers 73 formed in an outer shape that extends in a state and is inserted into the intervertebral disc space M from the distal end portion so that the adjacent vertebral bodies L1 and L2 are corrected and held at appropriate intervals.
  • 73 are further provided.
  • the pair of spacers 73 and 73 and the pair of clamp arms 74 and 74 are provided in respective planes whose main axes are shifted by approximately 90 °.
  • Such a configuration of the holding device main body 70a simplifies the structure and operation, and the pair of spacers 73 and 73 are inserted into the intervertebral disc space M from the distal end, so that the adjacent vertebral bodies L1 and L2 are properly connected. Since the distance between the left and right side surfaces of the adjacent vertebral bodies L1 and L2 is held and fixed by the fixing claws 74b having a plurality of sharp protrusions 74c of each pair of clamp arms 74 and 74, respectively, while being corrected and held at intervals. In the interbody fusion surgery, it is possible to correct the distance between adjacent vertebral bodies L1 and L2 and to perform reliable fixation / retention simultaneously in a short time. As a result, the operation time can be shortened compared to the conventional interbody fusion surgery, so that the physical and mental burdens of medical staff including patients and doctors, the surgical invasion of patients, and the economic burden can be further reduced. it can.
  • FIG. 30 is a plan view (upper half section) showing a concept of an intervertebral body space holding device 70 ′ for interbody fusion surgery according to a modified embodiment of the present invention
  • FIG. 31 is an interbody space holding device of FIG. 70 'is a longitudinal sectional view (upper half section)
  • FIG. 32 is a view taken along arrow VV of FIG.
  • components having the same functions as those of the above-described embodiment are given the same reference numerals and symbols in order to simplify the description even if the dimensions and shapes are slightly different.
  • the interbody space holding device 70 ′ of this modified embodiment is similar to the first shaft portion 71 and the distal end portion 71 a of the first shaft portion 71 similar to that of the above-described one embodiment via the first support shaft P ⁇ b> 1.
  • a pair of clamp arms each having a fixed claw 74b that is pivotably overlapped and pivotally mounted in an orthogonal plane of the vertebral bodies L1 and L2, and is connected to the tip of the support portion 74'a.
  • the holding device main body 70'a having 74 'and 74' and the second shaft portion 76 and the intermediate portion of each pair of clamp arms 74 'and 74' on the side opposite to the overlapping surface as in the above embodiment Brackets in which one end portions are pivotably overlapped and pivotally mounted via the second support shafts P2 and P2, and the other end portions project from the tip end portion 76a of the second shaft portion 76.
  • 78 is pivotally overlapped with the third support shaft P3 so as to be swingable.
  • the clamp arm open tube 70'b having a link member 79, 79 of each pair which is composed of.
  • the holding device body 70'a and the clamp arm opening / closing tube 70'b constitute a vertebral body clamping mechanism.
  • the support portion 74'a is formed in a shape having high rigidity unlike the elastic support portion 74a having appropriate elasticity of the one embodiment, as shown in FIG. Further, as the second shaft portion 76 moves forward or backward, each pair of link members 79, 79 are swung counterclockwise or clockwise around the third support shaft P3 to each pair of clamp arms.
  • the toggle mechanism 74 ′, 74 ′ is closed in the reduced diameter direction indicated by the two-dot chain line or opened in the enlarged diameter direction with the first support axis P1 as a fulcrum within the orthogonal plane of the vertebral bodies L1, L2. .
  • Each pair of clamp arms 74 ′ and 74 ′ is closed to the minimum when the position of the distal end portion 76 a of the second shaft portion 76 in the C1 axis direction is X 1 ′ (fully closed position), and X 2 (vertebral body grasping / fixing) Position), the left and right lateral surfaces of the vertebral bodies L1 and L2 are gripped / fixed, and the X3 '(fully open position) opens to the maximum.
  • the vertebral body clamping mechanism including the holding device main body 70 ′ a and the clamp arm opening / closing tube 70 ′ b constitutes a toggle mechanism.
  • the clamping / fixing force between the left and right side surfaces of L1 and L2 is increased, and the reliability of the interbody space holding device can be further improved.
  • the interbody space holding device 70 ′ of this modified embodiment is similar to the adjacent vertebral body L 1, similar to the interbody space holding device 70 of the above embodiment, at the distal end portion 71 a of the first shaft portion 71. It further includes at least one pair of spacers 73 and 73 formed in an outer shape so that L2 is corrected and held at an appropriate interval.
  • the first and second shaft portions 71 and 76 of the interbody space holding devices 70 and 70 ′ of the one embodiment and the modified embodiment are both substantially oval, for example.
  • a hollow shape corresponding to the outer shape / size of the vertebral body such as a substantially elliptical or substantially rectangular cross section, or a substantially circular or substantially polygonal cross section (not shown).
  • the first shaft portion 71 is considerably larger than the shaft portion 81 of the main body insertion driver, the intervertebral body fixing device 10 or the intervertebral body is inserted into the first shaft portion 71.
  • a guide cylinder 71b (indicated by a two-dot chain line) having a relatively large inner diameter may be provided as necessary.
  • reinforcing plates 75 and 75 extending over the inner surfaces corresponding to the left and right clamp arms 74 and 74 at the tip of the first shaft portion 71 may be provided as necessary.
  • the distance between the reinforcing plates 75 and 75 is set to be slightly larger than, for example, at least about 2 mm from their maximum outer diameter so as not to interfere with the interbody fusion device 10 or the shaft portion 81.
  • FIG. 33 is a longitudinal sectional view (upper half section) showing the concept of an interbody space holding device 70 ′′ of still another modified embodiment of the present invention
  • FIG. 34 is an interbody space holding device 70 ′ of FIG. ′ ′ Plan view (upper half section)
  • FIG. 35 is a view taken along the line WW in FIG. 34.
  • components having the same functions as those of the embodiment described above are given the same reference numerals and symbols in order to simplify the description even if the dimensions are slightly different.
  • the intervertebral body space holding device 70 ′′ is provided with a grasping portion 72 at the rear end, and a cannula K (see FIG. 1) in the abdominal portion Ma for endoscope provided on the living body abdominal portion MN1 side.
  • a hollow long first shaft portion 71 ′ inserted to the vicinity of the front surface of the vertebral bodies L 1 and L 2 via the reference), and extended on the outer surface of the first shaft portion 71 ′ so as to be rotatable along the axial direction.
  • a long fixed screw member 76'b in which the screw portion 76'a formed at the tip is inserted into and fixed to one or both front surface portions of the adjacent vertebral bodies L1, L2, and the first shaft portion 71.
  • one or a plurality of needle-like protrusions 71c that can project into one or both front surface portions of the adjacent vertebral bodies L1 and L2.
  • the long fixing screw member 76'b is rotatably inserted into the insertion hole 75c of the rear support member 75a and the front support member 75b provided upright on the outer surface of the first shaft portion 71 '.
  • a driver or wrench engaging groove (not shown) or a head portion 76'c having a hexagonal outer shape is provided.
  • the long fixing screw member 76'b, the rear support member 75a, and the front support member 75b constitute a vertebral body fixing mechanism 76 ', and the first shaft portion 71' inserted into the cannula K is held at the rear end portion or gripped.
  • the elongated fixing screw member 76 ′ is inserted through the head 76′c. While pressing b, it is rotated clockwise, for example, and inserted into and fixed to one or both front portions of the vertebral bodies L1, L2.
  • the interbody space holding device 70 ′′ of this modified embodiment is adjacent to the vertebral body fixing mechanism 76 ′ and the needle-like protrusion 71 c provided on the outer surface of the first shaft portion 71 ′ and the distal end portion 71 ′, respectively.
  • the vertebral bodies L1 and L2 are fixed to each other by screwing and piercing into the front portions of the vertebral bodies L1 and L2, respectively, so that the structure and operation are simple. Since the vertebral bodies L1 and L2 to which a relatively large external force is applied when transplanted and fixed between the vertebral bodies L1 and L2 are not displaced rearward or left and right, the reliability of intervertebral body space retention in interbody fusion surgery Sex is secured.
  • the gripping portions 72 and 77 are boss portions 72a fitted to the rear ends of the first and second shaft portions 71, 71 'and 76, which are set to lengths that are sequentially exposed to the outside of the cannula K, respectively. , 77a and at least one handle or a plurality of handles (handles) standing upright, but can be formed in any other gripping shape (not shown) such as a known cylindrical type.
  • the rear members of the shaft portion excluding the distal ends of the first and second shaft portions 71, 71 ′, 76 and other clamp mechanisms, the vertebral body fixing mechanism 76 ′, the spacers 73, 73 ′, etc. It can be composed of a lightweight polymer material such as a resin. It is desirable that the interbody space holding devices 70, 70 ′, and 70 ′′ are composed of a combination of Ti and polymer materials that are as light as possible to reduce the overall weight and improve operability.
  • FIG. 36 is a longitudinal sectional view (upper half section) showing a concept of a main body insertion driver 80 according to an embodiment of the present invention
  • FIG. 37 is a view taken along the line SS of FIG. 36
  • FIG. 38 is an embodiment of the present invention.
  • FIG. 39 is a view taken along the line TT in FIG. 38.
  • the body insertion driver 80 is provided with a gripping portion 82 at the rear end, and the vertebrae are interposed through the first shaft portions 71 and 71 ′ of the interbody space holding devices 70, 70 ′ and 70 ′′.
  • a hollow long shaft portion 81 inserted to the vicinity of the front surfaces of the bodies L1 and L2, and a rear end engaging portion 29 (formed on the rear end surface 13 of the body 11 of the interbody fusion device 10 at the distal end of the shaft portion 81) 3) and a tip engaging portion 83 that engages.
  • the gripping part 82 is attached to the rear end of the shaft part 81 set to a length exposed to the outside of the rear end of the first shaft parts 71, 71 ′ of the interbody space holding devices 70, 70 ′, 70 ′′. It is formed in the shape of at least one pair or a plurality of handles (handles) standing on the fitted boss portion 82a.
  • the front end engaging portion 83 is formed in a plurality of partial arcuate claw shapes that are engaged with and engaged with the partial arc-shaped rear end engaging portion 29 (FIG. 3) of the main body 11, and the front end of the nail
  • the portion has a shape that can be easily fitted into the rear end engaging portion 29, such as a corner portion being cut.
  • the front end engaging portion 83 is formed in a shape that matches the arbitrary shape of the rear end engaging portion 29.
  • the tip engaging portion 83 is made of a hard metal such as SUS or Ti, and the shaft portion 81 can be made of a light polymer material such as a resin. It is desirable that the main body insertion driver 80 is lightened as a whole, for example, to be constructed by combining Ti and polymer materials that are as light as possible to improve operability.
  • the pressing screw driver 90 is provided with a grip portion 92 at the rear end, and a long shaft portion 91 inserted into the vicinity of the front surface of the vertebral bodies L1 and L2 through the shaft portion 81 of the main body insertion driver 80, and the shaft portion
  • the front end 91 includes a front end engaging portion 93 that engages with a rear end engaging portion 44 (FIG. 10) formed at the rear end portion of the cap 42 of the pressing screw 40.
  • the grip portion 92 is at least one pair or a plurality of handles (e.g., standing on a boss portion 92a fitted to the rear end of the shaft portion 91 set to a length exposed to the outside of the rear end of the main body insertion driver 80. It is formed in a handle shape. That is, as shown in FIG. 1, the pressing screw driver 90 is exposed to the outside from the rear end surface of the main body insertion driver 80 when the intervertebral body fixing device 10 is fixed between the vertebral bodies L1 and L2, and is held by the grip portion 92. It has a sufficient length that can be gripped.
  • the front end portion 93a of the front end engaging portion 93 is formed, for example, in the shape of a plus driver that engages with the rear end engaging portion 44 (FIG. 10) of the pressing screw 40.
  • the front end 93a is shaped like a hexagon wrench that engages with the hexagonal hole. It is formed in a shape (not shown) that fits any shape of the engaging portion 44.
  • the tip engaging portion 93 is made of a hard metal such as SUS or Ti, and the shaft portion 91 can be made of a light polymer material such as a resin. It is desirable that the pressure screw driver 90 is lightened as a whole including the shaft portion 91 formed in a hollow shape to improve operability.
  • the gripping portions 82 and 92 can be formed in any other gripping shape (not shown) such as a known cylindrical shape.
  • FIG. 40 shows a conceptual longitudinal cross-sectional view (cross-section of the main part) of the interbody fusion surgery system of the modified embodiment to which the interbody space holding device 70 ′′ of the modified embodiment is applied.
  • the interbody fusion device 10 is formed from the abdominal MN1 side to the front surface of the spine. While observing with an endoscope (or a laparoscope) (not shown) or the capsule endoscope through a cannula K in the abdominal cavity Ma for endoscope, the interbody space holding device 70, the body insertion driver 80, and a pressing screw An intervertebral body fixing surgical method that uses a screwdriver 90 to fit into the intervertebral disc M between the vertebral bodies L1 and L2 and fixes the vertebral bodies L1 and L2 will be described as a main feature.
  • vertebral body fixation device 10 Prior to surgery, after the patient's optimal vertebral body fixation device 10 dimensions and desired distraction have been evaluated, the patient is distracted and the vertebral body (vertebral) alignment corrected simultaneously as shown in FIG. 41 (a).
  • Human body MN including arms and legs so that the shoulder is not lowered to the head side in a so-called crushed position where the legs are bent upwardly on the spinal table Bd To fix.
  • the spinal table Bd is tilted, the foot is raised and the head is lowered, so that the head is lowered and the waist is in the Trendelenburg state, and the following operation is started.
  • laparoscopic ports Ma, Mb, Mc, Md, and a plurality of incision wounds Mf of about several millimeters are provided at predetermined positions of the abdominal part MN1, for example, with an electric knife.
  • an insufflation gas such as CO2 is supplied into the abdominal cavity through a puncture needle such as an access needle. inject.
  • the port Ma is a main laparoscopic port for inserting the interbody fusion device 10 and is arranged so as to aim at a substantially central portion between the vertebral bodies L1 and L2.
  • the port Mb is disposed on the central axis of the abdominal part MN1, for example, a few millimeters to 10 cm from the navel near the head.
  • the abdominal wall is disposed on the side of the upper abdominal vessel opposite to the vertebral bodies L1 and L2.
  • the ports Mc and Md are arranged slightly shifted so as to face each other on the left and right sides of the port Mb.
  • An appropriate retractor (forceps) (not shown) is inserted through the ports Mc and Md, and a treatment for appropriately separating the internal organs from the periphery of the target vertebral body is performed.
  • pretreatment step a pretreatment such as pushing a bone margin such as a dural capsule and a transverse nerve root (not shown) to the side is performed (pretreatment step).
  • a treatment trocar sleeve Tr such as a verse step or a bar support is disposed in the port Ma portion.
  • the hollow cannula (or power shield sleeve) K which is the outer cylinder of the trocar sleeve Tr, after the puncture needle and the puncture needle are removed, various treatment tools Tp described later are inserted up to the spinal column (spine) L portion.
  • FIGS. 27 and 28 a pair of clamp arms to the vicinity of the front surfaces of the vertebral bodies L1 and L2 through a cannula K inserted into the endoscope port Ma provided on the abdominal part MN1 side.
  • the intervertebral space holding device 70 with 74 and 74 closed is inserted, and a pair of spacers 73 and 73 are inserted into the intervertebral disc space M from the tip to correct the adjacent vertebral bodies L1 and L2 to an appropriate interval.
  • the pair of clamp arms 74 and 74 are opened and closed again so as to sandwich the left and right side surfaces of the adjacent vertebral bodies L1 and L2 by the fixing claws 74b, respectively, via a plurality of sharp protrusions 74c ( Piercing) and fixing (interbody space holding process).
  • the opening / closing operation of each pair of clamp arms 74, 74 is performed by moving the clamp arm opening / closing pipe 70b backward or forward as described above.
  • a transplant driver drill or a hollow tubular tube is used by using an endoscope (or a laparoscope) inserted into the first shaft portion 71 of the interbody space holding device 70 from the abdominal part MN1 side.
  • an endoscope or a laparoscope
  • a cutter perforator
  • a pilot hole having an outer diameter slightly narrower than the outer diameter of the main body 11 of the vertebral body fixing device 10 is drilled to an appropriate depth in the intervertebral disc space M between the vertebral bodies L1, L2. Installation process).
  • the first shaft of the interbody space holding device 70 from the abdomen MN1 side with the rear end engaging portion 29 of the main body 11 engaged with the front end engaging portion 83 of the main body insertion driver 80. It is inserted into the portion 71, and the main body 11 is pressed and rotated to be screwed and fixed to a predetermined position of the lower hole in the intervertebral disc space M (main body inserting step). At this time, as shown in FIG. 8, the main body 11 is screwed into the outer surface tops of the male screws 14 and 15 by biting into and engaging with the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2.
  • the shaft portion 81 of the body insertion driver 80 from the abdomen MN ⁇ b> 1 side in a state where the rear end engagement portion 44 of the press screw 40 is engaged with the front end engagement portion 93 of the press screw driver 90. It is inserted into the internal threaded portion 16 of the rear end surface 13 of the main body 11 which is inserted and fixed between the vertebral bodies L1 and L2, and is rotated and screwed in while pressing, and 1 at the tip 43 surface of the male threaded portion 41.
  • the rear surfaces 31, 31 of the pair of pins 30, 30 are pressed so that the tips 32, 32 side of the pins 30, 30 are guided along the guide holes 17, 18 of the inclination angles ⁇ 1, ⁇ 2, respectively, and are bent sequentially.
  • the surfaces L1a and L2a are inclined and inserted into the vertebral bodies L1 and L2 (pin insertion and fixing step).
  • the press screw 40 is held by the cap 42 continuous surface of the main body 11 while being sufficiently pressed and held by hand or mechanical rotation restraining means (not shown) so as not to rotate the gripping portion 82 of the main body insertion driver 80. Screw into the internal thread 16 up to a predetermined trowel contacting the rear end face 13.
  • the cap 42 finally comes into contact with the rear end surface 13 of the main body 11, thereby defining the screwing allowance of the pressing screw 40 into the main body 11 for a predetermined stroke and the reverse rotational frictional force of the pressing screw 40. Therefore, it has the effect of preventing the reverse rotation of the pressing screw 40 and the effect of preventing the pin 30 from coming off.
  • the interbody fusion device 10 is a small size having an outer shape adapted to an appropriate distance between the vertebral bodies L1 and L2, and after the main body 11 is screwed between the vertebral bodies L1 and L2, the pressing screw 40 is used. Is simply bent into the female screw 16 of the main body 11 and is bent along the guide holes 17 and 18 from the tip 32 of the pin 30 that is pressed, and is inserted into the vertebral bodies L1 and L2 and fixed.
  • the interbody fusion treatment can be easily performed in a short time only by screwing around one axis from the direction of the main axis C1.
  • the interbody fusion surgery system, the surgical method, and the interbody space holding device of the present invention are greatly reduced in operation scale as compared with the conventional interbody fusion surgery, and operated. Since both the time and the recovery period can be greatly shortened, the physical and mental burdens of medical staff including patients and doctors, surgical invasion of patients, and economic burdens can be significantly reduced. Then, the pin 30 inserted and fixed in the vertebral bodies L1 and L2 can prevent the body 11 from retreating or rotating from the proper position, and the intervertebral body fixing reliability is ensured.
  • the intermediate fixing structure and operation are greatly simplified and compact, and the operability and economy are more advantageous.
  • FIG. 11 is a longitudinal cross-sectional view (main part cross-section) showing the state of fixation between the vertebral bodies L1 and L2 of the interbody fusion device 10a according to another embodiment (Example 2) of the present invention, and FIG. FIG.
  • the interbody fusion device 10a of the second embodiment is engaged with and fixed to the front surface portions of the adjacent vertebral bodies L1 and L2 loosely fitted to the pressing screw 50 with respect to the interbody fusion device 10 of the first embodiment.
  • the configuration is exactly the same as that of the first embodiment except that a fixing reinforcing tool 60 for reinforcing fixation between the vertebral bodies L1 and L2 is added. Accordingly, here, the same reference numerals are given to the constituent members having the same functions as those in the first embodiment even if the shapes are slightly different.
  • the pressing screw 50 has the same configuration as that of the pressing screw 40 in the interbody fusion device 10 of the first embodiment, but the male screw portion 51 that is screwed into the female screw 16 of the main body 11 has a fixed reinforcing tool 60 as compared with the pressing screw 40. The only difference is that it is longer by adding.
  • a cross groove 54 as shown in FIG. 12 is formed on the rear end surface of the cap 52 of the press screw 50 so that the tip engagement portion 93 of the press screw driver 90 is engaged.
  • a hexagonal hole having a concave groove shape with which an engaging portion 93 formed in a hexagonal wrench shape may be formed.
  • the fixed reinforcing member 60 is provided with a boss 61 that is loosely fitted to the male screw portion 51 of the pressing screw 50, and is vertically provided on the outer surface of the boss 61 so as to be vertically symmetrical, and the rear end surface of the boss 61 portion is pressed against the cap 52 portion of the pressing screw. And a pair of arms 62 and 62 that are engaged and fixed to the front portions of the adjacent vertebral bodies L1 and L2, respectively.
  • the material of the fixing reinforcing member 60 there are medical grade SUS, Ti, etc., as in the case of the main body 11, and Ti is particularly suitable from the viewpoint of strength and light weight.
  • the arm 62 is provided on the rear end side of the cap 52 side, and is erected on the outer surface of the boss 61 along the plate-like flange 62a whose tip is bent by approximately 90 ° toward the vertebral bodies L1 and L2, and the plate-like flange 62a.
  • the web 62b is formed in a substantially T-shaped cross section.
  • the distal end portion of the distal end of the arm 62 is formed in a tapered shape so as to be easily engaged with and fixed to the abdominal side surfaces of the vertebral bodies L1 and L2.
  • the distal end portion of the arm 62 of the fixed reinforcing tool 60 is appropriately positioned from the opposing surfaces L1a and L2a of the front surface portions of the adjacent vertebral bodies L1 and L2. Engage substantially T-shaped engaging grooves L1b and L2b to be engaged (fixed reinforcement engaging groove engaging step).
  • the pressing screw 50 is held by the cap 52 continuous surface while the pressing screw 50 is firmly pressed and held by hand or mechanical rotation restraining means (not shown). Screw into the internal thread 16 up to a predetermined trowel that contacts the rear end surface of the boss 60.
  • the interbody fixing method includes at least a pretreatment process, an intervertebral body space holding process, a pilot hole drilling process, a main body insertion process, a fixing reinforcement engaging groove drilling process, pin insertion, and fixing reinforcement. It has a tool fixing process.
  • the interbody fusion surgical system and the surgical method using the interbody fusion device 10a of the second embodiment have the same advantages as those of the first embodiment, and in addition, the fixation is loosely fitted to the pressing screw 50.
  • the distal ends of a pair of arms 62 of the reinforcing tool 60 are engaged with and fixed to the front portions of the adjacent vertebral bodies L1 and L2 by pressing the rear end surface of the boss 61 against the cap portion 52 of the pressing screw 50, respectively. Therefore, since the interbody fusion is strongly reinforced by a simple operation, the reliability of the interbody fusion can be easily improved.
  • the arm 62 can be provided with appropriate rigidity, and the reverse reaction force of the pressing screw 50 is increased and held by the rigidity reaction force. The retaining effect can be further improved.
  • FIG. 13 is a longitudinal sectional view (main part sectional view) showing a concept of an interbody fusion device 10b of still another embodiment (Example 3) of the present invention
  • FIG. 14 is a view taken along the line PP in FIG. .
  • the interbody fusion device 10b of the third embodiment is different from the interbody fusion device 10 of the first embodiment only in that the outer shape of the main body 11b is substantially tapered and formed into a hollow truncated cone shape.
  • the configuration is exactly the same as in the first embodiment. Therefore, the same reference numerals are given to constituent members having the same functions as those in the first embodiment even if the shapes are slightly different, and the description thereof will be omitted because they are duplicated.
  • the outer shape of the main body 11b of Example 3 is formed in a substantially tapered truncated cone shape having a taper along its length at an angle corresponding to the normal anterior bay posture angle of the lower vertebral body L2, for example, approximately 9 °.
  • the frustoconical taper angle of the main body 11b widens so that the adjacent vertebral bodies L1 and L2 form an appropriate front bay posture angle when the main body 11b is fitted in a predetermined position over the outer diameters of the front end and the rear end.
  • a quantity can be defined.
  • FIG. 15 is a longitudinal sectional view (main part sectional view) showing a concept of an interbody fusion device 10c of still another embodiment of the present invention (Example 4), and FIG. 16 (a) is a friction plate 55 of FIG.
  • FIG. 5B is a cross-sectional view taken along the line GG of FIG. 5B, and FIG.
  • the interbody fusion device 10c according to the fourth embodiment is loosely accommodated in the female screw 16 of the main body 11b with respect to the interbody fusion device 10b according to the third embodiment, and is provided at the rear ends 31 and 31 of the pins 30 and 30.
  • the rest of the configuration is exactly the same as that of the third embodiment, except that a friction plate 55 arranged in contact is added. Accordingly, here, the same reference numerals are given to the structural members having the same functions as those in the third embodiment even if the shapes are slightly different.
  • the friction plate 55 has a pair of appropriate depths for fitting the pin rear ends 31, 31 on the contact surface side with the pin rear ends 31, 31b.
  • the pin fixing grooves 55a and 55a are formed.
  • the friction plate 55 is fixed to the pin rear ends 31 and 31 by welding or bonding without providing the pin fixing groove 55a. Also good.
  • the friction plate 55 may be simply placed in contact with the pin rear ends 31, 31 without using the pin fixing groove 55a or the movement restraining means of the pin rear ends 31, 31 such as fixing. .
  • the pin rear end 31, 31 part of the pressing screw 40 or 50 is pressed via the friction plate 55, and therefore the pressing screw 40 or 50 and the pin rear end 31 are pressed.
  • the pin rear end 31, 31 surface is not directly subjected to the rotational force of the pressing screw 40 or 50 and the pin rear end 31, 31 portion is in contact with the inner surface of the female screw 16 portion of the main body 11b.
  • the pressing screw 40 or 50 is screwed into the female screw 16 with a small torque and the pin 30 is smoothly pushed forward without almost receiving the force of sliding (moving away) in the lateral direction with many gaps. Is possible.
  • FIG. 17 is a longitudinal sectional view (main part sectional view) showing the concept of an interbody fusion device 10d according to another embodiment of the present invention (Example 5), and FIG. 18 is a view taken along the line QQ of FIG. 19 is a plan view of FIG.
  • the outer surface engaging portion 14 of the main body 11 in the interbody fusion device 10 of the first embodiment is formed in a male screw shape, whereas the outer surface engagement of the main body 11d.
  • the configuration is exactly the same as that of the first embodiment except that the portion 14a is formed in a plurality of spline teeth parallel to the main axis C1. Therefore, the same reference numerals are given to constituent members having the same functions as those in the first embodiment even if the shapes are slightly different, and the description thereof will be omitted because they are duplicated.
  • the outer surface engaging portion 14a is formed in a plurality of spline teeth parallel to the main shaft C1
  • the main bodies 11 and 11b in the first to third embodiments can be screwed only by pressing the main body 11d. Since the rotation operation can be omitted, the vertebral bodies L1 and L2 can be fitted and fixed in a short time, and the operability is improved.
  • the radial outer surface vertex and axial tip of the spline teeth that are the outer surface engaging portion 14a are formed in a sharp blade shape, and can be easily fitted between the vertebral bodies L1 and L2 by pressing the main body 11d. be able to.
  • FIG. 20 is a longitudinal sectional view (major section) showing a concept of an interbody fusion device 10e of another embodiment of the present invention (Example 6), and FIG. 21 is a view taken along the line RR of FIG. 22 is a plan view of FIG.
  • the outer surface engaging portion 14b of the main body 11d in the interbody fusion device 10d of the fifth embodiment is formed in a spline shape, whereas the outer surface engagement of the main body 11e. Except for the point that the joint portion 14c is formed in a plurality of sawtooth shapes parallel to the main axis C1, the rest of the configuration is exactly the same as in the first or fifth embodiment. Therefore, the same reference numerals are given to the constituent members having the same functions as those in the first or fifth embodiment even if the shapes are slightly different, and the description thereof is omitted because it is duplicated.
  • the outer surface engaging portion 14a is formed in a plurality of sawtooth shapes parallel to the main shaft C1, the rotation for screwing the main bodies 11, 11b in the first to third embodiments just by pressing the main body 11e. Since the operation can be omitted, the vertebral bodies L1 and L2 can be inserted and fixed in a short time, and the operability is improved.
  • the vertebral body is pressed by pressing the main body 11e.
  • L1 and L2 it is possible to secure the reliability of fixing by preventing the main body 11e from coming off.
  • FIG. 23 is a longitudinal sectional view (major section) showing the concept of an interbody fusion device 10f according to another embodiment (Example 7) of the present invention.
  • the interbody fusion device 10f according to the seventh embodiment is different from the interbody fusion device 10 according to the first embodiment in that the pin 30a has a relatively short straight shape and the tip of the pressing screw 40a.
  • the configuration is the same as that of the first embodiment except that the shape of 43a is different. Therefore, the same reference numerals are given to constituent members having the same functions as those in the first embodiment even if the shapes are slightly different, and the description thereof will be omitted because they are duplicated.
  • the pair of pins 30a and 30a of the seventh embodiment are formed in a relatively short straight shape, and are loosely accommodated in the pair of guide holes 17 and 18, respectively.
  • Each tip 32a is formed in a sharp shape as appropriate, and in the initial state before the main body 11 is inserted between the vertebral bodies L1 and L2, as shown by the two-dot difference line in FIG. That is, it is accommodated in the outlets of the guide holes 17 and 18 so as not to protrude from the valley diameter.
  • the pressing screw 40a has a male screw portion 41 and a cap 42 having the same shape as the pressing screw 40 of the first embodiment, but the distal end portion 43a of the male screw portion 41 extends in a round bar shape slightly thinner than the hollow inner surface 16a.
  • An inclined surface 43a is formed that is cut so that the corners of the front end are in contact with the rear ends 31a and 31a of the pins 30a and 30a.
  • FIG. 24 (a) is a longitudinal sectional view (main section) showing the concept of an interbody fusion device 10g according to another embodiment (Example 8) of the present invention, and FIG. It is I arrow principal part sectional drawing.
  • the interbody fusion device 10g according to the eighth embodiment has a relatively long straight shape with respect to the interbody fusion device 10e according to the seventh embodiment, and a pair of pins 30b.
  • the rest of the configuration is exactly the same as that of the seventh embodiment except that the arrangement of the pair of guide holes 17a and 18a for accommodating 30b is different. Therefore, the same reference numerals are given to the structural members having the same functions as those in the seventh embodiment even though the shapes are slightly different, and the description thereof will be omitted because they are duplicated.
  • the pair of pins 30b and 30b of the eighth embodiment are formed in a relatively long straight shape and are loosely accommodated in a pair of guide holes 17a and 18a, which will be described later.
  • Each tip 32b is appropriately sharpened, and in the initial state (standby position) before the main body 11 is inserted between the vertebral bodies L1 and L2, as shown by the two-point difference line in FIG. It is accommodated in the outlets of the guide holes 17a and 18a within the valley diameter of the male screw 14, that is, so as not to protrude from the valley diameter.
  • the pins 30b and 30b accommodated in the pair of guide holes 17a and 18a provided in the main body 11g are arranged eccentrically with respect to the central axis of the main body 11g, for example. . Thereby, the mutual interference of the rear ends 31b and 31b at the standby position of the pair of pins 30b and 30b can be avoided.
  • the inclined axes C2 and C3 which are the central axes of the pair of guide holes 17a and 18a, are arranged in a plane substantially parallel to the central axis, but the tip 32b of the pin 30b is pushed in.
  • they may be arranged in any direction and asymmetrically with respect to the main axis C1, or they are eccentric with respect to the main axis C1 and arranged in a plane in any direction. Also good.
  • FIG. 25 is a longitudinal sectional view (major section) showing the concept of an interbody fusion device 10h according to another embodiment (Example 9) of the present invention.
  • the shape of the pair of pins 30c and 30c and the guide holes 17c and 18c is gentler toward the distal end than the interbody fusion device 10g according to the eighth embodiment.
  • the rest of the configuration is exactly the same as that of the eighth embodiment except that it is formed in a concave arc or curve. Therefore, the same reference numerals are given to the structural members having the same functions as those of the eighth embodiment even if the shapes are slightly different, and the descriptions thereof are omitted because they are duplicated.
  • a pair of concave arcs or curved guide holes 17c, 18c provided in the main body 11h is provided on the main body 11h so as to avoid mutual interference between the rear ends 31c, 31c at the standby position of the pair of pins 30c, 30c.
  • the pin 30c can be arranged along an arbitrary direction as long as the tip 32c of the pin 30c is pushed and does not protrude from the outer surface of the vertebral bodies L1 and L2 with respect to the central axis.
  • FIG. 26 is a longitudinal sectional view (major section) showing the concept of an interbody fusion device 10i of still another embodiment (Example 10) of the present invention.
  • the shape of the pair of pins 30d and 30d and the guide holes 17d and 18d is gentler toward the distal end than the interbody fusion device 10h of the ninth embodiment.
  • the rest of the configuration is exactly the same as that of the ninth embodiment except that it is formed in a convex arc or curve. Therefore, the same reference numerals are given to the structural members having the same functions as those in the ninth embodiment even if the shapes are slightly different.
  • the pair of convex arcs or curved guide holes 17d and 18d provided in the main body 11i avoids mutual interference between the rear ends 31d and 31d at the standby position of the pair of pins 30d and 30d.
  • it can be arranged along any direction as long as it is decentered, for example, left and right with respect to the central axis of the main body 11i and the tip 32d of the pin 30d is pushed and does not protrude from the outer surface of the vertebral bodies L1 and L2. .
  • FIG. 44 is a longitudinal sectional view (main section) showing the concept of an interbody fusion device 10j according to still another embodiment (Example 11) of the present invention
  • FIG. 45 is a state in which the pressing screw 40j of FIG. 44 is removed.
  • the interbody fusion device 10j according to the eleventh embodiment is integrated with the base end portion 33 in which a pair of pins 30j and 30j are provided with a female screw hole 34 at the rear end of the interbody fusion device 10 according to the first embodiment.
  • the press screw 40j is provided with an insertion hole 44 that is coaxial with the female screw hole 34 of the base end 33, and the other configuration is exactly the same as in the first embodiment. is there. Accordingly, here, the same reference numerals are given to the constituent members having the same functions as those in the first embodiment even if the shapes are slightly different.
  • the pressing screws 40 and 40j of the above embodiments including this embodiment are moved from the main body 11 to 11i by the rotation operation in the direction opposite to the screwing direction into the main bodies 11 to 11i, and the main bodies 11 to 11i are intervertebral bodies. It can be removed from between the vertebral bodies by rotation and / or extraction operation in the direction opposite to the direction of insertion into the body, and can be taken out of the body.
  • the interbody fusion device 10j is configured so that the pressing screw 40j is attached to the main body 11 when an unexpected suppuration disorder due to infection or the like occurs after being fixed between the vertebral bodies via the pins 30j and 30j. Can be pulled out from the vertebral body by a pulling driver 95 having a male screw portion 95a for screwing the pins 30j and 30j into the female screw hole 34 of the base end portion 33 and taken out of the body together with the main body 11. Thereafter, the intervertebral body fixing device 10j can be re-fixed between the vertebral bodies after a treatment such as filling the vertebral bodies with antibiotics or aggregates if necessary.
  • the pressing screw 40j does not have to be completely removed from the main body 11.
  • the extraction screwdriver 95 can be inserted into the insertion hole 4 provided in the pressing screw 40j and the male screw portion 95a at the distal end portion can be screwed into the female screw hole 34 of the base end portion 33 of the pin 30j.
  • the pins 30j and 30j can be extracted from the vertebral body by the above-described extraction operation and taken out of the body together with the main body 11.
  • a blind plug (not shown, male screw portion 95a in FIG. 44) having an engaged portion such as a plus driver groove or a hexagonal hole at the rear end portion is usually provided. Is inserted and the blind plug is inserted by a screwdriver (not shown) having an engaging portion at the tip thereof that engages with the engaged portion prior to the pulling operation of the pins 30j and 30j. It can be removed from the female screw hole 34 and taken out of the body.
  • the blind plug inserted in the female screw hole 34 of the base end portion 33 of the pin 30j so as to be able to be taken out prevents foreign matter such as intervertebral spinal fluid or bone forming material from entering the female screw hole 34.
  • the extraction driver can be easily and quickly screwed into the female screw hole at the base end portion of the pin, and the operability of removing the interbody fusion device 10j is improved.
  • the blind plug inserted in the female screw hole 34 is inserted into the insertion hole 44 of the pressing screw 40j in a state of being screwed into the female screw 16 of the main body 11, and the driver (not shown) is inserted through the blind plug. It can be detached from the female screw hole 34 by engaging with the engaged portion at the end.
  • the pins 30j and 30j are mounted in the female screw 16 of the main body 11 with the blind plug inserted in the female screw hole 34 first, and the interbody fusion device At the time of removal, it is possible to sequentially take out the blind plug and the pins 30j and 30j after taking out the pressing screw to the outside.
  • FIG. 46 is a longitudinal cross-sectional view (main cross-sectional view) showing a concept of an interbody fusion device 10k according to still another embodiment (Example 12) of the present invention
  • FIG. 47 is a state in which the pressing screw 40k of FIG. 46 is removed.
  • the interbody fusion device 10k according to the twelfth embodiment is different from the interbody fusion device 10j according to the eleventh embodiment in that the pair of pins 30k and 30k each have a base end portion 33k provided with a female screw hole 34k at the rear end.
  • the press screw 40k is provided with a pair of insertion holes 45, 45 coaxial with the female screw hole 34k of the base end portion 33k, respectively, except that the pressing screw 40k is provided in a continuous manner.
  • the configuration is exactly the same. Therefore, here, the same reference numerals are given to the structural members having the same functions as those of the eleventh embodiment even if the shapes are slightly different.
  • pressing screw 40k of this embodiment is also rotated and pulled out from the inside of the main body 11 in the direction opposite to the screwing direction into the main body 11, and the main body 11 is also rotated in the direction opposite to the fitting direction between the vertebral bodies. It can be removed from between the vertebral bodies by the operation and can be taken out of the body.
  • the pressing screw 40k is attached to the main body 11 in the event that an unexpected suppuration disorder due to infection or the like occurs after being fixed between the vertebral bodies via the pins 30k, 30k. And the pins 30k and 30k are pulled out from the vertebral body by a pull-out driver 96 having male screw portions 96a screwed into the female screw holes 34k and 34k of the base end portions 33k and 33k, respectively, and taken out from the body together with the main body 11. Can do. Thereafter, the intervertebral body fixing device 10k can be re-fixed between the vertebral bodies after a treatment such as packing between the vertebral bodies with antibiotics or aggregates as necessary.
  • a blind plug (not shown, but not shown, male threaded portion 96a in FIG. 46) having a engaged portion such as a Phillips screwdriver groove or a hexagonal hole in the rear end portion is also usually provided in the female threaded hole 34k of the base end portion 33k of the pin 30k.
  • a screwdriver (not shown) provided with engaging portions at the distal end portions of the blind plugs to engage with the engaged portions prior to the pulling-out operation of the pins 30k and 30k. Can be removed from the female screw hole 34k and taken out of the body.
  • each member can be arbitrarily changed.
  • a plurality of pins 30, 30A to 30F, 30a to 30d, 30j, and 30k are arranged on one side of the vertebral bodies L1 and L2 in the extreme case, or two pairs such as substantially axisymmetric or asymmetrical.
  • the pins 30, 30A to 30F, 30a to 30d, 30j, and 30k are correspondingly thinner in the space accommodated in the female screw 16 of the main body 11, 11b to 11i as the quantity increases.
  • the outer surface engaging portion 14b of the main body 11 in the fifth embodiment can form the radial outer surface top portion of the spline teeth in a plurality of continuous sawtooth shapes.
  • the pair of arms 62 of the fixed reinforcing member 60 is not T-shaped in cross section, but at least the tip side is formed as a single plate, and one or more sharp pin-like protrusions are formed on the front surface of the plate. It is also possible to do.
  • the engaging grooves L1b and L2b are not provided in the front surface of the vertebral bodies L1 and L2 (fixed reinforcing tool engaging groove drilling It is also possible to press the tip of the arm 62 against the front surface of the vertebral bodies L1 and L2 and directly insert and fix the pin-like protrusions or sharp blades.
  • the shaft portion 81 can be a connection type that can be attached and detached in two in the longitudinal direction.
  • the front end engaging portion 93 of the pressing screw driver 90 is engaged with the rear end engaging portion 44 of the pressing screw 40, 50, 40 a, and the gripping portion 82 side shaft portion 81 is separated and shortened. It becomes easy to insert into the engaging portion 83 side shaft portion 81, and then the gripping portion 82 side shaft portion 81 can be reconnected, thereby improving operability.
  • interbody fusion devices 10, 10a to 10i, 10j, and 10k of the embodiments described above are inserted into the intervertebral disc space M between two adjacent vertebral bodies L1 and L2, and between the vertebral bodies L1 and L2.
  • the intervertebral body fixing device can be directly inserted into the intervertebral disc M, but is inserted between the vertebral bodies L1 and L2 after removing the intervertebral disc M that has been crushed and damaged by hernia or other defects or aging as necessary. May be.

Abstract

L'invention concerne un système d'intervention chirurgicale pour fusion lombaire intervertébrale qui comprend un dispositif de fusion lombaire intervertébrale simple et de petite taille, présente d'excellentes propriétés de manipulation, une fiabilité élevée et un rendement économique élevé, et permet de mettre en œuvre un traitement de fusion lombaire intervertébrale en peu de temps, ce qui permet de réduire considérablement l'inconfort du patient; et un dispositif pour maintenir l'espace lombaire intervertébral qui s'utilise dans une intervention chirurgicale de fusion lombaire intervertébrale. Le système d'intervention chirurgicale pour fusion lombaire intervertébrale destiné à être monté entre des corps lombaires (L1, L2) adjacents à fusionner comprend: un corps principal (11-11i), dans lequel des parties (15, 14-14c) de contact de surface extérieure entrant en contact avec des faces opposées (L1a, L2a) des corps lombaires sont formées sur la surface extérieure d'une plaque cylindrique sensiblement creuse ou une plaque conique creuse amincie qui présente une partie inférieure à l'extrémité avant et est adaptée au corps intervertébral lombaire; et un ou plusieurs trous de guidage (17-17d, 18-18d) pénétrant dans la direction du corps lombaire depuis la partie profonde d'une vis femelle (16), prévue dans la face (16a) intérieure creuse côté extrémité arrière, vers la surface extérieure, et qui sont formés et se déploient vers l'extérieur en forme d'éventail ouvert; et un dispositif (10-10k) pour fixer le corps lombaire intervertébral, qui comprend une ou plusieurs broches (30-30k) engagées dans les trous de guidage et des vis (40-40k, 50) de pressage interagissant avec la vis femelle (16), qui appuient sur l'extrémité arrière des broches grâce à la force de poussée de celles-ci, le côté extrémité avant de celles-ci étant guidé suivant les trous de guidage sous l'action des vis de pressage appuyant sur l'extrémité arrière des broches, de manière à insérer le dispositif dans les corps lombaires.
PCT/JP2010/051558 2009-02-10 2010-02-04 Système d'intervention chirurgicale pour fusion lombaire intervertébrale et dispositif pour maintenir l'espace intervertébral lombaire s'utilisant dans une intervention chirurgicale de fusion lombaire intervertébrale WO2010092893A1 (fr)

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JP2010550492A JP5553268B2 (ja) 2009-02-10 2010-02-04 椎体間固定外科手術システム及び椎体間固定外科手術用椎体間スペース保持装置

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JP2009-029014 2009-02-10
JP2009029014 2009-02-10

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Cited By (27)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012141715A1 (fr) * 2011-04-15 2012-10-18 Synthes Usa, Llc Ensemble de fixation
EP2618787A2 (fr) * 2010-09-23 2013-07-31 DePuy Synthes Products LLC Dispositif de fusion intervertébrale autonome
WO2013116464A1 (fr) 2012-01-31 2013-08-08 Blackstone Medical, Inc. Prothèse de disque intervertébral et procédé
JP2013539396A (ja) * 2010-09-03 2013-10-24 グローバス メディカル インコーポレイティッド 拡張可能な固定デバイスおよびその設置方法
US8882775B2 (en) 2011-04-15 2014-11-11 DePuy Synthes Products, LLC Fixation assembly
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US10182921B2 (en) 2012-11-09 2019-01-22 DePuy Synthes Products, Inc. Interbody device with opening to allow packing graft and other biologics
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