WO2017054506A1 - 横向移位钉尾、横向可调节脊柱螺钉及植入方法 - Google Patents

横向移位钉尾、横向可调节脊柱螺钉及植入方法 Download PDF

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Publication number
WO2017054506A1
WO2017054506A1 PCT/CN2016/085194 CN2016085194W WO2017054506A1 WO 2017054506 A1 WO2017054506 A1 WO 2017054506A1 CN 2016085194 W CN2016085194 W CN 2016085194W WO 2017054506 A1 WO2017054506 A1 WO 2017054506A1
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Prior art keywords
nail
tail
mounting head
screw
laterally adjustable
Prior art date
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PCT/CN2016/085194
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English (en)
French (fr)
Inventor
刘明岩
邱勇
宋跃明
陈其昕
让-夏尔勒与埃克
刘瑞锋
Original Assignee
上海三友医疗器械股份有限公司
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Publication date
Priority claimed from CN201520771288.2U external-priority patent/CN205107855U/zh
Priority claimed from CN201510642652.XA external-priority patent/CN106551721B/zh
Application filed by 上海三友医疗器械股份有限公司 filed Critical 上海三友医疗器械股份有限公司
Priority to EP16850131.0A priority Critical patent/EP3357442A4/en
Priority to JP2018517295A priority patent/JP2018531081A/ja
Priority to KR1020187012070A priority patent/KR102240675B1/ko
Priority to US15/765,121 priority patent/US20180303519A1/en
Priority to AU2016333197A priority patent/AU2016333197B2/en
Publication of WO2017054506A1 publication Critical patent/WO2017054506A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7041—Screws or hooks combined with longitudinal elements which do not contact vertebrae with single longitudinal rod offset laterally from single row of screws or hooks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7046—Screws or hooks combined with longitudinal elements which do not contact vertebrae the screws or hooks being mobile in use relative to the longitudinal element
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A61B17/7037—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other wherein pivoting is blocked when the rod is clamped

Definitions

  • the invention relates to a lateral displacement tail.
  • the invention also relates to a laterally adjustable spinal screw and method of implantation.
  • the application of spinal internal fixation technology began in the 1960s to treat a variety of spinal diseases, such as spinal deformity, adolescent scoliosis, spinal fractures, and degenerative diseases of the spine.
  • the spinal fixation technique can be briefly described as the following steps: First, select the spinal segment to be fixed, and implant anchoring instruments (such as hooks or hooks) at specific ends of the segment and all or part of the vertebral body between them.
  • a locking instrument such as a fixed rigid plate or a fixed rod
  • a locking instrument such as a fixed rigid plate or a fixed rod
  • the bone graft material is placed between the inner vertebral bodies, and the spinal segment is gradually integrated into one body after a period of surgery to ensure long-term stability.
  • Each single vertebra can be divided into a front and a rear, a front part, that is, an abdomen direction part, a rear part, a back direction part, and a bone tissue connecting the front and the back is called a pedicle. All the screws that are inserted into the vertebral body through the pedicle from the posterior into the vertebral body are collectively referred to as pedicle screws, and the studs that are usually left behind are used to lock the connecting rods.
  • the pedicle screw is the most commonly used anchoring device in the current spinal fixation system, consisting of a nail tail (a threaded portion implanted inside the bone) and a nail seat (the rest remaining outside the bone).
  • pedicle screws are divided into fixed angle screws (as shown in Figure 1, the nail tail and the nail seat are integrated) and variable angle screws (as shown in Figure 2, the nail tail and the nail seat have a certain fold Adjust the angle) two.
  • screws implanted in different vertebral bodies may form a right and left misalignment, which may cause great difficulty in loading the connecting rod, especially in the case of using multiple screws.
  • doctors have to make some compromises, such as trying to arrange the screws into a line, so that it is difficult to ensure that each screw is implanted under ideal conditions, or by bending the connecting rod to fit each nail seat, which makes the operation difficult.
  • an object of the present invention is to provide a lateral displacement tail, a laterally adjustable spinal screw and an implantation method for solving a plurality of screws implanted in a vertebral body in the prior art. It is difficult to line up the problem.
  • the present invention provides a lateral displacement tail
  • the nail tail includes a fixed column that can be screwed into the vertebral body and a platform at the end of the fixed column, and the platform is provided with
  • the mounting head to which the nail base is attached has an eccentricity between the center of the mounting head and the axis of the fixed post.
  • the eccentricity between the center of the mounting head and the axis of the fixed post ranges from 1 mm to 5 mm.
  • the outer peripheral surface of the fixing post is provided with a thread.
  • the outer surface of the mounting head is a spherical surface, and the top of the mounting head is provided with a non-circular mounting adjustment hole that is recessed inward.
  • the present invention further provides a laterally adjustable spinal screw, the screw comprising the tail of the above-mentioned technical solution and a nail seat mounted on the mounting head of the nail tail, the top of the nail seat is provided In the rod groove of the connecting rod, the rod groove is recessed downward from the top of the nail seat and penetrates the nail seat in the radial direction.
  • the bottom of the rod groove is a curved surface adapted to the outer peripheral surface of the connecting rod, and the side of the rod groove is provided with a locking bolt Matching locking threads.
  • the nail base comprises a nail seat jacket and a sliding tension ring sleeved in the nail seat jacket, and the sliding tension ring is sleeved on the mounting head of the nail tail, and the rod groove is located at one end of the nail seat shell away from the sliding tension ring.
  • the sliding tension ring is provided with a ball socket in which the mounting head is placed, the ball socket being provided with an opening facing the mounting head, the diameter of the opening being smaller than the maximum diameter of the mounting head.
  • the circumferential surface of the socket is provided with a plurality of extending grooves uniformly distributed in the circumferential direction, and the extending groove extends from the opening to an end corresponding to the opening.
  • the inner peripheral surface of the nail housing facing the tail end is provided with a limiting ring, and the inner circumferential surface of the limiting ring cooperates with the outer circumferential surface of the opening of the socket.
  • the inner peripheral surface of the nail housing has a loose portion that is recessed inwardly corresponding to the portion of the ball socket, and a gap is maintained between the loose portion and the outer circumferential surface of the socket.
  • the sidewall of the sliding tension ring is further provided with at least one limiting slot extending downward from the top, and the nail housing is provided with a limiting pin corresponding to the limiting slot.
  • an end of the sliding tension ring facing the rod groove is provided with an arc groove, and an inner circumferential surface of the arc groove corresponds to a bottom of the rod groove, and an inner circumferential surface of the arc groove is convex when the sliding tension ring is installed in position Out of the bottom of the rod groove.
  • the present invention also provides a method of implanting a laterally adjustable spinal screw into a vertebral body.
  • the laterally adjustable spinal screw is as described in the above technical solution.
  • the implantation method comprises the following steps:
  • the lateral displacement nail tail, the laterally adjustable spinal screw and the implantation method of the present invention have the following beneficial effects:
  • the lateral displacement nail tail, the lateral adjustable spine screw and the implantation method, the nail seat is connected into a line by designing a brand new screw, so that the installation process of the connecting rod is reliable and effective, and the spine is not improperly twisted and reduced.
  • the difficulty of the doctor's surgery has improved the surgical results.
  • Figure 1 shows a schematic view of the structure of a fixed angle screw in the prior art.
  • FIG. 2 is a schematic view showing the structure of a variable angle screw in the prior art.
  • Fig. 3 is a schematic view showing the structure of the lateral displacement nail tail of the present invention.
  • Figure 4 shows a front view of the lateral shifting tail shown in Figure 3.
  • Figure 5 is a schematic view showing the structure of the laterally adjustable spinal screw of the present invention.
  • Figure 6 is a schematic view showing the structure of the nail holder of the laterally adjustable spinal screw shown in Figure 5.
  • Figure 7 is a perspective view showing the nail holder shown in Figure 6.
  • Figure 8 is a schematic view showing the structure of the sliding tension ring of the nail holder shown in Figure 6.
  • 9 to 14 are schematic views showing the steps of the method of implanting the laterally adjustable spinal screw shown in Fig. 5.
  • the present invention provides a lateral displacement tail 1 which includes a screw that can be screwed into the vertebral body 6.
  • the fixing post 11 and the platform 12 at the end of the fixing post 11 are provided with a mounting head 13 for connection with the nail base 2, and an eccentricity is formed between the center of the mounting head 13 and the axis of the fixing post 11.
  • the position of the mounting head 13 can be adjusted by rotating the fixing post 11, so that the center of the mounting head 13 is maximally close to the reference line L (ie, the placement position of the connecting rod 3), so that it can be mounted on
  • the staple holders 2 on the mounting head 13 are located as far as possible in a straight line so that all the nail holders 2 can be connected by a connecting rod 3, which is located at the most optimal position on the spine without undue distortion of the spine.
  • the range of the eccentricity D between the center of the mounting head 13 and the axis of the fixing post 11 is preferably 1 mm to 5 mm, and the range of the eccentricity D substantially satisfies the range in which the tail 1 is rotated by 1/4 of a circumference, so that The mounting head 13 is maximally close to the requirement of the reference line L.
  • the outer peripheral surface of the fixing post 11 is provided with a thread.
  • the outer surface of the mounting head 13 is preferably a spherical surface, and the top of the mounting head 13 is provided with a non-circular mounting adjustment hole 14 recessed inwardly.
  • the cross section of the mounting adjustment hole 14 is preferably hexagonal so that a hex driver can be inserted into the mounting adjustment hole 14 and the position of the mounting head 13 can be adjusted using a hex driver.
  • the present invention provides a laterally adjustable spine screw comprising a stud 1 as described above and a stud 2 mounted on the mounting head 13 of the stud 1 with the top of the stud 2
  • a rod groove 21 for placing the connecting rod 3 the rod groove 21 is recessed downward from the top of the nail base 2 and penetrates the nail base 2 in the radial direction
  • the bottom of the rod groove 21 is a curved surface adapted to the outer peripheral surface of the connecting rod 3, the rod
  • the side surface of the groove 21 is provided with a locking thread 22 that cooperates with the locking bolt 4.
  • the nail base 2 Since the nail base 2 has a certain lateral displacement relative to the fixing post 11 of the tail 1 , if the nail base 2 is mounted on the tail 1 in advance, when the nail tail 1 rotates, the outer circumference of the nail base 2 is large, It is convenient to operate, and therefore the present invention proposes an arborable nail base design.
  • the nail base 2 After the nail tail 1 is fixed on the vertebral body 6, the nail base 2 is mounted on the nail tail 1.
  • the nail holder 2 mounted on the mounting head 13 is rotatable on the mounting head 13 so that the axes of the rod slots 21 of the plurality of nail holders 2 are aligned, so that the connecting rod 3 can be placed in the rod groove 21, and a plurality of rod grooves are provided. 21 connected together.
  • a locking bolt 4 is also fitted from the top of the rod groove 21 to engage the locking bolt 4 with the locking thread 22 on the side of the rod groove 21.
  • a specific structure of the nail base 2 is that the nail base 2 includes a nail seat outer sleeve 23 and a sliding tension ring 24 sleeved in the nail seat outer sleeve 23, and the sliding tension ring 24 is sleeved on the mounting head 13 of the nail tail 1
  • the groove 21 is located at one end of the nail housing 23 away from the sliding tension ring 24.
  • the sliding tension ring 24 is provided with a ball socket 25 on which the mounting head 13 is placed, the ball socket 25 being provided with an opening 26 facing the mounting head 13, the diameter of the opening 26 being smaller than the maximum diameter of the mounting head 13.
  • the mounting head 13 is rotatable at multiple angles within the ball socket 25 to allow the nail base 2 to be adjusted at multiple angles.
  • the circumferential surface of the ball socket 25 is provided with a plurality of extending grooves 27 uniformly distributed in the circumferential direction, and the extending groove 27 is open to the opening from the opening 26.
  • the corresponding end of 26 extends.
  • the ball socket 25 provided with the extending groove 27 is shaped like a petal. When the mounting head 13 is inserted into the ball socket 25 from the opening 26, the extending groove 27 is provided so that the ball socket 25 has a certain elasticity and can be slightly inclined.
  • the outer expansion ensures the smooth installation of the mounting head 13; when the connecting rod 3 is installed in the rod groove 21, the connecting rod 3 exerts a certain pressure on the sliding tension ring 24, and the setting of the extending groove 27 can make the ball socket 25 With a certain elasticity, the length of the sliding tension ring 24 in the axial direction can be changed in time to adapt to the installation of the connecting rod 3.
  • the inner circumferential surface of the nail housing 23 faces the end of the nail tail 1 with a limiting ring 28, the inner circumferential surface of the limiting ring 28 and the ball socket 25 The outer peripheral surface of the opening 26 is fitted.
  • the inner peripheral surface of the nail housing 23 is provided with a loose portion 29 recessed inwardly corresponding to the portion of the socket 25, and a gap is provided between the loose portion 29 and the outer peripheral surface of the socket 25 to provide a space for the ball socket 25 to be deformed.
  • the sidewall of the sliding tension ring 24 is further provided with at least one limiting slot 210 extending downward from the top.
  • the nail housing 23 is provided with a limiting pin 211 corresponding to the limiting slot 210.
  • An end of the sliding tension ring 24 facing the rod groove 21 is provided with an arcuate groove 212, and an inner circumferential surface of the arc groove 212 corresponds to the bottom of the rod groove 21, and when the sliding tension ring 24 is installed in position, the inside of the arc groove 212 The circumferential surface protrudes from the bottom of the rod groove 21.
  • a method of implanting the laterally adjustable spinal screw into a vertebral body comprising the steps of:
  • each tail 1 Places the mounting head 13 of each tail 1 in the ball socket 25 of the nail base 2, connect the tail 1 to the nail base 2, and rotate the nail base 2 so that the axis of the rod groove 21 of all the nail bases 2 is located. On the same line;
  • a locking bolt 4 is attached one by one at the top of each nail base 2, and the locking bolt 4 extends into the rod groove 21 and cooperates with the locking thread 22 in the rod groove 21, at which time the connecting rod 3 will be curved.
  • the groove 212 applies a certain pressure to move the sliding tension ring 24 downward, and the ball socket 25 is deformed to lock the mounting head 13.
  • the lateral displacement nail tail, the lateral adjustable spine screw and the implantation method of the present invention are designed by a brand new
  • the screws realize the connection of the nail bases, which makes the installation process of the connecting rods reliable and effective, does not cause improper distortion of the spine, reduces the difficulty of the doctor's surgery, and improves the surgical effect. Therefore, the present invention effectively overcomes various shortcomings in the prior art and has high industrial utilization value.

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Abstract

一种横向移位钉尾(1)、横向可调节脊柱螺钉及植入方法，螺钉包括钉尾(1)和安装于钉尾(1)的安装头(13)上的钉座(2)，钉座(2)的顶部设有用于放置连接棒(3)的棒槽(21)，棒槽(21)从钉座(2)的顶部向下凹陷并沿径向贯穿钉座(2)，棒槽(21)的底部为与连接棒(3)的外周面相适应的曲面，棒槽(21)的侧面设有与锁定螺栓(4)相配合的锁定螺纹(22)；钉尾(1)包括一根能旋入椎体(6)内的固定柱(11)和位于固定柱(11)的端部的平台(12)，平台(12)上设有用于与钉座(2)连接的安装头(13)，安装头(13)的中心与固定柱(11)的轴线之间具有偏心距。该横向移位钉尾(1)、横向可调节脊柱螺钉及植入方法，通过设计一个全新的螺钉，实现钉座(2)连成一线，使连接棒(3)的安装过程可靠有效，不会造成脊柱不适当的扭曲，减低了医生手术的难度，提高了手术效果。

Description

横向移位钉尾、横向可调节脊柱螺钉及植入方法 技术领域
本发明涉及一种横向移位钉尾。
本发明还涉及一种横向可调节脊柱螺钉及植入方法。
背景技术
脊柱内固定技术的应用始于上世纪60年代，用来手术治疗多种脊柱疾病，如脊柱畸形、青少年脊柱侧弯、脊柱骨折和脊柱退变疾病等。脊柱内固定技术可简述为以下几个步骤：首先，选择需固定的脊柱节段，在该节段两端和其间的全部或部分椎体上的特定部位植入锚接器械(如钩或螺钉等)；然后，将连接器械(如固定刚板或固定棒)锁定于每个钩或螺钉上，从而限制该脊柱节段内部相对运动，使其成为一个稳定体；最后，在该节段内各椎体间放入植骨材料(如自体骨或骨替代材料)，期待手术后一段时间内该脊柱节段逐渐融合成为一体，以保证长期的稳定。
每个单一脊椎可分为前方和后方，前方即腹部方向部分，后方即背部方向部分，连接前方和后方之间的骨组织称为椎弓根。所有由后方进入骨头经过椎弓根植入椎体内的螺钉统称为椎弓根螺钉，通常留在后方的钉尾配棒槽用来锁定连接棒。
椎弓根螺钉是目前脊柱内固定系统中最通常使用的锚接器械，由钉尾(植入骨头内部的螺纹部分)和钉座(其余留在骨头外部部分)组成。一般说来，椎弓根螺钉分为固定角度螺钉(如图1所示，钉尾和钉座为一体)和可变角度螺钉(如图2所示，钉尾和钉座有一定的折动调节角度)两种。
在一个脊柱固定手术中通常使用多枚螺钉，将螺钉分别植入每个需要固定的椎体内，然后将连接棒装入每个螺钉槽内锁定以最终达到固定脊柱的目的。螺钉的植入主要根据目标椎体的解剖特征和手术空间的限制，因此每棵螺钉进入骨头的位置和方向即使在相邻两个椎体之间也有可能很不同，固定角度螺钉的缺点在于无法调节脊柱在侧位面上的角度，锁定连接棒时会引起固定阶段内椎体间过度屈伸，而使用可调节角度螺钉可以很大程度上避免这类问题。然而在脊柱正位面上，植入不同椎体内的螺钉可能形成左右错位，这样会给连接棒的装入尤其在使用多个螺钉的情况下造成很大困难。通常医生不得不做出某些妥协，比如尽量将螺钉排成一线，从而难以保证每枚螺钉在理想状态下植入，或者通过弯曲连接棒来配合连接每个钉座，这样会使得手术操作困难复杂并增加一定的不确定性或造成脊柱不适当的扭曲。
直至目前为止，还没有能满意地解决这个问题的脊柱内固定器械和方法。
发明内容
鉴于以上所述现有技术的缺点，本发明的目的在于提供一种横向移位钉尾、横向可调节脊柱螺钉及植入方法，用于解决现有技术中植入椎体内的多根螺钉难以排成一线的问题。
为实现上述目的及其他相关目的，本发明提供一种横向移位钉尾，钉尾包括一根能旋入椎体内的固定柱和位于固定柱的端部的平台，平台上设有用于与钉座连接的安装头，安装头的中心与固定柱的轴线之间具有偏心距。
优选的，安装头的中心与固定柱的轴线之间的偏心距的范围为1mm～5mm。
优选的，固定柱的外周面设有螺纹。
优选的，安装头的外表面为一球面，安装头的顶部设有向内凹陷的非圆形的安装调节孔。
为实现上述目的及其他相关目的，本发明还提供一种横向可调节脊柱螺钉，螺钉包括上述技术方案所述的钉尾和安装于钉尾的安装头上的钉座，钉座的顶部设有用于放置连接棒的棒槽，棒槽从钉座的顶部向下凹陷并沿径向贯穿钉座，棒槽的底部为与连接棒的外周面相适应的曲面，棒槽的侧面设有与锁定螺栓相配合的锁定螺纹。
优选的，钉座包括钉座外套和套在钉座外套内的滑动涨紧环，滑动涨紧环套在钉尾的安装头上，棒槽位于钉座外套远离滑动涨紧环的一端。
进一步的优选，滑动涨紧环设有放置安装头的球窝，球窝设有面向安装头的开口，开口的直径小于安装头的最大直径。
更进一步的优选，球窝的周面上设有多个沿周向均匀分布的延伸槽，延伸槽从开口向与开口对应的一端延伸。
更进一步的优选，钉座外套的内周面面向钉尾的一端设有限位圈，限位圈的内周面与球窝的开口的外周面相配合。
更进一步的优选，钉座外套的内周面对应球窝的部分设有向内凹陷的宽松段，宽松段与球窝的外周面之间保持间隙。
进一步的优选，滑动涨紧环的侧壁上还设有从顶部向下延伸的至少一个限位槽，钉座外套上设有与限位槽对应的限位钉。
进一步的优选，滑动涨紧环面向棒槽的一端设有弧形槽，弧形槽的内周面与棒槽的底部相对应，滑动涨紧环安装到位时，弧形槽的内周面凸出于棒槽的底部。
为实现上述目的及其他相关目的，本发明还提供一种将横向可调节脊柱螺钉植入椎体内的方法，所述横向可调节脊柱螺钉如上述技术方案所述，植入方法包括以下步骤：
1)在椎体上确定每个螺钉的入钉点P，将所述每个螺钉的钉尾逐一从预设的入钉点P旋入椎体内；
2)在椎体上设定连接棒的放置位置，将连接棒的放置位置标记为参照直线L；
3)旋转平台，使安装头的中心最大限度地接近所述参照直线L；
4)在每个钉尾的安装头上装好钉座，旋转钉座，使所有钉座的棒槽的轴线位于同一条直线上；
5)将连接棒插入棒槽中，使所有钉座连为一体；
6)在每个钉座的顶部逐一装上锁定螺栓，锁定螺栓伸入棒槽内，并棒槽内的锁定螺纹相配合。
如上所述，本发明横向移位钉尾、横向可调节脊柱螺钉及植入方法，具有以下有益效果：
该横向移位钉尾、横向可调节脊柱螺钉及植入方法，通过设计一个全新的螺钉，实现钉座连成一线，使连接棒的安装过程可靠有效，不会造成脊柱不适当的扭曲，减低了医生手术的难度，提高了手术效果。
附图说明
图1显示为现有技术中的固定角度螺钉的结构示意图。
图2显示为现有技术中的可变角度螺钉的结构示意图。
图3显示为本发明横向移位钉尾的结构示意图。
图4显示为图3所示的横向移位钉尾的正视图。
图5显示为本发明横向可调节脊柱螺钉的结构示意图。
图6显示为图5所示的横向可调节脊柱螺钉的钉座的结构示意图。
图7显示为图6所示的钉座的立体示意图。
图8显示为图6所示的钉座的滑动涨紧环的结构示意图。
图9至图14显示为图5所示的横向可调节脊柱螺钉的植入方法的步骤示意图。
元件标号说明
1    钉尾
11   固定柱
12   平台
13   安装头
14   安装调节孔
2    钉座
21   棒槽
22   锁定螺纹
23   钉座外套
24   滑动涨紧环
25   球窝
26   开口
27   延伸槽
28   限位圈
29   宽松段
210  限位槽
211  限位钉
212  弧形槽
3    连接棒
4    锁定螺栓
5    钉尾专用把持起子
6    椎体
具体实施方式
以下由特定的具体实施例说明本发明的实施方式，熟悉此技术的人士可由本说明书所揭露的内容轻易地了解本发明的其他优点及功效。
请参阅图3至图14。须知，本说明书所附图式所绘示的结构、比例、大小等，均仅用以配合说明书所揭示的内容，以供熟悉此技术的人士了解与阅读，并非用以限定本发明可实施的限定条件，故不具技术上的实质意义，任何结构的修饰、比例关系的改变或大小的调整，在不影响本发明所能产生的功效及所能达成的目的下，均应仍落在本发明所揭示的技术内容所能涵盖的范围内。同时，本说明书中所引用的方向及量化用语，如“上”、“下”、“左”、“右”、“中间”及“一”等的用语，亦仅为便于叙述的明了，而非用以限定本发明可实施的范围，其相对关系的改变或调整，在无实质变更技术内容下，当亦视为本发明可实施的范畴。
如图3至图4所示，本发明提供一种横向移位钉尾1，钉尾1包括一根能旋入椎体6内 的固定柱11和位于固定柱11的端部的平台12，平台12上设有用于与钉座2连接的安装头13，安装头13的中心与固定柱11的轴线之间具有偏心距。
通过采用偏心的安装头13，可通过旋转固定柱11，调整安装头13的位置，使安装头13的中心最大限度地接近参照直线L(即连接棒3的放置位置)，这样可使安装在安装头13上的钉座2尽量位于一条直线上，使所有钉座2可通过一根连接棒3连接，脊柱螺钉位于脊柱上最理想的位置，不会造成脊柱不适当的扭曲。
安装头13的中心与固定柱11的轴线之间的偏心距D的范围优选为1mm～5mm，该偏心距D的范围基本上满足钉尾1在旋转1/4周的范围内，即可使安装头13最大限度地接近参照直线L的要求。
为了便于钉尾1与椎体6的固定，固定柱11的外周面设有螺纹。
安装头13的外表面优选为一球面，安装头13的顶部设有向内凹陷的非圆形的安装调节孔14。安装调节孔14的截面优选为六角形，这样可以在安装调节孔14中插入六角起子，使用六角起子调整安装头13的位置。
如图5至图8所示，本发明提供一种横向可调节脊柱螺钉，包括如上所述的钉尾1和安装于钉尾1的安装头13上的钉座2，钉座2的顶部设有用于放置连接棒3的棒槽21，棒槽21从钉座2的顶部向下凹陷并沿径向贯穿钉座2，棒槽21的底部为与连接棒3的外周面相适应的曲面，棒槽21的侧面设有与锁定螺栓4相配合的锁定螺纹22。
由于钉座2相对于钉尾1的固定柱11有一定的横向移位，若预先将钉座2安装在钉尾1上，钉尾1旋转时，钉座2的运动外圆较大，不方便操作，因此本发明提出了一种可装配的钉座设计，在钉尾1在椎体6上固定好后，再将钉座2安装于钉尾1上。安装在安装头13上的钉座2可在安装头13上旋转，使多个钉座2的棒槽21的轴线成一直线，使连接棒3可以放置在棒槽21内，将多个棒槽21连在一起。为了固定连接棒3，还从棒槽21的顶部装有锁定螺栓4，将锁定螺栓4与棒槽21的侧面的锁定螺纹22相配合。
钉座2的一种具体结构为：钉座2包括钉座外套23和套在钉座外套23内的滑动涨紧环24，滑动涨紧环24套在钉尾1的安装头13上，棒槽21位于钉座外套23远离滑动涨紧环24的一端。
滑动涨紧环24设有放置安装头13的球窝25，球窝25设有面向安装头13的开口26，开口26的直径小于安装头13的最大直径。安装头13可在球窝25内多角度转动，使钉座2可多角度调节。
球窝25的周面上设有多个沿周向均匀分布的延伸槽27，延伸槽27从开口26向与开口 26对应的一端延伸。设有延伸槽27的球窝25的形状像花瓣一样，当安装头13从开口26放入球窝25的过程中，延伸槽27的设置，可使球窝25具有一定的弹性，能略微向外扩展，保证安装头13的顺利安装；而当连接棒3安装到棒槽21中时，连接棒3会对滑动涨紧环24施加一定的压力，延伸槽27的设置，可使球窝25具有一定的弹性，可适时地改变滑动涨紧环24沿轴向的长度，以适应连接棒3的安装。
为了保证滑动涨紧环24不会从钉座外套23中滑落，钉座外套23的内周面面向钉尾1的一端设有限位圈28，限位圈28的内周面与球窝25的开口26的外周面相配合。
钉座外套23的内周面对应球窝25的部分设有向内凹陷的宽松段29，宽松段29与球窝25的外周面之间保持间隙，提供了供球窝25变形的空间。
滑动涨紧环24的侧壁上还设有从顶部向下延伸的至少一个限位槽210，钉座外套23上设有与限位槽210对应的限位钉211。当滑动涨紧环24插入钉座外套23中到达预定位置时，限位钉211卡在限位槽210的底部，将滑动涨紧环24与钉座外套23的相对位置锁定。
滑动涨紧环24面向棒槽21的一端设有弧形槽212，弧形槽212的内周面与棒槽21的底部相对应，滑动涨紧环24安装到位时，弧形槽212的内周面凸出于棒槽21的底部。当连接棒3安装到棒槽21中后，从棒槽21的顶部装上锁定螺栓4，由于弧形槽212的内周面凸出于棒槽21的底部，连接棒3会对弧形槽212施加一定的压力，使滑动涨紧环24向下移动，此时，球窝25变形后锁紧安装头13，使横向可调节脊柱螺钉的整体结构更加稳固。
将上述横向可调节脊柱螺钉植入椎体内的方法，包括以下步骤：
1)在椎体6上确定每个螺钉的入钉点P，使用钉尾专用把持起子5将每个螺钉的钉尾1逐一从预设的入钉点P旋入椎体6内；
2)在椎体6上设定连接棒3的放置位置，将连接棒3的放置位置标记为参照直线L；
3)使用六角起子插入安装调节孔14中，旋转平台12，使安装头13的中心最大限度地接近参照直线L；
4)将每个钉尾1的安装头13放置在钉座2的球窝25内，使钉尾1与钉座2连接，旋转钉座2，使所有钉座2的棒槽21的轴线位于同一条直线上；
5)将连接棒3插入棒槽21中，使所有钉座2连为一体；
6)在每个钉座2的顶部逐一装上锁定螺栓4，锁定螺栓4伸入棒槽21内，并与棒槽21内的锁定螺纹22相配合，此时，连接棒3会对弧形槽212施加一定的压力，使滑动涨紧环24向下移动，球窝25变形后锁紧安装头13。
综上所述，本发明横向移位钉尾、横向可调节脊柱螺钉及植入方法，通过设计一个全新 的螺钉，实现钉座连成一线，使连接棒的安装过程可靠有效，不会造成脊柱不适当的扭曲，减低了医生手术的难度，提高了手术效果。所以，本发明有效克服了现有技术中的种种缺点而具高度产业利用价值。
上述实施例仅例示性说明本发明的原理及其功效，而非用于限制本发明。任何熟悉此技术的人士皆可在不违背本发明的精神及范畴下，对上述实施例进行修饰或改变。因此，举凡所属技术领域中具有通常知识者在未脱离本发明所揭示的精神与技术思想下所完成的一切等效修饰或改变，仍应由本发明的权利要求所涵盖。

Claims (13)

  1. 一种横向移位钉尾(1)，其特征在于：所述钉尾(1)包括一根能旋入椎体(6)内的固定柱(11)和位于所述固定柱(11)的端部的平台(12)，所述平台(12)上设有用于与钉座(2)连接的安装头(13)，所述安装头(13)的中心与所述固定柱(11)的轴线之间具有偏心距。
  2. 根据权利要求1所述的横向移位钉尾(1)，其特征在于：所述安装头(13)的中心与所述固定柱(11)的轴线之间的偏心距的范围为1mm～5mm。
  3. 根据权利要求1所述的横向移位钉尾(1)，其特征在于：所述固定柱(11)的外周面设有螺纹。
  4. 根据权利要求1所述的横向移位钉尾(1)，其特征在于：所述安装头(13)的外表面为一球面，所述安装头(13)的顶部设有向内凹陷的非圆形的安装调节孔(14)。
  5. 一种横向可调节脊柱螺钉，其特征在于：所述螺钉包括权利要求1至4任一项的钉尾(1)和安装于所述钉尾(1)的安装头(13)上的钉座(2)，所述钉座(2)的顶部设有用于放置连接棒(3)的棒槽(21)，所述棒槽(21)从所述钉座(2)的顶部向下凹陷并沿径向贯穿所述钉座(2)，所述棒槽(21)的底部为与所述连接棒(3)的外周面相适应的曲面，所述棒槽(21)的侧面设有与锁定螺栓(4)相配合的锁定螺纹(22)。
  6. 根据权利要求5所述的横向可调节脊柱螺钉，其特征在于：所述钉座(2)包括钉座外套(23)和套在所述钉座外套(23)内的滑动涨紧环(24)，所述滑动涨紧环(24)套在所述钉尾(1)的安装头(13)上，所述棒槽(21)位于所述钉座外套(23)远离所述滑动涨紧环(24)的一端。
  7. 根据权利要求6所述的横向可调节脊柱螺钉，其特征在于：所述滑动涨紧环(24)设有放置所述安装头(13)的球窝(25)，所述球窝(25)设有面向安装头(13)的开口(26)，所述开口(26)的直径小于所述安装头(13)的最大直径。
  8. 根据权利要求7所述的横向可调节脊柱螺钉，其特征在于：所述球窝(25)的周面上设有多个沿周向均匀分布的延伸槽(27)，所述延伸槽(27)从所述开口(26)向与所述开口(26)对应的一端延伸。
  9. 根据权利要求7所述的横向可调节脊柱螺钉，其特征在于：所述钉座外套(23)的内周面面向钉尾(1)的一端设有限位圈(28)，所述限位圈(28)的内周面与所述球窝(25)的开口(26)的外周面相配合。
  10. 根据权利要求7所述的横向可调节脊柱螺钉，其特征在于：所述钉座外套(23)的内周 面对应所述球窝(25)的部分设有向内凹陷的宽松段(29)，所述宽松段(29)与所述球窝(25)的外周面之间保持间隙。
  11. 根据权利要求6所述的横向可调节脊柱螺钉，其特征在于：所述滑动涨紧环(24)的侧壁上还设有从顶部向下延伸的至少一个限位槽(210)，所述钉座外套(23)上设有与所述限位槽(210)对应的限位钉(211)。
  12. 根据权利要求6所述的横向可调节脊柱螺钉，其特征在于：所述滑动涨紧环(24)面向所述棒槽(21)的一端设有弧形槽(212)，所述弧形槽(212)的内周面与所述棒槽(21)的底部相对应，所述滑动涨紧环(24)安装到位时，所述弧形槽(212)的内周面凸出于所述棒槽(21)的底部。
  13. 一种将横向可调节脊柱螺钉植入椎体内的方法，所述横向可调节脊柱螺钉如权利要求5至12任一项所述，其特征在于，所述植入方法包括以下步骤：
    1)在所述椎体(6)上确定每个螺钉的入钉点P，将所述每个螺钉的钉尾(1)逐一从预设的入钉点P旋入所述椎体(6)内；
    2)在椎体(6)上设定连接棒(3)的放置位置，将所述连接棒(3)的放置位置标记为参照直线L；
    3)旋转所述平台(12)，使所述安装头(13)的中心最大限度地接近所述参照直线L；
    4)在所述每个钉尾(1)的安装头(13)上装好钉座(2)，旋转所述钉座(2)，使所有钉座(2)的棒槽(21)的轴线位于同一条直线上；
    5)将连接棒(3)插入所述棒槽(21)中，使所有钉座(2)连为一体；
    6)在每个钉座(2)的顶部逐一装上锁定螺栓(4)，所述锁定螺栓(4)伸入所述棒槽(21)内，并所述棒槽(21)内的锁定螺纹(22)相配合。
PCT/CN2016/085194 2015-09-30 2016-06-08 横向移位钉尾、横向可调节脊柱螺钉及植入方法 WO2017054506A1 (zh)

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EP16850131.0A EP3357442A4 (en) 2015-09-30 2016-06-08 CROSS-SHIFTING SCREW TAIL, LATERALALLY ADJUSTABLE VERTEBRAL SCREW, AND IMPLANTATION METHOD
JP2018517295A JP2018531081A (ja) 2015-09-30 2016-06-08 横方向変位型スクリュー後尾、横方向調整可能型脊柱スクリュー及びその埋め込み方法
KR1020187012070A KR102240675B1 (ko) 2015-09-30 2016-06-08 횡방향 시프팅 나사 꼬리, 횡방향 조절 가능한 척추 나사 및 이식 방법
US15/765,121 US20180303519A1 (en) 2015-09-30 2016-06-08 Transverse shift screw tail, transverse adjustable spinal screw, and implantation method
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CN201510642652.XA CN106551721B (zh) 2015-09-30 2015-09-30 横向可调节脊柱螺钉
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