WO2017119862A1 - Implant de remplacement corporel télescopique pour vertèbre "las-3" et procédé d'implantation - Google Patents

Implant de remplacement corporel télescopique pour vertèbre "las-3" et procédé d'implantation Download PDF

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Publication number
WO2017119862A1
WO2017119862A1 PCT/UA2016/000073 UA2016000073W WO2017119862A1 WO 2017119862 A1 WO2017119862 A1 WO 2017119862A1 UA 2016000073 W UA2016000073 W UA 2016000073W WO 2017119862 A1 WO2017119862 A1 WO 2017119862A1
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WO
WIPO (PCT)
Prior art keywords
implant
rod
shells
filler
bodies
Prior art date
Application number
PCT/UA2016/000073
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English (en)
Russian (ru)
Inventor
Алексей Сергеевич НЕХЛОПОЧИН
Сергей Николаевич НЕХЛОПОЧИН
Original Assignee
Алексей Сергеевич НЕХЛОПОЧИН
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Application filed by Алексей Сергеевич НЕХЛОПОЧИН filed Critical Алексей Сергеевич НЕХЛОПОЧИН
Publication of WO2017119862A1 publication Critical patent/WO2017119862A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs

Definitions

  • the invention relates to medicine, namely to traumatology, neurosurgery, orthopedics and vertebrology when restoring the functions of the anterior supporting complex after resection of one or more vertebral bodies, and can be used in the surgical treatment of diseases and injuries of the spine during anterior fusion at the level of the cervical and thoracolumbar spine using artificial implants.
  • Known vertical mesh endoprosthesis of the vertebra made in the form of a hollow cylindrical rod with through lateral holes located in tiers along the perimeter of each tier, with the teeth located at the ends of the rod formed by dissection of the upper and lower tier of the holes, and the cavity of the rod filled with crushed bone material or its substitute.
  • the method of implanting this endoprosthesis involves resection of the damaged vertebral body in the required and sufficient volume, distraction of the vertebral segment and introduction of a vertical endoprosthesis instead of the resected vertebra into the resulting gap, as well as fixing the restored portion of the spine using plates attached to adjacent to the resected vertebra with screws [see article: Harms J Instrumented spinal surgery Principles and techniques- Thieme, Stuttgart-New York, 1999. - P. 198].
  • the main significant drawback of the known endoprosthesis is the imperfection of its design, which not only does not provide reliable stabilization of the vertebral motor segment due to the inability to fix its design to the bodies of adjacent vertebrae, which can cause prolapse (subsidence) of the endoprosthesis in the bodies of these vertebrae.
  • additional fixation of the vertebral motor segment by the ventral plate is necessary, which in itself complicates and increases the operation time.
  • errors in the selection of the length of the endoprosthesis at the stage of its formation before installation in the intervertebral space of the spine can lead to a number of postoperative complications.
  • a telescopic prosthesis of the vertebral body is also known, which is a central hollow stem with a unidirectional external thread, on which a half-housing and a nut are screwed on one side, the rotation of which ensures the movement of the stem (extension / retraction) to change the total length of the endoprosthesis .
  • the half-shell has a through side holes located in tiers, one of which is threaded to install a locking screw in it to exclude the possibility of its rotation relative to the longitudinal axis of the endoprosthesis.
  • the implantation method using a known telescopic prosthesis involves the complete or partial resection of a damaged or damaged vertebral body at the required level and the introduction of a telescopic prosthesis into the resulting bone defect, the stock of which is pre-filled with crushed natural bone or artificial filler, as well as fixing the structure using screws screwed through the L-shaped half-plates into the vertebrae adjacent to the resected [see prospectus by ulrich GmbH & Co. KG. ulrich medical ® SPINAL SYSTEMS. Endoprosthesis ADDplus TM - vertebral body replacement with blades].
  • the main joint significant drawback of the known technical solutions is the impossibility of forming a reliable bone block instead of a resected vertebral body, since the endoprosthesis rod does not have an internal cavity of sufficient volume for the filler (the diameter of the internal cavity in the rod does not exceed 5 mm).
  • the length of the internal cavity increases, and in its central part there is a filling defect (insufficiency) between the half-housing filler and the rod filler, and the lack of technical capability (there is no access to the internal cavity in the center of the endoprosthesis) to fill this deficiency with an additional portion of the filler will inevitably lead to the formation of bone-fibrous or fibrous fusion of the filler in the center of the endoprosthesis, which reduces the effectiveness of fusion.
  • the structural complexity of the known telescopic the prosthesis due to the presence of a nut and also several types of holes in the half-shell, as well as the increased complexity of changing the length of the prosthesis and fixing its length.
  • the telescopic prosthesis of the vertebral body is a central hollow rod with a thread that is directed in different directions from its center, onto which half-shells with teeth are screwed on their outer ends, and equipped with L-shaped half-plates with twin screw holes, as well as the stem and half-bodies have through lateral radial holes of the same diameter, located in tiers.
  • the implantation method using a known telescopic prosthesis of the vertebral body involves the complete or partial resection of the damaged or damaged vertebral body at the required level and the introduction of a telescopic prosthesis into the resulting bone defect, the stock of which is pre-filled with crushed natural bone or artificial filler, as well as the reclamation of a segment of the spine and fixation of the structure with the help of L-shaped half-plates attached with screws to adjacent vertebral vertebrae [see US Pat. Of Ukraine N ° 85708 according to Claus F61F 2/44 published on November 25, 2013 in Bull. NQ 22].
  • the main common disadvantage of the known method of implantation and telescopic prosthesis of the vertebral body is that it is impossible to form a supportive bone block instead of a resected vertebra using crushed filler (bone material) during anterior spinal fusion. or its substitute), since it is practically impossible for the latter to completely and densely fill the inner cavity of the rod of the telescopic prosthesis.
  • the filler at the implant poles will already be insufficient for sure, but it is not possible to add it to the inside of the endoprosthesis due to the lack of technical capabilities in the half-shells, for example, functional openings of sufficient size, which could provide free access to the internal cavity of the used telescopic prosthesis of the vertebral body. Therefore, the filler, of course, will simply be absent at the sites of contact of the endoprosthesis with the bodies of adjacent vertebrae.
  • the second significant drawback of the known technical solutions is the imperfection of the method of fixing the half-shells relative to the rod, which automatically causes a complication of the structure of the half-shells themselves due to the need to make radial lateral threaded holes in them for fixing the stem with screws.
  • This method of fixation creates some technological inconvenience (it is necessary to thread in all holes, and use only one of them to screw the lock screw into the hole, which turned out to be in a convenient place for this, which is technically and functionally not justified).
  • the basis of the invention is the task of further improving the known telescopic vertebral implant implant and the method of implanting it, as well as improving the medical parameters of treatment and rehabilitation of patients by making it possible to form a reliable bone block by making appropriate structural changes in the half-shells and the telescopic body replacing implant stock - Tata of the vertebra and the corresponding changes in the implantation process, which, together, provide access the internal cavity of the telescopic body-replacing implant after it is inserted into the spine and allow it not only to be completely filled with natural or artificial filler, but also to densify the latter, creating favorable conditions for the formation of a supportable bone block in the future, and also to simplify and maximize reliability to the maximum fixation of implant elements without any change in its total length, individually selected for a particular case of trauma or pathology of the vertebra in the conc etnogo patient due to fundamental changes in the retainer structure.
  • the telescopic vertebral body implant which is a central hollow rod with a thread that is multidirectional from its center, onto which half-shells with teeth are screwed on their outer ends, and equipped with L-shaped half-plates with pair openings for screws, as well as stock and half-shells open lateral radial holes of the same diameter, arranged in tiers, according to the proposal, in the half-shells under the L-shaped half-plates there are windows, mainly of rectangular shape, the height of which reaches almost the ends of the half-shells through which an additional portion of the filler is fed into the rod cavity, and the jumpers in the half-cases between the windows and their outer ends are made continuous with an extremely minimal thickness in their central sections to ensure that they can be forced iba in the direction of the longitudinal central axis of the implant without considerable efforts to secure the half-shells but the relative stem, as well as the lateral openings in the stem are made in the form of longitudinal grooves.
  • Figure 1 design of the proposed telescopic body-replacing vertebral implant, side view.
  • Figure 2 is the same, rear view.
  • Figure 3 is the same, end view.
  • Figure 4 is the same, plan view.
  • Figure 5 the proposed telescopic body-replacing vertebral implant prepared for installation in the spine (the stock is filled with filler, which is sealed), plan view.
  • Figure 6 the proposed telescopic body-replacing vertebral implant installed in the bone defect at the time of its additional unwinding (for the extension of adjacent vertebrae more than the required level), there is a lack of filler around adjacent vertebral vertebrae.
  • Figure 7 filling the internal cavity of the body-replacing implant with an additional portion of the filler.
  • Figure 8 the proposed telescopic body-replacing vertebral implant installed in the spine at the moment of additional extension of the adjacent vertebrae is more than the necessary level with the supplemented but not yet consolidated filler.
  • Figure 9 the proposed telescopic body-replacing vertebral implant installed in the spine at the time of decreasing its vertical size to a given distraction (filler compaction is observed).
  • Figure 10 is a diagram of the locking of a given position of the half-bodies relative to the rod. Description of a preferred embodiment of the invention
  • the proposed telescopic body-replacing vertebral implant contains a central cylindrical hollow rod 1 with multidirectional (left and right) threads from the center.
  • holes 2 are made for a tool (not shown) for its rotation.
  • the through lateral openings in the rod 1 are made in the form of longitudinal grooves 3.
  • half-bodies 4 are screwed with an internal corresponding multidirectional thread, to which L-shaped half-plates 5 with twin holes 6 for screws (not shown) are inseparably connected.
  • the cylindrical half-shells 4 have radial through lateral openings 7 arranged in tiers.
  • teeth 8 are formed, which prevent the half-shells 4 from shifting from the originally chosen place of their spatial orientation in the bone defect formed after resection of the vertebral body by introducing the teeth 8 into adjacent vertebral bodies.
  • the windows 9 are made from the L-shaped plates 5.
  • the jumper 10 in the half-shell 4 between the window 9 and its inner end has at its center the minimum thickness obtained in the process of forming the jumper 10 itself, for example, by grinding or milling (the process of shrinking until a “flat” is obtained).
  • the method of implanting the proposed telescopic body-replacing vertebral implant is carried out in the process of anterior spinal fusion as follows (using the example of the cervical spine).
  • a full or partial (depending on the pathology) resection of the damaged vertebral body is performed in the required interval.
  • a telescopic body-replacing implant pre-filled with filler 11 in the initial position, the half-bodies 4 are screwed into the rod 1 to such a level that the ends of the rod are higher than the teeth 8), are placed in the bone defect formed after resection of the affected or injured vertebral body between adjacent vertebrae. At this stage, these adjacent vertebrae can contact the ends of the stem 1 or such contact is minimal, depending on the pre-selected initial length of the telescopic body-replacing implant.
  • the closure plates of adjacent vertebral bodies are used as a direct sealing device, which, when the total length of the implant is reduced, act as pistons compressing the filler in the cavity of the implant.
  • end plates of adjacent vertebral bodies as a “working organ” has certain advantages, which are as follows.
  • the maximum compression (compaction) of any material is observed from the side of the piston, and as you move away from it, the compression force gradually dissipates due to the redistribution of the constituent forces exerting pressure on the material ( The strengths are gradually reduced and replaced by tangential components, which become more and more as you move away from the piston).
  • closure plates of adjacent vertebral bodies as means transmitting the compression force is the most successful technical solution, which allows simultaneous implant implantation in the interbody gap and the formation of a dense pillar from the filler 11, which is guaranteed to be in contact with the bodies adjacent vertebrae, which creates favorable conditions for the formation of a complete bone block in the future.
  • the implant is fixed with the help of L-shaped plates 5.
  • screws (not shown) are installed in the paired holes 6, with which the L-shaped plates 5 are screwed to adjacent call bodies.
  • the jumpers 10 are deformed (with a special tool from the outside, bending them in the center) in the middle of the implant.
  • the central sections of the jumpers 10 partially enter (deepen, bend) into the longitudinal grooves 3 of the rod 1, after which the rotation of the rod 1 relative to the half-shells 4 becomes no longer possible. Then the wound is sutured in layers.
  • the necessary reconstruction of the vertebral motor segment is achieved.
  • the bone tissue grows through the grooves 3 into the inside of the rod 1, where it grows together with the filler 11 located in the central cavity of the implant, and bone fusion of the filler 11 of the implant occurs not only with the bodies of adjacent vertebrae, but also with the remains of the resected body vertebra, which ensures not only a stable stabilization of the implant between the bodies of adjacent vertebrae, but also a reliable restoration of the supporting ability of the spine.
  • the teeth 8 at the outer ends of the half-shells 4 can have any configuration, including a columnar one with parallel sides, and their number can be different, including the minimum - three teeth 8 at each end, and the supporting surfaces of the ends of the half-shells 4 can be made inclined, as proposed and described in the patent of Ukraine N2 108579 C2.
  • the placement on the outer ends of the half-shells 4 of only three teeth 8, equally spaced from each other, is sufficient for reliable fixation of the implant and, at the same time, less traumatic for adjacent vertebrae.
  • the execution of the end surfaces of the half-shells 4 inclined makes it possible to take into account the natural angle of inclination of the end plates of the adjacent vertebrae and thus ensure complete restoration of the sagittal profile of the patient's spine.
  • the presence of a supporting platform at the end of the half-body 4, together with the blunt ends of the teeth 8, allows you to get the maximum supporting surface, and thus reduce the load on adjacent vertebrae, minimize their damage and reduce the likelihood of their destruction.
  • the claimed technical solutions are tested in practice.
  • the proposed telescopic body-replacing vertebral implant and the method of implanting it do not contain a single structural element or materials, as well as methods for performing fusion, which could not be recreated at the present stage of development of science and technology, in particular, in the field of neurosurgery , traumatology, orthopedics and vertebrology, therefore, the proposed technical solutions meet the condition of "industrial applicability", have technical and other advantages over the well-known counterpart ami, which confirms the possibility of achieving a technical result by the claimed objects.
  • a significant difference between the claimed telescopic body-replacing vertebral implant and the method of implanting it from the previously known ones is that the windows are made in the half-cases, allowing access to the inner cavity of the rod, the jumpers between the windows and the ends of the half-cases are solid with an extremely minimal thickness on their central sections, and in the rod, instead of round holes, longitudinal grooves are made.
  • the indicated distinctive features, in aggregate, make it possible to fill the internal cavity with the missing filler quantity followed by its compaction, simplify the technology of fixing the half-shells relative to the rod, which, as a result, allows to form a supportable bone block, to ensure high reliability of the implant fixation in the vertebra.
  • the medical effect of the implementation of the proposed technical solutions is obtained by simplifying and shortening the time of implantation regarding installation and fixation of a telescopic body-replacing implant, as well as the ability to quickly form a uniform a dense dense column of filler in the implant cavity along its entire length.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Neurology (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

Ce groupe d'inventions se rapporte au domaine de la médecine et peut être utilisé en neurologie dans le traitement de troubles et de dommages de la colonne vertébrale.. L'implant pour vertèbre consiste en un montant creux central avec des filetages allant dans différentes directions de puis son centre, sur lesquels viennent se visser un demi-corps avec des dents à leurs extrémités externes, et comportant des demi-plaques en forme de Г avec des ouvertures appariées sous les vis. Les demi-corps comportent des ouvertures radiales latérales traversantes d'un même diamètre disposées en étages. Dans les demi-corps et sous les demi-plaques en forme de Г se trouvent des fenêtres. Des pontets dans les demi-corps entre les fenêtres et leurs extrémités externes sont formés d'un seul tenant avec une épaisseur minimale limite dans leurs sections centrales. Après avoir placé l'implant entre deux vertèbres adjacentes, on effectue une hypercorrection du profil sagittal du segment vertébral opéré, et l'on ajoute dans la cavité ainsi formée de l'implant une quantité supplémentaire nécessaire de matière de charge jusqu'à ce qu'elle soit complètement remplie, après quoi on procède à un compactage. Les demi-corps de l'implant sont fixés par courbure forcée des des pontets fins dans les gorges du montant. Ce groupe d'inventions permet de remplir pleinement la cavité de l'implant, de former un bloc osseux capable d'appui, et d'assurer une fixation rigide des demi-corps par rapport au montant.
PCT/UA2016/000073 2016-01-04 2016-06-23 Implant de remplacement corporel télescopique pour vertèbre "las-3" et procédé d'implantation WO2017119862A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
UAA201600107 2016-01-04
UA201600107 2016-01-04

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WO2017119862A1 true WO2017119862A1 (fr) 2017-07-13

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN108685627A (zh) * 2018-06-15 2018-10-23 陕西东望科技有限公司 一种基于3d打印的脊柱假体及其制备方法
CN112370220A (zh) * 2020-10-20 2021-02-19 广东施泰宝医疗科技有限公司 一种可调高度、可转动的椎体假体

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8337558B2 (en) * 2008-01-29 2012-12-25 Aesculap Ag Vertebral body replacement implant
UA91698U (uk) * 2014-02-26 2014-07-10 Микола Олексійович Корж Ендопротез сегмента хребта

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8337558B2 (en) * 2008-01-29 2012-12-25 Aesculap Ag Vertebral body replacement implant
UA91698U (uk) * 2014-02-26 2014-07-10 Микола Олексійович Корж Ендопротез сегмента хребта

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN108685627A (zh) * 2018-06-15 2018-10-23 陕西东望科技有限公司 一种基于3d打印的脊柱假体及其制备方法
CN112370220A (zh) * 2020-10-20 2021-02-19 广东施泰宝医疗科技有限公司 一种可调高度、可转动的椎体假体

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