WO2018233237A1 - 一种脊柱椎板切除术后用的人工椎板 - Google Patents

一种脊柱椎板切除术后用的人工椎板 Download PDF

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Publication number
WO2018233237A1
WO2018233237A1 PCT/CN2017/115396 CN2017115396W WO2018233237A1 WO 2018233237 A1 WO2018233237 A1 WO 2018233237A1 CN 2017115396 W CN2017115396 W CN 2017115396W WO 2018233237 A1 WO2018233237 A1 WO 2018233237A1
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lamina
screw
laminectomy
oblong hole
spinal
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PCT/CN2017/115396
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English (en)
French (fr)
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尹飞
郭丽
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吉林大学
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Publication of WO2018233237A1 publication Critical patent/WO2018233237A1/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
    • A61B17/7059—Cortical plates

Definitions

  • the invention relates to the medical field, in particular to an artificial lamina for spinal laminectomy.
  • the lamina can be partially or completely regenerated after total laminectomy, and the regenerated lamina causes spinal stenosis.
  • Shen Kangping experts believe that the mechanism of spinal can restenosis after total laminectomy is: fibroblasts invade the defect area, fibrous tissue gradually forms, fills in the lamina defect area and compresses the spinal cord, along with the fibrous tissue to the cartilage tissue, The evolution of bone tissue until the completion of laminar regeneration, this compression persists, and fibrosis is mainly caused by the infiltration of fibroblasts in the rough side of the sacral spine muscle into the intermuscular hematoma.
  • the compressed nerve is easy to cause severe pain after lumbar spine surgery, and the scar adhesion has become a failure syndrome of lumbar spine surgery (Failed baclc surgery syndrome).
  • FBSS failed baclc surgery syndrome
  • the key to preventing spinal can restenosis is to prevent the compression and adhesion of the fibrous tissue filled by the laminectomy after the full laminectomy.
  • Fibrosis in the defect area is a normal pathological reaction, and it is more practical to prevent the fibrous tissue from compressing the spinal cord or the dural sac to prevent the formation of fibrous tissue.
  • the object of the present invention is to solve the above-mentioned lack of artificial lamina replacement after the existing spinal laminectomy, and the soft tissue such as muscles which are closed when the incision is pressed, which is prone to neurological symptoms and even paralysis problems, and provides a spinal lamina. Artificial lamina for resection.
  • the invention is composed of a lamina, a first screw and a second screw.
  • the two ends of the lamina have a first oblong hole and a second oblong hole.
  • the first screw is disposed in the first oblong hole, and the second screw is disposed in the second oblong circle.
  • the lamina is composed of a fixed plate body and a rotating plate body, and the rotating plate body is hinged on the fixed plate body through the rotating shaft;
  • the lamina is arched
  • the fixed plate body has a first sleeve
  • the rotating plate body has a second sleeve
  • the rotating shaft is respectively inserted in the first sleeve and the second sleeve.
  • the laminectomy is performed, the spinal cord is exposed, and the decompression surgery is completed.
  • the lamina is placed above the spine, and the rotating plate can be rotated for convenient positioning, and then according to the first oblong hole and the second oblong hole.
  • the lamina is installed, the fixed plate body portion is first installed, and the first screw is installed in the first oblong hole, the first screw is Match the threaded holes on the same side, tighten the first screw, then adjust the rotating plate body, install the second screw in the second oblong hole, the second screw cooperates with the screw hole on the same side, tighten the second screw, and the installation is completed.
  • the lamina is above the spinal cord, so that it can block soft tissues such as muscles that are closed when the incision is closed, so that the spinal cord can be prevented from being oppressed, and serious complications such as neurological symptoms and even paralysis can be avoided.
  • the artificial lamina of different specifications is selected. Before the artificial lamina is placed, in order to be closely embedded with the defect, proper pruning is required;
  • cancellous bone particles should be implanted between the facet joints and the artificial lamina to facilitate the early fusion of the fixed segments.
  • artificial lamina is not recommended.
  • the invention has the advantages of simple structure, convenient use, firm fixation and convenient disassembly, and can block soft tissues such as muscles that are closed when the incision is closed, so that the spinal cord can be prevented from being pressed and adhered, and serious complications such as neurological symptoms and even paralysis can be avoided after the operation, and the patient can be used for a long time. Implanted for use.
  • Figure 1 is a schematic perspective view of the present invention.
  • Figure 2 is an exploded perspective view of the present invention.
  • Figure 3 is a schematic view of the force applied during use of the present invention.
  • Figure 4 is a schematic perspective view of the present invention in use.
  • Figure 5 is a schematic view of the cervical vertebrae force after laminectomy.
  • Figure 6 is a schematic view of the cervical vertebrae force before the laminectomy.
  • the present invention is composed of a lamina 1, a first screw 2 and a second screw 3.
  • the ends of the lamina 1 have a first long circle. a hole 112 and a second oblong hole 121, the first screw 2 is disposed in the first oblong hole 112, and the second screw 3 is disposed in the second oblong hole 121;
  • the lamina 1 is composed of a fixed plate body 11 and a rotating plate body 12, and the rotating plate body 12 is hinged on the fixed plate body 11 through the rotating shaft 13;
  • the lamina 1 is arched
  • the fixed plate body 11 has a first sleeve 111 thereon, and the rotating plate body 12 has a second sleeve 122.
  • the rotating shaft 13 is respectively inserted into the first sleeve 111 and the second sleeve 122.
  • Figure 1 Please refer to Figure 1, Figure 2, Figure 3, Figure 4, Figure 5 and Figure 6.
  • the rotating plate body 12 can be rotated for convenient positioning, and then according to the positions of the first oblong hole 112 and the second oblong hole 121, two threads are punched on the sides of the vertebrae at the segments scheduled for laminectomy.

Abstract

一种脊柱椎板切除术后用的人工椎板，由椎板（1）、第一螺钉（2）和第二螺钉（3）组成，椎板（1）两端具有第一长圆孔（112）和第二长圆孔（121），第一螺钉（2）设置在第一长圆孔（112）内，第二螺钉（3）设置在第二长圆孔（121）内；椎板（1）是由固定板体（11）和转动板体（12）组成，转动板体（12）通过转轴（13）铰接在固定板体（11）上；椎板（1）为拱形；固定板体（11）上具有第一轴套（111），转动板体（12）上具有第二轴套（122），转轴（13）分别穿在第一轴套（111）和第二轴套（122）内。够阻挡关闭切口时合拢的肌肉等软组织，使脊髓避免受到压迫以及粘连，避免术后产生神经症状甚至瘫痪等严重并发症，患者可长时间植入使用。

Description

一种脊柱椎板切除术后用的人工椎板 技术领域
本发明涉及医疗领域，特别涉及一种脊柱椎板切除术后用的人工椎板。
背景技术
脊椎手术中经常需要解除神经压迫而做椎板切除减压术，椎板切除后硬膜囊或者说脊髓会失去椎板的保护而显露在外，由于多数患者不会产生脊髓压迫症状，所以目前临床并不采取一些措施保护脊髓。但是，如果椎板的切除范围比较大，脊髓显露的范围也就会很大，手术结束后，分离到两侧的肌肉等软组织合拢起来就会压到脊髓，严重的会产生瘫痪，并且随着全椎板切除术治疗椎管狭窄技术日渐成熟，一些术后并发症为椎板再生以及再生后引起的椎管狭窄也逐渐被人们重视，最近国内外有较多的椎板完全再生文献报道，全椎板切除后椎板可以部分再生或完全再生，再生的椎板导致椎管狭窄。沈康平等专家认为椎板全切除后椎管再狭窄的机制为：成纤维细胞侵入缺损区域，纤维组织逐渐形成，在椎板缺损区域填充并且使脊髓受压，随着纤维组织向软骨组织、骨组织的演变直至椎板再生完成，这种压迫持续存在，而纤维化则主要是由背侧损伤了骶棘肌粗糙面的成纤维细胞侵入肌间血肿所致。同时研究发现硬膜周围的纤维化既来自后方损伤的骶棘肌亦来自前弓损伤的纤维环和后纵韧带，同时前方的粘连会包绕神经根而导致侧方受累，从而首次提出了纤维化形成的三维立体学说。1974年LaRacoa经同样的实验提出了瘢痕形成的后源学说，认为硬膜外瘢痕粘连来自椎板外损伤肌肉的粗糙面面向椎管再生的结果，因此全椎板切除后椎板缺损区形成大量的瘢痕组织与暴露在外面的硬脊膜及神经根发生粘 连、牵扯、压迫，受压神经极易引起腰椎术后严重的疼痛，而瘢痕粘连已成为腰椎术后失败综合征(Failed baclc surgery syndrome FBSS)的一个主要原因，因此预防椎管再狭窄的关键在于防止全椎板切除后填充的纤维组织对脊髓或硬膜囊的压迫及粘连，另外必须清醒的认识到全椎板切除后手术部位缺损区的纤维化是正常的病理反应，预防纤维组织对脊髓或硬膜囊的压迫等防止纤维组织的形成显得更有实际意义。
现有技术，国内外学者采取各种物理和化学的方法防止椎板切除术后硬膜周围粘连形成，如用半流质材料(几丁糖、透明质酸)充填硬膜囊及神经根周围达到三维屏障作用，由于流动性大，局部药物不能保持稳定，效果不佳，有脊柱椎板切除术后缺少人工椎板代替，切口时合拢的肌肉等软组织压迫脊髓，容易产生神经症状，甚至出现瘫痪等问题。
发明内容
本发明的目的是要解决上述现有脊柱椎板切除术后缺少人工椎板代替，切口时合拢的肌肉等软组织压迫脊髓，容易产生神经症状，甚至出现瘫痪等问题，而提供一种脊柱椎板切除术后用的人工椎板。
本发明是由椎板、第一螺钉和第二螺钉组成，椎板两端具有第一长圆孔和第二长圆孔，第一螺钉设置在第一长圆孔内，第二螺钉设置在第二长圆孔内；
椎板是由固定板体和转动板体组成，转动板体通过转轴铰接在固定板体上；
所述椎板为拱形；
所述固定板体上具有第一轴套，转动板体上具有第二轴套，转轴分别穿在第一轴套和第二轴套内。
本发明的工作原理和过程：
脊柱手术中，做椎板切除手术，显露脊髓，完成减压手术，先将本椎板放置在脊柱上方定位，转动板体可转动，方便定位，然后根据第一长圆孔和第二长圆孔的位置，在预定做椎板重建的节段经椎两侧弓根打两个螺纹孔，安装椎板，先安装固定板体部分，将第一螺钉安装在第一长圆孔内，第一螺钉与同侧的螺纹孔相配合，拧紧第一螺钉，然后调整转动板体，将第二螺钉安装在第二长圆孔内，第二螺钉与同侧的螺纹孔相配合，拧紧第二螺钉，安装完成，椎板在脊髓的上方，从而能够阻挡关闭切口时合拢的肌肉等软组织，使脊髓避免受到压迫，避免术后产生神经症状甚至瘫痪等严重并发症。
本椎板植入存在以下注意事项：
1、椎管减压尽可能彻底，包括神经根管减压与神经根的松解，尽可能保留小关节；
2、根据术中测量椎板缺损大小选择不同规格的人工椎板，在安置人工椎板前，为使其与缺损处紧密相嵌，需进行适当修剪；
3、术中须彻底止血，特别是椎管内；
4、术中需在关节突关节间及人工椎板旁植入松质骨粒，以利固定节段早期融合，对于不行相应节段融合的患者，暂不建议安置人工椎板。
本发明的有益效果：
本发明结构简单、使用方便，固定牢靠，拆卸方便，够阻挡关闭切口时合拢的肌肉等软组织，使脊髓避免受到压迫以及粘连，避免术后产生神经症状甚至瘫痪等严重并发症，患者可长时间植入使用。
附图说明
图1是本发明的立体示意图。
图2是本发明的分解立体示意图。
图3是本发明使用时受力示意图。
图4是本发明使用时的立体示意图。
图5是椎板切除手术后的颈椎受力示意图。
图6是椎板切除手术前的颈椎受力示意图。
具体实施方式
请参阅图1、图2、图3、图4、图5和图6所示，本发明是由椎板1、第一螺钉2和第二螺钉3组成，椎板1两端具有第一长圆孔112和第二长圆孔121，第一螺钉2设置在第一长圆孔112内，第二螺钉3设置在第二长圆孔121内；
椎板1是由固定板体11和转动板体12组成，转动板体12通过转轴13铰接在固定板体11上；
所述椎板1为拱形；
所述固定板体11上具有第一轴套111，转动板体12上具有第二轴套122，转轴13分别穿在第一轴套111和第二轴套122内。
本发明的工作原理和过程：
请参阅图1、图2、图3、图4、图5和图6所示，脊柱4手术中，做椎板切除手术，显露脊髓5，完成减压手术，先将本椎板1放置在脊柱4上方定位，转动板体12可转动，方便定位，然后根据第一长圆孔112和第二长圆孔121的位置，在预定做椎板重建的节段经椎两侧弓根打两个螺纹孔，安装椎板1，先安装固定板体11部分，将第一螺钉2安装在第一长圆孔112内，第一螺钉2与同侧的螺纹孔相配合，拧紧第一螺钉2，然后调整转动板体12，将第二螺钉3安装在第二长圆孔121内，第二螺钉3与同侧的螺纹孔相配合，拧紧第二螺钉3， 安装完成，椎板1在脊髓的上方，从而能够阻挡关闭切口时合拢的肌肉等软组织，使脊髓5避免受到压迫，避免术后产生神经症状甚至瘫痪等严重并发症。

Claims (4)

  1. 一种脊柱椎板切除术后用的人工椎板，其特征在于：是由椎板(1)、第一螺钉(2)和第二螺钉(3)组成，椎板(1)两端具有第一长圆孔(112)和第二长圆孔(121)，第一螺钉(2)设置在第一长圆孔(112)内，第二螺钉(3)设置在第二长圆孔(121)内。
  2. 根据权利要求1所述的一种脊柱椎板切除术后用的人工椎板，其特征在于：所述椎板(1)是由固定板体(11)和转动板体(12)组成，转动板体(12)通过转轴(13)铰接在固定板体(11)上。
  3. 根据权利要求2所述的一种脊柱椎板切除术后用的人工椎板，其特征在于：所述固定板体(11)上具有第一轴套(111)，转动板体(12)上具有第二轴套(122)，转轴(13)分别穿在第一轴套(111)和第二轴套(122)内。
  4. 根据权利要求1所述的一种脊柱椎板切除术后用的人工椎板，其特征在于：所述椎板(1)为拱形。
PCT/CN2017/115396 2017-06-23 2017-12-11 一种脊柱椎板切除术后用的人工椎板 WO2018233237A1 (zh)

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CN107088086A (zh) * 2017-06-23 2017-08-25 吉林大学 一种脊柱椎板切除术后用的人工椎板
CN108095812B (zh) * 2018-02-06 2024-04-26 深圳市宝安区中医院 高强度脊柱棘突固定装置
CN108992152A (zh) * 2018-07-27 2018-12-14 中国医学科学院北京协和医院 脊柱内固定系统
CN109567918B (zh) * 2018-11-27 2020-07-17 中南大学湘雅医院 医用钛合金锥板定位系统
CN109431662B (zh) * 2018-12-12 2021-05-28 南昌大学第二附属医院 腰椎后路椎板重建装置

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