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CN100400016C - 有支承在滚动体上的关节部分的椎间植入物 - Google Patents

有支承在滚动体上的关节部分的椎间植入物 Download PDF

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Publication number
CN100400016C
CN100400016C CNB028300718A CN02830071A CN100400016C CN 100400016 C CN100400016 C CN 100400016C CN B028300718 A CNB028300718 A CN B028300718A CN 02830071 A CN02830071 A CN 02830071A CN 100400016 C CN100400016 C CN 100400016C
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CN
China
Prior art keywords
intervertebral implant
joint
described intervertebral
groove
parts
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Fee Related
Application number
CNB028300718A
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English (en)
Other versions
CN1713868A (zh
Inventor
M·埃比
D·伯卡德
R·弗里格
B·莱西曼
小R·马蒂斯
P·帕夫洛夫
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
AO Technology AG
Original Assignee
Synthes USA LLC
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Filing date
Publication date
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Publication of CN1713868A publication Critical patent/CN1713868A/zh
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Publication of CN100400016C publication Critical patent/CN100400016C/zh
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • 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
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    • 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
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Abstract

本发明涉及一种椎间植入物(1)，尤其人造椎间盘，它有一条中心线(2)、一个适用于支靠在位于上方的椎骨体底板上的上部(10)和一个适用于支靠在位于下方的椎骨体盖板上的下部(20)，其中：A)上部(10)有一个前侧的侧面(11)、一个背侧的侧面(12)、两个侧向的侧面(13、14)、一个上部对合面(15)和一个下部表面(16)；B)下部(20)有一个前侧的侧面(21)、一个背侧的侧面(22)、两个侧向的侧面(23、24)、一个下部对合面(25)和一个上部表面(26)；其中C)这两个部分(10、20)可以通过设在两个部分(10；20)之间的关节(38；39)彼此相对运动，以及D)每个关节(38；39)有一条旋转轴线(3；4)，这两条旋转轴线(3；4)彼此横向排列；E)每个关节(38；39)包括至少一个与各自的旋转轴线(3；4)同轴的轴(34；36)和一个承接轴(34；36)的轴瓦(35；37)；以及F)在轴(34；36)与轴瓦(35；37)之间夹入滚动体(70)。

Description

有支承在滚动体上的关节部分的椎间植入物
技术领域
本发明涉及一种椎间植入物。
背景技术
在去除损坏的天然椎间盘或椎间盘损坏的髓核后，在两个相邻椎骨体的椎间空隙内置入植入物或假体。这样做的目的是重新造成尽可能自然的状态，也就是说，尤其在两个相邻的椎间体之间恢复原来的椎间盘高度并因而恢复原始的间距。此外，应能尽可能没有障碍地按其自然的方式实施相邻椎骨体彼此的相对运动。在这一方面重要的是，在向前/向后倾斜时，亦即椎骨体弯曲和伸展时，以及在椎骨体侧向屈折时，在自然的界限内保持运动的可能性。沿脊柱的天然韧带和肌肉基本上保持完整无损，所以它们继续稳定机械的椎间盘代用品的运动。
由DE-A-3529761
Figure C0283007100051
已知一种按此类型的椎间盘假体。这种已知的椎间盘假体主要由两个对称的、有面对面定向的凹形滑动面和各一个在外部的表面的挡板以及一个定位在挡板之间、有与挡板上凹的滑动面互补设计的凸形滑动面的定距块组成，上述在外部的表面支靠在相邻椎骨体的底板或盖板上。按一种实施形式，滑动面设计为一个外圆柱形的部分表面，其中设在两个挡板上的滑动面设计为各与在定距块上的相邻滑动面互补，以及每两个互补的滑动面构成一个可绕旋转轴线旋转的关节的可互相移动的关节面。此关节包括一个上部和一个下部的各有一根旋转轴线的关节部分。这两根旋转轴线互相错开90°。这种已知的椎间盘假体的缺点是，
a)通过设计只有一个旋转中心的椎间盘内假体，不能考虑可以通过天然椎间盘传递的、尤其在天然椎间盘的情况下彼此独立的前-后和侧向弯曲时叠加的回转运动；
b)由于尤其在沿前-后方向滑移时产生的剪切运动使脊椎关节(小面关节)受载，由此会引起患者疼痛；
c)在两个可相互滑动的关节面上产生有害的摩擦力。此外，在关节部分运动时其结果是在这些表面产生磨损，亦即尤其磨坏和阻力。还存在“粘滑”(Stick-Slip)效应的危险；
d)机械的椎间盘代用品几乎不能避免所涉及的运动环节的继续退化。恢复原始的运动状况显著减轻痛苦以及使患者改善生活质量。然而当疼痛重新发生时必须对保养状况进行复查。在这种情况下通常完全拆除按传统结构方式的椎间盘假体以及加固运动环节。这种手术极大地加重患者的负担；以及
e)通常不考虑与相邻椎骨体的接触面的形状。传统结构方式的椎间盘代用品植入物有平的接触面，它们往往不与龙骨状隆凸互补。
发明内容
本发明提供补救措施。本发明的目的是创造一种椎间植入物，它包括一个关节，关节的轴提供摩擦力最小的支承。
按本发明，为达到此目提供了这样一种椎间植入物，它有一条中心线、一个适用于支靠在位于上方的椎骨体底板上的上部和一个适用于支靠在位于下方的椎骨体盖板上的下部，其中
A)上部有一个前侧的侧面、一个背侧的侧面、两个侧向的侧面、一个上部对合面和一个下部表面；
B)下部有一个前侧的侧面、一个背侧的侧面、两个侧向的侧面、一个下部对合面和一个上部表面；
C)这两个部分可以通过两个设在两个部分之间的关节彼此相对运动，其中
D)每个关节有一条旋转轴线以及这两条旋转轴线彼此横向排列；
E)这两个关节通过一个与上部连接的上部关节部分、一个中部关节部分和一个与下部连接的下部关节部分实现；
F)每个关节包括一个有至少一根与旋转轴线同轴的轴的第一关节部分和一个有至少一个承接轴的轴瓦的第二关节部分，
其特征为：
G)在轴与轴瓦之间夹入滚动体。
采用本发明获得的优点主要是，由于按本发明的椎间植入物使得
-沿前-后方向和向侧面的回转运动是独立的；
-不允许与植入物相邻的椎骨体滑移运动，由此保护小面关节；
-通过滚动体在表面上滚动将摩擦面减小到最低程度；以及
-由于滚动体的滚动运动取代关节面的滑动运动，在关节内产生较小的摩擦力，因而不妨碍椎骨体的相对运动，尤其是脊柱的侧向屈折和弯曲/伸展运动。
按本发明的椎间植入物一种优选的实施形式，滚动体是滚珠。也可以夹入其他旋转体替代滚珠，尤其是可使用于标准滚动轴承的滚动体，如滚柱、圆锥体或桶(Tonnen)。
每个关节滚动体的数量可以在3至12个之间，优选地为4个。按照椎间植入物的结构尺寸，滚动体直径，尤其滚珠直径，在0.3mm与6mm之间。
由于在沿脊柱不同的椎间盘空隙内天然的旋转轴线位置不同，所以旋转轴线的布局可能是歪斜的或是相交的。
按另一种实施形式，将关节部分设计为，使同轴于旋转轴线的中部关节部分包括至少一根属于下部关节的轴，以及下部关节部分包括至少一个承接此轴的轴瓦，以及，同轴于旋转轴线的上部关节部分包括至少一根属于上部关节的轴，以及中部关节部分包括至少一个承接此轴的轴瓦。中部关节部分在其表面之一上有至少一根轴和在其另一个表面上有至少一个轴瓦的这种设计，允许椎间植入物有尽可能小的结构高度。
按本发明的椎间植入物的再另一种实施形式，可以从前侧的侧面那里在两个部分上安置一些装置，借此可将这两个部分在前侧彼此相对保持规定的间距。由此可达到的优点是，这两个部分可具有固定保持的高度地插入椎间空隙内一个位置，以及可在插入椎间空隙后绕关节运动和可被置于支靠在相邻椎骨体的底板或盖板上。
按本发明的椎间植入物另一种实施形式，此装置可以暂时锁止两个部分绕关节的可运动性。由此可获得的优点是，借助一种最小的侵入性手术，可以锁止整合在椎间空隙内的关节。这尤其在手术后出现疼痛的情况下是特别有利的，也就是说，在那里所涉及的脊柱环节发生进一步退化以及外科医生考虑将所涉及的椎骨并合。优选地可将此装置安置在两个部分的两个前侧的侧面上。通过这种后来的二次锁止两个部分绕关节的运动能力，增强此椎间植入物并转化为一种关节固定术植入物(并合保持器)。
按本发明的椎间植入物再一种实施形式，此装置包括一个嵌入件，它可以装入在上部和下部彼此对置的表面上的各一个凹槽内。优选地，凹槽设计为燕尾状导向装置，它们在前侧的侧面开口，所述嵌入件与燕尾状导向装置互补设计的端部可以从前侧插入燕尾状导向装置中。由此可获得的优点是，通过插入嵌入件可以锁止两个部分绕关节的可运动性。若将燕尾状导向装置设计为使它们朝椎间植入物的中心线渐缩，使嵌入件可以附加地楔入燕尾状导向装置，则可以提高锁止的刚性。
按本发明的椎间植入物再另一种实施形式，两个部分制有孔，用于安装骨固定装置，尤其骨螺钉，其中，孔的纵轴线相对于中心线处于倾斜的位置。优选地，两个部分之一的两个孔从前侧的侧面到对合面贯通。若规定只是轴向固定椎间植入物，则纵轴线可以仅从侧向观察相对于中心线是倾斜的，或，若规定角向稳定地固定椎间植入物，则纵轴线从前侧观察可同样从两个部分的内表面朝对合面是发散的。
按本发明的椎间植入物另一种实施形式，安装骨固定装置用的孔制有内螺纹，由此可做到将骨固定装置更加刚性地固定在两个部分中。优选地，这些孔设计为锥形，所以通过内螺纹与骨固定装置头部的外螺纹之间的锥形螺纹连接，可以达到骨固定装置在两个部分的每一个上更牢固地固定。
对合面优选地设计为凸的并制有形式上为金字塔形隆凸的三维结构。通过对合面的这种设计，考虑了椎骨体端板的解剖学。
按本发明的方法主要用于通过椎间植入物替代受损的天然椎间盘并包括下列步骤：
A)借助为此所设的装置将椎间植入物的一个或多个关节锁定在一个或多个关节规定的位置；
B)将椎间植入物插入要治疗的椎间空隙内；
C)拆卸和取走用于锁定在椎间植入物内的一个或多个关节的装置。通过锁定关节可获得的优点是，具有在外部的对合面的可运动的部分可以更方便地置入要治疗的椎间空隙。
按本发明方法的另一种应用，方法包括借助规定用于锁止一个或多个关节的装置，事后锁定在已植入的椎间植入物上的一个或多个关节。由此可获得的优点是，当出现患者的术后疼痛时，或当所涉及的运动环节进一步退化时，在椎间植入物上的一个或多个关节可以通过手术后装上为此所设的装置锁定。这种事后的锁止可以通过最小侵入性，优选地腹腔镜检查术实施。因此，此椎间植入物承担保持器的任务，从而可以增强脊柱所涉及的运动环节。
附图说明
下面借助多种实施例的局部示意图详细说明本发明和本发明的进一步发展。
其中：
图1  按本发明的椎间植入物一种实施形式的分解图；
图2  按本发明的椎间植入物图1所示实施形式处于组合状态的透视图；
图3  从旁边看按本发明的椎间植入物另一种实施形式的视图；以及
图4  图3所示实施形式透视图。
具体实施方式
图1和2表示按本发明的椎间植入物1一种实施形式，它包括一个上部10、一个下部20和两个关节38；39，其中，上部10有一个横向于中心线2布置的上部对合面15用于支靠在相邻椎骨体的底板上，下部20有一个横向于中心线2布置的下部对合面25用于支靠在相邻椎骨体的盖板上。上部10和下部20通过关节39；39可彼此相对运动地连接，其中，上部10相对于下部20绕横向于中心线2布置的第一旋转轴线3的可运动性限制在一个从+10°至-6°的角度范围内，以及绕横向于中心线2并垂直于第一旋转轴线3布置的第二旋转轴线4的可运动性限制在一个±7°的角度范围内。
两个关节38；39通过三个关节部分31；32；33实现，其中下部关节部分33和上部关节部分31各构成一个与中部关节部分32配合工作的关节38；39。关节38；39分别有一条旋转轴线3；4，这两条旋转轴线3；4彼此横向排列，特别是，这些旋转轴线彼此垂直以及垂直于中心线2。下部关节39包括一根设在中部关节部分32上与第一旋转轴线3同轴、由两部分组成的轴36，以及包括两个设在下部关节部分33上承接轴36的轴瓦37。上部关节38由一个设在上部关节部分31上与第二旋转轴线4同轴的轴34和一个设在中部关节部分32上承接轴34的轴瓦35组成。轴瓦35；37和轴34；36有槽71，槽在正交于各自的旋转轴线3；4观察的横截面内设置为相对于旋转轴线3；4的圆弧形并用于容纳作为滚动体70的滚珠。圆弧形的中心角在0°与180°之间。滚动体70在槽71内轴向导向。
此外，在轴34；36末端安装与旋转轴线3；4同轴的凸块90，它们可移动地安装在下部关节部分和中部关节部分32的长孔导向装置91内。通过在长孔导向装置91内导向的凸块90，限制关节部分31；32；33绕旋转轴线3；4的转角。此外，椎间植入物1通过安装在长孔导向装置91内的凸块90组合在一起。
两个部分10；20彼此的相对运动可通过装置40可释放地锁止。在本实施形式中，装置40包括一个可从两个部分10；20前侧的侧面11；21那里横向于中心线2和平行于两个部分10；20侧向的侧面13；14；23；24插入的嵌入件41。嵌入件41的插入在两个凹槽42；43内进行，它们设计为燕尾状导向装置。嵌入件41从两个部分10；20的前侧的侧面11；21插入设计为燕尾状导向装置的凹槽42；43内，以及借助螺钉44固定在下部20上。此外，嵌入件41设计为端部与凹槽42；43互补，所以使这两个部分10；20在插入嵌入件41时平行于中心线2彼此相对固定。
图3表示按本发明的椎间植入物1的一种实施形式，它与图1和2所示实施形式的区别仅在于，这两个部分10；20包括用于安装骨固定装置81的孔80，其中，骨固定装置80在这里设计为骨螺钉。孔80有纵轴线83，它们与中心线2相交一个角度γ。角度γ在20°与65°的范围内。此外，两个部分10；20之一的各两个孔80(图4)从前侧的侧面11；21到对合面15；25贯穿。孔80的纵轴线83只是从侧向观察相对于中心线2倾斜。此外，孔80设计为锥形地朝对合面15；25渐缩并制有内螺纹82，它们用于可旋入地安装设计为骨螺钉的骨固定装置81制有互补外螺纹的螺钉头84。
图4中表示的按本发明的椎间植入物1实施形式与图3中表示的实施形式的差别仅在于，孔80的纵轴线83附加地从前侧观察从两个部分10；20的内表面16；26向对合面15；25发散。

Claims (20)

1.椎间植入物(1)，有一条中心线(2)、一个适用于支靠在位于上方的椎骨体底板上的上部(10)和一个适用于支靠在位于下方的椎骨体盖板上的下部(20)，其中
A)上部(10)有一个前侧的侧面(11)、一个背侧的侧面(12)、两个侧向的侧面(13、14)、一个上部对合面(15)和一个下部表面(16)；
B)下部(20)有一个前侧的侧面(21)、一个背侧的侧面(22)、两个侧向的侧面(23、24)、一个下部对合面(25)和一个上部表面(26)；
C)这两个部分(10、20)可以通过两个设在两个部分(10；20)之间的关节(38；39)彼此相对运动，其中
D)每个关节(38；39)有一条旋转轴线(3；4)以及这两条旋转轴线(3；4)彼此横向排列；
E)这两个关节(38；39)通过一个与上部(10)连接的上部关节部分(31)、一个中部关节部分(32)和一个与下部(20)连接的下部关节部分(33)实现；
F)每个关节(38；39)包括一个有至少一根与旋转轴线(3；4)同轴的轴(34；36)的第一关节部分和一个有至少一个承接轴(34；36)的轴瓦(35；37)的第二关节部分，
其特征为：
G)在轴(34；36)与轴瓦(35；37)之间夹入滚动体(70)。
2.按照权利要求1所述的椎间植入物(1)，其特征为：同轴于旋转轴线(3)的中部关节部分(32)包括至少一根属于下部关节(39)的轴(36)，以及下部关节部分(33)包括至少一个承接此轴(36)的轴瓦(37)。
3.按照权利要求1或2所述的椎间植入物(1)，其特征为：同轴于旋转轴线(4)的上部关节部分(31)包括至少一根属于上部关节(38)的轴(34)，以及中部关节部分(32)包括至少一个承接此轴(34)的轴瓦(35)。
4.按照权利要求1或2所述的椎间植入物(1)，其特征为：滚动体(70)是旋转对称体。
5.按照权利要求1或2所述的椎间植入物(1)，其特征为：轴瓦(35；37)有槽(71)，滚动体(70)在槽内轴向导向。
6.按照权利要求1或2所述的椎间植入物(1)，其特征为：轴(34；36)有槽(71)，滚动体(70)在槽内轴向导向。
7.按照权利要求5所述的椎间植入物(1)，其特征为：槽(71)在与旋转轴线(3；4)正交的横截面内设计为有中心角在0°与180°之间的圆弧形。
8.按照权利要求1或2所述的椎间植入物(1)，其特征为：设装置(40)，它使两个部分(10；20)在其前侧的侧面(11；21)处测量彼此保持固定间距。
9.按照权利要求1或2所述的椎间植入物(1)，其特征为：设装置(40)，它适用于导致暂时锁止两个部分(10、20)绕关节(38；39)的可运动性。
10.按照权利要求8所述的椎间植入物(1)，其特征为：装置(40)可以安置在两个部分(10；20)的两个前侧的侧面(11、21)上。
11.按照权利要求9所述的椎间植入物(1)，其特征为：装置(40)包括有一个下端(45)和一个上端(46)的嵌入件(41)以及在两个部分(10；20)上各包括一个表面(16；26)内的凹槽(42；43)，凹槽在前侧的侧面(11；21)上开口；以及，嵌入件(41)可将其端部分别插入一个凹槽(42；43)内。
12.按照权利要求11所述的椎间植入物(1)，其特征为：凹槽(42；43)是燕尾状导向装置，以及嵌入件(41)的端部设计为与此燕尾状导向装置互补。
13.按照权利要求12所述的椎间植入物(1)，其特征为：燕尾状导向装置从前侧的侧面(11；21)向背侧的侧面(12；22)渐缩。
14.按照权利要求1或2所述的椎间植入物(1)，其特征为：上部和下部(10；20)各包括至少两个从前侧的侧面(11；21)到对合面(15；25)贯穿的具有纵轴线(83)的孔(80)，用于安装骨固定装置(81)。
15.按照权利要求14所述的椎间植入物(1)，其特征为：孔(80)的纵轴线(83)与中心线(2)相交一个角度γ。
16.按照权利要求15所述的椎间植入物(1)，其特征为：角度γ在20°与65°的范围内。
17.按照权利要求14所述的椎间植入物(1)，其特征为：孔(80)的纵轴线(83)从前侧的侧面(11；21)出发观察从内部表面(1 6；26)向对合面(15；25)发散。
18.按照权利要求14所述的椎间植入物(1)，其特征为：孔(80)朝对合面(15；25)呈锥形收缩。
19.按照权利要求14所述的椎间植入物(1)，其特征为：孔(80)有内螺纹(82)。
20.按照权利要求1所述的椎间植入物(1)，其特征为：所述两个关节(38；39)的旋转轴线(3；4)彼此垂直。
CNB028300718A 2002-12-17 2002-12-17 有支承在滚动体上的关节部分的椎间植入物 Expired - Fee Related CN100400016C (zh)

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ATE394084T1 (de) 2008-05-15
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US7473276B2 (en) 2009-01-06
TW200501925A (en) 2005-01-16
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BR0215965A (pt) 2005-09-27
EP1572036B1 (de) 2008-05-07
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AU2002347116B2 (en) 2006-10-26

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