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CN101716096A - 骨部分或椎骨用骨锚固装置及包括该骨锚固装置的稳定装置 - Google Patents

骨部分或椎骨用骨锚固装置及包括该骨锚固装置的稳定装置 Download PDF

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CN101716096A
CN101716096A CN200910204457A CN200910204457A CN101716096A CN 101716096 A CN101716096 A CN 101716096A CN 200910204457 A CN200910204457 A CN 200910204457A CN 200910204457 A CN200910204457 A CN 200910204457A CN 101716096 A CN101716096 A CN 101716096A
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bone anchoring
anchoring device
pressure elements
bone
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CN101716096B (zh
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L·比德曼
J·哈姆斯
W·马蒂斯
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Biedermann Technologies GmbH and Co KG
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    • 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 or setting implements
    • 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, e.g. 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
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61B17/70—Spinal positioners or stabilisers, e.g. 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
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    • 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, e.g. stabilisers comprising fluid filler in an implant
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Abstract

提供一种用于骨部分或椎骨的稳定装置，所述稳定装置包括用于锚固在骨部分或椎骨中的两个骨锚固装置和至少两个稳定杆(3a，3b)，其中至少一个骨锚固装置包括：锚固元件(10)，其具有用于锚固在骨部分或椎骨中的锚固段(11)和头部(12)；接收部(20)，其用于接收稳定杆(3a，3b)；其中接收部(20)具有用于接收头部(12)的座(24)，从而头部能够相对于接收部枢转；并且其中接收部包括第一压力元件(40，40′，400)，第一压力元件能够在接收部中运动，从而第一压力元件能够压在头部12上以便锁定头部的角位置；其中在接收部内设置有至少两个导引通道(46a，46b，46a′，46b′，460a，460b)，所述导引通道相互间隔开以便导引穿过至少两个稳定杆(3a，3b)从而杆不会相互接触。

Description

骨部分或椎骨用骨锚固装置及包括该骨锚固装置的稳定装置
技术领域
本发明涉及一种骨锚固装置，特别是一种连接到两个稳定杆的多轴骨螺钉，本发明还涉及一种包括这种骨锚固装置的稳定装置，特别是用于稳定脊柱的稳定装置。
背景技术
在US2004/0049190 A1中描述了一种用于骨、特别是用于椎骨的动态稳定装置。所述稳定装置包括：两个骨锚固元件，其中至少一个骨锚固元件是多轴骨螺钉；以及刚性杆，所述刚性杆具有纵向轴线并且连接到所述两个骨锚固元件。在所述两个骨锚固元件之间插入有一个弹性元件。所述弹性元件作用在骨锚固元件上以便沿着所述纵向轴线方向施加力。所述骨锚固元件中的一个骨锚固元件固定地连接到杆以防止杆的平移运动，并且另一个骨锚固元件能够滑动地连接到杆。
EP 1 800 614 A1描述了一种用于骨或椎骨的动态稳定装置，包括至少两个骨锚固元件以及连接所述骨锚固元件的至少一个弹性环形式的连接元件。在一个实施例中，骨锚固元件为多轴骨螺钉的形式，所述多轴骨螺钉的接收部容纳两个弹性环，每个弹性环可以连接到一个第二骨锚固元件。
发明内容
本发明的目的是提供一种骨锚固装置以及包括这种骨锚固装置的稳定装置，其允许动态稳定骨部分或椎骨并且允许动态稳定装置的弹性特性的各种设计。
所述目的通过根据权利要求1所述的骨锚固装置以及根据权利要求11所述的稳定装置实现。在从属权利要求中给出了其它研发成果。
模块化的双杆(即两个杆)的提供允许将骨锚固装置设计成在骨锚固装置的高度方面更为紧凑，因为每个杆可以设计成比单个杆更小。矮轮廓横截面的两个杆较一个单个杆还具有的优点在于杆的刚性被增强。双杆系统在弯曲载荷或扭转载荷方面的稳定性也被增强。
可以通过选择合适的杆和/或通过止挡(stops)和/或缓冲元件(damping elements)调节杆的滑动运动来调节稳定装置的动态特性。杆的动态特性可以变化。例如，杆可以具有相同或不同的弹性特性。杆可以由相同或不同的材料制成。
附图说明
本发明的其它特征和优点将从借助于附图对实施例的描述中变得明了。附图中：
图1示出稳定装置的透视图。
图2示出稳定装置的透视分解图。
图3示出根据第一实施例的骨锚固装置的分解图。
图4示出处于组装状态的图3的骨锚固装置的透视图。
图5示出第一实施例中的第一压力元件的侧视透视图。
图6示出第一实施例中的第二压力元件的透视图。
图7示出具有根据第一实施例的第一和第二压力元件的骨锚固装置的局部剖视图。
图8示出具有根据第二实施例的第一和第二压力元件的骨锚固装置的局部剖视图。
图9示出具有根据第三实施例的第一和第二压力元件的骨锚固装置的分解透视图。
图10示出处于组装状态的图9的骨锚固装置的透视图。
具体实施方式
现在参考图1-8中所示的稳定装置的实施例来详细描述本发明。所述稳定装置包括第一多轴椎弓根螺钉1、第二椎弓根螺钉2以及连接第一和第二椎弓根螺钉的两个杆3a、3b，以便稳定两个相邻的椎骨。
在每个杆上设置有弹簧元件4a、4b，并且两个杆3a、3b通过杆连接件5、6连接。杆3a、3b固定地夹紧在第二椎弓根螺钉2中并且能够如箭头所示那样滑动穿过第一椎弓根螺钉1。所述滑动运动借助于杆连接件6被限制，所述杆连接件6连接到杆3a、3b的自由端并且用作一个止挡。弹簧元件4a、4b和杆连接件5限制杆3a、3b相对于第一椎弓根螺钉1沿着第二椎弓根螺钉2的方向的滑动运动。所述弹簧元件提供弹性缓冲(elastic damping)。杆连接件5、6是套管，所述套管成形为分别具有用于导引穿过杆3a、3b的两个通道5a、5b、6a、6b。所述通道的间距对应于被导引穿过椎弓根螺钉的两个杆的间距。杆连接件5、6借助于压配合连接来连接杆3a、3b，所述压配合连接也就是通道的直径选择成使得杆被牢固地连接。杆连接件5、6可以由弹性体材料或任何其它生物相容材料制成。
该实施例中的弹簧元件4a、4b示出为像套管一样的、包围杆3a、3b的螺旋弹簧。所述弹簧元件4a、4b可以由任何生物相容材料(特别是钛、镍钛合金(例如镍钛诺))或其它材料制成。
杆3a、3b在具有垂直于杆的轴线的分量的力(诸如弯曲力)的作用下呈现挠性。为此，杆由不能压缩的材料制成，所述材料诸如不锈钢、钛、镍钛合金(诸如镍钛诺)、PEEK或碳增强的PEEK、或者其它生物相容材料。
应该注意的是，杆连接件和弹簧元件仅仅是用于连接两个杆、提供止挡并提供对滑动运动的缓冲作用的例子。
接下来，参考图3-7详细描述第一椎弓根螺钉1。第一椎弓根螺钉1包括螺钉元件10，螺钉元件10具有螺纹锚杆11和截球形头部12。在头部12的自由端设置有用于接合工具的凹槽13。第一椎弓根螺钉1还包括接收部20，接收部20具有第一端21和第二端22以及从第一端沿着第二端的方向延伸的同轴孔23。孔23在第二端22渐缩从而提供一个开口和用于螺钉头部12的座24，特别如图7中所示。
接收部20还包括从第一端21沿着第二端22的方向延伸的凹槽25，所述凹槽25提供沿着垂直于孔23的孔轴线的方向穿过接收部的通道，以用于导引穿过杆3a、3b。借助于该凹槽提供了两个自由支腿26a、26b。在第一端21附近，自由支腿26a、26b具有用于与固定螺钉30配合的内螺纹27。螺钉元件10和接收部20以及固定螺钉30均由刚性生物相容材料制成，所述刚性生物相容材料诸如类似不锈钢、钛或钛合金(诸如镍钛诺)的生物相容金属。
为了锁定头部12由此锁定螺钉元件10在接收部20的座24内的角位置，设置有第一压力元件40和第二压力元件50。第一压力元件40和第二压力元件50还形成用于将杆3a、3b导引穿过接收部20的导引元件。第一压力元件40具有基本为圆柱形的主体部分41，该主体部分41的尺寸制成为使得第一压力元件40可以插入接收部20中并且可以在孔23内沿着轴线方向运动。第一压力元件40在其面对螺钉元件的头部12的一侧包括图7中所示的圆柱形凹槽42，在该圆柱形凹槽42中设置有圆柱形插入物43。插入物43在其面对螺钉元件的头部12的一侧具有球形凹槽44，所述球形凹槽44的半径与螺钉元件的头部12的半径相适配。
第一压力元件40还包括矩形体主体部分45，该矩形体主体部分45成形为能够装配到接收部20的凹槽25中，特别如图3和4所示。矩形的宽度对应于凹槽25的宽度，并且长度选择成使得第一压力元件与接收部20的外表面28齐平，如图4中所示。矩形体主体部分在其与凹槽42相对的一侧包括两个截圆柱形凹槽46a、46b，所述截圆柱形凹槽46a、46b的圆柱半径略大于杆3a、3b的半径。凹槽46a、46b垂直于接收部20的同轴孔23的轴线延伸。凹槽46a、46b形成用于接收杆3a、3b的通道。因为凹槽46a、46b相互间隔开，所以在所述凹槽46a、46b之间形成有肋状突起47。凹槽46a、46b的深度优选地略大于杆3a、3b的半径。第一压力元件40还具有同轴孔48，用于提供使用工具接近螺钉元件的头部12的入口。类似地，圆柱形插入物43具有同轴孔49。圆柱形主体部分41和矩形体主体部分45示出为制成一体件，从而在通道46a、46b的每一侧提供截圆柱形突出部41a、41b。所述突出部便于在接收部20内导引第一压力元件40。一旦第一压力元件插入凹槽25中，矩形体主体部分45就防止第一压力元件在接收部内的转动。
第二压力元件50基本为矩形体形状并且宽度和长度对应于第一压力元件40的矩形体主体部分45的宽度和长度。因此，第二压力元件50也装配进接收部的凹槽25中。第二压力元件在其长边侧包括两个截圆柱形突出部51a、51b，这两个截圆柱形突出部51a、51b对应于第一压力元件的突出部41a、41b。第二压力元件50在其与第一压力元件40相对的一侧包括圆柱形凹槽52和同轴圆柱形突起53，固定螺钉30的相应的环形突起31和圆柱形凹槽32接合在圆柱形凹槽52和同轴圆柱形突起53中，如图7所示。由此，固定螺钉30可以是能够转动地连接到第二压力元件50。
第二压力元件50在其面对第一压力元件的一侧包括两个纵向截圆柱形通道56a、56b，这两个通道56a、56b在尺寸和间距方面与第一压力元件的通道46a、46b互补。通道56a、56b通过肋状突起57间隔开。
在图7中所示的组装状态下，第一压力元件经由插入物43压在头部12上。第二压力元件50压在第一压力元件40上，由此提供一个杆3a、3b容纳于其中的闭合的通道，并且杆与通道的壁形成间隙60。因为固定螺钉30能够转动地连接到第二压力元件，所以在第二压力元件50插入时能够将固定螺钉30拧紧。
第一压力元件和第二压力元件可以由便于杆3a、3b滑动的材料制成。例如，所述第一和第二压力元件可以由经涂覆的钛或镍钛合金制成，或者由PEEK或碳增强的PEEK制成。插入物43优选地由与螺钉元件的头部12相同的材料制成，例如由生物相容金属制成。代替设置插入物43，第一压力元件本身可以具有球形凹槽以便压在所述头部上。代替设置由便于滑动的材料或者由经涂覆或经处理以便于滑动的材料制成的第一和第二压力元件，杆3a、3b本身可以具有便于滑动的表面，例如经涂覆或经其它处理的表面。
图1、2和8中所示的第二椎弓根螺钉2与第一椎弓根螺钉1在第一和第二压力元件的设计上不同。所有其它部件相同并且具有相同的附图标记。因此，不再重复对相同部件的描述。第二椎弓根螺钉2的第一压力元件40′和第二压力元件50′的形状与第一椎弓根螺钉1的第一压力元件40和第二压力元件50的形状相同。然而，通道46a′、46b′、56a′、56b′的尺寸小于第一椎弓根螺钉的第一和第二压力元件的通道的尺寸。所述通道的半径适用于杆3a、3b的半径，并且所述通道的深度小于杆3a、3b的半径，从而如图8中所示，在组装状态下，杆3a、3b夹紧在第一压力元件40′和第二压力元件50′之间。
在图9和10中示出稳定装置的第二实施例并且未示出杆。第二实施例与参考图1-8描述的第一实施例的区别仅仅在于第一和第二压力元件400、500的形状。通道460a、460b的长度小于圆柱形主体部分410的直径。因此，第一压力元件400和第二压力元件500完全布置在接收部的圆柱形孔23内。
可以想到上面描述的实施例的改进实施例。例如，椎弓根螺钉和压力元件的设计可以是使得能够容纳两个以上的杆。可以使用具有不同弹性特性的杆。如果压力元件之一具有用于导引杆的通道就足够了，然而如果杆由通道从底部和从顶部导引则是有利的。第一压力元件的下部的形状可以是平坦的，然而适用于螺钉元件12的头部的形状的形状有利于将压力分布在头部上。
固定元件可以是两件式固定螺钉，其中套筒型的第一螺钉元件压在第一压力元件上以锁定头部12，而布置在第一螺钉元件内的定位螺钉型的第二螺钉元件压在第二压力元件上以固定图8中所示实施例中的杆。
接收部可以成形为如图中所示的顶部装载件或者成形为螺钉元件10从底部(即接收部的第二端)引入其中的底部装载件。
螺钉元件的锚杆不是必须具有螺纹。它可以是钩、钉的形式或者可以具有用于锚固在骨中的倒钩元件。
弹簧元件还可以设置成邻接外部止挡6。还可以想到的是，杆本身具有轴向的弹性弹簧部分。
使用中，首先将已经插入接收部20中的第一和第二椎弓根螺钉1、2的螺钉元件拧入相邻的椎骨中。可以预先组装第一压力元件，从而在将接收部对准之后可以分别将杆3a、3b插入接收部和第一压力元件的通道中。也可以预先组装杆3a、3b以及止挡和弹簧元件，并且可以将杆3a、3b插入作为双杆系统。对于特定的临床应用，第一椎弓根螺钉和止挡6沿着患者头部的方向削尖(point)。然而，椎弓根螺钉的布置取决于特定的临床状况。
接着，在将接收部和杆对准之后，通过插入固定螺钉连同第二压力元件并拧紧固定螺钉来固定螺钉元件相对于接收部的角位置。在图1、2和8中所示的第二椎弓根螺钉2的情况下，杆3a、3b和头部12被同时固定。在第一椎弓根的情况下，仅仅螺钉元件的头部12被固定，而杆仍然可以在通道内滑动。
如图1中所示，在脊柱运动段挠曲或伸展的过程中，杆可以滑动穿过第一椎弓根螺钉的接收部，由此所述滑动运动由用作止挡的杆连接件5和6限制并且由弹簧元件4a、4b缓冲。同时，杆可以承受弯曲力并且可以弯曲到由杆的材料的挠性提供的某一程度。

Claims (15)

1.一种骨锚固装置，包括：
锚固元件(10)，其具有用于锚固在骨部分或椎骨中的锚固段(11)和头部(12)；
接收部(20)，其用于接收稳定杆(3a，3b)；
其中接收部(20)具有用于接收头部(12)的座(24)，从而头部能够相对于接收部枢转；
并且其中接收部包括第一压力元件(40，40′，400)，第一压力元件能够在接收部中运动，从而第一压力元件能够压在头部12上以便锁定头部的角位置；
其特征在于：在接收部内设置有至少两个导引通道(46a，46b，46a′，46b′，460a，460b)，所述导引通道相互间隔开以便导引穿过至少两个稳定杆(3a，3b)从而杆不会相互接触。
2.根据权利要求1所述的骨锚固装置，其特征在于：导引通道设置在第一压力元件中位于远离头部的一侧上。
3.根据权利要求1或2所述的骨锚固装置，其特征在于：设置有第二压力元件(50，50′，500)，第二压力元件直接作用在第一压力元件或杆(3a，3b)上。
4.根据权利要求3所述的骨锚固装置，其特征在于：在第二压力元件处设置通道(56a，56b，56a′，56b′，560a，560b)。
5.根据权利要求1-5之一所述的骨锚固装置，其特征在于：所述通道的尺寸制成为大于杆以允许所述杆在所述通道中滑动。
6.根据权利要求5所述的骨锚固装置，其特征在于：所述通道的表面和/或所述杆的表面经过处理或者由便于滑动的材料制成。
7.根据权利要求1-4之一所述的骨锚固装置，其特征在于：所述通道的尺寸与所述杆的尺寸相同或者小于所述杆的尺寸，从而所述杆能够夹紧在所述通道中。
8.根据权利要求1-7之一所述的骨锚固装置，其特征在于：接收部具有第一端(21)和第二端(22)以及从第一端沿着第二端的方向延伸的同轴孔(23)，第一压力元件能够在所述孔中运动。
9.根据权利要求8所述的骨锚固装置，其特征在于：第二压力元件能够在所述孔中运动。
10.根据权利要求1-9之一所述的骨锚固装置，其特征在于：所述骨锚固装置还包括用于固定头部(12)在接收部中的位置的固定元件(30)。
11.一种用于稳定骨部分或椎骨的稳定装置，所述稳定装置包括：
用于锚固在骨部分或椎骨中的两个骨锚固装置，其中至少一个骨锚固装置是根据权利要求1-10之一所述的骨锚固装置；和
至少两个稳定杆(3a，3b)。
12.根据权利要求11所述的稳定装置，其特征在于：骨锚固装置中的一个骨锚固装置能够滑动地连接到杆，而另一个骨锚固装置固定地连接到杆。
13.根据权利要求12所述的稳定装置，其特征在于：设置有至少一个止挡(5，6)以用于限制杆的滑动运动。
14.根据权利要求11-13之一所述的稳定装置，其特征在于：所述杆在力的分量沿着垂直于杆的轴线的方向作用时呈现弯曲挠性。
15.根据权利要求11-14之一所述的稳定装置，其特征在于：所述杆包括用于缓冲杆的滑动运动的弹簧元件(4a，4b)，以便沿着杆的轴线提供弹性。
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US8795336B2 (en) 2014-08-05
TW201014562A (en) 2010-04-16

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