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CN101808598A - 椎间植入物 - Google Patents

椎间植入物 Download PDF

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Publication number
CN101808598A
CN101808598A CN200880109321A CN200880109321A CN101808598A CN 101808598 A CN101808598 A CN 101808598A CN 200880109321 A CN200880109321 A CN 200880109321A CN 200880109321 A CN200880109321 A CN 200880109321A CN 101808598 A CN101808598 A CN 101808598A
Authority
CN
China
Prior art keywords
arm
gap
implant
connector
space
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.)
Pending
Application number
CN200880109321A
Other languages
English (en)
Inventor
W·D·阿姆斯壮
S·E·怀特
R·F·Md·追尔
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.)
Warsaw Orthopedic Inc
Original Assignee
Warsaw Orthopedic Inc
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Warsaw Orthopedic Inc filed Critical Warsaw Orthopedic Inc
Publication of CN101808598A publication Critical patent/CN101808598A/zh
Pending legal-status Critical Current

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    • 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
    • A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
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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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    • 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
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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
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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Heart & Thoracic Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Vascular Medicine (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
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Abstract

本发明涉及定位于椎骨间的植入物。所述植入物可以包括接触第一椎骨的上表面，和接触第二椎骨的下表面。植入物可以包括在第一凸缘和第二凸缘间延伸的中心连接件。凸缘可以被造型以形成延伸植入物高度的间隙。可以在植入物的内部形成与间隙连通的空隙以容纳骨生长材料。

Description

椎间植入物
发明背景
本发明一般涉及脊椎植入物及使用方法，更具体地涉及包括环绕植入物主体外围的间隙的植入物。
脊柱分为四个区，包括颈、胸、腰和骶尾区。颈区包括标识为C1-C7的上部七块椎骨。胸区包括被标识为T1-T12的随后十二块椎骨。腰区包括五块椎骨L1-L5。骶尾区包括形成骶骨和尾骨的九块融合的椎骨。脊柱的椎骨以排列成弯曲构造，所述弯曲构造包括颈曲、胸曲和腰骶曲。椎间盘位于椎骨之间并允许屈曲、伸展、侧向弯曲和旋转。
多种情况可以导致椎间盘和/或椎骨的损伤。该损伤可以由多种原因产生，包括具体的事件如外伤、退化状况、肿瘤或感染。椎间盘和椎骨的损伤可以造成疼痛、神经缺损和/或活动度丧失。
多种方法包括替换整个或部分椎骨、整个或部分椎间盘，或者两种都替换。可以插入一个或多个替代植入物以替换损伤的椎骨和/或椎间盘。植入物可以进一步包括骨生长材料以促进植入物与一个或两个相邻的椎骨的融合。
发明概述
本申请涉及安装在第一和第二椎骨间形成的椎间隙内的植入物。植入物可以包括具有中心连接件(central web)的主体以及第一和第二向外伸出的凸缘。第一和第二凸缘可以沿中心连接件隔开。主体可以包括由一个或多个中心连接件和凸缘形成的外表面。主体可以进一步包括由接触第一椎骨的上表面和接触第二椎骨的下表面所限定的高度。第一和第二空隙可以在外表面内部形成，并且可以延伸主体的高度。第一间隙可以在中心连接件第一侧上的外表面中形成，并且第一间隙可以与第一空隙连通并延伸。第二间隙可以在中心连接件第二侧上的外表面中形成。第二间隙可以与第二空隙连通并延伸主体的高度。
附图简述
图1是依照一个实施方式的植入物的透视图。
图2-10是依照不同实施方式的植入物的顶视图。
图11是依照一个实施方式的植入物的侧视图。
图12是依照一个实施方式的植入物的侧视图。
图13是依照一个实施方式的植入物的侧视图。
图14是依照一个实施方式的植入物的侧视图。
图15是依照一个实施方式的支座的侧视图。
图16是依照一个实施方式的盖子的透视图。
图17是依照一个实施方式的带盖子的植入物的顶视图。
图18是依照一个实施方式的带盖子的植入物的透视图。
发明详述
本发明涉及安置在第一和第二椎骨之间形成的椎间隙内的植入物。图1图解说明了植入物10的实施方式，其中上表面91与第一椎骨接触，而下表面92与第二椎骨接触。植入物10包括在第一凸缘和第二凸缘30、40之间延伸的中心连接件20。凸缘30、40被造型以形成延伸植入物10的高度的间隙50。与间隙50连通的空隙51、52形成在植入物10的内部以容纳骨生长材料。
连接件20在凸缘30、40之间延伸并形成植入物10的中心部分。连接件20可以具有多种形状和尺寸。图1和图2包括具有基本不变的宽度的连接件20，而图3包括具有可变宽度的连接件20。图3的连接件20在凸缘30、40之间的中间点处减小为颈26。在颈26的每一侧宽度增加，在第二凸缘40处的宽度大于在第一凸缘30处的宽度。
连接件20也可以包括多个不同的部分。图4示例了连接件20的一个实施方式，该连接件20由多个部分(section)21、22、23形成，所述部分21、22、23被在其间形成的空隙24隔开。多个部分21、22、23和空隙24可以包括相同的或不同的形状和尺寸。图5示例了包括具有撑臂25的连接件20的另一实施方式，所述撑臂25分叉并与第一凸缘30连接。在另一实施方式中，连接件20被构造为单独的部分，其包括在上表面和下表面91、92之间延伸的孔洞。
连接件20可以进一步被安置在位于植入物10中心部分内的不同侧位。图1和2示例了连接件20横向居于植入物10中心并位于每个凸缘30、40的中间位置的实施方式。在如图5所示的其他实施方式中，连接件20侧向偏离植入物10的中心。在如图1、2和5所示的一些实施方式中，连接件20沿第一和第二凸缘30、40侧向隔开相同的距离。可选地，如图6所示，连接件20沿第一和第二凸缘30、40侧向隔开不同的位置。
第一和第二凸缘30、40沿连接件20隔开。凸缘30、40可以是相同的形状和尺寸，或者可以具有不同的形状和尺寸。图7是每个凸缘30、40具有相同形状和尺寸的实施方式。图2是第一凸缘30具有不同于第二凸缘40的形状的实施方式。图8是凸缘30、40具有不同形状和尺寸的实施方式。
如图2所示，第一凸缘30可以包括从连接件20的第一侧向外伸出的第一臂31和从连接件20的第二侧向外伸出的第二臂32。每个臂31、32包括形成间隙50的一侧的末端33。臂31、32可以具有如图2所示的相同的形状和尺寸，或者可以具有如图5和6所示的不同的形状和/或尺寸。同样地，第二凸缘40可以包括如图2所示的第一和第二臂41、42。每个臂41、42包括形成间隙50的一侧的末端43。臂41、42可以具有相同的或不同的形状和/或尺寸。
在一个实施方式中，凸缘30、40之一具有单一的臂。图8示例了第一凸缘30具有单一臂31的实施方式。第一间隙50a在单一臂31的末端33和臂41的末端43之间形成。第二间隙50b在连接件20和臂42的末端43之间形成。在如图9所示的一个实施方式中，植入物10包括单一凸缘30(即，没有第二凸缘40)。每个间隙50在臂末端33和连接件20之间形成。
在如图10所示的一个实施方式中，凸缘30、40的其中之一或两者包括具有扩大的宽度的末端33、34。扩大的末端33、34邻近间隙50。扩大的末端33、34邻近间隙50的表面积较大以分散从第一和第二椎骨施加到植入物10的力，并减轻发生在凸缘30、40的末端33、43的特殊应力。
如图11所示，植入物10包括在上表面91和下表面92之间测量的高度H。在一个实施方式中，高度H实质上是穿过植入物10的同一高度。在其他实施方式中，高度H可以不同于穿过植入物的高度。图12示例了一个实施方式，其中第一凸缘30的一部分具有较小的高度H’。该较小的高度有助于将植入物10插入在椎骨间，通过具有较小高度H’的部分最初插入椎间隙内。植入物10的各种其他部分可以依据使用情况具有更大的或更小的高度。
间隙50在上表面和下表面91、92之间延伸植入物10的高度H。在一个实施方式中，间隙50在连接件20相对侧的臂末端33、34之间形成。在一个实施方式中，间隙50在臂末端33、43之间形成。在其他实施方式中，间隙50由臂末端33或43与连接件20形成。图9包括在臂31、32的末端33和连接件20之间形成每个间隙50a、50b的实施方式。
间隙50可以具有相同的或不同的宽度W。图2包括具有相同宽度W的每个间隙50。图8包括第一间隙50a，其宽度W1比第二间隙50b的宽度W2大。
间隙50的宽度W可以是常数或可以沿高度而变化。图11包括沿上表面和下表面91、92之间的高度H而宽度W不变的实施方式。图13包括具有可变宽度的实施方式，其中第一凸缘30的末端33是直的而第二凸缘40的末端43包括弯曲形状。末端33、43使间隙50的中部宽度W大于在上表面和下表面91、92外部末端处的宽度W。图14包括在第一凸缘30和连接件20之间形成间隙50的实施方式。在上表面91处宽度W是最小的，在下表面92处则最大。
内部空隙51、52与间隙50连通并起到容纳骨生长材料的作用。空隙被束缚在横向侧面而在上侧面和下侧面不受束缚。空隙51、52可以包括相同的或不同的形状和尺寸。图2包括每个空隙51、52包括相同的形状和尺寸的一种实施方式。空隙51定位在间隙50a以内并被臂31、臂41和连接件20的内缘所束缚。空隙52定位在间隙50b以内并被臂32、臂42和连接件20的内缘所束缚。图5包括空隙51小于空隙52的实施方式。
盘80可以在植入物10的侧面上形成。盘80可以是连接到植入物的单独的一块(piece)，或者可以与主体整体地形成(即，主体盘80是整体构造)，支座80在上表面和下表面91、92的一个或两个上延伸以与椎骨的侧面接触从而使植入物10位于椎间隙内。支座80也防止植入物10过度插入椎间隙。一个或多个孔洞81可以延伸穿过支座80。孔洞81大小适合于接收紧固件(未显示)以将植入物10连接到椎骨。在如图15所示的一个实施方式中，孔洞81a定位在支座80的中心高度，向上朝向上表面91成角度，用以接合紧固件和第一椎骨。孔洞81b向下朝向下表面92成角度以接合第二椎骨。在一个实施方式中，如图15所示，盘80延伸越过整个主体。在如图12所示的另一个实施方式中，盘80延伸越过主体的一部分。
孔洞81可以延伸穿过盘80并进入凸缘30、40和/或连接件20中的一个。图7显示了孔洞81延伸穿过凸缘40进入连接件20的一个实施方式。图2显示了孔洞81延伸穿过凸缘40分别进入空隙51、52的一个实施方式。
齿75可以定位在上表面和下表面91、92中的一个或两个之上。齿75可以包括成角度的向以促进植入物10插入椎间隙，并保持在空隙内的合适定位。齿75可以延伸越过上表面和下表面91、92的整体或有限部分。椎间植入物的齿的实施方式在美国专利申请系列号11/394,452和11/412,330中公开，其中每篇文献通过引用并入本文。
盖子60可以附加于植入物10，延伸越过一个或多个间隙50。图16示例了盖子60的一个实施方式，其包括第一部分63和相对并隔开的臂61、62。盖子60所起的作用是：延伸越过一个或多个间隙50并阻止骨生长材料在空间51、52内无意的侧向移动。
在一个实施方式中，臂61、62与第一部分63连接，以在箭头Z方向上可移动。这可以通过由弹性材料构造的盖子60完成。当插入具有向外延伸的臂61、62的间隔件(spacer)10时，盖子60大小适合变形。一旦附加，臂61、62向植入物10的外部侧面施加压缩力，以保持盖子60的附加。孔洞64可以进一步在盖子60周围留出空间，并且大小适合接收紧固件以进一步将盖子60附到植入物10。
在另一实施方式中，臂61、62通过如铰链、枢轴或其他类似结构可移动地连接到第一部分63上。在盖子附加期间臂61、62可以移动分开以允许臂61、62沿植入物10的每一侧延伸。一旦定位，臂61、62可以内移以接触植入物10的外部侧面。孔洞64可以进一步绕盖子60定位以接收紧固件，从而将盖子60附到植入物10。
在使用中，植入物10最初被插入椎间隙。插入之前或插入之后，将骨生长材料嵌入空隙51、52。然后将盖子60附到植入物10的外部侧面。盖子60可以延伸越过一个或多个间隙50以保持骨生长材料。
图17包括盖子60附到植入物10的一个实施方式。第一部分63包括与第二凸缘40基本相配的形状。臂61、62实基本上与第二凸缘40的形状相配，并且包括延伸越过间隙50并与第一凸缘30接触的长度。盖子60也可以被定位在靠着支座80并延伸超过孔洞81以阻止紧固件的退出。图18包括单一臂61从第一部分63向外伸出的实施方式。臂61延伸穿过第一间隙50a。在该实施方式中，臂61具有比间隙50a更小的高度。
盖子60也可以以其他方式附到植入物10。在一个实施方式中，植入物10沿外部侧面具有凹槽，并且盖子60具有向外伸出的指状物。在附加期间，指状物滑动穿过外部侧面并安放在其中一个凹槽内以保持附加。其他附加方式可以包括咬合安装(snap fit)和压力装配(press fit)。
植入物10可以从多个方向插入椎间隙。在一个实施方式中，以前面的方法插入植入物10，其中支座80接触椎骨前侧面。其他的应用则考虑其他的方法，包括后面的、后外侧的、前外侧的、和侧面的方法到脊柱，并进入脊柱的其它区域，包括脊柱的颈、胸、腰和/或骶部分。
空间上的相对术语如“在……下”、“在……下面”、“低于”、“超过”、“上部”等，被用来灵活描述以解释一个元件相对于第二个元件的定位。这些术语意在包含除了那些描述在附图中的不同定位以外的装置的不同定向。进一步地，术语如“第一”、“第二”等也被用于描述不同元件、区域、部分等，并且也不是意在限制。类似的术语指通篇描述的类似元件。
如本文所用的，术语“具有”、“包含”、“包括”、“包括”等是开放式术语，其指明所述的元件或特征的存在，但不排除另外的元件或特征。冠词“一(a)”、“一(an)”“该”意图包括复数以及单数，除非上下文清楚地另外指明。
本发明可以以除了本文所阐述的的方式之外的其它具体方式实施，而不偏离本发明的范围和本质特征。因此，本实施方式在所有方面被认为是示例性的而不是限制性的，并且所附权利要求的含意和相等的范围内的所有改变都意图被包含在内。

Claims (11)

1.安装在第一椎骨和第二椎骨之间形成的椎间隙内的植入物，所述植入物包括：
包含连接件的主体，从所述连接件的第一侧向外延伸的第一对臂，和从所述连接件的第二侧向外延伸的第二对臂，所述主体包括由接触所述第一椎骨的上表面和接触所述第二椎骨的下表面所限定的高度；和
形成于所述第一对臂末端之间的第一间隙和形成于所述第二对臂末端之间的第二间隙，每个所述间隙延伸所述主体的高度。
2.根据权利要求1所述的植入物，进一步包括第一空隙和第二空隙，所述第一空隙与所述第一间隙连通并被所述连接件和所述第一对臂束缚在侧面，所述第二空隙与所述第二间隙连通并被所述连接件和所述第二对臂束缚在侧面，所述第一空隙和第二空隙的每一个未被束缚在上侧和下侧。
3.根据权利要求1所述的植入物，其中所述第一间隙和第二间隙的至少一个包括沿所述高度的恒定宽度。
4.根据权利要求1所述的植入物，其中所述第一间隙和第二间隙的宽度是相等的。
5.根据权利要求1所述的植入物，其中所述间隙的至少一个具有可变的宽度。
6.根据权利要求1所述的植入物，其中所述第一臂和第二臂的所述末端具有比所述臂的其余部分更大的宽度。
7.根据权利要求1所述的植入物，其中所述主体具有对称形状。
8.根据权利要求1所述的植入物，其中所述连接件和所述第一凸缘和第二凸缘形成对称的主体。
9.根据权利要求1所述的植入物，进一步包括盖子，所述盖子附在所述主体的外部侧面并延伸越过至少一个所述间隙。
10.根据权利要求1所述的植入物，进一步包括延伸穿过所述连接件的至少一部分的紧固件孔洞。
11.根据权利要求1所述的植入物，进一步包括紧固件孔洞，其延伸穿过所述第一对臂和所述第二对臂的臂的至少之一。
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