CN104323874A - Zero-incisura cervical interbody fusion cage with self-stabilizing ridges - Google Patents
Zero-incisura cervical interbody fusion cage with self-stabilizing ridges Download PDFInfo
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- 230000004927 fusion Effects 0.000 title claims abstract description 76
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 22
- 229910001069 Ti alloy Inorganic materials 0.000 claims description 6
- 229910052588 hydroxylapatite Inorganic materials 0.000 claims description 5
- 239000000463 material Substances 0.000 claims description 5
- XYJRXVWERLGGKC-UHFFFAOYSA-D pentacalcium;hydroxide;triphosphate Chemical compound [OH-].[Ca+2].[Ca+2].[Ca+2].[Ca+2].[Ca+2].[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O XYJRXVWERLGGKC-UHFFFAOYSA-D 0.000 claims description 5
- 239000004696 Poly ether ether ketone Substances 0.000 claims description 4
- 229920002530 polyetherether ketone Polymers 0.000 claims description 4
- 239000011247 coating layer Substances 0.000 claims 1
- 206010041591 Spinal osteoarthritis Diseases 0.000 abstract description 3
- 208000036319 cervical spondylosis Diseases 0.000 abstract description 3
- 230000006837 decompression Effects 0.000 abstract description 3
- 208000005801 spondylosis Diseases 0.000 abstract description 3
- 238000001356 surgical procedure Methods 0.000 abstract description 2
- 230000008468 bone growth Effects 0.000 description 6
- 230000000087 stabilizing effect Effects 0.000 description 5
- 238000009434 installation Methods 0.000 description 4
- 230000000694 effects Effects 0.000 description 3
- 230000012010 growth Effects 0.000 description 3
- 238000000034 method Methods 0.000 description 3
- 230000002980 postoperative effect Effects 0.000 description 3
- 208000019505 Deglutition disease Diseases 0.000 description 2
- 239000000956 alloy Substances 0.000 description 2
- 238000005520 cutting process Methods 0.000 description 2
- 238000007689 inspection Methods 0.000 description 2
- 208000002607 Pseudarthrosis Diseases 0.000 description 1
- RTAQQCXQSZGOHL-UHFFFAOYSA-N Titanium Chemical compound [Ti] RTAQQCXQSZGOHL-UHFFFAOYSA-N 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 230000005540 biological transmission Effects 0.000 description 1
- 239000011248 coating agent Substances 0.000 description 1
- 238000000576 coating method Methods 0.000 description 1
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- 238000003384 imaging method Methods 0.000 description 1
- 238000002513 implantation Methods 0.000 description 1
- 238000003780 insertion Methods 0.000 description 1
- 230000037431 insertion Effects 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 238000012806 monitoring device Methods 0.000 description 1
- 230000011164 ossification Effects 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 230000035807 sensation Effects 0.000 description 1
- 230000006641 stabilisation Effects 0.000 description 1
- 238000011105 stabilization Methods 0.000 description 1
- 229910052719 titanium Inorganic materials 0.000 description 1
- 239000010936 titanium Substances 0.000 description 1
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Abstract
本发明涉及颈椎医疗器械设备领域，尤其是一种带自稳嵴的零切迹颈椎椎间融合器。所要解决的技术问题是提供一种不仅能实现即刻稳定，且无需尾部拧入螺钉或插片固定的带自稳嵴的零切迹颈椎椎间融合器。带自稳嵴的零切迹颈椎椎间融合器，包括融合器本体、沿竖直方向设置于融合器本体内的植骨通槽，所述融合器本体的上表面和下表面均对称设置有成对的自稳嵴，所述自稳嵴中心轴线均互相平行且所述自稳嵴的顶面设置有防退倒齿。本发明构思的巧妙之处在于创造性的利用了自稳嵴，不仅可以使椎骨载荷的传导更均匀，避免了局部载荷集中，而且也十分便于临床的操作，减轻了患者的痛苦，十分具有推广的前景，尤其适用于颈椎病的前路减压融合手术治疗。
The invention relates to the field of cervical medical equipment, in particular to a zero-profile cervical intervertebral fusion device with a self-stabilizing ridge. The technical problem to be solved is to provide a zero-profile cervical intervertebral fusion device with a self-stabilizing ridge, which can not only achieve immediate stability, but also does not need to be screwed into the tail or inserted for fixation. A zero-profile cervical intervertebral fusion device with a self-stabilizing ridge, including a fusion device body and a bone graft channel vertically arranged in the fusion device body, the upper surface and the lower surface of the fusion device body are symmetrically provided with For a pair of self-stabilizing ridges, the central axes of the self-stabilizing ridges are parallel to each other, and the top surfaces of the self-stabilizing ridges are provided with anti-falling teeth. The ingenuity of the concept of the present invention lies in the creative use of self-stabilizing ridges, which can not only make the conduction of vertebral loads more uniform, avoid local load concentration, but also facilitate clinical operations, reduce the pain of patients, and are very popular. Prospect, especially suitable for anterior decompression and fusion surgery for cervical spondylosis.
Description
技术领域technical field
本发明涉及颈椎医疗器械设备领域，尤其是一种带自稳嵴的零切迹颈椎椎间融合器。The invention relates to the field of cervical spine medical devices, in particular to a zero-profile cervical intervertebral fusion device with a self-stabilizing ridge.
背景技术Background technique
颈前路椎间盘切除减压植骨融合术是治疗颈椎病的经典手术方式，椎间融合器的使用降低了植骨不融合、假关节的发生率，零切迹椎间融合器无需前方钛板辅助固定，减少了术后吞咽困难的发生。为达到术后即刻稳定性，目前市场中的零切迹椎间融合器植入后，需在其尾部斜行拧入2至4枚螺钉或嵌入两片插片以将融合器固定于上下椎体，操作繁琐，延长了手术时间，其费用也较高；植入螺钉或插片周围载荷集中致应力遮挡，不利于成骨；螺钉或插片式斜行固定易出现终板切割现象致内植物松动；螺钉或插片为多为钛合金材料构成，不透X线，行MRI或CT检查时伪影较大，干扰观察植骨空中骨生长的情况。Anterior cervical discectomy, decompression and bone graft fusion is a classic surgical method for the treatment of cervical spondylosis. The use of intervertebral fusion device reduces the incidence of non-fusion of bone graft and pseudarthrosis, and the zero-profile intervertebral fusion device does not require anterior titanium plate Auxiliary fixation reduces postoperative dysphagia. In order to achieve immediate postoperative stability, after implantation of the zero-profile intervertebral fusion cages currently on the market, 2 to 4 screws or two inserts need to be screwed obliquely at the tail to fix the fusion cages on the upper and lower vertebrae. The operation time is cumbersome, the operation time is prolonged, and the cost is also high; the concentrated load around the implanted screw or insert causes stress shielding, which is not conducive to bone formation; the oblique fixation of the screw or insert is prone to endplate cutting and causes internal damage. The plant is loose; the screws or inserts are mostly made of titanium alloy materials, which are opaque to X-rays, and the artifacts are relatively large during MRI or CT examinations, which interferes with the observation of bone graft growth in the air.
发明内容Contents of the invention
本发明所要解决的技术问题是提供一种不仅能实现即刻稳定，且无需尾部拧入螺钉或插片固定的带自稳嵴的零切迹颈椎椎间融合器。The technical problem to be solved by the present invention is to provide a zero-profile cervical intervertebral fusion device with a self-stabilizing ridge, which can not only achieve immediate stabilization, but also does not need to be screwed into the tail or inserted for fixation.
本发明解决其技术问题所采用的技术方案是：带自稳嵴的零切迹颈椎椎间融合器，包括融合器本体、沿竖直方向设置于融合器本体内的植骨通槽，所述融合器本体的上表面和下表面均对称设置有成对的自稳嵴，所述自稳嵴中心轴线均互相平行且所述自稳嵴的顶面设置有防退倒齿。The technical solution adopted by the present invention to solve the technical problem is: a zero-profile cervical intervertebral fusion device with a self-stabilizing ridge, including a fusion device body and a bone graft channel vertically arranged in the fusion device body. Pairs of self-stabilizing ridges are symmetrically arranged on the upper surface and the lower surface of the fuser body, and the central axes of the self-stabilizing ridges are parallel to each other, and the top surfaces of the self-stabilizing ridges are provided with anti-retraction teeth.
进一步的是，所述融合器本体内设置有定位传感装置。Further, a positioning sensing device is arranged in the fuser body.
进一步的是，所述自稳嵴的形状为前窄后宽的楔形。Further, the shape of the self-stabilizing ridge is wedge-shaped with a narrow front and a wide rear.
进一步的是，所述融合器本体的制作材料为聚醚醚酮。Further, the fusion device body is made of polyether ether ketone.
进一步的是，自稳嵴的制作材料为钛合金。Further, the self-stabilizing ridge is made of titanium alloy.
进一步的是，所述自稳嵴的表面和融合器本体的表面均设置有羟基磷灰石涂层。Further, both the surface of the self-stabilizing ridge and the surface of the fuser body are coated with hydroxyapatite.
进一步的是，所述自稳嵴的表面和融合器本体的表面均设置有防滑结构。Further, the surface of the self-stabilizing crest and the surface of the cage body are both provided with anti-slip structures.
进一步的是，所述融合器本体的上表面与上椎骨的上椎骨接触面紧密贴合。Further, the upper surface of the cage body is in close contact with the upper vertebra contact surface of the upper vertebra.
进一步的是，所述融合器本体的下表面与下椎骨的下椎骨接触面紧密贴合。Further, the lower surface of the cage body is in close contact with the lower vertebra contact surface.
进一步的是，所述融合器本体的背侧面设置有安装孔。Further, installation holes are provided on the back side of the fuser body.
本发明的有益效果是：在实际使用时，首先将待植入的骨骼放置于植骨通槽内，然后的，在待嵌入的上椎骨和下椎骨处开出用于容纳自稳嵴的上椎骨凹槽和下椎骨凹槽。接下来的，只需将融合器本体的前端嵌入到上椎骨和下椎骨之间后，随即通过外部工具将融合器本体敲入上椎骨和下椎骨之间即可。在敲入完毕后，自稳嵴很好的嵌套于上椎骨凹槽和下椎骨凹槽内，另外的，由于融合器本体的上表面与上椎骨的上椎骨接触面以及融合器本体的下表面与下椎骨的下椎骨接触面均紧密贴合，故而植骨通槽内的待植入的骨骼可以很理想的与上椎骨和下椎骨融合，直至最后很好的长合到一起。本发明构思的巧妙之处在于创造性的利用了自稳嵴，且此椎间融合器为解剖学设计，其上下表面与国人上下椎骨的终板形态一致，不仅可以使椎骨载荷的传导更均匀，避免了局部载荷集中，更有利于骨生长，而且也十分便于临床的操作，本发明十分具有推广前景，尤其适用于颈椎病的前路减压融合手术治疗。具体的讲，本发明的优点为：一、该融合器植入后，稳定嵴将椎间融合器与上下椎体牢固固定，具有良好的即刻稳定性，无需尾部拧入螺钉或插片固定，操作简便、节约手术时间和经济费用。二、稳定嵴为前窄后宽设计，两侧设计为粗糙结构，椎体后尾部稳定嵴对两侧椎体产生挤压作用，稳定性更好。三、本融合器为解剖型设计，其上下表面按照国人椎体的上下终板形态设计，使其与上下终板的贴合更好。四、本椎间融合器稳定嵴及上下面均有羟基磷灰石涂层，更有利于骨的生长。五、本椎间融合器上下稳定嵴对称分布，载荷传导更均匀，避免了局部载荷集中，更有利于骨生长。六、本椎间融合器上下稳定嵴垂着嵌入上下椎体中，稳定性更好，不易出现终板切割。七、本椎间融合器为聚醚醚酮材料，影像学检查相容性好。八、本椎间融合器为零切迹椎间融合器减少了术后异物感和吞咽困难的发生。The beneficial effects of the present invention are: in actual use, the bone to be implanted is firstly placed in the bone graft channel, and then the upper vertebra and the lower vertebra to be embedded are opened to accommodate the self-stabilizing ridge. Vertebral grooves and lower vertebral grooves. Next, you only need to embed the front end of the cage body between the upper vertebra and the lower vertebra, and then use an external tool to knock the cage body into the space between the upper vertebra and the lower vertebra. After knocking in, the self-stabilizing ridge is well nested in the groove of the upper vertebra and the groove of the lower vertebra. In addition, because the upper surface of the fusion device body contacts the upper vertebra of the upper vertebra and the lower surface of the fusion device body The surface is in close contact with the lower vertebra contact surface of the lower vertebra, so the bone to be implanted in the bone grafting channel can be ideally fused with the upper and lower vertebra until they grow together well. The ingenuity of the concept of the present invention lies in the creative use of the self-stabilizing ridge, and the intervertebral fusion device is anatomically designed, and its upper and lower surfaces are consistent with the shape of the end plates of the upper and lower vertebrae of Chinese people, which can not only make the conduction of vertebral load more uniform, It avoids local load concentration, is more conducive to bone growth, and is also very convenient for clinical operation. The present invention has great promotion prospects, and is especially suitable for anterior decompression and fusion surgery treatment of cervical spondylosis. Specifically, the advantages of the present invention are as follows: 1. After the cage is implanted, the stabilizing ridge firmly fixes the intervertebral cage with the upper and lower vertebral bodies, which has good immediate stability and does not need to be screwed into the tail to fix it with screws or inserts. It is easy to operate, saves operation time and economic cost. 2. The stabilizing ridge is designed to be narrow at the front and wide at the back, and the two sides are designed with a rough structure. The stabilizing ridge at the rear and tail of the vertebral body will squeeze the vertebral bodies on both sides, resulting in better stability. 3. The cage is anatomically designed, and its upper and lower surfaces are designed according to the shape of the upper and lower endplates of the Chinese vertebral body, so that it fits better with the upper and lower endplates. 4. The stable ridge and the upper and lower sides of the intervertebral fusion device are coated with hydroxyapatite, which is more conducive to the growth of bone. 5. The upper and lower stabilizing ridges of the intervertebral fusion device are symmetrically distributed, and the load conduction is more uniform, which avoids local load concentration and is more conducive to bone growth. 6. The upper and lower stable ridges of this intervertebral fusion device are embedded in the upper and lower vertebral bodies vertically, which has better stability and is less prone to endplate cutting. 7. The intervertebral fusion device is made of polyether ether ketone material, which has good compatibility in imaging examination. 8. This intervertebral fusion device is a zero-profile intervertebral fusion device, which reduces postoperative foreign body sensation and dysphagia.
附图说明Description of drawings
图1是本发明的主视图。Fig. 1 is a front view of the present invention.
图2是本发明的俯视图。Figure 2 is a top view of the present invention.
图3是本发明的侧视图。Figure 3 is a side view of the present invention.
图4是本发明安装于上椎骨和下椎骨之间的结构示意图。Fig. 4 is a schematic diagram of the structure of the present invention installed between the upper vertebra and the lower vertebra.
图中标记为：融合器本体1、自稳嵴11、防退倒齿111、植骨通槽12、安装孔13、上表面14、下表面15、定位传感装置16、防滑结构17、上椎骨2、上椎骨接触面21、上椎骨凹槽22、下椎骨3、下椎骨接触面31、下椎骨凹槽。The marks in the figure are: fusion body 1, self-stabilizing crest 11, anti-regression tooth 111, bone grafting groove 12, installation hole 13, upper surface 14, lower surface 15, positioning sensing device 16, anti-slip structure 17, upper surface Vertebra 2, upper vertebra contact surface 21, upper vertebra groove 22, lower vertebra 3, lower vertebra contact surface 31, lower vertebra groove.
具体实施方式Detailed ways
下面结合附图对本发明进一步说明。The present invention will be further described below in conjunction with the accompanying drawings.
如图1、图2、图3、图4所示的带自稳嵴的零切迹颈椎椎间融合器，包括融合器本体1、沿竖直方向设置于融合器本体1内的植骨通槽12，所述融合器本体1的上表面14和下表面15均对称设置有成对的自稳嵴11，所述自稳嵴11中心轴线均互相平行且所述自稳嵴11的顶面设置有防退倒齿111。The zero-profile cervical intervertebral fusion device with self-stabilizing ridge shown in Fig. 1, Fig. 2, Fig. 3 and Fig. 4 includes a fusion device body 1 and a bone graft channel arranged in the fusion device body 1 along the vertical direction. The groove 12, the upper surface 14 and the lower surface 15 of the fuser body 1 are symmetrically provided with a pair of self-stabilizing ridges 11, the central axes of the self-stabilizing ridges 11 are all parallel to each other and the top surfaces of the self-stabilizing ridges 11 An anti-retraction tooth 111 is provided.
作为本发明的关键，自稳嵴11不仅起到了固定的作用，而且还是实现载荷传导更均匀，避免了局部载荷集中，更有利于骨生长的关键设计。一般的，上表面14的成对的自稳嵴11互相对称，下表面15的成对的自稳嵴11互相对称，这样可以最好的实现力的均匀分布。自稳嵴11的顶面设置的防退倒齿111，如图3所示的，所述防退倒齿111是为了在便于融合器本体1嵌入的同时也防止融合器本体1从上椎骨接触面21和下椎骨接触面31之间滑出，从而让骨生长的环境更稳定。这样，提前置于植骨通槽12的骨骼可以很好的与上椎骨2和下椎骨3长合在一起。当然，一般在设计时，会优选将所述融合器本体1的上表面14与上椎骨2的上椎骨接触面21紧密贴合，以及所述融合器本体1的下表面15与下椎骨3的下椎骨接触面31紧密贴合，即本融合器本体1为解剖学设计，其上下表面与国人上下椎骨的终板形态一致，不仅可以使椎骨载荷的传导更均匀，这样更符合椎骨解剖学形状的结构可以让植骨通槽12内的骨骼更理想的与上椎骨接触面21和下椎骨接触面31贴合。As the key of the present invention, the self-stabilizing ridge 11 not only plays a role of fixation, but also realizes a more uniform load transmission, avoids local load concentration, and is more conducive to bone growth. Generally, the pairs of self-stabilizing ridges 11 on the upper surface 14 are symmetrical to each other, and the pairs of self-stabilizing ridges 11 on the lower surface 15 are symmetrical to each other, so that the best uniform force distribution can be achieved. The anti-retraction tooth 111 provided on the top surface of the self-stabilizing ridge 11, as shown in Figure 3, the anti-retreat tooth 111 is to facilitate the insertion of the fusion body 1 while also preventing the fusion body 1 from contacting the upper vertebra Between the surface 21 and the lower vertebra contact surface 31, it slides out, so that the environment for bone growth is more stable. In this way, the bones placed in the bone grafting groove 12 in advance can grow together with the upper vertebra 2 and the lower vertebra 3 well. Of course, in general design, it is preferred that the upper surface 14 of the fusion device body 1 and the upper vertebra contact surface 21 of the upper vertebra 2 closely fit, and the lower surface 15 of the fusion device body 1 and the lower vertebra 3 The contact surface 31 of the lower vertebra closely fits, that is, the cage body 1 is anatomically designed, and its upper and lower surfaces are consistent with the shape of the end plates of the upper and lower vertebrae of Chinese people, which not only makes the vertebral load conduction more uniform, but also conforms to the anatomical shape of the vertebrae The structure can make the bones in the bone grafting channel 12 fit more ideally with the upper vertebral contact surface 21 and the lower vertebral contact surface 31 .
为了在嵌入融合器本体1的过程中，对融合器本体1嵌入的深度有个准确的监控，可以选择在融合器本体1内设置定位传感装置16。通过体外的监控装置实时对定位传感装置16的位置变化进行监控，从而获取融合器本体1嵌入深度的准确数据，让手术效果更佳。另外，也可以考虑将自稳嵴11的形状为前窄后宽的楔形，如图2所示的，前窄后宽的楔形不仅大大的便于嵌入，而椎体的挤压作用而使嵌入后更加稳固，从而也让嵌入后的嵌入融合器本体1更稳固。更进一步的，也可以在所述自稳嵴11的表面和融合器本体1的表面均设置有防滑结构17，从而让嵌入后的嵌入融合器本体1同样的稳固，所述防滑结构17可以为波纹状的防滑面，也可以是贴附的防滑膜等等。结合实践的经验，为了便于利用手术的工具将融合器本体1嵌入到上椎骨2和下椎骨3之间，可以在所述融合器本体1的背侧面设置有安装孔13，在实际安装时，将与本椎间融合器配套的嵌入工具的尖端插入到安装孔13内，即可很好的为融合器本体1提供前进的推力，从而保证嵌入的进行。In order to accurately monitor the embedding depth of the fusion body 1 during the process of embedding the fusion body 1 , a positioning sensing device 16 may be installed in the fusion body 1 . The position change of the positioning sensing device 16 is monitored in real time by the monitoring device outside the body, so as to obtain accurate data of the embedding depth of the fusion cage body 1, so that the surgical effect is better. In addition, it is also possible to consider the shape of the self-stabilizing ridge 11 as a wedge shape with a narrow front and a wide rear. As shown in Figure 2, the wedge shape with a narrow front and a wide rear is not only convenient for embedding, but the extrusion effect of the vertebral body makes the embedding more difficult. It is more stable, so that the embedding fusion device body 1 after embedding is also more stable. Furthermore, an anti-slip structure 17 may also be provided on the surface of the self-stabilizing ridge 11 and the surface of the fusion device body 1, so that the embedded fusion device body 1 after embedding is equally stable, and the anti-slip structure 17 may be The corrugated anti-slip surface can also be an attached anti-slip film or the like. Combined with practical experience, in order to facilitate the use of surgical tools to embed the fusion cage body 1 between the upper vertebra 2 and the lower vertebra 3, a mounting hole 13 can be provided on the back side of the fusion cage body 1. During actual installation, Inserting the tip of the embedding tool matched with the intervertebral fusion device into the installation hole 13 can well provide a forward thrust for the fusion device body 1, thereby ensuring the progress of embedding.
传统的颈椎零切迹椎间融合器前方植骨孔平面均有钛合金材料的螺钉或插片拧入或插入上下椎体以达到椎间融合器的即刻稳定性。但因钛合金材料不透X线，MRI或CT检查时存在较大伪影，干扰对植骨孔中骨生长情况的观察。为了防止在进行X线，MRI或CT检查时伪影较大的问题，干扰观察植骨空中骨生长的情况，对于融合器本体1的制作材料优选为不会产生伪影的聚醚醚酮，从而大大的降低了对检查结果的干扰。而鉴于自稳嵴11的特殊功能，所述自稳嵴11的制作材料可以选择为钛合金，钛合金会在X线，MRI或CT检查时产生伪影，但本发明中的自稳嵴11结构较细长，所产生的伪影很小，也不会影响检测结果的判断。因此的，本发明在保证融合器本体1最佳的稳固效果的前提下大大的降低了伪影的面积，也会方便专业医务人员对检查结果的判断。Titanium alloy screws or inserts are screwed or inserted into the upper and lower vertebral bodies in the plane of the bone graft hole in front of the traditional cervical zero-profile intervertebral fusion to achieve immediate stability of the intervertebral fusion. However, because the titanium alloy material is opaque to X-rays, there are large artifacts in MRI or CT examinations, which interfere with the observation of bone growth in the bone graft hole. In order to prevent the problem of larger artifacts during X-ray, MRI or CT examinations and interfere with the observation of bone growth in the bone graft space, the material for the fusion cage body 1 is preferably polyether ether ketone that does not produce artifacts, Thereby greatly reducing the interference to the inspection results. In view of the special function of the self-stabilizing ridge 11, the material for making the self-stabilizing ridge 11 can be selected as titanium alloy, which will produce artifacts in X-ray, MRI or CT examinations, but the self-stabilizing ridge 11 in the present invention The structure is relatively slender, and the artifacts produced are very small, and will not affect the judgment of the detection results. Therefore, the present invention greatly reduces the area of artifacts on the premise of ensuring the best stabilizing effect of the fusion device body 1, and also facilitates professional medical personnel to judge the inspection results.
另外，还可以选择在所述自稳嵴11的表面和融合器本体1的表面均设置羟基磷灰石涂层，所述的羟基磷灰石可以很好的促进骨的生长，与本发明的固定效果相配合，大大的提高了骨骼的生产融合速度。In addition, it is also possible to choose to install hydroxyapatite coating on the surface of the self-stabilizing ridge 11 and the surface of the cage body 1. The hydroxyapatite can well promote the growth of bone, which is similar to that of the present invention. Combined with the fixed effect, the speed of bone production and fusion is greatly improved.
Claims (10)
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