CN1076851A - 皮下筋膜上椎弓根的内固定的方法及装置 - Google Patents

皮下筋膜上椎弓根的内固定的方法及装置 Download PDF

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CN1076851A
CN1076851A CN93100047A CN93100047A CN1076851A CN 1076851 A CN1076851 A CN 1076851A CN 93100047 A CN93100047 A CN 93100047A CN 93100047 A CN93100047 A CN 93100047A CN 1076851 A CN1076851 A CN 1076851A
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fixture
bone
vertebra
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哈雷特·H·马修斯
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Medtronic Sofamor Danek Inc
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Abstract

一种用于内部固定脊柱椎骨的方法包括切除受 影响的椎弓根盘核、准备骨移植物、将器械装入椎骨 以进行固定以及将骨移植物导入切除后的核空间等 步骤。椎间盘切除通过两个穿过纤维环的入口来进 行,一个入口支承切除工具,另一个支承一观测仪。 固定金属器具包括骨钉、固定板、配合螺母和连接 件。固定板、配合螺母和连接件支承在筋膜上但在皮 下,这样筋膜和肌肉组织就不会被损害。骨钉结构可 将固定金属器具支承在筋膜上。本发明又提供一三 件式扩张器装置以在此方法的骨钉植入步骤中使 用。

Description

本发明涉及一种脊柱椎骨的内固定的方法及装置。
很久就知道内固定是融合术的一种辅助手段,比如是横突融合术的辅助手段。在早先的已有技术中,外科医师切开病人的背部,分开组织和肌肉,以便暴露出需要进行手术的较大区域的脊柱。在一种已有技术的方法中,融合和固定是通过相邻椎骨的相对的横突间的骨段移植来实现的。然而,这个技术使正常的身体结构受到很大破坏并造成大量失血。况且,由于在椎体之间没有直接连接,因此这种外科技术不能使椎骨完全稳定。
在本技术领域内已知有许多类型的器械可以用来进行脊柱固定。比如,Harrington研制的脊柱器械采用了一种钩和杆的结构。植入Harrington脊柱器械需要对脊柱进行骨膜下剥离以避免损伤肌肉神经和血管。还需要解剖肌肉组织。在早期Harrington技术的某些方面还必须将脊柱棘突上的和脊柱内的韧带作剥离。
后来发展的技术涉及穿过皮肤和肌肉而放入骨内的金属器具。有些固定用的金属器具留在体外,在完成融合后卸除。这类技术的缺点是有很高的感染率和切口的发病率。
迄今为止,这种已有技术的脊柱固定和/或融合技术的特征是过多地损害病人脊柱和背部区域。因此需要一种既能使脊柱获得足够的稳定,同时又使感染和病人发病率尽可能降低。还需要这种方法能在融合完成后通过门诊就可以将固定金属器具经皮取出。
本发明构想了一种采用皮下筋膜上内固定的经皮融合技术。更具体地说,本发明这种使损伤达到最小限度的技术可使腰椎的椎间盘空间在适当的椎间盘切除和骨移植后得到较早融合。固定点是筋膜上的,即在肌肉筋膜上方,又在皮肤下方,即在皮肤表面之下。这样,没有肌肉组织会受到破坏,而操作过程的皮下特点大大降低了针道感染的危险性或发生骨髓炎的可能性。
本发明的最具特征之处在于本技术设想首先切除包括上、下终板在内的受损椎间盘,然后将骨移植材料置入椎间盘空间。在这之前,先植入固定用的器械。总的来说,此固定金属器具可包括带导管的自攻骨钉、固定板和用来从横向将板固定在棘突相对两侧上的连接件。
在一较佳方法中,导线从两边与椎弓根对准并植入其中。椎弓根的螺钉通过导线送进去拧入椎弓根内预先钻好的孔内。在导线轴去后,抬起皮肤,对筋膜上皮下空间内的组织进行解剖以便插入固定板。合适的钢板首先装在同侧螺钉上,然后对每一级的金属器械的相反侧的骨钉重复此过程,即在每个需稳定的椎骨处重复此过程。横切过相应螺钉之间的中线并随后将连接件用顶部加载插入装置定位在螺钉之间,即可横向连接这些双侧固定板。螺母也从顶部加载到每个相继的螺钉上以将连接件固定到板上并将板固定到椎弓根螺钉上。
在本发明方法中,与椎弓根螺钉拧合的螺母首先松弛地拧在螺钉上。然后骨钉进入椎体直到金属器具位于皮肤下,但又在每级器械处皮下空间内的筋膜之上。当固定金属器具处于最终停止位置时再将螺母拧紧。一旦固定器械到位,骨移植材料就穿过插管而导入椎间盘空间并由一紧塞器驱动到位。在移植骨到位且脊柱固定金属器具与适当的椎骨咬合后,就对皮下组织进行清洗和闭合。
本发明的另一特点是提供了非常适用于本发明的方法的一带插管的固定螺钉和骨钉。更具体地说,此螺钉包括一远端的有螺纹的杆部和一近端的与螺母拧合的柄部,柄部终止于一传动毂。远端螺纹杆部有与骨拧合的自攻螺纹。螺纹杆部和柄部之间有一足够长度的光滑杆体,这样当固定器械到位时就只有光滑杆体与肌肉组织相接触。靠近光滑杆体的柄端有一安装毂用来在螺母拧合到螺纹柄部之前支承着固定板。光滑杆体最好是占螺钉长度的一半左右,其中螺钉长度从与骨拧合的螺纹杆部尖端算起到安装毂的下侧。
本发明的又一特点是提供了一种三件式的扩张装置,用来便于椎骨的器械操作。更具体地说,此扩张装置包括三个同心设置的中空扩张管,每个扩张管在相应端制成尖锥形以便无损伤地插入病人体内。三个扩张管的直径依次减小但长度则依次增加。中间和最小的扩张管有便于在本方法的各步骤中抓住以便取出的滚花的端部。
本发明的一个目的是提供一种脊柱内固定的方法,它可使损害最小且病人健康的危险最小。另一个目的是提供这样一种技术,即它还允许暂时植入的金属器具可以在门诊时进行皮下拆除。
本发明的再一个目的是通过本技术的构想采用皮下的但在筋膜上的固定方式以避免损伤脊柱肌肉组织和韧带。本发明其他的目的和优点将从后面对本发明的描述中看得更为清楚。
图1是示出了在采用本发明方法植入固定器械后的病人脊柱剖面图;
图2是可用于本发明方法的骨钉的侧面图;
图3是在采用本发明植入固定器械后的脊柱后视图,图中示出了采用横过脊柱中线的连接件的双侧固定方法,这是从皮肤下面的示意图,但肌肉组织已移去以暴露出下层椎骨的详细情况。
图4A-4C是在将骨钉植入一椎骨的步骤中用于本发明方法的三件式扩张装置的各组件的侧面图。
为了便于对本发明原理的理解,现请参看附图中的实施例,而且采用专门语言进行描述。然而应当明白,实施例并不是想限制本发明的范围,图示装置的变化型式、进一步的改进以及图示的本发明原理的进一步应用对本发明技术领域内的熟练人员来说都应当是很容易想到的。
本发明首先设想了用于经皮融合技术的步骤,比如可用来在椎间盘组织去除后对相邻椎骨进行融合。根据本发明的较佳实施例,此方法施行于腰椎部分,但相信它也适用于脊柱的其它部位。病人在适当的准备工作后,俯卧在一可透过射线的加垫支承架上,支承架在整个过程中允许进行AP(前,后)和侧向荧光屏显示。先拍一张AP片,此时一外导针与受影响的椎间盘的终板平面相平行以确保整个过程相对于椎间盘空间在一准确的方向内进行。在AP放射照片上一引导线沿着导针像画出以划定进入的部位。
在本方法的融合技术的较佳实施例中,采用双入口法以清除出椎间盘核空间。作局部麻醉的入口点位于中线的双侧,位于离放射照片引导线约10厘米处的两侧(可在适合于较小病人的8厘米和适合于较大病人的12厘米之间变化)。
在筋膜和筋膜内肌肉组织被适当麻醉后,采用双针技术进行两侧的椎间盘造影术。根据此较佳方法,到椎间盘纤维环的初始入针点位于AP放射照片上的椎弓根线上,它是由位于植入器械的椎间盘间隙的上方和下方的椎弓根的中部的产生的线来定义的。两根针都进入核的后中央部,开始三角剖分。进行椎间盘影术以确定椎间盘疾病的性质以及涉及的椎间盘结构的被包含的和不被包含的情况。(未被包含的椎间盘是指折裂穿过较后的纵向韧带和/或纤维环,因此允许造影剂从核内空间自由地流入硬膜外空间)。
此较佳方法接着的步骤是将插管导入椎间盘空间。椎间盘X射线照片针的毂可除下作为插管的导线。扩张探头置于导线上而从两侧进入椎间盘纤维环内。护套置于探头上,逐渐增大的插管可从上面进去以使纤维环扩张到一适当的直径而便于椎间盘内操作。再次地,此先前步骤在上述两个入口点处从两侧进行并对每个受影响的椎间盘重复施行。
在此方法的一个方面,可视镜穿过每个纤维环而设置以检验纤维环并确保纤维环下的解剖。如果没有观察到神经组织而存在纤维环组织,在移走可视镜后将一环钻引入。对纤维环进行钻孔,并且采用各种尺寸的环钻以钻出一个直径足够的环洞以便除去椎间盘和进行盘外显示。
当每个双侧入口点处的环钻操作完成后,就有了两个入口。椎间盘切除可通过一个入口进行,而检验镜子置于另一个入口处。当通过观测入口完成椎间盘切除器械的直接显示时,就可认为通过一个入口的椎间盘材料的三角部分完成了。利用切割和吮吸器械或通过借助于激光的探子,受影响的椎间盘核内腔就被完全分割了,而且扩张了上下终板。器械可从每个入口移开并改变位置以完全切除椎间盘核。用于核的快速椎间盘去除器械以及快速的用于终板的磨锉装置可用来切除只融合而准备的组织。器械也可用来切除较后的韧带结构和维持纤维环内的环圈以产生足够的空腔以便导入骨移植物。可接受的装置包括锉子、激光器、刮器、测量仪以便将终板组织扩张到流血的状态。刚性和柔性的观察镜都能用来证实髓核内空腔的完全切除。一旦椎间盘内容也被从空腔完全清除且终板完全扩张后,可在每个插管内置入一紧塞器以在此接着的步骤期间防止感染。
在本发明较佳技术的这一点上,进行了骨移植物的采集。肯移植物的采集可由适于此目的的任何已知技术来完成。在本发明方法的一个特定实施例中,在适当的麻醉和止痛后,在髓后上嵴作一小的切割以暴露外嵴以便采集骨移植物。移植物从皮层松质骨板取得且准备好以进行移植过程。骨移植物制成一定形状以便容纳于在上述椎间盘切除期间采用的最大外插管的内径中。骨可与其他组织混合,比如骨引导管的质或形态发生材料。然后骨收集点就被清洗、干燥和在一小出口上闭合。
本发明过程的下一步骤,即器械使用步骤,在直接的荧光屏显示镜下进行。在AP荧光图象指引下,导入一导线(最好为0.062的导线)并且导线的尖端在一与安装插管的区域稍稍错开的位置插入皮肤。在一特定实施例中,导线从安装插管的区域横向地插入一厘米。荧光屏显示证实导针的位置为与椎弓根成15度角。导针用来触摸椎弓根上的皮层,然后由一槌锤锤击进行固定以防止导针的移动直到需要进一步进入。在导针已被插入皮质后,采用组织扩张以保护周围的肌肉组织。然后导针在侧向荧光屏显示下,进入椎弓根和椎体内。AP和荧光屏显示都用来确实插入的位置。对椎骨的每个椎弓根重复此过程。这样,对于每个要应用器械的椎骨来说,一对导针大约与中线成15°角且沿椎骨的每个椎弓根。
在完成导针的插入过程后,在导线插入点处进行切割,在一具体实施例中,长约2.0厘米。然后,采用固定夹具和Metzenbaum剪刀,皮下组织在筋膜上进行解剖。Metzenbaum剪刀也用来从横过中线的同侧针到后侧导针解剖筋膜上皮下组织。解剖这些组织提供了此方法接着的步骤中连接椎弓根螺钉的空间。
在本发明方法的下一步骤中,采用了一种三件式组织扩张装置来使每个导针处的组织扩张以接受第一带插管的钻头,接着接收较大直径的椎弓根插管的自攻骨钉。扩张装置包括三个直径和长度递增的渐尖的管子。这些管子从最小直径到最大直径依次导入以提供穿过组织的进路以便进行此方法的后面的步骤。在插入三件式组织扩张装置后,卸除最小的内部扩张装置以便沿着导针插入钻头。钻头用来钻入椎弓根的初始的三分之一。抽出钻头,然后除去中间的组织扩张装置,而最大的扩张装置仍保留在其位。自攻骨钉从导线上穿过最大的扩张装置插入直到它前进到椎弓根的50%深度处。当骨钉的位置已由侧向荧光屏显示中确定时,除去导线,且骨钉前进到骨钉的近尖端位于皮肤切口的层次处。对每个接着的椎骨内的每个椎弓根重复此过程直到所有骨钉到位以用于最后的内固定器械。
在一特定实施例中,带插管的钻头外径为4.5毫米,而带插管的骨钉直径可为5.5-8.5毫米。这样,在此特定实施例中,三件式扩张装置的中间扩张器的内径至少为4.5毫米,最好为5.2毫米,以通过其接受钻头。类似地,最大扩张器的内径至少大于骨钉,且最好为9.6毫米以容纳一定直径范围的骨钉。
固定夹具再次用来拾起皮肤,而且Metzenbaum剪刀用来解剖任何残留的皮下筋膜上组织以满足插入一细长固定板的需要。采用镊子将一适当尺寸的固定板插入2.0厘米切口。我们明白固定板尺寸适于配合在与相邻椎骨的椎弓根相咬合的骨钉上以在棘突的每一例提供足够的固定。用于同侧螺钉的固定板首先由镊子插入然后在每个需要器械的椎骨层次重复此过程。而且,连接件穿过在同侧导钉处的切口插入,并横过皮下空间内的中线以与同侧及反侧的骨针完成横向连接。连接件的类型可以是由Danek  Medical公司(本发明受让人)的CROSSLINK产品售出的那种。一旦每个固定板和连接件已拧合在适当骨钉的上方,以顶部加载的方式拧上螺母以便松弛地将金属器具固定在一起。
当每个螺母初步拧到其相应螺钉上时,骨钉按需要拧进而使所有固定金属器械在每级器械处位于皮下,但又在筋膜上。一旦每个骨钉到达在椎骨内的其最终安定位置时,以及一旦包括固定板和连接件在内的所有器械位于适当的筋膜上皮下空间,每级处的螺母就被拧紧了,而螺钉也就固定住了,这样就在固定装置的所有组件之间产生牢固的锁定。AP和侧向荧光屏显示可确证金属器械的最终位置,以便使手术操作令人满意。
一旦固定器械已被插入后,就对每个骨钉插入部位以及接纳固定组件的皮下空间进行彻底冲洗。对切口进行干燥及止血检查,接着用皮下吸收性缝线进行切口闭合。
固定金属器械闭合后,将注意力转移到前面的入口,椎间盘切除是通过这些入口进行的。在本发明方法的这个步骤中,紧塞器从入口除去,先前收集的骨移植物通过一插管进入椎间盘空间。将一光滑的紧塞器插入插管以便于骨移植材料通过插管进入空的椎间盘核空间。当骨移植材料完全填充同侧入口后,在反侧入口处也进行同样的步骤。由于第一入口已被移植材料充填,反侧移植步骤的目测是不可能的。然而,荧光屏显示可用来确定将紧塞器导入椎间盘核空腔,从而确认骨移植材料的位置。在移植过程完成后,将插管移走,对皮下组织进行冲洗,并用吸收性缝线闭合荧光镜入口处。
记住对本发明的上述描述并将注意力转向附图。在图1中,病人椎骨区域的剖视图显示了具有椎弓根部11的椎骨10。在此上部的剖视图中,显示了具有完整纤维环15但在切除椎间盘组织后具有一空的核空间16的椎盘间。固定金属器械只在由椎骨10的棘突确定的中线ML的一侧得到显示。然而,如图3所示,固定器械是植入在中线ML的每一侧上的。图3进一步显示了在由10和10′标出的相邻椎骨之间的固定方式,以及相应的人体部位10a、横突10b和10c棘突10d以及板层(laminae)。
图1中所示的入口部位25a和25b用于本方法的椎间盘切除步骤中。图1和图3显示了入口26a和26b的位置,椎间盘插管从这些入口除去,骨移植材料也从这些入口导入。如上所述,入口部位25a和25b位于离中线ML标称10.0厘米处。入口26a和26b的方向取成使椎间盘切除工具可从神经根高度处的椎骨的横突10c之下插入。
再参看图1,显示出病人的皮肤20从保护肌肉组织23的筋膜22分解下来以提供一筋膜上皮下空间25。显示出一切口27,固定金属器具从此切口根据上述方法插入。固定金属器具包括一骨钉30,它最好是一椎弓根螺钉。固定板40安装在螺钉30上并由螺母42固定在位。在图3的后视图中,也显示出固定金属器具包括横跨过相应骨钉30之间的中线的连接件44。
如图1中可清楚地看出,本发明的方法提供了用于给相邻椎骨安装器械以便于融合的技术。根据本发明植入固定器械由于插入是通过单一切口进行,比如通过切口27进行,并与每个椎弓根对准,因此对病人造成的侵害最小。更显著地,金属器具停留在筋膜上皮下空间25内,这样就不需要破坏肌肉组织。根据此方法,病人发病率降低了,而治愈率提高了。由于固定金属器具停留在肌肉层上方,就可在局部麻醉下在门诊治疗过程中进行卸除。
现请参看图2,骨钉的细节结构特别适合于图示的本方法。骨钉30包括一远端的螺纹杆部31,它在此较佳实施例中结构上为根据已知技术的自攻椎弓根螺钉。螺钉30的近端包括一机加工的螺纹柄部34,它具有螺纹以与用来固定固定板40和连接件44的螺母42相咬合。柄部34终结于一传动六角凹部35,凹部35与本技术领域内已知的适当的螺钉传动工具相配合。(或者,可用一六角形突起部来替代凹部35,而螺钉传动工具也作相应改变)。
远端杆部31和近端柄部34的中间部分是一光滑杆体32。光滑杆体32构成了一靠近近端螺纹柄部34的毂部33。毂部33包括一表面33a,其形状可支持固定板40。当螺母42拧紧到近端柄部34上时,固定板40锁定在螺母和毂部表面33a之间。毂部33支承着固定板以将其保持在筋膜上空间25内。表面33a最好稍稍弯曲以适合位于本领域已知的扇形固定板内。螺钉30沿整个长度插有插管,由孔36表示,用来插入导线。
光滑杆体32为接触筋膜和肌肉组织提供了不刺傲的表面。光滑杆体32的长度由围绕装有器械的椎骨的肌肉厚度来决定,且大体上其长度等于与孔配合的螺纹杆部31的长度。在一特定实施例中,从与孔配合的杆部31的顶端算到安装毂部33下面的螺钉30的长度为65-75毫米。与孔配合的远端杆部31的标称长度为35毫米以提供与椎骨的最佳配合。光滑杆体32占据了此65-75毫米长度的剩下的部分,或在30-40毫米之间。机加工螺纹柄部34从安装毂部33的表面33a算起的长度足够容纳固定板40、螺母42和一连接件44。在此特定实施例中,机加工螺纹柄部34的长度是10-15毫米,这样很少的柄部突出于螺母。根据病人和固定步骤的需要,骨钉30的直径可以在5.5-8.5毫米之间。当然应当明白,特定尺寸用来说明名义上的骨钉结构。这些尺寸可根据具体病人或步骤的需要变化,但仍遵从本发明的基本变化。
现请参看图4A-4C,显示了一种三件式扩张装置50的组件。如上所述,扩张装置用来便于将骨钉40植入病人的椎骨。装置50包括三个依次缩小且增长的扩张管51、56和61。每个扩张管在其相应端53、58和63逐渐缩小以便无外伤地将扩张管导入病人的皮肤和组织。每个扩张管装有插管或制成中管的,就如相应通孔52、57和62所示的那样。最细扩张管51的孔52的直径足以接纳一导线穿过其中。中间直径的扩张管56的孔57的直径略大于扩张管51的外径。类似地,较大直径扩张管61的孔62稍大于扩张管56的外径。
最小和中间直径的扩张管51和56的相应端54和59有滚花以提供一抓持表面用来卸除扩张管。扩张管的长度是渐变的,即最小直径管51有最大长度,而中间扩张管56比最外面的较大直径管61长。此长度差也便于当椎骨在本方法的器械植入步骤中钻孔之前和之后依次将扩张管51和56卸除。
在本发明的三件式护张装置50的一特定实施例中,最小直径的扩张管51的外径约5毫米,长度为152.5毫米,插管孔直径约2毫米。中间扩张管56外径为9.4毫米、长度约140.0毫米,插管36直径为5.15毫米(留下0.15毫米的间隙以插入扩张管51)。其内插入通过有骨钉30的最后的扩张管61外径为11.1毫米,长度为127.0毫米,插管孔直径为9.58以接纳穿过其中的中间护张管56以及骨钉30。
虽然在附图和上述说明书中详细地显示和描述了本发明,但它只是用来说明而不为文字所局限,应当明白显示和说明的只是较佳实施例,本发明精神范围内的所有变化和修改也希望得到保护。

Claims (9)

1、一种用于脊柱内固定的骨配合固定件,包括:
一具有配合在一椎骨内的螺纹的远端螺纹杆部;
一具有与一螺纹螺母配合的机加工螺纹的近端螺纹柄部;
一在所述螺纹杆部和所述螺纹柄部之间的光滑杆部,所述光滑杆部有一靠近所述螺纹柄部的毂部,所述毂部构成了一支承表面以支承与配合在所述近端柄部上的骨配合固定件相连的一细长固定件;
其特征在于,所述光滑杆部从所述螺纹杆部算到所述毂部的长度大约等于从病人的椎弓根到肌肉筋膜的距离,这样当所述远端螺纹杆部配合在病人椎骨内时所述毂部位于肌肉筋膜上方。
2、一种用来将骨钉植入椎骨的三件式扩张装置,包括:
一具有一渐缩端、一第一长度和一第一直径的第一管状扩张器;
一具有一渐缩端、一第二长度和一第二直径的第二管状扩张器;
一具有一渐缩端、一第三长度和一第三直径的第三管状扩张器;
其特征在于,所述第一直径大于所述第二直径,所述第二直径大于所述第三直径;
其中所述第一长度小于所述第二长度,所述第二长度小于所述第三长度。
3、如权利要求2所述的三件式扩张装置,其特征在于:所述第二管状扩张器有一与所述渐缩端相反的第二端,所述第二扩张器在靠近所述第二端处有一带滚花的外表面;以及:
所述第三管状扩张器有一与所述渐缩端相反的第二端,所述第三扩张器在靠近所述第二端处有一带滚花的外表面。
4、一种脊椎固定装置,其特征在于,包括:
一细长固定件,其结构为可植入于一病人靠近脊椎处;
至少两个具有一细长杆部的骨配合固定器,杆部的一端具有与一椎骨的一部分配合的装置,杆部还包括将细长固定件支承在病人肌肉组织之上、皮肤层之下的装置;以及:
用来在所述支承着固定件的装置处将细长固定件夹持到每个所述骨配合固定器的装置。
5、如权利要求4所述的脊椎固定装置,其特征在于,还包括:
一对适合于插入椎骨椎弓根的导针;
其中这对骨配合固定器的每一个都有用来穿过相应导针的插管。
6、如权利要求4所述的脊柱固定装置,其特征在于,所述细长固定件是一脊柱板,其内有一些开孔以接收每个骨配合固定器的一部分杆部穿过其内。
7、一种脊柱固定装置,其特征在于,包括:
一细长固定件,其结构可植入于一病人靠近脊柱处内;
至少两个具有一细长杆部的骨配合固定器,细长杆部的一端有用来与一部分椎骨配合的装置,此杆部还包括用来将细长固定件支承在病人肌肉组织上、皮肤层之下的装置,以及
用来在支承着固定件的所述装置处将细长固定件夹紧到每个所述骨配合固定件的装置;
多个管状组织扩张器,每个都具有一渐缩端,其中所述多个扩张器的每一个都有依次增大的直径以便一个接纳在另一个中,最大直径的扩张器的尺寸做成可接纳骨配合固定器穿过其中。
8、如权利要求7所述的脊柱固定装置,其特征在于,所述多个扩张器包括一中间扩张器,其尺寸可接纳穿过其中用来将螺纹攻入椎骨的椎弓根内以接纳其内的骨配合固定器的钻头,所述中间扩张器小于所述最大直径扩张器。
9、如权利要求8所述的脊柱固定装置,其特征在于,还包括一对适于插入椎骨椎弓根内的导针,每个骨配合固定器都有插管,进一步地,所述多个扩张器中的小于其它两个扩张器的一个其尺寸可接纳穿过其中的一导针。
CN93100047A 1992-03-17 1993-01-01 皮下筋膜上椎弓根的内固定的方法及装置 Pending CN1076851A (zh)

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CN100479773C (zh) * 2003-12-16 2009-04-22 德普伊斯派尔公司 用于以侵入性最小的方式放置脊椎固定元件的装置
CN103431904A (zh) * 2012-12-28 2013-12-11 周跃 单钉式经皮关节突椎弓根螺钉内固定系统
CN103431904B (zh) * 2012-12-28 2015-07-08 周跃 单钉式经皮关节突椎弓根螺钉内固定系统
CN107753095A (zh) * 2017-11-17 2018-03-06 常州集硕医疗器械有限公司 一种可与棒结合式脊柱板

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US5171279A (en) 1992-12-15
US20050038434A1 (en) 2005-02-17
EP0584293A1 (en) 1994-03-02
NZ246236A (en) 1997-11-24
US6793656B1 (en) 2004-09-21
NO934137L (no) 1993-11-16
EP0584293A4 (zh) 1994-08-31
US5728097A (en) 1998-03-17
US5357983A (en) 1994-10-25
AU4208396A (en) 1996-04-04
ZA929693B (en) 1993-06-09
AU3231693A (en) 1993-10-21
WO1993018722A1 (en) 1993-09-30
AU666908B2 (en) 1996-02-29
FI935062A0 (fi) 1993-11-16
US5496322A (en) 1996-03-05
FI935062A (fi) 1993-11-16
US5569248A (en) 1996-10-29
AU681816B2 (en) 1997-09-04
JPH06507820A (ja) 1994-09-08
BR9206001A (pt) 1994-10-11
US6033406A (en) 2000-03-07
NO934137D0 (no) 1993-11-16
CA2109077A1 (en) 1993-09-18
MX9206758A (es) 1993-09-01

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