CN1700895A - 环面修理系统和技术 - Google Patents

环面修理系统和技术 Download PDF

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Publication number
CN1700895A
CN1700895A CNA038119560A CN03811956A CN1700895A CN 1700895 A CN1700895 A CN 1700895A CN A038119560 A CNA038119560 A CN A038119560A CN 03811956 A CN03811956 A CN 03811956A CN 1700895 A CN1700895 A CN 1700895A
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CN
China
Prior art keywords
piece
obstruction
defective
obstruction piece
attachment portion
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CNA038119560A
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English (en)
Inventor
H·H·特里优
L·K·莱赫曼
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Warsaw Orthopedic Inc
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SDGI Holdings Inc
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Publication of CN1700895A publication Critical patent/CN1700895A/zh
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    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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Abstract

用来修理环面缺陷的系统和方法包括定位在环面缺陷内或邻近环面缺陷的至少一个阻塞件,用来将阻塞件固定到邻近组织的至少一个附连部分,以及用来将阻塞件放置和接合在环面缺陷内和/或邻近环面缺陷的器械。阻塞件至少部分地横贯环面缺陷延伸,以便修理缺陷和/或保持核的材料,一个或多个植入物,生物相容的材料或装置,和/或定位在脊椎盘空间内的其它的物体。

Description

环面修理系统和技术
技术领域
本发明一般地涉及脊椎外科的领域,具体来说,涉及用来修理脊椎盘的环面纤维化的系统和技术。
背景技术
有各种外科手术和病情会在环面纤维症中形成缺陷,例如,环缝术,椎间盘切除术,核手术,人造盘核或人造盘修补物的植入,或一盘疝形成的修理。环面缺陷的修理通常被认为费时和无效。因此,环面缺陷通常随其存在而不作修理。这可导致盘再形成疝的较高的发病率或从盘空间中去除植入物。
在修理环面物的手术中,利用缝合线将周围的组织拉在一起,试图关闭缺陷,这种做法则会遭遇困难的挑战。通常,环面缺陷是一相当大的洞,用传统的缝合技术难于关闭。有效地接合周围环面组织中的缝合线也会很困难,且在作出修理之后,缝合线会通过环面组织切断或撕裂。
因此,需要有用于脊椎外科的系统和方法,它在环面纤维化中提供对缺陷的有效的修理。本发明是尤其针对满足这种需要。
发明内容
本发明涉及用来修理环面缺陷的系统、技术和方法。系统的实施例包括至少一个定位在环面缺陷内或邻近环面缺陷的阻塞件,一个或多个连接到至少一个阻塞件的附连部分,其用来将阻塞件固定到邻近的脊椎骨,以及一用来将阻塞件放置到环面缺陷内和/或邻近环面缺陷的器械。阻塞件至少部分地横贯环面缺陷延伸,以便修理缺陷和/或保持核芯材料、一个或多个植入物、生物相容的材料或器械,和/或定位在盘空间内的其它的物体。
附图的简要说明
图1是涉及环面修理系统的一实施例的分解的立体图。
图2A-2C是可用于图1的环面修理系统的锚固件的各种实施例的侧视图。
图2D是另一实施例锚固件的一部分的立体图。
图3A-3G是可用于图1的环面修理系统的锚固件的各种实施例的侧视图。
图4A-4C分别示出一预插入结构和后插入结构的截面图,以及一后插入结构的侧视图,它们是相对于一对邻近的脊椎骨的图1的环面修理系统的结构。
图5示出一材料原料,由此可制造一包括部分的环面修理系统的阻塞件。
图6示出带有其它实施例的附连部分的环面修理系统的一部分。
图7是一实施例器械的远端部分的立体图,该器械用来在一环面缺陷内插入和接合本发明的环面修理系统。
图8是图7的器械的部分的侧视图,其中,图6的环面修理系统安装在器械上并延伸通过一牵引器套筒。
图9是图7的器械和环面修理系统的侧视图,图中示出环面修理系统插入到环面缺陷内,以及环面修理系统与邻近缺陷的脊椎骨的接合。
图10A-B分别示出用于图7的器械的一实施例的近端部分的侧视图和端视图。
图11是另一实施例锚固件的立体图。
图12A-12C分别是安装在一插入的器械上的图11的锚固件的立体图和侧视图。
图13示出接合在一环面缺陷内的图11的锚固件,其用一在其间延伸的阻塞件连接到邻近的脊椎骨。
图14是另一实施例的环面修理系统的立体图。
图15A-15C示出用来将一阻塞件附连到一锚固件上的各种装置。
图16A-16C是图14的插入器械和环面修理系统的一部分的局部侧视图,示出环面修理系统在环面缺陷处的插入和接合。
图17A-17C分别示出在预接合结构中、在接合结构中,以及在一平面图中的环面缺陷内的另一实施例的环面修理系统。
图18A-18B示意地示出另一实施例的器械,其用来将图17A-17C的环面修理系统插入和接合到邻近环面缺陷的脊椎骨。
图19A-19C是另一实施例的阻塞件和环面修理系统的锚固件的侧视图。
图20A-20B分别是接合在一环面缺陷内的图19A-19B的阻塞件和锚固件的侧视和正视的局部截面图。
图21A-21B分别是接合在一环面缺陷内的另一实施例的环面修理系统的侧视和正视的局部截面图。
图22A-22B分别是接合在一环面缺陷内的另一实施例的环面修理系统的侧视和正视的局部截面图。
图23A-23B分别是接合在一环面缺陷内的另一实施例的环面修理系统的侧视和正视的局部截面图。
图24A-24B分别是接合在一环面缺陷内的另一实施例的环面修理系统的侧视和正视的局部截面图。
图25A-25B分别是接合在一环面缺陷内的另一实施例的环面修理系统的侧视和正视的局部截面图。
图26A-26B分别是接合在一环面缺陷内的另一实施例的环面修理系统的侧视和正视的局部截面图。
图27A-27B分别是接合在一环面缺陷内的另一实施例的环面修理系统的侧视和正视的局部截面图。
图28是邻近一环面缺陷接合的另一实施例的环面修理系统的侧视截面图。
图29是邻近一环面缺陷接合的另一实施例的环面修理系统的侧视截面图。
图30是邻近一环面缺陷接合的另一实施例的环面修理系统的侧视截面图。
图31是邻近一环面缺陷接合的另一实施例的环面修理系统的侧视截面图。
图32A-32D示出一阻塞件的各种实施例,其包括附连到硬的骨组织上的环面修理系统的部分。
图33A-33D示出一阻塞件的各种实施例,其包括附连到软组织上的环面修理系统的部分。
图34A-34D示出一阻塞件的各种实施例,其包括附连到硬和软组织上的环面修理系统的部分。
具体实施方式
为了便于理解本发明的原理,现将参照附图中所示的实施例并采用特定的语言来描述本发明的实施例。然而,应该理解到,由此无意限制本发明的范围。对于本发明所涉及的技术领域内的技术人员来说,所示实施例中的任何这样的变化和进一步的修改,以及本文中说明的本发明的原理的任何这样的进一步应用,都被认为是正常出现的。
环面修理系统和方法包括一阻塞件,其由脊椎盘的环面纤维化中的缺陷内或邻近缺陷的一个或多个附连部分予以保持。阻塞件可阻塞环面纤维化内的所有的或部分的缺陷或空隙,这种情形可由外壳手术或盘形成疝而造成。一个或多个附连部分可连接到或一体地形成在阻塞件上。附连部分可接合到软组织和/或硬组织,或邻近缺陷或空隙的骨上。因此,附连部分将阻塞件相对于邻近的软或硬组织保持在缺陷或空隙内的大致固定的位置上。
参照本文所述的各种实施例,附连部分可使用各种装置和/或技术连接或固定到阻塞件,或可与阻塞件或阻塞件的延伸部一体地形成。阻塞件可通过以下方法连接或附连到附连部分上,例如,将附连部分缝合到阻塞件,热焊或热连接,粘结剂连接,三维编织或编结,螺钉,钉,销,大头钉或铆钉固定。此外,附连部分可在阻塞件放置到或靠近到环面缺陷之前或之后固定到阻塞件上。
阻塞件可由柔性的或呈现至少某些柔性的部件制成。这种部件的实例包括编织的织物管,编织和非编织的网,或编结或编织的结构,缝合线,系绳,绳索,平面件,带,丝线,缆索,或任何其它可横贯环面缺陷延伸的部件。此外,阻塞件可以是回弹的和/或弹性的,这样,在插入和附连过程中和插入和附连之后,它可呈各种形状。生长因子或细胞可包括在阻塞件内,以加速环面修理的过程。生长因子可以是转化生长因子β1,胰岛素状生长因子1,血小板衍生的生长因子,纤维原细胞生长因子,骨形态发生蛋白质(BMP),LIM矿物化蛋白质(LMP),以及它们的组合。
阻塞件可由任何生物相容的材料,合成材料或天然源材料,以及具有再吸收或非再吸收特性的材料。阻塞件材料的合适的实例包括:自体移植物、同种异体移植物,或异种移植物;组织材料包括有软组织、连接组织、去矿物质骨基质和其组合物;再吸收材料包括聚交酯、聚乙交酯、酪氨酸衍生的聚碳酸酯、聚酐、多原酸酯、聚磷腈、磷酸钙、羟磷灰石、生物活性玻璃、胶原质、白蛋白、纤维蛋白原以及它们的组合;以及非再吸收材料包括聚乙烯、聚酯、聚乙烯醇、聚丙烯腈、聚酰氨、聚四氟乙烯、聚对苯二甲酰对苯二胺、纤维素,以及它们的组合。
这里所述的附连部分可包括由任何生物相容材料制成的锚固件,其包括合成的或天然的自体移植物、同种异体移植物,或异种移植物组织,可以是再吸收或非再吸收的特性。组织材料的实例包括硬组织、连接组织、去矿物质骨基质和其组合物。再吸收材料的其它的实例是聚交酯、聚乙交酯、酪氨酸衍生的聚碳酸酯、聚酐、多原酸酯、聚磷腈、磷酸钙、羟磷灰石、生物活性玻璃以及它们的组合物。非再吸收材料的其它的实例是碳加强的聚合物的复合物、形状记忆合金、钛、钛合金、钴铬合金、不锈钢以及它们的组合。
现参照图1,图中示出根据本发明的一实施例的环面修理系统50。环面修理系统50包括一阻塞件和一附连部分,用来将阻塞件接合到邻近环面缺陷的一个或多个脊椎骨。在所示的实施例中,环面修理系统50包括一对锚固件70a、70b和一在锚固件70a、70b之间延伸的阻塞件52。阻塞件52具有一第一端54a和一第二端54b。第一端54a具有一接纳连接销56a的通过其间的通道,而第二端54b具有一接纳连接销56b的通过其间的通道。
现进一步参照图2A,总的表示为锚固件70的锚固件70a和70b各包括一具有一凹凸弧形或匙形的本体71。第一表面76具有一从末端74延伸的凸出的弧形部分和一从中延伸到端部73的线性部分。第二表面78具有一从末端74延伸的凹陷的部分和一从中延伸到端部73的线性部分。端部73包括一钩件86,其形成一沿着本体71的两侧之间延伸的插座72。插座72的尺寸适于接纳通过钩形件86和本体71之间的开口84的阻塞件52的两个端部54a、54b中的一个端部。插座72的尺寸还适于接纳侧向通过插座72的侧壁开口的两个连接销56a、56b中的一个对应的销;然而,连接销56a不能通过开口84。锚固件70连接到阻塞件52,使连接销56a、56b中的对应的销位于阻塞件52的对应端54a、54b中的通道内,而使端部54a、54b定位在插座72内。
在图2B中,示出类似于上述锚固件70的另一实施例锚固件70’。锚固件70’包括一沿着凸出弧形的第一表面76的粗糙部分75,当锚固件插入脊椎体内时,该粗糙部分阻止锚固件从脊椎体中拉出。粗糙部分75可包括一个或多个齿、道钉、锯齿状、滚花,或倒刺,以便与骨组织接合。在图2C中,锚固件70”包括一沿凹陷弧形的第二表面78的粗糙部分。可设计包括沿着第一表面76和第二表面78的粗糙部分的锚固件的其它的实施例。
现参照图2D,图中示出与锚固件70大致相同的另一实施例的锚固件170,但它与阻塞件52的连接具有一变化的端部结构。锚固件170包括一本体171,其具有一形成一插座172的端部173,如对锚固件70所讨论的,插座用来接纳销56和阻塞件的端部54a、54b。一开口184形成在钩形件186和本体171的端表面180之间。开口184具有的宽度A大小适于阻塞件52通过其间,但阻止连接销56通过其间。端表面180朝向端部173偏移,以使钩形件186的端部和开口184定位在更靠近端部173。这致使阻塞件52包在钩形件186周围的长度更短。其它的实施例可设计成:开口184可以定位成进一步朝向端部173,包括在表面176和178之间的开口184的定位。锚固件70、170可各设置有一宽度W2,其大约与它所连接的阻塞件的宽度W1相同或大于。
图3A-3G提供另外实施例的锚固件,其具有类似于锚固件70的形状并连接到阻塞件上。在图3A中,锚固件1000包括一具有用来接合阻塞件的一端部1006的本体1002,和通过本体1002形成的孔1004。在图3B中,锚固件1010包括一具有一端部1016的本体1012,其用来接合阻塞件。本体1012包括通过其间形成的一第一孔1014a和一第二孔1014b。锚固件1000内的孔1004和锚固件1010的孔1014a、1014b为骨通过锚固件向内长的途径,以便长时间固定在脊椎体内。这些孔还可接受紧固件,以便将锚固件接合在脊椎体内。
在图3C中,锚固件1020包括一具有一端部1026的本体1022,端部1026用来接合阻塞件。本体1022还包括在其一侧的一第一切口1024a和在其相对侧的一第二切口1024b。在图3D中,锚固件1030包括一具有一端部1036的本体1032,其用来接合阻塞件。本体1032包括多个在其一侧的第一切口1034a和在其相对侧的第二切口1034b。在所示的实施例中,设置三个切口1034a、1034b。切口1034比切口1024相对小一些,以便可设置增加数量的切口,而同时保持锚固件1030的结构完整性。通过沿锚固件的边缘面离插入方向提供倒刺或尖端的表面,它们阻止锚固件从脊椎骨中拉出,由此,锚固件1020、1030的切口提供初始的固定。通过骨通过切口的生长,可提高锚固件1020、1030的长时间的固定。
在图3E中,锚固件1040包括一具有一端部1046的本体1042,端部1046用来接合阻塞件。本体1042包括一尖顶拱的末端1044,其相对于端部1046在本体1042的边缘之间延伸,以便于穿过脊椎端板并进入脊椎体内。在图3F中,图中示出一锚固件1050,它包括一具有一端部1056的本体1052,端部1056用来接合阻塞件。本体1052在相对端部1056处包括一尖端1054,以便于穿过脊椎端板并进入脊椎体内。
在图3G中,锚固件1060包括一具有一端部1066的本体1062,端部1066用来接合阻塞件。本体1062沿其一侧包括多个柔性的第一件1064a和沿其相对侧的多个柔性的第二件1064b。部件1064a、1064b通常弯离本体1062并远离插入方向延伸(如锚固件1060所示)。在插入到脊椎体内的过程中,部件1064a、1064b沿本体1062向内弯曲,以提供沿本体1062的基本上光滑边缘的外形(如锚固件1060’所示),以便于插入。在插入之后,施加在本体1062上的拉出力致使部件1064a、1064b远离本体1062弯曲,并接合骨组织(如锚固件1060”所示)。
如图4A-4C所示,环面修理系统设置在脊椎V1和V2之间的环面缺陷X内或附近,以便修理或再建环面A。可以设想,环面A内的缺陷X可以已经形成,以便执行一环缝术、椎间盘切除术、核手术,或在椎间盘空间内的某些其它的手术,和/或由于老化、外伤、退化病情等已造成缺陷X。还可以设想,椎间盘的核N可以是天然的椎间盘核浆状的,或可以是人工的盘核或盘假体,融合装置,或已经通过缺陷X插入盘空间内的某些其它装置。围绕核延伸的核A的其余部分基本上是完好的,或使用系统和本发明的方法,或某些其它已知的环面修理技术已经进行修理的。
环面修理系统50示于图4A中,其中,阻塞件52定位在环面缺陷X内或附近,锚固件70a沿脊椎V1的端板延伸,以及锚固件70b沿脊椎V2的端板延伸。阻塞件52可由柔性材料制成,并坍瘪、折叠或其它方式定位成一缩小尺寸的结构,以便插入或靠近缺陷X。在图4B中,锚固件70a、70b已从其图4A的位置移动,并通过皮层的边缘或脊椎的端板嵌入在脊椎体V1、V2的对应的脊椎体内。可以设想,阻塞件52具有的锚固件70a、70b之间的长度,足以沿锚固件70a、70b之间的缺陷X的高度延伸。应该理解到,可以设想采用其它实施例的锚固件用于修理系统50和嵌入在脊椎V1和V2内。
如图4C所示,阻塞件52的沿环面A的宽度W1可以大约等于或小于缺陷X的宽度W,以使阻塞件52横贯所有缺陷X或缺陷X的一部分延伸,由此,有效地阻塞缺陷X和盘空间内的植入物或盘材料,阻止其突出或通过缺陷X逐出(如图4B中箭头F所示)。在一实施例中,阻塞件52的宽度W1约为缺陷X的宽度W的90%或不到。在另一实施例中,阻塞件52的宽度W1约为缺陷X的宽度W的50%或不到。在还有一实施例中,阻塞件52的宽度W1约为缺陷X的宽度W的10%或不到。此外,阻塞件52可具有的深度D1小于在缺陷X处的环面A的深度D,在缺陷X内提供附加的未阻碍的或未占据的区域,以便环面组织的生长和再生。
还可设想,阻塞件52可设置有一宽度W1,它大于缺陷X的宽度W。在这样一实施例中,环面缺陷X的宽度W可以扩大而容纳阻塞件52的宽度W1,以便插入缺陷内。当环面组织返回到其预扩大的状态时,周围的环面组织将压靠阻塞件52的宽度。或者,阻塞件52沿盘空间的外表面定位,并重叠环面组织的外部,以便附连和/或邻近脊椎体。可以设想,在此实施例中,宽度W1可高达或大于缺陷X的宽度W的50%。
可以设想,锚固件70a、70b接合脊椎V1和V2,其具有足够的防拉出能力,所以,不再需要补充的固定装置。然而,也可设置补充的固定装置来进一步增加锚固件70a、70b防拉出的能力。紧固件80a、80b可接合对应的脊椎V1和V2内的锚固件70a、70b,以提供增加的防拉出的能力(如图4B和4C所示)。钻一孔和/或在各脊椎骨内攻丝,并通过对应的锚固件70a、70b。紧固件80a通过锚固件70a放入脊椎骨V1内的孔中,而紧固件80b通过锚固件70b放入脊椎骨V2内的孔中。锚固件70a、70b也可设置有通过其间预成形的孔,以便接纳紧固件80a、80b。紧固件80a、80b可具有如图所示的螺纹的远端,或可具有一螺纹的近端,使一销从螺纹的近端向远端延伸,以便通过锚固件70a、70b内的孔进行定位。
在图5中,图中示出一原材料的实施例,阻塞件52可由该材料进行制造。原材料90具有管形,其尺寸适于提供多个阻塞件52a、52b、52c和52d。整齐的区域96设置在邻近的阻塞件之间,以允许阻塞件的宽度W1按要求确定尺寸。原材料90可设置有一基本的位于底下的丝网结构94,加强的丝网92围绕该结构设置。底下的丝网结构94可以粘结到或互相编织到沿原材料90的长度延伸的背衬98上。在所示的实施例中,底下的丝网结构94包括垂直纤维和水平纤维,而加强丝网92包括对角的纤维。不同的纤维定向抵抗因脊椎柱在缺陷X处的运动而施加到阻塞件52的拉伸、侧向弯曲和转动的载荷。
在图6中,图中示出附连到阻挡件52的另一实施例锚固件70。锚固件70类似于锚固件70,但包括一从末端74延伸到本体71内的槽88。如下文中进一步讨论的,槽88的尺寸适于接纳一保持件,用来将锚固件70连接到一插入器械内。
现参照图7,图中示出一用来将修理系统50插入和接合在一环面缺陷内的插入器械100的实施例。器械100包括一可移动地定位在一致动件104内的安装件102。安装件102包括一远端安装部分106,它在其远端处具有一驱动件108。驱动件108包括一上驱动部分108a和一下驱动部分108b。各驱动部分108a、108b分别包括一近端定向的驱动表面118a、118b。安装部分106还包括一从上驱动部分108a延伸的上安装表面116a,以及一从下驱动部分108b延伸的下安装表面116b。上安装表面116a和下安装表面116b大致彼此平行地延伸到致动件104内。上安装表面116a和下安装表面116b之间的侧表面可以是介于表面116a、116b之间的凸出的弧形,或者为另外的形状,以便当安装部分106一转动时提供一凸轮的作用来驱动锚固件进入到邻近的脊椎体内(如下文中进一步讨论的)。
致动件104在其远端处包括一上致动表面120a和一下致动表面120b。致动表面120a、120b呈凹陷形以接合附连部分,例如,锚固件70或本文中所述的其它的锚固件的凸出弧形的第一表面76。致动件104还包括位于槽112(图7中仅示出一个)内的从中向远端延伸的一上保持件114a和一下保持件114b。上和下保持件114a、114b相对于致动件104可移动,以便有选择地接合和脱开在安装部分106上的锚固件,诸如在锚固件70内的槽88。
如图8和9所示,具有带锚固件70a、70b的附连部分的环面修理系统50安装在安装部分106上。上驱动部分108a的驱动表面118a与上锚固件70a的端部73a接触,而下驱动部分108b的驱动表面118b与锚固件70b的端部73b接触。锚固件70a的本体定位在上安装表面116a上,使锚固件的凹陷侧朝向上脊椎V1的端板定向。锚固件70b的本体定位在下安装表面116b上,使锚固件的凹陷侧朝向下脊椎V2的端板定向。阻塞件52围绕锚固件70a’和锚固件70b’之间的驱动件108的远端延伸。驱动件108的远端110可具有一在上驱动部分108a和下驱动部分108b之间延伸的凸出的外形,以在阻塞件插入时将阻塞件52保持在一拉紧或相对拉紧的状态。
上和下保持件114a、114b定位在锚固件70a、70b的槽88的对应的一个中,以便在插入到缺陷X之前和之中将修理系统50保持在安装部分106上。当修理系统50相对于缺陷X处于一要求的插入位置时,上和下保持件114a、114b可用一工具或与插入器械100相连的其它的致动部分(未示出),从槽88中拔出。可以设想,安装部分106可以从安装件102的近端轴103上拆卸。轴103和致动件104可以设置为一可重复使用的器械,而修理系统50和安装部分106设置为一附连到近端轴部分103的可置换的盒。在此形式中,多个安装部分106可设置有预安装在其上的各种尺寸的修理系统,外科医生可选择提供要求高度和宽度的阻塞件的修理系统。
用插入器械100将修理系统50插入缺陷X内,可以通过以下方式执行,通过一打开的切口,使组织后退而暴露出环面缺陷X,或通过一微创切口,或通过一如图8局部地所示的诸如套筒125的一牵引器套筒。在图9中,修理系统50用插入器械100定位在缺陷X内。安装件102沿箭头P的方向朝向近端移动而使锚固件70a、70b与致动表面120a、120b的对应的表面接触。当安装件102进一步沿方向P移动时,致动表面120a、120b驱动锚固件70a、70b的对应的一个到第一致动的位置,并进入到邻近脊椎V1、V2的端板内。当驱动件108邻近致动表面120a、120b时,然而,锚固件70a’、70b’不能进一步通过近端运动P驱动入端板内。通过沿任一转动方向(例如,如箭头R所示的方向)转动插入器械100,锚固件70a、70b可进一步被驱动入端板内到达第二致动位置。插入器械100的转动致使安装部分106起作一凸轮件,它进一步驱动锚固件70a、70b进入到脊椎V1和V2的对应的端板内。
现参照图10A和10B,图中示出一手柄系统的实施例,该系统可包括插入器械100的一近端部分。手柄系统包括一固定臂122和一可枢转地连接到固定臂上的可移动臂124。致动件104固定到固定的手柄122上。手柄系统还包括一端部件126和一围绕安装件102的远端延伸并螺纹地啮合到端部件的缸127。一扭矩臂128从端部件126向外延伸。可移动臂124’、端部件126’和扭矩臂128’用虚线表示处于环面修理系统50的未致动状态。扭矩臂128可设置成销、杆的形式,或可被外科医生握持的其它部件的形式,以便沿箭头R所示的方向(或沿与箭头R相对的方向)转动端部件126和缸127。这相对于致动件104又线性地和近端地移动安装件102,且锚固件沿致动表面120a、120b被驱动或凸出,以便穿入脊椎端板。
安装件102沿箭头P的方向朝向近端地驱动,以便用致动表面120a、120b致动安装在其上的修理系统50的锚固件,如图所示,安装件102的近端102a运动到近端102a’所示的部位。在此致动的位置,通过围绕枢轴销130将可移动臂枢转到用实线所示的位置,则转动可移动臂124的上端抵靠或邻近固定臂122进行定位。这指示外科医生初始的致动已完成。通过扭矩臂128与手柄124的接触,和/或通过其上端处的固定手柄122与可移动手柄124之间的接触,可移动手柄124还可阻塞扭矩臂128进一步转动。然后,全部手柄组件可沿箭头R的方向(或沿与箭头R相对的方向)转动而转动安装件102,致使凸轮表面沿着和/在安装部分106的安装表面116a、116b之间进一步驱动修理系统50的锚固件进入邻近的脊椎内。
在一特定的实施例中,可以设想,致动件104的近端部分是一安装在固定臂122上的10mm直径的管,而安装件102的近端部分103是安装在可移动臂124上的8mm直径的杆。插入器械100可具有一在安装件102的远端和固定臂122的内侧之间延伸的约为7英寸的长度。安装件102相对于致动件104的拉回,以便致动修理系统50从其插入结构到一第一致动位置,可以约为3mm,此后,施加扭矩使修理系统50的锚固件凸出到一第二致动位置,其中,锚固件进一步嵌入在邻近的脊椎内。
现参照图11,图中示出另一实施例的锚固件270,在锚固件270插入脊椎端板之前或之后,阻塞件可接合到锚固件270内。锚固件270包括一本体271,它在其一端具有一边缘274,用来插入到脊椎端板内。本体271还包括一第一表面276,它具有一凸出部分,而一相对的第二表面278,它具有一凹陷部分。多个孔272通过本体271形成在邻近端部273的第一表面276和第二表面278之间。阻塞件的端部可通过缝合线、铆钉、螺钉,或其它延伸通过阻塞件而进入或通过孔272延伸的其它的紧固件,附连到锚固件270。
如图12A至12C所示,锚固件270可安装到插入器械200的安装件206上。安装件206包括一具有一锚固件270定位在其上的安装表面205的安装部分208。锚固件270包括一孔275,一紧固件可通过该孔延伸而暂时地将锚固件270接合到安装部分208。插入器械200包括一致动件204,安装件200可移动地定位在其中。安装件204在其远端包括一致动表面202。当安装件206沿箭头P的方向相对于致动件204移动时,致动表面202接触锚固件270的第一侧276,末端274远离安装部分206移动并进入到邻近的脊椎端板内。
如图13所示,阻塞件52可固定到已插入的锚固件270a、270b以提供修理系统250。可以设想,在锚固件中的一个或两个锚固件接合到邻近脊椎端板内之后,阻塞件52可附连到锚固件270a、270b的对应的锚固件上。还可设想,阻塞件52可预先附连到锚固件270a、270b上,并如上所述地相对于插入器械100插入。一旦位于缺陷X内的位置,阻塞件52可抵制由植入物或盘材料产生的逐出或挤出力(如箭头F所示)。
现参照图14,图中示出另一实施例的环面修理系统350。修理系统350包括一具有一附连部分的阻塞件352,附连部分包括一附连在其一端的第一锚固件370a和一附连在其另一端的第二锚固件370b。阻塞件352类似于上述的阻塞件52。阻塞件352包括一横贯缺陷X的宽度W的全部或一部分延伸的宽度W1。锚固件370包括多个齿、倒刺、锯齿形,或沿着其一侧形成的其它的接合装置372。
现参照图15A至15C,图中示出用来将阻塞件连接到附连部分的各种装置。在图15A中,锚固件370包括一沿着其一端延伸的插座374。阻塞件352呈环面的形式并具有一端在插座374内。以与锚固件70中所讨论相同的方式,一连接销356定位在插座374内的阻塞件352的环面部分内,以将阻塞件352的端部保持在其中。
在图15B中,锚固件370’包括沿着其一侧延伸的齿372’。锚固件370包括一形成在其一端内的通道374’,阻塞件的一环面部分通过该通道延伸并将锚固件370’与其连接。在此实施例中,阻塞件352的宽度可以小于锚固件370’的宽度,以使通道374’沿着锚固件370’的宽度的一部分形成。在图15C中,锚固件370”包括齿372”和沿其一端的插座374”。锚固件370”还包括一个或多个与插座374”连通的、延伸通过其间的孔376”。可用延伸通过孔376”的缝合线378”,还可通过阻塞件352,阻塞件352可以附连到插座374”内的锚固件370”。在所示的实施例中,阻塞件352的端部折叠在其自身上,以便对接合的缝合线378”的材料提供一加强的区域。
现参照图16A-16C,图中示出用来插入本发明的修理系统的另一实施例的插入器械300。器械300针对于修理系统350进行描述,但也可设想应用于本文所述的其它的修理系统。在图16A至16C中,仅示出插入器械300的上半部,应该理解到,插入器械300的下半部可以对称地形成。器械300包括一沿致动件302可移动地定位的安装件304。锚固件370安装在如上述相对于插入器械100和200所描述那样的安装件304上。如图16B所示,当安装件304相对于致动件302沿箭头P的方向朝向近端曳拉时,通过致动件302的致动表面308,锚固件370被推到第一致动位置而进入脊椎V1的端板内。当安装件304已经致动而相对于致动件302到达第一致动位置时,安装件304沿箭头R的方向转动。安装件304的凸轮表面310推靠在锚固件370的端部上,以推锚固件370到达一进一步嵌入在脊椎V1的端板内的第二致动位置。在锚固件370与邻近脊椎接合之前或之后,阻塞件352可接合到锚固件370。
现参照图17A至17C,图中示出另一实施例的环面修理系统450。修理系统450包括一阻塞件452和一连接到阻塞件452的附连部分。附连部分包括一连接到阻塞件452的一端的第一锚固件470a和一连接到阻塞件452的另一端的第二锚固件470b。在所示的实施例中,阻塞件452用销454附连到锚固件470a,而阻塞件452的另一端用销456附连到锚固件470b。当修理系统450从其插入位置移动到其致动或接合位置时,这允许阻塞件452的端部相对于锚固件转动。也可设想其它的装置来将阻塞件452附连到锚固件470a、470b上。
在图17A中,修理系统450显示为邻近或位于脊椎V1和V2之间的环面A内的缺陷X。在图17B中,修理系统450已致动或移动到一致动位置,其中,锚固件470a、470b已经彼此移离,以便分别接合到脊椎V1和V2。锚固件470a、470b可以设置有齿、倒刺、锯齿形、道钉472a、472b,或沿其设置的其它装置,以便在插入其中时阻止从脊椎体中拉出。
在图17C中,图中示出修理系统450和阻塞件452,其中,这里所述的阻塞件不需占据缺陷X的全部深度D,但只要其一部分。然而,还可设想,这里所述的阻塞件可以占据全部的或大部分的深度D。此外,阻塞件可侧向沿宽度W也可沿深度D进行对中,以将缺陷X内的任何未阻塞的区域的尺寸减到最小。然而,修理系统450也可侧向偏移缺陷X的一侧,以便对第二修理系统提供空间。修理系统450还可沿深度D设置在各种部位处,视外科医生所遇到的操作上的和/或解剖上的情况而定。
在图18A和18B中,图中示出一插入器械的示意图,该插入器械用来致动或移动修理系统450从其缺陷X内的插入位置到达其与脊椎V1和V2的接合位置。插入器械400包括一连接到第二臂404的第一臂402。锚固件470a安装在或接触第一臂402的远端安装部分,而锚固件470b安装在或接触第二臂404的远端安装部分408。第一臂402和第二臂404可相对于彼此移动,从锚固件470a、470b定位在缺陷X内或靠近缺陷的图18A松动插入结构到达锚固件470a、470b分别接合到脊椎V1、V2的图18B中的致动结构。在锚固件470a、470b与邻近脊椎V1、V2接合之前或之后,阻塞件452可以接合到锚固件470a、470b。
现参照图19A,图中示出另一实施例的阻塞件502。阻塞件502具有一由缝合线、编结线、索线、绳,或股线状的材料形成的本体。阻塞件502的第一端504a包括一带有眼孔的附连部分,而第二端504b也包括一带有眼孔的附连部分。另一实施例的阻塞件502’示于图19B中。阻塞件502’具有一由片材形成的本体,该材料可以是编织或非编织的材料。阻塞件502’的第一端504a’包括一带有眼孔的附连部分,而第二端504b’也包括一带有眼孔的附连部分。阻塞件502、502’的端部可以卷边、缝合、铆接、螺纹连接、夹紧、胶合或其它的方式紧固到附连部分。附连部分还包括一呈如图19C所示的销紧固件的形式的锚固件510。锚固件510具有一螺纹部分512和一从中朝向远端延伸的销516。一工具接合凹陷514设置在销紧固件的近端。
图20A和20B示出一包括阻塞件502的修理系统500和一包括锚固件510a、510b的附连部分。阻塞件502定位在缺陷X内,使其第一端504a定位在由脊椎V1的端板形成到脊椎V1的本体内的隧道或孔内。阻塞件502的第二端504b定位在由脊椎V2的端板形成到脊椎V2的本体内的隧道或孔内。锚固件510a定位在从脊椎V1的一面延伸的钻孔或孔内,以使销516延伸通过第一端504a处的眼孔。锚固件510b定位在从脊椎V2的一面延伸的钻孔或孔内,以使销516b延伸通过第二端504b处的眼孔。
可以设想,本文所述修理系统的锚固件从其延伸的脊椎V1和V2的面可包括脊椎V1、V2的前面的、前面偏一侧的、侧面的、后面偏一侧的,或后面的部分。还应该理解的是,阻塞件502’可类似地固定在缺陷X内,阻塞件502’可设置有一如阻塞件52所述的宽度。
图21A和21B示出一包括阻塞件522的修理系统520和一包括锚固件530a、530b的附连部分。为了将阻塞件522附连到脊椎V1和V2,阻塞件522定位在缺陷X内,使其上端定位在由脊椎V1的端板形成到脊椎V1的本体内的隧道或孔内。阻塞件522的下端定位在由脊椎V2的端板形成到脊椎V2的本体内的隧道或孔内。锚固件530a用缝合线等附连到阻塞件522的上端,并如阻塞件522的上端那样延伸到同样的隧道或孔内。锚固件530b用缝合线等附连到阻塞件522的下端,并如阻塞件522的下端那样延伸到同样的隧道或孔内。在所示的实施例中,锚固件530a、530b包括从中延伸的可枢转的张裂缝,以阻止锚固件从其接合的脊椎体内拉出。
图22A和22B示出一包括阻塞件542的修理系统540和一包括锚固件550a、550b的附连部分。为了将阻塞件542附连到脊椎V1和V2,阻塞件542定位在缺陷X内,使其上端定位在由脊椎V1的端板形成到脊椎V1的本体内的隧道或孔内。阻塞件542的下端定位在由脊椎V2的端板形成到脊椎V2的本体内的隧道或孔内。锚固件550a用缝合线等附连到阻塞件542的上端,并如阻塞件542的上端那样延伸到同样的隧道或孔内。锚固件550b用缝合线等附连到阻塞件542的下端,并如阻塞件542的下端那样延伸到同样的隧道或孔内。在所示的实施例中,锚固件550a、550b包括从中侧向延伸的翼或倒刺,以阻止锚固件从其接合的脊椎体内拉出。
图23A和23B示出一包括阻塞件562的修理系统560和一包括锚固件570a、570b的附连部分。为了将阻塞件562附连到脊椎V1和V2,阻塞件562定位在缺陷X内,使其第一端564a定位在形成为从脊椎V1的端板通过脊椎的本体并在脊椎V1的一面处敞开的隧道或孔内。阻塞件562的第二端564b定位在形成为从脊椎V2的端板通过脊椎的本体并在脊椎V2的一面处敞开的隧道或孔内。锚固件570a连接到第一端564a并邻接邻近隧道开口的脊椎V1的面。锚固件570b连接到第二端564b并邻接邻近隧道开口的脊椎V2的面。在一种形式中,可以设想,锚固件570a、570b是钮扣,其具有一线或从中延伸的附连环圈,环圈接合到形成在脊椎V1和V2内的隧道内的阻塞件562的附连部分上。在另一形式中,植入物放置通过锚固件内的孔,并通过在植入物的端部上打结或用缝合线等将植入物的端部系到锚固件上而使植入物固定到锚固件。
图24A和24B示出一类似于修理系统560的修理系统560’。然而,阻塞件562包括一上部562a和一单独的下部562b。在上部562a和下部562b与对应的脊椎V1、V2接合之后,在中间部分564处上部562a附连到下部562b。可以设想,可用缝合线,将端部系连或打结在一起,热焊接,或将端部熔合在一起来实施附连,或用紧固件等来附连端部。
图25A和25B示出一包括位于缺陷X内的阻塞件602的修理系统600。为了将阻塞件602附连到脊椎V1和V2,阻塞件602定位在缺陷X内,使其第一端604定位在形成为从脊椎V1的端板通过脊椎的本体并在脊椎V1的一面处敞开的隧道或孔内。阻塞件602的第二端606定位在形成为从脊椎V2的端板通过脊椎的本体并在脊椎V2的一面处敞开的隧道或孔内。阻塞件602沿着脊椎V1和V2的面成环圈,以使端部604、606彼此邻近并彼此系连在一起。可以设想,系连可以采取缝合线或将端部打结在一起。
在图26A和26B中,修理系统600设置有彼此附连的阻塞件602的端部604、606,以便将阻塞件602附连到脊椎V1和V2。设想的附连装置包括热焊接或熔合端部在一起,端部缝合在一起,或用钉、大头钉、螺钉等将端部紧固在一起。在图27A和27B中,修理系统600包括两个阻塞件602a和602b在缺陷X内,并如上所述地附连到脊椎V1和V2。
在图28-31中,图中示出用来附连邻近环面缺陷X和沿着脊椎V1和V2的面的阻塞件的各种装置。在图28中,修理系统610包括邻近缺陷X并沿脊椎V1和V2延伸的阻塞件612。为了将阻塞件612附连到脊椎V1和V2,阻塞件612的端部延伸入形成在脊椎V1和V2的隧道或孔内,并用锚固件620a和620b附连到对应的脊椎V1和V2。锚固件620a、620b随同附连在其上的阻塞件612的部分定位在形成在脊椎体V1和V2内的隧道或孔内。
在图29中,修理系统630包括沿脊椎V1和V2邻近缺陷X延伸的阻塞件632。为了将阻塞件632附连到脊椎V1和V2,阻塞件632的端部嵌入在形成在脊椎V1和V2内的隧道或孔内,并用过盈螺钉640a和640b附连在其中。
在图30中,修理系统650包括邻近缺陷X和沿着脊椎V1和V2延伸的阻塞件652。为了将阻塞件652附连到脊椎V1和V2,阻塞件652的端部用大头钉或钉660a和660b附连到脊椎V1和V2的面上。在图31中,修理系统670包括邻近缺陷X和沿着脊椎V1和V2延伸的阻塞件672。为了将阻塞件672附连到脊椎V1和V2,阻塞件672的端部用骨螺钉680a和680b附连到脊椎V1和V2的面上。
现参照图32A至32D,阻塞件的各种实施例用标号690表示。阻塞件690具有用来连接到诸如骨质的脊椎体V1和V2的硬组织的结构。阻塞件690可以通过锚固件固定到邻近环面缺陷X的脊椎体上,以便保持缺陷内或邻近缺陷的阻塞件690的定位。
在图32A中,阻塞件690a包括一在上端694a和下端695a之间延伸的本体部分692a。阻塞件690a包括一矩形的或正方形的形状。上端694a可设置有一对上孔696a,而下端695a可设置有一对下孔697a。锚固件、螺钉、钉、销、紧固件,或其它的附连装置可通过孔696a、697a定位,或连接到阻塞件690a的端部,以便将阻塞件690a接合到邻近缺陷X或位于缺陷X内的脊椎V1和V2。
在图32B中,阻塞件690b包括一在上端694b和下端695b之间延伸的本体部分692b。阻塞件690b包括一卵形的形状,但也可设想其它的形状。上端694b可设置有一上孔696b,而下端695b可设置有一下孔697b。锚固件、螺钉、钉、销、紧固件,或其它的附连装置可通过孔696b、697b定位,或连接到阻塞件690b的端部,以便将阻塞件690b接合到脊椎V1和V2。
在图32C中,阻塞件690c包括一在上端694c和下端695c之间延伸的本体部分692c。阻塞件690c包括一卵形的形状,但也可设想其它的形状。锚固件、螺钉、钉、销、紧固件,或其它的附连装置可直接通过对应的上端694c和下端695c定位,或上和下端可连接到将阻塞件690c接合到脊椎V1和V2的锚固件上。
在图32D中,阻塞件690d包括一本体部分692d,其具有的一上部接片694d带有一从本体部分692d向上延伸的细长的、宽度减小的形状。本体部分692d还包括一下接片部分695d,其具有一从本体部分692d向下延伸的细长的、宽度减小的形状。这些细长的、宽度减小的接片可通过一过盈的螺钉或其它嵌入的锚固件,使接片随同锚固件至少部分地嵌入在脊椎V1、V2内,进行附连或接合,例如,如图20A和20B、图21A和21B、图22A和22B所示。接片也可连接到本文中所述的锚固件,以便与脊椎V1和V2接合。
在图33A至33D中,图中示出与围绕环面缺陷X的邻近的环面组织连接的阻塞件700的各种实施例。在图33A中,阻塞件700a包括一本体部分702a,其具有一带有矩形形状的第一侧向接片704a和一带有矩形形状的相对的第二侧向接片705a,各从本体部分702a侧向向外延伸。侧向接片704a、705a可用缝合线、钉或其它合适的附连装置接合到邻近环面缺陷X的环面组织。可以设想,本体部分702a的高度H1不需沿脊椎V1和V2之间的缺陷X的全部高度H延伸(图4A)。在一实施例中,高度H1小于缺陷X的高度的90%。在另一实施例中,高度H1小于缺陷X的高度的50%。
在图33B中,阻塞件700b包括一本体部分702b,其具有一带有半圆或倒圆端的形状的第一侧向接片704b和一带有半圆或倒圆端形状的相对的第二侧向接片705b。侧向接片704b、705b可用缝合线、钉或其它合适的附连装置接合到邻近环面缺陷X的环面组织。可以设想,本体部分702b的高度H1可设置为与阻塞件700a所讨论的那样。
在图33C中,阻塞件700c包括一本体部分702c,其具有一带有半圆或倒圆端的形状的第一侧向接片704c和一带有半圆或倒圆端形状的相对的第二侧向接片705c。侧向接片704c、705c在本体部分702c的中间处变细到一减小高度的结构,以形成一数字8形状。侧向接片704c、705c可用缝合线、钉或其它合适的附连装置接合到邻近环面缺陷X的环面组织。可以设想,本体部分702c的高度H1可设置为与阻塞件700a所讨论的那样。
在图33D中,阻塞件700d包括一本体部分702d,其具有一对在接片端部处的侧向延伸的突缘706d。本体部分702d包括一相对的第二侧向接片705d,其具有一对在接片端部处的侧向延伸的突缘707d。在侧向接片704d、705d上的侧向突缘对缝合的附连提供添加周缘长度的延伸部。侧向接片704d、705d在本体部分702d的中间处变细到一减小高度的结构,以形成一数字8形状。侧向接片704d、705d可用缝合线、钉或其它合适的附连装置接合到邻近环面缺陷X的环面组织。可以设想,本体部分702d的高度H1可设置为与阻塞件700a所讨论的那样。
现参照图34A至34D,图中示出使用上述附连技术将阻塞件800连接到硬组织和软组织的各种实施例。在图34A中,阻塞件800a具有一本体部分802a,其带有一用来接合硬组织的上接片804a和相对的下接片805a。上接片804a具有一孔808a,用来接纳或便于附连到一锚固件,而下接片805a具有一孔809a,用来接纳或便于附连到一锚固件。本体部分802a包括相对的侧向延伸的接片806a、807a,用来附连到缺陷周围的软组织。上和下接片和侧向接片一起形成图34A的实施例中的八角形。
在图34B中,阻塞件800b具有一本体部分802b,其带有一用来接合硬组织的上接片804b和相对的下接片805b。上接片804b具有一孔808b,用来接纳或便于附连到一锚固件,而下接片805b具有一孔809b,用来接纳或便于附连到一锚固件。本体部分802b包括相对的侧向延伸的接片806b、807b,用来附连到缺陷周围的软组织。上和下接片和侧向接片一起形成图34B的实施例中的十字形。
在图34C中,阻塞件800c具有一本体部分802c,其带有一用来接合硬组织的上接片804c和相对的下接片805c。上接片804c具有一孔808c,用来接纳或便于附连到一锚固件,而下接片805c具有一孔809c,用来接纳或便于附连到一锚固件。本体部分802c包括相对的侧向延伸的接片806c、807c,用来附连到缺陷周围的软组织。上和下接片和侧向接片一起形成图34C的实施例中的弧形或曲线十字形。
在图34D中,阻塞件800d具有一本体部分802d,其带有一上接片804d和下接片805d。接片804d、805d具有一细长的、宽度减小的结构,如图32D的实施例中所讨论的那样,用来嵌入到脊椎V1、V2内。本体部分802d还包括第一侧向部分806d和相对的第二侧向部分807d,用来附连到环面缺陷周围的软组织。
图32A-D和图34A-D的阻塞件实施例可设置有具有如阻塞件50讨论那样的宽度的本体部分。此外,图34A-D的阻塞件实施例可设置有如阻塞件700a讨论那样的高度。
尽管在附图中和上述的描述中已经详细地图示和介绍了本发明的实施例,但这些实施例在特征上应认为是说明性的而不是限制性的,应该理解到,所有落入本发明的精神内的变化和修改要求受到保护。

Claims (68)

1.一用来修理脊椎盘的环面缺陷的系统,其包括:
至少一个定位在至少邻近环面缺陷的阻塞件;以及
一个从所述至少一个阻塞件延伸的附连部分,其中,所述附连部分可从第一位置致动到第二位置,在第一位置中,所述至少一个阻塞件和所述附连部分至少邻近缺陷,而在第二位置中,所述阻塞件横贯缺陷延伸,且所述附连部分接合到邻近的组织。
2.如权利要求1所述的系统,其特征在于,所述阻塞件是柔性的,可呈一减小尺寸的结构,以便至少邻近缺陷定位。
3.如权利要求1所述的系统,其特征在于,所述阻塞件具有沿环面的一宽度,它小于沿环面的缺陷的宽度。
4.如权利要求1所述的系统,其特征在于,所述附连部分包括一可接合到脊椎盘的一侧上的第一脊椎体的第一锚固件,以及一可接合到脊椎盘的另一侧上的第二脊椎体的第二锚固件。
5.如权利要求4所述的系统,其特征在于,所述第一锚固件和所述第二锚固件各包括一本体,其具有一连接到所述阻塞件的一邻近端的第一端和一与所述第一端相对的末端,其中,所述本体具有一凹陷-凸出的弧形,以使所述末端偏离所述第一端。
6.如权利要求5所述的系统,其特征在于,所述末端具有尖锐的边缘。
7.如权利要求4所述的系统,其特征在于,所述第一锚固件和所述第二锚固件各包括一本体,其具有一形成一插座的第一端,用来接纳所述阻塞件的一邻近端。
8.如权利要求7所述的系统,其特征在于,所述阻塞件的各个所述端部具有一接纳通过其间的连接销的通道,所述连接销和所述阻塞件的所述端部可定位在所述第一锚固件和所述第二锚固件的所述插座中的对应的一个内。
9.如权利要求4所述的系统,其特征在于,所述第一锚固件和所述第二锚固件各包括用来阻止从第一和第二脊椎体中拉出的装置。
10.如权利要求9所述的系统,其特征在于,所述用来阻止拉出的装置可从下面的组群中选择:一螺纹形式、锯齿形、倒刺、带有凹陷-凸出的弧形体,以及可枢转的张裂缝。
11.如权利要求1所述的系统,其特征在于,所述阻塞件包括可附连到邻近缺陷的环面组织的侧向延伸部。
12.如权利要求1所述的系统,其特征在于,所述阻塞件包括非多孔的材料。
13.如权利要求1所述的系统,其特征在于,所述阻塞件由一可再吸收材料制成,其选自以下的组群:自体移植物,同种异体移植物,异种移植物,硬组织,连接组织,去矿物质骨基质,聚交酯,聚乙交酯,酪氨酸衍生的聚碳酸酯,聚酐,多原酸酯,聚磷腈,磷酸钙,羟磷灰石,生物活性玻璃,胶原质,白蛋白,纤维蛋白原以及它们的组合。
14.如权利要求1所述的系统,其特征在于,所述阻塞件由非再吸收材料制成,其选自以下的组群:聚乙烯、聚酯、聚乙烯醇、聚丙烯腈、聚酰氨、聚四氟乙烯、聚对苯二甲酰对苯二胺、纤维素,以及它们的组合。
15.如权利要求1所述的系统,其特征在于,所述阻塞件和所述附连部分各包括可再吸收的材料。
16.如权利要求1所述的系统,其特征在于,所述阻塞件和所述附连部分各包括非再吸收的材料。
17.如权利要求1所述的系统,其特征在于,还包括一位于脊椎盘空间内的植入物。
18.如权利要求1所述的系统,其特征在于,在所述第一位置中,所述附连部分大致沿位于缺陷的各侧上的脊椎端板延伸,而在所述第二位置中,所述附连部分延伸入脊椎端板内。
19.如权利要求1所述的系统,其特征在于,缺陷具有一沿环面的宽度,而所述阻塞件延伸横贯沿环面的缺陷的宽度的约90%或不到。
20.如权利要求1所述的系统,其特征在于,所述阻塞件具有一本体结构,它包括选自以下组群的一个或多个部件:织物管,缝合线,系绳,绳索,平面件,带,丝线,缆索,网片,以及编结物。
21.如权利要求1所述的系统,其特征在于,还包括:
一第二阻塞件可至少邻近环面的缺陷定位;
一第二附连部分连接到所述第二阻塞件,其中,所述第二附连部分具有一第一位置和一第二位置,在第一位置中,所述第二阻塞件和所述第二附连部分至少邻近缺陷,而在第二位置中,所述第二阻塞件横贯缺陷定位,所述第二附连部分接合到邻近的组织。
22.如权利要求1所述的系统,其特征在于,所述附连部分包括用来接合所述阻塞件的装置。
23.如权利要求1所述的系统,其特征在于,还包括一插入器械,所述阻塞件和所述附连部分安装在插入器械上。
24.如权利要求23所述的系统,其特征在于,所述插入器械包括一可移动地连接到一致动件的安装件,所述致动件包括至少一个可与所述安装件上的所述附连部分接合的致动表面,以便将所述附连部分从所述第一位置朝向所述第二位置移动。
25.如权利要求24所述的系统,其特征在于,所述插入器械包括一与所述附连部分可移动地接合的保持件,以防止所述附连部分移离所述第一位置。
26.如权利要求24所述的系统,其特征在于,所述安装件包括一驱动件,其构造成:当所述安装件相对于所述致动件移动时,驱动件沿着所述致动器表面移动所述附连部分。
27.如权利要求24所述的系统,其特征在于,在所述第一位置中:
所述安装件包括一上部和一下部;
所述附连部分包括一安装在所述上部上的第一锚固件和一安装在所述下部上的第二锚固件;以及
所述阻塞件围绕所述安装件的远端在所述第一锚固件和所述第二锚固件之间延伸。
28.一用来修理脊椎盘的环面缺陷的系统,其包括:
至少一个定位在至少邻近环面缺陷的阻塞件;以及
一个从所述至少一个阻塞件延伸的附连部分,其中,所述附连部分可接合到邻近缺陷的骨质组织,其中,当所述至少一个阻塞件横贯缺陷定位且附连部分接合到邻近缺陷的骨质组织时,所述阻塞件包括一沿环面的宽度,其小于沿环面的缺陷的宽度。
29.如权利要求28所述的系统,其特征在于,所述阻塞件的所述宽度小于缺陷宽度的约90%。
30.如权利要求28所述的系统,其特征在于,所述阻塞件的所述宽度小于缺陷宽度的约50%。
31.如权利要求28所述的系统,其特征在于,所述阻塞件的所述宽度小于缺陷宽度的约10%。
32.如权利要求28所述的系统,其特征在于,还包括:
一第二阻塞件横贯环面的缺陷定位;以及
一第二附连部分连接到所述第二阻塞件,其中,所述第二附连部分可接合到邻近的骨质组织。
33.如权利要求28所述的系统,其特征在于,所述附连部分可从一第一位置致动到一第二位置,在第一位置中,所述至少一个阻塞件和所述附连部分定位在至少邻近缺陷,而在第二位置中,所述阻塞件横贯缺陷定位,且所述附连部分接合到邻近的组织。
34.如权利要求28所述的系统,其特征在于,所述阻塞件是柔性而呈一减小尺寸的结构,以便定位在至少邻近缺陷处。
35.如权利要求28所述的系统,其特征在于,所述附连部分包括一接合到脊椎盘的一侧上的第一脊椎体的第一锚固件,以及一接合到脊椎盘的另一侧上的第二脊椎体的第二锚固件。
36.如权利要求35所述的系统,其特征在于,所述第一锚固件和所述第二锚固件各包括一本体,其具有一连接到所述阻塞件的邻近端的第一端。
37.如权利要求36所述的系统,其特征在于,所述阻塞件的所述端嵌入在第一脊椎和第二脊椎中的对应一个中。
38.如权利要求36所述的系统,其特征在于,各个所述第一和第二锚固件的所述本体具有一凹陷-凸出的弧形。
39.如权利要求35所述的系统,其特征在于,所述第一锚固件和所述第二锚固件各包括用来阻止从骨质组织中拉出的装置。
40.如权利要求28所述的系统,其特征在于,所述阻塞件包括附连到邻近缺陷的环面组织的侧向延伸部分。
41.如权利要求28所述的系统,其特征在于,所述附连部分包括所述至少一个阻塞件的一部分。
42.如权利要求41所述的系统,其特征在于,所述阻塞件包括一附连部分,它的各端嵌入到缺陷的脊椎端板中的对应的一个中。
43.如权利要求42所述的系统,其特征在于,所述附连部分各包括一接合所述阻塞件的所述嵌入部分的锚固件。
44.如权利要求28所述的系统,其特征在于,所述阻塞件具有一本体结构,它包括选自以下组群的一个或多个部件:织物管,缝合线,系绳,绳索,平面件,带,丝线,缆索,网片,以及编结物。
45.一用来修理脊椎盘的环面缺陷的系统,缺陷具有一沿脊椎盘的环面的宽度,其包括:
一第一锚固件,其接合到邻近脊椎盘的脊椎中的一个;
一第二锚固件,其接合到邻近脊椎盘的脊椎中的另一个;以及
一阻塞件,其延伸在脊椎之间并连接到所述第一锚固件和所述第二锚固件,所述阻塞件具有一沿环面的宽度,它小于沿环面的缺陷的宽度。
46.如权利要求45所述的系统,其特征在于,所述阻塞件的所述宽度小于缺陷宽度的约90%。
47.如权利要求45所述的系统,其特征在于,所述阻塞件的所述宽度小于缺陷宽度的约50%。
48.如权利要求45所述的系统,其特征在于,所述阻塞件是柔性的。
49.如权利要求45所述的系统,其特征在于,缺陷具有一介于环面的外表面和脊椎盘的核之间的深度,所述阻塞件具有的一小于缺陷的深度的一半的深度。
50.如权利要求45所述的系统,其特征在于,各个所述第一锚固件和所述第二锚固件选自以下的组群:带有凹陷-凸出弧形的本体,螺钉,过盈螺钉,销紧固件,钉,以及纽扣。
51.一用来修理脊椎盘的环面缺陷的方法,其包括:
定位一具有一至少邻近环面缺陷的附连部分的阻塞件;以及
致动附连部分,以将附连部分接合到邻近脊椎盘的至少一个脊椎,使阻塞件横贯环面缺陷延伸。
52.如权利要求51所述的方法,其特征在于,附连部分包括一接合到至少一个脊椎的第一锚固件和一接合到邻近脊椎盘的另一个脊椎的第二锚固件。
53.如权利要求51所述的方法,其特征在于,致动附连部分,将第一锚固件和第二锚固件同时接合到邻近脊椎盘的脊椎。
54.如权利要求51所述的方法,其特征在于,阻塞件是柔性的。
55.如权利要求51所述的方法,其特征在于,还包括将阻塞件连接到附连部分。
56.如权利要求51所述的方法,其特征在于,致动附连部分包括:用致动器械的线性运动将附连部分致动到一第一致动位置。
57.如权利要求56所述的方法,其特征在于,致动附连机构还包括:用致动器械的旋转运动将附连部分致动到一第二致动位置。
58.一用来修理相邻脊椎之间的脊椎盘的环面缺陷的方法,其包括:
提供一阻塞件,其具有一在第一端和一第二端之间的长度;
坍瘪阻塞件;
将坍瘪的阻塞件定位在至少邻近环面缺陷;
延伸阻塞件的第一端朝向邻近脊椎盘的一个脊椎;
延伸阻塞件的第二端朝向邻近脊椎盘的另一个脊椎;
将阻塞件的第一端接合到一个脊椎;以及
将阻塞件的第二端接合到另一个脊椎。
59.如权利要求58所述的方法,其特征在于,阻塞件具有一沿环面的宽度,它小于沿环面的缺陷的宽度。
60.如权利要求58所述的方法,其特征在于,第一端连接到第一锚固件,而第二端连接到第二锚固件。
61.如权利要求60所述的方法,其特征在于,
当阻塞件定位在至少邻近环面缺陷时,第一锚同件和第二锚固件各沿对应的脊椎的端板之一延伸,以及
当接合到环面缺陷时,第一锚固件和第二锚固件各延伸到对应的脊椎之一中。
62.如权利要求61所述的方法,其特征在于,接合第一端和接合第二端包括:通过脊椎内的第一锚固件和第二锚固件中的对应的一个定位紧固件。
63.一用来将环面修理系统插入到脊椎盘的环面缺陷处的器械,其包括:
一致动件;以及
一环面修理系统安装在其上的安装件,所述致动件接合环面修理系统,以便将环面修理系统移动到与邻近缺陷的至少一个脊椎接合。
64.如权利要求63所述的器械,其特征在于,所述安装件相对于所述致动件可移动。
65.如权利要求63所述的器械,其特征在于,所述安装件包括一与环面修理系统接合的驱动部分,以将环面修理系统移动到与所述致动件接触。
66.如权利要求63所述的器械,其特征在于,所述安装件相对于所述致动件可作线性移动,以将环面修理系统移动到与至少一个脊椎接合的一第一致动位置。
67.如权利要求66所述的器械,其特征在于,所述安装件相对于环面修理系统可转动,以将环面修理系统从所述第一致动位置移动到与至少一个脊椎接合的一第二致动位置。
68.如权利要求63所述的器械,其特征在于,所述致动件包括一保持件,其可与安装件上的环面修理系统接合。
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US7223289B2 (en) 2007-05-29
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