CN1822803B - 由颈部假体和植入器械组成的装置 - Google Patents

由颈部假体和植入器械组成的装置 Download PDF

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CN1822803B
CN1822803B CN2004800203782A CN200480020378A CN1822803B CN 1822803 B CN1822803 B CN 1822803B CN 2004800203782 A CN2004800203782 A CN 2004800203782A CN 200480020378 A CN200480020378 A CN 200480020378A CN 1822803 B CN1822803 B CN 1822803B
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soleplate
projection
intervertebral endoprosthesis
opening
reception opening
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CN1822803A (zh
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A·克勒
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Waldemar Link GmbH and Co KG
Cervitech Inc
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Abstract

多部件椎间内假体(9)和植入器械(1)组成的装置,其中所述多部件椎间内假体具有上和下终板(91,92)和在上下终板之间的滑动核心(93),其中为每个终板(91,92)分配了一对接收开口(96,97)或者接收凸起,所述植入器械具有把手区域(21,31)和带保持凸起(51,52)或保持开口的抓取区域(22,32),所述保持凸起或保持开口可进入到接收开口(96,97)或者接收凸起内以将椎间内假体(9)保持在植入器械(1)上,接收开口(96,97)布置在椎间内假体(9)的外侧端面上,并且至少分配给终板(92)之一的一对接收开口(96)具有向另一个终板(91)方向扩展的形状。

Description

由颈部假体和植入器械组成的装置
技术领域
本发明涉及由多部件椎间内假体和植入器械组成的装置,其中所述多部件椎间内假体具有上和下终板和在上下终板之间的滑动核心,其中为每个终板分配了一对接收开口或者接收凸起,所述植入器械具有把手区域和带保持凸起或保持开口的抓取区域,所述保持凸起或保持开口可进入到接收开口或者接收凸起内以将椎间内假体保持在植入器械上。
背景技术
为植入椎间假体,由于难以达到植入位置,所以需要特殊的植入器械。为能够用植入器械保持椎间假体,已知的是,在终板的外侧端面上设置指向植入方向的孔,适当形成的植入器械的杆接合在所述孔内(US-A-5,314,477和WO-A-0119295)。这种保持方式虽然相当可靠,但孔的位置需求减少了端面并从而减少了整个终板。这种结构不太适合在狭窄的条件下使用。
在另一种已知的(EP-A-1 306 064)椎间假体-系统情况下,没有设置孔,植入器械具有两对相互刚性连接的抓取部分来代替孔,它们各在其间通过摩擦力保持一个终板。对于如在颈部脊柱中使用的和必须非常精确定位的非常小的植入物,这可能导致不可靠。
发明内容
本发明的任务在于,提供一种改进的由椎间内假体和植入器械组成的装置,其特别适合如特别在颈部脊柱区域出现的狭窄条件下植入的要求。
根据本发明,上述任务通过由多部件椎间内假体和植入器械组成的装置来解决,其中所述椎间内假体具有上终板和下终板和在所述上终板及下终板之间的滑动核心,所述植入器械具有把手区域和抓取区域,其中为每个终板分配了一对接收开口而为抓取区域配置了一对保持凸起,或者为每个终板分配了一对接收凸起而为抓取区域配置了一对保持开口,其中所述保持凸起能够进入到接收开口内,或者所述接收凸起能够进入到保持开口内,以将椎间内假体保持在植入器械上,所述接收开口或者接收凸起布置在椎间内假体的外侧端面上,并且至少分配给终板之一的一对接收开口具有向另一个终板方向扩展的形状。向另一个终板方向扩展的形状应理解为,接收开口为向其中伸入的保持凸起在一个方向上,即向另一个终板的方向上提供自由空间,从而在该方向上看,保持凸起可占据不同的位置。也可以说,终板可以做成象长孔一样,其中长孔的纵轴指向另一个终板。这样形成的接收开口的可取实施形式是狭槽。
通过接收开口的这种实施方式,根据本发明的装置允许抓取和植入带有不同厚度的滑动核心的椎间内假体,不用为此进行调整或改变。从而在进行手术期间,如果指定的椎间内假体不适合,则外科医生可从全部设备中找出另一个不同高度的假体并简单容易地用植入器械接收并植入。特别在例如用于颈部脊柱的小椎间内假体情况下,这具有明显的优点,其中颈部脊柱由于其小,所以在植入时只允许小的偏差。
本发明还涉及其它优选的改进方案。
代替如现有技术中将接收开口(或者-接收凸起)布置在终板的端面上,将接收开口(或者-接收凸起)布置在外侧侧面上减少了位置需要。其允许比较节省空间的和比较小的椎间内假体实施形式。布置在外侧侧面上具有另外的优点,即保持凸起垂直于植入方向布置,这样在植入椎间内假体内,通过形状锁合进行传力。由于这种设计,椎间内假体一方面可靠地保持在植入器械上,另一方面还可通过脱开形状锁合易于与植入器械分开。在现有技术中则情况不同,由于指向植入方向的保持凸起,通过摩擦连接传力。这意味着定位不可靠和不可取的高脱开力以克服摩擦。因此,本发明操作容易并且定位精确,这特别在空间狭窄的条件下是最重要的。
最好具有一个扩展形状的接收开口在分配的终板整个高度上延伸。这允许在较大的范围上补偿不同的高度。但具有一个扩展形状的接收开口还可布置在滑动核心上,或者布置在终板和滑动核心上。在后者情况下,重要的是布置在这两个部分上的接收开口要相互对齐。接收开口可在滑动核心高度的一部分上延伸,或者最好在滑动核心的整个高度上延伸。
可取的是,选择接收开口的形状,使得其随着深度的增加而变细。由此易于导入相应的保持凸起,并且还实现了可靠的配合,从而仅有小的间隙或者没有间隙。
最好分配给另一个终板的一对接收开口具有集聚的形状。与在扩展形状情况下不同,在集聚形状的情况下,接合的保持凸起没有可用的自由空间,即保持凸起只能占据一个位置。可取的是该接收开口是圆孔。由此椎间内假体关于其中撮合的保持凸起并从而关于植入器械占据规定的位置。由于根据本发明的设计,带有扩展形状的接收开口可允许因为不同的滑动核心高度或者制造公差导致的椎间内假体尺寸差别。从而虽然椎间内假体可能有差别,也能被明确地保持。两对接收开口的形状不同还具有防止搞错的优点。因此,即椎间内假体只能以合适的定向保持在植入器械上;由此避免了反向的布置。
通常,接收开口布置在椎间内假体上,保持凸起布置在植入器械上。这是被证明有效的布置方式。但本发明不限于此,而是可以将凸起布置在椎间内假体上,将开口布置在植入器械上。
特别有利的是,用不同厚度的滑动核心为椎间内假体设置了不同的尺寸。由此可分别根据解剖要求,选择合适的椎间内假体并用植入器械植入,而不必改变植入器械。如果外科医生在手术过程中发现,开始设置的椎间内假体太高或太低,则他仅需要选择另一个高度合适的椎间内假体并可容易地将其植入。
植入器械最好设计为钳子。保持凸起可布置在钳口部分的内侧。由此能够通过简单地闭合钳子将保持凸起插入到接收开口内,并这样将椎间内假体保持在钳子上。此外,设计成钳子还得到了节省空间的结构。由此特别在如颈部脊椎区域的狭窄空间条件下,在操作方面具有明显的优点。此外,钳子形的结构具有下面的优点,即可用其容易地补偿椎间内假体的不同宽度尺寸。这是通过根据椎间内假体的宽度尺寸或多或少地闭合钳子实现的。结合根据本发明的接收开口设计,既可以补偿椎间内假体的不同宽度尺寸,也可以补偿椎间内假体的不同厚度。这使装置具有高的通用性。
保持凸起最好是薄片形的和销钉形的。这种保持凸起能够很好地配合接收开口的形状,并保证椎间内假体可靠和高精度配合地安装在植入器械上。
可取的是在抓取区域设置带有止动面的方块件以贴靠在椎间内假体上。在用植入器械接收椎间内假体的情况下,保持凸起伸入到接收开口内(或者反过来),并使椎间内假体相对植入器械占据规定的位置。方块件布置为其止动面贴靠在椎间内假体上。植入椎间内假体所需的力可通过止动面施加到椎间内假体上,保持凸起不需要承受该向植入方向作用的力。保持凸起可以做得比较细小,做成精确定位所希望的那样纤细,不用考虑在敲入时的高力载荷。此外,方块件具有有利的作用,即它防止椎间内假体转动和防止椎间内假体的元件展开。这使易于可靠、简单和定位精确地植入椎间内假体。
方块件可在纵向上借助操作装置移动。但它也可刚性布置在抓取区域上。在刚性布置的情况下,应该理解为,在使用植入器械情况下,方块件为了保持和植入是不动的;但不应排除,它可以为调整目的而移动,例如为适应另外的假体尺寸而移动。这可例如通过借助紧固螺钉固定来实现。但最好方块件借助贯穿螺栓固定在抓取区域上。
可取的是在方块件上布置一个杆,杆带有在手柄部分后部区域的把手。杆使得易于将植入力施加到植入器械和椎间内假体上。为此,把手最好设计为冲击头。
有利的是将刚性方块件布置在钳口镶块上。由此可简单地通过更换钳口镶块来适应不同的椎间内假体。
附图说明
下面参考示出了优选实施例的附图解释本发明。其中:
图1为从上侧看到的根据本发明装置的总体视图;
图2为从下侧看到的植入器械的总体视图;
图3为以纵轴剖面示出的植入器械钳口部分放大局部视图;
图4为另一个钳口镶块的局部视图;
图5为带有上面布置的椎间内假体的植入器械的局部视图;
图6为植入器械另一个实施形式的钳口部分的放大局部视图;
图7为植入器械另一个实施形式的钳口部分的放大局部视图;
图8为根据图7的植入器械的手柄部分的局部视图。
具体实施方式
在所示实施例情况下,涉及为钳子的植入器械(总体上用附图标记1表示)和作为椎间内假体的颈部假体9。
颈部假体9由上终板91,下终板92和在两个终板之间布置的滑动核心93组成。该颈部假体用于植入在人颈部脊柱的两个相邻椎骨之间的空间内。在此上终板91固定在头椎的下侧,下终板92固定在尾椎的上侧。为能够用钳子1可靠地接收要植入的颈部假体9,上和下终板91,92各有接收开口。接收开口在腹侧固定法兰94,95前部,位于终板的前部区域。分配给上终板91的接收开口是带有沉孔的圆孔97。分配给下终板92的接收开口是位于下终板92侧面上的狭槽96本身和在滑动核心93的侧面上构造的狭槽96’。狭槽96和96’对齐,从而它们形成连续的沟槽。不是强制要求狭槽96,96’既构造在下终板92上也构造在滑动核心93上;仅在终板92内设置狭槽也是足够的。
钳子1由两个钳子半体2,3构成,这两个钳子半体通过回转接头4可运动地相互连接。钳子半体2,3在其后部区域各有一个手柄部分21,31,并在其前部区域各有一个钳口部分22,32。回转接头布置在手柄区域21,31和钳口部分22,32之间的过渡部分中。回转接头由钳子半体2上的轴颈42构成(在图1中它从附图平面向上延伸),该轴颈支承在另一个钳子半体3中部区域的合适开口43内。轴颈42具有通孔44,该通孔从钳子半体2,3的手柄侧区域向钳口侧区域延伸。后面还要对其进行详细说明。回转轴承4允许钳子半体2,3的手柄部分21,31一个在另一个上运动,由此闭合和打开钳口部分22,32。
钳口部分22,32起到抓取部分的作用。它们在前部区域在其相互面向的内侧,各具有两个指向夹紧方向的凸起51,52。这些凸起不是直接布置在钳口部分22,32上,而是布置在钳口镶块53上,镶块借助螺栓(未示出)可更换地在钳口部分22,32的外侧固定在相应的接收部内。每个钳口镶块各具有一个凸起51和一起凸起52。凸起51是销钉形的并位于上部区域,而凸起52是薄片形的并位于钳口镶块53的下部区域。凸起51,52的尺寸和布置与要接收的颈部假体9的相应接收开口相匹配。下面对此详细说明。
圆孔97的尺寸与钳子1的销钉形凸起51匹配。由于沉孔,销钉形凸起51可容易地插入圆孔97内。狭槽96,96’具有向上终板91方向的细长形状。布置在钳子1上的薄片形凸起52在其宽度上与狭槽96,96’的宽度一致,从而它沿着狭槽被引导。由此通过接合到圆孔97内的销钉形凸起52固定了颈部假体9相对钳子1的相对位置,而薄片形凸起52根据滑动核心93的厚度在不同的位置接合在狭槽96,96’内,并从而能够补偿不同的滑动核心93。在图5a中示出了中等厚度的颈部假体和带有凸起51和52的钳子1前部区域。在用钳子1接收颈部假体9的情况下,销钉形凸起51接合到圆孔97内并将颈部假体固定不动。薄片形凸起52接合到下终板92的狭槽96内和接合到直接相连的滑动核心93的狭槽96’下部区域内。为进行比较,在图5b内示出了带有厚滑动核心93’的颈部假体9’。销钉形凸起51仍然接合到接收孔97内。但由于较厚的滑动核心93’,薄片形凸起52不再接合到下终板92的狭槽96内,而是接合到滑动核心93’的狭槽96’内。由此尽管颈部9’的高度不同,但同样能可靠地在钳子1上被保持在规定的位置。
在钳口部分22上布置了导轨60,被该导轨保持的方块件61可在钳子半体2上向前后方向纵向移动。导轨60设计为钳口部件22的钳口镶块53中的长孔。侧面在方块件61内布置的埋头止动螺钉接合在构成导轨60的长孔内并在纵向上引导方块件61。替代长孔还可以设置其它的允许在纵向上可前后移动地引导方块件的导向元件,例如燕尾槽导向装置。方块件61在其前端备有止动面62,该止动面与颈部假体9相互作用。
操作装置7作用在方块件61上,该操作装置从方块件61的后部区域穿过通孔44延伸到手柄部分21,31之间的区域。操作装置包括与方块件61的连接元件70,在所示实施例中,该连接元件是适合传递推力的旋转轴承(Wirbellager),此外操作装置还包括杆71和用于操作的把手72。在杆71的前部区域设置了外螺纹73,该外螺纹与作为固定在器械上的导向装置的轴颈42的通孔44内的互补内螺纹(未示出)共同起作用。由此能够通过转动把手72来沿着导轨60前后移动杆71,并从而通过连接元件70来移动方块件61。把手72是球形把手,在其外壳表面上具有合适的表面造型,如粗糙的沟形75,以为外科医生提供良好的抓握性。
把手72的后端备有凸出的拱形件76。其作用操作装置7的冲击头。将作用在冲击头的拱形件76上的冲击的冲力通过操作装置7的杆71、止推旋转轴承70和方块件61传递到方块件的止动面62上。
作为另外一种选择,代替可纵向移动的方块件61,设置和布置一个刚性布置在钳子半体2上的方块件61’,使得其止动面62’贴靠在被保持的颈部假体9上。当使用的颈部假体9虽然高度尺寸和/或宽度尺寸有差别,但纵向尺寸相同时,这是特别有利的。因为颈部假体9通过根据本发明的接收开口96,97和保持凸起51,52的造型被保持在规定的位置,所以方块件的纵向移动性不是强制必需的。由于位置确定,所以用刚性方块件61’也能够使其止动面62’贴靠在颈部假体9上。能够和在带有可移动方块件的实施形式情况下一样,可靠并适度地传递植入力,特别是冲击力。很明显,在刚性布置的方块件61’的情况下,导轨60不是必要的。但也可保留导轨,那么在这种情况下可借助紧固螺栓66固定方块件61’(图6)。为更好地固定,长孔60备有供紧固螺栓66用的网纹65。更简单的是刚性方块件61’在抓取部分上借助焊接或者螺栓连接固定在抓取部分22或其钳口镶块53上。在后者情况下,最好设置沉入到钳口镶块53的孔67内的螺栓68(参看图7)。因为操作装置7不再需要进行纵向调整,所以可取消杆71上的外螺纹以及在通孔44内的配对螺纹;通孔44仅起到杆71的导向装置的作用。止推旋转轴承70也不用传递旋转运动,并可由刚性止推连接代替,例如由螺栓连接或者焊接代替。把手72还用作冲击头,并为此最好具有拱形件76。通过省却方块件61’的可纵向移动布置和取消用于移动方块件的操作装置,该实施形式的制造成本更低,并且维护更简单。
在另一个实施形式情况下,除此以外,为进一步简化,将手柄部分21的后端设计成冲击头并备有拱形件76’。必要时,可以设置加强杆71’,该加强杆将挺杆部分21的后端与其前端连接。
在带有刚性方块件61’的实施形式情况下,冲力从拱形件76,76’通过杆71,71’和钳子半体2传递到方块件61’及其止动面62’上。
在钳子1后部区域为手柄部分21,31设置了定位器8。定位器包括可摆动的定位元件83和止动销84(它们分别面对面布置在手柄部分21,31上),脱开装置81,底座82和弹簧87。手柄部分21的后端为叉形件,其中止动销84由叉形件基点的倒角构成。定位元件83通过底座82支承在由手柄部分21,31展成的平面内。弹簧87是片弹簧,作用于支承在底座82内的定位元件83的端部,使得该端部被向前压向止动销84。从底座82开始,定位元件83具有宽的区域和窄的区域。在其窄的区域中,定位元件83在其前端具有齿部86,在钳子1闭合状态,止动销84接合并定位在该齿部内,从而手柄部分21,31不能相互分离,从而确保植入器械1意外展开。由此还能够向钳子1上施加大载荷,如例如作用在拱形件76上的锤击,而不用担心意外打开,并且外科医生也不需要用手的力保证手柄部分21,31不要意外打开。为在植入之后打开钳子1,通过向后压脱开元件81使元件83向后摆动,由此止动销84离开定位元件83,从而手柄部分21,31在弹簧11的作用下相互分离。在钳子1的打开状态,定位元件83克服弹簧87的力向后摆动。在定位元件83的宽区域中设置了设计为长孔的导向装置85,该导向装置用于在钳子1打开时也将杆71保持在纵轴10的规定位置,并在受到较高冲击载荷时也能避免杆71纵弯曲。
此外,在手柄部分31上固定了片弹簧11,该片弹簧围绕杆71伸向另一个手柄部分21。在钳子1闭合情况下,该片弹簧11受压并使植入器械1在定位元件83脱开后能够自动打开,以便能够取下。
下面描述与颈部假体9的相互作用。为用钳子1接收颈部假体9,将颈部假体9放到钳口部分22,32之间的区域中并闭合钳子1,由此钳口部分22,32相向运动。在此凸起51,52接合到两个终板91,92的相应接收开口内,其中销51接合到孔97内,薄片52接合到狭槽96,96’内。由此颈部假体9在夹紧方向上被无间隙地保持在钳子1上。凸起51,52和孔97和狭槽96形式的接收开口的不同实施形式保证颈部假体9只能以正确的定位被保持在钳子1上。如果钳子1如在所示实施例中还另外备有上侧用的标记14,则实际上排除了由于颈部假体9定向颠倒导致的错误植入。在这样将颈部假体9以正确定位接收在钳子1上之后,可借助操作装置7通过转动把手72使杆71向前运动,从而方块件61以其止动面62从后面贴靠到颈部假体9的法兰94,95上。在此方块件使颈部假体9张紧靠在凸起51,52上,并从而将颈部假体9安置在规定的位置。最终以这种方式消除了在凸起51,52和孔97和狭槽96之间的纵轴方向上存在的间隙。由此颈部假体9被可靠并且精确定位地保持在植入器械1上。此外,方块件61贴靠在两个终板91,92的法兰93,94上还防止两个终板91,92在其前端相互分开。由此避免了颈部假体展开,颈部假体展开会妨碍成功进入椎间空间。
此外,还可不必改变钳子1就能植入其它高度的颈部假体。在图5中示出了颈部假体9,9’,其中假体9’具有较厚的滑动核心93’。滑动核心93’(和滑动核心93一样)备有狭槽96’,该狭槽与下终板92的狭槽96对齐。接收开口在下终板92上作为狭槽96并且其延伸部分作为在滑动核心93’中的狭槽96’,使得能够用不改变凸起51,52布置的同一钳子1抓取并可靠地保持颈部假体9’。在此通过接合到孔97内的销钉形凸起51保证了定位精度。
但在需要时,如图4中所示,还可设置其它的钳口镶块53’,该钳口镶块具有布置不同的凸起51’,52’。在所示实例中,凸起更靠近并处于一个平面内。由此钳子1可适用于其它的椎间内假体,例如适用于特别小的治疗儿童的椎间内假体。
方块件61以其止动面62提供了尺寸足够大的传力表面,以将施加到作为冲击头的拱形件76上的冲力传递到颈部假体9上。这具有很大的优点,即为精确定位而做得纤细的凸起51,52不必传递冲击力,从而即使在较高冲击载荷情况下,由于方块件61或61’以其止动面62承担了传力,也排除了由于过载导致凸起51,52弯曲或者甚至折断的危险。
根据本发明的钳子1能够防止搞错并精确定位地将颈部假体9布置在钳子1上,其中防止了颈部假体9意外打开。此外,由于带有止动面62的方块件61或61’,即使在小尺寸钳子1的情况下也能够传递较大的力。由此保证了可靠植入假体。小的尺寸还具有另外的优点,即为外科医生提供了良好的观察和达到植入位置的条件。

Claims (18)

1.多部件椎间内假体(9)和植入器械(1)组成的装置,其中所述多部件椎间内假体具有上终板和下终板(91,92)以及在所述上终板及下终板之间的滑动核心(93),所述植入器械具有把手区域(21,31)和抓取区域(22,32),其中为每个终板(91,92)分配了一对接收开口(96,97)而为抓取区域(22,32)配置了一对保持凸起(51,52),或者为每个终板(91,92)分配了一对接收凸起而为抓取区域(22,32)配置了一对保持开口,其中所述保持凸起(51,52)能够进入到接收开口(96,97)内,或者所述接收凸起能够进入到保持开口内,以将椎间内假体(9)保持在植入器械(1)上,
其特征在于,
所述接收开口(96,97)或者接收凸起布置在所述椎间内假体(9)的外侧端面上,并且至少分配给所述终板(92)之一的一对接收开口(96)具有向另一个终板(91)方向扩展的形状。
2.根据权利要求1所述的装置,其特征在于,
所述具有扩展形状的接收开口(96)是狭槽。
3.根据权利要求1或2所述的装置,其特征在于,
所述具有扩展形状的接收开口(96)在相应的终板(92)的整个高度上延伸。
4.根据权利要求1或2所述的装置,其特征在于,
所述具有扩展形状的接收开口(96’)在滑动核心(93’)的部分高度上延伸。
5.根据权利要求1或2所述的装置,其特征在于,
所述具有扩展形状的接收开口(96’)在滑动核心(93)的整个高度上延伸。
6.根据权利要求1或2所述的装置,其特征在于,
所述具有扩展形状的接收开口(96)随着深度的增加变细。
7.根据权利要求1或2所述的装置,其特征在于,
所述分配给另一个终板(91)的接收开口(97)具有集聚的形状。
8.根据权利要求7所述的装置,其特征在于,所述分配给另一个终板(91)的接收开口是圆孔。
9.根据权利要求2所述的装置,其特征在于,
所述保持凸起的与作为狭槽的接收开口共同作用的部分构造为薄片形(52),而所述保持凸起的其它部分构造为销钉形(51)。
10.根据权利要求1或2所述的装置,其特征在于,
所述保持开口布置在植入器械(1)上,所述接收凸起布置在椎间内假体(9)上。
11.根据权利要求1或2所述的装置,其特征在于,
用不同厚度的滑动核心(93)为椎间内假体(9,9’)设置了不同的尺寸。
12.根据权利要求1或2所述的装置,其特征在于,
在抓取区域设置了带有止动面(62)的方块件(61’)以贴靠在椎间内假体(9)上,该方块件与受力零件连接以向椎间内假体(9)施加植入力。
13.根据权利要求12所述的装置,其特征在于,
方块件(61’)刚性布置在抓取区域(22)上。
14.根据权利要求13所述的装置,其特征在于,
方块件(61’)借助贯穿螺栓(68)固定。
15.根据权利要求13所述的装置,其特征在于,
方块件(61’)借助紧固螺栓(66)固定。
16.根据权利要求12所述的装置,其特征在于,
在方块件(61’)上布置一个杆(71),该杆带有在手柄部分(21)后部区域的把手(72)。
17.根据权利要求16所述的装置,其特征在于,
所述把手是冲击头(76)。
18.根据权利要求12所述的装置,其特征在于,
方块件(61’)布置在一钳口镶块(53)上。
CN2004800203782A 2003-07-15 2004-02-04 由颈部假体和植入器械组成的装置 Expired - Fee Related CN1822803B (zh)

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