CN1863492A - 后部元件运动恢复装置 - Google Patents

后部元件运动恢复装置 Download PDF

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Publication number
CN1863492A
CN1863492A CNA2004800288634A CN200480028863A CN1863492A CN 1863492 A CN1863492 A CN 1863492A CN A2004800288634 A CNA2004800288634 A CN A2004800288634A CN 200480028863 A CN200480028863 A CN 200480028863A CN 1863492 A CN1863492 A CN 1863492A
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CN
China
Prior art keywords
replacement devices
superior facet
facet replacement
prosthetic appliance
vertebral plate
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
CNA2004800288634A
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English (en)
Inventor
B·M·贝里
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
SDGI Holdings 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 SDGI Holdings Inc filed Critical SDGI Holdings Inc
Publication of CN1863492A publication Critical patent/CN1863492A/zh
Pending legal-status Critical Current

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    • 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 ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/7064—Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
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Abstract

一种用于插入由一个或多个切除的脊椎后部结构形成的间隙中的假体装置。该假体装置包括：具有下部用于代替切除的椎板的桥板；至少一个下小面替代装置，连接于所述桥板的下部，以替代切除的下关节突；和至少一个上小面替代装置，以代替切除的上关节突。所述至少一个上小面替代装置与所述至少一个下小面替代装置关节联接。

Description

后部元件运动恢复装置
发明领域
本发明一般涉及脊柱外科装置，更具体地涉及脊柱后部元件的替换。
发明背景
各种损伤和变形可破坏脊椎后部结构，包括蒂、椎板和关节及棘突。为治疗这些损伤和变形相关的疼痛和能力丧失，可手术切除或用假体装置代替一个或多个后部椎骨结构。例如，年龄、疾病或损伤可导致椎间盘断裂，椎体实际上闭合。这也可导致一个或多个关节如面关节，或椎板的负荷、磨损、破坏和引起的疼痛的增加，可导致手术摘除小面，即椎骨关节面切除术和/或手术摘除椎板，即椎板切除术。
目前用于替代在椎骨关节面切除术或椎板切除术中摘除的结构的假体装置可导致面关节不动或另一种极端，脊柱运动过度。因此，需要一种装置，以在椎骨关节面切除术或椎板切除术后恢复脊柱更自然的运动。
发明概述
本发明涉及一种假体装置，以啮合由一个或多个切除的脊椎后部结构形成的间隙中。在一个实施方式中，假体装置包括桥板，其下部用于代替切除的椎板；至少一个下小面替代装置，连接于桥板的下部，以替代切除的下关节突；和至少一个小节面替代装置，以代替切除的上关节突。至少一个上小面替代装置与至少一个下小面替代装置关节联接。
在另一个实施方式中，多水平假体装置包括连接于至少一个第一下小面替代装置的第一桥板和连接于至少一个上下面伸展的第二桥板。至少一个下小面替代装置与至少一个上下面伸展关节联接。在另一个实施方式中，至少一个经椎板紧固件延伸通过并连接于第一椎骨的椎板，至少一个下小面替代装置连接于经椎板紧固件。
在另一个实施方式中，本发明涉及一种将具有至少一个经椎板紧固件和至少一个下小面替代装置的关节面假体装置最小侵入性地安装入脊柱的器械。在本实施方式中，所述器械包括：第一管状部件，以使至少一个经椎板紧固件进入脊柱的一个椎骨板的邻近，并使至少一个经椎板紧固件延伸入椎板。至少一个经椎板紧固件的连接部分延伸通过椎板。本实施方式还包括第二管状部件，以使至少一个小节面替代装置连接于至少一个经椎板紧固件的连接部分。
附图简要说明
图1是具有受损的后部元件的椎骨的脊柱的透视图。
图2是本发明的一个实施方式的椎骨植入物组合件的分解透视图。
图3是位于脊柱中图2的假体的透视图。
图4是本发明第二个实施方式的位于脊柱内且形状可代替椎骨后部元件的假体的透视图。
图5是本发明第三个实施方式的位于脊柱内且形状可代替椎骨后部元件的假体的透视图。
图6a是具有系链的小面替代组合件的分解透视图。
图6b是具有柔性鞘的小面替代组合件的分解透视图。
图7a是本发明第四个实施方式的位于脊柱内且形状可代替椎骨后部元件的假体的透视图。
图7b是具有小面替代装置的经椎板紧固件的分解透视图。
图8是用于安装假体以代替椎板后部元件的器械的透视图。
发明详述
为促进对本发明原理的理解，现在将参考实施方式或实施例，附图中的说明并使用具体的语言来描述这些实施方式或实施例。但是，应理解，这不是对本发明范围的限制。本文所述实施方式中的任何改变和进一步改进，以及所述本发明原理的进一步应用，就如本发明相关领域技术人员通常所理解的那样。
参考图1，参考数字10表示具有在上椎骨14和下椎骨16之间延伸的第一受损椎骨12的脊柱。受损椎骨12的后部结构包括由蒂12c和12d支持的上关节面12a和12b，一对在蒂12c和12d之间延伸的椎板12e和12f，从椎板12e和12f的连接处背侧伸出的棘突12g，从椎板12e与蒂12c及椎板12f与蒂12d各自的连接处支持的下关节面12h和12i。这些后部结构跨过椎孔18。
在典型的外科椎板切除术中，椎板12e、12f与棘突12g一起被切除，产生在上椎骨14和下椎骨16的后部结构间的空腔。外科椎骨关节面切除术涉及摘除下关节面12h和12i，并涉及摘除相邻椎骨16的上关节面16a和16b。椎板切除术可与椎骨关节面切除术一起进行，并涉及摘除大于一个椎骨的后部结构。提供本发明一个实施方式的假体组合件，以代替一个或多个切除的后部结构。
现在参考图2，本发明一个实施方式的后假体组合件可在涉及椎骨12的椎板切除术(图1)，椎骨12的下椎骨关节面切除术(图1)和椎骨16的上椎骨关节面切除术(图1)中使用。后假体组合件通常表示为参考数字20，包括连接于一对蒂螺钉24和26的桥板22，一对下小面替代装置28和30，一对上小面替代装置32和34和棘突缓冲器36，所有的连接方式如下所述。
桥板22的构型可跨过椎孔18(图1)，其包括具有末端部分40和42的板38。棘突假体44可从板38的中心附近背侧延伸。在一些实施方式中，板38可为拱形，在其它实施方式中，它相对平坦。桥板22可由多种材料形成，包括钛，不锈钢，或可透过射线的聚合材料如英国Victrex PLC提供的聚醚醚酮(PEEKTM)。取决于所选材料和后假体组合件20中容许的运动量，桥板22可为刚性或不为刚性。
桥板22的末端部分40和42可分别具有螺纹孔46和48，其构型可接受蒂螺钉24和26。蒂螺钉24和26的构型可分别旋入蒂12c和12d(图1)。在一些实施方式中，可选择压紧的蒂桩、粘合剂或其它蒂连接机制代替蒂螺钉。覆盖板(未示出)或本领域已知的任何类型的装置可用来防止一旦安装蒂螺钉24和26从蒂旋出。
一对下小面替代装置28和30的构型代替下关节面12h和12i。在一个实施方式中，下小面替代装置28是可拆卸的，使得以后替换单一装置28而不替换整个桥板。在本实施方式中，下小面替代装置28包括头部50，杆52可从头部延伸。头部50可为球形或可假设解剖学形状，以降低磨损并使面关节处的关节相对自然排列。至少一部分杆52为管形并带有内螺纹54。许多材料可单独或一起使用，形成包含PEEKTM、不锈钢、钛、钴铬、锆涂料和陶瓷的下小面替代装置28。小面装置28还可包括弹簧或其它缓冲系统(未示出)以降低半制约关节中的磨损和震动。下小面替代装置30的特征可与装置28相似或相同，将不再详述。
一对下小面连接件56和58从桥板22的下部伸出，其构型可分别接受下小面替代装置28和30。在一个实施方式中，连接件56可具有外螺纹60，其构型可旋入下小面替代装置28的内螺纹54。装置30可以相似或相同的方式啮合连接件58。虽然描述了螺纹连接，但应理解，在可选实施方式中也可使用其它连接组合件，使下小面替代装置28和30连接于桥板22。而且，虽然已描述下小面替代装置28和30是可拆卸的，但应理解，在可选实施方式中它们也可以永久附加于桥板22。
下小面替代装置28可与上小面替代装置32关节联接，形成人工面关节。上小面替代装置32可包括头部62，主干64从头部延伸。主干64的构型可紧固于下椎骨16，例如可是螺纹的。上小面替代装置32可以是，例如，蒂螺钉或压紧的蒂桩。头部62可以是形状可接受下小面替代装置28的头部50的槽，或头部62的形状可选自多种适合啮合下小面替代装置28的几何形状。上小面替代装置32可由多种材料形成，包括钛、不锈钢和PEEKTM。应理解，在可选的实施方式中，可将下和上小面替代装置的构型倒过来，使得下小面替代装置28的头部形状为槽以啮合上小面替代装置32上的球形头部62。上小面替代装置32的特点可与装置34相似或相同，将不再详述。
弹性缓冲器36可连接于棘突假体44的末端，并在相邻椎骨的棘突间延伸(例如14和16)，缓冲棘突假体44与相邻椎骨棘突间的界面。在一个实施方式中，缓冲器36包括中心孔66和一对切口68和70，中心孔的构型装在棘突假体44的末端上，每个末端部分的形状啮合相邻的棘突。弹性缓冲器36可由任何弹性材料构成，包括水凝胶或其它弹性体。一旦安装，弹性缓冲器36可允许棘突区域中有限的运动而不使运动过度，对棘突和相邻结构造成损伤。
现在参考图3，显示了椎骨12的椎板切除术和涉及椎骨12的下关节面12h和12i与下椎骨16上关节面16a和16b的椎骨小面切除术后的脊柱10(图1)。后假体组合件20的安装需要通过旋入、压紧或本领域已知的另一植入方法，将上小面替代装置32和34手术植入椎骨16的蒂中。桥板22可啮合椎板切除术和椎骨小面切除术所产生的间隙中，并使用蒂螺钉24和26紧固于蒂12c和12d。应理解，可使用其它类型的紧固件如蒂桩代替蒂螺钉24和26。
在桥板22连接于椎骨12之前或之后，可将下小面替代装置28和30分别螺旋地连接于下小面连接件56和58。下小面替代装置28和30可移动地啮合上小面替代装置32和34。由小面替代装置形成的关节接合可在脊柱10中恢复或保持运动。安装时，桥板22保持或增加原来的孔间隔(foramen space)18。弹性缓冲器36中的孔66可位于棘突假体44的末端上，切口68和70分别与椎骨14和16的棘突弹性啮合。在如图4所示的一个实施方式中，可用缓冲器连接装置72使弹性缓冲器36的末端部分连接于相邻椎骨的棘突(例如图1的14)。缓冲器连接装置72可以是，例如，延伸通过弹性缓冲器36和环绕或通过椎骨14的棘突的线缆。需要时，也可使用类似的缓冲器连接装置72，或另外用来使弹性缓冲器36连接于椎骨16的棘突。这种缓冲器连接装置72可提供假体组合件20的附加的稳定性而不会在脊柱10中完全限制运动。
现在参考图5，在椎骨12和椎骨14的椎板切除术以及椎骨12、14和16的椎骨小面切除术之后，多水平后假体组合件74可置于脊柱10中(图1)。多水平后假体组合件74可包括第一桥板22(图2)；第二桥板76；两对蒂螺钉24，26，78，和80；两对下小面替代装置28，30，82，和84；以及弹性缓冲器36和86。桥板76可包括桥板22中描述的所有结构，包括从桥板76的中心附近背面延伸的棘突假体88，还包括一对从桥板76的上部伸出的上小面伸展结构90和92。可排列伸展结构90和92，以分别啮合下小面替代装置28和30。伸展结构90包括槽94，其形状可接受具有球形或解剖学形状头部50的下小面替代装置28。在其它实施方式中，头部50是槽，伸展结构90包括形状啮合槽的头部。伸展结构92与伸展结构90相似或相同。桥板76和伸展结构90和92由许多材料形成，例如包括钛、不锈钢或PEEKTM。
多水平后假体组合件74的弹性缓冲器86可连接于棘突假体88的末端，并在椎骨16的棘突和弹性缓冲器36之间延伸，缓冲棘突假体88与相邻天然和人工棘突间的界面。在一个实施方式中，弹性缓冲器86包括下端切口96，其形状啮合椎骨16的棘突。弹性缓冲器86的上端包括凸起98，其形状啮合弹性缓冲器36的切口70。弹性缓冲器86可由任何弹性材料构成，包括水凝胶或其它弹性体。使用上述缓冲器连接装置72，弹性缓冲器36和86还可连接于相邻棘突或人工棘突。多水平后假体组合件74的另一个实施方式包括多于两个的桥板及相关的连接结构。
现在参考图6a，为防止图3中关节的不自然运动并降低下小面替代装置28和上小面替代装置32形成的关节磨损，可采用运动制约机制100。在一个实施方式中，运动制约机制100包括弹性系链102，可延伸通过下小面替代装置28和上小面替代装置32。调节机制104可连接于系链，以将系链固定就位并使其在手术过程中绷紧。附加地或可选地，运动制约机制100包括弹性鞘106，其至少部分环绕下小面替代装置28和上小面替代装置32。运动制约机制100包括钳位机制108，以将鞘106固定就位。除了限制运动，鞘106还具有限制关节面替代装置中产生的任何磨损碎片的附加优点。
而且，附加地或可选地，可用水凝胶至少部分制约由下小面替代装置28和上小面替代装置32形成的关节。可在图3的下小面替代装置30与上小面替代装置34形成的连接处，或任何由图5的多水平后假体组合件74的下小面替代装置、上小面伸展结构、或上小面替代装置形成的连接处，使用相似或相同的运动制约装置100。
现在参考图7a，在另一个实施方式中，椎骨12的下小面12h和12i和椎骨16的上小面16a和16b的椎骨关节面切除术之后，用上小面替代装置32和34(图2)，下小面替代装置28和30(图2)及经椎板紧固件110和112进行关节重建。
如图7b所示，经椎板紧固件110可包括头部114和螺杆116。在一个实施方式中，螺纹118可在螺杆116的末端部分形成，与头部114相对，以啮合下小面替代装置28的内螺纹54。螺纹118可以是机螺纹，在这种情况下，下小面替代装置的内螺纹54也是机螺纹。螺杆116的中心部分可具有与螺纹118不同螺纹特征的螺纹120。螺纹120可以是骨螺纹。在另一个实施方式中，用单螺纹形式如骨螺纹可拧螺杆116。然后，也可拧下小面替代装置28的内螺纹54以接受单螺纹形式。
再参考图7a，在所述椎骨小面切除术之后，可将经椎板紧固件110拧入椎板12f，向下关节面12h的前方位置并继续推进直到至少一部分紧固件110延伸入摘除下关节面12h所形成的空腔内。该过程可采用许多技术，例如包括，部分用于螺钉放置的Magerl技术。可如上所述安装上小面替代装置32。将经椎板紧固件110拧入通过椎板12f，下小面替代装置28拧入经椎板紧固件110。然后，下小面替代装置28可与上小面替代装置32关节联接。在一些实施方式中，下小面替代装置28可连接于上小面替代装置32，同时经椎板紧固件110拧入下小面替代装置28。本实施方式中也可使用任何所述运动制约机制100。
经椎板紧固件112可与经椎板紧固件110相似或相同，因此，将不再详述。可以与上述经椎板紧固件110类似的方式进行经椎板紧固件112的安装，将紧固件112拧入通过椎板12e以啮合下小面替代装置30。
在一个实施方式中，使用经皮、最小侵入性或显像导向技术以避免扰乱肌肉结构，可实现上述关节重建。例如，现在参考图8，可使用一系列管或管状部件代替经椎板紧固件110和112，下小面替代装置28和30以及上小面替代装置32和34。将具有能使经椎板紧固件110通过通道的最小直径的第一管122经皮插入并延伸至椎板12e(图1)。经椎板紧固件110可通过第一管122，以允许如上所述安装。第一管122可侧向延伸远离椎板12e。相似或相同的管124可用于植入经椎板紧固件112。将具有能使下和上小面替代装置28和32通过通道的最小直径的第二管122经皮啮合并延伸至小面12h和16a的椎骨关节面切除术所形成的空腔内(图1)。下和上小面替代装置28和32可通过第二管126，以允许如上所述安装。第二管126可从椎板12e背面向外延伸。可使用相似或相同的管植入下或上小面替代装置30和34。管122，124，126和128可以是容纳人工结构的安装所需的任何长度。例如，第一管122可相对较长，而第二管可126相对较短。
虽然本发明只详细描述了几个示例性实施方式，但是本领域技术人员将容易理解，实质上不背离本发明的新说明和优点，示例性实施方式中的任何改变都是可能的。因此，所有这种改变都包括在本发明的范围内，如所附权利要求书所述。在权利要求书中，方法加功能语句用于描述进行所述功能时的本文所述结构，不仅是结构等价物，还是等价的结构。

Claims (21)

1.一种用于插入由一个或多个切除的脊椎后部结构形成的间隙中的假体装置，所述假体装置包括：
用于代替切除的椎板的桥板，其中，所述桥板具有一下部；
至少一个下小面替代装置，连接于所述桥板的下部；和
至少一个上小面替代装置，
其中，所述至少一个上小面替代装置与所述至少一个下小面替代装置关节联接。
2.如权利要求1所述的假体装置，其特征在于，所述至少一个下小面替代装置与桥板整体连接。
3.如权利要求1所述的假体装置，其特征在于，所述至少一个下小面替代装置与桥板螺纹连接。
4.如权利要求1所述的假体装置，其特征在于，所述至少一个下小面替代装置包括与至少一个上小面替代装置接触的球形部分。
5.如权利要求1所述的假体装置，所述装置还包括运动制约机制，以控制至少一个下小面替代装置与至少一个上小面替代装置间的关节范围。
6.如权利要求5所述的假体装置，其特征在于，所述运动制约机制包括在至少一个下小面替代装置与至少一个上小面替代装置间延伸的系链。
7.如权利要求5所述的假体装置，其特征在于，所述运动制约机制包括至少部分延伸超过至少一个下小面替代装置和至少一个上小面替代装置的鞘。
8.如权利要求5所述的假体装置，其特征在于，所述运动制约机制包含水凝胶。
9.如权利要求1所述的假体装置，所述装置还包括固定连接于桥板且可移动地连接于至少一个相邻椎骨的弹性缓冲器。
10.如权利要求9所述的假体装置，其特征在于，所述弹性缓冲器包括至少一个切口，用于可移动地连接至少一个相邻椎骨。
11.如权利要求9所述的假体装置，其特征在于，所述弹性缓冲器由水凝胶形成。
12.如权利要求9所述的假体装置，所述装置还包括延伸通过弹性缓冲器以限制缓冲器与至少一个相邻椎骨间的运动的缓冲器连接装置。
13.如权利要求1所述的假体装置，所述装置还包括至少一个蒂螺钉，用于将桥板固定于椎骨。
14.一种用于插入由一个或多个切除的脊椎后部结构形成的间隙中的多水平假体装置，所述假体装置包括：
连接于至少一个第一下小面替代装置的第一桥板；和
连接于至少一个上小面伸展结构的第二桥板，
其中，所述至少一个下小面替代装置与所述至少一个上小面伸展结构关节联接。
15.如权利要求14所述的多水平假体装置，所述装置还包括至少一个上小面替代装置，所述第二桥板连接于所述至少一个第二下小面替代装置，所述至少一个第二下小面替代装置与所述至少一个上小面替代装置关节联接。
16.如权利要求14所述的多水平假体装置，所述装置还包括：
固定连接于第一桥板的第一弹性缓冲器；和
固定连接于第二桥板的第二弹性缓冲器，
其中，所述第一弹性缓冲器可移动地连接于所述第二弹性缓冲器。
17.一种用于啮合由一个或多个切除的小面形成的间隙中的假体装置，所述假体装置包括：
至少一个可延伸通过并连接于第一椎骨的椎板的经椎板紧固件；和
至少一个连接于经椎板紧固件的下小面替代装置。
18.如权利要求17所述的假体装置，所述装置还包括至少一个连接于第二椎骨的上小面替代装置，其中，所述至少一个上小面替代装置与至少一个下小面替代装置关节联接。
19.如权利要求17所述的假体装置，其特征在于，所述至少一个经椎板紧固件具有第一外螺纹，所述至少一个下小面替代装置具有内螺纹，所述经椎板紧固件螺纹连接于所述至少一个下小面替代装置。
20.如权利要求19所述的假体装置，其特征在于，所述至少一个经椎板紧固件具有第二外螺纹，用于螺纹连接第一椎骨的椎板。
21.一种用于将包括至少一个经椎板紧固件和至少一个下小面替代装置的关节小面假体装置最小侵入性地安装入脊柱的器械，所述器械包括：
第一管状部件，用于使至少一个经椎板紧固件进入脊柱的一个椎骨的椎板附近，并使至少一个经椎板紧固件延伸入椎板，其中，至少一个经椎板紧固件的连接部分延伸通过椎板；
第二管状部件，用于连接至少一个下小面替代装置与至少一个经椎板紧固件的连接部分。
CNA2004800288634A 2003-08-06 2004-08-06 后部元件运动恢复装置 Pending CN1863492A (zh)

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JP4500311B2 (ja) 2010-07-14
CA2534992A1 (en) 2005-02-17
JP2007501076A (ja) 2007-01-25
WO2005013864A3 (en) 2005-06-30
AU2004263125A1 (en) 2005-02-17
US7377942B2 (en) 2008-05-27
US20050033434A1 (en) 2005-02-10
WO2005013864A2 (en) 2005-02-17

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