CN1893895A - 用于侧向插入的关节盘修补物 - Google Patents
用于侧向插入的关节盘修补物 Download PDFInfo
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- CN1893895A CN1893895A CNA2004800069980A CN200480006998A CN1893895A CN 1893895 A CN1893895 A CN 1893895A CN A2004800069980 A CNA2004800069980 A CN A2004800069980A CN 200480006998 A CN200480006998 A CN 200480006998A CN 1893895 A CN1893895 A CN 1893895A
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- Prior art keywords
- knuckle
- parts
- prosthesis device
- vertebra
- joint
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Abstract
提供一种用来侧向地插入椎间空间内的假体修补物装置(40)。该假体修补物装置包括一具有一第一侧向延伸的突缘(58)的第一部件(42),其用来从侧向逼近第一脊骨地接合一第一椎骨,该第一部件具有一第一关节表面(52)。假体修补物装置还包括一具有一第二侧向延伸的突缘(68)的第二部件(44),其用来从侧向逼近第二脊骨地接合一第二椎骨,该第二部件具有一第二关节表面(72),以便与第一关节表面合作而允许在第一和第二部件之间作关节的运动。
Description
相关申请
本申请要求对2003年2月12日提交的美国临时申请No.60/446,963的优先权。出于合法的目的本文援引美国临时申请No.60/446,963以供参考。
技术领域
本发明一般地涉及整形和脊骨外科的领域,在某些实施例中,本发明涉及用于全部地或局部地更换天生椎间盘的椎间假体接头,以及用于其中的方法和工具。
背景技术
在对影响脊骨运动体节的疾病、受伤或畸形的治疗中(尤其是,影响盘组织的情形),人们早就知道移去某些或全部劣化的、破裂的或其它形式失效的盘组织。在涉及移去椎间盘组织或其它形式椎间盘不在脊骨运动体节内的诸多病例中,医生采用各种纠正措施来确保合适地间隔先前由移去的盘组织所分开的脊骨。
在某些实例中,使用移植的骨组织、一关节融合部件,或其它的组成物或装置,将两个相邻的脊骨融合在一起。然而,椎骨融合手术在医学界中引起一些问题,即,椎间融合的生物-机械刚度趋于使相邻的脊骨运动体节快速地变坏。具体来说,与天生椎间盘不同,椎骨融合阻止融合的脊骨相对于彼此枢转和转动。这种可移动性的缺乏趋于增加相邻的脊骨运动体节上的应力。
此外,好几种病情可形成在相邻的脊骨运动体节内,包括有椎间盘退变、椎间盘疝、不稳定性、脊骨狭窄、椎关节强硬,以及骨上小平面接头关节炎。因此,许多病人会由于椎骨融合而需要另外去除椎间盘和/或其它类型的外科手术。因此对脊骨融合需要有替代方案。具体来说,本发明涉及一从侧向逼近插入的关节盘修补物。
发明内容
提供一种用来侧向地插入椎间空间内的假体修补物装置。该假体修补物装置包括一具有一第一侧向延伸的突缘的第一部件,其用来从侧向逼近接合一第一椎骨,该第一部件具有一第一关节表面。假体修补物装置还包括一具有一第二侧向延伸的突缘的第二部件,其用来从侧向逼近接合一第二椎骨,该第二部件具有一第二关节表面以便与第一关节表面合作而允许在第一和第二部件之间作关节的运动。在另一实施例中,提供一种用来侧向地插入椎间空间内的假体修补物装置。该假体修补物装置包括一第一关节部件和一第二关节部件,第一关节部件具有一在侧向插入其中的过程中用来侧向地接合一第一椎骨的装置,第二关节部件具有一在侧向插入其中的过程中用来侧向地接合一第二椎骨的装置。第一和第二关节部件之一包括一突出,而第一和第二关节部件之另一个包括一凹陷,这样,突出接合凹陷而在第一和第二关节部件之间提供关节的运动。
在另一实施例中,提供一种用来插入形成在一对椎关节强硬的椎骨之间的椎间空间内的假体修补物装置。该假体修补物装置包括一第一部件,其具有一沿第一承载表面侧向延伸的第一突缘和一具有从中延伸的突出的第一关节表面。假体修补物装置还包括一第二部件,其具有一沿第二承载表面侧向延伸的第二突缘,该第二突缘偏离第一突缘,以适应第一椎骨和第二椎骨之间的椎关节强硬的关系及具有形成在其中的一凹入的第二关节表面。第一部件的突出接合第二部件的凹入,以在第一和第二部件之间提供关节的运动。
提供一种用来形成假体修补物装置的一部分的假体修补部件。该假体修补部件包括一第一表面,其具有用来从侧向逼近地接合一椎骨的突缘,该突缘沿第一表面基本上侧向地延伸,以及一与第一表面相对的第二表面,该第二表面适于接合另一假体修补部件。
在另一实施例中,提供一从侧向逼近将假体修补物装置插入椎间空间内的方法。该方法包括提供一假体修补物装置,该假体修补物装置具有一第一关节部件和一沿第一关节部件的表面侧向地延伸的第一突缘,以及具有一第二关节部件和一沿第二关节部件的表面侧向地延伸的第二突缘。该方法还包括将第一关节部件侧向地插入到第一椎骨内和将第二关节部件侧向地插入到第二椎骨内,第二椎骨邻近于第一椎骨。
在另一实施例中,提供一从侧向将假体修补物装置插入第一椎骨和第二椎骨之间的椎间盘空间内的方法。该方法包括提供一包括一第一关节部件的假体修补物装置。第一关节部件包括一承载表面和一关节表面、一形成在承载表面上的基本上侧向地延伸的隆突以接合第一椎骨和形成在关节表面内的一凹陷。该方法还包括提供带有第二关节部件的假体修补物装置,第二关节部件包括一承载表面和一关节表面、一形成在承载表面上的基本上侧向地延伸的隆突以接合第二椎骨和从关节表面延伸的一突出以接合第一关节部件的凹陷。该方法还包括基本上侧向地将假体修补物装置插入椎间盘空间内以使假体修补物装置与第一和第二椎骨接合。
附图的简要说明
图1是一椎骨强硬的椎骨柱的一部分的侧视图。
图2是图1所示的一对相邻椎骨端板的侧视图。
图3a是图2所示的带有一杆和螺钉结构的一对相邻椎骨端板的侧视图。
图3b是图3a的一对相邻椎骨体的纵向局部截面图。
图4a是根据本发明的一实施例的用于侧向插入的一关节假体修补接头的立体图。
图4b是根据本发明的另一实施例的用于侧向插入的一关节假体修补接头的立体图。
图4c是图4b的用于侧向插入的关节假体修补接头的前视图。
图5是图4a的假体修补接头的纵向视图。
图6是图4a的假体修补接头的侧视图。
图7是图4a的设置在一对强硬椎骨端板之间的假体修补接头的局部的侧向截面图。
图8是设置在一对椎骨端板之间的另一变化的关节的假体修补接头的局部的侧向截面图。
图9是根据本发明的另一实施例的一变化的关节假体修补接头的立体图。
图10是图9的设置在一对强硬椎骨端板之间的假体修补接头的局部的侧向截面图。
图11是设置在一对椎骨端板之间的一变化的关节假体修补接头的局部的侧向截面图。
图12是根据本发明的另一实施例的椎间盘假体修补物的立体图。
图13是根据本发明的另一实施例的一变化的椎间盘假体修补物的立体图。
图14是根据本发明的另一实施例用于前插入的一变化的关节假体修补接头的立体图。
图15是图14的假体修补接头的纵向视图。
图16是图14的假体修补接头的侧视图。
图17是图14的设置在一对强硬椎骨端板之间的假体修补接头的侧视图。
图18是根据本发明的另一实施例的用于前插入的一变化的关节假体修补接头的纵向视图。
图19是根据本发明的还有另一实施例的用于前插入的一变化的关节假体修补接头的纵向视图。
图20是根据本发明的还有另一实施例的用于前插入的一变化的关节假体修补接头的纵向视图。
图21是具有用来接纳图18的假体修补接头的槽的一对椎骨端板的纵向视图。
图22是具有用来接纳图19的假体修补接头的槽的一对椎骨端板的纵向视图。
图23是具有用来接纳图20的假体修补接头的槽的一对椎骨端板的纵向视图。
图24是图14的设置在一对强硬椎骨端板之间的假体修补接头和一整形植入物的局部的侧向截面图。
图25是图14的设置在一对强硬椎骨端板之间的假体修补接头和一尖端螺钉的局部的侧向截面图。
图26是图25所示结构的示意俯视图。
图27是示出一用于穿孔插入的路径的一椎骨体的示意俯视图。
图28是根据本发明的另一实施例的用于穿孔插入的一变化的关节假体修补接头的立体图。
图29是图28的假体修补接头的侧视图。
图30是图28的假体修补接头的纵向视图。
图31a是设置在一对椎骨端板之间的图28的假体修补接头的局部侧向截面图。
图31b是设置在一对椎骨端板之间的图28的假体修补接头的局部纵向截面图。
图32是示出一形成在一椎骨端板内的穿孔槽的示意俯视图。
图33是示出一显示插在一椎骨端板上的研磨装置示意俯视图。
图34a是显示为设置在一对相邻椎骨端板之间的图33的研磨装置的侧视图。
图34b是图34a的研磨装置的研磨工具的详图。
图34c是另一变化的研磨工具的详图。
图35是图33的研磨装置的示意图。
图36是根据本发明的另一实施例的用于穿孔插入的一变化的关节假体修补接头的立体图。
图37是图36的假体修补接头的侧视图。
图38是图36的假体修补接头的纵向视图。
图39是根据本发明的另一实施例的用于前斜插入的一变化的关节假体修补接头的立体图。
图40是图39的假体修补接头的纵向视图。
图41是图39的假体修补接头的侧视图。
图42是设置在一对椎骨端板之间的图39的假体修补接头的局部侧向截面图。
图43是设置在一对椎骨端板之间的图39的假体修补接头的局部纵向截面图。
图44a是示出一用来接纳图39的假体修补接头的形成在一椎骨端板内的一槽的示意俯视图。
图44b是示出一与图39的假体修补接头插入相关的对齐过程的示意图。
图45是根据本发明的还有另一实施例的一变化的假体修补接头的分解的立体图。
图46是图45的假体修补接头的立体图。
图47是图46的假体修补接头的纵向视图。
图48是一对相邻椎骨端板的纵向视图。
图49a是图45的假体修补接头的一关节部件的平面图。
图49b是沿线49b-49b截取的图49a的关节部件的截面图。
图50a是图45的假体修补接头的一模制突出部件的平面图。
图50b是沿线50b-50b截取的图50a的模制突出部件的截面图。
图51是插入图49a的关节部件内的图50a的模制突出部件的平面图。
图52是插入图49a的关节部件内的图50a的模制突出部件的平面图,示出相对于图51处于不同位置的模制突出部件。
具体实施方式
为了便于理解本发明的原理,现将参照示于附图中的诸实施例或实例,并将用具体的语言来描述它们。然而,应该理解到,由此并不意图限制本发明的范围。与本发明相关的本技术领域内的技术人员通常会对于所描述的实施例构思出任何的变化和其它的修改,以及对本文所描述的本发明的原理的任何其它的应用。这样,分别描述的各实施例的个别的特征可以组合起来形成另外的实施例。此外,讨论了诸如强硬椎关节那样畸形的诸多实例;然而,应该理解到,本文所述的各种假体修补物装置不仅可适用于强硬椎骨之间,而且也可适用于基本上对齐的椎骨。
I.侧向纠正
在诸如椎骨前移那样的畸形的许多病例中,一个或多个椎骨体可相对于其它的椎骨或骶骨移位。在这样的畸形中,希望通过从其先前的位置重新定位移位的椎骨体,来减小移位的程度。减小椎骨前移可以是技术要求很高的手术,需要很小心地防止损伤神经和损坏周围的软组织。
现参照图1,图中示出一椎骨柱10的一部分的侧视图,示出了一组相邻的上和下脊骨V1、V2、V3、V4,它们被天生的椎间盘D1、D2、D3分开。示出四个脊骨只是意在举例而已。另一实例将是一骶骨和一脊骨。如图所示,脊骨V2沿箭头22所示方向从脊骨V1中脱位。同样地,脊骨V3沿箭头23所示方向脱位,脊骨V4沿箭头24所示方向脱位。希望分别沿与箭头22、23、24相对的方向移动脊骨V2、V3、V4,来纠正脊骨V2、V3、V4的位置。
现参照图2,为了另外的举例,下面将讨论两个移位的脊骨,它们表示为下脊骨VL和上脊骨VU。在一实施例中,定位在两个脊骨VL和VU之间的某些或全部的天生椎间盘通常通过分离术或类似的外科手术移去,手术的细节为本技术领域内的技术人员所公知。移去疾患的或退化的椎间盘会导致形成上和下脊骨VU和VL之间的一椎间空间S。
在本实施例中,要求将一假体修补接头插入到椎间空间S内,其类似于2002年1月9日提交的美国专利系列No.10/042,589中所揭示的假体修补接头,本文援引该专利以供参考。然而,某些变化需要以上参考的假体修补接头。对于下面的描述,所讨论和描述的假体修补接头可以与以上参考的专利申请中揭示的假体修补接头相同,例外之处将在下面进行讨论和提出。椎骨前移至今还没有由侧向外科方法进行纠正。然而,在某些例子中,由于存在血管和/或神经丛,所以,椎骨前移的纠正可要求采用侧向方法。在某些实施例中,当纠正腰椎区域内的椎骨前移时,侧向方法可以是特别地合适,但应该理解到,也可考虑用于其它的椎骨区域。
参照图3a和3b,例如,通过提供一对骨螺钉30、32以便分别地插入脊骨VL和VU内,由此可由一侧向方法解决椎骨前移的纠正。在一实施例中,骨螺钉30、32是双皮层的。然而,应该理解到,骨螺钉也可采用单皮层的。此外,骨螺钉30、32可以由各种材料形成,例如,任何的可再吸收材料、钛和PEEK。由于使用PEEK材料形成的X光照射中不显影的特性,所以PEEK实施例具有优点。还应该理解到,骨螺钉30、32可以由任何其它机械结构构成,这样,它们可呈销或铆钉的形式。此外,骨螺钉30、32不局限于具有接合脊骨VL和VU的螺纹部分。
骨螺钉30、32可以通过一杆34彼此连接,该杆构造成围绕两个骨螺钉转动。应该理解到,可以使用杆34之外的其它各种连接部件。例如,可使用一非一致的连接件来连接骨螺钉30、32。一非一致的连接件可提供多个可接合的狭缝和/或槽,以便帮助其围绕骨螺钉转动。杆34可在将骨螺钉30、32插入脊骨VL和VU内之前进行连接,或者,可在放置螺钉之后相继地进行连接。通过沿箭头36的方向对杆34施加一转动力,促使上脊骨VU相对于下脊骨VL回到一理想的位置。例如,通过一可由外科医生使用的转动的扳手(未示出)可以施加该转动力。应该理解到,上脊骨VU相对于下脊骨VL不需全部地达到一完全纠正的位置,但移位可以至少得到减小。
尽管未予示出,在另一实施例中,可以考虑到椎关节强硬的脊骨VL和VU可以从两个侧向方向来解决。因此,基本上雷同于骨螺钉30、32的一对骨螺钉可从与骨螺钉30、32相对的方向插入位于相对侧上的脊骨VL和VU。在这样一结构中,杆34可用一棘轮系统来更换,该系统接合各个骨螺钉对,这样,脊骨VL和VU可相对于彼此转动,以促进脊骨相对于彼此进入一理想的位置。
还有,杆34可包括任何数量和类型的接合装置以便接纳任何数量和类型的由外科医生使用的转动工具。例如,当杆34与一对应的转动工具接合时,一键连接可提供更大的稳定性。在一实例中,可使用一夹紧工具,而对应的夹紧槽可形成在杆34内以便接纳夹紧工具。这样一结构可帮助实现转动所需要的力。
此外,可考虑附加的杆34和骨螺钉30、32用于转动强硬的脊骨VL和VU回到相对于彼此的理想的位置。附加的杆34和骨螺钉30、32可在手术过程中提供附加的稳定性。
此外,尽管显示为一基本上侧向的插入,但骨螺钉30、32插入到脊骨VL和VU内可以相对于侧向方向略微地倾斜。在插入过程中骨螺钉30、32的这种倾斜可提供一较佳的夹持角,外科医生从该夹持角开始相对于彼此转动脊骨VL和VU。
参照图4a、5和6,图中示出一偏移的椎间关节的假体修补接头40,用来插入到椎间空间S内(图2)以帮助纠正椎骨前移。关节的假体修补接头40大致沿一纵向轴线L延伸,其包括一第一关节部件42和一第二关节部件44。关节部件42、44合作形成假体修补接头40,它的尺寸和构造用来部署在相邻椎骨体VU、VL(图2)之间的椎间空间S内(图2)。
假体修补接头40在相邻的椎骨体之间提供相对的枢转和转动运动,以保持或恢复基本上类似于由天生椎间盘提供的正常的生物-机械运动那样的运动。具体来说,关节部件42、44允许围绕多个轴线相对于彼此枢转,其中,包括围绕纵向轴线L的侧向的或一侧到一侧的枢转运动,以及围绕一横向轴线T的前-后的枢转运动。应该理解到,在本发明的一实施例中,允许关节部件42、44围绕位于与纵向轴线L和横向轴线T相交的一平面内的任何轴线而相对于彼此枢转。
此外,允许关节部件42、44围绕一转动轴线R相对于彼此转动。尽管假体修补接头40已经图示和描述为提供一特定组合的关节运动,但应该理解到,其它组合的关节运动也是可能的,例如,相对的平移或线性运动,而这样的运动被认为落入本发明的范围之内。
尽管假体修补接头40的关节部件42、44可以由各种各样的材料形成,但在本发明的一实施例中,关节部件42、44由钴-铬-钼金属合金形成(ASTM F-799或F-75)。然而,在本发明的其它实施例中,关节部件42、44可以由其它材料形成,例如,钛或不锈钢、诸如聚乙烯的聚合物材料,或任何其它生物相容的材料,它们对于本技术领域内的技术人员是明白公知的。
关节部件42、44各分别包括一承载表面46、48,它们可定位成直接接触椎骨,并较佳地涂以促进骨生长的物质,例如,由磷酸钙形成的羟磷灰石涂层。此外,关节部件42、44的承载表面46、48可分别地在涂以促进骨生长的物质之前进行粗糙化处理以便进一步提高骨的生长。这样的表面粗糙可借助于以下方法实施,例如,酸蚀刻、压花纹、涂敷起泡涂料,或本技术领域内的技术人员可想到的其它粗糙化的方法。
关节部件42包括一支承板50,其具有一关节表面52和相对的承载表面46。支承板50的尺寸和形状基本上对应于相邻脊骨体VL的脊骨端板的尺寸和形状(图2)。支承板50可包括一个或多个槽54或其它类型的标记,以便于接纳或接合对应的外科器械的部分(未示出),从而帮助操纵和将假体修补接头40插入到相邻脊骨体VU、VL(图2)之间的椎间空间S内(图2)。外科器械(未示出)较佳地构造成将关节部件42、44保持在一预定的定向,并在假体修补接头40操纵和插入过程中保持相对于彼此的空间关系,且一旦合适地定位在相邻脊骨之间后释放关节部件42、44。
在本发明的一实施例中,关节部件42包括一具有凸出形状的突出56,其可构造成一球体形状的球(示出其一半)。应该理解到,也可构思其它构造的突出56,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。还应该理解到,关节部件42的其余部分可呈平面或非平面的结构,例如,围绕突出56延伸的角形或锥形结构。
一突缘部件或隆突58从支承表面46延伸并构造成部署在相邻脊骨端板内预先形成的开口内。对于支承表面46,隆突58可涂以促进骨生长的物质,例如,由磷酸钙形成的羟磷灰石涂层。此外,隆突58可在涂以促进骨生长的物质之前进行粗糙化处理以便进一步提高骨的生长。在一实施例中,隆突58沿横向轴线T延伸并基本上沿支承表面46对中。然而,应该理解到,也可考虑隆突58的其它的位置和定向。
在一实施例中,隆突58沿关节部件42的大部分横向地延伸。这样一实施例适于插入假体修补接头40,与前向方法相比其使用侧向方法插入假体修补接头40。在另一实施例中,隆突58可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突58可以构造成一翼形的隆突,包括横贯隆突58的主体部分延伸的侧向部分(未示出)。
在一实施例中,隆突58包括三个延伸通过其中的开口60,以便于骨通过其生长而提高对于相邻脊骨体VU、VL的固定能力(图2)。然而,应该理解到可以通过隆突58形成任何数量的开口60,包括单一的开口或两个或多个开口。还应该理解到,开口60不必全部延伸通过隆突58,但可以局部地延伸通过其间。还应该理解到,隆突58不必形成任何局部地或全部地延伸通过其间的开口60。此外,尽管开口60显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口60。
在一实施例中,关节部件44包括一支承板70,其具有一关节表面72和相对的承载表面48。支承板70的尺寸和形状基本上对应于相邻脊骨体VU的脊骨端板的尺寸和形状。支承板70可包括一个或多个槽74或其它类型的标记,以便于接纳或接合对应的外科器械的部分,就如以上参照关节部件42所讨论的那样。在一实施例中,关节表面72包括一凹陷76。在一实施例中,凹陷76具有一凹入的形状,并构造成一球形的插座。然而,应该理解到,也可考虑采用其它结构的凹陷76,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。关节表面72的其余部分可以呈倾斜或其它方式构造以便于插入和/或使用假体修补物。
尽管凹入的凹陷76显示为具有一大致光滑的不中断的关节表面,但应该理解到,表面的下陷或内腔可以沿凹陷76的一部分形成,以提供一用来清洗出诸如颗粒状的碎物的装置,这样的碎物存在于邻接的关节部件42、44之间。在这样的情形中,突出56的凸出的关节表面可以形成一大致光滑的、不中断的关节表面。在另一实施例中,各个凸出的突出56和凹入的凹陷76可以形成一表面的下陷,以便于去除存在于邻接的关节部件42、44之间的颗粒物质。
一构造成类似于关节部件42的隆突58的突缘部件或隆突68从承载表面48延伸。在一实施例中,隆突68沿横向轴线T延伸,并偏移支承表面48的中心。这样一实施例将适于使用侧向方法插入假体修补接头40。然而,应该理解到,也可考虑使用其它形状、位置和定向的隆突68。例如,在图4b和4c中,隆突48和68可相对于横向轴线T倾斜,以便帮助绕过静脉、动脉、骨质部分,或在插入假体修补接头40过程中在位置上阻碍的其它障碍物。再者,隆突68可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突68可以构造成一翼形的隆突,包括横贯隆突68的主体部分延伸的横向部分。
在一实施例中,参照图5,隆突68还包括三个延伸通过其中的开口70,以便于骨通过其生长而提高对于相邻脊骨体的固定能力。然而,应该理解到可以通过隆突68形成任何数量的开口70,包括单一的开口或两个或多个开口。还应该理解到,隆突68不必形成局部地或全部地延伸通过其间的任何的开口70。此外,尽管开口70显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口70。如上所述,直接与脊骨接触的承载表面46、48较佳地涂以促进骨生长的物质。具体来说,承载表面48和隆突68的表面可涂以羟磷灰石涂层,以促进与相邻脊骨体VU的骨质接合。如上所述,承载表面48和隆突68的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。在某些实施例中,一个或两个隆突58、68可包括一锋利的前边缘(如图4的边缘68a所示)。由于有了这样的边缘,隆突插入到相关的脊骨体内变得方便。再者,边缘68a可以具有足够的锋利度,这样,相邻的脊骨体不需要一槽来用于接纳隆突68(将在下文中详细地讨论)。
参照图7,为了适于将偏移的假体修补接头40插入一强硬椎骨的椎间空间内,可以准备局部纠正的上和下脊骨VU、VL来将假体修补接头40(图7中显示为截面)接纳在其间。具体来说,细长的开口或槽80、82可以分别沿上和下脊骨VU、VL的脊骨端板形成为预定的宽度和预定的深度。槽80、82可以彼此侧向地偏移以适应移位的脊骨VL和/或VU。在一实施例中,细长槽80、82呈矩形并分别侧向地延伸通过脊骨VU、VL。在一特定的实施例中,槽80、82通过凿削或刮削而形成。然而,本技术领域内的技术人员会想到构思形成槽80、82的其它的方法,例如,通过钻削或铰削。此外,对于某些实施例的假体修补接头40,隆突58和/或68可分别形成其自己的对应的槽80、82。参照图8,在一实施例中,上和下脊骨VU、VL可全部地纠正,因此,一变化的关节的假体修补接头90可用于纠正椎骨强硬症。关节的假体修补接头90可以基本上类似于假体修补接头40,例外之处在于关节的假体修补接头90的各种元件的定向。例如,为了适应插入全部纠正的上和下脊骨VU、VL内,关节的假体修补接头90可包括一侧向延伸的隆突92,其基本上对中在关节的接头90的上关节部件94上,以及一侧向延伸的隆突96,其基本上对中在下关节部件98上。此外,上关节部件94可包括一基本上对中的凹陷100,以对应于从下关节部件98延伸的基本上对中的突出102。在一实施例中,当设置在完全纠正的上和下脊骨VU、VL之间时,上和下关节部件94、98基本上彼此齐平。
为了适于插入偏移的假体修补接头90,可准备前部纠正的上和下脊骨VU、VL来将假体修补接头90接纳在其间。具体来说,细长的开口或槽104、106可以分别沿上和下脊骨VU、VL的脊骨端板形成为预定的宽度和预定的深度。槽104、106可以彼此基本上对齐以容纳完全纠正的上和下脊骨VU、VL。在一实施例中,细长槽104、106呈矩形并分别侧向地延伸通过脊骨VU、VL。在一特定的实施例中,槽104、106通过凿削或刮削而形成。然而,本技术领域内的技术人员会想到构思形成槽104、106的其它的方法,例如,通过钻削或铰削。此外,对于某些实施例的假体修补接头,隆突92和/或96可分别形成其自己的对应的槽104、106。
参照图9,在一变化的实施例中,可使用一滑动的假体修补接头110来帮助用侧向方法处理椎骨强硬症。滑动的接头110基本上沿纵向轴线L延伸,并包括一第一可滑动的部件112和一第二可滑动的部件114。可滑动的部件112、114合作而形成滑动接头110,其尺寸和结构适于部署在相邻脊骨体之间的椎间空间内。
滑动接头110提供相邻脊骨体之间的运动,以保持或恢复类似于天生椎间盘提供的正常的生物-机械运动那样的某些运动。具体来说,允许可滑动部件112、114相对于彼此在轴向平面内平移。
尽管假体修补接头110的可滑动部件112、114可以由各种材料形成,但在一实施例中,可滑动部件112、114可由钻-铬-钼金属合金形成(ASTM F-799或F-75)。然而,在其它的实施例中,可滑动部件112、114可以由其它材料形成,例如,钛或不锈钢、诸如聚乙烯的聚合物材料,或任何其它生物相容的材料,它们对于本技术领域内的技术人员是明白公知的。直接与脊骨接触而定位的可滑动部件112、114的表面较佳地可涂以促进骨生长的物质,例如,由磷酸钙形成的羟磷灰石涂层。此外,直接与脊骨接触而定位的可滑动部件112、114的表面较佳地在涂以促进骨生长的物质之前进行粗糙化处理以便进一步提高骨的生长。这样的表面粗糙可借助于以下方法实施,例如,酸蚀刻、压花纹、涂敷起泡涂料,或本技术领域内的技术人员可想到的其它粗糙化的方法。
可滑动部件112包括一支承板116,其具有一可滑动的表面118和一相对的承载表面120。支承板116的尺寸和形状较佳地基本上对应于相邻脊骨体的脊骨端板的尺寸和形状。支承板116可包括一个或多个槽122或其它类型的标记,以便于接纳和接合对应的外科器械的部分(未示出),从而帮助操纵和将假体修补接头110插入到相邻脊骨之间的椎间空间内。外科器械(未示出)较佳地构造成将可滑动部件112、114保持在一预定的定向,并在假体修补接头110操纵和插入过程中保持相对于彼此的空间关系,且一旦合适地定位在相邻脊骨之间后释放可滑动部件112、114。
一突缘部件或隆突124从承载表面120延伸并构造成部署在相邻脊骨端板内预先形成的开口内。在一实施例中,隆突124从承载表面120垂直地延伸,并沿承载表面120近似地中心定位。然而,应该理解到也可考虑隆突124的其它的位置和定向。在一实施例中,隆突124沿着支承板114的大部分横向地延伸。这样一实施例适于使用侧向方法插入假体修补接头110。在另一实施例中,隆突124可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突124可以构造成一翼形的隆突,包括横贯隆突124的主体部分延伸的横向部分。
隆突124包括延伸通过其中的开口126,以便于骨通过其生长而提高对于相邻脊骨的固定能力。然而,应该理解到可以通过隆突124形成任何数量的开口126,包括单一的开口或三个或多个开口。还应该理解到,开口126不必全部延伸通过隆突124,但可以局部地延伸通过其间。还应该理解到,隆突124不必形成任何局部地或全部地延伸通过其间的开口126。此外,尽管开口126显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口126。如上所述,直接与脊骨接触的可滑动的部件112的表面较佳地可涂以促进骨生长的物质。具体来说,承载表面120和隆突124的表面可涂以羟磷灰石涂层以促进与相邻脊骨的骨质接合。还如上所述,承载表面120和隆突124的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在一实施例中,可滑动部件114包括一支承板128,其具有一可滑动的表面130和一相对的承载表面132。支承板128的尺寸和形状较佳地基本上对应于相邻脊骨的脊骨端板的尺寸和形状。支承板128可包括一个或多个槽134或其它类型的标记,以便接纳和接合对应的外科器械的部分,就如参照可滑动部件112所讨论的那样。
一突缘部件或隆突136的构造类似于可滑动部件112的隆突124,它从承载表面132延伸。在一实施例中,隆突136从承载表面132垂直地延伸,并沿承载表面132偏移以适于强硬的脊骨的位移。再者,隆突136的偏移的位置帮助绕过静脉、动脉、骨质部分,或在插入假体修补接头110过程中在位置上阻碍的其它障碍物。还应该理解到,也可考虑隆突136的其它的位置、形状、定向和隆突136的数量。还应该理解到,出于类似的或另外的原因,隆突136可以不同地定位、成形或定向,或可使用多个隆突136。
在一实施例中,隆突136沿着支承板128的大部分横向地延伸。与诸如前向方法的其它方法相比,这样一实施例适于使用侧向方法插入假体修补接头110。在另一实施例中,隆突136可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突136可以构造成一翼形的隆突,包括横贯隆突136的主体部分延伸的横向部分。
隆突136包括三个延伸通过其中的开口138,以便于骨通过其生长而提高对于相邻脊骨的固定能力。然而,应该理解到可以通过隆突136形成任何数量的开口138,包括单一的开口或三个或多个开口。还应该理解到,开口138不必全部延伸通过隆突136,但可以局部地延伸通过其间。还应该理解到,隆突136不必形成任何局部地或全部地延伸通过其间的开口138。此外,尽管开口138显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口138。如上所述,直接与脊骨接触的可滑动部件114的表面较佳地涂以促进骨生长的物质。具体来说,承载表面132和隆突136的表面可涂以羟磷灰石涂层,以促进与相邻脊骨的骨质接合。如上所述,承载表面132和隆突136的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在某些实施例中,一个或两个隆突124、136可包括一锋利的前边缘(如边缘124a、136a所示)。由于有了这样的边缘,隆突124、136插入到相关的脊骨体内变得方便。再者,边缘124a、136a可以具有足够的锋利度,这样,脊骨体不需要一槽来用于分别接纳隆突124、136(将在下文中详细地讨论)。
参照图10,为了适于将假体修补接头110插入一强硬椎骨的椎间空间内,可以准备上和下脊骨VU、VL来接受其间的假体修补接头110。具体来说,细长的开口或槽142、144可以分别沿上和下脊骨VU、VL的脊骨端板形成为预定的宽度和预定的深度。槽142、144可以彼此侧向地偏移以适应移位的脊骨VL和/或VU。在本发明的一实施例中,细长槽142、144呈矩形并侧向地延伸通过脊骨VU、VL。在一特定的实施例中,槽142、144通过凿削或刮削而形成。然而,本技术领域内的技术人员会想到构思形成槽142、144的其它的方法,例如,通过钻削或铰削。此外,对于某些实施例的假体修补接头,隆突124和/或136可形成其自已的对应的槽。
参照图11,在一实施例中,上和下脊骨VU、VL可全部地纠正,因此,一变化的关节的假体修补接头150可用于纠正椎骨强硬症。关节的假体修补接头150可以基本上类似于关节的假体修补接头110,例外之处在于隆突的定向。例如,为了适应插入到全部纠正的上和下脊骨VU、VL内,关节的假体修补接头150可包括一隆突152和一隆突156,前者基本上对中在关节的接头的上关节部件154上,而后者基本上对中在下关节部件158上。在一实施例中,当设置在完全纠正的上和下脊骨VU、VL之间时,上和下关节部件154、158基本上彼此齐平。
为了适于插入偏移的假体修补接头150,可准备全部纠正的上和下脊骨VU、VL来将假体修补接头150接纳在其间。具体来说,细长的开口或槽160、162可以沿上和下脊骨VU、VL的脊骨端板形成为预定的宽度和预定的深度。槽160、162可以彼此基本上对齐以容纳完全纠正的上和下脊骨VU、VL。在一实施例中,细长槽160、162呈矩形并分别侧向地延伸通过脊骨VU、VL。在一特定的实施例中,槽160、162通过凿削或刮削而形成。然而,本技术领域内的技术人员会想到构思形成槽160、162的其它的方法,例如,通过钻削或铰削。此外,对于某些实施例的假体修补接头,隆突152和/或156可分别形成其自己的对应的槽160、162。
参照图12和13,融合板和笼也可装备有一个或多个隆突,并以与上述保持运动的实施例一致的方式从侧向插入,并优于传统的融合结构。特别地参照图12,一侧向假体修补物170包括一笼172、一上隆突174以及一下隆突176。笼172通过支承板178、180分别连接到上和下隆突174、176。笼172可包括LT-CAGETM腰部锥形融合装置的许多特征,该装置由田纳西州(TN)的Memphis市的MedtronicSofamor Danek公司提供。并可用来包含生物材料和/或其它促进骨生长的材料。再者,侧向隆突174、176可在融合发生时帮助保持纠正的脊骨位移。
参照图13,一假体修补物190包括一板192、一上隆突194、一下隆突196、一上支承板198,以及一下支承板200。板192可以用来在两个支承板198、200之间保持一要求的距离,并促进融合。由于板192可以相对地薄,所以,盘空间的其余部分可以填充生物材料、骨材料,和/或其它促进骨生长的材料。
II.前向纠正
在某些实例中,椎骨前移可要求由前向方法进行纠正。参照图14-16,图中示出一根据本发明的另一实施例的椎间关节的假体修补接头210。该假体修补接头210大致沿一纵向轴线L延伸,其包括一第一关节部件212和一第二关节部件214。关节部件212、214合作形成关节的假体修补接头210,它的尺寸和构造用来部署在一对脊骨体之间的椎间空间内,例如,在相邻椎骨体VU、VL之间的椎间空间S内。
假体修补接头210在相邻的椎骨体VU、VL之间提供相对的枢转和转动运动,以保持或恢复基本上类似于由天生椎间盘提供的正常的生物-机械运动那样的运动。具体来说,关节部件212、214允许围绕多个轴线相对于彼此枢转,其中,包括围绕纵向轴线L的侧向的或一侧到一侧的枢转运动,以及围绕一横向轴线T的前-后的枢转运动。应该理解到,在一实施例中,允许关节部件212、214围绕位于与纵向轴线L和横向轴线T相交的一平面内的任何轴线而相对于彼此枢转。此外,允许关节部件212、214围绕一转动轴线R相对于彼此转动。尽管假体修补接头210已经图示和描述为提供一特定组合的关节运动,但应该理解到,其它组合的关节运动也是可能的,例如,相对的平移或线性运动,而这样的运动被认为落入本发明的范围之内。
尽管假体修补接头210的关节部件212、214可以由各种各样的材料形成,但在一实施例中,关节部件212、214由钴-铬-钼金属合金形成(ASTM F-799或F-75)。然而,在其它实施例中,关节部件212、214可以由其它材料形成,例如,钛或不锈钢、诸如聚乙烯的聚合物材料,或任何其它生物相容的材料,它们对于本技术领域内的技术人员是明白公知的。直接与脊骨接触而定位的关节部件212、214的表面可涂以促进骨生长的物质,例如,由磷酸钙形成的羟磷灰石涂层。此外,直接与脊骨接触而定位的关节部件212、214的表面在涂以促进骨生长的物质之前进行粗糙化处理以便进一步提高骨的生长。这样的表面粗糙可借助于以下方法实施,例如,酸蚀刻、压花纹、涂敷起泡涂料,或本技术领域内的技术人员可想到的其它粗糙化的方法。
关节部件212包括一支承板216,其具有一关节表面218和一相对的承载表面220。支承板216的尺寸和形状可基本上对应于相邻脊骨的脊骨端板的尺寸和形状。支承板216可包括一个或多个槽222或其它类型的标记,以便于接纳和接合对应的外科器械的部分(未示出),从而帮助操纵和将关节的假体修补接头210插入到相邻脊骨之间的椎间空间内。外科器械(未示出)较佳地构造成将关节部件212、214保持在一预定的定向,并在关节的假体修补接头210操纵和插入过程中保持相对于彼此的空间关系,且一旦合适地定位在相邻脊骨之间后释放关节部件212、214。
在一实施例中,关节表面218包括一具有凸出形状的突出224,其可构造成一球体形状的球(示出其一半)。应该理解到,也可构思其它构造的突出224,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。还应该理解到,关节表面218的其余部分可呈平面或非平面的结构,例如,围绕突出224延伸的角形或锥形结构。
在一实施例中,突出224的凸出的关节表面被一沿突出224延伸的表面下陷或内腔226中断。在一实施例中,表面下陷226构造成一槽。然而,应该理解到,也可考虑采用其它类型的表面下陷,包括根本没有下陷。槽226的一个用途是便于移去存在于关节部件212、214的邻接部分之间的物质。具体来说,槽226可帮助清除诸如颗粒材料之类的物质,它们存在于关节部件212、214的邻接的关节表面之间。
一突缘部件或隆突230从支承表面220延伸并构造成部署在相邻脊骨端板内预先形成的开口内。在一实施例中,隆突230从承载表面220垂直地延伸,并沿承载表面220近似地中心定位。然而,应该理解到也可考虑隆突230的其它的位置和定向。在一实施例中,隆突230基本上沿着支承板216的全部长度延伸。这样一实施例适于使用前向方法插入关节的假体修补接头210。在另一实施例中,隆突230可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突230可以构造成一翼形的隆突,包括横贯隆突230的主体部分延伸的横向部分(未示出)。
隆突230还包括延伸通过其中的一对开口232,以便于骨通过其生长而提高对于相邻脊骨的固定能力。然而,应该理解到可以通过隆突230形成任何数量的开口232,包括单一的开口或三个或多个开口。还应该理解到,开口232不必全部延伸通过隆突230,但可以局部地延伸通过其间。还应该理解到,隆突230不必形成任何局部地或全部地延伸通过其间的开口232。此外,尽管开口232显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口232。如上所述,直接与脊骨接触的关节部件212的表面较佳地可涂以促进骨生长的物质。具体来说,承载表面220和隆突230的表面可涂以羟磷灰石涂层以促进与相邻脊骨的骨质接合。还如上所述,承载表面220和隆突230的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在一实施例中,关节部件214包括一支承板240,其具有一关节表面242和一相对的承载表面244。支承板240的尺寸和形状可基本上对应于相邻脊骨的脊骨端板的尺寸和形状。支承板240可包括一个或多个槽246或其它类型的标记,以便接纳和接合对应的外科器械的部分,就如以上参照关节部件212所讨论的那样。
在一实施例中,关节表面242包括一凹陷250,其具有一凹入的形状,诸如一球形的插座的形状。然而,应该理解到,也可考虑采用其它结构的凹陷250,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。关节表面242的其余部分可以呈倾斜或其它方式构造以便于插入和/或使用关节的假体修补接头。
尽管凹入的凹陷250显示为具有一大致光滑的不中断的关节表面,但应该理解到,表面的下陷或内腔可以沿凹陷250的一部分形成,以帮助清洗出诸如颗粒状碎物的物质,这样的碎物存在于邻接的关节部件212、214的关节表面之间。在这样的情形中,球224的凸出的关节表面可以形成一大致光滑的、不中断的关节表面。在另一实施例中,各个凸出的突出224和凹入的凹陷250可以形成一表面的下陷,以便于去除存在于邻接的关节表面之间的颗粒物质。
一构造成类似于关节部件212的隆突230的突缘部件或隆突260从承载表面244延伸。在一实施例中,隆突260从承载表面244垂直地延伸,并沿承载表面244近似地中心定位。然而,应该理解到,也可考虑隆突260的其它的位置和定向。还应该理解到,关节部件214可包括从承载表面244延伸的两个或多个隆突260。
在一实施例中,隆突260基本上沿支承板240的全部长度延伸。这样一实施例可适于使用前向逼近的方法插入假体修补接头210。在还有一实施例中,隆突260可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突260可以构造成一翼形的隆突,包括横贯隆突260的主体部分延伸的横向部分(未示出)。
隆突260还包括一对延伸通过其中的开口262,以便于骨通过其生长而提高对于相邻脊骨的固定能力。然而,应该理解到可以通过隆突260形成任何数量的开口262,包括单一的开口或三个或多个开口。还应该理解到,开口262不必全部延伸通过隆突260,但可以局部地延伸通过其间。还应该理解到,隆突260不必形成任何局部地或全部地延伸通过其间的开口262。此外,尽管开口262显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口262。如上所述,直接与脊骨接触的关节部件214的表面较佳地可涂以促进骨生长的物质。具体来说,承载表面244和隆突260的表面可涂以羟磷灰石涂层以促进与相邻脊骨的骨质接合。还如上所述,承载表面244和隆突260的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在某些实施例中,一个或两个隆突230、260可包括一锋利的前边缘(如图14的边缘260a所示)。由于有了这样的边缘,隆突插入到相关的脊骨体内变得方便。再者,边缘260a可以具有足够的锋利度,这样,脊骨体不需要一槽来用于接纳隆突260(将在下文中详细地讨论)。
为了治疗脱位的脊骨,例如,与脊椎前移相关的图1中的脊骨V1-V5,应该认识到外科医生实施的完全纠正和对齐一关节强硬体节的任务不可能实现或达到理想程度。因此,共同悬而未决和目前援引的美国专利系列No.10/042,589中所描述的基本的关节,现具有一相关的位移来对应于脊骨的位移。即,对于两个相邻关节强硬的脊骨之间的位移量,使假体修补接头210的关节与其对应。在某些实施例中,这样的位移可通过以下的方法实现:将一个或多个突出224定位在关节部件212的关节表面218上的一偏移的位置内,以及将一个或多个凹入250定位在关节部件214的关节表面242上的一偏移的位置内。这允许实施一未纠正的或局部纠正的位移。
具体来说,参照图14和17,突出224相对于关节表面218偏移。例如,当下脊骨(图17的VL)沿后向方向(图17中的箭头P所示)偏移时,关节部件212可以构造成突出224沿相对于关节表面218为前向的方向偏移。继续该实例,上脊骨VU因此沿前向方向(图17中的箭头A所示)偏离下脊骨VL,因此,关节部件214可以构造成凹入250沿相对于关节表面242为后向方向偏离。这样,关节部件212、214可以构造成通过突出224和凹入250彼此接合,但彼此仍偏离以适于图17的上和下脊骨VU、VL的关节强硬的关系。现参照图16,在另一实施例中,关节的接头210可以修改为使支承板216包括一延伸的部分270以便适于相对于图17的更明确的位移(箭头272所示),和/或提供防止半脱位的附加的稳定性。突出224可以定位在延伸的部分270上,以在关节部件212、214之间提供更加明确的位移。
参照图2和17,为了适于将假体修补接头210插入椎间空间S内,可准备上和下脊骨VU、VL来将假体修补接头210接纳在其间。具体来说,细长的开口或槽208、282可以分别沿上和下脊骨VU、VL的脊骨端板形成为预定的宽度和预定的深度。在一实施例中,细长槽280、282呈矩形并从脊骨VU、VL的前侧284朝向后侧延伸。在一特定的实施例中,槽280、282通过凿削或刮削而形成。然而,本技术领域内的技术人员会想到构思形成槽280、282的其它的方法,例如,通过钻削或铰削。此外,对于某些实施例的假体修补接头210,隆突230和/或260可分别形成其自已的对应的槽280、282。准备工作和槽280、282的示例尺寸进一步描述在共同未决的和现在所援引的美国专利系列No.10/042,589中。
现参照图18-20,在其它的实施例中,一个或两个关节部件212、214可包括不同数量的隆突和/或修改的隆突。特别地参照图18,两个隆突290和292从承载表面244延伸,并构造成部署在相邻脊骨端板内的预先形成的开口内。在一实施例中,两个隆突290、292从承载表面244垂直地延伸,并沿承载表面244的一中心部分平行且等距离地间隔。
特别地参照图19,两个隆突294和296从承载表面224延伸,并构造成部署在相邻脊骨端板内的预先形成的开口内。在一实施例中,两个隆突294、296从承载表面224垂直地延伸,并沿承载表面224的一中心部分平行且等距离地间隔。应该理解到,也可考虑其它位置和定向的隆突290、292、294和296。
特别地参照图20,类似于图14的隆突260,隆突298从承载表面244延伸,例外的是,隆突298包括一与承载表面244相对的侧向延伸的或“翼形”的部分300。翼形部分300可提供若干个功能,包括保持紧密地抵靠脊骨体VU的承载表面244,并基本上防止关节部件214任何沿纵向的运动。同样地,隆突302从承载表面224延伸,并包括一与承载表面224相对的“翼形”的部分304。翼形部分304可提供若干个功能,包括保持紧密地抵靠脊骨体VL的承载表面224,并基本上防止关节部件212任何沿纵向的运动。
参照图21-23,为了适于将上述变化的假体修补接头210插入椎间空间S内,可准备上和下脊骨VU、VL来将关节的假体修补接头210接纳在其间。特别地参照图21,对于图18的假体修补接头210的构造来说,多个槽310和312可以沿上脊骨VU的脊骨端板形成,而一单一槽314沿下脊骨VL的脊骨端板形成。特别地参照图22,对于图19的假体修补接头210的构造来说,多个槽316、318和320、322可以分别沿上脊骨VU和下脊骨VL的脊骨端板形成。特别地参照图23,对于图20的假体修补接头210的构造来说,翼形槽324、326可以分别沿上脊骨VU和下脊骨VL的脊骨端板形成。槽310、312、314、316、318、320、322、324、326可以与参照图17的上述讨论相同的方式来实现。对于翼形槽324、326可使用一标准凿,或者,可使用一独特的翼形凿。
参照图24,除了假体修补接头210之外,可使用一编织的整形外科移植物330起作两个脊骨VU、VL之间的人造韧带。编织的移植物330的一实施例揭示在美国专利系列No.10/082,579中,本文援引该专利以供参考。移植物330起作一天生韧带应起的功能,并帮助稳定和进一步将两个脊骨VU、VL固定在一起,还帮助防止进一步的位移(或防止位移返回到外科手术前的方式)。
参照图25和26,可以考虑一部分的裂开,例如,由一将诸如一关节突起334的后部元件连接到脊骨VL的骨元件332的裂开来予以说明,该裂开也可在脊椎前移的纠正过程中由前向方法进行治疗。应该理解到,为了清晰起见,裂开的骨元件332在图25中已予以夸大。部分的裂开可这样进行修理:驱使一具有一螺纹部分336a和一非螺纹部分336b的尖头螺钉336进入脊骨体VL内的开口338内,通过骨元件332,并进入关节突起334内。在某些实施例中,所有的或部分的开口338可以用一钻头或凿子(未示出)进行预钻削。尖头螺钉336插入并通过前向方向进入,可使用多个螺钉来修理多个突起。通过固定裂开的后元件并紧固尖头螺钉336,脊骨VL得到修理。
III.穿孔的假体修补接头
在某些实例中,由于可能损坏重要的解剖学上的结构,例如,神经根、硬脑膜、黄韧带以及椎间韧带,所以,通常难于逼近和清洗缺陷的椎间盘空间。例如,保存韧带的结构对于恢复体节和其相邻的对应部分的生物机械稳定性极其重要。在这些情形中,穿孔的方法可通过打开一侧上的神经孔允许清理全部的椎间盘空间。在合适的清理之后,可以通过其后的贯穿蒂的内脱位达到进一步扩大清理的椎间空间。尽管该方法已经用于融合技术,例如,穿孔的腰部体间融合,即,TLIF,但迄今还未用于保持运动的移植物上。
参照图27,在一穿孔的方法中,椎间盘V如箭头400所示逼近。该逼近介于一后逼近和一侧逼近之间,且在某些情形中,盘仅有一侧需要被暴露(右或左)以便实施手术。
参照图28-30,图中示出一根据本发明的另一形式的椎间关节的假体修补接头410。该关节的假体修补接头410大致地沿纵向轴线L延伸,并包括一第一关节部件412和一第二关节部件414。关节部件412、414合作而形成关节接头410,其尺寸和结构适于部署在相邻脊骨体之间的椎间空间内。
假体修补接头410提供相邻脊骨体之间的相对的枢转和转动运动,以保持或恢复基本上类似于由天生椎间盘提供的正常生物-机械运动那样的关节假体修补接头410的运动。具体来说,关节部件412、414允许围绕多个轴线相对于彼此枢转,其中,包括围绕纵向轴线L的侧向的或一侧到一侧的枢转运动,以及围绕一横向轴线T的前-后的枢转运动。应该理解到,在一实施例中,允许关节部件412、414围绕位于与纵向轴线L和横向轴线T相交的一平面内的任何轴线而相对于彼此枢转。此外,较佳地允许关节部件412、414围绕一转动轴线R相对于彼此转动。尽管关节假体修补接头410已经图示和描述为提供一特定组合的关节运动,但应该理解到,其它组合的关节运动也是可能的,这样的运动被认为落入本发明的范围之内。还应该理解到,也可考虑其它类型的关节运动,例如,相对的平移或线性运动。
尽管假体修补接头410的关节部件412、414可以由各种各样的材料形成,但在一实施例中,关节部件412、414由钴-铬-钼金属合金形成(ASTM F-799或F-75)。然而,在其它实施例中,关节部件412、414可以由其它材料形成,例如,钛或不锈钢、诸如聚乙烯的聚合物材料,或任何其它生物相容的材料,它们对于本技术领域内的技术人员是明白公知的。直接与脊骨接触而定位的关节部件412、414的表面较佳地可涂以促进骨生长的物质,例如,由磷酸钙形成的羟磷灰石涂层。此外,直接与脊骨接触而定位的关节部件412、414的表面在较佳地涂以促进骨生长的物质之前进行粗糙化处理以便进一步提高骨的生长。这样的表面粗糙可借助于以下方法实施,例如,酸蚀刻、压花纹、涂敷起泡涂料,或本技术领域内的技术人员可想到的其它粗糙化的方法。
关节部件412包括一支承板416,其具有一关节表面418和一相对的承载表面420。支承板416的尺寸和形状可基本上对应于相邻脊骨的脊骨端板的尺寸和形状。在一实施例中,支承板416的形状便于一穿孔插入的方法。这样,支承板416包括弧形侧的部分422a、422b,它们形成为在关节表面418和承载表面420之间延伸的支承板416的大致细长的部分。尽管未予示出,但支承板416可包括一个或多个槽或其它类型的标记,以便接纳和接合对应的外科器械的对应部分(未示出),从而帮助操纵和将假体修补接头410插入到相邻脊骨之间的椎间空间内。外科器械(未示出)较佳地构造成将关节部件412、414保持在一预定的定向,并在假体修补接头410操纵和插入过程中保持相对于彼此的空间关系,且一旦合适地定位在相邻脊骨之间后释放关节部件412、414。
在一实施例中,关节表面418包括一具有凸出形状的突出424,其可构造成一球体形状的球(示出其一半)。应该理解到,也可构思其它构造的突出424,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。还应该理解到,关节表面418的其余部分可呈平面或非平面的结构,例如,围绕突出424延伸的角形或锥形结构。
一突缘部件或隆突426从支承表面420延伸并构造成部署在相邻脊骨端板内预先形成的开口内。在一实施例中,隆突426从承载表面420垂直地延伸,并沿承载表面420近似地中心定位。然而,应该理解到也可考虑隆突426的其它的位置和定向。在一实施例中,隆突426沿着支承板416的大部分横向地延伸。隆突426大致上沿类似于图27的箭头400的方向呈弧形。隆突426的弯曲程度可基本上类似于和一致于侧部422a、422b的弯曲程度。与上述前向或侧向方法相比,这样一实施例适于使用穿孔方法插入假体修补接头410。在另一实施例中,隆突426可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突426可以构造成一翼形的隆突,包括横贯隆突426的主体部分延伸的横向部分(未示出)。
隆突426还包括延伸通过其中的三个开口428,以便于骨通过其生长而提高对于相邻脊骨的固定能力。然而,应该理解到可以通过隆突426形成任何数量的开口428,包括单一的开口或三个或多个开口。还应该理解到,开口428不必全部延伸通过隆突426,但可以局部地延伸通过其间。还应该理解到,隆突426不必形成任何局部地或全部地延伸通过其间的开口428。此外,尽管开口428显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口428。如上所述,直接与脊骨接触的关节部件412的表面较佳地可涂以促进骨生长的物质。具体来说,承载表面420和隆突426的表面可涂以羟磷灰石涂层以促进与相邻脊骨的骨质接合。还如上所述,承载表面420和隆突426的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在一实施例中,关节部件414包括一支承板430,其具有一关节表面432和一相对的承载表面434。支承板430的尺寸和形状可基本上对应于相邻脊骨的脊骨端板的尺寸和形状。在一实施例中,支承板430的形状便于穿孔插入方法。这样,支承板416包括弧形侧的部分436a、436b,它们形成为在关节表面432和承载表面434之间延伸的支承板430的大致细长的部分。尽管未予示出,但支承板430可包括一个或多个槽或其它类型的标记,以便接纳和接合外科器械的对应部分,就如以上参照关节元件412所讨论的那样。
在一实施例中,关节表面432包括一凹陷440,凹陷440具有一构造成一球形的插座的凹入的形状。然而,应该理解到,也可考虑采用其它结构的凹陷440,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。关节表面432的其余部分可以呈倾斜或其它方式构造以便于插入和/或使用假体修补物。
尽管凹入的凹陷440显示为具有一大致光滑的不中断的关节表面,但应该理解到,表面的下陷或内腔可以沿凹陷440的一部分形成,以提供一用来清洗出诸如颗粒状的碎物的装置,这样的碎物存在于邻接的关节部件412、414的关节表面之间。在这样的情形中,球424的凸出的关节表面可以形成一大致光滑的、不中断的关节表面。在另一实施例中,各个凸出的突出424和凹入的凹陷440可以形成一表面的下陷,以便于去除存在于邻接的关节表面之间的颗粒物质。
一构造成类似于关节部件412的隆突426的突缘部件或隆突450从承载表面434延伸。在一实施例中,隆突450可中心地定位。隆突450沿类似于隆突426和图27的箭头400的方向呈弧形。隆突450的弯曲程度可基本上类似于和一致于侧部436a、436b的弯曲程度。与上述前向或侧向方法相比,这样一实施例适于使用穿孔方法插入假体修补接头410。在某些实施例中,隆突450的位置可以偏移,以便帮助绕过静脉、动脉、骨质部分,或在插入假体修补接头40过程中在位置上阻碍的其它障碍物。还应该理解到,隆突450还可以不同地定位、成形或定向,出于类似的或附加的原因,可以使用更多的隆突450。再者,隆突450可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突450可以构造成一翼形的隆突,包括横贯隆突450的主体部分延伸的横向部分(未示出)。
在一实施例中,隆突450还包括延伸通过其中的三个开口452,以便于骨通过其生长而提高对于相邻脊骨的固定能力。然而,应该理解到可以通过隆突450形成任何数量的开口452,包括单一的开口或三个或多个开口。还应该理解到,开口452不必全部延伸通过隆突450,但可以局部地延伸通过其间。还应该理解到,隆突450不必形成任何局部地或全部地延伸通过其间的开口452。此外,尽管开口452显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口452。如上所述,直接与脊骨接触的关节部件414的表面较佳地可涂以促进骨生长的物质。具体来说,承载表面434和隆突450的表面可涂以羟磷灰石涂层以促进与相邻脊骨的骨质接合。还如上所述,承载表面434和隆突450的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在某些实施例中,一个或两个隆突426、450可包括一锋利的前边缘(分别如图30的边缘460、462所示)。由于有了这样的边缘,隆突插入到相关的脊骨体内变得方便。再者,边缘460、462可以具有足够的锋利度,这样,相邻的脊骨体不需要一槽来用于接纳隆突426、450(将在下文中详细地讨论)。
参照图31a和31b,为了适于将偏移的假体修补接头410插入椎间空间内,可以准备上和下脊骨VU、VL来将假体修补接头410接纳在其间。特别地参照图31a,对于图28-30的假体修补接头410的结构来说,多个槽470、472沿上和下脊骨VU、VL的脊骨端板形成。槽470、472可以由隆突426、450本身形成,或可预先准备。
还参照图32,在假体修补接头410插入上和下脊骨VU、VL之间内之前,可要求准备一个或多个槽470、472。如槽472所示,根据弧形隆突426、450,槽470、472可以呈弧形,以在插入过程中便于假体修补接头410运动。
参照图33-35,作为对仅提供直槽切削的凿削的变体,可使用一结合一研磨工具502的研磨导向器500,用来切削上和下脊骨VU、VL内的弧形槽470、472(图32中用标号472表示)。研磨导向器500和研磨工具502可由包括诸如钛的生物相容材料的任何材料形成。研磨导向器500包括一细长的弧形部件503,其形成一弧形的开口504以对应于用于槽470、472的要求的弧形的形状。当然,研磨导向器500的弯曲程度和由此的弧形开口504可根据槽470、472的要求的弧形变化。在一实施例中,研磨导向器500由一可弯曲的材料形成,在改造之后该材料保持刚性的形状,这样,不必换出研磨导向器,就可变化弧形开口504的弯曲程度。研磨导向器500和由此的弧形开口504也具有足够的长度,这样,如果槽470、472需要继续通过脊骨的任何后元件,则槽的这样的延伸部可同时地实现。
特别地参照图34a和34b,在一实施例中,研磨工具502包括一钻头510,其定位成可转动和在弧形开口504内平移。在一实施例中,钻头510是一双凹槽刳钻,其可同时地延伸入上和下脊骨VU、VL内。
钻头510还适于接纳一平移力以使钻头可在弧形开口504内前后地移动。参照图34b,在一实施例中,钻头柄530以任何传统的方式连接到一外壳522(示出其一部分)。柄530从外壳522延伸并通过形成在相对于外科医生(未示出)的研磨导向器500一近端534内的槽532。这样,柄530可由外科医生平移,由此,平移钻头510通过弧形的开口504。以此方式,柄530适于对钻头510施加平移运动。为了适于钻头510在弧形开口504内的运动,一对承载组件512、514可邻近于外壳522定位以便沿弧形开口导向钻头510。
外壳522容纳一转动组件,在一实施例中,该组件是一齿轮组件524。齿轮组件524包括一驱动齿轮526,其连接到一可转动的轴并围绕其延伸。轴528通过一由电源516(图35)代表的外部源而转动。在一实施例中,轴528容纳在柄530内。
齿轮组件524还包括一钻头齿轮531,其连接到研磨钻头510并围绕其延伸。钻头齿轮531定位在研磨钻头510上,以使钻头齿轮正交于并接触于驱动齿轮526。因此,轴528的转动通过齿轮组件524对研磨钻头510施加转动。一对环形的台阶535、536也连接到研磨钻头510,以使研磨钻头可通过弧形开口504容易地前后移动,而沿上或下方向没有滑动(如图34b所示)。应该理解到,齿轮组件524只是示例一可用于对研磨钻头510施加转动运动的组件。其它类型的施加转动的组件都被认为落入本发明的范围之内,例如,气动类型的系统。
参照图34c,在这样一实施例中,可使用一气动系统538来对研磨钻头510施加转动。在一实施例中,使用一Medtronic Midas Rex马达对气动系统提供动力(用P代表)。使用一传统的阀539来控制为转动研磨钻头510所供应的气流和压力。在还有的其它实施例中,可考虑手动的或组合的动力供应作为优选的动力供应516(图34b)和P(图34c)。
再次参照图34a和34b,还提供一导向柄540,以使研磨导向器500相对于研磨钻头510独立地移动。因此,在一实施例中,研磨导向器500可通过导向柄540用一个手保持,同时,用另一个手研磨钻头510可通过柄530在弧形开口504内移动。在某些实施例中,如图34b所示,柄530可延伸通过导向柄540。其结果,参照图35,研磨钻头510适于沿箭头R1所示的方向转动,并适于沿箭头R2所示的方向平移通过弧形开口504。
在操作过程中,可使用研磨导向器500和研磨工具502切削一槽(诸如槽472)以准备脊骨体VL来接纳假体修补接头410的下部。外科医生首先选择赋予槽472的要求的曲率量,并选择或构造对应的研磨导向器500。然后,外科医生用穿孔方法接近脊骨体VL,以将研磨导向器500定向到上和下脊骨VU、VL之间的盘空间内,并邻接研磨钻头510而抵靠上和下脊骨VU、VL。在合适地定位后,外科医生然后可通过电源516致动研磨工具502而开始用研磨钻头510切削入上和下脊骨VU、VL内。
研磨导向器500可由外科医生或通过外部器械拿持,以使研磨钻头510通过研磨导向器在平移运动过程中使研磨导向器静止不动。研磨导向器500的曲率引导研磨钻头510穿孔通过上和下脊骨VU、VL而切削一穿孔的槽(诸如图32中下脊骨VL内所示的槽472),以准备上和下脊骨来接纳穿孔的假体修补接头410。
在一变化的实施例中,假体修补接头410的隆突可以呈其它变化的形状和结构,以帮助用于插入接头的弧形的穿孔的逼近。参照图36-38,隆突550和560分别从承载表面434和420延伸。与图28-30的隆突450、426相比,隆突550和560相对较短,因此,分别沿承载表面434、420的短的部分延伸。隆突550、560的相对较短可分别帮助以下开口470、472内的这些隆突。此外,隆突550、560的短小性以及这样的隆突分别地随从开口470、472的方便性,可以允许隆突构造成直的或弧形的隆突,它们增加了假体修补接头410设计的选择性。隆突550、560还可形成锥形以帮助将隆突插入上和下脊骨VU、VL内。
IV.前斜的假体修补接头
可用来避免对诸如神经根、硬脑膜、黄韧带以及椎间韧带等重要解剖上结构造成可能破坏的另一方法是前斜向的方法。例如,由于主血管附连在脊椎的前面,所以,直地前向逼近脊骨L4和L5之间的盘空间以及超级的盘对齐,可以在全部盘更换移植物插入过程中防止高的外科手术的风险。
参照图39-41,图中示出根据本发明的另一形式的椎间关节假体修补接头600。假体修补接头600大致地沿纵向轴线L延伸,并包括一第一关节部件602和一第二关节部件604。关节部件602、604合作而形成假体修补接头600,它的尺寸和结构用来部署在相邻脊骨体之间的椎间空间内。
假体修补接头600在相邻脊骨体之间提供相对的枢转和转动运动,以保持或恢复基本上类似于由天生椎间盘提供的正常生物-机械运动那样的运动。具体来说,关节部件602、604允许围绕多个轴线相对于彼此枢转,其中,包括围绕纵向轴线L的侧向的或一侧到一侧的枢转运动,以及围绕一横向轴线T的前-后的枢转运动。应该理解到,在一优选的实施例中,允许关节部件602、604围绕位于与纵向轴线L和横向轴线T相交的一平面内的任何轴线而相对于彼此枢转。此外,可允许关节部件602、604围绕一转动轴线R相对于彼此转动。尽管关节的假体修补接头600已经图示和描述为提供一特定组合的关节运动,但应该理解到,其它组合的关节运动也是可能的,这样的运动被认为落入本发明的范围之内。还应该理解到,也可考虑其它类型的关节运动,例如,相对的平移或线性运动。
尽管假体修补接头600的关节部件602、604可以由各种各样的材料形成,但在一实施例中,关节部件602、604由钴-铬-钼金属合金形成(ASTM F-799或F-75)。然而,在本发明的其它实施例中,关节部件602、604可以由其它材料形成,例如,钛或不锈钢、诸如聚乙烯的聚合物材料,或任何其它生物相容的材料,它们对于本技术领域内的技术人员是明白公知的。直接与脊骨接触而定位的关节部件602、604的表面可涂以促进骨生长的物质,例如,由磷酸钙形成的羟磷灰石涂层。此外,直接与脊骨接触而定位的关节部件602、604的表面较佳地在涂以促进骨生长的物质之前进行粗糙化处理以便进一步提高骨的生长。这样的表面粗糙可借助于以下方法实施,例如,酸蚀刻、压花纹、涂敷起泡涂料,或本技术领域内的技术人员可想到的其它粗糙化的方法。
关节部件602包括一支承板610,其具有一关节表面612和一相对的承载表面614。支承板610的尺寸和形状可基本上对应于相邻脊骨的脊骨端板的尺寸和形状。在一实施例中,支承板610的形状呈三角形结构,以便于从脊椎的左或右侧斜向插入地逼近,这样,包括侧部P1、P2和P3。侧部P1、P2和P3可以采取各种结构,包括弧形的(P2所示)或直线的(P1和P3所示)结构。
支承板610可包括一个或多个槽616或其它类型的标记,以便于接纳和接合外科器械(也未示出)的对应的部分,从而帮助操纵和将假体修补接头600插入到相邻脊骨之间的椎间空间内。外科器械(未示出)较佳地构造成将关节部件602、604保持在一预定的定向,并在关节的假体修补接头600操纵和插入过程中保持相对于彼此的空间关系,且一旦合适地定位在相邻脊骨之间后释放关节部件602、604。
在一实施例中,关节表面612包括一具有凸出形状的突出620,其可构造成一球体形状的球(示出其一半)。应该理解到,也可构思其它构造的突出620,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。还应该理解到,关节表面612的其余部分可呈平面或非平面的结构,例如,围绕突出620延伸的角形或锥形结构。一突缘部件或隆突640从支承表面614延伸并构造成部署在相邻脊骨端板内预先形成的开口内。在一实施例中,隆突640从承载表面614垂直地延伸,并沿承载表面614近似地中心定位。然而,应该理解到也可考虑隆突640的其它的位置和定向。此外,出于类似的或附加的原因,可使用更多个隆突640。
在一实施例中,隆突640沿着支承板610的大部分延伸。隆突640是直的,但沿着一个方向朝向槽616延伸,并与支承板610的诸侧部之一P1平行。在本实施例中,隆突640定位在横向轴线T和侧向轴线L之间。与以上所讨论的前向、侧向,或穿孔方法相对,这样一实施例适于使用一斜向方法插入假体修补接头600。在另一实施例中,隆突640可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突640可以构造成一翼形的隆突,包括横贯隆突640的主体部分延伸的横向部分(未示出)。
隆突640还包括一对延伸通过其间的开口646以便于骨生长而提高对于相邻脊骨的固定能力。此外,一间隙648也可形成在隆突640内以进一步便于骨生长。间隙648还提供一参考点,这样,在插入假体修补接头600的过程中可使用X线来评估支承板602的定位和对齐。应该理解到,任何数量的开口646或间隙648可通过隆突640形成,包括一单一的开口或间隙,或若干个开口或间隙。还应该理解到开口646和间隙648不必全部延伸通过隆突640,但可以局部地延伸通过其间。还应该理解到,隆突640不必形成任何局部地或全部地延伸通过其间的开口646或间隙648。此外,尽管开口646显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口646。如上所述,直接与脊骨接触的关节部件602的表面可涂以促进骨生长的物质。具体来说,承载表面614和隆突640的表面可涂以羟磷灰石涂层以促进与相邻脊骨的骨质接合。还如上所述,承载表面614和隆突640的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在一实施例中,关节部件604包括一支承板650,其具有一关节表面652和一相对的承载表面654。支承板650的尺寸和形状基本上对应于相邻脊骨的脊骨端板的尺寸和形状。在一实施例中,支承板610的形状呈三角形结构,以便于从脊椎的左或右侧斜向插入地逼近,这样,包括侧部P4、P5和P6。侧部P4、P5和P6可以采取各种结构,包括弧形的(P5所示)或直线的(P4和P6所示)结构。支承板650可包括一个或多个槽656或其它类型的标记,以便接纳或接合对应的外科器械的部分,就如以上参照关节部件602所讨论的。
在一实施例中,关节表面652包括一具有一凹入形状的凹陷,其构造成一球形的插座。然而,应该理解到,也可考虑采用其它结构的凹陷660,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。关节表面652的其余部分可以呈倾斜或其它方式构造以便于插入和/或使用假体修补物。
尽管凹入的凹陷660显示为具有一大致光滑的不中断的关节表面,但应该理解到,表面的下陷或内腔可以沿凹陷660的一部分形成,以提供一用来清洗出诸如颗粒状的碎物的装置,这样的碎物存在于关节部件602、604的邻接的关节表面之间。在这样的情形中,球620的凸出的关节表面可以形成一大致光滑的、不中断的关节表面。在本发明的另一实施例中,各个凸出的突出620和凹入的凹陷660可以形成一表面的下陷,以便于去除存在于邻接的关节表面之间的颗粒物质。
一构造成类似于关节部件602的隆突640的突缘部件或隆突670从承载表面654延伸。在一实施例中,隆突670可中心地定位,并直接地或成线平行于隆突640。隆突670是直的,但沿着一个方向朝向槽656延伸,并与支承板650的诸侧部之一平行P4。与以上所讨论的前向、侧向,或穿孔方法相比,这样一实施例适于使用一斜向方法插入假体修补接头600。在另一实施例中,隆突670的位置可以偏移,以便帮助绕过静脉、动脉、骨质部分,或在插入假体修补接头600过程中在位置上阻碍的其它障碍物。
还应该理解到,隆突670还可以考虑其它的定位、形状、定向,以及数量。还应该理解到,出于类似的或附加的原因,可以使用更多的隆突670。再者,隆突670可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突670可以构造成一翼形的隆突,包括横贯隆突670的主体部分延伸的横向部分(未示出)。在一实施例中,隆突670还包括延伸通过其中的一对开口676,以便于骨通过其生长而提高对于相邻脊骨的固定能力。间隙678还提供一参考点,这样,在插入假体修补接头600的过程中可使用X线来评估支承板604的定位和对齐。应该理解到,任何数量的开口676或间隙678可通过隆突670形成,包括一单一的开口或间隙,或若干个开口或间隙。还应该理解到开口676和间隙678不必全部延伸通过隆突670,但可以局部地延伸通过其间。还应该理解到,隆突670不必形成任何局部地或全部地延伸通过其间的开口676或间隙678。此外,尽管开口676显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口676。如上所述,直接与脊骨接触的关节部件602的表面较佳地可涂以促进骨生长的物质。具体来说,承载表面654和隆突670的表面可涂以羟磷灰石涂层以促进与相邻脊骨的骨质接合。还如上所述,承载表面654和隆突670的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在某些实施例中,一个或两个隆突640、670可包括一锋利的前边缘(如边缘680、682所示)。由于有了这样的边缘,隆突640、670插入到相关的脊骨体内变得方便。再者,边缘680、682可以具有足够的锋利度,这样,脊骨体不需要一槽来用于接纳隆突640、670(将在下文中详细地讨论)。
参照图42-44a,为了适于将假体修补接头600插入椎间空间内,可以准备上和下脊骨VU、VL来将假体修补接头600接纳在其间。特别地参照图43,对于图38-40的假体修补接头600的构造来说,多个槽690、692分别沿下脊骨VL和上脊骨VU的脊骨端板形成。槽690、692可以由隆突640、670自己形成,或可用上述的一个或多个方法预先进行准备。从图42-44中可见,如果一个或多个血管694阻碍直地前向逼近,则斜向逼近将允许前向/侧向插入。植入物600的设计也确保了一足够的接触表面来接触脊骨VU、VL的骨质端板。
参照图44b,在一实施例中,假体修补接头600可通过诸如共同未决的美国专利申请系列No.10/430,473中所揭示的导向器那样的仪器插入椎间空间内,本文援引该专利以供参考。在一插入假体修补接头600的插入过程的实例中,脊骨VL、VU的中线M使用一成像设备定位,而一销695沿着中线插入上脊骨VU内。然后,一倾斜的导向件696通过一突缘697连接到销695,然后,一与倾斜的导向部件696相连的柄(未示出)调整到一合适的位置。然后,一倾斜导向部件696的倾斜销698挤入到上脊骨VU内而固定倾斜的导向部件,由此,指示出进入的参考点和用于假体修补接头600的植入物插入的方向。然后,可使用导向器(未示出)由一前向-倾斜方法将假体修补接头600植入椎间空间内,其细节在共同未决的美国专利申请系列No.10/430,473中有更完全的讨论。
V.移动承载的假体修补接头
在另一实施例中,上述假体修补接头可以进行修改而提供平移以及转动运动。例如,参照图45-47,一用于前向插入的移动承载的假体修补接头通常用标号700表示。应该理解到,仅为了阐明起见,移动承载的假体修补接头700是对于前向插入描述的,因此,可考虑各种插入方向用于移动承载的假体修补接头。
假体修补接头700大致地沿一纵向轴线L延伸,并包括一第一关节部件702和一第二关节部件704。关节部件702、704合作形成假体修补接头700,它的尺寸和构造用来部署在一对椎骨体之间的椎间空间内,例如,相邻的脊骨体VS、VI之间的椎间空间S1(图48)。
假体修补接头700在相邻的椎骨体VS、VI之间提供相对的枢转和转动运动,以保持或恢复基本上类似于由天生椎间盘提供的正常的生物-机械运动那样的运动,但添加平移运动的元件。具体来说,关节部件702、704允许围绕多个轴线相对于彼此枢转,其中,包括围绕纵向轴线L的侧向的或一侧到一侧的枢转运动,以及围绕一横向轴线T的前-后的枢转运动。应该理解到,在一实施例中,允许关节部件702、704围绕位于与纵向轴线L和横向轴线T相交的一平面内的任何轴线而相对于彼此枢转。此外,允许关节部件702、704围绕一转动轴线R相对于彼此转动。此外,允许关节部件702、704相对于彼此平移(将在下文中进一步描述)。
尽管假体修补接头700的关节部件702、704可以由各种各样的材料形成,但在一实施例中,关节部件702、704由钴-铬-钼金属合金形成(ASTM F-799或F-75)。然而,在其它实施例中,关节部件702、704可以由其它材料形成,例如,钛或不锈钢、诸如聚乙烯的聚合物材料,或任何其它生物相容的材料,它们对于本技术领域内的技术人员是明白公知的。直接与脊骨接触定位的关节部件702、704的表面可涂以促进骨生长的物质,例如,由磷酸钙形成的羟磷灰石涂层。此外,直接与脊骨接触定位的关节部件702、704的表面可在涂以促进骨生长的物质之前进行粗糙化处理以便进一步提高骨的生长。这样的表面粗糙可借助于以下方法实施,例如,酸蚀刻、压花纹、涂敷起泡涂料,或本技术领域内的技术人员可想到的其它粗糙化的方法。
关节部件702包括一支承板706,其具有一关节表面708和一相对的承载表面710。支承板706的尺寸和形状基本上对应于相邻脊骨的脊骨端板的尺寸和形状。支承板706可包括一个或多个槽712或其它类型的标记,以便于接纳和接合对应的外科器械的部分(未示出),从而帮助操纵和将假体修补接头700插入到相邻脊骨体之间的椎间空间内。外科器械(未示出)较佳地构造成将关节部件702、704保持在一预定的定向,并在关节假体修补接头700操纵和插入过程中保持相对于彼此的空间关系,且一旦合适地定位在相邻脊骨之间后释放关节部件702、704。
在一实施例中,参照图49a和49b,一凹陷714形成在关节表面708内。一沿关节表面708形成凹陷714的圆周的边缘716与凹陷表面718保持同心的关系,然而由于凹陷714的离散的圆形侧720(图49b),其具有比凹陷表面小的直径。尽管参照具有一圆形的情形进行描述,但应该理解到,凹陷714可呈诸如正方形、三角形或矩形等的任何数量的形状。
参照图50a和50b,凹陷714(图49b)设计成接纳一部分的模制的突出部件722。突出部件722包括一突缘部分724,其形状适于对应于凹陷714的形状。这样,突缘部分724包括一离散的圆周侧726,其终止在一大致平面的接合表面728。接合表面728适于接合基本上平面凹陷的表面718(图49b)。然而,应该理解到,尽管显示为基本上平面的,但接合表面728和凹陷的表面718可呈任何数量的对应的形状。接合表面728的直径小于凹陷表面718的直径。由此,允许模制的突出部件722相对于关节部件702平移。
模制的突出部件722的其余部分由具有一凸出形状的突出730形成,该形状可以构造成球形的球体(示出其一半)。应该理解到,也可考虑突出730的其它构造,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。还应该理解到,关节表面708的其余部分可呈平面或非平面的结构,例如,围绕突出730延伸的角形或锥形结构。
在一实施例中,突出730的凸出的关节表面被一沿突出730延伸的表面下陷或内腔732中断。在一实施例中,表面下陷732构造成一槽。然而,应该理解到,也可考虑采用其它类型的表面下陷,包括根本没有下陷。槽732的一个用途是便于移去存在于关节部件702、704的邻接部分之间的物质。具体来说,槽732可帮助清除诸如颗粒材料之类的物质,即,它存在于关节部件702、704的邻接的关节表面之间。
参照图45和49b,一突缘部件或隆突740从支承表面710延伸并构造成部署在相邻脊骨端板(诸如图48中的VI)内预先形成的开口内。在一实施例中,隆突740从承载表面710垂直地延伸,并沿承载表面710近似地中心定位。然而,应该理解到也可考虑隆突740的其它的位置和定向。
在一实施例中,隆突740基本上沿着支承板706的全部长度延伸。这样一实施例适于使用前向方法插入关节的假体修补接头700。然而,如上所述,也可考虑使用诸如侧向、穿孔以及前斜逼近的其它方法来插入假体修补接头700。在另一实施例中,隆突740可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突740可以构造成一翼形的隆突,包括横贯隆突740的主体部分延伸的横向部分(未示出)。
隆突740还包括一对延伸通过其中的开口742,以便于骨通过其生长而提高对于相邻脊骨体的固定能力。然而,应该理解到可以通过隆突740形成任何数量的开口742,包括单一的开口或三个或多个开口。还应该理解到,开口742不必全部地延伸通过隆突740,但可局部地延伸通过其间。还应该理解到,隆突740不必形成任何局部地或全部地延伸通过其间的开口742。此外,尽管开口742显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口742。如上所述,直接与脊骨接触的关节部件702的表面较佳地涂以促进骨生长的物质。具体来说,承载表面710和隆突740的表面可涂以羟磷灰石涂层,以促进与相邻脊骨体的骨质接合。如上所述,承载表面710和隆突740的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
参照图45-47,在一实施例中,关节部件704包括一支承板750,其具有一关节表面752和一相对的承载表面754。支承板750的尺寸和形状基本上对应于相邻脊骨的脊骨端板的尺寸和形状。支承板750可包括一个或多个槽756或其它类型的标记,以便于接纳和接合对应的外科器械的部分,就如以上参照关节部件702所讨论的那样。
在一实施例中,关节表面752包括一具有凹入形状的凹陷758(图47),例如,一球形插座的凹陷。然而,应该理解到,也可构思其它构造的凹陷758,例如,圆柱、椭球或其它弓形结构,或可能是非弓形的结构。关节表面752的其余部分可以呈倾斜或其它方式构造以便于插入和/或使用关节假体修补接头700。尽管凹入的凹陷758显示为具有一大致光滑的不中断的关节表面,但应该理解到,表面的下陷或内腔可以沿凹陷758的一部分形成,以帮助清洗出诸如颗粒状的碎物,这样的碎物存在于关节部件702、704的邻接的关节表面之间。在这样的情形中,突出730的凸出的关节表面可以形成一大致光滑的、不中断的关节表面。在另一实施例中,各个凸出的突出730和凹入的凹陷758可以形成一表面的下陷,以便于去除存在于邻接的关节表面之间的颗粒物质。
一类似于关节部件702的隆突740构造的突缘部件或隆突760从支承表面754延伸。在一实施例中,隆突760从承载表面754垂直地延伸,并沿承载表面754近似地中心定位。然而,应该理解到也可考虑隆突760的其它的位置和定向。还应该理解到,关节部件704可包括从承载表面754延伸的两个或多个隆突760。
在一实施例中,隆突760基本上沿着支承板750的全部长度延伸。这样一实施例适于使用前向方法插入假体修补接头700。然而,如上所述,也可考虑使用诸如侧向、穿孔以及前斜逼近的其它方法来插入假体修补接头700。在另一实施例中,隆突760可以倾斜、锥形,或构造成某些其它的形状,以便于隆突的功能性要求。在还有的另一实施例中,隆突760可以构造成一翼形的隆突,包括横贯隆突760的主体部分延伸的横向部分(未示出)。
隆突760还包括一对延伸通过其中的开口762,以便于骨通过其生长而提高对于相邻脊骨的固定能力。然而,应该理解到可以通过隆突760形成任何数量的开口762,包括单一的开口或三个或多个开口。还应该理解到,开口762不必全部地延伸通过隆突760,但可局部地延伸通过其间。还应该理解到,隆突760不必形成任何局部地或全部地延伸通过其间的开口762。此外,尽管开口762显示为具有一圆形结构,但应该理解到也可考虑采用其它尺寸和结构的开口762。如上所述,直接与脊骨接触的关节部件704的表面较佳地涂以促进骨生长的物质。具体来说,承载表面754和隆突760的表面可涂以羟磷灰石涂层,以促进与相邻脊骨的骨质接合。如上所述,承载表面754和隆突760的表面可在涂敷羟磷灰石涂层之前进行粗糙化处理。
在某些实施例中,一个或两个隆突740、760可包括一锋利的前边缘(如图45和46的边缘760a所示)。由于有了这样的边缘,隆突740、760插入到相关的脊骨体内变得方便。再者,边缘760a可以具有足够的锋利度,这样,脊骨体不需要一槽来用于接纳隆突760(将在下文中详细地讨论)。
参照图45,通过将模制的突出部件722插入到形成在关节部件702的关节表面708内的凹陷714内,可移动的承载假体修补接头700进行组装。一旦组装后,假体修补接头700即准备插入到相邻脊骨体VS、VI之间的盘空间S1内(图48)。
参照图48,为了适于将假体修补接头700插入椎间空间S1内,可以准备相邻的脊骨体VS、VI来将假体修补接头700接纳在其间。对于图45-47的假体修补接头700的结构来说,槽770、772分别沿脊骨VS和脊骨VI的脊骨端板形成。槽770、772可以由隆突740、760本身形成,或可根据以上讨论的一个或多个方法预先准备。
一旦插入盘空间S1内后,由于模制的突出722与关节部件704的凹入的凹陷758接合,所以,假体修补接头700允许关节部件704相对于关节部件702作平移运动。例如,在图51中,模制的突出722显示为处于一后向的位置(其可导致关节部件704沿后向P运动),而在图52中,模制的突出722显示为处于一前向的位置(其可导致关节部件704沿前向A运动)。当然,图51和52仅是示范实施模制的突出722和对应的凹陷714所允许的平移运动,因此,模制的突出722的平移运动量和由此的关节部件704相对于关节部件702的运动可以变化,包括除P和A之外的方向。此外,在关节部件702的凹陷714内的模制的突出722的定位,允许模制的突出相对于关节部件702旋转。因此,在这样一实施例中,模制的突出722添加了这样一好处:能独立于赋予关节部件704的平移运动,赋予关节部件704以转动(通过与凹陷758的接合)。平移和转动运动之间如此的独立关系,相对于其移动运动依赖于转动运动(反之亦然)的假体修补接头添加了在假体修补接头700处经历的移动量。
本发明已经对若干个优选的实施例进行了描述。本技术领域内的技术人员读了本发明描述之后会明白许多改进或修改,这些改进或修改被认为落入在本发明的精神和范围之内。例如,在不脱离本发明的一定的多个方面,上述关节的接头的诸关节部件可以反过来。因此,应该理解到,若干个修改、变化以及替换意欲用于上述的本发明,在某些实例中,将使用本发明的某些特征,而不对应地使用其它的特征。还应该理解到,诸如“纵向”和“横向”之类的空间参考仅是为了说明的目的而采用的,可在本发明的范围之内变化。因此,应该认识到,附后的权利要求书应认为是广义的并与本发明的范围相一致。
Claims (27)
1.一用来侧向地插入椎间空间内的假体修补物装置,该假体修补物装置包括一具有一第一侧向延伸的突缘的第一部件,用来从侧向逼近接合一第一椎骨,该第一部件具有一第一关节表面,假体修补物装置还包括一具有一第二侧向延伸的突缘的第二部件,用来从侧向逼近接合一第二椎骨,该第二部件具有一第二关节表面以便与第一关节表面合作而允许在第一和第二部件之间作关节的运动。
2.如权利要求1所述的假体修补物装置,其特征在于,第一和第二椎骨处于一脊椎强硬的关系,而第一突缘相对于第二突缘偏移,以适于插入到脊椎强硬的第一和第二脊骨内。
3.如权利要求1所述的假体修补物装置,其特征在于,第一和第二椎骨处于一对齐的关系,而第一突缘与第二突缘对齐,以适于插入到对齐的第一和第二脊骨内。
4.如权利要求1所述的假体修补物装置,其特征在于,第一部件还包括一与第一关节表面处于相对关系的第一承载表面,第一承载表面适于接合第一椎骨。
5.如权利要求4所述的假体修补物装置,其特征在于,第一突缘沿第一承载表面的大部分延伸。
6.如权利要求4所述的假体修补物装置,其特征在于,第二部件还包括一与第二关节表面处于相对关系的第二承载表面,第二承载表面适于接合第二椎骨。
7.如权利要求6所述的假体修补物装置,其特征在于,第二突缘沿第二承载表面的大部分延伸。
8.如权利要求1所述的假体修补物装置,其特征在于,第一和第二突缘各包括至少一个通过其中的孔。
9.如权利要求6所述的假体修补物装置,其特征在于,第一和第二承载表面各涂以促进骨生长的物质。
10.如权利要求1所述的假体修补物装置,其特征在于,第一和第二突缘各涂以促进骨生长的物质。
11.如权利要求1所述的假体修补物装置,其特征在于,第一和第二突缘各包括一锋利的部分,用来分别地贯穿第一和第二脊骨。
12.如权利要求1所述的假体修补物装置,其特征在于,第一和第二部件由钴-铬-钼金属合金形成。
13.如权利要求1所述的假体修补物装置,其特征在于,第一和第二部件各包括侧向地形成在其中的至少一个槽,以接纳一外科器械。
14.如权利要求1所述的假体修补物装置,其特征在于,第一部件包括一从第一关节表面延伸的突出。
15.如权利要求14所述的假体修补物装置,其特征在于,第二部件包括一形成在第二关节表面内的凹陷。
16.如权利要求15所述的假体修补物装置,其特征在于,突出是一凸出的部分,而凹陷是一凹入的部分。
17.如权利要求16所述的假体修补物装置,其特征在于,凸出部分和凹入部分合作以允许在第一和第二部件之间的关节运动。
18.一用来侧向地插入椎间空间内的假体修补物装置,该假体修补物装置包括一第一部件和一第二部件,第一部件具有一在侧向插入其中的过程中用来侧向地接合一第一椎骨的装置,第二部件具有一在侧向插入其中的过程中用来侧向地接合一第二椎骨的装置,其中,第一和第二部件之一包括一突出,而第一和第二部件之另一个包括一凹陷,这样,突出接合凹陷而在第一和第二部件之间提供关节的运动。
19.如权利要求18所述的假体修补物装置,其特征在于,用来分别地侧向接合第一和第二脊骨的第一和第二装置是侧向地延伸的突缘。
20.如权利要求19所述的假体修补物装置,其特征在于,第一侧向地延伸的突缘沿第一部件的一承载表面的大部分延伸。
21.如权利要求19所述的假体修补物装置,其特征在于,第二侧向地延伸的突缘沿第二部件的一承载表面的大部分延伸。
22.一用来插入形成在一对椎关节强硬的椎骨之间的椎间空间内的假体修补物装置,该假体修补物装置包括:
一第一部件,包括:
一沿第一承载表面侧向延伸的第一突缘;以及
一从第一关节表面延伸的突出;以及
一第二部件,适于接合第一部件,包括:
一沿第二承载表面侧向延伸的第二突缘,在第二部件与第一部件接合后,该第二突缘偏离第一突缘,由此适应第一椎骨和第二椎骨之间的椎关节强硬的关系;以及
一形成在第二关节表面内的凹陷;
其中,突出和凹陷彼此接合,以在第一和第二部件之间提供关节的运动。
23.一用来形成假体修补物装置的一部分的假体修补部件,该假体修补部件包括一第一表面,该第一表面具有用来从侧向逼近地接合一椎骨的突缘,该突缘沿第一表面基本上侧向地延伸,以及一与第一表面相对的第二表面,该第二表面适于接合另一假体修补部件。
24.一从侧向逼近将假体修补物装置插入椎间空间内的方法,该方法包括提供一假体修补物装置,该假体修补物装置具有一第一关节部件和一沿第一关节部件的表面侧向地延伸的第一突缘,以及具有一第二关节部件和一沿第二关节部件的表面侧向地延伸的第二突缘,该方法还包括将第一关节部件侧向地插入到第一椎骨内和将第二关节部件侧向地插入到第二椎骨内,第二椎骨邻近于第一椎骨。
25.如权利要求24所述的方法,其特征在于,在插入过程中,第一和第二突缘分别接合和贯穿第一和第二椎骨。
26.如权利要求24所述的方法,其特征在于,在插入过程中,第一和第二突缘分别插入到第一和第二椎骨的预先形成的开口内。
27.一从侧向将假体修补物装置插入第一椎骨和第二椎骨之间的椎间盘空间内的方法,该方法包括:
提供一假体修补物装置,该装置包括:
一第一关节部件,该部件包括:
一承载表面和一关节表面;
一形成在承载表面上的基本上侧向地延伸的隆突,
以接合第一椎骨;以及
一形成在关节表面内的凹陷;
一第二关节部件,该部件包括:
一承载表面和一关节表面;
一形成在承载表面上的基本上侧向地延伸的隆突,
以接合第二椎骨;以及
一从关节表面延伸的突出以接合第一关节部件的凹陷;
基本上侧向地将假体修补物装置插入椎间盘空间内以使假体修补物装置与第一和第二椎骨接合。
Applications Claiming Priority (3)
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US44696303P | 2003-02-12 | 2003-02-12 | |
US60/446,963 | 2003-02-12 | ||
PCT/US2004/004071 WO2004071359A1 (en) | 2003-02-12 | 2004-02-12 | Articular disc prosthesis for lateral insertion |
Publications (2)
Publication Number | Publication Date |
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CN1893895A true CN1893895A (zh) | 2007-01-10 |
CN1893895B CN1893895B (zh) | 2010-05-12 |
Family
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CN2004800069980A Expired - Fee Related CN1893895B (zh) | 2003-02-12 | 2004-02-12 | 用于侧向插入的关节盘修补物 |
CNB2004800070028A Expired - Fee Related CN100571657C (zh) | 2003-02-12 | 2004-02-12 | 用于穿孔插入的关节盘修补物 |
CNB2004800074141A Expired - Lifetime CN100539966C (zh) | 2003-02-12 | 2004-02-12 | 用于前斜向插入的关节盘修补物 |
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CNB2004800070028A Expired - Fee Related CN100571657C (zh) | 2003-02-12 | 2004-02-12 | 用于穿孔插入的关节盘修补物 |
CNB2004800074141A Expired - Lifetime CN100539966C (zh) | 2003-02-12 | 2004-02-12 | 用于前斜向插入的关节盘修补物 |
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US (12) | US20040158254A1 (zh) |
EP (7) | EP1599155B1 (zh) |
JP (7) | JP2006517453A (zh) |
CN (3) | CN1893895B (zh) |
AT (3) | ATE555730T1 (zh) |
AU (7) | AU2004211983A1 (zh) |
CA (7) | CA2515640A1 (zh) |
WO (7) | WO2004071359A1 (zh) |
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CN115105267A (zh) * | 2021-07-29 | 2022-09-27 | 天津理工大学 | 骨-假体界面间隙装置 |
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