CN100353919C - 用于阻止两个连续的脊椎骨移动的棘突间器械 - Google Patents
用于阻止两个连续的脊椎骨移动的棘突间器械 Download PDFInfo
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- A—HUMAN NECESSITIES
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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
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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
- A61B17/7053—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant with parts attached to bones or to each other by flexible wires, straps, sutures or cables
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Abstract
用于阻止脊柱的两个连续的脊椎骨(8,9)移动的棘突间器械,其特征在于它包括:两个衬垫(2a,2b;11a,11b;20a,20b),其内表面(3a,3b;12a,12b)将压靠在所述脊椎骨(8,9)的棘突(6,7)的侧面上,以及韧带(4,5a,5b,5c,5d;17a,17b,18,19;23,24),其将所述衬垫(2a,2b;11a,11b;20a,20b)彼此连接并连接到所述棘突(6,7),以便在脊柱相对于其正常位置屈伸移动期间,通过所述衬垫(2a,2b;11a,11b;20a,20b)施加在棘突(6,7)侧面的压力随脊柱从所述正常位置离开而增加。
Description
技术领域
本发明涉及在脊柱移动期间阻止两个脊椎骨会合到一起的外科植入领域。
背景技术
当棘突间盘遭受相当大的磨损或恶坏时,在脊柱弯曲(向前移动)或伸展(向后移动)期间,它们可能变得无力防止两个连续的脊椎骨过度的会合在一起。而这种会合在一起可能带来压迫脊神经的后果,这对病人来说是非常痛苦的。在最严重的情况下,在最大移动期间该会合在一起可能会发展到脊椎骨彼此接触。
用于解决该问题的第一种公知的方法是将一个有问题的脊椎骨固定到另一个上,以便在它们之间保持永久足够的间隔。可以利用各种板状器件进行固定。然而,它使病人大大丧失了移动能力,因为它阻止了脊柱在问题区域的任何弯曲或伸展。
已经知道的是,利用人造韧带绑扎有问题的脊椎骨的棘突。这使得可以保持脊椎骨伸展的运动自由度而同时将允许弯曲的最大幅度限制到防止在脊椎骨前面之间接触的程度。然而,这不能阻止在脊椎骨的后部接触,尽管在该区最可能发生压迫脊神经。
也已经知道,在棘突之间插入棘突间楔子,如文献EP-A-0 392 124中所述。这些楔子由例如聚四氟乙烯的刚性材料制成,因此可以防止在脊柱的伸展期间它们分开的棘突之间的任何接触。它们优选通过穿过它们并环绕棘突的人造韧带固定就位。借助于这些韧带,也可以限制脊柱在问题区域的弯曲移动的幅度。
然而,在棘突之间具有刚性元件的事实导致实际上失去了在那一点的脊柱的伸展移动,或至少当突起接触到楔子时突然中断该移动。
希望能够使用一种使脊椎骨-椎盘-脊椎骨块(功能单元)的正常行为更切实地再生的器件,其中通常只逐渐地发生阻碍脊柱移动的情况。
发明内容
本发明的目的是提供一种满足此要求的器械。
为此目的,本发明的主题为用于阻止脊柱的两个连续的脊椎骨移动的棘突间的器械,其特征在于它包括:
-两个衬垫,其内表面用于压住所述脊椎骨棘突的侧面,
-以及韧带,其将所述衬垫彼此连接并连接到所述棘突,以便在脊柱从其正常位置屈伸移动期间,通过所述衬垫施加在棘突侧面的压力随脊柱从所述正常位置离开而增加。
每个所述衬垫可以具有穿入棘突间间隔的突起。
每个所述衬垫可以由折叠并缝合在其本身上的带子构成。
每个所述衬垫可以由实心物体构成。
该器械可以包括销,其穿过朝向分开两个脊椎骨的棘突间的间隔的所述衬垫中的横向穿孔,所述销具有能靠在所述衬垫表面上的凸缘,该表面从脊柱转向外面。
所述韧带可以包括:
-一个带状韧带,它绕衬垫紧密配合并具有当拉紧时构成间隔的自由部分,该间隔具有大于分开脊椎骨棘突间的距离的宽度“d”以及
-四个其它韧带,它们中的每一个连接到衬垫的上部或下部。
每个所述衬垫可以包括:
-一个连接衬垫上部和下部的纵向穿孔,以及
-连接衬垫内表面和外表面的两个上下横向穿孔,
所述韧带可以有四个,其中两个韧带分别插入在一个所述纵向穿孔中,一个韧带插入在所述衬垫的上部横向穿孔中,以及一个韧带插入在所述衬垫的下部横向穿孔中。
在每个衬垫中,所述横向穿孔可以与所述纵向穿孔相交,插入在纵向穿孔中的韧带为带状,插入在横向穿孔中的所述韧带穿过插入在纵向穿孔中的韧带。
每个衬垫可以具有连接衬垫的上部和下部的纵向穿孔和插入所述纵向穿孔的韧带,该韧带的一端是自由的,另一端成形为环,从而它可以与插入在另一个衬垫的纵向穿孔中的韧带的自由端绑扎。
本发明的主题还是一种制造用于这种棘突间器械的衬垫的方法,其特征在于所述衬垫由折回并缝合在其本身上、并由例如聚酯或弹性体材料制成的带子制成。
可以理解,本发明在于提供一种棘突间器械,其主要元件由压靠在棘突侧面的两个元件组成。它们由具有可压缩性和低弹性的相对柔性的材料构成。聚酯和弹性体,乃至一些复合材料,可以用于此目的。它们可以具有这样的形状,即在静止时稍微穿入棘突间的间隔。它们通过人造的韧带与棘突抵靠固定,并为了形成一个组件而彼此连接:
-或者通过相同的韧带将它们与棘突抵靠固定到位;
-或者通过封套将它们限制在彼此相隔一定距离内并当器械就位时棘突在其上支撑;
-或者通过定心销,其穿过两衬垫并穿过棘突间的间隔;
-或者同时通过这些器械的几个。
将该元件压靠在棘突上,由此在脊柱的伸展移动和弯曲移动期间,以及在转动移动期间,它们将侧向压力同等地传递给它们。这些压力随着脊柱离开它的正常位置而增加,最后其足够大以在发生脊椎骨过度会合到一起之前防止其移动的可能性。
附图说明
借助于下面的附图将更好地描述本发明:
-图1a,1b示出本发明的第一实施例,其处于静止状态(图1a)并位于两个脊椎骨之间(图1b);
-图2a,2b示出处于静止状态的本发明的第二实施例,从纵截面(图2a)和侧面(图2b)的前面看;
-图3a和3b示出在纵截面上看、在其放置的两个阶段上的本发明的第二实施例。
-图4示出在其放置以后在纵截面上看的本发明第三实施例。
具体实施方式
图1a和1b示出本发明的第一实施例。在静止状态(图1a),棘突间器械1为两个衬垫2a、2b的形式,每个具有基本上为平面3a、3b形状的内表面,其在楔子就位时支撑在脊椎骨上。在示出的例子中,这些衬垫2a、2b的每一个由具有一些收缩性和低弹性的材料例如聚酯或弹性体制成的带子形成,折叠并缝合在其本身上以堆叠形成总体的外形,即例如半球形、半卵形等。衬垫2a、2b在相同的带型韧带4内紧密配合,韧带4由与衬垫2a、2b类似的材料制成,它的自由部分一方面与衬垫3a、3b的上部连接,另一方面与其下部连接,这使得平面3a、3b是自由的。该带子4本身带有四个韧带5a、5b、5c、5d,它们分别在衬垫2a、2b的上下部相应的邻近处与其连接。将带子4固定于衬垫2a、2b,并在静止状态下,当拉紧时,它的自由部分在衬垫2a、2b的内表面3a、3b之间提供一个宽度为“d”的间隔。
当棘突间器械1置于两个连续的上脊椎骨8和下脊椎骨9的棘突6、7上时,其如图1b中所示。将器械1插在棘突6、7之间,它们在高度方向上分开基本上小于“d”的长度。这样,上脊椎骨8的棘突6的下部和下脊椎骨9的棘突7的上部拉紧带子4。该拉紧使衬垫2a、2b受挤压并聚集在一起,其中的平坦内表面3a、3b与棘突6、7的侧面接触,并在箭头10、10′、10″、10的方向对它们施加压力。通过在上脊椎骨8的棘突6的上部结扎韧带5a、5b和在下脊椎骨9的棘突7的下部结扎韧带5c、5d来完成器械1的放置。
这样,当脊柱进行伸展时,也就是说当病人向后弯曲时,以及当棘突6、7彼此靠近时,在其自由端施加于带子4上的拉紧力增加。其效果是逐渐地增加衬垫2a、2b(尤其是在它们的端部)的压力,并通过它们在箭头10、10′、10″、10的方向在棘突6、7上施加压力。计算器械1的各种元件的尺寸和机械特性,以便通过衬垫2a、2b施加在棘突6、7上的压力最后变得足够大,以在引起突起6、7之间通过的脊神经损伤之前阻止它们会合到一起,正如发生在健康的功能单元上的一样。
另一方面,当脊柱处于弯曲时,也就是说当病人向前屈身时,并且当棘突6、7倾向于彼此离开时,它具有增加施加于韧带5a、5b、5c、5d上的拉紧力的效果。该增加的拉紧力传送到带子4固定于衬垫2a、2b的部分上。和前面的情况相同,它具有逐渐地增加衬垫2a、2b的压力、和增加通过它们以箭头10、10′、10″、10的方向施加在棘突6、7上的压力的效果。必要的是,棘突6、7的分离超过一定程度后,这些压力变得足够大,以阻止更进一步的分离,而这种分离有引起损伤的危险,如同健康的功能单元发生的一样。韧带5a、5b、5c、5d也在阻止并中断脊柱的弯曲移动中起一定作用,因为它们限制伸展的可能性。
作为变体,每个衬垫2a、2b可以由实心物体的形式制成,例如中衬有聚酯的硅制成,它朝向棘突6、7的面可以是平坦的(如在上述的例子中)或每个可以具有突起,该突起稍微穿入棘突间的间隔以便可以更有效和可靠地阻止棘突6、7的会合在一起的移动。
图2a、2b、3a、3b所示的本发明的变体具有这样的衬垫11a、11b,它们由基本上为半球形的或半卵形的实心物体制成。在所示的例子中,每个衬垫11a、11b具有朝向棘突6、7的具有平坦形状的面12a、12b,可以理解为每个所述面12a、12b具有如上所述突起。
每个衬垫11a、11b具有一系列的穿孔,它们将为各种韧带提供通道,使得能够将衬垫11a、11b连接到棘突6、7上:
-一个纵向穿孔13a、13b,在示出的例子中基本上位于与将要离开棘突6、7的衬垫11a、11b的面14a、14b的外围平行,并将衬垫11a、11b的上部区域连接到下部区域;
-两个横向穿孔15a、15b;16a、16b,一个15a、15b位于衬垫11a11b的上部,另一个16a、16b位于衬垫11a、11b的下部,并连接衬垫11a、11b的内表面12a、12b和外表面14a、14b。
在示出的例子中,横向穿孔15a、15b;16a、16b经过纵向的穿孔13a、13b;然而,该结构不是必需的。
韧带按如下经过各种的穿孔:
-每个带子型韧带17a、17b经过一个衬垫11a、11b的纵向的穿孔13a、13b;
-同一个线型的上部韧带18经过每个衬垫11a、11b的上部横向穿孔15a、15b;
-同一个线型的下部韧带19经过每个衬垫11a、11b的下部的横向穿孔16a、16b。
在示出的例子中,每个线型韧带18、19经过带型连接17a、17b,但是必须清楚这种布置不是必需的,尤其是如果横向的穿孔(15a、15b;16a、16b)不经过纵向的穿孔13a、13b时。
如图3a、3b所示植入通过衬垫11a、11b提供的棘突间器械。
首先,衬垫11a、11b靠着两个连续的脊椎骨的棘突6、7放置,上部线型韧带18在上部脊椎骨的棘突6的下面通过,下部线型韧带19在下部脊椎骨的棘突7的上面通过。然后线型韧带18、19绕它们相应的棘突6、7绑扎,如图3a所示。
其次,将带型韧带17a、17b系在或彼此固定在它们的两个末端,如图3b所示。将衬垫11a、11b压靠在棘突6、7上完成该手术,使它们得以在脊柱屈伸运动期间与图1a、1b所示类似的方式工作。
与图1a、1b描述和示出的变体比较,该变体具有无需为其植入而分段棘突间韧带的优点。因此提高了脊柱有关区域的稳定性。
衬垫11a、11b可以由在其本身上折叠的带子构成,如衬垫2a、2b一样,而不是由如图所示的实心物体构成。在这种条件下,带型韧带17a、17b可以简单地固定于衬垫11a、11b的外表面14a、14b上,而不用置于衬垫11a、11b中的纵向穿孔13a、13b内。而且,该结构还可以与实心衬垫11a、11b同时采用。
本发明的另一个变体如图4所示。在该变体中,棘突间器械由两个衬垫20a、20b构成,每个具有能够深入棘突间隔的突起21a、21b(如前面已经提到的,该突起可以位于已经描述的其他变体的衬垫上)。这些衬垫20a、20b具有与上述的变体的纵向穿孔13a、13b类似的纵向穿孔22a、22b。后者的每一个包括线或带型韧带23、24,将其一端25、26成形为环。将韧带23、24插入衬垫20a、20b中,以便一个环25位于其衬垫20a的下表面上,另一个环26位于其衬垫20b的上表面上。当棘突间器械就位时,将每个韧带23、24的自由端绑扎在另一个韧带24、23的环25、26中。
这样,当脊柱进行弯曲活动时,通过棘突6、7施加在韧带23、24的力拉紧后者,它们将衬垫20a、20b压靠在棘突6、7上,和上述的变体一样阻止了它们的移动。当脊柱进行伸展活动时,在通过棘突6、7施加在突起21a、21b上的力的作用下,衬垫20a、20b将彼此分离;然而,该分离被施加于韧带23、24上的力阻止了。后者将这些力传递到衬垫20a、20b的大部分,它们将压靠在棘突6、7上,并因此阻止它们会合到一起。由此将再次产生与上述变体已经描述的类似的效果。
在如图4所示的例子中,棘突间器械具有另一个特征,它仅是可选择的,且同样可以用到本发明的其他变体上。每个衬垫20a、20b具有横向穿孔27、28,其基本上位于衬垫20a、20b的中部。在器械已经就位之后,穿孔将朝向棘突间的间隙并彼此相对。销29经过这些横向的穿孔27、28,销29由刚性的或可稍微变形的材料制成、在它的末端安装凸缘30、31、并且每个靠在从脊柱转向外面的衬垫20a、20b的表面上。在棘突间的器械已经就位之前或之后,该销29插入到衬垫20a、20b中。该销29的主要功能是为衬垫20a、20b提供相互的对中。它也可以防止在脊柱伸展移动期间衬垫20a、20b的横向扩张。然后,衬垫20a、20b承受的应力转移到它们的末端,这增加了施加于棘突6、7上的压力。
作为变体,销29可以由一个衬垫20a、20b的突起组成,它插入另一个衬垫的横向穿孔中,并在插入另一个衬垫之后通过固定到销上的凸缘保持定位。
必须理解,已经描述和示出的例子不是限制性的,尤其是如果没有明显的不相容性来阻止,它可以变换成一些其他不同的元件,而这些元件仅描述了其中的一种。
Claims (9)
1.用于阻止脊柱的两个连续的脊椎骨(8,9)移动的棘突间器械,其特征在于它包括:
两个衬垫(2a,2b;11a,11b;20a,20b),其内表面(3a,3b;12a,12b)用于压靠在所述脊椎骨(8,9)的棘突(6,7)的侧面上,
韧带(4,5a,5b,5c,5d;17a,17b,18,19;23,24),其将所述衬垫(2a,2b;11a,11b;20a,20b)彼此连接并连接到所述棘突(6,7)上,以便在脊柱从其正常位置屈伸移动期间,通过所述衬垫(2a,2b;11a,11b;20a,20b)施加在棘突(6,7)侧面的压力随着脊柱从所述正常位置离开而增加。
2.根据权利要求1所述的器械,其特征在于:每个所述衬垫具有穿入棘突间间隔的突起(21a,21b)。
3.根据权利要求1或2所述的器械,其特征在于:每个所述衬垫(2a,2b)由折叠并缝合在其本身上的带子构成。
4.根据权利要求1或2所述的器械,其特征在于:每个所述衬垫(11a,11b;20a,20b)由实心物体构成。
5.根据权利要求1所述的器械,其特征在于:该器械包括销(29),其穿过朝向分开两个脊椎骨(8,9)的棘突间的间隔的所述衬垫(20a,20b)中的横向穿孔(27,28),所述销(29)具有能靠在所述衬垫(20a,20b)的表面上的凸缘(30,31),该表面从脊柱朝向外面。
6.根据权利要求1所述的器械,其特征在于:所述韧带包括:
一个带状韧带(4),它绕衬垫(2a,2b)紧密配合并具有当拉紧时构成一间隔的自由部分,该间隔具有大于分开脊椎骨(8,9)的棘突(6,7)的距离的宽度“d”,以及
四个其它韧带(5a,5b,5c,5d),它们每个都连接到衬垫(2a,2b)的上部或下部上。
7.根据权利要求1所述的器械,其特征在于:每个所述衬垫(11a,11b)都包括:
一个连接衬垫(11a,11b)的上部和下部的纵向穿孔(13a,13b),
连接衬垫(11a,11b)的内表面和外表面的两个上横向穿孔(15a,15b)和下横向穿孔(16a,16b),
所述韧带有四个,其中两个韧带(17a,17b)分别插入在一个所述纵向穿孔(13a,13b)中,一个韧带(18)插入在所述衬垫(11a,11b)的上部中的横向穿孔(15a,15b)中,以及一个韧带(19)插入在所述衬垫(11a,11b)的下部横向穿孔(16a,16b)中。
8.根据权利要求7所述的器械,其特征在于:在每个衬垫(11a,11b)中,所述横向穿孔(15a,15b;16a,16b)与所述纵向穿孔(13a,13b)相交,插入在纵向穿孔(13a,13b)中的韧带(17a,17b)为带状,插入在横向穿孔(15a,15b;16a,16b)中的所述韧带(18,19)穿过插入在纵向穿孔(13a,13b)中的韧带(17a,17b)。
9.根据权利要求1所述的器械,其特征在于:每个衬垫(20a,20b)具有连接衬垫(20a,20b)的上部和下部的纵向穿孔(22a,22b)和插入在所述纵向穿孔(22a,22b)中的韧带(23,24),该韧带的一端是自由的,另一端(25,26)成形为环,从而它可以与插入在另一个衬垫(20b,20a)的纵向穿孔(22a,22b)中的韧带(23,24)的自由端绑扎。
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FR0302038A FR2851154B1 (fr) | 2003-02-19 | 2003-02-19 | Dispositif inter-epineux pour freiner les mouvements de deux vertebres successives, et procede de fabrication d'un coussin lui etant destine |
FR03/02038 | 2003-02-19 |
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US (1) | US7520887B2 (zh) |
EP (1) | EP1594412A1 (zh) |
JP (1) | JP4330617B2 (zh) |
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CN (1) | CN100353919C (zh) |
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CA (1) | CA2516323C (zh) |
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- 2004-02-17 CA CA002516323A patent/CA2516323C/en not_active Expired - Fee Related
- 2004-02-17 WO PCT/IB2004/000390 patent/WO2004073533A1/en active Search and Examination
- 2004-02-17 EP EP04711670A patent/EP1594412A1/en not_active Withdrawn
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- 2004-02-17 KR KR1020057015201A patent/KR101066714B1/ko not_active IP Right Cessation
- 2004-02-17 JP JP2006502436A patent/JP4330617B2/ja not_active Expired - Fee Related
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CN1774213A (zh) | 2006-05-17 |
AU2004212776B2 (en) | 2010-06-17 |
CA2516323A1 (en) | 2004-09-02 |
EP1594412A1 (en) | 2005-11-16 |
KR20050103497A (ko) | 2005-10-31 |
US20060217726A1 (en) | 2006-09-28 |
FR2851154A1 (fr) | 2004-08-20 |
JP4330617B2 (ja) | 2009-09-16 |
JP2006517824A (ja) | 2006-08-03 |
FR2851154B1 (fr) | 2006-07-07 |
US7520887B2 (en) | 2009-04-21 |
KR101066714B1 (ko) | 2011-09-21 |
CA2516323C (en) | 2010-01-19 |
WO2004073533A1 (en) | 2004-09-02 |
AU2004212776A1 (en) | 2004-09-02 |
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