CN100574728C - Replacement device and system - Google Patents
Replacement device and system Download PDFInfo
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- CN100574728C CN100574728C CN03807584A CN03807584A CN100574728C CN 100574728 C CN100574728 C CN 100574728C CN 03807584 A CN03807584 A CN 03807584A CN 03807584 A CN03807584 A CN 03807584A CN 100574728 C CN100574728 C CN 100574728C
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Abstract
The invention discloses a kind of replacement device (10), this replacement device comprises: have first anchor plate (16) first implantable (12) and with this separable coupled concave volume of first anchor plate (16) (18), and, have second anchor plate (20) second implantable (14) and with this separable coupled convex body of second anchor plate (20) (22), this convex body (22) is used for movably meshing with concave volume (18), wherein said concave volume uses first male part to be coupling in this manner on described first anchor plate, thereby along with removing of first male part, allow described concave volume to separate, keep described first anchor plate simultaneously and be implanted on the vertebra from described first anchor plate; Perhaps wherein said convex body uses second male part to be coupling in this manner on described second anchor plate, thereby along with the removing of second male part, allows described convex body to separate from described second anchor plate, keeps described second anchor plate simultaneously and is implanted on the vertebra.
Description
The cross-reference of related application
The application's requirement enjoys in submit applications on March 30th, 2002, application number is 60/368,783 and in submit applications on May 16th, 2002, application number is 60/381, the priority of 529 U.S. Provisional Patent Application, these two applications all be with Lytton Williams as first inventor, its whole contents as this paper all the such integral body of statement be incorporated herein by reference.
Technical field
The present invention relates to be implanted to intravertebral replacement device of patient and system thereof.
Background technology
The spinal column of human body is flexible structure, and it comprises 33 by the separated vertebra of intervertebral disc.Intervertebral disc serves as the amortisseur liner between the adjacency vertebra and allow bending between the vertebra.Usually, intervertebral disc is by vertebral pulp, and fibrous ring and end plate are formed.Vertebral pulp comprises inner tremelloid nuclear, and this nuclear occupies the 25-40% of described dish cross-sectional area.Fibrous ring is the collagen fibers composite construction, and it is added in hoop power, torsion and bending force on the dish around vertebral pulp and opposing.The end plate of cartilage will coil with vertebra in each side of dish to be separated.
Current, back pain is ubiquitous public health problem, particularly in the old people.The backache meeting with serious that continues makes the patient become weak and incapacitation.The common cause that causes this pain is normally because intervertebral disc is unusual.For example, wound, stress, damage, disease, perhaps abuse all may cause one or more vertebra and/or one or more intervertebral disk injury.More precisely, the disease of vertebra and intervertebral disc may comprise, but be not limited to: (1) disk ring ruptures such as ring crack; (2) intervertebral disc chronic inflammatory disease; (3) with the local prolapse of intervertebral disc that comprises or break away from extruding; And (4) are around the vertebra instability of intervertebral disc.
Invented out the method for various treatment backaches.For instance, lighter backache can be passed through medicine or other harmless therapy for treating.Yet serious backache need be excised the impaired or cacergastic back of at least a portion tissue usually.Intervertebral disc also might break, and disruptive intervertebral disc can remove by surgical operation, and two adjacent vertebraes can merge near the intervertebral disc that is removed.Selectable, the end plate of two adjacent vertebraes can be merged from rear side by screw or other fusing device.Though these fusion steps confirm that the cacergastic treatment to some intervertebrals is successful, have also exposed some shortcomings.For instance, this back mixing operation may produce pseudarthrosis.
As previously mentioned, need development can imitate the implantable intervertebral device of vertebra natural motion.
Summary of the invention
The application relates to multiple intervertebral device, and this intervertebral device can be implanted in patient's spinal column in several ways, with the treatment various disease conditions.
The invention discloses the embodiment of replacement device, this replacement device comprises first implantable, have first anchor plate that is implanted on the vertebra and with the separable coupled concave volume of this first anchor plate; And, second implantable, have second anchor plate that is implanted on the vertebra and with the separable coupled convex body of this second anchor plate, this convex body is used for movably meshing with concave volume, wherein said concave volume uses first male part to be coupling in this manner on described first anchor plate, thereby along with removing of first male part, allow described concave volume to separate, keep described first anchor plate simultaneously and be implanted on the vertebra from described first anchor plate; Perhaps wherein said convex body uses second male part to be coupling in this manner on described second anchor plate, thereby along with the removing of second male part, allows described convex body to separate from described second anchor plate, keeps described second anchor plate simultaneously and is implanted on the vertebra.
In another embodiment, intervertebral device is disclosed, and this intervertebral device comprises: first implantable, this first implantable has first anchor plate and the separable concave volume that is coupled on this first anchor plate that is implanted on the vertebra, and many anchor logs place on the described anchor plate periphery; And second implantable, this second implantable has second anchor plate and the separable convex body that is coupled on this second anchor plate that is implanted on the vertebra, many anchor logs place on the described anchor plate periphery, described convex body is used for movably meshing with described concave volume, wherein said concave volume uses first male part to be coupling in this manner on described first anchor plate, thereby along with removing of first male part, allow described concave volume to separate, keep described first anchor plate simultaneously and be implanted on the vertebra from described first anchor plate; Perhaps wherein said convex body uses second male part to be coupling in this manner on described second anchor plate, thereby along with the removing of second male part, allows described convex body to separate from described second anchor plate, keeps described second anchor plate simultaneously and is implanted on the vertebra.
In yet another embodiment, described and partly coiled intervertebral device, and comprised, first's dish device, this first's dish device has first anchor plate and separable half concave volume that is coupled to described first anchor plate, and many anchor logs place on the described first anchor plate periphery; And second portion dish device, this second portion dish device has second anchor plate and the separable semi-convex body that is coupled on described second anchor plate, many anchor logs place on the described second anchor plate periphery, and described semi-convex body is used for movably meshing with described half concave volume.
In addition, described and in patient's spinal column, to have implanted the method for intervertebral disk prosthesis, and be included in the dish gap be provided between two adjacent vertebraes, in the dish gap, place at least one intervertebral disk prosthesis, with the end plate of vertebra cartilage be positioned at least one anchor log engagement on the intervertebral disk prosthesis.
In another embodiment, the method of implanting intervertebral disk prosthesis in patient's vertebra is disclosed, and be included in provide between two adjacent vertebraes the dish gap, in this dish gap, be placed on its inside and have first implantable of concave volume, with at least one anchor log engagement on the end plate of vertebra cartilage and first implantable, in the dish gap, place second implantable with convex body, make the end plate of vertebra cartilage and second implantable go up at least one anchor log engagement, and first implantable concave volume is engaged in the convex body on second implantable.
In yet another embodiment, the method of repairing the intervertebral disc device that is implanted into the patient body is disclosed, and be included in provide between two adjacent vertebraes the dish gap, has first implantable first vertebra that is implanted to wherein, first implantable coupling with concave volume coupled with it, and, has implantation second implantable second vertebra wherein, second implantable coupling with convex body coupled with it, remove and concave volume is coupled to first implantable male part, remove concave volume and stay first anchor plate that is implanted to first vertebra from first implantable, on first anchor plate, place the concave volume of replacing, by male part the concave volume of replacing is coupled to first anchor plate, and makes the convex body engagement of first implantable the replacement concave volume and second anchor plate.
In addition, the anterior lateral approach (anterior lateral method) that gets involved patient's vertebra has been described here, and comprise, patient is placed lateral position, determine the position of the intervertebral disc that will enter in the spinal column, the dish gap by the needs reparation, the inboard and outside cuts out otch along the axis in patient skin, cutting subcutaneous tissue and the fascia under it, blunt is peeled off outer oblique, blunt is peeled off transversus, blunt is peeled off internal oblique, and blunt is peeled off the peritoneum behind the vertebra, does not damage lumbal plexus or nerve root ground pro-or peels off psoas muscle at the back blunt, regain peritoneum to the inside and towards vertebra head side, the vascular that ligation is cut open, and the vascular of ligation regained with the outside to the inside, to be provided to the passage of vertebra.
Other purpose of the present invention, feature, and advantage will embody in the specific descriptions below.
Description of drawings
Fig. 1 is the perspective view of replacement device embodiment;
Fig. 2 is the longtitudinal view of replacement device embodiment;
Fig. 3 is the front view of replacement device anchor plate embodiment;
Fig. 4 is the perspective view of the replacement device first anchor plate embodiment, and concave volume is removed from it;
Fig. 5 is the side view of the replacement device first anchor plate embodiment, and concave volume is from wherein removing along line 5-5 shown in Figure 4;
Fig. 6 is the perspective view of the replacement device concave volume embodiment that removes from first anchor plate;
Fig. 7 is the side view of the replacement device concave volume embodiment that removes along line 7-7 shown in Figure 6 from first anchor plate;
Fig. 8 is the perspective view of first implantable embodiment of replacement device;
Fig. 9 is the perspective view of first implantable another embodiment of replacement device;
Figure 10 is the perspective view of first implantable the embodiment of replacement device in the assembling;
Figure 11 is the perspective view of first implantable embodiment of the replacement device that assembles;
Figure 12 is the perspective view of second implantable embodiment of replacement device;
Figure 13 is the perspective view of the replacement device second anchor plate embodiment, and convex body is from wherein removing;
Figure 14 is the side view of the second anchor plate embodiment of replacement device, and convex body edge line 14-14 as shown in figure 13 removes;
Figure 15 is the perspective view of the replacement device convex body embodiment that removes from second anchor plate;
Figure 16 is along the embodiment side view of line 16-16 shown in Figure 15 from the second anchor plate replacement device convex body
Figure 17 is the perspective view of replacement device toxoplasma embodiment;
Figure 18 is the embodiment view of replacement device convex body spare;
Figure 19 is another embodiment view of replacement device convex body spare;
Figure 20 is the longtitudinal view of replacement device embodiment, and power is applied on it along its center line;
Figure 21 is the longtitudinal view of replacement device embodiment, and power departs from center line and is applied on it;
Figure 22 is another embodiment view of replacement device convex body;
Figure 23 is a replacement device embodiment longtitudinal view shown in Figure 22, and power is applied on it along its center line;
Figure 24 is a replacement device embodiment longtitudinal view shown in Figure 22, and power departs from its center line and is applied on it;
Figure 25 is a part dish displacement apparatus embodiment view;
Figure 26 is the part dish displacement apparatus diskware embodiment of a first view;
Figure 27 is a part dish displacement apparatus second portion diskware embodiment view;
Figure 28 is that intervertebral disc is positioned at two adjacent intervertebral perspective views;
Figure 29 is that intervertebral disc is positioned at two at a distance of the perspective view between the adjacent vertebrae of distance D 6;
Figure 30 is the perspective view of two adjacent vertebra distance of separation D6;
Figure 31 is that second implantable of replacement device is positioned at two adjacent intervertebral embodiment perspective views;
Figure 32 is second implantable of replacement device and the coupled embodiment perspective view of vertebra;
Figure 33 is that first implantable of replacement device is positioned at two adjacent intervertebral embodiment perspective views;
Figure 34 is first implantable of replacement device and the coupled embodiment perspective view of vertebra;
Figure 35 is and coupled first implantable embodiment perspective view that is meshed with coupled second implantable of adjacent vertebrae together of vertebra;
Figure 36 is and coupled first implantable another embodiment perspective view that is meshed with coupled second implantable of adjacent vertebrae together of vertebra;
Figure 37 is second implantable the perspective view before convex body replaces it that is coupled to vertebra;
Figure 38 is coupled to second implantable of vertebra to carry out the perspective view that convex body is replaced, and in the drawings, convex body removes;
Figure 39 is coupled to second implantable of vertebra to carry out the perspective view that convex body is replaced, and wherein, replaces the convex body of usefulness and has put into the dish gap;
Figure 40 is and coupled first implantable embodiment perspective view that is meshed with coupled second implantable of adjacent vertebrae together of vertebra;
Figure 41 is before the dish fusion process, with coupled first implantable embodiment perspective view that is meshed with coupled second implantable of adjacent vertebrae together of vertebra
Figure 42 be with dish fusing device coupling before, the embodiment perspective view that first anchor plate and second anchor plate are coupled with vertebra respectively; And
Figure 43 embodiment perspective view that to be first anchor plate that formerly is coupled with vertebra respectively and second anchor plate be coupled with the dish fusing device.
The specific embodiment
Replacement device disclosed herein can be implanted in the mammiferous spinal column.The intervertebral disk prosthesis that is different from formerly has the accessories apparatus that is used for fiber disc vertebral pulp or fibrous ring, intervertebral disk prosthesis disclosed herein comprises at least one anchor plate, this anchor plate has one or more anchor logs thereon, this anchor log is used for the dish displacement apparatus is meshed and is coupled with the spinal vertebrae cartilaginous end plates, thus in case implant the steadiness that can increase device.In addition, replacement device disclosed herein can have the replacement assembly, makes that thus the surgeon can be according to each patient's the physiology's restriction and the change customization related device of physiological conditions.In addition, replacement device can be made different sizes, make thus device can the implant patient spinal column in different positions.For instance, the size of intervertebral device is used for the lumbar segment of implant patient spinal column.In another embodiment, the size of intervertebral device is for implantation into the cervical vertebra section of patient's spinal column.
Fig. 1 and Fig. 2 illustrate embodiment different views of replacement device.As shown in Figure 1, intervertebral device 10 comprises first implantable 12 and second implantable 14, and this size of second implantable makes movably engagement of itself and first implantable 12.Comprise first anchor plate 16 for described first implantable 12, on this anchor plate, be shaped on concave volume 18.Similarly, described second implantable 14 comprises second anchor plate 20, be shaped on convex body 22 on this anchor plate.Selectable, this convex body 22 can use, and for instance, male part 23 is connected to second anchor plate 20 separably.Though do not illustrate, concave volume 18 can use male part 23 to be connected separably with first anchor plate 16.Male part 23 can include, but are not limited to for instance, comprises the screw of holding screw, bolt, pin, locking piece, button, cover pinning, friction holding device, magnetic force holding device and springlock.Each first and second anchor plate 16,20 can include one or more anchor log 24 from wherein extending.As shown in Figure 1, anchor log 24 can place first and second anchor plates, 16,20 peripheries, makes described anchor log 24 thrust and remain on thus and installs in surface or the structure.For instance, anchor log 24 can thrust and remain in the hyaloidin end plate of patient's vertebra.This first implantable 12, the second implantable 14, perhaps their boths can comprise therapeutic agent or marking agent thereon.For instance, this first implantable 12, the second implantable 14, perhaps their boths can plasma sprayings or are comprised anchor log 24 plasma spraying or that cover titanium layer thereon.
Fig. 3 is illustrated in detail in first anchor plate 16 that its periphery has a plurality of anchor logs 24.As shown in Figure 3, anchor log 24 comprises grappling body 26, and this grappling body 26 defines anchor cavity 28.This is formed at anchor cavity 28 in the grappling body 26 and allows or promote tissue or bone grafting material to grow in it or by anchor cavity 28 growths, thus with first anchor plate 16 firm be coupled to vertebra.Anchor log 24 can comprise sharp keen or sharp-pointed tip 30, and this tip makes anchor log 24 can thrust contiguous tissue.For instance, in migration process, when limiting or eliminate the division of vertebra, these anchor log 24 described sharp keen tips 30 make anchor log enter into easily in the end plate of vertebra.In another embodiment, anchor log 24 can not use sharp keen or sharp-pointed tip, and by circle, blunt or atraumatic most advanced and sophisticated the replacement.
As shown in Figure 3, grappling body 26 comprises successive wall, and this wall defines anchor cavity 28.Nonrestrictive, at least one grappling body 26, anchor log 24, perhaps anchor plate 16,20, comprise at least one passage, groove, short and small teat, button, perforation thereon, and perhaps other interruption is in its surface grown to help or to promote to organize within it.For instance, limit the surface, inside of anchor cavity 28, the outer surface of anchor cavity 26, perhaps two of anchor cavity 26 surfaces all are porous or coarse promoting being organized in growth inside, or slick to make things convenient for anchor log 24 to penetrate in the vertebra.In another embodiment, anchor log 24, anchor plate 16,20, perhaps the two all can comprise a cover layer, for example titanium-plasma cover layer or have groove thereon and rough surface is provided thus.
Place the anchor log 24 on the anchor plate 16,20 can make different length, diameter, perhaps shape.In one embodiment, anchor log 24 comprises solid column or body.In an optional embodiment, anchor log 24 comprises structure hollow or piped.For instance, be formed at anchor cavity 28 in the anchor log 24 can have about 0.5 millimeter to about 0.9 millimeter breadth wise dimension.In another embodiment, the tip part 32 of anchor log 24 can be straight, crooked, disperse, astringent, and/or can comprise an edge, and antelabium, perhaps cut-out feature is organized in growth inside to strengthen or to improve.In another embodiment, anchor log 24, anchor plate 16,20, it is placed on it that perhaps the two can have therapeutic agent.The example of therapeutic agent can comprise, for example, hydroxyapatite, biological activity protein (for example, osteogenin albumen), perhaps other promotion is organized in the wherein therapeutic agent of growth.In another optional embodiment, anchor plate 16,20 placed on it and/or anchor log 24 can plasma sprayings or can be comprised titanium projection or salient point.Comprise that as first anchor plate, 16, the second anchor plates 20 being similar to the front describes such anchor log 24 (referring to Fig. 1-2).
As Figure 1-3, this anchor log 24 is vertical extends out from anchor plate 16,20.In an optional embodiment, anchor log 24 extends out at a certain angle from first and second anchor plates 16,20 respectively, and can be straight substantially, curved, taper, disperse, truncated cone-shaped, perhaps conical.This anchor log 24 can or be made with anchor plate 16,20 by the state of the art and anchor plate 16,20 global formations and link to each other, such as, the plasma welding.First and second implantable 12,14, respectively, perhaps any part wherein, can from or merge a plurality of biocompatible materials in addition and make, comprise, indefiniteness, titanium or titanium alloy, rustless steel, cobalt-chromium alloy, vanadium, pottery or ceramic material, as aluminium oxide and zinc oxide ceramics, Nitinol, memorial alloy, plastics, at commercial known " polyether-ether-ketone (peek) " (polyether-ether-ketone) (polyetherether ketone) or " super polyether-ether-ketone (Ultrapeek) " (polyether-ketone, ether ketone, ketone) carbon fiber reinforced polymer, Merlon, polypropylene, polyethylene is inserted the polysulfone plastic material of glass or carbon fiber cellulose B (carbon fibers Kevlar), synthetic material, the different metal alloy, lactoprene, perhaps other bio-compatible is chemical inert material substantially.In addition, intervertebral device of the present invention can comprise, (echogenic) of echo gene, and ray is impervious, perhaps radiolucent material.
Fig. 4-8 illustrates first implantable 12 difference composition.Shown in Figure 4 and 5, first anchor plate 16 comprises substrate 40, and this substrate is used for accepting thereon and supports one or more anchor log 24.This substrate 40 keeps wall 42A with first and second respectively, and 42B is communicated with.First keeps flange 44A and first to keep wall 42A to form integral body, is connected with it, perhaps otherwise coupled logical, limits the first retaining groove 46A thus.Similarly, second keeps flange 44B and second to keep wall 42B to form integral body, is connected with it, perhaps otherwise coupled logical, limits the second retaining groove 46B thus.The inner surface 48 of substrate 40 further limits the first and second retaining groove 46A, 46B respectively.As a result, receptor concave volume receptor 50 keeps wall 42A, 42B by the inner surface 48, the first and second of substrate 40, and first and second keep flange 44A, 44B to form.As shown in Figure 4, at least one male part groove 52 can be formed at first and keep wall 42A, and second keeps wall 42B, perhaps on these two maintenance walls.Selectively, at least one male part groove 52 can be formed on any parts of foregoing first anchor plate 16.
Fig. 6-9 shows concave volume 18 and removes from first anchor plate 16 (referring to Fig. 4-5).Concave volume 18 defines groove 60 therein.As shown in Figure 6, groove 60 limits longitudinal concave arc A1, this spill arc A1 and longitudinal axis L
oSide by side, horizontal spill arc A2 and transverse axis L
aSide by side, perhaps groove limits the two, and thus, when meshing with the first implantable element 12 (referring to Fig. 2), second implantable 14 is free to along spill arc A1, and A2 or the two move.In the embodiment shown in this, concave volume 18 comprises the first and second plain-straight-face flange 62A respectively, 62B, and this flange is respectively adjacent to groove 60.As shown in Figure 9, concave volume 18 can comprise four plain-straight-face flange 62A, 62B, and 62C, 62D, these flanges are respectively adjacent to groove 60.Concave volume 18 can be made does not have plain-straight-face flange, perhaps selectable, can be shaped on the plain-straight-face flange of any amount thereon.Still with reference to Fig. 6-9, plain-straight-face flange 62A, 62B can limit groove 60.In addition, plain-straight-face flange 62A, 62B can make when second implantable 14 and first implantable 12 engagement, be used for limiting or limit second implantable 14 vertically, side direction, rotation, arc or transverse movement.
Still with reference to accompanying drawing 6-8, concave volume 18 comprises at least the first supporting walls 64A and the second supporting walls 64B.The first coupling track 66A is manufactured on the first supporting walls 64A.Same, the second coupling track 66B is manufactured on the second supporting walls 64B.The substrate 68 and the first and second coupling track 66A, 66B connects.The first and second coupling track 66A, 66B is assembled so that be contained in the receptor concave volume receptor 50, and with first and second keep flange 44A, 44B meshes (referring to Figure 4 and 5), separably concave volume 18 is coupled to first anchor plate 16 thus.Can hold the male part receptor 70 of male part 23 therein, receptor can place any part of aforementioned concave volume 18.
In the illustrated embodiment, concave volume 18 comprises the coupling track 66A that can mesh first anchor plate 16,66B, thereby with concave volume 18 separable first anchor plates 16 that are connected to.In optional embodiment, can use various coupling device well known in the art with described concave volume 18 separable first anchor plates 16 that are coupled in, these coupling devices comprise, for instance, the device of frictional fit, locking piece, magnetic coupling device, reverse lock (twist locks), perhaps the snap-fastener adapting device.
Figure 10 and 11 illustrates first implantable device 12 of assembling different phase.As shown in the figure, substrate 40 inner surfacies of substrate 68 contiguous first anchor plates 16 of concave volume 18.Afterwards, advancing in concave volume 18 edges line L1 as shown in figure 10, advances in the receptor concave volume receptor 50 of first anchor plate 16 in the last concave volume 18.The continuous process that concave volume 18 enters receptor concave volume receptor 50 makes the first and second supporting walls 64A, the 64B and the first and second coupling track 66A, 66B and first and second keeps wall 42A, 42B and first and second keeps flange 44A, the 44B engagement is therefore with concave volume 18 separable first anchor plates 16 that are connected to.Retractible or separable male part 23 can be inserted into (as Fig. 4 and 6) in male part groove 52 and the male part receptor 70, thus concave volume 18 is fixed to first anchor plate 16.In the embodiment shown, concave volume 18 is made along transverse axis L
aSlide and mesh and be coupled to first anchor plate 16.In optional embodiment, concave volume 18 is made along longitudinal axis L
oSlide and mesh and be coupled to first anchor plate 16.
Figure 12-19 illustrates second implantable 14 embodiment.As shown in the figure, second implantable 14 comprises second anchor plate 20, and this anchor plate has and its separable convex body that is connected 22.One or more anchor log 24 is placed on it or be communicated with this second anchor plate 20.At least one male part 23 is used for convex body 22 is fixed to second anchor plate 20.As shown in figure 12, convex body 22 can limit convex arc A3 longitudinally, horizontal convex arc A4, and perhaps therefore the two, when meshing first implantable 12 (with reference to Fig. 8), can move freely second implantable 14 convex body 22 in concave volume 18.Described convex arc A3 and A4 can be symmetric, asymmetrical.
With reference to Figure 13 and 14, second anchor plate 20 comprises the substrate 80 that is shaped on convex body receptor 82 thereon, receptor.In one embodiment, convex body receptor 82 can become one with the inner surface 84 of substrate 80 or be attached to it.The outer surface 86 of substrate 80 can comprise one or more anchor log 24 thereon thereon.In the illustrated embodiment, anchor log 24 places on the periphery of outer surface 86 of substrate 80, therefore makes anchor log 24 engagements and remaining in the end plate of patient's vertebra cartilage.In the illustrated embodiment, a convex body receptor 82 is positioned on the inner surface of substrate 80.In optional embodiment, the convex body receptor 82 of any amount can be positioned on the inner surface of substrate 80.Convex body receptor 82 can comprise and is positioned on the coupling body 90 or the couple flange 88 that is connected with this coupling body, therefore forms coupling groove 92, and this coupling groove meshes with convex body 22, and convex body is remained on wherein.Couple flange 88 is slotted as shown in figure 13.Yet this couple flange 88 is not the groove structure shown in being defined as, and the making toxoplasma 100 be inserted into horizontal, vertical or vertically be engaged to coupling groove 92 of its manufacturing, thus with convex body receptor 82 fixed engagement and be coupled to second anchor plate 20.In another embodiment, couple flange 88 can comprise or comprise in a different manner successive flange, groove, perhaps other coupling shape.At least one securing member receptor 94 that can receive male part 23 (referring to accompanying drawing 12) can be positioned on the random component of described second anchor plate 20.
Figure 15-17 shows the embodiment of the convex body 22 of intervertebral device 10.As shown in the figure, convex body 22 comprises toxoplasma 100, and this toxoplasma comprises first surface 102, and this first surface has at least one convex body bonder 104 thereon.First and second supporting walls 106,108 divide other, are connected 102 with first surface and connect.Bottom 110 and first and second supporting walls 106,108 connect.In the illustrated embodiment, bottom 110 is connected with first surface 102.In optional embodiment, bottom 110 can not contact with first surface 102.At least one fastening groove 112 is positioned on first supporting walls 106.Selectable, fastening groove can be positioned on second supporting walls 108 or the bottom 110.Fastening groove 112 is assembled and is used for receiving therein male part 23 (referring to Fig. 2), thus with convex body 22 removable be connected to second anchor plate 20.
Convex body spare 120 comprises mating surface 122, and this surface movably is engaged to the groove 60 of first implantable 21 (referring to Fig. 6).Coupled surface 124 can place in abutting connection with mating surface 122, and can comprise at least one coupling securing member 126 thereon.Coupling securing member 126 and toxoplasmatic convex body bonder 104 engagements, and keep this convex body bonder therein.In the illustrated embodiment, coupling securing member 126 first surface that is coupled to toxoplasma 100 102 that convex body spare 120 is removable.The first surface that is coupled to toxoplasma 100 102 selectable, that coupling securing member 126 is non-removable with convex body spare 120.Can use various coupling securing member 126 well known in the art so that convex body spare 120 is coupled on the toxoplasma 100, this comprises, for instance, sells the keeper of slidable fit, friction keeper, springlock, and twistlock.In another embodiment, convex body spare 120 can be made one with toxoplasma 100 or be connected with this toxoplasma 100, uses method well known in the art, comprises, for instance, stick coupling, rotating welding, sound wave welding, surface casting (over-casted), with the foundry goods molding, and can comprise global feature, such as undercutting (undercut) hole or groove are arranged thereon.
With reference to Figure 16 and 17, at least second supporting walls 108 of toxoplasma 100 comprises bindiny mechanism or connects groove 114, this bindiny mechanism or connect groove and be used to mesh convex body receptor 82 on second anchor plate, 20 inner surfacies 84, thus, with convex body 22 removable be coupled to second anchor plate 20.Male part 23 can place the fastening groove 112 of convex body 22 and the securing member receptor 94 of second anchor plate 20, convex body 22 is fixed to second anchor plate 20.In the illustrated embodiment, connecting hole 116 and retaining groove 118 cooperates is coupled to convex body 22 second anchor plate 20.Selectable, can use various coupling mechanisms that convex body 22 is coupled to second anchor plate 20, comprise, for instance, magnetic coupling device, twistlock, slidable fit device, friction fit device, lock token, and other coupling mechanism well known in the art.In the illustrated embodiment, convex body 22 is assembled into meshing and coupling with second anchor plate 20 of can sliding along lateral shaft.In optional embodiment, convex body 22 is assembled into meshing and coupling with second anchor plate 20 of can sliding along the longitudinal axis.
The curvature on toxoplasma 100 surfaces 102 and shape can be decided by the thickness and the surface curvature of needed convex body spare 120.The radius of curvature of second implantable 20 convex body 22 can be a constant, perhaps convex arc A3 longitudinally, and along horizontal convex arc A4, perhaps both change along them.Figure 18 illustrates convex body spare 120 embodiment, and it has the radius of curvature R 1 that is roughly constant.Selectable, Figure 19 illustrates the embodiment of convex body spare 120, and it has the radius of curvature of variation.As shown in the figure, proximal end region 128A has radius of curvature R 2, and the radius of curvature of zone line is R3, and the radius of curvature of remote area is R4, and wherein radius R 2 and R4 are bigger than radius R 3.Similarly, groove 60 (referring to Fig. 4) can comprise it roughly being the radius of curvature of constant, and is perhaps selectable, changes as described in can be upward.
The center line M of applying as power F2 from intervertebral device 10
LShift second implantable 14 rotation in first implantable 12.As shown in figure 21, be applied to power F2 located adjacent proximal end zone 150 on second implantable 14.As a result, the convex body 22 that is coupled in second anchor plate 20 rotates in the concave volume 18 that is coupled in first anchor plate 16.As a result, first implantable 12 proximal end region is separated a segment distance D2 from second implantable 14 proximal end region 150, and wherein distance D 2 is less than distance D 1.As shown in the figure, second implantable 14 moving in first implantable 12 can be freely, offers intervertebral device 10 thus along the longitudinal axis, transverse axis, perhaps these two axle motions in a big way.
Figure 22-24 illustrates the optional embodiment of convex body spare 22 ', and second implantable 14 ' rotatablely moving in first implantable 12 is affined therein, and be conditional, or limited.As shown in Figure 22, restricted convex body 22 ' comprises body 200, and this body is shaped on toxoplasma 202 thereon.In one embodiment, toxoplasma 202 is as a whole with body 200.In optional embodiment, this toxoplasma 202 comprises that by various coupling mechanisms for instance, screw is fastened, pin, and bonding agent, and separable and body 200 is coupled.Toxoplasma 202 can comprise convex body bonder 204, and this adapter is used for receiving therein the coupling securing member 126 (referring to Figure 16) of convex body spare 120.Body 200 comprises the connection groove 214 that is formed at wherein, to be used for meshing therein and keeping the convex body receptor 82 (referring to Figure 13) of second anchor plate 20.At least be shaped on a limit flange on the body 200.In the illustrated embodiment, the first limit flange 205A and the second limit flange 205B are along the longitudinal axis L of body 200
oBe provided with.In optional embodiment, one or more limit flange 205A, 205B can be along the transverse axis L of body 200
aBe provided with.
Shown in Figure 23 and 24, the convex body spare 22 ' that is limited can be coupled with second anchor plate 20.Toxoplasma 202 is inserted in first implantable 12 the groove 60 and is engaged with.Figure 23 shows along centrage M
LBe applied to first implantable 12 and implantable 14 ' the power F3 that is limited.Between the second limit flange 205b and first implantable 12 a segment distance D3 is arranged.As shown in figure 24, when leaving center line M
LWhen applying power F4, the first limit flange 205A and 140 engagements of convex body proximal end region define the second limit flange 205B thus and can leave first implantable 12 ultimate range D4.
The optional embodiment of Figure 25-27 intervertebral device.As shown in the figure, part or partly coil (as, the intervertebral disc of partial rupture) that device 210 can be used to replace damage, (as scoliotic) of pathological changes, the perhaps vertebra of other incomcopetence.Intervertebral device 10 shown in the image pattern 1 is such, and part is coiled device 210 and comprised first's diskware 212 and second portion diskware 214.As foregoing first implantable 12, first's diskware 212 comprises first anchor plate 216, and this first anchor plate is separable to be coupled with half concave volume 218.One or more anchor log 24 is used for that device is coiled in first and is connected to patient's anatomy.For instance, anchor log can coil first the end plate that device 212 meshed and be coupled to vertebra.Similarly, second portion dish device 214 comprises second anchor plate 220, has one or more anchor log 24 on this anchor plate, separable and semi-convex body 222 couplings of this anchor plate.Half concave volume 218 and semi-convex body 222 use coupling device well known in the art, respectively with 216,220 couplings of first and second anchor plates.For instance, can use coupling device described above and method, respectively, be coupled to first and second anchor plates 216,220 half concave volume 218 and semi-convex body 222.
Then, the reference location of on patient skin, drawing labelling, and X ray, for instance, the AP/LAP X ray of patient's spine uses the intervertebral disc position of labelling.In case the position of intervertebral disc is determined and labelling gets off, just coil on the gap or near directly cut out otch.The length of otch may be different according to patient's anatomical features.In another embodiment, the otch on the patient skin can be 2.5 centimetres to 10 centimetres.Otch can be from inboard position, cross-table, and end at lateral position.In another embodiment, the central authorities of otch can evenly extend 2.5 centimetres from the axillary fossa center line, and the intervertebral disc that will be repaired (such as, L5-S1) outside, gap is extended 2.5 centimetres.Otch passes subcutaneous tissue and arrives fascia under it.In addition, outer oblique separates along its fiber blunt.Flesh is crosswise formed similar blunt with internal oblique to be separated.
Then, determine peritoneum, and use blunt to separate therein.The blunt of peritoneum is implemented after being separated in patient's spinal vertebrae body.The self-sustaining retracting device is inserted into this position with muscle around keeping, and the inlet of repairing the position is provided.The psoas muscle that needs on the vertebral body to repair is discerned, and blunt is peeled off or muscle division incision therein.This is peeled off or cuts and can implement before separating vertebra dish gap and end plate and afterwards, does not damage lumbosacral plexus or nerve root from surrounding structure.Traction apparatus is inserted into interesting areas with the separator gap.For instance, Stiemman pin or Homer traction apparatus can further be fixed this interesting areas.
Continue to peel off inboard, a side and tail side that tissue and peritoneum are recovered to cone.Selectable, peritoneum can be recovered to the afterbody of the cone that needs reparation.Be accompanied by peritoneum and regain, the blood vessel of cutting can, but be not necessary, ligation is also turned back with the outside to the inside, and the dish gap can be recognized.Continue front side and rear side and peel off, with further segregation dish gap.Traction apparatus such as the Homer traction apparatus or have the Stiemman pin of flange, can be placed into dish gap near-end, and the intervertebral disc passage of front side or rear side is provided thus.
Figure 28-35 illustrates a kind of method that intervertebral device 10 is inserted into patient's spinal column.As shown in figure 28, the intervertebral disc 250 of damaged places between two adjacent vertebraes.Vertebra L4 and L5 are shown in Figure 28-30, yet those of ordinary skills can understand, and this intervertebral device 10 can be inserted in the diverse location of patient's spinal column.The external rings fiber pulls up from end plate, and vertebral pulp and ring remove from impaired intervertebral disc 250 together, can remove impaired intervertebral disc thus.Shown in Figure 29 and 30, adjacent vertebra L4, the L5 branch is opened a segment distance D6, and impaired intervertebral disc 250 removes from the dish gap.Fragment can remove from the dish gap such as hyperosteogeny or remaining intervertebral disc material.
Be accompanied by the dish gap and removed fragment, the assembly of intervertebral device 10 just can be inserted in patient's the spinal column.Shown in Figure 31 and 32, can place the dish gap for second implantable 14 and be inserted into vertebra L4, so that the end plate of anchor log 24 and vertebra meshes and is fixed therein.Be accompanied by second implantable 14 and be fixed to vertebra L4, first implantable 12 can be inserted into adjacent vertebra L5.Shown in Figure 33-35, first implantable 12 can place the dish gap, and anchor log 24 and the engagement of vertebra L5 end plate, and is fixed therein.In implantation process, first and second implantable 12,14 with the vertebra and the relativeness of anatomical structure on every side, can pass through, for instance, X ray, IVUS and echolocation device monitor.In the illustrated embodiment, second implantable 14 insertion is early than first implantable 12 insertion, and is the insertion with respect to first implantable 12 cephalad.One of ordinary skill in the art will appreciate that the order of implantation and implantable device 12,14 positions respect to one another can change, and are not limited only to order recited above and position.
Shown in Figure 36-40 is that the assembly to the intervertebral device 10 implanted is changed when implanting.Figure 36 illustrates the intervertebral device 10 with first implantable 12 and second implantable 14 and is implanted between vertebra L4 and the L5.Change the assembly of this intervertebral device 10, with adjacent vertebra L4, L5 separates, with the passage of the intervertebral device 10 that is provided to implantation.Then, the coupling device 23 that concave volume 18 or convex body 22 is respectively fixed to first or second anchor plate 16,20 is removed.As Figure 37, shown in 38, along with removing of coupling device 23, convex body 22 can separate from second anchor plate 20, stays second anchor plate 20 that is coupling on the vertebra L4 thus.Then, shown in Figure 39 and 40, the convex body of replacing 22 is placed in the dish gap.Convex body receptor 82 on the coupling groove 114 on the convex body 22 of this replacement and second anchor plate 20 meshes and is maintained by it, thus the convex body of replacing 22 is coupled to second anchor plate 20.In case coupling, coupling device 23 just can be inserted in the fastening groove 12 of convex body 22 of replacement, and in the securing member receptor 94 of second anchor plate 20, fix.First implantable 12 concave volume 18 can be changed from 16 separation of first anchor plate and with above-mentioned identical mode.
In optional embodiment, concave volume 18 and convex body 22 can remove from first and second anchor plates respectively, and put replacement by coiling and attaching together, and thus, merge vertebra L4 and L5.As shown in figure 41, first and second implantable 12,14, vertebra L4, the L5 of implantation are separated by distance D 7.Then, vertebra L4, L5 branch open a segment distance D8 so that the passage in dish gap to be provided.In case separately, male part 23 removes on first and second implantable 12,14, makes concave volume 18 to remove from first anchor plate 16 thus, convex body 22 can remove from second anchor plate 20.As shown in figure 42, first and second anchor plates 16,20 are connected with vertebra L4, L5.Then, coupling apparatus 260 is inserted into the dish gap, and is coupled by one or more male part 23 and first and second anchor plates 16,20, thus with vertebra L4 and L5 and be incorporated into together.Can with first close second anchor plate, 16,20 coupled exemplary combination or implanting device is disclosed in the United States Patent (USP) 6,113,638 of granting Lytton.A.Williams, its whole disclosure is incorporated in this as a reference as a whole.
In case this intervertebral device 10 is implanted, the surgeon can remove traction apparatus so that peritoneum is got back to natural place.Before closing surgical site, the surgeon can be at vertebra, gives therapeutic agent on peritoneum or the surrounding tissue.Then, closed subcutaneous tissue and stitching.
In a word, the embodiment that disclosed here of the present invention is the explanation of the first-selected embodiment of the present invention.Also can use other method in spirit of the present invention.Therefore, the present invention is not limited only to shown in the description of the present invention with described.
Claims (31)
1. replacement device comprises:
One first implantable, have first anchor plate and a separable concave volume that is coupling on described first anchor plate that is implanted on first vertebra; And
One second implantable, have second anchor plate and a separable convex body that is coupling on described second anchor plate that is implanted on the second adjacent vertebra, this convex body is used for and the relatively-movable engagement of this concave volume;
Wherein said concave volume uses first male part to be fixed in this manner on described first anchor plate, thereby along with the removing of first male part, allows described concave volume to separate from described first anchor plate, keeps described first anchor plate simultaneously and is implanted on first vertebra; Perhaps/and
Wherein said convex body uses second male part to be fixed in this manner on described second anchor plate, thereby along with the removing of second male part, allows described convex body to separate from described second anchor plate, keeps described second anchor plate simultaneously and is implanted on second vertebra.
2. device as claimed in claim 1 is characterized in that, first male part is or/and second male part is selected from by pin locking piece, button, toggle, friction retention means, magnetic fixing device, and in the cohort formed of snap lock.
3. device as claimed in claim 1 is characterized in that, first male part is or/and second male part is selected from screw or bolt.
4. device as claimed in claim 1 is characterized in that, described first anchor plate further comprises:
One substrate;
At least one keeps wall, and this keeps wall to be communicated with this substrate;
At least one keeps flange, and this keeps flange to be communicated with this maintenance wall, and is shaped on the concave volume receptor that at least one is used for admitting this concave volume within it;
At least one male part receptor, this male part receptor are formed on described first anchor plate; And
At least one anchor log, this anchor log is positioned on the periphery of described substrate, and is used for meshing and being maintained in this vertebral endplate with the end plate of first vertebra.
5. device as claimed in claim 4 is characterized in that described concave volume also comprises at least one supporting walls, and this supporting walls is shaped at least one coupling rail thereon, and described coupling rail is used for making this concave volume and engagement of this first anchor plate and coupling separably.
6. device as claimed in claim 1 is characterized in that described concave volume also comprises the groove that at least one is made within it.
7. device as claimed in claim 6 is characterized in that, described groove limits the vertical arc that is provided with along described concave volume longitudinal axis.
8. device as claimed in claim 6 is characterized in that, described groove limits the transverse arc that is provided with along described concave volume transversal line.
9. device as claimed in claim 6 is characterized in that, described groove limits a vertical arc and a transverse arc.
10. device as claimed in claim 6 is characterized in that also comprising that at least one is positioned at the flange on the described concave volume, and this flange is used for limiting described groove.
11. device as claimed in claim 10 is characterized in that, when described second implantable convex body and described first implantable 's concave volume engagement, described flange contacts with described second implantable, thereby limits this motion of second implantable.
12. device as claimed in claim 1 is characterized in that also comprising that at least one is used for admitting therein the bonder groove with first male part, and described concave volume is fixed on this first anchor plate.
13. device as claimed in claim 12 is characterized in that, described first male part is selected from by pin, locking piece, button, toggle, friction retention means, magnetic fixing device, and the cohort of snap lock composition.
14. device as claimed in claim 1 is characterized in that, described second anchor plate also comprises:
Substrate with inner surface;
One places the convex body receptor on the described substrate inner surface, and this convex body receptor is used for and the convex body engagement, and this convex body is kept within it; And
At least one anchor log, described anchor log places on the periphery of this substrate, and is used for meshing with the end plate of second vertebra, and is held within it.
15. device as claimed in claim 14 is characterized in that, described convex body also comprises:
Toxoplasma with first surface and bottom;
The supporting walls that at least one is communicated with this bottom; And
At least one connects groove, and described connection groove places on this bottom, and this connection groove is used for keeping with this convex body receptor engagement and by this convex body receptor.
16. device as claimed in claim 15 is characterized in that also comprising a convex body bonder, described convex body bonder places on this toxoplasma.
17. device as claimed in claim 16 is characterized in that also comprising a mating surface, this mating surface is coupled with this toxoplasma separably.
18. device as claimed in claim 15, it is characterized in that also comprising at least one limit flange, this limit flange places on this convex body, when described second implantable convex body when described first implantable concave volume is meshed, this limit flange contacts with this first implantable, thereby limits this motion of second implantable.
19. device as claimed in claim 1 is characterized in that, described convex body limits the vertical arc that is provided with along described concave volume longitudinal axis.
20. device as claimed in claim 1 is characterized in that, described convex body limits the transverse arc that is provided with along described convex body transversal line.
21. device as claimed in claim 1 is characterized in that, described convex body limits a vertical arc and a transverse arc.
22. device as claimed in claim 1 is characterized in that, the radius of curvature of described convex body is constant substantially.
23. device as claimed in claim 1 is characterized in that, the radius of curvature of described convex body is transformable.
24. device as claimed in claim 1 is characterized in that, comprises at least one securing member receptor, this securing member receptor is used for admitting second male part within it, is used for this convex body is fixed to this second anchor plate.
25. device as claimed in claim 24 is characterized in that, described second male part is selected from by pin, locking piece, button, toggle, friction retention means, magnetic fixing device, and the cohort of snap lock composition.
26. device as claimed in claim 1 is characterized in that also comprising a plurality of anchor logs, described anchor log places on the periphery of described first anchor plate and second anchor plate, and this anchor log is used for meshing with vertebral endplate.
27. device as claimed in claim 26 is characterized in that, described anchor log comprises a grappling body, and this grappling body limits an anchor cavity, and has terminal tip.
28. device as claimed in claim 27 is characterized in that, this end tip is fined away.
29. device as claimed in claim 27 is characterized in that, this end tip is undamaged.
30. device as claimed in claim 1 is characterized in that, at least one in described this first anchor plate and second anchor plate or described both are plasma sprayings.
31. an intervertebral disc replacement system comprises:
One first implantable, this first implantable has one and is implanted to first anchor plate on first vertebra and is coupled to concave volume on this first anchor plate separably, a plurality of anchor logs that place on the described first anchor plate periphery of this first anchor plate configuration; And
One second implantable, this second implantable has one and is implanted to second anchor plate and on the second adjacent vertebra and is coupled to convex body on this second anchor plate separably, the a plurality of anchor logs that place on the described second anchor plate periphery of this second anchor plate configuration, described convex body is used for meshing movably with described concave volume;
Wherein said concave volume uses first male part to be fixed in this manner on described first anchor plate, thereby along with the removing of first male part, allows described concave volume to separate from described first anchor plate, keeps described first anchor plate simultaneously and is implanted on first vertebra; Perhaps/and
Wherein said convex body uses second male part to be fixed in this manner on described second anchor plate, thereby along with the removing of second male part, allows described convex body to separate from described second anchor plate, keeps described second anchor plate simultaneously and is implanted on second vertebra.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US36878302P | 2002-03-30 | 2002-03-30 | |
| US60/368,783 | 2002-03-30 | ||
| US60/381,529 | 2002-05-16 |
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| Publication Number | Publication Date |
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| CN1697633A CN1697633A (en) | 2005-11-16 |
| CN100574728C true CN100574728C (en) | 2009-12-30 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN03807584A Expired - Fee Related CN100574728C (en) | 2002-03-30 | 2003-03-28 | Replacement device and system |
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