CN1133002A - 矫形缆索固定方法和设备 - Google Patents

矫形缆索固定方法和设备 Download PDF

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CN1133002A
CN1133002A CN94193789.5A CN94193789A CN1133002A CN 1133002 A CN1133002 A CN 1133002A CN 94193789 A CN94193789 A CN 94193789A CN 1133002 A CN1133002 A CN 1133002A
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cable
anchor clamps
tightener
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D·F·米勒
M·C·舍曼
R·A·发力斯
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Medtronic Sofamor Danek Inc
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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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

将一双孔L形束缚器(14)束缚在一缆索(10)的一端。缆索的另一端缠绕骨头(11)和附加其上的一矫形装置(12)，然后穿过束缚器上的另一孔(24)。一可释放的杠杆操作缆索夹具(38)被装在缆索上，后面是一个张紧工具(17)。该张紧工具(17)在缆索上施加一预定位张力。将缆索夹具夹持在缆索上保持该张力。将该工具卸下用于另一缆索。当准备好最后张紧时，将该张紧工具重新装上，调整到理想的最终张力，再将束缚器挤压到缆索上以保持该最终张力。然后松开缆索夹具和张紧工具并从缆索上卸下，最后在束缚器处将缆索剪断。

Description

矫形缆索固定方法和设备
       本发明的技术背景
本发明一般涉及矫形和脊骨外科，特别是将缆索固定于骨头上的方法和装置。
人们已经开发了多种将骨头固定在位和将器械固定在骨头上的方法和装置。虽然单股金属丝多年来用于各种外科手术，近年来越来越多地采用多股缆索，特别是用在位置难以接近，而且强度和长久稳定性非常重要的场合。1989年12月26日公开的Galline等人的美国专利US4,889,110就是一例，在该例中，一锚固板11上有四个孔，孔中容纳两个束缚管和两个束缚环，束缚管和束缚环束缚着将一大转子固定在股骨上的多股缆索。使用多股缆索的另一例是Songer等人的美国专利US5,116,340和4,966,600。后一份专利使用了一圈38和一带法兰的管状束缚器28，如图1，或一止动件94、杆96、和一带前突缘60的束缚器，如图6，来固定缆索。由于那些束缚器外形有点象大礼帽，所以在该行业被称为‘大礼帽(tophat)’束缚器。由于需要尽可能减小安装缆索的空间，Songer专利中的那种束缚器非常小。结果很难处理，戴着外科手套不易操作，容易失落。因此需要提供一种系统，该系统不需要单独分开的束缚器，束缚器能够可靠地固定于缆索上并牢固地抓住缆索，也不需要象Songer专利的图1实施例那样，在穿过小圈38的缆索中产生缆索与缆索之间的接触应力。为此发明了一种新的装在缆索上的束缚器。此外，不管采用一单独分开的束缚器，还是采用装在缆索上的束缚器，希望能够将束缚器预先定位在缆索上它应具有的大致的最后位置上，在固定在缆索上的最后位置之前能够相对于骨头和其固定装置对缆索做一些最后的定位调整，特别是在脊骨外科手术中。还希望在同一手术中同时对几根缆索进行这种操作，而无需使用几个缆索张紧工具就可在缆索上保持最终定位之前的预张力。事实上，一些使用大礼帽束缚器纠正脊骨畸形的医生进行手术时在每个缆索上采用至少两个大礼帽束缚器。在这种情况下，每一缆索使用的两个束缚器位于脊骨不同部位。例如使用Songer型张紧器将缆索在骨头和脊柱上拉紧时，外束缚器先被束缚在缆索上，内侧束缚器尚未被束缚。沿着脊骨继续这一过程直到所有缆索都被束缚上。由于医生先操作一根缆索，接着再操作另一根，先被张紧了的缆索中的一根或多根中的张力有时会由于脊柱或骨头的运动而松弛。医生要返回来对这些缆索施加附加张力，再将内侧束缚器束缚在缆索上。然后将内侧和外侧束缚器之间的缆索切断，并去掉外侧束缚器和缆索。这种手术浪费了全部外侧束缚器，它们都是由植入物专用的材料制成。本发明就是要解决这个问题。
             本发明的简述
简而言之，按照本发明的一个典型实施例，一个带有两个通孔的束缚器，其中一个通孔用于束缚或以其它方式固定缆索的一端。缆索的另一端缠绕一根或几根骨头及任何通过该缆索系在该骨头上的矫形器具或固定装置，再穿过束缚器的另一孔中，然后又将其穿过一个小的采用杠杆原理的缆索夹具。通过使用一个张紧工具将缆索拉紧，该工具装在缆索上并和位于缆索夹一端的一承窝内的接合面相接合。在缆索夹另一端的一接合面与束缚器的一接合面相结合。这样缆索夹具就位于束缚器和张紧工具之间。在进行缆索和任一连接于缆索的固定装置相对于骨头定位调整时，缆索被张紧到一个适合于将物体保持在位的预加最终张紧量。操作缆索夹上的杠杆将该夹具固定在缆索上保持住缆索上的张力，这样就可从缆索上卸下张紧工具，将其用于该手术中的另一缆索上。当医生确认缆索已妥善就位后，张紧工具又被安装在该缆索上，与缆索夹具相接合并将缆索张紧到预先设定值，即缆索的预加最终张力值。然后释放缆索夹具上的杠杆，调整张紧工具，将张紧量增加或(可能性较小)减小到缆索永久固定位置的最终理想值。这样束缚器就被束缚在缆索上。卸下张紧工具，移去缆索夹具，将缆索的自由端沿束缚器的接合面剪断。
             附图的简述
图1是采用本发明的方法和设备将束缚器组件应用于一骨头和棒的示意图。
图2是一穿入缆索的束缚器组件的放大的局部示图，但省略了骨头和棒。
图3是安装在张紧器(部分示出)一端的缆索夹具的放大的纵剖面图。
图4是沿图3中4-4线剖开，沿箭头方向看去的缆索夹具的横剖面图。
图5是本发明的典型实施例的脊柱局部示图，示出了几根缆索将植入物保持在脊柱上。
图6是一沿图5中的6-6线剖开并沿箭头方向看去的横剖面图，从不同方向示出了缆索束缚器。
            优选实施例的说明
为了有利于对本发明的原理的理解，现参考图示实施例，并用专门的术语对其进行说明。然而无论如何不应理解为这是对本发明范围的限制，对本发明相关领域熟知的技术人员通常可以对图示说明的装置做出变化和进一步的修改，也可以进一步采用本发明的原理。
现在详细参考附图，更具体地说是图1，目的是要围绕骨头11和棒12以适当的张力绑缚缆索10，并将其保持住。为此，缆索的自由端13绕过骨头11和棒12，而在工厂中就与缆索的另一端16(图2)固定好的束缚器14被保持在骨头上方的一适当位置。再将缆索的自由端13向上穿过束缚器内的孔24，然后再穿过张紧工具17的中心通道。然而按照本发明，在将缆索的自由端插入张紧工具之前，先将其插入一缆索夹具38的小端部37内的轴向延伸通道36中。再将缆索向上穿过通道36，从夹具的上端39伸出。然后将缆索的自由端13向上穿过张紧工具17的中心通道，并将张紧工具沿缆索向下滑动，其柱状顶端22被插入夹具38上端的圆柱状工具接收承窝41，并被送到使顶部22的平端面与夹具38内的承窝底部的工具承接面42相接触。缆索夹具38的小顶端平面43与束缚器14的工具接收上端平面相接触。
将缆索与张紧工具保持在使工具与夹具和夹具与束缚器之间实现面接触，操作张紧工具上端的夹具凸轮操作杆18使其在图1所示的实线位置从而将张紧工具的一部分19A夹紧在缆索上。19A插在与一杆相固连的19B上，该杆插入张紧工具的套筒20内。操作手杆21时，部分19B就由棘轮作用从套筒20内伸出。套筒的顶端22挨靠在夹具38内的工具承接面42上，夹具顶面43接触并支承在束缚器的上端23上。进一步转动工具的棘轮将缆索向上穿过束缚器14中的孔24及夹具38中的孔36，直到达到一个足以将棒12保持在紧靠骨头就位的张力，但是很可能小于在棒和任何与该棒有关的其它固定装置相对于骨头处于理想的最终位置时所加的最终张力。该预加最终张力值在部分19B上的一刻度盘26上指示出来，部分19A由一经过标定的弹簧约束在部分19B内。记下该张紧量，以供后面参考。杠杆44可从图3所示的打开位置(虚线)绕缆索夹具38上的轴46转动，将其向下推到图1中实线所示的锁定位置使其凸轮部分47夹紧缆索。然后可将张紧工具的杆18打开，从缆索上卸下张紧工具。缆索夹具将保持缆索中给定的张力。这时可将张紧工具移到另一根缆索和夹具上，以同样方式进行操作。就这样，可以将若干根缆索及与其相连的固定装置定位，并保持最后张紧之前对它们进行操作和调整位置所需的张力。这种方法对于沿着一根棒或其它固定装置使用多根具有一定间距的缆索是十分理想的。
现在参考图5，图中示出了脊柱51的一部分，两根脊柱棒52和53用缆索固定在脊柱51上，这样做可以纠正脊骨畸形，例如脊柱侧凸。缆索54和56用来将棒52固定到脊柱上的骨头57和58上。缆索54紧紧地缠绕着骨头57和棒52，其自由端穿过束缚器59的孔和缆索夹具61并从缆索夹具中伸出。虽然在图中由于空间有限将缆索割断，但应该理解，如果需要，应将伸出夹具的缆索保留足够长，以便能重新装上张紧工具17对缆索进行重新张紧。类似地，缆索56穿过束缚器62和与之接合的夹具63并从夹具63的另一端伸出。
另一根脊柱棒53由穿过束缚器66、夹具67并从该夹具中伸出的缆索64固定在骨头57上。该夹具保持着缆索64将棒53和骨头固定在一起所需的张力。缆索68将要用于固定骨头58和棒53，其一端69已在束缚器71中固定，另一端沿箭头72从另一孔中穿入束缚器中，并穿过缆索夹具73中心的轴向通道及张紧工具17(由于空间有限只局部示出)的顶部。夹具73的杠杆74打开着，所以夹具可以按照箭头76所指的方向沿缆索自由滑动。将缆索68拉紧，使束缚器71顶到棒53。然后将夹具73向上拉，使其顶到束缚器71的端部，而张紧工具17的顶端被推入缆索夹具的承窝内，从而将所有部件71，73和37推到一起。将张紧工具(图1)上的夹紧杠杆18锁闭在缆索上并操作棘轮手柄21拉紧缠绕在骨头和棒53上的缆索。这同已经绕在骨头和相应各棒并被拉紧的缆索54，56和64的张紧过程是一样的。
在缆索68被张紧到适当的程度，夹具73装在缆索上以后，可以用同样的方法沿着棒52和53对其它缆索和骨头进行操作。在完成上述操作以后，如果由于手术过程中脊骨被拉直而使张力有些松弛，已经固定好的缆索中的任一根，例如54或64或56或68不再象所要求的那样紧，可以再在缆索54，56，64或68或其它缆索上再次装上张紧工具，如果必要的话，将它们拉紧到理想的最终张紧状态。在这些都做完以后，例如对于缆索54，在束缚器59上加上一个束缚工具，将束缚器59永远束缚在缆索上并在缆索54中保持理想的张力。在对缆索54进行最后拉紧之前，可以操作张紧工具，使该工具和夹具61之间的缆索张紧到足以避免当夹具上的杠杆77打开以从缆索上释放夹紧凸轮时缆索的突然运动。事实上该凸轮设计成单方向自锁的，杠杆锁住时凸轮不允许缆索相对于夹具沿箭头76的方向运动，但缆索可以沿箭头72的方向由张紧工具拉过凸轮。因此不必为最后拉紧缆索而用手打开杠杆77。在缆索内已确立了理想的最终张力时，束缚器59被永久束缚在缆索上。如果杆77尚未被打开，现在可将其打开，这样就可将张紧工具释放并从缆索上卸下，然后从缆索上卸下夹具61。在束缚器59的外侧端78将缆索切断。对别的缆索也可以用同样的方法。
更具体地考虑重访缆索的情况，例如图6中的缆索54或图1中的缆索10，比如说，医生认为棒和/或其它部件及缆索已准确就位只待最终张紧，或者当医生注意到在沿棒上其它位置处进行操作时，该缆索的张力已从原来调好的理想状态松弛下来，这时可以象先前一样再将张紧工具装在缆索上。当顶部22牢固地座入承窝的底部，张紧工具的杠杆18锁在缆索上。通过棘轮板手21操作棘轮，直到刻度盘上的读数再次达到原来已达到的预加最终张力值，或者医生认为张力已经增大到理想的终值。然后将一个单独的束缚工具(未示出)施加在束缚器14(图1)的部分27上，将其束缚在缆索从孔24中伸出的部分，从而固定住在该孔中的缆索并保持缆索绕骨头的最终张力。这时可以松开张力工具的夹紧杠杆18，打开缆索夹具的杠杆77(如果前面没有打开的话)，这样就可以把张紧工具和缆索夹具38从缆索上卸下。再将缆索从束缚器的接合面23处截断，截断面要与面23平齐。缆索保持固定在骨头和棒上。
参考图2，插在束缚器14的基部32内的缆索的一端31已经在工厂中通过将部分33放在胎具中进行模压而将其固定。在手术过程中，如上所述缆索缠绕好骨头和棒并张紧到最后的张力值以后，由一适用的束缚工具，例如在本领域已知的，将束缚器的柱状部分27在点34处压扁。缆索从底部36到顶部接合面23向上穿过纵向孔24的部分在理想的最终张力被加到缆索上以后由这种工具冷束缚住。
图6示出了本发明的另一特征。缆索张紧到足够的程度，张紧工具被卸下以后，缆索夹具基本上如图6所示直立在病人背部的伤处。在纠正脊骨畸形的手术中需增加缆索并将其拉紧时，骨头的运动会导致一些以前张紧了的缆索又有些松弛。这种情况发生时，缆索夹具的重量抵消了原来拉紧的缆索保持夹具直立的作用，夹具开始在伤口内向图5中以实线(图6中虚线)示出的大致水平的位置躺倒。因此医生拥有一个快速方便的指示器，指示哪一根缆索肯定需要重访，以便重新张紧。
作为一个例子，为了将缆索夹具所占空间减至最小，缆索夹具的顶部37的直经为.240英寸，张紧器的柱状顶部也是如此。承窝内径大约为.260英寸，其深度大约为.450英寸。总长大约为1.500英寸。材料为17-4PH不锈铸钢。凸轮和杠杆由455不锈钢制成。凸轮曲线的中心偏离凸轮轴46的轴线，以便在杠杆从虚线位置开始闭锁时凸轮逐渐拉紧缆索，但是当接近闭锁的实线位置时略微放松，从而夹具在一个方向上自锁，防止夹具在箭头72的方向上沿缆索退回。
当然，应该理解，如果需要在缆索的圈内固定两根骨头，或一根或多根骨头和一根或多根脊骨棒或其它固定装置，或两根或多根缆索串联再缠绕骨头和植入物，可以用类似方法进行。本发明使用时不仅可以采用附图中所示的缆索端部止动装置，也可采用上述Galline和Songer专利中所示的止动装置(例如，圈，束缚器或杆)。
虽然在附图和上述说明书中已经对本发明作了详细说明和描述，但是应该认为这是说明性的，而不是限定性的，应该理解，图示并描述的只是优选的实施例，所有在本发明的精神所包括的范围内的变化和修改都希望得到保护。

Claims (24)

1.一种围绕骨头固定缆索的方法，包括如下步聚：
取一根一端具有一止动装置的缆索，将缆索的另一端缠绕骨头并向该止动装置返回；
将缆索的该另一端通过一孔送入该止动装置中；
将缆索的该另一端通过一孔送入一可手动闭锁和释放的缆索夹具，并将该缆索夹具置于该止动装置上；
在缆索的该另一端被送入该夹具的孔中后，使该夹具和缆索的一部分，在该夹具和缆索的该另一端之间与一缆索张紧工具接合；
使用该工具对缆索施加位置调整张力；
当在缆索上施加的张力处于一理想的定位张力值时将位于夹具孔中的缆索部分临时固定在该孔中；
从缆索上卸下张紧工具。
2.如权利要求1所述的方法，其特征在于：该固定步骤是这样进行的，扳动该夹具上的一个杠杆来迫使夹具的凸轮表面处于与夹具孔中的缆索部分夹紧的位置。
3.如权利要求1所述的方法，其特征在于：该缠绕、送入和张紧步骤可在缆索自身不接触的情况下进行。
4.如权利要求1所述的方法，其特征在于：还包括在围绕骨头缠绕缆索之前在缆索上固定止动装置的步骤。
5.如权利要求1所述的方法，其特征在于还包括如下步聚：
在从缆索上卸下张紧工具之后将其重新装在缆索上；
操作该张紧工具在缆索中建立理想的最终张力；
将该止动装置夹到缆索上，使缆索不能在止动装置内滑动；
从缆索上卸下缆索夹具和张紧工具；
在缆索夹具与止动装置接合的位置将缆索截断。
6.如权利要求5所述的方法，其特征在于：还包括在按权利要求3所述的步骤重新装在最先提到的缆索上之前至少在一个其它缆索上重复权利要求1所述的步骤。
7.如权利要求5所述的方法，其特征在于：还包括如下步骤：
包括一植入物装置；
在将缆索的该另一端送入该止动装置的孔中之前用缆索缠绕该植入物装置。
8.如权利要求5所述的方法，其特征在于还包括如下步骤：
在重新装上张紧工具以后，由该工具在缆索上施加至少与缆索先前张紧时所建立的同样大小的张力；
释放缆索夹具上的一夹紧件，使缆索解除夹紧状态。
9一种外科缆索组件，包括：
一束缚器，具有一带穿孔的可束缚部分；
一缆索，具有一相对该束缚器固定的端部和一可穿过束缚器中的通孔被其接收的端部；
一缆索夹具，具有一杠杆操作的凸轮，该凸轮被夹紧到穿过束缚器孔的那部分缆索上。
10.如权利要求9所述的缆索组件，其特征在于：夹具凸轮设置成当夹具一开始沿缆索在离开束缚器的方向上运动，夹具凸轮就在缆索上夹紧。
11.如权利要求10所述的缆索组件，其特征在于：夹具凸轮设置成当由一张紧工具拉紧缆索并推动夹具时，就松开到足已适应夹具沿缆索在朝向束缚器的方向上的运动。
12.如权利要求11所述的缆索组件，其特征在于：还包括一张紧工具，其内有一接收部分缆索通过的通道，该工具被夹在缆索上，其一部分置于缆索夹具内的一承窝内。
13.如权利要求12所述的缆索组件，其特征在于：张紧工具有一细长的顶部，其上有一顶端；缆索夹具有一承窝，该工具的顶部可滑动地置于该承窝内，承窝有一底部与工具的顶端相接合。
14.如权利要求13所述的缆索组件，其特征在于：缆索夹具有一细长的顶部，其具有与张紧工具的顶部相同的最大横截面尺寸。
15.如权利要求14所述的缆索组件，其特征在于：缆索夹具的顶部和承窝部分具有大致为圆柱形的外表面。
16.如权利要求14所述的缆索组件，其特征在于：缆索夹具的承窝部分和顶部由材质均一的单一金属铸件制成。
17.一种围绕脊柱中骨头和植入物固定缆索的设备，包括：
一第一缆索，其一端有一止动装置，该缆索适合于缠绕一骨头和一植入物的一部分并穿过该止动装置到达另一端；
一手动的可闭锁和可释放的缆索夹具装置，它与缆索和止动装置相接合并保持缆索的张力以将缆索固定于骨头和植入物。
18.如权利要求17所述的设备，其特征在于：该夹具装置还包括一凸轮，其上带有一杠杆操作器，该凸轮与缆索接合并将缆索锁定在夹具上，需要时，可操纵该杠杆从缆索上松开凸轮。
19.如权利要求17所述的设备，其特征在于：该夹具装置内有一用于接受缆索张紧工具的接受装置。
20.如权利要求19所述的设备，其特征在于：该工具接受装置为一承窝，用以接受张紧工具的一部分。
21.如权利要求17所述的设备，其特征在于还包括：
一第二缆索，其一端带有一止动装置，该第二缆索适合于缠绕另一根骨头和植入物的一部分并穿过该第二缆索上的止动装置到达该第二缆索的另一端；
一第二手动的可闭锁和可释放缆索夹具装置，它与第二缆索和缆索上的止动装置相接合并保持第二缆索上的张力以将第二缆索固定于第二根骨头和植入物。
22.如权利要求21所述的设备，其特征在于：该第二夹具装置还包括一凸轮，其上带有一杠杆操作器，该凸轮与第二缆索接合并将该第二缆索锁定在夹具中，需要时，可操纵杠杆从第二缆索上松开凸轮。
23.如权利要求21所述的设备，其特征在于：该第二夹具内有一个用于接受缆索张紧工具的接受装置。
24.如权利要求23所述的设备，其特征在于：该工具接受装置为一承窝，用以接受张紧工具的一部分。
CN94193789.5A 1993-09-02 1994-08-31 矫形缆索固定方法和设备 Pending CN1133002A (zh)

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