CN1764417A - 用于骨固定的装置 - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
- A61B17/7026—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form
- A61B17/7029—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form the entire longitudinal element being flexible
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- 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
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00858—Material properties high friction, non-slip
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00862—Material properties elastic or resilient
Abstract
本发明涉及一种用于骨固定的装置(1),尤其用在脊柱外科手术中。它带有至少两个骨固定元件(2),它们都具有一个可以锚定在骨上或者其内的部分(3)以及一个通道(4)。该装置(1)包括至少两个可插入每两个相邻的骨固定元件(2)的通道(4)中的并可固定在其中的纵向的柔性连接元件(5)。该装置一方面允许在装置植入期间在解剖学情况和外科手术达到的结果方面的很大的柔性,另一方面通过该装置的可相互移动的元件的简单锁定允许其完全的固定。此外它应该可以实现脊柱的微创治疗。
Description
技术领域
本发明涉及一种按权利要求1的前序部分所述的用于骨固定的装置。
背景技术
在大多使用的已知的脊柱稳定系统中采用刚性的连接杆,以便连接锚定在脊柱上的元件。这种刚性的连接允许将由外科医生实施的脊柱的校正固定在一个期望的位置上。这种刚性连接的缺点在于其在外科手术中的操作。除了例外的情况外,外科医生不能将多个锚定元件这样安置在脊柱上,使得它们可以与一根刚性直杆连接。因此,该刚性杆必须在外科手术中成形。这种成形是很费事的并且可能导致在锚定元件上出现不期望的应力集中。为了改进该系统在外科手术中的操作,因此需要开发这样的锚定元件,使其杆连接元件构造成可绕多轴线转动的。这种可转动性虽然简化了刚性杆的插入,因为该刚性杆不必再精确地预先成形,但由此也产生了这种多轴线连接元件体积大的缺点。不依赖于是否涉及可绕单一轴线转动还是可绕多轴线转动的锚定元件,都存在很大的缺点,即在成功地与一根刚性杆连接的情况下,对脊柱进行进一步的校正可能是非常有限的。
在CROCK ET AL的US-A 3,997,138中公开了一种用于脊柱的骨固定装置,其中两个蒂螺钉(Pedikelschrauben)植入相关的相邻的椎骨体中并且借助于两个可夹在蒂螺钉头部中的在封闭的通道中的杆相互连接。这种装置的缺点在于,当使用柔性杆时,整个装置在进行固定后总是保持柔性的,并没有真正的固定。
在HALL的US-A 4,041,939中公开了另一种用于脊柱的骨固定装置,其中一连串的蒂螺钉植入相关的脊柱段的椎骨体中并且借助于一个可夹在蒂螺钉头部中的在封闭的通道中的缆线相互连接。由此该装置具有与CROCK ET AL的装置相同的缺点,因为在此在将缆线固定在蒂螺钉的头部中后整个装置仍旧保持柔性,并没有达到固定。
因此在锚定元件之间的以细金属丝、细杆或者特制的柔性缆线形式的已知的连接元件都具有缺点,即由外科医生进行的校正,除了在拉伸方向外,都不能足够固定。因此脊柱的放松、位置校正或者骨折固定借助于已知的柔性杆系统不能进行。
发明内容
在此本发明消除弊端。本发明的目的在于提出一种用于骨固定的装置,其一方面允许在装置植入期间在解剖学情况和外科手术达到的结果方面的很大的柔性,另一方面通过该装置的可相互移动的元件的简单锁定允许其完全的固定。此外应该可以实现脊柱的微创治疗。
本发明通过一种具有权利要求1所述特征的装置来实现该目的。
本发明其它优选的方案在从属权利要求中说明。
通过本发明实现的优点主要在于,由于本发明的装置,免除了刚性纵梁的复杂的适配,而不必承受柔性纵梁的缺点。此外在将单个的骨固定元件成功连接在脊柱上后,单个骨固定元件的位置可以相对改变。相关的椎骨体相互之间的新位置(脊柱校正)可以通过柔性连接元件在骨固定元件中的锁定来固定。由于柔性连接元件的弹性,其插入可以实现一个最小的软组织伤害。
在一种特别的实施方式中,所述骨固定元件具有一个锁定元件,插入其通道中的连接元件相对于骨固定元件的运动通过该锁定元件可以有选择地固定和松开。通过这种柔性连接元件在两个相邻骨固定元件的通道中的这种锁定可以消除其在通道中的可移动性,由此可以使得整个装置固定。
骨固定元件可以从下面的组中选出:骨螺钉、骨拉钩和接骨板。
在一种特殊的实施方式中,通道是一个外周封闭的沟槽。这种封闭的沟槽的优点在于可以减小该骨固定元件的尺寸,并且简化其设计。典型的是,该通道是一个外周开口的沟槽,优选以具有U型横截面的槽的形式。该U型横截面具有优点,即柔性连接元件可以通过U型开口设置在里面而不必穿过。此外在柔性连接元件装配好之后还可以布置一个附加的次级骨固定元件。
在一种特别的实施方式中,该连接元件是杆形的,优选具有一个圆形的横截面外形。
连接元件的数量优选为四个、五个、六个或者七个。
在一种特别的实施方式中,通道的横截面以及连接元件的横截面这样相互适配,使得连接元件可以形状封闭地安装在通道中。
合理的是,通道的横截面是多边形的,优选正方形、长方形或者三角形。通道横截面的多边形结构具有优点,即连接元件可以放置到一个确定的位置。由此可以预先确定两个连接元件或者整个装置的连接在一个方向上的最大抗弯刚度。
在一种特别的实施方式中,连接元件在通道中相互接触。通过这种措施在锁定的情况下可以消除连接元件相互之间的纵向移动和旋转,这使得整个装置达到所期望的固定。
在另一种实施方式中,骨固定元件构成为骨螺钉,并且可锚定在骨中的部分是一个带有螺纹的螺杆,其中骨螺钉具有一个头部,在该头部中有一个形式为U型槽的通道,该通道可以通过一个帽状的锁定元件这样封闭,使得在槽中的连接元件的移动可以被锁定。
在一种特别的实施方式中,柔性连接元件的表面具有一个粗糙部分或者微观结构部分。由此可以实现连接元件之间的摩擦附着的提高。
在另一种实施方式中,柔性连接元件的表面具有一个宏观结构部分。通过这种措施同样可以实现连接元件之间的摩擦附着的提高。
在另一种实施方式中,通道的表面具有一个粗糙部分或者微观结构部分。由此可以实现与连接元件的摩擦附着的提高。
为了更好地理解本发明,下面还公开一种用于骨固定的方法,该方法由以下的操作步骤组成:
a)将每个带有一个通道的骨固定元件借助于它的可锚定的部分锚定在一个骨或者骨碎片上或者其内;
b)将两个或者多个纵向的柔性连接元件插入到两个相邻的骨固定元件的通道中;
c)将两个相邻的骨固定元件的通道用一个锁定元件封闭,由此锁定插入通道中的连接元件相对于骨固定元件的运动并且由此固定整个装置。
由该方法可实现的优点是多样性的:
(1)与两个骨固定元件的最优位置可能的偏差不起作用,因为柔性连接元件允许很大的变化性(相对于按现有技术的刚性纵梁,它在这种情况下必须首先从病人身上移去并且由外科医生用专用工具弯曲成需要的形状);
(2)通过连接元件的锁定消除其柔性,并使得整个装置固定,使得其最终状态与使用一种刚性纵梁相同;
(3)单个骨固定元件的位置在有连接元件的情况下可以彼此相对改变并固定在一个新的位置。
附图说明
下面借助于多个实施例的部分示意的视图还更详细地解释本发明以及本发明的进一步拓展。其中:
图1示出带有两个蒂螺钉以及四个柔性纵杆的本发明装置处于未锁定、柔性状态的透视图;
图2示出按图1的装置的一个蒂螺钉的头部的横截面图;
图3示出一个带有封闭的通道的蒂螺钉的头部的一种方案的横截面图。
具体实施方式
在图1中示出的用于骨固定的装置1包括两个以蒂螺钉形式的骨固定元件2以及四个纵向的柔性的以柔性细圆杆形式的连接元件5,连接元件可以与骨固定元件2连接。为此目的,骨固定元件2具有一个可以锚定在骨内的以带有螺纹的螺杆形式的部分3以及一个具有U型通道4的头部7。骨固定元件2的通道4可以用一个空心帽6形式的带有内螺纹10(图2)和内六角8的锁定元件6封闭。为此目的,骨固定元件2的头部7具有外螺纹9,锁定元件6可以拧到其上,使得在通道4中的纵向柔性连接元件5不仅可以相互固定还可以相对于相关的骨固定元件2在其位置上被固定。装置1这种固定状态在图2中示出。
在图3中示出了一个骨固定元件2的另一种方案,其中代替一个开口的U型通道4,有一个封闭的、沟槽形的、具有近似正方形横截面的通道4。为了固定插入通道4中的连接元件5,设有一个固定螺钉11,其可以通过延伸到通道4中的孔12拧入,直到其压到连接元件5上并由此起到锁定作用。
Claims (15)
1.一种用于骨固定的装置(1),带有至少两个骨固定元件(2),它们都具有一个可以锚定在骨上或者其内的部分(3)以及一个通道(4),其特征为:该装置(1)包括至少两个可插入到每两个相邻的骨固定元件(2)的通道(4)中的并可固定在其中的纵向的柔性连接元件(5)。
2.按权利要求1所述的装置(1),其特征为:所述骨固定元件(2)具有一个锁定元件(6),插入通道(4)中的连接元件(5)相对于骨固定元件(2)的运动通过该锁定元件可以有选择地固定和松开。
3.按权利要求1或2所述的装置(1),其特征为:所述骨固定元件(2)从下面的组中选出:骨螺钉、骨拉钩和接骨板。
4.按权利要求1到3中任一项所述的装置(1),其特征为:所述通道(4)是一个外周封闭的通道。
5.按权利要求1到3中任一项所述的装置(1),其特征为:所述通道(4)是一个外周开口的沟槽,优选以具有U型横截面的槽的形式。
6.按权利要求1到5中任一项所述的装置(1),其特征为:所述连接元件(5)是杆形的,优选具有圆形横截面外形。
7.按权利要求1到6中任一项所述的装置(1),其特征为:所述连接元件(5)的数量为四个、五个、六个或者七个。
8.按权利要求1到7中任一项所述的装置(1),其特征为:所述通道(4)的横截面以及连接元件(5)的横截面这样相互适配,使得连接元件(5)可以形状封闭地安装在通道(4)中。
9.按权利要求1到8中任一项所述的装置(1),其特征为:所述通道(4)的横截面为多边形,优选正方形、长方形或者三角形。
10.按权利要求1到9中任一项所述的装置(1),其特征为:在通道(4)中的连接元件(5)相互接触。
11.按权利要求1到10中任一项所述的装置(1),其特征为:所述骨固定元件(2)是骨螺钉,并且可锚定在骨内的部分(3)是一个带有螺纹的螺杆,其中该骨螺钉具有一个头部(7),在该头部中实现一个形式上为一个U型槽的通道(4),该通道可以用一个帽状的锁定元件(6)这样封闭,使得在槽中的连接元件(5)的移动可以被锁定。
12.按权利要求1到11中任一项所述的装置(1),其特征为:所述柔性连接元件(5)的表面具有一个粗糙部分或者微观结构部分。
13.按权利要求1到12中任一项所述的装置(1),其特征为:所述柔性连接元件(5)的表面具有一个宏观结构部分。
14.按权利要求1到13中任一项所述的装置(1),其特征为:所述通道(4)的表面具有一个粗糙部分或者微观结构部分。
15.一种用于骨固定的方法,包括以下操作步骤:
a)将每个带有一个通道(4)的骨固定元件(2)借助于它的可锚定的部分(3)锚定在一个骨或者骨碎片上或者其内;
b)将两个或者多个纵向的柔性连接元件(5)插入到两个相邻的骨固定元件(2)的通道(4)中;
c)将两个相邻的骨固定元件(2)的通道(4)用一个锁定元件(6)封闭,由此锁定插入通道(4)中的连接元件(5)相对于骨固定元件(2)的运动并且由此固定整个装置。
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Application Number | Priority Date | Filing Date | Title |
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PCT/CH2003/000253 WO2004091413A1 (de) | 2003-04-15 | 2003-04-15 | Vorrichtung zur knochenfixation |
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CNA038263114A Pending CN1764417A (zh) | 2003-04-15 | 2003-04-15 | 用于骨固定的装置 |
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US (1) | US20060069390A1 (zh) |
EP (1) | EP1613225B1 (zh) |
JP (1) | JP2006513796A (zh) |
CN (1) | CN1764417A (zh) |
AR (1) | AR043870A1 (zh) |
AT (1) | ATE407633T1 (zh) |
AU (1) | AU2003213981B2 (zh) |
BR (1) | BR0318222A (zh) |
CA (1) | CA2522664A1 (zh) |
CL (1) | CL2004000786A1 (zh) |
DE (1) | DE50310484D1 (zh) |
ES (1) | ES2314184T3 (zh) |
TW (1) | TW200501927A (zh) |
WO (1) | WO2004091413A1 (zh) |
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-
2003
- 2003-04-15 BR BRPI0318222-3A patent/BR0318222A/pt not_active IP Right Cessation
- 2003-04-15 EP EP03709556A patent/EP1613225B1/de not_active Expired - Lifetime
- 2003-04-15 WO PCT/CH2003/000253 patent/WO2004091413A1/de active IP Right Grant
- 2003-04-15 DE DE50310484T patent/DE50310484D1/de not_active Expired - Lifetime
- 2003-04-15 CN CNA038263114A patent/CN1764417A/zh active Pending
- 2003-04-15 AU AU2003213981A patent/AU2003213981B2/en not_active Ceased
- 2003-04-15 ES ES03709556T patent/ES2314184T3/es not_active Expired - Lifetime
- 2003-04-15 JP JP2004570779A patent/JP2006513796A/ja active Pending
- 2003-04-15 AT AT03709556T patent/ATE407633T1/de not_active IP Right Cessation
- 2003-04-15 CA CA002522664A patent/CA2522664A1/en not_active Abandoned
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2004
- 2004-04-02 TW TW093109197A patent/TW200501927A/zh unknown
- 2004-04-13 CL CL200400786A patent/CL2004000786A1/es unknown
- 2004-04-15 AR ARP040101268A patent/AR043870A1/es unknown
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2005
- 2005-10-14 US US11/250,518 patent/US20060069390A1/en not_active Abandoned
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CA2522664A1 (en) | 2004-10-28 |
JP2006513796A (ja) | 2006-04-27 |
WO2004091413A1 (de) | 2004-10-28 |
CL2004000786A1 (es) | 2005-02-18 |
ES2314184T3 (es) | 2009-03-16 |
DE50310484D1 (de) | 2008-10-23 |
AR043870A1 (es) | 2005-08-17 |
ATE407633T1 (de) | 2008-09-15 |
AU2003213981B2 (en) | 2007-07-19 |
TW200501927A (en) | 2005-01-16 |
AU2003213981A1 (en) | 2004-11-04 |
BR0318222A (pt) | 2006-04-04 |
EP1613225A1 (de) | 2006-01-11 |
US20060069390A1 (en) | 2006-03-30 |
EP1613225B1 (de) | 2008-09-10 |
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