CN104586545B - 髓核假体 - Google Patents

髓核假体 Download PDF

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Publication number
CN104586545B
CN104586545B CN201510011599.3A CN201510011599A CN104586545B CN 104586545 B CN104586545 B CN 104586545B CN 201510011599 A CN201510011599 A CN 201510011599A CN 104586545 B CN104586545 B CN 104586545B
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CN
China
Prior art keywords
prosthese
section
batten
hinge
interlocking member
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Expired - Fee Related
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CN201510011599.3A
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English (en)
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CN104586545A (zh
Inventor
T·维拉
H·杜富尔
J·阿莱因
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LDR Medical SAS
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LDR Medical SAS
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Expired - Fee Related legal-status Critical Current
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
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    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A61F2/4465Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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    • A61F2002/30004Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30014Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
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Abstract

髓核假体(30)包括多个节(32),所述节包括前部节和尾部节,以及联接所述节的至少一个连接,该假体具有打开位置,在该位置所述节沿连接以串联线设置,其中在串联线的一端具有前部节并在串联线的另一端具有尾部节;以及闭合位置,在该位置所述节被设置以形成前部节和尾部节基本并置的盘形。所述节之间的连接是铰链(34a),该铰链联接并且自由地铰接所述节以便于髓核假体的打开和闭合。

Description

髓核假体
本申请是申请日为2008年6月16日、名称为“髓核假体”的中国专利申请200880103450.6的分案申请。
技术领域
本发明涉及在椎间盘或椎间盘间隙中髓核假体(nucleus prosthesis)的植入,并且更具体涉及椎间盘的髓核的置换。
背景技术
位于脊骨的两块椎骨之间的椎间盘提供了结构支撑并且分散了施加在脊柱上的作用力。除了将椎骨保持在一起外,还能够使脊骨呈竖直姿态和自然弯曲(脊柱前凸或脊柱后凸,例如在正常的生理范围内),健康的椎间盘能够弯曲、伸展、侧向弯曲以及椎骨的轴向旋转。
椎间盘的主要部分包括环状纤维、髓核以及软骨板(cartilage endplates)。该环状纤维是直接附连到椎间盘上面和下面椎骨的坚韧的环状纤维。轮缘状的环状纤维支撑邻近的椎骨并且限制其平动和转动的相对位移。该环状纤维还包含髓核。该髓核是盘的中心部分,其包括提供给许多关节和椎间盘的缓冲性能的富有弹性的胶状物质。
由于疾病或年龄的关系椎间盘可能会受损或变得易损坏。一个常见的问题是椎间盘疝气,在其中部分髓核被挤压通过环状纤维的开口。穿过椎管的部分髓核可压迫脊骨神经,通常将导致神经损伤、剧烈疼痛、麻木、行动不便以及肌肉乏力。当天然椎间盘的退变或疾病已经发展到用例如药物、注射、和/或物理治疗的非手术治疗无效的这种程度,可能需要外科干预。
治疗退变或病变的椎间盘的常规方法包括盘的天然骨组织的移除和邻近椎骨的熔合(椎间盘关节固定术intervertebral arthrodesis)。在椎间盘关节固定术之前通常被认为的另一个最常用的常规方法,包含移除天然的骨组织并且通过椎间盘假体置换椎间盘。
发明内容
本发明的各种实施例提供了髓核假体,其包括包含前部节和尾部节的多个节,以及联接节的连接。各种实施例的假体有打开位置,在该位置节沿连接以在串联线的一端具有前部节及在串联线的另一端具有尾部节的串联方式设置,以及闭合位置,在该位置节被设置来形成具有大致并置的前部节和尾部节的盘形。
即时发明的各种实施例被布置来用作熔合装置(例如,关节固定术)。但是,熔合消除了邻近椎骨之间的可动性并且能将压力和活动转移到该熔合处上面和/或下面的椎间盘,因此,维持盘空间正上方和正下方的椎骨的可动性的治疗方法可优先选用。本发明的各种实施例可被布置用于维持盘空间正上方和正下方的椎骨的一些可动性。
方法的各种实施例被公开(作为说明)。例如方法的一个实施例包括将多个连接的节插入到环状纤维中并且闭合髓核假体以便插入到环状纤维中的第一个节(例如前部节)和插入到环状纤维的最后节(例如尾部节)大致邻接。
本发明的目的是通过提供易于植入并且能防止盘完全取出的假体来消除以前技术的至少一部分缺点。
本目的的至少一些方面通过髓核假体来实现,该髓核假体包括包含前部节和尾部节的多个节,和至少一个联接节的连接,该假体的特征在于其包括:
打开位置,在该位置节沿连接以在串联线的一端具有前部节及在串联线的另一端具有尾部节的串联方式设置;和
闭合位置,在该位置节被设置来形成具有前部节和大致并置的尾形轮廓;
并且在节之间的连接包括至少一个铰链,该铰链联接并且自由地铰接该节以便有利于髓核假体的打开和闭合。
根据一些实施例的另一个特征,一个或多个节是有弹性的。
根据一些实施例的另一个特征,一个或多个节有弹性梯度。
根据一些实施例的另一个特征,一个或多个节有具有第一弹性的内部部分和具有第二弹性的外部部分。
根据一些实施例的另一个特征,在节之间的连接包括至少一个柔性连接。
根据一些实施例的另一个特征,柔性连接是系带。
根据一些实施例的另一个特征,节包括布置来连接在一起的互锁元件。
根据一些实施例的另一个特征,互锁元件被布置为允许节相对于彼此垂直运动。
根据一些实施例的另一个特征,互锁元件通过在至少一个节的至少一个面上的公互锁元件和在至少另一个节上的至少一个面上的母互锁元件组成,所述的公互锁元件和母互锁元件是彼此互补的。
根据一些实施例的另一个特征,公互锁元件包括销并且母互锁元件包括通道,销能在该通道内滑动。
根据一些实施例的另一个特征,假体包括在柔性连接一端上的封闭元件。
根据一些实施例的另一个特征,封闭元件被布置来与柔性连接的另一端相接合,这种接合被布置来促进假体进入闭合位置。
根据一些实施例的另一个特征,封闭元件包括柔性连接的环。
根据一些实施例的另一个特征,封闭元件包括在柔性连接一端的止动块。
根据一些实施例的另一个特征,柔性连接采用通过节的正切路径。
根据一些实施例的另一个特征,柔性连接采用通过沿节的沟槽的路径。
根据一些实施例的另一个特征,假体包括连接一个或多个节的条板。
根据一些实施例的另一个特征,一个或多个节通过位于条板通道中的销被连接到该条板。
根据一些实施例的另一个特征,在至少两个节间的铰链通过位于条板通道中的销连接到该条板。
根据一些实施例的另一个特征,当假体闭合时,条板被布置来围绕节折叠。
根据一些实施例的另一个特征,条板被布置来包围假体在其闭合位置的大致盘形。
根据一些实施例的另一个特征,假体包括系带,该系带连接到该条板上并且当拉力施加到该系带时被布置来折叠该条板。
根根据一些实施例的另一个特征,条板有不同于节弹性的弹性。
根据一些实施例的另一个特征,假体包括窗并且假体形成了熔合装置。
根据一些实施例的另一个特征,假体包括布置来维持节的至少一个外壳。
根据一些实施例的另一个特征,一方面,该外壳有与假体的闭合位置相匹配的内部,另一方面,随着假体进入外壳其被布置来从其打开位置转变为闭合位置。
根据一些实施例的另一个特征,当假体在其闭合位置时,并置设置的的前部节和尾部节通过前部节的表面和尾部节的表面相接触,每个表面包括一个互锁元件。
根据一些实施例的另一个特征,条板包括当假体闭合时能促使其围绕节折叠的凹口。
本发明的另一个目的是通过提出一种易于实现的植入方法来消除以前技术的至少一部分缺点。
本目的的至少一些方面通过一种方法实现,其包括:
将多个连接的节插入到环状纤维中;并且
将节连接在一起以便插入到环状纤维的第一节的表面和插入到环状纤维的最后节的表面是大体并置设置的。
根据一些实施例的另一个特征,该方法包括收紧沿节设置的系带。
根据一些实施例的另一个特征,该方法包括将位于系带一端的封闭元件附连到到系带的另一端。
根据一些实施例的另一个特征,插入包括将节插入到插入器械中,该插入器械可引入到环状纤维中。
在附图和本公开的描述中提出了本发明的一个或多个实施例的详细描述。在领会该描述、附图及权利要求后,本发明的其他特征、对象以及优点将会更加明显。
附图说明
图1是一部分脊柱的侧视图。
图2是一部分脊柱的横截面图。
图3A和图3B是根据一些实施例的典型的髓核假体的透视图。
图4A和图4B是根据一些实施例的典型的髓核假体的俯视图。
图5是根据一些实施例的插入器械的透视图。
图6是根据一些实施例被手术植入椎间盘的典型的髓核假体的正面的横截面图。
图7是根据一些实施例被手术植入的典型的髓核假体的正面的横截面图。
图8是根据一些实施例在手术植入典型的髓核假体后,一部分人类脊柱的横截面图。
图9是根据一些实施例的典型的髓核假体的透视图。
图10是根据一些实施例的典型的髓核假体的俯视图。
图11是根据一些实施例的典型的髓核假体的透视图。
图12是根据一些实施例的典型的髓核假体的俯视图。
图13A和图13B分别是根据一些实施例的典型的髓核假体的透视图和平面图。
图14是根据一些实施例的用于髓核假体的典型的保持器的透视图。
图15是根据一些实施例的典型的髓核假体的透视图。
图16是根据一些实施例的典型的髓核假体的透视图。
图17是根据一些实施例的典型的髓核假体的透视图。
图18是根据一些实施例的图17的典型的髓核假体的横截面图。
图19是根据一些实施例的图17的典型的髓核假体的另一个横截面图。
图20是根据一些实施例的典型的髓核假体的透视图。
图21是根据一些实施例的典型的髓核假体的透视图。
图22是根据一些实施例的典型的外壳的透视图。
图23是根据一些实施例的典型的外壳的透视图。
图24是根据一些实施例的典型的髓核假体装置的透视图。
图25是根据一些实施例的插入到外壳中的典型的假体的正面横截面图。
图26示意地描述了根据一些实施例的假体的插入。
图27示意地描述了根据一些实施例的假体的插入。
图28描述了包括脊柱固定部件的实施例。
图29描述了包括弹性的脊柱稳定部件的实施例。
图30描述了包括多个假体的实施例。
图31描述了布置来减轻或施加脊柱前凸实施例。
具体实施方式
图1一部分脊柱10的代表性的侧面图。特别地,图示部分10表示了两块椎骨12a和12b之间的椎间盘14。如图2所描述的部分10的横截面图所示,盘14包括环状纤维16和髓核18。如前所述,如果环状纤维16破裂,髓核可从破裂处暴露出来并且可给脊柱神经施加压力(未示出)。
图3A和图3B根据多个实施例描述了处于打开位置的典型的髓核假体30。在各种实施例中,可安排移植来减轻由椎间盘凸出(或其他退变或病理情况)造成的不适而仍然为椎骨提供了活动范围。假体30能被手术植入到环状纤维16内,例如如果环状纤维16仍然是足够健康并完整无缺。在一些实施例中,假体30能被用来增大剩余髓核18。假体30的各种实施例能被用来置换已经完全提取出来的髓核18。假体30还能被设计来在已经经历了完全的椎间盘切除术(椎间盘的全部移除)的椎间盘间隙插入和展开。然而,在这种情况下,如下所述假体将作为熔合的肌间保持器并且可包括孔或空隙(或窗或凹槽)。作为熔合器的假体的这个实施例还可包括例如已知类型的骨质锚定装置,在熔合完成之前其可在邻近椎骨上固定该假体。假体30还可被用来缓解除了椎间盘凸出以外的其他不利情况;例如假体30能被用来缓解有关环状纤维16硬化和/或髓核脱水、或其他的退变或病理情况的问题。
在假体30被用作熔合装置的各种实施例中,该假体能被布置在环状纤维的其余部分内或被布置在实施了完全椎间盘切除手术的椎间盘间隙内。作为熔合装置,假体30能被布置来促使骨组织的向内生长并且能被设置在盘空间中从而有利于椎骨12a和12b的熔合。
假体30包括多个节32。图3A和图3B每个分别表示了三个节32a、32b和32c,但是在可替换的实施例中,假体30可包括两个以上的任意合适数量的节。例如,假体30可有两个节、四个节、五个节、六个节等等。节32可由适于保持椎骨12a和12b之间间隙的刚性的或半刚性的材料组成。例如节32可由半刚性的塑性材料组成,当假体30已经被植入环状纤维16后,该半塑性材料至少部分地是具有弹性从而使节32能更好地吸收节上承载的压力。在其他实施例中,在一部分或全部节32中该节32也可是刚性的。刚性和半刚性部分的组合可被用于节32的各种实施例中来提供所需的支撑性能。
节32可通过至少一个构件连接起来。例如在图3A和图3B中,节32通过铰链34a(节32a和32b之间)和铰链34b(节32b和32c之间)连接。节32还可通过如柔性连接的一个或多个其他的连接元件,例如如系带36,连接在一起。系带36可采用通过一个或多个节32、通过穿过节的通道或通过遵循沿节的沟槽的路径的正切路径。在其他构型中,系带36可采用其他的合适路径(例如,放射状、环形、弧形、内曲形、向上倾斜状、编织状)通过节32。系带36可由合成纤维,例如特拉华州,威明顿(Wilmington)的纳幕尔杜邦公司的(E.I.du Pont deNemoursand Company)生产的涤纶聚酯纤维,其他聚合物、或其他合适的材料。其他类型的连接还可被用来联接节32,例如如下面进一步所述。
在一些实施例中,节例如通过至少一个柔性连接如系带和例如通过自由的铰接构件如铰链连接。各种实施例可有如图17所示的铰链140a、140b、140c或140d和/或图4A、4B、6、10或11(无参考)所示的铰链,和/或其他形式的铰接构件,通过维持它们基本在同一平面更好地连接节同时在所述平面中自由地连接它们。铰链可包括旋转轴,节能自由地围绕该轴枢转转动,例如在图3A、3B、7、9、13A或13B中所示的铰链(34a和34b)上可见的旋转轴。围绕铰链的旋转轴节的自由旋转的如此布置有利于假体的打开和闭合。因此这些铰链形成了将节联接在一起的连接但是他们仍能自由地铰接节。由这样的铰链形成的关节没有任何限制(围绕旋转轴,至少对于某些角度范围)并且因此节的枢转转动有利于假体的打开和闭合。在一些实施例中,设置铰链因此节保持在相同平面(例如相对于彼此,它们被固定在相同的水平面上)但能围绕旋转轴自由枢转转动,从而打开或闭合假体。例如通过从节的主体延伸的环绕部分旋转轴的节的一部分,并且通过从另一节的主体延伸的环绕部分旋转轴的另一节的一部分,所述节的所述部分相对于旋转轴沿与旋转轴大致平行但能围绕该轴自由旋转的方向被固定,形成铰链。例如在一些变型中从节的主体延伸的部分可是主体本身的一部分,如图中所示的节的棱角。这些部分和/或轴还可包括止动机构,该止动机构阻止旋转轴在沿与该旋转轴大致平行方向的这些部分内运动。铰链例如这些能刚性地连接节(在盘或髓核的平面),但能自由地铰接连接节(例如围绕旋转轴)。在一些实施例中,铰链可通过从围绕部分旋转轴的节延伸的凸片(lug)形成。在其他实施例中,铰链通过节的前侧面和/或后侧面以及另一节的后侧面和/或前侧面直接形成。这些前侧面和后侧面(定义的“前面的”和“后面的”与假体的节的描述相匹配),因此可包括至少一部分,该部分旨在接纳旋转轴并且与用来接纳另一个节的相应部分的至少一个凹槽相邻。本领域的技术人员将会意识到铰链的各种可替换的可能的布置能联接和铰接连接节。例如系带36还可包括封闭元件,如环38。如下所述在手术植入假体30的过程中环38能被使用。例如其他紧固装置或保持装置可被用作封闭元件代替环,如挂钩、扣锁或夹钳。在假体30的打开位置,节32可沿系带36以串联线方式(如,一个接一个)从接近环38的节32c到远离环38的节32a被设置。在打开位置,假体30将有前部节如节32c,和尾部节如节32a,具有通过假体30被植入的方向(参见如图6、25)所确定的名称“前面的”和“后面的”。因此在打开位置,假体30有横截面区域40,该区域40在宽度上一般被节32的宽度42约束以及在高度上一般被节32的高度44约束。假体30可有任意合适的高度44或宽度42。例如,假体32的高度44和宽度42能基于病人的椎间盘14或椎间盘间隙的高度和宽度来选择。
(示出几乎闭合位置的图4A、4B、7、10和12,以及表示了闭合位置的图15和图30),节32形成了适合支撑椎骨12a和12b的外形。合适的外形可根据病人的解剖学和假体30的预期的布置而不同,例如在环状纤维内布置、在已经经历过完全的椎间盘切除术(discectomy)的椎间盘间隙内布置、作为熔合装置布置、或正常情况或施加了脊柱前凸或脊柱后凸情况的布置。不管是何种所期望的布置,用来支撑椎骨12a和12b的合适的外形在该文中将被成为“盘形”。这个名称涉及相对于椎间盘的髓核的外形。就本文的目的而言,盘形可是如图所示的直线形式和平的圆柱形式。然而,其他的外形也可被使用,例如一般化的圆柱,即通过沿轴如直线或通过可能是平的、凸的、凹的、或上述组合的表面在两侧交界的更加一般的空间曲线扫掠可变的横截面所确定的外形。实际上,平直的圆柱通过圆形基底和竖直的高度被确定,但是一般化的圆柱可通过任意弯曲或多边形的外形和弯曲的或竖直的高度被确定。即时的髓核假体可有这些类型的一般化圆柱的任意外形。一般化圆柱外形的椎骨接触表面可有采用任何合适形状(如圆、椭圆、卵形、矩形、蛋形等等)的边缘。盘形也可以采用一般化的椭球体、多面体、一般的螺旋管形或另一种外形。当假体30处在闭合位置时通过节32形成的盘形可是实心的或可是大致中空的。在图3A和图3B所述的实施例中,节32的每个都有楔形、饼形或锥形形状,但是其他形状也可被使用。
各种实施例可具有用来缓解对椎骨表面的损坏的削边、锥形边、倒角边的结构。例如,图3A和图4A所述的实施例在节的侧壁和上表面和下表面之间有削边。另外,在一些实施例中,例如图3A和图4A所述的前部节的内表面46可有上边缘、下边缘和/或外边缘,其被去角从而有利于假体30的闭合以及减轻在闭合过程中对周围组织的损坏。
当假体30处于闭合位置时通过节32形成的盘形可有沿其一块或两块椎骨的接触表面和/或沿假体的一个或多个节的一个或多个外壁和/或内壁或表面的一个或多个孔或空隙。这些孔可包括盲孔或通过节的孔。例如,图3A描述了一个实施例,在该实施例中孔或空隙沿椎骨的接触表面33a、33b和33c被设置。在该实施例中,孔或空隙是相对较小的圆柱形孔。空隙(35)能被设计来容纳从邻近椎骨内向生长的骨头,这可促使在环状纤维16内或在椎间盘间隙内假体30的稳定。孔或空隙还能被布置来促进熔合。例如图3B描述了假体30的实施例,该实施例具有被布置为骨头内向生长以促使椎骨12a和12b熔合的许多孔35。在节的上表面和下表面的孔35可被连接从而骨头的内向生长能从上面的椎骨连续延伸到下面的椎骨。另外,孔能沿节的内表面连接从而促使邻接的骨头内向生长贯穿假体30。例如,图3B所示假体的实施例基本上是中空的,但是其他实施例可利用孔或空隙的不同的构型和不同的范围。使用骨组织或骨组织的自然替代物或合成替代物,或通过其他技术能促使图3A和图3B的实施例,以及其他实施例的骨头的内向生长。
图4根据各种实施例描述了处于几乎闭合位置的假体30。当闭合位置时,此实施例的节32a、32b和32c将有大致圆柱形式的盘形。特别地,在假体30的闭合位置,节32围绕铰链34a和34b折叠,因此节32的表面46大致与节32的表面46并置。当假体30处于闭合位置时,节32a的表面46与节32c的表面46邻接。换句话说,当假体30处于闭合位置时,串联排列节32中的第一个节与该串联排列的最后一个节是大致邻接的。
图5根据各种实施例描述了插入器械。在该所述实施例中,插入器械是导杆,该导杆被布置为斜槽50,该斜槽具有沿斜槽50的长度延伸的通道51。例如插入器械有布置来接纳假体如所述的铰接假体30的开口端52。通道51最好有与假体的横截面轮廓(如与打开位置的假体的横截面互补)互补的内横截面。在一些实施例中,当假体穿过通道到达插入点(如在环状纤维内或在完全椎间盘切除的椎间盘内),与假体的横截面轮廓40互补的插入器械的内横截面将倾向于保持假体的节例如所述的假体30的节32a、32b和32c良好对齐。转向器,例如弯曲的导向装置53,可在插入器械50的末端任意设置。转向器可有适于促使假体节闭合的弹性,同时仍有利于插入器械的抽回。
可选地,转向器可有选择性的弹性,例如通过具有在其中转向器是相对刚性的用来插入假体的装置,和通过具有在其中转向器是相对弹性的用来插入器械抽回的另一个装置。例如导向装置可有沿插入方向的多个铰接连接的节,公共通道通过该插入轴。在假体插入过程中,例如具有合适曲率的末端的“J”型弹簧钢花键(spline)(具有记忆形状或弹簧特性),可被迫使成为平直位置并且可沿插入工具的长度通过通道进入导向装置节的通道。当花键被完全插入通过插入工具的通道并且公共通道通过铰接的偏转节,导向装置将倾向于维持合适的曲率来插入假体。当假体已经被插入,花键能从通道中完全抽出,释放在铰接的偏转节上的保形力以及在插入器械抽回过程中允许它们铰接连接并且彼此对齐。
在各种实施例中,在假体的插入过程中可使用定位器。例如图5所描述的定位器被布置为杆54。例如定位器可布置有操纵装置,如图5所示的实施例的把手或球形把手55。例如定位器可有联接器,如图5所示的凹口56。在所述的实施例中,凹口56有与假体节的尾端互补的表面,但是也可使用其他的连接构件。定位器还可有作为连接元件或其部件的转接区。例如,图5所示的实施例有被布置为通道57的转接区,系带36的端部能贯穿该转接区。
在各种实施例中,定位器可被用来沿插入器械推动假体。在一些实施例中,当利用连接元件如系带36闭合假体时,定位器可被用来维持髓核假体在环状纤维16内或在椎间盘间隙内,并且在闭合操作中还可被用来更进一步推动假体进入适当的位置。
图6根据各种实施例表示了可被用来将髓核假体30手术植入到环状纤维16的技术。如图所示,例如,插入器械如斜槽或通道50可通过环状纤维16的外科切口20被插入到髓核18的位置。一些或全部髓核18可通过斜槽50(移除为显示)或用其他方式被移除。在打开位置这,此时假体通过斜槽50进入环状纤维16,同时环38首先进入。外科切口的横截面区域可与横截面轮廓40大致相同,即使如下所述处于闭合位置的假体30有稍大与该轮廓40的横截面区域。
图7根据各种实施例表示了在假体手术植入到环状纤维16内的过程中处于几乎闭合位置的假体30。当假体30进入环状纤维16时,环38和节32c与环状纤维16的表面相接触,该环状纤维使得节32c和节32b围绕铰链34b折叠。随着假体持续进入环状纤维16内,节32b和节32a随后将围绕铰链34a折叠。这时,环38能与系带36(接近节32a)的另一端接合。一旦环38与系带的另一端接合,假体30能通过拉与环38相对的系带的一端被促使进入闭合位置。环38与系带36另一端的接合能被布置来使得系带围绕节32a、32b和32c拉紧,并且促使假体进入闭合位置。插入器械50当然可被用于此来便于假体的移除,如以下详细说明。
这种拉紧可通过用于系带36上的一种或多种润滑剂来辅助完成。如上所述,当假体30处于闭合位置时,节32a的表面46a和节32c的表面46c是大体并置的。当系带36被拉紧时定位器54可被用来保持假体30的位置。
接着,环38能被永久地拉紧来维持假体30处于闭合位置。在可替换的实施例中,其他技术能被用来保持假体30处于闭合位置。当假体30处于闭合位置后,系带36能被削减、斜槽50能被移除并且环状纤维能被闭合。外科切口最好有足够的尺寸以便处于闭合位置的假体30将不能通过该外科切口,尽管在一些实施例中,假体30能返回到打开位置经由该外科切口移除假体。
图8表示了在假体30已经手术植入环状纤维16后脊柱的一节10。如图所示,假体30被放置在环状纤维16内以助于椎骨的支撑和振动的吸收。图8表示了在环状纤维16内部髓核假体30的非熔合安装。然而,将会意识到本文所述的任何假体在环状纤维16内或在已经历过完全的椎间盘切除术的椎间盘间隙内能可替换地重新装配用作熔合装置。
图9表述假体30的另一个实施例。在该实施例中,假体30包括通过铰链34a和34b及系带36连接在一起的节70a、70b和70c。在可替换的实施例中,其他的联接和/或连接可被使用。节70每个分别包括公互锁元件72和母互锁元件74。如图10所示,假体30的该实施例的俯视图,当假体30处于闭合位置时互锁元件72和74彼此互锁。在各种实施例中,公互锁元件72由与节70相同的弹性材料制成。当假体的这个实施例处于闭合位置时互锁元件72和74可被布置来防止在各个节70之间其的水平运动和垂直运动,或可被布置来允许节70水平地和/或垂直地的有界的相对运动。
图11表示假体30的另一个实施例的透视图,在该图中当假体30处于闭合位置时假体30的各个节相对彼此能垂直运动。假体30的这个实施例包括经由系带36连接在一起的节90a、90b和90c。在该实施例中,系带36穿过钻孔96,该钻孔采用通过每个节90a、90b和90c并且通过沿节边缘的任意沟槽98的正切路径。在其他实施例中,任意沟槽98能围绕一个或多个节90a、90b和90c延伸来代替孔96。当领会本公开后,孔96和/或沟槽98的其他组合对于本领域的技术人员来说将是显而易见的。在其他可替换的实施例中,其他连接也可被用来将节90连接在一起。
在图11和图12所示的实施例中,节90每个都包括公互锁元件92和母互锁元件94。在该实施例中,母互锁元件94在竖直方向上比公互锁元件92较长。这种结构能使公互锁元件92在母互锁元件94内滑动,允许节90相对彼此垂直运动。在其他实施例中,在提供节90的相对垂直运动情况下,其他合适的机构可被用于互锁节90。
如图12,假体30的这个实施例的俯视图所示,关节通过当假体30处于闭合位置时彼此咬合的互锁元件92和94形成。公互锁元件92可在母互锁元件94内竖直滑动。例如公互锁元件92可被布置为销,并且母互锁元件94可被布置为通道,该通道具有与销的外部轮廓互补的内部轮廓。因此,当假体30的实施例如该实施例处于闭合位置时,互锁元件92和94被布置来在各个节90之间能够垂直运动。在各种实施例中,公互锁元件92由与节90相同的弹性材料制成。
图13A和13B表示了假体30的另一个实施例。假体30的这个实施例包括节110a、110b和110c。节110的每个节包括第一弹性区域112和第二弹性区域114,第一弹性区域和第二弹性区域是由具有不同的弹性常数的材料组成。在一些实施例中,节110a、110b和110c也可表示通过部分节110a、110b和110c的弹性梯度。具有不同弹性区域或弹性梯度的节,类似地当然可在多个其他实施例中布置。
在该实施例中,节110a、110b和110c用两个系带36a和36b连接在一起。正如较早描述的实施例,系带36a和36b被用来促使节110进入闭合位置,并且可被用来维持假体30处于闭合位置。在图13A和13B所描述的实施例中,系带36a和36b贯穿在节110中,但是其他合适的系带结构也能被使用(例如,正切路径穿过节110中的孔或沿节110的侧壁沟槽的单个系带)。此外,在一些实施例中,系带36a和36b可被润滑从而有利于它们相对于节110的运动。
连接元件可被设计来容纳邻近椎骨的外形轮廓和不规则表面。例如在各种实施例中,系带36a和36b可被布置有弹性,当假体处于闭合位置时这将允许假体30的各个节彼此相对垂直运动。或者,系带36a和36b可被布置有弹性,这将允许节110a、110b和110c分散开来适应邻近椎骨的一个或两个表面上的任何突起。
各种实施例可用一个或多个节,在该实施例中节的高度在节的不同部分可不同。这种变型可容纳邻近椎骨表面的不同外形轮廓。例如图13A、13B和15所示的实施例的节110a、110b和110c有比部分114a、114b和114c稍高的部分112a、112b和112c。
不同的实施例还可有保持系带的保持器。图13A和图13B所示的实施例包括采用止动块116a和116b形式的保持器。止动块116a和116b分别沿系带36a和36b被设置,并且分别有合适的尺寸插入通道120a和120b内来保持或锁住假体30处于闭合位置。止动块能被用来牢固固定系带36a和36b每个的末端,或每个系带的一端可用止动块116牢固固定并且另一端直接扣紧到节,例如相对于图13B和15中节110c所示。根据如图14所述的各种实施例的止动块116的放大图。其他合适类型的止动块、塞子、夹钳、碰锁扣锁、锁、掣子)和挡块也可被用作保持器。此外,除了图13A、13B和15所述的一个实施例外保持器可被用来锁其他所述的假体实施例。
图16是根据不同的实施例的髓核假体130的透视图。假体130包括132a、132b和132c、系带134和条板(在一些实施例中,包括如后面所述的铰链滑动的轨道)。节132在材质和外形上可与上述节32、70、90和110大致相似。换句话说,节132具有这样的外形,当其闭合在一起(参见图20)时节132形成如上所述的盘形。而且,节132的高度和宽度可根据病人的盘14或椎间盘间隙的尺寸来选择。系带134也与以上所述的系带36大致相似。如图示,系带134可在条板136的端部之间来回地纵向穿过。
在图16所示的实施例中,随着节132一起进入闭合位置,条板136优选地被布置来围绕节132弯曲或伸缩。条板136能包括具有与节的弹性相似或不同的弹性材料,或能有弹性梯度。例如支架能有凹槽(recess)或空隙(void),如图16所示的凹口(notch)38,这将有利于条板136的弯曲或收缩。凹口(notch)38可沿如图16所示的条板的内侧面任意打开,或沿条板的外表面打开。或者,凹口(notch)不能沿条板的内侧面或外侧面打开。条板136还可由具有足够弹性的材料制成从而在没有任何凹口(notch)或凹槽(recess)情况下可适应所要求的弯曲或伸缩。
图17是假体130的另一个实施例的部分透视图。为便于说明,系带134在图17中略去。节132a、132b和132c通过铰链140b和140c连接在一起并且通过140a、140b、140c和140d连接到条板136。如图所述,140b和140c中的每个都被连接到一个或多个节132从而形成串联节。每个铰链140还可有在条板136的沟槽如形成引导铰链的轨道内滑行的销。例如,在该实施例中,铰链140b在节132a和132b之间联接并且在沟槽142中滑行,以及铰链140c在节132b和132c之间联接并且在沟槽142中滑行。铰链140a单独与节132a联接,铰链140d单独与节132c联接,并且铰链140a和140d中的每个都在沟槽内滑行。在可替换的实施例中,其他机构可被用来将节132联接到条板136。
图18和图19表示了沿图17所示的切割线的横截面图。特别地,图18和图19突出显示了节132、铰链140和沟槽142之间的空间关系。图18表示了通过一个节132的假体130的剖面图,以及图19表示了通过一个铰链140的假体130的剖面图。如图18和图19所示,铰链140包括在沟槽内滑动的销150。因此,节132能在沟槽142内自由运动。在可替换的实施例中,一个或多个节132每个都装备有与条板136联接的销150。在不同的实施例中,铰链140可没有销,并且装有节132的销可是保持节132与条板136相连的唯一构件。其他形式的保持器可用来代替销;例如节132的一侧或两侧以及铰链140可被布置有与条板136中楔形榫头形通道相符合的整体的或附连的楔形榫头突出端。其他形式的突出端也可被用作保持器,例如与节132的一侧或两侧及铰链140成整体的或附连到节132的一侧或两侧及铰链140的“T”型突出端,该突出端与条板136中的“T”型通道相符合。
如上所述,假体130被布置闭合从而节132形成了盘形。特别地,象以上述的假体30,假体130以打开位置可被手术引入环状纤维16然后随着其进入椎间盘弯曲成闭合位置。在不同的实施例中,通过拉系带134使假体130呈弯曲形。图20表示了处于闭合位置的假体130。如图所示,条板136包围节132,使其保持在闭合位置。于是假体130可通过固定系带134被牢固固定在闭合位置以便其保持条板136的末端彼此邻近。图21表示假体130的可替换的实施例,在该实施例中,条板136通常包围节132。例如,在该实施例中,条板136的上表面和下表面可在节132上延伸。或者,沟槽142还可被扩大来包围节132。
图22描述了可被假体的不同实施例所用的外壳162。外壳162可被布置成盘形并且可被布置来包围假体,如假体30或130或另一个合适的髓核假体。外壳162的上表面和下表面中的每个可能是贯穿表面或可选部分的表面(以前所述的假体)的大致平的、凸的或凹的。外壳162可由任意合适的生物相容的材料制成,例如涤纶聚酯纤维(Dacron polyesterfiber)、其他的聚合物或塑料或其他合适的材料。在各种实施例中,选择外壳162的厚度、编织或弹性来产生所需的刚性。当外力没有作用在外壳162上时,在各种实施例中的刚性可足以使外壳162有正常的外形,如盘形。在一些实施例中,外壳162将有弹性和/或刚性,当使外壳162变形的作用力停止作用时,该外壳162的弹性和/或刚性易使外壳162恢复到其正常的外形。或者,例如在包括包,如纤维袋的外壳的实施例中外壳162可没有合适的限定外形。而且,在一些实施例中,外壳通过编织形成,例如聚酯纤维织物,并且可被裁剪或编织以便有大致盘形。在这些实施例中,构成外壳的编织物可包括纤维之间的空间,其被布置来允许病人身体的周围的纤维组织在这些空间内生长。这种生长可增强外壳并且可使其表面光滑,因此例如当病人活动时,有利于外壳在盘(或髓核)空间内滑动的能力。
图24是根据不同的实施例假体组合装置160的透视图。假体组合装置160包括如图23所示的外壳162,其包含髓核假体,例如如上所述的髓核假体30或130,和能被用来闭合外壳162的系带164。
图25根据一些实施例表示了假体组合装置160的外科植入。外壳162可与插入器械连在一起,例如如所述的斜槽50。外壳和插入器械可提供给各种实施例中的外科装配。在一些实施例中,外科切口在环状纤维中形成后,外壳162被装配到斜槽50的一端并且可被放置到环状纤维16中。
在各种其他实施例中,外壳可与插入器械分离地来提供。在一些实施例中,外科切口在环状纤维中形成后,插入器械如斜槽50被安装以及外壳162被压缩或折叠并且通过斜槽50进入髓核区域。
一旦在环状纤维16或椎间盘间隙内,在各种实施例中外壳162可大致恢复到其正常的外形。虽然图25所述的实施例描述了假体30的特殊的实施例,但是任何其他合适的假体构型可使用,如假体130或假体30和130的任何变型。外壳162将优选具有与髓核假体30的闭合位置相符的内部。在一个有利的实施例中,外壳162可被装配到斜槽50的一端上并且因此当其被放置在环状纤维或椎间盘间隙内时可维持打开位置,从而有利于假体随后进入外壳内。如图25所述,假体30以打开位置通过在方向170的斜槽50进入外壳162,现在外壳在环状纤维16内。随着假体30进入外壳162,其折叠直到假体30处于闭合位置。还可用系带36拉紧假体30使其进入闭合位置。在假体30被插入和折叠进入闭合位置后,外壳162可用系带164闭合,例如通过拉系带。接着,修剪系带164、移除斜槽50以及封闭外科切口。在可替换的实施例中,假体组合装置160可被用作在完全的椎间盘切除术过程中已经移除的盘14的替代物。
在各种实施例中,插入器械的使用可有优点。例如在外壳162没有据够的刚性使其有正常的外形的实施例中,插入器械在假体插入过程中可被用来保持外壳打开和/或固定。例如图26表示了包括纤维贷162的外壳的实施例。斜槽50的末端保持外壳162敞开并且在假体的插入过程中保持外壳162固定。假体可通过通道51,同时节32a、32b和32c以串联设置进入外壳162。在所述的实施例中,节32c首先遇到导向装置53,其引起节转向并且开始闭合节32a、32b和32c。在各种实施例中,前部节(如图26的节32c)端部的侧向操纵可有利于闭合,例如图26所述,在该图中节32c的端部朝向包括导向装置53(在图26所示的方向中其是通道51的上壁)的通道51的外侧壁移动,这引起了节32c和32b之间的铰链朝向通道51(在图26所示的方向中其是通道51的下壁)的内侧壁移动,这又将引起节32b和32a之间的铰链朝向通道51的前壁移动,因此,如图27所示将节32b和32a放置在适当的位置为了更好地闭合这些节。
在各种实施例中,假体可装有其他的脊柱稳定结构。例如,图28描述了一个实施例,在该实施例中假体30被布置为熔合装置并且被植入到如上所述的髓核16内,然而其他假体的实施例和植入方法也可被使用。对于这个实施例和其他实施例,脊柱后路稳定装置能被用来给椎间盘的排列提供额外的稳定性。在所述的实施例中,在每块椎骨12a和12b中植入椎弓根螺钉81。在优选实施例中,椎弓根螺钉81最好能被布置如2004年4月12日提交的美国专利申请No.10/473,999(或FR2823093),或2004年11月7日提交的美国专利申请No.10/498,234(或FR2833151)所述,该两个专利通常都由本申请的受让人所拥有,并且其两者都通过参考合并于此。杆82被固定到每个螺钉81并且易于保持椎骨12a和12b处于手术过程中由外科医生所确定的对准方式中。在领会这个公开后对于本领域的这些技术人员来说,也可使用其他脊柱固定装置。
弹性椎骨稳定装置还可装有假体。例如,图29描述了使用了椎骨支撑装置的实施例,该椎骨支撑装置如2007年2月8日提交的美国专利申请No.11/672,745(或FR0611198)所述,其通常由本申请的受让人所拥有,并且其通过参考合并于此。在所述的实施例中,椎弓根螺钉81被植入到每个椎骨12a和12b中。连接元件83包括阻尼元件84和由阻尼元件84铰接连接的刚性元件85。每个刚性元件85分别被固定到每个椎弓根螺钉81。椎骨支撑装置提供了刚性元件85的柔性关节,其可提供给椎骨12a和12b一些活动自由。在各种实施例中,阻尼元件84调节了在连接元件83运动过程中其所经受的压力,并且易于恢复椎骨12a和12b到所要求的外形。
在一些实施例中,多个假体可在环状纤维16内或椎间盘间隙内布置。例如,图30描述了一个实施例,该实施例使用能在环状纤维内插入或在实施了完全椎间盘切除术的椎间盘间隙内布置的两个合适尺寸的假体30。其他实施例可使用多于两个的假体。其他假体的实施例也可被使用,并且假体实施例的组合也可被使用。外壳可与用在多假体实施例的各种假体中的一个、多个或全部一起使用。多假体实施例还可与其他脊柱稳定结构,如以上所述的结构,一起使用。
各种实施例可被布置来减轻或施加脊柱前凸或脊柱后凸。例如图31描述了在环状纤维内植入并且布置来减轻或施加了脊柱前凸的髓核30的实施例。所描述的假体30的上表面和下表面是有角度的因此假体30的前面部分比后面部分较薄。脊柱后凸的情况能通过安装具有前面部分比后面部分较厚的假体来被减轻或施加。在领会了本申请的公开后,本领域的技术人员将会意识到根据本发明假体的许多不同的实施例可任意地被布置来减轻或施加脊柱前凸或脊柱后凸。
在领会本公开后本领域的技术人员将会意识到本文所公开的各种方法、过程和其他技术的步骤不需要以任意特殊的顺序实现,除非另有明确地说明或逻辑上需要满足明确说明的情况。此外,在领会本公开的后本领域的这些技术人员将会意识到本发明在不偏离本发明的原理和范围情况下可以多种不同的形式体现并且可实现各种变化、置换和更替。本文提及的表面或其他结构称为“顶部”、“上面”、“底部”、“下面”,或具有“高度”、“宽度”或“长度”,以及方向参考如“水平的”和“垂直的”,一般是任意的并且仅是为了方便,以及在领会本公开后本领域的这些技术人员将会意识到这些名称可在特殊实施例中作适当地调整。所述的实施例仅是说明性的而不是限制性的,并且本发明的范围仅由以下权利要求所限定。

Claims (28)

1.髓核假体(30、130、160)包括多个节(32、70、90、110、132),所述节包括前部节和尾部节,以及联接所述节(32、70、90、110、132)的至少一个连接(34、36、134、140、164),所述髓核假体(30、130、160)包括:
打开位置,在打开位置所述节(32、70、90、110、132)沿所述连接(34、36、134、140、164)以串联线设置,其中在所述串联线的一端具有所述前部节并且在所述串联线的另一端具有所述尾部节;
所述髓核假体(30、130、160)的特征在于:
其包括闭合位置,在所述闭合位置所述节(32、70、90、110、132)被设置以形成具有所述前部节和所述尾部节并置的盘形;
每个节具有尾部内表面、前部内表面和外表面;
在所述闭合位置,节(32、70、90、110、132)的所述尾部内表面与邻接的节(32、70、90、110、132)的所述前部内表面并置;
在所述节(32、70、90、110、132)之间的所述连接(34、36、134、140、164)包括至少一个铰链(34a、34b、140a、140b、140c、140d);并且
所述节(32、70、90、110、132)之间的所述连接(34、36、134、140、164)进一步包括至少一个柔性连接(36、134、164),所述至少一个柔性连接(36、134、164)通过孔(96)和/或沿沟槽(98)在所述节(32、70、90、110、132)的每一个的至少所述外表面的至少部分上穿过,所述柔性连接或者穿过所述外表面在所述铰链的外侧从所述铰链的周边经过所述铰链(34a、34b、140a、140b、140c、140d),或者穿过所述前部内表面和尾部内表面在所述铰链的内侧从所述铰链的周边经过所述铰链(34a、34d、140a、140b、140c、140d)。
2.根据权利要求1所述的假体(30、130、160),其特征在于所述打开位置和闭合位置通过拉动所述柔性连接(36、134、164)的自由端而被配置。
3.根据权利要求1所述的假体(30、130、160),其特征在于所述至少一个柔性连接(36、134、164)还通过孔(96)和/或沿沟槽(98)在所述节(32、70、90、110、132)的所述尾部内表面和前部内表面的至少部分上穿过。
4.根据权利要求1所述的假体(30、130、160),其特征在于一个或多个所述节(32、70、90、110、132)是弹性的。
5.根据权利要求1所述的假体(30、130、160),其特征在于一个或多个所述节(32、70、90、110、132)具有弹性梯度。
6.根据权利要求1所述的假体(30、130、160),其特征在于一个或多个所述节(32、70、90、110、132)包含具有第一弹力的内部部分和具有第二弹力的外部部分。
7.根据权利要求1所述的假体(30、130、160),其特征在于所述柔性连接是系带(36、134、164)。
8.根据权利要求1所述的假体(30、130、160),其特征在于所述节包括被配置以连接在一起的互锁元件(72、74、92、94)。
9.根据权利要求8所述的假体(30、130、160),其特征在于所述互锁元件(72、74、92、94)被配置以允许所述节(32、70、90、110、132)相对彼此垂直运动。
10.根据权利要求8和9中的一个权利要求所述的假体(30、130、160),其特征在于所述互锁元件(72、74、92、94)由在至少一个节(32、70、90、110、132)的至少一个面上的公互锁元件(72、92)和在至少另一个节(32、70、90、110、132)的至少一个面上的母互锁元件(74、94)构成,所述公互锁元件和母互锁元件彼此互补。
11.根据权利要求10所述的假体(30、130、160),其特征在于所述公互锁元件(72、92)包括销以及所述母互锁元件(74、94)包括能使所述销在其中滑动的通道。
12.根据权利要求6所述的假体(30、130、160),其特征在于所述髓核假体包括在所述柔性连接(36、134、164)一端上的封闭元件(38、116)。
13.根据权利要求12所述的假体(30、130、160),其特征在于所述封闭元件(38、116)被配置以与所述柔性连接(36、134、164)的另一端接合,同时这样的接合被配置以促使所述髓核假体(30、130、160)进入闭合位置。
14.根据权利要求12和13中的一个权利要求所述的假体(30、130、160),其特征在于所述封闭元件(38、116)包括所述柔性连接(36、134、164)的环(38)。
15.根据权利要求12和13中的一个权利要求所述的假体(30、130、160),其特征在于所述封闭元件(38、116)包括在所述柔性连接(36、134、164)一端的止动块(116)。
16.根据权利要求6所述的假体(30、130、160),其特征在于所述柔性连接(36、134、164)采用通过所述节(32、70、90、110、132)的正切路径。
17.根据权利要求1所述的假体(30、130、160),其特征在于所述髓核假体包括与一个或多个节(32、70、90、110、132)联接的条板(136)。
18.根据权利要求17所述的假体(30、130、160),其特征在于一个或多个节(32、70、90、110、132)通过位于所述条板(136)的通道(142)内的销(150)与所述条板(136)联接。
19.根据权利要求17和18中的任一个权利要求所述的假体(30、130、160),其特征在于在至少两个所述节(32、70、90、110、132)之间的铰链(140)通过位于所述条板(136)的通道(142)内的销(150)与所述条板(136)附连。
20.根据权利要求17所述的假体(30、130、160),其特征在于当所述假体(30、130、160)闭合时,所述条板(136)被配置以绕所述节(32、70、90、110、132)折叠。
21.根据权利要求17所述的假体(30、130、160),其特征在于所述条板(136)被配置以包围处于所述闭合位置的所述髓核假体的大致盘形。
22.根据权利要求17所述的假体(30、130、160),其特征在于所述髓核假体包括系带(36、134、164),所述系带与所述条板(136)联接并且被配置以当在所述系带(36、134、164)上作用拉力时折叠所述条板(136)。
23.根据权利要求17所述的假体(30、130、160),其特征在于所述条板(136)具有与所述节(32、70、90、110、132)的弹力不同的弹力。
24.根据权利要求1所述的假体(30、130、160),其特征在于所述假体(30、130、160)包括窗(35)并且形成熔合装置。
25.根据权利要求1所述的假体(30、130、160),其特征在于所述髓核假体包括至少一个外壳(162),所述外壳被配置以保持所述节(32、70、90、110、132)。
26.根据权利要求25所述的假体(30、130、160),其特征在于,在一方面,所述外壳(162)具有与所述假体(30、130、160)的所述闭合位置相符合的内部,并且在另一方面,随着所述髓核假体进入所述外壳(162),所述髓核假体被配置以从所述打开位置转变到所述闭合位置。
27.根据权利要求1所述的假体(30、130、160),其特征在于当所述假体处于所述闭合位置时,并置的所述前部节和所述尾部节通过所述前部节的表面(46a)和所述尾部节的表面(46c)相接触,每个表面都包括互锁元件。
28.根据权利要求17所述的假体(30、130、160),其特征在于所述条板(136)包括凹口,当所述髓核假体闭合时,所述凹口有利于所述髓核假体围绕所述节折叠。
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CN104586545A (zh) 2015-05-06
US20080312743A1 (en) 2008-12-18
KR20150109488A (ko) 2015-10-01
EP2170226B1 (en) 2016-03-30
FR2917287B1 (fr) 2010-09-03
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FR2917287A1 (fr) 2008-12-19
KR20100024417A (ko) 2010-03-05
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WO2008152501A3 (en) 2009-02-19
RU2489119C2 (ru) 2013-08-10
AU2008263569A1 (en) 2008-12-18
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US20170172761A1 (en) 2017-06-22
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US20140135935A1 (en) 2014-05-15
US9526622B2 (en) 2016-12-27
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