CN1976651A - 用于稳定-修复装置的系统和方法 - Google Patents
用于稳定-修复装置的系统和方法 Download PDFInfo
- Publication number
- CN1976651A CN1976651A CNA2005800124164A CN200580012416A CN1976651A CN 1976651 A CN1976651 A CN 1976651A CN A2005800124164 A CNA2005800124164 A CN A2005800124164A CN 200580012416 A CN200580012416 A CN 200580012416A CN 1976651 A CN1976651 A CN 1976651A
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- CN
- China
- Prior art keywords
- spinal column
- flexible member
- column insert
- plates
- plate
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/442—Intervertebral or spinal discs, e.g. resilient
- A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
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- A61F2002/30062—(bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
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Abstract
公开一种用于插入两骨之间的一运动保持植入物装置(20)。该运动保持植入物装置包括一用于接合一第一骨的第一板(22)和一用于接合一第二骨的第二板(24)。一关节连接元件(26)设置于两板之间,且一运动控制元件(28)连接至两板中的一个或两个。在一些实施例中,运动保持元件构造成约束、抑制和/或缓冲在两板之间的相对运动。
Description
技术领域
本发明一般地涉及整形外科领域和其中使用的关节植入物。在一些实施例中,本发明涉及用于完全或部分替代一自然椎间盘的椎间盘修复关节及其使用方法。
背景技术
在对于骨关节和疾病、损伤或畸形的治疗中,例如那些影响脊柱运动部分的骨关节,尤其是那些影响盘组织的骨关节,移除一退化的、断裂的或以其它方式失效的盘的一些或全部,这是长久以来已知的。在涉及从一脊柱运动部分中被移除或以其它方式缺少的椎间盘组织的情形下,采取了矫正措施来确保之前通过被移除的盘组织而分离的椎骨的适当间距。
在一些例子中,通过使用移植的骨组织、一人工融合组件或者其它组件或装置,两个邻近的椎骨被融合在一起。然而,脊柱融合方法已在医疗界中引起了关注,椎间融合的生物机械刚性可能使得邻近的脊柱运动部分倾向于迅速退化。更特别地,与一自然椎间盘不同,脊柱融合防止了融合的椎骨相对于彼此枢转和旋转。这样活动性的缺乏趋向于增加邻近的脊柱运动部分的应力。
在其它的例子中,已提出椎间盘关节成形术,以用于在维持在邻近的椎骨之间的枢转和/或旋转的某个范围的同时,防止其间的椎间间距的收缩。这样的装置通常包括设置于上板和下板之间的关节元件,上板和下板进一步连接至相应的上级椎骨和下级椎骨。该关节元件通常构造成允许椎骨相对于彼此枢转和/或旋转。然而,这些运动保持装置可能会导致来自非限制活动的损伤。对于患有诸如脊柱前凸或脊椎前移的脊柱畸形的病人,这样的活动或者稳定性的缺乏可能会使盘替换康复恶化。
发明内容
在一实施例中,提供一种用于插入两骨之间的一运动保持植入物装置,该骨例如但不限于椎骨。该运动保持植入物装置包括一用于接合一第一骨的第一板和一用于接合一第二骨的第二板。一关节连接元件设置于两板之间,且一运动控制元件连接至两板中的一个或两个。在一些实施例中,运动保持元件构造成约束、抑制和/或缓冲在两板之间的相对运动。
在另外的实施例中,提供一种用于插入两椎骨本体之间的脊柱植入物。该脊柱插入物包括一用于接合第一椎骨本体的第一板和一用于接合第二椎骨本体的第二板。该脊柱插入物也包括设置于两板之间的一关节连接元件和连接至两板中的一个或两个的一弹性运动控制元件。在一些实施例中,关节连接元件和运动控制元件构造成在两椎骨本体之间提供枢转和旋转运动。同样在一些实施例中,关节连接元件构造成在两椎骨本体之间提供旋转和平移运动。
还提供一种用于在两骨之间插入一运动保持植入物的方法。在一实施例中,该方法包括确定运动保持植入物的一所需形状,并确定对于运动保持植入物的一运动的程度。根据形状和运动程度的确定来选定一个或多个弹性元件,并组装一个或多个弹性元件进入运动保持植入物。一旦组装完,在两骨之间插入运动保持装置。
还提供一种用于外科中在两骨之间设定一关节的工具。在一实施例中,该工具包括至少一个运动保持植入物,该运动保持植入物具有用于接纳至少一个弹性元件的至少一个凹处。该工具也包括与运动保持植入物一同使用的多个弹性元件。当接纳于其中时,这些多个弹性元件能够提供一运动保持植入物的多个不同构造。
附图的简要说明
图1是作为一例子的一脊柱的一部分的一侧视图,本发明的一个或多个实施例可以在该例子中实施。
图2是根据本发明的一些实施例的、一运动保持植入物装置的一框图。
图3a、3b和4-39是根据本发明的众多实施例的、许多不同运动保持植入物的众多立体、剖面和分解图。
图40是用于插入根据本发明的一实施例的、一运动保持植入物的一方法的一流程图。
具体实施方式
为了促进对本发明的原理的理解,现在参照在附图中说明的实施例或例子,并且将使用专用语言来描述同样的事物。然而应该理解,不因此想要限定本发明的范围。本领域的普通技术人员通常会想到在所描述的实施例中的任何替换和进一步的修正以及在此描述的本发明原理的进一步应用。如此,可以组合分别描述的实施例的单独特征来形成附加的实施例。此外,贯穿众多的实施例,重复参考标号。这样的重复并不暗示着某些实施例的特征必须或应该随其它实施例使用。而是想要具有来自附图和讨论的一个或多个特征的一广泛种类的不同实施例。
参见图1,标号10涉及一具有一关节位置的一人体解剖,在该关节位置本发明的一个或多个实施例可以实施。在此例中,人体解剖包括一具有一损伤的、患病的或以其它方式损坏的、在椎骨14、16之间延伸的椎间盘12的脊骨。根据本发明的一个或多个实施例,可以通过一椎间盘修复来替换损坏的盘12的一些或全部。尽管详细讨论了脊椎产品,但仍预期到其它的实施例,包括那些与诸如髋部和膝盖的大规模整形和诸如手指和手腕的小规模整形相关的产品以及牙齿相关的产品。
参见图2,继续一脊椎植入物的现在的例子,可以在两个脊椎元件(在本实施例中是椎骨14和16)之间设置一运动保持植入物装置20。装置20包括用于接合第一(例如,上级)椎骨14的一第一板22和用于接合第二(例如,下级)椎骨16的一第二板24。装置20还包括设置于两个板22、24之间的一关节连接元件26。在一些实施例中,关节连接元件26可以是与板22、24的其中之一或全部分离的结构,诸如在美国专利第5,674,296号、第6,019,792号以及美国公开申请第2002/0035400号和第2003/0199982号中所公开的,这些结合于此作为参照。在其它的实施例中,关节连接元件26可以与板22、24中的一个或两个形成整体或以其它方式连接至其,诸如在美国专利第5,258,031号、第6,113,637号以及美国公开申请第2003/0208273号所公开的,这些结合于此作为参照。为了示例,对于板22、24和关节连接元件26继续参照在美国公开申请第2003/0208273号中所公开的实施例。
除了关节连接元件26之外,在两个板22、24之间插入一运动控制元件28。运动控制元件28可以连接至板22、24中的一个或两个,并可以包括设置于不同位置的一个或多个组件。同样,该一个或多个组件可以提供不同的作用,包括限制、缓冲或抑制在两个板22、24之间的相对运动。
参见图3a-8,在一些实施例中,修复装置20在邻近的椎骨本体之间提供相对枢转和旋转的运动,来维持或恢复基本类似于由一自然椎间盘提供的一正常的生物机械运动。更特别地,允许板22、24相对于彼此绕许多轴线枢转,包括绕纵向轴线L横向或左右地枢转运动以及绕一横向轴线T前后地枢转运动。应该理解,在说明书的一些实施例中,允许板22、24相对于彼此、绕设置在与轴向轴线和横向轴线相交的一平面中的任何轴线枢转。
此外,在一些实施例中,允许板22、24相对于彼此绕一旋转轴线R旋转。尽管已经说明和描述修复装置20作为提供关节连接运动的一特定组合,但应该理解,关节连接运动的其它组合也是可能的,例如,沿着由轴线L和T限定的平面相对平移或直线运动,且这样的运动是被预期为落入本说明书的范围之内的。
尽管修复装置20的板22、24可以由一广泛种类的材料形成,但在本说明书的一些实施例中,板22、24由一钴-铬-钼金属合金(ASTM F-799或F-75)形成。同样在本实施例中,板的至少一部分可以被一非晶氧化物涂层所覆盖。然而,在本发明的另外的实施例中,板22、24可以由其它材料形成,这些材料诸如钛、不锈钢、陶瓷、例如聚乙烯的聚合物材料、或者对于本领域普通技术人员是显而易见的任何其它生物相容材料。
板22、24中的每一个都包括一支撑面30、32,支撑面30、32分别地可以设置成与椎骨直接接触和可以被一促进骨生长的物质所覆盖,例如由磷酸钙形成的一羟磷灰石涂层。此外,板22、24的支撑面30、32分别地可以在被促进骨生长的物质所覆盖之前变粗糙来进一步增强骨的生长。这样的使表面变粗糙可以通过例如酸蚀、滚花、涂边的应用、或者本领域普通技术人员会想到的任何其它变粗糙方法来完成。
在一些实施例中,关节连接元件26包括具有一凸出形状的一突起物56,该凸出形状构造成一球形的球(显示了其一半)。应该理解,也可以预期到突起物56的其它构造,例如,圆柱形、椭圆形或者其它拱形构造或可能非拱形构造。同样应该理解,板22的其余部分可以呈现平面或非平面构造,例如在突起物56附近延伸的一角状或圆锥形构造。
继续本例子,板24包括一凹处58。在一些实施例中,凹处58具有一凹入的形状,并构造成一球形槽。然而,应该理解,也可以预期到凹处58的其它构造,例如,圆柱形、椭圆形或者其它拱形构造或可能非拱形构造。
尽管凹入的凹处58被显示成具有一一般地平滑、不间断的关节表面,但应该理解,沿着凹处58的一部分可以限定一表面凹陷或空穴,来提供清除物质的一装置,这些物质例如位于邻接的两板22、24之间的颗粒碎片。在此情形下,突起物56的凸出关节表面可以可选择地限定一一般地平滑、不间断的关节表面。在另外的实施例中,凸出突起物56和凹入凹处58都限定了一表面凹陷以利于设置于邻接的两板22、24之间的颗粒物质的去除。在另外的实施例中,凹处58可以包括一槽,例如在当前结合的美国专利第6,113,637号所显示的,用于允许分别的板22、24之间的平移运动。
板22、24可以连接至其相应的椎骨12、14的方法有很多种,包括但不限于使用一凸缘元件或龙骨60、一在椎骨本体附近延伸的用于接纳一个或多个骨螺钉的边缘部分、和由本结合的参照讨论和/或建议的其它构造。
参照图3a-4的实施例,板22、24中的每一个都包括多个凹处62、64,用于接纳通过一绳索68连接的一个或多个弹性元件66。应该理解,弹性元件66和/或绳索68可以包括许多不同的材料,包括但不限于橡胶聚合物、弹性金属或塑料。也可以添加一例如超高分子量聚乙烯(UHMWP)的涂层至弹性元件66和/或绳索68的外表面。
此外,弹性元件66和/或绳索68的一些或全部可以由一生物吸收材料构成,从而可以随时间的过去而改变其性质。可选择地或附加地,弹性元件66和/或绳索68的一些或全部可以由一响应于其环境而改变性质的材料构成,例如形状记忆金属。在另外的实施例中,弹性元件66和/或绳索68的一些或全部可以由响应于例如一射频信号的一外部刺激而改变性质的材料制成。例如,在首先处理一脊椎前移条件的一周期期间,装置20可以要求附加的缓冲或约束,但随着脊椎前移的存在,缓冲或约束可以被减少或去除。此外,可以使用绳索68以利于在装置20内的元件66的组装和定位以及在插入期间维持定位。应该理解,在其它实施例中,可以不使用绳索68。同样,如同在目前结合的美国专利公开第2002/0035400号中所显示的,但未在本发明的附图中显示的,可以使用一护套来围绕两板22、24之间区域的一些或全部,这些区域包括弹性元件66。
在一些实施例中,凹处62、64的形状配合地对应于弹性元件66的形状。在此方法中,弹性元件66与板22、24持续接触,并因此在其间提供一约束的缓冲。所提供的缓冲量可以通过诸如每个元件66的尺寸、一个或多个元件是否包括一中空部分、或元件的材料成分的因素来控制。同样,一个或多个元件的中空部分可以被一例如凝胶的、影响弹性的材料所填满。在另外的实施例中,一个或多个中空部分可以被一随时间的过去而改变性质或响应于诸如上面讨论的那些材料的其它条件的材料所填满。进一步的设计选择也可以允许除了缓冲之外的一些运动,例如上面讨论的、绕轴线R、L和T中的一个或多个而运动。
参照图5-6的实施例,板22、24都包括多个凹处72、74,用于接纳一个或多个弹性元件66。在这些实施例中,当与相应的弹性元件66配合时,一个或多个凹处72、74的形状包括一个或多个缝隙76。以此方式,弹性元件66与板22、24持续接触但仅仅半约束。这允许了在凹处72、74的形状接触弹性元件66之前的一些旋转“滑动”,以此方式来防止进一步的滑动。应该理解,根据元件66的弹性性质,还可以提供附加的运动。在一些实施例中,缝隙76也可以支持元件66在一负荷下的一弹性压缩和膨胀。
参照图7-8的实施例,板24包括多个凹处,这些凹处可以类似于凹处64(图4)或74(图6)。为了示例,凹处64会进一步讨论,但应该理解,想要在在此公开的不同实施例的众多特征之间的一广泛范围的可替换性。板22包括以相应于凹处64的一轨道的形式存在的一凹处82,两者都用于接纳一个或多个弹性元件66。在这些实施例中,弹性元件66通过凹处64被约束,但允许在轨道82中移动,从而支持绕轴线R的相对非限制的径向运动。此外,应该理解,根据元件66的弹性性质或一较宽的轨道82,还提供了在其它方向的附加移动。在一些实施例中,轨道82可被分为几部分,来防止超过一预先确定量的径向移动。
现在参见图9,板22、24都包括多个凹处92、94,用于接纳由一绳索98连接的一个或多个弹性元件96。弹性元件96可以具有多种形状和/或结构,在一些实施例中它在相同的装置20中具有不同的形状和/或结构。在本实施例中,弹性元件96成形为轮子,而凹处92、94的形状配合地对应于弹性元件96的形状。以此方式,弹性元件96与板22、24持续接触,并因此在其间提供一约束的缓冲。所提供的缓冲量可以通过诸如每个元件96的尺寸、一个或多个元件是否包括一中空部分、或元件的材料成分的因素来控制。
本实施例提供了一些独特的特征。举例来说,当两板22、24之间的绕轴线R的一旋转运动出现时,弹性元件96会被驱动来绕轴99旋转。轴99可以固定至元件96和绳索98中的一个或全部,或这可以允许完全旋转。当弹性元件96开始旋转时,这引起了在两板22、24之间发生的一分离。另一个独特的特征是,在弹性元件96和突起物56之间的绳索98的定位帮助使装置20在插入适当位置(对于本实施例是在盘间隔中)时保持适当的排列。同样,例如当凹入的凹处58包括一用于促进平移运动的槽时,绳索98可以用于防止多余的平移运动。
现在参见图10-11,在其它的实施例中,板22、24分别包括圆柱形的凹处102、104。弹性元件106成形成圆柱形,且凹处102、104的形状配合地对应于弹性元件的形状。以此方式,弹性元件96与板22、24持续接触,并因此在其间提供一缓冲。取决于圆柱形元件106的形状和成分,它们可以在运动中以不同方向提供一所需量的约束。
参见图12-17,在其它实施例中,板22包括以一通孔形式存在的一凹处112。通孔112包括一锥形边或边缘112a,这将在下面详细讨论。板24包括一凹处114,该凹处114并不延伸穿过板。弹性元件116成形成圆柱形,且凹处112、114的形状配合地对应于弹性元件的形状。弹性元件116也可以包括一边缘116a,该边缘116a成形成在通孔中接合相应的边缘112a。以此方式,每个弹性元件116可被插入或落入穿过相应的通孔112,边缘112a、116a会“吻合”并防止弹性元件穿过掉下。一旦在位,诸如螺钉、铆钉、可旋转元件或销的一锁定元件118固定在通孔中。例如,假如锁定元件118是一螺钉,通孔可以具有一用于接纳螺钉的表面,例如相应的螺纹。因此,弹性元件被固定至板22。
特别参见图12,在一些实施例中,弹性元件116与板24持续接触,其中末端116b与相应的凹处114接触。在此实施例中,弹性元件116在板22、24之间提供一约束的缓冲。在这些实施例的一些中,当装置完全组装好时,边缘116a、112a不必接触。而通过控制锁定元件118可以选择每个弹性元件的有效高度。
例如,假如锁定元件是一螺钉,螺钉可以以一预先确定量螺纹地拧进通孔凹处112,由此控制相应的锁定元件延伸入两板22、24之间的间隔的量。因此,板可以以不同的排列放置,包括平行或不平行的排列,来适应病人的需要。
特别参见图14,在其它实施例中,弹性元件116具有一长度从而它们并不“正常地”到达其相应的凹处。在一些实施例中,例如图14所示,甚至可以不是在板24中的一相应的凹处(与图12的凹处114相比较)。在这些实施例中,板22、24在一正常位置不受限制。一正常位置可以是板22、24在一例如基本平行的所需位置的一位置。在例如脊柱前凸的情况下,一正常位置可以是不平行的来考虑到前凸椎骨的偏移性质。当具有脊柱的基本移动或弯曲时,该位置不再“正常”。弹性元件116并不影响绕轴线R的任何旋转移动,但在板22、24之间提供缓冲器以用于其它的移动。
特别参考图15,在其它实施例中,弹性元件116也可以具有不同的尺寸或形状,来提供不同的缓冲作用。例如,一相对较长的弹性元件116c可以与一相对较短的弹性元件116d一起使用。这一例子可以用于例如脊柱前凸的情形,或者可以用于限定在脊柱中的一相对正常角度。尽管显示了一缓冲排列,缓冲器型排列也可以受益于这些不同尺寸的弹性元件116c、116d。
参见图16-18,在其它的实施例中,弹性元件116具有一根部分116e和一颈部分116g。此外,通孔凹处112中的一个或多个可以包括一插入开口112b。在组装期间,弹性元件116的颈部分116g可以滑过插入开口112b,直到边缘116a接合边缘112a为止。假如插入开口112b比通孔凹处112小,则弹性元件116可以“咬合入”凹处,并仍然充分地固定在位。
特别参见图17,在一些实施例中,弹性元件116中的一个或多个可以包括一中空部分116f,类似于上面相对于图3a-4所讨论的中空部分。中空部分116f给元件116提供附加的弹性。应该理解,不同的弹性元件116可以具有不同尺寸的中空部分116f,假如完全地,来适应对于装置20的特定需要。
参见图18-19,在其它的实施例中,板22、24分别包括一螺纹凹处122和一凹处124。销形弹性元件126成形成圆柱形,且凹处122、124的形状配合地对应于弹性元件的形状。弹性元件126包括一螺纹端126a,该螺纹端126a成形以螺纹地拧入相应的螺纹凹处122。一旦在位,弹性元件126就固定至板22。特别参见图19,在一些实施例中,弹性元件126中的一个或多个包括一中空部分126b。同样,应该理解,螺纹端126a可以以一自攻螺纹的形式存在,且凹处122包括例如由聚醚醚酮(PEEK)制成的一可拧螺纹的表面。
现在参考图20-22,在其它的实施例中,板22、24分别包括一燕尾凹处142和一槽凹处144。特别参见图20-21,三个弹性元件146成形成四分之一圆拱形,具有成形成一燕尾用于接合燕尾凹处142的一顶部146a和用于在槽凹处144中滑动的一底部分146b。一旦在位,弹性元件146被固定至板22。对于一些实施例,可以通过插入一开口150的一锁定元件148来获得附加的固定,这些锁定元件148诸如螺钉、销、环氧树脂、胶合剂或楔。同样在一些实施例中,弹性元件146中的一个或多个可以包括一开口146c,该开口146c可以增加柔性和/或可压缩性。特别参见图20,一旦在位,弹性元件146在两板22、24之间提供压缩约束,但仍然考虑到绕轴线R的旋转。特别参见图22,在其它的实施例中,弹性元件146可以在两板22、24之间提供一间隔的缓冲器,但仍然考虑到绕轴线R的旋转。在这些实施例中,假如需要的话,可以不使用槽凹处144。同样,诸弹性元件146可以相对直立且平行于彼此。以此方式,弹性元件146可以从一前面的或一后面的通路中去除。在一些实施例中,在装置20的前侧和后侧可以具有锁定元件148,以利于锁定元件和由此的弹性元件的后续接入。
现在参见图23-26,在其它实施例中,板22、24分别包括环形槽凹处152、154。在本图中,在两槽凹处之间设置一单独的、环形弹性元件156。对于一些实施例,例如图25-26所示,可以通过用一插入一开口161的锁定元件160锁定弹性元件156的一部分158(在本实施例中,该部分连接至弹性元件)来获得附加的固定,这些锁定元件160诸如螺钉、销、环氧树脂、胶合剂或楔。同样在一些实施例中,弹性元件156中的一个或多个可以包括一切去部分156a或一开口156b,这些可以增加其柔性和/或可压缩性。一旦在位,弹性元件156在两板22、24之间提供压缩约束,但仍然考虑到绕轴线R的旋转。
现在参见图27-31,在其它实施例中,运动控制元件28可以减少或修正在一个或多个不同方向的移动量。特别参见图27-28,板22、24分别包括环状圆柱形凹处162、164。一个或多个环状弹性元件设置于两个环状圆柱形凹处162、164之间。弹性元件166包括肋166a、166b,用于分别向内固定至环状圆柱形凹处162、164,并也可以包括开口166c,用于在每个弹性元件中改变柔性量。
特别参见图29-32,板22、24分别包括通孔凹处172、174,这些可以类似于上面相对于图16所讨论的那些通孔凹处。尽管不必需,但通孔凹处172、174中的一个或多个可以分别包括开口172a、174a,以利于装置20的组装。一个或多个圆柱形弹性元件176设置在凹处172、174之间。弹性元件176包括边缘176a、176b,用于分别向内固定至通孔凹处172、174,并也可包括不同的尺寸和/或成分(如图30所示)用于在每个弹性元件中改变柔性量。同样,弹性元件176的形状可以被修正来达到不同的柔性、缓冲、抑制或其它特征。例如,在图32中的弹性元件176包括一部分176c来作为一缓冲器或衬垫。
现在参见图33,在一些实施例中,可以使用一广泛种类的不同弹性元件。在所示的例子中,两个来自图29的弹性元件176与两个来自图17的弹性元件116联合使用。同样,可以选择弹性元件116、117的间隔来适应一所需的效果。
现在参见图34-36,在其它实施例中,一些弹性元件190可以连接至两板中的一个,例如板22,且其它弹性元件192可以连接至相对的板,例如板24。此外,在这些实施例中,弹性元件190、192包括例如UHMWPE的一顶部涂层194,来提供更好的耐磨性。在由参考箭头196所示的倾斜方向和由参考箭头198所示的旋转方向提供了部分约束。然而,如图36所示,当产生一预先确定量的转动时,缓冲器190、192“碰撞”从而减少或防止进一步的旋转198。
现在参见图37-39,在其它实施例中,弹性元件可以设置在板22、24的外边缘上。在图37的实施例中,一个或多个弹性元件(例如可拉伸的橡皮圈)200配合在板22、24各自的狭槽202、204中。在图38的实施例中,一个或多个弹性元件206通过例如销的连接机构208连接至板22、24。在图39的实施例中,一个或多个弹性元件210配合在板22的狭槽212和相反的板24(未显示)的对应狭槽中。现在参见图40,根据本发明的一个或多个实施例,也提供了一方法300用于植入运动保持装置20。尽管方法300可应用于在诸如膝盖或髋部的脊柱外的过程,但为了简便和清晰,将继续现在的一脊柱植入物的例子。
方法300开始于步骤302,在该步骤中选定了一特定的植入物装置。在步骤304中,选择了一弹性元件。如上所述,有一广泛种类的用于完成缓冲、抑制和/或约束的弹性元件。在步骤306中,选择了每个弹性元件的尺寸。在一些上述的例子中,诸如脊柱前凸或脊柱前移的畸形可以呈现出对于植入物装置的病人特定的形状。同样,取决于所处的盘位置,脊柱的通常弯曲呈现出不同形状的开口。
在步骤308中,一旦选择了弹性元件,就必须选择弹性元件的特征。如上所述,一个或多个弹性元件具有与其它弹性元件不同范围的柔性,这可能是需要的。同样,可以需要一些弹性元件随时间或响应于其它条件而改变。在一些实施例中,在操作期间,例如通过医生用刀切割或开槽于弹性元件的一部分,可以修正弹性元件的特征。
在步骤310中,植入物装置与选择的弹性元件组装在一起,而在步骤312,将植入物装置插入病人体内。
本说明书已对几个较佳的实施例进行了描述。对于阅读了本说明书之后的本领域普通技术人员是显而易见的改进或修正被认为在本申请的精神和范围内。因此,应该理解,在前面的说明书中想要求修正、变化和替换,在一些例子中,本说明书的一些特征可以不相应地与其它特征一起使用。同样应该理解,所有的空间参照,诸如“纵向”和“横向”,仅仅是为了说明且可以在本说明书的范围内变化。因此,广泛地和以与本说明书的范围一致的方式来解释所附的权利要求,这是适当的。
本说明书包括但不限于下面标号的项目:
1.一种运动保持植入物装置包括:一用于接合一第一骨的第一板;一用于接合一第二骨的第二板;设置于两板之间的一关节连接元件;以及连接至两板中的一个或两个的一运动控制元件。
2.项目标号1的装置,其中运动控制元件构造成约束两板之间的相对运动。
3.项目标号1的装置,其中运动控制元件构造成抑制两板之间的相对运动。
4.项目标号1的装置,其中运动控制元件构造成当两板之间的运动达到一预先确定的阈值时,在两板之间提供一缓冲器。
5.项目标号1的装置,其中运动控制元件包括多个弹性元件。
6.项目标号5的装置,其中多个弹性元件中的至少两个具有不同形状。
7.项目标号5的装置,其中多个弹性元件中的至少两个具有不同柔性。
8.项目标号5的装置,其中多个弹性元件构造成以一不平行的构造设置两板。
9.一种用于插入两个椎骨本体之间的脊柱插入物,包括:一用于接合第一椎骨本体的第一板;一用于接合第二椎骨本体的第二板;设置于两板之间的一关节连接元件;以及连接至两板中的一个或两个的一弹性运动控制元件。
10.项目标号9的脊柱插入物,其中关节连接元件和运动控制元件构造成在两椎骨本体之间提供枢转和旋转的运动。
11.项目标号9的脊柱插入物,其中关节连接元件构造成在两椎骨本体之间提供旋转和平移的运动。
12.项目标号9的脊柱插入物,其中关节连接元件是一非弹性球和槽。
13.项目标号9的脊柱插入物,其中两板被一非晶氧化物涂层所覆盖。
14.项目标号9的脊柱插入物,其中关节连接元件包括一具有一凸出形状的突起物。
15.项目标号9的脊柱插入物,其中运动控制元件包括一超高分子量聚乙烯(UHMWP)的涂层。
16.项目标号9的脊柱插入物,其中运动控制元件包括多个弹性组件。
17.项目标号16的脊柱插入物,其中运动控制元件包括在多个弹性组件之间连接的一绳索。
18.项目标号16的脊柱插入物,其中至少一个弹性元件由一生物吸收材料构成。
19.项目标号16的脊柱插入物,其中至少一个弹性元件由一响应于其环境而改变性质的材料构成。
20.项目标号16的脊柱插入物,其中至少一个弹性元件由一响应于一外部刺激而改变性质的材料构成。
21.项目标号16的脊柱插入物,其中至少一个弹性元件包括一中空部分。
22.项目标号16的脊柱插入物,其中至少一个弹性元件充满凝胶。
23.项目标号16的脊柱插入物,其中至少一个弹性元件成形成一轮子。
24.项目标号16的脊柱插入物,其中至少一个弹性元件成形成一圆柱。
25.项目标号16的脊柱插入物,其中至少一个弹性元件成形成一球体。
26.项目标号16的脊柱插入物,其中至少两个弹性元件具有不同高度。
27.项目标号16的脊柱插入物,其中至少两个弹性元件具有不同形状。
28.项目标号16的脊柱插入物,其中至少两个弹性元件具有不同柔性。
29.项目标号16的脊柱插入物,其中两板在一第一位置不受限制,且在一第二位置通过运动控制元件至少部分地受限制。
30.项目标号16的脊柱插入物,其中至少一板包括多个凹处,一个或多个弹性元件可以插入其中。
31.项目标号30的脊柱插入物,其中至少一个弹性元件可以咬合入至少一个凹处。
32.项目标号30的脊柱插入物,其中至少一个弹性元件可以螺纹地拧入至少一个凹处。
33.项目标号30的脊柱插入物,其中多个凹处成形成一环形燕尾排列。
34.项目标号16的脊柱插入物,其中每个板包括至少一个凹处,至少一个弹性元件可以连接至该凹处,其中,弹性元件的第一个可以连接至两板中的一个,弹性元件的第二个可以连接至两板中的另一个。
35.项目标号16的脊柱插入物,其中至少一板包括在一表面上的至少一个凹处,该表面接合相应的椎骨本体并接纳至少一个弹性元件。
36.项目标号16的脊柱插入物,其中至少一个弹性元件通过一连接机构连接至一板。
37.项目标号9的脊柱插入物,其中至少一个板包括配合地对应于运动控制元件的一凹处。
38.项目标号9的脊柱插入物,其中至少一个板包括用于接纳运动控制元件的一凹处。
39.项目标号38的脊柱插入物,其中凹处的形状提供一运动控制元件可以在其中滑行的缝隙。
40.项目标号38的脊柱插入物,其中凹处以一轨道的形式存在。
41.项目标号38的脊柱插入物,其中凹处包括运动控制元件可以插入穿过的一通孔。
42.项目标号41的脊柱插入物,其中通孔包括一边缘,该边缘用于接纳和接合在运动控制元件上的一相应的边缘。
43.项目标号41的脊柱插入物,还包括:用于接合通孔和在其中固定运动控制元件的一锁定元件。
44.项目标号43的脊柱插入物,其中锁定元件是一螺钉。
45.一种用于在两骨之间插入一运动保持植入物的方法,包括:确定运动操持植入物的一所需形状;确定对于运动保持植入物的一运动的程度;根据形状和运动程度的确定来选定一个或多个弹性元件;组装一个或多个弹性元件进入运动保持植入物;以及在两骨之间插入组装的运动保持装置。
46.项目标号45的方法,还包括:在确定所需形状或运动程度或都确定两者之后,从多个不同构造的植入物中选定运动保持植入物。
47.一种用于外科中在两骨之间设定一关节的工具,包括:至少一个运动保持植入物,该运动保持植入物具有用于接纳至少一个弹性元件的至少一个凹处;以及与运动保持植入物一同使用的多个弹性元件,这些多个弹性元件用于当接纳于其中时提供一运动保持植入物的多个不同构造。
48.项目标号47的工具,其中运动保持植入物构造成接纳多个不同形状的弹性元件。
49.项目标号47的工具,其中运动保持植入物构造成接纳多个不同形状的弹性元件。
50.项目标号47的工具,其中诸弹性元件形状类似,但提供不同程度的柔性。
Claims (26)
1.一种运动保持植入物装置,包括:
一第一板,用于接合一第一骨;
一第二板,用于接合一第二骨;
一关节连接元件,设置于两板之间;以及
一运动控制元件,连接至两板中的一个或两个。
2.如权利要求1所述的装置,其特征在于,所述运动控制元件构造成约束在两板之间的相对运动。
3.如权利要求1所述的装置,其特征在于,所述运动控制元件构造成当两板之间的运动达到一预先确定的阈值时,在两板之间提供一缓冲器。
4.如权利要求1所述的装置,其特征在于,所述运动控制元件包括多个弹性元件。
5.一种用于插入两个椎骨本体之间的脊柱插入物,包括:
一第一板,用于接合第一椎骨本体;
一第二板,用于接合第二椎骨本体;
一关节连接元件,设置于两板之间;以及
一弹性运动控制元件,连接至两板中的一个或两个。
6.如权利要求5所述的脊柱插入物,其特征在于,所述关节连接元件和所述运动控制元件构造成在两椎骨本体之间提供枢转和旋转的运动。
7.如权利要求5所述的脊柱插入物,其特征在于,所述关节连接元件构造成在两椎骨本体之间提供旋转和平移的运动。
8.如权利要求5所述的脊柱插入物,其特征在于,所述关节连接元件是一非弹性球和槽。
9.如权利要求5所述的脊柱插入物,其特征在于,所述两板被一非晶氧化物涂层所覆盖。
10.如权利要求5所述的脊柱插入物,其特征在于,所述关节连接元件包括一具有一凸出形状的突起物。
11.如权利要求5所述的脊柱插入物,其特征在于,所述运动控制元件包括一超高分子量聚乙烯(UHMWP)的涂层。
12.如权利要求5所述的脊柱插入物,其特征在于,所述运动控制元件包括多个弹性组件。
13.如权利要求12所述的脊柱插入物,其特征在于,所述运动控制元件包括在所述多个弹性组件之间连接的一绳索。
14.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件由一生物吸收材料构成。
15.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件由一响应于其环境而改变性质的材料构成。
16.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件由一响应于一外部刺激而改变性质的材料构成。
17.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件包括一中空部分。
18.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件充满凝胶。
19.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件成形成一轮子。
20.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件成形成一球体。
21.如权利要求12所述的脊柱插入物,其特征在于,所述两板在一第一位置不受限制,且在一第二位置通过所述运动控制元件至少部分地受限制。
22.如权利要求12所述的脊柱插入物,其特征在于,至少一板包括多个凹处,一个或多个所述弹性元件可以插入其中。
23.如权利要求22所述的脊柱插入物,其特征在于,所述多个凹处成形成一环形燕尾排列。
24.如权利要求12所述的脊柱插入物,其特征在于,每个板包括至少一个凹处,至少一个所述弹性元件可以连接至该凹处,其中,所述弹性元件的第一个可以连接至两板中的一个,所述弹性元件的第二个可以连接至两板中的另一个。
25.如权利要求12所述的脊柱插入物,其特征在于,至少一个所述弹性元件通过一连接机构连接至一板。
26.如权利要求5所述的脊柱插入物,其特征在于,至少一个所述板包括用于接纳所述运动控制元件的一凹处。
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-
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2005
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- 2005-03-15 WO PCT/US2005/008722 patent/WO2005089680A1/en active Application Filing
- 2005-03-15 CN CNA2005800124164A patent/CN1976651A/zh active Pending
- 2005-03-15 CA CA002560064A patent/CA2560064A1/en not_active Abandoned
- 2005-03-15 AU AU2005222651A patent/AU2005222651A1/en not_active Withdrawn
- 2005-03-15 EP EP05725718A patent/EP1740131A1/en not_active Withdrawn
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US9770338B2 (en) | 2007-06-20 | 2017-09-26 | Hh Spinal Llc | Posterior total joint replacement |
CN102215787A (zh) * | 2008-11-20 | 2011-10-12 | 活动脊柱技术有限公司 | 联结的椎间盘假体 |
CN102215787B (zh) * | 2008-11-20 | 2015-11-25 | 活动脊柱技术有限公司 | 联结的椎间盘假体 |
CN110538013A (zh) * | 2019-09-11 | 2019-12-06 | 北京爱康宜诚医疗器材有限公司 | 脊柱融合假体 |
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CA2560064A1 (en) | 2005-09-29 |
AU2005222651A1 (en) | 2005-09-29 |
JP2007529277A (ja) | 2007-10-25 |
EP1740131A1 (en) | 2007-01-10 |
US7806933B2 (en) | 2010-10-05 |
US20050203626A1 (en) | 2005-09-15 |
WO2005089680A1 (en) | 2005-09-29 |
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