WO2000035385A1 - Prothese de disque intervertebral a comportement mecanique ameliore - Google Patents

Prothese de disque intervertebral a comportement mecanique ameliore Download PDF

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Publication number
WO2000035385A1
WO2000035385A1 PCT/FR1999/003073 FR9903073W WO0035385A1 WO 2000035385 A1 WO2000035385 A1 WO 2000035385A1 FR 9903073 W FR9903073 W FR 9903073W WO 0035385 A1 WO0035385 A1 WO 0035385A1
Authority
WO
WIPO (PCT)
Prior art keywords
plates
face
prosthesis according
plate
prosthesis
Prior art date
Application number
PCT/FR1999/003073
Other languages
English (en)
Inventor
Fabien Gauchet
Régis LE COUËDIC
Original Assignee
Dimso (Distribution Medicale Du Sud-Ouest)
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=9533877&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=WO2000035385(A1) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Application filed by Dimso (Distribution Medicale Du Sud-Ouest) filed Critical Dimso (Distribution Medicale Du Sud-Ouest)
Priority to KR1020017007283A priority Critical patent/KR20020012537A/ko
Priority to DE1139935T priority patent/DE1139935T1/de
Priority to DE69936062T priority patent/DE69936062T2/de
Priority to CA002354167A priority patent/CA2354167A1/fr
Priority to US09/857,726 priority patent/US6733532B1/en
Priority to JP2000587707A priority patent/JP4214680B2/ja
Priority to EP99958285A priority patent/EP1139935B1/fr
Priority to AU15685/00A priority patent/AU767081B2/en
Publication of WO2000035385A1 publication Critical patent/WO2000035385A1/fr

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Classifications

    • 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
    • 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
    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • 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
    • A61F2/30721—Accessories
    • A61F2/30742—Bellows or hose-like seals; Sealing membranes
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30133—Rounded shapes, e.g. with rounded corners kidney-shaped or bean-shaped
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30448—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using adhesives
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30474—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using an intermediate sleeve interposed between both prosthetic parts to be coupled
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30518—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
    • A61F2002/30528—Means for limiting said movement
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30563—Special structural features of bone or joint prostheses not otherwise provided for having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
    • 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
    • A61F2002/443—Intervertebral or spinal discs, e.g. resilient made of articulated components having two transversal endplates and at least one intermediate component
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/005—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using adhesives
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0015—Kidney-shaped, e.g. bean-shaped
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00—Surgery
    • Y10S606/907—Composed of particular material or coated
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00—Surgery
    • Y10S606/907—Composed of particular material or coated
    • Y10S606/91—Polymer

Definitions

  • Document EP-0 356 112 discloses an intervertebral disc prosthesis comprising two plates and a cushion of compressible material interposed between the plates and fixed to them. Such a prosthesis allows significant mobility between the two adjacent vertebrae. It can in particular undergo compression movements between the two vertebrae, and torsion along three axes perpendicular to each other. Its mechanical behavior is therefore close to that of a healthy natural intervertebral disc.
  • An object of the invention is to provide a disc prosthesis of a different type and making it possible to approach even more the mechanical properties of a healthy natural intervertebral disc.
  • an intervertebral disc prosthesis comprising two plates and a cushion interposed between the plates, the cushion comprising a compressible body having ends in contact with the plates, in which at least one end is free to move relative to the associated tray in a direction parallel to the tray.
  • the or each end of the body is housed in a recess in one of the plates capable of forming a lateral stop for this end.
  • the or each end has a face having a contact zone with a face of the associated plate, the faces being arranged so that the contact zone has an area which increases when the stress on the plate is increased towards the body.
  • the mechanical reaction of the prosthesis during the compression of the body varies very little as a function of the change in dimension of the following body; the direction of compression.
  • the curve of this reaction as a function of the variation in height of the cushion is slightly inclined relative to the horizontal for low compression values and little effort is provided at the start of the race. This property reproduces that of a healthy natural disc.
  • the or each end has a contact face with a face of the associated plate, the two faces being curved in at least one common direction and being respectively concave and convex.
  • the body comprises a viscoelastic material, in particular silicone.
  • this material has, in compression, a behavior such that the aforementioned curve has a hysteresis shape, which again brings the behavior of the prosthesis closer to that of the healthy natural disc.
  • the prosthesis comprises a fluid interposed between the plates.
  • the fluid especially when it is compressible, further increases the hysteresis form.
  • the fluid is in contact with the plates.
  • the fluid extends around the periphery of the body.
  • the prosthesis comprises an enclosure containing the fluid and arranged so that it has a cross-sectional area parallel to the substantially invariable plates when a stress on the plates varies towards one another.
  • the prosthesis is intended for the lumbar region of the spine.
  • FIG. 1 is a perspective view of a prosthesis according to the invention
  • - Figure 2 is an axial sectional view along the plane II-II of the prosthesis of Figure 1;
  • - Figure 3 is an enlarged view of a detail D of Figure 2;
  • - Figure 4 is a curve indicating the compressive force F exerted by the two plates on the cushion as a function of the variation of the distance separating them;
  • FIG. 5 is a sectional view of a detail of an alternative embodiment of the prosthesis.
  • FIG. 6 is a simplified view similar to Figure 2 showing a second alternative embodiment.
  • the intervertebral disc prosthesis 2 is here particularly intended for the lumbar region of the spine of the human body. It comprises two flat plates 4 having a general shape in the form of a rear hilum bean in plan view. Each plate 4 comprises a central circular plate 6 and a ring 8 extending at the periphery of the plate in the plane of the latter. At rest, the two plates 4 extend parallel to each other, at a distance and facing each other with their contours in coincidence. On each plate 4, the crown 8 and the plate 6 each have a groove 27 for receiving a seal 31.
  • the disc prosthesis 2 comprises a cushion or intermediate portion 10 interposed between the two plates 4.
  • the cushion comprises a compressible solid body 12, here made of viscoelastic material, for example silicone.
  • This body has a shore-A hardness advantageously between 60 and 100, and here about 80.
  • the body 12 has a shape of revolution around its main axis 14. It has a cylindrical lateral face 16 and two end faces axial 18 generally perpendicular to axis 14 and of slightly spherical convex shape. Each face 18 therefore has two identical curvatures in planes perpendicular to each other.
  • the body 12 is arranged coaxially with the plates 6.
  • Each plate 6 has a flat central face INTERNAL '20 perpendicular to axis 14 and in contact with an axial end 18 of the respective body 12.
  • the convex spherical face 18 of the body is supported on the flat face 20 of the plate.
  • the body 12 is supported without anchoring on each of the plates 4 so . that it is movable relative to each of these plates in a direction parallel to the plates, that is to say perpendicular to the main axis 14.
  • the compression of the body 12 exerted by the plates 4 and account given the shape of the faces of the plates and of the body, mobility in this direction results in a rolling, possibly without sliding, of each axial end 18 of the body on the face 20 of the plate with which it is in contact.
  • the body 12 therefore rolls between the two plates. These then move laterally with respect to each other while remaining parallel if necessary. This avoids the transmission of lateral stresses from one to the other of the vertebrae.
  • the cushion 10 further comprises a bellows 22.
  • the bellows surrounds the body 14 coaxially therewith and at a distance therefrom. It has a symmetrical shape of revolution around the axis 14. Its wall has undulations in profile 24 making it possible to vary the length of the bellows 22 in the axial direction 14, without significantly varying the area of its section transversely to the axis 14.
  • this bellows like the plates 4, is made of titanium or titanium alloy, so that it has a certain axial rigidity and forms a compression spring. It can also be deformed in a direction perpendicular to the axis 14 or undergo a twist around the axis 14 or any axis perpendicular thereto.
  • the bellows 22 has at its two axial ends edges glued to respective edges of the plates 6 extending projecting from the internal face 20. The bonding is carried out in leaktight manner so that the bellows 22 defines with the two plates 6 a sealed enclosure with variable volume extending around the body 12.
  • This enclosure contains a fluid, in this case a gas which is here air.
  • the corrugations 24 closest to the body 12 extend away from the latter to allow free circulation of the gas from one to the other of the plates 6.
  • the bellows 22 has in this case ten convolutions, that is to say eight external ridges in addition to the two fixing ridges to the plates. Here it has an external diameter of approximately 30 mm and an internal diameter of approximately 17 mm. Its height, when the prosthesis " " is unloaded, is 10 mm.
  • the wall of the bellows can be produced by means of one, two or three sheets each of 0.1 mm thick and the sum of the thicknesses of which forms the thickness of the wall.
  • the bellows here has a stiffness of approximately 1.6 N / mm.
  • Each ring 8 has two tabs 25 projecting from an external face of the plate 4 perpendicular to the plane of the plate.
  • Each tab 25 has an orifice 27 passing right through it in the direction of the center of the plate and, on one face of the tab 25 opposite the plate 4, an impression of spherical shape.
  • the holes 27 allow the reception of a bone screw 26 having a head 28, a lower face of which has a male spherical shape cooperating with the female imprint of the tab 25 to allow free orientation of the screw 26 relative to the associated tab.
  • the curve Ca relating to the increase in the compressive force F, presents from the origin 0 a portion Cal with a slight slope, then a portion Ca2 with a steeper slope.
  • the curve Cd illustrating the reduction in compression F presents for the highest values of the force F a portion Cdl of steep slope, then for the lowest values of the force F a portion Cd2 of lower slope.
  • the presence of a portion of slight slope in the vicinity of the origin for the curves Ca and Cd is mainly due to the conformation of the contact faces 18, 20 of the body 12 and of the plates 4, which results in the area of the area of mutual contact between each plate and the body, generally in the form of a disc, increases when the force F is increased. This increase occurs until reaching the maximum surface area of the contact zone, when the whole face 18 touches the plate 4.
  • connection points Ja and Jd respectively form the junction between the curves Cal and Ca2, and Cdl and Cd2.
  • the point Ja corresponds to the force F for which the maximum contact surfaces between the plates and the body are reached.
  • the point Jd corresponds to the effort for which these surfaces cease to be maximum.
  • the prosthesis can be configured so that the point Ja corresponds to a value of ⁇ l between 25% and 75% of the maximum variation in length envisaged for the prosthesis in use.
  • each plate 4 facing the body 12 has a recess 32, here in "U”, forming lateral stop, in which is housed the corresponding axial end 18 of the body.
  • the relative lateral displacements of the body 12 relative to each plate 4 are thus limited to a certain range.
  • the face 20 can be curved and concave in one or two directions, as is the case here, and the face 18 can be curved and convex in the corresponding direction (s), the radius of curvature of the face 20 being, for each direction, greater than that of the face 18 in the corresponding direction.
  • the two faces 18, 20 are here spherical.
  • the radii of curvature of the surfaces 18 and 20 will for example be between 70 and 80 mm, and 140 and 200 mm respectively.
  • the two ends of the body 12 have a contact surface 18 with the associated plate of variable area and making it movable laterally relative to the body.
  • the fluid may be a liquid, or even a mixture of a liquid and a gas, the latter being for example sparingly soluble in the liquid.
  • the body may have an elliptical shape in cross section to the axis 14.
  • the internal face 20 of the plates 4 may be convex, the axial end face 18 of the body 12 being flat, or concave with a radius of curvature greater than that of the face 20 of the plate.
  • the two faces in contact with the plate and the body may be convex.
  • the curvature of the faces can be limited to a single plane.
  • the characteristics relating to the casing 22 can be implemented independently of the other characteristics.

Abstract

La prothèse de disque intervertébral comporte deux plateaux (4) et un coussin (10) interposé entre les plateaux, le coussin comportant un corps compressible (12) présentant des extrémités (18) en contact avec les plateaux (4). Au moins l'une des extrémités (18) est libre de se déplacer par rapport au plateau associé suivant une direction parallèle au plateau.

Description

"PROTHESE DE DISQUE INTERVERTEBRAL A COMPORTEMENT MECANIQUE AMELIORE " . L'invention concerne les prothèses de disque intervertébral . On connaît d'après le document EP-0 356 112 une prothèse de disque intervertébral comportant deux plateaux et un coussin en matériau compressible interposé entre les plateaux et fixé à ceux-ci. Une telle prothèse autorise une importante mobilité entre les deux vertèbres adjacentes. Elle peut notamment subir des mouvements de compression entre les deux -vertèbres, et de torsion suivant trois axes perpendiculaires entre eux. Son comportement mécanique est donc proche de celui d'un disque intervertébral naturel sain. Toutefois, elle a notamment pour inconvénient que les sollicitations latérales de chaque vertèbre sur le disque suivant une direction perpendiculaire à la direction longitudinale du rachis sont transmises en intégralité à l'autre vertèbre, ce qui n'est pas le cas dans un vrai disque sain. Or, ces contraintes de cisaillement sont nuisibles .
Un but de l'invention est de fournir une prothèse de disque d'un type différent et permettant d'approcher encore davantage les propriétés mécaniques d'un disque intervertébral naturel sain.
En vue de la réalisation de ce but, on prévoit selon l'invention une prothèse de disque intervertébral comportant deux plateaux et un coussin interposé entre les plateaux, le coussin comportant un corps compressible présentant des extrémités en contact avec les plateaux, dans laquelle au moins l'une des extrémités est libre de se déplacer par rapport au plateau associé suivant une direction parallèle au plateau.
Ainsi, on évite l'apparition de sollicitations latérales trop importantes entre les deux vertèbres suivant une direction perpendiculaire à la direction longitudinale du rachis. On reproduit donc mieux le comportement d'un disque naturel sain.
Avantageusement, la ou chaque extrémité du corps est logée dans un renfoncement de l'un des plateaux apte à former une butée latérale pour cette extrémité.
Ainsi, on peut limiter les déplacements relatifs latéraux entre le corps et le ou les plateaux.
Avantageusement, la ou chaque extrémité présente une face ayant une zone de contact avec une face du plateau associé, les faces étant agencées de sorte que la zone de contact a une superficie qui augmente lorsqu'on augmente une sollicitation du plateau en direction du corps.
Ainsi, pour les valeurs de compression les plus basses, la réaction mécanique de la prothèse lors de la compression du corps varie très peu en fonction du changement de dimension du corps suivant; la direction de compression. Autrement dit, la courbe de cette réaction en fonction de la variation de hauteur du coussin est peu inclinée par rapport à l'horizontale pour de faibles valeurs de compression et on fournit peu d'effort en début de course. Cette propriété reproduit celle d'un disque naturel sain.
Avantageusement, la ou chaque extrémité présente une face de contact avec une face du plateau associé, les deux faces étant courbes dans au moins une direction commune et étant respectivement concave et convexe.
Ainsi, après un déplacement latéral relatif du corps et du plateau, ces deux faces assurent un auto- centrage de ces éléments les replaçant dans une disposition coaxiale. Lorsque la face concave a au moins un rayon de courbure supérieur à un rayon de courbure correspondant de la face convexe, on obtient en outre une zone de contact de superficie variable telle que précitée.
Avantageusement, le corps comprend un matériau viscoélastique, notamment du silicone.
Ainsi, ce matériau a, en compression, un comportement tel que la courbe précitée a une forme en hystérésis, ce qui rapproche encore le comportement de la prothèse de celui du disque naturel sain.
Avantageusement, la prothèse comprend un fluide interposé entre les plateaux. Le fluide, notamment lorsqu'il est compressible, accroît encore la forme en hystérésis.
Avantageusement, le fluide est en contact avec les plateaux.
Avantageusement, le fluide s'étend en périphérie du corps.
Avantageusement, la prothèse comporte une enceinte renfermant le fluide et agencée de sorte qu'elle a une superficie de section transversale parallèlement aux plateaux sensiblement invariable lorsque varie une sollicitation des plateaux l'un vers l'autre.
Avantageusement, la prothèse est destinée à la zone lombaire du rachis.
D'autres caractéristiques et avantages de l'invention apparaîtront encore dans la description suivante d'un mode préféré de réalisation et de deux variantes donnés à titre d'exemples non limitatifs. Aux dessins annexés :
- la figure 1 est une vue en perspective d'une prothèse selon l'invention ; - la figure 2 est une vue en coupe axiale selon le plan II-II de la prothèse de la figure 1 ;
- la figure 3 est une vue à échelle agrandie d'un détail D de la figure 2 ; - la figure 4 est une courbe indiquant la force de compression F exercée par les deux plateaux sur le coussin en fonction de la variation de la distance les séparant ;
- la figure 5 est une vue en coupe d'un détail d'une variante de réalisation de la prothèse ; et
- la figure 6 est une vue simplifiée analogue à la figure 2 montrant une deuxième variante de réalisation.
La prothèse de disque intervertébral 2 selon l'invention est ici particulièrement destinée à la zone lombaire de la colonne vertébrale du corps humain. Elle comporte deux plateaux plats 4 ayant une forme générale en haricot à hile postérieur en vue en plan. Chaque plateau 4 comporte une plaque circulaire centrale 6 et une couronne 8 s 'étendant en périphérie de la plaque dans le plan de celle-ci. Au repos, les deux plateaux 4 s'étendent parallèlement l'un à l'autre, à distance et en regard l'un de l'autre avec leurs contours en coïncidence. Sur chaque plateau 4, la couronne 8 et la plaque 6 présentent chacune une gorge 27 pour la réception d'un joint 31.
La prothèse de disque 2 comporte un coussin ou partie intermédiaire 10 interposé entre les deux plateaux 4. Le coussin comporte un corps solide compressible 12, ici en matériau viscoélastique, par exemple en silicone. Ce corps a une dureté shore-A avantageusement comprise entre 60 et 100, et ici d'environ 80. Le corps 12 a une forme de révolution autour de son axe principal 14. Il présente une face latérale cylindrique 16 et deux faces d'extrémités axiales 18 généralement perpendiculaires à l'axe 14 et de forme légèrement sphérique convexe. Chaque face 18 présente donc deux courbures identiques dans des plans perpendiculaires entre eux. Le corps 12 est disposé coaxialement avec les plaques 6. Chaque plaque 6 présente une face centrale interne- plane' 20 perpendiculaire à l'axe 14 et en contact avec une des extrémités axiales 18 respectives du corps 12. Ainsi, la face sphérique convexe 18 du corps est en appui sur la face plane 20 du plateau. Le corps 12 est en appui sans ancrage sur chacun des plateaux 4 de sorte . qu' il est mobile par rapport à chacun de ces plateaux suivant une direction parallèle aux plateaux, c'est-à-dire perpendiculaire à l'axe principal 14. Compte tenu de la compression du corps 12 exercée par les plateaux 4, et compte tenu de la forme des faces des plateaux et du corps, la mobilité suivant cette direction se traduit par un roulement, éventuellement sans glissement, de chaque extrémité axiale 18 du corps sur la face 20 du plateau avec laquelle elle est en contact. Le corps 12 roule donc entre les deux plateaux. Ceux-ci se déplacent alors latéralement l'un par rapport à- l'autre tout en demeurant si besoin parallèles entre eux. On évite ainsi la transmission de contraintes latérales de l'une à l'autre des vertèbres.
Le coussin 10 comporte en outre un soufflet 22. Le soufflet entoure le corps 14 coaxialement à celui-ci et à distance de celui-ci. Il a une forme symétrique de révolution autour de l'axe 14. Sa paroi présente de profil des ondulations 24 permettant de faire varier la longueur du soufflet 22 suivant la direction axiale 14, sans que varie sensiblement la superficie de sa section transversalement à l'axe 14. En l'espèce, ce soufflet, de même que les plateaux 4, est réalisé en titane ou alliage de titane, de sorte qu'il présente une certaine rigidité axiale et forme un ressort de compression. Il peut également être déformé suivant une direction perpendiculaire à l'axe 14 ou subir une torsion autour de l'axe 14 ou d'un axe quelconque perpendiculaire à celui-ci .
Le soufflet 22 présente à ses deux extrémités axiales des bords collés à des bords respectifs des plaques 6 s 'étendant en saillie de la face interne 20. Le collage est réalisé de façon étanche de sorte que le soufflet 22 définit avec les deux plaques 6 une enceinte étanche à volume variable s ' étendant autour du corps 12. Cette enceinte renferme un fluide, en l'espèce un gaz qui est ici de l'air. Les ondulations 24 les plus proches du corps 12 s'étendent à distance de celui-ci pour permettre une libre circulation du gaz de l'une à l'autre des plaques 6.
Le soufflet 22 présente en l'espèce dix convolutions, soit huit crêtes externes en plus des deux crêtes de fixation aux plateaux. Il a ici un diamètre externe d'environ 30 mm et un diamètre interne d'environ 17 mm. Sa hauteur, lorsque la prothèse"" est hors charge, vaut 10 mm. La paroi du soufflet peut être réalisée au moyen d'une, deux ou trois feuilles chacune de 0,1 mm d'épaisseur et dont la somme des épaisseurs forme l'épaisseur de la paroi. Le soufflet a ici en propre une raideur d'environ 1,6 N/mm.
Chaque couronne 8 comporte deux pattes 25 s 'étendant en saillie d'une face externe du plateau 4 perpendiculairement au plan du plateau. Chaque patte 25 présente un orifice 27 la traversant de part en part en direction du centre de la plaque et, sur une face de la patte 25 opposée au plateau 4, une empreinte de forme sphérique. Les orifices 27 permettent la réception d'une vis à os 26 ayant une tête 28 dont une face inférieure a une forme sphérique mâle coopérant avec l'empreinte femelle de la patte 25 pour permettre une libre orientation de la vis 26 par rapport à la patte associée.
Pour réaliser un ancrage à court "terme de la prothèse de disque 2 dans la colonne, on pourra ancrer les vis 26 dans le spondyle des vertèbres adjacentes au disque à remplacer. Toutefois, on pourra prévoir un ancrage dit à long terme où, en outre, les surfaces des plateaux 4 en contact avec les vertèbres adjacentes sont recouvertes d'hydroxyapatite, ou de toute autre substance connue en soi pouvant stimuler la croissance osseuse. Avant recouvrement, lesdites surfaces pourront être traitées pour obtenir un état de surface plus ou moins poreux, présentant des points d'ancrage pour le tissu osseux, pour assurer une meilleure interface avec ledit tissu osseux. On a représenté en figure 4 l'allure de la courbe C indiquant l'intensité d'un effort de compression F exercé sur le coussin 10 (c' est-à-drre sur les deux plateaux 4) en faisant abstraction de leur déformabilité, quasi nulle, suivant la direction axiale 14, en fonction de la variation de la longueur 1 du coussin suivant la direction axiale 14 (ou encore de la distance entre les deux plateaux) . Cette courbe représente également la réaction mécanique R du coussin 10 dans les mêmes conditions. Cette courbe C n'est pas linéaire. De plus, elle présente une forme en hystérésis : la courbe Ca indiquant l'augmentation de la compression F à partir de l'origine zéro étant distincte de celle Cd indiquant la diminution de la compression F jusqu'à l'origine, et s 'étendant tout entière au-dessus de cette dernière. Cette forme en hystérésis prononcée est due principalement au matériau viscoélastique du corps et subsidiairement à l'association dans le coussin 10 du corps 12 et du fluide. En outre, la courbe Ca, relative à l'augmentation de la force de compression F, présente- à partir de l'origine 0 une portion Cal à faible pente, puis une portion Ca2 à pente plus forte. La courbe Cd illustrant la diminution de la compression F présente pour les valeurs les plus élevées de la force F une portion Cdl de forte pente, puis pour les valeurs les plus basses de la force F une portion Cd2 de pente plus faible. La présence d'une portion de faible pente au voisinage de l'origine pour les courbes Ca et Cd est due principalement à la conformation des faces de contact 18, 20 du corps 12 et des plateaux 4, qui entraîne que la superficie de la zone de contact mutuel entre chaque plateau et le corps, généralement en forme de disque, augmente lorsqu'on augmente la force F. Cette augmentation se produit jusqu'à atteindre la superficie maximale de la zone de contact, lorsque toute la face 18 touche le plateau 4.
Les points de raccordement Ja et Jd forment respectivement la jonction entre les courbes Cal et Ca2, et Cdl et Cd2. Sur la courbe Ca, le point Ja correspond à l'effort F pour lequel les surfaces maximales de contact entre les plateaux et le corps sont atteintes. De même, sur la courbe Cd, le point Jd correspond à l'effort pour lequel ces surfaces cessent d'être maximales.
La prothèse pourra être configurée de sorte que le point Ja corresponde à une valeur de Δl située entre 25% et 75% de la variation maximale de longueur envisagée pour la prothèse en utilisation.
En référence à la figure 5, on pourra prévoir dans une variante de réalisation (présentant par ailleurs les autres caractéristiques de la prothèse de la figure 1) que la face 20 de chaque plateau 4 en regard du corps 12 présente un renfoncement 32, ici en « U », formant butée latérale, dans lequel vient se loger l'extrémité axiale 18 correspondante du corps. On limite ainsi à une certaine plage les déplacements relatifs latéraux du corps 12 par rapport à chaque plateau 4.
Dans la variante de la figure 6, la face 20 peut être courbe et concave dans une ou deux directions, comme c'est le cas ici, et la face 18 peut être courbe et convexe dans la ou les directions correspondantes, le rayon de courbure de la face 20 étant, pour chaque direction, plus grand que celui de la face 18 dans la direction correspondante. Les deux faces 18, 20 sont ici sphériques. Les rayons de courbure des surfaces 18 et 20 seront par exemple compris entre 70 et 80 mm, et 140 et 200 mm respectivement. Un tel agencement permet d'obtenir un auto-centrage des deux- faces tout en autorisant un déplacement latéral relatif du corps 12 par rapport au plateau suivant une direction quelconque perpendiculaire à une direction longitudinale du rachis.
Dans le mode de réalisation de la figure 2, les deux extrémités du corps 12 présentent une surface de contact 18 avec le plateau associé de superficie variable et le rendant mobile latéralement par rapport au corps.
Au contraire, dans la variante de la figure 6, seule l'une des extrémités 18 du corps 12 présente cette propriété. L'autre extrémité, inférieure sur la figure 6, a une forme plane circulaire à zone de contact invariable avec le plateau associé et fixe par rapport à celui-ci .
Bien entendu, on pourra apporter à l'invention de nombreuses modifications sans sortir du cadre de celle-ci.
Le fluide pourra être un liquide, voire un mélange d'un liquide et d'un gaz, ce dernier étant par exemple faiblement soluble dans le liquide.
Le corps pourra avoir une forme elliptique en section transversale à l'axe 14.
La face interne 20 des plateaux 4 pourra être convexe, la face d'extrémité axiale 18 du corps 12 étant plane, ou concave à rayon de courbure plus grand que celui de la face 20 du plateau. Les deux faces en contact du plateau et du corps pourront être convexes.
La courbure des faces pourra être limitée à un seul plan.
On pourra mettre en oeuvre les caractéristiques relatives à l'enveloppe 22 (ressort, distance au corps 12) indépendamment des autres caractéristiques.

Claims

REVENDICATIONS
1. Prothèse de disque intervertébral comportant deux plateaux (4) et un coussin (10) interposé entre les plateaux, le coussin comportant un corps compressible
(12) présentant des extrémités (18) en contact avec les plateaux (4), caractérisée en ce qu'au moins l'une des extrémités (18) est libre de se déplacer par rapport au plateau associé suivant une direction parallèle au plateau.
2. Prothèse selon la revendication 1, caractérisée en ce que la ou chaque extrémité (18) du corps est logée dans un renfoncement (32) de l'un des plateaux (4) apte à former une butée latérale pour cette extrémité.
3. Prothèse selon la revendication 1 ou 2, caractérisée en ce que la ou chaque extrémité présente une face (18) ayant une zone de contact avec une face
(20) du plateau associé, les faces (18, 20) étant agencées de sorte que la zone de contact a une superficie qui augmente lorsqu'on augmente une sollicitation du plateau (4) en direction du corps (12) .
4. Prothèse selon l'une -quelconque des revendications 1 à 3, caractérisée en ce que la ou chaque extrémité (18) présente une face de contact avec une face (20) du plateau associé (4) , les deux faces (18, 20) étant courbes dans au moins une direction commune et étant respectivement concave et convexe.
5. Prothèse selon l'une quelconque des revendications 1 à 4, caractérisée en ce que le corps (12) comprend un matériau viscoelastique, notamment du silicone.
6. Prothèse selon l'une quelconque des revendications 1 à 5, caractérisée en ce qu'elle comprend un fluide interposé entre les plateaux (4) .
7. Prothèse selon la revendication 6, caractérisée en ce que le fluide est en contact avec les plateaux
(4) .
8. Prothèse selon la revendication 6 ou 7, caractérisée en ce que le fluide s'étend en périphérie du corps (12) .
9. Prothèse selon l'une quelconque des revendications 6 à 8, caractérisée en ce qu'elle comporte une enceinte (22) renfermant le fluide et agencée de sorte qu' elle a une superficie de section transversale parallèlement aux plateaux (4) sensiblement invariable lorsque varie une sollicitation des plateaux l'un vers l'autre.
10. Prothèse selon l'une quelconque des revendications 1 à 9, caractérisée en ce qu'il s'agit d'une prothèse de disque intervertébral lombaire.
PCT/FR1999/003073 1998-12-11 1999-12-09 Prothese de disque intervertebral a comportement mecanique ameliore WO2000035385A1 (fr)

Priority Applications (8)

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KR1020017007283A KR20020012537A (ko) 1998-12-11 1999-12-09 기계적 특성이 향상된 추간 원판 보철
DE1139935T DE1139935T1 (de) 1998-12-11 1999-12-09 Bandscheibenprothese mit verbessertem mechanischen verhalten
DE69936062T DE69936062T2 (de) 1998-12-11 1999-12-09 Bandscheibenprothese mit verbessertem mechanischen verhalten
CA002354167A CA2354167A1 (fr) 1998-12-11 1999-12-09 Prothese de disque intervertebral a comportement mecanique ameliore
US09/857,726 US6733532B1 (en) 1998-12-11 1999-12-09 Intervertebral disc prosthesis with improved mechanical behavior
JP2000587707A JP4214680B2 (ja) 1998-12-11 1999-12-09 機械的挙動が改善された椎間板補綴具
EP99958285A EP1139935B1 (fr) 1998-12-11 1999-12-09 Prothese de disque intervertebral a comportement mecanique ameliore
AU15685/00A AU767081B2 (en) 1998-12-11 1999-12-09 Intervertebral disc prosthesis with improved mechanical behaviour

Applications Claiming Priority (2)

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FR98/15672 1998-12-11
FR9815672A FR2787017B1 (fr) 1998-12-11 1998-12-11 Prothese de disque intervertebral a comportement mecanique ameliore

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WO2000035385A1 true WO2000035385A1 (fr) 2000-06-22

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EP (1) EP1139935B1 (fr)
JP (1) JP4214680B2 (fr)
KR (1) KR20020012537A (fr)
AT (1) ATE361721T1 (fr)
AU (1) AU767081B2 (fr)
CA (1) CA2354167A1 (fr)
DE (2) DE69936062T2 (fr)
ES (1) ES2167294T1 (fr)
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WO (1) WO2000035385A1 (fr)
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FR2787017A1 (fr) 2000-06-16
US6733532B1 (en) 2004-05-11
ATE361721T1 (de) 2007-06-15
ZA200104845B (en) 2001-09-07
CA2354167A1 (fr) 2000-06-22
JP2002532142A (ja) 2002-10-02
ES2167294T1 (es) 2002-05-16
JP4214680B2 (ja) 2009-01-28
KR20020012537A (ko) 2002-02-16
EP1139935A1 (fr) 2001-10-10
FR2787017B1 (fr) 2001-04-27
EP1139935B1 (fr) 2007-05-09
DE69936062D1 (de) 2007-06-21
AU1568500A (en) 2000-07-03
AU767081B2 (en) 2003-10-30
DE1139935T1 (de) 2002-08-22
DE69936062T2 (de) 2008-01-10

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