WO2000035386A1 - Prothese de disque intervertebral a enceinte de liquide - Google Patents

Prothese de disque intervertebral a enceinte de liquide Download PDF

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Publication number
WO2000035386A1
WO2000035386A1 PCT/FR1999/003074 FR9903074W WO0035386A1 WO 2000035386 A1 WO2000035386 A1 WO 2000035386A1 FR 9903074 W FR9903074 W FR 9903074W WO 0035386 A1 WO0035386 A1 WO 0035386A1
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WO
WIPO (PCT)
Prior art keywords
prosthesis
liquid
plates
intervertebral disc
axis
Prior art date
Application number
PCT/FR1999/003074
Other languages
English (en)
Inventor
Fabien Gauchet
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
Application filed by Dimso (Distribution Medicale Du Sud-Ouest) filed Critical Dimso (Distribution Medicale Du Sud-Ouest)
Priority to KR1020017007284A priority Critical patent/KR20020015677A/ko
Priority to DE69933136T priority patent/DE69933136T2/de
Priority to JP2000587708A priority patent/JP4211221B2/ja
Priority to AU15686/00A priority patent/AU765060B2/en
Priority to CA002354164A priority patent/CA2354164A1/fr
Priority to US09/857,657 priority patent/US6395032B1/en
Priority to EP99958286A priority patent/EP1137376B1/fr
Publication of WO2000035386A1 publication Critical patent/WO2000035386A1/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
    • A61F2/441—Joints for the spine, e.g. vertebrae, spinal discs made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
    • 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
    • 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
    • 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
    • A61B17/7059—Cortical plates
    • 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
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    • 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
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    • 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
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    • 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
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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    • 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
    • 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
    • A61F2002/30535—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
    • A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring 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
    • 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
    • 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
    • A61F2002/30581—Special structural features of bone or joint prostheses not otherwise provided for having a pocket filled with fluid, e.g. liquid
    • 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
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    • 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
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    • A61F2230/0015—Kidney-shaped, e.g. bean-shaped
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    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys
    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
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    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00592—Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
    • A61F2310/00796—Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite

Definitions

  • the assembly can constitute a partial damper.
  • the curve representing the compressive force as a function of the variation in length of the prosthesis along its main axis has a hysteresis shape, just like a healthy natural intervertebral disc.
  • the prosthesis comprises two plates extending on either side of the cushion, the body being fixed to at most one of the plates.
  • a so-called long-term anchoring may be provided in which, in addition, the surfaces 8 of the plates 4 in contact with the adjacent vertebrae are covered with hydroxyapatite, or any other substance known per se which can stimulate bone growth. Before covering, said surfaces 8 can be treated to obtain a more or less porous surface state, having anchoring points for the bone tissue, to ensure a better interface with said bone tissue.

Abstract

La prothèse de disque intervertébral (2) comprend un coussin compressible (14) comportant un corps (22) réalisé dans un matériau, et un liquide (20) apte à venir en contact avec le corps (22). Le liquide et le matériau sont tels que le liquide ne mouille pas le corps (22).

Description

"PROTHESE DE DISQUE INTERVERTEBRAL A ENCEINTE DE LIQUIDE " . L'invention concerne les prothèses de disque intervertébral .
On connaît, par exemple du document EP-0 277 282, une prothèse de disque intervertébral destinée à remplacer un disque intervertébral. Elle comporte deux plateaux aptes à venir en appui contre les plateaux vertébraux des vertèbres adjacentes au disque à remplacer, et un cousin interposé entre les plateaux. Le coussin comporte un corps compressible et une enceinte renfermant un liquide. Cette prothèse a pour inconvénient que le corps compressible est susceptible de s'user, modifiant ainsi à terme le comportement mécanique de la prothèse. De plus, son frottement contre les plateaux provoque l'érosion de particules pouvant migrer dans le corps du patient.
Un but de l'invention est de fournir une prothèse dont le comportement mécanique soit identique sur une longue période de temps, et réduisant les risques de libération de particules dans le corps du patient. En vue de la réalisation de ce but, on prévoit selon l'invention une prothèse de disque intervertébral comprenant un coussin compressible comportant un corps réalisé dans un matériau, et un liquide apte à venir en contact avec le corps, dans laquelle le liquide et le matériau sont tels que le liquide ne mouille pas le corps.
Sachant que le liquide ne mouille pas le corps, la mise en contact forcée du liquide avec le corps requiert une certaine énergie. Cette énergie est restituée en intégralité lorsqu'on permet au liquide de se séparer à nouveau du corps. On produit ainsi une sorte d'effet ressort. Cet effet est d'autant plus important que la surface de contact du liquide avec le corps est grande. La prothèse peut donc encaisser des efforts très importants, en se déformant en compression ou en flexion, puis produire la déformation inverse en restituant l'énergie emmagasinée. Une telle prothèse peut stocker dans un petit volume une quantité d'énergie considérable. En outre, le mouvement du liquide au contact du corps ne génère aucune usure : la prothèse est donc susceptible de présenter le même, comportement mécanique sur une période de temps très longue. De plus, l'absence de frottement entre des pièces solides fait pratiquement disparaître tout risque de libération de particules dans le corps.
L'effet ressort sera très élevé en présence d'un corps poreux même de volume très réduit.
Si l'on prévoit que le corps présente des cavités communiquant entre elles suivant des réseaux très longs, le chemin à parcourir par le liquide lors de l'entrée et de la sortie est particulièrement élevé. Il s'ensuit que le liquide dissipe une partie de l'énergie par sa seule circulation dans le corps. Dès lors, l'ensemble peut constituer un amortisseur partiel. La combinaison de l'effet ressort avec l'effet amortisseur entraîne alors que pour la prothèse, la courbe représentant l'effort en compression en fonction de la variation de longueur de la prothèse suivant son axe principal a une forme en hystérésis, tout comme un disque intervertébral naturel sain. On approche donc de près le comportement mécanique d'un véritable disque. Avantageusement, la prothèse comporte deux plateaux s' étendant de part et d'autre du coussin, le corps étant fixé à au plus un des plateaux.
D'autres caractéristiques et avantages de l'invention apparaîtront encore dans la description suivante d'un mode préféré de réalisation donné à titre d'exemple non limitatif. Aux dessins annexés : la figure 1 est une vue en coupe axiale d'une prothèse selon le mode préféré de réalisation de l'invention ; la figure 2 est la courbe montrant la variation de la force de compression appliquée à la prothèse en fonction de l'évolution de sa hauteur suivant son axe ; et la figure 3 est une vue en perspective de la prothèse de la figure 1.
En référence aux figures 1 et 3, la prothèse 2 comprend deux plateaux 4 ayant en plan une forme générale circulaire ou bien de préférence une forme en haricot à hile postérieur. Les deux plateaux sont plats et s'étendent en vis-à-vis parallèlement l'un à l'autre en étant centrés sur un axe principal 9 de la prothèse perpendiculaire aux plateaux.
Chaque plateau 4 comporte deux pattes 6 s' étendant en saillie d'une face externe 8 du plateau 4 perpendiculairement au plan du plateau. Chaque patte 6 présente un orifice 10 la traversant de part en part en direction du centre du plateau et, sur une face de la patte 6 opposée au plateau 4, une empreinte 12 de forme sphérique. Les orifices 10 permettent la réception d'une vis à os 11 ayant une tête dont une face inférieure a une forme sphérique mâle coopérant avec 1 ' empreinte femelle 12 de la patte 6 pour permettre une libre orientation de la vis par rapport à la patte associée.
Sur la figure 1, les deux pattes 6 de chaque plateau ont été ramenées dans le même plan de coupe, ce qui n'est pas le cas en réalité, comme le montre la figure 3.
Pour réaliser un ancrage à court terme de la prothèse de disque 2 dans la colonne, on pourra ancrer les vis 11 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 8 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 8 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.
La prothèse présente un coussin 14 interposé entre les plateaux. Ce coussin comporte un soufflet 16. Il a une forme symétrique de révolution autour de l'axe 9. Sa paroi présente de profil des ondulations permettant de faire varier la longueur du soufflet 16 suivant la direction axiale 9, sans que varie sensiblement la superficie de sa section transversalement à l'axe 9. 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 9 ou subir une torsion autour de l'axe 9 ou d'un axe quelconque perpendiculaire à celui-ci.
Le soufflet 16 présente à ses deux extrémités axiales des bords collés à des bords respectifs des plateaux 4 s 'étendant, par exemple mais de façon non illustrée, en saillie d'une face interne 18 des plateaux. Le collage est réalisé de façon étanche de sorte que le soufflet 16 définit avec les deux plateaux 4 une enceinte étanche à volume variable. Le soufflet 16 présente, par exemple et de façon non illustrée, dix convolutions, soit huit crêtes externes en plus des deux crêtes de fixation aux plateaux 4. 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.
L'enceinte délimitée par le soufflet 16 et les deux plateaux 4 est remplie d'un liquide 20. Le coussin 14 comporte un corps 22 qui est ici ancré à la face interne plane 18 de l'un des deux plateaux, par exemple le plateau inférieur 4 sur la figure 1. A cette fin, un relief 24 venu du plateau s'étend dans le corps. La forme du corps peut par exemple être cylindrique d'axe 9. Le corps sera par exemple suffisamment étroit perpendiculairement à l'axe 9 pour ne jamais venir en contact avec le soufflet lors de déformations de la prothèse. De même, un espace libre suffisant sera ménagé entre l'extrémité libre, ici supérieure, du corps 22 et le plateau opposé pour qu'ils ne viennent jamais en contact mutuel. Le corps 22 est environné par le liquide apte à venir en contact avec lui.
Le liquide 20 et le matériau du corps 22 seront de préférence biocompatibles. Ils sont choisis de sorte que le liquide soit non mouillant à l'égard du corps, c'est- à-dire qu'en l'absence de sollicitation à cette fin il tende à demeurer hors de contact du corps. Le liquide sera par exemple de l'eau et le matériau du corps un matériau biocompatible tel que du titane ou un alliage de titane. Ce matériau sera de préférence poreux pour offrir une grande surface de contact avec le liquide. De plus, on fera en sorte que les cavités du corps constituant ses pores communiquent entre elles suivant des réseaux assez longs afin de fournir un effet amortisseur en plus de l'effet ressort. Sur la figure 1, les pores ou cavités 26 du corps 22 ont été illustrés de façon schématique pour plus de clarté. Il va de soi que ces pores sont invisibles à l'échelle de la figure 1 et infiniment plus nombreux que ceux illustrés. Ainsi, la hauteur h étant mesurée de l'un à l'autre des plateaux au niveau de l'axe 9, la courbe illustrant sur la figure 2 la variation de la compression F de la prothèse suivant son axe 9 en fonction de sa variation, négative, de hauteur Δh, aura une forme en hystérésis. Ainsi, la courbe Ca indiquant l'évolution de la force F lorsque celle-ci augmente est tout entière au-dessus de la courbe Cd illustrant la décroissance de la force F. Cette forme est due à la combinaison de l'effet ressort et de l'effet amortisseur. On pourra prévoir une poche de gaz à l'intérieur de l'enceinte de liquide.
La prothèse selon l'invention est particulièrement adaptée à la zone lombaire du rachis.
Bien entendu, on pourra apporter à l'invention de nombreuses modifications sans sortir du cadre de celle- ci. Le corps 22 pourra être sans ancrage à l'égard des plateaux. Il sera ainsi libre de se déplacer spontanément à l'égard de chacun d'eux. La prothèse pourra alors être agencée pour qu' en toute position et tout état de sollicitation de la prothèse, le corps 22 soit en contact avec au plus l'un des plateaux.
Le corps 22 pourra avoir une forme en ellipsoïde.

Claims

REVENDICATIONS
1. Prothèse de disque intervertébral (2) comprenant un coussin compressible (14) comportant un corps (22) réalisé dans un matériau, et un liquide (20) apte à venir en contact avec le corps (22) , caractérisée en ce que le liquide et le matériau sont tels que le liquide ne mouille pas le corps (22) .
2. Prothèse selon la revendication 1, caractérisée en ce que le matériau est poreux.
3. Prothèse selon les revendications 1 à 2, caractérisée en ce que la prothèse comporte deux plateaux (4) s' étendant de part et d'autre du coussin
(14), le corps (22) étant fixé à au plus un des plateaux.
4. Prothèse selon l'une quelconque des revendications 1 à 3, caractérisée en ce qu'elle est agencée de sorte qu'une courbe (c) d'une compression (F) de la prothèse suivant un axe principal (9) de la prothèse en fonction d'une variation (Δh) de dimension (h) de la prothèse suivant cet axe a une forme en hystérésis .
PCT/FR1999/003074 1998-12-11 1999-12-09 Prothese de disque intervertebral a enceinte de liquide WO2000035386A1 (fr)

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KR1020017007284A KR20020015677A (ko) 1998-12-11 1999-12-09 액체 챔버를 구비한 추간판 디스크 인공 보철물
DE69933136T DE69933136T2 (de) 1998-12-11 1999-12-09 Bandscheibenprothese mit flüssigkeitsgefüllter kammer
JP2000587708A JP4211221B2 (ja) 1998-12-11 1999-12-09 液体チャンバーを備えた椎間板補綴具
AU15686/00A AU765060B2 (en) 1998-12-11 1999-12-09 Intervertebral disc prosthesis with liquid chamber
CA002354164A CA2354164A1 (fr) 1998-12-11 1999-12-09 Prothese de disque intervertebral a enceinte de liquide
US09/857,657 US6395032B1 (en) 1998-12-11 1999-12-09 Intervertebral disc prosthesis with liquid chamber
EP99958286A EP1137376B1 (fr) 1998-12-11 1999-12-09 Prothese de disque intervertebral a enceinte de liquide

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FR9815673A FR2787018B1 (fr) 1998-12-11 1998-12-11 Prothese de disque intervertebral a enceinte de liquide
FR98/15673 1998-12-11

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EP (1) EP1137376B1 (fr)
JP (1) JP4211221B2 (fr)
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AT (1) ATE338521T1 (fr)
AU (1) AU765060B2 (fr)
CA (1) CA2354164A1 (fr)
DE (1) DE69933136T2 (fr)
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AU1568600A (en) 2000-07-03
CA2354164A1 (fr) 2000-06-22
US6395032B1 (en) 2002-05-28
AU765060B2 (en) 2003-09-04
EP1137376B1 (fr) 2006-09-06
JP2002532143A (ja) 2002-10-02
DE69933136D1 (de) 2006-10-19
DE69933136T2 (de) 2007-07-19
KR20020015677A (ko) 2002-02-28
JP4211221B2 (ja) 2009-01-21
FR2787018B1 (fr) 2001-03-02
FR2787018A1 (fr) 2000-06-16
ATE338521T1 (de) 2006-09-15
EP1137376A1 (fr) 2001-10-04
ZA200104846B (en) 2002-01-21

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