WO2014090114A1 - Pedicle screw and anterior thoracic/lumbar vertebral internal fixation system - Google Patents

Pedicle screw and anterior thoracic/lumbar vertebral internal fixation system Download PDF

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Publication number
WO2014090114A1
WO2014090114A1 PCT/CN2013/088731 CN2013088731W WO2014090114A1 WO 2014090114 A1 WO2014090114 A1 WO 2014090114A1 CN 2013088731 W CN2013088731 W CN 2013088731W WO 2014090114 A1 WO2014090114 A1 WO 2014090114A1
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WO
WIPO (PCT)
Prior art keywords
anterior
internal fixation
screw
fixation system
gasket
Prior art date
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PCT/CN2013/088731
Other languages
French (fr)
Chinese (zh)
Inventor
高耀平
田芳
林忠
陈伟
Original Assignee
上海微创骨科医疗科技有限公司
苏州海欧斯医疗器械有限公司
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Application filed by 上海微创骨科医疗科技有限公司, 苏州海欧斯医疗器械有限公司 filed Critical 上海微创骨科医疗科技有限公司
Publication of WO2014090114A1 publication Critical patent/WO2014090114A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7044—Screws or hooks combined with longitudinal elements which do not contact vertebrae also having plates, staples or washers bearing on the vertebrae
    • 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
    • A61B17/8695—Washers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032—Screws or hooks with U-shaped head or back through which longitudinal rods pass
    • 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
    • A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
    • 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
    • A61B2017/8655—Pins or screws or threaded wires; nuts therefor with special features for locking in the bone

Definitions

  • This invention relates to the field of orthopedic implants, and more particularly to the field of spinal surgery, such as implants for treating or repairing spinal diseases in patients, and more particularly to pedicle screws and thoracolumbar anterior internal fixation systems. Background technique
  • anterior decompression and fusion surgery can restore the height of the intervertebral disc and intervertebral foramen and reconstruct the stability of the thoracolumbar spine.
  • Anterior bone grafting combined with internal fixation provides strong support for the anterior structure of the spine and restores the spine with sufficient stability.
  • the anterior interbody fusion and the larger blood supply between the vertebral bodies provide a more ideal bone graft, so the success rate of fusion is higher.
  • Anterior fusion is often the ideal or even the only option when posterior fusion surgery fails. As shown in Fig.
  • a conventional thoracolumbar anterior fixation system includes: a pedicle screw 4', a spacer 5', a screw plug (not shown), a transverse connector 3', a connecting rod and a 2'.
  • a nail rod system By assembling such a nail rod system, it is combined with the vertebral body into a fixed frame to stabilize the spinal segments in the frame that require treatment.
  • Chinese utility model patent 99235520 X discloses a thoracolumbar anterior reduction and fixation The utility model comprises a strut, a vertebral body screw, a cross bridge clip and a door shaped foot board, wherein the support rod is composed of a connecting tube butting telescopic rod, and the support rod and the vertebral body screw are vertically connected by the fastening screw.
  • the Chinese utility model patent CN 03236836.4 discloses another anterior spinal multi-segment internal fixation orthosis device, which comprises a plurality of pedicle screws, connecting rods, tightening screw plugs and pads for screwing into the vertebral body.
  • the vertebral screws mounted on each of the spacers are at least one of which is a universal joint screw.
  • the Chinese utility model patent 200920222845.X discloses another double-hole two-legged anatomical gasket and a thoracolumbar anterior nail rod system, which is a saddle-shaped double-arc gasket body with a section in the length and width directions.
  • the utility model patent 201120387224.4 discloses another thoracolumbar anterior internal fixation system, comprising: a pair of first and second links arranged in parallel, a pair of connection blocks for connecting the first and second links, And a plurality of screws disposed on the first and second links, which add a circular arc gasket and a circular gasket to the conventional spinal nail rod system, and the gasket is adapted to provide a screw angle of 10°.
  • the pad 5' is first inserted into the vertebral body during operation, and then the pedicle screw 4' is screwed into the hole in the spacer 5'. Vertebral body. The strength of tapping the gasket is difficult to master, and it can't be touched lightly. If it is heavy, it will damage the spinal cord. Summary of the invention
  • the object of the invention is to solve this problem.
  • the present invention proposes a pedicle screw for use in a thoracolumbar anterior internal fixation system.
  • the pedicle screw includes a head having an internal thread and a screw having an external thread, wherein the pedicle screw further includes a spacer, and the screw is provided with a circumferential groove at a side bordering the head, the pad a tab snaps in the circumferential groove, the washer being rotatable relative to the screw about a longitudinal axis of the screw, and the head The bottom surface abuts against the upper surface of the gasket.
  • the pedicle screw of the present invention simplifies and reduces the difficulty of surgical operation, because the pedicle screw can be pressed into the vertebral body while the pedicle screw is screwed in.
  • the original two steps can be combined into one step, and there is no need to beat again.
  • the gasket reduces the damage to the patient and saves the operation time.
  • the bottom surface of the head is a convex spherical surface
  • the upper surface of the spacer is a concave spherical surface. Under this configuration, since the bottom spherical surface of the pedicle screw and the top spherical surface of the spacer are automatically centered and pressed, the combination is relatively dense, and the instability is not caused in the first stage after the fixation.
  • the firmness of the implant to the vertebral body is increased.
  • the binding of the bone thread to the vertebral body axially increases the bone density due to the resistance of the spacer.
  • the upper surface of the spacer is provided with an elastically deformed groove in the radial direction.
  • the present invention also provides a thoracolumbar anterior internal fixation system, comprising a screw plug, a connecting rod, wherein the thoracolumbar anterior internal fixation system further comprises a plurality of pedicles as described above fixed on the connecting rod a screw, the pedicle screw being fixed to the connecting rod by the internal thread of the head being engaged with the corresponding screw plug.
  • the internal fixation system of the present invention can be used for anterior orthopedic fixation of the scoliosis, or for thoracolumbar fractures, thoracolumbar spine tumors and other spinal deformities, and the anterior sphenoidal single-segment or multi-segment internal fixation is required.
  • the thoracolumbar anterior internal fixation system is a lumbar thoracic anterior interbody fusion system
  • the lumbar thoracic anterior interbody fusion internal fixation system comprises two connecting rods, and further includes At least one cross-linker between the two connecting rods is mounted, and each of the connecting rods is fixed with a plurality of the pedicle screws.
  • the thoracolumbar anterior internal fixation system is a anterior spinal internal fixation double rod orthopedic system comprising two connecting rods, each of which is fixed with a plurality of said pedicle screws.
  • the thoracolumbar anterior internal fixation system is a spinal anterior internal fixation single rod orthopedic system comprising a single connecting rod, and the connecting rod is fixed with a plurality of the pedicle screws.
  • FIG. 1 is a schematic view showing a thoracolumbar anterior internal fixation system according to an embodiment of the present invention, which is shown as a thoracolumbar anterior interbody fusion system.
  • FIG. 2 is a schematic view of a pedicle screw according to an embodiment of the present invention.
  • Fig. 3 is a schematic view showing the pedicle screw shown in Fig. 2 with the spacer removed.
  • Figure 4 is a schematic illustration of the spacer of the pedicle screw shown in Figure 2.
  • Figure 5 is a schematic illustration of another embodiment of a gasket of the present invention.
  • Figure 6 is a schematic illustration of another embodiment of a gasket of the present invention.
  • Figure 7 is a schematic illustration of a anterior spinal fixation double rod orthopedic system.
  • Figure 8 is a schematic illustration of a anterior spinal fixation single rod orthotic system.
  • Figure 9 is a schematic illustration of a prior art spinal anterior rod system. List of reference signs
  • FIG. 1 shows an embodiment of a thoracolumbar anterior internal fixation system of the present invention.
  • the thoracolumbar anterior internal fixation system is a thoracolumbar anterior interbody fusion system.
  • the system comprises four pedicle screws, two connecting rods 3 and a transverse connector 4 mounted between the connecting rods 3, each pedicle screw passing through the internal thread of its head 1 and the corresponding screw plug 2
  • the external threads are respectively fixed to the two connecting rods 3, and each of the connecting rods 3 is fixed with two pedicle screws.
  • Figure 2 shows a pedicle screw of an embodiment of the invention.
  • the pedicle screw of the embodiment of the present invention is composed of two parts, namely a spacer 5 and a pedicle screw.
  • the pedicle screw includes a head 1 and a screw 6, the head 1 has an internal thread, and the threaded root of the screw 6 that is in contact with the head is provided with a circumferential groove 8.
  • the bottom surface 7 of the head 1 is configured as a convex spherical surface.
  • Figure 4 shows an embodiment of the shim 5.
  • the spacer 5 is circular, and a plurality of stitches 11 are arranged along the circumference of the circle.
  • the upper surface 9 of the spacer 5 is configured as a concave spherical surface to cooperate with the bottom surface 7 of the head 1 of the pedicle screw.
  • An elastic groove 10 is also provided on the upper surface 9 of the gasket 5.
  • Figures 5-6 show other embodiments of the gasket.
  • the spacer 5 is square and has four stitches which are respectively arranged at the four corners.
  • the spacer 5 is also square and has 4 stitches, but is disposed at an intermediate position of the four sides, respectively.
  • the spacer 5 is screwed along the threaded end of the screw 6 of the pedicle screw.
  • the elastic groove 10 in the spacer 5 is deformed, and after reaching the circumferential groove 8 of the root of the thread, the elastic groove 10 is restored.
  • the spacer 5 is snapped into the circumferential groove 8 so as to be integral with the pedicle screw, but still free to rotate about the longitudinal axis of the pedicle screw relative to the screw 6, while the bottom surface of the head 1 7 abuts against the upper surface 9 of the gasket 5.
  • the spacer 5 is positioned by a staple driver and screwed into the pedicle screw to engage the vertebral body.
  • the bottom surface 7 (the convex spherical surface) of the screw 6 of the pedicle screw abuts against the upper surface 9 (the concave spherical surface) of the spacer 5 and the relative rotation between the screw 6 and the spacer Therefore, pressure is applied to the spacer 5 so that the nail 11 on the spacer is slowly pressed into the vertebral body.
  • the pedicle screw of the present invention can also be used for different thoracolumbar anterior internal fixation systems, as shown in Fig. 7, the anterior spinal fixation double rod orthotic system including only two connecting rods and the single body shown in Fig. 8 A single rod orthopedic system is fixed in the anterior spinal column of the connecting rod.
  • the invention integrates a pedicle screw and a gasket in a conventional thoracolumbar anterior internal fixation system to form a novel pedicle screw.
  • This configuration simplifies and reduces the difficulty of surgical operation.
  • the original surgical procedure is to first insert the gasket into the vertebral body, and then screw the pedicle screw into the vertebral body along the hole in the shims.
  • the strength of tapping the shims is difficult to grasp, and the light can not be knocked in. spinal cord.
  • it is screwed into the new vertebral body screw and the gasket is pressed into the vertebral body.
  • the two steps are combined one step, no need to tap the gasket, the damage to the patient is reduced, and the operation time is saved.
  • the above configuration can also increase the firmness of the implant to the vertebral body.
  • the axial force of the bone thread and the vertebral body will increase the bone density due to the resistance of the shims, and the instability will not occur in the first stage after fixation.

Abstract

Disclosed is pedicle screw and an anterior thoracic/lumbar vertebral internal fixation system. The pedicle screw comprises a head (1) having an internal thread and a screw rod (6) having an external thread. The pedicle screw also comprises a gasket (5). A circumferential groove (8) is arranged at the end of the screw rod (6) connected to the head (1). The gasket (5) is clamped in the circumferential groove (8). The gasket (5) can rotate relative to the screw rod (6) around the longitudinal axis of the screw rod (6), and the upper surface of the gasket (5) abutting against the bottom surface of the head (1). The gasket (5) is pressed into a vertebral body while screwing the pedicle screw, which reduces the difficulty of surgical operation and the injury to a patient, saves the operation time and increases the degree of firmness of bonding of an implant and the vertebral body. The anterior thoracic/lumbar vertebral internal fixation system comprises a screw plug (2), a connecting rod (3) and the pedicle screw.

Description

椎弓根螺钉及胸腰椎前路内固定系统 技术领域  Pedicle screw and thoracolumbar anterior internal fixation system
本发明涉及骨科植入物领域， 具体涉及脊柱外科、 诸如用于治疗 或修复患者的脊柱疾病的植入物领域， 特别涉及椎弓根螺钉及胸腰椎 前路内固定系统。 背景技术  Field of the Invention This invention relates to the field of orthopedic implants, and more particularly to the field of spinal surgery, such as implants for treating or repairing spinal diseases in patients, and more particularly to pedicle screws and thoracolumbar anterior internal fixation systems. Background technique
治疗或修复患者的脊柱疾病的脊柱外科手术已有几十年的历史。 目前， 临床上用于脊柱内固定矫形， 胸腰椎骨折、 胸腰段脊柱肿瘤以 及其它畸形等疾病需要进行脊柱前路手术内固定治疗时， 医生通常根 据患者情况选用前路或后路手术入路的方法。 当脊柱前、 中柱不稳、 椎体病变、 结核、 肿瘤时， 使用前路内固定可以明显增加脊柱在各个 方向上的稳定性和剔除病变、 重塑脊柱生理形态。 前路减压及融合手术除了达到减压目的外， 还能恢复椎间盘及椎 间孔的高度， 重建胸腰椎稳定性。 前路植骨与内固定结合可为脊柱前 路结构提供强有力的支持， 并使脊柱恢复足够的稳定性。 前路椎体间 融合与后路融合相比， 椎体间较大的接触面及丰富的血供提供了更为 理想的植骨床， 因而融合术的成功率更高。 当后路融合手术失败后， 前路融合术往往成为更为理想甚至唯一的选择。 如图 9所示， 常规的胸腰椎前路固定系统包括： 椎弓根螺钉 4'、 垫片 5'、 螺塞 （未示出） 、 横联器 3'、 连接棒 Γ和 2'。 通过装配这样 的钉棒系统使之与椎体结合成一个固定框架来稳定框架内需要治疗的 脊柱节段。 中国实用新型专利 99232520 X公开了一种胸腰椎前路复位固定装 置， 它包括撑杆、 椎体螺钉、 横桥夹片和门形脚板， 其中支撑杆由连 接管对接伸缩杆组成， 支持杆与椎体螺钉由紧固螺钉垂直连接。 中国实用新型专利 CN 03236836.4公开了另一种脊柱前路多节段 内固定矫形装置， 该固定装置包含若干个用于拧入椎体的包含椎弓根 螺钉、 连接棒、 缩紧螺塞和垫片， 安装于每一垫片上的椎体螺钉至少 有一个为万向螺钉。 中国实用新型专利 200920222845.X公开了又一种双孔双脚解剖形 垫片及胸腰椎前路钉棒系统， 该垫片是一马鞍形双弧垫片体， 其长度 和宽度方向上的截面均是弯曲的圆弧形， 具有与人体椎体骨面吻合的 椎体解剖表面， 而该胸腰椎前路钉棒系统包括 4个椎弓根螺钉、 2个所 述垫片、 2根连接棒、 1-2个横联器。 中国实用新型专利 201120387224.4公开了又一种胸腰椎前路内固 定系统， 包括： 一对平行设置的第一、 第二连杆， 用于连接该第一、 第二连杆的一对连接块， 以及设于第一、 第二连杆上的多个螺钉， 其 在常规的脊柱钉棒系统基础上增加圆弧形垫片和圆形垫片， 垫片适用 于提供 10° 的螺钉角度。 在如图 9所示的现有胸腰椎前路内固定系统中， 手术时需先将垫 片 5 '敲入椎体， 再将椎弓根螺钉 4'沿垫片 5 '上的孔拧入椎体内。 敲打 垫片的力度较难掌握， 轻了敲不进去， 重了会损伤脊髓。 发明内容 Spinal surgery for treating or repairing a patient's spinal disease has been around for decades. At present, when clinically used for spinal internal fixation orthopedics, thoracolumbar fractures, thoracolumbar spine tumors and other deformities require anterior spinal surgery, doctors usually choose anterior or posterior approach based on the patient's condition. Methods. When the anterior and middle column are unstable, vertebral lesions, tuberculosis, and tumors, the use of anterior internal fixation can significantly increase the stability of the spine in all directions and eliminate the lesions and reshape the physiological morphology of the spine. In addition to the purpose of decompression, anterior decompression and fusion surgery can restore the height of the intervertebral disc and intervertebral foramen and reconstruct the stability of the thoracolumbar spine. Anterior bone grafting combined with internal fixation provides strong support for the anterior structure of the spine and restores the spine with sufficient stability. Compared with the posterior fusion, the anterior interbody fusion and the larger blood supply between the vertebral bodies provide a more ideal bone graft, so the success rate of fusion is higher. Anterior fusion is often the ideal or even the only option when posterior fusion surgery fails. As shown in Fig. 9, a conventional thoracolumbar anterior fixation system includes: a pedicle screw 4', a spacer 5', a screw plug (not shown), a transverse connector 3', a connecting rod and a 2'. By assembling such a nail rod system, it is combined with the vertebral body into a fixed frame to stabilize the spinal segments in the frame that require treatment. Chinese utility model patent 99235520 X discloses a thoracolumbar anterior reduction and fixation The utility model comprises a strut, a vertebral body screw, a cross bridge clip and a door shaped foot board, wherein the support rod is composed of a connecting tube butting telescopic rod, and the support rod and the vertebral body screw are vertically connected by the fastening screw. The Chinese utility model patent CN 03236836.4 discloses another anterior spinal multi-segment internal fixation orthosis device, which comprises a plurality of pedicle screws, connecting rods, tightening screw plugs and pads for screwing into the vertebral body. The vertebral screws mounted on each of the spacers are at least one of which is a universal joint screw. The Chinese utility model patent 200920222845.X discloses another double-hole two-legged anatomical gasket and a thoracolumbar anterior nail rod system, which is a saddle-shaped double-arc gasket body with a section in the length and width directions. Each has a curved circular arc shape and has a vertebral body anatomical surface that conforms to the human vertebral body bone surface, and the thoracolumbar anterior nail rod system includes four pedicle screws, two of the spacers, and two connecting rods. , 1-2 cross-linkers. The utility model patent 201120387224.4 discloses another thoracolumbar anterior internal fixation system, comprising: a pair of first and second links arranged in parallel, a pair of connection blocks for connecting the first and second links, And a plurality of screws disposed on the first and second links, which add a circular arc gasket and a circular gasket to the conventional spinal nail rod system, and the gasket is adapted to provide a screw angle of 10°. In the existing thoracolumbar anterior internal fixation system shown in Fig. 9, the pad 5' is first inserted into the vertebral body during operation, and then the pedicle screw 4' is screwed into the hole in the spacer 5'. Vertebral body. The strength of tapping the gasket is difficult to master, and it can't be touched lightly. If it is heavy, it will damage the spinal cord. Summary of the invention
本发明的目的是解决这一问题。 为此， 本发明提出一种用于胸腰 椎前路内固定系统中的椎弓根螺钉。 所述椎弓根螺钉包括具有内螺纹 的头部和具有外螺纹的螺杆， 其中， 所述椎弓根螺钉还包括垫片， 所 述螺杆在接壤所述头部的一端设有周向凹槽， 垫片卡扣在所述周向凹 槽中， 所述垫片可绕螺杆的纵向轴线相对于螺杆旋转， 且所述头部的 底表面抵靠于所述垫片的上表面。 本发明的椎弓根螺钉简化和降低手 术操作难度， 因为手术时可以在拧入椎弓根螺钉的同时将垫片压入椎 体中， 原先的两个步骤可以合为一步， 而且无需再敲打垫片， 减轻对 患者的损伤， 节约手术时间。 优选地， 所述头部的底表面为凸球面， 所述垫片的上表面为凹球 面。 在此构造下， 由于椎弓根螺钉的底部球面和垫片的顶部球面自动 定心压入， 其结合比较致密， 固定后一期不会产生失稳现象。 另外， 增加植入物与椎体结合的牢固度。 在拧入椎弓根螺钉时因垫片的抵抗 力而使骨螺纹与椎体的结合轴向增加骨密度。 优选地， 所述垫片的上表面沿径向设有弹性变形凹槽。 本发明还提供一种胸腰椎前路内固定系统， 其包括螺塞、 连接棒， 其中， 所述胸腰椎前路内固定系统还包括固定在连接棒上的多个如上 所述的椎弓根螺钉， 所述椎弓根螺钉通过其头部的内螺纹与相应的螺 塞配合而固定在连接棒上。 本发明的内固定系统可用于脊柱侧弯前路内固定矫形， 或胸腰椎 骨折、 胸腰段脊柱肿瘤以及其它脊柱畸形等疾病需要进行脊柱前路单 节段或多节段手术内固定治疗。 根本发明的实施例， 所述胸腰椎前路内固定系统为腰胸椎前路椎 体间融合内固定系统， 所述腰胸椎前路椎体间融合内固定系统包括两 个连接棒， 且还包括安装所述两个连接棒之间的至少一个横联器， 每 个连接棒上都固定有多个所述椎弓根螺钉。 根本发明的实施例， 所述胸腰椎前路内固定系统为脊柱前路内固 定双棒矫形系统， 其包括两个连接棒， 每个连接棒上都固定有多个所 述椎弓根螺钉。 根本发明的实施例， 所述胸腰椎前路内固定系统为脊柱前路内固 定单棒矫形系统， 其包括单个连接棒， 所述连接棒上固定有多个所述 椎弓根螺钉。 本发明的优势是降低手术操作难度， 减轻对患者的损伤， 节约手 术时间， 增加植入物与椎体结合的牢固度。 附图说明 The object of the invention is to solve this problem. To this end, the present invention proposes a pedicle screw for use in a thoracolumbar anterior internal fixation system. The pedicle screw includes a head having an internal thread and a screw having an external thread, wherein the pedicle screw further includes a spacer, and the screw is provided with a circumferential groove at a side bordering the head, the pad a tab snaps in the circumferential groove, the washer being rotatable relative to the screw about a longitudinal axis of the screw, and the head The bottom surface abuts against the upper surface of the gasket. The pedicle screw of the present invention simplifies and reduces the difficulty of surgical operation, because the pedicle screw can be pressed into the vertebral body while the pedicle screw is screwed in. The original two steps can be combined into one step, and there is no need to beat again. The gasket reduces the damage to the patient and saves the operation time. Preferably, the bottom surface of the head is a convex spherical surface, and the upper surface of the spacer is a concave spherical surface. Under this configuration, since the bottom spherical surface of the pedicle screw and the top spherical surface of the spacer are automatically centered and pressed, the combination is relatively dense, and the instability is not caused in the first stage after the fixation. In addition, the firmness of the implant to the vertebral body is increased. When the pedicle screw is screwed in, the binding of the bone thread to the vertebral body axially increases the bone density due to the resistance of the spacer. Preferably, the upper surface of the spacer is provided with an elastically deformed groove in the radial direction. The present invention also provides a thoracolumbar anterior internal fixation system, comprising a screw plug, a connecting rod, wherein the thoracolumbar anterior internal fixation system further comprises a plurality of pedicles as described above fixed on the connecting rod a screw, the pedicle screw being fixed to the connecting rod by the internal thread of the head being engaged with the corresponding screw plug. The internal fixation system of the present invention can be used for anterior orthopedic fixation of the scoliosis, or for thoracolumbar fractures, thoracolumbar spine tumors and other spinal deformities, and the anterior sphenoidal single-segment or multi-segment internal fixation is required. In an embodiment of the invention, the thoracolumbar anterior internal fixation system is a lumbar thoracic anterior interbody fusion system, and the lumbar thoracic anterior interbody fusion internal fixation system comprises two connecting rods, and further includes At least one cross-linker between the two connecting rods is mounted, and each of the connecting rods is fixed with a plurality of the pedicle screws. In an embodiment of the invention, the thoracolumbar anterior internal fixation system is a anterior spinal internal fixation double rod orthopedic system comprising two connecting rods, each of which is fixed with a plurality of said pedicle screws. In an embodiment of the invention, the thoracolumbar anterior internal fixation system is a spinal anterior internal fixation single rod orthopedic system comprising a single connecting rod, and the connecting rod is fixed with a plurality of the pedicle screws. The invention has the advantages of reducing the difficulty of the operation operation, reducing the damage to the patient, saving the operation time, and increasing the firmness of the combination of the implant and the vertebral body. DRAWINGS
通过下面参照附图对本发明实施例进行的详细描述， 本发明的特 征及其优点将是显而易见的。 在图中：  The features and advantages of the present invention will be apparent from the description of the appended claims appended claims. In the picture:
图 1 是本发明实施例的胸腰椎前路内固定系统的示意图， 其显示 为胸腰椎前路椎体间融合内固定系统。  BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a schematic view showing a thoracolumbar anterior internal fixation system according to an embodiment of the present invention, which is shown as a thoracolumbar anterior interbody fusion system.
图 2是本发明实施例的椎弓根螺钉的示意图。  2 is a schematic view of a pedicle screw according to an embodiment of the present invention.
图 3是图 2所示的椎弓根螺钉移除了垫片的情况下的示意图。 图 4是图 2所示的椎弓根螺钉的垫片的示意图。  Fig. 3 is a schematic view showing the pedicle screw shown in Fig. 2 with the spacer removed. Figure 4 is a schematic illustration of the spacer of the pedicle screw shown in Figure 2.
图 5是本发明的垫片的另一实施例的示意图。  Figure 5 is a schematic illustration of another embodiment of a gasket of the present invention.
图 6是本发明的垫片的另一实施例的示意图。  Figure 6 is a schematic illustration of another embodiment of a gasket of the present invention.
图 7是脊柱前路内固定双棒矫形系统的示意图。  Figure 7 is a schematic illustration of a anterior spinal fixation double rod orthopedic system.
图 8是脊柱前路内固定单棒矫形系统的示意图。  Figure 8 is a schematic illustration of a anterior spinal fixation single rod orthotic system.
图 9是现有技术的脊柱前路钉棒系统的示意图。 附图标记列表  Figure 9 is a schematic illustration of a prior art spinal anterior rod system. List of reference signs
1、 椎弓根螺钉的头部 2、 螺塞 3、 连接棒 4、 横联器  1. The head of the pedicle screw 2, the screw plug 3, the connecting rod 4, the transverse joint
5、 垫片 6、 椎弓根螺钉的螺杆  5, the gasket 6, the screw of the pedicle screw
7、 凸球面 8、 周向凹槽  7, convex spherical surface 8, circumferential groove
9、 凹球面 10、 弹性槽 1 1、 针脚  9, concave spherical surface 10, elastic groove 1 1, stitch
Γ 连接棒 2' 连接棒 3' 横联器 4'椎弓根螺钉 5 ' 垫片 具体实施方式 下面 照附图描述本发明的实施例。 图 1 示出了本发明的胸腰椎前路内固定系统的一个实施例。 在本 例中， 胸腰椎前路内固定系统为胸腰椎前路椎体间融合内固定系统。 该系统包括四个椎弓根螺钉， 两个连接棒 3和安装在连接棒 3之间的 一个横联器 4，各椎弓根螺钉通过其头部 1的内螺纹与相应的螺塞 2的 外螺纹配合而分别固定于两个连接棒 3上， 每个连接棒 3上固定有两 个椎弓根螺钉。 图 2显示了本发明实施例的椎弓根螺钉。 如图 2所示， 本发明实 施例的椎弓根螺钉由两个零件组成， 即垫片 5 和椎弓根螺钉。 如图 3 所示， 椎弓根螺钉包括头部 1和螺杆 6， 头部 1具有内螺纹， 且螺杆 6 与头部相接的螺纹根部设有周向凹槽 8。 另外， 头部 1的底表面 7构造 成凸球面。 图 4显示了垫片 5的实施例。 在本例中， 垫片 5为圆形， 沿圆形 的圆周布置有若干个针脚 11。 另外， 垫片 5的上表面 9构造成凹球面， 以与椎弓根螺钉的头部 1 的底表面 7协作。 垫片 5的上表面 9上还设 有弹性槽 10。 图 5-图 6显示了垫片的其它实施例。在图 5中， 垫片 5为正方形， 有 4个针脚， 分别布置在四个角部。 在图 6中， 垫片 5也为正方形， 也有 4个针脚， 但是分别布置在四条边的中间位置。 垫片 5沿椎弓根螺钉的螺杆 6的螺纹末端旋入， 随着螺杆 6慢慢 变粗， 垫片 5中的弹性槽 10变形， 到达螺纹根部的周向凹槽 8处后， 弹性槽 10恢复原始状态， 使垫片 5被卡扣在周向凹槽 8内， 从而与椎 弓根螺钉成为一体， 但是仍可相对于螺杆 6 绕椎弓根螺钉的纵向轴线 自由旋转， 同时头部 1的底表面 7抵靠于垫片 5的上表面 9。 手术时， 通过一个上钉起子来定位垫片 5， 并拧入椎弓根螺钉， 使之与椎体结合。 在拧入椎弓根螺钉时， 由于椎弓根螺钉的螺杆 6 的 底表面 7 (凸球面） 和垫片 5的上表面 9 (凹球面） 相抵靠且螺杆 6和 垫片之间能够相对旋转， 所以对垫片 5施加压力， 使垫片上的钉脚 11 被慢慢压入椎体内。 本发明的椎弓根螺钉还可用于不同的胸腰椎前路内固定系统， 如 图 7 所示的仅包括两个连接棒的脊柱前路内固定双棒矫形系统和图 8 所示的包括单个连接棒的脊柱前路内固定单棒矫形系统。 本发明将常规胸腰椎前路内固定系统中的椎弓根螺钉和垫片合成 一体， 形成一种新型椎弓根螺钉。 这一构造简化和降低手术操作难度。 原手术步骤是先将垫片敲入椎体， 再将椎弓根螺钉沿垫片上的孔拧入 椎体内， 敲打垫片的力度较难掌握， 轻了敲不进去， 重了会损伤脊髓。 现在是拧入新型椎体螺钉的同时将垫片压入椎体中， 两步骤合成一步， 无需敲打垫片， 减轻对患者的损伤， 节约手术时间。 另外， 上述构造 还可以增加植入物与椎体结合的牢固度。 在拧入新型椎体螺钉时因垫 片的抵抗力使骨螺纹与椎体的结合轴向会增加骨密度， 固定后一期不 会产生失稳现象。 本领域技术人员可以理解， 以上描述只是示例性的。 在不背离本 发明的思想和范围的情况下， 本领域技术人员可以对本发明作出多种 修改和变化。 Γ connecting rod 2' connecting rod 3' cross-linking device 4' pedicle screw 5' gasket embodiment Embodiments of the present invention are described below with reference to the drawings. Figure 1 shows an embodiment of a thoracolumbar anterior internal fixation system of the present invention. In this example, the thoracolumbar anterior internal fixation system is a thoracolumbar anterior interbody fusion system. The system comprises four pedicle screws, two connecting rods 3 and a transverse connector 4 mounted between the connecting rods 3, each pedicle screw passing through the internal thread of its head 1 and the corresponding screw plug 2 The external threads are respectively fixed to the two connecting rods 3, and each of the connecting rods 3 is fixed with two pedicle screws. Figure 2 shows a pedicle screw of an embodiment of the invention. As shown in Fig. 2, the pedicle screw of the embodiment of the present invention is composed of two parts, namely a spacer 5 and a pedicle screw. As shown in Fig. 3, the pedicle screw includes a head 1 and a screw 6, the head 1 has an internal thread, and the threaded root of the screw 6 that is in contact with the head is provided with a circumferential groove 8. In addition, the bottom surface 7 of the head 1 is configured as a convex spherical surface. Figure 4 shows an embodiment of the shim 5. In this example, the spacer 5 is circular, and a plurality of stitches 11 are arranged along the circumference of the circle. In addition, the upper surface 9 of the spacer 5 is configured as a concave spherical surface to cooperate with the bottom surface 7 of the head 1 of the pedicle screw. An elastic groove 10 is also provided on the upper surface 9 of the gasket 5. Figures 5-6 show other embodiments of the gasket. In Fig. 5, the spacer 5 is square and has four stitches which are respectively arranged at the four corners. In Fig. 6, the spacer 5 is also square and has 4 stitches, but is disposed at an intermediate position of the four sides, respectively. The spacer 5 is screwed along the threaded end of the screw 6 of the pedicle screw. As the screw 6 is gradually thickened, the elastic groove 10 in the spacer 5 is deformed, and after reaching the circumferential groove 8 of the root of the thread, the elastic groove 10 is restored. In its original state, the spacer 5 is snapped into the circumferential groove 8 so as to be integral with the pedicle screw, but still free to rotate about the longitudinal axis of the pedicle screw relative to the screw 6, while the bottom surface of the head 1 7 abuts against the upper surface 9 of the gasket 5. At the time of surgery, the spacer 5 is positioned by a staple driver and screwed into the pedicle screw to engage the vertebral body. When the pedicle screw is screwed in, the bottom surface 7 (the convex spherical surface) of the screw 6 of the pedicle screw abuts against the upper surface 9 (the concave spherical surface) of the spacer 5 and the relative rotation between the screw 6 and the spacer Therefore, pressure is applied to the spacer 5 so that the nail 11 on the spacer is slowly pressed into the vertebral body. The pedicle screw of the present invention can also be used for different thoracolumbar anterior internal fixation systems, as shown in Fig. 7, the anterior spinal fixation double rod orthotic system including only two connecting rods and the single body shown in Fig. 8 A single rod orthopedic system is fixed in the anterior spinal column of the connecting rod. The invention integrates a pedicle screw and a gasket in a conventional thoracolumbar anterior internal fixation system to form a novel pedicle screw. This configuration simplifies and reduces the difficulty of surgical operation. The original surgical procedure is to first insert the gasket into the vertebral body, and then screw the pedicle screw into the vertebral body along the hole in the shims. The strength of tapping the shims is difficult to grasp, and the light can not be knocked in. spinal cord. Now it is screwed into the new vertebral body screw and the gasket is pressed into the vertebral body. The two steps are combined one step, no need to tap the gasket, the damage to the patient is reduced, and the operation time is saved. In addition, the above configuration can also increase the firmness of the implant to the vertebral body. When the new vertebral body screw is screwed, the axial force of the bone thread and the vertebral body will increase the bone density due to the resistance of the shims, and the instability will not occur in the first stage after fixation. Those skilled in the art will appreciate that the above description is merely exemplary. Numerous modifications and changes can be made to the invention without departing from the spirit and scope of the invention.

Claims

权 利 要 求 书 claims
1. 椎弓根螺钉， 其包括具有内螺纹的头部和具有外螺纹的螺杆， 其特征在于， 所述椎弓根螺钉还包括垫片， 所述螺杆在接壤所述头部 的一端设有周向凹槽， 垫片卡扣在所述周向凹槽中， 所述垫片能够绕 螺杆的纵向轴线相对于螺杆旋转， 且所述头部的底表面抵靠于所述垫 片的上表面。 1. A pedicle screw, which includes a head with internal threads and a screw rod with external threads, characterized in that the pedicle screw also includes a spacer, and the screw rod is provided with one end adjacent to the head. A circumferential groove, a gasket is snapped into the circumferential groove, the gasket can rotate relative to the screw about the longitudinal axis of the screw, and the bottom surface of the head is against the upper surface of the gasket.
2. 根据权利要求 1所述的椎弓根螺钉， 其特征在于， 所述头部的 底表面为凸球面， 所述垫片的上表面为凹球面。 2. The pedicle screw according to claim 1, wherein the bottom surface of the head is a convex spherical surface, and the upper surface of the gasket is a concave spherical surface.
3. 根据权利要求 1或 2所述的椎弓根螺钉， 其特征在于， 所述垫 片的上表面沿径向设有弹性槽。 3. The pedicle screw according to claim 1 or 2, characterized in that the upper surface of the gasket is provided with elastic grooves along the radial direction.
4. 胸腰椎前路内固定系统， 其包括螺塞、 连接棒， 其特征在于， 所述胸腰椎前路内固定系统还包括固定在连接棒上的多个如权利要求 1-3中任一项所述的椎弓根螺钉， 所述椎弓根螺钉通过其头部的内螺纹 与相应的螺塞配合而固定在连接棒上。 4. Anterior thoracolumbar internal fixation system, which includes screw plugs and connecting rods. It is characterized in that the anterior thoracolumbar internal fixation system also includes a plurality of screws fixed on the connecting rods as claimed in any one of claims 1-3. The pedicle screw described in the item above is fixed on the connecting rod through the internal thread of the head of the pedicle screw and the corresponding screw plug.
5. 根据权利要求 4所述的胸腰椎前路内固定系统， 其特征在于， 所述胸腰椎前路内固定系统为腰胸椎前路椎体间融合内固定系统， 所 述腰胸椎前路椎体间融合内固定系统包括两个连接棒， 且还包括安装 所述两个连接棒之间的至少一个横联器， 每个连接棒上都固定有多个 所述椎弓根螺钉。 5. The anterior thoracolumbar internal fixation system according to claim 4, wherein the anterior thoracolumbar internal fixation system is an anterior lumbar and thoracic interbody fusion internal fixation system, and the anterior lumbar and thoracic internal fixation system is The interbody fusion internal fixation system includes two connecting rods, and also includes at least one cross-connector installed between the two connecting rods, and a plurality of the pedicle screws are fixed on each connecting rod.
6. 根据权利要求 4所述的胸腰椎前路内固定系统， 其特征在于， 所述胸腰椎前路内固定系统为脊柱前路内固定双棒矫形系统， 其包括 两个连接棒， 每个连接棒上都固定有多个所述椎弓根螺钉。 6. The thoracolumbar anterior internal fixation system according to claim 4, characterized in that the thoracolumbar anterior internal fixation system is a double-rod anterior spinal internal fixation orthopedic system, which includes two connecting rods, each A plurality of the pedicle screws are fixed on the connecting rods.
7. 根据权利要求 4所述的胸腰椎前路内固定系统， 其特征在于， 所述胸腰椎前路内固定系统为脊柱前路内固定单棒矫形系统， 其包括 单个连接棒， 所述连接棒上固定有多个所述椎弓根螺钉。 7. The thoracolumbar anterior internal fixation system according to claim 4, characterized in that, The thoracolumbar anterior internal fixation system is a single rod orthopedic system for anterior spinal internal fixation, which includes a single connecting rod, and a plurality of the pedicle screws are fixed on the connecting rod.
PCT/CN2013/088731 2012-12-12 2013-12-06 Pedicle screw and anterior thoracic/lumbar vertebral internal fixation system WO2014090114A1 (en)

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