CN1134243C - 椎骨盘稳定器 - Google Patents

椎骨盘稳定器 Download PDF

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Publication number
CN1134243C
CN1134243C CNB961961600A CN96196160A CN1134243C CN 1134243 C CN1134243 C CN 1134243C CN B961961600 A CNB961961600 A CN B961961600A CN 96196160 A CN96196160 A CN 96196160A CN 1134243 C CN1134243 C CN 1134243C
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China
Prior art keywords
implant
adjacent vertebrae
main body
locking device
parts
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Expired - Fee Related
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CNB961961600A
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CN1192669A (zh
Inventor
马德哈万・皮沙罗蒂
马德哈万·皮沙罗蒂
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Individual
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Individual
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First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=27395462&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=CN1134243(C) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Priority claimed from US08/210,229 external-priority patent/US6093207A/en
Priority claimed from US08/482,974 external-priority patent/US5697977A/en
Priority claimed from US08/475,211 external-priority patent/US5658336A/en
Application filed by Individual filed Critical Individual
Publication of CN1192669A publication Critical patent/CN1192669A/zh
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Abstract

本发明公开了一种椎骨盘稳定器。该椎骨盘稳定器包括一种中间张开的、可移动的盘植入物(22)，该植入物的截面形状基本上为矩形，其最小高度(H)小于其最大宽度(W)，植入物可拆卸地安装在一个扣环起子上，以便插入到切除局部椎间盘后的两个相邻椎骨(16，18)之间的解剖学区域内，使植入物可前后移动地定位在盘空间内，并使该植入物的张开的中间部分和较小尺寸的端部(25，36)两者均与相邻椎骨接合的位置上，然后旋转植入物，以便使限定植入物的高度的植入物的侧面(34)与相邻椎骨的主体接合。将一个锁定装置固定到植入物上，以便阻止植入物进一步旋转。

Description

椎骨盘稳定器
本发明涉及一种椎间的植入物和稳定邻近椎骨的方法。本发明特别地涉及用于脊柱融合的，中间部分张大的矩形盘状植入物。如果在处理病人时有必要，本发明还可望用于脊椎前移的复位术，例如包括脊柱的椎骨对中。本发明的第二方面涉及一种插入到相邻的、未对中的椎骨之间的装置，该装置与相邻椎骨的主体接合并牵引椎骨重新对中。
脊柱的错位，特别是发生在颈区和腰区的错位一直是医学领域的难题。对于一个椎骨在另一个椎骨上呈半脱位状态而引起脊柱不对中的情况，传统的处理方式是采用穿过一个板伸展的螺钉，将螺钉拧紧，从而牵引未对中的椎骨重新对中。但是这种处理方法常常会损坏椎间盘，例如造成椎间盘破裂或突出，这将压迫神经的根部。如果突出很严重，两侧均会产生压迫。这种情况往往不能借助板和螺钉来重新使椎骨对中而得到校正，这样在脊椎前移复位术之后往往还需要在融合术中进行切除椎间盘这种外科手术。这种传统的处理椎间盘破裂的方法称为椎间盘切除术，即从椎骨间切除椎间盘。在手术中，所有或部分椎间盘被切除，留下将困扰病人的整个余生的缺憾。另一种手术方法是用一个骨移植物，一般为取自病人的髂嵴的骨片来替代椎间盘的空间，使椎骨在椎间盘的上面和下面融合并消除椎骨之间的空隙。
但是结合融合术的椎间盘切除术并不理想，因为移植骨没有椎间盘的软骨组织的功能，即没有缓冲的作用，并且会引起一些并发症。首先，用于填充盘空间的常用的填充骨与椎间盘的空间不一致，因为椎间盘的空间为中间宽，而前端和后端窄。因此，目前所用的填充骨仅有四个位于椎间盘的空间的前部和后部的接触点。第二，从相邻椎骨的脊柱后部侧面进入椎间盘使得在偏离相邻椎骨的主体处产生一个空间，这个问题比由于椎间的空间形状而产生的有限接触而造成的稳定性问题更严重。另一个麻烦是可能引起感染或切除植入物可能需要一些其它条件。另外，如果骨片没有融合，它们甚至可能从盘空间上脱出而压迫神经根部。
虽然在现有技术领域中公开了各种修复用填充骨或植入物，但它们都存在下述的局限性：不能与盘空间的形状一致，当从偏心处插入时缺少稳定性，很难精确定位，不能移去或存在其它缺点。例如美国专利4,863,476(欧洲同族专利为EP-A-0260044)描述了一种有一细长主体的植入物，该细长主体纵向分成两部分，并且有一个在该植入物插入盘空间后能增加两部分之间距离的凸轮装置。但是，这种装置基本上是圆柱形的，这样接触仅位于盘空间的前部和后部，从而增加不稳定性。在现有技术中还公开了椎间盘修补物(例如美国专利3,867,728、4,309,777、4,863,477和4,932,969以及法国专利申请8816184)，这些修补物可能与相邻的椎间盘有更多的接触，但它们并未用在椎间盘融合术中。这些技术还包括如美国专利4,759,769中描述的脊柱连接修复术。在该文件中也未指出当融合术为优选外科手术时可以采用该技术。
因此，有必要提供一种用于使椎骨重新对中和用于脊柱融合术中的处理方法，特别是提供一种可以对位和在脊柱融合术中使椎骨稳定在相邻的椎间盘上的装置。本发明为了满足上述需要而提供一种包括一细长植入物的椎骨盘稳定器，所述植入物的截面形状基本上为矩形，具有第一、第二、第三和第四侧面，第一和第二侧面限定其最小高度，第三和第四侧面限定其最大宽度。第三和第四侧面从植入物的一端到另一端为弧形的，使得植入物的两个端部之间的中间部分的宽度大于两个端部的宽度。其中第一、第二侧面和/或第五与第六侧面中的一个限定了用来与一其上形成有椎骨支撑表面的锁定装置接合的表面。植入物的一端可拆卸地安装有该锁定装置，以防止锁定装置相对于植入物旋转。在一优选实施例中，锁定装置的支承表面与植入物的高度方向大约成90°。
本发明还提供一种切除在两者之间构成盘空间的椎间盘的一部分之后稳定两相邻椎骨的方法，该方法包括以下步骤：将一个基本上为矩形的、细长的、其宽度大于其高度的植入物插入盘空间，植入物的取向为使其顶部和底部与相邻椎骨的主体接合；将植入物在盘空间内近似旋转90°，使植入物的侧面与相邻的椎骨的主体接触，以便阻止植入物相对于椎骨旋转。
本发明还提供一种用于使相邻的椎骨对中的装置，该装置包括一个具有纵向过孔的细长手柄；一个植入物，其包括第一和第二并排设置的部件，且第一部件一体地安装在手柄上；和一个设在植入物上的装置，用以可选择地与相邻的椎骨接合，以便阻止第一和第二部件分别与相邻椎骨之间相对移动。心轴通过手柄上的过孔定位并与第二部件相连，使第二部件相对于第一部件在手柄的纵轴方向上移动。为了使第二部件能相对于第一部件精确地移动，并且能确定将相邻椎骨牵引至对中状态所需要的机械进给量，心轴最好是有螺纹的，同时手柄上的孔设有相匹配的螺纹，心轴这样的旋转可使第二部件沿手柄纵轴移动。
本发明还提供一种在切除在相邻椎骨之间椎间盘的一部分而构成盘空间之后对中该相邻椎骨的方法，该方法包括以下步骤：将一个细长的植入物插入盘空间，该植入物包括第一和第二并排设置的部件，其上形成有一个可选择地与相邻的盘空间接合的装置；使第二部件相对于第一部件移动，直到第一和第二部件近似地与相邻椎骨对中。将植入物大致旋转90°，使椎骨接合装置与椎骨接合，然后第二部件相对于第一部件移动，以便使之与椎骨对中，该椎骨与同第一部件相接合的那个椎骨对中。
现在参见附图。图1为插有本发明的椎间盘稳定器的局部人体脊柱和与植入物相邻的局部椎骨主体的侧向视图，图中用剖开和/或阴影线表示通过椎间盘稳定器使两个椎骨主体接合。
图2为图1所示椎间盘稳定器的分解透视图。
图3为由安装在其上的手柄代替了图2所示锁定装置的图1所示椎间盘稳定器的顶视图。
图4为本发明椎间盘稳定器的第二优选实施例的分解透视图。
图5为按照本发明构成的用来校正两相邻椎骨错位的装置的优选实施例的纵向局部剖视图。
图6为图5所示装置的端视图。
图7与图5相似，不同的是将心轴从装置上移去。
图8为图5所示装置的端视图。
图9为从图5所示装置中移去后的心轴的侧视图。
图10为图5所示心轴的端视图。
图11为腰部脊柱的局部侧向示意图，图中示出了用图5所示装置使第4和第5腰椎对中。
图12为图5所示装置的另一个实施例的顶视平面图，图中示出了主体的两半部分并排设置。
图13为图12所示装置的顶视平面图，图中示出了主体的两半个部分的第二位置。
更详细地说，图1示出了植入在人体的脊柱内的按照本发明教导构成的椎间盘稳定器。总体上用参考符号10表示的椎间盘稳定器植入到相邻的椎骨16和18的主体12和14之间的盘空间(未标参考符号)内。椎间盘20的一部分通过简单的椎间盘切除术(diskectomy)和小型椎板切开术(laminotomy)从上述盘空间处切除。
现在参见图2，椎间盘稳定器10包括一个细长的植入物22、锁定装置24和一个用来可拆卸地将锁定装置24安装在植入物22的一端25上的装置。在所示的这个优选实施例中，安装装置为一个穿过锁定装置24内孔28的螺栓26，该螺栓26的螺纹与在植入物22的一端25上的孔30内壁相配合螺纹啮合。
详细地说，植入物22包括第一和第二侧面32以及第三和第四侧面34，这四个侧面限定了植入物的截面为大致矩形的形状。矩形截面的高H由第一和第二侧面32间的距离限定，宽W由第三和第四侧面34间的距离限定，比较H和W可以清楚地看到，植入物22的高H比其宽W小。正如下面将要解释的那样，H应尽可能地小，以便有助于将植入物22的第二端36插入并放置在椎间盘20的一部分取出后留下的盘空间处，而为了能如所希望的那样稳定相邻椎骨16和18，W应尽可能地大。第三和第四侧面34从植入物22的一端到另一端为弧形，这样，植入物22的位于两端25和36之间的部分的宽度W′比两端25和36的宽度W″大。由于植入物22的第一和第二侧面32基本上为平的，而第三和第四侧面34从一端25到另一端36为弧形的，因此植入物22被描述为双平面、双凸面植入物。植入物22的双凸面34上设有正如下面将要描述那样的多个咬入相邻椎骨16和18的齿38。为了在插入盘空间时尽可能地减少损伤脊髓神经，而使植入物22的一端36为钝头或倒为圆角形。
在所示的优选实施例中，锁定装置24从端部40沿穿过孔28的轴方向上看基本上为方形，从侧面看锁定装置为U形的。U形锁定装置24的臂44的内表面42为平的，目的是当锁定装置24安装到植入物上并由螺栓26固定时，该内表面能与植入物22的第一和第二侧面32相接触，从而阻止锁定装置24相对于植入物22旋转。表面42上设有一个用来接纳形状相配合的开启装置48的槽46，该槽便于使锁定装置24组装到植入物22上。在各部分的功能不变的情况下，槽46也可以设在植入物22上，而开启装置48设在锁定装置24上。锁定装置24上的孔28与植入物22上的孔30对准。
锁定装置24的方形端40的侧面表面50靠在相邻椎骨16和18的主体12和14上，这在下面将要详细描述。对于从本发明公开的内容中获益的本领域技术人员来说不难理解，贴靠表面50不一定是平的，锁定装置24的端40也不一定是方形的。如果需要，也可以采用其它形状和结构来确保限制锁定装置24靠向相邻椎骨16和18的主体的移动。采用双平面、中间扩大、双凸面的植入物的目的是能使植入物22插入到盘空间，并能翻转近似90°，从而增加盘的高度和盘空间的稳定性。采用锁定装置24的目的是锁住处于垂直状态的植入物，防止不稳定，从而保持盘的高度。
现在参见图3，图中示出了一个安装在植入物22的一端25上的扣环起子(applicator)52。扣环起子52借助将其螺纹端部54拧入植入物22的螺纹孔30而安装在植入物22上。当扣环起子52的端部54一直拧入孔30中，以便阻止两者的相对移动时，植入物22被插入到盘空间并用扣环起子52使其转动，这将在后面解释。当植入物22的转动受到限制时，反方向旋转扣环起子，使之从植入物22上拆卸下来。
图1所示为例如用在腰部椎间盘稳定方法即“LIDS”中的本发明的稳定器10。按照一个简单的椎间盘切除的要求完成外科手术。然后通过小型椎板切开术暴露椎间盘20。切除椎间盘，解除所有对神经根部的压迫。切除背部纵向韧带(未示出)和椎间盘纤维软骨，直到相应的相邻椎骨16和18的主体12和14暴露在盘空间的上下。
采用如国际专利申请PCT/US95/00347公开的摊开器(spreaders)使椎骨16和18展开以开放盘空间，一旦达到所希望的“展开”状态，就用网状骨质的骨片(未示出)填充盘空间的中间部分。由于背部另一侧和盘空间中心的韧带未受损伤，因此骨片可保持在盘空间内。
接下来将经选择适配盘空间的具有高度H和宽度W的植入物22拧到扣环起子52的螺纹端54上。用扣环起子52将尺寸合适的植入物22插到盘空间内，植入物22的取向能使其顶部和底部，即第一和第二侧面32与相应的相邻椎骨16和18的主体12和14接合。接下来用扣环起子52使植入物22进一步向内(或向外)沿前-后方向移动进入盘空间内，这样使得当用扣环起子52旋转近似90°时，植入物22位于盘空间的位置为：植入物22的扩大的中间部分和第三和第四侧面34的宽度较小的两端25和36与相邻椎骨16和18的主体12和14的相对上和下表面接触。为了旋转方便，位于第一和第二表面32以及第三和第四表面34之间的植入物22的角部应倒圆，该角部用35表示。圆角35在旋转时的作用如平面或斜坡那样有效撬开相邻椎骨16和18。椎骨主体12和14的相应的上下表面有些向内凹，这样植入物22的较宽的中间部分W”使得植入物22能比通常的取代装置更多地与相应的椎骨主体12和14接合，这样使能为融合提供更强的稳定性，从而阻止如后面将要描述的植入物22的进一步旋转。
一旦植入物22放置在盘空间处，接下来将扣环起子拧松卸下并从病人的手术切口中取出。然后将锁定装置24通过同样的切口插入，并且借助于槽46和开启装置48使锁定装置24上的孔28与植入物22上的孔30对准，将螺栓26插入并牢固地将锁定装置24固定在植入物22上。用这种方式将锁定装置24固定在植入物22上可防止锁定装置24与植入物22之间的相对旋转，并且锁定装置24的支撑表面50支撑着相邻椎骨16和18的主体12和14可防止锁定装置24相对于支撑表面50支撑的相邻椎骨16和18旋转。支撑表面50支撑着相应的椎骨主体12和14的包括无网状骨质骨的外端板，该外端板提供一个坚硬的、相对光滑的表面。锁定装置24的一端40最好提供有多种不同的尺寸和形状，而不只是如图所示的方形端40，从而允许外科医生选择合适的尺寸和形状的锁定装置来适配椎骨主体之间的空间。
如果有必要，可以将少量本领域公知的生理相容的粘接剂只涂敷在与植入物中间部分相连的网状骨质的骨片上，以便封闭张开的盘空间的剩余部分。在LIDS处理中采用本发明的植入物固定脊柱后，病人不久就能行走。在盘空间变窄以前，网状骨质的骨片已开始融合。
稳定器10还能有效地用于完成背部外侧的横突间的融合中。用锁定装置24将植入物22插入如前所述椎间盘的一部分被切除后留下的盘空间内并使背部外侧发生融合。由于植入物22使脊柱保持稳定，直到背部外侧融合变固态为止，所以病人一般在外科手术后不久即可行走。该处理步骤也可以防止背部外侧融合中存在的共同问题，即盘空间变窄。
与传统的植入物相比，实现植入物22的移除要容易得多，将螺栓26从植入物22上拧出，将锁定装置24从盘空间抽出。再次插入扣环起子52并拧入植入物22的孔30中，将植入物22旋转近似90°，使具有最小高度的第一和第二侧面与相邻椎骨16和18的主体12和14接触，以便允许植入物22进行从盘空间离开的背侧方向上移动。
图4示出了本发明植入物的另一个实施例，其中植入物22′的第一和第二侧面32′基本上为平的，但与它们的纵轴不平行。植入物22′呈楔形，易于插入盘空间内，倒圆端36′减少了在插入盘空间时损伤脊髓神经的可能性。同样，比较植入物22′的宽度W′，W″和W可以看到，在植入物22′一端36′处的宽度W小于另一端25′处的宽度W″，W′和W两者的宽度都小于植入物22′的扩大的中间部分的宽度W″。在又一个提供阻止植入物22在盘空间内前后移动阻力的实施例(未示出)中的装置，设置在紧靠植入物22的一端25上的齿38(例如在植入物22的远端部分的齿)向端25倾斜，紧靠植入物22的另一端36上的齿38向端36倾斜。在植入物22的中间部分的齿，例如在两组倾斜齿之间的齿垂直取向。
现在参见图5至13，图中示出按照本发明教导构成的用来对中相邻椎骨的装置。整体用参考符号110表示的该装置包括一个细长的手柄111和一个细长的主体112组成。主体112包括第一和第二并排部件113和114，第一部件113整体地安在手柄111上，而第二部件114在手柄111的筒身115的纵向轴线方向上相对于第一部件113可以移动。在主体112上设有齿138状的装置，当主体12插入相邻椎骨133，137两者之间时，该装置用来有选择地与两椎骨接合，从而阻止第一部件113与同其接合的相邻的椎骨137之间和第二部件114与同其接合的相邻的椎骨133之间的相对运动。
手柄115的轴115设有一个贯穿的纵向孔116，孔内有一个心轴117，第二部件114安装在心轴117上。柱身115在与第一部件113的相对的另一端上设有一个管状圆筒118，在圆筒内有一个卡圈119。卡圈119上也设有一个纵向的孔116′，孔116′的纵轴与心轴117的纵轴线对准，且孔116′内设有一组用以接纳心轴117的螺纹端部121的螺纹120。保持器122借助螺钉123保持在圆筒118的一端，保持器122使卡圈119保持在圆筒118内。一个调节旋钮124借助螺钉126整个在安装圆筒118上。这样，由于具有这种结构，当通过拧调节旋钮124使心轴117旋转时，第二部件114相对于第一部件113从部件113和114处于相互之间并排平行的位置关系的第一位置沿手柄111的柱身115的纵轴移动到第二位置，此时两部件113和114仍互相平行，但如图11所示不再并排。参见图7至10，可以看到第一部件113的一个表面制成半圆形的凹槽127以接纳圆形的心轴117，从而当第二部件114从第一位置移动到第二位置时使两部件113和114保持紧密的、平行的且并排的位置关系。
当第一和第二部件113和114处于如图5和6所示的第一并排位置时，例如当心轴117旋转带动第二部件114的一端136靠向手柄111的一端154时，两部件113和114构成一个细长的主体112，该主体与图1至4所示的整体的植入物22相似，观察此时的主体可以看到，并排的两部件113和114构成的主体112由第一和第二侧面132以及第三和第四侧面134组成，其截面基本上为矩形。第一和第二侧面132限定了矩形截面的高H6，第三和第四侧面134限定了其宽度W6，比较H6和W6可以看到，主体112的高度H6比其宽度W6小。正如下面将要解释的，为了有利于第二端136的插入和主体112在椎间盘空间的定位而应使H6尽可能地小，该椎间盘空间是切除椎间盘130的一部分后留下的，而为了使相邻椎骨133和137获得所希望的稳定性而应使W6尽可能地大。第三和第四侧面134从主体的一端到另一端为弧形的，使得主体122位于端部125和136之间的中间部分的宽度W′6比端部125和136的宽度W″6大。由于主体112的侧面132基本上为平的，而侧面134从一端125到另一端136为弧形的，主体112被称成双面的、双凸面的主体。主体112的凸面或弧形面134上设有多个咬入相邻椎骨133和137的齿138，这正如后面将要更详细地解释那样。主体112的一端136为钝头或倒圆的，目的是为了在插入盘空间时能尽量减少损伤脊髓神经。
现在参见图11，图中示出了用于脊椎前移复位术的装置110的使用方式。在图11中，所示的第四腰椎(L4)133已向前旋转移位，该椎骨与第五腰椎(L5)137和包括骶骨135的椎骨未对中。为了校正这种错位，先进行一个简单的椎间盘切除术，然通过小型椎板切开术暴露椎间盘(未示出)。切除椎间盘物质，完全解除所有对神经根部的压迫。切除背部纵向韧带(未示出)和椎间盘纤维软骨，直到相应的相邻椎骨(L4和L5)的主体129和131暴露在盘空间的上下。
采用如国际专利申请PCT/US95/00347公开的摊开器使椎骨133和137展开，以便开放盘空间。接下来将具有第一和第二部件113和114(此时第一和第二部件呈上述并排位置关系)的装置110的主体112插入盘空间内，使其顶部和底部，即基本上为平的第一和第二侧面132与相邻椎骨133和137接合，以便使在主体112的第三和第四侧面134上形成的齿138伸入盘空间内而不与相邻椎骨133和137接合。当按如下所述旋转时，植入物在盘空间内的取向使得第一部件113作为主体112的一部分与L5 137的主体131接触，同时第二部件114与L4 133的主体129接触。换句话说，主体112的取向使得第一部件113位于紧靠与脊柱的轴即中心线CL对准的椎骨137的主体131定位，第二部件114紧靠没有对中的椎骨133的主体129的轴线定位。将装置110的主体112插入，直到第一部件113的中间部分部与L5 137的主体131的上表面的凹处邻接。然后使用调节旋钮124，使心轴117旋转向前推动第二部件114例如具有比较大的宽度W″6的部分，直到第二部件114例如具有比较大的宽度W″6的中间部分位于与L4 133的主体129的下表面的凹下相邻接的位置。如上所述，当主体112按下面将描述的那样旋转近似90°时，构成装置110的主体112的每个部件113和114的那个比较宽的中部部分W″6可以与椎骨的主体的凹形表面实现最大限定的接合。由于每个外科手术的情况不同，因此手术可能需要在将装置110的主体插入盘空间之前“预调节”主体112，即通过推动第二部件114一定的量，使之处于未对准位置。L4 133相对于L5 137的滑移量可由公知的方法计算出来和/或从X光片或其它图像中估算出来。
一旦通过把每个部件的较宽的中间部分放置在椎骨的相应的凹面处，使第一和第二部件113和114近似与每个相邻椎骨133和137对中后，就使用手柄111的圆筒18，使装置110的主体112旋转近似90°，使成形在第一和第二部件113和114上的齿138与相应的相邻椎骨133和137的主体129和121接合，这正如图11所示。接下来使用调节旋钮124，使心轴117朝相反方向旋转，将第二部件114向后拉向第一部件，并与第一部件113形成并排的、平行的关系，然后把接合在第一部件上的椎骨例如L4 133拉到与L5137对中的位置。
椎间盘切除术和椎板切开术最好是在两侧进行。换句话说，上面描述的外科手术是在相邻椎骨的中心线的一侧进行的，这样被切除的椎间盘的部分相对于相应的相邻椎骨133和137的主体129和131是“偏心”的。相同的外科手术在相邻椎骨的中心线的另一侧即第二侧进行，并使第二装置110(为了清楚的目的未示出)的主体112在第二步骤之后插入盘空间内。旋转两个装置110的相应的调节旋钮124使相邻椎骨133和137对中，直到所述的两个椎骨对中为止。通过这种方式可以使两个装置中的每一个的主体112即使在移去其它植入物后也仍能与相邻椎骨保持在对中状态。
旋转近似90°将主体112移开(最好是绕与齿138和相应的相邻椎骨133和137接合的方向相反的方向旋转)，这样使齿138不再与L4 133和L5 137接合。当第二装置的主体仍留在盘空间的中心线的第二侧时，将在扣环起子52的一端上的如图1至4所示的植入物22插入主体112从中移去的盘空间内并与相邻椎骨133和137的主体129和131邻接，前后移动植入物22，以便使植入物22处在下述状态下：当用扣环起子使植入物22旋转时，植入物22的张开的中间部分以及第三和第四侧面34的宽度较小的端部25和36与相应的相邻椎骨133和137的主体129和131的上下表面接触。
旋转之后，反拧扣环起子52，使之从植入物22上拆卸下来并从手术切口中抽出。接下来如前所述将锁定装置24穿过同样的切口插入，借助于凹槽46和开启装置48，使锁定装置24上的孔28与植入物22的孔30对准，插入螺栓26，牢固地将锁定装置24固定到植入物22上。一旦整体的植入物22被锁定在相邻椎骨133和137的中心线的第一侧位置后，就移去位于在整个步骤中保持在中心线的第二侧上的第二装置10的主体12。然后用网状骨质的骨片从第二侧填充盘空间，同时将第二个整体的植入物22(也未示出)以前述相同的方式插入、放置、旋转并锁定在其位置上。如果需要，可以采用少量的生理相容的公知的粘结剂涂敷在网状骨质的骨片上的刚好位于植入物的中间的部分上，以封闭通向盘空间开口的剩余部分。
现在参见图12和13，图中示出了本发明用于脊椎前移复位术的装置的另一个实施例，该装置总体上用参考标号110a来表示。在可能的地方，装置110a的元件部分用与装置110的相对应的部分相同的数字(和“a”标号)来标注。装置110a包括一个手柄111a和一个主体112a，主体112a由相应的第一(固定的)和第二(可移动的)部件113a和114a组成。第二部件114a通过一个转节140a安装在位于柱身115a的纵向孔116a内的心轴117a上，并通过位于心轴117a的外表面上的螺纹121a和位于手柄111a的柱身115a上的螺纹120的动作相对于第一部件113a移动。装置110a的主体112a的截面形状与装置110的主体112相同，都大致为矩形，装置110a的零部件的功能也与装置110的零部件的功能一样。
装置110a还包括多个在相应的第一和第二部件113a和114a的相对表面144a和146a上形成的精细的细齿142a。细齿142a的作用是阻止第二部件114a相对于第一部件113a纵向移动。

Claims (7)

1.一种椎骨盘稳定器，包括：
一个细长的立方形的植入物(22)，该植入物具有第一(32)、第二(32)、第三(34)、第四(34)、第五(25)和第六侧面(36)，所述六个侧面为所述植入物提供形状基本上为矩形的截面，第一和第二侧面限定了该矩形的最小高度(H)，第三和第四侧面限定了该矩形的最大宽度(W)，第三和第四侧面(34)从所述植入物的一端(25)到所述植入物的另一端(36)为弧形，从而使所述植入物的中间部分的宽度大于所述植入物的端部的宽度；其特征在于所述第一、第二侧面(32)和/或第五与第六侧面(25，36)中的一个限定了用来与一个上面形成有椎骨支撑表面(50)的锁定装置(24)接合的表面；
可拆卸地将所述锁定装置安装到所述植入物的一端的装置(26，28，30)，从而在使用中阻止所述锁定装置相对于所述植入物旋转。
2.如权利要求1所述的稳定器，其中所述植入物的第三和第四侧面(34)上设置有齿(38)。
3.如权利要求1所述的稳定器，其中所述锁定装置上有一个平坦表面(42)，该表面与所述植入物的第一或第二侧面(32)接触，以便阻止所述锁定装置相对于所述植入物旋转。
4.如权利要求1所述的稳定器，其中位于第一、第二、第三和第四侧面之间的所述植入物的各角(35)被倒圆。
5.如权利要求1所述的稳定器，其中所述植入物的与安装锁定装置的端相对的另一端(36)被倒圆。
6.如权利要求1所述的稳定器，其中当该支撑表面(50)固定到所述植入物上时，所述支撑表面(50)相对所述植入物的第一和第二侧面取向成一个近似90°的角。
7.如权利要求1-6中任一项所述的稳定器，还包括一个可拆卸地安装在所述植入物(22)上的扣环起子(52)。
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DE69623616D1 (de) 2002-10-17
WO1996040016A3 (en) 1997-02-13
EP0830116B1 (en) 2002-09-11
JPH11510405A (ja) 1999-09-14
US5653762A (en) 1997-08-05
WO1996040016A2 (en) 1996-12-19
AU6090096A (en) 1996-12-30
CN1192669A (zh) 1998-09-09
ES2182985T3 (es) 2003-03-16
MX9709599A (es) 1998-10-31
CA2222025A1 (en) 1996-12-19
CA2222025C (en) 2007-11-27
EP0830116A2 (en) 1998-03-25
JP3761196B2 (ja) 2006-03-29

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