CN1784181A - 动态固位装置和带有这种固位装置的、用于骨特别是用于椎骨的动态稳定装置 - Google Patents

动态固位装置和带有这种固位装置的、用于骨特别是用于椎骨的动态稳定装置 Download PDF

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CN1784181A
CN1784181A CNA2004800120309A CN200480012030A CN1784181A CN 1784181 A CN1784181 A CN 1784181A CN A2004800120309 A CNA2004800120309 A CN A2004800120309A CN 200480012030 A CN200480012030 A CN 200480012030A CN 1784181 A CN1784181 A CN 1784181A
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head
pressure piece
fixing device
described dynamic
rod
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CN100486537C (zh
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J·哈姆斯
L·比德尔曼
H·拉普
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Biedermann Technologies GmbH and Co KG
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A61B17/7038Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other to a different extent in different directions, e.g. within one plane only
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74Devices for the head or neck or trochanter of the femur
    • A61B17/742Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/746Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to a plate opposite the femoral head
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86Pins or screws or threaded wires; nuts therefor
    • A61B17/8605Heads, i.e. proximal ends projecting from bone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002Longitudinal elements, e.g. rods
    • A61B17/7004Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7008Longitudinal elements, e.g. rods with a cross-section which varies along its length with parts of, or attached to, the longitudinal elements, bearing against an outside of the screw or hook heads, e.g. nuts on threaded rods
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7032Screws or hooks with U-shaped head or back through which longitudinal rods pass

Abstract

提供一种动态固位装置(1),其包括一个具有一杆(3)用以在骨或者椎骨中固位的部件(2),还包括一个与所述杆(3)连接的头(4)以及一个用于它的接纳件(5)和一个作用于所述头(4)的压力件(20),其中,所述压力件(20)弹性地构成,使其在所述部件(2)运动时对头(4)施加一个反向传动的力。此外,提供一种特别是用于椎骨的动态稳定装置,它包括一个棒(100)和两个与该棒连接的固位装置,其中,至少一个固位装置动态构成。

Description

动态固位装置和带有这种固位装 置的、用于骨特别是用于椎骨的动态稳定装置
技术领域
本发明涉及一种动态固位装置和一种带有这种固位装置的、用于骨特别是用于椎骨的动态稳定装置。
背景技术
处理椎间盘缺损的公知方法是手术取出缺损的椎间盘并利用两个相邻的椎骨体使椎间盘空隙骨质加强。在这种方法中,脊柱的邻接受到加强的脊柱节的段特别是在椎间盘的区域内负担过重。另一种处理方法是取出缺损的椎间盘并随后装入一个人工椎间盘。因为在大多数情况下后小面关节和韧带组织受到严重损害,所以通常不再能由人工椎间盘从后面进行自然的运动控制。因此高的剪力和扭力对所处理的脊柱节产生磨损作用。
DE 42 39 715 C2公开了一种用于稳定椎骨的固定系统,其中可以降低作用到在骨中定位的部件上的旋转和压力/拉力-交替负荷。但不能进行弹性减振或者产生运动的运动导向。
EP 0 669 109 B1公开了一种用于稳定相邻胸椎的装置,利用该装置可以从后面部分减轻受损椎间盘和椎间关节的负担。该装置具有两个椎弓根螺钉,它们各自与一个由弹性塑料组成的带固定连接并通过该预张力的带相互连接。此外为传递压力,在两个螺钉头之间还有一个套在弹性带上的耐压体。然而,使用这种带有耐压体的纺织带不能使脊柱的运动节产生多轴的导向稳定性。
US 5,474,555公开了一种多轴骨螺钉,带有一个螺钉件和一个与其连接的用于一根棒的接纳件,其允许接纳件和椎骨之间进行有限的运动。但利用这种螺钉不能实现运动的弹性减振。
US 5,961,356公开了一种多轴骨螺钉方式的固位件,其中,作用于头的压力件包括一个作用到内置棒上的弹簧件。
发明内容
本发明的目的在于提供一种固位装置,它可以将例如像棒这种机械装置动态固定在骨或者椎骨上,特别是它可以在用于人工椎间盘的稳定运动导向和减负的动态稳定装置上使用。此外,本发明的目的还在于提供一种用于骨特别是用于椎骨的动态稳定装置,它可以从后面进行人的椎间盘的运动控制和减负。
该目的通过权利要求1的固位装置或通过权利要求17的动态稳定装置得以实现。本发明的进一步构成在从属权利要求中给出。
附图说明
本发明的其他特征来自于借助附图对实施例的说明。其中:
图1示出固位装置第一实施方式在无负荷状态下的局部剖视图;
图2示出图1的固位装置在负荷状态下静止时的局部剖视图;
图3示出图1的固位装置在力作用于固位件时在负荷状态下的局部剖视图;
图4示出图1-3所示固位件实施方式的压力件的第二实施方式的示意图;
图5a示出固位件第二实施方式的局部剖视图;
图5b-5e示出用于制造第二实施方式的一种变型方案的螺钉件的制造步骤;
图6示出固位件第三实施方式的剖视图;
图7示出动态稳定装置第一实施方式的示意图;
图8示出在第一应用情况下动态稳定装置第二实施方式的示意图;
图9示出在第二应用情况下动态稳定装置第二实施方式的示意图;
图10a-c示出动态固位装置另一实施方式的剖视图;以及
图11示出动态固位装置另一实施方式在无负荷状态下的剖视图;
图12示出在负荷状态下图11所示的实施方式;以及
图13示出图11和12所示实施方式的作用方式示意图。
具体实施方式
正如特别是从图1-3中可看到的那样,动态固位装置1构成为多轴螺钉。该装置具有一个带有螺杆件3和与其整体构造的头4的螺钉件2以及一个接纳件5。头4基本上球缺形构成并在其与杆件3相对置的末端上具有一个扩展边或凸缘6,从而形成一个平的端面7,其直径大于头的球缺形段的直径。此外,端面7上形成一个用于与旋入工具嵌接的间隙(凹槽)。
接纳件5基本上构成为圆柱体对称的结构并在其一端上具有一个轴对称定向的第一孔10,该孔的直径大于杆3的螺纹段直径并小于头4的球缺形段的球直径。还具有一个同轴的第二孔11,它在与第一孔10相对置的末端上敞开,而且其直径的大小使螺钉件2可以通过敞开的末端利用其螺纹段穿过第一孔10并利用头4的球缺形段一直通到第二孔的底部。与第一孔10邻接,在接纳件上具有一个空心球缺形段12,其半径基本上等于头4的球缺形段的半径。此外,接纳件还具有一个从敞开的末端向第一孔10延伸的U形间隙13,该U形间隙的底部对着第一孔10并通过两个自由的翼边14形成,图中仅示出其中的一个。与翼边14的自由端邻接,在接纳件内构成一内螺纹15。U形间隙13的宽度略大于一根要装在其内的、连接多个这种多轴螺钉的棒100的直径。U形间隙的深度尺寸这样确定,使其在置入棒的情况下在翼边之间可以旋入一个定位螺钉16。
接纳件的球缺形段12优选表面抛光或者利用一种提高滑动性的材料进行涂层,从而可使头4在接纳件的球缺形段内易于回转。作为选择或者补充,头4表面抛光或者涂层。
在置入的棒100和螺钉件的头4之间具有一个压力件20。压力件20以圆柱形构成,其直径小于接纳件的第二孔11的内径并优选等于头的端面7的直径。压力件20的轴向长度略大于或者等于头4的端面7在装入状态下与U形间隙13底部的距离。压力件是弹性的,在所示的实施例中其由弹性体构成。
在压力件20和装入的棒100之间还具有一个在面朝棒的那侧覆盖压力件的盖21,它由刚性材料例如由塑料或者适宜人体的金属构成。盖21的外径尺寸这样确定,使盖在接纳件的第二孔内可滑动移动,而且在压力件20处于无负荷状态的情况下盖的内径基本上相当于压力件20的外径。盖恰恰在这种程度上搭接压力件,即,使压力件在负荷下可以在径向上延伸。
图1示出无负荷状态,其中,螺钉件2、压力件20和盖21插入接纳件内并且棒100装入U形间隙13内,但内部螺钉尚未拧紧。在这种状态下,盖21远离压力件20的那侧22处于略高于U形间隙13底部的位置上,从而棒以其底面置放于盖的上表面22上并因此在棒的底面和U形间隙13的底部之间形成一个间隙23。
在如图1所示的操作时,首先将螺钉件2从接纳件5的敞开端插入接纳件中直至头紧贴在接纳件的球缺形段12上。然后将螺钉件旋入椎骨内。接着将压力件20与上面安装的盖21共同装入接纳件内,将接纳件定向校准并装入棒。最后将内螺钉16旋入接纳件。
如图2所示,将内螺钉这样旋入,直至它将棒压向U形间隙的底部并因此将其定位。棒由此压在盖21上,盖用于将由棒施加的压力均匀地分布到压力件的整个表面上。由于压力件的弹性,该压力件通过棒施加的力被预压缩。压力件在此方面形成图2所示的径向向外凸起的形状。在图2所示的状态下,压力件20处于相对于螺钉头4预力作用下并由于反向传动力以其底面均匀地压到头的端面7上。因此头被压向接纳件的球缺形段12。
通过脊柱的自身运动,旋入椎骨体内的螺钉件2从其静止位置中移动出来。在椎骨向棒方向与棒轴线成90°角度运动时,产生压力件的均匀压缩,此时杆与接纳件的角度保持不变。如图3所示,在椎骨与棒轴线成非90°的角度运动时,产生头的回转,头很容易地在接纳件的球缺形段12内滑动。由此螺钉头的端面7在一侧向压力件施加压缩力,此压缩力将其单侧在边缘附近压缩。而在相对置的那侧,处于预力下的压力件由于压力降低而膨胀。因比压力件始终保持与螺钉头接触。
由于压力件的弹性,通过压缩向螺钉头上形成一种反向传动的力。因此椎骨返回到其由外科医师定位的原始位置的运动得到支持。
通过选择具有所要求压缩性的压力件的弹性体材料,可以调整椎骨的运动极限。如果该材料仅有很低的可压缩性,那么该装置仅从静止位置少量偏移。如果该材料具有很强的可压缩性,那么可以扩大偏转范围。作为弹性体材料可以使用例如聚氨酯或者聚硅氧烷这种适宜人体的弹性体。
通过相对于接纳件第二孔的直径选择螺钉头凸缘6的直径,也可以或者额外地调整回转范围。如果凸缘6在螺钉头2所回转的位置上触到接纳件的壁,那么就不能再继续回转。
图4示出依据第二实施方式的压力件25。压力件25具有一个罐形结构的外壳,由一个底部26和一个如盖一样封闭底部的上部27组成。内部设置至少两个彼此对置的、但最好四个或者多个在周向均匀地彼此间隔开的螺旋弹簧28,它们利用其一端与底部并利用其另一端与上部连接。螺旋弹簧28设置在外壳壁的附近,因为如从图3所看到的那样,压缩力在压力件的边缘大于中心。螺旋弹簧的强度这样选择,使其通过螺钉头可以取得所希望的或者所要求的压缩。
如果固位装置具有依据第二实施方式的压力件,那么不需要在第一实施方式中所介绍的盖21,因为压力件的上面由刚性材料组成。
其操作与第一实施方式相同地进行。为防止压力件25在接纳件内侧向移动,在另一种变型方案中,压力件的直径仅略小于接纳件的第二孔11的直径。
在另一种实施方式中,压力件本身作为螺旋弹簧构成。螺旋弹簧的直径则相当于第二实施方式的罐形外壳的直径。也可以是例如一个或者多个盘形弹簧这样的其他弹簧。
在另一种实施方式中,在第一实施方式的由弹性体构成的压力件20中,具有与图4相同或者类似设置的螺旋弹簧,它们在制造压力件时被同时铸入。这些弹簧有助于弹性体的弹性特性。
在第一实施方式的一种变型方案中,压力件20和盖21预安装在接纳件5内并通过例如接纳件内所设的弯鼓孔(Krpfbohrung)和压力件内与其对应的沉孔防止脱落。在这种情况下,压力件20和盖21具有一同轴的中心孔,螺钉工具可以从中穿过,以便将螺钉件2旋入骨内。如果压力件和盖不预安装的话也可以设置该孔。
在另一种实施方式中,压力件这样构成,使其面朝盖21和/或者头的端面7的那面向压力件的内部成凹面弯拱。这样,在与盖的和/或者螺钉头的平面的共同作用下可以提高边缘上的压缩弹性。
在另一种变型方案中,头没有凸缘,而是如图6所示例如半圆形地构成,从而该端面具有螺钉头的最大直径。重要的是,为与压力件共同作用,存在一个保证边缘上力传递的足够大的端面。
在图5a所示的固位装置的第二实施方式中,螺钉件2′相对于接纳件5的静止位置与接纳件的中轴线M成一个不同于0°的角度α。在这种情况下,螺钉件2′为两部分式的结构。它包括一个头40和一个可与其连接的螺杆30。螺杆30在其一端上具有一个无螺纹的段31。此外在该端端面具有一个用于与螺钉工具嵌接的间隙(凹槽)32。如第一实施方式中那样,头40包括一个球缺形段和一个在远离杆的那侧上与其连接的凸缘41,它具有一个用于与压力件共同作用的端面42。头40在远离端面的那侧具有一个与头的对称轴线成一预先规定的角度α延伸的孔43。孔的直径等于杆30的无螺纹段31的外径,从而杆可摩擦锁合地插入孔内。为提高对插入的杆的夹紧作用,头在其壁上可具有未示出的缝隙,从而孔有一个弹性边。
或者,在孔43内具有一内螺纹并在杆段31上具有与之配合的外螺纹,从而杆可旋入头内。
固位装置的其他部件如图1-3的实施例或其变型方案。
操作时,首先将杆30旋入椎骨内,然后将接纳件5利用其第一孔10倾斜装到杆30上或装到凸出的无螺纹段31上,然后将头40连同压力件和需要时的盖在预压缩状态下利用适当的工具插入接纳件内并利用孔43推到杆上。杆30的纵轴线因此与头40的中轴线并因此与接纳件5的中轴线具有一个预定的角度α。接着装入棒并最后如第一实施方式中那样将所有部件通过内螺钉16定位。如第一实施方式中那样,在椎骨运动时反向传动的力使头重新回压到其静止位置内。虽然角位置通过孔43的角度预先规定,但是外科医师仍可以通过将接纳件绕其轴线转动或者将头略微回转再进行调整。
在第二实施方式的另一种变型方案中,头与杆整体构成,但构成弹性压力件的支承面的头的端面与杆轴线成一个角度。图5b-5e示出这种螺钉件200的制造步骤。螺钉件200具有一个螺杆300和一个与其整体连接的球缺形头400。该头如图5b所示这样铣削,使端面700与杆轴线具有一个预先规定的角度。接着如图5c所示,制造带有与端面700垂直的内螺纹的孔701。如图5c所示,在该孔内旋入一个带有凸缘形头和带有头上用于以后旋入骨内的间隙601的螺钉600,其中,凸缘的直径大于头400的直径。然后将图5e所示加工好的螺钉件200装入接纳件内。
操作时,将螺钉件200装入接纳件内并随后旋入骨内。通过与杆轴线成预先规定的角度分布的面700,螺钉件200在静止位置上与接纳件具有预先规定的角度。压力件和棒的装入如前所述方式进行。
凸缘也可以与螺钉件整体构成。
在图10a-10c所示第二实施方式的另一种变型方案中,接纳件5本身不具有其上紧贴着头的球缺形段,而是在接纳件内具有一个由弹性体构成的插入件500,它有圆柱体形的外壁并从第一孔10开始侧面包围球缺形段,或者如图10a所示为环形结构并仅具有一个用于螺钉头的接触面501。此外具有一个压在头4上的刚性压力件502。压力件502具有一个与螺钉头配合的球缺形间隙。操作时,在将螺钉2和接纳件5彼此校正后将螺钉头4通过定位螺钉16和压力件502以所要求的角位置压向插入件,该插入件与此同时如图10b所示因为很容易压缩而处于预力作用下。该位置形成静止位置。在椎骨运动时螺钉头压向插入件500,从而可以使螺钉头在该位置上变形并且与此同时如图10c所示螺钉从静止位置偏移。同时,所产生的反向传动力将头重新压入其静止位置。在该实施方式中,所要求的角位置可以从螺钉杆向相应构成静止位置的接纳件自由调整。
在另一种变型方案中压力件楔形构成。
在图6所示的第三实施方式中,固位装置这样构成,使头和棒可以独立承受负荷。为此与第一实施方式的区别在于,压力件50具有一个第一弹性段51和一个与其邻接的第二刚性段52,它们相互固定连接,第二段具有一个U形间隙53,其尺寸这样确定,使棒100可以装入其中。压力件的U形间隙沿圆柱体轴线方向看大于棒的直径。由此,U形间隙所形成的自由翼边54、55在装入棒的情况下从该棒凸出。此外,设置一螺母或套管式的封闭件56,该封闭件具有与接纳件的内螺纹共同作用的外螺纹57和内螺纹58。在封闭件56内具有一个内螺钉59。
操作时,通过封闭件56将施加到刚性压力件部分52和弹性压力件部分51上的力因此施加到螺钉头上。棒与此无关地通过内螺钉59定位。如果希望的话,棒也可以保持移动。在这种情况下,将内螺钉仅这样多地旋入,即,使棒仍可在接纳件的U形间隙内滑动。
压力件50在段51和52相互固定连接的所示实施方式中整体式构成。在一种变型方案中,它由两部分构成并由依据图1实施方式的一个弹性件51和一个具有U形间隙的非弹性件52组成。
图7示出一种按第一实施方式的用于椎骨的动态稳定装置。该装置特别是可在这种情况下使用,即去除一个椎间盘或者一个椎骨,并通过一个刚性的融合件60替代,该融合件例如是壁上带有开口的管形植入物并例如利用可以使骨生长的骨物质填充。
该稳定装置在后侧区域内具有两个通过一刚性棒100相互连接的动态骨固位装置1、1′。每个骨固位装置1、1′按照前述实施方式之一构成。通过压力件的弹性设计和由此相关的减振作用,形成了对前融合件60的间歇性限制负荷,从而造成骨加速向融合件内并环绕融合件生长。因此加速了愈合过程。
图8示出一种按第二实施方式的用于椎骨的动态稳定装置。该装置特别是可在这种情况下使用,即去除一个椎间盘并通过一个椎间盘假体61替代。该稳定装置包括两个通过一刚性棒100相互连接的动态固位装置101、101′。至少一个固位装置101、101′按照图6所示的实施方式构成,其特征在于,通过压力件50,压力这样施加到螺钉头上,使棒可在轴向上移动。稳定装置还包括一个在棒上的两个固位装置之间设置的弹簧件102以及至少一个棒上的挡块103,它设置在棒100在其中滑动地保持的那个固位装置的与弹簧件102相对置的那侧上。在图8所示的实施例中设置两个这样的挡块,而且棒滑动地保持在两个固位装置101、101′中。弹簧102在预力下装入固位装置之间并因此起到伸长弹簧的作用。
操作时,棒100的后侧纵向弹性与固位装置101、101′的多轴减振的组合可以实现运动控制并减轻椎间盘假体的负担。该稳定装置对于任何人工椎间盘结构均可使用。
图9示出图8所示稳定装置的另一种应用,该装置在后侧区域内包括伸长弹簧棒和上述多轴减振螺钉形式的动态固位装置。在这种应用情况下,人体的椎间盘受到一定程度损伤,它在减轻负担的情况下可重新恢复。稳定装置在此方面减轻人体椎间盘的负担并同时限制运动范围,从而不会出现继续损伤椎间盘的过激运动并可以使椎间盘在例如夜间或者平躺时的静止阶段得到痊愈。
图11-13介绍了本发明的另一种实施方式。与图1-3实施方式中所示部件相应的部件具有相同的附图标记。依据图11,在该实施方式中,除了设置在棒和头之间的弹性压力件20,还具有一个第二弹性压力件600。该第二压力件600环形构成并这样设置,使其在凸缘6与球缺形段邻接的部位上包括螺钉头。在所示的实施例中,第二压力件600作为O形环构成。压力件的直径及其环直径这样确定尺寸,使图11所示在无负荷状态下装入接纳件5内的环接触头的外侧和接纳件的内壁。第二压力件600宜在螺钉件装入接纳件时已经安装在螺钉头上。
操作时,压力件600在图12中所示的棒定位的负荷状态下变形。通过变形时产生的压缩,在螺钉头的方向上产生一预力。依据图13,在螺钉件2从其静止位置运动出来时第一压力件20产生一个由箭头F1表示的从上面反向传动作用于螺钉头端面7的力,而第二压力件600产生一个由箭头F2表示的从端面7下面的侧面并与力F1对角偏置的反向传动作用于螺钉头的力。如通过图13中箭头A所示,作用于螺钉头的使其重新进入起始位置的复位力因此通过所述第二压力件600得以提高。此外,第二压力件600降低了第一压力件20的磨损。
通过选择彼此可以不同的第一压力件20和第二压力件600的材料,可以对减振进行所要求的调整。例如,第一压力件由比第二压力件更硬或更重的可压缩材料构成。
在该实施方式的一种变型方案中,第二压力件600不是构造为O形环,而是构造为成型环。
本发明并不局限于所介绍的实施方式。单个实施方式的部件可与其他实施方式的部件进行组合。特别是本发明也不局限于多轴螺钉,而是作为固位部件也可以设置一种取代螺纹杆的钩。此外,接纳件也可以这样设计,使螺钉可以从下面插入接纳件内。在这种情况下,设置一成型环作为螺钉头的支座。

Claims (18)

1.一种动态固位装置,其包括一个具有一杆(3、30、300)用以在骨或者椎骨中固位的部件(2、2′、2″、200),还包括一个与所述杆(3、30)连接的头(4、40、400)以及一个用于它的接纳件(5)和一个作用于所述头的压力件(20、25、50),其特征在于,所述压力件(20、25、50)弹性地构成,使其在所述部件(2、2′、2″、200)运动时对头(4、40)施加一个反向传动的力。
2.按权利要求1所述的动态固位装置,其特征在于,压力件(20、25、50)作用于头(4、40)的远离杆(3、30)的那侧上。
3.按权利要求1或2所述的动态固位装置,其特征在于,压力件(20、51)由一种弹性体构成。
4.按权利要求1或2所述的动态固位装置,其特征在于,压力件(25)具有至少一个弹簧件(28)。
5.按权利要求1-4之一所述的动态固位装置,其特征在于,头(4、40)在其远离杆(3、30)的那侧具有一个平面(7、42),而压力件(20、25、50)则具有一个与该面共同作用的平面。
6.按权利要求5所述的动态固位装置,其特征在于,头(4、40)在其远离杆的末端上具有一个扩展边(6、41)。
7.按权利要求1-6之一所述的动态固位装置,其特征在于,接纳件(5)具有一个用于头(4、40)的接触面(12),而且接触面和/或头为减少摩擦而进行抛光或者涂层。
8.按权利要求1-7之一所述的动态固位装置,其特征在于,压力件(20)的在装入接纳件(5)内的状态下远离头(4、40)的那侧设有一个刚性的中间件(21)。
9.按权利要求1-8之一所述的动态固位装置,其特征在于,头(40)和杆(30)作为单独的部件构成,而杆(30)可以在与头的中心轴线成一预先规定的角度α的情况下与头相连接。
10.按权利要求1-9之一所述的动态固位装置,其特征在于,压力件(5)以圆柱形构成并具有一个第一弹性段(51)和一个与其邻接的带有一U形间隙(53)的第二刚性段(52),通过它形成两个自由的翼边(54、55),其中,U形间隙(53)的深度大于置入接纳件内的棒(100)的直径。
11.按权利要求10所述的动态固位装置,其特征在于,压力件(50)由两部分构成,其中,一部分通过弹性段(51)构成,而另一部分则通过带有U形间隙的刚性段(52)构成。
12.按权利要求1-11之一所述的动态固位装置,其特征在于,压力件设计为装入接纳件内的由弹性体构成的插入件,它具有一个用于在负荷状态下贴靠螺钉头的接触面。
13.按权利要求12所述的动态固位装置,其特征在于,插入件环形构成并包围所述螺钉头。
14.按权利要求1-13之一所述的动态固位装置,其特征在于,所述压力件(20、25、50)为第一压力件,并设置一个环形包围螺钉头的第二弹性压力件(600)。
15.按权利要求14所述的动态固位装置,其特征在于,第二压力件构造为O形环或者成型环。
16.按权利要求1-15之一所述的动态固位装置,其特征在于,接纳件具有一个用于放入一根棒的U形间隙,而且压力件(2、25、50)设置在头和棒之间并这样设计,使其在棒放置于U形间隙的底部中时通过所放入的棒的压力被预压缩。
17.一种用于骨特别是用于椎骨的动态稳定装置,其包括至少两个与一根棒(100)连接的固位装置(1、1′;101、101′),其特征在于,其中至少一个固位装置(1、1′;101、101′)为按权利要求1-16之一所述的动态固位装置。
18.按权利要求17所述的动态稳定装置,其特征在于,在棒上在各固位装置(101、101′)之间设置一个弹簧件(102)。
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US8562652B2 (en) 2013-10-22
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US20140066986A1 (en) 2014-03-06

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