CN1909849A - 具有多功能钻子引导器的板系统 - Google Patents
具有多功能钻子引导器的板系统 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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- 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
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
- A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread
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- A—HUMAN NECESSITIES
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- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
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- 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
- A61B17/72—Intramedullary pins, nails or other devices
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- 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
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
Abstract
提供了一种骨固定系统,其包括骨板和外科钻子引导器。钻子引导器组件包括一个或多个对准钻子管子,其远程地对准骨板内的相应紧固件孔,并包括接合骨板内的孔的板保持器。该外科钻子引导器可释放地锁定在板保持器上。
Description
技术领域
本发明涉及骨固定系统,其包括彼此可释放地接附的板和外科钻子引导器,以提供两者之间的精确对准。更具体说,本发明涉及骨板和板保持器以及外科钻子引导器组件,该骨板具有相对于板以预定角度定向的紧固件孔,该组件具有至少一个对准骨板上相应紧固件孔的对准钻子引导筒,以便以适当的角度钻孔。
背景技术
在多种整形外科应用中使用外科固定板是广为接受的。外科医生使用的板用于修正、对准和改变病人骨的压力,并且通常利用多个紧固件固定到骨上,紧固件如螺钉,其通过板上的孔来安装。紧固件的适当定向和对准以及板可靠的外科固定是有利的,以在移植后避免将来的并发症。
必须特别小心地安装在脊柱应用中使用的骨板,因为板在脊柱颈区用于长期的椎间固定、骨碎片固定和前部减压。脊柱手术的误差余地非常小,尤其因为脊髓的敏感性和脊髓周围介入过程所固有的风险。特别是,可用来安置紧固件的脊椎骨的尺寸相当有限。
每个固定紧固件应当和与其相关的板孔适当对准,以便每个螺钉正确地固定于板上并且以合适的角度进入骨。螺钉在板孔内的任何未对准具有损害组织的危险。此外,不适当固定的螺钉可导致板与骨材料的不稳定或不可靠的连接,这样潜在地使板的有用性失效了。特别是,锁定板要求精确的紧固件对准。
发明内容
本发明涉及骨板、外科钻子引导器组件,该组件包括至少一个对准钻子管子,其构造来接收和引导外科钻头;并涉及板保持器,其与板和钻子引导器组件相结合。钻子引导器组件构造并确定尺寸为允许其结合板保持器和板,以在对准钻子管子和骨板之间提供固定的尺寸和角度对准。
骨板具有两对或多对固定孔,并且沿板的中心纵轴线可具有一个或多个狭槽。固定孔优选地为圆锥形的,并且优选地具有螺纹。与骨板一起使用的接骨螺钉优选地具有有螺纹或无螺纹的圆锥形头部,以便与骨板内的固定孔匹配。骨板内的固定孔可以朝向骨板中心轴线成角度直至约10°,也可以沿着骨板纵轴线的方向向上或向下成角度直至约15°的角度,该纵轴线通常对准脊柱的长度方向。狭槽可以有螺纹,或者在其端部具有扩孔,以允许结合钻子引导器组件或板保持器。骨板可具有任何厚度,并且其厚度可以沿着其长度和宽度而变化,虽然示范性的厚度为2.2mm。该板也可以具有梯级特征部或凸缘,以有助于在骶骨岬上安置该板。
板保持器可包括具有圆形截面的杆,其具有结合板内的螺纹孔的短的螺纹部分,在与螺纹端部相反的端部具有短的非圆形部分,例如如六边形部分,并在两个端部之间具有径向凹槽。板保持器接附于板上,并允许用户从远离板的位置并且不接触板来操作该板。
钻子引导器组件优选地包括手柄构件、偏移手柄柄杆、外柄杆、外柄杆上的释放套筒、用来接合板保持器杆的径向凹槽的位于外柄杆壁内的捕获滚珠棘爪、及释放套筒弹簧,该弹簧在轴向偏压释放套筒,使其远离与骨板相对的外柄杆的端部。释放套筒优选地捕获地接附于外柄杆上,使其可绕着外柄杆旋转,并相对于外柄杆具有有限的轴向移动。由于释放套筒锥形的内表面或释放套筒内直径增大的部分,逆着弹簧的偏压来按压释放套筒,允许外柄杆壁内的捕获滚珠棘爪发生径向移动。
通过在板保持器上滑动钻子引导器组件的外柄杆,并且将板保持器的非圆形端部与钻子引导器组件的外柄杆端部匹配的非圆形孔对准,来完成钻子引导器组件与板保持器的结合。当允许释放套筒返回至其弹簧偏压的位置时,捕获滚珠棘爪接合板保持器的径向凹槽,且将钻子引导器组件锁定在板保持器上。释放套筒可具有非圆形孔,其周边接合板保持器的匹配非圆形端部的周边。释放套筒能够相对于外柄杆旋转,以允许将板保持器拧上和拧下骨板,而钻子引导器组件其余部分保持静止。虽然钻子引导器组件和板保持器之间的连接被描述为与杆同轴线并且在杆上滑动的柄杆,其他实施例是可能的,例如包括具有接附于板保持器侧面的柄杆的钻子引导器组件。
钻子引导器组件可包括一个或两个引导筒,以允许固定销或接骨螺钉、钻子、丝锥及锥子以预定轨线通过筒。引导筒可具有多于一个插入位置,带有从单一出口位置偏移的可变的或预定的轨线。利用枢转机构,钻子引导器的单筒实施例的引导筒可以是可移动的,以允许在骨板纵轴线两侧钻孔入骨内。钻子引导器组件的双筒实施例的引导筒也优选地具有接头片,以接合骨板的狭槽,从而防止钻子引导器组件相对于骨板旋转。钻子引导器组件的单筒实施例在外柄杆上也优选地具有接头片,以接合骨板的狭槽,从而防止钻子引导器组件相对于骨板旋转。
钻子引导器组件的手柄可具有棘轮齿轮机构,其允许相对于按钮凸轮的轴线进行递增的转动。通过在转动手柄时按压并保持按钮凸轮,来操作该棘轮。手柄可以以预定的角度间隔来锁定。
附图说明
在附图中披露了本发明的优选特征,其中类似的参考字符在几个视图中都代表类似的元件,其中:
图1是双筒钻子引导器组件、板保持器及骨板的透视图;
图2是图1中骨板的顶视图;
图3是图1中骨板的侧视图;
图4是沿图2中的线IV-IV截取的图1中骨板的截面图,带有接骨螺钉;
图5是骨板替代实施例的侧视图;
图6是沿图5中的线VI-VI截取的图5中骨板替代实施例的截面图,带有接骨螺钉;
图7是与图2至图6中骨板一起使用的接骨螺钉的透视图;
图8是图1中双筒钻子引导器组件的透视分解图;
图8a是图8中显示的双筒钻子引导器组件的手柄构件下侧的详图;
图9是单筒钻子引导器组件的透视分解图;
图9a是图9中显示的单筒钻子引导器组件的手柄构件下侧的详图;
图9b是图9中显示的单筒钻子引导器组件的弯曲轴容纳凹槽的详图;
图10是单筒钻子引导器组件的透视图;
图11是单筒钻子引导器组件的替代实施例的透视图;以及
图12是图11中显示的单筒钻子引导器组件替代实施例的钻子引导筒和外柄杆之间的铰链连接的详图。
具体实施方式
参考图1,显示了示范性的双筒钻子引导器组件100和板保持器140,其适合与有狭槽的脊柱颈段的锁定骨板160一起使用。虽然作为用于脊柱颈区的颈部板显示并描述了骨板、板保持器和钻子引导器组件,但应当理解:该骨板特征部适用于其他骨板,并且钻子引导器组件和板保持器也可与其他骨板一起使用。组件100包括手柄构件106、偏移手柄柄杆110、释放套筒120、外柄杆126和钻子引导筒130a与130b。通过按压并保持按钮凸轮108,钻子引导器组件100的手柄构件106能够递增地转动。释放按钮凸轮108将手柄106锁定在相对于偏移手柄柄杆110的适当位置。
参考图2,脊柱颈段的锁定骨板160为粗略的狗骨形状,带有两对固定孔:上固定孔170a及下固定孔170b;以及沿骨板160的纵轴线181的狭槽180。虽然其他厚度是可能的,骨板160示范性的厚度范围为大约1.5mm至大约4mm,骨板160可以由钛、钛合金、不锈钢或其他生物相容的材料来制造。狭槽180的每个端部优选地具有螺纹、埋头孔或同时具有这两者,以允许板保持器140与骨板160结合。如图3和4所示,骨板160的下侧184沿着其纵轴线181和其横轴线184优选地具有波状外形,以便与其将要接附的椎骨的外表面匹配。固定孔的角度相对于轴线171、173来确定,该轴线垂直于由点174a-d(显示于图2和3中)所形成的平面,这些点位于骨板160的延伸顶表面上的固定孔170a、170b的中心。在具有多于两对固定孔的骨板中,端部的固定孔对用来形成参考平面。确定固定孔170a、170b的圆锥形的内表面172的方向,使得骨紧固件接骨螺钉190的尖端相对于轴线171、173而锁定在大约1°至10°的向内的角度γ,优选地为大约4.3°。图3显示了上固定孔对170a,定向该对固定孔,使得骨紧固件190的尖端以相对于轴线171成角度α相对于脊柱在向上的方向上延伸。以相对于轴线173成角度β相对于脊柱向下定向下固定孔对170b。上固定孔对170a的向上的角度α可以从0到15°变化,优选地为大约12°,而下固定孔170b的向下的角度β可以从0到10°变化,优选地为大约6°。
虽然显示的骨板160具有两对固定孔170a和170b,但骨板可具有额外的固定孔对170c、170d等,以便跨接额外的椎骨。位于处于骨板端部的固定孔170a、170b之间的固定孔,优选地垂直于由孔170a、170b形成的平面来定向,但可以相对于脊柱向上或向下变化大约5°,并且从骨板160的任一端部看,可以朝向中心纵轴线181成角度γ,其与孔170a、170b的角度匹配。此外,虽然说明和描述的骨板160具有成对的固定孔,也可以为每个椎骨提供单一固定孔或具有单一与成对固定孔组合的骨板。
固定孔170a、170b可以带有螺纹,使得圆锥形的接骨螺钉头194螺纹匹配,如图7所示。和接合骨的下螺纹192相比,接骨螺钉头194的圆锥形螺纹195可具有较大的螺距。在插入接骨螺钉190时,圆锥形螺纹195和下螺纹192之间螺纹螺距的这种差别,导致板和椎骨之间产生压缩。
图5显示了脊柱颈段的锁定骨板替代实施例的侧视图。骨板260具有三对固定孔270a、270b、270c,虽然多于三对固定孔是可能的。图6带有接骨螺钉190的骨板260的截面图。如图5和6所示,骨板260的下侧284具有波状外形,以便与其将要接附的椎骨的外表面匹配。孔270a、270b的角度α、β和γ可以采用与骨板160的孔170a、170b的角度α、β和γ相同的值。从骨板260的侧面看,额外孔对270c的轴线275优选地垂直于由孔270a、270b所形成的平面。当从骨板260的任一端部看时,中心轴线275可以具有在骨板160的轴线171、173的角度γ的相同范围内的方向。图5和6也显示了可选的梯级特征部262,其优选地形成肩部或凸缘,以适应骶骨岬的形状,从而有助于在骶骨板上安置骨板260。梯级特征部也是骨板160的选择特征部。
参考图8,板保持器140包括杆141,其大部分长度(优选地为大约长200mm)优选地为圆柱形的,在杆141的远端142处优选地具有螺纹143。杆141结合骨板160。骨板160在狭槽180的端部182处优选地具有螺纹183,以便与杆141远端142处的螺纹143匹配。作为另一种选择,板保持器140的远端142可具有可扩张的衬套,其与骨板160的狭槽180的扩孔端部182匹配。板保持器140的近端144可具有非圆形的截面,如六边形形状。也可以使用除六边形之外的非圆形形状。在板保持器140的近端144下方的是径向凹槽146。板保持器140允许用户从远程位置不接触板来操作骨板160、260。
如图8所示,通过在杆141的近端144上滑动钻子引导器组件100的外柄杆126的远端127,钻子引导器组件100与板保持器140结合。释放套筒120以捕获的不可释放的方式连接到外柄杆126的近端129上,例如如通过锻压。释放套筒120能够在有限范围内轴向移动,并能够相对于外柄杆126旋转。弹簧122在外柄杆126的近端129上方的释放套筒120内部保持捕获,偏压释放套筒120,使其远离外柄杆126的近端129。滚珠棘爪124通常突入外柄杆126的钻孔内,防止外柄杆126在板保持器140上滑动。释放套筒120逆着释放套筒弹簧122的偏压轴向压向外柄杆126的远端127,以允许滚珠棘爪124向外移入释放套筒120具有较大内直径(图中未示)的区域,从而允许钻子引导器组件100被进一步推到板保持器140上。从释放套筒120上去除压力,引起释放套筒弹簧122的偏压使释放套筒120返回至其最远离骨板160的轴向位置,促使滚珠棘爪124向内接合板保持器140内的径向凹槽146,从而将钻子引导器组件100锁定到板保持器140上。
释放套筒120的上端具有非圆形孔128,优选地为六边形孔,孔128的周边接合板保持器140的非圆形近端144。虽然显示的孔128和近端144为六边形,应当理解:其他匹配形状是可能的。释放套筒120能够相对于外柄杆126旋转,以拧上和拧下板保持器140,从而允许板保持器140与骨板160接合以及板保持器140从骨板160上脱离。虽然钻子引导器组件和板保持器之间的连接被描述为与杆同轴并且在杆上滑动的柄杆,其他实施例是可能的,例如包括具有接附于板保持器侧面的柄杆的钻子引导器组件。
手柄构件106通过偏移手柄柄杆110从外柄杆126上偏移,以允许更佳的可见度和至骨板160及椎骨的通路。手柄柄杆110机械地接附于外柄杆126上,例如通过焊接、铜焊或摩擦装配。通过按压按钮凸轮108并转动手柄构件106,手柄构件106能够绕偏移手柄柄杆110枢转,以便当外科医生交替他正操作的板160和椎骨的侧面时,提供更大的可见度和通路。利用与手柄柄杆的径向凹槽113宽松接合的定位螺钉112,手柄构件106保持在手柄柄杆110上。逆着凸轮弹簧116的偏压来按压按钮凸轮108,使按钮凸轮108的棘爪109移动脱离与手柄构件106内的棘爪凹槽115(显示于图8a中)的接合,而棘爪109保持与手柄柄杆110的棘爪凹槽111接合,从而允许手柄构件106相对于偏移手柄柄杆110旋转,其带有可选的滚珠轴承114,以使旋转容易。释放按钮凸轮108上的压力,允许凸轮弹簧116使按钮凸轮108的棘爪109返回,以接合手柄构件106的棘爪凹槽115,同时保持按钮凸轮108的棘爪109与手柄柄杆110的棘爪凹槽111接合,以防止手柄构件106相对于手柄柄杆110旋转。
钻子引导筒130a、130b机械地接附于外柄杆126上,例如通过铜焊、焊接或摩擦装配。钻子引导筒130a、130b可具有多个插入位置133,带有形成通道的预定轨线,通道通过单一出口位置135来对准。例如,图8b显示了具有两个插入位置133的钻子引导筒130a,形成沿轴线134a、134b的通道。一个轨线可以大致垂直于骨板,而其余轨线可以相对于垂直轨线偏移和/或倾斜。预定轨线优选地匹配骨板160的固定孔170的各种轨线,比起可调节轨线钻子引导器所可能的精度,其允许更高的精度。显示的钻子引导筒具有两个插入位置133和两个预定轨线。然而,可以有具有其他预定轨线的额外插入位置133,以允许钻子引导器与多种骨板一起使用。钻子引导筒130a、130b可以选择性地具有单一插入位置133和单一出口位置135。最后,钻子引导筒130a、130b可具有单一插入位置133和多于一个出口位置135,或多个插入位置133和多个出口位置135。优选地确定引导筒130a、130b的尺寸,以允许固定销或接骨螺钉、钻子、丝锥及锥子通过。当固定部件和工具插入引导筒130a、130b内时,引导筒130a、130b内的缝槽137允许外科医生看见固定部件和工具。钻子引导筒130a、130b具有接头片132,其接合骨板160的狭槽180,以防止钻子引导器组件100相对于骨板160旋转。
图9显示了示范性的单筒钻子引导器组件200和板保持器140的分解图,其适合与有狭槽的脊柱颈段的锁定骨板160一起使用。虽然作为用于脊柱颈区的颈部板显示并描述了骨板、板保持器和钻子引导器组件,但应当理解:该钻子引导器组件和板保持器也可与其他骨板一起使用。组件200包括手柄构件206、偏移手柄柄杆210、释放套筒220、外柄杆226和钻子引导筒230。通过按压并保持按钮凸轮208,钻子引导器组件200的手柄构件206能够递增地转动。释放按钮凸轮208,将手柄锁定在相对于手柄柄杆210的适当位置。
如图9和10所示,通过在板保持器140的近端144上滑动钻子引导器组件200的外柄杆226的远端227,钻子引导器组件200与板保持器140结合。滚珠棘爪224通常突入外柄杆226的钻孔内,防止外柄杆226在板保持器140上滑动。释放套筒220逆着释放套筒弹簧222的偏压轴向压向外柄杆226的远端227,以允许滚珠棘爪224向外移入释放套筒220具有较大内直径(图中未示)的区域,从而允许钻子引导器组件200被进一步推到板保持器140上。从释放套筒220上去除压力,引起释放套筒弹簧222的偏压使释放套筒220返回至其最远离骨板160的轴向位置,促使滚珠棘爪224向内接合板保持器的径向凹槽146,从而将钻子引导器组件200锁定到板保持器140上。外柄杆226的远端具有锁定接头片232,其插入于锁定板160的狭槽180内,以防止钻子引导器组件200相对于骨板160旋转,并提供两者的对准。
释放套筒220的上端具有六边形孔228,孔228的周边接合板保持器240的六边形近端244。虽然显示的孔228和近端244为六边形,应当理解:其他匹配形状是可能的。释放套筒220能够相对于外柄杆226旋转,以将板保持器140拧到骨板160上以及将板保持器140从骨板160上拧下。
手柄构件206通过偏移手柄柄杆210从外柄杆226上偏移,以允许更佳的可见度和至骨板及椎骨的通路。通过按压按钮凸轮208并转动手柄构件206,手柄构件206能够绕手柄柄杆210枢转,以便当外科医生交替他正操作的骨板160和椎骨的侧面时,提供更大的可见度和通路。利用与手柄柄杆的径向凹槽213宽松接合的定位螺钉212,手柄构件206保持在手柄柄杆210上。逆着凸轮弹簧216的偏压来按压按钮凸轮208,使按钮凸轮208的棘爪209移动脱离与手柄构件206内的棘爪凹槽215(显示于图9a中)的接合,而棘爪209保持与手柄柄杆210的棘爪凹槽211接合,从而允许手柄构件206相对于手柄柄杆210旋转。释放按钮凸轮208上的压力,允许凸轮弹簧216使按钮凸轮208的棘爪209返回,以接合手柄构件206的棘爪凹槽215,同时保持按钮凸轮208的棘爪209与手柄柄杆210的棘爪凹槽211接合,以防止手柄构件206相对于手柄柄杆210旋转。
单筒钻子引导器组件200提供了使外科医生具有更大可见度的优势,因为在一个时间板只有一个侧面被钻子引导筒230所遮掩。钻子引导筒230通过弯曲轴250(其主要尺寸为大约90mm长,直径为大约2mm)接附于外柄杆226上,弯曲轴由不锈钢或其他柔性的生物相容的材料制成,其穿过外柄杆226上的柄杆铰链突出物252a-d和钻子引导筒230上的钻子引导筒铰链突出物234。弯曲弯曲轴250,以便为操作钻子引导筒230提供指形柄258。定位销236插入穿过钻子引导筒铰链突出物234内的钻子引导筒定位销孔238以及弯曲轴250内的弯曲轴定位销孔254,以将钻子引导筒230锁定到弯曲轴250上,使得钻子引导筒230和弯曲轴250在柄杆铰链突出物252a-d内一起旋转。弯曲轴250具有减小直径的部分251,例如9mm长度的大约1mm直径。下柄杆铰链突出物252c、252d偏离上柄杆铰链突出物252a、252b,使得弯曲轴250在减小直径的部分251处略成弓形弯曲,从而形成在该方向偏压弯曲轴指形柄258的弹簧力。上柄杆铰链突出物252a具有弯曲轴容纳凹槽256a、256b,其在弯曲轴250弯曲形成弯曲轴指形柄258的位置处容纳内半径253,以将钻子引导筒230分别锁定在钻子引导器组件200的左侧或右侧。通过向上提拉弯曲轴250,直至弯曲轴指形柄258离开弯曲轴容纳凹槽256a,并通过旋转和锁定钻子引导筒230和弯曲轴250,直至弯曲轴指形柄258定位于弯曲轴容纳凹槽256b上,钻子引导筒230从左侧移动到右侧。由于弓形弯曲的弯曲轴下端259的弹簧力,释放弯曲轴250允许弯曲轴指形柄258位于弯曲轴容纳凹槽256b内,该弹簧力来自弯曲轴250的减小直径部分251的弓形弯曲。
钻子引导筒230优选地具有带有预定轨线的多个插入位置233,预定轨线优选地倾斜于或偏离单一出口位置235,虽然具有单一插入位置233和单一出口位置235的钻子引导筒230是可能的。此外,具有单一插入位置233和多于一个出口位置235的钻子引导筒230是可能的。当钻子引导筒230移动以交替板的侧面时,多个插入位置233提供了适当的轨线,并且也提供了骨板160的上下固定孔170a、170b所需要的各种轨线。比起可调节轨线钻子引导器所可能的精度,预定轨线允许更高的精度。引导筒230允许固定销或接骨螺钉、钻子、丝锥及锥子通过。当固定部件和工具插入引导筒230内时,引导筒230内的缝槽237允许外科医生看见固定部件和工具。
图11显示了单筒钻子引导器的替代实施例。钻子引导器组件300具有相对长(代表性的长度:大约80mm)的钻子引导筒330,在钻子引导筒330(代表性的外直径:大约10-12mm)的内部具有限深器(肩部,图中未示),其在预定深度阻挡钻头。手柄构件306、按钮凸轮308、偏移手柄柄杆310、外柄杆326以及释放套筒320相应于钻子引导器组件100的手柄构件106、按钮凸轮108、偏移手柄柄杆110、外柄杆126以及释放套筒120。接头片335优选地通过焊接或铜焊接附于外柄杆326上,并具有水平部分335a和垂直部分335b。销350优选地通过焊接、铜焊或机械连接接附于接头片水平部分335a上,并平行于外柄杆326。销350具有狭槽337,其始于销350的上端并延伸穿过销350的部分长度。狭槽337隔开半球形的止动器355a、355b,其比止动器355a、355b下方的销350的部分具有更大的直径。止动器355a、355b将钻子引导筒铰链334固定到销350上。为了将钻子引导筒330转换到骨板160的相对侧,外科医生朝自己拉钻子引导筒330,使得钻子引导筒铰链334离开接头片垂直部分335b,以允许外科医生将钻子引导筒330枢转到相对侧。当钻子引导筒铰链334的上表面339接触止动器355a、355b时,外科医生朝自己拉钻子引导筒330促使止动器355a、355b一起更靠近,形成偏压钻子引导筒铰链334远离外科医生的弹簧力。随后释放钻子引导筒330,在贴靠钻子引导筒铰链334上表面339的被压缩止动器355a、355b的弹簧力作用下,钻子引导筒330返回至其下方位置,使得钻子引导筒铰链334由接头片335保持在角位置。
现在描述利用以上披露的系统在椎骨中钻孔的方法。外科医生将板保持器插入到骨板的缝槽内。外科医生随后可释放地将钻子引导器组件锁定到板保持器上。外科医生拿着钻子引导器组件的手柄,将骨板施加到合适的椎骨上。外科医生随后将钻头对准钻子引导器组件的合适的钻子引导筒的合适插入位置,并将钻头插入至钻子引导筒内。外科医生随后钻第一孔,其与板的第一紧固件孔的中心轴线同轴线。第一接骨螺钉随后插入至钻子引导筒内,并将拧入第一孔。如果使用双筒钻子引导器组件,外科医生随后将钻头对准邻近钻子引导筒的合适插入位置。如果使用单筒钻子引导器组件,外科医生枢转钻子引导筒,直至其对准邻近板内第一紧固件孔的紧固件孔的上方,并将钻头对准钻子引导筒的合适插入位置。外科医生随后钻第二孔,其与板内第二紧固件孔的中心轴线同轴线,并安装第二接骨螺钉。外科医生随后逆时针旋转钻子引导器组件上的释放套筒,这从板上脱离板保持器。外科医生从板移走钻子引导器组件和接附的板保持器,并通过逆时针旋转释放套筒,将板保持器插入至骨板内的第二孔,重复钻孔、在板的相邻通孔内安装接骨螺钉、以及移走钻子引导器组件和板保持器的过程,直至钻完所有的相邻孔对并插入接骨螺钉。
虽然这儿参考特定实施例显示并描述了本发明,但应当理解:在不违反本发明的精神和范围的情况下,可以对所描述的实施例进行形式、结构、布置、比例、材料及部件等的各种添加、替换或改动,这些使用于实践中,并尤其适合于特定的环境和操作要求。例如,可使用各种装置将板保持器接附于骨板或钻子引导器组件上。此外,板可具有各种厚度、形状和外形;并具有各种固定孔结构。
Claims (24)
1.一种用于脊柱手术的骨板组件,其包括:
骨板,其具有纵轴线、远端、近端、多对固定孔,每个固定孔具有中心轴线,每对固定孔围绕纵轴线对称布置,以接收穿过其中的骨锚固器,固定孔具有圆锥形的支持面,其朝向骨板的纵轴线向内成角度,其中,邻近远端的固定孔的中心轴线朝向远端成角度,邻近近端的固定孔对的中心轴线朝向近端成角度,圆锥形支持面具有螺纹,以匹配骨锚固器上的相应螺纹,从而以预定角度沿着纵轴线固定骨锚固器。
2.根据权利要求1所述的骨板组件,进一步包括沿着板的中心纵轴线的至少一个缝槽。
3.根据权利要求2所述的骨板组件,其中,缝槽的端部至少具有部分螺纹。
4.根据权利要求3所述的骨板组件,其中,缝槽的由无螺纹部分隔开的两个端部至少具有部分螺纹。
5.根据权利要求1所述的骨板组件,进一步包括梯级特征部,以有助于骨板在骶骨岬上的安置。
6.一种外科钻子引导器组件,其包括:
具有纵轴线的柄杆;
至少一个钻子引导筒,其接附于外柄杆上,并构造为接收及引导外科钻头;
接合骨板内开口的接头片,以对准钻子引导器组件,并使钻子引导器组件稳定;
可释放地接附于外柄杆和骨板上的杆;以及
用于接附柄杆和杆的释放机构。
7.根据权利要求6所述的外科钻子引导器组件,进一步包括手柄构件,其通过偏移手柄臂从柄杆偏移。
8.根据权利要求7所述的外科钻子引导器组件,其中,手柄构件相对于偏移手柄臂枢转。
9.根据权利要求6所述的外科钻子引导器组件,其中,释放机构具有非圆形通道。
10.根据权利要求6所述的外科钻子引导器组件,其中,杆的一端具有非圆形截面。
11.根据权利要求6所述的外科钻子引导器组件,其中,杆的一端具有螺纹。
12.根据权利要求6所述的外科钻子引导器组件,进一步包括一个或多个位于柄杆内的滚珠爪以及位于杆上的凹槽,其中,一个或多个滚珠爪和凹槽用于可释放地将柄杆接附于杆上。
13.根据权利要求6所述的外科钻子引导器组件,其中,钻子引导筒围绕柄杆上的铰链而枢转。
14.根据权利要求6所述的外科钻子引导器组件,其中,有两个钻子引导筒。
15.根据权利要求6所述的外科钻子引导器组件,其中,钻子引导筒具有多个钻子插入位置。
16.根据权利要求6所述的外科钻子引导器组件,其中,钻子引导筒在不同角度方向具有多个插入通道。
17.根据权利要求16所述的外科钻子引导器组件,其中,插入通道具有朝向骨板纵轴线大约0°至大约10°的角度方向,并具有沿骨板纵轴线向上或向下大约75°至大约90°的角度方向。
18.根据权利要求6所述的外科钻子引导器组件,其中,钻子引导筒具有限深器,以防止钻头超出预定深度。
19.根据权利要求6所述的外科钻子引导器组件,其中,接头片接附于钻子引导筒上。
20.根据权利要求8所述的外科钻子引导器组件,进一步包括按钮凸轮,其中,通过按钮凸轮上的爪与手柄构件内的爪凹槽移入接合或移出脱离,手柄构件和偏移手柄臂可释放地锁定在角度位置。
21.一种在椎骨上安装骨板的方法,其包括以下步骤:
将板保持器插入至锁定骨板内;
将钻子引导器组件可释放地锁定在板保持器上;
将骨板放置在椎骨上;
将钻头对准钻子引导器组件的钻子引导筒内的插入位置;
穿过锁定骨板内的紧固件孔,在骨内钻孔;
将接骨螺钉插入至紧固件孔内;以及
通过旋转钻子引导器组件上的释放套筒,从锁定骨板上释放板保持器杆和钻子引导器组件。
22.根据权利要求21所述的在椎骨上安装骨板的方法,其中,在钻子引导器组件锁定于板保持器之前,将骨板放置于椎骨上。
23.根据权利要求21所述的方法,进一步包括步骤:通过旋转释放套筒,将板保持器杆插入至锁定骨板的第二缝槽内。
24.根据权利要求21所述的方法,其中,接骨螺钉插入至钻子引导筒内,并用螺纹拧入紧固件孔内。
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US10/619,472 US7731721B2 (en) | 2003-07-16 | 2003-07-16 | Plating system with multiple function drill guide |
US10/619,472 | 2003-07-16 |
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CNA2004800266847A Pending CN1909849A (zh) | 2003-07-16 | 2004-07-16 | 具有多功能钻子引导器的板系统 |
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US (2) | US7731721B2 (zh) |
EP (1) | EP1651122B1 (zh) |
JP (1) | JP2007523693A (zh) |
KR (1) | KR20060035762A (zh) |
CN (1) | CN1909849A (zh) |
AT (1) | ATE498368T1 (zh) |
AU (1) | AU2004258937A1 (zh) |
BR (1) | BRPI0412677A (zh) |
CA (1) | CA2532747A1 (zh) |
DE (1) | DE602004031429D1 (zh) |
ES (1) | ES2363270T3 (zh) |
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2004
- 2004-04-30 US US10/837,085 patent/US20050015093A1/en not_active Abandoned
- 2004-07-16 EP EP04757129A patent/EP1651122B1/en active Active
- 2004-07-16 AT AT04757129T patent/ATE498368T1/de active
- 2004-07-16 ZA ZA200600858A patent/ZA200600858B/en unknown
- 2004-07-16 DE DE602004031429T patent/DE602004031429D1/de active Active
- 2004-07-16 BR BRPI0412677-7A patent/BRPI0412677A/pt not_active IP Right Cessation
- 2004-07-16 JP JP2006520409A patent/JP2007523693A/ja active Pending
- 2004-07-16 CA CA002532747A patent/CA2532747A1/en not_active Abandoned
- 2004-07-16 WO PCT/US2004/023193 patent/WO2005009487A2/en active Application Filing
- 2004-07-16 CN CNA2004800266847A patent/CN1909849A/zh active Pending
- 2004-07-16 PL PL04757129T patent/PL1651122T3/pl unknown
- 2004-07-16 KR KR1020067001039A patent/KR20060035762A/ko not_active Application Discontinuation
- 2004-07-16 ES ES04757129T patent/ES2363270T3/es active Active
- 2004-07-16 AU AU2004258937A patent/AU2004258937A1/en not_active Abandoned
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Also Published As
Publication number | Publication date |
---|---|
ZA200600858B (en) | 2007-07-25 |
PL1651122T3 (pl) | 2011-11-30 |
JP2007523693A (ja) | 2007-08-23 |
ES2363270T3 (es) | 2011-07-28 |
DE602004031429D1 (de) | 2011-03-31 |
EP1651122B1 (en) | 2011-02-16 |
US20050015092A1 (en) | 2005-01-20 |
ATE498368T1 (de) | 2011-03-15 |
US7731721B2 (en) | 2010-06-08 |
WO2005009487A2 (en) | 2005-02-03 |
KR20060035762A (ko) | 2006-04-26 |
EP1651122A4 (en) | 2008-08-13 |
EP1651122A2 (en) | 2006-05-03 |
WO2005009487A3 (en) | 2005-10-20 |
CA2532747A1 (en) | 2005-02-03 |
AU2004258937A1 (en) | 2005-02-03 |
US20050015093A1 (en) | 2005-01-20 |
BRPI0412677A (pt) | 2006-10-03 |
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