WO2001056489A1 - Bone plate - Google Patents

Bone plate Download PDF

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Publication number
WO2001056489A1
WO2001056489A1 PCT/EP2001/000883 EP0100883W WO0156489A1 WO 2001056489 A1 WO2001056489 A1 WO 2001056489A1 EP 0100883 W EP0100883 W EP 0100883W WO 0156489 A1 WO0156489 A1 WO 0156489A1
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WO
WIPO (PCT)
Prior art keywords
bone plate
bone
slots
plate according
plate
Prior art date
Application number
PCT/EP2001/000883
Other languages
German (de)
French (fr)
Inventor
Robert Schultz
Original Assignee
Aesculap Ag & Co. Kg
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 Aesculap Ag & Co. Kg filed Critical Aesculap Ag & Co. Kg
Publication of WO2001056489A1 publication Critical patent/WO2001056489A1/en

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Classifications

    • 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
    • A61B17/7059Cortical plates
    • 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
    • A61B17/80Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8085Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with pliable or malleable elements or having a mesh-like structure, e.g. small strips
    • 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
    • A61B17/80Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/809Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with bone-penetrating elements, e.g. blades or prongs

Definitions

  • the invention relates to a bone plate for connecting at least two bone parts, in particular vertebral bodies, with a plate-shaped contact area for each bone part and with at least one push-through opening for a bone screw in each contact area.
  • Such bone plates are used to fix two bone parts relative to one another as precisely and permanently as possible, for example two fragments after a fracture of a bone or two adjacent vertebral bodies, which are to be fixed in the event of damage to the intervertebral disc so that the intervertebral disc is relieved.
  • fixation leads to the fact that the adjacent bone parts which are fixed over the bone plate are completely immovable relative to one another, and this is not desirable in some cases.
  • fixation devices on the spine are known which allow certain movements of the vertebral bodies relative to one another.
  • fixation systems in which pedicle screws screwed into the vertebral bodies are connected to each other at their ends protruding from the vertebral bodies by means of rods or ropes, which in turn have a certain flexibility and therefore enable the pedicle screws to move to a small extent against each other and incline towards each other (EP 0 381 588 Bl; W095 / 19149; EP 0 677 277 A2; EP 0 516 567 Bl; WO98 / 22033; W094 / 14384; EP 0 669 109 Bl; FR 2745706 AI; WO93 / 20771).
  • rod or rope systems are therefore only suitable to a limited extent, in particular in the case of minimally invasive technology, on bone parts if their defined connection is desired while allowing little room for movement. It is an object of the invention to design a generic bone plate so that it offers the possibility of limited movement of the bone parts connected to it.
  • a bone plate of the type described in the introduction in that at least one slot running transversely to the longitudinal direction of the bone plate is arranged in the bone plate between two contact areas, which begins at a side edge of the bone plate and extends at least up to half the width of the bone plate ,
  • slits which end on the same side edge of the bone plate, then these enable the two contact areas of this bone plate to be pivoted relative to one another when the contact areas are pressed against one another.
  • the pivoting takes place about an axis that is perpendicular to the plane of the bone plate, the pivoting angle is limited by the fact that the side walls of the slot or slots come into contact with one another.
  • the length of the slits is greater than half the width of the bone plate, for example the length of the slit or slits can be at least three quarters of the width of the bone plate, this depends, among other things, on how soft the bone plate is against compression and pivoting and what strength properties are desired against bending out of the bone plate.
  • the slots end at their end in the bone plate in an extension, which is preferably circular. This expansion relieves the load and prevents damage to the plate material due to excessive tension in this area.
  • the side walls of the slot or slots converge in the direction of the open end lying on a side edge of the bone plate. This ensures that in the event of a pression or pivoting the side walls come to rest against each other in the area of their open end and thereby limit the further compression or pivoting.
  • the compression and pivoting movement of the bone plate is limited to a relatively small amount, in particular when vertebral bodies are connected, for example it can be provided that the sum of the smallest widths of all slots open to the same side of the plate between two contact areas between 0.5 and 2 mm.
  • the bone plate has a greater thickness in the area of the slots than in the contact areas.
  • the bone plate in the sections provided with slots is reinforced against bending out of the plane of the bone plate, so that despite the cross-sectional weakening through the slots, the strength against such a bending is retained.
  • the bone plate is provided with a wear-reducing coating in the region of the slots.
  • the bone plate in the contact area carries at least one mandrel protruding transversely to the plate surface, preferably a mandrel with a rectangular cross section.
  • This mandrel enters the bone material of the bone part against which the contact area lies and fixes the contact area together with the bone screw screwed into the bone part Bone plate reliably relative to the bone part, in particular also against rotation in the plane of the plate.
  • a bone plate has two abutment areas, between which there is a slot or several slits, but it is also possible to provide bone plates with at least three abutment areas, between which slots are arranged, so that, for example, the connection of three adjacent vertebral bodies is possible with such a bone plate.
  • FIG. 1 shows a longitudinal sectional view along line 1-1 in FIG. 2 through two adjacent vertebral bodies and a bone plate connecting them and provided with transverse slots;
  • Figure 2 a plan view of the vertebral body and the bone plate of Figure 1 and
  • Figure 3 a view similar to Figure 2 in an embodiment for connecting three adjacent vertebral bodies.
  • the invention is explained below using the example of the connection of two or more vertebral bodies, but the invention can also be used for the connection of other bone parts or bone fragments in which a connection is desired while maintaining a certain relative movement possibility.
  • the bone plate 1 shown in FIGS. 1 and 2 serves to connect two adjacent vertebral bodies 2, between which an intervertebral disc 3 is arranged.
  • the bone plate 1 has the shape of an elongated plate strip, it ends on both sides in a contact area 4, the width of which is reduced compared to the central area 5 lying between the contact areas 4.
  • a push-through opening 6 is provided for a bone screw 7, in the exemplary embodiment shown the push-through opening 6 has a spherical cap-shaped cross section, on which a likewise spherical cap-shaped head 8 of the bone screw 7 can be placed in such a way that the bone screw 7 relative to the bone plate to a certain extent Can be inclined to a large extent ( Figure 1).
  • the bone plate 1 On its side facing the bone, the bone plate 1 is flat, on this side it carries, in addition to the push-through openings, a mandrel 9 projecting perpendicularly from the bone plate 1, which is rectangular in cross-section and extends approximately over half the width of the bone plate 1 extends. This mandrel 9 is formed in one piece with the bone plate 1 and between the side edges
  • the central area 5 of the bone plate 1 has a greater thickness than the two contact areas 4, for example the thickness in this area can be 20 to 40% greater than in the contact area 4.
  • transverse slots 11 are arranged, each beginning at a side edge 10 of the bone plate 1 and extending over a considerable part of the width of the bone plate 1, in the exemplary embodiment shown approximately three-quarters of the width of the bone plate 1.
  • Each transverse slot 11 has two flat, from the open end 12 of the cross slot
  • transverse slot 11 starting from diverging side walls 13 which open into an essentially circular extension 14 at the closed end of the transverse slot 11.
  • four such transverse slots are arranged next to one another at a slight distance along the bone plate 1, adjacent cross-slots 11 being open toward opposite side edges 10 of the bone plate 1, so the adjacent transverse slots 11 are arranged opposite each other.
  • the bone plate 1 consists of a body-compatible material that is elastically deformable to a small extent, for example titanium, a titanium alloy, but it is also possible to use a composite material, for example carbon fiber-reinforced polyether ether ketone.
  • a body-compatible material that is elastically deformable to a small extent
  • a composite material for example carbon fiber-reinforced polyether ether ketone.
  • the mobility of the bone plate 1 can be adjusted, so that only a limited compression and a limited pivoting of the contact areas in the plane of the bone plate are possible.
  • bone plates when connecting adjacent vertebral bodies, bone plates can be used which have a length of approximately 50 mm, a width of just under 20 mm and a thickness of 4 mm, the width of the slots at their open end 12 being 0.3 mm and their distance 1 to 2 mm.
  • a maximum compression of 0.6 mm can be achieved in the axial direction and a maximum deflection of the order of 2.5 °.
  • the bone plate In order to connect two vertebral bodies to one another with such a bone plate, the bone plate is, for example, brought ventrally-laterally to the vertebral body and is tightened against the outside using the bone screws 7, the spikes 9 enter the vertebral body 2 and fix the bone plate 1 together the bone screws 7 securely to the vertebral body.
  • the bone screws 7 can be provided with a longitudinal bore 15 so that the bone screws can be screwed into the vertebral body along a guide wire inserted into the vertebral body, which is removed again after the bone screws 7 have been screwed in.
  • the bone plate 1 has two contact areas 4 and a single central area 5 arranged between them.
  • a total of three spaced-apart abutment areas 4 are provided, with a middle area 5 with transverse slots 11 being provided between two adjacent abutment areas 4, with such a bone plate, three adjacent vertebral bodies 2 can be fixed relative to one another such that in In the longitudinal direction of the bone plate there remains little possibility of compression and that adjacent vertebral bodies 2 can be pivoted to a small extent against one another about a pivot axis which is perpendicular to the bone plate 1.
  • a pivoting out of the bone plate level 1 is largely precluded by the stability of the central region 5, in particular by the thickening of the central region 5 with respect to the contact regions 4.

Abstract

The invention concerns a bone plate for connecting at least two bone parts, especially vertebral bodies, comprising a fixing area in the shape of a plate for each of the bone parts and at least one through hole for a bone screw in each of the fixing areas. The invention aims at enabling a given relative movement of the bone parts. To this end, at least one slot extending crosswise in relation to the longitudinal direction of the bone plate is disposed between two fixing areas. Said slot begins on a lateral edge of the bone plate and extends at least up to the half-width of the bone plate.

Description

KNOCHENPLATTE BONE PLATE
Die Erfindung betrifft eine Knochenplatte zur Verbindung von mindestens zwei Knochenteilen, insbesondere Wirbelkörpern, mit einem plattenformigen Anlagebereich für jedes Knochenteil und mit mindestens einer Durchstecköffnung für eine Knochenschraube in jedem Anlagebereich.The invention relates to a bone plate for connecting at least two bone parts, in particular vertebral bodies, with a plate-shaped contact area for each bone part and with at least one push-through opening for a bone screw in each contact area.
Derartige Knochenplatten werden verwendet, um zwei Knochenteile relativ zueinander möglichst exakt und dauerhaft zu fixieren, beispielsweise zwei Fragmente nach einer Fraktur eines Knochens oder zwei benachbarte Wirbelkörper, die bei einer Schädigung der Bandscheibe so fixiert werden sollen, daß die Bandscheibe entlastet wird.Such bone plates are used to fix two bone parts relative to one another as precisely and permanently as possible, for example two fragments after a fracture of a bone or two adjacent vertebral bodies, which are to be fixed in the event of damage to the intervertebral disc so that the intervertebral disc is relieved.
Bei herkömmlichen Knochenplatten führt eine solche Fixierung dazu, daß die benachbarten und über die Knochenplatte festgelegten Knochenteile relativ zueinander völlig unbeweglich sind, und dies ist in manchen Fällen nicht erwünscht. So wäre es beispielsweise bei der Festlegung von Wirbelkörpern günstig, in geringem Umfang eine Annäherung der Wirbelkörper und auch eine Verschwenkung der Wirbelkörper gegeneinander zu ermöglichen, da dies der natürlichen Bewegung der Wirbelkörper näher käme als eine völlig starre Fixierung der Wirbelkörper; dadurch werden die Möglichkeiten der Regeneration einer geschädigten Bandscheibe verbessert. Es sind zu diesem Zwecke Fixiereinrichtungen an der Wirbelsäule bekannt, die gewisse Bewegungen der Wirbelkörper relativ zueinander zulassen. Dabei handelt es sich um Fixationssysteme, bei denen in die Wirbelkörper eingeschraubte Pedikelschrauben an ihren aus den Wirbelkörpern hervorstehenden Enden über Stäbe oder Seile miteinander verbunden werden, die dann ihrerseits eine gewisse Flexibilität aufweisen und daher den Pedikelschrauben ermöglichen, sich in geringem Umfange gegeneinander zu verschieben und gegeneinander zu neigen (EP 0 381 588 Bl; W095/19149; EP 0 677 277 A2; EP 0 516 567 Bl; WO98/22033; W094/14384; EP 0 669 109 Bl; FR 2745706 AI ;WO93/20771 ) .In conventional bone plates, such a fixation leads to the fact that the adjacent bone parts which are fixed over the bone plate are completely immovable relative to one another, and this is not desirable in some cases. For example, when fixing vertebral bodies, it would be favorable to allow the vertebral bodies to approach each other to a small extent and also to allow the vertebral bodies to pivot relative to one another, since this would come closer to the natural movement of the vertebral bodies than a completely rigid fixation of the vertebral bodies; this improves the possibilities of regeneration of a damaged intervertebral disc. For this purpose, fixation devices on the spine are known which allow certain movements of the vertebral bodies relative to one another. These are fixation systems in which pedicle screws screwed into the vertebral bodies are connected to each other at their ends protruding from the vertebral bodies by means of rods or ropes, which in turn have a certain flexibility and therefore enable the pedicle screws to move to a small extent against each other and incline towards each other (EP 0 381 588 Bl; W095 / 19149; EP 0 677 277 A2; EP 0 516 567 Bl; WO98 / 22033; W094 / 14384; EP 0 669 109 Bl; FR 2745706 AI; WO93 / 20771).
Diese Systeme sind relativ kompliziert aufgebaut, da zwischen den Pedikelschrauben und den Haltestäben oder -seilen zusätzlich Klemmvorrichtungen vorgesehen werden müssen, die eine starre Verbindung herstellen und in der Lage sind, hohe Drehmomente zu übertragen. Außerdem sind derartige Systeme sperrig, da die Haltestäbe und Halteseile im Abstand zu den Knochenteilen an den Pedikelschrauben anliegen müssen. Das Anlegen ist kompliziert, da nicht nur die Pedikelschrauben eingesetzt sondern auch die Klemmverbindungen hergestellt und fixiert werden müssen.These systems are of relatively complicated construction, since additional clamping devices must be provided between the pedicle screws and the holding rods or cables, which establish a rigid connection and are able to transmit high torques. In addition, systems of this type are bulky, since the holding rods and holding ropes have to rest against the pedicle screws at a distance from the bone parts. The application is complicated because not only the pedicle screws have to be inserted but also the clamp connections have to be made and fixed.
Diese Stab- oder Seilsysteme sind daher nur begrenzt geeignet, insbesondere bei minimalinvasiver Technik an Knochenteilen eingesetzt zu werden, wenn deren definierte Verbindung gewünscht wird unter Einräumung eines geringen Bewegungsspielraums. Es ist Aufgabe der Erfindung, eine gattungsgemäße Knochenplatte so auszubilden, daß sie die Möglichkeit einer begrenzten Bewegung der mit ihr verbundenen Knochenteile bietet.These rod or rope systems are therefore only suitable to a limited extent, in particular in the case of minimally invasive technology, on bone parts if their defined connection is desired while allowing little room for movement. It is an object of the invention to design a generic bone plate so that it offers the possibility of limited movement of the bone parts connected to it.
Diese Aufgabe wird bei einer Knochenplatte der eingangs beschriebenen Art erfindungsgemäß dadurch gelöst, daß zwischen zwei Anlagebereichen mindestens ein quer zur Längsrichtung der Knochenplatte verlaufender Schlitz in der Knochenplatte angeordnet ist, der an einer Seitenkante der Knochenplatte beginnt und sich mindestens bis zur halben Breite der Knochenplatte erstreckt.This object is achieved according to the invention in a bone plate of the type described in the introduction in that at least one slot running transversely to the longitudinal direction of the bone plate is arranged in the bone plate between two contact areas, which begins at a side edge of the bone plate and extends at least up to half the width of the bone plate ,
Wenn nur Schlitze vorgesehen sind, die an derselben Seitenkante der Knochenplatte enden, so ermöglichen diese eine Verschwenkung der beiden Anlagebereiche dieser Knochenplatte gegeneinander, wenn die Anlagebereiche gegeneinander gedrückt werden. Die Verschwenkung erfolgt dabei um eine Achse, die senkrecht auf der Ebene der Knochenplatte liegt, der Schwenkwinkel wird dadurch begrenzt, daß die Seitenwände des Schlitzes oder der Schlitze aneinander zur Anlage kommen.If only slits are provided which end on the same side edge of the bone plate, then these enable the two contact areas of this bone plate to be pivoted relative to one another when the contact areas are pressed against one another. The pivoting takes place about an axis that is perpendicular to the plane of the bone plate, the pivoting angle is limited by the fact that the side walls of the slot or slots come into contact with one another.
Es kann aber auch vorgesehen sein, daß bei einer Knochenplatte mit mehreren Schlitzen benachbarte Schlitze an gegenüberliegenden Seitenkanten der Knochenplatte beginnen. Dann ermöglicht diese Knochenplatte nicht nur eine Verschwenkung um die genannte Schwenkachse, sondern auch eine Kompression in Längsrichtung der Knochenplatte, wobei diese Kompression dadurch begrenzt wird, daß die beiden Seitenwände aller Schlitze aneinander zur Anlage kommen. Die Bewegungsmöglichkeiten einer solchen Knochenplatte sind somit eingeschränkt auf eine Kompression in axialer Richtung und auf eine Verschwenkung um eine senkrecht auf der Knochenplatte stehende Schwenkachse, ein Verbiegen aus der Knochenplattenebene heraus ist dagegen weitgehend unterbunden, gegen eine solche Bewegung bietet eine Knochenplatte im Gegensatz zur herkömmlichen flexiblen Stab- oder Seilsystemen eine hohe Festigkeit.However, it can also be provided that in the case of a bone plate with a plurality of slots, adjacent slots start on opposite side edges of the bone plate. Then this bone plate not only enables pivoting about the said pivot axis, but also compression in the longitudinal direction of the bone plate, this compression being limited by the fact that the two side walls of all the slots come into contact with one another. The possibilities of movement of such a bone plate are thus restricted to compression in the axial direction and to pivoting about a pivot axis perpendicular to the bone plate; bending out of the plane of the bone plate is largely prevented, however, in contrast to the conventional flexible one, a bone plate offers such movement Bar or rope systems have high strength.
Es kann vorgesehen sein, daß die Länge der Schlitze größer ist als die halbe Breite der Knochenplatte, beispielsweise kann die Länge des oder der Schlitze mindestens dreiviertel der Breite der Knochenplatte betragen, dies hängt unter anderem davon ab, wie weich die Knochenplatte gegenüber Kompression und Verschwenkung sein soll und welche Festigkeitseigenschaften gegen ein Verbiegen aus der Knochenplatte heraus gewünscht werden.It can be provided that the length of the slits is greater than half the width of the bone plate, for example the length of the slit or slits can be at least three quarters of the width of the bone plate, this depends, among other things, on how soft the bone plate is against compression and pivoting and what strength properties are desired against bending out of the bone plate.
Bei einer bevorzugten Ausführungsform ist vorgesehen, daß die Schlitze an ihrem in der Knochenplatte liegenden Ende in einer Erweiterung enden, die vorzugsweise kreisförmig ausgebildet ist. Diese Erweiterung bildet eine Entlastung und verhindert in diesem Bereich eine Beschädigung des Plattenmaterials durch überhöhte Spannungen.In a preferred embodiment it is provided that the slots end at their end in the bone plate in an extension, which is preferably circular. This expansion relieves the load and prevents damage to the plate material due to excessive tension in this area.
Weiterhin ist es vorteilhaft, wenn die Seitenwände des oder der Schlitze in Richtung auf das offene, an einer Seitenkante der Knochenplatte liegende Ende konvergieren. Dadurch wird sichergestellt, daß bei einer Kom- pression oder Verschwenkung die Seitenwände im Bereich ihres offenen Endes aneinander zur Anlage kommen und dadurch die weitere Kompression beziehungsweise Verschwenkung begrenzen.It is also advantageous if the side walls of the slot or slots converge in the direction of the open end lying on a side edge of the bone plate. This ensures that in the event of a pression or pivoting the side walls come to rest against each other in the area of their open end and thereby limit the further compression or pivoting.
Die Kompressions- und Verschwenkbewegung der Knochenplatte wird insbesondere bei Verbindung von Wirbelkörpern auf ein relativ geringes Maß begrenzt, so kann beispielsweise vorgesehen sein, daß die Summe der kleinsten Breiten aller zur selben Seite der Platte hin offenen Schlitze zwischen jeweils zwei Anlagebereichen zwischen 0,5 und 2 mm liegt.The compression and pivoting movement of the bone plate is limited to a relatively small amount, in particular when vertebral bodies are connected, for example it can be provided that the sum of the smallest widths of all slots open to the same side of the plate between two contact areas between 0.5 and 2 mm.
Es ist weiterhin günstig, wenn die Knochenplatte im Bereich der Schlitze eine größere Dicke aufweist als in den Anlagebereichen. Dadurch wird die Knochenplatte in den mit Schlitzen versehenen Abschnitten gegen eine Verbiegung aus der Knochenplattenebene heraus verstärkt, so daß trotz der Querschnittsschwächung durch die Schlitze die Festigkeit gegen eine solche Biegung erhalten bleibt.It is furthermore favorable if the bone plate has a greater thickness in the area of the slots than in the contact areas. As a result, the bone plate in the sections provided with slots is reinforced against bending out of the plane of the bone plate, so that despite the cross-sectional weakening through the slots, the strength against such a bending is retained.
Bei einer bevorzugten Ausführungsform ist vorgesehen, daß die Knochenplatte im Bereich der Schlitze mit einer verschleißmindernden Beschichtung versehen ist.In a preferred embodiment it is provided that the bone plate is provided with a wear-reducing coating in the region of the slots.
Günstig ist es, wenn die Knochenplatte im Anlagebereich mindestens einen quer zur Plattenfläche abstehenden Dorn trägt, vorzugsweise einen Dorn mit einem rechteck- förmigen Querschnitt. Dieser Dorn tritt in das Knochenmaterial des Knochenteils ein, an dem der Anlagebereich anliegt, und fixiert zusammen mit der in das Knochenteil eingedrehten Knochenschraube den Anlagebereich der Knochenplatte zuverlässig relativ zum Knochenteil, insbesondere auch gegen eine Verdrehung in der Plattenebene.It is expedient if the bone plate in the contact area carries at least one mandrel protruding transversely to the plate surface, preferably a mandrel with a rectangular cross section. This mandrel enters the bone material of the bone part against which the contact area lies and fixes the contact area together with the bone screw screwed into the bone part Bone plate reliably relative to the bone part, in particular also against rotation in the plane of the plate.
Es ist dadurch sichergestellt, daß die Relativbewegung der Knochenteile zueinander ausschließlich durch den mit Schlitzen versehenen Teil der Knochenplatte gesteuert wird.This ensures that the relative movement of the bone parts to one another is controlled exclusively by the slotted part of the bone plate.
Im einfachsten Fall weist eine Knochenplatte zwei Anlagebereiche auf, zwischen denen sich ein Schlitz oder mehrere Schlitze befinden, es ist aber auch möglich, Knochenplatten mit mindestens drei Anlagebereichen vorzusehen, zwischen denen jeweils Schlitze angeordnet sind, so daß beispielsweise auch die Verbindung von drei nebeneinanderliegenden Wirbelkörpern mit einer solchen Knochenplatte möglich wird.In the simplest case, a bone plate has two abutment areas, between which there is a slot or several slits, but it is also possible to provide bone plates with at least three abutment areas, between which slots are arranged, so that, for example, the connection of three adjacent vertebral bodies is possible with such a bone plate.
Die nachfolgende Beschreibung bevorzugter Ausführungs- formen der Erfindung dient im Zusammenhang mit der Zeichnung der näheren Erläuterung. Es zeigen:The following description of preferred embodiments of the invention serves in conjunction with the drawing for a more detailed explanation. Show it:
Figur 1: eine Längsschnittansicht längs Linie 1-1 in Figur 2 durch zwei benachbarte Wirbelkörper und eine diese verbindende, mit Querschlitzen versehene Knochenplatte;1 shows a longitudinal sectional view along line 1-1 in FIG. 2 through two adjacent vertebral bodies and a bone plate connecting them and provided with transverse slots;
Figur 2: eine Draufsicht auf die Wirbelkörper und die Knochenplatte der Figur 1 undFigure 2: a plan view of the vertebral body and the bone plate of Figure 1 and
Figur 3 : eine Ansicht ähnlich Figur 2 bei einem Ausführungsbeispiel zur Verbindung von drei nebeneinander liegenden Wirbelkörpern. Die Erfindung wird nachstehend am Beispiel der Verbindung von zwei oder mehreren Wirbelkörpern erläutert, die Erfindung kann aber auch bei der Verbindung von anderen Knochenteilen oder Knochenfragmenten Anwendung finden, bei denen eine Verbindung unter Beibehaltung einer gewissen Relativbewegungsmöglichkeit gewünscht wird.Figure 3: a view similar to Figure 2 in an embodiment for connecting three adjacent vertebral bodies. The invention is explained below using the example of the connection of two or more vertebral bodies, but the invention can also be used for the connection of other bone parts or bone fragments in which a connection is desired while maintaining a certain relative movement possibility.
Die in den Figuren 1 und 2 dargestellte Knochenplatte 1 dient der Verbindung von zwei benachbarten Wirbelkörpern 2, zwischen denen eine Bandscheibe 3 angeordnet ist.The bone plate 1 shown in FIGS. 1 and 2 serves to connect two adjacent vertebral bodies 2, between which an intervertebral disc 3 is arranged.
Die Knochenplatte 1 hat die Form eines länglichen Plattenstreifens, sie endet an beiden Seiten jeweils in einem Anlagebereich 4, dessen Breite gegenüber dem zwischen den Anlagebereichen 4 liegenden Mittelbereich 5 reduziert ist. In jedem Anlagebereich 4 ist eine Durchstecköffnung 6 für eine Knochenschraube 7 vorgesehen, bei dem dargestellten Ausführungsbeispiel hat die Durchstecköffnung 6 einen kugelkalottenförmigen Querschnitt, an dem ein ebenfalls kugelkalottenförmiger Kopf 8 der Knochenschraube 7 so angelegt werden kann, daß die Knochenschraube 7 gegenüber der Knochenplatte in gewissem Umfange geneigt werden kann ( Figur 1 ) .The bone plate 1 has the shape of an elongated plate strip, it ends on both sides in a contact area 4, the width of which is reduced compared to the central area 5 lying between the contact areas 4. In each contact area 4, a push-through opening 6 is provided for a bone screw 7, in the exemplary embodiment shown the push-through opening 6 has a spherical cap-shaped cross section, on which a likewise spherical cap-shaped head 8 of the bone screw 7 can be placed in such a way that the bone screw 7 relative to the bone plate to a certain extent Can be inclined to a large extent (Figure 1).
Auf ihrer dem Knochen zugewandten Seite ist die Knochenplatte 1 eben ausgebildet, auf dieser Seite trägt sie unmittelbar neben den Durchstecköffnungen jeweils einen senkrecht von der Knochenplatte 1 abstehenden Dorn 9, der im Querschnitt rechteckig ausgebildet ist und sich etwa über die halbe Breite der Knochenplatte 1 erstreckt. Dieser Dorn 9 ist einstückig mit der Knochenplatte 1 ausgebildet und zwischen den SeitenrändernOn its side facing the bone, the bone plate 1 is flat, on this side it carries, in addition to the push-through openings, a mandrel 9 projecting perpendicularly from the bone plate 1, which is rectangular in cross-section and extends approximately over half the width of the bone plate 1 extends. This mandrel 9 is formed in one piece with the bone plate 1 and between the side edges
10 der Knochenplatte 1 mittig positioniert.10 of the bone plate 1 positioned in the middle.
Der Mittelbereich 5 der Knochenplatte 1 weist eine größere Dicke auf als die beiden Anlagebereiche 4, beispielsweise kann die Dicke in diesem Bereich 20 bis 40% größer sein als im Anlagebereich 4.The central area 5 of the bone plate 1 has a greater thickness than the two contact areas 4, for example the thickness in this area can be 20 to 40% greater than in the contact area 4.
In diesem Mittelbereich 5 sind mehrere Querschlitze 11 angeordnet, die jeweils an einem Seitenrand 10 der Knochenplatte 1 beginnen und sich über einen erheblichen Teil der Breite der Knochenplatte 1 erstrecken, in dem dargestellten Ausführungsbeispiel etwa über dreiviertel der Breite der Knochenplatte 1. Jeder Querschlitz 11 weist zwei ebene, vom offenen Ende 12 des QuerschlitzesIn this central region 5, a plurality of transverse slots 11 are arranged, each beginning at a side edge 10 of the bone plate 1 and extending over a considerable part of the width of the bone plate 1, in the exemplary embodiment shown approximately three-quarters of the width of the bone plate 1. Each transverse slot 11 has two flat, from the open end 12 of the cross slot
11 ausgehend divergierende Seitenwände 13 auf, die am geschlossenen Ende des Querschlitzes 11 in eine im wesentlichen kreisförmige Erweiterung 14 einmünden. Bei dem dargestellten Ausführungsbeispiel sind vier derartige Querschlitze in geringfügigem Abstand nebeneinander längs der Knochenplatte 1 angeordnet, wobei jeweils benachbarte Querschlitze 11 zu gegenüberliegenden Seitenrändern 10 der Knochenplatte 1 hin offen sind, die benachbarten Querschlitze 11 sind also jeweils entgegengesetzt angeordnet.11 starting from diverging side walls 13 which open into an essentially circular extension 14 at the closed end of the transverse slot 11. In the exemplary embodiment shown, four such transverse slots are arranged next to one another at a slight distance along the bone plate 1, adjacent cross-slots 11 being open toward opposite side edges 10 of the bone plate 1, so the adjacent transverse slots 11 are arranged opposite each other.
Die Knochenplatte 1 besteht aus einem körperverträglichen Material, das in geringem Umfange elastisch verformbar ist, beispielsweise aus Titan, aus einer Titanlegierung, es ist jedoch auch die Verwendung eines Verbundwerkstoffes möglich, beispielsweise von karbonfaserverstärktem Polyetheretherketon. Durch die Breite und die Dimensionierung der Querschlitze 11 kann die Beweglichkeit der Knochenplatte 1 eingestellt werden, so daß nur eine begrenzte Kompression und eine begrenzte Verschwenkung der Anlagebereiche in der Ebene der Knochenplatte möglich sind. Beispielsweise können bei der Verbindung von benachbarten Wirbelkörpern Knochenplatten zur Anwendung kommen, die etwa eine Länge von 50 mm, eine Breite von knapp 20 mm und eine Dicke von 4 mm aufweisen, wobei die Breite der Schlitze an deren offenem Ende 12 0,3 mm beträgt und ihr Abstand 1 bis 2 mm. Mit einer solchen Knochenplatte kann in axialer Richtung eine maximale Kompression von 0,6 mm erreicht werden und eine maximale Verbiegung in der Größenordnung von 2,5°. Selbstverständlich können diese Abmessungen entsprechend den Anforderungen abgeändert werden, dies gilt auch für die Anzahl der Querschlitze.The bone plate 1 consists of a body-compatible material that is elastically deformable to a small extent, for example titanium, a titanium alloy, but it is also possible to use a composite material, for example carbon fiber-reinforced polyether ether ketone. By the width and the dimensioning of the transverse slots 11, the mobility of the bone plate 1 can be adjusted, so that only a limited compression and a limited pivoting of the contact areas in the plane of the bone plate are possible. For example, when connecting adjacent vertebral bodies, bone plates can be used which have a length of approximately 50 mm, a width of just under 20 mm and a thickness of 4 mm, the width of the slots at their open end 12 being 0.3 mm and their distance 1 to 2 mm. With such a bone plate, a maximum compression of 0.6 mm can be achieved in the axial direction and a maximum deflection of the order of 2.5 °. Of course, these dimensions can be changed according to the requirements, this also applies to the number of cross slots.
Um mit einer solchen Knochenplatte zwei Wirbelkörper miteinander zu verbinden, wird die Knochenplatte beispielsweise ventral - lateral an die Wirbelkörper herangeführt und mit Hilfe der Knochenschrauben 7 gegen deren Außenseite gespannt, dabei treten die Dorne 9 in die Wirbelkörper 2 ein und fixieren die Knochenplatte 1 zusammen mit den Knochenschrauben 7 sicher an den Wirbelkörper. Die Knochenschrauben 7 können mit einer Längsbohrung 15 versehen sein, so daß die Knochenschrauben längs eines in den Wirbelkörper eingesetzten Führungsdrahtes in den Wirbelkörper eingeschraubt werden können, der nach dem Eindrehen der Knochenschrauben 7 wieder entfernt wird. Bei dem Ausführungsbeispiel der Figuren 1 und 2 weist die Knochenplatte 1 zwei Anlagebereiche 4 und einen einzigen dazwischen angeordneten Mittelbereich 5 auf.In order to connect two vertebral bodies to one another with such a bone plate, the bone plate is, for example, brought ventrally-laterally to the vertebral body and is tightened against the outside using the bone screws 7, the spikes 9 enter the vertebral body 2 and fix the bone plate 1 together the bone screws 7 securely to the vertebral body. The bone screws 7 can be provided with a longitudinal bore 15 so that the bone screws can be screwed into the vertebral body along a guide wire inserted into the vertebral body, which is removed again after the bone screws 7 have been screwed in. In the embodiment of FIGS. 1 and 2, the bone plate 1 has two contact areas 4 and a single central area 5 arranged between them.
Bei dem Ausführungsbeispiel der Figur 3 sind insgesamt drei im Abstand voneinander angeordnete Anlagebereiche 4 vorgesehen, wobei jeweils zwischen zwei benachbarten Anlagebereichen 4 ein Mittelbereich 5 mit Querschlitzen 11 vorgesehen ist, mit einer solchen Knochenplatte können drei benachbarte Wirbelkörper 2 relativ zueinander so fixiert werden, daß in Längsrichtung der Knochenplatte eine geringe Kompressionsmöglichkeit verbleibt und daß benachbarte Wirbelkörper 2 in geringem Umfange um eine Schwenkachse gegeneinander verschwenkt werden können, die senkrecht auf der Knochenplatte 1 steht. Eine Verschwenkung aus der Knochenplattenebene 1 heraus ist dagegen durch die Stabilität des Mittelbereichs 5 weitgehend ausgeschlossen, insbesondere durch die Verdickung des Mittelbereichs 5 gegenüber den Anlagebereichen 4. In the embodiment of Figure 3, a total of three spaced-apart abutment areas 4 are provided, with a middle area 5 with transverse slots 11 being provided between two adjacent abutment areas 4, with such a bone plate, three adjacent vertebral bodies 2 can be fixed relative to one another such that in In the longitudinal direction of the bone plate there remains little possibility of compression and that adjacent vertebral bodies 2 can be pivoted to a small extent against one another about a pivot axis which is perpendicular to the bone plate 1. A pivoting out of the bone plate level 1, on the other hand, is largely precluded by the stability of the central region 5, in particular by the thickening of the central region 5 with respect to the contact regions 4.

Claims

P A T E N T A N S P R Ü C H EP A T E N T A N S P R U C H E
Knochenplatte ( 1 ) zur Verbindung von mindestens zwei Knochenteilen, insbesondere Wirbelkörpern ( 2 ) , mit einem plattenformigen Anlagebereich ( 4 ) für jedes Knochenteil und mit mindestens einer Durchstecköffnung ( 6 ) für eine Knochenschraube (7) in jedem Anlagebereich (4), dadurch gekennzeichnet, daß zwischen zwei Anlagebereichen Bone plate (1) for connecting at least two bone parts, in particular vertebral bodies (2), with a plate-shaped contact area (4) for each bone part and with at least one insertion opening (6) for a bone screw (7) in each contact area (4), characterized that between two investment areas
(4) mindestens ein quer zur Längsrichtung der Knochenplatte (1) verlaufender Schlitz (11) in der Knochenplatte (1) angeordnet ist, der an einer Seitenkante ( 10 ) der Knochenplatte ( 1 ) beginnt und sich mindestens bis zur halben Breite der Knochenplatte ( 1 ) erstreckt .(4) at least one slot (11) running transversely to the longitudinal direction of the bone plate (1) is arranged in the bone plate (1), which begins at a side edge (10) of the bone plate (1) and extends at least up to half the width of the bone plate (4) 1) extends.
Knochenplatte nach Anspruch 1, dadurch gekennzeichnet, daß die Länge des oder der Schlitze (11) mindestens dreiviertel der Breite der Knochenplatte (1) beträgt.Bone plate according to claim 1, characterized in that the length of the slot or slots (11) is at least three-quarters of the width of the bone plate (1).
Knochenplatte nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß bei einer Knochenplatte (1) mit mehreren Schlitzen (11) benachbarte Schlitze (11) an gegenüberliegenden Seitenkanten (10) der Knochenplatte (1) beginnen. Knochenplatte nach einem der voranstehenden Ansprüche, dadurch gekennzeichnet, daß die Schlitze (11) an ihrem in der Knochenplatte (1) liegenden Ende in einer Erweiterung (14) enden.Bone plate according to claim 1 or 2, characterized in that in the case of a bone plate (1) with a plurality of slots (11), adjacent slots (11) begin on opposite side edges (10) of the bone plate (1). Bone plate according to one of the preceding claims, characterized in that the slots (11) end in an extension (14) at their end lying in the bone plate (1).
5. Knochenplatte nach Anspruch 4, dadurch gekennzeichnet, daß die Erweiterung (14) kreisförmig ausgebildet ist.5. Bone plate according to claim 4, characterized in that the extension (14) is circular.
Knochenplatte nach einem der voranstehenden Ansprüche, dadurch gekennzeichnet, daß die Seitenwände (13) des oder der Schlitze (11) in Richtung auf das offene, an einer Seitenkante (10) der Knochenplatte (1) liegende Ende (12) konvergieren.Bone plate according to one of the preceding claims, characterized in that the side walls (13) of the slot or slots (11) converge towards the open end (12) lying on a side edge (10) of the bone plate (1).
Knochenplatte nach einem der voranstehenden Ansprüche, dadurch gekennzeichnet, daß die Summe der kleinsten Breiten aller zur selben Seite der Knochenplatte (1) hin offenen Schlitze (11) zwischen jeweils zwei Anlagebereichen (4) zwischen 0,5 und 2 mm liegt.Bone plate according to one of the preceding claims, characterized in that the sum of the smallest widths of all slots (11) open to the same side of the bone plate (1) between two contact areas (4) is between 0.5 and 2 mm.
8. Knochenplatte nach einem der voranstehenden Ansprüche, dadurch gekennzeichnet, daß die Knochen- platte (1) im Bereich der Schlitze (11) eine größere Dicke aufweist als in den Anlagebereichen (4). 8. Bone plate according to one of the preceding claims, characterized in that the bone plate (1) has a greater thickness in the area of the slots (11) than in the contact areas (4).
Knochenplatte nach einem der voranstehenden Ansprüche, dadurch gekennzeichnet, daß die Knochenplatte (1) im Bereich des Schlitzes (11) mit einer verschleißmindernden Beschichtung versehen ist. Bone plate according to one of the preceding claims, characterized in that the bone plate (1) is provided with a wear-reducing coating in the area of the slot (11).
10. Knochenplatte nach einem der voranstehenden Ansprüche, dadurch gekennzeichnet, daß sie im Anlagebereich (4) mindestens einen quer zur Plattenfläche abstehenden Dorn (9) trägt.10. Bone plate according to one of the preceding claims, characterized in that it carries at least one mandrel (9) projecting transversely to the plate surface in the contact area (4).
11. Knochenplatte nach Anspruch 10, dadurch gekennzeichnet, daß der Dorn (9) im Querschnitt rechteckig ist.11. Bone plate according to claim 10, characterized in that the mandrel (9) is rectangular in cross section.
12. Knochenplatte nach einem der voranstehenden Ansprüche, dadurch gekennzeichnet, daß sie mindestens drei Anlagebereiche (4) umfaßt, zwischen denen jeweils Schlitze (11) angeordnet sind. 12. Bone plate according to one of the preceding claims, characterized in that it comprises at least three contact areas (4), between which slots (11) are arranged.
PCT/EP2001/000883 2000-02-03 2001-01-27 Bone plate WO2001056489A1 (en)

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