CN101094627A - 全椎间盘置换的方法和装置 - Google Patents
全椎间盘置换的方法和装置 Download PDFInfo
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- CN101094627A CN101094627A CNA2005800453053A CN200580045305A CN101094627A CN 101094627 A CN101094627 A CN 101094627A CN A2005800453053 A CNA2005800453053 A CN A2005800453053A CN 200580045305 A CN200580045305 A CN 200580045305A CN 101094627 A CN101094627 A CN 101094627A
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- Prior art keywords
- intervertebral
- prosthesis
- prostheses
- intervertebral prostheses
- spherical crown
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Orthopedic Medicine & Surgery (AREA)
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- Neurology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Public Health (AREA)
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- Vascular Medicine (AREA)
- Cardiology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Veterinary Medicine (AREA)
- Physical Education & Sports Medicine (AREA)
- Prostheses (AREA)
- Materials For Medical Uses (AREA)
- Automatic Disk Changers (AREA)
- Holders For Sensitive Materials And Originals (AREA)
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- Portable Nailing Machines And Staplers (AREA)
Abstract
一种通过背路全置换受损椎间盘的方法,包括步骤:取走受损的椎间盘(3)的椎间盘物质;通过椎间孔外路(23)将椎间假体(30)***到椎间盘间隙中。一种椎间假体(100),特别是椎间盘假体包括:A)第一假体组件(101),其具有横过中心轴线(103)设置的第一并置表面(107);B)第二假体组件(102),其具有横过中心轴线(103)设置的第二并置表面(108),;由此C)所述第一和第二假体组件(101,102)通过关节(106)相连;由此D)当平行于所述中心轴线(103)看时,所述第一和第二假体组件(101,102)是细长的形状,其具有长轴(127)和横向短轴(128);E)所述中心轴线(103)、长轴(127)和横向短轴(128)相交,所述中心轴线(103)与横向短轴(128)确定了一个中面(126);F)所述第一和第二假体组件(101,102)具有与所述中心轴线(103)垂直的横截面,其基本是卵形或椭圆形的;由此G)所述横截面包括至少两个凹部(125,130),其位于所述中面(126)的不同侧和所述长轴(127)的同侧上。
Description
背景技术
目前,关于全椎间盘置换装置***的现有技术是前路植入,即正前路,侧前路(倾斜的),侧路。外科医生根据治疗级别或他的个人经验在经腹膜进路或腹膜后路之间确定。然而,由于存在主血管(例如,动脉,腔静脉),在有血管外科医生的情况下,到脊柱的前路被经常采用,因而带来额外的花费。
在GERBER的US6719794中,公开了椎间熔合植入的***方法。取走受损伤的椎间盘,同时经过与脊椎中线偏移的后路进行移植***到受损伤的椎间盘,不利地是,这样的经椎间孔路包括小关节的局部解剖。
从EISERMANN的US2004/0225365中得知了用于经椎间孔路***到椎间隙的假体装置。为了允许第一和第二组件以及其邻接的椎骨之间的关节运动,已知的假体装置包括两个具有关节面的组件。已公开的经椎间孔路可能引起对例如神经根、硬脑膜、黄韧带和椎间韧带的重要的解剖结构的潜在破坏。
发明内容
因此,本发明的目的是提供用于全椎间盘置换装置***的方法,包括背路植入脊椎,无需完全或局部解剖小关节。
根据本发明的方法,通过椎间孔外路可以实现上述目的,其中椎间孔外路包括一个入口,其位于前纵韧带和后纵韧带之间的椎间纤维软骨中,用于取走受损伤的椎间盘并植入全椎间盘替换物。
本发明的方法提供了下列特定的优点:
与前路或椎间孔路相比,可以获得通向椎间隙的较宽的开口;
外科医生通过神经组织,不需切开小关节;
可在脊椎横突可视的情况下,进行正确的路径检测;
当进行背部固定程序时,病人处于卧姿;以及
外科医生习惯于对病人进行定位和切割。
在优选实施例中,椎间孔外路进入椎间盘的关键元素是在横突(脊椎横突)前面的路径。
在另一实施例中,该方法还包括下列步骤:
A)通过对准腰背筋膜,超过中间(extra-medially)进行背部切割,即远离中纵平面;
B)用基尔希讷氏丝(Kirschner wire)接近受损伤的椎间盘;
C)沿基尔希讷氏丝将套管针和保护套管***到受损伤的椎间盘;
D)用切割仪器切割出一个宽为W、面积为A的通向椎间纤维软骨的入口;
E)用手术设备取走椎间盘的物质:
F)用手术设备清洁相邻上下椎体的端板;
G)用牵张器打开或扩大椎间隙;
H)利用植入固定器将椎间假体通过该入口***。
在另一实施例中,用手术设备通过保护套管取走椎间盘物质。优点是在取走椎间盘物质期间,保护套管的使用能够更好的保护周围的软组织。
在另一实施例中,在距前纵韧带和后纵韧带的距离X>0处切割入口,优点是为了稳定可能发生危险的椎骨段,使前纵韧带和后纵韧带保持完好。
在另一实施例中,该距离X为2mm到38mm之间。
在又一实施例中,入口的宽度W处于8mm到36mm之间。
在另一实施例中,入口的面积A处于24mm2到684mm2之间,高度优选处在3到19mm之间。
在又一实施例中,与要治疗的椎间盘相邻的椎体的牵张步骤通过保护套管执行。
在另一实施例中,为了保持外科医生对该位置的开阔视野,与要治疗的椎间盘相邻的椎体的牵张通过轻微地弯曲牵张器来执行。
在又一实施例中,在不切开小关节的情况下可执行全椎间盘置换程序。
在另一实施例中,在不切开横突脊椎的情况下可执行全椎间盘置换程序。
在又一实施例中,通向要治疗的椎间隙的通道基本是直的。优点是由于通道基本是直的,可以使用基本为直的仪器例如清洁相邻的椎体端板或进行其它的手术操作。
在另一实施例中,切口减小成管。
在又一实施例中,利用通过(不接近)脊髓,并定位、移动以及标记神经根,减小破坏神经组织的风险。
本发明的另一目的是提供椎间假体,当从垂直于其中心轴线的方向看时,其轮廓具有最小的宽度,但仍具有足够的关节区。
根据本发明,通过椎间假体可实现上述目的,该假体主要包括第一和第二假体组件,每个组件具有横过该中心轴线布置的并置表面,适于接触每个相邻椎体的端板。此外,所述第一和第二假体组件通过关节相连。当平行于所述中心轴线看时,所述第一和第二假体组件是细长的形状,其具有长轴和横向短轴线,由此所述中心轴线长轴和横向短轴相交,所述中心轴线与横向短轴确定了一个中面。所述第一和第二假体组件具有与所述中心轴线垂直的横截面,其基本是卵形或椭圆形的,所述横截面包括至少第一和第二凹面,其位于中面的不同侧和长轴的同侧上。
根据本发明的椎间假体具有下列特定优点:
第一和第二假体组件在面向其侧端的部分具有较小的宽度,但与关节所在的中面仍具有足够的邻接宽度,所述较小的宽度允许通过椎间孔外路进行移植,所述与中面的足够的邻接宽度可以实现适合于正常椎间盘的关节结构;
为了特别注意这个事实,即在假体所在的位置在它们变性期间,椎体的多骨端板形状发生变化,即,一段时间后它们变得较起伏,第一和第二假体组件(骨接触板)上的不必要的物质要被取走;以及
外科医生决定不取走的脊椎端板的后边界上的可能的骨赘也要考虑在内,即,因为假体可在起伏的端板上操作,所以椎间假体可以较容易地定位。
在椎间假体的优选实施例中,所述第一和第二假体组件的横截面是放大的肾的形状,其基本对称于所述中面设置。
在另一实施例中,所述至少两个凹面具有大致半椭圆形或半卵形形状。
在又一实施例中,所述至少两个凹面基本对称于所述中面设置。
仍在另一实施例中,所述第一和第二假体组件具有平行于所述长轴测量的长度H,其中所述的至少两个凹面每个都具有平行于所述长轴测量的宽度W,所述宽度W等于所述长度H的15%到35%之间。
在又一实施例中,所述第一和第二假体组件具有平行于所述横向短轴测量的最大宽度B,其中所述的至少两个凹面每个都具有平行于所述横向短轴测量的深度T,所述深度T等于所述最大宽度B的5%到25%之间。
在另一实施例中,所述第一和第二假体组件的所述横截面具有大致椭圆形的边界,所述边界第一辅助顶点处的曲率半径小于第二辅助顶点处的曲率半径。
在又一实施例中,所述第一辅助顶点与所述至少两个凹面处于所述长轴的同侧。
在另一实施例中,假体组件的长度H与其宽度B的比是3∶1到5∶1之间。这种设计的主要优点是:为了将两个假体组件植入椎间隙(椎间盘)中,唯一必须的是清出狭窄的入口通道以实现椎间孔外路。
在另一实施例中,所述关节设置为球窝关节,其包括连接到该第一和第二假体组件之一的球冠和适合所述球冠的处于所述第一和第二假体组件中的另一个中的球窝。
在又一实施例中,椎间假体是由两部分组成的,即,球冠与两个假体组件之一制成一件。
在另一实施例中,假体组件是由三部分组成的,使得形成第三部分的球冠可连接到两个假体组件之一。从该事实可基本看出这种设计的优点:板和球冠可使用不同的材料制成,从而可以实现关节面最佳的滑动性能。板的优选材料是钛或钛合金以及聚醚醚酮或覆膜变体,球冠的优选材料是高交联聚乙烯(X-UHMWPE)、钴和铬的合金或陶瓷材料。
仍在另一实施例中,椎间假体至少由三部分组成,且包括具有球窝的关节外壳,由此所述关节外壳可连接到所述第一和第二假体组件之一作为第三部分。从该事实可基本看出这种设计的优点:板和球冠可使用不同的材料制成,从而可以实现关节面最佳的滑动性能。
在又一实施例中,球冠和关节外壳由金属和塑料制成的混合材料组成。这个实施例的优点是:可以使用已得到证实的关节替换材料,例如高交联聚乙烯(X-UHMWPE)以及钴和铬的合金。而且从该事实可看到其它优点:可以实现关节面相对位移的较低的摩擦力,而且能够补偿轴向冲击载荷。
在另一实施例中,使用陶瓷-陶瓷关节。
在又一实施例中,球冠和球窝表面覆有碳化钛或无定形碳(ADLC),从而显著地降低了摩擦系数。
在另一实施例中,至少球冠是由记忆金属或能够膨胀的材料(例如,水凝胶)制成。
仍在另一实施例中,至少球冠是由可流动的热固性材料制成。包含这种热固性的、易流动的物质的单体、共聚用单体、均聚物、低聚物或混合物可从下面组进行恰当地选择:
a)聚乙二醇,优选聚乙二醇丙烯酸酯;
b)n-乙烯吡咯烷酮;以及
c)乙烯基,优选乙烯醇;以及
d)苯乙烯。
由此得到的聚合体可以对其弹性进行较大改变。从该事实可基本看出这种设计的优点:由于关节体积的减小,椎间假体的***具有较小的侵入性,增大后的体积适于实现最佳的关节功能。
在另一实施例中,该第一假体组件选自第一套至少M≥2的第一假体组件,第二假体组件选自第二套至少N≥2的第二假体组件。所述第一和第二套可包括设有不同高度、关节半径或各自半径的中心位置,即,旋转中心的第一和第二假体组件。通过该实施例,可以实现下列优点:
当两个组件部件以组合方式设置时,旋转中心的位置是可调节的:
组件也可对球冠的半径进行改变,这使得调节椎间假体的旋转中心成为可能;
旋转中心的位置、角度、椎间假体的平动部分可在相当广泛的范围内自由选择,该平动部分是横过假体组件的中心轴线的相对运动部分;
假体组件也可考虑运动部分的关节需求,因为可能包括具有不同半径的球冠。在偏移期间,较大的球冠半径具有较高的平动部分,在病人脊骨的弯曲作用下将增加的压力施加在小关节上,导致其加速受损;
假体组件的高度和椎间假体的关节球冠的相应半径可以改变,因而可适应于不同椎间隙的尺寸。
在另一实施例中,每个所述第一和第二假体组件包括中间面,所述第一和第二中间面互相面对。至少第一或第二中间面设有至少一个具有切口的腔,其设置在所述第一和第二假体组件的第一或/和第二侧端,所述具有切口的腔适合于容纳植入固定器的锚固构件。
根据本发明的植入固定器设有套筒和锚固构件,例如,可***到腔和切口中的钩状构件,其可移动地布置在套筒的中心孔中,所述植入固定器还具有设有前部的前端,该前部与根据本发明的椎间假体的第一和/或第二组件的侧端相适合。此外,植入固定器设有固定机构,以将锚固构件推向套筒,从而将椎间假体的侧端压靠在该前部上。
附图说明
参照示出了根据本发明的方法的附图,结合下面的说明,本发明的其它目的和优点将变得更加明显。在附图中:
图1是通过脊柱、垂直于该脊柱的纵轴线的横剖面;
图2是处于卧姿的病人背部的平面视图;
图3是病人背部肌肉构造的平面视图;
图4是通过病人身体、垂直于脊柱的纵轴线的横剖面,且从头盖看去;
图5是脊柱的腰椎部分的透视图,根据本发明方法的实施例的一个步骤,基尔希讷氏丝***到受损伤的椎间盘;
图6是脊柱的腰椎部分的透视图,根据本发明方法的实施例的一个步骤,套管针和保护套管在基尔希讷氏丝上滑动;
图7是脊柱的腰椎部分的透视图,根据本发明方法的实施例的一个步骤,切割设备滑动通过盖保护套;
图8是脊柱的腰椎部分的透视图,切出一个通向受损的椎间盘的入口;
图9是根据本发明方法的实施例的一个步骤,脊柱的腰椎部分连同牵张器的透视图;
图10是根据本发明方法的实施例的一个步骤,脊柱的腰椎部分连同椎间假体以及植入固定器的透视图;
图11是脊柱部分连同***的椎间假体的侧视图;
图12是脊柱部分连同***的椎间假体的前视图;
图13是根据本发明的椎间假体的实施例的顶视图;
图14是图13实施例的正视图;
图15是图13和图14的实施例的侧视图;
图16是图13-15的实施例的第二假体组件的透视图;
图17是沿图16的第二假体组件的长轴的横剖面;
图18是图16和图17的第二假体组件的一个侧端的放大视图;
图19是根据本发明,图16-18的第二假体组件连同植入固定器的实施例的前端的透视图;以及
图20是根据本发明,图16-18的第二假体组件连同植入固定器的实施例的套筒部分的透视图。
具体实施方式
根据本发明,通过椎间孔外路置换椎间盘的优选方法的说明:
1.进行超过中间(extra-medial)大约7cm,即,距离中纵面2大约7cm的背部切割12,由此为了最小化的肌肉损伤,以腰背筋膜为目标(图3);
2.用基尔希讷氏丝14接近受损的椎间盘3,该基尔希讷氏丝在横突脊椎6前面的椎间孔外路23中,由此必须使用X-射线控制,例如图像增强器(图5);
3.沿基尔希讷氏丝14经过肋突17将套管针15和保护套管16***到受损的椎间盘3(图6);
4.用切割仪器19切出一个宽W高H(图8)的入口9,通向远离前纵韧带5(图1)和后纵韧带5(图1)的椎间纤维软骨18;
5.用通过保护套管16的刮匙、骨钳、勺子取走椎间盘物质,优选使用内窥镜;
6.清洁相邻上下椎体10、11的端板,特别是,使用特殊仪器,如喷水器或超声装置,优选使用内窥镜;
7.为了保持外科医生对该位置的开阔视野,通过轻微地弯曲牵张器20取走受损的椎间盘3,由此通过保护套管16(图6)或软组织牵开器进行牵张(图9);
8.利用植入固定器22通过入口9***椎间假体30,由此为了控制椎间假体30的位置,必须使用X-射线控制,例如图像增强器(图10)。
在椎骨的后外侧融合时,例如,通过利用接骨螺钉将骨移植物固定到蒂或横突脊椎上,椎间孔外路进入椎体的详细说明可在下述文献中找到:
Watkins Melvin B.
“Posterolateral fusion of the lumbar and lumbosacral spine”
J Bone Joint Surg Am.1953 Oct;35-A(4):1014-8
Watkins Melvin B.
“Posterolateral fusion in pseudoarthrosis and posterior elementdefects of the lumbosacral spine”
Clin Orthop Relat Res.1964 Jul-Aug;35:80-5.
图11和12示出了手术过程完成后的情形,即,椎间假体30已经植入到两个椎体10、11之间。所示的椎间假体包括上和下并置构件24、25,其外表面椎体10、11的端板。此外,椎间假体30包括关节地连接到该上和下并置构件24、25的关节26,使得两个并置构件24、25之间以及两个相邻的椎骨10、11之间能够实现关节运动。
图13-15示出了椎间假体100的实施例,其包括第一假体组件101,第二假体组件102以及关节地连接所述第一和第二假体组件101、102的关节106。与所述关节106相对的该第一和第二假体组件101、102分别包括第一并置表面107、第二并置表面108,由此所述第一并置表面107构造成用于抵靠从顶部接触该椎间假体100的第一椎间体10的基板,而第二并置表面108构造成用于抵靠从底部接触该椎间假体100的第二椎间体11的覆板。关节106构造为球窝关节,所述球窝关节包括处于第二假体组件102处的球冠112和处于第一假体组件101中的与所述球冠112相叠合的球窝111。
每个第一和第二并置表面108、109横过中心轴线103设置。当平行于所述中心轴103看时,所述第一和第二假体组件101、102具有细长的形状,其具有长轴127和横向短轴128,由此所述中心轴103、长轴127和横向短轴128相交。所述中心轴103与横向短轴128还确定了一个中面126。此外,所述第一和第二假体组件101、102具有与所述中心轴103垂直的横截面,其基本是椭圆形的,所述横截面包括两个凹面125,其位于所述中面126的不同侧和所述长轴127的同侧上。
两个凹面125对称于所述中面126设置,使得所述两个凹面125之一设置在圆的第一象限,该圆的中心与长轴127、横向短轴128以及中心轴103的交点重合,其圆周与所述横截面的边界129在主顶点处相切。所述两个凹面125的第二个顺时针地设置在所述圆的紧接的第二象限。此外,两个凹面125具有大致半椭圆形状,在平行于所述横向短轴128方向测得的深度为T,其等于所述第一和第二假体组件101、102的最大宽度B的大约5%。
该第一和第二假体组件101、102分别包括中间面109、110,所述第一和第二中间面109、110互相面对。如图16到18所示,第二中间面110设有两个腔131,所述腔具有设置在所述第一和第二假体组件101、102的第一和第二侧端133、134处的切口132,由此所述具有切口132的腔131适合于容纳植入固定器22的锚固构件141(图19、20),从而在从左侧或右侧接近椎间隙时,外科医生可以选择各自的孔133。
图19和20示出了植入固定器22的实施例,其设有套筒140和锚固构件141,以及一个位于前端的钩状构件。锚固构件141可***到孔131和切口132中,并且可移动地布置在套筒140的中心孔中。植入固定器22还具有设有前部143的前端142,该前部143与该第一和/或第二假体组件101、102的侧端133、134(图16)相适合。此外,植入固定器22设有固定机构(图中未示出),以将锚固构件141推到套筒140中,从而将椎间假体的侧端133压靠在前部143上。为了使椎间假体100能够沿椎间孔外路***,套筒140是弯曲的。
Claims (40)
1、一种通过背路全置换受损伤的椎间盘的方法,包括步骤:取走受损的椎间盘(3)的椎间盘物质;通过椎间孔外路(23)将椎间假体(30)***到椎间盘间隙中。
2、根据权利要求1所述的方法,其特征在于:椎间孔外路(23)在横突脊椎的前面经过。
3、根据权利要求1或2所述的方法,还包括下列步骤:
A)通过以腰背筋膜为目标,进行超过中间地(extra-medially)背部切割(12),即远离中纵平面(2);
B)用基尔希讷氏丝(14)接近受损的椎间盘(3);
C)沿基尔希讷氏丝(14)将套管针(15)和保护套管(16)***到受损的椎间盘(3);
D)用切割仪器(19)切割出一个宽W、面积为A的通向椎间纤维软骨(18)的入口(9);
E)用手术设备取走椎间盘的物质:
F)用手术设备清洁相邻上下椎体(10,11)的端板;
G)用牵张器(20)打开或扩大椎间隙;
H)利用植入固定器(22)将椎间假体(30)通过所述入口(9)***。
4、根据权利要求3所述的方法,其特征在于:用手术设备通过保护套管(16)将椎间盘物质取走。
5、根据权利要求3或4所述的方法,其特征在于:在距前纵韧带和后纵韧带的距离X>0处切割入口(9)。
6、根据权利要求5所述的方法,其特征在于:所述距离X等于2mm到38mm之间。
7、根据权利要求3到6的任意一项所述的方法,其特征在于:入口(9)的宽度W处于8mm到36mm之间。
8、根据权利要求3到7的任意一项所述的方法,其特征在于:入口(9)的面积A处于24mm2到684mm2之间。(高度在3到19mm之间)
9、根据权利要求3到8的任意一项所述的方法,其特征在于:与要治疗的椎间盘相邻的椎体的牵张通过保护套管(16)执行。
10、根据权利要求3到9的任意一项所述的方法,其特征在于:为了保持外科医生对位置的开阔视野,与要治疗的椎间盘相邻的椎体的牵张通过轻微地弯曲牵张器(20)来执行。
11、根据权利要求1到10的任意一项所述的方法,其特征在于:全椎间盘置换程序在不切开小关节的情况下执行。
12、根据权利要求1到11的任意一项所述的方法,其特征在于:全椎间盘置换程序在不切开横突脊椎的情况下执行。
13、根据权利要求1到12的任意一项所述的方法,其特征在于:通向要治疗的椎间隙的通道基本是直的。
14、根据权利要求1到13的任意一项所述的方法,其特征在于:切口可减小成管。
15、根据权利要求1到14的任意一项所述的方法,其特征在于:利用通过脊髓、定位、移动以及标记神经根,减小破坏神经组织的风险。
16、一种椎间假体(100),特别是椎间盘假体包括:
A)第一假体组件(101),其具有横过中心轴线(103)设置的第一并置表面(107),用于接触第一相邻椎间体的端板;
B)第二假体组件(102),其具有横过中心轴线(103)设置的第二并置表面(108),用于接触第二相邻椎间体的端板;由此
C)所述第一和第二假体组件(101,102)通过关节(106)相连;由此
D)当平行于所述中心轴线(103)看时,所述第一和第二假体组件(101,102)是细长的形状,其具有长轴(127)和横向短轴(128);
E)所述中心轴线(103)、长轴(127)和横向短轴(128)相交,所述中心轴线(103)与横向短轴(128)确定了一个中面(126);
F)所述第一和第二假体组件(101,102)具有与所述中心轴线(103)垂直的横截面,其基本是卵形或椭圆形的;由此
G)所述横截面包括至少两个凹部(125),其位于所述中面(126)的不同侧和所述长轴(127)的同侧上。
17、根据权利要求16所述的椎间假体(100),其特征在于:所述第一和第二假体组件(101,102)的横截面是放大的肾的形状,其基本对称于所述中面(126)设置。
18、根据权利要求16或17所述的椎间假体(100),其特征在于:所述至少两个凹部(125)具有大致半椭圆形或半卵形形状。
19、根据权利要求16到18的任意一项所述的椎间假体(100),其特征在于:所述至少两个凹部(125)基本对称于所述中面(126)设置。
20、根据权利要求16到19的任意一项所述的椎间假体(100),其特征在于:所述第一和第二假体组件(101,102)具有平行于所述长轴(127)测量的长度H,其中所述的至少两个凹面(125)每个都具有平行于所述长轴(127)测量的宽度W,所述宽度W等于所述长度H的15%到35%之间。
21、根据权利要求16到20的任意一项所述的椎间假体(100),其特征在于:所述第一和第二假体组件(101,102)具有平行于所述横向短轴(128)测量的最大宽度B,其中所述的至少两个凹面(125)每个都具有平行于所述横向短轴(128)测量的深度T,所述深度T等于所述最大宽度B的3%到25%之间。
22、根据权利要求16到21的任意一项所述的椎间假体(100),其特征在于:所述第一和第二假体组件(101,102)的所述横截面具有大致椭圆形的边界(129),所述边界(129)第一辅助顶点处的曲率半径小于第二辅助顶点处的曲率半径。
23、根据权利要求22所述的椎间假体(100),其特征在于:所述第一辅助顶点与所述至少两个凹部(125)处于所述长轴(127)的同侧。
24、根据权利要求16或23所述的椎间假体(100),其特征在于:所述第一和第二假体组件(101,102)具有平行于所述长轴(127)测量的长度H和平行于所述横向短轴(128)测量的最大宽度B,由此该长度H与宽度B的比是在3∶1到5∶1之间。
25、根据权利要求16到24的任意一项所述的椎间假体(100),其特征在于:所述关节(106)构造为球窝关节,其包括连接到所述第一和第二假体组件(101,102)之一的球冠(112)和适合所述球冠(112)、处于所述第一和第二假体组件(101,102)中的另一个中的球窝(111)。
26、根据权利要求25所述的椎间假体(100),其特征在于:第一和第二假体组件(101,102)之一与球冠(112)由一个构件组成。
27、根据权利要求25所述的椎间假体(100),其特征在于:所述椎间假体(100)至少由三部分组成,球冠(112)是可连接到所述第一和第二假体组件(101,102)之一的第三部分。
28、根据权利要求25或27的任意一项所述的椎间假体(100),其特征在于:所述椎间假体(100)至少由三部分组成,且包括具有球窝(111)的关节外壳,其可连接到所述第一和第二假体组件(101,102)之一作为第三部分。
29、根据权利要求28所述的椎间假体(100),其特征在于:球冠(112)和关节外壳由金属和塑料的材料配对制成。
30、根据权利要求28所述的椎间假体(100),其特征在于:球冠(112)和关节外壳由陶瓷-陶瓷的材料配对制成。
31、根据权利要求16到30的任意一项所述的椎间假体(100),其特征在于:球冠(112)和球窝(111)表面覆有碳化钛或无定形碳(ADLC)。
32、根据权利要求16到31的任意一项所述的椎间假体(100),其特征在于:至少球冠(112)是由记忆金属制成。
33、根据权利要求25到31的任意一项所述的椎间假体(100),其特征在于:至少球冠(112)是由能够膨胀的材料制成。
34、根据权利要求25到31的任意一项所述的椎间假体(100),其特征在于:至少球冠(112)是由可流动的热固性材料制成。
35、根据权利要求34所述的椎间假体(100),其特征在于:至少球冠(112)是由包含热固性的、易流动的物质的单体、共聚用单体、均聚物、低聚物或混合物制成。
36、根据权利要求35所述的椎间假体(100),其特征在于:所述热固性的、易流动的物质,可从下面选择:
a)聚乙二醇,优选聚乙二醇丙烯酸酯;
b)n-乙烯吡咯烷酮;以及
c)乙烯基,优选乙烯醇;以及
d)苯乙烯。
37、根据权利要求16到36的任意一项所述的椎间假体(100),其特征在于:所述第一假体组件(101)选自第一套至少M≥2的第一假体组件(101)。
38、根据权利要求16到37的任意一项所述的椎间假体(100),其特征在于:所述第二假体组件(102)选自第二套至少N≥2的第二假体组件(102)。
39、根据权利要求16到38的任意一项所述的椎间假体(100),其特征在于:所述第一和第二假体组件(101,102)每个都包括中间面(109,110),所述第一和第二中间面(109,110)互相面对,至少第一中间面(109)设有至少一个具有切口(132)的腔(131),其设置在所述第一和第二假体组件的第一或/和第二侧端(133,134),并且适合于容纳植入固定器(22)的锚固构件(141)。
40、一种设有套筒(140)和锚固构件(141)的植入固定器(22),其可移动地布置在套筒(140)的中心孔中,所述植入固定器(22)还具有设有前部(143)的前端(142),该前部(143)与根据权利要求16到39的任意一项所述的椎间假体(100)的第一和/或第二假体组件(101,102)的侧端(133,134)相适合。
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