CN101330886A - 小面关节假体 - Google Patents

小面关节假体 Download PDF

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Publication number
CN101330886A
CN101330886A CNA2006800471427A CN200680047142A CN101330886A CN 101330886 A CN101330886 A CN 101330886A CN A2006800471427 A CNA2006800471427 A CN A2006800471427A CN 200680047142 A CN200680047142 A CN 200680047142A CN 101330886 A CN101330886 A CN 101330886A
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CN
China
Prior art keywords
prosthese
guide post
supporting member
vertebra
slit
Prior art date
Legal status (The legal status 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 status listed.)
Granted
Application number
CNA2006800471427A
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English (en)
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CN101330886B (zh
Inventor
H·D·林克
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Facet Link Inc
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Deru GmbH
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    • A61F2/4405—Joints for the spine, e.g. vertebrae, spinal discs for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes
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Abstract

本发明涉及一种用于脊柱的小面关节(12)的假体，该假体包括支承件(23)和导向杆(21)。该支承件(23)包括用于支承在椎骨(1)的关节面(13，14)上的压板(24)和与之位置相反的支承嵌件(27)，该支承嵌件具有用于相邻椎骨(11)的关节面共同作用的关节面。该导向杆(21)借助摆动关节固定在支承件(23)上。这样，支承力始终通过压板(24)传递到椎骨(1)上。因此，导向杆(21)可设计成狭长，从而椎骨(1)上用于容纳导向杆的缝隙(18)同样也可设计成狭长。这实现了不仅保留骨质而且简单可靠的植入。

Description

小面关节假体
本发明涉及一种脊柱小面关节的假体，该假体包括支承件和保持件。
背部疼痛经常要归因于在脊柱区域内的病理变化。一种主要原因在于两个相邻椎骨之间的相互作用和它们的连接。这特别涉及椎间盘和小面关节。由于疾病或过度疲劳，或者因为受伤或老损，可能会损坏椎骨之间的连接。这导致了活动限制，疼痛，直至丧失活动性。过去的治疗关注椎间盘疗法。因此，已经公开了各种人造关节，这些人造关节代替损坏的自然椎间盘被植入。因而，间接地也会补偿小面关节上的缺陷或者减轻这些缺陷的后果。但是，已经表明，这是不足够的，而是在很多情况下也需要对小面关节进行针对性的治疗。
为了在小面关节区域内进行治疗，人们已经尝试了各种疗法。在最简单的情况下，治疗局限于减轻由小面关节而引起的疼痛，特别是通过在有关的小面关节区域内注射减痛剂。另一种疗法在于移除小面关节。因此，虽然疼痛的一个原因被消除，但是这是以脊柱生物机械学特性的严重变化为代价。缺少的小面关节明显降低了脊柱的稳定性并因此使得脊柱其他区域的负荷更重，这并非罕见地导致了在相邻连接的区域内的缺陷。对于相反的方法，即通过固定的连接来固定小面关节，也有类似的情况。在这里，生物机械学特性也受到负面影响。病人的活动性变得更糟，此外还使得在相邻椎骨的区域内的负荷更高。
此外，也已公开的是小面关节在它们的关节面区域内设有保护帽。为了给保护帽提供空间，必须在相当大的范围内从自然支承面中切除材料。这种去除组织常常会导致周围健全组织的自然供给的中断，结果是坏死性的变化。
为了克服传统的治疗方法的缺点，已经开发出各种小面关节假体。
WO-A-2004/098465公开了一种昂贵的椎间盘假体，其包括装在其上的附加的小面关节假体。因此，该假体适合同时治疗椎间盘和小面关节。由于这种结合，这种假体的结构复杂并且尺寸相对较大。这引起了入口尺寸大的昂贵的手术。用这种假体来治疗在颈椎区域的小面关节是有困难的。
WO-A-2005/037149公开了一种结构紧凑的小面关节假体。该假体具有一弹性元件，该弹性元件带有盘状的加厚部，该加厚部设置在小面关节的支承表面之间。假体的固定是通过固定元件来实现，这些固定元件被***在相应的关节突内的通孔内。由于这些通孔必须相互对齐，所以它们的形成相当难并且要求畅通无阻的入口。此外，该假体提供了一种灵活的，但原本不存在的小面关节的机械联接。在这一点上，生物机械学特性也改变了。
WO-A-2004/103227公开了另一种特殊的小面关节假体。该假体包括两个组件，它们分别具有支承件和用于固定在相邻椎骨上的保持件。上组件借助螺钉固定在椎骨板中。该螺钉具有相对长的杆部，该杆部导致了不利的杠杆比例，进而加重了骨板的负担。为了避免螺钉的折断，螺钉的尺寸必须设计得较大。该假体具有多个突出部，这本身带来了刺激周围组织的危险。此外，将上组件固定到骨板上，而不是固定在相应的关节突上，这导致了生物机械学特性的改变。US-A-2005/0049705公开了一种带有穿过骨板的紧固螺钉的类似小面关节假体。该固定螺钉以其头部位于骨板之上并通过在椎骨中形成的通道中延伸至下小面关节面，一支承件设置在此处并借助紧固螺钉被固定。该支承件与小面关节设置在相邻椎骨的相对件共同作用，该相对件借助简单的钟形件固定在椎骨上。这种假体的缺点在于，穿过骨板的通道的形成相当昂贵，而且支承件和螺钉的精确配合的接合是很困难的，因为该接合取决于相应的小面关节面角度。因此，特别是在脊柱的颈部区域中产生了在操纵方面的明显困难。
US-A-2004/0049272公开了一种小面关节假体，该假体包括支承件，该支承件带有牢牢地设置在其上且***椎骨中的保持杆。该支承件具有杯状的弯曲部并包括压板和支承壳，该压板用于支撑在椎骨上的压板，该支承壳与设在小面关节的相应的相对面上的毡状的相对件共同作用。该保持杆可以固定或可拆卸地与支承件连接。但是同样地，正是如在颈部区域中所存在的空间情况狭窄的情况下，当保持杆和相对件必须在原位置上组装时，该假体在操纵方面极为棘手。如果它们预先装配，那么在狭窄的空间情况下会产生***困难。为了可靠的固定，保持杆必须，这可能会在那里引起刺激。
US-A-0 177 240公开了一种小面关节假体，该假体包括支承件，该支承件带有可拧紧在其上的导向杆。该支承件的底面作为用于支撑在椎骨上的压板，而其位置相反的一面作为与相对关节面共同作用的支承面。导向杆在其位置相反的端部上具有相对元件，该相对元件可以设有螺丝刀插口。将导向杆固定在支承件上是借助螺纹连接来进行。在狭窄的情况下，正是在颈椎区域内，在精确的位置上形成相应的通孔以及支承件与导向杆的连接可能增加相当大的困难。
本发明的任务在于提供一种改进的小面关节假体，该假体具有较小的侵入性并具有与自然小面关节相接近的生物机械学特性。
根据本发明的解决方案在于独立权利要求的特征。有利的改进方案是从属权利要求的内容。
一种脊柱小面关节假体包括支承件和作为保持件的导向杆，该假体的支承件包括用于支撑在椎骨上的压板和对置的支承壳，该支承壳具有与相邻椎骨的关节面共同作用的关节面，根据本发明，在这种小面关节假体中设有摆动关节，用于将导向杆固定在支承件上。本发明的核心是这样的构思，即提供一种假体，一方面在该假体中，将假体保持在它的预定位置上的功能与吸收支承力的功能分离，另一方面，该假体可与各种人体构造情况相适应并因此可容易地装配。小面关节的关节面以不同的倾斜度在椎骨上形成。胸椎具有例如与颈椎不同的倾斜度。为了能够容易地补偿这些差别以及不同病人的个体差别，导向杆通过摆动关节固定在支承件上。这使得角度能够与相应的人体构造情况相适应。本发明不需要以一定的角度精确地对准支承面的通道，紧固螺钉必须***该通道中并在该通道中与支承件连接，而是一个可简单形成的缝隙对本发明来说就足够了，该缝隙相对于支承面的角度方向可在更大的范围内变化。该缝隙使得本发明的假体在正确的位置上的***变得容易并使得可能手术技术上有利地在椎骨上加工出缝隙，即在关节突上在上下关节面之间的方向制作。本发明的小面关节假体只需要***该缝隙中，而不需要进行各个部件的复杂装配或者连接，特别是不必如在现有技术中那样，导向杆要借助螺纹连接与支承件连接。因此，本发明特别适合于在很难触及且空间狭窄的位置上植入，例如特别是在颈椎区域。由于这种装配简便性，本发明的假体可以设计得很小。这使得小尺寸的导向杆进而小尺寸的缝隙就足够成为可能。为此所需的对椎骨的加工极少。该缝隙可从侧面，优选是从背外侧引入椎骨中。因此，该假体实现了特别有利的触及路径。总体上，本发明的假体允许在很大程度上保留自然骨质。因此，本发明的假体适于侵入性较小的手术。甚至在相应地选择支承面的弯曲部的情况下，本发明的假体实现了单边局部替代，也就是实现了与相邻椎骨的自然关节面共同作用。此外，利用本发明的假体，关节的运动中心保持在其原始位置上。因此，本发明的假体将有利的生物机械学特性与比较容易的可植入性的优点相结合，该可植入性也只具有很小的侵入性。
但是，为了更加精确地与个体差异的人体构造相适应，可能有利的是，摆动关节可在横向与导向杆纵轴线的第二方向上活动。因此，实现了在正面内的活动性。为此，摆动关节可设计成球窝关节，或者优选是万向节。
适合地，导向杆在中间位置与压板成斜角地布置在支承件上。因此，实现了在人体构造上有利的形状。通常，摆动关节在横向于导向杆的纵轴线的方向上是可活动的，这就足够了。因此，实现了在矢状面上的活动性。
在最简单的情况下，导向杆具有圆形横截面。但是，适合的是，导向杆具有非圆形，优选为矩形或椭圆形横截面。选择尺寸，使得视方向而定，导向杆的宽度比缝隙的宽度更小或更大。这实现了，将导向杆以其窄的方向***缝隙，并在它的预定位置上围绕纵轴线旋转导向杆，直到它夹紧在缝隙中。因此，防止该导向杆无意滑出。在这里，对于矩形横截面，由于棱边实现了啮合作用，从而得到了附加的固定。但是，非圆形横截面不是一定需要的，因为由于根据本发明的缝隙的尺寸设计得尽可能小，通常可以预期到快速愈合。为了进一步防止本发明假体发生无意脱位，可以适合地沿着导向杆形成径向突出的锯齿。该锯齿附加地防止导向杆无意的侧向滑出。为了这个目的，在导向杆上也可设置连接片，该连接片用于固定在椎骨上，例如借助螺纹连接。
为了将支承件附加地固定在椎骨上，适合地在压板上设置一个为了与椎骨啮合而设计的啮合部。因此，支承件在支承力的作用下自动地压入椎骨。因此，附加地防止了移动或转动。该啮合部可以由单个的齿组成，或者可以设置齿排，例如成圆形布置。为了进一步改善与椎骨的连接，此外还可以在压板上设置促进骨骼生长的涂层。这种涂层的一个例子是羟磷灰石。这有利于假体地长到椎骨上。
与压板对置地在支承件上形成的关节壳优选具有凸的或凹的弯曲部。设计哪种弯曲部，这取决于相应椎骨的构造形状。适合地，选择该弯曲部，使得它与设置在相邻椎骨上的关节面的形状相协调，假体与该关节面一起形成小面关节。
根据一种特别有利的，在必要时受到独立的保护的实施方式，在导向杆的另一端上设置第二支承件，该支承件带有压板和支承嵌件。因此，可以形成一种假体，借助该假体可在相互紧挨的级中治疗小面关节。在这里，只需要一个缝隙，把假体的导向杆***该缝隙中。该实施方式的另一个优点是，由于在导向杆的两端上设有压板，实现了附加的固定可靠性。在这里，导向杆优选设计成由多个部件组成。
伸缩的杆结构是适合的。因此，可以使导向杆的长度与椎骨的厚度相协调，更准确地说，与从椎骨的一个关节面到另一个关节面的缝隙长度相协调。该伸缩结构可以由同心地相互运动的元件构成，或者通过螺纹连接构成。为了防止无意的分离运动，该分离运动会导致支承件从其在椎骨中的位置松开的危险，适合地设有用于导向杆杆部的锁止装置。为此，可以设置单独的止动元件。但是，也可以为螺纹连接选择这样的螺距，该螺距产生自锁作用。该螺纹连接提供这样的优点，即通过简单地旋转其中一个支承件可以改变导向杆的长度，以实现支承件牢固的配合。此外，适合地在其中至少一个支承件上设置用于螺栓扳手的容纳部。
在导向杆两端上的支承件可以设计成不同结构。特别适合的是，为位于导向杆的一端(上端)上的支承件提供圆形的外轮廓，而为位于导向杆的另一端(下端)上的支承件提供矩形的外轮廓。在这里，概念，“圆形和矩形”，不能理解为严格数学意义上的含义，而应当理解为一般含义。特别地，矩形可以具有圆角，从而具有椭圆形的形状。借助这种形状可以实现更好地接近小面关节的自然关节面的形状。
但是，在导向杆的对置的端部上并不一定设置第二支承件。同样有利地，可以在那里设计一个加厚部。适合地，该加厚部在其指向支承件的一侧上具有弯曲部。因此，即使在提供单边关节时也可以实现与在在两边都设有支承件的情况下同样高的固定可靠性。作为加厚部的设计方案实现了在椎骨中的深入的布置，以致带有加厚部的导向杆(与具有第二支承件的情况不同)不会从椎骨体中突出。相邻小面关节的值得保留的自然关节面可以通过这种方式期望地得到保留。为了植入只需要在为容纳加厚部而预定的位置上扩大缝隙，例如通过钻孔。有利的是将加厚部指向支承件的一侧设计成旋转对称，更确切地说，优选设计为弯曲部。因此，在通过钻头形成附加的容纳空间时，可以实现加厚部特别良好地与骨骼材料接触，而且当为了固定将导向杆围绕其纵向轴线转动时，也正好可以实现该良好接触。加厚部的一种特别适合的形状是球体或回转椭球体。
本发明的假体特别适合在椎骨的多个相互紧挨的级中的治疗。为此，优选地设计一种成套假体，该成套假体由至少一个带有两个支承件的假体和两个分别带有一个支承件的假体构成。因此，可以治疗在两个相邻的级中的小面关节。但是，通过附加地使用带有两个支承件的假体，还也可以增加其他级。本发明的一个特别的优点在于这种多级病理治疗的能力。借助本发明的假体，自然生物机构学特性在很大程度上得到保留，从而即使在应用到多个级的情况下，由于本发明假体的良好的生物机械学特性，既不必担心活动性受到限制，也不必担心稳定性的丧失。
此外，本发明还涉及一种包括保持件和支承件的假体的植入方法，其中，该支承件包括压板和与之对置的支承嵌件，该支承嵌件具有与相邻椎骨的关节面共同作用的关节面，该方法包括如下加工步骤：在椎骨的关节突上加工一个缝隙，该缝隙从该椎骨的一个关节面朝着椎骨的另一个关节面的方向延伸；将导向杆***缝隙内，其中，支承件的压板支撑在关节面上。本发明的方法具有这样的优点，即只要在椎骨上加工一个简单的缝隙。该缝隙的尺寸可以设计得很小，因为它只需要容纳导向元件，而不必承受假体的保持力。特别地，可以从背外侧设置该缝隙。这实现了一种特别有利的触及性，进而实现了一种简化的手术技术。在这里，对于带有支承件的本发明的假体的植入，甚至不需要缝隙延伸至其他关节面；借助一个局部缝隙，经常就可以提供足够的用于容纳导向杆的空间。
从侧面将假体***缝隙可容易且无需大的力耗费地实现。为了可靠的锁止，适合地可以进行如下设计：导向杆具有椭圆形横截面，并且在***缝隙之后被转动，以致该导向杆以其宽的横截面夹紧在缝隙中。因此，不仅实现了本发明假体容易的***，而且实现了本发明的假体的良好固定以防止其从缝隙中无意滑出。此外，还可以设计该缝隙，使得导向杆有过盈。在这里，可以选择尺寸，使得在导向杆与缝隙之间形成压配合。
下面参照附图来说明本发明，在这些附图中示出了有利的实施例。
图1a)-c)示出了第一实施例的侧视图、正视图及后视图；
图2示出了沿图1的线II-II剖切的横向剖视图；
图3示出了带有根据第一实施例的一种变型方案的植入假体的颈椎区域的侧向放大图；
图4a)-b)示出了第一实施例的另一种变型方案的局部纵向剖视图和横向剖视图；
图5a)-b)示出了本发明假体的第二实施例的正视图和后视图；
图6示出了带有植入的根据第二实施例的颈椎骨假体的颈椎的局部视图；
图7示出了一种预定的颈椎植入位置的侧视图；
图8示出了附有注释的颈椎骨的放大视图。
为了更加容易地理解本发明，首先来说明预定的植入位置。假体是为脊柱的小面关节而设计。图7示出了人体脊柱的一部分，准确地说，是颈椎的一部分。可看出多个(三个)上下叠置的椎骨。这些椎骨在它们的前面区域内(在图的右边)具有一个标记通道，上升及下降的神经束在该标记通道中延伸。这些椎骨在它们的后面区域内(在图的左边)具有向后的突出部(棘突)。在椎骨的侧面上分别具有关节突15。该关节突分别具有两个关节面，位于上部区域的上关节面13以及位于下部的下关节面14。两个上下叠置的椎骨1，1’的上关节面13和下关节面14共同作用。它们一起构成一个小面关节12。上下叠置的椎骨1，1’分别通过两个小面关节12和一个椎间盘11相互连接。
图8详细示出了上关节面13及其在椎骨1上的布置。这些上关节面13位于关节突15上。它们与水平面成一个大约80°的很陡的角度布置在椎骨1的后侧。此外，这些上关节面13还相对于横轴线向外转过一个角度。该角度在图8中表示为角度β。该角度例如为20°。下关节面1 4相应地构造。该下关节面设置在关节突15上且位于下面。椎骨1’的下关节面14设计成与布置在其下面的椎骨1的上关节面1 3互补。
本发明设计了由于疾病或受伤而有缺陷的关节面13，14的代替物。图1a)-c)绘出了本发明的假体2的第一实施例。该假体包括导向杆21，该导向杆通过一个设计成销支座的摆动关节22可角度运动地设置在支承件23上。该支承件23在其面向导向杆21的一侧上包括压板24和在其相反的一侧上包括支承壳27。后者可以由滑动性良好的塑料材料(例如聚乙烯)组成。可选地，可进行如下设计：将支承壳27可旋转运动地设置在压板27上。为此，压板24在其顶面上具有盆状的凹进处，支承壳27以一个被设计成钝状的底面被安置在该凹进处内。但是，同样可行的是，支承壳27由一种生物相容的金属合金组成，例如CoCrNi。后者开发了这样的符合目的的现实性，即将带有压板24和支承壳27的支承件23设计成一体。压板24指向导向杆21的一侧用于支撑在椎骨1上，更准确地说，支撑在需要治疗的关节面13，14上。为了改善压板24在椎骨1上的固定，适合地设有凸出部，凸出部在所示的实施例中设计成环状的啮合部25。在植入状态下，啮合部25啮合到需要治疗的关节面13，14上，并且该啮合部将本发明假体2的压板24进而将支承件23固定在预定位置上。
导向杆21用于确定假体2的位置。进行如下设计：在椎骨1的关节突15上，在需要治疗的小面关节12的区域内形成一个缝隙18。该缝隙18如此定向，使得它沿着从上关节面13向下关节面14的方向经过关节突15延伸。该缝隙18的长度可以在关节突15的整个高度上延伸，或者如图3所示，延伸到与需要治疗的关节面13，14相邻的区域上。可以设计缝隙18的横截面尺寸，使得它足够用于容纳导向杆21和摆动关节22；在将摆动关节沉入的情况下，横截面就足够用于容纳导向杆21了。图4a示出了一种这样的变型方案，该变型方案包括在一体设计的支承件23’上的作为摆动关节设置的球窝关节22’。本发明的假体2可以通过将它的导向杆21简单地***关节突15上的缝隙18内而被移动到它的植入位置上。在这里，由于摆动关节22，支承件23自动地调整，使得该支承件占据一个符合斜度α和β的角度。因此，压板24与关节突15需要治疗的关节面13，14面接触。该压板24将出现的支承力传递到关节突15上。导向杆21基本上只用于假体2的定位，但在植入状态下不需要传递支承力。该导向杆的尺寸因此可以设计得很小。这使得可以将缝隙18的尺寸选择得相应地小。这特别具有这样的优点，即缝隙18的宽度越小，可望在成功植入之后，缝隙18愈合得更早更快。因此，假体2以特别可靠的且生物相容的方式防止了出现从缝隙18不希望地脱位。
为了在成功植入之后一开始就具有防止假体2无意地滑出的尽可能良好的可靠性，导向杆21的杆部优选不是设计成圆柱形，而是设计成椭圆形(图2)或矩形(图4b)。这使得，在植入时可以将导向杆21如此定向，使得该导向杆以其小的横截面被***缝隙18内(参见图2中的虚线)。如果假体2被预先移动至在缝隙18中的预定植入位置，那么它的导向杆21转动90°，使得导向杆21宽的横截面在缝隙18的宽度上延伸。适合地，缝隙18的宽度在这里是如此进行选择，使得该宽度小于椭圆形导向杆21的最大宽度。由此在转动后的状态下产生夹紧作用，该夹紧作用将导向杆21进而将假体2固定在植入位置上。为了进一步提高固定可靠性，可以在导向杆21上形成锯齿28，该锯齿在假体的嵌入状态下切入包围缝隙18的骨骼材料中。此外，还可以设置连接片4，用于借助螺钉(未示出)进行附加固定。另外，适合的是压板24和导向杆21至少在它们的为与椎骨1接触而确定的表面上涂有促进生长的涂层，例如羟磷灰石。
图3又示出了第一实施例的一种变型方案，在该变型方案中，在导向杆21的与支承件23对置的端部上设有球状的加厚部29。该加厚部容纳在一扩大部19中，该扩大部是在缝隙18上，在一个距关节面相当于导向杆21长度的距离处形成。该扩大部可以由外科医生在植入时容易地借助螺旋钻头从侧面进行加工。由于球状加厚部29在其靠近支承件23的一侧上的旋转对称的弯曲部，可以实现几乎面齐平的接触，而且当如前面所述，当为了固定将导向杆21转动90度时，也可实现如此的接触。
支承壳27可以具有平的外侧作为关节面。但是优选的是，使该支承壳具有凸的形状(用于上关节面13)或凹的形状(用于下关节面14)；但相反的形状同样是可行的。适合地，选择支承件23的轮廓，使得为代替下支承面14而设计的支承壳27具有矩形外轮廓(例如棱边被倒圆的矩形形状，参见图1)。与之相反地，在治疗上支承面13时，支承壳优选具有圆形的轮廓(参见图5和后面的说明)。
图5和图6示出了本发明的第二实施例。同样的部件用相同的附图标记表示。本发明的假体3的这个第二实施例与在图1和图2所示的第一实施例2的主要区别在于，在导向杆21的对置的端部上设有第二支承件33。导向杆设计成由两个部件构成，包括一个附加的内导向杆31。通过***内导向杆31，可以改变上支承件23与下支承件33之间的距离。优选地，设有止动装置39作为固定装置。应当可看出，替换的实施形式可用于改变长度，例如借助螺纹30(参见图5b)。下支承件33同样通过摆动关节与导向杆31可角度运动地连接。适合的是，该摆动关节设计成可在两个旋转自由度中运动的万向节32。
为了简化在图5b所示的实施例中的旋入，优选地在支承件33，即支承壳37的外侧上形成一个转动工具容纳部。在所示的实施例中，设有六角形的凹陷38。该凹陷优选是布置，使得它位于内导向杆31的轴向延长部分中。因此，可以简单的方式，借助六角螺栓扳手，必要时在摆动位于其上的椎骨1”之后，将内导向杆31旋入导向杆21内。在有利的触及条件下，这还可以在下支承件33稍微倾斜的情况下完成；在这里，当摆动关节设计成万向节32时，较大的角度也是可能的。借此实现了通过支承件23，33对椎骨1施加压力。因此，可以增进在椎骨1’中的骨骼生长，从而假体3快速且可靠地长入椎骨1’中。
图6示出了处于植入状态的本发明的假体3的第二实施例。可看到，支承件33支撑在上关节面13上，而支承件23支撑在椎骨1’的下关节面14上。假体3因此适合于治疗在两个上下叠置的级中的小面关节12。在相邻的椎骨中可以设置具有支承件23的假体2，或可以设置又是在两个级上延伸的假体3，或者在必要时可以不设置任何假体。由于支承件23，33及其支承壳27，37符合生理学模型的形状，使得假体2，3以它的支承壳37与相邻椎骨1的自然关节面13，14共同作用。如图3所示，支承壳27与椎骨1中的假体2共同作用。
为了植入本发明假体3的第二实施例，与在第一实施例中相应地进行设计。但是，缝隙18’设计成在关节突15的整个高度上延伸。
下面说明一种用于本发明假体的手术技术。根据该技术，进行脊柱的后部触及。在移开覆盖物之后，打开包围需要治疗的小面关节12的关节囊(未示出)。由于为了植入本发明的假体2，3只需要尺寸相对较小的入口，以只是受到极小程度损害的形式来打开关节囊就足够了。另外，关节囊可以保留；与在传统的手术方法中不同，移除关节囊不是必需的。相反地，在成功植入假体之后，关节囊可以重新形成。通至小面关节12的入口在打开关节囊之后是暴露的。然后，在下一个步骤中，借助本身已知的涡轮铣刀从背外侧在椎骨1，1’的关节突上形成缝隙18，18’，本发明的假体2，3可植入该缝隙中。在这里，缝隙18，18’沿着从各自的关节突15的上关节面13到下关节面14的方向延伸。缝隙18，18’的长度可以根据需要进行选择，例如为了植入假体2的第一实施例而选取延伸到靠近相关小面关节12的区域上，而为了植入第二实施例而选取在关节突15的整个高度上。如已经提到的，缝隙18，18’的宽度可以选取得很小，以有利于快速愈合。然后，将假体2，3的导向杆21，31装入缝隙18，18’内并将其***，直到支承件23，33已经到达需要治疗的小面关节12的关节面13，14上的预定位置。在必要时，然后通过转动椭圆形或矩形的杆部21将假体2，3固定。只要需要，对于根据第二实施例3的假体，改变导向杆21，31的长度，直到两个支承件23，33以它们各自的压板24，34牢牢地支撑在椎骨上。以此结束了假体2，3的植入。在封上手术伤口之后，通过转动椭圆形杆部21来实现假体2，3的初始固定，而长期地，由于缝隙18，18’所需的很小的宽度，可预期到愈合。因此，实现了假体的持久且生物相容的固定。

Claims (24)

1.用于脊柱小面关节的假体，该假体包括支承件(23)和带有导向杆(21)的保持件，其中，该支承件(23，33)包括用于支撑在椎骨(1)上的压板(24)和与之对置的支承壳(27，37)，该支承壳具有与相邻椎骨(1’)的关节面共同作用的关节面，其特征在于，为了将导向杆(21)固定在支承件(23)上，设有摆动关节(22)。
2.如权利要求1所述的假体，其特征在于，所述摆动关节是万向节(32)。
3.如前述权利要求中任一项所述的假体，其特征在于，在所述导向杆(21)的另一端上设有第二支承件(33)，该第二支承件包括压板(34)和支承嵌件(37)。
4.如权利要求3所述的假体，其特征在于，设有伸收式地***导向杆(21)内的内导向杆(31)。
5.如权利要求4所述的假体，其特征在于，设有锁止装置(39)，用于防止导向杆(21，31)的分离运动。
6.如权利要求3至5中任一项所述的假体，其特征在于，位于导向杆(21，31)的上端上的所述支承件(23)具有椭圆形包络线的轮廓，而位于导向杆的下端上的支承件(33)具有矩形包络线的轮廓。
7.如前述权利要求中任一项所述的假体，其特征在于，所述支承件(23，33)中至少一个在其关节面上具有拧紧孔(38)并与所述内导向杆(31)不可相对扭转地连接。
8.如前述权利要求中任一项所述的假体，其特征在于，所述支承件(23)与压板(24)和支承嵌件(27)一体地构成。
9.如权利要求1或2所述的假体，其特征在于，在所述导向杆(21)的另一端上设有加厚部(29)。
10.如权利要求9所述的假体，其特征在于，所述加厚部(29)在其指向支承件(23)的一侧上具有弯曲部。
11.如权利要求10所述的假体，其特征在于，所述弯曲部设计成旋转对称的。
12.如权利要求9至11中任一项所述的假体，其特征在于，所述加厚部(29)设计成回转椭球体。
13.如前述权利要求中任一项所述的假体，其特征在于，所述导向杆(21)被设计成用于***椎骨(1)的关节面(13，14)之间的缝隙(18)中。
14.如前述权利要求中任一项所述的假体，其特征在于，所述导向件(21)具有非圆形的，优选是矩形或椭圆形的横截面(21)，该横截面的最大宽度大于缝隙(18)的宽度。
15.如前述权利要求中任一项所述的假体，其特征在于，沿着所述导向杆(21)设有径向突出的锯齿(28)。
16.如前述权利要求中任一项所述的假体，其特征在于，在所述压板(24)上设有与椎骨(1)作用的啮合部(25)。
17.如前述权利要求中任一项所述的假体，其特征在于，所述压板(24，34)设有促进骨骼生长的涂层，特别是由羟磷灰石组成的涂层。
18.如前述权利要求中任一项所述的假体，其特征在于，所述支承壳(27，37)具有包括凸的弯曲部的关节面。
19.如权利要求14所述的假体，其特征在于，在相邻椎骨(1’)上共同作用的关节面具有互补的弯曲部。
20.成套假体，其包括至少一个如前述权利要求中任一项所述的假体，其特征在于，设有至少一个带有两个支承件(23，33)的假体(3)和至少一个带有一个支承件(23)的假体(2)。
21.如前述权利要求中任一项所述的假体的植入方法，该假体包括支承件(23，33)和以倾斜角度设置在其上的导向杆(21)，其特征在于，在椎骨(1)上加工出缝隙(18，18’)，该缝隙从椎骨(1)的一个关节面(13)朝着椎骨(1)的另一个关节面(14)的方向延伸；以及将导向杆(21)***缝隙(18，18’)中，其中，该支承件(23，33)以压板(24，34)接触在位于关节面(13，14)上。
22.如权利要求21所述的方法，其特征在于，从背外侧在椎骨(1)的关节突(15)上加工所述缝隙(18，18’)。
23.如权利要求21或22所述的方法，其特征在于，将所述缝隙(18’)加工直至所述椎骨(1)的另一个关节面。
24.如权利要求22或23所述的方法，其特征在于，设置通至所述缝隙(18)中的横向孔(19)。
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