CN103598913A - 万向椎间融合器推进器 - Google Patents
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- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Abstract
一种万向椎间融合器推进器,其包括套筒,其特征是:所述套筒前部是弧形,所述套筒前端是出口,所述套筒内设有推杆,推杆前端是推板,推杆后端是旋转推进手柄。所述套筒弧形内侧有观察窗,所述套筒前端出口是半圆形或半矩形,所述套筒后端设有外螺纹,外螺纹上设有螺帽,螺帽中间设有通透的内螺纹。所述推杆前半部分是弹性材料,所述推杆后半部分是钢性材料,钢性材料上面设有外螺纹,弹性材料前端是推板、后端是一个圆形凹形槽,钢性材料前端是一个圆球、后端是旋转推进手柄。
Description
技术领域
本发明涉及一种万向椎间融合器推进器,属于医疗器具技术领域。
背景技术
众所周知,目前在临床上应用的腰椎椎间融合器形状大部分为长方体型,少部分的融合器为月牙状。为打入方便,融合器一般制成长约25mm,宽及高约10mm左右的形状,内部中空可以装入碎骨。术中将硬膜囊及神经根向内侧牵开,空出足够的空间在上下神经根之间将椎间融合器按其长轴方向打入。一般需双侧进行同样的操作。此技术存在如下问题:一、术中要想打入融合器,必须用锤子用力敲打,对周围神经的扰动较大。同时因融合器紧邻上下神经根,融合器打入时周围神经处于无保护状态,故融合器边缘很容易损伤上下神经根及内侧硬膜囊。二、沿融合器长轴方向打入时为保护神经方面的考虑,融合器的方向受到明显限制,只能垂直方向或稍微斜形打入,使融合器呈其它方向的要求无法实现。同时因为椎间隙较狭窄,只能在打入时预先调整融合器的方向,打入后很难调整方向。三、手术时一侧只能打入一枚融合器。很多医生往往在一侧斜形打入一枚融合器,以求双侧平衡,但一枚融合器的融合面积较小,且斜形融合器无法保证脊柱的双侧平衡,对双侧椎弓根螺钉应力不平均,可能造成内固定的松动失效。为了扩大融合面及保持两侧平衡,应用长方形的融合器一般需要在两侧各打入一枚。两侧操作增加了手术时间及神经损伤的风险。四、用力打入时,可能损伤上下椎体终板,造成了融合器下沉入椎体,从而影响融合效果。五、月牙状的融合器的融合面积较小,无论是单侧还是双侧只能打入一枚,无法打入多枚融合器。
发明内容
本发明所要解决的技术问题是克服上述现有技术的不足,提供一种构造简单,使用方便的万向椎间融合器推进器。
本发明解决其技术问题所采用的技术方案是:一种万向椎间融合器推进器,其包括套筒,其特征是:所述套筒前部是弧形,所述套筒前端是出口,所述套筒内设有推杆,推杆前端是推板,推杆后端是旋转推进手柄。
进一步地,所述套筒弧形内侧有观察窗,所述套筒前端出口是半圆形或半矩形,所述套筒后端设有外螺纹,外螺纹上设有螺帽,螺帽中间设有通透的内螺纹。
进一步地,所述推杆前半部分是弹性材料,所述推杆后半部分是钢性材料,钢性材料上面设有外螺纹,弹性材料前端是推板、后端是一个圆形凹形槽,钢性材料前端是一个圆球、后端是旋转推进手柄。
使用时先将推进器组合好,再将填满碎骨的融合器顺着滑槽的方向放入滑槽内装入套筒内,将推杆安装顶在融合器的后侧。术中首先行所涉及节段的多枚椎弓根螺钉的打入,不安装内固定杆或仅松松地将内固定杆固定地螺钉上,维持适当的局部稳定。将融合节段的一侧小关节突关节切除小部分,或完全切除上下关节突关节,显露椎管及周围上下神经组织。分开神经周围粘连,将硬膜囊及椎管内下位神经根向内侧牵开,显露椎管内结构,完成致压因素的切除,在椎间隙内刮除上位椎体的下缘及下位椎体的上缘终板软骨,直至软骨下骨,将推进器(弧向上或下)呈扁状在关节突内侧或外侧放入椎间隙,顺时针旋转90度,将椎间隙撑开,并用手柄调整其出口方向。可将碎骨块或骨泥先通过融合器推入椎间隙内。再将推进器内的融合器小心地用推杆推入(或拧入)椎间隙内。移动推进器,可进一步调整融合器方向。进行第二枚融合器的打入。此时融合器的周围仍存在空腔,可将碎骨块或骨泥通过推进器推入椎间隙内空腔中,并使其位于预定部位,另用压杆将碎骨压实。取出推进器。安装双侧内固定杆,纵向加压后拧紧内固定螺帽。X线透视内固定物的位置,如融合器的位置不佳可松开双侧内固定杆,用大号的推进器扩大椎间隙的高度,用角状嵌入器(?)调整融合器的位置后退出推进器,再进行双侧螺钉的加压紧固,并使上下椎体缘与融合器密切接触。
本发明的有益效果是:(1)通过推进器的作用将融合器任意改变方向拧入椎间隙内,并将其打入到对侧,照顾到对侧的椎间支撑融合,对于对侧不需减压的患者免除对侧手术操作的风险。(2) 推进器周围存在滑槽壁,其在融合器打入时对周围神经组织起到保护作用。(3)推进器可以扩大椎间隙的高度,方便了融合器的进入,不必使用骨锤强力打入椎间隙,只需用推杆将融合器推入椎间隙,避免了对终板的破坏和对神经的震动影响。(4)可以从一侧以横形或其它任意方向打入两枚融合器,增加了椎间融合率。(5) 将碎骨通过推进器推入椎间隙,同时对其进行打压,有利于碎骨的骨长入,增加融合率。(6) 适用于市面上所有的融合器的打入。包括方形及月牙状的融合器,为其提供打入的滑槽并为其周围组织的进行保护。(7) 所述套筒弧形内侧设计成纵形微型开口观察窗,可以监测进入的融合器的方向深度,以方便进行及时调整。(8) 术中设计成多种角度及宽度的推进器,适合不同体型的患者。(9)调整推进器进入的部位,可从椎间隙的极外侧(即关节突处或关节突外侧)***椎间隙,进行椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion, TLIF)。并可在微创手术入路中配合应用此器械进行TLIF椎间融合,从而减少对周围软组织的影响。
附图说明
下面结合附图1对本发明进一步说明。
附图1是本发明的结构示意图。
附图1中1. 套筒,2. 出口,3.推杆,4.推板,5.旋转推进手柄,6.观察窗,7.外螺纹,8.螺帽,9.内螺纹,10.外螺纹,11.弹性材料,12.钢性材料,13.圆形凹形槽,14.圆球。
具体实施方式
在附图1中,一种万向椎间融合器推进器,其包括套筒1,其特征是:所述套筒1前部是弧形,所述套筒1前端是出口2,所述套筒1内设有推杆3,推杆3前端是推板4,推杆3后端是旋转推进手柄5。所述套筒1内侧有观察窗6,所述套筒1前端是出口2是半圆形或半矩形,所述套筒1后端设有外螺纹7,外螺纹7上设有螺帽8,螺帽8中间设有通透的内螺纹9。所述推杆3前半部分是弹性材料11,所述推杆3后半部分是钢性材料12,钢性材料12上面设有外螺纹10,弹性材料11前端是推板4、后端是一个圆形凹形槽13,钢性材料12前端是一个圆球14、后端是旋转推进手柄5。
使用时先将推进器组合好,再将填满碎骨的融合器顺着滑槽的方向放入滑槽内装入套筒内,将推杆安装顶在融合器的后侧。术中首先行所涉及节段的多枚椎弓根螺钉的打入,不安装内固定杆或仅松松地将内固定杆固定地螺钉上,维持适当的局部稳定。将融合节段的一侧小关节突关节切除小部分,或完全切除上下关节突关节,显露椎管及周围上下神经组织。分开神经周围粘连,将硬膜囊及椎管内下位神经根向内侧牵开,显露椎管内结构,完成致压因素的切除,在椎间隙内刮除上位椎体的下缘及下位椎体的上缘终板软骨,直至软骨下骨,将推进器(弧向上或下)呈扁状在关节突内侧或外侧放入椎间隙,顺时针旋转90度,将椎间隙撑开,并用手柄调整其出口方向。可将碎骨块或骨泥先通过融合器推入椎间隙内。再将推进器内的融合器小心地用推杆推入(或拧入)椎间隙内。移动推进器,可进一步调整融合器方向。进行第二枚融合器的打入。此时融合器的周围仍存在空腔,可将碎骨块或骨泥通过推进器推入椎间隙内空腔中,并使其位于预定部位,另用压杆将碎骨压实。取出推进器。安装双侧内固定杆,纵向加压后拧紧内固定螺帽。X线透视内固定物的位置,如融合器的位置不佳可松开双侧内固定杆,用大号的推进器扩大椎间隙的高度,用角状嵌入器调整融合器的位置后退出推进器,再进行双侧螺钉的加压紧固,并使上下椎体缘与融合器密切接触。
Claims (3)
1.一种万向椎间融合器推进器,其包括套筒,其特征是:所述套筒前部是弧形,所述套筒前端是出口,所述套筒内设有推杆,推杆前端是推板,推杆后端是旋转推进手柄。
2.根据权利要求1所述的一种万向椎间融合器推进器,其特征是:所述套筒弧形内侧有观察窗,所述套筒前端出口是半矩形,所述套筒后端设有外螺纹,外螺纹上设有螺帽,螺帽中间设有通透的内螺纹。
3. 根据权利要求1所述的一种万向椎间融合器推进器,其特征是:所述推杆前半部分是弹性材料,所述推杆后半部分是钢性材料,钢性材料上面设有外螺纹,弹性材料前端是推板、后端是一个圆形凹形槽,钢性材料前端是一个圆球、后端是旋转推进手柄。
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CN105105891A (zh) * | 2015-09-29 | 2015-12-02 | 天津市天津医院 | 置入椎间融合器的套管装置 |
CN105708517A (zh) * | 2016-04-19 | 2016-06-29 | 苏州瑞华医院有限公司 | 一种带推杆的空心环钻 |
CN108095867A (zh) * | 2018-02-12 | 2018-06-01 | 博能华医疗器械(北京)有限公司 | 一种四面可撑开型椎间融合器 |
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US20110071634A1 (en) * | 2009-08-19 | 2011-03-24 | The Governors Of The University Of Alberta | End plate slider/distractor for posterior intervertebral device and method |
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