CN110123430B - 骨锚和细长器械的*** - Google Patents
骨锚和细长器械的*** Download PDFInfo
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- CN110123430B CN110123430B CN201910101530.8A CN201910101530A CN110123430B CN 110123430 B CN110123430 B CN 110123430B CN 201910101530 A CN201910101530 A CN 201910101530A CN 110123430 B CN110123430 B CN 110123430B
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Abstract
提供一种骨锚和细长器械的***,其包括骨锚,所述骨锚包括具有第一端部和第二端部的柄部以及穿过所述柄部从所述第一端部延伸至所述第二端部的通道,所述通道限定通道轴线;其中,在所述柄部的所述第二端部处或附近,在所述通道的内壁处设置内部推进结构;和细长器械,所述细长器械构造成延伸通过所述通道;其中所述细长器械包括尖端部分和与所述柄部的所述内部推进结构配合的外部推进结构,以便允许所述尖端部分沿朝向所述第二端部的方向在所述通道中前进并且沿朝向所述第一端部的相反的方向上向后移动;并且其中能够从所述通道移除具有所述尖端部分的所述细长器械。
Description
技术领域
本申请涉及一种骨锚的***,所述骨锚具有插管状柄和可***该插管状柄中的细长器械。
背景技术
在脊柱外科手术中,特别是在微创手术(MIS)中,已知使用诸如克氏针(K丝)的导丝,所述导丝经皮地穿过皮肤而被放置到骨锚位于脊柱的椎骨中的预期位置中。在一些情况下,预先钻出用于骨锚的孔,并且预先攻出用于骨锚的螺纹。然后沿着导丝引导具有插管状柄的骨锚并且最终将所述骨锚旋拧入椎弓根中。此后,移除导丝。这种骨锚和手术例如由US 8,690,930 B2所已知。
本领域中已知其他的用于通过引导销或钻头引导的插管状的骨锚。例如,US 5,098,435描述了一种骨稳定***,其包括引导销和形成骨锚的插管,其中引导销在其前端部处设置有钻孔设备,用于在预定的位置处钻出进入到骨折骨中的引导孔。使用该***包括将引导销***骨中、将插管放置在引导销上以及将插管推进到骨中的步骤。
US 7,938,848 B2描述了一种椎弓根螺钉,其具有沿螺钉的纵向轴线延伸的通道。钻头延伸穿过该通道,其中钻头的第一端部从通道的远侧开口延伸离开。
US 9,095,395 B2描述了一种用于引导包括纵向通道的骨螺钉的外科K丝,其中在K丝的远端处形成闭合元件,用于闭合骨螺钉的纵向通道的远端出口开口。在一些实施例中,闭合元件通过螺纹而连接到所述纵向通道。
发明内容
本发明的目的是提供一种骨锚和细长器械的***,其具有广泛的应用范围并且简化了外科手术,特别是MIS手术。
该目的通过一种骨锚和细长器械的***来解决,所述***包括:骨锚,所述骨锚包括柄部和通道,所述柄部具有第一端部和第二端部,所述通道穿过所述柄部从所述第一端部延伸至所述第二端部,所述通道限定通道轴线;其中在所述柄部的所述第二端部处或附近,在所述通道的内壁处设置内部推进结构;和细长器械,所述细长器械构造成延伸穿过所述通道;所述细长器械包括尖端部分和与所述柄部的所述内部推进结构配合的外部推进结构,以便允许所述尖端部分沿朝着所述第二端部的方向在所述通道中前进并且沿朝着所述第一端部的相反方向上向后移动;并且其中能够从所述通道移除具有所述尖端部分的所述细长器械。在从属权利要求中给出了进一步的改进。
***的细长器械可以是例如切割装置、K丝、用于感测植入部位处的特征的传感器、标记器或任何其他器械。每个细长器械和骨锚一起形成可以被放置在植入部位上的单元,并且与细长器械相关的手术步骤可以被执行。之后,可以从骨锚的通道移除该器械,并且如果需要,可以将另一种类型的细长器械***通道中。因此,骨锚可以根据所需器械的特定功能而选择性地与各种器械组装在一起。这提供了该***的广泛的应用范围。
在细长器械是切割装置的情况下,所述***允许使用***的切割装置而非使用K丝、预钻孔和预攻螺纹来放置骨锚。这节省了外科手术中的时间。此外,可以选择具有适合于特定临床情况(其中将使用骨锚)的切割部分的形状和长度的切割装置。
在细长器械是K丝的情况下,该***允许将具有K丝的骨锚作为单元放置在骨表面上并且将K丝尖端压入骨中。此后,K丝可以用作为引导设备。
在细长器械是标记器的情况下,骨锚和标记器元件可以相对于彼此具有限定的位置关系,使得可以精确地检测骨锚的位置。
附图说明
通过附图,从本发明的实施例的描述中,其他的特征和优点将变得显而易见。
在附图中:
图1示出了骨锚和切割装置形式的细长器械的***的实施例的分解透视图;
图2示出了处于组装状态中的图1***的透视图;
图3a示出了图1和图2的***的剖视图,其中在延伸通过骨锚的通道轴线的平面中截取横截面;
图3b示出了图3a的放大部分;
图4示出了在将骨锚植入到椎骨的椎弓根中的步骤期间被附接到图1至图3b的***的器械的透视图;
图5a至图5c示出了将图1至图3b的******椎骨的椎弓根中的剖视图;
图6示出了在移除细长器械之后的***的骨锚的剖视图;
图7示出了骨锚和各种细长器械的透视图,所述细长器械各自均可以与所述骨锚一起使用以便形成***;
图8示出了***的一部分的剖视图,其中细长器械包括改进的K丝;
图9示出了***的一部分的剖视图,其中细长器械包括传感器;
图10示出了***的一部分的剖视图,其中,细长器械包括标记器。
具体实施方式
图1至图4示出了骨锚1和切割装置20形式的细长器械的***的实施例。骨锚1包括柄部2,所述柄部具有位于第一端部处的头部3和自由的第二端部4。头部3可以具有球形外表面部分,所述球形外表面部分限定骨锚1的最大外径。骨螺纹5可以设置在柄部2的外表面的至少一部分上。柄部2可以略微地朝向第二端部4渐缩。用于与工具接合的接合凹部6可以形成在头部3的自由端部的表面处。
如图3a和图3b详细所示的那样,骨锚1为插管状。所述骨锚包括完全穿过骨锚从头部3延伸到第二端部4的通道7。通道7由从第一端部延伸到距第二端部4一定距离的同轴孔形成。所述孔的轴线限定通道的纵向轴线L。在与第二端部4毗邻的部分中,通道7的直径略微小于同轴孔的直径。内螺纹8形式的内部推进结构设置在毗邻或靠近第二端部4的通道内。在同轴孔和该推进结构之间可以形成肩部9。肩部9用作支座以限制细长器械的***。这允许在骨锚1和细长器械之间实现精确的位置关系。骨锚1中的通道7的最小内径由内螺纹8限定。
如图6所示,在柄部2的壁中,可以设置至少一个(优选地多个)径向开口10用于形成用于待引入骨锚1中的骨水泥或药物物质的出口。
切割装置20形式的细长器械是基本杆状的构件,其包括第一端部或后端部21(图4中示出)以及相对的第二端部或前端部22。基本上,切割装置20形成为圆柱形杆,所述圆柱形杆具有从后端部21到前端部22的长度,所述长度大于骨锚1的长度。具体地,切割装置20的长度使得切割装置20构造成延伸穿过骨锚1的通道7、在一侧上从骨锚1的第二端部4突出,并且构造成延伸穿过用于***骨锚的器具100(图4中示出)使得后端部21从器具100突出。
毗邻前端部22设置尖端部分23,所述尖端部分包括切割刃24。例如,切割刃24可以由尖端部分23的外表面中的凹部形成,其中,凹部的至少一个边缘构造成执行切割功能。尽管在图中示出了一个切割刃24,但是可以设置多个切割刃。切割刃或多个切割刃的形状可以分别是直的,并且切割刃24可以在纵向方向上延伸或者可以是螺旋形的或者可以具有构造成切割骨的任何其他形状。毗邻尖端部分23或者与所述尖端部分隔开一定距离的切割装置包括具有外螺纹25形式的外部推进结构的区段,所述外螺纹构造成与骨锚1的内螺纹8配合。具有外螺纹25的区段的轴向长度可以大于或等于骨锚1的具有内螺纹8的区段的长度,使得当切割装置20***骨锚1的通道7中时,可以在一定范围内精确调整切割装置20的位置。在具有外螺纹25的区段之后,可以设置小颈部分26。切割装置的其余部分或主要部分27可以形成为具有光滑表面的圆柱形杆,所述圆柱形杆的外径略微小于通道7的同轴孔的内径,使得切割装置20可以在同轴孔内滑动。
此外,切割装置20可以在主要部分27上的、在切割装置***通道7中时位于骨锚1外侧的位置处具有用于与器具100的一部分相接合的接合结构(未示出)。这种接合部分旨在当切割装置20已经***骨锚中并且尖端部分23从骨锚1的第一端部4延伸出去时,相对于骨锚1旋转地固定切割装置20。
骨锚1和切割装置20可以各自由生物相容性材料(例如钛或不锈钢)、生物相容性合金(例如NiTi合金,所述NiTi合金例如是镍钛诺)、镁或镁合金、或者生物相容的塑料材料(例如聚醚醚酮(PEEK)或聚﹣1﹣丙交酯酸(PLLA)构成。另外,这些部件可以由彼此相同或不同的材料制成。
为了组装,骨锚1可以被器具100保持,并且切割装置20以这样的方式***骨锚1的通道7中,即通过配合螺纹8、25,调整切割装置的长度,和调整相应的从骨锚1的第二端部4突出的切割部分23的长度。应该注意的是,切割装置20和骨锚1也可以被预先组装,然后用器械夹紧。通过选择切割装置20的类型,即选择切割刃24的形状和尖端部分23的长度,并且通过调整从骨锚1的具有螺纹的第二端部4突出的部分的长度,可以提供适合于植入部位的特定要求的***。最后,切割装置20通过螺纹8、25被轴向固定到骨锚,并且通过配合切割装置20和器具100的接合部分(未示出)而被旋转地固定。因此,骨锚1和切割装置20构造成作为单元***骨中。
现在转到图5a至图5c,其示出了具有切割装置20的骨锚1和器具100的一部分。器具100被示出为示例性实施例。所述器械包括:从头部3的外侧接合所述头部的第一头部接合部分101;在凹部6中接合头部3的第二头部接合部分102;和夹紧套筒103,其将第一头部接合部分101压向头部3使得骨锚1的头部3牢固地夹紧在器械中。第二头部接合部分102包括用于使切割装置20穿过的通道。如图5a所示,由骨锚1和切割装置20组成的单元被放置到骨锚1待被***的位置,例如椎骨500的椎弓根。切割刃24用于穿透皮质骨。因此,尖端部分23为骨锚1准备通路,使得骨锚1可以容易地旋拧进入。可以省略预钻孔。
然后,如图5b和图5c所示,将骨锚1旋拧入椎弓根中,直到最终将柄部2植入且头部3从骨表面突出。可以借助于成像方法来实施骨锚1与切割装置20的放置。
当骨锚处于最终位置时,后退旋拧切割装置20并且从骨锚移除所述切割装置,如图6所示。如果需要,可以通过***塞构件和/或骨水泥来封闭第二端部4,或者可以注入能够从开口10流出的其他物质。
图7描绘了骨锚1和各种细长器械。这些器械可以包括例如切割装置20、医疗导丝30(例如修改的K丝)、传感器40和标记器50。器械中的每个器械与骨锚1一起形成单元。各种器械和骨锚可以形成模块化***,其允许根据预期用途而选择性地将一个细长器械与骨锚1组合。
在图8中更详细地示出了医用导丝30(比如修改的K丝)形式的细长器械。导丝30具有基本光滑的外表面,其外径略微小于螺纹8的内径使得导丝30可以被引导通过骨锚1的通道7。通常,导丝30具有尖端部分31,所述尖端部分构造成被压入骨中。在距尖端部分31一定距离处,设置有外螺纹32形式的外部推进结构,所述外螺纹构造成与骨锚1的内螺纹8配合。优选地,外螺纹32的轴向长度小于内螺纹8的轴向长度。更详细地说,外螺纹32的轴向长度仅包括轴向固定导丝30以防止在通道7中滑动所需数量的螺纹圈。这可以是至少一个螺纹圈或仅仅少量的螺纹圈。外螺纹32可以位于远离尖端部分31的位置处,使得当外螺纹32接合内螺纹时尖端部分31以及优选地毗邻尖端部分31的部分33从第二端部4突出。
在使用中,通过将导丝30旋拧入骨锚1中来组装导丝30和骨锚1,并且将***作为单元放置在骨表面上,使得导丝的尖端部分31被压入骨中。此后,可以向下旋拧骨锚1直到螺纹脱离啮合。在这种状况下,导丝可以用作为通常的导丝,并且可以沿导丝3朝向植入部位引导骨锚1和其他的部件。或者,骨锚和修改的K丝可以作为单元放置在骨表面上,K丝可以压入骨中并且沿着内螺纹进一步向下旋拧。
在图9中示出了传感器40形式的细长器械。如图9所示,传感器40包括壳体41,所述壳体是基本管状的并且构造成穿过骨锚1的通道7。壳体41具有可以延伸通过第二端部4的尖端部分42。毗邻尖端部分42,壳体41包括外螺纹43形式的推进结构,所述外螺纹构造成与骨锚1的内螺纹8配合。外螺纹43的轴向长度可以大于或等于内螺纹8的轴向长度。毗邻外螺纹43,可以存在颈部分44,壳体41的主要部分45紧接着所述颈部分44,所述主要部分具有光滑的外表面。传感器元件46定位在壳体41中,其中传感器元件46包括尖端部分47,所述尖端部分构造成感测相应的特征(例如骨密度)或者构造成执行神经监控。可以设想任何其他合适的传感器元件。
可以在骨锚已经***骨中时***传感器40,或者所述传感器可以与骨锚1预组装在一起并且与骨锚1一起***骨中。
在图10中更详细地示出了标记器50形式的细长器械,所述标记器例如是用于通过X射线检测和/或标记骨上的位置的标记器。标记器50是基本杆状的,其内径略微小于骨锚1的同轴孔的内径。设置尖端部分51,所述尖端部分包括标记器元件52,例如能够由X射线检测的元件。在距尖端部分51一定距离处,设置外螺纹53形式的外部推进结构,所述外螺纹构造成与骨锚1的内螺纹8配合。外螺纹53的轴向长度可以小于或等于内螺纹8的轴向长度。可以与外螺纹53毗邻的肩部54构造成抵靠通道7中的肩部或台阶部9,以便限制将标记器50***骨锚中。肩部54位于这样的位置,使得当肩部54抵靠肩部9时,标记器元件定位在第二端部4处并且可以略微从第二端部4突出。通过由肩部9提供的止动件,限定了标记器50相对于骨锚1的位置。因此,标记器50可以精确地指示骨锚1的位置。
在使用中,优选地,标记器50和骨锚1可以被预先组装并且***骨中。
可以设想对上述***的进一步修改。骨锚的形状不限于实施例中所示的形状。可以使用任何类型的骨锚,例如没有骨螺纹的骨锚,例如骨钉。骨锚的头部示出为球形的。然而,可以设想任何其他合适的头部。特别地,用于提供多轴骨锚的接收部件可以附接到头部。
骨锚的通道可以具有圆柱形以外的形状。骨锚的壁中的开口可以具有任何形状,特别是也可以设想纵向延伸的狭缝。最后,也可以省略开口。
推进结构被示出为螺纹,然而,可以使用多个同心肋状件以形成推进结构或者可以使用允许切割装置在通道内连续地或渐进地前进的另一推进结构。
细长器械的各种特征也可以组合以提供细长器械的其他实施例。
Claims (17)
1.一种骨锚和细长器械的***,其包括:
骨锚(1),所述骨锚包括柄部(2)和通道(7),所述柄部具有第一端部(3)和第二端部(4),所述通道穿过所述柄部(2)从所述第一端部(3)延伸至所述第二端部(4),所述通道(7)限定通道轴线(L);
其中在所述柄部(2)的所述第二端部(4)处或附近,在所述通道(7)的内壁处设置内部推进结构(8);和
细长器械(20、30、40、50),所述细长器械构造成延伸穿过所述通道(7);
其中所述细长器械(20、30、40、50)包括尖端部分(23、31、42、51)和与所述柄部(2)的所述内部推进结构(8)配合的外部推进结构(25、32、43、53),以便允许所述尖端部分(23、31、42、51)沿朝着所述第二端部(4)的方向在所述通道(7)中前进并且沿朝着所述第一端部(3)的相反方向上向后移动;
并且其中能够从所述通道(7)移除具有所述尖端部分(23、31、42、51)的所述细长器械;并且
所述***还包括工具(100),所述工具具有第一部分和第二部分,所述第一部分构造成保持所述柄部(2),所述第二部分构造成保持所述细长器械(20、30、40、50)使得所述细长器械(20、30、40、50)轴向且旋转地固定到所述柄部(2)。
2.根据权利要求1所述的***,其中,所述内部推进结构(8)是内螺纹,所述外部推进结构(25、32、43、53)是外螺纹。
3.根据权利要求2所述的***,其中,所述内螺纹和所述外螺纹是圆柱形螺纹。
4.根据权利要求1至3中任一项所述的***,其中,所述尖端部分(23、31、42、51)构造成在所述通道(7)中从所述第一端部(3)前进到所述第二端部(4)。
5.根据权利要求1至3中任一项所述的***,其中,所述细长器械(20、30、40、50)的长度使得当所述尖端部分(23、31、42、51)位于或靠近所述通道(7)的所述第二端部(4)时所述细长器械从所述柄部(2)的所述第一端部(3)延伸出来。
6.根据权利要求1至3中任一项所述的***,其中,所述内部推进结构(8)和所述外部推进结构(25、32、43、53)被构造成以这种方式配合,所述方式使得沿轴向方向固定所述细长器械(20、30、40、50)相对于所述骨锚的位置以防止移位。
7.根据权利要求1至3中任一项所述的***,其中,所述细长器械(20、30、40、50)还包括第一接合结构,所述第一接合结构被构造为与所述骨锚处或工具处的第二接合结构配合,以防止所述细长器械(20、30、40、50)相对于所述骨锚旋转。
8.根据权利要求1至3中任一项所述的***,其中,所述外部推进结构(25、32、43、53)的轴向长度大于或等于所述内部推进结构(8)的轴向长度。
9.根据权利要求1至3中任一项所述的***,其中,所述细长器械(20、30、40、50)包括后端部(21)和颈部(26、44),所述后端部与所述尖端部分(23)相对,所述颈部在朝着所述后端部(21)一侧处毗邻或接近所述外部推进结构(25、43)。
10.根据权利要求1至3中任一项所述的***,其中,所述外部推进结构(25、32)的轴向长度小于所述内部推进结构(8)的轴向长度。
11.根据权利要求1至3中任一项所述的***,其中,所述尖端部分(23)包括至少一个切割刃(24),所述至少一个切割刃构造成切入骨中。
12.根据权利要求1至3中任一项所述的***,其中,在所述通道(7)的所述内壁处设置止动件(9),以便限制所述细长器械***所述骨锚中。
13.根据权利要求1至3中任一项所述的***,其中,所述细长器械(20、30、40、50)包括管。
14.根据权利要求1至3中任一项所述的***,其中,所述细长器械是整体式部件。
15.根据权利要求4所述的***,其中,所述尖端部分(23、31、42、51)构造成在所述通道(7)中从所述第一端部(3)前进到所述第二端部(4)直到所述尖端部分从所述第二端部(4)延伸出来。
16.根据权利要求10所述的***,其中,所述外部推进结构的轴向长度具有足以紧固所述细长器械(20、30、40、50)以防止在轴向方向上滑动的长度。
17.根据权利要求12所述的***,其中,所述尖端部分包括传感器元件(46)或标记器元件(52)。
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EP3524181B1 (en) * | 2018-02-09 | 2021-11-10 | Biedermann Technologies GmbH & Co. KG | System of a bone anchor and an elongate instrument |
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2018
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- 2018-02-09 EP EP21207111.2A patent/EP3970639A1/en active Pending
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US5098435A (en) * | 1990-11-21 | 1992-03-24 | Alphatec Manufacturing Inc. | Cannula |
US5957953A (en) * | 1996-02-16 | 1999-09-28 | Smith & Nephew, Inc. | Expandable suture anchor |
WO2017147537A1 (en) * | 2016-02-26 | 2017-08-31 | Activortho, Inc. | Active compression apparatus, methods of assembly and methods of use |
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JP2024015370A (ja) | 2024-02-01 |
EP3524181B1 (en) | 2021-11-10 |
US20190247102A1 (en) | 2019-08-15 |
US11191583B2 (en) | 2021-12-07 |
JP2019136504A (ja) | 2019-08-22 |
US20220133374A1 (en) | 2022-05-05 |
EP3524181A1 (en) | 2019-08-14 |
CN110123430A (zh) | 2019-08-16 |
EP3970639A1 (en) | 2022-03-23 |
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