CN1309350C - 将植入物供应到脊椎空间内的器械和方法 - Google Patents
将植入物供应到脊椎空间内的器械和方法 Download PDFInfo
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- CN1309350C CN1309350C CNB028273141A CN02827314A CN1309350C CN 1309350 C CN1309350 C CN 1309350C CN B028273141 A CNB028273141 A CN B028273141A CN 02827314 A CN02827314 A CN 02827314A CN 1309350 C CN1309350 C CN 1309350C
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- Prior art keywords
- implant
- passage
- mold members
- towards
- lateral dimension
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/441—Joints for the spine, e.g. vertebrae, spinal discs made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
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- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
- A61F2250/0048—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in mechanical expandability, e.g. in mechanical, self- or balloon expandability
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/006—Additional features; Implant or prostheses properties not otherwise provided for modular
- A61F2250/0063—Nested prosthetic parts
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Abstract
用来将植入物(50、90、90’、102、102’)供应到一椎间盘空间(S)内的医疗器械和方法,其包括一模具件(70、110),该模具件构造成将植入物(50、90、90’、102、102’)从一初始结构转变为一具有减小的侧向外形的变形结构,以便以最小的创伤方式***到椎间盘空间(S)内。在一实施例中,模具件(70、110)包括一尺寸适于接纳处于初始结构的植入物(50、90、90’、102、102’)的开口(72、120),其中,植入物(50、90、90’、102、102’)和模具件(70、110)之间的相对位移致使植入物(50、90、90’、102、102’)朝向外形减小的变形结构转变。在一特殊的实施例中,开口包括一轴向通道(120),通道包括一第一部分(122),其具有一对应于植入物(50、90、90’、102、102’)的基本上平面的初始结构的大致矩形的截面,以及一第二部分(124),其具有一对应于植入物(50、90、90’、102、102’)的基本上圆柱形的变形结构的大致圆形的截面。
Description
相关申请
本申请要求对2001年12月13日提交的未决的美国临时申请系列号No.60/341,343的优先权,本申请是2001年11月15日提交的未决的美国专利申请系列号No.09/998,978的部分继续申请,其要求对2000年11月15日提交的美国临时申请系列号No.60/248,807的优先权,并且也是2000年4月26日提交的未决的美国专利申请系列号No.09/559,899的部分继续申请,其要求对1999年4月26日提交的美国临时申请系列号No.60/131,053的优先权,本文援引各申请的全部内容以供参考。
技术领域
本发明一般地涉及外科器械的领域,以及用于治疗脊骨的方法,具体来说,涉及用来提供一植入物到脊椎空间内的器械和方法。
背景技术
脊柱是一紧密地连接的脊椎体的柔软链。在一正常的人类脊椎中,有七个颈椎骨、十二个胸椎骨和五个腰椎骨。在腰椎骨下方是骶骨和尾骨。各个别的脊椎体具有一硬的致密骨的外壳体。脊椎体内是一容纳红的骨髓的蜂窝状的松质骨。所有的红血球和许多的白血球产生在松质骨内,血细胞在那里成熟后才释放到血流中。
椎间盘(也称之为脊骨盘)在相邻的脊椎体之间起作一软垫的作用,以允许其间有控制的运动。一健康的椎间盘包括三个部分:一凝胶状的内芯(髓核),一系列重叠的和层合的层的坚韧的纤维质环(环形纤维),以及将椎间盘连接到邻近的脊椎体的薄的皮层骨的上和下的薄软骨层(脊椎骨端板)。
一椎间盘可因外伤(例如,破裂形成疝)或疾病(例如,椎间盘退变疾病)引起移位和/或损坏。一破裂形成疝的椎间盘可突出而其本身压迫神经,由此,导致下腿疼痛,肌肉失去控制或瘫痪。为了治疗破裂成疝的疾病,椎间盘的冒犯的部分(通常包括髓核的突出部分)通过众所周知的外科手术予以去除。退变性椎间盘疾病通常造成椎间盘逐渐地减小高度,由此,导致环形纤维弯曲,撕裂或沿径向和/或周向方向分离,一般地导致慢性的和丧失能力的背痛。退变性椎间盘疾病可通过外科方法治疗,去除髓核和融合相邻的脊椎体,以稳定关节。在这两种情形中,不管是移去某些髓核还是全部的髓核,这些手术在相邻的椎间盘上留下较大的应力,来补偿失去的运动能力,它又造成相邻的椎间盘的过早地退变。
目前假体的椎间盘植入物术的一个缺点在于,为了在相邻脊椎之间的脊椎空间内***假体的椎间盘植入物,要求有大的或多个切口和/或切去,由此,减弱椎间盘的环形纤维和/或其它的部分。此外,环形纤维的切口或切去不易修复,由此,增加这样的风险:假体的椎间盘植入物可最终跑出脊椎空间并可能干扰或损坏相邻的解剖学的组织。目前假体椎间盘植入物的其它的不足之处在于,有时要求在脊椎空间内***多个侧向间隔的假体植入物,由此,要求小心地和精确地定位假体植入物,以确保合适的载荷承载特性(例如,参见授予Ray等人的美国专利No.5,674,295)。
现代外科的趋向是利用最小的创伤外科技术恢复身体的功能和/或解剖学上的结构的形式(即,修复)。通过形成最少数量的切口和尽可能小的切口进行外科修复损坏的组织或关节的能力,形成最小的外伤和病人的痛苦,同时,基本上得到最佳的临床成果。
因此,通常要求工业界提供改进的医疗器械和方法来将植入物供应到脊椎空间内,较佳地以最小的创伤方式。本发明满足装置需要,并以创新和不明显的方式提供其它的好处和优点。
发明内容
本发明一般地涉及用来对脊椎空间提供植入物的医疗器械和方法。尽管本文涵盖的本发明的实质可由附后的权利要求书唯一予以确定,但下面将简要地描述本文揭示的表征优选实施例特征的本发明的某些形式。
在本发明的一个形式中,提供用来在脊椎空间内供应植入物的医疗器械,其包括一形成一尺寸适宜接纳植入物的开口的模具件,此时,植入物呈初始的结构,其中,植入物和模具件之间的相对位移致使植入物从初始的结构过渡到一变形的结构,该变形的结构相对于初始的结构具有一减小的侧向外形。
在本发明的另一个形式中,提供用来在脊椎空间内供应植入物的医疗器械,其包括一形成一构造成接纳植入物的内腔的载体盒,一具有一近端和一远端的伸展套管,伸展套管的远端构造成将植入物***到脊椎空间内,以及一由载体盒和伸展套管的至少一个形成的折叠模具,折叠模具沿从内腔到伸展套管的方向形成一向内减小的锥形,这样,当植入物通过内腔移位到伸展套管内时,将相对平的结构再构造成大致圆柱形的结构。
在本发明的另一个形式中,提供用来在脊椎空间内供应植入物的医疗器械,其包括一用来将植入物从一大致平的结构过渡到一非平的结构的装置,所述非平的结构具有一相对于初始结构减小的侧向外形,一用来有选择地将植入物保持在非平的结构的装置,以及一用来将植入物***到脊椎空间内的装置。
在本发明的另一个形式中,提供用来治疗一部分脊椎的***,其包括一植入物,以及一形成一尺寸适宜接纳植入物的开口的模具件,此时,植入物呈初始的结构,其中,植入物和模具件之间的相对位移致使植入物从初始的结构过渡到一变形的结构,该变形的结构相对于初始的结构具有一减小的侧向外形。
在本发明的另一个形式中,提供用来将植入物供应到脊椎空间内的方法,其包括提供一植入物,以及一形成一尺寸适宜接纳植入物的开口的模具件,同时,呈一初始的结构,植入物相对于模具件移位,以及将植入物从初始的结构过渡到一变形的结构,该变形的结构相对于初始的结构具有一减小的侧向外形。
本发明的一个目的是提供用来将植入物供应到脊椎空间内的改进的医疗器械和方法。
本发明的其它的目的、特征、优点、益处和方面将从本文所包含的附图和描述中变得明白。
附图的简要说明
图1是根据本发明的一个形式的植入物的俯视平面图。
图2是根据本发明的一个形式的器械的俯视平面图,用来将图1所示的植入物供应到脊椎空间内。
图3是沿图2的线3-3截取的图2中所示的器械的截面立体图。
图4是沿图3的线4-4截取的图3中所示的器械的截面立体图。
图5是图2所示的器械的俯视平面图,图1所示的植入物以初始的盘形结构***其中。
图6是图2所示的器械的俯视平面图,图1所示的植入物以折叠的结构设置在器械的导管部分内。
图7是根据本发明的另一实施例的植入物。
图8是根据本发明的另一实施例的植入物。
图9是根据本发明的另一形式的用来将植入物供应到脊椎空间内的器械的立体图。
图10是根据本发明的一形式的使用如图9所示的器械将植入物供应到脊椎空间内的植入物的立体图。
图11是如图10所示的植入物的立体图,显示为一卷起的结构。
图12是如图11所示的卷起的植入物的端视图。
图13是如图10所示的植入物的立体图,显示为一折叠的结构。
图14是如图10所示的植入物的端视图,显示为部分卷起、部分折叠的结构。
图15是根据本发明的另一形式的植入物的立体图。
图16是图9所示器械的俯视平面图。
图17是沿图16的线17-17截取的图16中所示的器械的截面图。
图18是沿图16的线18-18截取的图16中所示的器械的截面图。
图19是沿图16的线19-19截取的图16中所示的器械的截面图。
图20是沿图16的线20-20截取的图16中所示的器械的截面图,其中,植入物设置在器械的供应部分内。
图21是沿图17的线21-21截取的图16中所示的器械的截面图。
图22是沿图16的线22-22截取的图16中所示的器械的截面图。
图23是沿图22的线23-23截取的图22中所示的器械的截面图。
图24是图9中所示的器械的局部截面图,示出植入物供应到椎间盘空间内。
具体实施方式
为了有利于理解本发明的原理,现将参照附图中所示的实施例,并用专用的语言来描述实施例。然而,应该理解的是,这样做法并不限制本发明的范围,本发明所涉及的技术领域内的技术人员通常会构思出所示装置的变体和其它的改型,以及本文中所示的本发明的原理的其它的应用。
参照图1,图中示出根据本发明的一种形式的植入物50。在本发明的一实施例中,植入物50是一适于***到脊椎空间内的脊椎植入物。在一特定的实施例中,植入物50是一假体的髓核,其适于***到椎间盘空间内以替代至少一部分自然的椎间盘髓核。然而,应该理解的是,植入物50可构造成替代脊骨的其它的部分,也可用于除脊骨之外的解剖学上的有关部分。
在本发明的一方面,假体髓核50能从一初始的、相对平的盘形结构(图1)转变为一更加紧凑、折叠的结构(图6),在假体髓核50***到脊椎空间内后,又重新变形为初始的盘形结构。假体髓核50较佳地由相当弹性的材料形成,以便于在初始的盘形结构和折叠的结构之间变形,并朝向初始的结构重新形成。
在本发明的一实施例中,一力施加装置52从假体髓核50延伸,并用来通过一供应器械曳拉该假体髓核50,其细节将在下面讨论。在一实施例中,力施加装置52包括一个或多个细丝或线54a-54d。在另一实施例中,细丝54a-54d包括缝合线。在一特殊的实施例中,缝合线54a-54d分别通过延伸通过假体髓核50的小孔56a-56d***,由此,形成对应数量的缝合线环。这样,通过简单地剪断缝合线环的一侧,并通过对应的小孔56a-56d抽拉缝合线环的断开的部分,缝合线54a-54d即可从假体髓核50中移去。然而,应该理解的是,在本发明的范围内,也可构思其它类型和结构的力施加装置52,例如,适于推假体髓核50通过一供应器械的一推力机构或杆。
参照图2-4,图中示出根据本发明的一种形式的供应器械60,其用来将假体的髓核50供应到脊椎空间内。在本发明的一实施例中,器械60沿纵向轴线L延伸,并大致地包括一折叠的部分62和一***的部分64。在本发明的另一实施例中,折叠部分62通过连接装置66可释放地连接到***部分64,以允许折叠部分62有选择地从***部分64中脱开。
在本发明的一实施例中,折叠部分62包括一折叠模70。为清晰起见,图3-4示出折叠模70的一半,应理解到,全部的折叠模70包括一相同结构的相对的一半(未示出),其与示出的一半合作而形成折叠部分62。在一实施例中,折叠模70的各半具有一板形的结构,并形成一内腔72和多个折叠元件74。内腔72的尺寸和形状适于接纳假体的髓核,而假体的髓核50处于其初始的结构。在一实施例中,内腔72具有一大致圆形的横截面,其对应于假体髓核50的初始的盘形结构的尺寸和形状。然而,内腔72可形成其它的横截面,例如,长形、椭圆形、矩形或多边形的横截面。
如图3和4所示,在本发明的一实施例中,折叠元件74包括多个折叠引导76和多个折叠的槽或凹口77。折叠的引导76和槽77大致沿纵向轴线L在内腔72和连接装置66之间延伸,起到开始减小假体髓核50的横截面尺寸的过程,该过程从初始的盘形结构(图1)朝向减小外形的折叠的结构(图6),以适应将假体的髓核50加载到供应器械60的***部分64内。在一实施例中,折叠模70将假体髓核50从一相当平的初始结构转变为一基本上圆柱形的折叠的结构。折叠的引导76和槽77从内腔72朝向连接装置66向内逐渐地变小,以便于假体髓核50朝向变形结构的转变,逐渐地转变到邻近具有一基本上圆柱形截面的连接装置66的供应部分78。
在本发明的一实施例中,***部分64大致地包括一套管80和至少部分地设置在套管80内的排出杆或柱塞82。套管80大致地沿纵向轴线L延伸,并形成一内腔84,其尺寸和形状适于接纳处于减小外形的折叠结构的假体的髓核50(图6)。在一实施例中,排出杆82相对于套管80沿箭头B的方向(图6)可轴向地位移,以从内腔84中排出假体的髓核50和***到脊椎空间内。
如上所述,供应器械60的折叠部分62通过连接装置66可释放地连接到***部分64,以在假体髓核50加载到***部分64的内腔84内之后,允许折叠部分62有选择地从***部分64中脱开。在本发明的所示的实施例中,连接装置66形成一在折叠部分62的供应部分78和***部分64的内腔84之间连通的通道,以允许假体髓核50在其间传输。
在本发明的一实施例中,连接装置66包括一易碎的区域88,其构造成允许折叠部分62有选择地碎掉,并与***部分64分离。在一特殊的实施例中,易碎的区域88包括一强度减弱的区域,例如,一壁厚减小的区域。然而,应该理解的是,也可构思其它类型的和结构的连接装置66。例如,在另一实施例中,连接装置66可包括诸如一舌和槽连接之类的滑动连接,由此,折叠部分62相对于***部分64可位移,以便有选择地将折叠部分62从***部分64中脱离。在另一实施例中,连接装置66可包括有螺纹的连接,由此,折叠部分62螺纹地连接到***部分64,以在其间通过有选择的拆卸。
参照图5,假体髓核50初始定位在折叠模70的内腔72内,而同时呈大致平的盘形的结构,使细丝或缝合线54a-54d沿各自的折叠引导76和槽77延伸和通过套管80内的内腔84。细丝54a-54d沿箭头A的方向曳拉,它又对假体髓核50施加一轴向的拉力,横贯折叠模70的折叠元件74曳拉假体髓核50,由此,导致假体髓核50转变为一折叠的结构,其相对于初始的盘形结构(图1)具有一减小的侧向外形(图6)。假体髓核50还进一步曳拉通过连接部分66内的通道86,进入到套管80内的内腔84的远端部分内。如上所述,通过简单地剪断缝合线环,并曳拉缝合线环的剪断的部分通过假体髓核50内的对应的小孔56a-56d,则细丝或缝合线54a-54d可从假体髓核50中脱离。应该认识到的是,在假体髓核50加载到套管内腔84内或其后将假体髓核50供应到脊椎空间内之后,缝合线54a-54d可移去。
尽管本发明所示的实施例使用细丝或缝合线54a-54d作为力的施加装置52,来曳拉假体髓核50横贯折叠模70的折叠元件74,进入到套管80的内腔84内,但应该理解到,也可构思其它类型和结构的施力装置52。例如,施力装置52可构造成通过一推力和/或旋转力来移位假体髓核50横贯折叠元件74和进入到内腔84内。此外,应该认识到,折叠元件74可呈其它的形状和结构,来将假体髓核转变为其它类型的变形的结构。例如,折叠元件74可变化地构造成卷曲和/或卷起假体髓核50,转变为一变形的结构,其相对于初始的盘形结构具有一减小的侧向外形。还应认识到,折叠元件74不需要一定是完全地由折叠模70限定,但也可沿连接装置66内的通道86延伸,进入到套管80内的内腔84内。
现参照图6,一旦假体髓核50折叠成减小外形的结构并加载到套管80内,供应器械60的折叠部分62通过连接装置66有选择地从***部分64中脱开。如上所述,在本发明所示的实施例中,连接装置66包括一易碎的区域88,其构造成允许折叠部分62突然折断或断离***部分64,由此,提供带有一敞开末端的套管80,以便无阻碍地***脊椎空间内。然后,通过一相对小的进入口或尺寸略大于套管80的外截面的开口***,以最小创伤的方式将套管80的末端部分可定位在脊椎空间内。然后,排出杆82沿套管内腔84朝着箭头B的方向轴向地位移,与假体髓核50接合。排出杆82沿箭头B的方向进一步的位移,推移假体髓核50从套管80进入到脊椎空间内。在假体髓核50从套管80内排出并定位在脊椎空间内之后,假体髓核50将开始重新变形或朝向初始的盘形结构放开。
参照图7和8,图中分别示出假体髓核90和90’的另外的实施例,它们可与供应器械60一起使用。假体髓核90和90’构造成类似于假体髓核50。具体来说,假体髓核90和90’各具有一初始的盘形结构,其能转变为一更加紧凑的折叠结构,并在将假体髓核***到脊椎空间内后,再变形恢复到初始的结构。此外,一施力装置92从各假体髓核90和90’延伸,以便假体髓核移位通过供应器械60。在一实施例中,施力装置92包括一个或多个细丝或线94a-94d。在一特殊的实施例中,细丝54a-54d包括分别通过小孔96a-96d***的缝合线,并延伸通过假体髓核90和90’,由此,形成一对应数量的缝合线环。然而,应该理解的是,只要落入本发明的范围内,也可构思其它类型和结构的施力装置92。
假体髓核90和90’各包括多个零件,它们起作允许、帮助、方便、引导、帮助和/或控制假体髓核90和90’的变形和/或恢复变形。如图7所示,在本发明的一实施例中,假体髓核90包括多个加肋的部分98,它们大致地平行于细丝94a-94d和/或供应器械60的纵向轴线L定向。如图8所示,在本发明的另一实施例中,假体髓核90’包括多个加肋的部分98’,它们大致地垂直于细丝94a-94d和/或供应器械60的纵向轴线L定向。在本发明的其它的实施例中,假体髓核90和90’可包括加肋部分98和98’的组合。尽管假体髓核50、90和90’的所示的实施例,在初始结构时具有一大致平的盘形结构(图1、7和8),但应该理解到,也可构思其它的形状和结构。在本发明的其它的实施例中,假体髓核50、90和90’可包括多个内部的或外部的表面(例如,壁、阻挡、支承等),它们可互连来提供带有添加程度的强度和/或稳定性的假体髓核。此外,这样的表面的一个或多个部分可予以加强,或制得更刚性,以便于沿预定的方向和/或定向膨胀或定向的膨胀,这样,提供带有特定尺寸和/或形状的假体髓核50、90和90’。一旦假体髓核50、90和90’定位在脊椎空间内,由于肿胀、水合作用、膨胀、反应或其它的方法,假体髓核可构造成形状变化,上述细节公开在2000年4月26日提交的美国专利申请系列号No.09/559,899中,本文已援引其内容以供参考。
尽管所示的假体髓核50、90和90’的实施例具有一体的单件的结构,但在本发明的其它的实施例中,假体髓核可包括一个或多个附加的部件或元件,它们融入、包含在内,或附着在植入物的其余部分上。例如,这样添加的部件或元件可包括具有一编织图形的材料,或可包括这样一材料,其构造成允许、帮助、方便、引导、帮助和/或控制假体髓核50、90和90’的变形和/或恢复变形,以提供带有一特定尺寸和/或形状的植入物。在本发明的另一实施例中,假体髓核50、90和90’可包括一在植入物供应到脊椎空间内之前或之后,其它部件可放置在其中的外部部件。或者,假体髓核50、90和90’可在植入物供应到脊椎空间内之前或之后,放置到其它的部件内。
参照图9,图中示出根据本发明的另一形式的供应器械100。如在下文中将会详细地讨论的,供应器械100构造成将植入物102供应到一解剖学上的空间内,例如,一脊椎空间。在一实施例中,供应器械100构造成将植入物102供应到一相邻脊椎体之间的椎间盘空间内。然而,应该理解的是,供应器械100也可与脊骨的其它部分一起使用,或与脊骨外面的解剖学上的部分一起使用。
供应器械100沿一纵向轴线L延伸,并大致地包括一模具件110、一供应件112,以及一个或多个施力件114,它们适于沿模具件110位移植入物102进入到供应件112内。如在下文中将会详细地讨论的,模具件110构造成将植入物102从一初始的结构转变或重新成形为一适于***到脊椎空间内的变形的结构。植入物102的变形的结构较佳地成形为能以最小的创伤方式允许植入物102***脊椎空间内。也如在下文中将会详细地讨论的,供应件112构造成在植入物102***脊椎空间内之前,接纳和有选择地将植入物102保持在变形的结构。此外,在本发明的一实施例中,模具件110可释放地连接到供应件112上,以允许模具件110有选择地与供应件112分离或移去,其细节将在下文中描述。
在本发明的一实施例中,模具件110形成一开口120,其构造成接纳植入物102并将植入物102从初始的结构转变为变形的结构。在另一实施例中,开口120包括一大致沿纵向轴线L延伸的通道,并包括一限定一第一横向尺寸d1的第一部分122,和一限定比第一横向尺寸d1小的第二横向尺寸d2。在本发明的一实施例中,第二横向尺寸d2小于第一横向尺寸d1的一半。在本发明的另一实施例中,第二横向尺寸d2小于第一横向尺寸d1的三分之一。然而,应该认识到,只要落入本发明的范围内,也可构思横向尺寸d1、d2之间的其它的比例。
第一通道部分122的尺寸适于接纳植入物102,同时其保持一初始的结构并具有略小于横向尺寸d1的侧向外形。当植入物102轴向地沿通道120朝向第二通道部分124位移时,植入物102从初始的结构朝向一变形的结构转变,变形的结构相对于初始的结构具有一减小的侧向外形。通道120较佳地沿一横向方向从第一通道部分122朝向第二通道部分124向内变小,以便于植入物102从初始结构朝向变形结构过渡。一旦定位在第二通道部分124内,植入物102将具有一近似等于第二通道部分124的横向尺寸d2的减小的侧向外形。
在本发明的所示的实施例中,第一通道部分122具有一形成大致的矩形截面的开槽的结构,而第二通道部分124形成一大致的圆形截面。在此实施例中,植入物102初始地具有一适于***到矩形通道部分122内的大致平的结构,然后,随着植入物102沿通道120朝向圆形通道部分124移位,结构朝向一大致圆形的结构过渡。然而,应该理解到,第一和第二通道部分122、124可构造成形成其它类型的横截面,例如,正方形、多边形、长形和/或椭圆形的截面,或本技术领域内的技术人员将会想到的任何其它合适的截面。同样地,应该认识到,植入物102相应地可形成非平面的初始结构和/或非圆柱形的变形的结构。
在本发明的一实施例中,供应件112大致地包括一保持件130,其构造成接纳和保持植入物102处于减小外形的变形的结构,以及一排出件132,其构造成有选择地从保持件130排出植入物102到脊椎空间内。在一实施例中,保持件130包括一外管部分140和一近端的手柄部分142。外管部分140形成一轴向的内腔或套管通道144,其适于接纳处于变形结构时的植入物102,并在***到脊椎空间内之前有选择地将植入物102保持在变形的结构。外管部分140还形成一轴向延伸的槽146,其用途将在下面讨论。在一实施例中,排出件132包括一内杆部分150和一近端手柄部分152。内杆部分150适于沿外管140内的内腔144作轴向位移,以接合植入物102和从外管140排出植入物102进入脊椎空间内。
如上所述,在本发明的一实施例中,模具件110可释放地连接到供应件112,以在将植入物102加载到供应件112内的内腔144内之后,允许模具件110有选择地从供应件112分离或移去。这样,植入物102可从邻近供应件112的无阻碍的远端部分的内腔144排出,进入到脊椎空间内。移去之后,空的模具件110可以丢弃。或者,模具件110可进行消毒后供再次使用。
在本发明的一实施例中,供应件112通过一易碎的区域196(图16)可释放地连接到模具件110,该易碎区域构造成允许模具件110有选择地突然折断或断离供应件112。在一特殊的实施例中,易碎区域196包括一强度减小的区域,例如,一壁厚减小的区域。然而,应该理解到,器械100可装备有其它的零件来允许模具件110有选择地从供应件112分离或移去。例如,在另一实施例中,器械100可包括一介于模具件110和供应件112之间的滑动连接,例如,一舌和槽结构,以允许模具件110有选择地从供应件112移去。在另一实施例中,器械100可包括一介于模具件110和供应件112之间的螺纹的连接,以提供模具件110的有选择的移去。在另一实施例中,模具件110和供应件112一体地形成为一单一件的结构。然而,应该理解到,模具件110和供应件112可变化地形成为分离的元件,它们可在以后附连在一起而形成一体的结构。
在本发明的一实施例中,施力件114包括一个或多个接合到植入物102的细丝或线件160。在所示的实施例中,细丝件160包括一缝合线,它通过一延伸通过植入物102的小孔162而形成环。然而,应该理解到,只要落入本发明的范围内,也可构思其它类型和结构的施力件114。尽管本发明所示的实施例包括一单一的细丝件或缝合线环160,但应该理解到,也可使用多细丝件,例如,如图1所示,以及上述对于植入物50的描述。
在本发明的一实施例中,缝合线环160沿供应件112内的套管通道144延伸通过模具件110内的通道120,并延伸出沿供应件112形成的轴向槽146。一钩形件170附连在邻近轴向槽146的缝合线环160。如将会认识到的,沿箭头A的方向曳拉钩形件170将张紧缝合线环160,并将对应地移位植入物102通过模具件110,以将植入物102从初始的结构朝向变形的结构转变。植入物102转变为变形的结构之后,通过简单地剪断缝合线环160的一侧并曳拉缝合线环的剪断部分通过植入物102内的小孔162,缝合线环160可从植入物102移去。尽管本发明所示的实施例利用细丝或缝合线160来曳拉植入物102通过模具件110,但应该理解到,也可构思其它类型和结构的施力件114。例如,施力件114可构造成通过轴向的推力和/或旋转力来移位植入物102通过折叠件110。
参照图10,图中示出根据本发明的一种形式的植入物102。在一实施例中,植入物102是一适于***到脊椎空间内的脊骨植入物。在一特殊的实施例中,植入物102是一假体的或人工的髓核,它适于***椎间盘空间内以替代一自然的椎间盘的髓核的至少一部分,以此,恢复类似于自然椎间盘功能的生物力学的功能。然而,应该理解到,植入物102可用来替代脊骨的其它部分,或可变化地用于脊骨外的解剖学的其它的部分。
植入物102较佳地由生物学上相容的材料做成的相当薄的圆片形成。在本发明的一实施例中,植入物102在初始结构时具有一大致平的盘形的结构,大致沿由x轴和y轴定义的平面延伸。尽管植入物102显示为具有一大致的圆形,但也可构思其它形状和结构的植入物102,包括卵形、椭圆形、腰子形、矩形或多边形的植入物,或本技术领域内的技术人员将会想到的任何其它的形状。在本发明的一优选的实施例中,植入物102由一柔性可变形的材料形成,以便于从初始结构转变为外形减小的变形的结构。在本发明的另一实施例中,植入物102由一弹性可变形的材料形成,以便于植入物102从初始的结构转变为弹性地变形的结构,并朝向初始结构恢复变形。
如图11-14所示,植入物102能从如图10所示的平面的结构转变为各种变形的结构。例如,如图11和12所示,植入物102可变形为卷起的或卷曲的结构,由此,相对于如图10所示的初始结构,减小沿y轴的植入物102的侧向尺寸或外形。如图13所示,植入物102也可变形为一折叠结构,其形成多个大致沿x轴延伸的折叠部分102a,也导致植入物102沿y轴减小侧向尺寸或外形。此外,如图14所示,植入物102可变形为一部分卷起、部分卷曲的结构,其形成多个折叠部分102a和多个卷起或卷曲的部分102b,同样地,导致植入物102沿y轴减小侧向尺寸或外形。应该理解到,除了或组合本文中特别描述和图示的变形的结构,植入物102可转变为其它变形的结构。此外,应该认识到,植入物102可从如图10所示的平面结构转变为任何非平面的结构。
参照图15,图中示出根据本发明的另一实施例的植入物102’。植入物102’构造成类似于植入物102,较佳地具有一初始的大致平面的结构,其大致沿由x轴和y轴定义的平面延伸。然而,植入物102’包括一个或多个零件,其起作允许、帮助、方便、引导、帮助和/或控制植入物102的变形和/或恢复变形。
在本发明的一实施例中,植入物102’包括一个或多个弹性件或压杆103,它们大致地沿着x轴延伸,以便于植入物102从变形结构朝向其初始结构恢复变形(例如,从一卷起、卷曲,或折叠的结构朝向一大致平面的结构恢复变形)。在另一实施例中,弹性压杆103由一超弹性材料形成,以进一步帮助从变形的结构朝向其初始的结构恢复变形。在一特殊的实施例中,压杆103由一形状记忆材料形成,以将记忆特征融入到植入物102’内,以便于从变形的结构朝向一“记忆”的初始结构恢复变形。尽管植入物102’的所示的实施例示出一特殊的结构和弹性压杆103的定向,但应该理解到,也可构思其它的结构,包括具有一个或多个弹性压杆103的实施例,它们横向于x轴交替地布置,以便沿y轴延伸。
此外,应该理解到,其它的零件可包括在植入物102、102’内,以便于或帮助变形和/或恢复变形。例如,如以上对于植入物90和90’所述的,植入物102’可包括一个或多个加肋的部分和/或一个或多个刚性的、半刚性的,或柔性的部分,它们融入在、包围在内,或附连在植入物的其余部分。此外,植入物102、102’的部分可由具有特殊材料的编织或颗粒图形的材料形成,以沿特殊的方向和/或定向引导变形和/或恢复变形。此外,植入物102、102’可形成多个开口和/或凹口或槽,以对变形和/或恢复变形提供一定程度的控制。此外,植入物102、102’可形成为复合物,其包括两种或多种不同的材料,以沿一特定的方向和/或定向调节变形和/或恢复变形。
还应该认识到,植入物102、102’可包装成一初始的基本上平面的结构,以提供方便的包装、搬运、运输、储存和组装。此外,通过提供带有一初始的基本上平面结构的植入物102、102’,就在***到椎间盘空间内之前,相继地转变为一变形的结构,植入物102、102’不太可能发展成一偏置或形状记忆,否则,如果植入物包装在供应件内,在一长的时间内处于变形的结构,则会发生偏置或形状记忆,这在运输和储存的过程中是可见到的。
联合地参照图16-21,图中示出有关模具件110的进一步的细节。如上所述,模具件110形成一轴向延伸的通道120,它包括一第一部分122,其具有一形成一横向尺寸d1的大致矩形的截面,以及一第二部分124,其具有一形成一减小的横向尺寸d2的大致圆柱形的截面。在本发明的一实施例中,模具件110包括一折叠块或容器180,其形成一通道120和沿通道120的至少一部分作轴向延伸的多个折叠元件或引导182。折叠元件182起作起始和便于植入物102从初始结构朝向变形结构的转变(图22-24),以便适应植入物102加载到供应件112的内腔144内。尽管折叠元件182图示为全部由模具件110形成,但应该理解到,折叠元件182可部分地由供应件112形成(例如,延伸到供应管140的内腔144内)。
如图18和19所示,通道120由一上表面184和一相对的下表面186界定。在本发明的一实施例中,折叠元件182包括从上表面184延伸的多个上突出190,以及在相邻成对的突出190之间形成的多个槽或凹口191。同样地,折叠元件182包括从下表面186延伸的多个下突出192,以及在相邻成对的突出192之间形成的多个槽或凹口193。在一实施例中,上突出190相对于下突出192横向地偏移,以使上突出190设置在相对的下槽193,而下突出192设置在相对的上槽191。如图21所示,折叠元件182较佳地沿横向方向从第一通道部分122朝向第二通道部分124相对于彼此向内变小,以便于植入物102的折叠。在本发明的一特殊的实施例中,上和下突出190、192的至少远端部分具有一三角形结构,以便进一步帮助折叠植入物102。然而,应该理解到,也可构思其它形状和结构。
参照图22和23,图中示出定位在供应管140的内腔144内的处于变形/折叠结构的植入物102。植入物102起初以基本上平面的初始结构(图9)设置在模具件110的外面。如上所述,沿箭头A的方向通过钩形件170曳拉缝合线环160,对植入物102施加一轴向的拉力,它又曳拉植入物102通过模具件110,并进入供应件112的远端部分。具体来说,植入物102通过通道120和横贯折叠元件182(例如,突出190、192和槽191、193)的轴向位移,将植入物102从初始的平面结构朝向基本上圆柱形的变形结构(图23)转变,并将变形的植入物102加载到供应件112的内腔144内。
如图23所示,植入物102的变形/折叠结构具有一相对于如图9所示的植入物102的初始结构的沿y轴的减小的侧向尺寸或外形。一旦加载到内腔144内,供应管140起作暂时地容纳和有选择地将植入物102保持在变形/折叠的结构。如上所述,通过简单地剪断缝合线环的一侧并曳拉该断开的缝合线环通过植入物102内的小孔162,缝合线环160即可从植入物102中脱离。应该认识到,在植入物102加载到供应管140内之后或植入物102供应到脊椎空间内之后,可移去缝合线环160。一旦植入物102折叠成减小外形的结构并加载到供应管112内,模具件110有选择地从供应件112移去。如上所述,在本发明所示的实施例中,模具件110断离供应件112或在易碎区域196突然折断,由此,提供带有无阻碍的敞开远端的供应管140。
参照图24,图中示出***到一椎间盘D内以便将植入物102供应到椎间盘空间S内的供应管140的远端部分140a。在本发明的一实施例中,在将供应管140***到椎间盘空间S内之前,髓核200的至少一部分被移去以形成一中空的腔室202,其细节为本技术领域内的技术人员所熟知。此外,一小的进入口或开口204形成通过环形的纤维化206,与中空的腔室202连通。进入开口204较佳地只是略大于供应管140的外截面,以便以最小的创伤方式允许供应管140的远端部分140a***到椎间盘空间S内。
在远端部分140a通过进入开口204***椎间盘空间腔202内之后,供应件112的内杆部分150沿箭头B的方向朝着管内腔144作轴向的位移,以接合植入物102和从供应管140将植入物102排出到椎间盘腔202内。一旦植入物102供应到椎间盘空间腔202内,植入物102将朝向其初始的基本上平面的结构(图9)恢复变形或展开。植入物102的位置和/或定向可在椎间盘空间腔202内调整,或通过张紧缝合线环160(如果仍连接在植入物102上),可从椎间盘空间腔202中移去。供应管140的远端部分140a还可用来在椎间盘空间腔202内调整植入物102的位置和/或定向。
在本发明的另一实施例中,植入物102可构造成:在***到椎间盘空间之后,由于肿胀、水合作用、膨胀、反应或其它的方法,植入物102可形状变化,以便沿z轴线(图10)增加植入物102的高度,以致大致地对应于椎间盘空间腔202的高度。同样地,植入物102还可构造成:在***到椎间盘空间之后,沿x轴线和/或y轴线增加尺寸,以致大致地对应于椎间盘空间腔202的内周缘。此外,有关上述的和其它的膨胀零件和特征的细节公开在2000年4月26日提交的美国专利申请系列号No.09/559,899中,本文已援引其内容以供参考。
如现应认识到的,在通过供应器械100转变到其变形的结构之前,植入物102具有至少一个尺寸(例如,一y向尺寸),其大于植入物102要求通过其中的***进入口的最大尺寸。因此,由本发明提供的一个优点在于,植入物102供应到椎间盘空间S内,可通过相当小的***进口或开口以最小创伤的方式实现,由此,将减弱周围组织的创伤减到最小,例如,环形的纤维化组织或髓核的其余的部分。
尽管本发明已在附图中和上述的描述中作了图示和描述,但这些图示和描述在性质上应被认为是说明性的而不是限制性的,应该理解到,这里只是示出和描述了优选的实施例,所有落入本发明精神内的变化和改型要求予以保护。
Claims (60)
1.用来在脊椎空间内供应一植入物的器械,其包括:
一模具件,其形成一尺寸适宜接纳植入物的开口,此时,植入物呈初始的结构,所述开口包括一沿一轴线延伸的通道,所述通道包括:一第一部分,其形成一尺寸适于接纳处于初始结构的植入物的第一横向尺寸;以及一第二部分,其形成一小于所述第一横向尺寸的第二横向尺寸;以及
其中,所述模具件构造成:植入物和所述模具件之间的相对位移致使植入物从初始的结构转变到一变形的结构,该变形的结构相对于初始的结构具有一减小的侧向外形,
其中,植入物朝向所述通道的所述第二部分的轴向位移使植入物从初始结构朝向变形的结构转变。
2.如权利要求1所述的器械,其特征在于,所述模具件包括多个引导,以便于将植入物从初始的结构转变到一折叠的结构。
3.如权利要求1所述的器械,其特征在于,所述通道的所述第一部分具有一矩形的截面。
4.如权利要求1所述的器械,其特征在于,所述通道的所述第二部分具有一圆形的截面。
5.如权利要求1所述的器械,其特征在于,所述通道的所述第一部分具有一矩形的截面,其中,所述通道的所述第二部分具有一圆形的截面。
6.如权利要求1所述的器械,其特征在于,所述通道沿横向方向从所述第一部分朝向所述第二部分向内变小,以便于植入物从初始结构朝向变形的结构转变。
7.如权利要求1所述的器械,其特征在于,所述模具件包括沿所述通道的至少一部分作轴向延伸的多个折叠元件,以便于植入物从初始结构朝向变形的结构转变。
8.如权利要求7所述的器械,其特征在于,所述折叠元件具有一三角形的结构。
9.如权利要求7所述的器械,其特征在于,所述折叠元件沿横向方向从所述通道的所述第一部分朝向所述通道的所述第二部分朝向彼此向内变小,以便于植入物从初始结构朝向变形的结构转变。
10.如权利要求7所述的器械,其特征在于,所述通道由一第一表面和一相对面向的第二表面界定,所述折叠元件的第一系列从所述第一表面延伸,所述折叠元件的第二系列从所述第二表面延伸。
11.如权利要求10所述的器械,其特征在于,所述折叠元件的所述第一系列相对于所述折叠元件的所述第二系列横向地偏移。
12.如权利要求11所述的器械,其特征在于,所述折叠元件的所述第一系列相对于所述折叠元件的所述第二系列以交替的方式横向地设置。
13.如权利要求1所述的器械,其特征在于,所述模具件形成一系列沿所述通道的至少一部分作轴向延伸的槽,以便于植入物从初始结构朝向变形的结构转变。
14.如权利要求1所述的器械,其特征在于,所述第二横向尺寸小于所述第一横向尺寸的一半。
15.如权利要求14所述的器械,其特征在于,所述第二横向尺寸小于所述第一横向尺寸的三分之一。
16.如权利要求1所述的器械,其特征在于,还包括一供应件,其用于接合和有选择地在***到脊椎空间内之前将植入物保持在变形的结构。
17.如权利要求16所述的器械,其特征在于,所述供应件可释放地连接到所述模具件。
18.如权利要求17所述的器械,其特征在于,所述供应件通过一易碎的连接部分可释放地连接到所述模具件。
19.如权利要求16所述的器械,其特征在于,所述模具件和所述供应件一体地形成为一单一件结构。
20.如权利要求16所述的器械,其特征在于,所述供应件形成一至少部分地通过其间延伸的内腔,所述内腔的尺寸适于接纳保持变形结构的植入物。
21.如权利要求20所述的器械,其特征在于,所述供应件包括一套管。
22.如权利要求20所述的器械,其特征在于,所述供应件包括一排出件,其至少部分地设置在所述内腔内并用于从所述内腔排出植入物进入到脊椎空间内。
23.如权利要求22所述的器械,其特征在于,所述排出件包括一可沿所述内腔轴向地移位的杆,以便接合植入物并从所述内腔将植入物排出到脊椎空间内。
24.如权利要求1所述的器械,其特征在于,还包括至少一个施力件,其用于接合植入物并相对于所述模具件移位植入物,致使植入物从初始结构朝向变形的结构转变。
25.如权利要求24所述的器械,其特征在于,所述至少一个施力件包括与植入物接合的至少一个细丝件,由此,所述至少一个细丝件的轴向张紧导致植入物相对于所述模具件的轴向位移,致使植入物从初始结构朝向变形的结构转变。
26.如权利要求23所述的器械,其特征在于,所述至少一个细丝件包括一缝合线。
27.如权利要求26所述的器械,其特征在于,所述缝合线包括一延伸通过由植入物形成的小孔的缝合线环。
28.如权利要求1所述的器械,其特征在于,所述模具件由一材料块形成。
29.如权利要求1所述的器械,其特征在于,所述模具是一个折叠模具,其包括:一载体盒,其形成一构造成接纳植入物的内腔;一具有一近端和一远端的伸展套管,所述远端构造成将植入物***到脊椎空间内;以及
其中,所述折叠模具沿从所述内腔到所述伸展套管的方向形成一向内减小的锥形,这样,当植入物通过所述内腔移位到所述伸展套管时,将植入物从相对平的结构再构造成圆柱形的结构。
30.如权利要求29所述的器械,其特征在于,还包括将力施加到植入物上的装置,以使植入物从所述内腔朝向所述伸展套管位移。
31.如权利要求29所述的器械,其特征在于,还包括排出装置,其用来将植入物从所述伸展套管排出并进入到脊椎空间内。
32.如权利要求29所述的器械,其特征在于,还包括用来可释放地将所述载体盒连接到所述伸展套管的装置。
33.一用来治疗一部分脊椎的***,其包括:
一植入物;以及
一形成一尺寸适宜接纳植入物的开口的模具件,此时,植入物呈一初始的结构,所述开口包括一沿一轴线延伸的通道,所述通道包括:一形成一第一横向尺寸的第一部分,该尺寸适于接纳处于初始结构的植入物;以及一形成一第二横向尺寸的第二部分,该尺寸小于所述第一横向尺寸;以及
其中,所述模具件构造成:植入物和所述模具件之间的相对位移致使植入物从初始的结构过渡到一变形的结构,该变形的结构相对于初始的结构具有一减小的侧向外形,
其中,植入物朝向所述通道的所述第二部分的轴向位移使植入物从初始结构转变到变形结构。
34.如权利要求33所述的***,其特征在于,所述第二横向尺寸小于所述第一横向尺寸的一半。
35.如权利要求33所述的***,其特征在于,所述第二横向尺寸小于所述第一横向尺寸的三分之一。
36.如权利要求33所述的***,其特征在于,所述植入物的所述初始结构是平的。
37.如权利要求33所述的***,其特征在于,所述植入物的所述变形结构是圆柱形的。
38.如权利要求33所述的***,其特征在于,所述植入物的所述初始结构是平的,其中,所述植入物的所述变形结构是圆柱形的。
39.如权利要求33所述的***,其特征在于,所述植入物的所述变形结构包括一折叠结构。
40.如权利要求33所述的***,其特征在于,所述植入物的所述变形结构包括一卷起结构。
41.如权利要求33所述的***,其特征在于,所述植入物的所述变形结构包括一卷曲结构。
42.如权利要求33所述的***,其特征在于,还包括附着在植入物上的至少一个细丝件,由此,所述至少一个细丝件的张紧导致所述植入物相对于所述模具件轴向地位移,致使植入物从所述初始结构朝向所述变形结构转变。
43.如权利要求33所述的***,其特征在于,所述植入物由一薄的柔性的可变形的材料形成,以便于从所述初始结构朝向所述变形结构转变。
44.如权利要求43所述的***,其特征在于,所述植入物由一可弹性变形的材料形成,以便于从所述变形结构朝向所述初始结构恢复。
45.如权利要求33所述的***,其特征在于,所述植入物包括一个或多个零件,其便于所述植入物从所述初始结构变形到所述变形的结构,并再朝向所述初始结构恢复。
46.如权利要求33所述的***,其特征在于,所述植入物是一假体的髓核,其适于供应到相邻脊椎之间的椎间空间内。
47.一用来将一植入物供应到脊椎空间内的方法,其包括:
提供一植入物;
提供一形成一尺寸适宜接纳植入物的开口的模具件,此时,植入物呈一初始的结构,所述开口包括一沿一轴线延伸的通道,所述通道包括:一形成一第一横向尺寸的第一部分,该尺寸适于接纳处于初始结构的植入物;以及一形成一第二横向尺寸的第二部分,该尺寸小于所述第一横向尺寸;
使植入物相对于模具件移位;以及
将植入物从初始的结构转变到一变形的结构,该变形的结构相对于初始的结构具有一减小的侧向外形,其中,植入物朝向所述通道的所述第二部分的轴向位移使植入物从初始结构转变到变形结构。
48.如权利要求47所述的方法,其特征在于,还包括暂时地将植入物保持在变形的结构。
49.如权利要求47所述的方法,其特征在于,还包括将植入物***到脊椎空间内,此时,植入物处于变形结构。
50.如权利要求49所述的方法,其特征在于,还包括:
提供一供应件;
将供应件与植入物接合,此时,植入物处于变形结构;以及
在***前有选择地将植入物保持在变形的结构。
51.如权利要求50所述的方法,其特征在于,供应件可释放地连接到模具件;以及还包括在***前有选择地从供应件脱开模具件。
52.如权利要求51所述的方法,其特征在于,脱开包括断裂。
53.如权利要求49所述的方法,其特征在于,还包括使植入物朝向初始结构恢复。
54.如权利要求47所述的方法,其特征在于,形成在模具中的开口包括一沿一轴线延伸的通道,该通道包括一形成一第一横向尺寸的第一部分和一形成一比第一横向尺寸小的第二横向尺寸的第二部分,通道的第一部分的尺寸适于接纳处于初始结构的植入物;以及
其中,该方法还包括植入物朝向通道的第二部分的轴向的位移,以使植入物从初始结构朝向变形结构转变。
55.如权利要求54所述的方法,其特征在于,还包括将植入物预加载在通道的第一部分内。
56.如权利要求47所述的方法,其特征在于,结构的转变包括折叠。
57.如权利要求47所述的方法,其特征在于,结构的转变包括卷起。
58.如权利要求47所述的方法,其特征在于,结构的转变包括卷曲。
59.如权利要求47所述的方法,其特征在于,位移包括在植入物上施加一拉力。
60.如权利要求47所述的方法,其特征在于,结构转变包括横贯由模具件形成的多个引导曳拉植入物。
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EP (1) | EP1465538A4 (zh) |
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Also Published As
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US20030125748A1 (en) | 2003-07-03 |
US7081120B2 (en) | 2006-07-25 |
CA2470196A1 (en) | 2003-06-26 |
EP1465538A4 (en) | 2008-04-23 |
WO2003051212A2 (en) | 2003-06-26 |
AU2002351368A1 (en) | 2003-06-30 |
US8480744B2 (en) | 2013-07-09 |
JP2005516648A (ja) | 2005-06-09 |
US20060253122A1 (en) | 2006-11-09 |
CN1615107A (zh) | 2005-05-11 |
WO2003051212A3 (en) | 2003-10-16 |
EP1465538A2 (en) | 2004-10-13 |
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