JP3819962B2 - 椎体間固定インプラントのガイド装置 - Google Patents

椎体間固定インプラントのガイド装置 Download PDF

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JP3819962B2
JP3819962B2 JP07911396A JP7911396A JP3819962B2 JP 3819962 B2 JP3819962 B2 JP 3819962B2 JP 07911396 A JP07911396 A JP 07911396A JP 7911396 A JP7911396 A JP 7911396A JP 3819962 B2 JP3819962 B2 JP 3819962B2
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inner cylinder
hollow inner
outer cylinder
guide protrusion
guide device
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JPH09266917A (ja
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泰明 徳橋
聡 小島
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ペンタックス株式会社
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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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • 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
    • A61F2/4611—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 of spinal prostheses
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
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    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
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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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    • 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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    • 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
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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    • A—HUMAN NECESSITIES
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    • 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
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    • A—HUMAN NECESSITIES
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    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/3085—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
    • 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
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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
    • A61F2002/4625—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 with relative movement between parts of the instrument during use
    • A61F2002/4627—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 with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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Description

【０００１】
【技術分野】
本発明は、頸椎等の椎体の変性疾患治療のため、隣接椎体間にインプラントを螺合させる際に使用するガイド装置（治具）に関する。
【０００２】
【従来技術およびその問題点】
頸椎の変性疾患治療のため、環椎（第１頸椎）と第２頸椎の間の亜脱臼部位にスクリュー（インプラント）を螺合固定する手術法が知られている。しかし、この手術は、スクリュー螺合部位に極めて接近した位置に脊髄や神経根が存在するため、手術時にこれら脊髄や神経根を損傷するおそれがある。このため、手術時間に多くを要し、術者、患者双方の大きな負担となっていた。
【０００３】
【発明の目的】
本発明は、このような隣接椎体間にスクリュー等のインプラントを固定する手術の際に、脊髄や神経根を損傷するおそれなく、安全に手術を行なうことができるインプラントのガイド装置を得ることを目的とする。
【０００４】
【発明の概要】本発明の椎体間固定インプラントのガイド装置は、隣接椎体の間にインプラントを固定する際に用いるガイドであって、把持部と；この把持部に固定され、内周にインプラント固定用治具を挿脱可能な中空内筒と；この中空内筒の先端部に前方に突出させて設けた、脊髄の横に押し当てられる第一のガイド突起と；上記中空内筒の外側に少なくとも回動自在に嵌めた移動外筒と；この移動外筒の先端部に前方に突出させて設けた、神経根の横に押し当てられる第二のガイド突起と；を備え、上記第一ガイド突起を脊髄の横に、上記第二ガイド突起を神経根の横にそれぞれ押し当てながら挿入した状態で、上記移動外筒を中空内筒に対して相対回動させることを特徴としている。
【０００５】
このガイド装置によると、インプラント挿入部位に内筒及び移動外筒を当て付けるとき、その第一ガイド突起を脊髄の横に、第二ガイド突起を神経根の横にそれぞれ押し当てながら挿入し、次に、移動外筒を回動させることにより、第二ガイド突起によって神経根を損傷することなく、移動させることができる。インプラントの挿入固定手術は、以上のセットが終了した状態において、内筒内に治具、例えば、ドリルやドライバーを順次挿入して行なう。
【０００６】
移動外筒は、内筒に対する軸方向移動も可能とすることが望ましく、さらに径方向に突出する操作ノブを一体に設けることが好ましい。
【０００７】
【発明の実施形態】
図１ないし図４に示す、本発明による椎体間固定インプラントのガイド装置は、把持部１０、中空内筒２０、および移動外筒３０を備えている。把持部１０は、円柱状部１１と偏平部１２とを有し、偏平部１２の先端に、中空内筒２０の一端部が固定されている。円柱状部１１には、滑り止めのローレット１３が付されている。
【０００８】
中空内筒２０は、その一端開口部２１を偏平部１２に開口させた状態で、ねじ２２により該円柱状部１１に固定されている。この中空内筒２０の他端部の端面は、中心部が尖った平面山形部２３をなしている。この平面山形部２３の一方の頂部には、移動外筒３０を中空内筒２０の外周に嵌めた後、第一ガイド突起２４が固定ねじ２５で固定されている。第一ガイド突起２４は、中空内筒２０の前方に該中空内筒２０の軸線と平行な方向に突出している。
【０００９】
移動外筒３０は、中空内筒２０の外周に回動及び軸線移動自在に嵌められ、その把持部１０側の一端部に、径方向に突出する操作ノブ３１を有し、他端部に、第二ガイド突起３２を有する。この第二ガイド突起３２は、移動外筒３０の前方に該移動外筒３０の軸線と平行な方向に突出している。移動外筒３０は、その端面３３が中空内筒２０の第一ガイド突起２４の端部と係合して抜け止められ、第二ガイド突起３２が第一ガイド突起２４の両側面と係合してその回動範囲が１回転以下に規制される。
【００１０】
図５ないし図１０は、以上の構成を有する椎体間固定インプラントのガイド装置を用いた手術法の概略図であり、環椎（第１頸椎）５０と第２頸椎６０との間のＡ部位に、インプラントとしてのスクリュー９０を螺合固定する場合を例示している。まず、術者は把持部１０を把持し、脊髄７０と神経根８０を避けながら、図５、図６に示すように、中空内筒２０をＡ部位に当て付ける。このとき、中空内筒２０の平面山形部２３を尖らせているために滑りを防止できる。この際、第一ガイド突起２４は、脊髄７０を損傷しないように、脊髄７０の側部に押し付ける。次に、または同時に、第二ガイド突起３２を脊髄７０及び神経根８０とは接触しない位置に位置させて移動外筒３０を押し込み、その後、図７、図８に示すように、移動外筒３０を回動させて第二ガイド突起３２により神経根８０を押し上げる。このとき、移動外筒３０が軸線移動自在であるため、第二ガイド突起３２は凹凸のある頸椎上に沿って引っ掛かりなく回動できる。このセット状態では、脊髄７０及び神経根８０は、中空内筒２０の中心孔から十分逃げた位置にある。６１は第２頸椎６０の棘突起である。
【００１１】
このセット状態で、中空内筒２０の一端開口部２１から、先ずドリルを挿入して環椎（第１頸椎）５０と第２頸椎６０の隣接部位に下穴を穿ける。次に、ドリルを抜いてからタップを挿入して下ねじを切った後、スクリュー９０を一端開口部２１から中空内筒２０内に挿入し、さらにドライバーを挿入してスクリュー９０を回転させ、下ねじに螺合固定させる（図９、図１０）。手術の態様によってはドリルとタップのいずれか一方の加工は省略することができる。
【００１２】
以上の手術において、中空内筒２０の第一ガイド突起２４は脊髄７０がドリルやタップあるいはスクリュー９０によって損傷されるのを防止し、移動外筒３０の第二ガイド突起３２は同様に神経根８０が損傷されるのを防止する。よって、最初の中空内筒２０と移動外筒３０のセットを注意深く実行すれば、後の下穴加工およびスクリュー９０の螺合固定作業は、極めて高い安全性で迅速に行なうことができる。
【００１３】
上記実施例では、インプラントとしてスクリューを例示したが、スクリュータイプ以外のインプラントのガイド装置としても本発明装置は利用できる。
【００１４】
【発明の効果】
本発明によれば、隣接椎体間にインプラントを固定する手術の際に、脊髄や神経根を損傷するおそれなく、安全に手術を行なうことができるインプラントのガイド装置が得られる。
【図面の簡単な説明】
【図１】本発明による椎体間固定インプラントのガイド装置の実施例を示す斜視図である。
【図２】同正面図である。
【図３】同平面図である。
【図４】同側面図である。
【図５】本発明による椎体間固定インプラントのガイド装置を用いた手術法を模式的に示す、頸椎の手術部位の背面図である。
【図６】同側面図である。
【図７】図５とは異なる状態の頸椎の手術部位の背面図である。
【図８】同側面図である。
【図９】図５、図７とは異なる状態の頸椎の手術部位の背面図である。
【図１０】同側面図である。
【符号の説明】
１０ 把持部
２０ 中空内筒
２１ 一端開口部
２４ 第一ガイド突起
３０ 移動外筒
３１ 操作ノブ
３２ 第二ガイド突起
５０ 環椎（第１頸椎）
６０ 第２頸椎
７０ 脊髄
８０ 神経根
９０ スクリュー（インプラント）

Claims (4)

  1. 隣接椎体の間にインプラントを固定する際に用いるガイド装置であって、
    把持部と；
    この把持部に固定され、内周にインプラント固定用治具を挿脱可能な中空内筒と；
    この中空内筒の先端部に前方に突出させて設けた、脊髄の横に押し当てられる第一のガイド突起と；
    上記中空内筒の外側に少なくとも回動自在に嵌めた移動外筒と；
    この移動外筒の先端部に前方に突出させて設けた、神経根の横に押し当てられる第二のガイド突起と；
    を備え、
    上記第一ガイド突起を脊髄の横に、上記第二ガイド突起を神経根の横にそれぞれ押し当てながら挿入した状態で、上記移動外筒を中空内筒に対して相対回動させることを特徴とする椎体間固定インプラントのガイド装置。
  2. 請求項１において、移動外筒は、軸方向移動も可能である椎体間固定インプラントのガイド装置。
  3. 請求項１または２において、移動外筒には、径方向に突出する操作ノブが一体に設けられている椎体間固定インプラントのガイド装置。
  4. 請求項１ないし３のいずれか１項において、第一のガイド突起は、中空内筒の外面に固定されていて、移動外筒の抜け止め機能および回動範囲規制機能を持つ椎体間固定インプラントのガイド装置。
JP07911396A 1996-04-01 1996-04-01 椎体間固定インプラントのガイド装置 Expired - Fee Related JP3819962B2 (ja)

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JP07911396A JP3819962B2 (ja) 1996-04-01 1996-04-01 椎体間固定インプラントのガイド装置
US08/829,229 US5885300A (en) 1996-04-01 1997-03-31 Guide apparatus of intervertebral implant
DE19713416A DE19713416B4 (de) 1996-04-01 1997-04-01 Führungsvorrichtung für ein Zwischenwirbelimplantat

Applications Claiming Priority (1)

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JP07911396A JP3819962B2 (ja) 1996-04-01 1996-04-01 椎体間固定インプラントのガイド装置

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