JP4060589B2 - 脊柱の椎体間に装入する生体埋め込み部材、及び、これを取り扱う手術具 - Google Patents

脊柱の椎体間に装入する生体埋め込み部材、及び、これを取り扱う手術具 Download PDF

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JP4060589B2
JP4060589B2 JP2001398572A JP2001398572A JP4060589B2 JP 4060589 B2 JP4060589 B2 JP 4060589B2 JP 2001398572 A JP2001398572 A JP 2001398572A JP 2001398572 A JP2001398572 A JP 2001398572A JP 4060589 B2 JP4060589 B2 JP 4060589B2
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living body
embedded
body implanting
surgical instrument
threaded
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JP2002238929A (ja
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ノイマン カルステン
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ウルリッヒ ゲーエムベーハー ウント コンパニ カーゲー
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    • 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
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30774—Apertures or holes, e.g. of circular cross section internally-threaded
    • 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
    • A61F2/30767—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
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30777—Oblong apertures
    • 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
    • A61F2/30767—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
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30784—Plurality of holes
    • A61F2002/30785—Plurality of holes parallel
    • 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
    • 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
    • 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
    • A61F2002/4631—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor the prosthesis being specially adapted for being cemented
    • 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
    • A61F2002/4632—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using computer-controlled surgery, e.g. robotic surgery
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit

Landscapes

  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Neurology (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Description

【０００１】
【発明の属する技術分野】
本発明は、脊柱から離された椎骨または椎骨部分に代わるスペース保持部材として、脊柱の椎体の間に装入するための生体埋め込み部材に関する。また、生体埋め込み部材の長さを変更するための手術具に関する。
【０００２】
【従来の技術】
スペース保持部材が、第１の埋め込み部分と第２の埋め込み部分とを備え、これら第１及び第２の埋め込み部分が、生体埋め込み部材の長さ変更のために、共通の長軸方向にて、互いに位置・姿勢をシフト可能である。そして、手術具により、これらの間の長さを変更することができる。
【０００３】
このような生体埋め込み部材が、例えばＤＥ４４２３２５７Ａ１号により公知である。この公知の生体埋め込み部材は、実際の使用により非常に良好であることが証されており、これを用いると生体への埋め込みの後に非常に良好な結果が得られている。
【０００４】
【発明が解決しようとする課題】
しかしながら、手術時に、開かれた脊柱に埋め込む際に、以下の点で部分的に問題があることが知られた。第１の埋め込み部分を第２の埋め込み部分に対してねじるためには大きな作業領域を必要とする。振れ動きのモーションによって相互のねじり動きが達成されるからである。このような振れ動きのためのスペースは、いつも充分に利用可能というものでない。特には、生体中への最小限の器具挿入により外科手術を行うミニマル−インヴァーシブ(minimal-invasive）な外科治療においては、脊柱への小さなアクセス経路しか与えられない。
【０００５】
したがって、発明の根底を成す課題は、冒頭に述べたような生体埋め込み部材について、生体埋め込み部材の取り扱いのための手術具を振れ動かせるスペースを必要とすることなしに、長さ変更が可能となるように構成することである。また、本発明の課題は、本発明の生体埋め込み部材に組み合わされて用をなすように特に良好に適合された手術具を供給することである。
【０００６】
【課題を解決するための手段】
この課題における生体埋め込み部材に関する部分は、冒頭に述べたような生体埋め込み部材において、次のようであることにより解決される。第１の埋め込み部分の側に、回転可能なネジ切リングが配され、該ネジ切りリングのリング状ネジ切り部が、第２の埋め込み部分の側のネジ切り部に噛み合わされる。また、ネジ切リングがベベルギア状歯列、すなわち、かさ歯車形成面を備える。
【０００７】
【発明の実施の形態】
この生体埋め込み部材により次のような大きな利点が得られる。ベベルギア状歯列を備えることにより、生体埋め込み部材に対して純然たる半径方向から取り付けられた手術具を用いて、該手術具をねじるだけで、第２の埋め込み部分をねじ込むことができる。また、長さ変更のためには、実質的に点状の生体埋め込み部材へのアクセス経路で十分である。このため、単に引き延ばしの目的でキズが増大するということがないようにされている。
【０００８】
本発明の好ましい実施態様によると、第１及び第２の埋め込み部分が管状スリーブとして形成され、第１の埋め込み部分が、ネジ切リングと共に、第２の埋め込み部分を外側から囲むことが想定されている。２つのスリーブを用いる本発明の形状構成によると、生体埋め込み部材の内部空間が空いており、例えば、骨セメントを充填するのに、または、患者自身または他人の骨の削り粉を充填するのに用いることができるという利点が得られる。生体埋め込み部材を周囲の組織に確実に根付かせることができるようになっているのである。第１の埋め込み部分に対する第２の埋め込み部分のねじ回しにより生体埋め込み部材の長さを変える際にネジ切り部が締め付けられたり自己制動を起こすというようなこと避けるために、第１の埋め込み部分に配されたピンを受け入れるための少なくとも１つの案内スリットが第２の埋め込み部分中に設けられる。ここでの案内性を向上させるためには、２重に、案内スリットとピンとが直径方向に配列されていれば良いことが示された。すなわち、直径方向に整列された案内スリットとピンとの組み合わせが、２つ備えられれば良いことが実証により知られた。
【０００９】
手術具を用いたネジ切リングの操作を簡単なものにするために、スリーブ状の第１の埋め込み部分の壁に、少なくとも１つの突き抜け部が存在する。この突き抜け部は、ネジ切リングの側の縁を切り込むように配されている。すなわち、突き抜け部は、ネジ切リングの側の縁から引き込んだ湾状をなすように配されている。言い換えると、ネジ切リングの側の縁に掛かるまで延びて該縁を部分的に切り取るように配されている。この突き抜け部は、生体埋め込み部材に接ぎ付けられる手術具に対する支持当接部として利用可能となっている。
【００１０】
手術具に対する案内長さがスリーブ壁の厚みに限られないようにするためには、第２の埋め込み部分が、突き抜け部に整列する２つの長穴ないしスロット穴を有する。これら長穴の存在により、第１の埋め込み部分の壁の突き抜け部に対向して、該突き抜け部からアクセス可能にネジ切孔を構成することが可能となる。
【００１１】
生体埋め込み部材を周囲の組織に、より速く根付かせるためには、第２の埋め込み部分における、第１の埋め込み部分とは逆の端部に、突き出し部が形成されているなら好ましいことが知られた。この突き出し部により、第２の埋め込み部分と椎体との当接面が拡げられる。この突き出し部は、第２の埋め込み部分の自由端から距離をおいて配されているなら、中に入れ込まれる骨セメントまたは骨の接着剤からの、保護部材としての作用を行い、同時に、第２の埋め込み部分のネジ切面が骨セメント等により塞がれたり損傷を受けたりするのを防ぐ。これに代えて、突き出し部中に、生体埋め込み部材の長軸に平行して突き抜ける孔が形成されていても良い。
【００１２】
第２の埋め込み部分の側のネジ切り部のところでの、ネジ切リングの案内長をなるべく大きくするためには、ネジ切リングの内周にリング状カラー部が備えられるというふうに生体埋め込み部材を構成することができる。
【００１３】
ネジ切リングの位置・姿勢を第１の埋め込み部分に対して確実に固定することができるようにするためには、本発明の生体埋め込み部材において、第１の埋め込み部分が、管状スリーブをなすように形成され、生体埋め込み部材の長軸に垂直に延びる横方向溝が備えられる。合目的には、この横方向溝が、突き抜け部とネジ切孔とを結ぶ接続軸に対して平行に配される。また、該接続軸から見て、横方向溝が、第１の埋め込み部分の管状スリーブの両側に形成されているなら好都合である。
【００１４】
前記課題における手術具に関する部分は、以下により解決される。手術具により引き伸ばし可能な生体埋め込み部材は、ネジ接続を介して長さ調節可能でベベルギア状歯列を有し、脊柱から離された椎骨に代わるスペース保持部材として、脊柱の椎体の間に装入するためのものである。本発明の手術具においては、シャフトの自由端の側に、シャフト軸に共軸に、ベベルギア状歯列を備えたピニオンが配されている。この手術具によると、生体埋め込み部材から半径方向に離されたシャフトを用い、生体埋め込み部材の長軸と垂直をなすように配した上で、単にシャフトを長軸の周りに回転させるだけで、ピニオンのベベルギア状歯列を回転させることができる。該ピニオンがネジ切リングのベベルギア状歯列と協同で作用を行うとき、生体埋め込み部材の長さを変更するのに必要な、第１の埋め込み部分と第２の埋め込み部分との相互の回転が引き起こされる。
【００１５】
手術の際、手術具の取り扱いをより容易にするために、次のことが想定されている。シャフトは、回転可能にグリップ中に嵌め込まれ、ピニオンとは逆の端部に、ローレット掛け部、すなわちギザギザを付けられた個所によって、駆動されるように備えられている。
【００１６】
手術具の特に好ましい実施態様によると、次のように構成されることを特徴とする。シャフトが中空シャフトとして形成され、該中空シャフト中に、該シャフトに対して回転可能なロッドが嵌め込まれる。該ロッドの自由端はピニオンを貫いており、該ロッドには、ネジ切孔に対応するロッドネジ切り部が構成される。このような構成であると、次のような利点が得られる。手術具に対する第１の埋め込み部分の位置・姿勢を、ロッドネジ切り部によって確実に固定する。したがって、ピニオンのベベルギア状歯列をネジ切リングのベベルギア状歯列に噛み合わせるようにするのに必要な圧力を加えることによっては、脊柱の椎体の間にすでに配置されたスペース保持部材の位置・姿勢が変えられることがない。
【００１７】
本発明の他の好ましい実施態様によると、次のように構成されることを特徴とする。シャフトがグリップに固定されたスリーブ中に配される。該スリーブは、ピニオンの側の端部に、ネジ切リングと第１の埋め込み部分との間の軸方向位置を互いに固定するための、フォーク指を備えたフォークを有する。
【００１８】
ここで、以下のようであるなら特に好ましいことが知られた。フォークが、生体埋め込み部材を保持する全部で４本のフォーク指を有し、これらフォーク指のうち２本が、第１のフォーク対にまとめられてネジ切リングに当接するように備えられる。残りの２本は、第２のフォーク対にまとめられて横方向溝に差し込まれるように備えられる。
【００１９】
このような手術具を用いると、生体埋め込み部材を非常に確実に捕らえて予め定められた位置に保持することができる。ここで、長さ変更のために必要なシャフトの回転を行っても、操作領域内で生体埋め込み部材がずれたり、または、第１の生体埋め込み部材と第２の生体埋め込み部材とが互いに移動することで長さ延長に影響を与えてしまうおそれがない。生体埋め込み部材の長さ延長の変化は、ネジ切リングによって防止されているのであり、ネジ切リングの回転により生じるということがない。
【００２０】
消毒による衛生状態の向上の観点からは、ローレット掛け部を備えたシャフト、ロッド、及び、スリーブを備えたグリップが分解可能に組み立てられているのが合目的である。
【００２１】
以下において、図面に描かれた実施例を用いて本発明について詳細に説明する。
【００２２】
図示された生体埋め込み部材１は、脊柱から離された椎骨または椎骨部分のためのスペース保持部材として、図面には描かれていない脊柱の椎体の間に装入するために用いられる。この生体埋め込み部材１が、第１の埋め込み部分２と第２の埋め込み部分３とを有する。これら第１及び第２埋め込み部分は、椎体を引き離すという意味で長さを変更できるように、共軸の長軸方向に互いに位置・姿勢をシフトすることが可能である。第１の埋め込み部分２と第２の埋め込み部分３とが管状スリーブとして形成されており、第１の埋め込み部分２が第２の埋め込み部分３を外側から囲む。第１の埋め込み部分２に、回転可能なネジ切リング４が割り当てられている。該ネジ切リング４は、その内周面にリング状ネジ切り部５を有し、該ネジ切り部でもって第２の埋め込み部分３の側のネジ切り部６に噛み合わされる。ネジ切リング５は、外周面に、ベベルギア状歯列７を備える(図８)。
【００２３】
特には図３及び図６から明らかなように、第２の埋め込み部分３に、２つの互いに対向し合う案内スリット８が形成されており、これら案内スリット８中へと、第１の埋め込み部分２に割り当てられたピン９が延びる(図２)。
【００２４】
ピン９に加えて、第１の埋め込み部分２が突き抜け部１０を有する。該突き抜け部１０は、第１の埋め込み部分２におけるネジ切リング４の側の縁１１を部分的に切り取るように配され、対向側に構成されたネジ切孔１２に対して整列されている。すなわち互いに中心を合わせられている。突き抜け部１０に整列されるようにして、第２の埋め込み部分３中に、２つの長穴１３が備えられる。これら長穴１３の範囲内で、ネジ切孔１２は、いずれの高さ位置に持ってくることもできる。ここでの高さ位置は、第１の埋め込み部分１に対する第２の埋め込み部分３の高さ位置である。
【００２５】
第２の埋め込み部分３には、該部分の自由端から距離をおいて、第１の埋め込み部分２とは逆の側に、突き出し部１４が形成されており、該突き出し部１４には、第１の生体埋め込み部材１の長軸に平行に通じた穴１５が構成されている。
【００２６】
ネジ切リング４が内周に沿ってリング状カラー部１６を有している。一方、第１の生体埋め込み部材２は、管状スリーブをなし、埋め込み部材１の長軸に垂直に延びる横方向溝１７を有している。この該横方向溝１７は、突き抜け部１０とネジ切孔１２とを結ぶ接続軸に平行に配列されており、図示された実施例においては、横方向溝１７が該接続軸を挟む両側に、２つ、備えられる。
【００２７】
ネジ切リング４に構成されたリング状カラー部１６と、横方向溝１７とは、以下に詳述するような手術具１８をより良好に配置し位置決めするのに役立つ。手術具１８は、生体埋め込み部材１の長さを調節する操作のために用いられる。
【００２８】
手術具１８が、この長さ調節のために、シャフト１９の自由端に、シャフト軸に共軸なピニオン２０を有している。該ピニオン２０にベベルギア状歯列２１が形成されている(図９、図１０)。シャフト１９自体は、中空シャフトとして形成されており、該中空シャフト中にはロッド２２が中空シャフトに対して回転可能に取り付けられている。該ロッド２２がピニオン２０を貫いており、ロッド２２の自由端には、ネジ切孔１２に対応するロッドネジ切り部２３が備えられる。中空シャフト自体が回転可能にグリップ部２４中に嵌め込まれている。また、該グリップ部２４にはスリーブ２５が備えられ、該スリーブ２５中には中空シャフトが差し込まれている。このスリーブ２５は、ピニオン２０の側の端部に、４つのフォーク指２７を備えたフォーク２６を有している。これらフォーク指のうちで、２つは、第１のフォーク対２８にまとめられ、他の２つは第２のフォーク対２９にまとめられている。
【００２９】
生体埋め込み部材１及び手術具１８の構造について以上に述べたので、以下に、これらの協同作用、すなわちこれらが組み合わさった際の機能について詳述する。
【００３０】
２つの椎体の間にスペース保持部材としての本発明の生体埋め込み部材１を配置するために、まず、生体埋め込み部材１がフォーク２６のところに差し込まれる。第２のフォーク対２９が一対の横方向溝１７に差し込まれる。第１のフォーク対２８は、ネジ切リング４に当接するとともに、半径方向内側にてリング状カラー部１６に当接する。このようにして、ネジ切リング４は、生体埋め込み部材１の長軸に沿った、第１の埋め込み部分２に対する軸方向移動を行えないようにされる。次いで、ロッド・ネジ切り部２３を備えたロッド２２が、第１の埋め込み部分２の突き抜け部１０と、第２の埋め込み部分３の２つの長穴１３とを挿通して、第１の埋め込み部分２のネジ切孔１２にねじ込まれて接合される。その結果、手術具１８は、もはや生体埋め込み部材１から半径方向に引き離すことができなくなり、そのため、手術具１８の位置・姿勢が生体埋め込み部材１に対して全体的に固定される。
【００３１】
同時に、ネジ切孔１２中にロッドネジ切り部２３をねじ込むことにより、ピニオン２０のベベルギア状歯列２１がネジ切リング４のベベルギア状歯列７と噛み合わされる。そのため、これに続いて、シャフト１９をローレット掛け部３０によってシャフト軸の周りに回転させると、シャフト軸に対して９０度回転して配された、生体埋め込み部材１の長軸の周りに、ネジ切リング４が回転する。
【００３２】
生体埋め込み部材１を正しく配置して引き伸ばした後に、手術具１８は、上述したステップを、趣旨にしたがって、逆に行うことにより、再び生体埋め込み部材１から解き放される。このようにして遮られることなくアクセス可能となった案内スリット８、長穴１３、及び、ネジ切孔１２、並びに突き抜け部１０を通じて、生体埋め込み部材１は、骨セメント、または、別個または類似の骨材料を生体埋め込み部材中に入れ込むための、スリーブ状の第１の埋め込み部分２と第２の埋め込み部分３の内部への充分なアクセス可能性を与える。
【００３３】
図１中に符号３１を付された取り付け具が、コンピュータ位置決め用の位置決め器と、手術具１８とを連結するのに役立つ。
【００３４】
【発明の効果】
生体埋め込み部材に対して半径方向から取り付けられた手術具をねじるだけで、生体埋め込み部材の長さを変更することができ、また、実質上点状のアクセス経路で充分である。
【図面の簡単な説明】
【図１】本発明の生体埋め込み部材について、本発明の手術具によって操作される様子を示す斜視図である。
【図２】本発明の生体埋め込み部材について、他から引き離した状態で示す斜視図である。
【図３】第２の埋め込み部分の斜視図である。
【図４】第１の埋め込み部分の斜視図である。
【図５】図４とは異なる視点から見た場合の、第１の埋め込み部分の斜視図である。
【図６】第２の埋め込み部分の側面図である。
【図７】第２の埋め込み部分について、図６の状態から９０度回転させた様子を示す側面図。
【図８】ベベルギア状歯列を有するネジ切リングの横断面図である。
【図９】本発明の手術具について、構成部材に分解した様子を示す平面図である。
【図１０】本発明の手術具について、完全に組み立てられた様子、及び構成部材に分解した様子を示す斜視図である。
【図１１】スリーブのフォークについての斜視図である。
【図１２】図１のXII部を示す拡大図である。
【符号の説明】
１ 生体埋め込み部材
２ 第１の埋め込み部分
３ 第２の埋め込み部分
４ 第２の埋め込み部分の側に配されるネジ切リング
５ ネジ切リング４の内周面のネジ切り部
６ 第２の埋め込み部分３の側のネジ切り部
７ ネジ切リング４の外周面にあるベベルギア状歯列
８ 第２の埋め込み部分３の案内スリット
９ 案内スリット９中に延びるピン
１０ 第１の埋め込み部分２の壁の突き抜け部
１１ 第１の埋め込み部分２における、ネジ切リング４の側の縁
１２ 突き抜け部１０と対向するネジ切孔
１３ 突き抜け部１０及びネジ切孔１２に整列されている長穴

Claims (20)

  1. 脊柱から離された椎骨または椎骨部分に代わるスペース保持部材として脊柱の椎体の間に装入するための生体埋め込み部材であって、第１の埋め込み部分(２)と第２の埋め込み部分(３)とを備え、これらが共通の長軸方向にて、生体埋め込み部材(１)の長さの変更のために互いに位置・姿勢を変更可能である生体埋め込み部材において、第１の埋め込み部分(２)には回転可能なネジ切リング(４)が割り当てられ、このネジ切リング(４)のリング状ネジ切り部(５)が、第２の埋め込み部分(３)に割り当てられたネジ切り部(６)に噛み合わされ、また、該ネジ切リング(４)がベベルギア状歯列(７)を備えており、
    第１の埋め込み部分 ( ２ ) 及び第２の埋め込み部分 ( ３ ) が管状スリーブとして構成されており、第１の埋め込み部分 ( ２ ) 及びネジ切リング ( ４ ) が、第２の埋め込み部分 ( ３ ) を外側から囲むものであり、
    スリーブ状の第１の埋め込み部分 ( ２ ) の壁に少なくとも１つの突き抜け部 ( １０ ) があり、この突き抜け部 ( １０ ) が、ネジ切リング ( ４ ) の側の縁 ( １１ ) を部分的に切り取るように配されたことを特徴とする生体埋め込み部材。
  2. 請求項１に記載の生体埋め込み部材において、第２の埋め込み部分 ( ３ ) が、突き抜け部 ( １０ ) と整列されている２つの長穴 ( １３ ) を有することを特徴とする生体埋め込み部材。
  3. 請求項２に記載の生体埋め込み部材において、突き抜け部 ( １０ ) と向き合うように、第１の埋め込み部分 ( ２ ) の壁に、ネジ切孔 ( １２ ) が形成されていることを特徴とする生体埋め込み部材。
  4. 請求項１〜３のいずれかに記載の生体埋め込み部材において、第２の埋め込み部分 ( ３ ) には、第１の埋め込み部分 ( ２ ) に配されたピン ( ９ ) を受け入れるための少なくとも１つの案内スリット ( ８ ) が形成されていることを特徴とする生体埋め込み部材。
  5. 請求項４に記載の生体埋め込み部材において、直径方向に配列される案内スリット ( ８ ) 及びピン ( ９ ) が、２組、備えられることを特徴とする生体埋め込み部材。
  6. 請求項１〜５のいずれかに記載の生体埋め込み部材において、第１の埋め込み部分 ( ２ ) における突き抜け部 ( １０ ) の周囲の端面は、突き抜け部 ( １０ ) が直径方向外側へと向かって広がるように傾斜しており、これにより、ベベルギア状歯列 ( ２１ ) を備えたピニオン ( ２０ ) のための支持当接部をなしていることを特徴とする生体埋め込み部材。
  7. 請求項１〜６のいずれかに記載の生体埋め込み部材において、第１の埋め込み部分 ( ２ ) は、ネジ切リング ( ４ ) の側の端部が、ベベルギア状歯列 ( ７ ) に沿った傾斜面をなし、ネジ切リング ( ４ ) は、第２の埋め込み部分 ( ３ ) に組み合わされた状態で、外周面が、第２の埋め込み部分 ( ３ ) の外周面と連続する一つの円筒面をなすことを特徴とする生体埋め込み部材。
  8. 請求項１〜７のいずれかに記載の生体埋め込み部材において、第２の埋め込み部分(３)には、第１の埋め込み部分(２)とは逆の端部に、突き出し部(１４)が形成されていることを特徴とする生体埋め込み部材。
  9. 請求項８に記載の生体埋め込み部材において、突き出し部(１４)が、第２の埋め込み部分(３)の自由端から距離をおいて配されていることを特徴とする生体埋め込み部材。
  10. 請求項８または９に記載の生体埋め込み部材において、突き出し部(１４)には、生体埋め込み部材(１)の長軸に平行に突き抜ける穴(１５)が形成されていることを特徴とする生体埋め込み部材。
  11. 請求項１〜１０のいずれかに記載の生体埋め込み部材において、ネジ切リング(４)が内周に、リング状カラー部(１６)を有していることを特徴とする生体埋め込み部材。
  12. 請求項２〜１１のいずれかに記載の生体埋め込み部材において、第１の埋め込み部分(２)が、管状スリーブをなすように形成され、生体埋め込み部材(１)の長軸に垂直に延びる横方向溝(１７)を有していることを特徴とする生体埋め込み部材。
  13. 請求項１２に記載の生体埋め込み部材において、横方向溝(１７)が、突き抜け部(１０)とネジ切孔(１２)とを結ぶ接続軸に対して平行に配されていることを特徴とする生体埋め込み部材。
  14. 請求項１３に記載の生体埋め込み部材において、横方向溝(１７)が、第１の埋め込み部分(２)の管状スリーブにおける、前記接続軸を挟む両側に形成されていることを特徴とする生体埋め込み部材。
  15. ベベルギア状歯列(７)を有しネジ接続によって縦方向に位置・姿勢を変更可能であって、脊柱から離された椎骨または椎骨部分に代わるスペース保持部材として脊柱の椎体の間に装入するための、請求項１〜１４のいずれかに記載の生体埋め込み部材(１)について、引き延ばしを行うための手術具において、シャフト(１９)の自由端の側に、シャフト軸に共軸に、ベベルギア状歯列(２１)を備えたピニオン(２０)が配され、
    シャフト ( １９ ) が中空シャフトとして形成され、該中空シャフト中には中空シャフトに対して回転可能なロッド ( ２２ ) が嵌め込まれ、該ロッド ( ２２ ) の自由端がピニオン ( ２０ ) を貫いており、また、該ロッド ( ２２ ) には、ネジ切孔 ( １２ ) に対応するロッドネジ切り部 ( ２３ ) が形成されていることを特徴とする手術具。
  16. 請求項１５に記載の手術具において、シャフト(１９)は、回転可能にグリップ(２４)中に嵌め込まれ、ピニオン(２０)とは逆の端部にあるローレット掛け部(３０)でもって駆動するように備えられていることを特徴とする手術具。
  17. 請求項１５または１６に記載の手術具において、ロッド ( ２２ ) の他の自由端に、ロッド ( ２２ ) を回転させるのに用いる大径部が設けられていることを特徴とする手術具。
  18. 請求項１５〜１７のいずれかに記載の手術具において、シャフト(１９)がグリップ(２４)に固定されたスリーブ(２５)中に配されていて、該スリーブ(２５)は、ピニオン(２０)の側の端部に、ネジ切リング(４)と第１の埋め込み部分(２)との相互の軸方向位置を固定するフォーク指(２７)を備えたフォーク部(２６)を有していることを特徴とする手術具。
  19. 請求項１８に記載の手術具において、フォーク部(２６)が、生体埋め込み部材(１)を保持するフォーク指(２７)を都合４本有しており、これら４本のうちの２本のフォーク指は、第１のフォーク対(２８)にまとめられてネジ切リング(４)に当接するように備えられ、他の２本のフォーク指は、第２のフォーク対(２９)にまとめられて横方向溝(１７)に差し込まれるように備えられたことを特徴とする手術具。
  20. 請求項１５〜１９のいずれかに記載の手術具において、ローレット掛け部(３０)を備えたシャフト(１９)と、ロッド(２２)と、スリーブ(２５)とを備えたグリップ部(２４)が分解可能に組み立てられていることを特徴とする手術具。
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