JP4331235B2 - プレート - Google Patents
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- JP4331235B2 JP4331235B2 JP2007335762A JP2007335762A JP4331235B2 JP 4331235 B2 JP4331235 B2 JP 4331235B2 JP 2007335762 A JP2007335762 A JP 2007335762A JP 2007335762 A JP2007335762 A JP 2007335762A JP 4331235 B2 JP4331235 B2 JP 4331235B2
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- plate
- bone screw
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7058—Plates mounted on top of bone anchor heads or shoulders
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- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
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- A61B17/17—Guides or aligning means for drills, mills, pins or wires
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- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
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- 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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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- A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
- A61B17/8019—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones where the means are a separate tool rather than being part of the plate
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- A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8625—Shanks, i.e. parts contacting bone tissue
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
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- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8085—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with pliable or malleable elements or having a mesh-like structure, e.g. small strips
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- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
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- 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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- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
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- A61B17/8625—Shanks, i.e. parts contacting bone tissue
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- 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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- 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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- 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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
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- A61B2017/8655—Pins or screws or threaded wires; nuts therefor with special features for locking in the bone
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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
- A61F2/0077—Special surfaces of prostheses, e.g. for improving ingrowth
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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- Heart & Thoracic Surgery (AREA)
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- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Neurology (AREA)
- Dentistry (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
- Adornments (AREA)
- Orthopedics, Nursing, And Contraception (AREA)
- Materials For Medical Uses (AREA)
- Professional, Industrial, Or Sporting Protective Garments (AREA)
- Solid-Sorbent Or Filter-Aiding Compositions (AREA)
- Compounds Of Unknown Constitution (AREA)
- Diaphragms For Electromechanical Transducers (AREA)
- Color Television Systems (AREA)
- Ultra Sonic Daignosis Equipment (AREA)
Description
また、公知のプレーティングシステムを使用すると、側面から見た場合の頚椎の正常な湾曲である脊椎前弯も消失され得る。
これらの部品は、それらを特に精密な小さい終端ネジドライバーと係合する必要があるということによって特徴付けられる。これらのインター固定要素は、外科手術中にプレートの輪郭を変更するための労力によって簡単に不効率的なものになる。
本明細書の最初の方で引用した米国特許第5,364,399号および5,423,826号に開示されたシステムは、両皮質(bicortical)ネジを並列または斜めに装着させる薄いステンレス鋼製プレートを含み、このプレートはネジ穴および溝の組み合わせを有する。
このシステムは、何ら骨ネジのための固定手段を含まない。
本発明の一の目的は、椎骨にプレートを取り付けるのに用いられる複数の骨ネジが、単操作によって同時に定位置に簡単且つ確実に固定され得る固定(ロッキング)機構を提供することである。
本発明のさらなる目的は、椎骨からプレートの下方の椎骨への骨成長を促進するように型押し(textured)か、さもなければ処理されているプレートを提供することである。
本発明の別の目的は、少なくとも一部生物吸収性である前頚部プレーティングシステムを提供することである。
本発明の別の目的は、少なくとも部分的に骨成長促進物質を含む前頚部プレーティングシステムを提供することである。
本発明のさらに別の目的は、本発明のプレートを取付するための改良方法を提供することである。
また、新規骨ネジは、使用中に骨ネジが引き出されるのを防止するように開示されている。これは、ネジ山の外径または頂径が、ヘッドの下から先端部の上までの骨ネジの軸部全長に沿って実質的に一定に維持されるネジを含むデザインによって達成されるものであり、より小さい外径のネジ山は挿入が容易である。ネジ先端はタッピン型であるためにその末端に溝が付けられている。また、ネジ山は、椎骨素材(stock)の完全性に切り込み、保護するために極端に薄くて鋭い側面も有している。
本発明による複合の固定する前頚部の固定プレート2の好ましい実施態様が図1−5に示される(2レベルの固定(隣接した3つの椎骨)に使用される例でここに示される)。プレート2は、一般的に細長い形態を有し、その輪郭はおおむね、ローブあるいは横方向の突出部4が角およびプレート2の側部中心に存在するために、矩形からはかけ離れている。各ローブ4は丸い輪郭をしており、各々円形骨ネジ受け穴6を含んでいる。2つの追加の中間円形の骨ネジ受け穴8が、プレート2の側部内側に位置し、プレート2の縦軸中心線上に中心を有する。ローブ4は、プレート2に、各骨ネジ受け穴6を囲む領域における付加的な強度をもたらす。プレート2のための他の形状が使用されても良いことは認識される。
図6は、図1のプレート2の平面図で、固定受け穴に挿入された固定要素20、21を備える。好ましい実施態様では、固定要素20、21は、ネジの形状で、固定穴12のネジ付き内部3と協働する。固定要素20、21の各々は、その初期の開いた方向で示されており、ここで、各固定要素20、21の頭部23の中の切り欠き22の方向は、固定要素20、21の頭部23によって妨げることなく、骨ネジ30が隣接する骨ネジ受け穴6、8に進入することを可能とするように構成されている。頭部23により妨害されることなく骨ネジが隣接する骨ネジ受け穴へ挿入することが可能とするような構成であれば、頭部23を他の配置とすることも可能である事を理解されたい。
図22に示される複合固定プレート230の別の実施態様において、固定要素が、図23に示されるネジ付き固定キャップ300の形状であってもよい。ネジ付き固定キャップ300は、図22に示されるプレート230の上部内の固定要素用の窪み304の内周上のネジ山303に一致する外周上に、ネジ山302を有する。固定キャップ300は、特にその幅と比較すると、相対的に薄い。固定キャップ300の上部305は、同じように構成された駆動ツールを収容するための非円形貫通孔306を備えている。
図24Aおよび24Bは、本発明の骨ネジ30の1つの実施態様の側面図を提供する。図27は、骨ネジ30の平面図である。各固定要素20、21の凹部24として、同じ形態を有してもよい形状とされた凹部34が、骨ネジ頭部32の中心にあり、この場合には、固定要素20、21を回転するのに使用した同一のツールで回転されてもよい。骨ネジ30のドライバ係合部分は、溝を彫られていても良く、それは雄型あるいは雌型でありうる(示されるように)ことは理解されよう。
椎体間固定を完了し、外科医は、固定すべき領域の脊柱の前面に沿って、あらゆる骨スプールあるいは局所的な不整を取り除く。
外科医によって測径器、定規、テンプレート、などによって脊柱上の距離を測定することによって正しい長さのプレートが選ばれる。そのプレートは、固定される脊柱の距離を測って、固定される各々の端部の椎骨のそれぞれの部分を部分的に覆うのに十分な長さを有する。
プレートホルダーを利用して、プレートは傷害部位に置かれて、固定される脊柱の部分と関係がある位置、長さ、そして、ネジ穴配列を確かめるために配置される。
図31に示すように、このように、配置されて、しっかりと保持されるプレートについては、プレートは固定される(例示のみであるが、主要な脊椎骨として示す)いずれの椎骨に付けられてもよい。
パイロット(ガイド)穴パンチ60は図32に示された通りフルート2に付けられる。または、この代わりに、好ましいわけではないが、図37に示された通り、ドリルガイドが使われてもよい。いずれにしても、確実にパイロット穴形成手段は、位置が調整され、そして、プレート骨ネジ受け穴壁によって捕らえられる。
パイロット穴は、それから図32のパイロット穴パンチで突くことまたは図37のドリルで穿設することによって形成される。好ましいわけではないが、選択肢として、パイロット穴の形成は全体で処理されてもよく、そのパスに沿った後部脊椎皮質への距離より短い長さを有するように選ばれた正しいネジが、直接挿入されてもよい。
適切に選択されたネジは、ネジドライバ係合手段の具体的な形状にかかわらず、ネジドライバに取り付けられる。また、ネジは、挿入サイトへの挿入の間、しっかりとドライバに固定されるように締まりばめを有するように設計されている。図41、42、63、64、80および81は、ドライバおよびネジのこの種の嵌合を成し遂げる多様な方法を示す。ネジおよびドライバ界面におけるウェッジングに加え、クリップ、ばね、および他の手段が図80に示されているように、一時的かつ反転可能にドライバにネジを固定することは知られている。ここで、溝を彫られた内側にはねているスリーブは、そのままでプレートにネジ込まれて、自動的にネジキャップをリシースして押し戻されるまで、ネジキャップを保持する。
同様の方法で、外科医の選択によって、固定された椎骨内に含まれる各椎骨であって、固定構造物のちようど端部椎骨に残りの骨ネジが挿入することが可能であり、または付加的に、ネジを固定移植片に挿入することが可能である。
図31に示すように、固定骨移植片構造物を形成している隣接の椎骨50間の脊骨の椎間腔において、あらかじめ取り付けられた固定移植ブロック51によって、椎骨50a−cは、お互いから分離される。プレート2は、図を単純化するために取り除かれる要素20、21を固定ことに関する図31に示される。好ましい実施態様において、固定要素20、21は、椎骨50の椎体にプレート2を配置する前に、図6に示される位置にあらかじめ取付けられても良い、および好ましくはそうされ、このことにより外科時間および問題を除く。
第2の圧縮アーム130の末端部にも、着脱可能なポスト134を収容できる穴106と同じ穴132を有する。これら穴106および132は同じものとされ、これにより、どちらの圧縮アーム104、130でも、着脱可能なポスト134を保持するために使用可能とされ、また、圧縮ツール100がいかなる方向においても使用可能とされている。フルートに対して角度があるときでさえも操作可能とするプレート係合フック110を備え、プレート係合要素108および圧縮ポスト54が2本の圧縮アーム104,130の穴106、132において回転しスライドすることができることによって、圧縮ポスト54およびプレートを介して、装置を脊柱に、容易に取付け可能とさせる。
上記の手順は椎体50a、50bおよび50cに、完全に挿入される骨ネジ30を用いて実行され、脊柱前弯が骨移植片構造物51の圧縮の間、維持されることに注意されたい。
単一の固定プレートシステムを、ここで記述する。図47-52は、単一の固定プレートシステムの第一の実施態様の図である。プレート600の輪郭は、図1-5に示されるプレート2と同じものである。プレート600は、骨ネジ受け穴602を含み、図56−59に示される固定キャップ610の形状で、対応する固定要素を収容する内部のネジ切り603がなされている。例えば、プレート600において、骨ネジ穴602は、4−6mmの好ましい範囲を有するおよそ5mmの外径と;この使用のための3.5−5.8mmの範囲で、およそ4.8mmのネジ付き内径を有する。ネジ山以外の取付け手段は使用してもよく、例えば、それはバヨネット型取付要素である。
キャップ610が、キャップドライバ1004の端部およびそれからキャップドライバの中心縦開口部を通過している骨ネジドライバのシャフト1010を有するキャップドライバ1004の上へ挿入される。図に示されているように、骨ネジドライバシャフト1010は、キャップ610内の凹部306を通り抜けて、骨ネジ170の頭部内の凹部180を係合する。骨ネジ170は、プレート600内の骨ネジ受け穴において取り付けられて示されている。骨ネジドライバのハンドル(図示せず)は回転させられ、それによって、適所に骨ネジ170がネジ込まれる。骨ネジドライバの径が、キャップ610の凹部306の幅未満であるので、骨ネジドライバ1010はキャップ610が回転することなく、回転することが可能となる。
図54-56は、本発明の単一の固定プレーティングシステムに使用される、骨ネジ170を示す。骨ネジ170は、頭部172の段をつけられた構成に関してのみ、詳細に先に述べた骨ネジ30と異なる。好ましくは、骨ネジ170はネジ軸部に隣接して、軸部176の最大径に等しい縮小された径を具備する下部部分174を含む。頭部172の部分178も、下部部分174より小径とされている。ネジ山182は、上述の骨ネジ30と同じ構成を有する。しかし、骨ネジのどちらの実施態様でも、プレートのいずれにも使用しうる。
6、8、408 骨ネジ受け穴
12 ロックネジ穴
20 ロックネジ
30、170 骨ネジ
20、21、300 ロッキング部材
Claims (10)
- 少なくとも2つの頚椎体の前面に接触するためのヒトの前頚椎で使用するプレートシステムであって、
縦軸と、椎間腔に亘って延び且つ少なくとも2つの隣接する頚椎体の部分と重なるのに十分な長さと、前記頚椎体を配置するための下面と、該下面と対向する上面とを有し、前記下面が前記プレートの縦軸の実質部分に沿って凹んでいる、プレート(500、600、900)と、
中央長手軸線を有し、少なくとも2つの頚椎体の各々に係合するようになっている少なくとも2つの骨ネジ(170)であって、その各々が頚椎内に挿入するための先端と、前記先端とは反対側の基端とを有し、前記骨ネジの少なくとも1つは、骨ネジの中央長手軸線を横断する最大の断面積を前記基端近くに有する、骨ネジ(170)と、
前記プレートの上面から下面にかけてプレートを貫通する少なくとも2つの骨ネジ受け穴(502、528、602、910、950)であって、少なくとも一方の前記骨ネジ受け穴は一方の前記頚椎体と関連し、少なくとも他方の前記骨ネジ受け穴は他方の前記頚椎体と関連しており、前記骨ネジ受け穴の各々は、中央軸線を有し、前記プレートを頚椎に取り付けるために骨ネジの一つを受け入れるようになっている、前記骨ネジ受け穴(502、528、602、910、950)と、
固定要素の各々が、前記骨ネジ受け穴の一つの中に挿入される前記骨ネジの一つだけを前記プレートに固定するようになっている少なくとも一つの固定要素(506、508、522、610)であって、前記骨ネジの少なくとも一つが前記最大の断面積の地点において接触面領域を有し、該接触面領域がほぼ平坦な部分を有し、前記少なくとも一つの固定要素の各々が、前記骨ネジの一つを前記プレートに保持するように前記骨ネジの各一つの前記接触面領域の平坦な部分に接触するようになっている、固定要素と
を備えるプレートシステム。 - 前記固定要素(506、508、610)は、前記プレートに着脱可能に結合されている請求項1記載のプレートシステム。
- 前記固定要素は、前記骨ネジの一つを前記骨ネジ受け穴の一つの中へ挿入可能な開始位置から、単一の前記骨ネジが挿入されるべき前記骨ネジ受け穴の一つの少なくとも一部を覆うようになる最終位置まで移動可能である、請求項1または2に記載のプレートシステム。
- 前記固定要素(508、522)は、前記開始位置から最終位置まで回転するようになっている、請求項3に記載のプレートシステム。
- 前記固定要素(508、522)の完全な一回転よりも少ない回転で、前記固定要素(508、522)を前記開始位置から最終位置まで回転する、請求項4に記載のプレートシステム。
- 前記固定要素(508、522)の少なくとも一部が、前記開始位置から最終位置までスライドする、請求項3乃至5のいずれか一項に記載のプレートシステム。
- 前記固定要素が、ネジ(508)、リベット(522)またはキャップ(506、610)の少なくとも一つである、請求項1に記載のプレートシステム。
- 前記固定要素(508、522)が、少なくとも一つの切断セグメント(510、524)を有するほぼ円形のヘッドを有する、請求項1から7のいずれか一項に記載のプレートシステム。
- 前記固定要素が、カム面、傾斜面、ネジ付き面の少なくとも一つを有する、請求項1に記載のプレートシステム。
- 前記骨ネジ受け穴の少なくとも一つが、その中に受け入れられるようになっている適切な寸法の骨ネジと締まりばめを形成するように形成されている、請求項1から9のいずれか一項に記載のプレートシステム。
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- 1998-02-11 ES ES03028651T patent/ES2291586T3/es not_active Expired - Lifetime
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US10450419B2 (en) | 2014-07-16 | 2019-10-22 | Thin Film Electronics Asa | High-molecular-weight polysilane and method for producing same |
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