JP5960056B2 - 医療装置、およびそれを用いた、人を除く動物の体内に装置を係止する方法 - Google Patents
医療装置、およびそれを用いた、人を除く動物の体内に装置を係止する方法 Download PDFInfo
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- JP5960056B2 JP5960056B2 JP2012537276A JP2012537276A JP5960056B2 JP 5960056 B2 JP5960056 B2 JP 5960056B2 JP 2012537276 A JP2012537276 A JP 2012537276A JP 2012537276 A JP2012537276 A JP 2012537276A JP 5960056 B2 JP5960056 B2 JP 5960056B2
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Description
本発明は、医療技術の分野に関する。特に、本発明は、医療装置、およびそれを用いた、人を除く動物の体内に装置を係止する方法に関し、特にインプラント、埋め込み用の器具および埋め込み方法に関する。
ねじが生体の骨組織に係止される場合、しばしば、骨の安定性が不十分になったり、骨への係止の安定性が不十分になったりするという問題が生じる。特に、骨梁組織においては、ねじに作用する如何なる負荷もほんのわずかな骨梁にしか伝わらず、ねじと骨との接続箇所の耐荷重能力と、長期間の安定性とに対して悪影響を及ぼす。これは、特に、骨粗鬆症もしくは骨減少症の骨組織または脆くなった骨組織の場合には深刻である。
である。
これらの実施例においては、軸は非円形の断面を有し得る。たとえば、軸はブレード状になるようにやや平たくなっていてもよい。特に、軸は、椎弓根を貫通する場合、椎弓根の形状に従うように横方向よりも長手方向の方がより大きい延在部を有するようなものであってもよい。加えて、このような非円形の断面は、ねじり運動に対して必要に応じて付加的な安定性をもたらし得る。
以下において、本発明および実施例を実行するための方法を、添付の図面を参照して説明する。図面は大部分が概略的に図示される。図面においては、同じ参照番号は同じまたは類似の要素を指す。
図1aおよび図1bに概略的に図示される装置は、たとえば、硬組織および/または硬組織置換材料において係止するための外科用インプラントであり得る。当該装置は、手術用ねじおよび/またはアンカー(縫合糸アンカーもしくは歯冠が取付けられるインプラントなど)の機能と同様の機能を有し得るか、または、たとえば、周囲の組織に送達すべき物質を含有することによって、および/もしくは電子装置などの異なる装置を含むことなどによって、「単独型の」機能を有し得る。本発明の他のすべての実施例と同様に、装置は、外科手術後に患者の体内に残されるよう設計されている場合、硬組織および/または硬組織置換材料において係止された外科手術用装置が外科手術時に果たし得る如何なる機能をも有し得る。外科手術後に患者の体内に残されるように設計された装置の代替例として、さまざまな実施例に従った装置は、特に明確な規定のない限り、たとえば以下に教示のとおり、一時的なアンカーまたは補強装置であってもよい。
c.孔14は円形でないか、またはほぼ円形であるが、細長である。図示される実施例においては、軸延在部は、円周方向に沿った延在部よりも実質的に大きい。
図1cに図示されるタイプの遠位孔は必ずしも円筒形ではない。むしろ、壁から遠位孔の内側に突出る不規則な要素を含め、他の形状が用いられてもよい。
h.傾斜部分12は、球形ではなく円錐形であり、このため、長手方向軸を通る面の断面は直線であり凹状ではない。
これらの特徴は、すべて(図3〜図5の実施例のように)組合せて、または個々に、または如何なる下位の組合せでも実現可能であり、かつ、(代替的な)傾斜部分の形状を指す特徴bおよびhを除く特徴a〜dとの如何なる組合せでも実現可能である。
k.長手方向ボア13は貫通ボアであり、これにより、低侵襲手術時にワイヤによって案内されるのに適した医療装置が得られる。貫通ボアは、肩部11.5が構築されるように遠位側に向かって狭くなっている。肩部は挿入要素18のための停止構造としての役割を果たす。この挿入要素18は、遠位側にある液化可能な要素のための長手方向の開口部の終端をなし、壁15および傾斜部分12を含む方向付け構造を備える。挿入要素は、肩部11.5と共に協働して圧力嵌めをもたらす遠位側の先細部分19を含む。
l.壁15の端縁15.1は中心に向かって傾斜する(特徴iを参照)。
この明細書中に記載された多層的な係止または補強は、このように、被覆要素または初めは別個である挿入要素の第1の方向付け構造で行われ、その後(液化材料が少なくとも部分的に再度凝固した後)、付加的に(第2の)挿入要素のさらなる方向付け構造で行われ、次いで第2の液化が行われる。この多層的な係止または補強は、本発明の局面とは無関係に適用されてもよい。すなわち、液化可能な材料が押当てられる方向付け構造が角度をなして組立てられていない状況において適用されてもよい。
Claims (14)
- 医療装置(1)であって、外科手術中に生体の硬組織および/または硬組織置換材料と接触させるのに適した被覆要素(11)を含み、
被覆要素は、被覆要素の近位端から遠位方向に達する長手方向の開口部(13)を規定する長手方向ボアと、開口部(13)の壁に開口し、前記開口部の周方向に間隔をおいて配列された複数の孔(14)とを有し、
医療装置はさらに液化可能な要素(21)を含み、前記液化可能な要素(21)は、長手方向の開口部(13)に挿入可能であるかまたは挿入され、近位側から当たるエネルギの衝撃によって少なくとも部分的に液化可能であり、これにより、液化材料が壁における孔(14)を通り、前記長手方向の開口部から出て、硬組織および/または硬組織置換材料の構造に流れ込むようにし、
医療装置はさらに、前記液化可能な要素のうち別々の部分を別々の前記孔に方向付けるように、長手方向の開口部(13)の内側において、方向付け構造(11.2,12,15)を含み、該方向付け構造は、前記長手方向の開口部(13)の遠位端に隣接する方向付け構造本体(11.2)と、前記方向付け構造本体から近位側へ突き出る分離部分とを含み、
前記方向付け構造は、前記長手方向の開口部(13)の内周の周方向の位置により変化し、それにより、前記方向付け構造の近位側の容積を別々の部分に細分して、前記液化可能な要素(21)の前記別々の部分を前記複数の孔(14)のうちの所定の孔に方向付ける、医療装置。 - 分離部分は、方向付け構造本体(11.2)から近位側に突出る少なくとも1つの壁(15)を含む、請求項1に記載の医療装置。
- 壁(15)は、孔(14)同士の間または2つの孔の間から長手方向の開口部の中心にまで延在する、請求項2に記載の医療装置。
- 前記分離部分は、エネルギが衝突している間に液化可能な要素に切込むことのできる切刃(15.1)を含む、請求項1から3のいずれかに記載の医療装置。
- 方向付け構造は被覆要素(11)の方向付け構造である、請求項1から3のいずれかに記載の医療装置。
- 長手方向ボア(13)は貫通ボアであり、停止構造(11.5)を含み、
前記装置はさらに、方向付け構造を含みボア(13)に挿入可能な挿入要素(18)を含み、挿入要素は、近位側から挿入されたときに停止構造に当たるよう形作られている、請求項1から3のいずれかに記載の医療装置。 - 停止構造(11.5)は、挿入要素(18)と協働して圧力嵌めを規定する、請求項6に記載の医療装置。
- 方向付け構造は、長手方向軸から前記孔のうちの1つの孔の遠位端に向かって傾斜する少なくとも1つの傾斜部分(12)を含む、請求項1から3のいずれかに記載の医療装置。
- 被覆要素(11)はさらに雄ねじ(11.4)を含む、請求項1から3のいずれかに記載の医療装置。
- インプラントである、請求項1から3のいずれかに記載の医療装置。
- 硬組織および/または硬組織置換材料の構造に貫入する前記液化可能な要素によって硬組織および/または硬組織置換材料を強化するために備えられた補強装置である、請求項1から3のいずれかに記載の医療装置。
- 椎弓根係止装置(41)であって、前記椎弓根係止装置の遠位部分が堆骨の椎体に突出るように、概して背側方向から堆骨の柄のうちの1つを通って人または動物の堆骨に埋込まれており、
椎弓根係止装置は、脊柱を安定させるための整形外科用装置を固定するための近位側の頭部(42)を含み、堆骨に係止することのできる遠位側の軸部分(43)を含み、長手方向の開口部が近位側の頭部から軸部分に達する、請求項1から3のいずれかに記載の医療装置。 - 軸部分(43)は雄ねじ(11.4)を含む、請求項12に記載の医療装置。
- 人を除く動物の体内に装置を係止する方法であって、
− 被覆要素を設けるステップを含み、前記被覆要素は、前記被覆要素の近位端から遠位方向に達する長手方向の開口部(13)を規定する長手方向ボアと、開口部(13)の壁に開口し、前記開口部の周方向に間隔をおいて配列された複数の孔(14)とを備え、前記方法はさらに、
− 液化可能な要素(21)を設けるステップと、
− 人を除く動物の体の硬組織および/または硬組織置換材料と被覆要素を接触させるステップと、
− 前記液化可能な要素が少なくとも部分的に長手方向ボア内にある間、前記液化可能な要素を遠位方向に向かって押して方向付け構造に押当て、同時に前記液化可能な要素に機械的振動を与えて、該液化可能な要素を少なくとも部分的に液化させ、孔を通じて押出して、硬組織および/または硬組織置換材料に押込むステップとを含み、前記方向付け構造は、前記開口部(13)の内側において、前記液化可能な要素のうち別々の部分を別々の前記孔に方向付けるように、該方向付け構造により、前記液化可能な要素のうち別々の孔を通って押出される部分が分離され、該方向付け構造は、遠位側で長手方向の開口部(13)の終端をなす方向付け構造本体(11.2)を含み、前記方向付け構造はさらに、前記方向付け構造本体から近位側に突出る分離部分を備え、前記方向付け構造は前記長手方向開口部(13)の内周の周方向の位置によって変化し、それによって、前記方向付け構造本体の近位側の容積を別々の部分に細分し、前記液化可能な要素(21)の別々の部分が前記孔(14)のうちの所定の孔に方向付けられ、前記方法はさらに、
− 前記液化可能な要素を再度凝固させて、硬組織および/または硬組織置換材料において被覆要素のためのアンカーを設けるステップを含む、方法。
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