KR20010051887A - 척추 고정 조립체 - Google Patents

척추 고정 조립체 Download PDF

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Publication number
KR20010051887A
KR20010051887A KR1020000069815A KR20000069815A KR20010051887A KR 20010051887 A KR20010051887 A KR 20010051887A KR 1020000069815 A KR1020000069815 A KR 1020000069815A KR 20000069815 A KR20000069815 A KR 20000069815A KR 20010051887 A KR20010051887 A KR 20010051887A
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KR
South Korea
Prior art keywords
fusion cage
plate
spinal fixation
fixation assembly
opening
Prior art date
Application number
KR1020000069815A
Other languages
English (en)
Inventor
프레이저로버트
Original Assignee
디퍼이 아크로메드 인코포레이티드
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Publication date
Application filed by 디퍼이 아크로메드 인코포레이티드 filed Critical 디퍼이 아크로메드 인코포레이티드
Publication of KR20010051887A publication Critical patent/KR20010051887A/ko

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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
    • A61F2/30767—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
    • 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
    • A—HUMAN NECESSITIES
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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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A61F2/4465—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
    • A—HUMAN NECESSITIES
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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
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059—Cortical plates
    • A—HUMAN NECESSITIES
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A—HUMAN NECESSITIES
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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
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    • 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
    • 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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    • 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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    • A61F2/00—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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    • A61F2/00—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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    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • 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
    • A61F2002/30841—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • A61F2002/30845—Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes with cutting edges
    • 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
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891—Plurality of protrusions
    • A61F2002/30892—Plurality of protrusions 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
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • A61F2230/0034—D-shaped
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0069—Three-dimensional shapes cylindrical
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys
    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Cardiology (AREA)
  • Vascular Medicine (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Neurology (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

척추 고정 조립체는 판이 결합되는 융합 케이지를 포함한다. 상기 판은 골 나사를 수용, 유지 및 방향 설정하도록 구성된다.

Description

척추 고정 조립체 {Anterior Lumbar Interbody Fusion Cage With Locking Plate}
본 발명은 의료용 장치에 관한 것이며, 특히 인접한 추골체의 융합을 촉진하기 위한 이식 구조에 관한 것이다.
노화 뿐만 아니라 상해는 신경근 압박에 기인한 동통을 발생시키는 척추의 뼈, 추간판, 관절 및, 인대의 변화를 초래한다. 소정의 상황에서, 동통의 완화는 척추골 융합술을 수행함으로써 제공될 수 있다. 이는 두 개 이상의 인접한 추골을 접합하여 상기 인접한 추골들을 더 이상 서로에 대해 이동하지 않도록 하는 것을 포함하는 수술이다.
척추의 추골의 융합을 촉진하기 위한 다수의 보철 장치가 공지되어 있으며, 상기 장치는 외과 의사에 의해 수행될 수 있는 척추에 대한 접근(전방, 후방, 측방 등)에 기초하여 부분적으로 분류될 수 있다. 공지된 어떠한 장치도 완전히 만족스럽지는 않으며, 개선이 요구된다.
본 발명은 특히 척추에 대한 전방 접근을 위해 사용되는 공지된 척추골 융합술 장치를 개선하는 것이다. 예시적인 실시예에서, 척추 고정 조립체는 판이 결합되는 융합 케이지를 구비한다. 상기 판은 골 나사를 수용, 유지 및 방향 설정하도록 구성되며, 이에 의해 융합을 촉진하도록 융합 케이지와 인접한 추골체를 안정한 관계로 유지시킨다.
상기 조립체의 다른 특징은 함께 미끄럼 가능하며, 모티스(mortise)와 테논(tennon)으로 함께 접합하는 융합 케이지에 결합되는 판을 구비할 수 있다. 상기 판은 상기 융합 케이지의 상부 및 내부측 중 하나 또는 모두에 골 나사가 통과되며 유지되는 연장부 또는 탭(tab)을 구비할 수 있다. 상기 탭은 요구에 따라 골 나사를 방향 설정시키도록 각형성될 수 있다.
융합 케이지는 볼록한 상부면 및 내부면을 구비할 수 있으며, 전방면으로부터 후방면으로 테이퍼질 수 있다. 융합 케이지와 판은 삽입 공구 가이드 및 보어 및 노치와 같은 결합부를 구비할 수 있다. 핀(fin)은 융합 케이지의 내부면 및 상부면 상의 하나 이상의 지점에 제공될 수 있다.
본 발명은 첨부 도면을 참조하여 하기의 상세한 설명으로부터 더욱 명백하게 이해할 수 있을 것이다.
도 1은 본 발명에 따른 융합 케이지의 평면도.
도 2는 도 1의 융합 케이지의 전방면을 도시한 도면.
도 3은 골 나사를 갖는 도 1의 융합 케이지의 측면도.
도 4는 케이지의 상부면에 핀(fin)을 갖는 본 발명에 따른 융합 케이지의 실시예의 평면도.
도 5는 도 4의 융합 케이지의 전방면을 도시한 도면.
도 6은 도 4의 융합 케이지의 측면도.
도 7은 융합 케이지의 삽입을 위해 분리된 인접한 추골체를 도시한 도면.
도 8은 도 1의 융합 케이지의 배치 후의 척추의 일부를 도시한 도면.
도 9는 도 4의 융합 케이지의 배치 후의 척추의 일부를 도시한 도면.
도 10은 본 발명에 따른 골 결합 핀의 측방 입면도.
도 11은 종래의 골 결합 핀의 상면도.
* 도면의 주요 부분에 대한 부호의 설명 *
10 : 본체 12 : 전방면
14 : 후방면 16 : 상부면
18 : 내부면 20 : 판
28, 30 : 횡단 소자 36', 38', 40', 42' : 탭
46, 48 : 골 나사 50 : 핀
도 1은 본 발명에 다른 융합 케이지의 평면도이다. 상기 케이지는 두 개의 추골체를 수직으로 분리하는 환형부의 형상 및 크기를 갖는 본체(10)를 구비한다. 상기 본체(10)는 환자에 대한 배향과 관련하여 명명된 면을 구비한다. 특히, 본체(10)는 전방면(12), 후방면(14), 상부면(16) 및 내부면(18)(도 2 참조)을 구비한다. 특별히 지정된 경우를 제외하고는, 본원에 사용된 용어 "면(face)"은 최외곽 표면{"표면(face surface)"이라 명명함} 또는 특정 기하학적 형상(예를 들면, 평면 형상)을 의미하는 것은 아니다. 오히려, "면"은 본체(10)의 상이한 측부 상의 일반적인 영역을 의미한다. 탄소 파이버 복합 재료 또는 다른 방사선 투과성 재료가 상기 본체의 제조에 매우 적합하다.
상기 케이지는 본체(10)와 결합할 수 있는 판(20)을 또한 포함한다. 티타늄 또는 탄소 파이버 복합 재료가 판(20)에 적합한 재료이다. 도 1, 도 2 및 도 3에 도시한 바와 같이, 판(20)은 척추에 대한 전방 접근을 위해 본체(10)의 전방면(12)에 결합된다. 그러나, 융합 케이지의 다른 실시예는 척추에 대한 전방측방 또는 측방 접근을 위해 요구에 따라 전방면(12) 이외의 다른 위치에서 본체(10)에 판(20)을 결합하도록 구성된다.
판(20)이 본체(10)에 단단히 결합되어 판과 본체가 서로에 대해 이동할 수 없지만, 상기 판과 본체는 서로에 대해 이동하도록 결합될 수도 있다. 예를 들면, 예시적인 실시예에서, 판(20)은 본체(10)에 의해 한정된 모티스(26) 내에 배치된 테논(24)을 구비하며, 상기 테논은 모티스 내에서 상향 및 내향으로 미끄럼 가능하다.
도 1을 계속 참조하면, 상기 융합 케이지는 제 1 횡단 소자(28) 및 제 2 횡단 소자(30)를 또한 갖추며, 상기 제 1 및 제 2 횡단 소자는 후방면(14)을 전방면(12)에 결합시킨다. 횡단 소자(28,30)는 본체(10)의 구조적 완전성을 증가시키며 지지면에 부가적인 하중을 제공한다. 또한 횡단 소자(28,30)는 융합 케이지 삽입 공구를 위한 안내 경로를 제공하도록 구성된다. 예를 들면, 예시적인 실시예에서 안내 경로는 공간(32) 내의 횡단 소자들 사이에 배치된다. 상기 안내 경로는 도 2에 도시한 바와 같이 판(20)에 의해 한정되거나 본체의 상부면(16) 또는 내부면(18) 중 하나 또는 모두 내에 노치 또는 오목부(34)를 또한 구비할 수 있다. 예시적인 실시예에서, 안내 경로는 약 8mm의 폭을 가지며 전방 및 내부면 하부로 약 1mm 내지 2mm 오목하게 형성된다.
도 2를 참조하면, 전방면(12)과 결합된 판(20)의 실시예를 도시한다. 본 실시예에서, 네개의 골 나사 구멍(36,38,40,42)이 안내 보어 또는 구멍(44)으로서 도시되어 있다. 안내 구멍(44)은 본체(10) 내의 보어(46)(도 1 참조)와 정렬된다. 안내 구멍(44)과 보어(46)는 삽입 공구(도시 않음)의 부분을 수용하도록 구성되며, 안내 구멍과 보어는 나사와 같은 공구 결합부를 갖출 수 있다. 도시한 바와 같이, 골 나사 구멍(36,38,40,42)은 판 연장부 또는 탭(36',38',40',42')에 의해 한정되거나 내부에 배치될 수 있으며, 상기 탭 및 판(20)의 나머지 부분은 모두 동일 평면 상에 배치되며, 또는 탭 중 하나 이상은 다른 탭 중 하나 이상 또는 판의 나머지 부분에 대해 정렬될 수 있다.
도 3을 참조하면, 각각 헤드 및 섕크(shank)를 갖는 골 나사(46,48)는, 상기 각각의 나사의 헤드가 탭 내의 개구를 통과하는 것을 방지하기 위해 각각의 탭과 결합하도록 각각 탭(40',38') 내의 구멍을 통하여 배치된다. 예시적인 실시예에서, 나사는 약 3.6mm의 직경과 약 22mm의 길이를 갖는다. 상기 나사는 "잠금 (locking)" 형태이므로, 판 내의 구멍으로 후퇴되지 않는다.
도 3을 계속 참조하면, 탭(38',40')은 판(20)의 나머지 부분에 대해 각형성되므로, 골 나사(46,48)는 본체(10)의 중심 평면 "P"에 대해 각형성된다. 탭과 판 뿐만 아니라 나사와 중심 평면에 의해 형성된 각은 "α"로 나타내며, 특정 부위 및 환자의 해부 조직에 의해 결정된다. 각 "α"는 15°내지 60°의 범위에 있지만, 대부분의 경우 "α"는 약 20°이다. 그러나, 다른 실시예에서, 탭은 판(20)의 나머지 부분에 대해 용이하게 만곡되도록 가요성을 갖는다. 도 3에는 약간 볼록한 내부 표면(18) 및 상부 표면(16) 및 약간 테이퍼진(약 10°) 또는 웨지형 외형으로 편평해지는 융합 케이지의 다른 장점적인 양태를 또한 도시하며, 본체(10)는 후방면(14)에서 보다 전방면(12) 더 두껍다.
도 4를 참조하면, 횡단 소자(28,30)의 상부면 상에 날카로운 핀(50)을 갖는 융합 케이지가 도시되어 있다. 도 5 및 도 6에 도시한 바와 같이, 핀(50)은 횡단 소자(28,30)의 내부면 상에 또한 제공될 수 있다. 적합한 핀은 약 1mm 내지 2mm의 높이를 갖는다. 도 10 및 도 11은 적합한 핀을 더욱 상세히 도시한다. 도 10에 도시한 바와 같이, 적합한 핀(50)은 제 1 단부(68) 및 제 2 단부(70)를 가지며, 각각의 핀은 통상 전방 및 후방으로 방향 설정되어 있으며 상기 제 1 단부는 융합 케이지의 후방면(14)에 근접하며 제 2 단부는 전방면(12)에 근접한다. 하나 이상의 핀은 테이퍼지므로, 제 2 단부(70)는 제 1 단부가 형성 또는 장착되는 케이지의 면과 동일한 높이로 일체화되는 제 1 단부(68) 보다 높다. 또한, 도 4 및 도 11에 도시한 바와 같이, 제 2 단부(70)는 날카로워지는 제 1 단부(68) 보다 넓다.
도 10을 계속 참조하면, 후방면(72)는 제조 중에 일정 범위의 핀 구성을 제공하도록 각형성될 수 있다. 후방면(72)과, 대향하는 핀 측부(76,78)의 교차에 의해 형성되는 선(74)에 의해 한정되는 각이 작으면(예를 들면, α1), 상부핀 부분(80)은 핀이 제 2 단부(70)를 향해 이동하는 경우 뼈 내로 즉시 매립되는 "스파이크(spike)"를 형성한다. 도 10의 점선으로 도시한 바와 같이, 도 11의 상부로 부터 볼 때, 후방면(72)과, 대향하는 핀 측부(76,78)의 교차에 의해 형성되는 선(74)에 의해 한정되는 각이 크면(예를 들면, α2), 상부핀 부분(80)은 융합 케이지가 두 개의 추골체 사이로 압박됨에 따라 핀과 뼈가 서로를 향해 압박될 때 뼈 내로 즉시 매립되는 "스파이크"를 형성한다.
도 4, 도 5 및 도 6의 융합 케이지는 판(20)을 구비하지 않지만, 삽입 공구를 결합하기 위한 보어(46) 뿐만 아니라, 안내 경로 또는 홈을 구비한다. 본 발명의 부가적인 장점은 본 발명의 양태를 고려할 때 명백해진다.
도 7은 인접한 추골체(52,54)의 측면도이며, 본 발명에 따른 융합 케이지의 삽입을 위해 상기 추골체들은 외과용 이식편(56)에 의해 신장 또는 분리되어 있으며, 말단부만 도시되어 있으며, 상기 추간판은 제거되며 이식 영역이 준비된다.
도 8은 이식된 후의 도 1, 도 2 및 도 3에 대해 상술한 융합 케이지를 도시한다. 본 양태에서, 추골체의 일부는 골 나사(58,60)가 본체 내로 침투된 것을 도시하기 위해 절단되어 도시되어 있다. 골 나사(62,64)는 융합 케이지의 전방 표면(66)과 동일한 높이 또는 약간 낮은 높이로 위치하는 것이 중요하며, 따라서 척추를 따르는 주혈관이 손상될 가능성이 최소화된다.
도 9는 이식된 후의 도 4, 도 5 및 도 6에 대해 상술한 융합 케이지를 도시한다. 본 양태에서, 추골체의 일부는 핀(50)이 추골체(52,54) 내로 침투된 것을 도시하기 위해 절단되어 도시되어 있다. 핀(50)은 높이 및 폭 모두에 대해 테이퍼진 것을 주목하라. 따라서, 핀의 전방 및 후방 배향과 관련된 테이퍼 형성은 핀에 기인한 저항을 최소화하면서 융합 케이지가 추골체 사이에 삽입되도록 하며, 이에 의해 추골체 사이의 필요한 신장 길이를 최소화할 수 있다. 또한, 핀의 상승된 제 2 단부는, 일단 추골체 사이에 배치되면, 융합 케이지가 전방 방향으로 압박되는 경우 추골 내로 매립됨에 따라서 융합 케이지의 전방 이동을 방지한다. 다시 말하면, 핀은 고정을 강화하며 배출 방지 효과를 제공한다.
융합 케이지를 추골체 사이에 삽입하기 전에, 본체(10)와 횡단 소자(28,30)(구비되는 경우)에 의해 경계 형성된 공간은 융합을 촉진시키기 위해 자가 이식 또는 동종 이식 뼈, 또는 탈염화 뼈 매트릭스(demineralized bone matrix; DBM)로 충전된다. 약 석달의 기간이 경과한 후, 추골체는 융합된다.
상술한 설명으로부터 명백히 이해할 수 있는 바와 같이, 본 발명은 많은 장점을 제공한다. 예를 들면, 융합 케이지는 충분히 넓고 두꺼우므로, 절개된 추간판을 교체하는데 단지 단일의 케이지만이 요구된다. 융합 케이지 본체의 외형 및 약간 만곡되거나 볼록한 상부 및 내부면은 원래 추간판의 형상과 매우 근접하며, 훌륭하고 안정되며 내하중성 면을 제공한다. 판이 구비되는 경우, 판은 척추로부터 본체가 분리되지 않도록 하며, 전방 접근을 즉시 가능하게 한다. 또한, 상기 판은 관통되지 않으며 또는 경질의 내하중성 피질성 뼈를 손상시키지 않고 골 나사가 추골체 내로 깊숙히 매립되도록 한다. 또한, 판 및 본체는 비교적 용이한 조작 및 적합하게 구성된 외과용 공구로의 삽입을 가능하게 하는 특징을 갖는다.
물론, 당업자들은 상술한 실시예에 기초하여 본 발명의 다른 특징 및 장점을 이해할 수 있을 것이다. 따라서, 본 발명은 청구범위에 나타낸 것을 제외하고는 특별히 도시하고 설명한 것에 의해 제한되는 것은 아니다. 본원에 참조한 모든 공보 및 참조 문헌은 본원에 참조로서 관련된다.
본 발명에 따르면, 척추에 대한 전방 접근을 용이하게 하는 척추골 융합술 장치를 제공할 수 있다.

Claims (23)

  1. 후방면, 전방면, 상부면 및, 내부면을 갖는 융합 케이지와,
    상기 융합 케이지와 결합되며, 골 나사를 수용하기 위한 개구를 한정하는 판 및,
    헤드 및 섕크를 갖는 골 나사를 포함하며,
    상기 섕크는 상기 판 내의 개구를 통과하기 위한 치수를 가지며, 상기 헤드는 상기 헤드가 상기 판 내의 개구를 통과하는 것을 방지하도록 상기 판에 결합되기 위한 치수를 갖는 척추 고정 조립체.
  2. 제 1 항에 있어서, 상기 판은 상기 융합 케이지의 전방면에 결합되는 척추 고정 조립체.
  3. 제 1 항에 있어서, 상기 판은 상향 및 내향으로 이동 가능하도록 상기 융합 케이지와 미끄럼 가능하게 결합되는 척추 고정 조립체.
  4. 제 1 항에 있어서, 상기 판 및 상기 융합 케이지는 모티스 및 테논으로 결합되는 척추 고정 조립체.
  5. 제 1 항에 있어서, 상기 융합 케이지는 내부면 및 상부면을 한정하도록 상기 상부면으로부터 상기 내부면을 분리하는 중심 평면을 포함하며, 상기 판은 상기 융합 케이지의 내부측에 제 1 개구를 한정하며, 상기 융합 케이지의 상부측에 제 2 개구를 한정하는 척추 고정 조립체.
  6. 제 5 항에 있어서, 상기 판은 상기 제 1 개구를 한정하는 제 1 탭과, 상기 제 2 개구를 한정하는 제 2 탭을 또한 포함하는 척추 고정 조립체.
  7. 제 6 항에 있어서, 상기 제 1 탭 및 상기 제 2 탭은 가요성인 척추 고정 조립체.
  8. 제 6 항에 있어서, 상기 제 1 탭 및 상기 제 2 탭 중 하나는 상기 판에 대해 15°내지 60°로 각형성되는 척추 고정 조립체.
  9. 제 6 항에 있어서, 상기 제 1 탭 및 상기 제 2 탭 중 하나는 상기 판에 대해 20°로 각형성되는 척추 고정 조립체.
  10. 제 1 항에 있어서, 상기 상부면 및 상기 내부면 중 하나는 볼록한 척추 고정 조립체.
  11. 제 1 항에 있어서, 상기 융합 케이지는 상기 후방면에서 보다 상기 전방면에서 더 두꺼운 척추 고정 조립체.
  12. 제 11 항에 있어서, 상기 융합 케이지는 상기 전방면으로부터 상기 후방면으로 10°로 테이퍼지는 척추 고정 조립체.
  13. 제 11 항에 있어서, 상기 융합 케이지는 제 1 횡단 소자 및 제 2 횡단 소자를 갖는 고리를 한정하는 척추 고정 조립체.
  14. 제 13 항에 있어서, 상기 제 1 및 제 2 횡단 소자는 상기 전방면으로부터 상기 후방면으로 연장되는 척추 고정 조립체.
  15. 제 14 항에 있어서, 상기 제 1 횡단 소자는 상기 제 2 횡단 소자와 평행한 척추 고정 조립체.
  16. 제 5 항에 있어서, 상기 융합 케이지는 상기 중심 평면 상에 중심을 가지며 상기 전방면에서 개방된 보어를 한정하는 척추 고정 조립체.
  17. 제 16 항에 있어서, 상기 판은 상기 융합 케이지에 의해 한정된 보어와 정렬되는 보어를 한정하는 척추 고정 조립체.
  18. 제 1 항에 있어서, 상기 상부면 및 상기 전방면 중 하나에 상기 융합 케이지로부터 외향으로 연장되는 다수의 핀을 또한 포함하는 척추 고정 조립체.
  19. 제 1 항에 있어서, 상기 전방면으로부터 상기 후방면으로 연장되는 상기 상부면 및 상기 내부면 중 하나에 노치를 또한 포함하는 척추 고정 조립체.
  20. 후방면, 전방면, 상부면 및, 내부면을 갖는 융합 케이지와,
    상기 융합 케이지의 전방면에 결합되며, 골 나사를 수용하기 위한 개구를 한정하는 판 및,
    헤드 및 섕크를 갖는 골 나사를 포함하며,
    상기 섕크는 상기 판 내의 개구를 통과하기 위한 치수를 가지며, 상기 헤드는 상기 헤드가 상기 판 내의 개구를 통과하는 것을 방지하도록 상기 판에 결합되기 위한 치수를 가지며,
    상기 융합 케이지는 내부면 및 상부면을 한정하도록 상기 상부면으로부터 상기 내부면을 분리하는 중심 평면을 구비하며, 상기 판은 상기 융합 케이지의 내부면 상에 제 1 개구 및 상기 융합 케이지의 상부면 상에 제 2 개구를 한정하며,
    상기 판은 상기 제 1 개구를 한정하는 제 1 태브 및 상기 제 2 개구를 한정하는 제 2 태브를 또한 포함하며, 상기 제 1 태브 및 상기 제 2 태브 중 하나는 상기 판에 대해 15°내지 60°의 각도로 각형성되는 척추 고정 조립체.
  21. 제 20 항에 있어서, 상기 상부면 및 상기 내부면 중 하나는 볼록하며, 상기 융합 케이지는 상기 후방면에서 보다 상기 전방면에서 더 두꺼운 척추 고정 조립체.
  22. 후방면, 전방면, 상부면 및, 내부면을 갖는 융합 케이지와,
    상기 상부면 및 상기 전방면 중 하나에 상기 융합 케이지로부터 외향으로 연장되는 다수의 핀을 포함하며,
    상기 상부면 및 상기 내부면 중 하나는 볼록하며, 상기 융합 케이지는 상기 후방면에서 보다 상기 전방면에서 더 두꺼운 척추 고정 조립체.
  23. 제 22 항에 있어서, 상기 전방면으로부터 상기 후방면을 향해 연장되는 상기 상부면 및 상기 내부면 중 하나에 노치를 또한 포함하는 척추 고정 조립체.
KR1020000069815A 1999-11-24 2000-11-23 척추 고정 조립체 KR20010051887A (ko)

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EP (1) EP1103236B1 (ko)
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ATE336969T1 (de) 2006-09-15
US20020082597A1 (en) 2002-06-27
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