CN102026584B - 具有复位功能的扭转位矫正器具 - Google Patents
具有复位功能的扭转位矫正器具 Download PDFInfo
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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
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
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Abstract
本发明提供的器具和方法用于操控骨锚和脊椎骨固定元件。在此公开的器具和方法特别适合有利地使骨锚相对于另一骨旋转以校正附接到骨锚的椎骨的角度旋转。所述器具不需要在操控前使脊椎骨固定元件插入骨锚中。所述器具可进一步用于使脊椎骨固定元件插入骨锚中。
Description
相关申请
本申请要求2008年3月10日提交的美国专利申请12/075,412的权益,该申请的内容由此通过引用并入本文。
背景技术
在脊椎畸形手术过程中,脊椎的弯曲(例如脊柱的冠状弯曲和/或脊椎的矢状弯曲)可通过植入骨锚和脊椎骨固定元件的结构进行纠正。用于这种结构中的骨锚的示例包括钩和骨螺钉。用于这种结构中的脊椎骨固定元件的示例是杆。
在一种类型的脊椎骨手术过程中,医生首先使脊椎后方露出,并将骨锚附接到选定的脊椎椎骨。然后,医生将脊椎骨固定元件插入到骨锚的接纳部分中以连接所选定的椎骨,由此固定椎骨的相对位置。
通常,需要可控的机械力以便利方式将脊椎骨固定元件和骨锚结合在一起。此过程典型地被称为“复位”。为了完成复位,医生必须在去除用于将杆插入的力之前,将锁定机构(例如固定螺钉)插入到椎骨锚中以将脊椎骨杆锁定到植入物。
除了校正脊椎的弯曲以外,还可校正一个或多个椎骨相对于其它椎骨的角度旋转。用于校正椎骨角度旋转的传统手术过程包括使通过骨锚连接到椎骨的脊椎骨固定元件(例如脊椎骨杆)旋转。在包括脊椎骨杆的结构的情况下,此过程典型地被称为“椎体扭转位矫正”。椎体扭转位矫正可在连接到旋转的脊椎骨杆的骨锚与植入有各骨锚的椎骨之间的界面上施加相当大的应力。这种应力可能导致一个或多个骨锚失效或损伤椎骨。因此,需要改进用于操控椎骨的器具和方法。
传统的扭转位矫正器具被设计为在复位已经执行完毕且脊椎骨固定元件已经紧固到骨锚之后使用。不过,在旋转过程中骨锚通常结合在固定元件上,从而阻碍运动或需要相当大的力才能实现运动。因此,在一些情况下,在复位前执行扭转位矫正可能是有益的。此外,复位和扭转位矫正需要不同器具。这样,必须移除一个器具以允许使用另一器具。
发明内容
在此公开用于操控骨锚和脊椎骨固定元件的器具和方法。在此公开的器具和方法特别适合有利地使骨锚相对于另一骨旋转,以校正附接到骨锚的椎骨的角度旋转。所述器具不需要在操控之前将脊椎骨固定元件插入骨锚中。所述器具进一步可用于在复位时将脊椎骨固定元件插入骨锚中。
根据一个示例性实施例,一种用于操控椎骨的器具可包括:轴,其具有近端、远端和在所述近端与所述远端之间延伸的内腔;一个或多个指状物,其设置在所述轴的远端处,且限定狭槽;外套,其围绕所述轴设置,并且被构造以在所述轴的远端上滑动;和复位元件。所述外套在第一位置与第二位置之间滑动。当所述外套处于所述第一位置时,所述一个或多个指状物不受限于所述外套,从而允许所述一个或多个指状物将所述脊椎骨固定元件接纳于所述狭槽中并接合所述脊椎骨固定元件接纳构件。当所述外套处于所述第二位置时,所述一个或多个指状物受限于所述外套,从而将所述脊椎骨固定元件固定于所述狭槽中且所述一个或多个指状物接合所述骨锚的所述脊椎骨固定元件接纳构件,从而允许通过所述器具操控所述脊椎骨固定元件和所述骨锚。所述复位元件被构造以穿过所述轴的内腔并且接合所述偏离的脊椎骨固定元件,从而将所述偏离的脊椎骨固定元件复位到所述骨锚的脊椎骨固定元件接纳构件中。
根据另一个示例性实施例,一种用于操控一个或多个椎骨的系统可包括:如前所述的第一器具;如前所述的第二器具;和连接所述第一器具和所述第二器具的连接器。在示例性实施例中,所述连接器可包括用于接纳所述第一器具的第一接纳元件和用于接纳所述第二器具的第二接纳元件。所述第一接纳元件能够相对于所述第二接纳元件进行调节。
根据另一个示例性实施例,一种操控骨锚和脊椎骨固定元件的方法包括:将骨锚连接到椎骨;将脊椎骨固定元件定位在所述骨锚的接纳构件的近处;连接如前所述的器具;和操控所述第一器具以先旋转骨锚并接着旋转所述脊椎骨固定元件。还可使用复位元件将所述脊椎骨固定元件复位到所述骨锚中。
附图说明
参照以下结合附图的详细描述,将更全面地理解在此公开的器具和方法的这些和其它特征和优点,其中,在不同视图中相似的附图标记总是指代相似的元件。附图例示出在此公开的器具和方法的原理,并显示出相对尺寸,不过未按比例显示。
图1是用于操控椎体的器具的示例性实施例的立体图,例示出器具接合骨锚;
图2A是图1的器具的轴的俯视图,例示出与器具其它元件分离的轴;
图2B是图1的器具的轴的侧视截面图,例示出与器具其它元件分离的轴;
图3是图1的器具的接合机构的立体图,例示出与器具其它元件分离的接合机构;
图4A图1的器具的套的俯视图,例示出与器具其它元件分离的套;
图4B是图1的器具的套的侧视截面图,例示出与器具其它元件分离的套;
图5A是图1的器具的立体图,例示出套处于第一位置;
图5B是图1的器具的立体图,例示出套处于第二位置;
图5C是图1的器具的立体图,例示出套处于第三位置;
图6A是图1-5B的器具的远端的侧视截面图,显示出该器具与骨锚的相互作用和插入器具;
图6B是图6A的安装器具的远端的立体图,显示出器具与锁定机构的相互作用;
图7A是图1-5B的器具的侧视图,显示出该器具与骨锚的相互作用和插入器具;
图7B是图1-5B的器具的侧视截面图,显示出该器具与骨锚的相互作用和插入器具;
图8是用于连接两个器具(例如,图1的器具)的连接器的立体图,例示出连接器处于打开位置;
图9是图8的连接器的局剖侧视图,例示出连接器处于打开位置;
图10是图8的连接器的立体图,例示出连接器处于锁合位置并连接两个器具(例如,图1的器具);
图11是图8的连接器的立体图,例示出连接器处于锁合位置并连接两个器具(例如图1的器具),其中连接器可在多个不同位置适应于器具;
图12是与接合到第一椎骨的第一骨锚相连的第一器具和与接合到第二椎骨的第二骨锚相连的第二器具的立体图,例示出相对于第二椎骨调节第一椎骨的方法;
图13和14是将第一器具连接到第二器具的连接器的立体图,例示出相对于第二椎骨调节第一椎骨第三椎骨的方法;
图15是将第一器具连接到第二器具的连接器的立体图,其中第一和第二器具沿侧向附接到相同的椎骨,例示出椎骨的方法;和
图16是用于连接多个器具的多个连接器的立体图。
具体实施方式
现在将描述特定的示例性实施例,以对于在此公开的器具和方法的结构、功能、制造和使用的原理提供整体的认识。这些实施例的一个或多个示例在附图中例示。本领域普通技术人员应理解,在此具体描述和在附图中具体图示的器具和方法是非限制性示例性实施例,而本发明的范围仅由权利要求书限定。结合一个示例性实施例图示或描述的特征可与其它实施例的特征相结合。这样的修改和变化将包含在本发明的范围内。
用词“一个”和“一种”在此用于表示一个或表示多于一个(即,表示至少一个)文法对象。作为示例中,“一个元件”表示一个元件或多于一个元件。
用词“包括”、“包含”、“具有”及它们的派生词在此可替换地用作包容性的开放式的用词。例如,使用“包括”、“包含”或“具有”表示:所包括、包含或具有的任意元件,并不是由含所述动词的句式的主语所涵盖的唯一元件。
图1例示出用于操控骨锚并从而操控附接有骨锚的椎体的器具的示例性实施例。示例器具10包括:轴12,锚接合机构14,围绕轴12设置的外套16,和复位元件18。示例器具10可用于操控骨锚19和脊椎骨固定元件20用以植入或调节。示例器具10还可用于接合被植入椎骨中的骨锚19并通过操控器具10而操纵骨锚19和椎骨。例如,示例器具10可用于使骨锚19旋转并使椎骨相对于其它椎骨旋转,由此校正椎骨角度方位。这样,在以示例性方式使用时,器具10可用于对脊椎椎骨的角度方位实施分段校正,并可通过复位元件18将脊椎骨固定元件20复位到骨锚19中。
示例器具10可由任意生物相容材料制成,且生物相容材料例如包括:金属(例如不锈钢或钛),聚合物,陶瓷,或它们的复合物。器具10的长度和直径可根据被处理的脊椎骨区域(例如,腰、胸或颈)和途径(例如,后部、前部或侧部)而不同。例如,器具10的长度可被选择为至少从皮肤切口延伸至椎骨近处。器具10的直径可被选择为有利于通过开放切口或最小介入切口而定位器具10。在特定的示例性实施例中,例如,器具的直径可被选择为有利于器具10传送通过最小介入进入装置(例如,插管或可张开牵引器)。
为了例示目的,示例器具10的每个元件将被独立论述和与其它元件结合论述。
图2A和2B例示出与示例器具10的其余部分分离的轴12。示例器具10的轴12可具有:远端22,近端24,和在近端24与远端22之间延伸的内腔26。在示例性实施例中,轴12大致为管形,并具有大致圆形截面。本领域技术人员应认识到,轴12可以具有其它截面形状,包括:椭圆形或直线形。轴12的内腔26在尺寸上适于接纳复位元件18、复位元件。在其它实施例中,复位元件18或复位元件的一部分可被移除,并且诸如螺丝刀或类似物的其它器具可穿过轴12。
在特定实施例中,轴12可进一步包括被构造为与复位元件18配合的表面构造,以有助于轴与复位元件18的协作。例如,轴12的内腔26可包括螺纹30,用于引导复位元件18插入通过内腔26。轴的近端24还可具有连接元件32,用于将器具10连接到连接器。该连接器可用于连接多个器具。轴与其它元件的协作将在下文中更详细论述。
接合机构14位于轴12的远端22处。接合机构14被构造以接合骨锚19,例如钩、单轴向骨螺钉、或多轴向骨螺钉,并由此将器具10连接到骨锚19,其连接方式足以允许操控骨锚和植入有骨锚的椎骨。接合机构14还用于抓紧可插入或者不插入骨锚19中的脊椎骨固定元件20,例如脊椎骨杆。在示例性实施例中,锚接合机构14是在轴12的远端22处的一个或多个指状物34A和34B,其限定设置在指状物34A和34B之间的狭槽36。
指状物34A和34B的放大图在图3中可见。在特定示例性实施例中,指状物34A和34B可沿径向具有柔性和弹性以利于连接到骨锚。例如,指状物34A和34B可从第一松弛位置沿径向弯曲分开,以利于指状物在骨锚19的一部分上沿纵向前进。一旦定位在骨锚19的一部分的周围,则由于指状物34A和34B试图返回第一松弛位置,因此指状物34A和34B可在骨锚上提供径向压缩力。
在所示的示例性实施例中,每个指状物34A和34B都包括一个或多个沿径向向内面对的突起38A、38B,突起38A、38B在尺寸和形状上适于设置在骨锚19的一部分中提供的开口内,以利于通过指状物34A和34B保持骨锚19。突起的尺寸、形状和数量可根据例如骨锚上提供的开口和所希望的连接类型而变化。锚接合机构14如何与骨锚19相互作用的进一步的示例将在下文中论述。
狭槽36使得指状物34A和34B分离。狭槽36被构造以接纳脊椎骨固定元件20,脊椎骨固定元件20可从骨锚19偏离。示例器具10允许在不需将脊椎骨固定元件20插入骨锚19中的情况下操控骨锚19。狭槽36可具有相当大的尺寸,以允许脊椎骨固定元件20与骨锚19的脊椎骨固定元件接纳构件40偏离,而同时仍允许指状物34A和34B接合和保持骨锚19。在特定实施例中,狭槽36可从轴12的远端22延伸约20mm。
在特定实施例中,接合机构14可进一步用于在骨锚被操控的同时在骨锚19的近处抓紧脊椎骨固定元件20或以其它方式将脊椎骨固定元件20保持在骨锚19的近处。指状物34A和34B还可用于在复位过程中引导脊椎骨固定元件20进入骨锚19的接纳构件40中。
虽然在此论述的接合机构14的示例性实施例以两个指状物34A和34B作为特征,不过应理解,在不背离本发明的范围或精神的情况下,本发明也可通过仅一个指状物或其它指状物构造而实施。在得益于本公开内容的情况下,其它实施方式和构造对于本领域技术人员而言将是显见的。
图4A和4B例示出与示例器具10其余部分分离的外套16。示例器具10的外套16围绕轴12设置,并且可具有:远端42,近端44,和在近端44与远端42之间延伸的内腔46。外套16和轴12可具有互补的形状,以利于外套16在内轴12上的定位。例如,在所示的实施例中,外套16大致为管形。外套16的纵轴线与细长轴12的纵轴线重合。轴12可设置在外套16的内腔46内,以允许外套16相对于轴12可移动。例如,外套16可沿轴12的纵轴线移动。在特定实施例中,套16和轴12可具有互锁表面构造50A和50B,在套16沿轴12移动时,互锁表面构造50A和50B保持套16在轴12上的方位。例如,套16上的表面构造50A可为凸部,而表面构造50B可为凹槽以接纳所述凸部。在其它实施例中,套16可包括锁定部件以允许用户将套16沿轴12锁定就位。
在示例性实施例中,套16进一步包括与接合机构14的狭槽36对应的狭槽48。狭槽48类似于狭槽36,被构造以接纳脊椎骨固定元件20(见图1),脊椎骨固定元件20可从骨锚19的接纳构件40偏离,从而允许骨锚19在不需要将脊椎骨固定元件20插入骨锚19的接纳构件40中的情况下进行接合。
外套16可沿轴12的远端22滑动以与接合机构14相互作用。对此的示例在图5A和5B中可见。外套16可在第一近位置(其中接合机构14的指状物34A和34B不受限并且前进超过外套16的远端42)与第二近位置(其中指状物34A和34B的大部分设置在套16内并且受限于套16)之间相对于轴12移动。指状物34A和34B可被构造为当套16处于第一位置时将骨锚19和脊椎骨固定元件20封装和抓紧在所述指状物之间,如图5A中可见。在示例性实施例中,例如,指状物34A和34B可在套16移动到第一位置时移动而相互分开,以利于在指状物34A和34B之间定位骨锚19的接纳构件40。
当套16沿箭头52的方向移动到第二远位置时,指状物34A和34B可保持抓紧骨锚19,以进一步将骨锚19和脊椎骨固定元件20保持在指状物34A和34B之间,如图5B中可见。通过处于第二远位置的外套16,可限制和防止指状物34A和34B分离。这样,套16与接合机构14相互作用而作为筒夹以保持骨锚19。在示例性实施例中,例如,骨锚19被保持在指状物34A和34B之间,其保持方式足以允许通过操控器具而操纵脊椎骨固定元件20、骨锚19和植入有骨锚19的椎骨。例如,脊椎骨固定元件20、骨锚19和椎骨可通过器具10被操控,沿器具10的轴线移动和/或沿垂直于器具10的轴线的方向移动。
在特定实施例中,套16可进一步移动到第三远位置,如图5C中可见。当套16移动到第三位置时,套16可接合被接纳在狭槽48中的脊椎骨固定元件20,并用于将脊椎骨固定元件20推入骨锚19的接纳构件40中。这样,套16可用于复位或部分复位脊椎骨固定元件20。
虽然套16已经被描述为一标准件,不过应理解,在不背离本发明的精神和范围的情况下,套16可由多个部件制成。例如,套16可具有用于限制指状物34A和34B的一个部件和用于复位脊椎骨固定元件20的另一部件。在得益于本公开内容的情况下,其它实施方式和构造对于本领域技术人员而言将是显见的。
在一些实施例中,复位元件18用于实现将脊椎骨固定元件20复位到骨锚19的接纳构件40中。图6A图示出示例器具10的远端的截面图,其中使用复位元件18以复位脊椎骨固定元件20。在此示例中,接合机构14的指状物34A和34B已经接合和抓紧骨锚19。突起38A和38B已经接合骨锚19的接纳构件40。套16也已经移动到限制指状物34A和34B的第二远位置以紧固骨锚19。复位元件18穿过轴12的内腔26,使得器具18的远端60接合并推动脊椎骨固定元件20进入骨锚19的接纳构件40中。在特定实施例中,复位元件18可具有螺纹,所述螺纹被构造以接合轴12的内腔26中的螺纹30(见图2B)。这样,通过旋转复位元件18,螺纹30用于使复位元件18前进以实现复位。
复位元件18还可设置有对中机构62,以确保复位元件18在轴12的内腔26中位于中心。在图6A的示例中,对中机构62是一壳体。在此示例中,壳体62还包括弹簧偏置机构64,当器具的远端60接触到脊椎骨固定元件20时,壳体62接合成组的螺纹66。
在特定实施例中,复位元件18也可用于插入锁定元件68,例如固定螺钉,以在复位之后紧固脊椎骨固定元件20。对此的示例在图6B中可见。在此,固定螺钉68设置在复位元件18的远端60上,其中复位元件18用于复位脊椎骨固定元件20以及插入固定螺钉68。弹簧偏置机构64可在固定螺钉68的螺纹70与复位元件18的螺纹之间提供一定间隙,例如在复位元件18的螺纹装配和固定螺钉68的螺纹装配与接纳构件40的螺纹装配不同步的情况下。
在其它的实施例中,复位元件18可包括多个部件。例如,一个部件可用于复位,而另一部件用于插入固定螺钉68。对此的示例在图7A和7B中可见。
图7A是具有两个单独部分的复位元件18的一个实施例的侧视图。图7B是图7A中的复位元件18的截面图。在此实施例中,复位元件18包括用于复位的第一部分和用于插入固定螺钉68的第二部分。第一部分包括轴72,轴72具有:远端74,近端76,和从近端76延伸到远端74的内腔。第一部分进一步包括手柄78,以作为轴72的近端76。第二部分还包括具有远端82和近端84的轴80。第二部分的轴80穿过第一部分的轴72的内腔。第二部分还在轴80的近端84处包括手柄86。由于第二部分的轴80穿过第一部分的轴72,因此,复位元件18的每个部分均可独立于另一部分操作。这样,为了实现复位,用户可使用第一部分的手柄78使轴72行进通过示例器具10的轴12的内腔26以接合脊椎骨固定元件20。同样,为了插入固定螺钉68,用户可使用手柄86使第二部分的轴80行进以将轴80的远端82上的固定螺钉68插入到骨锚19的接纳部分40中。
器具10的抓紧和保持骨锚19的能力提供了操控骨锚19用于调节的能力。因此,器具10的另一示例性使用是用于扭转位矫正。
如前所述,示例器具10可包括连接元件32,连接元件32被构造以接合连接器(例如下述的示例连接器100)用于将器具10连接到另一器具(例如用于操控椎骨的另一器具)。在所示的示例性实施例中,例如,轴14包括位于轴14的近端24处的连接元件32。连接元件32可被构造以允许器具10相对于连接器进行多轴向运动。例如,示例性实施例的连接元件32可至少部分地为球形以接合连接器的互补形状的接纳元件。在得益于本公开内容的情况下,其它可能的几何形状和构造对于本领域技术人员而言将是显见的。
图8一11例示出连接器100的一个示例性实施例,用于连接两个或更多个器具并有利于器具的协同运动。示例连接器100特别适于连接一个或多个器具(例如前述的器具10)用于操控椎骨。不过,本领域技术人员应认识到,连接器100可用于连接任何类型的脊椎或手术器具。
还应理解,示例连接器100仅为多种任意可能构造中的一种可能示例。在得益于本公开内容的情况下,连接器、接纳元件和锁合机构的其它可能的实施例、实施方案和构造对于本领域技术人员而言将是显见的。
示例连接器100可包括多个接纳元件102A和102B,且每个接纳元件连接到器具。可提供任意数量的接纳元件102A和102B。在所示的示例性实施例中,连接器100包括用于接纳第一器具的可调第一接纳元件102A和用于接纳第二器具的第二接纳元件102B。第一接纳元件102A和/或第二接纳元件102B可相对于彼此而调节以利于连接到间隔分开的两个器具。例如,在所示的示例性实施例中,第一接纳元件102A可相对于第二接纳元件102B和连接器100而调节,而第二接纳元件102B相对于连接器100被固定。
示例连接器100可包括第一臂104,第一臂104在由铰接销108限定的枢转点处被可枢转地连接到第二臂106。示例连接器100可在打开位置(如图8和9中所示,其中第一臂104的第一端110与第二臂106的第一端112分离)与锁合位置(如图8和9中所示,其中第一臂104的第一端110联接到第二臂106的第一端112)之间移动。打开位置有利于将器具连接到接纳元件和调节可调接纳元件,例如接纳元件102A。示例连接器100可包括锁合机构114,用于选择性地将第一臂104的第一端110联接到第二臂106的第一端112。在示例性的实施例中,锁合机构114可包括位于第一臂104上的钩120,钩120可选择性地接合位于第二臂106上的钩保持元件122。柱形按钮126连接到钩122。按钮沿朝向铰接部108的方向的运动使得钩120与钩保持元件122脱离接合,并由此使第一臂104从第二臂106松脱。弹簧127沿远离铰接部108的方向偏置按钮126,并由此将钩120偏置到接合位置。钩120的外表面128可弯曲或倾斜以提供凸轮表面,该凸轮表面在与钩保持元件122的底表面接合时使得钩120从接合位置朝向铰接部108移动,由此允许钩120接合钩保持元件122。
第一臂104和/或第二臂106可包括接纳构件,用于在连接器处于打开位置时将可调接纳元件102保持在臂上。例如,示例连接器200的第二臂106包括保持销125,用于将第一接纳元件102A保持在第二臂106上。保持销125可沿其轴线在伸展位置(其中销125阻止接纳元件沿臂106移动)与收缩位置(其有利于将接纳元件102从臂106上移除和将接纳元件102设置在臂106上)之间被调节。可提供弹簧127以将销125偏置到伸展位置。
在示例性实施例中,第一接纳元件102A包括:狭槽132,用于接纳第二臂106并且允许第一接纳元件102A相对于第二臂106和其它接纳元件(例如第二接纳元件102B)运动。在示例性实施例中,第一臂104包括多个齿130,用于当连接器100处于锁合位置时接合一个或多个接纳元件(例如第一接纳元件102A)上的多个齿。齿130与设置在可调接纳元件(例如可调接纳元件102A)上的齿的接合,可阻止可调接纳元件的运动,由此使可调接纳元件相对于第一臂104、第二臂106和其它接纳元件而固定就位。
第一接纳元件102A大致为具有开口134的C形,以利于将器具定位在接纳元件102A内。第一臂104在连接器处于锁合位置时可跨接开口134定位,以将器具保持在第一接纳元件102A中。第一接纳元件102A可被构造以允许器具相对于接纳元件102A并因此相对于连接器100的多轴向运动。例如,第一接纳元件102A可包括大致球形表面136,以限定用于器具的连接元件(例如,前述示例器具10的连接元件32)的定位或接合表面。当连接到连接器100的第一接纳元件102A时,器具10可沿多个方向运动,例如,垂直于、平行于和围绕器具10的轴线而运动,如图10和11中所示。
在示例性实施例中,第二接纳元件102B可通过第一臂104上设置的第一弧形表面140A和第二臂106上设置的第二弧形表面140B限定。当连接器100处于如图8和9中所示打开位置时,第一弧形表面140A可与第二弧形表面140B间隔分开,以利于将器具定位在第二接纳元件102B内。当连接器100处于如图10和11所示的锁合位置时,第一弧形表面140A与第二弧形表面140B间隔分开足以将器具保持在第二接纳元件102B内的距离。类似于第一接纳元件102A,第二接纳元件102B也可被构造以允许器具相对于接纳元件102B并由此相对于连接器100进行多轴向运动。例如,第一弧形表面140A和第二弧形表面140B可均具有部分球形表面142A、142B,以协同限定用于器具的连接元件(例如,前述示例器具10的连接元件32)的定位或接合表面。当被连接到连接器100的第二接纳元件102B时,器具10可沿多个方向运动,例如,垂直于、平行于和围绕器具10的轴线而运动,如图10和11中所示。
虽然连接器100的示例性实施例被描述和图示为具有两个接纳元件,不过接纳元件的数量和类型(即,固定的或可调的)可改变以适应于所希望连接的器具的数量。例如,图13和14中所示的示例连接器100包括三个接纳元件:一个固定接纳元件和两个可调接纳元件。
示例器具10可用于操控骨锚和植入有骨锚的椎骨。在操控椎骨的一个示例方法中,器具10可联接到接纳构件或骨锚的其他部分。例如,参见图12,第一器具10A可联接到骨锚19的接纳构件40。
在示例方法中,包括被植入多个椎骨中的多个骨锚和连接各骨锚的脊椎骨杆的脊椎结构在使用第一器具以操控椎骨之前定位。例如,第一骨锚19A可连接到第一椎骨VB1,第二骨锚19B可连接到第二椎骨VB2,第三骨锚19C可连接到第三椎骨VB3,且第四骨锚19D可连接到第四椎骨VB4。在示例方法中,第一、第二、第三和第四椎骨彼此相邻。在其它示例方法中,各骨锚可连接到不相邻的椎骨以形成脊椎骨结构。骨锚可植入椎骨的任意适合部分中。例如,在示例方法中,每个骨锚植入到椎根弓中。
脊椎骨固定元件20A可相对于骨锚定位。例如,脊椎骨固定元件可定位在每个骨锚19的接纳构件40之中或其近处。
在特定示例性实施例中,第二结构可位于脊椎的相对于第一结构的相反侧上。在示例方法中,第五骨锚19E连接到第一椎骨VB1且与第一骨锚19A相对设置,第六骨锚19F连接到第二椎骨VB2且与第二骨锚19B相对设置,第七骨锚19G连接到第三椎骨VB3且与第三骨锚19C相对设置,第八骨锚19H连接到第四椎骨VB4且与第四骨锚19D相对设置。第二脊椎骨固定元件20B可连接到骨锚19E-H。
本领域技术人员应认识到,图中所示结构是示例结构,以利于在此描述所述器具和方法的使用。在不背离本发明的范围的情况下,也可使用采用相同或不同骨锚和固定元件的其它结构。
在连接第一器具10A之后,可操控第一器具10A,以相对于第一椎骨VB1、第三椎骨VB3和第四椎骨VB4而操纵第二骨锚19B和第二椎骨VB2。例如,第一器具10A可围绕脊椎轴线A(如图12中的箭头R所示)运动,以使第二椎骨VB2围绕脊椎轴线A旋转。而且,器具10可用于沿任意方向操纵第二骨锚19B和第二椎骨VB2。
在示例方法中,第二器具10B可连接到第五骨锚19E,第五骨锚19E连接到第一椎骨VB1。可操控第二器具10B和第一器具10A以相对彼此地操纵第一椎骨VB1和第二椎骨VB2。例如,第一器具10A可围绕脊椎轴线A旋转以使第二椎骨VB2围绕脊椎旋转,第二器具10B可围绕脊椎轴线A旋转以使第一椎骨VB1围绕脊椎轴线A旋转。第一器具10A和第二器具10B可提供相反的扭矩以利于第一和第二椎骨的运动。例如,第一器具10A和第二器具10B可围绕脊椎轴线A沿相反方向旋转,以利于校正第二椎骨VB2和第一椎骨VB1的角度方位。
在示例方法中,复位元件18可插入穿过第一器具10A的轴12的内腔26,以实现用于第二骨锚19B的锁定机构68的复位或插入。
图13和14例示出操控多个椎骨的示例方法。在示例方法中,第一器具10A可连接到骨锚19B,骨锚19B连接到第二椎骨。此外,第二器具10B可连接到骨锚19E,骨锚19E连接到第一椎骨;且第三器具10C可连接到骨锚19H,骨锚19H连接到第四椎骨VB4。第二和第三器具10B、10C可通过例如前述的连接器100之类的连接器相连。在将第二和第三器具10B、10C连接到相应骨锚之后,第一接纳元件102A可相对于第二接纳元件102B进行调节,以利于使第二器具10B连接到第一接纳元件102A和使第三器具10C连接到第二接纳元件102B。连接器100可被移动以操控第二器具10B和第三器具10C,以使第一椎骨VB1和第四椎骨VB4相对于彼此旋转。例如,连接器100可沿由箭头R所示方向围绕轴线A旋转,以使第一椎骨VB1和第四椎骨VB2相对于第二椎骨VB2和第三椎骨VB3而围绕脊椎轴线A旋转。而且,第一器具10A可与连接器100协同旋转,以使第二椎骨BV2围绕脊椎轴线A旋转。连接器100,以及与其相连的第二器具10B和第三器具10C,和第一器具10A可提供相反的扭矩。例如,连接器100和第一器具10A可以围绕脊椎轴线A沿相反方向旋转,以利于校正第一椎骨VB1、第二椎骨VB2和第四椎骨VB4的角度方位。
图15例示出用于旋转单一椎骨的示例方法,通过将器具附接到沿侧向插入相同椎骨中的骨锚。在示例方法中,第一器具10A可连接到骨锚19A,骨锚19A连接到第一椎骨VB1。此外,第二器具10B可连接到骨锚19E,骨锚19E从骨锚19A的侧方连接到第一椎骨VB1。第一和第二器具10A和10B可通过例如前述连接器100之类的连接器相连。在将第一和第二器具10A、10B连接到相应的骨锚之后,第一接纳元件102A可以相对于第二接纳元件102B进行调节,以利于使第一器具10A连接到第一接纳元件102A和使第二器具10B连接到第二接纳元件102B。连接器100可被移动以操控第二器具10A和第二器具10B,以使第一椎骨VB1旋转。例如,连接器100可沿由箭头R所示方向围绕轴线A旋转,以使第一椎骨VB1围绕脊椎轴线A旋转。
图16例示出用于操控使用多个连接器而相连的多个椎骨的示例方法。在示例方法中,第一器具10A可连接到骨锚19E,骨锚19E连接到第一椎骨VB1。此外,第二器具10B可连接到骨锚19F,骨锚19F连接到第二椎骨VB2;第三器具10C可连接到骨锚19G,骨锚19G连接到第三椎骨VB3。第一和第二器具10A和10B可通过第一连接器100A相连。第一连接器100A的第一接纳元件102A可相对于第一连接器100A的第二接纳元件102B进行调节,以利于使第一器具10A连接到第一接纳元件102A和使第二器具10B连接到第二接纳元件102B。
然后,第二和第三器具10B和10C可通过第二连接器100B相连。第二连接器100B的第一接纳元件102A’可相对于第二连接器100B的第二接纳元件102B’进行调节,以利于使第二器具10B连接到第一接纳元件102A’和使第三器具10C连接到第二接纳元件102B’。由于第二器具10B既连接到第一连接器100A又连接到第二连接器100B,因此这进而使第三器具10C连接到第一器具10A。于是连接器100A和100B可被移动以操控第一器具10A、第二器具10B和第三器具10C,以使第一椎骨VB1、第二椎骨VB2和第三椎骨VB3相对于彼此旋转。
虽然本发明的器具和方法已参照其示例性实施例具体显示和描述,不过,本领域普通技术人员应理解,在不背离本发明的精神和范围的情况下,可在形式和细节上进行各种改变。本领域普通技术人员应认识到或能够确定,通过使用常规试验就可针对在此具体描述的示例性实施例获得多种等同方案。这样的等同方案将被涵盖在本发明和所附权利要求书的范围内。
Claims (6)
1.一种器具,用于操控骨锚和从所述骨锚偏离的脊椎骨固定元件,所述器具包括:
轴,其具有近端、远端和在所述近端与所述远端之间延伸的内腔;
一个或多个指状物,其设置在所述轴的远端处,并被构造以接合骨锚的脊椎骨固定元件接纳构件,且限定狭槽以接纳从所述脊椎骨固定元件接纳构件偏离的脊椎骨固定元件;
外套,其围绕所述轴设置,并且被构造以在所述轴的远端上在第一位置、第二位置与第三位置之间滑动;当所述外套处于所述第一位置时,所述一个或多个指状物不受限于所述外套,从而允许所述一个或多个指状物将所述脊椎骨固定元件接纳于所述狭槽中和所述一个或多个指状物接合所述脊椎骨固定元件接纳构件;当所述外套处于所述第二位置时,所述一个或多个指状物受限于所述外套,从而将所述脊椎骨固定元件固定于所述狭槽中且所述一个或多个指状物接合所述骨锚的所述脊椎骨固定元件接纳构件,从而允许通过所述器具操控所述脊椎骨固定元件和所述骨锚;在所述外套处于所述第三位置时,所述外套将所述偏离的脊椎骨固定元件复位到所述骨锚的脊椎骨固定元件接纳构件中;和
复位元件,其被构造为穿过所述轴的内腔并且接合所述偏离的脊椎骨固定元件,从而将所述偏离的脊椎骨固定元件复位到所述骨锚的脊椎骨固定元件接纳构件中;
其中所述轴的所述内腔包括内螺纹,用于接合穿过所述轴的内腔的所述复位元件上的对应螺纹,所述轴还包括连接元件,所述连接元件被构造以接合用于将所述器具连接到另一器具的连接器;
其中所述外套包括与由所述一个或多个指状物限定的狭槽对应的狭槽,外套的狭槽被构造用于在所述外套处于第二位置时接纳从所述脊椎骨固定元件接纳构件偏离的脊椎骨固定元件。
2.如权利要求1所述的器具,其中,所述连接元件被构造以允许所述器具相对于所述连接器进行多轴向运动。
3.如权利要求1所述的器具,其中,所述器具进一步被构造为将锁定机构插入所述骨锚中,以使所述脊椎骨固定元件固定到所述骨锚。
4.一种用于操控一个或多个椎骨的系统,所述系统包括:
第一器具,包括:
轴,其具有近端、远端和在所述近端与所述远端之间延伸的内腔;
一个或多个指状物,其设置在所述轴的远端处,并被构造以接合骨锚的脊椎骨固定元件接纳构件,且限定狭槽以接纳从所述脊椎骨固定元件接纳构件偏离的脊椎骨固定元件;
外套,其围绕所述轴设置,并且被构造以在所述轴的远端上在第一位置、第二位置与第三位置之间滑动;当所述外套处于所述第一位置时,所述一个或多个指状物不受限于所述外套,从而允许所述一个或多个指状物将所述脊椎骨固定元件接纳于所述狭槽中和所述一个或多个指状物接合所述脊椎骨固定元件接纳构件;当所述外套处于所述第二位置时,所述一个或多个指状物受限于所述外套,从而将所述脊椎骨固定元件固定于所述狭槽中且所述一个或多个指状物接合所述骨锚的所述脊椎骨固定元件接纳构件,从而允许通过所述器具操控所述脊椎骨固定元件和所述骨锚;在所述外套处于所述第三位置时,所述外套将所述偏离的脊椎骨固定元件复位到所述骨锚的脊椎骨固定元件接纳构件中;
复位元件,其被构造以穿过所述轴的内腔并且接合所述偏离的脊椎骨固定元件,从而将所述偏离的脊椎骨固定元件复位到所述骨锚的脊椎骨固定元件接纳构件中;和
其中所述轴的所述内腔包括内螺纹,用于接合穿过所述轴的内腔的所述复位元件上的对应螺纹;
第二器具,包括:
轴,其具有近端、远端和在所述近端与所述远端之间延伸的内腔;
一个或多个指状物,其设置在所述轴的远端处,并被构造以接合骨锚的脊椎骨固定元件接纳构件,且限定狭槽以接纳从所述脊椎骨固定元件接纳构件偏离的脊椎骨固定元件;
外套,其围绕所述轴设置,并且被构造以在所述轴的远端上在第一位置、第二位置与第三位置之间滑动;当所述外套处于所述第一位置时,所述一个或多个指状物不受限于所述外套,从而允许所述一个或多个指状物将所述脊椎骨固定元件接纳于所述狭槽中和所述一个或多个指状物接合所述脊椎骨固定元件接纳构件;当所述外套处于所述第二位置时,所述一个或多个指状物受限于所述外套,从而将所述脊椎骨固定元件固定于所述狭槽中且所述一个或多个指状物接合所述骨锚的所述脊椎骨固定元件接纳构件,从而允许通过所述器具操控所述脊椎骨固定元件和所述骨锚;在所述外套处于所述第三位置时,所述外套将所述偏离的脊椎骨固定元件复位到所述骨锚的脊椎骨固定元件接纳构件中;
复位元件,其被构造以穿过所述轴的内腔并且接合所述偏离的脊椎骨固定元件,从而将所述偏离的脊椎骨固定元件复位到所述骨锚的脊椎骨固定元件接纳构件中;和
其中所述轴的所述内腔包括内螺纹,用于接合穿过所述轴的内腔的所述复位元件上的对应螺纹;和
连接器,其连接所述第一器具和所述第二器具,所述连接器包括:用于接纳所述第一器具的第一接纳元件和用于接纳所述第二器具的第二接纳元件,所述第一接纳元件能够相对于所述第二接纳元件而调节;
其中所述第一器具或第二器具的所述轴包括连接元件,所述连接元件被构造以接合用于将所述器具连接到另一器具的连接器;
其中所述第一器具或第二器具的所述外套包括与由所述一个或多个指状物限定的狭槽对应的狭槽,外套的狭槽被构造用于在所述外套处于第二位置时接纳从所述脊椎骨固定元件接纳构件偏离的脊椎骨固定元件。
5.如权利要求4所述的系统,其中,所述第一器具能够相对于所述第一接纳元件进行角度调节。
6.如权利要求5所述的系统,其中,所述第二器具能够相对于所述第二接纳元件进行角度调节。
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AU2009223550A1 (en) | 2009-09-17 |
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AU2009223550B2 (en) | 2014-06-26 |
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