CN103501717A

CN103501717A - Polyaxial bone anchor with open planar retainer, pop-on shank and friction fit insert

Info

Publication number: CN103501717A
Application number: CN201180068730.XA
Authority: CN
Inventors: 罗杰.P.杰克逊; J.L.瑟伯
Original assignee: Individual
Current assignee: Individual
Priority date: 2010-12-29
Filing date: 2011-12-29
Publication date: 2014-01-08
Also published as: JP2014507970A; KR101606358B1; AU2011353096A1; KR20130137202A; EP2658461A1; WO2012091737A1; KR20160036095A; WO2012091737A8

Abstract

A polyaxial bone screw assembly includes a threaded shank body having an integral upper portion receivable in an integral receiver, the receiver having an upper channel for receiving a longitudinal connecting member and a lower cavity cooperating with a lower opening. A friction fit compression insert (some with lock and release feature), a planar split retaining ring and a shank upper portion cooperate to provide for pop- or snap-on assembly of the shank with the receiver either prior to or after implantation of the shank into a vertebra. The shank and receiver once assembled cannot be disassembled and the receiver and insert may include aligned tool receiving apertures for lock and release of the polyaxial mechanism.

Description

Universal bone anchor with the smooth localizer of opening, hasp bar and frictional fit plug-in unit

Technical field

The present invention relates to universal (polyaxial) with the head bone screw bar for bone surgery, more specifically relate to spine (spine) operation, and relate in particular to this screw with the receptor component assembly, the receptor component assembly comprises compression or compressing plug-in unit and (expansion-only) breach localizer that only expands, be used for bone screw club head snap close, catch and keep the receptor component assembly, and subsequently with respect to receiver assembly fixed bone screw bar.

Background technology

Bone screw is for being permitted eurypalynous spinal operation, in order to multiple implant is fixed to along on the vertebra of spinal column, to reach stable and/or to adjust the purpose that spine is aimed at.Closed end (closed-ended) and beginning (open-ended) bone screw are arranged although known, the beginning screw especially is very suitable for being connected to rod and connector arm, because this rod or arm do not need by enclosed hole (closed bore), but can be arranged or shift onto in the receptor or the open channel in head of this screw.Usually, screw must be together with head unit as a whole, or be inserted in bone as the prefabricated unit of bar and pivotable receptor (such as universal bone screw assembly) form.

Typical beginning bone screw comprises threaded bar (shank), and this bar has the outstanding branch of the pair of parallel that forms bar or arm, and this bar has for receiving excellent U-lag or passage.As be used in the spine technique for fixing, hook can also comprise similar open end (open end) with the other types adapter, for receiving other rod or parts fixing and rock-steady structure.

For the commonsense method of spine-supporting is provided, be that bone screw is implanted to some bone, then these bones and then support are supported by this rod such as excellent vertical structure or these bone.Such bone screw can have the head fixing with respect to its bar or receptor, or can be the type of Universal screw nail.In fixing bone screw, excellent receptor head can not move with respect to bar, and rod must be located can be placed in the receptor head well.Sometimes do so very difficult or can not realize.Therefore, universal bone screw is normally preferred.Universal bone screw of beginning typically allows head or receptor to rotate loosely or loosely about bar, until during the final stage of medical operating by realize this expectation position of rotation of receptor with respect to the fixing expectation of bar position of rotation, now rod or other longitudinal connecting component are inserted in receptor, insert subsequently lock screw or other closure.This lax feature may be undesirable in some cases, and may make this operation more difficult.And often expectation and receptor or head insert the bone screw bar separately, because the thing that the volume of receptor or head (bulk) may hinder the surgeon to do.This screw with this ability is sometimes referred to as the modular Universal screw nail.

Concrete referrer module formula snap close (snap-on) or the universal stalk of hasp (pop-on) (pedicle) screw system, it has the bar receiver assembly, prior art has illustrated and has instructed receptor and some localizer parts to form the concept of assembly, wherein between each several part, produce contractile locking and engage, with respect to receptor and localizer, to fix club head.Receptor of the prior art and club head localizer assembly have comprised contractile retainer rings and/or low pressure plug-in unit, it has the structure of expansion and contraction clip shell type (collet-type), this structure engages because localizer and/or jacket structured and receptor direct contacts the collapsible locking had for club head, causes the retainer rings of plug-in unit and/or jacket type structure to lean against on club head and shrinks.

Prior art about modular Universal screw nail assembly also shows and has instructed, contact surface on chuck and/or the localizer outside and on the receptor inboard can be taper, cone shape, round, bending, anfractuose, circular, and produces other configurations of the locking joint of collapsible type with respect to receptor for club head.

In addition, about the prior art of modular Universal screw nail assembly, show and instruct, when plug-in unit or localizer, during in position upwards and at receptor expansion groove or intracavity, club head can enter and break away from chuck shape structure or the localizer on plug-in unit.Normally like this, unless thereby plug-in unit and/or localizer are blocked and can not be upwards back in receptor hole or chamber.

Summary of the invention

The difference of the present invention and prior art is, once, on the each several part snap close or on connecting, not allow receptor to remove from club head.Even it is also like this that localizer can return back up to situation in expanding chamber.Have been found that this method or design compare with the prior art of modularity universal type screw, be safer and can provide more resistances to pullout forces.While using in the modular Universal screw nail as shown in prior art design, the chuck shape structure from bottom pressure plug-in unit to downward-extension has been found for the pullout forces run into some spine reattachment surgeries a little less than some.The present invention is designed to address these problems.

The difference of the present invention and prior art also is, the cooperation plug-in unit that the breach retainer rings is provided and there is chuck shape bottom additional structure part, and wherein additional structure not exclusively participates in the locking joint of club head with respect to described receptor.Only expansion breach or opening locator ring in the present invention are positioned at fully below club head hemisphere in receptor, and can be stronger, more solid structures, with opposing, are applied to the larger pullout forces on assembly.The retainer rings pedestal also can be supported near the loading surface of the level substantially lower openings in the receptor bottom better.With the design of prior art, compare, this design has been found to be stronger and safer, and as mentioned above; Once and just be assembled and can not be opened, the design of prior art is used the collapsible locking of some type to engage between parts.

Therefore, universal bone screw assembly according to the present invention comprises: bar, have monoblock type top or head and for being fixed to the body of bone; Limit the independent receptor of top open channel, centre bore, lower chamber and lower openings; (a) and (b) in two kinds of structures, (a) top descends and spin friction cooperation bottom packed card, the additional structure provided with the interim frictional fit of club head is provided, (b) top decline, non-rotating frictional fit plug-in unit, it has the susceptor surface of extending between the forward and backward surface of receptor arm, and the additional structure with the interim frictional fit of club head is provided; And for the elasticity of capturing club head in the receptor lower chamber breach localizer that only expands, before rod lock is become to desired configuration, club head and this frictional fit plug-in unit and receptor frictional engagement, but still can in non-lax mode, move with respect to frictional fit plug-in unit and receptor.In certain embodiments, plug-in unit extends fully between the receptor arm that limits receiver channel, and therefore in any stage of assembling, all keeps aiming at receptor and can not rotating with respect to receptor.In other embodiments, by leaning against on plug-in unit, press or a plurality of parts of curling receptor, top descends and the rotation plug-in unit is fixed with respect to receptor.By snapping into the club head on the plug-in unit additional structure that is shown as elastic plate, this plug-in unit is the engaging lever head in operation, and spaced apart with localizer.As previously mentioned, owing to by the closure top cover, by being pressed on rod or other longitudinal connecting components, being applied to the downward force on packed card, by the frictional engagement between the part of the plug-in unit above additional structure and breach localizer, bar is finally locked onto the position fixing with respect to receptor, and wherein rod or other longitudinal connecting components are captured in receptor hole and passage.In the embodiment shown, localizer and plug-in unit are loaded into downwards in receptor, but the localizer embodiment upwards loaded also has the ability to anticipate.Before or after in bar is inserted to bone, club head can be positioned at the lower opening of receptor lower chamber in the receptor lower chamber.Some packed cards comprise locking and release characteristic, and for locking independently omnidirectional mechanism, therefore described screw can be used as fixing uni-axial screws.Bar can have hollow pipe, to apply for the invasive surgical operation.Receptor is without any spring auricle (tab) or the chuck shape structure of type.Pressure plug-in unit and/or localizer all engage less than the collapsible locking of any type receptor-localizer with respect to club head.In certain embodiments, plug-in unit also can have the outside and upwardly extending arm of elasticity, these arms are disposed in the opening in receptor chamber, once make localizer and the club head of capturing enter in the bottom in receptor chamber, localizer and the club head of capturing are by firm and remain in the zone of receptor lock chamber.Like this, club head and localizer just can not return back up in the receptor chamber.

Similarly, in bar is implanted to vertebra before or after, the receptor assembled in advance, frictional fit packed card and breach localizer can be pushed to (push-on), snap into (snapped-on) or snap onto on (popped-on) club head.Such snap close process comprises the following steps: club head upwards is loaded in the receptor lower openings, club head presses the bottom of retainer rings, and elastic positioner is expand in the dilation or chamber in receptor chamber, subsequently on the hemisphere of club head or top by localizer elastic restoration after the ring-type localizer to original or close to nominal form.Club head also enters in the frictional fit bottom of plug-in unit, at localizer, turns back to neutrality or close to neutral when directed, and the panel lock of the frictional fit part of plug-in unit, to club head, provides non-lax being connected between plug-in unit and club head.Frictional fit between club head and plug-in unit is temporarily, and is not the part of final locking mechanism.In an illustrated embodiment, when bar finally is locked between the bottom of packed card and localizer, the frictional fit chuck shape plate of plug-in unit no longer engages with the club head tight friction fit, and they no longer contact with receptor.Contacting of locking expanded types between club head and breach localizer, and the non-taper locking of the expanded types between the lock chamber in the bottom in retainer rings and receptor chamber engages, forms final fixing.In the top in receptor chamber or expanding chamber, localizer can expand more mainly with allowing club head to pass through, but, between final lockup period, when the lock chamber surface in localizer reclines bottom, receptor chamber and club head are forced to recline retainer rings downwards, localizer has limited expansion to keep club head.In certain embodiments, when omnidirectional mechanism is locked, oppressed or the wedge of a plurality of parts of plug-in unit leans against on the apparent surface of receptor, cause interference, not collapsible locking to engage, allow adjust or remove rod or other connecting elements, and can not lose the expected angle relation between bar and receptor.This independently, not collapsible lock-in feature allows Universal screw nail to work as fixing uni-axial screws.

Bottom pressure plug-in unit also can be configured to independently be locked by instrument or utensil, therefore allows the hasp Universal screw nail or being transferred, compressing and/or to rotate around rod along rod, so that improved spine correction technology to be provided.Such instrument engages the hasp receptor from the side, so bonded package is to force plug-in unit to enter the latched position in receptor downwards.Still in position and correct and to be maintained, then rod is fixed in receiver channel by the closure cap lock instrument, afterwards removing tool.This process can relate to a plurality of screws, and all these screws are by handled with a plurality of instruments simultaneously, to realize the correction of expectation.

Target of the present invention further comprises equipment and the method that easy use is provided and is particularly suitable for its intended purpose, and wherein this instrument manufactures more cheap.Consider by reference to the accompanying drawings following the description, other targets of the present invention and advantage will become apparent, and accompanying drawing has been illustrated some embodiment of the present invention by the mode of illustrating and give an example.

Accompanying drawing forms the part of this description and comprises exemplary embodiment of the present invention, shows different target of the present invention and feature.

The accompanying drawing explanation

Fig. 1 is the decomposition anterior elevational view according to universal bone screw assembly of the present invention, this universal bone screw assembly comprises only expansion localizer and the frictional fit lower compression plug-in unit of bar, receptor, opening, further shows a part and the closure top cover of the longitudinal connecting component of bar form.

Fig. 2 shows the amplification top plan view of the bar in Fig. 1.

Fig. 3 is the simplified cross-sectional view along the line 3-3 intercepting of Fig. 2.

Fig. 4 is the amplification side elevation view of the receptor in Fig. 1.

Fig. 5 is the enlarged perspective of the receptor in Fig. 4.

Fig. 6 is the amplification top plan view of the receptor in Fig. 4.

Fig. 7 is the amplification bottom plan view of the receptor in Fig. 4.

Fig. 8 is the amplification cross sectional view along the line 8-8 intercepting of Fig. 6.

Fig. 9 is the amplification cross sectional view along the line 9-9 intercepting of Fig. 6.

Figure 10 is the enlarged perspective of the localizer in Fig. 1.

Figure 11 is the simplification top plan view of the localizer in Figure 10.

Figure 12 is the bottom plan view of the localizer in Figure 10.

Figure 13 is along the amplification cross sectional view of the line 13-13 intercepting of Figure 11.

Figure 14 is the enlarged perspective of the plug-in unit in Fig. 1.

Figure 15 is another enlarged perspective of the plug-in unit in Fig. 1.

Figure 16 is the anterior elevational view of the plug-in unit in Figure 14.

Figure 17 is the simplification top plan view of the plug-in unit in Figure 14.

The bottom plan view of the plug-in unit in Figure 18 Figure 14.

Figure 19 is the amplification cross sectional view along the line 19-19 intercepting of Figure 17.

Figure 20 is the amplification cross sectional view along the line 20-20 intercepting of Figure 17.

Figure 21 is the anterior elevational view of the amplification of the localizer of Fig. 1 and receptor, and wherein a plurality of parts of receptor cut to illustrate its details open, localizer is shown and is loaded into receptor (shown in broken lines) downwards to reach the insertion stage of assembling.

Figure 22 is the anterior elevational view of localizer and receptor, and its a plurality of parts are cut open, are similar to the situation shown in Figure 21, and the mode with anterior elevational view illustrates the starting stage of plug-in unit in assembling in Fig. 1 equally.

Figure 23 is the amplification anterior elevational view of localizer, receptor and plug-in unit, and its a plurality of parts are cut open, are similar to the situation shown in Figure 22, is illustrated in the plug-in unit in the follow-up phase of assembling, and the elastic arm of plug-in unit presses the inner surface of receptor.

Figure 24 is similar to the simplification anterior elevational view that a plurality of parts of Figure 23 are cut open, further shows amplification in the Fig. 1 in the assembling first stage and local bar, and wherein the hemisphere of localizer, club head and vertebra parts are all shown in broken lines.

Figure 25 is similar to the partial front elevational view that a plurality of parts of Figure 24 are cut open, illustrate localizer around the club head mid portion in swelling state, head hemisphere is shown in broken lines.

Figure 26 is similar to the partial front elevational view that a plurality of parts of Figure 25 are cut open, and bar top or the head device that is positioned is captured fully.

Figure 27 is similar to another partial front elevational view that a plurality of parts of Figure 26 are cut open, the lower plate of bar top or the described plug-in unit of head frictional engagement.

Figure 28 is the amplification fragmentary sectional view along the line 28-28 intercepting of Figure 27.

Figure 29 is similar to the partial front elevational view that a plurality of parts of Figure 27 are cut open, bar top and localizer are shown and are moved to (seated) position of taking one's seat of lower receptor intracavity downwards, the plug-in unit arm, in neutral state basically, is captured described plug-in unit below the lug of receptor.

Figure 30 is the partial front elevational view that a plurality of parts of the whole parts shown in Fig. 1 are cut open, and assembly as shown in Figure 29 is illustrated the stage of utilizing rod and the assembling of closure top cover.

Figure 31 is similar to the partial front elevational view that a plurality of parts of Figure 30 are cut open, is illustrated in final latched position.

Figure 32 is that another that be similar to that a plurality of parts of Figure 31 cut open amplifies partial front elevational view.

Figure 33 is the amplification cross sectional view along the line 33-33 intercepting of Figure 31.

Figure 34 is used the enlarged perspective for the optional locking plug-in unit of the plug-in unit shown in alternate figures 1 with together with assembly in Fig. 1.

Figure 35 is the top plan view of the plug-in unit in Figure 34.

Figure 36 is the anterior elevational view of the plug-in unit in Figure 34.

Figure 37 is the anterior elevational view of the amplification cut open of a plurality of parts of receptor in Fig. 1 and the plug-in unit in localizer and Figure 34, and the form that this anterior elevational view is the anterior elevational view simplified, illustrate plug-in unit and be trapped in receptor and the shipping position in non-locking.

Figure 38 is the partial front elevational view of bar, receptor, localizer, rod and closure in Fig. 1, and wherein a plurality of parts are cut open and fitted together with the locking plug-in unit shown in Figure 34, but the locked stage in assembling.

Figure 39 is the amplification partial front elevational view that is similar to Figure 38, and the interference locking of plug-in unit and receptor is shown.

Figure 40 is the amplification fragmentary sectional view along the line 40-40 intercepting of Figure 38.

Figure 41 is similar to the amplification partial front elevational view that a plurality of parts of Figure 39 are cut open, after being illustrated in and having removed the rod and closure top cover in Fig. 1, bar, localizer, plug-in unit and receptor remain on lock-out state, and further with decomposition view, optional deformable rod and collaborative optional closure top cover are shown.

Figure 42 is similar to the partial front elevational view that a plurality of parts of Figure 41 are cut open, and the remainder that optional rod and closure top cover are fixed to assembly is shown.

Figure 43 is the simplification partial front elevational view that a plurality of parts of the assembly of Figure 42 are cut open, wherein without optional rod and closure top cover, and further illustrate by two-piece tool plug-in unit is discharged from receptor, this two-piece tool has plug-in part bonding part and outer tubular retaining part.

Figure 44 is the simplification partial front elevational view of the two-piece tool of Figure 43, and the maintenance pin of plug-in part bonding part is shown in broken lines.

Figure 45 is the amplification fragmentary, perspective view of the plug-in part bonding part of instrument shown in Figure 44, and wherein a plurality of parts cut to illustrate details wherein open.

Figure 46 is the amplification fragmentary, perspective view of the assembly in Figure 30, but the bar illustrated is with respect to receptor at angle, and further be illustrated in the closure top cover and bar as illustrated with receptor when the concerning of loosening, non-locking for independently lock the optional locking tool of described bar with respect to described receptor.

Figure 47 is the fragmentary, perspective view of the part of the locking tool in Figure 46.

Figure 48 is assembly in Figure 46 and the amplification partial front elevational view of locking tool, and wherein a plurality of parts cut to illustrate its details open.

Figure 49 is the decomposition diagram according to another embodiment of universal bone screw assembly of the present invention, this assembly comprises localizer and the crown packed card of frictional fit of bar, receptor, split ring form, and a part and the closure top cover of the longitudinal connecting component of bar form further is shown.

Figure 50 is the amplification top plan view of the bar of Figure 49.

Figure 51 is the simplified cross-sectional view along the line 51-51 intercepting of Figure 50.

Figure 52 is the enlarged perspective of the receptor of Figure 49.

Figure 53 is the side front view of the receptor of Figure 52.

Figure 54 is the top plan view of the receptor of Figure 52.

Figure 55 is the bottom plan view of the receptor of Figure 52.

Figure 56 is the amplification cross sectional view along the line 56-56 intercepting of Figure 54.

Figure 57 is the amplification cross sectional view along the line 57-57 intercepting of Figure 54.

Figure 58 is the enlarged perspective of the localizer of Figure 49.

Figure 59 is the anterior elevational view of the localizer of Figure 58.

Figure 60 is the top plan view of the localizer of Figure 58.

Figure 61 is the bottom plan view of the localizer of Figure 58.

Figure 62 is the amplification cross sectional view along the line 62-62 intercepting of Figure 60.

Figure 63 is the enlarged perspective of the plug-in unit of Figure 49.

Figure 64 is the anterior elevational view of the plug-in unit of Figure 63.

Figure 65 is another perspective view of the plug-in unit of Figure 63.

Figure 66 is the side front view of the plug-in unit of Figure 63.

Figure 67 is the top plan view of the plug-in unit of Figure 63.

Figure 68 is the bottom plan view of the plug-in unit of Figure 63.

Figure 69 is the amplification cross sectional view along the line 69-69 intercepting of Figure 67.

Figure 70 is along the amplification cross sectional view of the line 70-70 intercepting of Figure 67.

Figure 71 is the anterior elevational view of the amplification of the localizer of Figure 49 and receptor, and wherein a plurality of parts of receptor cut to illustrate its details open, and localizer is in the centre position (shown in broken lines) by being loaded into receptor downwards the time.

Figure 72 is similar to the anterior elevational view that a plurality of parts of Figure 71 are cut open, and the plug-in unit of Figure 49 further is shown with the Zoom Side front view, the commitment in plug-in unit assembling shown in broken lines.

Figure 73 is similar to the anterior elevational view that a plurality of parts of Figure 72 are cut open, is illustrated in the plug-in unit rotated in described receptor during the assembling stage after the assembling stage shown in Figure 72.

Figure 74 is the enlarged perspective that a plurality of parts of assembly shown in Figure 73 are cut open, and the subsequent step with respect to the part of plug-in unit curling (crimp) receptor further is shown.

Figure 75 is the side front view of the amplification of assembly shown in Figure 74.

Figure 76 is similar to the simplification anterior elevational view that a plurality of parts of Figure 73 are cut open, and curling with Figure 74 and 75, and optional assembling stage of the bar that utilizes Figure 49 further is shown with partial front elevational view, at first its king-rod is implanted in vertebra (shown in broken lines), with receptor, localizer and plug-in unit, assembles mutually subsequently.

Figure 77 is similar to the amplification partial front elevational view that a plurality of parts of Figure 76 are cut open, and the stage of bar (not being implanted in vertebra) in assembling mutually with localizer is shown, and localizer is upwards pushed into plug-in unit to be engaged.

Figure 78 is similar to the amplification partial front elevational view that a plurality of parts of Figure 77 are cut open, and the localizer illustrated is around the top of bar in swelling state, and the top of bar is in the stage with the plug-in unit combination.

Figure 79 is the partial front elevational view of the simplification of the assembly as shown in Figure 78, and a plurality of parts cut to be illustrated in the assembling stage between top, localizer and the plug-in unit of bar open.

Figure 80 is the partial front elevational view that is similar to the simplification that a plurality of parts of Figure 78 cut open, the described plug-in unit of top frictional engagement of bar, and described localizer is in neutral state basically.

Figure 81 is the partial front elevational view of the amplification of the assembly as shown in Figure 80, engaging between the top that more part cuts to be illustrated in bar open and plug-in unit.

Figure 82 is the partial front elevational view that is similar to the simplification that a plurality of parts of Figure 80 and 81 cut open, the anterior elevational view of cutting open with a plurality of parts equally illustrate with Figure 49 in rod and the assembly of closure top cover in latched position.

Figure 83 is the simplification partial side elevational view of the assembly of Figure 82.

Figure 84 is the enlarged perspective according to optional locking plug-in unit of the present invention, its in the assembly of Figure 49 to substitute the plug-in unit shown in Figure 49.

Figure 85 is the side front view of the amplification of plug-in unit in Figure 84, and wherein a plurality of parts cut to illustrate its details open.

Figure 86 is the anterior elevational view of the amplification of plug-in unit in Figure 84, and wherein a plurality of parts cut to illustrate its details open.

Figure 87 is the anterior elevational view of the amplification of receptor in Figure 49 and localizer, and the plug-in unit illustrated in this receptor and localizer and Figure 84 assembles, and, in anterior elevational view, a plurality of parts cut to illustrate its details open.

Figure 88 is the side front view of the simplification of the assembly in Figure 87.

Figure 89 is the anterior elevational view of the simplification of receptor (its a plurality of parts are cut open), localizer and plug-in unit in Figure 87, further illustrate and the assembling of the bar (illustrating with partial front elevational view) of Figure 49, and the stage assembled in the rod with Figure 49 and closure top cover (illustrating with anterior elevational view equally).

Figure 90 is similar to the amplification partial front elevational view that a plurality of parts of Figure 89 are cut open, but described plug-in unit is shown and receptor, localizer, rod and the locking of closure top cover assemble.

Figure 91 is similar to the simplification partial front elevational view that a plurality of parts of Figure 90 are cut open, but rod and closure top cover are shown to be removed, the locking plug-in unit keeps locking relation with respect to receptor, and further with decomposition view, optional deformable rod and crew-served closure top cover is shown.

Figure 92 is similar to the partial front elevational view that a plurality of parts of Figure 91 are cut open, and optional deformable rod and the closure top cover of remainder in locking relation with assembly is shown.

Figure 93 is the simplification partial front elevational view that a plurality of parts of the assembly of Figure 91 are cut open, wherein without optional rod and closure top cover, and further illustrate by two-piece tool plug-in unit is discharged from receptor, this two-piece tool has plug-in part bonding part and outer tubular retaining part.

Figure 94 is the simplification partial front elevational view of the two-piece tool of Figure 93, and the maintenance pin of plug-in part bonding part is shown in broken lines.

Figure 95 is the amplification fragmentary, perspective view of the plug-in part bonding part of instrument shown in Figure 94, and wherein a plurality of parts cut to illustrate details wherein open.

Figure 96 is the amplification fragmentary, perspective view with the identical assembly shown in Figure 90, except bar with respect to receptor at angle, and further be illustrated in closure top cover and rod and receptor when the concerning of loosening, non-locking for independently lock the optional locking tool of described bar with respect to described receptor.

Figure 97 is the fragmentary, perspective view of the part of the locking tool in Figure 96.

Figure 98 is assembly in Figure 96 and the amplification partial front elevational view of locking tool, and wherein a plurality of parts cut to illustrate its details open.

The specific embodiment

As requested, specific embodiments of the invention are disclosed herein; Yet should understand the disclosed embodiments is only example of the present invention, can be with multi-form realization.Therefore, concrete structure disclosed herein and function detail should not be construed as restrictive, but, only as basis and the representative basis of claim, for instructing those skilled in the art, with any suitable concrete structure almost, by different modes, realize the present invention.Also note that, in this application to any location referred to shown in different accompanying drawings of mentioning of term top, bottom, the word such as upper and lower, and the normal connotation that is applied to this device, and be not intended to limit the location of bone attachment structure in practical application.

With reference to figure 1-Figure 33, Reference numeral 1 represents generally according to universal bone screw equipment of the present invention or assembly.Assembly 1 comprises bar 4, and this bar further comprises and upwardly extending top or the integrally formed body 6 of head construction 8; Receptor 10; Split ring localizer 12, and have for the compression with the non-locking structure engaged of club head 8 frictional fit or compressing plug-in unit 14.Receptor 10, localizer 12 and packed card 14 initial set load, and can be before or after in bar body 6 implantation vertebras 17, further with bar 4, assembling mutually (referring to Figure 24), as hereinafter described in more detail.Fig. 1 and Figure 31-Figure 33 further illustrate for capturing (capture) longitudinal connecting component, for example the rod 21, closure (closure) structure 18, rod 21 and then engage described packed card 14, this packed card 14 presses the top 8 of bar, make its CONTACT WITH FRICTION localizer 12 regularly, in order to capture and fixing longitudinal connecting component 21, therefore with respect to the fixing described member 21 of vertebra 17 in receptor 10.Shown rod 21 is hard, rigidity, inelastic and is columniform, has cylindrical outer surface 22.Forseeable, in other embodiments, rod 21 can be elastic, deformable and/or made and had different cross-sectional geometries by different materials.Receptor 10 and bar 4 cooperations, make receptor 10 and bar 4 can be relative to each other and and fix (secure) in any from a side to opposite side and a plurality of angles in vertical selected angular range, a plurality of joints link position or a plurality of rotation location, to realize that receptor 10 engages with the movable or articulated type of bar 4, until while ending up close to implant surgery receptor and bar the two relative to each other lock or fixing.

As shown in the best in Fig. 1-Fig. 3, bar 4 is microscler, bar body 6 has the thread forms of the bone mono-or two guiding of implantable screw thread 24((lead) of spiral type coiling or different thread type), this screw thread from top or the adjacent cervical region 26 of head 8 near extend to the tip 28 of body 6 and extend radially outwardly from body 6.During use, the body 6 that utilizes screw thread 24 to grasp (grip) and advance is implanted in vertebra 17, with most advanced and sophisticated 28, guide and use installation or driven tool (not shown) to drive downwards, arrive cervical region 26 places or near position in order to be implanted in vertebra, as more fully described in following paragraph.Bar 4 has the elongation rotation axis identified generally by Reference numeral A.

Cervical region 26 axially extends upward from bar body 6.With the adjacent upper top 32 of body 6 of screw thread 24 terminations, compare, cervical region 26 can have identical radius or typically have the radius dwindled a little.Bar top or head 8 are from cervical region 26 further axially and stretch out, this bar top or head 8 provide connectivity or capturing apparatus, and it is arranged on upper end 32 and also therefore is arranged on this vertebra at a distance of a distance when body 6 is implanted vertebra 17 at a distance of a distance.

Bar top 8 is disposed for realizing, was connected with the pivotable between localizer 12 and receptor 10 at bar 4 before being fixed to respect to the desired locations of receptor 10 by bar 4.Bar top 8 has external male and spherical surface 34 basically, and this surface 34 outwards extends upward and end in certain embodiments basically smooth top or flange (rim) surface 38 from cervical region 26.In an illustrated embodiment, the surface 39 of frusto-conical extends to top surface 38 from spherical surface 34, during bar is with respect to receptor 10 and plug-in unit 14 pivotables, provides extra space.The outer radius of spherical surface 34 is disposed for the sliding cooperation with the provisional friction-type of plug-in unit 14 plate with recessed or flat surfaces, non-lax (non-floppy), and inboard stairstepping surface and the final frictional engagement of plug-in unit 14 at an upper portion thereof, as discussed more fully in following paragraph.Masthead section surface 38 is substantially perpendicular to axis A.Spherical surface 34 in the present embodiment is basically level and smooth, but can comprise in certain embodiments that roughening or other surface treatment and its size and dimension are arranged for cooperating with packed card 14 and final frictional engagement and with the final frictional engagement of localizer 12.Bar spherical surface 34 is exclusively by plug-in unit 14 and localizer 12, and can't help to limit the inner surface in receptor chamber, locks onto appropriate location.

Surperficial 45 parts of countersunk head substantially flat pedestal or stairstepping base (seating) limit internal drive feature or impression section (imprint) 46.Shown internal drive feature 46 is formed in the aperture in top surface 38, has star shape, and it is designed to receive the instrument (not shown) of Allen's wrench (Allen wrench) type, and it enters in aperture for rotation and driving bone screw bar 4.Forseeable, this in-house tool connected structure can be taked different tool engagement forms, and can comprise difform one or more aperture, such as aperture a pair of isolated aperture or many lobular shape or hexagonal.Drive base or the base-plates surface 45 of feature 46 to be arranged to be substantially perpendicular to axis A, drive feature 46 additionally coaxial with axis A.As shown in Figures 2 and 3, drive base 45 can comprise oblique or stairstepping surface, this surface can further strengthen and the grasping of driven tool.In operation, the driven tool (not shown) is received in internal drive feature 46, rest against the surface of pedestal 45 places engages drive feature 46, for bar body 6 is driven and rotates to vertebra 17, this operation or as example carry out before in bar 4 as shown in Figure 24 is attached to receptor 10, perhaps after bar 4 is attached to receptor 10, carry out, now by the driven tool extended in receptor 10, bar body 6 is driven in vertebra 17.

Bar 4 shown in figure is hollow (cannulated), has the little medium pore 50 extended on the whole length of bar 4 along axis A.This hole 50 is limited by the interior cylindrical wall of bar 4, and has at the circular open at the most advanced and sophisticated 28a of bar place with in the upper shed that drives base 45 places to be connected with external drive section 46.Hole 50 is coaxial with screw thread body 6 and described top 8.Hole 50 provides the passage through bar 4 inside for the one section line (not shown) be inserted into before insertion rod body 6 in vertebra 17, and this line is for being inserted into bar body 6 in vertebra 17 guiding is provided.Forseeable, bar may be solid, and by comprising that metal or nonmetallic different materials make.

In order to provide with the biological activity of bone, engage, threaded rod body 6 can be coated, bore a hole, make porous or otherwise process.This processing can include, but are not limited to the metal coating of plasma spraying coating or other types, or calcium phosphate coating for example; Or, such as by sputter, sandblast or acid etching, roughening, perforation or indentation being carried out in the bar surface, this allows bone inwardly growth or growth thereon.Some metal coating serves as the ingrown support of bone (scaffold).The bioceramic calcium phosphate coating includes, but are not limited to: type alpha tricalcium phosphate and bata-tricalcium phosphate (Ca ₃(PO ₄) ₂, tetracalcium phosphate (Ca ₄p ₂o ₉), amorphous calcium phosphate and hydroxyapatite (Ca ₁₀(PO ₄) ₆(OH) ₂).The coating that for example has hydroxyapatite is desirable, because hydroxyapatite is chemically similar in appearance to bone aspect content of mineral substances, and by identification, be bioactive (bioactive), therefore can not only have supported bone inwardly to grow, also initiatively participated in the bone combination.

With particular reference to Fig. 1 and Fig. 4-Fig. 9, receptor 10 has the outward appearance of U-shaped substantially, has the outline of partial discontinuous, local facet and local buckling, and local columniform inside and outside contour.Receptor 10 has rotation axis B, and it is shown and aligns with the rotation axis A of bar 4 or identical in Fig. 1, and this orientation is desirable, but does not need this orientation during receptor 10 and bar 4 are assembled.In receptor 10 pivotal attachment to after bar 4, in bar 4 is implanted vertebras 17 before or after, axis B typically is arranged to respect to axis A at angle, as example as shown in Figure 46, Figure 46 illustrates with handling and the assembly 1 of locking tool.

Receptor 10 comprises curved surface bottom base part 60, it limits whole hole or inner chamber with 61 indications, pedestal 60 is integrally formed with a pair of relative setting arm 62, this forms carriage and is limited to this to the passage 64 between arm 62 arm 62, this passage 64 is with on the whole with the upper sheds of 66 indications with smooth lower channel is partly or base 68 basically, the width of passage 64 is suitable for operationally receiving the part of rod 21 or another vertical adapter between described arm 62, and the horizontal expansion part that closely receives plug-in unit 14, passage 64 is communicated with pedestal chamber 61.In relative smooth peripheral arm surface 69 basically partly limit passage 64, and be positioned at each arm inside basically on each side of cylindrical surface (whole indicate with 70).Lower apparent surface's part 71 on arm surface 69 ends at lower bottom base 68 places.The inner surface 70 of arm, comprise different inner circle cylindrical profile separately, and of its middle and upper part is guiding and the advancing structure 72 of the coiling of part spirality, and this structure is positioned at the adjacent of the top surface 73 of each arm 62.In an illustrated embodiment, guiding and advancing structure 72 are interlocking flange forms of part spirality coiling, and it is configured to the analog structure on closure arrangement 18, coordinate when rotated, as following, describe more fully.Yet, forseeable is for some embodiment of the present invention, guiding and advancing structure 72 can be that the spiral type of flat thread, buttless thread, dihedral screw thread or other screw-like or non-threaded shape is coiled discontinuous advancing structure alternatively, for downward guiding closure arrangement 18 and it is advanced between arm 62 operationally when rotated, and finally reverse during near rod 21 or other longitudinal connecting component in closure arrangement 18.Forseeable, arm 62 may have (break-off) extension of disconnection.

On the outer surface 76 of arm 62, form the round as a ball triangle in a pair of relative top (triangular) or triangle (delta-shaped) instrument and receive and engage aperture 74, each aperture has by top arcuate surface 75 and smooth lower surface 75 ' forms basically through hole.Each through-hole surfaces 75 and 75 ' extends through arm inner surface 70.Size and dimension with aperture 74 of throughhole portions 75 and 75 ' is arranged for and receives locking, release and other manipulation tool, and in an illustrated embodiment, receive retainer rings 12(between 10 mid-terms to receptor in localizer 12 top-loaded as shown in broken lines in Figure 21), as described in more detail below.Each aperture 74 further comprises the instrument alignment surface 77 of inclination, and this surface is around arch bore portion 75 and do not have extension to pass completely through respective arms 62.It should be noted that receptor 10 is monolithic constructions and without any spring auricle or chuck shape structure.As discussed in more detail below, the geometry that extends outwardly into the plug-in unit 14 in the receiver channel 64 at 69 places, peripheral arm surface stops plug-in unit 14 to rotate at assembly process, and therefore prevented and any misalignment of receptor 10 and rod 21 or other longitudinal connecting component, this misalignment may occur in the packed card for other type sometimes.With plug-in unit 14, localizer 12 and bar 4 assembly process; During bar and receptor 10 are implanted in vertebras by bar body 6 when pre-assembled; By bone anchor assemblies 1 and rod 21 and closure arrangement 18 assembly process; With some plug-in units are being locked according to the present invention with respect to receptor 10 and are being discharged adjustment, during with receptor 10 inner surfacies, producing frictional engagement or to break away from this frictional engagement, aperture 74 and extra instrument receiving aperture or groove (not shown) can be used for keeping receptor 10, as described in more detail below.Forseeable, instrument receives groove or aperture can be configured to different shape and size, and is arranged on other position on receptor arm 62.

Return to the inner surface 70 of receptor arm 62, being positioned under guiding and advancing structure 72 is discontinuous cylindrical surface 80, its part be defined for lead and advancing structure 72 stretch out (run-out) feature.The diameter of cylindrical surface 80 is equal to or slightly greater than the larger diameter of guiding and advancing structure 72.With the direction towards pedestal 60, advance downwards, after the cylindrical surface 80 of each arm, be to be positioned at annular protuberate basic unit or the surface cylindrical surface 82 below 83, this annular protuberate basic unit or surface 83 extend internally and vertically or a little obliquely extend towards axis B towards axis B.The diameter on surface 82 is less than the diameter on surface 80.The size and dimension on surface 82 is configured to closely receive at first and rubs and keeps the part of plug-in unit 14, as described in more detail below.Being positioned at surface below 82 is discontinuous annular surface or narrow lug (ledge) 84, and it is arranged to be substantially perpendicular to axis B.The discontinuous cylindrical surface 86 of part is positioned on each arm, below lug surface 84 and adjacent with it.The diameter on surface 86 is greater than the diameter on surface 82.At each arm place, the part of aperture surface 75 is adjacent to cylindrical surface 86, otherwise surface 86 ends at lower lug 87 places.The discontinuous cylindrical surface 88 of part is positioned on each arm, below lower lug 87 and adjacent with it.The diameter on surface 88 is greater than the diameter on surface 86.Surface 88 ends at lip 89 places, and lip 89 extends internally towards receptor axis B.What be positioned at lip 89 belows is the discontinuous cylindrical surface 90 of part.Surface 90 also partly limits inner chamber 61, and this inner chamber 61 is substantially in 74 belows, the 75 ' aperture of locating, surface and below passage base 68.The diameter of cylindrical surface 90 is a bit larger tham discontinuous surperficial 88 diameter.Surface 90 ends at lug surface 91 under chamber, and this surface 91 stretches out away from axis B and can be perpendicular to axis B, but is shown as the downward outward extending frusto-conical surface away from axis B.A plurality of through holes 75 in aperture 74 extend through arm separately at 86,88 and 90 places, surface, and the Shear tool joined wall 77 extends basically on every side of each hole surface 75, and in the main position contrary with inner surface 86 and 88 is formed on arm outer surface 76.

With particular reference to Fig. 1,5,6 and 8, turn back to basically smooth circumferential surface 69, each arm 62 comprises ridge or the backstop 92 of a pair of projection, is positioned on each surface 69, have four backstops 92 altogether, it is positioned near annular surface 87 and extends to cylindrical surface 88 from front and rear surfaces or arm surface 94.The backstop 92 of an arm 62 is directly in the face of the relative a pair of backstop 92 on another arm 62, and each backstop 92 is outwards outstanding away from respective flat surface 69.Shown backstop 92 is microscler, and extends on the direction perpendicular to axis B.As described in more detail below, backstop 92 cooperates that with the surface of plug-in unit 14 plug-in unit 14 is remained in the passage 64 of receptor 10.In an illustrated embodiment, each backstop 92 comprises lower surface or lug 95 smooth with part and that part curved surface 96 is adjacent.Be positioned at backstop 92 under surface 96 flats, concordant with surface 69 or can be from surface 69 indents (inset) slightly.Every group of relative surface 96 is crooked toward each other, and ends at adjacent separately bottom surface section 71.Rib (edge) 97 limits each curved surface 96 and the junction of adjacent bottom surface section 71 separately.Be less than the second width recorded between the apparent surface 69 between backstop 92 and arm top surface 73 at the first width recorded between relative surface portion 71, for plug-in unit 14 ' provides relative smooth locking interference engagement surface, as hereinafter described in more detail.The size and dimension of plug-in unit 14 is configured to closely be received between surface 71 but also can slides between surface 71.

Turn back to Fig. 8 and Fig. 9, surface 91 annular or truncated cone partly limits pedestal chamber 61, and is positioned at cylindrical surface 90 belows adjacent with it.Another cylindrical surface 99 is positioned at surperficial 91 belows adjacent with it.Surface 99 also limits the part in pedestal chamber 61.Cylindrical surface 99 is oriented and is arranged essentially parallel to axis B, and its size and dimension is configured to receive the retainer rings 12 of expansion.Surface 91 and 99 limits circumferential notches, the size and dimension of this circumferential notches is provided in localizer 12 and receives localizer 12 when expands in bar 8 bar tops 8, and this localizer 12 moves up and expands by the receptor pedestal and when passage 64 moves at assembly process bar 8.Forseeable, this recess can be taper or conical in configuration.The size and dimension that is positioned at the cylindrical surface 101 of cylindrical surface 99 belows is configured to for example closely receive when basic neutral position (neutral position) as shown in Figure 37 and around the bottom of localizer 12 when localizer 12.Therefore, the diameter of cylindrical surface 101 is less than the diameter of cylindrical surface 99, and cylindrical surface 99 limits expansion area or the expanding chamber of localizer 12.Surface 101 by one or more oblique, surfaces 102 crooked or taper in conjunction with or be connected to surface 99.Surface 102 allows localizer 12 slip and neutrality or nominal (nominal) location in the space limited by surface 101, and allowing localizer 12 finally to be arranged on the substantially horizontal annular surface 104 in bottom, this surface 104 is positioned at cylindrical surface 101 belows adjacent with it.Annular surface 104 is arranged to be substantially perpendicular to axis B.

Be positioned at 104 belows, annular base surface and with it adjacent be another basically columniform surperficial 106, this surface 106 communicates with oblique or bottom opening enlarging surface 107, surface 107 communicates with the outer frame surface 108 of pedestal 60, it is limited to the under shed in the pedestal chamber 61 of receptor 10, and this under shed is on the whole with 110 indications.

With particular reference to Fig. 1 and Figure 10-Figure 13, when bar top 8 and localizer 12 are arranged on receptor 10 when interior, under shed or 12 operations of breach localizer are trapped in bar top 8 in receptor 10, and the central axis of localizer 12 is identical with the axis B that is associated with receptor 10.Retainer rings 12 is made by the elastomeric material such as rustless steel or titanium alloy, makes localizer 12 to expand during the different step of assembling, as described in more detail below.Localizer 12 has the through hole of centre gangway or hollow, on the whole with 121 indications, its from encircle 12 top surface 122 to surface, bottom 124 fully by ring 12.The surface that limits passage or hole 121 comprises adjacent to the discontinuous inner cylindrical surface 125 of top surface 122 with adjacent to the discontinuous frusto-conical surface 127 on surface 125, and these two surfaces are the not pressurized in neutrality, unexpanded coaxial when directed at localizer 12.Rib 128 is limited by top surface 122 and the junction of cylindrical surface 125.As example as shown in Figure 31, when assembly 1 locks onto Shi，Gan top, final position 8 finally at the described localizer 12 of rib 128 place's frictional engagement.Localizer 12 further comprise the exterior cylindrical surfaces 130 that is positioned at top surface 122 adjacents and the outside adjacent with lower surface 124 oblique or frusto-conical surface 132.Surface 130 is oriented to be parallel with the central axis of localizer 12.In some embodiments of the invention, can form isolated otch (notch) (not shown) in cylindrical surface 130, to receive a maintenance and manipulation tool (not shown).In certain embodiments, can on the surfaces externally and internally of localizer, form other otch with localizer between 12 phases of expansion by stress equilibrium be distributed on whole localizer 12.

It is relative to each other spaced apart when neutral non-compressed state that elastic positioner 12 further comprises that the first and second end surfaces 134 and 135, the first and second end surfaces 134 and 135 are arranged in localizer.At localizer, in neutral state, time surface 134 also can contact with 135.Two end surfaces 134 and 135 all are arranged to be substantially perpendicular to top surface 122 and lower surface 124.The width X of surface between 134 and 135 very narrow (slit can be made by the EDM processing), take during operation as localizer 12 stability be provided.Because localizer 12 can load in the neutral state next top, and localizer 12 do not need compressedly to be engaged in receptor chamber 61, and width X can be much smaller than the required width of bottom-loading compression set device ring.Gap X only works in expansion, to allow localizer 12 8 expansions around bar top.This causes stronger localizer, it provides the more Surface Contact with bar top 8 when locking, cause comparing with the retainer rings with larger breach more strong being connected had than the glitch probability, and, the never inwardly compression because localizer only expands, localizer can not experience at assembly process and typically be applied to the mechanical stress on ring spring Sort positioning device well known in the prior art, and this mechanical stress is not only inwardly compressed but also outwards expanded.

Can predict, in some embodiments of the invention, localizer 12 inner surfacies can comprise roughening or extra material, to be increased in before under rod 2 or other longitudinal connecting component lock, lean against the frictional fit on bar top 8.And the

surface

134 and 135 shown in the embodiment 10-13 shown in Figure 10-13 is arranged essentially parallel to the central axis of localizer, however can predict be surface orientation become is tilted or to become low-angle can be desirable.

With particular reference to Fig. 1 and Figure 14-20, the size and dimension of the frictional fit packed card 14 illustrated is configured to by the received device 10 of upper shed 66 receives and is loaded into receptor 10 downwards.Operation center's axis of packed card 14 is identical with the central axis B of receptor 10.In operation, plug-in unit is frictional engagement bone screw bar top 8 advantageously, allows when intra-operative is approaching the operation process ending bar with respect to before receptor 10 lockings, and bar 4 is arranged to non-locking with respect to the angle of receptor 10 but right and wrong are loose.As following will be with respect to the plug-in unit 14 ' as shown in Figure 34-40 in greater detail, in some embodiments of the invention, by for example from rod 21 and the compression of closure top cover 18, bar 4 being locked into to the plug-in unit of a position, required angle with respect to receptor 10, also be forced in 71 places, arm surface and receptor 10 interference engagement that a pair of relative receptor of receptor 10 is smooth, even and therefore also can be by bar 6 maintenance latched positions when rod 21 and closure top cover 18 are removed.If necessary, such latched position also can discharge by the surgeon.Non-locking plug-in unit 14 and locking plug-in unit 14 ' are preferably by making such as rustless steel or the such hard elastomeric material of titanium alloy, so that the frictional fit panel to be provided, also make the arm of plug-in unit in certain embodiments to be pushed toward each other or to press, in the commitment of shipment and assembling, such part outwards presses receptor 10.

Non-locking packed card 14 comprises body 150, it has external cylindrical surface and the inner U-shaped surface of part, plug-in unit has on the whole the opposed end with 151 indications, the size and shape of plug-in unit 14 is configured to extend ground fully by the U-shaped passage 64 between the relative front and rear surfaces at arm 62 or positive 94, so that with the

surface

96 and 71 of receptor arm side surface 69, backstop 92, backstop 92 belows, and 68 cooperations of passage base.The U-shaped channel surface formed in body 150 or saddleback 153 also extend between plug-in unit end 151, and when plug-in unit 14 is assembled with receptor 10, saddleback 153 and receiver channel 64 substantial alignment.Saddleback 153 forms by insert body 150 with by two upright arms 156, and size and shape is configured to closely receive rod 21 or other longitudinal connecting component.Can predict, optional plug-in unit embodiment can be configured to comprise smooth clamping surface, and it closely clamps the square or rectangular rod and clamps cylindrical bar-shaped, rope, or telescopic rope longitudinal connecting component.

Therefore plug-in unit 14 bodies 150 are with integrally formed in the pair of straight armstand 156 of locating in the top, also integrally formed with the additional structure (super structure) to downward-extension, this additional structure is shown in a pair of relative crown chuck extension 158 of plug-in unit 14 lower ends, and each additional structure extension 158 ends at trough of belt lower surface 159.Hole with 160 indications is configured to mainly also pass through in insert body 150 insert body 150 on the whole, and this hole is extended and communicates with the U-shaped passage formed by saddleback 153 and upright arm 156 along axis B, and extends between chuck extension 158.Hole 160 size and shapes are configured to drive and other operation tools provide space and space for bar.

The arm 156 be arranged on the every side of saddleback 153 extends upward from saddleback, and its size is configured to and is disposed for finally to be placed in receptor cylindrical surface 86 and 88 inside under closure top cover 118 and be spaced away.Inner upper arm surface 157 up and a little stretches out from the remainder of U-shaped saddleback 153.Arm 156 size and shapes also are arranged for resilient receptor cylindrical surface 82 places that temporarily are placed on.Arm 156 comprises that being shown as the columniform outer subordinate of part protrudes surface 162, and adjacent to curved surface 163 on 162 outside, surface, and surface 163 is crooked and the also enlarging from every side direction of body 150 of protruding.Surface 163 is adjacent to smooth top surface 164, this top surface finally is positioned to the relation of opening at interval with closure top cover 18, make only frictional engagement rod 21 of closure top cover 18, rod 21 is pressed to plug-in unit saddleback 153 downwards, so localizer 12 is pressed on bar 4 tops 8, so that with the omnidirectional mechanism of angle locking bone screw assembly 1 of expectation.Each in top surface 164 up and away from adjacent saddleback surface 157 tilts.

Each the part cylindrical surface 162 that is positioned at flared surfaces 163 belows separately extends to bottom or the lower surface 165 of the part annular of insert body 150 from surface 163.Within each surperficial 162 size and shape is configured to be engaged in substantially receptor arm internal arms surface (on the whole with 70 indications).What can predict is, in some embodiments of the invention, for example, when rod 21 during by deformable material manufacture, arm 156 can be extended and top surface does not tilt, and the closure top cover is arranged so that arm, more particularly, the arm top surface is engaged closed thing top cover 18 directly finally, with the locking omnidirectional mechanism.Arm outer surface 162 further comprises otch or the groove formed thereon, for receiving and engage locking tool.Specifically, in the embodiment shown, each surface 162 has V-notch or the recess for receiving tool, and intersect on this otch limited by upper inclined surface 167 and the surface of lower flat 168, and the center operations axis of plug-in unit 14 is arranged to be substantially perpendicular in the surface 168 of lower flat.Surface 167 and 168 cooperations, and when plug-in unit 14 is captured and operates on, be positioned at receptor 10 when inner with receptor aperture through hole 75 separately, surperficial and surperficial 75 ' align, as the following more detailed description.Also be anticipated that, in certain embodiments, arm 163 can extend upward and not outwards enlarging or tapered.

Plug-in unit 14 extends outward to each end 151 in the same manner from cylindrical outer arm surface 162 basically.Basically smooth outer surface 170 reaches basically smooth surface 171 from each arm surface 162, and this surface 171 is arranged perpendicular to arm surface 162, and basically limits each end 151.Each end face 171 is adjacent with bottom extension surface 172, and surface 172 is arranged essentially parallel to surface 165 and extends and extend internally towards insert body 150.What be adjacent to each side surface 170 is basically smooth top or top surface 173, and it extends to each end face 171 from one of them arm 156.Each surface 170 forms narrow outer strip, and adjacent and perpendicular to the narrow lug 174 of bottom.Lug is parallel with upper face 173.The flat surfaces 175 of indent is adjacent with each lug surface 174, bottom, and the outside flat side surface 170 be parallel to is separately extended.The size of the width between relative surface 175 is configured such that surface 175 is slidably received between relative receptor underarm surface 71.In other embodiment of the present invention, width between surface 175 can be extended, make between smooth surface 71 surface 175 must be pushed down to provide plug-in unit to lean against the not interference engagement of retractable type of locking on receptor, and therefore lock the omnidirectional mechanism of bone screw assembly, described with respect to plug-in unit 14 ' as follows.Surface 175 terminates in smooth end face 177 and extension surface, bottom 178.The part on each surface 175 extends to smooth end face 171 always.

On the whole with the insert hole of 160 indications, basically be limited to body 150 by columniform inner surface 180 basically, surface 180 communicates with saddleback 153, also with the concave surface of bottom basically spherical surface 181 communicate, the radius on surface 181 is same as or basically similar in appearance to bar top or the radius on the surface 34 of head 8.The part on surface 181 terminates in body lower surface 165.Surface 181 also limits the inner surface of crown chuck extension 158.Along spherical surface 181, be positioned between the lower body surface 165 of cylindrical surface 180 and part annular is bar grip surface part 182.Grip surface part 182 comprises one or more stairsteppings surface or ridge, and its size and shape is configured to grasp and thrust when plug-in unit 14 locks lean against on head surface 34 club head 8.Can predict, stairstepping surface portion 182 can comprise more or less stairstepping surface, and covers the larger or less surface area of spherical surface 181.Can predict, bar grip surface part 182 and spherical surface 181 may be extraly or comprise alternatively roughening or veined surface or surface treatment, or can be by indentation, engrave annular knurl etc., for strengthening the frictional engagement with bar top 8.

Extend and have substantially two chuck extensions 158 on the inner spherical surface 181 of interruption on the direction contrary with two arms 156, also comprise basically extend through vertically lower surface 159 from bar grip surface part 182 adjacents run through slit or groove 183.Illustrated embodiment comprises a groove 183 that is positioned at each extension 158 center.Can predict, other embodiment of the present invention can comprise more or less groove 183 or there is no groove.Groove 183 is equally cut apart each extension 158 basically, forms spherical finger piece, auricle or the plate 196 of resilient part of four separation, and it extends to surface, bottom 159 from bar grip portion 182.In other words, discontinuous inner spherical surface 181 further is divided into four parts or plate 184, and each has discontinuous partial interior spherical surface 181 and has outer surface 185, and it is columniform in form basically.Plate 184 size and shapes are configured to spherical surface 34 elastic expansions around bar top 8, then snap close and friction grip surface 34.In the embodiment shown, spherical surface 181 is designed to have neutral or unexpansive radius, this radius is same as or is slightly smaller than the radius on bar surface 34, makes when auricle or panel 184 grip surface 34, and plug-in unit 14 chuck extension parts 138 are in neutrality or state that expand a little.In other embodiment, unexpansive radius is same as or is greater than the radius on bar surface.Under these circumstances, the contact surface area between bar and plug-in unit is enough to provide non-loose frictional fit.In addition, bar surface and/or spherical surface 181 can comprise the surface character of roughening or trough of belt, between bar and plug-in unit, to provide frictional fit.In other embodiments, elastic plate 184 has the pre-assembled radius that is a bit larger tham bar surface 34, and can be curved inwardly to produce the tighter frictional fit with the bar surface.When bar 4 when being pressed downwardly into rod 21 on plug-in unit base 153 or other connecting elements by closure top cover 18 and locking onto appropriate location, at first along bar surface 34 slidably the tight part 182 of plug-in unit 14 bar cramp then protrude into or thrust surface 34 and therefore bar top 8 is fixed firmly to plug-in unit at part 182 places.Can predict, in certain embodiments, spherical surface 181 can be plane or smooth.

The size and dimension in hole 160 is configured to receive the driven tool (not shown) through it, be driven to bone when bar body 6 in the situation that with receptor 10 is mutually attached in the time, the driven tool engaging lever drives feature 46.And hole 160 can receive manipulation tool, this manipulation tool discharges from the position with the receptor locking for optionally locking plug-in unit 14 ', this instrument is pressed on bar downwards, and locates or utilize other tool engagement feature to grasp described plug-in unit 14 ' at relative through hole 166 '.Can also approach hole 166 ' from receptor through hole 74 for the manipulation tool that plug-in unit 14 ' is extracted to (un-wedge) from receptor 10.Return with reference to plug-in unit 14, by the

surface

167 and 168 outer otch that limit, can also receive the instrument that extends through receptor through hole 74, the such temporary locking omnidirectional mechanism with as shown in Figure 46 and 48, below will describe in more detail.Shown plug-in unit 14 can further comprise further feature, comprises extra groove and recess, remains in receptor 10 for steering package 14 with by plug-in unit 14, and provide enough spaces between localizer 12 and plug-in unit 14.

With reference to figure 1 and Figure 30-Figure 33, in shown microscler rod or longitudinal connecting component 21(figure, its part only is shown) can be any in the multiple implant of utilizing in spine reconstruct operation, but typically be columniform, microscler structure, there is outside level and smooth, cylindrical surface 22 that there is consistent diameter basically.Rod 21 can be made by the material a little less than various metals, metal alloy, nonmetal and deformable and compressibility, includes but not limited to the rod of being made by the material (such as polycarbonate polyurethane (PCU) and polyethylene) of gum elastic, polyether-ether-ketone (PEEK) and other type.

Can adopt various shape for the longitudinal connecting component used together with assembly 1, include but not limited to rod or the rod of ellipse, rectangle or other shaped form or polygon cross section.Can revise the shape of plug-in unit 14, closely to remain on the specific longitudinal connecting component used in assembly 1.Some embodiment of assembly 1 also can be used together with the tensioning rope.Such rope can be made of a variety of materials, and these materials comprise polyester or other plastic optical fibre, rope or line, such as polyethylene terephthalate.In addition, vertically adapter can be the part of the connecting elements that is as general as dynamic stability more grown, wherein columniform or size and dimension rod shape part is arranged for packed card 14 receptions of received device, and this plug-in unit 14 has the passage of U-shaped, rectangle or other shape in order to closely receive longitudinal connecting component.Longitudinal connecting component can be with flexible or damped part is integrally formed or otherwise be fixed to this flexible or damped part, and this size and dimension flexible or damped part is configured to for example between phase adjacency pair bone screw assembly 1.Damped part or buffer can be attached to longitudinal connecting component in the one or both sides of bone screw assembly 1.According to required application, the rod of longitudinal connecting component or rod (or rod or rod parts) can be made of a variety of materials, and the scope of these materials is from deformable plastics to hard metal.Therefore, rod of the present invention and rod can be made by the material that includes but not limited to metal and metal alloy and other suitable material, and wherein metal and metal alloy include but not limited to rustless steel, titanium, titanium alloy and chrome-cobalt alloy; Other suitable material comprises plastic polymer, such as polyether-ether-ketone (PEEK), superelevation average molecular weight northylen (UHMWP), polyurethane and composite, this composite comprises and comprises carbon fiber, natural or artificial elastomeric composite, the wherein all polyisoprene in this way of natural or artificial elastomer (natural rubber) and synthesized polymer body, copolymer and thermoplastic elastomer (TPE), this thermoplastic elastomer (TPE) is for example polyurethane elastomer, such as the polycarbonate polyurethane elastomer.

With reference to figure 1 and Figure 30-Figure 33, the closure arrangement illustrated together with assembly 1 or closure top cover 18 rotatably are received between the isolated arm 62 of receptor 10.It should be noted that closure 18 top covers can be by being the closure arrangement be screwed into or slide into.Shown closure arrangement 18 is columniform basically, and the guiding and the advancing structure 193 that comprise the external helicoid shape coiling of flange forms, this guiding and advancing structure 190 are in operation and be arranged on guiding and advancing structure 72 combination on operating on the arm 62 of receptor 10.According to the present invention, the flange forms of utilization can be taked various ways, is included in the 6th of the present patent application people, the form of describing in 726, No. 689 United States Patent (USP)s, and this patent is incorporated herein as a reference.Although can predict, closure arrangement guiding and advancing structure can be replacedly buttress threads, flat thread, the advancing structure of the spiral type coiling of dihedral screw thread or other screw-like or non-threaded shape, for downward guiding closure arrangement 18 and it is advanced between arm 62 operationally when rotated, and have when closure arrangement 18 advances in passage 64 and to resist the characteristic that arm 62 opens, as the 6th, 726, in No. 689 United States Patent (USP)s, describe herein shown in flange forms be preferred, because reducing to cooperate and offset this intensity, the intensity that the intensity of the increase provided by this flange forms advantageously causes with any reduction profile of receptor 10 reduces, this can more advantageously engage the longitudinal connecting component parts.Shown closure arrangement 18 also comprises the top surface 194 with internal drive section 196, the form of this internal drive section 196 is aperture, be shown as star internal drive section, such as the internal drive section of selling with trade mark TORX, it can be perhaps hexagon drive division for example, or such as trough of belt, (tri-wing) three wings, spanner, other such internal drive section of two or more difform apertures, and analog structure.Size and dimension is arranged for the driven tool (not shown) that engages with internal drive section 196 for engaged closed thing 18 rotatably, and if need for closure 18 is broken away from from receptor arm 62.What can also predict is, closure arrangement 18 can comprise (break-off) head that fractures alternatively, this head design becomes to make such head at the moment of torsion of pre-selected, for example, to break away from the pedestal of (break from) closure under the effect of 70 to 140 pound power.Such closure arrangement also will comprise pedestal, and this pedestal has the internal drive section removed for closure.The pedestal of this closure or lower surface 198 are smooth, and further comprise in certain embodiments of the present invention for engaging and thrust the flange (rim) 199 on the surface 22 of rod 21.It should be noted that in certain embodiments, closure top cover bottom surface 198 can comprise central point, and does not need in other embodiments to comprise a little and/or flange.Closure top cover 18 can further comprise sleeve pipe (cannulation) through hole (not shown), and this through hole extends along the central axis of closure top cover, and extends through top surface and the lower surface of closure top cover.Such through hole provides the path through closure 18 inside for the one section line (not shown) inserted in closure 18, and this section line inserts in closure so that for the closure top cover is inserted in receptor arm 62 guiding is provided.

Figure 41 and the interchangeable closure top cover 218 illustrated in 42 for using together with the deformable rod with such such as PEEK rod 221.Except point or fritter (nub) 289 are positioned at the flange that replaces closure top cover 18 on dome-shaped surface 290,218Yu top 18, top is identical.Closure top cover 218 comprises guiding and advancing structure 283, top 284, internal drive 286 and bottom outer ring surface 288 in addition, these with corresponding guiding with respect to closure top cover 18 descriptions and advancing structure 193, top 194, internal drive section 196 is identical with lower surface 198 or substantially similar.In certain embodiments, internal drive section 286 is not large as the drive division 196 of closure top cover 18, this less drive division is for acting on the less situation of power on the deformable rod, and must be for example and not that for example following the discussion is used to the plug-in unit 14 ' in bone screw assembly of the present invention when the locking plug-in unit.

Turn back to assembly 1, preferably, receptor 10, localizer 12 and packed card 14 are assembled under the environment of plant, and this environment of plant comprises for keeping, align and handle the instrument of each parts.In some cases, at factory's place's bar 4, also with receptor 10, localizer 12 and packed card 14, assemble.In other examples, at first expectation implants 4, adds subsequently pre-assembled receptor, localizer and packed card when inserting.Like this, the surgeon can be advantageously and is more easily implanted and handle described bar 4, utilizes described bar transfer (distract) or compress vertebrae, and works on bar top or around head and do not have the receptor of cooperation to hinder.In other examples, what the surgeon personnel expected is, bar and receptor, localizer and the packed card of desired size and/or kind (for example, hydroxyapatite (hydroxyapatite) surface treatment on coarse surface treatment and/or bar 6 being carried out in top 8) is pre-assembled.Allow the surgeon select suitable size or advantageously reduced inventory requirements through the bar 4 of suitably processing, therefore reduced whole cost and improved logistics and distribution.

Figure 21-Figure 23 shows the pre-assembled of receptor 10, localizer 12 and packed card 14.With particular reference to Figure 21, at first localizer 12 inserts in upper receptor opening 66, and with cylindrical surface 130 guiding, wherein top surface 122 is shown in broken lines towards the relative arm 62(of receptor 10 with lower surface 124).Then localizer 12 drops in passage 64 in such side direction mode, and near the described localizer 12 that tilts of position receptor aperture 74 subsequently makes the top surface 122 now also shown in broken lines towards receptor opening 66().Afterwards, localizer 12 drops in receptor chamber 61, until lower surface 124 is placed in Figure 21 with on the annular lower portion chamber susceptor surface 104 shown in solid line.

With reference to Figure 22 and 23, plug-in unit 14 is loaded in receptor 10.As shown in Figure 22, plug-in unit 14 is loaded in receptor by opening 66, wherein the lower surface 159 of the crown chuck 158 of frictional fit is towards receptor chamber 61, and when plug-in unit 14 drops in passage 64 surface 170 and 175 towards the smooth arm surfaces 69 that limit described passage 64.When plug-in unit 14 drops in receptor, side surface 170 is received slidably by the relative receptor inner arm surface 69 that limits passage 64, until plug-in unit 14 arrives backstop 92.Plug-in unit 14 can further be pressed downwards, until plug-in unit 14 is captured in receptor 10, as shown in Figure 23 as the best, wherein surface 170 is inwardly slightly pushed or is pressed towards receptor axis B, to allow relative surface 170 engage receptor backstop 92 and then move downward through backstop 92, after backstop 92, stop plug-in unit 14 to move up and leave receiver channel 64.Particularly, if plug-in unit 14 moves up towards the opening 66 of receptor, plug-in unit surface 173 nestles up the lower surface 95 of backstop 92, stop the movement further made progress of plug-in unit 14, unless plug-in unit 14 is being utilized when receptor opening 66 moves up instrument surface 170 is pushed toward each other.

With further reference to Figure 23 and Figure 24, now plug-in unit 14 no longer, towards further landing downwards of localizer 12, because outer arm surface 163 engages described receptor arm surface 82, and is slightly inwardly pressed by this surface 82.Therefore plug-in unit 14 remains on the position shown in Figure 23 and 24 by its elastic arm 156, and this elastic arm 156 is pressing cylindrical surface 82 in receptor, and this is the desired locations loaded and transported together with the bar 4 separated as assembly.Therefore, receptor 10, localizer 12 and plug-in unit 14 combinations are now pre-assembled and be ready to assemble mutually with bar 4, and this assembling can be located carry out in factory, by the surgeon personnel, before implantation, is carried out, perhaps direct-assembling is to the bar 4 of implanting, as will be described herein.

As shown in Figure 24, by using suitable driven tool (not shown) to rotate described bar 4, by bone screw bar 4 or the whole assembly 1 that formed by the bar 4 assembled, receptor 10, localizer 12 and packed card 14, be screwed to such as vertebra 17(shown in broken lines) bone in, this driven tool drives and rotates described bar body 6 being bonded in operation of internal drive section 46 places by it.Particularly, vertebra 17 can be holed to minimize the pressure be added on bone in advance, and can in vertebra 17, insert the leading line (not shown) and think that bar 4 provides guide with respect to placement and the angle of vertebra.Can utilize leading line to do guide by using tap (tap) to make further discharge port (tap hole).Then, by the opening that at first leading line is screwed into to 28 places, bottom, then leading line being screwed out to the open top that drives feature 46 places, by utilizing collar aperture 50, bone screw bar 4 or whole assembly 1 are threaded on leading line.Then by being used as the line of placing guide that bar 4 is driven in vertebra.Forseeablely be, by utilize leading line and with receptor, coordinate can attached tower instrument, can be percutaneous or (minimally invasive) invasive operative Modality come insertion rod and other bone screw assemblies part, excellent 21(also to there is in certain embodiments central lumen) and closure top cover 18(also with centre bore).In the time of in not with the remainder ground situation of assembly 1, bar 4 being driven into to vertebra 17, bar 4 can or be driven to the final position of expectation or is driven to that slightly exceed or outstanding position, so that the facility during for receptor, packed card with assembling in advance and localizer assembling creates conditions.

With further reference to Figure 24, receptor, plug-in unit and the localizer of assembling are placed on 8 tops, bar top in advance, until bar top is received in receptor opening 110.With particular reference to Figure 25-Figure 29, along with bar top 8 moves in the inside 61 of receptor pedestal, localizer 12 is upwards pressed on bar top 8, localizer 12 is moved in the bulge in receptor chamber 61, the bulge in receptor chamber 61 is partly limited by annular upper portion or lug surface 91 and cylindrical surface 99.Along with part 8 continues to move up towards passage 64, surface 34 forces localizer 12 outwards to move towards cylindrical surface 99, and as shown in Figure 25, moving up of localizer 12 is subject to the prevention of annular surface 91 simultaneously.With reference to Figure 26 and Figure 27, when the center of localizer expansion recess is crossed in spheroid central authorities (shown in broken lines) movement of head 8, localizer 12 starts to turn back to its neutral state.With further reference to Figure 27-Figure 28, and at this moment, spherical surface 34 moves at the deflection auricle of crown chuck extension 158 or panel 184 places and engages with the noncontinuous surface 181 of plug-in unit 14.As shown in Figure 28 as the best, auricle 184 a little outwards expands with receiving surface 34.With further reference to Figure 28 and Figure 29, spherical surface 34 then with the complete frictional engagement of plate inner surface 181.Now, plug-in unit 14 plates and surface 34 are in quite tight frictional fit, and under the effect of certain power, but surface 34 is with respect to plug-in unit 14 pivotables.Therefore, now, even before localizer 12 drops to the position of taking one's seat on receptor annular surface 104, between plug-in unit 14 and bar top 8 generation tight, non-lax ball-and-socket and engages.

With reference to Figure 29, then can upwards draw described receptor, or then bar 4 and attached localizer 12 be moved down into desired locations, now localizer 12 is positioned on surface 104.Again, this can by receptor 10 upwards pull or in some cases by bar 4 further is driven in vertebra 17 and completes.Now, plug-in unit arm 156 bent outwards are to being arranged under lug 84 and the receptor surface limited by discontinuous cylindrical surface 86, make in the situation that there is no the special tool(s) plug-in unit 14 that can not move up, and make and localizer 12 can not be shifted out to the lock part of the receptor chamber limited by receptor base 104 and cylindrical surface 101.In certain embodiments, when receptor 10 and bar 4 are pre-assembled, can be at this moment by the driven tool (not shown) being inserted into to receptor and bar drive in 46 and bar 4 rotations and the desired locations that is driven into vertebra 17 being implanted to whole assembly 1.With reference to Figure 29 and Figure 30, and also for example with reference to Figure 46 and Figure 48, now, receptor 10 can be hinged (articulate) to the expected angle position with respect to bar 4, this receptor 10 can be held by the frictional fit between plug-in unit 14 deflection auricles 184 and bar top 8, but not locked.

With reference to figure 30-33, rod 21 finally is positioned to cooperate with at least two bone screw assemblies 1 with open or (percutaneous) mode percutaneous.Then closure arrangement 18 advances between the arm 62 of each receptor 10.By using the instrument engaged with interior drive division 196, closure arrangement 18 is rotated, until reach selected pressure, now rod 21 engages the U-shaped susceptor surface 153 of described packed card 14, stairstepping grip surface 182 is pressed to bar spherical surface 34, the rib on stairstepping surface 182 thrusts spherical surface 34, and bar top 8 is forced into and localizer 12 locking frictional engagement.Particularly, along with closure arrangement 18 is rotated and is moved down in corresponding receiver 10, flange 199 engages and thrusts rod surface 22, closure arrangement 18 presses rod 21 downwards and rod 21 is biased into and plug-in unit 14 compression engagement, plug-in unit is advanced to rib 128 lockings and engages towards localizer 12 inside body rib 128 pushing ram tops 8 and by it, localizer 12 lower surface 124 friction abutment surfaces 104, and outside cylindrical surface 130 outwards expands and near the receptor cylindrical surface 101 that limits the receptor lock chamber.For example, for respect to receptor 10 fixed bone screw bars 6, can on the closure top cover, apply about 80 moments of torsion to about 120 pound power.If expectation schematic diagram illustrating 1, this process contrary by the procedural order with describing for assembling before herein completes.

With reference to figure 34-Figure 40, the optional locking illustrated is used for the bar 4 with describing before this paper, receptor 10, localizer 12, closure top cover 18 with release packed card 14 ' together with rod 21, and the assembly of generation is identified as for example assembly 1 ' in Figure 39-Figure 40.Except the size of plug-in unit 14 ' as described in more detail below is arranged for the rib 97 and adjacent flat surface 71 locking interference engagement with receptor 10, plug-in unit 14 ' can be identical with the plug-in unit 14 of describing before this paper and be shown as basically similar in appearance to plug-in unit 14.Shown plug-in unit 14 ' is different from plug-in unit 14 parts and also is: plug-in unit 14 ' comprises instrument receiving aperture 166 ', and does not have for the arm that expands outwardly at shipment and early stage assembling stage Elastic joint receptor 10.

Therefore, locking plug-in unit 14 ' comprises body 150 ', a pair of opposite end 151 ', saddleback surface 153 ', a pair of arm 156 ', a pair of arm upper face 157 ', a pair of crown chuck extension 158 ' with lower surface 159 ', hole 160 ', Outer cylindrical arm surface 162 ', arm top surface 164 ', body lower surface 165 ', comprise the surface 167 ' of outer inclination and a pair of v shape aperture on lower flat surface 168 ', there is outer flat side surface 170 ', flat end surface 171 ', pair of base extension 172 ', upper surface 173 ', narrow lower lug 174 ', plug-in unit flat side surface 175 ', flat end surface 177 ', the extension of lower surface 178 ', interior cylindrical surface 180 ', interior spherical surface 181 ' and interior grip surface part 182 ', crack 183 ' and with the deflection panel 184 ' of outer surface 185 ', these parts are in form and function aspects is same as respectively or basically similar in appearance to the body 150 of describing about plug-in unit 14 before herein, a pair of opposite end 151, saddleback surface 153, a pair of arm 156, a pair of arm upper face 157, a pair of crown chuck extension 158 with lower surface 159, hole 160, Outer cylindrical arm surface 162, arm top surface 164, body lower surface 165, comprise the surface 167 of outer inclination and a pair of v shape aperture on lower flat surface 168, there is outer flat side surface 170, flat end surface 171, pair of base extension 172, upper surface 173, narrow lower lug 174, embed flat side surface 175, flat end surface 177, the extension of lower surface 178, interior cylindrical surface 180, interior spherical surface 181 and interior grip surface part 182, crack 183 and deflection panel 184 with outer surface 185.As mentioned above, plug-in unit 14 ' does not comprise the upper outer surface 163 of expansion, but comprises the cylindrical surface 162 ' that extends to body bottom or lower surface 165 ' from top surface 164 '.In addition, top arms surface 164 ' does not tilt, but is arranged to be arranged essentially parallel to the flat surfaces of lower surface 165 '.Plug-in unit 14 ' comprises the perforation eyelet (through hole) 166 ' for receiving manipulation tool, and described eyelet 166 ' is 162 ' upper formation on the arm surface, and is positioned at directly over the surface 167 ' of inclination and adjacent with surface 167 '.

The size and dimension of plug-in unit 14 ' flat side surface 175 ' is arranged in the bottom of receiver channel 64 and receptor locking interference engagement.In other words, the size of the width recorded between surface 175 ' is configured to enough large, with require must by instrument or a plurality of instrument or by closure top cover 18 use enough defeating compel rod 21 and lean against on plug-in unit 14 ' downwards, force plug-in unit 14 ' to enter in the space between the receptor surface 71 started at edge surface 97 places, with by the plug-in unit interference engagement lock onto in the receptor between flat surfaces 71.

With reference to figure 37-Figure 40, with plug-in unit 14, with the light sliding relation between receptor 10, compare, except when bar 4 while being locked into place plug-in unit 14 ' must be oppressed form and lock beyond interference engagement with receptor 10 downwards, plug-in unit 14 ' is by the mode identical with the above mode of describing with respect to assembly 1, assemble generation component 1 ' with receptor 10, localizer 12, bar 4, rod 21 and closure top cover 18.Equally, receptor arm 156 ' does not engage the surface 82 of receptor 10.But, before assembling mutually with rod 21 and closure top cover 18, packed card 14 ' outer surface 170 ' is received slidably by receptor surface 71, but surface 175 ' is not like this.Plug-in unit 14 ' therefore is prevented from further moving down at rib 97 places, unless by locking tool or be forced to move down the closure top cover by the closure top cover to press down on rod upper, this rod and then to press down on plug-in unit 14 ' upper, as shown in Figure 38-Figure 40.With further reference to Figure 38, now, receptor 10 can be with being hinged to respect to 4 one-tenth angle positions of expecting of bar, and shown in Figure 46 and Figure 48, bar 4 for example will be held by the frictional fit between card 184 ' and bar top 8, but not locked.

Rod 21 finally is positioned to cooperate with at least two bone screw assemblies 1 ' with open or mode percutaneous.Then, closure arrangement 18 is inserted between the arm 62 of each receptor 10 or advances between arm 62.By using the instrument engaged with interior drive division 196, closure arrangement 18 is rotated, until reach selected pressure, now rod 21 engages the U-shaped susceptor surface 153 ' of described packed card 14 ', plug-in unit stairstepping bar grip surface 182 ' is further pressed to bar spherical surface 34, the rib on stairstepping surface 182 ' thrusts spherical surface 34, and bar top 8 is forced into and localizer 12 locking frictional engagement.Particularly, along with closure arrangement 18 is rotated and is moved down in corresponding receiver 10, flange 199 engages and thrusts rod surface 22, closure arrangement 18 presses rod 21 downwards and rod 21 is biased into and plug-in unit 14 ' compression engagement, plug-in unit 14 ' is pressed to localizer 12 lockings and engages towards localizer 12 push strut tops 8 and by it, localizer 12 friction abutment surfaces 104, and outwards expand and lean against on cylindrical surface 101.For example, for respect to receptor 10 fixed bone screw bars 6, can on the closure top cover, apply about 80 moments of torsion to about 120 pound power.The helical form flange forms is tightened to 100 pound power and can produce the power of 1000 pounds, and have been found that the interference engagement that produces about 700-900 pound power between the rib 97 of the flat surfaces 175 ' of plug-in unit 14 ' and receptor and flat surfaces 71.Therefore, along with closure arrangement 18 and rod 21 are pressed plug-in unit 14 ' downwards towards the pedestal of receptor 10, plug-in unit surface 175 ' enters receptor rib 97 places are oppressed, and therefore compressing and fixing described plug-in unit 14 engage with surperficial 71 frictional interference of receptor.

With reference to Figure 41, now, can become flexible or remove closure top cover 18, and/or capable of regulating and/or remove described excellent 21, and the frictional fit of locating between plug-in unit 14 ' and receptor 10 on plug-in unit surface 175 ' will remain locked in position, advantageously maintain the locking angle position of bar 4 with respect to receptor 10.

With further reference to Figure 41 and Figure 42, now, another rod, such as deformable excellent 221 and crew-served optional closure top cover 218 can be loaded into the assembly pinned, produce optional assembly 201 '.As mentioned above, closure drive division 286 can advantageously be made the drive division that is less than closure 18, makes at assembly process deformable excellent 221 and can excessively not pressed or be out of shape, because omnidirectional mechanism locks.

With reference to figure 43-45, the two-piece tool 600 illustrated is for discharging plug-in unit 14 from receptor 10.Instrument 600 comprises inner flexible tubular structure, with the relative pin of inwardly facing (prong) 612 be positioned on penetrating via 616 both sides.Passage 616 can end at and the isolated position of pin 612, or can further extend upward and run through described instrument, produces two-piece tool 610.Instrument 600 comprises outside more rigid tubular element 620, and it has less penetrating via 622.At flexure member 610 pins 612 by outwardly-bent, then be engaged on receptor 10, then, after being installed in the through hole in relative aperture 74 of receptor 10 and being contained in the hole 166 ' that aligning on the arm that is positioned at plug-in unit 14 ' is relative, member 620 is assemblied in slidably manages on 610.In Figure 43, shown instrument 600 is during discharging plug-in unit 14 ' from receptor 10, external member 620 is around internals 610 and by pin 612, be clamped in receptor 10 and, in plug-in unit 14 ' aperture, instrument 600 is pulled upward away from bar 4 simultaneously.Can predict, when instrument 600 can further be included in pin and tubular element and is pulled upward under be pressed in the structure on receptor 10, such structure can be positioned at instrument 600 and for example be depressed on the top surface 73 of receptor arm.

Replacedly, can use another manipulation tool (not shown), it and inserts in the plug-in unit passage formed by saddleback 153 in opening 66 places are inserted into receptor, and its pin or extension extend outwardly in plug-in unit through hole 166 '; Thereafter the piston-like of instrument part directly presses against on bar top 8, pulls thus plug-in unit 14 ' away from receptor surface 90, therefore discharges universal type mechanism.In such period, bar 4 can be hinged with respect to receptor 10, and the expectation frictional fit turn back between plug-in unit 14 flexed plates and bar surface 34, make and still have relation adjustable but that right and wrong are loose between bar 4 and receptor 10.If expectation schematic diagram illustrating 1, this process contrary by the procedural order with describing for assembling before herein completes.

With reference to figure 46-48, another manipulation tool with 700 indications is shown on the whole, it is for independently plug-in unit 14 ' being locked onto to receptor 10, or as shown for independently non-locking plug-in unit 14 being locked onto to receptor 10 provisionally.Instrument 700 comprises a pair of relative arm 712, each arm has the extension 716 of joint, this joint extension 716 is positioned to respect to arm 712 separately at angle, make when instrument by when receptor moves down, the one or more inner surfacies 718 that engage extension 716 slide with bonded package 14 along the surface 77 of receptor and the surface 167 of plug-in unit 14, and surface is pressed on plugin table face 168 the universal type mechanism with locked component 1 for 720 times.As shown in figure 48, when plug-in unit 14 is leaned against on receptor 10 by lock, instrument lower surface 720 does not reduce as far as possible on receptor surface 75 ', but keeps spaced away.In the embodiment shown, surface 718 is further comprised that by round as a ball a little and each arm extension 716 smooth 722，Gai bottom surface, bottom surface 722 and lower surface 720 produce rib, on surface 167, with the junction point on surface 168, inserting and grasp plug-in unit 14.Instrument 700 can comprise multiple clamping and push/pull mechanism, and such as the handle instrument, it can comprise ratchet feature, articulated tool or for example rotate screw device.

With reference to figure 49-83, Reference numeral 1001 represents on the whole according to another universal bone screw equipment or assembly of the present invention.Assembly 1001 comprises bar 1004, and this bar further comprises with upwardly extending top or head shape captures the integrally formed body of structure 1,008 1006; Receptor 1010; Be shown as the locator structure of elastic opening ring 1012, and the crown chuck compression of frictional fit or compressing plug-in unit 1014.Receptor 1010, localizer 1012 and packed card 1014 are assembling at first, and can before or after in bar body 1006 implantation vertebras 1017, further with bar 1004, assemble mutually, as described in more detail below.Figure 49 and Figure 82-Figure 83 further illustrate for capturing longitudinal connecting component, for example, the closure arrangement 1018 of rod 1021, rod 1021 and then engage described packed card 1014, the top 1008 that this packed card 1014 presses bar makes its CONTACT WITH FRICTION localizer 1012 regularly, in order to capture in receptor 1010 and fixing longitudinal connecting component 1021, therefore with respect to the fixing described member 1021 of vertebra 1017.Shown rod 1021 in form and function aspects basically similar in appearance to the rod 21 of describing before herein.Forseeable, in other embodiments, rod 1021 can be elastic, deformable and/or have different cross-sectional geometries.Receptor 1010 and bar 1004 cooperate in some way, make receptor 1010 and bar 1004 can be relative to each other and and in any from a side to opposite side and a plurality of angles in vertical selected angular range, a plurality of joints link position or a plurality of rotation location, fix, to realize that receptor 1010 engages with the movable or articulated type of bar 1004, until while ending up close to implantation process receptor and bar the two relative to each other lock or be fixed up.

Best shown in Figure 49-Figure 51, bar 1004 is microscler, bar body 1006 has the thread forms of the mono-or two guiding of the implantable bone screw thread 1024(of spiral type coiling), this screw thread is from extending to the tip 1028 of body 1006 and extend radially outwardly from it with top or the adjacent cervical region 1026 of head 1008.During use, utilize screw thread 1024 to grasp and the body 1006 that advances is implanted in vertebra 1017, guide and use installation or driven tool (not shown) to drive downwards with most advanced and sophisticated 1028, in order to be implanted to arrival cervical region 1026 places or near position in vertebra.Bar 1004 has the elongation rotation axis identified generally by Reference numeral A.

Cervical region 1026 axially extends upward from bar body 1006.With the adjacent upper top 1032 of the body 1006 of screw thread 1024 terminations, compare, cervical region 1026 can have identical radius or typically have the radius dwindled a little.Bar top or head 1008 from cervical region 1026 further axially and stretch out, this bar top or head 1008 provide be arranged on upper end 1032 at a distance of a distance and therefore when body 1006 is implanted vertebra 1017, be arranged on and this vertebra at a distance of connectivity or the capturing apparatus of a distance.

Bar top 1008 is disposed for realizing, was connected with the pivotable between localizer 1012 and receptor 1010 at bar 1004 before bar 1004 is fixed to desired locations with respect to receptor 1010.Bar top 1008 has external male and spherical surface 1034 basically, and this surface 1034 outwards extends upward and end at basically smooth top or ledge surface 1038 from cervical region 1026.The outer radius of spherical surface 1034 is disposed for and the discontinuous recessed formula mantle friction formula of packed card 1014, non-lax sliding cooperation, and carries out final frictional engagement and thrust by the step-like grip portion of plug-in unit 1014.Top surface 1038 is substantially perpendicular to axis A.Spherical surface 1034 in the present embodiment is basically level and smooth, but can comprise in certain embodiments that roughening or other surface treatment and its size and dimension are arranged for cooperating with packed card 1014 and final frictional engagement and with the final frictional engagement of localizer 1012.Bar spherical surface 1034 is exclusively by plug-in unit 1014 and localizer 1012, and can't help to limit the inner surface in receptor chamber, and locking puts in place.

The substantially flat pedestal of countersunk head or stairstepping susceptor surface 1045 parts limit internal drive feature or impression section 1046.Shown internal drive feature 1046 is formed in the aperture in top surface 1038, has hex shape, is designed to receive the hexagon instrument (not shown) of Allen's wrench type, and it enters in aperture for rotation and driving bone screw bar 1004.Forseeablely be, this in-house tool connected structure can be taked different tool engagement forms, and can comprise difform one or more aperture, such as a pair of isolated aperture or many lobular shape or aperture star, such as with trade mark TORX, sell those, or similar form.Drive base or the base-plates surface 1045 of feature 1046 to be arranged to be substantially perpendicular to axis A, drive feature 1046 additionally coaxial with axis A.As shown in Figure 50 and Figure 51, drive base 1045 can comprise oblique or stairstepping surface, this surface can further strengthen and the grasping of driven tool.In operation, the driven tool (not shown) is received in internal drive feature 1046, be arranged in six surfaces of pedestal 1045 places engages drive feature 1046, in order to bar body 1006 is driven and rotates in vertebra 1017, this operation or carried out before bar 1004 is attached to receptor 1010, perhaps after bar 1004 is attached to receptor 1010, carry out, now by the driven tool extended in receptor 1010, bar body 1006 is driven in vertebra 1017.

Bar 1004 shown in figure is hollow, has the little medium pore 1050 extended on the whole length of bar 1004 along axis A.This hole 1050 is limited by the interior cylindrical wall of bar 1004, and has at the circular open at most advanced and sophisticated 1028 places of bar with in the upper shed that drives base 1045 places to be connected with external drive section 1046.Hole 1050 is coaxial with screw thread body 1006 and described top 1008.Hole 1050 provides the passage through bar 1004 inside, and for be inserted into one section line (not shown) of vertebra 1017 before insertion rod body 1006, this line is for being inserted into bar body 1006 in vertebra 1017 guide is provided.Can as described with respect to the bar body 6 of assembly 1 herein, bar body 1006 be processed or coating.

With particular reference to Figure 49 and Figure 52-Figure 57, receptor 1010 has the outward appearance of U-shaped substantially, has partial discontinuous and local columniform inside and outside contour.Receptor 1010 has rotation axis B, it is shown in Figure 49 for aliging with the rotation axis A of bar 1004 or identical, this orientation is desirable, but during receptor 1010 and bar 1004 are assembled, do not need this orientation (referring to, for example, Figure 76 shows receptor 1010 " hasp (pop on) " to bar 1004, and this bar 1004 is implanted in vertebra 1017 and is arranged to respect to receptor at angle).After receptor 1010 is attached to bar 1004 pivotly, this is attached at before or after bar 1004 implants in vertebras 1017, and axis B typically is arranged to respect to axis A at angle, as for example as shown in Figure 96

Receptor 1010 comprise limit whole with 1061 holes of indicating or the columniform pedestal 1060 basically of inner chamber, pedestal 1060 is integrally formed with a pair of relative setting arm 1062, this forms carriage and is limited to this to the path 10 64 between arm 1062 arm 1062, this path 10 64 is with on the whole with upper sheds and U-shaped lower channel part or the base 1068 of 1066 indications, the width of path 10 64 be suitable for operationally fitting (snugly) receive described excellent 1021 or the part of another vertical adapter, sleeve or other soft dynamic linkers such as tensioning rope adapter between described arm 1062, path 10 64 is communicated with pedestal chamber 1061.Relative substantially flat arm surface 1069, outside front and back partly is limited to the path 10 64 directly over base 1068, surface 1069 has advantageously reduced extension (run) on described rod (, narrower receptor part is provided, and then larger space is provided between the bone anchor and larger passage (more access) therefore is provided along described rod or other connecting elements), and provide flat surfaces 1069, for flushing or close contact with other links in certain embodiments, the all sleeves cooperated with the connecting elements of rod or rope type in this way of miscellaneous part, buffer or distance piece.

Each arm 1062 has generally with 1070 surfaces, inside of indicating, this internal table face comprises multiple inner circle cylindrical profile, one of these profile middle and upper parts is guiding and the advancing structure 1072 of the coiling of part spirality, and this structure is positioned at the adjacent of the top surface 1073 of each arm 1062.In an illustrated embodiment, guiding and advancing structure 1072 are interlocking flange forms of part spirality coiling, are configured to the analog structure on closure arrangement 1018, coordinate when rotated, as following, describe more fully.Yet, forseeable is for some embodiment of the present invention, guiding and advancing structure 1072 can be the discontinuous advancing structure of the spirality coiling of flat thread, buttress thread, reflex angle screw thread or other screw-like or non-threaded shape alternatively, for downward guiding closure arrangement 1018 and it is advanced between arm 1062 operationally when rotated, and finally reverse during near rod 1021 or other longitudinal connecting component in closure arrangement 1018.Forseeable, arm 1062 may have (break off) extension that fractures.

On the outer surface 1076 of arm 1062, form a pair of relative round as a ball triangle (triangular) or triangle (delta-shaped) instrument in top and receive and engage aperture, it is generally with 1074 indications, and each aperture has by top arcuate surface 1075 and smooth lower surface 1075 ' forms basically through hole.Each through-hole surfaces 1075 and 1075 ' extends through arm inner surface 1070.Size and dimension with aperture 1074 of throughhole portions 1075 and 1075 ' is arranged for receiving locking, release and other manipulation tool, and in localizer 1012 top-loaded to contributing to receive during in receptor 1010 and load retainer rings 1012 downwards.Each aperture 1074 further comprises the instrument alignment surface 1077 of inclination, and this surface is around arch bore portion 1075 and not exclusively extend through respective arms 1062.In the present embodiment, limit along the part of the receptor on the surface 1077 of arch aperture part location, plug-in unit 1014 with receptor 1010 assembly process curling (crimp) in plug-in unit 1014, as will be described in more detail.In other embodiments of the invention, limiting other walls or the surface in aperture 1074 or limit the other materials of other apertures or groove can be inwardly curling.It should be noted, receptor 1010 is monolithic constructions and without any spring auricle or chuck shape structure.Replacedly, in certain embodiments, spring auricle or other movably structure can be included on receptor 1010 or plug-in unit 1014, for the rotation about with respect to receptor 1010 with move axially (along axis A) plug-in unit 1014 is remained on to desired locations.Preferably, plug-in unit and/or receptor dispose in assembling and implantation process, stoping plug-in unit with respect to the receptor rotation but allow plug-in unit to carry out with respect to receptor the structure that some move up and down.

What be positioned at each 1074 top, center, triangle aperture is cylindrical depression or aperture 1078, and it also is formed in each arm surface 1076, but does not extend through inner surface 1070.Also be formed with two pairs of extra instruments and receive and engage aperture 1079 on the front and rear surfaces 1069 of receptor arm 1062.Transition base-plates surface 1080 is across between the flat surfaces 1069 at U-shaped base 1068 and cylindrical base 1060 places, and surface 1080 is downward-sloping towards pedestal 1060 at angle with respect to axis B.With plug-in unit 1014, localizer 1012 and bar 1004 assembly process; When bar and receptor 1010 is pre-assembled by bar body 1006, implant in vertebras during; By bone anchor assemblies 1001 and rod 1021 and closure arrangement 1018 assembly process; And locked and discharged adjustment at some plug-in units with respect to 1010 pairs of inventions of receptor, during with receptor 1010 inner surfacies, producing frictional engagement or to break away from this frictional engagement, some or all in

aperture

1074,1078 and 1079 can be used for keeping receptor 1010, as described in more detail below.Forseeable, instrument receives groove, depression or aperture and can be configured to different shape and size, and is arranged on other position on receptor arm 1062.

Turn back to the surface, inside 1070 of receptor arm 1062, what be positioned at guiding and advancing structure 1072 belows is discontinuous cylindrical surface 1082, and its part is defined for the feature of stretching out of guiding and advancing structure 1072.The diameter of cylindrical surface 1082 is equal to or slightly greater than the larger diameter of guiding and advancing structure 1072.With the direction towards pedestal 1060, advancing downwards, is protuberate basic unit or surface 1084 at the adjacent of the cylindrical surface 1082 of each arm, and surface 1084 extends internally and tilts towards axis B towards axis B.Adjacent with surface 1084 and what be positioned at its below is another cylindrical surface 1086, surface 1086 diameter is less than the diameter on surface 1082.Through-hole surfaces 1075 and 1075 ' mainly extends through arm at surperficial 1086 places, and the top of each arch 1075 extends through in surface 1082.Be positioned near each aperture surface 1075 is inner surface portion 1087, during being assembled in receptor 1010 at plug-in unit 1014, the thin-walled at surperficial 1077 places is when plug-in unit 1014 is curling, these inner surface portion 1087 bonded package 1014, as described in more detail below.Continuous annular surface 1088 is positioned at cylindrical surface 1086 belows and adjacent with cylindrical surface 1086.The other discontinuous cylindrical surface 1086 that part forms receptor arm 1062 also the interface place between surface 1086 and annular surface 1088 and near continuously, the top in formation receptor chamber 1061.Surface 1088 is arranged to be substantially perpendicular to axis B or slopes inwardly towards axis B.Continuous interior cylindrical surface 1090 is adjacent to annular surface 1088, and extends downwardly in receptor pedestal 1060.Receptor axis B is arranged to be parallel in surface 1090.The diameter on surface 1090 is slightly smaller than the diameter on surface 1086.Cylindrical surface 1086 and 1090 size are configured to receive a plurality of parts of plug-in unit 1014, and as described in more detail below, in certain embodiments, provide the locking interference engagement with the cylindrical part that locks plug-in unit.

Now, about pedestal 1060, and more specifically, pedestal chamber 1061, extend to the bottom that the surface 1090 that limits pedestal chamber 1061 is divided in the Ministry of War in feudal China in this pedestal, ends at annular surface or lug 1095 places.Lug 1095 stretches out away from axis B, and is substantially perpendicular to axis B.

From lug 1095 to downward-extension is cylindrical surface 1099, and this surface 1099 partly limits pedestal chamber 1061, and especially limits the expanding chamber of localizer 1012.Cylindrical surface 1099 is oriented and is arranged essentially parallel to axis B, and its size and dimension is configured to receive the localizer 1012 expanded.Surface 1095 and 1099 limits circumferential notches, the size and dimension of this circumferential notches is provided in localizer 1012 and 1008 receives this localizer while expanding around bar top, this localizer 1012 expands when path 10 64 moves up at the described bar 1004 of bar 1004 assembly process, the size and dimension of this circumferential notches also arranges to form backstop or constriction moves up together with bar section 1008 to prevent the localizer 1012 expanded, position or state or position or the state in whole expansions of localizer 1012 in demi-inflation no matter, surface 1095 all prevents that localizer 1012 from upwards leaving chamber 1061.The size and dimension that is positioned at the cylindrical surface 1101 of cylindrical surface 1099 belows is configured to, when localizer as shown in for example Figure 71 in neutral position the time closely receive localizer 1012.Therefore, the diameter of cylindrical surface 1101 is less than the diameter of cylindrical surface 1099, and cylindrical surface 1099 limits the expansion area of localizer 1012.Surface 1101 by one or more oblique, crooked or cone shape surperficial 1102 in conjunction with or be connected to surface 1099.Surface 1102 allows localizers 1012 progressively to slide to move in the space or lock chamber limited by surface 1101, and permission localizer 1012 finally sits in and is positioned at cylindrical surface 1101 belows and is adjacent on the lower annular surface 1104 on this surface 1101.

Be positioned at 1104 belows, annular base surface and be adjacent be another basically columniform surperficial 1106, this surface 1106 communicates with oblique or bottom opening surface 1107 expansion, surface 1107 communicates with the outer frame surface 1108 of pedestal 1060, be limited to the under shed in the pedestal chamber 1061 of receptor 1010, this under shed is on the whole with 1110 indications.

With particular reference to Figure 49 and Figure 58-Figure 62, under shed or 1012 operations of breach localizer are trapped in bar top 1008 in receptor 1010, when bar top 1008 and localizer 1012 are arranged on receptor 1010 when interior, the central axis of localizer 1012 is identical with the axis B that is associated with receptor 1010.Retainer rings 1012 is made by the elastomeric material such as rustless steel or titanium alloy, makes localizer 1012 to expand during a plurality of steps of assembling, as described in more detail below.Localizer 1012 has the through hole of centre gangway or hollow, on the whole with 1121 indications, its from encircle 1012 top surface 1122 to surface, bottom 1124 fully by ring 1012.The surface that limits passage or hole 1121 comprises adjacent to the discontinuous inner cylindrical surface 1125 of top surface 1122 with adjacent to the discontinuous frusto-conical surface 1127 on surface 1125, these two surfaces at localizer 1012 in neutrality, unexpanded coaxial when directed.Rib 1128 is limited by top surface 1122 and the junction of cylindrical surface 1125.Rib 1128 can comprise chamfering or inclined-plane.As for example as shown in Figure 82, when assembly 1001 locks onto Shi，Gan top, final position 1008 finally at the described localizer 1012 of rib 1128 place's frictional engagement.Localizer 1012 further comprises the exterior cylindrical surfaces 1130 that is positioned at top surface 122 adjacents and the oblique or frusto-conical surface 1132 adjacent to the outside of lower surface 1124.Surface 1130 is oriented to be parallel with the central axis of localizer 1012.In some embodiments of the invention, can form isolated otch (not shown) in cylindrical surface 1130, keep and the manipulation tool (not shown) to receive.In certain embodiments, the other otch on the surfaces externally and internally of localizer can make localizer between 1012 phases of expansion by stress equilibrium be distributed on whole localizer 1012.

Elastic positioner 1012 further comprises the first and second end surfaces 1134 and 1135, and it is relative to each other spaced apart when neutral non-compressed state that these two surfaces are arranged in localizer.At localizer, in neutral state, time surface 1134 also can contact with 1135.Two end surfaces 1134 and 1135 all are arranged to be substantially perpendicular to top surface 1122 and lower surface 1124.The width X very narrow (slit can by EDM process make) of surface between 1134 and 1135, take during operation as localizer 1012 stability be provided.Because localizer 1012 can be with the neutral state top loading, and localizer 1012 do not need compressedly to be engaged in receptor chamber 1061, and width X can be much smaller than the required width of bottom-loading compression set device ring.Gap X only works in expansion, to allow localizer 1,012 1008 expansions around bar top.This causes stronger localizer, and the more Surface Contact that it provides with bar top 1008 when locking, cause comparing with the retainer rings with larger breach more strong being connected had than the glitch probability.And, the never inwardly compression because localizer 1012 only expands, localizer 1012 can not experience at assembly process and typically be applied to the mechanical stress on ring spring Sort positioning device well known in the prior art, and this mechanical stress is not only inwardly compressed but also outwards expanded.

Can predict, in some embodiments of the invention, localizer 1012 inner surfacies can comprise roughening or extra material, to increase before under by rod 1021 or other longitudinal connecting component lock, lean against the frictional fit on bar top 1008.And the embodiment shown in Figure 28-63 illustrates surface and 1134 and 1135 is arranged essentially parallel to the central axis of localizer, yet can predict, surface orientation is become or to become low-angle can be desirable.

With particular reference to Figure 49 and Figure 63-70, the size and shape of the crown packed card 1014 of the frictional fit illustrated is provided in the received device 1010 in upper shed 1066 places and receives and be loaded in receptor 1010 downwards.Operation center's axis of packed card 1014 is identical with the central axis B of receptor 1010.In operation, plug-in unit is frictional engagement bone screw bar top 1008 advantageously, permission intra-operative approaching operation process when ending bar with respect to receptor 1010 lockings before, bar 1004 is arranged to nonlocking with respect to the angle of receptor 1010 but right and wrong are loose.As following will be with respect to the plug-in unit 1014 ' as shown in Figure 84-92 in greater detail, in some embodiments of the invention, by for example from rod 1021 and the compression of closure top cover 1018, bar 1004 being locked into to the plug-in unit of the position, angle of a requirement with respect to receptor 1010, therefore also be forced in interior cylindrical surface 1090 places and engage with receptor 1010 interference engagement, even and also bar 1006 can be remained on to latched position when rod 1021 and closure top cover 1018 are removed.If necessary, such latched position also can discharge by the surgeon.Non-locking plug-in unit 1014 and locking plug-in unit 1014 ', preferably by making such as rustless steel or the such solid elastic material of titanium alloy, make a plurality of parts of plug-in unit or to snap onto on bar top 1008 and be extruded or be pressed against on receptor 1010 and utilize releasing tool to extract from receptor 1010 by snap close.

Non-locking crown chuck packed card 1014 comprises columniform body 1136 basically, this body 1136 is integrally formed with the arm 1137 of the pair of upright of locating in the top, also, with integrally formed at the downward elasticity of extension additional structure of its lower end (superstructure), the form of this downward elasticity of extension additional structure is a pair of relative crown chuck extension 1138.Hole with 1140 indications is configured to mainly in body 1136 and by this body 1136 on the whole, this hole communicates with the penetrating via that is substantially U-shaped formed by saddleback 1141, and these saddleback 1141 parts are limited by body 1136 by upright arm 1137 and part.The size and shape of saddleback 1141 is configured to closely, snugly engage columniform excellent 1021 and comprise crooked lower bottom base 1142.Can predict, optional embodiment can be configured to comprise smooth maintenance surface, and it closely keeps the square or rectangular rod and keeps cylindrical bar-shaped, rope, or telescopic rope longitudinal connecting component.The arm 1137 be arranged on the every side of saddleback 1141 extends upward from body 1136.The size of arm 1137 is configured to and is disposed for finally to be held in place receptor guiding and advancing structure 1072 belows cylindrical stretch out surperficial 1082 and inner surface 1084 and 1086 places or near.What can predict is, in some embodiments of the invention, for example, when rod 1021 during by deformable material manufacture, plug-in unit arm 1137 can be extended and the closure top cover is arranged so that finally engaged closed thing top cover 1018 directly of arm, with the locking omnidirectional mechanism.In such embodiments, plug-in unit 1014 will comprise rotation stopping structure or feature on its outer surface, this structure or feature connect the cooperative structures on the inwall that is positioned at receptor 1010, when the closure top cover is rotated into while engaging with plug-in unit, stop the rotation of plug-in unit with respect to receptor.In the present embodiment, arm 137 comprises outer surface 1143, it is cylindrical and from basically smooth top surface 1144, extend near the lower surface 1148 of chuck extension 1138 that outer surface 1143 is shown as part, this top surface 1144 finally is positioned to the relation of opening at interval with closure top cover 1018, make only frictional engagement rod 1021 of closure top cover 1018, rod 1021 is pressed against downwards on susceptor surface 1142, plug-in unit 1014 and then press bar 1004 tops 1008, localizer 1012 is pressed on this bar top 1008, so that the omnidirectional mechanism of angle locking bone screw assembly 1001 with expectation.Particularly, shown part columniform surperficial 1143 each extend to the isolated flange of lower surface 1148 or the lug 1150 with chuck extension 1138 from one of them arm top surface 1144.Each flange or lug 1150 are positioned near the annular lower surface 1151 of insert body 1136.Is discontinuous exterior cylindrical surfaces 1152 between each flange 1150 and each extension lower surface 1148, and this exterior cylindrical surfaces 1152 partly limits each chuck extension 1138 and has the overall diameter that is less than arm cylindrical surface 1143 diameters.Run through groove 1154 and medially be formed in each chuck extension 1138, this groove 1154 extends through described extension at lower surface 1148, exterior cylindrical surfaces 1152 places, and in insert body 1136 place's parts extend to exterior cylindrical surfaces 1143.Shown embodiment comprises the groove 1154 be centrally located in each extension 1138.Can predict, other embodiment of the present invention can comprise more or less groove 1154.Groove 1154 is equally cut apart each extension 1138 basically, forms resilient fingers, auricle or the plate 1154 of four separation that extend to lower surface 1148.

The size and dimension on surface 1143 is configured to basically be engaged in receptor arm 1062.Arm outer surface 1143 further comprises otch formed thereon or groove, for receiving manipulation, release and locking tool.Although not shown, each surface 1143 can comprise one or more through holes or other apertures, for receiving tool, and the hole shown in going up such as for example locking plug-in unit in Figure 84 1014 '.Be positioned between two parties in each surface 1143 and (be in certain embodiments below through hole) and be formed with in this surface 1143 generally with 1156 triangle for receiving tool or triangular incision or the recesses of indicating, it is limited by upper inclined surface 1157 parts and intersects with lower flat surfaces 1158, and this time flat surfaces 1158 is arranged to be substantially perpendicular to the central axis (in plug-in unit is arranged on receptor the time also perpendicular to the axis B of receptor) of plug-in unit 1014.While being positioned at receptor 1010 inside on plug-in unit 1014 is captured and operates, in surface 1167 and surface 1168, each cooperates and aligns with receptor aperture through-hole surfaces 1077 and 1075 ' separately, as the following more detailed description.In the embodiment shown, also form a pair of isolated v shape or square notch or groove 1160 and 1161 in each surface 1143, it extends near the surface 1158 of central triangle cutting part or otch 1156 from corresponding top surface 1144.Groove 1160 and 1161 cooperates with the curling wall inner surface 1087 of receptor, to help described plug-in unit passage saddleback 1141, with receiver channel 1064, aims at, as for example as shown in Figure 74 and 75.Shown a pair of groove 1160 and 1161 tilts toward each other a little, as shown in Figure 66 as the best, from lower surface 1162 and 1163 separately, extends to the immediate position at arm top surface 1144.

The U-shaped passage formed by saddleback 1141 also partly limits by being positioned near arm top surface 1144 inner flat surface 1165.Saddleback 1141 also communicates with the hole 1140 in inner cylindrical surface 1166, and surface 1166 is centrally located in insert body 1136 and further communicates with chuck space, bottom, and this space extends to the discontinuous lower surface 1148 of chuck extension 1138.Inner cylindrical surface 1166 also communicates with lower concave surface portion 1168, and it is identical or basically similar with the radius on the surface 1034 of bar top or head 1008 that this lower concave surface portion 1168 has substantially spherical profile and its radius.Surface 1168 mainly terminates in body lower surface 1151, but also extends in the surface, inside of chuck extension 1138 and partly limit this surface, inside.Is bar grip surface part 1170 along inner surface 1168 between cylindrical surface 1166 and body lower surface 1151.This grip surface part 1170 comprises one or more stairsteppings surface or ridge, and the size and dimension of this stairstepping surface or ridge is provided in when plug-in unit 1014 locks lean against on head surface 1034 and grasps and thrust club head 1008.In an illustrated embodiment, whole inner surface 1168 forms by step shape part basically, and therefore whole surface also can be described as having a plurality of cylindrical surfaces of diameter alternation.Forseeablely be, stairstepping surface portion 1170 can comprise the stairstepping surface that number is more or less, the surface area greater or lesser with covering internal surface 1168, inner surface 1168 has the same or analogous spheric profile in surface 1034 with club head 1008.Forseeablely be, bar grip surface part 1170 and surface 1168 arbitrary and all can be extraly or comprise alternatively roughening or veined surface or surface treatment, or can be by indentation, engrave annular knurl etc., for strengthening the frictional engagement with bar top 1008.Below body lower surface 1151, each chuck extension 1138 comprises a pair of internal upper part sweep 1172 and a pair of flat surfaces part 1173, and each flat surfaces part 1173 is between adjacent flex part 1172 and adjacent respective base surface 1148.The size of each flat surfaces part 1173, shape and position relative to each other are configured to provide the non-locking frictional fit with the spherical surface 1034 of bar top or head 1008, as described in more detail below.Forseeable, in some embodiments of the invention, flat surfaces 1173 can be replaced by rounding surface, the radius on this rounding surface or greater or lesser than bar surface 1034 identical with bar surface 1034.

The size and dimension of insert hole 1140 is configured to receive the driven tool (not shown) through it, bar body 1006 and receptor 1100 mutually attached be driven to bone in the time, this driven tool engaging lever driving feature 46.And hole 1140 can receive the manipulation tool discharged from the position with the receptor locking for optionally locking plug-in unit 1014 ', this instrument is pressed on bar downwards, and in relative through hole or utilize other tool engagement feature to grasp described plug-in unit 1014 '.Can also approach such tooling hole from receptor through hole 1074 for the manipulation tool that plug-in unit 1014 ' is extracted to (un-wedge) from receptor 1100.Shown plug-in unit 1014 can further comprise further feature, comprises groove and recess, remains in receptor 1010 for steering package 1014 with by plug-in unit 1014, and provide enough spaces between localizer 1012 and plug-in unit 1014.

The overall diameter had in the insert body 1136 between arm 1137 and chuck extension 1138 is slightly smaller than the diameter between the crestal culmination (crest) of the guiding of receptor 1010 and advancing structure 1072, thereby allow packed card 1014 top-loaded in receptor opening 1066, plug-in unit 1014 is being inserted to the arm 1137 of receptor plug-in unit 1014 between 1010 mid-terms between receptor arm 6102.Once the arm 1137 of plug-in unit 1014 is positioned at guiding and advancing structure below 1072 substantially, plug-in unit 1014 is rotated and puts in place about receptor axis B, until top surface 1144 be positioned at lead and advancing structure 1072 under, as described in more detail below.

With reference to Figure 49 and Figure 82-Figure 83, in shown microscler rod or longitudinal connecting component 1021(figure, its part only is shown) can be any in the multiple implant of utilizing in spine reconstruct operation, but typically be columniform, microscler structure, there is outside level and smooth, cylindrical surface 22 consistent diameter basically.Shown rod 1021 is identical or basically similar with the rod 21 of describing before herein.Can adopt various shape for other longitudinal connecting components that use together with assembly 1001, include but not limited to rod or the rod of ellipse, rectangle or other shaped form or polygon cross section.Can revise the shape of plug-in unit 1014, so that longitudinal connecting component is closely kept, and if need to fix or capture slidably assembly 1001.Some embodiment of assembly 1001 also can be used together with the tensioning rope.Such rope can be made of a variety of materials, and these materials comprise polyester or other plastic optical fibre, rope or line, such as polyethylene terephthalate.In addition, vertically adapter can be a part that is as general as the dynamic stability connecting elements of more growing, the packed card 1014 that its size and dimension columniform or rod shape part is arranged for received device receives, and this plug-in unit 1014 has the passage of U-shaped, rectangle or other shape in order to closely receive longitudinal connecting component.Longitudinal connecting component can be with flexible or damped part is integrally formed or otherwise be fixed to this flexible or damped part, and this size and dimension flexible or damped part is configured between the bone screw assembly 1001 of for example phase adjacency pair.Damped part or buffer can be attached to longitudinal connecting component in the one or both sides of bone screw assembly 1001.According to required application, the rod of longitudinal connecting component or rod (or rod or rod parts) can be made of a variety of materials, the scope of these materials from the deformable plastic such as soft such non-metallic material expect hard metal.Therefore, rod of the present invention and rod can be made by the material that includes but not limited to metal and metal alloy and other suitable material, and wherein metal and metal alloy include but not limited to rustless steel, titanium, titanium alloy and cochrome; Other suitable material comprises plastic polymer, such as polyether-ether-ketone (PEEK), superelevation average molecular weight northylen (UHMWP), polyurethane and composite, this composite comprises and comprises carbon fiber, natural or artificial elastomeric composite, the wherein all polyisoprene in this way of natural or artificial elastomer (natural rubber) and synthesized polymer body, copolymer and thermoplastic elastomer (TPE), this thermoplastic elastomer (TPE) is for example polyurethane elastomer, such as the polycarbonate polyurethane elastomer.

With reference to Figure 49 and Figure 82-Figure 83, the closure arrangement illustrated together with assembly 1001 or closure top cover 1018 are identical or basically similar to the closure top cover 18 of describing with respect to assembly 1 before herein.It should be noted that closure 1018 top covers can be by being the closure arrangement be screwed into or slide into.Shown closure arrangement 1018 is columniform basically, and the guiding and the advancing structure 1182 that comprise the outside spirality coiling of flange forms, this guiding and advancing structure 1182 are in operation and be arranged on guiding and advancing structure 1072 combination on operating on the arm 1062 of receptor 1010.Shown closure arrangement 1018 also comprises the top surface 1184 with internal drive section 1186, the form of this internal drive section 1186 is aperture, be shown as star internal drive section, such as the internal drive section of selling with trade mark TORX, it can be perhaps hexagon drive division for example, or such as trough of belt, (tri-wing) three wings, spanner, other such internal drive section of two or more difform apertures, and analog structure.Size and dimension is arranged for the driven tool (not shown) that engages with internal drive section 1166 for engaged closed thing 1018 rotatably, and if need for closure 1018 is broken away from from receptor arm 1062.What can also predict is, closure arrangement 1018 can replacedly comprise (brea-off) head that fractures, this head design becomes to make such head at the moment of torsion of pre-selected, for example, to break away from the pedestal of (break from) closure under the effect of 70 to 140 pound power.Such closure arrangement also will comprise pedestal, and this pedestal has the internal drive section removed for closure.The pedestal of this closure or lower surface 1188 are smooth, and further comprise in certain embodiments of the present invention flange 1190, and may further include or can further not comprise the central point (not shown), flange 1190 and or the described some surface 1022 that (not shown) is used for engaging and thrusting rod 1021.Closure top cover 1018 can further comprise sleeve pipe (cannulation) through hole (not shown), and this through hole extends along the central axis of closure top cover, and extends through top surface and the lower surface of closure top cover.Such through hole provides the path through closure 1018 inside for the one section line (not shown) inserted in closure 1018, and this section line inserts in closure to be thought the closure top cover is inserted in receptor arm 1062 guiding is provided.

Figure 91 and the interchangeable closure top cover 1218 illustrated in 92 for using together with the deformable rod with such such as PEEK rod 1221.Except point or fritter (nub) 1289 are positioned at the flange that replaces closure top cover 1018 on dome-shaped surface 1290, top 2118 is identical with top 1018.Closure top cover 1218 comprises guiding and advancing structure 1283, top 1284, internal drive section 1286 and bottom outer ring surface 1288 in addition, these with guiding with respect to closure top cover 1018 descriptions and advancing structure 1183, top 1184, internal drive section 1186 is identical with lower surface 1188 or substantially similar.In certain embodiments, internal drive section 1286 is not large as the drive division 1186 of closure top cover 1018, this less drive division is for acting on the less situation of power on the deformable rod, and must be for example and not that for example following the discussion is used to the plug-in unit 1014 ' in bone screw assembly of the present invention when the locking plug-in unit.

Turn back to assembly 1110, preferably, receptor 1010, localizer 1012 and packed card 1014 are assembled under the environment of plant, this environment of plant comprises instrument (tooling), for keeping, pressing and align each parts and compression or expand described plug-in unit 1014 arms and/or chuck extension, if need also for the part towards the curling receptor 1010 of plug-in unit 1014.In some cases, at factory's place's bar 1004, also with receptor 1010, localizer 1012 and packed card 1014, assemble.In other examples, at first expectation implants bar 1004, adds pre-assembled receptor, localizer and packed card on position subsequently.Like this, the surgeon can be advantageously and is more easily implanted and handle described bar 1004, utilizes described bar transfer (distract) or compress vertebrae, and works on bar top or around head and do not have the receptor of cooperation to hinder.In other examples, what the surgeon personnel expected is, bar and receptor, localizer and the packed card of desired size and/or kind (for example, hydroxyapatite (hydroxyapatite) surface treatment on coarse surface treatment and/or bar 1006 being carried out in top 1008) is pre-assembled.Allow the surgeon to select suitable size or advantageously reduced inventory requirements through the bar 1004 of suitably processing, therefore having reduced whole cost.

The pre-assembled of receptor 1010, localizer 1012 and packed card 1014 has been shown in Figure 71-Figure 75.At first localizer 1012 is loaded into downwards in receptor 1010 by upper opening 1066 in the side direction mode, and wherein outer surface 1130 is towards receiver channel base 1068.Localizer 1012 is then between arm 1062, and descend towards receptor pedestal 1060, as in Figure 71 with as shown in dotted line, localizer is rotated or tilts to the position in receptor base 1060 inner chambers 1061, wherein localizer lower surface 1124 is handled to the position (also shown in broken lines) towards annular surface 1104, then sit in fully on annular base surface 1104, as illustrated with solid line in Figure 71.With reference to Figure 72, then packed card 1014 is loaded into downwards in receptor 1010 by upper opening 1066, wherein crown chuck extension lower surface 1148 is towards receptor arm top surface 1073, and plug-in unit arm 1137 and plug-in unit chuck extension 1138 are between relative receptor arm 1062.Then plug-in unit 1014 descends towards passage base 1068, until stretching out of receptor surface 1082 restrictions of plug-in unit 1014 arm upper surfaces 1144 and guiding and advancing structure 1072 belows is regional adjacent.Afterwards, rotate described plug-in unit 1014 about receptor axis B in clockwise or counterclockwise mode, until upper arm surface 1144 is under guiding and advancing structure 1072 as shown in Figure 73, now the U-shaped passage 1141 of plug-in unit 1014 aligns with the U-shaped path 10 64 of receptor 1010.In certain embodiments, during the surface, inside in rotation with spaced apart (clear) receptor arm 1062, plug-in unit arm 1137 and chuck extension 1138 may need to be compressed a little.As shown in Figure 73-Figure 75, the outside cylindrical surface 1143 and 1152 of plug-in unit 1014 is received in the cylindrical surface 1086 and 1090 of receptor.With particular reference to Figure 74 and Figure 75, by the instrument (not shown) is inserted in receptor aperture 1074, be positioned at the receptor thin-walled 1077 of arch throughhole portions 1075 inclined surface on every side then by inwardly curling towards axis B, instrument is pressed the surface wall 1077 of described inclination, until the groove 1160 that inner wall surface 1087 forms in the outside cylindrical surface 1143 of each plug-in unit arm 1137 and 1161 places engage described plug-in unit 1014.Relative wall surface 1087 is crimped onto arranging in groove 1160 and 1161 and keeps plug-in unit 1014U shape passage 1141 and receptor U-shaped path 10 64 substantial alignment, but during the bottom loaded of for example bar shown in Figure 77 1004, allows plug-in unit 1014 to move up along receptor axis B.Therefore, receive the curling prevention plug-in unit 1104 of wall 1077 about receptor axis B rotation, but when certain power is applied in the surface 1087 to slide curling up or down along groove 1160 and 1161, allow plug-in unit 1014 to carry out limited moving axially with respect to receptor 1010 along axis B.By stoping plug-in unit 1014 by receptor opening 1066 mobile guiding and advancing structure 1072 upward and outward, and, by being arranged in localizer 1012 and the receptor annular surface 1104 of plug-in unit 1014 belows, receptor 1010 pedestals 1060, plug-in unit 1014 arms 1137 are trapped in receptor 1010 fully.

In some embodiments of the invention, the top of plug-in unit 1014 or side surface can comprise that elasticity is outstanding or a plurality of elasticity is outstanding, frictional engagement to be to remain on plug-in unit 1014 on the top of receptor 1010 when facing with the internal table of receptor 1010 during some number of assembling steps, also between plug-in unit 1014 and receptor 1010, provides still slidably coordinating of friction-type.In an illustrated embodiment, plug-in unit 1014 freely slides in the axial direction basically on the top of receptor 1010, and the size and dimension of plug-in unit 1014 is configured such that at localizer 1012 above plug-in unit 1014 during club head 1008 inflated around is positioned at cylindrical surface 1099, expanding chamber or the recess of localizer 1012 served as on surface 1099.

Now, receptor, plug-in unit and locator association are ready to be shipped to the terminal use, and the two all is captured on packed card 1014 and localizer 1012 in receptor 1010, makes and basically prevents that such parts from moving or being lost to beyond receptor 1010.Receptor 1010, packed card 1014 and localizer 1012 combinations can assemble with bar 1004 now, this assembling can be carried out at the factory place, by the surgeon personnel, before implantation, carried out, perhaps for example, as shown in Figure 76, direct-assembling is to the bar 1004 of implanting, wherein as Figure 77, with illustrating, assemble as shown in most of accompanying drawings of processing, align with receptor axis B at assembly process rod axis A, or these two axis are oriented relative to one another to an angle as shown in Figure 76.

As shown in Figure 76, by using suitable driven tool (not shown) to rotate described bar 1004, bone screw bar 1004 or the whole assembly 1001 that is comprised of the bar 1004 assembled, receptor 1010, localizer 1012 and packed card 1014 are screwed in the bone such as vertebra 1017, and this driven tool drives and rotates described bar body 1006 being bonded in operation of internal drive section 10046 places by it.Particularly, vertebra 1017 can be holed to minimize the pressure be added on bone in advance, and can in vertebra 1017, insert the leading line (not shown) and think that bar 1004 provides guide with respect to placement and the angle of vertebra.Can utilize leading line to do guide by using tap (tap) to make further discharge port (tap hole).Then, by then leading line being screwed out in the open top that drives feature 1046 places in the opening that at first leading line is screwed into to 28 places, bottom, by utilizing collar aperture 1050, bone screw bar 1004 or whole assembly 1001 are screwed on leading line.Then by being used as the line of placing guide that bar 1004 is driven in vertebra.Forseeable, by utilizing leading line, can percutaneous or the minimally-invasive operative Modality come insertion rod and other bone screw assemblies part, excellent 1021(also to there is in certain embodiments central lumen) and closure top cover 18(also with centre bore).In the time of in not with the remainder ground situation of assembly 1001, bar 1004 being driven into to vertebra 1017, bar 1004 can or be driven to the final position of expectation or is driven to that slightly exceed or outstanding position, so that be easy to assemble with receptor, packed card and the localizer of assembling in advance.

With reference to Figure 76 and Figure 77, receptor, plug-in unit and the localizer of assembling are placed on 1008 tops, bar top in advance, until bar top is received in opening 1110.With particular reference to Figure 77 and Figure 78, along with bar top 1008 moves in the inside 1061 of receptor pedestal, bar top 1008 upwards is pressed into part in the recess that cylindrical surface 1099 limits and part is limited by annular surface 1095 by localizer 1012.With particular reference to Figure 78 and Figure 79, along with part 1008 continues to move up towards path 10 64, the top surface 1122 of localizer 1012 connects receptor annular surface 1095, stops moving up and forcing localizer 1012 outwards to move towards the cylindrical surface 1099 that limits receptor expansion recess of localizer 1012 when spherical surface 1034 continues to move with upward direction.With reference to Figure 80 and Figure 81, when the center by the surface 1099 localizer expansion recesses that limit is crossed by the spheroid central authorities of head 1008, localizer 1012 starts around spherical surface 1034 contractions.And at this moment, spherical surface 1034 moves at intralaminar part flat surfaces 1173 places and engages with plug-in unit 1014 chuck plates 1155, plate 1155 a little outwards expands with receiving surface 1034 at first.Plate 1,155 1090 is outwards pressed towards surface, and this forms complete frictional engagement for the spherical surface 1034 as shown in Figure 81 enters with intralaminar part surface 1173 enough space is provided.Now, plug-in unit 1014 and surface 1034 are in quite tight frictional fit, and under the effect of certain power, but surface 1034 is with respect to plug-in unit 1014 pivotables.Therefore, now, between plug-in unit 1014 and bar top 1008 generation tight, non-lax ball-and-socket type is connected.

Then, by upwards pulling receptor 1010, perhaps in some cases by bar 1004 further is driven in vertebra 1017, bar 1004 and attached plug-in unit 1014 can be manipulated to and further be moved down into desired locations, in order to receive rod 1021 or other longitudinal connecting component.And, in certain embodiments, when receptor 1010 and bar 1004 are pre-assembled, can be at this moment by the driven tool (not shown) being inserted into to receptor and bar drive in 1046 and bar 1004 rotations and the desired locations that is driven into vertebra 1017 being implanted to whole assembly 1001.And now, receptor 1010 can be hinged to the expected angle position with respect to bar 1004, shown in Figure 83, but, before inserting rod or closure top cover, by the frictional engagement between localizer 1012 and bar top 1008, receptor 1010 can be held but be not locked.

With reference to Figure 82 and Figure 83, rod 1021 finally is positioned to cooperate with at least two bone screw assemblies 1001 with open or mode percutaneous.Then closure arrangement 1018 is inserted between the arm 1062 of each receptor 1010 and advances between arm 1062.By using the instrument engaged with interior drive division 196, closure arrangement 1018 is rotated, until reach selected pressure, now rod 1021 engages the U-shaped susceptor surface 1142 of described packed card 1014, plug-in unit stairstepping bar grip surface 1170 is pressed against on bar spherical surface 1034, the rib on stairstepping surface thrusts spherical surface 1034, and bar top 1008 is forced into and localizer 1012 locking frictional engagement.Particularly, along with closure arrangement 1018 is rotated and is moved down in corresponding receiver 1010, flange 1190 engages and thrusts rod surface 1022, closure arrangement 1018 is pressed against on rod 1021 downwards and rod 1021 is biased into and plug-in unit 1014 compression engagement, plug-in unit 1014 is pressed to localizer 1012 lockings and engages towards localizer 1012 push strut tops 1008 and by it, localizer 1012 friction is in abutting connection with described surperficial 1104, and outwards expands and lean against on cylindrical surface 1101.For example, for respect to receptor 1010 fixed bone screw bars 1006, can on the closure top cover, apply about 80 moments of torsion to about 120 pound power.

With reference to figure 84-Figure 89, optional locking is shown and discharges packed card 1014 ', for the bar 1004 with describing before this paper, receptor 1010, localizer 1012, closure top cover 1018, together with rod 1021, use, the assembly of generation is identified as for example assembly 1001 ' in Figure 89-Figure 90.Except the size of plug-in unit 1014 ' as described in more detail below is arranged for coordinating (particularly with receptor 1010 locking frictional interference, locking between the bottom of the cylindrical form interior surface 1090 of receptor 1010 and the exterior cylindrical surfaces 1143 ' of plug-in unit arm 1137 ' is interfered) in addition, plug-in unit 1014 ' can be identical or basically similar with the plug-in unit 1014 of describing before this paper.Shown plug-in unit 1014 ' is different from plug-in unit 1014 parts and also is: plug-in unit 1014 ' comprises a pair of relative through hole 1159 ' for receiving tool, as described in more detail below.

Therefore, with reference to figure 84-Figure 86, locking plug-in unit 1014 comprises body 1136 ', a pair of relative arm 1137 ', a pair of crown chuck extension 1138 ', through hole 1140 ', U-shaped saddleback surface 1141 ' with base 1142 ', arm outer surface 1143 ', arm top surface 1144 ', chuck extension lower surface 1148 ', arm flange or lug surface 1150 ', annular lower portion body surface 1151 ', bottom exterior cylindrical surfaces 1152 ', groove 1154 ', the plate 1155 ' formed by groove, otch 1156 ' with upper angled surface 1157 ' and lower flat surface 1158 ', there is lower surface 1162 ' separately and 1163 ' a pair of groove 1160 ' and 1161 ', interior smooth apparent surface 1165 ', interior cylindrical surface 1166 ', interior spheric profile 1168 ' with grip surface part 1170 ', crooked inner surface 1172 ' and chuck flat internal grasp frictional fit surface 1173 ', and these parts are in form and function aspects is same as respectively or basically similar in appearance to the corresponding body 1136 of describing with respect to plug-in unit 1014 before herein, a pair of relative arm 1137, a pair of crown chuck extension 1138, through hole 1140, U-shaped saddleback surface 1141 with base 1142, arm outer surface 1143, arm top surface 1144, chuck extension lower surface 1148, arm flange or lug surface 1150, annular lower portion body surface 1151, bottom exterior cylindrical surfaces 1152, groove 1154, the panel 1155 formed by groove, otch 1156 with upper angled surface 1157 and lower flat surface 1158, there is lower surface 1162 separately and 1163 a pair of groove 1160 and 1161, interior smooth apparent surface 1165, interior cylindrical surface 1166, interior spheric profile 1168 with grip surface part 1170, crooked inner surface 1172 and smooth frictional fit grip surface 1173.

Plug-in unit 1014 ' exterior cylindrical surfaces 1143 ' be positioned at instrument otch 1156 ' below and be positioned at lug or flange 1150 ' is located or near, the size and dimension on this surface 1143 ' is arranged in cylindrical surface 1090 places and receptor 1010 locking interference engagement, and cylindrical surface 1090 partly limits inner chamber 1061.In other words, flange 1150 ' locate or directly over arm surface 1143 ' between the size of the width that records or diameter be configured to enough large, with require must by instrument or a plurality of instrument or by closure top cover 1018 use enough defeating compel rod 1021 and lean against on plug-in unit 1014 ' downwards, force plug-in unit 1014 ' to enter in the space that starts, limited by cylindrical surface 1090 by receptor surperficial 1088 and the surperficial 1090 rib places that limit, with in cylindrical surface 1090 places lock onto receptor 1010 by plug-in unit 1014 ' interference.

With reference to figure 87-Figure 90, with plug-in unit 1014, with the light sliding relation between receptor 1010, compare, except when bar 1004 while being locked into place plug-in unit 1014 ' must be oppressed form and lock beyond interference engagement with receptor 1010 downwards, plug-in unit 1014 ' is by the mode identical with the above mode of describing with respect to assembly 1001, assemble generation component 1001 ' with receptor 1010, localizer 1012, bar 1004, rod 1021 and closure top cover 1018.Especially, before assembling mutually with rod 1021 and closure top cover 1018, packed card 1014 ' exterior cylindrical surfaces 1152 ' is received slidably by receptor cylindrical surface 1090, but surface 1143 ' is not like this.Plug-in unit 1014 ' therefore is prevented from further moving down at 1088 places, receptor surface, unless passed through locking tool or passed through the closure top cover to the lower compression rod, this rod and then upper at plug-in unit 1014 ' to lower compression, as shown in Figure 89 and Figure 90.With further reference to Figure 89, now, receptor 1010 can be switched to the angle position of expectation with respect to bar 1004, and shown in Figure 96, bar 1004 for example will be held by the frictional fit between localizer 1012 chuck plates and bar top 1008, but not locked.

Rod 1021 finally is positioned to cooperate with at least two bone screw assemblies 1001 ' with open or mode percutaneous.Then, closure arrangement 1018 is inserted between the arm 1062 of each receptor 1010 and advances between arm 1062.By using the instrument engaged with interior drive division 1186, closure arrangement 1018 is rotated, until reach selected pressure, now rod 1021 engages the U-shaped susceptor surface 1142 ' of described packed card 1014 ', plug-in unit stairstepping bar grip surface 1170 ' further is pressed against on bar spherical surface 1034 and is pressed in bar spherical surface 1034, the rib on stairstepping surface 1170 ' thrusts spherical surface 1034, and bar top 1008 is forced into and localizer 1012 locking frictional engagement.Particularly, along with closure arrangement 18 is rotated and is moved down in corresponding receiver 1010, flange 1190 engages and thrusts rod surface 1022, closure arrangement 1018 presses rod 1021 downwards and rod 1021 is biased into and plug-in unit 1014 ' compression engagement, plug-in unit 1014 ' is pressed to localizer 1012 lockings and engages towards localizer 1012 push strut tops 1008 and by it, localizer 1012 friction abutment surfaces 1104, and the cylindrical surface 1101 that reclines that outwards expands.For example, for respect to receptor 1010 fixed bone screw bars 1006, can on the closure top cover, apply about 80 moments of torsion to about 120 pound power.The helical form flange forms is tightened to about 100 pound power and can produce the approximately power of 900 to 1000 pounds, and have been found that, depend on the manufacturing tolerance problem between parts, the interference engagement produced between the cylindrical surface 1090 of the cylindrical surface 1143 ' of plug-in unit 1014 ' and receptor can be overcome under about 500-700 pound power.Therefore, along with closure arrangement 1018 and rod 1021 are pressed plug-in unit 1014 ' downwards towards the pedestal of receptor 1010, plug-in unit surface 1143 ' is in the rib place limited by receptor annular surface 1088 and cylindrical surface 1090 is forced into receptor, therefore force described plug-in unit 1014 with receptor at surperficial 1090 places or surfacewise 1090 frictional interference engage and be fixed, the while does not affect the locking of universal type mechanism self basically.

With reference to Figure 91, now, can become flexible or remove closure top cover 1018, and/or capable of regulating and/or remove described excellent 1021, and the frictional fit of locating between plug-in unit 1014 ' and receptor 1010 on plug-in unit surface 1143 ' will remain locked in position, advantageously maintain the locking angle position of bar 1004 with respect to receptor 1010.

With further reference to Figure 91 and Figure 92, now, another rod, can be loaded into collaborative optional closure top cover 1218 assembly locked such as deformable excellent 1221, produces optional assembly 1201 '.As mentioned above, closure drive division 1286 can advantageously be made the drive division that is less than closure 1018, makes at assembly process deformable excellent 1221 and can excessively not pressed or be out of shape, because omnidirectional mechanism locks.

With reference to figure 93-Figure 95, illustrate on the whole with 1600 the indication two-piece tool for plug-in unit 1014 ' is discharged from receptor 1010.Instrument 1600 comprises inner flexible tubular structure, with the relative pin of inwardly facing 1612 be positioned on penetrating via 1616 both sides.Passage 1616 can end at and the isolated position of pin 1612, or can further extend upward and run through described instrument, produces two-piece tool 1610.Instrument 1600 comprises outside more rigid tubular element 1620, and it has less penetrating via 1622.At flexure member 1610 pins 1612 by outwardly-bent, then be enclosed on receptor 1010, then, after being installed in the through hole in relative aperture 1074 of receptor 1010 and being contained in the hole 1159' that aligning on the arm that is positioned at plug-in unit 1014' is relative, member 1620 is assemblied in slidably manages on 1610.In Figure 93, shown instrument 1600 is during opening plug-in unit 1014 ' from receptor 1010 releases, when instrument 1600 is pulled upward away from bar 1004, external member 1620 is around internals 1610 and by pin 1612, remain in receptor 1010 and in plug-in unit 1014 ' aperture.What can predict is, when instrument 1600 can further be included in pin and tubular element and is pulled upward under be pressed in the structure on receptor 1010, such structure can be positioned at instrument 1600 and for example be depressed on the top surface 1073 of receptor arm.

Alternatively, can use another manipulation tool (not shown), it and inserts in the plug-in unit passage formed by saddleback 1141 ' in opening 1066 places are inserted into receptor, and its pin or extension extend outwardly in plug-in unit through hole 1159 '; Thereafter the piston-like of instrument part directly presses against on bar top 1008, pulls thus plug-in unit 1014 ' away from receptor surface 1090, therefore discharges universal type mechanism.Now, bar 1004 can be with respect to receptor 1010 by pivotable, and the frictional fit of expectation turns back between localizer 1012 and bar surface 1034, makes and still have relation adjustable but that right and wrong are loose between bar 1004 and receptor 1010.If described assembly is decomposed in expectation, this process contrary by the procedural order with describing for assembly 1001 before herein completes.

With reference to figure 96-98, another manipulation tool with 1700 indications is shown on the whole, for independently plug-in unit 1014 ' being locked onto to receptor 1010, or in certain embodiments, for provisionally non-locking plug-in unit 1014 being locked onto to receptor 1010.Instrument 1700 comprises a pair of relative arm 1712, each arm has the extension 1716 of joint, this joint extension 1716 is positioned to respect to arm 1712 separately at angle, make when instrument by when receptor moves down, the one or more inner surfacies 1718 that engage extension 1716 are along the surface 1077 of receptor and slide with bonded package 1014 ' along 1157 ' of plug-in unit 1014 ', it is upper that surface is pressed in plugin table face 1158 ' for 1720 times, so that cylindrical arms surface 1143 ' is pushed into, interferes lock fit in described receptor cylindrical surface 1090.As shown in Figure 98, when plug-in unit 1014 ' is leaned against on receptor 1010 by lock, instrument lower surface 1720 does not reduce as far as possible on receptor surface 7105 ', but keeps spaced away.In the embodiment shown, surface 1718 is further comprised smooth bottom surface 1722 by round as a ball a little and each arm extension 1722, this bottom surface 1722 produces rib with lower surface 1720, on surface 1157 ', with the junction point on surface 1158 ', inserting and grasp plug-in unit 1014 '.Instrument 1700 can comprise multiple maintenance and push/pull mechanism, and such as the handle instrument, it can comprise ratchet feature, articulated tool or for example rotate screw device.

Although it should be understood that and illustrated and described some form of the present invention herein, the present invention be not limited to the concrete form describing and illustrate or parts arrange.

Claims

1. a universal type bone anchor is characterized in that comprising:

A) there is the receptor of body, described body delimit chamber, described body is integrally formed with a pair of relative arm that limits passage, described passage is connected with described chamber, the size and dimension of described passage is arranged for receiving the part of longitudinal connecting component, described chamber is connected with lower openings, and each arm has the first instrument receiving aperture that extends through described arm;

B) have the bar of body and top-surface camber part, wherein said top-surface camber partly has hemisphere, and described bar body extends through the lower openings of described receptor;

C) be arranged in the elastic opening localizer of described chamber, described localizer is inflatable around described bar top in described chamber, and receive the described bar top hemisphere through described localizer, so that described bar top is trapped in described chamber, when described bar with respect to described receptor during in latched position described localizer in swelling state and the described receptor that fixedly reclines, when in described latched position described bar top press described localizer and with described receptor in isolated relation; And

D) plug-in unit, described plug-in unit and described bar upper bond, and on described bar top and described longitudinal connecting component between the described part in described receiver channel, described plug-in unit has a pair of relative upright arm, each arm has the second instrument receiving aperture formed thereon, the first instrument receiving aperture of described the second instrument receiving aperture and described receptor aligns, and the size and dimension of described the second instrument receiving aperture is arranged for directly engaging with locking and releasing tool, described plug-in unit has the additional structure to downward-extension, with respect to described receptor by described rod lock to the interim frictional engagement of described additional structure and described bar top before final position, but before locking under the effect of described bar at certain force with respect to described additional structure pivotable.

2. universal type bone anchor as claimed in claim 1, wherein said plug-in unit has the recline outer surface of described receptor of friction lock releasedly.

3. universal type bone anchor as claimed in claim 1, wherein said receiver channel is first passage, and described plug-in unit has second channel, described plug-in unit by top-loaded in described receptor, and then rotation to above described localizer and the described second channel position of aliging with described first passage.

4. universal type bone anchor as claimed in claim 1, wherein said plug-in unit further comprises the horizontal expansion part, this horizontal expansion part is received by described receiver channel.

5. universal type bone anchor as claimed in claim 1, wherein said receptor has at least one the curling wall surface be pressed against in described plug-in unit.

6. universal type bone anchor as claimed in claim 1, wherein said localizer has at least the first flat surfaces, and this at least the first flat surfaces is positioned on the second flat surfaces that part limits described receptor chamber.

7. universal type bone anchor as claimed in claim 1, wherein said localizer has the first outside non-conical surface, and this first outside non-conical surface engages with the second surface that part limits described receptor chamber.

8. universal type bone anchor as claimed in claim 1, wherein said plug-in unit additional structure comprises a plurality of elastic plates with the interim frictional engagement in described bar top.

9. universal type bone anchor as claimed in claim 8, wherein said plate surface is spill.

10. universal type bone anchor as claimed in claim 8, wherein said plate surface is smooth.

11. a bone anchor comprises:

A) bar, the monoblock type top that it has the body for being fixed to bone and has the first spherical surface;

B) receptor, it has top and pedestal, the top of described receptor limits open channel, described pedestal has the first surface that part limits chamber, described passage is connected with described chamber, described receptor also has part and limits the first instrument receiving surface run through aperture, described instrument receiving surface with respect to the central axis of described receptor with an inclined at inclination angles;

C) at least one plug-in unit, it is arranged in described receptor and size and dimension is configured to directly engage and co-operating with locking and releasing tool, described plug-in unit has second the Shear tool receiving surface, and this second the Shear tool receiving surface is oriented to receive inclined surface with the first instrument of described receptor and aligns; With

D) elastic opening ring, it has at least one flat surfaces and at least one cylindrical surface, described ring is captured on described intracavity and inflatable around at least a portion of described bar, wherein between described bar top and described ring and the locking that occurs only to expand between described ring cylindrical surface and described receptor engage, the flat surfaces of described ring is positioned on the annular surface of described receptor.

12. bone anchor as claimed in claim 11, wherein said plug-in unit has the additional structure of downward orientation, the interim frictional engagement of additional structure and described bar top of described downward orientation before described bar is locked onto to final position with respect to described receptor, but make described bar under the effect of certain force with respect to described additional structure pivotable, when described bar with respect to described receptor during in latched position described ring in swelling state and the described receptor that fixedly reclines, when in described latched position described bar top press described ring and with described receptor in isolated relation.

13. bone anchor as claimed in claim 11, wherein said plug-in unit has the recline outer surface of described receptor of friction lock releasedly.

14. bone anchor as claimed in claim 11, wherein said receiver channel is first passage, and described plug-in unit has second channel, described plug-in unit is by top-loaded in described receptor, and then rotation is to above described localizer and the described second channel position of aliging with described first passage.

15. bone anchor as claimed in claim 11, wherein said plug-in unit further comprises the horizontal expansion part, and this horizontal expansion part is received by described receiver channel.

16. a bone anchor is characterized in that comprising:

A) bar, the monoblock type top that it has the body for being fixed to bone and has the first spherical surface and hemisphere;

B) receptor, it has top and pedestal, and described receptor top limits open channel, and described base part ground limits chamber, and described passage is connected with described chamber;

C) at least one plug-in unit, it is arranged in described receptor, and to rear surface, extends fully by described open channel from the front surface of described receptor, and described plug-in unit has the plate with the downward orientation of the first spherical surface frictional fit of described bar; With

D) elastic opening locating ring, it has at least one flat base surface, and described ring is captured on described intracavity and inflatable around the hemisphere of described bar; With

E) wherein, between described bar top and described ring and the locking that occurs only to expand between described locating ring and described receptor engage.

17. bone anchor as claimed in claim 16, wherein said plug-in unit further comprises elastic arm, this elastic arm have can with the protruding surface of a part of frictional engagement of described receptor, in the described protruding surface of described bar assembly process, described plug-in unit being remained on to the top in described receptor chamber temporarily.

18. a bone anchor is characterized in that comprising:

A) bar, the monoblock type top that it has the body for being fixed to bone and has the first spherical surface, described the first spherical surface has hemisphere;

B) receptor, it has top and pedestal, and the top of described receptor limits first passage, and described base part ground limits chamber, and described passage is connected with described chamber;

C) at least one plug-in unit, it has second channel, described plug-in unit by top-loaded in described receptor, then rotate to above described localizer and position that described second channel aligns with described first passage, described plug-in unit has the plate with the downward orientation of the first spherical surface frictional fit of described bar; With

D) elastic opening bar locating ring, it has at least one flat base surface, and described ring is captured on described intracavity and inflatable around the hemisphere of described bar; And

E) wherein, between described bar top and described ring and the locking that occurs only to expand between described ring and described receptor engage.