CN1997327A - 小关节假体的多轴调节 - Google Patents

小关节假体的多轴调节 Download PDF

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Publication number
CN1997327A
CN1997327A CNA2004800405214A CN200480040521A CN1997327A CN 1997327 A CN1997327 A CN 1997327A CN A2004800405214 A CNA2004800405214 A CN A2004800405214A CN 200480040521 A CN200480040521 A CN 200480040521A CN 1997327 A CN1997327 A CN 1997327A
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CN
China
Prior art keywords
facet joint
artificial
prostheses
retaining element
connector
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
CNA2004800405214A
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English (en)
Inventor
马克·A·赖利
戴维·T·斯廷森
罗伯特·M·斯克里布纳
小伦纳德·J·托基什
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Archus Orthopedics Inc
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Archus Orthopedics Inc
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Filing date
Publication date
Application filed by Archus Orthopedics Inc filed Critical Archus Orthopedics Inc
Publication of CN1997327A publication Critical patent/CN1997327A/zh
Pending legal-status Critical Current

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Abstract

提供了利用用于将假体固定到椎骨上的多轴连接机构来置换相邻椎骨之间的自然小关节的假体、系统和方法。连接到上相邻椎骨上的头部假体置换自然小关节的下半部分。连接到下相邻椎骨上的尾部假体置换自然小关节的上半部分。头部和尾部假体两者都被构造成带有人造小关节结构，该人造小关节结构包括配合并且形成人造关节结构的关节连接表面。多轴连接机构允许在头部或尾部假体连接到椎骨上时或之后沿一个以上的轴调节人造小关节结构的位置。

Description

小关节假体的多轴调节
技术领域
本发明涉及用于治疗各种类型的脊椎病的假体、系统和方法，尤其涉及假体到脊椎的连接。
背景技术
如图1所示，人类的脊柱10包括一连串的三十三个层叠的椎骨12，这些椎骨分成五个区域。颈部区域包括七块椎骨，称为C1-C7。胸部区域包括十二块椎骨，称为T1-T12。腰部区域包括五块椎骨，称为L1-L5。骶骨区包括五块椎骨，称为S1-S5。尾骨区包括四块椎骨，称为Co1-Co4。
图2示出了正常人的一块腰椎12的俯视图。尽管腰椎12根据位置会有稍许变化，但它们具有许多共同特征。每块椎骨12包括椎体14。两块短骨，即蒂状骨16从椎体14的每一侧向后延伸，形成椎弓18。
在每块蒂状骨16的后端，椎弓18张开成骨平板，称之为骨板20。骨板20彼此融合形成棘突22。棘突22起连接肌肉和韧带的作用。蒂状骨16到骨板20的平滑过渡被形成的一连串棘突打断。
两块横突24从蒂状骨16和骨板20的接合处在每一边侧向伸出。横突24用作将肌肉连接到椎骨12上的杆。四块关节突，即两块上部关节突26和两块下部关节突28也从蒂状骨16和骨板20的接合处伸出。上部关节突26为尖的椭圆骨板，从椎骨的每一边向上伸出，而下部关节突28为椭圆骨板，从每一边向下突出。
上部和下部关节突26和28分别具有一个称之为骨面的自然骨结构。上部关节面30面向上，而下部关节面31(参见图3)面向下。当相邻的椎骨12对准时，由平滑关节软骨覆盖的骨面30和31互锁形成小关节32，也称为关节突间关节。
小关节32由上半部分和下半部分组成。上半部分由关节32下面的椎骨层形成，下半部分由关节32上面的椎骨层形成。例如，在L4-L5小关节中，关节32的上半部分由L5椎骨上的骨结构形成(即L5椎骨上的上部关节表面和支撑骨26)，关节32的下半部分由L4椎骨上的骨结构形成(即L4椎骨上的下部关节表面和支撑骨28)。
每对相邻椎骨12之间的椎间盘34使椎骨12之间可以相对滑动运动。从而椎骨12的结构和排列允许椎骨12相对彼此在一定范围内运动。
背痛，特别是处于“后背腰部”或腰骶(L4-S1)区域的背痛是常见疾病。在许多情况下，疼痛严重限制了人的活动能力和生活质量。这种疼痛可以由各种脊椎病引起。
通过疾病或损伤，一个或多个椎体的骨板、棘突、关节突或骨面可以被损坏，从而脊椎不再能彼此关节连接或适当对准。这能够导致不希望的解剖学结构、丧失活动能力和疼痛或不适。
例如，脊椎小关节可以由外伤或各种疾病损伤。这些疾病包括骨关节炎、强直性脊柱炎和退行性脊椎滑脱。小关节的损伤通常导致神经压力，也称为神经“挟捏”，或神经压迫或碰撞。结果引起疼痛、解剖结构不对准和相应的丧失活动能力。神经压力也可以在没有小关节病的情况下发生，例如在椎间盘突出的情况下发生。
传统的治疗小关节病的一种方法是脊椎稳定，也称为椎间稳定。椎间稳定防止了脊椎之间的相对运动。通过防止运动可以减少疼痛。也可以用各种方法实现这种稳定。
一种稳定方法是脊椎融合。另一种稳定方法是固定任意数量的椎骨以稳定并防止椎骨的运动。
另一传统治疗方法是减压椎板切除术。这个过程包括切除骨板以减轻神经压力。
这些传统治疗方法受制于各种限制和不稳定的成功率。此外，所述的治疗方法没有一种可以使脊椎正确对准或恢复到希望的解剖学结构。另外，通过使椎骨保持在固定位置的稳定技术永久限制了人的活动。
因此，需要这样的假体、系统和方法，其克服与当前用于脊椎病的各种治疗的策略和设计相关的问题和缺陷，尤其需要带有连接机构的脊椎假体，所述连接机构在连接到椎骨时便于定位假体。
发明内容
本发明提供了这样设计的假体、系统和方法，其使用用以将假体固定到椎骨上的多轴连接机构在基本上包括L1-L2，L3-L4，L4-L5，L5-S1，T11-T12和T12-L1的所有脊柱层置换自然小关节和骨板的可能部分。所述假体、系统和方法帮助脊椎建立期望的解剖结构并且使个体恢复理想的活动范围。所述假体、系统和方法也通过缓解源神经压迫和碰撞帮助减轻或缓和脊柱疼痛。
为了在这里进行描述，体现本发明特征的假体相对于它们所代替的给定自然小关节部分被称为“头部”或“尾部”。如前面所述，自然小关节，例如小关节32(图3)，具有上半部分和下半部分。从解剖学来看，关节的上半部分由关节下面的椎骨层形成，由于它更靠近人的脚，因此在这里被称为小关节的“尾部”部分。小关节的下半部分由关节上面的椎骨层形成，由于它更靠近人的头，因此被称为小关节的“头部”部分。因此，在使用中置换自然小关节的尾部部分(即上半部分)的假体将被称为“尾部”假体。类似地，在使用中置换自然小关节的头部部分(即下半部分)的假体将被称为“头部”假体。
在一个方面，本发明提供了一种小关节假体，其包括通过可多轴调节的连接件连接到固定元件上的人造小关节元件。在一些实施例中，所述可多轴调节的连接件适于和被构造成允许所述人造小关节元件相对于所述固定元件围绕一个以上的轴旋转，以便使假体满足患者的需要。所述可多轴调节的连接件可以进一步适于和被构造成允许所述人造小关节元件的位置在可调节的范围内相对于所述固定元件可连续调节并且可以包括限位件。
在各种实施例中，所述人造小关节元件适于可相对于所述固定元件在中间、在侧向、在上部和/或在下部运动。在一些实施例中，在所述小关节假体安装到患者体内之后，所述可多轴调节连接件可以适于和被构造成允许人工小关节元件相对于固定元件运动。本发明还可以包括紧固件，该紧固件适于和被构造成防止所述人造小关节元件和所述固定元件之间的运动。
在一些实施例中，所述人造小关节元件可以包括头部小关节支承表面和头部小关节支承表面支撑件(support)。当所述小关节假体被安装在患者体内时，所述头部小关节支承表面和所述头部小关节支承表面支撑件可以适于和被构造成从椎骨的中线侧向地布置或大致在椎骨的中线布置。
在一些实施例中，所述人造小关节元件可以包括尾部小关节支承表面和尾部小关节支承表面支撑件。当小关节假体被安装在患者体内时，所述尾部小关节支承表面和所述尾部小关节支承表面支撑件可以适于和被构造成从椎骨的中线侧向地布置。
小关节假体还可以包括在所述人造小关节元件和所述固定元件之间的可纵向调节连接件。例如，在其中所述人造小关节元件包括小关节支承表面和小关节支承表面支撑件的实施例中，所述小关节支承表面支撑件可以适于和被构造成可相对于所述固定元件纵向运动。所述小关节假体还可以包括紧固件，该紧固件适于和被构造成防止所述小关节支承表面支撑件和所述固定元件之间的相对运动。所述小关节支承表面支撑件还可以进一步适于和被构造成可围绕支撑件的纵向轴线旋转。
在一些实施例中，所述可多轴调节连接件可以包括小关节元件连接表面和固定元件连接表面，其中小关节元件连接表面和固定元件连接表面适于和被构造成可相对于彼此运动。在一些实施例中，所述可多轴调节连接件可以包括连接到所述人造小关节元件上并且可相对于所述固定元件运动的底座构件，所述底座构件可以进一步适于和被构造成可相对于所述人造小关节元件运动。
本发明的另一方面是一种小关节假体，其包括：第一和第二人造小关节元件；固定元件；以及在所述第一或第二小关节元件中的至少一个和所述固定元件之间的可多轴调节连接件。在一些实施例中，所述第一人造小关节元件可以包括人造头部小关节元件，所述第二人造小关节元件可以包括人造尾部小关节元件。所述固定元件可以是头部固定元件，所述可多轴调节连接件可以包括头部可多轴调节连接件，其中所述小关节假体进一步包括尾部固定元件和在所述人造尾部小关节支承元件和所述尾部固定元件之间的尾部可多轴调节连接件。在一些实施例中，所述人造头部小关节元件包括头部支承表面和头部支承表面支撑件，并且在一些实施例中，所述人造尾部小关节元件包括尾部支承表面和尾向支承表面支撑件。
根据本发明的该方面，所述第一和第二人造小关节元件还可以分别包括第一和第二人造头部小关节元件。固定元件可以是第一头部固定元件，并且所述可多轴调节连接件可以包括第一头部可多轴调节连接件，其中所述小关节假体进一步包括第二头部固定元件和在所述第二人造头部小关节元件和所述第二头部固定元件之间的第二头部可多轴调节连接件。在一些实施例中，所述第一和第二人造头部小关节元件可以分别包括第一和第二头部支承表面。在一些实施例中，所述第一和第二人造小关节元件可以分别包括第一和第二支撑臂以及由所述第一和第二支撑臂中的至少一个支承的至少一个头部支承表面。在这些实施例中，当所述假体被安装在患者体内时，所述头部支承表面可以大致布置在椎骨的中线处，并且所述假体还可以包括人造尾部小关节元件，所述人造尾部小关节元件包括适于和被构造成与所述头部支承表面配合的尾部支承表面。所述头部支承表面还可以适于围绕支承它的一个或多个支撑臂旋转。
仍根据本发明的该方面，所述可多轴调节连接件可以适于和被构造成允许所述人造小关节元件中的至少一个相对于所述固定元件围绕一个以上的轴旋转。所述可多轴调节的连接件也可以进一步适于和被构造成允许所述人造小关节元件中的至少一个的位置在可调节的范围内相对于所述固定元件可连续调节并且可以包括限位件。在所述人造小关节元件安装到患者体内之后，所述可多轴调节的连接件也可以适于和被构造成允许所述人造小关节元件中的至少一个相对于所述固定元件运动。在一些实施例中，所述小关节假体进一步包括紧固件，该紧固件适于和被构造成防止所述人造小关节元件中的至少一个和所述固定元件之间的相对运动。
仍根据本发明的该方面，所述小关节假体可以进一步包括在所述人造小关节元件中的至少一个和所述固定元件之间的可纵向调节连接件。在一些实施例中，所述人造小关节元件中的至少一个包括小关节支承表面和小关节支承表面支撑件，其中所述小关节支承表面支撑件适于和被构造成可相对于所述固定元件纵向运动。所述小关节假体可以进一步包括紧固件，该紧固件适于和被构造成防止所述小关节支承表面支撑件和所述固定元件之间的相对运动。在一些实施例中，所述小关节支承表面支撑件可以进一步适于和被构造成可围绕支撑件的纵向轴线旋转。
进一步根据本发明的该方面，所述可多轴调节的连接件可以包括小关节元件连接表面和固定元件连接表面，其中所述小关节元件连接表面和固定元件连接表面适于和被构造成可相对于彼此运动。所述可多轴调节的连接件可以包括连接到所述人造小关节元件中的至少一个上并且可相对于所述固定元件运动的底座构件，所述底座构件可进一步适于和被构造成可相对于所述人造小关节元件中的至少一个运动。
本发明的又一方面提供了一种小关节假体，其包括：第一和第二固定元件；人造小关节支承表面(例如头部支承表面)，其适于和被构造成当所述小关节假体被安装在患者体内时大致布置在椎骨的中线处；以及第一和第二可多轴调节的连接件，它们分别在所述小关节支承表面与第一和第二固定元件之间。在一些实施例中，所述第一和第二可多轴调节的连接件均可以适于和被构造成允许所述第一和第二固定元件相对于所述人造小关节支承表面围绕一个以上的轴旋转。所述小关节假体还可以进一步包括第一和第二紧固件，所述紧固件适于和被构造成防止所述人造小关节支承表面分别和所述第一和第二固定元件之间的相对运动。
根据本发明的该方面的小关节假体还可以包括分别在所述人造小关节支承表面和所述第一和第二固定元件之间的第一和第二可纵向调节的连接件。在一些实施例中，所述小关节假体可以包括布置在所述第一固定元件和所述人造小关节支承表面之间的第一支撑臂和布置在所述第二固定元件和所述人造小关节支承表面之间的第二支撑臂，所述第一和第二支撑臂均适于和被构造成支承所述人造小关节支承表面并且可分别相对于所述第一和第二固定元件纵向运动。所述小关节假体还可以进一步包括第一和第二紧固件，所述紧固件均适于和被构造成防止所述人造小关节支承表面和所述固定元件之间的相对运动。在一些实施例中，所述第一支撑臂可以进一步适于和被构造成围绕第一支撑臂纵向轴线旋转，并且所述第二支撑臂进一步适于和被构造成围绕第二支撑臂纵向轴线旋转。所述第一和第二支撑臂可以是两个分离部件，或者它们可以是一个整体部件。在一些实施例中，可以使用分别在所述小关节支承表面与所述第一和第二固定元件之间的第三和第四可多轴调节的连接件。
本发明的再一方面提供了一种小关节假体，其包括由第一和第二支撑臂支撑的人造小关节支承表面，当所述小关节假体被安装在患者体内时，所述支撑臂适于和被构造成将所述人造小关节支承表面大致布置在椎骨的中线处；以及适于和被构造成分别将所述第一和第二支撑臂连接到椎骨上的第一和第二固定元件。所述第一和第二支撑臂和所述人造小关节支承表面可以是一个整体部件。在一些实施例中，所述小关节假体进一步包括分别在所述第一和第二臂与所述第一和第二固定元件之间的第一和第二可多轴调节的连接件。在一些实施例中，可以使用分别在小关节支承表面和所述第一和第二固定元件之间的第三和第四可多轴调节的连接件。
本发明的另一方面提供了一种安装人造小关节假体的方法，其中所述假体包括小关节元件和固定元件，所述方法包括以下步骤：用固定元件将所述假体连接到椎骨上；以及将小关节元件和固定元件的位置调节成相对方位。调节步骤可以包括相对于固定元件在中间、在侧向、在上部和/或在下部移动所述小关节元件的步骤。在一些实施例中，在调节步骤之前执行连接步骤，而在一些实施例中，在调节步骤之后执行连接步骤。
在一些实施例中，调节步骤包括相对于所述固定元件围绕一个以上的轴旋转所述小关节元件。所述方法还可以包括在所述旋转步骤之后防止所述小关节元件进一步旋转的步骤。
在其中所述小关节元件包括小关节支承表面的方法的实施例中，调节步骤可以包括从椎骨的中线侧向地或大致在椎骨的中线定位所述小关节支承表面的步骤，并且可以包括朝尾部或朝头部定位所述小关节支承表面的步骤。
所述调节步骤还可以包括相对于所述固定元件纵向移动所述小关节元件的步骤。在一些实施例中，所述方法还可以包括在所述移动步骤之后防止所述小关节元件进一步纵向移动的步骤。所述调节步骤还可以包括围绕小关节元件纵向轴线旋转所述小关节元件的步骤。
在以下描述和附图以及在后附权利要求中描述了本发明的其它特征和优点。
附图说明
图1是正常人的脊柱的侧视图；
图2是正常人的腰椎的俯视图；
图3是相邻正常人体腰椎L4和L5的侧视图；
图4是根据本发明构造的头部假体的一个实施例的透视图，所述头部假体用于置换上椎体上自然小关节的下半部分；
图5是图4中所示头部假体的的俯视图；
图6是图4中所示头部假体的主视图；
图7是图4中所示头部假体的侧视图；
图8是图4中所示头部假体的前向剖视图；
图9是描绘图4中所示头部假体的各种部件的分解透视图，包括固定螺钉、固定螺母、人造小关节结构、固定插入件，底座构件和多轴螺钉构件；
图10A和10B分别提供了图9中所示固定螺钉的俯视图和侧面剖视图；
图11A和11B分别提供了图9中所示固定螺母的俯视图和侧视图；
图12A-12D分别提供了图9中所示固定插入件的俯视图、主视图、前向剖视图和侧视图；
图13A-13C分别提供了图9中所示底座构件的俯视图、主视图和前向剖视图；
图14A-14D分别提供了图9中所示多轴螺钉构件的侧视图、俯视图、仰视图和侧面剖视图；
图15是根据本发明构造的尾部假体的一个实施例的透视图，所述尾部假体用于置换下椎体上自然小关节的上半部分；
图16是图15中所示尾部假体的俯视图；
图17是图15中所示尾部假体的侧视图；
图18是图15中所示尾部假体的主视图；
图19是图15中所示尾部假体的前向剖视图；
图20是本发明的两对头部和尾部假体安装在患者体内时的后视图；
图21是图20的两对已安装的头部和尾部假体的后向透视图；
图22是根据本发明另一实施例的已安装的头部和尾部假体的后向透视图；
图23是图22中所示假体的后视图；
图24是图22和23中所示假体的侧视图；
图25是根据本发明又一实施例的已安装的头部和尾部假体的后视图；
图26是图25的假体的侧视图；
图27是图25和26的假体的透视图；
图28是沿图25中所示的线A-A截取的局部剖视图；
图29是图25-27的头部假体的一部分的透视图；
图30是沿图29中所示的线A-A截取的局部剖视图；
图31是图25-27的尾部假体的透视图；以及
图32是沿图31中所示的线A-A截取的局部剖视图。
具体实施方式
虽然在此公开的内容提供了具体细节，以使本领域技术人员能够实施本发明的各种实施例，但是在此公开的实际实施例仅作为本发明的例子，本发明可以以其他具体结构实施。因此，尽管下面描述了本发明的优选实施例，但可以在不脱离本发明的情况下，改变优选实施例的细节。涵盖在后附权利要求及其等同方案的含义和范围内的所有实施例意味着被权利要求包括。
图4-14显示了人造小关节头部假体40的一个实施例，其被构造成例如在手术去除形成小关节下部的关节突之后置换自然小关节的下部。当头部假体40连接到椎骨上时，人造小关节结构44与小关节32的上半部分关节连接。小关节32的上半部分可以包括小关节的在小关节表面32下方椎体上的自然上半部分(即，自然上关节连接表面30和支撑骨结构26)。作为另一选择，小关节32的上半部分可以包括人造小关节假体，例如图15-19中所示的尾部假体100。
头部假体40包括通过多轴连接件41连接到固定元件52上的人造小关节元件44，所述多轴连接件41允许小关节元件44和固定元件52围绕一个以上的轴相对于彼此旋转。从其结构的具体说明可以看出，图4-14的实施例允许通过小关节元件和固定元件围绕多个不同轴的相对旋转连续调节通过可调节范围，直至限位件所提供的运动限制。然而，在其它实施例中，可以限制旋转轴的数量，并且可以仅仅允许以离散增量运动。在各种实施例中，小关节元件可以相对于固定元件在中间、在侧向、在上部和/或在下部运动。
可以在植入之前、植入之后或在植入前后设置小关节元件44和固定元件52的相对位置。在植入和调节之后，小关节元件44的小关节支承表面74可以根据情况的要求处于患者体内解剖学上的正确位置或者处于非解剖学上的正确位置。例如，图20显示了小关节头部假体40，其被植入和调节以从椎骨115和117的中线119侧向地放置小关节支承表面74。
在可选择的实施例中，其它凸形或凹形可以用于小关节支承表面。支承表面74可以由生物相容金属(例如钴铬钢、手术用钢、钛、钛合金、钽、钽合金、铝等)、陶瓷、聚乙烯、生物相容聚合物和假体领域中已知的其它材料形成。
固定元件52可以是螺钉、杆、螺丝锥、金属丝、缝钉，粘合剂、骨和假体领域中已知的其它材料。在图4-14所示的实施例中，固定元件是带有头部54和固定部分56的螺钉。带有形状与驱动器工具配合的外周边的槽58形成于头部54中。固定元件52的底部尖端57可以包括切割边缘59，该切割边缘59便于固定元件52插入到蒂状骨中或椎骨的其它部分中。
本发明可以采用合适的多轴连接结构，例如在美国专利No.5,360,431中公开的结构，上述专利的公开内容被结合于此以作参考。在图4-14的实施例中，头部假体40的多轴连接件41包括连接到小关节元件44的支撑臂72的底座42。在可选择的实施例中，底座42可以与小关节元件44成一整体。如图8、13C和14A中所示，底座42具有凹形内表面91，该凹形内表面91对应于形成在固定元件52的头部54上的相应凸形表面53，并与之配合。底座42内的固定插入件50也具有凹形表面78，其对应于如图所示的固定元件头部54，并与之配合。凹形表面91和78沿凸形表面53滑动，以允许通过小关节元件44和固定元件52之间的相对旋转沿任何期望的轴连续调节。形成于底座42的内侧上的限位表面93与固定元件52相互作用，以将底座42和固定元件52之间的相对旋转运动的范围限制在可调节范围内。
在一些实施例中，也可以提供小关节假体以用于小关节支承表面位置的纵向调节。例如，在图4-14所示的实施例中，可纵向调节的连接件71允许支撑臂72沿其纵向轴线相对于固定元件52运动。在该实施例中，可纵向调节的连接件71以杆状支撑臂72和形成于固定插入件50上的U形通道之间的相互作用的方式构成。可以在植入之前、植入之后或植入前后设置支撑臂72和固定元件52的相对位置，以调节小关节支承表面的位置。
如果需要，支撑臂72也可以围绕其纵向轴线旋转。尽管图4-14中所示的实施例具有基本上为球形的小关节支承表面74，但也可以采用其它小关节支承表面形状，并且支撑臂72的旋转可以帮助调节小关节支承表面的方位。再一次地，可以在植入之前、植入之后或植入前后设置支撑臂72、小关节支承表面74和固定元件52的相对位置。
下面描述头部小关节假体40的安装、组装和使用的一个优选方法。通过底座42的内孔插入固定元件52，直到其头部54抵靠在底座42底表面91上。形成于底座42内的颈部92的直径小于头部54的直径，以防止固定元件52穿过底座42。然后将驱动器工具(未示出)放置在槽58中，以将固定元件52拧入到蒂状骨或椎骨的其它部分中。在一些实施例中，可以在拧入固定元件52之前在椎骨中形成插入孔。骨水泥也可以用于在插入后将固定元件52保持在适当的位置。
接着，将固定插入件50放置到底座42中抵靠在固定元件头部54上。限定固定插入件50的上表面76的U形通道与底座构件42的U形开口84对准。将人造小关节元件44的支撑臂72放置在底座42的U形开口84和固定插入件50中。
固定螺母48与人造小关节元件44之上的底座42的外周边螺纹接合。类似地，固定螺钉46与人造小关节元件44之上的底座42的内周边螺纹接合。固定螺钉46的中心由开孔64限定，该开孔64具有的与相应的驱动器工具(未示出)配合的圆周形状。
在紧固固定螺钉46和固定螺母48之前，通过围绕固定元件头部54的外表面旋转人造小关节元件44、固定插入件50和底座42调节底座42的位置。如上所述，固定插入件50和底座42与头部54的滑动相互作用允许小关节元件54相对于固定元件52围绕一个以上的轴相对旋转。也可沿着和围绕人造小关节元件44的纵向轴线在底座42内调节人造小关节元件44，以将小关节支承表面74放置在其所需位置。当紧固时，固定螺母48和固定螺钉46起到紧固件的作用，以防止人造小关节元件44和固定元件52之间的进一步相对运动。当然，也可以使用本领域中已知的其它紧固件。
图15-19显示了人造尾部小关节假体100的一个实施例，其被构造成例如当手术去除形成小关节上部的关节突之后置换自然小关节的上部。当尾部假体100连接到椎骨上时，人造小关节结构104与小关节的下半部分关节连接。小关节的下半部分可以包括小关节的在小关节表面下方椎体上的自然下半部分(即，如图2和3中所示的自然下关节连接表面31和支承骨结构28)。作为另一选择，小关节的下半部分可以包括人造小关节结构44，例如图4-14中所示的头部假体。
假体100包括通过多轴连接件115连接到固定元件116上的人造小关节元件104，所述多轴连接件115允许小关节元件104和固定元件116围绕一个以上的轴相对于彼此旋转。与图4-14中所示的实施例类似，图15-19的实施例允许通过小关节元件和固定元件围绕多个不同轴的相对旋转连续调节通过可调节范围，直至限位件所提供的运动限制。然而，在其它实施例中，可以限制旋转轴的数量，并且可以仅仅允许以离散增量运动。
可以在植入之前、植入之后或在植入前后设置小关节元件104和固定元件116的相对位置。在植入和调节之后，小关节元件104的小关节支承表面118可以根据情况的要求处于患者体内解剖学上的正确位置或者处于非解剖学上的正确位置。例如，图20显示了小关节假体104，其被植入和调节以从椎骨115和117的中线119侧向地放置小关节支承表面118。
在可选择的实施例中，其它凸形或凹形可以用于小关节支承表面。支承表面118可以由生物相容金属(例如钴铬钢、手术用钢、钛、钛合金、钽、钽合金、铝等)、陶瓷、聚乙烯，生物相容聚合物和假体领域中已知的其它材料形成。
固定元件116可以是螺钉、杆、螺丝锥、金属丝、缝钉、粘合剂、骨和假体领域中已知的其它材料。与图4-14中所示的实施例类似，该实施例中的固定元件116是带有头部114和固定部分的螺钉。带有形状与驱动器工具配合的外周边的槽形成于头部114中，并且固定元件116的底部尖端可以包括切割边缘，该切割边缘便于固定元件116插入到蒂状骨或椎骨的其它部分中。
该实施例的尾部假体的许多方面类似于上述头部假体的方面。如图15-19中所示，尾部假体100的多轴连接件115包括连接到小关节元件104的支撑臂102上的底座112。在可选择的实施例中，底座112可以与小关节元件104形成整体。底座112具有凹形内表面，对应于在固定元件116的头部114上形成的相应凸形表面，并与之配合。底座112内的固定插入件110也具有凹形表面，对应于如图所示的固定元件头部114，并与之配合。底座的凹形表面沿固定元件头部114的凸形表面滑动，以允许通过小关节元件104和固定元件116的相对旋转沿任何期望的轴连续调节。形成于底座112的内侧上的限位表面120与固定元件116相互作用，以将底座112和固定元件116之间的相对旋转运动的范围限制在可调节的范围内。
在一些实施例中，也可以提供小关节假体以用于小关节支承表面位置的纵向调节。例如，在图15-19所示的实施例中，可纵向调节的连接件111允许支撑臂102沿其纵向轴线相对于固定元件116运动。在该实施例中，可纵向调节的连接件111由杆状支撑臂102和形成于固定插入件110上的U形通道之间的相互作用形成。可以在植入之前、植入之后或植入前后设置支撑臂102和固定元件116的相对位置，以调节小关节支承表面的位置。
尾部小关节支承表面118具有与球形的相应人造头部小关节支承表面配合的形状。在该实施例中，支承表面118基本上为凹形，其沿一个轴126的长度大于沿垂直轴128的长度。当然，也可以使用其它支承表面形状。支撑臂102可以围绕其纵向轴线旋转，以调节支承表面118的方位，并且可以在植入之前、植入之后或植入前后设置支撑臂102、小关节支承表面118和固定元件116的相对位置。
下面描述尾部小关节假体40的安装、组装和使用的一个优选方法。通过底座112的内孔插入固定元件116，直到其头部114抵靠在底座112的内表面91上。形成于底座112内的颈部122的直径小于固定元件头部114的直径，以防止固定元件116穿过底座112。然后用驱动器工具(未示出)将固定元件116拧入到蒂状骨或椎骨的其它部分中。在一些实施例中，插入孔可以在拧入固定元件116之前形成于椎骨中。骨水泥也可以用于在插入后将固定元件116保持在适当的位置。
接着，将固定插入件100放置到底座112中抵靠在固定元件头部114上。固定插入件100的上表面中的U形通道与底座构件112的U形开口对准。将人造小关节元件104的支撑臂102放置在底座112的U形开口和固定插入件100中。
固定螺母108与人造小关节元件104之上的底座112的外周边螺纹接合。类似地，固定螺钉106与人造小关节元件104之上的底座112的内周边螺纹接合。固定螺钉106的中心由开孔限定，该开孔具有与相应的驱动器工具(未示出)配合的圆周形状。
在紧固固定螺钉106和固定螺母108之前，通过围绕固定元件头部114的外表面旋转人造小关节元件104、固定插入件100和底座112调节底座112的位置。如上所述，固定插入件100和底座112与头部114的滑动相互作用允许小关节元件104相对于固定元件116围绕一个以上的轴相对旋转。人造小关节元件104也可沿着和围绕其纵向轴线在底座112内调节，以将小关节支承表面118放置在其理想位置。当紧固时，固定螺母108和固定螺钉106起到紧固件的作用，以防止人造小关节元件104和固定元件116之间的进一步相对运动。当然，也可以使用本领域中已知的其它紧固件。
根据从这里的描述，应当理解，头部假体40或尾部假体100可以用于单侧小关节置换(在给定椎体的一侧上)。假体40和100也可以用于提供双侧小关节置换(即，在给定椎体的左右两侧上)。
此外，如图20和21中所示，包括假体40和100的系统可以用于提供一个或多个自然小关节的完整(即上和下)小关节置换。根据需要定位头部假体40和尾部假体100，以形成代替自然小关节的关节系统。头部假体40连接到上相邻椎骨上并且代替自然小关节的头部部分的关节连接功能。类似地，尾部假体100连接到下相邻椎骨上并且代替自然小关节的尾部部分的关节连接功能。假体40和100的小关节支承表面因此进行配合以提供人造关节构造。根据需要，完整小关节置换可以是单侧的或双侧的。在图20和21中显示了双侧小关节置换。
图20提供了去除相邻椎骨的左右两侧上的自然小关节的上下半部之后的两个相邻的腰椎的后视图。由于去除了自然小关节的上下半部，人造关节构造不需要受到在切除自然小关节之前早已存在的自然小关节连接的限制，并且可以与之相异。
优选地，多轴连接机构被构造成将头部假体40连接到上相邻椎骨上和/或将尾部假体100连接到下相邻椎骨上。如前所述，当多轴连接机构连接到上和/或下椎骨上之后，多轴连接机构允许沿着一个以上的轴调节头部和/或尾部假体40、100(视情况而定)的人造小关节结构的位置。图20和21中所示的系统130包括用于头部假体和尾部假体两者的多轴连接机构。因此，当假体连接到椎骨上时，为内科医生定位假体40和100的关节连接表面提供了最大灵活性。可以充分调节人造小关节结构的位置，以获得相邻椎骨之间的最佳关节连接，同时产生椎骨的椎体之间的理想脊柱前凸角。
图22-24显示了根据本发明的另一实施例的头部和尾部小关节假体，其提供了大致位于其上连接有假体的椎骨的中心或中线处的人造小关节。头部假体200具有小关节元件201，该小关节元件201包括支撑头部支承表面元件206的两个支撑臂或杆202和204。尽管可以使用其它材料，支撑臂202和204优选由生物相容金属(例如钴铬钢、手术用钢、钛、钛合金、钽、钽合金、铝等)、陶瓷、聚乙烯、生物相容聚合物和假体领域中已知的其它材料形成。在该实施例中，支撑臂202和204与支承表面构件206是分离元件，并且可以选自包含不同尺寸元件的成套工具，以满足患者的需要。例如，长度尺寸范围为10mm-25mm的支撑臂可以用于连接到L4椎骨上的头部假体。
在可选择的实施例中，支撑臂202和204可以形成为整体元件并且也可以与支承表面206形成一体。在其它替代实施例中，一个或多个轴套(未示出)布置在支承表面元件206与支撑臂202和204之间，以允许支承表面元件206围绕支撑臂202和204旋转。
支撑臂202和204均通过固定元件连接到上椎骨208上，所述固定元件例如为螺钉、杆、螺丝锥、金属丝、缝钉、粘合剂、骨和假体领域中已知的其它材料。如图所示，固定元件将假体200连接到椎骨208的蒂状骨部分上。也可以与椎骨208的其它部分连接。
支撑臂202和204与它们相应的固定元件之间的多轴连接件210和212允许支撑臂202和204相对于固定元件围绕一个以上的轴旋转，由此允许头部小关节元件201相对于固定元件围绕一个以上的轴旋转。实际上，多轴连接件210和212允许支撑臂202和204与它们的固定元件之间围绕多个轴连续调节，直到由限位件提供的运动限制。在该实施例中，多轴连接件210和212基本上与图4-19的实施例中所示的那些相同。然而，在其它实施例中，可以使用其它多轴连接件；也可以限制旋转轴的数量，并且可以仅仅允许以离散增量运动。
可以在植入之前、植入之后或植入前后设置头部小关节元件201和固定元件的相对位置，另外，该实施例提供了小关节元件201和固定元件之间的纵向调节。可纵向调节的连接件214和216分别允许臂202和204沿着纵向轴线相对于它们的固定元件运动。再一次地，该实施例的可纵向调节的连接件基本上与上面关于图4-19中所示的实施例所述的可纵向调节的连接件类似。在该实施例中，需要时支撑臂202和204也可以围绕纵向轴线旋转。可以在植入之前、植入之后或植入前后设置支撑臂202和204与它们的固定元件的相对纵向和旋转位置，以调节头部小关节支承表面206的位置。
图22-24也显示了一种尾部小关节假体300，其带有由支撑臂304和306支撑的人造小关节支承表面302。在该实施例中，如图所示，人造小关节支承表面302基本上布置在椎骨308的中线处，以便与头部假体200的小关节支承表面206接触和相互作用。例如在椎骨的蒂状骨部分，固定元件310和312分别将支撑臂304和306连接到椎骨308上。固定元件310和312可以是螺钉、杆、螺丝锥、金属丝、卡钉、粘合剂、骨和假体领域中已知的其它材料。在该实施例中，支撑臂304和306与小关节支承表面302形成为整体部件。在其它实施例中，这些元件可以形成为分离部件。在使用中，尾部假体300可以选自成套工具，该成套工具包含有不同尺寸的尾部假体，例如用于L5椎骨的32mm-60mm宽的假体。
图25-30显示了本发明的又一实施例，该实施例提供了大致位于椎骨的中线处的另一人造小关节。头部假体400具有小关节元件，该小关节元件包括支撑头部支承元件406的两个支撑臂或杆402和404。在该实施例中，小关节元件406包括小关节支承表面元件414，其中小关节支承表面416形成于其一侧上。如图所示，小关节支承表面元件414具有从其后侧伸出的板418。在该实施例中，板418通过在横臂中心点420处的压入配合连接件连接到小关节支承表面元件414上。板418分别通过多轴连接件422和424连接到支撑臂402和404。假体的合适尺寸(例如板418的宽度和支承表面416的尺寸)可以由校准工具确定和适当地选择。
支撑臂402和404均通过固定元件连接到上椎骨408上，所述固定元件例如为螺钉、杆、螺丝锥、金属丝、缝钉、粘合剂、骨和假体领域中已知的其它材料。如图所示，固定元件是将假体400连接到椎骨408的蒂状骨部分的螺钉403。还可以与椎骨408的其它部分连接。
支撑臂402和404与它们相应的固定元件之间的多轴连接件410和412允许支撑臂402和404相对于蒂状骨固定元件围绕一个以上的轴旋转，由此允许头部小关节元件406相对于蒂状骨固定元件围绕一个以上的轴旋转。实际上，多轴连接件410和412允许支撑臂402和404与它们的固定元件之间围绕多个轴连续调节，直到由限位件提供的运动限制。在该实施例中，多轴连接件410和412基本上与图4-19的实施例中所示的那些相同。然而，在其它实施例中，可以使用其它多轴连接件；也可以限制旋转轴的数量，并且可以仅仅允许以离散增量运动。
在图30中显示了该实施例中的多轴连接件422和424的结构。如图所示，支撑臂404具有带有大致球形表面428的头部426，所述球形表面428布置在形成于板418中的球窝430中。支撑臂404延伸通过板418中的开口432，所述开口432比支撑臂404的臂部分宽但比支撑臂头部426窄。从图30可以看出，支撑臂404和板418之间的连接允许支撑臂404和板418围绕一个以上的轴相对于彼此旋转。一旦获得正确的相对方位，将安装在支撑臂404的螺纹部分436上的螺母434紧固在板418上。螺母434的凹面与板418的下侧的凸形匹配，以允许将螺母434紧固在板418上，从而保持支撑臂404和板418的相对方位。多轴连接件422具有基本上类似的构造。
尽管可以使用其它材料，支撑臂402和404与板418优选由钛形成，并且小关节元件406优选由生物相容金属(例如钴铬钢、手术用钢、钛、钛合金、钽、钽合金、铝等)、陶瓷、聚乙烯、生物相容聚合物和假体领域中已知的其它材料形成。
尾部假体500具有由支撑臂504和506支撑的人造小关节支承表面502。在该实施例中，如图28中所示，人造小关节支承表面502基本上布置在椎骨508的中线处，以便与头部假体400的小关节支承表面416接触和相互作用。支撑臂504和506在安装到患者体内后将小关节支承表面502升高到椎骨的硬膜部分上方。
例如在如图所示椎骨的蒂状骨部分，固定元件510和512将尾部假体500连接到椎骨508上。固定元件510和512可以是螺钉、杆、螺丝锥、金属丝、缝钉、粘合剂、骨和假体领域中已知的其它材料。在图25-30所示的实施例中，固定元件510和512是自攻螺钉。
可以通过使用校准工具确定尾部假体500的合适尺寸。为了将尾部假体500连接到椎骨508上，如本领域中已知的，探针用于确定待使用的合适螺钉长度。探针为螺钉形成导向孔。如图30中所示，分别将螺钉510和512插入到尾部螺钉外壳514和516中，所述尾部螺钉外壳514和516具有大致圆锥形内表面，例如外壳514的表面518。所述螺钉具有基本上为球形的头部，例如螺钉510的螺钉的头部520。球形螺钉头与圆锥形螺钉外壳表面的相互作用允许螺钉以90°以外的角度插入。在插入后，带有基本上为球形的凹形底面的固定螺钉522和524分别被插入到螺钉外壳514和516中，从将支撑臂504和506保持在它们各自的螺钉上。
头部和尾部支承表面之间的相互作用控制它们所连接的椎骨怎样相对于彼此运动。支承表面的形状可以提供运动限位件，并且可以帮助代替被去除的韧带的功能。例如，本发明的一些优选实施例的头部和尾部支承表面提供的运动范围为0-20度的弯曲、0-10度的延伸、0-15度的轴向旋转和0-4度的侧向弯曲。
头部和尾部支承表面的相对形状也控制它们所连接的椎骨之间的相对运动的性质。例如，由上面关于图22-24所述的可动头部支承表面提供的相对运动的性质不同于图25-30中所示实施例的凹形头部支承表面和凸形尾部支承表面之间的接触连接的滑动点。
尽管已显示和描述了本发明的优选实施例，应当理解的是，可以在不背离本发明的精神和范围的情况下，可对其作出各种变化。

Claims (61)

1.一种小关节假体，其包括通过可多轴调节的连接件连接到固定元件上的人造小关节元件。
2.根据权利要求1所述的小关节假体，其中，所述可多轴调节的连接件适于和被构造成允许所述人造小关节元件围绕一个以上的轴相对于所述固定元件旋转。
3.根据权利要求2所述的小关节假体，其中，所述可多轴调节的连接件进一步适于和被构造成允许所述人造小关节元件的位置相对于所述固定元件在可调节的范围内可连续调节。
4.根据权利要求2所述的小关节假体，其中，所述可多轴调节的连接件包括限位件。
5.根据权利要求1所述的小关节假体，其中，所述人造小关节元件适于可相对于所述固定元件在中间运动。
6.根据权利要求1所述的小关节假体，其中，所述人造小关节元件适于可相对于所述固定元件在侧向运动。
7.根据权利要求1所述的小关节假体，其中，所述人造小关节元件适于可相对于所述固定元件在上部运动。
8.根据权利要求1所述的小关节假体，其中，所述人造小关节元件适于可相对于所述固定元件在下部运动。
9.根据权利要求1所述的小关节假体，其中，在所述小关节假体安装到患者体内之后，所述可多轴调节的连接件适于和被构造成允许所述人工小关节元件相对于所述固定元件运动。
10.根据权利要求1所述的小关节假体，进一步包括紧固件，该紧固件适于和被构造成防止所述人造小关节元件和所述固定元件之间的运动。
11.根据权利要求1所述的小关节假体，其中，所述人造小关节元件包括头部小关节支承表面和头部小关节支承表面支撑件。
12.根据权利要求11所述的小关节假体，其中，当所述小关节假体安装在患者体内时，所述头部小关节支承表面和所述头部小关节支承表面支撑件适于和被构造成从椎骨的中线侧向地布置。
13.根据权利要求11所述的小关节假体，其中，当所述小关节假体安装在患者体内时，所述头部小关节支承表面和所述头部小关节支承表面支撑件适于和被构造成大致布置在椎骨的中线处。
14.根据权利要求1所述的小关节假体，其中，所述人造小关节元件包括尾部小关节支承表面和尾部小关节支承表面支撑件。
15.根据权利要求14所述的小关节假体，其中，当所述小关节假体安装在患者体内时，所述尾部小关节支承表面和所述尾部小关节支承表面支撑件适于和被构造成从椎骨的中线侧向地布置。
16.根据权利要求1所述的小关节假体，进一步包括在所述人造小关节元件和所述固定元件之间的可纵向调节的连接件。
17.根据权利要求16所述的小关节假体，其中，所述人造小关节元件包括小关节支承表面和小关节支承表面支撑件，所述小关节支承表面支撑件适于和被构造成可相对于所述固定元件纵向运动。
18.根据权利要求17所述的小关节假体，进一步包括紧固件，该紧固件适于和被构造成防止所述小关节支承表面支撑件和所述固定元件之间的相对运动。
19.根据权利要求17所述的小关节假体，其中，所述小关节支承表面支撑件进一步适于和被构造成可围绕支撑件纵向轴线旋转。
20.根据权利要求1所述的小关节假体，其中，所述可多轴调节的连接件包括小关节元件连接表面和固定元件连接表面，所述小关节元件连接表面和固定元件连接表面适于和被构造成可相对于彼此运动。
21.根据权利要求1所述的小关节假体，其中，所述可多轴调节的连接件包括连接到所述人造小关节元件上并且可相对于所述固定元件运动的底座构件。
22.根据权利要求21所述的小关节假体，其中，所述底座构件进一步适于和被构造成可相对于所述人造小关节元件运动。
23.一种小关节假体，包括：
第一和第二人造小关节元件；
固定元件；以及
在所述第一或第二小关节元件中的至少一个和所述固定元件之间的可多轴调节的连接件。
24.根据权利要求23所述的小关节假体，其中，所述第一人造小关节元件包括人造头部小关节元件，所述第二人造小关节元件包括人造尾部小关节元件。
25.根据权利要求24所述的小关节假体，其中，所述固定元件包括头部固定元件，并且所述可多轴调节的连接件包括头部可多轴调节的连接件，所述小关节假体进一步包括尾部固定元件和在所述人造尾部小关节支承元件和所述尾部固定元件之间的尾部可多轴调节的连接件。
26.根据权利要求25所述的小关节假体，其中，所述人造头部小关节元件包括头部支承表面和头部支承表面支撑件。
27.根据权利要求25所述的小关节假体，其中，所述人造尾部小关节元件包括尾部支承表面和尾部支承表面支撑件。
28.根据权利要求23所述的小关节假体，其中，所述第一和第二人造小关节元件分别包括第一和第二人造头部小关节元件。
29.根据权利要求28所述的小关节假体，其中，所述固定元件包括第一头部固定元件，并且所述可多轴调节的连接件包括第一头部可多轴调节的连接件，所述小关节假体进一步包括第二头部固定元件和在所述第二人造头部小关节元件和所述第二头部固定元件之间的第二头部可多轴调节的连接件。
30.根据权利要求28所述的小关节假体，其中，所述第一和第二人造头部小关节元件分别包括第一和第二头部支承表面。
31.根据权利要求28所述的小关节假体，其中，所述第一和第二人造小关节元件分别包括第一和第二支撑臂以及由所述第一和第二支撑臂中的至少一个支撑的至少一个头部支承表面。
32.根据权利要求31所述的小关节假体，其中，当所述假体被安装在患者体内时，所述头部支承表面大致布置在椎骨的中线处。
33.根据权利要求32所述的小关节假体，其中，所述头部支承表面适于围绕支撑它的一个或多个支撑臂旋转。
34.根据权利要求32所述的小关节假体，进一步包括人造尾部小关节元件，所述人造尾部小关节元件包括适于和被构造成与所述头部支承表面配合的尾部支承表面。
35.根据权利要求34所述的小关节假体，其中，所述可多轴调节的连接件适于和被构造成允许所述人造小关节元件中的至少一个围绕一个以上的轴相对于所述固定元件旋转。
36.根据权利要求35所述的小关节假体，其中，所述可多轴调节的连接件进一步适于和被构造成允许所述人造小关节元件中的至少一个的位置相对于所述固定元件在可调节的范围内可连续调节。
37.根据权利要求35所述的小关节假体，其中，所述可多轴调节的连接件包括限位件。
38.根据权利要求23所述的小关节假体，其中，在所述人造小关节元件安装到患者体内之后，所述可多轴调节的连接件适于和被构造成允许所述人造小关节元件中的至少一个相对于所述固定元件运动。
39.根据权利要求23所述的小关节假体，进一步包括紧固件，该紧固件适于和被构造成防止所述人造小关节元件中的至少一个和所述固定元件之间的相对运动。
40.根据权利要求23所述的小关节假体，进一步包括在所述人造小关节元件中的至少一个和所述固定元件之间的可纵向调节的连接件。
41.根据权利要求40所述的小关节假体，其中，所述人造小关节元件中的至少一个包括小关节支承表面和小关节支承表面支撑件，所述小关节支承表面支撑件适于和被构造成可相对于所述固定元件纵向运动。
42.根据权利要求41所述的小关节假体，进一步包括紧固件，该紧固件适于和被构造成防止所述小关节支承表面支撑件和所述固定元件之间的相对运动。
43.根据权利要求41所述的小关节假体，其中，所述小关节支承表面支撑件进一步适于和被构造成可围绕支撑件纵向轴线旋转。
44.根据权利要求23所述的小关节假体，其中，所述可多轴调节的连接件包括小关节元件连接表面和固定元件连接表面，所述小关节元件连接表面和固定元件连接表面适于和被构造成可相对于彼此运动。
45.根据权利要求23所述的小关节假体，其中，所述可多轴调节的连接件包括连接到所述人造小关节元件中的至少一个上并且可相对于所述固定元件运动的底座构件。
46.根据权利要求45所述的小关节假体，其中，所述底座构件进一步适于和被构造成可相对于所述人造小关节元件中的至少一个运动。
47.一种小关节假体，包括：
第一和第二固定元件；
人造小关节支承表面，当所述小关节假体被安装在患者体内时，该人造小关节支承表面适于和被构造成大致布置在椎骨的中线处；以及
分别在所述小关节支承表面与第一和第二固定元件之间的第一和第二可多轴调节的连接件。
48.根据权利要求47所述的小关节假体，其中，所述第一和第二可多轴调节的连接件均适于和被构造成允许所述第一和第二固定元件围绕一个以上的轴相对于所述人造小关节支承表面旋转。
49.根据权利要求47所述的小关节假体，进一步包括第一和第二紧固件，所述第一和第二紧固件适于和被构造成防止所述人造小关节支承表面分别与所述第一和第二固定元件之间的相对运动。
50.根据权利要求47所述的小关节假体，进一步包括在所述人造小关节支承表面分别与所述第一和第二固定元件之间的第一和第二可纵向调节的连接件。
51.根据权利要求50所述的小关节假体，进一步包括：设置在所述第一固定元件和所述人造小关节支承表面之间的第一支撑臂；以及布置在所述第二固定元件和所述人造小关节支承表面之间的第二支撑臂，所述第一和第二支撑臂均适于和被构造成支撑所述人造小关节支承表面并且可分别相对于所述第一和第二固定元件纵向运动。
52.根据权利要求51所述的小关节假体，进一步包括第一和第二紧固件，所述第一和第二紧固件均适于和被构造成防止所述小关节支承表面支撑件和所述固定元件之间的相对运动。
53.根据权利要求51所述的小关节假体，其中，所述第一支撑臂进一步适于和被构造成可围绕第一支撑臂纵向轴线旋转，并且所述第二支撑臂进一步适于和被构造成可围绕第二支撑臂纵向轴线旋转。
54.根据权利要求51所述的小关节假体，其中，所述第一和第二支撑臂包括两个分离部件。
55.根据权利要求51所述的小关节假体，其中，所述第一和第二支撑臂构成一个整体部件。
56.根据权利要求47所述的小关节假体，其中，所述人造小关节支承表面适于和被构造成头部小关节支承表面。
57.根据权利要求47所述的小关节假体，进一步包括分别在所述小关节支承表面与所述第一和第二固定元件之间的第三和第四可多轴调节的连接件。
58.一种小关节假体，包括：
由第一和第二支撑臂支撑的人造小关节支承表面，当所述小关节假体被安装在患者体内时，所述第一和第二支撑臂适于和被构造成将所述人造小关节支承表面大致布置在椎骨的中线处；以及
适于和被构造成分别将所述第一和第二支撑臂连接到椎骨上的第一和第二固定元件。
59.根据权利要求58所述的小关节假体，其中，所述第一和第二支撑臂与所述人造小关节支承表面构成一个整体部件。
60.根据权利要求58所述的小关节假体，进一步包括分别在所述第一和第二臂与所述第一和第二固定元件之间的第一和第二可多轴调节的连接件。
61.根据权利要求60所述的小关节假体，进一步包括分别在所述小关节支承表面与所述第一和第二固定元件之间的第三和第四可多轴调节的连接件。
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CN105142576B (zh) * 2013-03-15 2017-04-12 内奥斯外科公司 用于修复椎间盘的装置

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