DE3922044A1 - Treatment of fractured vertebra - by instrument which avoids any force on intact adjacent to vertebrae - Google Patents

Treatment of fractured vertebra - by instrument which avoids any force on intact adjacent to vertebrae

Info

Publication number
DE3922044A1
DE3922044A1 DE19893922044 DE3922044A DE3922044A1 DE 3922044 A1 DE3922044 A1 DE 3922044A1 DE 19893922044 DE19893922044 DE 19893922044 DE 3922044 A DE3922044 A DE 3922044A DE 3922044 A1 DE3922044 A1 DE 3922044A1
Authority
DE
Germany
Prior art keywords
instrument according
tube
threaded rod
instrument
expansion tube
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.)
Granted
Application number
DE19893922044
Other languages
German (de)
Other versions
DE3922044C2 (en
Inventor
Matthias Dr Richter-Turtur
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
RICHTER TURTUR MATTHIAS DR
Original Assignee
RICHTER TURTUR MATTHIAS DR
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by RICHTER TURTUR MATTHIAS DR filed Critical RICHTER TURTUR MATTHIAS DR
Priority to DE19893922044 priority Critical patent/DE3922044A1/en
Publication of DE3922044A1 publication Critical patent/DE3922044A1/en
Application granted granted Critical
Publication of DE3922044C2 publication Critical patent/DE3922044C2/de
Granted legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/885—Tools for expanding or compacting bones or discs or cavities therein
    • A61B17/8852—Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc
    • A61B17/8858—Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc laterally or radially expansible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors

Abstract

The surgical instrument for treating a fractured vertebra consists of a spreader tube (2) with longitudinal slots. This spreader tube (2) is supported in an outer tube (1) which has an internal screw thread (4) at one end. A screwed spindle (3) with a knob (7) at its outer end engages the screw thread (4). The inner end of the screwed spindle is fitted with a cone. As the spindle (3) is rotated the cone is moved axially and expands the spreader tube which acts on the fractured vertebra (10). USE/ADVANTAGE - The surgical instrument for treating a fractured vertebra does not impose any force on the intact adjacent vertebrae.

Description

Die bisherigen Verfahren zur Behandlung von gebrochenen Wirbelkörpern beziehen die benachbarten Wirbelkörper mit ein. Die benutzten Instrumentarien sind auf diese Vorgehensweise abgestellt. Die Einbeziehung von intakten Nachbarwirbeln ist jedoch nachteilig, da eine Schädigung derselben zu befürchten ist.The previous procedures for the treatment of broken Vertebral bodies include the neighboring vertebral bodies. The used instruments are on this approach switched off. The inclusion of intact neighboring vertebrae is however, disadvantageous since there is a risk of damage to the same is.

Aufgabe der vorliegenden Erfindung ist es, mit einem einfachen Instrumentarium eine Wiederaufrichtung gebrochener Wirbelkörper von dorsal zu erreichen, ohne dabei die intakten benachbarten Wirbelkörper einzubeziehen.The object of the present invention is with a simple Instrumentarium a rebuilding broken Reach vertebral body from the dorsal without losing the intact include adjacent vertebrae.

Gelöst wird diese Aufgabe durch ein Instrumentarium wie es in Anspruch 1 gekennzeichnet ist. Vorteilhafte Ausbildungen der Erfindung sind in Ansprüchen 2-19 angegeben.This task is solved by an instrument like the one in Claim 1 is marked. Advantageous training of the Invention are set out in claims 2-19.

Als Mittel zur Spreizung des inneren Endes des Spreizrohres kann eine Gewindestange dienen. Das Gewinde kann auch entfallen, wenn durch andere Mittel, z. B. am äußeren Ende, eine Arretierung gewährleistet ist. Es sind jedoch auch andere Mittel zur Spreizung, wie Druck-Zug-Stangen, an einem Seil geführter konischer Kopf etc. möglich, die eine Aufspreizung des Spreizrohres bewirken.As a means of spreading the inner end of the expansion tube serve a threaded rod. The thread can also be omitted if by other means, e.g. B. at the outer end, a lock is guaranteed. However, there are other means of Spreading, like push-pull rods, guided on a rope conical head etc. possible, which spread the Cause expansion tube.

Mit dem erfindungsgemäßen Instrumentarium wird eine operative Aufrichtung gebrochener Wirbelkörper von dorsal möglich.With the instruments according to the invention, an operative Broken vertebrae can be erected from the dorsal direction.

Nach transcutaner oder nach operativer Freilegung des Wirbelbogens des verletzten Wirbels von dorsal werden die Bogenwurzeln des Wirbels unter Röntgenkontrolle aufgebohrt. Sodann wird das Instrumentarium in Form eines Arbeitsrohres beidseits bis in den Wirbelkörper plaziert. Durch den Arbeitskanal wird dann das erfindungsgemäße Instrumentarium vorgeschoben, bis es ausreichend weit im Wirbelkörper steckt. Die Arme des Spreizers können dann je nach Bruchform nach vorn, zur Mitte oder nach hinten geöffnet werden, um so die komprimierte Berstung wieder aufzurichten.After transcutaneous or after surgical exposure of the Vertebral arch of the injured vertebra from dorsal become the Arch roots of the vertebra drilled out under X-ray control. Then the instruments in the form of a working tube on both sides placed in the vertebral body. Then through the working channel advanced the instruments according to the invention until it is sufficiently far in the vertebral body. The arms of the spreader can then move forward, towards the center or towards the rear, depending on the shape of the fracture opened at the back, so the compressed bursting again to erect.

Unter endoskopischer oder offener Kontrolle kann dann zusätzlich transspinal ein Arbeitsrohr in den Bandscheibenraum eingebracht werden. Mit feinen Biopsiezangen wird das restliche zerstörte Bandscheibengewebe, das durch die Verletzung nicht in den Wirbel­ körper eingedrungen ist, entfernt. Der geleerte Bandscheibenraum wird schließlich über die Arbeitsrohre mit Spongiosamehl aufgefül­ lt.Then, under endoscopic or open control, additional A working tube is inserted transspinally into the intervertebral disc space will. The rest is destroyed with fine biopsy forceps Intervertebral disc tissue that is not injured in the vertebra body has penetrated, removed. The empty disc space is finally filled with cancellous bone flour through the working pipes according to

Mit dem erfindungsgemäßen Instrumentarium läßt sich die endoskopische Operation von Bandscheiben ebenfalls durchführen.With the instruments according to the invention, the also perform endoscopic surgery of intervertebral discs.

Weitere Einzelheiten und Vorteile der Erfindung werden im folgenden an einem Ausführungsbeispiel näher erläutert. Es zeigtFurther details and advantages of the invention are described in following explained in more detail using an exemplary embodiment. It shows

Fig. 1 ein erfindungsgemäßes Arbeitsrohr, Fig. 1 shows an inventive working tube,

Fig. 2 eine erste Variante des erfindungsgemäßen Instrumentes, das in einen aufzurichtenden Wirbelkörper eingeführt ist, Fig. 2 shows a first variant of the instrument according to the invention, which is inserted into a vertebral body righted,

Fig. 3 eine zweite Variante des erfindungsgemäßen Instrumentariums und Fig. 3 shows a second variant of the instruments according to the invention and

Fig. 4 eine weitere Variante des erfindungsgemäßen Instrumentariums. Fig. 4 shows a further variant of the instruments according to the invention.

In Fig. 2 ist ein erfindungsgemäßes Instrumentarium in einem aufzurichtenden Wirbelkörper 10 dargestellt. Die anliegenden Wirbelkörper 9 werden zur Wiederaufrichtung nicht benötigt. Das "äußere" Rohrende ist mit einem Gewinde 4 versehen, auf das ein Trichter 5 oder ein Schlagschutzring (Fig. 1) aufgeschraubt werden kann. Das Arbeitsrohr weist eine Dichte von 4-12 mm, bevorzugt 8 mm auf.In FIG. 2, an inventive instrument is illustrated in a righted vertebral body 10. The adjacent vertebral bodies 9 are not required for straightening up. The "outer" pipe end is provided with a thread 4 onto which a funnel 5 or an impact protection ring ( FIG. 1) can be screwed. The working tube has a density of 4-12 mm, preferably 8 mm.

Der Wirbelspreizer Typ 1 gemäß Fig. 2 weist eine ca. 20 cm lange Gewindestange 3, deren "inneres" Ende einen konischen Kopf 11 trägt. Die Gewindestange 3 ist eingedreht in ein mit Innengewin­ de ausgestattetem Spreizrohr 2, dessen Außendurchmesser bündig dem Innendurchmesser des Arbeitsrohres 1 entspricht, so daß es durch dieses hindurchgeschoben werden kann. Das "innere" Ende des Spreiz­ rohres 2 ist auf einer Länge von 2,5 cm geschlitzt, um aufgespreizt werden zu können. Das "innere" Ende der Gewindestange 3 trägt einen nach außen konisch erweiterten Kopf 11 (bis auf den Innendurchmesser des Arbeitsrohres). Bei Rückdrehung der Gewindestange 3 paßt sich die­ ser in das Spreizrohr 2 und drängt die Repositionsschenkel 12 auseinan­ der (Fig. 2).The vortex spreader type 1 according to FIG. 2 has an approximately 20 cm long threaded rod 3 , the "inner" end of which carries a conical head 11 . The threaded rod 3 is screwed into a spreader tube 2 equipped with internal thread de, the outer diameter of which corresponds flush to the inner diameter of the working tube 1 , so that it can be pushed through it. The "inner" end of the expansion tube 2 is slotted to a length of 2.5 cm in order to be able to be expanded. The "inner" end of the threaded rod 3 carries an outwardly conically widened head 11 (except for the inner diameter of the working tube). When the threaded rod 3 is turned back, the water fits into the expansion tube 2 and urges the reduction leg 12 apart ( FIG. 2).

Der Wirbelspreizer Typ 2 gemäß Fig. 3 weist im wesentlichen das Bauprinzip des Wirbelspreizers Typ 1 auf. Im Gegensatz zum Typ 1 ist die Schlitzung des "inneren" Endes jedoch nicht durchgezogen, sondern endet ca. 2 mm vor dem Ende. Bei Rückdrehung der Gewindestange 3 wird dadurch eine in etwa rautenförmige oder bauchige Aufspreizung bewirkt, die zur Reposition der Deck- und Grundplatte im mittleren Bereich führt (Fig. 3). Dabei kann ein Gelenk 8 angeordnet sein. Die Aufspreizung kann jedoch auch durch elastisches Ausbiegen der Gewindestange 3 erfolgen.The vortex spreader type 2 according to FIG. 3 essentially has the construction principle of the vortex spreader type 1. In contrast to type 1, the slit of the "inner" end is not pulled through, but ends approx. 2 mm before the end. When the threaded rod 3 is turned back, an approximately diamond-shaped or bulbous expansion is brought about, which leads to the reduction of the cover and base plate in the central region ( FIG. 3). A joint 8 can be arranged. However, the spreading can also be done by elastic bending of the threaded rod 3 .

Fig. 3 zeigt den Wirbelspreizer Typ 3 mit einer Gewindestange 3 mit Innengewinde. Die Gewindestange 3 liegt bündig dem Arbeitsrohr 1 an. In die Gewindestange 3 ist ein Spreizrohr 2 mit Außengewinde geführt, welches an seinem inneren Ende gelenkig verbundene Abspreizschenkel 6 trägt. Die nach hinten öffnenden Abspreizschenkel 6 weisen eine Länge von 0,5 bis 4 cm, bevorzugt 2,5 cm auf und liegen in nicht abgespreiztem Zustand auf der Gewindestange auf. Durch Drehen der Gewindestange werden die Abspreizschenkel dorsal abgespreizt, wodurch die dorsale Aufrichtung der Deck- und Grundplatte sowie der Hinterkante des Wirbelkörpers bewirkt wird (Fig. 4). Fig. 3 shows the vortex spreader type 3 with a threaded rod 3 with an internal thread. The threaded rod 3 lies flush with the working tube 1 . In the threaded rod 3 , an expansion pipe 2 with an external thread is guided, which carries at its inner end articulated expansion legs 6 . The expansion legs 6 opening towards the rear have a length of 0.5 to 4 cm, preferably 2.5 cm, and lie on the threaded rod in the non-expanded state. By turning the threaded rod, the spreading legs are spread out dorsally, which causes the dorsal erection of the cover and base plate and the rear edge of the vertebral body ( FIG. 4).

Die Erfindung ist keineswegs auf das dargestellte Ausführungsbeispiel beschränkt. Vielseitige Anwendungen sind im Rahmen der Erfindung, wie sie in den Ansprüchen gekennzeichnet ist, möglich.The invention is by no means based on that illustrated Embodiment limited. Versatile applications are in Framework of the invention as characterized in the claims is possible.

Claims (19)

1. Instrumentarium zur Wirbelbruchbehandlung, dadurch gekennzeichnet, daß es ein Arbeitsrohr (1), ein in diesem geführtes Spreizrohr (2) und Mittel (3) aufweist, die eine Spreizung des inneren Endes des Spreizrohres bewirken.1. Instrumentation for vertebral fracture treatment, characterized in that it has a working tube ( 1 ), a spreader tube guided in this ( 2 ) and means ( 3 ) which cause the inner end of the spreader tube to expand. 2. Instrumentarium nach Anspruch 1, dadurch gekennzeichnet, daß die Mittel (3) eine Gewindestange aufweisen.2. Instrument set according to claim 1, characterized in that the means ( 3 ) have a threaded rod. 3. Instrumentarium nach Anspruch 2, dadurch gekennzeichnet, daß die Gewindestange (3) an ihrem inneren Ende einen konischen Kopf (11) trägt. 3. Instrument set according to claim 2, characterized in that the threaded rod ( 3 ) carries a conical head ( 11 ) at its inner end. 4. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß das Spreizrohr (2) ein Innengewinde aufweist.4. Instrument set according to one of the preceding claims, characterized in that the expansion tube ( 2 ) has an internal thread. 5. Instrumentarium nach Anspruch 4, dadurch gekennzeichnet, daß das Innengewinde des Spreizrohres (2) mit der Gewindestange kämmt.5. Instrument according to claim 4, characterized in that the internal thread of the expansion tube ( 2 ) meshes with the threaded rod. 6. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß die Gewindestange (3) in einem Spreizrohr geführt ist.6. Instrument according to one of the preceding claims, characterized in that the threaded rod ( 3 ) is guided in an expansion tube. 7. Instrumentarium nach einem der gekennzeichneten Ansprüche, dadurch gekennzeichnet, daß das Arbeitsrohr an einem Ende ein Gewinde (4) aufweist.7. Instrument according to one of the marked claims, characterized in that the working tube has a thread ( 4 ) at one end. 8. Instrumentarium nach Anspruch 6, dadurch gekennzeichnet, daß auf das Gewinde ein Trichter (5) oder ein Schlagschutzring aufschraubbar ist.8. Instrument according to claim 6, characterized in that a funnel ( 5 ) or an impact protection ring can be screwed onto the thread. 9. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß in das Arbeitsrohr (1) ein mit scharfer Spitze versehener Trokar einführbar ist.9. Instrument according to one of the preceding claims, characterized in that a trocar provided with a sharp tip can be inserted into the working tube ( 1 ). 10. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß das Spreizrohr (2) am inneren Ende zur Bildung von Repositionsschenkeln (12) geschlitzt ist.10. Instrument set according to one of the preceding claims, characterized in that the expansion tube ( 2 ) is slotted at the inner end to form reduction legs ( 12 ). 11. Instrumentarium nach Anspruch 10, dadurch gekennzeichnet, daß die Schlitzung 0,5 bis 5 cm, bevorzugt 2,5 cm beträgt.11. Instrument according to claim 10, characterized in that the slit is 0.5 to 5 cm, preferably 2.5 cm. 12. Instrumentarium nach Anspruch 10 oder 11, dadurch gekennzeichnet, daß die Schlitzung am inneren Ende des Spreizrohres (2) beginnt.12. Instrument according to claim 10 or 11, characterized in that the slitting begins at the inner end of the expansion tube ( 2 ). 13. Instrumentarium nach Anspruch 10 oder 11, dadurch gekennzeichnet, daß die Schlitzung ca. 1-15 mm, bevorzugt 2 mm von inneren Ende des Spreizrohres beginnt.13. Instrument according to claim 10 or 11, characterized characterized in that the slitting approximately 1-15 mm, preferably 2 mm from inner end of the expansion tube begins. 14. Instrumentarium nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß das Spreizrohr (2) ein Außengewinde aufweist.14. Instrument according to claim 1 or 2, characterized in that the expansion tube ( 2 ) has an external thread. 15. Instrumentarium nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß die Gewindestange 3 im Arbeitsrohr (1) geführt ist und ein Innengewinde aufweist.15. Instrument according to claim 1 or 2, characterized in that the threaded rod 3 is guided in the working tube ( 1 ) and has an internal thread. 16. Instrumentarium nach Anspruch 14 und 15, dadurch gekennzeichnet, daß die Gewinde von Spreizrohr und Gewindestange miteinander kämmen.16. Instrument according to claim 14 and 15, characterized characterized in that the threads of the expansion tube and threaded rod comb together. 17. Instrumentarium nach einem der Ansprüche 1, 2, 14, 15 oder 16, dadurch gekennzeichnet, daß das Spreizrohr (2) an dessen innerem Ende über ein Gelenk mit diesem verbundene Abspreizschenkel (6) trägt, die durch die Gewindestange abspreizbar sind.17. Instrument according to one of claims 1, 2, 14, 15 or 16, characterized in that the expansion tube ( 2 ) carries at its inner end via an articulation connected to this expansion leg ( 6 ) which can be expanded by the threaded rod. 18. Instrumentarium nach einem der vorhergehenden Ansprüche, dadurch gekennzeichnet, daß die Gewindestange (3) eine Betätigungsvorrichtung (7) trägt.18. Instrument according to one of the preceding claims, characterized in that the threaded rod ( 3 ) carries an actuating device ( 7 ). 19. Instrumentarium nach Anspruch 13, dadurch gekennzeichnet, daß das Spreizrohr (2) im geschlitzten Bereich ein Gelenk (8) aufweist.19. Instrument according to claim 13, characterized in that the expansion tube ( 2 ) has a joint ( 8 ) in the slotted area.
DE19893922044 1989-07-05 1989-07-05 Treatment of fractured vertebra - by instrument which avoids any force on intact adjacent to vertebrae Granted DE3922044A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
DE19893922044 DE3922044A1 (en) 1989-07-05 1989-07-05 Treatment of fractured vertebra - by instrument which avoids any force on intact adjacent to vertebrae

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
DE19893922044 DE3922044A1 (en) 1989-07-05 1989-07-05 Treatment of fractured vertebra - by instrument which avoids any force on intact adjacent to vertebrae

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DE3922044A1 true DE3922044A1 (en) 1991-02-07
DE3922044C2 DE3922044C2 (en) 1991-05-29

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