DE4208116C2 - Bandscheibenendoprothese - Google Patents

Bandscheibenendoprothese

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Publication number
DE4208116C2
DE4208116C2 DE4208116A DE4208116A DE4208116C2 DE 4208116 C2 DE4208116 C2 DE 4208116C2 DE 4208116 A DE4208116 A DE 4208116A DE 4208116 A DE4208116 A DE 4208116A DE 4208116 C2 DE4208116 C2 DE 4208116C2
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Germany
Prior art keywords
prosthesis
intervertebral disc
plates
core
section
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Expired - Fee Related
Application number
DE4208116A
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English (en)
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DE4208116A1 (de
Inventor
Karin Dr Buettner-Janz
Jean-Philippe Dr Lemaire
Arnold Keller
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.)
Waldemar Link GmbH and Co KG
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Waldemar Link GmbH and Co KG
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Priority to DE4208116A priority Critical patent/DE4208116C2/de
Application filed by Waldemar Link GmbH and Co KG filed Critical Waldemar Link GmbH and Co KG
Priority to EP93102993A priority patent/EP0560141B1/de
Priority to ES93102993T priority patent/ES2094393T3/es
Priority to AT93102993T priority patent/ATE144695T1/de
Priority to DE59304327T priority patent/DE59304327D1/de
Priority to US08/028,967 priority patent/US5401269A/en
Priority to JP5052070A priority patent/JP3017371B2/ja
Publication of DE4208116A1 publication Critical patent/DE4208116A1/de
Application granted granted Critical
Publication of DE4208116C2 publication Critical patent/DE4208116C2/de
Anticipated expiration legal-status Critical
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425Intervertebral or spinal discs, e.g. resilient made of articulated components
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/3011Cross-sections or two-dimensional shapes
    • A61F2002/30112Rounded shapes, e.g. with rounded corners
    • A61F2002/30125Rounded shapes, e.g. with rounded corners elliptical or oval
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/3011Cross-sections or two-dimensional shapes
    • A61F2002/30138Convex polygonal shapes
    • A61F2002/30156Convex polygonal shapes triangular
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108Shapes
    • A61F2002/30199Three-dimensional shapes
    • A61F2002/30252Three-dimensional shapes quadric-shaped
    • A61F2002/30253Three-dimensional shapes quadric-shaped ellipsoidal or ovoid
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/3039Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • A61F2002/30392Rotation
    • A61F2002/30393Rotation with additional means for limiting said rotation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30621Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30639Features concerning the anatomical functioning or articulation of the prosthetic joint having rolling elements between both articulating surfaces
    • A61F2002/30642Features concerning the anatomical functioning or articulation of the prosthetic joint having rolling elements between both articulating surfaces having a single rolling (or sliding) ball articulating between two cups
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30621Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30649Ball-and-socket joints
    • A61F2002/30663Ball-and-socket joints multiaxial, e.g. biaxial; multipolar, e.g. bipolar or having an intermediate shell articulating between the ball and the socket
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30841Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891Plurality of protrusions
    • A61F2002/30892Plurality of protrusions parallel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425Intervertebral or spinal discs, e.g. resilient made of articulated components
    • A61F2002/443Intervertebral or spinal discs, e.g. resilient made of articulated components having two transversal endplates and at least one intermediate component
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004Rounded shapes, e.g. with rounded corners
    • A61F2230/0008Rounded shapes, e.g. with rounded corners elliptical or oval
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017Angular shapes
    • A61F2230/0023Angular shapes triangular
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063Three-dimensional shapes
    • A61F2230/0073Quadric-shaped
    • A61F2230/0076Quadric-shaped ellipsoidal or ovoid
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10STECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00Surgery
    • Y10S606/907Composed of particular material or coated
    • Y10S606/91Polymer

Description

Die Erfindung betrifft eine Bandscheibenendoprothese mit zwei Prothesenplatten, die mit den Endplatten der zugehörigen Wirbelkörper zu verbinden sind, und einem Prothesenkern, der mit mindestens einer Prothesenplatte über eine eine Rotations­ bewegung um die Hochachse gestattende Gelenkfläche zusammenwirkt.
Bei bekannten Bandscheibenendoprothesen dieser Art (EP 0 176 728 A1, FR 26 59 226 A1, DE 28 04 936 A1) ist die Gelenk­ fläche sphärisch. Die durch die Prothese miteinander verbunde­ nen Wirbelkörper können daher nicht nur Beugebewegungen in der Medianebene und der Frontalebene, sondern auch Rotationsbewe­ gungen um die Hochachse frei durchführen. Diese Rotationsbewe­ gung wird auch nicht durch Anschläge von Abschlußplattenteilen aneinander gehindert. - Bei einer anderen bekannten Band­ scheibenendoprothese (DE 30 23 353 C2) wird hingegen eine Rotationsbewegung durch Abschlußplattenanschläge aneinander unmöglich gemacht; eine Schwenkbewegung ist lediglich in der Medianebene möglich. Dies hat nicht nur den Nachteil, daß an den Abschlußplatten Teile aus gleichem Material mit entspre­ chend hohem Abrieb und hoher Reibung aufeinander gleiten, sondern daß auch bei einer Rotationsbewegung des Körpers auf die Verankerung der Prothese an den zugehörigen Wirbelkörpern hohe Kräfte wirken, die im Hinblick auf eine dauerhafte Fixation der Prothesenteile an den Wirbelkörpern nachteilig sind. Jedoch hat auch die freie Drehbeweglichkeit der zuvor erwähnten Prothesen Nachteile in sofern, als der notwendige Drehwiderstand, der von der natürlichen Bandscheibe dank deren Faserbeschaffenheit und -anordnung geleistet werden kann, mindestens bis zur Bildung ausreichenden Narbengewebes ent­ fällt und daher die Wirbelbogengelenke überlastet werden können, was zu Beschwerden führen kann.
Erwünscht ist deshalb eine Bandscheibenendoprothese, die der Verdrehung um die Hochachse einen Widerstand entgegensetzt, ohne daß dies durch Anschläge an den Abschlußplatten erzielt wird.
Die erfindungsgemäße Lösung besteht darin, daß die Gelenkflä­ che im Medianschnitt und im Frontalschnitt Krümmungsbögen von unterschiedlichem mittlerem Radius bildet. Vorzugsweise sind die Krümmungsradien im Medianschnitt kleiner als im Frontalschnitt. Die Krümmungsradien in den zueinander quer stehenden Hauptrichtungen unterscheiden sich zweckmäßigerweise um den Faktor 1,2 bis 2,5, vorzugsweise 1,5 bis 2. Sie sind zweckmäßigerweise in den Hauptschnittebenen Kreisbögen oder der Kreisbogenform angenähert.
Die Wirkung dieser Maßnahme besteht darin, daß eine Rotation der Prothesenteile um die Hochachse zwar möglich ist, daß aber die Prothese dabei infolge des Aufgleitens der seitlichen schrägen Flanken der Gleitflächen aufeinander auseinanderge­ spreizt wird, wodurch aufgrund der Gewichtsbelastung ein rückführendes Moment entsteht. Umgekehrt könnte man auch sagen, daß die Rotationsbewegung der Prothese um die Hochachse sanft gebremst wird und die Prothese eine Tendenz hat, zur neutralen Stellung zurückzukehren.
In manchen Fällen kann es trotz des erfindungsgemäß erzeugten Widerstands gegen eine Rotation der Prothese um die Hochachse zweckmäßig sein, den maximal verfügbaren Rotationswinkel durch Anschläge zu begrenzen, die zwischen den Prothesenplatten oder besser zwischen dem Prothesenkern und den damit über Gelenk­ flächen zusammenwirkenden Prothesenplatten wirken können. Diese Anschläge werden so angeordnet, daß sie im allgemeinen nicht in Funktion treten, weil innerhalb des normalen Rotati­ onsbereichs der durch die erfindungsgemäße Formgebung der Gleitflächen erzeugte Rotationswiderstand ausreicht. Sie sollen lediglich eine Rotation solchen Ausmaßes ausschließen, daß dadurch Schäden am Wirbelapparat oder an der Prothese verursacht werden könnten. Im allgemeinen vermeidet man Anschläge zwischen Prothesenteilen, weil bei heftigem Anschlag unter Körperschwung Kräfte entstehen können, die den Verbund zwischen dem Prothesenteil und dem Knochen gefährden können. Diese Gefahr besteht im vorliegenden Fall nicht, weil der Körperschwung durch den Rotationswiderstand der Gleitflächen hinreichend geschwächt worden ist, bevor die Anschläge er­ reicht werden.
Bei einer bevorzugten Ausführungsform werden die Anschläge in die Gleitflächen des Prothesenkerns und der damit zusammenwir­ kenden Prothesenplatte(n) eingearbeitet. Diese können zweckmä­ ßigerweise die Form einer Nut in der einen Fläche und einer Feder in der anderen Fläche annehmen, wobei deren Kontur so gewählt ist, daß der gewünschte Rotationsbereich ebenso gewährleistet ist wie eine hinreichende Beugung nach vorne und zu beiden Seiten. Zwar ist es bekannt (US-PS 4 759 766), die Prothesenplatten und den Prothesenkern mit zusammenwirkenden Vorsprüngen und Nuten zu versehen. Jedoch ist deren Form nicht zur Bildung eines Anschlags gegen Rotationsbewegung geeignet; dies ist auch nicht erforderlich, weil die Gelenkflächen zylindrisch sind und keine Rotationsmöglichkeit bieten.
Zusätzlich zu oder statt der Nut-Feder-Verbindung kann die Rotationsbegrenzung auch bewirkt werden durch einen vorzugs­ weise umlaufenden Kragen an einem der beiden Teile und einen damit zusammenwirkenden Rand am anderen Teil. Solche zusammen­ wirkenden Kragen und Ränder an dem Prothesenkern und den Prothesenplatten sind bei kreisrund begrenzten Prothesenteilen an sich bekannt (EP 0 176 728 A1, Fig. 1 bis 3), um die Teile gegenüber seitlicher Relativbewegung zusammenzuhalten. Bei ovaler Grundform der Teile vermögen sie auch deren Rotation um die Hochachse zu begrenzen.
Die Erfindung wird im folgenden näher unter Bezugnahme auf die Zeichnung erläutert, die vorteilhafte Ausführungsbeispiele veranschaulicht. Darin zeigen:
Fig. 1 einen mittleren Frontalschnitt durch die Prothese in deren Neutralstellung,
Fig. 2 einen der Fig. 1 entsprechenden Schnitt bei seitlicher Beugung,
Fig. 3 einen Medianschnitt durch die Prothese,
Fig. 4 eine der Fig. 3 entsprechende Darstellung bei Beugung nach vorne,
Fig. 5 eine Draufsicht auf die Außenfläche der Prothesenplatten,
Fig. 6 eine Draufsicht auf den Prothesenkern,
Fig. 7 eine Draufsicht auf die Innenseite der Prothesenplatten, jeweils von einer ersten Ausführungsform der Erfindung,
Fig. 8 bis 11 Darstellungen entsprechend den Fig. 1, 3, 6 und 7 einer zweiten Ausführungsform,
Fig. 12 und 13 Darstellung entsprechend den Fig. 1 und 3 einer dritten Ausführungsform,
Fig. 14 und 15 zwei der Fig. 1 entsprechende Darstellungen einer vierten und einer fünften Ausführungs­ form der Erfindung.
Die dargestellte Bandscheibenendoprothese besteht aus den Prothesenplatten, nämlich der Grundplatte 1 und der Deckplatte 2, und dem Prothesenkern 3. Die Prothesenplatten bestehen aus Metall. Ihre Deckflächen 4, die sich an die ihnen zugewendeten Deckflächen der Wirbelkörper anlegen, sind mit Zähnen 5 versehen, die in die Wirbelkörper eindringen und dadurch eine Fixation der Prothese gegenüber den Wirbelkörpern bewirken.
Der Prothesenkern 3 besteht aus Kunststoff mit guten Gleitei­ genschaften, insbesondere hochdichtem Polyethylen. Die Prothe­ senplatten und der Prothesenkern bilden Gelenkflächen 6, die im Neutralzustand (Fig. 1 und 3) kongruent sind. Im mittigen Frontalschnitt (Fig. 1) stellen sie ebenso Kreisbögen dar wie im Medianschnitt (Fig. 3). In allen sonstigen Sagittal- und Frontalschnitten bilden sie vorzugsweise Kreisbögen oder sind sie Kreisbögen angenähert. Dadurch ergeben sich die in Fig. 2 und 4 veranschaulichten Möglichkeiten einer seitlichen und frontalen Beugebewegung, die bei schräger Beugung auch kombi­ niert auftreten können. Der Prothesenkern 3 ist mit einem Kragen 7 versehen, der mit dem Rand 8 der Prothesenplatten 1, 2 zusammenwirkt, um die seitliche Relativbewegung des Prothe­ senkerns gegenüber den Prothesenplatten zu beschränken, wie man in Fig. 2, rechte Seite, gut erkennt. Insoweit kann die Prothese als bekannt betrachtet werden.
Erfindungsgemäß sind die Krümmungsradien der Gelenkflächen 6 im Sagittalschnitt und Frontalschnitt unterschiedlich, nämlich im Sagittalschnitt (Fig. 3) kleiner als im Frontalschnitt (Fig. 1). während bei sphärischer Gestaltung der Gleitflächen deren Kongruenz auch dann noch erhalten bleibt, wenn die Prothesenplatten sich gegenüber dem Prothesenkern (im Sinne des Pfeils 10) um die Hochachse 9 verdrehen, ist die Kongruenz bei der erfindungsgemäßen Gelenkflächenkonfiguration in den Schnittebenen, die von den Hauptebenen abweichen, nicht mehr vorhanden. In diesen äußeren Schnittebenen steigt der Prothe­ senkern bei der Rotation an den Flanken der Gelenkflächen der Prothesenplatten hoch. Dadurch werden die Prothesenplatten entgegen dem auf ihnen lastenden Körpergewicht schraubenförmig auseinandergezwungen. Das Körpergewicht verursacht demzufolge ein gegenwirkendes Moment, das die Prothesenplatten in die Neutralstellung zurückzudrehen sucht. Der Verdrehung der Prothesenplatten wirkt ein Widerstand entgegen, dessen Größe durch die Steilheit der zusammenwirkenden Flanken der Gelenk­ flächen der Prothesenplatten und des Prothesenkerns bestimmt wird. Durch die Bemessung dieser Flanken läßt sich der Widerstand somit in geeigneter Weise bemessen. Er wird zweck­ mäßigerweise so bemessen, daß er keinesfalls die zwischen den Prothesenplatten und den Wirbelkörpern übertragbaren Veranke­ rungskräfte übersteigt.
Bei einem gewissen Verdrehwinkel kommt der Kragen 7 des Prothesenkerns mit dem Rand 8 der Prothesenplatten auch dann in Eingriff, wenn die Symmetrieachsen 9 sämtlicher Komponenten miteinander fluchten. Dadurch ist ein Anschlag gegen eine zu grobe Verdrehung gegeben. Durch die Bemessung des Abstands des Kragens von den Gelenkflächen bzw. von dem Rand 8 der Neutral­ stellung kann leicht der Verdrehwinkel bemessen werden, bei welchem die Anschlagfunktion eintritt. In diesem Zusammenhang sei vermerkt, daß der Verlauf des Kragens 7 bzw. des Randes 8 nicht unbedingt parallel sein muß zum Verlauf der äußeren Begrenzung der Gelenkflächen 6.
Die zweite Ausführungsform gemäß Fig. 8 bis 11 stimmt mit der ersten Ausführungsform überein, soweit nicht im folgenden anders beschrieben.
Für den Fall, daß die durch den Kragen 7 und den Rand 8 gegebene Begrenzung der Rotationsbewegung 10 nicht ausreicht, ist der Prothesenkern mit einer in der Medianebene verlaufen­ den Rippe 11 versehen, die in eine entsprechend verlaufende Nut 12 in der zugeordneten Gelenkfläche der Prothesenplatte(n) eingreift. Die Umrisse der Rippe 11 und der Nut 12 in Drauf­ sicht (Fig. 10 und 11) unterscheiden sich ein wenig. Nicht nur ist die Rippe 11 im Medianschnitt und im Frontalschnitt ein wenig kürzer als die Nutweite, damit die Beugungsbewegungen gemäß Fig. 2 und 4 durchgeführt werden können, sondern vor allem auch ist die Rippe 11 an ihren Enden schmaler als im Mittelbereich und als die Nut, so daß sie eine gewisse Drehbe­ wegung innerhalb der Nut 12 durchführen kann. Diese Rotations­ bewegung wird erst dann beendet, wenn die schmaleren Enden der Rippe 11 an den Seitenwänden der Nute 12 anschlagen. Falls - wie in den dargestellten Beispielen vorausgesetzt - die Prothese mit paarigen Gleitflächen oberhalb und unterhalb des Prothesenkerns versehen ist, müssen selbstverständlich zu beiden Prothesenplatten hin Anschläge des Prothesenkerns vorgesehen sein. Wenn der Prothesenkern hingegen mit einer Prothesenplatte fest verbunden ist, genügen derartige Anschlä­ ge an lediglich einer Seite.
Da die Rippe 11 im Zusammenwirken mit der Nut 12 nicht nur die Rotationsbewegung, sondern auch die Beugebewegungen der Prothese begrenzt, ist der Kragen 7 am Prothesenkern nicht erforderlich, wie die Ausführung gemäß Fig. 12 und 13 zeigt, die ansonsten mit derjenigen gemäß Fig. 8 bis 11 überein­ stimmt.
Während in der zweiten und dritten Ausführung (Fig. 8 bis 13) die Rippe am Prothesenkern und die damit zusammenwirkende Nut an den Prothesenplatten vorgesehen war, sind die Verhältnisse bei der Ausführungsform gemäß Fig. 14 umgekehrt; die Rippe 13 an den Prothesenplatten ragt jeweils in eine Nut 14 am Prothe­ senkern. Auch in diesem Fall bat die Rippe 13 die in Fig. 10 dargestellte, nach den Enden zu sich verjüngende Form, während die Nut 14 parallelflankig ist.
Die Ausführung gemäß Fig. 14 läßt sich sowohl ohne als auch mit Kragen am Prothesenkern benutzen. Während die Ausführung gemäß Fig. 14 die Version ohne Kragen darstellt, veranschau­ licht Fig. 15 die Alternative mit Kragen 7 am Prothesenkern 3.

Claims (8)

1. Bandscheibenendoprothese mit zwei Prothesenplatten (1, 2), die mit den Endplatten der zugehörigen Wirbelkörper zu verbinden sind, und einem Prothesenkern (3), der mit mindestens einer Prothesenplatte (1, 2) über eine eine Rotationsbewegung (10) um die Hochachse (9) gestattende Gelenkfläche (6) zusammenwirkt, dadurch gekennzeichnet, daß die Gelenkfläche (6) im Medianschnitt und im Frontal­ schnitt Krümmungsbögen von unterschiedlichem mittlerem Radius bildet.
2. Bandscheibenendoprothese nach Anspruch 1, dadurch gekenn­ zeichnet, daß der Krümmungsradius im Medianschnitt (Fig. 3) kleiner als im Frontalschnitt (Fig. 1) ist.
3. Bandscheibenendoprothese nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß der mittlere Krümmungsradius in der einen Hauptrichtung um den Faktor 1,2 bis 2,5 (vorzugswei­ se 1,5 bis 2) größer ist als in der quer dazu verlaufenden Hauptrichtung.
4. Bandscheibenendoprothese nach einem der Ansprüche 1 bis 3, dadurch gekennzeichnet, daß die Krümmungsbögen der Gelenk­ fläche (6) sowohl im Medianschnitt als auch im Frontal­ schnitt im wesentlichen Kreisbögen sind.
5. Bandscheibenendoprothese nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, daß der Prothesenkern (3) und die damit über eine Gelenkfläche (6) verbundene(n) Prothesen­ platte(n) mit zusammenwirkenden Anschlägen zur Begrenzung der Schwenkbewegung versehen sind.
6. Bandscheibenendoprothese nach Anspruch 5, dadurch gekenn­ zeichnet, daß der Prothesenkern (3) oder die Prothesenplat­ te(n) (1, 2) mit wenigstens einer Nut (12, 14) bzw. einer darin geführten Feder (Rippe 11, 13) versehen sind, die in der Hauptbewegungsrichtung verlaufen und mit Rotations­ spiel zueinander ausgerüstet sind.
7. Bandscheibenendoprothese nach Anspruch 5, dadurch gekenn­ zeichnet, daß der Prothesenkern (3) oder die Prothesen­ platte(n) (1, 2) einen den Rand (8) des jeweils anderen Teils mit Rotationsspiel umfassenden Kragen (7) aufweist (aufweisen).
8. Bandscheibenendoprothese nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, daß die Prothesenplatten (1, 2) mit zusammenwirkenden Anschlägen zur Begrenzung der Schwenkbewegung versehen sind.
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AT93102993T ATE144695T1 (de) 1992-03-13 1993-02-25 Bandscheibenendoprothese
DE59304327T DE59304327D1 (de) 1992-03-13 1993-02-25 Bandscheibenendoprothese
EP93102993A EP0560141B1 (de) 1992-03-13 1993-02-25 Bandscheibenendoprothese
US08/028,967 US5401269A (en) 1992-03-13 1993-03-10 Intervertebral disc endoprosthesis
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JPH067391A (ja) 1994-01-18
US5401269A (en) 1995-03-28
EP0560141A1 (de) 1993-09-15
ES2094393T3 (es) 1997-01-16
DE4208116A1 (de) 1993-09-23
EP0560141B1 (de) 1996-10-30

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