CN1964681B - 椎间盘假体 - Google Patents

椎间盘假体 Download PDF

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CN1964681B
CN1964681B CN2005800183618A CN200580018361A CN1964681B CN 1964681 B CN1964681 B CN 1964681B CN 2005800183618 A CN2005800183618 A CN 2005800183618A CN 200580018361 A CN200580018361 A CN 200580018361A CN 1964681 B CN1964681 B CN 1964681B
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plate
fuse
adapting device
intervertebral disk
disk prosthesis
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CN1964681A (zh
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W·泽格尔斯
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LDR Medical SAS
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    • A61F2002/30518Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements with possibility of relative movement between the prosthetic parts
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Abstract

本发明涉及一种椎间盘假体,它包括至少三个零件,所述三个零件包括上板(1)、下板(2)和活动芯子(3),活动芯子至少相对于下板(2)可活动,配合装置(23、33)能限制或消除所述芯子(3)相对于下板(2)分别绕基本平行于下板(2)的轴线平移和绕基本垂直于下板(2)的轴线转动,至少一个板的表面的至少一部分是弯曲的并与芯子(3)的曲面(30)互补且与之接触。其中芯子(3)的曲面(30)的顶点(31)相对于所述曲面(30)的中心(32)在至少一个方向上是偏心的。

Description

椎间盘假体
技术领域
本发明涉及一种椎间盘假体,用于代替纤维软骨盘,确保在脊柱的脊椎骨之间的结合。
背景技术
在本技术领域中各种类型的椎间盘假体是熟知的。许多假体,例如在专利申请FR 2846 550和WO 02 089 701中,包括一个下板和一个上板,它们形成一种围绕中心芯子的笼子。这些假体的一部分能够使上板相对于中心芯子旋转,可选择允许中心芯子相对于下板滑动。中心芯子相对于下板的这种滑动是一个必要特征,这是因为在带着假体的病人进行活动的过程中,它必须使中心芯子自动定位在理想位置中以吸收施加假体上的约束。中心芯子与至少一个板配合绕一个不平表面的位移能够使假体的板之间倾斜,这方便带着假体的病人的活动。中心芯子的位移也防止它在受到主要的约束时的蠕变。从现有技术特别是专利申请WO 03/075804A,DE203 10432U和DE 20310433U中,人们已经知道一种椎间盘假体,它包括与可选择的中心芯子的曲面相互配合的两块板。其中曲面在至少一个方向相对于假体的几何中心是偏心的,这些假体具有如下缺点,即两个相配合的曲面都偏心,因为这些假体不包括任何芯子或包括不能活动的芯子,因此不能使芯子自动定位在理想的位置以吸收施加在假体上的约束。大多数已知的假体还具有如下的缺点,即它们的曲面不具有圆形的周边,因而不允许这些板彼此相对转动。不能相对转动形成病人不舒服的来源,并由于该转动通常需要一种通过可活动的芯子来实现的平移而使情况更糟。
在这篇文章中,重要的是提出一种假体,它允许在板之间施加一个永久的倾斜和导致例如脊柱前突。根据带着假体的病人的脊柱的病症,有时优选的是假体允许这种病症的纠正。按照外科医生的意愿,中心芯子的位移在至少一个方向应当被限制。然而,当病人活动时,假体的元件的相对位置在允许的位移范围之内能够改变。
发明内容
本发明一些实施例的一个目的是提供一种椎间盘假体,它允许假体的不同零件彼此之间有限运动并包括一个用于限制其在至少一个方向位移的芯子。
一种椎间盘假体,包括至少三个零件,所述三个零件包括第一板、第二板和活动芯子,芯子相对于这些板中的至少一个至少以旋转方式活动,芯子具有一个曲面和一个基本上平的表面,所述曲面接触第一板的互补曲面的至少一部分,基本上平的表面接触第二板的一个基本上平的表面的至少一部分,位于第二板和芯子的周边附近的凸起和凹入配合装置限制或阻止芯子相对于第二板沿基本上平行于所述基本上平的表面的轴线的平移运动,并限制或阻止芯子相对于第二板绕基本上垂直于所述基本上平的表面的轴线的旋转运动,其中芯子的曲面的顶点在至少一个方向上相对于芯子的所述曲面的几何中心是偏心的。
根据另一个实施例,当病人不动时芯子的静止位置在与芯子的曲面的顶点的偏心方向相反的方向上转移,由于当板锚固在脊椎骨上时第一板和第二板的对称轴线是对齐的,与芯子的曲面互补的第一板的曲面导致芯子的所述曲面的偏心顶点与板的对称轴线对准,因此导致芯子在与其曲面的顶点的偏心方向相反方向上转移,这引起芯子上存在的配合装置和第二板上存在的配合装置的结合,这种结合因此限制了芯子在与曲面的顶点的偏心方向相反方向上的位移。
根据另一个实施例,同样的板能够和不同芯子组装,芯子之间的差别在于它们的曲面的顶点相对于芯子的所述曲面的中心的位置。
根据另一个实施例,同样的芯子能够和不同的板组装,板之间的差别在于表示板的上下表面的中间平面之间的角度。
根据另一个实施例,在上板的上表面和下板的下表面之间的角度能够通过代表第二板和/或第一板的上下表面的中间平面形成一个角度来产生,或通过借助于配合装置来限制芯子绕使至少一个板倾斜的一个位置运动来产生。
根据另一个实施例,同样的板能够与不同厚度和/或尺寸的芯子组装。
根据另一个实施例,芯子的曲面是芯子的凸起上表面,第一板曲面是上板下表面的凹入部分。
根据另一个实施例,每个凸起配合装置的尺寸稍微小于每个凹入配合装置的尺寸,以便允许在芯子和第二板之间有微小间隙。
根据另一个实施例,每个凸起装置的尺寸基本上与每个凹入装置的尺寸相同,以便防止在芯子和第二板之间的任何间隙。
根据另一个实施例,芯子是由聚乙烯制造的。
根据另一个实施例,第一板和第二板是由金属制造的。
根据另一个实施例,第二板包括与芯子的凸起装置配合的凹入装置。
根据另一个实施例,芯子的凸起装置是位于芯子两侧边缘上的两个接触板,第二板的凹入装置是四个壁,所述四个壁成对安置在第二板的两侧边缘的每一个上。
根据另一个实施例,构成第二板的凹入配合装置的壁朝向假体中心弯曲,以便覆盖芯子的凸起装置的至少一部分并阻止其提升。
根据另一个实施例,第二板包括与芯子的凹入装置配合的凸起装置。
根据另一个实施例,第二板的凸起装置是在假体两个边缘上的彼此面对的两个接触板,芯子的凹入装置是两个凹槽。
根据另一个实施例,第二板的凸起装置是在假体两个边缘附近的彼此面对的两个壁,芯子的凹入装置是凹槽。
根据另一个实施例,第二板的凸起装置是在假体两个边缘上的朝向假体内部弯曲并彼此面对的两个突起,芯子的凹入装置是两个凹槽。
根据另一个实施例,突边的至少一个由配置有孔的接触板代替,凸耳通过贯穿该孔的销子固定在接触板上。
根据另一个实施例,第一板在其上表面的至少一部分是凸起的,在适应脊椎骨的形状。
附图说明
在下面参考附图给出的描述中将介绍各种实施例的其他特征和优点,其中:
图1a和1b分别示出根据本发明一个实施例的假体的芯子的侧视图和顶视图。
图2a和2b分别示出本发明第一实施例中的假体的前视图和侧视图,图2c和2d分别示出本发明第二实施例中的假体的前透视图和侧视图。
图3a和3b分别示出本发明一个实施例中的假体下板的顶视图和根据图3a的平面A-A的断面图,图3c示出带有芯子的下板的顶视图,图3d和3e分别示出本发明一个实施例中的假体上板的顶视图和根据图3d的平面B-B的断面图。
具体实施方式
根据本发明一个实施例的椎间盘假体包括第一板1、第二板2和芯子3,第一板1通过芯子3相对于第二板2是活动连接的,特别地在图2a到2d中可明显看出。在下列描述中,根据附图中示出的假体所给定的方位,第一板1称为上板,第二板2称为下板。在不偏离本发明的范围的情况下,这里描述的假体也能够反向定位在脊椎骨之间,这样第一板1将是下板,第二板2将是上板。如下面所描述的,第一板包括一个曲面(凹入的或凸起的),该曲面和芯子的互补曲面(凸起的或凹入的)配合。第二板包括一个基本上平的表面,该表面和芯子的基本上平的表面配合。所描述的这些各种表面在不偏离本发明的范围的情况下可以属于假体的第一板和第二板中的任何一个。
根据本发明的这个实施例的假体的一个优点是,它包括一些简单的零件,这些零件的尺寸能够确定以适合于脊柱的不同脊椎骨。
芯子3厚度较薄(从3到15mm,取决于假体要插入在其间的脊椎骨)。为了使约束被良好吸收,芯子3可以例如由聚乙烯制造,它是一种模拟自然椎间盘的弹性的物理性能的可压缩材料。
芯子3优选地在其上下表面中的至少一个的至少一部分上具有凸起部30。优选地,芯子3也具有凸起或凹入的配合装置33,该配合装置与在至少一个板1、2上存在的各自凹入或凸出的配合装置23是互补的。
现在将参照图1到3对这些实施例中的一个作一描述。在这个实施例中,芯子3的上表面具有凸起部30,特别地在图1a中可清楚看出。芯子3的这个凸起表面和上板1的凹入部10是互补的,在图3d和3e中特别明显。如在图1A和1B中特别清楚地示出的,芯子3的凸起部30适于与上板1的凹入部10配合,上板1的凹入部10的圆形周边例如通过使上板1在凸起部30上倾斜(任何方向)沿着芯子3的凸起部30位移。芯子3的凸起部30因此经常通过凹入部的互补曲面之间的接触靠在上板1的具有圆形周边凹入部10上。当带着假体的病人弯曲时,这个凹入部10使上板1倾斜。芯子3的下表面和下板2的上表面可以是平面,以便允许芯子3相对于下板2具有间隙,该间隙出现在根据基本上平行于下板2的一条轴线的平移方向,以及出现在绕基本上垂直于下板2的一条轴线旋转的旋转方向。另外,芯子3的凸起表面30和上板1的圆形凹入部10的形状的互补使上板1在芯子3上绕一个基本垂直于上板1的轴线旋转。在带着假体的病人活动时,上板1的这种倾斜和芯子的这种间隙将允许芯子3朝向理想位置移动以吸收施加到假体的约束。因此,在上板1和芯子3之间的运动以及芯子3相对于下板2的间隙允许病人活动,并选择地消除定位该假体的缺陷。这种间隙同样具有防止由于施加到假体的约束引起的过早磨损的优点。
根据一些实施例的椎间盘假体允许例如修正脊柱前突的缺陷。希望在假体的上板1和下板2之间存在一个角度。这样的一个角度能够通过制造上板来得到,上板的代表其上下表面的中间平面形成一个角度。另一种可能性涉及下板,它的代表其上下表面的中间平面形成一个角度,如图2c和2d中示出的,其中下板2的下表面20和其上表面形成一个角度。得到这样一个角度的另一种可能性只有通过与本发明优选实施例同样类型的假体来实现,并在于芯子相对于假体的中心的稍微偏置地放置。芯子的这个稍微偏置放置能够例如通过调整凸起和凹入的配合装置之间的位置来维持。如果外科医生例如希望假体产生保持在一个数值范围的脊柱前突,他将选择这样一种假体,由于在芯子3和下板2之间的配合装置的精确调节,假体的芯子3在相对于下板2的平移方向和旋转方向但在使至少一个板有一个轻微的永久倾斜的位置附近具有轻微的间隙。
根据优选实施例的假体具有这样一个特征,该假体一旦定位在病人的脊椎骨之间将改善其性能。这个特征在于这样一个事实,即芯子3的曲面30的顶点31即这个曲面的最高点31(在侧视图中),相对于芯子3的这个曲面30的几何中心32即与曲面周边中的任何点等距离的点32(在顶视图中)或芯子3的纵向和横向对称轴的交叉点,是偏心的。在所示的一些例子中,芯子3的曲面30是凸起的,第一板的曲面是上板1下表面的凹入部分10。但是明显的是本假体的各种元件能够重新设置,以使凸起表面在一个板上,凹入表面在芯子上。和这个凸起表面30互补的上板1的凹入部分10的中心绕凸起表面30的顶点31旋转。虽然上板绕这个顶点31是可动的,但是上板1将因此平均地定心在芯子3的凸起表面30的顶点31上,因为上板1的凹入部分绕凸起表面30的顶点31旋转。经过两个相邻脊椎骨的中心的竖直轴线一般地是对齐的,即使它们取决于病人的活动或取决于脊柱的所讨论的区域可能稍微倾斜。因此重要的是在静止位置时,经过板1、2中心的和经过芯子3的凸起表面30的顶点31的竖直轴线也是对齐的。既然这些轴线是对齐的,芯子3的凸起表面30的偏心顶点31一定处在这些板的中心的轴线上,芯子的中心相对于下板2是偏心的。这样芯子3的静止位置相对于假体的中心将是偏心的。如图3C中示出的,其中为了清晰起见上板1未示出,芯子相对于假体中心是偏心的,芯子3的配合装置33在用虚线圈起的区域中接触下板2的配合装置23。图2B也强调芯子3相对于假体中心的侧视图的这种转移。芯子3的转移及配合装置33和下板配合装置23之间的接触也将限制芯子3在与凸起表面30的顶点31偏离中心的方向相反方向上的位移。然后,我们能够选择芯子3的凸起表面30的顶点31要转移的方向和幅度,以便实现希望的位移减小。然后,芯子3例如只能在顶点31相对于芯子3的凸起表面30的中心32转移的方向上位移。如果带着根据这个实施例的假体的病人在与顶点31的这个转移相反方向上弯身,那么芯子3能够在顶点31的这个转移的方向上运动,从而减小在经过这些板中心的竖直轴线之间的转移,如果芯子3的凸起表面30的顶点31不是偏心的,该转移将会发生。因此,这个特征的一个必然后果是甚至在病人弯身时它允许永久地限制在经过假体中心的竖直轴线之间的转移。例如,我们能够选择一种芯子3,它的凸起表面30的顶点31是向后偏心的,以致在静止位置中的芯子完全地偏心到假体的前部并且不能够再向前位移。这样一种芯子因此限制芯子向前面的位移并减小病人能够向后弯曲的角度。然而,如果病人向前弯曲,上板1向前面倾斜,从而导致经过上板中心的竖直轴线相对于经过下板2中心的竖直轴线的转移。然而,这种转移通过使芯子3向假体的后面位移而被消除。当上板绕芯子3的凸起表面30的偏心顶点31可动时,这种转移可以更好地消除。然后,带有偏心顶点31的芯子3楔入其在假体中的开孔的后部,允许经过这些板中心的竖直轴线比带有偏心顶点的芯子更好地对齐。
一些实施例的另一个优点涉及假体在接受病人的脊椎骨之间的植入。在带有可动芯子的假体的植入过程中,假体的芯子倾向于运动到在假体中其开孔内的行程的远端。这样,病人装有一个对他/她的脊柱产生稍微倾斜的假体。一旦他/她已从手术中恢复,由于病人的活动,这种倾斜能够清除。然而,这种倾斜引起病人相当大的不舒服。由于根据优选实施例的假体的芯子3顶点31的偏心设置,芯子3将趋向于运动到偏心的静止位置,其中顶点31相对于上下板的轴线是对齐的。由于假体轴线的这种自发对齐,在静止位置板不产生任何倾斜,病人将已装上不引起任何不舒服的假体。
在图1到3的实施例中,芯子3具有凸起配合装置33,它和下板2上存在的凹入配合装置23是互补的。芯子3的凸起配合装置33例如是基本上为平行六面体形状的搭扣,如图1a和1b中具体可见的。如图3a和3b中具体所示,凹入配合装置23例如可以包括成对地安置在下板2的两个侧边缘中的每一个上的四个壁。这些壁能够朝向假体中心轴,以便覆盖芯子3的凹入配合装置23的至少一部分,以及避免提升芯子3和上板1。在图1到3示出的这个实施例中,芯子3的每个凸起装置33的尺寸稍微小于下板2的每个凹入装置22的尺寸,以便允许芯子3相对于下板2的一个有限间隙,这个间隙出现在根据基本上平行于下板2的一条轴线的平移方向以及在绕基本上垂直于下板2的一条轴线的旋转方向。这些配合装置23,33还在假体上施加太多约束时防止芯子3从假体弹出。
在未示出的一个可选实施例中,芯子3的每个凸起配合装置33的尺寸基本上与下板2的每个凹入配合装置23的尺寸相同,以便避免芯子3相对于下板2在平移方向和在旋转方向的任何间隙。在旋转情况中,假体的唯一允许运动是上板1相对于芯子3的运动。
在未示出的一个可选实施例中,芯子3具有凹入配合装置,该凹入装置例如包括下板2上存在的凸起装置的互补凹槽。下板2的这些凸起装置例如可以包括两个接触板或两个突边,接触板或两个突边例如在下板2的两个边缘上朝向假体内部并彼此相对弯曲。
在未示出的另一个可选实施例中,下板2具有榫钉。芯子3在其下表面下补充有两个井孔。下板2的榫钉和芯子3的井孔的尺寸将适应根据选择的芯子在平移中和在旋转中的轻微间隙或任何间隙的希望结果。
在未示出的一个可选实施例中,上板1上表面的一部分是凸起的,以便较好地适应假体将要安置在其上的脊椎骨,脊椎骨的下表面是空的。那么,上板1的凸起部安置位于上板的前部。因为脊椎骨的上表面基本上是平的,当下板的下表面没有必要是凸起的或空的时,下板2基本上是平的。
对于专家们来说,必要明显的是,在不偏离所述的本发明要求保护的申请范围的情况下,本发明可以有许多其他特别形式的实施例。因此,实施例必须通过说明来考虑,但是在附录权利要求所限定的范围内能够改变,本发明不一定局限于上面给出的细节。

Claims (20)

1.一种椎间盘假体,包括至少三个零件,所述三个零件包括第一板(1)、第二板(2)和芯子(3),芯子(3)具有一个曲面和一个基本上平的表面,所述曲面接触第一板(1)的互补曲面的至少一部分,所述基本上平的表面接触第二板(2)的一个基本上平的表面的至少一部分,其中:
-芯子(3)的曲面(30)的顶点(31)在至少一个方向上相对于芯子(3)的所述曲面(30)的几何中心是偏心的,
-芯子(3)相对于这些板(1、2)中的至少一个是活动的;
-位于第二板(2)和芯子(3)的周边附近的凸起和凹入配合装置(23、33)限制芯子(3)相对于第二板沿基本上平行于所述基本上平的表面的轴线的平移运动,并限制芯子相对于第二板绕基本上垂直于所述基本上平的表面的轴线的旋转运动。
2.如权利要求1所述的椎间盘假体,其中当病人不动时芯子(3)的静止位置在与芯子(3)的曲面(30)的顶点(31)的偏心方向相反的方向上转移,由于当板锚固在脊椎骨上时第一板(1)和第二板(2)的对称轴线是对齐的,与芯子(3)的曲面(30)互补的第一板(1)的曲面(10)导致芯子(3)的所述曲面(30)的偏心顶点(31)与板(1、2)的对称轴线对准,因此导致芯子(3)在与其曲面(30)的顶点(31)的偏心方向相反方向上转移,这引起芯子(3)上存在的配合装置(33)和第二板(2)上存在的配合装置(23)的结合,这种结合因此限制了芯子(3)在与曲面(30)的顶点(31)的偏心方向相反方向上的位移。
3.如权利要求1所述的椎间盘假体,其中同样的板(1、2)能够和不同芯子(3)组装,芯子(3)之间的差别在于它们的曲面(30)的顶点(31)相对于芯子(3)的所述曲面(30)的中心(32)的位置。
4.如权利要求1所述的椎间盘假体,其中同样的芯子(3)能够和不同的板(1、2)组装,板之间的差别在于表示板的上下表面的中间平面之间的角度。
5.如权利要求1所述的椎间盘假体,其中在所述假体的所述第一板(1)和所述第二板(2)之间的角度能够通过代表第二板(2)和/或第一板(1)的上下表面的中间平面形成一个角度来产生,或通过借助于所述配合装置(23、33)来限制芯子(3)绕使至少一个板(1、2)倾斜的一个位置运动来产生。
6.如权利要求1所述的椎间盘假体,其中同样的板(1、2)能够与不同厚度和/或尺寸的芯子(3)组装。
7.如权利要求1所述的椎间盘假体,其中芯子(3)的曲面(30)是芯子(3)的凸起上表面,第一板(1)曲面是第一板(1)的凹入部分。
8.如权利要求1所述的椎间盘假体,其中每个凸起配合装置(33)的尺寸稍微小于每个凹入配合装置(23)的尺寸,以便允许在芯子(3)和第二板(2)之间有微小间隙。
9.如权利要求1所述的椎间盘假体,其中每个凸起配合装置(33)的尺寸基本上与每个凹入配合装置(23)的尺寸相同,以便防止在芯子(3)和第二板(2)之间的任何间隙。
10.如权利要求1所述的椎间盘假体,其中芯子(3)是由聚乙烯制造的。
11.如权利要求1所述的椎间盘假体,其中第一板(1)和第二板(2)是由金属制造的。
12.如权利要求1所述的椎间盘假体,其中第二板(2)包括与芯子(3)的凸起配合装置(33)配合的凹入配合装置(23)。
13.如权利要求12所述的椎间盘假体,其中芯子(3)的凸起配合装置(33)是位于芯子(3)两侧边缘上的两个接触板,第二板(2)的凹入配合装置(23)是四个壁,所述四个壁成对安置在第二板(2)的两侧边缘的每一个上。
14.如权利要求13所述的椎间盘假体,其中构成第二板(2)的凹入配合装置(23)的壁朝向假体中心弯曲,以便覆盖芯子(3)的凸起配合装置(33)的至少一部分并阻止其提升。
15.如权利要求1所述的椎间盘假体,其中第二板(2)包括与芯子(3)的凹入配合装置配合的凸起配合装置。
16.如权利要求15所述的椎间盘假体,其中第二板(2)的凸起配合装置是在假体两个边缘上的彼此面对的两个接触板,芯子(3)的凹入配合装置是两个凹槽。
17.如权利要求15所述的椎间盘假体,其中第二板(2)的凸起配合装置是在假体两个边缘附近的彼此面对的两个壁,芯子(3)的凹入配合装置是凹槽。
18.如权利要求15所述的椎间盘假体,其中第二板(2)的凸起配合装置是在假体两个边缘上的朝向假体内部弯曲并彼此面对的两个突起,芯子(3)的凹入配合装置是两个凹槽。
19.如权利要求18所述的椎间盘假体,其中所述突起中的至少一个由配置有孔的接触板代替,凸耳通过贯穿该孔的销子固定在接触板上。
20.如权利要求1所述的椎间盘假体,其中第一板(1)在其上表面的至少一部分是凸起的,以适应脊椎骨的形状。
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FR2869528B1 (fr) 2007-02-02
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US20050246024A1 (en) 2005-11-03
US9445915B2 (en) 2016-09-20
IL178842A0 (en) 2007-03-08
KR20070004069A (ko) 2007-01-05
WO2005104996A1 (en) 2005-11-10
BRPI0510391A (pt) 2007-11-13
IL178842A (en) 2011-11-30
MXPA06012459A (es) 2007-01-31
US8002835B2 (en) 2011-08-23
RU2006141843A (ru) 2008-06-10
US20090157188A1 (en) 2009-06-18
JP4986846B2 (ja) 2012-07-25
US20180235770A1 (en) 2018-08-23
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US20150245918A1 (en) 2015-09-03
US8974532B2 (en) 2015-03-10
ZA200608883B (en) 2008-11-26
RU2361546C2 (ru) 2009-07-20
US20120053693A1 (en) 2012-03-01
CA2564987A1 (en) 2005-11-10
JP2007534410A (ja) 2007-11-29
FR2869528A1 (fr) 2005-11-04
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EP1750624A1 (en) 2007-02-14
US7494508B2 (en) 2009-02-24

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