CN111839835B - Intervertebral fusion fixer for lateral anterior approach vertebral body reconstruction - Google Patents
Intervertebral fusion fixer for lateral anterior approach vertebral body reconstruction Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS 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
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS 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
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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- A61F2230/0069—Three-dimensional shapes cylindrical
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Abstract
The invention discloses an intervertebral fusion fixator for reconstructing a lateral anterior approach vertebral body, relates to the field of medical instruments, and solves the technical problem of providing a fusion fixator used in cooperation with a lateral anterior approach operation of cervical vertebra. The technical scheme adopted by the invention is as follows: the fusion fixing device comprises a fusion fixing body and screws, wherein the fusion fixing body comprises a vertebral body fusion part and an intervertebral fusion part, the vertebral body fusion part is of a columnar structure in the vertical direction, the vertebral body fusion part comprises four side surfaces, namely a front side surface, a back side surface, a left side surface, a right side surface and a top bottom surface, a first bone implantation cavity is arranged between the top bottom surfaces, a second bone implantation cavity is arranged between the left side surface and the right side surface, the upper part of the left side surface, the lower part of the left side surface, the upper part of the right side surface or the lower part of the right side surface of the vertebral body fusion part is connected with the intervertebral fusion part, and the intervertebral fusion part is provided with a third bone implantation cavity; the fusion fixing body is also provided with at least two screws which are respectively used for fixing with the residual vertebral body with relatively large size and the adjacent vertebral bodies at the upper side and the lower side. The invention is suitable for the cervical vertebra side front approach operation.
Description
Technical Field
The invention relates to the field of medical instruments, in particular to an intervertebral fusion fixator in orthopedic medicine.
Background
Cervical spondylolisthesis (Anterior cervical vertebral total ablation cervical fusion, ACCF) is suitable for patients who do not achieve good spinal decompression following simple discectomy. For patients with both anterior and posterior spinal compression, combined posterior canal enlargement can be considered on the basis of ACCF. The ACCF is also an ideal choice for patients with vertebral body lesions (tumors, etc.), cervical dislocation and kyphotic deformity. The internal implant materials such as the anterior cervical steel plate, the titanium mesh and the like improve the initial stability, the supporting strength and the bone grafting fusion rate of the ACCF operation.
According to the physiological structure characteristics of the vertebral body, the esophagus and the trachea are arranged in front of the cervical vertebral body, the trachea and the esophagus need to be pulled in the existing cervical anterior approach operation, the front of the vertebral body is exposed, and then the related operation is carried out. Traction of the esophagus and trachea in the approach operation in front of the cervical vertebra can increase the risk of postoperative dysphagia.
Dysphagia refers to a condition caused by difficulty in smoothly and safely feeding a bolus in the mouth into the stomach. The oral pharyngeal dysphagia and the esophageal dysphagia can be classified according to the site where the dysphagia occurs. Dysphagia can be classified into functional, structural and neurological dysphagia according to the cause of the dysphagia. Central nervous system lesions of the brain, peripheral neuromuscular junction lesions, and esophageal smooth muscle injuries can all cause dysphagia, see literature: clave P, Shaker R.Dysphagia: current reliability and scope of the recipe [ J]Nat Rev Gastroenterol Hepatol 2015,12(5): 259-270. Any irritation or irritation of the esophagus, such as intraoperative esophageal traction, and stimulation of the anterior cervical steel plate, is believed to have an effect on the development of postoperative dysphagia. Dysphagia is considered to be the result of a multifactorial complex effect, and the specific overall mechanism remains to be further studied. The dysphagia influencing factors which are relatively accepted by scholars at home and abroad at present comprise: age, sex, C4To C6Surgical segment, right side Smith-Robinson approach, high incisional steel plate, intraoperative esophageal traction time and strength, use of hormones, application of BMP, etc., see literature: rosenthal BD, Nair R, Hsu WK, et al Dysphahaga and Dysphania Association Tools After inorganic plasma proton Surgery [ J]Clin spin Surg, 2016. Dysphagia can cause patient discomfort, reduce patient surgical satisfaction, and can also cause various complications such as aspiration pneumonia, dehydration, malnutrition, etc. Rihn et al report that the incidence of dysphagia following anterior cervical surgery is as high as 70%, see literature: rihn JA, Kane J, Albert TJ, et al, where the affinity and sensitivity of a dysphaia after organism scientific supply [ J]Clin Orthopsrelat Res,2011,469(3): 658-665. Yue WM et al performed a clinical study with up to 7 years follow-up and reported that dysphagia still occurred in 30% of patients at their last follow-up, see literature: yue WM, Brodner W, Highland TRallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating:a 5to 11-year follow-up study[J].Eur Spine J,2005,14(7):677-682。
Aiming at the problem that the anterior approach operation of cervical vertebra, namely the anterior ACCF operation, can obviously increase the occurrence risk of dysphagia, a new approach mode for operation is proposed: a lateral and anterior approach operation of cervical vertebra. When the anterior approach operation of cervical vertebra side, after drawing off arterial sheath, the long neck muscle is stripped off and exposed to reach the anterior position of centrum side, and esophagus drawing is not needed in the operation process. Taking partial excision and decompression of the C5 vertebral body as an example, when excision is performed, the vertebral body is firstly cut into the vertebral body from the side surface almost in parallel, and then expanded when half of the vertebral body is cut, the operation visual field is expanded, excision of tissues such as osteophytes, calcified fibrous rings and the like in the rear range of the vertebral body is completed, decompression of the spinal cord is completed, and compression on nerves and the spinal cord is relieved.
The approach operation of the cervical vertebra side front is minimally invasive, the esophagus does not need to be pulled, the incidence rate of postoperative dysphagia can be obviously reduced theoretically, and meanwhile, normal structures such as the fibrous ring and the anterior longitudinal ligament in the front of the intervertebral space can be reserved. The anterior approach operation of cervical vertebra side not only can increase the stability of postoperative patient operation section, moreover because normal tissue such as fibrous ring, ligament exists, interior implant need not direct contact esophagus, consequently can reduce postoperative dysphagia incidence from a plurality of aspects.
The internal implant instruments such as the fixing plate used in the anterior approach operation of the cervical vertebrae cannot be applied to the anterior approach operation of the lateral cervical vertebrae. The visual field of the cervical vertebra anterior approach operation is different from the visual field of the cervical vertebra lateral anterior approach operation, the surgical visual field of the cervical vertebra anterior approach operation is relatively small, and the cervical vertebra lateral approach operation reaches the vertebral body lateral space; the latter surgery has a larger visual field in front of the vertebral body, and currently, a special matched internal implant instrument is lacked. If fusion fixation is forcibly performed using an existing instrument, the following problems arise: (1) failure to implant, even if implanted, can damage surrounding normal structures; (2) can not be fixed; (3) damage to the anterior annulus fibrosus and ligaments can result in damage to surrounding structural tissues such as muscles, ligaments, nerves, etc. as a result of violent traction. In addition, the front of the cervical vertebra is flat and wide, the existing screw fixing holes and fixing methods cannot be used in the visual field of approach in front of the side of the cervical vertebra, and special matching instruments are lacked.
The approach of the operation at the front side of the cervical vertebra can reduce the risk of dysphagia, increase the stability of the post-operation segment, promote early rehabilitation training and ensure that the patient returns to normal life as soon as possible. However, since the operation space for the lateral anterior approach is small and the approach from the lateral side is not possible to perform the operation such as screw fixation using the conventional fusion fixator, there is no fusion fixator suitable for the lateral anterior approach of cervical vertebrae.
Disclosure of Invention
The invention aims to solve the technical problem of providing a fusion fixator used in cooperation with a lateral and anterior approach operation of cervical vertebra, and aims to reduce fusion time, improve the success rate of bone grafting fusion and reduce the probability of postoperative dysphagia.
The technical scheme adopted by the invention for solving the technical problems is as follows: the intervertebral fusion fixer for reconstructing the vertebral body with the lateral front approach comprises a fusion fixing body and screws, wherein the fusion fixing body comprises a vertebral body fusion part and an intervertebral fusion part, the vertebral body fusion part is of a columnar structure in the vertical direction, four side surfaces of the vertebral body fusion part are respectively a front side surface, a back side surface, a left side surface and a right side surface, a first bone implantation cavity is arranged between the top surface and the bottom surface of the vertebral body fusion part, a second bone implantation cavity is arranged between the left side surface and the right side surface, the upper part of the left side surface, the lower part of the left side surface, the upper part of the right side surface or the lower part of the right side surface of the vertebral body fusion part are connected with the intervertebral fusion part, the intervertebral fusion part is of a plate-shaped structure, and a third bone implantation cavity is arranged between the top surface and the bottom surface of the intervertebral fusion part;
the fusion fixing body is also provided with at least two screw holes and matched screws, one end of each screw hole for feeding the screw is positioned on the front side surface of the vertebral body fusion part or the front side surface of the intervertebral fusion part, at least one first screw penetrates from the front side surface of the fusion fixing body and points to the area enclosed by the vertebral body fusion part and the intervertebral fusion part, and at least one second screw penetrates from the front side surface of the fusion fixing body and points to the upper part or the lower part of the intervertebral fusion part.
Further, the method comprises the following steps: the vertebral body fusion part and the intervertebral fusion part are integrally or movably connected. Specifically, the method comprises the following steps: the movable connection is that the vertebral body fusion part is connected with the intervertebral fusion part through a buckle or a ball groove.
Further, the method comprises the following steps: the first bone grafting cavity is communicated with the second bone grafting cavity.
Specifically, the method comprises the following steps: the outer contour of the intervertebral fusion part on the horizontal section is crescent, oval or fan-shaped.
Further, the method comprises the following steps: the upper part of the left side surface of the vertebral body fusion part and the lower part of the left side surface are connected with the intervertebral fusion part and are axially symmetrical about a horizontal plane, and the upper part of the right side surface of the vertebral body fusion part and the lower part of the right side surface are connected with the intervertebral fusion part and are axially symmetrical about the horizontal plane; the upper part of the left side surface of the vertebral body fusion part and the upper part of the right side surface of the vertebral body fusion part are connected with the intervertebral fusion part, and the two structures are axially symmetrical about the sagittal plane.
Specifically, the method comprises the following steps: the fusion fixing body is provided with two screw holes and two screws, the two screws are respectively a first screw and a second screw, and one ends of the two screw holes, which are used for feeding the screws, are positioned on the front side surface of the vertebral fusion part. More specifically: the lower part of the right side surface of the vertebral body fusion part is connected with the intervertebral fusion part; the projection of the axial direction of the first screw on the sagittal plane is inclined upwards by 40-50 degrees relative to the horizontal plane, and the included angle formed by the projection of the axial direction of the first screw on the horizontal plane and the coronal plane is 15-30 degrees; the projection of the axial direction of the second screw on the sagittal plane is inclined downwards by 40-50 degrees relative to the horizontal plane, and the included angle formed by the projection of the axial direction of the second screw on the horizontal plane and the coronal plane is 15-45 degrees.
Or the fusion fixing body is provided with three screw holes and three screws, one ends of the three screw holes, which are used for feeding the screws, are positioned on the front side surface of the vertebral body fusion part, and the three screws are respectively a first screw, a second screw and a third screw; two screw holes of the three screw holes are used for leading one ends of screws to be respectively positioned on the left side surface and the right side surface of the vertebral body fusion part, and the screws in the two screw holes are respectively a first screw and a third screw. Specifically, the method comprises the following steps: the lower part of the right side surface of the vertebral body fusion part is connected with the intervertebral fusion part; the projection of the axial direction of the first screw on the sagittal plane is inclined upwards by 40-50 degrees relative to the horizontal plane, and the included angle formed by the projection of the axial direction of the first screw on the horizontal plane and the coronal plane is 15-30 degrees; the projection of the axial direction of the second screw on the sagittal plane is inclined downwards by 40-50 degrees relative to the horizontal plane, and the included angle formed by the projection of the axial direction of the second screw on the horizontal plane and the coronal plane is 15-45 degrees; the projection of the axial direction of the third screw on the sagittal plane is inclined upwards by 40-50 degrees relative to the horizontal plane, and the included angle formed by the projection of the axial direction of the third screw on the horizontal plane and the coronal plane is 45-75 degrees.
The invention has the beneficial effects that: firstly, through the lateral anterior approach operation of cervical vertebra and the lateral anterior approach vertebral body reconstruction intervertebral fusion fixator, the existing anterior ACCF operation is changed into the cervical anterior discectomy decompression fusion operation (ACDF operation) with two gap fusion, the crawling replacement distance of bones is shortened, so the fusion time is shortened, the fusion efficiency of a patient is increased, the postoperative recovery time is shortened, and the rapid rehabilitation is facilitated. Secondly, in the operation processes of implanting the fusion cage, implanting bones, fixing screws and the like, because the esophagus does not need to be pulled, and artificial materials such as internal implants and the like do not directly contact with the esophagus, the direct stimulation and interference on the esophagus can be avoided, and the incidence rate of postoperative dysphagia is remarkably reduced. And the third bone grafting cavity is favorable for healing of the removed vertebral body and can also realize bony healing of the removed vertebral body reconstruction part and the adjacent vertebral body end plate. The fusion fixator improves the success rate of bone grafting fusion, and patients do not need to wear external fixation tools such as neck supports for a long time after operation, can return to normal work and life earlier, has small psychological influence on the patients, and is favorable for reducing the burden of sanitation and economy. Fourthly, the fusion fixator can meet the operation requirements of minimally invasive surgery of lateral anterior approach surgery, can be implanted and subjected to screw fixation operation, and solves the problem that the conventional ACCF surgery internal fixation instrument cannot be used in lateral anterior approach surgery. Fifth, in the operation process of implanting the fusion fixator of the present invention, the anterior and contralateral fibrous rings and anterior longitudinal ligament of the patient can be preserved, the normal tissue of the patient can be preserved as much as possible, the segmental stability of the patient can be maintained to the maximum extent, the neck support does not need to be worn after the operation, the neck activity and rehabilitation training can be performed earlier, and the early rehabilitation of the patient is facilitated.
The vertebral body fusion part and the intervertebral fusion part are movably connected, and the vertebral body fusion part and the intervertebral fusion part can rotate relatively in a small range, so that the vertebral bodies can rotate in a small range. The first bone grafting cavity and the second bone grafting cavity are communicated with each other, so that the bone grafting fusion is facilitated.
Drawings
Fig. 1 is a schematic view illustrating a procedure of the anterior approach of cervical vertebrae of the present invention.
FIG. 2 is a schematic structural view of a fusion anchor according to an embodiment of the present invention.
Fig. 3 is a schematic view of the fusion anchor of fig. 2 in mated position with a vertebral body.
Reference numerals: a vertebral body fusion part 1, an anterior side surface 11, a posterior side surface 12, a left side surface 13, a right side surface 14, a top surface 15, a bottom surface 16, a first bone grafting cavity 17 and a second bone grafting cavity 18; a second screw outlet hole 19-2 and a third screw outlet hole 19-3; the intervertebral fusion part 2 and the third bone grafting cavity 21; a first residual vertebral body 31, a second residual vertebral body 32.
Detailed Description
As shown in fig. 1, the excision process of the cervical vertebra side anterior approach operation related to the invention is roughly as follows: first, the resection is performed in parallel in a straight direction from the anterior side of the vertebral body, and the incision does not penetrate to the vertebral foramen. The incision can be made on either the left or right anterior side of the vertebral body, with the left side of figure 1 showing the incision on the anterior left side of the vertebral body. Then, the incision is expanded bilaterally to enlarge the surgical field, as shown in fig. 1. Finally, the excision of osteophytes, calcified fibrous rings and other tissues in the rear range of the vertebral body is completed, and the excision process is completed, as shown in the right part of the figure 1. For convenience of description, the vertebral body to be resected is referred to as a resected vertebral body, the upper and lower vertebral bodies are adjacent vertebral bodies, and the left and right residual portions of the incision of the resected vertebral body are respectively referred to as a first residual vertebral body 31 and a second residual vertebral body 32, as shown on the right of fig. 1.
The invention relates to a lateral anterior approach vertebral body reconstruction intervertebral fusion fixator, which is used for reconstructing a resected vertebral body and fusing and fixing the resected vertebral body and adjacent vertebral bodies on the upper side and the lower side. The invention will be further explained with reference to the drawings.
The invention discloses an intervertebral fusion fixer for reconstructing lateral anterior approach vertebral body, which comprises a fusion fixing body and a screw, wherein one structure of the fusion fixing body is shown as figure 2. The fusion fixing body comprises a vertebral body fusion part 1 and an intervertebral fusion part 2, the vertebral body fusion part 1 is of a columnar structure in the vertical direction, for convenience of description, four side surfaces of the vertebral body fusion part 1 are respectively marked as a front side surface 11, a back side surface 12, a left side surface 13 and a right side surface 14 according to the orientation relation of the fusion fixing body relative to a human body after the fusion fixing body is implanted into the human body, wherein the front side surface 11, the back side surface 12, the left side surface 13 and the right side surface 14 approximately correspond to the front side, the back side, the left side and the right side of the human body. The other two surfaces of the vertebral body fusion part 1 are a top surface 15 and a bottom surface 16, respectively, which correspond to the upper and lower parts of the human body, respectively.
The vertebral body fusion 1 is used to implant the incision site of the resected vertebral body, see fig. 3. The height of the vertebral body fusion 1 is approximately half the length of the resected vertebral body. The vertebral body fusion part 1 is quadrangular in horizontal section, and the corresponding sides of the left side surface 13 and the right side surface 14 are flat and straight and are respectively used for being attached and fixed with the resection surfaces of the first residual vertebral body 31 and the second residual vertebral body 32. The corresponding edges of the front side surface 11 and the back side surface 12 of the vertebral body fusion part 1 can be straight, and the better proposal is that the edges are in certain radian, and the front side surface 11 and the back side surface 12 are cambered surfaces or curved surfaces, so that the vertebral body fusion part 1 can better adapt to the physiological shape of the vertebral body. A first bone graft cavity 17 is provided between the top surface 15 and the bottom surface 16 of the vertebral body fusion 1. The first bone graft cavity 17 is circular, oval or otherwise shaped in horizontal cross-section for effecting intervertebral fusion of the resected vertebral body with an adjacent vertebral body. A second bone graft cavity 18 is provided between the left side 13 and the right side 14 of the vertebral body fusion 1, the second bone graft cavity 18 being used to resect the fusion between the two residual vertebral bodies, i.e. the first residual vertebral body 31 and the second residual vertebral body 32. The first bone grafting cavity 17 and the second bone grafting cavity 18 are communicated with each other.
The upper part of the left side surface 13, the lower part of the left side surface 13, the upper part of the right side surface 14 or the lower part of the right side surface 14 of the vertebral body fusion part 1 are connected with the intervertebral fusion part 2. The fusion fixation body comprises the four schemes. When the incision is positioned at the left front side of the excised vertebral body, as shown in fig. 1 and 3, two fusion fixing bodies which need to be used are respectively an upper part of the right side surface 14 of the vertebral body fusion part 1 connected with the intervertebral fusion part 2 and a lower part of the right side surface 14 of the vertebral body fusion part 1 connected with the intervertebral fusion part 2, the vertebral body fusion parts 1 of the two fusion fixing bodies are both implanted into the incision, the intervertebral fusion parts 2 are respectively implanted into the upper side and the lower side of the excised vertebral body, and the total height of the vertebral body fusion parts 1 of the two fusion fixing bodies is consistent with the height of the excised vertebral body. The upper connecting interbody fusion 2 of the right side 14 of the vertebral body fusion 1 is axially symmetric about the horizontal plane with the lower connecting interbody fusion 2 of the right side 14. Wherein the version shown in figure 2 is a lower portion of the right side 14 of the vertebral body fusion 1 connecting the intervertebral fusion 2.
When the incision is positioned on the right front side of the excised vertebral body, two fusion fixing bodies which are needed to be used are an upper part connecting intervertebral fusion part 2 of the left side surface 13 of the vertebral body fusion part 1 and a lower part connecting intervertebral fusion part 2 of the left side surface 13 of the vertebral body fusion part 1 respectively, and the total height of the vertebral body fusion part 1 of the two fusion fixing bodies is consistent with the height of the excised vertebral body. The two configurations of the upper connecting interbody fusion cage 2 of the left side surface 13 of the vertebral body fusion cage 1 and the lower connecting interbody fusion cage 2 of the left side surface 13 of the vertebral body fusion cage 1 are axisymmetric with respect to the horizontal plane. In addition, the two structures of the superior interlinkage interbody fusion cage 2 on the left side 13 of the vertebral body fusion cage 1 and the superior interlinkage interbody fusion cage 2 on the right side 14 of the vertebral body fusion cage 1 are axisymmetric with respect to the sagittal plane.
The intervertebral fusion 2 has a plate-like structure, and a third bone graft cavity 21 is provided between the top surface 15 and the bottom surface 16 of the intervertebral fusion 2. The intervertebral fusion part 2 is used for being implanted between the resected vertebral body and the adjacent vertebral bodies on the upper and lower sides, and the third bone grafting cavity 21 is used for intervertebral fusion of the resected vertebral body and the adjacent vertebral bodies. The outer contour of the intervertebral fusion part 2 on the horizontal section is crescent, oval or fan-shaped. The vertebral body fusion part 1 and the intervertebral fusion part 2 are integrally or movably connected, preferably movably connected, so that the vertebral body fusion part 1 and the intervertebral fusion part 2 can swing in a small range. For example, the vertebral body fusion 1 and the intervertebral fusion 2 are connected by a snap or ball groove.
The fusion fixing body is further provided with at least two screw holes and screws matched with the screw holes, the screws penetrate through the screw holes of the fusion fixing body and are implanted into the resected vertebral body and the resected vertebral body, and fixation between the fusion fixing body and the vertebral body is achieved. In order to implant the screws after the fusion fixing body is placed into the incision of the vertebral body, one end of the screw hole for inserting the screws is positioned on the front side surface of the fusion fixing body, namely, the front side surface 11 of the vertebral body fusion part 1 or the front side surface of the intervertebral fusion part 2, wherein the front side surface of the intervertebral fusion part 2 is the surface which is positioned on the same side with the front side surface 11 of the vertebral body fusion part 1. Since the front side of the vertebral body fusion part 1 is wider and higher than the front side of the intervertebral fusion part 2, the ends of the screw holes for inserting the screws are preferably provided on the front side 11 of the vertebral body fusion part 1.
The fusion fixing body is provided with at least two screws, at least one first screw and at least one second screw. On the basis that the fusion fixing body is provided with the first screw and the second screw, a third screw can be arranged.
The first screw penetrates from the front side 11 of the vertebral body fusion part 1 and points to the area enclosed by the vertebral body fusion part 1 and the intervertebral fusion part 2. The first screw is used to fix the vertebral body fusion 1 to a relatively large residual vertebral body. With the incision on the anterior left side of the vertebral body, the first screw is used to implant a second residual vertebral body 32, see fig. 3. When the incision is on the anterior right side of the resected vertebral body, a first screw is used to implant a first residual vertebral body on the left side of the incision. The first screw may be one or two, preferably one.
Second screws are threaded from the anterior side 11 of the vertebral body fusion 1 and directed above or below the intervertebral fusion 2, and are intended to be implanted in the adjacent vertebral body. One end of the screw hole corresponding to the second screw for feeding the screw is positioned on the front side 11 of the vertebral body fusion part 1, one end of the screw hole corresponding to the second screw for discharging the screw is marked as a second screw passing hole 19-2, and the second screw passing hole 19-2 is preferably arranged at the lower part of the rear side 12 of the vertebral body fusion part 1, as shown in fig. 2. The second screw is preferably one or two.
The third screw is used for fixing the vertebral body fusion 1 with a relatively small residual vertebral body. With the incision on the anterior left side of the vertebral body, a third screw is used to implant the first residual vertebral body 31, see fig. 2. When the incision is on the anterior right side of the vertebral body, a third screw is used to implant a second residual vertebral body on the right side of the incision. The third screw can be one or two, preferably one, and is preferably a screw which is shorter and smaller than the first screw and the second screw; further, the third screw may not be provided. In fig. 2, one end of the screw hole corresponding to the third screw for screw feeding is located on the front side 11 of the vertebral body fusion part 1, one end of the screw hole corresponding to the third screw for screw discharging is a third screw passing hole 19-3, and the third screw passing hole 19-3 is located on the left side 13 of the vertebral body fusion part 1.
The first and second screws are preferably provided one by one, and the third screw may be provided one or not. No matter the fusion fixing body is provided with two screws or three screws, the angles of the screws are preferably fixed and stable. The angle of the screw will be described with reference to fig. 3, taking as an example the lower portion of the right side surface 14 of the vertebral body fusion part 1 connecting the intervertebral fusion part 2.
The projection of the axial direction of the first screw on the sagittal plane is inclined upwards by 40-50 degrees relative to the horizontal plane, and the best angle is 45 degrees; the projection of the axial direction of the first screw on the horizontal plane and the coronal plane form an included angle of 15-30 degrees, and 20 degrees is optimal. The projection of the axial direction of the second screw on the sagittal plane is inclined downwards by 40-50 degrees relative to the horizontal plane, and the best angle is 45 degrees; the projection of the axial direction of the second screw on the horizontal plane and the coronal plane form an included angle of 15-45 degrees, and the best angle is 30 degrees. The projection of the axial direction of the third screw on the sagittal plane is inclined upwards by 40-50 degrees relative to the horizontal plane, and the angle is optimal at 45 degrees; the projection of the axial direction of the third screw on the horizontal plane and the coronal plane form an included angle of 45-75 degrees, namely the included angle of the third screw and the connecting line of the transverse protruding holes at the two sides of the excised vertebral body (or the posterior wall of the vertebral body) in the horizontal plane is 45-75 degrees.
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| CN114081688B (en) * | 2021-11-12 | 2023-08-01 | 四川大学华西医院 | Fusion and non-fusion adjustable intelligent intervertebral implant for vertebral column |
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