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CN1867304A - 成套颈椎骨间假体 - Google Patents

成套颈椎骨间假体 Download PDF

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CN1867304A
CN1867304A CNA2004800304603A CN200480030460A CN1867304A CN 1867304 A CN1867304 A CN 1867304A CN A2004800304603 A CNA2004800304603 A CN A2004800304603A CN 200480030460 A CN200480030460 A CN 200480030460A CN 1867304 A CN1867304 A CN 1867304A
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prosthese
radius
joint
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slidingsurface
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H·D·林克
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Waldemar Link GmbH and Co KG
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Abstract

一种成套颈部椎骨间假体，其包含一对用于形成关节的滑动表面(16)，该关节具有预先确定的关节运动中心(18)，为了更好适应颈部椎间盘的不同关节半径，该颈部椎骨间假体系统包含至少两种滑动平面对(16)具有不同的曲率半径(17)的不同假体，其中与用于更多地位于尾侧的椎骨对的假体相比，用于更多地位于头侧的椎骨对的假体具有更大的滑动表面对(16)曲率半径(17)。

Description

成套颈椎骨间假体
本发明涉及颈椎骨间假体，其包含一对用于形成关节的滑动表面。在这种假体的第一种公知类型中，该关节运动的中心点位于假体内部(US-A-5425773)或比所述假体高出一点(US-A-5895428)。这不符合该假体准备模拟的自然状况。在另一类型椎骨间假体中(FR-A-2718635)，该关节由一对滑动表面形成，滑动表面共同的曲率中心位于假体外侧，也就是在其下方。这接近自然状况但距离它们仍太远。在第三种椎骨间假体类型中(US-A-5401269；EP-A-955021；EP-A-1166725)，两对方向相反的滑动表面设置在透镜状假体核心的两侧，具有自动调整的不确定的关节中心点。这最接近自然状况但很难安置在脊柱颈段的狭窄的椎骨间隙内。
本发明基于以下认识：颈椎骨间关节运动的中心点在不同的椎骨之间是不同的(L.penning：Functional Pathology of the Cervical Spine；Excerpta Medica 1968，1-23页；WO9911203)。从该认识出发，本发明试图使假体关节运动更接近自然状况。
本发明可通过提供一种成套颈椎骨间假体来实现该目标，该成套颈椎骨间假体包含至少两种不同假体，其在该滑动平面对上具有不同的曲率半径以及具有不同的关节运动中心点位置。依据本发明，与用于更多地位于尾侧的椎骨对的假体相比，用于更多地位于头侧的椎骨对的假体具有更大的滑动表面曲率半径。根据病变位置，手术医生可从该成套假体中选择合适的假体，进而确保与假体相配合的椎骨间关节的运动比迄今所能达到的更类似于自然状况。
在有些情况下，当该成套假体仅包含两种不同假体时就可能足够了，也就是一种假体具有高于确定的平均值的滑动表面曲率半径以及一种假体具有低于确定的平均值的滑动表面曲率半径。该平均值适宜的为18mm。例如，成套假体可包含滑动表面曲率半径为22mm的第一假体和滑动表面曲率半径为14mm的另一假体。有利的是具有数目更多的滑动表面半径不同的假体，如刚才引证中列举的该成套假体可通过滑动表面半径为18mm的假体以及可能的话还可通过滑动表面半径为10mm的假体来补充。
本发明还涉及用于从多种不同关节半径的椎骨间假体中确定适于置换颈部椎间盘的椎骨间假体的方法。该方法突出优势在于确定相关关节的关节半径并选择关节半径接近该关节半径的假体。在本文中，该关节半径应理解为关节运动的中心点和假体中点之间的距离。该方法由假体制造者来实施；对于脊柱颈段的每一椎骨间隙，制造者根据大量个体确定平均关节半径，或从资料中获得该平均值，然后在椎骨间假体系统中为这个椎骨间隙配备尺寸等级。下表举例说明如何在确定的尺寸系列内为个体的椎骨间隙配备滑动表面曲率半径的尺寸等级(毫米)。
  椎骨间隙   “大”系列   “中”系列   “小”系列
  C2/C3C3/C4C4/C5C5/C6C6/C7   2222181814   2018181414   1818161412
关于小曲率半径的使用，此处应当注意关节中心还位于假体外部。
附图示出了一种实施例，以解释上面使用的术语。
由下盖板11、上盖板12和假体芯13组成的椎骨间假体插入椎骨体1和2之间。该假体芯13通过底切的支承边缘的板条14以及定位器15稳固地保持在下盖板11上，其中板条包围该假体的三个侧面。通过上盖板12，它形成具有滑动表面半径17和曲率中心点18的球形滑动表面对16，该曲率中心点形成由假体形成的关节的运动中心。这意味着盖板11、12和连接至它们的椎骨1、2相互间能够进行相对运动，该相对运动为围绕中心点18的转动运动，只要该滑动表面对16单独确定该相对运动。实际上，其它滑动面，也就是关节面也参与相对运动的确定，以使实际上发生的相对运动可以与此有一点偏差。然而，不言而喻的是，由假体限定的关节运动的中心点18越是与自然的运动中心点一致，该关节运动越协调，并且病人越不会持续性疼痛。该关节半径的确定不依赖于该滑动表面半径，并且与后者不同之处在于从自然的关节运动的中心点至该假体或容纳所述假体的椎骨间隙的几何中点测量该关节半径。
用于更多位于颅椎骨间隙的假体(特别是C2/C3和C3/C4)的突出优势一方面在于比用于更多位于尾椎骨间隙的假体(特别是C5/C6和C7/C8)具有更大的关节半径。另一方面，更多插入颅骨侧的特别在AP方向上，即前后方向(Anteroposterior)的假体可比更多插入尾部的假体具有更小的表面积。因此，本发明的另一个特征在于成套椎骨间假体包括至少一种第一假体，第一假体的关节半径大于第二假体且其表面积(特别在AP方向上)小于第二假体。

Claims (5)

1.成套颈部椎骨间假体，其包含一对用于形成关节的滑动表面(16)，该关节具有预先确定的关节运动中心(18)，其特征在于：该成套假体包含至少两种不同假体，其在该滑动平面对上具有不同的曲率半径以及具有关节运动的中心点的不同位置，其中与用于更多地位于尾侧的椎骨对的假体相比，用于更多地位于头侧的椎骨对的假体具有更大的滑动表面(16)曲率半径(17)。
2.如权利要求1所述的成套颈部椎骨间假体，其特征在于：它包含至少一种滑动表面半径(17)在18mm以上的假体和至少一种滑动表面半径(17)小于18mm的假体。
3.如权利要求1或2所述的颈部椎骨间假体系统，其特征在于它包含至少一种滑动表面半径小于15mm的假体。
4.尤其如权利要求1所述的颈部椎骨间假体系统，其特征在于：它包含至少一种第一假体，该第一假体在前后方向上的面积小于第二假体并且滑动表面半径大于第二假体。
5.一种方法，制造者通过该方法将包含数个尺寸等级的成套椎骨间假体的一个尺寸等级与人脊柱颈段的确定的椎骨间隙对应配属，其特征在于：获取该椎骨间隙的平均关节半径，以及配备给它关节半径接近该获取的关节半径的尺寸等级。
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