DE102014102200A1 - Implant for the stabilization of spinous processes and medical instruments - Google Patents

Abstract

The invention relates to an implant for stabilizing spinous processes of adjacent vertebral bodies relative to each other, comprising a first abutment element (18) and a second abutment element (20) at a variable distance to this, the sides facing away from each other to be stabilized on spinous processes (12, 14) can be applied at least one clamping element (30) coupled to the first abutment element (18) for reaching through the intervertebral space (16), along which clamping element (30) the second abutment element (20) is movable, at least one locking device (32) arranged on the second abutment element (20) ) comprising a locking element receptacle (54) and a locking element (56) received therein for coupling with the at least one tensioning element (20) and locking the second abutment element (20) against movement at least in a direction away from the first abutment element (18) the locking element (54) and the at least one clamping element (20) together nwirkende engagement members (44, 78) include or form. To provide such an implant, which can be handled easily in a structurally simple design, the invention proposes that the locking element (56) along a locking direction (68) from an unlocking position into a locking position can be transferred, wherein the engagement members (44, 78) on at least one clamping element (30) and the locking element (56) in its unlocked position do not couple with each other and are positively engaged in its locking position, and that the locking element (56) arranged transversely to the locking direction (68) form-fitting manner in the locking element receptacle (54) and the Engagement of the engagement members (44, 78) can only be canceled by transferring the locking element (56) from the locking position to the unlocked position. Moreover, the invention relates to a medical instrumentation.

Description

The invention relates to an implant for stabilizing spinous processes of adjacent vertebral bodies relative to each other, comprising a first contact element and a second contact element at a variable distance to this, which can be applied from mutually remote sides to be stabilized spinous processes, at least one coupled to the first contact element clamping element for reaching through the intervertebral space along which tensioning element the second abutment element is movable, at least one locking device arranged on the second abutment element comprising a locking element receptacle and a locking element received therein for coupling with the at least one tensioning element and locking the second abutment element against movement at least in the direction away from the first abutment element comprises, wherein the locking element and the at least one clamping element comprise or form cooperating engagement members.

Moreover, the invention relates to a medical instrumentation.

An implant of the type mentioned is, for example, in the WO 2013/167731 A1 described. The implant has an expandable perforated ring as a locking element. The locking element can be introduced by spreading the legs of the ring in the locking element recording. The legs can engage around a clamping element in the form of a rod and approach each other behind this again, wherein they engage with the clamping element.

The implant disclosed in the cited document has proven itself in practice. It would be desirable to provide a structurally simpler, easy-to-use implant.

The object of the present invention is to provide a generic implant that can be handled easily with a structurally simple design.

This object is achieved with an implant of the type mentioned in the present invention that the locking element in the locking element receiving along a locking direction of an unlocking position can be converted into a locking position, wherein the engagement members on at least one clamping element and the locking element in its unlocked position not coupled together and in whose locking position are positively engaged, and that the locking element arranged transversely to the locking direction positively in the locking element receiving and the engagement of the engaging members can only be canceled by transferring the locking element from the locking position to the unlocked position.

In the implant according to the invention, the locking element can be transferred from an unlocking position, in which the engagement members are not in engagement, into a locking position, preferably by displacement. In the locking position, the engagement members are in positive engagement. As a result, the second abutment element can be secured against movement in the direction away from the first abutment element. Transverse to the locking direction, the locking element is arranged in a form-fitting manner in the locking element receptacle. In contrast to the implant described in the cited document, the locking element is in particular not expandable, whereby the engagement elements could be disengaged. This gives the possibility, in particular, of securing the second abutment element against movement in the direction of the first abutment element by means of a structurally simple locking device, if the locking element receptacle is held on the second abutment element, for example fixed rigidly or movably thereto. Only by transferring the locking element against the locking direction from the locking position to the unlocked position, the engagement of the engagement members can be canceled. As a result, in particular the possibility is given to change the distance of the contact elements relative to each other handling friendly. This is advantageous, for example, during repositioning of the implant during implantation or during a revision operation.

It is favorable if the locking element comprises a material recess with a first recess area and a second recess area, wherein an edge of the material recess on the first recess area is free of engagement members of the locking element and has at least one engagement member of the locking element on the second recess area the at least one clamping element can be transferred by transferring the locking element from the unlocking position into the locking position from the first recess area into the second recess area and vice versa. The at least one tensioning element engages through the first recess area, do not couple the engagement members with each other. If the locking element is transferred into the locking position, the at least one tensioning element can pass through the second recess area. The engagement members are in positive engagement.

It proves to be advantageous if the material recess is a self-contained through opening of the locking element and the recess areas are passage areas of the passage opening. The passage opening is in this embodiment, in particular a slot. Transverse to the direction of the elongated hole, the locking element is arranged in a form-fitting manner in the locking element receptacle. The edges of the elongated hole are not spread relative to each other. Regardless of the position of the locking element relative to the locking element receiving the cross section of the passage opening is constant.

The passage opening is, for example, an opening of the locking element.

In particular, in the two last-mentioned advantageous embodiments, it is advantageous if the locking element is held captive in the locking element receptacle.

The locking element is preferably dimensionally stable, in particular to ensure the aforementioned constant cross-section of the passage opening regardless of the relative position of the locking element in the locking element receiving.

It proves to be advantageous if the engagement members on the at least one clamping element arranged, in the longitudinal direction spaced from each other comprise circumferential ribs and at least one arranged on the locking element groove, into which a circumferential rib engages in the locking position of the locking element. The circumferential ribs and the at least one groove, preferably a plurality of grooves, form stops which block a movement of the locking element in its locking position relative to the at least one tensioning element. As a result, movement of the locking element receptacle and of the second abutment element away from the first abutment element and in the direction of the first abutment element can also be prevented. The circumferential ribs extend at least over part of the circumference of the at least one tensioning element. The at least one groove, preferably a plurality of grooves, preferably extend over at least one half circumference of the at least one tensioning element.

Conveniently, the locking element along the at least one clamping element is arranged positively in the locking element receiving. On the locking element acting forces can be derived from the locking element recording and on this to the second contact element and vice versa.

The locking element is preferably movably mounted in the locking element receptacle for transferring from the unlocked position into the locking position. Conveniently, the locking element is guided displaceably in the locking element holder. For example, the locking element can be moved in a direction perpendicular to the direction of the at least one clamping element aligned plane. Transverse to the displacement direction and transverse to the direction of the clamping element, the locking element is positively positioned in the locking element receiving. As a result, it is guided by this. In particular, it can not be expanded in this direction, as mentioned above.

From what has been said above, it can be seen that the locking direction can be aligned in particular transversely to the at least one tensioning element.

It is advantageous if the implant comprises at least one securing device with a first securing member coupled to the locking element and a second securing member, which are movable in the locking position of the locking element relative to each other from a release position into a securing position in which they against securing the locking element against Movement cooperate in the unlocked position. As a result, the reliability of the implant can be increased. The securing position engaging securing members secure the locking element against unwanted movement of the locking position in the unlocked position.

Preferably, the second securing member is coupled to the locking element receptacle. For example, the second securing member with the locking element receiving is in non-positive or cohesive connection.

In a structurally simple embodiment, the first securing member is formed integrally with the locking element and / or the second securing member formed integrally with the locking element receiving.

It can be provided that the locking element is a total of one piece.

In a corresponding manner it can be provided that the locking element receptacle is a total of one piece.

In the securing position, the securing members preferably act positively and / or positively.

In an advantageous embodiment of the implant, the first securing member and the second securing member form cooperating, counter to the locking direction effective stops. Acts on the locking element, a force with a component opposite to the locking direction, the securing members contact each other and block the locking element, so that it is not transferred to the unlocked position.

It is particularly favorable when the first securing member and the second securing member are biased relative to each other for transferring from the armed position to the securing position. If the locking element is transferred into the locking position, this can be done to a certain extent "automatic" backup of the locking element. Due to the bias of the securing members relative to each other, they automatically assume the securing position, without requiring the intervention of a user for this purpose. The implant proves to be particularly easy to handle and reliable.

In an advantageous embodiment of the implant, it is favorable if the securing members comprise a projection which is held resiliently on the locking element receptacle or on the locking element and a shoulder arranged on the locking element or on the locking element receptacle, and if the projection interacts with the shoulder in the securing position. The resilient projection, for example configured as a tongue, is biased relative to the other securing member (the shoulder). As explained above, the securing members can thereby automatically assume the securing position when the locking element assumes the locking position. The projection can be raised against the bias of the paragraph and thereby the fuse links are transferred to the armed position. This gives the possibility to transfer the locking element in the unlocked position.

Overall, it is advantageous if the first securing member and the second securing member can be transferred from the securing position into the releasing position and when the locking element can be transferred from the locking position into the unlocking position.

The securing members are preferably transferable from the unlocking position into the securing position along a securing direction oriented transversely to the locking direction, for example along or parallel to the at least one tensioning element.

It is advantageous if the locking element receptacle comprises or forms a sleeve in which the at least one tensioning element is displaceably guided.

Alternatively or additionally, it can be provided that the at least one tensioning element is displaceably guided on the second contact element.

In an advantageous embodiment of the implant, it is favorable if the locking element receptacle is formed separately from the second contact element and is supported on it against movement in the direction of the first contact element.

In a corresponding manner it can be provided that the locking element receptacle is supported on the second abutment element against movement away from the first abutment element.

By combining the two above-mentioned embodiments, provision is made in particular for the locking element receptacle to be held on the second abutment element.

The locking element receptacle can also be held on the second contact element by being firmly connected thereto.

It is advantageous if the locking element receptacle and the second contact element comprise or form cooperating articulated members, via which the locking element receptacle is tiltable about at least one tilting axis relative to the second contact element. This gives the possibility that the second abutment element tilted relative to the locking element receiving and also to at least one clamping element. The implant can thus better adapt to the contour of the spinous processes to be stabilized.

Conveniently, the joint members comprise spherical joint surfaces or form spherical joint surfaces. As a result, the implant can be adapted in a particularly good manner to the contour of the spinous processes. For example, the joint members are spherical cap-shaped or hollow spherical cap-shaped.

In order to hold the locking element receptacle formed separately from the second abutment element, the following is preferably provided: the second abutment element comprises a holding receptacle in which the locking element receptacle is held, wherein the locking element receptacle comprises or forms two holding members which can be brought from a holding state into an inserting state and vice versa; wherein the holding members in the approximate insertion state in the holding receptacle insertable and therein in the holding state are transferable, in which they are spaced from each other further than in the insertion state. The holding members can be approximated to each other, so that the locking element receptacle can be inserted into the holding receptacle of the second contact element. Therein, the holding members can be brought to a greater distance from each other and held in the holding state of the holding receptacle. For example, the retaining receptacle undercuts the retaining members. The holding members are preferably under elastic deformation of insertion in the holding state and vice versa. The holding members preferably form the above-mentioned hinge members.

In an advantageous embodiment, the implant comprises two clamping elements, two locking devices and, if appropriate, two securing devices, wherein each clamping element is associated with a locking device and a securing device.

The locking element receptacles of the two locking devices are preferably formed separately from each other. However, they can also be connected to each other.

Conveniently, the locking devices and / or the securing devices are identical in order to achieve a structurally simple design.

It is advantageous if the locking devices mutually secure rotation around the respective clamping element. The direction of the action on the locking device, for example with a locking instrument or an unlocking instrument, can thereby be maintained for simplified handling.

Alternatively or additionally, it can be provided that the implant comprises at least one anti-rotation device for securing the at least one locking device against rotation about the at least one clamping element.

The at least one tensioning element is preferably fixed to the first contact element and immovable to it.

The investment elements are conveniently one piece.

The abutment elements may have a central portion and at the opposite sides end portions. The end portions may be arranged transversely to the longitudinal direction of the respective contact element offset at the central portion. The end portions are preferably fixed at the middle portion over a respective deformation range. The deformation region comprises, for example, a material recess, for example a material weakening. The end portions can thereby be moved in a simpler manner relative to the central portion and in particular bent so that they can be better adapted to the contour of the spinous processes. The end portions may be pre-bent in the direction of the respective other contact element. If the abutment elements are moved toward one another, the end sections thereby come into contact with the spinous processes at an early stage.

The abutment elements preferably have anchoring members facing the respective other abutment element for engagement in the spinous processes. The anchoring members are for example thorn-shaped. Anchor members of the first and second abutment members are preferably arranged in a gap to reduce weakening of the spinous processes.

As already mentioned, the invention also relates to a medical instrument. An inventive instrument, with the above-mentioned object can also be achieved, comprises an implant of the aforementioned type and a locking instrument having a holding tool for applying to the locking element receiving and a locking tool to transfer the locking element from the unlocked position to the locking position , The holding tool is for example a so-called hold-down device with which the locking element receptacle is acted upon by a force directed away from the surgeon. The locking tool can be acted upon, for example, with a directed to the surgeon force to transfer the locking element in the locked position, in particular by moving. The locking instrument and the holding tool can be guided together.

It is advantageous if the locking element and the locking tool comprise or form corresponding alignment members for correct relative positioning and / or if the locking element holder and the holding tool comprise or form corresponding alignment members for correct relative positioning. As a result, the handling of the instruments can be improved.

The instrumentation preferably comprises an unlocking instrument, which has a holding tool for application to the locking element receptacle and an unlocking tool. With the unlocking tool, the locking element can be transferred from the locking position into the unlocking position. Preferably that is Unlocking tool suitable to transfer the securing members from the securing position to the armed position, provided that the implant comprises the above-mentioned securing device. The unlocking tool can be acted upon, for example, by the surgeon with a force pointing away from him and the holding tool with a pointing to the surgeon force to move the locking instrument in particular sliding in the distal direction. The holding tool and the unlocking tool can be guided together.

It is advantageous if the locking element and the unlocking tool comprise or form corresponding alignment members for correct relative positioning and / or if the locking element receptacle and the holding tool comprise or form corresponding alignment members for correct relative positioning. This facilitates the handling of the instruments.

• 1. Implantat zur Stabilisierung von Dornfortsätzen benachbarter Wirbelkörper relativ zueinander, umfassend ein erstes Anlageelement (18) und ein zweites Anlageelement (20) in veränderbarem Abstand zu diesem, die von einander abgewandten Seiten an zu stabilisierende Dornfortsätze (12, 14) anlegbar sind, mindestens ein mit dem ersten Anlageelement (18) gekoppeltes Spannelement (30) zum Durchgreifen des Zwischenwirbelraums (16), längs welchem Spannelement (30) das zweite Anlageelement (20) beweglich ist, mindestens eine am zweiten Anlageelement (20) angeordnete Verriegelungseinrichtung (32), die eine Verriegelungselementaufnahme (54) und ein darin aufgenommenes Verriegelungselement (56) zum Koppeln mit dem mindestens einen Spannelement (20) und Verriegeln des zweiten Anlageelementes (20) gegen Bewegung zumindest in vom ersten Anlageelement (18) weg weisender Richtung umfasst, wobei das Verriegelungselement (54) und das mindestens eine Spannelement (20) zusammenwirkende Eingriffsglieder (44, 78) umfassen oder bilden, dadurch gekennzeichnet, dass das Verriegelungselement (56) in der Verriegelungselementaufnahme (54) längs einer Verriegelungsrichtung (68) von einer Entriegelungsstellung in eine Verriegelungsstellung überführbar ist, wobei die Eingriffsglieder (44, 78) am mindestens einen Spannelement (30) und am Verriegelungselement (56) in dessen Entriegelungsstellung nicht miteinander koppeln und in dessen Verriegelungsstellung formschlüssig in Eingriff stehen, und dass das Verriegelungselement (56) quer zur Verriegelungsrichtung (68) formschlüssig in der Verriegelungselementaufnahme (54) angeordnet und der Eingriff der Eingriffsglieder (44, 78) nur durch Überführen des Verriegelungselementes (56) von der Verriegelungsstellung in die Entriegelungsstellung aufhebbar ist.
• 2. Implantat nach Satz 1, dadurch gekennzeichnet, dass das Verriegelungselement (56) eine vom mindestens einen Spannelement (30) durchgriffene Materialausnehmung (70) mit einem ersten Ausnehmungsbereich (72) und einem zweiten Ausnehmungsbereich (74) umfasst, wobei ein Rand (76) der Materialausnehmung (70) am ersten Ausnehmungsbereich (72) frei von Eingriffsgliedern (78) des Verriegelungselementes (56) ist und am zweiten Ausnehmungsbereich (74) mindestens ein Eingriffsglied (78) des Verriegelungselementes (56) aufweist, wobei das mindestens eine Spannelement (30) durch Überführen des Verriegelungselementes (56) von der Entriegelungsstellung in die Verriegelungsstellung vom ersten Ausnehmungsbereich (74) in den zweiten Ausnehmungsbereich (72) und umgekehrt überführbar ist.
• 3. Implantat nach Satz 1 oder 2, dadurch gekennzeichnet, dass die Materialausnehmung (70) eine in sich geschlossene Durchgangsöffnung (70) des Verriegelungselementes (56) ist und die Ausnehmungsbereiche (72, 74) Durchgangsbereiche (72, 74) der Durchgangsöffnung (70) sind.
• 4. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Verriegelungselement (56) in der Verriegelungselementaufnahme (54) unverlierbar gehalten ist.
• 5. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Verriegelungselement (56) formstabil ist.
• 6. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Eingriffsglieder (44, 78) am mindestens einen Spannelement (30) angeordnete, in dessen Längsrichtung (40) voneinander beabstandete Umfangsrippen (38) umfassen sowie mindestens eine am Verriegelungselement (56) angeordnete Nut (80), in die eine Umfangsrippe (38) in der Verriegelungsstellung des Verriegelungselementes (56) eingreift.
• 7. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Verriegelungselement (56) längs des mindestens einen Spannelementes (30) formschlüssig in der Verriegelungselementaufnahme (54) angeordnet ist.
• 8. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Verriegelungselement (56) in der Verriegelungselementaufnahme (54) zum Überführen von der Entriegelungsstellung in die Verriegelungsstellung beweglich gelagert ist, insbesondere in der Verriegelungselementaufnahme (54) verschiebbar geführt ist.
• 9. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Verriegelungsrichtung (68) quer zum mindestens einen Spannelement (30) ausgerichtet ist.
• 10. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Implantat (10) mindestens eine Sicherungseinrichtung (34) umfasst mit einem mit dem Verriegelungselement (56) gekoppelten ersten Sicherungsglied (82) und einem zweiten Sicherungsglied (90), die in der Verriegelungsstellung des Verriegelungselementes (56) relativ zueinander von einer Entsicherungsstellung in eine Sicherungsstellung beweglich sind, in der sie zum Sichern des Verriegelungselementes (56) gegen Bewegung in die Entriegelungsstellung zusammenwirken.
• 11. Implantat nach Satz 10, dadurch gekennzeichnet, dass das zweite Sicherungsglied (90) mit der Verriegelungselementaufnahme (54) gekoppelt ist.
• 12. Implantat nach Satz 10 oder 11, dadurch gekennzeichnet, dass das erste Sicherungsglied (82) einstückig mit dem Verriegelungselement (56) gebildet ist und/oder dass das zweite Sicherungsglied (90) einstückig mit der Verriegelungselementaufnahme (54) gebildet ist.
• 13. Implantat nach einem der Sätze 10 bis 12, dadurch gekennzeichnet, dass die Sicherungsglieder (82, 90) in der Sicherungsstellung kraft- und/oder formschlüssig zusammenwirken.
• 14. Implantat nach einem der Sätze 10 bis 13, dadurch gekennzeichnet, dass das erste Sicherungsglied (82) und das zweite Sicherungsglied (90) relativ zueinander vorgespannt sind zum Überführen von der Entsicherungsstellung in die Sicherungsstellung.
• 15. Implantat nach einem der Sätze 10 bis 14, dadurch gekennzeichnet, dass die Sicherungsglieder (82, 90) einen an der Verriegelungselementaufnahme (54) oder am Verriegelungselement (56) federnd gehaltenen Vorsprung (92) sowie einen am Verriegelungselement (56) bzw. an der Verriegelungselementaufnahme (54) angeordneten Absatz (84) umfassen, und dass der Vorsprung (92) mit dem Absatz (84) in der Sicherungsstellung zusammenwirkt.
• 16. Implantat nach einem der Sätze 10 bis 15, dadurch gekennzeichnet, dass die Sicherungsglieder (82, 90) entlang einer quer zur Verriegelungsrichtung (68) ausgerichteten Sicherungsrichtung von der Entsicherungsstellung in die Sicherungsstellung überführbar sind.
• 17. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Verriegelungselementaufnahme (54) eine Hülse (66) umfasst oder bildet, in der das mindestens eine Spannelement (30) verschiebbar geführt ist.
• 18. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass die Verriegelungselementaufnahme (54) getrennt vom zweiten Anlageelement (20) gebildet ist und sich an diesem gegen Bewegung in Richtung auf das erste Anlageelement (18) abstützt.
• 19. Implantat nach Satz 18, dadurch gekennzeichnet, dass die Verriegelungselementaufnahme (54) und das zweite Anlageelement (20) zusammenwirkende Gelenkglieder (50, 62) umfassen oder bilden, über die die Verriegelungselementaufnahme (54) um mindestens eine Kippachse kippbeweglich zum Anlageelement (20) ist.
• 20. Implantat nach Satz 19, dadurch gekennzeichnet, dass die Gelenkglieder (50, 62) sphärische Gelenkflächen (52, 64) umfassen oder bilden.
• 21. Implantat nach einem der Sätze 18 bis 20, dadurch gekennzeichnet, dass das zweite Anlageelement (20) eine Halteaufnahme (48) umfasst, in der die Verriegelungselementaufnahme (54) gehalten ist, wobei die Verriegelungselementaufnahme (54) zwei von einem Haltezustand in einen Einführzustand und umgekehrt bringbare Halteglieder (60) umfasst oder bildet, wobei die Halteglieder (60) im aneinander angenäherten Einführzustand in die Halteaufnahme (48) einführbar und darin in den Haltezustand überführbar sind, in dem sie voneinander weiter beabstandet sind als im Einführzustand.
• 22. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Implantat (10) zwei Spannelemente (30), zwei Verriegelungseinrichtungen (32) und gegebenenfalls zwei Sicherungseinrichtungen (34) umfasst, wobei jedem Spannelement (30) eine Verriegelungseinrichtung (32) und eine Sicherungseinrichtung (34) zugeordnet ist.
• 23. Implantat nach Satz 22, dadurch gekennzeichnet, dass die Verriegelungseinrichtungen (32) und/oder dass die Sicherungseinrichtungen (34) identisch sind.
• 24. Implantat nach Satz 22 oder 23, dadurch gekennzeichnet, dass die Verriegelungseinrichtungen (32) sich gegenseitig um Rotation um das jeweilige Spannelement (30) sichern.
• 25. Implantat nach einem der voranstehenden Sätze, dadurch gekennzeichnet, dass das Implantat (10) mindestens eine Verdrehsicherungseinrichtung umfasst zur Sicherung der mindestens einen Verriegelungseinrichtung (32) gegen Rotation um das mindestens eine Spannelement (30).
• 26. Medizinisches Instrumentarium, umfassend ein Implantat (10) nach einem der voranstehenden Sätze und ein Verriegelungsinstrument (102), das ein Haltewerkzeug (106) aufweist zum Anlegen an die Verriegelungselementaufnahme (54) und ein Verriegelungswerkzeug (112), um das Verriegelungselement (56) von der Entriegelungsstellung in die Verriegelungsstellung zu überführen.
• 27. Instrumentarium nach Satz 26, dadurch gekennzeichnet, dass das Verriegelungselement (56) und das Verriegelungswerkzeug (112) korrespondierende Ausrichtglieder (88, 114) zur korrekten Relativpositionierung umfassen oder bilden und/oder dass die Verriegelungselementaufnahme (54) und das Haltewerkzeug (106) korrespondierende Ausrichtglieder (94, 110) zur korrekten Relativpositionierung umfassen oder bilden.
• 28. Instrumentarium nach Satz 26 oder 27, dadurch gekennzeichnet, dass das Instrumentarium (100) ein Entriegelungsinstrument (104) umfasst, das ein Haltewerkzeug (116) aufweist zum Anlagen an die Verriegelungselementaufnahme (54) und ein Entriegelungswerkzeug (120), mit dem Sicherungsglieder (82, 90) einer Sicherungseinrichtung (34) des Implantates (10) von einer Sicherungsstellung in eine Entsicherungsstellung überführbar sind und das Verriegelungselement (54) von der Verriegelungsstellung in die Entriegelungsstellung überführbar ist.
• 29. Instrumentarium nach Satz 28, dadurch gekennzeichnet, dass das Verriegelungselement (56) und das Entriegelungswerkzeug (120) korrespondierende Ausrichtglieder (86, 122) zur korrekten Relativpositionierung umfassen oder bilden und/oder dass die Verriegelungselementaufnahme (54) und das Haltewerkzeug (116) korrespondierende Ausrichtglieder (96, 118) zur korrekten Relativpositionierung umfassen oder bilden.

The above description thus includes in particular the embodiments of an implant and a medical instrumentation defined below in the form of numbered sets:

• 1. implant for stabilizing spinous processes of adjacent vertebral bodies relative to one another, comprising a first abutment element ( 18 ) and a second contact element ( 20 ) at a variable distance to this, the sides facing away from each other on to be stabilized spinous processes ( 12 . 14 ) can be applied, at least one with the first investment element ( 18 ) coupled clamping element ( 30 ) for reaching through the intervertebral space ( 16 ), along which tensioning element ( 30 ) the second contact element ( 20 ) is movable, at least one on the second contact element ( 20 ) arranged locking device ( 32 ), which has a locking element receptacle ( 54 ) and a locking element received therein ( 56 ) for coupling with the at least one tensioning element ( 20 ) and locking the second contact element ( 20 ) against movement at least in the first contact element ( 18 ) facing away direction, wherein the locking element ( 54 ) and the at least one tensioning element ( 20 ) cooperating engagement members ( 44 . 78 ) comprise or form, characterized in that the locking element ( 56 ) in the locking element receptacle ( 54 ) along a locking direction ( 68 ) is transferable from an unlocking position into a locking position, wherein the engagement members ( 44 . 78 ) on at least one tensioning element ( 30 ) and on the locking element ( 56 ) in its unlocked position do not couple with each other and in the locking position are positively engaged, and in that the locking element ( 56 ) transversely to the locking direction ( 68 ) positively in the locking element receptacle ( 54 ) and the engagement of the engagement members ( 44 . 78 ) only by transferring the locking element ( 56 ) can be canceled by the locking position in the unlocked position.
• 2. Implant according to sentence 1, characterized in that the locking element ( 56 ) one of the at least one tensioning element ( 30 ) durchgreife material recess ( 70 ) with a first recessed area ( 72 ) and a second recessed area ( 74 ), where one edge ( 76 ) of the material recess ( 70 ) at the first recessed area ( 72 ) free of engaging members ( 78 ) of the locking element ( 56 ) and at the second recessed area ( 74 ) at least one engaging member ( 78 ) of the locking element ( 56 ), wherein the at least one tensioning element ( 30 ) by transferring the locking element ( 56 ) from the unlocked position into the locking position of the first recess area (FIG. 74 ) in the second recessed area ( 72 ) and vice versa.
• 3. implant according to sentence 1 or 2, characterized in that the Materialausnehmung ( 70 ) a self-contained passage opening ( 70 ) of the locking element ( 56 ) and the recesses ( 72 . 74 ) Transit areas ( 72 . 74 ) of the passage opening ( 70 ) are.
• 4. Implant according to one of the preceding sentences, characterized in that the locking element ( 56 ) in the locking element receptacle ( 54 ) is held captive.
• 5. Implant according to one of the preceding sentences, characterized in that the locking element ( 56 ) is dimensionally stable.
• 6. Implant according to one of the preceding sentences, characterized in that the engagement members ( 44 . 78 ) on at least one tensioning element ( 30 ), in its longitudinal direction ( 40 ) spaced apart circumferential ribs ( 38 ) and at least one on the locking element ( 56 ) groove ( 80 ) into which a circumferential rib ( 38 ) in the locking position of the locking element ( 56 ) intervenes.
• 7. Implant according to one of the preceding sentences, characterized in that the locking element ( 56 ) along the at least one tensioning element ( 30 ) positively in the locking element receptacle ( 54 ) is arranged.
• 8. Implant according to one of the preceding sentences, characterized in that the locking element ( 56 ) in the locking element receptacle ( 54 ) is movably mounted for transferring from the unlocked position into the locking position, in particular in the locking element receptacle ( 54 ) is guided displaceably.
• 9. implant according to one of the preceding sentences, characterized in that the locking direction ( 68 ) transversely to the at least one clamping element ( 30 ) is aligned.
• 10. Implant according to one of the preceding sentences, characterized in that the implant ( 10 ) at least one security device ( 34 ) comprises one with the locking element ( 56 ) coupled first securing member ( 82 ) and a second securing member ( 90 ), which in the locking position of the locking element ( 56 ) are movable relative to each other from a release position into a securing position in which they are used to secure the locking element ( 56 ) cooperate against movement in the unlocked position.
• 11. Implant according to sentence 10, characterized in that the second securing member ( 90 ) with the locking element receptacle ( 54 ) is coupled.
• 12. Implant according to sentence 10 or 11, characterized in that the first securing member ( 82 ) in one piece with the locking element ( 56 ) is formed and / or that the second securing member ( 90 ) in one piece with the locking element receptacle ( 54 ) is formed.
• 13. Implant according to one of the sentences 10 to 12, characterized in that the securing members ( 82 . 90 ) cooperate in the securing position non-positively and / or positively.
• 14. Implant according to one of the sentences 10 to 13, characterized in that the first securing member ( 82 ) and the second securing member ( 90 ) are biased relative to each other for transferring the Entsicherungsstellung in the securing position.
• 15. Implant according to one of the sentences 10 to 14, characterized in that the securing members ( 82 . 90 ) one on the locking element receptacle ( 54 ) or on the locking element ( 56 ) resiliently held projection ( 92 ) and one on the locking element ( 56 ) or on the locking element receptacle ( 54 ) paragraph ( 84 ) and that the projection ( 92 ) with paragraph ( 84 ) cooperates in the securing position.
• 16. Implant according to one of the sentences 10 to 15, characterized in that the securing members ( 82 . 90 ) along a direction transverse to the locking direction ( 68 ) aligned securing direction of the Entsicherungsstellung be transferred to the securing position.
• 17. Implant according to one of the preceding sentences, characterized in that the locking element receptacle ( 54 ) a sleeve ( 66 ), in which the at least one tensioning element ( 30 ) is guided displaceably.
• 18. Implant according to one of the preceding sentences, characterized in that the locking element receptacle ( 54 ) separated from the second contact element ( 20 ) is formed and at this against movement in the direction of the first contact element ( 18 ) is supported.
• 19. implant according to sentence 18, characterized in that the locking element receptacle ( 54 ) and the second contact element ( 20 ) cooperating joint members ( 50 . 62 ), via which the locking element receptacle ( 54 ) tiltable about at least one tilting axis to the contact element ( 20 ).
• 20. Implant according to sentence 19, characterized in that the joint members ( 50 . 62 ) spherical joint surfaces ( 52 . 64 ) include or form.
• 21. Implant according to one of the sentences 18 to 20, characterized in that the second contact element ( 20 ) a holding receptacle ( 48 ), in which the locking element receptacle ( 54 ) is held, wherein the locking element receptacle ( 54 ) two of a holding state in an insertion state and vice versa engageable holding members ( 60 ), wherein the holding members ( 60 ) in the approximated insertion state into the holding receptacle ( 48 ) are insertable and therein in the holding state can be transferred, in which they are spaced from each other further than in the insertion state.
• 22. Implant according to one of the preceding sentences, characterized in that the implant ( 10 ) two clamping elements ( 30 ), two locking devices ( 32 ) and, where appropriate, two security devices ( 34 ), each tensioning element ( 30 ) a locking device ( 32 ) and a safety device ( 34 ) assigned.
• 23. Implant according to sentence 22, characterized in that the locking devices ( 32 ) and / or that the safety devices ( 34 ) are identical.
• 24. Implant according to sentence 22 or 23, characterized in that the locking devices ( 32 ) mutually rotate about the respective clamping element ( 30 ) to back up.
• 25. Implant according to one of the preceding sentences, characterized in that the implant ( 10 ) comprises at least one anti-rotation device for securing the at least one locking device ( 32 ) against rotation about the at least one tensioning element ( 30 ).
• 26. Medical device comprising an implant ( 10 ) according to one of the preceding sentences and a locking instrument ( 102 ), which is a holding tool ( 106 ) for application to the locking element receptacle ( 54 ) and a locking tool ( 112 ) to the locking element ( 56 ) to be transferred from the unlocked position into the locking position.
• 27. Instrumentation according to sentence 26, characterized in that the locking element ( 56 ) and the locking tool ( 112 ) corresponding alignment members ( 88 . 114 ) for correct relative positioning or form and / or that the locking element receptacle ( 54 ) and the holding tool ( 106 ) corresponding alignment members ( 94 . 110 ) comprise or form for correct relative positioning.
• 28. Instrumentarium according to sentence 26 or 27, characterized in that the instrumentation ( 100 ) an unlocking instrument ( 104 ) comprising a holding tool ( 116 ) for abutment with the locking element receptacle ( 54 ) and an unlocking tool ( 120 ), with the securing members ( 82 . 90 ) a security device ( 34 ) of the implant ( 10 ) can be converted from a securing position into a releasing position and the locking element ( 54 ) is transferable from the locking position to the unlocked position.
• 29. Instrumentarium according to sentence 28, characterized in that the locking element ( 56 ) and the unlocking tool ( 120 ) corresponding alignment members ( 86 . 122 ) for correct relative positioning or form and / or that the locking element receptacle ( 54 ) and the holding tool ( 116 ) corresponding alignment members ( 96 . 118 ) comprise or form for correct relative positioning.

The following description of preferred embodiments of the invention is used in conjunction with the drawings for a more detailed explanation of the invention. Show it:

1 a perspective view of an implant according to the invention, partially in exploded view;

2 : the implant off 1 in an implantation position in which it stabilizes adjacent spinous processes relative to one another;

3 a sectional view taken along the line 3-3 in 2 ;

4 : A perspective view of an instrument according to the invention, comprising the implant 1 and a locking instrument;

5 a sectional view taken along the line 5-5 in 4 wherein the locking instrument is used to lock the implant;

6 : a representation accordingly 4 , wherein instead of the locking instrument a Entriegelungsinstrument the instrument is shown and

7 a sectional view taken along the line 7-7 in 6 , wherein the implant is unlocked with the unlocking instrument.

1 shows a perspective view of a reference numeral 10 proven advantageous embodiment of an implant according to the invention. The implant 10 serves to stabilize spinous processes 12 . 14 adjacent vertebrae relative to each other ( 2 ). The spinous processes 12 . 14 are over an intervertebral space 16 spaced apart.

The implant has a first contact element 18 and second contact element 20 on. Each investment element 18 . 20 includes a middle section 22 and at its opposite end sides two end portions 24 . 26 , Transverse to a longitudinal direction of each investment element 18 . 20 in the intended use of the implant 10 in cranial-caudal direction, are the end sections 20 . 26 offset at the middle section 22 arranged. The investment elements 18 . 20 thereby have a step-like shape in plan view. This serves to stabilize a plurality of spinous implants 10 to position so that a respective end section 24 (For example, cranial) of the caudal implant 10 next to an end section 26 (for example caudal) of the cranial implant 10 is positioned.

The end sections 24 . 26 the investment elements 18 . 20 lie opposite each other.

Each end section 24 . 26 is at the corresponding middle section 22 over a deformation range 28 connected. The deformation area 28 includes, for example, a material recess, for example as in the case of the implant 10 at least one groove. Also conceivable is a hinge connection of the end sections 24 . 26 with the middle section 22 ,

The deformation area 28 allows the end sections 24 . 26 relative to the middle section 22 moved and in particular can be bent. Preferably, the end portions 24 . 26 in the direction of the other investment element 18 . 20 pre-bent ( 1 ). By the possibility of the investment elements 18 . 20 at the deformation areas 28 can deform, an improved adaptation of the implant 10 to the contour of the spinous processes 12 . 14 done as in 2 is shown.

The investment elements 18 . 20 are each formed in one piece.

At each end section 24 . 26 anchoring members are arranged, in the present case thorn-shaped. The Anchoring links can enter the spinous processes 12 . 14 for better anchoring of the implant 10 intervention. The anchoring elements of the system elements 18 . 20 stand on gap to a locally excessive weakening of the spinous processes 12 . 14 to avoid.

The implant 10 includes at least one clamping element 30 , at least one locking device 32 and at least one securing device 34 , In the present case are two clamping elements 30 , two locking devices 32 and two security devices 34 present, which are designed in particular identical. The following is therefore only on a clamping element 30 , a locking device 32 and a safety device 34 received.

The tensioning element 30 is designed as a staff 36 , The rod 36 is preferably on the contact element 18 fixed and across the plane of the middle section 22 aligned.

The rod 36 includes sections of a plurality of circumferential ribs 38 in the longitudinal direction 40 of the staff 36 spaced apart from each other. Between adjacent circumferential ribs 38 are ring grooves 42 arranged. The circumferential ribs 38 form engagement members 44 of the staff 36 ,

The rod 36 passes through a passage opening 46 on the second contact element 20 , The passage opening 46 is especially at the middle section 22 educated. The passage opening 46 forms a holding receptacle 48 for a part of the locking device 32 , which will be discussed later. The edge of the passage opening 46 forms a joint member 50 with a spherical joint surface 52 , The articular surface 52 is hollow spherical cap.

The locking device 32 includes a locking element receptacle 54 and a locking element 56 , For receiving the locking element 56 includes the locking element receptacle 54 a receiving section 58 , At the recording section 58 are two holding members 60 established. The holding members 60 are each designed spherical cap and form articulated members 62 , Accordingly, the joint members 62 a spherical cap-shaped articular surface 64 on.

The holding members 60 can be transferred from a holding state shown in the drawing in an insertion state, not shown. This is done by applying force to the holding members 60 such that they are approximated to each other. This gives the possibility of the locking element receptacle 54 with the holding members 60 in the holding receptacle 48 introduce. In the stop recording 48 become the holding members 60 again transferred from the insertion state in the holding state shown in the drawing. The transfer of the holding members 60 takes place under elastic deformation.

Take the holding members 60 the holding state in the holding receptacle 48 a, is the locking element receptacle 54 on the second contact element 20 held. The locking element holder 54 is in particular tiltable on the second contact element 20 held, as the articular surfaces 52 and 64 interact. This serves for better adaptation of the implant 10 to the contour of the spinous processes 12 . 14 ( 2 ), because it allows the tilting of the plant elements 18 . 20 relative to each other.

The locking element holder 54 forms a sleeve 66 that from the bar 36 is penetrated. In doing so, the rod touches 36 the space between the holding members 60 and the receiving section 58 , The rod 36 can on the investment element 20 away side again from the receiving section 58 escape. Through the sleeve 66 becomes the staff 36 longitudinal 40 slidably guided, unless he, as explained below, relative to this by means of the locking element 56 is locked.

The locking element 56 serves to the locking element recording 54 immovable at the bar 36 to be defined herein as "locking". Because the locking element receptacle 54 on the contact element 20 is held, is also the contact element 20 at the bar 36 locked. This is also called "locking the implant 10 Designates at which a movement of the contact elements 18 . 20 relative to each other is not possible.

The locking element 56 can in the locking element holder 54 , in particular their receiving section 58 , to locking the staff 36 be transferred from an unlocked position into a locking position. In particular, the locking element 56 along a locking direction 68 slidable in the receiving section 58 stored. The locking direction 68 is transverse to the longitudinal direction 40 aligned. The locking element 56 is sized so that it is transverse to the longitudinal direction 40 and across the locking direction 68 positively in the receiving section 58 is positioned. Regardless of the position of the locking element 56 when moving in and against the locking direction 68 it retains across the position in the receiving section 58 at. Transverse to the longitudinal direction 40 and to the locking direction 68 is the locking element 56 especially not expandable.

The locking element 56 is present in one piece and dimensionally stable. Longitudinal 40 is the locking element 56 positively in the receiving section 58 arranged. A movement of the locking element 56 relative to the locking element receptacle 54 is characterized only longitudinal and opposite to the locking direction 68 possible.

The locking element 56 has a material recess on in the form of a passage opening 70 , in the present case preferably an opening. The passage opening 70 includes a first passage area 72 and a second passageway area adjacent thereto 74 , The passage opening is from an edge 76 edged.

The rod 36 passes through the passage opening 70 , Since the rod 36 also the sleeve 66 engages, is the locking element 56 captive in the locking element holder 54 held.

The passageway area 72 is sized so that the rod 36 can be passed and relative to the locking element 56 is mobile. In particular, the edge 76 free of engagement members of the locking element 56 for interaction with the engaging members 44 ,

At the second passage area 74 In contrast, are engagement members 78 of the locking element 54 arranged. The engaging members 78 comprise a recess in the form of a groove 80 , In the present case are three grooves 80 available. The grooves 80 extend on the edge 76 preferably over at least half the circumference of the rod 36 ,

The circumferential ribs 38 can form-fit in the grooves 80 intervention. Rib-shaped projections between the grooves 80 can in the annular grooves 42 intervention. In this case, the circumferential ribs act 38 and the grooves 80 as mutual attacks. This will cause a movement of the locking element 56 longitudinal 40 prevented.

The locking element 56 further comprises a securing member 82 , In the present case is the securing member 82 end on the locking element 56 arranged and the passage area 72 adjacent. The fuse link 82 includes a paragraph 84 , Paragraph 84 forms one opposite to the locking direction 68 effective stop.

Paragraph 84 is interrupted in sections and accordingly comprises two segments, which pass through a recess 86 on the locking element 56 are separated from each other. The recess 86 forms an alignment member of a tool mentioned below.

On the opposite side has the locking element 56 another recess 88 on, which also forms an alignment member for a tool.

The locking element holder 54 includes, in particular at the receiving portion 58 , a security link 90 for cooperation with the securing member 82 , The security members 82 . 90 form the safety device 34 , The fuse link 90 is configured here as a projection 92 , for example in tongue form. The lead 92 is at the attachment element 20 opposite side of the receiving portion 58 arranged.

The security members 82 . 90 are biased relative to each other. The bias is due to the elastic determination of the projection 92 at the receiving section 58 , The bias is parallel to the longitudinal direction 40 aligned. This allows the fuse links 82 . 90 move so relative to each other that the projection 92 with the paragraph 84 coupled. The lead 92 Accordingly, forms a counter to the locking direction 68 effective stop for sales 84 ,

The recording section 58 has a recess 94 which forms an alignment member for a tool. The recess 94 is at the side of the receiving section 58 arranged at which the projection 92 is positioned.

On the opposite side has the receiving section 58 an arcuate contour 96 on. The contour 96 forms an alignment member for a tool.

The implant 10 is part of a preferred embodiment of a device according to the invention 100 , The instrumentation 100 is in the 4 to 7 partially shown and covered over the implant 10 an interlocking instrument 102 and an unlocking instrument 104 , The instruments 102 . 104 are only partially shown in the drawing.

The locking instrument 102 has a holding tool 106 on with one to the edge of the recess 94 layable holding section 108 , At the holding section 108 is a lead 110 arranged. The lead 110 forms an alignment member, which is in the recess 94 is insertable.

The locking instrument further includes a locking tool 112 with a lead 114 , The lead 114 serves to act on the locking element 56 , Furthermore, the lead 114 an alignment member for cooperation with the recess 88 ,

The holding tool 106 and the locking tool 112 are led together and displaceable relative to each other.

The unlocking instrument 104 includes a holding tool 116 holding a holding section 118 having. The holding section 118 forms an alignment member for interaction with the contour 96 to which it can be applied.

The unlocking instrument 104 further includes an unlocking tool 120 , The unlocking tool 120 has a lead 122 on. The lead 122 forms an alignment member for cooperation with the recess 86 , The lead 122 also serves the security members 82 . 90 separate from each other, and for applying force to the locking element 56 ,

The holding tool 116 and the unlocking tool 120 are slidably connected.

Below is the function of the instrumentation 100 and the implant 10 with reference in particular to the 4 to 7 described.

In an insertion position of the implant 10 is the locking element 56 in the locking element receptacle 54 arranged. The rod 36 passes through the passage area 72 , The locking element 56 assumes an unlocked position. The investment elements 18 . 20 are movable relative to each other. They can attach to the spinous processes 12 . 14 be positioned. With an insertion tool, not shown in the drawing, the contact elements 18 . 20 be approximated or removed from each other until the desired position is reached. The end sections 24 . 26 can be bent as explained above. The locking element holder 54 can be relative to the contact element 20 be tilted. As a result, the implant becomes 10 transferred to an implantation position.

Subsequently, the implant with the help of the locking instrument 102 be locked. In this case, the holding tool 106 under alignment of the projection 110 in the recess 94 be positioned. The holding tool 106 is a hold-down.

The locking tool 112 can under alignment of the tab 114 in the recess 88 be positioned. By applying force to the locking tool 112 becomes the locking element 56 transferred from the unlocked position into the locking position. This is done by moving the locking element 56 in the locking direction 68 and under the guidance of the receiving section 58 , 5 shows the implant during the movement of the locking element 56 ,

In the locking position of the locking element 56 the rod goes through 36 the passageway area 74 , The circumferential ribs 38 are with the grooves 80 in positive engagement. A movement of the investment elements 18 . 20 relative to each other is no longer possible, in both directions along the longitudinal direction 40 , The implant 10 is locked.

Takes the locking element 56 the locking position, are the locking members 82 . 90 can be transferred from a previously adopted Entsicherungsstellung in a backup position. In the release position ( 5 ) is the lead 92 on the heel 84 on. The safety position is taken up, so to speak, "automatically" without the intervention of the user, that the projection 92 towards the heel 84 is biased. This will be the lead 92 automatically transferred to the securing position, in which he with the paragraph 84 the opposite to the locking direction 68 effective stops. As a result, it is no longer possible, the locking element 56 without the aid of the unlocking instrument 104 to transfer again from the locking position to the unlocked position.

To unlock the implant 10 For example, during repositioning during implantation or revision surgery, the surgeon may use the unlocking instrument 104 deploy. The holding tool 116 can under alignment of the holding section 118 at the contour 96 to the receiving section 58 be aligned. Subsequently, the unlocking tool 120 be acted upon by a pioneering force from the surgeon. The lead 122 can in the recess 86 intervention.

By applying force to the unlocking tool 120 First, the recess 86 partially overlapping projection 92 be contacted. This makes it possible for the securing members 82 . 90 from the securing position to the unlocking position ( 7 ). This allows, upon further application of force to the unlocking tool 120 with the lead 122 the locking element 56 to contact. The locking element 56 can counter the locking direction 68 be transferred from the locking position to the unlocked position. The engagement of the circumferential ribs 38 and the grooves 80 is thereby canceled. The rod 36 again reaches through the passage area 72 , The investment elements 18 . 20 can be moved relative to each other.

The implant is particularly advantageous 10 in that, as mentioned, the locking element 56 transverse to the locking direction 68 and transverse to the longitudinal direction 40 positively in receiving portion 58 is arranged. The passage opening 70 is not expandable. Just by moving the locking element from the locking position to the unlocked position is the engagement of the engagement members 44 . 78 canceled. This also allows in particular, the investment elements 18 . 20 with locked implant 10 to secure against movement in both directions relative to each other. Despite structurally simple design, the implant proves 10 therefore especially easy to handle.

The two locking devices 32 at the implant 10 can rotate each other around the respective clamping element 30 to back up. The direction of the impact on the implant 10 with the instruments 102 . 104 can be maintained. Alternatively or additionally, it can be provided that the respective locking device 32 secured against rotation with respect to the contact element via an anti-rotation device not shown in the drawing 20 is.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• WO 2013/167731 A1 [0003]

Claims (25)

Implant for stabilizing spinous processes of adjacent vertebral bodies relative to each other, comprising a first abutment element ( 18 ) and a second contact element ( 20 ) at a variable distance to this, the sides facing away from each other on to be stabilized spinous processes ( 12 . 14 ) can be applied, at least one with the first investment element ( 18 ) coupled clamping element ( 30 ) for reaching through the intervertebral space ( 16 ), along which tensioning element ( 30 ) the second contact element ( 20 ) is movable, at least one on the second contact element ( 20 ) arranged locking device ( 32 ), which has a locking element receptacle ( 54 ) and a locking element received therein ( 56 ) for coupling with the at least one tensioning element ( 20 ) and locking the second contact element ( 20 ) against movement at least in the first contact element ( 18 ) facing away direction, wherein the locking element ( 54 ) and the at least one tensioning element ( 20 ) cooperating engagement members ( 44 . 78 ) comprise or form, characterized in that the locking element ( 56 ) in the locking element receptacle ( 54 ) along a locking direction ( 68 ) is transferable from an unlocking position into a locking position, wherein the engagement members ( 44 . 78 ) on at least one tensioning element ( 30 ) and on the locking element ( 56 ) in its unlocked position do not couple with each other and in the locking position are positively engaged, and in that the locking element ( 56 ) transversely to the locking direction ( 68 ) positively in the locking element receptacle ( 54 ) and the engagement of the engagement members ( 44 . 78 ) only by transferring the locking element ( 56 ) can be canceled by the locking position in the unlocked position. Implant according to claim 1, characterized in that the locking element ( 56 ) one of the at least one tensioning element ( 30 ) durchgreife material recess ( 70 ) with a first recessed area ( 72 ) and a second recessed area ( 74 ), where one edge ( 76 ) of the material recess ( 70 ) at the first recessed area ( 72 ) free of engaging members ( 78 ) of the locking element ( 56 ) and at the second recessed area ( 74 ) at least one engaging member ( 78 ) of the locking element ( 56 ), wherein the at least one tensioning element ( 30 ) by transferring the locking element ( 56 ) from the unlocked position into the locking position of the first recess area (FIG. 74 ) in the second recessed area ( 72 ) and vice versa. Implant according to claim 1 or 2, characterized in that the material recess ( 70 ) a self-contained passage opening ( 70 ) of the locking element ( 56 ) and the recesses ( 72 . 74 ) Transit areas ( 72 . 74 ) of the passage opening ( 70 ) are. Implant according to one of the preceding claims, characterized in that the locking element ( 56 ) in the locking element receptacle ( 54 ) is held captive. Implant according to one of the preceding claims, characterized in that the engagement members ( 44 . 78 ) on at least one tensioning element ( 30 ), in its longitudinal direction ( 40 ) spaced apart circumferential ribs ( 38 ) and at least one on the locking element ( 56 ) groove ( 80 ) into which a circumferential rib ( 38 ) in the locking position of the locking element ( 56 ) intervenes. Implant according to one of the preceding claims, characterized in that the locking element ( 56 ) along the at least one tensioning element ( 30 ) positively in the locking element receptacle ( 54 ) is arranged. Implant according to one of the preceding claims, characterized in that the locking element ( 56 ) in the locking element receptacle ( 54 ) is movably mounted for transferring from the unlocked position into the locking position, in particular in the locking element receptacle ( 54 ) is guided displaceably. Implant according to one of the preceding claims, characterized in that the implant ( 10 ) at least one security device ( 34 ) comprises one with the locking element ( 56 ) coupled first securing member ( 82 ) and a second securing member ( 90 ), which in the locking position of the locking element ( 56 ) are movable relative to each other from a release position into a securing position in which they are used to secure the locking element ( 56 ) cooperate against movement in the unlocked position. Implant according to claim 8, characterized in that the second securing member ( 90 ) with the locking element receptacle ( 54 ) is coupled. Implant according to claim 8 or 9, characterized in that the first securing member ( 82 ) in one piece with the locking element ( 56 ) is formed and / or that the second securing member ( 90 ) in one piece with the locking element receptacle ( 54 ) is formed. Implant according to one of claims 8 to 10, characterized in that the securing members ( 82 . 90 ) co-operate positively and / or positively in the securing position. Implant according to one of claims 8 to 11, characterized in that the first securing member ( 82 ) and the second securing member ( 90 ) are biased relative to each other for transferring the Entsicherungsstellung in the securing position. Implant according to one of claims 8 to 12, characterized in that the securing members ( 82 . 90 ) one on the locking element receptacle ( 54 ) or on the locking element ( 56 ) resiliently held projection ( 92 ) and one on the locking element ( 56 ) or on the locking element receptacle ( 54 ) paragraph ( 84 ) and that the projection ( 92 ) with paragraph ( 84 ) cooperates in the securing position. Implant according to one of claims 8 to 13, characterized in that the securing members ( 82 . 90 ) along a direction transverse to the locking direction ( 68 ) aligned securing direction of the Entsicherungsstellung be transferred to the securing position. Implant according to one of the preceding claims, characterized in that the locking element receptacle ( 54 ) a sleeve ( 66 ), in which the at least one tensioning element ( 30 ) is guided displaceably. Implant according to one of the preceding claims, characterized in that the locking element receptacle ( 54 ) separated from the second contact element ( 20 ) is formed and at this against movement in the direction of the first contact element ( 18 ) is supported. Implant according to claim 16, characterized in that the locking element receptacle ( 54 ) and the second contact element ( 20 ) cooperating joint members ( 50 . 62 ), via which the locking element receptacle ( 54 ) tiltable about at least one tilting axis to the contact element ( 20 ). Implant according to claim 17, characterized in that the joint members ( 50 . 62 ) spherical joint surfaces ( 52 . 64 ) include or form. Implant according to one of claims 16 to 18, characterized in that the second contact element ( 20 ) a holding receptacle ( 48 ), in which the locking element receptacle ( 54 ) is held, wherein the locking element receptacle ( 54 ) two of a holding state in an insertion state and vice versa engageable holding members ( 60 ), wherein the holding members ( 60 ) in the approximated insertion state into the holding receptacle ( 48 ) are insertable and therein in the holding state can be transferred, in which they are spaced from each other further than in the insertion state. Implant according to one of the preceding claims, characterized in that the implant ( 10 ) two clamping elements ( 30 ), two locking devices ( 32 ) and, where appropriate, two security devices ( 34 ), each tensioning element ( 30 ) a locking device ( 32 ) and a safety device ( 34 ) assigned. Implant according to one of the preceding claims, characterized in that the implant ( 10 ) comprises at least one anti-rotation device for securing the at least one locking device ( 32 ) against rotation about the at least one tensioning element ( 30 ). Medical instrumentation comprising an implant ( 10 ) according to any one of the preceding claims and a locking instrument ( 102 ), which is a holding tool ( 106 ) for application to the locking element receptacle ( 54 ) and a locking tool ( 112 ) to the locking element ( 56 ) to be transferred from the unlocked position into the locking position. Instrumentarium according to claim 22, characterized in that the locking element ( 56 ) and the locking tool ( 112 ) corresponding alignment members ( 88 . 114 ) for correct relative positioning or form and / or that the locking element receptacle ( 54 ) and the holding tool ( 106 ) corresponding alignment members ( 94 . 110 ) comprise or form for correct relative positioning. Instrumentarium according to claim 22 or 23, characterized in that the instrumentation ( 100 ) an unlocking instrument ( 104 ) comprising a holding tool ( 116 ) for abutment with the locking element receptacle ( 54 ) and an unlocking tool ( 120 ), with the securing members ( 82 . 90 ) a security device ( 34 ) of the implant ( 10 ) can be converted from a securing position into a releasing position and the locking element ( 54 ) is transferable from the locking position to the unlocked position. Instrumentarium according to claim 24, characterized in that the locking element ( 56 ) and the unlocking tool ( 120 ) corresponding alignment members ( 86 . 122 ) comprise or form for correct relative positioning and / or that the locking element receptacle ( 54 ) and the holding tool ( 116 ) corresponding alignment members ( 96 . 118 ) comprise or form for correct relative positioning.

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