JPH0551304B2 - - Google Patents

Info

Publication number: JPH0551304B2
Authority: JP; Japan
Prior art keywords: plug; vertebrae; bone; tissue; implant
Prior art date: 1987-09-11
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.): Expired - Lifetime

Application number

JP1503992A

Other languages

English (en)

Other versions

JPH03503133A (ja

Inventor

Jon Daburyu Buranteigan

Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)

Individual

Original Assignee

Individual

Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)

1987-09-11

Filing date

1989-03-10

Publication date

1993-08-02

1989-03-10 Application filed by Individual filed Critical Individual

1991-07-18 Publication of JPH03503133A publication Critical patent/JPH03503133A/ja

1993-08-02 Publication of JPH0551304B2 publication Critical patent/JPH0551304B2/ja

Status Granted legal-status Critical Current

Links

Classifications

- 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
- A61F2/4465—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 having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
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- A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the spine
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- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/686—Plugs, i.e. elements forming interface between bone hole and implant or fastener, e.g. screw
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
- A61B17/7059—Cortical plates
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
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- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
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- 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
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- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
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- A61F2/4603—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2002/4625—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
- A61F2002/4627—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
- 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
- A61F2/46—Special tools for implanting artificial joints
- A61F2/4603—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2002/4629—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof connected to the endoprosthesis or implant via a threaded connection
- 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
- 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
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0004—Rounded shapes, e.g. with rounded corners
- A61F2230/0006—Rounded shapes, e.g. with rounded corners circular
- 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
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0019—Angular shapes rectangular
- 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
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0017—Angular shapes
- A61F2230/0021—Angular shapes square
- 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
- A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
- A61F2230/0028—Shapes in the form of latin or greek characters
- A61F2230/0058—X-shaped
- 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
- A61F2230/0063—Three-dimensional shapes
- 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
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0069—Three-dimensional shapes cylindrical
- 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
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0082—Three-dimensional shapes parallelepipedal
- 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
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0082—Three-dimensional shapes parallelepipedal
- A61F2230/0084—Three-dimensional shapes parallelepipedal cubical
- 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
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
- A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers
- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00017—Iron- or Fe-based alloys, e.g. stainless steel
- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
- 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
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00029—Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/907—Composed of particular material or coated

Landscapes

Health & Medical Sciences (AREA)
Orthopedic Medicine & Surgery (AREA)
Biomedical Technology (AREA)
Engineering & Computer Science (AREA)
Life Sciences & Earth Sciences (AREA)
General Health & Medical Sciences (AREA)
Heart & Thoracic Surgery (AREA)
Animal Behavior & Ethology (AREA)
Public Health (AREA)
Veterinary Medicine (AREA)
Surgery (AREA)
Oral & Maxillofacial Surgery (AREA)
Neurology (AREA)
Transplantation (AREA)
Vascular Medicine (AREA)
Cardiology (AREA)
Molecular Biology (AREA)
Medical Informatics (AREA)
Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
Dentistry (AREA)
Physical Education & Sports Medicine (AREA)
Prostheses (AREA)

Description

請求の範囲１脊椎柱１０，１００の隣接する脊椎骨２−
３，３−４の対向面、及び隣接する脊椎骨の間の
平円盤状空間１４，１１４に、横方向に向いて準
備された収納場所に置かれる補綴装置で、それは
並行して置かれた固形のプラグ１１，３１−３
４，１１１から構成され、そのサイズと形状は隣
接する脊椎骨の準備された収納場所に固定された
横方向の支柱を形成するもので、前記隣接する脊
椎骨の間に必要な平円盤状空間を確保し、それぞ
れのプラグは粗い表面１１ｂ，３１ｂ，３２ｂ，
３４ｄ，１２２を持ち、前記準備された場所に噛
み合うように納められ、脊椎骨から骨が内部に成
長しやすくし、またそれぞれのプラグは挿入道具
を装着出来る装置のついた端面を持ち、その装置
１９，１１１ｄはプラグの内部に向かつて伸び、
挿入道具２４，１２０にプラグの先端を固定して
装着し、準備された場所にプラグを先端から挿入
し易くした、脊椎柱の補綴装置。

２平円盤状空間１４，１１４をはさんで間隔の
開いた対向面を持つ隣接する脊椎骨体２−３，３
−４を、平円盤状空間を確保しながら、互いに融
合させる方法で、それは粗い表面１１ｂ，３１
ｂ，３２ｂ，３４ｄ，１２２を持つ不活性の固形
プラグ１１，３１−３４，１１１を挿入道具２
４，１２０の端部に装着し、脊椎骨の接続してい
る側面から内側に、前記間隔の開いた対向面に対
面する横方向チヤンネルを切り掘り、そのチヤン
ネルは脊椎骨の反対側側面１６，１１６の手前で
終り、挿入道具に乗せられたプラグを先端から前
記チヤンネルに挿入して脊椎骨を支える支柱を形
成し、プラグを動かすことなしにプラグから挿入
道具を取りはずし、脊椎骨から前記粗い表面の回
りに骨が内方成長して連結状態にし易くする、隣
接した脊椎骨を融合する方法。

３隣接する脊椎骨体を連結する組織１１２ａを
持つ損傷を受けて破損した脊椎骨の平円盤状組織
の両対向面に間隔の開いた対向面を持つ隣接した
脊椎骨２−３，３−４を融合するために採用され
た補綴装置で、脊椎骨体の前記対向面にはその中
に並んで掘られた横方向のチヤンネル１５，１１
５があり、前記平円盤状組織はチヤンネルに並行
した開口部１２１ａを持ち、補綴装置は固形の不
活性プラグ１１，３１−３４，１１１から構成さ
れ、それは並行したチヤンネルの底面の間の損傷
を受けた平円盤状空間よりも大きな高さがあり、
平円盤状組織を引き伸ばしてプラグがチヤンネル
に押し込まれるようにし、損傷を受けていない平
円盤状空間の初期状態を維持し、前記プラグの表
面１１ｂ，３１ｂ，３２ｂ，３４ｄ，１２２がチ
ヤンネル１５，１１５の表面と噛み合い、チヤン
ネルに固定された脊椎骨体から骨組織の内方成長
がし易くされ、脊椎骨体を互いに固定された状態
に融合する、補綴装置。

４破損し損傷を受けた中間の平円盤状組織によ
り連結された間隔の開いた隣接する脊椎骨体を互
いに融合するために、請求項１記載の補綴装置を
使用する方法で、それは間隔の開いた脊椎骨の隣
接する表面に横方向に並行に並んだチヤンネル１
５，１１５を掘り、並んだチヤンネルに通じる平
円盤状組織１１２ａに開口部１２１ａを作り、固
形の不活性プラグ１１，３１−３４，１１１をチ
ヤンネルおよび平円盤状組織の開口部に押し込
み、隣接する脊椎骨を押し広げて平円盤状組織を
伸ばして、損傷を受けていない平円盤状組織の空
間を維持し、前記プラグには不規則な表面１１
ｂ，３１ｂ，３２ｂ，３４ｄ，１２２がついてい
てチヤンネルの表面をしつかりと掴み、プラグが
脊椎骨に融合するように骨の内方成長を促進す
る、脊椎柱補綴装置の使用方法。

５プラグの粗い表面は、固形金属から放射状に
伸びかつ脊椎骨に噛み合うようにプラグの挿入道
具を装着する端部に向かつて傾斜がついた先導面
３２ｃ，１２２ｃを有するかかり３２ｂ，１２２
であり、かつ骨の内方成長を受ける広い領域を提
供している、請求項１記載の補綴移植装置。

６挿入道具を装着する装置が、プラグの端面に
あけられた内側にねじのきつてある穴１９，１１
１ｄで、挿入道具の先端がそこにねじこまれるよ
うになつた、請求項１記載の補綴移植装置。

７端面には、内側にねじのきつてある穴から放
射状に伸びる半径方向のスロツト２０のついた、
請求項１記載の補綴移植装置。

８粗い表面が、こぶのある表面１１ｂ、穴ぼこ
のある表面３１ｂ，かかりのある表面３２ｂ，１
２２、荒毛のある表面３４ｄ、および準備された
収納場所に噛み合うネジきりのある表面３２ｂの
グループから選ばれた表面である、請求項１記載
の補綴移植装置。

９粗い表面が、プラグ周辺から放射状に伸びる
かかり３２ｃ，３２ｄで、プラグの挿入方向に曲
げられ、準備された収納場所に挿入し易くし、プ
ラグを引き出そうとすると収納場所に噛み合つて
出せなくなる、請求項１記載の補綴移植装置。

１０プラグが固形の棒１１，３１−３４，１１
１で、脊椎骨の固い皮相骨１８，１１８に填まり
合うのに十分な長さがあり、皮相骨を越えて突き
出すことなしに脊椎骨の柔らかい繊維質骨１７，
１１７に広がる、請求項１記載の補綴移植装置。

１１粗い表面３４ｄがプラグ上のプラスチツ
ク・コーテイング３４ｃの周辺につけられた、請
求項１記載の補綴移植装置。

１２横方向のチヤンネル１５，１１５が平な側
面を持ち、固形プラグ３１，１１１が直方体であ
る、請求項３記載の補綴移植装置。

１３直方体プラグがチヤンネルの入り口に向か
つて傾斜の附いた先導端１１９ｃを持つ、請求項
１２記載の補綴移植装置。

１４プラグは高さよりも長い長さを持ち、幅は
高さよりも狭い、請求項１記載の補綴移植装置。

１５プラグには少なくとも一個のスロツト１２
４，１２５があり、そこに移植骨材１２６を受け
入れるようにした、請求項１記載の補綴移植装
置。

１６プラグは長手方向に垂直のスロツト１２４
と、前記垂直のスロツト１２４と交差する横方向
に水平のスロツト１２５を持つ、請求項１５記載
の補綴移植装置。

１７プラグが放射状に広がる無数のこぶ１２２
を持ち、それらの表面が溝１２３によつて分離さ
れている、請求項３記載の補綴移植装置。

１８こぶ１２２が傾斜した前表面１２２ｃを持
つ、請求項１７記載の補綴移植装置。

１９プラグ１１１がＸ線透過性材料から成型さ
れる、請求項３記載の補綴移植装置。

２０Ｘ線透過性材料がガラスあるいは炭素繊維
で充填された、請求項１９記載のプラグ１１１。

２１プラグ１１１がガラスおよび炭素繊維で充
填されたポリエーテル・スルホン樹脂から成型さ
れた、請求項３記載の補綴移植装置。

２２プラグ１１１が傾斜した前面１１１ａと挿
入道具を受け入れる穴１１１ｄのついた後面１１
１ｃを持つ、請求項３記載の補綴移植装置。

明細書本発明は、脊椎柱の隣接する脊椎骨の対向面の
下ごしらえした場所に横方向に挿入されて、脊椎
骨の間の正常な平円盤状空間を確保するために脊
椎骨に融合される支柱を形成する、補綴器具の技
術に関する。これらの器具は、平円盤状空間に平
行に並んだ固形の不活性の挿入物で形成され、骨
組織が内方に向かつて成長しやすくするためにそ
の表面が粗くなつている。

挿入物は、隣接する脊椎骨の間に挿入しやすく
するためにひとつの器具上に縦に装着され、正常
な平円盤状空間に矯正する高さがあり、つぶれて
損傷を受けた平円盤状空間の残つている組織を引
き伸ばす。望ましい挿入物には、脊椎骨に噛み合
うかかりがあり、骨の接ぎ木材を入れる溝があ
り、脊椎骨の間に挿入しやすくするために先端が
先細になつており、そして、それはＸ線透過性材
料から形成される。

1988年５月10日づけの私の合衆国特許第
4743256号で指摘したように、背中の下方の痛み
の主要な原因は、腰部の脊椎骨の間の平円盤状組
織の破裂あるいは変質に起因する。背中の最下部
の痛みは（座骨神経痛）は、脊椎骨の間の平円盤
状組織の損傷による脊髄神経の根の圧迫に起因
し、背中の下方の痛みは平円盤状組織の陥没に起
因し、これらは損傷を受けて不安となつた脊椎骨
の接合部で体重の大部分を支えることの悪影響の
結果である。座骨神経痛の痛みおよび背中の下方
の痛みを和らげるための外科的処置としては一般
には次の方法がある。

１破裂した柔らかい平円盤状組織の切除この方法は脊髄神経を圧迫する平円盤状組織の
一部分を除去するもので、一般的には座骨神経痛
による脚部の痛みを和らげるのに成功しているけ
れども、半分以上の場合には背中の痛みの再発が
ある。ある期間に渡つて平円盤状組織は破裂の結
果次第に高さが減少し、この高さの減少が脊椎骨
の後方の面接合部がうまく噛み合わない状態をつ
くり、その結果脊柱部分のすべての要素が関節炎
への変化を起こすことになる。骨質の浸食（脊柱
狭窄）による神経根の圧迫の再発もまた拡大す
る。この原因による、継続する、あるいは再発す
る背中の痛みは、痛みおよび損害を引き起こす主
な原因となつてきた。

２後方部分の融合による平円盤状組織の切除骨質薄層の間の骨の成長を促す伝統的な後方部
分の融合、あるいは横方向の突起の間での後方側
面の融合は、隣接する脊椎骨の間の動きを止める
けれども、体重の約90％は変質した平円盤状組織
を通して伝達されなければならないので、これが
痛みを引き起こすという事実を変えるものではな
い。さらに、後方部分の融合は骨質の過成長を引
き起こす傾向があり、これが脊柱狭窄による神経
根の圧迫となる。

３中間体を用いた前方部分の融合による平円盤
状組織の切除中間体を用いた融合技術、すなわち柔らかい平
円盤状組織を完全に除去し、患者自身の骨（自己
骨）あるいは移植された骨（相同骨）で置き換え
る方法は、もし隣接する脊椎骨の間で堅い融合が
得られるならば一般的には成功である。しかし残
念ながら、成功率はたつたの約50％である。

４腰部の脊椎骨間の後方部分の融合による平円
盤状組織の切除（PLIF）この方法は骨と神経組織の間の正常な解剖学上
の関係を再形成するもので、多くの利点がある。
脊椎骨体の間の堅く融合された骨質体を通じて体
重を支えることにより、典型的な、不安定で損傷
を受けた平円盤状組織による物理的痛みを緩和
し、一般的には、長期間にわたる平円盤状組織の
損傷、あるいはさらに進む悪化をふせぐ。平円盤
状組織を完全に除去することにより、同じ損傷を
受けた平円盤状組織のヘルニア再発を防ぐことが
出来る。

しかしこのPLIF処理にはいくつかの重大な欠
点、すなわち技術的に非常にむつかしい点があ
り、したがつて予期したような成功をおさめてお
らず、広く使用されてもいない。それは必然的に
小さな深い穴での大量の出血をひきおこし、患者
には生理的な圧迫感を与え、外科医には心理的な
苦悩を与える。さらに、患者自身の腸骨の端から
とる自分の移植骨を使用することは、手術個所を
広げ、苦痛を伴う第二の手術個所をつくる。十分
な強度を持つ多量の自生の骨を得ることは困難で
あるので、一般的には相同の貯蔵骨が使用され
る。中間体の骨の移植には強度に問題があり、ま
た骨の合体に問題がある。治療が行われている時
に平円盤状部分の陥没を防ぐためには、中間体位
置での支柱として強力な皮相骨が必要とされる。
外科医師は残念ながら手術中に手操作の道具で必
要な支柱を作る必要があり、これらの皮相骨の支
柱は最適に加重支えに対して十分広くなく、それ
らは一年以上にわたつて非常にゆつくりと進む治
癒過程によつて自身で固定される。さらに、12ケ
月から18ケ月にわたつて治癒する柔らかい網状組
織の骨もまた伝統的な中間体融合には必要とされ
る。

整形外科では、移植された骨はいわゆる「潜行
性の置換」と呼ばれるプロセス、すなわち、まず
毛細血管が移植された骨の中に成長し、移植され
た骨は再吸収され、次に新しい骨細胞が移植骨の
母組織にそつて成長するというプロセスによつて
治癒することは良く理解されている。移植骨の構
造支柱が再吸収されている間、関係した部分の動
きは依然として防がねばならず、しばしば添え木
やギブスが使用されるけれども、全プロセスは望
まれるほど信頼性のあるものではなかつた。もつ
と「外来」のものである相同の貯蔵骨は一緒に成
長するためにはもつと長い時間を必要とし、また
患者自身の骨を使用する場合に比べて失敗する割
合はより高いと見積もられる。実際において、ど
ちらの供給源からの骨も融合プロセスに対して最
適なものではない。

私の前述の合衆国特許第4743256号は、損傷さ
れたあるい変質した脊椎骨の平円盤状組織に起因
する脊椎の痛みを、隣接した脊椎骨の間の平円盤
状組織のスペースを固形の移植物で広げることに
より解消する、改良された外科的方法を提示して
おり、この場合、固形の移植物は骨の内部への成
長をしやすくする表面をもち、移植物が脊椎骨と
一体となり平円盤状組織のスペースを保持する恒
久的な体重支持のための支柱を提供するために、
固形の移植物は脊椎骨の下ごしらえした場所に植
え付けられる。

本発明は、固形移植物を下ごしらえした場所に
移植しやすくするために固形移植物には挿入用具
を受ける端表面があり、骨の内部への成長を促進
するために移植物の周辺には粗くされた幾何学的
模様の表面がある固形移植物を提供することによ
り、この種技術をさらに改善する。本発明はまた
新しい挿入用具で移植方法を改善することによ
り、更にこの種の技術を改善する。

本発明により、私の前記合衆国特許第4743256
号により一般的に提示されているタイプの固形の
詰め物は、更に改善されて、挿入用具を受ける受
け部の付いた端表面をつけて隣接した脊椎骨の下
ごしらえした場所へプラグを挿入し易くし、周辺
表面を幾何学的模様に粗くして脊椎骨の間にはめ
易くし骨の内部への成長を促進するようにしてい
る。望ましいプラグには、一方の端に内部にネジ
溝のきつてある軸方向の穴があり、終端表面には
この穴から放射状に広がる翼あるいはスロツトが
ついている。挿入用具がこの穴にネジこまれスロ
ツト受け部にはまりこんだスリーブによつて囲ま
れる。端部を挿入用具によつて支えられたプラグ
は隣接する脊椎骨の間の準備の出来た場所に挿入
され、適切な位置に位置決めされた時、スリーブ
は回転に対してプラグを固定する役割を果たし、
プラグを移動する事なくネジをゆるめてプラグか
ら用具を取り出すことが出来る。

プラグを埋め込む場所は、隣接する脊椎骨の対
向する表面に溝が形成出来るようにドリルを正し
く位置ぎめするために、隣接する脊椎骨の後方端
に埋め込まれた突き出した歯を持つドリル・ガー
ドにより囲まれたドリルによつて、穴明けされて
形成される。この溝は硬い皮相骨を含むように十
分広く長い必要があるが、脊椎骨の前方側まで貫
通しないのが望ましい。逆にいえば、もしドリル
が脊椎骨の前方部分から挿入される場合には、ド
リル操作は後方側の直前で停止するのが望まし
い。

私の前述の合衆国特許第4743256号に提示して
いるように、このプラグは不活性の固形金属、例
えばステンレス・スチール、コバルト−クロム−
モリデブン合金、チタンなどで作られる。しか
し、本発明では、これらのプラグの周辺表面は、
私の以前の特許に提示されたような金属粒子の多
孔質のコーテイングをもつている必要はなく、骨
の内部への固定のために窪みや尖つた先や針毛や
こぶやまた同じような不均一性をつけることが可
能である。これらの粗くされた表面はプラグ本体
の一部分であつてもよいし、本体にポリマ樹脂の
ようなものをコーテイングしたものでもよい。針
毛や尖つた先のある表面は硬くすることも柔軟に
することも出来、もし必要ならば挿入を容易に
し、取り出しに抵抗性があるようにすることが出
来る。

プラグの端面にあるネジをきつた穴の望ましい
形状は、長さがプラグの長さの半分以下で止めら
れ、プラグの直径の1/3以下の直径のものである。
プラグの端面には、翼あるいはスロツトが、穴か
ら直径方向に放射状にひろがり、しかしそれはプ
ラグの外周から内側に入つたところで終わるよう
につけられている。

粗い表面を形成するポリマーのコーテイングで
望ましいのは、移植した環境で劣化に対して抵抗
性のあるナイロン、ポリオレフイン、ビニール、
あるいは同様の樹脂である。

本発明はまた長方形をした脊椎骨補綴プラグあ
るいはブロツクを提供するもので、それらは、脊
椎体の隣接した表面の長方形をした横方向あるい
は垂直方向のチヤンネルあるいは溝にはまりこ
み、まだ脊椎骨を繁げている残つた平円盤の環状
の組織を広げるだけの高さを持つている。これら
の横方向に矩形のチヤンネルあるいはスロツトに
はまりこむ、平らな側面を持つ長方形をしたある
いは直方体ブロツクあるいはプラグが提供され、
それらは横方向のスロツトの開放端に容易に挿入
出来て脊椎骨を押し広げる様に面取りしたあるい
は傾斜のついた先導端部を持ち、したがつて、そ
れぞれのブロツクあるいはプラグの上部及び底部
表面は引き伸ばされた平円盤状組織のあるスロツ
トにしつかりと固定され、脊椎骨がプラグ掴むよ
うにしている。これらのプラグは、挿入器具の先
端に装着された状態で、脊椎柱のスロツトに、横
方向あるいは水平方向から挿入され、またこれら
のプラグは骨の内部への成長を促進するために粗
くされた表面を持ち、またプラグには垂直方向あ
るいは水平方向のまたは水平方向と垂直方向が交
差したスロツトがあり、そこには骨の接ぎ木材
料、たとえば骨盤の腸骨突起から切り取られた骨
片のようなものが詰められている。この移植剤
が、移植されたプラグの周囲に成長し、プラグか
ら脊椎骨の中へ成長していくひとかたまりとなつ
た生きた骨を作りだす。

また、本発明によると、ブロツクあるいはプラ
グを、不活性金属で作るかわりに、ナイロン、ポ
リカーボネート、ポリプロピレン、ポリアセター
ル、ポリエチレン、ポリスチレンなどのプラスチ
ツクで、望ましくはガラス・フアイバやカーボ
ン・フアイバの入つたものなどのＸ線透過性材料
で作ることも可能である。これらのプラスチツク
は注入モールデイング法によつて作ることが出
来、軽量で、大きな荷重に絶える強さを持ち、骨
の治癒状況をエツクス線で視覚化する点で改良さ
れた方法である。ガラス・フアイバやカーボン・
フアイバなどのフアイバで強化したプラスチツク
もまた望ましい。適切なカーボン・フアイバ複合
剤としては、カーボン・フアイバで強化されたポ
リエステル・スルフオンが、“VICTRES P.E.
S.”の商品名で供給されている。適切な品質のも
のは30％のガラス・フアイバが入れられた“4101
G.L.−30”および30％のカーボン・フアイバが入
れられた。450 C.A.−30”である。これらの材
料はデラウエア州WilmingtonのICI Industriesか
ら供給されている。ミネソタ州WinonaのFiber
−Rite Corporationから売られているタイプの
カーボン・フアイバ・プラスチツクもまた有効で
ある。

本発明の望ましい実施例は添付する図面に示さ
れている。

第１図は人の脊椎柱の下方部分の側立面図で一
部分が取り除かれ下方の脊椎骨のいくつかの間に
本発明の補綴移植プラグが挿入された様子を示す
図、第２図は第１図の一部分を示す後方からの立面
図で第１図の線−にそつた図、第３図は第２図の線−にそつて破断した時
の一部立面図で表わされた断面図、第４図は垂直方向に見た部分拡大立面図で隣接
した脊椎骨の間の場所に移植プラグ収納場所を準
備する方法を示す図、第５図は第４図に同様の図で隣接する脊椎骨の
間に準備した位置に移植プラグが挿入される様子
を示す図、第６図は本発明のつぶつぶのある表面を持ちそ
の端部に挿入道具用受け穴のついた補綴プラグの
一つの形状を示す透視図、第７図は本発明の周辺部に穴のついた移植プラ
グのもう一つの形状を示す透視図、第８図はその周辺部に曲がり可能な固定用突起
のついた本発明による補綴プラグの軸方向の破断
面を示す側立面図、第９図は第６図に同様の図でプラグの周辺面を
粗くするために溝がついている様子を示す透視
図、第１０図は放射状の荒毛のついた樹脂コーテイ
ングをほどこした本発明による補綴プラグの透視
図、第１１図は第１０図の線６−６にそつた横方向
断面図、第１２図は、人の脊椎柱の下方部分の側立面図
で、一部分が取り除かれ、本発明の平らな側面を
持つ直方体の補綴移植プラグが、隣接する脊椎骨
の対向面のあいだの直方形の溝あるいはチヤンネ
ルに挿入され、損傷を受けヘルニアになつた組織
を取り除くために部分的に切除された人の平円盤
状組織にある脊椎骨を支持する様子を示す図、第１３図は第１２の線８−８にそつた部分の後
方からの立面図、第１４図は第１３図の線９−９にそつて水平方
向に破断した時の一部立面図で表わした横断面
図、第１５図は、垂直方向に破断した部分拡大側立
面図で、本発明の試験用あるいはゲージ・プラグ
が隣接する脊椎骨の横向きの直方形のスロツトの
位置に挿入され、これらの脊椎骨に連結された残
つた平円盤状組織を引き伸ばし、適切なサイズの
恒久的移植プラグを受け入れる収納場所のサイズ
をきめる様子を示す図、第１６図は脊椎骨の平円盤を示す平面図、内部
の骨髄を取り除き、平円盤状組織を部分的に取り
除いて、プラグを受け入れるために掘られたチヤ
ンネルにならんだギヤツプあるいはスロツトを提
供する様子を示す図、第１７図は第１５図に示されるように使用する
ための平らな表面を持つ試験用あるいはゲージ用
プラグの透視図、第１８図は本発明の恒久的移植プラグあるいは
移植ブロツクの望ましい形状を示す透視図、第１９図は第１８図のプラグの線１９−１９に
そつた長手方向の垂直断面図。

第１図から第５図まで番号１０は一般的に人間
の脊椎柱の下方部分を示し、そこでは隣接する脊
椎骨が本発明による補綴移植器具によつて支持さ
れている様子、あるいは移植の場所を準備する方
法、あるいは準備された場所に移植器具を挿入す
る方法を示している。

第１図で、脊椎柱１０は、１から５まで番号の
付いた５個の下部脊椎骨を示す。隣接した脊椎骨
２番と３番、隣接した脊椎骨３番と４番は本発明
の補綴移植器具１１によつて分離され支持され
る。脊椎骨１番と２番および脊椎骨４番と５番
は、健康で損傷を受けていない平円盤状組織１２
によつて支えられ分離されて、隣接する脊椎骨の
間の平円盤状スペースを保持している。人体本来
の平円盤状組織が、２番と３番の間、および３番
と４番の間の平円盤状のスペースから除去され、
平円盤状スペース１４は補綴移植器具１１によつ
て保持される。隣接する脊椎骨の対面する表面に
は、一般に脊椎柱１０の軸に対して横方向に形成
される下ごしらえした収納場所あるいはチヤンネ
ル１５があり、移植物１１の円筒形対向表面をき
ちんと受け入れる。これらの横方向の収納場所１
５は十分に広く且つ深く、中央の柔らかい海綿状
の骨にひろがり、隣接する脊椎骨の固い皮相骨を
も含む。しかし、収納場所には移植器具１１を固
定するためにめくらになつた端部１６がある。

第２図および第３図に示されるように、移植器
具１１は、横方向の収納場所１５に端を先に向け
て挿入された一対の横並びとなつている円筒形の
プラグの形状であり、その収納場所はこれらのプ
ラグの対応表面を受け入れそれと噛み合う独立し
た円筒形状である。

脊椎骨の柔らかい海綿状の骨が第３図の１７で
示されており、それは脊椎骨３番の固い皮相骨１
８によつて囲まれている。準備された収納場所１
５はこの固い皮相骨の部分を含み、したがつて、
移植器具１１は柔らかい海綿状の骨に広がり、そ
して固い皮相骨１８に乗つかる。

プラグ１１は準備された収納場所１５にぴつた
りと収まり、これらの収納場所のめくらとなつた
端部１６に底をつける。

プラグは固く、望ましくは固体で、粗くなつた
表面を持ち、隣接する脊椎骨からの骨の内部への
成長をはかるための強力な固定用の点あるいは細
穴を形成している。それらはステンレス・スチー
ル、コバルト−クロミウム−モリブデン合金、チ
タンあるいは同様の不活性金属で作ることが出来
る。それらは多くの異なる形状や、異なる周表面
の形状をとることが出来る。それらは挿入器具を
受ける端面を持ち、その受け部は、準備された収
納場所に挿入するために、および、装着状態を乱
すことなしに器具を取りはずすために、器具の上
にプラグを装着するために使用される。これらの
器具受け入れ部は、プラグの一方の端面１１ａに
あけられた内側にネジのある円形の穴１９の形で
示されている。端面１１ａにはタツプ穴１９を直
径方向に横切る放射状のスロツト２０がつけられ
て、タツプ穴１９から放射状に広がる翼を形成し
ている。タツプ穴１９は端面１１ａから軸方向に
内側に向かつて比較的短い距離だけ延び、それで
挿入用具のネジ穴にしつかりと固定するために十
分な数のネジ山がとれる様にしている。

第４図に示されるように、隣接する脊椎骨２番
と３番との間の収納場所１５は、両方の脊椎骨の
後方側面にはめこんで固定するための歯あるいは
尖つた先２３のついたドリル・ガード２２の中を
滑つて進む回転ドリルあるいは穴ぐり器２１によ
つて容易に下ごしらえすることが出来る。ドリル
は脊椎骨の後方側面からスリーブ２２を通つて進
み、穴掘り動作はこれらの脊椎骨の前方側面より
も手前でストツプし、準備する収納場所にめくら
となつている端部１６を作る。

収納場所１５は第４図に示されるドリル装置に
より容易に準備出来るが、挿入される移植物の形
状にみあうように、ほぞ穴穴ぐり器あるいはのみ
の形状をした道具で準備することも出来る。

第５図に示されるように、移植器具１１は、移
植器具１１の端面１１ａにあるタツプ穴１９には
まりあうネジをきつた端部２６があり反対側端部
は容易に掴むことの出来るハンドル２７に装着さ
れた軸部２５を持つ挿入用具２４によつて、脊椎
骨２番と３番の後方側面から、準備された収納場
所１５に容易に挿入される。スリーブ２８は軸２
５上にスライド出来るように装着され、それは前
方端に放射状スロツト２０にはまりあう両直径方
向に反対に開いたキイあるいは突出部２９を持
つ。スリーブの反対側端部にはぎざぎざの付いた
頭部３０がある。

軸のネジのきつてある終端部２６をさらすため
に軸２５上に引つ込んだスリーブ２８を持つ挿入
用具２４は、タツプ穴１９にねじ込まれめくらに
なつた穴の終端に固定される。プラグ１１はこの
ように挿入用具にしつかりと固定され、挿入用具
は、プラグを準備された収納場所１５に納め、収
納場所のめくらとなつた終端部１６に固定するよ
うに操作される。プラグを収納場所に位置ぎめし
た後に、スリーブ２８は軸２５上を前進して、そ
の先端部突起２９がスロツト２０に固定され、軸
は、スリーブのぎざぎざの付いた頭部３０をしつ
かりとつかんでスリーブとプラグの回転を防ぐよ
うにしながら、ネジがゆるめられ、取りはずされ
る。

プラグ１１の詳細が第６図に示されており、そ
れは固形の円筒棒形状で、その端面１１ａには内
部にネジをきつた穴１９があり、穴は軸方向に内
側に延び、直径方向に放射状のスロツト２０がつ
いていて、スリーブ２８の突起２９を受ける翼を
提供する。円筒状の棒１１はギザギザのある粗い
周辺表面１１ｂをもち、骨の内部への成長を促進
するためにピラミツド状のピツト１１ｃを形成す
る。プラグは脊椎骨の後方および前方の側面の間
の準備の出来た収納場所にぴつたりはまり込む寸
法である。その寸法は諸条件に合致するように非
常に広く、直径が約5/8インチで長さが約１イン
チのプラグ・サイズが有益である。そのようなプ
ラグの端面１１ａのタツプ穴１９は、直径が約1/
８インチで深さが1/4インチのものである。スロツ
トは周辺部から内側で終わり、約1/8インチの深
さである。

本発明の補綴移植器具のもう一つの適切な形状
が第７図に示されており、そこでは器具３１は正
方直方体で、端面３１ａにはタツプ穴１９と溝あ
るいはスロツト２０がある。器具３１は穴のあい
た周辺部３１ｂを持ち、骨の内部への成長を促進
するために多数の小さな穴を形成する。本発明の
補綴器具３２のもう一つの形状が第８図に示され
ており、そこでは器具は円筒プラグ３２で、端面
３２ａにはタツプ穴１９とスロツト２０がある。
円筒形プラグの周囲には長手方向に間隔の開いた
円形のリブ３２ｂがある。これらのリブは、プラ
グのネジのある端に向かつて傾いた皿状の突起あ
るいは返りを形成し、したがつて、それらは準備
された収納場所に滑り込むように傾いているが、
骨に食い込むようになつていてプラグを収納場所
から取り出すに際して抵抗力を持たせている。図
示されるように、リブは凸形の先導面３２ｃと凹
形の尻尾の面３２ｄをもつている。そのような形
状はプラグが収納位置に押し込まれる時には曲が
り易くなつていて、引き出しや回転に対しては抵
抗力があるように元に戻る。もし必要ならば、リ
ブには軸方向にスロツトをつけ無数の返り突起と
することも可能である。

第９図の実施例３３では、移植器具は固形の円
筒状棒であり、端面３３ａにはタツプ穴１９とス
ロツト２０があり、円筒外周には３３ｂに示され
るように外からネジがきつてある。プラグが時計
方向に回転されるときに、このネジはプラグを準
備された収納場所に前進させる。ネジは骨の組織
にかみあうような鋭いエツジを持つようにするこ
とも出来る。

第１０図及び第１１図の移植プラグ３４もま
た、他のプラグと同様に終端表面３４ａはタツプ
穴１９とスロツト２０を持つているが、固形の円
筒形状の芯３４ｂにはポリマ樹脂のカバー３４ｃ
がついていて、カバーの円周表面には直立した針
毛３４ｄがついている。これらの針毛は内部への
骨の成長を促進する張り出した表面を形成する。

本発明の器具には多くの他のタイプの粗い不規
則な表面が取り付け可能で、それらにはその詳細
が前述の特許第4743256号に提示されているよう
な、固形の金属板に金属ボールや金属ビーズを焼
結させたものがある。

図には補綴移植プラグが横に並行に並べて装着
され、体重の荷重を支えるために固い皮相骨の上
にぴつたりと乗つかつて、平円盤状空間を保持す
る一対の支柱を形成する。これらの移植プラグ
は、急速な骨の内部成長を促進する表面を持ち、
これが比較的短い成長期間に移植プラグを隣接す
る脊椎骨に融合させる。

第１２−１４図には、参照番号１００は一般に
人間の脊椎柱の下部を示し、そこでは隣接する脊
椎骨は本発明の補綴移植ブロツクあるいはプラグ
で支持される。

第１５図は、本発明のゲージあるいは試し用ブ
ロツクが、隣接する脊椎骨に作られた横方向に長
方形をしたスロツトに水平方向から挿入される
時、陥没した脊椎骨間の平円盤状組織を引き伸ば
して、隣接する脊椎骨の間隔が広げられる様子を
示す。

第１２図では、脊椎柱１００は五個の下方の脊
椎骨１−５番を示す。隣接した脊椎骨２番と３
番、隣接した脊椎骨３番と４番は、本発明による
補綴移植ブロツクあるいはプラグ１１１による分
離され、支持される。脊椎骨１番と２番、および
脊椎骨４番と５番は健康な損傷を受けていない人
の平円盤状組織１１２によつて支持され分離され
て、隣接する脊椎骨間の正常な平円盤状空間を維
持する。

自然な人間の平円盤状組織１１２の損傷を受け
た部分は、平円盤状空間１１４が移植ブロツクあ
るいは移植プラグ１１１によつて支持された状態
で、脊椎骨２番と３番および３番と４番とから除
去される。脊椎骨間の平円盤状組織１１２の健康
な環帯状組織を出来るだけたくさん残すのが望ま
しく、そうすると、残された平円盤状組織１１２
ａは、少なくとも部分的には移植プラグを取り囲
み、これらの移植プラグによる張力のもとにおか
れる。しかし、残つた環帯状平円盤状組織のいく
ぶんかは、移植プラグ１１１のためのスペースを
作るために、除去しなければならないかもしれな
い。

隣接する脊椎骨の対面する表面には、まず、恒
久的に移植するプラグ１１１の適切なサイズを決
めるため本発明のテスト用ブロツクあるいはプラ
グがぴつたりした状態で受け入れられるように、
脊椎柱１００の軸に対して横方向に切り取られた
平らな側面を持つ長方形をしたチヤンネルあるい
は溝１１５がある。これらの横方向のチヤンネル
１１５は、中央部の柔らかい繊維質の骨の部分に
広がり、隣接する脊椎骨の固い皮相骨部分を含む
に十分な幅と深さがある。脊椎骨の間に残る損傷
を受けていない人の平円盤状組織１１２ａもま
た、移植プラグ１１１を受け入れるために切除さ
れたり削つて形を整えられたりして、出来るだけ
多くの健康な環状の繊維質組織が移植プラグを取
り囲むようにする。

望ましい平らな側面をもつ長方形のチヤンネル
１１５には、移植プラグ１１１が接触するめくら
になつた端部１１６がある。

第１３図および第１４図に示されるように、移
植プラグ１１１は並列に配置される一対の直方体
のプラグで、横方向のチヤンネル１１５に端から
差し込まれる。これらのチヤンネルは、直方体の
プラグの上端面、底端面および側面をぴつたりと
受け入れるための、平らな底面および側壁を持
つ。第１４図では、脊椎骨の柔らかい繊維質の骨
が１１７で示され、それは固い皮相骨によつて囲
まれている。チヤンネル１１５はこの固い皮相骨
を含み、したがつて、移植プラグは柔らかい繊維
質の骨に広がり、固い皮相骨に乗せられる。

チヤンネル１１５は、ほぞ穴を掘るのみ状の道
具で形成され、平円盤状組織１１２ａがプラグ１
１１の通路を阻害する時には、組織が縁取りさ
れ、押し広げられて、路をつける。

第１８図および第１９図に示された移植プラグ
あるいはブロツク１１１は、固く、不活性で、固
体で、平らな側面をした直方体で、横幅よりも高
さの方が高く、高さよりも長さの方が長い。これ
らは、第１７図に示される１１９のような試験用
あるいはゲージ用ブロツクと共に使用される。こ
れらのブロツク１１９は平らで滑らかな側面及び
端面を持ち、平らな前方端面１１９ｃがあり、平
らな後方端面１１９ｄがある。前方端面１１９ｃ
は、まるくなつたコーナー１１９ｆのある平らな
傾斜付きの側面１１９ｅによつて囲まれるように
し、導入部の直方形の部分に傾斜を付けてある。

後方端面１１９ｄには、その中心部分に内側に
溝のきつてある軸方向のめくら穴１１９ｇがあ
る。

典型的な外科手術では、ゲージ・ブロツク１１
９が、長さが約25mmで、幅が約11mmで、高さは13
mmから17mmまで変化するが、これらのパラメータ
は非常に大きく変えることも出来て、患者の脊柱
のサイズに依存することも理解されたい。傾斜部
分１１９ｆの傾斜角は望ましくは約30°である。
斜面のまるくなつたコーナー１１９ｆは、斜面の
上面、底面および側面の間の鋭く尖つたコーナー
をなくする。

第１５図で示されるように、試験用ブロツクあ
るいはゲージ・ブロツク１１９は、ねじ穴１１９
ｆにねじ込まれた道具１２０に装着されて、チヤ
ンネル１１５に圧力をかけて押し込まれるように
選択される。ブロツクの傾斜の付いた前面端１１
９ｃは、ゲージ・ブロツク１１９を受け入れるた
めに、残りの組織に穴をきつていくか、あるいは
平円盤状組織の繊維を押し広げることによつて、
チヤンネル１１５の入り口をカバーする平円盤状
組織１１２ａのどの部分をも、通り抜けることが
出来る。

第１６図に示されるように、チヤンネルが掘ら
れた脊椎骨の平円盤１１２の残りの健康な組織１
１２ａが、このチヤンネル１１５にゲージ・ブロ
ツク１１９がはまるスロツト１２１を拓くよう
に、トリミングされる。これらのスロツトはチヤ
ンネル１１５と正しく揃えられ、開放した前方端
１２１ａとめくらとなつた後方端１２１ｂを持
つ。損傷を受けた平円盤状組織１１２からその該
髄を切除し、隣接する脊椎骨を連結し移植ブロツ
クを取り囲む繊維状組織の環を残しておくことが
望ましい。

適切にはまりあうゲージ・ブロツク１１９は、
チヤンネルの掘られた脊椎骨に差し込んで、トラ
イアル・アンド・エラーで選択される。これらの
ブロツクは平らな表面を持ち、たとえチヤンネル
１１５にきつくはまり合つたときでも、取り除く
ことが出来る。

第１５図に示されるように、挿入道具１２０の
端部にねじどめされたゲージ・ブロツク１１９
は、対面するチヤンネル１１５底面の間の高さ間
隔よりも広い高さを持つように選択される。そう
すると、このブロツクが並んだチヤンネル１１５
の開放端から押し込まれるとき、傾斜を持つ導入
部１１９ｃがこれらのチヤンネルの底部とかみあ
い、ブロツクがチヤンネルに押し込まれると、チ
ヤンネルの底部を押し広げ、したがつてまた脊椎
骨を連結している平円盤状組織１１２ａを引き伸
ばす。ブロツクはチヤンネルのめくらとなつてい
る端部１１６に押し付けられ、平円盤状組織の繊
維に加わる張力が決まる。平円盤状組織の繊維に
適切な荷重をかけ、チヤンネルにぴつたりはまり
あうにふさわしいサイズのブロツク１１９が入れ
られる時には、恒久的な移植プラグ１１１のサイ
ズはゲージ・ブロツクのサイズよりもわずかに大
きなものが選択される。次に、そのような恒久プ
ラグが導入道具１２０の先端にねじどめされ、ゲ
ージ・ブロツク１１９が引き抜かれ、そして挿入
道具上の恒久的移植プラグ１１１がチヤンネル１
１５のしかるべき位置に押し込まれる。

望ましい恒久的移植ブロツクあるいはプラグ１
１１が第１８図及び第１９図に示されている。こ
のプラグは選択されたゲージ・ブロツクとほぼ同
じ平側面寸法を持つているが、これらの平らな上
面、底面及び側面から突き出したもりあがつた環
状のこぶ１２２があり、直方形をしたチヤンネル
１１５の底面及び側面壁に噛み合いそれを掴む粗
い表面を提供する。これらのこぶは、環状の溝１
２３および長手方向のチヤンネル１２３ａによつ
て分離され、したがつてそれぞれのこぶ１２２は
平らな垂直の背壁１２２ａを持ち、一対の平らな
垂直の側壁１２２ｂおよび傾斜の付いた前面１２
２ｃを持つこととなる。

プラグ１１１は、ゲージ・ブロツク１１９の導
入部１１９ｃおよび傾斜した側壁１１９ｅと同様
に、傾斜した側壁１１１ｂに囲まれた細くなつた
導入部１１１ａを持つ。さらに、垂直の後方壁１
１１ｃは後方壁１１９ｄと同じで、ゲージ・ブロ
ツク１１９の後方壁１１９ｄと同じように、内部
にねじがきつてあるねじ穴１１１ｄがつけてあ
る。

さらに、移植プラグ１１１は垂直方向にスロツ
ト１２４があり、そこを通じてプラグの上面と底
面を連結する。この垂直方向のスロツト１２４は
長方形をしており、その幅はブロツクの幅の約1/
３で、長さは、プラグの前面端および後面端の近
くまで伸びている。

このスロツト１２４は、水平方向に貫通するス
ロツト１２５と中央部で交差している。逆にいえ
ば、ブロツク１１１はただ一つの水平方向および
垂直方向のスロツトを持つているものと理解され
よう。

スロツト１２４と１２５はブロツクあるいはプ
ラグ１１１に空洞を作り、その空洞は、望ましく
は、患者の骨盤から取られた移植片１２６によつ
て満たされる。移植プラグ１１１の中に納められ
た骨財は、やがて溝あるいはチヤンネル１２４お
よび１２５から成長してはみだし、プラグ１１１
を取り囲むこぶ１２２の間の円周方向および長手
方向のチヤンネルに伸びていき、さらに隣接する
脊椎骨の骨組織の中に成長していく。

移植プラグが脊椎骨の間のしかるべき位置に押
し込まれた時、こぶ１２２の傾斜した前面はプラ
グをチヤンネル１１５のめくら端１１６の方へ前
進運動させるようにするが、こぶの鋭い矢状の先
端は脊椎骨に噛み合うので、プラグの後退を防
ぐ。したがつて、一度プラグが適切な位置に納め
られると、その位置から移動することはない。

プラグ１１１の高さは平円盤状組織の約20から
30ポンドの張力荷重を支えるに十分な高さが望ま
しい。そのような張力荷重は脊椎骨をプラグにし
つかりと引つ張りつけるのみならず、骨の内部へ
の成長を促進する。

本発明による望ましい補綴用プラグあるいはブ
ロツク１１１は、外科的処置を容易にし単純化す
るのみならず、脊椎骨がプラグと組織融合するの
を促進するものである。こぶによつて作られた粗
い表面は、このように、脊椎骨に固定する目的お
よび骨の内部への成長のためのチヤンネルを提供
する目的という複数の目的に利用される。

JP1503992A 1987-09-11 1989-03-10 脊椎の間の融合を促進する外科的補綴用移植装置 Granted JPH03503133A (ja)

Applications Claiming Priority (3)

Application Number	Priority Date	Filing Date	Title
US9546187A	1987-09-11	1987-09-11
US173,928		1988-03-28
US07/173,928 US4834757A (en)	1987-01-22	1988-03-28	Prosthetic implant

Publications (2)

Publication Number	Publication Date
JPH03503133A JPH03503133A (ja)	1991-07-18
JPH0551304B2 true JPH0551304B2 (ja)	1993-08-02

Family

ID=26790256

Family Applications (1)

Application Number	Title	Priority Date	Filing Date
JP1503992A Granted JPH03503133A (ja)	1987-09-11	1989-03-10	脊椎の間の融合を促進する外科的補綴用移植装置

Country Status (8)

Country	Link
US (2)	US4834757A (ja)
EP (1)	EP0307241B1 (ja)
JP (1)	JPH03503133A (ja)
AT (1)	ATE83639T1 (ja)
AU (1)	AU614609B2 (ja)
CA (1)	CA1292596C (ja)
DE (1)	DE3876909T2 (ja)
WO (1)	WO1989009035A1 (ja)

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Also Published As

Publication number	Publication date
JPH03503133A (ja)	1991-07-18
ATE83639T1 (de)	1993-01-15
CA1292596C (en)	1991-12-03
AU614609B2 (en)	1991-09-05
EP0307241A3 (en)	1989-05-24
WO1989009035A1 (en)	1989-10-05
EP0307241A2 (en)	1989-03-15
AU3436389A (en)	1989-10-16
DE3876909T2 (de)	1993-04-29
DE3876909D1 (de)	1993-02-04
US4834757A (en)	1989-05-30
US4878915A (en)	1989-11-07
EP0307241B1 (en)	1992-12-23

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US8361153B2 (en)	2013-01-29	Porous intervertebral distraction spacers
US6863689B2 (en)	2005-03-08	Intervertebral spacer having a flexible wire mesh vertebral body contact element
WO2002017823A1 (en)	2002-03-07	A prosthetic implant for spinal interbody fusion and a inserting apparatus thereof
US8348958B2 (en)	2013-01-08	Insertion tool for use with intervertebral spacers
AU2001292826B2 (en)	2006-09-28	Osteogenic fusion devices
US20030014113A1 (en)	2003-01-16	Trial intervertebral distraction spacers
US20040024407A1 (en)	2004-02-05	Vertebral bone distraction instruments
US20030014114A1 (en)	2003-01-16	Vertebral bone distraction instruments
JP2005538749A (ja)	2005-12-22	展開可能な骨係合用突出部を有する脊椎融合インプラント、ならびにこれを使用するための器具および方法
JPH08266565A (ja)	1996-10-15	癒着装置、駆動工具及び移植方法
JPH09506790A (ja)	1997-07-08	椎間脊椎の融合のための補綴埋め込み部材
KR920003405B1 (ko)	1992-04-30	보철장치
AU769376B2 (en)	2004-01-22	Osteogenic fusion device
NZ503429A (en)	2001-10-26	Fusion implant device formed of bone and to be located in spine

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