DE19604246B4 - Distanzhaltendes Implantat zum Ersetzen von fehlenden Wirbelknochen - Google Patents

Distanzhaltendes Implantat zum Ersetzen von fehlenden Wirbelknochen Download PDF

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Publication number
DE19604246B4
DE19604246B4 DE19604246A DE19604246A DE19604246B4 DE 19604246 B4 DE19604246 B4 DE 19604246B4 DE 19604246 A DE19604246 A DE 19604246A DE 19604246 A DE19604246 A DE 19604246A DE 19604246 B4 DE19604246 B4 DE 19604246B4
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Germany
Prior art keywords
elements
implant
implant according
distance
inner element
Prior art date
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 - Fee Related
Application number
DE19604246A
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English (en)
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DE19604246A1 (de
Inventor
Jean-François JEANSON
Marc Dr. Ameil
Hervé DINVILLE
Jean Dr. Huppert
Thierry Dr. Marnay
Michel Dr. Gau
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Aesculap AG
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Aesculap AG
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Publication date
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Priority to DE29623988U priority Critical patent/DE29623988U1/de
Publication of DE19604246A1 publication Critical patent/DE19604246A1/de
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Publication of DE19604246B4 publication Critical patent/DE19604246B4/de
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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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 or spinal discs
    • A—HUMAN NECESSITIES
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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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    • A61F2/46—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
    • A61F2/4611—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • A—HUMAN NECESSITIES
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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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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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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
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    • A61F2002/3039—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • A61F2002/30398—Sliding
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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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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
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    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30879—Ribs
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • 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

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Neurology (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

Distanzhaltendes Implantat zum Ersetzen von fehlenden Wirbelknochen, das Elemente aufweist, die relativ zueinander axial bewegbar und festlegbar sind, wobei die Elemente ineinander angeordnet werden können und einander berührende Flächen tragen, die mit miteinander in Eingriff bringbaren Formgestaltungen versehen sind, die derart zusammenwirken, daß ein Auseinanderziehen der Elemente ermöglicht, ihr Zusammenschieben dagegen verhindert wird, dadurch gekennzeichnet, daß das äußere Element (1) und das innere Element (2) jeweils als Hohlzylinder ausgebildet sind.

Description

  • Die Erfindung betrifft ein distanzhaltendes Implantat zum Ersetzen von fehlenden Wirbelknochen, das Elemente aufweist, die relativ zueinander axial bewegbar und festlegbar sind, wobei die Elemente ineinander angeordnet werden können und einander berührende Flächen tragen, die mit miteinander in Eingriff bringbaren Formgestaltungen versehen sind, die derart zusammenwirken, daß ein Auseinanderziehen der Elemente ermöglicht, ihr Zusammenschieben dagegen verhindert.
  • Es ist bekannt, daß die infolge von Verletzungen oder Entfernung von Geschwülsten entstehenden Knochenausfälle durch aus einem anderen Teil des Knochensystems entnommene körpereigene Knochen (Transplantat), Alloplastik und/oder distanzhaltende mechanische Elemente ersetzt werden können.
  • Auch bei der Verwendung von körpereigener oder alloplastischer Materie ist ein Abstützen der die Knochenausfallstelle umgebenden Teile erforderlich, da die Eingliederung der autologen Transplantate eine längere Zeit beansprucht und deren sofortige Belastung nicht möglich ist.
  • Zu diesem Zweck werden in bekannter Weise aus einem Titannetz gefertigte Zylinder verwendet, welche einerseits das zwischen die Wirbelknochen implantierte Material umgeben und gleichzeitig die benachbarten Wirbelknochen mechanisch abstützen. Derartige Zylinder aus Titannetz müssen jedoch gemein sam mit Knochenschrauben und Fixierstäben verwendet werden, wodurch ihre Anwendung außerordentlich kompliziert und zeitaufwendig wird.
  • Gemäß einer anderen bekannten Lösung wird die Knochenfehlstelle durch distanzhaltende Elemente ersetzt, die eine einstellbare Länge aufweisen und mit Klauen versehen sind. Die Länge der distanzhaltenden Elemente kann mittels Schraubenbefestigung an beiden Seiten des Implantates eingestellt werden, was unter Operationsbedingungen äußerst schwierig ist.
  • In der DE 4012622 C1 ist ein gattungsgemäßes Wirbelkörperimplantat beschrieben mit zwei Teilen, von denen eines plattenförmig ausgebildet ist, während das andere einen Spalt zwischen zwei parallelen Wänden aufweist. Durch eine Zahnung wird sichergestellt, daß die Teile einander angenähert, nicht jedoch von einander entfernt werden können. Allerdings ist ein elastisches Polster notwendig, um die Zähne in Eingriff zu bringen. Außerdem können die gegeneinander verschiebbaren Teile mit umgebenden Gewebeteilen in Kontakt kommen, so daß eine Verletzung dieser Gewebeteile nicht ausgeschlossen werden kann.
    •
  • Es ist Aufgabe der Erfindung, ein gattungsgemäßes Implantat so weiterzubilden, daß sich ein wesentlich einfacherer Aufbau ergibt und daß die Gefahr von Verletzungen herabgesetzt wird.
  • Diese Aufgabe wird bei einem distanzhaltenden Implantat der eingangs beschriebenen Art erfindungsgemäß dadurch gelöst, daß das äußere Element und das innere Element jeweils als Hohlzylinder ausgebildet sind.
  • Günstig ist es dabei, wenn an der inneren Mantelfläche des äußeren Elementes sägezahnförmige Nuten ausgebildet sind und an der äußeren Mantelfläche des inneren Elementes sägezahnförmige Rippen, die eine an die Gestalt der Nuten angepaßte beziehungsweise diese ergänzende Form aufweisen.
  • Bei einer weiteren vorteilhaften Ausführungsform der Erfindung weist die innere Mantelfläche des äußeren Elements mindestens eine axial ausgerichtete Rippe auf, wohingegen die Wand des inneren Elements mindestens einen axial ausgerichteten komplementären Schlitz aufweist, in den die Rippe eingreifen kann, so daß die beiden Elemente in ihrer Lage fixiert sind.
  • Bei einer anderen Ausführungsform der Erfindung ist ein Ende des äußeren Elements mit einem Boden verschlossen, dessen Außenseite mit Eingriffsklauen versehen ist, und ein Ende des inneren Elements ist ebenfalls mit einem Boden verschlossen, dessen Außenseite mit Eingriffsklauen versehen ist. Es können jedoch auch solche Elemente verwendet werden, bei denen beide Enden offen sind, wobei an ihrem einen Ende jedoch ein mit Klauen oder einem Stützfuß versehener Pfropfen angeordnet ist.
  • Bei einer bevorzugten Ausführungsform der Erfindung sind die Elemente zylinderförmig und weisen einen zylindrischen Hohlraum auf, während die sägezahnförmigen Nuten als Kreisnuten und die sägezahnförmigen Rippen als umlaufende Rippen ausgebildet sind.
    •
  • Weitere Ausgestaltungen und Details der Erfindung werden nachstehend anhand eines Ausführungsbeispiels in Verbindung mit den Zeichnung näher erläutert. In der Zeichnung zeigen:
  • 1 ein äußeres Element eines erfindungsgemäßen Implantates in Schnittdarstellung,
  • 2 ein inneres Element eines erfindungsgemäßen Implantates in Halbschnittdarstellung, und
  • 3 ein erfindungsgemäßes Implantat in Schnittdarstellung.
  • Das in den Figuren dargestellte äußere Element 1 und das innere Element 2 sind bei der gezeigten Ausführungsform aus den Zylindern 3 bzw. 4 ausgebildet. Die äußere Mantelfläche des äußeren Elementes 1 ist zylindrisch, in seine innere, ebenfalls zylindrische Mantelfläche sind Nuten 5 eingearbeitet. Die Nuten 5 sind im Querschnitt sägezahnförmig ausgebildet, wobei die Tiefe der Nuten jeweils in Richtung auf das Ende, in das das innere Element 2 eingeführt wird, abnimmt. Der Zylinder 3 ist unten mit einem Boden 6 abgeschlossen. Der Boden 6 ist mit Klauen 7 versehen. Auf der äußeren Mantelfläche des Zylinders 3 sind einander gegenüberliegend zwei entlang von Mantellinien verlaufende Nuten 8 ausgebildet, so daß auf der Innenseite zwei vorspringende Rippen 8a geformt sind.
  • Aus 2 ist ersichtlich, daß der Hohlraum des Zylinders 4 des inneren Elementes 2 ebenfalls von einem Boden 9 begrenzt ist, dessen Außenseite mit Klauen 10 versehen ist. An dem unteren Teil der äußeren Mantelfläche des Zylinders 4 sind Rippen 11 angeordnet. Diese Rippen 11 sind im Querschnitt ebenfalls sägezahnförmig und passen in die Nuten 5 des äußeren Elementes 1. Der Zylinder 4 des inneren Elementes 2 weist eine dünnere Wand auf als der Zylinder 3 des äußeren Elementes 1 und an seiner Mantelfläche sind fast über die ganze Länge Schlitze 12 ausgebildet. Die zusammen durch die dünne Wand des Zylinders 4 und die Schlitze 12 sichergestellte elastische Ausbildung ermöglicht es, wenn die Elemente einmal ineinander eingesetzt sind, daß das innere Element 2 aus dem äußeren Element 1 herausbewegbar ist, wobei die Rippen 11 des inneren Elementes 2 aus den Nuten 5 des äußeren Elementes 1 herausspringen und in die jeweils dahinterliegenden Nuten einrasten. Somit bilden das innere Element 1 und das äußere Element 2 ein längenveränderliches und -verstellbares distanzhaltendes Implantat, das gegen ein Zusammenschieben verriegelt ist, aber durch Verlagern des Elements 2 stufenweise auseinandergezogen werden kann.
  • Dadurch, daß die Rippen 8a des äußeren Elementes 1 und die Schlitze 12 des inneren Elementes 2 miteinander in Deckung gebracht werden, kann das Implantat in der gewünschten Lage fixiert werden, ohne daß zusätzliche Befestigungsmittel erforderlich sind.
  • Das Einsetzen kann im konkreten Fall so erfolgen, daß das Implantat in vollkommen zusammengeschobenem Zustand des äußeren und inneren Elementes an die Stelle der Knochenfehlstelle zwischen die nächst benachbarten Wirbelknochen eingefügt wird und die Elemente mittels einer Zange so weit auseinandergezogen werden, bis die benachbarten Wirbelknochen in die gewünschte Position gelangen. Das Einsetzen besteht somit praktisch nur aus zwei einfachen Arbeitsschritten, welche auch unter Operationsbedingungen einfach und sicher durchgeführt werden können. Erforderlichenfalls können die Elemente gegeneinander in der oben erwähnten Weise unter Zusammenwirken der Rippen 8a und der Schlitze 12 verkeilt werden.
  • Im Vergleich mit den bekannten Implantaten vereinfacht die erfindungsgemäße Lösung in außerordentlicher Weise die Durchführung der erforderlichen Arbeitsabläufe beim Einsetzen des Implantates dadurch, daß zur Festlegung der relativ zueinander bewegbaren Elemente kein gesonderter Arbeitsschritt erforderlich ist und der einmal eingestellte Abstand sich durch eine falsche Bewegung oder aus sonstigen Gründen nicht verändern kann.
  • Natürlich kann das Implantat in zahlreichen Varianten ausgebildet sein, z.B. auf die Weise, daß anstelle der Klauen andere Stützelemente z.B. Stützfüße verwendet werden. Die die Elemente bildenden rohrförmigen Körper können an beiden Seiten offen sein, in diesem Fall können die Stützflächen oder Klauen pfropfenartig in das eine Ende der Elemente eingefügt werden.

Claims (5)

  1. Distanzhaltendes Implantat zum Ersetzen von fehlenden Wirbelknochen, das Elemente aufweist, die relativ zueinander axial bewegbar und festlegbar sind, wobei die Elemente ineinander angeordnet werden können und einander berührende Flächen tragen, die mit miteinander in Eingriff bringbaren Formgestaltungen versehen sind, die derart zusammenwirken, daß ein Auseinanderziehen der Elemente ermöglicht, ihr Zusammenschieben dagegen verhindert wird, dadurch gekennzeichnet, daß das äußere Element (1) und das innere Element (2) jeweils als Hohlzylinder ausgebildet sind.
  2. Implantat nach Anspruch 1, dadurch gekennzeichnet, daß an der inneren Mantelfläche des äußeren Elements (1) sägezahnförmige Nuten (5) ausgebildet sind und an der äußeren Mantelfläche des inneren Elements (2) sägezahnförmige Rippen (11) ausgebildet sind, die eine an die Gestalt der Nuteln (5) angepaßte bzw. diese ergänzende Form aufweisen.
  3. Implantat nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß auf der inneren Mantelfläche des äußeren Elements (1) mindestens eine axiale Rippe (8a) ausgebildet ist und daß die wand des inneren Elements (2) mindestens einen axialen Schlitz (12) aufweist, in den die Rippe (8a) eingreifen kann, so daß die Lage der beiden Elemente zueinander fixiert ist.
  4. Implantat nach einem der Ansprüche 1 bis 3, dadurch gekennzeichnet, daß beide Enden wenigstens eines der Elemente (1, 2) offen sind und an einem der Enden ein mit axialen Klauen (7) oder einem Stützfuß versehener Pfropfen (6) angeordnet ist.
  5. Implantat nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, daß wenigstens ein Ende eines Elements (1, 2) mit einem Boden (9) abgeschlossen und an seiner äußeren Seite mit Klauen (7) versehen ist.
DE19604246A 1995-02-06 1996-02-06 Distanzhaltendes Implantat zum Ersetzen von fehlenden Wirbelknochen Expired - Fee Related DE19604246B4 (de)

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FR9501326 1995-02-06
FR9501326A FR2730158B1 (fr) 1995-02-06 1995-02-06 Dispositif de maintien d'un ecartement normal entre les vertebres et destine au remplacement de vertebres manquantes

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US7918876B2 (en) 2003-03-24 2011-04-05 Theken Spine, Llc Spinal implant adjustment device
US7544208B1 (en) 2004-05-03 2009-06-09 Theken Spine, Llc Adjustable corpectomy apparatus
US8337559B2 (en) 2005-04-21 2012-12-25 Globus Medical, Inc. Expandable vertebral prosthesis
DE102008010607A1 (de) * 2008-02-22 2009-08-27 Heinrich Dr. Böhm Implantatvorrichtung für die Wirbelsäule
DE102008010607B4 (de) * 2008-02-22 2016-03-24 Heinrich Böhm Implantatvorrichtung für die Wirbelsäule
DE102010047901A1 (de) 2010-10-11 2012-04-12 Heinrich Böhm Implantat für die Wirbelsäule und Betätigungsinstrument
WO2012048920A1 (de) 2010-10-11 2012-04-19 Boehm Heinrich Implantat für die wirbelsäule und betätigungsinstrument
US9308098B2 (en) 2010-10-11 2016-04-12 Heinrich Boehm Implant for the spinal column and actuating instrument
DE102010047901B4 (de) 2010-10-11 2019-01-10 Heinrich Böhm Implantat für die Wirbelsäule und Betätigungsinstrument

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JPH08266564A (ja) 1996-10-15
KR960030899A (ko) 1996-09-17
DE19604246A1 (de) 1996-08-08
DE29623988U1 (de) 2001-03-08
US5723013A (en) 1998-03-03
FR2730158A1 (fr) 1996-08-09
FR2730158B1 (fr) 1999-11-26

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