ES2256884T3 - Sistema de contencion y fusion intersomatica. - Google Patents

Sistema de contencion y fusion intersomatica.

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Publication number
ES2256884T3
ES2256884T3 ES97919466T ES97919466T ES2256884T3 ES 2256884 T3 ES2256884 T3 ES 2256884T3 ES 97919466 T ES97919466 T ES 97919466T ES 97919466 T ES97919466 T ES 97919466T ES 2256884 T3 ES2256884 T3 ES 2256884T3
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ES
Spain
Prior art keywords
box
plate
vertebrae
internal
assembly
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Expired - Lifetime
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ES97919466T
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English (en)
Inventor
Jacques Benezech
Albert Alby
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ScientX SA
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ScientX SA
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Classifications

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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
    • 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
    • A61F2/447—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 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
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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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • 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
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7059—Cortical plates
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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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    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
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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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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30428—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by inserting a protrusion into a slot
    • A61F2002/30431—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by inserting a protrusion into a slot made by first pushing a necked button longitudinally and then sliding it laterally within a keyhole slot
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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • 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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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30593—Special structural features of bone or joint prostheses not otherwise provided for hollow
    • A—HUMAN NECESSITIES
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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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    • A61F2310/00005—The prosthesis being constructed from a particular material
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Landscapes

  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Tents Or Canopies (AREA)
  • Lining Or Joining Of Plastics Or The Like (AREA)
  • Peptides Or Proteins (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)

Abstract

SISTEMA DE CONTENCION Y DE FUSION INTERSOMATICA DE LAS VERTEBRAS QUE LLEVA AL MENOS UNA ALOJAMIENTO INTERNO ABIERTO QUE RECIBE EL HUESO ESPONJOSO Y ESTA DESTINADO A INTERPONERSE ENTRE DOS VERTEBRAS DURANTE LA DISECTOMIA, CARACTERIZADO PORQUE DICHO ALOJAMIENTO (1) LLEVA EN SU CARA ANTERIOR (5) UN ELEMENTO EXTERNO QUE FORMA UNA PLACA (12) QUE SE EXTIENDE EN UN PLANO SENSIBLEMENTE PERPENDICULAR AL PLANO DE INTRODUCCION DEL ALOJAMIENTO (1), POR AMBAS PARTES DE ESTE, Y DISPONIENDO EN CADA UNO DE SUS EXTREMOS DE MEDIOS DE ANCLAJE (13, 14) EN AL MENOS DOS VERTEBRAS ADYACENTES QUE HAN DE SOLIDARIZARSE ENTRE SI MEDIANTE EL ALOJAMIENTO (1). EL SISTEMA PUEDE DESOLIDARIZARSE EN DOS PARTES: ALOJAMIENTO Y PLACA.

Description

Sistema de contención y fusión intersomática.
La presente invención se refiere a un sistema de contención y de fusión intersomática de las vértebras compuesto consta por lo menos por una caja interna abierta que recibe el hueso esponjoso y destinada a ser interpuesta entre dos vértebras con motivo de una discectomía y a poder proceder a la colocación de un injerto óseo o un material que favorezca la fusión intersomática que favorecerá la fusión de las dos vértebras en cuestión.
Tales cajas se conocen, por ejemplo, por las solicitudes de patente FR2703580, EP493698, EP599419, FR212815, EP307241, EP615428.
Estas cajas tienen una forma globalmente paralelepipédicas u ovoides. Son rígidas, metálicas o de un material biocompatible y están destinadas a recibir hueso esponjoso gracias a unas caras superior e inferior abiertas.
Se conoce, por otro lado, por el documento EP017965, una prótesis compuesta por:
- una caja interna con caras superior e inferior abierta para recibir un injerto óseo, destinada a ser interpuesta entre dos vértebras en una discectomía;
- y una placa externa que se extiende en un plano sensiblemente perpendicular al plano de introducción de la caja, a una y otra parte de la misma, y que dispone de medios de anclaje en por lo menos las dos vértebras adyacentes que quedarán unidas entre ellas por medio de la caja.
Se conoce asimismo, por el documento FR 2703580, una caja de forma paralelepipédica pero que no consta de placa de fijación en las vértebras.
Aunque las cajas del tipo arriba mencionado dan generalmente buen resultado, no es menos cierto que en ciertos casos se debe asegurar el posicionamiento y la "no movilidad" de la caja para protegerse de manera segura ante una posible migración o evitar cualquier riesgo de desplazamiento secundario de la caja.
La invención quiere lograr estos objetivos y se refiere para ello a un sistema de contención y de fusión intersomática de las vértebras de acuerdo con la reivindicación 1.
Dicha caja es rígida, de metal o material plástico biocompatible, de forma globalmente paralelepipédica y está adaptada al espacio intervertebral y prevista para recibir el hueso esponjoso o el material sustituto óseo gracias a sus caras superior e inferior abiertas y/o por una apertura frontal.
El sistema de la invención se realiza según las necesidades en forma de caja-placa monobloque o en forma de una caja interna y una placa externa, que constan de medios de ensamblaje de la placa a la caja.
La presente invención se refiere asimismo a las características que se destacarán durante la descripción que se va a realizar y que deberán considerarse por separado o según todas sus combinaciones técnicas posibles.
Esta descripción dada a título de ejemplo no limitativo permitirá comprender mejor como se puede realizar la invención, haciendo referencia a los dibujos que se adjuntan, en los que:
- la figura 1 es una vista despiezada de un sistema de contención según un primer ejemplo de realización.
- la figura 2 es una vista despiezada de un sistema de contención según un segundo ejemplo de realización de la invención, de acuerdo con el objeto de la reivindicación 1.
- la figura 3 es una vista de un sistema de contención monobloque.
A título de ejemplo no limitativo, la caja 1 representada en la figura 1 está globalmente compuesta por un paralelepípedo rígido cuyas paredes laterales 2, 3, 4, 5, están destinadas a encerrar el hueso esponjo o el sustituto óseo y cuyas caras superiores 8 e inferior 9 están abiertas hacia dos vértebras sucesivas.
Las caras anterior 5 y posterior 3 tienen alturas determinadas con el fin asegurar el mantenimiento de un espacio intervertebral adecuado.
Siempre según el presente ejemplo, las paredes laterales 2 y 4 de la caja 1 están provistas de amplios agujeros 10 y 11 con una forma semejante a la de las paredes laterales correspondientes 2 y 4 en los que están perforados.
La caja 1 está así provista de aberturas en cuatro de sus caras. La caja 1 consta además en su cara anterior 5 de un elemento externo que forma una brida 12 (llamada a continuación placa) que se extiende en un plano sensiblemente perpendicular al plano de introducción de la caja 1, a una y otra parte de ésta, y que dispone en cada uno de sus extremos de medios de anclaje 13 y 14 a por lo menos dos vértebras adyacentes que se unirán entre sí por medio de la caja 1.
Por supuesto, la brida externa o placa 12 podría obtenerse de manera monobloque con la caja interna 1. Por ejemplo, por moldeo del conjunto caja-placa.
Sin embargo, según el presente ejemplo de realización, se ha preferido presentar una placa 12 y una caja interna 1 realizadas por separado y posteriormente unidas entre ellas empleando medios de ensamblaje.
Siempre según el ejemplo de la figura 1, estos medios de ensamblaje de la placa 12 a la caja 1 están constituidos por un pasador 15 cilíndrico realizado en una cara anterior vertical 5 de dicha caja y una ranura periférica 17 practicada por debajo de la cabeza circular 16 de dicho pasador 15, pudiendo introducirse dicha cabeza 16 en una parte correspondiente de una zona ensanchada 18 de un agujero oblongo 19 con forma de botonera perforada en la placa 12, y siendo dicha garganta 17 de una dimensión suficiente para poder deslizarse entre los bordes laterales de una zona más estrecha 20 de dicha botonera hasta que la cabeza 16 del pasador 15 coopere en enclavamiento axial con la cara externa 21 de la placa 12.
Se puede prever que tal introducción del pasador en la botonera pueda hacerse haciendo fuerza en la zona más estrecha.
Por supuesto, la caja que se acaba de describir más arriba podrá tener dimensiones distintas tanto en altura como en anchura y en profundidad.
También podrá tener, como en el ejemplo siguiente, una forma anatómica preferida.
También se puede suponer que la colocación del hueso esponjoso u otro sustituto óseo se hará previamente o después de situar la caja 1 entre las vértebras.
El ejemplo de realización representado en la figura 2 difiere fundamentalmente del anterior en que los medios de ensamblaje de la placa 12A en la caja 1A están compuestos por una guía en cola de milano cuya parte en forma de muesca 30 está realizada en una cara interna 31 de la placa 12A en un sentido de deslizamiento vertical y la parte espiga correspondiente 32 en la cara frontal externa 5A de la caja 1A, o inversamente.
Se observará que de acuerdo con el presente ejemplo de realización, la caja 1A ya no tiene aberturas laterales como en el ejemplo anterior.
De hecho, la cara frontal externa 5A de la caja 1A y la cara correspondiente 31 de la placa 12A con la que ésta coopera constan cada una de unos agujeros oblongos idénticos 33, 34 destinados a hacerlos coincidir en el momento del ensamblaje de la placa 12A con la placa 1A, de manera que permitan la introducción del hueso esponjoso, frontalmente después de la colocación de la caja 1A.
Se observará igualmente la forma y el perfil particular de la caja 1A según el ejemplo de la figura 2 que permiten una adaptación perfecta al espacio intervertebral.
El ejemplo de realización representado en la figura 3 difiere del ejemplo de la figura 2 en que está realizado de manera monobloque.
La cara anterior 5A de la caja-placa consta de un agujero oblongo 33 de manera que se pueda introducir frontalmente el hueso esponjoso en la parte caja tras la colocación de dicha caja-placa.
De manera común a los ejemplos de realización de las figuras 1, 2 y 3 que se acaban de mencionar, los medios de anclaje de la placa 12, 12A en las vértebras, tras la fijación de la caja 1, 1A, se llevan a cabo por medio de tornillos pediculares (no representados) que atraviesan unos agujeros correspondientes 13, 14 practicados en los extremos de dicha brida 12, 12A.
Hay que señalar, según otra característica de la invención, que los agujeros de fijación 13, 14 de la placa 12, 12A está situados a una y otra parte de un eje vertical medio X, X' del conjunto, en una diagonal Y, Y'.
Según una forma de realización no representada, el sistema de contención puede emplear dos o más cajas internas 1, 1A solidarizadas entre ellas y con respecto a tres o más vértebras sucesivas por medio de una placa 12, 12A que consta de dos medios de ensamblaje 15, 18 o 30, 32 con dichas cajas 1, 1A y dos agujeros de fijación de extremidad 13, 14 y un agujero intermedio que coopera con tres o más tornillos pediculares de anclaje a las vértebras.
Las placas están representadas con un tornillo de fijación por vértebra pero pueden tener más, por ejemplo 2.
Se entiende que el sistema de contención también puede estar compuesto por dos o varios conjuntos caja-placa tal y como están definidos en los ejemplos de las figuras 1, 2 o 3 conectados entre ellos por dichas placas que se superponen o no, dos a dos.
Los sistemas de contención de la invención están realizados en aleación de titanio o un material equivalente o en una materia plástica bio-compatible.

Claims (8)

1. Sistema de contención y de fusión intersomática de las vértebras que consta de:
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por lo menos una caja interna (1A) con caras superior (8) e inferior (9), abierta para recibir el hueso esponjoso o el sustituto óseo y destinada a su interposición entre dos vértebras con ocasión de una discectomía,
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y una placa externa (12A) que se extiende en un plano sensiblemente perpendicular al plano de introducción de la caja (1A), a una y otra parte de ésta, y que dispone de medios de anclaje (13, 14) en por lo menos las dos vértebras adyacentes que se quieren unir entre ellas por medio de la caja (1A),
caracterizado en que la caja (1A) está compuesta por una pared anterior (5A), una pared posterior (3) y dos paredes laterales (2, 4), formando estas paredes un paralelepípedo rígido con la cara superior (8) convexa en vista lateral, de manera que la forma y el perfil de la caja estén adaptados al espacio intervertebral delimitado por dos vértebras adyacentes y en que la caja (1A) está equipada con una placa externa (12A) que presenta, en cada uno de sus extremos, como medios de anclaje, un solo agujero de fijación para el paso de un tornillo de anclaje en la vértebra adyacente, estando situados dichos agujeros (13, 14) en una diagonal (y-y') a una y otra parte de un eje vertical medio (X-X') del conjunto.
2. Sistema según la reivindicación 1, caracterizado en que la placa externa (12A) y la pared anterior (5A) de la caja (1A) tienen cada una un agujero oblongo (34, 33) que permite introducir frontalmente hueso esponjoso en la caja.
3. Sistema según la reivindicación 1, caracterizado en que la placa externa (12A) se obtiene de manera monobloque con la caja interna (1A).
4. Sistema según la reivindicación 1, caracterizado en que la placa externa (12) y la caja interna (1A) se realizan por separado y se unen posteriormente entre ellas con ayuda de medios de ensamblaje.
5. Sistema según la reivindicación 4 caracterizado en que los medios de ensamblaje de la placa (12A) en la caja (1A) están compuestos por una guía en cola de milano cuya parte en forma de muesca (30) está realizada en una cara interna (31) de la placa (12A) en un sentido de deslizamiento vertical y la parte espiga correspondiente (32) en la cara frontal externa (5A) de la caja (1A), o inversamente.
6. Sistema según la reivindicación 5 caracterizado en que la cara frontal externa (5A) de la caja (1A) y la cara correspondiente (31) de la placa (12A) con la que coopera tienen cada una unos agujeros oblongos idénticos (33, 34) destinados a hacerlos coincidir durante el ensamblaje de la placa (12A) en la caja (1A), de manera que permita la introducción del hueso esponjoso, frontalmente tras la colocación de la caja (1A).
7. Sistema según la reivindicación 1, caracterizado en que la caja interna tiene, además de las caras superior (8) e inferior (9) abiertas, unas paredes laterales (2,4) provistas de agujeros de introducción (10,11) del hueso esponjoso.
8. Sistema según una de las reivindicaciones anteriores, caracterizado en que implementa por lo menos dos cajas internas (1A) solidarizadas entre ellas y con respecto a por lo menos tres vértebras sucesivas por medio de una placa (12A) que consta de dos medios de ensamblaje (30, 32) con dichas cajas (1A) y dos agujeros de fijación de extremidad (13, 14) y un agujero de fijación intermedio que coopera con por lo menos tres tornillos de anclaje en las vértebras.
ES97919466T 1996-04-03 1997-04-02 Sistema de contencion y fusion intersomatica. Expired - Lifetime ES2256884T3 (es)

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FR9604196A FR2747034B1 (fr) 1996-04-03 1996-04-03 Systeme de contention et de fusion intersomatique
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DE69734977D1 (de) 2006-02-02
FR2747034A1 (fr) 1997-10-10
EP0891169B1 (fr) 2005-12-28
ATE314029T1 (de) 2006-01-15
PT891169E (pt) 2006-05-31
EP0891169A1 (fr) 1999-01-20
BR9710703A (pt) 1999-08-17
JP2000508187A (ja) 2000-07-04
FR2747034B1 (fr) 1998-06-19
WO1997037620A1 (fr) 1997-10-16
DE69734977T2 (de) 2006-08-31
US6235059B1 (en) 2001-05-22
JP3955632B2 (ja) 2007-08-08

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