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JP3514765B2 - 椎間板関節整形装置 - Google Patents

椎間板関節整形装置

Info

Publication number
JP3514765B2
JP3514765B2 JP52563895A JP52563895A JP3514765B2 JP 3514765 B2 JP3514765 B2 JP 3514765B2 JP 52563895 A JP52563895 A JP 52563895A JP 52563895 A JP52563895 A JP 52563895A JP 3514765 B2 JP3514765 B2 JP 3514765B2
Authority
JP
Japan
Prior art keywords
ball
joint
arthroplasty device
joint surface
socket
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
JP52563895A
Other languages
English (en)
Other versions
JPH10501705A (ja
Inventor
ボイド，ローレンス・エム
サリブ，リチャード・エム
ペティン，ケネス・エイ
Original Assignee
エスディージーアイ・ホールディングス・インコーポレーテッド
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.)
Filing date
Publication date
Priority claimed from US08/223,119 external-priority patent/US5425773A/en
Application filed by エスディージーアイ・ホールディングス・インコーポレーテッド filed Critical エスディージーアイ・ホールディングス・インコーポレーテッド
Publication of JPH10501705A publication Critical patent/JPH10501705A/ja
Application granted granted Critical
Publication of JP3514765B2 publication Critical patent/JP3514765B2/ja
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

Links

Classifications

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    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
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    • 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
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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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
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    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2/4425—Intervertebral or spinal discs, e.g. resilient made of articulated components
    • A61F2002/443—Intervertebral or spinal discs, e.g. resilient made of articulated components having two transversal endplates and at least one intermediate component
    • 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
    • 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
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • 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
    • A61F2220/005—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using adhesives
    • 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
    • A61F2220/0058—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements soldered or brazed or welded
    • 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
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0008—Rounded shapes, e.g. with rounded corners elliptical or oval
    • 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
    • A61F2230/0063—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
    • A61F2230/0071—Three-dimensional shapes spherical
    • 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
    • A61F2230/0073—Quadric-shaped
    • A61F2230/0076—Quadric-shaped ellipsoidal or ovoid
    • 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
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0039—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in diameter
    • 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
    • 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
    • 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
    • A61F2310/00179—Ceramics or ceramic-like structures
    • 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
    • A61F2310/00179—Ceramics or ceramic-like structures
    • A61F2310/00185—Ceramics or ceramic-like structures based on metal oxides
    • A61F2310/00203—Ceramics or ceramic-like structures based on metal oxides containing alumina or aluminium oxide
    • 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
    • A61F2310/00179—Ceramics or ceramic-like structures
    • A61F2310/00185—Ceramics or ceramic-like structures based on metal oxides
    • A61F2310/00239—Ceramics or ceramic-like structures based on metal oxides containing zirconia or zirconium oxide ZrO2
    • 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
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00395—Coating or prosthesis-covering structure made of metals or of alloys
    • A61F2310/00407—Coating made of titanium or of Ti-based 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
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00976—Coating or prosthesis-covering structure made of proteins or of polypeptides, e.g. of bone morphogenic proteins BMP or of transforming growth factors TGF
    • 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)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Transplantation (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Prostheses (AREA)
  • Massaging Devices (AREA)
  • Farming Of Fish And Shellfish (AREA)
  • Surgical Instruments (AREA)
  • Passenger Equipment (AREA)
  • Cosmetics (AREA)
  • Pinball Game Machines (AREA)

Description

【発明の詳細な説明】 発明の背景 本発明は外科関節交換装置に関し、特に、脊椎の連続
する椎骨間の変質又は破損した椎間板の交換技術に関す
る。
現在、米国で行われる腰椎固定（fusion）の件数は毎
年約60,000件であり、カナダ国で行われる腰椎固定の件
数は毎年約30,000件である。脊椎固定は背中の下部の痛
み及び椎間板の変質のための処置として頻繁に使用さ
れ、内部固定装置の使用は堅固な固定を得るための外科
医の能力を増大させてきた。しかし、固定及び内部固定
の生態力学的な剛直性は脊椎の運動セグメントに隣接す
る部分を急激に悪化させるかもしれないという関心が高
まっている。首尾よく固定を行われた患者の長期間の追
跡調査によれば、50％の患者が引き続き痛みを訴えてい
る。他の関節におけるように、脊椎運動セグメントの固
定に代わるものはそれぞれ固有の利点を有する。
長年にわたり、良好な椎間板関節整形装置を設計する
研究が試みられてきた。米国特許第4,946,378号明細書
は一対の端本体を有し、端本体間に保持された医療用合
成ポリマー中間部材を備えた人工椎間板を開示してい
る。この中間部材はある程度の可撓性を有する。これと
幾分似ているが、米国特許第5,002,576号明細書は本体
と矛盾を生じないシリコンの如き粘弾性材料で満たされ
た閉じた波形チューブにより分離された端カバープレー
トと有する人口椎間板を開示している。また、米国特許
第4,932,975号明細書はエラストマー媒体により囲まれ
たサスペンションプレートを収容する一対の端部材を有
する椎骨補綴をを開示している。端部材即ち端ハウジン
グは可撓性で膨脹可能なベローズにより相互連結されて
いる。
他の試みは米国特許第4,349,921号、同第4,714,469
号、同第4,759,769号、同第4,863,476号、同第4,936,84
8号、同第4,997,432号、同第5,047,055号及び同第5,07
1、437号明細書、並びに、PCT特許WO92/14423号明細書
に開示されている。上記米国特許第4,349,921号明細書
は隣接する椎骨表面に隣接し、２つの素子から形成され
た凸状の内外表面を有する人口椎間板を開示しており、
２つの素子間の撓み及び拡張が可能となっている。上記
米国特許第4,714,469号明細書は所定の厚さを有する単
一部材の人口椎間板を開示している。上記米国特許第4,
759,769号明細書は後部で一緒にヒンジ止めされ、剛直
なコイルバネにより前部で互いに離れるように偏倚され
た上方及び下方の部材を有する人口椎間板を開示してい
る。上記米国特許第4,863,476号明細書は隣接する椎骨
間の空間を増大させるように膨脹可能な２部品脊椎移植
装置を開示している。上記米国特許第4,936,848号明細
書は中空で剛直な球状の人口椎間板を開示している。球
状の壁は骨の断片を配置するために球状の空所（キャビ
ティ）に対して開口した窓を有する。上記米国特許第4,
997,432号明細書は通常合成材料から成る摺動コア本体
により分離されたプレートを有する人口椎間板を開示し
ている。上記米国特許第5,047,055号明細書は特定の圧
縮強度を有するヒドロゲルで作られ、水和されたときに
人間の椎間板の形をとる人口椎間板を開示している。上
記米国特許第5,071,437号明細書は人間の椎間板と同様
の曲げ特性を有するエラストマーコア材料により分離さ
れこのエラストマーコア材料に連結された２つの剛直な
端プレートを有する人口椎間板を開示している。
最後に、米国特許第4,595,663号明細書、米国特許再
発行第32,499号明細書及び米国特許第5,037,438号明細
書は関節の交換に応用するためにジルコニアを含むセラ
ミック材料の使用を開示している。
良好な椎間板関節整形装置が満たさねばならないある
基本的な基準がある。材料の疲労強度が最も重要であ
る。脊椎固定を受けた患者の平均寿命は42才なので、装
置の寿命期間は40年を越えるものとするべきである。平
均的な人間が１年間に２百万歩歩き、脊椎に125,000回
の顕著な屈曲が作用すると仮定すれば、40年間での脊椎
負荷サイクルの低目の見積もり数は８千５百万サイクル
になる。安全係数を提供するためには、装置は少なくと
も１億サイクルの疲労限界を持つように設計すべきであ
る。
このような耐久性のほかに、良好な椎間板関節整形装
置のための材料は生理学的に矛盾を生じないものでなけ
ればならない。移植装置の摩耗量は最小限に抑えなけれ
ばならない。移植装置は普通の椎間板空間の構造上の範
囲内に収容されるのに十分な程度に小さくすべきである
が、後方にある小面関節（facet joint）の負荷を除去
又は軽減するために椎間板空間を拡張させるべく補綴椎
間板の高さを増大させる方が有利であることが分かって
いる。
本発明は上述の基準を満たすと共に、現在行われてい
る固定の90％に代えて良好な関節整形を行うことができ
る。
発明の概要 本発明はソケット部分を有する第１部材とソケット部
分に嵌合するボール部分を有する第２部材とから成る椎
間板関節整形装置に関する。第１椎骨と第２椎骨との間
から椎間板を切り取ることにより生じた空間に関して、
ボール部分がソケット部分内に嵌合するように、第１部
材は第１椎骨に隣接して嵌め込まれ、第２部材は第２椎
骨に隣接して嵌め込まれる。
一実施例においては、第１タブを有する第１ベースプ
レートが第１部材に締結され、第２タブを有する第２ベ
ースプレートが第２部材に締結される。第１及び第２タ
ブにネジを挿通して、ベースプレート従って対応する第
１及び第２部材を隣接する椎骨に締結する。
別の実施例においては、第１及び第２部材は、好まし
くはチタンでできた金属インサートカップに締結され
る。チタンのインサートカップを使用すると、いくつか
の利点が得られる。すなわち、（１）構造体に引っ張り
支持を与え、第１及び第２部材の材料を圧縮状態に維持
する。（２）インサートカップ外表面の前端への抵抗フ
ィンの取り付けを可能にし、機械加工、はんだ付け、溶
接、接着等の既知の方法による軸回転に対して更に抵抗
する。（３）焼結やスプレー（噴霧）の如き既知の技術
を使用した骨内部成長式の固定を促進するためのチタン
ビードコーティングの如きコーティングを容易に接着で
きる表面を提供する。
（４）金属の厚さを増減させることによりインサートカ
ップの寸法を容易かつ安価に変更できるような状態で、
第１及び第２部材を１つの寸法に維持することのできる
構造体を提供する。
本発明はまた、初期のネジ固定を不用とすることので
きる場合に適用できる。骨はセラミック内で内部成長で
きることが分かっている。従って、本発明の一形態にお
いては、第１及び第２部材にとって好ましい材料は酸化
ジルコニウムセラミック又は酸化アルミニウムセラック
である。上述のセラミックは生理学的に矛盾を生じない
ものであり、疲労強度は用途に対して必要数の設計サイ
クルを提供できるようなものとする。摩耗は最小限に抑
えられ、移植装置は通常の椎間板空間の構造上の範囲内
に収容されるのに十分なほど小さくできる。現時点で
は、酸化ジルコニウムセラミック又は酸化アルミニウム
セラミックが好ましいが、性能上の要求を満たす他の材
料を使用することもできる。
いずれの場合も、基準を満たした材料を用いれば、本
発明は更に、圧縮を除いて、通常の椎間板運動を擬態す
る３個までの自由度での運動を提供する。好ましい実施
例においては、椎間板関節整形装置は、前後の剪断運
動、軸回転運動及び軸方向の圧縮運動を拘束した状態
で、15度までの撓み、５度までの伸び、及び、５度まで
の横曲げを提供するような形状を有する。別の実施例に
おいては、装置は上述の３度の運動を提供し、制限され
ない軸回転を提供するような形状を有する。本発明の関
節整形装置は後方にある小面関節の拡張（distractio
n）を維持し、これにより痛みの原因の可能性を減少さ
せるために、非圧縮性となるように設計される。
関節整形装置は、周囲の柔らかな組織即ち椎間板の環
体が緊張状態（張力付与状態）となり、関節整形装置の
位置ずれを防止するように、非圧縮性とされた椎間板空
間内に配置される。このような状況においては、本発明
によるボール部分及びソケット部分は緩い運動部分を排
除し、可能な運動の最大の融通性を提供する。
従って、本発明により得られる利点及び目的は多い。
以下、添付図面を参照して本発明を詳細に説明する。
図面の簡単な説明 第１図は椎骨本体間の健全な椎間板を示す腰椎の前面
図、 第２図は第１図と同様の図であるが、椎間板の代わり
に本発明に係る椎間板関節整形装置を配置した図、 第３図は本発明の参考例に係る椎間板関節整形装置の
側断面図、 第４図は第３図の装置の前面図、 第５図は本発明の実施例に係る椎間板関節整形装置の
斜視図で、ボール及びソケットの形状を破線にて示す
図、 第６図は図５の椎間板関節整形装置を配置した状態を
示す２つの椎骨の前面図、 第７図は第５図の装置の側面図、 第８図は本発明の他の実施例に係る椎間板関節整形装
置の下方部材の斜視図、 第９図は椎間板関節整形装置の上方部材の斜視図で、
第８図のボール形状に対応するソケット形状を破線にて
示す図、 第10図は本発明の更に別の実施例に係る椎間板関節整
形装置の下方部位の斜視図で、ボール形状を破線にて示
す図、 第11図は第10図のボール形状に対応するソケット形状
を備えた椎間板関節整形装置の斜視図、 第12図は本発明に係る別のボール形状を備えた椎間板
関節整形装置の上面図、 第13図は13−13線における第12図の椎間板関節整形装
置の断面図、 第14図は14−14線における第12図の椎間板関節整形装
置の断面図、 第15図は本発明に係るインサートカップの上方から見
た斜視図、 第16図は第15図のインサートカップの側面図、 第17図は椎間板関節整形装置の下方部材を装着した状
態での第15図のインサートカップの側面図、 第18図は本発明に係る別のインサートカップの上方か
ら見た斜視図、 第19図は第18図のインサートカップの側面図、 第20図は一対の第18図のインサートカップ内に装着さ
れた椎間板関節整形装置の断面図で、一方のインサート
カップへの関節整形装置のネジ取り付けを示す図、 第21図は第20図の円内の拡大図で、第18図のインサー
トカップへの関節整形装置のネジ取り付けを示す図、 第22図は列をなす抵抗歯及びビードポケットを合体し
たインサートカップの上方から見た斜視図である。
好ましい実施例の説明 以下、本発明の原理の理解を促進するため、図面を参
照しながら本発明の実施例につき特定の用語を用いて説
明する。ただし、実施例は本発明の要旨を限定するもの
ではなく、種々の変形及び修正が可能であり、本発明の
原理の更なる応用は当業者にとって容易に実行できるこ
とは言うまでもない。
第１図ないし第４図を参照すると、同じ符号は同一又
は対応する部品を示し、特に第２図と参照すると、本発
明に係る椎間板関節整形装置と類似した参考例の装置を
符号10にて示す。装置10は上方の第１椎骨本体12と下方
の第２椎骨本体14との間に移植された状態で示され、こ
れらは代表的な腰椎16の一部を形成する。第１図に示す
腰椎16は健全な椎間板18を含む。装置10は椎間板を切り
取ることにより生じる空間内に代わり配置される補綴板
である。
第３、４図に示すように、椎間板関節整形装置10は上
方組立体20及び下方組立体22を有する。上方組立体20は
ソケット26を備えた第１部材24を有する。上方に延びる
タブ30を有するベースプレート28は第１部材24に締結さ
れる。第１部材24はベースプレート28の隣接する面34に
適合しこの面に締結される上面32を有する。上面32とは
反対側の面36はソケット26を具備する。面36はソケット
26のすべての側部で上方に傾斜するように形成され、傾
斜はソケット26の入口から上面32の方に向かっている。
ベースプレート28は、当業者にとって既知の生理学的
に矛盾を生じない接着剤又は他の締結機構により面34に
沿って第１部材24の面32に締結された平坦な板である。
ベースプレート28の上面38は椎骨本体12に適合するよう
に形成されている。一般に、面38は平坦であり、椎骨本
体12の適合する面は手術中平坦にされる。タブ30は上方
に延び、ベースプレート28と一体になっている。タブ30
は開口40を備え、組立体20を椎骨本体12に締結するため
に開口を通してネジ42（下方のベースプレート48に関し
て示す）を使用することができる。
下方組立体22はソケット26内に緩く嵌合するボール46
を備えた第２部材44を有する。タブ50を有するベースプ
レート48はタブ30を有する上方のベースプレート28と類
似しているので、詳細に説明しない。第２部材44は第１
部材24及び上方ベースプレート28に関連して先に述べた
方法と類似の方法でベースプレート48の隣接する面54に
締結される下面52を有する。下面52とは反対側の面56は
上方に延びたボール46を有する。面56はボール46から離
れるようにボール46のすべての側で傾斜し、ボール46が
ソケット26と嵌合する場所を除いて、第１部材24と第２
部材44との間に空間を形成する。好ましい例において
は、面56、36は４つの異なる方向において傾斜面に沿っ
てボール46及びソケット26から離れるように傾斜する。
ボール46及びソケット26は実質上卵形又は細長い形状を
呈し、端部では４半分球状を呈する。
参考例による運動セグメントは、本発明と同様に、椎
間板関節整形装置10、及び、これに隣接する上方及び下
方の椎骨本体から成る。ボール46及びソケット26の正確
な輪郭、及び、面36、56の周囲の表面は運動セグメント
の撓み、伸び、横曲げ、剪断及び回転において許される
運動範囲を決定する。
健全な腰椎関節において観察される主な運動は撓み／
伸びである。典型的な椎骨L4、L5間の椎間板は13度の撓
みと、３度の伸びと、３度の横曲げと、１度の軸回転
と、少量の剪断とを許容する。撓み／伸びのための回転
中心は椎間板空間の後方部分に位置する。参考例は本発
明と同様に緩い拘束の概念に基礎を置く。１つの好まし
い例では、正常な椎間板の撓み、伸び及び横曲げ運動を
擬態する３個の自由度が許される。軸回転、前後の剪断
及び軸方向の圧縮は後方の小面関節を保護するために椎
間板関節整形装置10により拘束される。更に、周囲の柔
らかな組織の束縛部を張力状態に置くように椎間板空間
を非圧縮性にすることにより装置が挿入される。これに
より、関節整形位置が位置ずれするのを防止する助けと
なる。装置は15度の撓み、５度の伸び、５度の横曲げ及
び２ミリメートルの剪断を提供するように形造られる。
関節表面は雄型凸状ボール表面に対して関節運動を行う
凹状雌型ソケット表面である。このような構成により、
緩い運動部分が排除される。
参考例は本発明と同様に、粒子の発生を抑え、圧縮に
よる軸方向運動を阻止する第１及び第２部材24、44のた
めの材料を使用する。このような材料としてはセラミッ
クが適しており、好ましい例においては、セラミック材
料として酸化ジルコニウムを使用し、別の好ましい例に
おいては、酸化アルミニウムを使用する。材料の仕様は
理想的な摩耗特性及び生理学的な両立性を示す。弾性係
数は従来使用されているセラミックより小さく、ひび割
れも少ない。上記材料の特性は交換した関節整形椎間板
に対して、必要な40年の月日だけは持続することが分か
った。
第１−４図に示したような参考例は本発明と同様に、
好ましくはクロムコバルト又はチタンから作られたベー
スプレートに締結されたセラミック部材24、44を使用す
る。金属ベースプレートの目的は長期固定における骨の
内部成長を助長し、短期固定に対して隣接する椎骨本体
へのネジ取り付けを可能にすることである。しかし、装
置10が周囲の柔らかな組織の束縛部を張力状態に置く非
圧縮性の椎間板空間に配置されているので、初期のネジ
固定が不要になる場合があることを諒解されたい。更
に、骨の内部成長はセラミック内で生じることが分かっ
ている。それ故、全体の椎間板関節整形装置を第１及び
第２部材24、44、即ち、２つのセラミックの関節片のみ
で作ることができる。
本発明と同様に参考例を実施するのに適当な手術技術
は、米国ミネソタ州55407、ミネアポリス、2800 シカ
ゴ・アベニュー・サウス（2800 Chicago Avenue South,
Minneapolis,Minnesota 55407）所在のリチャード・エ
ム・サリブ、エム・ディ・インスチテュート・フォー・
ロウ・バック・ケア（Richard M.Salib,M.D.,Institute
for Low Back Care）から入手できる書物「Femoral Co
rtical Ring Plus Cancellous Dowel:An Alternative i
n an Anterior Lumber Interbody Fusion」に記載され
ている。
第５−14図は本発明に係る椎間板関節整形装置の諸実
施例を示す。第５図には、第１−４図に示すものと同様
の椎間板関節整形装置110を示す。椎間板関節整形装置1
10は楕円形のボール146及びソケット126を有し、これら
ボール及びソケットは、その最大長さが前後端158、160
に対して横方向の第１軸線に沿って位置し、最小長さが
表面156に沿い第１軸線に垂直な第２軸線に沿って位置
するように指向している。好ましい実施例においては、
楕円形ボール及びソケット形状の半径は第１軸線に沿っ
ては0.322インチ即ち約8.18mmであり、第２軸線に沿っ
ては0.173インチ即ち約4.39mmである。別の実施例にお
いては、ボール及びソケット形状の半径は第１軸線に沿
っては0.431インチ即ち約10.95mmであり、第２軸線に沿
っては0.256インチ即ち約6.50mmである。一般に、ボー
ルの半径が大きいほど、圧縮、回転及び軸方向負荷に対
する抵抗が一層大きくなる。
関節整形装置110の前端から回転中心までの距離165は
前端158と後端160との間の長さの65％に当たる後方に位
置し、通常の腰椎の回転中心に一致する。本発明は更
に、脊椎の他の領域の回転中心に装置110の回転中心を
一致させるように装置を位置決めする。
第５、７図に示すように、第１関節表面136はソケッ
ト126から離れるように傾斜し、第２関節表面156は平坦
形状を維持するが、本発明では、関節表面136、156のい
ずれか一方を傾斜させることができる。傾斜の度合いは
関節表面136、156間の相対回転量を決定し、第１関節表
面136はいずれかの方向における５度までの横曲げ、５
度までの伸び、及び、15度までの撓みを提供するように
傾斜している。好ましい実施例においては、第１関節表
面136はいずれかの方向における５度の横曲げ、５度の
伸び、及び、15度の撓みを提供するように傾斜してい
る。この実施例においては、ボール146及びソケット126
は第５図に符号170にて示すようないずれかの方向にお
ける５度までの軸回転を許容するような所定の嵌合を行
うように形状づけられている。ボール146及びソケット1
26の細長い形状特性により、他の回転は禁止される。
第６、７図は第１椎骨12と第２椎骨14との間に位置し
た第５図の椎間板関節整形装置110を示す。第６図は椎
間板関節整形装置110の前方から見た図であり、第７図
はその装置の側面図である。第６、７図は共に、第５図
の椎間板関節整形装置110の断面を示す。
第８、９図は、本発明の関節整形装置の他の実施例を
示す。第８図の装置210のボール246及び第９図のソケッ
ト226は球状を呈し、横方向端部では部分的に円筒状を
呈する。
関節整形装置210の前端から回転中心までの距離265は
前端258と後端260との間の長さの65％に当たる後方に位
置し、通常の腰椎の回転中心に一致する。本発明は更
に、脊椎の他の領域の回転中心に装置210の回転中心を
一致させるように装置を位置決めする。
第９図に示すように、第１関節表面236はソケット226
から離れるように傾斜し、第２関節表面256は平坦形状
を維持するが、本発明では、関節表面236、256のいずれ
か一方を傾斜させることができる。傾斜の度合いは関節
表面236、256間の相対回転量を決定し、第１関節表面23
6はいずれかの方向における５度までの横曲げ、５度ま
での伸び、及び、15度までの撓みを提供するように傾斜
している。好ましい実施例においては、第１関節表面23
6はいずれかの方向における５度の横曲げ、５度の伸
び、及び、15度の撓みを提供するように傾斜している。
この実施例においては、ボール246及びソケット226は椎
間板関節整形装置110に対して実質上符号170にて示すよ
うないずれかの方向における５度までの軸回転を許容す
るような所定の嵌合を行うように形状づけることができ
る。ボール246及びソケット226の細長い形状特性によ
り、他の回転は禁止される。
第10、11図には、関節整形装置310の他の実施例を示
し、この実施例では、第10図のボール部分346及び第11
図の対応するソケット部分326は３つの球状部分346
（ａ）、346（ｂ）、346（ｃ）及び326（ａ）、326
（ｂ）、326（ｃ）からそれぞれ成る。ボール346（ａ）
及びソケット326（ａ）の半径はボール346（ｂ）、346
（ｃ）及びソケット326（ｂ）、326（ｃ）の半径より大
きくなるように寸法づけられる。更に、ボール部分346
（ｂ）、346（ｃ）及びソケット部分326（ｂ）、326
（ｃ）は同じ半径となるように寸法づけられ、第10、11
図に示すように、ボール346（ａ）及びソケット部分326
（ａ）から横方向に同じ距離だけ離れている。
関節整形装置310の前端から回転中心迄の距離365は前
端358と後端360との間の長さの65％に当たる後方に位置
し、通常の腰椎の回転中心に一致する。本発明は更に、
脊椎の他の領域の回転中心に装置310の回転中心を一致
させるように装置を位置決めする。
第11図に示すように、第１関節表面336はソケット326か
ら離れるように傾斜し、第２関節表面356は平坦形状を
維持するが、本発明では、関節表面336、356のいずれか
一方を傾斜させることができる。傾斜の度合いは関節表
面336、356間の相対回転量を決定し、第１関節表面336
はいずれかの方向における５度までの横曲げ、５度まで
の伸び、及び、15度までの撓みを提供するように傾斜し
ている。好ましい実施例においては、第１関節表面336
はいずれかの方向における５度の横曲げ、５度の伸び、
及び、15度の撓みを提供するように傾斜している。この
実施例においては、ボール部分346及びソケット部分326
は椎間板関節整形装置110に対して実質上符号170にて示
すようないずれかの方向における５度までの軸回転を許
容するような所定の嵌合を行うように形状づけることが
できる。ボール346（ｂ）及び対応するソケット326
（ｂ）、並びに、ボール346（ｃ）及び対応するソケッ
ト326（ｃ）の位置により、他の回転は禁止される。
第10、11図の構成により、軸回転に対する必要な拘束
を維持した状態で、ボール部分346とソケット部分326と
の間の接触面積を最大にできる。
第12−14図は関節整形装置410の他の好ましい実施例
を示し、ボール446及びソケット426は球状を呈してい
る。この実施例は脊椎の長手軸のまわりでの実質上拘束
されない回転を許容する。通常の状態の下では、小面
（facets）を保護するために、回転を拘束すべきであ
る。しかし、椎間板関節整形装置410を挿入するために
環体の小さな部分のみを除去する場合には、残りの環体
により回転に対する有効な抵抗を提供し、この構成によ
る小面の生理学的な垂直負荷のみを許容するのが望まし
い。それ故、軸回転に対する拘束は不要となり、従っ
て、椎間板関節整形装置は撓み／伸び、横曲げ及び軸回
転についての椎間板の正常な運動を擬態する３つの自由
度を許容することができる。この特定の実施例において
は、前後方向の剪断、横方向の剪断及び軸方向の圧縮は
拘束される。
関節整形装置410の前端から回転中心465迄の距離は前
端458と後端460との間の長さの65％に当たる後方に位置
し、通常の腰椎の回転中心に一致する。本発明は更に、
脊椎の他の領域の回転中心に装置410の回転中心を一致
させるように装置を位置決めする。
第13、14図に示すように、第１関節表面436はソケッ
ト426から離れるように傾斜し、第２関節表面456は平坦
形状を維持するが、本発明では、関節表面436、456のい
ずれか一方を傾斜させることができる。傾斜の度合いは
関節表面436、456間の相対回転量を決定し、第１関節表
面436はいずれかの方向における５度までの横曲げ、５
度までの伸び、及び、15度までの撓みを提供するように
傾斜している。好ましい実施例においては、第１関節表
面はいずれかの方向における５度の横曲げ、５度の伸
び、及び、15度の撓みを提供するように傾斜している。
ここで第15−22図を参照すると、本発明の椎間板関節
整形装置の各実施例では、装置は手術による移植の前に
インサートカップに締結できる。第15−17図はインサー
トカップ70の一実施例を示す。インサートカップ70は、
椎間板関節整形部材をインサートカップ内に圧入するこ
とにより、部材324の如き第１部材の上面、又は、表面7
2において第17図に示すような部材344の如き第２部材の
下面のいずれかに締結されるような形状を有する。本発
明はまた、例えば、人体に対して矛盾を生じない接着
剤、テープ、溶接又はクリップ機構を用いて、インサー
トカップ70を椎間板関節整形装置の表面に締結する他の
手段を使用できる。インサートカップ70は第５、６図に
示すような一方の椎骨表面に係合するための係合表面76
を具備する。係合表面76は第５図に示すような脊椎に対
して垂直な軸線のまわりで実質上凸状となっている。こ
の形状は椎骨の頂面及び底面の自然な輪郭を追従し、軸
回転及び前後の剪断に関して装置を安定させるように作
用する。
第18−21図はインサートカップ170の別の実施例を示
し、このインサートカップは、第20図に示すように、部
材324の如き第１部材の外表面又は部材344の如き第２部
材の外表面を摺動収容するための収容表面172を具備す
る。インサートカップ70の実施例と同様に、インサート
カップ170は椎骨表面に係合するための凸状の係合表面1
76を具備する。椎間板関節整形装置の部材は、第20図に
示すように、部材344の如き部材にカップ170を螺合させ
ることにより、インサートカップ170に取り付けられ
る。第21図に詳示するように、ネジ78はインサートカッ
プ170の皿穴80を貫通し、部材344の別の開口82にネジ係
合する。
インサートカップ70又は170にとって好ましい材料は
チタンの如き金属である。インサートカップは機械加工
やモールド成形の如き種々の既知の方法で形成でき、本
発明の一実施例においては、インサートカップはモール
ド成形される。本発明の椎間板関節整形装置にチタンの
インサートカップを使用すると、構造体に対する引っ張
り支持を提供し、第１及び第２部材を圧縮状態に維持
し、金属材料の厚さを増減させることによりインサート
カップの寸法を容易かつ安価に変更できる状態で椎間板
関節整形装置の部材を単一寸法に維持できる等の種々の
利点が得られる。
椎間板関節整形装置にチタンのインサートカップを使
用した際の別の利点は、インサートカップが抵抗フィン
やスパイクや歯をセラミックよりも容易に取り付けるこ
とのできる表面を提供できることである。第６図はイン
サートカップの外表面の前端への抵抗フィン92の取り付
けを示す。これらのフィンは軸回転に対する関節整形装
置の抵抗を向上させるように作用し、機械加工、はんだ
付け、溶接又は接着の如き既知の方法でインサートカッ
プに取り付けることができる。一実施例においては、フ
ィンはインサートカップに溶着される。第22図は、椎間
板空間への関節整形装置の容易な挿入を許容するのが反
対方向への移動には抵抗する、インサートカップ70の表
面に取り付けられた列をなす歯94を示す。列をなす歯94
をインサートカップに取り付けるために上述の任意の取
り付け方法を使用できるが、一実施例においては、イン
サートカップの機械加工中に歯をインサートカップ内に
形成する。
椎間板関節整形装置にチタンのインサートカップを使
用した際の更に別の利点は、インサートカップがコーテ
ィングを容易に接着できる表面を提供することである。
第６、７図は骨内部成長式の固定を促進するためにイン
サートカップの外表面へのチタンビードコーティング90
の適用を示す。コーティングを施すために焼結やスプレ
ーの如き種々の既知の技術を使用でき、一実施例におい
ては、チタンビードコーティング90がインサートカップ
の外表面に噴霧（スプレー）される。第22図はチタンビ
ードのコーティングを受け入れるために３組の歯列94間
に設けられたビードボケット96を示す。第22図の実施例
においては、列をなす歯は装置挿入方向とは逆の方向へ
の椎間板関節整形装置の移動に抵抗する。ビードポケッ
ト96内に位置したチタンビードコーティングは、インサ
ートカップの外表面を適所に保持し、任意の方向におけ
るインサートカップの運動に対する抵抗を高めるように
作用する骨内部成長式の固定を助長する。
以上、図面に基づき本発明の実施例を詳細に説明した
が、本発明の実施例のみに限定されるものではなく、本
発明の要旨内で種々の変形、修正が可能であることは言
うまでもない。
フロントページの続き (72)発明者 ペティン，ケネス・エイ アメリカ合衆国コロラド州80525，フォ ート・コリンズ，オーク・リーフ・コー ト 1130 (56)参考文献 特開 昭63−164948（ＪＰ，Ａ) 特開 平６−7391（ＪＰ，Ａ) 特開 昭57−29348（ＪＰ，Ａ) 特表 平４−505574（ＪＰ，Ａ) 米国特許5258031（ＵＳ，Ａ) 国際公開94／04100（ＷＯ，Ａ１) (58)調査した分野(Int.Cl.7，ＤＢ名) A61F 2/44

Claims (17)

    (57)【特許請求の範囲】
  1. 【請求項１】脊椎の第１椎骨と第２椎骨との間で椎間板
    の代わりに配置されるようになった椎間板関節整形装置
    において、 第１椎骨に係合でき、第１関節表面と、第１後端部と、
    第１前端部とを備えた第１部材であって、これらの端部
    がその間に横方向の中央線を画定し、この中央線が上記
    第１後端部と第１前端部とから同じ距離だけ離れている
    第１部材と； 第２椎骨に係合でき、上記第１関節表面に対面した第２
    関節表面と、上記第１後端部及び第１前端部の対応する
    １つに対して並置する第２後端部及び第２前端部とを備
    えた第２部材と； 上記第１及び第２関節表面により画定される上記第１及
    び第２部材間に位置し、上記中央線と上記第１後端部と
    の間に位置したボール／ソケット関節であって、当該中
    央線に平行な第１軸線及びこの第１軸線に対して垂直で
    脊椎のサジタル画内に存在する第２軸線のまわりでの、
    上記第１部材と第２部材との間の相対回転を許容するボ
    ール／ソケット関節と； から成り、上記第１及び第２関節表面のうちの一方が上
    記ボール／ソケット関節の全周において当該関節から離
    れるようにそれぞれ第１又は第２部材の方へ傾斜し、当
    該他方の関節表面が該関節のまわりで上記第１軸線及び
    第２軸線により画定された平面に実質上平行となってい
    ることを特徴とする椎間板関節整形装置。
  2. 【請求項２】請求の範囲第１項に記載の椎間板関節整形
    装置において、上記傾斜した表面が上記第１軸線から上
    記前端部へ第１角度で延びる第１の傾斜面と、当該第１
    軸線から上記後端部へ第２角度で延びる第２の傾斜面
    と、上記第２軸線から離れるようにかつ反対方向にそれ
    ぞれ第３角度及び第４角度で当該第２軸線から延びる第
    ３及び第４の傾斜面とを有し、上記第１、第２、第３及
    び第４角度が上記他方の関節表面に関して測定されるこ
    とを特徴とする椎間板関節整形装置。
  3. 【請求項３】請求の範囲第２項に記載の椎間板関節整形
    装置において、上記第３及び第４角度は、上記第１関節
    表面が上記第２関節表面に接触する前に、上記第２軸線
    のまわりにおいて上記第１部材と第２部材との間の第１
    所定角度までの相対回転を許容するように寸法づけられ
    ていることを特徴とする椎間板関節整形装置。
  4. 【請求項４】請求の範囲第３項に記載の椎間板関節整形
    装置において、上記第２角度は、上記第１関節表面が上
    記第２関節表面に接触する前に、上記第１軸線のまわり
    での上記後端部に向かう方向への、上記第１部材と第２
    部材との間の第２所定角度までの相対回転を許容するよ
    うに寸法づけられていることを特徴とする椎間板関節整
    形装置。
  5. 【請求項５】請求の範囲第４項に記載の椎間板関節整形
    装置において、上記第１角度は、上記第１関節表面が上
    記第２関節表面に接触する前に、上記第１軸線のまわり
    での上記前端部に向かう方向への、上記第１部材と第２
    部材との間の第３所定角度までの相対回転を許容するよ
    うに寸法づけられていることを特徴とする椎間板関節整
    形装置。
  6. 【請求項６】請求の範囲第５項に記載の椎間板関節整形
    装置において、上記ボール／ソケット関節が上記第１軸
    線に沿って上記第１部材の第１関節表面上に形成された
    ボール部分と、上記第２部材の第２関節表面上に対応し
    て形成され、上記ボール部分を収容するようなソケット
    部分とを有することを特徴とする椎間板関節整形装置。
  7. 【請求項７】請求の範囲第６項に記載の椎間板関節整形
    装置において、細長い上記ボール部分が上記第１軸線お
    よび第２軸線の少なくとも１つに沿って円形の横断面を
    呈することを特徴とする椎間板関節整形装置。
  8. 【請求項８】脊椎の第１椎骨と第２椎骨との間で椎間板
    の代わりに配置されるようになった椎間板関節整形装置
    において、 第１椎骨に係合でき、第１関節表面と、第１後端部と、
    第１前端部とを備えた第１部材であって、これらの端部
    がその間に横方向の中央線を画定する第１部材と； 第２椎骨に係合でき、上記第１関節表面に対応した第２
    関節表面と、上記第１後端部及び第１前端部の対応する
    １つに対しって並置する第２後端部及び第２前端部とを
    備えた第２部材と； 上記第１及び第２関節表面により画定される上記第１及
    び第２部材間に位置した細長いボール／ソケット関節
    と； から成り、上記ボール／ソケット関節が、 上記第１部材の第１関節表面上に形成され、上記中央線
    に平行な第１軸線に沿って延びた細長いボール部分と、 上記第２部材の第２関節表面上に対応して形成されたソ
    ケット部分であって、上記第１部材と当該第２部材との
    間の相対回転を制限するように当該細長いボール部分を
    収容するソケット部分と、 から成り、上記第１及び第２関節表面のうちの一方が上
    記ボール／ソケット関節の全周において当該関節から離
    れるようにそれぞれ第１又は第２部材の方へ傾斜し、当
    該他方の関節表面が該関節のまわりで上記脊椎のサジタ
    ル面に垂直に配置された平面に実質上平行となっている
    ことを特徴とする椎間板関節整形装置。
  9. 【請求項９】請求の範囲第８項に記載の椎間板関節整形
    装置において、上記細長いボール部分及び上記ソケット
    部分が上記第１関節表面に平行な平面内において楕円形
    の横断面を呈することを特徴とする椎間板関節整形装
    置。
  10. 【請求項１０】請求の範囲第８項に記載の椎間板関節整
    形装置において、上記細長いボール部分及び上記ソケッ
    ト部分が上記第１関節表面に平行な平面内において部分
    的に円形の横断面を呈し、部分的に円筒状の部分に形成
    された両端を有することを特徴とする椎間板関節整形装
    置。
  11. 【請求項１１】請求の範囲第８項に記載の椎間板関節整
    形装置において、上記細長いボール／ソケット関節が複
    数個の別個のボール部分と、これに対応するソケット部
    分とを有することを特徴とする椎間板関節整形装置。
  12. 【請求項１２】請求の範囲第11項に記載の椎間板関節整
    形装置において、上記複数個のボール部分及びソケット
    部分が第１のボール及びソケット部分と、上記第１のボ
    ール部分の両側で当該第１ボール部分から等距離だけ離
    れて位置した第２及び第３のボール及びソケット部分と
    を有することを特徴とする椎間板関節整形装置。
  13. 【請求項１３】請求の範囲第12項に記載の椎間板関節整
    形装置において、上記第１、第２及び第３のボール部分
    が上記第１関節表面に平行な平面内において円形の横断
    面を呈し、当該第１ボール部分が当該第２及び第３ボー
    ル部分の半径より大きな半径を有することを特徴とする
    椎間板関節整形装置。
  14. 【請求項１４】請求の範囲第13項に記載の椎間板関節整
    形装置において、上記第２及び第３のボール部分が同じ
    半径を有することを特徴とする椎間板関節整形装置。
  15. 【請求項１５】請求の範囲第１項に記載の椎間板関節整
    形装置において、上記第１及び第２部材をジルコニアで
    作ったことを特徴とする椎間板関節整形装置。
  16. 【請求項１６】請求の範囲第１項に記載の椎間板関節整
    形装置において、上記第１及び第２部材をアルミナで作
    ったことを特徴とする椎間板関節整形装置。
  17. 【請求項１７】脊椎の第１椎骨と第２椎骨との間で椎間
    板の代わりに配置されるようになった椎間板関節整形装
    置において、 第１関節表面と、第１後端部と、第１前端部とを備えた
    第１部材であって、これらの端部がその間に横方向の中
    央線を画定し、この中央線が上記第１後端部と第１前端
    部とから同じ距離だけ離れている第１部材と； 上記第１関節表面に対面した第２関節表面と、上記第１
    後端部及び第１前端部の対応する１つに対して並置する
    第２後端部及び第２前端部とを備えた第２部材と； 上記第１及び第２部材間に位置し、上記横方向の中央線
    に平行な第１軸線及びこの第１軸線に対して垂直な第２
    軸線のまわりでの、上記第１部材と第２部材との間の相
    対回転を許容する関節であって、 上記第１部材の上記第１関節表面に形成された第１、第
    ２及び第３のボール部分であって、これらのボール部分
    が上記横方向の中央線に平行な軸線に沿って円形の横断
    面を呈し、第１ボール部分が第２及び第３のボール部分
    より大きな半径を有し、第２及び第３ボール部分が同じ
    半径を有していて、第１ボール部分の両側に位置する第
    １、第２及び第３のボール部分と、上記第１関節表面の
    上記ボール部分に対して実質上相補的な関係で上記第２
    関節表面に形成され、当該ボール部分を収容するように
    形状づけられたソケット部分とを有する関節と； 上記第１部材を挿入できる第１のインサートカップと； 上記第２部材を挿入できる第２のインサートカップと； から成り、上記各インサートカップが第１及び第２椎骨
    にそれぞれ係合できる係合表面を有し、これらの係合表
    面が上記第２軸線のまわりで凸状となって配置されてい
    ることを特徴とする椎間板関節整形装置。
JP52563895A 1992-01-06 1994-06-10 椎間板関節整形装置 Expired - Fee Related JP3514765B2 (ja)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US81705292A 1992-01-06 1992-01-06
US07/990,925 US5258031A (en) 1992-01-06 1992-12-14 Intervertebral disk arthroplasty
US08/223,119 US5425773A (en) 1992-01-06 1994-04-05 Intervertebral disk arthroplasty device
US08/223,119 1994-04-05
PCT/US1994/006530 WO1995026697A1 (en) 1992-01-06 1994-06-10 Intervertebral disk arthroplasty device

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AU7313394A (en) 1995-10-23
ES2227058T3 (es) 2005-04-01
EP1752117A3 (en) 2009-09-30
EP0754018A1 (en) 1997-01-22
EP1188423B1 (en) 2004-09-15
EP0754018A4 (en) 1997-04-09
EP0754018B1 (en) 2002-05-22
DE69434013T2 (de) 2005-09-15
PT1188423E (pt) 2004-11-30
US5258031A (en) 1993-11-02
WO1995026697A1 (en) 1995-10-12
EP1421922B1 (en) 2007-02-21
EP1421922B8 (en) 2007-04-18
ATE217778T1 (de) 2002-06-15
JPH10501705A (ja) 1998-02-17
ZA944507B (en) 1995-02-14
JP2004136100A (ja) 2004-05-13
JP4001859B2 (ja) 2007-10-31
ES2282790T3 (es) 2007-10-16
ATE275897T1 (de) 2004-10-15
EP1188423A1 (en) 2002-03-20
PT1421922E (pt) 2007-03-30
DE69434929T2 (de) 2007-11-08
DE69434929D1 (de) 2007-04-05
ATE354325T1 (de) 2007-03-15
EP1421922A1 (en) 2004-05-26
DE69434013D1 (de) 2004-10-21
EP1752117A2 (en) 2007-02-14

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