Source: https://patents.google.com/patent/JP2015024135A/en
Timestamp: 2020-08-15 12:20:54
Document Index: 33919705

Matched Legal Cases: ['art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 71', 'art 6', 'art 7', 'art 6', 'art 6', 'art 6', 'art 71', 'art 71', 'art 78', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 71', 'art 6', 'art 6', 'art 6', 'art 6', 'art 79', 'art 6', 'art 6', 'art 6', 'art, 61', 'art, 8', 'art, 8']

JP2015024135A - Coupling assembly for coupling rod to bone anchoring element, and kit of bone anchoring device and coupling assembly - Google Patents
Coupling assembly for coupling rod to bone anchoring element, and kit of bone anchoring device and coupling assembly Download PDF
JP2015024135A
JP2015024135A JP2014148778A JP2014148778A JP2015024135A JP 2015024135 A JP2015024135 A JP 2015024135A JP 2014148778 A JP2014148778 A JP 2014148778A JP 2014148778 A JP2014148778 A JP 2014148778A JP 2015024135 A JP2015024135 A JP 2015024135A
JP2014148778A
JP2015024135A5 (en
JP6218689B2 (en
ビルフリート・マティス
ベルント・フィッシャー
ビーダーマン・テクノロジーズ・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング・ウント・コンパニー・コマンディートゲゼルシャフトＢｉｅｄｅｒｍａｎｎ Ｔｅｃｈｎｏｌｏｇｉｅｓ Ｇｍｂｈ ＆ Ｃｏ． Ｋｇ
Biedermann Technologies Gmbh & Co Kg
2013-07-24 Priority to US201361858026P priority Critical
2013-07-24 Priority to EP13177919.1A priority patent/EP2829243B1/en
2013-07-24 Priority to US61/858,026 priority
2013-07-24 Priority to EP13177919.1 priority
2014-07-22 Application filed by ビーダーマン・テクノロジーズ・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング・ウント・コンパニー・コマンディートゲゼルシャフトＢｉｅｄｅｒｍａｎｎ Ｔｅｃｈｎｏｌｏｇｉｅｓ Ｇｍｂｈ ＆ Ｃｏ． Ｋｇ, Biedermann Technologies Gmbh & Co Kg, ビーダーマン・テクノロジーズ・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング・ウント・コンパニー・コマンディートゲゼルシャフトＢｉｅｄｅｒｍａｎｎ Ｔｅｃｈｎｏｌｏｇｉｅｓ Ｇｍｂｈ ＆ Ｃｏ． Ｋｇ filed Critical ビーダーマン・テクノロジーズ・ゲゼルシャフト・ミット・ベシュレンクテル・ハフツング・ウント・コンパニー・コマンディートゲゼルシャフトＢｉｅｄｅｒｍａｎｎ Ｔｅｃｈｎｏｌｏｇｉｅｓ Ｇｍｂｈ ＆ Ｃｏ． Ｋｇ
2015-02-05 Publication of JP2015024135A publication Critical patent/JP2015024135A/en
2016-08-18 Publication of JP2015024135A5 publication Critical patent/JP2015024135A5/ja
2017-10-25 Publication of JP6218689B2 publication Critical patent/JP6218689B2/en
230000001808 coupling Effects 0.000 title claims abstract description 72
238000010168 coupling process Methods 0.000 title claims abstract description 72
238000005859 coupling reactions Methods 0.000 title claims abstract description 72
210000002414 Leg Anatomy 0.000 claims description 26
238000003780 insertion Methods 0.000 claims description 12
230000004308 accommodation Effects 0.000 claims 4
229910001000 nickel titaniums Inorganic materials 0.000 description 2
An improved coupling assembly for coupling a rod to a bone anchor element that provides improved or easier handling during surgery and has an expanded field of application. A coupling assembly for coupling a rod to a bone anchor element, the coupling assembly including a receiving part, a recess for receiving the rod, and a receiving space for receiving a head of the bone anchor; A pressure element configured to be at least partially positioned within the receiving space; a first end including a first end face; a channel for inserting a rod adjacent to the first end; And a rod receiving element comprising a second end having a second end face facing the two end sides. [Selection] Figure 1
The present invention relates to a coupling assembly for coupling a rod to a bone anchor element, the coupling assembly comprising a recess for receiving the rod and a receiving part for receiving a head of the bone anchor element. And a pressure element for tightening the head and a rod receiving element cooperating with the pressure element. When the bone anchor element is inserted into the coupling assembly, the pressure element and the rod receiving element are first clamped with the head of the bone anchor element without securing the rod, and then with one drive lock element It is configured to cooperate so that the rod can be fixed. The invention further relates to a bone anchor device comprising such a coupling assembly and a bone anchor element. Furthermore, the present invention relates to a kit of such a coupling assembly and different rod receiving elements that allows the use of rods having different diameters.
US Patent Publication No. 2010/0160980 describes a method and locking mechanism for securing bone screws and rods to the spine. The locking mechanism includes a main body, an insert, a rod seat, and a set screw. The body includes a bottom that is configured to receive a bone screw and insert, but prevents the insert and bone screw from penetrating the bottom once the insert and bone screw are engaged. . The rod seat is between the rod and the insert.
US Patent Publication No. 2013/0018428 includes an orthopedic fixation device that includes a coupling element and a bone fastener that can be mounted into the coupling element through the bottom of the bore of the coupling element. It is described.
There remains a need to provide a coupling assembly for coupling a rod to a bone anchor element and a bottom-mounted polyaxial bone anchor device improved for various aspects.
US Patent Publication No. 2010/0160980 US Patent Publication No. 2013/0018428
In particular, it is an object of the present invention to provide an improved coupling assembly for coupling a rod to a bone anchor element that provides improved or easier handling during surgery and has an expanded field of application. It is to be.
This object is solved by a coupling assembly according to claim 1, a bone anchor device according to claim 16, a coupling assembly according to claim 19 and a kit of different rod receiving elements. Further developments are described in the dependent claims.
The coupling assembly has a structure that allows a locking element to sequentially lock the head and rod of the bone anchor element with a single drive. By tightening the locking element, the rod is still movable while the head is first tightened. As the co-operating portion of the pressure element and rod receiving element deforms, the rod is then secured to the head lock.
The pressure element may have an indentation or indentation in its inner wall that allows the bone anchor element to pivot at a greater angle in the direction of the indentation or inner indentation compared to the opposite direction. . Since the pressure element can rotate within the coupling element as long as the head is not locked, the position of the enlarged swivel angle can be selected within 360 ° of the central axis.
Once the head is inserted, the rod receiving element engages the receiving part such that the pressure element is held in a pre-locked position that prevents disengagement of the head of the bone anchor element. In the pre-lock position, the head of the bone anchor element may be held by a frictional force applied to the head by the pressure element. The frictional force may be such that the head can still be turned by applying a force that overcomes the frictional force.
According to an embodiment of the invention, the pressure element has a slit ring at its lower end. The slit ring can be expanded radially and allows the insertion of the head of the bone anchor element. The force required to introduce the head into the flexible part of such a pressure element is reduced compared to a pressure element having only a longitudinal axis or a coaxial slit. This further facilitates handling during surgery.
The coupling assembly can be assembled in situ with a bone anchor element that has already been inserted into the bone or spine. The rod receiving element may be designed to receive a rod of a specific diameter or diameter range. By providing a kit with a coupling assembly and at least additional rod receiving elements configured to receive rods of different diameters, the coupling assembly can be used with rods of different diameters. Thereby, the application field of a bone anchor apparatus is expanded.
The bone anchor device can be part of a modular system, such as the length of the shank, e.g. different thread types, pitches, different diameters of cannulated or non-cannulated shanks, etc. It includes several bone anchor elements that can differ with respect to the anchor characteristics of the shank and one coupling assembly. Modularity can be further increased by using different rod receiving elements to couple different diameter rods to the coupling assembly. This opens up the surgeon the choice between a wide variety of implants. In addition, the cost for inventory management can be reduced.
Further features and advantages of the invention will become more apparent from the description of various embodiments using the accompanying drawings.
1 is an exploded perspective view of a first embodiment of a bone anchor device. FIG. 2 is a perspective view of the bone anchor device of FIG. 1 in an assembled state. FIG. 3 is a cross-sectional view of a bone anchor device according to the first embodiment of FIGS. 1 and 2 taken perpendicular to the axis of the inserted rod. FIG. FIG. 3 is a cross-sectional view of a bone anchor device according to the first embodiment of FIGS. 1 and 2 taken in a plane including the central axis and the rod axis of the inserted rod. It is a perspective view from the upper part of the receiving component according to 1st Embodiment. It is a perspective view from the bottom part of the receiving component shown in FIG. FIG. 7 is a top view of the receiving component illustrated in FIGS. 5 and 6. FIG. 7 is a cross-sectional view of the receiving component illustrated in FIGS. 5 and 6 along line AA in FIG. 7. 1 is a perspective view from above of a pressure element according to a first embodiment. FIG. FIG. 10 is a perspective view from the bottom of the pressure element illustrated in FIG. 9. FIG. 10 is a top view of the pressure element illustrated in FIG. 9. FIG. 11 is a cross-sectional view of the pressure element of FIGS. 9 and 10 along line BB in FIG. 11. FIG. 6 is a side view of a second embodiment of a pressure element. It is a perspective view from the upper side of 3rd Embodiment of a pressure element. It is a perspective view from the upper part of 4th Embodiment of a pressure element. It is a perspective view from the upper part of the rod receiving element according to 1st Embodiment. FIG. 17 is a perspective view from the bottom of the rod receiving element of FIG. 16. FIG. 18 is a top view of the rod receiving element illustrated in FIGS. 16 and 17. FIG. 18 is a cross-sectional view of the rod receiving element of FIGS. 16 and 17 taken along line DD in FIG. FIG. 6 is a cross-sectional view of a coupling assembly of a bone anchor device according to a first embodiment, taken in a plane that includes a central axis and is perpendicular to the rod axis, wherein the pressure element and the rod receiving element are pre-assembled with the receiving part is there. It is a figure which shows the enlarged part of FIG. 20a. It is an expanded sectional view of cooperation between the receiving component in a modification, a pressure element, and a rod receiving element. FIG. 3 is a cross-sectional view of a first step of assembling a bone anchor device according to the first embodiment. FIG. 6 is a cross-sectional view of a second step of assembling the bone anchor device according to the first embodiment. It is sectional drawing of the 3rd step which assembles the bone anchor apparatus according to 1st Embodiment. FIG. 6 is a cross-sectional view of the step of tightening the head of the bone anchor element in the coupling assembly according to the first embodiment. FIG. 7 is a cross-sectional view of a bone anchor device having a rod and a locking element inserted in a step of locking the head without locking the rod. FIG. 4 is a cross-sectional view of a bone anchor device having an inserted rod and locking element in a step of locking the rod. FIG. 26b shows an enlarged part of the detail of FIG. 26a. FIG. 3 is a perspective exploded view of a kit of coupling assemblies having different rod receiving elements for using rods having different diameters. 1 is a cross-sectional view of a bone anchor device having a first diameter inserted rod and a rod receiving element adapted to receive a first diameter rod. FIG. FIG. 4 is a cross-sectional view of a bone anchor device having an inserted rod, a locking element, and a rod receiving element adapted for use with a second diameter rod different from the first diameter. FIG. 6 is a cross-sectional view of a bone anchor device according to a second embodiment with an inserted rod and locking element taken in a plane that includes the central axis of the coupling assembly and is perpendicular to the rod axis.
1 and 2, the bone anchor device according to the first embodiment includes a bone anchor element 1 in the form of a bone screw having a shank 2 at least partially provided with a bone screw thread and a head 3. The head 3 has a spherical segmented outer surface part, which includes the sphere's maximum outer diameter E and a flat free end with a recess 4 for engagement with a screw-in tool.
The bone anchor device further includes a coupling assembly 5 for receiving the stabilizing rod 100 and for coupling the stabilizing rod 100 to the bone anchor element 1. The coupling assembly 5 comprises a receiving part 6 for receiving the head 3 of the bone anchor element 1 and receiving the rod 100, a pressure element 7 arranged to be arranged in the receiving part 6, and a receiving part 6 And a rod receiving element 8 configured to be disposed within. The pressure element 7 functions to lock the head 3 in the receiving part 6. The rod receiving element 8 functions to receive the rod 100 and to act on the pressure element 7 to lock the head 3. At least one pin 9 for cooperating with the rod receiving element 8 may be provided.
Furthermore, for fixing the rod 100 in the receiving part 6 and the rod receiving element 8 and for applying a force on the pressure element 7 via the rod receiving element so as to lock the head 3 in the receiving part 6. A locking element 10 in the form of an internal thread is provided.
Here, the receiving component 6 will be described with reference to FIGS. 1 to 8. The receiving part 6 has a first end 6a which is an upper end and an opposite second end 6b which is a lower end, and a symmetrical central axis C passes through the first end 6a and the second end 6b. A coaxial bore 61 is provided on the central axis C. In the first region adjacent to the first end 6a, the receiving part 6 is directed towards the first end 6a, with a substantially U-shaped recess 62 having a bottom directed towards the second end 6b. And two free legs 62a and 62b. In the region of the legs 62a, 62b, an internal thread 63 is provided which cooperates with the locking element 10. The channel formed by the U-shaped recess 62 is sized to receive the rod 100 therein for connecting a plurality of bone anchor devices. In the region of the legs 62a, 62b to a substantially axial height defined by the bottom of the U-shaped recess 62, the bore 61 has a first inner diameter. In the region below the legs 62a, 62b, the bore 61 has a widened portion 61a having a diameter larger than the first inner diameter of the first portion. Between the second end 6b and the widened portion 61a, the bore 61 has a reduced width portion 61b that tapers toward the second end 6b having a conical angle. An opening 64 is provided in the second end 6b, and the diameter of the opening 64 is the maximum diameter E of the head 3 so that the head 3 can be inserted from the second end 6b of the receiving part 6. Greater than. The widened portion 61 a and the reduced width portion 61 b define a receiving space for the head 3 of the bone anchor element 1.
A first groove 66 extending in the circumferential direction at a certain distance from the first end 6a below the female screw 63 is provided on the inner surface of each of the legs 62a and 62b. The first groove 66 functions to engage the retaining portion of the rod receiving element 8 as will be described below. A circumferentially extending second groove 67 may be provided at the lower end of the internal thread 63, and the second groove 67 also functions to engage the retaining portion of the rod receiving element.
One of the legs 62a, 62b is provided with a transverse bore 68 that extends through the legs, for example through the legs 62b, in a direction substantially perpendicular to the central axis M to receive the pin 9. . The bore 68 is located substantially at the center of the leg. The pin 9 is preferably long enough that once inserted into the bore 68, the pin 9 extends a short distance into the bore 61 to provide a stop for the rod receiving element 8, as will be described below. Have The pin 9 may be flush with the outer surface of the receiving part 6 when inserted.
In particular, as seen in FIGS. 1 and 9-12, the pressure element 7 has a first end having a free end face 7a and a second end 7b. The second end 7 b of the pressure element 7 is configured to be closer to the second end 6 b of the receiving part 6 than the first end of the pressure element 7 when the pressure element 7 is arranged in the receiving part 6. Has been. Adjacent to the second end 7 b, the pressure element 7 has a cap-like flexible part 71 with a substantially spherical segmented hollow interior chamber 72. The cap-like portion 71 is open at the second end 7b so as to allow the insertion of the head 3 of the bone anchor element 1. The outer surface of the cap-shaped portion 71 has a reduced width portion 71a adjacent to the second end 7b that tapers in the direction toward the second end 7b. The taper substantially corresponds to the taper of the reduced width portion 61 b of the receiving part 6. The reduced width portion extends substantially within the spherical segmented outer surface portion 71b. At one circumferential position, there is an inner recessed portion 73 adjacent to the second end so that the wall of the cap-shaped portion 71 is thinner at the recessed portion 73 than the remaining portion. The width and height of the indentation 73 is such that the shank 2 of the bone anchor element can extend through it. Thereby, when the bone anchor element 1 is inserted, the bone anchor element 1 can be turned in the direction of the recessed portion 73 at an angle larger than the opposite direction. Therefore, the turning angle is expanded to one side. The enlargement can be, for example, approximately 10 °, but other enlarged swivel angles may be contemplated, depending on the wall thickness and geometry.
A slit 74 extending in the circumferential direction is provided at a distance from the second end 7b. The slit 74 extends circumferentially around the central axis C of the receiving part 7 along a plane substantially perpendicular to the central axis C when the pressure element 7 is arranged in the receiving part 6. Furthermore, the slit 74 extends around the central axis C by more than about 180 °, preferably more than 270 °, more preferably more than 340 °. Thus, the slit 74 provides a ring-shaped part at the second end, which is integrally connected to the other part of the pressure element 7 by a wall forming a connection band 76. The connection band 76 has a circumferential length such that a stable connection of the ring-shaped part to the other part of the pressure element 7 is obtained. At one end of the circumferentially extending slit 74 there is a substantially vertical slit 77 extending from the second end through the entire ring-shaped portion 75 into the slit 74. Thereby, the ring-shaped part is cut out or divided in the circumferential direction to form a slit ring 75 that can be expanded and compressed in the radial direction. The width of the vertical slit 77 is preferably smaller than the width of the circumferential slit 74. The outer surface of the slit ring 75 is tapered to form an outer surface portion 71 a that is reduced in width toward the second end of the pressure element 7. The position and size of the slit ring 75 are enlarged so that the width of the vertical slit 77 becomes larger when the head 3 of the bone anchor element 1 is inserted from the open end of the cap-like portion 71. When the head 3 is completely inserted into the hollow inner chamber 72, the slit ring 75 encloses the head 3 below the maximum diameter E and the maximum diameter E of the head 3 in the direction toward the shank 2. Degree.
The maximum outer diameter of the cap-shaped portion 71 is slightly smaller than the inner diameter of the first portion of the bore 61 of the receiving part 6 and is smaller than the diameter of the bore in the widened portion 61a. Therefore, the slit ring 75 can be enlarged within the widened portion 61 a of the receiving part 6.
Opposite the second end 7b of the cap-like part 71 is a conical bore 78a that tapers towards the first end face 7a and allows access to the recess 4 of the head 3 of the anchor element 1. A conical tapered portion 78 is provided. The conical portion 78 is of a height and outer dimensions such that it can penetrate the bottom opening of the rod receiving element 8 described below. At a distance from the first end face 7a, an annular projection 78b is formed in the conical segmented portion 78 having a flat upper surface and an inclined lower surface. The outer peripheral surface 78c of the protrusion 78b is substantially cylindrical.
A transition portion between the cap-shaped portion 71 and the conical section-shaped portion 78 forms a contact portion that widens toward the first end surface 7 a and cooperates with a part of the rod receiving element 8. There is a conical widening collar 79 having a flat upper surface 79a. The conical flange 79 extends in the radial direction beyond the first end surface 7a and further beyond the protrusion 78b. The flat upper surface 79a is located axially below the first end surface 7a of the pressure element 7. The structure and / or size of the flange 79 is such that the flange 79 is at least slightly deformable in the axial direction when an axial load acts on the flat upper surface 79a. In this case, the buttock extends outward. The deformation of the buttocks may be elastic deformation.
FIG. 13 is a modified embodiment of the pressure element. The pressure element 7 'differs only in the transverse slit of the cap-like part. The cap-like portion 71 'has a slit 74' that extends at least partially in a spiral shape around the central axis from a substantially vertical slit 77 '. In a further variation, the slit 77 'is not substantially vertical and is merely a part of the spiral slit 74'.
Another modified embodiment of the pressure element is shown in FIG. The pressure element 7 ″ differs from the pressure element according to the embodiment shown in FIGS. 9 to 12 according to the shape of the conical saddle. The conical saddle is provided with slits 79b at equal intervals, which are circumferential. A ridge portion 79 'is formed, and in the illustrated embodiment, four ridge portions 79' are formed, depending on the number of slits and the size and thickness of the ridge portion, the specific flexibility of the ridge portion 79 '. Can be achieved.
A further modified embodiment of the pressure element is illustrated in FIG. The pressure element 7 "" differs from the pressure element shown in FIGS. 9 to 12 depending on the design of the cap-like part. The cap-like part 71 "comprises a plurality of equally spaced vertical slits 77". The vertical slit 77 ″ is open toward the second end 7b and is closed by a circular portion 77a widened in the direction toward the first end of the pressure element 7 ″ ″. Number of slits The size and size are selected to achieve a particular flexibility of the cap-like portion 71 ″. Furthermore, the pressure element 7 ″ according to this embodiment does not have an annular projection 78 b at the conical sectioned part 78.
It should be understood that many different combinations of features of various embodiments of the pressure element can be combined to produce various other embodiments of the pressure element.
1 and FIGS. 16 to 19, the rod receiving element 8 is a separate part from the pressure element 7. The rod receiving element 8 is a substantially cylindrical part with a first end having a free end surface 8a and an opposite second end having a free end surface 8b. Adjacent to the first end having the first end face 8a is a substantially rectangular recess 81 that cuts out a portion of the cylinder so that two free upstanding legs 81a, 81b remain. The free end faces of the portions 81a and 81b form a first end face 8a. On the second end 8 b side, there is an opening 82, preferably a circular opening, which extends through the rod receiving element 8 into the recess 81. The inner diameter of the aperture 82 is smaller than the outer diameter of the first end surface 7a of the pressure element so that the first end surface 7a of the pressure element can extend through the aperture 82 into the rod receiving element 8. . Further, the inner diameter of the aperture 82 is substantially the same as the outer diameter of the cylindrical outer surface portion 78c of the annular projection 78b provided in the conical sectioned portion 78 of the pressure element 7, or Has a slightly smaller size. Thus, when the conical portion 78 extends through the aperture 82 of the rod receiving element 8, the pressure element 7 can be held together with the rod receiving element 8, and the cylindrical outer surface portion 78c of the projection 78 is tightened. By fitting, the hole 82 contacts the inner circumferential surface of the rod receiving element 8.
Two concave cylindrical segmented rod support projections 83a and 83b are provided on both sides of the bore forming the opening 82 at the bottom of the recess 81 between the legs 81a and 81b. The radius of the concave portions 83a, 83b is preferably selected to be adapted to the radius of the particular rod used. The rod support protrusions 83a, 83b may be separated from the legs 83a, 83b by grooves 84 on each side of the protrusion. The width of the recess 81 is such that the rod 100 can be received in the recess 81. When the rod 100 is inserted into the recess 81 of the rod receiving element 8, it can rest on the rod support projections 83a, 83b. The height of the leg portions 81a and 81b is such that when the rod 100 is disposed in the channel 81 and placed on the rod support protrusions 83a and 83b, the first end surface 8a is positioned slightly above the rod upper surface. It is.
The outer diameter of the rod receiving element 8 is only slightly smaller than the inner diameter of the bore 61 of the receiving part 6 so that the rod receiving element 8 can move in the bore 61 and is guided into the bore 61.
The rod receiving element 8 further comprises an elongated depression 85 extending from each bottom 81a, 81b substantially from the bottom of the depression 81 to a distance from the first end face 8a. The recess 85 extends through the entire area of each leg portion 81a, 81b in the radial direction. The recess 85 has a width such that the pin 9 can be accommodated therein. The lower end 85a of each elongated recess 85 forms a stop for the pin 9 extending into the respective recess. The stop prevents the rod receiving element 8 from escaping from the first end 6a of the receiving part 6 when the pressure element 7 is in the insertion position. Furthermore, the recess 85, together with the at least one pin 9, may serve as a fixing device that maintains the alignment between the recess 62 of the receiving part 6 and the channel 61 of the rod receiving element 8.
The rod receiving element 8 further includes a circumferentially extending protrusion 86 having a flat upper surface 86a and an inclined lower surface 86b at each leg at the approximate center of each axial leg. The inclination of the inclined lower surface 86 b is such that the protrusion 86 can be removed from the grooves 66 and 67 when the rod receiving element is pushed downward toward the second end 6 b of the receiving part 6. As shown in FIGS. 20 a and 25, the shape of the protrusion 86 is such that the protrusion 86 is fitted into the grooves 66 and 67, respectively, and the flat upper surface 86 a abuts against the upper edge of the grooves 66 and 67. It is possible.
Furthermore, each leg is provided with a cylindrical section-type depression 87 extending in the longitudinal direction, which extends from the bottom of the depression 81 to the first end face 8a.
The bone anchor device may be wholly or partly a biocompatible material, such as a biocompatible metal or metal alloy, such as titanium, stainless steel, a nickel-titanium alloy such as nitinol, or a polyether ether, for example. It consists of a biocompatible plastic material such as ketone (PEEK).
Referring to FIGS. 20a-20c, the coupling assembly may be pre-assembled in the following manner. The rod receiving element 8 and the pressure element 7 are inserted into the receiving part 6. Thereby, the pressure element may be inserted through the lower opening 64 of the receiving part 6. The rod receiving element 8 may be inserted from the first end 6a of the receiving part by slightly pushing the legs 81a, 81b together until the projection 86 snaps into the second groove 67. In the first embodiment illustrated in FIGS. 20a and 20b, the pressure element 7 is temporarily held in the rod receiving element 8 by an interference fit. This is achieved in the opening 82 by the cylindrical surface portion 78c of the projection 78b on the pressure element 7 having a slightly larger size relative to the inner surface of the rod receiving element 8. The flat upper surface 86a abuts the upper edge of the second groove 67 in the receiving part 6 and prevents the rod receiving element 8 from escaping from the first end 6a of the receiving part during the insertion of the pressure element. Is done. The pressure element 7 is also in the uppermost position, where the flat surface 79 a of the flange 79 abuts on the second end face 8 a of the rod receiving element 8.
With this arrangement, the cap-shaped portion 71, in particular, the slit ring 75 is located at a position where the coaxial bore 61 has the widened portion 61a having the maximum inner diameter. As can be seen in FIG. 20a, the slit ring 75 has an expanding space in this position.
In an alternative embodiment, as illustrated in FIG. 20c where the pressure element does not have an annular protrusion 78b, for example in the case of a pressure element 7 ″ ′ as illustrated in FIG. Rather than being held in the insertion position by an interference fit with the rod receiving element 8, it is snapped to the outermost edge of the collar 79 that engages the third groove 69 inside the receiving part, thereby inserting the insertion position. The third groove 69 may be small and shallow because it is only necessary to hold the pressure element in the insertion position.
The use of the coupling assembly 5 with the bone anchor element 1 and the rod 100 will be described with reference to FIGS. As shown in FIG. 21, a suitable bone anchor element 1 is first implanted in the bone. In FIG. 21, reference numeral 200 illustrates the bone surface. Since the bone anchor element 1 can be placed in the implantation site without the coupling assembly being connected, the step of implantation of the bone anchor element 1 is facilitated. Thereafter, the coupling assembly 5 with the pressure element 7 and the rod receiving element 8 in the insertion position is placed on the head 3 of the bone anchor element 1. As shown in FIG. 23, the head 3 enters the receiving part 6 through the lower opening 64 and passes through the open second end 7 b of the pressure element 7 to the cap-like portion 71 of the pressure element 7. enter. When the head 3 comes into contact with the slit ring 75 of the pressure element 7, the pressure element 7 is pushed in a state where the flange 79 is in contact with the second end face 8b of the rod receiving element, and the bottom 85a of the elongated recess 85 of the leg 81b. The rod receiving element is shifted upward until it contacts the pin 9 extending through the leg 62b of the receiving part 6. Accordingly, the rod receiving element 8 is prevented from being pushed out from the first end 6a of the receiving part 6 when the head is inserted.
The pressure element 7 is rotatable in the receiving part. The pressure element 7 may be arranged in such a way that the indentation 73 giving an enlarged swivel angle is in a particular position. To accomplish this, an alignment feature (not shown) can be provided that can rotate the pressure element such that the recessed portion 73 assumes a desired position.
When the head 3 is further introduced into the cap-shaped portion 71, the slit ring 75 expands within the widened portion 61 a of the bore 61 of the receiving part 6. At this time, the head 3 can be completely inserted. Since the slit ring 75 does not expand at the connection band 76, the insertion of the head 3 is not at all coaxial with the central axis C, and may be slightly off or displaced from the central axis C. By further introducing the head 3, the slit ring 75 can be expanded to the maximum, and the head 3 can be put into the upper part of the hollow inner chamber 72 until the head 3 abuts against the inner wall of the chamber 72. Here, as shown in FIG. 23, the slit ring 75 can elastically contract around the head 3.
When the head 3 abuts against the inner wall of the cap-shaped portion 71 in the upper region, the slit ring 75 includes the portion of the head 3 below the region having the maximum diameter E as seen in FIG. In this state, the slit ring 75 clamps the head 3 by friction, so that the bone anchor element 1 can be pivoted to a desired angular position relative to the receiving part 6 and the pressure element 7 and the head 3 Can be held there by a friction fit between.
Finally, as shown in FIG. 24, the slit ring 75 is pushed into the reduced width portion 61b by pulling the receiving part 6 with an instrument (not shown) and depressing the rod receiving element 8. The tapered outer surface 71 a of the ring 75 engages with the reduced width portion 61 b of the receiving part 6. At the same time, the protrusion 86 snaps into the first groove 66 of the receiving part 6. In this state, as shown in FIG. 24, because of the stopper provided by the upper edge of the groove 66 with which the flat upper surface 86a of the protrusion 86 of the rod receiving element 8 abuts, the rod receiving element 8 is moved upward. It is prevented from moving. The head 3 is already clamped by the cap-like part 71 of the pressure element 7. Since the slit ring 75 is located between the head 3 and the reduced width portion 61b of the receiving part, the lower opening 64 of the receiving part 6 is narrowed, and the head 3 falls off the lower opening 64. Extrusion is prevented. This is a pre-lock state.
In clinical use, typically at least two bone anchor devices are inserted into the bone and the receiving parts are aligned. Since the head 3 of the bone anchor element 1 is held in the pressure element by frictional forces, the receiving part 6 can be easily aligned manually and its angular position is between the head and the pressure element 7. Maintained by frictional force. Next, as seen in FIG. 25, the rod 100 is inserted into the receiving part 6 and the locking element 10 is screwed between the legs 62 a, 62 b of the receiving part 6. The rod 100 is first supported by the support surfaces 83a, 83b of the rod receiving element 8. When the locking element is tightened, while the rod receiving element 8 is moved slightly downward, the locking element 10 simply contacts the first end face 8a of the rod receiving element 8 and applies a force to the first end face 8a. As shown in FIG. 25, the force F is transmitted to the flat upper end surface 79a of the flange 79 of the pressure element 7 via the second end surface 8b, transmitted to the head 3, and from the head 3 to the slit ring. 75 and the receiving part. Thereby, the rod 100 is still movable in the direction of the rod axis while the head 3 is locked in the angular position with respect to the receiving part.
Referring now to FIGS. 26a and 26b, further advancement of the locking element 10 can be seen in FIG. 26b because the second end face 8b applies a greater force F to the upper surface 79a of the flange 79 of the pressure element 7. Thus, the collar part 79 is slightly deformed. As a result, the rod receiving element 8 can further move downward slightly, so that the locking element 10 presses the rod. Thereby, the rod is fixed. In this state, force is transmitted to the head 3 and the receiving part 6 through the rod and the first end face 7 a of the pressure element 7.
As shown in FIGS. 3 and 4, in the locked state, the anchor element 1 can take a greater pivot angle than the opposite direction when it is abutted against the depression 73 of the pressure element by the shank. .
If the position of the rod 100 relative to the receiving part 6 needs to be corrected, the locking element 10 is rotated in reverse until the pressure on the rod is relieved and the rod becomes movable again. Since the slit ring 75 is held in the reduced width portion of the receiving part, the lock of the head 3 is maintained.
FIG. 27 shows a kit of bone anchoring devices having a coupling assembly with at least two rod receiving elements 8, 8 ′. The coupling assembly 5 comprising the receiving part 6, the pressure element 7 and the rod receiving element 8 is the same as described above and can have all the previously described variants. The rod receiving element 8 is a first rod receiving element and is sized and configured to receive the rod 100, which is a first rod having a first outer diameter. The rod receiving element 8 ′ is a second rod receiving element and is sized and configured to receive a second rod 100 ′ having a second diameter that is smaller than the first diameter of the first rod 100. . As a result, the rod support surfaces 83a ′, 83b ′ of the second rod receiving element 8 ′ may have a curvature corresponding to the second rod 100 ′ having the second diameter. Furthermore, the height of the upright legs 81a ', 81b' of the second rod receiving element 8 'is such that when the second rod 100' is inserted into the rod receiving element 8 ', the second rod 100' It is smaller than the height of the leg portions 81a and 81b of the first rod receiving element 8 so as to protrude slightly above the upper surface of the rod. The outer diameter and the inner diameter are the same as those of the first rod receiving element 8.
FIG. 28 shows a bone anchor device having a second rod receiving element 8 ′ and coupled to the second rod 100 ′. FIG. 29 shows a first bone anchoring device having a first rod receiving element 8 and coupled to the first rod 100. Since the height of the second rod receiving element 8 'is smaller than the height of the first rod receiving element 8, the locking element 10 is compared to using a first diameter rod 100 as illustrated in FIG. Thus, it must be screwed deeper between the legs as illustrated in FIG.
The kit allows a variety of rods with different diameters to be used with a single bone anchor device by selecting the appropriate rod receiving element. It is also possible to use one rod having areas of different diameters, for example a rod having a first diameter in one area and a second diameter smaller than the first diameter in another area. In this case, the first bone anchor device has a first rod receiving element with a greater height and the second bone anchor device has a second rod receiving element with a smaller height. The kit enables a variety of applications and provides the benefits of a modular system. For example, for bone anchor elements, any type of anchor element can be used and combined with the coupling assembly. These anchor elements are, for example, screws of different lengths, screws with different diameters, cannulated screws, screws with different thread forms, claws, hooks and the like. The head and the shank may be separate parts that can be connected to each other.
Furthermore, a kit of coupling assemblies with at least one further pressure element can be provided. The pressure element can be designed with no depression for an enlarged swivel angle, or two or more equally spaced to have several depressions, for example an swivel angle enlarged in two or more directions It is also possible to have an indented hole. By combining elements such as a pressure receiving element and a rod receiving element with a receiving part, the most suitable bone anchor device for a particular clinical application can be easily created.
With reference to FIG. 30, a second embodiment of the coupling assembly will be described. FIG. 30 shows a bone anchor device comprising an anchor element 1, a rod 100 and a locking element 10 as in the previous embodiment. The pressure element 700 differs from the pressure element of the previous embodiment in that it does not have a deformable part that cooperates with the rod receiving element and does not have an annular projection for being connected to the rod receiving element with an interference fit. . Instead, the pressure element 700 comprises a non-deformable annular projection 790 having a flat top surface 790a that cooperates with the flange-shaped conical widening projection 890 at the second end of the rod receiving element 800. As described in the previous embodiment, the hook-shaped protrusion 890 has a substantially inverted shape compared to the hook 79. The hook-shaped protrusion 890 is slightly flexible when engaged with the flat upper surface 790 a of the pressure element 700 when a load acts on the rod receiving element 800 via the locking element 10. Further, the rod receiving element 800 has a second inner projection 880 having a conical outer surface configured to engage the conical outer surface of the conical portion 78 of the pressure element 700 to temporarily hold the pressure element 700. At the end 8b. In this embodiment, the deformation occurs at the rod receiving element 800. The effect is the same as in the previously described embodiment, i.e. the rod receiving element can move slightly downwards when the locking element 10 is tightened, so that the first end face 7a of the pressure element moves upwards. Contacting the rod, the locking element 10 can engage the rod.
Various variations of the embodiments described above may be contemplated. The receiving part is not limited to the illustrated shape. The depression 61 may not have an accurate U shape. The bore 61 can have several areas with different widths, as long as an enlarged portion is provided that provides space for the expansion of the pressure element. Although the reduced width portion at the bottom of the receiving part is illustrated as being tapered, it may be circular. Furthermore, the outer surface of the cap-shaped part at the lower end of the pressure element can be circular. The combination of the receiving part and the pressure element surface that cooperate with each other to clamp the head can be tapered and tapered, tapered and circular, and vice versa. The pressure element may have a cylindrical portion instead of the conical portion 78.
The head and correspondingly the inner chamber and the outer surface of the cap-like part of the pressure element can have other shapes. For example, there may be two opposing flattened portions and the swivel connection may be unilateral.
Any kind of rod can be used. Although a rod having a smooth surface is illustrated, a roughened rod or a rod having a structure may be used. The rod may be a flexible rod.
While a number of different embodiments have been disclosed herein, it is recognized that different parts from different embodiments can be mixed and adapted to produce a variety of still other different embodiments.
5,5 'coupling assembly, 6a first end, 6b second end, 6 receiving part, 61 recess, 3 head, 64 aperture, 1 bone anchor, 61a, 61b receiving space, 7, 7', 7 ″, 7 ″ ′, 700 pressure element, 7a first end face, 7b second end, 71; 71 ′, 71 ″ flexible part, 8a first end face, 100, 100 ′ rod, 81 channel, 8b Second end face, 8, 8 ', 800 Rod receiving element, 79, 79', 790 part, 8b, 890 part
A coupling assembly for coupling a rod to a bone anchor element, said coupling assembly (5,5 ')
A receiving part (6) having a first end (6a), a second end (6b) and a central axis (C) extending through the first end (6a) and the second end (6b) )When,
A recess (61) for receiving the rod;
An accommodation space (61a, 61b) for accommodating the head (3) of the bone anchor (1), wherein the accommodation space (61a, 61b) is used to insert the head (3). 2 with an opening (64) at the end (6b), said coupling assembly (5, 5 ') further comprising
A pressure element (7, 7 ′, 7 ″, 7 ″ ′, 700) configured to be at least partially positioned in the receiving space (61a, 61b), the pressure element (7, 7 ′, 7 ″, 7 ″ ′, 700) are a first end having a first end surface (7a) and a second end facing the second end (6b) side of the receiving part (6) ( 7b), a central axis coaxial with the central axis (C) of the receiving part (6), and a flexible part (71; 71 ', 71 ") for tightening the inserted head (3) Said coupling assembly further comprising:
A first end with a first end face (8a), a channel (81) for inserting a rod (100, 100 ') adjacent to the first end, and the receiving part (6) A rod receiving element (8, 8 ', 800) which is a separate part with a second end having a second end face (8b) facing the second end (6b) side, The end face (8a) of the rod protrudes beyond the upper surface of the inserted rod (100, 100 '),
The first end face (7a) of the pressure element (7, 7 ', 7 ", 7"', 700) extends into the channel (81) of the rod receiving element (8, 8 '). Configured,
The pressure element (7, 7 ', 7 ", 7"', 700) comprises a part (79, 79 ', 790), said part being said pressure element (7, 7', 7 ", 7"). ', 700) to move the first end face (7a) axially further into the channel (81) of the rod receiving element (8, 8'). 7 ″, 7 ″ ′, 700) of said part (79, 79 ′, 790) and / or said rod receiving element (8, 8 ′, 800) of part (8b, 890) or both. A coupling assembly configured to cooperate with the portion (8b, 890) of the rod receiving element (8, 8 ', 800) under an axial load.
The rod receiving element (8, 8 ′, 800) has an opening (82) at the second end, and the first of the pressure elements (7, 7 ′, 7 ″, 7 ″ ′, 700). 1 end surface (7a) is formed by the surface portion (79, 79 ', 790) of the pressure element (7, 7', 7 ", 7" ', 700) or the rod receiving element (8, 8', 800). ) When any of the surface portions (8b, 890) are deformed, the rod receiving element (8, 8 ') such that the first end face (7a) of the pressure element forms a rod support. 2. The coupling assembly of claim 1, wherein the coupling assembly is configured to extend through the aperture (82) in the rod and into the channel (81) for the rod (100, 100 ′).
The receiving part (6) includes a reduced width portion (61b) on an inner wall near the opening (64), and the reduced width portion (61b) is formed of the pressure element (7, 7 ', 7 ", 7"). ', 700) in cooperation with the outer surface portion (71a) of the flexible portion (71) to tighten the inserted head (3) from the opening (64) in the head. 3. A coupling assembly according to claim 1 or 2 configured to prevent detachment.
The outer surface portion (71a) of the reduced width portion (61b) of the receiving part (6) and the flexible portion (71) of the pressure element (7, 7 ', 7 ", 7"', 700). The coupling assembly of claim 3, wherein both are tapered or circular, or one is tapered and the other is circular, or vice versa.
The pressure element (7, 7 ', 7 ", 7"', 700) is rotatable in the receiving part (6) when the inserted head (3) is not locked. Item 5. The coupling assembly according to any one of Items 1 to 4.
The flexible element (71) of the pressure element (7, 7 ', 7 ", 7"', 700) extends at least partially around the central axis (C), the pressure element (7, 7 ′, 7 ″, 7 ″ ′, 700) spaced from the second end (7b) and the second end (7b) of the pressure element from the second end (7b). A second slit (77, 77 ') extending into the first slit, wherein the first slit (74, 74') is spaced apart from the second slit (77, 77 '). 6. A coupling assembly according to any one of the preceding claims, extending and longer than the second slit.
The coupling assembly according to claim 6, wherein the first slit (74, 74 ') defines a slit ring (75) configured to laterally enclose the inserted head (3). .
The flexible part (71) of the pressure element (7, 7 ', 7 ", 7"', 700) comprises a recessed part (73) on the inner wall of the second end (7b), the recessed part Part (73) allows the head (3) inserted by the shank (2) to pivot in the direction of the recessed part (73) with a greater pivot angle than the opposite direction. 8. A coupling assembly according to any one of claims 7.
The pressure element (7, 7 ', 7 ", 7"', 700) comprises a substantially conical section or cylindrical second part (78), said second part (78) comprising: The first end having the first end surface (7a), and a coaxial conical or cylindrical bore (78a) extending from the first end into the first flexible portion (71); 9. A coupling assembly according to any one of the preceding claims, comprising:
Said part (79, 79 ', 790) of said pressure element (7, 7', 7 ", 7" ', 700) cooperating with said part (8b, 890) of said rod receiving element (8, 8') ) Is formed by protrusions (79, 79 ', 790) extending radially beyond the outer periphery of the first end (7a) of the pressure element. The coupling assembly as described.
11. The protrusion (79) is a substantially conical ridge extending away from the flexible portion (71) toward the first end of the pressure element (7). The coupling assembly as described.
The rod receiving element (8, 8 ', 800) comprises two spaced legs (81a, 81b), the free ends of the legs (81a, 81b) being the first end face (8a). 12. A coupling assembly according to any one of the preceding claims, forming a rod support surface (83a, 83b, 83a ', 83b').
The receiving part (6) or the rod receiving element (8, 8 ') is provided with a first holding projection (9), the first holding projection (9) of the head (3). In the insertion position of the rod receiving element (8, 8 ') enabling insertion into the pressure element (7), the rod receiving element (8, 8') passes through the first end (6a). And a first retaining recess on the other side of the receiving part (6) and the rod receiving element (8, 8 ') so as to be provided with a first stop for preventing the receiving part (6) from coming off. 13. A coupling assembly according to any one of claims 1 to 12, configured to cooperate with (85).
The rod receiving element (8, 8 ') or the receiving part (6) includes a second holding projection (86), and the second holding projection (86) includes the pressure element (7, 7). ′, 7 ″, 7 ″ ′, 700) is in a position to prevent removal of the inserted head, the rod receiving element (8,8 ′, 800) is the said part of the receiving part (6). A second holding on the other side of the receiving part (6) and the rod receiving element (8, 8 ') so that a second stop is provided to prevent movement towards the first end (6a) side. 14. A coupling assembly according to any one of the preceding claims, configured to cooperate with a recess (66).
The pressure element (7, 7 ', 7 ", 7"', 700) is located between the rod receiving element (8, 8 ', 800) and the second end (6b) of the receiving part. Insertion for the head (3) configured to be arranged in a receiving part (6) and connected to the rod receiving element (8, 8 ', 800) or the receiving part (6) 15. A coupling assembly according to any one of the preceding claims, configured to be temporarily held in position.
A bone anchor device,
A bone anchor element (1) having a shank (2) to be fastened to the bone and head (3);
A rod (100, 100 ');
A coupling element (5,5 '), the coupling element comprising:
An accommodation space (61a, 61b) for accommodating the head (3) of the bone anchor element (1), the accommodation space (61a, 61b) for inserting the head (3) Having an opening (64) at the second end (6b), the bone anchor device further comprising:
A pressure element (7, 7 ′, 7 ″, 7 ″ ′, 700) configured to be at least partially positioned in the receiving space (61a, 61b); and the pressure element (7, 7 ′, 7). ″, 7 ″ ′, 700) is a first end having a first end surface (7a) and a second end (7b) facing the second end (6b) side of the receiving part (6). ), A central axis coaxial with the central axis (C) of the receiving part (6), and flexible portions (71, 71 ′, 71 ″) for tightening the inserted head (3) The bone anchor device further comprises
A first end with a first end face (8a), a channel (81) for inserting a rod (100, 100 ') adjacent to the first end, and the receiving part (6) A rod receiving element (8, 8 ', 800) which is another part with a second end having a second end face (8b) facing the second end (6b) side,
The first end face (7a) of the pressure element (7, 7 ', 7 ", 7"', 700) extends into the channel (81) of the rod receiving element (8, 8 ', 800). Configured as
The bone anchor device further includes
A locking element (10) configured to advance radially into the receiving part (6) to lock the head (3) and the rod (100, 100 ');
The pressure element (7, 7 ', 7 ", 7"', 700) comprises a part (79, 79 ', 790), said part (79, 79', 790) comprising said pressure element (7, 79). 7 ′, 7 ″, 7 ″ ′) to further move the first end face (7a) in the axial direction into the channel (81) of the rod receiving element (8, 8 ′, 800). Either the part (79, 790) of the pressure element (7, 7 ', 7 ", 7"', 700) or the part (8b, 890) of the rod receiving element (8, 8 ', 800) is deformed. The portion (8b, 890) of the rod receiving element (8, 8 ') under an axial load applied to the rod receiving element (8, 8') by the locking element (10) A bone anchor device configured to cooperate with.
The rod receiving element (8, 8 ', 800) and the pressure element (7, 7', 7 ", 7" ', 700) are first loaded when the locking element (10) is tightened. The element (10) allows the head (3), not the rod, via the rod receiving element (8, 8 ', 800) and the pressure element (7, 7', 7 ", 7" ', 700). The bone anchor device according to claim 16, wherein a load is applied to the rod (100, 100 ') when applied to the rod only and then further tightening the locking element (10).
A bone anchor device according to claim 16 or 17, wherein the coupling assembly (5) is a coupling assembly according to any one of claims 1 to 15.
The rod receiving element (8, 8 ', 800) is a first rod having a channel having a first depth configured to receive a first rod (100) having a first rod diameter. A receiving element (8,800), said rod receiving element (8,8 ', 800) further configured to receive a second rod (100') having a second rod diameter, A kit comprising at least a second rod receiving element (8 ') having a channel (81') having a depth of, said first depth being different from said second depth.
JP2014148778A 2013-07-24 2014-07-22 Coupling assembly, bone anchor device and coupling assembly kit for coupling rod to bone anchor element Active JP6218689B2 (en)
US201361858026P true 2013-07-24 2013-07-24
EP13177919.1A EP2829243B1 (en) 2013-07-24 2013-07-24 Coupling assembly for coupling a rod to a bone anchoring element, kit of such a coupling assembly different rod receiving elements and bone anchoring device
US61/858,026 2013-07-24
EP13177919.1 2013-07-24
JP2015024135A true JP2015024135A (en) 2015-02-05
JP2015024135A5 JP2015024135A5 (en) 2016-08-18
JP6218689B2 JP6218689B2 (en) 2017-10-25
ID=48875568
JP2014148778A Active JP6218689B2 (en) 2013-07-24 2014-07-22 Coupling assembly, bone anchor device and coupling assembly kit for coupling rod to bone anchor element
US (2) US9439680B2 (en)
EP (1) EP2829243B1 (en)
JP (1) JP6218689B2 (en)
KR (1) KR20150012211A (en)
CN (1) CN104337565B (en)
ES (1) ES2611158T3 (en)
TW (1) TW201509368A (en)
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2013-07-24 ES ES13177919.1T patent/ES2611158T3/en active Active
2013-07-24 EP EP13177919.1A patent/EP2829243B1/en active Active
2014-07-21 CN CN201410345581.2A patent/CN104337565B/en active IP Right Grant
2014-07-21 TW TW103124857A patent/TW201509368A/en unknown
2014-07-22 JP JP2014148778A patent/JP6218689B2/en active Active
2014-07-23 KR KR1020140093593A patent/KR20150012211A/en not_active Application Discontinuation
2014-07-23 US US14/339,304 patent/US9439680B2/en active Active
2016-08-05 US US15/229,740 patent/US10022158B2/en active Active
KR20150012211A (en) 2015-02-03
CN104337565B (en) 2018-07-10
US10022158B2 (en) 2018-07-17
TW201509368A (en) 2015-03-16
ES2611158T3 (en) 2017-05-05
JP6218689B2 (en) 2017-10-25
US9439680B2 (en) 2016-09-13
EP2829243B1 (en) 2016-11-02
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