Source: https://patents.google.com/patent/CN104337565B/en
Timestamp: 2020-08-11 10:40:26
Document Index: 49003967

Matched Legal Cases: ['art 6', 'art 67', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 7', 'art 6', 'art 71', 'art 6', 'art 71', 'art 73', 'art 73', 'art 73', 'art 1', 'art 6', 'art 7', 'art 71', 'art 6', 'art 6', 'art 78', 'art 78', 'art 78', 'art 78', 'art 78', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 8', 'arts 78', 'art 6', 'art 6', 'art 7', 'art 6', 'art 6', 'art 73', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 6', 'art 10', 'art 6', 'art 73', 'art 6', 'art 8']

CN104337565B - Couple a rod to coupling assembly, external member and the bone anchoring device of bone anchoring element - Google Patents
Couple a rod to coupling assembly, external member and the bone anchoring device of bone anchoring element Download PDF
CN104337565B
CN104337565B CN201410345581.2A CN201410345581A CN104337565B CN 104337565 B CN104337565 B CN 104337565B CN 201410345581 A CN201410345581 A CN 201410345581A CN 104337565 B CN104337565 B CN 104337565B
CN201410345581.2A
CN104337565A (en
L·比德尔曼
B·菲舍尔
2014-07-21 Application filed by 比德尔曼技术有限责任两合公司 filed Critical 比德尔曼技术有限责任两合公司
2015-02-11 Publication of CN104337565A publication Critical patent/CN104337565A/en
2018-07-10 Publication of CN104337565B publication Critical patent/CN104337565B/en
238000004873 anchoring Methods 0.000 title claims abstract description 78
230000001808 coupling Effects 0.000 title claims abstract description 61
238000005859 coupling reaction Methods 0.000 title claims abstract description 61
238000003780 insertion Methods 0.000 claims description 29
A kind of coupling assembly for being used to couple a rod to bone anchoring element is provided, the coupling assembly includes：Receiving part；Pressure elements；Bar receiving element；The first end face of wherein described pressure elements is configured to extend into the channel of the bar receiving element；And wherein described pressure elements includes part, the part is configured to the part deformation for the part or bar receiving element for causing the pressure elements with the partial cooperative of the bar receiving element under axial loading, so as to further move to the first end face of the pressure elements in the axial direction in the channel of the bar receiving element.
Couple a rod to coupling assembly, external member and the bone anchoring device of bone anchoring element
The present invention relates to for coupling a rod to the coupling assembly of bone anchoring element, wherein coupling assembly includes receiving part Part has to receive the recess of bar and the accommodation space for accommodating the head of bone anchoring element, and also has clamping head The pressure elements in portion and the bar receiving element to cooperate with pressure elements.Pressure elements and bar receiving element are configured to such side Formula, which cooperates, causes the head that when anchoring element is inserted into coupling assembly, can clamp bone anchoring element first without fixed link simultaneously And it can then use single driving locking member fixed link.The invention further relates to including such coupling assembly and bone anchoring element Bone anchoring device.Moreover, it relates to such coupling assembly and allow use with different-diameter bar different bars The external member of receiving element.
US 2010/0160980A1 describe locking mechanism and the method that bone screws and bar are fixed to backbone.Locking mechanism Including main body, insertion piece, bar holder and fixing screws.Main body includes the bottom point for being configured to receive bone screws and insertion piece, but It is once insertion piece and bone screws engagement, prevent insertion piece and bone screws from passing through.Bar holder is between bar and insertion piece.
US 2013/0018428A1 descriptions include coupling element and the orthopedic fixator of bone fastener, and thus bone fastens Part can be in the bottom loaded to coupling element by the lumen pore in coupling element.
It remains a need for the coupling assembly for coupling a rod to bone anchoring element and improved bottom fills in all respects Load formula Polyaxial bone anchoring device.
Particularly, the object of the present invention is to provide a kind of for coupling a rod to the improved connection group of bone anchoring element Part, provide during operation improvement or easier operates and with widened application field.
The purpose is by coupling assembly, the coupling assembly of the bone anchoring device of the application and the application and not according to the application External member with bar receiving element is realized.The application further includes alternatively improved.
Coupling assembly has a kind of structure, and the structure, which allows sequentially to lock bone anchor with locking member using single driving, to be consolidated The head of element and bar.By tightening locking member, head is clamped first, while bar is still removable.When pressure elements and bar When being deformed between the cooperation part of receiving element, the fixed link after locking head.
Pressure elements can have the recess or sunk part at its inner wall, and the recess or sunk part allow bone anchor Gu element compares the angle for being pivoted to bigger in the opposite direction on the direction of recess or inner recess.As long as due to unlocked head Then pressure elements is just rotatable in coupling element in portion, therefore can select to expand angle of pivot in 360 ° around central axis Position.
Bar receiving element is engaged in this way with receiving part so that pressure elements is maintained at pre-locked position, once Pre-locked position described in being inserted into head prevents the removal on the head of bone anchoring element.In pre-locked position, the head of bone anchoring element The frictional force that portion can be applied to by pressure elements on head is kept.Frictional force can through applied force to overcome friction Power, the pivot on head is still possible.
According to an embodiment of the invention, pressure elements has the ring that cracks in its bottom end.Cracking ring can be in radial direction side Upwards expansion with allow bone anchoring element head insertion.Compared with only there is the pressure elements of longitudinal direction or coaxial slits, Head is introduced into necessary power in such flex section of pressure elements to reduce.This is further simplified perioperative behaviour Make.
Coupling assembly can be assembled with the bone anchoring element being already inserted into bone or vertebra in situ.Bar receiving element can be with It is designed to receive the bar of special diameter or diameter range.By providing the bar for including coupling assembly and being configured to receive different-diameter At least one addition rod receiving element external member, coupling assembly can be used together with the bar of different-diameter.This expands bone anchor It is fixedly mounted with the application field put.
Bone anchoring device can be a part for modular system, and the modular system includes can be about their handle Anchorage characteristics different (such as different thread types, screw pitch, different hollow shanks or the non-hollow handles of the length in portion, shank The diameter in portion) several bone anchoring elements and a coupling assembly.It can also will couple group by using different bar receiving elements Part is connected to the bar of different-diameter and further increases modularization.This make surgeon can between diversified implantation material into Row selection.Furthermore it is possible to reduce the cost of inventory.
The other feature and advantage of the present invention become more apparent upon the description for using attached drawing from each embodiment.In the accompanying drawings：
Fig. 1 shows the perspective exploded view of the first embodiment of bone anchoring device；
Fig. 2 shows the perspective view in the bone anchoring device of Fig. 1 of assembled state；
Fig. 3 shows the cross-sectional view of the bone anchoring device of the first embodiment according to Fig. 1 and 2, and the section is perpendicular to insertion Bar axis obtain；
Fig. 4 shows the cross-sectional view of the bone anchoring device of the first embodiment according to Fig. 1 and 2, and the section is at the center that includes It is obtained in the plane of the rod axis of axis and the bar being inserted into；
Fig. 5 shows the birds-eye perspective of receiving part according to first embodiment；
Fig. 6 shows the face upwarding view of the receiving part shown in Fig. 5；
Fig. 7 shows the vertical view of the receiving part shown in Figures 5 and 6；
Fig. 8 shows the cross-sectional view of the receiving part shown in the Figures 5 and 6 along the line A-A in Fig. 7；
Fig. 9 shows the birds-eye perspective of pressure elements according to first embodiment；
Figure 10 shows the face upwarding view of the pressure elements shown in Fig. 9；
Figure 11 shows the vertical view of the pressure elements shown in Fig. 9；
Figure 12 shows the cross-sectional view of the pressure elements of Fig. 9 and 10 along the line B-B in Figure 11；
Figure 13 shows the side view of the second embodiment of pressure elements；
Figure 14 shows the birds-eye perspective of the 3rd embodiment of pressure elements；
Figure 15 shows the birds-eye perspective of the fourth embodiment of pressure elements；
Figure 16 shows the birds-eye perspective of bar receiving element according to first embodiment；
Figure 17 shows the face upwarding view of the bar receiving element of Figure 16；
Figure 18 shows the vertical view of the bar receiving element shown in Figure 16 and 17；
Figure 19 shows the cross-sectional view of the bar receiving element of Figure 16 and 17 along the line D-D in Figure 18；
Figure 20 a show the cross-sectional view of the coupling assembly of bone anchoring device according to first embodiment, wherein pressure elements It is pre-assembled with bar receiving element and receiving part, and the wherein section is comprising central axis and perpendicular to the flat of rod axis It is obtained in face；
Figure 20 b show the amplifier section of Figure 20 a；
Figure 20 c are shown in the amplification of the cooperation between the receiving part in modification example, pressure elements and bar receiving element Cross-sectional view；
Figure 21 shows the cross-sectional view of the first step of assembling bone anchoring device according to first embodiment；
Figure 22 shows the cross-sectional view of the second step of assembling bone anchoring device according to first embodiment；
Figure 23 shows the cross-sectional view of the third step of assembling bone anchoring device according to first embodiment；
Figure 24 shows the horizontal stroke according to first embodiment that the head of bone anchoring element is clamped in the step in coupling assembly Sectional view；
Figure 25 is shown in locking head without having the bone anchoring device of insertion rod and locking member in the step of locking level Cross-sectional view；
There is the cross-sectional view of the bone anchoring device of insertion rod and locking member in the step of Figure 26 a are shown in locking level；
Figure 26 b show the amplifier section of the details of Figure 26 a；
Figure 27 shows coupling assembly and for using the saturating of the external member of the different bar receiving elements of the bar with different-diameter Depending on exploded view；
Figure 28 shows the bar of the insertion with first diameter and the bar with the bar for being suitable for receiving first diameter receives The cross-sectional view of the bone anchoring device of element；
Figure 29 shows the bone anchor of the bar with the bar and locking member that are inserted into and bar receiving element and with second diameter The cross-sectional view put is fixedly mounted with, the bar receiving element is suitble to the bar with the second diameter different from first diameter to be used together；
Figure 30 shows the cross-sectional view with the bar being inserted into and the bone anchoring device according to second embodiment of locking member, Wherein the section obtains in the central axis comprising coupling assembly and the plane perpendicular to rod axis.
In fig 1 and 2, bone anchoring device according to first embodiment includes the bone anchoring element 1 in the form of bone screws, The bone anchoring element has carries the shank 2 of bone thread and head 3 at least partly.Head 3 has outside the maximum for including ball The ball section shape outer surface part of diameter E and with for the flat free end of the recess 4 engaged with being screwed into tool.
Bone anchoring device further includes for receiving stabiliser bar 100 and for stabiliser bar 100 to be connected to bone anchoring element 1 Coupling assembly 5.Coupling assembly 5 includes the head 3 for receiving bone anchoring element 1 and the receiving part for receiving bar 100 Part 6 is configured to the pressure elements being arranged in receiving part 67 and is also arranged to the bar being arranged in receiving part 6 reception Element 8.Pressure elements 7 is used to head 3 being locked in receiving part 6.Bar receiving element 8 is used to receive bar 100 and be used for Pressure elements 7 is acted on locking head 3.At least one pin 9 can also be provided for cooperating with bar receiving element 8.
In addition, the locking member 10 in the form of inner bolt is provided, neutralized for bar 100 to be fixed on receiving part 6 In bar receiving element 8, and for exerting a force on pressure elements 7 head 3 being locked in reception via bar receiving element In component 6.
Receiving part 6 is explained referring now to Fig. 1 to 8.Receiving part 6 has as the first end 6a on top and conduct The opposite the second end 6b of bottom end, center axis of symmetry C pass through first end 6a and the second end 6b.Offer and central axis Lumen pore 61 coaxial C.In the first area of neighbouring first end 6a, receiving part 6 has generally U-shaped recess 62, the U-shaped Recess is with two free side legs 62a, the 62b extended towards the second end 6b bottoms oriented and towards first end 6a. The internal thread 63 to cooperate with locking member 10 is equipped in the region of leg 62a, 62b.The channel size formed by U-shaped recess 62 It determines into and receives bar 100 wherein to connect multiple bone anchoring devices.In the region of leg 62a, 62b substantially until by The height on axial direction that the bottom of U-shaped recess 62 limits, lumen pore 61 have the first internal diameter.Under leg 62a, 62b In region, lumen pore 61 has widened section 61a, and the diameter that the widened section has is more than the first internal diameter of first part. Between the second end 6b and widened section 61a, lumen pore 61 has with cone angle towards narrowed portion tapered the second end 6b 61b.Opening 64 is located at the second end 6b at, be open 64 diameter more than the maximum gauge E on head 3 to allow from receiving part 6 The second end 6b be inserted into head 3.Widened section 61a and narrowed portion 61b limits the appearance on the head 3 for bone anchoring element 1 Receive space.
Under internal thread 63 from first end 6a at a certain distance from circumference extend the first groove 66 be located at leg 62a, In the inner surface of each of 62b.First groove 66 with the holding part of bar receiving element 8 for engaging, as described below.Circumference Second groove 67 of extension can be located at the lower end of internal thread 63, be also used for engaging with the holding part of bar receiving element.
Lateral lumen pore 68 is equipped at one in leg 62a, 62b, the transverse direction lumen pore is being approximately perpendicular to central shaft The side of line M extends upward through leg, for example by leg 62b to receive pin 9.Lumen pore 68 is located substantially at the center of leg Place.Pin 9 preferably there is such length to cause once being inserted into lumen pore 68, and 9 short distance of pin extends in lumen pore 61 to provide For the locating part of bar receiving element 8, as described below.Pin 9 can be flushed with the outer surface of receiving part 6 upon insertion.
Particularly in Fig. 1 and 9 to 12 it can be seen that, pressure elements 7 have with free end face 7a first end and The second end 7b.When pressure elements 7 is arranged in receiving part 6, the second end 7b of pressure elements 7 is configured to than pressure member The first end of part 7 is closer to the second end 6b of receiving part 6.Pressure elements 7 has hat shape flexibility adjacent to the second end 7b Part 71, the hat shape flex section have the hollow interior chamber 72 of substantially ball section shape.Hat shape flex section 71 is in the second end 7b Place open wide with allow bone anchoring element 1 head 3 insertion.The outer surface of hat shape flex section 71 has neighbouring the second end 7b Narrowed portion 71a, the narrowed portion is tapered on the direction towards the second end 7b.Taper corresponds roughly to receiving part The taper of the narrowed portion 61b of part 6.Narrowed portion is transitioned into substantially ball section shape outer surface part 71b.In a circumferential position Place have neighbouring the second end inner recess 73 so that cap-like portion 71 wall at sunk part 73 ratio at rest part It is thinner.The width and depth of sunk part 73 allow the shank 2 of bone anchoring element to extend wherein.It is solid first when being inserted into bone anchor This allows the shank 2 of bone anchoring element 1 to be pivoted to more big angle than in the opposite direction on the direction of sunk part 73 during part 1. Therefore, angular side is pivoted to expand.Expansion for example can be about 10 °, however, depending on wall thickness and geometry can be pre- Expect other expansion angle of pivot.
Circumference is equipped at a certain distance from from the second end 7b and extends slit 74.When pressure elements 7 is arranged in receiving part 6 Slit 74 circumferentially extends along the plane for being approximately perpendicular to central axis C around the central axis C of receiving part 7 when middle.This Outside, slit 74 extends beyond 180 °, preferably more than 270 ° and more preferably beyond 340 ° around central axis C.So it borrows Help slit 74, the annular section at the second end is provided, the annular section is divided by forming the wall portion of connect band 76 It is integrally connected to the rest part of pressure elements 7.There is connect band 76 such length in a circumferential direction it is carried It is stably connected with for the rest part of annular section to pressure elements 7.In an end of circumference extension slit 74, have from the Two ends extend completely through the roughly vertical slit 77 that annular section 75 enters slit 74.By means of this, annular section is in circle It is cut through or divides in circumferential direction and form the ring 75 that cracks, the ring that cracks can be expanded and be shunk in radial directions.It is perpendicular The width of straight slit 77 is preferably less than the width of circumferential slit 74.The crack outer surface of ring 75 for taper and is formed towards pressure The constriction outer surface part 71a of the second end of power element 7.The positions and dimensions of ring 75 of cracking cause when from cap-like portion 71 When open end is inserted into the head 3 of bone anchoring element 1, the ring 75 that cracks expands so that the width of vertical slit 77 becomes larger, and works as When head 3 is fully inserted into hollow interior chamber 72, crack ring 75 on the direction towards shank 2 at maximum gauge E and Head 3 is surrounded under the maximum gauge E on head 3.
The maximum outside diameter of cap-like portion 71 be slightly less than the internal diameter of the first part of the lumen pore 61 of receiving part 6 and again smaller than The diameter of lumen pore in widened section 61a.Therefore, the ring 75 that cracks can expand in the widened section 61a of receiving part 6.
Conical portion 78, the conical portion court are equipped in the side of the cap-like portion 71 opposite with the second end 7b It is tapered and with allowing the conical lumen pore 78a close to the recess 4 on the head 3 of anchoring element 1 first end 7a.Circular cone There is such height and external dimensions it can be opened to pass through the bottom of bar receiving element 8 described below for shape part 78 Mouthful.Annular projection 78b is formed at conical section shape part 78 at a certain distance from from first end face 7a, the annular projection 78b With flat upper surfaces and inclined lower surface.The external peripheral surface 78c of protrusion 78b is substantial cylindrical.
There is circular cone to widen collar 79 in the transition part office of cap-like portion 71 and conical section shape part 78, the circular cone is widened Collar 79 widens towards first end face 7a and has flat upper surfaces 79a, and the flat upper surfaces form to receive with bar The fitting of the part cooperation of element 8.Conical collar 79 extends beyond first end face 7a and also surpasses in radial directions Go out protrusion 78b.Flat upper surfaces 79a is located axially under the first end face 7a of pressure elements 7.The structure of collar 79 And/or size so that the collar 79 when Axial Loads are in flat upper surfaces 79a is at least slightly deformable in the axial direction. In this case, collar extends to the outside.The deformation of collar can be flexible deformation.
Figure 13 shows the modification embodiment of pressure elements.Pressure elements 7 ' only with respect to the lateral slit in cap-like portion not Together.Cap-like portion 71 ' is narrow with being extended from roughly vertical slit 77 ' with spiral fashion at least partly around central axis Seam 74 '.In further modification, slit 77 ' is not roughly vertical, but an only part for spirality slit 74 '.
Another modification embodiment of pressure elements is shown in fig. 14.Pressure elements 7 " with according to Fig. 9 to 12 Difference lies in the shapes of conical collar for the pressure elements of embodiment.Conical collar is at a regular distance by slit 79b Break to form circumference collar portion 79 ', in an illustrated embodiment, form four collar portions 79 '.Using the quantity of slit with And the size and thickness of collar portion can obtain the specific flexibility of collar 79 '.
Describe the embodiment further changed of pressure elements in fig.15.Pressure elements 7 " ' with Fig. 9 to 12 shown in Difference lies in the designs of cap-like portion for pressure elements.Cap-like portion 71 " including equally spaced from multiple vertical slits 77”.Vertical slit 77 " towards the second end 7b open wide and towards pressure elements 7 " ' first end direction on by adding Wide circular portion 77a is closed.The quantity and size of slit are selected to obtain the specific flexibility of cap-like portion 71 ".In addition, according to The pressure elements 7 " of the embodiment ' without the annular projection 78b at conical section shape part 78.
It should be understood that many various combinations of the feature of each embodiment of pressure elements can combine to generate pressure elements Various other embodiments.
Referring now to Fig. 1 and Figure 16 to 19, bar receiving element 8 is independently of the component of pressure elements 7.It is substantially cylinder Shape component, the opposite the second end including the first end with free end face 8a and with free end face 8b.It is neighbouring to have The first end of first end face 8a has substantially rectangular recess 81, and a part for the substantially rectangular recess excision cylinder causes two It freely erects leg 81a, 81b to retain, the free end face of the leg forms first end face 8a.On the second end 8b, have and pass through Bar receiving element 8 extends to opening 82, circular opening in recess 81.The internal diameter of opening 82 is less than the first of pressure elements The outer diameter of end face 7a allows the first end face 7a of pressure elements to be extended in bar receiving element 8 by opening 82.In addition, it opens The internal diameter of mouth 82 and the cylindrical outer surface portion 78c of annular projection 78b being located at the conical section shape part 78 of pressure elements 7 Outer diameter compared to roughly the same or with undersize slightly.Therefore when conical portion 78 extends through bar receiving element 8 Opening 82 and protrusion 78 bar receiving elements of the cylindrical outer surface portion 78c in a manner of interference engagement at contact openings 82 Pressure elements 7 can be held togather with bar receiving element 8 during 8 peripheral inner surfaces.
Two fluted column section shape bar supporting projections 83a, 83b are located on the bottom of recess 81 between leg 81a and 81b Form the both sides of the lumen pore of opening 82.The radius of recess portion 83a, 83b is preferably selected such that it is suitable for spy to be used The radius of fixed pole.Bar supporting projections 83a, 83b can be detached by the groove 84 on every side of protrusion with leg 83a, 83b. The width of recess 81 causes bar 100 to may be received in recess 81.When in the recess 81 of 100 insertion rod receiving element 8 of bar, it It can rest in bar supporting projections 83a, 83b.The height of leg 81a, 81b to be placed into channel 81 when bar 100 and First end face 8a is slightly above on bar upper surface when resting in bar supporting projections 83a, 83b.
The internal diameter that the outer diameter of bar receiving element 8 is just slightly less than the lumen pore 61 of receiving part 6 so that bar receiving element 8 can be with It is moved in lumen pore 61 and is guided wherein.
Bar receiving element 8 is additionally included in the elongated recess 85 at each leg 81a, 81b, and the elongated recess is substantially from recessed Sunken 81 bottom is extended to from a certain distance from first end face 8a.Recess 85 extends completely through each leg in radial directions 81a、81b.Recess 85 has a width such that pin 9 can accommodate wherein.The bottom end 85a formation of each elongated recess 85 is used for Extend to the locating part of the pin 9 in respective recesses.Locating part prevents bar receiving element 8 when pressure elements 7 is in insertion position It is detached from by the first end 6a of receiving part 6.In addition, recess 85 can at least one pin 9 together be used as fixing device with Keep the alignment between the recess 62 of receiving part 6 and the channel 61 of bar receiving element 8.
The approximate center of the also each leg on each leg in the axial direction of bar receiving element 8 has with flat The circumference extension protrusion 86 of smooth upper surface 86a and inclined lower surface 86b, the gradient of the inclined lower surface cause when towards connecing Protrusion 86 can be moved to except groove 66,67 when the second end 6b of receipts component 6 pushes down on lever receiving element.Protrusion 86 Shape to can see in Figure 20 a and 25, and protrusion 86 is correspondingly mated into groove 66,67 and can use flat upper table Face 86a is against the upper limb of groove 66,67.
In addition, the cylindrical section being longitudinally extended that first end face 8a is extended to from the bottom of recess 81 is equipped on each leg Shape recess 87.
Bone anchoring device is wholly or partially by biocompatible material, such as biocompatible metal or metal alloy (example Such as titanium, stainless steel, Nitinol, such as Nitinol) or biocompatible plastic material, such as polyether-ether-ketone (PEEK) manufacture.
It, can pre-assembled coupling assembly with the following methods with reference to figure 20a to 20c.By bar receiving element 8 and pressure elements 7 It is inserted into receiving part 6.It is possible thereby to the lower openings 64 by receiving part 6 are inserted into pressure elements.It can be by slightly will Leg 81a, 81b press together until protrusion 86 is snapped into the second groove 67, and are inserted from the first end 6a of receiving part Enter bar receiving element 8.Pressure elements 7 is temporarily retained in shown first embodiment in figs. 20 a and 20b by interference engagement In bar receiving part 8.This passes through pressure of the inner surface at the opening 82 relative to bar receiving element 8 with mistake size slightly The cylindrical surface parts 78c of protrusion 78b on element 7 is realized.Prevent bar receiving element 8 logical during the insertion of pressure elements The first end 6a for crossing receiving part is detached from, the reason is that flat upper surfaces 86a is against the upper of the second groove 67 in receiving part 6 Edge.Pressure elements 7 is also at its uppermost position in fig-ure, and the flat surfaces 79a of middle shaft collar 79 is against the second end of bar receiving element 8 Face 8a.
By means of the arrangement, cap-like portion 71, particularly the ring 75 that cracks are located at such position, coaxial at the position Lumen pore 61 has the widened section 61a with maximum inner diameter.It can be seen that, the ring 75 that cracks has space at this in Figure 20 a Position expands.
In alternate embodiment as shown in fig. 20 c, wherein pressure elements does not have annular projection 78b, such as schemed Pressure elements 7 " shown in 15 ', pressure elements 7 does not connect by the interference engagement with bar receiving element 8 but via being bonded on It receives the snapping connection for outer most edge of the collar 79 of the third groove 69 at the inside of component and is maintained at insertion position.Third is recessed Slot 69 can be small and shallow, the reason is that it is only necessary to pressure elements is maintained at insertion position.
With reference to figures 21 to 26b, it will explain that coupling assembly 5 is used together with bone anchoring element 1 with bar 100.Such as institute in Figure 21 Show, first, suitable bone anchoring element 1 is implanted into bone.In figure 21, reference numeral 200 describes bone surface.Since bone anchor is consolidated Element 1 can be placed into without the coupling assembly being attached thereto in implant site, therefore convenient for the step of implantation bone anchoring element 1 Suddenly.Thereafter, bone anchoring element will be placed into the pressure elements 7 in insertion position and the coupling assembly 5 of bar receiving element 8 On 1 head 3.As shown in Figure 23, head 3 enters receiving part 6 and by the spacious of pressure elements 7 by lower openings 64 Open the cap-like portion 71 that the second end 7b enters pressure elements 7.When 3 contact element 7 of head crack ring 75 when, pressure member Part 7 is elongated until leg 81b with the second end face 8b and upward displacement bar receiving element of collar 79 against bar receiving element Recess 85 bottom 85a against the leg 62b for extending through receiving part 6 pin 9.Therefore, when being inserted into head, prevent bar from connecing Element 8 is received to be pushed out by the first end 6a of receiving part 6.
Pressure elements 7 is rotatable in receiving part.It may be positioned such that the sunk part for providing and expanding angle of pivot 73 are in specific position.For this purpose, alignment characteristics (not shown) can be provided, the alignment characteristics allow rotational pressure element to cause Sunk part 73 is in desired locations.
Head 3 is further introduced into cap-like portion 71 in the widened section 61a of the lumen pore 61 of receiving part 6 so that cracking Ring 75 expands.Then it is fully inserted into head 3.It is not expanded at connect band 76 due to cracking ring 75, the insertion on head 3 Can not be accurately coaxial with central axis C, but can slightly away central axis C or with central axis C misalignment.Pass through Head 3 is further introduced into, the top that the ring 75 that cracks may be expanded to utmostly and head 3 is allowed to enter hollow interior chamber 72 Point until head 3 is against the inner wall of room 72.Herein, the ring 75 that cracks can flexibly be shunk around head 3, such as institute in Figure 23 Show.
In fig 23 it can be seen that, when head 3 in upper area against the inner wall of cap-like portion 71 when, the ring 75 that cracks wraps Enclose the part under the region with maximum gauge E on head 3.In this state, the ring 75 that cracks frictionally clamps head 3, Bone anchoring element 1 relative to receiving part 6 is pivoted to and it is expected Angle Position and can be by pressure elements 7 and head Frictional fit between 3 remains there.
Finally, receiving part 6 and down-pressed pole receiving element 8 are pulled with instrument (not shown), as shown in Figure 24, will opened It stitches ring 75 to be pressed into narrowed portion 61b so that the narrowed portion of the conical outer surface 71a engaging receivers component 6 for the ring 75 that cracks 61b.Meanwhile protrusion 86 is snapped into the first groove 66 of receiving part 6.In this state, as shown in Figure 24, due to groove Locating part that 66 upper limb is provided and prevent bar receiving element 8 from moving up, the flat upper table of the protrusion 86 of bar receiving element 8 Face 86a is against the upper limb.Head 3 clamps via the cap-like portion 71 of pressure elements 7.Due to cracking, ring 75 is located at head 3 Between the narrowed portion 61b of receiving part, therefore 64 constriction of lower openings of receiving part 6 and head 3 is prevented under Portion's opening 64 is dropped out or is released.This is pre-locked state.
In Clinical practice, usually at least two bone anchoring devices are inserted into bone and are directed at receiving part.Due to bone The head 3 of anchoring element 1 is maintained at by frictional force in pressure elements, therefore can easily manual alignment receiving part 6 is simultaneously And its Angle Position is kept by the frictional force between head and pressure elements 7.Then, it can see in fig. 25, bar 100 It is inserted into receiving part 6 and 10 twist-on of locking member is between leg 62a, 62b of receiving part 6.Bar 100 is connect first by bar Receive support surface 83a, 83b support of element 8.The make-up of locking member moves down slightly bar receiving element 8, while locks member Part 10 only contacts the first end face 8a of bar receiving element 8 and exerts a force to first end face 8a.Power F is via second end face 8b It is transmitted on the planar upper end face 79a of the collar 79 of pressure elements 7 and 75 He of ring of cracking is transmitted on head 3 and from head 3 In receiving part, as shown in Figure 25.By means of this, head 3 is locked in its Angle Position relative to receiving part, and bar 100 Still it is moved on the direction of rod axis.
Referring now to Figure 26 a and Figure 26 b, it can be seen that, being advanced further for locking member 10 leads to second in Figure 26 b End face 8b is applied to the power F of bigger on the upper surface 79a of the collar 79 of pressure elements 7 so that collar 79 deforms slightly.By In this, bar receiving element 8 can be moved further downwards slightly so that locking member 10 is extruded on bar.Bar is consolidated as a result, It is fixed.In this state, power is transmitted to by the first end face 7a of bar and pressure elements 7 on head 3 and receiving part 6.
In the locked state, as shown in Figures 3 and 4, when the anchoring element sunk part 73 of shank abutting pressure elements When anchoring element 1 can than in the opposite direction be in bigger angle of pivot.
If necessary adjustable stem 100 is relative to the position of receiving part 6, back rotation locking member 10 is until acting on The pressure of bar is released and bar becomes freely moving again.Since the ring 75 that cracks is maintained at the narrowed portion of receiving part In, therefore keep the locking on head 3.
Figure 27 shows the external member of bone anchoring device and the coupling assembly including at least two bar receiving elements 8,8 '.Including connecing The coupling assembly 5 of receipts component 6, pressure elements 7 and bar receiving element 8 is identical with previously described and can have such as previous institute The all modifications stated.Bar receiving element 8 is the first bar receiving element and size determines into and be configured to receive bar 100, described Bar is the first bar for having first external diameter.Bar receiving element 8 ' is that size determines into and be configured to receive the second of the second bar 100 ' Bar receiving element, second bar have the second diameter of the first diameter less than the first bar 100.Therefore, the second bar receives member Bar support surface 83a ', the 83b ' of part 8 ' can be with the curvature corresponding to the second bar 100 ' with second diameter.In addition, the The setting leg 81a ' of two bar receiving elements 8 ', the height of 81b ' are less than the height of leg 81a, 81b of the first bar receiving element 8 Degree, so as to only protrude slightly into when in 100 ' insertion rod receiving element 8 ' of the second bar the upper boom surface of the second bar 100 ' it On.It is dimensionally identical with the first bar receiving element 8 on outer diameter and internal diameter.
Figure 28 shows bone anchoring device, and the bone anchoring device has the second bar receiving element 8 ' and is connected to the second bar 100’.Figure 29 shows the first bone anchoring device, and first bone anchoring device has the first bar receiving element 8 and is connected to the One bar 100.Since the height of the second bar receiving element 8 ' is less than the height of the first bar receiving element 8, with institute in such as Figure 27 Show that the situation using first diameter bar 100 is compared, locking member 10 must be screwed between leg it is deeper, as shown in Figure 27.
It, can be by the way that appropriate bar receiving element use be selected to have using single bone anchoring device by means of the external member The various bars of various diameters.The bar of the section with different-diameter can be even used, such as with the in a section The bar of one diameter and the second diameter less than first diameter in another section.In this case, the first bone anchoring device packet It includes with including receiving with the second bar compared with low height compared with the first bar receiving element of big height and the second bone anchoring device Element.External member is suitble to various the advantages of applying and providing modular system.For example, for bone anchoring element, it is all types of Anchoring element can be used and be combined with coupling assembly.These anchoring elements are such as different lengths, have different-diameter Screw, hollow screw, screw, nail, the hook etc. with different thread shapes.Head and shank can also be attachable only each other Vertical component.
Furthermore it is possible to provide the external member of coupling assembly and at least one other pressure elements.Pressure elements can design Into not for expand the recess of angle of pivot or can have it is several recess, for example two or more equidistant intervals recess with Just there is expansion angle of pivot in two or more directions.By combining such as element of pressure elements and bar receiving element With receiver, the most suitable bone anchoring device applied for specific clinical can be easily generated.
The second embodiment of coupling assembly is described with reference to figure 30.Figure 30 shows that have identical with preceding embodiment anchors The bone anchoring device of element 1, bar 100 and locking member 10.The difference of pressure elements 700 and the pressure elements in preceding embodiment It is the deformable segment that it does not cooperate with bar receiving element and does not have to connect it in a manner of interference engagement The annular projection of bar receiving element.Different from this, pressure elements 700 includes the non-deformable annular with flat upper surfaces 790a Protrusion 790, the non-deformable annular projection widen protrusion with the axis annular taper at the second end of bar receiving element 800 890 cooperations.Compared with collar 79 as in the previous embodiment, axis circular protrusion 890 has substantially opposite shape.When it During the flat upper surfaces 790a of activating pressure element 700 when load acts on bar receiving element 800 via locking member 10 it With small flexibility.In addition, bar receiving element 800 includes the inner process with conical external surface at its second end 8b 880, the inner process 880 is configured to the conical external surface of the conical portion 78 of activating pressure element 700 temporarily to protect Hold pressure elements 700.In this embodiment, deformation is happened at bar receiving element 800.In effect and previously described embodiment It is identical, that is, bar receiving element can move down slightly the first end face 7a so that pressure elements when tightening locking member 10 It moves up to contact bar and locking member 10 can be with engaging lever.
It is anticipated that the various modifications of previously described embodiment.Receiving part is not limited to precise shapes as depicted. Recess 61 need not have accurate U-shaped.Lumen pore 61 can have several sections of different in width, as long as the expansion for pressure elements The enlarged for providing space is provided.Narrowed portion at the bottom of receiving part is shown as taper, but may be It is round.Moreover, can be circle in the outer surface of the cap-like portion of the bottom end of pressure elements.It cooperates to clamp head The combination on the surface of receiving part and pressure elements can be taper and taper, taper and circle (vice versa) and it is round and It is round.Pressure elements can have the cylindrical part instead of conical portion 78.
The interior room of the cap-like portion of head and correspondingly pressure elements and outer surface can have another shape.It such as can be with In the presence of two opposite flattening sections for making to be pivotably attached on monoplane.
All types of bars can be used.Although bar of the display with smooth surface, can use coarse bar or tool Structured bar.Bar can also be flexibility bar.
Although there is disclosed herein many different embodiments, it will be appreciated that the different components from different embodiments It can be mixed and matched to generate various other other different embodiments.
1. a kind of for coupling a rod to the coupling assembly of bone anchoring element, the coupling assembly (5,5') includes：
Receiving part (6), the receiving part have first end (6a), the second end (6b) and extend through described first End (6a) and the central axis (C) of the second end (6b),
For receive the recess of bar (61) and
For accommodating the accommodation space of the head of bone anchor assembly (1) (3) (61a, 61b), the accommodation space (61a, 61b) has Opening (64) at the second end (6b) is to be inserted into the head (3)；
Pressure elements (7,7', 7 ", 7 " ', 700), the pressure elements is configured to be positioned at least partially at the accommodation space In (61a, 61b), the pressure elements (7,7', 7 ", 7 " ', 700) have and include the first end of first end face (7a) and face The second end (7b) of the second end (6b) of the receiving part (6), the center with the receiving part (6) The coaxial central axis of axis (C) and the flex section (71 for clamping insertion head (3)；71', 71 "),
Bar receiving element (8,8', 800), the bar receiving element are the individual components for including first end and the second end, institute The first end for stating bar receiving element includes first end face (8a) and the first end insertion rod for the neighbouring bar receiving element The channel (81) of (100,100'), the second end of the bar receiving element, which has, faces toward the described of the receiving part (6) The second end face (8b) of the second end (6b), wherein the first end face (8a) of the bar receiving element is projected into the bar of insertion On the upper surface of (100,100')；
Wherein the pressure elements (7,7', 7 ", 7 " ', 700) the first end face (7a) be configured to extend into the bar and receive In the channel (81) of element (8,8', 800)；And
Wherein the pressure elements (7,7', 7 ", 7 " ', 700) including part (79,79', 790), the part is configured in axis Cooperate to the part (890) of load effect lower with the bar receiving element (8,8', 800) so that the pressure elements (7,7', 7 ", 7 " ', 700) part (890) deformation of part (79,79', 790) or the bar receiving element (8,8', 800) or both All deform, so as to by the pressure elements (7,7', 7 ", 7 " ', 700) the first end face (7a) in the axial direction enterprising one In moved further to the channel (81) of the bar receiving element (8,8').
2. coupling assembly according to claim 1, (8,8', 800) have wherein the bar receiving element connects in the bar Receive the opening (82) at the second end of element and wherein the pressure elements (7,7', 7 ", 7 " ', 700) described the End face (7a) is configured to extend to the bar (100,100') by the opening (82) of the bar receiving element (8,8') The channel (81) in so that when the pressure elements (7,7', 7 ", 7 " ', 700) the part (79,79', 790) or The first end face (7a) shape of the pressure elements during part (890) deformation of the bar receiving element (8,8', 800) Into bar support.
3. coupling assembly according to claim 1 or 2, wherein the receiving part (6) is included in close to receiving part (6) The second end (6b) at the opening (64) inner wall at narrowed portion (61b), the narrowed portion is configured to and institute State pressure elements (7,7', 7 ", 7 " ', 700) the flex section outer surface part (71a) cooperation, with clamp be inserted into head Portion (3) and prevent the opening (64) at the second end (6b) by receiving part (6) from removing the head.
4. coupling assembly according to claim 3, wherein the narrowed portion (61b) of the receiving part (6) and institute State pressure elements (7,7', 7 ", 7 " ', 700) the flex section the outer surface part (71a) all for taper or circle, Either the narrowed portion be taper and the outer surface portion to be divided into circle or the narrowed portion be round and described appearance Face is divided into taper.
5. coupling assembly according to claim 1 or 2, wherein when unlocked insertion head (3) pressure elements (7, 7', 7 ", 7 " ', 700) it is rotatable in the receiving part (6).
6. coupling assembly according to claim 1 or 2, wherein the pressure elements (7,7', 7 ", 7 " ', 700) it is described Flex section have with the pressure elements (7,7', 7 ", 7 " ', 700) the second end (7b) be spaced apart, at least portion Point the second end of the ground around the first slit (74,74') of the central axis (C) extension and from the pressure elements (7b) extends to the second slit (77,77') in first slit, and wherein first slit (74,74') extension is remote From second slit (77,77') and longer than second slit.
7. coupling assembly according to claim 6, (74,74') limit the ring (75) that cracks wherein first slit, described The head (3) for transversely surrounding insertion is configured in the ring that cracks.
8. coupling assembly according to claim 1 or 2, wherein the pressure elements (7,7', 7 ", 7 " ', 700) it is described The second end (7b) that flex section is included in the pressure elements is in sunk part (73) at its inner wall, the recessed portion Point allow the head (3) being inserted into and shank (2) together on the direction of the sunk part (73) ratio in the opposite direction with more Big angle of pivot pivots.
9. coupling assembly according to claim 1 or 2, wherein the pressure elements (7,7', 7 ", 7 " ', 700) including big Cause part the having including pressure elements of the part (78) of conical section shape or cylinder, the substantially conical section shape or cylinder The first end of the first end face (7a) and the first end from the pressure elements are extended in the flex section It is coaxial cone or cylindrical bore (78a).
10. coupling assembly according to claim 1 or 2, wherein the part with the bar receiving element (8,8', 800) (890) cooperation the pressure elements (7,7', 7 ", 7 " ', 790) part (79,79', 790) by extending in radial directions Protrusion beyond the excircle of the first end (7a) of the pressure elements is formed.
11. coupling assembly according to claim 10, wherein the protrusion is far from the flex section and towards institute State the conical shaped collar of the first end extension of pressure elements (7).
12. coupling assembly according to claim 1 or 2, (8,8', 800) are including between two wherein the bar receiving element The leg (81a, 81b) separated and bar support surface (83a, 83b, 83a', 83b'), the free end of the leg form described The first end face (8a) of bar receiving element.
13. coupling assembly according to claim 1 or 2, wherein the receiving part (6) or the bar receiving element include First keep protrusion (9), it is described first holding protrusion be configured to it is another in the receiving part (6) and the bar receiving element First on one keeps recess (85) cooperation, so as to provide the first locating part, in the insertion position of the bar receiving element, First locating part prevents the bar receiving element to be moved to the reception by the first end (6a) of the receiving part Except component (6), wherein head (3) is allowed to be inserted into the pressure elements (7) in the insertion position of the bar receiving element.
14. coupling assembly according to claim 13, wherein the bar receiving element or the receiving part (6) include Two keep protrusions (86), it is described second holding protrusion be configured to it is another in the receiving part (6) and the bar receiving element On one second keep recess (66) cooperation, so as to provide the second locating part, when the pressure elements (7,7', 7 ", 7 " ', 700) when preventing the removal to be inserted into the position on head in it, second locating part prevents the bar receiving element (8,8', 800) The first end (6a) towards the receiving part (6) is mobile.
15. coupling assembly according to claim 1 or 2, wherein the pressure elements (7,7', 7 ", 7 " ', 700) be configured to The bar receiving element (8,8', 800) and the second end of the receiving part are arranged in the receiving part (6) Between (6b), and be configured to by the connection with the bar receiving element (8,8', 800) or with the receiving part (6) Head (3) are temporarily maintained at insertion position by connection.
16. a kind of bone anchoring device, including：
Bone anchoring element (1), the bone anchoring element have head (3) and for anchoring to the shank of bone (2)；
Bar (100,100')；
Coupling assembly (5,5'), the coupling assembly includes：
For receive the recess of the bar (61) and
For accommodating the accommodation space (61a, 61b) on the head (3) of the bone anchoring element (1), the accommodation space (61a, 61b) has the opening (64) at the second end (6b) to be inserted into the head (3)；
Pressure elements (7,7', 7 ", 7 " ', 700), the pressure elements is configured to be positioned at least partially at the accommodation space In (61a, 61b), the pressure elements (7,7', 7 ", 7 " ', 700) have and include the first end of first end face (7a) and face The second end (7b) of the second end (6b) of the receiving part (6), the center with the receiving part (6) The coaxial central axis of axis (C) and the flex section (71,71', 71 ") for clamping the head (3) being inserted into,
Bar receiving element (8,8', 800), the bar receiving element are the individual components for including first end and the second end, institute The first end for stating bar receiving element includes first end face (8a) and the first end insertion for the neighbouring bar receiving element The channel (81) of bar (100,100'), the second end of the bar receiving element have the institute for facing toward the receiving part (6) State the second end face (8b) of the second end (6b)；
Locking member (10), the locking member are configured to advance to lock in the receiving part (6) in the axial direction The fixed head (3) and the bar (100,100')；
Wherein the pressure elements (7,7', 7 ", 7 " ', 700) including part (79,79', 790), the pressure elements it is described Part be configured under the axial load on the bar receiving element (8,8', 800) is applied to by the locking member (10) with Part (890) cooperation of the bar receiving element (8,8', 800) so that the pressure elements (7,7', 7 ", 7 " ', 700) portion Part (890) deformation of point (79,790) or the bar receiving element (8,8', 800), so as to by the pressure elements (7,7', 7 ", 7 " ', 700) the first end face (7a) further moves to the bar receiving element (8,8', 800) in the axial direction The channel (81) in.
17. bone anchoring device according to claim 16, (8,8', 800) and the pressure wherein the bar receiving element Element (7,7', 7 ", 7 " ', 700) be arranged so that load is by the locking member when initially tightening the locking member (10) (10) via the bar receiving element (8,8', 800) and the pressure elements (7,7', 7 ", 7 " ', 700) be applied only to it is described It is not applied on the bar on head (3), and then load is applied to when further tightening the locking member (10) On the bar (100,100').
18. bone anchoring device according to claim 16 or 17, wherein the coupling assembly is according to claim 1 to 15 Any one of described in coupling assembly.
19. a kind of external member, including the coupling assembly according to any one of claim 1 to 15, wherein the bar receives Element (8,8', 800) includes the first bar receiving element, and the first bar receiving element is with being configured to receive with the first shank diameter Channel the first bar, that there is the first depth, and further include at least the second bar receiving element, the second bar receiving element tool Have and be configured to receive the channel the second bar, with the second depth with the second shank diameter, wherein first depth is different In second depth.
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