【０００１】[0001]
【発明の属する技術分野】本発明は、椎体に植設される
骨ねじ体と、脊柱に沿って配置されるロッドとを結合手
段によって固定するロッド固定装置に関するものであ
る。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a rod fixing device for fixing a bone screw body implanted in a vertebral body and a rod arranged along a spinal column by a connecting means.
【０００２】[0002]
【従来の技術】例えばヒトの脊柱の治療または曲がりを
矯整する等の目的を持って、椎体に骨ねじ体を植設し、
各骨ねじ体と脊柱に沿って配置されるロッドとを結合す
る手術が行われる。このような場合、従来は、特開平１
０−４３２０１に示すように、１本の骨ねじ体にコネク
タ組体を用いてロッドを固定する装置が使われてきた。2. Description of the Related Art For example, a bone screw body is implanted in a vertebral body for the purpose of treating a human spinal column or correcting bending.
Surgery is performed to connect each screw body with a rod placed along the spinal column. In such a case, conventionally, Japanese Patent Laid-Open No.
As shown in 0-43201, devices have been used to secure a rod using a connector assembly to a single bone screw body.
【０００３】従来の装置を使用する場合、１箇所では１
本の骨ねじ体が全荷重を負担するため、外力によって固
定部分が動き易く、所定の位置関係がくずれるおそれが
あった。また、ロッドの長さに等しい範囲にわたって背
部を切開する必要があり、手術にも治療にも長い時間が
かかる上、患者の身体に加わる負担も大きいものとな
る。When using a conventional device, one device is used at one place.
Since the bone screw body of the book bears the entire load, the fixed portion is likely to move due to an external force, and the predetermined positional relationship may be broken. In addition, it is necessary to make an incision in the back over a range equal to the length of the rod, which requires a long time for both surgery and treatment and also imposes a heavy burden on the patient's body.
【０００４】[0004]
【発明が解決しようとする課題】本発明は前記の点に着
目してなされたものであって、その課題は、施術後固定
部分が動きにくく、長期間、所定の位置関係が保持され
るようにする点にある。また本発明の他の課題はより小
規模な手術を実現し、患者の身体にかかる負担を軽減す
る点にある。SUMMARY OF THE INVENTION The present invention has been made in view of the above points, and it is an object of the present invention to fix a fixed portion after treatment so that a predetermined positional relationship is maintained for a long period of time. There is a point to. Another object of the present invention is to realize a smaller-scale operation and reduce the burden on the patient's body.
【０００５】[0005]
【課題を解決するための手段】前記の課題は骨ねじ体と
ロッドとの結合手段として、ロッドを固定するために骨
ねじ体と螺合可能な結合具を具備し、骨ねじ体の側方に
て椎体に植設される支えねじを、骨ねじ体に結合する
か、または骨ねじ体に固定される固定体に結合した構成
を有するロッド固定装置によって達成することができ
る。Means for Solving the Problems The above-mentioned problem is to provide a connecting means for connecting a bone screw body and a rod with a coupling tool that can be screwed into the bone screw body to fix the rod. the support screws to be implanted in the vertebral body in,to bind to bone screw body
Alternatively , it can be achieved by means of a rod fixing device having a construction connected to a fixing body which is fixed to the bone screw body.
【０００６】[0006]
【発明の実施の形態】本発明のロッド固定装置は、主と
して、ヒトの脊柱を構成する、複数の椎体を所定の位置
関係に保持する場合に適用される。BEST MODE FOR CARRYING OUT THE INVENTION The rod fixing device of the present invention is mainly applied when a plurality of vertebral bodies constituting a human spinal column are held in a predetermined positional relationship.
【０００７】このロッド固定装置は、椎体に植設される
骨ねじ体と、脊柱に沿って配置されるロッドと、それら
を結合するための結合手段とを有している。また本発明
のロッド固定装置は、椎体側面への施術、所謂前方脊柱
再建（前方固定）に適する。[0007] This rod fixing device has a bone screw body to be implanted in a vertebral body, a rod arranged along the spinal column, and a connecting means for connecting them. Further, the rod fixing device of the present invention is suitable for the operation on the lateral side of the vertebral body, so-called anterior spinal column reconstruction (anterior fixation).
【０００８】骨ねじ体は、椎体に尖端をねじ入れて植設
するためのおねじ部を有しており、かつまたロッドを受
け入れる部分即ち受け部を他端部に有している。ロッド
の受け部は、上方に開いた例えば略Ｕ字状の形態を有す
ることが望ましい。The bone screw body has an external thread portion for screwing and implanting a tip in a vertebral body, and also has a portion for receiving a rod, that is, a receiving portion at the other end portion. It is desirable that the receiving portion of the rod has a substantially U-shaped configuration that opens upward.
【０００９】結合手段は、ロッドを骨ねじ体に固定して
結合状態とするための手段である。そのため、骨ねじ体
は螺合可能な部分を受け部周辺に有しており、その部分
に結合手段が螺合可能とされる。結合手段において、骨
ねじ体の他端部におねじ部を設ける場合には、結合具は
１種のナットと考えて良い。その他の場合、結合具は単
独または複数の部材からなる。The connecting means is a means for fixing the rod to the bone screw body to bring it into a connected state. Therefore, the bone screw body has a screwable portion around the receiving portion, and the coupling means can be screwed to the portion. In the coupling means, when the threaded portion is provided on the other end of the bone screw body, the coupling tool may be considered as one type of nut. In other cases, the coupler comprises a single piece or multiple pieces.
【００１０】植設される骨ねじ体は、その側方にて椎体
に植設される支えねじによって支持される。支えねじ
は、従来１箇所１本の骨ねじだけであったロッド支持装
置を２本のねじで植立可能にするもので、これにより外
力、特に回転モーメントに対する抗力が高められ、かつ
また、骨組織自体が脆弱な場合にも必要な安定性が得ら
れるようになる。The implanted bone screw body is supported laterally by a support screw implanted in the vertebral body. The support screw enables the rod support device, which has conventionally been only one bone screw at one location, to be erected with two screws, thereby increasing the resistance to an external force, particularly a rotation moment, and The required stability will be obtained even if the organization itself is fragile.
【００１１】支えねじは、骨ねじ体に直接固定される
か、或いは骨ねじ体に取り付けた固定体という部材を介
して間接に固定される。骨ねじ体に直接固定される場合
にも、ロッドと共に結合子によって固定されることもあ
り、またロッドとは離れて結合子によって固定されるこ
ともある。また、ロッドとも結合子とも関係なく支えね
じを固定することもできる。The support screw is directly fixed to the bone screw body or indirectly fixed through a member called a fixing body attached to the bone screw body. Even when it is directly fixed to the bone screw body, it may be fixed by the connector together with the rod, or may be fixed by the connector apart from the rod. Further, the supporting screw can be fixed regardless of the rod and the connector.
【００１２】[0012]
【実施例】以下図面を参照して本発明をより詳細に説明
する。The present invention will be described in more detail with reference to the drawings.
【００１３】図１〜図４に実施例１を示す。図中、１０
は骨ねじ体であり、先端部側におねじ部１１を有し、他
端の頭部側にロッドを受け入れる受け部１２を有してい
る。受け部１２は略Ｕ字状を有し、上方に開いた所謂オ
ープンタイプである。Embodiment 1 is shown in FIGS. 10 in the figure
Is a bone screw body having a threaded portion 11 on the tip side and a receiving portion 12 for receiving a rod on the head side at the other end. The receiving portion 12 has a substantially U shape, and is a so-called open type that opens upward.
【００１４】受け部１２はおねじ部頭部にあって、両端
に立ち上がり部１３を有しており、立ち上がり部１３の
内面にめねじ部１４を設けている。このめねじ部１４は
結合手段１５の一部を構成する。実施例１の結合手段１
５は、骨ねじ体側の立ち上がり部１３、１３の外側に嵌
まる環状を有し、かつ上記めねじ部１４と同ねじ径のめ
ねじ部１４′を有する環状の結合具１６と、上記めねじ
部１４、１４′に螺合可能なおねじ部１７を有する結合
子１８とから成る。The receiving portion 12 is at the head of the male screw portion, has rising portions 13 at both ends, and an internal thread portion 14 is provided on the inner surface of the rising portion 13. The female screw portion 14 constitutes a part of the coupling means 15. Coupling means 1 of Example 1
Reference numeral 5 denotes an annular coupling member 16 having an annular shape fitted to the outside of the rising portions 13, 13 on the bone screw body side and having an internal thread portion 14 'having the same screw diameter as the internal thread portion 14, and the internal thread. And a connector 18 having a male screw portion 17 that can be screwed into the portions 14 and 14 '.
【００１５】骨ねじ体１０の受け部１２には、上方から
配置されるロッド２１の下に位置する支えねじ２０の取
り付け口１９が設けられている。この取り付け口１９に
は支えねじ２０の他端部が嵌まり、ロッド２１と接触可
能な状態にある。The receiving portion 12 of the bone screw body 10 is provided with a mounting port 19 for a support screw 20 located below a rod 21 arranged from above. The other end of the support screw 20 is fitted into the mounting port 19 and is in a state of being able to contact the rod 21.
【００１６】故に、椎体２２に骨ねじ体１０をねじ込み
によって植設し、取り付け口１９から支えねじ２０を同
様に椎体２２にねじ込みによって植設することで、図４
に示すように支えねじ２０により支持された骨ねじ体１
０の植設が可能となる。この手術は身体背面において植
設該当箇所だけを例えばＸ状に切り込むことにより行な
われるので、従来のようにロッド長さにわたって切開す
る必要がない。Therefore, the bone screw body 10 is implanted in the vertebral body 22 by screwing, and the support screw 20 is similarly implanted in the vertebral body 22 from the mounting port 19 as shown in FIG.
Bone screw body 1 supported by a supporting screw 20 as shown in FIG.
0 can be planted. Since this operation is performed by cutting, for example, an X-shaped portion on the rear surface of the body only in the area corresponding to the implantation, it is not necessary to make an incision over the length of the rod as in the conventional case.
【００１７】ロッド２１は、植設された骨ねじ体１０の
受け部１２に上方から差し込んで配置される。この作業
は、１箇所の切り込み口から内視鏡を先行させ血管等を
避けながらロッド２１を差し込むことにより行えるの
で、傷口を拡大しなくて良い。全ての骨ねじ体１０への
ロッド２１のセットが終わったなら、結合手段１５の環
状の結合具１６を立ち上がり部１３に嵌め、結合子１８
を用いてロッド２１を締め付け、固定を終える（図
４）。最後に傷口が縫合され、手術を完了する。The rod 21 is inserted into the receiving portion 12 of the implanted bone screw body 10 from above and arranged. Since this work can be performed by inserting the rod 21 while avoiding a blood vessel or the like by advancing the endoscope through one notch, it is not necessary to enlarge the wound. When the setting of the rods 21 on all the bone screw bodies 10 is completed, the annular coupling tool 16 of the coupling means 15 is fitted to the rising portion 13, and the connector 18 is attached.
The rod 21 is tightened by using to complete the fixing (FIG. 4). Finally, the wound is sutured to complete the surgery.
【００１８】次に図５〜図８により本発明の実施例２を
示す。実施例２では、結合手段１５の骨ねじ体側の要素
がおねじ部２３に変わっており、かつ支えねじ２０の取
り付け部２４が受け部内ではなく外に出ている点で実施
例１のものと相違している。これらの相違により、結合
手段１５の結合具２５は、上記おねじ部２３に螺合可能
なめねじ部２６を有するキャップ状のものとなり、ロッ
ド２１と支えねじ２０はその結合具２５の下端によって
螺合進行方向へ押さえ付けられるような状態とされる
（図８）。Next, a second embodiment of the present invention will be described with reference to FIGS. In the second embodiment, the element on the bone screw body side of the coupling means 15 is changed to the male screw portion 23, and the mounting portion 24 of the supporting screw 20 is out of the receiving portion rather than in the receiving portion. It's different. Due to these differences, the coupling tool 25 of the coupling means 15 becomes a cap-shaped having a female thread portion 26 that can be screwed into the male thread portion 23, and the rod 21 and the support screw 20 are screwed by the lower end of the coupling tool 25. It is brought into a state in which it is pressed in the advancing direction (FIG. 8).
【００１９】実施例２の他の構成は実施例１のものと同
様で良いので符号を各図に援用し、詳細な説明は省略す
る。実施例２の場合にも、まず骨ねじ体１０を椎体２２
に植設し、支えねじ２０を取り付け部２４より椎体２２
にねじ込んで植設する。ロッド２１は受け部１２に配置
するとともに、結合具２５により支えねじ２０とともに
固定することができる。The other structure of the second embodiment may be the same as that of the first embodiment, so the reference numerals are used in the respective drawings, and the detailed description will be omitted. Also in the case of the second embodiment, first, the bone screw body 10 is attached to the vertebral body 22.
The support screw 20 from the mounting portion 24 to the vertebral body 22.
Screw and plant. The rod 21 can be arranged in the receiving portion 12 and fixed with the supporting screw 20 by the coupling 25.
【００２０】よって骨ねじ体１０は図８に示すように支
えねじ２０によって支持された状態となる。また必要な
手術の規模、手術に要する時間、治癒時間等も実施例１
の場合と同様に短時間で済む。Therefore, the bone screw body 10 is in a state of being supported by the support screw 20 as shown in FIG. In addition, the scale of the required operation, the time required for the operation, the healing time, etc. were also set in Example 1.
It can be done in a short time as in the case of.
【００２１】さらに、実施例３について図９〜図１２を
参照して説明する。実施例３は、骨ねじ体１０から離れ
た場所に支えねじ２０を取り付ける例である。このため
に、結合子１８によって骨ねじ体１０に固定体２７を取
り付け、固定体２７を用いて支えねじ２０を取り付け
る。Further, a third embodiment will be described with reference to FIGS. The third embodiment is an example in which the support screw 20 is attached to a place apart from the bone screw body 10. For this purpose, the fixing body 27 is attached to the bone screw body 10 by the connector 18, and the supporting screw 20 is attached using the fixing body 27.
【００２２】この固定体２７は骨ねじ体１０の立ち上が
り部１３を嵌め込み可能な嵌め込み部２８を有し、嵌め
込むと段部２９の係合により受け止められる。立ち上が
り部１３と環状の結合具１６には実施例１と同様にめね
じ部１４、１４′があり、これらに螺合可能なおねじ部
１７を有する結合子１８により、結合具１６で固定体２
７の上面を加圧して固定体２７が骨ねじ部１０に固定さ
れる構成である。The fixed body 27 has a fitting portion 28 into which the rising portion 13 of the bone screw body 10 can be fitted, and when fitted, it is received by the engagement of the step portion 29. As in the first embodiment, the rising portion 13 and the annular coupling member 16 have internal thread portions 14 and 14 ', and a connector 18 having an external thread portion 17 that can be screwed into these is used to fix the fixing member 2 in the coupling member 16.
The fixing member 27 is fixed to the bone screw portion 10 by pressing the upper surface of the fixing member 27.
【００２３】支えねじ２０を取り付けるための嵌合孔３
０は、固定体２７の嵌め込み部２８から十分離れた場所
に設定されており、この嵌合孔３０はテーパー嵌合によ
って支えねじ２０と一体に結合される構造を持つ。図１
１、図１３参照。このテーパー嵌合は、例えば工具の柄
の部分に見られる円錐形と駆動側のテーパースリーブと
の嵌め合いによる固着と同様のテーパー面３１、３２を
有するものとする。Fitting hole 3 for attaching support screw 20
0 is set at a position sufficiently distant from the fitting portion 28 of the fixed body 27, and the fitting hole 30 has a structure that is integrally connected to the support screw 20 by taper fitting. Figure 1
1, see FIG. This taper fitting is assumed to have the same tapered surfaces 31 and 32 as the fixation by the fitting between the conical shape found in the handle portion of the tool and the taper sleeve on the driving side.
【００２４】故に実施例３の場合は、支えねじ２０の位
置を予め十分正確に決めておき、骨ねじ体１０に組み付
けられている固定体２７の嵌合孔３０へ差し込んで椎体
２２にねじ込んで行く過程の最後にテーパー嵌合が生じ
るようにする。他の構成及び手術の手順は実施例１のも
のと同様で良い。そこで構成については符号を援用して
詳細な説明を省略する。Therefore, in the case of the third embodiment, the position of the supporting screw 20 is determined sufficiently accurately in advance, and the supporting screw 20 is inserted into the fitting hole 30 of the fixing body 27 assembled to the bone screw body 10 and screwed into the vertebral body 22. Allow taper mating to occur at the end of the process. Other configurations and procedures of surgery may be similar to those of the first embodiment. Therefore, for the configuration, the reference numerals are used and the detailed description is omitted.
【００２５】以上の説明から明らかなように、本発明の
ロッド固定装置は、ロッド２１を胸椎、腰椎等の椎体２
２の前側において取り付ける、所謂前方固定において威
力を発揮する。これは図４、図８、図１３及び図１４か
らも理解される。なお実施例３のテーパー嵌合方式は実
施例２についても、また必要があれば実施例１について
も同様に実施することができる。As is clear from the above description, in the rod fixing device of the present invention, the rod 21 is connected to the vertebral body 2 such as the thoracic vertebra or the lumbar vertebra.
It exerts its power in so-called front fixing, which is attached on the front side of 2. This can also be understood from FIGS. 4, 8, 13 and 14. The taper fitting method of the third embodiment can be similarly applied to the second embodiment and, if necessary, to the first embodiment.
【００２６】本発明により、非常に強力な固定が得られ
るので、主となるロッド２１に対して、さらに補助ロッ
ド３３を平行的に設置することができる。この例は図１
４に示されており、主ロッド２１と補助ロッド３３とは
上下から挟み持つコネクター３４、３４を用いて結合す
る。鎖線で示すように主ロッド２１を曲げる場合もあり
得るが、どちらの場合でもコネクター３４、３４を用い
て、ねじで示された結合子３５によって結合し、両ロッ
ド２１、３３を一体化する。According to the present invention, a very strong fixation can be obtained, so that the auxiliary rod 33 can be installed parallel to the main rod 21. This example is shown in Figure 1.
4, the main rod 21 and the auxiliary rod 33 are connected to each other by using connectors 34 and 34 which are sandwiched from above and below. In some cases, the main rod 21 may be bent as shown by a chain line, but in both cases, the connectors 34, 34 are used to be joined by a connector 35 shown by a screw so that the two rods 21, 33 are integrated.
【００２７】例示したコネクター３４は骨ねじ体１０の
頭部側面に接して係合状態となる内隅３６を有し、骨ね
じ体頭部に押し付けた状態で固定されることにより、が
たがなく組み立てられる。故に補助ロッド３３による補
強構成がさらに信頼性を高いものとする。このため、支
えねじ２０による支持効果も１００％生かされ、従来の
ロッドによる椎体の固定などとは比較にならない効果が
得られる。The illustrated connector 34 has an inner corner 36 which comes into contact with the head side surface of the bone screw body 10 and is in an engaged state, and is fixed by being pressed against the head portion of the bone screw body. Can be assembled without. Therefore, the reinforcing structure by the auxiliary rod 33 makes the reliability higher. Therefore, the supporting effect of the supporting screw 20 is fully utilized, and an effect which is not comparable to the conventional fixation of the vertebral body by the rod is obtained.
【００２８】[0028]
【発明の効果】本発明は以上の如く構成されかつ作用す
るものであるから、手術の際に患部を２箇所において例
えばＸ状に切開することにより骨ねじ体と支えねじを有
する本装置を植設し、次いで内視鏡併用によりロッドを
一方の切開部から差し込み、両方の切開部に植設されて
いるねじ体に夫々固定することができるため、術後固定
部分が動くおそれがなく、長期間、所定の位置関係が保
持される効果があり、かつまたそのことが広範囲の切開
を不必要とし、より小規模な手術で達成可能とするの
で、患者にかかる身体的な負担も非常に軽減され、特に
骨ねじ体を補助する支えねじにより固定力が分散される
ため、椎体が脆弱な場合にも確実な固定を得ることがで
き、例えば骨粗鬆症の患者に対しても効果的な処方が可
能となる。EFFECTS OF THE INVENTION Since the present invention is constructed and operates as described above, the present apparatus having a bone screw body and a supporting screw is implanted by performing an incision, for example, in an X shape at two affected areas during an operation. Since the rod can be inserted through one of the incisions and then fixed to the screw bodies implanted in both incisions by using the endoscope together, there is no risk of the post-operative fixation part moving, The physical position of the patient is greatly reduced because it has the effect of maintaining a predetermined positional relationship for a certain period of time, and it also does not require extensive incision and can be achieved with smaller surgery. In particular, since the fixing force is dispersed by the support screw that assists the bone screw body, it is possible to obtain a reliable fixation even when the vertebral body is fragile. For example, an effective prescription for patients with osteoporosis is possible. It will be possible.
【図１】本発明に係るロッド固定装置の実施例１を示す
分解斜視図。FIG. 1 is an exploded perspective view showing a first embodiment of a rod fixing device according to the present invention.
【図２】（ａ）その止め具の平面図。（ｂ）同じく断面図。FIG. 2A is a plan view of the stopper.(B) Similarly, a sectional view.
【図３】（ａ）同じく骨ねじ体の平面図。（ｂ）同じく断面図。FIG. 3A is a plan view of the bone screw body.(B) Similarly, a sectional view.
【図４】実施例１のものの組み立て状態の断面図。FIG. 4 is a sectional view of the assembled state of the first embodiment.
【図５】本発明の実施例２を示す分解斜視図。FIG. 5 is an exploded perspective view showing a second embodiment of the present invention.
【図６】（ａ）その止め具の平面図。（ｂ）同じく断面図。FIG. 6A is a plan view of the stopper.(B) Similarly, a sectional view.
【図７】（ａ）同じく骨ねじ体の平面図。（ｂ）同じく断面図。FIG. 7A is a plan view of a bone screw body.(B) Similarly, a sectional view.
【図８】実施例２のものの組み立て状態の断面図。FIG. 8 is a sectional view of an assembled state of the second embodiment.
【図９】本発明の実施例３を示す分解斜視図。FIG. 9 is an exploded perspective view showing a third embodiment of the present invention.
【図１０】（ａ）その止め具の平面図。（ｂ）同じく断面図。FIG. 10 (a) is a plan view of the stopper.(B) Similarly, a sectional view.
【図１１】（ａ）同じく固定体の平面図。（ｂ）同じく断面図。FIG. 11A is a plan view of the fixed body.(B) Similarly, a sectional view.
【図１２】（ａ）骨ねじ体の平面図。（ｂ）同じく断面図。FIG. 12 (a) is a plan view of a bone screw body.(B) Similarly, a sectional view.
【図１３】実施例３のものの組み立て状態の断面図。FIG. 13 is a sectional view of an assembled state of the third embodiment.
【図１４】本発明の装置をヒトの脊柱の固定に適用した
例を示す正面図。FIG. 14 is a front view showing an example in which the device of the present invention is applied to fixation of a human spinal column.
─────────────────────────────────────────────────────フロントページの続き (56)参考文献 特開 平４−215750（ＪＰ，Ａ) 特開 平10−43201（ＪＰ，Ａ) 国際公開99／55246（ＷＯ，Ａ１) (58)調査した分野(Int.Cl.7，ＤＢ名) A61B 17/58 310─────────────────────────────────────────────────── ─── Continuation of the front page (56) References JP-A-4-215750 (JP, A) JP-A-10-43201 (JP, A) International Publication 99/55246 (WO, A1) (58) Fields investigated (Int.Cl.7 , DB name) A61B 17/58 310
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| JP2000067391AJP3383257B2 (en) | 2000-03-10 | 2000-03-10 | Rod fixing device |
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| JP2000067391AJP3383257B2 (en) | 2000-03-10 | 2000-03-10 | Rod fixing device |
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| JP2001252283A JP2001252283A (en) | 2001-09-18 |
| JP3383257B2true JP3383257B2 (en) | 2003-03-04 |
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| JP2000067391AExpired - Fee RelatedJP3383257B2 (en) | 2000-03-10 | 2000-03-10 | Rod fixing device |
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