WO2010092893A1 - Surgical operation system for lumbar interbody fusion and device for keeping lumbar interbody space to be used in surgical operation for lumbar interbody fusion - Google Patents

Abstract

Disclosed are a surgical operation system for lumbar interbody fusion provided with a lumbar interbody fusion device which has a simple constitution and a small size, shows excellent handling properties, high reliability and high economical efficiency, enables the performance of a lumbar interbody fusion treatment within a short time and thus largely reduces the burden on a patient; and a device for keeping lumbar interbody space to be used in a surgical operation for lumbar interbody fusion. A surgical operation system for lumbar interbody fusion that is to be mounted in between lumbar bodies (L1, L2) adjacent to each other to fuse the lumbar interbody, comprising: a main body (11-11i), wherein outer surface-engagement parts (15, 14-14c) engaging to the opposing faces (L1a, L2a) of the lumbar bodies are formed on the outer surface of a substantially hollow cylindrical or tapered hollow conical board having a bottom at the front end and fitting for the lumbar interbody, and one or more guide holes (17-17d, 18-18d) penetrating along the lumbar body direction from the deep part of a female screw (16), which is provided in the hollow inner face (16a) in the back end side, to the outer surface while spreading out in the open-fan shape are formed; and a device (10-10k) for fixing the lumbar interbody which comprises one or more pins (30-30k) engageably placed in the guide holes and press screws (40-40k, 50) interconnecting with the female screw (16) and pressing the back end of the pins due to the thrust force thereof, and the front end side of which is guided along the guide holes due to the press screws pressing the back end of the pins so that the device is inserted into the lumbar bodies.

Description

椎体間固定外科手術システム及び椎体間固定外科手術用椎体間スペース保持装置Interbody fusion surgery system and interbody fusion space holding device for interbody fusion surgery

　本発明は、２つの隣接する椎体（椎骨）の間の適正な間隔に修正された椎間板スペースに椎体間固定装置を嵌入して椎体間を固定する椎体間固定外科手術に関し、特に、短時間で容易に椎体間固定処置を行うことにより患者の負担、手術侵襲を著しく軽減する信頼性の高い椎体間固定外科手術システム及び椎体間固定外科手術用椎体間スペース保持装置に関する。The present invention relates to an interbody fusion surgery in which an interbody fusion device is inserted into an intervertebral disc space modified at an appropriate interval between two adjacent vertebral bodies (vertebrae) to fix the vertebral bodies. Highly reliable interbody fusion surgery system and interbody fusion space holding device for interbody fusion surgery that significantly reduce the burden on the patient and surgical invasion by performing the interbody fusion treatment easily in a short time About.

　近年増大する椎間板の辷り症やヘルニヤその他の欠陥あるいは老化などによる脊柱（脊椎）外科手術においては、損傷した椎間板に隣接する２つの椎体（椎骨）が適正な間隔に修正されて固定される。この多くの場合、環状体を除いて損傷した椎間板全体が切除され、脊柱に沿って伸びる神経に損傷を与えないように隣接する２つの椎体間の椎間板の空隙間すなわち椎間板スペースに何らかの支持体を配置する必要がある。In recent years, in spinal surgery (vertebral spine) due to disc stiffness, herniation and other defects or aging, the two vertebral bodies (vertebrae) adjacent to the damaged intervertebral disc are corrected and fixed at appropriate intervals. In many cases, the entire injured disc is excised except for the annulus and some support in the disc space or disc space between two adjacent vertebral bodies so as not to damage the nerves extending along the spinal column Need to be placed.

　早期の技術において、前記２つの隣接する椎体の固定を促進するために骨材料が前記椎体間の支持体として充填されるとともに、損傷した前記椎体を安定的に連結固定するプレート又はロッドが用いられている。しかし、前記椎体が骨材料により固定されると、前記椎体の安定性を維持するために椎体に固定されたプレートやロッドなどの固定部材はもはや余分な邪魔ものとなる。さらに、これらのロッド又はプレートを移植固定する外科手術は、全身麻酔により脊柱の背後から行われ、脊柱の背後には筋肉や脊柱に沿って伸びる神経が複雑に錯綜し、これらの筋肉を剥がしたり、神経を損傷しないようにしたりする処置が煩わしく長時間を要する大手術で、手術侵襲が過大であった。In early technology, plates or rods are filled with bone material as a support between the vertebral bodies to facilitate the fixation of the two adjacent vertebral bodies and stably connect and fix the damaged vertebral bodies Is used. However, when the vertebral body is fixed by bone material, a fixing member such as a plate or a rod fixed to the vertebral body to maintain the stability of the vertebral body is no longer an obstacle. In addition, the surgical procedure for implanting and fixing these rods or plates is performed from behind the spinal column by general anesthesia, and the muscles and nerves that extend along the spinal column are complicatedly complicated behind the spinal column, and these muscles can be peeled off. This is a major operation that takes a long time because it is troublesome to prevent the nerve from being damaged, and the surgical invasion is excessive.

　そこで近年、脊柱の背後から移植固定する前記ロッド又はプレートなどを用いず、背後側又は腹部側から損傷を受けた椎間板を切除し、完全な関節固定がなされるように、椎間板の空隙をなす隣接する椎体の間の安定性を維持するための移植部材すなわち椎体間固定装置を開発する多数の試みが特に欧米を中心になされている。Therefore, in recent years, without using the rod or plate to be transplanted and fixed from behind the spinal column, the damaged intervertebral disc is excised from the back side or the abdominal side, and adjacent to the intervertebral disc space so that complete joint fixation is achieved. Numerous attempts have been made, especially in the West, to develop implants or interbody fusion devices to maintain stability between vertebral bodies.

　このような椎体間固定装置として最近提案されている代表的な次の２つの例がある。以下の説明において、生体（人体）内の機材又は椎体に対して背側方向の部分を「先端」又は「先端部」、腹側方向の部分を「後端」又は「後部」と呼ぶ。There are two typical examples that have recently been proposed as such an interbody fusion device. In the following description, a portion in the dorsal direction with respect to the equipment or vertebral body in the living body (human body) is referred to as “tip” or “tip”, and a portion in the ventral direction is referred to as “rear end” or “rear”.

　図４８は従来の第１例の椎体間固定装置の斜視図、図４９は従来の第２例の椎体間固定装置が椎体間に固定された状態の縦断面図（主要部断面）である。FIG. 48 is a perspective view of the conventional interbody fusion device of the first example, and FIG. 49 is a longitudinal sectional view (main part cross section) of the conventional interbody fusion device of the second example fixed between the vertebral bodies. It is.

　第１例の椎体間固定装置１００は、図４８に示すように、前端１１３が開口又は閉鎖面で後端１１２が開口した先細り中空円錐台形の外面に雄ねじ１１８及び１１９が形成されるとともに、平行な切頭形側壁１２２が形成された本体１１１からなり、図示しない隣接する椎体間に雄ねじ１１８、１１９を介して螺入される構成である。（特許文献１参照）。As shown in FIG. 48, theinterbody fusion device 100 of the first example hasmale threads 118 and 119 formed on the outer surface of a tapered hollow frustoconical shape with thefront end 113 opened or closed and therear end 112 opened, It consists of amain body 111 formed with parallel truncatedside walls 122 and is screwed in between adjacent vertebral bodies (not shown) viamale screws 118 and 119. (See Patent Document 1).

　第２例の椎体間固定装置は、図４９に示すように、前端２５３が開口又は閉鎖面で後端２５６が一部開口した先細り中空円錐台形の外面に雄ねじ２５８及び２５９が形成されるとともに、平行な切頭形側壁２６２が形成された本体２５１と、後端２５６にそれぞれ隣接する上下の椎体Ｌ４、Ｌ５方向に末広がり状に傾斜して設けられた１対のねじ孔２６７、２６７に挿通され、椎体Ｌ４、Ｌ５内に傾斜して螺入する１対の骨ねじ２８０、２８０と、後端２５６の中心部に螺入して１対の骨ねじ２８０、２８０のヘッド２８１、２８３を共に押圧する止めねじ２８２とからなり、前記本体２５１が隣接する椎体Ｌ４、Ｌ５間に雄ねじ２５８、２５９を介して螺入された後に、１対の骨ねじ２８０、２８０が椎体Ｌ４、Ｌ５内に斜めに螺入する構成である。（特許文献２参照）。In the interbody fusion device of the second example, as shown in FIG. 49,male threads 258 and 259 are formed on the outer surface of a tapered hollow frustoconical shape in which thefront end 253 is open or closed and therear end 256 is partially open. , And a pair ofscrew holes 267 and 267 provided so as to incline in a divergent shape toward the upper and lower vertebral bodies L4 and L5 adjacent to therear end 256, respectively. A pair ofbone screws 280, 280 that are inserted and tilted into the vertebral bodies L4, L5, andheads 281, 283 of the pair ofbone screws 280, 280 that are screwed into the center of therear end 256. And a pair ofbone screws 280, 280 are inserted into the vertebral body L4, after themain body 251 is screwed between the adjacent vertebral bodies L4, L5 viamale screws 258, 259. Screw into L5 diagonally It is formed. (See Patent Document 2).

　前記第１例及び第２例の椎体間固定装置は、いずれも本体１１１、２５１が隣接する上下の椎体間に挿入することができる小型サイズのものであることから、特に前記従来のロッド又はプレート等を移植固定する大掛かりな背後側からの外科手術に比べて腹部側から腹腔鏡を用いて比較的短時間で容易に椎体間に移植固定することができ、患者の負担、手術侵襲を大幅に軽減する効果が期待できるものである。Since the interbody fusion devices of the first example and the second example are both of a small size that can be inserted between the upper and lower vertebral bodies to which themain bodies 111 and 251 are adjacent, particularly the conventional rod. Or it can be transplanted and fixed between vertebral bodies in a relatively short time using a laparoscope from the abdominal side compared with the large-scale surgical operation from the back side of transplanting and fixing plates, etc. Can be expected to significantly reduce.

　また、これらの椎体間固定装置を椎体間に移植固定する際に予め必要となる、２つの隣接する椎体（椎骨）間の適正な間隔を修正して椎間板スペースを保持するための椎体間スペース保持装置の最近提案されている代表的な次の例がある。In addition, a vertebra for maintaining an intervertebral disc space by correcting an appropriate interval between two adjacent vertebral bodies (vertebrae) required in advance when implanting and fixing these interbody fusion devices between vertebral bodies. There is a typical example of the recently proposed interbody space holding device.

　図５０は従来の代表的な椎体間スペース保持装置（腹側前弯症伸長外部スリーブ）の斜視図、図５１は図５０の椎体間スペース保持装置が椎体間に挿入された状態の側面図である。FIG. 50 is a perspective view of a conventional typical interbody space holding device (ventral ventral lordosis extending external sleeve), and FIG. 51 is a side view of the interbody space holding device of FIG. 50 inserted between the vertebral bodies. FIG.

　従来の代表的な椎体間スペース保持装置（腹側前弯症伸長外部スリーブ）３００は、図５０、５１に示すように、後端に筒状外部端３３０が設けられた長尺の中空管状部材３０２の先端３１０にいずれも連設され、隣接する椎体Ｌ６、Ｌ７の前面部にそれぞれ係合する複数の歯３１２、及び椎体Ｌ６、Ｌ７間の椎間板スペースの高さを回復するような高さを有するように１８０度の関係で対向し延長する一対の延長部３２０及び３２２が備えられた構成である。（特許文献３の図３１、３２等参照）。As shown in FIGS. 50 and 51, a conventional typical interbody space holding device (ventral anterior lordosis extending outer sleeve) 300 is a long hollow tubular member provided with a cylindricalouter end 330 at the rear end. 302 is connected to thedistal end 310 of 302, and a plurality ofteeth 312 respectively engaged with front surfaces of adjacent vertebral bodies L6 and L7, and a height that restores the height of the disc space between the vertebral bodies L6 and L7. In this configuration, a pair ofextension portions 320 and 322 are provided so as to face each other and extend at a 180-degree relationship. (See FIGS. 31 and 32 of Patent Document 3).

特開２００７－７５６３２号公報（優先権主張番号：ＵＳ０８／６０３，６７４）JP 2007-75632 A (priority claim number: US08 / 603, 674)特表２００２－５０１７８４号公報（優先権主張番号：ＵＳ０９／０１４，９０１）JP-T-2002-501784 (priority claim number: US09 / 014,901)特開２００４－２６７７８６号公報（優先権主張番号：ＵＳ０８／３９６，４１４）JP 2004-267786 A (priority claim number: US08 / 396,414)

　しかしながら、特許文献１（第１例）に記載の椎体間固定装置は、本体１１１が隣接する上下の椎体間に雄ねじ１１８、１１９を介して螺入されるだけの構成であることから、椎体間に挿入された後に椎体間の適正位置から後退あるいは回転して椎体間の適正間隔保持が崩れ易いという問題点がある。However, the interbody fusion device described in Patent Document 1 (first example) is configured such that themain body 111 is simply screwed between the adjacent upper and lower vertebral bodies viamale screws 118 and 119. After insertion between vertebral bodies, there is a problem that the proper spacing between the vertebral bodies tends to be lost by retreating or rotating from an appropriate position between the vertebral bodies.

　これに対して、特許文献２（第２例）に記載の椎体間固定装置は、本体２５１が隣接する椎体Ｌ４、Ｌ５間に雄ねじ２５８、２５９を介して螺入された後に、本体２５１の後端２５６に挿通された１対の骨ねじ２８０、２８０が椎体Ｌ４、Ｌ５内に斜めに螺入する構成であることから、前記特許文献１におけるような本体２５１の椎体間の適正位置からの後退や回転を防止することができるように改善されてはいる。しかし、後端２５６に隣接する上下の椎体Ｌ４、Ｌ５方向に末広がり状に傾斜して設けられたそれぞれ１対のねじ孔２６７、２６７、骨ねじ２８０、２８０及び１対の骨ねじ２８０、２８０の抜け止め用止めねじ２８２の構造並びにそれらの加工が煩雑であり、さらに、本体２５１及び止めねじ２８２とこれらの主軸に交叉する１対の骨ねじ２８０、２８０とのいわゆる３軸方向のねじ込み操作を腹腔鏡利用により狭隘な場所で行う必要があり、その操作性に劣るとともに腹腔鏡を用いて本体２５１、骨ねじ２８０、２８０及び止めねじ２８２をねじ込むための移植ドライバーの機構が複雑化し、コストも増大する等々の問題点がある。In contrast, in the interbody fusion device described in Patent Document 2 (second example), themain body 251 is screwed between the adjacent vertebral bodies L4 and L5 via themale screws 258 and 259, and then themain body 251. Since the pair ofbone screws 280 and 280 inserted through therear end 256 is obliquely screwed into the vertebral bodies L4 and L5, the appropriateness between the vertebral bodies of themain body 251 as inPatent Document 1 is described. It has been improved to prevent retraction and rotation from position. However, a pair ofscrew holes 267, 267, abone screw 280, 280, and a pair ofbone screws 280, 280, which are provided so as to incline toward the upper and lower vertebral bodies L4, L5 adjacent to therear end 256, respectively. The structure of thesetscrew 282 for retaining the screw and the processing thereof are complicated, and further, a so-called triaxial screwing operation of themain body 251 and thesetscrew 282 and a pair ofbone screws 280, 280 intersecting with these main shafts. And the use of a laparoscope in a confined place, the operability is inferior and the mechanism of the transplant driver for screwing themain body 251, thebone screws 280 and 280 and theset screw 282 using the laparoscope becomes complicated, and the cost There are also problems such as an increase.

　また、特許文献３に記載の椎体間スペース保持装置（腹側前弯症伸長外部スリーブ）３００は、人体腹部から隣接する椎体Ｌ６、Ｌ７の前面まで形成された内視鏡用腹腔部内のカニューレ（図示しない）内に先端から挿入して押し込むことにより中空管状部材３０２の先端３１０にそれぞれ設けられた一対の延長部３２０及び３２２を介して椎間板スペースの高さが回復されるとともに複数の歯３１２が椎体Ｌ６、Ｌ７の前面部に突刺して椎体Ｌ６、Ｌ７を固定するだけであることから、その後で前記椎体間固定装置を椎体Ｌ６、Ｌ７間に移植固定する際に比較的大きな外力が負荷される椎体Ｌ６、Ｌ７が複数の歯３１２との係合が離脱して後方又は左右の側方にずれ易いという欠点がある。In addition, the interbody space holding device (ventricular lordosis extension external sleeve) 300 described inPatent Document 3 is a cannula in the abdominal part for endoscope formed from the human abdomen to the front surface of the adjacent vertebral bodies L6 and L7. By inserting and pushing in (not shown) from the distal end, the height of the disc space is restored and a plurality ofteeth 312 is restored via a pair ofextensions 320 and 322 provided at thedistal end 310 of the hollowtubular member 302, respectively. Since the vertebral bodies L6 and L7 are merely pierced into the front portions of the vertebral bodies L6 and L7 to fix the vertebral bodies L6 and L7, the interbody fusion device is relatively fixed when transplanting and fixing the vertebral bodies L6 and L7. The vertebral bodies L6 and L7 to which a large external force is applied have a drawback in that the engagement with the plurality ofteeth 312 is disengaged and the vertebral bodies L6 and L7 are liable to shift backward or left and right.

　そこで、本発明は、上記従来技術の問題点に鑑みてなされたものであり、本発明の目的は、簡潔な構成で、全体構造の単純化、小型化が図られ、操作性、信頼性及び経済性に優れ、短時間で容易に椎体間固定処置を行うことにより患者の負担、手術侵襲を著しく軽減する椎体間固定装置を具備する椎体間固定外科手術システム及びその外科手術に必要な信頼性を向上させた椎体間固定外科手術用椎体間スペース保持装置を提供することにある。Therefore, the present invention has been made in view of the above-mentioned problems of the prior art, and an object of the present invention is to simplify and reduce the overall structure with a simple configuration, and to improve operability, reliability and Necessary for interbody fusion surgery system with an interbody fusion device that is highly economical and easily reduces the burden on the patient and surgical invasion by performing the interbody fusion treatment easily in a short time. It is an object of the present invention to provide an interbody space holding device for interbody fusion surgery with improved reliability.

　上記目的を達成するため、請求項１の発明の椎体間固定外科手術システムは、２つの隣接する椎体（椎骨）間の適正な間隔を保持するように形成された前端有底の略中空円筒又は先細り中空円錐台の外面に前記２つの椎体の対向面部に係合する外面係合部が形成されるとともに、後端側の中空内面に適宜深さの雌ねじが形成され、さらに該雌ねじの先端中空内面から前記椎体の対向面に向かって径方向に末広がりに傾斜し外面まで貫通する１つ又は複数の屈曲状又はストレート状のガイド孔が穿設された本体と、前記ガイド孔内に遊嵌収容され、先端側が前記各ガイド孔に沿って挿通された屈曲状又はストレート状の１本又は複数のピンと、前記本体の雌ねじに螺合しその軸方向推進力により、前記ピンの後端を押圧する押圧ねじとを備え、前記本体が前記椎体間の椎間板スペースに外面係合部を介して嵌入され固定された後に、前記ピンが前記本体の雌ねじに螺合された押圧ねじの軸方向推進力により後端を押圧されて先端側がガイド孔に沿って順次案内され前記椎体内に差込まれる椎体間固定装置を具備することを特徴とする。In order to achieve the above object, the interbody fusion surgical system according to the first aspect of the present invention is a generally hollow body with a front end that is formed so as to maintain an appropriate distance between two adjacent vertebral bodies (vertebrae). An outer surface engaging portion that engages with the opposing surface portions of the two vertebral bodies is formed on the outer surface of the cylindrical or tapered hollow truncated cone, and a female screw of an appropriate depth is formed on the hollow inner surface on the rear end side. A main body in which one or a plurality of bent or straight guide holes are formed so as to incline in the radial direction from the hollow inner surface of the distal end toward the opposing surface of the vertebral body and penetrate to the outer surface; One or a plurality of bent or straight pins inserted into the guide holes along the guide holes and screwed into the female screw of the main body, and the axial propulsive force of the rear ends of the pins. A pressing screw for pressing the end After the main body is inserted and fixed in the intervertebral disc space via the outer surface engaging portion, the rear end is pressed by the axial thrust of the pressing screw screwed into the female screw of the main body. And an intervertebral body fixing device in which the distal end side is sequentially guided along the guide hole and inserted into the vertebral body.

　請求項２の発明は、請求項１記載の椎体間固定外科手術システムであって、前記略中空円筒形本体の中央部外径が僅かに太めの太鼓状に形成されていることを特徴とする。The invention according toclaim 2 is the interbody fusion surgical system according toclaim 1, characterized in that the outer diameter of the central part of the substantially hollow cylindrical body is formed in a slightly thick drum shape. To do.

　請求項３の発明は、請求項１記載の椎体間固定外科手術システムであって、前記ピンは、丸や多角形を含む任意断面形状の中実又は中空の棒状体もしくは少なくとも先端側又は全長に亘り複数の薄板材又は丸や各種扁平型を含む任意断面形を有する線材が積層されて一体的な丸や多角形を含む任意断面形状の棒状積層体からなり、その先端部が尖鋭状に形成されていることを特徴とする。A third aspect of the present invention is the interbody fusion surgical system according to the first aspect, wherein the pin is a solid or hollow rod-shaped body having an arbitrary cross-sectional shape including a circle or a polygon, or at least the distal end side or the entire length. It consists of a rod-shaped laminated body with an arbitrary cross-sectional shape including a round or polygonal shape laminated with a plurality of thin plate materials or a wire having an arbitrary cross-sectional shape including circles and various flat shapes, and the tip thereof is sharp It is formed.

　請求項４の発明は、請求項１乃至請求項３のいずれか１項記載の椎体間固定外科手術システムであって、前記１本又は複数のピンは、後端に雌ねじ穴が設けられた基端部が個別又は一体的に形成され連設されており、前記押圧ねじは前記本体内への螺合方向とは逆方向の回転操作により前記本体内から、前記本体は前記椎体間への嵌入方向とは逆方向への回転及び／又は引抜き操作により椎体間からそれぞれ取外され体外に取出し可能であって、前記ピンが椎体内に差込まれた後で、前記押圧ねじが前記本体から引抜かれるとともに、前記ピンが基端部の雌ねじ穴に螺合する雄ねじ部を先端部に備えた引抜きドライバーにより前記椎体間から引抜かれ、前記本体と共に体外に取出されるように構成されていることを特徴とする。The invention according to claim 4 is the interbody fusion surgical system according to any one ofclaims 1 to 3, wherein the one or more pins are provided with a female screw hole at a rear end. Proximal end portions are individually or integrally formed and continuously provided, and the pressing screw is rotated from within the main body by a rotation operation in a direction opposite to the screwing direction into the main body, and the main body is moved between the vertebral bodies. Can be removed from between the vertebral bodies by being rotated in the direction opposite to the insertion direction and / or withdrawing operation, and removed from the body. After the pin is inserted into the vertebral body, The pin is pulled out from the main body, and the pin is pulled out from between the vertebral bodies by a pull-out driver having a male threaded portion that engages with a female threaded hole at the base end, and is taken out of the body together with the main body. It is characterized by being.

　請求項５の発明は、請求項４記載の椎体間固定外科手術システムであって、前記ピン基端部の雌ねじ穴内には、通常、後端部に被係合部を有する盲プラグが挿嵌されており、前記ピンの引抜き操作に先立ち、前記盲プラグが前記被係合部に係合する係合部を先端部に備えたドライバーにより前記雌ねじ穴内から取外され体外に取出し可能であることを特徴とする。A fifth aspect of the present invention is the interbody fusion surgical system according to the fourth aspect, wherein a blind plug having an engaged portion at the rear end is normally inserted into the female screw hole of the pin base end. Prior to the pulling-out operation of the pin, the blind plug can be removed from the female screw hole and taken out of the body by a screwdriver having an engaging portion that engages the engaged portion at the tip. It is characterized by that.

　請求項６の発明は、請求項１記載の椎体間固定外科手術システムであって、前記外面係合部は、雄ねじ状に形成されていることを特徴とする。A sixth aspect of the invention is the interbody fusion surgical system according to the first aspect, wherein the outer surface engaging portion is formed in a male screw shape.

　請求項７の発明は、請求項１記載の椎体間固定外科手術システムであって、前記外面係合部は、前記主軸に平行な複数のスプライン歯状に形成されていることを特徴とする。The invention according toclaim 7 is the interbody fusion surgical system according toclaim 1, wherein the outer surface engaging portion is formed in a plurality of spline teeth parallel to the main axis. .

　請求項８の発明は、請求項１記載の椎体間固定外科手術システムであって、前記外面係合部は、前記主軸に平行な複数の鋸歯状に形成されていることを特徴とする。The invention according toclaim 8 is the interbody fusion surgical system according toclaim 1, wherein the outer surface engaging portion is formed in a plurality of sawtooth shapes parallel to the main axis.

　請求項９の発明は、請求項１、請求項６乃至請求項８のいずれか１項記載の椎体間固定外科手術システムであって、前記外面係合部の軸方向先端及び径方向外面頭頂部が尖鋭刃状に形成されていることを特徴とする。The invention according to claim 9 is the interbody fusion surgical system according to any one ofclaims 1, 6 to 8, wherein the distal end in the axial direction and the outer radial head of the outer surface engaging portion are provided. The top is formed in the shape of a sharp blade.

　請求項１０の発明は、請求項１乃至請求項９のいずれか１項記載の椎体間固定外科手術システムであって、前記本体には、外面の上下・左右にそれぞれ連通する血管新生用開口部及び骨内部成長用開口部が複数設けられていることを特徴とする。A tenth aspect of the invention is the interbody fusion surgical system according to any one of the first to ninth aspects, wherein the main body has an angiogenesis opening communicating with the upper, lower, left, and right sides of the outer surface. And a plurality of openings for bone ingrowth.

　請求項１１の発明は、請求項１乃至請求項１０のいずれか１項記載の椎体間固定外科手術システムであって、前記押圧ねじの後端に前記本体の後端面の全面又は一部を覆うキャップが形成されていることを特徴とする。The invention ofclaim 11 is the interbody fusion surgical system according to any one ofclaims 1 to 10, wherein the whole or part of the rear end surface of the main body is attached to the rear end of the pressing screw. A covering cap is formed.

　請求項１２の発明は、請求項１１記載の椎体間固定外科手術システムであって、前記押圧ねじに遊嵌されるボスと、該ボスの外面に軸対称に立設され、前記押圧ねじのキャップ部にボス部後端面が押圧されて先端部が前記隣接する椎体の腹部側前面にそれぞれ係合固定される１対のアームと、からなる固定補強具をさらに備えることを特徴とする。The invention according toclaim 12 is the interbody fusion surgical system according toclaim 11, wherein the boss is loosely fitted to the pressing screw, and is erected on the outer surface of the boss so as to be axially symmetrical. It further comprises a fixing reinforcing tool comprising a pair of arms whose rear end surface is pressed against the cap portion and whose front end portion is engaged and fixed to the abdomen front surface of the adjacent vertebral body.

　請求項１３の発明は、請求項１乃至請求項１２のいずれか１項記載の椎体間固定外科手術システムであって、前記本体の雌ねじ内に遊嵌収容され、前記ピンの後端部に当接配置される摩擦板をさらに備えることを特徴とする。A thirteenth aspect of the invention is the interbody fusion surgical system according to any one of the first to twelfth aspects, wherein the interbody fusion surgical system is loosely accommodated in the female screw of the main body, and is attached to the rear end portion of the pin. It is further characterized by further including a friction plate disposed in contact therewith.

　請求項１４の発明は、請求項１３記載の椎体間固定外科手術システムであって、前記ピンの後端部が、少なくとも左右方向への移動が拘束されるように前記摩擦板に係合又は固定されていることを特徴とする。The invention according toclaim 14 is the interbody fusion surgical system according toclaim 13, wherein the rear end portion of the pin is engaged with the friction plate so as to be restrained from moving at least in the left-right direction. It is fixed.

　請求項１５の発明は、請求項１乃至請求項１４のいずれか１項記載の椎体間固定外科手術システムであって、前記椎体間固定装置は、腹部側から腹腔鏡を併用した椎体間固定外科手術により前記椎体間に固定されることを特徴とする。The invention ofclaim 15 is the interbody fusion surgery system according to any one ofclaims 1 to 14, wherein the interbody fusion device is a vertebral body using a laparoscope in combination from the abdominal side. It is fixed between the vertebral bodies by interstitial surgery.

　請求項１６の発明は、請求項１乃至請求項１５のいずれか１項記載の椎体間固定外科手術システムであって、後端に把持部が設けられた中空長尺のシャフト部の先端に前記椎体間固定装置の本体の後端部に形成された後端係合部に係合する先端係合部を有し、該先端係合部を前記本体の後端係合部に係合した状態で、生体腹部から前記椎体の前面まで形成された内視鏡用腹腔部内のカニューレ内に挿入されて前記２つの隣接する椎体間の適正な間隔を保持する椎体間スペース保持装置の中空部内に挿入され、前記本体を押圧又は／及び回転することにより前記椎体間に嵌入させる本体嵌入ドライバーを備えることを特徴とする。A sixteenth aspect of the present invention is the interbody fusion surgical system according to any one of the first to fifteenth aspects, wherein the distal end of a hollow long shaft portion having a grip portion at the rear end is provided. A front end engaging portion that engages with a rear end engaging portion formed at a rear end portion of the main body of the interbody fusion device, and the front end engaging portion is engaged with the rear end engaging portion of the main body; In this state, the interbody space holding device is inserted into a cannula in the abdominal cavity for endoscope formed from the living body abdomen to the front surface of the vertebral body to maintain an appropriate distance between the two adjacent vertebral bodies. And a main body insertion driver for inserting the main body between the vertebral bodies by pressing or / and rotating the main body.

　請求項１７の発明は、請求項１６記載の椎体間固定外科手術システムであって、前記本体嵌入ドライバーは、先端係合部が金属製で、シャフト部は高分子材料からなることを特徴とする。The invention according toclaim 17 is the interbody fusion surgery system according toclaim 16, wherein the main body insertion driver has a tip engaging portion made of metal and a shaft portion made of a polymer material. To do.

　請求項１８の発明は、請求項１６又は請求項１７記載の椎体間固定外科手術システムであって、後端に把持部が設けられた長尺のシャフト部の先端に前記椎体間固定装置の押圧ねじの後端部に形成された後端係合部に係合する先端係合部を有し、該先端係合部を前記押圧ねじの後端係合部に係合した状態で前記本体嵌入ドライバーの中空部内に挿入し、前記押圧ねじを前記椎間板スペースに固定された前記椎体間固定装置の本体の雌ねじ部に挿入して押圧しながら回転することにより前記雌ねじに螺合させその軸方向推進力により前記ピンの先端側をガイド孔に沿って順次案内させて前記椎体内に差込む押圧ねじドライバーをさらに備えることを特徴とする。The invention ofclaim 18 is the interbody fusion surgery system according to claim 16 orclaim 17, wherein the interbody fusion device is attached to the distal end of a long shaft portion provided with a grip portion at the rear end. A front end engaging portion that engages with a rear end engaging portion formed at a rear end portion of the pressing screw, and the front end engaging portion is engaged with the rear end engaging portion of the pressing screw in the state where the front end engaging portion is engaged. Inserted into the hollow part of the body-inserting driver, inserted into the female screw part of the main body of the interbody fusion device fixed to the intervertebral disc space and rotated while being pressed to be screwed into the female screw, and It is further characterized by further comprising a pressing screw driver that sequentially guides the distal end side of the pin along the guide hole by an axial driving force and inserts the pin into the vertebral body.

　請求項１９の発明は、請求項１８記載の椎体間固定外科手術システムであって、前記押圧ねじドライバーは、先端係合部が金属製で、シャフト部は高分子材料からなることを特徴とする。The invention according toclaim 19 is the interbody fusion surgical system according toclaim 18, wherein the pressing screw driver has a tip engaging portion made of metal and a shaft portion made of a polymer material. To do.

　請求項２０の発明の椎体間固定外科手術用椎体間スペース保持装置は、生体の椎体間固定外科手術の際に、２つの隣接する椎体（椎骨）間の適正な間隔を修正して椎間板スペースを保持するための装置であって、後端に把持部が設けられ、生体腹部側に設けられた内視鏡用腹腔部内のカニューレを介して前記椎体の前面近傍まで挿入される中空長尺の第１のシャフト部と、該第１のシャフト部の先端部に軸方向に沿って延設され、前記隣接する椎体の左右両側面をそれぞれ挟持し固定する固定爪が先端に連接されて前記椎体の直交面内で開閉可能な少なくとも各１対のクランプアームと、を有する椎体クランプ機構を備えることを特徴とする。The interbody space holding device for interbody fusion surgery according to the invention of claim 20 corrects an appropriate interval between two adjacent vertebral bodies (vertebrae) during a body interbody fusion surgery. A device for holding the intervertebral disc space, having a gripping portion at the rear end and being inserted to the vicinity of the front surface of the vertebral body via a cannula in the abdominal portion for endoscope provided on the living body abdominal portion side A hollow long first shaft portion and a fixing claw extending in the axial direction at the distal end portion of the first shaft portion and holding and fixing the left and right side surfaces of the adjacent vertebral bodies at the distal end And a vertebral body clamping mechanism having at least one pair of clamp arms connected to each other and capable of opening and closing in an orthogonal plane of the vertebral body.

　請求項２１の発明は、請求項２０記載の椎体間固定外科手術用椎体間スペース保持装置であって、前記椎体クランプ機構は、先端に前記各固定爪が連設され、後端部が前記第１のシャフト部の先端部に連設され、フリー状態では前記固定爪をそれぞれ前記椎体の直交面内で拡径して開くように屈曲されて弾支する弾性支持部を有する各１対のクランプアームと、前記第１のシャフト部に前進／後退自在に外嵌され、後端に把持部が設けられた中空長尺の第２のシャフト部の先端部が前進して前記弾性支持部を外側から押圧することにより前記各１対のクランプアームを縮径方向に閉じ、その先端部が前記弾性支持部から後退することにより前記各１対のクランプアームを拡径方向に開くクランプアーム開閉管と、を備えることを特徴とする。The invention ofclaim 21 is the interbody space holding device for interbody fusion surgery according to claim 20, wherein the vertebral body clamp mechanism has each of the fixing claws connected to the tip, and the rear end Each having an elastic support portion that is elastically supported by being bent so as to open and expand the fixed claw in the orthogonal plane of the vertebral body in a free state. A pair of clamp arms and a front end portion of a hollow long second shaft portion which is externally fitted to the first shaft portion so as to be movable forward / backward, and provided with a gripping portion at the rear end are advanced to the elasticity. Clamps that open the pair of clamp arms in the diameter increasing direction by closing the pair of clamp arms in the diameter reducing direction by pressing the support parts from the outside and retreating the tip parts from the elastic support parts. An arm opening and closing tube.

　請求項２２の発明は、請求項２０記載の椎体間固定外科手術用椎体間スペース保持装置であって、前記椎体クランプ機構は、先端に前記各固定爪が連設され、後端部が前記第１のシャフト部の先端部に第１の支持軸を介して前記椎体の直交面内で揺動自在に枢着された各１対のクランプアームと、前記第１のシャフト部に前進／後退自在に外嵌され、後端に把持部が設けられた中空長尺の第２のシャフト部と、前記各１対のクランプアームの中間部に第２の支持軸を介してそれぞれ一端部が揺動自在に枢着されるとともに、その各他端部が前記第２のシャフト部の先端部に第３の支持軸を介して揺動自在に枢着された各１対のリンク部材と、からなり、前記第２のシャフト部が前進又は後退することにより前記各１対のリンク部材を前記第３の支持軸を支点として反時計回り又は時計回りに揺動させて前記各１対のクランプアームを前記椎体の直交面内で前記第１の支持軸を支点として縮径方向に閉じ又は拡径方向に開くトグル機構を構成することを特徴とする。The invention ofclaim 22 is the interbody space holding device for interbody fusion surgery according to claim 20, wherein the vertebral body clamping mechanism has the respective fixing claws connected to the tip, and the rear end portion. A pair of clamp arms pivotally attached to the distal end portion of the first shaft portion via a first support shaft in an orthogonal plane of the vertebral body, and the first shaft portion A hollow long second shaft portion that is externally fitted so as to be able to move forward / backward and a grip portion is provided at the rear end, and an intermediate portion of each of the pair of clamp arms via a second support shaft. Each pair of link members is pivotably attached to each other, and each other end thereof is pivotally attached to the tip of the second shaft portion via a third support shaft. And each of the pair of link members is moved in the first shaft by the second shaft portion moving forward or backward. The pair of clamp arms are closed or expanded in the diameter-reducing direction with the first support shaft as a fulcrum within the orthogonal plane of the vertebral body by swinging counterclockwise or clockwise around the support shaft as a fulcrum. A toggle mechanism that opens in a direction is configured.

　請求項２３の発明は、請求項２０乃至請求項２２のいずれか１項記載の椎体間固定外科手術用椎体間スペース保持装置であって、前記固定爪の椎体挟持面に前記椎体の側面に突刺可能な複数の尖鋭突起を有することを特徴とする。The invention ofclaim 23 is the interbody space holding device for interbody fusion surgery according to any one of claims 20 to 22, wherein the vertebral body is provided on the vertebral body clamping surface of the fixation claw. It has a plurality of sharp protrusions that can be pierced on the side surface.

　請求項２４の発明の椎体間固定外科手術用椎体間スペース保持装置は、生体の椎体間固定外科手術の際に、２つの隣接する椎体（椎骨）間の適正な間隔を修正して椎間板スペースを保持するための装置であって、後端に把持部が設けられ、生体腹部側に設けられた内視鏡用腹腔部内のカニューレを介して前記椎体の前面近傍まで挿入される中空長尺の第１のシャフト部と、該第１のシャフト部の外面に軸方向に沿って回転自在に延設され、先端に形成されたねじ部が前記隣接する椎体の一方又は両方の前面部に羅入し固定される長尺固定ねじ部材と、前記第１のシャフト部の先端部に突設され、前記隣接する椎体の一方又は両方の前面部に突刺可能な一つ又は複数の針状突起と、を備えることを特徴とする。The interbody space holding device for interbody fusion surgery according to the invention ofclaim 24 corrects an appropriate distance between two adjacent vertebral bodies (vertebrae) during a body interbody fusion surgery. A device for holding the intervertebral disc space, having a gripping portion at the rear end and being inserted to the vicinity of the front surface of the vertebral body via a cannula in the abdominal portion for endoscope provided on the living body abdominal portion side A hollow elongate first shaft portion and a threaded portion that extends in the axial direction on the outer surface of the first shaft portion so as to be rotatable in the axial direction, are formed on one or both of the adjacent vertebral bodies. A long fixing screw member that is inserted into and fixed to the front surface portion, and one or a plurality that can project into the front surface portion of one or both of the adjacent vertebral bodies protruding from the distal end portion of the first shaft portion A needle-like protrusion.

　請求項２５の発明は、請求項２０乃至請求項２４のいずれか１項記載の椎体間固定外科手術用椎体間スペース保持装置であって、前記第１のシャフト部の先端部に前記椎体の外径より僅かに狭い間隔で前記椎体間スペースに向かい軸方向に沿って対向状態で延設され、先端部から前記椎間板スペース内に挿入されることにより前記隣接する椎体を適正な間隔に修正して保持するような外形形状に形成された少なくとも１対のスペーサーをさらに備えることを特徴とする。A twenty-fifth aspect of the invention is the interbody space holding device for interbody fusion surgery according to any one of the twenty-second to twenty-fourth aspects, wherein the vertebra is provided at a distal end portion of the first shaft portion. The adjacent vertebral bodies are properly connected to each other by extending into the intervertebral space at an interval slightly narrower than the outer diameter of the body and facing the intervertebral space in the axial direction. It is further characterized by further comprising at least one pair of spacers formed in an outer shape so as to be corrected and held at intervals.

　請求項１の発明によれば、椎体間固定装置が隣接する椎体間の適正な間隔に適合する外形を有する小型であり、本体を椎体間に嵌入し固定した後に押圧ねじを本体の雌ねじにねじ込むだけで押圧されたピンの先端側がガイド孔に沿って案内され椎体内に差込まれて固定される簡潔な構成であることから、腹腔鏡を利用して全て本体主軸方向からの一軸による押圧又は／及びねじ込み操作のみで容易に短時間で椎体間固定処置を行うことができる。これにより、従来の椎体間固定外科手術に比べて手術規模が大幅に縮小化されるとともに手術時間及び回復期間とも大幅に短縮できるため、患者や医者を含む医療スタッフの肉体及び精神的負担、患者の手術侵襲さらには経済的負担を著しく軽減することができる。According to the first aspect of the present invention, the interbody fusion device is a small size having an outer shape adapted to an appropriate distance between adjacent vertebral bodies, and after the main body is inserted and fixed between the vertebral bodies, the pressing screw is attached to the main body. Since the tip side of the pin that is pressed just by screwing into the female screw is guided along the guide hole and is inserted into the vertebral body and fixed, all from the main axis direction using the laparoscope The interbody fusion treatment can be easily performed in a short time by only pressing or / and screwing by one axis. As a result, the operation scale can be greatly reduced as compared to conventional interbody fusion surgery, and the operation time and recovery period can be greatly reduced, so that the physical and mental burden of medical staff including patients and doctors, The surgical invasion and even the economic burden on the patient can be significantly reduced.

　これに加えて、椎体内に差込まれ固定されたピンにより椎体間固定装置本体の椎体間の適正位置からの後退や回転を防止することができ、椎体間固定の信頼性が確保されるとともに、椎体間固定構造及び全て本体主軸方向の一軸による押圧又は／及びねじ込みだけの操作が上記の如く大幅に簡潔化及びコンパクト化され、操作性及び経済性とも一層優れた椎体間固定装置を具備した椎体間固定外科手術システムを提供することができる等々の効果がある。In addition, the pin inserted and fixed in the vertebral body can prevent the intervertebral body fixing device body from retreating or rotating from the appropriate position between the vertebral bodies. The vertebral body is secured, and the interbody fixing structure and the operation of only pressing or / and screwing by one axis in the main body axis direction are greatly simplified and compacted as described above, and the operability and economy are further excellent. It is possible to provide an interbody fusion surgical system having an interbody fusion device, and so on.

　請求項２の発明によれば、請求項１の発明と同様な効果を有するのに加えて、略中空円筒形本体の中央部外径が僅かに太めの太鼓状に形成されているため、椎体間にしっかり固定される効果がある。According to the invention ofclaim 2, in addition to having the same effect as that of the invention ofclaim 1, the outer diameter of the central part of the substantially hollow cylindrical main body is formed in a slightly thick drum shape. There is an effect that is firmly fixed between the bodies.

　請求項３の発明によれば、請求項１の発明と同様な効果を有するのに加えて、ピンの先端部が尖鋭に形成されているため、椎体内部にピンを容易に差込み易くする。また、中空の棒状体あるいは棒状積層体からなるピンは、比較的容易に屈曲など変形し易く先端部側が本体のガイド孔に沿ってスムースに案内される操作性が向上するとともに、特に棒状積層体からなるピンは任意の形状に形成することが容易で設計の自由度が向上する等々の効果がある。According to the invention ofclaim 3, in addition to having the same effect as that of the invention ofclaim 1, since the tip of the pin is formed sharply, the pin can be easily inserted into the vertebral body. Further, a pin made of a hollow rod-like body or a rod-like laminated body is relatively easy to bend and deform, and the tip side is smoothly guided along the guide hole of the main body. Such a pin can be easily formed into an arbitrary shape, and the design flexibility is improved.

　請求項４の発明によれば、請求項１乃至請求項３のいずれか１項の発明と同様な効果を有するのに加えて、ピンを介して椎体間に椎体間固定装置が固定された後で万一感染症などによる不慮の化膿障害が発生した場合に、ピンを基端部の雌ねじ穴に螺合する引抜きドライバーにより椎体間から引抜いて本体と共に体外に取出し、椎体間に抗生剤や必要に応じて骨材等を詰める等の処置を施してから再度椎体間固定装置を椎体間に固定し直すことができる効果がある。According to the invention of claim 4, in addition to having the same effect as the invention of any one ofclaims 1 to 3, the interbody fusion device is fixed between the vertebral bodies via the pins. In the unlikely event that an unexpected suppuration disorder occurs due to infection, etc., the pin is pulled out from between the vertebral bodies by a pulling screwdriver that is screwed into the female screw hole at the proximal end, and is taken out of the body together with the main body. There is an effect that the interbody fusion device can be re-fixed between the vertebral bodies again after a treatment such as filling with an antibiotic or an aggregate if necessary.

　請求項５の発明によれば、請求項４の発明と同様な効果を有するのに加えて、ピン基端部の雌ねじ穴内に取出し可能に挿嵌された盲プラグにより雌ねじ穴内に椎体間内髄液や骨形成材料等の異物の侵入を防止することから、ピンの引抜き操作に先立ち前記盲プラグを雌ねじ穴内から取外してピン基端部の雌ねじ穴に引抜きドライバーを容易に素早くねじ込み易くすることができるので椎体間固定装置取外しの操作性を向上させる効果がある。According to the invention of claim 5, in addition to having the same effect as that of the invention of claim 4, the intervertebral body is inserted into the female screw hole by the blind plug that is removably inserted into the female screw hole of the pin base end portion. To prevent intrusion of foreign matter such as cerebrospinal fluid and bone forming material, remove the blind plug from the female screw hole before pulling out the pin, and make it easy to quickly and easily screw the extraction screwdriver into the female screw hole at the base end of the pin. Therefore, the operability of removing the interbody fusion device can be improved.

　請求項６の発明によれば、請求項１の発明と同様な効果を有するのに加えて、外面係合部が雄ねじ状に形成されているため、本体を椎体間に容易にねじ込み固定することができる効果がある。According to the invention of claim 6, in addition to having the same effect as that of the invention ofclaim 1, since the outer surface engaging portion is formed in a male screw shape, the main body can be easily screwed and fixed between the vertebral bodies. There is an effect that can.

　請求項７の発明によれば、請求項１の発明と同様な効果を有するのに加えて、外面係合部が前記主軸に平行な複数のスプライン歯状に形成されているため、本体を押圧するだけで短時間に椎体間に嵌入し固定することができ、操作性が向上する効果がある。According to the invention ofclaim 7, in addition to having the same effect as that of the invention ofclaim 1, the outer surface engaging portion is formed in a plurality of spline teeth parallel to the main shaft, so that the main body is pressed. It is possible to insert and fix between vertebral bodies in a short time just by doing so, and there is an effect of improving operability.

　請求項８の発明によれば、請求項１の発明と同様な効果を有するのに加えて、外面係合部が前記主軸に平行な複数の鋸歯状に形成されているため、本体を押圧するだけで短時間に椎体間に容易に嵌入して抜け止めによる固定の信頼性が確保できる効果がある。According to the invention ofclaim 8, in addition to having the same effect as that of the invention ofclaim 1, the outer surface engaging portion is formed in a plurality of sawtooth shapes parallel to the main shaft, so that the main body is pressed. It has the effect of being able to easily fit between vertebral bodies in a short time and to secure the fixing reliability by retaining.

　請求項９の発明によれば、請求項１、請求項６乃至請求項８のいずれか１項の発明と同様な効果を有するのに加えて、外面係合部の軸方向先端及び径方向外面頭頂部が尖鋭刃状に形成されているため、椎体間への本体の嵌入が一層容易化する効果がある。According to the invention of claim 9, in addition to having the same effects as those of the invention of any one ofclaims 1, 6 to 8, the axial front end and the radial outer surface of the outer surface engaging portion Since the top of the head is formed in a sharp blade shape, there is an effect of facilitating the insertion of the main body between the vertebral bodies.

　請求項１０の発明によれば、請求項１乃至請求項９のいずれか１項の発明と同様な効果を有するのに加えて、本体外面の上下・左右に複数の血管新生用開口部及び骨内部成長用開口部が設けられていることから、これらの開口部は椎体を囲繞する高度に血管化された組織に接触して血管新生を促進する通路となるとともに、隣接する椎体対向面部からの出血が骨内部組織成長を容易にする通路となって椎体間固定を促進する効果がある。このように、椎体間が一旦固定されると、椎体間固定装置自体が骨塊の一種の固定体となる。According to the invention ofclaim 10, in addition to having the same effect as that of any one ofclaims 1 to 9, a plurality of angiogenesis openings and bones are provided on the upper, lower, left and right sides of the outer surface of the main body. Due to the presence of ingrowth openings, these openings contact the highly vascularized tissue surrounding the vertebral body to provide a path for promoting angiogenesis and adjacent vertebral body facing surfaces The bleeding from the vertebrae serves as a passage for facilitating bone internal tissue growth and has an effect of promoting interbody fusion. As described above, once the intervertebral body is fixed, the interbody fixing device itself becomes a kind of fixed body of the bone mass.

　請求項１１の発明によれば、請求項１乃至請求項１０のいずれか１項の発明と同様な効果を有するのに加えて、押圧ねじの後端に形成されたキャップが本体の後端の全面又は一部を覆うことにより、固定を促進する骨形態発生タンパク質を液体担体内に含有し本体中空内部に充填される骨形成材料等の流出を防止する効果がある。また、キャップは、最終的に本体の後端面又は椎体の前面部に当接することにより、本体内部への押圧ねじのねじ込み代を規定するとともに押圧ねじの逆回転摩擦力がアップするため押圧ねじの逆回転防止効果及びこれによるピンの抜け止め効果をも有する。According to the invention ofclaim 11, in addition to having the same effect as the invention of any one ofclaims 1 to 10, the cap formed at the rear end of the pressing screw is provided at the rear end of the main body. By covering the entire surface or a part thereof, there is an effect of preventing the outflow of the bone-forming material or the like that contains the bone morphogenic protein that promotes fixation in the liquid carrier and is filled in the hollow body. In addition, since the cap finally comes into contact with the rear end surface of the main body or the front surface of the vertebral body, the screw screw is allowed to be screwed into the main body, and the reverse rotational frictional force of the press screw is increased. This also has the effect of preventing the reverse rotation of the pin and preventing the pin from coming off.

　請求項１２の発明によれば、請求項１１の発明と同様な効果を有するのに加えて、押圧ねじに遊嵌された固定補強具の１対のアーム先端部が押圧ねじのキャップ部にボス部後端面が押圧されることにより隣接する椎体の前面部にそれぞれ係合し固定されるため、椎体間固定が強固に補強されるとともに、アームの剛性反力により押圧ねじの逆回転摩擦力がアップするため押圧ねじの逆回転防止効果及びこれによるピンの抜け止め効果を一層向上させることができる。According to the invention ofclaim 12, in addition to having the same effect as that of the invention ofclaim 11, a pair of arm tip portions of the fixing reinforcement loosely fitted to the press screw are bosses on the cap portion of the press screw. When the rear end surface of each part is pressed and engaged with the front part of the adjacent vertebral body, the interbody fixation is strongly reinforced, and the reverse rotation friction of the pressing screw is caused by the arm's rigid reaction force. Since the force increases, the effect of preventing the reverse rotation of the pressing screw and the effect of preventing the pin from coming off can be further improved.

　請求項１３の発明によれば、請求項１乃至請求項１２のいずれか１項の発明と同様な効果を有するのに加えて、押圧ねじのピン後端部押圧が摩擦板を介して行われることから、押圧ねじとピン後端面側との摩擦力が減少するとともにピン後端面が直接押圧ねじの回転力を受けないためピン後端部が本体雌ねじ部内面との隙間の多い左右方向に押し遣られようとする力を殆ど受けることなく、押圧ねじも小トルクでねじ込まれるとともにピンがスムースに前方に押し込まれることが可能になる効果がある。According to the invention ofclaim 13, in addition to having the same effect as the invention of any one ofclaims 1 to 12, the pin rear end pressing of the pressing screw is performed via the friction plate. Therefore, the frictional force between the pressing screw and the pin rear end surface is reduced and the pin rear end surface is not directly subjected to the rotational force of the pressing screw. There is an effect that the pressing screw can be screwed with a small torque and the pin can be smoothly pushed forward without almost receiving the force to be sent.

　請求項１４の発明によれば、請求項１３の発明と同様な効果を有するのに加えて、ピンの後端部が少なくとも左右方向への移動が拘束されるように摩擦板に係合又は固定されているため、特にピン後端部が本体雌ねじ部内面との隙間の多い左右方向に押し遣られようとする力を殆ど受けることなく、押圧ねじも小トルクで雌ねじ内にねじ込まれるとともにピンがスムースに押し込まれることができる信頼性の向上効果がある。According to the fourteenth aspect of the invention, in addition to having the same effect as the thirteenth aspect of the invention, the rear end portion of the pin is engaged or fixed to the friction plate so that the movement in the left-right direction is restricted at least. Therefore, the push screw is screwed into the female screw with a small torque and the pin is not subjected to almost any force that tends to be pushed in the left-right direction with a large gap with the inner surface of the female screw part. There is an effect of improving reliability that can be pushed in smoothly.

　請求項１５の発明によれば、請求項１乃至請求項１４のいずれか１項の発明と同様な効果を有するのに加えて、前記椎体間固定装置が腹部側から腹腔鏡を併用した椎体間固定外科手術により椎体間に固定されることから、従来の背中側からの椎体間固定外科手術に比べて手術規模が大幅に縮小化されるとともに手術時間及び回復期間とも大幅に短縮できるため、患者や医者を含む医療スタッフの肉体及び精神的負担、患者の手術侵襲さらには経済的負担を著しく軽減することが可能となる効果がある。According to the invention ofclaim 15, in addition to having the same effect as the invention of any one ofclaims 1 to 14, the interbody fusion device is a vertebra using a laparoscope in combination from the abdomen side. Because it is fixed between vertebral bodies by interbody fusion surgery, the operation scale is greatly reduced and the operation time and recovery period are also greatly reduced compared to the conventional interbody fusion surgery from the back side. Therefore, the physical and mental burden of the medical staff including the patient and the doctor, the surgical invasion of the patient, and the economic burden can be remarkably reduced.

　請求項１６の発明によれば、請求項１乃至請求項１５のいずれか１項の発明と同様な効果を有するのに加えて、本体嵌入ドライバーの後端把持部を把持して先端係合部に椎体間固定装置本体の後端部を係合した状態で内視鏡用腹腔部のカニューレ内に挿入された椎体間スペース保持装置の中空部内に挿入して押圧又は／及び回転することにより椎体間への椎体間固定装置本体の嵌入及び固定操作を容易化する効果がある。According to the invention ofclaim 16, in addition to having the same effect as the invention of any one ofclaims 1 to 15, in addition to gripping the rear end grip portion of the body insertion driver, the tip engagement portion And inserting into the hollow portion of the interbody space holding device inserted into the cannula of the abdominal cavity for endoscope with the rear end of the interbody fusion device main body engaged with the body, and pressing or / and rotating. This has the effect of facilitating the fitting and fixing operation of the interbody fixing device body between the vertebral bodies.

　請求項１７の発明によれば、請求項１６の発明と同様な効果を有するのに加えて、本体嵌入ドライバーは、先端係合部を硬質な金属製で、シャフト部は軽量な樹脂などの高分子材料から構成することができるため全体が軽量化され、操作性を向上させる効果がある。According to the invention ofclaim 17, in addition to having the same effect as that of the invention ofclaim 16, the main body insertion driver has a tip engaging portion made of hard metal and the shaft portion is made of a lightweight resin or the like. Since it can be composed of a molecular material, the whole is reduced in weight and has the effect of improving operability.

　請求項１８の発明によれば、請求項１６又は請求項１７の発明と同様な効果を有するのに加えて、押圧ねじドライバーの後端把持部を把持して先端係合部に押圧ねじの後端部を係合した状態で前記本体嵌入ドライバーの中空部内に挿入し、押圧ねじを椎体間固定装置の本体の雌ねじ部に挿入して押圧しながら回転することにより雌ねじに螺合させその軸方向推進力により前記ピンの先端側を順次ガイド孔に沿って案内させながら椎体内に差込むことができ、本体主軸方向の一軸によるピン差込み固定操作を容易化する効果がある。According to the invention ofclaim 18, in addition to having the same effect as that of the invention ofclaim 16 orclaim 17, the rear end grip portion of the press screw driver is gripped and the tip engagement portion is placed behind the press screw. Inserted into the hollow part of the main body insertion driver with the end engaged, and inserted into the female screw part of the main body of the interbody fusion device and rotated while rotating, and screwed into the female screw. The pin can be inserted into the vertebral body while sequentially guiding the tip side of the pin along the guide hole by the direction propulsive force, and there is an effect of facilitating the pin insertion fixing operation by one axis in the main body main axis direction.

　請求項１９の発明によれば、請求項１８の発明と同様な効果を有するのに加えて、本体嵌入ドライバーが先端係合部を硬質な金属製で、シャフト部は軽量な樹脂などの高分子材料から構成することができるため全体が軽量化され、操作性を向上させる効果がある。According to the nineteenth aspect of the present invention, in addition to having the same effect as the eighteenth aspect of the invention, the main body insertion driver has a tip engaging portion made of a hard metal, and the shaft portion is a lightweight polymer such as a resin. Since it can be comprised from a material, the whole is reduced in weight and there exists an effect which improves operativity.

　請求項２０の発明によれば、２つの隣接する椎体間の適正な間隔を修正して椎間板スペースを保持する椎体間固定外科手術用椎体間スペース保持装置は、椎体クランプ機構の固定爪により隣接する椎体の左右両側面をそれぞれ挟持し固定することから、その後で椎体間固定装置を椎体間に移植固定する際に比較的大きな外力が負荷される椎体が後方又は左右の側方にずれないため椎体間固定外科手術における椎体間スペース保持の信頼性が確保される効果がある。According to the twentieth aspect of the present invention, there is provided an interbody fusion surgical interbody space holding device that corrects an appropriate distance between two adjacent vertebral bodies to maintain an intervertebral disc space. Since the left and right side surfaces of adjacent vertebral bodies are sandwiched and fixed by the claws, the vertebral bodies to which a relatively large external force is applied when the interbody fusion device is subsequently implanted and fixed between the vertebral bodies are posterior or left and right Therefore, there is an effect that the reliability of the interbody space retention in the interbody fusion surgery is ensured.

　請求項２１の発明によれば、請求項２０の発明と同様な効果を有するのに加えて、第１のシャフト部に外嵌されたクランプアーム開閉管の前進又は後退により弾性支持部を有する各１対のクランプアームを縮径方向に閉じ又は拡径方向に開くことから、隣接する椎体の左右両側面をそれぞれ挟持し固定する椎体間スペース保持装置の構造及び操作が簡易化される効果がある。According to the invention ofclaim 21, in addition to having the same effect as that of the invention of claim 20, each of the elastic support portions is provided by advancing or retreating the clamp arm opening / closing pipe fitted on the first shaft portion. Since a pair of clamp arms are closed in the diameter-reducing direction or opened in the diameter-enlarging direction, the structure and operation of the interbody space holding device that clamps and fixes the left and right side surfaces of adjacent vertebral bodies are simplified. There is.

　請求項２２の発明によれば、請求項２０の発明と同様な効果を有するのに加えて、椎体クランプ機構が第１のシャフト部の先端部に枢着された各１対のクランプアーム及び第２のシャフト部の先端部に枢着された各１対のリンク部材を備え、第２のシャフト部が前進又は後退することにより各１対のクランプアームを椎体の直交面内で縮径方向に閉じ又は拡径方向に開くトグル機構を構成したことから、隣接する椎体の左右両側面の挟持／固定力が強大化され、椎体間スペース保持装置の信頼性を一層向上させる効果がある。According to the invention ofclaim 22, in addition to having the same effect as that of the invention of claim 20, each of the pair of clamp arms in which the vertebral body clamping mechanism is pivotally attached to the distal end portion of the first shaft portion, and Each pair of link members pivotally attached to the tip of the second shaft portion is provided, and each pair of clamp arms is reduced in diameter in the orthogonal plane of the vertebral body as the second shaft portion advances or retracts. Since the toggle mechanism that closes in the direction or opens in the diameter expansion direction is configured, the clamping / fixing force between the left and right sides of the adjacent vertebral bodies is increased, and the reliability of the interbody space holding device is further improved. is there.

　請求項２３の発明によれば、請求項２０乃至請求項２２のいずれか１項の発明と同様な効果を有するのに加えて、固定爪の複数の尖鋭突起が椎体の側面に容易に突刺して椎体を強固に固定／保持する信頼性をさらに向上させる効果がある。According to the invention ofclaim 23, in addition to having the same effect as that of any one of claims 20 to 22, the plurality of sharp protrusions of the fixed claw can be easily pierced on the side surface of the vertebral body. Thus, there is an effect of further improving the reliability of firmly fixing / holding the vertebral body.

　請求項２４の発明によれば、２つの隣接する椎体間の適正な間隔を修正して椎間板スペースを保持する椎体間固定外科手術用椎体間スペース保持装置は、第１のシャフト部の外面及び先端部にそれぞれ設けられた長尺固定ねじ部材及び針状突起により、前記隣接する椎体の一方又は両方の前面部にそれぞれ螺入、突刺して抜け止め効果を伴って固定することから、椎体間スペース保持装置の構造及び操作が簡易であるとともに、その後で椎体間固定装置を椎体間に移植固定する際に比較的大きな外力が負荷される椎体が後方又は左右の側方にずれないため椎体間固定外科手術における椎体間スペース保持の信頼性が確保される効果がある。According to the invention ofclaim 24, an interbody fusion space holding device for interbody fusion surgery that corrects an appropriate distance between two adjacent vertebral bodies and holds an intervertebral disc space is provided on the first shaft portion. From a long fixing screw member and a needle-like projection provided on the outer surface and the distal end, respectively, one or both front surfaces of the adjacent vertebral bodies are respectively screwed and pierced to be fixed with a retaining effect. The structure and operation of the interbody space holding device is simple and the vertebral body to which a relatively large external force is applied when the interbody fusion device is subsequently implanted and fixed between the vertebral bodies is located on the posterior or left and right sides. Therefore, the reliability of the interbody space retention in the interbody fusion surgery is ensured.

　請求項２５の発明によれば、請求項２０乃至請求項２４のいずれか１項の発明と同様な効果を有するのに加えて、１つの椎体間スペース保持装置に椎体クランプ機構又は長尺固定ねじ部材／針状突起と椎間板スペース内に挿入されることにより隣接する椎体を適正な間隔に修正して保持する外形形状を有する１対のスペーサーとを兼備することから、椎体間固定外科手術における隣接する椎体の適正な間隔に修正及び固定／保持が同時に短時間で行うことができる。これにより、従来の椎体間固定外科手術に比べて手術時間が短縮できるため、患者や医者を含む医療スタッフの肉体及び精神的負担、患者の手術侵襲さらには経済的負担を軽減する効果がある。According to the invention ofclaim 25, in addition to having the same effect as that of the invention of any one of claims 20 to 24, a vertebral body clamping mechanism or a long length is provided in one interbody space holding device. Intervertebral body fixation because it combines a fixed screw member / needle-like process and a pair of spacers having an outer shape that holds the adjacent vertebral bodies at appropriate intervals by being inserted into the intervertebral disc space. Correction and fixation / holding can be performed simultaneously in a short time at an appropriate interval between adjacent vertebral bodies in a surgical operation. As a result, the operation time can be shortened as compared with the conventional interbody fusion surgery, thereby reducing the physical and mental burden of medical staff including patients and doctors, the surgical invasion of the patient, and the economic burden. .

本発明の一実施形態（実施例1）の椎体間固定外科手術システムの概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fusion surgery system of one Embodiment (Example 1) of this invention.本発明の実施例1の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of Example 1 of this invention.図２のＡ－Ａ矢視図である。FIG. 3 is an AA arrow view of FIG. 2.（ａ）は図２のＢ－Ｂ矢視断面図、（ｂ）は図２のＣ－Ｃ矢視断面図である。(A) is a cross-sectional view taken along the line BB in FIG. 2, and (b) is a cross-sectional view taken along the line CC in FIG.（ａ）、（ｂ）、（ｃ）、（ｄ）、（ｅ）、（ｆ）は、それぞれ本発明の別の変形実施形態のピンの概念を示す一部断面図である。(A), (b), (c), (d), (e), (f) is a partial sectional view showing a concept of a pin of another modified embodiment of the present invention.図２のＤ－Ｄ矢視断面図である。FIG. 3 is a sectional view taken along the line DD in FIG. 2.図２の平面図である。FIG. 3 is a plan view of FIG. 2.図２の椎体間固定装置本体の椎体間への嵌入状態を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the insertion state between the vertebral bodies of the interbody fixing device main body of FIG.図２の椎体間固定装置の椎体間への固定完了状態を示す縦断面図（主要部断面）である。FIG. 3 is a longitudinal sectional view (main section) showing a state of fixation between vertebral bodies of the interbody fusion device of FIG. 2.図９のＥ－Ｅ矢視図である。FIG. 10 is an EE arrow view of FIG. 9.本発明の別の実施形態（実施例２）の椎体間固定装置の椎体間への固定完了状態を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the fixation completion state between the vertebral bodies of the interbody fixing device of another embodiment (Example 2) of this invention.図１１のＦ－Ｆ矢視図である。FIG. 12 is an FF arrow view of FIG. 11.本発明のまた別の実施形態（実施例３）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 3) of this invention.図１３のＰ－Ｐ矢視図である。It is a PP arrow line view of FIG.本発明のまた別の実施形態（実施例４）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 4) of this invention.（ａ）は図１５の摩擦板部のＧ－Ｇ矢視断面図、（ｂ）は（ａ）のＨ－Ｈ矢視断面図である。15A is a cross-sectional view taken along the line GG of the friction plate portion of FIG. 15, and FIG. 15B is a cross-sectional view taken along the line HH of FIG.本発明のまた別の実施形態（実施例５）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 5) of this invention.図１７のＱ－Ｑ矢視図である。It is a QQ arrow line view of FIG.図１７の平面図である。It is a top view of FIG.本発明のさらに別の実施形態（実施例６）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 6) of this invention.図２０のＲ－Ｒ矢視図である。FIG. 21 is an RR arrow view of FIG. 20.図２０の平面図である。It is a top view of FIG.本発明のまた別の実施形態（実施例７）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 7) of this invention.（ａ）は本発明のまた別の実施形態（実施例８）の椎体間固定装置の概念を示す縦断面図（主要部断面）、（ｂ）は（ａ）のＩ-Ｉ矢視要部断面図である。(A) is the longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 8) of this invention, (b) is II arrow view required of (a). FIG.本発明のまた別の実施形態（実施例９）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 9) of this invention.本発明のさらに別の実施形態（実施例１０）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 10) of this invention.本発明の一実施形態の椎体間スペース保持装置の概念を示す縦断面図（上半部断面）である。It is a longitudinal cross-sectional view (upper half cross section) which shows the concept of the interbody space holding | maintenance apparatus of one Embodiment of this invention.図２７の椎体間スペース保持装置の平面図（上半部断面）である。It is a top view (upper half cross section) of the interbody space holding device of FIG.図２７のＵ－Ｕ矢視図である。FIG. 28 is a view taken from the direction of the arrows U-U in FIG. 27.本発明の別の実施形態の椎体間スペース保持装置の概念を示す平面図（上半部断面）である。It is a top view (upper half cross section) which shows the concept of the interbody space holding | maintenance apparatus of another embodiment of this invention.図３０の椎体間スペース保持装置の縦断面図（上半部断面）である。It is a longitudinal cross-sectional view (upper half cross section) of the interbody space holding device of FIG.図３１のＶ－Ｖ矢視図である。FIG. 32 is a view on arrow VV of FIG. 31.本発明のさらに別の実施形態の椎体間スペース保持装置の概念を示す縦断面図（上半部断面）である。It is a longitudinal cross-sectional view (upper half cross section) which shows the concept of the interbody space holding | maintenance apparatus of another embodiment of this invention.図３３の椎体間スペース保持装置の平面図（上半部断面）である。FIG. 34 is a plan view (upper half section) of the interbody space holding device of FIG. 33.図３４のＷ－Ｗ矢視図である。FIG. 35 is a view on arrow WW in FIG. 34.本発明の一実施形態の本体嵌入ドライバーの概念を示す縦断面図（上半部断面）である。It is a longitudinal cross-sectional view (upper half part cross section) which shows the concept of the main body insertion driver of one Embodiment of this invention.図３６のＳ－Ｓ矢視図である。FIG. 37 is a view taken along the line SS of FIG. 36.本発明の一実施形態の押圧ねじドライバーの概念を示す側面図である。It is a side view which shows the concept of the press screw driver of one Embodiment of this invention.図３８のＴ－Ｔ矢視図である。FIG. 39 is a view on arrow TT in FIG. 38.本発明の図３３の椎体間スペース保持装置を適用した変形実施形態の椎体間固定外科手術システムの概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fusion surgery system of the deformation | transformation embodiment to which the interbody space holding | maintenance apparatus of FIG. 33 of this invention is applied.（ａ）は本発明の一実施形態の椎体間固定外科手術における患者の砕石位状態を概念的に示す側面図、（ｂ）は（ａ）に引続き患者のトレンデレンブルグ体位状態を概念的に示す側面図である。(A) is a side view conceptually showing a patient's lithotripsy state in the interbody fusion surgery of one embodiment of the present invention, and (b) is a conceptual view of a patient's Trendelenburg position following (a). FIG.本発明の一実施形態の椎体間固定外科手術における患者の腹部側の腹腔鏡用ポートの配置状態を概念的に示す平面図である。It is a top view which shows notionally the arrangement | positioning state of the laparoscopic port of the patient's abdominal side in the interbody fusion surgery of one Embodiment of this invention.本発明の一実施形態の椎体間固定外科手術における患者の腹部側からの処置工程を概念的に示す側面図である。It is a side view which shows notionally the treatment process from the abdomen side of the patient in the interbody fusion surgery of one Embodiment of this invention.本発明のまた別の実施形態（実施例１１）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 11) of this invention.図４４のＸ－Ｘ矢視図である。FIG. 45 is a view on arrow XX in FIG. 44.本発明のさらに別の実施形態（実施例１２）の椎体間固定装置の概念を示す縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) which shows the concept of the interbody fixing device of another embodiment (Example 12) of this invention.図４６のＹ－Ｙ矢視図である。FIG. 47 is a view on arrow YY in FIG. 46.従来の第１例の椎体間固定装置の斜視図である。It is a perspective view of the conventional interbody fusion device of the first example.従来の第２例の椎体間固定装置が椎体間に固定された状態の縦断面図（主要部断面）である。It is a longitudinal cross-sectional view (main part cross section) of the state by which the conventional interbody fixing device of the 2nd example was fixed between vertebral bodies.従来の代表的な椎体間スペース保持装置（腹側前弯症伸長外部スリーブ）の斜視図である。It is a perspective view of the conventional typical interbody space holding | maintenance apparatus (ventral side lordosis extension external sleeve).図５０の椎体間スペース保持装置（腹側前弯症伸長外部スリーブ）が椎体間に挿入された状態の側面図である。FIG. 52 is a side view showing a state in which the interbody space holding device (ventral ventral lordosis extending external sleeve) of FIG. 50 is inserted between vertebral bodies.

　以下、本発明の椎体間固定外科手術システム、外科手術方法及び椎体間スペース保持装置を最良に実施するための形態の具体例を、添付図面を参照しながら詳細に説明する。Hereinafter, specific examples of the best mode for carrying out the interbody fusion surgery system, the surgical method, and the interbody space holding device of the present invention will be described in detail with reference to the accompanying drawings.

　図１は本発明の一実施形態（実施例1）の椎体間固定外科手術システムの主要構成概念を示す縦断面図（主要部断面）、図２は本発明の実施例1の椎体間固定装置１０の概念を示す縦断面図（主要部断面）、図３は図２のＡ－Ａ矢視断面図、図４（ａ）、（ｂ）はそれぞれ図２のＢ－Ｂ矢視断面図、Ｃ－Ｃ矢視断面図、図５（ａ）、（ｂ）、（ｃ）、（ｄ）、（ｅ）、（ｆ）はそれぞれ本発明の別の変形実施形態のピンの概念を示す一部断面図、図６は図２のＤ－Ｄ矢視断面図、図７は図２の平面図、図８は椎体間固定装置１０の椎体Ｌ１、Ｌ２間への嵌入状態を示す縦断面図（主要部断面）、図９は椎体間固定装置１０の椎体Ｌ１、Ｌ２間への固定完了状態を示す縦断面図（主要部断面）、図１０は図９のＥ－Ｅ矢視図である。なお、ここに添付した図面は、いずれも内部構造を分かり易くするため軸方向に比べて径方向を拡大してノットスケールで表現された主要構成概念を示す概念図である。FIG. 1 is a longitudinal sectional view (main section) showing a main configuration concept of an interbody fusion surgical system according to an embodiment (Example 1) of the present invention, and FIG. 2 is an intervertebral body of Example 1 of the present invention. FIG. 3 is a sectional view taken along the line AA in FIG. 2, and FIGS. 4A and 4B are sectional views taken along the line BB in FIG. FIGS. 5A, 5B, 5C, 5C, 5D, 5E, 5F, and 5F are cross-sectional views taken along arrows CC, respectively. 6 is a cross-sectional view taken along the line DD of FIG. 2, FIG. 7 is a plan view of FIG. 2, and FIG. 8 is a diagram showing a state where theinterbody fusion device 10 is inserted between the vertebral bodies L1 and L2. 9 is a longitudinal sectional view (cross section of the main part), FIG. 9 is a longitudinal sectional view (cross section of the main part) showing a state of fixation between the vertebral bodies L1 and L2 of theinterbody fusion device 10, and FIG. FIG. Each drawing attached here is a conceptual diagram showing the main structural concept expressed in knot scale by enlarging the radial direction compared to the axial direction in order to make the internal structure easy to understand.

　本発明の一実施形態の椎体間固定外科手術システムは、図１に示すように、前端有底の略中空円筒状の外面に椎体Ｌ１、Ｌ２間に係合して嵌入される雄ねじ状の外面係合部１４、１５が形成され、後端側中空内面１６ａに設けられた雌ねじ１６内面から椎体方向に末広がりに外面まで貫通する１つ又は複数のガイド孔１７、１８が穿設された本体１１、ガイド孔内に遊嵌収容された１つ又は複数のピン３０、及び雌ねじ１６に螺合しピン後端を押圧してピンの先端側をガイド孔に沿って椎体内に差込む押圧ねじ４０を有し、２つの隣接する椎体（椎骨）Ｌ１、Ｌ２間の椎間板スペースＭに嵌入して椎体Ｌ１、Ｌ２を固定する椎体間固定装置１０と、椎体間固定装置１０を椎体Ｌ１、Ｌ２間に移植固定するのに先立ち、生体例えば人体ＭＮの腹部ＭＮ１側から椎体Ｌ１、Ｌ２間の中心に向けて穿設された内視鏡用ポートＭａ内に挿入されるカニューレＫと、カニューレＫ内に挿入し、椎体Ｌ１、Ｌ２間の適正な間隔を修正して椎間板スペースＭを保持するための椎体間スペース保持装置７０と、先端係合部８３に椎体間固定装置１０の本体１１の後端係合部２９に係合した状態で椎体間スペース保持装置７０の中空部内に挿入し、本体１１を押圧し回転して椎体Ｌ１、Ｌ２間に嵌入させる本体嵌入ドライバー８０と、先端係合部９３に椎体間固定装置１０の押圧ねじ４０の後端係合部４４に係合した状態で本体嵌入ドライバー８０の中空内に挿入し、押圧ねじ４０を本体１１の雌ねじ部１６に挿入し押圧しながら螺入させる押圧ねじドライバー９０と、を具備する。As shown in FIG. 1, the interbody fusion surgical system according to an embodiment of the present invention is a male screw shape that is engaged and fitted between vertebral bodies L1 and L2 on a substantially hollow cylindrical outer surface having a front end. Outersurface engaging portions 14 and 15 are formed, and one or a plurality of guide holes 17 and 18 penetrating from the inner surface of thefemale screw 16 provided on the rear end side hollowinner surface 16a to the outer surface so as to extend toward the vertebral body are formed. Themain body 11, one or a plurality ofpins 30 loosely accommodated in the guide hole, and thefemale screw 16 are screwed together and the rear end of the pin is pressed so that the distal end side of the pin is inserted into the vertebral body along the guide hole. An intervertebralbody fixing device 10 that has apressing screw 40 to be inserted and fits into an intervertebral disc space M between two adjacent vertebral bodies (vertebrae) L1 and L2, and fixes the vertebral bodies L1 and L2. Prior to transplantation and fixation of 10 between the vertebral bodies L1 and L2, A cannula K inserted into the endoscope port Ma drilled from the side of the part MN1 toward the center between the vertebral bodies L1 and L2, and inserted into the cannula K, and an appropriate distance between the vertebral bodies L1 and L2 In a state where the intervertebralspace holding device 70 for holding the intervertebral disc space M by correcting the interval and the distalend engaging portion 83 engaged with the rearend engaging portion 29 of themain body 11 of theinterbody fixing device 10. Theinterbody fixing device 10 is inserted into the hollow portion of the interbodyspace holding device 70, themain body 11 is pressed and rotated to be inserted between the vertebral bodies L1 and L2, and the intervertebralbody fixing device 10 is inserted into the distalend engaging portion 93. Apress screw driver 90 is inserted into the hollow of the mainbody insertion driver 80 in a state of being engaged with the rearend engaging portion 44 of thepress screw 40, and thepress screw 40 is inserted into thefemale screw portion 16 of themain body 11 and screwed while being pressed. And.

　さらに、椎体間固定外科手術の際に観察及び各種事前／事後の処置をするため、いずれも図示しない別途複数の内視鏡用腹腔から挿入される内視鏡（又は腹腔鏡）あるいは本体嵌入ドライバー８０中空内に収設されるカプセル内視鏡等を備えることが望ましい。Furthermore, in order to perform observation and various pre / post treatments during interbody fusion surgery, an endoscope (or a laparoscope) or a main body is inserted through a plurality of endoscope abdominal cavity (not shown). It is desirable to provide a capsule endoscope or the like housed in the hollow of thedriver 80.

　本発明の実施例1の椎体間固定装置１０は、椎体Ｌ１、Ｌ２間の適正な間隔に適合する前端有底の略中空円筒状に形成され、外面に椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ部に外面頭頂部が係合して嵌入される雄ねじ状の外面係合部１４、１５が形成された本体１１と、本体１１の後端面１３側の中空内面１６ａに形成された雌ねじ１６と、雌ねじ１６の奥行き部から椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａに向かって径方向に略軸対称な末広がりに傾斜して外面まで貫通し穿設された１対のガイド孔１７、１８と、雌ねじ１６内に本体１１の主軸Ｃ１に沿って遊嵌収容され、先端３２側がそれぞれ１対のガイド孔１７、１８に沿って案内され屈曲し挿通された１対のピン３０、３０と、雌ねじ１６に螺合しその軸方向推進力により、ピン３０、３０の後端３１、３１を押圧する押圧ねじ４０と、から概略構成されている。Theinterbody fusion device 10 according to the first embodiment of the present invention is formed in a substantially hollow cylindrical shape with a front end that fits an appropriate distance between the vertebral bodies L1 and L2, and the opposing surface of the vertebral bodies L1 and L2 on the outer surface. Amain body 11 formed with externalthread engaging parts 14 and 15 into which outer surface tops engage with L1a and L2a parts, and a female thread formed on a hollowinner surface 16a on the rear end face 13 side of themain body 11 16 and a pair of guide holes 17 inclined from the depth of thefemale screw 16 toward the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2 in a radially axially symmetric shape and penetrating to the outer surface, 18 and a pair ofpins 30, 30 that are loosely fitted and accommodated in thefemale screw 16 along themain axis C 1 of themain body 11, and whosedistal end 32 side is guided along a pair of guide holes 17, 18, bent, and inserted, respectively. Thepin 3 is screwed into thefemale screw 16 and its axial propulsive force Thepress screw 40 that presses the rear ends 31 and 31 of 0 and 30 is schematically configured.

　本体１１は、椎体Ｌ１、Ｌ２間の適正な間隔を保持するように形成された外形を有し、２つの椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ間がほぼ平行面あるいは背部側方向に減縮する例えば水平面に対して９°前後の傾斜面形状となっている場合に対応するように図１に示すような略中空円筒で、中央部外径が僅かに例えば０．１ｍｍオーダー太めの太鼓状に形成される。本体１１は、椎体Ｌ１、Ｌ２の太さすなわち奥行きなどの大きさによるが、椎体Ｌ１、Ｌ２間に収容される例えば概ね外径が１８～２２ｍｍで、全長が２５ｍｍ～４５ｍｍ程度である。この場合、本体１１の前端面１２は、凸曲面又は図示しない略円錐面状に形成され、脊柱の背後の神経部に触れないよう神経部の十分手前の椎体Ｌ１、Ｌ２間に配置されることが必要である。Themain body 11 has an outer shape formed so as to maintain an appropriate distance between the vertebral bodies L1 and L2, and the opposing surfaces L1a and L2a of the two vertebral bodies L1 and L2 are substantially parallel or dorsal. For example, a drum with a substantially hollow cylinder as shown in FIG. 1 whose outer diameter is slightly thicker, for example, on the order of 0.1 mm, so as to correspond to the case of an inclined surface shape of about 9 ° with respect to a horizontal plane. It is formed in a shape. Themain body 11 is accommodated between the vertebral bodies L1 and L2, for example, having an outer diameter of approximately 18 to 22 mm and a total length of approximately 25 to 45 mm, depending on the size of the vertebral bodies L1 and L2. In this case, thefront end surface 12 of themain body 11 is formed in a convex curved surface or a substantially conical surface not shown, and is disposed between the vertebral bodies L1 and L2 sufficiently in front of the nerve portion so as not to touch the nerve portion behind the spinal column. It is necessary.

　本体１１は、椎体Ｌ１、Ｌ２間の強大な例えば１０００ｋｇオーダーの圧縮力に耐える十分な強度及び生物学的適合性を有する材料あるいは不活性材料から形成される。これらの材料としては、例えば、医療等級のステンレス鋼（ＳＵＳ）、チタン（Ｔｉ）、多孔性タンタル複合材料等の多孔性材料などがあり、特に強度及び軽量な点からはＴｉが好適である。Themain body 11 is formed of a material having sufficient strength and biological compatibility to withstand a strong compressive force between the vertebral bodies L1 and L2, for example, on the order of 1000 kg, or an inert material. Examples of these materials include porous materials such as medical grade stainless steel (SUS), titanium (Ti), and a porous tantalum composite material. Ti is particularly preferable from the viewpoint of strength and light weight.

　本体１１の外面には、椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ部に外面頭頂部が食い込み係合する外面係合部として雄ねじ１４、１５が形成される。雄ねじ１４、１５の谷径が椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ間距離にほぼ接触する程度が望ましく、雄ねじ１４、１５のねじ山高さは例えば概ね３～４ｍｍ弱程度である。雄ねじ１４、１５は、脊椎に加わる高荷重により本体１１が椎体Ｌ１、Ｌ２間から押し出されないよう椎体Ｌ１、Ｌ２内に十分に係合することが望ましい。雄ねじ１４、１５のピッチは、椎体間固定装置１０を椎体Ｌ１、Ｌ２間の所定の位置に保持するのに必要なねじ係合量に応じて、例えば概ね２～３ｍｍ程度である。雄ねじ１４、１５のねじ山高さ及びピッチは、必要に応じて上記より小さい値に形成することができることはいうまでもない。External threads 14 and 15 are formed on the outer surface of themain body 11 as outer surface engaging portions in which the outer surface crown portion bites into and engages the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2. It is desirable that the valley diameter of themale screws 14 and 15 is substantially in contact with the distance between the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2. The thread height of themale screws 14 and 15 is, for example, about 3 to 4 mm. Themale screws 14 and 15 are desirably sufficiently engaged in the vertebral bodies L1 and L2 so that themain body 11 is not pushed out between the vertebral bodies L1 and L2 due to a high load applied to the spine. The pitch of themale screws 14 and 15 is, for example, about 2 to 3 mm, depending on the amount of screw engagement required to hold theinterbody fusion device 10 at a predetermined position between the vertebral bodies L1 and L2. Needless to say, the thread height and pitch of themale threads 14, 15 can be formed to a value smaller than the above as required.

　この実施例では、図３、４、６、７に示すように、本体１１は前端面１２側を残して後方の外面の左右両側の頭頂部が適宜な幅でカットされた略平行なカット側面１９、１９が形成されている。従って、前端面１２側の雄ねじ１５は全周完全ねじであるが、その後方のカット側面１９、１９が形成された断面部分円筒の上下外面に形成された雄ねじ１４は部分ねじとなっている。雄ねじ１４、１５の軸方向先端（ねじ端）及び径方向外面頭頂部は尖鋭刃状に形成されており、前端面１２側の完全ねじである雄ねじ１５は、先頭ねじとして本体１１を椎体Ｌ１、Ｌ２間に容易に螺入させることができる。In this embodiment, as shown in FIGS. 3, 4, 6, and 7, themain body 11 is a substantially parallel cut side surface in which the tops on both the left and right sides of the rear outer surface are cut with an appropriate width, leaving the front end face 12 side. 19 and 19 are formed. Therefore, themale screw 15 on the front end face 12 side is a full screw, but themale screw 14 formed on the upper and lower outer surfaces of the cross-section partial cylinder in which the cut side faces 19 and 19 on the rear side are formed is a partial screw. The axial front ends (screw ends) and the radial outer surface crests of themale screws 14 and 15 are formed in a sharp blade shape, and themale screw 15 which is a complete screw on thefront end surface 12 side uses themain body 11 as a vertebral body L1. , L2 can be easily screwed in.

　本体１１の全長に亘りカット側面１９、１９を形成した場合は、本体１１を図示９０°横にすれば本体１１をねじ込まなくても椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ間に容易に挿入することもできる。この場合は、本体１１を椎体Ｌ１、Ｌ２間に挿入後９０°回転して縦てることにより、図８に示すように、本体１１が椎体Ｌ１、Ｌ２間の適正な間隔を保持して固定される。また、カット側面１９、１９は、椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ間で骨の内部成長による骨状固定のための領域を提供するのに好適となる。When the cut side surfaces 19 and 19 are formed over the entire length of themain body 11, themain body 11 can be easily inserted between the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2 without screwing themain body 11 if themain body 11 is turned 90 ° in the figure. You can also In this case, themain body 11 is rotated 90 ° after being inserted between the vertebral bodies L1 and L2, and is held vertically so that themain body 11 maintains an appropriate distance between the vertebral bodies L1 and L2, as shown in FIG. Fixed. The cut side surfaces 19 and 19 are suitable for providing a region for bone-like fixation by bone ingrowth between the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2.

　また、本体１１のカット側面１９、１９の後端部は、椎体間固定装置１０の椎体Ｌ１、Ｌ２間への挿入固定に際し、いずれも図示しない移植ドライバーのシャフトの先端に設けられたトング（挟持具）により把持されるようにもなっている。なお、上記移植ドライバーは公知のものを利用することができるが、本体１１を椎体Ｌ１、Ｌ２間に嵌入させる本発明の一実施形態の本体嵌入ドライバーについては後述する。Further, the rear end portions of the cut side surfaces 19 and 19 of themain body 11 are provided at the tip of the shaft of the transplant driver (not shown) when theinterbody fusion device 10 is inserted and fixed between the vertebral bodies L1 and L2. It can also be held by a (holding tool). Although a known one can be used as the transplant driver, a main body insertion driver according to an embodiment of the present invention in which themain body 11 is inserted between the vertebral bodies L1 and L2 will be described later.

　本体１１の後端面１３側から穿設された中空内面１６ａには、適宜奥行きの雌ねじ１６が形成されるとともに、雌ねじ１６の奥行き部の中空内面１６ａから椎体Ｌ１、Ｌ２方向に略軸対称に末広がりに主軸Ｃ１に対し傾斜角Θ１、Θ２の傾斜軸Ｃ２、Ｃ３に沿って外面まで貫通する上下１対のガイド孔１７、１８が穿設されている。傾斜角Θ１、Θ２は、椎体Ｌ１、Ｌ２の配置状況及びピン３０の太さや可撓性等の状況に応じて適宜決定され、両者は略等しい又は若干異なる傾斜角に設定してもよい。同一条件では、ピン３０の押し込み力は傾斜角Θ１、Θ２にほぼ比例するような傾向を示す。A hollowinner surface 16a drilled from therear end surface 13 side of themain body 11 is formed with afemale screw 16 having an appropriate depth, and is substantially axisymmetric in the vertebral body L1 and L2 directions from the hollowinner surface 16a of the depth portion of thefemale screw 16. A pair of upper and lower guide holes 17 and 18 penetrating to the outer surface along the inclined axes C2 and C3 of the inclination angles Θ1 and Θ2 with respect to the main axis C1 are formed at the end. The inclination angles Θ1 and Θ2 are appropriately determined according to the arrangement state of the vertebral bodies L1 and L2 and the situation such as the thickness and flexibility of thepin 30, and both may be set to be substantially equal or slightly different inclination angles. Under the same conditions, the pushing force of thepin 30 tends to be substantially proportional to the inclination angles Θ1 and Θ2.

　なお、いずれも図示しないが、傾斜軸Ｃ２、Ｃ３は、ピン３０の先端３２が押し込まれて椎体Ｌ１、Ｌ２の外面からはみ出さない限り、主軸Ｃ１に対しそれぞれ任意の方向に且つ非対称に配置されてもよく、あるいは主軸Ｃ１に対し偏心し且つ任意の方向の面内に配置されてもよい。Although not shown, the inclined axes C2 and C3 are arranged in any direction and asymmetrically with respect to the main axis C1 as long as thedistal end 32 of thepin 30 is not pushed and protrudes from the outer surface of the vertebral bodies L1 and L2. Alternatively, it may be eccentric with respect to the main axis C1 and arranged in a plane in any direction.

　また、本体１１には、図２～４、６、７等に示すように、側面開口２１、２２、２３及び上下面開口２４、２５、２６などの複数の開口が穿設されている。そして、図２～４等に示すように、中空内面１６ａの先端面に側面開口２１及び上下面開口２４とも連通する小穴２８が穿設されている。側面開口２１、２２、２３は椎体Ｌ１、Ｌ２を囲繞する高度に血管化された組織に接触して血管新生を促進し、上下面開口２４、２５、２６は椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ間で骨の内部成長による骨状固定を促進する。このため、本体１１には強度を損なわない限り多数の開口を極力相互に連通するように穿設することが望ましい。Further, as shown in FIGS. 2 to 4, 6, 7, etc., themain body 11 has a plurality of openings such asside openings 21, 22, 23 and upper andlower openings 24, 25, 26. As shown in FIGS. 2 to 4 and the like, asmall hole 28 communicating with the side surface opening 21 and the upper andlower surface openings 24 is formed in the distal end surface of the hollowinner surface 16a. Theside openings 21, 22, 23 contact the highly vascularized tissue surrounding the vertebral bodies L1, L2 to promote angiogenesis, and the upper andlower surface openings 24, 25, 26 are opposite surfaces of the vertebral bodies L1, L2. Bone-like fixation by bone ingrowth is promoted between L1a and L2a. For this reason, it is desirable to drill a large number of openings in themain body 11 so as to communicate with each other as much as possible unless the strength is impaired.

　さらに、本体１１の後端面１３には、１対の後端開口２７、２７及び円周部に沿って複数例えば６個の部分円弧状開口が穿設されている。この部分円弧状開口は、本体１１を椎体Ｌ１、Ｌ２間に嵌入するための後述の本体嵌入ドライバーの先端係合部が嵌合して係合する後端係合部２９である。後端係合部２９は、このような部分円弧状開口に代えて、後端面１３面に例えばいずれも図示しない六角形の凹溝を設けて本体嵌入ドライバーの六角形状の先端係合部を係合させるようにしてもよい。Furthermore, therear end surface 13 of themain body 11 has a pair ofrear end openings 27 and 27 and a plurality of, for example, six partial arc-shaped openings formed along the circumferential portion. This partial arc-shaped opening is a rearend engaging portion 29 in which a front end engaging portion of a main body insertion driver described later for fitting themain body 11 between the vertebral bodies L1 and L2 is engaged and engaged. The rearend engaging portion 29 is provided with, for example, a hexagonal concave groove (not shown) on therear end surface 13 in place of such a partial arc-shaped opening to engage the hexagonal front end engaging portion of the main body insertion driver. You may make it match.

　なお、本体１１に多孔性タンタル－カーボン複合材料例えば米国インプレックス社の商品名「ヘドロセル（ＨＥＤＲＯＣＥＬ）」などの多孔性材料を用いる場合は、上記のような側面開口２１、２２、２３及び上下面開口２４、２５、２６を設けなくてもよく、相互に連結された多孔部が骨の内部成長及び血管新生を促進することができる。この多孔性材料は、多孔質の骨の構造に似ているとともに、人体の骨の弾性率に近い弾性率を有していることから、本発明の椎体間固定装置には最適とも言える。When themain body 11 is made of a porous tantalum-carbon composite material, for example, a porous material such as “HEDROCEL” (trade name of US Implex Co., Ltd.), theside openings 21, 22, 23 and the upper and lower surfaces as described above are used. Theopenings 24, 25, and 26 may not be provided, and the interconnected porous portions may promote bone ingrowth and angiogenesis. This porous material resembles the structure of a porous bone and has an elastic modulus close to that of a human bone, so it can be said to be optimal for the interbody fusion device of the present invention.

　１対のピン３０、３０は、雌ねじ１６内に上下に主軸Ｃ１方向に並列して遊嵌収容され、それぞれ後端３１側が本体１１の主軸Ｃ１に沿って延伸するとともに先端３２側がそれぞれ１対のガイド孔１７、１８に沿って案内され屈曲し挿通される。各先端３２は、適宜尖鋭状に形成され、本体１１が椎体Ｌ１、Ｌ２間に差込まれる前の初期状態においては雄ねじ１４の谷径以内に、すなわち谷径から突出しないようガイド孔１７、１８の出口内に収容されている。The pair ofpins 30, 30 are loosely accommodated in thefemale screw 16 in parallel in the direction of the main axis C <b> 1, therear end 31 side extends along the main axis C <b> 1 of themain body 11, and thefront end 32 side is a pair each. It is guided along the guide holes 17 and 18, bent and inserted. Eachtip 32 is appropriately sharpened, and in the initial state before themain body 11 is inserted between the vertebral bodies L1 and L2, the guide holes 17 and so on do not protrude from the valley diameter of themale screw 14, that is, from the valley diameter. It is accommodated in 18 outlets.

　この実施例のピン３０は、丸あるいは多角形など任意断面形状の中実又は中空の棒状体からなり、図３～４等に示すように、例えば一辺が数ｍｍ程度の四角棒材で、Ｔｉ製の本体より柔らかく、適宜な屈曲性及び強度のある例えば医療等級のＳＵＳなどからなる。Thepin 30 of this embodiment is formed of a solid or hollow rod-like body having an arbitrary cross-sectional shape such as a circle or a polygon. For example, as shown in FIGS. It is softer than the main body and is made of, for example, medical grade SUS having appropriate flexibility and strength.

　また、この実施例の中実又は中空の一体型棒状体からなるピン３０に替えて、図４（ａ）又は（ｂ）におけると同様な方向のピンの一部断面図である図５（ａ）～（ｆ）に示すように、少なくとも先端側又は全長に亘り複数の薄板材３０Ａｎ、３０Ｄｎ又は丸や各種扁平断面等任意断面型を有する線材３０Ｂｎ、３０Ｅｎ、３０Ｃｎ、３０Ｆｎが積層されて一体的な丸あるいは多角形など任意断面形状の棒状積層体からなるそれぞれ別の変形形態のピン３０Ａ、３０Ｂ、３０Ｃ、３０Ｄ、３０Ｅ、３０Ｆとすることもできる。Moreover, it replaces with thepin 30 which consists of a solid or hollow integrated rod-shaped body of this Example, and is a partial sectional view of the pin in the same direction as in FIG. 4A or FIG. ) To (f), a plurality of thin plate materials 30An, 30Dn or wire rods 30Bn, 30En, 30Cn, 30Fn having an arbitrary cross-sectional shape such as a round shape or various flat cross-sections are laminated and integrated at least over the tip side or the entire length. Thepins 30A, 30B, 30C, 30D, 30E, and 30F may be different from each other in the form of a rod-like laminate having an arbitrary cross-sectional shape such as a round shape or a polygonal shape.

　変形形態のピン３０Ａ、３０Ｂ、３０Ｃは、それぞれ図５（ａ）、（ｂ）、（ｃ）に示すように、少なくとも先端側又は全長に亘り複数の薄板材３０Ａｎ、丸型線材３０Ｂｎ、長円扁平型線材３０Ｃｎが積層されて一体的な略四角形断面形状の棒状積層体に形成される。As shown in FIGS. 5A, 5B, and 5C, thedeformed pins 30A, 30B, and 30C each include a plurality of thin plate materials 30An, a round wire 30Bn, and an oval shape at least on the distal end side or the entire length. The flat wire rods 30Cn are laminated to form a rod-like laminate having an integral substantially square cross section.

　変形形態のピン３０Ｄ、３０Ｅ、３０Ｆは、それぞれ図５（ｄ）、（ｅ）、（ｆ）に示すように、少なくとも先端側又は全長に亘り幅の異なる複数の薄板材３０Ｄｎ、丸型線材３０Ｅｎ、長円扁平型線材３０Ｆｎが積層されて一体的な略菱形断面形状の棒状積層体に形成される。As shown in FIGS. 5D, 5E, and 5F, thedeformed pins 30D, 30E, and 30F include a plurality of thin plate materials 30Dn and round wire rods 30En having different widths at least on the tip side or the entire length, respectively. The oblong flat wire 30Fn is laminated to form a rod-like laminated body having a substantially rhombic cross section.

　このような積層体からなる変形形態のピン３０Ａ、３０Ｂ、３０Ｃ、３０Ｄ、３０Ｅ、３０Ｆは、形状を保持するために根元部の薄板材３０Ａｎ、３０Ｄｎ又は線材３０Ｂｎ、３０Ｅｎ、３０Ｃｎ、３０Ｆｎをそれぞれ相互に接着又は溶着して一体的に形成されることが望ましい。これにより、先端部側は各薄板材３０Ａｎ、３０Ｄｎ又は線材３０Ｂｎ、３０Ｅｎ、３０Ｃｎ、３０Ｆｎが各々フリーな状態であるため本体１１のガイド孔１７、１８に沿って案内され比較的容易に屈曲し易くなり、本体のガイド孔に沿ってスムースに案内される操作性が向上する。さらに、これらの積層体からなるピン３０Ａ～３０Ｆは、任意の形状に一体的に積層し形成することが容易であり、設計の自由度が向上する。The deformed pins 30A, 30B, 30C, 30D, 30E, and 30F made of such a laminate are mutually connected to the thin plate members 30An and 30Dn or the wire rods 30Bn, 30En, 30Cn, and 30Fn at the base portion in order to maintain the shape. It is desirable to be integrally formed by bonding or welding to each other. As a result, since the thin plate members 30An, 30Dn or the wire rods 30Bn, 30En, 30Cn, 30Fn are in a free state, the distal end side is guided along the guide holes 17 and 18 of themain body 11 and can be bent relatively easily. Thus, the operability of being smoothly guided along the guide hole of the main body is improved. Further, thepins 30A to 30F made of these laminates can be easily laminated and formed in an arbitrary shape, and the degree of design freedom is improved.

　そこで、雌ねじ１６及び中空内面１６ａの内径は、ピン３０あるいは３０Ａ～３０Ｆの太さ及び本体１１の外径ならびにこの両者の強度等の兼ね合いから適宜決定される。中空内面１６ａは、雌ねじ１６の下孔の役割をも有している。Therefore, the inner diameters of thefemale screw 16 and the hollowinner surface 16a are appropriately determined from the balance of the thickness of thepin 30 or 30A to 30F, the outer diameter of themain body 11, the strength of both, and the like. The hollowinner surface 16a also serves as a pilot hole for thefemale screw 16.

　押圧ねじ４０は、図８、９に示すように、本体１１の雌ねじ１６に螺合する雄ねじ部４１の後端に本体１１の後端面１３の全面又は一部を覆う大きさの略円板フランジ状のキャップ４２が連設されている。雄ねじ部４１のキャップ４２連設面からの長さは、ピン３０を椎体Ｌ１、Ｌ２内に差込む長さに対応したピン３０押し込みストロークに対応し、押圧ねじ４０を雌ねじ１６に前記ストローク螺入させたときキャップ４２連設面が本体１１の後端面１３面に当接した状態となるように設定することが望ましい。また、キャップ４２の大きさは、必要に応じて椎体Ｌ１、Ｌ２間を覆うような大きさとすることもできる。押圧ねじ４０の材質としては、本体１１と同様に、医療等級のＳＵＳ、Ｔｉ、多孔性タンタル複合材料等の多孔性材料などがあり、特に強度及び軽量な点からはＴｉが、骨の内部成長及び血管新生の促進性からは多孔性タンタル複合材料などが好適である。As shown in FIGS. 8 and 9, thepressing screw 40 is a substantially disc flange having a size that covers the whole or part of therear end surface 13 of themain body 11 at the rear end of themale screw portion 41 that is screwed into thefemale screw 16 of themain body 11. Acap 42 is continuously provided. The length of themale screw portion 41 from the surface where thecap 42 is provided corresponds to thepin 30 pressing stroke corresponding to the length of inserting thepin 30 into the vertebral bodies L1 and L2, and thepressing screw 40 is connected to thefemale screw 16 with the stroke screw. It is desirable to set so that the continuous surface of thecap 42 is in contact with therear end surface 13 of themain body 11 when it is inserted. Further, the size of thecap 42 can be set so as to cover between the vertebral bodies L1 and L2 as necessary. As the material of thepressing screw 40, there are porous materials such as medical grade SUS, Ti, porous tantalum composite material, etc., as in the case of themain body 11. Especially, Ti is a bone ingrowth in terms of strength and light weight. From the viewpoint of promoting angiogenesis, a porous tantalum composite material or the like is preferable.

　キャップ４２の後端面には、前記移植ドライバー又は後述の押圧ねじドライバーの先端係合部が係合する後端係合部として例えば、図１０に示すように、十字溝４４が形成されている。後端係合部４４は、十字溝に代えていずれも図示しない移植ドライバー又は押圧ねじドライバーの例えば六角レンチ状に形成された先端係合部が係合する六角形穴を穿設してもよい。For example, as shown in FIG. 10, across groove 44 is formed on the rear end surface of thecap 42 as a rear end engaging portion that engages with a tip engaging portion of the transplant driver or a press screw driver described later. The rearend engaging portion 44 may be formed with a hexagonal hole that engages with a distal end engaging portion formed in, for example, a hexagon wrench shape of a transplant driver or a pressure screw driver (not shown) instead of the cross groove. .

　図２７は本発明の一実施形態の椎体間固定外科手術用椎体間スペース保持装置７０の概念を示す縦断面図（上半部断面）、図２８は図２７の椎体間スペース保持装置７０の平面図（上半部断面）、図２９は図２７のＵ－Ｕ矢視図である。FIG. 27 is a longitudinal sectional view (upper half section) showing a concept of an interbodyspace holding device 70 for interbody fusion surgery according to an embodiment of the present invention, and FIG. 28 is an interbody space holding device of FIG. 70 is a plan view (upper half section), and FIG. 29 is a view taken in the direction of arrows U-U in FIG.

　本発明の一実施形態の椎体間スペース保持装置７０は、後端に把持部７２が設けられ、生体腹部ＭＮ１側に設けられた内視鏡用腹腔部Ｍａ内のカニューレＫ（図１参照）を介して椎体Ｌ１、Ｌ２の前面近傍まで挿入される中空長尺の第１のシャフト部７１、及び第１のシャフト部７１の先端部７１ａに軸方向に沿って延設され、隣接する椎体Ｌ１、Ｌ２の左右両側面をそれぞれ挟持し固定する固定爪７４ｂが先端に連接されて椎体Ｌ１、Ｌ２の直交面内で開閉可能な少なくとも各１対のクランプアーム７４、７４を有する保持装置本体７０ａと、第１のシャフト部７１に前進／後退自在に外嵌され、後端に把持部７７が設けられた中空長尺の第２のシャフト部７６からなり、前進又は後退することにより各１対のクランプアーム７４、７４を縮径方向に閉じ又は拡径方向に開くクランプアーム開閉管７０ｂと、からなる。保持装置本体７０ａとクランプアーム開閉管７０ｂとから椎体クランプ機構を構成している。An intervertebral bodyspace holding device 70 according to an embodiment of the present invention includes a cannula K in an abdominal part Ma for endoscope provided on a living body abdominal part MN1 side with agrip 72 at a rear end (see FIG. 1). The hollow longfirst shaft portion 71 inserted to the vicinity of the front surface of the vertebral bodies L1 and L2 via the vertebral body and thedistal end portion 71a of thefirst shaft portion 71 are extended along the axial direction and are adjacent to the vertebrae. A holding device having at least one pair ofclamp arms 74 and 74 that can be opened and closed in the orthogonal planes of the vertebral bodies L1 and L2 with fixingclaws 74b that clamp and fix the left and right side surfaces of the bodies L1 and L2 respectively. It consists of amain body 70a and a hollow longsecond shaft portion 76 which is fitted to thefirst shaft portion 71 so as to be movable forward / backward and provided with a grippingportion 77 at the rear end. A pair ofclamp arms 74, 74 A clamparm closing pipe 70b open to closed or expanded direction direction of reducing the diameter, made of. A vertebral body clamping mechanism is constituted by the holding devicemain body 70a and the clamp arm opening /closing tube 70b.

　この実施形態の保持装置本体７０ａは、図２８に示すように、先端に各固定爪７４ｂが連設され、後端部が第１のシャフト部７１の先端部７１ａに連設され、フリー状態では固定爪７４ｂをそれぞれ椎体Ｌ１、Ｌ２の直交面内で拡径して開くように屈曲されて弾支する弾性支持部７４ａを有する各１対のクランプアーム７４、７４を備える。As shown in FIG. 28, the holding devicemain body 70a of this embodiment has the fixedclaws 74b connected to the tip, the rear end connected to thetip 71a of thefirst shaft portion 71, and in the free state. A pair ofclamp arms 74 and 74 each having anelastic support portion 74a that is bent and elastically supported so as to expand and open the fixingclaws 74b in the orthogonal planes of the vertebral bodies L1 and L2, respectively.

　そして、クランプアーム開閉管７０ｂは、第２のシャフト部７６の先端部７６ａが前進して弾性支持部７４ａを外側から押圧することにより各１対のクランプアーム７４、７４を２点鎖線で示す縮径方向に閉じ、その先端部７６ａが弾性支持部７４ａから後退することにより各１対のクランプアーム７４、７４を２点鎖線で示す拡径方向に開く。各１対のクランプアーム７４、７４は、第２のシャフト部７６の先端部７６ａのＣ１軸方向の位置がＸ１（全閉位置）のとき最小に閉じ、Ｘ２（椎体把持／固定位置）のとき椎体Ｌ１、Ｌ２の左右側面を把持／固定し、Ｘ３（全開位置）のとき最大に開く。The clamp arm opening /closing pipe 70b is a contraction of the pair ofclamp arms 74, 74 indicated by a two-dot chain line by thedistal end portion 76a of thesecond shaft portion 76 moving forward and pressing theelastic support portion 74a from the outside. The pair ofclamp arms 74 and 74 are opened in a diameter increasing direction indicated by a two-dot chain line by closing in the radial direction and retreating thedistal end portion 76a from theelastic support portion 74a. Each of the pair ofclamp arms 74, 74 is closed to the minimum when the position of thedistal end portion 76a of thesecond shaft portion 76 in the C1 axis direction is X1 (fully closed position), and is X2 (vertebral body grasping / fixing position). Sometimes the left and right lateral surfaces of the vertebral bodies L1 and L2 are gripped / fixed, and open to the maximum at X3 (fully open position).

　固定爪７４ｂの椎体挟持面には、椎体Ｌ１、Ｌ２の左右側面に突刺可能な複数の尖鋭突起７４ｃを有する。The vertebral body clamping surface of the fixedclaw 74b has a plurality ofsharp protrusions 74c that can be pierced on the left and right side surfaces of the vertebral bodies L1 and L2.

　また、この実施例の保持装置本体７０ａは、第１のシャフト部７１の先端部７１ａに椎体Ｌ１、Ｌ２の外径より僅かに狭い間隔で椎体間スペースＭに向かい軸方向に沿って対向状態で延設され、先端部から椎間板スペースＭ内に挿入されることにより隣接する椎体Ｌ１、Ｌ２を適正な間隔に修正して保持するような外形形状に形成された少なくとも１対のスペーサー７３、７３をさらに備える。１対のスペーサー７３、７３と各１対のクランプアーム７４、７４とはその主軸が略９０°ずれた各平面内に設けられる。Further, the holdingdevice body 70a of this embodiment is opposed to the intervertebral space M along the axial direction at a slightly narrower distance than the outer diameter of the vertebral bodies L1 and L2 to thedistal end portion 71a of thefirst shaft portion 71. At least one pair ofspacers 73 formed in an outer shape that extends in a state and is inserted into the intervertebral disc space M from the distal end portion so that the adjacent vertebral bodies L1 and L2 are corrected and held at appropriate intervals. , 73 are further provided. The pair ofspacers 73 and 73 and the pair ofclamp arms 74 and 74 are provided in respective planes whose main axes are shifted by approximately 90 °.

　こような、保持装置本体７０ａの構成により、構造及び操作が簡易化され、１対のスペーサー７３、７３が先端から椎間板スペースＭ内に挿入されることにより隣接する椎体Ｌ１、Ｌ２を適正な間隔に修正して保持するとともに、各１対のクランプアーム７４、７４の複数の尖鋭突起７４ｃを有する固定爪７４ｂにより隣接する椎体Ｌ１、Ｌ２の左右両側面をそれぞれ挟持し固定することから、椎体間固定外科手術における隣接する椎体Ｌ１、Ｌ２の適正な間隔修正及び信頼性の高い固定／保持が同時に短時間で行うことができる。これにより、従来の椎体間固定外科手術に比べて手術時間が短縮できるため、患者や医者を含む医療スタッフの肉体及び精神的負担、患者の手術侵襲さらには経済的負担をさらに軽減することができる。Such a configuration of the holding devicemain body 70a simplifies the structure and operation, and the pair ofspacers 73 and 73 are inserted into the intervertebral disc space M from the distal end, so that the adjacent vertebral bodies L1 and L2 are properly connected. Since the distance between the left and right side surfaces of the adjacent vertebral bodies L1 and L2 is held and fixed by the fixingclaws 74b having a plurality ofsharp protrusions 74c of each pair ofclamp arms 74 and 74, respectively, while being corrected and held at intervals. In the interbody fusion surgery, it is possible to correct the distance between adjacent vertebral bodies L1 and L2 and to perform reliable fixation / retention simultaneously in a short time. As a result, the operation time can be shortened compared to the conventional interbody fusion surgery, so that the physical and mental burdens of medical staff including patients and doctors, the surgical invasion of patients, and the economic burden can be further reduced. it can.

　図３０は本発明の変形実施形態の椎体間固定外科手術用椎体間スペース保持装置７０´の概念を示す平面図（上半部断面）、図３１は図３０の椎体間スペース保持装置７０´の縦断面図（上半部断面）、図３２は図３１のＶ－Ｖ矢視図である。この形態における前記一実施形態と同様な機能を有する構成部材には、若干寸法形状が異なっても記述を平易化するため同一の符号及び記号を付してある。30 is a plan view (upper half section) showing a concept of an intervertebral bodyspace holding device 70 ′ for interbody fusion surgery according to a modified embodiment of the present invention, and FIG. 31 is an interbody space holding device of FIG. 70 'is a longitudinal sectional view (upper half section), and FIG. 32 is a view taken along arrow VV of FIG. In this embodiment, components having the same functions as those of the above-described embodiment are given the same reference numerals and symbols in order to simplify the description even if the dimensions and shapes are slightly different.

　この変形実施形態の椎体間スペース保持装置７０´は、前記一実施形態と同様な第１のシャフト部７１、及び第１のシャフト部７１の先端部７１ａに第１の支持軸Ｐ１を介して椎体Ｌ１、Ｌ２の直交面内で揺動自在に重ね合されて枢着され、前記一実施形態と同様な固定爪７４ｂが支持部７４´ａの先端に連接された各１対のクランプアーム７４´、７４´を有する保持装置本体７０´ａと、前記一実施形態と同様な第２のシャフト部７６及び各１対のクランプアーム７４´、７４´の中間部の反重ね合せ面側に第２の支持軸Ｐ２、Ｐ２を介してそれぞれ一端部が揺動自在に重ねられて枢着されるとともに、その各他端部が第２のシャフト部７６の先端部７６ａに突設されたブラケット７８に第３の支持軸Ｐ３回りに揺動自在に重ね合されて枢着された各１対のリンク部材７９、７９を有するクランプアーム開閉管７０´ｂと、からなる。The interbodyspace holding device 70 ′ of this modified embodiment is similar to thefirst shaft portion 71 and thedistal end portion 71 a of thefirst shaft portion 71 similar to that of the above-described one embodiment via the first support shaft P <b> 1. A pair of clamp arms each having a fixedclaw 74b that is pivotably overlapped and pivotally mounted in an orthogonal plane of the vertebral bodies L1 and L2, and is connected to the tip of the support portion 74'a. The holding device main body 70'a having 74 'and 74' and thesecond shaft portion 76 and the intermediate portion of each pair of clamp arms 74 'and 74' on the side opposite to the overlapping surface as in the above embodiment Brackets in which one end portions are pivotably overlapped and pivotally mounted via the second support shafts P2 and P2, and the other end portions project from thetip end portion 76a of thesecond shaft portion 76. 78 is pivotally overlapped with the third support shaft P3 so as to be swingable. And the clamp arm open tube 70'b having alink member 79, 79 of each pair which is composed of.

　保持装置本体７０´ａ及びクランプアーム開閉管７０´ｂは、椎体クランプ機構を構成している。この変形実施形態の椎体クランプ機構は、支持部７４´ａが前記一実施形態の適宜な弾力性を有する弾性支持部７４ａとは異なり剛性が大きい形状に形成されており、図３０に示すように、第２のシャフト部７６が前進又は後退することにより各１対のリンク部材７９、７９を第３の支持軸Ｐ３回りに反時計方向又は時計方向に揺動させて各１対のクランプアーム７４´、７４´を椎体Ｌ１、Ｌ２の直交面内で第１の支持軸Ｐ１を支点としていずれも２点鎖線で示す縮径方向に閉じ又は拡径方向に開くトグル機構を構成している。各１対のクランプアーム７４´、７４´は、第２のシャフト部７６の先端部７６ａのＣ１軸方向の位置がＸ１´（全閉位置）のとき最小に閉じ、Ｘ２（椎体把持／固定位置）のとき椎体Ｌ１、Ｌ２の左右側面を把持／固定し、Ｘ３´（全開位置）のとき最大に開く。The holding device body 70'a and the clamp arm opening / closing tube 70'b constitute a vertebral body clamping mechanism. In the vertebral body clamping mechanism of this modified embodiment, the support portion 74'a is formed in a shape having high rigidity unlike theelastic support portion 74a having appropriate elasticity of the one embodiment, as shown in FIG. Further, as thesecond shaft portion 76 moves forward or backward, each pair oflink members 79, 79 are swung counterclockwise or clockwise around the third support shaft P3 to each pair of clamp arms. Thetoggle mechanism 74 ′, 74 ′ is closed in the reduced diameter direction indicated by the two-dot chain line or opened in the enlarged diameter direction with the first support axis P1 as a fulcrum within the orthogonal plane of the vertebral bodies L1, L2. . Each pair ofclamp arms 74 ′ and 74 ′ is closed to the minimum when the position of thedistal end portion 76 a of thesecond shaft portion 76 in the C1 axis direction isX 1 ′ (fully closed position), and X 2 (vertebral body grasping / fixing) Position), the left and right lateral surfaces of the vertebral bodies L1 and L2 are gripped / fixed, and the X3 '(fully open position) opens to the maximum.

　この変形実施形態の椎体間スペース保持装置７０´は、保持装置本体７０´ａ及びクランプアーム開閉管７０´ｂからなる椎体クランプ機構がトグル機構を構成していることから、隣接する椎体Ｌ１、Ｌ２の左右両側面の挟持／固定力が強大化され、椎体間スペース保持装置の信頼性を一層向上させることができる。In the interbodyspace holding device 70 ′ of this modified embodiment, the vertebral body clamping mechanism including the holding devicemain body 70 ′ a and the clamp arm opening /closing tube 70 ′ b constitutes a toggle mechanism. The clamping / fixing force between the left and right side surfaces of L1 and L2 is increased, and the reliability of the interbody space holding device can be further improved.

　また、この変形実施形態の椎体間スペース保持装置７０´も、第１のシャフト部７１の先端部７１ａに前記一実施形態の椎体間スペース保持装置７０と同様の、隣接する椎体Ｌ１、Ｌ２を適正な間隔に修正して保持するような外形形状に形成された少なくとも１対のスペーサー７３、７３をさらに備える。Also, the interbodyspace holding device 70 ′ of this modified embodiment is similar to the adjacentvertebral body L 1, similar to the interbodyspace holding device 70 of the above embodiment, at thedistal end portion 71 a of thefirst shaft portion 71. It further includes at least one pair ofspacers 73 and 73 formed in an outer shape so that L2 is corrected and held at an appropriate interval.

　また、上記一実施形態及び変形実施形態の椎体間スペース保持装置７０、７０´の第１及び第２のシャフト部７１、７６は、図２９、３２に示すように、いずれも例えば略長円形、略楕円形又は略四角形断面あるいは図示しない略円形や略多角形断面など椎体の外形形状／寸法に相応する中空形状に形成される。そして、例えば本体嵌入ドライバーのシャフト部８１に比べて第１のシャフト部７１が相当大きくなるような場合、第１のシャフト部７１内には、挿通される椎体間固定装置１０あるいは椎体間固定装置１０の本体１１を椎体Ｌ１、Ｌ２間に嵌入するための後述の本体嵌入ドライバーのシャフト部８１の挿入案内用として、椎体間固定装置１０あるいはシャフト部８１の最大外径より例えば２ｍｍ程度大きな内径のガイド筒７１ｂ（２点鎖線で示す）を必要に応じて設けてもよい。In addition, as shown in FIGS. 29 and 32, the first andsecond shaft portions 71 and 76 of the interbodyspace holding devices 70 and 70 ′ of the one embodiment and the modified embodiment are both substantially oval, for example. And a hollow shape corresponding to the outer shape / size of the vertebral body, such as a substantially elliptical or substantially rectangular cross section, or a substantially circular or substantially polygonal cross section (not shown). For example, when thefirst shaft portion 71 is considerably larger than theshaft portion 81 of the main body insertion driver, the intervertebralbody fixing device 10 or the intervertebral body is inserted into thefirst shaft portion 71. For insertion guide of ashaft portion 81 of a body insertion driver to be described later for inserting themain body 11 of the fixingdevice 10 between the vertebral bodies L1 and L2, for example 2 mm from the maximum outer diameter of theinterbody fixing device 10 or theshaft portion 81. Aguide cylinder 71b (indicated by a two-dot chain line) having a relatively large inner diameter may be provided as necessary.

　また、図２７乃至２９に示すように、第１のシャフト部７１の先端部の左右のクランプアーム７４、７４部に対応する内面に架け亘る補強板７５、７５を必要に応じて設けてもよい。この場合、補強板７５、７５間の距離は、椎体間固定装置１０あるいはシャフト部８１に干渉しないようにそれらの最大外径より若干例えば少なくとも２ｍｍ程度大きく設定される。In addition, as shown in FIGS. 27 to 29, reinforcingplates 75 and 75 extending over the inner surfaces corresponding to the left and right clamparms 74 and 74 at the tip of thefirst shaft portion 71 may be provided as necessary. . In this case, the distance between the reinforcingplates 75 and 75 is set to be slightly larger than, for example, at least about 2 mm from their maximum outer diameter so as not to interfere with theinterbody fusion device 10 or theshaft portion 81.

　図３３は本発明のさらに別の変形実施形態の椎体間スペース保持装置７０´´の概念を示す縦断面図（上半部断面）、図３４は図３３の椎体間スペース保持装置７０´´の平面図（上半部断面）、図３５は図３４のＷ－Ｗ矢視図である。この形態における前記実施形態と同様な機能を有する構成部材には、若干寸法形状が異なっても記述を平易化するため同一の符号及び記号を付してある。FIG. 33 is a longitudinal sectional view (upper half section) showing the concept of an interbodyspace holding device 70 ″ of still another modified embodiment of the present invention, and FIG. 34 is an interbodyspace holding device 70 ′ of FIG. ′ ′ Plan view (upper half section), FIG. 35 is a view taken along the line WW in FIG. 34. In this embodiment, components having the same functions as those of the embodiment described above are given the same reference numerals and symbols in order to simplify the description even if the dimensions are slightly different.

　この別の変形実施形態の椎体間スペース保持装置７０´´は、後端に把持部７２が設けられ、生体腹部ＭＮ１側に設けられた内視鏡用腹腔部Ｍａ内のカニューレＫ（図１参照）を介して椎体Ｌ１、Ｌ２の前面近傍まで挿入される中空長尺の第１のシャフト部７１´と、第１のシャフト部７１´の外面に軸方向に沿って回転自在に延設され、先端に形成されたねじ部７６´ａが隣接する椎体Ｌ１、Ｌ２の一方又は両方の前面部に羅入し固定される長尺固定ねじ部材７６´ｂと、第１のシャフト部７１´の先端部７１´ａに突設され、隣接する椎体Ｌ１、Ｌ２の一方又は両方の前面部に突刺可能な一つ又は複数の針状突起７１ｃと、を備える。The intervertebral bodyspace holding device 70 ″ according to another modified embodiment is provided with a graspingportion 72 at the rear end, and a cannula K (see FIG. 1) in the abdominal portion Ma for endoscope provided on the living body abdominal portion MN1 side. A hollow longfirst shaft portion 71 ′ inserted to the vicinity of the front surface of thevertebral bodies L 1 andL 2 via the reference), and extended on the outer surface of thefirst shaft portion 71 ′ so as to be rotatable along the axial direction. A long fixed screw member 76'b in which the screw portion 76'a formed at the tip is inserted into and fixed to one or both front surface portions of the adjacent vertebral bodies L1, L2, and thefirst shaft portion 71. And one or a plurality of needle-like protrusions 71c that can project into one or both front surface portions of the adjacent vertebral bodies L1 and L2.

　長尺固定ねじ部材７６´ｂは、第１のシャフト部７１´の外面に立設された後部支持部材７５ａ及び前部支持部材７５ｂの挿通孔７５ｃ内に回転自在に挿通され、後端部に図示しないドライバー又はレンチ係合溝あるいは六角型外形を有する頭部７６´ｃを備えている。The long fixing screw member 76'b is rotatably inserted into theinsertion hole 75c of therear support member 75a and thefront support member 75b provided upright on the outer surface of the first shaft portion 71 '. A driver or wrench engaging groove (not shown) or a head portion 76'c having a hexagonal outer shape is provided.

　長尺固定ねじ部材７６´ｂ、後部支持部材７５ａ及び前部支持部材７５ｂは椎体固定機構７６´を構成し、カニューレＫ内に挿入された第１のシャフト部７１´を後端部又は把持部７２を介して押圧して先端部の針状突起７１ｃを隣接する椎体Ｌ１、Ｌ２の一方又は両方の前面部に突刺した後に、頭部７６´ｃを介して長尺固定ねじ部材７６´ｂを押圧しながら例えば時計回りに回転させて椎体Ｌ１、Ｌ２の一方又は両方の前面部に羅入し固定する。The long fixing screw member 76'b, therear support member 75a, and thefront support member 75b constitute a vertebral body fixing mechanism 76 ', and the first shaft portion 71' inserted into the cannula K is held at the rear end portion or gripped. After pressing through theportion 72 to pierce the frontal portion of one or both of the adjacent vertebral bodies L1 and L2 with the needle-like protrusion 71c at the distal end, the elongated fixingscrew member 76 ′ is inserted through thehead 76′c. While pressing b, it is rotated clockwise, for example, and inserted into and fixed to one or both front portions of the vertebral bodies L1, L2.

　この変形実施形態の椎体間スペース保持装置７０´´は、第１のシャフト部７１´の外面及び先端部７１´ａにそれぞれ設けられた椎体固定機構７６´及び針状突起７１ｃにより、隣接する椎体Ｌ１、Ｌ２の一方又は両方の前面部にそれぞれ螺入、突刺して抜け止め効果を伴って固定することから、構造及び操作が簡易であるとともに、その後で椎体間固定装置１０を椎体Ｌ１、Ｌ２間に移植固定する際に比較的大きな外力が負荷される椎体Ｌ１、Ｌ２が後方又は左右の側方にずれないため椎体間固定外科手術における椎体間スペース保持の信頼性が確保される。The interbodyspace holding device 70 ″ of this modified embodiment is adjacent to the vertebralbody fixing mechanism 76 ′ and the needle-like protrusion 71 c provided on the outer surface of thefirst shaft portion 71 ′ and thedistal end portion 71 ′, respectively. The vertebral bodies L1 and L2 are fixed to each other by screwing and piercing into the front portions of the vertebral bodies L1 and L2, respectively, so that the structure and operation are simple. Since the vertebral bodies L1 and L2 to which a relatively large external force is applied when transplanted and fixed between the vertebral bodies L1 and L2 are not displaced rearward or left and right, the reliability of intervertebral body space retention in interbody fusion surgery Sex is secured.

　なお、前記把持部７２、７７は、それぞれカニューレＫの外部に順次露出する長さに設定された第１、第２のシャフト部７１、７１´、７６の後端に嵌着されたボス部７２ａ、７７ａ上に立設された少なくとも１対又は複数の取手（ハンドル）状に形成されているが、公知の円筒型などその他任意の把持形状（図示しない）に形成することができる。The grippingportions 72 and 77 areboss portions 72a fitted to the rear ends of the first andsecond shaft portions 71, 71 'and 76, which are set to lengths that are sequentially exposed to the outside of the cannula K, respectively. , 77a and at least one handle or a plurality of handles (handles) standing upright, but can be formed in any other gripping shape (not shown) such as a known cylindrical type.

　また、第１、第２のシャフト部７１、７１´、７６の先端部及びその他のクランプ機構、椎体固定機構７６´及びスペーサー７３、７３´等の部材を除くシャフト部の後方部材は、例えば樹脂などの軽量な高分子材料から構成することができる。椎体間スペース保持装置７０、７０´、７０´´は、極力軽量なＴｉや高分子材料を組み合せて構成するなど全体を軽量化して操作性を向上させることが望ましい。Further, the rear members of the shaft portion excluding the distal ends of the first andsecond shaft portions 71, 71 ′, 76 and other clamp mechanisms, the vertebralbody fixing mechanism 76 ′, thespacers 73, 73 ′, etc. It can be composed of a lightweight polymer material such as a resin. It is desirable that the interbodyspace holding devices 70, 70 ′, and 70 ″ are composed of a combination of Ti and polymer materials that are as light as possible to reduce the overall weight and improve operability.

　図３６は本発明の一実施形態の本体嵌入ドライバー８０の概念を示す縦断面図（上半部断面）、図３７は図３６のＳ－Ｓ矢視図、図３８は本発明の一実施形態の押圧ねじドライバー９０の概念を示す側面図、図３９は図３８のＴ－Ｔ矢視図である。FIG. 36 is a longitudinal sectional view (upper half section) showing a concept of a mainbody insertion driver 80 according to an embodiment of the present invention, FIG. 37 is a view taken along the line SS of FIG. 36, and FIG. 38 is an embodiment of the present invention. FIG. 39 is a view taken along the line TT in FIG. 38.

　一実施形態の本体嵌入ドライバー８０は、後端に把持部８２が設けられ、前記椎体間スペース保持装置７０、７０´、７０´´の第１のシャフト部７１、７１´内を介して椎体Ｌ１、Ｌ２の前面近傍まで挿入される中空長尺のシャフト部８１と、シャフト部８１の先端に椎体間固定装置１０の本体１１の後端面１３に形成された後端係合部２９（図３）に係合する先端係合部８３とからなる。In one embodiment, thebody insertion driver 80 is provided with a grippingportion 82 at the rear end, and the vertebrae are interposed through thefirst shaft portions 71 and 71 ′ of the interbodyspace holding devices 70, 70 ′ and 70 ″. A hollowlong shaft portion 81 inserted to the vicinity of the front surfaces of the bodies L1 and L2, and a rear end engaging portion 29 (formed on therear end surface 13 of thebody 11 of theinterbody fusion device 10 at the distal end of the shaft portion 81) 3) and atip engaging portion 83 that engages.

　把持部８２は、前記椎体間スペース保持装置７０、７０´、７０´´の第１のシャフト部７１、７１´後端の外部に露出する長さに設定されたシャフト部８１の後端に嵌着されたボス部８２ａ上に立設された少なくとも１対又は複数の取手（ハンドル）状に形成されている。Thegripping part 82 is attached to the rear end of theshaft part 81 set to a length exposed to the outside of the rear end of thefirst shaft parts 71, 71 ′ of the interbodyspace holding devices 70, 70 ′, 70 ″. It is formed in the shape of at least one pair or a plurality of handles (handles) standing on the fittedboss portion 82a.

　先端係合部８３は、本体１１の部分円弧状の後端係合部２９（図３）に嵌入して係合する複数の部分円弧形の爪状に形成されており、その爪の先端部は角部がカットされるなど後端係合部２９に嵌入し易い形状となっている。なお、先端係合部８３は、後端係合部２９の任意の形状に適合する形状に形成される。The frontend engaging portion 83 is formed in a plurality of partial arcuate claw shapes that are engaged with and engaged with the partial arc-shaped rear end engaging portion 29 (FIG. 3) of themain body 11, and the front end of the nail The portion has a shape that can be easily fitted into the rearend engaging portion 29, such as a corner portion being cut. The frontend engaging portion 83 is formed in a shape that matches the arbitrary shape of the rearend engaging portion 29.

　先端係合部８３はＳＵＳやＴｉなどの硬質の金属製で、シャフト部８１は例えば樹脂などの軽量な高分子材料から構成することができる。本体嵌入ドライバー８０は、極力軽量なＴｉや高分子材料を組み合せて構成するなど全体を軽量化して操作性を向上させることが望ましい。Thetip engaging portion 83 is made of a hard metal such as SUS or Ti, and theshaft portion 81 can be made of a light polymer material such as a resin. It is desirable that the mainbody insertion driver 80 is lightened as a whole, for example, to be constructed by combining Ti and polymer materials that are as light as possible to improve operability.

　押圧ねじドライバー９０は、後端に把持部９２が設けられ、本体嵌入ドライバー８０のシャフト部８１内を介して椎体Ｌ１、Ｌ２の前面近傍まで挿入される長尺のシャフト部９１と、シャフト部９１の先端に押圧ねじ４０のキャップ４２の後端部に形成された後端係合部４４（図１０）に係合する先端係合部９３とからなる。Thepressing screw driver 90 is provided with agrip portion 92 at the rear end, and along shaft portion 91 inserted into the vicinity of the front surface of the vertebral bodies L1 and L2 through theshaft portion 81 of the mainbody insertion driver 80, and the shaft portion Thefront end 91 includes a frontend engaging portion 93 that engages with a rear end engaging portion 44 (FIG. 10) formed at the rear end portion of thecap 42 of thepressing screw 40.

　把持部９２は、本体嵌入ドライバー８０後端の外部に露出する長さに設定されたシャフト部９１の後端に嵌着されたボス部９２ａ上に立設された少なくとも１対又は複数の取手（ハンドル）状に形成されている。すなわち、押圧ねじドライバー９０は、図１に示すように、椎体間固定装置１０の椎体Ｌ１、Ｌ２間への固定完了状態において本体嵌入ドライバー８０の後端面より外側に露出して把持部９２を把持できる十分な長さを有する。Thegrip portion 92 is at least one pair or a plurality of handles (e.g., standing on aboss portion 92a fitted to the rear end of theshaft portion 91 set to a length exposed to the outside of the rear end of the mainbody insertion driver 80. It is formed in a handle shape. That is, as shown in FIG. 1, thepressing screw driver 90 is exposed to the outside from the rear end surface of the mainbody insertion driver 80 when the intervertebralbody fixing device 10 is fixed between the vertebral bodies L1 and L2, and is held by thegrip portion 92. It has a sufficient length that can be gripped.

　先端係合部９３の先端部９３ａは、押圧ねじ４０の後端係合部４４（図１０）に係合する例えばプラスドライバ状に形成されている。なお、後端係合部４４が十字溝に代えて図示しない例えば六角形穴に形成される場合は、先端部９３ａはその六角形穴に係合する六角レンチ状に形状されるなど、後端係合部４４の任意の形状に適合する形状（図示しない）に形成される。Thefront end portion 93a of the frontend engaging portion 93 is formed, for example, in the shape of a plus driver that engages with the rear end engaging portion 44 (FIG. 10) of thepressing screw 40. When the rearend engaging portion 44 is formed in a hexagonal hole (not shown) instead of the cross groove, thefront end 93a is shaped like a hexagon wrench that engages with the hexagonal hole. It is formed in a shape (not shown) that fits any shape of the engagingportion 44.

　先端係合部９３はＳＵＳやＴｉなどの硬質の金属製で、シャフト部９１は例えば樹脂などの軽量な高分子材料から構成することができる。押圧ねじドライバー９０は、シャフト部９１を中空状に形成するなども含めて全体を軽量化して操作性を向上させることが望ましい。Thetip engaging portion 93 is made of a hard metal such as SUS or Ti, and theshaft portion 91 can be made of a light polymer material such as a resin. It is desirable that thepressure screw driver 90 is lightened as a whole including theshaft portion 91 formed in a hollow shape to improve operability.

　なお、前記把持部８２、９２は、公知の円筒型などその他任意の把持形状（図示しない）に形成することができる。The grippingportions 82 and 92 can be formed in any other gripping shape (not shown) such as a known cylindrical shape.

　ここで、前記変形実施形態の椎体間スペース保持装置７０´´を適用した変形実施形態の椎体間固定外科手術システムの概念縦断面図（主要部断面）を図４０に示す。Here, FIG. 40 shows a conceptual longitudinal cross-sectional view (cross-section of the main part) of the interbody fusion surgery system of the modified embodiment to which the interbodyspace holding device 70 ″ of the modified embodiment is applied.

　次に、図１、８、９、２７～２９、３６～３９、４１～４３等を参照し、一実施形態の椎体間固定装置１０を、腹部ＭＮ１側から脊椎の前面まで形成された内視鏡用腹腔部Ｍａ内のカニューレＫを介していずれも図示しない内視鏡（又は腹腔鏡）あるいは前記カプセル内視鏡で観察しながら椎体間スペース保持装置７０、本体嵌入ドライバー８０及び押圧ねじドライバー９０を用い、椎体Ｌ１、Ｌ２の間の椎間板Ｍ部に嵌入し椎体Ｌ１、Ｌ２間を固定する椎体間固定外科手術方法について、その主要な特徴となる部分を説明する。Next, referring to FIGS. 1, 8, 9, 27 to 29, 36 to 39, 41 to 43, etc., theinterbody fusion device 10 according to one embodiment is formed from the abdominal MN1 side to the front surface of the spine. While observing with an endoscope (or a laparoscope) (not shown) or the capsule endoscope through a cannula K in the abdominal cavity Ma for endoscope, the interbodyspace holding device 70, thebody insertion driver 80, and a pressing screw An intervertebral body fixing surgical method that uses ascrewdriver 90 to fit into the intervertebral disc M between the vertebral bodies L1 and L2 and fixes the vertebral bodies L1 and L2 will be described as a main feature.

　手術の前に、患者の最適な椎体固定装置１０の寸法及び望ましい伸延が評価決定された後、図４１（ａ）に示すように、患者を伸延及び椎体（椎骨）の整列修正が同時にできる脊柱手術台Ｂｄ上に上向きに寝かせて脚をく字状に屈曲させるいわゆる砕石位をとった状態で専用の足代に載せ、肩が頭側に下がらないように腕及び脚部を含む人体ＭＮを固定する。Prior to surgery, after the patient's optimal vertebralbody fixation device 10 dimensions and desired distraction have been evaluated, the patient is distracted and the vertebral body (vertebral) alignment corrected simultaneously as shown in FIG. 41 (a). Human body MN including arms and legs so that the shoulder is not lowered to the head side in a so-called crushed position where the legs are bent upwardly on the spinal table Bd To fix.

　引続き、図４１（ｂ）に示すように、脊柱手術台Ｂｄを傾け、足部を上げて頭部を下げる状態いわゆる頭部低位・腰部高位のトレンデレンブルグ状態にし、以下の手術を開始する。Subsequently, as shown in FIG. 41 (b), the spinal table Bd is tilted, the foot is raised and the head is lowered, so that the head is lowered and the waist is in the Trendelenburg state, and the following operation is started.

　このトレンデレンブルグ状態で、図４２に示すように、腹部ＭＮ１の所定の位置に例えば電気メスにより数ｍｍ程度の切開創Ｍｆを適宜複数ヶ所設けて腹腔鏡用ポートＭａ、Ｍｂ、Ｍｃ、Ｍｄ、Ｍｅ等を設定し、そこから対象となる前記椎体Ｌ１、Ｌ２に対応する手術場所を観察するために例えばアクセスニードルなどの穿刺針を通して腹腔内にＣＯ２などの不活性ガスである気腹ガスを注入する。このように、腹部ＭＮ１側から気腹ガスを腹腔内に注入して腸部を下腹部側に押し遣り、内視鏡（又は腹腔鏡）を介して椎体Ｌ１、Ｌ２近傍の視界を確保する。ポートＭａは、前記椎体間固定装置１０を挿入するための主要な腹腔鏡用ポートなるもので、前記椎体Ｌ１、Ｌ２間のほぼ中央部を目指して配置される。ポートＭｂは、腹部ＭＮ１の中心軸上で例えば臍から数ｍｍ～１０ｃｍ程度頭部寄りに配置される。腹壁は、椎体Ｌ１、Ｌ２部とは反対の上腹部の脈管の側方に配置される。In this Trendelenburg state, as shown in FIG. 42, laparoscopic ports Ma, Mb, Mc, Md, and a plurality of incision wounds Mf of about several millimeters are provided at predetermined positions of the abdominal part MN1, for example, with an electric knife. In order to observe the surgical site corresponding to the target vertebral bodies L1 and L2 from there, for example, Me or the like, an insufflation gas such as CO2 is supplied into the abdominal cavity through a puncture needle such as an access needle. inject. In this way, pneumoperitoneum gas is injected into the abdominal cavity from the abdominal part MN1 side, the intestine part is pushed to the lower abdominal part side, and a field of view near the vertebral bodies L1 and L2 is secured through the endoscope (or laparoscope). . The port Ma is a main laparoscopic port for inserting theinterbody fusion device 10 and is arranged so as to aim at a substantially central portion between the vertebral bodies L1 and L2. The port Mb is disposed on the central axis of the abdominal part MN1, for example, a few millimeters to 10 cm from the navel near the head. The abdominal wall is disposed on the side of the upper abdominal vessel opposite to the vertebral bodies L1 and L2.

　ポートＭｃ、Ｍｄは、ポートＭｂの左右側に互いに対向するように僅かにずらして配置される。ポートＭｃ、Ｍｄを通して図示しない適宜なリトラクタ（鉗子）を挿入し、対象となる椎体部の周囲から適宜内臓物を引き離す処置などが行われる。The ports Mc and Md are arranged slightly shifted so as to face each other on the left and right sides of the port Mb. An appropriate retractor (forceps) (not shown) is inserted through the ports Mc and Md, and a treatment for appropriately separating the internal organs from the periphery of the target vertebral body is performed.

　このようにして、腹部ＭＮ１側に設けられた複数個所のポートＭａ、Ｍｂ、Ｍｃ、Ｍｄ、Ｍｅから内視鏡（又は腹腔鏡）を介して椎体Ｌ１、Ｌ２に隣接する腹部側及び左右側面のいずれも図示しない硬膜包及び横断神経根などの骨辺縁物を脇に押し遣るなどの事前処置を施す（事前処置工程）。In this way, the abdominal side and the left and right side surfaces adjacent to the vertebral bodies L1 and L2 from the ports Ma, Mb, Mc, Md, and Me provided on the abdominal part MN1 side via the endoscope (or laparoscope) In either case, a pretreatment such as pushing a bone margin such as a dural capsule and a transverse nerve root (not shown) to the side is performed (pretreatment step).

　この際、図４３に示すように、例えばバーサステップあるいはバーサポートなどの処置用トロカールスリーブＴｒがポートＭａ部内に配置される。トロカールスリーブＴｒの外筒である中空状のカニューレ（又はパワーシールドスリーブ）Ｋ内には、穿刺針や穿刺針が抜き外された後に後述の各種処置具Ｔｐが脊柱（脊椎）Ｌ部まで挿入される。At this time, as shown in FIG. 43, for example, a treatment trocar sleeve Tr such as a verse step or a bar support is disposed in the port Ma portion. In the hollow cannula (or power shield sleeve) K which is the outer cylinder of the trocar sleeve Tr, after the puncture needle and the puncture needle are removed, various treatment tools Tp described later are inserted up to the spinal column (spine) L portion. The

　次いで、腹部ＭＮ１側に設けられた内視鏡用ポートＭａ部内に挿入されたカニューレＫを介して、図２７、２８に示すように、椎体Ｌ１、Ｌ２の前面近傍まで各１対のクランプアーム７４、７４を閉じた状態の椎体間スペース保持装置７０を挿入し、１対のスペーサー７３、７３を先端から椎間板スペースＭ内に挿入して隣接する椎体Ｌ１、Ｌ２を適正な間隔に修正して保持すると同時に、各１対のクランプアーム７４、７４を開き固定爪７４ｂにより隣接する椎体Ｌ１、Ｌ２の左右両側面をそれぞれ挟持するように再度閉じて複数の尖鋭突起７４ｃを介して（突刺し）固定する（椎体間スペース保持工程）。このとき、各１対のクランプアーム７４、７４の開閉操作は、前記したように、クランプアーム開閉管７０ｂを後退又は前進させることにより行う。Next, as shown in FIGS. 27 and 28, a pair of clamp arms to the vicinity of the front surfaces of the vertebral bodies L1 and L2 through a cannula K inserted into the endoscope port Ma provided on the abdominal part MN1 side. The intervertebralspace holding device 70 with 74 and 74 closed is inserted, and a pair ofspacers 73 and 73 are inserted into the intervertebral disc space M from the tip to correct the adjacent vertebral bodies L1 and L2 to an appropriate interval. At the same time, the pair ofclamp arms 74 and 74 are opened and closed again so as to sandwich the left and right side surfaces of the adjacent vertebral bodies L1 and L2 by the fixingclaws 74b, respectively, via a plurality ofsharp protrusions 74c ( Piercing) and fixing (interbody space holding process). At this time, the opening / closing operation of each pair ofclamp arms 74, 74 is performed by moving the clamp arm opening /closing pipe 70b backward or forward as described above.

　次に、いずれも図示しないが、腹部ＭＮ１側から椎体間スペース保持装置７０の第１のシャフト部７１内に挿入した内視鏡（又は腹腔鏡）を用いて移植ドライバーのドリル又は中空の管状カッター（穿孔器）により椎体Ｌ１、Ｌ２の間の椎間板スペースＭ部に椎体固定装置１０の本体１１の外径より僅かに細い外径の下穴を適宜深さまで穿設する（下穴穿設工程）。Next, although not shown in the figure, a transplant driver drill or a hollow tubular tube is used by using an endoscope (or a laparoscope) inserted into thefirst shaft portion 71 of the interbodyspace holding device 70 from the abdominal part MN1 side. With a cutter (perforator), a pilot hole having an outer diameter slightly narrower than the outer diameter of themain body 11 of the vertebralbody fixing device 10 is drilled to an appropriate depth in the intervertebral disc space M between the vertebral bodies L1, L2. Installation process).

　前記下穴穿設工程後、本体嵌入ドライバー８０の先端係合部８３に本体１１の後端係合部２９を係合した状態で腹部ＭＮ１側から椎体間スペース保持装置７０の第１のシャフト部７１内に挿入し、本体１１を押圧及び回転させて椎間板スペースＭ部の前記下孔の所定位置までねじ込み嵌入させて固定する（本体嵌入工程）。このとき本体１１は、図８に示すように、雄ねじ１４、１５の外面頭頂部が椎体Ｌ１、Ｌ２の対向面Ｌ１ａ、Ｌ２ａ部に食い込み係合して螺入される。After the pilot hole drilling step, the first shaft of the interbodyspace holding device 70 from the abdomen MN1 side with the rearend engaging portion 29 of themain body 11 engaged with the frontend engaging portion 83 of the mainbody insertion driver 80. It is inserted into theportion 71, and themain body 11 is pressed and rotated to be screwed and fixed to a predetermined position of the lower hole in the intervertebral disc space M (main body inserting step). At this time, as shown in FIG. 8, themain body 11 is screwed into the outer surface tops of themale screws 14 and 15 by biting into and engaging with the opposing surfaces L1a and L2a of the vertebral bodies L1 and L2.

　次いで、図８、９に示すように、押圧ねじドライバー９０の先端係合部９３に押圧ねじ４０の後端係合部４４を係合した状態で腹部ＭＮ１側から本体嵌入ドライバー８０のシャフト部８１内に挿入し、押圧ねじ４０を椎体Ｌ１、Ｌ２間に嵌入し固定した本体１１の後端面１３の雌ねじ部１６に挿入し押圧しながら回転してねじ込み、雄ねじ部４１の先端４３面で１対のピン３０、３０の後端３１、３１面を押圧してピン３０、３０の先端３２、３２側をそれぞれ傾斜角Θ１、Θ２のガイド孔１７、１８に沿って案内し順次屈曲させながら対向面Ｌ１ａ、Ｌ２ａ部から椎体Ｌ１、Ｌ２内に傾斜して差込み固定する（ピン差込み固定工程）。このとき、本体嵌入ドライバー８０の把持部８２を回転しないように別途いずれも図示しない人手又は機械的回転拘束手段により十分押圧して保持しながら、押圧ねじ４０をキャップ４２連設面が本体１１の後端面１３に当接する所定トロークまで雌ねじ１６内に螺入する。Next, as shown in FIGS. 8 and 9, theshaft portion 81 of thebody insertion driver 80 from the abdomen MN <b> 1 side in a state where the rearend engagement portion 44 of thepress screw 40 is engaged with the frontend engagement portion 93 of thepress screw driver 90. It is inserted into the internal threadedportion 16 of therear end surface 13 of themain body 11 which is inserted and fixed between the vertebral bodies L1 and L2, and is rotated and screwed in while pressing, and 1 at thetip 43 surface of the male threadedportion 41. The rear surfaces 31, 31 of the pair ofpins 30, 30 are pressed so that thetips 32, 32 side of thepins 30, 30 are guided along the guide holes 17, 18 of the inclination angles Θ1, Θ2, respectively, and are bent sequentially. The surfaces L1a and L2a are inclined and inserted into the vertebral bodies L1 and L2 (pin insertion and fixing step). At this time, thepress screw 40 is held by thecap 42 continuous surface of themain body 11 while being sufficiently pressed and held by hand or mechanical rotation restraining means (not shown) so as not to rotate the grippingportion 82 of the mainbody insertion driver 80. Screw into theinternal thread 16 up to a predetermined trowel contacting therear end face 13.

　このようにキャップ４２は、最終的に本体１１の後端面１３に当接することにより、本体１１内部への押圧ねじ４０の所定ストロークのねじ込み代が規定されるとともに押圧ねじ４０の逆回転摩擦力がアップするため押圧ねじ４０の逆回転防止効果及びこれによるピン３０の抜け止め効果を有する。In this way, thecap 42 finally comes into contact with therear end surface 13 of themain body 11, thereby defining the screwing allowance of thepressing screw 40 into themain body 11 for a predetermined stroke and the reverse rotational frictional force of thepressing screw 40. Therefore, it has the effect of preventing the reverse rotation of thepressing screw 40 and the effect of preventing thepin 30 from coming off.

　以上説明したように、椎体間固定装置１０は椎体Ｌ１、Ｌ２間の適正な間隔に適合する外形を有する小型であり、本体１１を椎体Ｌ１、Ｌ２間に螺入した後に押圧ねじ４０を本体１１の雌ねじ１６にねじ込むだけで押圧されたピン３０の先端３２からガイド孔１７、１８に沿って屈曲され椎体Ｌ１、Ｌ２内に差込み固定される簡潔な構成であることから、腹腔鏡を併用して全て主軸Ｃ１方向からの一軸回りのねじ込み操作のみで容易に短時間で椎体間固定処置を行うことができる。As described above, theinterbody fusion device 10 is a small size having an outer shape adapted to an appropriate distance between the vertebral bodies L1 and L2, and after themain body 11 is screwed between the vertebral bodies L1 and L2, thepressing screw 40 is used. Is simply bent into thefemale screw 16 of themain body 11 and is bent along the guide holes 17 and 18 from thetip 32 of thepin 30 that is pressed, and is inserted into the vertebral bodies L1 and L2 and fixed. Thus, the interbody fusion treatment can be easily performed in a short time only by screwing around one axis from the direction of the main axis C1.

　このようにして、本発明の椎体間固定外科手術システム、外科手術方法及び椎体間スペース保持装置は、従来の椎体間固定外科手術に比べて手術規模が大幅に縮小化されるとともに手術時間及び回復期間とも大幅に短縮できるため、患者や医者を含む医療スタッフの肉体及び精神的負担、患者の手術侵襲さらには経済的負担を著しく軽減することができる。そして、椎体Ｌ１、Ｌ２内に差込まれ固定されたピン３０により本体１１の適正位置からの後退や回転を防止することができ、椎体間固定の信頼性が確保されるとともに、椎体間固定構造及び操作が大幅に簡潔化及びコンパクト化され、操作性及び経済性とも一層有利となる。As described above, the interbody fusion surgery system, the surgical method, and the interbody space holding device of the present invention are greatly reduced in operation scale as compared with the conventional interbody fusion surgery, and operated. Since both the time and the recovery period can be greatly shortened, the physical and mental burdens of medical staff including patients and doctors, surgical invasion of patients, and economic burdens can be significantly reduced. Then, thepin 30 inserted and fixed in the vertebral bodies L1 and L2 can prevent thebody 11 from retreating or rotating from the proper position, and the intervertebral body fixing reliability is ensured. The intermediate fixing structure and operation are greatly simplified and compact, and the operability and economy are more advantageous.

　図１１は本発明の別の実施形態（実施例２）による椎体間固定装置１０ａの椎体Ｌ１、Ｌ２間への固定完了状態を示す縦断面図（主要部断面）、図１２は図１１のＦ－Ｆ矢視図である。FIG. 11 is a longitudinal cross-sectional view (main part cross-section) showing the state of fixation between the vertebral bodies L1 and L2 of theinterbody fusion device 10a according to another embodiment (Example 2) of the present invention, and FIG. FIG.

　実施例２の椎体間固定装置１０ａは、実施例１の椎体間固定装置１０に対して、押圧ねじ５０に遊嵌され隣接する椎体Ｌ１、Ｌ２の前面部にかけ亘り係合し固定されることにより椎体Ｌ１、Ｌ２間の固定を補強するための固定補強具６０が追加されている点が異なるだけで、他は実施例１と全く同様の構成である。従ってここで、実施例１と同様な機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してある。Theinterbody fusion device 10a of the second embodiment is engaged with and fixed to the front surface portions of the adjacent vertebral bodies L1 and L2 loosely fitted to thepressing screw 50 with respect to theinterbody fusion device 10 of the first embodiment. Thus, the configuration is exactly the same as that of the first embodiment except that a fixing reinforcingtool 60 for reinforcing fixation between the vertebral bodies L1 and L2 is added. Accordingly, here, the same reference numerals are given to the constituent members having the same functions as those in the first embodiment even if the shapes are slightly different.

　押圧ねじ５０は、実施例１の椎体間固定装置１０における押圧ねじ４０と全く同様の構成であるが、本体１１の雌ねじ１６に螺合する雄ねじ部５１が押圧ねじ４０に比べ固定補強具６０が追加される分長くなっている点が異なるだけである。Thepressing screw 50 has the same configuration as that of thepressing screw 40 in theinterbody fusion device 10 of the first embodiment, but themale screw portion 51 that is screwed into thefemale screw 16 of themain body 11 has a fixed reinforcingtool 60 as compared with thepressing screw 40. The only difference is that it is longer by adding.

　また、押圧ねじ５０のキャップ５２の後端面には、押圧ねじドライバー９０の先端係合部９３が係合するための例えば、図１２に示すような十字溝５４が形成されているが、十字溝５４に代えていずれも図示しない六角レンチ状に形成された係合部９３が係合する凹溝状の六角形穴を穿設してもよい。For example, across groove 54 as shown in FIG. 12 is formed on the rear end surface of thecap 52 of thepress screw 50 so that thetip engagement portion 93 of thepress screw driver 90 is engaged. Instead of 54, a hexagonal hole having a concave groove shape with which an engagingportion 93 formed in a hexagonal wrench shape (not shown) may be formed.

　固定補強具６０は、押圧ねじ５０の雄ねじ部５１に遊嵌されるボス６１と、それぞれボス６１外面に上下軸対称に立設され、押圧ねじのキャップ５２部にボス６１部後端面が押圧されて先端部が隣接する椎体Ｌ１、Ｌ２の前面部にそれぞれ係合固定される１対のアーム６２、６２と、からなる。The fixed reinforcingmember 60 is provided with aboss 61 that is loosely fitted to themale screw portion 51 of thepressing screw 50, and is vertically provided on the outer surface of theboss 61 so as to be vertically symmetrical, and the rear end surface of theboss 61 portion is pressed against thecap 52 portion of the pressing screw. And a pair ofarms 62 and 62 that are engaged and fixed to the front portions of the adjacent vertebral bodies L1 and L2, respectively.

　固定補強具６０の材質としては、本体１１と同様に、医療等級のＳＵＳ、Ｔｉなどがあり、特に強度及び軽量な点からはＴｉが好適である。As the material of thefixing reinforcing member 60, there are medical grade SUS, Ti, etc., as in the case of themain body 11, and Ti is particularly suitable from the viewpoint of strength and light weight.

　アーム６２は、キャップ５２側の後端側に設けられ、先端が椎体Ｌ１、Ｌ２側に略９０°屈曲された板状フランジ６２ａ、及び板状フランジ６２ａに沿ってボス６１外面に立設されたウエブ６２ｂからなる横断面略Ｔ字形に形成されている。この場合、アーム６２先端の先端部は、椎体Ｌ１、Ｌ２の腹部側側面に喰い込み係合して固定され易いようにテーパ状に先鋭に形成される。Thearm 62 is provided on the rear end side of thecap 52 side, and is erected on the outer surface of theboss 61 along the plate-like flange 62a whose tip is bent by approximately 90 ° toward the vertebral bodies L1 and L2, and the plate-like flange 62a. Theweb 62b is formed in a substantially T-shaped cross section. In this case, the distal end portion of the distal end of thearm 62 is formed in a tapered shape so as to be easily engaged with and fixed to the abdominal side surfaces of the vertebral bodies L1 and L2.

　次に、この実施形態の椎体間固定装置１０ａを腹部ＭＮ１側からいずれも図示しない腹腔鏡あるいは前記カプセル内視鏡等で観察しながら椎体間スペース保持装置７０、本体嵌入ドライバー８０及び押圧ねじドライバー９０を用い、椎体Ｌ１、Ｌ２の間の椎間板Ｍ部に嵌入して椎体Ｌ１、Ｌ２間を固定する椎体間固定外科手術方法について、前記実施例１の椎体間固定装置１０における場合と異なる主要な特徴部分を説明する。Next, while observing theinterbody fusion device 10a of this embodiment from the abdominal part MN1 side with a laparoscope (not shown) or the capsule endoscope, the interbodyspace holding device 70, thebody insertion driver 80, and the pressing screw In theinterbody fusion device 10 of the first embodiment described above, an interbody fusion surgery method in which the intervertebral body L1 and L2 is fixed by inserting into the intervertebral disc M portion between the vertebral bodies L1 and L2 using thedriver 90. Main features different from the case will be described.

　前記実施例１におけると同様な下穴穿設工程の後又は前に、隣接する椎体Ｌ１、Ｌ２の前面部のそれぞれ対向面Ｌ１ａ、Ｌ２ａから適宜位置に固定補強具６０のアーム６２先端部が係合する略Ｔ字形の係合溝Ｌ１ｂ、Ｌ２ｂを穿設する（固定補強具係合溝穿設工程）。After or before the pilot hole drilling step similar to that in the first embodiment, the distal end portion of thearm 62 of the fixed reinforcingtool 60 is appropriately positioned from the opposing surfaces L1a and L2a of the front surface portions of the adjacent vertebral bodies L1 and L2. Engage substantially T-shaped engaging grooves L1b and L2b to be engaged (fixed reinforcement engaging groove engaging step).

　次いで、前記実施例１におけると同様な本体嵌入工程に続いて、押圧ねじドライバー９０の先端係合部９３に固定補強具６０のボス６１内にねじ部５１を挿通した押圧ねじ５０の後端係合部５４を係合した状態で本体嵌入ドライバー８０のシャフト部８１内に挿入し、押圧ねじ５０を椎体Ｌ１、Ｌ２間に嵌入し固定した本体１１の雌ねじ部１６に挿入して押圧しながら回転してねじ込み、雄ねじ部５１の先端面５３でピン３０、３０の後端３１、３１面を押圧してピン３０、３０の先端３２、３２側をガイド孔１７、１８に沿って案内し順次屈曲させながら対向面Ｌ１ａ、Ｌ２ａ部から椎体Ｌ１、Ｌ２内に傾斜して差込み固定するとともに、押圧ねじ５０のキャップ５２前端面からの軸方向推進力により固定補強具６０のアーム６２先端部をそれぞれ椎体Ｌ１、Ｌ２の前面部の係合溝Ｌ１ｂ、Ｌ２ｂに押圧して係合し固定する（ピン差込及び固定補強具固定工程）。このとき、本体嵌入ドライバー８０の把持部８２を回転しないように別途いずれも図示しない人手又は機械的回転拘束手段によりしっかり押圧して保持しながら、押圧ねじ５０をキャップ５２連設面が固定補強具６０のボス後端面に当接する所定トロークまで雌ねじ１６内に螺入する。Subsequently, following the main body fitting step similar to that in the first embodiment, the rear end engagement of thepressing screw 50 in which thescrew portion 51 is inserted into theboss 61 of the fixing reinforcingtool 60 through thetip engaging portion 93 of thepressing screw driver 90. Inserting into theshaft portion 81 of the mainbody insertion driver 80 with thejoint portion 54 engaged, and inserting and pressing thepressing screw 50 into thefemale screw portion 16 of themain body 11 inserted and fixed between the vertebral bodies L1 and L2. Rotating and screwing, pressing the rear ends 31 and 31 of thepins 30 and 30 with the front end surface 53 of themale screw portion 51 to guide the front ends 32 and 32 of thepins 30 and 30 along the guide holes 17 and 18 and sequentially Inclined and inserted into the vertebral bodies L1 and L2 from the opposing surfaces L1a and L2a while being bent, and the distal end portion of thearm 62 of the fixingreinforcement 60 by the axial propulsive force from the front end surface of thecap 52 of thepressing screw 50 Engaging groove of each front portion of the vertebral body L1, L2 L1b, engaged and fixed to pressing the L2b (pin plug and the fixed brace fixing step). At this time, while the grippingportion 82 of the mainbody insertion screwdriver 80 is not rotated separately, thepressing screw 50 is held by thecap 52 continuous surface while thepressing screw 50 is firmly pressed and held by hand or mechanical rotation restraining means (not shown). Screw into theinternal thread 16 up to a predetermined trowel that contacts the rear end surface of theboss 60.

　すなわち、実施例２における椎体間固定方法は、少なくとも事前処置工程、椎体間スペース保持工程、下穴穿設工程、本体嵌入工程、固定補強具係合溝穿設工程、ピン差込み及び固定補強具固定工程を有する。That is, the interbody fixing method according to the second embodiment includes at least a pretreatment process, an intervertebral body space holding process, a pilot hole drilling process, a main body insertion process, a fixing reinforcement engaging groove drilling process, pin insertion, and fixing reinforcement. It has a tool fixing process.

　実施例２の椎体間固定装置１０ａを用いた椎体間固定外科手術システム及び外科手術方法は、前記実施例１と同様な利点を有するのに加えて、押圧ねじ５０に遊嵌された固定補強具６０の１対のアーム６２先端部が押圧ねじ５０のキャップ部５２にボス６１部後端面が押圧されることにより隣接する椎体Ｌ１、Ｌ２の前面部にそれぞれ係合し固定されることから、簡単な操作で椎体間固定が強固に補強されるため、椎体間固定の信頼性を容易に向上させることができる。また、アーム６２に適宜の剛性を持たせることができ、その剛性反力により押圧ねじ５０の逆回転摩擦力がアップして保持されるため押圧ねじ５０の逆回転防止効果及びこれによるピン３０の抜け止め効果を一層向上させることができる。The interbody fusion surgical system and the surgical method using theinterbody fusion device 10a of the second embodiment have the same advantages as those of the first embodiment, and in addition, the fixation is loosely fitted to thepressing screw 50. The distal ends of a pair ofarms 62 of the reinforcingtool 60 are engaged with and fixed to the front portions of the adjacent vertebral bodies L1 and L2 by pressing the rear end surface of theboss 61 against thecap portion 52 of thepressing screw 50, respectively. Therefore, since the interbody fusion is strongly reinforced by a simple operation, the reliability of the interbody fusion can be easily improved. In addition, thearm 62 can be provided with appropriate rigidity, and the reverse reaction force of thepressing screw 50 is increased and held by the rigidity reaction force. The retaining effect can be further improved.

　図１３は本発明のまた別の実施形態（実施例３）の椎体間固定装置１０ｂの概念を示す縦断面図（主要部断面）、図１４は図１３のＰ－Ｐ矢視図である。FIG. 13 is a longitudinal sectional view (main part sectional view) showing a concept of aninterbody fusion device 10b of still another embodiment (Example 3) of the present invention, and FIG. 14 is a view taken along the line PP in FIG. .

　実施例３の椎体間固定装置１０ｂは、実施例１の椎体間固定装置１０に対して、本体１１ｂの外形が略先細り中空円錐台状に形成されている点が異なるだけで、他は実施例１と全く同様の構成である。従ってここで、実施例１と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してあり、個々の説明は重複するので省略する。Theinterbody fusion device 10b of the third embodiment is different from theinterbody fusion device 10 of the first embodiment only in that the outer shape of themain body 11b is substantially tapered and formed into a hollow truncated cone shape. The configuration is exactly the same as in the first embodiment. Therefore, the same reference numerals are given to constituent members having the same functions as those in the first embodiment even if the shapes are slightly different, and the description thereof will be omitted because they are duplicated.

　実施例３の本体１１ｂの外形は、下方の椎体Ｌ２の正常な前湾姿勢角度に対応する角度例えば略９°でその長さに沿ってテーパを有する略先細り円錐台形に形成されている。この本体１１ｂの円錐台形テーパ角は、本体１１ｂが前端及び後端の外径に亘り所定の位置に嵌入されたときに隣接する椎体Ｌ１、Ｌ２が適正な前湾姿勢角度を成すように広がる量を画定することができる。The outer shape of themain body 11b of Example 3 is formed in a substantially tapered truncated cone shape having a taper along its length at an angle corresponding to the normal anterior bay posture angle of the lower vertebral body L2, for example, approximately 9 °. The frustoconical taper angle of themain body 11b widens so that the adjacent vertebral bodies L1 and L2 form an appropriate front bay posture angle when themain body 11b is fitted in a predetermined position over the outer diameters of the front end and the rear end. A quantity can be defined.

　図１５は本発明のまた別の実施形態（実施例４）の椎体間固定装置１０ｃの概念を示す縦断面図（主要部断面）で、図１６の（ａ）は図１５の摩擦板５５部のＧ－Ｇ矢視断面図、（ｂ）は（ａ）のＨ－Ｈ矢視断面図である。FIG. 15 is a longitudinal sectional view (main part sectional view) showing a concept of aninterbody fusion device 10c of still another embodiment of the present invention (Example 4), and FIG. 16 (a) is afriction plate 55 of FIG. FIG. 5B is a cross-sectional view taken along the line GG of FIG. 5B, and FIG.

　実施例４の椎体間固定装置１０ｃは、実施例３の椎体間固定装置１０ｂに対して、本体１１ｂの雌ねじ１６内に遊嵌収容され、ピン３０、３０の後端３１、３１部に当接配置される摩擦板５５が追加されている点が異なるだけで、他は実施例３と全く同様の構成である。従ってここで、実施例３と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してある。Theinterbody fusion device 10c according to the fourth embodiment is loosely accommodated in thefemale screw 16 of themain body 11b with respect to theinterbody fusion device 10b according to the third embodiment, and is provided at the rear ends 31 and 31 of thepins 30 and 30. The rest of the configuration is exactly the same as that of the third embodiment, except that afriction plate 55 arranged in contact is added. Accordingly, here, the same reference numerals are given to the structural members having the same functions as those in the third embodiment even if the shapes are slightly different.

　摩擦板５５のピン後端３１、３１部との当接面側には、図１６（ａ）、(ｂ)に示すように、ピン後端３１、３１部が嵌入する適宜深さの１対のピン固定溝５５ａ、５５ａが穿設されている。As shown in FIGS. 16 (a) and 16 (b), thefriction plate 55 has a pair of appropriate depths for fitting the pin rear ends 31, 31 on the contact surface side with the pin rear ends 31, 31b. Thepin fixing grooves 55a and 55a are formed.

　ピン後端３１、３１部がピン固定溝５５ａ、５５ａに嵌入することにより左右、上下方向への移動が拘束されるため、押圧ねじ４０又は５０（図８～１２）により摩擦板５５を介してピン後端３１、３１部が押圧されて先端３２、３２側が椎体Ｌ１、Ｌ２内に差込まれる場合、特にピン後端３１、３１部が本体１１ｂの雌ねじ１６部内面との隙間の多い左右方向に横滑りして移動する（逃げる）ことなく、ピン１１がスムースに前方に押し込まれガイド孔１７、１８に沿って椎体Ｌ１、Ｌ２内に差込まれ易くなる。Since therear end portions 31 and 31 of the pins are inserted into thepin fixing grooves 55a and 55a, the movement in the left and right and up and down directions is restrained. When the pin rear ends 31 and 31 are pressed and thetips 32 and 32 are inserted into the vertebral bodies L1 and L2, the left and right sides of the pin rear ends 31 and 31 have a large gap with the inner surface of thefemale thread 16 portion of themain body 11b. Thepin 11 is smoothly pushed forward without slipping in the direction (moving away) and easily inserted into the vertebral bodies L1 and L2 along the guide holes 17 and 18.

　また、ピン後端３１、３１部の横滑りなどによる移動（逃げ）を拘束するため、ピン固定溝５５ａを設けなくとも、摩擦板５５をピン後端３１、３１部に溶接又は接着により固着してもよい。Further, in order to restrain the movement (escape) of the pin rear ends 31 and 31 due to side slipping, thefriction plate 55 is fixed to the pin rear ends 31 and 31 by welding or bonding without providing thepin fixing groove 55a. Also good.

　これに対して、前記ピン固定溝５５ａや固着などのピン後端３１、３１部の移動拘束手段を用いることなく、摩擦板５５を単にピン後端３１、３１部に当接配置するだけでもよい。いずれにしても、摩擦板５５を配置することにより、摩擦板５５を介して押圧ねじ４０又は５０のピン後端３１、３１部押圧が行われることから、押圧ねじ４０又は５０とピン後端３１、３１面側との摩擦力が減少するとともにピン後端３１、３１面が直接押圧ねじ４０又は５０の回転力を受けないためピン後端３１、３１部が本体１１ｂの雌ねじ１６部内面との隙間の多い左右方向に横滑りして移動し（逃げ）ようとする力を殆ど受けることなく、押圧ねじ４０又は５０も小トルクで雌ねじ１６内にねじ込まれるとともにピン３０がスムースに前方に押し込まれることが可能である。On the other hand, thefriction plate 55 may be simply placed in contact with the pin rear ends 31, 31 without using thepin fixing groove 55a or the movement restraining means of the pin rear ends 31, 31 such as fixing. . In any case, by placing thefriction plate 55, the pinrear end 31, 31 part of thepressing screw 40 or 50 is pressed via thefriction plate 55, and therefore thepressing screw 40 or 50 and the pinrear end 31 are pressed. , The pinrear end 31, 31 surface is not directly subjected to the rotational force of thepressing screw 40 or 50 and the pinrear end 31, 31 portion is in contact with the inner surface of thefemale screw 16 portion of themain body 11b. Thepressing screw 40 or 50 is screwed into thefemale screw 16 with a small torque and thepin 30 is smoothly pushed forward without almost receiving the force of sliding (moving away) in the lateral direction with many gaps. Is possible.

　図１７は本発明のまた別の実施形態（実施例５）の椎体間固定装置１０ｄの概念を示す縦断面図（主要部断面）、図１８は図１７のＱ－Ｑ矢視図、図１９は図１７の平面図である。FIG. 17 is a longitudinal sectional view (main part sectional view) showing the concept of aninterbody fusion device 10d according to another embodiment of the present invention (Example 5), and FIG. 18 is a view taken along the line QQ of FIG. 19 is a plan view of FIG.

　実施例５の椎体間固定装置１０ｄは、実施例１の椎体間固定装置１０における本体１１の外面係合部１４が雄ねじ状に形成されているのに対して、本体１１ｄの外面係合部１４ａが主軸Ｃ１に平行な複数のスプライン歯状に形成されている点が異なるだけで、他は実施例１と全く同様の構成である。従ってここで、実施例１と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してあり、個々の説明は重複するので省略する。In theinterbody fusion device 10d of the fifth embodiment, the outersurface engaging portion 14 of themain body 11 in theinterbody fusion device 10 of the first embodiment is formed in a male screw shape, whereas the outer surface engagement of themain body 11d. The configuration is exactly the same as that of the first embodiment except that theportion 14a is formed in a plurality of spline teeth parallel to the main axis C1. Therefore, the same reference numerals are given to constituent members having the same functions as those in the first embodiment even if the shapes are slightly different, and the description thereof will be omitted because they are duplicated.

　この実施例では、外面係合部１４ａが主軸Ｃ１に平行な複数のスプライン歯状に形成されているため、本体１１ｄを押圧するだけで前記実施例１～３における本体１１、１１ｂのねじ込むための回転操作を省くことができることから短時間に椎体Ｌ１、Ｌ２間に嵌入し固定することができ、操作性が向上する。In this embodiment, since the outersurface engaging portion 14a is formed in a plurality of spline teeth parallel to the main shaft C1, themain bodies 11 and 11b in the first to third embodiments can be screwed only by pressing themain body 11d. Since the rotation operation can be omitted, the vertebral bodies L1 and L2 can be fitted and fixed in a short time, and the operability is improved.

　また、外面係合部１４ａであるスプライン歯の径方向外面頭頂部及び軸方向先端部は尖鋭刃状に形成されており、本体１１ｄを押圧することにより椎体Ｌ１、Ｌ２間に容易に嵌入させることができる。Further, the radial outer surface vertex and axial tip of the spline teeth that are the outersurface engaging portion 14a are formed in a sharp blade shape, and can be easily fitted between the vertebral bodies L1 and L2 by pressing themain body 11d. be able to.

　図２０は本発明のまた別の実施形態（実施例６）の椎体間固定装置１０ｅの概念を示す縦断面図（主要部断面）、図２１は図２０のＲ－Ｒ矢視図、図２２は図２０の平面図である。FIG. 20 is a longitudinal sectional view (major section) showing a concept of aninterbody fusion device 10e of another embodiment of the present invention (Example 6), and FIG. 21 is a view taken along the line RR of FIG. 22 is a plan view of FIG.

　実施例６の椎体間固定装置１０ｅは、実施例５の椎体間固定装置１０ｄにおける本体１１ｄの外面係合部１４ｂがスプライン歯状に形成されているのに対して、本体１１ｅの外面係合部１４ｃが主軸Ｃ１に平行な複数の鋸歯状に形成されている点が異なるだけで、他は実施例１あるいは５等と全く同様の構成である。従ってここで、実施例１あるいは５と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してあり、個々の説明は重複するので省略する。In theinterbody fusion device 10e of the sixth embodiment, the outersurface engaging portion 14b of themain body 11d in theinterbody fusion device 10d of the fifth embodiment is formed in a spline shape, whereas the outer surface engagement of themain body 11e. Except for the point that thejoint portion 14c is formed in a plurality of sawtooth shapes parallel to the main axis C1, the rest of the configuration is exactly the same as in the first or fifth embodiment. Therefore, the same reference numerals are given to the constituent members having the same functions as those in the first or fifth embodiment even if the shapes are slightly different, and the description thereof is omitted because it is duplicated.

　この実施例では、外面係合部１４ａが主軸Ｃ１に平行な複数の鋸歯状に形成されているため、本体１１ｅを押圧するだけで前記実施例１～３における本体１１、１１ｂのねじ込むための回転操作を省くことができることから椎体Ｌ１、Ｌ２間に短時間で嵌入し固定することができ、操作性が向上する。In this embodiment, since the outersurface engaging portion 14a is formed in a plurality of sawtooth shapes parallel to the main shaft C1, the rotation for screwing themain bodies 11, 11b in the first to third embodiments just by pressing themain body 11e. Since the operation can be omitted, the vertebral bodies L1 and L2 can be inserted and fixed in a short time, and the operability is improved.

　また、外面係合部１４ａである鋸歯はそれぞれ前後端面が後方に傾斜し、径方向外面頭頂部及び軸方向先端部は尖鋭刃状に形成されているため、本体１１ｅを押圧することにより椎体Ｌ１、Ｌ２間に容易に嵌入させることができるとともに、本体１１ｅの抜け止めによる固定の信頼性が確保できる。In addition, since the front and rear end surfaces of the saw teeth that are the outersurface engaging portions 14a are inclined rearward, and the radial outer surface vertex and the axial tip are formed in a sharp blade shape, the vertebral body is pressed by pressing themain body 11e. In addition to being able to easily fit between L1 and L2, it is possible to secure the reliability of fixing by preventing themain body 11e from coming off.

　図２３は、本発明のまた別の実施形態（実施例７）の椎体間固定装置１０ｆの概念を示す縦断面図（主要部断面）である。FIG. 23 is a longitudinal sectional view (major section) showing the concept of an interbody fusion device 10f according to another embodiment (Example 7) of the present invention.

　実施例７の椎体間固定装置１０ｆは、実施例１の椎体間固定装置１０に対して、ピン３０ａの形状が比較的短いストレート状に形成されている点、及び押圧ねじ４０ａの先端部４３ａの形状が異なるだけで、他は実施例１と全く同様の構成である。従ってここで、実施例１と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してあり、個々の説明は重複するので省略する。The interbody fusion device 10f according to the seventh embodiment is different from theinterbody fusion device 10 according to the first embodiment in that thepin 30a has a relatively short straight shape and the tip of thepressing screw 40a. The configuration is the same as that of the first embodiment except that the shape of 43a is different. Therefore, the same reference numerals are given to constituent members having the same functions as those in the first embodiment even if the shapes are slightly different, and the description thereof will be omitted because they are duplicated.

　実施例７の１対のピン３０ａ、３０ａは、比較的短いストレート状に形成され、それぞれ１対のガイド孔１７、１８内に遊嵌収容される。各先端３２ａは、適宜尖鋭状に形成され、本体１１が椎体Ｌ１、Ｌ２間に差込まれる前の初期状態においては、図２３の２点差線で示すように、雄ねじ１４の谷径以内にすなわち谷径から突出しないようガイド孔１７、１８の出口内に収容されている。The pair ofpins 30a and 30a of the seventh embodiment are formed in a relatively short straight shape, and are loosely accommodated in the pair of guide holes 17 and 18, respectively. Eachtip 32a is formed in a sharp shape as appropriate, and in the initial state before themain body 11 is inserted between the vertebral bodies L1 and L2, as shown by the two-dot difference line in FIG. That is, it is accommodated in the outlets of the guide holes 17 and 18 so as not to protrude from the valley diameter.

　押圧ねじ４０ａは、前記実施例１の押圧ねじ４０と同様な形状の雄ねじ部４１及びキャップ４２を有するが、雄ねじ部４１の先端部４３ａが中空内面１６ａより僅かに細い丸棒状に延設され、その先端角部がピン３０ａ、３０ａの後端３１ａ、３１ａに当接するようにカットされた傾斜面４３ａが形成されている。Thepressing screw 40a has amale screw portion 41 and acap 42 having the same shape as thepressing screw 40 of the first embodiment, but thedistal end portion 43a of themale screw portion 41 extends in a round bar shape slightly thinner than the hollowinner surface 16a. Aninclined surface 43a is formed that is cut so that the corners of the front end are in contact with therear ends 31a and 31a of thepins 30a and 30a.

　図２４の（ａ）は本発明のまた別の実施形態（実施例８）の椎体間固定装置１０ｇの概念を示す縦断面図（主要部断面）、（ｂ）は（ａ）のＩ－Ｉ矢視要部断面図である。FIG. 24 (a) is a longitudinal sectional view (main section) showing the concept of an interbody fusion device 10g according to another embodiment (Example 8) of the present invention, and FIG. It is I arrow principal part sectional drawing.

　実施例８の椎体間固定装置１０ｇは、実施例７の椎体間固定装置１０ｅに対して、ピン３０ｂの形状が比較的長いストレート状に形成されている点、及び１対のピン３０ｂ、３０ｂを収容する１対のガイド孔１７ａ、１８ａの配置が異なるだけで、他は実施例７と全く同様の構成である。従ってここで、実施例７と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してあり、個々の説明は重複するので省略する。The interbody fusion device 10g according to the eighth embodiment has a relatively long straight shape with respect to theinterbody fusion device 10e according to the seventh embodiment, and a pair ofpins 30b. The rest of the configuration is exactly the same as that of the seventh embodiment except that the arrangement of the pair ofguide holes 17a and 18a for accommodating 30b is different. Therefore, the same reference numerals are given to the structural members having the same functions as those in the seventh embodiment even though the shapes are slightly different, and the description thereof will be omitted because they are duplicated.

　実施例８の１対のピン３０ｂ、３０ｂは、比較的長いストレート状に形成され、それぞれ後述する１対のガイド孔１７ａ、１８ａ内に遊嵌収容される。各先端３２ｂは、適宜尖鋭状に形成され、本体１１が椎体Ｌ１、Ｌ２間に差込まれる前の初期状態（待機位置）においては、図２４（ａ）の２点差線で示すように、雄ねじ１４の谷径以内に、すなわち谷径から突出しないようガイド孔１７ａ、１８ａの出口内に収容されている。The pair ofpins 30b and 30b of the eighth embodiment are formed in a relatively long straight shape and are loosely accommodated in a pair ofguide holes 17a and 18a, which will be described later. Eachtip 32b is appropriately sharpened, and in the initial state (standby position) before themain body 11 is inserted between the vertebral bodies L1 and L2, as shown by the two-point difference line in FIG. It is accommodated in the outlets of the guide holes 17a and 18a within the valley diameter of themale screw 14, that is, so as not to protrude from the valley diameter.

　本体１１ｇに設けられる一対のガイド孔１７ａ、１８ａ内に収容されるピン３０ｂ、３０ｂは、図２４（ｂ）に示すように、本体１１ｇの中心軸に対して例えば左右に偏心して配置されている。これにより、１対のピン３０ｂ、３０ｂの前記待機位置における後端３１ｂ、３１ｂ部の相互干渉を回避することができる。As shown in FIG. 24B, thepins 30b and 30b accommodated in the pair ofguide holes 17a and 18a provided in themain body 11g are arranged eccentrically with respect to the central axis of themain body 11g, for example. . Thereby, the mutual interference of the rear ends 31b and 31b at the standby position of the pair ofpins 30b and 30b can be avoided.

　なお、一対のガイド孔１７ａ、１８ａの中心軸である傾斜軸Ｃ２、Ｃ３は、この実施例では中心軸に対してそれぞれ略平行面内に配置されているが、ピン３０ｂの先端３２ｂが押し込まれて椎体Ｌ１、Ｌ２の外面からはみ出さない限り、主軸Ｃ１に対しそれぞれ任意の方向に且つ非対称に配置されてもよく、あるいは主軸Ｃ１に対し偏心し且つ任意の方向の面内に配置されてもよい。In this embodiment, the inclined axes C2 and C3, which are the central axes of the pair ofguide holes 17a and 18a, are arranged in a plane substantially parallel to the central axis, but thetip 32b of thepin 30b is pushed in. As long as they do not protrude from the outer surfaces of the vertebral bodies L1 and L2, they may be arranged in any direction and asymmetrically with respect to the main axis C1, or they are eccentric with respect to the main axis C1 and arranged in a plane in any direction. Also good.

　図２５は、本発明のまた別の実施形態（実施例９）の椎体間固定装置１０ｈの概念を示す縦断面図（主要部断面）である。FIG. 25 is a longitudinal sectional view (major section) showing the concept of an interbody fusion device 10h according to another embodiment (Example 9) of the present invention.

　実施例９の椎体間固定装置１０ｈは、実施例８の椎体間固定装置１０ｇに対して、１対のピン３０ｃ、３０ｃ及びガイド孔１７ｃ、１８ｃの形状が先端方向に向かってそれぞれ緩やかな凹状の円弧又は曲線状に形成されている点が異なるだけで、他は実施例８と全く同様の構成である。従ってここで、実施例８と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してあり、個々の説明は重複するので省略する。In the interbody fusion device 10h according to the ninth embodiment, the shape of the pair ofpins 30c and 30c and the guide holes 17c and 18c is gentler toward the distal end than the interbody fusion device 10g according to the eighth embodiment. The rest of the configuration is exactly the same as that of the eighth embodiment except that it is formed in a concave arc or curve. Therefore, the same reference numerals are given to the structural members having the same functions as those of the eighth embodiment even if the shapes are slightly different, and the descriptions thereof are omitted because they are duplicated.

　本体１１ｈに設けられる凹状の円弧又は曲線状の一対のガイド孔１７ｃ、１８ｃは、１対のピン３０ｃ、３０ｃの待機位置における後端３１ｃ、３１ｃ部の相互干渉を回避するように、本体１１ｈの中心軸に対し例えば左右に偏心させ、ピン３０ｃの先端３２ｃが押し込まれて椎体Ｌ１、Ｌ２の外面からはみ出さない限り、任意の方向に沿って配置することができる。A pair of concave arcs orcurved guide holes 17c, 18c provided in themain body 11h is provided on themain body 11h so as to avoid mutual interference between the rear ends 31c, 31c at the standby position of the pair ofpins 30c, 30c. For example, thepin 30c can be arranged along an arbitrary direction as long as thetip 32c of thepin 30c is pushed and does not protrude from the outer surface of the vertebral bodies L1 and L2 with respect to the central axis.

　図２６は、本発明のさらに別の実施形態（実施例１０）の椎体間固定装置１０ｉの概念を示す縦断面図（主要部断面）である。FIG. 26 is a longitudinal sectional view (major section) showing the concept of an interbody fusion device 10i of still another embodiment (Example 10) of the present invention.

　実施例１０の椎体間固定装置１０ｉは、実施例９の椎体間固定装置１０ｈに対して、１対のピン３０ｄ、３０ｄ及びガイド孔１７ｄ、１８ｄの形状が先端方向に向かってそれぞれ緩やかな凸状の円弧又は曲線状に形成されている点が異なるだけで、他は実施例９と全く同様の構成である。従ってここで、実施例９と同様の機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してあり、個々の説明は重複するので省略する。In the interbody fusion device 10i of the tenth embodiment, the shape of the pair ofpins 30d and 30d and the guide holes 17d and 18d is gentler toward the distal end than the interbody fusion device 10h of the ninth embodiment. The rest of the configuration is exactly the same as that of the ninth embodiment except that it is formed in a convex arc or curve. Therefore, the same reference numerals are given to the structural members having the same functions as those in the ninth embodiment even if the shapes are slightly different.

　実施例１０においても、本体１１ｉに設けられる凸状の円弧又は曲線状の一対のガイド孔１７ｄ、１８ｄは、１対のピン３０ｄ、３０ｄの待機位置における後端３１ｄ、３１ｄ部の相互干渉を回避するように、本体１１ｉの中心軸に対し例えば左右に偏心させ、ピン３０ｄの先端３２ｄが押し込まれて椎体Ｌ１、Ｌ２の外面からはみ出さない限り、任意の方向に沿って配置することができる。Also in the tenth embodiment, the pair of convex arcs orcurved guide holes 17d and 18d provided in the main body 11i avoids mutual interference between therear ends 31d and 31d at the standby position of the pair ofpins 30d and 30d. Thus, it can be arranged along any direction as long as it is decentered, for example, left and right with respect to the central axis of the main body 11i and thetip 32d of thepin 30d is pushed and does not protrude from the outer surface of the vertebral bodies L1 and L2. .

　図４４は本発明のまた別の実施形態（実施例１１）による椎体間固定装置１０ｊの概念を示す縦断面図（主要部断面）、図４５は図４４の押圧ねじ４０ｊを取外した状態のＸ－Ｘ矢視図である。44 is a longitudinal sectional view (main section) showing the concept of aninterbody fusion device 10j according to still another embodiment (Example 11) of the present invention, and FIG. 45 is a state in which thepressing screw 40j of FIG. 44 is removed. FIG.

　実施例１１の椎体間固定装置１０ｊは、実施例１の椎体間固定装置１０に対して、一対のピン３０ｊ、３０ｊが後端に雌ねじ穴３４が設けられた基端部３３が一体的に形成され連設されている点、押圧ねじ４０ｊに基端部３３の雌ねじ穴３４と同軸の挿通孔４４が開設されている点が異なるだけで、他は実施例１と全く同様の構成である。従ってここで、実施例１と同様な機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してある。Theinterbody fusion device 10j according to the eleventh embodiment is integrated with thebase end portion 33 in which a pair ofpins 30j and 30j are provided with afemale screw hole 34 at the rear end of theinterbody fusion device 10 according to the first embodiment. The only difference is that thepress screw 40j is provided with aninsertion hole 44 that is coaxial with thefemale screw hole 34 of thebase end 33, and the other configuration is exactly the same as in the first embodiment. is there. Accordingly, here, the same reference numerals are given to the constituent members having the same functions as those in the first embodiment even if the shapes are slightly different.

　なお、この実施例を含む上記実施例の押圧ねじ４０、４０ｊは本体１１～１１ｉ内への螺合方向とは逆方向の回転操作により本体１１～１１ｉ内から、本体１１～１１ｉは椎体間への嵌入方向とは逆方向への回転及び／又は引抜き操作により椎体間からそれぞれ取外され体外に取出し可能である。It should be noted that thepressing screws 40 and 40j of the above embodiments including this embodiment are moved from themain body 11 to 11i by the rotation operation in the direction opposite to the screwing direction into themain bodies 11 to 11i, and themain bodies 11 to 11i are intervertebral bodies. It can be removed from between the vertebral bodies by rotation and / or extraction operation in the direction opposite to the direction of insertion into the body, and can be taken out of the body.

　この実施例の椎体間固定装置１０ｊは、ピン３０ｊ、３０ｊを介して椎体間に固定された後で万一感染症などによる不慮の化膿障害が発生した場合に、押圧ねじ４０ｊを本体１１から引抜くとともに、ピン３０ｊ、３０ｊを基端部３３の雌ねじ穴３４に螺合する雄ねじ部９５ａを備えた引抜きドライバー９５により椎体内から引抜いて本体１１と共に体外に取出すことができる。その後、椎体間に抗生剤や必要に応じて骨材等を詰める等の処置を施してから再度椎体間固定装置１０ｊを椎体間に固定し直すことができる。Theinterbody fusion device 10j according to this embodiment is configured so that thepressing screw 40j is attached to themain body 11 when an unexpected suppuration disorder due to infection or the like occurs after being fixed between the vertebral bodies via thepins 30j and 30j. Can be pulled out from the vertebral body by a pullingdriver 95 having amale screw portion 95a for screwing thepins 30j and 30j into thefemale screw hole 34 of thebase end portion 33 and taken out of the body together with themain body 11. Thereafter, the intervertebralbody fixing device 10j can be re-fixed between the vertebral bodies after a treatment such as filling the vertebral bodies with antibiotics or aggregates if necessary.

　ここで、ピン３０ｊ、３０ｊを椎体内から引抜き先端部３２ｊが本体１１のガイド穴１７内に隠れるまで引抜く空間が雌ねじ１６内に確保できれば押圧ねじ４０ｊを本体１１から完全に取外さなくともよく、押圧ねじ４０ｊに開設された挿通孔４内に引抜きドライバー９５を挿通させてピン３０ｊの基端部３３の雌ねじ穴３４内に先端部の雄ねじ部９５ａを螺合させることができるので、以降ピン３０ｊ、３０ｊを前記引抜き操作により椎体内から引抜いて本体１１と共に体外に取出すことができる。Here, if the space for extracting thepins 30j and 30j from the vertebral body until thedistal end portion 32j is hidden in theguide hole 17 of themain body 11 can be secured in thefemale screw 16, thepressing screw 40j does not have to be completely removed from themain body 11. Well, since theextraction screwdriver 95 can be inserted into the insertion hole 4 provided in thepressing screw 40j and themale screw portion 95a at the distal end portion can be screwed into thefemale screw hole 34 of thebase end portion 33 of thepin 30j. Thepins 30j and 30j can be extracted from the vertebral body by the above-described extraction operation and taken out of the body together with themain body 11.

　また、ピン３０ｊ基端部３３の雌ねじ穴３４内には、通常、後端部に例えばプラスドライバ溝や六角穴などの被係合部を有する盲プラグ（図示しないが、図４４の雄ねじ部９５ａに相当する）が挿嵌されており、ピン３０ｊ、３０ｊの前記引抜き操作に先立ち、前記被係合部に係合する係合部を先端部に備えたドライバー（図示しない）により前記盲プラグを雌ねじ穴３４内から取外し体外に取出すことができる。Further, in thefemale screw hole 34 of thebase end portion 33 of thepin 30j, normally, a blind plug (not shown,male screw portion 95a in FIG. 44) having an engaged portion such as a plus driver groove or a hexagonal hole at the rear end portion is usually provided. Is inserted and the blind plug is inserted by a screwdriver (not shown) having an engaging portion at the tip thereof that engages with the engaged portion prior to the pulling operation of thepins 30j and 30j. It can be removed from thefemale screw hole 34 and taken out of the body.

　このピン３０ｊ基端部３３の雌ねじ穴３４内に取出し可能に挿嵌された盲プラグにより雌ねじ穴３４内に椎体間内髄液や骨形成材料等の異物の侵入を防止することから、ピンの引抜き操作に先立ち盲プラグを取外すことによりピン基端部の雌ねじ穴に引抜きドライバーを容易に素早くねじ込み易くすることができ、椎体間固定装置１０ｊ取外しの操作性が向上する。The blind plug inserted in thefemale screw hole 34 of thebase end portion 33 of thepin 30j so as to be able to be taken out prevents foreign matter such as intervertebral spinal fluid or bone forming material from entering thefemale screw hole 34. By removing the blind plug prior to the extraction operation, the extraction driver can be easily and quickly screwed into the female screw hole at the base end portion of the pin, and the operability of removing theinterbody fusion device 10j is improved.

　なお、雌ねじ穴３４内に挿嵌された盲プラグは、本体１１の雌ねじ１６内に螺合された状態の押圧ねじ４０ｊの挿通孔４４内にいずれも図示しない前記ドライバーを挿通させて盲プラグ後端部の被係合部に係合させて雌ねじ穴３４内から取外すことができる。The blind plug inserted in thefemale screw hole 34 is inserted into theinsertion hole 44 of thepressing screw 40j in a state of being screwed into thefemale screw 16 of themain body 11, and the driver (not shown) is inserted through the blind plug. It can be detached from thefemale screw hole 34 by engaging with the engaged portion at the end.

　また、押圧ねじに挿通孔４４を設けない場合は、先に雌ねじ穴３４内に前記盲プラグを挿嵌した状態でピン３０ｊ、３０ｊを本体１１の雌ねじ１６内に装着し、椎体間固定装置取外しの際には押圧ねじを対外に取出してから順次盲プラグ、ピン３０ｊ、３０ｊの取出し操作を行うことができる。Further, when theinsertion hole 44 is not provided in the pressing screw, thepins 30j and 30j are mounted in thefemale screw 16 of themain body 11 with the blind plug inserted in thefemale screw hole 34 first, and the interbody fusion device At the time of removal, it is possible to sequentially take out the blind plug and thepins 30j and 30j after taking out the pressing screw to the outside.

　図４６は本発明のさらに別の実施形態（実施例１２）による椎体間固定装置１０ｋの概念を示す縦断面図（主要部断面）、図４７は図４６の押圧ねじ４０ｋを取外した状態のＸ－Ｘ矢視図である。46 is a longitudinal cross-sectional view (main cross-sectional view) showing a concept of aninterbody fusion device 10k according to still another embodiment (Example 12) of the present invention, and FIG. 47 is a state in which thepressing screw 40k of FIG. 46 is removed. FIG.

　実施例１２の椎体間固定装置１０ｋは、実施例１１の椎体間固定装置１０ｊに対して、一対のピン３０ｋ、３０ｋがそれぞれ後端に雌ねじ穴３４ｋが設けられた基端部３３ｋが個別に形成され連設されている点、押圧ねじ４０ｋに基端部３３ｋの雌ねじ穴３４ｋとそれぞれ同軸の一対の挿通孔４５、４５が開設されている点が異なるだけで、他は実施例１１と全く同様の構成である。従ってここで、実施例１１と同様な機能を有する構成部材には一部形状が若干異なっていても同一の符号を付してある。Theinterbody fusion device 10k according to the twelfth embodiment is different from theinterbody fusion device 10j according to the eleventh embodiment in that the pair ofpins 30k and 30k each have abase end portion 33k provided with afemale screw hole 34k at the rear end. The only difference is that thepress screw 40k is provided with a pair of insertion holes 45, 45 coaxial with thefemale screw hole 34k of thebase end portion 33k, respectively, except that thepressing screw 40k is provided in a continuous manner. The configuration is exactly the same. Therefore, here, the same reference numerals are given to the structural members having the same functions as those of the eleventh embodiment even if the shapes are slightly different.

　なお、この実施例の押圧ねじ４０ｋも本体１１内への螺合方向とは逆方向の回転操作により本体１１内から、本体１１も椎体間への嵌入方向とは逆方向への回転及び引抜き操作により椎体間からそれぞれ取外され体外に取出し可能となっている。Note that thepressing screw 40k of this embodiment is also rotated and pulled out from the inside of themain body 11 in the direction opposite to the screwing direction into themain body 11, and themain body 11 is also rotated in the direction opposite to the fitting direction between the vertebral bodies. It can be removed from between the vertebral bodies by the operation and can be taken out of the body.

　この実施例の椎体間固定装置１０ｋも、ピン３０ｋ、３０ｋを介して椎体間に固定された後で万一感染症などによる不慮の化膿障害が発生した場合に、押圧ねじ４０ｋを本体１１から引抜くとともに、ピン３０ｋ、３０ｋを基端部３３ｋ、３３ｋの雌ねじ穴３４ｋ、３４ｋにそれぞれ螺合する雄ねじ部９６ａを備えた引抜きドライバー９６により椎体内から引抜いて本体１１と共に体外に取出すことができる。その後、椎体間に抗生剤や必要に応じて骨材等を詰める等の処置を施してから再度椎体間固定装置１０ｋを椎体間に固定し直すことができる。In theinterbody fixing device 10k of this embodiment, thepressing screw 40k is attached to themain body 11 in the event that an unexpected suppuration disorder due to infection or the like occurs after being fixed between the vertebral bodies via thepins 30k, 30k. And thepins 30k and 30k are pulled out from the vertebral body by a pull-outdriver 96 havingmale screw portions 96a screwed into the female screw holes 34k and 34k of thebase end portions 33k and 33k, respectively, and taken out from the body together with themain body 11. Can do. Thereafter, the intervertebralbody fixing device 10k can be re-fixed between the vertebral bodies after a treatment such as packing between the vertebral bodies with antibiotics or aggregates as necessary.

　また、ピン３０ｋ基端部３３ｋの雌ねじ穴３４ｋ内にも、通常、後端部に例えばプラスドライバ溝や六角穴などの被係合部を有する盲プラグ（図示しないが、図４６の雄ねじ部９６ａに相当する）が挿嵌されており、ピン３０ｋ、３０ｋの前記引抜き操作に先立ち、前記盲プラグがそれぞれ前記被係合部に係合する係合部を先端部に備えたドライバー（図示しない）により雌ねじ穴３４ｋ内から取外され体外に取出すことができる。Also, a blind plug (not shown, but not shown, male threadedportion 96a in FIG. 46) having a engaged portion such as a Phillips screwdriver groove or a hexagonal hole in the rear end portion is also usually provided in the female threadedhole 34k of thebase end portion 33k of thepin 30k. And a screwdriver (not shown) provided with engaging portions at the distal end portions of the blind plugs to engage with the engaged portions prior to the pulling-out operation of thepins 30k and 30k. Can be removed from thefemale screw hole 34k and taken out of the body.

　以下、前記盲プラグ及びピン３０ｋ、３０ｋの引抜き操作は、前記実施例１１と同様に行うことができるので、詳細な説明は省略する。Hereinafter, since the operation of pulling out the blind plug and thepins 30k and 30k can be performed in the same manner as in Example 11, detailed description thereof will be omitted.

　以上に記した種々の実施形態の他に、各部材の形状、寸法及び材質は任意に変更することができる。例えば、図示しないが、ピン３０、３０Ａ～３０Ｆ、３０ａ～３０ｄ、３０ｊ、３０ｋは、極端な場合椎体Ｌ１、Ｌ２のいずれか側に１本、あるいは略軸対称又は非対称に２対など複数配置することもできる。ただし、ピン３０、３０Ａ～３０Ｆ、３０ａ～３０ｄ、３０ｊ、３０ｋは、数量を増やすに従って外径が本体１１、１１ｂ～１１ｉの雌ねじ１６内に収容されるスペース内に相応して細くなる。In addition to the various embodiments described above, the shape, size and material of each member can be arbitrarily changed. For example, although not shown, a plurality ofpins 30, 30A to 30F, 30a to 30d, 30j, and 30k are arranged on one side of the vertebral bodies L1 and L2 in the extreme case, or two pairs such as substantially axisymmetric or asymmetrical. You can also However, thepins 30, 30A to 30F, 30a to 30d, 30j, and 30k are correspondingly thinner in the space accommodated in thefemale screw 16 of themain body 11, 11b to 11i as the quantity increases.

　また、例えば実施例５における本体１１の外面係合部１４ｂがスプライン歯の径方向外面頭頂部を複数の連続的な鋸歯状に形成することもできる。Further, for example, the outersurface engaging portion 14b of themain body 11 in the fifth embodiment can form the radial outer surface top portion of the spline teeth in a plurality of continuous sawtooth shapes.

　また、固定補強具６０の１対のアーム６２を横断面Ｔ字形ではなく、少なくとも先端部側を一枚板状にして、さらにその板の前面上に先鋭なピン状突起を１個又は複数形成することも可能である。アーム６２先端部にこのような先鋭なピン状突起又は尖鋭刃などを設けることにより、椎体Ｌ１、Ｌ２の前面部に係合溝Ｌ１ｂ、Ｌ２ｂを設けることなく（固定補強具係合溝穿設工程を省略）、アーム６２先端部を椎体Ｌ１、Ｌ２の前面部に押圧して前記ピン状突起又は尖鋭刃を直接差込み固定することも可能である。In addition, the pair ofarms 62 of the fixed reinforcingmember 60 is not T-shaped in cross section, but at least the tip side is formed as a single plate, and one or more sharp pin-like protrusions are formed on the front surface of the plate. It is also possible to do. By providing such a sharp pin-like protrusion or sharp blade at the tip of thearm 62, the engaging grooves L1b and L2b are not provided in the front surface of the vertebral bodies L1 and L2 (fixed reinforcing tool engaging groove drilling It is also possible to press the tip of thearm 62 against the front surface of the vertebral bodies L1 and L2 and directly insert and fix the pin-like protrusions or sharp blades.

　さらに、例えば本体嵌入ドライバー８０は、図示しないが、シャフト部８１を長手方向２分割で着脱可能な連結型とすることもできる。これにより、押圧ねじドライバー９０の先端係合部９３に押圧ねじ４０、５０、４０ａの後端係合部４４を係合した状態で、把持部８２側シャフト部８１を分離して短くなった先端係合部８３側シャフト部８１内に挿入し易くなり、その後把持部８２側シャフト部８１を再連結することができ、操作性が向上する。Further, for example, although the mainbody insertion driver 80 is not illustrated, theshaft portion 81 can be a connection type that can be attached and detached in two in the longitudinal direction. As a result, the frontend engaging portion 93 of thepressing screw driver 90 is engaged with the rearend engaging portion 44 of thepressing screw 40, 50, 40 a, and the grippingportion 82side shaft portion 81 is separated and shortened. It becomes easy to insert into the engagingportion 83side shaft portion 81, and then the grippingportion 82side shaft portion 81 can be reconnected, thereby improving operability.

　なお、以上述べた実施例の椎体間固定装置１０、１０ａ～１０ｉ、１０ｊ、１０ｋは、２つの隣接する椎体Ｌ１、Ｌ２の間の椎間板スペースＭ部に嵌入して椎体Ｌ１、Ｌ２間を固定する椎体間固定装置であって、椎間板Ｍに直接嵌入できるが、ヘルニヤその他の欠陥あるいは老化などにより押し潰され損傷した椎間板Ｍを必要に応じ取り除いてから椎体Ｌ１、Ｌ２間に嵌入してもよい。Note that theinterbody fusion devices 10, 10a to 10i, 10j, and 10k of the embodiments described above are inserted into the intervertebral disc space M between two adjacent vertebral bodies L1 and L2, and between the vertebral bodies L1 and L2. The intervertebral body fixing device can be directly inserted into the intervertebral disc M, but is inserted between the vertebral bodies L1 and L2 after removing the intervertebral disc M that has been crushed and damaged by hernia or other defects or aging as necessary. May be.

　１０、１０ａ、１０ｂ、１０ｃ、１０ｄ、１０ｅ、１０ｆ、１０ｇ、１０ｈ、１０ｉ、１０ｊ、１０ｋ　椎体間固定装置
　１１、１１ｂ、１１ｃ、１１ｄ、１１ｅ、１１ｇ、１１ｈ、１１ｉ　本体
　１２　　　前端面
　１３　　　後端面
　１４　　　外面係合部（（部分）雄ねじ）
　１４ａ　　外面係合部（スプライン歯）
　１４ｂ　　先端部（尖鋭刃）
　１４ｃ　　外面係合部（鋸歯）
　１５　　　外面係合部（（完全）雄ねじ）
　１６　　　雌ねじ
　１６ａ　　中空内面
　１７、１７ａ、１７ｃ、１７ｄ、１８、１８ａ、１８ｃ、１８ｄ　ガイド孔
　１９　　　カット側面
　２１、２２、２３　側面開口
　２４、２５、２６　上下面開口
　２７　　　後端開口
　２８　　　小穴
　２９、４４、５４　後端係合部
　３０、３０Ａ、３０Ｂ、３０Ｃ、３０Ｄ、３０Ｅ、３０Ｆ、３０ａ、３０ｂ、３０ｃ、３０ｄ、３０ｊ、３０ｋ　ピン
　３０Ａｎ、３０Ｄｎ　薄板材
　３０Ｂｎ、３０Ｅｎ、３０Ｃｎ、３０Ｆｎ　線材
　３１、３１ａ、３１ｂ、３１ｃ、３１ｄ、３１ｊ、３１ｋ　（ピンの）後端
　３２、３２ａ、３２ｂ、３２ｃ、３２ｄ、３２ｊ、３２ｋ　（ピンの）先端
　３３、３３ｋ　基端部
　３４、３４ｋ　雌ねじ穴
　４０、４０ａ、４０ｊ、４０ｋ、５０　押圧ねじ
　４１、４１ｊ、４１ｋ、５１、９５ａ、９６ａ　雄ねじ部
　４２、４２ｊ、４２ｋ、５２　キャップ
　４３、５３　先端面
　４３ａ　　先端部
　４３ｂ　　傾斜面
　４４、４５　挿通孔
　５５　　　摩擦板
　５５ａ　　ピン固定溝
　６０　　　固定補強具
　６１　　　ボス
　６２　　　アーム
　６２ａ　　フランジ
　６２ｂ　　ウエブ
　７０、７０´、７０´´　（椎体間固定外科手術用）椎体間スペース保持装置
　７０ａ、７０´ａ　保持装置本体
　７０ｂ、７０´ｂ　クランプアーム開閉管
　７１、７１´　第１のシャフト部
　７１ａ、７１´ａ、７６ａ　先端部
　７１ｂ　　ガイド筒
　７１ｃ　　針状突起
　７２、７７、８２、９２　把持部
　７２ａ、７７ａ、８２ａ、９２ａ　ボス部
　７３、７３´　スペーサー
　７４、７４´　クランプアーム
　７４ａ　　弾性支持部
　７４´ａ　支持部
　７４ｂ　　固定爪
　７４ｃ　　尖鋭突起
　７５　　　補強板
　７５ａ　　後部支持部材
　７５ｂ　　前部支持部材
　７５ｃ　　挿通孔
　７６　　　第２のシャフト部
　７６´　　椎体固定機構
　７６´ａ　ねじ部
　７６´ｂ　長尺固定ねじ部材
　７６´ｃ　頭部
　７８　　　ブラケット
　７９　　　リンク部材
　８０　　　本体嵌入ドライバー
　８１、９１　シャフト部
　８３、９３　先端係合部
　９０　　　押圧ねじドライバー
　９５、９６　引抜きドライバー
　Ｂｄ　　　脊柱手術台
　Ｃ１　　　（本体の）主軸
　Ｃ２、Ｃ３　（ガイド孔の）傾斜軸（中心軸）
　Ｋ　　　　カニューレ
　Ｌ　　　　脊柱（脊椎）
　Ｌ１、Ｌ２　椎体（椎骨）
　Ｌ１ａ、Ｌ２ａ　対向面
　Ｌ１ｂ、Ｌ２ｂ　係合溝
　Ｍ　　　　椎間板（椎間板スペース）
　Ｍａ、Ｍｂ、Ｍｃ、Ｍｄ、Ｍｅ　（内視鏡用）ポート
　Ｍｆ　　　切開創
　ＭＮ　　　生体（人体）
　ＭＮ１　　腹（部）
　ＭＮ２　　背（部）
　Ｐ１　　　第１の支持軸
　Ｐ２　　　第２の支持軸
　Ｐ３　　　第３の支持軸
　Ｘ１、Ｘ１´　全閉位置
　Ｘ２　　　椎体把持／固定位置
　Ｘ３、Ｘ３´　全開位置
　Θ１、Θ２　傾斜角10, 10a, 10b, 10c, 10d, 10e, 10f, 10g, 10h, 10i, 10j, 10kInterbody fusion device 11, 11b, 11c, 11d, 11e, 11g, 11h, 11iMain body 12Front end surface 13Rear end surface 14 Outer surface engaging part ((part) male thread)
14a Outer surface engaging part (spline teeth)
14b Tip (sharp blade)
14c Outer surface engaging part (saw tooth)
15 Outer surface engaging part ((complete) male thread)
16 Female thread 16a Hollow inner surface 17, 17a, 17c, 17d, 18, 18a, 18c, 18d Guide hole 19 Cut side surface 21, 22, 23 Side opening 24, 25, 26 Upper lower surface opening 27 Rear end opening 28 Small hole 29, 44, 54 Rear end engaging portion 30, 30A, 30B, 30C, 30D, 30E, 30F, 30a, 30b, 30c, 30d, 30j, 30k Pin 30An, 30Dn Thin plate material 30Bn, 30En, 30Cn, 30Fn Wire rod 31, 31a, 31b 31c, 31d, 31j, 31k (Pin) rear end 32, 32a, 32b, 32c, 32d, 32j, 32k (Pin) front end 33, 33k Base end 34, 34k Female screw hole 40, 40a, 40j, 40k , 50 Press screw 41, 41j, 41k, 51, 95a, 96a Male thread part 42 42j, 42k, 52 Cap 43, 53 Tip surface 43a Tip portion 43b Inclined surface 44, 45 Insertion hole 55 Friction plate 55a Pin fixing groove 60 Fixing reinforcement 61 Boss 62 Arm 62a Flange 62b Web 70, 70 ′, 70 ″ ( Interbody space holding device 70a, 70'a Holding device body 70b, 70'b Clamp arm open / close tube 71, 71 'First shaft portion 71a, 71'a, 76a Tip portion 71b Guide cylinder 71c Needle-like protrusions 72, 77, 82, 92 Grip part 72a, 77a, 82a, 92a Boss part 73, 73 'Spacer 74, 74' Clamp arm 74a Elastic support part 74'a Support part 74b Fixing claw 74c Sharp protrusion 75 Reinforcing plate 75a Rear support member 75b Front support member 75c Insertion hole 7 Second shaft portion 76 'Vertebral body fixing mechanism 76'a Screw portion 76'b Long fixing screw member 76'c Head 78 Bracket 79 Link member 80 Body insertion driver 81, 91 Shaft portion 83, 93 Tip engagement portion 90 Press screw driver 95, 96 Pull-out driver Bd Spine operating table C1 (main body) main axis C2, C3 (guide hole) inclined axis (central axis)
K cannula L spine (spine)
L1, L2 Vertebral bodies (vertebrae)
L1a, L2a Opposing surfaces L1b, L2b Engagement groove M Intervertebral disc (disc space)
Ma, Mb, Mc, Md, Me (for endoscope) port Mf Incision wound MN Living body (human body)
MN1 belly (part)
MN2 back (part)
P1 First support shaft P2 Second support shaft P3 Third support shaft X1, X1 ′ Fully closed position X2 Vertebral body grasping / fixing position X3, X3 ′ Fully open position Θ1, Θ2 Inclination angle

Claims (25)

1. 　２つの隣接する椎体（椎骨）間の適正な間隔を保持するように形成された前端有底の略中空円筒又は先細り中空円錐台の外面に前記２つの椎体の対向面部に係合する外面係合部が形成されるとともに、後端側の中空内面に適宜深さの雌ねじが形成され、さらに該雌ねじの先端中空内面から前記椎体の対向面に向かって径方向に末広がりに傾斜し外面まで貫通する１つ又は複数の屈曲状又はストレート状のガイド孔が穿設された本体と、
   　前記ガイド孔内に遊嵌収容された屈曲状又はストレート状の１本又は複数のピンと、
   　前記本体の雌ねじに螺合しその軸方向推進力により、前記ピンの後端を押圧する押圧ねじと、
   を備え、
   　前記本体が前記椎体間の椎間板スペースに外面係合部を介して嵌入され固定された後に、前記ピンが前記本体の雌ねじに螺合された押圧ねじの軸方向推進力により後端を押圧されて先端側がガイド孔に沿って順次案内され前記椎体内に差込まれる椎体間固定装置を具備することを特徴とする椎体間固定外科手術システム。An outer surface that engages the opposing surface portions of the two vertebral bodies on the outer surface of a generally hollow cylinder or tapered hollow truncated cone with a front end formed so as to maintain an appropriate distance between two adjacent vertebral bodies (vertebrae) An engaging portion is formed, and a female screw of an appropriate depth is formed on the hollow inner surface on the rear end side. Further, the outer surface is inclined outwardly from the hollow inner surface of the distal end of the female screw toward the opposite surface of the vertebral body in the radial direction. A main body with one or more bent or straight guide holes penetrating to
   One or a plurality of bent or straight pins loosely accommodated in the guide holes;
   A pressing screw that is screwed into the female screw of the main body and presses the rear end of the pin by its axial propulsive force;
   With
   After the main body is inserted and fixed in the intervertebral disc space via the outer surface engaging portion, the rear end is pressed by the axial thrust of the pressing screw screwed into the female screw of the main body. An interbody fusion surgery system comprising an interbody fusion device in which a distal end side is sequentially guided along a guide hole and inserted into the vertebral body.
2. 　前記略中空円筒形本体の中央部外径が僅かに太めの太鼓状に形成されていることを特徴とする請求項１記載の椎体間固定外科手術システム。The interbody fusion surgical system according to claim 1, wherein the outer diameter of the central portion of the substantially hollow cylindrical main body is formed in a slightly thick drum shape.
3. 　前記ピンは、丸や多角形を含む任意断面形状の中実又は中空の棒状体もしくは少なくとも先端側又は全長に亘り複数の薄板材又は丸や各種扁平型を含む任意断面形を有する線材が積層されて一体的な丸や多角形を含む任意断面形状の棒状積層体からなり、その先端部が尖鋭状に形成されていることを特徴とする請求項１記載の椎体間固定外科手術システム。The pin is a solid or hollow rod-shaped body having an arbitrary cross-sectional shape including a circle and a polygon, or a plurality of thin plate materials or a wire having an arbitrary cross-section including a circle and various flat shapes over the entire length. 2. The interbody fusion surgery system according to claim 1, wherein the system comprises a bar-shaped laminate having an arbitrary cross-sectional shape including an integral circle and polygon, and the tip portion thereof is formed in a sharp shape.
4. 　前記１本又は複数のピンは、後端に雌ねじ穴が設けられた基端部が個別又は一体的に形成され連設されており、
   　前記押圧ねじは前記本体内への螺合方向とは逆方向の回転操作により前記本体内から、前記本体は前記椎体間への嵌入方向とは逆方向への回転及び／又は引抜き操作により椎体間からそれぞれ取外され体外に取出し可能であって、
   　前記ピンが椎体内に差込まれた後で、前記押圧ねじが前記本体から引抜かれるとともに、前記ピンが基端部の雌ねじ穴に螺合する雄ねじ部を先端部に備えた引抜きドライバーにより前記椎体間から引抜かれ、前記本体と共に体外に取出されるように構成されていることを特徴とする請求項１乃至請求項３のいずれか１項記載の椎体間固定外科手術システム。The one or more pins have a base end portion provided with a female screw hole at the rear end, and are individually or integrally formed and connected.
   The pressing screw is rotated from the inside of the main body by a rotation operation in a direction opposite to the screwing direction into the main body, and the main body is rotated by a rotation and / or extraction operation in a direction opposite to the insertion direction between the vertebral bodies. It can be removed from between the body and taken out of the body,
   After the pin is inserted into the vertebral body, the pressing screw is withdrawn from the main body, and the pin is screwed into the female screw hole of the base end portion by a pulling screwdriver having a male screw portion at the distal end portion. The interbody fusion surgical system according to any one of claims 1 to 3, wherein the interbody fusion surgery system is configured to be extracted from between vertebral bodies and taken out of the body together with the main body.
5. 　前記ピン基端部の雌ねじ穴内には、通常、後端部に被係合部を有する盲プラグが挿嵌されており、
   　前記ピンの引抜き操作に先立ち、前記盲プラグが前記被係合部に係合する係合部を先端部に備えたドライバーにより前記雌ねじ穴内から取外され体外に取出し可能であることを特徴とする請求項４記載の椎体間固定外科手術システム。A blind plug having an engaged portion at the rear end is usually inserted into the female screw hole of the pin base end,
   Prior to the pulling-out operation of the pin, the blind plug can be removed from the female screw hole and taken out of the body by a screwdriver having an engaging portion that engages with the engaged portion at the tip. The interbody fusion surgical system according to claim 4.
6. 　前記外面係合部は、雄ねじ状に形成されていることを特徴とする請求項１記載の椎体間固定外科手術システム。The interbody fusion surgical system according to claim 1, wherein the outer surface engaging portion is formed in a male screw shape.
7. 　前記外面係合部は、前記主軸に平行な複数のスプライン歯状に形成されていることを特徴とする請求項１記載の椎体間固定外科手術システム。2. The interbody fusion surgical system according to claim 1, wherein the outer surface engaging portion is formed in a plurality of spline teeth parallel to the main axis.
8. 　前記外面係合部は、前記主軸に平行な複数の鋸歯状に形成されていることを特徴とする請求項１記載の椎体間固定外科手術システム。The interbody fusion surgical system according to claim 1, wherein the outer surface engaging portion is formed in a plurality of sawtooth shapes parallel to the main axis.
9. 　前記外面係合部の軸方向先端及び径方向外面頭頂部が尖鋭刃状に形成されていることを特徴とする請求項１、請求項６乃至請求項８のいずれか１項記載の椎体間固定外科手術システム。The intervertebral body according to any one of claims 1 and 6, wherein an axial tip and a radial outer surface vertex of the outer surface engaging portion are formed in a sharp edge shape. Fixed surgical system.
10. 　前記本体には、外面の上下・左右にそれぞれ連通する血管新生用開口部及び骨内部成長用開口部が複数設けられていることを特徴とする請求項１乃至請求項９のいずれか１項記載の椎体間固定外科手術システム。10. The body according to any one of claims 1 to 9, wherein the main body is provided with a plurality of openings for angiogenesis and openings for bone ingrowth that respectively communicate with the top, bottom, left and right of the outer surface. Interbody fusion surgery system.
11. 　前記押圧ねじの後端に前記本体の後端面の全面又は一部を覆うキャップが形成されていることを特徴とする請求項１乃至請求項１０のいずれか１項記載の椎体間固定外科手術システム。The interbody fusion surgery according to any one of claims 1 to 10, wherein a cap that covers the whole or part of the rear end surface of the main body is formed at the rear end of the pressing screw. system.
12. 　前記押圧ねじに遊嵌されるボスと、
    　該ボスの外面に軸対称に立設され、前記押圧ねじのキャップ部にボス部後端面が押圧されて先端部が前記隣接する椎体の腹部側前面にそれぞれ係合固定される１対のアームと、からなる固定補強具をさらに備えることを特徴とする請求項１１記載の椎体間固定外科手術システム。A boss loosely fitted to the pressing screw;
    A pair of arms which are erected on the outer surface of the boss in an axially symmetrical manner, and the rear end surface of the boss portion is pressed against the cap portion of the pressing screw, and the front end portion is engaged and fixed to the front side of the abdomen of the adjacent vertebra The interbody fusion surgical system according to claim 11, further comprising a fixation reinforcing tool comprising:
13. 　前記本体の雌ねじ内に遊嵌収容され、前記ピンの後端部に当接配置される摩擦板をさらに備えることを特徴とする請求項１乃至請求項１２のいずれか１項記載の椎体間固定外科手術システム。The intervertebral body according to any one of claims 1 to 12, further comprising a friction plate that is loosely received in the female screw of the main body and is disposed in contact with a rear end portion of the pin. Fixed surgical system.
14. 　前記ピンの後端部が、少なくとも左右方向への移動が拘束されるように前記摩擦板に係合又は固定されていることを特徴とする請求項１３記載の椎体間固定外科システム。14. The interbody fusion surgical system according to claim 13, wherein a rear end portion of the pin is engaged with or fixed to the friction plate so that movement in at least the left-right direction is restricted.
15. 　前記椎体間固定装置は、患者の腹部側から腹腔鏡を併用した椎体間固定外科手術により前記椎体間に固定されることを特徴とする請求項１乃至請求項１４のいずれか１項記載の椎体間固定外科手術システム。The intervertebral body fixing device is fixed between the vertebral bodies by interbody fusion surgery using a laparoscope in combination from the abdominal side of the patient. The interbody fusion surgical system as described.
16. 　後端に把持部が設けられた中空長尺のシャフト部の先端に前記椎体間固定装置の本体の後端部に形成された後端係合部に係合する先端係合部を有し、
    　該先端係合部を前記本体の後端係合部に係合した状態で、生体腹部から前記椎体の前面まで形成された内視鏡用腹腔部内のカニューレ内に挿入されて前記２つの隣接する椎体間の適正な間隔を保持する椎体間スペース保持装置の中空部内に挿入され、前記本体を押圧又は／及び回転することにより前記椎体間に嵌入させる本体嵌入ドライバーを備えることを特徴とする請求項１乃至請求項１５のいずれか１項記載の椎体間固定外科手術システム。A distal end engaging portion that engages with a rear end engaging portion formed at the rear end portion of the body of the interbody fusion device at the distal end of a hollow long shaft portion provided with a grip portion at the rear end. ,
    With the distal end engaging part engaged with the rear end engaging part of the main body, the two adjacent parts are inserted into a cannula in an abdominal part for endoscope formed from a living body abdominal part to the front surface of the vertebral body. A body insertion driver that is inserted into the hollow portion of the interbody space holding device for maintaining an appropriate distance between the vertebral bodies to be inserted between the vertebral bodies by pressing or / and rotating the body. The interbody fusion surgery system according to any one of claims 1 to 15.
17. 　前記本体嵌入ドライバーは、先端係合部が金属製で、シャフト部は高分子材料からなることを特徴とする請求項１６記載の椎体間固定外科手術システム。The interbody fusion surgery system according to claim 16, wherein the main body insertion driver has a tip engaging portion made of metal and a shaft portion made of a polymer material.
18. 　後端に把持部が設けられた長尺のシャフト部の先端に前記椎体間固定装置の押圧ねじの後端部に形成された後端係合部に係合する先端係合部を有し、
    　該先端係合部を前記押圧ねじの後端係合部に係合した状態で前記本体嵌入ドライバーの中空部内に挿入し、前記押圧ねじを前記椎間板スペースに固定された前記椎体間固定装置の本体の雌ねじ部に挿入して押圧しながら回転することにより前記雌ねじに螺合させその軸方向推進力により前記ピンの先端側をガイド孔に沿って順次案内させて前記椎体内に差込む押圧ねじドライバーをさらに備えることを特徴とする請求項１６又は請求項１７記載の椎体間固定外科手術システム。A distal end engaging portion that engages with a rear end engaging portion formed at the rear end portion of the pressing screw of the interbody fusion device at the distal end of a long shaft portion provided with a grip portion at the rear end. ,
    In the interbody fusion device, the distal end engaging portion is inserted into the hollow portion of the main body insertion driver in a state where the distal end engaging portion is engaged with the rear end engaging portion of the pressing screw, and the pressing screw is fixed to the intervertebral disc space. Inserted into the female threaded portion of the main body and rotated while being pressed, screwed into the female thread, and the axial propulsive force is used to sequentially guide the distal end side of the pin along the guide hole to be inserted into the vertebral body The interbody fusion surgical system according to claim 16 or 17, further comprising a screw driver.
19. 　前記押圧ねじドライバーは、先端係合部が金属製で、シャフト部は高分子材料からなることを特徴とする請求項１８記載の椎体間固定外科手術システム。19. The interbody fusion surgical system according to claim 18, wherein the pressing screw driver has a tip engaging portion made of metal and a shaft portion made of a polymer material.
20. 　生体の椎体間固定外科手術の際に、２つの隣接する椎体（椎骨）間の適正な間隔を修正して椎間板スペースを保持するための装置であって、
    　後端に把持部が設けられ、生体腹部側に設けられた内視鏡用腹腔部内のカニューレを介して前記椎体の前面近傍まで挿入される中空長尺の第１のシャフト部と、
    　該第１のシャフト部の先端部に軸方向に沿って延設され、前記隣接する椎体の左右両側面をそれぞれ挟持し固定する固定爪が先端に連接されて前記椎体の直交面内で開閉可能な少なくとも各１対のクランプアームと、を有する椎体クランプ機構を備えることを特徴とする椎体間固定外科手術用椎体間スペース保持装置。A device for correcting the proper spacing between two adjacent vertebral bodies (vertebrae) to preserve disc space during living interbody fusion surgery,
    A hollow long first shaft portion that is provided to the vicinity of the front surface of the vertebral body through a cannula in the abdominal portion for endoscope provided on the living body abdominal portion side with a gripping portion at the rear end;
    A fixing claw that extends in the axial direction at the distal end portion of the first shaft portion and clamps and fixes both the left and right side surfaces of the adjacent vertebral bodies is connected to the distal end so as to be within the orthogonal plane of the vertebral body. An intervertebral body space holding device for interbody fusion surgery, comprising a vertebral body clamp mechanism having at least one pair of clamp arms that can be opened and closed.
21. 　前記椎体クランプ機構は、
    　先端に前記各固定爪が連設され、後端部が前記第１のシャフト部の先端部に連設され、フリー状態では前記固定爪をそれぞれ前記椎体の直交面内で拡径して開くように屈曲されて弾支する弾性支持部を有する各１対のクランプアームと、
    　前記第１のシャフト部に前進／後退自在に外嵌され、後端に把持部が設けられた中空長尺の第２のシャフト部の先端部が前進して前記弾性支持部を外側から押圧することにより前記各１対のクランプアームを縮径方向に閉じ、その先端部が前記弾性支持部から後退することにより前記各１対のクランプアームを拡径方向に開くクランプアーム開閉管と、を備えることを特徴とする請求項２０記載の椎体間固定外科手術用椎体間スペース保持装置。The vertebral body clamping mechanism is
    Each of the fixed claws is connected to the distal end, and the rear end portion is connected to the distal end of the first shaft portion. In the free state, the fixed claws are expanded and opened in the orthogonal plane of the vertebral body. A pair of clamp arms each having an elastic support portion that is bent and elastically supported,
    A distal end portion of a hollow long second shaft portion that is externally fitted to the first shaft portion so as to be able to move forward / backward and a grip portion is provided at the rear end moves forward to press the elastic support portion from the outside. Each of the pair of clamp arms is closed in the diameter-reducing direction, and a clamp arm opening and closing tube that opens the pair of clamp arms in the diameter-expanding direction by retreating the tip of the pair from the elastic support portion. The interbody space holding device for interbody fusion surgery according to claim 20.
22. 　前記椎体クランプ機構は、
    　先端に前記各固定爪が連設され、後端部が前記第１のシャフト部の先端部に第１の支持軸を介して前記椎体の直交面内で揺動自在に枢着された各１対のクランプアームと、
    　前記第１のシャフト部に前進／後退自在に外嵌され、後端に把持部が設けられた中空長尺の第２のシャフト部と、
    　前記各１対のクランプアームの中間部に第２の支持軸を介してそれぞれ一端部が揺動自在に枢着されるとともに、その各他端部が前記第２のシャフト部の先端部に第３の支持軸を介して揺動自在に枢着された各１対のリンク部材と、からなり、
    　前記第２のシャフト部が前進又は後退することにより前記各１対のリンク部材を前記第３の支持軸を支点として反時計回り又は時計回りに揺動させて前記各１対のクランプアームを前記椎体の直交面内で前記第１の支持軸を支点として縮径方向に閉じ又は拡径方向に開くトグル機構を構成することを特徴とする請求項２０記載の椎体間固定外科手術用椎体間スペース保持装置。The vertebral body clamping mechanism is
    Each fixing claw is connected to the distal end, and the rear end is pivotally attached to the distal end of the first shaft portion via a first support shaft so as to be swingable in an orthogonal plane of the vertebral body. A pair of clamp arms;
    A hollow long second shaft portion that is externally fitted to the first shaft portion so as to be movable forward / backward, and a grip portion is provided at the rear end;
    One end of each pair of clamp arms is pivotally attached to a middle portion of the pair of clamp arms via a second support shaft, and each other end thereof is connected to the tip of the second shaft portion. A pair of link members pivotably supported via three support shafts,
    As the second shaft portion moves forward or backward, the pair of link members are swung counterclockwise or clockwise with the third support shaft as a fulcrum, so that the pair of clamp arms are 21. The intervertebral fusion surgical vertebra according to claim 20, wherein a toggle mechanism is configured to close in the diameter reducing direction or open in the diameter expanding direction with the first support shaft as a fulcrum in an orthogonal plane of the vertebral body. Interbody space holding device.
23. 　前記固定爪の椎体挟持面に前記椎体の側面に突刺可能な複数の尖鋭突起を有することを特徴とする請求項２０乃至請求項２２のいずれか１項記載の椎体間固定外科手術用椎体間スペース保持装置。The intervertebral fusion surgery according to any one of claims 20 to 22, wherein the vertebral body clamping surface of the fixed claw has a plurality of sharp protrusions that can be inserted into the side surface of the vertebral body. Interbody space holding device.
24. 　生体の椎体間固定外科手術の際に、２つの隣接する椎体（椎骨）間の適正な間隔を修正して椎間板スペースを保持するための装置であって、
    　後端に把持部が設けられ、生体腹部側に設けられた内視鏡用腹腔部内のカニューレを介して前記椎体の前面近傍まで挿入される中空長尺の第１のシャフト部と、
    　該第１のシャフト部の外面に軸方向に沿って回転自在に延設され、先端に形成されたねじ部が前記隣接する椎体の一方又は両方の前面部に羅入し固定される長尺固定ねじ部材と、
    　前記第１のシャフト部の先端部に突設され、前記隣接する椎体の一方又は両方の前面部に突刺可能な一つ又は複数の針状突起と、を備えることを特徴とする椎体間固定外科手術用椎体間スペース保持装置。A device for correcting the proper spacing between two adjacent vertebral bodies (vertebrae) to preserve disc space during living interbody fusion surgery,
    A hollow long first shaft portion that is provided to the vicinity of the front surface of the vertebral body through a cannula in the abdominal portion for endoscope provided on the living body abdominal portion side with a gripping portion at the rear end;
    A long length that is rotatably extended along the axial direction on the outer surface of the first shaft portion, and a screw portion formed at the tip is inserted into and fixed to one or both front portions of the adjacent vertebral bodies. A fixing screw member;
    One or a plurality of needle-like protrusions projecting from the distal end of the first shaft portion and capable of being stabbed into one or both front surfaces of the adjacent vertebral bodies Interbody space retention device for fixed surgery.
25. 　前記第１のシャフト部の先端部に前記椎体の外径より僅かに狭い間隔で前記椎体間スペースに向かい軸方向に沿って対向状態で延設され、先端部から前記椎間板スペース内に挿入されることにより前記隣接する椎体を適正な間隔に修正して保持するような外形形状に形成された少なくとも１対のスペーサーをさらに備えることを特徴とする請求項２０乃至請求項２４のいずれか１項記載の椎体間固定外科手術用椎体間スペース保持装置。The distal end portion of the first shaft portion extends in a state of being opposed to the intervertebral space at an interval slightly narrower than the outer diameter of the vertebral body along the axial direction, and is inserted into the intervertebral disc space from the distal end portion. 25. The apparatus according to claim 20, further comprising at least one pair of spacers formed in an outer shape so as to correct and hold the adjacent vertebral bodies at appropriate intervals. The interbody space holding device for interbody fusion surgery according to claim 1.

Images