KR101166614B1 - Orthopedic plate system - Google Patents

Abstract

Orthopedic medical devices and methods are disclosed, including cylindrical orthopedic plates and clamps and securing members for attaching the plate to tissues such as bone tissue. In one embodiment, the plate includes cylindrical sides and ends, and the clamps are fitted to the plate. Also disclosed are lateral connecting members and additional devices in the form of connecting plates that can be used with orthopedic plates. Methods of using the disclosed apparatus are also described.

Lateral connection member, non-stress configuration, yoke member, shank portion, internal drive print

Description

Orthopedic plate system {ORTHOPEDIC PLATE SYSTEM}

The present invention relates to orthopedic medical devices and methods comprising an orthopedic plate, a clamp, a bone fixation member and a locking memebr.

In the field of orthopedic surgery, an elongated plate or rod may be secured to the bones to hold and hold them in place. For example, in surgery to fuse damaged vertebrae, the vertebrae are placed in the corrected position desired by the surgeon. A flat plate, ie, a plate with flat lower upper surfaces, is disposed adjacent or leaning against the bone and secures the plate to the bone using bone anchors. Bone screws or bolts may be used as bone anchors, which are positioned by drilling one or more holes in the bone (s) to screw the anchors into the holes. The anchor may be screwed into the hole through the plate, or the plate may be disposed at a point around the anchor after it is screwed into the hole. The anchor and the plate are fixed to each other to prevent relative movement. In this way, the bones are maintained and / or supported properly aligned for treatment.

Other orthopedic systems use rods to connect bone anchors and provide stability to tissues such as vertebrae. Such rods may be disposed along the vertebrae and may be configured to, for example, hold and support the bone in the desired position.

To enhance understanding of the principles of the present invention, reference will be made to the embodiments shown in the drawings, and special terminology will be used to describe the embodiments. It should be understood, however, that it is not intended to limit the scope of the invention. Such modifications and further changes in the described apparatuses, as well as additional applications for the principles of the invention described herein, are also contemplated as possible to one of ordinary skill in the art to which the invention relates.

1-5, an orthopedic implant system 20 of one embodiment is shown. In this embodiment, the implant system 20 includes a plate member 22, one or more clamps 24 and a bone fixation member 26 connected to the clamps 24. Any of these elements may be used in varying numbers without departing from the scope of the present invention. For example, the plurality of plate members 22 may be used in connection with each other, and the clamps 24 and the bone may depend on the size, shape or other configuration of the plate member, the medical problem to be solved and / or other factors. Fixing members 26 may additionally be used.

In one embodiment, the plate member 22 is generally in the form of an elongate ellipse, the first side or rail 32, the second side or rail 34, the first end 36 and the second end. 38 is provided. In the embodiment shown, the sides 32, 34 and the ends 36, 38 form or enclose a space 40. Each of the sides 32, 34 has a length between the ends 36, 38, and in certain embodiments the sides 32, 34 are substantially straight across the length between the ends 36, 38. to be. Further, the sides 32, 34 are cylindrical, for example the cross section perpendicular to the longitudinal axis of the sides 32, 34 is substantially circular. Similarly, the ends 36, 38 are substantially cylindrical, for example the cross section perpendicular to the central axis is also substantially circular. In the illustrated embodiment, the sides 32, 34 are each the same as each other and have the same diameter as the diameters of the ends 36, 38. Thus, the plate member 22 may be considered as a single substantially cylindrical rod that is bent to a continuous substantially elliptical shape where the ends meet. The member can also be thought of as two parallel cylindrical rods with ends bent to meet each other. Since the sides 32, 34 are cylindrical, the plate member 22 can be more easily bent around or in any twist, without requiring cutting, assembly and machining of the two rods, which This is because there are no corners or material concentration. It is also possible to use plate member 22 with a variety of implants designed for use with cylindrical rods. Of course, the diameters of each side may be different from each other and / or the diameters of the ends, and other configurations may be changed.

In one embodiment clamp 24 may be used with plate member 22. The clamp 24 of one embodiment shown in FIGS. 1-5 includes a yoke member 52 and a crown member 54. The yoke member 52 has an upper portion 56 that is slightly narrower than the lower portion 58. In a particular embodiment, the top 56 is sized to be able to be inserted through the space 40 of the plate member 22 and has a threaded portion 60. In a particular embodiment, the top 56 has a width dimension substantially equal to the closest distance between the sides 32, 34 of the plate member 22. The top 56 also includes an opening, ie an aperture 62. At least some of the holes 62 comprise a print or profile 64 (such as a hexagonal print, a TORX print or similar surfaces) or otherwise configured to be engaged by a tool. In the illustrated embodiment, the lower portion 58 of the yoke member 52 has a chamber 66, a groove 68 toward the open end of the chamber 66 and a beveled edge 70. do. The chamber 66 is sized to receive at least a portion of the bone fixation member (eg, member 26), as described below. The chamber 66 may be in communication with the aperture 62 of the top 56 and generally open at one side of the yoke member 52 having surfaces 72, 74 facing the plate member 22. Can be. Ring member 76 is shown seated in groove 68. When the ring member 76 is in the groove 68, the inner dimension of the ring member 76 is smaller than the outer dimension of the portion of the fastening member in the chamber 66. The ring member 76 may be substantially planar, corrugated and / or C-shaped in an unstressed configuration that is slightly larger than the diameter of the groove 68, such that the ring member 76 is retained in the groove 68. . Alternatively, the ring member 76 may have other configurations or properties as made of shape memory material.

The crown member 54 of the illustrated embodiment has an upper surface 78 through which the hole 80 extends, an internal surface 82 that may be substantially spherical, and elongated fingers: 84). The crown member 54 is generally sized to be movably fitted within the chamber 66 such that the ring member 76 is between the crown member 54 and the inclined edge 70. The hole 80 is in communication with the chamber 66 and is substantially aligned with the aperture 62 of the top 56 of the yoke member 52 in the illustrated embodiment. In the embodiment shown, the fingers 84 of the crown member 54 extend at least slightly over the surfaces 72, 74.

In one embodiment a bone fixation member 26 is shown. In general, the bone fixation member 26 of the illustrated embodiment includes a head portion 90 and a threaded portion including an internal driving print 92 as described with respect to the print 64. And a threaded shank portion 94. Head portion 90 is substantially partially spherical and includes one or more ridges 96 that may be present at the circumference. As described above, the head portion 90 is sized to fit within the chamber 66 and to be held in place by the ring member 76, so that the bone fixation member 26 is multiaxial with respect to the yoke member 52. It can be arranged as. In the embodiment shown, the bone fixation member 26 is shown as a screw, but may be replaced with a hook or other type of orthopedic implant or device.

Nut 100 is also provided in the illustrated embodiment. The nut 100 has internal threads 102, a lower opening 104 that can be partially inclined and substantially partially cylindrical, and has external flats for driving. It may also include an enlarged lower part 106 extending slightly laterally than the upper part 108. Upper part 108 may include different driving prints or configurations.

In use, clamp 24 and bone fixation member 26 may be connected prior to surgery or at other times desired by the surgeon or others. The crown member 54 is inserted into the chamber 66 of the yoke member 52 above the head portion 90 before the head portion 90 of the bone fixation member 26 is inserted into the chamber 66. The ring member 76 is disposed around the shank portion 94 and inserted into the chamber 66 through the inclined opening 70. As described above, the ring member 76 may be compressed if appropriate, for example, if the ring member 76 is C-shaped with an unstressed diameter that is larger than the diameter of the chamber 66. Can be. The ring member 76 is advanced into the chamber 66 and at least partially disposed in the groove 68. Thus, in the illustrated embodiment, the head portion 90 of the bone fixation member 26 is disposed between the ring member 76 and the crown member 54 in the chamber 66 of the yoke member 52.

Bone fixation member 26 and clamp 24 are attached to tissue such as vertebrae. In one embodiment, a hole may be drilled in the vertebrae to a size suitable for the bone fixation member 26. The threaded shank portion 94 is inserted into the hole, and in one embodiment an appropriately configured tip (not shown) with the tip is inserted into the print 92, with the bone fixation member 26 The clamp 24 is pre-adjusted not only through the hole 62 of the yoke member 52 but also through the hole 80 of the crown member 54, thereby rotating the threaded shank portion 94 into the bone. When the shank portion 94 is screwed into the bone to the desired depth, the tool is removed from the yoke member 52. The clamp 24 may be rotated and / or pivoted around the head 90 of the bone fixation member 24 in a relative position as desired by the surgeon.

The plate member 22 is then placed on the clamp 24 by inserting the top 56 of the yoke member 52 through the space 40 of the plate member 22. Sides 32 and 34 of the plate member 22 may abut the fingers 84 of the crown member 54. As the surgeon desires, the plate member 22 is adjusted relative to the clamp 24 and / or the combination of the plate member 22 and the clamp 24 is adjusted relative to the bone fixation member 26. The nut 100 is screwed into the upper portion 56 of the yoke member 52 and tightened with respect to the plate member 22. Tightening of the nut 100 presses the plate member 22 against the crown member 54, and the bone fixation member 26 is gripped between the ring member 76 and the surface 82 of the crown member 54. . It will be appreciated that other clamps 24 and bone fixation members 26 as described above may be disposed in other tissues, such as adjacent vertebrae, and may be connected to plate member 22. In addition or alternatively, other types of bone implants or orthopedic devices may be connected to adjacent bone or other tissue, or may simply be connected between the plate member 22 and another orthopedic implant or instrument. .

Plate member 22 may be used with various clamps, bone fixation members, and other implant structures. Among these, embodiments of the clamp 124 and the bone fixing member 126 are shown in FIGS. 6 to 10. Clamp 124 includes a U-shaped yoke member 152 having a base 158 with a pair of legs 156 and a hole 162. In the illustrated embodiment, the aperture 162 may be a substantially conical conical section 164a that is widened outwardly, and may be substantially conical and wider outwardly, or may be substantially spherical or otherwise. Or a lower section 164b, which may be of other configurations or a combination thereof. Each leg 156 forms a recess 165 with the base 158. In a particular embodiment, the recesses 165 are curved, the radius of curvature of which is substantially the same as the radius of curvature of the sides 32, 34 of the plate member 22. As shown in this embodiment, the recesses 165 are less than one quarter of the circumference of one side of the plate member 22 of one embodiment such that the plate member 22 is easily disposed next to the yoke member 152. Adjacent or spaced apart. In an embodiment where the recesses 165 abut or space apart one quarter or more of the circumference of one side of the plate member 22, the yoke member 152 has sides 32, 34 of the plate member 22. ), Or either one of the ends 36, 38 can be inserted between the legs 156 and the yoke member 152 can slide along the plate member 22 to the desired relative position. have.

The bone fixation member 126 is a bolt having a media head portion 190 between the threaded shank 194 and the upper threaded portion 195 for connection with tissue such as the vertebrae. Embodiments of such bolts are described in US Pat. No. 6,280,445, the entire contents of which are incorporated herein by reference. Head portion 190 has a substantially spherical top portion 197 that abuts lower hole portion 164b and is pivotable about lower hole portion 164b. The upper thread 195 includes an inner print 199 for driving the bone fixation member 126. Print 199 may be configured as described above with respect to prints 64 and 92.

Nut 200 is also shown in this embodiment. Nut 200 is similar to that described in US Pat. No. 6,315,779, the entire contents of which are incorporated herein by reference. The nut 200 of the illustrated embodiment is slightly more than the upper part 208 with inner threads 202, a lower cylindrical skirt 203 surrounding the lower opening 204, and a drive outer flat portion. And an enlarged lower part 206 extending laterally.

The upper part 208 can include different prints or configurations for driving. Underside 209 of nut 200 may be wider outward and substantially conical. In addition to the nut 200, the washer 210 has a flat underside 212, a curved or conical upper side 214 and an upper threaded portion 195 of the bone fixation member 126. It may be provided with a hole or slot 216 to move in one or more planes with respect to 210. The nut 200 and the washer 210 can be used together to form a pre-assembled unit, and the skirt 203 can be bent or otherwise extended so that the nut 200 can move the washer 210. The nut 200 may be prevented from being removed from the washer 210 while allowing it to move along or rotate about it.

In use, the clamp 124 may be connected to either or both of the bone fixation member 126 and the plate member 22 prior to surgery or at other times desired by the surgeon or others. In one embodiment, the bone fixation member 126 is attached to tissue such as vertebrae. For example, a hole may be drilled in the vertebrae in a size suitable for the threaded shank 194 of the bone fixing member 126. The threaded shank 194 is inserted into the hole, and in one embodiment a properly configured tip (not shown) is inserted into the print 192 and then the threaded shank 194 is removed. Rotate into the bone When the shank portion 194 is screwed into the bone to the desired depth, the tool is removed.

If not pre-connected, the clamp 124 is disposed in the bone fixation member 126 so that the upper threaded portion extends over the clamp 124 and the intermediate head portion 190 is for example in an aperture portion 162b. At least partially in contact with the clamp 124. The clamp 124 may be rotated and / or pivoted about the head portion 90 of the bone fixation member 24 in a relative position as desired by the surgeon. The plate member 22 may be disposed over the bone fixation member 126 and adjacent to the clamp 124 when the plate member 22 is not previously connected to the clamp 124. In this position, the sides 32, 34 of the plate member 22 are at least partially present in the recess 165 of the clamp 124, and the upper threaded portion 195 of the bone fixation member 126 is the plate member. It extends through the space 40 of 22.

The plate member 22 and the clamp 124 may be pivoted by the bone fixation member 126 by pivoting the bone fixation member 126 along one plane of the slot 216 and / or the length of the plate member 22 as the surgeon desires. Can be adjusted against. The nut 200 and the washer 210 are disposed above the upper threaded portion 195 of the bone fixation member 126, and the nut 200 is screwed down to tighten the washer 210 with respect to the plate member 22. Press In addition, tightening of the nut 200 pulls the bone fixing member 126, and as a result, the head 190 presses the clamp 124 against the plate member 22 to lock the structure. It will be appreciated that the nut 200 can be used without or with the washer 210. In other implementations, it will also be appreciated that a nut 100 or other type of nut used with or without a washer 210 may be used with the securing member 126. For example, a nut such as nut 200 '(FIGS. 11-15) can be provided with a substantially flat bottom. Locking plate member 22, clamp 124, and bone fixation member 126 with a nut, such as nut 200 ′, allows the plane or multi-axis of bone fixation member 126 relative to clamp 124 and plate member 22. Directional arrangements are substantially limited or prohibited.

Additional components may be provided separately or in a kit in embodiments as described above or in other embodiments. For example, as shown in FIGS. 16-17, a lateral connector 300 is shown connected to the plate member 22. The connector 300 includes a connecting member 302, a post 304, and a nut 306. The connecting member 302 includes a block portion 308 through which the first opening receives at least a portion of the elongate member, such as an orthopedic rod R. 310 and a second opening 312 to which a fixing screw (not shown) for locking the elongate member R with respect to the block portion 308 is screwed. The connecting member 302 further comprises an extension portion 316 extending laterally from the block portion 308, and in certain embodiments the extension portion 316 is substantially at one surface of the block portion 308. Vertically. In the illustrated embodiment, one side of the extension 316 includes two recesses 318 that are substantially cylindrical and have a diameter that is substantially the same as the diameter of the sides 32, 34 of the plate member 22. do. The recesses 318 receive at least a portion of the sides 32, 34 of the plate member 22, and in one embodiment the walls of the recesses 318 are formed from the sides of the plate member 22. 32 and 34, respectively. As shown in the embodiments of FIGS. 16-17, the recesses 318 are on one side of the extension 316 facing away from the block portion 308 and the elongate member R. FIG. do. It will be appreciated that the recesses 318 may be present on either side of the extension 316. A hole penetrating the extension 316 is provided between the recesses 318.

In the illustrated embodiment, the post 304 includes a body 320 having a substantially cylindrical upper 322 and lower flange 324. Top 322 may be threaded and may include a print 326 such as an internal hexagon, tors or other configuration to receive the tool. The flange 324 generally extends laterally from the body 320, but may extend around other portions around the body 320 or around the entirety of the body 320. In certain embodiments, the flange 324 has an end 328 that is substantially planar, spherical or otherwise configured to make an angle of inclination with respect to the rest of the flange 324. As described further below, the flange 324 is sized such that at least a portion of the ends 328 may abut a portion of the sides 32, 34 of the plate member 22. The nut 306 is sized to be threaded therein and threaded to the top 322 of the post 304.

The connector 300 may be connected to the plate member 22 as desired by the surgeon, prior to or during surgery. An extension 316 is disposed above or below the plate member 22 such that the sides 32, 34 of the plate member 22 are at least partially present in the recesses 318 of the extension 316. . The top 322 of the post 304 is inserted through the space 40 and the hole 319 of the plate member 22 so that the ends 328 of the flange 324 are the sides 32 of the plate member 22. And 34). (In the illustrated embodiment) The nut 306 is screwed into the post 304 and tightened against the extension 316 to lock the plate member 22 between the extension 316 and the flange 324. Alternatively, connector 300 may be connected under plate member 22 (ie, as opposed to those shown in FIGS. 16-17) and nut 306 may be in direct contact with plate member 22 and flanged. 324 abuts extension 316. Plate member 22 may be locked between nut 306 and flange 324. An elongate member R, such as a spinal rod, is inserted into the block portion 308 before or after being connected to the plate member 22 and locked by a set screw (not shown).

Other devices that can be connected to the plate member 22 are additional connecting or stabilizing members, such as the connecting plate 400 of one embodiment shown in FIG. In this embodiment, the connecting plate 400 is connected to other tissues or devices, such as a joining portion 402 attached to the plate member 22 and a device implanted in, for example, the lingual bone or the lingual bone Plate portion 404. Coupling 402 includes a hole 406 through the coupling and a slot 408 through the coupling, where the slot 408 is in a plane that is substantially perpendicular to the axis of the hole 406. The slot 408 has a width sufficient for the plate member 22 to pass through such that the space 40 and the hole 406 of the plate member 22 communicate with each other. When a thread is formed inside the hole 406, a fixing screw 409 may be provided to lock the engaging portion 402 with respect to the plate member 22. Alternatively, the post 304 and the nut 306 are provided with the plate member as substantially described above with respect to the connecting member 300 and the plate member 22, regardless of whether the hole 406 is threaded. It can be used to lock the engagement portion 402 with respect to (22).

In the illustrated embodiment, the plate portion 404 has one or more holes 410, which receive bone screws that are implanted into the sacrum or other bone through the holes 410, or other types of orthopedic implants or instruments. Can accommodate In one embodiment of FIG. 16, two bone screws 412 extend through one or more holes 410. The bone screw passing through the plate portion 404 is provided with a separate threaded hole for the set screw, the head of which is provided to overlap the head of the bone screw so as to prevent the bone screw from loosening or falling out of the bone. It will be appreciated. The plate portion 404 and the coupling portion 402 can be oriented with respect to each other as can be guaranteed for certain orthopedic correction procedures or anatomical arrangements. For example, the connecting plate 400 of the illustrated embodiment is shown with the plate portion 404 non-planar with respect to the coupling portion 402, with an obtuse angle formed therebetween. Such structures may be useful with plate members 22 connected to the lower lumbar spine (s) or sacral spine (s) (such as L5 or S1), which the surgeon may also laterally connect to the sacrum or other bones. want. The angle between the coupling portion 402 and the plate portion 404 may vary (by bending the connection plate 400 or providing the kit with various angles of the connection plates 400), which may be the patient's anatomy or To best meet the needs. In other implementations, the plate portion 404 and the coupling portion 402 can be substantially planar with one another, be non-planar but twisted to share a longitudinal axis, or otherwise have a different configuration.

The connecting plate 400 may be connected to the plate member 22 as the surgeon desires, prior to or during the surgical procedure. One end 36 or 38 of the plate member 22 is inserted into the slot 408 of the coupling 402 so that the connecting plate 400 is placed on the plate member 22 as desired by the surgeon. If a thread is formed in the hole 406 and a screw 409 is provided, the screw 409 is screwed into the hole 406 with respect to the plate member 22 and the plate member 22 with respect to the engaging portion 402. To lock them. When the post 304 and the nut 306 are used, the top 322 of the post 304 is inserted through the hole 406 of the coupling portion 402 and the space 400 of the plate member 22, As a result, the flange 324 adjoins or abuts the engagement portion 402, and the top 322 extends from the engagement portion 402. Once the nut 306 is screwed into the post 304 and tightened against the engagement portion 402, the slot 408 is compressed to lock the plate member 22 therein. Alternatively, the hole 406 and / or flange 324 may have a flange 324 fitted through at least a portion of the hole 406 and an end 328 of the flange 324 of the plate member 22. It is size adjacent or abutting sides 32, 34. When the nut 306 is tightened with respect to the engagement portion 402, the plate member 22 is gripped between the flange 324 and the engagement portion 402. The plate portion 404 may be connected to tissue or other implants or devices before or after the coupling portion 402 is connected to the plate member 22. However, as long as the plate member 22 can move in one or more directions before being anchored to bone or other tissue, it is first connected to the tissue or device by the plate portion 404 and thereafter to the plate member 22. If that is the case, it may be rather easy to use the connecting plate 400.

Referring to FIG. 17, another embodiment of the connecting plate 400 ′ is shown connected to the plate member 22. The connecting plate 400 'is substantially the same as the connecting plate 400, but with the second plate portion 404a added. In this embodiment, the coupling portion 402 is present between the plate portions 404 and 404a and the plate portion 404a is angled with respect to the coupling portion 402 so that the plate portions 404 and 404a are non-planar. But are substantially parallel. The plate portion 404a includes a hole 410a and through which the screw 412a or other implant or device may extend, for example, into the bone. Other features described above with respect to the plate portion 404 can also be found within the plate portion 404a.

It will be appreciated that the components shown in the various figures are not limited to those used in the embodiments shown or specifically described, but may be used in other embodiments or in combination with other embodiments. Thus, for example, one plate member 22 may be used with one clamp 24 and one clamp 124, and the components shown for clamp 24 may be used with clamp 124. have.

Parts of the implant system of the present invention may be manufactured in the form of a kit comprising a plurality of sizes and shapes of a single part, or a plurality of sizes and shapes of all parts that may be included within the system of the present invention. For example, such kits may include, for example, a set of elongate members 22 and / or 100 of various lengths and having different numbers or orientations of slots and / or holes. In the case of elongate member 100, the kit may comprise a set of elongate members having various bending angles along longitudinal axis 106. Sets of washers, bolts, screws and nuts as disclosed herein may also be provided. In addition, tools such as wrenches and screwdrivers compatible with the components of the implant system of the present invention may also be included.

The devices of the present invention are preferably made of rigid biocompatible materials such as stainless steel, titanium, certain plastics or other known materials.

Although the invention has been shown and described in detail in the drawings and above detailed description, it is to be considered merely illustrative and does not limit the scope of the invention thereto, only preferred embodiments have been shown and described and the spirit of the invention It is understood that all changes and modifications included within are desirable to be protected.

1 is a side elevational view of an orthopedic plate system of one embodiment.

2 is a plan view of one embodiment of FIG.

3 is an end elevational view of the embodiment of FIG. 1.

4 is a cross-sectional view taken along line 4-4 in the direction of the arrow of FIG. 2 for one embodiment of FIG.

FIG. 5 is a cross-sectional view taken along line 5-5 in the direction of the arrow of FIG. 1 for one embodiment of FIG.

6 is a measurement side view of an orthopedic plate system of one embodiment.

7 is a plan view of one embodiment of FIG.

8 is an end front view of the embodiment of FIG. 6.

FIG. 9 is a sectional view taken along line 9-9 in the arrow direction of FIG. 7 for the embodiment of FIG.

10 is a cross-sectional view taken along line 10-10 in the direction of the arrow of FIG. 6 for one embodiment of FIG.

11 is a measurement side view of an orthopedic plate system of one embodiment.

12 is a plan view of one embodiment of FIG.

13 is an end front view of the embodiment of FIG. 11.

14 is a cross-sectional view taken along line 14-14 in the direction of the arrow of FIG. 11 for the embodiment of FIG.

15 is a cross-sectional view taken along line 15-15 in the direction of the arrow of FIG. 11 for the embodiment of FIG.

16 is a perspective view of an orthopedic plate system of one embodiment.

16A is a perspective view of an apparatus that may be used with one embodiment of FIG. 16.

17 is a perspective view of an orthopedic plate system of one embodiment.

Claims (25)

A plate member having cylindrical first and second side surfaces and first and second ends, the plate member defining an enclosed space surrounded by the side and the end portions; A clamp adjacent the plate member, the clamp receiving a first recess for receiving at least a portion of the first side of the plate member and a second housing for receiving at least a portion of the second side of the plate member A recess having a recess and including a yoke member and a crown member, the upper portion through which the yoke member extends through the space, a lower surface and an opening through the lower surface; A clamp having a lower portion having a chamber to be formed, the clamp having a crown member adapted to slide in the chamber and having one or more laterally extending fingers; A bolt connected to the clamp and connected to the bone, the bolt having a first threaded portion, a medial head and a second threaded portion, wherein the second threaded portion of the hole and plate member of the U-shaped member; A bone fixation member extending through the space; And Holding the plate member in a clamp and bone fixation member, comprising a nut and washer, and the washer comprising a locking member present between the nut and the plate member. delete The apparatus of claim 1 wherein the yoke member has an opening therethrough through which the yoke member communicates with the chamber. The bone fixing member of claim 1, wherein the bone fixation member is a bone screw having a threaded shaft and a head, the head having an aperture, wherein the tightening tool is located at the top of the yoke member. A device extending through the hole to the hole of the head. The apparatus of claim 1, wherein the first side has one diameter, the second side has one diameter, and the diameters are the same. 2. An apparatus according to claim 1, wherein the ends are circular in cross section, have one diameter, and the diameters of the ends are the same as the diameters of the sides. The apparatus of claim 1, wherein the first side has one diameter, the second side has one diameter, and one or more of the diameters are uniform along each side. The clamp of claim 1, wherein the clamp comprises a U-shaped member having a first leg, a second leg, and a base portion, the base portion having a hole therethrough, the first recess being at least The device is formed in part by the first leg and the base portion, and the second recess is formed at least in part by the second leg and the base portion. delete delete delete The portion of claim 1, wherein the first side of the plate member has one diameter, the second side of the plate member has one diameter, and the first recess has a diameter equal to the diameter of the first side of the plate member. And the second recess has a portion having a diameter equal to the diameter of the second side of the plate member. The method of claim 1, A lateral connecting member having a block portion and an extension portion, the block portion having a first hole for receiving the elongate member and a screw for locking the elongate member in the block portion. A second hole for receiving, the extension having a first recess for receiving at least a portion of the first side of the plate member, a second recess for receiving at least a portion of the second side of the plate member, and A lateral connecting member having a hole present between the recesses of the lateral connecting member; A post member having a threaded portion and a flange portion, the post member extending through the space of the plate member and the hole of the extension of the lateral connecting member such that the flange portion is adjacent to the plate member. A post member present; And And a nut screwed onto the threaded portion of the post member, whereby the lateral connecting member is locked between the nut and the flange portion of the post member. The method of claim 1, A lateral connecting member having a joining portion and at least one plate portion, the joining portion having a hole through it and a slot through the joining portion perpendicular to the hole, The slot has a width sufficient to allow the plate member to pass through the slot, and the plate portion has one or more holes therethrough to receive the bone screw through the hole; And And a screw that is screwed against the plate member into the hole of the coupling portion, whereby the coupling portion and the plate member can be locked to each other. 15. The apparatus of claim 14, wherein the engagement portion is angled with respect to the plate portion. The method of claim 1, A lateral connecting member having a coupling portion and at least one plate portion, the coupling portion having a hole passing therethrough and a slot passing through the coupling portion perpendicular to the hole, the slot being adapted to allow the plate member to pass through the slot. A lateral connecting member having a sufficient width, said plate portion having one or more holes therethrough to receive bone screws through the holes; A post member having a threaded portion and a flange portion, comprising: a post member extending through a space of the plate member and a hole of a coupling portion of the lateral connecting member, the post member having the flange portion adjacent to the plate member; And And a nut screwed onto the threaded portion of the post member, whereby the lateral connecting member is locked between the nut and the flange portion of the post member. delete delete delete delete 14. The method of claim 13, Wherein the first recess has one wall in contact with at least a portion of the first side of the plate member and the second recess has one wall in contact with at least a portion of the second side of the plate member. . 22. The apparatus of claim 21, wherein the concave portion faces away from the block portion. delete delete 15. The device of claim 14, further comprising means for locking the engagement portion of the lateral connecting member to the plate member.

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