CN101267782B - 用于锚定在股骨中的具有叶片状柄的髋关节假体 - Google Patents

用于锚定在股骨中的具有叶片状柄的髋关节假体 Download PDF

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CN101267782B
CN101267782B CN2006800345496A CN200680034549A CN101267782B CN 101267782 B CN101267782 B CN 101267782B CN 2006800345496 A CN2006800345496 A CN 2006800345496A CN 200680034549 A CN200680034549 A CN 200680034549A CN 101267782 B CN101267782 B CN 101267782B
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femur
far
foliaceous
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CN101267782A (zh
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W·莫泽
A·塞德尔
D·文德勒
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Smith and Nephew Orthopaedics AG
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Plus Orthopedics AG
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Abstract

一种用于锚定在股骨中的具有叶片状柄的髋关节假体，所述叶片状柄一方面具有一个包括假体颈(18)的部段(19)、另一方面具有一个向远端的端部(20)逐渐缩小的股骨锚定部段(21)，所述股骨锚定部段的侧面的窄边(22)包括一远端的直线部段(23)和一近端的弧形部段(11)，其中，直线部段(23)在柄(10)全长(LG)的60％至75％的长度(LD)上延伸。

Description

用于锚定在股骨中的具有叶片状柄的髋关节假体
技术领域
本发明涉及一种用于锚定在股骨中的具有叶片状柄的髋关节假体，所述叶片状柄一方面具有一个包括假体颈的部段和另一方面具有一个向远端的端部逐渐缩小的股骨锚定部段。
背景技术
这样的叶片状柄是公知的。在此方面仅示例性地参阅EP 0 240815 B1。在那里示出和描述了一种按图6的柄。据此，该柄1一方面包括具有一个包括假体颈7的部段、另一方面包括一个向远端的端部3逐渐缩小的股骨锚定部段2。该股骨锚定部段从远端的端部3沿柄纵轴线4的方向全面地成锥形扩大。居中的窄侧面5从所说锥体出发过渡到一持续弯曲的圆弧，该圆弧终止于一个平面内，该平面垂直于假体颈轴线6延伸地朝柄叶片或股骨锚定部段2端接假体颈7。假体颈7终止于一个向外成锥形逐渐缩小的轴颈，在其上可套装一个未示出的球形活接头。
侧面的窄边8从锥形的扩大部向外扩展而形成一转子翼9，然后，其经由柄叶片或锚定部段的一个肩部接入到所说的假体颈端接平面。
所述柄用于在股骨中不粘固地锚定。但原则上本发明也应涉及到粘固的柄。
在两种情况下都必须在股骨中事先提供一个柄容纳空间或一个相应的空腔，具体而言，要借助于一种符合于柄形状的成形器械、特别是锉。该成形器械或者说锉精确地符合于相应的柄的几何形状，或者针对性地与此不同，目的是要得到一种用于压配合的预定的过小尺寸或一种预定的过盈尺寸作为用于粘固剂外皮的空间。
在打开髋关节和切除股骨颈以后，在近端的股骨中准备骨质的支承用以容纳锚定柄。依据柄形状，利用合适的成形器械、特别是锉，通过沿柄轴线的下沉操作而产生锚定骨床。为了在由海绵状骨和软组织充满的骨髓腔中进行下沉操作，将锉经由一个作为击锤作用的重物或利用其他适当的器械向前推进。对于弯曲的柄轴线的情形，要使成形器械或锉沿着弯曲的轨迹成弧形下沉，而对于直的柄轴线，则使锉沿着直线向前推进，该直线基本上符合于近端的骨髓腔的轴线。
对于髋关节假体柄的不粘固式锚定，锚定部段作为直柄的实施形式在临床上已证明是特别适用的。该方案的特点是具有安全的植入技术、高的初始稳定性和良好的长入性能。这样的柄的手术技术决定了：骨髓腔不仅要在股骨颈的切除表面的平面内、而且还要向侧面在大转子的区域内被打开。对此参阅图4。该图表明，在这个区域内，肌腱根部的部分切除也是必需的。该切除的大小当然是要取决于近端的股骨的特有的形状以及直柄的造型。
近来，利用最小侵入(微创)的手术技术，越来越多地实施关节内假体的植入。该技术的目的是使患者能够比较迅速地康复，与此相关联的是较小的疼痛负担和较短的住院时间。在最小侵入的手术技术中，使手术创伤、特别是对于机能非常重要的组织的创伤保持很小。对于髋关节的机能，肌肉和肌腱是重要的织组特征。此外，最小侵入的植入技术的目的是还要避免肌腱和肌肉根部在大转子的区域内被切除和剥离。因此，传统的直柄对于最小侵入技术的应用是存在缺点的。
为了避免在大转子上肌腱根部区域内的切除，对于直柄的情况，可以在转子区域内斜切侧面的部分。具有展平的肩部部分的直柄基本上是已知的。在此方面只示例性地指出所谓的米勒直柄(Müller-Geradschaft)，其示出和描述于“Technique d’implantationde prothèses totales de Müller par voie latérale transglutéale”，Encyclopédie Medico-Chirurgicale(Paris)(医疗外科大全(巴黎))44666，1991年。
这种展平的肩部的目的在于避免在转子体的区域内造成较大的缺损。通常，在构造该展平时，要设计侧面柄部分的这样一个部分，该部分在尺寸系统中恒定不变并带有倾斜于柄轴线的直线延伸或带有半径。相应于植入物的锉通常要构造成与植入物几何形状相同。从技术角度看，要用锉在大转子的区域内制出一凹切部，例如由图5可看出。
在植入髋关节假体柄时，利用渐增尺寸的锉将骨床一直成形到最好的配合尺寸。相应的锉同时顺应已存在的、由上述的锉尺寸所构造的骨床的形状。由于通过沿着一条直的轴线的下沉操作来实现直柄的远端部分构造，因此在配合精度方面对于倾斜的或弯曲的肩部部分达到一致。但这受到手术医生的锉技术和个体的骨质量的影响。
发明内容
从所述现有技术出发，本发明的目的是，提供一种开头所述型式的叶片状柄，它能特别好地适用于最小侵入的手术技术。同时还应保留传统的直柄型植入物的优点。但应尽可能保护好肌肉和肌腱根部。
为此，本发明提供一种用于锚定在股骨中的具有叶片状柄的髋关节假体，所述叶片状柄一方面具有一个包括假体颈的部段、另一方面具有一个向远端的端部逐渐缩小的股骨锚定部段，所述股骨锚定部段的侧面的窄边包括一远端的直线部段和一近端的弧形部段，其中，直线部段在柄全长的60％至75％的长度上延伸；其特征在于，所述近端的弧形部段设计为“等切面曲线”的形状，该等切面曲线符合于在下述情况下由柄的侧面窄边的近端端部所描述或确定的曲线，即，在它插入股骨内一个互补的空腔中时，保持侧面远端的和近端居中的柄外形与所配的空腔边界之间的接触。
按照本发明，柄的侧面的窄边包括一远端的直线部段和一近端的弧形部段，其中，直线部段在柄全长的60％至75％的长度上延伸。
本发明特别提出这样一种用于锚定在股骨中的具有叶片状柄的髋关节假体，所述叶片状柄一方面具有一个包括假体颈的部段、另一方面具有一个向远端的端部逐渐缩小的股骨锚定部段，所述股骨锚定部段的侧面的窄边包括一远端的直线部段和一近端的弧形部段，其特征在于，所述近端的弧形部段设计为“等切面曲线”的形状，该等切面曲线符合于在下述情况下由柄的侧面窄边的近端端部所描述或确定的曲线，即，在它插入股骨内一个互补的空腔中时，保持侧面远端的和近端居中的柄外形与所配的空腔边界之间的接触。
本发明还提出一种用于锚定在股骨中的具有叶片状柄的髋关节假体，所述叶片状柄一方面具有一个包括假体颈的部段、另一方面具有一个向远端的端部逐渐缩小的股骨锚定部段，所述股骨锚定部段的侧面窄边包括一远端的直线部段和一近端的弧形部段，其中，直线部段在叶片状柄全长的60％至75％的长度上延伸；其特征在于，所述近端的弧形部段设计为“等切面曲线”的形状，该等切面曲线符合于在下述情况下由一与所述叶片状柄相应的锉的侧面窄边的近端端部所描述或确定的曲线，即，在该锉插入股骨内一个互补的空腔中时，保持侧面远端的和近端居中的锉外形与所配的空腔边界之间的接触。
附图说明
图1示出了按照本发明设计的髋关节假体的叶片状柄的侧视图；
图2示出了在本发明的柄上近端弧形部段的延伸形状，其中，在该视图中还标示出一些局部特征区域(即12、13、14的位置)；
图3针对按照图6、图7和图1的各种方案示出了柄侧面窄边的近端端部的插入路径；
图4和图5示出了利用传统的直柄型植入物进行手术时采取的处理方式；
图6示出了传统的(EP0240815B1)叶片状柄的设计形式；
图7示出了一种设想的设计形式，其中，将侧面远端的直线部段向近端的区域延伸。
具体实施方式
如上所述，在本发明中，凸起的近端弧形部段的延伸形状是特别重要的，其中，特别优选的形状的特征在于，将弧形部段设计为“等切面曲线(Schleppkurve，曳物线)”，该曲线描述或确定柄的侧面窄边的近端端部，对此要符合下述情况：在它(或一相应的锉)插入股骨内一个互补的空腔中时，保持侧面远端的和近端居中的柄外形与所配的空腔边界之间的接触。因此，近端的肩部部分的最佳形状由柄在骨床中的引导而产生，如其在图2中所示的那样。柄10的侧面近端的柄弯11符合于曲线12，该曲线描述了柄10的侧面窄边的近端端部在其插入股骨内一个互补的空腔中时的径迹，同时满足这样的条件：保持侧面远端的柄外形13和近端居中的柄外形14与图中未示出的空腔的相应边界之间的接触。此外还图示了按本发明构造的柄10的侧视图(腹侧的或背侧的)，而且是与传统的按照图6或者说EP 0 240 815 B1的叶片状柄进行了对比。由图1可以很好地看出，与现有技术相比采取了哪些措施。按图6的转子翼9的侧面由侧面近端的弧形部段11予以修整，其优点是，相应小地缩小了在转子体中的干预，并且特别是在植入柄10时或在其空腔的构成时还更少地损害肌肉或肌腱的根部。在所谓喉结形的(Adam’schen)弧形区域(图2中区域14)内和在侧面远端的端部(图2中区域13)上的接触区域描绘了一个沿着侧面的肩部的弧形。该弧形由一多项式(x阶曲线)描述。该曲线可以连续地紧接侧面远端的柄几何形状；但优选该曲线与其形成一交割。无论如何，将侧面近端的弧形部段构造为，使肩部在远端直柄部分的整个插入路径上与其精密接触或者离开转子区域内的骨结构具有一恒定不变的间距。由此实现了精确匹配的最佳肩部部分，其与骨床无间隙配合或者具有精确给定的用于粘固剂的间隙，这要根据应当采取无粘固植入还是有粘固植入而定。
原则上还可设想，将侧面远端的直线部段按图7向近端的区域延续。但该实施形式远未象按图1的本发明实施形式那样保护肌肉和肌腱。这特别由图3可明显看出，其中，针对按照图6、图7和图1的各种方案，示出了柄侧面窄边的近端端部的插入路径。插入路径15适于按图6的实施形式(现有技术)。插入路径16适于按图7的实施形式，而插入路径17适于按图1的本发明的实施形式。据此可知，在本发明的实施形式中在转子中的干预是最小的。
再次参照图1，应该指出，该图示出了按照本发明设计的髋关节假体的叶片状柄10。该柄一方面具有一包括假体颈18的部段19和另一方面具有一个向远端的端部20逐渐缩小的股骨锚定部段21，股骨锚定部段的侧面的窄边22包括一远端的直线部段23和一近端的弧形部段11，其中，直线部段23在柄10全长的60％至75％的长度上延伸。按所示的实施形式，侧面的直线部段23可以无突变地过渡到侧面的弧形部段11，亦即它是相切的。但如上所述，完全可行的是，该过渡包括一突变，亦即是成钝角的。
如上所述，特别有利的是，将侧面的弧形部段11设计为“等切面曲线”的型式，它描述和确定了柄10的侧面窄边的近端端部在其插入股骨内一个互补的空腔中时、在侧面远端的和近端居中的柄外形与所配的空腔边界之间保持接触情况下的径迹，对此再次参阅图2。
依据柄的尺寸以及外部条件，将近端的弧形部段11优选构造为具有恒定的、但特别是持续或非连续变化的在200mm与500mm之间的半径。
也已证明接近实际情况的是，近端的弧形部段11构造为具有从远端向近端持续或非连续地变得越来越大的半径。
弧形部段也可以优选设计为双曲线、抛物线或椭圆的部段，而使相应的部段向远端在一预定点转入到锥形的直线部段23，在该点的切线与柄轴线24形成一个等于半锥角的角度。
对于柄本身还应该提到，锚定部段在侧面远端的直线部段23的长度上从远端的端部20开始沿其纵轴线24或者是全面地或者只是侧面居中地成锥形扩大。
此外应该提到，柄10的横截面优选是矩形的，但也可以是梯形的或菱形的。
上述锚定部段21的全面的锥形扩大具有在约0.5°与6°之间、特别是在约1°与3°之间的锥角，而且特别是还在腹侧的和/或背侧的侧面上。
申请文件中所公开的全部特征都是请求保护的内容，它们对发明而言均很重要，只要它们单独地或组合地相对于现有技术是新的。
附图标记清单
现有技术：
1  柄
2  股骨锚定部段
3  远端的端部
4  纵轴线
5  居中的窄边
6  假体颈轴线
7  假体颈
8  侧面的窄边
9  转子翼
本发明：
10  柄
11  近端侧面的柄弯(侧面近端的弧形部段)
12  曲线
13  侧面远端的柄外形
14  近端居中的柄外形
15  按图6的柄的插入曲线
16  按图7的柄的插入曲线
17  按图1的柄的插入曲线
18  假体颈
19  部段
20  远端的端部
21  股骨锚定部段
22  侧面的窄边
23  远端侧面的直线部段
24  柄轴线

Claims (11)

1.用于锚定在股骨中的具有叶片状柄(10)的髋关节假体，所述叶片状柄一方面具有一个包括假体颈(18)的部段(19)、另一方面具有一个向远端的端部(20)逐渐缩小的股骨锚定部段(21)，所述股骨锚定部段的侧面窄边(22)包括一远端的直线部段(23)和一近端的弧形部段(11)，其中，直线部段(23)在叶片状柄(10)全长(LG)的60％至75％的长度(LD)上延伸；其特征在于，所述近端的弧形部段(11)设计为“等切面曲线”的形状，该等切面曲线符合于在下述情况下由所述股骨锚定部段的侧面窄边的近端端部所描述或确定的曲线，即，在该叶片状柄插入股骨内一个互补的空腔中时，保持侧面远端的柄外形(13)和近端居中的柄外形(14)与所配的空腔边界之间的接触。
2.按照权利要求1所述的假体，其特征在于，所述远端的直线部段(23)或者是无突变地即相切地、或者是有突变地即在角度偏向的情况下过渡到所述近端的弧形部段(11)。
3.按照权利要求1所述的假体，其特征在于，所述近端的弧形部段(11)构造为具有恒定的、或者是持续或非连续变化的在200mm与500mm之间的半径。
4.按照权利要求1所述的假体，其特征在于，所述近端的弧形部段(11)构造为具有从远端向近端持续或非连续地变得越来越大的半径。
5.按照权利要求1所述的假体，英特征在于，所述股骨锚定部段在侧面远端的直线部段(23)的长度上从远端的端部(20)朝近端的端部或者是全面地或者只是侧面居中地成锥形扩大。
6.按照权利要求1所述的假体，其特征在于，所述叶片状柄的横截面是矩形的、梯形的或菱形的。
7.按照权利要求5所述的假体，其特征在于，对于股骨锚定部段(21)全面地成锥形扩大的情况，锥角在腹侧的和/或背侧的侧面上为0.5°至6°。
8.按照权利要求7所述的假体，其特征在于，所述锥角为1°至3°。
9.用于锚定在股骨中的具有叶片状柄(10)的髋关节假体，所述叶片状柄一方面具有一个包括假体颈(18)的部段(19)、另一方面具有一个向远端的端部(20)逐渐缩小的股骨锚定部段(21)，所述股骨锚定部段的侧面窄边(22)包括一远端的直线部段(23)和一近端的弧形部段(11)，其特征在于，所述近端的弧形部段(11)设计为“等切面曲线”的形状，该等切面曲线符合于在下述情况下由所述股骨锚定部段的侧面窄边的近端端部所描述或确定的曲线，即，在该叶片状柄插入股骨内一个互补的空腔中时，保持侧面远端的柄外形(13)和近端居中的柄外形(14)与所配的空腔边界之间的接触。
10.按照权利要求9所述的假体，其特征在于，所述远端的直线部段(23)或者是无突变地即相切地、或者是有突变地即在角度偏向的情况下过渡到所述近端的弧形部段(11)。
11.用于锚定在股骨中的具有叶片状柄(10)的髋关节假体，所述叶片状柄一方面具有一个包括假体颈(18)的部段(19)、另一方面具有一个向远端的端部(20)逐渐缩小的股骨锚定部段(21)，所述股骨锚定部段的侧面窄边(22)包括一远端的直线部段(23)和一近端的弧形部段(11)，其中，直线部段(23)在叶片状柄(10)全长(LG)的60％至75％的长度(LD)上延伸；其特征在于，所述近端的弧形部段(11)设计为“等切面曲线”的形状，该等切面曲线符合于在下述情况下由一与所述叶片状柄相应的锉的侧面窄边的近端端部所描述或确定的曲线，即，在该锉插入股骨内一个互补的空腔中时，保持侧面远端的和近端居中的锉外形与所配的空腔边界之间的接触。
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