CN101484094A - 解剖学运动铰接假体 - Google Patents

解剖学运动铰接假体 Download PDF

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CN101484094A
CN101484094A CNA2007800250363A CN200780025036A CN101484094A CN 101484094 A CN101484094 A CN 101484094A CN A2007800250363 A CNA2007800250363 A CN A2007800250363A CN 200780025036 A CN200780025036 A CN 200780025036A CN 101484094 A CN101484094 A CN 101484094A
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rotation
tibial component
component
knee
hinged
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CN101484094B (zh
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R·小迪斯
P·小克拉布特里
J·尼尔森
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Smith and Nephew Inc
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Smith and Nephew Richards Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A61F2/3836—Special connection between upper and lower leg, e.g. constrained
    • A61F2/384—Special connection between upper and lower leg, e.g. constrained hinged, i.e. with transverse axle restricting the movement
    • A61F2/385—Special connection between upper and lower leg, e.g. constrained hinged, i.e. with transverse axle restricting the movement also provided with condylar bearing surfaces
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A61F2/3836—Special connection between upper and lower leg, e.g. constrained
    • A61F2/384—Special connection between upper and lower leg, e.g. constrained hinged, i.e. with transverse axle restricting the movement
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A61F2/3859—Femoral components

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Abstract

一种铰接膝盖假体(10)，包括胫骨部件(16)和股骨部件(14)。胫骨部件(16)设置成与胫骨相连。所述胫骨部件具有支承面(128)。股骨部件(14)设置成铰接于胫骨部件(16)并且相对于胫骨部件(16)旋转。股骨部件(14)包括内髁(30)和外髁(32)。所述内外髁(30和32)具有偏心矢面曲面(50)，设置成在胫骨部件(16)的支承面(128)上滚动和平移。提供了一种使铰接膝盖(10)在弯曲范围内旋转的方法。该方法将股骨部件(14)固定连接到胫骨部件(16)。当铰接膝盖(10)弯曲时，引发股骨部件(14)相对于胫骨部件(16)的轴向旋转。

Description

解剖学运动铰接假体
相关申请的参见
【0001】本申请要求2006年6月30日提交的美国临时申请No.60/806,383的受益权。在此以参见的方式引入每份申请的全部内容。
技术领域
【0002】本申请大体上涉及膝盖假体，更具体来说，涉及铰接膝盖假体。
背景技术
【0003】多数铰接膝盖假体仅仅提供机械装置以恢复关节的类似铰的功能。其他的铰接膝盖假体提供更接近于正常运动的假体，然而，它们通常依赖残留软组织来恢复关节的正常运动能力。多数情况下，残留软组织在手术时已经受损和/或缺失/移除了。因此，软组织不能对恢复正常运动起非常重要的作用，尤其是前/后(A/P)平移或正常的轴向旋转，包括旋转到“转到头”的位置。此外，在通过强迫假体运动来恢复正常运动能力时，残留软组织可能会受损。
【0004】在用于实现轴向旋转的假体系统中，现有系统通过允许设置旋转平台来实现旋转。一般来说，两个关节假体(通常为胫骨插入物或结构体)之一允许有旋转自由度。这使得软组织可以以更正常的方式旋转关节。然而，多数软组织已经受损，已不能再现正常或近乎正常的旋转了。
【0005】A/P平移运动很少被考虑研究。在那些确实考虑了A/P平移的假体中，使用与关节连接机构(通常为杆)或胫骨关节几何形状相靠的凸轮机构来迫使胫骨在膝盖弯曲时相对于股骨远端向前移动。这种A/P平移的方法在利用凸轮和杆的方法的主流全膝盖置换术(TKA)中很常见，在这种利用凸轮和杆的方法中，凸轮置于股骨关节假体上，杆在胫骨关节假体上。这通常是指后方稳定型或十字稳定型膝盖置换术。这些铰接膝盖通常将力集中在很小的区域中(例如带有点接触和/或线接触的凸轮和杆)，这会增加置换体的磨损并缩短其寿命。
【0006】在美国专利5358527和5800552中，通过弯曲来实现A/P平移，然而铰接膝盖却不能控制和/或保持A/P平移的固定极限。换句话说，当与胫骨支承面的接触不能保持时股骨可以弯曲和后移。这样当发生A/P平移时，股骨部件就不能保持与胫骨部件的接触。
【0007】本领域仍有对具备正常运动能力的假体的需求，其包括A/P平移和/或正常轴向旋转。此外，仍有对具备正常运动能力假体的需求，其能够减少假体上的磨损和减小作用于残留软组织上的力。
发明内容
【0008】本发明提供一种铰接膝盖假体，包括胫骨部件和股骨部件。胫骨部件设置成与胫骨相连。胫骨部件具有支承面。股骨部件设置成铰接于胫骨部件，并相对于胫骨部件旋转。股骨部件包括内髁和外髁。内外髁具有矢面曲面，其被设置成用于引发在胫骨部件支承面上的轴向旋转。
【0009】内外髁可以具有多个偏心矢面曲面，其用于在胫骨部件的支承面上旋转。
【0010】胫骨部件的支承面设置成具有前部和后部。支承面的后部具有设置成指引股骨部件的内外髁的部分。股骨部件和胫骨部件之间的接触点前/后平移且轴向旋转。
【0011】铰接膝盖还可以包括轴铰销。轴铰销横向置于内髁和外髁之间。偏心矢面曲面具有不与轴铰销对准的旋转中心。
【0012】铰接膝盖假体还可以包括杆，杆设置成从胫骨部件延伸至股骨部件。杆的近心端设置成与轴铰销相连。
【0013】内髁的偏心矢面曲面的一部分的旋转中心可以不与外髁的偏心矢面曲面的一部分的旋转中心对准。内外髁指引股骨部件相对于胫骨部件的轴向旋转。
【0014】内髁的偏心矢面曲面的一部分的旋转中心可以与外髁的偏心矢面曲面的一部分的旋转中心对准，其中，内外髁指引股骨部件相对于胫骨部件的前/后平移。
【0015】股骨部件的内髁还可以包括同心的矢面曲面。内髁的同心的矢面曲面的旋转中心不与外髁的偏心矢面曲面的一部分的旋转中心对准。内外髁引导股骨部件相对于胫骨部件的轴向旋转。
【0016】内髁的第一偏心矢面曲面的旋转中心可以不与外髁的第一偏心矢面曲面的旋转中心对准。当第一偏心矢面曲面与胫骨部件接触时，内外髁指引股骨部件相对于胫骨部件的轴向旋转和前/后平移。内髁第二偏心矢面曲面的旋转中心与外髁第二偏心矢面曲面的旋转中心对准，其中，当第二偏心矢面曲面与胫骨部件接触时，内外髁指引股骨部件相对于胫骨部件的前/后平移。
【0017】铰接膝盖假体可以包括设置为接受杆的套。该套被设置为允许股骨部件相对胫骨部件轴向旋转。
【0018】本发明提供了一种使铰接膝盖在弯曲范围内旋转的方法。该方法将股骨部件固定连接于胫骨部件。当铰接膝盖弯曲时可引发股骨部件相对于胫骨部件的轴向旋转。
【0019】所述方法还可以包括步骤：当铰接膝盖弯曲时引发股骨部件相对于胫骨部件前/后平移。
【0020】所引发的平移步骤和引发的轴向旋转步骤可以同时发生。
【0021】所引发的轴向旋转步骤可以通过假体膝盖的弯曲范围中的一个部分发生。
【0022】所引发的轴向旋转步骤可以通过假体膝盖的弯曲范围中第一部分和假体膝盖的弯曲范围中的第二部分发生。
【0023】弯曲范围中的第一部分可以不与弯曲范围中的第二部分相邻。
【0024】随着铰接膝盖通过膝盖的弯曲范围，所引发的轴向旋转步骤可以在变化的角速度下发生。
【0025】固定连接步骤可以包括将带套杆连接于胫骨插入物，以使带套杆的被套部分和带套杆的杆部分相对于彼此轴向旋转。固定连接步骤还包括将轴铰销固定于带套杆，以使轴铰销将股骨部件的内髁横向连接于股骨部件的外髁。
【0026】所述方法还包括步骤：将带套杆的被套部分固定于胫骨部件的茎杆。
【0027】所述方法还包括步骤：当铰接膝盖弯曲时将带套杆的被套部分相对于带套杆的杆部分进行轴向移动。
【0028】因此，包含可A/P平移和/或正常轴向旋转的具备正常运动能力的假体可以根据本发明阐述的结构来实现。这些具备正常运动能力的假体可以减小对假体的磨损并减小施加于残留软组织上的力。本发明的进一步特征、方面和优点，以及本发明的结构和各种实施例的操作，以下参照附图进行详细的描述。
附图说明
【0029】在此引入的附图，其本身构成本说明书的一部分，示出了实施例，并与描述一起，用于解释本发明的原理。在附图中：
【0030】图1是铰接膝盖一个实施例的等轴视图；
【0031】图2是图1中实施例的剖开立体图；
【0032】图3是图1中实施例的侧视图；
【0033】图4是图3中实施例的剖开立体图；
【0034】图5是铰接膝盖一个实施例的等轴视图；
【0035】图6是图5中实施例的剖开立体图；
【0036】图7是图5中实施例的侧视图；
【0037】图8是图7中实施例的剖开立体图；
【0038】图9是胫骨插入物的一个实施例的等轴视图；
【0039】图10是图9中胫骨插入物的顶视图；
【0040】图11是铰接膝盖的股骨部件的一个实施例的侧视图；
【0041】图12、13分别是铰接膝盖的一个实施例伸直时的侧视图和等轴视图；
【0042】图14、15分别是图12中铰接膝盖弯曲20度时的侧视图和等轴视图；
【0043】图16、17分别是图12中铰接膝盖弯曲40度时的侧视图和等轴视图；
【0044】图18、19分别是图12中铰接膝盖弯曲90度时的侧视图和等轴视图；
【0045】图20、21分别是图12中铰接膝盖弯曲120度时的侧视图和等轴视图；
【0046】图22、23分别是图12中铰接膝盖弯曲150度时的侧视图和等轴视图；
【0047】图24-26分别是铰接膝盖的一个实施例伸直时的侧视图、等轴视图和顶视图；
【0048】图27-29分别是图27中铰接膝盖弯曲20度时的侧视图、等轴视图和顶视图；
【0049】图30-32分别是图27中铰接膝盖弯曲40度时的侧视图、等轴视图和顶视图；
【0050】图33-35分别是图27中铰接膝盖弯曲90度时的侧视图、等轴视图和顶视图；
【0051】图36-38分别是图27中铰接膝盖弯曲120度时的侧视图、等轴视图和顶视图；和
【0052】图39-41分别是图27中铰接膝盖弯曲150度时的侧视图、等轴视图和顶视图。
具体实施方式
【0053】参照附图，其中相似的标号代表相似的组件。图1-4示出了铰接膝盖的一个实施例的视图。
【0054】现在参照图1，图1是铰接膝盖10的一个实施例的等轴视图。铰接膝盖10包括股骨部件14、胫骨部件16、销套18和销20。胫骨部件16包括胫骨插入物24和胫骨基座26。股骨部件14包括内髁30和外髁32。销20将髁30和32连接于套18。套18通过带套杆与胫骨部件相连(以下讨论)。
【0055】当膝盖弯曲时，股骨部件14相对于胫骨部件16旋转。股骨部件14绕着销20旋转。股骨部件14的轴向旋转和前/后(A/P)平移被胫骨插入物24和髁30、32的形状所驱使。股骨部件14的轴向旋转和前/后(A/P)平移可以发生，这是因为销20能够轴向旋转和相对于铰接膝盖10的杆和套轴向平移。
【0056】股骨部件14和胫骨部件16分别连接于股骨和胫骨。将茎杆36插入股骨和胫骨中以将股骨部件和胫骨部件固定于骨头上。这些茎杆的长度和厚度可以根据所需要的固定程度、骨头的尺寸和骨头中骨髓腔的尺寸进行调整。
【0057】现在参照图2，图2是图1中实施例的剖开立体图。该剖开立体图沿着股骨髁之间的矢面取得。图2示出了套18里的销20。套18与环绕杆42的杆套40相连。杆42连接于胫骨基座26，并可以非对称地连接于胫骨基座26。杆套40可以相对于杆42轴向平移和轴向旋转。套18(因此销20)可以相对于胫骨部件16轴向旋转和轴向平移。旋转和平移允许股骨部件14轴向旋转和在A/P方向上平移。A/P平移可以由髁表面来完成，髁表面具有曲度且旋转中心位于销20之外。当股骨部件14旋转时，衬套46阻止过度伸展，这样膝盖就不会过度伸展。
【0058】现在参照图3，图3是图1中实施例的侧视图。销20位于膝盖10的中心的后方。髁32上的曲线50相对于与股骨部件14的旋转中心，即销20，是偏心的。当膝盖弯曲时，销20相对于胫骨部件16轴向旋转和轴向平移。
【0059】现在参照图4，图4是图3中实施例的剖开立体图。该剖开立体图沿着与图2剖开立体图相同的矢面取得。该剖开立体图示出了铰接膝盖10的杆套40和杆42。螺钉56将杆接收物58固定于杆以将杆套40锁定在杆42上。这样，杆套40和销套18可以旋转并轴向平移，而不会使杆42脱位。
【0060】现在参照图5-8，这些图示出了铰接膝盖70的另一个实施例的视图。现在参照图5，图5是铰接膝盖70的一个实施例的等轴视图。铰接膝盖70包括股骨部件74、胫骨部件76、销套78和销80。胫骨部件76包括胫骨插入物84和胫骨基座86。股骨部件74包括内髁90和外髁92。销80将髁90和92与销套78连接。套78通过带套杆与胫骨部件相连。
【0061】当膝盖弯曲时，股骨部件74相对于胫骨部件76旋转。股骨部件74绕着销80旋转。股骨部件74的轴向旋转和前/后(A/P)平移被胫骨插入物84和髁90、92的形状所驱使。股骨部件74的轴向旋转和前/后(A/P)平移可以发生是因为销80能够轴向旋转和相对于铰接膝盖70的杆和套轴向平移。
【0062】股骨部件74和胫骨部件76分别连接于股骨和胫骨。茎杆96插入股骨和胫骨中以将股骨部件和胫骨部件固定于骨头上。这些茎杆的长度和厚度可以根据所需要的固定程度、骨头的尺寸和骨头中骨髓腔的尺寸进行调整。
【0063】现在参照图6，图6是图5中实施例的剖开立体图。该剖开立体图沿着股骨髁之间的矢面取得。图6示出了套78里的销80。套78与插入杆套102的杆100相连。杆套102连接于胫骨基座86。杆100可以相对于杆套102轴向旋转和轴向平移。销套78(因此销80)可以相对于胫骨部件76轴向旋转和轴向平移。旋转和平移允许股骨部件74轴向旋转和A/P平移。A/P平移可以由髁表面来完成，髁表面具有曲度且旋转中心位于销80之外。当股骨部件74旋转时，衬套106阻止过度伸展，这样膝盖就不会过度伸展。
【0064】现在参照图7，图7是图5中实施例的侧视图。销80位于膝盖70的中心的后方。髁92上的曲线110与股骨部件74的旋转中心，即销80，是偏心的。当膝盖弯曲时，销80相对于胫骨部件76轴向旋转和轴向平移。
【0065】现在参照图8，图8是图7中实施例的剖开立体图。该剖开立体图沿着与图6剖开立体图相同的矢面取得。该剖开立体图示出了铰接膝盖70的杆100和杆套102。杆100的大头部分106将杆100固定于股骨部件74，从而，当杆100插入杆套102中时，股骨部件74相对于胫骨部件76对准并保持在原处。杆100和销套78可以旋转并轴向平移，而不会使股骨部件74从胫骨基座86中脱位。
【0066】现在参照图9和10，这些图示出了胫骨插入物120的视图。图9是胫骨插入物120的一个实施例的等轴视图，图10是图9中胫骨插入物120的顶视图。胫骨插入物120包括用于从胫骨基座或股骨部件接收所述杆的杆孔124。支承面128上的方向线126显示了股骨部件在胫骨插入物120上接合的痕迹线。当股骨部件在插入物120上旋转时，在线126上的位置向后移动。胫骨插入物120的后部倾斜以使股骨部件轴向旋转和向后平移。胫骨插入物120与髁的曲面一起，引起股骨部件的A/P平移和轴向旋转。
【0067】现在参照图11，图11是铰接膝盖的股骨部件130的实施例的侧视图。髁131的曲面包括：第一远心端部分132，其具有第一旋转中心134；第二后端部分136，其具有与销孔140同心的第二旋转中心138；第三近心端部分142，其具有第三旋转中心144。旋转中心134和144偏心于销孔140。当膝盖旋转时，股骨部件130和胫骨插入物之间的接触点产生垂直于股骨部件130并与那部分曲面的旋转中心对准的力。当接触点位于曲面的远心端部分，垂直力指向旋转中心134。在远心端部分132和后端部分136之间的交界处，垂直力与旋转中心134和138共线。类似地，在后端部分136和近心端部分142的交界处，垂直力与旋转中心138和144共线。因此，在旋转过程中接触点不会跳跃而是平滑移动。
【0068】曲面的偏心使接触点处的侧向力得以控制轴向旋转和A/P平移。因为所述力与胫骨和股骨表面垂直，接触点处的反作用力引发A/P运动和轴向旋转。铰接膝盖的销、套、杆允许股骨部件130相对于胫骨部件平移和旋转。
【0069】现在参照图12-23，这些图示出了铰接膝盖的实施例处于不同弯曲角度时的侧视图和等轴视图。图12和13分别是铰接膝盖的实施例伸直时的侧视图和等轴视图。位于销轴线前方的接触点150是股骨部件152和胫骨部件154之间的接触点。胫骨部件在接触点150处向后远心端倾斜，这样，产生了试图将股骨部件向后推的反作用接触力。图13示出了股骨部件152伸直时的位置。
【0070】现在参照图14和15，图14、15分别是图12中铰接膝盖弯曲20度时的侧视图和等轴视图。当膝盖弯曲时，接触点150向后移动。此外，如图15所示，股骨部件152相对于胫骨部件154发生了旋转。轴向旋转是由作用在内髁和外髁的反作用力所产生的力矩之差驱使的。
【0071】现在参照图16和17。图16、17分别是图12中铰接膝盖弯曲40度时的侧视图和等轴视图。接触点150已向后移动，股骨部件已继续轴向旋转。接触点的变化显示了当膝盖旋转时股骨部件的A/P平移。膝盖弯曲的初期，大部分运动是轴向旋转，只发生了一些A/P平移。这种“后滚”和旋转与正常的关节运动相似。这些运动由胫骨部件和股骨部件的形状所驱使。这将作用于膝盖骨的剪切力减到最小，否则作用于膝盖骨的剪切力可能会试图迫使股骨部件做出这些运动。膝盖骨处剪切力的产生可能会引起疼痛和修复失败。
【0072】当髁的曲面从远心端偏心部分过渡到后端同心部分时，这已参照图11讨论过，接触力150指向销孔的中心。
【0073】现在参照图18和19。图18和19分别是图12中铰接膝盖弯曲90度时的侧视图和等轴视图。在同心部分继续弯曲时，A/P平移和轴向旋转停止。到销孔中心的距离保持不变，因为髁后端部分的曲率中心和销孔同心。
【0074】现在参照图20和21，图20和21分别是图12中铰接膝盖弯曲120度时的侧视图和等轴视图。当髁的曲面从后端同心部分过渡到近心端偏心部分时，这已参照图11讨论过，接触力150指向销孔中心。随着接触力150移到销孔中心的后方，从接触点到销孔中心的距离减小。
【0075】现在参照图22和23，图22和23分别是图12中铰接膝盖弯曲150度时的侧视图和等轴视图。当铰接膝盖继续旋转，接触力通常引发A/P平移和少量的轴向旋转。这再次与正常的膝盖运动大体一致。这个实施例描述了由胫骨部件154和股骨部件152的表面特征所驱使的A/P平移和轴向旋转，其他的实施例可以使用其他的方法来实现这些运动。
【0076】更多的实施例通常试图控制股骨部件和胫骨部件之间的侧向力。例如，髁上的侧向力之差可以引发运动。另外，在控制作用在另一侧上的力时将作用在一侧的侧向力保持在很小或零可以控制轴向旋转。为产生更大的旋转，力可以方向相反以增加轴向旋转量。由于旋转是由力矩控制的，另一个控制旋转的方法是控制力臂。
【0077】另一个实施例与相应的股骨关节表面的胫骨关节可以产生的接触点偏离于与横向轴铰销垂直的平面。通常，所述平面延伸通过内/外和/或外/内方向延伸。当膝盖在其运动范围内运动时，相应的关节接合几何形状保持平行于相同的平面或偏离相同的平面，以产生在关节运动范围内的全程、部分和/或不同范围的轴向旋转。
【0078】在另一个实施例中，股骨内髁或外髁的相对于横向铰销的位置关节面的同心的矢面曲面和相反股骨髁的关节面可以具有相对铰销位置的偏心矢面曲面。通过一定范围的运动，这改变了或至少部分地改变了与胫骨关节的内/外或外/内的接触点。胫骨关节面对应于股骨曲面并引发在关节运动范围内的全程、部分和/或不同范围的轴向旋转。
【0079】可替代地，内髁或外髁的相对于横向铰销的位置关节面的同心的矢面曲面和相反髁的相对于铰销的位置关节面的偏心矢面曲面可以引起所述运动。胫骨关节面对应于股骨曲面，在该曲面处，相应的内侧或外侧的偏心段遵循与多个弯曲角度和相应的接触点相关的运动预置路径。在围绕胫骨杆/套轴线和相应的内侧或外侧同心段的轴向旋转的过程中，这些接触点的径向平移遵循与多个弯曲角度和相应的接触点围绕胫骨杆/套的轴的轴向旋转运动相关的预置路径。这引发在关节运动范围内的全程、部分和/或不同范围的轴向旋转。
【0080】另一个实施例包含股骨假体，其内侧和外侧关节髁部分都具有相对于横向轴销的位置的偏心矢面曲面。具有相应的关节几何形状的胫骨插入物，即随着股骨关节上的偏心接触点的平移而前倾和/或后倾，在内/外或外/内方向上改变从而引发在关节运动范围内的全程、部分和/或不同范围的轴向旋转。
【0081】在另一个实施例中，内髁或外髁的关节面在相对于横向轴销的位置的同心的矢面曲面和相反髁的关节面可以具有相对铰销的位置的偏心矢面曲面。胫骨关节面对应于股骨曲面，在该曲面处，相应的内侧或外侧偏心段遵循与多个弯曲角度和相应的接触点的运动相关的预置路径，这些接触点在围绕胫骨杆/套轴线轴向旋转的过程中径向平移。相应的内侧或外侧同心段遵循与多个弯曲角度和相应接触点在围绕胫骨杆/套的轴线的轴向旋转的过程中的运动相关的预置的倾斜和/或下降路径，这引发在关节运动范围内的全程、部分和/或不同范围的轴向旋转。
【0082】可替代地，股骨假体的内侧和外侧关节髁部分都具有相对于横向销的位置的同心的矢面曲面。具有相应的关节几何形状的胫骨插入物，或者倾斜和/或下降，形成相对于股骨关节面轴向旋转的路径。平移/旋转自由度允许横向销旋转和平移股骨假体。
【0083】现在参照图24-41，这些图示出了铰接膝盖的一个实施例处于不同弯曲角度时的侧视图、等轴视图和顶视图。图24-26分别是铰接膝盖的一个实施例伸直时的侧视图、等轴视图和顶视图。股骨部件180相对于胫骨部件184围绕销182旋转。接触区域200示出了胫骨插入物186可能与股骨部件180接触的区域。图24-41中的接触区域200示出了股骨部件180如何沿着胫骨插入物186旋转和平移。
【0084】现在参照图27-29，图27-29分别是图27中铰接膝盖弯曲20度时的侧视图、等轴视图和顶视图。股骨部件180继续相对于胫骨部件184围绕销182旋转。接触区域200，尤其是外侧接触区域，已向后滚动。外侧接触区域的向后滚动对应于股骨部件180相对于胫骨部件184的轴向旋转。
【0085】现在参照图30-32，图30-32分别是图27中铰接膝盖弯曲40度时的侧视图、等轴视图和顶视图。股骨部件180相对于胫骨部件184继续围绕销182旋转。接触区域200已继续向后滚动，外侧接触区域再次相对于内髁向后方平移的更远。这对应于更大程度的轴向旋转。
【0086】现在参照图33-35，图33-35分别是图27中铰接膝盖弯曲90度时的侧视图、等轴视图和顶视图。股骨部件180相对于胫骨部件184继续围绕销182旋转。从弯曲40度到弯曲90度，在旋转在曲面的同心部分段继续进行时，旋转和平移被最小化。
【0087】现在参照图36-38，图36-38分别是图27中铰接膝盖弯曲120度时的侧视图、等轴视图和顶视图。股骨部件180相对于胫骨部件184继续围绕销182旋转。类似于从40度到90度的弯曲，从弯曲90度到弯曲120度，旋转在曲面的同心部分段继续进行时，旋转和平移被最小化。
【0088】现在参照图39-41，图39-41分别是图27中铰接膝盖弯曲150度时的侧视图、等轴视图和顶视图。股骨部件180相对于胫骨部件184继续围绕销182旋转。随着弯曲从120度继续进行到150度，接触区域200发生平移，且只有很小量的轴向旋转。
【0089】因此，当膝盖弯曲时，所述旋转允许膝盖骨沿着膝盖骨沟滑动而不产生作用于膝盖骨的力。此外，能够进行近似自然运动的铰接膝盖不会产生作用于软组织的力。这有助于保留初始被手术损伤的软组织。另外，一些软组织在手术中已经被移除，因此，残留软组织必须进行更大强度的工作以完成任务。减小施加于软组织上的力能够减少术后肿胀、疼痛和作用于软组织上的附加应力。
【0090】从上述内容可以看出本发明的若干优点已经实现和达到。
【0091】所选择并描述的实施例只是为了最好地解释本发明的原理和实际应用，以允许本领域的技术人员以多种实施方式和针对特定用途的多种改变来最好地利用本发明。
【0092】由于在不脱离本发明范围的情况下，可对本说明书中描述和图示的方法和结构进行多种改变，所有包含在上述描述中或由附图所示的内容应当解释为阐释性而非限制性的。因此，本发明的广度和范围不应当受限于任何以上描述的示例性实施例中的任何一个，而是应当仅根据下面所附的权利要求及其等同物来限定。

Claims (20)

1.一种铰接膝盖假体，包括：
a.胫骨部件，设置成与胫骨相连，胫骨部件具有支承面；以及
b.股骨部件，设置成铰接于胫骨部件并且相对于胫骨部件旋转，股骨部件包括：
i.内髁；以及
ii.外髁，内髁和外髁具有矢面曲面，设置成引发在胫骨部件的支承面上的轴向旋转。
2.权利要求1的铰接膝盖假体，其中，内髁和外髁具有多个偏心矢面曲面，设置成在胫骨部件的支承面上旋转。
3.权利要求1或2的铰接膝盖假体，其中，胫骨部件的支承面设置成具有前部和后部，支承面的后部的一部分设置成引导股骨部件的内外髁以使股骨部件和胫骨部件之间的接触点在前/后方向平移并且轴向旋转。
4.权利要求1-3之一的铰接膝盖假体，还包括轴铰销，该轴铰销横向位于内外髁之间，偏心矢面曲面具有不与轴铰销对准的旋转中心。
5.权利要求1-4之一的铰接膝盖假体，还包括设置成从胫骨部件延伸至股骨部件的杆，该杆的近心端部分设置成与轴铰销相连。
6.权利要求1-5之一的铰接膝盖假体，其中，内髁的偏心矢面曲面的一部分的旋转中心不与外髁的偏心矢面曲面的一部分的旋转中心对准，其中，内外髁指引股骨部件相对于胫骨部件的轴向旋转。
7.权利要求1-6之一的铰接膝盖假体，其中，内髁的偏心矢面曲面的一部分的旋转中心与外髁的偏心矢面曲面的一部分的旋转中心对准，其中，内外髁指引股骨部件相对与胫骨部件的前/后平移。
8.权利要求1-7之一的铰接膝盖假体，其中，股骨部件的内髁还包括同心的矢面曲面，其中，内髁的同心的矢面曲面的旋转中心不与外髁的偏心矢面曲面的一部分的旋转中心对准，其中，内外髁指引股骨部件相对于胫骨部件的轴向旋转。
9.权利要求2的铰接膝盖假体，其中，内髁的第一偏心矢面曲面的旋转中心不与外髁的第一偏心矢面曲面的旋转中心对准，其中，当在第一偏心矢面曲面与胫骨部件接触时，内外髁指引股骨部件相对于胫骨部件的轴向旋转和前/后平移，以及
内髁的第二偏心矢面曲面的旋转中心与外髁的第二偏心矢面曲面的旋转中心对准，其中，当第二偏心矢面曲面与胫骨部件接触时，内外髁指引股骨部件相对于胫骨部件的前/后平移。
10.权利要求5的铰接膝盖假体，还包括用于接收杆的套，该套设置成允许股骨部件相对于胫骨部件的轴向旋转。
11.一种使铰接膝盖在弯曲范围内旋转的方法，包括步骤：
a.将股骨部件固定连接于胫骨部件；
b.当铰接膝盖弯曲时，引发股骨部件相对于胫骨部件的轴向旋转。
12.权利要求11的方法，还包括当铰接膝盖弯曲时引发股骨部件相对于胫骨部件的前/后平移的步骤。
13.权利要求12的方法，其中，引发平移的步骤和引发轴向旋转的步骤同时发生。
14.权利要求11-13之一的方法，其中，引发轴向旋转的步骤通过假体膝盖的弯曲范围的一部分发生。
15.权利要求11-13之一的方法，其中，引发轴向旋转的步骤通过假体膝盖的弯曲范围的第一部分和假体膝盖的弯曲范围的第二部分发生。
16.权利要求15的方法，其中，弯曲范围的第一部分不与弯曲范围的第二部分相邻。
17.权利要求11-16之一的方法，其中，当铰接膝盖在膝盖弯曲范围内弯曲时，引发轴向旋转的步骤以变化的角速度发生。
18.权利要求11-17之一的方法，其中，固定连接步骤包括以下步骤：
a.将带套杆连接于胫骨插入物，以使带套杆的被套部分和带套杆的杆部分相互轴向旋转；以及
b.将轴铰销固定于带套杆，以使轴铰销将股骨部件的内髁横向连接至外髁。
19.权利要求18所述的方法，还包括步骤：将所述带套杆的被套部分固定到胫骨部件内的茎杆上。
20.权利要求18或19的方法，还包括步骤：当铰接膝盖弯曲时，相对于带套杆的杆部分，轴向移动带套杆的被套部分。
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