CN102048599A - 肩假体可调式肱头机构 - Google Patents
肩假体可调式肱头机构 Download PDFInfo
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Abstract
本发明公开了肩假体。所述肩假体包括头部,所述头部具有腔体。所述头部还包括第一支承表面,所述第一支承表面被构造成与关节窝的第二支承表面配合。所述肩假体也包括干,所述干具有限定于其中的凹槽,并且所述干被构造成被肱骨接纳。所述肩假体也包括第一连接器,所述第一连接器具有近端和远端。所述第一连接器也包括螺纹腔体和外壁。所述外壁接合所述干的所述凹槽,并且所述螺纹腔体在所述第一连接器的所述近端处开口。所述肩假体也包括第二连接器,所述第二连接器具有螺纹端,所述螺纹端被确定尺寸并被成形用于在所述第一连接器的所述螺纹腔体中配合。所述第二连接器也具有头部连接器端,所述头部连接器端被确定尺寸并被成形用于在所述头部的所述腔体内配合。所述第一连接器的所述外壁被确定尺寸并被成形用于在所述第二连接器被旋入所述螺纹腔体中时在所述近端处伸展。
Description
技术领域
本发明涉及假体装置,尤其是肩假体,更具体地讲,本发明涉及肩假体和用于肩关节置换的使用方法。
发明背景
肩假体市场状态已取得进展,使得外科医生通常以两种策略方法中的一种处理肩关节置换手术。一种策略为根据制造商的肩假体或肩假体产品系列进行肩关节置换手术。尤其是,给外科医生提供仪器和技术指南用于具体的肩假体或假体线。指南和/或仪器指示或规定了用于植入物(假体)的肱头切除术的角度。该角度与肱骨髓内(IM)腔相关并设计成与已经存在于假体设计中的一组最佳角度相匹配。
另一种策略为根据患者的解剖构造进行肩关节置换手术。尤其是,肱头在根据外科医生的意见认为是“解剖学”的角度下被切除,而不是根据已经存在于假体设计中的角度被切除。对假体进行设计使得假体的构造在手术中是可调节的。这允许假体成为可调式的并由此可与骨准备相匹配。
甚至相对于手术策略的这两种分歧的方式,在肩手术中的普遍问题是将肱骨切除角度与设计到假体中的预定角度相匹配。该角度可描述介于假体关节轴环和干的骨干剖面之间的角度。就无轴环的干而言,该角度可描述干的长轴和假体关节头部的下面之间的差值。据考虑,如果切除角与假体的角度相同,则就固定和生物力学而言最佳,从而允许被切除骨的上面和植入物的下面紧密接触。
此外,这种假体植入角将对假体关节的生物力学具有显著影响。目前,市场上的大多数假体体系规定了骨切除的内翻角/外翻角。该策略不允许外科医生在假体已造模后轻易改变生物力学,更不必说植入假体。
目前市售的某些已知的产品试图解决上述问题中的至少一个。首先,Tomier-Aequalis体系在干的干骺端区域内提供模块化接合,其允许在干和肱头之间的小嵌段互相交换。该嵌段可以多个角度提供,因此允许外科医生在切除时选择最佳配合多骨解剖学的嵌段。然而该体系具有两个主要的弱点。第一,使用模块化嵌段明显地迫使设计只能在有限的增量内允许角度的调节。第二,需要通过模块嵌段来调节角度迫使外科医生取出干,换出组件然后将干复位。这带来了不便以及干扰切除骨的风险,并会影响固定。
作为上述问题解决方案的第二种市售产品为CenterPulse Anatomica(现为Zimmer,Inc.)。该产品提供了可相对于假体的干部分以内翻角/外翻角和前角/后角无限可调式肱头。这通过位于干的上面上的球形突出实现,该球形突出配合成肱头中的球形凹槽。这些配合面允许肱头围绕干关节接合,从而允许肱头的可调式定位。肱头可相对于干被锁紧就位。该解决方案提供了颈轴角的调节以及能够通过前角/后角的灵活性影响这种角度的调节。然而,锁紧装置为次佳装置。尤其是,锁紧装置要求锁紧螺丝的转向,使其头部面向侧面和下面,一旦干接合就没有通路。这消除了即时调节头部位置的能力,并且如果关节面需要修整会迫使进行全面修整。最后,即使当肱头尚未就位时,肱骨干上的突出也会限制外科医生在关节窝置换的准备中触及关节窝。
在一些情况下,讨论了球顶部上有狭缝的球形球。有狭缝的球形球应当接合头部中的凹槽。此概念为球体允许肱头在手术期间旋转,但一旦选择了正确的角度,该球体就可膨胀并锁紧到凹槽中。然而,球体膨胀时,与凹槽接触的点随着球体膨胀而朝外移动。这导致球体和凹槽之间的接合不稳定。
因此,需要允许调节肱头角位的肩假体和/或使用方法。
因此,还需要允许几乎无限地调节肱头角位的肩假体和/或使用方法。
因此,还需要允许在手术期间具备可调节性并且在装置使用周期内具备稳定性的肩假体和/或使用方法。
也期望有一旦组件位于合适的位置就允许组件一起锁紧的肩假体。
发明内容
根据本发明的一个实施例,提供肩假体,肩假体包括头部,头部具有限定于其中的腔体。头部还具有:第一支承表面,第一支承表面被构造成与关节窝的第二支承表面配合;干,干具有限定于其中的凹槽并被构造成在肱骨中被接纳。肩假体也包括第一连接器,第一连接器具有近端和远端。第一连接器也包括螺纹腔体和外壁,外壁用于接合干的凹槽。螺纹腔体在第一连接器的近端处开口。肩假体还包括第二连接器,第二连接器具有螺纹端,螺纹端被确定尺寸并被成形用于在第一连接器的螺纹腔体中配合。第二连接器也具有头部连接器端,头部连接器端被确定尺寸并被成形用于在头部的腔体内配合。第一连接器外壁被确定尺寸并被成形用于在第二连接器旋入螺纹腔体中时在近端处伸展。
根据另一个实施例,提供肩假体。肩假体包括:头部,头部具有限定于其中的腔体;和干,干具有限定于其中的凹槽。凹槽具有:第一开口端,第一开口端限定在干的近表面中;第二封闭端;和侧壁,侧壁在两者间延伸。肩假体还包括:颈杆,颈杆具有第一联接部分,第一联接部分被构造成与头部腔体以摩擦配合的方式配合;和第二联接部分,第二联接部分被构造成被干的凹槽接纳。颈杆包括锁紧部分,锁紧部分被确定尺寸并被成形用于将第二联接部分锁紧到颈杆。第二联接部分具有近端和远端,并且锁紧部分在近端接合第二联接部分。颈杆的第二联接部分的近端被构造成伸展,从而当锁紧元件的第二部分在颈杆的第二联接部分的远端内被接纳时将颈杆联接到干。
根据另一个实施例,提供了组装肩假体用于肩关节成形术的方法。该方法包括使用:头部,头部具有限定于其中的腔体;和干,干具有限定于其中的凹槽。也使用第一连接器,第一连接器具有近端和远端。第一连接器也包括螺纹腔体和外壁,外壁用于接合干的凹槽。螺纹腔体在第一连接器的近端处开口。该方法还包括使用第二连接器,第二连接器具有螺纹端,螺纹端被确定尺寸并被成形用于在第一连接器的螺纹腔体中配合。第二连接器也具有头部连接器端,头部连接器端被确定尺寸并被成形用于在头部的腔体内配合。该方法还包括将第一连接器插入干的凹槽中并且第一连接器调节到所需角度。然后,将第二连接器全部旋入第一连接器中,从而导致第一连接器的近端伸展。这导致将第一连接器锁紧到干。
附图说明
附图中:
图1为根据本发明的一个实施例的肩假体的分解透视图;
图2为图1的肩假体的颈杆的透视图;
图3为图1的肩假体的第一连接器的透视图;
图4为图3的第一连接器的底视图;
图5为图1的肩假体的第二连接器的透视图;
图6为图1的干和颈杆的截面视图,其中干在一个特定的取向;
图7为图1的干和颈杆的截面视图,其中干在另一个特定的取向;
图8为图1的干和颈杆的截面视图,其中颈在另一个特定的取向;
图9为图1的头部、颈杆和干的截面视图,其根据本发明的一个实施例一起联接;和
图10为示出根据本发明的一个实施例的方法的流程图。
在所有这几个视图中,对应的参考符号指示对应的部分。相同的参考符号趋于在所有这几个视图中指示相同的部分。
具体实施方式
虽然本发明易受各种修改形式和替代形式的影响,但其具体实施例已在附图中以举例的方式示出,并且本文将详细说明。然而应当理解,本文无意将本发明限制为所公开的具体形式,相反,其目的在于涵盖本发明的精神和范围内的所有修改形式、等同形式和替代形式。
现在参见图1,图中示出肩假体的示例性实施例,一般以10标明。肩假体10包括肱骨组件或干12、颈杆14和头部16。头部16适于与联接到颈杆14。
如图1所示,干12包括主体18,主体18具有远侧(或干)部分20和近侧(或颈杆)部分22。干12可以具有或没有翅片、轴环、缝合孔等。近侧部分22具有优选大致平坦的表面或平表面24,平表面24具有延伸进入近侧部分22中的凹槽26。在一个实施例中,内壁28限定凹槽26。凹槽26可以具有锥形内壁28。在其它实施例中,凹槽26可以为圆柱形的形状。
现在参见头部16,头部16通过形成为通常的部分类球体的主体30来表征。尤其是,主体30被成形为适形于关节窝。主体30具有符合通常的部分类球体的关节面32和底部表面34。应当理解,头部16代表任何尺寸的肩假体头部。本主题发明允许各种尺寸的头部与本发明肩假体10的其它组件一起使用。虽然植入患者体内时最终仅有一种尺寸的头部用于肩假体10,但在将干12植入肱骨中(即在干12在最后阶段植入肱骨期间和/或之后)时,本发明的肩假体10的组件允许试用和/或使用各种尺寸的头部。各种头部可以确定为不同比例和/或尺寸。
头部16还包括凹槽、由主体内的内表面37限定的腔体30等,主体30在下侧或底部表面34上开口。内表面(内壁)37及由此的腔体36为锥形,并且将在下文进行更全面的描述。
现在参见图2-5,图中示出颈杆14。在该实施例中,颈杆14包括两个单独的组件:第一连接器38和第二连接器40。第一连接器38包括近端42和远端44。在其它实施例中,颈杆14可以为单一的组件,但具有两个相对彼此可移动的连接器。在一些实施例中,这两个连接器38、40可以预先组装在一起。第一连接器38包括螺纹腔体46和外壁48。外壁48接合干12的凹槽26。
第二连接器40包括螺纹端50和头部连接器端52。头部连接器端52将第二连接器联接到头部16。头部连接器端52为凸锥形形状,使得当头部连接器端52插入头部16的腔体36中时,头部连接器端52以锥形锁紧到腔体36中。在其它实施例中,头部连接器端52可能不是锥形的,并且可以使用其它已知的方法将头部连接器端52锁紧到头部16的腔体36中。
第二连接器40的螺纹端50被确定尺寸并被成形用于旋入第一连接器38的螺纹腔体46中。第一连接器38的螺纹腔体46的直径比第二连接器40的螺纹端50的直径略小。当螺纹端50被旋入螺纹腔体46中时,螺纹端50迫使第一连接器38的近端42伸展。
在该图示实施例中,第一连接器38在近端42处包括多个狭缝54。狭缝54由多个联轴器区段56限定。在该实施例中,具有3个狭缝54和3个联轴器区段56。在其它实施例中,可以具有其它数目的狭缝54和联轴器区段56。当第二连接器40的螺纹端50被旋入螺纹腔体46中时,狭缝54允许联轴器区段56分开和伸展。
现在参见图6,图6示出被引入干12的凹槽26中之后的颈杆14。尤其是,将第一连接器38(类球体的形状)插入凹槽26中。颈杆限定纵向轴线58,而干12的平表面24限定平面60。颈杆14被插入后,颈杆14的纵向轴线58和限定的平面60形成α角。在图6中,α角为90度,从而表明在颈杆14和干12之间没有偏移。
图7示出干12相对于颈杆14的偏移。在该实施例中,α角小于90度。换句话讲,颈杆14向左成角度。图8也示出干12相对于颈杆14的偏移,因为α角不止90度(即颈杆14向右成角度)。干12沿着两个正交轴为无限可调,以相对于颈杆14进而头部16设置干12的空间取向。这可以在干12设置在患者的肱骨中之前或之后实现。
应当理解,图6-8仅示出相对于一个旋转轴的角取向。其它旋转轴正交于示出的轴,并且(虽然未示出)在各自的空间取向显示具有相同的角位移。
一旦确定了干12的适当角取向,就将销62插入干12的销接纳孔64(图2)。销与第一连接器38的狭缝54中形成的孔64接合并有效地使干12和第一连接器38相对于彼此保持在相同的位置中。然后,第二连接器40被旋入第一连接器38中,使螺纹端50迫使联轴器区段56朝外推压并接合干12的凹槽26的内壁28。此类径向伸展固定了干12相对于颈杆14的取向。
如图9所示,颈杆14通过头部连接器端52以可脱开的方式固定到头部16上。一旦设置了α角(如图6-8所示),就可将头部16联接到颈杆14。用户将第二连接器40的锥形头部连接器端52与头部的锥形腔体36联接。一旦设置了α角,并且外科医生做好附连头部的准备,外科医生就可在干12植入肱骨中并且设置了α角之后,尝试不同尺寸的头部和/或改变头部以及进行空间取向。因为设置了α角,用户可尝试不同尺寸的头部,同时保持偏移精度。
现在参见图10,图中示出流程图,该流程图示出本发明一个实施例的使用。在步骤s100,将第一连接器38联接到第二连接器40。将第二连接器40的螺纹端50松弛地旋入第一连接器38中。在一些实施例中,可以预先组装第一连接器38和第二连接器40。在其它实施例中,它们可以为具有两个部分的单一组件,这两个部分相对于彼此为可移动的。然后,在步骤s102,将第一连接器38置于干12的凹槽26中。然后,在步骤s104,将第一连接器38调节到相对于干12的所需角度。在一些实施例中,一旦实现所需的角度,就在步骤s106将销62穿过干中的销孔64并穿过第一连接器38设置。然后,将第二连接器40完全旋到第一连接器38上,从而导致联轴器区段56伸展并接合干12的壁28(步骤s108)。伸展的联轴器区段56引起颈杆14在所需角度被锁紧到干中。然后,在步骤s110将头部16附接到第二连接器40的头部连接器端52。虽然该实施例示出介于头部16和第二连接器40之间的锥形锁紧连接,但也可以采用其它已知类型的连接。如果使用销62,可以在步骤s112将销62移除。
肩假体10可以由任何已知的生物相容性材料制成。例如,肩假体10可以由钛、钴、铬和/或不锈钢制成。也可以使用其它已知的生物相容性移植材料或医用级移植材料。
虽然上述的实施例涉及肩假体,但应当理解,这些试验物也可以用于替代植入物。
虽然附图示出长肱骨骨干的使用,但应当理解,词语“干”并非要求具有延伸到髓内腔中的远侧部分。如本文所用,“干”意指延伸到肱骨中的组件。
本文描述了源自肩假体的各种特征的本主题发明的多个优点。应当注意的是,本主题发明的肩假体的替代实施例可能不包括所有所述特征,但仍然得益于这种特征的优点中的至少某些。本领域的普通技术人员可以容易地设计其肩假体的特有的具体实施,使肩假体具备本主题发明的特征中的一种或多种,并且在本主题发明的精神和范围内。
Claims (20)
1.一种肩假体,包括:
头部,所述头部具有限定于其中的腔体,所述头部还具有第一支承表面,所述第一支承表面被构造成与关节窝的第二支承表面配合,
干,所述干具有限定于其中的凹槽,所述干被构造成在肱骨中被接纳;
第一连接器,所述第一连接器具有近端和远端,所述第一连接器也包括螺纹腔体和外壁,所述外壁用于接合所述干的所述凹槽,所述螺纹腔体在所述第一连接器的所述近端处开口;和
第二连接器,所述第二连接器具有螺纹端,所述螺纹端被确定尺寸并被成形用于在所述第一连接器的所述螺纹腔体中配合,所述第二连接器也具有头部连接器端,所述头部连接器端被确定尺寸并被成形用于在所述头部的所述腔体内配合;
其中所述第一连接器的所述外壁被确定尺寸并被成形用于在所述第二连接器被旋入所述螺纹腔体中时在近端处伸展。
2.根据权利要求1所述的肩假体,其中所述第一连接器的所述外壁限定至少一个狭缝,所述至少一个狭缝在所述近端处开始并朝所述远端延伸。
3.根据权利要求2所述的肩假体,其中所述至少一个狭缝被确定尺寸并被成形用于允许所述第一连接器的所述近端在所述第二连接器的所述螺纹端被旋入所述第一连接器中时伸展。
4.根据权利要求2所述的肩假体,其中所述干包括用于接纳销的销孔,并且所述至少一个狭缝被确定尺寸并被成形用于与所述销孔对齐并且接纳所述销,使得所述销将所述第一连接器在所述干中锁紧到位,以使得在所述第二连接器被旋入所述螺纹腔体中时,所述第一连接器不旋转。
5.根据权利要求1所述的肩假体,其中所述干中限定的所述凹槽为锥形凹槽。
6.根据权利要求1所述的肩假体,其中所述干中限定的所述凹槽为圆柱形凹槽。
7.根据权利要求1所述的肩假体,其中所述螺纹连接端和所述头部中的所述腔体通过锥形锁连接。
8.一种肩假体,包括:
头部,所述头部具有限定于其中的腔体;
干,所述干具有限定于其中的凹槽,所述凹槽具有:(i)在所述干的近侧表面内被限定的第一开口端,(ii)第二封闭端,以及(iii)在所述第一开口端和所述第二封闭端两者间延伸的侧壁;和
颈杆,所述颈杆具有:(i)第一联接部分,所述第一联接部分被构造成与所述头部的所述腔体以摩擦配合的方式配合,和(ii)第二联接部分,所述第二联接部分被构造成在所述干的所述凹槽中被接纳,其中所述颈杆包括锁紧部分,所述锁紧部分被确定尺寸并被成形用于将所述第二联接部分锁紧到所述颈杆,其中所述第二联接部分具有近端和远端,并且所述锁紧部分在所述近端处接合所述第二联接部分,并且所述颈杆的所述第二联接部分的所述近端被构造成当所述锁紧组件的所述第二部分在所述颈杆的所述第二联接部分的近端内被接纳时伸展,从而将所述颈杆联接到所述干。
9.根据权利要求8所述的肩假体,其中:所述头部还具有第一支承表面,所述第一支承表面被构造成与关节窝的第二支承表面配合,并且所述干被构造成在肱骨的髓腔中被接纳。
10.根据权利要求8所述的肩假体,其中所述颈杆的所述第二联接部分的所述近端还具有多个联轴器区段,所述多个联轴器区段彼此被间隔开。
11.根据权利要求10所述的肩假体,其中:所述多个联轴器区段包括三个联轴器区段,并且所述三个联轴器区段中的每一个都通过轴向狭缝与所述三个联轴器区段的另一个分开。
12.根据权利要求10所述的肩假体,其中所述第二联接部分包括螺纹腔体,所述螺纹腔体被确定尺寸并被成形用于接纳所述锁紧部分的螺纹端。
13.根据权利要求12所述的肩假体,其中所述螺纹腔体为锥形并且所述锁紧部分的所述螺纹端为圆柱形,使得当所述锁紧部分的所述螺纹端被旋入所述锥形螺纹腔体中时,所述腔体的所述近端伸展。
14.根据权利要求10所述的肩假体,其中所述颈杆为模块化的并且所述锁紧部分与所述第二联接部分分开。
15.一种组装肩假体以用于肩关节成形术的方法,所述方法包括:
使用:头部,所述头部具有限定于其中的腔体;干,所述干具有限定于其中的凹槽;第一连接器,所述第一连接器具有近端和远端,所述第一连接器也包括螺纹腔体和外壁,所述外壁用于接合所述干的所述凹槽,所述螺纹腔体在所述第一连接器的所述近端处开口;以及第二连接器,所述第二连接器具有螺纹端,所述螺纹端被确定尺寸并被成形用于在所述第一连接器的所述螺纹腔体中配合,所述第二连接器也具有头部连接器端,所述头部连接器端被确定尺寸并被成形用于在所述头部的所述腔体内配合;
将所述第一连接器插入所述干的所述凹槽中;
将所述第一连接器调节到所需角度;以及
将所述第二连接器完全旋入所述第一连接器中,导致所述第一连接器的所述近端伸展,从而将所述第一连接器锁紧到所述干。
16.根据权利要求15所述的方法,还包括:在将所述第一连接器调节到所需角度之后,将销插入所述干和第一连接器,从而使所述第一连接器相对于所述干以所需角度锁紧。
17.根据权利要求16所述的方法,还包括:在将所述第二连接器完全旋入所述第一连接器中之后,将所述销从所述第一连接器和所述干中取出。
18.根据权利要求15所述的方法,还包括:在将所述第二连接器完全旋入所述第一连接器中之后,将所述头部联接到所述第二连接器上。
19.根据权利要求18所述的方法,其中所述联接包括将所述头部通过锥形锁锁紧到所述第二连接器上。
20.根据权利要求15所述的方法,其中所述第一连接器的所述近端包括多个狭缝,所述多个狭缝由多个联轴器区段限定,并且当所述第二连接器被旋入所述第一连接器中时,所述多个联轴器区段朝外伸展以接合所述凹槽的所述壁。
Applications Claiming Priority (2)
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US12/609,040 US20110106267A1 (en) | 2009-10-30 | 2009-10-30 | Shoulder prosthesis adjustable humeral head mechanism |
US12/609040 | 2009-10-30 |
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CN102048599A true CN102048599A (zh) | 2011-05-11 |
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CN2010105382659A Pending CN102048599A (zh) | 2009-10-30 | 2010-10-29 | 肩假体可调式肱头机构 |
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US (1) | US20110106267A1 (zh) |
EP (1) | EP2316386A1 (zh) |
JP (1) | JP2011092735A (zh) |
CN (1) | CN102048599A (zh) |
AU (1) | AU2010235884A1 (zh) |
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Also Published As
Publication number | Publication date |
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EP2316386A8 (en) | 2011-09-21 |
AU2010235884A1 (en) | 2011-05-19 |
EP2316386A1 (en) | 2011-05-04 |
US20110106267A1 (en) | 2011-05-05 |
JP2011092735A (ja) | 2011-05-12 |
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