CN102300519A - 用于髋臼关节成形术的方法和装置 - Google Patents

用于髋臼关节成形术的方法和装置 Download PDF

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Publication number
CN102300519A
CN102300519A CN2009801563646A CN200980156364A CN102300519A CN 102300519 A CN102300519 A CN 102300519A CN 2009801563646 A CN2009801563646 A CN 2009801563646A CN 200980156364 A CN200980156364 A CN 200980156364A CN 102300519 A CN102300519 A CN 102300519A
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bone
ilium
pipeline
acetabular
irrotational
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CN102300519B (zh
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M·D·里斯
D·C·克尔曼
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Smith and Nephew Inc
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Smith and Nephew Richards Inc
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Abstract

一种用于在髂骨的髋臼中执行髋臼关节成形术的方法可包括定位髂骨的髂骨管道。该髂骨管道从髋臼的表面大体上朝髂嵴的一部分延伸。压紧步骤压紧沿髂骨管道对准的非旋转的骨移除工具，从而使非旋转的骨移除工具移除髂骨管道内的骨并形成骨空隙。另一步骤将固定植入物固定在管道空隙中。通过固定植入物将髋臼植入物安装在髋臼中。

Description

用于髋臼关节成形术的方法和装置
相关申请的交叉引用
本申请要求享有于2008年12月2日提交的题名为“髂骨管道假体”的美国临时申请No.60/119,210的权利。该申请的公开通过引用而全部结合在本文中。
发明背景
发明领域
本发明大体上涉及准备髋臼骨以用于固定髋臼植入物的方法，并且更具体地说，涉及一种使用非旋转切削装置来准备髋臼的方法。此外，本发明涉及一种使用拉刀和锉刀将髋臼增大物固定到髂骨管道上的方法。
相关技术
在过去，髂骨管道已被用于将人造髋臼支承面牢固地固定到骨盆的骨上。这样的假体利用了螺纹柱状部(该柱状部被附连至其上具有联接面的帽状物上)，并且在本领域被称为“环形假体”。环形假体通常是整体式的，并且由金属制成。非接合的聚乙烯附于金属上(UPM)髋部假体也被用于固定到髂骨管道上。UPM髋部假体是上述全金属环形假体的后续物。
为此，所有当前利用髂骨管道以用于固定的髋臼假体都没有为外科医生提供模块化、手术进行时可采取的选项，和/或材料选择。
此外，用于这样利用用于固定的髂骨管道的髋臼假体的髋臼准备的现有技术方法需要旋转切削装置，例如半球形铰刀、钻头、铰刀或螺钉。
本发明的概述
前述需求通过本发明的若干方面而满足。
根据本发明的一个方面，提供了一种准备髋臼区域以用于接受髋臼植入物的方法，该髋臼植入物设置为用以接合髂骨的髓内管的至少一部分。该方法包括这样的步骤：使用至少一个用于骨移除的非旋转装置来准备髂骨的髓内表面以用于接受所述髋臼植入物。该植入物例如可为髋臼假体的柱状部分，或者用于促进髋臼假体稳定性的增大物。
根据本发明的其它方面，提供了用于准备髂骨的髓内管的一部分的外科器械。所提供的外科器械可设置为拉刀或锉刀，其用作用于髂骨移除的非旋转装置。
根据本发明的还有另一方面，提供了一种用于在髂骨的髋臼中执行髋臼关节成形术的方法。该方法可包括定位髂骨的髂骨管道。髂骨管道从髋臼的表面大体上朝髂嵴的一部分延伸。压紧步骤压紧沿髂骨管道对准的非旋转的骨移除工具，从而使该非旋转的骨移除工具移除髂骨管道内的骨并形成骨空隙。另一步骤将固定植入物固定在髂骨管道空隙中。通过固定植入物将髋臼植入物安装在髋臼中。
另一方面提供定位步骤，其可包括使所述髂骨管道中空的步骤。
根据另一方面，定位步骤可包括使管道探寻夹具定位在髂骨上。
根据还有另一方面，管道探寻夹具可包括第一部分、第二部分和对准引导装置。使管道探寻夹具定位的步骤还包括使管道探寻夹具的第一部分靠着髋臼的一部分定位，以及使管道探寻夹具的第二部分靠着髂嵴的一部分定位，从而使对准引导装置沿髂骨管道的轴线对准。
还有另一方面还可包括产生被皮层骨包围的骨空隙。
根据另一方面，压紧步骤还可包括压紧多个非旋转的骨移除工具。
根据还有另一方面，压紧步骤还可包括压紧多个不同大小的非旋转的骨移除工具。
在还有另一方面，固定步骤还可包括将固定植入物接合到管道空隙中的步骤。
根据另一方面，髋臼植入物可以是髋臼帽。
根据还有另一方面，髋臼构件可以是髋臼保持架。
另一方面提供了一种用于髂骨管道的非旋转的骨移除工具。该工具可包括骨移除面，其设置为用以从髂骨管道中移除骨并形成骨空隙。定位部分可设置为用以将骨移除面定位在髂骨管道中。骨移除面可相对于定位部分设置为使得骨移除面在髂骨管道中产生骨空隙，从而使骨移除面邻接皮层骨。
在还有另一方面，定位部分可以是设置为用以容纳套管的中空部分。
根据另一方面，骨移除面可自手术前图像形成。
根据还有另一方面，骨移除面可由多个部分形成，该多个部分连接在一起以形成不规则的形状。
在还有另一方面，骨移除工具可包括多个模块化的活动面，从而使每个模块化的活动面可单独地附连到非旋转的骨移除工具上。骨空隙通过一系列压紧步骤中形成的该多个模块化的活动面的组合而形成。
本发明可适用的其它领域将从后文所提供的详细描述中变得显而易见。应当理解，该详细描述和特定示例虽然指示本发明的某些实施例，但是其只是用于说明性的目的，并且不意图限制本发明的范围。
附图的简要描述
附图被包括在说明书中并形成说明书的一部分，其显示了本发明的实施例，并与书面描述一起用于说明本发明的原理、特点和特征。在附图中：
图1a至图1j显示了根据一个实施例的准备髋臼区域的方法；
图2a至图2j显示了根据另一实施例的准备髋臼区域的方法；
图3是部分重建的髋部的前冠视图，其显示了髂骨的髂骨管道区域以及先前存在的股骨植入物；
图4是完全重建的髋部的前冠视图，其使用图1a至图2j中所示的一种或多种方法将根据本发明的一个实施例的髋臼假体植入；
图5a显示了对于用于髂骨移除的非旋转装置的不同截面轮廓的某些示例。
图5b显示了对于用于髂骨移除的非旋转装置的不同套筒式截面轮廓的某些示例；
图6是根据本发明的某些实施例的在远端会合的渐缩形拉刀的立体图；
图7是根据本发明的某些实施例的其上具有切削面的拉刀的立体图；
图8是根据本发明的某些实施例的在远端会合的弯曲的渐缩形拉刀的立体图；
图9是根据本发明的某些实施例的弯曲的渐缩形拉刀的立体图；
图10至图13显示了根据本发明的某些实施例的拉刀或锉刀的几何形状；
图14a显示了用于在髂骨的第一侧上临时地或永久地植入髂骨管道中的按解剖学整形的增大物或试验物的示例。
图14b显示了按解剖学整形的拉刀或锉刀的示例，其用于在髂骨的不同于第一侧的第二侧上准备髂骨管道。
图15是显示了根据本发明的使用铰刀的某些实施例的方法步骤的示意图。
图16是显示了根据本发明的某些实施例的方法步骤的示意图。
图17是用于插入髂管道探寻杆的夹具，管道探寻杆可有利地与计算机辅助外科手术(CAS)系统一起使用。
图18是根据某些实施例的用于插入管道探寻杆的夹具。
图19是根据其它实施例的用于插入管道探寻杆的夹具。
实施例的详细描述
下面对优选实施例的描述实质上只是示例性的，并且决非意图限制本发明、其应用或用途。
本发明部分地提供一种准备髋臼区域的方法以用于容纳髋臼植入物(尤其是多孔增大物或假体)，其利用髂骨管道作为稳定的锚定器或作为用于合适定向的装置。本发明的方法利用髂骨管道作为完好的可反复确认的解剖标志，其可被用来将髋臼植入物以相对高的可信度定向和/或安装。本文所使用的“髋臼植入物”可包括下列任何一种或多种(不带有限制性)：多孔金属、多孔增大物、半多孔增大物、非多孔增大物、髋臼保持架、髋臼壳体、髋臼衬里，或者设置为用于植入髋臼骨中或髋臼骨周围的装置或其部分。本发明的方法尤其有利地用于具有柱状部分的植入物，该柱状部分设置为用于插入准备好的髂骨管道中，大体上形成用于构建失去或受损的骨的“基础”。在可能的情况下优选地利用无接合剂的植入物选项，然而，本发明的髋臼植入物可包含接合选项。
本发明的有用性并不限于髋臼，而且还可在肩关节成形术中(例如外伤的情况下)具有某些实用性。
图1a至图1j显示了根据一个实施例的准备髋臼区域的方法。转到图1a，提供了髂骨10的髋臼12。管道探寻套管22在这个实施例中是导杆，但可另外地为销或铰刀，或者在髂骨管道内延伸的一些其它引导工具，其经由导杆插入器夹具20而定位在髂骨10的管道11中。导杆插入器夹具可具有用于握持的把手24，以及被容纳在髋臼12中的定位端26。
夹具20以环状方式移动，直至导杆22与髂骨10的髓内管11对准。然后使用压紧力或通过在导杆22上提供自钻末端(self-drillingtip)14而将导杆22插入髓内管11中。或者，夹具20可被用来在单独的步骤中为导杆22预先钻孔。
图1b显示了使用在导杆22上滑动的空心铰刀30在导杆22上铰孔的步骤。虽然未在图中显示，但是，如果不使用导杆22，铰刀30不需要是中空的。在这种情况下，外科医生将使铰刀简单地定向、铰孔，并使铰刀在髓内管11中留在原位。铰刀30具有切削面16，其有助于通过移除骨而打开髂骨管道11。可提供一系列具有不同直径大小的铰刀30以适应不同的患者，并且在其上可提供深度标记以指示骨移除的深度。
在铰孔完成之后，可将用于髂骨移除的非旋转装置(例如空心拉刀或锉刀44)放置在铰刀30上，如图1c中所示的那样。拉刀44被连接到具有压紧面42的拉刀把手40上或与其制成整体，如传统地对于股骨和肱骨柱状部拉削所做的那样。虽然未在图中显示，但是，如果不使用导杆22和铰刀30(例如在骨质疏松的情况下)，拉刀44不需要是中空的。可提供一系列或一组具有不同几何形状和大小的拉刀44以适应不同的患者、独特情形和/或左髋臼区域或者右髋臼区域，如下文将论述的那样。
拉刀44被压紧到髂骨管道11中同时被导杆22和铰刀30引导。拉刀44相对于铰刀30和杆22的径向定向通常在压紧50之前完成。在压紧50之后，拉刀44经由施加到拉刀44或拉刀把手40上的拔出力52从管道11中移除，如图1e中所示的那样。拉刀44的移除在髂骨10中产生骨空隙18，其设置为用以容纳预定的髋臼植入物60。植入物60例如可为髋臼假体的柱状部或多孔增大物，如图中所示的那样。空隙18优选地在髂骨管道11的界限内产生，并且优选地由通过拉刀44暴露的髂骨10的内皮层骨定界。然后将植入物60插入空隙18中，并通过摩擦配合或接合剂而固定。单独的压紧器(未显示)或拉刀把手40可有助于将植入物60固定在空隙18内。
接下来，提供髋臼构件80(例如髋臼保持架、壳体82或衬里84)并安装在植入物60上。在某些实施例中，可能需要提供骨接合剂和/或骨移植材料70至准备好的髋臼区域。作为备选，或者与骨接合剂和/或骨移植材料70结合，可使用松质骨螺钉、皮层螺钉、栓、线或线缆(未显示)进一步将髋臼构件80、82、84固定至髋臼区域。
图2a至图2j显示了根据另一实施例的准备髋臼区域的方法。转到图2a，提供了髂骨10的髋臼12。管道探寻导杆22经由导杆插入器夹具20而定位在髂骨10的管道11中。可提供一系列具有不同直径大小的导杆22以适应不同的患者，并且在其上可提供深度标记以指示骨移除的深度。导杆插入器夹具可具有用于握持的把手24，以及被容纳在髋臼12中的定位端26。夹具20以环状方式移动，直至导杆22与髂骨10的髓内管11对准。然后使用压紧力或通过在导杆22上提供自钻末端14而将导杆22插入髓内管11中。或者，夹具20可被用来在单独的步骤中为导杆22预先钻孔。图2b显示了移除夹具20和将导杆22留在原位的步骤。
在导杆插入完成之后，可将用于髂骨移除的非旋转装置(例如空心拉刀或锉刀44)放置在导杆22上，如图2c中所示的那样。拉刀44被连接到具有压紧面42的拉刀把手40上或与其制成整体，如传统地对于股骨和肱骨柱状部拉削所做的那样。虽然未在图中显示，但是，如果不使用导杆22(例如在骨质疏松的情况下)，拉刀44不需要是中空的。可提供一系列或一组具有不同几何形状和大小的拉刀44以适应不同的患者、独特情形和/或左髋臼区域或者右髋臼区域，如下文将论述的那样。
拉刀44被压紧到髂骨管道11中同时被导杆22引导。拉刀44相对于铰刀30和杆22的径向定向通常在压紧50之前完成。在压紧50之后，拉刀44经由施加到拉刀44或拉刀把手40上的拔出力52从管道11中移除，如图2e中所示的那样。拉刀44的移除在髂骨10中产生骨空隙18，其设置为用以容纳预定的固定植入物60。植入物60例如可为髋臼假体的柱状部或多孔增大物，如图中所示的那样。空隙18优选地在髂骨管道11的界限内产生，并且优选地由通过拉刀44暴露的髂骨10的内皮层骨定界。然后将植入物60插入空隙18中，并通过摩擦配合或接合剂而固定。单独的压紧器(未显示)或拉刀把手40可有助于将植入物60固定在空隙18内。
接下来，提供髋臼构件80(例如髋臼保持架、壳体82或衬里84)并安装在植入物60上。在某些实施例中，可能需要提供骨接合剂70至准备好的髋臼区域。作为备选，或者与骨接合剂70结合，可使用松质骨螺钉、皮层螺钉、栓、线或线缆(未显示)进一步将髋臼构件80、82、84固定至髋臼区域。
图3显示了髂骨的髂骨管道区域的前冠视图。所示的是显示了在根据本发明的方法植入髋臼假体之前的手术前的患者情况的示例的示意图。预先存在的股骨头部假体86’与髋臼12的磨损的自然软骨联接(即，髋部半关节成形术)。髂骨10的髂骨管道11的固定部分15被显示为正好位于股骨头部假体86’上方。髋臼植入物的大小和几何形状基于手术前的模板而选择，同时考虑与髂骨10的髓内管11的内表面18的压配合质量。
图4是根据本发明的一个实施例的使用图1a至图2j中所示的方法步骤植入的髋臼假体的前冠视图。在准备髂骨管道11之后，可将固定植入物60插入并压配合在髂骨管道11的壁18中。在图4中所示的情况下，植入物60是多孔增大物。然后在植入物60的部分的顶部、侧面或附近将第一接合剂和/或骨移植材料覆盖物70’应用到髋臼区域12上。例如，可使中间分碎的骨移植物靠置着增大物60。
然后将髋臼构件80(例如髋臼保持架(如图所示))应用在第一覆盖物70’上。保持架80可包括一个或多个用于稳定性的凸缘80’，并且还可包括一个或多个孔80’(其用作螺钉安装装置)或者用于骨接合剂和/或骨移植材料覆盖物70’的交错咬合的简单表面，以用于改进固定。髋臼保持架80可设有罩或支持物，以用于增加支撑至衬里84和/或骨接合剂层70”(其将衬里84粘接到保持架80上)。
然后可将一个或多个额外的髋臼构件(例如髋臼衬里84或髋臼壳体固定到接合的髋臼构件80上。通过一个或多个应用在髋臼构件80上的第二接合剂和/或骨移植材料覆盖物70”可有助于一个或多个额外的髋臼构件84的固定。任一覆盖物或两个覆盖物70’、70”均可被一个或多个其它固定装置取代，包括但不限于摩擦配合、螺钉、栓、销钉、线、骨基质(例如矿化的和/或去矿化的)、线缆和夹具。在所示的特定示例中，未使用髋臼壳体，并且替代地，衬里84被直接固定到保持架80上。然而，在保持架(80)和衬里(84)之间可使用髋臼壳体(82)。
图5a显示了对于用于髂骨移除的非旋转装置的不同截面轮廓的一些示例。用于髂骨移除的非旋转装置(例如锉刀和拉刀)可包括许多几何形状。几何形状在沿着其长度的不同位置处可包括一个或多个不同的截面。外围轮廓可包括多边形，例如八边形102和梯形102’，并且可包括弯曲的或B-样条形状102”。
图5b显示了对于用于髂骨移除的非旋转装置的不同空心截面轮廓的一些示例。如果利用导杆22或铰刀30，可采用延伸通过拉刀的长度的中心孔以将拉刀定向和引导到髂骨10的髓内管11中。所述中心孔可具有能够挤压的任何横截面形状，包括但不限于弯曲的形状(例如圆形和椭圆形104)，以及多边形(例如三角形104”、矩形104’和六边形104”’)。
图6是根据本发明的某些实施例的在远端会合的渐缩形拉刀的立体图。拉刀110可为或者可不为中空的112，并且可包括一个或多个会合表面111，会合表面111可以是平面的。
图7是根据本发明的某些实施例的其上具有切削面的拉刀的立体图。所示的是髋臼拉刀110，其可为或者可不为中空的112，并且其可在一些部分处包括光滑表面113、113’或切削面114、114’。切削面114、114’可为整形外科领域中任何已知的那样。
图8是根据本发明的某些实施例的在远端会合的弯曲的渐缩形拉刀110的立体图。拉刀110可具有一个或多个会合表面115、116，其中至少一个表面在至少一个平面中是弯曲的。
图9是根据本发明的某些实施例的弯曲的渐缩形拉刀110的立体图。拉刀110可具有会合表面117、118，其中至少一个表面在横平面中是弯曲的。
图10至图13显示了根据本发明的某些实施例的用于拉刀、锉刀、增大物和髋臼植入物柱状部类似物的可能的几何形状。所示的是非径向对称的几何形状120、122、124、126，其可具有或者可不具有比近端几何形状更小的远端几何形状128，以用于更容易插入到髂骨10的髓管中。几何形状120、122、124、126可以是偏心的或均匀挤压的，其具有等同的近端几何形状和远端几何形状128。几何形状120、122、124、126可单独为增大物122提供，或者可提供给整体的髋臼植入物121、125的柱状部120、126。或者，可提供几何形状120、122、124、126作为柱状部124，以用于经由连接装置127、129连接到单独的髋臼植入物123上。连接装置127、129可包括(无限制性)：接合剂、莫氏渐缩、压配合、螺纹接合、外-内螺纹连接、拧入到凸起部中的单独的螺钉等等。连接装置129可用于备选用途，例如用于附连或对准用于准备髋臼区域部分的其它外科器械的装置。
图14a显示了用于髂骨的第一侧的髂骨管道中的移植的按解剖学整形的试验性植入物或增大物130的示例。增大物130可以是如由虚线所示的较大的植入物138的较小部分。例如，增大物130可具有整体式凸缘以用作接合剂支持物，或者增大物130可以是髋臼壳体的柱状部分。在图14a中所示的实施例中，增大物130的外表面132优选地设计成在管道11准备好之后最大限度地增加位于增大物130与髓内管11之间的皮层骨和/或松质骨接合部。增大物130优选地是多孔的，从而避免接合剂固定；然而，可构思其它表面质地。例如，如果增大物130要被用作试验性复位期间的试验性增大物，那么表面质地可以是平滑的，以便容易插入和拔出。
图14b显示了按解剖学整形的拉刀或锉刀134的一个示例，其用于在髂骨的不同于第一侧的第二侧上准备髂骨管道11。拉刀或锉刀134可包括标记140，其可传递信息给外科医生，例如大小、类型、患者的侧、序号、制造商等等。拉刀或锉刀134可如图1c、1e、2c和2e中所示的那样与拉刀把手40制成整体，或者可具有用于联接的装置142，该装置142容许将拉刀或锉刀134从拉刀把手40上移除。如果使用辐射能(例如CT、MRI或X射线)扫描患者，那么可给外科医生提供定制的增大物130和拉刀134以满足特定缺陷。
图15显示了根据本发明的某些实施例的方法步骤的示意图。具体而言，图15描述了图1a至图1j中所示的方法步骤。可选地，执行步骤202，其中外科医生将管道探寻导杆22放置到髂骨10的髓内管11中。如果外科医生使用管道探寻导杆22，那么在步骤204中可将空心铰刀30放置在导杆22上。然后根据需要在步骤206中铰大髓内管11，以使管道11打开到足够用于拉削。其它外科器械可附连到导杆22或铰刀30上，或从其延伸。可省略铰孔步骤206，或者使用一个或多个不同直径大小的铰刀重复铰孔步骤206。在髂骨10的髓内管11铰大206之后，可将最后的铰刀30留在管道11中以用于在拉削步骤210中使用。将管道11拉削210，并且然后将拉刀44从髋臼区域12移除。拉削210可被其它用于从髂骨管道11移除骨材料的非旋转手段替代，例如使用骨凿或压紧装置移除骨，如下文论述的那样。如果外科医生选择使用导杆22或铰刀30，那么拉刀可以是中空的以用作对准特征用以相对于导杆或铰刀对准，并且将执行使拉刀在导杆22和/或铰刀30上滑动的步骤208。如果导杆22和空心铰刀30不用于外科手术，那么拉刀44不需要是中空的。通过在导杆22上使用较大直径的铰刀在不同深度处铰孔以在髂骨管道11中形成一个或多个“埋头孔”，和/或通过拉削髋臼区域12的表面部分，可完成对髋臼区域12的进一步准备212、214。
一旦在髂骨管道11和/或周围髂骨10中产生合适的骨空隙18，在步骤216中可从髋臼区域12移除一些或所有之前插入的器械(例如管道探寻导杆22、铰刀30、拉刀44)，以便有助于试验性复位的步骤218。如果使用空心增大植入物60和试验性增大物，那么在试验性复位218之前不需要移除器械216。在这种情况下，试验性增大物和/或增大植入物60在导杆22、铰刀30或拉刀44上滑动，并且之后在外科过程中将从髂骨10移除该器械。试验218同时将导杆22或铰刀30留在管道11中容许外科医生根据需要容易地再铰大和增大试验性增大物大小以实现最佳配合和皮层接合。试验性复位步骤218是可选步骤，并且在相应大小和形状的拉刀变得难以移除的情况下可以省略。
当建立了最佳的大小、形状或配合时，可移除该一个或多个试验性增大物，并将一个或多个植入增大物60插入其位置220。然后可将接合剂70置于插入的增大物222上，使保持架80或其它髋臼构件(例如髋臼壳体)附连224到接合剂70’上，并且然后可利用第二接合剂层70”将衬里84或其它髋臼构件接合226到保持架80或其它髋臼构件上。应当注意，接合剂70可被摩擦、螺钉或本文所述的任何其它固定手段替代。
例如，如果待插入髂骨10中的增大物60是不同增大物的模块化组合，或者具有不规则或非标准形状，那么可将一个或多个不同的拉刀或模块化的互锁/可互换的拉刀部件(未显示)顺序地“堆叠”，以便形成与不规则或非标准形状的增大物60的形状互补的独特的拉刀几何形状。或者，可利用具有不同形状的整体式拉刀连续地使用步骤210和212，从而产生具有所述不规则形状的骨空隙18。
在另一示例中，外科医生可在导杆22上铰孔206，将铰刀30留在髓内管11中，使用第一拉刀44在铰刀30上拉削210，移除第一拉刀44，使用第二拉刀(未显示)在髓内管11和髋臼区域12中拉削埋头孔，移除第二拉刀，并且然后使用半球形的铰刀(未显示)圆化通过第二拉刀形成的埋头孔，以便在髂骨10中形成截头-球形的埋头孔部分。
图16是显示了根据本发明的某些实施例的方法步骤的示意图。具体而言，图16描述了执行如图2a至2j中所示的外科手术的方法300。可选地，执行步骤302，其中外科医生将管道探寻导杆22放置到髂骨10的髓内管11中。如果外科医生使用管道探寻导杆22，那么在步骤304中将空心拉刀44放置在导杆22上并且然后将管道11拉削306。所提供的其它外科器械可设置为附连到导杆22上或从其延伸。拉削306可被用于从髂骨管道11移除骨材料的其它非旋转手段替代，例如使用骨凿或压紧装置移除骨，如下文论述的那样。在步骤304期间，拉刀44上的一个或多个中空部通常用作对准特征以用于相对于导杆22对准。如果导杆22和拉刀44是键槽联接的或有键的，其将在压紧50期间有助于拉刀44相对于髂骨的不同径向定向以实现最佳骨配合。如果导杆22不用于外科手术，那么拉刀44不需要是中空的。一旦拉削306结束，将拉刀44从髋臼区域12移除308。通过在导杆22上使用铰刀在不同深度处铰孔以在髂骨管道11中形成一个或多个“埋头孔”，和/或通过拉削髋臼区域12的表面部分，可完成对髋臼区域12的进一步准备310、312。在该过程期间可在任何时刻执行使用增大试验物的一个或多个试验步骤，尤其是在拉削步骤1c-1e、2c-2e或铰孔步骤1b期间或之后以及在植入最终增大物60之前。试验物可根据待植入的增大物而定制形状和尺寸，然而，优选地不带有高摩擦或多孔外表面(使用在待植入的增大物上)而形成，以便容易插入和从髂骨移除。
例如，如果待插入髂骨10中的增大物60是不同增大物的模块化组合，或者具有不规则或非标准形状，那么可将一个或多个不同的拉刀或模块化的互锁/可互换的拉刀段(未显示)顺序地“堆叠”，以便形成与不规则或非标准形状的增大物60的形状互补的独特的拉刀几何形状。或者，可利用具有不同形状的整体式拉刀连续地使用步骤310和312，从而产生具有所述不规则形状的骨空隙18。
在另一示例中，外科医生可使用第一拉刀44在导杆22上拉削306，移除第一拉刀44，使用第二拉刀(未显示)在髓内管11和髋臼区域12中拉削埋头孔，移除第二拉刀，并且然后使用半球形的铰刀(未显示)圆化通过第二拉刀形成的埋头孔，以便在髂骨10中形成截头-球形的埋头孔部分。
一旦在髂骨管道11和髂骨10中产生合适的骨空隙18，在步骤314中从髋臼区域12移除所有器械(例如管道探寻导杆22、铰刀30和拉刀44)。利用试验性髋臼植入物进行试验，例如可将增大试验物插入空隙18中以确保合适的配合和稳定性。然后在步骤316中将髋臼植入物60(例如增大物)插入并固定在准备好的髂骨管道11的空隙18中。然后可使用本文所公开的任何装置将后续髋臼构件80、82、84、86附连到髋臼区域12上，如步骤318、320和322中所示的那样。
本文所用的用语“增大物”可包括(无限制性)下列一种或多种：“多孔骨-内生长结构”、“多孔网状开室网络”、“生物相容的金属泡沫”、“陶瓷泡沫”(例如多孔羟磷灰石)、“聚合物泡沫”(例如多孔聚醚醚酮、多孔超高分子量聚乙烯)、“小梁结构”、“多孔表面-质地”(例如通过喷砂或腐蚀产生的多孔层)、“具有多孔外层的固体衬底”、“具有至少一种烧结粉末的多孔涂层的装置”、“多孔的烧结粉末结构”(例如多孔烧结球形颗粒和/或非对称颗粒)、“火焰喷涂的金属”(例如火焰喷涂的钛)、“等离子体喷涂的金属”(例如等离子体喷涂的钛)、“非多孔结构”(例如聚合物、金属或陶瓷材料的块等)，或者多孔的同种异体移植物。可以构思，对于一个或多个增大物可应用一种或多种“生物活性”处理(比如HA)。
应当理解，用于骨移除的非旋转装置可包括不同于拉刀和锉刀的器械。举例说来，骨凿(例如箱形骨凿)、冲头、切削片(例如往复式锯片或摆动式锯片)、压紧移植工具、柔性刀具(例如柔性铰刀或柔性钻具，其类似于用于将圆顶式螺钉通过髋臼帽插入的那些)、弯曲的锥子(例如来回旋转和用手摆动的装置)、手动铰刀、渐缩形铰刀、非渐缩形铰刀、非空心T形把手髓内装置(例如用于膝关节复位中的对准的Charnley锥或髓内杆)、弯曲的刮器、手持式圆锯、铰刀(中空的或非中空的)以及振动性刀具都可与拉刀和锉刀结合使用，或代替拉刀和锉刀使用。
因为某些外科医生可能发现难以定位管道11，所以夹具400可包括阵列和/或基准标记404，如图17中所示的那样，从而使其可在计算机辅助外科手术(CAS)系统(未显示)中用作外科器械。CAS系统用于有助于夹具400相对于髂骨10的空间定向，以便确保导杆22在髓内管11中的准确放置。一旦夹具400正确放置，就可将其销连到髂骨上(未显示销孔)或通过摩擦保持在合适位置，同时使导杆22通过入口402插入。入口402用作用于导杆的引导面，并且可包括缝隙、槽、滑动面或孔，只要入口402的大小和形状定制成用于与导杆22互补接合即可。应当注意，可构思用于导杆22和入口402的多种截面几何形状。还可构思入口402可等同地用作用于切削引导物(例如锉刀、拉刀、切削刀具、铣刀或铰刀)的引导。
或者，可使用夹具410，例如图18中所示的夹具。夹具410设置为用以将销或导杆22引导到髂骨管道11中。夹具410包括外伸支架装置412和底部部分416，在底部部分416中具有入口416。底部部分416被放置在髋臼12中(邻近上穹顶)。夹具414的顶部部分被放置在髂骨边缘上，在ASIS 19之后大约3cm，ASIS 19通常是IM管道11延伸的地方。
此外，CT扫描和手术前计算机建模方法可展现髂骨空隙11，可利用一个或多个用于固定的增大物60填充髂骨空隙11。使用传统的X射线或计算机层析成像(CT、MRI)方法来扫描患者。利用软件(例如Materialise的MIMICS)对扫描获得的数据(例如*.DICOM文件格式)进行预处理，并且然后上传至合适的建模软件(例如Unigraphics/NX、CATIA、AutoCAD、Pro/Engmeer、SolidWorks等等)，以便产生患者的髂骨10和/或髋臼区域12的3D数字CAD模型。测量和量化患者的髂骨管道11，并且可制造患者特定的增大物60以使最佳地适配患者。3D数字模型还可用来产生定制的患者特定的块420，其具有与患者的髋臼区域12的一部分的轮廓一致的表面426。所述患者特定的块420还包括入口428，其设置为用以将管道探寻销或杆22引导到髂骨管道中。成形的表面426用作用于使入口428相对于患者的骨10空间定位的装置，以用于管道探寻杆22的最佳定位。如上所述，还构思入口402可等同地用作用于切削引导物(例如锉刀、拉刀、切削刀具、铣刀或铰刀)的引导。
或者，可确定髂骨管道11用于放置管道探寻杆22而没有夹具20、400、410、420。这可通过沿着髂嵴摸索以找到髂骨管道11，从而找到从上髋臼12延伸至髂骨翼的髂骨10的较厚部分来实现，只要患者不是太肥胖即可。
如本文所述，可将髋臼植入物60压配合在髂骨管道11中。在某些情况下，发明者实际上已经将本发明缩减至可用印第安纳州华沙市Zimmer公司制造的#7小梁金属增大物来实践。然而，应当理解，可利用任何适合于植入到髂骨10的髓内管中的增大物60。应执行这样的试验，其利用具有与待植入的植入物60基本相似的大小和形状特征的试验性增大物(未显示)，从而确保良好的皮层接合和稳定性。
应当注意，该说明书中公开的方法提供了一种极其容易的方法来建立非常良好的固定和稳定的优良支持物，用以将保持架接合在增大物上。因为在利用本发明的手术期间不需要螺钉，所以可保持周围的骨的完整性，并减少手术时间。发明者已经观察到，使用本文所公开的增大物的髓内固定明显优于任何类型的螺钉固定。
因为在不脱离本发明的范围的情况下可对示例性实施例(如上面参考相应图示所述的那样)作出各种修改，所以，包含在前述描述中并在附图中显示的所有内容都意图被理解为说明性而非限制性的。例如，如果骨的质量不好，那么在拉削之前可能不需要插入导杆的步骤和/或铰孔的步骤。因此，本发明的广度和范围不应受任何上述示例性实施例的限制，而应当仅仅根据所附权利要求和其等同物来限定。

Claims (15)

1.一种用于在髂骨的髋臼中执行髋臼关节成形术的方法，包括下列步骤：
a)定位所述髂骨的髂骨管道，所述髂骨管道从所述髋臼的表面大体上朝髂嵴的一部分延伸；
b)压紧沿所述髂骨管道对准的非旋转的骨移除工具，从而使所述非旋转的骨移除工具移除所述髂骨管道内的骨并形成骨空隙；
c)将固定植入物固定在所述管道空隙中；以及
d)通过所述固定植入物将髋臼植入物安装在所述髋臼中。
2.根据权利要求1所述的方法，其特征在于，所述定位步骤包括使所述髂骨管道中空的步骤。
3.根据权利要求1或2中任一项所述的方法，其特征在于，所述定位步骤包括使管道探寻夹具定位在所述髂骨上。
4.根据权利要求3所述的方法，其特征在于，所述管道探寻夹具包括第一部分、第二部分和对准引导装置，所述使管道探寻夹具定位的步骤还包括下列步骤：使所述管道探寻夹具的第一部分靠着所述髋臼的一部分定位，以及使所述管道探寻夹具的第二部分靠着所述髂嵴的一部分定位，从而使所述对准引导装置沿所述髂骨管道的轴线对准。
5.根据权利要求1或2中任一项所述的方法，其特征在于，所述压紧步骤还包括在皮层骨附近产生骨空隙。
6.根据权利要求1或5中任一项所述的方法，其特征在于，所述压紧步骤还包括压紧多个非旋转的骨移除工具。
7.根据权利要求1或7中任一项所述的方法，其特征在于，所述压紧步骤还包括压紧多个不同大小的非旋转的骨移除工具。
8.根据权利要求1或6中任一项所述的方法，其特征在于，所述固定步骤还包括将所述固定植入物接合到所述管道空隙中的步骤。
9.根据权利要求1或8中任一项所述的方法，其特征在于，所述髋臼植入物是髋臼帽。
10.根据权利要求1或8中任一项所述的方法，其特征在于，所述髋臼构件是髋臼保持架。
11.一种用于髂骨管道的非旋转的骨移除工具，包括，
a)骨移除面，所述骨移除面设置为用以从所述髂骨管道中移除骨并形成骨空隙；和
b)定位部分，所述定位部分设置为用以将所述骨移除面定位在所述髂骨管道中；其中，所述骨移除面相对于所述定位部分设置为使得所述骨移除面在所述髂骨管道中产生骨空隙，从而使所述骨移除面邻接皮层骨。
12.根据权利要求11所述的非旋转的骨移除工具，其特征在于，所述定位部分是被设置为用以容纳套管的中空部分。
13.根据权利要求11或12中任一项所述的非旋转的骨移除工具，其特征在于，所述骨移除面自手术前图像形成。
14.根据权利要求11或13中任一项所述的非旋转的骨移除工具，其特征在于，所述骨移除面由多个部分形成，所述多个部分连接在一起从而形成不规则形状。
15.根据权利要求11或13中任一项所述的非旋转的骨移除工具，其特征在于，所述骨移除工具包括多个模块化的活动面，从而使每个模块化的活动面可单独地附连至所述非旋转的骨移除工具；所述骨空隙通过一系列压紧步骤中形成的所述多个模块化的活动面的组合而形成。
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