CN102300520A - 髂骨管道假体 - Google Patents
髂骨管道假体 Download PDFInfo
- Publication number
- CN102300520A CN102300520A CN2009801564117A CN200980156411A CN102300520A CN 102300520 A CN102300520 A CN 102300520A CN 2009801564117 A CN2009801564117 A CN 2009801564117A CN 200980156411 A CN200980156411 A CN 200980156411A CN 102300520 A CN102300520 A CN 102300520A
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- Prior art keywords
- thing
- increase
- acetabular
- cylindrical portion
- acetabular bone
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Abstract
一种用于髂骨的髂骨管道和髋臼中的移植的髋臼假体装置包括柱状部和髋臼构件。柱状部设置为用以被植入髂骨管道中。髋臼构件设置为用以被植入髋臼中并固定到柱状部上。髋臼构件还可包括连接部分以便将髋臼构件可调整地连接到柱状部上,从而使髋臼构件设置为在被固定至柱状部之前能定向在多个定向上。
Description
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
本发明大体上涉及固定髋臼植入物的方法,并且更具体而言涉及使用髂骨的管道将髋臼增大物(augment)单独地或结合髋臼壳体固定至髋部的装置和方法。
相关技术
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。图1显示了这种现有技术装置的一个示例。图1中所示的是全金属环形假体装置(900),其设置为用于安装在髂骨管道中。装置(900)通常包括其上具有螺纹(902)的柄部(901)、轴基部(903)、过渡区域(904)和支承帽(905),支承帽(905)具有内支承面(907)和边缘(906)。通常,装置(900)被构造为一个均质的整体式金属件,其没有给外科医生留下可调整性或材料选项。此外,一旦装置(900)的柄部(901)被固定到髂骨管道中,支承帽(905)、边缘(906)和支承面(907)相对于髂骨或髋臼的定向与柄部(901)同心地固定。因此,装置(900)的固定可能是以不提供最佳头部覆盖为代价的,最佳头部覆盖对于整个运动范围的稳定性是必需的。
图2a到图2d显示了安装所述环形假体装置(900)的方法步骤。首先,将安装在基部(920)上的管道引导装置(922)插入髋臼。将管道引导装置(922)插入髂骨的髓内管(即“髂骨管道”),并且然后留在髂骨管道内。其次,使空心铰刀(924)在管道引导装置(922)上滑动并铰大髂骨管道。然后将管道引导装置(922)和铰刀(924)从髂骨管道移除。第三,具有刃口(928)的截头圆锥形铰刀(926)在髋臼中扩出截头圆锥形沉头凹腔。沉头凹腔提供用于过渡区域(904)和支承帽(905)的间隙。最后,通过将装置(900)拧入髂骨管道而将环形假体装置(900)插入并固定到髂骨管道中。扭矩接合装置(930)设置在暴露的边缘(906)上或其附近。
图3a和图3b显示了现有技术的环形假体(950)的另一示例,其被称为非接合的聚乙烯附于金属上(UPM)髋部假体。UPM髋部假体(950)是图1中所示的全金属环形假体(900)的后续物,并且类似地利用髂骨管道以用于将髋臼支承面牢固地固定到骨盆的骨上。假体(950)包括连接支承帽(956)的截头圆锥形部分(954)。支承帽(956)具有通常半球形的支承面(955),并且截头圆锥形部分(954)具有偏心轴或偏置轴(952),其上具有凸起物。金属环(953)居中于槽(957)内以容许支承帽(956)的边缘在射线照片上可见。
假体(950)(例如图3a和图3b中所示的假体)通常由整块的超高分子量的聚乙烯形成,并且通常可被描述为一种偏置的圆锥形帽,其上安装有鳍状骨间钉。因为UPM假体(950)是偏心的,所以其依赖于压入精确铰孔的髋臼中的楔形压配合,而非同心地拧入髂骨管道中。
偏心的截头圆锥形部分(954)用于防止旋转,并且容许少量的倒转调整以用于更好的头部覆盖和稳定性。沿着截头圆锥形部分(954)的纵向轴线延伸的槽赋予额外的旋转稳定性。将假体(950)适配到穿过髂耻支持物的中心建立的铰出的轨道中,并且将帽冲压到合适位置。图3a和图3b中所示的髋臼假体(950)通常与环形或诺维奇型(Norwich-type)的非接合股骨构件结合使用。
图26显示了由Zimmer公司提供的现有技术的Trabecular MetalTM髋臼增大物(1000,1002,1004,1006)的一些示例。增大物由多孔的钽组成,并且在修正髋关节成形外科手术期间意图填充大的骨空隙,从而可获得髋臼帽的稳定性(未显示髋臼帽)。这些现有技术的增大物不具有设置为用于插入髂骨的髓内管中的突出部分。增大物还缺乏用于将该增大物安装至髂骨的髓内管的装置。根据本文展示的教导,即便使螺钉(未显示)通过设于某些增大物(1000,1002,1004)上的其中一个孔(1020)而插入髂骨的髓内管中,增大物也不会正确地承座在髋臼中,其将变得不稳定,并且不会如预期那样作用。最后,这些现有技术的增大物(1000,1002,1004,1006)没有像本发明的增大物那样被设计成或预期是模块化、可互换、可互连以及可调整的。
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。另外,所有设计为用以填充大的骨空隙的传统增大物都没有为外科医生提供使用髂骨管道作为在苛刻情况下提供假体支撑和指示正确定向的装置的选项。
此外,上述现有技术的髋臼假体(900,950)已经被设计用于并且只用于初次髋部外科手术(即首次髋部外科手术)。也就是说,这种利用髂骨管道以用于固定的现有技术装置并不意图解决许多特殊情况、相当大的骨损失、不良的骨质量,以及在复杂的修正髋部外科手术期间(即,在首次髋部外科手术之后的外科手术)外科医生面临的其它挑战。
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,提供了一种方法,其提供适合于在修正髋部外科手术中使用的髋臼植入物。该植入物包括设置为用于固定在髂骨管道内的柱状部分、壳体部分以及用于将所述壳体部分可调整地安装到所述柱状部分上的装置。
根据本发明的另一方面,提供了一种植入适合于在修正髋部外科手术中使用的髋臼植入物的方法。该方法包括下列步骤:找寻髂骨管道,铰大髂骨管道,将柱状部分插入准备好的髂骨管道中,以及使用用于可调整地安装的装置将壳体部分固定到柱状部分上。
根据还有另一方面,用于髂骨的髂骨管道和髋臼中的移植的髋臼假体装置包括柱状部和髋臼构件。柱状部可设置为用以被植入髂骨管道中。髋臼构件可设置为用以被植入髋臼中并固定到柱状部上。髋臼构件还可包括连接部分以便使髋臼构件可调整地连接到柱状部上,从而使髋臼构件设置为在固定至柱状部之前可定向在多个定向上。
本发明的还有另一方面设置为,连接部分可以是增大物。该增大物可设置为用以被容纳在柱状部与髋臼构件之间。增大物的第一表面可设置为使增大物相对于柱状部定向,并且增大物的第二表面可设置为使髋臼构件相对于柱状部定向。
根据另一方面,提供了多个增大物。该多个增大物的其中每一个可具有设置为使增大物相对于柱状部定向的第一表面以及设置为使髋臼构件相对于柱状部定向的增大物的第二表面,从而使该多个增大物的其中每一个将髋臼构件定向在与该多个增大物的至少一个其它增大物不同的定向上。
根据还有另一方面,连接部分可以是髋臼构件中的定位部分。
根据另一方面,连接部分可以是髋臼构件中的槽。该槽可具有多个位置,固定元件可通过该位置将髋臼构件固定到柱状部上。
根据另一方面,固定元件可以是螺钉。
根据还有另一方面,髋臼装置可以是髋臼壳体。
还有另一方面可提供第二增大物,其设置为用以被容纳在增大物与髋臼构件之间,从而使第二增大物填充增大物与髋臼构件之间的骨空隙。
根据另一方面,增大物和柱状部通过渐缩锁定而固定在一起。
根据还有另一方面,增大物还包括骨固定元件以便将增大物固定到骨上。
还有另一方面可提供销钉作为骨固定元件。
另一方面提供了将髋臼假体装置植入髋臼中的方法。该方法铰大髂骨管道。另一步骤将柱状部固定在髂骨管道内。另一步骤将髋臼构件可调整地定位在髋臼中以确定髋臼构件的合适定向。髋臼构件可被固定到柱状部上。
根据另一方面,定位髂骨管道的步骤可利用管道引导装置来执行。
根据还有另一方面,铰孔步骤包括通过使铰刀在管道引导装置上前进而铰大髂骨管道。
还有另一方面可提供可调整地定位的步骤,其包括将增大物放置在柱状部与髋臼构件之间。增大物的第一表面可设置为使增大物相对于柱状部定向,并且增大物的第二表面可设置为使髋臼构件相对于柱状部定向。
根据另一方面,可调整地定位的步骤还可包括从多个增大物中选择增大物。所述多个增大物的其中每一个可具有设置为使增大物相对于柱状部定向的第一表面以及设置为使髋臼构件相对于柱状部定向的增大物的第二表面,从而使该多个增大物的其中每一个将髋臼构件定向在与该多个增大物的至少一个其它增大物不同的定向上。
还有另一方面可包括将增大物固定到骨上的步骤。
根据另一方面,增大物可设有骨钉。
根据还有另一方面,可调整地定位的步骤还可包括,通过柱状部使髋臼构件的定位部分定向,以及将髋臼构件固定到柱状部上。
根据另一方面,将髋臼构件固定到柱状部上的步骤可包括将髋臼构件拧紧到柱状部上。
本发明可适用的其它领域将从后文所提供的详细描述变得显而易见。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1是现有技术的全金属环形假体的正视图;
图2a至图2d显示了安装图1的假体的方法;
图3a至图3b是现有技术的非接合的聚乙烯附于金属上(UPM)髋部假体的正视图;
图4是根据本发明的一个实施例的髋臼假体的正视图;
图5a至图5f描绘了根据本发明的某些实施例的柱状部分。
图6a至图6d显示了根据本发明的某些实施例的柱状部分末端;
图7是根据本发明的某些实施例的多孔柱状部分的侧视图;
图8a至图8d显示了根据本发明的某些实施例的柱状增大物,其具有不同的偏心率和偏置;
图9a至图9f显示了根据本发明的某些实施例的柱状增大物构造;
图9g至图9i显示了根据本发明的某些实施例的与楔形物、衬垫以及其它增大物相结合的柱状增大物。
图10显示了根据本发明的某些实施例的接合的髋臼假体;
图11显示了根据本发明的某些其它实施例的接合的髋臼假体;
图12显示了根据本发明的其它实施例的接合的髋臼假体;
图13显示了根据本发明的还有其它实施例的接合的髋臼假体;
图14显示了根据本发明的某些实施例的无接合剂的髋臼假体;
图15显示了根据本发明的其它实施例的无接合剂的髋臼假体;
图16显示了根据本发明的还有其它实施例的无接合剂的髋臼假体;
图17至图19显示了根据本发明的实施例的无接合剂的髋臼假体,其利用轨道系统以用于可调整安装;
图20是显示安装根据本发明的髋臼假体的某些外科技术方法步骤的示意性流程图。
图21显示了通过横向螺钉连接到L形同种异体移植物上的无接合剂的髋臼假体,该横向螺钉可目标性地固定到所述假体的柱状部分上。
图22显示了均质的整体式多孔增大物,其具有适合于插入并固定到髂骨的髓内管中的突出部。
图23显示了根据本发明的增大物,其设有用于钉入或螺旋安装到髂骨的髓内管中的装置。
图24显示了与图23中所示的增大物相似的增大物,但其具有突出部以用于填充围绕髂骨的髓内管的入口的空隙。
图25显示了与图23中所示的增大物相似的增大物,其能够在固定装置(例如栓或螺钉)被插入髂骨的髓内管之后安装到髋臼上。
图26显示了由Zimmer公司提供的现有技术的髋臼增大物的某些示例,其不具有设置为用于插入髂骨的髓内管中的突出部分,并且其不具有用于插入螺钉的装置或用于安装至髂骨的髓内管的装置。
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。
本发明部分地提供了一种利用髂骨管道作为稳定的锚固物和用于指示正确定向的装置来重建髋臼区域的方法。有时候患者的髋臼区域可能被损坏到不能识别的程度。本发明的方法利用髂骨管道作为完好、可重复发现、易于定位的解剖标志,其即使在严重的外伤或修复情况下也可以相对高的可信度用作锚固支撑物以及用作定向和安装髋臼壳体的装置。柱状部分被插入髂骨管道中,基本上形成用于构建失去或受损的骨的“基础”。可使用一系列楔形物、衬垫和增大物来构建所述失去或受损的骨和提供一种髋臼壳体,该髋臼壳体是在另外产生不良固定和初始稳定性的情况下用于固定的改进的装置。
优选的是利用无接合剂选项,然而,本发明的髋臼植入物可包括接合选项。
图4显示了根据本发明的一个实施例的髋臼假体(1)。假体(1)可包括柱状部分(10)、第一增大物部分(20)、第二增大物部分(30)和壳体部分(40)。柱状部分(10)可具有外柄部部分(12)、顶端部分(18)、阳式或阴式渐缩形柱状部分(16),以及位于所述阳式或阴式渐缩形柱状部分(16)的会聚端的渐缩形末端(14)。第一增大物部分(20)可包括相应的阳式或阴式渐缩形增大物部分(26),其与所述阳式或阴式渐缩形柱状部分(16)相对应并互锁。第一增大物部分(20)包括柱状部侧表面几何形状(22)、壳体侧表面几何形状(24)和周边几何形状(28),其根据需要可以是简单的或复杂的以便最佳地适配预定患者群体或个别患者。可选的第二增大物部分(30)也具有柱状部侧表面几何形状(32)、壳体侧表面几何形状(34)以及周边几何形状(38),其可结合所述第二增大物部分(20)使用以增加壳体(40)的偏置,或者提供间隙空间填充物,从而减少在壳体(40)和柱状部(10)之间使用的用以固定壳体(40)的接合剂的量。壳体(40)包括外部几何形状(42)和内部几何形状(44)。内部几何形状(44)可以是用于与自然或人造股骨头部构件联接的支承面,或者其可设置为用以容纳与自然或人造股骨头部构件联接的衬里。外部几何形状(42)可以是根据需要的简单或复杂的任何几何形状以便最佳地适配预定患者群体或个别患者,但其优选地通过半球形多孔结构形成。
图5a至图5f显示了用于本发明的范围内的外柄部部分(12)的若干选项。图5a显示了适合于接合到髂骨管道中的平滑的外柄部部分(12a)。图5b显示了带槽的外柄部部分(12b),其适合于防止柱状部(10)在髂骨管道内旋转并为柱状部(10)提供一定量的柔性。图5c显示了柱状部(10)的外柄部部分(12c),其上包括羟磷灰石、BMP、抗菌剂-浸泡的羟磷灰石、镇痛剂的其中任何一种,或者其它涂层。图5d显示了具有外柄部部分(12d)的柱状部分(10),该外柄部部分(12d)包括多孔支架,例如钛泡沫、多孔陶瓷(例如羟磷灰石)、烧结的珠状物、烧结的非对称颗粒等等。图5e显示了柱状部(10)的外柄部部分(12e),其包括螺钉固定装置,例如自攻螺纹牙形(self-threading profile)。图5f显示了用方头螺钉(12f)固定至髂骨的髓内管的柱状部(10)。
图6a至图6d显示了根据本发明的范围内的若干不同实施例的柱状部顶端。柱状部(10)的端部可以是如图6a中所示的子弹形状、如图6b中所示的锥形形状、如图6c中所示的圆柱形形状,或者如图6d中所示的双分叉形状以减少疼痛。柱状部(10)可以在轮廓上为阶梯状或带倒角的,并且可包括图5a至图7中所示的特征的组合。
图7显示了模块化的柱状部,其包括至少第一柱状部分(10’)和第二柱状部分(10”)。第一柱状部分(10’)可以是例如整形的多孔增大物。第二柱状部分(10”)可以是例如其上具有阳式渐缩形部分(16”)的实心帽,其设置为用以与第一增大物部分(20)或第二增大物部分(30)相配合。如果第一柱状部分(10’)由低强度的多孔结构形成,那么其可使其空心以容纳与第二柱状部分(10”)集成整体或分开的芯部,以便增加模块化柱状部的整体强度。
图8a至图8d显示了不同的第一增大物部分(20)的构造。增大物部分(20)可设有阳式或阴式渐缩形增大物部分(26a,26b,26c,26d),其设计为用以与相应的阳式或阴式渐缩形柱状部分(16)协作和互锁。阳式或阴式渐缩形增大物部分(26a)可如图8a中所示是同心的,或者阳式或阴式渐缩形增大物部分(26b)可如图8b中所示是偏心的。或者,阳式或阴式渐缩形增大物部分(26c)可如图8c中所示是居中附连并且倾斜的,或者阳式或阴式渐缩形增大物部分(26d)可如图8d中所示是偏心并且倾斜的。通过改变阳式或阴式渐缩形增大物部分(26a,26b,26c,26d)的构造,可增加外科手术进行时的可调整性。
如图8a至图8d中所示,本发明的增大物(20)可包括偏置以及不同的壳体侧几何形状(24,27)。壳体侧几何形状可较大弯曲(27,27’,27”)或较少弯曲(24,24’,24”)。增大物部分(20)还可包括不同的壳体侧几何形状偏置。例如,壳体侧几何形状可包括标准偏置(24)、中间偏置(24’)和/或高的偏置(24”)。
图9a至图9f显示了根据本发明的某些实施例的增大物构造。增大物(20)可设置为单个均质的金属、陶瓷或聚合物件,其具有如图9a中所示的平滑表面(29a),或者增大物(20)可包括两个压配在一起的件。如图9b中所示,在围绕阳式或阴式渐缩形增大物部分(26a,26b,26c,26d)的一个或多个区域中,可将涂层(29b)或类似物(例如羟磷灰石、骨接合剂或骨空隙填料)应用到增大物(20)的外部。或者,多孔结构(29c)可形成为所述增大物(20)的一部分。在本发明的增大物(20)中可形成孔(25a-i),以便将所述增大物(20)固定到周围的骨上,以及相对于柱状部分(10)的定向锁定增大物(20)的径向定向。
图9g至图9i显示了根据本发明的某些实施例的与楔形物和衬垫相结合的增大物。一系列楔形物(100)或偏置衬垫(102)可用于“构建”较大的骨部分已受损的髋臼区域。整形的或特别的楔形物(104)可用于引导到髋臼壳体上的安装。半球形的偏置衬垫(106,108)还可用于将髋臼壳体(40)可调整地安装到柱状部分(10)上。可在楔形物(100,104)、增大物(20,30)和衬垫(102,106,108)上可选地利用一个或多个销钉(25j),以便有助于骨的固定,防止旋转,和有助于在所述增大物、衬垫和楔形物之间产生稳定性。
图10显示了根据本发明的某些实施例的接合的髋臼假体(1)。假体(1)包括柱状部分(10)、第一增大物部分(20)、第二增大物部分(30)和壳体部分(40)。第一增大物部分(20)设置为用以与柱状部分(10)一起形成渐缩锁定的连接。可选的用于固定的第一装置(50)(例如具有埋头头部(53)和螺纹轴(51)的螺钉)可通过第一增大物部分(20)中的孔(21)而插入并且进入柱状部分(10)中的螺纹孔(11)内。孔(21)可具有埋头孔(23),其适于容纳所述可选的用于固定的第一装置(50)的一部分(53)。可选地,用于固定的第二装置(例如紧固螺钉(60))可插入通过第一增大物部分(20)中的孔(25),以便将第一增大物部分(20)固定到周围的骨上,以及防止第一增大物部分(20)相对于柱状部分(10)的旋转。
第二增大物部分(30)可用于使髋臼壳体(40)进一步自柱状部(10)间隔开。第二增大物部分(30)优选地具有形成合适大小和形状的外围轮廓(38),从而容许其柱状部侧的面(32)与第一增大物部分(20)相接触。
图11显示了与图10中所示相似的接合的髋臼假体;然而,第二增大物部分(30)并不利用可选的用于固定的第二装置(60)将第二增大物部分(30)固定到第一增大物部分(20)上。替代地,用于固定的第一装置(50)伸出穿过第二增大物部分(30)中的其中至少一个渐缩形孔(33)。所述用于固定的第一装置(50)伸出穿过第一增大物部分(20)中的间隙孔(21)并进入柱状部分(10)中的螺纹孔(11)。用于固定的第一装置(50)的埋头头部(53)在第二增大物部分(30)的壳体侧表面(34)下方靠置在该其中至少一个渐缩形孔(33)内。通过与不同孔(33)一起利用用于固定的装置(50)可实现不同的假体构造。
图12显示了根据本发明的其它实施例的接合的髋臼假体。图12中所示的假体(1)类似于图10和图11中所示的那些,除了不利用第二增大物部分(30)之外。替代地,第一增大物部分(20)的壳体侧表面(24)用作用于第一增大物部分(20)与壳体部分(40)之间的接合剂储器(70)的接合剂坝。因为第一增大物部分刚性地固定至柱状部分(10),并且壳体(40)被接合至第一增大物部分(20),所以所有部分(10,20,40)都彼此刚性地固定。接合剂储器(70)提供了这样一种装置,其可单独地调整壳体部分(40)的位置和定向,同时仍然利用第一增大物部分(20)的稳定平台和柱状部分(10)的稳定基础。
图13显示了根据本发明的还有其它实施例的接合的髋臼假体。柱状部分(10)具有带螺纹的外轮廓(12e),其用作用于将所述柱状部分(10)固定至准备好或未准备好的髂骨管道的装置。柱状部分包括阳式或阴式渐缩形部分(16),其与第一增大物部分(20)上的阳式或阴式渐缩形部分(26)相配合并渐缩锁定。第一增大物部分具有壳体侧表面(24),其用作用于接合剂储器(70)的接合剂坝,接合剂储器(70)将髋臼壳体部分(40)联接到第一增大物部分(20)上。柱状部分(10)、第一增大物部分(20)和壳体部分(40)中的每一个牢固地固定在一起,并且直接或间接地锚定到髂骨管道上以改善稳定性。在固化之前,接合剂储器(70)提供一种将壳体部分(40)可调整地安装到假体(1)的剩余部分以及周围的骨上的装置。
图14显示了根据本发明的某些实施例的无接合剂的髋臼假体。假体(1)非常类似于图11中所示的假体。然而,第二增大物部分(30)由聚合材料(例如聚醚醚酮、超高分子量聚乙烯、聚乙烯、聚氨酯等等)形成,并且,第一增大物部分(20)包括偏心并倾斜的渐缩形部分(26)。用于固定的装置(50)包括用于调整的装置(53),其设置为用以将柱状部分(10)、第一增大物部分(20)和第二增大物部分(30)固定在一起,同时提供柱状部分(10)与第一增大物部分(20)之间无限旋转的可调整性,以及在预定范围内的第一增大物部分(20)与第二增大物部分(30)之间无限切向运动和无限旋转的可调整性。髋臼壳体部分(40)具有安装孔(45)以及用于将髋臼壳体部分(40)固定到第二增大物部分(30)上的装置(80)。所述用于固定的装置(80)可包括自攻自断螺钉,其设计成可直接自攻到聚合物的第二增大物部分(30)中。在一个优选实施例中,第一增大物部分(20)和第二增大物部分(30)通过连接手段组合成单个预组装的增大物件。连接手段可为可拆卸的并且包括可调整的连杆、卡扣机构或机械互锁装置。或者,连接手段可为不可拆卸的并且包括机械熔合、化学联接、熔合模制或粘接。虽然可选择任何材料,但是优选地,第一增大物部分(20)由金属材料制成,并且第二增大物部分(30)由聚合物制成。
图15显示了根据本发明的其它实施例的无接合剂的髋臼假体。第二增大物部分(20)被整形为具有面向壳体的表面(24),该表面(24)与髋臼壳体部分(40)的外表面(42)一致。提供了用于将髋臼壳体部分(40)固定到第一增大物部分(20)上的装置(80)。所述装置(80)可为例如螺钉或栓,其适合于穿过壳体部分(40)中的孔(45),并且直接拧入第一增大物部分(20)的材料中。第一增大物部分(20)可包括聚合材料、金属材料或陶瓷材料,并且可包括或可不包括多孔部分。用于第一增大物部分(20)的材料可包括(但不限于)多孔的羟磷灰石(HA)、多孔的钛以及多孔的钽。可选的用于固定的第一装置(50)可包括埋头头部(53),其靠置在所述面向壳体的表面(24)下。
图16显示了根据本发明的还有其它实施例的无接合剂的髋臼假体。柱状部分(10)包括整体的凸缘部分(19)以及一个或多个可选的用于固定的第二装置(60)(例如一个或多个皮层骨螺钉或松质骨螺钉或一个或多个整体式销钉(60’))。第一增大物部分(20)包括大体上半球形的增大物,其具有一个或多个定向或固定突出物(22a)。突出物(22a)设置为用以适配到一个或多个位于柱状部分(10)的部分上(例如邻近凸缘部分(19))的互补的凹部(17)中。如果具有的凹部(17)比具有的突出物(22a)更多,那么第一增大物部分(20)可相对于柱状部分(10)以多种方式就位、定位、定向和固定。可选的第二固定装置(60)可用于将第一增大物部分(20)固定到周围的骨上,并且还将第一增大物(20)的柱状部侧表面(22)压靠在柱状部分(10)和/或凸缘部分(19)的壳体侧表面上。第一增大物部分(20)的壳体侧表面(24)可设置为与髋臼壳体部分(40)的外部几何形状(42)一致。用于固定所述壳体部分(40)的装置(80)可被用来将壳体部分(40)固定到第一增大物部分(20)上或周围的骨上。例如,并且无限制性,如果第一增大物部分由多孔金属制成,那么在第一增大物部分(30)中将钻出与壳体部分(40)中得到的安装孔(45)对准的孔(未显示),并且然后将装置(80)拧入所述孔(未显示)中。或者,如果第一增大物部分(20)由聚合材料(例如聚醚醚酮)制成,并且装置(80)包括自攻自段螺纹的螺钉,那么所述装置(80)可直接拧入第一增大物部分(20)的材料中,以便将壳体部分(40)固定到第一增大物部分(30)上而不钻孔。
图17至图19显示了根据本发明的实施例的无接合剂的髋臼假体(1),其利用了定位部分,该定位部分可包括与用于将第一增大物部分(20)固定到柱状部分(10)上的装置(50)结合的可调整的轨道(27,29)。定位部分(27,29)包括对于所述用于固定的装置(50)的头部部分(53)而言足够大的埋头孔(27)。轨道(27,29)还包括由一系列切口(29)组成的槽以用于使所述装置(50)的螺纹柄部(51)通过。用于固定的装置(50)例如可包括螺钉,该螺钉可从柱状部分(10)中的螺纹孔(11)松开。当所述螺钉(50)松开时,第一增大物部分(20)可在与所述轨道(27,29)的几何形状相对应的不同方向(90,92)上移动。当确定第一增大物部分(20)相对于柱状部分(10)的预期位置时,将螺钉(50)拧紧从而使其头部(53)靠置在其中一个所述切口(29)中。摩擦力将第一增大物部分(20)保持到柱状部分(10)上。之后,可通过上面的实施例中任一个所述的装置(80)将髋臼壳体部分(40)附连到第一增大物部分(20)上。
图20是显示用于安装根据本发明的某些实施例的髋臼假体的某些外科技术方法步骤(200)的示意性流程图。首先,使用管道引导工具或类似物找到髂骨管道(202)。其次,铰大髂骨管道(206)以容纳所使用的柱状部分(10)的大小。铰孔步骤可利用在管道导向装置(204)上滑动的空心铰刀。然后将所有器械(即管道引导装置和/或与之相关联的铰刀)从准备好的髂骨管道(208,214)移除。根据增大物的形状和构造以及存在的骨缺陷可进行二次铰孔或切除(210,212)。然后以任何方便的方式将柱状部分(10)插入并固定至髂骨管道(216),从而形成可在其上利用增大物、垫片和楔形物执行髋臼重建的“基础”。然后将一个或多个增大物和/或其它中间部件在预定位置放置在髋臼区域中(218),从而形成靠置在所述柱状部分(10)上的平台——从而提供基底基础以用于供其它增大物、衬垫、楔形物和/或接合剂储器(70)靠置和固定(220)。还可实施其它髋臼准备步骤,例如铰孔以用于壳体压配合和自体移植充填。最后,将壳体部件(40)附连到一个或多个增大物和/或中间部件上(222)。增大物和/或中间部件用作使用位于髂骨管道(504)中的柱状部(10)以用于将支承面可调整地固定到髋臼上的装置,柱状部(10)用作支撑和/或定向部件。
图21显示了通过固定到所述假体(300)的柱状部分(316)上的横向螺钉(318)连接至同种异体移植物(320)的无接合剂的髋臼假体(300)。同种异体移植物(320)可以是L形的并且可作为医用产品而提供,或者其可通过对切除的股骨头部(302)的部分整形而在外科手术进行时提供。假体(300)包括壳体增大物部分(310),其具有适合于靠置在髂骨(500)内的髋臼空腔(502)上的外表面。增大物部分(310)的内表面(308)适合于与第二壳体或衬里形成接合剂覆盖接合(mantle interface)或非接合的摩擦干涉。或者,内表面(308)设有支承面以便与自然的或修复的股骨头部(未显示)进行接触。内表面(308)可适合于经由用于摩擦接触的粗糙面、机械互锁装置或接合剂的其中任何一项或多项而将一个或多个额外的多孔或实心的增大物固定到其上。第二固定装置(314)可用来改善假体(300)的稳定性。优选地,准备髂骨(500)的髓内管(504),并且然后在其中插入柱状部分(316)。增大物部分(310)位于髋臼空腔(502)中,并且然后经由连接部分(312)锁定到柱状部分(316)上。连接部分(312)可包括莫氏渐缩锁定(Morse taper lock)或任何其它已知的锁定装置,例如螺纹连接、螺钉、卡环、球式棘爪或弹性卡指。柱状部分(316)可设有用于附连L形同种异体移植物(320)的装置,例如用于插入克氏针的螺纹孔或孔口。
图22显示了包括均质的整体式多孔增大物(410)的无接合剂的髋臼假体(400),该增大物(410)具有适合于插入固定在髂骨(500)的髓内管(504)中的突出部(416)。突出部(416)可根据缺陷的严重性或髓内管(504)的大小而具有不同的形状和长度。增大物(410)可由网状泡沫结构、烧结的珠状物以及烧结的非对称颗粒的其中任何一种形成(无限制性),并且可包括钛、钽、锆、生物陶瓷(多孔的羟磷灰石)、聚合物(例如聚醚醚酮、超高分子量聚乙烯)、生物相容材料,以及其组合。
髂骨(500)的髓内管(504)优选地在插入增大物(410)之前准备好;然而,这个步骤可以不是必需的。除了突出部(416)之外,可使用一个或多个第二固定装置(412,414)将增大物(410)固定到髋臼骨(502)上。增大物(410)的内表面部分(408)适合于与第二壳体或衬里形成接合剂覆盖接合或非接合的摩擦干涉。或者,内表面(308)可设有单独的支承面,以便与自然的或修复的股骨头部(未显示)进行接触。内表面(308)还可适合于经由用于摩擦接触的粗糙面、机械互锁装置或接合剂的其中任何一项或多项而将一个或多个额外的多孔或实心的增大物固定到其上。
图23显示了根据本发明的某些实施例的非接合的假体(600)。假体(600)包括多孔的增大物(610),其适合于填充髋臼区域(502)中的骨空隙。增大物(610)包括内表面部分(608),其适合于与第二壳体或衬里形成接合剂联接或非接合的摩擦干涉。或者,内表面部分(608)可设有单独的支承面以便与自然的或修复的股骨头部(未显示)进行接触。内表面部分(608)还可适合于经由用于摩擦接触的粗糙面、机械互锁装置或接合剂的其中任何一项或多项而将一个或多个额外的多孔或实心的增大物固定到其上。
多孔增大物(610)包括用于将其自身安装到髂骨(500)的髓内管(504)上的装置。用于安装的装置可包括例如孔或通道(612),该孔或通道(612)具有埋头孔并且被合适地定向,从而使得当增大物(610)完全地承座在髋臼空腔(502)中时,栓或螺钉(616)可插入增大物(610)并到髂骨(500)的髓内管(504)中,从而将增大物(610)固定地固定到髋臼(502)上。可使用第二固定装置(614,620)以用于额外的增大物稳定性。一旦植入非接合的假体(600),可使用摩擦、接合剂或螺钉将髋臼帽假体(未显示)安装至内表面部分(608)。
在某些实施例(例如图24中所示的实施例)中,无接合剂的假体(700)可包括多孔的增大物(710),其具有内表面(708)和设置为用于与髋臼骨(502)形成摩擦接合的外表面。增大物(710)可包括突出部(720),突出部(720)围绕髂骨(500)的髓内管(504)的入口部分延伸。突出部(720)可包括一个或多个用于使固定装置(716)固定到其上的装置(712)。固定装置(716)可以是螺钉、栓、杆或可拆卸的柱状部分(无限制性)。固定装置(716)被插入髂骨(500)的髓内管(504)中以便使增大物(710)定向和固定在髋臼(502)中。可利用用于固定的第二装置(714)来得到更大的稳定性。应当注意,内表面部分(708)可适合于经由用于摩擦接触的粗糙面、机械互锁装置或接合剂的其中任何一项或多项而将一个或多个额外的多孔或实心的增大物固定到其上。或者,内表面部分(708)可设有用于与自然股骨头部或股骨头部植入构件(未显示)联接的支承面。
在某些实施例(例如图25中所示的实施例)中,可能需要在附连增大物(810,810’)之前将用于固定的装置(816)(例如杆、栓或螺钉)固定到髓内管(504)。在这种情况下,用于固定的装置(816)可部分地插入到髂骨(500)的髓内管(504)中,以容许用于使增大物(810,810’)从中间、侧面、前面、后面或下面的侧引入的空间。一旦增大物(810,810’)被合适地定位,那么可将用于固定的装置(816)完全插入髓内管(504)以便将增大物(810,810’)拧紧到髋臼空腔(502)上。在所示的实施例中,增大物(810,810’)经由孔或槽(806,806’)中的埋头孔或支架保持靠着髋臼(502)。在增大物(810,810’)上可提供第二固定装置(804,804’)以便使增大物(810,810’)更好地固定到髋臼空腔(502)上。例如,第二固定装置(804,804’)可以是设置为用以容纳栓或骨螺钉的孔或槽。
应当注意,本文公开的植入物和假体的任何部分可作为用于试验性复位的试验性构件和器械而形成。在某些情况下,增大物可设置为使用机械互锁装置卡扣在一起。
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。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 (20)
1.一种用于髂骨的髂骨管道和髋臼中的移植的髋臼假体装置,包括:
a)柱状部,所述柱状部设置为用以被植入所述髂骨管道中;和
b)髋臼构件,所述髋臼构件设置为用以被植入所述髋臼中并固定到所述柱状部上,所述髋臼构件还包括连接部分以便将所述髋臼构件可调整地连接到所述柱状部上,从而使所述髋臼构件设置为在固定至所述柱状部之前能定向在多个方向上。
2.根据权利要求1所述的髋臼假体装置,其特征在于,所述连接部分是增大物,所述增大物设置为用以被容纳在所述柱状部与所述髋臼构件之间,所述增大物的第一表面设置为使所述增大物相对于所述柱状部定向,并且所述增大物的第二表面设置为使所述髋臼构件相对于所述柱状部定向。
3.根据权利要求1或2中任一项所述的髋臼假体装置,其特征在于,还包括多个增大物,所述多个增大物的其中每一个具有设置为使所述增大物相对于所述柱状部定向的第一表面以及设置为使所述髋臼构件相对于所述柱状部定向的第二表面,从而使所述多个增大物的其中每一个将所述髋臼构件定向在与所述多个增大物的至少一个其它增大物不同的定向上。
4.根据权利要求1所述的髋臼假体装置,其特征在于,所述连接部分是所述髋臼构件中的定位部分。
5.根据权利要求1或4中任一项所述的髋臼假体装置,其特征在于,所述连接部分是所述髋臼构件中的槽,所述槽具有多个位置,固定元件可通过所述位置将所述髋臼构件固定到所述柱状部上。
6.根据权利要求5所述的髋臼假体装置,其特征在于,所述固定元件是螺钉。
7.根据权利要求1或3中任一项所述的髋臼假体装置,其特征在于,所述髋臼装置是髋臼壳体。
8.根据权利要求2或3中任一项所述的髋臼假体装置,其特征在于,还包括第二增大物,所述第二增大物设置为用以被容纳在所述增大物与所述髋臼构件之间,从而使所述第二增大物填充所述增大物与所述髋臼构件之间的骨空隙。
9.根据权利要求2或8中任一项所述的髋臼假体装置,其特征在于,所述增大物和所述柱状部通过渐缩锁定而固定在一起。
10.根据权利要求2或8中任一项所述的髋臼假体装置,其特征在于,所述增大物还包括骨固定元件以便将所述增大物固定到骨上。
11.根据权利要求10所述的髋臼假体装置,其特征在于,所述骨固定元件是销钉。
12.一种将髋臼假体装置植入髋臼中的方法,包括下列步骤:
a)铰大髂骨管道;
b)将柱状部固定在所述髂骨管道内;
c)将髋臼构件可调整地定位在所述髋臼中以确定所述髋臼构件的合适定向;以及
d)将所述髋臼构件固定到所述柱状部上。
13.根据权利要求12所述的方法,其特征在于,还包括通过管道引导装置定位所述髂骨管道的步骤。
14.根据权利要求13所述的方法,其特征在于,所述铰孔步骤包括通过使铰刀在所述管道引导装置上前进而铰大所述髂骨管道。
15.根据权利要求12或14中任一项所述的方法,其特征在于,所述可调整地定位的步骤包括将增大物放置在所述柱状部与所述髋臼构件之间,所述增大物的第一表面设置为使所述增大物相对于所述柱状部定向,并且所述增大物的第二表面设置为使所述髋臼构件相对于所述柱状部定向。
16.根据权利要求15所述的方法,其特征在于,所述可调整地定位的步骤还包括从多个增大物中选择一个增大物,所述多个增大物的其中每一个具有设置为使所述增大物相对于所述柱状部定向的第一表面以及设置为使所述髋臼构件相对于所述柱状部定向的所述增大物的第二表面,从而使所述多个增大物的其中每个增大物将所述髋臼构件定向在与所述多个增大物的至少一个其它增大物不同的定向上。
17.根据权利要求15所述的方法,其特征在于,还包括将所述增大物固定到骨上的步骤。
18.根据权利要求17所述的方法,其特征在于,所述增大物设有骨钉。
19.根据权利要求12或14中任一项所述的方法,其特征在于,所述可调整地定位的步骤还包括:
a)通过所述柱状部使所述髋臼构件的定位部分定向;以及
b)将所述髋臼构件固定到所述柱状部上。
20.根据权利要求19所述的方法,其特征在于,将所述髋臼构件固定到所述柱状部上的步骤包括将所述髋臼构件拧紧到所述柱状部上。
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