CN105167888A - 用于fai手术的方法和设备 - Google Patents
用于fai手术的方法和设备 Download PDFInfo
- Publication number
- CN105167888A CN105167888A CN201510754179.4A CN201510754179A CN105167888A CN 105167888 A CN105167888 A CN 105167888A CN 201510754179 A CN201510754179 A CN 201510754179A CN 105167888 A CN105167888 A CN 105167888A
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- Prior art keywords
- implant
- bone
- acetabular bone
- view
- acetabular
- Prior art date
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- A61F2250/0018—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
Abstract
本发明公开了用于FAI手术的方法和设备。一种用于盆骨中的髋臼的部分边缘植入物包括脊状部、支承表面和固定表面。脊状部被定向为替换盂唇。支承表面被构造为与髋臼的关节表面对准。支承表面从脊状部朝着髋臼的顶点延伸。固定表面被构造为将植入物固定于盆骨的经制备的骨头表面。
Description
本发明为分案申请,其母案的申请号为201080017951.X,申请日为2010年2月25日且发明名称为“用于FAI手术的方法和设备”。
相关申请的交叉引用
本申请要求2009年2月24日提交的美国临时申请No.61/155,060的权益。该申请的公开内容整体地通过引用并入。
技术领域
本发明一般地涉及髋关节手术,并且更特别地涉及用于治疗股骨髋臼撞击症的手术方法、工具和植入物。
背景技术
股骨髋臼撞击症或称FAI是髋关节的疾病,其中,股骨头和髋臼异常地摩擦,对髋关节造成损伤。可能对股骨头或髋臼的关节软骨或对在髋臼边缘上或周围的盂唇软骨造成损伤。
具体地,FAI可以采取两种形式中的一个:凸轮或钳状物。两种形式之间的差别由作为损伤起因的髋关节的异常确定。FAI的凸轮形式在股骨头和颈的关系是非球面的或不是完美的圆形时发生。此圆度的损失促成了头和关节窝之间的异常接触。钳状物形式在髋臼过多地覆盖股骨头时发生。此过度覆盖通常沿着髋臼的正面顶部边缘存在,并导致盂唇软骨被“钳”在关节窝的边缘与前股骨头-颈结合部之间。在大多数情况下,凸轮和钳状物形式一起存在(因此产生FAI的复合形式)。
可以用手术介入来实现FAI的治疗。通过关节镜检查,可以仔细检查髋关节以评估髋关节并治疗通过两个至四个1cm切口所发现的损伤。通过关节镜检查,常常能够治疗FAI的所有组成部分,诸如盂唇损伤、受损软骨以及球与关节窝之间的摩擦。修复可以包括清创术、微裂逢技术、盂唇修复以及骨减压。必须小心防止在骨整形术程序期间损坏髋关节的血液供应。
开放手术技术要求通过切口(约6至10英寸)进行髋关节脱臼。上股骨截骨术允许股骨头从关节窝的脱臼,使关节的所有部分暴露。此暴露允许治疗球与关节窝之间的异常接触和盂唇损伤,而同时保护到髋关节的血液供应。在这两种类型的治疗中,采用骨头去除和修复来解决FAI。
发明内容
鉴于上述内容开发了本发明。在本发明的一个实施例中,用于盆骨中的髋臼的部分边缘植入物包括脊状部、支承表面和固定表面。脊状部被定向为替换盂唇(labrum)。支承表面被构造为与髋臼的关节表面对准。支承表面从脊状部朝着髋臼的顶点延伸。固定表面被构造为将植入物固定于盆骨的经制备的骨头表面。
在本发明的另一方面,固定表面通常垂直于髋臼的关节表面。
在本发明的另一方面,髋臼的顶点具有朝着由髋臼的边缘限定的平面延伸的中心轴线,还包括从固定部分延伸至脊状部的边缘部分,该边缘部分确定脊状部的方向。
另一实施例提供由第一柔顺材料和第二较硬材料制成的植入物。
在另一实施例中,植入物的脊状部由第一柔顺材料制成。
在另一实施例中,所述固定表面由第一柔顺材料制成。
另一实施例包括大体上垂直地从支承表面延伸的插入部分和从植入物的边缘部分延伸的固定凸缘。所述插入部分和所述凸缘部分随着凸缘部分和插入部分远离髋臼延伸而朝着彼此会聚。
在另一实施例中,髋臼的顶点具有朝着由髋臼的边缘限定的平面延伸的中心轴线,植入物还包括位于支承部分与边缘部分之间的过渡部分,所述过渡部分使边缘部分朝着髋臼的中心轴线延伸。
在另一实施例中,植入物翻转到髋臼的边缘上。
另一实施例提供固定表面,其为延伸到盆骨中的柱。在另一实施例中,植入物被用缝合线固定到骨头。
本发明的另一方面提供用于将股骨从髋臼间隔开的隔离物。该隔离物包括匙和腔室(plenum)。匙部分被构造为缠绕在股骨的头部周围。腔室被附着于匙并构造为使匙膨胀。匙在膨胀时使髋臼从股骨分离。
在另一实施例中,匙还包括被构造为在圆韧带周围延伸的切口部分。
在另一实施例中,隔离物还包括硬部分,硬部分延伸通过匙,使得可以将匙推入髋关节中。另一实施例允许硬部分在匙的周界周围延伸。
本发明的另一方面提供了用于切割髋臼边缘的一部分的切割引导件。该引导件包括大体上平面的矩形部件和轴线。大体上矩形的平面部件在中心部分中具有开口。开口的边形成切割表面。该开口具有宽度和高度。该轴线延伸过平面部件。该轴线形成折叠线,平面部件可在折叠线上折叠,使得当平面部件在髋臼边缘上折叠时,开口的边在边缘上延伸并被构造为引导切割部件去除骨头至由开口的高度限定的深度。
在另一实施例中,开口的宽度被设置为植入物的宽度。
在另一实施例中,折叠线是弯曲的。
另一实施例提供弯曲的折叠线是相对于髋臼的半径弯曲的。
下面参考附图来详细地描述本发明的其它特征、方面和优点,以及本发明的各种实施例的结构和操作。
附图说明
被结合在本说明书中并构成其一部分的附图示出了本发明的实施例,并连同本说明书一起用于解释本发明的原理。在附图中:
图1是用于治疗FAI的髋臼植入物的实施例的视图;
图2是图1的实施例的另一视图;
图3是图1的实施例的另一视图;
图4A至4F是与图1的实施例类似的髋臼植入物的实施例的视图;
图5A和5B是髋臼上的图1的植入物的视图;
图6是图5单独植入物和髋臼的剖视图;
图7A是用于治疗FAI的髋臼植入物的另一实施例的视图;
图7B和7C是被附着于髋臼的图7A的实施例的视图;
图8A和8B是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图9A是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图9B是图9A的髋臼和植入物的分解图;
图10A是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图10B是图10A的髋臼和植入物的分解图;
图11是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图12是图11的髋臼和植入物的分解图;
图13是示出用于凸轮型FAI的受影响区域的股骨的视图;
图14A至14D是用于治疗股骨上的FAI的股植入物的实施例的视图;
图15是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图16是图15的实施例的剖视图;
图17是用于治疗FAI的髋臼植入物的另一实施例的视图;
图18是具有缝合线的图17的实施例的视图;
图19是被附着于髋臼的具有缝合线的图17的实施例的视图;
图20是用于治疗FAI的髋臼植入物的另一实施例的视图;
图21是用于治疗FAI的髋臼植入物的另一实施例的视图;
图22是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图23是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图24是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图;
图25是用于治疗FAI的髋臼植入物的另一实施例的视图;
图26是被弯曲成适当形状以用于植入和固定螺钉的图25的植入物的分解图;
图27是图26的植入物和螺钉的剖视图;
图28是髋臼植入物和固定螺钉的实施例的分解图;
图29是具有植入物的髋臼的视图;
图30A是可以如图29所示地植入的植入物的实施例的视图;
图30B是可以如图29所示地植入的植入物的实施例的另一视图;
图30C是可以如图29所示地植入的植入物的实施例的另一视图;
图31是用于髋臼植入物的引导标记器的视图;
图32是图31的引导标记器的另一视图;
图33是放置在髋臼的表面上的图31的引导标记器的视图;
图34是骨头切割引导件的视图;
图35是被折叠成适当的取向以被接收在髋臼上的图34的切割器和骨头切割引导件的视图;
图36是定向在髋臼中的测量仪器的视图;
图37是定向在髋臼中的图36的测量仪器的另一视图;
图38是测量仪器的另一实施例的视图;
图39是用于将股骨从髋臼分离的隔离仪器的视图;
图40是在圆韧带周围被插入髋关节中的图39的隔离仪器的部分视图;
图41是示出从髂骨脊至盂唇或髋臼缺陷的通道的髋臼的视图;
图42是图41的髋臼的另一视图,示出了从髂骨脊至盂唇或髋臼缺陷的通道;
图43A至43F是将插入图41和图42所示的通道中的髋臼植入物的不同实施例的视图;以及
图44是具有不同半径的髋臼植入物的多个骨头配合表面的视图。
具体实施方式
参考附图(其中相同附图标记指示相同元件),图1是用于治疗FAI的髋臼植入物10的实施例的视图。植入物10具有插入部分12、凸缘部分14、脊状部15、边缘部分16、边缘弯曲部分17、支承表面18和边缘支承过渡部19。对于本实施例的附加视图而言,图2是图1的实施例的另一视图且图3是图1的实施例的又一视图。在图3中,安装孔11被定位在凸缘部分14上。可以将插入部分12构造为大体上与髋臼的支承表面垂直地插入髋臼中。然后,支承表面19将位于大体上与髋臼的支承表面齐平处。边缘支承过渡部19通常可以是支承表面19的弯曲部分,其使支承表面19过渡至边缘部分16。边缘部分16从支承表面19朝着髋臼的中心轴线向内延伸。此边缘部分16然后可以用来帮助捕捉股骨的头部(这是被去除的表面的功能,虽然被去除的表面被损坏,使其去除成为必要。因此,植入物可以恢复被去除的受损表面的功能,而不引起从受损组织、骨头或软骨产生的负面病理反应。
边缘部分16具有脊状部,其使边缘部分16从植入物10的支承表面侧过渡至固定侧(通过凸缘部分14)。可以通过将螺钉或销穿过螺钉孔11的方式(如在本实施例中所示的)或者通过关于其它实施例所讨论的装置,将凸缘部分14固定到髋臼。可以将植入物10的边缘弯曲部分17的尺寸确定为适合于髋臼。因此,不同髋臼的变化的直径可能需要植入物的各种边缘弯曲部分17。另外,根据受损区域的尺寸,可以改变植入物10的厚度、植入物10的宽度和边缘部分16的深度以适合病人的特定解剖结构。
这些实施例通常共享某些公共特征,即支承部分、用于替换盂唇的边缘部分和固定部分。可以预期在本公开的范围内,本文所述的不同变体可以通过提供所述的这些特征并然后将其组合来实现期望的植入物实施例。
图4A至4F是与图1的实施例类似的髋臼植入物10的实施例的视图。这些实施例允许将不同的材料用于植入物10的不同区域。可以将第一较硬材料部分20(例如金属、多孔材料或PEEK)用于支承表面的部分,同时可以将较柔性、柔顺的材料部分22(例如聚氨酯)用于凸缘和骨头分界面。此类实施例可以提供执行植入物10的功能所需的结构,而同时允许植入物与髋臼之间的更顺应的接触表面。可以由特定关节的动态特性来确定一种类型的材料相对于另一种的量。例如,在图4B中,植入物的大部分由较硬材料20制成。在此类实施例中,所述动态特性可以在植入物上产生比诸如图4E所示的植入物更大的负荷,在图4E所示的植入物中只有边缘部分是由较硬材料20制成的。所施加的负荷、植入物硬度与顺应性之间的连续性可能都促成了植入物10的材料组成,使得植入物可以由较硬材料20(图4A所示)制成或者完全由较柔顺的材料(如图4F所示)制成。
图5A和5B是盆骨1000的髋臼1002中的髋臼边缘1004上的图1的植入物10的视图。如前所述,植入物10在髋臼1004的边缘上延伸。植入物10的边缘部分16被定位为大体上朝着髋臼的中心轴线延伸(或至少不继续延伸髋臼的球形特征更多)。如在本实施例中所示,不存在延伸通过植入物10的凸缘部分的螺钉孔。必要时,可以通过植入物10上的骨头向内生长表面或通过其它机械装置来实现固定装置。
图6是图5的植入物和髋臼的剖视图。植入物10通过机械压配合被固定于髋臼。部分12和14在盆骨中朝着彼此会聚。因此,一旦植入物被放在骨头上,则植入物将不会移位,因为会聚表面将骨头夹在插入部分12与凸缘14之间。可以通过使植入物10从髋臼1002内部翻转到边缘上来实现此类压配合。此类方法要求插入部分12首先接合骨头,然后使凸缘14翻转到骨头的顶部上。
图7A是用于治疗FAI的髋臼植入物的另一实施例的视图。此双材料植入物30也具有较硬部分20和较柔性部分22。然而,较柔性部分包括植入物30的固定部分,其在本示例中为插入部分32和凸缘部分34。然后可以将植入物30包在髋臼的边缘周围。如图7A和7B所示,图7B和7C是被附接于髋臼1000的图7A的实施例的视图。可以将插入部分32放入髋臼的经制备的凹陷部分1006中。然后可以将柔性部分22包在边缘周围并固定到髋臼(例如通过安装孔31)到髋臼1000。然后可以将较柔性的支承部分38和边缘部分36定位为调整至适当深度以保持植入物30的支承表面38与髋臼的自然支承表面对准,并且还可以将边缘部分36的脊状部35定位成被适当地定向以提供被植入物30替换的捕捉特征。
图8A和8B是在髋臼1002上植入的用于治疗FAI的髋臼植入物40的另一实施例的视图。本实施例可以是硬支承材料(诸如Oxinium),其可以压配合到骨头中。此类实施例可能要求非常精确的骨头制备以及制备的形状的特定尺寸的匹配,解决髋臼1002的自然特性。植入物40的支承表面48则可以是硬支承,正如整个植入物40是硬材料一样。可以用具有对于植入物40的骨头接触表面而言期望的形状的工具来制备用于接收此类植入物的骨头,使得制备可以一次发生而不是更拟合的程序,其中可以基于其它骨头部分的较早制备来制备骨头的不同部分。植入物40可以处于恒定的压缩负荷下,使得几乎不存在植入物40从髋臼移位的风险。
图9A是在髋臼上植入的用于治疗FAI的髋臼植入物50的另一实施例的视图。图9B是图9A的植入物50和髋臼的分解图。可以将安装孔51定位于凸缘54a和54b上以将植入物50安装到骨头。植入物50的边缘部分上的脊状部55提供植入物50的约束特征。支承表面58延伸至髋臼中以与髋臼的自然支承表面相匹配。在图9B的剖视图中,使骨头制备表面1010、1012a和1012b制备好以接收植入物50。
图10A是在髋臼上植入的用于治疗FAI的髋臼植入物60的另一实施例的视图。图10B是图10A的髋臼和植入物60的分解图。可以将安装孔61定位于凸缘64上以将植入物60安装到骨头。植入物60的边缘部分上的脊状部65提供植入物60的约束特征。支承表面68延伸至髋臼中以与髋臼的自然支承表面相匹配。在图9B的剖视图中,使骨头制备表面1010、1012c制备好以接收植入物60。
图11是在髋臼上植入的用于治疗FAI的髋臼植入物70的另一实施例的视图。图12是图11的髋臼和植入物70的分解图。可以将安装孔71定位于植入物70上以将植入物70安装到骨头。植入物70的边缘部分上的脊状部75提供植入物70的盂唇替换特征。支承表面78延伸至髋臼中以与髋臼的自然支承表面相匹配。在图9B的剖视图中,使骨头制备表面1010制备好以接收植入物70。
在图9A至图12的实施例中,骨头制备在不使用柔顺材料的情况下与植入物表面匹配。因此,骨头制备将可能来自于经引导的压印或切割表面,而不是来自于使用骨钻(burr)等的自由手动切割。由于经制备的表面指引整个植入物的位置,所以经制备的表面必须不仅考虑底层骨头,而且考虑植入物的边缘特性和支承表面特性。
图13是股骨2000的视图,示出用于凸轮型FAI的受影响区域2004。球形股骨头2002可以产生受影响区域2004。可能需要用清创术且然后用被设计为限制骨过度生长(如可能由于与髋臼的接触所引起持续应力而发生)的植入物来治疗受影响区域。图14A至14D是用于治疗股骨上的FAI的股骨植入物80a、80b、80c和80d的实施例的视图。可以使用安装孔81a、81b、81c和81d来将植入物安装到股骨上。替换地,可以在手术进行时模制植入物的形状,或者在手术之前从股骨的放射摄影扫描来模制植入物的形状。植入物可以由刚性或柔性材料制成并用本文所讨论的任何安装装置来安装。
图15是在髋臼上植入的用于治疗FAI的髋臼植入物90的另一实施例的视图。图16是图15的实施例的剖视图。植入物90由柔性材料制成,其可以在过渡部97处弯曲,使得螺钉300可以穿过植入物90的凸缘部分94将植入物固定到骨头,螺钉300具有头部302,头部302的直径大于孔91的直径。边缘部分96的脊状部95替换盂唇。支承表面98接触股骨头。过渡部97还使支承表面在髋臼1002和植入物90的支承表面98之间过渡。
骨头制备可以包括将髋臼的边缘的一部分切掉的单个平面表面。然后,螺钉300可以抵靠着骨头表面1014挤压凸缘94以通过螺钉300的轴304上的固定元件306将植入物90固定到骨头。然后可以使植入物90的边缘部分96移动至螺钉头302上的位置。还可以用缝合线或其它固定元件将边缘部分96固定于凸缘94,使得边缘部分96相对于凸缘94变硬。
图17是用于治疗FAI的髋臼植入物100的另一实施例的视图。可以在已进行髋臼边缘的单个平面切割之后植入此楔型植入物(类似于图15的植入物)。可以用缝合线或金属丝将图17以及图18和19的植入物100固定到髋臼。图18是具有缝合线310的图17的实施例的视图。图19是被附接到髋臼1002的具有缝合线310的图17的实施例的视图。缝合线310可以延伸穿过缝合线引导件101穿过植入物100并进入骨头中的缝合线引导件1016。骨头匹配表面104,边缘部分106,在脊状部105中终止,沿着支承表面108延伸。因此,在边缘部分、过渡至髋臼中的自然软骨的支承表面和植入物100中的固定装置中存在盂唇替换。
图20和21是用于治疗FAI的髋臼植入物的其它实施例的视图。类似于前述实施例,本实施例是具有双材料结构的楔型设计。较刚性部分20和较柔性部分22。如前所述,此类特征可以在被植入时为植入物提供一定的柔顺性。如图22所示,图22是在髋臼上植入的用于治疗FAI的髋臼植入物的另一实施例的视图,其中,柔顺材料22是骨头分界面。图23和24类似地示出双材料组合,其中,植入物的较柔顺部分和较刚性部分包括植入物的不同部分。
图25是用于治疗FAI的髋臼植入物160的另一实施例的视图。植入物包括较刚性材料20和较柔性材料22。安装装置161可以将植入物固定到骨头。凹口166可以允许使植入物弯曲。可以将释放部(relief)163定位为与凹口166相对以在植入物被弯曲时释放植入物中的应力。相对的表面168和169可以在植入物弯曲时相互接触。在替换实施例中,斜面167可以使植入物的支承表面过渡至骨头。
图26是被弯曲成适当形状以用于植入和固定螺钉的图25的植入物的分解图。图27是图26的植入物和螺钉的剖视图。植入物可以形成骨头分界面1024和1026以接触骨头。螺钉300然后可以穿过安装装置161以将植入物160固定到髋臼1002。当植入物弯曲到髋臼1002上时形成脊状部165。
图28是髋臼植入物170和固定螺钉300的实施例的分解图。植入物可以由较刚性材料20和较柔性材料22的双材料制成。螺钉300可以通过安装孔171a装在埋头孔171b中。脊状部175可以在植入物被固定到骨头时替换盂唇。
图29是具有植入物180的髋臼1002的视图。植入物180可以在植入物180的支承表面与髋臼的关节表面之间包括斜面187。植入物可以具有骨头分界面,其更一般地与髋臼的关节表面平行地行进。大体上相互垂直的两个切口在骨头中形成大体上矩形的凹陷。在具有与此类似的植入物设计的某些情况下(与楔形实施例或覆盖(layover)实施例相反),骨头表面上的负荷可能是优选的。在此类设计中,大体部分仍是完好的,即骨头接触表面、支承表面和替换盂唇的约束部分。
图30A至30C是可以如图29所示地植入的植入物180、190和200的实施例的视图。在植入物中,斜面187、197和207在髋臼关节表面附近使植入物释放,从而在植入物与髋臼之间形成间隙1030a、1030b和1030c。支承表面188、198和208与髋臼关节表面对准。边缘部分186、196和206延伸至髋臼腔体中并在替换盂唇的脊状部185、195和205中终止。
图31是用于髋臼植入物的引导标记器400的视图。把手402沿着轴404延伸至引导件406。引导件406上的深度记号412可以用标记408a-d(图32所示)通过半径(r1、r2、r3和r4)来设置植入物的深度。可以通过标记410来确定宽度(w1、w2)。基于所需的骨头去除,该标记可以确定植入物的尺寸,为了使植入物适当地配合而必须去除的骨头的深度以及植入物的正确半径。
图33是放置在髋臼表面上的图31的引导标记器的视图。引导件使用半径标记来确保确定髋臼的适当半径。通过使引导件的边在受损部位的一端上对准,可以使用宽度标记来测量植入物的宽度。可以根据标记112来确定深度,标记112可以显示为了使植入物位于与髋臼的关节表面齐平处所需的去除深度。
图34是骨头切割引导件500的视图。引导件500中的开口502产生用于切割深度的引导表面504。可以使引导件500弯曲,使得下部508和上部506覆盖髋臼的边缘。如图35所示,图35是手术工具520上的切割器522以及被折叠至适当取向以便被接收在髋臼上的图34的骨头切割引导件的视图。
图36是定向在髋臼1002中的测量仪器600的视图。仪器600包括被附接到半球形头部606的轴604。深度标记608位于轴604上。测头610在轴引导件612中沿着轴604滑动。可以使头部606位于髋臼内以确定轴的倒转(version)和内收的方向。测头然后可以通过使用标记608来测量至损伤1004的深度。测头上的半径标记可以测量髋臼边缘的半径。图37是定向在髋臼中的图36的测量仪器的另一视图。
图38是测量仪器600的另一实施例的视图。测头610’可以是可反转的。另外,可以将损伤深度桨状物(paddle)611放置在测头的端部上。测头610’可以测量从轴的深度,并且浆状物611可以测量损伤的深度。
图39是用于将股骨从髋臼分离的隔离仪器700的视图。隔离仪器700包括通过管704附接到叉状可膨胀匙703的腔室702。匙703包括被切口部分706分离的第一指状物705和第二指状物707。加硬部件708可以使匙703变硬以便插入。控制模块710包括单向阀712、压力释压旋钮714和压力安全阀716。腔室702可以使匙703膨胀以使指状物部分705和707膨胀。指状物部分705和707(如图40所示)可以避开圆韧带。在膨胀时,匙可以在不损伤圆韧带的情况下使股骨从髋臼分离。可以沿着匙703的边放置加硬装置709,使得可以将匙推入髋关节中。
图41是髋臼的视图,示出从髂嵴至盂唇或髋臼缺陷的通道1060。图42是图41的髋臼的另一视图,示出了从髂嵴至盂唇或髋臼缺陷的通道。通道1060允许植入物的远侧至近侧取向或植入物的近侧至远侧取向。在使用通过髂嵴的这些不同通道的情况下,可以控制盂唇处的植入物取向。在图43A至43F中示出通过这些通道插入的植入物。
图43A至43F是髋臼植入物的不同实施例的视图,其被插入图41和图42所示的通道中。每个植入物210、220、230、240、250和260具有沿着通道延伸的柱。每个植入物具有脊状部(类似于43A中的215)、支承部分(例如,图43B中的228)和边缘部分(类似于图43C中的236)。该柱可以由柔顺材料22制成,被压配合或螺纹连接到植入物中。根据植入的近侧或远侧方向,螺纹连接的设计可以具有旋转部件242或252。柱提供用于植入物在骨头1000中的固定。
图44是具有不同半径R1、R2、R3的髋臼植入物的多个骨头匹配表面278a、278b和278c的视图。利用变化的半径和变化的方向、以及控制植入物在骨头中的深度的能力,可以用良好的固定、适当的支承放置和适当的盂唇替换来实现适当的取向。
鉴于上述内容,将看到实现并获得了本发明的多个优点。
选择并描述实施例是为了最好地解释本发明的原理及其实际应用以从而使得本领域的技术人员能够在各种实施例中最好地利用本发明并具有适合于所预期的特定使用的各种修改。
由于在不脱离本发明的范围的情况下可以对本文所述和所示的构造和方法进行各种修改,所以意图在于应将包含在前述说明中或在附图中示出的所有内容解释为说明性的而不是限制性的。因此,本发明的宽度和范围不应受到任何上述示例性实施例的限制,而是应仅仅依照以下所附权利要求及其等同物来限定。
Claims (19)
1.一种用于盆骨中的髋臼的部分边缘植入物,包括:
脊状部,其被定向为替换盂唇;
支承表面,其被构造为与所述髋臼的关节表面对准,其中,所述支承表面从所述脊状部朝着所述髋臼的顶点延伸,以及
固定表面,其被构造为将所述植入物固定于所述盆骨的经制备的骨头表面。
2.如权利要求1所述的植入物,其中,所述固定表面大体上垂直于所述髋臼的关节表面。
3.如权利要求1或权利要求2所述的植入物,其中,所述髋臼的顶点具有朝着由所述髋臼的边缘限定的平面延伸的中心轴线,还包括从所述固定部分延伸至所述脊状部的边缘部分,所述边缘部分确定所述脊状部的方向。
4.如权利要求1至3中的任一项所述的植入物,其中,所述植入物由第一柔顺材料和第二较硬材料制成。
5.如权利要求4所述的植入物,其中,所述植入物的脊状部由第一柔顺材料制成。
6.如权利要求4所述的植入物,其中,所述固定表面由第一柔顺材料制成。
7.如权利要求1所述的植入物,还包括:
插入部分,其大体上垂直地从所述支承表面延伸;以及
固定凸缘,其从所述植入物的边缘部分延伸,其中,所述插入部分和所述凸缘部分随着所述凸缘部分和插入部分远离所述髋臼延伸而朝着彼此会聚。
8.如权利要求7所述的植入物,其中,所述髋臼的顶点具有朝着由所述髋臼的边缘限定的平面延伸的中心轴线,所述植入物还包括位于所述支承部分与所述边缘部分之间的过渡部分,所述过渡部分朝着所述髋臼的中心轴线延伸所述边缘部分。
9.如权利要求7或权利要求8所述的植入物,其中,所述植入物被翻转到所述髋臼的边缘上。
10.如权利要求1所述的植入物,其中,所述固定表面是延伸到所述盆骨中的柱。
11.如上述权利要求中的任一项所述的植入物,其中,所述植入物用缝合线固定到骨头。
12.一种用于将股骨从髋臼间隔开的隔离物,包括:
匙部分,其被构造为包在所述股骨的头部周围;以及
腔室,其被附接到所述匙且被构造为使所述匙膨胀,其中,所述匙在膨胀时使所述髋臼从所述股骨分离。
13.如权利要求12所述的隔离物,其中,所述匙还包括被构造为在圆韧带周围延伸的切口部分。
14.如权利要求12或13所述的隔离物,还包括硬部分,所述硬部分延伸通过所述匙,使得所述匙能被推入髋关节中。
15.如权利要求14所述的隔离物,其中,所述硬部分在所述匙的周界周围延伸。
16.一种用于切割髋臼的边缘的一部分的切割引导件,包括:
大体上矩形的平面部件,其具有在中心部分中的开口,所述开口的边形成切割表面,所述开口具有宽度和高度;以及
延伸过所述平面部件的轴线,所述轴线形成折叠线,所述平面部件能在折叠线上折叠,使得当所述平面部件折叠到髋臼边缘上时,所述开口的边在所述边缘上延伸并被构造为引导切割部件去除骨头至由所述开口的高度限定的深度。
17.如权利要求16所述的切割引导件,其中,所述开口的宽度被设置为所述植入物的宽度。
18.如权利要求16或17所述的切割引导件,其中,所述折叠线是弯曲的。
19.如权利要求18所述的切割引导件,其中,所述弯曲的折叠线是相对于所述髋臼的半径弯曲的。
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US20120283840A1 (en) | 2012-11-08 |
CN102421390A (zh) | 2012-04-18 |
CN102421390B (zh) | 2016-01-20 |
CA2753429A1 (en) | 2010-09-02 |
JP5599827B2 (ja) | 2014-10-01 |
KR20120109990A (ko) | 2012-10-09 |
EP2490625A2 (en) | 2012-08-29 |
AU2016200524A1 (en) | 2016-03-10 |
US8900320B2 (en) | 2014-12-02 |
BRPI1007988A2 (pt) | 2016-03-01 |
RU2011137986A (ru) | 2013-04-10 |
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