CN105796213A - 模块化反转式肩部整形外科植入物及其植入方法 - Google Patents

模块化反转式肩部整形外科植入物及其植入方法 Download PDF

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CN105796213A
CN105796213A CN201610028514.7A CN201610028514A CN105796213A CN 105796213 A CN105796213 A CN 105796213A CN 201610028514 A CN201610028514 A CN 201610028514A CN 105796213 A CN105796213 A CN 105796213A
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humerus
parts
lining ring
ring
edge
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CN105796213B (zh
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J.查瓦里亚
D.T.托德
D.彭塞特
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DePuy Synthes Products Inc
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DePuy Synthes Products Inc
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  • Health & Medical Sciences (AREA)
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Abstract

本发明公开了模块化反转式肩部整形外科植入物及其植入方法，所述模块化反转式肩部整形外科植入物包括肱骨杆部件和能够分离的骨折骨骺部件，所述骨折骨骺部件具有形成于其中的多个缝合孔。所述骨折骨骺部件被构造成用于接收用于外科地修复肱骨近端骨折的多个缝合线。

Description

模块化反转式肩部整形外科植入物及其植入方法
技术领域
本公开总体上涉及整形外科植入物，并且更具体地涉及反转式肩部整形外科植入物。
背景技术
在患者的一生中，由于例如疾病或创伤原因，可能需要对患者执行全肩部置换手术。在全肩部置换手术中，利用肱骨假体来置换患者的肱骨的自然头部。肱骨假体通常包括植入到患者的肱骨的髓内管中的细长杆部件和固定到该杆部件上的半球形假体头部件。在此类全肩部置换手术中，肩胛骨的自然关节盂表面利用提供支承表面的关节盂部件进行重建或或换句话讲进行置换，其中肱骨假体的假体头部件可在所述支承表面上进行关节运动。
然而，在一些情况下，患者的自然肩(包括其软组织)已恶化到关节不稳定和疼痛的严重程度。在许多此类情况下，可能需要改变肩部的力学结构。使用反转式肩部植入物来达到上述目的。顾名思义，反转式肩部植入物逆转了健康肩部的解剖结构或结构。具体地讲，反转式肩部植入物被设计成使得被称为关节盂凸形支承头(glenosphere)部件的假体头(即球窝关节中的“球”)固定到患者的肩胛骨，同时使被称为肱骨杯的对应的凹形支承件(即球窝关节中的“承窝”)固定到患者的肱骨。此类反转构型允许患者的三角肌(其为较大的和较强健的肩部肌肉之一)提起臂部。
在一些情况下，患者的自然肩部解剖结构还已遭受创伤，例如肱骨近端骨折。肱骨近端骨折是老年患者中最常见的骨折之一。在肱骨近端骨折情况下，患者肱骨通常断裂为多块，包括肱骨头、更大的结节、更小的结节和肱骨干。
发明内容
根据一个方面，模块化反转式肩部整形外科植入物包括被构造成用于植入到患者肱骨中的细长肱骨杆部件。该植入物还包括可与肱骨杆部件分离的骨折骨骺部件。该骨折骨骺部件包括杯形主体，所述杯形主体具有形成于其上端的环形边缘。侧向缝合衬圈，该侧向缝合衬圈在由边缘的最前点和边缘的最后点限定的环形边缘的区段内从杯形主体的环形边缘向外延伸。前内侧缝合衬圈，该前内侧缝合衬圈在由边缘的最前点和边缘的最内点限定的环形边缘的区段内从杯形主体的环形边缘向外延伸。后内侧缝合衬圈，该后内侧缝合衬圈在由边缘的最后点和边缘的最内点限定的环形边缘的区段内从杯形主体的环形边缘向外延伸。侧向缝合衬圈、前内侧缝合衬圈和后内侧缝合衬圈彼此不连接。植入物还包括固定到肱骨杆部件和骨折骨骺部件的锁紧螺钉，以及固定到骨折骨骺部件的肱骨杯部件。该肱骨杯部件具有被构造成用于与关节盂凸形支承头部件的圆头表面进行关节运动的凹形支承表面。
侧向缝合衬圈、前内侧缝合衬圈和后内侧缝合衬圈中的每一个可呈现形成于其中的多个缝合孔。在这种情况下，缝合孔可被径向地定位在侧向缝合衬圈、前内侧缝合衬圈和后内侧缝合衬圈上。
侧向缝合衬圈可比前内侧缝合衬圈和后内侧缝合衬圈两者长。
在一个实施例中，前内侧缝合衬圈和后内侧缝合衬圈在尺寸上相似并且沿杯形主体的环形边缘彼此相背对。
骨折骨骺部件的杯形主体的外表面具有形成于其后端的多个缝合凹坑。形成于骨折骨骺部件的杯形主体的此类缝合凹坑中的每一个被壁隔开，其中此类壁中的每一个具有形成于其中的缝合孔。
骨折骨骺部件的杯形主体的外表面还可具有贯穿其延伸的多个缝合孔，其中此类缝合孔中的每一个沿前后方向延伸。
根据另一个方面，模块化反转式肩部整形外科植入物包括被构造成用于植入到患者肱骨中的细长肱骨杆部件。该植入物还包括可与肱骨杆部件分离的骨折骨骺部件。骨折骨骺部件包括具有圆形外表面的杯形主体、形成于杯形主体的圆形外表面的下端的通道、以及定位在该通道中以便在该通道内形成多个缝合凹坑的多个壁。多个壁中的每一个具有形成于其中的缝合孔。植入物还可包括固定到肱骨杆部件和骨折骨骺部件的锁紧螺钉，以及固定到骨折骨骺部件的肱骨杯部件。该肱骨杯部件具有被构造成用于与关节盂凸形支承头部件的圆头表面进行关节运动的凹形支承表面。
骨折骨骺部件的杯形主体的外表面具有贯穿其延伸的另外的缝合孔，其中这种另外的缝合孔沿前后方向延伸。
骨折骨骺部件的杯形主体可包括形成于其上端的环形边缘，其中多个缝合衬圈从环形边缘向外延伸。
此类缝合衬圈中的每一个具有形成于其中的多个缝合孔，其中缝合孔径向地定位在缝合衬圈上。
缝合衬圈可包括侧向缝合衬圈，该侧向缝合衬圈在由边缘的最前点和边缘的最后点限定的环形边缘的区段内从杯形主体的环形边缘向外延伸。缝合衬圈还可包括前内侧缝合衬圈，该前内侧缝合衬圈在由边缘的最前点和边缘的最内点限定的环形边缘的区段内从杯形主体的环形边缘向外延伸。另外，缝合衬圈还可包括后内侧缝合衬圈，该后内侧缝合衬圈在由边缘的最后点和边缘的最内点限定的环形边缘的区段内从杯形主体的环形边缘向外延伸。侧向缝合衬圈、前内侧缝合衬圈和后内侧缝合衬圈彼此不连接。
侧向缝合衬圈可比前内侧缝合衬圈和后内侧缝合衬圈两者长。
前内侧缝合衬圈和后内侧缝合衬圈可在尺寸上相似并且沿杯形主体的环形边缘彼此相背对。
还根据另一个方面，外科地修复患者肱骨的近侧骨折的方法包括旋转锁紧螺钉以将细长肱骨杆部件固定到骨折骨骺部件，并且将肱骨杆部件植入到患者肱骨的髓内管中。该方法包括推进第一缝合线使其穿过患者肱骨的肱骨干，穿过形成于骨折骨骺部件的环形缝合衬圈的第一缝合孔，并且穿过患者肱骨的更大结节近侧的患者肩袖。推进第二缝合线使其穿过患者肱骨的肱骨干，穿过形成于骨折骨骺部件的环形缝合衬圈的第二缝合孔，并且穿过患者肱骨的更小结节近侧的患者肩袖。推进第三缝合线使其穿过位于骨折骨骺部件的外部下表面上的缝合凹坑中的第三缝合孔，穿过患者肱骨的更大结节，并且穿过患者肱骨的更小结节。
该方法还包括拉紧第三缝合线以便使患者肱骨的更大结节和患者肱骨的更小结节彼此接触，并且然后系住第三缝合线以便将患者肱骨的更大结节和患者肱骨的更小结节固定成彼此接触。
该方法还包括在系住步骤之后，将聚合的肱骨杯安装在骨折骨骺部件上。
形成于肱骨杆部件的上表面的突片可被定位在形成于骨折骨骺部件的下表面的多个凹口中，以便在旋转锁紧螺钉之前，将骨折骨骺部件相对于肱骨杆部件以所选的扭转角进行定位。
附图说明
具体地参考以下附图进行详细说明，其中：
图1是模块化反转式肩部整形外科植入物的透视图；
图2是图1的模块化反转式肩部整形外科植入物骨折骨骺部件和锁紧螺钉的上正视图；
图3是图1的模块化反转式肩部整形外科植入物骨折骨骺部件的侧正视图；
图4是图1的模块化反转式肩部整形外科植入物骨折骨骺部件的后正视图；
图5是图1的模块化反转式肩部整形外科植入物的分解透视图，其示出了用于调整骨折骨骺部件相对于肱骨杆部件的扭转角的锁定突片和锁定凹口；和
图6-18是透视图，其示出了用于将图1的模块化反转式肩部整形外科植入物植入到患者肱骨中以外科地修复肱骨近端骨折的外科手段，需注意，为了清楚地描述，已经将软组织(即回旋肌腱)从图17和图18中移除。
具体实施方式
虽然本发明的概念易于具有各种修改形式和替代形式，但本发明的具体示例性实施例已在附图中以举例的方式示出，并且将在本文中详细说明。然而，应当理解，本文无意将本发明的概念限制为所公开的具体形式，而是相反，本发明的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。
表示解剖参考(例如前、后、内、外、上、下等)的术语可在本发明通篇中用来提及本文所述整形外科植入物和患者的自然解剖结构两者。这些术语在解剖学研究和整形外科领域都具有公知的含义。除非另外指明，否则说明书和权利要求中使用的此类解剖参考术语旨在符合其公知的含义。
现在参见图1-5，示出了用于在肱骨近端骨折之后替换患者的自然肩关节的模块化反转式肩部整形外科植入物10。模块化反转式肩部整形外科植入物10包括圆形(例如，半球形)关节盂凸形支承头部件12，通过植入到肩胛骨的骨组织中的关节盂安装板部件14将所述圆形关节盂凸形支承头部件固定到患者肩胛骨的关节盂表面。关节盂凸形支承头部件12在模块化肱骨假体20的聚合的肱骨杯18的支承表面16上进行关节运动。如图1可见，模块化肱骨假体20包括骨折骨骺部件22和肱骨杆部件24。锁紧螺钉26(参见图2)以期望的扭转角将骨折骨骺部件22锁定到肱骨杆部件24(如下文所详述)。在将模块化肱骨假体20植入患者肱骨的髓内管中之后将肱骨杯18固定到骨折骨骺部件22(参见图6-18)。
如图5可见，细长肱骨杆部件24的上端具有形成于其中的镗孔28。将形成于骨折骨骺部件22的下端的管状柱30接收在杆部件的镗孔28中。限定杆部件的镗孔28的远侧端部的侧壁具有在其中限定的多个母螺纹(未示出)。推进锁紧螺钉26的公螺纹使其穿过骨折骨骺部件22的管状柱30，并且使其与形成于肱骨杆部件24的母螺纹螺纹接合，以使骨折骨骺部件22和肱骨杆部件24彼此锁定。
如图5可见，细长肱骨杆部件24的上端还具有形成于其中的突片32。突片32从杆部件的上端的平坦表面向上延伸。骨折骨骺部件22的下端的平坦表面具有在其中限定的多个凹口34。相对于骨折骨骺部件的管状柱30的中心轴线径向地定位凹口34。外科医生可相对于肱骨杆部件24旋转骨折骨骺部件22，使得突片32被接收到选定的一个凹口34中，以调整骨折骨骺部件22相对于肱骨杆部件24的扭转角(在用锁紧螺钉26将两个部件彼此锁定之前)。
如图2-4可见，骨折骨骺部件22包括具有圆形外表面38的杯形主体36。部件的主体36具有锁定肱骨杯18的中空内室40。管状柱30的镗孔通向内室40的底部以接收锁紧螺钉26的头部。部件的主体36的上端限定环形边缘42。环形边缘42限定内室40的开口。
多个缝合衬圈44、46、48从骨折骨骺部件的环形边缘42向外延伸。具体地讲，在本文所述的实施例中，侧向缝合衬圈44从环形边缘42的侧向区段54向外延伸，前内侧缝合衬圈46从环形边缘42的前内侧区段56向外延伸，并且后内侧缝合衬圈48从环形边缘42的后内侧区段58向外延伸。如图2可见，侧向缝合衬圈44比前内侧缝合衬圈46和后内侧缝合衬圈48两者长，前内侧缝合衬圈46和后内侧缝合衬圈48具有相似尺寸。缝合衬圈44、46、48中的每一个具有形成于其中的多个缝合孔50。缝合孔50径向地定位在缝合衬圈44、46、48上。如下文更详细所述，缝合线可穿过缝合孔50以将患者的肱骨及周围软组织的多种特征结构固定到骨折骨骺部件22，并且因此固定到模块化反转式肩部整形外科植入物10。
还如图2可见，缝合衬圈44、46、48彼此不连接。换句话讲，缝合衬圈44、46、48每个包括与其他缝合衬圈44、46、48的端边间隔开的不同的端边。例如，侧向缝合衬圈44的端边64与前内侧缝合衬圈46和后内侧缝合衬圈48两者对应的端边66、端边68间隔开。同样，前内侧缝合衬圈46和后内侧缝合衬圈48两者对应的端边66、端边68彼此间隔开。这以几何形式示于图2中，其中侧向缝合衬圈44定位在由边缘42的最前点52和边缘42的最后点62限定的环形边缘42的区段(即，侧向区段54)内。前内侧缝合衬圈46定位在由边缘的最前点52和边缘42的最内点64限定的环形边缘42的区段(即，前内侧区段56)内，并且后内侧缝合衬圈48定位在由边缘42的最后点62和边缘42的最内点64限定的环形边缘42的区段(即，后内侧区段58)内以便与前内侧缝合衬圈46相背对。
应当理解，缝合衬圈44、46、48没有一直共同地围绕环形边缘42的周边延伸的这种布置在可降低侵犯一些患者的发生率。具体地讲，根据特定患者的解剖结构，骨折骨骺部件22的设计(即，沿其最内侧没有缝合衬圈)可降低骨折骨骺部件的内侧在其他方面以一定活动范围接触患者的肩胛骨的机会。这种构型还有利于在植入或移除模块化反转式肩部整形外科植入物10期间，使骨折骨骺部件22与插入工具或起拔工具配合。
如图3和图4可见，骨折骨骺部件的杯形主体36的圆形外表面38的侧面的下端具有形成于其中的通道70。形成于通道70内的位置处的主体36的多个壁72，从而形成多个缝合凹坑74。壁72中的每一个具有形成于其中的缝合孔76。以与缝合衬圈44、46、48的缝合孔50相似的方式，缝合线可穿过缝合孔76以将患者的肱骨及周围软组织的多种特征结构固定到骨折骨骺部件22，并且因此固定到模块化反转式肩部整形外科植入物10。
如图4可见，缝合孔76中的每一个(在图4中命名为参考数字78)位于通道70的内侧上，并且沿前后方向延伸。如下文所述，这种缝合孔78允许安装“环绕型”或环扎型缝合线。
可用植入物等级的生物相容性金属来构造骨折骨骺部件22和肱骨杆部件24，但是还可使用其他材料。这样的金属的例子包括钴(包括钴合金，诸如钴铬合金)、钛(包括钛合金，诸如Ti6Al4V合金)以及不锈钢。此类金属部件22、24还可以涂覆有表面处理剂，诸如透明质酸(HA)，以增强生物相容性。此外，可对接合自然骨的骨折骨骺部件22和肱骨杆部件24的表面(诸如骨折骨骺部件22的圆形外表面38和肱骨杆部件24的外表面)进行纹理化处理以有利于将该部件固定到骨。此类表面也可为多孔涂覆的，以促进骨向内生长用于持久固定。
此外，模块化反转式肩部整形外科植入物10的部件中的每一个可设置有各种不同的构型和尺寸，以提供适形于不同患者的不同解剖结构所需的灵活性。例如，骨折骨骺部件22和聚合的肱骨杯18可设置有不同直径以匹配给定患者的需求。此外，如图3中以虚线所示，骨折骨骺部件22可设置有不同构型，其中管状柱30向前或向后偏置(例如，2mm)以提供偏心的左右选择。另外，例如，肱骨杆部件24可设置有各种长度和直径，以匹配给定患者的需求。
现在参见图6-18，示出了外科手术，其中模块化反转式肩部整形外科植入物10被植入患者的肱骨80中以外科修复肱骨近端骨折。该外科手术从术前规划开始，其中，除了别的以外，可获得CT扫描或其他类型的术前图像，以规划模块化反转式肩部整形外科植入物10的布置、位置和取向。当术前计划结束后，解剖并收缩患者的软组织，以允许触及骨折的肩关节。通常实现患者肩关节的完全暴露。
外科医生然后装配模块化反转式肩部整形外科植入物10。具体地讲，外科医生选择期望尺寸和构型的骨折骨骺部件22和肱骨杆部件24，并且然后插入锁紧螺钉26使其穿过骨骺部件22的管状柱30。可通过将从杆部件上端的平坦表面向上延伸的突片32插入到形成于骨折骨骺部件22的下端的选定的一个凹口34，来选择骨折骨骺部件22相对于肱骨杆部件24的扭转角(参见图5)。然后，外科医生可使用内六角驱动器或类似物(未示出)来驱动锁紧螺钉26，从而将骨折骨骺部件22和肱骨杆部件24彼此锁定。在外科手术的这一时刻，外科医生还可装配与最终植入物的形状和尺寸相符的试验部件以用于手术的后续使用。
然后，如图6所示，外科地移除患者骨折的肱骨头并且标记更大的结节82和更小的结节84。外科医生然后准备患者的肱骨80的髓内管86以接收反转式肩部整形外科植入物10的肱骨杆部件24。初始地，外科医生使用相对较小直径的起动器扩孔钻，并且随后使用更大的扩孔钻进行扩孔以获得患者髓内管86的期望通道。图6示出了患者已扩孔的肱骨80。
如图7可见，外科医生然后在骨折线下面大约2cm的位置钻取穿过肱骨干88的后外侧部分的一对缝合孔90、92。还在骨折线下面大约2cm的位置钻取穿过肱骨干88的前外侧部分的一对缝合孔94、96。外科医生然后放置一股缝合线102使其以内向外的方式穿过缝合孔90，并且返回穿过缝合孔92，从而产生患者肱骨80外侧的环。如将在下文更详细所述，这种缝合线102将用于重新附接更大的结节82。然后通过放置缝合线104使其穿过缝合孔94和缝合孔96来重复这一过程。这种缝合线104将用于重新附接更小的结节84。推进另一个缝合线106使其穿过缝合孔92和缝合孔94，从而产生相同类型的环，所述环将用于修复更大结节82和更小结节84之间的间隔。
如图8所示，推进另外的缝合线108使其穿过前后方向的缝合孔78。如将在下文所述，这种缝合线108将用作“环绕型”缝合线。在安装缝合线108之前或之后，将装配的和锁定的模块化肱骨假体20(即，骨折骨骺部件22和肱骨杆部件24)插入到患者肱骨80的髓内管86中。如果骨接合剂用于将植入物10固定在髓内管86内，则定位夹具(未示出)可用于将模块化反转式肩部整形外科植入物10夹到肱骨80以设定植入物10的高度。
然后，如图9和图10所示，在更大结节82和更小结节84的每一个中钻取孔120。如图10可见，另外的缝合线110定位在骨折骨骺部件的缝合凹坑74的缝合孔76中。如下文所述，这种缝合线110将穿过所钻取的孔120以将结节82、结节84与模块化反转式肩部整形外科植入物10系在一起。
如图11和12所示，外科医生然后推进“环绕型”缝合线108的后肢使其在骨/肌腱界面附近穿过更大的结节回旋肌腱122。用穿过更小的结节回旋肌腱124的缝合线108的前肢重复该过程。
如图12所示，推进缝合线104的一端使其穿过侧向缝合衬圈44的前侧上的缝合孔50中的一个，并且推进缝合线104的另一端使其穿过前内侧缝合衬圈46的缝合孔50中的一个。然后缝合线104的两端皆在肌腱/更小的结节界面附近穿过回旋肌腱124。通过使缝合线102的一端穿过侧向缝合衬圈44的后侧上的缝合孔50中的一个，使另一端穿过后内侧缝合衬圈48上的缝合孔50来重复这种过程，并且然后使两端皆在骨/肌腱界面附近穿过更大的结节回旋肌腱122。同样，如图13所示，缝合线106的端部穿过侧向缝合衬圈44的侧面上的独立的缝合孔50。然后，缝合线106的一端在骨/肌腱界面附近穿过更大的结节回旋肌腱122，并且缝合线106的另一端在骨/肌腱界面附近穿过更小的结节回旋肌腱124。
现在参见图14，缝合线110的一端(还参见图10)穿过在更大的结节82中所钻取的孔120，并且缝合线110的另一端穿过在更小的结节84中所钻取的孔120。然后拉紧和系住缝合线110以使结节82、84在一起并且将它们固定到模块化反转式肩部整形外科植入物10。
如图15所示，外科医生然后推进缝合线104的端部，所述缝合线104的端部穿过所钻取的骨孔96、穿过前内侧缝合衬圈46、以及穿过更小的结节回旋肌腱124向下返回，并且在所钻取的骨孔94和所钻取的骨孔96之间产生的环下穿行。然后向上拉紧缝合线104从而将环向上拉到更小的结节84上并且产生改进的“图8”。外科医生然后系住并且修剪多余的缝合线104。
外科医生通过推进缝合线102的端部来重复该过程，如图16所示，所述缝合线102的端部穿过所钻取的骨孔90、穿过后内侧缝合衬圈48、以及穿过更大的结节回旋肌腱122向下返回，并且在所钻取的骨孔90和所钻取的骨孔92之间产生的环下穿行。然后向上拉紧缝合线102从而将环向上拉到更大的结节82上并且产生改进的“图8”。外科医生然后系住并且修剪多余的缝合线102。
如图17和图18所示，外科医生然后使缝合线106的端部从所钻取的骨孔92向下在所钻取的骨孔92和所钻取的骨孔94之间产生的环下穿行。外科医生然后向上拉紧缝合线106，从而将环向上牵拉到更大的结节82上并且产生改进的“图8”。外科医生然后系住并且修剪多余的缝合线106。然后将“环绕型”缝合线108的两端拉紧、系在一起(围绕结节82、结节84两者)，并且进行修剪以为骨折复位提供另外的稳定性。
外科医生然后完成剩余的手术步骤，例如安装肱骨杯18和安装关节盂凸形支承头部件12。外科医生然后闭合手术位点。
尽管在附图和上述说明中已详细地举例说明和描述了本公开，但此类说明和描述应视为示例性的而不是限制性的，应当理解的是，仅示出和描述了示例性的实施例，并且本公开的实质内的所有改变和变型都应受到保护。
本公开具有从本文所述的设备、系统和方法的各种特征产生的多个优点。应当注意的是，本公开的装置、系统和方法的替代实施例可能不包括所描述的所有特征，但仍然可以受益于这些特征的优点中的至少一些。本领域的普通技术人员可以轻松设计出其自己对所述设备、系统和方法的具体实施，该具体实施可包含本发明特征中的一项或多项，并且仍属于由随附权利要求限定的本发明的实质和范围内。

Claims (18)

1.一种模块化反转式肩部整形外科植入物，包括：
被构造成用于植入到患者肱骨中的细长肱骨杆部件，
能够与所述肱骨杆部件分离的骨折骨骺部件，所述骨折骨骺部件包括(i)杯形主体，所述杯形主体具有形成于其上端的环形边缘，(ii)侧向缝合衬圈，所述侧向缝合衬圈在由所述边缘的最前点和所述边缘的最后点限定的所述环形边缘的区段内从所述杯形主体的所述环形边缘向外延伸，(iii)前内侧缝合衬圈，所述前内侧缝合衬圈在由所述边缘的最前点和所述边缘的最内点限定的所述环形边缘的区段内从所述杯形主体的所述环形边缘向外延伸，和(iv)后内侧缝合衬圈，所述后内侧缝合衬圈在由所述边缘的最后点和所述边缘的最内点限定的所述环形边缘的区段内从所述杯形主体的所述环形边缘向外延伸，其中所述侧向缝合衬圈、所述前内侧缝合衬圈和所述后内侧缝合衬圈彼此不连接，
固定到所述肱骨杆部件和所述骨折骨骺部件的锁紧螺钉，和
固定到所述骨折骨骺部件的肱骨杯部件，所述肱骨杯部件具有被构造成用于与关节盂凸形支承头部件的圆头表面进行关节运动的凹形的支承表面。
2.根据权利要求1所述的模块化反转式肩部整形外科植入物，其中：
所述侧向缝合衬圈、所述前内侧缝合衬圈和所述后内侧缝合衬圈中的每一个具有形成于其中多个缝合孔，并且
所述缝合孔径向地定位在所述侧向缝合衬圈、所述前内侧缝合衬圈和所述后内侧缝合衬圈上。
3.根据权利要求1所述的模块化反转式肩部整形外科植入物，其中所述侧向缝合衬圈比所述前内侧缝合衬圈和所述后内侧缝合衬圈两者长。
4.根据权利要求1所述的模块化反转式肩部整形外科植入物，其中所述前内侧缝合衬圈和所述后内侧缝合衬圈在尺寸上相似并且沿所述杯形主体的所述环形边缘彼此相背对。
5.根据权利要求1所述的模块化反转式肩部整形外科植入物，其中所述骨折骨骺部件的杯形主体的外表面具有形成于其后端的多个缝合凹坑。
6.根据权利要求5所述的模块化反转式肩部整形外科植入物，其中：
形成于所述骨折骨骺部件的所述杯形主体的多个缝合凹坑中的每一个由壁隔开，并且
隔开形成于所述骨折骨骺部件的所述杯形主体的多个缝合凹坑的所述壁中的每一个具有形成于其中的缝合孔。
7.根据权利要求1所述的模块化反转式肩部整形外科植入物，其中：
所述骨折骨骺部件的所述杯形主体的外表面具有贯穿其延伸的多个缝合孔，并且
所述缝合孔中的每一个沿所述前后方向延伸。
8.一种模块化反转式肩部整形外科植入物，包括：
被构造成用于植入到患者肱骨中的细长肱骨杆部件，
能够与所述肱骨杆部件分离的骨折骨骺部件，所述骨折骨骺部件包括(i)具有圆形外表面的杯形主体，(ii)形成于所述杯形主体的所述圆形外表面的下端的通道，(iii)定位在所述通道内以便在所述通道内形成多个缝合凹坑的多个壁，其中所述多个壁中的每一个具有形成于其中的缝合孔，
固定到所述肱骨杆部件和所述骨折骨骺部件的锁紧螺钉，和
固定到所述骨折骨骺部件的肱骨杯部件，所述肱骨杯部件具有被构造成用于与关节盂凸形支承头部件的圆头表面进行关节运动的凹形的支承表面。
9.根据权利要求8所述的模块化反转式肩部整形外科植入物，其中：
所述骨折骨骺部件的所述杯形主体的外表面具有贯穿其延伸的另外的缝合孔，并且
所述另外的缝合孔沿所述前后方向延伸。
10.根据权利要求8所述的模块化反转式肩部整形外科植入物，其中所述骨折骨骺部件的所述杯形主体包括：
形成于其上端的环形边缘，和
从所述杯形主体的所述环形边缘向外延伸的多个缝合衬圈。
11.根据权利要求10所述的模块化反转式肩部整形外科植入物，其中所述多个缝合衬圈中的每一个具有形成于其中的多个缝合孔，所述缝合孔径向地定位在所述多个缝合衬圈上。
12.根据权利要求10所述的模块化反转式肩部整形外科植入物，其中所述多个缝合衬圈包括：
侧向缝合衬圈，所述侧向缝合衬圈在由所述边缘的最前点和所述边缘的最后点限定的所述环形边缘的区段内从所述杯形主体的所述环形边缘向外延伸，
前内侧缝合衬圈，所述前内侧缝合衬圈在由所述边缘的最前点和所述边缘的最内点限定的所述环形边缘的区段内从所述杯形主体的所述环形边缘向外延伸，和
后内侧缝合衬圈，所述后内侧缝合衬圈在由所述边缘的最后点和所述边缘的最内点限定的所述环形边缘的区段内从所述杯形主体的所述环形边缘向外延伸，其中所述侧向缝合衬圈、所述前内侧缝合衬圈和所述后内侧缝合衬圈彼此不连接。
13.根据权利要求12所述的模块化反转式肩部整形外科植入物，其中所述侧向缝合衬圈比所述前内侧缝合衬圈和所述后内侧缝合衬圈两者长。
14.根据权利要求12所述的模块化反转式肩部整形外科植入物，其中所述前内侧缝合衬圈和所述后内侧缝合衬圈在尺寸上相似并且沿所述杯形主体的所述环形边缘彼此相背对。
15.一种外科地修复患者肱骨的近侧骨折的方法，所述方法包括：
旋转锁紧螺钉以将细长肱骨杆部件固定到骨折骨骺部件，
将所述肱骨杆部件植入到所述患者肱骨的髓内管中，
推进第一缝合线使其穿过所述患者肱骨的肱骨干，穿过形成于所述骨折骨骺部件的环形缝合衬圈的第一缝合孔，并且穿过所述患者肱骨的更大结节近侧的患者肩袖，
推进第二缝合线使其穿过所述患者肱骨的肱骨干，穿过形成于所述骨折骨骺部件的所述环形缝合衬圈的第二缝合孔，并且穿过所述患者肱骨的更小结节近侧的患者肩袖，和
推进第三缝合线使其穿过位于所述骨折骨骺部件的外部下表面上的缝合凹坑中的第三缝合孔，穿过所述患者肱骨的更大结节，并且穿过所述患者肱骨的更小结节。
16.根据权利要求15所述的方法，还包括：
拉紧所述第三缝合线以便使所述患者肱骨的更大结节与所述患者肱骨的更小结节彼此接触，以及
系住所述第三缝合线以便将所述患者肱骨的更大结节与所述患者肱骨的更小结节固定成彼此接触。
17.根据权利要求16所述的方法，还包括在所述系住步骤之后将聚合的肱骨杯安装在所述骨折骨骺部件上。
18.根据权利要求15所述的方法，还包括将形成于所述肱骨杆部件的上表面的突片定位在形成于所述骨折骨骺部件的下表面的多个凹口中，以便在旋转所述锁紧螺钉之前，将所述骨折骨骺部件相对于所述肱骨杆部件以所选的扭转角进行定位。
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