CN108135587B - 在髋关节置换假体中从髋臼杯移除髋臼球的工具和方法 - Google Patents

在髋关节置换假体中从髋臼杯移除髋臼球的工具和方法 Download PDF

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CN108135587B
CN108135587B CN201680044145.9A CN201680044145A CN108135587B CN 108135587 B CN108135587 B CN 108135587B CN 201680044145 A CN201680044145 A CN 201680044145A CN 108135587 B CN108135587 B CN 108135587B
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jaw
acetabular
shaft
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CN108135587A (zh
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扎菲尔·特曼尼尼
布莱恩·万黑尔
琳达·布拉登
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Hip Innovation Technology LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4637—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30649—Ball-and-socket joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
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    • A61F2002/348—Additional features
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4619—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof for extraction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
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Abstract

用于从植入的髋关节假体中的髋臼杯提取髋臼球的手术工具，其中，髋臼球借助莫氏锥度附接到从髋臼杯的凹部的底部延伸的柄上。由于该工具在保持杯上的压力的同时施加相反的压力拉动球，因而该手术工具使外科医生能够在不拉动髋臼杯的情况下移除髋臼球，并且不会破坏任何骨长入。

Description

在髋关节置换假体中从髋臼杯移除髋臼球的工具和方法
技术领域
本发明涉及在反向髋关节假体(reverse hip prosthesis)中使用的手术工具。更具体地，本发明涉及用于从髋臼杯(acetabular cup)中提取髋臼球(acetabular ball)的手术工具。
相关技术
在美国专利第8,313,531B2号和第8,540,779B2号中描述了一种反向髋关节假体。在美国专利第8,992,627B2号中还描述了假体和翻修手术方法。这三个专利公开的整体内容通过引用并入本文。
发明内容
如上述专利所述，借助于莫氏锥度(Morse taper)将髋臼球附接到髋臼杯柄上。该髋臼杯柄从髋臼杯的凹面的底部延伸。本发明的手术工具使得外科医生能够从植入的假体上移除髋臼球，而无需拉动髋臼杯并且不破坏任何骨长入。在本公开中，我们不时地使用术语“髋臼球提取器”来描述本发明的工具，并且术语“工具”或“器械”有时用来指代本发明的第一和第二实施方式中的任一个或两者。
附图说明
图1是本发明的手术工具的第一实施方式的立体图。
图2是本发明的手术工具的第二实施方式的平面图。
图3是本发明的手术工具在第一步骤中的剖视图，示出了定位在已被附接在髋臼杯中的髋臼球上方的夹爪。
图4是与髋臼球和杯完全接合的第二步骤中的手术工具的平面图。
图5是沿着图4的剖面线A-A截取的剖视图。
图6是本发明的手术工具在第三步骤中的剖视图，示出了从髋臼杯的柄分离的髋臼球。
图7是用于髋臼球提取器的手柄或外轴的平面图。
图8是髋臼球提取器的夹爪组件的平面图。
图9是髋臼球提取器的阻挡杆的平面图。
图10是髋臼球提取器的手柄钟状件的平面图。
图11是髋臼球提取器的第二实施方式的轴螺母的平面图。
图12是本发明的工具的第二实施方式的局部分解图。
图12A是图12的近端的放大图。
具体实施方式
工具1是本发明的工具的第一实施方式，并且在图1中以立体的形式示出。工具1a是本发明的工具的第二实施方式，并且以局部分解图的形式和平面的形式分别在图12和图2中示出。
参考图1至图6，工具1包括夹爪轴10，夹爪轴10在其远端处具有两个或两个以上的夹爪2。每个夹爪2绕销12可枢转，其中销12具有垂直于夹爪轴10的中心轴线的轴线。夹爪轴10具有带螺纹的近端11(见图8、图12和图12A)。夹爪轴10同心地设置在外轴4中。本文称为手柄钟状件3的钟形元件附接到外轴4的远端。手柄钟状件3的内部尺寸设计成，当通过夹爪轴10朝向工具1的近端运动而使得夹爪2被拉入到手柄钟状件3中时，使夹爪2闭合，这将在下文中更详细的解释。手柄钟状件3在其远端处具有圆周钟状边缘33，圆周钟状边缘33的尺寸被设计成接合髋臼杯的圆周杯边缘23。外轴4具有可选的滚花部分5。
夹爪轴螺母9或9a通过螺纹拧到夹爪轴10的近端上，并且外轴螺母6或6a被附接到外轴4的近端上。当夹爪轴螺母邻接外轴螺母并且轴4的近端处的螺纹是右旋时，通过以顺时针方向(或右旋方向)旋转来拧紧夹爪轴螺母9或9a将在螺母6或6a上施加远端力(distalforce)，使得夹爪轴10相对于外轴4沿近端方向移动。作为进一步的解释，上述螺母彼此相邻地设置，并使夹爪轴螺母9或9a设置在外轴螺母6或6a的近端。夹爪轴10在图3、图5和图6中的以剖面的形式并在图8中以平面的形式示出。图12和图12A示出了夹爪轴10的带螺纹的近端11；图12A是图12中所示工具的近端A的放大图。图7是外轴4的、在其上具有外轴螺母6a的平面图。图8以平面的形式示出了其上具有夹爪2的夹爪轴10，而在图9中以平面的形式示出了阻挡杆8。图10和图11分别是手柄钟状件3和夹爪轴螺母9a的平面图。
工具1与工具1a之间的差别与外轴螺母6和6a以及夹爪轴螺母9和9a中的差别有关。螺母6和9是滚花的，并且在滚花部分中设置孔7以接纳用于在工具的操作中起到杠杆作用的阻挡杆8。螺母6a和9a也是滚花的，但是它们分别另外设置有六角部分14和15。在六角部分14和15中为阻挡杆8设置孔7a。六角部分允许外科医生使用一个或多个扳手(未示出)来代替一些或全部的阻挡杆，以在工具的操作期间获得增加的杠杆作用。当然，对于本领域技术人员而言显而易见的是，位于具有其它形状(不同于六角形状)的螺母的外表面上的扁平部分可被用来使得允许使用扳手或其它工具以获得增加的杠杆作用。
在图3至图6中示出了工具的操作。当沿远端方向推动夹爪轴10同时保持轴4时，夹爪2被允许打开，使得夹爪从手柄钟状件3移出。夹爪2通过销12铰接。在图3中，夹爪2在其被推出手柄钟状件3之后并且被推在髋臼球20上的剖面中示出。对于本领域技术人员而言可使用两个或两个以上的夹爪是显而易见的。髋臼球20借助于莫氏锥度牢固地附接在柄21上。柄21被附接到髋臼杯22的凹面并且从髋臼杯22的凹面延伸。
在图4和图5中，手柄钟状件3的远端处的圆周钟状边缘33已经被推至与髋臼杯22的圆周杯边缘23接合。当工具已经以此种方式与球和杯接合时，下一个步骤是在转动夹爪轴螺母9或9a的同时抓紧轴4，使夹爪轴沿近端方向移动，使得夹爪2拉动髋臼球20，同时手柄钟状件3在髋臼杯22的圆周杯边缘23上施加反作用力。反作用力防止拉动髋臼杯22，使得杯不会从髋臼中被拉出。当需要额外的杠杆作用以在髋臼球20上施加拉力并且在髋臼杯22上施加相反的推力时，棒或阻挡杆8放置在外轴螺母6或6a的孔7或7a中，并且另一个棒或阻挡杆8放置在夹爪轴螺母9或9a的孔7或7a中。孔7和7a垂直于螺母的中心轴线。如果需要更多的杠杆作用，则从轴螺母6a或9a中的一个或两个上移除阻挡杆8，并且通过将扳手的开口端(未示出)放置在一个或两个六角部分14或15上方而在任一个或两个轴螺母上使用扳手。如图6中的空间30所示，当施加足够的力时，球从柄21分离。

Claims (5)

1.一种手术工具，包括：
夹爪轴，具有设置在所述夹爪轴的远端处的、两个或多于两个的夹爪，每个所述夹爪具有弯曲内表面，所述弯曲内表面至少部分地抵靠髋臼球的大致球形表面，所述髋臼球借助莫氏锥度附接到从髋臼杯的凹面延伸的柄上，每个所述夹爪能够绕垂直于所述夹爪轴的中心轴线的轴线枢转，并且所述夹爪轴具有螺纹近端；
外轴，在所述外轴中同心地设置所述夹爪轴，所述外轴具有附接到其远端的钟形元件，所述钟形元件具有围绕所述钟形元件的远端处的开口的圆周钟状边缘，所述圆周钟状边缘的尺寸设计成与所述髋臼杯的圆周杯边缘抵靠接合；所述钟形元件内部尺寸设计成，当所述夹爪轴朝向所述手术工具的近端运动而使得所述夹爪被拉入所述钟形元件中时，使所述夹爪闭合并且所述夹爪的弯曲内表面的至少一部分抵靠接合所述髋臼球的弯曲表面；并且所述圆周钟状边缘与所述髋臼杯的圆周杯边缘抵靠接合；以及
夹爪轴螺母，螺纹连接到所述夹爪轴的近端上，其中，拧紧所述夹爪轴螺母会在所述外轴的近端上施加沿远端方向的压力，使所述夹爪轴相对于所述外轴向近端移动，从而使所述夹爪在所述髋臼球上施加拉力，同时在所述夹爪在所述髋臼球上施加拉力时所述夹爪将所述夹爪的弯曲内表面与所述髋臼球的弯曲表面接合，同时使所述钟形元件的所述圆周钟状边缘在所述髋臼杯的所述圆周杯边缘上施加反作用力，直到所述夹爪轴螺母的足够拧紧致使所述髋臼球从所述柄释放。
2.根据权利要求1所述的手术工具，还包括附接到所述外轴的近端的外轴螺母，所述夹爪轴螺母和所述外轴螺母彼此相邻地设置，并且所述夹爪轴螺母设置在所述外轴螺母的近端。
3.根据权利要求2所述的手术工具，其中，所述夹爪轴螺母和所述外轴螺母各自还包括分别垂直于它们的中心轴线的孔，每个所述孔的尺寸被设计为接纳棒，其中，所述棒起提供用于相对于所述外轴螺母转动所述夹爪轴螺母的杠杆作用。
4.根据权利要求3所述的手术工具，其中，所述夹爪轴螺母和所述外轴螺母中的一个或两个还在其外表面上包括扁平部分，以便于扳手或其它工具的接合以提供增加的杠杆作用。
5.一种套件，包含权利要求1所述的手术工具。
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