CN109199643B - Assembled ankle-protecting knee-protecting tibia dry prosthesis - Google Patents

Assembled ankle-protecting knee-protecting tibia dry prosthesis Download PDF

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Publication number
CN109199643B
CN109199643B CN201810615824.8A CN201810615824A CN109199643B CN 109199643 B CN109199643 B CN 109199643B CN 201810615824 A CN201810615824 A CN 201810615824A CN 109199643 B CN109199643 B CN 109199643B
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bone
tibia
prosthesis
protecting
knee
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CN109199643A (en
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屠重棋
赵坤
肖聪
王杰
卢敏勋
周勇
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West China Hospital of Sichuan University
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West China Hospital of Sichuan University
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/28Bones
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/28Bones
    • A61F2002/2892Tibia
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389The prosthesis being coated or covered with a particular material
    • A61F2310/00592Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
    • A61F2310/00796Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

The invention relates to a combined ankle-protecting knee-protecting tibia dry prosthesis, which comprises a tibia near-end base and a combined section prosthesis, wherein the bottom of the tibia near-end base is connected with the top of the combined section prosthesis, a bone trabecula structure is arranged at the top of the tibia near-end base, the center of the top surface of the bone trabecula structure is provided with a groove, a plurality of U-shaped nail holes and a plurality of suture holes are arranged on the side surface of the tibia near-end base so as to reconstruct a patellar ligament, the movement function of a knee joint is saved, and two nail channels are arranged on two sides of the tibia near-end base side by side. The bone trabecula structure is used at the top of the proximal tibial plateau, so that bone ingrowth can be promoted, the groove on the top surface of the bone trabecula structure is convenient to insert into cancellous bone, the artificial bone trabecula is convenient to combine tightly with bone, the aim of retaining epiphysis can be achieved, the bone growth capacity of an infant due to the excision or destruction of the epiphysis is reduced, and the deformity of lower limbs is avoided; and then the screw is used for auxiliary fixation, so that the initial stability and the middle-long term stability can be achieved, and meanwhile, the operation time and the operation difficulty are greatly reduced.

Description

Assembled ankle-protecting knee-protecting tibia dry prosthesis
Technical Field
The invention relates to the technical field of medical appliances, in particular to a combined ankle-protecting knee-protecting tibia dry prosthesis.
Background
Malignant bone tumors are common in the affected areas of the femur and tibia metaphysis, especially around the knee joint. Malignant bone tumor is common in children and teenagers in the age stage of onset. Tibia is an important weight-bearing bone, and is a main component of knee joint. Early diagnosis and multidisciplinary assistance by the use of neoadjuvant chemotherapy and adjuvant chemotherapy have led to 5-year survival rates approaching 80%. The implementation of new surgical techniques, the higher functional requirements of patients, the improvement of the design level of the prosthesis and the appearance of new imaging techniques make the limb-protecting surgery a possible existing conventional treatment mode.
But the current treatment mode for the proximal malignant bone tumor of the tibia of children or teenagers is as follows: after complete tumor resection, tibial tumor knee replacement is performed. The method can destroy metaphyseal parts of proximal tibia and distal femur of the affected side, has great influence on growth of bone of the affected side, can cause unequal length of lower limbs to claudication, and needs to carry out revision surgery for multiple times in the later period. The knee joint of the patient is ensured, and the bone defect is reconstructed, which cannot be satisfied by the existing prosthesis. When the tumor at the proximal end of the tibia is completely resected and the proximal epiphysis of the tibia can be completely reserved, the aim of obtaining good initial stability is to be achieved immediately, meanwhile, the interface is to be healed quickly, and good long-term stability and good knee joint function are also to be ensured, so that the method is an important point of current research.
Disclosure of Invention
The invention aims to provide a combined ankle-protecting knee-protecting tibia dry prosthesis which is beneficial to promoting bone ingrowth, promoting rapid healing of an interface and improving middle-long term stability.
In order to achieve the above purpose, the invention adopts the following technical scheme:
the combined ankle and knee protecting tibia dry prosthesis comprises a tibia near-end base and a combined section prosthesis, wherein the bottom of the tibia near-end base is connected with the top of the combined section prosthesis, a bone trabecula structure is arranged at the top of the tibia near-end base, a groove is formed in the center of the top surface of the bone trabecula structure, and a plurality of U-shaped nail holes and a plurality of suture holes are formed in the side surface of the tibia near-end base.
Furthermore, two nail channels are arranged on two sides of the proximal tibial abutment side by side, and penetrate through the bottom surface and the side wall of the groove in sequence.
Preferably, the side wall of the groove is a conical surface.
Further, the bone trabecular structure includes a lower abutment and an upper bone trabecular Liang Huanxing fence, the bone trabecular Liang Huanxing fence being centered on the abutment top surface, the abutment covering the top surface of the tibial proximal abutment.
Preferably, the height of the abutment is 2mm and the height of the bone-small Liang Huanxing-bar is 5mm.
Further, the thickness of the top of the bone small Liang Huanxing fence is 1mm, and the thickness of the bottom of the bone small Liang Huanxing fence is 5mm.
Further, the assembled section prosthesis comprises a shank extension section and a distal prosthesis, wherein the distal prosthesis comprises a distal abutment and an intramedullary stem, the top of the intramedullary stem is connected with the bottom of the distal abutment, the top of the distal abutment is connected with the bottom of the shank extension section, and the top of the shank extension section is connected with the bottom of the shank proximal abutment.
The bottom surface of the tibia stem extension section is provided with a limiting table, the bottom surface of the limiting table is provided with an outer cone extending towards a far-end base table, the top surface of the far-end base table is provided with a limiting groove matched with the limiting table, the bottom surface of the limiting groove is provided with an inner cone cavity matched with the outer cone, and the limiting table is in interference fit with the limiting groove; the proximal tibial abutment bottom has the location boss that extends to the dry extension of tibia, the dry extension top surface of tibia has the caulking groove with the cooperation of location boss, location boss and caulking groove interference fit.
Wherein, the proximal tibial abutment, the tibial stem extension and the distal prosthesis are all made of titanium alloy.
Further, the outer surface of the lower part of the distal abutment and the outer surface of the upper part of the intramedullary stem are both provided with a hydroxyapatite coating.
Compared with the prior art, the invention has the following beneficial effects:
1. In the invention, the bone trabecular structure is used at the top of the proximal tibial plateau, so that bone ingrowth can be promoted, and the middle-long-term stability is achieved; the conical grooves are formed in the top surface of the trabecula structure, so that the trabecula structure is convenient to insert into cancellous bone, the artificial trabecula is convenient to combine with bone tightly, and two crossed screws on the inner side and the outer side are assisted to fix, so that the initial stability can be achieved, and the operation time and the operation difficulty are greatly reduced;
2. The invention can achieve the purpose of reserving epiphysis, the limit residual proximal tibia only needs to reserve 2cm in length, and for patients with proximal tibia malignant tumor (especially children), the invention can achieve the purpose of delaying replacement of tumor knee joints, reserve own knee joints, reserve proximal tibia and distal femur epiphysis, and reduce double lower limb deformity caused by resection or destruction of epiphysis;
3. A U-shaped nail hole is reserved in front of the proximal tibial abutment, so that the U-shaped nail or the Kirschner wire can be conveniently driven in all directions, the patellar ligament can be rebuilt, and the movement function of the knee joint can be saved; the whole prosthesis is all biological type fixed without bone cement.
4. The self ligament around the knee joint can be reserved without considering the problem of reconstructing the surrounding ligament, thereby ensuring the stability of the knee joint.
Drawings
FIG. 1 is a schematic diagram of the structure of the present invention;
FIG. 2 is a three-dimensional view of a tibial proximal console;
FIG. 3 is a cross-sectional view of a tibial proximal console;
FIG. 4 is a cross-sectional view of a tibial stem extension;
FIG. 5 is a cross-sectional view of the distal prosthesis;
In the figure: 1-proximal tibial plateau, 2-tibial stem extension, 3-distal prosthesis, 4-hydroxyapatite coating, 5-nail canal, 6-suture hole, 7-U-shaped nail hole, 11-trabecular plateau, 12-bone trabecular Liang Huanxing fence, 13-groove, 14-trabecular structure, 15-positioning boss, 21-caulking groove, 23-external taper, 24-limit table, 31-distal abutment, 32-intramedullary stem, 33-internal taper cavity, 34-limit groove.
Detailed Description
The present invention will be described in further detail with reference to the accompanying drawings, in order to make the objects, technical solutions and advantages of the present invention more apparent.
As shown in fig. 1, the assembled ankle-protecting knee-protecting tibia dry prosthesis disclosed by the invention comprises a tibia near-end base 1 imitating tibia anatomical morphology characteristics and an assembled segment prosthesis, wherein the bottom of the tibia near-end base 1 is connected with the top of the assembled segment prosthesis, and the assembled segment prosthesis comprises a tibia diaphysis extension segment 2 and a distal prosthesis 3. The characteristics of the tibia imitating anatomical morphology are that the biomechanical conduction is more in accordance with the normal tibia condition.
The distal prosthesis 3 comprises a distal abutment 31 and an intramedullary stem 32, the top of the intramedullary stem 32 being connected to the bottom of the distal abutment 31, the top of the distal abutment 31 being connected to the bottom of the tibial stem extension 2, the top of the tibial stem extension 2 being connected to the bottom of the tibial proximal abutment 1. The proximal tibial abutment 1, the stem extension 2 and the distal prosthesis 3 are made of titanium alloy, and the outer surface of the lower part of the distal abutment 31 and the outer surface of the upper part of the intramedullary stem 32 are provided with hydroxyapatite coatings 4.
The bone trabecula structure 14 is arranged at the top of the tibia near-end base 1, so that bone ingrowth can be promoted, and the middle-long term stability can be achieved; while the trabecular bone structure 14 demonstrates a large roughness, increases friction and reduces slippage. The side of the tibia near-end base 1 is provided with a plurality of U-shaped nail holes 7 and a plurality of suture holes 6, the U-shaped nail holes 7 are reserved in front of the tibia near-end base 1, so that the tibia near-end base 1 can be conveniently driven into a U-shaped nail or a Kirschner wire in all directions, a patellar ligament is fixed, and strip-shaped suture holes 6 are reserved for reinforcing the patellar ligament to be fixed; the whole prosthesis is all biological type fixed without bone cement.
As shown in fig. 2 and 3, the center of the top surface of the bone trabecular structure 14 is provided with a groove 13, two nail paths 5 are arranged on two sides of the tibia proximal base 1 side by side, the nail paths 5 sequentially penetrate through the bottom surface and the side wall of the groove 13, and the nail paths 5 are used for auxiliary fixation of mounting screws in the initial stage and can be removed in the later stage. Preferably, the side walls of the recess 13 are tapered. The grooves 13 are convenient for inserting cancellous bone, so that the artificial bone trabecula is convenient to combine tightly with the bone, and then the two intersecting screws on the inner side and the outer side are used for fixing in an auxiliary manner, so that the initial stability can be achieved, and the operation time and the operation difficulty are greatly reduced.
The trabecular structure 14 comprises a lower trabecular platform 11 and an upper small bone Liang Huanxing fence 12, the small bone Liang Huanxing fence 12 is arranged in the center of the top surface of the trabecular platform 11, the trabecular platform 11 covers the top surface of the proximal tibial abutment 1, and the inner peripheral area of the small bone Liang Huanxing fence 12 forms a groove 13. The height of the trabecular platform 11 is 2mm, and the height of the bone small Liang Huanxing fence 12 is 5mm. The thickness of the top of the bone small Liang Huanxing fence 12 is 1mm and the thickness of the bottom of the bone small Liang Huanxing fence 12 is 5mm.
As shown in fig. 3 and 4, a positioning boss 15 extending towards the tibia stem extension section 2 is arranged at the bottom of the tibia proximal base 1, a caulking groove 21 matched with the positioning boss 15 is arranged on the top surface of the tibia stem extension section 2, the positioning boss 15 is in interference fit with the caulking groove 21, and the length of the positioning boss 15 is 1cm. Of course, the length of the positioning boss 15 may be set as desired. A specially-made positioning boss 15 is reserved as a combination interface, and a combination section can be added according to the length of the tibia defect.
As shown in fig. 4 and 5, the lower end of the tibial stem extension section 2 is provided with an outer cone 23 extending towards a distal abutment 31, the top of the distal abutment 31 is provided with an inner cone cavity 33 matched with the outer cone 23, and the outer cone 23 is in interference fit with the inner cone cavity 33. The bottom surface of the shank extension section 2 is provided with a limiting table 24, the outer cone 23 is arranged on the bottom surface of the limiting table 24, the top surface of the distal base table 31 is provided with a limiting groove 34 matched with the limiting table 24, the inner cone cavity 33 is arranged on the bottom surface of the limiting groove 34, and the limiting table 24 is in interference fit with the limiting groove 34. The tibial diaphysis extension section 2 is connected with the distal prosthesis 3 in a matched manner, and the matched section can be increased according to the length of the tibial defect.
The invention can achieve the aim of deferring the replacement of the tumor knee joint for patients with proximal tibia malignant tumors, especially children, reserve the knee joint of the patients, reserve the distal femur epiphysis, and reduce double lower limb deformity caused by epiphysis excision or damage.
There are, of course, many other embodiments of the invention that can be made by those skilled in the art in light of the above teachings without departing from the spirit or essential scope thereof, but that such modifications and variations are to be considered within the scope of the appended claims.

Claims (7)

1. The combined ankle-protecting knee-protecting tibia dry prosthesis comprises a tibia near-end base (1) and a combined section prosthesis, wherein the bottom of the tibia near-end base (1) is connected with the top of the combined section prosthesis; the side surface of the tibia proximal base (1) is provided with a plurality of U-shaped nail holes (7) and a plurality of suture holes (6); two nail channels (5) are arranged on two sides of the tibia near-end base (1) side by side, and the nail channels (5) sequentially penetrate through the bottom surface and the side walls of the groove (13);
The bone trabecular structure (14) comprises a bone trabecular platform (11) at the lower part and a bone small Liang Huanxing fence (12) at the upper part, wherein the bone small Liang Huanxing fence (12) is arranged on the top surface of the bone trabecular platform (11), and the bone trabecular platform (11) covers the top surface of the tibia near-end base (1).
2. The modular ankle-and knee-protecting tibial dry prosthesis of claim 1, wherein: the height of the trabecular bone platform (11) is 2mm, and the height of the small Liang Huanxing-bone fence (12) is 5mm.
3. The modular ankle-and knee-protecting tibial dry prosthesis of claim 1 or 2, wherein: the thickness of the top of the bone small Liang Huanxing fence (12) is 1mm, and the thickness of the bottom of the bone small Liang Huanxing fence (12) is 5mm.
4. The modular ankle-and knee-protecting tibial dry prosthesis of claim 1, wherein: the assembly section prosthesis comprises a shank extension section (2) and a distal prosthesis (3), wherein the distal prosthesis (3) comprises a distal abutment (31) and an intramedullary stem (32), the top of the intramedullary stem (32) is connected with the bottom of the distal abutment (31), the top of the distal abutment (31) is connected with the bottom of the shank extension section (2), and the top of the shank extension section (2) is connected with the bottom of the shank proximal abutment (1).
5. The modular ankle and knee protecting tibial dry prosthesis of claim 4, wherein: the tibia stem extension section (2) is characterized in that a limiting table (24) is arranged on the bottom surface of the tibia stem extension section (2), an outer cone (23) extending towards a distal base (31) is arranged on the bottom surface of the limiting table (24), a limiting groove (34) matched with the limiting table (24) is formed in the top surface of the distal base (31), an inner cone cavity (33) matched with the outer cone (23) is formed in the bottom surface of the limiting groove (34), and the limiting table (24) is in interference fit with the limiting groove (34); the proximal tibial abutment (1) bottom has location boss (15) to the extension of shank extension (2), shank extension (2) top surface have with caulking groove (21) of location boss (15) adaptation, location boss (15) and caulking groove (21) interference fit.
6. The modular ankle-and knee-protecting tibial dry prosthesis of claim 4 or 5, wherein: the tibia near-end base (1), the tibia stem extension section (2) and the distal prosthesis (3) are all made of titanium alloy.
7. The modular ankle and knee protecting tibial dry prosthesis of claim 6, wherein: the outer surface of the lower part of the far end base (31) and the outer surface of the upper part of the intramedullary stem (32) are both provided with a hydroxyapatite coating (4).
CN201810615824.8A 2018-04-26 2018-06-14 Assembled ankle-protecting knee-protecting tibia dry prosthesis Active CN109199643B (en)

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CN109199643B (en) * 2018-04-26 2024-05-31 四川大学华西医院 Assembled ankle-protecting knee-protecting tibia dry prosthesis
CN109984872A (en) * 2019-04-25 2019-07-09 苏州伯塔医疗科技有限公司 A kind of proximal humerus protects head and prosthese transformation treatment device
CN111134907A (en) * 2020-01-08 2020-05-12 武汉优联百康医疗科技有限公司 Novel tibial prosthesis locking handle and preparation method thereof
CN111467087A (en) * 2020-05-18 2020-07-31 四川大学华西医院 3D prints porous thighbone near-end arc intramedullary handle in surface
CN111888055A (en) * 2020-08-06 2020-11-06 北京市春立正达医疗器械股份有限公司 Femur distal prosthesis with retained epiphysis
CN111870409A (en) * 2020-08-14 2020-11-03 北京力达康科技有限公司 Tibia far-end ankle joint prosthesis
CN111938878A (en) * 2020-08-28 2020-11-17 中国人民解放军总医院 Tibia prosthesis
CN112472371A (en) * 2020-12-04 2021-03-12 北京力达康科技有限公司 Keep shin bone false body of bone dirt line
CN113425464A (en) * 2021-05-11 2021-09-24 上海市第一人民医院 Joint prosthesis
CN113413249B (en) * 2021-07-06 2023-01-13 四川大学华西医院 Dissect bionical type shin bone near-end tumour half knee joint prosthesis
CN113456313B (en) * 2021-07-06 2022-07-05 四川大学华西医院 Hinge-free ligament bionic type tumor half/total knee joint prosthesis reconstruction system

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