CN109199647A - 半髁式人工膝关节 - Google Patents

半髁式人工膝关节 Download PDF

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Publication number
CN109199647A
CN109199647A CN201710530828.1A CN201710530828A CN109199647A CN 109199647 A CN109199647 A CN 109199647A CN 201710530828 A CN201710530828 A CN 201710530828A CN 109199647 A CN109199647 A CN 109199647A
Authority
CN
China
Prior art keywords
knee joint
tibial
condyle
prosthesis
shin 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.)
Granted
Application number
CN201710530828.1A
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English (en)
Other versions
CN109199647B (zh
Inventor
朱红文
黄国富
董荣华
朱天谋
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Guizhou Outras Technology Co ltd
Original Assignee
Tianjin Fuhua Medical Science And Technology Co Ltd
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Tianjin Fuhua Medical Science And Technology Co Ltd filed Critical Tianjin Fuhua Medical Science And Technology Co Ltd
Priority to CN201710530828.1A priority Critical patent/CN109199647B/zh
Priority to PCT/CN2018/093790 priority patent/WO2019007287A1/zh
Priority to EP18828229.7A priority patent/EP3649989A4/en
Priority to JP2020522772A priority patent/JP7011057B2/ja
Priority to US16/628,033 priority patent/US11129721B2/en
Publication of CN109199647A publication Critical patent/CN109199647A/zh
Application granted granted Critical
Publication of CN109199647B publication Critical patent/CN109199647B/zh
Active legal-status Critical Current
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Abstract

本发明记载了一种半髁式人工膝关节，该膝关节包括股骨假体和胫骨假体，所述胫骨假体截面呈类腰型，所述胫骨假体设置在胫骨平台髁间脊的一侧，并位于股骨假体的下方，该人工膝关节还包括固定胫骨假体的定位销；在所述胫骨假体的底面上开设有假体豁槽，在所述胫骨假体的下方开设有胫骨豁槽，所述假体豁槽与所述胫骨豁槽相对应，一起构成容纳定位销的限位孔洞；通过该定位销与限位孔洞的配合能够确保胫骨假体与胫骨平台髁间脊之间相对位置稳定、平衡，当两个半髁式(内外侧)人工(半)膝关节同时安装在一个膝关节中时，两个人工(半)膝关节中的限位孔洞联通，共用一个定位销，从而形成一个完整地组合式全膝关节；所述胫骨假体包括上垫片和下垫片，在下垫片上设置有弹性构件。

Description

半髁式人工膝关节
技术领域
本发明涉及一种医用人工关节假体，具体涉及一种半髁式人工膝关节。
背景技术
目前，膝关节替换手术是世界上针对膝关节病变和损伤的最根本性治疗方案，替换手术中将关节假体也称之为人工膝关节植入到人体内，用以替换人体天然的膝关节；随着科技的逐渐进步，对于人工膝关节和替换手术的进一步要求越来越高，人们既希望减少痛苦，还希望提高使用寿命，更希望术后恢复效果更佳，甚至希望能达到正常健康人的水平，为此，各种各样的人工膝关节逐步问世，各种构思设想纷纷提出，然而，目前主流的手术方法及人工膝关节还远远不能满足上述要求；
人体的两个主要腿骨是股骨和胫骨，股骨在上，胫骨在下，股骨和胫骨相交并且相互作用的位置即为膝关节；在膝关节中的一段股骨称之为股骨下端，在膝关节中的一段胫骨称之为胫骨上端；股骨下端和胫骨上端变大，为膝关节的稳定提供支撑基础；
股骨下端形成两个分离的髁，髁的下表面是平滑的圆形并且被关节软骨覆盖，所述两个分离的髁并不是对称的，内侧髁较大，外侧髁较小，以适应内侧和外侧不同的受力情况；胫骨上端包括浅的、凹形的、被关节软骨所覆盖的外侧和内侧平台，内侧平台大于外侧平台，整个胫骨平台被外侧平台和内侧平台之间的隆起或结节所分离；
髌骨(膝盖骨)埋在股四头肌肌腱中，股四头肌肌腱将前上大腿的股四头肌肌肉组织连接到髌骨，髌骨韧带将髌骨连接到位于膝关节正下方的胫骨；股四头肌肌腱、髌骨和髌骨韧带的组合更像一个滑轮，将由股四头肌肌肉组织产生的力经由屈曲的膝关节传递至胫骨，从而使得腿变直或者减慢屈曲的速度，显然，髌骨也具有保护膝关节免受撞击损伤的其他功能；
交叉韧带的作用是在屈曲和伸展期间使髁大致定位在胫骨上，在膝关节的屈曲期间，由前交叉韧带所施加的张力限制髁向后位移，在膝关节的伸展期间，后交叉韧带限制髁向前位移；
膝关节半月板对于膝关节发挥正常功能具有至关重要的作用，除了增加关节对称性外，半月板在使力经过膝关节时得到缓冲和分化，减弱股骨与胫骨之间的摩擦和冲击；
然而，目前流行的膝关节置换手术中，往往是直接切除自然的胫骨平台，换上人工的胫骨平台，并且在股骨表面安装有形状类似的股骨髁假体，从而使得新的股骨髁假体与人工胫骨平台相互作用，这就导致术后的膝关节中没有了交叉韧带和半月板，有的甚至连髌骨也没有了，所以现行的手术方法及相应的人工膝关节本身特性导致了这样的手术后不可能具有期望的恢复效果，这样的手术破坏了膝关节原有的生理结构和特性，对膝关节造成了永久性的不可逆损坏，急需做出调整，需要一种能够保留交叉韧带、髌骨，并具有半月板缓冲功能的新的人工膝关节。
另外，经过多年临床研究获知，膝关节病变中，内侧髁和外侧髁，内侧平台和外侧平台的损伤程度并不相同，往往受到人的行为习惯、工作习惯等影响，位于内侧的髁或平台先行损坏，再导致另外一侧的髁或平台加速损坏，并且在此过程中病人承受巨大痛苦，如果此过程中进行手术，往往将没有损坏的一侧也一同切除，因为胫骨平台和新的股骨髁都是整体式的；而且，大多数膝关节病变都是由、半月板、股骨髁或者胫骨平台退变、磨损导致的，交叉韧带和髌骨损坏的极少；
为此，有人提出用半髁式膝关节替换已有的整体式膝关节，这种想法虽然值得提倡，但是在实际执行过程中却遇到了极大困难，最终无法实现，或者其真实效果还要低于原本的整体式膝关节；其主要问题在于，当更换了半髁式膝关节，更换部分与完好部分在功能、高度上不匹配，不能有效延缓完好部分的损坏速度，当原本完好的另一部分膝关节也损坏后，仍然需要手术更换人工膝关节，此时如果也使用半髁式膝关节，则两个半髁式膝关节在高度、尺寸、弹性等方面难以协调一致，使用效果不良，如果更换整体式膝关节，原来更换的半髁式膝关节又显得毫无意义，还涉及到胫骨与股骨的二次破损安装。
由于上述问题，本发明人对现有的人工膝关节做了深入研究，设计出一种能够解决上述问题的新的半髁式人工膝关节。
发明内容
为了克服上述问题，本发明人进行了锐意研究，设计出一种半髁式人工膝关节，该膝关节包括股骨假体和胫骨假体，所述胫骨假体截面呈类腰型，所述胫骨假体设置在胫骨平台髁间脊的一侧，并位于股骨假体的下方，在所述胫骨假体的底面上开设有假体豁槽，在所述胫骨假体的下方的胫骨上开设有胫骨豁槽，所述假体豁槽与所述胫骨豁槽相对应，与髁间脊孔洞一起构成限位孔洞；所述限位孔洞穿透/穿入胫骨平台髁间脊，该人工膝关节还包括可嵌入到所述限位孔洞中的定位销，通过该定位销与限位孔洞的配合能够确胫骨假体与胫骨平台髁间脊之间相对位置稳定、平衡，当两个半髁式人工膝关节同时安装在一个膝关节的内外侧时，两个半髁人工膝关节中的限位孔洞联通，共用一个定位销，形成一个完整地组合式全膝关节；所述胫骨假体包括上垫片和下垫片，在下垫片上设置有弹性构件，从而完成本发明。
具体来说，本发明的目的在于提供一种半髁式人工膝关节，其特征在于，该膝关节包括股骨假体1和胫骨假体2，
所述胫骨假体2设置在胫骨平台髁间脊31的一侧，并位于股骨假体1的下方。
其中，所述胫骨假体2包括上垫片21和下垫片22，
其中，在下垫片22上设置有弹性构件6，通过该弹性构件6来缓冲由股骨假体1传递至胫骨假体2上垫片的冲击力，使得上垫片21具有类半月板功能。
其中，所述弹性构件6贯穿下垫片22，并固定安装在下垫片22上，上端伸出下垫片22上方，顶置于上垫片下表面。
其中，所述弹性构件6包括套筒61和弹簧62，弹簧62下端埋置于套筒61中，弹簧上端顶置于上垫片下表面，
套筒61穿过下垫片22，套筒底端安装于胫骨上的孔腔7中。
其中，在所述套筒61底部设有调节所述弹簧62松紧的螺栓63。
其中，所述胫骨假体2置于髌骨后侧下方。
其中，该人工膝关节还包括定位销5；通过所述定位销5将胫骨假体2固定于胫骨上。
其中，所述定位销5一端上部安装于胫骨假体2中，其另一端嵌入到胫骨平台髁间脊31中。
其中，在所述胫骨假体2的底部开设有假体豁槽23，
在所述胫骨假体2之下的胫骨顶部开设有胫骨豁槽32，所述假体豁槽23与所述胫骨豁槽32相对应，一起形成容纳定位销5的限位孔洞4，且该限位孔洞穿入胫骨平台髁间脊31。
本发明还提供一种如上文所述的半髁式人工膝关节的使用方法，该方法包括如下步骤：
步骤1，将股骨假体1安装在股骨髁上；
步骤2，在胫骨平台上开设出安放胫骨假体2的空间，
步骤3，在胫骨上挖出胫骨豁槽32并延伸该胫骨豁槽32至胫骨平台髁间脊31，在胫骨平台髁间脊31上形成髁间脊孔洞33；
步骤4，在胫骨上挖出孔腔7；
步骤5，将胫骨假体2上的套筒嵌入到孔腔7中，同时调整假体豁槽21、胫骨豁槽32和髁间脊孔洞33的相对位置，使得假体豁槽21与胫骨豁槽32、以及髁间脊孔洞33一起构成限位孔洞4；
步骤6，将定位销5安装到限位孔洞4中，待定位销5固定后通过骨水泥固定胫骨假体2；
其中，优选地，在执行步骤5以前，通过旋转螺栓63调节弹簧62的松紧。
本发明所具有的有益效果包括：
(1)根据本发明提供的人工膝关节具有较小的胫骨假体，能够放置在胫骨平台髁间脊的侧部，从而使得不必切除、破坏胫骨平台髁间脊，所以胫骨平台髁间脊上的交叉韧带可以完好保留，从而使得使用效果和患者体验极大增强；
(2)根据本发明提供的人工膝关节具有较小的胫骨假体，可以根据病情只更换一部分膝关节，或者分阶段进行假体移植，先更换或者只更换一个本申请提供的半髁式人工膝关节，如有必要，可以后续再更换一个本申请提供的半髁式人工膝关节，实际应用更为灵活方便；
(3)根据本发明提供的人工膝关节的胫骨假体上设置有弹性构件，能够模拟半月板的功能，提供缓冲减震效果，使得人工膝关节与自然膝关节更加实质性相似；
(4)根据本发明提供的人工膝关节胫骨假体的弹性构件中弹簧弹性/弹力可调，可以根据不同年龄和身体状况进行调节，能够确保该弹簧弹性/弹力处于最佳的状态；
(5)根据本发明提供的人工膝关节胫骨假体的弹性构件设置在向下凸出的筒状结构中，该筒状结构嵌入到胫骨上的孔腔内，从而还能够启动对胫骨假体的限位固定作用；
(6)根据本发明提供的人工膝关节的胫骨假体上开设有假体豁槽，还设置有连通胫骨假体与胫骨平台髁间脊的定位销，从而将胫骨假体完全固定在胫骨上，固定方式简单，效果良好；
(7)根据本发明提供的人工膝关节的胫骨假体上开设有假体豁槽，还设置有连通胫骨假体与胫骨平台髁间脊的定位销，能够在必要的时候允许再添加一个半髁式人工膝关节，并且可以通过延长、贯通限位孔洞，即将髁间脊孔洞由盲孔变为通孔，通过原定位销固定两个半髁式人工膝关节，全方位地限制固定了两个胫骨假体之间的相对位置，使得人工膝关节受力均衡，整体稳态，使用寿命长，患者体验良好。
附图说明
图1示出根据本发明一种优选实施方式的半髁式人工膝关节装配爆炸图；
图2示出根据本发明一种优选实施方式的半髁式人工膝关节中股骨假体结构示意图；
图3示出根据本发明一种优选实施方式的半髁式人工膝关节中限位孔洞/定位销截面形状图示意图；
图4示出根据本发明一种优选实施方式的半髁式人工膝关节中限位孔洞/定位销截面形状图示意图；
图5示出根据本发明一种优选实施方式的半髁式人工膝关节中限位孔洞/定位销截面形状图示意图；
图6示出根据本发明一种优选实施方式的半髁式人工膝关节中胫骨假体结构示意图；
图7示出根据本发明一种优选实施方式的半髁式人工膝关节中胫骨假体上弹性构件剖视图；
图8示出根据本发明一种优选实施方式的半髁式人工膝关节胫骨结构示意图；
图9示出根据本发明一种优选实施方式的半髁式人工膝关节中安放两个半髁式人工膝关节的胫骨结构示意图；
图10示出根据本发明一种优选实施方式的人工膝关节中股骨假体与股骨装配爆炸图；
图11示出根据本发明一种优选实施方式的人工膝关节中股骨假体与股骨装配后的结构示意图。
附图标号说明：
1-股骨假体
11-前扣盖
12-固定刺
13-后扣盖
14-固定销
2-胫骨假体
21-上垫片
22-下垫片
23-假体豁槽
3-胫骨
31-胫骨平台髁间脊
32-胫骨豁槽
33-髁间脊孔洞
4-限位孔洞
5-定位销
6-弹性构件
61-套筒
62-弹簧
63-螺栓
7-孔腔
8-股骨
具体实施方式
下面通过附图和实施例对本发明进一步详细说明。通过这些说明，本发明的特点和优点将变得更为清楚明确。
在这里专用的词“示例性”意为“用作例子、实施例或说明性”。这里作为“示例性”所说明的任何实施例不必解释为优于或好于其它实施例。尽管在附图中示出了实施例的各种方面，但是除非特别指出，不必按比例绘制附图。
根据本发明提供的半髁式人工膝关节，如图1中所示，该人工膝关节包括股骨假体1和胫骨假体2，其中，股骨假体1设置在股骨8下端，并替换股骨下端的一部分骨结构，胫骨假体2设置在胫骨3上端，并替换胫骨上端胫骨平台上的一部分骨结构；本申请中所述胫骨平台为胫骨上与股骨下端接触的面，胫骨平台的中央有胫骨平台髁间脊31，也称之为隆起或结节，其上附着有十字交叉韧带，胫骨平台主要由所述胫骨平台髁间脊两侧的内侧平台和外侧平台构成。
所述胫骨假体2用以替换内侧平台或外侧平台，所述胫骨假体替换内侧平台或外侧平台后，胫骨平台上未被替换部分(胫骨平台髁间脊)高度与胫骨假体高度基本一致，即经由胫骨假体替换了一部分胫骨结构后，胫骨高度和外形都没有变化。
所述股骨假体只有一个单髁，包括前扣盖11、固定刺12、后扣盖13和固定销14，如图1和图2中所示；
具体来说，如图10和图11中所示，所述股骨假体1的外形与其替换的部分股骨外形一致，其外部呈圆弧面状，在股骨假体1的两端分别设置前扣盖11和后扣盖13，用以使得所述股骨假体固定在股骨上，其中，所述后扣盖13顶端朝向前扣盖方向倾斜；
安装所述股骨假体时，首先在股骨上挖出内凹的假体固定区域，当股骨假体安装在该区域内以后，刚好可以将该区域填满，使得股骨恢复到挖出所述假体固定区域以前的状态；即股骨假体1通过嵌入到假体固定区域来固定在股骨上。
在股骨假体的内侧还设置有固定刺12和固定销14，在股骨上加工假体固定区域时，还要在相应位置，在骨松质中挖出盲孔，股骨假体1扣合在假体固定区域时，固定销14嵌入到所述盲孔内；
同时，在骨松质上，靠近前骨皮质处开设出锥形槽/锥形孔，其中，所述前骨皮质是指与前扣盖11相接触的骨皮质，所述锥形槽/锥形孔的具体形状、数量都与固定刺12的形状、数量相对应，当股骨假体扣合在假体固定区域时，固定刺12上尖锐的插入到该锥形槽/锥形孔内；
优选地，盲孔的孔径尺寸略小于固定销14的外径尺寸；在固定销14嵌入到盲孔内的过程中，必然会迫使盲孔的孔径扩大，压迫该骨松质区域，从而形成紧密的固结；
优选地，所述固定刺12和固定销14都可以是一个或多个，本申请中优选地固定刺有两个，固定销有一个，相应地，所述盲孔和锥形槽/锥形孔的数量与固定销14和固定刺12的数量匹配。
股骨上与所述前扣盖11、后扣盖13相接触的区域为骨皮质区域，具有较高的强度和韧性；
本发明进一步优选地，前扣盖11与所述固定刺12临近，前扣盖11扣在骨皮质外部，固定刺12插入到骨松质中，并且从内侧顶在骨皮质上，从而加紧骨皮质，与后扣盖13一同形成窝槽进而扣合固定在股骨上；同时，前扣盖11与所述固定刺12一起组成截面呈V型的槽状结构，股骨上经过磨削加工的骨皮质即顶在该槽状结构的底部；通过所述固定刺12和所述截面呈V型的槽状结构共同辅助前扣盖11对骨皮质的固定，从而使得前扣盖11和后扣盖13可以卡扣在股骨上；能够科学合理地使得股骨假体与股骨之间的固结牢固可靠，能够经受长时间的考验。
在一个优选的实施方式中，所述股骨假体的表面积尺寸较小，所以体积和重量都较小，具体来说，所述股骨假体1外表面的面积约占股骨内侧半髁/股骨外侧半髁外表面积的60％以下，优选地可达到40％～55％左右；本申请中优选为50％左右，相当于股骨髁表面积的四分之一左右；
所述股骨假体位于股骨滑车的一侧，股骨假体1的替换不影响股骨滑车的正常工作，所以替换股骨假体1对于髌骨的正常工作及安装位置无影响。
本发明中优选地，所述胫骨假体位于股骨假体1的下方，该胫骨假体替换发生病变的内侧平台或者外侧平台，为了放置固定所述胫骨假体，需要对胫骨或者胫骨平台作出一定结构上的改造，当所述胫骨假体只有一个时，改造后的胫骨或者为胫骨平台如图8中所示。
如果在已经更换了本申请所述的单髁式人工膝关节后，另外半髁关节也发生病变破损后，需用用另一个半髁式人工膝关节进行替换，即胫骨平台上设置两个胫骨假体，所述两个胫骨假体2分别设置在胫骨平台髁间脊31的两侧，胫骨假体2替换胫骨平台中的内侧平台和外侧平台，并承托股骨假体1。当胫骨假体有两个时，改造后的胫骨或者称之为胫骨平台如图9中所示。
所述胫骨假体2的上表面具有向内、向下凹陷，类似于天然胫骨平台上的内侧平台和外侧平台，如图1中所示。
所述胫骨假体2的截面呈腰型或者类腰型，其外轮廓与被挖掉的部分胫骨平台一致，所述截面为水平截面。
所述胫骨假体2的截面尺寸约为胫骨平台截面尺寸的三分之一。
在一个优选的实施方式中，如图1中所示，该人工膝关节还包括固定胫骨假体2的定位销5；
优选地，所述定位销5一端上部安装于胫骨假体2中，其另一端嵌入到胫骨平台髁间脊31中；
具体来说，在所述胫骨平台髁间脊上还开设有髁间脊孔洞33，定位销一端埋置在髁间脊孔洞33中，另一端的上部安装于胫骨假体2中，另一端的下部安装于胫骨中。
在一个优选的实施方式中，如图6中所示，在所述胫骨假体2的底部开设有假体豁槽23，
在所述胫骨假体2的下方开设有胫骨豁槽32；即，在所述胫骨假体下方的胫骨/胫骨平台上开设有胫骨豁槽32，如图8和图9中所示。
所述假体豁槽23与所述胫骨豁槽32相对应，与髁间脊孔洞33一起构成限位孔洞4，该限位孔洞用于安装所述定位销5，如图3、图4和图5中所示。
当所述胫骨假体2只有一个时，即为单髁式人工膝关节，所述限位孔洞延伸至胫骨平台髁间脊31内，并不穿透所述胫骨平台髁间脊31，即髁间脊孔洞是盲孔。
在一个优选的实施方式中，定位销的长度值大于一个胫骨假体2上假体豁槽23的长度值，该定位销的长度值小于一个假体豁槽23的长度值与胫骨平台髁间脊31宽度值之和。从而，当胫骨假体只有一个时，该定位销能够满足定位固定作用，当在同一关节上安装第二个半髁式人工膝关节时，即胫骨假体再增加一个时，所述限位孔洞4的长度自然随之延长，即，在安装第二个胫骨假体时，将原本的限位孔洞延伸、延长，即将髁间脊孔洞由盲孔变为通孔，其中，在一个优选实施方式中，该定位销可以进一步向延长后的限位孔洞内深入移动，最终定位销完全贯穿胫骨平台髁间脊31，定位销的两端都嵌入到假体豁槽23内，起到对胫骨假体2的限位和固定作用；在另外一种优选实施方式中，将原来的定位销取出，更换一个长度更长的定位销，同样插入到所述限位孔洞内；本发明中优选地，不更换定位销，将原本的定位销向内推进即可完成限位固定。
优选地，胫骨平台髁间脊31的宽度值小于或等于假体豁槽23的长度值。
当安装第二个单髁式人工膝关节时，所述限位孔洞穿透胫骨平台髁间脊31，两个胫骨假体2对应的两个限位孔洞互相连通，形成一个更长的限位孔洞；优选地，所述限位孔洞4及定位销5穿透胫骨平台髁间脊31，连通两个胫骨假体2；即在所述限位孔洞4的轴向方向上，限位孔洞是由三部分拼接而成的，其中位于两端的两部分，都是由上方的假体豁槽23和下方的胫骨豁槽32围成的；位于中间的第三部分则完全是开设在胫骨平台髁间脊31上的髁间脊孔洞33。
值得注意的是，由于定位销的存在，其能够固定位于胫骨平台髁间脊两侧的两个胫骨假体2的水平高度，还可以使得位于胫骨平台髁间脊一侧的一个胫骨假体与胫骨平台髁间脊保持在一个期望的水平高度范围内，从而使得替换后的膝关节股骨的生理高度与替换前膝关节股骨生理高度基本一致，在此基础上执行对胫骨假体2的固定，从而使得胫骨假体处于合理位置，确保术后患者体验良好。
在一个优选的实施方式中，如图3、图4和图5中所示，所述限位孔洞4的截面形状与定位销5的截面形状一致；该截面形状可以为椭圆形、正方形、梯形、菱形、三角形、五边形、五角星形、六边形、八边形等等各种形状，在各种截面形状的定位销中，三角形、正方形、梯形和多边形的使用效果更好一些，本发明中优选地选择梯形，并且该梯形上底位于假体豁槽23中，下底位于胫骨豁槽32中，并且上底长度大于下底长度。
在一个优选的实施方式中，所述定位销的截面尺寸和限位孔洞的截面尺寸相对应，二者之间紧密配合，优选地为过盈配合；从而使得定位销嵌入到一定深度后难以继续伸入，并被卡死，此时定位销刚好停留在期望的位置，优选地，该位置为正中心位置，不会向两侧偏离；
在一个优选的实施方式中，所述限位孔洞的截面尺寸和和限位孔洞的截面尺寸相对应，定位销可以嵌入到限位孔洞的相应深度位置，在所述定位销的端面上可设置有膨胀螺栓，当定位销位于期望的位置，优选为正中心位置时，通过旋拧所述膨胀螺栓，使得定位销卡死固定在限位孔洞中，从而确保定位销的位置稳固，不会向两侧偏移；
在一个优选的实施方式中，所述定位销的截面尺寸均一不变，但是限位孔洞的截面尺寸是变化的，在所述定位销的端面上设置有膨胀螺栓，定位销从限位孔洞上尺寸较大的一侧伸入，定位销嵌入到一定深度后难以继续伸入，从而使得定位销能够停留在期望的位置，并且此时旋拧所述膨胀螺栓，使得定位销卡死固定在限位孔洞中，使得定位销的固定更为稳固。
本发明中，所述定位销有一个或者多个，每个定位销都与一个限位孔洞相配合，当定位销有多个时，限位孔洞也有多个，定位销的数量与限位孔洞的数量保持一致。
所述胫骨假体2置于胫骨前上端面位置，髌骨后侧下方，优选地，胫骨假体2的设置位置与髌骨下缘保持预定距离，自然胫骨平台与髌骨之间的距离值等于该预定距离值；通过胫骨平台假体2替换自然胫骨平台，对于髌骨本身没有实质影响，也不影响髌骨的滑动。本申请中所述的自然胫骨平台是指人体内自然生长的胫骨平台，其中，自然即表示自然存在的。
在一个优选的实施方式中，如图6和图7中所示，所述胫骨假体2包括上垫片21和下垫片22，上垫片21和下垫片22之间通过螺栓、销轴等方式进行固定，使得上垫片21和下垫片22之间可以在竖直方向上有一定的相对位移，在其他方向上不能相对移动。
在下垫片22上设置有弹性构件6。通过该弹性构件6来缓冲由股骨假体1传递至胫骨假体2上垫片21的冲击力，使得上垫片21具有类半月板功能。所述半月板为人体膝关节中起到缓冲减震作用的软骨组织；具体来说，当股骨假体1传递给胫骨假体2冲击力时，首先由上垫片21受到该冲击力，并且致使上垫片21向下移动，从而压迫弹性构件6，并且随着弹性构件6的反作用力的逐渐增大，上垫片21向下移动的速度越来越小，其上的冲击力也越来越小，最终上垫片抵压在下垫片上，共同将作用力传递给胫骨，由于经过了弹性构件6的缓冲，该作用力对应胫骨的损耗可以忽略，从而达到类似半月板的缓冲作用，即称之为具有类半月板功能。
本申请中，所述弹性构件6可以包括弹簧，也可以包括气囊、缓冲垫片等能起到缓冲减震作用的具有一定弹性的构件，其设置在上垫片21的下方，能够缓冲上垫片21传递来的冲击力即可，可以根据具体结构特征选择适宜的具体安放位置。
下面以包括弹簧的弹性构件为例进行说明；
所述弹性构件6贯穿并固定在下垫片22上，位于下垫片22上方的部分弹性构件6顶在上垫片21的下表面，位于下垫片22下方的部分弹性构件6呈柱状。
优选地，具体来说，如图7中所示，所述弹性构件6包括套筒61和弹簧62，
其中，弹簧62下端埋置于套筒61中，弹簧上端顶置于上垫片下表面。从而使得由股骨假体传递给上垫片21的力经过弹簧62的缓冲后再作用到下垫片22上；
本发明中所述的假体豁槽23开设在所述下垫片22上。
在一个优选的实施方式中，所述套筒61嵌入到开设在胫骨3上的孔腔7中。优选地孔腔的截面形状与套筒61的截面形状一致，截面尺寸也一致，二者可以紧密贴合，从而使得胫骨与胫骨假体之间相对位置稳定，没有相对位移。所述套筒61和孔腔7的截面形状可以为各种形状，如多边形、四边形、三角形椭圆形、圆形等等，本发明中优选地该截面形状为圆形。
所述套筒既能够起到保护安放弹簧的作用，也能够起到限位、固定胫骨假体2的作用，从而使得胫骨假体2整体结构简单，简化胫骨假体的安放固定过程。
本发明中优选地，所述弹簧62始终处于非拉伸状态，
在一个优选的实施方式中，如图7中所示，在所述套筒61的底部设置有螺栓63，该螺栓63可随着旋转而在竖直方向上移动，在所述套筒61内部，所述螺栓的顶部顶在弹簧62的底部，从而可以通过控制螺栓63在竖直方向上的位置来调节弹簧62的弹性大小；螺栓63在竖直方向向上移动，弹簧62被压迫，弹簧62的弹性增大，螺栓63在竖直方向向下移动，弹簧62的压迫程度减小，弹簧62的弹性减小；从而可以根据患者的年龄和身体状况调节适宜的弹簧弹性，或者称之为弹簧松紧，从而使得上垫片21和下垫片22之间的弹性与半月板的弹性一致，使得上垫片21和下垫片22的总高度/厚度与未更换人工膝关节一侧的高度一致，
还可以在安装第二个半髁式人工膝关节时，使得上垫片21和下垫片22的总高度/厚度与在先更换的半髁式人工膝关节的胫骨假体2的高度一致，从而解决了分两次更换的两侧两个胫骨假体2之间高度、弹性不一致的问题，使得分批次手术后的效果良好。
在一个优选的实施方式中，在所述套筒61的底部和/或螺栓63附近刻画刻度线，使得通过该刻度线能够直接读出螺栓63的旋拧程度；从而便于在安放弹性构件6时调节弹簧松紧；
优选地，所述弹簧62包括设置在顶部，用以与上垫片21接触的顶块。
本发明中，所述弹簧62可以由金属、各种高分子聚合物等材料制成。
本发明提供一种半髁式人工膝关节的使用方法，
该人工膝关节为上文中所述的半髁式人工膝关节，该方法包括如下步骤：
步骤1，在胫骨平台上开设出安放胫骨假体2的空间，优选地，该空间开位于胫骨平台髁间脊31的一侧，并且在开设该空间的过程中，对于胫骨平台髁间脊31及其上的十字韧带没有破坏；进一步优选地，还不会对髌骨及其所在的股四头肌肌腱造成损伤；
步骤2，在胫骨上挖出胫骨豁槽32并延伸该胫骨豁槽32至胫骨平台髁间脊31，在胫骨平台髁间脊31上形成髁间脊孔洞33；在胫骨上挖出孔腔7；胫骨豁槽32和孔腔7的数量不固定，可以是一个、两个或者多个，优选地都选择一个；
步骤3，将胫骨假体2上的套筒嵌入到孔腔7中，同时调整假体豁槽23、胫骨豁槽32和髁间脊孔洞33的相对位置，使得假体豁槽23、胫骨豁槽32和髁间脊孔洞33一起构成限位孔洞4；
步骤4，将定位销5安装到限位孔洞4中；
步骤5，通过定位销5固定胫骨假体2的高度位置，通过调节骨水泥的注入量进一步固定胫骨假体2的高度。
优选地，在执行步骤3以前，通过旋转螺栓63调节弹簧62的松紧，其中，还使用弹性检测设备检测弹簧的松紧/强度，以保证弹性构件6中弹簧的松紧/强度一致；
优选地，还包括任选的如下步骤：
步骤a，将上垫片21、下垫片22和弹性构件6组装为完整的胫骨假体2，
步骤b，安装股骨假体1，其中，股骨假体固定在股骨上，并且位于胫骨假体上方，与胫骨假体相接触；优选地，首先在所述股骨上挖出假体固定区域，再将股骨假体嵌入到该区域，并且由于股骨假体具有特殊的弧度及前扣盖11和后扣盖13，股骨假体扣合在股骨上，同时股骨假体上的固定刺12插入到股骨的骨松质中，股骨假体上的固定销14嵌入到股骨上挖出的固定销14内，从而实现股骨假体与股骨之间的固定。
任选地，完成上述半髁式人工膝关节的安装后，如有必要，可以在该膝关节上继续安装另外一个人工膝关节；
如在先的膝关节替换了胫骨平台的内侧平台，在后的膝关节则替换胫骨平台的外侧平台；如在先的膝关节替换了胫骨平台的外侧平台，在后的膝关节则替换胫骨平台的内侧平台；
安装新的另一个半髁式人工膝关节时重复上述步骤，其中，步骤3中的限位孔洞4与在先的限位孔洞重合，将髁间脊孔洞33由盲孔变为通孔，
步骤4中定位销5为原半髁式人工膝关节中的定位销，继续推动该定位销，使其穿过胫骨平台髁间脊，位于膝关节中心位置，该定位销两端分别嵌入到两个胫骨假体中。
本发明提供一种半髁式人工膝关节置换方法，
该人工膝关节为上文中所述的半髁式人工膝关节，该方法包括如下步骤：
步骤1，在胫骨平台上开设出安放胫骨假体2的空间，优选地，该空间开位于胫骨平台髁间脊31的一侧，并且在开设该空间的过程中，对于胫骨平台髁间脊31及其上的十字韧带没有破坏；进一步优选地，还不会对髌骨及其所在的股四头肌肌腱造成损伤；
步骤2，在胫骨上挖出胫骨豁槽32并延伸该胫骨豁槽32至胫骨平台髁间脊31，在胫骨平台髁间脊31上形成髁间脊孔洞33；在胫骨上挖出孔腔7；胫骨豁槽32和孔腔7的数量不固定，可以是一个、两个或者多个，优选地都选择一个；
步骤3，将胫骨假体2上的套筒嵌入到孔腔7中，同时调整假体豁槽23、胫骨豁槽32和髁间脊孔洞33的相对位置，使得假体豁槽23、胫骨豁槽32和髁间脊孔洞33一起构成限位孔洞4；
步骤4，将定位销5安装到限位孔洞4中；
步骤5，通过定位销5固定胫骨假体2的高度位置，通过调节骨水泥的注入量进一步固定胫骨假体2的高度。
优选地，在执行步骤3以前，通过旋转螺栓63调节弹簧62的松紧，其中，还使用弹性检测设备检测弹簧的松紧/强度，以保证弹性构件6中弹簧的松紧/强度一致；
优选地，还包括任选的如下步骤：
步骤a，将上垫片21、下垫片22和弹性构件6组装为完整的胫骨假体2，
步骤b，安装股骨假体1，其中，股骨假体固定在股骨上，并且位于胫骨假体上方，与胫骨假体相接触；优选地，首先在所述股骨上挖出假体固定区域，再将股骨假体嵌入到该区域，并且由于股骨假体具有特殊的弧度及前扣盖11和后扣盖13，股骨假体扣合在股骨上，同时股骨假体上的固定刺12插入到股骨的骨松质中，股骨假体上的固定销14嵌入到股骨上挖出的固定销14内，从而实现股骨假体与股骨之间的固定。
任选地，完成上述半髁式人工膝关节的安装后，如有必要，可以在该膝关节上继续安装另外一个人工膝关节；
如在先的膝关节替换了胫骨平台的内侧平台，在后的膝关节则替换胫骨平台的外侧平台；如在先的膝关节替换了胫骨平台的外侧平台，在后的膝关节则替换胫骨平台的内侧平台；
安装新的另一个半髁式人工膝关节时重复上述步骤，其中，步骤3中的限位孔洞4与在先的限位孔洞重合，将髁间脊孔洞33由盲孔变为通孔，
步骤4中定位销5为原半髁式人工膝关节中的定位销，继续推动该定位销，使其穿过胫骨平台髁间脊，位于膝关节中心位置，该定位销两端分别嵌入到两个胫骨假体中。
以上结合了优选的实施方式对本发明进行了说明，不过这些实施方式仅是范例性的，仅起到说明性的作用。在此基础上，可以对本发明进行多种替换和改进，这些均落入本发明的保护范围内。

Claims (10)

1.一种半髁式人工膝关节，其特征在于，该膝关节包括股骨假体(1)和胫骨假体(2)，
所述胫骨假体(2)设置在胫骨平台髁间脊(31)的一侧，并位于股骨假体(1)的下方。
2.根据权利要求1所述的半髁式人工膝关节，其特征在于，
所述胫骨假体(2)包括上垫片(21)和下垫片(22)，
其中，在下垫片(22)上设置有弹性构件(6)，通过该弹性构件(6)来缓冲由股骨假体(1)传递至胫骨假体(2)上垫片的冲击力，使得上垫片(21)具有类半月板功能。
3.根据权利要求1所述的半髁式人工膝关节，其特征在于，
所述弹性构件(6)贯穿下垫片(22)，并固定安装在下垫片(22)上，上端伸出下垫片(22)上方，顶置于上垫片下表面。
4.根据权利要求3所述的半髁式人工膝关节，其特征在于，
所述弹性构件(6)包括套筒(61)和弹簧(62)，弹簧(62)下端埋置于套筒(61)中，弹簧上端顶置于上垫片下表面，
套筒(61)穿过下垫片(22)，套筒底端安装于胫骨上的孔腔(7)中。
5.根据权利要求4所述的半髁式人工膝关节，其特征在于，
在所述套筒(61)底部设有调节所述弹簧(62)松紧的螺栓(63)。
6.根据权利要求1所述的半髁式人工膝关节，其特征在于，
所述胫骨假体(2)置于髌骨后侧下方。
7.根据权利要求1所述的半髁式人工膝关节，其特征在于，
该人工膝关节还包括定位销(5)；通过所述定位销(5)将胫骨假体(2)固定于胫骨上。
8.根据权利要求7所述的半髁式人工膝关节，其特征在于，
所述定位销(5)一端上部安装于胫骨假体(2)中，其另一端嵌入到胫骨平台髁间脊(31)中。
9.根据权利要求1所述的半髁式人工膝关节，其特征在于，
在所述胫骨假体(2)的底部开设有假体豁槽(23)，
在所述胫骨假体(2)之下的胫骨顶部开设有胫骨豁槽(32)，所述假体豁槽(23)与所述胫骨豁槽(32)相对应，一起形成容纳定位销(5)的限位孔洞(4)，且该限位孔洞穿入胫骨平台髁间脊(31)。
10.一种如权利要求1-9所述的半髁式人工膝关节的使用方法，其特征在于，该方法包括如下步骤：
步骤1，将股骨假体(1)安装在股骨髁上；
步骤2，在胫骨平台上开设出安放胫骨假体(2)的空间，
步骤3，在胫骨上挖出胫骨豁槽(32)并延伸该胫骨豁槽(32)至胫骨平台髁间脊(31)，在胫骨平台髁间脊(31)上形成髁间脊孔洞(33)；
步骤4，在胫骨上挖出孔腔(7)；
步骤5，将胫骨假体(2)上的套筒嵌入到孔腔(7)中，同时调整假体豁槽(21)、胫骨豁槽(32)和髁间脊孔洞(33)的相对位置，使得假体豁槽(21)与胫骨豁槽(32)、以及髁间脊孔洞(33)一起构成限位孔洞(4)；
步骤6，将定位销(5)安装到限位孔洞(4)中，待定位销(5)固定后通过骨水泥固定胫骨假体(2)；
其中，优选地，在执行步骤5以前，通过旋转螺栓(63)调节弹簧(62)的松紧。
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