CN109567983B - Horn-shaped implant and implantation method thereof - Google Patents
Horn-shaped implant and implantation method thereof Download PDFInfo
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- CN109567983B CN109567983B CN201811441095.5A CN201811441095A CN109567983B CN 109567983 B CN109567983 B CN 109567983B CN 201811441095 A CN201811441095 A CN 201811441095A CN 109567983 B CN109567983 B CN 109567983B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- 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
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
Abstract
The invention discloses a horn-shaped implant and an implantation method thereof, relates to the technical field of ligament reconstruction, and aims to solve the technical problems of stress concentration at one side of a tunnel portal caused by the wiper effect of a bone tunnel portal after ligament reconstruction, bone absorption, tunnel portal expansion and stress concentration, abrasion and fracture of transplanted ligaments caused by disappearance of side stress in the prior art. The trumpet implant comprising: the horn-shaped structure and the base column communicated with the necking end of the horn-shaped structure are provided with side wings on the outer side wall of the base column; the horn face structure is used for covering a bone tunnel opening, and the matrix column extends into the bone tunnel and is fixed in the bone tunnel by the side wings; the trumpet-shaped surface structure is formed by connecting single or multiple curved surfaces, and the multiple curved surfaces are mutually tangent to serve as transition surfaces at the opening of the bone tunnel.
Description
Technical Field
The invention relates to the technical field of ligament reconstruction, in particular to a trumpet-shaped implant and an implantation method thereof.
Background
Ligament damage can greatly influence the normal life of patients, and the currently clinically visible ligament damage is various and comprises knee joint ligament damage, shoulder joint ligament damage, elbow joint ligament damage, ankle joint ligament damage and the like. Among them, as an important stabilizer of the knee joint, Anterior Cruciate Ligament (ACL) is one of the most vulnerable ligaments, and ACL injury directly causes instability of the knee joint, so that the quality of life of a patient is greatly reduced, and secondary injury of other accessory structures of the knee joint such as meniscus and the like is caused for a long time, and finally arthritis occurs.
At present, the method for clinically treating ligament injury mainly comprises ligament reconstruction, namely, an autograft ligament, a allograft ligament or an artificial ligament is used for replacing an original ligament so as to recover the stability of a joint, avoid secondary injury of other joint accessory structures and reduce the incidence rate of arthritis. In the traditional ligament reconstruction operation, two ends of a ligament graft are respectively fixed in corresponding bone tunnels, and tunnel mouths of the bone tunnels in joints are positioned at the stop points of original ligament, so that the dissection and functional reconstruction of the ligament are realized to the maximum extent.
Although ligament reconstructive surgery can restore joint stability in a short period of time, there are a series of complications long-term after surgery. Wherein, the enlargement of bone tunnel and the secondary rupture of ligament belong to one of the complications after ligament reconstruction operation. An important factor directly related to the above two complications is the occurrence of the "wiper effect" (windshield with effect) after ligament reconstruction. Two types of relative movement can occur between the graft ligament and the bone tunnel: 1. relative motion along the long axis of the bone tunnel, 2. relative motion perpendicular to the long axis of the bone tunnel. The movement of the ligament graft perpendicular to the bone tunnel axis is referred to as the "wiper effect". The bone tunnel portal in the joint, the "wiper effect" manifests as wiper-like swinging of the graft perpendicular to the tunnel axis. In the joint, the direction of the transplant body is suddenly changed at the tunnel portal, and the ligament transplant body is not combined with the bone tunnel in the early stage after the ligament reconstruction, so that the transplant body and the bone tunnel can relatively slide in the movement process of the knee joint, and the tunnel portal is a sharp edge, so that the stress concentration on the edge of the tunnel portal and the transplant body in contact with the edge can be caused by the tension on the transplant body, and the ligament transplant body can be worn in the sliding process. Ligament abrasion caused by friction between the artificial ligament and the articular facet, particularly abrasion of the ligament graft at the entrance of the bone tunnel, has been considered as one of the causes of fracture of the ligament graft. The generation of wear particles may also cause serious complications such as synovitis, third party granular reactions and osteolysis. Evans et al found that abraded particles of the artificially transplanted ligament can cause moderate to severe macrophage infiltration of the synovial membrane. In addition, compare with complete knee joint, the unilateral stress concentration and the contralateral stress disappearance of bone tunnel mouth also can finally lead to the bone absorption of tunnel mouth after the ligament reconstructive art, lead to tunnel mouth to enlarge, and the graft is not hard up, and the wearing and tearing aggravation between graft and bone tunnel leads to ligament graft fracture, finally leads to the failure of ligament reconstructive art. Hsu et al measured the enlargement of the bone tunnel at 3, 6, 12 and 18 months post-surgery and found that the tunnel portal (bone tunnel at the joint site) was enlarged in diameter more than the ligament fixation (bone tunnel plug site) due to the "wiper effect" effect. However, revision surgery after failure of ligament reconstruction is relatively difficult and extremely challenging, especially for successful removal of ligament fixation devices, and for fixation of new ligament grafts in enlarged bone tunnels, all of which are significant challenges for the operating physician.
Therefore, some studies have taken appropriate measures to avoid the occurrence of the "wiper effect", and Tosi et al have proposed that the quadriceps femoris tendon has a larger cross-sectional area than the patellar ligament and the popliteal muscle, so that by using the quadriceps femoris tendon as a ligament graft for ACL reconstruction surgery, a good press-fit (press-fit) can be generated between the ligament graft and the bone tunnel, thereby reducing the gap therebetween, further restricting the relative movement thereof, reducing the occurrence of the "wiper effect", and preventing the bone tunnel from being enlarged. In order to make up for the difference between the cross sections of the flat patellar ligament graft and the patellar bone block and the bone tunnel, Paessler et al sews the patellar ligament graft by using a suture line and processes the patellar bone block into a cylindrical shape, so that the patellar ligament graft and the bone block at the end part of the patellar ligament graft are matched with the shape of the bone tunnel, and the press fit effect between the graft and the bone tunnel is realized, thereby reducing the wiper effect. Barrett et al used an artificial bone block to fill the bone defect in the bone tunnel during the revision of the ACL reconstruction, thereby avoiding the "wiper effect" caused by the space left between the previously enlarged bone tunnel and the transplanted ligament. However, corresponding solutions are rarely found at present for the problems of bone dissolution at the tunnel portal, tunnel portal expansion and transplanted ligament abrasion caused by the "horn effect" at the bone tunnel portal.
Disclosure of Invention
The invention aims to provide a horn-shaped implant and an implantation method thereof, and aims to solve the technical problems of stress concentration at one side of a tunnel portal caused by the 'wiper effect' of a bone tunnel portal after ligament reconstruction, bone absorption, tunnel portal expansion and stress concentration, abrasion and fracture of transplanted ligaments caused by disappearance of opposite side stress in the prior art.
The present invention provides a trumpet implant comprising: the horn face structure is characterized in that the necking end of the horn face structure is communicated with a base column, and the outer side wall of the base column is provided with a side wing; the horn face structure is used for covering a bone tunnel opening, and the base body column extends into the bone tunnel and is fixed in the bone tunnel through the side wing; the horn-shaped structure is formed by connecting one or more curved surfaces, and the curved surfaces are mutually tangent to be used as transition surfaces at the opening of the bone tunnel.
The upper surface of the horn surface structure is provided with a first curved surface and a second curved surface, and the lower surface of the horn surface structure is provided with a third curved surface and a fourth curved surface; the first curved surface is used as a transition curved surface at the opening of the bone tunnel; the second curved surface is used as a transition curved surface of the first curved surface and a bone surface, and the second curved surface is tangent to the first curved surface and the fourth curved surface respectively; the curvature circle of the third curved surface is concentric with the curvature circle of the first curved surface, and the third curved surface and the first curved surface together form an upper transition surface and a lower transition surface of the horn-shaped surface structure at the opening of the bone tunnel.
Specifically, the surface of the inner side wall of the base column is arranged in a tangent manner with the first curved surface, and the surface of the outer side wall of the base column is arranged in a tangent manner with the third curved surface.
In practical application, the side wings and the horn-shaped surface structures are arranged at intervals, and the side wings are used for fixing the matrix columns in the bone tunnel through press fit.
The matrix column is of a cylindrical hollow structure matched with the bone tunnel; the side wings are formed by a set of concentric wedge-shaped lamellae surrounding the base cylinder.
Specifically, the section of the wedge-shaped sheet is a group of barb-shaped triangular structures.
Preferably, the horn face structure, the base column and the side wings are made of any one of polyetheretherketone, high-crosslinking polyethylene, titanium alloy, stainless steel and cobalt-chromium-molybdenum alloy materials.
Compared with the prior art, the horn-shaped implant has the following advantages:
the invention provides a horn-shaped implant, which comprises: the horn face structure is characterized in that the necking end of the horn face structure is communicated with a base column, and the outer side wall of the base column is provided with a side wing; the horn face structure is used for covering a bone tunnel opening, and the matrix column extends into the bone tunnel and is fixed in the bone tunnel by the side wings; the trumpet-shaped surface structure is formed by connecting single or multiple curved surfaces, and the multiple curved surfaces are mutually tangent to serve as transition surfaces at the opening of the bone tunnel. According to the analysis, the horn-shaped implant provided by the invention has the advantages that the horn-shaped structure is used as the transition curved surface at the bone tunnel opening, so that a sharp bone tunnel opening edge in the traditional ligament reconstruction is replaced, and stress concentration and ligament abrasion generated when the sharp bone tunnel opening is contacted with transplanted ligaments are avoided; in addition, when transplanting ligament and tubaeform implant and contacting in bone tunnel mouth department, the tension on the ligament passes through tubaeform implant transmission to whole bone tunnel mouth, prevents that one side stress concentration of bone tunnel mouth in traditional ligament reconstruction art, bone absorption and the bone tunnel that the contralateral stress disappearance caused from expanding.
The invention also provides an implantation method of the horn-shaped implant, which comprises the following steps: manufacturing a bilateral bone tunnel; polishing the bone tunnel portal in the joint by using a polishing tool; screwing the horn-shaped implant into the bone tunnel, and slightly pressing the horn-shaped implant structure downwards to fit the bone surface.
The implantation method of the horn-shaped implant has the same advantages as the horn-shaped implant in the prior art, and the detailed description is omitted.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, and it is obvious that the drawings in the following description are some embodiments of the present invention, and other drawings can be obtained by those skilled in the art without creative efforts.
Fig. 1 is a first perspective structural view of a horn-shaped implant according to an embodiment of the present invention;
FIG. 2 is a schematic view of a second perspective view of a horn-shaped implant according to an embodiment of the present invention;
FIG. 3 is a schematic longitudinal sectional view of a second perspective view of a flared implant according to an embodiment of the present invention;
FIG. 4 is an enlarged schematic view of region A in FIG. 3;
FIG. 5 is an enlarged schematic view of the area B in FIG. 3;
fig. 6 is a schematic flow chart structure diagram illustrating an implantation method of a horn-shaped implant according to an embodiment of the present invention.
In the figure: 1-horn face structure; 2-a matrix column; 11-a first curved surface; 12-a second curved surface; 13-a third curved surface; 14-a fourth curved surface; 3-flanks; 31-wedge shaped sheet.
Detailed Description
The technical solutions of the present invention will be described clearly and completely with reference to the accompanying drawings, and it should be understood that the described embodiments are some, but not all embodiments of the present invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
In the description of the present invention, it should be noted that the terms "center", "upper", "lower", "left", "right", "vertical", "horizontal", "inner", "outer", etc., indicate orientations or positional relationships based on the orientations or positional relationships shown in the drawings, and are only for convenience in describing the present invention and simplifying the description, but do not indicate or imply that the system or element being referred to must have a specific orientation, be constructed and operated in a specific orientation, and thus, should not be construed as limiting the present invention. Furthermore, the terms "first," "second," and "third" are used for descriptive purposes only and are not to be construed as indicating or implying relative importance.
In the description of the present invention, it should be noted that, unless otherwise explicitly specified or limited, the terms "mounted," "connected," and "connected" are to be construed broadly, e.g., as meaning either a fixed connection, a removable connection, or an integral connection; the connection can be mechanical connection or electrical connection; they may be connected directly or indirectly through intervening media, or they may be interconnected between two elements. The specific meanings of the above terms in the present invention can be understood in specific cases to those skilled in the art.
Fig. 1 is a first perspective structural view of a horn-shaped implant according to an embodiment of the present invention; FIG. 2 is a schematic view of a second perspective view of a horn-shaped implant according to an embodiment of the present invention; FIG. 3 is a schematic longitudinal sectional view of a second perspective view of a flared implant according to an embodiment of the present invention; fig. 4 is an enlarged schematic view of a region a in fig. 3.
As shown in fig. 1-3 in combination with fig. 4, an embodiment of the present invention provides a trumpet-shaped implant including: the horn face structure 1 is characterized in that the necking end of the horn face structure 1 is communicated with a base column 2, and the outer side wall of the base column is provided with a side wing 3; the horn face structure 1 is used for covering a bone tunnel opening, and the matrix column 2 extends into the bone tunnel and is fixed in the bone tunnel by the side wings 3; the trumpet-shaped surface structure 1 is formed by connecting single or multiple curved surfaces, and the multiple curved surfaces are mutually tangent to serve as a transition surface at the opening of the bone tunnel.
Compared with the prior art, the horn-shaped implant provided by the embodiment of the invention has the following advantages:
the horn-shaped implant provided by the embodiment of the present invention, as shown in fig. 1 to 3 in combination with fig. 4, includes: the horn face structure 1 is characterized in that the necking end of the horn face structure 1 is communicated with a base column 2, and the outer side wall of the base column 2 is provided with a side wing 3; the horn face structure 1 is used for covering a bone tunnel opening, and the matrix column 2 extends into the bone tunnel and is fixed in the bone tunnel by the side wings 3; the trumpet-shaped surface structure 1 is formed by connecting single or multiple curved surfaces, and the multiple curved surfaces are mutually tangent to serve as a transition surface at the opening of the bone tunnel. From the analysis, it can be known that, in the horn-shaped implant provided by the embodiment of the invention, because the horn-shaped structure is used as the transition curved surface at the bone tunnel opening, the sharp bone tunnel opening edge in the traditional ligament reconstruction is replaced, and stress concentration and ligament abrasion generated when the sharp bone tunnel opening is contacted with the transplanted ligament are avoided; in addition, when transplanting ligament and tubaeform implant and contacting in bone tunnel mouth department, the tension on the ligament passes through tubaeform implant transmission to whole bone tunnel mouth, prevents that one side stress concentration of bone tunnel mouth in traditional ligament reconstruction art, bone absorption and the bone tunnel that the contralateral stress disappearance caused from expanding.
In the horn-shaped implant provided by the embodiment of the present invention, the upper surface of the horn-shaped structure 1 has a first curved surface 11 and a second curved surface 12, and the lower surface of the horn-shaped structure 1 has a third curved surface 13 and a fourth curved surface 14; the first curved surface 11 is used as a transition curved surface at the opening of the bone tunnel; the second curved surface 12 is used as a transition curved surface of the first curved surface 11 and the bone surface, and the second curved surface 12 is tangent to the first curved surface 11 and the fourth curved surface 14 respectively; the curvature circle of the third curved surface 13 is concentric with the curvature circle of the first curved surface 11, and the third curved surface 13 and the first curved surface 11 jointly form an upper transition surface and a lower transition surface of a horn-shaped surface structure at the opening of the bone tunnel. The arc-shaped transition of the first curved surface 11 replaces the original sharp bone tunnel edge, and the contact of the first curved surface 11 and the ligament graft can avoid the stress concentration at the edge of the bone tunnel opening, thereby effectively avoiding ligament abrasion and rupture caused by stress concentration; the feature that the second curved surface 12 is tangent to the rest curved surfaces enables the edge of the horn-shaped surface structure to be smoothly transited to the bone surface, thereby effectively avoiding stress concentration of the edge of the horn-shaped surface structure and the bone surface contacted with the edge.
In actual production, the diameter of the horn face structure 1 can be 6-18 mm; the curvature radius of the first curved surface 11 may be 1-4 mm, and the curvature radius of the third curved surface 13 may be 0-3.5 mm.
Specifically, as shown in fig. 1-3 in combination with fig. 4, the inner sidewall surface of the base pillar 2 may be disposed tangentially to the first curved surface 11, and the outer sidewall surface of the base pillar 2 may be disposed tangentially to the third curved surface 13, so that the inner and outer sidewall surfaces of the base pillar 2 can be smoothly transited to the trumpet face structure 1.
In practical applications, as shown in fig. 1 to 3, the outer sidewall of the base pillar 2 may be provided with a side wing 3, and the side wing 3 and the trumpet-shaped surface structure 1 are arranged at an interval; the shoulder 3 is used to fix the base post 2 in the bone tunnel by press-fitting, and its barb-shaped structure makes it have a function of resistance to pull-out.
As shown in fig. 1-3, the above-mentioned base pillar 2 can adopt a cylindrical hollow structure matching with the bone tunnel, so as to better connect the trumpet-shaped structure 1 and the bone tunnel; the above-mentioned lateral wings 3 may be constituted by a set of concentric wedge-shaped lamellae 31 surrounding the base cylinder 2.
In actual production and manufacture, the base column 2 can be arranged in different sizes in consideration of the selection of the diameter of the bone tunnel in ligament reconstruction, for example: the diameter of the inner wall of the substrate column 2 may be in the range of 6 to 10mm, the wall thickness of the substrate column 2 may be 0.5 to 1.5mm, and the height of the substrate column 2 may be 0 to 30 mm.
Fig. 5 is an enlarged schematic view of a region B in fig. 3.
Specifically, as shown in fig. 5, the section of the wedge-shaped sheet 31 may be a set of barb-shaped triangular structures, and the top angle b of the barb-shaped triangular structures may be 0 ° to 45 °.
Further, the maximum distance d between the adjacent wedge-shaped thin sheets 31 can be 300-.
Still further, the width e of the wedge-shaped sheet 31 in the direction perpendicular to the axis of the base cylinder 2 may be 0 to 0.5 mm. Too wide a wing 3 may increase the difficulty of press-fitting, so that 0 to 0.5mm is preferable.
In actual production, the height a of the wedge-shaped sheet 31 covering the substrate column 2 can be 0-30 mm; the height c of each set of wedge-shaped lamellae 31 may be 0.5-1 mm.
Preferably, the horn-shaped structure 1, the base pillar 2 and the side wings 3 may be made of any one or a combination of more of polyetheretherketone, high-crosslinking polyethylene, titanium alloy, stainless steel and cobalt-chromium-molybdenum alloy materials, so as to ensure that the horn-shaped implant can satisfy good biocompatibility, certain ductility and good mechanical strength.
Fig. 6 is a schematic flow chart structure diagram illustrating an implantation method of a horn-shaped implant according to an embodiment of the present invention.
An embodiment of the present invention further provides an implantation method of a horn-shaped implant, as shown in fig. 6, including the following steps: step S1, making bilateral marrow tracts; step S2, grinding the bone tunnel portal in the joint by using a grinding tool; and step S3, screwing the trumpet-shaped implant into the bone tunnel, and slightly pressing the trumpet-shaped implant downwards to fit the bone surface.
The horn-shaped implant and the implanting method thereof provided by the embodiment of the invention can effectively improve the phenomena of stress concentration at one side of a bone tunnel portal in a joint after ligament reconstruction surgery, bone absorption at the tunnel portal and bone tunnel expansion caused by disappearance of opposite side stress, and can also avoid the problem of ligament transplant abrasion and fracture caused by friction between a sharp bone tunnel portal and the ligament transplant (the wiper effect).
The above description is only for the purpose of illustrating the preferred embodiments of the present invention and is not to be construed as limiting the invention, and any modifications, equivalents, improvements and the like that fall within the spirit and principle of the present invention are intended to be included therein.
Claims (3)
1. A flared implant, comprising: the horn face structure is characterized in that the necking end of the horn face structure is communicated with a base column, and the outer side wall of the base column is provided with a side wing; the horn face structure is used for covering a bone tunnel opening, and the base body column extends into the bone tunnel and is fixed in the bone tunnel through the side wings;
the upper surface of the horn surface structure is provided with a first curved surface and a second curved surface, and the lower surface of the horn surface structure is provided with a third curved surface and a fourth curved surface; the second curved surface is used as a transition curved surface of the first curved surface and a bone surface, and the second curved surface is tangent to the first curved surface and the fourth curved surface respectively;
the curvature circle of the third curved surface is concentric with the curvature circle of the first curved surface, and the third curved surface and the first curved surface together form an upper transition curved surface and a lower transition curved surface of the horn-shaped surface structure at the opening of the bone tunnel;
the surface of the inner side wall of the basal body column is tangent to the first curved surface to form a characteristic horn surface of the horn-shaped implant, and the surface of the outer side wall of the basal body column is tangent to the third curved surface;
the matrix column is of a cylindrical hollow structure matched with the bone tunnel; the side wings are formed by a set of concentric wedge-shaped lamellae surrounding the base cylinder; the section of the wedge-shaped sheet is of a barb-shaped triangular structure.
2. The flared implant of claim 1 wherein said shoulder is spaced from said flared surface structure, said shoulder adapted to secure said base post in a bone tunnel by a press fit.
3. The trumpet-shaped implant as claimed in claim 1 or 2, wherein the trumpet-shaped face structure, the basal cylinder and the side wings are made of any one of polyetheretherketone, high cross-linked polyethylene, titanium alloy, stainless steel and cobalt-chromium-molybdenum alloy material.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201811441095.5A CN109567983B (en) | 2018-11-28 | 2018-11-28 | Horn-shaped implant and implantation method thereof |
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| CN201811441095.5A CN109567983B (en) | 2018-11-28 | 2018-11-28 | Horn-shaped implant and implantation method thereof |
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| CN109567983A CN109567983A (en) | 2019-04-05 |
| CN109567983B true CN109567983B (en) | 2020-12-22 |
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