CN110475527A - 关节固定板 - Google Patents

关节固定板 Download PDF

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CN110475527A
CN110475527A CN201880023361.4A CN201880023361A CN110475527A CN 110475527 A CN110475527 A CN 110475527A CN 201880023361 A CN201880023361 A CN 201880023361A CN 110475527 A CN110475527 A CN 110475527A
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arthrodesis
plate according
arthrodesis plate
anchorage
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H·D·林克
J·特伯
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Waldemar Link GmbH and Co KG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • 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
    • A61F2/30—Joints
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30136—Rounded shapes, e.g. with rounded corners undulated or wavy, e.g. serpentine-shaped or zigzag-shaped
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30261—Three-dimensional shapes parallelepipedal
    • A61F2002/30265—Flat parallelepipeds
    • 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
    • A61F2/30—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
    • A61F2002/30622—Implant for fusing a joint or bone material
    • 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
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30904—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves serrated profile, i.e. saw-toothed
    • 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
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2002/3093—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth for promoting ingrowth of bone tissue
    • 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
    • A61F2/30—Joints
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • A61F2002/4243—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for interphalangeal joints, i.e. IP joints
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00011—Metals or alloys
    • A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Abstract

本发明涉及一种用于固定关节特别是用于手指关节的关节固定板(2)，其包括以机械刚性方式彼此连接的近端锚固区域(4)和远端锚固区域(6)，其特征在于，两个锚固区域之一的至少一个外轮廓(10，12)具有起伏的横截面，例如屋顶形，或者通过涂层设置有交替的波峰和波谷，和/或具有横向箭头状横截面。

Description

关节固定板
本发明涉及一种用于加固关节特别是手指关节的关节固定板，其包括近端锚固区域和远端锚固区域，所述近端锚固区域和远端锚固区域以机械刚性的方式彼此连接。
关节假体以及接骨板用于整形外科和创伤外科。后者也用于损伤关节的计划性加固(关节固定术)的特殊应用。外科医生应尽可能快速、简单和微创地附着此类植入物，关节固定板也必须锚固在患骨上，以确保骨骼和植入物之间的力可靠且持久地传递。
已知的用于手指关节的假体也被锚固到例如髓腔中，而不使用螺钉。关节固定植入物通常从外面拧到骨头上。所述锚固方法通常需要手掌或背侧入路，而且有损伤屈肌和/或伸指肌腱的风险。
构成本发明的基础的目的是提供一种尤其用于手指关节的关节固定板，该关节固定板在外科手术连接期间的处理和锚固方面得到改进。
根据本发明，该目的通过具有权利要求1的特征的关节固定板来解决。在从属权利要求中给出了有利的实施方式。
根据本发明的关节固定板用于加固关节，特别是手指关节，但也加固其他主要具有铰链型功能的关节。它包括以机械刚性方式彼此连接的近端锚固区域和远端锚固区域。
根据本发明，关节固定板的特征在于，两个锚固区域之一的至少一个外轮廓具有起伏的箭头状横截面(即，平行于箭头状面的平面中的起伏横截面)。
除了连续的(例如正弦的)波峰和波谷之外，在本发明的上下文中，术语“起伏的”还包括其他凹口形轮廓，例如屋顶形状或锯齿形状的轮廓。这意味着锚固区域的外轮廓不必一定要在圆形、连续的波峰和波谷中延伸。相反，起伏的外轮廓的上升侧和下降侧也可以被配置为线性的、部分线性的，甚至以任何方式起伏和/或不连续。换句话说，锚固区域的外轮廓在其波峰和波谷的区域中不必在几何意义上连续弯曲，也可以不连续地构造。因此，外轮廓的波峰和波谷也可以具有边缘的形状，使得起伏的横截面以角或点的形式形成，并且构成方向上的点状或锐边变化。因此，根据本发明的起伏的外轮廓可以在技术上产生，例如，通过例如利用等离子喷涂工艺将涂层施加到原始平坦的外部轮廓上。如果以这样的方式控制等离子体喷涂过程，使得在锚固区域的不同点获得不同的涂层厚度，则可以产生起伏的轮廓。同样在这种情况下，波峰的形状(即，外轮廓的局部最高区域)可以根据使用的颗粒的形状构造为以任何方式被修圆，但是也可以被配置为例如成角度的或者具有不连续的弯曲表面。波谷(即外轮廓的局部最深区域)也是如此。
当以这种方式设计时，根据本发明的关节固定板被配置用于以下目的，并且因此使得能够以以下方式将根据本发明的植入物锚固(特别是也用于远端指间关节或近端指间关节的关节固定)在骨端上，所述骨端借助于根据本发明的关节固定板彼此机械连接(刚性地连接，用于关节固定)：外科医生可以从内侧或外侧(例如通过铣削工具或摆动锯)在面向(通过植入物彼此刚性连接的骨头的)关节缺损的近端骨端和远端骨端中产生水平槽(其优选地位于指骨的冠状面中并且大致延伸穿过其中心轴线)，该水平槽特别优选不完全沿另一方向(外侧或内侧)穿过所述骨头。现在，外科医生可以从同一侧(内侧或外侧)将两个锚固区域中的一个(优选地，其具有(在中外侧方向上)比其高度(在掌背方向上)更宽的横截面，特别是平坦的矩形横截面)插入该切口中。这样做时，他只需考虑手指内侧或外侧不太相关的结构。因此，没有像传统植入物那样伤害手掌或背部结构的危险。当将锚固区域从内侧或外侧插入扁平槽中时，在植入物和骨头末端之间会形成一个角度稳定的连接(尤其是在箭头状平面内)甚至是，该连接能够牢固地防止拔出，换句话说，是由于“压入配合”(或从技术工程角度而言，是由于过盈配合)：为此，扁平槽的宽度(高度)应由外科医生配置，以(略)小于优选锚固区域的多个横截面的高度(根据本发明配置，横向截面的高度优选地小于宽度)。针对植入物的另一个锚固区域，至此所描述的过程(在骨头的末端形成一个扁平槽；将锚固区域从内侧或外侧插入到扁平槽中)在骨头的另一端重复，用于连接植入物以进行关节固定。按照本发明，通过这种方式以成角度的稳定且不可抽出的方式连接至两个骨端的两个锚固区域以机械刚性方式彼此相互连接，即彼此成180°角(例如，直线)或任意角度(尤其是30°)。以这种方式安装，根据本发明的植入物刚性地桥接骨头的两个末端以进行关节固定。
因此，根据本发明的关节固定板的两个锚固区域特别地被构造成借助于压入配合(摩擦配合或过盈配合)分别被锚固在扁平槽中(该扁平槽将在外科医生待治疗的骨头中产生)，其中各个锚固区域的(优选多个)横截面的高度大于各自槽的高度(宽度)。
因此，根据本发明的关节固定板，特别地构造成借助于压入配合而被锚固在指骨的冠状面中的两个骨端部的每一个中的扁平槽中，并且大致穿过其中心轴线。根据本发明，两个锚固区域之一的至少一个外轮廓具有本发明所指的起伏的箭头状横截面，这进一步促进了该锚固。该横截面例如也可以是锯齿形的，具有直型的上升侧和直型的下降侧。该起伏的横截面特别地构造成通过其波峰压入扁平槽的切割表面或边界表面。这可以增强局部压入配合，即在波峰处，也可以通过将波峰压入切割表面来确保形状配合。
根据本发明，促进压入配合锚固的优选是关节固定板，其中锚固区域的顶侧和底侧总体上都具有起伏的箭头状横截面，因此可以将整个表面(也就是说，优选地在植入物的纵向方向上的整个长度上，即通常在近端-远端方向上，和/或优选地，在植入物的整个宽度上，即通常在横向方向上)压入扁平槽的上下切割表面。
然后特别优选的是，顶侧和底侧的起伏的箭头状横截面至少部分地，优选整体上彼此平行地延伸。这不仅是锚固区域外轮廓的起伏的箭头状横截面，而且是整个锚固区域。
下面参照本发明的实施方式的附图描述本发明的这些和其他特征。
附图说明
图1a从箭头状平面的侧面以侧视图示出了根据本发明的关节固定板；
图1b从正面以前平面的俯视图示出了根据本发明的关节固定板；
图1c示出了从远侧观察的根据本发明的关节固定板的横截面图；
图2示出了如图1所示的根据本发明的关节固定板的三维视图。
图1和图2中示出了关节固定板2。关节固定板2用于加固关节，特别是手指关节(未示出)。它包括近端锚固区域4和远端锚固区域6以及轴区域8，该轴区域以机械刚性方式将两个锚固区域彼此连接。两个锚固区域4、6具有横截面(在图1c中示出了一个)，该横截面的宽度(沿横向方向的b)大于其高度(沿手掌背方向的h)。
两个锚固区域4、6的外部轮廓10、12总体上在平行于箭头状面的平面中具有起伏的横截面(图1a)。该横截面是锯齿形的，具有直型的上升侧10和直型的下降侧12。该起伏的横截面还特别构造成通过其“波峰”14压入扁平槽(17，仅以虚线示意性显示)的平坦切割面16中。这可以促进局部压配合，即在波峰14处，也可以通过将波峰14压入切割表面16中来确保与槽17的形状配合。锚固区域4、6的顶侧和底侧总体上都具有起伏的箭头状横截面10、12。顶侧和底侧总体上几乎完全彼此平行地延伸。
两个锚固区域4、6的每个横截面(在图1c中示出)是矩形的，其中一些矩形横截面的角具有倒角18(倒圆的边缘(未示出)也是根据本发明的替代方案)，即在所有波峰14的区域中。
两个锚固区域4、6的体积在近端-远端方向上与直边缘20呈线性延伸(图1b)。轴区域的体积也沿近端-远端方向线性延伸，直边缘20在一个方向上，并且还与两个锚固区域的体积的延伸方向对齐，即与共同的直边缘20对齐。可替代地(未示出)，轴区域在其沿近端-远端方向的延伸中可以具有纽结，该纽结使两个锚固区域在箭头状平面(图1a)中彼此成一定角度(特别是对于近端指间关节处的关节固定，该角度优选地可以是1°至40°或5°至35°或30°，或者对于远端指间关节的关节固定，该角度可以优选为1°到50°或5°到45°或30°)。这种构造使植入物特别适合于指间关节的关节固定，因为在该区域中，手指关节的关节固定术通常在具有这种尺寸的屈曲位置进行。
所示的植入物2旨在作为永久植入物，并且为此由钛合金制成。表面粗糙(Ra>4)以促进骨骼的积累和生长。该表面涂覆有促进生长的涂层(未示出，例如磷酸钙)。
示的植入物2具有以下尺寸，这些尺寸已被证明可有效用作DIP关节处的关节固定板。植入物2的整个扁平矩形横截面的厚度h(图1c)为1.6mm(优选在1.4至1.8mm之间)，宽度b为7mm(优选在6至8mm之间)。植入物2的总长度为26mm(优选在20mm与30mm之间)。齿或波峰14超出顶侧22的平面突出0.5mm(优选在0.2至1.0mm之间)，波谷深0.5mm(优选在0.1至1.0mm之间)。侧面10、12相对于顶侧22的平面(冠状面)具有30°的倾斜角(优选在20°和40°之间)。

Claims (11)

1.一种用于固定关节特别是手指关节的关节固定板，其包括以机械刚性方式彼此连接的近端锚固区域和远端锚固区域，其特征在于，两个锚固区域之一的至少一个外轮廓具有起伏的箭头状和/或横向横截面。
2.根据权利要求1所述的关节固定板，其特征在于，所述锚固区域构造成用于通过压入配合而锚固在旨在通过所述关节固定板进行关节固定的关节缺损的两个骨端的每一个骨端的扁平槽中，相应的锚固区域具有比相应的槽更厚的横截面。
3.根据前述权利要求中的一项所述的关节固定板，其特征在于，所述锚固区域的顶侧和底侧具有起伏的箭头状和/或横向横截面。
4.根据前述权利要求中任一项所述的关节固定板，其特征在于，所述顶侧和底侧的起伏的箭头状和/或横向横截面至少部分地彼此平行地延伸。
5.根据前述权利要求中任一项所述的关节固定板，其特征在于，所述起伏的箭头状和/或横向横截面为锯齿形，具有直型的上升侧和直型的下降侧。
6.根据前述权利要求中的一项所述的关节固定板，其特征在于，所述两个锚定区域的至少一部分具有宽度比高度大和/或为矩形的横截面。
7.根据前述权利要求中任一项所述的关节固定板，其特征在于，所述矩形横截面的角和/或所述关节固定板的边缘具有倒角和/或被修圆。
8.根据前述权利要求中的一项所述的关节固定板，其特征在于，所述两个锚固区域的体积在近端-远端方向上基本线性地延伸，或者所述两个锚固区域彼此成角度地定向。
9.根据前述权利要求所述的关节固定板，其特征在于，所述角度为1°至50°，或5°至45°，或30°。
10.根据前述权利要求中的任一项所述的关节固定板，其特征在于，在所述两个锚固区域之间形成可枢转且可锁定的连接，该链接使得所述角度可调节。
11.根据前述权利要求中任一项所述的关节固定板，其特征在于，所述可锁定的连接包括互补的接触表面，所述互补的接触表面彼此叠置，特别是围绕枢转轴线具有星形纹理，和/或能够以形状配合和/或摩擦配合的方式锁定。
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