CN110494100B - 颞下颌假体 - Google Patents

颞下颌假体 Download PDF

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CN110494100B
CN110494100B CN201880012557.3A CN201880012557A CN110494100B CN 110494100 B CN110494100 B CN 110494100B CN 201880012557 A CN201880012557 A CN 201880012557A CN 110494100 B CN110494100 B CN 110494100B
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glenoid
insert
support
shell
prosthesis
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CN110494100A (zh
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乔尔·费里
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Universite Lille 2 Droit et Sante
Institut National de la Sante et de la Recherche Medicale INSERM
Centre Hospitalier Universitaire de Lille
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Universite Lille 2 Droit et Sante
Institut National de la Sante et de la Recherche Medicale INSERM
Centre Hospitalier Regional Universitaire de Lille CHRU
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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
    • A61F2/30—Joints
    • A61F2/30988—Other joints not covered by any of the groups A61F2/32 - A61F2/4425
    • A61F2/3099—Other joints not covered by any of the groups A61F2/32 - A61F2/4425 for temporo-mandibular [TM, TMJ] joints
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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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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A—HUMAN NECESSITIES
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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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    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
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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
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/3039—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • A61F2002/30398—Sliding
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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
    • A61F2/30—Joints
    • A61F2/30988—Other joints not covered by any of the groups A61F2/32 - A61F2/4425
    • A61F2/3099—Other joints not covered by any of the groups A61F2/32 - A61F2/4425 for temporo-mandibular [TM, TMJ] joints
    • A61F2002/30991—Mandibular components
    • 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
    • A61F2/30988—Other joints not covered by any of the groups A61F2/32 - A61F2/4425
    • A61F2/3099—Other joints not covered by any of the groups A61F2/32 - A61F2/4425 for temporo-mandibular [TM, TMJ] joints
    • A61F2002/30993—Temporal components
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/006—Additional features; Implant or prostheses properties not otherwise provided for modular
    • 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

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  • Prostheses (AREA)

Abstract

本发明涉及一种颞下颌假体，包括关节盂部件(12)和用于关于关节盂部件铰接的髁突部件(14)，关节盂部件包括：‑由金属材料制成的关节盂支撑件(18)；以及‑由非金属材料制成并且限定用于髁突部件的头部的底座以限定所述铰接的关节盂插入件(20)，其中，关节盂支撑件限定具有开口(28)的壳体(26)，关节盂插入件通过所述开口可插入到所述壳体中，所述开口在关节盂支撑件的外侧(E)上开口，关节盂支撑件包括可配置在被动位置和主动位置中的突出部(40)，在所述被动位置和所述主动位置中，所述突出部分别允许将关节盂插入件插入到所述壳体中和从所述壳体中抽出以及禁止将关节盂插入件插入到所述壳体中和从所述壳体中抽出。

Description

颞下颌假体
技术领域
本发明涉及颞下颌假体，以及用于组装这种假体的方法。
背景技术
颞下颌假体或“颞下颌关节(temporo-mandibular joint，TMJ)”通常包括关节盂部件和铰接在所述关节盂部件上的髁突部件。在使用位置，将关节盂部件刚性地固定到颞骨，将髁突部件刚性地固定到患者的下颌骨上。
为了避免在患者体内金属颗粒的任何释放，应该避免关节盂部件与髁突部件之间的金属-金属接触。然而，关节盂部件是金属的对于有效且紧凑地固定到颞骨是有利的。
此外，必须将关节盂部件和下颌骨部件非常精确地分别固定在颞骨和下颌骨上，以保证有效的铰接。
需要至少部分地解决这些限制的解决方案。
本发明的目的是提供这样的解决方案。
发明内容
为此，本发明提供了根据权利要求1的假体。
如将进一步详细描述的，对于关节盂插入件使用非金属材料、特别是聚合物材料，避免了由于关节盂部件和髁突部件之间的摩擦而导致的金属颗粒的任何释放。
此外，只有当关节盂支撑件已经固定在颞骨上并且髁突部件已经固定在下颌骨上时，才能将关节盂插入件固定在关节盂支撑件上。因此，可以选择一种关节盂插入件，该关节盂插入件在使用位置完美适合髁突部件。
最后，通过简单地改变突出部的位置，可以相对于关节盂支撑件容易地固定关节盂插入件。这使得最终固定关节盂插入件更容易。
优选地，根据本发明的假体包括从属于权利要求1的权利要求的一个或多个可选特征。
本发明还涉及用于组装根据权利要求11的假体的方法。
优选地，根据本发明的方法包括从属于权利要求10的权利要求的一个或多个可选特征。
本发明还涉及一种颞下颌假体，包括关节盂部件和用于在使用位置关于所述关节盂部件铰接的髁突部件，其中，所述关节盂部件和髁突部件分别刚性地固定到患者的颞骨和下颌骨，所述髁突部件包括被配置为支承在所述患者的下颌骨的颈部(neck)上的第一止动件，以及被配置为支承在所述下颌骨的升支(ramus)上的第二止动件。
有利地，髁突部件可以相对于下颌骨以非常高的精度容易地布置。操作者仅将第一止动件置于下颌骨的颈部上，然后使髁突部件以前后运动旋转，直到第二止动件抵靠下颌骨的升支。
附图说明
通过参照本发明的示例性和非限制性实施方式阅读下文的详细描述并通过检查附图，将更好地理解本发明，其中：
-图1示出在拆卸位置的根据本发明的假体；以及
-图2示出在组装位置的相同假体。
具体实施方式
定义
“患者”是接收根据本发明的假体的生物、特别是人。
“包括”应该以其广泛且非限制性的含义理解，除非另有规定。
优选实施方式的详细描述
附图示出包括关节盂部件12和髁突部件14的假体10。关节盂部件12包括关节盂支撑件18和关节盂插入件20。
关节盂支撑件18由金属材料制成，优选地由钛或钛合金制成。
关节盂支撑件18包括支撑件锚固板22，该支撑件锚固板用于固定到颞骨。优选地，支撑件锚固板包括关节盂锚固孔24，通过该关节盂锚固孔可以将关节盂锚固螺钉驱动到颞骨中。
在优选的实施方式中，支撑件锚固板为网格(grid)，这使得骨的再生长和细胞定植更快。
关节盂支撑件18包括壳体26，该壳体被配置为接收关节盂插入件20。
更具体地，壳体26包括开口28，可以通过该开口将关节盂插入件20引入到壳体26中。
壳体26包括与开口28相反的底部30。
壳体26还包括两个引导导轨32，关节盂插入件可以在所述两个引导导轨上滑动，就像抽屉可以在柜橱中滑动一样。
壳体26在关节盂支撑件18的外侧上开口、即朝向脸颊开口，底部30朝向颅底的中间部分、即内侧取向。在图2中，外侧和内侧分别称为“E”和“I”。该布置使得关节盂插入件20更容易插入到壳体26中。
优选地，外侧E为关节盂支撑件的、支撑件锚固板22在其上延伸的侧。
根据本发明，关节盂支撑件18还包括突出部40，该突出部在分别如图1和图2所示的被动位置和主动位置之间是塑性可变形的。因此，突出部40在被动位置和主动位置中保持其形状。
在被动位置(图1)，突出部40不阻碍关节盂插入件20引入到壳体26中，也不阻碍将关节盂插入件从壳体中抽出。
在主动位置(图2)，突出部40阻碍关节盂插入件20引入到壳体中，或者在如图2所示的使用位置，阻碍将关节盂插入件从所述壳体中抽出。优选地，当将关节盂插入件插入到壳体26中时，突出部保持在主动位置，关节盂插入件20与壳体的底部30接触。
在优选的实施方式中，突出部被配置为从被动位置手动地可变形到主动位置，优选地无需任何工具。
在实施方式中，突出部40与支撑件锚固板22是一体形成的，优选地还与壳体26是一体形成的。
为了使突出部40的弯曲更容易，优选地提供弱化线42。该弱化线可以通过局部减小厚度和/或通过提供孔来形成。
关节盂插入件20优选地由聚合物材料制成，优选地由聚乙烯制成。关节盂插入件限定了用于接收髁突部件14的头部56的支承表面44。支承表面44优选是凹形的，优选地是基本上球形的。
关节盂插入件20还包括两个侧向槽46，这两个侧向槽被配置为与关节盂部件18的引导导轨32配合。
最后，关节盂插入件20包括插入件螺钉孔48，当插入的关节盂与壳体26的底部30接触时，插入件螺钉孔面向相应的支撑件螺钉孔50。在使用位置，组装螺钉通过插入件螺钉孔48穿过关节盂插入件20、通过支撑件螺钉孔50穿过关节盂支撑件18，并且优选地穿透到颞骨中。优选地，插入件螺钉孔48在插入件的外面(external face)51上开口、即在使用位置中面向皮肤的面上开口。
髁突部件14包括支撑头部56的髁突锚固板52，该头部用于支承在支承表面44上。髁突锚固板52包括髁突锚固孔58，以便用髁突锚固螺钉将髁突锚固板52固定到下颌骨上。
髁突锚固板22还包括第一止动件60和第二止动件62。
有利地，止动件60和止动件62使得髁突部件定位在下颌骨上更加容易。
在所示的实施方式中，第二止动件62通过弯曲髁突锚固板52而获得，优选地朝向嘴的内部弯曲。将第一止动件焊接在髁突锚固板52上。
根据本发明的假体的不同部件的组装优选如下：
利用关节盂锚固螺钉和髁突锚固螺钉分别穿过关节盂锚固孔24和髁突锚固孔58，将关节盂锚固板52和髁突锚固板52分别固定到患者的颞骨和下颌骨上。
在将髁突部件14固定到下颌骨上之前，止动件60和止动件62有助于在下颌骨上找到正确的位置。更具体地，操作者首先将第一止动件60置于已断裂的下颌骨的颈部N上。这限定了髁突部件14沿高度方向H的位置。然后，操作者使髁突部件14以前后运动旋转，直到第二止动件62抵靠下颌骨的升支R。
然后操作者推动关节盂插入件20，以便分别将两个导轨32接合在两个槽46内。然后，操作者将关节盂插入件20在导轨32上朝向底部30推动，优选地直到关节盂插入件20抵靠所述底部30。
有利地，壳体26的朝向外侧E的开口使得关节盂插入件20的插入更容易。
然后，操作者将突出部40从其被动位置(图1)弯曲到其主动位置(图2)，其中，突出部40至少部分地延伸越过壳体26的开口28。突出部40在其主动位置(40)支承在关节盂插入件20上，因此将关节盂插入件保持固定在底部30和突出部40之间。通过引导导轨32与槽46的配合来侧向地保持关节盂插入件。因此，利用突出部40，操作者使关节盂插入件20相对于关节盂支撑件18固定。
然后，操作者测试髁突部件的头部56与关节盂插入件20的支承表面44之间的配合是否完全正确。
如果不是这种情况，则操作者可以沿相反方向弯曲突出部40，直到突出部的被动位置。然后，操作者可以抽出关节盂插入件并对其进行调整、即修改或改变关节盂插入件，使其更好地与髁突部件14的头部56匹配。
有利地，操作者可以容易地测试不同的关节盂插入件20，而不需要一定将任何插入件部件固定到关节盂支撑件18上。
因此，操作者可以找到与髁突部件14完美匹配的关节盂插入件20。
一旦操作者找到了合适的关节盂插入件20，就驱动组装螺钉穿过插入件螺钉孔48和支撑件螺钉孔50，优选地，驱动进入到颞骨内部。
通过将关节盂插入件20用突出部40固定，使关节盂插入件20用所述组装螺钉的最终固定更容易。
最后，由于与髁突部件14配合的所述关节盂插入件20是非金属的、优选地是聚合物材料的，因此不存在金属-金属摩擦，这有利地避免了患者口腔中金属颗粒的任何释放。
现在很清楚，本发明提供了一种假体，该假体可以很容易地被测试，直到该假体完美符合患者的需求，并且在使用中不造成金属颗粒的任何释放。
当然，本发明不限于所公开和所示出的实施方式，这些实施方式仅作为示例性和非限制性示例提供。

Claims (15)

1.一种颞下颌假体，包括关节盂部件(12)和用于在使用位置关于所述关节盂部件铰接的髁突部件(14)，其中，所述关节盂部件和所述髁突部件分别刚性地固定到患者的颞骨和下颌骨，
所述关节盂部件包括：
-关节盂支撑件(18)，所述关节盂支撑件由金属材料制成；以及
-关节盂插入件(20)，所述关节盂插入件由非金属材料制成，并且限定用
于所述髁突部件(14)的头部(56)的底座以限定所述铰接；
其中，所述关节盂支撑件(18)限定具有开口(28)的壳体(26)，所述关节盂插入件(20)通过所述开口可插入到所述壳体中，所述开口(28)在所述关节盂支撑件(18)的外侧(E)上开口，所述外侧为所述关节盂支撑件的在所述使用位置朝向所述患者的皮肤取向的侧；
所述关节盂支撑件(18)包括可配置在被动位置和主动位置中的突出部(40)，在所述被动位置和所述主动位置中，所述突出部分别允许将所述关节盂插入件(20)插入到所述壳体中和从所述壳体中抽出以及禁止将所述关节盂插入件(20)插入到所述壳体中和从所述壳体中抽出，
所述突出部(40)在所述被动位置和所述主动位置之间是塑性可变形的。
2.根据权利要求1所述的假体，其中，所述关节盂支撑件(18)包括滑动引导件(32)，所述滑动引导件被配置为在所述突出部(40)的所述被动位置，引导所述关节盂插入件(20)滑入到所述壳体中和滑出所述壳体。
3.根据权利要求2所述的假体，其中，所述滑动引导件为导轨。
4.根据权利要求1-3中任一项所述的假体，其中，所述关节盂支撑件包括底部(30)，所述底部限制所述关节盂插入件(20)插入到所述壳体(26)中。
5.根据权利要求4所述的假体，其中，所述关节盂插入件(20)包括插入件螺钉孔(48)，并且所述关节盂支撑件包括支撑件螺钉孔(50)，所述插入件螺钉孔和所述支撑件螺钉孔被配置为使得当所述关节盂插入件在所述壳体中并与所述底部(30)接触时，组装螺钉能够穿过所述插入件螺钉孔(48)和所述支撑件螺钉孔(50)以组装所述关节盂插入件和所述关节盂支撑件。
6.根据权利要求5所述的假体，其中，所述插入件螺钉孔(48)在所述插入件的面(51)上开口，所述面在所述使用位置面向所述患者的皮肤。
7.根据权利要求1所述的假体，其中，所述突出部(40)为手动可变形的。
8.根据权利要求1所述的假体，其中，所述突出部(40)在所述主动位置至少部分地关闭所述开口(28)。
9.根据权利要求1所述的假体，其中，所述关节盂支撑件(18)包括网格，所述网格被配置为在所述使用位置与所述颞骨接触，以便使骨细胞更容易定植。
10.根据权利要求1所述的假体，其中，所述关节盂支撑件是钛或钛合金的和/或所述关节盂插入件是聚乙烯的。
11.根据权利要求1所述的假体，其中，所述髁突部件包括第一止动件(60)和/或第二止动件(62)，所述第一止动件被配置为支承在所述患者的下颌骨的颈部(N)上，所述第二止动件被配置为支承在所述下颌骨的升支(R)上。
12.根据权利要求1所述的假体，其中，所述关节盂支撑件包括支撑件锚固板，所述支撑件锚固板用于固定到颞骨，所述突出部与所述支撑件锚固板是一体形成的。
13.根据权利要求1所述的假体，其中，所述关节盂插入件由聚合物材料制成。
14.一种用于组装根据权利要求1所述的假体的方法，所述方法包括如下步骤：
a)将所述关节盂插入件(20)插入到所述壳体(26)中，所述突出部(40)在所述被动位置；
b)将所述突出部(40)置于所述主动位置，以使所述关节盂插入件(20)相对于所述壳体(26)固定。
15.根据权利要求14所述的方法，在步骤b)之后，包括如下步骤：
c)测试所述髁突部件(14)是否与所述关节盂插入件(20)匹配；
d)如果不匹配，则将所述突出部(40)置于被动位置，从所述壳体(26)中抽出所述关节盂插入件(20)，调整所述关节盂插入件(20)使其更好地与所述髁突部件(14)匹配，将调整后的关节盂插入件(20)插入到所述壳体(26)中，将所述突出部(40)置于主动位置，然后重新开始步骤c)；
e)将所述关节盂插入件(20)刚性地固定在所述关节盂支撑件(18)上。
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