CN111281618A - 反转膝部假体 - Google Patents

反转膝部假体 Download PDF

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CN111281618A
CN111281618A CN202010156167.2A CN202010156167A CN111281618A CN 111281618 A CN111281618 A CN 111281618A CN 202010156167 A CN202010156167 A CN 202010156167A CN 111281618 A CN111281618 A CN 111281618A
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femoral
liner
tibial tray
length
posterior
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扎菲尔·特曼尼尼
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Joint Innovation Technology LLC
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Abstract

一种用于膝部置换外科手术的反转膝部假体，具有股骨组件和滑车组件。股骨组件包括固定在股骨中的柄和具有大体凹形部分的股骨杯，大体凹形部分具有关节连接在滑车组件上的尺寸。股骨杯还包括后唇部和前唇部，其中前唇部比后唇部更长。滑车组件固定至胫骨托，胫骨托转而固定至胫骨，并且滑车组件具有带狭窄腰部的横向弯曲主体。股骨杯的大体凹形部分具有从大体凹形部分向外延伸的脊状件，脊状件具有关节连接在狭窄腰部上的尺寸。

Description

反转膝部假体
相关申请的交叉引用
本申请是要求于2013年9月27日提交的第61/883,228号美国临时申请的优先权的非临时申请。
技术领域
本发明总体涉及膝部表面再塑假体，并且本发明更具体地涉及用于膝部表面再塑的膝部植入假体。
背景技术
可注意到膝部表面再塑假体多年来用于治疗由关节炎或继发于创伤的病变而损坏的关节连接表面。一般地，天然膝关节包括具有两个髁表面的上股骨关节连接表面和包括与上股骨髁平滑关节连接的两个杯形托状胫骨。通常，膝部置换假体由多种类型的假体组成，其中，膝部的关节连接组件被移除并且用金属和聚乙烯组件置换。
现有技术的装置试图复制天然关节连接表面的几何结构，其中，股骨组件具有半圆的C状设计，例如，第4,224,898号美国专利中所描述的。双髁设计也类似地公开在Buechel的第4,309,778号和Pappas的第4,470,158号现有美国专利中。较新的双髁设计描述在第D473,307S号美国专利和第6,197,064B1号美国专利中。现有技术将双髁假体描述成具有用于股骨髌骨关节连接的中间髌骨槽。其它膝部植入装置用于仅表面再塑一个股骨髁，例如，第7,141,053号美国专利和第6,726,724号美国专利中所描述的单髁假体。铰接式植入体的多种设计主要被描述成用于修正过程以及妨碍使用传统植入体的骨缺损和不稳定的情况。本发明的设计不是铰接式。并且，与铰接式设计不同的是，本设计允许胫骨和股骨的两个关节连接表面在例如蹲或者在奔跑时的活动极限范围内轻微分离。
在这些方面，根据本发明的反转膝部表面再塑假体基本上脱离了传统构思和现有技术的设计，并且，这样一来，提供了主要为了使用反转几何结构对股骨和胫骨的关节连接表面进行表面再塑的目的而开发的装置，其中，股骨组件具有杯形托的形状，并且胫骨组件的优选实施方式具有柱状物、弯曲表面或滑车的形状，该形状在其中间部分具有槽。在这种情况下，反转几何结构既在机械学上也在解剖学上提供了超越之前已知的膝部植入体的显著优势。机械上的优势是明显增大了胫骨和股骨之间的接触表面，从而减少了压力，并且因此减轻了磨损。
在之前已知的植入体中，弯曲的股骨植入体表面以非常小的表面面积接触平的胫骨关节连接表面，因此压力负载可能超过身体重量的三到四倍。这种应力集中增强了聚乙烯胫骨托的磨损并且降低了植入体的功效和寿命。在本反转膝部植入体中，接触表面包围股骨杯的凹形表面，从而将压力负载分布到大的表面之上，从而使磨损最小化。解剖学上的优点在于本反转几何结构和前唇部特征消除了对交叉韧带的需要。本股骨杯的形状提供了在前后平面中的可观的稳定性，并且防止股骨向前滑动。在站立姿势和步行的摆动阶段期间，股骨杯的前唇部和后唇部的限制几何结构代替了前交叉韧带和后交叉韧带的机械作用。
发明内容
鉴于现有技术中已知的膝部表面再塑假体中固有的上述缺点，本发明提供了在膝部表面再塑过程中使用的新的反转膝部表面再塑假体构造。本发明的假体提供了增大的活动范围和增强的稳定性以及大量减小的磨损。
附图说明
当结合附图考虑时，本发明的各种其它目的、特征以及伴随的优点将被充分地理解并且其将变得更透彻，其中，相同的参考符号在全部多个附图中指代相同或相似的部分，并且在附图中：
图1是假体的侧部剖面图。
图1A是详细示出了图1的聚乙烯内衬和股骨杯的局部分解剖面图。
图2是植入的假体的主视图，其以截面示出了股骨和胫骨，其中，股骨组件位于股骨中，并且胫骨组件位于胫骨中。
图2A和2B是图2的股骨柄和股骨杯的两个实施方式的剖面图。
图3是股骨杯的立体图。
图4是包括滑车组件和胫骨托的胫骨组件的主视立体图。
图4A是图4的胫骨托的俯视图。
图4B是图4A的主视立体图。
图4C是沿图4A的剖面线A-A截取的剖面图。
图4D是图4的具有螺钉的附加部分的滑车组件的立体图。
图4E是图4D的仰视图。
图5是示出了滑车组件和后凹座的胫骨组件的后视图。
图6是假体的则面立体图，其中，后唇部位于后凹座中，以允许过度弯曲。
图7是本发明的可替代的实施方式的剖面图。
具体实施方式
参考附图，本发明大体包括股骨组件，股骨组件具有待插入并固定在股骨和股骨杯14中的柄1或1A。贝壳形式的内衬2或2A固定在股骨杯14的凹形表面上。应理解的是，优选的内衬是聚乙烯，但是，如本领域所公知的，除了聚乙烯以外的材料也可用作内衬。内衬包括从前向后定向的脊状件20。脊状件20关节连接于滑车组件3的中央槽21中。脊状件20通过引导件18和内衬锁定连接片24固定至杯。如分解剖面图1A所示，引导件18的尺寸设置为配合在凹座26中。凹座26在其侧壁中具有锁定内衬凹座27。随着引导件18被按压到凹座26中，朝向引导件18的侧壁按压内衬锁定连接片24，并且，在引导件18被完全按压到凹座28中时，内衬锁定连接片24立刻打开在内衬凹座27中，从而将内衬2锁定到股骨杯14中。
股骨杯具有后唇部4或4A和前唇部5。前唇部5必须具有比后唇部4或4A更长的长度，以使得交叉韧带是不必要的。
参考图4和图5，滑车组件3具有横向弯曲主体，横向弯曲主体具有变窄的腰部21。上述滑车组件3具有高度抛光表面，高度抛光表面将允许与带内衬的股骨杯进行关节连接。滑车组件通过颈部16附接至胫骨托19或19A。然后(图5)，颈部16和滑车组件3提供中央后凹座23，中央后凹座在极度屈曲时接纳股骨杯的后唇部4(见图6)。
如基于本文中的公开将对本领域的技术人员显而易见的，具有将胫骨组件固定至胫骨的各种方式。在本文中，讨论了两种胫骨组件实施方式。在图4中，胫骨托19设置有植入胫骨中的稳定桩22。在图1、图2、图5和图6中，胫骨托19A设置有稳定鳍状件7，在稳定鳍状件7上具有植入到胫骨中的肋7A。胫骨托19或19A可使用螺钉进一步固定至胫骨，螺钉例如图4C中以截面示出的螺钉31。
在胫骨托固定至胫骨后，滑车组件3固定至胫骨托19。这通过将滑车组件3滑动到胫骨托19或19A的开槽部分中完成。胫骨托具有托锁定连接片17，托锁定连接片17以与内衬锁定连接片24相同的方式起作用。当滑车组件3滑动到胫骨托中时，向下按压托锁定接头17，直到槽17A放置在托锁定接头17之上，然后，接头17向上弹并将滑车组件3锁定在适当位置。
图4A、图4B和图4C更详细地示出了图4的胫骨托19。胫骨托19的实施方式包括稳定桩22、开槽部分6、后凹口25和可选的螺钉孔30。图4C以截面示出了在可选的螺钉孔30中的一个的平头螺钉31。胫骨托可通过本领域已知的各种方式固定至胫骨，诸如螺钉、销、胶合剂或它们的各种组合。除了胫骨托19A包括稳定鳍状件7，而胫骨19包括稳定桩22之外，图4的胫骨托19的构造与图1、图2、图5和图6的胫骨托19A的构造相同。
图4D是图4的滑车组件3的立体图。滑车组件3包括中央槽21、颈部18和连接片32。图4E是图4D的仰视图。如上所述，滑车组件3通过将连接片32滑动到槽6中并将连接片32锁定到适当位置而固定至胫骨托19。
胫骨托19包括半圆形凹口25(图4A和图5)，以允许极度屈曲。
包括本发明的膝部置换假体的构成部分的套件包括具有不同尺寸的两个或更多个试验塑料植入体以及具有与试验塑料植入体相同尺寸的本发明的两个或更多个假体。因此，试验塑料植入体各包括柄和股骨杯、滑车组件以及胫骨组件。两个或多个不同厚度的永久内衬以及两个或多个试验塑料内衬也包括在套件中，每个试验塑料内衬具有对应于永久内衬厚度的厚度。在使用试验植入体和内衬的外科手术期间，选择适当厚度的永久内衬(例如聚乙烯内衬)，以给患者制造最适合的假体。试验塑料内衬的构造与永久内衬的不同之处在于引导件18不包括锁定连接片24。这允许外科医生测试各个试验塑料植入体中的不同厚度的试验塑料内衬。
在用于植入本发明的假体的外科手术方法中，外科医生将首先完成前中线切口。然后，使髌骨横向脱位并且使膝部弯曲。然后，通过插入髓内引导杆并且然后使用切割引导件进行适当的末端股骨切割来准备股骨。然后，通过使用切割引导件进行适当的切割来准备胫骨。然后，将试验塑料植入体暂时植入患者体内，并且对试验塑料内衬进行测试。然后，对膝部的活动范围进行稳定性检查。当稳定性符合要求时，将试验塑料植入体组件移除，并且用具有与试验植入体和试验内衬相同尺寸的永久假体和永久内衬置换试验塑料植入体组件。因此，胫骨托固定在适当位置，随后通过冲击将股骨柄固定到股骨中。当膝部屈曲时，内衬被锁定在适当位置。然后，将滑车组件固定到胫骨托中。髌骨根据对其关节面的损伤程度可需要或可不需要表面再塑。
应当注意，以下实施方式被认为是上述实施方式的替换，其可以以结合或单独的方式合并：
胫骨组件和股骨组件可由诸如钛的金属制成或者可由诸如钴铬合金的金属合金制成。胫骨组件和股骨组件也可由陶瓷制成，诸如氧化铝或氮化硅等，或者可由具有用于预定目的的足够强度的其它生物相容材料制成。
如图2所示的凹槽15是股骨和滑车组件3之间的空间。可以使凹槽15更宽以便允许滑车相对股骨杯的一些转动。
作为具有滑车形状的胫骨组件的替代，其可具有弯曲表面，该弯曲表面在其中间部分不具有槽，并且股骨杯的凹形表面将结构兼容地成形，以防止不期望的横向运动。图7中以截面示出了该实施方式。柄1A与图1的柄1相同，但是股骨杯14A与股骨杯14不同，这是因为股骨杯14A具有延伸到滑车组件3A的端部之上的侧部，从而限制股骨杯相对于滑车组件的横向运动。颈部18A实质上具有与颈部16相同的构造。聚乙烯内衬2B关节连接在滑车组件3A的顶部上，并且聚乙烯内衬2B的侧部34可关节连接在滑车组件3A的端部33上。

Claims (7)

1.一种膝部假体，包括：
股骨组件，具有位于近端处的可插入式股骨杯以及位于远端处的股骨柄，所述股骨杯包括凹形表面和内衬，所述内衬固定至所述凹形表面内；
胫骨托，能够固定至胫骨的部分；
滑车组件，具有横向弯曲主体，所述横向弯曲主体具有狭窄腰部，所述内衬具有从所述内衬向外延伸的脊状件，所述内衬的所述脊状件具有关节连接在所述横向弯曲主体的所述狭窄腰部上的尺寸，以及
所述股骨杯还包括具有第一长度的后唇部以及具有第二长度的前唇部，其中，所述前唇部的所述第二长度比所述后唇部的所述第一长度更长，并且所述滑车组件还包括后凹座，所述后凹座在极度屈曲期间接纳所述后唇部，同时保持所述内衬与所述滑车组件的狭窄腰部之间接触。
2.如权利要求1所述的膝部假体，其中所述股骨柄适于固定至股骨，并且所述股骨组件固定至所述胫骨托，所述胫骨托适于固定至胫骨，以及其中，所述滑车组件能够经由所述胫骨托的开槽部分固定至所述胫骨托，其中，所述滑车组件的部分可滑动地接合至所述胫骨托中并与所述胫骨托相接合。
3.如权利要求1所述的膝部假体，其中所述内衬由聚乙烯组成。
4.一种适于在膝部置换外科手术中使用的套件，包括：
两个或更多个不同尺寸的试验塑料股骨组件，每个所述试验股骨组件都具有位于近端处的股骨杯以及位于远端处的股骨柄，每个所述股骨杯都包括凹形表面，所述凹形表面具有用于在滑车组件上进行关节连接的尺寸；
两个或更多个不同尺寸的试验塑料滑车组件，每个所述试验塑料滑车组件都具有横向弯曲主体，所述横向弯曲主体具有狭窄腰部，所述股骨杯的所述凹形表面具有从所述凹形表面向外延伸的脊状件，所述脊状件具有在所述狭窄腰部上进行关节连接的尺寸，
所述股骨杯还包括具有第一长度的后唇部以及具有第二长度的前唇部，其中，所述第二长度比所述第一长度更长，并且每个所述滑车组件均还包括后凹座，所述后凹座在极度屈曲期间接纳所述后唇部；
两个或更多个试验塑料内衬，具有不同的厚度；以及
一个或多个试验塑料胫骨托；
并且所述套件还包括如权利要求1所述的两个或更多个膝部假体，每个如权利要求1所述的膝部假体的尺寸都与试验塑料植入体的尺寸一致；以及
两个或多个内衬，每个所述内衬的厚度都与试验塑料内衬的厚度一致。
5.一种膝部假体，包括：
股骨组件，具有位于近端处的可插入式股骨杯以及位于远端处的股骨柄，所述股骨杯包括凹形表面和可插入式的内衬，所述内衬位于所述凹形表面内；
胫骨托；
滑车组件，具有横向弯曲主体，所述弯曲主体具有狭窄腰部和两个端部，所述内衬具有从所述内衬向外延伸的脊状件，所述内衬的所述脊状件具有关节连接在所述横向弯曲主体的所述狭窄腰部上的尺寸；以及
其中，所述股骨组件包括侧部，所述侧部具有仅延伸到所述滑车组件的两个端部的一部分之上的尺寸，
所述股骨杯还包括具有第一长度的后唇部以及具有第二长度的前唇部，其中所述前唇部的所述第二长度比所述后唇部的所述第一长度更长，并且所述滑车组件还包括后凹座，所述后凹座在极度屈曲期间接纳所述后唇部，同时保持所述内衬与所述滑车组件的狭窄腰部之间接触。
6.如权利要求5所述的膝部假体，其中，所述股骨柄适于固定至股骨，并且所述滑车杯固定至胫骨托，所述胫骨托适于固定至所述胫骨，以及其中，所述滑车组件能够经由所述胫骨托的开槽部分固定至所述胫骨托，其中，所述滑车组件的部分可滑动地接合至所述胫骨托中并与所述胫骨托相接合。
7.如权利要求5所述的膝部假体，其中所述内衬由聚乙烯组成。
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WO2015048273A1 (en) 2015-04-02
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BR112016006674B1 (pt) 2021-12-14
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