CN112245068A

CN112245068A - Spongy bone reconstruction porous ring-shaped prosthesis

Info

Publication number: CN112245068A
Application number: CN202011250807.2A
Authority: CN
Inventors: 周一新; 杨德金; 邵宏翊; 唐浩; 黄勇
Original assignee: Beijing Jishuitan Hospital
Current assignee: Beijing Jishuitan Hospital
Priority date: 2020-11-11
Filing date: 2020-11-11
Publication date: 2021-01-22

Abstract

The invention discloses a spongy bone reconstruction porous ring-shaped prosthesis, which is characterized in that: comprises a hollow main body part; the main body part comprises a hollow tubular inner surface, an outer surface matched with the shape in the cavity of the femoral bone marrow, an upper end surface positioned at the top and a lower end surface positioned at the bottom, and porous structures are formed on the inner surface, the outer surface, the upper end surface and the lower end surface of the main body part. The porous structure on the outer surface of the main body part can ensure that the reconstructed prosthesis can obtain bone ingrowth, improve the long-term integral strength of the femur and the main body part, reduce the risk of fracture around the long-term prosthesis and improve the long-term fixing curative effect of the reconstructed prosthesis; the porous structure on the inner surface of the main body part can enable the bone cement to form enough micro-twistlocks between the inner surface of the main body part and the bone cement femoral prosthesis, so that the fixing effect of the cement prosthesis is improved, the problem of high failure rate of the cement prosthesis in the existing reconstruction method is solved, and the curative effect of patients with severe bone defect revision is improved.

Description

Spongy bone reconstruction porous ring-shaped prosthesis

Technical Field

The invention relates to a spongy bone reconstruction porous metal ring-shaped prosthesis, and belongs to the field of medical instruments.

Background

Artificial hip replacement is an effective means for treating various terminal coxitis. Artificial hip arthroplasty is a procedure to treat various artificial hip replacement failures. Due to severe osteolysis, stress shielding, infection around the prosthesis, multiple surgical history, osteoporosis, iatrogenic bone defects caused by perforation or windowing when the original prosthesis or residual bone cement is taken out and the like caused by loosening or abrasion, the femur side is often subjected to bone defects of different degrees in the artificial hip revision surgery. The difficulty in reconstruction is that there is often a severe bone defect on the femoral side, and the femur often incorporates proximal anatomical remodeling during revision, such as varus or retroversion remodeling. Thus, the femoral side bone defect reconstruction strategy is determined based on the severity of the bone defect, the amount and quality of bone remaining, and anatomical remodeling changes.

Many scholars have proposed the typing of femoral side bone defects, the most widely used type being the Paprosky type, which takes into account the three factors of bone defect site (metaphysis or diaphysis), residual bone mass and support of the proximal femur, and the length of the isthmus of the shaft available for distal fixation. The physician can objectively assess the femoral bone defect based on the typing and select an appropriate reconstruction method based on the defect typing. For severe femoral bone defects, particularly for bone defects caused by the fact that a medullary cavity forms a horn-shaped structure expanding downwards or the medullary cavity of the femur expands to form a chimney-pipe shape (chimney-pipe shape), a bone-free stem isthmus is used for fixing a femoral stem, and at present, traditional reconstruction methods such as assembling a conical ridged titanium stem, pressing bone grafting, proximal femoral allograft bone-prosthesis compound and proximal femoral replacement can be selected. The incidence of early prosthesis subsidence after the operation of assembling the conical titanium handle with the ridge is higher, the risk of fracture in the operation or after the operation is increased, and a series of complications such as stress concentration, stress shielding, insufficient effective fixed length, unstable prosthesis fixation and the like can be caused. Proximal femoral allograft bone-prosthesis composites present potential risks of disease transmission, resorption and nonunion of the graft, aseptic loosening, periprosthetic fractures and infection. The proximal femoral replacement dislocation rate is high and the long-term survival rate is low, and is only suitable for treating the elderly patients with low activity and a great deal of serious bone defects. The pressing bone grafting has the potential of reconstructing the bone mass of a patient in theory, but has the defects of higher risks of fracture in operation, postoperative prosthesis sinking and the like, higher technical requirements of the operation, time consumption, risk of disease transmission, bone grafting absorption and the like.

Disclosure of Invention

In view of the above problems, the present invention aims to provide a cancellous bone reconstruction porous metal ring-shaped prosthesis for treating severe bone defects of a femur, so that bone cement can form enough micro-twistlocks in a femoral medullary cavity, the fixation effect of a bone cement handle is improved, the overall reconstruction strength of the femur and the prosthesis is improved, the problem of high failure rate of a cement prosthesis in the existing reconstruction method is solved, and the curative effect of patients with severe bone defects is improved.

In order to achieve the purpose, the invention adopts the following technical scheme: a cancellous bone reconstruction porous ring prosthesis comprising a hollow body portion; the main body part comprises a hollow tubular inner surface, an outer surface matched with the shape in the cavity of the femoral bone marrow, an upper end surface positioned at the top and a lower end surface positioned at the bottom, and porous structures are formed on the inner surface, the outer surface, the upper end surface and the lower end surface of the main body part.

In some embodiments, the body portion has a solid layer between the inner surface and the outer surface, and the thickness of the solid layer is 1-10 mm.

In some embodiments, the porous structure is a bone-like trabecular structure, the porous structure having a pore size of 700 μm ± 300 μm and a porosity of 50% to 80%.

In some embodiments, the main body is made of titanium alloy or tantalum metal and is formed by 3D printing.

In some embodiments, the section of the coronal plane of the inner surface is rectangular or trapezoidal, the length of the bottom side of the trapezoid is 1 cm-6 cm, and the length of the top side is 0.8cm-3 cm; the cross section is circular or elliptical, the diameter of the circle is 0.8 cm-6 cm, the major axis of the ellipse is 1 cm-6 cm, and the minor axis is 0.5 cm-3 cm.

In some embodiments, the cross-section of the outer surface is circular or elliptical, the diameter of the circle is 1.2cm to 6.4cm, the major axis of the ellipse is 1.2cm to 6.4cm, the minor axis of the ellipse is 0.9cm to 3.4cm, and the cross-section of the coronal surface of the outer surface is rectangular or trapezoidal.

In some embodiments, the height of the body portion is 1cm to 10cm, and the thickness of the body portion is 1mm to 20 mm.

By adopting the technical scheme, the invention has the following advantages: the spongy bone reconstruction porous ring-shaped prosthesis comprises a main body part, wherein the main body part comprises a hollow tubular inner surface, an outer surface matched with the shape in the cavity of a femoral bone marrow, an upper end surface positioned at the top and a lower end surface positioned at the bottom, porous structures are formed on the inner surface, the outer surface, the upper end surface and the lower end surface of the main body part, and the porous structures on the outer surface of the main body part can enable the reconstruction prosthesis to obtain bone ingrowth, improve the long-term integral strength of the femur and the main body part, reduce the risk of fracture around the long-term prosthesis and improve the long-term fixing curative effect of the reconstruction prosthesis; the porous structure on the inner surface of the main body part can enable the bone cement to form enough micro-twistlocks between the inner surface of the main body part and the bone cement femoral prosthesis, so that the fixing effect of the cement prosthesis is improved, the problem of high failure rate of the cement prosthesis in the existing reconstruction method is solved, and the curative effect of patients with severe bone defect revision is improved.

Drawings

FIG. 1 is a schematic view of the overall construction of a reconstruction prosthesis according to the present invention;

FIG. 2 is a schematic cross-sectional view of a reconstruction prosthesis of the present invention;

fig. 3 is a schematic view of the present invention installed in the femoral medullary cavity.

Detailed Description

The invention is described in detail below with reference to the figures and examples. It is to be understood, however, that the drawings are provided solely for the purposes of promoting an understanding of the invention and that they are not to be construed as limiting the invention.

It should be noted that all the directional indicators (such as the near end, the far end, the front end, the rear end, the upper end, the lower end, etc.) in the present embodiment are only used to explain the relative position relationship, the motion situation, etc. of the components in the general operation posture, that is, the side close to the operator is referred to as the near end or the rear end, and the side far away from the operator is referred to as the far end or the front end; if the operating posture changes, the directional indication changes accordingly.

As shown in fig. 1 and 2, the cancellous bone reconstruction porous ring prosthesis provided in this embodiment includes a hollow main body 10; the main body 10 includes an inner surface 101 having a hollow tubular shape, an outer surface 102 adapted to the shape of the femoral medullary cavity, an upper end surface 103 at the top, and a lower end surface 104 at the bottom, and the inner surface 101, the outer surface 102, the upper end surface 103, and the lower end surface 104 of the main body 10 are all formed with a porous structure.

When the reconstruction prosthesis provided by the embodiment is used, the main body part 10 is driven into a femoral medullary cavity, the outer surface 102 of the main body part 10 is in press fit with the inner wall of the femoral medullary cavity, and a porous structure on the outer surface 102 of the main body part 10 can obtain bone ingrowth, so that the prosthesis obtains a long-term biological fixation foundation; the bone cement femoral prosthesis penetrates through the inside of the main body part 10, the bone cement can permeate into the porous structure on the inner surface 101 of the main body part 10, the bone cement forms a micro-hinge between the inner surface 101 of the main body part 10 and the bone cement femoral prosthesis, the success rate of renovation of the cement femoral prosthesis is improved, meanwhile, artificial bone or coating material for promoting bone ingrowth can be sprayed in the porous structure on the outer surface 102 of the main body part 10, so that the bone integration is stimulated, or antibiotic medicine or antibacterial material or coating is filled in the porous structures on the inner surface 101 and the outer surface 102, and the periphery of the prosthesis is prevented from infection or the bone ingrowth is promoted. It is understood that the number of main bodies 10 injected into the femoral bone marrow cavity is not determined, and is determined according to the degree of femoral defect of the patient.

In the above embodiment, preferably, the solid layer 105 is arranged between the inner surface 101 and the outer surface 102 of the main body part 10, and the thickness of the solid layer 105 is 1-10 mm, so that the bone cement is prevented from permeating into the outer surface 102 from the inner surface 101, and the bone cement is prevented from influencing the bone ingrowth potential of the outer surface 102.

In the above embodiment, preferably, the porous structure is a bone-like trabecular structure, the pore diameter of the porous structure is 700 μm ± 300 μm, and the porosity is 50% -80%.

In the above embodiment, the main body 10 is preferably made of metal, and may be formed by 3D printing, for example, by electron beam melting 3D printing, and the main body 100 may be made of titanium alloy or tantalum metal.

In the above embodiment, preferably, the coronal section of the inner surface 101 may be rectangular or trapezoidal, the length of the bottom side of the trapezoid is 1cm to 6cm, and the length of the top side is 0.8cm to 3 cm; the cross section is circular or elliptical, the diameter of the circle is 0.8 cm-6 cm, preferably 1 cm-2.5 cm, the major axis of the ellipse is 1 cm-6 cm, and the minor axis is 0.5 cm-3 cm.

In the above embodiment, preferably, the cross section of the outer surface 102 may be circular or elliptical, the diameter of the circle is 1.2cm to 6.4cm, the major axis of the ellipse is 1.2cm to 6.4cm, the minor axis is 0.9cm to 3.4cm, and the cross section of the coronal surface of the outer surface 102 may be rectangular or trapezoidal or other shapes to adapt to the shape of the femoral intramedullary canal.

In the above embodiment, the height of the body 10 is preferably 1cm to 10cm, more preferably 1.2cm to 4cm, and the thickness of the body 10 is preferably 1mm to 20mm, more preferably 2mm to 6 mm.

As shown in fig. 3, based on a cancellous bone reconstruction porous ring prosthesis in any of the above embodiments, the present invention also provides an implantation method of a cancellous bone reconstruction porous ring prosthesis, which comprises the following steps:

1) obtaining hip joint examination data of the affected side and the healthy side of a patient before operation; reconstructing the shape of the femur by using a computer, selecting a cancellous bone reconstruction porous ring-shaped prosthesis with a proper specification, or customizing the cancellous bone reconstruction porous ring-shaped prosthesis according to the 3D printing of the patient specific medullary cavity structure;

2) performing preoperative planning according to the bone cement femoral prosthesis form;

3) exposing the femur to be reconstructed in an operation, performing reaming of a femoral medullary cavity, and filing the femoral medullary cavity to a preset size;

4) the spongy bone reconstruction porous ring-shaped prosthesis is driven into a planned preset position before operation in a femoral medullary cavity by using a special instrument, so that the spongy bone reconstruction porous ring-shaped prosthesis is pressed and fixed in the medullary cavity;

5) bone cement is poured into the medullary cavity to infiltrate the porous ring prosthesis, and then the bone cement femoral stem is implanted.

The present invention has been described with reference to the above embodiments, and the structure, arrangement, and connection of the respective members may be changed. On the basis of the technical scheme of the invention, the improvement or equivalent transformation of the individual components according to the principle of the invention is not excluded from the protection scope of the invention.

Claims

1. A cancellous bone reconstruction porous ring prosthesis characterized by: comprises a hollow main body part; the main body part comprises a hollow tubular inner surface, an outer surface matched with the shape in the cavity of the femoral bone marrow, an upper end surface positioned at the top and a lower end surface positioned at the bottom, and porous structures are formed on the inner surface, the outer surface, the upper end surface and the lower end surface of the main body part.

2. A cancellous bone-reconstructing porous ring prosthesis according to claim 1 wherein: a solid layer is arranged between the inner surface and the outer surface of the main body part, and the thickness of the solid layer is 1-10 mm.

3. A cancellous bone-reconstructing porous ring prosthesis according to claim 1 wherein: the porous structure is a bone-like trabecular structure, the aperture of the porous structure is 700 mu m +/-300 mu m, and the porosity is 50-80%.

4. A cancellous bone-reconstructing porous ring prosthesis according to claim 1 wherein: the main part is titanium alloy or tantalum metal material, adopts 3D to print the shaping and forms.

5. A cancellous bone-reconstructing porous ring prosthesis according to claim 1 wherein: the section of the coronal plane of the inner surface is rectangular or trapezoidal, the length of the bottom side of the trapezoid is 1 cm-6 cm, and the length of the top side is 0.8cm-3 cm; the cross section is circular or elliptical, the diameter of the circle is 0.8 cm-6 cm, the major axis of the ellipse is 1 cm-6 cm, and the minor axis is 0.5 cm-3 cm.

6. A cancellous bone-reconstructing porous ring prosthesis according to claim 1 wherein:

the cross section of the outer surface is circular or elliptical, the diameter of the circle is 1.2 cm-6.4 cm, the major axis of the ellipse is 1.2 cm-6.4 cm, the minor axis of the ellipse is 0.9 cm-3.4 cm, and the section of the coronal surface of the outer surface is rectangular or trapezoidal.

7. A cancellous bone-reconstructing porous ring prosthesis according to claim 1 wherein: the height of the main body part is 1 cm-10 cm, and the thickness of the main body part is 1 mm-20 mm.