CN112842614A - 用于植入髋关节置换假体的手术托盘、器械及方法 - Google Patents

用于植入髋关节置换假体的手术托盘、器械及方法 Download PDF

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Publication number
CN112842614A
CN112842614A CN202110233289.1A CN202110233289A CN112842614A CN 112842614 A CN112842614 A CN 112842614A CN 202110233289 A CN202110233289 A CN 202110233289A CN 112842614 A CN112842614 A CN 112842614A
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cup
trial
ball
femoral
acetabular
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CN202110233289.1A
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Inventor
扎菲尔·特曼尼尼
史蒂文·麦克唐纳
布莱恩·万黑尔
泰勒·戴维斯
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Hip Innovation Technology LLC
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Hip Innovation Technology LLC
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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
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4637—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
    • A61F2002/4638—Tools for performing screwing, e.g. nut or screwdrivers, or particular adaptations therefor
    • A—HUMAN NECESSITIES
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    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4637—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
    • A61F2002/4641—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis for disconnecting
    • 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
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4681—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering

Abstract

在髋关节置换手术中使用的手术托盘、工具及方法，其中，髋关节置换假体是逆向髋关节假体。本发明的试验部件、专用工具及方法使外科医生能够基于最适合于病人骨骼的尺寸和角度来确定用于植入病人体内的逆向髋关节假体的最佳部件。

Description

用于植入髋关节置换假体的手术托盘、器械及方法
分案声明
本申请是申请日为2016年8月15日、申请号为201680048600.2的中国专利申请的分案申请。
技术领域
本发明涉及在有关逆向髋关节假体中使用的手术器械和方法。更具体地，本发明涉及在髋关节置换手术中使用的器械托盘、手术工具和试验植入物。
背景技术
第8313531B2号和第8540779B2号美国专利中描述了逆向髋关节假体。第8992627B2号美国专利中也描述了所述假体和翻修手术方法。这三项专利的公开内容通过引用以其整体并入本文。
发明内容
如以上引用的专利中所描述的，逆向髋关节假体通常包括髋臼球和股骨杯，其中，髋臼球附接到髋臼杯中的柄，股骨杯附接到股骨柄，其中，股骨杯在髋臼球上形成关节。本发明的手术托盘、工具及方法使外科医生能够使用试验植入物和专用手术工具基于尺寸和角度确定用于植入病人体内的逆向髋关节假体的最佳部件。本公开中，申请人有时使用术语“工具”来表示手术工具。
附图说明
图1A和图1B示出了包括用于为植入手术准备股骨的工具的一套托盘。
图2A、图2B和图2C示出了包括用于为植入手术准备髋臼的工具的一套托盘。
图3A、图3B和图3C示出了包括用于确定尺寸并植入髋臼杯和髋臼球的试验植入物和工具的一套托盘。
图4A、图4B和图4C示出了包括用于筛选确定尺寸并植入股骨杯的试验植入物和工具的一套托盘。
图5A、图5B、图5C、图5D和图5E包括试验髋臼杯的正视图、剖视图和立体图。
图6A、图6B、图6C和图6D包括用于与试验髋臼杯一起使用的第一试验髋臼球的正视图、剖视图和立体图。
图7A、图7B、图7C、图7D、图7E和图7F包括用于与植入的髋臼杯一起使用的第二试验髋臼球的正视图、剖视图、细节图和立体图。
图8A、图8B、图8C、图8D和图8E示出了图7A至7F中所示类型的第二试验髋臼球的多种视图，以及放置在髋臼杯的柄上的所述球的正视图和剖视图。
图9A、图9B和图9C以立体图和正视图示出了用于安装和移除试验髋臼杯的手柄，并且示出了拧入到试验髋臼杯中的手柄的剖视图，所述试验髋臼杯位于髋臼的代表性部分中。
图10A、图10B、图10C、图10D、图10E和图10F包括第一试验股骨杯的正视图、剖视图、细节图和立体图。
图11A、图11B、图11C、图11D、图11E和图11F包括图10A至图10F中所示类型的第一试验股骨杯的附加视图，以及位于第一股骨植入物中的所述杯的立体图和正视图。
图12A、图12B、图12C、图12D、图12E和图12F示出了第二试验股骨杯的正视图、剖视图、细节图和立体图。
图13A、图13B、图13C、图13D、图13E、图13F和图13G示出了图12A至图12F中所示类型的第二试验股骨杯的附加视图，以及位于第二股骨植入物中的所述杯的立体图、正视图和剖视图。
图14是示出位于试验髋臼杯中的第一试验髋臼球以及用于将所述球附接到所述杯并从所述杯移除的工具的剖视图。
图15是示出在第一试验髋臼球上、处于关节连接位置中的第一试验股骨杯的剖视图。
图16A、图16B、图16C、图16D、图16E、图16F、图16G和图16H示出了按压组件及其部件的多种视图，所述按压组件用于将衬里按压在股骨杯中。
图17是图16A至图16H的按压组件的正视图且按压组件中具有股骨杯。
图18是图17的剖视图。
图19是插入-移除工具的立体图。
图20是图19的工具的正视图。
图21是适合于与插入-移除工具一起使用的试验髋臼球的另一实施方式的正视图。
图22是示出在工具与图21的试验髋臼球接触以便于将球从髋臼杯移除时的图19和图20的工具的位置的立体图。
图23是在手术中使用的常规电钻的正视图。
具体实施方式
用于为髋关节植入手术准备股骨的工具分别包括在图1A和图1B的第一套钢托盘1和2中。托盘1包括铰刀(reamer)3、右手手柄4和左手手柄5。托盘1中还包括T形手柄6和盒式骨刀(box osteotome)7。在股骨已经通过切除股骨头来为手术做好准备之后，盒式骨刀7被用作中心冲(center punch)以在股骨中形成初始开口，所述初始开口作为用于正确定位铰刀3的引导。然后，适合于连接到铰刀3的近端3a的T形手柄6被附接到铰刀，并且外科医生将铰刀3的远端3b放置到初始开口中，并在施加压力的同时转动手柄以在股骨中形成袋状囊(pocket)。右手手柄4和左手手柄5分别适合于连接到铰刀的近端3a，用于旋转铰刀以在股骨中形成深的袋状囊，从而为使用拉刀(broach)8做好准备，拉刀8与托盘2一起在下文进行说明。右手操作的外科医生使用右手手柄4，并且左手操作的外科医生使用左手手柄5。
托盘2包括一套两个或两个以上不同尺寸的拉刀8。拉刀具有从9mm(在图1B的左手边上)到21mm(在图1B的右手边上)的范围内的尺寸。在附图中，从左到右的每个拉刀8比其左侧的拉刀大1mm。从附图中可以看出，拉刀是锥形的，并且每个拉刀的尺寸指的是所述拉刀的顶部(近端8a)处的最大直径。拉刀8(还称为粗锉刀)插入到深的袋状囊中，并使用锤9在近端8a处将拉刀8敲击到股骨中。手柄10拧入到股骨植入物75的近端处或近端附近的螺纹凹部75a中(参见图13)，并用于将股骨植入物植入到股骨中。
用于为髋关节移植手术准备髋臼的工具分别包括在图2A、图2B和图2C的第二套钢托盘11、12和13中。托盘11和托盘12共同地包括两个或两个以上(图2A和图2B中示出了25个)不同尺寸的髋臼切骨器14，所述髋臼切骨器14用于将髋臼骨切割成合适的尺寸以容纳对应尺寸的髋臼杯。驱动轴和驱动轴手柄用于将钻具140(参见图23)连接到髋臼切骨器14。托盘13示出了两个不同尺寸的驱动轴15和两个驱动轴手柄16。驱动轴具有适合于连接到切骨器的远端15b以及适合于连接到驱动轴手柄16的远端16b的近端15a。驱动轴手柄16的近端16a适合于连接到钻具140的夹头(chuck)141。
用于植入髋臼杯和髋臼球的试验植入物和工具分别包括在图3A、图3B和图3C的第三套钢托盘21、22和23中。
托盘21包括导钻手柄24、两个或两个以上钻头25、两个或两个以上导钻26、两个或两个以上第二试验髋臼球27以及试验髋臼球插入-移除工具28。每个钻头25具有对应尺寸的导钻。
托盘22包括两个或两个以上第一试验髋臼球29、两个或两个以上试验髋臼杯30以及通用手柄31。
托盘23包括髋臼杯冲击器组件的元件。托盘23包括另一通用手柄31、髋臼杯手柄32、在其近端处具有突出把手34的内轴33、两个前倾导杆35、至少一个(并且优选地，三个)有缝夹套件38以及至少一个(并且优选地，三个)髋臼球冲击器37。倾斜和前倾导引36具有用于将导引36维持在髋臼杯手柄32上的适当位置中的蝶形螺钉(未示出)。这在申请人于2016年7月15日提交的共同未决的第PCT/US 16/42441号国际申请中进行了详细的描述。
用于植入股骨杯的试验植入物和工具分别包括在图4A、图4B和图4C的第四套钢托盘41、42和43中。
托盘41和托盘42仅包括两个或两个以上第一试验股骨杯44。这些第一试验股骨杯44可在尺寸、颈部长度和偏移角度上不同。优选地，在拉刀从股骨中移除之前，第一试验股骨杯44适合于临时地附接到来自托盘2的拉刀8的近端。替代地，第一试验股骨杯44可以临时地附接到如图11E和图11F中所示的股骨植入物49的近端。
托盘43包括适合于临时地附接到股骨植入物49(参见图11E和图11F)的两个或两个以上第二试验股骨杯45。托盘还包括用于将聚合衬里按压到股骨杯中的按压件46、股骨杯定位器47以及柱塞48和48a(另外参见图16C、图16D、图16E和图16F)。
更具体地，针对包括在以上讨论的托盘中的各种部件，图5A至图5E示出了试验髋臼杯30的多种视图。图5E是试验髋臼杯的立体图。图5A是侧视图，并且图5D是图5A的剖视图。图5B是俯视图，并且图5C是仰视图。
试验髋臼杯30具有外表面和内凹表面，其中，外表面适合于适配髋臼骨的经过处理的表面。优选地，外表面为凸表面。具有内部带螺纹的开口51的柄50从凹表面的底部延伸，并且杯的特征在于多个可选的贯通开口52。带螺纹的开口51容纳通用手柄31的螺纹，所述通用手柄31用于安装杯30以及从髋臼移除杯30(参见图9C)。开口51的螺纹还容纳图6A至图6D中示出的第一试验髋臼球29。本发明的试验髋臼球为半球状的，并且可包括如下所述的平坦部分和斜面。图6D是试验髋臼球29的立体图，图6A是侧视图，图6B是俯视图，并且图6C是剖视图。带螺纹的部分60拧入到开口51中。六角形开口61示出在平坦部分62a中，并且容纳用于将球29拧入和拧出杯30的工具28(参见图3A)。可选的斜面部分62b邻近于带螺纹的部分60，并且围绕球29的基座生成斜面边缘。
图7和图8与第二试验髋臼球27有关。
图7A至图7F示出了所述球27的多种视图。球27可以临时地附接到植入的髋臼杯70(参见图8D和图8E)以确定用于假体的球的最佳尺寸。图8A至图8C以不同的视图示出了第二试验髋臼球27。
图7F和图8C是球27的立体图，图7A和图8A是球27的侧视图，并且图7B和图8B是俯视图。图7C是球27的仰视图，并且图7D是沿着图7A的剖面线7D截取的剖视图。图7E中示出了图7D的环绕部分7E的细节图。
第二试验髋臼球27包括用于压印识别尺寸信息的平坦顶部部分62。球27具有开口63，所述开口63的尺寸设计成适配髋臼杯70的柄71。狭槽64设置在突起物65的一侧上，以使得更容易的将球放置在柄71上以及将球从柄移除。
图9B以侧视图示出了通用手柄31，并且图9A以立体图示出了通用手柄31。图9C是拧入到试验髋臼杯30中的通用手柄31的剖视图，所述试验髋臼杯30在髋臼骨80的代表性部分中。手柄31用于将试验杯30放置到髋臼骨80中。
图10中示出了第一试验股骨杯44的多个视图。图11示出了杯44的更多视图以及位于股骨植入物49中的杯44的视图。
图10F、图11A和图11C中示出了第一试验股骨杯44的三个不同的立体图。图10A、图11B和图11D示出了取自不同角度的杯44的侧视图。图10B是俯视图，图10C是仰视图，并且图10D是沿着图10A的剖面线10D截取的剖视图。图10E是取自图10D的环绕部分10E的细节图。图11F是附接到植入物49的杯44的侧视图，并且图11E是附接到植入物49的杯44的立体图。
第一试验股骨杯44具有以远离第一凹部分91(即，与第一凹部分91相反)延伸的柄的形式的基座部分90。容纳拉刀8的近端或植入物49的柄的开口92包括在基座部分90内。设置狭槽93和狭槽93a使得更容易将杯放置在拉刀或柄上，并且便于后续移除杯。
图12A至图12F中以多个视图示出了第二试验股骨杯45。图13A至图13G示出了杯45的更多视图以及位于股骨植入物75中的杯45的视图。图12F和图13D中示出了杯45的立体图，图12A和图13A中示出了侧视图，图12B和图13C中示出了俯视图，并且图12C和图13B中示出了仰视图。图12D是沿着图12A的剖面线12D截取的剖视图，并且图12E是取自图12D的环绕部分12E的细节图。图13E是位于植入物75中的杯45的立体图，图13G是位于植入物75中的杯45的侧视图，并且图13F是图13G的剖视图。
第二试验股骨杯45具有远离第二凹部分96延伸且适合于容纳在股骨植入物75内的柄95。柄95中的开口97与狭槽98协同工作，以便于将杯45附接到股骨植入物75中以及将杯45从股骨植入物75中移除。
图14以截面示出了试验髋臼球插入-移除工具28，所述试验髋臼球插入-移除工具28插入到试验髋臼球29的六角形开口中。这是与球有关的、用于将球拧入或拧出试验髋臼杯30的工具的位置，杯30示出在髋臼骨80的代表性部分中。
图15中示出了在试验髋臼球29上的位置中的试验股骨杯44。股骨杯44附接到植入物49，并且试验髋臼杯30示出在髋臼骨80中。
图16示出了用于将聚合衬里按压到股骨杯中的按压件46的元件。图16A中示出了按压件46的立体图。参考图16A至图16F以及图17和图18，按压件包括基座101，所述基座101上附接有支架102。按压棒103设置在轴104上，并且圆柱体件105设置在轴104的远端处。圆柱体件105接触并按压在合适尺寸的柱塞48上。其中具有股骨杯110的股骨杯定位器47定位在基座101上。如图18中的截面所示，聚合衬里111的凹部分定位在柱塞106上，并且衬里111的凸部分定位在股骨杯110的凹部分上。然后，使用按压棒103向下推动柱塞48，使得圆柱体件105接触并向下按压在柱塞上，同时还使手柄108保持稳定直到衬里111卡入到股骨杯110的凹部分中的位置中。
图19和图20中示出了插入-移除工具120。所述工具在尺寸和结构上与止血钳类似。所述工具在其近端处包括手柄121以及棘齿部分122。铰接件123定位成提供杠杆作用，并且夹持件124设置在远端处。位于铰接件123与夹持件124之间的工具的部分可选择性地成角度(例如，以约20°(未示出))。
在本申请中，工具120的优选用途是从髋臼杯70中移除试验髋臼球27a。为此，图22示出了定位在球27a上的工具120。球27a具有所有与以上描述的球27相同的特征，且具有以圆周凹槽的形式的凹痕130的附加特征，所述圆周凹槽设置成允许夹持球并将球拉离髋臼杯70的柄71(参见图8E)。

Claims (12)

1.用于逆向髋关节假体的试验髋臼杯，包括：
杯部，具有外表面，所述外表面适合于适配髋臼骨的经过处理的表面；以及
内凹表面；
所述外表面和所述内表面具有可选的贯通开口；以及
所述内凹表面具有从所述内凹表面的底部延伸的柄，所述柄内部有螺纹。
2.根据权利要求1所述的试验髋臼杯，其中，所述外表面是凸的。
3.用于逆向髋关节假体的试验髋臼球，包括：
半球形的球部，具有从所述球部延伸的柄以及在与所述柄相对的球表面上的平坦部分。
4.根据权利要求3所述的试验髋臼球，其中，所述柄外部有螺纹。
5.根据权利要求3所述的试验髋臼球，其中，所述柄包括开口，所述开口的尺寸设计成容纳髋臼杯的柄。
6.根据权利要求4所述的试验髋臼球，还包括：
开口，在所述平坦部分的中央，所述开口的尺寸和形状设计成在带螺纹的部分被拧入到试验髋臼杯的内部带螺纹的柄中时容纳用于拧紧和拧松所述试验髋臼球的工具。
7.用于逆向髋关节假体的试验股骨杯，包括：
杯部，具有适合于在髋臼球上形成关节的凹表面；以及
柄，从与所述凹表面相对的所述杯部的外表面延伸，所述柄适合于附接到拉刀的近端或股骨植入物的近端。
8.根据权利要求7所述的试验股骨杯，其中，所述柄适合于容纳拉刀的近端或股骨植入物的近端。
9.根据权利要求7所述的试验股骨杯，其中，所述柄适于容纳在股骨植入物的近端内。
10.用于将聚合衬里按压到用于逆向髋关节假体的股骨杯中的按压件，包括：
基座，所述基座上附接有支架，所述支架适合于容纳轴，所述轴具有在所述轴的近端处的按压棒和在所述轴的远端处的圆柱体件，所述圆柱体件适合于按压在柱塞上；
股骨杯定位器，与所述圆柱体件相对地定位在基座上；
其中，股骨杯具有定位在所述股骨杯定位器中的凹表面，其中所述凹表面处于向上定向的位置中，并且聚合衬里具有定位在所述柱塞上的凹部分和定位在所述股骨杯的凹部分之上的凸部分，使得在使用所述按压棒向下推动所述柱塞而引起所述圆柱体件接触并向下按压所述柱塞时，使所述衬里卡入到所述股骨杯中的位置中。
11.试验髋臼球，所述试验髋臼球中具有圆周凹槽，以提供用于将所述试验髋臼球插入到髋臼杯或试验髋臼杯中或将所述试验髋臼球从髋臼杯或试验髋臼杯移除的夹持表面。
12.用于插入或移除根据权利要求11所述的试验髋臼球的工具，所述工具包括：
手柄，在所述工具的近端处，靠近棘齿部分，
夹持件，在所述工具的远端处，以及
铰接件，设置在所述近端与所述远端之间；
所述夹持件适合于夹持所述试验髋臼球的圆周凹槽。
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