CN113081400B - 翼状无柄髋关节假体 - Google Patents

翼状无柄髋关节假体 Download PDF

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Publication number
CN113081400B
CN113081400B CN201911342256.XA CN201911342256A CN113081400B CN 113081400 B CN113081400 B CN 113081400B CN 201911342256 A CN201911342256 A CN 201911342256A CN 113081400 B CN113081400 B CN 113081400B
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China
Prior art keywords
wing
cup body
shaped cup
neck
tuberosity
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CN201911342256.XA
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CN113081400A (zh
Inventor
朱红文
黄国富
董荣华
朱天谋
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Guizhou Outras Technology Co ltd
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Guizhou Outras Technology Co ltd
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Priority to CN201911342256.XA priority Critical patent/CN113081400B/zh
Application filed by Guizhou Outras Technology Co ltd filed Critical Guizhou Outras Technology Co ltd
Priority to AU2020412078A priority patent/AU2020412078A1/en
Priority to EP20906930.1A priority patent/EP4079263A4/en
Priority to US17/787,904 priority patent/US20230022118A1/en
Priority to JP2022538798A priority patent/JP2023507041A/ja
Priority to CA3166754A priority patent/CA3166754A1/en
Priority to PCT/CN2020/138378 priority patent/WO2021129622A1/zh
Priority to GB2210678.5A priority patent/GB2606949A/en
Publication of CN113081400A publication Critical patent/CN113081400A/zh
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    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/365—Connections of heads to necks

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Abstract

本发明公开了一种翼状无柄髋关节假体，该假体包括可紧密扣罩在股骨颈和粗隆间的翼状杯体，通过该翼状杯体将人工球头与股骨组织固接为一体，其中翼状杯体整体呈倒置的杯状，倒扣在股骨颈残端外部，通过中心锁钉和尾钉加固，在所述翼状杯体上设置有能够卡扣在小粗隆外部的小粗隆护翼和能够覆盖在转子间线外部的杯翼，从而为该翼状杯体提供额外的支撑，使其更为稳固，另外，在翼状杯体上还开设有大开窗或者通孔，以便于为股骨上的滋养血管留出空间，降低滋养血管的损伤率，进而提高术后恢复效果。

Description

翼状无柄髋关节假体
技术领域
本发明涉及种医用人工关节假体，具体涉及一种缓冲/非缓冲式翼状无柄髋关节假体。
背景技术
人体髋关节为大腿骨(股骨)与骨盆所形成的关节，髋关节是一种球形的关节，包含一个球形的股骨头和一个类似于碗状的髋臼，球状外表层及碗状物内表层均覆盖有平滑的软骨，滑囊膜分泌粘液使摩擦降低至最小。当髋关节产生病变时，软骨不再平滑，滑膜囊因发炎而萎缩，所以髋关节再也不能像平常一样运转自如。当髋关节因退化、病变或外伤导致疼痛、僵硬或变形，甚至行动不便，无法以药物或其他治疗方法缓解症状时，通常会以手术的方式为病人置换人工髋关节，以期待使病人恢复日常的活动能力。
人工髋关节假体仿照人体髋关节的结构，包括用于替换髋臼的假体金属杯和用于替换股骨头的球形端头，其中该球形端头固定在股骨柄上，通过股骨柄将球形端头固定在人体股骨上，
最近几十年中，国内所进行的球形端头置换手术中，绝大部分采用了有柄的髋关节假体，即在所述股骨柄的下端设置有插销，通过将插销插入股骨髓腔的方式将股骨柄固定在人体股骨上；
如专利号为86201016名称为带有骨矩分力装置的髋关节假体，利号为90225988.1名称为锁环型髋关节假体系列等专利文献记载的髋关节假体，但是这种有柄的髋关节假体存在着很多弊端，比如：
(1)有柄式髋关节假体在植入时需要较大面积的破坏削去股骨上的生理结构，术中出血较大，后续还会影响股骨髓腔的供血及生理代谢。
(2)有柄式髋关节假体在使用一段时间后，股骨柄与其所在的股骨之间的紧密程度逐渐降低，二者之间会变得松动，在身体压力的作用下，股骨柄及其上的插销进一步下沉，导致患者两条腿的长短不一，还会进一步影响髋关节的正常生理功能。
(3)有柄式髋关节假体有着使用周期及使用者年龄的限制，一般要求使用者的年龄在45岁以上，并且其事实上的使用寿命难以达到20年以上，后续也难以更换，个别情况下还会发生柄体断裂等难以克服的并发症。
为了尝试克服上述问题，发明人经过30余年的潜心研究，逐渐设计出一种无柄式的髋关节假体，部分研究成果记载在陆续公开的专利文献中，如专利号为CN98200233.5名称为无柄解剖形人工髋关节，专利号为00244070.9名称为自锁式无柄人工髋关节，专利号为200520027479.4名称为组合型缓冲式无柄髋关节，专利号为201230597170名称为人工无柄髋关节罩体等相关专利文献，上述文献记载的无柄式髋关节假体陆续解决了一些有柄髋关节假体存在的问题，但是有些问题仍然未能彻底解决，另外随着社会的逐渐进步，医生自身对于治愈标准的要求越来越高，越来越追求治愈的极限及患者的生活质量，自然会有更多的问题需要进一步克服。
由于上述原因，本发明人对现有的无柄假体做了深入研究，设计出一种能够解决上述问题的新的翼状无柄髋关节假体。
发明内容
为了克服上述问题，本发明人进行了锐意研究，设计出一种翼状无柄髋关节假体，该假体包括够罩在股骨颈残端外部的翼状杯体，通过该翼状杯体将人工球头与股骨组织固接为一体，并且在人工球头与翼状杯体之间设置缓冲器件，以便于提高该关节假体的使用效果，其中翼状杯体整体呈倒置的杯状，倒扣在股骨颈残端外部，通过中心锁钉和尾钉加固，在所述翼状杯体上设置有能够卡扣在小粗隆外部的小粗隆护翼和能够覆盖在转子间线外部的杯翼，从而为该翼状杯体提供额外的支撑，使其更为稳固，另外，在翼状杯体上还开设有大开窗或者通孔，以便于为股骨上的滋养血管留出空间，降低滋养血管的损伤率，进而提高术后恢复效果，从而完成本发明。
具体来说，本发明的目的在于提供一种翼状无柄髋关节假体，该假体包括可紧密扣罩在股骨颈和粗隆间31外部的翼状杯体6，
所述翼状杯体6的前端开口，裸露出翼状杯体6内的股骨颈残端；
所述翼状杯体6前端底部向斜下方延伸形成有小粗隆护翼10，该小粗隆护翼10可紧密卡扣在小粗隆32外部。
在所述翼状杯体6的侧部向斜下方延伸形成有杯翼7；该杯翼7能够固定在转子间线33上。
本发明所具有的有益效果包括：
(1)根据本发明提供的翼状无柄髋关节假体，其中通过翼状杯体倒扣在股骨颈残端上进行固定，从而能够减少对原生股骨组织的破坏，降低手术出血；
(2)根据本发明提供的翼状无柄髋关节假体，其上设置有小粗隆护翼和杯翼，能够为该翼状杯体提供额外的受力点，使得翼状杯体与股骨之间的连接更为稳固；
(3)根据本发明提供的翼状无柄髋关节假体，其中的翼状杯体上开设有大开窗或者通孔，能够更多的保留股骨上的供血通道；
(4)根据本发明提供的翼状无柄髋关节假体，其上设置有缓冲器件，并且将该缓冲器件安装在人工球头内部，进一步增强缓冲减震效果；
(5)根据本发明提供的翼状无柄髋关节假体，其上的翼状杯体在安装时，对股骨组织的损伤很小，其对股骨组织的损伤程度仅仅是有柄关节置换手术的前序步骤，所以当该无柄髋关节假体达到使用寿命后，能够方便地更换新的人工髋关节。
附图说明
图1示出根据本发明一种优选实施方式的翼状无柄髋关节假体安装在股骨上时的一个角度的结构示意图；
图2示出根据本发明一种优选实施方式的翼状无柄髋关节假体安装在股骨上时的另一个角度的结构示意图；
图3示出根据本发明一种优选实施方式的翼状无柄髋关节假体安装在股骨上时的又一个角度的结构示意图；
图4示出根据本发明一种优选实施方式的翼状无柄髋关节假体整体结构示意图；
图5示出根据本发明一种优选实施方式的翼状无柄髋关节假体中颈杆完全伸入到颈杆孔中时的结构示意图；
图6示出根据本发明一种优选实施方式的翼状无柄髋关节假体中颈杆被缓冲器件向外弹出到最大行程时的结构示意图；
图7示出根据本发明一种优选实施方式的翼状无柄髋关节假体中限位腔室和限位凸起的结构示意图。
附图标号说明：
1-人工球头
11-颈杆孔
12-缓冲器件容纳腔
13-限位槽
2-缓冲器件
31-粗隆间
32-小粗隆
33-转子间线
4-颈杆
41-限位凸起
42-限位腔室
43-压缩弹簧
5-主固定台
51-颈椎孔段
52-钉锥孔段
6-翼状杯体
61-尾翼
62-辅助固定台
63-锥形孔
64-大开窗
7-杯翼
71-杯翼通孔
8-尾钉
9-中心锁钉
10-小粗隆护翼
具体实施方式
下面通过附图和实施例对本发明进一步详细说明。通过这些说明，本发明的特点和优点将变得更为清楚明确。
在这里专用的词“示例性”意为“用作例子、实施例或说明性”。这里作为“示例性”所说明的任何实施例不必解释为优于或好于其它实施例。尽管在附图中示出了实施例的各种方面，但是除非特别指出，不必按比例绘制附图。
根据本发明提供的翼状无柄髋关节假体，如图1、图2、图3和图4中所示，该假体包括能够紧密扣罩在股骨颈和粗隆间31外部的翼状杯体6，所述翼状杯体6为倒置的杯形结构，开口朝向斜下方，即所述股骨颈残端与所述翼状杯体6内壁面紧密联系，彼此贴紧，从而使得翼状杯体6的安装更为稳固。
本申请中所述的翼状杯体6在安装之前，仅需去除人体股骨上的股骨头，股骨颈大部分保留，大转子、小转子也都基本保留，可以根据不同人群不同的解剖形态，适应性去除一部分骨皮质，将骨皮质上的部分区域磨薄，以便于该翼状杯体6的安装。在安装该翼状杯体6时，需要在尽量少地破坏骨组织的情况下，确保其安装的强度及稳定性，以便于尽量保护股骨自身的供血通道和骨小梁，使其能够维持其自身的生理功能。
其中，保留的部分股骨颈称之为股骨颈残端，本申请中所述的翼状杯体6在安装时对股骨颈、粗隆间等骨组织的破坏较小，能够保留更多的股骨颈，基本保留完整的粗隆间，生长在粗隆间的颈升动脉等组织结构也都可以保留；
虽然现有的无柄髋关节对于股骨损伤减少，但是仍然会破环一定范围的股骨生理结构，尤其是必然会破坏一定范围的骨小梁，导致术后患者的造血功能受损；术后植入假体与人体之间的生物相容性仍然难以彻底解决。
本申请中的翼状杯体6能够允许保留的股骨颈相对于现有的无柄髋关节置换时能够保留的股骨颈更多，能够至少多保留10～20％的股骨颈，还能够进一步分散作用在股骨上的应力，使得股骨组织受到的剪力更小，并且留出生长滋养血管的空间，使得残留股骨能够正常生长。
所述翼状杯体6的前端开口，裸露出翼状杯体6内部的股骨颈残端和粗隆间31，该前端开口也称之为大开窗结构，如图4中的标记64所示；通过设置该大开窗结构使得该处股骨颈外部的滋养血管得以保留，股骨颈中的骨小梁也免遭破坏；
具体来说，在该翼状杯体6安装完成后，大开窗位置处的滋养血管，尤其是滋养血管进出股骨的抵止点处不会受到的翼状杯体6的剪切力，该滋养血管及骨小梁能够维持正常的生理功能和生理支撑，从而使得骨小梁不易过早地发生股骨组织的废用性吸收，能够极大地降低股骨颈残端术后坏死的发生率。
如图4中所示，图中的左侧方向即为本申请中所述的前方，图中右侧方向即为本申请中所述的后方。
所述翼状杯体6前端底部向斜下方延伸形成有小粗隆护翼10，该小粗隆护翼10能够卡扣在小粗隆/小转子32外部；通过该小粗隆护翼10与小粗隆/小转子32卡扣连接能够为该关节假体提供一个新的限位固定作用力，增加该关节假体的牢固及稳定性。所述小粗隆护翼10与翼状杯体6的前端都位于所述前端开口的周围，从而形成所述大开窗结构。
优选地，所述小粗隆护翼10与小粗隆32之间彼此贴紧，该小粗隆护翼10可紧密卡扣在小粗隆32外部，更优选地，所述小粗隆护翼10具有一定的弹性，当将所述小粗隆护翼10卡扣到小粗隆32外部时，小粗隆护翼10需要朝向外侧形变，在其弹性力的作用下，小粗隆护翼10与小粗隆32的连接更为紧密。
如图1、图4中所示，翼状杯体6安装在股骨上以后，小粗隆护翼10与颈杆4的轴线所成的角度为110度～115度，优选为112～113度，本发明人发现当该夹角为112～113度时小粗隆护翼10与小粗隆之间的连接稳定，不易滑落，该小粗隆护翼10还能够为翼状杯体6提供足够强大的支撑力，确保翼状杯体6稳定地固定在股骨上。
本申请中的小粗隆护翼10沿着小粗隆顶部延伸，保留小粗隆，并且嵌在小粗隆上部及内侧周围，覆盖在小粗隆和股骨主体生长的连接部位之外，还能够起到另一个支点的作用，进一步增强翼状杯体6与股骨之间的连接强度。
所述翼状杯体6的侧部向斜下方延伸形成有杯翼7；所述杯翼7设置有一个或者两个，当设置有两个时，两个杯翼分别位于翼状杯体6的两侧，本申请中优选地设置有两个杯翼7，如图1、图3和图4中所示，其中一个杯翼7向斜下方延伸能够嵌入在转子间线33的松质骨内部，并与股骨上的转子间线卡和固定，从而能够进一步稳固该翼状杯体，为翼状杯体6与股骨之间的固接提供额外的着力点；另一个杯翼7设置在股骨的另一侧，可以紧贴股骨外表面，为翼状杯体6与股骨之间的固接提供额外的着力点。
优选地，所述杯翼7具有一定的弧度，与人体股骨，尤其与转子间线外部的生理弧度相适应，以便于使得杯翼7能够贴紧转子间线，并且不会过度损伤股骨结构。
在所述杯翼7上开设有杯翼通孔71，该杯翼通孔71使得杯翼7下方的股骨结构免遭破坏，能维持股骨外部滋养血管的生理功能。
传统的有柄关节假体在植入固定过程中，对于股组织表面的供血通道的破坏极大，有柄假体植入后，股骨上部区域基本难以再次重建供血通道；传统的无柄假体植入后在一些空隙处能够恢复一部分供血通道，但是仍然会对于股组织表面形成环形卡压，不能完全满足供血需求，而且后期恢复的供血通道的使用效果不如原生的供血通道。
本申请中所述翼状杯体6的杯口边缘呈非对称的曲线型，该曲线型边缘能够使得翼状杯体6与股骨表面之间不会完全贴紧，能够存在一定的空隙，从而使得股骨表面上的部分供血通道得以保留，在该空隙处使得股骨表面能够通过代偿性增生产生出新的供血通道，同时避免对股骨近端形成环形卡压
进一步优选地，在所述小粗隆护翼10上，在靠近粗隆间的位置处向外凸出，在其内部形成有内凹通道101，所述内凹通道贯穿所述小粗隆护翼10，所述内凹通道101与股骨之间留有一定的空腔，从而能够通过该空腔来容纳依附在股骨外部的血管及周围组织，尤其是能够把颈升动脉置于该空腔内；
通过设置该内凹通道101能够防止小粗隆护翼10剪切破坏该血管及周围组织，保证翼状杯体6内外体液循环畅通，避免翼状杯体6的组织结构坏死，降低并发症的发生几率。
优选地，所述内凹通道101可以设置一个或者多个，更优选地，所述内凹通道101设置两个。
在另一个优选地实施方式中，在所述小粗隆护翼10的内侧边缘设有弧形缺口，并向外隆起，用以保护股骨颈颈升动脉，即颈升动脉穿过该弧形缺口，并被保护在小粗隆护翼10的下方；进一步优选地，所述小粗隆护翼10上构成该的弧形缺口两条边都朝向人工球头所在方向弯折，并在远离颈升动脉的位置彼此连接，从而使得小粗隆护翼10与股骨之间应力集中的勒痕避开血管集丰富的区域，降低安装翼状杯体6对股骨上血运通道的影响，提高术后的恢复效果。
在一个优选的实施方式中，在所述翼状杯体6的内部设置有筒形的主固定台5，该主固定台5与所述翼状杯体6内侧的顶面相连，所述主固定台用于在该翼状杯体6上安装人工球头1和中心锁钉9，以便于实现股骨头假体的置换。
优选地，在所述主固定台内部开设有通孔，以便于从翼状杯体6的顶部旋入中心锁钉，也便于人工球头上的颈杆嵌入固定在翼状杯体6中。
所述中心锁钉9的前端穿过该翼状杯体6后旋入到股骨组织的近端，即大粗隆和小粗隆之间的位置。
优选地，所述主固定台5从所述翼状杯体6的顶部穿出，即所述主固定台的顶部裸露在翼状杯体6之外，这样的结构设计能够增强主固定台5与翼状杯体6之间的连接强度，也能够方便于颈杆4与翼状杯体6之间的连接固定，方便对准安装；
在所述翼状杯体6后端向外延伸形成尾翼61，在所述尾翼下方设置有筒形的辅助固定台62，该辅助固定台内部开设有通孔，该通孔从所述尾翼的顶部穿出，以便于从尾翼的顶部旋入尾钉8，通过尾钉辅助固定所述翼状杯体6。
所述尾钉8的前端穿过该翼状杯体6后旋入到股骨组织的近端，在大粗隆和小粗隆之间，更优选地为靠近大粗隆的位置处。
髋关节是人体关节中的重要缓冲关节，需要具备一定的缓冲能力，现有的有柄假体很少有顾及到缓冲效果的案例，在无柄假体中涉及过一些缓冲器件，如专利号为200520027479.4名称为组合型缓冲式无柄髋关节专利中，通过设置缓冲避震弹簧来缓解冲击力，但是在实际使用过程中发现该方案存在一定的缺陷需要进一步改进，人体髋关节的减震功能主要源于股骨头附近的软骨，而该方案中将缓冲避震弹簧设置在紧邻股骨假体的位置，与人体上的功能位置不同，导致股骨假体与股骨结合位置受到了缓冲避震弹簧的直接作用，承受了更多的作用力，难以减少人体运动载荷，导致应力集中，导致该方案中股骨假体的稳定性较差；另外，该方案需要现场安装该缓冲避震弹簧及对应的限制销钉，操作难度较大，医生为此花费的时间较多，导致手术时间延长。
在一个优选的实施方式中，所述人工球头1仿照人体的股骨头的外形尺寸进行设计，上部结构呈球形，在人工球头底部设置有通孔，以便于颈杆的一端插入到人工球头内，颈杆的另一端插入到翼状杯体6的主固定台中；
所述人工球头可以是带有缓冲功能的人工球头，也可以是非缓冲的人工球头；
由于该人工球头与翼状杯体的具体安装是在置换手术的过程中进行的，而且安装完成后人工球头与翼状杯体都将完全植入到人体内，没有二次调整的机会，所以对于二者之间连接的可靠性，连接后的使用寿命、抗拉、抗压强度以及连接安装的快速方便程度都有很高的要求。
另外，现有的带有减震功能的无柄髋关节假体中，减震结构设置在翼状杯体结构内部，从而带来了一系列的问题；
为此，在本申请的一个优选实施方式中，在所述人工球头1的内部设置有缓冲器件2，所述缓冲器件2一端与人工球头1的内壁抵接，另一端与颈杆4抵接；颈杆4固定在翼状杯体6上，人工球头1与颈杆4之间可以有一定程度的相对移动，当人工球头1受到压力时，人工球头1有向下移动的趋势，从而压迫缓冲1器件2，随着人工球头1向下移动，缓冲器件2逐渐变形，其上的弹力逐渐增大，最终再由所述缓冲器件2将人工球头1弹回原位置。
进一步优选地，如图5和图6中所示，在所述人工球头1中开设有供颈杆4伸入的颈杆孔11，在颈杆孔11上方还联通有缓冲器件容纳腔12，所述颈杆4能够在颈杆孔11中往复移动，当所述颈杆4伸入到所述颈杆孔11的最深处时，能够基本填充满所述颈杆孔11；所述缓冲器件容纳腔12的孔径比颈杆4小，所以颈杆4不能伸入到缓冲器件容纳腔12中，从而为颈杆4提供了一个方向的限位；图5示出了颈杆4完全伸入到所述颈杆孔11中时的结构示意图，图6示出了颈杆4被缓冲器件2向外弹出到最大行程时的结构示意图；图中用虚线表示人工球头1内部的轮廓结构，用实线表示人工球头1和颈杆4的外部轮廓结构。
优选地，颈杆4顶部杆身的截面尺寸等于或者略小于颈杆孔11的截面尺寸，从而方便于颈杆4与人工球头1之间的相对移动。
优选地，在所述容纳腔12的侧壁上开设有限位槽13，与之对应地，在所述颈杆4上设置有向侧方伸出的限位凸起41，所述限位凸起41嵌入到所述限位槽13中，限位凸起41在限位槽13中随着颈杆4一同移动，通过限位凸起41和限位槽13之间的配合为颈杆4的移动提供另一个方向的限位，从而确保颈杆4和人工球头1之间不会彼此脱离。
在实际使用过程中，该人工球头1不仅仅要与颈杆之间稳固连接，不可脱离，还必须确保人工头1与颈杆4之间能够实现快速安装，降低安装难度，节约安装时间。
优选地，如图7所示，在所述颈杆4上开设有横向设置的限位腔室42，所述限位凸起41呈长杆状，其大部分结构位于所述限位腔室42中，且在限位腔室42的底部设置有压缩弹簧43，当需要将颈杆4插入到人工球头1中时，向内压迫所述限位凸起41，使得其整体都嵌入到所述限位腔室42中，同时压迫其内部的压缩弹簧43，当所述限位凸起41临近限位槽13时，压缩弹簧43会把限位凸起41的端部从限位腔室42中推出，使得限位凸起41进入限位槽13中，从而完成颈杆4与人工球头之间的连接安装。
所述缓冲器件2可以为具有生物相容性材料制成的弹簧或者弹片或者其他带有弹性的机构，本申请中对此不作特别限定。
现有的无柄假体为了不破坏髓腔，没有插入髓腔内的长销，其固定方式相对与有柄假体来说不够牢靠，另外，无论是否在无柄假体上安装自锁螺钉，其假体上的受力都不够平衡，在长时间作用下，股骨损伤变形仍然是难以避免的，随着使用年限的逐渐延长，无柄假体与股骨之间的活动空隙越来越大，逐渐影响使用效果，甚至会导致一些其他并发症。
在一个优选的实施方式中，如图4中所示，所述主固定台5上的通孔包括颈椎孔段51和钉锥孔段52，颈椎孔段51和钉锥孔段52都是从上向下逐渐变窄的锥孔型；
所述颈椎孔段51用于供颈杆4插入，并与颈杆4固接，优选地，颈杆4的下端呈锥台形，与所述颈椎孔段51的内径尺寸一致，且颈杆4与颈椎孔段51过盈配合，当颈杆4完全插入到颈椎孔段51中以后即可完成二者之间的固接；
所述钉锥孔段52用于供中心锁钉9穿过，并与中心锁钉9的尾部固接，优选地，中心锁钉9的尾部呈锥台形，与所述钉锥孔段52的内径尺寸一致，且中心锁钉9的尾部与钉锥孔段52过盈配合，当中心锁钉9主体穿过钉锥孔段52，并且中心锁钉9尾部嵌入到钉锥孔段52中以后即可完成二者之间的固接；
颈椎孔段51和钉锥孔段52接触的位置径向尺寸突变，即位于下方的钉锥孔段52上最大的截面尺寸比位于上方的颈椎孔段51的最小截面尺寸小，从而使得颈杆4无法嵌入到钉锥孔段52中，防止颈杆4与中心锁钉9彼此干扰。
在一个优选的实施方式中，所述颈椎孔段51的锥度为1:17～1:25，优选为1:22；本发明人发现，当所述颈椎孔段51的锥度为1:22时，其既能够确保与颈杆4下端之间紧密固定，也能降低安装难度，使得颈杆4下端能够较为方便地插入到颈椎孔段51中。
在一个优选的实施方式中，所述钉锥孔段52的锥度为1:13～1:20，优选为1:15；本发明人发现，当所述钉锥孔段52的锥度为1:15时，其既能够确保与中心锁钉9尾部之间紧密固定，也能降低安装难度，中心锁钉9主体能够顺利穿过钉锥孔段52，并且钉锥孔段52能够与中心锁钉9的尾部固接。
在一个优选的实施方式中，如图4中所示，所述筒形的辅助固定台62内部开设有通孔，该通孔为锥形孔63，尾钉8穿过该锥形孔63，所述尾钉8的尾部呈圆台形，刚好能够嵌入到所述锥形孔63中，将尾钉旋拧到股骨中以后，尾钉的尾部与所述锥形孔63抵接，尾钉与助固定台62充分接触，从而确保尾钉和助固定台之间稳固连接。所述辅助固定台62的深度是大粗隆厚度的三分之二左右，既能够充分保证辅助固定台62与尾钉8之间的连接强度，还能够确保该辅助固定台62不会过度破坏大粗隆。
优选地，所述中心锁钉9和尾钉8的前端都设置有螺纹，以便于与股骨组织之间牢固固接，也便于通过旋拧的方式进入到股骨组织中，形成固定。
在一个优选的实施方式中，在所述翼状杯体6的壁面上还开设有通孔，通过该通孔能够裸露出翼状杯体6内部的股骨颈，从而使得股骨颈上的滋养血管免遭破坏，不会受到剪切应力的作用，能够维持正常的生理功能。
现有的一些无柄髋关节假体中也开设有通孔结构，旨在减少对滋养血管的破坏，但是往往效果不够理想，归结原因在于每个人的生理结构都不相同，每个人的滋养血管等组织的具体位置都不一致，所以即使开设了通孔，其作用效果也不够理想。
为此，本申请中优选地，在滋养血管相对集中的部位开设所述大开窗结构，即在所述翼状杯体6的前端开口，该开口区域能够裸露出翼状杯体6内部的股骨组织，其中，裸露出的股骨组织中包括颈升动脉及其周围具有生物活性的软组织，能够高供术后的恢复状况，减少病发症优选地，在安装所述翼状杯体6时，可以适当削去部分边缘轮廓，扩大所述大开窗的开口面积，以使得所述翼状杯体6的边缘壁面避开滋养血管，避免挤压破坏滋养血管，进一步保护原生的滋养血管，提高术后恢复效果。
现有的无柄假体取消了插入到骨髓腔中的销钉，使得其能够不受45岁的年龄限制，可以应用到年龄更小的患者身上，但是其使用寿命仍然是有限的，即使能够应用30-40年，但是对于年轻患者来说，在几十年后还要面临假体使用寿命到期，更换困难，风险巨大的问题，现有的无柄假体和有柄假体都没有考虑这个问题，所以，假体到期后的置换手术的难度极高，而且术后恢复效果必然是不够理想的。
在一个优选的实施方式中，所述翼状杯体6的内部尺寸较大，其轮廓线为不规则的曲线，从而使得在安装所述翼状杯体6时对股骨组织的破坏程度较小，而且术后对滋养血管的破坏较少，在该髋关节假体使用寿命到期后，取出该髋关节假体后仍然可以进一步安装有柄的髋关节假体。
在本发明的描述中，需要说明的是，术语“上”、“下”、“内”、“外”、“前”、“后”等指示的方位或位置关系为基于本发明工作状态下的方位或位置关系，仅是为了便于描述本发明和简化描述，而不是指示或暗示所指的装置或元件必须具有特定的方位、以特定的方位构造和操作，因此不能理解为对本发明的限制。
以上结合了优选的实施方式对本发明进行了说明，不过这些实施方式仅是范例性的，仅起到说明性的作用。在此基础上，可以对本发明进行多种替换和改进，这些均落入本发明的保护范围内。

Claims (8)

1.一种翼状无柄髋关节假体，其特征在于，该假体包括可紧密扣罩在股骨颈和粗隆间(31)外部的翼状杯体(6)，
所述翼状杯体(6)的前端开口，裸露出翼状杯体(6)内的股骨颈残端和粗隆间(31)，该前端开口也称之为大开窗结构；通过设置该大开窗结构使得该处股骨颈外部的滋养血管得以保留，股骨颈中的骨小梁也免遭破坏；
所述翼状杯体(6)前端底部向斜下方延伸形成有小粗隆护翼(10)，该小粗隆护翼(10)可紧密卡扣在小粗隆(32)外部；小粗隆护翼(10)沿着小粗隆顶部延伸，保留小粗隆，并且嵌在小粗隆上部及内侧周围，覆盖在小粗隆和股骨主体生长的连接部位之外；
所述翼状杯体(6)的内部设置有筒形的主固定台(5)，所述主固定台(5)用于在该翼状杯体(6)上安装人工球头(1)和中心锁钉(9)；
所述主固定台(5)从所述翼状杯体(6)的顶部穿出，即所述主固定台的顶部裸露在翼状杯体(6)之外。
2.根据权利要求1所述的翼状无柄髋关节假体，其特征在于，
在所述翼状杯体(6)的侧部向斜下方延伸形成有杯翼(7)；该杯翼(7)能够固定在转子间线(33)上。
3.根据权利要求1所述的翼状无柄髋关节假体，其特征在于，
在所述翼状杯体(6)后端向外延伸形成尾翼(61)，在所述尾翼下方设置有筒形的辅助固定台(62)，
所述关节假体还包括尾钉(8)，所述尾钉(8)的前端穿过该翼状杯体(6)后旋入到股骨近端接近大粗隆的组织中。
4.根据权利要求1所述的翼状无柄髋关节假体，其特征在于，
所述人工球头(1)的上部结构呈球形，在人工球头底部设置有通孔，
所述关节假体还包括颈杆(4)，
所述颈杆(4)一端插入到人工球头的通孔内，颈杆(4)的另一端插入到翼状杯体(6)的主固定台(5)中。
5.根据权利要求4所述的翼状无柄髋关节假体，其特征在于，
在所述人工球头(1)的内部设置有缓冲器件(2)，所述缓冲器件(2)一端与人工球头(1)的内壁抵接，另一端与颈杆(4)抵接。
6.根据权利要求1所述的翼状无柄髋关节假体，其特征在于，
所述主固定台(5)内部开设有通孔，该通孔包括颈锥孔段(51)和钉锥孔段(52)，
所述颈锥孔段(51)供颈杆(4)插入，并与颈杆(4)固接；
所述钉锥孔段(52)供中心锁钉(9)穿过，并与中心锁钉(9)的尾部固接。
7.根据权利要求1所述的翼状无柄髋关节假体，其特征在于，
在所述翼状杯体(6)的壁面上还开设有通孔，通过该通孔能够裸露出翼状杯体(6)内部的股骨颈。
8.根据权利要求1所述的翼状无柄髋关节假体，其特征在于，
所述翼状杯体(6)前端开口处还能够裸露出颈升动脉及其周围具有生物活性的软组织。
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US17/787,904 US20230022118A1 (en) 2019-12-23 2020-12-22 Wing-shaped stemless hip prosthesis
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