CN115381605A - 一种骨盆生物重建节段假体 - Google Patents
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Abstract
一种骨盆生物重建节段假体,有效的解决了骨盆重建后双下肢不等长而出现远期脊柱侧弯等问题;包括股骨近端组件和股骨远端组件,股骨近端组件包括生物固定柄,生物固定柄一端固定有第一连接段,第一连接段一侧设有第一固定板,股骨远端组件包括骨水泥柄,骨水泥柄一端固定有第二连接段,第二连接段一侧设有第二固定板,第一连接段和第二连接段上开设有相互对应设置的多个连接孔,第一连接段和第二连接段经锁定螺钉进行连接固定;本发明结构简单巧妙,具有以下有益效果:可优化常规的髋移位旷置手术,增加患肢的长度,且可通过假体多孔的设计实现长期的稳定。
Description
技术领域
本发明涉及人工假体技术领域,特别是涉及一种骨盆生物重建节段假体。
背景技术
骨盆肿瘤可分为原发肿瘤和转移肿瘤,前者主要为软骨肉瘤、骨肉瘤、脊索瘤和神经源性肿瘤等,后者常见于乳腺癌、肾癌、前列腺癌及肺癌等的骨转移。骨盆肿瘤发病隐匿,早期诊断困难,往往发现时侵犯范围已经很大,加上骨盆周围解剖复杂并与很多重要脏器毗邻,手术难度大,并发症多,疗效欠佳,死亡率高。从前对骨盆肿瘤主要采取半骨盆切除或改良半骨盆切除截肢术,以后出现了各种骨盆肿瘤切除重建手术。任何骨盆肿瘤的切除均会造成骨缺损,大部分骨缺损需要进行重建以维持躯干和骨盆以及骨盆和下肢的连续性和稳定性。这样的重建可以使病人能够坐立、站立和行走,以维持日常生活的必要的活动,因此国内外开展骨盆肿瘤切除重建手术日益增多。尽管如此,骨盆肿瘤切除重建仍是骨科医师面临的重大挑战,手术前后及术中可能发生的问题还是很多,如出血多、瘤体切除难度大、重建稳定性难、选择重建方式复杂等。骨盆肿瘤切除重建的主要目的是:完全切除肿瘤;以最小的代价包括失血、并发症、疼痛、伤口愈合等完成切除术;提供骨盆稳定性;获得可靠及有良好功能的骨盆。重建方式选择的一般原则是:尽可能选择合适、简单的重建方;充分考虑患者的年龄和活动量,以及肿瘤的性质来选择恰当的重建方式;根据涉及不同区域的骨盆肿瘤的负重和几何形态,采用不同的重建方式。
骨盆肿瘤的外科治疗极具有挑战性。对于单独切除髂骨(I区)、坐骨或耻骨(III区),术后重建可能无法实现良好功能[26]。对于髋臼周围切除术(II区),重建通常用于维持股骨-骨盆的连续性并恢复力传递,以实现合理的术后功能。报道了许多重建方法,包括高压灭菌自体移植、血管化腓骨、同种异体移植、鞍形假体、定制假体和模块化半骨盆假体。然而,据报道,并发症的比例很高,根据序列和重建方法从40%到68%不等。并发症可能使外科医生几乎没有重建选择,并且常常导致截肢。
近年来,假体设计概念和制造技术的发展促进了了骨盆肿瘤保肢水平的进一步发展。然而,假体失败和伤口感染等并发症仍然严重限制这种重建手术的应用。此外,植入假体可能会降低辅助放射治疗对肿瘤(如尤因肉瘤)的治疗效果。与假体重建相比,髋关节置换已成为骨盆肉瘤保肢的可行选择。Carsten Gebert等人在2009年提出了髋关节转位的分型系统,不久之后,他们发表了该分类系统的随访结果。他们的结果表明,该骨盆旷置分型为髋臼周围肿瘤的髋关节移位和切除提供了重要的指导。且植入物的缺失可能有助于降低深部假体感染和机械故障的发生率。Hillmann等人报道,髋臼切除后,接受髋关节置换的患者比接受假体的患者并发症发生率更低。髋臼切除术后髋关节置换的先前方法具有减少同种异体骨或金属内假体的伤口并发症和感染的优势,但它们与肢体长度差异大、活动能力差和患者接受度低相关。因此,我们对该程序进行了修改,以解决肢体长度问题,并希望从功能结果、并发症发生率和肢体长度差异方面评估其有效性。股骨延长后旋转髋关节置换术是一种改良手术,旨在重建骨盆肿瘤切除后的巨大缺陷,并恢复肢体长度。这种骨盆重建方法可能没有与假体相关的缺点,如深部感染和长期松动。本团队前期回顾了本中心进行旷置手术的患者,随访了其肿瘤学、功能学预后,发现其肿瘤学预后与半骨盆置换术患者相比无明显差异,而远期的功能则优于半骨盆假体置换患者。大部分患者获得了稳定的生物学假关节。而其存在的主要问题依然是下肢不等长,大部分患者平均下肢不登长8-12公分,虽然通过鞋垫可消除3-4公分差距,但巨大的不等长依然可引起脊柱的代偿侧弯,可能引起后续的下腰痛发生。
因此,目前迫切需要能寻找到既能达到远期生物稳定重建,又能避免下肢不等长这种严重的功能缺陷,该方法可能将成为骨盆肿瘤切除后金属骨盆假体置换的重要替代选择!
发明内容
为克服现有技术的缺陷,本发明提供了一种骨盆生物重建节段假体,有效的解决了骨盆重建后双下肢不等长而出现远期脊柱侧弯等问题。
其解决技术问题的技术方案是:一种骨盆生物重建节段假体,包括股骨近端组件和股骨远端组件,股骨近端组件包括生物固定柄,生物固定柄一端固定有第一连接段,第一连接段一侧设有第一固定板,股骨远端组件包括骨水泥柄,骨水泥柄一端固定有第二连接段,第二连接段一侧设有第二固定板,第一连接段和第二连接段上开设有相互对应设置的多个连接孔,第一连接段和第二连接段经锁定螺钉进行连接固定。
在一个优选的实施例中,所述的第一连接段和第二连接段采用多孔材料,孔隙直径为600-1000微米,孔隙率为55-85%。
在一个优选的实施例中,所述的生物固定柄为锥形结构,生物固定柄的粗端与第一连接段固定连接。
在一个优选的实施例中,所述的第一连接段包括与生物固定柄连接的第一末端,第一末端上设有第一长板和第一短板,第一长板与第一短板之间设有第一插槽,第一长板的截面为半圆形,第一长板端部设有第一插板,连接孔设置在第一长板上。
在一个优选的实施例中,所述的第二连接段包括与骨水泥连接柄固定连接的第二末端,第二末端上设有第二长板和第二短板,第二长板与第二短板之间设有第二插槽,第二长板的截面为半圆形,第二长板端部设有第二插板,连接孔设置在第二长板上,第二插板能够插入第一插槽内,第二插槽与第一插板配合,第一连接段和第二连接段配合后形成圆柱体结构。
在一个优选的实施例中,所述的骨水泥柄为锥形结构,骨水泥的粗端与第二连接段固定连接。
在一个优选的实施例中,所述的第一固定板和第二固定板上均开设有固定孔,用于将第一固定板和第二固定板固定在股骨上。
本发明结构简单巧妙,具有以下有益效果:可优化常规的髋移位旷置手术,增加患肢的长度,且可提高假体多孔的设计实现长期的稳定。
附图说明
图1是本发明的结构示意图一。
图2是本发明的结构示意图二。
图3是本发明的爆炸结构示意图。
具体实施方式
以下结合附图对本发明的具体实施方式作进一步详细说明。在此需要说明的是,对于这些实施方式的说明用于帮助理解本发明,但并不构成对本发明的限定。此外,下面所描述的本发明各个实施方式中所涉及的技术特征只要彼此之间未构成冲突就可以相互组合。
需要说明的是,在发明的描述中,术语“上”、“下”、“左”、“右”、“前”、“后”等指示的方位或位置关系为基于附图所示对本发明结构的说明,仅是为了便于描述本发明的简便,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。
由图1至图3可知,一种骨盆生物重建节段假体,包括股骨近端组件和股骨远端组件,股骨近端组件包括生物固定柄1,生物固定柄1一端固定有第一连接段2,第一连接段2一侧设有第一固定板3,股骨远端组件包括骨水泥柄4,骨水泥柄4一端固定有第二连接段5,第二连接段5一侧设有第二固定板6,第一连接段2和第二连接段5上开设有相互对应设置的多个连接孔7,第一连接段2和第二连接段5经锁定螺钉进行连接固定。
本发明在具体使用时,
将股骨近端组件的生物固定柄1和股骨远端组件的骨水泥柄4分别插入到患者股骨截骨处的近端和远端,然后使用锁定螺钉将第一连接段2和第二连接段5连接起来,将股骨重建,然后将第一固定板3和第二固定板6使用锁定螺钉固定在股骨上,防止假体转动。
本发明中,第一连接段2和第二连接段5采用多孔材料,孔隙直径为600-1000微米,孔隙率为55-85%,多孔材料制成的第一连接段2和第二连接段5可以实现远期骨长入。
生物固定柄1为锥形结构,生物固定柄1的粗端与第一连接段2固定连接,骨水泥柄4为锥形结构,骨水泥柄4的粗端与第二连接段5固定连接,生物固定柄1和骨水泥柄4的细端向外,便于将其插入到股骨内。
第一连接段2和第二连接段5的结构相同,第一连接段2包括与生物固定柄1连接的第一末端8,第一末端8上设有第一长板9和第一短板10,第一长板9与第一短板10之间设有第一插槽11,第一长板9的截面为半圆形,第一长板9端部设有第一插板12,连接孔7设置在第一长板9上,所述的第二连接段5包括与骨水泥柄4固定连接的第二末端13,第二末端13上设有第二长板14和第二短板15,第二长板14与第二短板15之间设有第二插槽16,第二长板14的截面为半圆形,第二长板14端部设有第二插板17,连接孔7设置在第二长板14上,第二插板17能够插入第一插槽11内,第二插槽16与第一插板12配合,第一连接段2和第二连接段5配合后形成圆柱体结构。
第一连接段2和第二连接段5的结构相互配合,构成一个完整的圆柱体结构,第一连接段2和第二连接段5的分体式结构,能够大量的减少对股骨近端血运的破坏,减少远期股骨头坏死的风险。
第一固定板3和第二固定板6上均开设有固定孔18,用于将第一固定板3和第二固定板6固定在股骨上,在固定第一固定板3和第二固定板6时,使用单层皮质的锁定螺钉将假体与股骨连接。
本发明在手术中的具体使用方法为:
1、患者麻醉满意后,取侧卧漂浮体位,患处骨盆向上,做延长的髂腹股沟及SP切口,暴露肿瘤,按术前的规划进行髋臼肿瘤截骨及肿瘤切除。暴露患者股骨近端,股骨头脱位,截骨导板固定于大转子顶点,按术前规划进行小转子下方截骨,部分游离股骨近端软组织结构;
2、磨锉股骨近端及远端髓腔,分别将分体式假体进行安装:远端为骨水泥柄4插入,近端为生物固定柄1插入,锁定螺钉固定两段假体;通过外侧第一固定板3和第二固定板6进行假体近端及远端单皮质锁定螺钉固定;
3、骶髂关节残余骶骨处锚钉及外科补片重建关节囊,股骨头与重建关节囊进行缝合固定;
4、放置引流,逐层缝合股骨近端及骨盆软组织筋膜层,关闭切口。
本发明与现有技术相比,具有以下有益效果:
1.可实现骨盆肿瘤切除后的生物重建,避免假体的近期、远期并发症,并可随患者生长发育延长,实现生物稳定。
2.可最大限度减少骨盆生物重建后双下肢不等长,避免远期脊柱侧弯、步态异常,实现远期的生物稳定。
3.可最大限度减少重建对患者术后治疗的干扰。
4.分体式安装可尽量减少对股骨近端血运的破坏,减少远期股骨头坏死的风险。
最后应说明的是:以上所述仅为本发明的优选实施例而已,并不用于限制本发明,尽管参照前述实施例对本发明进行了详细的说明,对于本领域的技术人员来说,其依然可以对前述各实施例所记载的技术方案进行修改,或者对其中部分技术特征进行等同替换。凡在本发明的精神和原则之内,所作的任何修改、等同替换、改进等,均应包含在本发明的保护范围之内。
Claims (7)
1.一种骨盆生物重建节段假体,其特征在于,包括股骨近端组件和股骨远端组件,股骨近端组件包括生物固定柄(1),生物固定柄(1)一端固定有第一连接段(2),第一连接段(2)一侧设有第一固定板(3),股骨远端组件包括骨水泥柄(4),骨水泥柄(4)一端固定有第二连接段(5),第二连接段(5)一侧设有第二固定板(6),第一连接段(2)和第二连接段(5)上开设有相互对应设置的多个连接孔(7),第一连接段(2)和第二连接段(5)经锁定螺钉进行连接固定。
2.根据权利要求1所述的一种骨盆生物重建节段假体,其特征在于,所述的第一连接段(2)和第二连接段(5)采用多孔材料,孔隙直径为600-1000微米,孔隙率为55-85%。
3.根据权利要求1所述的一种骨盆生物重建节段假体,其特征在于,所述的生物固定柄(1)为锥形结构,生物固定柄(1)的粗端与第一连接段(2)固定连接。
4.根据权利要求1所述的一种骨盆生物重建节段假体,其特征在于,所述的第一连接段(2)包括与生物固定柄(1)连接的第一末端(8),第一末端(8)上设有第一长板(9)和第一短板(10),第一长板(9)与第一短板(10)之间设有第一插槽(11),第一长板(9)的截面为半圆形,第一长板(9)端部设有第一插板(12),连接孔(7)设置在第一长板(9)上。
5.根据权利要求1所述的一种骨盆生物重建节段假体,其特征在于,所述的第二连接段(5)包括与骨水泥柄(4)固定连接的第二末端(13),第二末端(13)上设有第二长板(14)和第二短板(15),第二长板(14)与第二短板(15)之间设有第二插槽(16),第二长板(14)的截面为半圆形,第二长板(14)端部设有第二插板(17),连接孔(7)设置在第二长板(14)上,第二插板(17)能够插入第一插槽(11)内,第二插槽(16)与第一插板(12)配合,第一连接段(2)和第二连接段(5)配合后形成圆柱体结构。
6.根据权利要求1所述的一种骨盆生物重建节段假体,其特征在于,所述的骨水泥柄(4)为锥形结构,骨水泥柄(4)的粗端与第二连接段(5)固定连接。
7.根据权利要求1所述的一种骨盆生物重建节段假体,其特征在于,所述的第一固定板(3)和第二固定板(6)上均开设有固定孔(18),用于将第一固定板(3)和第二固定板(6)固定在股骨上。
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