CN115475034A - 一种半骨盆假体 - Google Patents

一种半骨盆假体 Download PDF

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CN115475034A
CN115475034A CN202211191451.9A CN202211191451A CN115475034A CN 115475034 A CN115475034 A CN 115475034A CN 202211191451 A CN202211191451 A CN 202211191451A CN 115475034 A CN115475034 A CN 115475034A
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screw
universal
prosthesis
titanium rod
acetabular cup
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孙伟
蔡郑东
马小军
华莹奇
孙梦熊
王崇任
沈嘉康
左东青
汪红胜
昝鹏飞
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Shanghai First Peoples Hospital
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Abstract

本发明涉及一种半骨盆假体，设有髋臼杯，所述髋臼杯设有第一万向弓根螺钉和髋臼螺钉孔；所述第一万向弓根螺钉设有第一连接钛棒；所述第一连接钛棒设有第二万向弓根螺钉；所述髋臼杯上端设有髂骨体；所述髂骨体设有固定螺孔；所述固定螺孔设有连接螺钉；所述髂骨体右上侧设有第三万向弓根螺钉；所述第三万向弓根螺钉设有第二连接钛棒；所述第二连接钛棒设有第四万向弓根螺钉。其优点表现在：能帮助患者重建半骨盆的力学结构和关节功能，且采用不同角度钉入自攻螺钉，能够预防假体的松动或移位，通过增加连接钛棒分散原骨盆假体的应力，延长假体寿命及有效性，较高稳定性较高，结构简单，稳定性强，适用于骨盆需行瘤段切除后保留肢体及功能的患者。

Description

一种半骨盆假体
【技术领域】
本发明涉及骨科植入物技术领域，具体地说，是一种半骨盆假体。
【背景技术】
骨盆位于躯干的底部，承接脊柱与双下肢，在传导人体载荷和维持正常姿势上起到重要作用。骨盆肿瘤是毗邻盆腔重要解剖结构，累及范围广、外科手术技术复杂、术后并发症多。骨肿瘤发病率约为十万分之一，骨盆恶性肿瘤约占全身恶性骨肿瘤的3％，骨盆原发肿瘤相对少见，以软骨肉瘤最多，其次为骨肉瘤、骨巨细胞瘤等，而在发病初期，由于肿瘤位置较深，肿瘤早期往往不易查见。而出现症状就诊时肿瘤体积已经很大，侵犯范围广，累及泌尿、消化系统。
近年来随着放疗、化疗技术的发展及外科切除与重建技术的进步，骨盆肿瘤的治疗取得了显著的进步。尤其对于髋臼周围II+III区的恶性肿瘤，采取保肢治疗的患者与半骨盆离断的患者预后几乎没有差异。原发髋臼肿瘤一般采取瘤段切除+半骨盆假体重建手术方式，患者总生存率为47.2％～72％，假体生存率为42％～100％，MSTS93评分为37％～71.1％，主要并发症发生率33.3％～82.4％，其中存在的问题包括伤口愈合困难、深部感染、假体脱位等。肿瘤假体包括马鞍型假体、冰激凌假体、人工半骨盆定制、组配式模块化半骨盆假体等，往往远期并发症多、假体生存率低。对于累及II+III区肿瘤，目前的半骨盆假体设计保留了通过股骨近端、髋臼、坐骨结节以及脊柱的承重，为避免扩大创伤及手术时间过长等，大多数Ⅲ区半骨盆切除术后的骨盆缺损一般不进行重建。由于骨盆前环结构的不完整致使骨盆环受力做出改变，虽然承重得到保留，但骨盆环的稳定被破坏，同时该方案忽略了腰骶部稳定在骨盆稳定性中的作用。由于骨盆区域肿瘤的外科切除会破坏骨盆的完整性和稳定性，因此理解新型半骨盆假体的生物力学特性，对于科重建骨盆的力学结构及恢复其原始功能具有重要意义，设计出更加适应人体力学，更有利于远期生存率的假体。因此，亟需新一代假体的出现能够缩短手术时间、减少患者身体负担、保持骨盆环的稳定、减少围手术期及术后并发症的骨盆假体。
中国专利申请：CN212346823U公开了一种盆骨假体，包括髋臼杯，髋臼杯上分别设置有髂骨托和耻骨板，髂骨托上设置有髂骨托连接板，髂骨托连接板上与髂骨接触处、耻骨板上与耻骨接触处、髂骨托上与人体接触处均设有钽涂层多孔骨小梁界面；髂骨托的形状为不规则的多边形，髂骨托上设有多个锁紧长钉孔，多个锁紧长钉孔的轴线方向不同，锁紧长钉穿过髂骨托的锁紧长钉孔与骶骨或者腰椎骨连接。髂骨托上的钽涂层多孔骨小梁界面，够保证假体与宿主骨界面足够的结合强度，提高了假体在体内的长期稳定，假体与宿主骨组织深度融合；髂骨托连接板的钽涂层多孔骨小梁界面，增加假体稳定性和安全性，能起到机械支撑效果和骨长入效果；锁紧长钉孔，假体稳定性好，降低假体安装难度。但该假体在维持骨盆环的稳定上有所欠缺，承重能力相对来说较差，远期并发症多、假体生存率低，影响患者术后生活。
综上所述，亟需一种不仅能传导人体载荷和维持正常姿势，帮助患者重建半骨盆的力学结构和关节功能，还能减少假体与骨组织切面的应力，延长假体寿命及有效性，长期稳定，缩短手术时间、减少术后并发症的半骨盆假体。
【发明内容】
本发明的再一的目的是，提供一种不仅能传导人体载荷和维持正常姿势，帮助患者重建半骨盆的力学结构和关节功能，还能减少假体与骨组织切面的应力，延长假体寿命及有效性，长期稳定，缩短手术时间、减少术后并发症的半骨盆假体。
为实现上述目的，本发明采取的技术方案是：
一种半骨盆假体，设有髋臼杯，所述髋臼杯侧面设有第一万向弓根螺钉和多个髋臼螺钉孔；所述第一万向弓根螺钉上设有第一连接钛棒；所述第一连接钛棒的另一端设有第二万向弓根螺钉；所述髋臼杯上端设有髂骨体；所述髂骨体背侧设有多个固定螺孔；所述固定螺孔上设有与之匹配的连接螺钉；所述髂骨体右上侧设有第三万向弓根螺钉；所述第三万向弓根螺钉上设有第二连接钛棒；所述第二连接钛棒的另一端设有第四万向弓根螺钉。
作为一个优选例，所述第一万向弓根螺钉、第三万向弓根螺钉、髋臼杯和髂骨体为一体结构，且第一万向弓根螺钉和第三万向弓根螺钉设有螺帽，没有螺钉钉尾，螺帽内部设有锁紧螺纹。
作为另一优选例，所述第二万向弓根螺钉和第四万向弓根螺钉属于自攻螺钉，设有螺帽，螺帽内部设有锁紧螺纹。
作为另一优选例，所述第一连接钛棒和第一万向弓根螺钉、第二万向弓根螺钉的连接方式为卡接。
作为另一优选例，所述第二连接钛棒和第三万向弓根螺钉、第四万向弓根螺钉之间的连接方式为卡接。
作为另一优选例，所述连接螺钉为自攻螺钉，采用不同入钉角度钉入残余骶骨。
作为另一优选例，所述髋臼杯呈半球形状。
本发明优点在于：
1、本发明经过术前CT或MRI扫描后得到患者骨盆数据，通过3D打印得到一体成型半骨盆假体，对于无法对重建骨盆环、耻骨无法重建的患者重建了患侧半骨盆的力学结构和关节功能。
2、本发明采用不同角度钉入自攻螺钉，能够预防假体的松动或移位，且通过增加连接钛棒加强对腰椎及骶骨的固定连接，经试验证明能有效的分散原骨盆假体的应力，使假体在经受长时间人体复杂受力的情况下不易出现失效，以达到延长假体寿命及有效性的目的，具有较高稳定性。
3、本发明结构简单，稳定性强，适用于骨盆需行瘤段切除后保留肢体及功能的患者。
【附图说明】
附图1是本发明一种半骨盆假体的结构示意图。
附图2是本发明一种半骨盆假体的正面使用示意图。
附图3是本发明一种半骨盆假体的侧面使用示意图。
附图4是本发明一种半骨盆假体的第二万向弓根螺钉和第四万向弓根螺钉的结构示意图。
【具体实施方式】
下面结合实施例并参照附图对本发明作进一步描述。
附图中涉及的附图标记和组成部分如下所示：
1.髋臼杯 11.髋臼螺钉孔
2.第一万向弓根螺钉 3.第一连接钛棒
4.第二万向弓根螺钉 5.髂骨体
51.固定螺孔 52.连接螺钉
6.第三万向弓根螺钉 7.第二连接钛棒
8.第四万向弓根螺钉
实施例1
请参见图1、图2、图3和图4，图1是本发明一种半骨盆假体的结构示意图，图2是本发明一种半骨盆假体的正面使用示意图，图3是本发明一种半骨盆假体的侧面使用示意图，图4是本发明一种半骨盆假体的万向弓根螺钉结构示意图。所述一种半骨盆假体，设有髋臼杯1，所述髋臼杯1呈半球形状，中空结构，所述髋臼杯1侧面设有第一万向弓根螺钉2和多个髋臼螺钉孔11，所述髋臼螺钉孔11可根据临床实际情况用尺寸相符的螺钉钉入进周围存在的骨组织中；所述第一万向弓根螺钉2上设有第一连接钛棒3；所述第一连接钛棒3的另一端设有第二万向弓根螺钉4，所述第二万向弓根螺4钉钉于骶骨前方，所述第一连接钛棒3和第一万向弓根螺钉2、第二万向弓根螺钉4的连接方式为卡接；所述髋臼杯1上端设有髂骨体5；所述髂骨体5背侧设有多个固定螺孔51；所述固定螺孔上设有与之匹配的连接螺钉52，所述连接螺钉52为自攻螺钉，采用不同入钉角度钉入残余骶骨，能够预防假体的松动或移位；所述髂骨体5右上侧设有第三万向弓根螺钉6，所述第一万向弓根螺钉2、第三万向弓根螺钉6、髋臼杯1和髂骨体5为一体结构，且第一万向弓根螺钉2和第三万向弓根螺钉6设有螺帽，没有螺钉钉尾，螺帽内部设有锁紧螺纹；所述第三万向弓根螺钉6上设有第二连接钛棒7；所述第二连接钛棒7的另一端设有第四万向弓根螺钉8，所述第四万向弓根螺钉8钉于腰椎，所述第二万向弓根螺钉4和第四万向弓根螺钉8属于自攻螺钉，设有螺帽，螺帽内部设有锁紧螺纹，所述第二连接钛棒7和第三万向弓根螺钉6、第四万向弓根螺钉8之间的连接方式为卡接，第一连接钛棒3和第二连接钛棒7的增加能加强对腰椎及骶骨的固定连接，有效的分散原骨盆假体的应力，使假体在经受长时间人体复杂受力的情况下不易出现失效，延长假体寿命及有效性，稳定性较高，且以上假体、连接螺钉、万向弓根螺钉和连接钛棒的材质优选为钛合金。
本发明的使用方法和原理为：首先经过术前CT或MRI扫描后得到患者骨盆数据，评估切除部位，得出符合切除部位尺寸大小的半骨盆假体数据，再通过3D打印出一体成型半骨盆假体，其中固定零件都根据患者本身实际情况围绕着标准尺寸上下调节，最后通过手术将半骨盆假体接在剩余的骨盆上，连接螺钉52采用不同入钉角度钉入残余骶骨固定假体，第一万向弓根螺钉2、第二万向弓根螺钉4通过螺帽卡接第一连接钛棒3，第三万向弓根螺钉6、第四万向弓根螺钉8通过螺帽卡接第二连接7钛棒，根据实际情况选择髋臼杯1上的螺钉孔是否穿接螺钉，螺钉可钉于残余耻骨上也可钉于周围存在的其它骨组织中。
需要说明的是，本发明经过术前CT或MRI扫描后得到患者骨盆数据，通过3D打印得到一体成型半骨盆假体，对于无法对重建骨盆环、耻骨无法重建的患者重建了患侧半骨盆的力学结构和关节功能，采用不同角度钉入自攻螺钉，能够预防假体的松动或移位，且通过增加连接钛棒加强对腰椎及骶骨的固定连接，由以下实验可证明：术前CT或MRI扫描后得到患者骨盆数据后建立盆骨假体上有无连接钛棒固定的有限元模型，建模时对螺纹连接部分都实行粘接约束，其效果在宏观上等效于螺纹连接，划分网格后给与物理性能，所述螺钉孔、螺钉和装配配合面划分较细网格，剩余的部分划分较粗大的网格，这样既可以减小有限元网格规模，提高计算效率，也能得到足够精确的计算结果，再模拟人体上半身的质量加载0.278MPa、方向竖直向下的压强载荷，最后计算结果。从变形计算结果看，连接钛棒能明显加强盆骨的刚度，减小盆骨的总变形；无连接钛棒时盆骨最大变形为0.81mm，有连接钛棒时盆骨最大变形为0.553mm，变形减小了31.7％；两个工况下假体的变形量很小，可以忽略不计；从应力计算结果看，无连接钛棒时盆骨最大应力为59.1MPa，有连接钛棒时盆骨最大应力为51.9MPa，应力减小了12.2％；皮质骨的断裂强度约150MPa，增加的这点应力对强度没有太大影响；无论何种工况下，假体、连接钛棒及螺钉的应力均不超过100MPa，而钛合金强度高达895MPa，远远高于上述部件的实际应力，因此两种工况下应力的区别相对而言可以忽略，则计算结果表明连接钛棒明显加强盆骨的刚度及稳固性，证明连接钛棒能有效的分散原骨盆假体的应力，使假体在经受长时间人体复杂受力的情况下不易出现失效，以达到延长假体寿命及有效性的目的，髋臼杯1上的髋臼螺钉孔11也能根据临床实际情况用尺寸相符的螺钉钉入进周围存在的骨组织中，整体具有较高稳定性。本发明结构简单，稳定性强，适用于骨盆需行瘤段切除后保留肢体及功能的患者。
以上所述仅是本发明的优选实施方式，应当指出，对于本技术领域的普通技术人员，在不脱离本发明原理的前提下，还可以做出若干改进和补充，这些改进和补充也应视为本发明的保护范围。

Claims (7)

1.一种半骨盆假体，其特征在于，设有髋臼杯，所述髋臼杯侧面设有第一万向弓根螺钉和多个髋臼螺钉孔；所述第一万向弓根螺钉上设有第一连接钛棒；所述第一连接钛棒的另一端设有第二万向弓根螺钉；所述髋臼杯上端设有髂骨体；所述髂骨体背侧设有多个固定螺孔；所述固定螺孔上设有与之匹配的连接螺钉；所述髂骨体右上侧设有第三万向弓根螺钉；所述第三万向弓根螺钉上设有第二连接钛棒；所述第二连接钛棒的另一端设有第四万向弓根螺钉。
2.根据权利要求1所述的半骨盆假体，其特征在于，所述第一万向弓根螺钉、第三万向弓根螺钉、髋臼杯和髂骨体为一体结构，且第一万向弓根螺钉和第三万向弓根螺钉设有螺帽，没有螺钉钉尾，螺帽内部设有锁紧螺纹。
3.根据权利要求1所述的半骨盆假体，其特征在于，所述第二万向弓根螺钉和第四万向弓根螺钉属于自攻螺钉，设有螺帽，螺帽内部设有锁紧螺纹。
4.根据权利要求1所述的半骨盆假体，其特征在于，所述第一连接钛棒和第一万向弓根螺钉、第二万向弓根螺钉的连接方式为卡接。
5.根据权利要求1所述的半骨盆假体，其特征在于，所述第二连接钛棒和第三万向弓根螺钉、第四万向弓根螺钉之间的连接方式为卡接。
6.根据权利要求1所述的半骨盆假体，其特征在于，所述连接螺钉为自攻螺钉，采用不同入钉角度钉入残余骶骨。
7.根据权利要求1所述的半骨盆假体，其特征在于，所述髋臼杯呈半球形状。
CN202211191451.9A 2022-09-28 2022-09-28 一种半骨盆假体 Pending CN115475034A (zh)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN116327356A (zh) * 2023-02-27 2023-06-27 北京长木谷医疗科技有限公司 基于人工智能的脊柱手术术前规划方法、系统及存储介质

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN116327356A (zh) * 2023-02-27 2023-06-27 北京长木谷医疗科技有限公司 基于人工智能的脊柱手术术前规划方法、系统及存储介质
CN116327356B (zh) * 2023-02-27 2024-04-26 北京长木谷医疗科技股份有限公司 基于人工智能的脊柱手术术前规划方法、系统及存储介质

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