CN1192755C - 用于植入可粘固的内假体的组件 - Google Patents

用于植入可粘固的内假体的组件 Download PDF

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Publication number
CN1192755C
CN1192755C CN99810790.5A CN99810790A CN1192755C CN 1192755 C CN1192755 C CN 1192755C CN 99810790 A CN99810790 A CN 99810790A CN 1192755 C CN1192755 C CN 1192755C
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China
Prior art keywords
bar
centering
described assembly
sealing member
distal direction
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Expired - Fee Related
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CN99810790.5A
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English (en)
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CN1316892A (zh
Inventor
汉斯·施莫策尔
克里斯托弗·黑希格
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Smith and Nephew Orthopaedics AG
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Plus Endoprothetik AG
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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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00395—Coating or prosthesis-covering structure made of metals or of alloys
    • A61F2310/00407—Coating made of titanium or of Ti-based alloys
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00952—Coating, pre-coating or prosthesis-covering structure made of bone cement, e.g. pre-applied PMMA cement mantle

Abstract

本发明涉及一种用于植入可粘固的内假体的组件，包括一个安置工具(3)和至少两个要植入的零件，亦即一根内假体杆(4)和一个近中的定心和/或密封件(1)，杆(4)和安置工具(3)设计成互相可以连接，以及，定心和/或密封件(1)设计成可装在杆(4)上并可沿杆的延伸方向移动，以及，或者安置工具(3)包括一个止挡部分(3e)，它构成相对于定心和/或密封件(1)的止挡，或者在安置工具(3)和在杆(4)上加标记(6)，以保证在定心和/或密封件(1)与杆(4)之间确定的相对位置。

Description

用于植入可粘固的内假体的组件
本发明涉及一种用于植入可粘固的内假体的组件。
由印刷品DE 19518391 A1已知一种用于植入可粘固的内假体杆的近中侧定心和密封件，它一方面用作近中侧的定心辅助装置，另一方面防止骨水泥向近中侧方向泄漏，由此在将内假体插入骨髓腔时导致在其中的骨水泥压力增大。
这种已知的由内假体杆与相配设计的定心和密封件的组合存在的缺点是，内假体杆在股骨的骨髓腔内沿近中侧—远侧方向的插入深度只能很糟糕和因而不准确地调整。此外，此定心和密封件只有一种有限的密封效果和沿内侧—外侧不准确地定心。
本发明的目的是创造一种工具，它允许精确地植入一根可粘固的内假体杆。
此目的尤其借助于一种用于植入可粘固的内假体的组件达到，它包括至少两个要植入的零件，亦即一根内假体杆和一个近中的定心和/或密封件，定心和/或密封件设计成可装在杆上并可沿杆的延伸方向移动，其特征为：所述组件还包括一个安置工具，杆和安置工具设计成互相可以连接；以及，为了保证在定心和/或密封件与杆之间规定的相对位置，或者安置工具包括一个止挡部分，它构成相对于定心和/或密封件的止挡，或者在安置工具和在杆上加标记。
这种按本发明的设计的优点是，内假体杆在股骨的骨髓腔内的置入深度在植入过程中还可以调整。因此在植入过程中还可以按这样的方式例如可能调整大腿的长度和内假体杆的置入深度，亦即使得在手术完成后两条腿有相同的长度。按一种优选的设计，此组件包括一操作工具，它在杆安置前插入股骨的骨髓腔内，以便确定最佳的安置深度，从而尤其达到最理想的腿长或最理想的韧带张力。以此方式确定的最佳安置深度被读出，之后内假体杆按照此安置深度插入股骨内。
近中的定心和/或密封件在股骨近中区内面临的任务是，内假体杆在骨髓腔内定心，或密封在骨髓腔与杆之间的间隙，以防止在骨髓腔内的骨水泥流出，或同时不仅定心而且密封。这种既定心又密封的定心和密封件优选地设计为与杆的几何形状相配，使杆在保持密封效果的条件下可沿密封件朝着远侧的方向移动。
定心和密封件可安装在经切除术的股骨颈处，并可在它的近中段内至少部分插入骨髓腔，所以在这之后要插入的内假体杆各方面定心地插入骨髓腔内，此外还给予此构件有密封的效果，从而防止在骨髓腔内的骨水泥漏出。
按一种有利的设计，近中的定心和密封件由一套筒状本身沿近中侧—远侧方向延伸的机体构成，机体包括两个宽侧边界和两个窄侧边界，它们围绕着一个基本上矩形的内腔；以及，两个宽侧的边界各构成一个内侧面，它们沿近中侧—远侧方向基本上平行延伸。这种定心和密封件特别适用于设计为片状的内假体杆，它们的宽侧沿近中侧—远侧方向大体平行地延伸。由此在定心和密封件与内假体杆之间获得特有效的密封作用。一种定心和/或密封件设计为套筒状机体，它的内腔按一种有利的实施形式设计为，即使在植入了内假体杆的情况下，杆仍可以沿近中侧—远侧方向运动。若这是应期望的，那么也可以在植入后经过较长的时间再安置杆，因为并不妨碍沿近中侧—远侧方向运动。
定心和/或密封件有利地由一种聚合的骨水泥，尤其由聚甲基丙烯酸甲酯(PMMA)制造。在植入时，此定心和/或密封件与存在的骨水泥化学地化合成为特别均匀的化合物。但定心和/或密封件也可以用另一种材料制造，尤其是一种金属材料，例如生物相容的钛合金。
定心和/或密封件或满足定心功能或满足密封功能，或两种功能同时满足，这些功能是：
—杆在骨髓腔近中段内定心；
—在杆安置时沿近中侧—远侧方向定心地导引此杆；
—防止杆沿内侧—外侧方向倾斜和转动；
—密封在近中区内杆与股骨之间形成的间隙，从而在处于骨髓腔内的骨水泥上施加一个压力。
定心和/或密封件朝近中方向有一终端面，它被有利地用作基准面。优选地，此定心和/或密封件按这样的方式插入骨髓腔，即，使此基准面与股骨颈切除术后的平面齐平地延伸。内假体杆在插入前固定在一安置工具上，与此同时在安置工具上还固定了一个定距器，定距器设计为，当内假体杆深插入骨髓腔内时它贴靠在定心和/或密封件的基准面上并阻止杆进一步插入。借助此可提供不同尺寸的定距器，可以准确地调整内假体杆相对于切除面的安置深度。根据需要的安置深度选出适当的定距器，并在内假体杆插入前固定在安置工具上。
一个组件指的是一些彼此配套的零件，包括定心和/或密封件、内假体杆以及安置工具，必要时组合一个或多个定距器，其中，在此组件中只是定心和/或密封件以及内假体杆才规定作为植入物留在体内。
下面借助于多个实施例的附图说明本发明。其中：
图1近中侧定心和/或密封件透视图；
图2a另一种近中侧定心和/或密封件的侧视图；
图2b通过按图2a的构件的截面图；
图2c图2a所示构件的俯视图；
图3一个组件，包括安置工具、定心和/或密封件、定距器和杆；
图4带图3所示安置工具的已插入的杆；
图5通过另一种实施例的定心和/或密封件的截面图；
图6另一种组件，包括安置工具、定心和/或密封件和杆；以及
图7另一种组件，包括安置工具、定心和/或密封件和杆。
图3表示了一种按本发明的组件的实施例，包括一根内假体杆4，它设计为直杆，真正的杆4f有基本上矩形的截面，包括两个窄侧的侧面4c、4d以及两个宽侧的侧面4e。在近中端杆4f有内螺纹4a和用于关节头的锥体4b。组件还包括安置工具3，它有一连杆3d，冲头3c固定在连杆3d，冲头延伸出一个转接部分3b和一个外螺纹段3a。此组件还包括一个定距器2，它设计为套筒状矩形的机体2d，包括两个侧翼2a，它们构成上止挡面2b和下止挡面2c。此外，组件包括一个近中侧的定心和/或密封件1。定距器2设计为它以其上止挡面2b贴靠在冲头3c上。在内假体杆4插入时，下止挡面2c在某个时候与近中侧定心和/或密封件1的基准面1m、1n接触，并由此沿杆的延伸方向限定了内假体杆4与定心和/或密封件1的相对位置。因为定心和/或密封件1在植入时以它的面1m、1n优选地与股骨的切除面处于齐平位置，所以借助于此定距器2确定了杆4f的安置深度。定距器2可供手术者选择，它们设计为沿近中侧—远侧方向C有不同的长度。在图3和4中表示的定距器2可看作只是许多设计可能性中的一种实施例。定距器2的任务是提供上和下止挡2b、2c，以便保证杆4相对于近中侧的定心和/或密封件1或其基准面1m、1n有规定的安置深度。这一任务可借助于完全不同设计的定距器2来完成。
图4表示已处于插入位置的内假体杆4，图中没有画出股骨。在操作杆插入骨髓腔内后，手术者确定杆相对于切除平面的插入深度。手术者从多个定距器中选出能保证拟定的插入深度的那个定距器。将选出的定距器2固定在安置工具3上，然后内假体杆4借助内螺纹4a拧紧在外螺纹3a上。接着将定心和/或密封件1从远侧方向那里套到杆4f上。此后，内假体杆4与定心和/或密封件1一起，如图4所示插入骨髓腔内，直至定距器2与近中的定心和/或密封件1相靠并到达构成基准面的切除平面。在这种情况下，处于骨髓内的骨水泥受压缩并从骨髓腔朝定心和/或密封件1方向压挤。至少内侧面1b、1c、1d贴靠在内假体杆4上并造成密封作用。如果内假体杆4没有以其侧面4d贴靠在内侧面1e上，那么在这两个面之间形成间隙1p，骨水泥可以通过它漏出。手术者可例如用手指盖住此间隙1p，因此可通过将手指压紧在间隙1p上或通过适当地放开比较准确地控制骨水泥的泄出。内侧面1e也可以按这样的方式相对于侧面4d布置，或杆4按这样的方式深插在定心和/或密封件1中，即，使得在这两个面1e、1d之间形成密封作用，从而使构件1同时起定心和密封件的作用。按一种优选的实施形式，定心和/或密封件1设计为以及骨水泥选择为，使骨水泥从各方面围绕着近中侧的定心和/或密封件，因此骨水泥既在内侧面1b、1c、1d、1e与杆4f之间也在定心和/或密封件1外表面与股骨之间压出。
借助图2a至图2c说明定心和/或密封件的一种实施例。这种定心和/或密封件由一个套筒状的沿近中侧—远侧方向C延伸的机体构成，机体包括两个宽侧的边界1q、1r以及两个窄侧的边界1f、1g，如图2c的俯视图所示，这些边界围绕着一个基本上矩形的内腔1a。宽侧的边界1q、1r的内侧面1b、1c设计成基本上平行于近中侧—远侧方向C以及也平行于外侧-内侧方向A延伸。在图示的实施例中，窄侧边界1g的内侧面1d如图2c所示平行于近中侧—远侧方向C延伸。宽侧的内侧面1b、1c同样可以设计为平行于近中侧—远侧方向C延伸，但在图示的实施例中有一种朝远侧方向略有收敛的走向，这样设计的优点是改善了内假体杆4与内侧面1b、1c之间的密封效果。第二个窄侧边界1f有一个相对于内侧面1d倾斜延伸的内侧面1e。
在图示的实施例中，所有的边界1q、1r、1f、1g有一个沿近中侧—远侧方向C延伸的分段1l，连接在分段1k上的分段1l设计成有朝远侧方向收缩的壁厚，尤其从图2b中表示的截面图可以看出这一情况。宽侧的边界1q、1r朝近中侧的方向终止于基准面1m、1n。如图2a和2b所示，这些沿内侧—外侧方向A延伸的基准面1m、1n有一种依随着宽侧边界1r的走向而弯折的走向。
图5表示的机体1除了在有两个直线延伸的、亦即没有弯折点的宽侧边界1r、1q这一点上不同于按图2a至2c的实施例之外，其余的设计是相同的。
与图2b至2c所示的实施例不同，在图1中表示的机体1有一个沿内侧—外侧方向A设计得较厚的窄侧边界1g，除此之外它在中央有一个沿近中侧—远侧方向C延伸的贯通的缝隙10。
内假体的植入例如按以下所述：
股骨颈实施切除术。然后用骨锉扩宽骨髓腔。优选地令定心件的外形、亦即外表面1r、1k与骨锉的外形一致。接着将操作杆插入扩宽的骨髓腔内并在此操作杆上装上一个关节头。无论如何骨锉也可以设计为用于安装关节头或包括一个关节头，因此可暂时留在骨髓腔内。然后检测关节头的位置和操纵腿，为的是例如检验腿长，在这种情况下可以调整操作杆或骨锉尤其是沿近中侧—远侧方向C的安置深度，直至找到一个对腿最佳的位置。接着读出操作杆或骨锉的安置深度。然后从骨髓腔取出操作杆或骨锉，并在骨髓腔内注入骨水泥。接着如图6所示将定心和/或密封件1经杆4f的尖端套上，此杆固定在安置工具3上，必要时使用确定安置深度的定距器2(如图3或图4所示)，之后将杆插入骨髓腔。定心和/或密封件1同样插入骨髓腔内。在这里，收缩的分段1l有助于定心和/或密封件1可靠和定心地插入骨髓腔内。定心和/或密封件1按这样的方式压入，即，使终端面1m、1n优选地与切除面齐平地延伸，然后将杆继续插入，直至达到预先规定的安置深度。之后将安置工具3和可能使用的定距器2拆除。
在图示的实施例中，如图2c所示，窄侧的内侧面1d设计为沿近中侧—远侧方向C延伸，其优点是，当杆4f插入时此表面起支承和基准面的作用，在这种情况下这个表面1d不会造成杆4f沿内侧—外侧方向A移动。
此外，在杆尖端4g可设一远侧的定心件。
为了获得密封效果，需要将定心和/或密封件1的内侧面1b、1c、1d、1e设计为与杆4f的几何形状匹配地延伸，以达到密封作用。因此这些内侧面1b、1c、1d、1e，由对应的杆4f的形状预先规定，可设计为按完全不同的方式延伸，其目的是在杆4f与定心和/或密封件1之间获得密封效果，与此同时仍可沿近中侧—远侧方向C的相对移动。
图6表示了组件的一种实施例，它包括内假体杆4、远中侧定心和/或密封件1以及安置工具3。杆4上作有标记6，这些标记用数字“0”、“5”和“10”表示安置深度。安置工具3同样有数字相同的标记6。在植入时首先用操作工具确定最佳安置深度，在这种情况下在操作工具上也作有标记和写上数字。读出处于切除面的标记。然后，将定心和/或密封件在其上边缘1m、1n与切除面齐平时固定在骨髓腔内并将骨水泥引入骨髓腔内。接着将杆4固定在安置工具3上并插入骨髓腔。在插入过程中，手术者可通过标记6准确确定杆4相对于定心和/或密封件上边缘1m、1n的插入深度。
图7表示组件的另一种实施例，它包括内假体杆4、远侧中定心和/或密封件1以及安置工具3。冲头3c包括一个固定连接的止挡部分3e，它有一个用于挡靠在定心和密封件1上的止挡面2c。可以采用具有沿方向C设计为不同长度的止挡部分3e，从而可以通过适当地选择冲头3c来调整定心和/或密封件1与杆4的相对位置。

Claims (20)

1.用于植入可粘固的内假体的组件，包括至少两个要植入的零件，亦即一根内假体杆(4)和一个近中的定心和/或密封件(1)，定心和/或密封件(1)设计成可装在杆(4)上并可沿杆的延伸方向移动，其特征为：所述组件还包括一个安置工具(3)，杆(4)和安置工具(3)设计成互相可以连接；以及，为了保证在定心和/或密封件(1)与杆(4)之间确定的相对位置，或者安置工具(3)包括一个止挡部分(2，3e)，它构成相对于定心和/或密封件(1)的止挡，或者在安置工具(3)和在杆(4)上加标记(6)。
2.按照权利要求1所述的组件，其特征为：止挡部分(3e)设计为单独的定距器(2)。
3.按照权利要求2所述的组件，其特征为：定距器(2)设计为套筒状机体(2d)。
4.按照权利要求2或3所述的组件，其特征为：定距器(2)设计为矩形机体(2d)，它的宽侧边界(2a)构成一个朝定心和/或密封件(1)方向定向的止挡(2c)。
5.按照权利要求2至4之一所述的组件，其特征为：提供多个定距器(2)，它们设计为沿杆(4)的延伸方向长度不同。
6.按照权利要求1所述的组件，其特征为：止挡部分(3e)是安置工具(3)的组成部分以及与安置工具固定连接。
7.按照前列诸权利要求之一所述的组件，其特征为：定心和/或密封件由套筒状的本身沿近中侧一远侧方向(C)延伸的机体(1)构成；以及，机体(1)有一个具有一些朝向杆(4f)的边界(1b、1c、1d、1e)并按这种方式设计的内腔(1a)，即，贴靠在杆(4f)上的边界(1b、1c、1d、1e)中至少三个起沿近中侧一远侧方向(C)的密封作用。
8.按照前列诸权利要求之一所述的组件，其特征为：定心和/或密封件由套筒状的本身沿近中侧一远侧方向(C)延伸的机体(1)构成；机体(1)包括两个宽侧的边界(1q、1r)和两个窄侧的边界(1f、1g)，它们围绕着一个矩形的内腔(1a)；以及，两个宽侧的边界(1q、1r)各构成一个内侧面(1b、1c)，它们沿近中侧一远侧方向(C)平行延伸。
9.按照权利要求8所述的组件，其特征为：至少宽侧的边界(1q、1r)设计有一个沿近中侧一远侧方向(C)延伸壁厚朝远侧方向逐渐缩小的分段(1l)。
10.按照权利要求7至9之一所述的组件，其特征为：至少宽侧的边界(1q、1r)各有一个朝近中侧方向指的构成基准面(1m、1n)的终端面。
11.按照权利要求10所述的组件，其特征为：基准面(1m、1n)设计为沿内侧一外侧方向(A)弯折地延伸。
12.按照权利要求7至11之一所述的组件，其特征为：构件(1)用一种固化的骨水泥制造。
13.如权利要求12所述的组件，其特征为：构件(1)用聚甲基丙烯酸甲酯制造。
14.如权利要求7-11之一所述的组件，其特征为：构件(1)用金属制造。
15.如权利要求14所述的组件，其特征为：构件(1)用一种钛合金制造。
16.按照权利要求7至15之一所述的组件，其特征为：内侧亦即窄侧的边界(1g)有一个沿近中侧一远侧方向(C)延伸的内侧面(1d)和/或一个沿近中侧一远侧方向(C)延伸的缝隙(10)。
17.按照权利要求7至16之一所述的组件，其特征为：宽侧的内侧面(1b、1c)朝远侧方向有收敛地延伸。
18.按照前列诸权利要求之一所述的组件，其特征为：还包括一操作工具，它设计用于插入股骨的骨髓腔内，以及它可以确定杆(4)在骨髓腔内的插入深度。
19.按照权利要求18所述的组件，其特征为：操作工具有一个上面按这样的方式作有标记的杆，即当操作工具杆插入股骨内时可以读出相对于股骨切除面的插入深度。
20.按照权利要求18或19所述的组件，其特征为：操作工具包括一骨锉。
CN99810790.5A 1998-09-10 1999-08-26 用于植入可粘固的内假体的组件 Expired - Fee Related CN1192755C (zh)

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