CN1250170C - 用于插入髋臼假体的器械组 - Google Patents

用于插入髋臼假体的器械组 Download PDF

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CN1250170C
CN1250170C CNB018134467A CN01813446A CN1250170C CN 1250170 C CN1250170 C CN 1250170C CN B018134467 A CNB018134467 A CN B018134467A CN 01813446 A CN01813446 A CN 01813446A CN 1250170 C CN1250170 C CN 1250170C
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acetabular bone
shaping
bar
spare
nest
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CN1444466A (zh
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W·K·钟
S·M·里茨卡拉
A·凯勒
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Waldemar Link GmbH and Co KG
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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
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    • A61F2/4609—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of acetabular cups
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Abstract

一组用于插入一髋臼假体的器械，它有至少一个成形髋臼件(50)以及一杆(55)，杆(55)在轴向上与该成形髋臼件连接并且在一端上有一个要与一在成形髋臼件(52)上的对应接合件(53)相连的接合件(54)。为保证接合件(53，54)可以容易地在规定的外科手术区内受引导地相互靠拢，在成形髋臼件(52)上的接合件(53)被一个将杆端引向它的漏斗形导向面(43)包围着。

Description

用于插入髋臼假体的器械组
技术领域
髋关节假体由一个取代股骨头的假体部及一取代自然髋臼滑动面的窝槽假体组成。本发明涉及该窝槽假体的插入。
背景技术
在窝槽假体可被插入自然髋臼中以前，必须事先借助髋臼锉头对自然髋臼进行加工，以使其适应于特定的窝槽假体。这种加工及窝槽假体的插入自然从髋臼敞开侧进行。髋臼敞开的且由其边缘走向确定的方向以下被称为髋臼轴向。这通常也是医生在锉髋臼时确定髋臼锉轴向以及他随后插入窝槽假体的方向。为进行这样的加工，当使用传统手术技术时，外科手术医生需要打开较大的外科手术区。该外科手术区的宽度至少能允许插入窝槽假体、髋臼锉及一个大致沿髋臼轴向延伸的器械。因此，传统外科手术技术需要在髋臼轴向上比较大地切开覆盖组织。
公开了(WO97/47257)一组器械，通过所述器械，可以用两个小外科手术切口来代替一个大约位于轴向上的大切口，这两个小切口中的、位于垂直于髋臼轴向方向上的第一切口被用来插入髋臼锉及窝槽假体，即那些直径较大且在关节窝上直接需要的部分。位于轴向上的第二切口只用于器械杆的插入并因而可以非常小。在杆与成形髋臼件之间的并且是发挥作用所需的连接只有在两个部件都被插入在自然髋臼附近的切开点后才能实现。由于手术伤口缩小，所以给病人带来的压力也随之减轻。
在已知的仪器中，为这些器械设置一个支承引导件，该部件在一端上形成一用于引导经过一在股骨颈内的孔被引向髋臼的器械杆的导向面。在支承件的另一端上设有一用于支承臂的座，成形髋臼件被固定在支承臂上。人们希望这有助于把这些杆及相关的成形髋臼件经不同的手术切口导入同一手术区并且可以让它们相互接合地将其定位在同一轴线上。但是，用已知仪器无法实现此目的。相反，有经验的外科手术医生感到这是不方便的，因为他无法听凭其解剖学感觉来定位成形髋臼件。
发明内容
本发明的一个目的是可以获得上述类型的用于插入髋臼假体的器械组，它使得外科手术医生可以自由地接近器械杆并允许更轻松地将这些杆连接到成形髋臼件上。
为此，本发明提供一种用于插入一个髋臼假体的器械组，它有至少一个成形的髋臼件和一个杆，所述杆要在轴向上与该成形髋臼件相连并且在一端上具有一个要与一在该成形髋臼件上的对应接合件连接的接合件，该器械组有一个垂直于窝槽轴向地并可松开地与该成形髋臼件相连的拉手架，其中，在该成形髋臼件上的接合件被一个把该杆端引向所述接合件的漏斗形导向面包围着。
每个成形髋臼件具有要与一在有关杆的端部上的互补接合件相连的接合件。根据本发明，成形髋臼件的接合件被一个漏斗形导向面包围着，该导向面把杆端引向接合件。当外科手术医生在手术区内握住成形髋臼件并把杆推向它时，杆前端碰到允许医生使两个部分的接合件相互靠近的导向面。对医生来说，这要比他同时还要把精力集中在影响这两个部分位置的支承件状况上更容易完成。
在成形髋臼件上的接合件有利地是一个孔，如果需要，该孔可以配设有附加连接手段如螺纹和插接突起。杆的接合件则可以由被插入该孔中的且或许配设互补连接手段的销形杆端构成。
为了操控这些成形髋臼件，可以设置一个拉手架，它在任何情况下都被松开地与一个成形髋臼件相连。借助拉手架，该成形髋臼件被插入、定位并如此保持着，即经过其它手术切口插入的杆可以与该拉手架相连。一旦实现了这种连接，则可以松开拉手架，因为这个成形髋臼件的定位及定向现在由杆来决定。由该杆来操纵此成形髋臼件。这种操纵预计包括成形髋臼件与自然状况有关地移动或定向，如髋臼锉头转动以便锉髋臼，或者一窝槽假体的定向和植入。
当锉髋臼并插入窝槽假体时，通常使该股骨转动，从而它让开道。这与本发明有关地也是可行的。但是，为了避免不必要的损伤及外科手术的不可预测性，本发明(按照上述现有技术)优选通过开设一个穿透股骨且有利地大致在轴向上位于大腿骨颈内的孔来导入器械杆。为此，可根据本发明使用一个观察器械，它事先被接在股骨头上。它可被用来引导钻头和/或引导一根随后引导钻头的骨牵引针。
这样，被杆穿过的孔可以尽可能地窄，所述杆的截面被设计成有较小的径向宽度。包括其接合部的杆直径在沿至少8cm的长度上有利地小于15mm并最好小于10mm。当成形髋臼件中的接合部是一个具有互补凸起或凹槽的孔时，最佳地通过把杆接合部设计成有径向接合凸起或凹槽的销而满足了这个要求。这也使得把杆接合部引入成形髋臼件的接合部中变得更容易，因为在导向面目标区内的杆端或多或少依靠自身进入到形成成形髋臼件的接合部的孔中。
在髋臼锉头的情况下，接合部和导向面可以直接设置于其上。对窝槽假体及其部件来说，这并不总是可行的。在窝槽假体及其部件上，很少能有大范围的导向面。另外，一般不可能或不希望提供一接合部。因此，本发明提出了一个特殊的窝槽支承件，它支承该接合部并或许支承导向面并且具有与窝槽假体配合的且尤其是接触其边缘的连接装置。这些连接装置不移动要安置在或完全安置在支承件上；它们也可以至少部分地由用于引入窝槽假体及支承件的拉手架构成。
附图说明
下面参考表示一个有利的示范实施例的附图来更详细地说明本发明，其中：
图1示出了手术区的示意截面图。
图2示出了切除股骨头后的状态。
图3表示髋臼锉刀被插入。
图4表示髋臼定位器具被插入。
图5表示髋臼定位器具定位后的状态。
图6表示替换图4、5的器械方案。
图7示出了图4所示器械与拉手架的连接。
图8表示图7所示部件的侧视图。
图9表示窝槽定位器具的植入器械的插入。
图10表示窝槽衬的插入。
具体实施方式
如众所周知的那样，骨盆骨1形成具有一股骨头3关节面的髋窝2，即所谓的髋臼，股骨头3通过股骨颈4形成大腿骨5近体端。覆盖组织7位于体表(皮肤)6与关节之间。自然髋臼2的边缘8形成一个确定切口方向的开口，该方向如图所示地是由点划线9表示的髋臼轴向。在站立姿势下，股骨颈4具有大致与之相同的方向。
如果股骨头3及髋臼2的表面要用假体件取代，则沿一个在点划线10方向上延伸的第一切口25切除并移去股骨头3，该切口25的走向基本上垂直于方向9。
为给上述器械杆提供入口，在方向9上形成第二切口26，然后，一个观察装置15如按照图2所示方式被置于股骨头上。该装置由一框架16及一可调滑架17组成。在其一端上，框架16有一个位于一角架部18内的第一观察孔19。另外，可以设置凸起20来保证其被可靠固定在骨头切除面21上。在可在框架16垂直方向上移动的并可借助一螺钉22被固定在所需位置上的滑架17上，设有一个对准孔19的第二观察孔23。也可以在可调滑架17上设置凸起24，以允许该装置被更好地固定在骨头上。
在所示实施形式中，该装置被设计成夹具的形式。作为取代方式或除此之外，它也可以被设计用于插入一空心钻的骨牵引针。此项技术是已知的。
装置15被用来在股骨中钻孔30，孔30基本上对应于腿放松状态下的髋臼轴向9。孔30起始于内转节区中并且应该大致在切除面21的中心处露出来，从而可随后从该孔开始地在股骨中形成用于接纳股骨假体的洞。器械杆可与这个孔大致同轴地进入髋臼2。
下一阶段涉及使髋臼2准备接纳窝槽假体。这是借助一个由一传统设计的髋臼锉杯36和一支承件37组成的髋臼锉35来完成的，所述支承件37与髋臼锉杯36的边缘牢固相连并且在中心有一个配备有径向插接凸起39的孔38。这形成髋臼锉侧的接合件。
在杆40端上，与凸起39配合的插接槽42设置在与孔38配合的部分41内。当杆40端被插入孔38中并且在扩孔方向上转动时，这些接合部相互接合。由于孔38被一个通向它的漏斗形导向面43包围着，因而部分41被插入孔38中变得更容易了。
为在把髋臼锉头36引入髋臼并在那里使其与杆相连时固定髋臼锉头，它与一个一旦髋臼锉头36与杆40接合在一起就可轻易松开的拉手架45相连。
因此，外科手术医生可以通过使在股骨中的孔30宽到足以允许枢转和垂直于杆轴线地运动或者通过相应定位病人的腿而完全自由地设定锉动方向。
在髋臼2被锉削之后，借助杆40使髋臼锉35抬离该髋臼。该髋臼锉头则离开杆并且可以再次通过第一切口25被取走。为此，可再次使用拉手架45或任何其它器械。
在某些情况下，需要重新加工切除面21(DE-A 3216533)。因而，使用髋臼锉头(未示出)，其锉面指向切除面21并可能具有一与杆40相连的接合孔38。在孔30中引导杆40则保证了重新加工的切除面21相对孔30有理想的定向。如果这个孔因观察装置15而相对其中股骨假体的杆随后要从切除面21上露出的骨头地具有相同方向，则这也保证了切除面相对假体的正确定向。
在完成锉削加工后，借助拉手架45并通过手术切口25插入窝槽定位器具50。在所示例子中，这是一个人工杯，它要被固定在髋臼2中并又接纳一个如由聚乙烯构成的窝槽衬51(见图10)。
一支承件52按照如下所述的方式可松开地与窝槽定位器具相连，并且象髋臼锉35的支架37那样具有一个漏斗形导向面43及一作为接合件的孔53，该孔53设有用于与接合件54相连的螺纹，所述接合件被置于杆55端上并有对应的螺纹。当支承件52及窝槽定位器具与杆55相连时，拉手架45可以被松开。但是，只要拉手架不作用于窝槽定位器具50而是作用于接触支承件52，则不一定要这样做。
现在，窝槽定位器具50借助杆55在所需方向(图5)上被推入髋臼2中。随后，窝槽支承件52离开窝槽定位器具50并且借助杆55被抬离窝槽定位器具50。然后，它可以脱离杆55并且借助拉手架45或另一合适的器械从手术侧经手术切口25被取掉。图7放大示出了拉手架5及它与窝槽定位器具50及相关支承件52配合的示范实施例。拉手架5为U形框架，其分臂45结束于沿彼此相反地外指的钩70处。支承件52有径向对置的对准孔71，钩70在拉手架5被装上的状态下插入这些孔中。窝槽定位器具有一个预计如用于随后接纳窝槽衬件51的锁扣件的环槽72。在钩70端部上有凸起73，这些凸起73在所示的拉手架5装配状态下插入槽72中。通过这种措施，不仅拉手架5与支承件52相连，而且也与窝槽定位器具50牢固相连。
框架5的分臂45通过一扩张器装置74彼此相连，所述扩张装置74由两个其螺纹线走向相反的螺纹销75以及一个有配合螺纹的套76组成。如果在一个方向上使螺纹套76转动，则分臂45被展开。如果朝另一个方向使套76转动，则分臂被拉紧。图7表示展开状态下的支架，其中拉手架与支承件52和窝槽定位器具50牢固相连。如果要使支承件52脱离窝槽定位器具50，则拉手架5的分臂45通过转动螺纹套而略微合拢，从而这些凸起73脱离槽72，但钩70仍然在支承件的孔71中。现在，钩70可以与拉手架分开。在进一步合拢拉手架分臂45时，拉手架也可以脱离该支承件。按照相反的步骤来连接这些部件。
为简单起见，图7的拉手架5如图所示地象是大致在轴77的方向上延伸。而实际上，它是垂直于该轴地延伸，如图8所示的那样。
然而，在如图4、5所示实施例中的接合件54专门作用于支承件52。图6表示一个尤其是在窝槽定位器具50被置于有一螺纹孔53’的底座上时使用的一个替代实施例。支承件52取代螺纹孔53地具有一通孔53”。杆55以一凸缘56压在包围该孔53”的表面上并且给此位置传递将窝槽定位器具50塞入髋臼所需的力。
如果医生怀疑是否已用图4-8所示的器械将人工杯50足够牢固地固定在髋臼2中，则他可以用图9所示的器械继续推入人工杯50。该器械由一杆58及一置于一把手(未示出)上的并有一用于杆58的圆柱形端的接纳孔60的髋臼锉59组成。孔60被一个在这个例子中具有与图3、4所示实施例略微不同的漏斗形的导向面61包围着。它与其中心线(髋臼轴向9)的夹角向着中心减小，结果，杆58的末端离孔60越近，导向作用就越大。髋臼锉59具有一匹配于窝槽定位器具50的内形的球状外形。因此，它可以没有变形危险地将窝槽定位器具50带入髋臼2中。于是，杆58可以简单地从髋臼锉59中抽出并且髋臼锉可以从外科手术区被取走。
根据图10，窝槽衬件51可以被适当地插入窝槽定位器具50中。衬件50例如配备有一使其被牢牢固定在窝槽定位器具中的锁扣机构(如WO 9960955)。因此，为了安装衬件，所要做的就是在髋臼轴向上将其推入窝槽定位器具中。
这是借助一个杆55实现的，该杆在前端(如结合图4所述)有一螺纹段54并且该杆可以与一有对应螺纹孔66及包围该螺纹孔的导向面67的撞击头65连接。撞击头65有一个可以与窝槽衬件51的边缘配合以便将其准确对准窝槽方向的凸起环圈68。如果衬件本身有一个支承在人工杯50边缘上并因而与人工杯50对准的凸起环圈69，则上述情况是不一定必要的。
撞击头65与一拉手架杆80相连。例如，它在81处被可松开地螺纹连接到拉手架杆80上。为了在窝槽衬件51被安全固定在窝槽定位器具50上之前可靠地将窝槽衬件保持在撞击头上，拉手架杆80被一个在朝向撞击头的那端上有一边缘83的并通过一螺钉84与拉手架杆80相连的固定管82包围。通过转动该固定管，固定管可以被拧向及离开拉手架杆，从而借助边缘83把窝槽衬件51固定在髋臼锉65的一终端位置上，或在一拉回位置上松开它。
在衬件51在杯50中被卡接到位后，随着杆55脱离杯并通过手术切口25从外科手术区被取掉，可以撤出撞击头65。

Claims (6)

1、一种用于插入一个髋臼假体的器械组，它有至少一个成形的髋臼件和一个杆(40，55，58)，所述杆要在轴向上与该成形髋臼件相连并且在一端上具有一个要与一在该成形髋臼件上的对应接合件连接的接合件，该器械组有一个垂直于窝槽轴向(9)地并可松开地与该成形髋臼件相连的拉手架(45)，其特征在于，在该成形髋臼件上的接合件被一个把该杆端引向所述接合件的漏斗形导向面(43，61，67)包围着。
2、如权利要求1所述的器械组，其特征在于，在该成形髋臼件上的所述接合件是一个孔(38，53，60，66)。
3、如权利要求1或2所述的器械组，其特征在于，该成形髋臼件是一个窝槽假体(50)的一部分，该导向面设置在一个窝槽支承件(52)上，所述窝槽支承件具有与该成形髋臼件配合的连接装置并且该窝槽支承件与或能与该拉手架相连。
4、如权利要求3所述的器械组，其特征在于，在该成形髋臼件一侧的所述连接装置设置在该窝槽假体(50)的边缘上。
5、如权利要求3所述的器械组，其特征在于，所述连接装置至少部分地由该拉手架(45)构成。
6、如权利要求4所述的器械组，其特征在于，所述连接装置至少部分地由该拉手架(45)构成。
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AU6230801A (en) 2001-12-11
AU2001266002A1 (en) 2001-12-11
JP4372383B2 (ja) 2009-11-25
EP1284690B1 (de) 2007-12-05
DE10026157A1 (de) 2002-02-28
WO2001091673A1 (de) 2001-12-06
EP1284690A1 (de) 2003-02-26
AR032342A1 (es) 2003-11-05
DE50113349D1 (de) 2008-01-17
WO2001091648A1 (de) 2001-12-06
CN1444466A (zh) 2003-09-24
JP2003534096A (ja) 2003-11-18
AR032343A1 (es) 2003-11-05
ES2295167T3 (es) 2008-04-16
AU2001262308B2 (en) 2005-12-15

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