CN1273520A - 主轴线假体关节构造 - Google Patents

主轴线假体关节构造 Download PDF

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Publication number
CN1273520A
CN1273520A CN99801100A CN99801100A CN1273520A CN 1273520 A CN1273520 A CN 1273520A CN 99801100 A CN99801100 A CN 99801100A CN 99801100 A CN99801100 A CN 99801100A CN 1273520 A CN1273520 A CN 1273520A
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joint
bearing
ring member
inner ring
cycle component
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阿蒂拉·马迪
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Individual
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  • Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Animal Behavior & Ethology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Surgery (AREA)
  • Zoology (AREA)
  • Wood Science & Technology (AREA)
  • Prostheses (AREA)

Abstract

本发明提供了一种用于植入受治疗者内的人造关节,包括一个与固定装置(50)连接的外圈(10),固定装置(50)用于把外圈(10)固着在现有关节臼窝内。一个内圈构件(30)处于外圈(10)内并且一个第一轴承构件(21)并列置于其间。第一轴承构件(21)的法向轴线与正交于关节最频运动轴线的转动中心紧密一致。轴承部件(21)安装得与支持在主轴线上的部件匹配。第二轴承构件(22)可以设在内圈构件(30)和外圈构件(10)之间,外圈构件(10)约束关节在使用中产生的力,并把力集中在第一轴承构件(21)上。

Description

主轴线假体关节构造
本发明涉及人造关节，更具体地，涉及替换人及其它动物的人造关节。
任何动物的骨髂关节病残都可致残甚至致命。关节病残可源于疾病、外伤或者磨损。为了代偿关节的失常功能，动物往往改变其行为，包括运动恣势和运动模式。这些适应措施成效有限，并且常仅仅以不适当地把负荷分布在其它的骨髂和肌肉部分上来减轻损坏关节上的负荷。这种有害的代偿往往会在其它易损部位引起继发性的创伤病残。
移植的关节假体的显著进步基本上是本世纪中叶才开始的。尽管在外科技术、假体材料和治疗上有了很大的进步，但人造关节的使用寿命还是很有限。一般地，使用寿命取决于关节修复或者说替换术的复杂性、假体关节装置的构造，以及患者的重量和年龄。例如，一般的髋关节植入体可持续八到十二年。人造膝关节的使用寿命还要短。
现有的人造关节除了使用寿命不长之外，植入关节假体的手术还特别具有侵害性。例如，髋关节替换术往往需要住院达两周、还要有几个月的康复期。花费可超过四万美元。因此从使用寿命短、花费高两方面及患者的罹病率的角度上，关节替换术只有在不得不为之时才进行。以此方式延迟手术会对其他健康的组织造成损伤，并给患者带来不必要的疼痛。
迄今已经开发出了各种球窝关节(臼杵关节)的人造替换品。对于人类的髋关节替换，几种很相近的构造已经在业内成为标准。这些假体不论在构造上还是在植入上都遵循同样的基本原则。在传统的髋关节替换术中，先要在患者的髋窝中坎入人造臼窝。髋窝是髂骨、坐骨和耻骨的交会处；是一个容纳股骨头的天然的臼或者说窝，为厚厚的韧带关节软骨覆盖的四分之三球形。如果需要，然后把替换的球头部件连接在股骨上并插入到人造臼窝中。有些病例中可以保留患者的天然股骨头。
为把球头保持在臼窝中，已经开发出了数种不同的构造。最常用的方法是用患者的肌肉、肌健和韧带把球头保持在臼窝内，本文称之为＂半约束＂结构。在这些构造中，采用半球形的臼窝容纳球头并允许连接的股骨大范围运动。在安装半约束关节时，尽可能地把球窝与患者的自然解剖匹配是至关重要的。这是要保证患者的运动不会造成球头从关节脱臼。
在这种半约束结构中，为了增加稳定性和避免术后脱臼，在半球形臼窝中附加一个圆柱部分，以加深臼窝。球头不受臼窝的物理约束，但是比仅采用半球形要活动得多。此类球窝关节一般地提供一个约115度的运动弧度或者说运动范围。
有报导说采用半约束结构的关节植入术脱臼率低于5％。尽管脱臼率低是重要的，但因为脱臼可以使患者失动，并且可能需要再次手术。如再次手术，半约束结构所要求的关键性匹配甚至更为困难。因此，再次手术的脱臼率会更高。
作为半约束结构的变种的是球头受臼窝物理约束的结构。这种结构中，球形轴承包绕球头而起臼窝作用。轴承包绕球头的一半以上从而约束球头和股骨部分不脱臼。这类人造关节的滑动轴承一般地由高密度聚乙烯之类的塑料或者金属制造。轴承把球头包绕得越多，股骨部分与轴承接触前的运动范围越小。人们发现，在连接球头的干骨颈撞击轴承边缘时会产生致脱臼的力。因为在股骨部分接触轴承的边缘时与产生脱臼力的股骨纵向相关的杠杆作用会很重要。由于所涉及的显著的杠杆作用，作用在患者腿上相对小的力可以产生数百磅的脱臼力。因此，应当以半约束构造时避免脱臼的相同的方式避免脱臼力，换言之，通过把人造关节与患者自然解剖匹配来避免。
人们发现，有这种约束结构的人造髋由于杠杆作用造成的脱臼低于进行植入的0.5％。这个几率显著强于对半约束植入所报导的几率，但是，当然希望有更低的脱臼率。
除了脱臼的可能之外，人造关节替换的另一个问题归结于假体部件的变质。例如，时间长了以后塑料轴承会磨损。与此磨损相伴随，关节的术后使用引起的摩擦和应力常产生逐步造成并促进关节病残的微粒。这种变质常常产生显著的疼痛和对周围组织的损伤。一般地，伴随人造关节磨损的周围组织的变质，尤其是骨密质的变质，使续后的植入更加困难，更不易得到成功的结果。
现有的人造关节的一个基本的构造问题是假体工程师企图用人造材料再造、复制天然关节。可惜，人造材料还不能与其天然的、活的对手旗鼓相当。它们不能干得同样好，并因为没有自我修复能力更快地损坏。
因此本发明的目的是提供一种人造关节，它通过降低摩擦力和增加关节的强度为患者供应结实耐用的替换假体，从而它能为患者使用终身。
本发明的另一个目的是提供一种能够防止脱臼而不牺牲运动范围的人造关节。
本发明的又一个目的是提供一种人造关节，它加强了振动吸收和传导性能，使患者用得更加舒适。
本发明的再一个目的是提供一种人造关节，它与现有的关节假体相比，使外科医生在外科植入术中能得到更大的几何位置自由度。
本发明通过提供以根本上脱离在先的设计观念为基础的新颖的人造关节设计来实现上述目的及其它的目的和优点。
本文公开的发明不是力图模仿自然关节，而是提供独一无二的人造材料构成的工程假体，它不照猫画虎地模仿自然关节，但是能够适应植入受治疗者的解剖约束。
具体地，本发明提供一种假体关节装置，用于植入受治疗动物进行关节替换治疗，它包括一个其尺寸和构造可以植入在关节臼窝部分内的外圈构件。此外圈构件界定一个容纳轴承组件的腔并与把外圈构件固定在所述关节的臼窝部分内的固着装置相连接。包括在关节植入件内的还有一个轴承组件，它含有一个寓于外圈构件的腔内的内圈构件，并至少包括一个可转动地插入外圈构件和内圈构件之间的第一轴承装置。内圈再界定一个其尺寸和构造能够容纳关节的球头部分的假体臼窝。第一轴承装置的构成和定位使之能够自由地绕所述关节的主轴线旋转。在本发明的优选实施例中，假体关节装置还包括可转动地插在外圈构件和内圈构件之间的第二轴承装置，第二轴承装置优选地起集中由荷运动产生的力的作用，并且为把第一轴承装置约束为理想地绕正常轴承轴线旋转提供低磨擦力的手段。
应当理解，上述的一般说明和下文的详细说明和解释当然都只是解说性的，并不限制本发明。构成本说明书的一部分的附图表示本发明的优选实施例，并配合说明起解释本发明的原理的作用。
图1表示一个天然的人体髋关节。
图2表示一个植入人体髋关节的常规关节假体。
图3表示一个关节假体，它示出了植入人体髋关节的本发明构思。
图4为表示示范本发明构思的关节假体的组装轴承组件的剖面图。
图5表示示范本发明构思的关节假体的组装轴承组件的分解的剖面图。
为方便以下的说明，图1表示天然的人体髋部的基本解剖。股骨头连接在髋臼上并由围绕此关节的韧带和肌肉约束在自然的臼窝内。髋臼内覆极为光滑的软骨，软骨由通过此关节中心的血管来供给营养。在传统的人造髋替换中，软骨被去除，并铰除自然臼窝以容纳人造臼窝。如图2所示，在铰除了的髋窝内用水门汀、螺丝或者其它的固着装置连接了一个不锈钢臼。不锈钢是人造关臼窝部件最常用的材料，尽管也采用陶瓷及其它材料。在臼窝内放置一个滑动轴承，此轴承要把股骨部件约束在臼窝内，并且要模仿原有软骨的润滑作用。该滑动轴承最常采用高密度聚乙烯制做，并且支持各种运动范围的运动。
如上所述，本发明彻底脱离在先技术的人造关节结构。不去模仿自然的人体髋，本发明提供附加的机械元件来解决在先的关节假体的多个问题和局限性。为了解说本发明的基本构思，图3提供了一个植入人体髋内的示例性假体的示意图。如在先技术的人造关节构造的情况，臼窝部件固定在半约束结构的关节臼窝部(例如髋窝的铰除的臼窝部分)内。
然而，在本发明中，臼窝件部分包括一个尺寸做得可以植入在臼窝构件(例如，髋窝或者肩关节的损坏的或者人造地使之外翻的臼窝)内。为把外圈构件固定在自然关节臼窝内，设有固定装置把外圈构件固着在患者关节臼窝内。固定装置优选地含有常规的定位销，定位销穿经外圈构件的定位销槽50，并把它固定在臼窝中。另外，可以设想水门汀和其它的固定装置达到此目的。
外圈构件10界定一个容纳轴承组件12的腔11。轴承组件优选地包含一个寓于此腔中的内圈构件30，和可转动地插在外圈构件和内圈构件之间的第一轴承装置21。
内圈构件30界定一个假体臼窝31，它的尺寸做得可以容纳关节的球头部分，例如自然或者人造的股骨头60，或者肱骨头。重要地，第一轴承装置21构造并放置得能够自由地绕相应于关节的主负荷支承轴线的主轴线转动。在人体髋的情况下，大约99％的负荷运动沿关节运动的前/后轴线，因此此轴线就构成了主轴线。这也是人体肩关节的情况。正确的放置和构成第一轴承装置21以绕髋关节的主轴线转动示于图中(见图4和图5)。然而在本发明范围内，在其它的假体关节中放置和构成第一轴承装置将不同，这可被本行业技术人员按照本文容易地理解和常规地设计，以达到绕主负荷支承轴线自由地运动。一般地，第一轴承装置21相对于外圈构件10和内圈构件30选择和放置，从而，此轴承的法向(或者定义)轴线尽可能地与对着，或者正交于关节的最频运动轴线的转动中心一致。
图4中的组装关节说明本发明的一个附加部件，它是一个把内圈30紧贴地保持寓于外圈10中的保持装置40。如同在固着装置50的情况，可以用各种保持装置和构造来达到此作用。在本发明的优选方面，此保持装置为卡环形式，此环经棘爪配合或者螺丝，例如通过采用位在沿外圈内周和卡环外周的匹配螺纹(图4)，固定在于外圈内。
在本发明的优选实施例中，假体关节还包含一个缓冲装置，优选地包含一个第二轴承装置22，它可转动地插在内圈构件30和外圈构件10或者卡环40之间。在图4和5所示的实施例中，缓冲装置包含第二轴承装置，它构造和放置得集中负荷运动产生的力，并提供约束第一轴承装置21以理想地绕其正常支承轴线转动的低磨擦装置。在此实施例中，保持装置40约束第二轴承装置22(例如，滚珠轴承)于卡环和内圈30结合成的轴承壳内。这使轴承能够自由转动并起集中关节使用时产生的力的装置的作用。
在图5所绘的本发明的更详细的方面，外圈10提供一个腔11，它特别适于使槽66起容纳轴承座20的作用。此腔还造型得与轴承组件12的其它部件相符合，包括第一轴承装置21(例如滚针轴承)和内圈30，以及造型得容纳保持装置40。轴承座20为常规的滚针轴承座的形式并负责正确地分离和保持各个滚针。
除了上述的假体关节装置外，本发明还提供替换受治疗动物的损坏的关节的方法。此方法遵从常规的关节替换术，这里，把上述人造关节装置植入在患者损坏的关节中。
在本发明的优选实施例中，上述轴承组件的特点是滚针轴承作为装在常规的轴承座20中的第一轴承装置21，如图4和5所示。此外，在优选实施例中，标准滚珠轴承作为第二轴承装置22，处于内圈30的周向槽36中。在本发明的更优选的方面，轴承组件12的滚针轴承是带梢度的滚针止推轴承，支承主轴线上的负荷。此滚针轴承优选地由外科等级不锈钢，或者类似的坚硬耐用物质制造。
采用负荷的钢制防磨擦轴承，运动与主轴线一致，可以大大地降低磨擦力，进行无微粒的运转，达到可忽略的磨损，并有可能耐用终身。此类滚针轴承可以高频运转几千万转，并且峰值负荷可以远超过人或其它动物受治疗者正常使用中会经受的负荷。
尽管上述发明通过图解和举例详加说明以达到清楚理解的目的，应当理解，在所附权利要求书的范畴内可以进行某些变化和修改。因此，按照上述公开，本发明不局限于本文的举例、说明和附图，而是由所附权利要求书确定。

Claims (6)

1.一种用于植入受治疗动物中以进行关节替换的假体关节装置，包括：
一个其尺寸和构造可以植入在所述关节臼窝部分内的外圈构件，此外圈构件界定一个容纳一轴承组件的腔；把所述外圈构件固定在所述关节的所述臼窝部分内的固着装置；一个轴承组件，该组件含有一个寓于所述腔内的内圈构件和可转动地插在所述外圈构件和所述内圈构件之间的第一轴承装置，所述内圈构件界定一个其尺寸和构造能够容纳所述关节的球头部分的假体臼窝；其中，所述第一轴承装置的构成和定位使之能够自由地绕所述关节的主轴线旋转。
2.权利要求1所述的假体关节装置，还包括可转动地插入在所述外圈构件和所述内圈构件之间的第二轴承装置。
3.权利要求2所述的假体关节装置，其中，第二轴承装置构造和放置得集中由有荷运动产生的力，并且为把所述第一轴承装置约束为理想地绕法向轴承轴线旋转提供低磨擦力的手段。
4.一种替换受治疗动物关节的方法，包括以下步骤：
在所述患者的损坏关节中植入一种假体关节装置，它包含：一个其尺寸和构造可以植入在所述关节臼窝部分内的外圈构件，此外圈构件界定一个容纳一轴承组件的腔；把所述外圈构件固定在所述关节的所述臼窝部分内的固着装置；一个轴承组件，它含有一个寓于所述腔内的内圈构件和可转动地插在所述外圈构件和所述内圈构件之间的第一轴承装置，所述内圈构件界定一个其尺寸和构造能够容纳所述关节的球头部分的假体臼窝；其中，所述第一轴承装置的构成和定位使之能够自由地绕相应于所述关节的主负荷支承轴线的一主轴线旋转。
5.权利要求4所述的方法，其中，所述假体关节装置还包括可转动地插入在所述外圈构件和所述内圈构件之间的第二轴承装置。
6.权利要求5所述的方法，其中，所述第二轴承装置构造和放置得用于集中由有荷运动产生的力，并且为把所述第一轴承装置约束为理想地绕法向轴承轴线旋转提供低磨擦力的手段。
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AU3514399A (en) 1999-11-29

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