CN1433286A - 外科用手术骨分离装置 - Google Patents

外科用手术骨分离装置 Download PDF

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Publication number
CN1433286A
CN1433286A CN01810719A CN01810719A CN1433286A CN 1433286 A CN1433286 A CN 1433286A CN 01810719 A CN01810719 A CN 01810719A CN 01810719 A CN01810719 A CN 01810719A CN 1433286 A CN1433286 A CN 1433286A
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China
Prior art keywords
parts
magnet
connecting rod
gear
patient
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Granted
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CN01810719A
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English (en)
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CN1263429C (zh
Inventor
G·布伦
J·佩里
H·努尔德恩
J·梅斯瓦尼亚
J·科布
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University College London
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University College London
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Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
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Abstract

提供一种外科用的手术骨分离装置，用于对病人的骨骼或植入物非侵害地施加一个伸长力或张力，该装置包括固定机构，用于将该装置的第一和第二部件附接到一根骨头或毗连的两根骨头上，所述两个部件用一根长度可以伸长的连杆连接，一个磁铁通过一个减速齿轮箱连接在该连杆上，驱动机构安置在病人的外部，用于产生一个移动的或变化的电磁场，由此导致该磁铁转动而该连杆被伸长。

Description

外科用手术骨分离装置
本发明涉及外科用的手术骨分离装置，并以一种形式提供将一个伸长力或张力施加到病人骨骼内的骨头和/或植入物上的一种外科用的手术骨分离装置。
在恶性骨癌的治疗中，常常需要用外科手术切除一部分骨头并用一个假体替代它。在病人为儿童或青少年的情况下，骨骼连续生长，为了适应这种情况，该假体需要不时更换。在减少重新手术的次数的努力中，发展了原位伸长该假体的技术。达到该目的的方法包括在该假体中提供套管式的部件，它们预期在这些部件之间引入近似尺寸的垫片。已用于该目的的装置在《骨外科与关节外科杂志》1997年11月的第79b卷第6期第927～937页的Schindler等人的文献中得到描述。
虽然上述文献中描述的系统对于重复的重新手术是最好的，但它仍然需要不时地也可能是经常地用外科手术接触该假体的一部分，这取决于病人的生长速率。因为所有手术都带有一定的风险，包括引入感染的风险，所以本发明的一个目的是提供一种能够用于非侵害地伸长一个假体的装置。
按照本发明的一个方面，本发明提供一种外科用的手术骨分离装置，用于对病人的骨骼非侵害地施加一个伸长力或张力，该装置包括固定机构，用于将该装置的第一和第二部件附接到一根骨头或毗连的几根骨头上，所述两个部件用一根长度可以变化的连杆连接，一个磁铁通过一个减速齿轮箱连接在该连杆上，一个机构安置在病人的外部，用于产生一个移动的或变化的电磁场，由此导致该磁铁转动而该连杆的长度发生变化。
在实行中，该第一和第二部件及其相关连杆连同该磁铁都利用外科手术引入并固定在一根或几根骨头上，例如当安装一个假体或植入物时。
不时地当该装置需要伸长或拉伸时，在病人身体周围在该假体或植入物的区域内建立一个移动的电场，由此导致该两个部件被强制分开。通常，该磁场被安排成沿连接到该连杆上的该磁铁的所需移动方向而转动。
按照本发明的第二个方面，本发明提供一种可以伸长的内假体的替代装置，该装置包括用一根长度可以伸长的连杆连接的第一和第二部件，该第一部件包括一个肢体关节的部件，而该第二部件具有用于附接到一根部分切除的长骨头上的机构，一个磁铁连接在该连杆上，而一个机构适合于安置在病人的外部，用于产生一个移动的电磁场，由此导致该磁铁转动而该连杆被伸长。
按照本发明的手术骨分离装置具有超过现有方法(如上述文献中描述的)的显著优点，因为它避免了更多外科手术的创伤，减少了感染的风险，减少了手术产生的更多的伤疤组织的出现。而且，该装置可以在一个比外科手术过程中实际可能达到的更长的时期内受到伸长或拉伸。该装置也可以更加渐渐地和更加经常地受到伸长，这诱生一个膨胀或拉力，该力与组织的生长保持同步，并促进组织的生物学的生长。
在该手术骨分离装置的磁铁和可以相对移动的部件之间设置一个减速齿轮箱具有一些重要的优点。首先，它使得能够将一个均匀的延伸力施加到可以伸长的部件上。其次，它使得能够施加足够的力来克服伸长的阻力和抵抗当该骨头加载时装置长度收缩的任何倾向。
虽然按照本发明的装置的一个主要用途是上述文献中描述的假体的定期伸长，但是该装置对许多其它外科目的也是有价值的。其中之一是手术骨分离骨生成。该种治疗涉及拉伸骨头以便促进其生长。常规手续涉及提供一个外部框架(例如围绕一个肢体)，并以一定间隔距离将销钉固定在骨头上。然后在这些销钉之间安装张力杆，以便对该骨头施加一个恒定的张力。这些装置对病人极麻烦而笨重，常使病人难于或不能走路。此外，由于使用经过皮肤的销钉，产生相当大的感染风险。采用本发明的装置，该装置可以用外科手术引入，而那些部件固定在骨头上，并且可以通过将用于产生转动的电磁场的机构放置在被植入的装置的周围而连续地或间歇地施加张力作用。
该装置也具有治疗脊柱弯曲(脊柱侧凸)的用途。在该手续中，该装置的部件将固定在合适的椎骨上或一根肋骨和选定的椎骨上。利用一个外部产生的电磁场来施加手术骨分离力，以克服肢体组织的阻力和连杆的摩擦。该装置的使用不限于对骨头施加而脱位力，而能够以一种改进形式用于对腱的附接，由此能用于(例如)治疗大脑的麻痹。
因此，按照又一方面，本发明提供一种用于校正脊柱弯曲的外科用的手术骨分离装置，该装置包括第一和第二伸长杆，每根伸长杆在一端具有附接机构，用于固定在一根相应的椎骨上，一根连杆用于连接这两根伸长杆，使得带有附接机构的那两个端部可以相对移动，所述连杆连接在一个驱动机构上，该驱动机构包括一个可以转动的磁铁和一个减速齿轮箱，一个驱动机构安置在病人外部，用于产生一个移动的或变化的电磁场，由此导致该磁场转动而一根伸长杆上的附接机构相对于另一根伸长杆上的附接机构移动。
现在参照附图描述本发明的一个实施例，附图中：
图1是安装在一根股骨上并形成股骨假体的一部分的手术骨分离装置的透视图；
图2是表示假体的两个可以相对伸长的部分之间的一根连杆的放大示意图；
图2a是类似于图2但更详细地显示该连杆的图；
图3是齿轮箱的分解图；
图4例示将假体固定在一根骨头上的另一种方法；以及
图5是一种手术骨分离装置的用于校正脊柱弯曲的另一实施例的透视图。
参照附图，该手术骨分离装置包括两个部件，一个组成股骨髋假体的一部分的第一部件(1)和一个可相对移动的部件(2)，股骨髋假体包括一个形成一人造髋关节的球状关节(3)，部件(2)有一个插头(4)，用于固定在部分切除的股骨(5)上。部件(1)和(2)用一个连杆连接在一起，该连杆包括一个细长螺杆(6)和一个螺母(7)。连杆沿箭头X方向的轴向相对移动是利用一个连接在齿轮箱(9)上的可以转动的磁铁(8)来完成的。磁铁(8)通过齿轮箱(9)连接在主轴螺杆(6)上，磁铁(8)的转动导致螺杆转动，并因而导致该装置伸长。
磁铁的转动是通过在肢体周围放置一个电磁线圈(10)并产生一个移动的电场来完成的。磁铁设计成使得该移动的电场引导磁铁沿所要方向转动，从而导致装置伸长，磁铁和电磁线圈一起构成一个电马达。通常该电磁线圈采取一个线圈环的环状，它可以合并或埋置在一种磁性敏感材料(如软铁)中，该环的尺寸做成适合安放在包含该可伸长的手术骨分离装置的肢体周围。
该齿轮箱是一个高减速比齿轮箱，它可以具有一个几百量级的减速比，如约500。该减速比、磁铁转速和螺杆间距最好选择为转子一圈将推进螺杆百分之一毫米，例如0.001～0.01mm，通常约0.005mm。病人的腿可以长时间保持在该电磁线圈中，例如1～2小时，取决于伸长量或所需手术骨分离力的长度。
在一个伸长假体的手续中，人们通常希望每个阶段伸长假体5～6mm。该手术骨分离力应当使得它能克服连杆内的摩擦和假体周围软组织产生的阻力。
图3显示齿轮箱的细节。该齿轮箱包括两个行星齿轮并密封在一个外壳中，以防止体液渗入。图示的部件除部件(12)和部件(26)外全用不锈钢制成，部件(12)用钛合金制成，部件(26)用钴铬合金制成。
齿轮箱和磁铁组件设计在安装在连杆组件下端的一个室(201)中(见图2a)。
标号(11)表示一个轴向轴杆，其上有驱动磁铁转动。轴杆(11)的下端形成一个尖端，使得该轴杆被引入端帽中的一个凹口内(202，见图2a)。部件(12)是一个容纳永久磁铁(8)的壳体。该永久磁铁最好通过一个烧结工艺制成，具有环状并配装在一个联锁的环形盒(12)中，以保证磁铁在盒中不会转动。
在焊接入盒(12)中以后，该磁铁用一个其方向平行于盒(12)的直径的磁场磁化。部件(13)是到达齿轮箱第一级上的输入小齿轮。该小齿轮钻孔，配装在轴杆(11)上并能自由运行，并有一个联锁在盒(12)中的平面凸台。部件(14)和(17)作为插头和插座配装在一起，形成一个行星承载架组件，而行星齿轮(16)配装在该承载架组件中。每个齿轮级有三个相同的行星齿轮，它们装入承载架组件中，每个行星齿轮加工成在每端有一小的整体短轴。这两个短轴安置在每半个承载架组件的孔内。
部件(15)和(22)分别是第一和第二减速级的固定的内齿轮。这些齿轮每个啮合一组行星齿轮的面宽度的近似一半，并固定在齿轮箱的主体中。行星齿轮的剩余的一半与转动的内齿轮(18)啮合。与固定的内齿轮(15)中的齿数相比较的转动的内齿轮(18)中的齿数的减少提供该级的减速。齿数的较大数目的减少提供一个利用最少数目的齿轮和最小空间的较大减速。部件(18)、(19)和(20)组成一个组件，该组件将齿轮传动装置的第一级来的输出传递给第二级的输入。该组件包括一个齿轮腹板部件(19)，该部件(19)焊接在齿轮传动装置的第一级的转动的内齿轮和第二级的输入小齿轮两者上。
部件(21)、(22)、(23)、(24)和(25)包括用于第二级的固定内齿轮和行星齿轮和承载架组件。这些部件与齿轮传动装置的第一级的部件(14)、(15)、(16)、(17)和(18)相同。
部件(25)是齿轮传动装置的第二级的转动的内齿轮并焊接在部件(26)上，部件(26)是齿轮箱的输出轴。该输出轴通过图1、2和2a中示出的O形环密封件(203)而驱动螺杆(6)。
部件(26)是一个插头，配装在部件(25)中加工的插孔中，使得当准备焊接时该组件是自己卡紧的。部件(18)和(19)的情况也是如此配置的。
部件(26)有一个短插头，安置在承载架(24)的一面中的一个孔内。该插头的目的是保证行星承载架精确地位于机械的中心，部件(19)上设置了一个相似的插头，以便给第一级行星承载架定中心。
部件(26)的上表面有一个输出轴(27)，该轴(27)的端部为合适形状的驱动凸出部，啮合在导引螺杆(6)中。螺杆(6)螺纹式地安装在内轴(7)中。外轴(2)围绕内轴(7)，使得当导引螺杆(6)受到通过减速齿轮箱驱动的磁铁(8)转动时，内轴伸出外轴(2)。内轴(7)利用键(204)防止转动，键(204)固定在外轴(7)中的一个相应的孔中。键(204)有一个凸出部分，该凸出部分伸入内轴(7)中形成的长槽(205)中。
该装置可以包括一个整体结合的或分离的传感器，该传感器对磁铁(8)的旋转圈数计数，使得该装置的伸长程度可以受到监控和/或记录。
图4例示将该装置的一个部件固定在一根长骨上的另一种方法，该法形成提高的稳定性和骨头整体性。可以看到，假体的管状体(2)利用两个或多个从该管状体伸出的盘状条(401)固定在一个部分切除的骨头(5)上。这些盘状条有孔，以安装有单层外皮的螺钉(402)，从而将这些盘状条固定在骨头的外表面上。这些盘状条有长孔(403)以促使骨头向内生长，并除有一种晶状羟磷灰石涂层，以促使与骨头结合为整体。
图5表示一种适合于治疗脊柱弯曲的手术骨分离装置。在该实施例中，螺杆(501)和(502)设有附接机构(503)，如带螺钉或钩子的板或块体。取决于脊柱的弯曲度，螺杆(501)可以是直的或弯的。该附接机构可以包括一个连接在这些螺杆上的万向轴承或接头，使得附接机构能够考虑到脊柱的弯曲或变形而转动或旋转，并能牢固地附接在合适的椎骨上。
这两个螺杆用一个中央间隔件或块体(504)联结。块体(504)可以通过附接在脊柱上而变稳定，例如使用螺钉或钩子来附接。块体(504)包括一个由如图1～3中描述的可转动的磁铁和减速齿轮箱组成的驱动机构。但是，最终的驱动部件包括一个由输出轴承载的轮齿。该轮齿连接在两个由该轮齿转动的蜗杆驱动器上。在一个配置中，这两个蜗杆串联排列，使得它们沿相反方向受到驱动。在另一个配置中，这两个蜗杆可以排列成沿相同方向受到驱动。也可以使用单个蜗杆或两个或多个蜗杆的多重蜗杆驱动器来将该轮齿连接到螺杆上。每个蜗杆是圆柱形的并有一个中心螺纹钻孔。一个相应的螺杆(502)安装在该蜗杆内，螺杆上的螺纹与蜗杆内表面上的螺纹啮合。当蜗杆受轮齿转动时，螺杆也转动并沿螺杆纵向移动。螺杆的移动方向取决于互相配合的螺纹的指向，并取决于传递磁铁转动的蜗杆和齿轮的配置。以一种与图1～4中描述的配置相似的方式，利用一个围绕病人脊柱部位的外部环形线圈产生一个转动的电场。

Claims (14)

1.一种外科用的手术骨分离装置，用于对病人的骨骼或植入物非侵害地施加一个伸长力或张力，该装置包括固定机构，用于将该装置的第一和第二部件附接到一根骨头或毗连的数根骨头上，所述部件用一根长度可以伸长的连杆连接，一个磁铁通过一个减速齿轮箱连接在该连杆上，驱动机构安置在病人的外部，用于产生一个移动的或变化的电磁场，由此导致该磁铁转动而使该连杆伸长。
2.一种按照权利要求1所述的装置，其特征在于，该驱动机构适合于产生一个转动的磁场，该转动的磁场沿所需的磁铁转动方向转动。
3.一种按照权利要求1或2所述的装置，其特征在于，该连杆包括一个螺杆和螺母，而该磁铁通过该齿轮箱连接在该螺杆或螺母上，以产生相对转动，由此伸长该装置。
4.一种按照上述权利要求中任何一项所述的装置，其特征在于，在几个齿轮之间的齿数不同，由此按照齿轮数目和空间产生减速。
5.一种按照上述权利要求中任何一项所述的装置，其特征在于，该齿轮箱具有100∶1至1000∶1的传动比。
6.一种按照上述权利要求中任何一项所述的装置，其特征在于，该两个部件是用于固定在一根长骨头上的一个假体的两个部件。
7.一种按照权利要求6所述的装置，其特征在于，该长骨头是一根股骨。
8.一种可以伸长的内假体的替代装置，该装置包括用一根长度可以伸长的连杆连接的第一和第二部件，该第一部件包括一个肢体关节的部件，而该第二部件具有用于附接到一根部分切除的长骨头上的机构，一个磁铁连接在该连杆上，而一个机构适合于安置在病人的外部，用于产生一个移动的电磁场，由此使该磁铁转动而该连杆伸长。
9.一种按照权利要求8所述的装置，其特征在于，该磁铁是通过一个减速齿轮箱连接在该连杆上的。
10.一种按照权利要求8或9所述的装置，其特征在于，该第一部件包括一个髋或膝头节的部件。
11.一种按照权利要求8或10中任何一项所述的装置，其特征在于，该第二部件包括一个插头，适合于固定在一根长骨头的中间管腔中。
12.一种用于校正脊柱弯曲的外科用的手术骨分离装置，该装置包括第一和第二伸长杆，每根伸长杆在一端具有附接机构，用于固定在一根相应的椎骨上；一根连杆用于连接这些伸长杆，使得带有附接机构的那些个端部可以相对移动，所述连杆连接在一个驱动机构上，该驱动机构包括一个可以转动的磁铁和一个减速齿轮箱以及一个安置在病人外部的驱动机构，用于产生一个移动的或变化的电磁场，由此使该磁铁转动从而使一根伸长杆上的附接机构相对于另一根伸长杆上的附接机构移动。
13.一种按照上述权利要求中任何一项所述的装置，其特征在于，该驱动机构被配置成产生一个沿所需的磁铁转动方向转动的转动磁场。
14.一种按照权利要求12或13所述的装置，其特征在于，该连杆包括一个与一蜗杆啮合的驱动轮齿，该蜗杆围绕一根杆旋转，使得蜗杆的移动导致该杆沿其纵向伸长。
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