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CN1728976A - Minimally invasive joint implant with 3-dimensional geometry matching the articular surfaces - Google Patents

Minimally invasive joint implant with 3-dimensional geometry matching the articular surfaces Download PDF

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CN1728976A
CN1728976A CN 200380103843 CN200380103843A CN1728976A CN 1728976 A CN1728976 A CN 1728976A CN 200380103843 CN200380103843 CN 200380103843 CN 200380103843 A CN200380103843 A CN 200380103843A CN 1728976 A CN1728976 A CN 1728976A
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geometry
invasive
surfaces
joint
articular
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CN 200380103843
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Chinese (zh)
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菲利普·兰
丹尼尔·斯泰尼斯
哈赛因·博阿迪
大卫·米勒
巴里·J·林德
塞斯丽·安妮·施奈德
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康复米斯公司
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Abstract

本发明针对矫形植入物和系统。 The present invention is directed to systems and orthopedic implants. 本发明也涉及植入物的设计、制造、成型和植入方法,以及外科手术工具及其中所使用的套件。 The present invention also relates to a kit implant design, manufacture, shaping and implantation methods, and surgical tools and used. 通过分析待矫正关节表面并创造解剖或近解剖匹配装置而设计所述植入物;或选择一具有使所述植入物最佳匹配现有缺损特性的预先设计植入物。 By analyzing the articular surface to be corrected and to create an anatomical or near anatomic match the implant apparatus designed; or select a best match with the implant prior defect characteristics thereof predesigned implant.

Description

具有与关节表面相匹配的三维几何结构的微创关节植入物 Articular surface having a three-dimensional geometry that matches the minimally invasive joint implants

技术领域 FIELD

本发明针对矫形植入物和系统。 The present invention is directed to systems and orthopedic implants. 所述植入物可为关节植入物和/或插补关节植入物。 The implant can implant and / or implant articular joint interpolation. 本发明也涉及设计、制造、模制和植入植入物的方法以及随其使用的外科工具和套件。 The present invention also relates to a method of designing, manufacturing, molding and the implant and the implant with a surgical tool kit and its use. 本发明也涉及可对关节镜插入和轮廓改变进行修正的可自行扩展的矫形植入物。 The present invention also relates to self-expand to the orthopedic implant may be inserted and arthroscopic contour correcting changes. 最后,本发明涉及经定形以致所述植入物重建正常或接近正常的三维(3D)关节几何结构或排列和促进关节运动的关节植入物,所述促进关节运动超过关节运动的正常范围的60%到99.9%,且在活动期间能够承受高达施加关节的于正常剪切力的100%。 Finally, the present invention relates to shaping the implant such that normal or near normal reconstruction of three-dimensional (3D) and the joint geometry or arrangement to promote articulation joint implant, to promote articulation of the articulation exceeds the normal range 60% to 99.9%, during the event and be able to withstand the normal 100% higher shear Da Shijia joint.

背景技术 Background technique

存在多种类型的软骨,例如,透明软骨和纤维软骨。 There are various types of cartilage, e.g., hyaline cartilage and fibrocartilage. 透明软骨存在于骨骼的关节表面(例如,在关节中),负责提供运动关节的光滑流畅的活动特征。 Hyaline cartilage is present in the articular surface of the bone (e.g., in joints), is responsible for providing a smooth fluid motion activity characteristics of the joint. 考虑取决于关节的变化且特定言之在关节内的位置,关节软骨被牢牢地连接到其下的骨骼,并测得在人类关节中的厚度一般小于5mm。 Considered depends on the variation of the joint and in particular words within the joint position of the articular cartilage which is firmly connected to the bone, and the thickness was measured in human joint is generally less than 5mm. 另外,关节软骨为无神经、无血管、和无淋巴液(alymphatic)。 In addition, articular cartilage is no nerve, avascular, and no lymph (alymphatic). 在成人中,软骨通过双扩散系统经由滑膜和软骨的稠密细胞间质向存在于软骨结缔组织中的软骨细胞输送营养。 In adults, cartilage nutrition by a double diffusion transport system present in the connective tissue of cartilage chondrocytes via synovial cells and cartilage between dense mass.

成人软骨修复能力有限,因此,由如风湿性关节炎和/或骨关节炎的疾病或外伤产生的对软骨损伤可导致严重的身体残疾和衰弱。 Limited adult cartilage repair capacity, and therefore by such as rheumatoid arthritis and / or osteoarthritis disease or trauma resulting cartilage damage can lead to severe physical disability and debilitating. 此外,随着人的关节软骨变老,其拉伸性能发生改变。 Also, as people get older articular cartilage its tensile properties change. 因此,随着时间的过去,由于不断老化,成人的软骨的拉伸刚性和力量明显减小了。 Thus, over time, due to the aging, adult cartilage stiffness and tensile strength significantly reduced.

例如,直到生命的第三个十年,膝关节软骨的表面区域呈现拉伸力量增大,在生命的第三个十年之后,当在关节表面发生II型胶原质的可察觉损时,拉伸力量随着老化明显地减少。 For example, until the third decade of life, the surface area of ​​the knee articular cartilage exhibits increased tensile strength, after the third decade of life, when the occurrence of type II collagen in articular surface perceptible loss, pull extensor strength with aging is significantly reduced. 尽管胶原质含量不出现减少,但随着年龄的增大深区软骨出现拉伸力量逐渐减小。 Although collagen content does not appear to reduce, but with the increase of the deep zone cartilage aged tensile strength occurs gradually decreases. 所述观察指示随着老化软骨机械和由此结构组织发生改变,如果充分发展,软骨会出现创伤损伤。 The observation indicates cartilage with aging, and thereby the mechanical structure of the organization change, if fully developed, cartilage traumatic injuries occur.

通常,通过使用修复材料,例如,如用于美容修复的硅树脂或适当的金属合金替代关节来治疗软骨的重度损伤或缺损。 Typically, by using the repair material, such as silicone for cosmetic repair or metal alloy suitable alternative for the treatment of articular cartilage damage or severe defects. 见,例如2002年5月7日颁发的Schmotzer的美国专利申请案第6,383,228号;2001年3月20日颁发的Afriat等人的美国专利申请案第6,203,576号;2000年10月3日颁发的Ateshian等人的美国专利申请案第6,126,690号。 See, for example, US patent application Schmotzer 2002 May 7 issued No. 6,383,228; US Patent No. 6,203,576, 2001 March 20 issued Afriat, et al; 2000 October 3 issued Ateshian US Patent No. 6,126,690 and others. 所述修复装置的植入通常涉及下组织和股骨缺损,而未包括恢复原始软骨的全部功能,且使用某些装置,与组织和骨骼的大量缺损相关的严重的长期并发症可包括感染、骨质溶解以及植入物的松动。 Implanting the prosthetic device usually involving tissue and femoral defects, including but not all of the functions to restore the original cartilage, and the use of some devices, serious long-term complications associated with a large number of defective tissue and bone can include infection, bone mass dissolved and implant loosening thereof.

应了解关节造形术创伤大且需要外科手术切除修复中包括的一个或一个以上的骨骼的关节表面的整体的或大多数。 It should be understood arthroplasty and trauma require surgical removal of the whole or most of the repair included in one or more of the articular surface of the bone. 通常在所述程序中需要刮除相当大面积的髓隙以将假体的杆装配于骨骼内。 Typically requires scraping the relatively large area of ​​the program in the marrow space of the prosthesis stem to fit within the bone. 刮除导致患者的骨存量的缺损,且随着时间的过去,骨质溶解将频繁地导致假体松动。 Stock cause bone scraping the patient's defect, and over time, osteolysis will frequently lead to loosening of the prosthesis. 另外,随着时间的过去植入物和骨骼匹配处的区域退化,最终需要用假体置换。 In addition, over the implant and bone area at the time of the match degenerate, eventually need replacement with a prosthesis. 因为患者的骨存量有限,所以可能的置换术的数量也受限于关节造形术。 Because the patient's bone stock is limited, so the number of possible replacement is also limited arthroplasty. 简言之,15到20年病程以上,在某些情况下甚至更短的时期,患者会用完治疗选项,最终导致关节疼痛、无功能。 In short, over the course of 15-20 years, and in some cases even shorter period of time, the patient will run out of treatment options, eventually leading to joint pain, no function.

也已将以细胞(例如,软骨细胞、软骨细胞祖细胞、基质细胞、间叶细胞干细胞等)植入的基质、组织骨架或其它载体的用途描述为用于软骨修复的潜在的治疗。 It will also have cells (e.g., chondrocytes, chondrocyte progenitors, stromal cells, mesenchymal stem cells, etc.) use of a matrix implant, tissue scaffold, or other carriers described as a potential treatment for cartilage repair. 又见,1999年10月14日颁发的Fofonoff的国际公开案WO 99/51719;2001年12月6日颁发的Simon等人的WO 01/91672;和2001年3月15日颁发的Mansmann的WO 01/17463;和2001年9月4日颁发的Vibe-Hansen等人的美国专利申请案第6,283,980B1号;1998年12月1日颁发的Naughton等人的5,842,477;1998年6月23日的Schwartz颁发的5,769,899;1986年9月2日颁发的Caplan等人的4,609,551;1991年8月20日颁发的Vacanti等人的5,041,138;1993年3月30日颁发的Caplan等人的5,197,985;1993年7月13日颁发的Caplan等人的5,226,914;2001年12月11日颁发的Hardwick等人的6,328,765;2001年8月28日颁发的Rueger等人的6,281,195;和1989年7月11日颁发的Grande的4,846,835。 See also International Publication, 1999 October 14 issued Fofonoff of WO 99/51719; December 6, 2001 issued by Simon et al. WO 01/91672; and March 15, 2001 issued Mansmann of WO US Patent No. 6,283,980B1 and September 4, 2001 issue of Vibe-Hansen, et al.;; 01/17463 December 1, 1998 issued by Naughton, et al. 5,842,477; Schwartz, 1998 June 23 of 5,769,899 issued; September 2, 1986 issued by Caplan et al 4,609,551; August 20, 1991 issued Vacanti, et al. 5,041,138; 1993 March 30 issued Caplan et al, 5,197,985; July 1993 6,281,195 2001 August 28 issued Rueger et al;; on the 13th issued Caplan et al, 5,226,914; 2001 December 11 issued Hardwick et al, 6,328,765 and July 11, 1989 issued Grande of 4,846,835 . 然而,因为大多数生物替代材料不能实现与欲置换的正常无病人体组织类似或相同的形态学上的排列或结构,所以如同种异体移植和自体移植系统和组织骨架等生物置换材料的临床结果尚未确定,。 However, since the arrangement or structure similar to or identical morphologically normal tissue without the patient most organisms can not be achieved with alternative materials to be replaced, so as allograft and autograft systems and tissue scaffold biological replacement material clinical results not sure yet,. 然而,所述生物替代材料的机械耐久性仍未确定。 However, the mechanical durability of biological substitute materials remains uncertain.

2001年3月21日颁发的Fell等人的美国专利申请案第6,206,927号和2003年5月6日颁发的Fell等人的美国专利申请案第6,558,421号揭示了不需要骨切除的外科手术可植入的膝假体。 US Patent No. 6,558,421 US Patent No. 6,206,927 March 21, 2001 issued by Fell et al., 2003 and May 6 issue of Fell, who revealed not require bone resection surgery can be planted the knee prosthesis. 所述假体为具有一个或一个以上的直缘形状的大体椭圆形。 The prosthesis having one or more straight edges generally elliptical shape. 相应地,未将所述装置设计成大体上与体内的残余软骨和/或下骨的实际形状(轮廓)一致。 Accordingly, not the device and / or the actual shape (contour) of the bone or designed to substantially coincide with the residual cartilage in vivo. 因此,由于患者的周围软骨和/或下软骨下骨与假体之间的厚度和曲度存在差异,植入物的一体性相当困难。 Thus, due to the differences in curvature and thickness between the bone and the surrounding cartilage prosthetic cartilage patient and / or the lower, one of the implant difficult.

因此,仍需要一种使用以微创技术和用于所述修复和植入的工具而植入的一个或一个以上的植入物部分复制关节的自然几何结构的系统和方法,和重建关节的两个关节表面之间的自然或接近自然的三维几何关系的方法。 Thus, there remains a need for an implant portion using one or more minimally invasive techniques and tools for the repair implant and implantation of the replication system and method of the natural geometry of the joints, joint reconstruction and Natural or three-dimensional geometric relationships between the natural way to approach the two articular surfaces.

发明内容 SUMMARY

本发明提供用于修复关节的方法和组合物,特别地提供用于修复关节软骨并用于促进各种软骨和骨骼修复材料与受治疗者成一体的装置和植入物。 The present invention provides a method for repairing a joint and compositions, in particular to provide for repair of articular cartilage and for facilitating a variety of cartilage and bone repair materials and integrated into a subject devices and implants. 其中,本文所描述技术虑及与特定受治疗者的下软骨和/或骨骼和/或其它关节结构的轮廓大体上或完全一致的装置的生产。 Wherein subchondral production techniques described herein allow for a particular subject and / or bone and / or other joints contour substantially identical structure or device. 另外,装置也优选地与软骨的形状(大小)大体上或完全一致。 Additionally, the apparatus also preferably substantially or completely conform to the shape of the cartilage (size). 当关节软骨表面的形状(例如,大小、厚度和/或曲度)解剖或近似解剖地适合未损伤的软骨、受治疗者的原始软骨、和/或下骨时,修复的成功性提高。 When the shape of the articular cartilage surface (e.g., size, thickness and / or curvature) anatomic or near anatomic fit undamaged cartilage, the subject of the original cartilage and / or bone under repair successfully improved.

可在植入之前将修复材料定形,且所述定形可基于(例如)提供信息的电子图像,所述信息关于在缺损或患病软骨区域周围的任何“正常”软骨的曲度或厚度,和/或关于所述患病软骨缺损或区域的下面或周围的骨骼的曲度,以及包括关节的相对的匹配表面的骨骼和/或软骨。 The repair material can be shaped prior to implantation, and the shaped electron image based on information available (e.g.), the information on any "normal" curvature or thickness of the surrounding cartilage defect or area of ​​diseased cartilage, and / curvature with respect to the diseased cartilage or bone defects or below or around the area, as well as bone and / or cartilage of joints comprises opposing mating surfaces.

其中,本发明提供一种用于局部关节置换的微创方法。 Wherein, the present invention provides a minimally invasive method for partial joint replacement. 所述方法可致使因程序导致的骨存量的少量缺损或无缺损。 The method may cause bone stock caused by a small number of program defect or no defect. 另外,本文所描述的方法通过在植入物解剖或接近解剖地适合在周围或相邻软骨和/或软骨下骨之间而有助于恢复关节表面的完整性。 Further, the method described herein by anatomic or near anatomic implant fit between cartilage and / or subchondral bone and help to restore the integrity of the articular surface adjacent or around.

在大多数情况下,经修复的关节的关节灵活性范围将为正常灵活性的60%到99.9%。 In most cases, the restoration of joint mobility range for normal joint flexibility of 60% to 99.9%. 活动范围改良到85%到99.9%,更好的在90%到99.9%,最好的在95%到99.9%之间且理想的在98%到99.9%之间。 Improvement of activity to 85 to 99.9%, more preferably 90% to 99.9%, preferably between 95% to 99.9% and preferably between 98% to 99.9%.

另外,需要植入本发明装置的切口一般比需要植入当前可利用的植入物的切口小50%。 Further, the present invention requires incision implantation apparatus generally less than 50% of the required incision implant currently available implants. 例如,整个膝替代一般需要6-12英寸(15-30cm)的切口,而单腔隙膝置换需要3英寸(7cm)的切口。 For example, replace the entire knee generally requires 6 to 12 inches (15-30cm) of the cutout, while the single lacunar knee replacement requires 3 inches (7cm) incision. 根据本发明设计来修复胫骨表面的的植入物仅需要3cm的切口(大约1.5英寸),而用于修复胫骨表面和股骨髁的植入物组合需要3英寸(7cm)的切口。 To fix the tibial surface of the implant according to the design of the present invention requires only a 3cm incision (about 1.5 inches), and the implant compositions for repairing surface of the tibia and femoral condyles need to 3 inches (7cm) incision. 在另一实例中,传统的髋置换术需要6到12英寸(15-30cm)之间的单个切口,或在较小创伤技术中,需要1.5-4英寸(3-9.5cm)的两个切口。 In another example, the conventional hip arthroplasty requires a single incision between 6 to 12 inches (15-30cm), or a less invasive technique is required 1.5-4 inches (3-9.5cm) two cuts . 视需要单表面矫正还是双表面矫正而定,根据本发明的设计来修复髋臼的植入物需要1.5英寸(3cm)到6英寸(30cm)的单个切口。 Optionally a single surface or dual surface correction may be corrected, to repair the acetabulum depending on the design of the implant of the present invention require 1.5 inches (3cm) to 6 inches (30cm) of a single incision.

本发明的优点可包括(但不限于):(i)为个别患者定制关节修复(例如,患者特殊设计或解决方案),借此增强依修复程序的功效和缓和程度;(ii)消除在某些实施例的手术中外科医生测量待修复的缺损的需要;(iii)消除外科医生在植入程序期间定形材料的需要;(iv)提供了根据骨骼、软骨或组织图像或根据手术中探查技术评估修复材料的曲度或形状的方法;(v)提供了修复关节时仅有最小的骨存量缺损或(在某些实例中)无骨存量缺损的方法;和(vi)改良手术后的关节平整(congruity)。 Advantages of the present invention may include (but are not limited to) :( i) for individual customization of the articular repair a patient (e.g., a patient, or specially designed solutions), thereby enhancing the degree of efficiency and ease by fixes; (ii) elimination of a measurement surgeon surgical defect to be repaired in the embodiment need some embodiments; (iii) eliminating the need for the surgeon during the implantation procedure amorphous material; (iv) provides the bone, cartilage or tissue images or surgical exploration technique the method of assessment curvature or shape the repair material; only the smallest defect or bone stock (in some instances) method when no defect bone stock (v) providing the prosthetic joint; joint after surgery, and (vi) modified leveling (congruity).

因此,本文描述更精确地符合缺损(例如,植入的部位)且因此提供改良的关节修复的关节修复材料的设计和使用。 Thus, it described herein more precisely in line with the defect (e.g., site of implantation) and thus provides an improved joint repair design and use of joint repair material.

如所属领域技术人员应了解,可将植入物描述为一插补关节植入物、软骨缺损成形植入物、软骨投影植入物、和/或软骨下骨成形植入物。 As those skilled in the art will appreciate, the implant can be described as an interpolation joint implant, cartilage defect implant molded, the cartilage projected implant, lower and / or cartilage implant bone formation. 所述植入物具有上表面和下表面。 The implant has an upper surface and a lower surface. 上表面相对一关节的第一关节表面而下表面相对所述关节的第二关节表面,且进一步地,其中所述下表面或下表面中的至少一个具有与所述第一和第二关节表面中的一个的形状充分匹配的三维形状。 Opposing first upper surface of the joint articular surface and a lower surface opposite said second joint surface of the joint, and further, wherein the lower surface or lower surface having at least a first and second articular surface of the in the shape of a three-dimensional shape substantially match. 所述植入物适合置放于任何关节内,所述关节包括膝、髋、肩、肘、腕、指、趾、和踝。 The implant is placed in any suitable joint, said joint comprising a knee, hip, shoulder, elbow, wrist, finger, toe, and ankle. 植入物的上表面和下表面一般具有与植入物的上表面邻接的关节表面和植入物邻接的关节表面下表面中的至少一个的形状充分匹配的三维形状。 The implant upper and lower surfaces generally in the form of at least one surface of the lower abutment with the upper surface of the implant articular surface of the implant and the adjacent articular surface substantially match the three-dimensional shape. 所述植入物设计成具有患者重大软骨缺损的厚度或其分数一般在65%到99.9%之间。 The implant is designed to generally between 65% to 99.9% of patients with significant thickness cartilage defect or fractions thereof.

可由各种适当的材料制造植入物,所述材料包括生物相容材料、金属、金属合金、生物活性材料、聚合物、和其类似物。 By various suitable implant material, said material comprising a biocompatible material, metals, metal alloys, biologically active material, a polymer, and the like. 另外,可由复数个材料(包括涂层)制造植入物。 Further, by a plurality of material (including coating) manufactured implant.

植入物可进一步具有附着到关节的机构。 The implant may further have a mechanism attached to the joint. 适当的附着机构包括嵴、销钉、插针、横件、齿和突起。 Suitable attachment mechanism includes a crest, a pin, pins, cross-members, teeth and protrusions. 可提供稳定关节的额外机构(如嵴、边缘),沿外周表面的所有或一部分加厚。 May provide additional stability joint mechanism (e.g., ridges, edges), in all or part of the outer circumferential surface of the thickened.

也可设计植入物使得其具有两个或多个的组件。 The implant can also be designed such that it has two or more components. 根据所要的功能性,所述组件可整体成形、不可分割成形、互连成形、和相互依赖成形。 The functionality desired, the assembly may be integrally molded, integral molding, molded interconnect, forming and interdependent. 在多个组件情况下,可将关节接触组件设计成与关节滑动地或旋转地或其组合啮合。 In the case where a plurality of components, joint contact assembly may be designed to engage slidingly or rotationally joint or a combination. 或者,可将关节接触组件的任一个或两个固定到关节。 Alternatively, the joint may be any one or two of the contact assembly is fixed to the joint. 任何额外的组件可与其所啮合的任何其它组件整体成形、不可分割成形、互连成形或相互依赖成形。 Any other component of any additional component with which it is engaged integrally formed integral molding, molded interconnect molding or dependent.

植入物的每一组件或植入物本身可具有沿外周圆、椭圆、卵形、肾形、大体的圆、大体的椭圆、大体的卵形、大体的肾形的外周或周长所形成的形状。 Each component of the implant or the implant itself may have an outer circumference along a circle, ellipse, oval, kidney shaped, substantially circular, substantially elliptical, substantially oval, substantially kidney-shaped outer circumference or perimeter of the formed shape. 另外,植入物的每一组件本身可具有球形、半球形、非球面、凸面、凹面、大体的凸面、和大体的凹面的横截面形状。 Further, each component of the implant itself may have a spherical, hemispherical, aspherical, convex cross-sectional shape, concave, substantially convex, and substantially concave surface.

植入物的设计使得有助于使用10cm或更少的切口来植入。 Implant designed so as to facilitate the use of 10cm or less incision implantation. 此外,将植入物设计成恢复关节活动范围为正常关节活动的80%到99.9%。 Further, the implant is designed to restore normal range of motion for the joint activities of 80% to 99.9%.

植入物或其任何组件可具有各种形状使得植入物的外周可比植入物的中央部分的厚度更大。 Larger outer periphery of the implant, or any component thereof may have various shapes such implants implant thickness than the central portion. 或者,可设计植入物或其任何组件使得植入物的中央部分比外周的厚度大。 Alternatively, the implant may be designed so that the central component or any portion of the implant is larger than the thickness of the outer periphery. 从诸如前面部分、后面部分、侧面部分和中间部分的复数个方向看植入物,植入物或其任何组件可具有沿装置的后面部分的厚度,其等于或大于植入物的侧面、中间和前面部分中的至少一个的厚度。 Such as from the front portion, rear portion, the side portions and a plurality of intermediate portion viewed implant, implant or any component thereof may have a thickness along the rear portion of the apparatus, which is greater than or equal to the implant side, the intermediate and at least one thickness in the previous section. 或者,植入物或其任何组件可具有沿装置的后面部分的厚度,其等于或小于植入物的侧面、中间和前面部分中的至少一个的厚度。 Alternatively, the implant or any component thereof may have a thickness along the rear portion of the apparatus, which is smaller than or equal to at least one of the thickness of the side, front and middle portion of the implant. 在另一替代方法中,植入物或其任何组件可具有沿装置的中间部分的厚度,其等于或小于前面部分、后面部分和侧面部分中的至少一个的厚度。 In another alternative method, the implant, or any component may have a thickness in the middle portion of the device, which is less than or equal to the front portion, rear portion and a side portion of at least one of the thickness. 在另一替代方法中,植入物可具有沿装置的中间部分的厚度,其等于或大于前面部分、后面部分和侧面部分中的至少一个的厚度。 In yet another alternative, the implant may have a thickness in the middle portion of the apparatus, which is equal or greater than the front part, the thickness of the rear portion and side portions of at least one.

使用以下所描述的植入物修复关节的程序包括以下步骤:关节镜检查下植入具有上表面和下表面的植入物,其中所述上表面和下表面中的至少一个具有与关节表面的形状充分匹配的三维形状。 Described below using the repaired joint implant procedure includes the following steps: Under arthroscopic implantation of the implant having an upper surface and a lower surface, wherein said upper and lower surfaces and having at least one of the articular surface substantially match the shape of the three-dimensional shape. 在植入之前分析图像。 The image analysis prior to implantation. 所述图像一般为MRI、CT、X光、或其组合。 The image is generally MRI, CT, X ray, or a combination thereof.

根据本发明制造植入物的方法包括:判定关节的一个或一个以上的关节表面的三维形状;和产生具有上表面和下表面的植入物,其中所述上表面和下表面相对所述关节的第一和第二关节表面,且进一步地,其中所述上表面和下表面中的至少一个与所述关节表面的三维形状充分匹配。 The method for producing an implant according to the present invention comprises: determining a three-dimensional shape of the joint articular surface of one or more of; and generating implant having an upper surface and a lower surface, wherein said opposing upper and lower surfaces of the joint first and second articular surface, and further, wherein said at least one matched with the three-dimensional shape of the articular surface of the upper and lower surfaces.

此外,本发明提供一种使用植入物材料替代关节(例如,软骨和/或骨骼)的一部分(例如,患病区域和/或稍微大于患病区域的区域)的新颖装置和方法,其中植入物解剖的或接近解剖的适合周围结构和组织的至少一个表面,且使关节灵活性恢复到关节正常活动范围的60%到99.9%。 Further, the present invention provides an alternative to the joint (e.g., cartilage and / or bone) part (e.g., diseased area and / or area slightly larger than the diseased area) of the novel apparatus and methods of using the implant material, wherein the plant It was dissected into anatomical fit around or near the tissue structure and at least one surface, and the flexibility of the joint to return to the range of 60% to 99.9% of normal joint activity. 此外,在关节活动植入物可承受施加于关节上的剪切力的(高达)100%。 Furthermore, activities in the joint implant may be subjected to shear forces exerted on the joint (up to) 100%. 在装置和/或方法包括与下关节骨骼相关联的元素的情况下,本发明也提供与骨骼相关联元素与软骨下骨解剖的或接近解剖的对齐。 In the case of the apparatus and / or methods include an element with the lower joint of the bone is associated, the present invention also provides a skeletal element associated subchondral bone anatomy or nearly aligned with the anatomy. 本发明也能够对具有单个切口的植入位置进行预处理。 The present invention can also be pretreated with a single incision implantation site. 所述装置可未单组件、双组件,或具有复数个组件。 The device may not single component, two-component, or having a plurality of components.

本发明的方法包括步骤:(a)测量欲植入位置的尺寸(例如,厚度和/或曲度和/或大小)或欲植入位置周围区域的尺寸;和(b)提供与步骤(a)中所获得的测量结果一致的软骨替代物或材料。 The method of the present invention comprises the steps of: size (a) measuring the position of the intended implantation (e.g., thickness and / or curvature and / or size) to be implanted around the position or size of the region; and (b) providing in step (a measurements) obtained in the same material or a cartilage substitute. 在某些方面,步骤(a)包括测量欲植入位置周围软骨的厚度和测量欲植入位置周围软骨的曲度。 In certain aspects, step (a) comprises measuring the thickness of the implant to be measured and to be implanted around the position of the curvature of the cartilage surrounding the cartilage position. 或者,步骤(a)可包括测量欲植入位置的大小和测量欲植入位置周围的软骨的曲度;或测量在欲植入位置周围软骨的厚度、测量欲植入位置的大小、并测量欲植入位置周围软骨的曲度;或在欲植入位置处重建健康的软骨表面;或测量欲植入位置的大小和/或在欲植入位置处或欲植入位置周围测量软骨下骨的曲度或几何结构。 Alternatively, step (a) may comprise measuring the size of the intended implantation position and measuring the curvature of the cartilage to be implanted around the location; or measuring the position of the cartilage surrounding the intended implantation thickness measuring position to be the size of the implant, and measuring to implant the curvature of the cartilage surrounding the location; For implant location or rebuild healthy cartilage surface; or measuring the size of the intended implantation position and / or bone to be implanted at a location at or around the position to be measured cartilage implant geometry or curvature. 另外,可在欲植入位置处测量剩余软骨的厚度、曲度或表面几何结构,且可将其与软骨周围的厚度、曲度或表面几何结构相比较。 Further, at a position at the intended implantation measuring the remaining cartilage thickness, curvature or surface geometry, and may be, curvature or surface geometry as compared with the thickness of the surrounding cartilage. 此比较可用于更精确地得到软骨替代物或材料的形状。 This comparison can be used to more accurately obtain the shape of the cartilage replacement or material.

手术测量后选择替代材料的尺寸,所述测量例如,使用如超声波、MRI、CT扫描、用X光配色获得的X光成像和荧光检查法成像等成像技术进行的测量。 After the measurement operation to select the size of the replacement material, for example the measurement using ultrasound, MRI, CT scan, X-ray imaging and fluoroscopic imaging by X-ray imaging technique for obtaining color is. 机械探测器(有或无成像功能)也可用于选定尺寸,例如超声波探测器、激光、光学探测器、印压探测器、和可变形的材料。 Mechanical probe (with or without imaging capabilities) may also be used in a selected size, such as ultrasonic detectors, lasers, optical detectors, pressure detectors printing, and deformable material.

一个或一个以上的可植入装置包括三维物体。 One or more than one implantable device comprises a three-dimensional object. 在一膝中,植入物可用于一个(单腔隙)或多个(多腔隙)腔隙(compartment)。 In a knee, the implant can be used a (single lacunar) or more (multiple lacunar) cavities (compartment). 在所述膝中,植入物非椭圆形,但是符合关节软骨、软骨下骨和/或关节内结构的3D几何结构。 In the knee, the implant is non-elliptical, but which correspond to articular cartilage, bone and / or 3D geometry subchondral intraarticular structures. 植入物具有一对相对的面。 The implant has opposite faces couple. 植入物的一个面的轮廓与下软骨和/或骨骼轮廓相匹配或大体上匹配;而植入物的相对面的轮廓为相接的匹配关节表面创建一表面。 A surface contour of the lower implant cartilage and / or bone to match or substantially match the contour; while the opposite surface of the implant to create a contour to match a surface in contact with the articular surface. 例如,可使用模型化来投影相对面的表面以优化用于与关节匹配的表面。 For example, modeling the opposing face to the projection surface may be used to optimize the matching surface for the joint. 另外,可使用一圆形的界面来连接相对的面。 Further, the opposite surface may be connected using a circular interface. 界面也可在关节表面之外延伸。 Interface may also extend beyond the articular surface. 对关节镜检查插入而言,本发明的植入物也可为可自行扩展的并可修正的。 Insertion of arthroscopy, the implant of the present invention may also be extensible and self-correction.

装置的每一面不必在尺寸上统一。 Each side of the apparatus need not be uniform in size. 经由在任一给定点处所取的一轴线上的长度D可沿所述轴线可变。 Via any given point taken at a length D on the axis along the axis variable. 类似的,经由第二轴线(正交于所述第一轴线)长度2D同样也可沿所述轴线可变。 Similarly, via the length of the second axis (orthogonal to the first axis) 2D also be variable along the axis. 所属领域技术人员将了解沿第一轴线的任何D长度于沿第二轴线的任何D长度之间的比率可具有适合待矫正身体解剖的任何比率。 Those skilled in the art will appreciate that any D length along a first axis in any ratio between the length D along the second axis may have any suitable ratio of body anatomy to be corrected.

如所述领域技术人员将了解,不背离本发明的范畴的情况下,本文所描述的可植入关节假体的任一个可包括可(例如,滑动地)和/或可分离啮合的多个(例如,两片或多片)物体组件。 As the skilled artisan will appreciate that, without departing from the scope of the invention herein described may be any implantable joint prosthesis may include a (e.g., slidably) and / or a plurality of detachable engagement (e.g., two or more pieces) object assembly. 例如,可在具有其轮廓与下软骨和/或骨骼(部分地或大体上)一致的面的每一个组件中提供两块组件。 For example, it may have a profile with cartilage and / or bone (partially or substantially) identical for each component is provided in two side components. 在某些实施例中,可啮合的组件的相对表面为弯曲的。 In certain embodiments, the opposing surfaces of the engaging assembly may be curved. 可选择类似于或反映关节的至少一关节表面的曲度的曲度。 Curvature of the articular surface curvature of at least one selectively reflected or similar joints. 在其它实施例中,可啮合的组件的相对表面为平的。 In other embodiments, the opposing surfaces of the engaging assembly may be flat. 在其它实施例中,可啮合的组件的相对表面为平的和弯曲的组合。 In other embodiments, the opposing surfaces of the engaging assembly may be flat and curved combinations thereof. 可啮合的组件的相对表面为也可为不规则的。 Opposing surfaces of the engaging assembly may also be irregular. 在此种状况下,所述表面优选设计成在至少一个或一个以上的位置中彼此匹配。 In this condition, the surface is preferably designed to match each other in at least one or more than one position.

在本文所描述的任何方法中,可选择替代材料(例如,选自现存的修复系统库)。 In any of the methods described herein, the selectable alternative materials (e.g., selected from a library of existing repair system). 因此,可在手术前、手术中、或手术后生产替代材料。 Thus, prior to surgery, surgery, or surgery to produce alternative materials. 此外,本文所描述的任何方法中,也可使此项技术中已知的适当的技术、或手术前、手术中、或手术后来对替代材料进行定形。 In addition, any of the methods described herein, it is also known in the art can make appropriate technology, or before surgery, surgery, or alternative materials later surgical setting. 所述技术包括:手工、自动或通过机器;使用包括抛光、激光烧蚀、射频烧蚀、挤压、注射、模型化、压缩模型化和/或机械加工技术、或其类似物的机械磨蚀。 The techniques include: manually, automatically or by machine; includes the use of polishing, laser ablation, radiofrequency ablation, extrusion, injection, modeled, the model of compression and / or machining techniques, or the like mechanical abrasion. 最后,植入物可包括诸如药品、细胞、非细胞材料、药理学试剂、生物试剂、和其类似物等一个或一个以上的生物活性材料。 Finally, the implant may comprise a biologically active material, such as one or more drugs, cells, non-cellular material, pharmacological agents, biological agents, and the like, and the like.

本发明包括一种修复受治疗者中的软骨的方法,所述方法包括植入根据本文所描述的任何方法制备的软骨修复材料的步骤。 The present invention includes a method of repairing a subject cartilage, said method comprising the step of implanting cartilage repair material prepared according to any method described herein. 植入一般在关节镜下且可经由相对小的切口来完成。 Usually arthroscopic implantation and may be accomplished via a relatively small incision.

本发明也提供一种判定关节表面的曲度的方法,所述方法包括手术中使用机械探测器(mechanical probe)或外科手术机械导航系统(surgical mechanical navigation system)测量关节表面的曲度。 The present invention also provides a method of determining the curvature of the articular surface, the method comprising curvature surgery using a mechanical probe (mechanical probe) or a mechanical surgical navigation system (surgical mechanical navigation system) measuring the articular surface. 关节表面可包括软骨和/或软骨下骨。 May include articular surface cartilage and / or subchondral bone. 机械探测器(有或无成像功能)可包括:(例如)超声波探测器、激光、机械手(如钛FARO手(Titanium FARO arm))、光学探测器和/或可变形的材料或装置。 Mechanical probe (with or without imaging capabilities) may include, for example and) an ultrasonic probe, a laser, a robot (e.g., titanium FARO hand (Titanium FARO arm)), the optical detector and / or deformable material or device.

各种工具可用于便于装置的植入。 Tools can be used to facilitate a variety of implantable devices. 工具为辅助相对于关节表面最佳定位的装置的导向装置。 Auxiliary tool relative to the guide means of the optimal positioning of the articular surface. 以装置方式使用的工具和导向装置的设计取自适合于特定关节的装置的设计。 Design tools and means to guide the device from the design used in a manner suitable for the particular joint device. 工具可包括与植入位置或关节腔部分或大体一致的试验植入物或手术工具。 Tool may include a trial implant or the implant location of the joint cavity portion or substantially uniform or surgical tool.

本文所描述的任何修复系统或假体(例如,外部表面)可包括聚合体材料或流体材料。 Any repair systems or prostheses (e.g., exterior surface) described herein may include polymeric material or a fluid material. 可将聚合体材料连接到金属或金属合金。 Polymeric material may be attached to a metal or metal alloy. 当聚合体材料曝露于化学制品、能量射束、光源、超声波和其它物的时候,可注入聚合体材料且(例如)其可自硬化或硬化。 When the polymeric material is exposed to chemicals, energy beams, light, ultrasonic waves, and when the other thereof, and the polymeric material may be injected (e.g.,) which may be self-curing or hardened. 此外,本文所描述的任何系统或假体可适合于(例如)通过软骨替代材料的外表面中的开口(例如,外表面中的一开口造成骨骼表面上的复数个开口)接收注射剂。 In addition, any system or prostheses described herein may be suitable for (e.g.) cartilage replacement material through the outer surface of the opening (e.g., an opening in the outer surface caused by a plurality of openings on the bone surface) received injections. 可通过所述开口注入骨骼接合剂、治疗剂、和/或其它生物活性物质。 Through the opening bone cement injection, therapeutic agents, and / or other biologically active substances. 在某些实施例中,可需要在压迫关节表面或软骨下骨或骨髓的情况下注入骨骼接合剂以完成骨骼接合剂渗入植入位置的部分。 In certain embodiments, it may be desirable in the case of bone or bone marrow implanted under the pressure of the articular surface cartilage or bone cement to complete the partially penetrated the bone cement implantation site. 另外,可使本文所描述的任何修复系统或假体固定于骨髓中或软骨下骨中。 Further, the system can make any repair or prostheses described herein is fixed in the bone marrow or the subchondral bone. 一个或一个以上的加固延伸部分(例如,插针等)可通过骨骼和/或骨髓来延伸。 One or more reinforcing extension (e.g., pins, etc.) may extend through the bone and / or bone marrow.

在某些实施例中,可在不破坏软骨下骨的情况下或仅使用延伸到软骨下骨或穿过软骨下骨的少量插针或锚定器来植入软骨替代物系统。 In certain embodiments, it may be without the destruction of cartilage or bone case extends only to the bone through the subchondral bone or a small pin or anchor to the implant system subchondral cartilage substitute. 此项技术具有避免将来植入物“下沉”和骨质溶解导致关节不调和或植入物松动或其它并发症的优点。 This technique of avoiding future implant "sink" and leads to joint incongruity osteolysis or loosening of the implant or other complications of advantages.

如所属领域技术人员将了解,适当的关节可包括(说出若干个名字)膝、肩、髋、脊椎、椎间盘、肘、踝、腕、指、腕掌骨、中足、和前足关节。 As those skilled in the art will appreciate that the appropriate joint may include (say several names) knee, shoulder, hip, spine, intervertebral discs, elbow, ankle, wrist, finger, wrist metacarpal, midfoot, and forefoot joints. 所描述的技术同样不限于所发现的人类的关节,而可扩展到任何哺乳动物的关节。 The techniques described are not limited to the same human joints found, but can be extended to any mammal joints.

根据本文的揭示,本发明的此等和其它实施例对于所属领域技术人员将显而易见。 The herein disclosed, these and other embodiments of the present invention for the skilled in the art will be apparent.

附图说明 BRIEF DESCRIPTION

图1A为用于根据本发明评估修复关节的需要的方法的方块图,其中在接收选定的植入物之前现有关节表面不变或大体上不变。 FIG 1A is a block diagram for repairing a joint according to the needs assessment process of the present invention, wherein the existing joint surface of constant or substantially constant prior to receiving the selected implant. 图1B为用于根据本发明评估修复关节的需要的方法的方块图,其中在设计适合于完成修复的植入物之前现有关节表面不变或大体上不变。 FIG 1B is a block diagram for repairing a joint according to the needs assessment process of the present invention, wherein the existing articular surface repair constant or substantially constant before the implant is adapted to complete the design.

图2为股骨远端的关节软骨的三维厚度图像的再现。 Figure 2 is a reproduction of a three-dimensional image of a thickness of distal femur articular cartilage. 可(例如)由超声波、CT或MRI数据产生三维厚度图像。 It may be (e.g.) to produce a three-dimensional image generated by the ultrasonic thickness, CT or MRI data. 在软骨物质内的黑洞指示全部厚度的软骨缺损的区域。 Black Hole cartilage material within the indication area full thickness cartilage defect.

图3A为共中心地排列的光圈的泼拉西多(Placido)盘的实例。 3A is a common centrally arranged pouring aperture Raschig plurality (Placido) Examples disc. 图3B为在固定曲度的表面上的投影泼拉西多盘的实例。 3B is projected on the surface of the fixed curvature of the multi-plate splash Raschig examples.

图4为由在每一股骨髁上的共中心的光圈(泼拉西多盘)的投影产生的镜象。 Mirror 4 by co center aperture on each femoral condyle images (splash Raschig multi-plate) produced by projection.

图5为规则弯曲表面的2D彩色码拓扑图像的实例。 FIG 5 is a curved surface of the regular 2D topology example of a color code image.

图6为规则弯曲表面的3D彩色码拓扑图像的实例。 FIG 6 is an example of regular 3D curved surface topology of a color code image.

图7A-B为用于根据本发明评估修复关节的需要的方法的方块图,其中在接收植入物之前存在的关节表面被改变。 A block diagram of a method for repairing 7A-B is a need of a joint assessment of the present invention, wherein the articular surface of the implant prior to receiving presence is changed.

图8A为适合于在膝关节的胫骨平台(tibial plateau)处植入的本发明的关节植入物的透视图。 8A is a perspective view of a material suitable for implantation in the knee joint of the present invention, tibial platform (tibial plateau) at implantation. 图8B为图8A的植入物的俯视图。 8B is a plan view of FIG. 8A implant. 图8C为沿图8B中所展示线CC的图8B的植入物的横截面图。 FIG. 8C line CC cross-sectional view of the implant of FIG. 8B is shown in Figure 8B. 图8D为沿图8B中所展示的线DD的横截面图。 Figure 8D is a cross-sectional view taken along a line 8B shown in the DD. 图8E为沿图8B中所展示的线EE的横截面图。 FIG 8E is a cross-sectional view taken along a line 8B shown in the EE. 图8F为图8A的植入物的侧视图。 FIG 8F is a side view of the implant of FIG. 8A. 图8G为展示沿平行于径向平面的平面截取而植入的图8A的植入物的横截面图。 FIG. 8G is a cross-sectional view of the implant plane parallel to a radial plane taken and implanted in FIG. 8A is a display. 图8H为展示沿平行于冠状平面的平面截取而植入的图8A的植入物的横截面图。 FIG. 8H is a cross-sectional view of the implant plane parallel to the coronal plane taken and implanted in FIG. 8A is a display. 图8I为展示沿平行于轴向平面的平面截取而植入的图8A的植入物的横截面图。 8A cross-sectional view of the implant of FIG. 8I shows a plane taken in a direction parallel to the axial plane of the implant. 图8J为中间地(朝向胫骨平台的边缘)且前面地且后面地靠近骨骼而延伸的稍微较大的植入物。 FIG. 8J to intermediate (towards the edge of the tibial plateau) and anteriorly and slightly behind the larger implant that extends closer to the bone. 图8K为展示锚定器的图8A的关节植入物的替代实施例的侧视图。 A side view of the implant of FIG. 8K alternative embodiment of the anchor to show the joints of FIG. 8A. 图8L为展示锚定器的图8A的关节植入物的替代实施例的仰视图。 FIG. 8L implantation bottom view of an alternative embodiment thereof is a joint display of the anchor of FIG. 8A. 图8M和8N为由前面看且由侧面看的两块植入物的替代实施例。 FIG 8M and 8N by alternative embodiment in front view and a side view of two implants.

图9A和9B为分别在下的和上面观察点的适合于在股骨髁上使用的关节植入物的透视图。 9A and 9B, respectively lower and upper observation point is adapted to a perspective view of a joint implant for use on the femoral condyle. 图9C为图9A的植入物的侧视图。 FIG 9C is a side view of the implant 9A. 图9D为植入物的下面的图。 FIG 9D is following the implant of FIG. 图9E为植入物的上面的图且图9F为植入物的横截面。 FIG. 9E above was implanted and FIG 9F is a cross-section in FIG implant. 图9G为适合于在胫骨的两个骨节上使用的关节植入物的上面的图。 FIG 9G is suitable for the above joint implants used in both tibial condyles FIG. 图9H为图9G的植入物的侧面透视图。 FIG 9H is a side perspective view of the implant of FIG. 9G.

图10A为髋臼的侧视图。 10A is a side view of the acetabulum. 图10B为最接近的股骨的旋转图。 FIG 10B is closest to the rotation of the femur. 图10C为用于展示大体的恒定半径的髋关节的植入物的横截面图。 10C is a hip show a generally constant radius of the cross-sectional view of the implant.

图10D为类似于图10C中所见的植入物具有一圆的边缘和一不对称的半径的植入物的横截面图。 FIG. 10D has a cross-sectional view of an edge of the implant and a circle of a radius similar to asymmetric seen in FIG. 10C implant.

图11A为具有延伸到股骨头的凹头中的构件的植入物的横截面图。 11A is a cross-sectional view of a recess extending into the femoral head in the implant member. 图11B将植入物展示为半球、图11C为部分半球且图11D为围栏,其都展示额外的和替代的平面图。 FIG 11B shows the implant is hemispherical, partially hemispherical FIG. 11C and FIG. 11D is a fence, which are additional and alternative showing a plan view. 图11为具有辐条排列的植入物的替代实施例的图。 FIG embodiment of FIG. 11 is an alternative embodiment of the implant having a spoke arrangement.

图12A为具有延伸到髋臼窝中的构件的植入物的横截面图。 FIG 12A is a cross-sectional view extending into the acetabular socket of the implant member. 图12B-E为各种透视图,其中植入物为半球形、部分半球形、一围栏和一辐条。 FIG. 12B-E is a perspective view of a variety, wherein the implant is hemispherical, partially hemispherical, a fence and a spoke.

图13A为展示两块构造和光滑匹配表面的一双组件“负重可活动”植入物的横截面图。 FIG. 13A shows one pair of two component surfaces configured to match a smooth and "mobile bearing" cross-sectional view of the implant. 也展示平面图,其展示具有两个半球的双组件、具有一围栏或类围栏的外部组件(意即,在一维中半球形,但不在其余维中)的单个半球、具有具有围栏内部结构的单个半球、具有辐条内部组件的单个半球、和具有辐条外部组件的单个半球。 Also shows a plan view showing a double assembly has two hemispheres, or a fence having a fence type external component (meaning, hemispherical in one dimension, but not in the remaining dimension) of the single hemispherical, having an internal structure of the fence having single hemisphere, hemisphere having a single spoke internal components, and having a single spoke hemispherical external components.

图13B-J为双组件植入物的替代实施例,其中外部组件的内部表面具有一与内部组件的外部表面上的锯齿形啮合的结节。 FIG. 13B-J is a two-component implant alternative embodiment, wherein the inner surface of the outer assembly having a serrated nodules on the outer surface of the internal components of a meshing. 也展示额外的变化。 Also show additional changes.

图14A为具有延伸到股骨头的凹头中的构件的植入物的替代实施例。 Figure 14A is an alternate embodiment having a recess extending into the femoral head in the implant member. 图14B和图14C为横截面实施例,其中组件之一形成一半球而第二组件不形成半球。 FIGS. 14B and FIG. 14C is a cross-sectional embodiments, where one of the components forms a hemisphere while the second component does not form a hemisphere.

图15A为具有延伸到髋臼窝的构件的双组件“负重可活动”植入物的横截面图。 FIG. 15A having a two-component extending into the acetabular socket member "mobile bearing" cross-sectional view of the implant. 图15B和图15C为横截面实施例,其中组件之一形成一半球而第二组件不形成半球。 15B and 15C is a cross-sectional embodiments, where one of the components forms a hemisphere while the second component does not form a hemisphere.

图16A为三组件“负重可活动”植入物的横截面图。 FIG. 16A is a three-component "mobile bearing" cross-sectional view of the implant. 图16B-D为具有一个或一个以上的形成半球的组件的三组件“负重可活动”植入物的横截面图,而至少一其它组件不形成半球。 FIG. 16B-D with one or more components of a hemispherical three-component "mobile bearing" cross-sectional view of the implant and at least one other component does not form a hemisphere.

图17A为具有延伸到髋臼窝的构件的双组件“负重可活动”植入物的横截面图。 FIG. 17A having a two-component extending into the acetabular socket member "mobile bearing" cross-sectional view of the implant. 图17B和图17C为横截面实施例,其中组件之一形成一半球而第二组件不形成半球。 FIGS. 17B and 17C is a cross-sectional embodiments, where one of the components forms a hemisphere while the second component does not form a hemisphere.

图18A为具有延伸到髋臼窝的构件的双组件“负重可活动”植入物的横截面图。 FIG. 18A having a two-component extending into the acetabular socket member "mobile bearing" cross-sectional view of the implant. 图18B为延伸到髋臼组件的顶部上的髋臼窝中的图18A中所展示的构件的顶部上的四个垂直稳定面。 FIG four vertical stabilizing surface 18B on the top so as to extend to the top of the acetabular socket of the acetabular component of FIG. 18A exhibited member.

图19A为具有延伸到股骨头的凹头中的双构件“负重可活动”植入物的横截面图。 19A is a recess extending into the femoral head in a two-piece "mobile bearing" cross-sectional view of the implant. 图19B为双组件固定植入物的横截面图。 FIG. 19B is a cross-sectional view of a dual component implant fixation.

图20A为用于髋关节的具有变化的半径和厚度的植入物的横截面图。 20A is a cross-sectional view of an implant with varying radii and thickness of the hip joint. 图20B为用于髋关节的具有变化的半径和厚度的植入物的横截面图。 20B is a cross-sectional view of an implant with varying radii and thickness of the hip joint. 图20C用于髋关节的具有变化的半径和厚度的植入物的横截面图。 Figure 20C a cross-sectional view of an implant with varying radii and thickness of the hip joint. 图20D为用于髋关节的具有在下地和在上地延伸的边缘的植入物的横截面图。 FIG. 20D implants for the hip joint and having a lower edge extending in the cross-sectional view.

图21A为在诸如锁骨、肩胛骨、肩臼(glenoid)、肩峰、喙突和肱骨等肩关节中的骨质结构的正面图。 FIG 21A is a front view of the bone structure, such as the clavicle, scapula, the glenoid (glenoid), acromion, coracoid process of the shoulder joint and the humerus. 图21B为放置于肱头和肩臼之间的关节造形术装置图。 FIG 21B is placed in the apparatus of FIG arthroplasty between the humeral head and the glenoid. 图21C为具有与肱头的形状大体一致的肱骨表面和与肩臼的形状大体一致的肩臼表面的关节造形术装置的倾斜的正面横截面图。 A front cross-sectional view of FIG. 21C inclined arthroplasty device having a shape substantially coinciding with the humeral head of the humerus and the glenoid surface and a shape substantially identical glenoid surface. 图21D为具有与肱头的形状大体一致的肱骨表面和与肩臼的形状大体一致的肩臼表面的关节造形术装置的轴向横截面图。 FIG 21D is an axial cross-sectional view having a shape substantially coinciding with the humeral head of the humerus and the glenoid surface and a shape substantially the same surface of the glenoid arthroplasty device. 图21E为显示关节软骨和在上的和下肩臼缘的肩的倾斜的正面图。 FIG 21E is displayed on the articular cartilage and the inclined shoulder and the lower shoulder of the front edge of the acetabulum in FIG. 图21F为显示关节软骨和在上的和下肩臼缘的肩的轴向图。 FIG. 21F is a display and articular cartilage of the shoulder and lower shoulder axial view on the acetabular rim. 图21G为具有与肱头的形状大体一致的肱骨表面和与肩臼和肩臼缘的形状大体一致的肩臼表面的关节造形术装置的倾斜的正面横截面图。 A front cross-sectional view of FIG. 21G inclined arthroplasty device having a substantially conforming to the shape of the humeral head and the humeral surface shape of the glenoid and the glenoid rim of a substantially uniform glenoid surface. 图21H为具有与肱头的形状大体一致的肱骨表面和与肩臼和肩臼缘的形状大体一致的肩臼表面的关节造形术的轴向横截面图。 An axial cross-sectional view of FIG. 21H arthroplasty having a shape substantially coinciding with the humeral head and the surface shape of the humerus and the glenoid of the glenoid rim substantially uniform glenoid surface. 图21I为具有与肱头的形状大体一致的肱骨表面和与肩臼的形状大体一致的肩臼表面的关节造形术装置的倾斜的正面横截面图。 A front cross-sectional view of FIG. 21I inclined arthroplasty device having a shape substantially coinciding with the humeral head of the humerus and the glenoid surface and a shape substantially consistent with the glenoid surface. 展示一边缘在上和/或下地延伸,其提供肩臼上的稳定性。 It shows an edge and / or removably extended over which the glenoid provide stability. 图21J为具有与肱头的形状大体一致的肱骨表面和与肩臼的形状大体一致的肩臼表面的关节造形术装置的轴向横截面图。 FIG 21J is an axial cross-sectional view having a shape substantially coinciding with the humeral head of the humerus and the glenoid surface and a shape substantially the same surface of the glenoid arthroplasty device. 展示一边缘前面和/或后面延伸,其提供肩臼上的稳定性。 Show a front edge and / or rear extension, which provides stability to the glenoid. 图21K为具有与肱头的形状大体一致的肱骨形成表面和与肩臼的形状大体一致的肩臼表面的双组件“负重可活动”关节造形术装置的倾斜的正面横截面图。 FIG. 21K dual component surface forming the shape of the glenoid and the glenoid surface substantially uniform with substantially uniform as to the shape of the humeral head of the humerus "mobile bearing" obliquely front cross-sectional view of the device arthroplasty.

图21L为具有与肱头的形状大体一致的肱骨形成表面和与肩臼的形状大体一致的肩臼形成表面的双组件“负重可活动”关节造形术装置的轴向横截面图。 FIG. 21L is formed a two-component surface forming the surface shape of the glenoid and the glenoid is substantially uniform with substantially conforming to the shape of the humeral head humeral "mobile bearing" arthroplasty device axially cross-sectional view.

图21M为具有与肱头的形状大体一致的肱骨形成表面和与肩臼的形状大体一致的肩臼形成表面的双组件“负重可活动”关节造形术装置的替代图。 FIG. 21M forming a two-component surface forming the surface shape of the glenoid and the glenoid is substantially uniform with substantially conforming to the shape of the humeral head humeral "mobile bearing" replacement arthroplasty device of FIG. 所述装置在第一组件的表面上具有一结节,其与第二组件的表面上的锯齿形匹配以增强关节运动。 Said means having a nodule on the surface of the first component, which matches the serrated surface of the second assembly to enhance articulation.

图21N为双组件“负重可活动”关节造形术装置的倾斜的正面横截面图。 FIG. 21N is a two-component "mobile bearing" obliquely front cross-sectional view of the device arthroplasty. 图21O为双组件“负重可活动”关节造形术装置的倾斜的正面横截面图。 FIG. 21O dual component "mobile bearing" obliquely front cross-sectional view of the device arthroplasty. 图21P和Q为图21O中所展示的双组件“负重可活动”装置的替代实施例的横截面图。 FIG. 21P two-component and Q is as shown in FIG. 21O "mobile bearing" cross-sectional view of an alternative embodiment of the apparatus embodiment.

图22为显示肱骨远端、肘突和径向头的通过肘关节的倾斜的纵向图。 FIG 22 is a display of the distal humerus, the elbow joint by inclined longitudinal FIG elbow and a radially protruding head. 也展示软骨表面。 Also showed cartilage surface.

图23A为显示桡骨远端、尺骨和若干腕骨,在适当位置用关节造形术系统通过腕关节的纵向图。 FIG 23A is a display of the distal radius, the ulna and several wrist, in position with the longitudinal arthroplasty systems wrist of FIG. 图23B为显示远端桡骨、尺骨、和若干腕骨,通过腕关节的纵向图。 FIG. 23B show the distal end of radius, ulna, carpal bones, and a number of longitudinal through FIG wrist. 图23C为在适当位置用关节造形术系统显示远端桡骨、尺骨和若干腕骨的通过腕关节的纵向图。 FIG 23C is a display with an arthroplasty system in place by vertical wrist FIG distal radius, ulna and several of the carpal bones. 图23D为适合于腕的双组件“负重可活动”关节造形术装置的纵向图。 FIG 23D is a two-component fit to the wrist "mobile bearing" longitudinal arthroplasty device of FIG. 图23E为另一双组件造形装置的纵向图,在此种状况下没有边缘。 FIG 23E is a longitudinal view of another two-component forming device, without edges, in this situation. 图23F为双组件“负重可活动”关节造形术装置的纵向图。 FIG. 23F is a two-component "mobile bearing" longitudinal arthroplasty device of FIG.

图24为通过一指的径向图(sagittal view)。 Refer to FIG. 24 through a radial FIG (sagittal view). 展示将关节造形术装置插入掌骨头和最接近的指骨的底部之间。 Between the bottom of the display arthroplasty device into a metacarpal bone and the proximal phalange.

图25A为在适当位置处用关节造形术系统显示远端胫骨、距骨和跟骨和其它骨骼的通过踝关节的径向图。 FIG 25A is a display arthroplasty system in place by radially FIG ankle distal tibia, the talus and calcaneus and the other bones. 图25B为显示远端胫骨、远端腓骨和距骨的通过踝关节的冠状切面图(coronal view)。 FIG. 25B to show the distal tibia, the distal fibula and the talus by coronal section in FIG ankle (coronal view). 展示将关节造形术装置插入远端胫骨和胫距关节面之间。 The display arthroplasty device into the distal end of the tibia and the distance between the tibial articular surface. 图25C为显示远端胫骨、距骨和跟骨和其它骨骼的通过踝关节的径向图。 FIG 25C is a display distal tibia, the talus and calcaneus by the ankle bones and other radial FIG. . 也展示软骨表面。 Also showed cartilage surface. 展示将关节造形术装置插入远端胫骨和胫距关节面之间。 The display arthroplasty device into the distal end of the tibia and the distance between the tibial articular surface. 图25D为显示远端胫骨、远端腓骨和距骨的通过踝关节的冠状切面图。 FIG. 25D show the distal end of the tibia, fibula through the ankle joint and a distal coronal section talus FIG. 展示将关节造形术装置插入远端胫骨和胫距关节面之间。 The display arthroplasty device into the distal end of the tibia and the distance between the tibial articular surface.

图26为通过趾的径向图。 FIG 26 through FIG radial toe. 展示将关节造形术装置插入跖骨头和最接近的趾骨的底部之间。 The display arthroplasty device is inserted between the bottom of the metatarsal head and toe closest.

图27A-D为当将本发明的装置植入目标关节中时所使用的方法步骤的方块图。 FIG. 27A-D when the present invention is a method of implanting the joint target used in the step of the block diagram.

图28为适合于用来植入图8L中所展示的装置的植入物导向工具的平面图。 FIG 28 is a plan view of the implant is adapted to be used in the apparatus shown in FIG. 8L implant guide tool.

图29A和B为适合于用来植入图9B中所展示的装置的植入物导向工具的平面图。 29A and B are plan adapted for implantation apparatus shown in FIG. 9B implant guide tool.

具体实施方式 detailed description

给出以下描述使得所属领域的任何技术人员都可以制作和使用本发明。 The following description is given to enable any person skilled in the art can make and use the present invention. 对实施例的各种修正对于所属领域的技术人员来说将变得显而易见,且在不脱离由附着权利要求所界定的精神和范畴的情况下,本文所界定的一般原理可应用于其它实施例和应用中。 Various modifications to the case of the embodiment will become apparent to those skilled in the art, and without departing from the attached claims as defined by the spirit and scope of the generic principles defined herein may be applied to other embodiments and applications. 因而,本发明并不希望局限于所显示的实施例,而是符合与本文所揭示的原理和特征相一致的广泛范围。 Accordingly, the present invention is not intended to limited to the embodiments shown, but is in line with consistent with the principles disclosed herein, and a wide range of features. 为了达到完全理解所揭示的本发明的必要程度,在这篇申请案中所引用的所有颁予的专利、专利公开案和专利申请案的详细描述和图式都以引用的方式并入本文中。 To the extent necessary to achieve a complete understanding of the present invention is disclosed, issued to all patents, patent publications and patent applications in this application cited in the detailed description and drawings are incorporated herein by reference in .

如所属领域的技术人员将了解的,本发明的实施使用(除非另有指示)所属领域技术中常规的x射线成像和处理、x射线断层合成、包括A扫描、B扫描和C扫描的超声波、计算机断层摄影(CT扫描)、核磁共振成像(MRI)、光学相干断层摄影、单光子发射型断层摄影(SPECT)和正子放射型断层摄影(PET)的方法。 As those skilled in the art will appreciate, the embodiments (unless otherwise indicated) skilled in conventional x-ray imaging and processing, x-ray tomosynthesis, the present invention comprises A scan, B-scan and C-scan ultrasound, computed tomography (CT scan), magnetic resonance imaging (MRI), optical coherence tomography, single photon emission tomography (SPECT) and positron emission type tomography (PET) methods. 这些技术在文献中有详细阐释并且不必要在本文中进行描述。 Such techniques are explained in detail in the literature and are not necessarily described herein. 参阅,例如,X-RAY Structure Determination:A Practical Guide,第2版,编辑Stout andJensen,1989,John Wiley & Sons,出版社;Body CT:A Practical Approach,编辑Slone,1999,McGraw-Hill出版社;X-ray Diagnosis:A Physician′sApproach,编辑Lam,1998Springer-Verlag,出版社;和Dental Radiology:Understanding the X-Ray Image,编辑Laetitia Brocklebank 1997,哈佛大学Press出版社。 See, for example, X-RAY Structure Determination: A Practical Guide, 2nd Edition, edited Stout andJensen, 1989, John Wiley & amp; Sons, publishers; Body CT: A Practical Approach, editor Slone, 1999, McGraw-Hill Publishing ; X-ray Diagnosis: A Physician'sApproach, editor Lam, 1998Springer-Verlag, publishers; and Dental Radiology: Understanding the X-ray Image, editor Laetitia Brocklebank 1997, Harvard University Press publishing house.

1、关节的双面或多面评估其中,本发明允许从业者估计和治疗关节缺损,所述关节缺损源自(例如)关节疾病、软骨衰退、骨关节炎、血清反应呈阳性和血清反应呈阴性的关节炎、骨损伤、软骨损伤、外伤和/或由于使用过度或年纪的原因而导致的衰退。 1, or double-sided surface evaluation wherein the joint, the present invention allows the practitioner estimation and treatment of joint defects, the joint defect from (e.g.) a joint disease, cartilage recession, osteoarthritis, were seropositive and seronegative arthritis, bone damage, cartilage damage, trauma, and / or the use of excessive or age reasons caused recession. 所关注的区域的大小,体积和形状可仅包括具有缺损的软骨区域,但也可优选包括在所述软骨缺损周围的软骨部分。 Size, volume and shape of the region of interest may include only having a cartilage defect region, but may also preferably be included in the cartilage surrounding the cartilage defect portion. 另外,所关注的区域的大小、体积和形状可包括软骨下骨、骨髓和其它关节结构,例如半月板、韧带和腱。 Further, the size, volume and shape of the region of interest may include bone, bone marrow, and other articular structures subchondral, e.g. menisci, ligaments and tendons.

图1A是由从业者评估一个关节所采用的步骤的流程图。 FIG 1A is a flowchart of steps practitioner employed a joint evaluation. 首先,从业者获得目标关节10的测量结果。 First of all, the practitioner to obtain objective measurements joint 10. 通过得到关节的图像可完成获得测量结果的步骤。 The results obtained by the step of measuring the joint obtained image can be completed. 这个步骤在必要时可以重复11获得复数个图像从而进一步改进关节评估过程。 This step can be repeated if necessary to obtain a plurality of images 11 to further improve the joint assessment process. 一旦从业者获得必要的测量结果,就使用此信息生成待评估的目标关节的模型表示30。 Once the practitioner to obtain the necessary measurements, use this information to generate the target joint being assessed 30 model representation. 这个模型表示可采用构形图或影像的形式。 This model may take the form of representation or image of the configuration of FIG. 关节的模型表示可以是一维、二维或三维。 Joint representation of the model can be one-dimensional, two-dimensional or three-dimensional. 其可包括一个物理模型。 Which may include a physical model. 需要时可产生多个模型31。 Model 31 may generate a plurality of time required. 无论是原始模型或随后产生的模型或其两者都可以使用。 Either or both of the original model or model can be used subsequently generated. 在生成关节的模型表示30之后,从业者可视情况在正确的条件下生成目标关节的投影模型表示40。 After the model representation of the joint generated 30, the practitioner can optionally generate a projected model representation of target joint 40 under the right conditions. 这个过程在必要或需要时仍可以重复41。 This process still can be repeated 41 as necessary or desired. 选择过程50使用关节的构形条件与关节的投影影像之间的差异按需要地进行重复来实现所需的结果。 The difference between the configuration of the projected image and the condition of the joint 50 using the joint selection process is repeated to achieve the desired results according to need.

如所属领域的技术人员将了解的,如箭头32所示,从业者可直接从生成目标关节的模型表示30的步骤直接进行到选择合适的关节替代植入物50的步骤。 As those skilled in the art will appreciate that, as shown by the arrows, the practitioner may represent a model generated from the target joint 32 to the step 30 directly select a suitable joint replacement implant 50 of the step. 另外,选择了合适的关节替代植入物50之后,如流程24、25、26所示,获得目标关节的测量结果10、生成目标关节的模型表示30和生成投影模型40的步骤可以连续地或并行地重复。 Further, choose the appropriate joint replacements after 50, 24, 25 as shown in Scheme implant, obtain a measurement of a target joint 10, generating model representation of target joint 30 and generating projected model in step 40 may be continuously or repeated in parallel.

图1B是显示由从业者评估关节所采用步骤的替代流程图。 FIG 1B is a flowchart illustrating alternative steps employed joint evaluation by the practitioner. 首先,从业者获得目标关节的测量结果10。 First of all, the practitioner to obtain measurements of a target joint 10. 通过得到关节的图像可完成获得测量结果的步骤。 The results obtained by the step of measuring the joint obtained image can be completed. 这个步骤在必要时可以重复11来获得复数个图像从而进一步改进关节评估过程。 This step can be repeated if necessary to obtain a plurality of images 11 to further improve the joint assessment process. 一旦从业者获得必要的测量结果,就使用此信息生成待评估的目标关节的模型表示30。 Once the practitioner to obtain the necessary measurements, use this information to generate the target joint being assessed 30 model representation. 这个模型表示可采用构形图或影像的形式。 This model may take the form of representation or image of the configuration of FIG. 关节的模型表示可以是一维、二维或三维。 Joint representation of the model can be one-dimensional, two-dimensional or three-dimensional. 在必要或需要时可重复该过程31。 When necessary or desired procedure may be repeated 31. 可包括一个物理模型。 It can include a physical model. 在评估了关节的模型表示30之后,从业者可视情况在正确的条件下生成目标关节的受保护的模型表示40。 After evaluating the model representation of the joint 30, the practitioner can optionally generate a protected model representation of the target joint 40 under the right conditions. 这个过程在必要或需要时可以重复41。 This process may be repeated as necessary or desired 41. 从业者使用关节的构形条件与关节的投影影像之间的差异可接着设计合适的关节植入物52来实现正确的关节解剖,必要时就重复设计过程53来实现所需的植入物设计。 The difference between the configuration of the joint condition of the practitioner using the projection image of the joint can be achieved then the correct design of a suitable joint anatomy joint implant 52, the design process is repeated 53 as necessary to achieve the desired implant design . 从业者还可以评估提供另外的特征(例如边缘、销钉或锚定器)是否可以提高目标关节中的植入物性能。 Practitioners may also provide additional characteristics evaluation (e.g. edges, pins or anchors) can be increased if the implant performance in the target joint.

如所属领域的技术人员将了解的,如箭头38所示,从业者可直接从生成目标关节的模型表示30的步骤进行到设计合适的关节替代植入物52的步骤。 As those skilled in the art will appreciate that, as shown by the arrows, the practitioner may be expressed directly from step 30 to generate the model of the target joint 38 to the step of designing a suitable joint replacement implant 52. 类似于上文所示的流程,设计了合适的关节替代植入物52之后,如流程42、43、44所示,获得目标关节的测量结果10、生成目标关节的模型表示30和生成投影模型40的步骤可以连续地或并行地重复。 After the process similar to that shown above, the design of suitable joint replacement implant 52, 43, 44 as shown in the flow, the measurement results obtained target joint 10, generating model representation of target joint 30 and generating projected model step 40 may be repeated in parallel or sequentially.

所选定的或设计的关节植入物实现与关节的现有表面相适的解剖或近似的解剖构造,同时展现一个匹配的表面用于复制天然关节解剖构造的相对的关节表面。 Selected or designed to achieve a joint implant articular surface of the existing appropriate anatomical anatomy or similar, opposing articular surface while exhibiting a matching surface for replication of the natural joint anatomy. 在这种情况下,可以评估关节现有的表面以及所需的所得的关节表面。 In this case, evaluating existing articular surface and the articular surface of the resulting desired. 这个技术对于未锚定到骨骼中的植入物特别有用。 This technique is not particularly useful for anchoring the implant into the bone.

图2说明股骨远端的关节软骨的三维厚度图的色彩再现。 Figure 2 illustrates the distal femur articular cartilage color three-dimensional thickness map reproduction. 可从(例如)超声波、CT或MRI数据生成3维厚度图。 From (e.g.) ultrasound, CT or MRI data generating 3-dimensional thickness map. 软骨物质内的黑洞指示整个厚度软骨缺失的区域。 Black Hole indicates the entire thickness of cartilage loss of cartilage material within the region. 从3维厚度图可对软骨损伤的大小和形状的作出判断。 Determination may be made to the size and shape of the cartilage damage from the 3-dimensional thickness map.

如所属领域的技术人员将了解的,可使用任何合适的技术获得大小、曲度和/或厚度测量结果。 As those skilled in the art will appreciate, any suitable technique may be used to obtain the size, curvature and / or thickness measurements. 举例而言,可使用合适的机械构件、激光装置、电磁或光学跟踪系统、铸模、应用到变硬和“记忆表面轮廓”的关节表面的材料和/或所属领域已知的一种或更多种成像技术获得一维、二维和/或三维测量结果。 For example, using suitable mechanical means, laser devices, electromagnetic or optical tracking systems, molds, materials applied to the hard and "surface contour memory" of the articular surface and / or known in the art one or more types of imaging can obtain one-, two- and / or three-dimensional measurements. 可无需插补和/或外科手术(例如,使用探针或其它手术装置)而获得测量结果。 Used without interpolation and / or surgery (e.g., using a probe or other surgical device) to obtain a measurement result. 如所属领域的技术人员将了解的,修复装置的厚度可在任何给定时刻发生变化,这取决于在关节表面的任何特定位置上将要修复的软骨和/或骨骼的损伤深度。 As those skilled in the art will appreciate, the thickness of the repair device can vary at any given moment, depending on cartilage and / or bone lesion depth in any particular location on an articular surface to be repaired.

A.成像技术如所属领域的技术人员将了解的,适用于测量发病软骨区域或软骨缺失的厚度和/或曲度(例如软骨和/或骨骼的)或大小的成像技术包括使用x射线、核磁共振成像(MRI)、计算机断层摄影扫描(CT,也称为计算机轴向断层扫描或CAT)、光学相干断层摄影、SPECT、PET、超声波成像技术和光学成像技术。 A. imaging techniques as those skilled in the art will appreciate, the area for measuring the incidence of cartilage or cartilage loss of thickness and / or curvature (such as cartilage and / or bone) or size include the use of x-ray imaging techniques, nuclear magnetic resonance imaging (MRI), computed tomography scanning (CT, also known as computerized axial tomography or CAT), optical coherence tomography, SPECT, PET, ultrasound imaging and optical imaging. (参阅2002年3月21日公开的Alexander等人的国际专利公开案WO02/22014;2002年4月16日颁予Tsoref等人的美国专利第6,373,250号;和Vandeberg等人的(2002)放射线学(Radiology)222:430-436)。 (See 2002 March 21 public Alexander et al., International Patent Publication WO02 / 22014; US Patent No. 6,373,250, 2002 April 16, issued to Tsoref et al; and Vandeberg, et al. (2002) radiology (Radiology) 222: 430-436). 使用任何投药路径(例如,通过静脉、关节内等)可使用对比剂或其它增强试剂。 Any route of administration (e.g., by intravenous, intraarticular, etc.) may be used or other contrast enhancing agents.

在某些实施例中,使用CT或MRI评估组织、骨骼和其中的任何缺损(例如软骨损害或发病软骨区域)从而获得与软骨下骨或软骨衰退有关的信息并且提供关于损伤区域的形态上或生化上或生物力学上的信息。 In certain embodiments, the use of CT or MRI evaluation tissues, bone defects, and wherein any (e.g. cartilage lesions or cartilage onset region) so as to obtain information relating to bone or cartilage decay and provides information about the morphology of the damaged area or subchondral information on the biochemical or biomechanical. 具体而言,使用一个或一个以上这些方法可探测到例如裂缝、部分厚度或全厚度软骨缺失的改变和剩余软骨内的信号改变。 Specifically, using one or more of these methods can detect the change signal changes within residual cartilage such as cracks, partial thickness or full thickness cartilage loss, and. 对于基本NMR原理和技术的讨论,可参阅MRI基本原理和应用(MRI Basic Principles and Applications),第二版,MarkA.Brown和RichardC.Semelka,Wiley-Liss有限公司(1999)。 For a discussion of the basic principles and techniques of NMR, MRI can see the basic principles and applications (MRI Basic Principles and Applications), second edition, MarkA.Brown and RichardC.Semelka, Wiley-Liss, Ltd. (1999). 对于MRI(包括常规的T1和T2加权自旋回波成像、梯度回波(GRE)成像、磁转换对比(MTC)成像、快速自旋回波(FSE)成像、增强对比成像、快速获得松弛增强(RARE)成像、稳定状态下获得梯度回波(GRASS)和驱动平衡傅立叶转换(DEFT)成像)用于获得与软骨有关的信息的讨论,参阅Alexander等人的WO 02/22014。 For MRI (including conventional T1 and T2-weighted spin echo imaging, gradient echo (GRE) imaging, magnetic switching contrast (MTC) imaging, fast spin echo (FSE) imaging, contrast enhanced imaging, rapid relaxation enhancement is obtained (the RARE ) obtaining a gradient echo (the GRASS) imaging at steady state and drive the equilibrium Fourier transform (DEFT) imaging) for information related to the discussion of the cartilage is obtained, see Alexander et al. WO 02/22014. 因而,在优选实施例中,所获得的测量结果是基于所获得的如Alexander等人的WO 02/22014中所描述的关节的三维影像或最终形成3D信息的多组二维影像。 Thus, in a preferred embodiment, the measurement results obtained is based on the plurality of sets of two-dimensional image three-dimensional image of the obtained joints Alexander et al., As described in WO 02/22014 or final form 3D information. 可获得软骨单独的或与关节的移动模式(例如,弯曲到伸展、平移和/或软转)相结合的二维、三维图像或图。 Alone or cartilage obtained with joint movement pattern (e.g., the curved extension, translation and / or rotation soft) combines the two-dimensional, or three-dimensional image of FIG. 三维图像可包括与移动模式、接触点、两个或多个相对关节表面的接触带和在关节移动期间接触点或带的移动有关的信息。 It may include a three-dimensional image, a contact point with two or more contact opposing articular surface and information about the movement pattern during the joint movement of the contact point of the belt or movement. 二维或三维图像可包括与关节软骨的生化组分相关的信息。 May include two or three dimensional image associated with a biological component information articular cartilage. 另外,成像技术可随时间进行比较(例如),提供与所需的修复材料的形状和类型相关的最新信息。 In addition, imaging techniques can be compared over time (e.g.), the latest information related to the shape and type of repair material.

本文所描述的任何成像装置还可以在手术中使用(参阅下文),例如使用手持超声波和/或光学探针在外科手术中使关节表面成像。 Any image forming apparatus herein described may also be used (see below) during surgery, for example, hand-held ultrasound and / or optical imaging probe articular surface during the surgical manipulation.

B.外科手术测量另外,或除了上述的非插补性成像技术之外,在关节内窥镜检查或公开的关节切开手术期间可在手术中获得发病软骨区域或软骨缺失区域的大小的测量结果、软骨厚度和/或软骨或骨骼曲度的测量结果。 B. Further measurements surgery, or in addition to the non-imaging interpolation technique to measure the size of the cut can be obtained onset cartilage region or area of ​​cartilage loss during surgery or arthroscopy disclosed in joint during surgery As a result, measurements of cartilage thickness and / or curvature of cartilage or bone. 外科手术中的测量结果可涉及或不涉及与一个或一个以上关节表面区域的实际接触。 The measurement results of surgery may or may not involve actual contact with one or more regions of the articular surface.

适用于获得软骨或骨骼或其它软骨关节结构的外科手术中的测量结果并且生成表面的构形图的装置包括(但不限于)泼拉西多盘和激光干涉仪,和/或可变形材料或装置。 Suitable for obtaining measurements of cartilage or bone surgery, or other articular cartilage structure and configuration of the device of FIG surface include (but are not limited to) multi-disk and throwing Raschig laser interferometers, and / or deformable material or generated device. (参阅,例如2002年5月17日颁予Wooh等人的美国专利第6,382,028号;2000年5月2日颁予Levesque等人的6,057,927;1996年6月4日颁予Yamane等人的5,523,843;1998年12月8日颁予Sarver等人的5,847,804和1997年11月4日颁予Fujeda的5,684,562)。 (See, for example, 2002 May 17 awarded US Patent No. 6,382,028 Wooh, et al; 2000 May 2 issued to Levesque et al, 6,057,927; 1996 June 4, issued to Yamane et al, 5,523,843; December 8, 1998, issued to Sarver, et al. 5,847,804 and November 4, 1997 awarded Fujeda of 5,684,562).

图3A说明集中排列光环的泼拉西多盘。 3A illustrates arrangement of focused multi Raschig halo splash plate. 泼拉西多盘的集中阵列投影良好界定的具有变化半径的光环,这些光环可由经过光纤传输的激光或白光生成。 Multi-disc concentrated splash Rasi projection array having a well-defined halo of varying radius, these rings may be transmitted through the optical fiber to a laser or Bai Guangsheng. 泼拉西多盘可附着在内窥镜装置的末端(或附着在任何探针上,例如手持式探针),使得可将光环投影到软骨表面上。 Raschig multi-disk splash at the end of the endoscope can be attached to the device (or attached to any probe, for example, a hand-held probe) so that the halo may be projected onto the cartilage surface. 图3B说明经投影到固定曲度的表面上的泼拉西多盘的实例。 3B illustrates example via a projection onto the surface of the fixed curvature splash Raschig multiple discs. 可使用一个或一个以上相机(例如附着在装置上)捕获光环的反射。 You may use one or more cameras (e.g., attached to the device) to capture reflection halo. 使用数学分析确定表面曲度。 Use mathematical analysis to determine the surface curvature. 然后该曲度可(例如)作为软骨表面的彩色码的构形图显现在监控器上。 The curvature can then (for example) the configuration of FIG cartilage surface as a color code appearing on the monitor. 另外,可使用构形图的数学模型确定理想的表面构形,替换所分析区域中的任何软骨缺损。 Further, the configuration may be used to determine a mathematical model of FIG ideal surface topography to replace any cartilage defects in the area analyzed. 还可将该经计算的理想表面显现在监控器上(例如图2中所示的3维厚度图),并且可用于选择替代材料或再生材料的表面曲度。 The surface may also be calculated over appearing on the monitor (e.g., 3-dimensional thickness map shown in FIG. 2), and may be used to select alternative materials or recycled materials of the surface curvature.

图4显示由在每个股骨髁上投影集中的光环(泼拉西多盘)所产生的映象,证实了反射环上的表面轮廓中的变化效果。 Figure 4 shows a map projection on each femoral condyle concentrated halo (Raschig splash multi-plate) is produced, confirming the effect of the change on the reflecting surface profile of the ring.

类似地,激光干涉仪也可以附着在内窥镜装置的末端。 Similarly, the laser interferometer can also be attached at the end of the endoscope apparatus. 另外,一个小的传感器可复制在装置上以使用相移干涉测量确定软骨表面或骨骼曲度,从而产生软骨表面的条纹样式分析相位视觉图(前导波)。 In addition, a small sensor may be replicated on the device using a phase shifting interferometry to determine the curvature of cartilage or bone surface, whereby cartilage surface produce striped pattern analysis phase of visual images (leading wave). 然后可将曲度作为软骨表面的彩色码的构形图显现于监控器上。 It may then be used as the cartilage surface curvature configuration of FIG color code appearing on the monitor. 另外,可使用构形图的数学模型确定理想的表面构形以替代所分析区域中的任何软骨或骨骼缺损。 Further, a mathematical model may be used to determine the configuration of FIG ideal surface topography to replace any cartilage or bone defects in the area analyzed. 还可将该经计算的理想表面显现在监控器上并且可用于选择替代软骨的曲度。 The desired surface may also be calculated by appearing on a monitor and may be used to select the curvature of the cartilage substitute.

所属领域的技术人员将容易意识到,在不脱离本发明的范畴的情况下可使用用于光学测量软骨表面曲度的其它技术。 Those skilled in the art will readily appreciate without departing from the scope of the invention may use other techniques for optical measurements of the cartilage surface curvature. 举例而言,可生成(例如)图5和图6中所示的2维或3维图。 By way of example, may be generated (e.g.) in FIG. 5 and FIG. 2 or 3 dimensions shown in FIG. 6.

机构也可用于外科手术测量,例如可变形材料(例如凝胶体、铸模、任何变硬材料(例如直到加热、冷却或进行其它操作时才不可变形的材料))。 Mechanism can also be used for surgical measure, for example, deformable material (e.g. gels, molds, any hardening materials (e.g. up to heating, cooling or other material when the operation is not deformable)). 参阅Dickson等人的2002年5月2日公开的WO 02/34310。 See Dickson et al., WO 2002 May 2 public 02/34310. 举例而言,可对股骨髁应用可变形凝胶体。 For example, the femoral condyle can be applied to the deformable gel. 指向骨节的凝胶体侧可生成骨节的表面轮廓的阴模。 Gel point-side condyle surface profile may be generated condyle female mold. 然后该阴模可用于确定缺损的大小、缺损的深度和缺损中或周围的关节表面的曲度。 The female mold is then used to determine the size of the defect, the curvature of the articular surface defects and the depth of defects in or around. 这个信息可用于选择一种疗法,例如,一种关节表面修复系统。 This information may be used to select a therapy, for example, one joint surface repair system. 在另一个实例中,可对关节表面(例如股骨髁或胫骨平台)应用变硬材料。 In another example, the material can be applied to hard articular surface (e.g., femoral condyle or tibial plateau). 所述变硬材料可留在关节表面上直到变硬。 The hardened material may be left on the articular surface until hardening. 然后可将变硬材料从关节表面移除。 Then hardened material can be removed from the articular surface. 指向关节表面的变硬材料侧面可生成关节表面的阴模。 Directed hard articular surface of the articular surface material side may generate the female mold. 然后该阴模可用于确定缺损的大小、缺损的深度和缺损中或周围的关节表面的曲度。 The female mold is then used to determine the size of the defect, the curvature of the articular surface defects and the depth of defects in or around. 这个信息可用于选择一种疗法,例如,一种关节表面修复系统。 This information may be used to select a therapy, for example, one joint surface repair system. 在一些实例中,变硬系统可保持在合适的位置并且形成实际的关节表面修复系统。 In some examples, the system may be maintained hardens in place and form the actual articular surface repair system.

在某些实施例中,可变形材料包括复数个可个别移动的机械元件。 In certain embodiments, the deformable material comprises a plurality of individually movable mechanical element. 当压住所关注表面时,可在相对的方向上推动每个元件并且其推动(变形)的程度可对应于所关注表面的曲度。 When pressed against the surface of interest, each element can be pushed in a direction opposite to the push and degree (deformation) may correspond to the curvature of the surface of interest. 该装置可包括一个制动机构,使得可将所述元件固定在与软骨和/或骨骼的表面相符的位置。 The apparatus may comprise a braking mechanism, so that the element can be secured in a position consistent with and / or bone cartilage surface. 然后可从病人身上移走装置并进行曲度分析。 It may then be removed from the analysis means and march patient. 或者,每个可个别移动的元件可以包括指示变形到一个给定程度的数量和/或程度的标记。 Alternatively, each movable element may be individually modified to include an indication of the degree of a given number and / or extent of markers to. 相机可以用在手术中使装置成像并且所述影像可以进行保存并用于分析曲度信息。 The camera may be used in surgical manipulation and the image forming apparatus can be saved and analyzed for curvature information. 合适的标记包括(但不限于)实际的线性测量(米制或英制),对应于不同量的变形和/或相同色彩的不同的暗度和色调的不同色彩。 Suitable labels include (but are not limited to) the actual linear measurements (metric or imperial), corresponding to different amounts of deformation and / or darkness of different colors and different shades of the same color. 还可使用电子构件测量可移动元件的位移。 Electronic components may also be measured using the displacement of the movable member.

外科手术中测量软骨和软骨下骨的其它装置包括(例如)超声波探针。 Other surgical devices and measuring cartilage subchondral bone include (e.g.) an ultrasonic probe. 可对软骨应用(优选是手持式的)超声波探针并且可测量出软骨和/或软骨下骨的曲度。 Cartilage can be applied (preferably hand-held) and the ultrasound probe measurable curvature cartilage and / or subchondral bone. 另外,可以评估软骨缺损的大小并且可确定关节软骨的厚度。 Further, the size of the cartilage defect can be assessed and the thickness of the articular cartilage can be determined. 可在A模式、B模式或C模式中获得这种超声波测量。 Such ultrasound measurements can be obtained in the A mode, B mode or C mode. 如果获得A模式的测量,那么操作员通常可以若干不同的探针定向(例如,侧斜位和前后位)重复该等测量,以得到大小、曲度和厚度的三维评估。 If A-mode measurements is obtained, the operator typically several different probes can be oriented (e.g., anteroposterior and lateral oblique) repeating these measurements, to obtain a three-dimensional assessment of size, curvature and thickness.

所属领域的技术人员将容易意识到,使用光学、激光干涉仪、机械和超声波探针可使不同的探针设计成为可能。 Those skilled in the art will readily appreciate that the use of optical, laser interferometer, mechanical and ultrasound probes allow different probe designs. 探针优选是于持式的。 The probe is preferably held in a formula. 在某些实施例中,探针或至少一部分探针,一般是与组织相接触的探针是消过毒的。 In certain embodiments, at least a portion of the probe or the probe, the probe is generally in contact with the tissue is sterile. 使用消过毒的盖子可实现无菌性,例如类似于Lang的1999年2月25日公开的WO 99/08598A1中所揭示的。 Using sterile cover sterility can be achieved, for example, similar to Lang February 25, 1999 disclosed WO 99 / 08598A1 disclosed.

使用成像测试和/或外科手术测量进行的与关节软骨或软骨下骨有关的分析可以用于确定发病软骨或软骨缺失区域的大小。 Related bone articular cartilage or cartilage analysis using imaging tests and / or surgery may be used to determine measurements of cartilage or cartilage loss incidence size of the area. 举例而言,曲度在软骨缺失的区域中可突然发生改变。 For example, curvature may occur in the region of abrupt changes in cartilage loss. 曲度的这种突然的或意外的改变可用于探测发病软骨或软骨缺损的界线。 This sudden or unexpected change in curvature of the boundary may be used to detect the onset of cartilage or cartilage defects.

II.关节的单个表面的评估现在转到图7A,提供了一个结构图,显示了用于执行关节的单个表面的评估的步骤。 II. ASSESSMENT single joint surface Turning now to Figures 7A, a block diagram is provided showing steps performed for the assessment of a single surface of the joint. 如图1A和图1B,其获得目标关节的图像或测量结果60。 1A and 1B, the target joint which is obtained images or measurements 60. 其后,采取一个测量方法辅助选择一个适当的装置矫正缺损70。 Thereafter, a measurement method adopted to select a suitable auxiliary means 70 to correct the defect. 需要时可重复测量或成像步骤来促进识别大多数适当的装置以修复缺损80。 Measuring or imaging steps can be repeated if necessary to facilitate identification of most suitable means 80 to repair the defect. 一旦采取了测量方法,就选定一个装置用于矫正缺损90。 Once the measurements taken, to select a means for correcting the defect 90. 在这种情况下,仅复制关节的一个表面。 In this case, only a copy of the joint surface. 这种技术对于包括将植入物锚定入骨骼的机构的植入物尤其有用。 This technique is particularly useful for the implant comprises an anchoring means thereof into bone implants. 因而,所述植入物具有至少一个表面,其使用至少一个第二表面复制关节表面,所述第二表面与某些或所有的待修复的损伤关节的关节表面或骨骼有联系。 Accordingly, the implant has at least one surface, using at least a second articular surface replication surface, the second surface of the articular surface of the joint damage some or all of the bone to be repaired or associated.

如所属领域的技术人员将了解的,如由箭头38所示,从业者可从测量关节缺损70的步骤直接进行到选择合适的装置来修复缺损80的步骤。 As those skilled in the art will appreciate, suitable means such as by an arrow, the practitioner can proceed directly to step 38 from the selected measurement joint defect 70 to repair the defect 80 of the step. 另外,获得目标关节的测量结果60、测量关节缺损70、识别适合的装置来修复缺损80、选择装置来修复缺损90中的任何的或所有的步骤在需要时可重复一次或一次以上61、71、81、91。 Further, the measurement results obtained target joint 60, measuring a joint defect 70, identifying device suitable to repair the defect 80, the selecting means or to repair any defects in all of the steps 90 may be repeated one or more times if desired 61,71 , 81, 91.

类似于上述流程,在选择装置来修复缺损90之后,如由箭头65、66、67所示,获得目标关节的测量60、测量关节缺损70、识别合适的装置来修复缺损80的步骤可连续地或并行地重复。 After the process similar to the above, the selecting means 90 to repair the defect, as indicated by arrows 65, 66, obtain a measurement of a target joint 60, measuring a joint defect 70, the step 80 of identifying suitable means to repair the defect can be continuously parallel or repeated.

图7B显示了一种替代的方法。 Figure 7B shows an alternative method. 提供了一个结构图,显示执行关节的单个表面的评估的步骤。 Providing a structural diagram showing a step of performing a single surface assessment of the joint. 如图1A和图1B,其获得目标关节的图像或测量结果60。 1A and 1B, the target joint which is obtained images or measurements 60. 其后,采取一个测量方法辅助选择一个适当的装置以矫正缺损70。 Thereafter, a measurement method adopted to select a suitable auxiliary means 70 to correct the defect. 需要时可重复测量或成像步骤来促进识别大多数适当的装置以修复缺损80。 Measuring or imaging steps can be repeated if necessary to facilitate identification of most suitable means 80 to repair the defect. 一旦采取了测量方法,就制造一个装置用于矫正缺损92。 Once the measurements taken, to make a device 92 for correcting the defect.

如所属领域的技术人员将了解的,如由箭头39所示,从业者可从测量关节缺损70的步骤直接进行到选择制造装置来修复缺损92的步骤。 As those skilled in the art will appreciate that, as shown in step 70 the practitioner may defects measured by the arrow 39 from the joint directly to the selection step of the manufacturing apparatus to repair the defect 92. 另外,获得目标关节的测量结果60、测量关节缺损70、识别适合的装置来修复缺损80、制造装置来修复缺损92中的任何的或所有的步骤在需要时可重复一次或一次以上61、71、81、93。 Further, the measurement results obtained target joint 60, measuring a joint defect 70, identifying device suitable to repair the defect 80, the manufacturing apparatus to repair a defect in any or all of the 92 steps may be repeated if necessary one or more times 61, 71 , 81,93.

类似于上述流程,在制造装置来修复缺损92之后,如由箭头76、77、78所示,获得目标关节的测量结果60、测量关节缺损70、识别合适的装置来修复缺损80的步骤可连续地或并行地重复。 Similar to the above process, after the manufacturing apparatus to repair the defect 92, as indicated by arrows 77, 78, to obtain measurements of a target joint 60, measuring a joint defect 70, identifying device suitable to repair the defect 80 may be a continuous step repeatedly or in parallel.

各种方法可用于在单个表面的评估期间促进关节建模。 Various methods can be used to facilitate joint model during the evaluation of a single surface. 举例而言,使用与软骨的厚度和曲度有关的信息,可产生关节软骨和/或下骨的表面模型用于任何关节。 For example, the thickness and curvature information on use and cartilage, articular cartilage may be generated and / or bone surface model used for any joint. 关节的模型表示可以是一维、二维或三维。 Joint representation of the model can be one-dimensional, two-dimensional or three-dimensional. 可包括一物理模型。 It can include a physical model. 这个物理模型可以代表关节内的有限区域或可以涵盖整个关节。 This physical model can be representative of a limited area within the joint or can encompass the entire joint.

更具体而言,在膝关节中,物理模型仅可涵盖中间的或侧面的股骨髁、股骨髁和切口区域、中间的胫骨平台、侧面的胫骨平台、整个胫骨平台、中间的膝盖骨、侧面的膝盖骨、整个膝盖骨或整个关节。 More specifically, in the knee joint, the physical model only encompass femoral condyle or the side of the intermediate patella femoral condyles and the notch region, the medial tibial platform, the side of the tibial plateau, the entire tibial plateau, the middle of the knee, the side , the entire patella or the entire joint. 可确定关节发病区域的位置,例如使用3D坐标系统或Alexander等人的WO02/22014中所描述的3D欧几里德距离转换或拉普拉斯转换。 You can determine the position of incidence of the joint region, for example, a Euclidean distance in 3D 3D coordinate system or Alexander et al. WO02 / 22014 described the conversion or Laplace transform.

以这种方式,可精确确定待修复的缺损的大小。 In this manner, an accurate determination of the size of the defect can be repaired. 如将显而易见的,一些,但不是全部缺损可包括小于整个软骨。 As will be apparent, some, but not all may comprise less than the entire cartilage defect. 测量在一个或一个以上软骨缺损周围的正常发病的或仅仅是轻微发病的软骨厚度。 Measuring a normal incidence around one or more cartilage defects is only mild disease or cartilage thickness. 可在单个点或复数个点上获得这个厚度测量结果。 This thickness measurement can be obtained at a single point or plural points. 采取越多的测量步骤,测量结果就变得越精密和精确。 Take more measured steps, measurement becomes more precise and accurate. 因而,可在(例如)第2点、第4-6点、第7-10点、大于10点或整个剩余软骨处进行测量。 Thus, it may be (e.g.) a second point, 4-6 points, 7-10 points, more than 10 points or at the entire remaining cartilage is measured. 可获得二维和三维测量结果。 Two-dimensional and three-dimensional measurement results can be obtained. 另外,一旦确定缺损的大小,可选择有关适当的疗法(例如,替代等于或略微大于覆盖一个或一个以上关节表面的发病软骨的植入或植入物),使得可尽可能多地保护健康的周围组织。 Further, once the size of the defect is determined, the relevant select appropriate therapy (e.g., alternatively equal to or slightly larger than the coverage of one or more articular surface of the cartilage implant onset or implant), such that as much as possible to protect the health of surrounding tissue.

或者,可测量关节表面或下骨的曲度来设计和/或定形修复材料。 Alternatively, the measure of the bone or articular surface curvature designed and / or shaped repair material. 在这种情况下,可测量剩余软骨的厚度和关节表面的曲度来设计和/或定形修复材料。 In this case, to measure the thickness and curvature of the articular surface cartilage remaining designed and / or shaped repair material. 或者,可测量软骨下骨的曲度,并且所得的测量结果可用于设计、生产、选择和/或定形一个软骨替代材料。 Alternatively, the curvature of measurable bone cartilage, and the resulting measurements may be used to design, produce, selecting and / or setting a cartilage replacement material.

III.关节装置当前的装置是一个假体。 III. CURRENT device is a prosthetic joint device. 通过将现有软骨和/或骨骼的轮廓投影到自然关节结构的有效仿制形态上而确定假体或装置的形状。 Determining the shape of the prosthetic device or by projecting the existing cartilage and / or bone contour effective to form the natural joint generic structure. 装置大体上复原正常的关节排列和/或将适合的或大体适合的表面提供到紧密配合的相对的关节表面的最初或自然的关节表面。 Means substantially restoring normal joint alignment and / or appropriate or suitable surface substantially opposite to the articular surface to provide a close fit of the initial or natural articular surface. 另外,其实质上可消除其它衰退,因为装置的相符表面提供与关节的现有关节表面匹配的解剖结构或近似解剖结构。 Further, it may be substantially eliminate other recession provided as surface consistent with the conventional apparatus articulation surface matching or approximate anatomy anatomy. 经由一个小(例如,3cm到5cm)切口完成装置的插入并且不需要切除骨骼或对装置进行机械固定。 Via a small (e.g., 3cm to 5cm) incision complete insertion device and does not require bone resection or mechanical fixation means. 然而,所属领域的技术人员将了解,可提供额外的结构,例如横臂、翅片、销钉、齿状物(例如锥形的、三角形的、球形的或圆锥形的凸起)、或插针,这些结构能增强装置更有效地固定在关节表面上的能力。 However, those skilled in the art will appreciate, may provide additional structures, such as arm, fins, pins, teeth (e.g. tapered, triangular, spherical or conical projections), pins, or these structures can enhance the ability of the device on the articular surface more effectively fixed. 可容易地移除干扰装置放置的骨赘或其它结构。 Osteophytes can be easily removed or other structural interference device is placed. 通过占据解剖结构或近似解剖结构中的关节空间,所述装置改进了关节的稳定性并且复原了关节正常的或近似正常的机械排列。 By occupying the approximate anatomy or anatomy of the joint space, it improves the stability of the joint means and restoring the normal or near normal arrangement of mechanical joints.

通过获得和分析特定对象的图像并且设计与患者的关节解剖结构(软骨和/或骨骼)大体相符的装置,同时通过考虑到上述的现有关节表面解剖结构,可确定本文所述的装置的精确尺寸。 Exact design and joint anatomy of the patient (cartilage and / or bone) substantially match means, and by taking into consideration the above-described conventional articular surface anatomy may be determined herein by the specific object image is obtained, and the analysis device size. 因而,可为个体量身定做本装置的实际形状。 Thus, the actual shape of the present device can be tailored to the individual.

本发明的假体装置可以是适合不需要切除骨骼的微创、外科植入的装置。 The prosthetic device according to the present invention may be adapted not require bone resection minimally invasive, surgical implantation of the device. 所述装置可(但不一定需要)黏附到骨骼上。 The device may be (but need not) adhere to the bone. 举例而言,在膝盖中,装置可以是未分割的,也就是说,将其定位在一个隔室中,在该隔室中正常放置着自然的半月板。 For example, in the knee, the device may be undivided, that is, its positioning in a compartment, the compartment normally set the natural meniscus. 自然的半月板可以保持在适当的位置上或可以将其全部或部分移除,这取决于其状态。 The natural meniscus may be maintained at an appropriate position or may be wholly or partially removed, depending on its state. 在一般情形下,移除已经被拉掉的自然的半月板片,并且必要时可修整受损伤的区域。 In the general case, it has been pulled out to remove the natural meniscus sheet, trimming area may be damaged and when necessary. 或者,可移除所有剩余的半月板。 Alternatively, to remove all remaining meniscus. 这可以通过用于插入装置的切割步骤来完成。 This may be accomplished by the insertion device for cutting step. 对于许多植入物来说,还可以用关节镜方法完成,产生一个1-15cm长的切口,但优选为1-8cm长,并且更优选为1-4cm。 For many implants, it may also be accomplished by arthroscopic methods, to produce a 1-15cm long incision, but is preferably 1-8cm length, and more preferably from 1-4cm.

本文所述的植入物可在相同的平面(例如前后的或内外侧的或下侧或倾斜的平面)内或多个平面内具有变化的曲度和半径。 Within (e.g. plane or inside or outside the front and rear sides or inclined) of the implant described herein may be in the same plane or with a varying radius of curvature and a plurality of planes. 以这种方式,可定形关节表面修复系统从而实现植入物与植入处之间解剖结构或近似解剖结构的排列。 In this manner, the articular surface repair system can be shaped so as to realize an anatomical structure between the implant and the implant at or near the anatomical structure of the arrangement. 这种设计不仅允许不同程度的凸面或凹面,而且允许主体凸形内的凹入部分或反之亦然。 This design not only allows for different degrees of convex or concave, or vice versa, but also allows the recessed portion of the male body. 与修复中的关节紧密配合的植入物的表面可具有不定的布局,其可以是对修复中的关节表面的物理损伤的函数。 Surface of the implant and repair of joint may have a close-fitting indefinite layout, which may be a function of the articular surface repair physical damage. 尽管如此,所属领域的技术人员仍将意识到,可以基于通常的损伤式样制作植入物。 Nevertheless, those skilled in the art will appreciate that based on the usual pattern of damage produced implants. 还可以基于发生损伤前的关节结构的期望的正常协调制作植入物。 The implant can also be made based on the normal coordination of the desired configuration of the joint before damage occurs.

另外,制作植入物可解决在关节移动期间相对表面的形状所发生的改变。 Further, making the implant surface shape corresponding change resolves occurring during movement of the joints. 因而,植入物可解决在弯曲、伸展、外展、旋转、平移、滑动和其组合期间一个或一个以上的关节表面的形状的改变。 Thus, the implant can solve in flexion, extension, abduction, rotation, translation, or a change in shape of the articular surface of one or more thereof during the sliding and combinations thereof.

本文所描述的装置优选是边缘可转移的和自动定心的。 The apparatus described herein is preferably transferable edge and self-centering. 因而,在自然连接关节期间,允许装置作轻微移动,或在适当时改变其位置用来协调关节的自然移动。 Thus, during the natural joint connection, means for allowing slight movement, or change its position appropriate to coordinate the movement of the natural joint. 然而,装置在关节中并不是自由漂浮的。 However, the device is not a free-floating in the joints. 另外,通过在移动关节期间从第一位置平移到第二位置,当反向移动关节并且到达先前的位置时,装置趋于返回到其大体上原来的位置。 Further, during the movement of the joint from a first position to a second position, when the reverse movement of the joint and reaches the previous position, the device tends to return to its substantially original position. 结果,装置并不趋于渐进地“爬”向其所位于的隔室的一侧。 As a result, one side of the apparatus does not tend to progressively "creep" of the compartment to which it is located. 表面的不定布局以及植入物的稍微不规则形状促进植入物的自动定心性能。 Indefinite layout and slightly irregular surface of the implant to promote self-centering properties of the implant.

装置还可在一个关节表面上保持固定。 It means also remains fixed on one articular surface. 举例而言,在膝关节中,当股骨髁在装置上自由移动时,装置可在胫骨上保持居中位置。 For example, in the knee joint, the femoral condyle when the device is free to move, means may be centered position on the tibia. 与下关节表面紧密匹配的植入物的稍微不规则的形状有助于实现关节表面上的这种稳定性。 Slightly irregular shape of the implant articular surface of the lower closely matching contribute to this stability at the articular surface.

本文所描述的装置的关节内的运动视情况在需要时可由附属机械构件加以限制。 Optionally within the joint motion apparatus described herein may be restricted when necessary subsidiary mechanical member. 这些机械构件可(例如)允许装置旋转,但不允许其平移。 These mechanical components may be (e.g.) to allow rotation of the device, but not its translation. 它也可以允许装置在一个方向上平移,同时防止装置平移到另一个方向上去。 It may also allow the device to translate in one direction, while preventing the device is translated to the other direction up. 所述机械构件可进一步将装置固定在关节中,同时允许装置倾斜。 The mechanical means may further secure the device in the joint, while allowing the device is tilted. 合适的附属机械构件包括嵴、销钉、插针、横件、齿状物和突起。 Suitable mechanical member comprises a subsidiary crest, a pin, pins, cross-members, teeth and protrusions. 这些机械构件的配置可以是互相平行,或非平行定向。 These mechanical components may be arranged parallel to each other, or non-parallel orientation. 所述机械构件可以是锥形的、三角形的、球形的、圆锥形的或可实现效果的任何形状。 The mechanical member may be tapered, triangular, spherical, conical or any shape achievable effect. 可提供一个或一个以上附属机械构件。 It may provide one or more subsidiary mechanical member. 其中,提供一个以上机械构件时,所述机械构件可以覆盖装置的整个表面,或一部分表面。 Wherein, when more than a mechanical member, said mechanical member may cover the entire surface of the device, or part of the surface. 可提供另外的稳定性机械构件,例如嵴、边缘并沿着所有的或一部分外周表面加厚。 May provide additional stability mechanical member, e.g. crest, and thickened edge along all or a portion of an outer circumferential surface thereof.

植入物形状也可与其所定位位置上(例如筋骨脊骨部分)的关节的形状结合。 The implant may also be combined with the shape of the shape (e.g., bones of the spine portion) of the joint position it is located. 增加与胫骨脊骨(例如,胫骨脊骨的基部)一致性可有助于稳定与胫骨平台相对的植入物。 Increasing the tibial spine (e.g., the spine of the tibial base) can contribute to the stability and consistency of the platform relative to the tibial implant.

可选择所选定的植入物的高度或轮廓来改变相对于关节的承载能力。 Alternatively the selected height or profile of the implant is changed with respect to the carrying capacity of the joint. 另外,可以调节植入物的高度来解决骨骼或关节结构在解剖上的拓扑结构不正常。 Further, it is possible to adjust the height of the implant to the bone or joint structure resolve anatomical topology is not normal. 另外,对于本文所讲解的任何植入物来说,当遇到韧带松弛时,可调节植入物的高度、轮廓或其它尺寸来允许拉紧韧带装置从而改进功能。 Further, for any implant as taught herein, when experiencing ligamentous laxity, adjustable height, contour, or other size of the implant to allow the ligament tensioning device to improve the function. 以上行为最好大体上不干扰到骨骼的枢锥排列。 More preferably does not substantially interfere with the behavior of the bone pivot cone arrangement. 通常,关节可以承受住施加在运动关节上的100%的剪切力。 Typically, the joint can withstand the shear forces on the joint movement is applied to 100% live.

本发明的植入物一般将关节的灵活性恢复到特定对象关节的自然灵活性的99%。 Implant of the present invention will generally restore joint flexibility to 99% of the natural flexibility of the joints specific object. 举例而言,在膝盖总关节的情况下,通常范围是0到140°。 For example, in the case of total knee joints, usually in the range 0 to 140 °. 当前有效的解决方法通常将关节恢复到大体小于99.9%的范围。 The current effective solution to restore the joint range generally substantially less than 99.9%. 而本发明的植入物一般将运动范围恢复到病人正常运动范围的95-99.9%之间。 The implant of the present invention will generally restore the range of motion to between 95-99.9% of normal range of motion of the patient.

表1中描述了国家标准技术研究所(National Institute of Standards and Technology)(http://ovrt.nist.gov)获得的健康男性的手和臂的关节运动范围。 Table 1 describes the range of articulation NIST (National Institute of Standards and Technology) (http://ovrt.nist.gov) obtained in healthy male hands and arms.

表1手和臂关节的活动范围 Table 1 range of the arm and hand joint activities

表2中描述了国家标准技术研究所(http://ovrt.nist.gov)获得的健康男性的足和腿的关节运动范围。 Table 2 describes the joint range of motion NIST (http://ovrt.nist.gov) obtained from healthy men of foot and leg.

表2足和腿关节的活动范围 Table 2 foot and leg joints range of activities

本发明的植入物一般应将任何关节在表1和表2中的一个或一个以上的测量的运动范围恢复到病人正常动作范围的60-99.9%之间,并且最好在病人正常动作范围的95-99.9%之间。 The implant of the invention should generally be any joint in table 2 or a range of motion in Table 1 and more than one measurement is restored to between 60-99.9% of normal range of motion of the patient, and the patient is preferably in the range of normal operation between 95-99.9%.

如下文更为详细的讨论,本文所讲解的任何装置可以用各种方式加以制造,使得装置(例如)在插入后进行扩展。 Discussed in more detail below, any device as taught herein may be manufactured in various ways, such means (e.g.) expand after insertion. 扩展可以是自动的,半自动的或者由使用者调节。 Extension may be automatic, semi-automatic or adjusted by the user.

接着是根据本发明的范畴和讲解内容的关节植入物的说明性实例。 Next is an illustrative example of an implant in accordance with a joint and scope of the invention to explain the content.

A.膝盖图8A显示适合在膝关节的胫骨平台处植入的本发明的关节植入物100的透视图。 A. knee 8A shows a perspective view of the workpiece 100 for implantation in the knee joint of the present invention implanted at the tibial plateau. 如图8A所示,如上文关于图1A和图1B所描述,使用双表面评估产生植入物图。 8A, described above with respect to FIG. 1A and FIG. IB described, produced using a dual surface assessment of the implant of FIG.

植入物100具有一个上表面102和一个下表面104和一个外周106。 The implant 100 has an upper surface 102 and an outer peripheral surface 104 and a lower 106. 形成上表面102使得其形成容纳相对的关节表面的配对表面;在这个实例中部分下凹以容纳股骨。 Is formed on the mating surface 102 is formed such that a surface thereof opposite the receiving surface of the joint; in this example a concave portion for receiving the femur. 凹面可以是可变的凹面,使得其对相似于其矫正的关节配对表面的相对的关节表面呈现一个表面。 Concave concave surface may be variable, such that opposing articular surface of the articular correction thereof similar mating surface exhibits a surface. 下表面104具有一个凸面,其与关节的胫骨平台匹配或近似匹配,使得其产生一个与筋骨平台匹配的解剖结构或近似解剖结构。 Having a convex lower surface 104, with the joint tibial plateau matched or nearly matched, such that it generates a anatomy bones platform and matching or approximate anatomy. 根据胫骨平台的形状,下表面可以部分上凸。 The shape of the tibial plateau, the lower surface can be partially convex. 因而,下表面104对适合于现有表面内的胫骨平台呈现一个表面。 Thus, the lower surface 104 pairs fit within the existing surface of the tibial plateau presents a surface. 如所属领域的技术人员将了解,下表面104的凸面并不需要完全上凸。 As those skilled in the art will appreciate, the convex surface 104 does not need to completely convex. 而下表面104更多是由凸形和凹形元件组成以适合于胫骨平台的现有表面。 And the lower surface 104 is more male and female elements to fit the existing surface of the tibial platform. 因而,所述表面实质上是可变的凸形和凹形。 Thus, the variable surface is substantially convex and concave.

图8B显示图8A的植入物的俯视图。 8B shows a top view of the implant of FIG. 8A. 如图8B所示,植入物的内部形状108可以伸长。 8B, the inner shape of the implant 108 can be elongated. 伸长的形式可以采用各种形状,包括椭圆形、准椭圆形、跑道状等等。 The elongated form can take various shapes, including oval, quasi-elliptical, racetrack like shape. 然而,如将了解的,内部尺寸通常是不规则的,因而并不是形成一个真正的几何椭圆形。 However, as will be appreciated, the internal dimensions are typically irregular thus not forming a true geometric oval. 如所属领域的技术人员将了解的,植入物的实际的内部形状可视待矫正的关节缺损而变化。 As those skilled in the art will appreciate, the actual internal shape of the implant varies visible joint defect to be corrected. 因而长度L到宽度W的比率可以从(例如)0.5变到1.5,并且更具体的说可从0.25变到2.0。 Thus the length L to width W ratio may be changed from (e.g.) from 0.5 to 1.5, and more specifically can vary from 0.25 to 2.0. 如图8B进一步所示,当沿着植入物的宽度取点时,横跨植入物100的轴的长度发生变化。 As further shown in FIG 8B, when taken along the width of the implant site, the implant across the length of the shaft 100 is changed. 举例而言,如图8B所示,L1≠L2≠L3。 For example, as shown, L1 ≠ 8B L2 ≠ L3.

现在转向图8C到图8E,其描述沿着所示的线CC、DD和EE截取的图8B中所示的植入物的横截面。 Turning now to FIG. 8C FIG. 8E, description thereof taken along line CC shown, DD and EE of FIG cross-section of the implant shown in FIG. 8B. 植入物分别具有厚度t1、t2和t3。 The implant respectively have a thickness of t1, t2 and t3. 如通过横截面所说明的,植入物的厚度沿其长度L变化。 As illustrated by the cross section, the length L a varying thickness along the implant. 植入物100的特定位置处的实际厚度是待替代的软骨和/或骨骼和待复制的关节配对表面的厚度的函数。 The actual thickness of the implant at a particular location 100 is to be replaced cartilage and / or bone to be copied and mating articular surface of the thickness function. 另外,沿着植入物100长度和宽度的任何位置处的植入物100的轮廓是待替代的软骨和/或骨骼的函数。 Further, the profile at any position along the length and width of the implant 100 of the implant 100 is to be replaced cartilage and / or bone function.

图8F是图8A的植入物100的侧视图。 FIG 8F is a side view of the implant of FIG. 8A 100. 在这个实例中,第一末端处植入物100的高度h1不同于第二末端处植入物的高度h2。 In this example, first end 100 of the implant material is different from the height h1 of the height h2 of the second end of the implant. 另外,上边缘108在向下方向上可具有一个整体倾斜。 Further, an upper edge 108 in the downward direction may have a whole inclined. 然而,如所说明的,上边缘108的实际的倾斜沿其长度变化并且在某些实例中可以是正倾斜。 However, as illustrated, the actual inclination of the upper edge 108 varies along its length and in some instances may be a positive inclination. 另外,线边缘110在向下方向上可具有一个整体倾斜,然而,如所说明的,下边缘110的实际的倾斜沿其长度变化并且在某些实例中可以是正倾斜。 Further, the edge line 110 may have an overall tilt downward direction, however, as illustrated, the actual inclination of the lower edge 110 varies along its length and in some instances may be a positive inclination.

图8G是沿着人体中的矢状面所截取的横截面,其显示植入物100被植入于膝关节120内,使得植入物处于胫骨平台122上并且股骨124位于植入物100的上表面102上。 FIG. 8G is a cross section along the sagittal plane of the body taken, showing the implant 100 is implanted in the knee joint 120, so that the implant on the tibial plateau at 122 and 124 located in the femoral implant 100 upper surface 102. 图8H是沿着人体中的冠状平面所截取的横截面,其显示植入物100被植入于膝关节120内。 FIG. 8H is a cross-section along the coronal plane of the body taken, showing the implant 100 implanted within a knee joint 120 is. 如从此视图可以了解的,植入物100经定位,使得其适合较高的关节表面124。 As can be appreciated from this view, the implant 100 is positioned such that it is suitable articular surface 124 higher. 如所属领域的技术人员将了解的,需要时关节表面可以是中间的或侧面的面。 As those skilled in the art will appreciate that, if desired the joint may be a surface or a side surface of the intermediate.

图8I是沿着人体的轴平面所截取的横截面,其显示植入物100被植入于膝关节120内,显示从空中或上方所看到的视图。 FIG. 8I is a cross-section along an axial plane of the body taken, showing the implant 100 is implanted in the knee joint 120, a display view from the air or over the saw. 图8J是一个替代实施例的横截面,其中,植入物稍微大了点,使得其从中间(即,朝着胫骨平台的边缘,以及先前的和其后的延伸)延伸靠近骨骼。 Fig 8J is a cross section of an alternative embodiment, wherein the implant slightly larger point, so that it extends from the middle (i.e., toward the edge of the tibial plateau, as well as previous and subsequent extension) close to the bone.

图8K是根据替代实施例的本发明的植入物100的横截面。 FIG. 8K is a cross-sectional implant according to the present invention an alternative embodiment 100. 在这个实施例中,下表面104进一步包括关节锚定器112。 In this embodiment, the lower surface 104 further includes a joint anchor 112. 如如此实施例所示的,关节锚定器112形成从植入物100的下表面104延伸的一个突起、龙骨或垂直的元件,并且突出到(例如)关节的骨骼中。 As shown in the examples of such embodiment, the joint anchor 112 forms a protrusion extending from the lower surface 104 of the implant 100, keel or vertical member, and protrudes to (e.g.) in the bone joints. 另外,如图8L所示,关节锚定器112可具有一个横件114,使得关节锚定器112从底部看可以呈现处一个叉状或一个“X”。 Further, as shown in FIG. 8L, the joint anchor 112 can have a cross member 114, so that the joint anchor 112 may be presented at the bottom view of a fork or a "X". 如所属领域的技术人员将了解的,关节锚定器112可采取各种其它形式,同时仍可实现在关节中提供植入物增加的稳定性的相同目标。 As those skilled in the art will appreciate, the joint anchor 112 may take various other forms, while still providing an implant to achieve the same goal of increasing the stability of the joint. 这些形式包括(但不限于)插针、球状物、齿状物、球等。 These include (but are not limited to) pins, balls, teeth, balls and the like. 另外,需要时可提供一个或一个以上的锚定器112。 Further, providing one or more than one anchor 112 is needed.

装置可具有两个或多个的组件,一个实质上与胫骨表面紧密匹配而另一个大体上与股骨组件连接。 Device may have two or more components, a substantially closely matches the tibial surface and the other is connected to the femoral component generally. 所述两个组件可具有一个平坦的相对表面。 The two components can have a flat opposing surface. 或者,相对表面可以弯曲。 Alternatively, the opposing surface may be curved. 曲度可以是胫骨形状的映象,股骨形状包括关节运动期间的形状和半月板状形状,和其组合。 Mappings may curvature of the tibial shape, the femoral shape including during joint motion meniscus shape and plate-like shape, and combinations thereof. 图8M和图8N说明从侧面看和从前面看的双组件植入物的替代实施例的横截面。 FIGS cross section of an alternative embodiment of 8M and 8N illustrate from the side and from the front of a two-component implant embodiment.

现在转向图9A到图9F,其显示适合为图8A的植入物提供相对关节表面的植入物。 Turning now to FIGS. 9A to 9F, showing the opposing articular surface is adapted to provide the implant of FIG. 8A implant. 这个植入物矫正股骨的内表面上的缺损(即,(例如)与胫骨平台紧密配对的股骨部分)并且可单独使用,即,可用在股骨上,或与另一个关节修复装置组合使用。 This defect on the inner surface of the femur implant to correct (i.e., closely paired (e.g.) and the femoral portion tibial plateau) and can be used alone, i.e., can be used in the femur, or in combination with another joint repair device used. 图9A显示植入物150的透视图,所述植入物150具有一个弯曲的配对表面152和凸关节邻接表面154。 9A shows a perspective view of the implant 150, the abutment 152 and the convex articular surface of the implant mating surface 154 having a bend 150 thereof. 考虑到提供了锚定器156来促进植入物与股骨的连接,关节邻接表面154不需要形成一个与股骨匹配的解剖结构或近似解剖结构。 Considering the anchor 156 is provided to facilitate connection of the implant to the femur, the joint abutting surface 154 need not be formed with the anatomical structure of a match or approximate the anatomy of the femur. 在这个实例中,锚定器156显示为具有凹头的销钉。 In this example, the anchor 156 is shown with socket pins. 凹口促进股骨内的锚定过程。 Notch promote anchoring process within the femur. 然而,没有凹口的销钉也可用作具有其它配置的有助于锚定过程的销钉。 However, there is no recess having a dowel pin may be used as an anchor procedure helps other configurations. 植入物的销钉和其它部分可以是多孔涂覆的。 Pin and the other portion of the implant can be porous coated. 可不用粘牢骨骼或使用骨骼粘结剂而插入植入物。 May be used without bone cement or bone adhesive is inserted into the implant. 植入物可设计成邻接软骨下骨,即,其可大体上在软骨下骨的轮廓之后。 The implant may be designed to abut the bone cartilage, i.e., it may be after the subchondral bone contour substantially. 这具有优势,除了替代销钉孔之外无需移除骨骼,从而显著保护骨存量。 This has the advantage, in addition to the alternative pin hole without removing the bone, thereby significantly protect the bone stock. 如所属领域的技术人员将了解的,图9中所说明的用于修复髋关节的多组件解决方案也可应用于人体内的其它关节。 As those skilled in the art will appreciate, the solution for multi-component repair hip illustrated in FIG. 9 may be applied to other joints in the human body.

图9G和图9H说明适合为图8A的植入物提供相对表面的植入物151,其中所述植入物会覆盖股骨髁并且可视情况对着一个或一个以上图8A的植入物。 9G and 9H illustrate opposing surface adapted to provide the implant of FIG. 8A implant 151, wherein the implant will be covered against the femoral condyles and optionally one or more of the implant of FIG. 8A.

可设计关节造形系统来反映胫骨形状和/或股骨形状的样子。 Arthroplasty system can be designed to reflect the shape of the tibial and / or femoral like shape. 胫骨形状和股骨形状可包括软骨和骨骼。 Tibial shape and femoral shape can include cartilage and bone. 另外,植入物的形状还可包括其它关节结构(例如半月板)的部分或所有组件。 Further, the shape of the implant may also comprise other articular structures (e.g. meniscus) some or all of the components. 所述半月板是可压缩的,特别是在步行或荷载期间。 The menisci are compressible, in particular during the load or walking. 出于这个原因,植入物可设计成合并半月板形状的样子来解决荷载或身体活动期间半月板的压缩问题。 For this reason, the implant can be designed to look like the shape of the meniscus merge to solve the problem of compression loads or physical activity during the meniscus. 举例而言,植入物的下表面可设计成匹配胫骨平台(包括软骨或骨骼或其两者)的形状。 For example, the lower surface of the implant can be designed to match the shape of the tibial plateau (including cartilage or bone or both). 植入物的较高表面可以是胫骨(尤其在没有被半月板覆盖的区域)和半月板的关节表面的组合。 The implant surface may be higher tibia (especially in areas not covered by the meniscus), and a combination of the articular surface of the meniscus. 因而,装置的外形可以是半月板高度的一个反映。 Thus, the device profile may be a reflection of meniscal height. 压缩可占未压缩的半月板高度的(例如)20%、40%、60%或80%。 Compression may comprise uncompressed meniscal height (e.g.) 20%, 40%, 60% or 80%.

在某些实施例中,反映半月板形状的装置的外形可以由另一种(优选是压缩材料)材料制成。 In certain embodiments, the outer shape reflecting the shape of the meniscal devices may be from another (preferably a compressible material) material. 如果选择可压缩材料,那么优选设计成大体上匹配半月板的可压缩性和生物力学性能。 If the selected compressible material, it is preferably designed to substantially match the compressibility and biomechanical properties of the meniscus. 整个装置通常可由这类材料或非金属材料制成。 Typically the entire apparatus can be made of such a material or non-metallic material.

可通过一个成像测试直接测量出半月板的高度和形状。 A test can be measured by directly imaging the shape and height of the meniscus. 如果部分的或所有半月板都坏了,那么可通过测量对侧关节或使用可提供与半月板尺寸相关的估计的其它关节结构的测量来得到半月板的高度和形状。 If some or all of the meniscus are broken, it can provide measurement of other articular structures associated with the estimated size of the meniscus through the contralateral joint or using measurements obtained height and shape of the meniscus.

在另一个实施例中,可根据股骨将植入物的较高面定形。 In another embodiment, the high surface amorphous substance according to the femoral implant. 优选从相对于胫骨平台的股骨的活动模式得到形状,进而解决当股骨髁在胫骨和半月板上弯曲、伸展、旋转、平移和滑动时股骨形状和胫骨股骨接触区域中的变化的问题。 Preferably resulting shape from the relative active mode femur tibial plateau, then solve the problem change in femoral shape and tibiofemoral contact area when the femoral condyle of the tibia and meniscus flexion, extension, rotation, translation, and sliding in.

可使用所属领域中已知的当前或未来测试方法(例如,荧光透视法、MRI、步行分析和其组合)测量活动模式。 Known in the art may be used in the current or future test method (e.g., fluoroscopy, MRI, and combinations thereof walking analysis) measuring the active mode.

B.髋关节图10A是髋关节的髋臼200的侧视图。 B. hip FIG 10A is a side view of an acetabular hip joint 200. 软骨覆盖区域202具有一个倒转的U形。 Cartilage covering the area 202 having a reverse U-shape. 三角辐射软骨区域或髋臼上沟204位于软骨覆盖区域内。 Radiation area or triangular cartilage acetabular cartilage groove 204 located within the coverage area. 图10B是近端股骨210的旋转图。 10B is a proximal femur of rotation 210 of FIG. 还显示了软骨覆盖区域202和股骨头凹206。 Also shows the cartilage covering the femoral head and the recessed area 202 206.

现在转向适合髋关节的植入物,图10C是用于髋关节220的植入物的横截面。 Turning now to fit hip implant, FIG. 10C is a joint implant 220 of the cross-section of the hip. 当截取植入物长度上的任何点时,这个植入物的半径r大体上是固定的。 When taken at any point on the length of the implant, the radius r of the implant is substantially fixed. 可选择植入物的半径近似为植入物将进行矫正的股骨头的半径并且可测量啮合股骨头的植入物220的内表面半径。 Alternatively the implant the implant radius approximately the radius of the corrected femoral and measure the radius of the femoral head engages the inner surface 220 of the implant. 或者,可选择植入物的半径近似为髋臼或其组合的半径。 Or, alternatively, the implant radius approximately the radius of the acetabulum, or combinations thereof. 植入物的内表面222的半径面对着股骨并且还可与股骨的半径匹配或与髋臼的半径相似;面对着髋臼的植入物表面的半径还可与髋臼224的半径匹配或与股骨的半径相似;所属领域的技术人员将了解,髋臼的自然几何形状一般是非球面的,稍微不同于真实的球形。 Implanted in the surface thereof facing the femoral radius 222 and may also be matched to the radius of the femoral or acetabular similar radius; radius of the surface of the implant facing the acetabulum acetabulum 224 may match the radius or similar to the radius of the femur; ordinary skill in the art will appreciate, the geometry of the natural acetabulum generally aspheric, slightly different from the true spherical shape. 必要时可将植入物的半径调整为髋臼的变动半径从而提供更好的匹配。 The implant may be necessary to adjust the radius of the object when the radius variation of the acetabulum to provide a better match. 因而,植入物的较高表面和/或内表面在半径上都可以是球面的或非球面的。 Thus, higher surface and / or inner surface of the implant in the radius can be spherical or aspherical.

图10D是适合用于与图10C所看到的髋关节相类似的髋关节的植入物的横截面,特征在于具有一个圆形的边缘226。 10D is a cross-section suitable for use as seen in FIG. 10C is similar to the hip hip implant, characterized by having a rounded edge 226. 圆形边缘226是有利的,因为其可趋于避免在使用中锁住植入物,以及最小化与植入物相关的任何疼痛。 Circular edge 226 is advantageous in that it may tend to avoid locking the implant in use, and to minimize any implant-related pain.

图11A是适合用于与图10C所示的髋关节相类似的髋关节的植入物220的横截面,该植入物具有一个凸起物230,该凸起物230在股骨头240的股骨头凹的内表面222上延伸进股骨头240的股骨头凹中。 11A is a cross-section suitable for the hip joint shown in FIG. 10C is similar to the hip implant 220, the implant having a projection 230, the projection 240 of the femoral head was 230 shares 240 extends into the femoral bone on the inner surface 222 of the concave recess of the femoral head. 元件230可以用和植入物220相同的材料或不同于植入物的剩余部分的材料制成。 Element 230 and the implant can be the same material or a different material than the remaining portion 220 of the implant was made. 具有啮合股骨头凹的一个凸起物230的植入物的优势在于所述凸起物230可以约束植入物220相对于股骨头的移动(如图10B所示)。 A femoral head having an engagement concave projection advantage is that the implant 230 of the projections 230 may constrain movement of the implant relative to the femoral head 220 (FIG. 10B). 如所属领域的技术人员将了解的,凸起物230可以具有各种配置,同时仍可实现通过植入啮合股骨头凹时的相同效果。 As those skilled in the art will appreciate, the projections 230 may have various configurations, while still achieving the same effect engagement recess of the femoral head by implantation. 显示了植入物的各种平面图,有半球状的、部分半球状的或采用围栏的形式。 It shows a plan view of the various implants, hemispherical, partially hemispherical, or in the form of fences employed. 其它形状对于所属领域的技术人员来说将变得显而易见。 Other shapes to those skilled in the art will become apparent. 另外,植入物的边缘可以是圆形的,成斜角的或促进植入物操作的任何尺寸。 Further, the edge of the implant may be rounded, bevelled or promote any size of the implant operation. 图11B到图11E说明图11A中所示的植入物的替代实施例,其中的植入物是半球状的、部分半球状的、围栏状的和轮辐状的。 FIG. 11B to FIG. 11E illustrates an alternative implant shown in FIG. 11A in the embodiment, wherein the implant is hemispherical, partially hemispherical, rail and spoke-like shape.

图12A是适合用于髋关节的植入物220的横截面,该植入物220具有一个凸缘232,该凸缘232在髋臼上沟204的外表面224上延伸进髋臼上沟204中。 12A is a cross-section suitable for hip joint implant 220, the implant 220 has a flange 232, the flange 232 on the outer surface of the acetabulum in hip groove 204 extending into the groove on the hip acetabulum 224 204 in. 所述凸缘232可由和植入物220剩余部分相同的材料或不同的材料制成。 The flange 232 and the implant 220 may be the same material as the remaining part of or made of a different material. 所述凸缘232可用于约束植入物220相对于髋臼上沟的移动。 The flange 232 may be used to constrain movement of the implant 220 relative to the acetabulum of the hip groove. 如所属领域的技术人员将了解的,凸缘232可具有各种配置,同时仍可实现啮合髋臼上沟时的相同效果。 As those skilled in the art will appreciate, the flange 232 may have various configurations, while still achieving the same effect on the engaging groove acetabulum. 显示了植入物的各种平面图,有半球状的、部分半球状的或采用围栏或四叉冠状物的形式。 It shows a plan view of the various implants, hemispherical, partially hemispherical, or in the form of fences or the quad crown. 其它形状对于所属领域的技术人员来说将变得显而易见。 Other shapes to those skilled in the art will become apparent. 另外,植入物的边缘可以是圆形的,成斜角的或促进植入物操作的任何尺寸。 Further, the edge of the implant may be rounded, bevelled or promote any size of the implant operation. 图12B到图12E说明图12A中所示的植入物的替代实施例,其中的植入物是半球状的、部分半球状的、围栏状的和轮辐状的。 FIG. 12B to FIG. 12E illustrates an alternative implant shown in FIG. 12A in the embodiment, wherein the implant is hemispherical, partially hemispherical, rail and spoke-like shape.

图13A是具有各种平面图的双组件“负重可活动”植入物221的横截面。 13A is a plan view of a two-component having various "mobile bearing" cross-section 221 of the implant. 所述植入物具有一第一组件230和一第二组件231。 The implant assembly 230 having a first 231 and a second component. 第一组件与第二组件匹配并且具有两个光滑表面。 Matching the first and the second assemblies and having two smooth surfaces. 第二组件啮合于第一组件的外表面并且也具有两个光滑表面。 The second component engages the outer surface of the first component and also having two smooth surfaces. 在不脱离本发明的范畴的情况下,计划中的各种配置都是可以的。 Without departing from the scope of the invention, various configurations are possible plan. 举例而言,每个组件都可以是半球状的。 For example, each component can be hemispherical. 一个组件可以是半球状的,而另一个组件采用部分半球状、较短半球状、围栏或四叉圆顶的形状。 A component can be hemispherical while the other component part employed hemispherical, hemispherical shape shorter, fencing or quad dome. 图13B到图13F说明图13A中所示的植入物的替代实施例,其中的植入物具有至少一个是半球状的、部分半球状的、围栏状的或轮辐状的组件。 FIG. 13B to FIG. 13F illustrates an alternative implant shown in Figure 13A embodiment, wherein the implant has at least one hemispherical, partially hemispherical, rail-like or spoke-like components.

图13G到图13J是双组件“负重可活动”植入物的横截面。 FIG 13G to FIG 13J is a cross-section of a two-component "mobile bearing" implant. 所述植入物具有一第一组件和一第二组件。 The implant has a first component and a second component. 第一组件与第二组件匹配。 Matching the first and the second assemblies. 第二组件啮合于第一组件的外表面。 The second component engages the outer surface of the first component. 如本文所示,在第二组件上提供一个凸起物,其啮合于第一组件上的缺口,如所属领域的技术人员将了解的,尽管没有图示,在不脱离本发明的范畴的情况下,所述凸起物可位于第一组件上并且与第二组件上的井孔匹配。 As shown, the second component provided herein on a projection, which engages in the notch on the first component, as those skilled in the art will appreciate that, although not shown, without departing from the scope of the invention is the case next, the projections may be located on the first assembly and the wellbore on the second component matching. 如图所示,也可能在第一组件上,第二组件上或两者上提供其它的锚定机械构件。 As shown, the first component may also provide additional mechanical anchoring member on the second component, or both. 在不脱离本发明的范畴的情况下,计划中的各种配置都是可以的,只是未进行图示说明。 Without departing from the scope of the invention, various configurations are possible plan, but not be illustrated. 举例而言,每个组件都可以是半球状的。 For example, each component can be hemispherical. 一个组件可以是半球状的,而另一个组件采用部分半球状、稍短半球状、围栏或四叉圆顶的形状。 A component can be hemispherical while the other component part employed hemispherical, hemispherical shorter, fencing or quad dome shape.

图14A是双组件“负重可活动”植入物240的横截面,该植入物240具有一个凸起物246,所述凸起物延伸进股骨头的股骨头凹206中。 FIG 14A is a two-component "mobile bearing" cross-section of the implant 240, the implant 240 has a projection 246, the projection extending into the recess 206 of the femoral head of the femoral head. 双组件植入物240具有一第一组件242和一第二组件244。 240 two-component implant assembly 242 having a first 244 and a second component. 在第二组件244上提供一个凸起物246。 On the second assembly 244 provides a projection 246. 如上文相关于图11C所述,所述凸起物246可用于约束植入物240的第二组件244相对于股骨头的移动。 As described above in relation to the 11C, a projection 246 of the implant can be used to constrain the second assembly 240 is moved relative to the femoral head 244. 面对着髋臼的第一组件242可相对于面对着股骨头的第二组件244自由移动。 A first face of the acetabular component 242 facing the femoral head with respect to the second assembly 244 to move freely. 如所属领域的技术人员将了解的,可对双组件植入物进行配置使得啮合第二组件245的表面的第一组件243的表面具有相同的长度或大体上相同的长度。 As those skilled in the art will appreciate, the dual component implant may be configured such that the surfaces of the first assembly 245 engages the second assembly 243 have the same length or substantially the same length. 从而产生大体上互相匹配的配对组件。 Thereby producing substantially matches each counterpart assembly. 或者,可对所述组件进行配置使得一个组件可短于如图14B和图14C中所示的另一个组件。 Alternatively, the assembly can be configured such that one component may be shorter than another component as shown in FIG. 14B and FIG. 14C. 图15A是另一个双组件“负重可活动”植入物240的横截面,其具有一个延伸进髋臼上沟中的凸缘248。 15A is another two-component "mobile bearing" cross-section of the implant 240 having a groove extending into the acetabulum on the flange 248. 双组件植入物240具有一第一组件242和一第二组件244。 240 two-component implant assembly 242 having a first 244 and a second component. 在第一组件242上提供一个凸缘248。 On the first member 242 provides a flange 248. 所述凸缘248可用于约束植入物240的第一组件242相对于髋臼的移动。 The flange 248 may be used to move relative to the constrained acetabular implant 240 of the first assembly 242. 面对着股骨头的第二组件244可相对于面对着髋臼的第一组件242自由移动。 The second component 244 facing the femoral head with respect to a first face of the acetabular component 242 is free to move. 如上文相关于图13A所述,也可对图15A中所示的植入物加以配置使得一个组件可短于如图15B和图15C中所示的另一个组件。 As described above in relation to the FIGS. 13A, may be arranged on the implant shown in FIG. 15A such that a component can be shorter than another component as shown in FIG. 15B and FIG. 15C.

图16A是三组件“负重可活动”植入物250的横截面。 16A is a three-component "mobile bearing" cross-section 250 of the implant. 面对着髋骨的第一组件252具有一个延伸进髋臼204中的凸起物253。 Hip face 252 has a first component extending into the acetabular protrusion 204 253. 如上文所述,所述凸起物253可用于约束植入物250相对于髋骨的移动。 As described above, the projections 253 can be used to constrain movement of the implant 250 relative to the hip bone. 面对着股骨头的第二组件254具有一个延伸进股骨头凹206中的凸缘255。 The second component 254 facing the femoral head having a recess extending into the femoral head 206 in a flange 255. 如上文相关于单元件和双元件植入物所描述的,所述凸缘255可用于约束植入物250的第二组件254相对于股骨头的移动。 As described above in relation to dual-element and single element of the implant as described, the flange 255 may be used to constrain the implant 254 of the second assembly 250 to move relative to the femoral head. 第三组件256介于其它两个组件之间并且可在两者之间自由移动。 And a third component 256 interposed therebetween is freely movable between the other two components. 如所属领域的技术人员将了解的,第三组件256可介于第一组件252与第二组件254之间,使得其长度既能短于第一组件252和第二组件254(如图16B中所示)的长度又能长于第一组件252和第二组件254的长度(如图16C和图16D所示)。 As those skilled in the art will appreciate, the third component 256 may be interposed between the first component and the second component 252 between 254, such that its length is shorter than both the first component 252 and second component 254 (FIG. 16B length shown) longer than the length of the first component but the second component 252 and 254 (FIG. 16C and FIG. 16D). 类似地,第三组件的长度也能长于第一组件252和第二组件254的长度。 Similarly, the length of the third component can also be longer than the length of the first component 252 and second component 254.

图17A是类似于上文所示的植入物的另一个双组件“负重可活动”植入物240的横截面。 FIG 17A is another similar two-component implant as shown above "mobile bearing" cross-section 240 of the implant. 在这个实施例中,提供了锚定器来使第一组件242锚定髋臼上沟204。 In this embodiment, there is provided an anchor assembly 242 to the first anchoring groove 204 on the acetabulum. 所显示的锚定器是具有一个或一个以上插针262的形式。 Anchor is shown having the form of one or more pins 262. 使用两个大体平行的销钉将面对着髋臼的组件固定在髋臼上。 Using two pins substantially parallel to the face of the acetabular component is fixed to the acetabulum. 面对着股骨头的第二组件244可在面对着髋臼的第一组件242上自由移动。 The second component 244 facing the femoral head can move freely on the first component 242 facing the acetabulum. 如先前的实施例,相对于第二组件244的第一组件242的长度可以变化。 As in the previous embodiment, the first component relative to the second component 244 of the length 242 may vary. 图17B和图17C显示替代的横截面图,其中第一组件大于第二组件,反之亦然。 17B and 17C show alternative cross-sectional view, wherein the first component is greater than a second component, and vice versa. 如先前实施例,在不脱离本发明的范畴的情况下,计划中的各种配置都是可以的。 As the previous embodiment, without departing from the scope of the invention, various configurations are possible plan. 举例而言,每个组件都可以是半球状的。 For example, each component can be hemispherical. 一个组件可以是半球状的,而另一个组件采用部分半球状、稍短半球状、围栏或四叉圆顶的形状。 A component can be hemispherical while the other component part employed hemispherical, hemispherical shorter, fencing or quad dome shape.

图18A是另一个双组件“负重可活动”植入物240的横截面,该植入物240具有延伸进髋臼上沟204中的锚定器。 FIG 18A is another two-component "mobile bearing" cross-section of the implant 240, the implant 240 has a groove extending into the acetabulum 204 of the anchor. 面对着髋臼的锚定器采用突起的形式,该突起具有一个或一个以上翅片264。 Facing the acetabulum anchor employed in the form of projections, the projections having one or more fins 264. 面对着股骨头的第二组件244可在面对着髋臼的第一组件242上自由移动。 The second component 244 facing the femoral head can move freely on the first component 242 facing the acetabulum. 图18B是从顶部看到的图18A的植入物的视图,其显示元件顶部上的四个翅片(264、264′、264″、264)延伸到髋臼组件顶部上的髋臼上沟中。所述翅片可以是如图所示的尖的或大体上尖的或可具有圆形的边。 18B is a view seen from the top of the implant of FIG. 18A, which shows four fins on the top member (264,264 ', 264 ", 264) extends to the top of the acetabular component acetabulum groove. the fins may be or may have a generally pointed or rounded tip as shown in FIG edge.

图19A是另一个双组件“负重可活动”植入物240的横截面,该植入物240具有一个能延伸进股骨头的股骨头凹206中的锚定器266。 19A is another two-component "mobile bearing" cross-section of the implant 240, the implant 240 can have a recess extending into the femoral head of the femoral head 206 of the anchor 266. 在所示实施例中,使用一个或一个以上大体上平行的销钉(显示为268、268′)将面对着股骨头的第二组件244固定在股骨头上。 In the embodiment shown, using one or more substantially parallel pins (shown as 268,268 ') to the second component 244 facing the femoral head is fixed on the femoral head. 如先前实施例所示,第一组件242面对着髋臼,并且可在面对着股骨头的组件上自由移动。 As shown in the previous embodiment, the first component 242 facing the acetabulum, and can move freely in the assembly facing the femoral head.

图19B是另一个双组件植入物240的横截面。 19B is a cross-section of another dual component implant 240 thereof. 在这个实施例中,双组件240是固定的。 In this embodiment, a two-component 240 is fixed. 如本文中的说明,使用3个销钉或其它附着构件将股骨组件附着到股骨头上。 As described herein, the use of three pins or other attachment means attached to the femoral head of the femoral component. 需要时销钉的数目可以大于或小于3。 When the number of pins required may be greater than or less than 3. 优选地,软骨下骨除了销钉的进入点外保持这个完整设计。 Preferably, subchondral bone in addition to the entry point of the pin holding this complete design. 使用翅片264或类似的例如销钉的附着构件(图17A中所示)将髋臼组件附着到髋臼上。 Use fins 264 or similar attachment means such as pins (shown in FIG. 17A) attached to the acetabular component acetabulum. 附着构件可模铸到髋臼上沟中,使元件延伸进股骨中。 Molded member may be attached to the acetabulum groove, of the element extends into the femur. 除附着构件的进入区域外,优选软骨下骨也保持不变。 In addition to the entry region of the attachment member, preferably bone cartilage remains unchanged.

图20A是用于髋关节的具有变化的半径(r1,r2,r3)和厚度(t1,t2,t3)的植入物470的横截面;其中r1≠r2≠r3且厚度t1≠t2≠t3。 And FIG. 20A is a thickness (t1, t2, t3) of the cross-section of the implant 470 for radius (r1, r2, r3) have varying hip joint; wherein r1 ≠ r2 ≠ r3 and a thickness t1 ≠ t2 ≠ t3 . 如所属领域的技术人员将了解的,采用半径和厚度的三个测量值来说明点,但在不脱离本发明的范畴的情况下可使用更多的或更少的测量值。 As those skilled in the art will appreciate, the case of three measured value of the radius and the thickness of the point will be described, without departing from the scope of the invention may use more or fewer measurements. 另外,可使用半径和厚度的其它组合,例如,r1=r2≠r3,r1≠r2=r3,t1=t2≠t3和t1≠t2=t3。 Further, other combinations may be used radius and thickness, e.g., r1 = r2 ≠ r3, r1 ≠ r2 = r3, t1 = t2 ≠ t3 and t1 ≠ t2 = t3. 其它组合对于所属领域的技术人员来说将变得显而易见。 Other combinations of ordinary skill in the art will become apparent. 如图20A中的说明,中心部分c具有比一个或两个外周部分p1,p2相对较厚的厚度t。 DESCRIPTION OF FIG. 20A, the central portion c has a portion p1 than the one or two peripheral, p2 relatively thick thickness t.

图20B是用于髋关节的具有变化的半径和厚度的替代植入物470的横截面。 FIG 20B is a cross-section of an alternative implant having a varying radius and thickness of the hip joint 470. 在这个实施例中,中心部分c具有比一个或一个以上外周部分(p1,p2)相对较薄的厚度tc。 In this embodiment, the central portion c having one or more than an outer peripheral portion (p1, p2) is relatively thin thickness tc.

图20C是用于髋关节的具有变化的半径和厚度的替代植入物470的横截面。 FIG 20C is a cross-section of an alternative implant having a varying radius and thickness of the hip joint 470. 在这个实施例中,中心部分c具有比第一外周末端p1的厚度t1相对较薄的厚度tc,并且比外周部分的第二外周末端p2的厚度t2相对较厚。 In this embodiment, the central portion c has a thickness ratio of the first outer peripheral extremity p1 t1 TC relatively thin thickness, and an outer peripheral portion than the second end thickness t2 p2 weekend relatively thick.

图20D是用于髋关节的替代植入物470的横截面,该替代植入物470具有向上延伸Li和/或向下延伸的Ls一个或一个以上边缘或锚定延伸部分。 FIG 20D is a cross-section of a hip joint replacement implant 470, the implant 470 has alternate upwardly extending Li and / or Ls downwardly extending edge or one or more anchor extension portion. 将边缘设计成延伸超过关节表面而进入(例如)非软骨区域。 Designed to extend over the edge and into the articular surface (e.g.) a non-cartilaginous region. 其可大体上与周围的、外周的解剖结构一致。 Which is generally consistent outer periphery of the can with the surrounding anatomy. 边缘可提供额外的稳定性。 Edge may provide additional stability. 这种设计可以与双组件和三组件及“负重可活动”设计相结合。 This design may be designed and combined with the two-component and three-component "mobile bearing."

如所属领域的技术人员将了解的,图10到20中所示的植入物的空间形状可以是一维或一维以上的半圆形(即180°),但这并不一定是需要的。 As those skilled in the art will appreciate, the spatial shape of the implant shown in FIGS. 10 to 20 can be one or more than one dimension semicircular (i.e., 180 °), but this is not necessarily required . 当植入物在所有维度中是半圆形时,所述植入物形成一个半球状(也就是说,通过用一个平面穿过其中心进行切割而获得的一半的球体)。 When the implant is semicircular in all dimensions, said implant is formed a hemispherical (i.e., a half of a sphere obtained by cutting with a plane passing through its center). 当植入物在某些,但不是全部维度中是半圆形时,其形状就不会是半球状。 When the implant is semicircular in some, but not all of the dimensions, the shape of which would not be hemispherical. 该形状的较高和较低面中的一个面或两个面可以是非球状用于协调髋臼。 A higher surface and lower surface or both faces of the non-spherical shapes may be used to coordinate the acetabulum. 另外,当具有一个以上的组件时,可使用三维形状的组合。 Further, when having more than one component, a combination of three-dimensional shape can be used. 举例而言,第一组件可以是半球状的,而第二不见并不是,等等。 For example, the first component may be hemispherical, while the second is not seen, and the like.

另外,当这些植入物显示为具有一个到三个组件时,应了解,在不脱离本发明的范畴的情况下,每个组件都可以进一步更改成互相啮合的复数个组件。 Further, when these implants shown with one to three when the assembly should be appreciated, without departing from the scope of the invention, each component can be further changed into a plurality of intermeshing components.

所属领域的技术人员应进一步了解,图10到图20中所讲解的设计考虑事项可用于为其它关节设计植入物,例如膝盖、踝、肩、肘和手腕。 Those skilled in the art will further appreciate that design considerations in FIG. 10 to FIG. 20 may be used to explain other joint implant design, e.g. knee, ankle, shoulder, elbow and wrist. 为了避免使本发明变得含糊不清,本文所讲解的植入物的所有可能的配置都没有图示。 In order to avoid to obscure the present invention, all possible configurations of the implant as taught herein, are not shown.

C.肩图21A是肩关节300中的骨结构的正视图,所述肩关节可例如锁骨302、肩胛骨304、肩臼306、肩峰308、喙突310和肱骨312。 C. shoulder 21A is a front view of the bone structure of the shoulder 300, the shoulder 302 may be, for example, clavicle, scapula 304, the glenoid 306, shoulder 308, and humerus 312 310 coracoid process. 由斜线指示软骨覆盖区域314、316。 Coverage area indicated by oblique lines 314, 316 cartilage.

图21B是置于肱头313和肩臼306之间的关节造形装置320的视图。 21B is a view of the device 320 is placed between the humeral head arthroplasty glenoid 313 and 306. 关节造形装置320可具有与图4A到图4R中所示的设计特征相似的设计特征,例如复数个组件、负重可活动设计、附着和不附着设计、具有变化的厚度和曲度的设计、与肱头313或肩臼306或其两者相一致的设计、与关节软骨和/或软骨下骨相一致的设计、具有用于稳定目的的边缘或元件的设计。 Arthroplasty device 320 may have design features shown in FIGS. 4A to 4R similar design features, such as a plurality of components, weight-bearing activities can be designed, and not attached to attachment design, having a thickness and curvature of the design change, and glenoid humeral head 313 or 306, or both, consistent design, consistent with articular cartilage and / or cartilage Skeleton design having an edge or element designed for stabilization purposes.

图21C是关节造形装置320的倾斜横截面图,其具有至少部分与肱头313的形状相一致的肱骨接触表面322和至少部分与肩臼306的形状相一致的肩臼接触表面324。 FIG 21C is a cross sectional view of the inclination of the arthroplasty device 320, having a shape which at least partially coincides with the humeral head 313 form humeral contacting surface 322 and at least a portion of the glenoid 306 consistent with the glenoid contacting surface 324.

图21D是关节造形装置520的轴向横截面图,其具有与肱头的形状相一致的肱骨接触表面322和与肩臼306的形状相一致的肩臼接触表面324。 Arthroplasty device of FIG. 21D is a cross-sectional view of an axial 520, which is consistent with the shape of the humeral head 322 form humeral contacting surface 306 of the glenoid and a consistent glenoid contacting surface 324.

图21E是肩关节的倾斜正视图,其分别说明关节软骨316和上盂唇306′和下盂唇306″。图21F是肩关节的轴向视图,其分别说明关节软骨316和前盂唇307′和后盂唇307″。 FIG 21E is a front view of the inclined shoulder, which illustrate the articular cartilage 316 and the labrum 306 'and lower 306 labrum. "FIG. 21F is an axial view of the shoulder joint, which illustrate the articular cartilage 316 and 307 before the labrum '307 and the glenoid labrum. "

图21G是关节造形装置320的倾斜正横截面图,其具有与肱头313的形状相一致的肱骨接触表面322和与肩臼306和盂唇(306′,306″)的形状相一致的肩臼接触表面324。图21H是图21G中所示的关节造形装置320的轴向横截面图。如上文所示,提供一个与肱头313的形状相一致的肱骨接触表面322且提供一个与肩臼306和盂唇的形状相一致的肩臼接触表面324。 FIG 21G is a arthroplasty device of inclination 320 of positive cross-sectional view, having consistent with the shape of the humeral head 313 of the humeral contacting surface 322 and the shape of the glenoid 306 and the glenoid labrum (306 ', 306 ") is consistent with the shoulder mortar contact surface 324. FIG. 21H is an axial cross-sectional view of the arthroplasty device 320 shown in FIG. 21G in. as indicated above, there is provided a shape of the humeral head 313 coincides with the contact surface 322 of the humerus and provided with a shoulder 306 acetabular labrum and shape consistent with the glenoid contacting surface 324.

图21I是关节造形装置340的替代实施例的倾斜正横截面图,其具有与肱头313的形状相一致的肱骨接触表面342,和与肩臼306的形状大体上相一致的肩臼接触表面344。 FIG. 21I is inclined alternate embodiment 340 of the arthroplasty device is a cross-sectional view, which is consistent with the shape of the humeral head 313 with the humeral contacting surface 342, a generally consistent with the glenoid contact surface and the shape of the glenoid 306 344. 可提供在上方和/或在下方延伸的一个或一个以上的凸缘或边缘346,346′。 May be provided above and / or below one or more extending flange or edge 346 and 346 '. 所述边缘可经配置来提供肩臼上的稳定性。 The edge may be configured to provide stability on the glenoid. 图21J是图21I中所示的关节造形装置340的轴向横截面图,其具有与肱头313的形状相一致的肱骨接触表面342,和与肩臼306的形状大体上相一致的肩臼接触表面344。 FIG 21J is an axial cross-sectional view of the arthroplasty device 340 shown in FIG. 21I, which is consistent with the shape of the humeral head 313 with the humeral contacting surface 342, and a shape of the glenoid 306 substantially coincides glenoid a contact surface 344. 可提供在上方和/或在下方延伸的一个或一个以上边缘346″,346来提供肩臼306上的稳定性。 May be provided above and / or 346 in a downward extending edge of one or more ", 346 to provide stability on the glenoid 306.

图21K是双组件,“负重可活动”关节造形装置350的倾斜正横截面图,其具有与至少一部分肱头相一致的第一组件351的肱骨接触表面354和与至少一部分肩臼的形状相一致的第二组件353的肩臼接触表面354。 FIG. 21K is a two-component, tilt "mobile bearing" arthroplasty device 350 being a cross sectional view consistent with the humeral head with at least a portion of the first contact surface 351 of humeral component 354 and at least a portion of the shape of the glenoid consistent glenoid assembly 353 of the second contact surface 354. 如所属领域的技术人员将了解的,两个关节植入表面的半径可经选择以匹配或大体上匹配肱骨或肩臼或其两者。 As those skilled in the art will appreciate, the two surfaces of the joint implant may be a radius to match or substantially match or both humeral or glenoid selected. 另外,植入物可具有与肱骨或肩臼大体上一致或尽量一致的接触表面以实现所需的矫正和功能效果。 Further, the implant may have a contact surface substantially coincides with the humeral or glenoid or consistent as far as possible to achieve the desired correction function and effect. 此外,两个关节植入物表面356,358的旋转中心与肱头的旋转中心大体匹配。 Further, two joint implant surfaces 356, 358 of the rotation center of the rotation center substantially matching the humeral head. 如所属领域的技术人员将了解的,两个关节植入物表面356,358可具有包括平面在内的任何形状。 As those skilled in the art will appreciate, the two articular surface implant 356 can have any shape, including planar.

图21L是图21K中所示的双组件,“负重可活动”关节造形装置的轴向横截面图。 FIG. 21L is a double assembly shown in FIG. 21K, axial "mobile bearing" cross-sectional arthroplasty device of FIG. 在这个实施例中如图所示配置肱骨接触表面352使得其与肱头313的形状大体一致,且在这个实施例中配置肩臼接触表面354使得其与肩臼306的形状大体一致。 In this embodiment, the configuration shown in FIG humeral contacting surface 352 such that it substantially conforms to the shape of the humeral head 313 and the glenoid embodiment arranged such that a contact surface 354 which generally conform to the shape of the glenoid 306 in this embodiment. 两个关节植入物表面的半径可经选择以匹配肱骨、肩臼或其两者的表面。 Two of the articular surface of the radius of the implant may be selected to match the surface of the humerus, the glenoid, or both. 另外,两个关节植入物表面的旋转中心可经选择以大体上匹配肱头的旋转中心。 Further, the rotation centers of the two joint implant surface may be selected to substantially match the center of rotation of the humeral head. 图21M是一个替代实施例,其显示植入物具有一个在第一组件上的缺口和一个在第二组件上的球体。 FIG. 21M is an alternate embodiment, showing the implant having a notch and a ball on a first component on a second component. 可倒转缺口和球体的配置,使得在不脱离本发明的范畴的情况下,其位于相对的表面。 It can be inverted and the ball notches arranged such that, without departing from the scope of the invention, which is located on the opposite surface. 如将了解的,所示的球体和窝布置将促进植入物组件相对于彼此的移动,但可以帮助防止组件在操作中的不必要的移动。 As will be appreciated, the ball and socket arrangement shown will facilitate implant assembly move relative to each other, but can help prevent unwanted movement of the components in operation.

图21N是双组件,“负重可活动”关节造形装置360的另一个实施例的倾斜正横截面图。 FIG. 21N is a two-component, "mobile bearing" arthroplasty device 360 ​​of another embodiment of an inclined cross-sectional view of the embodiment positive. 植入物360具有一个第一组件362和一个第二组件364。 The implant assembly 360 having a first 362 and a second component 364. 肩臼组件364经配置而具有两个表面。 Glenoid component 364 is configured to have two surfaces. 第一表面363经配置而与第一组件362关节相对。 The first surface 363 opposite to the first joint assembly 362 is configured. 第二表面363经配置以与肩臼306配对。 The second surface 363 configured to cooperate with the glenoid 306 pairing. 使用一个或一个以上锚定器365将第二或肩臼组件364附着到肩臼上。 Using one or more second anchor 365 or glenoid assembly 364 is attached to the glenoid. 锚定器365可为销钉或翅片的形式或其它合适的配置以实现将肩臼组件364与肩臼锚定的所需结果。 The anchor 365 may be in the form of fins or pins, or other suitable configuration to achieve the glenoid and the glenoid assembly 364 of the anchor to a desired result. 可将这些销钉或翅片粘合,多孔涂覆或其两者。 These fins or pins may be bonded, porous coated, or both. 类似地,可将组件362的肩臼接触表面363粘合,多孔涂覆或其两者。 Similarly, the glenoid component 362 of an adhesive contact surface 363, or both the porous coating. 优选仅锚定器365延伸入软骨下骨中。 Preferably only the anchor 365 extends into the subchondral bone.

图21O是双组件,“负重可活动”关节造形装置370的替代实施例的倾斜正横截面图。 FIG. 21O is a two-component, "mobile bearing" arthroplasty device 370 of the alternative embodiment being inclined cross sectional view of FIG. 使用附着机构(例如销钉、翅片或如此实施例所示的长钉373)将肱骨接触组件372附着到肱头312上。 Using adhesive means (such as pins, fins or spikes illustrated embodiment thus 373) contacting the humeral component 372 attached to the humeral head 312. 可将这些销钉、翅片、齿(teeth)或长钉进行粘合、多孔涂覆或其两者。 These pins, fins, teeth (teeth) or spike may be bonded, porous coated, or both. 类似地,可将肱骨组件的下表面进行粘合或多孔涂覆或其两者。 Similarly, the lower surface of the humeral component may be porous coated or bonded or both. 优选仅附着机构自身(即,销钉、翅片或长钉)可延伸入软骨下骨中。 Preferably only attachment mechanism itself (i.e., pins, fins or spikes) may extend into the subchondral bone. 所述销钉、翅片,齿或长钉可以是锥形的、圆锥形的、三角形的、球形的、冠状的或任何类型的凸缘且可在表面上随机配置或有组织地进行配置(例如,列)。 The pins, fins, teeth or spikes may be tapered, conical, triangular, spherical, or any type of coronary flange and may be randomly arranged or arranged in an organized manner on the surface (e.g. column). 如本文所说明的,关节的肩臼侧具有一个关节软骨374。 As described herein, the glenoid side of the joint 374 has a joint cartilage. 植入物370可设计成与关节软骨374或软骨下骨或其两者相一致。 The implant 370 may be designed to be consistent with articular cartilage or subchondral bone 374, or both. 如图21P和21Q中所示,翅片和长钉可具有其它长度且可经配置使得翅片互相平行。 As shown in FIG. 21P and 21Q, the spike and the fins may have other lengths and may be configured such that the fins parallel to each other.

在另一个实施例中,植入物可适合于软组织损伤。 In another embodiment, the implant may be adapted to soft tissue injuries. 举例而言,在旋转肌肌腱撕裂的事件中,植入物可具有覆盖肱头的部分或所有上面的范围。 For example, in the rotator cuff tendon tears event, the implant may have a portion or all of the above range of the humeral head cover. 以这种方式,在软转肌肌腱撕裂后进行的肱头的高级移植并不导致肱头与肩锁关节的病理关节,产生疼痛和残疾。 In this manner, the humeral head is advanced transplant performed after the soft switch does not result in pathologic tendon tear joint humeral head and the acromioclavicular joint, causing pain and disability. 作为替代,肱头的上面可与植入物的延伸元件连接,进而避免了AC关节的骨质象牙化。 Alternatively, the above humeral head may be connected to the extension element of the implant, thereby avoiding eburnation AC joint.

D.肘图22是穿过肘关节600的倾斜纵向视图,其示范了肱骨远端602、肘突604和桡骨头606。 D. through the elbow 22 is a longitudinal view of the elbow joint 600 is inclined, which demonstrates the distal humerus 602, elbow 604 and radial projections 606 bone. 分别由603、605、607可见软骨表面。 603,605,607 respectively from the cartilage surface. 所说明的关节造形装置620是介于肱骨远端与尺骨608和桡骨610上的连接表面之间。 Arthroplasty device 620 is illustrated interposed between the connecting surface on the distal end of the humerus and ulna and radius 608 610. 关节造形装置620可具有和相关于图10到图20中所示的装置所示设计特征一样的设计特征,例如单组件、双组件、三组件;负重可活动设计;附着和不附着设计、具有变化的厚度和曲度的设计、与肱骨或尺骨或桡骨或其组合相一致的设计、与关节软骨和/或软骨下骨相一致的设计、具有用于稳定目的的边缘或元件的设计。 Arthroplasty device 620 may have design features and devices illustrated in FIGS. 20 to 10 shown in FIG relation to the same design features, e.g. single-component, two-component, three-component; mobile bearing design; and not attached to attachment design, having design thickness and curvature of the design change, consistent or ulna or humerus, or in combination with a radial design, and articular cartilage or cartilage and / Skeleton consistent, with an edge or element designed for stabilization purposes. 然而,为了避免使本发明含糊不清,这个申请案中所讲解的设计考虑事项的每个可能的变更都没有对这个关节进行说明。 However, to avoid ambiguity of the present invention, each of the possible changes to the design considerations are explained in this application are not on the joints is described.

E.腕关节图23A是穿过腕关节700的纵向视图,其示范了肱骨远端702、尺骨704和形成腕骨列706(例如舟骨、月骨、三角骨、头状骨和勾状骨)的若干腕骨。 E. wrist FIG. 23A is a longitudinal section through the wrist joint 700, 702 which demonstrates the distal humerus, ulna carpus columns 704 and 706 are formed (e.g. scaphoid, lunate, triquetrum, capitate bone and bone-hook) several wrist. 所说明的关节造形装置720是介于肱骨远端702、尺骨远端704与腕骨列近端的连接表面706′,706″,706之间。关节造形装置720与桡骨远端702的形状、腕骨列近端706的形状和这个实例中的三角纤维软骨708(虚线)的形状一致。 Illustrated arthroplasty device 720 is interposed between the distal end of the humerus 702, the distal ulna 704 is connected with the surface of the proximal carpal row 706 ', 706 ", between 706. Shapes 720 and 702 of the distal radius arthroplasty device, proximal carpal row triangular fibrocartilage same shape in this example 706 and 708 (dotted line) shape.

如所属领域的技术人员将了解的,关节造形装置720可具有和相关于图10到图20中所示的装置而描述的设计特征一样的设计特征,例如单组件、双组件、三组件;负重可活动设计;附着(例如,附着到桡骨远端上)和不附着设计、具有变化的厚度和曲度的设计、与桡骨或尺骨或腕骨或其组合相一致的设计、与关节软骨和/或软骨下骨且还与例如三角纤维软骨的其它关节结构相一致的设计、具有用于稳定目的的边缘或元件的设计。 As those skilled in the art will appreciate, the arthroplasty device 720 may have design features and devices illustrated in FIG. 10 to FIG. 20 described in relation to the same design features, e.g. single-component, two-component, three-component; weight movable design; attached (e.g., attached to the distal radius) and does not adhere to the design, the thickness and curvature of varying design, consistent with the radius or ulna with a design or a combination thereof, or wrist, articular cartilage and / or subchondral bone and also consistent with other joints e.g. triangular fibrocartilage structure design having an edge or element designed for stabilization purposes.

图23B是通过腕关节700的纵向视图,其说明桡骨远端702、尺骨704和形成腕骨列706(例如舟骨、月骨、三角骨、头状骨和勾状骨)的若干腕骨。 FIG 23B is a longitudinal view through the wrist joint 700 illustrating the distal radius 702, ulna 704, and a plurality of columns formed Carpal wrist 706 (e.g. scaphoid, lunate, triquetrum, capitate bone and bone-hook) of. 所说明的关节造形装置720是介于肱骨远端702、尺骨远端704与腕骨列近端706的连接表面706′,706″,706之间。关节造形装置720经配置使得其与至少一部分桡骨远端702的形状、尺骨远端704的形状和腕骨列近端706的形状一致。 Arthroplasty device 720 is illustrated interposed between the distal end of the humerus 702, 704 connected to the distal surface of the proximal ulna 706 and carpal row 706 ', 706 ", between 706. Arthroplasty device 720 is configured such that at least a portion thereof the shape of the distal radius 702, the distal ulna 704 and the shape of the proximal carpal row 706 of uniform shape.

图23C还是穿过腕关节700的纵向视图,其示范了桡骨远端702、尺骨704和若干腕骨706。 FIG 23C is a longitudinal view through the wrist joint 700, which is exemplary of the distal radius 702, ulna 704 and several carpal 706. 所显示的关节造形装置730是介于肱骨远端702、尺骨远端704与近端腕骨列(carpal row)706的连接表面706′,706″,706之间。所显示的关节造形装置730与桡骨远端702的形状、腕骨列近端706的形状和包括尺骨茎突710的尺骨远端704的形状大体一致。所见的边缘732沿着桡骨远端的中部和包括尺骨茎突710的尺骨远端704的侧部进行延伸;这样可提供植入物相对于这些骨骼的稳定性。一个或一个以上边缘732,或其它适合配置的凸缘可朝向任何关节骨的背部或中部进行延伸。 Arthroplasty device arthroplasty device 730 is shown interposed between the distal end of the humerus 702, a distal end 704 and proximal ulna carpal row (carpal row) surface 706 of the connector 706 ', 706 ", between 706. 730 shown the shape of the distal radius 702, the shape of the proximal carpal row 706 and ulna 710 including the ulnar styloid distal end 704 of a shape substantially consistent edge 732 as seen along the center of the distal radius and the ulnar styloid comprising 710 side portion 704 extends distal ulna; which can provide the implant with respect to the stability of these bones one or more edges 732, flanges or other suitable configuration may be any back toward the middle of the bone or extend.

图23D是双组件,“负重可活动”关节造形装置740的纵向视图。 23D is a two-component, "mobile bearing" longitudinal view of the arthroplasty device 740. 所述装置740具有一个第一组件742和一个第二组件744。 The device 740 has a first component 742 and second component 744 a. 每个组件具有与其它组件的表面进行连接的表面743、745。 Each component has a surface 743,745 for connection to the surface of other components. 两个连接植入物表面的半径可经选择以匹配桡骨702或尺骨704或腕骨706或其组合。 Two radii connecting the implant surface may be selected to match the radius or ulna 702 704 or 706 or a combination thereof wrist. 另外,两个连接植入物表面的旋转中心可经选择以匹配或接近关节700的旋转中心。 Further, the two connecting the rotational center of the implant surface may be selected to match or near the center of rotation of joint 700. 如所属领域的技术人员将了解的,两个连接植入物表面743、745可具有促进关节活动的任何形状,包括平面。 As those skilled in the art will appreciate, the two surfaces 743,745 connecting the implant can have any shape improving joint activities, including planar. 注意近端组件的边缘746、748在中间和侧面延伸。 Note that the proximal end of assembly 746, 748 extending in the middle and edge side. 边缘还可朝向背部和中部延伸。 Further toward the back edge and central extension.

图23E是另一个双组件,“负重可活动”关节造形装置750的纵向视图,在这个情形下没有边缘。 FIG 23E is another dual component, "mobile bearing" longitudinal view of the arthroplasty device 750, in this case no edge. 所述装置750具有一个第一组件752和一个第二组件754。 The device 750 has a first component 752 and second component 754 a. 每个组件具有与其它组件的表面进行连接的表面753、755。 Each component has a surface 753,755 for connection to the surface of other components. 从横截面图可以明显看到,第一组件的连接表面753的长度长于第二组件的连接表面755的长度。 From cross-sectional view we can clearly see that the length of the connecting surface of the first component 753 is longer than the length of the connecting surface 755 of the second assembly.

图23F是一个双组件,“负重可活动”关节造形装置760的纵向视图。 FIG. 23F is a dual component, "mobile bearing" longitudinal view of the arthroplasty device 760. 如所描述的,使用一个附着机构或锚定器766将面对着桡骨和尺骨的第一组件762附着到这些骨骼上。 As described, using one or anchor attachment mechanism 766 facing the radius and ulna of the first assembly 762 is attached to the bones. 合适的锚定器766包括销钉,如此实例所示,长钉和/或翅片,不作列举。 Suitable anchor 766 comprises a pin, as in this example, a spike and / or fins, is not exemplified. 如所属领域的技术人员将了解的,装置760的附着可限于仅附着到一个骨骼上(例如,尺骨或桡骨)。 As those skilled in the art will appreciate, the attachment device 760 may be limited to only attached to a bone (e.g., the ulna or radius).

F.手指图24是穿过手指800的径向图。 F. FIG 24 is a finger through the radial finger 800 of FIG. 所说明的关节造形装置820是介于掌骨头802与指骨近端804的基部之间。 Arthroplasty device 820 is illustrated interposed between the base of the proximal phalanx and the metacarpal bone 802 804. 所述关节造形装置820的一侧822与掌骨头802的形状一致且其相对的一侧824与指骨近端804的基部一致。 The arthroplasty device 820 conforms to the shape of the side 822 and the metacarpal bone 802 and consistent with the opposite side 824 of the base 804 of the proximal phalanx. 关节造形装置820可具有和图10到图20中所见的设计特征一样的设计特征,例如单组件、双组件、三组件;负重可活动设计;附着(例如,附着到掌骨头或指骨的基部上)和不附着设计、具有变化的厚度和曲度的设计、与近端或远端关节表面或其组合相一致的设计、与关节软骨和/或软骨下骨且还与其它关节结构相一致的设计、具有用于稳定目的的边缘或元件的设计。 Arthroplasty device 820 and may have design features seen in FIG. 10 to FIG. 20 of the same design features, e.g. single-component, two-component, three-component; mobile bearing design; attached (e.g., attached to the base of the metacarpal bones or phalanges on) and does not adhere to the design, the thickness and curvature of varying design, the proximal or the distal articular surface or combinations consistent design, articular cartilage and / or subchondral bone and also consistent with the other joint structure It designs, with elements for stabilization purposes or edge design. 类似的设计可应用于后足、中足和前足,包括脚趾。 Similar designs may be applied to the foot, midfoot and forefoot including the toes.

G.踝图25A是穿过踝关节900的径向图,其展示胫骨远端902、距骨904和跟骨906和其它骨骼。 G. ankle 25A is passing through the ankle joint 900 is radial view showing the distal end of the tibia 902, talus 904 and calcaneus 906 and the other bones. 还显示了软骨表面。 Also shows a cartilage surface. 所说明的关节造形装置920是介于胫骨远端902与talar dome904′之间。 Arthroplasty device 920 is illustrated interposed between the distal tibia 902 and the talar dome904 '. 在这个实施例中,关节造形系统920与距骨904的形状相一致。 In this embodiment, the shape of the arthroplasty system 920 and talus 904 coincide. 如所属领域的技术人员将了解的,且是先前讨论过的,装置可与软骨或软骨下骨或其两者的形状相一致。 As those skilled in the art will appreciate, and as discussed previously, the device may be consistent with the shape of the cartilage or subchondral bone, or both. 关节造形装置920可具有和图10到图20中所说明的装置的设计特征类似的设计特征,例如单组件、双组件、三组件;负重可活动设计;附着和不附着设计、具有变化的厚度和曲度的设计、与胫骨或距骨或腓骨相一致的设计、与关节软骨和/或软骨下骨相一致的设计、具有用于稳定目的的边缘或元件的设计。 The thickness of adhesion and non-adhesion design, with varying; arthroplasty device 920 can have and 10 the design characteristics of the device in FIG. 20 described similar design features, e.g. single-component, two-component, three-component; mobile bearing design activities and curvature design, consistent with the tibia or fibula talus or design, design and articular cartilage or cartilage and / Skeleton consistent, with an edge or element designed for stabilization purposes.

图25B是穿过踝关节900的冠状切面图,其说明胫骨远端902、腓骨远端908和距骨904。 25B is a coronal view through the ankle joint 900 illustrating the distal tibia 902, talus 904 and 908 of the distal fibula. 所说明的关节造形装置930是介于胫骨远端902与胫距关节面(talar dome)904′之间。 Arthroplasty device 930 is illustrated interposed between the distal tibia 902 and the tibial articular surface distance (talar dome) 904 'between. 在这个实例中,所显示的关节造形系统930与距骨904的形状相一致。 In this example, the shape of the arthroplasty system shown talus 930 and 904 coincide.

图25C是穿过踝关节900的径向图,其说明胫骨远端902、距骨904和跟骨906和其它骨骼。 FIG 25C through the ankle joint 900 is a radial view illustrating the distal tibia 902, talus 904 and calcaneus 906 and the other bones. 还显示了软骨表面。 Also shows a cartilage surface. 所描述的关节造形装置940是介于胫骨远端902与胫距关节面904′之间,在这个实例中,关节造形系统942的下表面与距骨904的形状大体一致。 Arthroplasty device 940 is described between the distal tibia 902 and the tibial articular surface from 904 ', in this example, the shape of the lower surface of the arthroplasty system 942 and the talus 904 substantially coincide. 上表面944与胫骨远端902和腓骨(908,未图示)的形状大体一致。 And the upper surface of the distal tibia 944 and fibula 902 (908 not shown) of a shape substantially the same. 所显示的边缘946在啮合距骨904的上表面942上。 Edges 946 shown engaging the upper surface of the talus 942 904.

图25D是穿过踝关节900的冠状切面图,其说明胫骨远端902、腓骨远端908和距骨904。 FIG 25D is a coronal view through the ankle joint 900 illustrating the distal tibia 902, talus 904 and 908 of the distal fibula. 所显示的关节造形装置950是介于胫骨远端902与胫距关节面904′之间。 Arthroplasty device 950 is between the display 904 'tibia distal articular surface 902 and Tibiotalar. 在这个实例中,关节造形系统的下表面952与距骨904的形状相一致。 In this example, the shape of the lower surface 952 of the arthroplasty system 904 consistent with the talus. 上表面954与胫骨远端902和腓骨908的形状相一致。 The upper surface of the distal tibia 954 and fibula 908 902 shapes coincide.

H.脚趾图26是穿过脚趾1000的径向图。 FIG 26 is H. toe toe radially through 1000 of FIG. 所说明的关节造形装置1020是介于掌骨头1002与近节趾骨1004的基部。 Arthroplasty device 1020 is described metacarpal bones between the base 1002 and 1004 of the proximal phalanx. 所说明的关节造形装置1020的第一表面1022与掌骨头的形状相一致且第二表面1024与近节趾骨的基部相一致。 Arthroplasty device explained in the first surface 1022 and 1020 coincide with the shape of metacarpal head and the second surface 1024 is consistent with the base of the proximal phalanx. 如所属领域的技术人员将了解的,关节造形装置可具有和图10到图20中所见的设计特征类似的设计特征,例如单组件、双组件、三组件;负重可活动设计;附着(例如,附着到掌骨头或指骨的基部上)和不附着设计、具有变化的厚度和曲度的设计、与近端或远端关节表面或其组合相一致的设计、与关节软骨和/或软骨下骨且还与其它关节结构相一致的设计、具有用于稳定目的的边缘或元件的设计。 As those skilled in the art will appreciate, the arthroplasty device may have features and design as seen in FIG. 20 to FIG. 10 of similar design features, e.g. single-component, two-component, three-component; mobile bearing design; attachment (e.g. attached to the base of the metacarpal bones or phalanges) and the design is not attached, of varying thickness and curvature of the design, the distal end of the proximal articular surface coincides, or a design or in combination with, articular cartilage and / or subchondral bone and other joints are also consistent with the design of the structure, with elements for stabilization purposes or edge design. 类似的设计可应用于后足、中足和前足。 A similar design can be applied to the foot, midfoot and forefoot.

D.装置制造、组合和特性可从所属领域中已知的各种合适的材料制备上文所述的装置,或根据本发明的讲解而制造的任何装置。 D. means for producing, said means suitable for preparing the above composition and properties of materials known in the art from various, or any device according to the teachings of the present invention manufactured. 发现有用于本发明的实例中的广泛种类的材料包括(但不限于)塑料、金属、陶瓷、生物材料(例如胶原质或其它细胞外基质材料)、羟磷灰石、细胞(例如干细胞、软骨细胞等),或其组合。 Examples of materials found in the present invention include a wide variety of (but not limited to) plastic, metal, ceramics, biological materials (e.g., collagen or other outer extracellular matrix materials), hydroxyapatite, cells (e.g., stem cells, cartilage cells, etc.), or combinations thereof. 基于与缺损和/或关节表面和/或软骨下骨相关的信息,可选定一种合适的材料。 Based on the defect and / or articular surface and / or information related to subchondral bone, a suitable material may be selected. 另外,使用本文所述的这些技术中的一个或一个以上技术,可形成具有弯曲部分的软骨替换部分或再生材料,所述弯曲部分能匹配特定软骨缺损,可符合关节表面的轮廓和形状,且可匹配周围软骨的厚度。 Further, the techniques described herein using one or more techniques, may form part of the cartilage replacement or regenerating material having a curved portion, the curved portions match a particular cartilage defect, can follow the contour and shape of the articular surface, and It matches the surrounding cartilage thickness. 另外,使用本文所述的这些技术中的一个或一个以上技术,可成形一个关节装置,其可在关节空间中匹配且可符合关节表面或其它关节结构的轮廓和形状。 Further, the techniques described herein using one or more techniques, may be formed a joint device which can be matched in the joint space and may conform to the contours and shape of the articular surface or other articular structures. 所述材料可包括材料的组合,且优选包括至少一个大体上非易曲材料。 The material may comprise a combination of materials and preferably comprises at least one substantially non-pliable material.

另外,材料可具有一个硬度梯度。 Further, the material may have a hardness gradient. 因而,例如硬度梯度可从装置的中心减少到外边缘。 Thus, for example, can reduce the hardness gradient from the center to the outer edge of the device. 因而生产出一种装置,其具有全面的坚固,但对于沿着某些或全部外表面的表面来说具有少量的可弯性。 Thereby to produce a device having a solid round, but along some or all of the outer surface is a surface having a small amount of pliability. 提供由具有某些可弯性的材料制成的外表面可提高植入物的能力来与关节配对。 It provided having an outer surface made of a material of some pliability enhance the ability of the implant to match the joint. 或者,在某些情形下,可制造出一种装置的外表面具有大于其内部的肖氏硬度值的装置。 Alternatively, in some cases, can be produced an outer surface of an apparatus having a large interior thereof means a Shore hardness values.

装置的内部硬度可使植入物适合在关节内执行。 Internal hardness may cause the implant device suitable for performing within the joint. 合适的硬度对于所属领域的技术人员来说将变得显而易见且可包含一个范围。 Suitable hardness to those skilled in the art will become apparent and may comprise a range. 通常,根据肖氏硬度衡量来讨论硬度,且其范围可从普通工程级材料塑料到强化钢和钛,且优选是关于钢的典型洛氏硬度标尺部分,硬塑料和陶瓷材料。 Typically, a Shore hardness measured according to hardness discussed, and may range from common engineering grade plastics to hardened steel material and titanium, and preferably about Rockwell hardness scale typical part, hard plastics and ceramic material such as steel. 从所需的高硬度装置,很明显装置以完全不同于先前技术的方式进行运作。 From the high hardness desired of the device, obviously the device in a manner completely different from the prior art operate. 本发明的装置的目的是实现类似于横跨的效果来桥接缺损的区域。 Destination device of the present invention is to realize an effect similar to bridge across the defect area. 然而,在复合变化中,任何单组件(像下文所述的生物活性材料组件)可软于支承材料。 However, in a composite variation, any single component (like a bioactive material component described hereinafter) may be softer than the supporting material.

当前,关节修复系统(包括装置)使用金属和/或聚合材料。 Currently, joint repair systems (including devices) metals and / or polymeric material. 参阅(例如)2001年3月20日颁予Afriat等人的美国专利第6,203,576号、2001年3月27日颁予Fell等人的美国专利第6,206,927号,和2001年11月27日颁予Ogle等人的美国专利第6,322,588号和其中引用的参考。 See (for example) US Patent No. 6,203,576, issued to Afriat, et al., 2001 March 20, 2001 March 27, issued to Fell et al., US Patent No. 6,206,927, and 2001 November 27 issued to Ogle US Patent No. 6,322,588, et al., and references cited therein. 类似的,广泛种类的金属发现可用于本发明的实例中,且可基于任何标准进行选择,例如,基于弹性来提供所需的坚硬度。 Similarly, a wide variety of metals can be found in the Examples of the present invention, and may be selected based on any criteria, for example, based elastomer to provide the desired stiffness. 非限制性的合适的金属实例包括银、金、铂、钯、铱、铜、锡、铅、锑、铋、锌、钛、钴、不锈钢、镍、铁合金、钴合金(例如埃尔基洛伊合金(Elgiloy)、钴铬镍合金和MP35N、镍钴铬钼合金,和镍钛诺TM、镍钛合金、铝、锰、铁、钽,和可慢慢形成多价金属铁来(例如)抑制与病人的体液或组织相接触的植入基板的石灰化的其它金属,和其组合。 Non-limiting examples of suitable metals include silver, gold, platinum, palladium, iridium, copper, tin, lead, antimony, bismuth, zinc, titanium, cobalt, stainless steel, nickel, iron alloys, cobalt alloys (e.g. 埃尔基洛伊alloy (Elgiloy®), and cobalt-chromium-nickel alloy as MP35N, nickel-cobalt-chromium-molybdenum alloy, and nitinol (TM), nickel-titanium alloy, aluminum, manganese, iron, tantalum, and slowly form polyvalent metal may be iron (e.g.) inhibition implantation calcification other substrate in contact with the metal patient's bodily fluids or tissues, and combinations thereof.

合适的合成聚合物包括(不限于)聚酰胺(例如尼龙)、聚酯、聚苯乙烯、聚丙烯酸酯、乙烯基聚合物(例如,聚乙烯、聚四氟乙烯、聚丙烯和聚氯乙烯)、聚碳酸酯、聚亚氨酯、聚二甲基硅氧烷、醋酸纤维素、聚甲基丙烯酸酯、聚醚醚酮、聚醚酮酮、乙烯乙烯醋酸酯、聚砜、尼龙纤维素、类似的共聚物和其混合物。 Suitable synthetic polymers include (not limited to) polyamides (e.g. nylon), polyesters, polystyrenes, polyacrylates, vinyl polymers (e.g., polyethylene, polytetrafluoroethylene, polypropylene and polyvinyl chloride) , polycarbonate, polyurethane, polydimethyl siloxane, cellulose acetate, polymethyl methacrylate, polyether ether ketone, polyether ketone ketone, ethylene vinyl acetate, polysulfone, nylon, cellulose, similar copolymers and mixtures thereof. 还可使用生物再吸收合成聚合物,例如右旋糖苷、羟乙基淀粉、凝胶衍生物、聚乙基吡咯啶酮、聚乙基醇、聚[N-(2-羟丙基)甲基丙烯酰]、聚(羟酸)、聚(ε己内酰胺)、聚乳酸、聚乙醇酸、聚(二甲基乙醇酸)、聚(羟基丁酸),且还可使用类似的聚合物。 Use may also be bioresorbable synthetic polymers such as dextran, hydroxyethyl starch, gelatin derivatives, poly-ethyl pyrrolidone, polyethyl alcohol, poly [N- (2- hydroxypropyl) acryloyl], poly (hydroxy acids), poly ([epsilon] -caprolactam), polylactic acid, polyglycolic acid, poly (dimethyl glycolic acid), poly (hydroxy butyrate), and similar polymers may also be used.

可使用任何各种方法来制备这些聚合物,包括常规的聚合物处理方法。 These polymers may be prepared using any of a variety of methods, including conventional polymer processing methods. 优选的方法包括(例如)注射成形,其适用于生产具有显著结构特征的聚合物组件;和快速成形方法,例如反应性注射成形和立体印刷术。 Preferred methods include (e.g.) an injection molding, which is suitable for the production of polymers having significant structural features of the assembly; and a rapid prototyping methods, such as a reactive injection molding and stereo lithography. 基板可通过物理磨损或化学改造而具有粗糙表面或成多孔状以促进金属涂层结合。 Substrate may have a rough surface or into a porous metal coating to facilitate binding by physical abrasion or chemical transformation.

聚合物可经注射成一个铸模,其反映关节表面或其它关节结构的外表。 Polymer may be injected into a mold, which is reflected on the outer surface of the joint or other joint structures.

可结合使用一种以上的金属和/或聚合物。 Using more than one metal and / or polymer may be incorporated. 且也可使用液态金属。 And the liquid metal can also be used. 例如,可使用聚合物涂覆一种或一种以上的含金属基板的一个或一个以上的区域,或者,可使用一种或一种以上的金属涂覆含聚合物的基板的一个或一个以上的区域。 For example, a coating may be a polymer of one or more metal-containing substrate, or more than one region, or a substrate, may be used one or more of metal-coated polymer containing one or more Area.

装置或其部分可以是多孔的或具有多孔涂覆。 Devices or portions thereof may be porous or porous coated. 多孔表面组件可由包括金属、陶瓷和聚合物的各种材料制成。 The porous surface of the component may be a variety of materials including metals, ceramics and polymers formed. 这些表面组件可接着被各种构件封闭在由各种材料形成的很多结构型心中。 These surface components can then be closed in many various structural members formed of various materials hearts. 合适的多孔涂覆包括(但不限于)金属、陶瓷、聚合物(例如,例如硅树脂橡胶的生物中性弹性体、聚对苯二甲酸乙二酯和/或其组合)或其组合。 Suitable porous coating including (but not limited to) metal, ceramic, polymeric (e.g., biologically neutral elastomers e.g. silicone rubber, polyethylene terephthalate and / or combinations thereof) or combinations thereof. 参阅,例如1971年9月20日颁予Hahn等人的美国专利第3,605,123号、1974年4月23日颁予Tronzo的美国专利第3,808,606号、1974年10月29日颁予Tronzo的美国专利第3,843,975号、颁予Smith的美国专利第3,314,420号、1976年10月26日颁予Scharchach的美国专利第3,987,499号、和德国Offenlegungsschrift第2,306,552号。 See, for example, September 20, 1971 US Patent No. 3,605,123, issued to Hahn et al, April 23, 1974 awarded US Patent No. 3,808,606 Tronzo, the October 29, 1974 issued to Tronzo US Patent No. 3,843,975, US Patent No. 3,314,420, issued to Smith and US Patent No. 3,987,499, issued to Scharchach of October 26, 1976, and German Offenlegungsschrift No. 2,306,552. 可具有一个以上的涂层且所述涂层可具有相同的或不同的多孔性。 It may have more than one coating and the coating may have the same or a different porosity. 参阅,例如1976年2月17日颁予Kahn等人的美国专利第3,938,198号。 See, for example, US Pat. No. 3,938,198, issued to Kahn et al, February 17, 1976.

可通过在芯周围使用粉末状聚合物并加热直到形成具有互连小孔的内部网状物的涂层而施加涂层。 By using a powdery polymer around the core and the coating formed was heated until the internal web having interconnected pores of the coating applied. 小孔的弯曲度(例如穿过小孔的路径的长度到直径的测量)对于评估这样的涂层用在假体装置上的成功率很重要。 Curvature apertures (e.g., a length to diameter measurement path through the aperture) is important for assessing the success of such a coating used in the prosthetic device. 还是参阅1980年7月22日颁予Morris的美国专利4,213,816号。 Or see the July 22, 1980 issued to Morris, US Patent No. 4,213,816. 可用粉末和颗粒的形式作为整体经受将粉末粘合在基板上的高温来施加多孔涂覆。 Available in the form of powders and granules of the powder as a whole is subjected to a high temperature adhesive on the substrate a porous coating is applied. 考虑到本文的讲解和所引用的参考,(例如)基于每个的熔融指数可确定对聚合物和/或粉末涂层进行合适选择。 Taking into account the explanation and reference cited herein, (e.g.) each based on the polymer melt index can be determined and / or powder coating is suitably selected.

本文所描述的任何装置还可包括一种或一种以上生物材料,可单独使用或与非生物材料结合使用。 Any device described herein may further comprise one or more biological materials can be used alone or in combination with non-biological materials. 生物材料的非限制性实例包括细胞(例如胎儿软骨细胞)、生物聚合物(例如,胶原质、弹性蛋白、蚕丝、角蛋白、凝胶、聚氨基酸、猫内脏结构、猫肠针缝合、例如纤维素和淀粉的聚糖)、自体移植物、同种异体移植物、异种移植物等。 Non-limiting examples of biological materials include cells (e.g., fetal chondrocytes), biopolymers (e.g., collagen, elastin, silk, keratin, gelatin, polyamino acids, cat visceral structures, cat gut suture needle, such as a fiber polysaccharides and prime starch), autograft, allograft, xenograft and the like. 参阅1995年12月26日颁予Slivka等人的第5,478,739号、1998年12月1日颁予Naughton等人的第,5,842,477号、2001年9月4日颁予Vibe-Hansen等人的第6,283,980号、和2002年2月4日颁予Salzmann等人的第6,365,405号美国专利。 See December 26, 1995 issued to Slivka et al., No. 5,478,739, 1998 December 1, issued to Naughton, et al. The first, No. 5,842,477, 2001 September 4, issued to Vibe-Hansen, who first 6,283,980 number, and February 4, 2002, issued to Salzmann et al., US Patent No. 6,365,405.

在某些实施例中,装置可包括一个或一个以上独立的(但优选是可啮合的)组件。 In certain embodiments, a device may comprise one or more separate (but preferably is engageable) components. 举例而言,两片装置可包括两个组件,其中每个组件包括一配对面。 For example, two devices may comprise two assemblies, wherein each assembly comprises a counterweight opposite. 两个组件可以是互锁的。 Two components can be interlocked. 当彼此配对时,成轮廓的面彼此相对且形成一个装置,所述装置安装在待矫正的缺损内且提供一个模拟或复制自然的关节表面的关节表面。 When paired with each other, the contoured surfaces opposite to each other and a forming apparatus, said mounting means and providing analog or a copy of the natural articular surface of the articular surface within the defect to be corrected. 可使用任何合适的互锁机构,包括可移动(例如键槽)系统;互锁扣;球形和键槽互锁系统;凹槽和凸缘系统等。 Any suitable interlocking mechanism includes a movable (e.g., keyway) system; cross latch; ball and keyway interlock system; the groove and the flange systems. 在一些实施例中,可啮合的组件表面是弯曲的。 In some embodiments, the assembly can be engaged surface is curved. 曲度可以反映一个或一个以上关节结构。 Curvature may reflect one or more joint structure.

在其它实施例中,装置的构造在安装入关节之后会发生改变。 In other embodiments, the configuration of the device will change after installation into the joint. 因而,可将装置设计成初始的构造。 Thus, the device can be designed as an initial configuration. 安装后,所述装置采取(assume)不同于初始构造的随后构造。 After installation, the apparatus taken (the ASSUME) differs from the initial configuration is then configured. 举例而言,所述装置可以是多组件装置,在第一构造中,其具有小的外形或小的三维形状。 For example, the device may be a multi-component device in the first configuration, which have a low profile or small three-dimensional shape. 安装之后,外科医生允许(或促使)装置采取第二构造,其可具有更大的外形或整体三维的形状。 After installation, the surgeon to allow (or cause) means to take the second configuration, it may have a larger overall three-dimensional shape or profile. 所述装置可自行形成其二级构造,或者可经操纵而形成二级构造,例如通过机械构件(例如展开所述装置或滑动彼此相对的装置的组件以使其采取更大的第二构造)。 The apparatus may form a secondary structure, which itself, or may be manipulated to form a secondary structure, for example by mechanical means (e.g., deploying the device or the slide assembly means relative to each other so as to take a larger second configuration) . 这些实施例的优势在于需要更小的切口。 The advantage of an embodiment that requires a smaller incision. 所述装置可(例如)在关节镜下以这种方式进行安装。 The device may be (e.g.) arthroscopic installed in this manner. 因而,可自动地,半自动地或手动地采取随后的构造。 Thus, automatically, semi-automatically or manually taking subsequent configuration.

文本所述的方法和组合可用于仅替换部分关节表面,例如,关节表面上的发病软骨或缺失软骨区域。 The text methods and compositions may be used to replace only a portion of the articular surface, e.g., the incidence of cartilage on the articular surface cartilage region or deletion. 在这些系统中,可设计关节表面修复系统来仅替换发病或缺失软骨区域或其可延伸超出发病或缺失软骨,例如进入正常邻近的软骨3或5mm。 In these systems, the articular surface repair system can be designed to replace only the onset of cartilaginous region or deletion or deletions may extend beyond the onset or cartilage, for example, into the normal cartilage near 3 or 5mm. 在某些实施例中,假体替换不大于约70%到80%的关节表面(例如,单股骨髁的任何给定的关节表面等),优选小于约50%到70%(或其中的任何值),最好小于约30%到50%(或其中的任何值),最好小于约20%到30%(或其中的任何值),甚至最好小于约20%的关节表面。 In certain embodiments, the prosthesis articular surface replacement is not greater than 70% to about 80% (e.g., single femoral condyle any given articular surface, etc.), preferably less than about 50% to about 70% (or any of them values), preferably less than about 30% to 50% (or any value), preferably less than about 20% to 30% (or any value), even more preferably less than about 20% of the articular surface.

E.替代附着机构如所属领域的技术人员将了解的,可提供各种附着机构来将植入物附着在目标关节中。 E. Alternative attachment means such as those skilled in the art will appreciate, a variety of attachment means may be provided to affix the implant in the target joint. 举例而言,附着机构可以是嵴、销钉、插针、横件和啮合植入物配对表面的其它凸缘。 For example, the attachment mechanism may be other flange crest, a pin, pins, cross-members and the engagement of the mating surfaces of the implant. 这些凸缘或机构可具有各种形状和横截面,包括锥形、三角形、圆锥形、球形、圆柱形、环形等。 These flanges or mechanism can have various shapes and cross-section, includes a tapered, triangular, conical, spherical, cylindrical, and annular. 可使用单个附着机构或需要时可使用复数个机构。 Mechanism can be used when a plurality of attachment mechanisms may be used single or need. 可使用所述形状的组合以实现更好的替换。 The shape may be used in combination to achieve a better alternative. 当使用复数个机构时,可以有组织的形式(例如,列、圆等)或杂乱的(随机)形式形成所述机构。 When a plurality of agencies may be organized in the form (e.g., a column, a circle, etc.) or scrambled (random) the forming mechanism forms. 在植入物的下表面上提供一个圆锥体状部分。 A cone-shaped portion on the lower surface of the implant. 另外,在使用了一个以上的附着机构时,彼此相对的方向可以是平行的或非平行的。 Further, when using more than one attachment means, in mutually opposite directions may be parallel or non-parallel.

在一个实例中,一个圆锥体定位在装置的下表面上,使得其置于(例如)胫骨软骨的下凹部分的底部。 In one example, a cone is positioned on the lower surface of the device, such that it is placed (e.g.) a bottom concave portion of the tibial cartilage. 圆锥体可和球体一样,也可通过(例如)圆柱状元件从植入物的下表面分离。 And spherical cones may be the same, can also be (e.g.) the lower cylindrical member is separated from the surface of the implant. 所属领域的技术人员将显而易见其它适合附着的几何形状。 Those skilled in the art will be apparent other suitable attachment geometry.

在另一个实例中,在植入物的表面上提供一个或一个以上圆柱状或大体圆柱状的插针。 In another example, one or more cylindrical or substantially cylindrical pin on the surface of the implant. 将插针定位使得每个插针至少与一个其它插针平行。 The pins of each pin is positioned such that the at least one other pin parallel.

在另一个实例中,一个磁体半固定附着机构置于软骨下骨层的下方,例如胫骨中。 In another example, a semi-fixed magnet attachment means disposed below subchondral bone layer, e.g. tibia. 另一个磁体或磁性材料嵌入或附着到装置的下表面上,接着通过第一磁体将其固定。 Another magnet or magnetic material embedded or attached to the lower surface of the device, followed by a first magnet which is fixed. 如所属领域的技术人员将了解的,可使用互相关联的复数个磁体。 As those skilled in the art will appreciate, the use of a plurality of magnets may be interrelated. 另外,可使用磁体的组合,使得每个表面具有有第一极的一个或一个以上磁体和有第二极的一个或一个以上磁体,使用相反磁极的磁体在相对的表面上(或与其关联的表面上)使所述表面与磁体啮合。 Further, magnets may be used in combination, such that each surface has a first electrode having one or more magnets and a second electrode of one or more magnets, the magnets having opposite polarities used (or associated therewith on the opposite surface surface) and the surface engaging the magnet. 此布置在需要防止装置在关节内旋转同时确保两个表面之间的联系处是有用的。 This arrangement requires means for preventing rotation of the joint while ensuring the link between the two surfaces is useful.

在另一个实例中,这种附着机构是一个螺丝或锚定器,其可在胫骨软骨的下凹部分的底部插入胫骨的软骨下骨。 In another example, the attachment means is a screw or anchor that can be inserted into the subchondral bone of the tibia at the bottom of the recessed portion of the tibial cartilage. 所述装置可固定到螺丝或锚定器或可具有一个半固定设计,例如通过并入在螺丝或锚定器上方滑动的狭槽。 The device may be secured to the screws or anchors, or may have a semi-fixed design, for example by screws or incorporated in sliding over the anchor slot.

可调节植入物的高度来矫正关节的拓扑结构不正常或轴偏离。 Height-adjustable joint implant to correct topology is not normal or axial misalignment. 举例而言,在膝关节中,可调节关节高度来矫正弓形腿或外翻足畸形。 For example, in the knee joint, the height of the joint may be adjusted to correct varus or valgus deformity. 可使用关节和相邻关节轴的测量来确定矫正。 May be used and the joint axis of the joint adjacent to the measurement determined correction. 举例而言,出于这个目的可使用CT或MRI扫描或四肢的负重X光照片。 By way of example, may be used for this purpose CT or MRI scan or weight-bearing X-ray photograph of the limbs.

也可选择或调节植入物厚度来矫正韧带松弛的现象。 Alternatively or adjusting the thickness of the implant to correct laxity phenomenon. 在膝关节中,例如,可选择一个稍厚的植入物来解决一个或一个以上十字状或间接韧带的松弛或撕裂的问题。 In the knee, for example, select a thicker implant to address one or more cross-shaped or indirectly ligament laxity or tearing problems. 植入物厚度的增加可以是均匀或不均匀的,例如主要在周边。 Increasing the thickness of the implant may be uniform or non-uniform, for example, primarily in the periphery. 外科医生可在外科手术时使用一个或一个以上实验假体或实际植入物以测试那种植入物厚度可产生与关节和植入物松弛有关的最佳结果。 The surgeon may use a surgical operation or when a prosthesis or more experiments to test the actual implant that the thickness of the implant may generate joint implants and related relaxation best results.

V.植入通常将本文所述的装置植入关节缺损区域。 V. implantable devices described herein typically implanted joint defect zone. 使用软骨替换或仍附着在基础材料或从基础材料移除的再生材料可执行植入。 Use of the cartilage replacement or still attached to the base material or recycled material is removed from the base material may perform implantation. 任何合适的方法和装置可用于植入,例如,2002年4月颁予Hangody等人的美国专利第6,375,658号、2002年3月19日颁予Torrie等人的第6,358,253号、2001年12月11日颁予Hardwick等人的第6,328,765号、和2001年3月22日公开的Cummings等人的国际公开案WO 01/19254中所描述的装置。 US Patent No. 6,375,658 by any suitable method and apparatus may be used to implant, for example, in April 2002 awarded Hangody et al., Issued to Torrie et al, March 19, 2002 No. 6,358,253, December 11, 2001 the device described in Japanese issued to Hardwick et al, No. 6,328,765, and March 22, 2001 public Cummings et al in international Publication No. WO 01/19254.

可使用关节镜辅助插入植入物。 May be used arthroscopically assisted insertion of the implant. 所述装置不需要在某些单侧和全部膝盖关节造形中用15到30cm的切口。 The device does not require all of the cuts and some unilateral knee arthroplasty with the 15 to 30cm. 在局部麻醉,通常是硬脑膜外麻醉的情况下进行程序。 In local anesthesia, the case where the procedure is usually carried out epidural anesthesia. 可对四肢近端部分应用止血带。 It may be part of the proximal limb tourniquet. 使用消毒技术来预备和遮盖(drape)有待修复关节的身体区域。 Sterile techniques to prepare and cover (drape) to be repaired joint areas of the body. 在膝盖的情况下,例如,使用常规的关节镜技术,可用探针(stylette)在关节的前内侧和前外侧处造成两个小的2mm的口。 In the case of the knee, e.g., using conventional arthroscopic techniques available probe (stylette) causes the two small 2mm port at the anterolateral and medial joint. 通过侧口插入关节镜。 Arthroscope inserted through the side port. 通过中间的口插入关节镜仪器。 Arthroscopic instrument inserted through the intermediate port. 使用关节镜可看到软骨缺损。 It can be seen arthroscopically cartilage defect. 软骨缺损定位装置可置于发病软骨内。 Cartilage defect incidence positioning means may be positioned within the cartilage. 所述探针可为U形,其第一臂可接触关节内的发病软骨的中心区域而U的第二臂留在关节外。 The probe may be U-shaped with a first arm may contact a central region in the pathogenesis of articular cartilage and the second arm of U remains outside the joint. U的第二臂指示软骨相对于皮肤的位置。 U indicates cartilage second arm relative to the skin. 外科医生在皮肤上对软骨缺损的位置作标记。 Marking the position of the surgeon cartilage defects on the skin. 在缺损上方开出一个3cm的切口。 In a cut-out over the defect of 3cm. 插入组织牵引器并看到缺损。 Insertion into tissue retractor and the defect seen.

接着将植入物插入关节中。 The implant is then inserted into the joint. 植入物前面的和后面的位置可以标以彩色。 Implant front and rear positions thereof can be marked in color. 举例而言,可以红色和一个小的字母“A”标记前面的销钉,同时后面的销钉可以是绿色且以小的字母“P”标记。 For example, red can and a small letter "A" mark in front of the pin, the pin while the latter may be green and with a small letter "P" mark. 类似地,植入物的中间可标以黄色且以小的字母“M”标记,同时植入物的侧面可以小的字母“L”标记。 Similarly, intermediate implant can be marked with a yellow and a small letter "M" marker, while the side surface thereof may implant a small letter "L" mark.

可如本文所述成像软骨区域以侦测缺失和/或发病软骨区域。 As described herein may be imaged to detect regions cartilage deletions and / or onset of cartilage region. 可确定邻近发病区域的软骨和软骨下骨的边缘和形状。 Adjacent the edge may be determined and the shape of the cartilage and subchondral bone regions of incidence. 可确定软骨的厚度。 The thickness of the cartilage can be determined. 可确定半月板或其它关节结构的形状。 It may determine the shape of the menisci or other articular structures. 可根据一个或一个以上上述测量确定装置的大小和形状。 Size and shape of the device may be determined according to one or more of the measurement. 详言之,可从具有不同大小和曲度范围的现有的或预先制成的植入物的目录或使用CAD/CAM技术按顾客要求设计或病人定制来(根据最适合)选择修复系统。 In detail, according to customer requirements can be customized to the patient to select the design or repair system (according to the most suitable), or from existing directories implant preformed curvature having a range of different sizes and or CAD / CAM technology. 可使用一个或一个以上由病人而定的参数生成按顾客要求而设计的植入物。 You may use one or more of a patient-specific parameter generation according to customer requirements and design of the implant. 可使用一个或一个以上病人待修复的关节的测量获得所述的由病人而定的参数。 Can be measured using one or more joints of a patient to be repaired by the patient may be obtained according to a parameter. 另外,现有的形状库可有约30个尺寸的级别。 Further, the shape of the conventional level of about 30 library size. 如所属领域的技术人员将了解的,在不脱离本发明的范畴的情况下,所述的库需要时可含有30个以上的形状或小于30个形状。 As those skilled in the art will appreciate that, without departing from the scope of the invention, the library may contain more than 30 or less than 30 the shape required shape.

更详细地说,为了将装置植入髋关节内,如上文所述,外科医生会划开一个小口。 More specifically, the means for hip joint implant, as described above, the surgeon will cut open a small opening. 可使用通常用于髋关节外科手术的组织牵引器以及其它手术仪器来曝露髋关节。 Generally used for hip surgery tissue retractor instruments and other surgical exposure of hip. 随后可打开囊。 Then open the bag. 第二个外科医生可继续拉股骨或胫骨以开放股骨头与髋臼之间的空间。 The second surgeon may continue to pull the femur or tibia in the open space between the femoral head and acetabulum. 执行程序的第一位医生可接着将关节造形装置插入关节内。 First doctor execution of the program may then be inserted into a joint arthroplasty device. 必要时,外科医生可以切除股骨头韧带(ligamentum capitis femoris)且清除关节表面部分(例如)以移除上唇(labral)组织或软骨皮瓣(cartilage flap)。 If necessary, the surgeon may cut the femoral head ligament (ligamentum capitis femoris) and the clear portion of the articular surface (e.g.) to remove the upper lip (labral) tissue or cartilage flaps (cartilage flap). 外科医生还具有移除位于丘脑枕区域中的脂肪的选择。 The surgeon also has the option to remove located fat pulvinar region.

或者,在包含自行延伸材料(例如镍钛诺)的关节造形系统中,外科医生可通过标准的或经修正的关节镜方法得以进入髋关节。 Alternatively, the system comprising arthroplasty itself extends material (e.g., nitinol), the surgeon can have access to the hip joint or amended by standard arthroscopic method. 可通过相同的或第二个入口或通过一个小的切口传递植入物。 The implant can pass through the same or a second inlet or through a small incision. 一旦到了关节中,植入物可延伸且变成其最终的形状。 Once into the joint, and the implant can extend into its final shape. 为了促进可延伸植入物的替换,可使用导管或铸模。 To facilitate replacement can extend implantation, using a catheter or mold. 导管或铸模可适合股骨或髋臼关节表面的3D轮廓且可置于植入物的预定位置。 Catheter or the mold may be adapted femoral or acetabular 3D surface profile and can be placed at a predetermined location of the implant. 植入物可接着沿着导管前进,或(例如)在导管或铸模中的空腔内前进。 The implant may then forward along the catheter, or (e.g.) a cavity mold or a catheter advance. 一旦植入物到达其预定位置,可移除导管或铸模而使植入物留在合适的位置。 Once the implant has reached its predetermined position, the mold or the catheter may be removed leaving the implant in place.

VI.装置铸模在本发明的另一个实施例中,可形成选定规格的容器或井孔(例如)来匹配特定对象需要的材料或形成各种大小的修复和/或材料的储备。 Vl. The mold apparatus In yet another embodiment of the present invention may be formed in a selected size container or well (e.g.) to match the material or form the specific subject in need of repair of various sizes and / or storage material. 使用从关节和从软骨缺损获得的厚度和曲度信息来设计容器的大小和形状。 And the thickness of the joint and the use of information obtained from the curvature of the cartilage defect to design the size and shape of the container. 更详细地说,可定形容器的内部以符合任何选定的测量,例如,如从特定对象的软骨缺损获得的测量。 More specifically, the inner container may be shaped to conform to any selected measurements, for example, such as measurements obtained from a cartilage defect of a specific object. 可由替换材料填充容器(铸模)以形成将被植入的装置。 Alternatively the container may be filled with a material (casting mold) to form a device to be implanted.

使用任何合适的技术生成铸模,所述技术可例如是计算机装置和自动控制,例如计算机辅助设计(CAD)和(例如)计算机辅助铸模(CAM)。 Using any suitable technique to generate the mold, the techniques may be, for example, a computer and automatic control means, for example, computer-aided design (CAD) and (e.g.) computer-aided casting mold (CAM). 因为所得的材料通常符合容器的内部轮廓,所以其能更好地匹配缺损且促进一体化。 Because the resulting material generally conform to the inner contour of the container, so that it can better match the defect and to facilitate integration.

VII.植入导管和手术工具上述铸模还可用于设计手术植入导管和工具,其具有至少一个外表面匹配或近似匹配下关节表面(骨骼和/或软骨)的轮廓。 VII. Implanted catheters and surgical tools for the design of the mold may be surgically implanted catheters and tools, having at least one outer surface of the match or approximate the profile of the articular surface (bone and / or cartilage) in matching. 在某些实施例中,两个或多个外表面匹配对应的关节表面。 In certain embodiments, two or more outer surfaces match the corresponding articular surface. 整个工具可以是圆形、环形、椭圆形、椭圆体、弯曲的或不规则的形状。 The entire tool may be circular, circular, oval, ellipsoid, curved or irregular shape. 可选择或调节形状以匹配或围绕发病软骨区域或略大于发病软骨的区域。 Selected or tuned to match the shape or area of ​​cartilage surrounding the onset or slightly larger than the incidence region of cartilage. 或者,可将工具设计成大于发病软骨区域。 Alternatively, the tool may be designed to be larger than the incidence region of cartilage. 可将工具设计成包括多数或整个关节表面。 The tools can be designed to include most or the entire articular surface. 可结合两个或更多工具(例如)而用于两个或多个关节表面。 May incorporate two or more tools (e.g.) was used in two or more articular surfaces.

可获得一个或一个以上电子图像以提供目标坐标,其界定了关节和/或骨骼表面和形状。 Obtain one or more electronic image to provide target coordinates, defining the joint and / or bone surface and shape. 例如,使用成像测试(例如CT或MRI扫描或站立的负重X光扫描)还可界定关节的生物机械轴。 For example, using an imaging test (e.g., CT or MRI scan or X-ray scanning standing weight) may also define biomechanical axis of a joint. 举例而言,如果手术涵盖到膝关节,可通过膝关节获得CT扫描或螺旋的CT扫描。 For example, if the surgery to cover the knee, available CT scan or helical CT scan through the knee joint. CT扫描可限于膝关节区域和股骨远端和胫骨近端。 CT scan may be limited to the knee region and distal femur and proximal tibia. 或者,扫描可包括穿过髋关节的图像且视情况还可包括踝关节的图像。 Alternatively, scanning may optionally include a through image and may further include an image of the hip joint of the ankle joint. 以这种方式,可界定解剖轴且可选定用于手术替换膝盖植入物的优选平面。 In this manner, the anatomical axis and preferably may define a plane for a surgical knee replacement implant can be selected. 扫描可以是邻近的。 Scanning may be contiguous.

或者,可穿过髋和踝关节区域获得选定的扫描平面以界定解剖轴。 Alternatively, the hip and ankle region through a selected scan plane obtained to define the anatomic axis. CT扫描可与内关节显影管理结合以使关节软骨可视化。 CT scans may be combined with intraarticular articular cartilage developing managed to visualize. 在另一个实例中,可使用非显影CT扫描。 In another example, a non-developing CT scan. 如果使用非显影,可以(例如)年龄、性别、种族、身高和体重匹配的个体的参考数据库来评估剩余的软骨厚度。 If a non-developing, may be (for example) the individual reference database age, sex, race, height and weight matched to evaluate the thickness of the remaining cartilage. 在重度关节炎中,可表现出正常软骨厚度的减少。 In severe arthritis, it may exhibit reduced normal cartilage thickness. 举例而言,在膝关节中,在具有重度关节炎的病人的负重区域中软骨厚度可表现为零或接近零,而在后部非负重区域可选择2mm或更小的值。 For example, in the knee joint, cartilage thickness may be zero in a region having a weight of patients with severe manifestations of arthritis or close to zero, while the non-weight-bearing area in the rear Alternatively 2mm or smaller values. 可接着将这些评估的软骨厚度添加到软骨下骨的曲度中以提供有关关节表面的形状的评估。 Cartilage thickness may then be added to these assessments curvature of the subchondral bone to provide an assessment concerning the shape of the articular surface. 如果使用MRI,可穿过外科医生正在动手术的膝盖获得高清晰度的扫描。 If you are using MRI, can pass through the surgeon operated on the knee is to obtain a high-resolution scan. 这种扫描有利于界定关节几何形状。 Such scanning geometry is conducive to defining a joint. 高清晰度扫描可附着有使用低清晰度的扫描通过邻接关节和骨骼以界定解剖轴。 High-resolution scan may be attached by low resolution scanning abutment joints and bones to define the anatomical axis.

如果涵盖了全部的膝关节造形术,在膝关节中可需要高清晰度的扫描,在髋关节,且视情况在踝关节中可需要较低清晰度的扫描。 If all covers knee arthroplasty, the knee may be required in the high resolution scan, the hip joint, and optionally may require lower resolution scan in the ankle joint. 可使用体线圈或不完整相控阵线圈获得这种较低清晰度扫描。 Using the body coil can be incomplete or phased array coil to obtain such lower resolution scans.

还可将成像测试结合。 Imaging may also be tested for binding. 举例而言,可使用膝盖MRI扫描来界定包括软骨下骨和软骨的膝关节的3D关节几何形状。 For example, knee MRI scan can be used to define the 3D geometry comprises a knee joint subchondral bone and cartilage. 膝盖MRI扫描可与描述了解剖轴的四肢的站立的、负重X光相结合。 Knee MRI scan can be described with a standing limb anatomical axis, the X-ray load combination. 以这种方式,可得到目标坐标和解剖轴,其可用于界定手术介入的优选平面。 In this manner, anatomy and target coordinate axes can be obtained, which preferably can be used to define the plane of surgical intervention.

目标坐标可用于(例如,使用CAD/CAM技术)定形装置以适合病人的解剖或选择适合病人的关节解剖的预制装置。 Target coordinates may be used (e.g., using CAD / CAM technology) shaped to fit the patient's anatomy apparatus or pre-selection means for a patient's joint anatomy. 如上文所示的,工具可具有匹配所有或部分关节或骨骼表面和形状的表面和形状,例如,类似于待植入的装置的“镜像”。 Indicated above, the tool may have to match all or part of the joint or bone surface and shape of the surface and shape, e.g., similar to the device to be implanted "mirror." 工具可包括孔、槽和/或洞以容纳例如钻子和锯子等的手术仪器,工具可用于部分的关节替换以及全部关节替换。 Tools may include holes, slots and / or holes to accommodate, for example, drills and saws and other surgical instruments, tools can be used to replace part of all of the joints and joint replacement. 举例而言,在整体膝盖关节造形术中,工具可用于植入物插入所需的切口平面的精确布局。 For example, the overall knee arthroplasty, the tool can be used to implant a desired layout accurately inserted into the cut plane. 以这种方式,可实现更多可再生的植入位置,且有潜力来提高临床效果和长期植入物存活。 In this way, we can achieve more renewable implant position, and has the potential to improve long-term clinical results and implant survival.

工具可具有一个、两个或更多组件。 Tool may have one, two or more components. 一部分工具可由金属制成,同时其它部分可由塑料制成。 Portion of the tool may be made of metal, while the other part may be made of plastic. 举例而言,在手术期间接触关节表面的表面可由塑料制成。 For example, the contact surface during operation of the joint surface be made of plastic. 以这种方式,就可以容易地且以低成本制造,例如使用快速成形技术。 In this manner, it can be manufactured easily and at low cost, for example using rapid prototyping techniques. 可为每个病人个别制成塑料组件或从现有的大小范围预先选择。 Plastic components may be individually formed for each patient or select from pre-existing size range. 关节表面表明塑料组件部分在任何病人中可具有相同的表面几何形状,例如块状。 It indicates that the plastic component portion of the articular surface in any patients may have the same surface geometry, such as a bulk. 以这种方式,可对塑料组件应用预先制成的金属组件。 In this manner, the metal components can be applied to preformed plastic components. 金属组件可包括手术导管,例如锯子或钻子的开口。 Surgical catheter assembly may include a metal, such as openings of a saw or drill. 塑料组件可通常具有开口,手术仪器通过这些开口可移向骨骼或软骨且不损坏塑料。 Plastic assembly may have a generally open, the openings through which surgical instruments can be moved without damaging the bone or cartilage plastic.

塑料组件确定金属组件和手术导管相关于关节表面的位置。 Metal component and the plastic component is determined in relation to the joint surface of the surgical catheter position. 在两种组件之间可引入隔片(例如)以调节骨骼切口的深度。 Between the two components may be introduced into the septum depth (e.g.) to adjust the cut bone. 因而,在膝关节中,外科医生可使用隔片测试弯曲和展开空隙,调节空隙并选择最适当的切平面。 Thus, in the knee joint, the surgeon may use bending test separator and expand the gap, the gap adjustment and selects the most appropriate cut plane. 另外,如果使用两个或多个组件,在组件之间可允许旋转调节。 Further, if two or more components, the components may be allowed between the rotation adjustment. 以这种方式,外科医生可(例如)在膝关节中平衡中间和侧面的间隔。 In this manner, a surgeon may be (e.g.) and the side surface of the intermediate equilibrium separation in the knee joint. 在完成了任何可选的旋转调节之后,在外科医生进行切开或作任何其它操作之前,可将组件相对于彼此或相对于骨骼或软骨固定起来。 After completion before any optional rotational adjustment, an incision or any other operations the surgeon may be with respect to the assembly relative to the bone or cartilage or fixed to each other.

组件和工具可设计成与用于关节造形(例如,整体膝盖关节造形)的现有的手术仪器套件相协调。 Tool assembly may be designed and coordinated with conventional arthroplasty kit for surgical instruments (e.g., whole knee arthroplasty) is. 应注意,工具可有助于减少用于关节造形的手术仪器的数量。 It should be noted, it can help to reduce the number of tools used for arthroplasty surgical instrument. 最终,此实施例可有助于改进与所需的位置和解剖轴相对的植入物的术后安排,进而减少假体松弛、植入物磨损、骨骼上的压力且进而改善长期效果。 Finally, this embodiment can contribute to improve the position and anatomy of the desired implantation shaft relative arrangement thereof, thereby reducing the slack of the prosthesis, implant wear, the pressure on the bone and thereby improve long-term effect.

通常,选择位置可致使用于随后安放植入物的解剖所需的切平面或钻孔方向。 Typically, the selection position may cause the drilling direction or plane for cutting a desired anatomical implant is then placed. 另外,可设计导管装置,使得钻子或锯子的深度受控,例如钻子或锯子不能进入比由装置厚度所界定的深度更深的组织,区块中的洞的大小可设计成与植入物的大小实质匹配。 Further, the catheter device may be designed such that the drill or saw a controlled depth, e.g. drill or saw can not enter deeper than the thickness of the tissue by the device as defined by the block size of the hole may be designed to implant the size substantially matched. 当选择这些槽或孔的方向时,可包括与有关其它关节或轴的信息和关节或四肢的排列信息。 When selecting the direction of these slots or holes, the arrangement may include information about other joints or axis information and a joint or limb. 可制备导管而用于本发明的任何植入物。 It may be prepared for any implant catheter of the present invention.

现在转到图28和图17中所示的植入导管的具体实例,提供这些实例用于说明目的。 Turning now to FIG. Specific examples of the placement catheter shown in FIG. 17 and 28, these examples are provided for purposes of illustration. 图28说明适用于和图8L中所示的植入物一起使用的植入导管1100。 28 illustrates a catheter suitable for implantation and the implant 1100 shown in FIG. 8L used together. 提供了关节成形主体1110。 Providing arthroplasty body 1110. 关节成形主体可经配置以具有至少一个匹配待使用的植入物100的外表面构造的外表面构造。 Arthroplasty body may be configured to have an outer surface configuration of the outer surface 100 configured to at least one matching implant to be used. 提供一个把柄1112让使用者能将导管放在将安置有植入物100的关节中。 1112 allows the user to provide a handle on the catheter can be arranged with a joint implant 100. 另外,提供一个锚定导管1114。 Further, there is provided a catheter anchoring 1114. 在这个实例中,锚定导管1114是在十字形中的主体1110内的开口中。 In this example, the conduit 1114 is anchored within an opening in the body 1110 of the cross-shaped. 如所属领域的技术人员将了解,锚定导管1114可采取各种适当的形状以使导管能执行其预定功能。 As those skilled in the art will appreciate, the anchoring catheter 1114 may take various suitable shapes so that the catheter can perform its intended function. 在这个实例中,十字形让使用者能识别关节的关节表面,其中锚定器112(图3L所示)定向在关节上。 In this example, the cross-shaped so that users can identify the articular surface of the joint, wherein the joint is oriented in the (FIG. 3L) anchor 112. 一旦将导管1100放到目标关节表面上,锚定导管1114可用于:标记锚定器可进入关节的位置;确定锚定器可进入关节的位置;在可放置锚定器的位置处制备关节表面;或其组合。 Once the catheter is placed on the target articular surface 1100, 1114 may be used to anchor the catheter: tag anchor accessible position of the joint; determining anchor accessible position of the joint; the preparation of the articular surface can be placed at the position of the anchor ; or combinations thereof.

现在转向图25A到图25B中所示的导管1200,其显示了适合与图9A到图9C中所示的植入物一起使用的导管的平面图。 Turning now to FIGS. 25A to conduit 1200 shown in 25B, the showing in FIG. 9A to a catheter adapted for use with the implant shown in plan view in FIG. 9C. 提供主体1210。 Providing a body 1210. 所述主体经配置以具有至少一个匹配或近似匹配待植入的植入物150的外表面构造的外表面构造。 The body configured to have at least one matching or approximately matching an outer surface configuration of the implant configured to be implanted in an outer surface 150. 提供一个把柄1212让使用者能够将导管放在安置有植入物150的关节表面上。 1212 allows a user to handle the catheter implant is disposed on the articular surface 150 of the upper. 另外,提供一个或一个以上锚定导管1214。 Further, providing one or more anchor catheter 1214. 在这个实例中,锚定导管(1214′、1214″、1214)是环形或大体环形,主体1210内的开口的直径足够大以容纳用于在骨骼中钻孔的钻头,在所述骨骼中将放置有植入物150的锚定器156的插针。如所属领域的技术人员将了解的,锚定导管1214可表现出各种适当的形状以使导管能执行其预定的功能。可提供额外的导管1216。所述额外的导管可执行和第一个导管1214一样的功能或可执行一个二级功能。在这个实例中,锚定导管1214可用于识别关节的关节表面,其中锚定器156(图9B到图9C中所示)可定向在关节上。一旦将导管1200放到目标关节表面上,锚定导管1214可用于:标记锚定器可进入关节的位置;确定锚定器可进入关节的位置;在可放置锚定器的位置处制备关节表面;或其组合。另外,导管1216可用于标记锚定器可进入关节的位置;确定锚定器可进入关节的位置;在可 In this example, the anchoring catheter (1214 ', 1214 ", 1214) is substantially ring-shaped or annular, the inner diameter of the opening 1210 is large enough to accommodate the body for a drill bit drilling a hole in the bone, in the bone the implant is placed anchor pins 150 was 156. as those skilled in the art will appreciate, the anchoring catheter 1214 may exhibit various suitable shapes so that the catheter can perform its intended function may be provided additional catheter 1216. the first additional conduit and a conduit 1214 may perform the same function or perform a second function. in this example, the anchoring catheter 1214 may be used to identify the articular surface of the joint, wherein the anchor (9B to 9C shown in FIG.) 156 may be oriented in the joint once the catheter into the target articular surface 1200, 1214 may be used to anchor the catheter: tag anchor may enter the position of the joint; determining anchor is position into the joint; the preparation of the articular surface can be placed at the position of the anchor; or combinations thereof Further, the catheter 1216 may be used to mark the position of the anchor into the joint may be; a. determining the position of an anchor may enter the joint; in the 放置锚定器的位置处制备关节表面;或其组合。 Placing the anchor prepared articular surface at the location; or combinations thereof.

在另一个实施例中,可对不在发病骨骼或软骨区域的区域中的骨骼或软骨应用一个框架。 Embodiment, a framework may be applied to the area is not the incidence of bone or cartilage or bone region cartilage in another embodiment. 所述框架可包括用于手术仪器的固定器和导管。 The frame may include a fixed and a conduit for the surgical instrument. 可将框架附着到一个或优选更早界定的解剖参考点上。 The frame may be attached to anatomical reference points on one or preferably defined earlier. 或者,使用成像测试(例如手术中所要的一个或一个以上的荧光图像),框架的位置可以相对于一个,优选更多的解剖标记进行十字对准。 Alternatively, using an imaging test (e.g., one or more fluorescence image in the desired operation), the position of the frame with respect to a, more preferred cross anatomical markers aligned. 可获得一个或一个以上电子图像以提供界定关节和/或骨骼表面和形状的目标坐标。 Obtain one or more electronic image to provide target coordinates to define a joint and / or bone surface and shape. 这些目标坐标可(例如)手动地或以电子方式或其组合而输入或转移到装置中,且信息可用于移动手术仪器所用的一个或一个以上的固定器或导管。 The target coordinates may be (e.g.) manually or electronically or a combination thereof is input or transferred to the device, and the information can be used for one or more fixed or mobile conduit surgical instrument employed. 通常,所选择的位置可产生用于随后放置一个或其它植入物的手术上或解剖上所要的切平面或钻头方向,所述植入物包括半侧、单侧或整体关节造形。 Typically, the selected location may produce hemi comprises, for unilateral or whole arthroplasty then placed on a tangential plane direction of the drill or a surgical implant or other anatomical or desired, the implant. 当选择这些槽或孔的方向时,可包括与其它关节或轴有关的信息和关节或四肢的排列信息。 When selecting the orientation of these grooves or holes, and may comprise the arrangement information of a joint or limb or joint with other related axes.

因为其与所选择的下关节表面的解剖布置,可用适当的工具产生锯子导管、钻头或用于扩展装置的导管的优选位置和方向。 Because of its lower articular surface of the selected anatomical arrangement, a suitable tool can be used to produce saw catheter, preferably for a drill bit or extended position and orientation of the catheter apparatus. 手术中,对关节表面应用手术辅助工具,用其实现近乎完美的或完美的解剖安装。 Surgery, surgery for articular surface of the auxiliary tool with which to achieve perfect or near-perfect anatomical installation. 外科医生可接着通过导管引入锯子(或其它工具)和制备用于此程序的关节。 The surgeon may then be introduced into the saw (or other tool) through the conduit and joint preparation for this procedure. 通过沿着解剖界定的平面切开软骨和/或骨骼,可实现更多可再生的位置,其最终可通过最优化生物机械压力而致使改善术后效果。 By cutting the cartilage and / or bone along a plane defined by the anatomy, can achieve more reproducible position, which ultimately can be optimized by mechanical pressure so that the biological effect of improving postoperative.

可通过多种方法建构本文所述的解剖矫正工具且可由任何材料制成,优选是透明材料,例如塑料、透明合成树脂、硅橡胶、SLA等,且通常在铸模之前为块状。 Anatomical correction tool may be constructed by various methods described herein and may be made of any material, preferably a transparent material, such as plastic, a transparent synthetic resin, silicone rubber, the SLA and the like, and typically prior to the mold block. 另外,可制造和使用可重复使用的工具(例如铸模)。 Further, the manufacture and use of reusable tools (e.g., molds). 可重复使用的材料的非限制型实例包括布绑腿和其它可变形材料(例如,一列可经配置以匹配关节表面的构形的可调节紧密相隔的插针)。 Non-limiting examples of materials of the type comprising a reusable cloth leggings and other deformable materials (e.g., a joint may be configured to match the surface configuration of adjustable closely spaced pins). 在这些实施例中,例如使用一种或一种以上计算机程序来确定界定关节的表面轮廓且将这些坐标转移(例如,拨入)到工具的目标坐标,可在手术期间从关节产生模铸,或者从关节的图像产生模铸。 In these embodiments, for example using one or more computer programs to determine the profile of a surface defining the joint and transfer these coordinates (e.g., incoming) to the target coordinates of the tool, it can be produced from molded joint during surgery, or a molding produced from the joint image. 随后,工具可精确地位于关节上,且因此可更精确地将钻子和植入物放到关节表面中和其上方。 Subsequently, the tool can be accurately positioned on the joint, and thus may be more accurately drill and implant articular surface and placed above it.

在一次性使用和可重复使用的实施例中,工具可设计成使得区块的深度控制钻子或锯子的深度,也就是说,钻子或锯子不能比区块的深度更深,且区块中的洞的大小可设计成与植入物的大小实质匹配。 In the disposable and reusable embodiments, the tool may be designed such that a depth control block drill or saw, i.e., drill or saw can not be deeper than the depth of the block, and the block the size of the hole may be designed to match the size of the substance of the implant. 工具可用于一般的假体植入,包括(但不限于)本文所述的关节修复植入物和用于在半侧或单侧或整体关节造形或包括生物学修复的其它关节系统的情形下扩展骨髓。 The tool can be used for general prosthesis implantation, including (but not limited to) the articular repair implants and in the case of a half of a whole or on one or other joint arthroplasty comprising or repair of biological systems described herein extended marrow.

这些手术工具还可用于移除发病软骨区域或比发病软骨区域略大的区域。 The surgical tool may also be used to remove cartilage onset or slightly larger than the incidence region of the region of cartilage region.

可通过图像引导手术系统(手术导航系统)来支持植入点的识别和准备和植入物的插入。 May be capable of recognizing and implant site preparation and implant insertion by the image guided surgical system (surgical navigation system). 在这样的系统中,可实时地以一维或2D或3D图像来跟踪与病人的解剖相关的手术仪器的位置和方向。 In such a system, real-time may be a one-dimensional or 2D or 3D images to track the position and orientation of the patient's anatomy associated with the surgical instrument. 可从手术后所获得的图像中(例如MR或CT图像)计算出这些2D或3D图像。 These can be calculated from a 2D image or a 3D image obtained after surgery (e.g., MR or CT images). 由附着在仪器上的标记确定手术仪器的位置和方向。 Determining the position and orientation of the surgical instrument by the marker attached to the instrument. 使用(例如)光学、声学或电磁信号通过侦测器可将这些标记定位。 Using (e.g.) an optical, acoustic or electromagnetic signals through the detector can be positioned such markers. 在没有图像引导的情况下也可使用手术导航系统,例如,通过使用四肢的动作研究来识别解剖轴。 In the case where no image guided surgical navigation system may also be used, e.g., by using motion study to identify the anatomic axis of the limbs.

在其它实施例中,本文所述的手术工具可包括硬化以形成关节表面的一个铸模的一种或一种以上的材料。 In other embodiments, the surgical tool described herein may comprise a hardened to form a mold of the articular surface of one or more materials. 已描述了可在原处硬化的多种的材料,其包括可经激发以经受相位改变的聚合物,例如液体的聚合物或半液体的聚合物,和通过曝露于空气、施加紫外线、可见光、曝露于血液、水或其它离子改变而硬化成固体或凝胶体的聚合物。 Have been described may be more material hardens in situ, which includes a polymer is excited to undergo phase change, such as a polymer or polymer liquid semi-liquid, and by exposure to air, application of ultraviolet, visible, exposed in the blood, water or other ionic changes harden into a solid or gel of the polymer. (参阅美国专利第6,443,988号和其中所引用的文献)。 (See U.S. Pat. No. 6,443,988 and references cited therein). 合适的可固化(curable)和硬化材料的非限制性实例包括聚亚氨酯材料(例如2002年9月3日颁予Felt等人的美国专利第6,443,988号;1994年2月22日颁予Khalil等人的第5,288,797号、1978年7月4日颁予Graham等人的第4,098,626号、和1986年6月10日颁予Chapin等人的第4,594,380号,和Lu等人的(2000)生物材料(BioMaterials)21(15):1595-1605描述的多孔聚(L-丙交酯酸泡沫);例如1992年11月10日颁予Rhee等人的美国专利第5,162,430号中揭示的亲水聚合物;Wake等人的(1995)“细胞移植(Cell Transplantation)”4(3):275-279、Wiese等人的(2001)“J.生物医学材料研究(J.Biomedical Materials Research)”54(2):179-188和Marier等人的(2000)“塑料重建手术(Plastic Reconstruct.Surgery)”105(6):2049-2058中所描述的水凝胶材料;透明质酸材料(例如Duranti等人(1998)“皮肤病手术(DermatologicSurgery)”24(12):1317-1325);例如壳状珠的扩展珠(例如Yusof等人的(2001)“ Suitable curable (Curable) and non-limiting examples of hardening materials include polyurethane materials (e.g. U.S. Pat. No. 6,443,988 issued to Felt et al., September 3, 2002; February 22, 1994 issued to Khalil et al., No. 5,288,797, July 4, 1978, issued to Graham et al., No. 4,098,626, and June 10, 1986, issued to Chapin et al., No. 4,594,380, and Lu et al (2000) biomaterials (BioMaterials) 21 (15): 1595-1605 porous poly (L- lactide acid foams) described herein; for example, disclosed in U.S. Patent No. 5,162,430 issued to Rhee et al., November 10, 1992 in the hydrophilic polymer ; the Wake et al. (1995) "cell transplantation (cell transplantation)" 4 (3): 275-279, Wiese et al. (2001) ". J Biomedical materials Research (J.Biomedical materials Research)" 54 (2 ): 179-188 and Marier et al. (2000) "plastic reconstruction (plastic Reconstruct.Surgery)" 105 (6): 2049-2058 hydrogel material as described herein; hyaluronic acid materials (e.g., Duranti et al. (1998) "dermatological surgery (DermatologicSurgery)" 24 (12): 1317-1325); e.g. a bead extended shell-shaped beads (e.g. Yusof et al. (2001) " J.生物医学材料研究(J.Biomedical Materials Research)”54(1):59-68);和/或用于牙科应用中的材料(参阅,例如在“聚合物科学和工程的简明百科全书(Concise Encyclopedia of Polymer Science andEngineering)”中的Brauer和Antonucci的“牙科应用(Dental Applications)”pp.257-258和1983年1月11日颁予Weissman的美国专利第4,368,040号)。可使用任何生物兼容材料,所述材料应具有充分的流动性以允许其传递到关节且在原处在病理生理学可接收的条件下经受完全的医治。材料还可以是生物可分解的。 J. of Biomedical Materials Research (J.Biomedical Materials Research) "54 (1): 59-68); and / or materials used in dental applications (see, for example," Concise Encyclopedia of Polymer Science and Engineering ( Concise Encyclopedia of Polymer Science andEngineering) "the Brauer and Antonucci" US Patent No. 4,368,040 for dental applications (dental applications) "pp.257-258 and January 11, 1983 issued to Weissman's). You can use any biocompatible material, the material should have sufficient fluidity to allow it to pass into the joint and subjected to complete healing at the original in the pathophysiology acceptable. material may also be biodegradable.

可固化材料可与本文所述的手术工具结合使用。 Curable material may be used in combination with a surgical tool as described herein. 举例而言,手术工具可在其中包括一个或一个以上用于接收注射的孔,且可通过所述的孔将可固化材料注射进去。 For example, where the surgical tool may comprise one or more apertures for receiving the injection, and through said hole injection into the curable material. 在原处凝固之前,材料可与面对着手术工具的关节表面相一致,且因此可通过硬化而形成表面的印痕,进而再造出一个正常的或近似正常的关节表面。 Place before solidification, the material may be in phase with the articular surface facing the surgical tool of the same, and thus may be formed by hardening the surface of prints, and thus recreate a normal or near normal articular surface. 另外,例如通过根据关节图像铸模所述材料或手术工具,可固化材料或手术工具还可与本文所述的成像测试和分析结合使用。 Further, for example, also be combined with imaging tests and analysis described herein The joint image by the molding material or the surgical tool, the curable material, or a surgical tool.

现在转到图27A到27D,其显示了植入本发明所讲解的装置的方法的步骤。 Turning now to FIGS. 27A to 27D, which shows the steps of the implantation device of the present invention is explained method. 首先,使用者划开一个切口以进入目标关节2610。 First, a notch cut open user to access the target joint 2610. 其后,使用植入导管制备关节表面2620。 Thereafter, the implant prepared using the articular surface of the conduit 2620. 制备关节表面可包括(例如)识别植入物在关节中的位置,标记植入物可附着的地方,和/或制备关节表面以接收植入物。 Preparation articular surface may include (e.g.) to identify the position of the implant in the joint, where the implant marker substance can be attached, and / or prepared to receive the implant articular surface. 必要时可重复这个制备过程。 If necessary repeat the preparation process. 如所属领域的技术人员将了解,在制备关节表面的过程中,使用者可首先识别植入物的地方且然后通过标记关节表面或移除骨骼或软骨来制备表面。 As those skilled in the art will appreciate that, in the process of preparing the surface of the joint, the user can first identify and then place the implant articular surface or by marking a surface prepared bone or cartilage removal. 一旦制备好关节表面,就安装植入物2640。 Once the articular surface Good preparation, the implant 2640 on the installation. 可通过使用本文所述的技术将植入物放在表面上或通过将植入物粘在表面上而安装植入物。 By using the techniques described herein on a surface of the implant by the implant or adhered to the mounting surface of the implant. 在将植入物安装在关节内之后,缝合伤口2650。 After the implant is installed within the joint, the wound was sutured 2650.

现在转到图27B中所示的步骤,使用者划开一个切口以进入目标关节2610。 27B in the step shown in FIG. Turning now to the user a notch cut open to access the target joint 2610. 其后,将一个框架附着在关节2660上。 Thereafter, a frame attached to the joint 2660. 尽管未在这个流程图显示,可执行图27A中所示的制备关节的步骤。 Although not show in the flowchart, the step of preparing the joint shown in FIG. 27A-executable. 接着将植入物安装在框架上2665。 The implant is then mounted on the frame 2665. 在将植入物安装在关节中之后,缝合伤口2650。 After the implant is installed in the joint, the wound was sutured 2650.

现在转到图27C中所示的步骤,使用者划开一个切口以进入目标关节2610。 Turning now to the steps shown in FIG. 27C, a notch cut open the user to access the target joint 2610. 其后,从关节移除发病软骨2670。 Thereafter, the incidence of cartilage is removed from the joint 2670. 尽管未在这个流程图中显示,在不脱离本发明的范畴的情况下,也可执行图27A中所示的制备关节的额外的步骤。 Although not shown in this flowchart without departing from the scope of the invention, additional steps may also be performed as shown in FIG prepared joint 27A. 然后安装植入物2675。 Then install the implant 2675. 在将植入物安装在关节内之后,缝合伤口2650。 After the implant is installed within the joint, the wound was sutured 2650.

现在转到图27D所示的步骤,使用者划开一个切口以进入目标关节2610。 Turning now to the steps shown in FIG. 27D, a notch cut open a user to access the target joint 2610. 尽管未在这个流程图中显示,在不脱离本发明的范畴的情况下,也可执行图27A中所示的制备关节的额外步骤。 Although not shown in this flowchart without departing from the scope of the invention, additional steps may also be performed as shown in FIG prepared joint 27A. 其后插入植入物2680。 Then insert the implant 2680. 接着对植入物的位置进行选择性的调节2682。 Next, the position of the implant 2682 is selectively adjusted. 在插入和定位植入物之后,调节植入物的外形2684。 After insertion and positioning of the implant, the implant 2684 adjusted shape. 在将植入物安装在关节中且调节好之后,缝合伤口2650。 After the implant is installed in a joint and regulate, 2650 suture the wound. 可选择选定的植入物高度或外形以改变相对于关节的负重能力。 Alternatively the selected implant height or profile to vary with respect to the weight-bearing capacity of the joint. 另外,可调节植入物的高度以解决骨骼或关节结构的解剖拓扑结构不正常的问题。 Further, the height of the implant may be adjusted to address the anatomical topology of a bone or joint structure is not working properly.

VII.套件本文还描述了套件,其包括本文所述的一种或一种以上方法、系统和/或组合物。 VII. Kits Also described herein are kits comprising one or more of the methods described herein, systems and / or combinations thereof. 详言之,套件可包括一个或一个以上以下各物:获得电子图像的指令(方法);评估电子图像的系统或指令;能分析或处理电子图像的一个或一个以上计算机构件;和/或用于植入植入物的一个或一个以上手术工具。 In detail, the kit may comprise one or each of more of the following objects: obtaining a command (method) the electronic image; evaluation system or instructions electronic images; can analyze or process an electronic image of one or more computer components; and / or with an implant to implant one or more surgical tool. 套件可包括其它材料,例如,指令、试剂、容器和/或成像辅助工具(例如,胶片、固定器、数字转换器等)。 Kits may comprise other materials, for example, instructions, reagents, containers and / or imaging aids (e.g., films, holders, digitizer, etc.).

包括以下实例来更充分地说明本发明。 The present invention includes the following examples more fully described. 另外,这些实例提供本发明的优选实施例且并不意味着限制其范畴。 Additionally, these examples provide preferred embodiments of the present invention and are not meant to limit the scope thereof.

出于说明和描述目的提供了本发明的实施例的先前描述。 For purposes of illustration and description provide embodiments of the previously described embodiments of the present invention. 这并不意味详尽的或把本发明限定在所揭示的明确形式中。 It is not intended to be exhaustive or to limit the invention to the precise form disclosed. 许多修改和变化对于所属领域的从业者来说将变得显而易见。 Many modifications and variations to the practitioner of ordinary skill will become apparent. 选择和描述实施例以最佳地解释本发明的原理和其实施应用,进而使所属领域的其它人员理解本发明和各种实施例,且涵盖了适用于特定使用的各种修正。 Example embodiments were chosen and described to best explain the principles of the present invention and its implementation of the application, thereby enabling others skilled in the art to understand the invention and various embodiments and covers various modifications suited to the particular use. 希望通过以下权利要求和其等价物界定本发明的范畴。 A desire to define the scope of the invention as claimed by the following claims and their equivalents.

Claims (157)

1.一种具有一第一表面和一第二表面的关节植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的一个的一部分或至少一部分具有与所述第一和第二关节表面中的一个的形状充分匹配的三维形状。 1. A joint having a first surface and a second surface of the implant, wherein a first opposing surface of said first articular surface of a joint and a second joint of the second surface opposite the articulating surface, and further, wherein said first or second surface of a part or a shape having at least a portion of said first and second articular surface is sufficiently matches the three dimensional shape.
2.一种具有一第一表面和一第二表面的关节植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有接近于所述第一和第二关节表面中的一个的形状的三维形状。 A joint implant having a first surface and a second surface, a first joint and a second joint surface wherein the first surface and opposite a joint of the joint relative to the second surface surface, and further, wherein said at least a portion of at least one of the first or second surface has a three-dimensional shape of a proximal said first and second joint surfaces.
3.一种具有一第一表面和一第二表面的软骨缺损成形植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述第一和第二关节表面中的一个的形状充分匹配的三维形状。 A first having a first surface and a second surface of the cartilage defect implant formed, wherein a first opposing surface of said first articular surface of a joint and the second surface opposite the articulating two articular surface, and further, wherein at least a portion of at least one of said first or second surface has a shape of one of said first and second articular surface is sufficiently matches the three dimensional shape.
4.一种具有一第一表面和一第二表面的软骨缺损成形植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有接近于所述第一和第二关节表面中的一个的的三维形状。 A cartilage having a first surface and a second surface defect in molded implant, wherein a second surface opposite said first joint surface of a first joint and a second surface opposite the said joint two articular surface, and further, wherein at least a portion of at least one of said first or second surface has a three-dimensional shape close to the first and the second joint surface.
5.一种具有一第一表面和一第二表面的软骨投影植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述第一和第二关节表面中的一个的形状充分匹配的三维形状。 A cartilage having a first surface and a second surface of the projection of the implant, wherein a first joint surface opposite said first surface opposite a joint of the joint and the second surface a second articular surface, and further, wherein at least a portion of at least one of said first or second surface having the shape of the first and second articular surface of a full three-dimensional shape matching.
6.一种具有一第一表面和一第二表面的软骨投影植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有一接近于所述第一和第二关节表面中的一个的形状的三维形状。 A having a first surface and a second surface cartilage projected implant, wherein a first joint surface opposite said first surface and opposite a joint of the second joint of the second surface a articular surface, and further, wherein said at least a portion of at least one of the first or second surfaces has a three-dimensional shape of a close said first and second articular surface.
7.一种具有一第一表面和一第二表面的软骨下骨成形植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的一个的至少一部分具有一与所述第一和第二关节表面中的一个的形状充分匹配的三维形状。 A having a subchondral a first surface and a second surface of the molded implant, wherein a first surface opposite said first joint surface and a joint surface opposite said second joint of the a second joint surface, and further, wherein at least a portion of said first or second surface of a three-dimensional shape having a shape of one of said first and second articular surface is sufficiently match.
8.一种具有一第一表面和一第二表面的软骨下骨成形植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的一个的至少一部分具有一接近于所述第一和第二关节表面中的一个的形状的三维形状。 A having a subchondral a first surface and a second surface of the molded implant, wherein a first surface opposite said first joint surface and a joint surface opposite said second joint of the a second joint surface, and further, wherein at least a portion of said first or second surface of a three-dimensional shape having a shape close to the first and a second joint surface.
9.一种具有一第一表面和一第二表面的软骨下骨投影植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的一个的至少一部分具有与所述第一和第二关节表面中的一个的形状充分匹配的三维形状。 9. A subchondral bone projected implant a first surface and a second surface, said second surface relative to said joint wherein a first of said opposite surface a first articular surface of a joint and a second joint surface, and further, wherein at least a portion of said first or second surface has a shape of the first and second articular surface of a full three-dimensional shape matching.
10.一种具有一第一表面和一第二表面的软骨下骨投影植入物,其中所述第一表面相对一关节的一第一关节表面且所述第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的一个的至少一部分具有一接近于所述第一和第二关节表面中的一个的形状的三维形状。 10. A subchondral bone projected implant a first surface and a second surface, said second surface relative to said joint wherein a first of said opposite surface a first articular surface of a joint and a second joint surface, and further, wherein at least a portion of said first or second surface of a three-dimensional shape having a shape close to the first and a second joint surface.
11.一种具有一第一表面和一第二表面的关节植入物,其中所述第一表面相对一关节的一第一关节表面且第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的一个的至少一部分具有与所述第一和第二关节表面中的一个的形状充分匹配的三维形状,且进一步地,其中所述植入物恢复关节运动可恢复到自然关节灵活性的90%到99.9%。 A joint having a first surface and a second surface of the implant, a second surface opposing articular joint wherein said surface opposite said first joint surface of a first joint and a second surface, and further, wherein at least a portion of said first or second surface has a shape of one of the first and second joint surface substantially match the three-dimensional shape, and further, wherein said implant recovery articulation was restored to 90 to 99.9% of natural joint mobility.
12.一种具有一第一表面和一第二表面的植入物,其中所述第一表面相对一关节的一第一关节表面且第二表面相对所述关节的一第二关节表面,且进一步地,其中所述第一或第二表面中的一个的至少一部分具有与所述第一和第二关节表面中的一个的形状充分匹配的三维形状,且进一步其中所述植入物可承受施加于所述关节的剪切力的100%。 12. A having a first surface and a second surface of the implant, wherein a first surface opposite said first joint surface and a joint surface opposite said second joint surface of a second joint, and further, wherein at least a portion of said first or second surface has a shape of one of the first and second joint surface substantially match the three-dimensional shape, and further wherein the implant can withstand 100% of the applied shear joint.
13.一种适用于哺乳动物的一关节的植入物,其中所述关节具有一第一关节表面和一第二关节表面,其中所述植入物具有一第一表面和一第二表面,其中所述第一表面相对一第一关节表面的至少一部分且所述第二表面相对一第二关节表面的至少一部分,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述第一关节表面和所述第二关节表面中的一个的形状充分匹配的三维形状。 A suitable implant a mammalian joint, wherein the joint has a first joint surface and a second articulating surface, wherein the implant has a first surface and a second surface, at least a portion of at least a portion and a second surface opposite said second joint surface wherein the first surface opposite a surface of the first joint, and further, wherein said first or second surface of at least one of the at least a portion having the shape of the first joint surface and said second joint surface substantially match one of the three-dimensional shape.
14.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物被置放于选自由膝、髋、肩、肘、腕、指、趾、和踝组成的群组中的一关节内。 And 14. The implant according to Claim 1,2,3,4,5,6,7,8,9,10,11,12 13, wherein the implant is selected from the group consisting of knee placed in , hip, shoulder, elbow, wrist, finger, toe within the group, and the ankle joint consisting of a.
15.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述的上表面和所述的下表面具有与所述关节表面中的一个的形状充分匹配的三维形状。 1,2,3,4,5,6,7,8,9,10,11,12 and 15. The implant of claim 13, wherein the lower surface of the upper surface and having said the shape of the articular surface of a full three-dimensional shape matching.
16.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有患者软骨缺损厚度。 1,2,3,4,5,6,7,8,9,10,11,12 and 16. The implant of claim 13, wherein the implant has a thickness cartilage defect in a patient.
17.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有患者软骨缺损厚度的85%。 1,2,3,4,5,6,7,8,9,10,11,12 and 17. The implant of claim 13, wherein the implant has a thickness cartilage defect 85 patients %.
18.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有患者软骨缺损厚度的65%到100%。 1,2,3,4,5,6,7,8,9,10,11,12 and 18. The implant of claim 13, wherein the implant has a thickness of 65 patients with cartilage defects to 100%.
19.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有患者软骨缺损厚度,外加一偏移值。 1,2,3,4,5,6,7,8,9,10,11,12 and 19. The implant of claim 13, wherein the implant has a thickness cartilage defect patient, plus an offset value.
20.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有患者软骨缺损厚度的85%,外加一偏移值。 1,2,3,4,5,6,7,8,9,10,11,12 and 20. The implant of claim 13, wherein the implant has a thickness cartilage defect 85 patients %, plus an offset value.
21.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有患者软骨缺损厚度的65%到100%,外加一偏移值。 1,2,3,4,5,6,7,8,9,10,11,12 and 21. The implant of claim 13, wherein the implant has a thickness cartilage defect 65 patients % to 100%, plus an offset value.
22.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物由包括金属或金属合金的材料来构造。 22. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant comprises a metal or a metal alloy materials to construct.
23.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述材料包括一种或一种以上的生物活性材料。 23. The biological implant and the 1,2,3,4,5,6,7,8,9,10,11,12 according to claim 13, wherein said material comprises one or more of active material.
24.根据权利要求22所述的植入物,其中所述植入物被一生物活性材料所覆盖。 24. The implant according to claim 22, wherein the implant is covered with a biologically active material.
25.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物包括金属或金属合金和聚合物。 And 25. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, wherein said implant comprises a metal or metal alloy and polymeric thereof.
26.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其进一步具有附着在选自由嵴、销钉、插针、横件、牙齿和突起组成的群组中的所述第一表面或所述第二表面中的至少一个上的结构。 26. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12, further having a ridge selected from adhering to the pins, the pins , on at least one of said structural cross member, and a protrusion teeth group consisting of a first surface or the second surface.
27.根据权利要求26所述的植入物,其进一步具有用于附着的复数个结构。 27. The implant of claim 26, further having a plurality of structures for attachment.
28.根据权利要求27所述的植入物,其中用于附着的结构的相对定向选自由对称、不对称、行、圆、三角形、和任意组成的群组。 28. The implant according to claim 27, selected from the group consisting of the relative orientation of the structures for attachment wherein the symmetrical, asymmetrical, rows, circles, triangles, and any composition of the group.
29.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其进一步具有一选自由嵴和边缘组成的群组中的外周结构。 1,2,3,4,5,6,7,8,9,10,11,12 and 29. The implant of claim 13, further having a group selected from the group consisting of consisting of ridges and edges the outer periphery of the structure.
30.根据权利要求29所述的植入物,其中所述外周结构沿所述植入物的整个周长延伸。 30. The implant according to claim 29, wherein said outer periphery structure thereof along the entire circumference of the implant extension.
31.根据权利要求30所述的植入物,其中所述外周结构沿所述植入物的周长的一部分延伸。 31. The implant according to claim 30, wherein said outer peripheral portion of the structure extending along the perimeter of the implant.
32.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述第一表面和第二表面的每一个具有关于穿过所述植入物的纵向轴线的斜率,且进一步地,其中关于所述第二表面斜率的第一表面斜率选自由正、负、和零组成的群组。 1,2,3,4,5,6,7,8,9,10,11,12 and 32. The implant of claim 13, wherein each of said first and second surfaces of the slope with respect to a longitudinal axis through the implant, and further wherein the first slope surface with respect to the slope of the second surface selected from the group consisting of positive, negative, and the group consisting of zero.
33.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物接近所述第一和第二关节表面中的一个的形状。 33. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant proximate the first and second a shape of the two articular surfaces.
34.根据权利要求33所述的植入物,其中所述植入物选自一植入物库。 34. The implant according to claim 33, wherein the implant is selected from a library of implants.
35.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物在插入一关节之后改变了构型。 35. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant after insertion of a joint changes structure.
36.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物在装载期间改变构型。 And 36. The implant according to Claim 1,2,3,4,5,6,7,8,9,10,11,12 13, wherein the implant changes configuration during loading.
37.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物进一步包括一第一组件和一第二组件。 37. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant further comprises a first component and a second component.
38.根据权利要求36所述的植入物,其中所述第一和第二组件为整体成形、不可分割成形、互连成形、和相互依赖成形的中的一个。 38. The implant according to claim 36, wherein said first and second components is integrally molded, integral molding, molded interconnect, and one of the interdependent shaped.
39.根据权利要求36所述的植入物,其中所述第一组件以固定地、滑动地、旋转地中的至少一个与所述关节啮合。 39. The implant according to claim 36, wherein said first assembly is fixedly, slidably, at least one engagement with the articulation of rotation.
40.根据权利要求36所述的植入物,其中所述第二组件以固定地、滑动地、旋转地中的至少一个来与所述关节啮合。 40. The implant according to claim 36, wherein said second assembly is fixedly, slidably, to engage with said at least one rotation of the joint.
41.根据权利要求36、37、38和39所述的植入物,其中所述第一组件与所述第二组件啮合。 36, 37 and 41. The implant of claim 39, wherein said first component and said second component engagement.
42.根据权利要求36、37、38和39所述的植入物,其中所述第一组件装配于所述第二组件内。 42. The implant of claim 37, 38 and according to claim 39, wherein said first assembly fitting within said second component.
43.根据权利要求36、37、38和39所述的植入物,其中所述第一组件滑动地与所述第二组件啮合。 36, 37 and 43. The implant of claim 39, wherein said first component is slidably engaged with the second component.
44.根据权利要求36、37、38和39所述的植入物,其中所述第一组件旋转地与所述第二组件啮合。 36, 37 and 44. The implant of claim 39, wherein said first assembly is rotatably engaged with the second component.
45.根据权利要求36、37、38和39所述的植入物,其中所述植入物的一部分具有一磁体。 36, 37 and 45. The implant of claim 39, wherein a portion of the implant has a magnet.
46.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有复数个组件。 And 46. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, wherein said implant has a plurality of components.
47.根据权利要求46所述的植入物,其中所述复数个组件的一第一组件以固定地、滑动地、旋转地中的至少一个与所述关节啮合。 47. The implant according to claim 46, wherein a plurality of said first assembly of components to be fixedly, slidably, at least one engagement with the articulation of rotation.
48.根据权利要求46所述的植入物,其中所述复数个组件的一第二组件以固定地、滑动地、旋转地中的至少一个与所述关节啮合。 48. The implant according to claim 46, wherein a plurality of said second assembly of components to be fixedly, slidably, at least one engagement with the articulation of rotation.
49.根据权利要求46、47和48所述的植入物,其中所述复数个组件的第一组件啮合所述复数个组件的第二组件。 49. The implant of claim 46, and claim 48, wherein the first component of the plurality of engaging said second assembly component plurality of components.
50.根据权利要求46、47和48所述的植入物,其中所述复数个组件的第一组件装配于所述复数个组件的第二组件内。 50. The implant of claim 46, 47 and according to claim 48, wherein said plurality of component mounting assembly of the first assembly within the second plurality of components.
51.根据权利要求46、47和48所述的植入物,其中所述复数个组件的第一组件滑动地啮合所述复数个组件的第二组件。 51. The implant of claim 46, 47 and according to claim 48, wherein the first component of the plurality of second assembly slidably engaging said plurality of component assembly.
52.根据权利要求46、47和48所述的植入物,其中所述复数个组件的第一组件旋转地啮合所述复数个组件的第二组件。 52. The implant of claim 46, and claim 48, wherein the first component of the plurality of components engages the second component of the rotation of a plurality of components.
53.根据权利要求46、47和48所述的植入物,其中所述复数个组件的第一组件旋转地并滑动地啮合所述复数个组件的第二组件。 53. The implant of claim 46, 47 and according to claim 48, wherein said plurality of components and a first component rotationally slidably engages the second component of the plurality of components.
54.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有一沿选自由圆、椭圆、卵形、肾形、大体的圆、大体的椭圆、大体的卵形、大体的肾形组成的群组中的周长形成的形状。 54. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein said implant has a direction selected from the group consisting of a circle, elliptical, oval, kidney shaped, substantially circular, substantially elliptical, substantially ovoid, kidney shaped substantially in the group consisting of perimeter formed.
55.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物具有一选自由球形、半球形、非球面、凸面、凹面、大体的凸面、和大体的凹面组成的群组中的下表面和上表面中的至少一个的横截面形状。 55. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein said implant has a selected from the group consisting of spherical, hemispherical shaped, the lower surface of the aspherical, convex, concave, substantially convex, and substantially concave group consisting of the upper surface and at least one cross-sectional shape.
56.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物为一软骨缺损成形植入物。 1,2,3,4,5,6,7,8,9,10,11,12 and 56. The implant of claim 13, wherein the implant is a cartilage defect implant shaped thereof.
57.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物为一软骨投影植入物。 1,2,3,4,5,6,7,8,9,10,11,12 and 57. The implant of claim 13, wherein the implant is a cartilage projected implant .
58.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物为一软骨下骨成形植入物。 58. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant is formed at a subchondral bone explants into the matter.
59.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物在外科上经由一10cm或更小的切口植入。 59. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant by surgery or on a 10cm smaller incision implantation.
60.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物在外科上经由一6cm或更小的切口植入。 60. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant by surgery or on a 6cm smaller incision implantation.
61.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述植入物在外科上经由一4cm或更小的切口植入。 61. The implant of claim 13 and claim 1,2,3,4,5,6,7,8,9,10,11,12 claim, wherein the implant via a surgical or in 4cm smaller incision implantation.
62.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节的活动范围被恢复到正常关节活动的80%到99.9%。 1,2,3,4,5,6,7,8,9,10,11,12 and 62. The implant according to claim 13, wherein the range of the joint is restored to normal activity joint movement 80 to 99.9%.
63.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节的活动范围被恢复到正常关节活动90%到99.9%。 1,2,3,4,5,6,7,8,9,10,11,12 and 63. The implant according to claim 13, wherein the range of the joint is restored to normal activity joint movement 90% to 99.9%.
64.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节的活动范围被恢复到正常关节活动的95%到99.9%。 1,2,3,4,5,6,7,8,9,10,11,12 and 64. The implant according to claim 13, wherein the range of the joint is restored to normal activity joint movement 95 to 99.9%.
65.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节的活动范围被恢复到正常关节活动的98%到99.9%。 1,2,3,4,5,6,7,8,9,10,11,12 and 65. The implant according to claim 13, wherein the range of the joint is restored to normal activity joint movement 98 to 99.9%.
66.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节为膝关节,且其中形状沿选自由圆、椭圆、卵形、肾形、大体的圆、大体的椭圆、大体的卵形、大体的肾形组成的群组中的周长形成。 1,2,3,4,5,6,7,8,9,10,11,12 and 66. The implant of claim 13, wherein the joint is a knee, and wherein the selected shape along consisting of a circle, ellipse, oval, kidney shaped, substantially circular, substantially elliptical, substantially oval, substantially the group consisting of kidney-shaped perimeter formed.
67.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节为膝关节,且其中所述植入物的上表面为大体的凸面。 And 67. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, wherein the joint is a knee, and wherein the implant the upper surface thereof is substantially convex.
68.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节为膝关节,且其中所述植入物的下表面为大体的凹面。 And 68. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, wherein the joint is a knee, and wherein the implant thereof into a generally concave lower surface.
69.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节为膝关节,且其中所述植入物的上表面包括凸面和凹面截面。 And 69. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, wherein the joint is a knee, and wherein the implant the upper surface thereof comprises convex and concave cross section.
70.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节为膝关节且所述植入物的下表面为大体的凹面。 And 70. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, wherein the joint is a knee implant and the the substantially concave lower surface.
71.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,其中所述关节为膝关节,且其中所述植入物的横截面选自由球形和非球面组成的群组。 And 71. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, wherein the joint is a knee, and wherein the implant the cross-section selected from the group consisting of spherical objects and the group consisting of an aspherical.
72.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,所述植入物的外周具有比所述植入物的中央部分更厚的厚度。 And 72. The implant according to claim 13 1,2,3,4,5,6,7,8,9,10,11,12, the outer periphery of the implant than the implant thicker thickness of the central portion thereof.
73.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的植入物,所述植入物的中央部分具有比外周更厚的厚度。 1,2,3,4,5,6,7,8,9,10,11,12 and 73. The implant according to claim 13, the implant has a central portion thicker than an outer periphery thickness of.
74.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物具有沿所述装置的后面部分的厚度,其等于或大于所述植入物的侧面、中间和前面部分中的至少一个的厚度。 74 has a front portion, rear portion, the side portions and the intermediate portion of the implant and the 1,2,3,4,5,6,7,8,9,10,11,12 according to claim 13, wherein the implant has a thickness along the rear portion of the apparatus, which is equal to or greater than a thickness of said at least one side, and the front middle portion of the implant.
75.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物具有沿所述装置的后面部分的厚度,其等于或小于所述植入物的侧面、中间和前面部分中的至少一个的厚度。 75. has a front portion, rear portion, the side portions and the intermediate portion of the implant and the 1,2,3,4,5,6,7,8,9,10,11,12 according to claim 13, wherein the implant has a thickness along the rear portion of the apparatus, which is smaller than or equal to the thickness of the at least one side, and in front of the intermediate portion thereof in the implant.
76.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物具有沿所述装置的中间部分的厚度,其等于或小于前面部分、后面部分、和侧面部分中的至少一个的厚度。 76 has a front portion, rear portion, the side portions and the intermediate portion of the implant and the 1,2,3,4,5,6,7,8,9,10,11,12 according to claim 13, wherein the implant has a thickness along the intermediate portion of the device, which is less than or equal to the front portion, rear portion, and a side portion of at least one of the thickness.
77.根据权利要求1、2、3、4、5、6、7、8、9、10、11、12和13所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物具有沿所述装置的中间部分的厚度,其等于或大于前面部分、后面部分和侧面部分中的至少一个的厚度。 77 has a front portion, rear portion, the side portions and the intermediate portion of the implant and the 1,2,3,4,5,6,7,8,9,10,11,12 according to claim 13, wherein the implant has a thickness along the intermediate portion of the device, which is equal or greater than the front part, the thickness of the rear portion and side portions of at least one.
78.根据权利要求37和46所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物的至少一个组件具有沿所述装置的后面部分的厚度,其等于或大于所述植入物的侧面、中间和前面部分中的至少一个的厚度。 78. has a front portion, rear portion, the side portions of the implant and the intermediate portion 37 and according to claim 46, wherein the at least one component of the implant has a thickness along the rear portion of the device, is equal to or greater than a thickness of said at least one side, and in front of the intermediate portion thereof in the implant.
79.根据权利要求37和46所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物的至少一个组件具有沿所述装置的后面部分的厚度,其等于或小于所述植入物的侧面、中间和前面部分中的至少一个的厚度。 79 has a front portion, rear portion, the side portions of the implant and the intermediate portion 37 and according to claim 46, wherein the at least one component of the implant has a thickness along the rear portion of the device, It is equal to or smaller than the thickness of the side, front and middle portion of the implant in at least one.
80.根据权利要求37和46所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物的至少一个组件具有沿所述装置的中间部分的厚度,其等于或小于前面部分、后面部分、和侧面部分中的至少一个的厚度。 80. The method of claim 37 and 46 having a front portion, rear portion, the side portions and the middle portion of the implant, wherein the at least one component of the implant has a thickness of the intermediate portion along the device, It is equal to or less than the front portion, rear portion, and at least one of the thickness of the side portions.
81.根据权利要求37和46所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物的至少一个组件具有沿所述装置的中间部分的厚度,其等于或大于前面部分、后面部分、和侧面部分中的至少一个的厚度。 81. The method of claim 37 and 46 having a front portion, rear portion, the side portions and the middle portion of the implant, wherein the at least one component of the implant has a thickness of the intermediate portion along the device, equal to or greater than the front portion, rear portion, and at least one of the thickness of the side portions.
82.一种用于修复关节的程序,其包括在关节镜检查下植入或以关节镜辅助植入具有第一和第二表面的植入物的步骤,其中所述第一或第二表面中的至少一个具有与一关节表面的形状充分匹配的三维形状。 82. A procedure for repairing joints, which comprises the step of implanting or arthroscopically implant having a first surface and a second auxiliary implant at arthroscopy, wherein the first or second surface At least one articulation surface has a shape of a three-dimensional shape sufficiently matched.
83.根据权利要求82所述的程序,且进一步包括在植入之前分析所述关节的图像的步骤。 83. The program according to claim 82, and further comprising the step of analyzing the image of the joint prior to implantation.
84.根据权利要求82所述的程序,其中所述图像为选自由MRI、CT、X光、和其组合组成的群组中的三维图像。 84. The program according to claim 82, wherein said image is selected from the group consisting of MRI, three-dimensional image group CT, X ray, and combinations thereof in the.
85.根据权利要求82所述的程序,其进一步包括做10cm或更小的切口的步骤。 85. The program according to claim 82, further comprising the step 10cm or less do incision.
86.根据权利要求82所述的程序,其进一步包括做6cm或更小的切口的步骤。 86. The program according to claim 82, further comprising the step or less do 6cm incision.
87.根据权利要求82所述的程序,其进一步包括做4cm或更小的切口的步骤。 87. The program according to claim 82, further comprising the step 4cm or less do incision.
88.一种制造适合于一关节的植入物的方法,所述方法包括以下步骤:判定所述关节的一个或一个以上的关节表面的三维形状;和制造具有一第一表面和一第二表面的植入物,其中所述第一表面和第二表面相对所述关节的第一和第二关节表面,且进一步地,其中所述第一或第二表面中的至少一个的一部分或整体与所述关节表面的三维形状充分匹配。 88. A method for producing an implant suitable for a joint, the method comprising the steps of: determining a three-dimensional shape of the joint articular surface of one or more of; manufacture and having a first surface and a second implant surface, wherein the first surface and a second surface opposite said first joint and second joint surface, and further, wherein said first or second surface of the at least a part or the whole of the and matched with the three-dimensional shape of the articular surface.
89.根据权利要求88所述的方法,其中所述三维形状由获得所述关节的图像决定。 89. The method according to claim 88, wherein said three-dimensional shape is determined by the obtained image of the joint.
90.根据权利要求89所述的方法,其中所述图像选自由MRI、CT、X光、和其组合组成的群组。 90. The method according to claim 89, wherein said image is selected from the group consisting of MRI, CT, X ray, and combinations thereof.
91.一种适合于具有上表面和下表面的膝关节的植入物,其中所述上表面相对于股骨的至少一部分且所述下表面相对胫骨表面的至少一部分,且进一步地,其中所述上表面或下表面中的至少一个具有与所述股骨和胫骨表面中的一个的形状充分匹配的三维形状。 91. A composition suitable for implantation having an upper surface and a lower surface of a knee joint, wherein the upper surface with respect to at least a portion of the surface at least opposing surface of the tibia and femur of the lower portion, and further, wherein said upper or lower surface having at least one of a shape of the femoral and tibial surfaces of the three-dimensional shape substantially match.
92.一种适合于具有上表面和下表面的髋关节的植入物,其中所述上表面啮合髋臼的至少一部分且所述下表面啮合股骨头的至少一部分,且进一步地,其中所述上表面或下表面中的至少一个的至少一部分具有与所述髋臼和所述股骨头表面中的一个的形状充分匹配的三维形状。 92. A suitable upper surface and having a lower surface of the hip implant, wherein the engaging surface of the acetabulum and the upper surface of the engagement of at least a portion of at least a portion of the femoral head, and further, wherein said upper or lower surface of at least one of at least a portion having a shape of the acetabulum and the femoral head surfaces of the three-dimensional shape that best matches.
93.一种适合于具有上表面和下表面的髋关节的植入物,其中所述上表面啮合所述胫骨头的的至少一部分且所述下表面啮合髋臼的至少一部分,且进一步地,其中所述上表面或下表面中的至少一个的至少一部分具有与所述髋臼和所述股骨头表面中的一个的形状充分匹配的三维形状。 93. A having an upper surface and adapted to lower hip implant surface, wherein the upper surface engages the bone and the tibia of at least a portion of the engagement surface at least a portion of the acetabulum, and further, wherein said at least a portion of at least one surface or lower surface having a shape of the acetabulum and the femoral head surfaces of the three-dimensional shape that best matches.
94.一种适合于具有上表面和下表面的踝关节的植入物,其中所述上表面啮合胫骨远端的至少一部分且所述下表面啮合胫距关节面的至少一部分,且进一步地,其中所述上表面或下表面中的至少一个的至少一部分具有与所述胫骨远端和胫距关节面表面中的一个的形状充分匹配的三维形状。 94. A method adapted to have an upper surface and a lower surface of the ankle implant, wherein the engaging surface of the distal tibia and the upper surface of at least a portion of the engaging surface of the tibial articular from at least a portion, and further, wherein at least a portion of at least one surface of the upper or lower surface having a three dimensional shape of the distal tibia and the tibial articular surface from a shape of the surface is sufficiently match.
95.一种适合于具有上表面和下表面的踝关节的植入物,其中所述上表面啮合胫距关节面的至少一部分且所述下表面啮合胫骨远端的至少一部分,且进一步地,其中所述上表面或下表面中的至少一个的至少一部分具有与所述胫骨远端和胫距关节面表面中的一个的形状充分匹配的三维形状。 95. A suitable upper surface and having a lower surface of the ankle implant, wherein said upper engaging surface tibiotalar joint surface and at least a portion of the lower surface engaging at least a portion of the distal end of the tibia, and further, wherein at least a portion of at least one surface of the upper or lower surface having a three dimensional shape of the distal tibia and the tibial articular surface from a shape of the surface is sufficiently match.
96.一种适合于具有一近端表面和一远端表面的趾关节的植入物,其中所述近端表面啮合跖骨头的至少一部分且所述远端表面啮合近节趾骨的至少一部分,且进一步地,其中所述近端或远端表面中的至少一个的至少一部分具有与所述跖骨头和近节趾骨表面中的一个的形状充分匹配的二维形状。 96. A surface suitable for having a proximal end and a distal phalangeal joint implant surface, wherein the proximal surface engaging at least a portion of the metatarsal head and engaging at least a portion of the distal surface of the proximal phalanx, and further, wherein at least a portion of at least one of the proximal or the distal surface has a shape of a two-dimensional shape of the metatarsal head and proximal phalanx surfaces sufficiently match.
97.一种适合于具有一第一表面和一第二表面的肩关节的植入物,其中所述第一表面啮合肱头的至少一部分且所述第二表面啮合肩臼的至少一部分,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述肱头和肩臼表面中的一个的形状充分匹配的二维形状。 97. A composition suitable for implantation shoulder having a first surface and a second surface, wherein said first surface engaging at least a portion of the humeral head and said second surface engaging at least a portion of the glenoid and further, wherein at least a portion of at least one of said first or second surface has a two-dimensional shape to the shape of the humeral head and the glenoid surface of one of the best matches.
98.一种适合于具有一第一表面和一第二表面的肘关节的植入物,其中所述第一表面啮合一肱骨远端的至少一部分且所述第二表面啮合尺骨和桡骨中的至少一个的至少一部分,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述肱骨远端、尺骨和桡骨表面中的一个的形状充分匹配的三维形状。 98. A composition suitable for implantation elbow having a first surface and a second surface, wherein the first surface engages at least a portion of a distal humerus and the second surface engages the ulna and radius at least a portion of at least one, and further, wherein said first or second surface of at least one of at least a portion having a shape of the distal humerus, ulna and radius surface substantially match the three-dimensional shape.
99.一种适合于具有一第一表面和一第二表面的腕关节的植入物,其中所述第一表面啮合桡骨远端的至少一部分且所述第二表面啮合尺骨远端的至少一部分,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述桡骨远端和尺骨远端表面中的一个的形状充分匹配的三维形状。 99. A wrist implant adapted for having a first surface and a second surface, wherein the first surface engages at least a portion of the distal radius and the second surface engages at least a portion of the distal ulna , and further, wherein at least a portion of at least one of said first or second surface having the shape of a distal surface of the distal ulna and radius substantially match the three-dimensional shape.
100.一种适合于具有一第一表面和一第二表面的指关节的植入物,其中所述第一表面啮合掌骨头的至少一部分且所述第二表面啮合指骨近端底部的至少一部分,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述掌骨头和指骨近端表面中的一个的形状充分匹配的三维形状。 100. A composition suitable for implantation knuckles having a first surface and a second surface, wherein the first surface engages at least a portion of the metacarpal head and the second surface engages at least a portion of the proximal phalanx of the bottom , and further, wherein at least a portion of at least one of said first or second surface having the shape of the metacarpal bone and proximal phalanx surfaces sufficiently matches a three-dimensional shape.
101.一种适合于具有上表面和下表面的膝关节的插补植入物,其中所述上表面相对于股骨的至少一部分且所述下表面相对一胫骨表面的至少一部分,且进一步地,其中所述上表面或下表面中的至少一个的至少一部分具有与所述股骨和胫骨表面中的一个的形状充分匹配的三维形状。 101. A adapted to have upper and lower surfaces of the knee implant of interpolation, wherein the upper surface with respect to at least a portion, and at least a portion of the lower surface of the femur relative to a surface of the tibia, and further, or wherein at least a portion of at least the upper surface of the lower surface has the shape of a three-dimensional shape of the femoral and tibial surfaces is sufficiently match.
102.一种适合于哺乳动物的具有一第一表面和一第二表面的关节的植入物,其中所述第一表面相对于第一关节表面的至少一部分且所述第二表面相对第二关节表面的至少一部分,且进一步地,其中所述第一或第二表面中的至少一个的至少一部分具有与所述股骨和胫骨表面中的一个的形状充分匹配的三维形状。 At least a portion and the second surface 102. A suitable implant to a mammal having a first articular surface and a second surface, wherein said first surface opposite to the first surface of the second articulation at least a portion of the articular surface, and further, wherein said at least one first or at least a portion of the second surface has a shape of a surface of the femur and the tibia in substantially match the three-dimensional shape.
103.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述上表面和所述下表面具有与所述植入物的上表面邻接且所述植入物的下表面邻接的关节表面的至少一个的形状充分匹配的三维形状。 103. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein said upper surface and said lower surface having the upper surface of the implant abuts and the lower surface of the implant articular surface thereof adjacent at least one of a shape substantially match the three-dimensional shape.
104.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物具有患者软骨缺损的厚度。 104. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant has a thickness cartilage defect in a patient.
105.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物具有患者软骨缺损厚度的85%。 105. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant has a thickness 85% of a cartilage defect in a patient .
106.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物具有患者软骨缺损厚度的65%到100%。 106. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant has a thickness of 65% of the patients with cartilage defects to 100%.
107.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物具有软骨缺损的厚度,外加一预定的偏移值。 107. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant has a thickness cartilage defect, plus a the predetermined offset value.
108.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中可选用所述偏移值来调整轴线不对准。 108. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein said offset value can be selected to adjust the axes are not aligned.
109.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物由包括金属或金属合金的材料构造。 109. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein said composition comprises a metal or metal alloy material of the implant structure.
110.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述材料包括一种或一种以上的生物活性材料。 110. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein said material comprises one or more biologically active material.
111.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物以生物活性材料覆盖。 111. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant is covered with a biologically active material.
112.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物包括金属或金属合金和聚合物。 112. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein said implant comprises a metal or metal alloy and a polymer .
113.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,且进一步具有用于附着在选自由嵴、销钉、插针、横件、牙齿和突起组成的群组中的所述上表面和所述下表面中的至少一个的结构。 113. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, and further has a ridge for attachment selected from the group consisting of, a pin, plug the needle, the cross member, and a protrusion teeth group consisting of at least one upper surface and the lower surface of the structure.
114.根据权利要求113所述的植入物,其进一步具有用于附着的复数个结构。 114. The implant of claim 113, further having a plurality of structures for attachment.
115.根据权利要求114所述的植入物,其中用于附件的结构的相对定向选自由对称、不对称、行、圆、三角形、和任意组成的群组。 115. The implant of claim 114, wherein the relative orientation of attachment selected from the group consisting of a symmetrical configuration, asymmetrical, rows, circles, triangles, and any composition of the group.
116.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其进一步具有选自由嵴和边缘组成的群组中的外周结构。 116. The 91,92,93,94,95,96,97,98,99,100,101, and implant of claim 102, further having a selected from the group consisting of ridges and edges of the group consisting of the outer periphery of the structure.
117.根据权利要求116所述的植入物,其中所述外周结构沿所述植入物的整个周长延伸。 117. The implant of claim 116, wherein said outer periphery structure thereof along the entire perimeter of the implant extension.
118.根据权利要求116所述的植入物,其中所述外周结构沿所述植入物的周长的一部分延伸。 118. The implant of claim 116, wherein the outer peripheral portion of the structure extending along the perimeter of the implant.
119.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述上表面和下表面的每一个具有关于穿过所述植入物的至少一部分的纵向轴线的斜率,且进一步地,其中关于所述在下表面的斜率的第一表面的斜率选自由正、负、和零组成的群组。 119. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein each of the upper and lower surfaces having wear on the slope of the implant through at least a portion of the longitudinal axis, and further wherein the slope of the first surface on the lower surface of the slope selected from the group consisting of positive, negative, and the group consisting of zero.
120.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物接近所述第一和第二关节表面中的一个的形状。 120. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant proximate the first and second a shape of the articular surface.
121.根据权利要求120所述的植入物,其中所述植入物选自一植入物库。 121. The implant of claim 120, wherein the implant is selected from a library of implants.
122.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物在插入关节之后改变了构型。 122. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant changes configuration after insertion joints .
123.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物进一步包括一第一组件和一第二组件。 123. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant further comprises a first component and a The second component.
124.根据权利要求123所述的植入物,其中所述第一和第二组件为整体成形的、不可分割成形、互连成形、和相互依赖成形中的一个。 124. The implant of claim 123, wherein said first and second component is integrally formed, integral molding, molded interconnect, and the interdependence of a molding.
125.根据权利要求123所述的植入物,其中所述第一组件以固定地、滑动地、旋转地中的至少一个与所述关节啮合。 125. The implant of claim 123, wherein said first assembly is fixedly, slidably, at least one engagement with the articulation of rotation.
126.根据权利要求123所述的植入物,其中所述第二组件以固定地、滑动地、旋转地中的至少一个与所述关节啮合。 126. The implant of claim 123, wherein said second assembly is fixedly, slidably, at least one engagement with the articulation of rotation.
127.根据权利要求123、124、125和126所述的植入物,其中所述第一组件啮合所述第二组件。 127. The implant of claim 123, 124 and 126 according to, wherein the first component engages the second component.
128.根据权利要求123、124、125和126所述的植入物,其中所述第一组件装配于所述第二组件内。 And 128. The implant of claim 123, claim 126, wherein said first assembly fitting within said second component.
129.根据权利要求123、124、125和126所述的植入物,其中所述第一组件滑动地啮合所述第二组件。 129. The implant of claim 123, 124 and 126 according to, wherein said first assembly slidably engaging the second component.
130.根据权利要求123、124、125和126所述的植入物,其中所述第一组件旋转地啮合所述第二组件。 130. The implant of claim 123, 124 and 126 according to, wherein said first assembly engaging the second rotary assembly.
131.根据权利要求123、124、125和126所述的植入物,其中所述植入物的一部分具有一磁体。 And 131. The implant of claim 123, claim 126, wherein said implant portion thereof with a magnet.
132.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物具有复数个组件。 132. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein said implant has a plurality of components.
133.根据权利要求132所述的植入物,其中所述复数个组件的一第一组件以固定地、滑动地、旋转地中的至少一个与所述关节啮合。 133. The implant of claim 132, wherein a first component of the plurality of assembly to fixedly, slidably, at least one engagement with the articulation of rotation.
134.根据权利要求132所述的植入物,其中所述复数个组件的一第二组件以固定地、滑动地、旋转地中的至少一个与所述关节啮合。 134. The implant of claim 132, wherein a plurality of said second assembly to assembly fixedly, slidably, at least one engagement with the articulation of rotation.
135.根据权利要求132、133和134所述的植入物,其中所述复数个组件的第一组件啮合所述复数个组件的第二组件。 As claimed in claim 132, 133 and 135. The implant of claim 134 wherein the first component of the plurality of engaging said second assembly component plurality of components.
136.根据权利要求132、133和134所述的植入物,其中所述复数个组件的第一组件装配于所述复数个组件的第二组件内。 As claimed in claim 132, 133 and 136. The implant of claim 134 wherein said plurality of components mounted on a first component of the plurality of components of the second component.
137.根据权利要求132、133和134所述的植入物,其中所述复数个组件的第一组件滑动地啮合所述复数个组件的第二组件。 As claimed in claim 132, 133 and 137. The implant of claim 134 wherein the first component of the plurality of second assembly slidably engaging said plurality of component assembly.
138.根据权利要求132、133和134所述的植入物,其中所述复数个组件的第一组件旋转地啮合所述复数个组件的第二组件。 As claimed in claim 132, 133 and 138. The implant of claim 134 wherein the first component of the plurality of components engages the second component of the rotation of plurality of assembly.
139.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物具有沿选自由圆、椭圆、卵形、肾形、正方形、矩形、大体的圆、大体的椭圆、大体的卵形、大体的肾形、大体的正方形、大体的矩形组成的群组中的周长形成的形状。 139. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant has a direction selected from the group consisting of round, oval, oval, kidney-shaped, square, rectangular, substantially circular, substantially elliptical group, generally oval, generally kidney-shaped, substantially square, substantially consisting of a rectangular shape formed in the perimeter.
140.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物具有选自由球形、半球形、非球面、凸面、凹面、大体的凸面、和大体的凹面组成的群组中的下表面和上表面中的至少一个的横截面形状。 140. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant is selected from the group consisting having a spherical, hemispherical, aspherical, convex, concave, substantially convex, and the lower surface of the group consisting of a generally concave upper surface and at least one cross-sectional shape.
141.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物为软骨缺损成形植入物。 141. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant is a cartilage defect implant molded.
142.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物为软骨投影植入物。 142. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant is a cartilage projected implant.
143.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物为一软骨下骨成形植入物。 143. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant is a bone implant at a Chondroplasty thereof.
144.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物经由10cm或更小的切口而外科手术植入。 144. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant via a 10cm or smaller incision surgically implanted.
145.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物经由6cm或更小的切口而外科手术植入。 145. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant via a 6cm incision or less surgically implanted.
146.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物经由4cm或更小的切口而外科手术植入。 146. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant via 4cm or less incision surgically implanted.
147.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述关节的活动的范围被恢复到正常关节活动的80%到99.9%。 147. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the movable range of the joint is restored to normal joint movement 80 to 99.9%.
148.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述关节的活动的范围被恢复到正常关节活动的90%到99.9%。 148. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the movable range of the joint is restored to normal joint movement 90 to 99.9%.
149.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述关节的活动的范围被恢复到正常关节活动的95%到99.9%。 149. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the movable range of the joint is restored to normal joint movement 95 to 99.9%.
150.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述关节的活动的范围被恢复到正常关节活动的98%到99.9%之间。 150. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the movable range of the joint is restored to normal joint movement between 98% to 99.9%.
151.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,所述植入物的外周的至少一部分具有比所述植入物的中央部分更厚的厚度。 151. 91,92,93,94,95,96,97,98,99,100,101 at least a portion, and implants according to claim 102, said implant having an outer circumference than the the central portion of the implant greater thickness.
152.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,所述植入物的中央部分具有比外周的至少一部分更厚的厚度。 152. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, the central portion of the implant has at least a portion of the outer peripheral thicker thickness.
153.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述植入物的边缘围绕一个或一个以上的位置。 153. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein the implant material around the edges of one or more of position.
154.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述上边缘进一步在下边缘的中间、侧面、前面和/或后面延伸。 154. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, wherein further the upper edge of the lower middle edge, side, front and / or rear extension.
155.根据权利要求91、92、93、94、95、96、97、98、99、100、101、和102所述的植入物,其中所述下边缘进一步在上边缘的中间、侧面、前面和/或后面延伸。 155. 91,92,93,94,95,96,97,98,99,100,101, and implants according to claim 102, further wherein said lower edge in the middle of the upper edge of the side, extending front and / or rear.
156.根据权利要求91、123和132所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物具有沿所述装置的前面部分、后面部分、侧面部分和中间部分中的至少一个的厚度,其等于或大于所述植入物的侧面、中间、前面和后面部分中的至少一个的厚度。 91,123 and 156. The claim has a front portion, rear portion, the side portions and the middle portion of the implant 132, wherein the implant has a portion along the front of the device, the rear portion, the side portions and at least one of the thickness of the intermediate portion, which is equal to or greater than a thickness of said at least one side, the intermediate, front and rear portions thereof in the implant.
157.根据权利要求91、123和132所述的具有前面部分、后面部分、侧面部分和中间部分的植入物,其中所述植入物具有沿所述装置的前面部分、后面部分、侧面部分和中间部分中的至少一个的厚度,其等于或小于所述植入物的侧面、中间、前面和后面部分中的至少一个的厚度。 91,123 and 157. claim having a front portion, rear portion, the side portions and the middle portion of the implant 132, wherein the implant has a portion along the front of the device, the rear portion, the side portions and the thickness of the intermediate portion of at least one of which is less than or equal to the thickness of the at least one side, the intermediate, front and rear portions thereof in the implant.
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