CN1819804A - 踝关节内用假体 - Google Patents

踝关节内用假体 Download PDF

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Publication number
CN1819804A
CN1819804A CNA038269783A CN03826978A CN1819804A CN 1819804 A CN1819804 A CN 1819804A CN A038269783 A CNA038269783 A CN A038269783A CN 03826978 A CN03826978 A CN 03826978A CN 1819804 A CN1819804 A CN 1819804A
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CN
China
Prior art keywords
middleware
sliding surface
wedge
endoprosthesis
downside
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CNA038269783A
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English (en)
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CN1819804B (zh
Inventor
H·科费德
A·克勒
H·D·林克
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Waldemar Link GmbH and Co KG
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Waldemar Link GmbH and Co KG
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Publication of CN1819804A publication Critical patent/CN1819804A/zh
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Abstract

用来替代踝关节的内用假体，由一与踝骨(2)连接的下元件(4)、一与胫骨(1)连接的上元件(3)和一中间件(5)组成，中间件既与下元件又与上元件形成一滑动关节。为了补偿解剖或手术的不规则性设置一中间件(5)，它在矢状断面内是楔形的。上元件(3)在额切面或矢状断面内也可以是楔形的。

Description

踝关节内用假体
已知一种内用假体用来代替踝关节，它由一与踝骨连接的元件，一与胫骨连接的元件和一中间件组成(DE-U-88 12 806，Prospect“LINKS.T.A.R.Totale Sprunggelenkprothese[H.Kofoed]der Firma waldemarLink(GmbH&Co.，)，Hamburg”)。踝骨元件和中间件通过滑动面共同作用，它们可以在矢状面内弯曲和拉伸。胫骨元件和中间件构成共同作用的滑动面，它们允许绕垂直轴线旋转。它们可以做平的，以便可以在AP和LM方向作平衡运动。稳定化通过天然韧带进行。
在已知假体中中间件的上、下滑动面相互平行地布置在额状面内，因为关节的人造替代品不应该引起方向改变。但是实际表明，在手术后关节的侧面和中间韧带常常具有不同的张力，由此可能造成病痛。这可能归因于解剖的不规则或者手术师选择了设置在胫骨上的用来与假体连接的具有不合理的取向的切除面。
本发明的目的是，避免或缓解解剂或者说手术部位和假体之间的不协调性。
本发明的解决方案在于权利要求1或权利要求5的特征。按照这些特征，中间件和/或胫骨元件设计成楔形。如果手术师断定，在采用普通假体时韧带张力是不同的，他可以通过采用在额状面内具有楔形形状的校正元件补偿。楔形校正板较厚的一侧设置在在采用普通元件时韧带张力不够的一侧，如果他看出，胫骨切除面不垂直于胫骨方向分布，或者如果他由于其他原因希望，假体平面不垂直于胫骨轴线分布，那么他也可以采用校正元件，其楔形形状位于矢状面内，如果手术师为了使上面元件的下滑动面相对于胫骨方向或受力方向具有一定的指向，那么他通常采用做成校正元件的胫骨元件。相反如果胫骨切除面的取向是正确的，并且为了考虑脚的解剖，则他优先采用做成校正元件的中间件。
本权利要求不涉及中间件在额状面的楔形结构，因为它是老的未在先公开的专利申请PCT/EP02/02573的主题。
上部元件是楔形的规定在实际上并不造成困难，因为不管其上侧的连接面还是其下侧的滑动面都是平的或基本上平的。对于中间件在矢状面内可能的楔形的规定与普通中间件比较是决定性的。其次不仅中间件大致平的上侧滑动面的方向，而且下侧滑动面的总取向都可以方便地确定。在本发明的意义上如果中间件与普通中间件相比在矢状面内向前或向后加厚，那么便算是楔形的。
在本发明范围内在矢状面内的楔形可以和在额状面内的楔形组合。但是在矢状面或额状面内的楔形也可以在额状面或矢状面内不是楔形的情况下出现。
楔角适宜于在1°到16°之间，优选是3°到8°度之间。
为了使中间体楔形的取向不会由于中间件绕垂直轴的旋转而改变，适宜于通过将共同作用的滑动面对相应地做得方向确定(例如圆柱形)的方法，强制地由踝骨或胫骨确定中间件的取向，踝骨和中间件之间的关节特别适合这种方式。
为了使手术师可以在不同的楔角中进行选择，对于每个假体必须给手术师提供多个不同的校正元件。为了减小由此带来的费用，将校正件设计得尽可能简单是适宜的。因此它由一始终保持不变的标准件和一楔形件组合而成是适宜的。标准件仅仅设置成简单的样式。只有楔形件需要存在不同的方案。特别是如果上部的元件用作校正元件并且标准件构成用来固定在胫骨上所需要的装置的话，便是这样。
下面参照附图详细说明本发明，附图表示优选的实施例，它们表示：
图1一配备假体的关节的矢状断面，
图2用透视图表示的展开的假体，
图3在装入中间件前植入的上、下假体元件的布局的透视图，
图4上部的校正元件的额切面，
图5上校正元件的矢状断面，
图6校正中间件的矢状断面，
图7做成两件的上校正元件。
假体设置在胫骨1和踝骨2之间，它由上部元件3、下部元件4和中间件5组成。上元件3具有一板形件6，其下侧面7构成一平的滑动面。突起8用来固定在胫骨，相应的切除缺口9内。
下元件4形成一凸形拱起的滑动面10，它可以做成圆柱形成圆锥形。它带一筋11，该筋位于在弯曲和拉伸运动时中间件的相对运动方向。此外下元件具有与胫骨1和排骨13相应的滑动面共同作用的侧面的小平面12。
中间件15具有一平的，与滑动面7相配的上侧面15和一下侧的滑动面16，它做得与下元件4的滑动面10互补。它含有一用来容纳筋11的槽17。因此相对于下元件4中间件5侧向移动。它只允许弯曲和拉伸运动。
上、下元件3和4适宜于由金属制成，中间件5由有利于滑动的塑料如聚乙烯制成。但是也可以采用其它具有足够强度和滑动能力的材料，例如陶瓷。
由于滑动面10和16互补的形状以及通过筋11和槽17的共同作用，中间件5不能相对于踝骨元件4绕垂直轴线旋转。亦即其取向通过下元件的取向确定。所示的实施例完全排除下元件和中间件之间绕垂直轴线的这种旋转运动，而也可以考虑这样的结构，在这种结构中允许在规定范围内或通过滑动面的结构仅仅有阻滞地或者不排除旋转运动。
上述借助于图1至3的说明既适用于具有普通元件的结构也适用于具有校正元件的结构。
在图4至6中表示校正元件的实施例，图4表示做成校正元件的上元件3的额位。在图中左面附近的边缘20做得比位于对面的边缘厚。元件相对于其额侧的中平面是对称的，因此较厚的一侧20允许根据手术师的选择放在关节的侧面或中间。
图5表示上元件3的矢状断面。它在图形左边的末端21处楔形加厚。这个元件的上侧面相对于额状面对称。因此加厚的末端可以根据手术师的选择设置在关节中的前面或后面。在这两个实施例中上固定面23和下滑动面7之间的楔角22处于5°的数量级。
图6表示一校正中间件5的矢状断面。其做成滑动面的下侧面16具有大致平行于辅助线24分布的总取向，为了表示楔角19辅助线在上滑动面15附近画出。在这种情况下前提是，在普通中间件时辅助线24平行于下侧面16的总取向分布。对于确定中间件楔形决定性的是，始终和假体系统的普通元件比较。
不要求校正分别仅仅限制在一个元件上。更确切地说既可以对于上元件又可以对于中间件采用校正元件。图1表示了这种方案。
一旦手术师植入下元件4，他便可以借助于合适的器械在张紧侧韧带的情况下确定胫骨的切除面25相对于下元件4是正常分布还是需要校正。在后一种情况下他决定，应该对于上元件还是中间件或者两件都选择校正元件，以及相应的楔形应该多大和按什么方向。如果装入上元件3，那么还可以进行相应的测量。然后确定，是否将校正元件用作中间件。
图7表示由一标准件25和一楔形件26组合成上元件3。因为标准件25构成固定机构8，楔形件26可以相应地做得比较简单，其中可以提供许多具有不同楔角的样品。两个零件可以用任何已知的方式相互结合，例如它们可以相互螺纹连接，它们也可以配备互补的相互嵌合的突起和凹槽，它们允许，不花大的力气将两个零件插在一起。

Claims (6)

1.用来替代踝关节的内用假体，包括一与踝骨(2)连接的形成上侧滑动面(10)的下元件(4)、一形成下侧滑动面(7)和具有一上连接面(23)以便与胫骨的切除面(25)连接的上元件(3)，以及一具有与上、下元件(3、4)的滑动面(7、10)共同作用的两个滑动面(15、16)的中间件，其特征为：上元件(3)在其下侧滑动面(7)和其上侧连接面(23)之间的矢状断面内，和/或中间件(5)在其滑动面(15、16)之间的矢状断面或额切面内是楔形的。
2.按权利要求1的内用假体，其特征为：在下元件(4)和中间件(5)上共同作用的滑动面(10、16)相对于垂直轴线基本上不可旋转地共同作用。
3.按权利要求1的内用假体，其特征为：在上元件(4)和中间件(5)上共同作用的滑动面(7、15)可相对于垂直轴旋转地共同作用。
4.按权利要求1至3之任一项的内用假体，其特征为：楔角(19、22)在1°至16°之间。
5.按权利要求1至4之任一项的内用假体，其特征为：楔形元件(3)由一提供不同楔角的楔形件(26)和一标准件(25)组合而成。
6.用本代替踝关节的内用假体系统，它包括一与踝骨(2)连接的形成上侧滑动面(10)的下元件(4)、一形成下侧滑动面(7)并具有一连接面(23)以便与腔骨(1)的切除面(25)连接的上元件(3)，和一具有两个与上、下元件(3、4)的滑动面(7、10)共同作用的滑动面(15、16)的中间件(5)，其中系统通常包括上元件和中间件，中间件的上、下侧面具有一基本上平行的总走向，其特征为：系统包括可替换普通上元件(3)的校正元件，它在其上、下侧面(7、23)之间在矢状面和/或额状面内做成楔形，和/或可替换普通中间件(5)的校正中间件，它们在其上侧面(15)和下侧面(16)的总体走向之间在矢状面内与普通中间件(5)相比是楔形的。
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EP1658023A1 (de) 2006-05-24

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