Detailed Description
The present invention will be described in further detail with reference to the accompanying drawings and examples. The features and advantages of the present invention will become more apparent from the description.
The word "exemplary" is used exclusively herein to mean "serving as an example, embodiment, or illustration. Any embodiment described herein as "exemplary" is not necessarily to be construed as preferred or advantageous over other embodiments. While the various aspects of the embodiments are presented in drawings, the drawings are not necessarily drawn to scale unless specifically indicated.
According to the utility model provides a buffering/non-buffering formula wing does not have handle hip joint prosthesis, as shown in fig. 1, fig. 2, fig. 3 and fig. 4, this prosthesis is including can closely detain the wing cup 6 of cover 31 outside between femoral neck and tuberosity, wing cup 6 is the cup-shaped structure of inversion, and the opening is towards oblique below, promptly the femoral neck stub with 6 internal faces of wing cup closely link, paste tightly each other to make wing cup 6's installation more firm.
Wing cup 6 in this application before the installation, only need get rid of the femoral head on the human thighbone, the thighbone neck most remains, and greater trochanter, lesser trochanter also all remain basically, can be according to the different anatomical morphology of different crowds, and partly bone cortex is got rid of to adaptability, grinds thinly with the partial region on the bone cortex to be convenient for this wing cup 6's installation. When the wing-shaped cup body 6 is attached, it is necessary to secure the strength and stability of the attachment so as to protect the blood supply passage and trabecula of the femur itself as much as possible and maintain the physiological function of the femur itself, while destroying the bone tissue as little as possible.
The remaining part of the femoral neck is called as a femoral neck stump, the wing-shaped cup body 6 has small damage to the femoral neck, intertrochanteric and other bone tissues when being installed, more femoral necks can be reserved, complete intertrochanteric is basically reserved, and tissue structures such as a carotid artery growing between the intertrochanteric and the like can be reserved;
although the existing hip joint without a handle has less damage to the femur, a certain range of physiological structures of the femur can still be damaged, particularly a certain range of trabecula bone can be damaged inevitably, and the hematopoietic function of postoperative patients is damaged; the biocompatibility between the implanted prosthesis and the human body after the operation is still difficult to completely solve.
Wing cup 6 in this application can allow the femoral neck that remains more than the femoral neck that can remain when present no handle hip joint replacement, can keep 10 ~ 20% more femoral neck at least, can further disperse the stress of acting on the thighbone for the shearing force that the thighbone tissue received is littleer, and reserves the space of growing trophoblastic blood vessel, makes remaining thighbone can normal growth.
The front end opening of the wing-shaped cup body 6, which exposes the femoral neck stump and the tuberosity 31 inside the wing-shaped cup body 6, is also called a large windowing structure, and is shown as a mark 64 in fig. 4; the arrangement of the large window structure ensures that the nourishing blood vessels outside the femoral neck are reserved, and the trabecula in the femoral neck is prevented from being damaged;
specifically, after the wing-shaped cup body 6 is installed, the vasa vasorum at the position of the large window, especially the cutting force of the wing-shaped cup body 6, which is not applied to the position where the vasa vasorum enters and exits the butting point of the femur, and the vasa vasorum and the trabecula can maintain normal physiological function and physiological support, so that the trabecula is not easy to be wasted and absorbed by femoral tissues prematurely, and the incidence rate of femoral neck stump postoperative necrosis can be greatly reduced.
As shown in fig. 4, the left direction in the drawing is the front as described in the present application, and the right direction in the drawing is the rear as described in the present application.
The bottom of the front end of the wing-shaped cup body 6 extends obliquely downwards to form a small tuberosity wing 10, and the small tuberosity wing 10 can be buckled outside the small tuberosity/small rotor 32; the small tuberosity protective wings 10 are connected with the small tuberosity/small rotor 32 in a buckling mode, so that a new limiting fixing acting force can be provided for the joint prosthesis, and the firmness and the stability of the joint prosthesis are improved. The front ends of the small trochanter wings 10 and the wing-shaped cup body 6 are positioned around the front end opening, so that the large window structure is formed.
Preferably, the small tuberosity flaps 10 and the small tuberosity 32 are attached to each other, the small tuberosity flaps 10 can be tightly buckled outside the small tuberosity 32, more preferably, the small tuberosity flaps 10 have certain elasticity, when the small tuberosity flaps 10 are buckled outside the small tuberosity 32, the small tuberosity flaps 10 need to be deformed towards the outside, and under the action of the elasticity, the connection between the small tuberosity flaps 10 and the small tuberosity 32 is tighter.
As shown in fig. 1 and 4, after the wing-shaped cup 6 is mounted on the femur, the angle formed by the small trochanter wing 10 and the axis of the neck 4 is 110 to 115 degrees, preferably 112 to 113 degrees, the inventor finds that when the included angle is 112 to 113 degrees, the connection between the small trochanter wing 10 and the small trochanter is stable and not easy to slip off, and the small trochanter wing 10 can provide enough strong supporting force for the wing-shaped cup 6 to ensure that the wing-shaped cup 6 is stably fixed on the femur.
The little tuberosity flap 10 in this application extends along little tuberosity top, remains little tuberosity to inlay around little tuberosity upper portion and inboard, cover outside the connection position that little tuberosity and thighbone main part grow, can also play the effect of another fulcrum, further strengthen the joint strength between wing cup 6 and the thighbone.
A cup wing 7 is formed by extending the side of the wing-shaped cup body 6 obliquely downward; the cup wings 7 are provided with one or two, and when two are provided, the two cup wings are respectively positioned at two sides of the wing-shaped cup body 6, and in this application, two cup wings 7 are preferably provided, as shown in fig. 1, 3 and 4, one of the cup wings 7 extends obliquely downwards and can be embedded in cancellous bone of an interrotor line 33 and clamped and fixed with an interrotor line on a femur, so that the wing-shaped cup body can be further stabilized, and an additional force application point is provided for the fixation between the wing-shaped cup body 6 and the femur; the other cup wing 7 is arranged on the other side of the femur and can be tightly attached to the outer surface of the femur, and an additional acting point is provided for the fixation between the wing-shaped cup body 6 and the femur.
Preferably, the cup wing 7 has a certain curvature, which is adapted to the human femur, especially the physiological curvature of the outside of the trochanter, so that the cup wing 7 can be tightly attached to the trochanter without excessively damaging the femur structure.
The cup wing 7 is provided with a cup wing through hole 71, and the cup wing through hole 71 prevents the femoral structure below the cup wing 7 from being damaged and can maintain the physiological function of nourishing blood vessels outside the femur.
In the process of implanting and fixing the traditional joint prosthesis with the handle, the blood supply channel on the surface of the femoral tissue is greatly damaged, and after the prosthesis with the handle is implanted, the blood supply channel is basically difficult to reconstruct in the upper area of the femur; after the traditional stem-free prosthesis is implanted, a part of the blood supply channel can be recovered at some gaps, but annular clamping pressure can still be formed on the surface of femoral tissues, the blood supply requirement cannot be completely met, and the blood supply channel recovered at the later stage is not as effective as the native blood supply channel.
In this application the rim of a cup edge of wing cup 6 is asymmetric curve, and this curve edge can make and can not paste tightly completely between wing cup 6 and the thighbone surface, can have certain space to make the part blood supply passageway on the thighbone surface can remain, make the thighbone surface produce new blood supply passageway through compensatory hyperplasia in this space department, avoid forming annular card to press the thighbone near-end simultaneously
It is further preferred that the small tuberosity wing 10 protrudes outwards at a position close to the tuberosity, and an inward concave channel 101 is formed inside the small tuberosity wing 10, and a certain cavity is left between the inward concave channel 101 and the femur, so that blood vessels and surrounding tissues attached to the exterior of the femur can be accommodated through the cavity, and particularly, a carotid artery can be placed in the cavity;
the concave channel 101 can prevent the small tuberosity protective wings 10 from shearing and damaging the blood vessels and the surrounding tissues, ensure the smooth circulation of the body fluid inside and outside the wing-shaped cup body 6, avoid the necrosis of the tissue structure of the wing-shaped cup body 6 and reduce the occurrence probability of complications.
Preferably, one or more concave channels 101 may be provided, and more preferably, two concave channels 101 are provided.
In another preferred embodiment, the small trochanter wings 10 are provided with an arc-shaped notch at their medial edges and bulge outward to protect the femoral carotid artery, i.e., the carotid artery passes through the arc-shaped notch and is protected under the small trochanter wings 10; further preferably, two sides of the arc-shaped notch formed on the small tuberosity protecting wing 10 are bent towards the direction of the artificial ball head and connected with each other at the position far away from the carotid artery, so that the tightening mark of stress concentration between the small tuberosity protecting wing 10 and the femur avoids the region with rich blood vessel concentration, the influence of the installation of the wing-shaped cup body 6 on the blood transport channel on the femur is reduced, and the postoperative recovery effect is improved.
In a preferred embodiment, a cylindrical main fixing table 5 is arranged inside the wing-shaped cup body 6, the main fixing table 5 is connected with the top surface of the inner side of the wing-shaped cup body 6, and the main fixing table is used for installing the artificial ball head 1 and the central locking nail 9 on the wing-shaped cup body 6 so as to realize replacement of the femoral head prosthesis.
Preferably, a through hole is formed in the main fixing table, so that the main fixing table can be screwed into the central locking nail from the top of the wing-shaped cup body 6, and a neck rod on the artificial ball head can be embedded and fixed in the wing-shaped cup body 6 conveniently.
The front end of the central locking nail 9 is threaded through the wing-shaped cup 6 and screwed into the proximal end of the femoral bone tissue, i.e. the position between the greater trochanter and the lesser trochanter.
Preferably, the main fixing table 5 penetrates out of the top of the wing-shaped cup body 6, namely the top of the main fixing table is exposed out of the wing-shaped cup body 6, the structural design can enhance the connection strength between the main fixing table 5 and the wing-shaped cup body 6, and the neck rod 4 and the wing-shaped cup body 6 can be conveniently connected and fixed, so that the alignment and installation are convenient;
the rear end of the wing-shaped cup body 6 extends outwards to form a tail wing 61, a cylindrical auxiliary fixing table 62 is arranged below the tail wing, a through hole is formed in the auxiliary fixing table, penetrates out of the top of the tail wing, so that the wing-shaped cup body 6 can be screwed into the tail nail 8 from the top of the tail wing, and the tail nail is used for assisting in fixing.
The front end of the tail pin 8 is threaded through the wing cup 6 and into the proximal end of the femoral bone tissue, between the greater trochanter and the lesser trochanter, more preferably near the greater trochanter.
The hip joint is an important buffering joint in human body joints, needs to have certain buffering capacity, the existing prosthesis with a handle rarely considers the buffering effect, some cushioning devices have been incorporated into stemless prostheses, such as the composite cushioned stemless hip joint, known as 200520027479.4, by providing cushioning springs to cushion the impact force, however, in the actual use process, the scheme has certain defects and needs to be further improved, the shock absorption function of the hip joint of the human body is mainly derived from the cartilage near the femoral head, in the scheme, the buffering shock-absorbing spring is arranged at a position close to the femoral prosthesis and is different from the functional position on a human body, so that the combination position of the femoral prosthesis and the femur is directly acted by the buffering shock-absorbing spring, more acting force is borne, the motion load of the human body is difficult to reduce, stress concentration is caused, and the stability of the femoral prosthesis in the scheme is poor; in addition, the scheme needs to install the buffer shock-absorbing spring and the corresponding limiting pin on site, the operation difficulty is high, and more time is spent by a doctor for the operation, so that the operation time is prolonged.
In a preferred embodiment, the artificial ball head 1 is designed according to the external dimension of the femoral head of a human body, the upper structure is spherical, a through hole is formed in the bottom of the artificial ball head, so that one end of a neck rod is inserted into the artificial ball head, and the other end of the neck rod is inserted into a main fixing table of the wing-shaped cup body 6;
the artificial ball head can be an artificial ball head with a buffering function or a non-buffering artificial ball head;
because this artifical bulb and wing cup's specific installation is gone on at the in-process of replacement operation, artifical bulb and wing cup will all implant the human body completely after the installation moreover, do not have the chance of secondary adjustment, so to the reliability of connecting between the two, life, tensile, compressive strength and the quick convenient degree of connection installation after the connection all have very high requirement.
In addition, in the existing stem-free hip joint prosthesis with the shock absorption function, the shock absorption structure is arranged inside the wing-shaped cup body structure, so that a series of problems are caused;
for this purpose, in a preferred embodiment of the present application, a buffer device 2 is arranged inside the artificial ball head 1, one end of the buffer device 2 abuts against the inner wall of the artificial ball head 1, and the other end abuts against the neck 4; neck 4 is fixed on wing cup 6, can have the relative movement of certain degree between artifical bulb 1 and the neck 4, and when artifical bulb 1 received pressure, artifical bulb 1 had the trend of downstream to oppression buffering 1 device 2, along with artifical bulb 1 downstream, buffering device 2 warp gradually, and elasticity crescent on it finally again by buffering device 2 rebounds artifical bulb 1 original position.
Further preferably, as shown in fig. 5 and 6, a neck hole 11 for the neck 4 to extend into is formed in the artificial ball head 1, a buffer device accommodating cavity 12 is communicated above the neck hole 11, the neck 4 can move back and forth in the neck hole 11, and when the neck 4 extends to the deepest part of the neck hole 11, the neck hole 11 can be filled with the buffer device accommodating cavity; the aperture of the buffer device accommodating cavity 12 is smaller than that of the neck 4, so that the neck 4 cannot extend into the buffer device accommodating cavity 12, and one-direction limit is provided for the neck 4; fig. 5 shows a schematic illustration of the neck 4 when it is fully inserted into the neck opening 11, and fig. 6 shows a schematic illustration of the neck 4 when it is ejected by the damping means 2 to the maximum travel; the profile of the interior of the artificial ball head 1 is shown by dashed lines, and the profile of the exterior of the artificial ball head 1 and the neck 4 is shown by solid lines.
Preferably, the cross-sectional dimension of the top shaft of the neck 4 is equal to or slightly less than the cross-sectional dimension of the neck hole 11, thereby facilitating relative movement between the neck 4 and the artificial ball head 1.
Preferably, a limiting groove 13 is formed on the side wall of the accommodating cavity 12, correspondingly, a limiting protrusion 41 which extends towards the side is arranged on the neck 4, the limiting protrusion 41 is embedded into the limiting groove 13, the limiting protrusion 41 moves along with the neck 4 in the limiting groove 13, and the movement of the neck 4 is limited in another direction through the matching between the limiting protrusion 41 and the limiting groove 13, so that the neck 4 and the artificial ball head 1 are prevented from being separated from each other.
In the in-service use process, this artifical bulb 1 not only need with the neck pole between firm be connected, can not break away from, still must ensure to realize quick installation between artifical head 1 and the neck pole 4, reduce the installation degree of difficulty, practice thrift installation time.
Preferably, as shown in fig. 7, a transversely disposed limiting chamber 42 is formed on the neck 4, the limiting protrusion 41 is in the shape of a long rod, most of the structure of the limiting protrusion is located in the limiting chamber 42, and a compression spring 43 is disposed at the bottom of the limiting chamber 42, when the neck 4 needs to be inserted into the artificial ball head 1, the limiting protrusion 41 is pressed inward, so that the whole body of the limiting protrusion is embedded into the limiting chamber 42, and the compression spring 43 inside the limiting protrusion is pressed, when the limiting protrusion 41 is close to the limiting groove 13, the compression spring 43 pushes the end of the limiting protrusion 41 out of the limiting chamber 42, so that the limiting protrusion 41 enters the limiting groove 13, and the connection and installation between the neck 4 and the artificial ball head are completed.
The buffer element 2 may be a spring or a leaf spring made of a biocompatible material or other elastic mechanisms, which are not particularly limited in this application.
The existing stem-free prosthesis has no long pin inserted into the medullary cavity in order to not damage the medullary cavity, and the fixing mode of the stem-free prosthesis is not firm enough relative to that of the stem-containing prosthesis, in addition, whether a self-locking screw is installed on the stem-free prosthesis or not, the stress on the prosthesis is not balanced enough, under the long-time action, the damage and deformation of the femur are still difficult to avoid, along with the gradual extension of the service life, the movable gap between the stem-free prosthesis and the femur is larger and larger, the use effect is gradually influenced, and even other complications can be caused.
In a preferred embodiment, as shown in fig. 4, the through hole of the main fixing table 5 comprises a cervical vertebra hole section 51 and a nail taper hole section 52, wherein both the cervical vertebra hole section 51 and the nail taper hole section 52 are of a taper hole type which gradually narrows from top to bottom;
the cervical vertebra hole section 51 is used for inserting the neck rod 4 and fixedly connecting with the neck rod 4, preferably, the lower end of the neck rod 4 is in a frustum shape and is consistent with the inner diameter of the cervical vertebra hole section 51, the neck rod 4 is in interference fit with the cervical vertebra hole section 51, and the neck rod 4 can be fixedly connected with the cervical vertebra hole section 51 after being completely inserted into the cervical vertebra hole section 51;
the nail taper hole section 52 is used for the central locking nail 9 to pass through and is fixedly connected with the tail part of the central locking nail 9, preferably, the tail part of the central locking nail 9 is frustum-shaped and is consistent with the inner diameter size of the nail taper hole section 52, the tail part of the central locking nail 9 is in interference fit with the nail taper hole section 52, when the main body of the central locking nail 9 passes through the nail taper hole section 52, and the tail part of the central locking nail 9 is embedded into the nail taper hole section 52, the fixed connection between the central locking nail 9 and the nail taper hole section 52 can be completed;
the radial dimension of the contact position of the cervical vertebra hole section 51 and the nail taper hole section 52 is suddenly changed, namely, the largest cross-sectional dimension of the nail taper hole section 52 positioned below is smaller than the smallest cross-sectional dimension of the cervical vertebra hole section 51 positioned above, so that the neck rod 4 can not be embedded into the nail taper hole section 52, and the neck rod 4 and the central locking nail 9 are prevented from interfering with each other.
In a preferred embodiment, the taper of the cervical spine hole section 51 is 1:17 to 1:25, preferably 1: 22; the inventor finds that when the taper of the cervical spine hole section 51 is 1:22, the cervical spine hole section can be tightly fixed with the lower end of the neck 4, and the installation difficulty can be reduced, so that the lower end of the neck 4 can be conveniently inserted into the cervical spine hole section 51.
In a preferred embodiment, the taper of the nail taper hole section 52 is 1:13 to 1:20, preferably 1: 15; the inventor finds that when the taper of the nail taper hole section 52 is 1:15, the nail taper hole section can be tightly fixed with the tail part of the central locking nail 9, the installation difficulty can be reduced, the main body of the central locking nail 9 can smoothly penetrate through the nail taper hole section 52, and the nail taper hole section 52 can be fixedly connected with the tail part of the central locking nail 9.
In a preferred embodiment, as shown in fig. 4, a through hole is opened inside the cylindrical auxiliary fixing table 62, the through hole is a tapered hole 63, the tail nail 8 passes through the tapered hole 63, the tail part of the tail nail 8 is in a circular truncated cone shape and just can be inserted into the tapered hole 63, after the tail nail is screwed into the femur, the tail part of the tail nail abuts against the tapered hole 63, and the tail nail is in sufficient contact with the auxiliary fixing table 62, so as to ensure a stable connection between the tail nail and the auxiliary fixing table. The depth of the auxiliary fixing table 62 is about two thirds of the thickness of the greater tuberosity, so that the connection strength between the auxiliary fixing table 62 and the tail nail 8 can be fully ensured, and the auxiliary fixing table 62 can be ensured not to excessively damage the greater tuberosity.
Preferably, the front ends of the central locking nail 9 and the tail nail 8 are provided with threads so as to be firmly fixed with the femoral bone tissue and to enter the femoral bone tissue in a screwing manner so as to form fixation.
In a preferred embodiment, the wall surface of the wing-shaped cup body 6 is further provided with a through hole, and the femoral neck inside the wing-shaped cup body 6 can be exposed through the through hole, so that the nourishing blood vessel on the femoral neck is prevented from being damaged, and the normal physiological function can be maintained without being affected by the shear stress.
Some current no handle hip joint prostheses have also seted up through-hole structure, aim at reducing the destruction to the nourish blood vessel, but often the effect is not ideal enough, and the reason lies in that everybody's physiological structure is all inequality, and the concrete position of tissue such as everybody's nourish blood vessel is all inconsistent, so even set up the through-hole, its effect is also not ideal enough.
For this reason, in this application, preferably, set up in the position that the vasa vasorum is concentrated relatively the structure of greatly windowing, namely the front end opening of wing cup 6, this open area can expose the inside femoral bone tissue of wing cup 6, wherein, including the soft tissue that has biological activity around the internal carotid artery in the femoral bone tissue that exposes, can high confession postoperative recovery situation, reduce the disease preferably, when installing wing cup 6, can suitably cut off some edge profile, enlarge the open area of greatly windowing to make the marginal wall of wing cup 6 avoid the vasa vasorum, avoid crushing and destroy the vasa vasorum, further protect native vasa vasorum, improve postoperative recovery effect.
The existing stem-free prosthesis cancels a pin inserted into a marrow cavity, so that the existing stem-free prosthesis is not limited by the age of 45 years, can be applied to patients with smaller ages, but has limited service life, even if the existing stem-free prosthesis can be applied for 30 to 40 years, for young patients, the problems of the end of the service life of the prosthesis, difficulty in replacement and great risk are faced after decades, and the existing stem-free prosthesis and the stem-containing prosthesis do not consider the problem, so the difficulty of the replacement operation after the prosthesis is extremely high, and the postoperative recovery effect is inevitably not ideal.
In a preferred embodiment, the wing-shaped cup 6 has a larger inner dimension and an irregular contour, so that the wing-shaped cup 6 has less damage to the femoral bone tissue when being installed and less damage to the trophoblast after the operation, and after the service life of the hip joint prosthesis is over, the hip joint prosthesis with a stem can be still further installed after being taken out.
In the description of the present invention, it should be noted that the terms "upper", "lower", "inner", "outer", "front", "rear", and the like indicate the position or positional relationship based on the operation state of the present invention, and are only for convenience of description and simplification of description, but do not indicate or imply that the device or element referred to must have a specific position, be constructed and operated in a specific orientation, and thus, should not be construed as limiting the present invention.
The present invention has been described above in connection with preferred embodiments, which are merely exemplary and illustrative. On this basis, can be right the utility model discloses carry out multiple replacement and improvement, these all fall into the utility model discloses a protection scope.