CZ300291B6 - Cástecná nebo úplná náhrada dlouhé kosti - Google Patents

Cástecná nebo úplná náhrada dlouhé kosti Download PDF

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Publication number
CZ300291B6
CZ300291B6 CZ20031654A CZ20031654A CZ300291B6 CZ 300291 B6 CZ300291 B6 CZ 300291B6 CZ 20031654 A CZ20031654 A CZ 20031654A CZ 20031654 A CZ20031654 A CZ 20031654A CZ 300291 B6 CZ300291 B6 CZ 300291B6
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CZ
Czechia
Prior art keywords
bone
replacement
collar
proximal
shank
Prior art date
Application number
CZ20031654A
Other languages
English (en)
Other versions
CZ20031654A3 (cs
Inventor
Meswania@Jay
Original Assignee
Stanmore Implants Worldwide Ltd.
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Stanmore Implants Worldwide Ltd. filed Critical Stanmore Implants Worldwide Ltd.
Publication of CZ20031654A3 publication Critical patent/CZ20031654A3/cs
Publication of CZ300291B6 publication Critical patent/CZ300291B6/cs

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30739—Devices connected to the proximal part of an endoprosthetic femoral shaft for reinforcing or replacing the trochanters, e.g. the greater trochanter
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/3607—Femoral heads ; Femoral endoprostheses including proximal or total replacement of the femur
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2/367—Proximal or metaphyseal parts of shafts
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3662—Femoral shafts
    • A61F2/3672—Intermediate parts of shafts
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30317—The prosthesis having different structural features at different locations within the same prosthesis
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    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
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Abstract

Cástecná nebo úplná náhrada dlouhé kosti u cloveka nebo jiných živocichu je tvorena proximální nebo distální koncovou cástí (1, 2), tvorící složku kloubu, jehož cást má být nahrazena telem (5), spojeným s distální nebo proximální koncovou cástí (1, 2) pro spojení se zbytkem kosti. Telo (5) a distální nebo proximální koncová cást (1, 2) jsou spojeny pomocí vnejšího kuželu (33, 42) a vnitrního kuželu (4, 7), pricemž jeden z techto kuželu je opatren výbežkem (32, 43), probíhajícím v podélném smeru náhrady, avšak mimo jeho podélnou osu a zasahující do odpovídajícího vyhloubení (31), výbežek (32, 43) mimoto udržuje prilehlé složky v požadovaném úhlovém vztahu. Na vnejším kuželu (33, 42), spojujícím stopku (8) s telem (5) je proveden výbežek (32, 43) a náhrada je dále opatrena prícne probíhajícím otvorem (36) pro umožnení prístupu nástroje pro oddelení cástí náhrady do koncové oblasti vnejšího kuželu (33, 42).

Description

Částečná nebo úplná náhrada dlouhé kosti
Oblast techniky
Vynález se týká úplných nebo částečných náhrad dlouhých kostí v lidském nebo živočišném organismu.
111 Do sa v adní stav techniky
V případě, že dojde k vážnému poškození končetin nebo k tomu. ze je nutno odstranit chirurgicky velkou část kosti, například v případě zhoubných kostních nádoru, je zapotřebí nahradit velkou část přirozené kosti. V těchto případech musí chirurg splnit celou řadu podmínek. K usnad15 nění takových zákroků si vynález klade za úkol navrhnout modulární systém, který tyto podmínky splňuje. Jedním z. typických požadavků je například náhrada proximální nebo distálni části stehenní kosti, popřípadě náhrada celé této kosti.
Podstata vynálezu
Podstatu vynálezu tvoří částečná nebo úplná náhrada dlouhé kosti u člověka nebo jiných živočichu, která je tvořena proximální nebo distálni koncovou částí, tvořící složku kloubu, jehož část má být nahrazena tělem, spojeným s distálni něho proximální koncovou částí a stopkou pro spo25 jení se zbytkem kosti, přičemž tělo. stopka a distálni nebo proximální koncová část jsou spojeny pomocí vnějšího kuželu a vnitřního kuželu, jeden z. těchto kuželů je opatřen výběžkem, probíhajícím v podélném směru náhrady, avšak mimo jeho podélnou osu a zasahujícím do odpovídajícího vyhloubení, mimoto výběžek udržuje přilehlé složky v požadovaném úhlovém vztahu a dále je stopka vnějším a vnitřním kuželem spojena s tělem, přičemž na vnějším kuželu je proveden výběžek a náhrada jc dále opatřena příčně probíhajícím otvorem pro umožnění přístupu nástroje pro oddělení částí náhrady do koncové oblasti vnějšího kuželu.
Náhrada podle vynálezu také obsahuje límec, který může být spojen s tělem nebo jeho prodloužením a který má takové rozměry, aby se mohl opřít o zbytek kosti, do níž má být náhrada zasa55 zena, límec je opatřen částí, která je povrchově zpracována tak, aby kost mohla snadno prorůstal strukturovaným povrchem tohoto límce.
V případě, že má jít o náhradu proximálního konce stehenní kosti, obsahuje lato náhrada s výhodou trochanterovou část, spojenou s tělem náhrady a s jej i stopkou, přičemž trochanterová část má tvar, který přibližně odpovídá anatomickému trochanteru včetně krčku stehenní kosti, na němž je uložena kulovitá část stehenní kosti a včetně plochy na druhé straně krčku pro spojení se zbytkem kosti nebo s měkkými tkáněmi.
Praktické provedení vynálezu bude osvětleno v souvislosti s přiloženými výkresy.
Přehled obrázků na výkresech
Na obr. I jc znázorněn pohled ze strany na sestavené části náhrady proximální části stehenní ?o kosti.
Na obr. 2 je znázorněn pohled ze strany na náhradu distálni části stehenní kosti.
Na obr. 3 jsou znázorněny různé pohledy na trochanterovou část náhrady podle vy nálezu.
Na obr. 4 jsou znázorněny různé pohledy na modulární systém těla náhrady podle vynálezu.
Na obr. 5 jsou znázorněny různé pohledy na stopku pro použití náhrady podle vynálezu.
Na obr. 6 jsou znázorněny různé pohledy na límec pro použití v náhradě podle vynálezu.
Na obr. 7 je znázorněno několik pohledů na modulární prodloužení těla náhrady podle vynálezu.
Příklady provedeni vynálezu
Na obr. I je schematicky znázorněna sestavená náhrada pro proximální část stehenní kosti, l ato náhrada je tvořena trochanterovou částí 1 s krčkem 2, který jc zkosen pro nasazení kulovité hlavice kloubu běžným způsobem, 1 rochanterová část | je podrobněji znázorněna v různých pohledech na obr. 3. Je možno pozorovat, že přibližně odpovídá anatomickému tvaru této části kosti a je opatřena plochou 3 pro spojeni se zbytkem kosti nebo s měkkými tkáněmi. Trochanterová část 1 má vnitřní kužel, jak je zřejmé z obr. 3 a je spojená s odpovídajícím kuželem těla 5. Podrobná konstrukce těla 5 je zřejmá z obr. 4, kde je zřejmé, že tělo 5 je opatřeno vnějším kuželem 33 na jednom konci pro spojení s kuželem trochanterové části i a na svém druhém konci je opatřeno vnitřním kuželem 7 pro spojení s jedním koncem stopky 8. která je podrobněji znázorněna na obr. 5.
Stopka 8 je upevněna do zbytku stehenní kosti 9 vtlačením nebo použitím kostního cementu. Distální konec těla 5 je obklopen límcem JO. který je podrobněji znázorněn na obr. 6. Límec JO má distální dolní konec IJ, který sc opírá o zbytek odstraněné kosti, který je tvořen v tomto případě zbytkem stehenní kosti 9. Rozměry límce IQ se voli tak, aby koncová plocha límce JO končila v souladu se zevním okrajem kosti 9. Límec JJ je na své zevní ploše opatřen výstupky nebo materiálem, podporujícím růst kosti, například hydroxyapatilcm. Tímto způsobem je podporován růst kosti přes povrch límce JO. čímž dochází k dokonalejšímu upevnění náhrady v kosti
9.
V případě odstranění poškozené kosti nebo kostního nádoru je často možné zachovat zbytek J_2 troehanteru. Tento zbytek 12 může obsahovat vazy nebo jinou měkkou tkáň. která může napomoci k upevnění trochanterové části i. Zbytek J_2 může být k trochanterové části i upevněn pomocí destičky l_3, která se spojí s plochou 3 trochanterové části i.
Na obr. 2 je znázorněn pohled na sestavenou náhradu distální části femuru, která obsahuje kondylární hlavovou část 21, tvořící horní část kolenního kloubu. Tato hlavová část 2_L je spojená s teleni 5 analogickým způsobem, jakým je s tělem 5 na obr. 1 spojena troclianterová část 1. Obdobným způsobem je spojeno tělo 5 se stopkou 8 a límcem JO. který zakrývá zkosenou dolní část těla 5, tak jak bylo svrchu popsáno v souvislosti s obr. I. Dolní zkosený konec 1 I těla 5 se opírá o zbývající plochu stehenní kosti 9. Obdobným způsobem je také upravena vnější plocha límce 10 pro podporu prorůstání nové kosti.
Podrobnosti trochanterové části 1 jsou zřejmé z obr. 3. Plocha 3 trochanterové části 1 je opatřena hroty 30. Tyto hroty 30 zajišťují pevné spojení se zbytkem J_2 kosti, jak je znázorněno také na obr. 1 a slouží k dokonalejšímu upevnění náhrady. Troclianterová část 1 je opatřena vnitřním kuželem s vyhloubením 3L Vyhloubení 3_[ odpovídá svým tvarem výběžku 32 na vnějším kuželu 33 těla 5, jak je také zřejmé z obr. 4. Troclianterová část 1 je rovněž opatřena příčným otvorem 34. do nějž je možno zasunout nástroj pro oddělení jednotlivých částic náhrady v případě potřeby. Jak je zřejmé z obr.4, je télo 5 rovněž opatřeno vnitřním kuželem 7 s vyhloubením 35, obdobným vyhloubení 31 v trochanterové části L J aké tělo 5 je opatřeno příčným otvorem 36, do ně jž je možno zasunout nástro j pro oddělení těla 5 a stopky 8 od sebe.
Jak je zřejmé z obr. 3, je troclianterová část 1 také opatřena příčnými otvor)· 36. l yto otvory jsou určeny pro přišití trochanterové části k měkkým tkáním, například ke šlachám v případě, že není k dispozici zbývající kost, která by mohla být upevněna k ploše 3.
CZ 300291 Bó
Trochanterová část i tvoří standardní složku modulárního systému, i když je nutno ji provést v pravém a levém provedeni. V některých případech je zapotřebí trochanterovou složku 1 upravit zejména v oblasti krčku pro potřeby jednotlivých nemocných.
Jak je znázorněno na obr. 4, je tělo 5 dodáváno v různých délkách v intervalech 15 mm, přestože jc jinak standardizováno, pokud jde o jeho kuželovité části. Mimoto je tělo 5 opatřeno zářezy 37. do nichž zapadají odpovídající výstupky 38, provedené integrálně s límcem J_0. Jak je znázorněno na obr. 6, límec Π) jc opatřen vnitřním zkosením 39, které odpovídá zkosení 40 na jednom konci těla 5. Spojení límce J_0 s tělem 5 a také výstupku 38 se zářezy 37 zajištuje upevuční límce l_0 bezpečně na těle 5. Jak je zřejmé z obr. 6, je límec 10 dodáván v řadě průměru Dl a D2.
Na obr. 5 jsou znázorněny různé pohledy na stopku 8. Jak je zřejmé z příčného řezu, je stopka vytvořena prostředky pro spojení s kostí, zejména s kostním kanálem a může být zcela přímá nebo zakřivená podle zakřivení tohoto kanálu. Proximální konec stopky 8 má vnější kužel 42. který·' odpovídá vnitřnímu kuželu 7 těla 5. Stopka 8 je rovněž opatřena výběžkem 43, který· odpovídá vyhloubení 35 v těle 5. Tělo 5 je opatřeno příčným otvorem 36 pro zavedení nástroje pro oddělení těla 5 od stopky 8. Jak je zřejmé z obr. 5, může být stopka 8 dodávána v celé řadě průměrů a délek a může být přímá nebo zakřivená tak, aby vyhovovala různým chirurgickým požadavkům při upevňování náhrady do kosti.
Na obr. 7 je znázorněno modulární prodloužení těla 5. které umožňuje prodloužit celou náhradu, znázorněnou na obr. I a 2. Toto modulární prodloužení 50 je opatřeno vnitřním kuželem 52 a vnějším kuželem 5J na svých opačných koncích, l íni odpovídá prodloužení 50 svým tvarem vnitřnímu kuželu 7 těla 5 a vnějšímu kuželu 42 stopky 8. Modulární prodloužení 50 může být použito s běžným tělem 5 nebo samostatně ke spojení trochanterové části 1 nebo hlavové části 2_1 sc stopkou 8.
I když takové provedení není podrobně znázorněno, že možno použít náhradu z obr. 1 a 2 tak, že je možno vynechal stopku 8 a límec LO. Mimoto je možno analogickým způsobem vytvořené části použít k náhradě jiné dlouhé kosti, například kosti pažní.
Jak bylo popsáno svrchu, je možno částí náhrady od sebe snadno oddělit pomocí nástroje, zavedeného do příčných otvorů 34, 36, například při revizi operačního pole.
Výhodným materiálem pro výrobu náhrady podle vynálezu je slitina titanu až na hlavu stehenní kosti, kde se s výhodou užije slitin kobaltu a chrómu nebo keramických materiálů.

Claims (6)

  1. 4 1, Částečná nebo úplná náhrada dlouhé kosti u člověka nebo jiných živočichů, která je tvořena proximální nebo distáíni koncovou částí (1,2). tvořící složku kloubu, jehož část má být nahrazena tělem (5). spojeným s distální nebo proximální koncovou částí (I, 2) a stopkou (8) pro spojení se zbytkem kosti, přičemž tělo (5) a distální nebo proximální koncová ěást (1, 2) jsou spojeny pomocí vnějšího kuželu (33, 42) a vnitřního kuželu (4, 7), jeden z těchto kuželů je opatřen to výběžkem (32, 43), probíhajícím v podélném směru náhrady, avšak mimo jeho podélnou osu a zasahující do odpovídajícího vyhloubení (31). výběžek (32, 43) mimoto udržuje přilehlé složky v požadovaném úhlovém vztahu, vyznačující se tím, žc na vnějším kuželu (33, 42), spojujícím stopku (8) s tělem (5) je proveden výběžek (32, 43) a náhrada je dále opatřena příčně probíhajícím otvorem (36) pro umožnění přístupu nástroje pro oddělení částí náhrady do koncoí.4 vé oblasti vnějšího kuželu (33. 42).
  2. 2. Náhrada podle nároku I, vyznačující se tím, že obsahuje límec (10), spojeny s tělem (5) nebo jeho prodloužením (50). rozměry límce (10)jsou upraveny pro dosednutí límce(IO) na koncovou plochu kosti, k níž má být náhrada upevněna, límec (10) je opatřen částí,
    2o zkosenou směrem ke zbývající ploše kosti a jeho vnější povrch je upraven pro podporu růstu kosti přes zkosenou část límec (10).
  3. 3. Náhrada podle nároku 2, vyznačující sc tím, že límec {10) je vytvořen se zevní plochou, opatřenou výstupky neboje opatřen povlakem hydroxyapatitu nebo jiného materiálu.
    2? podporujícího růst kosti.
  4. 4. Náhrada podle některého z nároků I až. 3. vyznačující se tím. žc jde o náhradu proximální částí stehenní kosti, náhrada obsahuje ěást pro náhradu Irochantcru, spojenou s tělem (5) nebo stopkou (8).
  5. 5. Náhrada podle nároku 4. vyznačující s c tím. že část pro náhradu trochanteru svým tvarem přibližně odpovídá anatomickému trochanteru a zahrnuje krcek (2) pro hlavici stehenní kosti a na opačné straně obecně plochý povrch (13) pro spojení se zbytkem kosti nebo měkkých tkání.
  6. 6. Náhrada podle nároku 5, vyznačující se tím. zc obecně plochý povrch (13)jc opatřen hroty (30) pro spojení sc zbytkem kosti.
CZ20031654A 2000-12-15 2001-12-07 Cástecná nebo úplná náhrada dlouhé kosti CZ300291B6 (cs)

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