EP3624735A1 - Method for producing a trapeziometacarpal prosthesis and resulting prosthesis - Google Patents

Method for producing a trapeziometacarpal prosthesis and resulting prosthesis

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Publication number
EP3624735A1
EP3624735A1 EP18723847.2A EP18723847A EP3624735A1 EP 3624735 A1 EP3624735 A1 EP 3624735A1 EP 18723847 A EP18723847 A EP 18723847A EP 3624735 A1 EP3624735 A1 EP 3624735A1
Authority
EP
European Patent Office
Prior art keywords
metacarpal
dimensional
prosthesis
trapezium
prosthetic
Prior art date
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.)
Withdrawn
Application number
EP18723847.2A
Other languages
German (de)
French (fr)
Inventor
Alain-Charles MASQUELET
Nassim JIHAZ
Salima BOUVIER
Frédéric MARIN
Christophe EGLES
Augustin LEREBOURS
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.)
Centre National de la Recherche Scientifique CNRS
Universite de Technologie de Compiegne
Assistance Publique Hopitaux de Paris APHP
Universite de Technologie de Compiegne UTC
Sorbonne Universite
Original Assignee
Centre National de la Recherche Scientifique CNRS
Universite de Technologie de Compiegne
Assistance Publique Hopitaux de Paris APHP
Universite de Technologie de Compiegne UTC
Sorbonne Universite
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 Centre National de la Recherche Scientifique CNRS, Universite de Technologie de Compiegne, Assistance Publique Hopitaux de Paris APHP, Universite de Technologie de Compiegne UTC, Sorbonne Universite filed Critical Centre National de la Recherche Scientifique CNRS
Publication of EP3624735A1 publication Critical patent/EP3624735A1/en
Withdrawn legal-status Critical Current

Links

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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • 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
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
    • 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
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A61F2002/30948—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques using computerized tomography, i.e. CT scans
    • 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
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A61F2002/30952—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques using CAD-CAM techniques or NC-techniques
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • A61F2002/4256—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints
    • A61F2002/4258—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for carpo-metacarpal joints, i.e. CMC joints for trapezo-metacarpal joints of thumbs
    • 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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
    • A61F2/4261—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for wrists
    • A61F2002/4271—Carpal bones
    • A61F2002/4274—Distal carpal row, i.e. bones adjacent the metacarpal bones
    • A61F2002/4276—Trapezium

Definitions

  • the present invention relates to the production of a prosthesis intended to specifically replace the trapezio-metacarpal joint of a patient's hand in case of potential damage to it.
  • arthroplasty The operation of replacing a human joint with a mechanical system is arthroplasty. It is a therapeutic solution commonly practiced in the case of osteoarthritis, which is a destruction or degeneration of the articular surfaces.
  • osteoarthritis which is a destruction or degeneration of the articular surfaces.
  • 1 arthroplasty is practiced by replacing the articular surfaces damaged by metal elements, high density polyethylene, ceramic or a sensible pyrocarbon mimic the geometrical characteristics morpho ⁇ functional joint so treated.
  • Rhizarthrosis is osteoarthritis of the base of the thumb specifically affecting the trapezoid bone and the proximal end of the first metacarpal. If these joints undergo arthroplasty, there are currently high rates of failure or limited functional recovery (in the order of 8 to 21%) resulting in a loss of quality of life and replacement rates. at ten years of the order of 25% for some models of prostheses. These failure rates or limited functional recovery can be explained by the fact that the prostheses are not specific to the patient.
  • a method for producing a trapezio-metacarpal prosthesis comprising a prosthetic trapezium intended to replace the damaged bone of the patient, said method comprising the following steps:
  • said method is characterized in that it further comprises, between steps c) and d), the following sub-steps:
  • a step of reconstructing the articulation surface of a proximal end of the first metacarpal of the trapezometacarpal joint comprising:
  • the method according to the invention may further comprise, after step d), a step arranging the prosthesis in the patient such that the receiving means comprises a through hole arranged to receive an anchor screw.
  • the three-dimensional impression of the trapezium and the pin can be made from powders of biocompatible materials.
  • the present invention also relates to a trapezio-metacarpal prosthesis comprising a prosthetic trapezium a metacarpal pin, characterized in that it is capable of being performed according to the method according to the invention.
  • the metacarpal peg may comprise two parts comprising a base and a head having the articulation surface with the prosthetic trapezium.
  • the prosthesis may comprise as anchoring means an anchor screw and a series of pins, forming the anchoring means received in the receiving means of the prosthetic trapezium.
  • a prosthetic trapezium comprising geometric parameters of the patient's bone makes it possible to integrate the anatomical and functional constraints of the patient and to obtain a trapezo-metacarpal prosthesis which is the most optimal for the latter.
  • the prosthesis thus obtained offers the recipient patient an effective treatment of rhizarthrosis.
  • FIG. 1 shows a top view of a skeleton of a hand with a trapezometacarpal prosthesis according to the invention
  • FIG. 2 shows a detailed side view of the prosthesis shown in FIG. 1;
  • Fig. 3 shows a three-dimensional view of the implantation of a prosthesis of Fig. 1 in the skeleton of the hand showing only the first metacarpal and trapezoidal bone;
  • FIG. 4 shows a diagram illustrating the steps of the method for producing the prosthesis of FIG. 1 according to the invention
  • FIG. 5 shows a three-dimensional profile view of a prosthetic trapezium of the prosthesis resulting from the process according to the invention (the steps of which are shown schematically in FIG. 4);
  • Figure 6 shows a sectional view of the prosthetic trapezium of Figure 5;
  • Figure 7 shows a three-dimensional view of a head of a metacarpal pin of the prosthesis of Figure 1 obtained by the method according to the invention, the steps of which are shown in Figure 4;
  • Figure 8 shows a three-dimensional view in section of the base of the metacarpal pion;
  • Figure 9 shows a three-dimensional view of a metacarpal pin in which its head is inserted into the base of Figure 8;
  • Figure 10 shows a three-dimensional view of an anchor screw for anchoring the prosthesis of Figure 1 in the trapezoid bone
  • Figure 11 shows a three-dimensional partial view of the surface of the prosthetic trapezium of Figure 5 carrying a series of pins and coming to the trapezoid bone;
  • Figures 12. a) to 12. e) show steps a) and b) of the method according to the invention, from a series of medical images (Figure 12. b) acquired trapezoid bone and the metacarpal bone ( Figure 12. a)), the bones are segmented numerically (( Figure 12b), digitally reconstructed in 3D ( Figure 12d) and then meshed in 3D ( Figure 12.e)).
  • the mesh models serve as a basis from which a three-dimensional digital model is produced;
  • Figure 13 compares the digital volume file from the CAD (in purple in Figure 12.e and Figure 13) and the STL file (in white);
  • FIGS. 14 a) to 14 c) show step c) of the method according to the invention, from the receiving and anchoring means (FIG. 14 a) positioned by CAD on the three-dimensional numerical model of the trapezium ( Figure 14.b) performed in the previous step to obtain a three-dimensional model adequate for the implementation of the prosthesis whose steps are described in Figure 4;
  • Figures 15. a) to 15. c) show the final achievement of the prosthetic trapezius (Figure 15. a), the base of the metacarpal pion ( Figure 15. b) and the head of the metacarpal pion ( Figure 15. c ) by the step d) of three-dimensional printing;
  • Figures 16. a) to 16. c) show the remodeling of the articular surface at the metacarpus of a trapezium (Figure 16.b and 16.c) from an anthropomorphic model of the healthy trapezius bone ( Figure 16). a) according to step 150 of the process according to the invention; Figures 17. a) and 17. b) show the extraction of the metacarpal articular surface from an anthropomorphic model used in 1 x 150 step of the method according to the invention;
  • Figure 18 is the result of a numerical simulation representing a metacarpal counter reconstructed from anatomical data from medical imaging.
  • CAA Three-Dimensional Assisted Design Software
  • SLM Selective Laser Melting
  • powders of biocompatible material for example powders of titanium alloys, such as Ti40 or TA6V, or;
  • FIGS. 1 to 3 show a trapezometacarpal prosthesis 1 according to the invention.
  • This trapezometacarpal prosthesis here comprises a prosthetic trapezium 1, a metacarpal piece 7 and an anchoring screw 3. It is intended to be placed between the first metacarpal 4 and the trapezoidal bone 2 of a patient.
  • Figures 5 and 6 show in particular the prosthetic trapezium 1. It has a first surface 11 which is substantially complementary to the articulating surface of the metacarpal pin 7 of the trapezio-metacarpal prosthesis according to the invention.
  • the prosthetic trapezium 1 also includes a second surface 12 which is complementary to a surface of the trapezoidal bone of the patient's hand. This second surface 12 is intended to allow the anchoring thereof on the trapezoidal bone by means of an anchor screw ( Figure 5).
  • the prosthetic trapezium 1 comprises receiving means 10 and anchoring means.
  • the receiving means 10 are a through hole extending from the medial surface 17 of the prosthetic trapezium 1 to the second surface 12 ( Figure 6).
  • the opening hole comprises, here, a countersink 13 of depth 16 located on the medial surface side 17 which continues with a cylindrical orifice 14 opening at the second surface 12 and of length 15.
  • the metacarpal peg 7 comprises two parts, here referred to one another: a base 5 and a head 6.
  • the base 5 comprises a plate 56 having a planar upper face 52, a plane lower face 51 and a lateral peripheral face 54 substantially similar to the dimensions of the proximal end of the first metacarpal of the patient's hand to be treated (FIG. 8). .
  • the head 6 of the metacarpal peg has a hinge surface 62, extending above a flat lower face 61, the dimensions of the proximal end of the first metacarpal of the hand of the patient to be treated, and having characteristics non-osteoarthritic (Figure 7).
  • the head 6 further comprises a cone 60 forming means for fixing the head 6 to the base 5 of the metacarpal peg 7 (FIGS. 8 and 9).
  • This tail 50 is intended to be inserted into the medullary canal of the first metacarpal of the patient's hand whose orientation and dimensions are determined from morphological parameters.
  • the base 5 comprises a hole 53 intended, during an assembly of the metacarpal peg 7, to receive the cone 60 of the head 6.
  • FIG. 10 and 11 show the anchoring means which may be used in the invention which may be in the form of an anchoring screw 3 (Figure 10), preferably with a series of pins 121 ( Figure 11). ).
  • FIG. 10 shows in particular that the anchoring screw 3 consists of a bone thread 32, has a head 31 intended to be entirely received in the counterbore 13 of the prosthetic trapezium as illustrated in FIG. 10.
  • FIG. the second surface 12 of the prosthetic trapezium comprises anchoring means, which may be for example in the form of a series of pins 121 for securing and strengthening, during implantation, the anchoring of the prosthetic trapezium 1 on Trapezoid bone of the patient.
  • pins 121 extend projecting from the second surface 12 around the cylindrical orifice 14 of the receiving means 10.
  • the pins 121 are of generally pyramidal shape with a polygonal or curvilinear base.
  • the number of pins 121 and their size are functions of the dimensions of the prosthetic trapezium 1 made.
  • anchoring such as for example small screws, hooks or other forms of pins (square-based in particular), or for example anchoring means created by a Hanging surface texturing (like Velcro for example).
  • Trapezoid bone and bone of the first metacarpal are scanned by MRI or tomography (first step 110).
  • the technical characteristics of medical imaging and point cloud extraction are chosen so as to discretize the cortical part of the bones ( Figures 12a) and 12b)). This acquisition makes it possible to assist in the realization of the various components of the trapezio-metacarpal prosthesis according to the invention.
  • EXAMPLE 2 Three-Dimensional Reconstruction of the Trapezoidal Bone of the Trapezo-Metacarpal Joint into a Three-Dimensional Digital Model (Step 120 of the Process According to the Invention)
  • the method for producing a trapezio-metacarpal prosthesis 100 comprises a second step 120 of reconstructing the trapezoid bone into a three-dimensional digital model from the series of FIG. previously acquired medical images.
  • a digital volume file (adapted smoothing parameter) is then processed by a CAD software.
  • Figure 13 compares the digital volume file from CAD (in purple in Figure 12e and 13) and the STL file (in white)
  • EXAMPLE 3 Realization in the three-dimensional model thus obtained of receiving means 10 and anchoring means 3 (step 130 of the method according to the invention) The method of producing 100 a trapezometacarpal prosthesis according to the invention The invention provides the realization, in the three-dimensional model of the trapezoid bone, receiving means 10 and anchoring means 3,121.
  • the receiving means 10, 13 and 14 and anchoring means 3 and 121 are made by CAD (FIGS. 14 a)) and then extracted by Boolean operation (addition of material or extraction of material) on the voluminal trapezium model (FIGS. )).
  • FIG. 14 b) shows the positioning of the receiving and anchoring means on the volume model of the trapezium.
  • EXAMPLE 4 Realization of a first surface 11 complementary to the articulating surface 62 of the metacarpal pion by remodeling from an anthropomorphic model of the trapezoid bone derived from healthy trapezoidal images (step 150 of the method according to US Pat. invention)
  • the invention comprises, prior to the three-dimensional printing step 140, an embodiment step 150 in the three-dimensional model thus obtained of the first surface 11.
  • the articular surface between the trapezoidal bone and the metacarpal bone is remodeled from an anthropomorphic model of the trapezoidal bone derived from healthy trapezoidal images ( Figures 16b) and 16c)).
  • Remodeling is done by extracting the articular surface of an anthropomorphic model of the trapezoid bone from at least one healthy trapezius (Figure 17b).
  • the surface 11 shown in FIGS. 16 (b) and 16 (c) is then positioned in the digital model in place of the non-healthy articular surface (FIG. 16 (b)).
  • a digital volume file is then produced by filling and / or by Boolean operation (addition or withdrawal) under a CAD software (FIG. 16c).
  • a digital volume file is then produced by filling and / or by Boolean operation (addition / withdrawal) under a CAD software.
  • Step 150 of the method according to the invention makes it possible to adapt the first rough surface 11 (step 120) and to produce, in the three-dimensional numerical model thus obtained, a surface 11 remodeled and complementary to the hinge surface 62 of the pion metacarpal from an anthropomorphic model of trapezoid bone from images of healthy trapezius bone. And so it corrects the deformities due to rhizarthrosis itself.
  • the invention comprises, prior to the three-dimensional printing step 140, a reconstruction step 160 in a digital model of the articulation surface 62 of a proximal end. of the first metacarpal.
  • the metacarpal peg 7 is in two parts: a head 6 made of polymer and a base 5 made of metal.
  • head 6 and the base 5 are glued to each other, forming a one-piece assembly.
  • This is possible by using, for the three-dimensional printing of the metacarpal pin 7, a multi-nozzle print head, one of which is dedicated to the powder of metallic material and another of the nozzles to the polymer powder.
  • the head 6 and the base 5 are snapped into one another to form the metacarpal peg 7.
  • EXAMPLE 6 Three-dimensional printing of the prosthetic trapezium (1) from the three-dimensional model from the previous step (step 140 of the method according to the invention).
  • the method of producing a trapezometacarpal prosthesis 100 according to the invention comprises, following step 150 (Example 4), a three-dimensional printing step 140 of the prosthetic trapezium 1 from the three-dimensional model thus obtained.
  • FIG. 15a shows the realization by three-dimensional printing of the trapezoid from the three-dimensional model resulting from step 150 (see Example 4) by SLM technology if the trapezium is made of metal alloys and by SLA technology if the trapezium is made of polymeric resin transparent photosensitive.
  • This three-dimensional printing by SLM technology can be carried out using powders of alloys of titanium, such as Ti40 or TA6V, or stainless steel powders, such as 316LVM.
  • EXAMPLE 7 Use of the trapezio-metacarpal prosthesis according to the invention obtained in Example 6 and postoperative tests using such a prosthesis.
  • the trapezio-metacarpal prosthesis according to the invention is tested in vivo during an arthroplasty operation.
  • the choice of the prosthetic trapezium and the metacarpal counter is made according to the preferences of the surgeon who will perform the operation to have the best match with the joint during operation. Different metacarpal pawn morphologies are proposed (made according to steps 160 and 170) with different sizes. The metacarpal counter is chosen in line with the defined prosthetic trapezium.
  • he then performs a trapezectomy. Then, he performs a resection of the proximal end of the first metacarpal, followed by a preparation of the medullary canal of the latter; then, the surgeon sets up the base 5 of the metacarpal peg 7 by introducing the tail 50 into the prepared medullary canal;
  • the head 6 is then put in place by introducing the cone 60 of the head 6 into the blind hole 53 of the base 5;
  • the practitioner sets up the prosthetic trapezium 1 so that the second surface 12 comes into contact with the trapezoid bone; - It corrects the three-dimensional orientation of the prosthetic trapezium 1 so that the first surface 11 of the prosthetic trapezium comes opposite the articulation surface 62 of the metacarpal pin 7;
  • the thread 32 is then inserted into the trapezoid bone to perform the anchoring of the prosthetic trapezium 1 with the latter;
  • the prosthetic trapezium 1 comprises anchoring means 121, the latter penetrate largely into the trapezoidal bone during a tightening of the anchoring screw 3;
  • Figures 19 a to c show that the prosthesis according to the invention allows the complete recovery of the kinematic extent of the thumb.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Vascular Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Transplantation (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physics & Mathematics (AREA)
  • Geometry (AREA)
  • Manufacturing & Machinery (AREA)
  • Prostheses (AREA)

Abstract

The present invention is directed to a method (100) for producing a trapeziometacarpal prosthesis intended to replace a potentially damaged trapeziometacarpal joint, in particular using a prosthetic trapezium (1). The present invention also relates to a method for producing a metacarpal pin (7) intended to replace the articular surface of the first metacarpus linked to the trapezium bone.

Description

PROCÉDÉ DE RÉALISATION D ' UNE PROTHÈSE TRAPÉZO-MÉTACARPIENNE  METHOD OF MAKING A TRAPEZO-METACARPIAN PROSTHESIS
ET PROTHÈSE OBTENUE  AND PROSTHESIS OBTAINED
La présente invention concerne la réalisation d'une prothèse destinée à remplacer spécifiquement l'articulation trapézo-métacarpienne de la main d'un patient en cas de potentiel endommagement de celle-ci. The present invention relates to the production of a prosthesis intended to specifically replace the trapezio-metacarpal joint of a patient's hand in case of potential damage to it.
L'opération consistant à remplacer une articulation humaine par un système mécanique est 1 ' arthroplastie . C'est une solution thérapeutique pratiquée couramment dans le cas de l'arthrose, qui est une destruction ou une dégénérescence des surfaces articulaires. Actuellement 1 ' arthroplastie se pratique par remplacement des surfaces articulaires endommagées par des éléments métalliques, en polyéthylène haute densité, en céramique ou encore en pyrocarbone sensé mimer les caractéristiques géométriques morpho¬ fonctionnelles de l'articulation ainsi traitée. The operation of replacing a human joint with a mechanical system is arthroplasty. It is a therapeutic solution commonly practiced in the case of osteoarthritis, which is a destruction or degeneration of the articular surfaces. Currently 1 arthroplasty is practiced by replacing the articular surfaces damaged by metal elements, high density polyethylene, ceramic or a sensible pyrocarbon mimic the geometrical characteristics morpho ¬ functional joint so treated.
Au niveau de la main, les articulations interphalangiennes et métacarpo-phalangiennes sont sujettes à l'arthrose. La rhizarthrose est l'arthrose de la base du pouce touchant spécifiquement l'os trapèze et l'extrémité proximale du premier métacarpien. Si ces articulations subissent une arthroplastie, on observe à l'heure actuelle des taux d'échec ou de reprise fonctionnelle limitée élevés (de l'ordre de 8 à 21%) entraînant une perte de qualité de vie du patient et des taux de remplacement à dix ans de l'ordre de 25% pour certains modèles de prothèses. Ces taux d'échec ou de reprise fonctionnelle limitée peuvent notamment s'expliquer par le fait que les prothèses ne sont pas spécifiques au patient.  In the hand, the interphalangeal and metacarpophalangeal joints are prone to osteoarthritis. Rhizarthrosis is osteoarthritis of the base of the thumb specifically affecting the trapezoid bone and the proximal end of the first metacarpal. If these joints undergo arthroplasty, there are currently high rates of failure or limited functional recovery (in the order of 8 to 21%) resulting in a loss of quality of life and replacement rates. at ten years of the order of 25% for some models of prostheses. These failure rates or limited functional recovery can be explained by the fact that the prostheses are not specific to the patient.
Or, il a été montré que chaque patient avait des caractéristiques mécaniques articulaires qui lui étaient propres en termes de cinématique (amplitude de mouvement, axes instantanés de rotation, ...) et de dynamique (force de contact, répartition de la pression de contact, ...) du fait des spécificités musculo-squelettiques du patient par la géométrie des os, la localisation des insertions musculaires, et les composantes physiologiques. En conséquence, la personnalisation et l'identification de paramètres spécifiques du sujet ou du patient sont devenues pertinentes pour l'analyse et la conception de prothèse. Au niveau de la main, cette problématique est d'autant plus réelle qu'il y a des variations anatomiques très importantes. Ainsi, 1 ' arthroplastie de l'articulation trapézo- métacarpienne est contrainte par sa complexité morphologique, sa petitesse et la géométrie spécifique au patient . However, it has been shown that each patient has articular mechanical characteristics that are specific to him in terms of kinematics (range of motion, instantaneous axes of rotation, etc.) and dynamics (contact force, distribution of the contact pressure, etc.) due to the musculoskeletal specificities of the patient by the geometry of the bones, the location of the muscle insertions, and the physiological components. As a result, personalization and identification of specific subject or patient parameters have become relevant for prosthesis analysis and design. At the level of the hand, this problem is all the more real because there are very important anatomical variations. Thus, arthroplasty of the trapezometacarpal joint is constrained by its morphological complexity, its smallness and the patient-specific geometry.
II n'existe à ce jour aucune thérapie totalement efficiente de la rhizarthrose . Par ailleurs, la main est un organe qui présente une grande variation anatomique ce qui requiert d'adapter l'élaboration de chaque implant aux spécificités anatomiques du patient. Dans ce domaine, les techniques d'élaboration actuellement utilisées, ne permettent pas de satisfaire ces contraintes.  To date, there is no fully effective therapy for rhizarthrosis. Moreover, the hand is an organ that has a large anatomical variation which requires adapting the development of each implant to the anatomical specificities of the patient. In this field, the development techniques currently used, do not meet these constraints.
Afin de pallier les inconvénients précités, le demandeur a mis au point un procédé de réalisation d'une prothèse trapézo-métacarpienne comprenant un trapèze prothétique destiné à remplacer l'os détérioré du patient, ledit procédé comprenant les étapes suivantes :  In order to overcome the aforementioned drawbacks, the applicant has developed a method for producing a trapezio-metacarpal prosthesis comprising a prosthetic trapezium intended to replace the damaged bone of the patient, said method comprising the following steps:
a . Acquisition d'une série d'images médicales d'une articulation trapézo-métacarpienne d'un patient à traiter de manière à intégrer les contraintes anatomiques et fonctionnelles du patient ;  at . Acquisition of a series of medical images of a trapezo-metacarpal joint of a patient to be treated so as to integrate the anatomical and functional constraints of the patient;
b . Reconstruction tridimensionnelle de l'os trapèze de l'articulation trapézo-métacarpienne en un modèle tridimensionnel numérique à partir de la série d'images médicales précédemment acquises, par traitement d' images pour générer des fichiers numériques du modèle tridimensionnel dudit objet ; b. Three-dimensional reconstruction of the trapezoid bone of the trapezio-metacarpal joint into a three-dimensional numerical model from the series of previously acquired medical images, by image processing for generating digital files of the three - dimensional model of said object;
c . Réalisation dans le modèle tridimensionnel ainsi obtenu, de moyens de réception et d'un moyen d'ancrage; et  vs . Realization in the three-dimensional model thus obtained, receiving means and an anchoring means; and
d. Impression tridimensionnelle du trapèze prothétique à partir du modèle tridimensionnel issu de l'étape précédente.  d. Three-dimensional impression of the prosthetic trapezium from the three-dimensional model from the previous step.
ledit procédé est caractérisé en ce qu' il comprend en outre, entre les étapes c) et d) , les sous étapes suivantes :  said method is characterized in that it further comprises, between steps c) and d), the following sub-steps:
- une étape de réalisation dans le modèle numérique tridimensionnel ainsi obtenu, d'une première surface complémentaire à la surface d' articulation du pion métacarpien par remodelage à partir d'un modèle anthropomorphique de l'os trapèze issu d' images de trapèze sain ; a step of producing, in the three - dimensional numerical model thus obtained, a first surface complementary to the articulating surface of the metacarpal pion by remodeling from an anthropomorphic model of the trapezoid bone derived from images of healthy trapezius;
- une étape de reconstruction de la surface d'articulation d'une extrémité proximale du premier métacarpien de l'articulation trapézo- métacarpienne comprenant : a step of reconstructing the articulation surface of a proximal end of the first metacarpal of the trapezometacarpal joint, comprising:
o la réalisation d'un modèle tridimensionnel à partir de la série d' images médicales acquises à l'étape a) ;  o the realization of a three-dimensional model from the series of medical images acquired in step a);
o l'intégration dudit modèle tridimensionnel de ladite surface d' articulation à la reconstruction dans un modèle numérique tridimensionnel du pion métacarpien, puis ; - une étape d' impression tridimensionnelle du pion métacarpien, précédant l'étape d) .  o integrating said three-dimensional model of said articulation surface with the reconstruction in a three-dimensional numerical model of the metacarpal pion, then; a step of three - dimensional printing of the metacarpal pion, preceding step d).
De manière avantageuse, le procédé selon l'invention peut en outre comporter après l'étape d) , une étape d'agencement dans le patient de la prothèse de telle sorte que les moyens de réception comprenant un orifice traversant agencé de sorte à recevoir une vis d'ancrage. Advantageously, the method according to the invention may further comprise, after step d), a step arranging the prosthesis in the patient such that the receiving means comprises a through hole arranged to receive an anchor screw.
De manière avantageuse, l'impression tridimensionnelle du trapèze et du pion peut être réalisée à partir de poudres de matériaux biocompatibles.  Advantageously, the three-dimensional impression of the trapezium and the pin can be made from powders of biocompatible materials.
La présente invention a aussi pour objet une prothèse trapézo-métacarpienne comportant un trapèze prothétique un pion métacarpien, caractérisé en ce qu'elle est susceptible d'être réalisée selon le procédé selon l'invention.  The present invention also relates to a trapezio-metacarpal prosthesis comprising a prosthetic trapezium a metacarpal pin, characterized in that it is capable of being performed according to the method according to the invention.
De manière avantageuse, le pion métacarpien peut comporter deux parties comprenant une base et une tête présentant la surface d'articulation avec le trapèze prothétique .  Advantageously, the metacarpal peg may comprise two parts comprising a base and a head having the articulation surface with the prosthetic trapezium.
De manière avantageuse, la prothèse peut comporter comme moyen d'ancrage une vis d'ancrage et une série de picots, formant le moyen d'ancrage reçue dans les moyens de réception du trapèze prothétique.  Advantageously, the prosthesis may comprise as anchoring means an anchor screw and a series of pins, forming the anchoring means received in the receiving means of the prosthetic trapezium.
Ainsi, la réalisation d'un trapèze prothétique comportant des paramètres géométriques de l'os du patient permet d' intégrer les contraintes anatomiques et fonctionnelles du patient et d'obtenir une prothèse trapézo- métacarpienne la plus optimale pour ce dernier. Une fois implantée, la prothèse ainsi obtenue offre au patient receveur un traitement efficace de la rhizarthrose .  Thus, the production of a prosthetic trapezium comprising geometric parameters of the patient's bone makes it possible to integrate the anatomical and functional constraints of the patient and to obtain a trapezo-metacarpal prosthesis which is the most optimal for the latter. Once implanted, the prosthesis thus obtained offers the recipient patient an effective treatment of rhizarthrosis.
D' autres avantages et particularités de la présente invention résulteront de la description qui va suivre et faite en référence aux figures annexées :  Other advantages and features of the present invention will result from the description which follows and with reference to the appended figures:
- La figure 1 montre une vue de dessus d'un squelette d'une main comportant une prothèse trapézo- métacarpienne selon l'invention ;  - Figure 1 shows a top view of a skeleton of a hand with a trapezometacarpal prosthesis according to the invention;
- La figure 2 montre une vue détaillée et de côté de la prothèse représenté sur la figure 1 ; La figue 3 montre une vue tridimensionnelle de l'implantation d'une prothèse de la figure 1 dans le squelette de la main, ne montrant que le premier métacarpe et l'os trapézoïde ; FIG. 2 shows a detailed side view of the prosthesis shown in FIG. 1; Fig. 3 shows a three-dimensional view of the implantation of a prosthesis of Fig. 1 in the skeleton of the hand showing only the first metacarpal and trapezoidal bone;
La figure 4 montre un diagramme illustrant les étapes du procédé de réalisation de la prothèse de la figure 1 selon l'invention ;  FIG. 4 shows a diagram illustrating the steps of the method for producing the prosthesis of FIG. 1 according to the invention;
La figure 5 montre une vue tridimensionnelle de profil d'un trapèze prothétique de la prothèse issue du procédé selon l'invention (dont les étapes sont schématisées sur la figure 4) ;  FIG. 5 shows a three-dimensional profile view of a prosthetic trapezium of the prosthesis resulting from the process according to the invention (the steps of which are shown schematically in FIG. 4);
La figure 6 montre une vue en coupe du trapèze prothétique de la figure 5 ;  Figure 6 shows a sectional view of the prosthetic trapezium of Figure 5;
La figure 7 montre une vue tridimensionnelle d'une tête d'un pion métacarpien de la prothèse de la figure 1 obtenue par le procédé selon l'invention dont les étapes sont représentées sur la figure 4; La figure 8 montre une vue tridimensionnelle en coupe de la base du pion métacarpien ;  Figure 7 shows a three-dimensional view of a head of a metacarpal pin of the prosthesis of Figure 1 obtained by the method according to the invention, the steps of which are shown in Figure 4; Figure 8 shows a three-dimensional view in section of the base of the metacarpal pion;
La figure 9 montre une vue tridimensionnelle d'un pion métacarpien dans lequel sa tête est insérée dans la base de la figure 8 ;  Figure 9 shows a three-dimensional view of a metacarpal pin in which its head is inserted into the base of Figure 8;
La figure 10 montre une vue tridimensionnelle d'une vis d'ancrage pour permettre l'ancrage de la prothèse de la figure 1 dans l'os trapézoïde;  Figure 10 shows a three-dimensional view of an anchor screw for anchoring the prosthesis of Figure 1 in the trapezoid bone;
La figure 11 montre une vue partielle tridimensionnelle de la surface du trapèze prothétique de la figure 5 portant une série de picots et venant au regard de l'os trapézoïde ;  Figure 11 shows a three-dimensional partial view of the surface of the prosthetic trapezium of Figure 5 carrying a series of pins and coming to the trapezoid bone;
Les figures 12. a) à 12. e) montrent les étapes a) et b) du procédé selon l'invention, à partir d'une série d'images médicales (figure 12. b) acquises de l'os trapèze et de l'os métacarpe (figure 12. a) ) , les os sont segmentés numériquement ((figure 12. b), reconstruits numériquement en 3D (figure 12. d) puis maillés en 3D (figure 12.e)). Les modèles maillés servent de base à partir desquels on réalise un modèle tridimensionnel numérique ; Figures 12. a) to 12. e) show steps a) and b) of the method according to the invention, from a series of medical images (Figure 12. b) acquired trapezoid bone and the metacarpal bone (Figure 12. a)), the bones are segmented numerically ((Figure 12b), digitally reconstructed in 3D (Figure 12d) and then meshed in 3D (Figure 12.e)). The mesh models serve as a basis from which a three-dimensional digital model is produced;
La figure 13 compare le fichier numérique volumique issu de la CAO (en violet sur la figure 12. e et la figure 13) et le fichier STL (en blanc) ;  Figure 13 compares the digital volume file from the CAD (in purple in Figure 12.e and Figure 13) and the STL file (in white);
Les figures 14. a) à 14. c) montrent l'étape c) du procédé selon l'invention, à partir des moyens de réception et d'ancrage (figure 14. a) positionnés par CAO sur le modèle tridimensionnel numérique du trapèze (figure 14. b) réalisé à l'étape précédente afin d'obtenir un modèle tridimensionnel adéquate à la mise en place de la prothèse dont les étapes sont décrite en figure 4; FIGS. 14 a) to 14 c) show step c) of the method according to the invention, from the receiving and anchoring means (FIG. 14 a) positioned by CAD on the three-dimensional numerical model of the trapezium (Figure 14.b) performed in the previous step to obtain a three-dimensional model adequate for the implementation of the prosthesis whose steps are described in Figure 4;
Les figures 15. a) à 15. c) montrent l'obtention finale du trapèze prothétique (figure 15. a), de la base du pion métacarpien (figure 15. b) et de la tête du pion métacarpien (figure 15. c) par l'étape d) d'impression tridimensionnelle ;  Figures 15. a) to 15. c) show the final achievement of the prosthetic trapezius (Figure 15. a), the base of the metacarpal pion (Figure 15. b) and the head of the metacarpal pion (Figure 15. c ) by the step d) of three-dimensional printing;
Les figures 16. a) à 16. c) montrent le remodelage de la surface articulaire au métacarpe d'un trapèze (figure 16. b et 16. c) à partir d'un modèle anthropomorphique de l'os trapèze sain (figure 16. a) d'après l'étape 150 du procédé selon l'invention; Les figures 17. a) et 17. b) montrent l'extraction de la surface articulaire au métacarpe issue d'un modèle anthropomorphique utilisé lors de 1 xétape 150 du procédé selon l'invention; Figures 16. a) to 16. c) show the remodeling of the articular surface at the metacarpus of a trapezium (Figure 16.b and 16.c) from an anthropomorphic model of the healthy trapezius bone (Figure 16). a) according to step 150 of the process according to the invention; Figures 17. a) and 17. b) show the extraction of the metacarpal articular surface from an anthropomorphic model used in 1 x 150 step of the method according to the invention;
La figure 18 est le résultat d'une simulation numérique représentant un pion métacarpien reconstruit à partir de données anatomiques issu de l'imagerie médicale. Figure 18 is the result of a numerical simulation representing a metacarpal counter reconstructed from anatomical data from medical imaging.
- Les figures 19. a) à 19. c) montrent le recouvrement des propriétés cinématiques d'une main dans laquelle une prothèse trapézo-métacarpienne selon l'invention a été implantée.  - Figures 19. a) to 19. c) show the recovery of the kinematic properties of a hand in which a trapezio-metacarpal prosthesis according to the invention has been implanted.
DISPOSITIF ET INSTRUMENTATION · Imagerie médicale (IRM TOMOGRAPHIE) ; DEVICE AND INSTRUMENTATION · Medical imaging (MRI TOMOGRAPHY);
• Logiciel « open source » MESHLAB pour la visualisation des fichiers STL ;  • MESHLAB open source software for viewing STL files;
• Logiciel de Conception Assistée Tridimensionnelle Interactive Appliquée (CATIA) ;  • Interactive Applied Three-Dimensional Assisted Design Software (CATIA);
· Dispositifs d' impression tridimensionnelle :  · Three-dimensional printing devices:
- dispositif utilisant la technique SLA (acronyme anglais pour « Stereolitograph Apparatus » : dispositif de stéréolithographie basé sur la photopolymérisation) ;  - device using the SLA technique (acronym for "Stereolitograph Apparatus": stereolithography device based on photopolymerization);
- dispositif utilisant la technique SLM (acronyme anglais pour « Sélective Laser Melting » : dispositif basé sur la fusion sélective par laser) .  - device using the SLM (Selective Laser Melting) technique: device based on selective laser melting.
MATERIAUX NECESSAIRES AUX IMPRESSIONS 3D MATERIALS NECESSARY FOR 3D PRINTING
- poudres de matériau biocompatible, par exemple des poudres d'alliages de titane, tels que le Ti40 ou le TA6V, ou ; powders of biocompatible material, for example powders of titanium alloys, such as Ti40 or TA6V, or;
- poudres d'acier inoxydable, par exemple le 316LVM, ou encore ; - poudres de polymères, par exemple du polyéthylène ou du PEEK (acronyme anglais pour Poly Ether Ether Ketone) . Les figures 1 à 3 montrent une prothèse trapézo- métacarpienne 1 selon l'invention. Cette prothèse trapézo- métacarpienne comporte ici un trapèze prothétique 1, un pion métacarpien 7 et une vis d'ancrage 3. Elle est destinée à être mise en place entre le premier métacarpien 4 et l'os trapézoïde 2 d'un patient. stainless steel powders, for example 316LVM, or else; polymer powders, for example polyethylene or PEEK (acronym for Poly Ether Ether Ketone). Figures 1 to 3 show a trapezometacarpal prosthesis 1 according to the invention. This trapezometacarpal prosthesis here comprises a prosthetic trapezium 1, a metacarpal piece 7 and an anchoring screw 3. It is intended to be placed between the first metacarpal 4 and the trapezoidal bone 2 of a patient.
Les figures 5 et 6, montrent en particulier le trapèze prothétique 1. Il présente une première surface 11 qui est sensiblement complémentaire de la surface d' articulation du pion métacarpien 7 de la prothèse trapézo-métacarpienne selon l'invention. Le trapèze prothétique 1 comporte également une deuxième surface 12 qui est complémentaire à une surface de l'os trapézoïde de la main du patient. Cette deuxième surface 12 est destinée à permettre l'ancrage de celui-ci sur l'os trapézoïde par l'intermédiaire d'une vis d'ancrage (figure 5) .  Figures 5 and 6 show in particular the prosthetic trapezium 1. It has a first surface 11 which is substantially complementary to the articulating surface of the metacarpal pin 7 of the trapezio-metacarpal prosthesis according to the invention. The prosthetic trapezium 1 also includes a second surface 12 which is complementary to a surface of the trapezoidal bone of the patient's hand. This second surface 12 is intended to allow the anchoring thereof on the trapezoidal bone by means of an anchor screw (Figure 5).
A cette fin, le trapèze prothétique 1 comporte des moyens de réception 10 et des moyens d'ancrage. Ici, les moyens de réception 10 sont un trou débouchant s' étendant depuis la surface médiale 17 du trapèze prothétique 1 jusqu'à la deuxième surface 12 (figure 6) . Le trou débouchant comprend, ici, un lamage 13 de profondeur 16 situé du côté de surface médiale 17 qui se poursuit par un orifice cylindrique 14 débouchant au niveau de la deuxième surface 12 et de longueur 15.  To this end, the prosthetic trapezium 1 comprises receiving means 10 and anchoring means. Here, the receiving means 10 are a through hole extending from the medial surface 17 of the prosthetic trapezium 1 to the second surface 12 (Figure 6). The opening hole comprises, here, a countersink 13 of depth 16 located on the medial surface side 17 which continues with a cylindrical orifice 14 opening at the second surface 12 and of length 15.
En références au figures 7 à 9, le pion métacarpien 7 comporte deux parties, ici rapportées l'une sur l'autre : une base 5 et une tête 6. La base 5 comprend un plateau 56 présentant une face supérieure 52 plane, une face inférieure 51 plane ainsi qu'une face périphérique latérale 54 sensiblement similaires aux dimensions de l'extrémité proximale du premier métacarpien de la main du patient à traiter (figure 8) . With reference to FIGS. 7 to 9, the metacarpal peg 7 comprises two parts, here referred to one another: a base 5 and a head 6. The base 5 comprises a plate 56 having a planar upper face 52, a plane lower face 51 and a lateral peripheral face 54 substantially similar to the dimensions of the proximal end of the first metacarpal of the patient's hand to be treated (FIG. 8). .
La tête 6 du pion métacarpien comporte une surface d'articulation 62, s'étendant au-dessus d'une face inférieure 61 plane, aux dimensions de l'extrémité proximale du premier métacarpien de la main du patient à traiter, et ayant des caractéristiques non arthrosiques (figure 7) . La tête 6 comporte en outre un cône 60 formant des moyens de fixation de la tête 6 à la base 5 du pion métacarpien 7 (figure 8 et 9) . Cette queue 50 est destinée à être insérée dans le canal médullaire du premier métacarpien de la main du patient dont l'orientation et les dimensions sont déterminées à partir de paramètres morphologiques. Au niveau de la face supérieure 52, la base 5 comporte un trou 53 destiné, lors d'un assemblage du pion métacarpien 7, à recevoir, le cône 60 de la tête 6.  The head 6 of the metacarpal peg has a hinge surface 62, extending above a flat lower face 61, the dimensions of the proximal end of the first metacarpal of the hand of the patient to be treated, and having characteristics non-osteoarthritic (Figure 7). The head 6 further comprises a cone 60 forming means for fixing the head 6 to the base 5 of the metacarpal peg 7 (FIGS. 8 and 9). This tail 50 is intended to be inserted into the medullary canal of the first metacarpal of the patient's hand whose orientation and dimensions are determined from morphological parameters. At the level of the upper face 52, the base 5 comprises a hole 53 intended, during an assembly of the metacarpal peg 7, to receive the cone 60 of the head 6.
Les figures 10 et 11 montrent les moyens d'ancrage susceptibles d'être utilisés dans l'invention qui peuvent être sous la forme d'une vis d'ancrage 3 (figure 10), de préférence avec une série de picots 121 (figure 11) . La figure 10 montre en particulier que la vis d'ancrage 3 est constituée d'un filetage 32 osseux, possède une tête 31 destinée à être entièrement reçue dans le lamage 13 du trapèze prothétique comme illustré en figure 10. La figure 11 montre en particulier la deuxième surface 12 du trapèze prothétique comporte des moyens d'ancrage, qui peuvent être par exemple sous la forme d'une série de picots 121 permettant de sécuriser et de renforcer, lors d'une implantation, l'ancrage du trapèze prothétique 1 sur le os trapézoïde du patient. Ces picots 121 s'étendent en saillie depuis la deuxième surface 12 autour de l'orifice cylindrique 14 des moyens de réception 10. Les picots 121 sont de forme générale pyramidale à base polygonale ou curviligne. Le nombre de picots 121 et leur dimension sont fonctions des dimensions du trapèze prothétique 1 réalisé. On peut imaginer d'autre moyen d'ancrages que les picots 121, comme par exemple des petites vis, des crochets ou encore d'autres formes de picots (à base carrée notamment) , ou par exemples des moyens d' ancrage créés par une texturation de surface accrochante (comme du velcro par exemple) . Figures 10 and 11 show the anchoring means which may be used in the invention which may be in the form of an anchoring screw 3 (Figure 10), preferably with a series of pins 121 (Figure 11). ). FIG. 10 shows in particular that the anchoring screw 3 consists of a bone thread 32, has a head 31 intended to be entirely received in the counterbore 13 of the prosthetic trapezium as illustrated in FIG. 10. FIG. the second surface 12 of the prosthetic trapezium comprises anchoring means, which may be for example in the form of a series of pins 121 for securing and strengthening, during implantation, the anchoring of the prosthetic trapezium 1 on Trapezoid bone of the patient. These pins 121 extend projecting from the second surface 12 around the cylindrical orifice 14 of the receiving means 10. The pins 121 are of generally pyramidal shape with a polygonal or curvilinear base. The number of pins 121 and their size are functions of the dimensions of the prosthetic trapezium 1 made. One can imagine other means of anchoring that the pins 121, such as for example small screws, hooks or other forms of pins (square-based in particular), or for example anchoring means created by a Hanging surface texturing (like Velcro for example).
Les exemples suivant illustrent le procédé de réalisation 100 d'une prothèse trapézo-métacarpienne selon l'invention, en s' appuyant sur le schéma de la figure 4. EXEMPLE 1 : Acquisition d'images médicales d'une articulation trapézo-métacarpienne (étape 110 du procédé selon l'invention)  The following examples illustrate the method of producing 100 a trapezio-metacarpal prosthesis according to the invention, based on the diagram of FIG. 4. EXAMPLE 1 Acquisition of Medical Images of a Trapezo-Metacarpal Joint (Step 110 of the method according to the invention)
L'os trapèze et l'os du premier métacarpe sont scannés par IRM ou par tomographie (première étape 110) . Les caractéristiques techniques de l'imagerie médicale et de l'extraction en nuage de points (séquences, pondération, contraste) sont choisies de telle sorte à discrétiser la partie corticale des os (figures 12a) et 12b) ) . Cette acquisition permet d'aider à la réalisation des différents composants de la prothèse trapézo-métacarpienne selon 1 ' invention . EXEMPLE 2 : Reconstruction tridimensionnelle de l'os trapèze de l'articulation trapézo-métacarpienne en un modèle tridimensionnel numérique (étape 120 du procédé selon 1' invention) Trapezoid bone and bone of the first metacarpal are scanned by MRI or tomography (first step 110). The technical characteristics of medical imaging and point cloud extraction (sequences, weighting, contrast) are chosen so as to discretize the cortical part of the bones (Figures 12a) and 12b)). This acquisition makes it possible to assist in the realization of the various components of the trapezio-metacarpal prosthesis according to the invention. EXAMPLE 2 Three-Dimensional Reconstruction of the Trapezoidal Bone of the Trapezo-Metacarpal Joint into a Three-Dimensional Digital Model (Step 120 of the Process According to the Invention)
A partir de cette série d'images médicales, le procédé de réalisation 100 d'une prothèse trapézo-métacarpienne selon l'invention comprend une deuxième étape 120 de reconstruction de l'os trapèze en un modèle tridimensionnel numérique à partir de la série d' images médicales précédemment acquises. From this series of medical images, the method for producing a trapezio-metacarpal prosthesis 100 according to the invention comprises a second step 120 of reconstructing the trapezoid bone into a three-dimensional digital model from the series of FIG. previously acquired medical images.
Pour réaliser cette reconstruction, on applique un masque numérique sur les images médicales avec un seuillage pour extraire l'os cortical, à partir duquel on construit le modèle. L'image 3D est ensuite reconstruite à partir du masque (figure 12c) ) . Cette image tridimensionnelle est ensuite exportée en fichier STL (figure 12d) ) . La visualisation tridimensionnelle du ficher STL est réalisée grâce à un logiciel, MESHLAB.  To perform this reconstruction, we apply a digital mask on the medical images with a thresholding to extract the cortical bone, from which we build the model. The 3D image is then reconstructed from the mask (Figure 12c)). This three-dimensional image is then exported as an STL file (FIG. 12d)). Three-dimensional visualization of the STL file is realized thanks to a software, MESHLAB.
Un fichier numérique volumique (paramètre de lissage adapté) est ensuite traité par un logiciel de CAO. La figure 13 compare le fichier numérique volumique issu de la CAO (en violet sur la figure 12. e et 13) et le fichier STL (en blanc)  A digital volume file (adapted smoothing parameter) is then processed by a CAD software. Figure 13 compares the digital volume file from CAD (in purple in Figure 12e and 13) and the STL file (in white)
EXEMPLE 3 : Réalisation dans le modèle tridimensionnel ainsi obtenu, de moyens de réception 10 et d'un moyen d'ancrage 3 (étape 130 du procédé selon l'invention) Le procédé de réalisation 100 d'une prothèse trapézo- métacarpienne selon l'invention prévoit la réalisation, dans le modèle tridimensionnel de l'os trapèze, de moyens de réception 10 et de moyens d'ancrage 3,121. Les moyens de réception 10, 13 et 14 et d'ancrage 3 et 121 sont réalisés par CAO (figures 14 a) ) puis extrait par opération booléenne (ajout de matière ou extraction de matière) sur le modèle de trapèze volumique (figures 14 c) ) . La figure 14 b) représente le positionnement des moyens de réception et d'ancrage sur le modèle volumique du trapèze. EXAMPLE 3: Realization in the three-dimensional model thus obtained of receiving means 10 and anchoring means 3 (step 130 of the method according to the invention) The method of producing 100 a trapezometacarpal prosthesis according to the invention The invention provides the realization, in the three-dimensional model of the trapezoid bone, receiving means 10 and anchoring means 3,121. The receiving means 10, 13 and 14 and anchoring means 3 and 121 are made by CAD (FIGS. 14 a)) and then extracted by Boolean operation (addition of material or extraction of material) on the voluminal trapezium model (FIGS. )). FIG. 14 b) shows the positioning of the receiving and anchoring means on the volume model of the trapezium.
EXEMPLE 4 : Réalisation d'une première surface 11 complémentaire à la surface d' articulation 62 du pion métacarpien par remodelage à partir d' un modèle anthropomorphique de l'os trapèze issu d'images de trapèze sain (étape 150 du procédé selon l'invention) EXAMPLE 4: Realization of a first surface 11 complementary to the articulating surface 62 of the metacarpal pion by remodeling from an anthropomorphic model of the trapezoid bone derived from healthy trapezoidal images (step 150 of the method according to US Pat. invention)
Selon le procédé de réalisation 100 d'une prothèse trapézo-métacarpienne, l'invention comprend préalablement à l'étape d'impression tridimensionnelle 140, une étape de réalisation 150 dans le modèle tridimensionnel ainsi obtenu de la première surface 11. According to the method of producing a trapezio-metacarpal prosthesis 100, the invention comprises, prior to the three-dimensional printing step 140, an embodiment step 150 in the three-dimensional model thus obtained of the first surface 11.
Dans le cas où l'os trapèze ne présente pas des caractéristiques saines (figure 16a)), la surface articulaire entre l'os trapèze et l'os métacarpe est remodelée à partir d'un modèle anthropomorphique de l'os trapèze issu d'images de trapèze sain (figures 16b) et 16c)) .  In the case where the trapezoid bone does not present healthy characteristics (figure 16a)), the articular surface between the trapezoidal bone and the metacarpal bone is remodeled from an anthropomorphic model of the trapezoidal bone derived from healthy trapezoidal images (Figures 16b) and 16c)).
Le remodelage se fait par extraction de la surface articulaire d'un modèle anthropomorphique de l'os trapèze issu d'au moins un trapèze sain (figure 17 b) ) . La surface 11 montrée sur les figures 16 b) et 16 c) est ensuite positionnée dans le modèle numérique en lieu et place de la surface articulaire aux caractéristiques non saines (figure 16 b) ) . Un fichier numérique volumique est ensuite réalisé par remplissage et/ou par opération booléenne (ajout ou retrait) sous un logiciel de CAO (figure 16 c) ) . Un fichier numérique volumique est ensuite réalisé par remplissage et/ou par opération booléenne (ajout/retrait) sous un logiciel de CAO. Remodeling is done by extracting the articular surface of an anthropomorphic model of the trapezoid bone from at least one healthy trapezius (Figure 17b). The surface 11 shown in FIGS. 16 (b) and 16 (c) is then positioned in the digital model in place of the non-healthy articular surface (FIG. 16 (b)). A digital volume file is then produced by filling and / or by Boolean operation (addition or withdrawal) under a CAD software (FIG. 16c). A digital volume file is then produced by filling and / or by Boolean operation (addition / withdrawal) under a CAD software.
L'étape 150 du procédé selon l'invention permet d'adapter la première surface 11 brute (étape 120) et de réaliser, dans le modèle numérique tridimensionnel ainsi obtenu, une surface 11 remodelée et complémentaire à la surface d'articulation 62 du pion métacarpien à partir d'un modèle anthropomorphique de l'os trapèze issu d'images d'os de trapèze sain. Et ainsi elle permet de corriger les déformations dues à la rhizarthrose elle-même.  Step 150 of the method according to the invention makes it possible to adapt the first rough surface 11 (step 120) and to produce, in the three-dimensional numerical model thus obtained, a surface 11 remodeled and complementary to the hinge surface 62 of the pion metacarpal from an anthropomorphic model of trapezoid bone from images of healthy trapezius bone. And so it corrects the deformities due to rhizarthrosis itself.
EXEMPLE 5 : Réalisation du pion métacarpien (étapes 160 et 170 du procédé selon l'invention) EXAMPLE 5 Production of the Metacarpal Counter (Steps 160 and 170 of the Process According to the Invention)
Selon le procédé de réalisation 100 d'une prothèse trapézo-métacarpienne, l'invention comprend, préalablement à l'étape d'impression tridimensionnelle 140, une étape de reconstruction 160 en modèle numérique de la surface d'articulation 62 d'une extrémité proximale du premier métacarpien . According to the embodiment method 100 of a trapezio-metacarpal prosthesis, the invention comprises, prior to the three-dimensional printing step 140, a reconstruction step 160 in a digital model of the articulation surface 62 of a proximal end. of the first metacarpal.
Pour cela, on part d'un modèle tridimensionnel obtenu à partir de la série d'images médicales acquises à l'étape 110 (figures 12a) à 12e) ) . La réalisation de la tête du pion métacarpien s'appuie sur la section du métacarpe et de la surface articulaire 62 du métacarpe avec le trapèze. La réalisation de la base 5 du pion métacarpien 7 s'appuie sur la section du métacarpe et de la cavité médullaire (41) (zone grisée ; figure 18) du métacarpe afin de favoriser le bon positionnement pendant l'implantation. Puis, on réalise par impression tridimensionnelle (étape 170) le pion métacarpien 7 (base 5 et tête 6) à partir du modèle tridimensionnel du pion tel qu'obtenu aux étapes 160 et 170 (exemple 5) et illustré sur les figures 15b et 15c. For this, we start from a three-dimensional model obtained from the series of medical images acquired in step 110 (Figures 12a) to 12e)). The realization of the head of the metacarpal pion rests on the section of the metacarpus and the articular surface 62 of the metacarpus with the trapezium. The realization of the base 5 of the metacarpal peg 7 is based on the section of the metacarpus and the medullary cavity (41) (shaded area, Figure 18) of the metacarpal to promote good positioning during implantation. Then, the metacarpal pin 7 (base 5 and head 6) is made by three-dimensional printing (step 170) from the three-dimensional model of the pion as obtained in steps 160 and 170 (Example 5) and illustrated in Figures 15b and 15c.
Dans une variante de réalisation, le pion métacarpien 7 est en deux parties : une tête 6 réalisée en polymère et une base 5 réalisée en métal.  In an alternative embodiment, the metacarpal peg 7 is in two parts: a head 6 made of polymer and a base 5 made of metal.
Une autre variante de réalisation est possible, dans laquelle la tête 6 et la base 5 sont collées l'une à l'autre, formant un ensemble monobloc. Cela est possible en utilisant, pour l'impression tridimensionnelle du pion métacarpien 7, une tête d'impression multi-buses, dont l'une des buses est dédiée à la poudre de matériau métallique et une autre des buses à la poudre de polymère.  Another alternative embodiment is possible, in which the head 6 and the base 5 are glued to each other, forming a one-piece assembly. This is possible by using, for the three-dimensional printing of the metacarpal pin 7, a multi-nozzle print head, one of which is dedicated to the powder of metallic material and another of the nozzles to the polymer powder.
Dans une autre variante, la tête 6 et la base 5 sont encliquetées l'une dans l'autre pour former le pion métacarpien 7.  In another variant, the head 6 and the base 5 are snapped into one another to form the metacarpal peg 7.
EXEMPLE 6 : Impression tridimensionnelle du trapèze prothétique (1) à partir du modèle tridimensionnel issu de l'étape précédente (étape 140 du procédé selon l'invention) . EXAMPLE 6: Three-dimensional printing of the prosthetic trapezium (1) from the three-dimensional model from the previous step (step 140 of the method according to the invention).
Le procédé de réalisation 100 d'une prothèse trapézo- métacarpienne selon l'invention comporte à la suite de l'étape 150 (exemple 4), une étape d'impression tridimensionnelle 140 du trapèze prothétique 1 à partir du modèle tridimensionnel ainsi obtenu. The method of producing a trapezometacarpal prosthesis 100 according to the invention comprises, following step 150 (Example 4), a three-dimensional printing step 140 of the prosthetic trapezium 1 from the three-dimensional model thus obtained.
La figure 15a) montre la réalisation par impression tridimensionnelle du trapèze à partir du modèle tridimensionnel issu de l'étape 150 (cf. Exemple 4) par technologie SLM si le trapèze est en alliages métalliques et par technologie SLA si le trapèze est en résine polymérique transparente photosensible.  FIG. 15a) shows the realization by three-dimensional printing of the trapezoid from the three-dimensional model resulting from step 150 (see Example 4) by SLM technology if the trapezium is made of metal alloys and by SLA technology if the trapezium is made of polymeric resin transparent photosensitive.
Cette impression tridimensionnelle par technologie SLM peut s'effectuer en utilisant des poudres d'alliages de titane, tels que le Ti40 ou le TA6V, ou des poudres d'acier inoxydable, comme le 316LVM. This three-dimensional printing by SLM technology can be carried out using powders of alloys of titanium, such as Ti40 or TA6V, or stainless steel powders, such as 316LVM.
EXEMPLE 7 : Utilisation de la prothèse trapèzo-métacarpienne selon l'invention obtenue à l'exemple 6 et essais postopératoires mettant en œuvre une telle prothèse. EXAMPLE 7 Use of the trapezio-metacarpal prosthesis according to the invention obtained in Example 6 and postoperative tests using such a prosthesis.
La prothèse trapézo-métacarpienne selon l'invention, telle qu'obtenue à l'exemple 6, est testée in vivo au cours d'une opération d' arthroplastie . The trapezio-metacarpal prosthesis according to the invention, as obtained in Example 6, is tested in vivo during an arthroplasty operation.
A cette fin, différentes morphologies de trapèze prothétique sont proposés (réalisé selon les étapes a) à d) ) avec différentes tailles.  To this end, different prosthetic trapezoid morphologies are proposed (made according to steps a) to d)) with different sizes.
Le choix du trapèze prothétique et du pion métacarpien se fait selon les préférences du chirurgien qui va réaliser l'opération afin d'avoir la meilleure adéquation avec l'articulation en cours d'opération. Différentes morphologies de pion métacarpien sont proposées (réalisés selon les étapes 160 et 170) avec différentes tailles. Le pion métacarpien est choisi en adéquation avec le trapèze prothétique défini.  The choice of the prosthetic trapezium and the metacarpal counter is made according to the preferences of the surgeon who will perform the operation to have the best match with the joint during operation. Different metacarpal pawn morphologies are proposed (made according to steps 160 and 170) with different sizes. The metacarpal counter is chosen in line with the defined prosthetic trapezium.
L' implantation de la prothèse trapézo-métacarpienne chez le patient est réalisée comme suit :  The implantation of the trapeziometacarpal prosthesis in the patient is carried out as follows:
- le praticien réalise une voie d'abord de l'articulation trapézo-métacarpienne qu'il doit remplacer par une prothèse trapézo-métacarpienne obtenue à l'exemple 6 ;  the practitioner realizes an approach of the trapezio-metacarpal joint that he must replace with a trapezio-metacarpal prosthesis obtained in example 6;
- il réalise ensuite une trapézectomie . Puis, il effectue une résection de l'extrémité proximale du premier métacarpien, suivie d'une préparation du canal médullaire de ce dernier ; - ensuite, le chirurgien met en place la base 5 du pion métacarpien 7 en introduisant la queue 50 dans le canal médullaire préparé ; - he then performs a trapezectomy. Then, he performs a resection of the proximal end of the first metacarpal, followed by a preparation of the medullary canal of the latter; then, the surgeon sets up the base 5 of the metacarpal peg 7 by introducing the tail 50 into the prepared medullary canal;
- la tête 6 est alors mise en place en introduisant le cône 60 de la tête 6 dans le trou borgne 53 de la base 5 ;  the head 6 is then put in place by introducing the cone 60 of the head 6 into the blind hole 53 of the base 5;
- puis, le praticien met en place le trapèze prothétique 1 de sorte à ce que la deuxième surface 12 vienne en contact avec l'os trapézoïde ; - il corrige l'orientation tridimensionnelle du trapèze prothétique 1 afin que la première surface 11 du trapèze prothétique vienne en regard de la surface d' articulation 62 du pion métacarpien 7 ; - Then, the practitioner sets up the prosthetic trapezium 1 so that the second surface 12 comes into contact with the trapezoid bone; - It corrects the three-dimensional orientation of the prosthetic trapezium 1 so that the first surface 11 of the prosthetic trapezium comes opposite the articulation surface 62 of the metacarpal pin 7;
- dès lors, le praticien met en place la vis d'ancrage 3 à travers le trou débouchant 10 ; - Then the practitioner puts the anchor screw 3 through the through hole 10;
- le filetage 32 est alors inséré dans l'os trapézoïde pour réaliser l'ancrage du trapèze prothétique 1 avec ce dernier ;  - The thread 32 is then inserted into the trapezoid bone to perform the anchoring of the prosthetic trapezium 1 with the latter;
- dans le cas où le trapèze prothétique 1 comporte des moyens d'ancrage 121, ces derniers pénètrent en grande partie dans l'os trapézoïde lors d'un serrage de la vis d'ancrage 3 ;  - In the case where the prosthetic trapezium 1 comprises anchoring means 121, the latter penetrate largely into the trapezoidal bone during a tightening of the anchoring screw 3;
- enfin, le praticien referme la capsula et l'incision cutanée .  - Finally, the practitioner closes the capsula and cutaneous incision.
On réalise ensuite des essais post-opératoires pour tester le recouvrement de l'étendue cinématique (mouvements de rétropulsion, antépulsion, abduction, adduction et circumduction) en condition saine de la main comprenant la prothèse de l'os trapèze selon l'invention.  Subsequent post-operative tests are then carried out to test the recovery of the kinematic extent (retropulsion, antepulsion, abduction, adduction and circumduction movements) under the sound condition of the hand comprising the prosthesis of the trapezoid bone according to the invention.
Les figures 19 a à c montrent que la prothèse selon l'invention permet le recouvrement complet de l'étendue cinématique du pouce.  Figures 19 a to c show that the prosthesis according to the invention allows the complete recovery of the kinematic extent of the thumb.

Claims

REVENDICATIONS
1. Procédé de réalisation (100) d'une prothèse trapézo-métacarpienne comprenant un trapèze prothétique (1), le procédé comportant des étapes successives de : 1. A method of producing (100) a trapezio-metacarpal prosthesis comprising a prosthetic trapezium (1), the method comprising successive steps of:
a . Acquisition (110) d'une série d'images médicales d'une articulation trapézo-métacarpienne d'un patient à traiter de manière à intégrer les contraintes anatomiques et fonctionnelles du patient;  at . Acquisition (110) of a series of medical images of a trapezo-metacarpal joint of a patient to be treated so as to integrate the anatomical and functional constraints of the patient;
b . Reconstruction (120) tridimensionnelle de l'os trapèze de l'articulation trapézo-métacarpienne en un modèle tridimensionnel numérique à partir de la série d' images médicales précédemment acquises, par traitement d'images pour générer des fichiers numériques du modèle tridimensionnel dudit objet ;  b. Three-dimensional reconstruction (120) of the trapezoidal bone of the trapezio-metacarpal joint into a three-dimensional digital model from the series of previously acquired medical images, by image processing to generate digital files of the three-dimensional model of said object;
c . Réalisation (130) dans le modèle tridimensionnel ainsi obtenu, de moyens de réception (10) et d'un moyen d'ancrage (3); et,  vs . Realization (130) in the three-dimensional model thus obtained, receiving means (10) and an anchoring means (3); and,
d. Impression (140) tridimensionnelle du trapèze prothétique (1) à partir du modèle tridimensionnel issu de l'étape précédente (130) . ledit procédé est caractérisé en ce qu' il comprend en outre, entre les étapes c) (130) et d) (140), les sous étapes suivantes :  d. Three-dimensional printing (140) of the prosthetic trapezium (1) from the three-dimensional model from the previous step (130). said method is characterized in that it further comprises, between steps c) (130) and d) (140), the following substeps:
- une étape de réalisation (150) dans le modèle numérique tridimensionnel ainsi obtenu, d'une première surface (11) complémentaire à la surface d'articulation (62) du pion métacarpien par remodelage à partir d'un modèle anthropomorphique de l'os trapèze issu d'images de trapèze sain ; - une étape de reconstruction (160) de la surface d'articulation (62) d'une extrémité proximale du premier métacarpien de l'articulation trapézo- métacarpienne comprenant : an embodiment step (150) in the three-dimensional numerical model thus obtained, of a first surface (11) complementary to the articulation surface (62) of the metacarpal counterpart by remodeling from an anthropomorphic model of the bone trapeze from images of healthy trapezius; a step of reconstructing (160) the articulation surface (62) of a proximal end of the first metacarpal of the trapezometacarpal joint comprising:
o la réalisation d'un modèle tridimensionnel à partir de la série d' images médicales acquises à l'étape a) ;  o the realization of a three-dimensional model from the series of medical images acquired in step a);
o l'intégration dudit modèle tridimensionnel de ladite surface d'articulation (62) à la reconstruction dans un modèle numérique tridimensionnel du pion métacarpien, puis ; o integrating said three-dimensional model of said hinge surface (62) with the reconstruction in a three-dimensional numerical model of the metacarpal pion, then;
- une étape (170) d'impression tridimensionnelle du pion métacarpien, précédant l'étape d) . -2-r Procédé selon la revendication 1, caractérisé en ce qu'il comporte en outre après l'étape d) , une étape d'agencement dans le patient de la prothèse de telle sorte que les moyens de réception (10) comprennent un orifice traversant (13,14) agencé de sorte à recevoir une vis d' ancrage ( 3 ) . a step (170) of three-dimensional printing of the metacarpal counter preceding step d). A method according to claim 1, characterized in that it further comprises, after step d), a step of arranging the prosthesis in the patient so that the receiving means (10) comprise a through orifice (13, 14) arranged to receive an anchor screw (3).
3. Procédé selon l'une des revendications 1, caractérisé en ce que l'impression tridimensionnelle (140,170) est réalisée à partir de poudre de matériaux biocompatibles. 3. Method according to one of claims 1, characterized in that the three-dimensional printing (140,170) is made from powder of biocompatible materials.
4. Prothèse trapézo-métacarpienne comportant un trapèze prothétique (1) un pion métacarpien (7), caractérisé en ce qu'elle est susceptible d'être réalisée selon le procédé selon les revendications 1 à 3. 4. Trapezo-metacarpal prosthesis comprising a prosthetic trapezium (1) a metacarpal peg (7), characterized in that it is capable of being carried out according to the process according to claims 1 to 3.
5. Prothèse selon la revendication 4, caractérisée en ce que le pion métacarpien comporte deux parties (5, 6) , les deux parties comprenant une base (5) et une tête (6) présentant la surface d'articulation (62) avec le trapèze prothétique . 6. Prothèse selon l'une des revendications 4 à 5, caractérisée en ce qu'elle comporte comme moyen d'ancrage une vis d'ancrage (3) et une série de picots (121), formant le moyen d'ancrage reçue dans les moyens de réception (10) du trapèze prothétique (1). 5. Prosthesis according to claim 4, characterized in that the metacarpal counter has two parts (5, 6), the two parts comprising a base (5) and a head (6) having the hinge surface (62) with the prosthetic trapezium. 6. Prosthesis according to one of claims 4 to 5, characterized in that it comprises as anchoring means an anchor screw (3) and a series of pins (121), forming the anchoring means received in the receiving means (10) of the prosthetic trapezium (1).
EP18723847.2A 2017-05-16 2018-05-16 Method for producing a trapeziometacarpal prosthesis and resulting prosthesis Withdrawn EP3624735A1 (en)

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US5702469A (en) * 1996-01-18 1997-12-30 Kinetikos Medical, Inc. Thumb joint prosthesis and related method of implantation
US6126690A (en) * 1996-07-03 2000-10-03 The Trustees Of Columbia University In The City Of New York Anatomically correct prosthesis and method and apparatus for manufacturing prosthesis
US20110004317A1 (en) * 2007-12-18 2011-01-06 Hacking Adam S Orthopaedic implants
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