ES2635542T3 - Guías glenoideas específicas para el paciente - Google Patents
Guías glenoideas específicas para el paciente Download PDFInfo
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- ES2635542T3 ES2635542T3 ES12784168.2T ES12784168T ES2635542T3 ES 2635542 T3 ES2635542 T3 ES 2635542T3 ES 12784168 T ES12784168 T ES 12784168T ES 2635542 T3 ES2635542 T3 ES 2635542T3
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1684—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the shoulder
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1778—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the shoulder
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- A—HUMAN NECESSITIES
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
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- 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
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- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
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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
- A61F2/02—Prostheses implantable into the body
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
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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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- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
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- 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
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
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- 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
- A61F2/30767—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
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30879—Ribs
- A61F2002/30881—Circumferential ribs, flanges or fins
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- 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
- A61F2/30767—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
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
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- 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
- A61F2/40—Joints for shoulders
- A61F2/4014—Humeral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic humeral shafts
- A61F2002/4018—Heads or epiphyseal parts of humerus
- A61F2002/4022—Heads or epiphyseal parts of humerus having a concave shape, e.g. hemispherical cups
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- 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
- A61F2/40—Joints for shoulders
- A61F2/4081—Glenoid components, e.g. cups
- A61F2002/4085—Glenoid components, e.g. cups having a convex shape, e.g. hemispherical heads
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- Oral & Maxillofacial Surgery (AREA)
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- Molecular Biology (AREA)
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Abstract
Un dispositivo ortopédico para una articulación de hombro de un paciente que comprende: Una guía (200) glenoidea que tiene una superficie (202) superior y una superficie (204) inferior, en la que la superficie inferior es una superficie específica del paciente, configurada como una superficie negativa de una cara (80) glenoidea basada en una imagen tridimensional de una articulación de hombro de un paciente reconstruido preoperatoriamente a partir de exploraciones de imagen de la articulación de hombro del paciente, incluyendo la guía glenoidea una primera guía (216) de perforación, caracterizado porque dicha primera guía de perforación es tubular y se extiende desde la superficie superior a lo largo de un primer eje (A) de alineación configurado preoperativamente con una orientación específica del paciente y un lugar de inserción para guiar un implante glenoideo en la cara glenoidea, en donde la guía glenoide incluye una segunda guía (214) de perforación tubular que se extiende desde la superficie superior a lo largo de un segundo eje (B) de alineación configurado preoperatoriamente con una orientación y ubicación específica del paciente para guiar un implante glenoideo en la cara glenoidea, y en donde la primera guía tubular y el primer eje de alineación están configurados para la artroplastia anatómica del hombro y en donde la segunda guía tubular de perforación y el segundo eje de alineación están configurados para la artroplastia de hombro inversa.
Description
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DESCRIPCION
Gmas glenoideas espedficas para el paciente Referencia cruzada a aplicaciones relacionadas
Esta solicitud reivindica prioridad a la patente de Estados Unidos 201213653868 presentada el 17 de octubre de 2012 y a la patente de Estados Unidos 201161552079P presentada el 27 de octubre de 2011.
Las caractensticas del preambulo de la reivindicacion 1 son conocidas por el documento WO 2011/110374 A1.
Introduccion
En la artroplastia del hombro se utilizan varias gmas e instrumentos para determinar un eje de alineacion y guiar un implante para la artroplastia anatomica o inversa del hombro. Las presentes ensenanzas proporcionan varios instrumentos espedficos para el paciente y otros para uso en artroplastia de hombro.
Resumen
La presente invencion proporciona un dispositivo ortopedico para una articulacion de hombro como se define en la reivindicacion 1. Las presentes ensenanzas proporcionan varios instrumentos espedficos del paciente para la artroplastia anatomica e inversa de hombro.
Las presentes ensenanzas proporcionan una grna glenoidea que tiene una superficie superior y una superficie inferior. La superficie inferior es una superficie espedfica del paciente, configurada como una superficie negativa de una cara glenoidea (o cavidad glenoidea) basada en una imagen tridimensional de una articulacion del hombro reconstruido de un paciente preoperatoriamente a partir de exploraciones de imagen de la articulacion del hombro del paciente. La grna glenoidea incluye una grna de perforacion tubular anatomica que se extiende desde la superficie superior a lo largo de un eje de alineacion anatomico configurado preoperatoriamente con una orientacion espedfica del paciente para guiar un implante glenoideo en la cara glenoidea para la artroplastia anatomica del hombro. La grna glenoidea tambien incluye una grna de perforacion tubular inversa que se extiende desde la superficie superior a lo largo de un eje de alineacion inverso configurado preoperatoriamente con una orientacion y ubicacion espedfica para el paciente para guiar una placa base glenoidea en la cara glenoidea para la artroplastia inversa del hombro.
En algunas realizaciones, la grna glenoidea puede incluir una superficie periferica espedfica del paciente que forma un labio configurado como un negativo de un borde glenoideo del paciente. El labio incluye una ranura de paso configurada para ver y marcar la cara glenoidea.
En algunas realizaciones, la grna glenoidea puede incluir una porcion de superficie periferica espedfica del paciente, configurada como negativa de una superficie coracoides del paciente.
En algunas realizaciones, la grna glenoidea puede usarse con una grna de perforacion configurada para acoplar un implante de placa base para artroplastia inversa. La grna de perforacion incluye un poste de perforacion tubular central que tiene una ubicacion espedfica para el paciente y un eje de perforacion espedfico del paciente orientado a lo largo del eje de alineacion inversa. El poste de perforacion tubular central puede configurarse para tener una altura espedfica para el paciente para controlar la profundidad de perforacion a traves del mismo. La grna de perforacion tambien puede incluir postes de perforacion perifericos con ejes de perforacion espedficos del paciente. Una perforacion que tiene un tope configurado para enganchar el poste central de perforacion para controlar la profundidad de perforacion a traves del mismo se puede incluir con la grna glenoidea y la grna de perforacion.
Otras areas de aplicabilidad de las presentes ensenanzas resultaran evidentes a partir de la descripcion proporcionada a continuacion. Debe entenderse que la descripcion y los ejemplos espedficos estan destinados unicamente a fines ilustrativos y no pretenden limitar el alcance de las presentes ensenanzas.
Breve descripcion de los dibujos
Las presentes ensenanzas se comprenderan mas completamente a partir de la descripcion detallada y los dibujos adjuntos.
La figura 1 es una vista despiezada de un implante de la tecnica anterior para artroplastia de hombro inverso;
La figura 2 es una vista ambiental del implante de la tecnica anterior de la figura 1;
La figura 3A es una vista ambiental que ilustra un pasador de grna utilizado durante el escariado en la artroplastia inversa de hombro;
La figura 3B es una vista ambiental que ilustra un pasador de grna despues del escariado en la artroplastia inversa de hombro;
La figura 4 es una vista en perspectiva de un implante de la tecnica anterior para artroplastia anatomica de hombro;
La figura 5 es una vista en perspectiva desde abajo de una gma glenoidea espedfica del paciente para la artroplastia inversa y anatomica de hombro de acuerdo con las presentes ensenanzas;
La figura 6 es una vista en perspectiva desde arriba de la gma glenoidea espedfica del paciente de la figura 5;
5 La figura 7 es una vista ambiental en perspectiva frontal de la gma glenoidea espedfica del paciente de la figura 5;
La figura 8 es una vista ambiental en perspectiva posterior de la gma glenoidea espedfica del paciente de la figura
5;
La figura 9 es una vista en perspectiva de un implante de placa base para la cara glenoidea;
La figura 10 es una vista en perspectiva de una gma de perforacion secundaria espedfica del paciente para uso en 10 artroplastia inversa de acuerdo con las presentes ensenanzas y mostrada con la placa base de la figura 9; y
La figura 11 es una vista en perspectiva de la gma de perforacion secundaria de la figura 10 mostrada con una herramienta de perforacion que tiene un tope de profundidad.
Los numeros de referencia correspondientes indican partes correspondientes a lo largo de las diversas vistas de los dibujos
15 Descripcion detallada
La siguiente descripcion es meramente de naturaleza ejemplar y no pretende en modo alguno limitar las presentes ensenanzas, aplicaciones o usos.
Las presentes ensenanzas proporcionan generalmente instrumentos quirurgicos espedficos del paciente que incluyen, por ejemplo, gmas de alineacion, gmas de perforacion y otras herramientas para uso en el remplazo de 20 articulacion del hombro, procedimientos de rejuvenecimiento del hombro y otros procedimientos relacionados con la articulacion del hombro o los diversos huesos de la articulacion del hombro, incluyendo la cara glenoidea o la cavidad de la escapula, la cabeza del humero y los hombros adyacentes. Las presentes ensenanzas pueden aplicarse al reemplazo anatomico del hombro y al reemplazo inverso del hombro. Los instrumentos espedficos del paciente se pueden utilizar con componentes de implante convencionales o con componentes de implante 25 espedficos del paciente y/o injertos oseos que se preparan utilizando metodos de imagen asistidos por ordenador
de acuerdo con las presentes ensenanzas. Modelado informatico para obtener imagenes tridimensionales de la anatoirna del paciente mediante exploraciones medicas de la anatoirna del paciente (como resonancia magnetica, tomograffa computarizada, ultrasonido, rayos X, PET, etc.), los componentes de protesis espedficos del paciente y las gmas especificas para pacientes, plantillas y otros instrumentos espedficos del paciente, pueden prepararse 30 utilizando diversos programas CAD y/o software disponible comercialmente, por ejemplo, por Object Research Systems o ORS, Montreal, Canada.
Los instrumentos espedficos del paciente y cualquier implante e injertos oseos espedficos para el paciente asociados se pueden disenar y fabricar generalmente basandose en el modelado informatico de la imagen anatomica tridimensional del paciente, generada a partir de exploraciones de imagenes medicas que incluyen, por 35 ejemplo, rayos X, MRI, CT, PET, ultrasonido u otras exploraciones medicas. Los instrumentos espedficos para el paciente pueden tener una superficie de acoplamiento tridimensional que es complementaria y se hace para acoplarse sustancialmente en una sola posicion (es decir, como una superficie sustancialmente negativa o de espejo o inversa) con una superficie osea tridimensional con o sin tejidos blandos asociados, que se reconstruye como una imagen tridimensional a traves del CAD o software antes mencionado. No es necesario incorporar irregularidades 40 muy pequenas en la superficie de acoplamiento tridimensional. Los instrumentos espedficos del paciente pueden incluir formaciones de guiado hechas a la medida, tales como, por ejemplo, orificios de gma o postes de gma canulados o extensiones o receptaculos de gma canulados que pueden ser utilizados para soportar o guiar otros instrumentos, tales como gmas de perforacion, escariadores, cortadores, gmas de corte y bloques de corte o para insertar pasadores de guiado K-alambre u otros sujetadores de acuerdo con un plan preoperatorio aprobado por 45 cirujano.
En diversas realizaciones, los instrumentos espedficos del paciente de las presentes ensenanzas tambien pueden incluir una o mas gmas tubulares espedficas del paciente para recibir y guiar una herramienta, tal como una gma de perforacion o pasador o alambre de gma en los puntos de insercion espedficos del paciente correspondientes y orientaciones relativas a un eje anatomico o inverso seleccionado para el paciente espedfico. Los instrumentos 50 espedficos del paciente pueden incluir formaciones de guia u orientacion y caractensticas para guiar la implantacion
de implantes espedficos del paciente o fuera del armazon asociados con el procedimiento quirurgico. La geometna, la forma y la orientacion de las diversas caractensticas de los instrumentos espedficos del paciente, asf como diversos implantes e injertos de hueso espedficos del paciente, si se utilizan, puede determinarse durante la fase de planificacion preoperatoria del procedimiento en relacion con el modelado asistido por ordenador de la anatoirna del 55 paciente. Durante la fase de planificacion preoperatoria, se pueden seleccionar instrumentos espedficos del
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paciente, implantes personalizados, semi-personalizados o no personalizados y otras herramientas no personalizadas y los componentes espedficos del paciente pueden ser fabricados para un paciente espedfico con la entrada de un cirujano u otro profesional asociado con el procedimiento quirurgico.
En la siguiente descripcion se definen los terminos "pacientes espedficos", "hechos a medida" o "personalizados" para aplicar a componentes, incluidas herramientas, implantes, porciones o combinaciones de los mismos, que incluyen ciertas caractensticas geometricas, incluyendo superficies, curvas u otras lmeas, y que se hacen para conformarse estrechamente sustancialmente como imagenes especulares o negativas o superficies complementarias de caractensticas geometricas correspondientes o puntos de referencia anatomicos de la anatoirna de un paciente obtenidos o recogidos durante una etapa de planificacion preoperatoria basada en imagenes computarizadas 3-D de la anatomfa correspondiente reconstruida a partir de exploraciones de imagen del paciente por metodos de formacion de imagenes por ordenador. Ademas, las caractensticas de guiado espedficas del paciente, tales como las aberturas de grna, las ranuras de grna, los elementos de grna u otros orificios o aberturas que estan incluidos en grnas de alineacion, grnas de perforacion, grnas de corte, raspadores u otros instrumentos o en implantes se definen como caractensticas que estan hechas para tener posiciones, orientaciones, dimensiones, formas y/o definen planos y ejes de corte espedficos de la anatomfa del paciente en particular incluyendo varios ejes anatomicos o mecanicos basados en el plan preoperatorio asistido por ordenador asociado con el paciente.
Las grnas espedficas del paciente pueden configurarse para acoplarse en alineacion con puntos de referencia anatomicos naturales orientando y colocando la grna de alineacion correspondiente intraoperatoriamente sobre la parte superior del hueso para acoplarse con los puntos de referencia correspondientes. Los puntos anatomicos funcionan como identificadores fiduciales pasivos o marcadores fiduciales para el posicionamiento de las diversas grnas de alineacion, grnas de perforacion u otros instrumentos espedficos del paciente.
Las diversas grnas de alineacion espedficas del paciente pueden estar hechas de cualquier material biocompatible, incluyendo, polfmero, ceramica, metal o combinaciones de los mismos. Las grnas de alineacion espedficas del paciente pueden ser desechables y pueden combinarse o usarse con componentes de corte y guiado reutilizables y no espedficos del paciente.
Mas espedficamente, las presentes ensenanzas proporcionan varias realizaciones de grnas de glenoideos espedficas del paciente y grnas de perforacion secundarias para la artroplastia anatomica e inversa. Las grnas glenoideas de las presentes ensenanzas pueden tener superficies de acoplamiento espedficas del paciente que hacen referencia a diversas porciones de la articulacion del hombro e incluyen grnas tubulares de perforacion, orificios de grna o manguitos u otras formaciones de grna que puedan posicionar con precision un cable grna para procedimientos posteriores de preparacion e implantacion de glenoideos y para propositos de alineacion, incluyendo control de posicion de implante, control de version de implante, control de inclinacion de implante para artroplastia anatomica e inversa.
A continuacion, cuando se describe una parte de una grna glenoidea como "referenciando" una parte de la anatomfa, se entendera que la porcion de referencia de la grna glenoidea es una parte espedfica del paciente que refleja o es un negativo de la correspondiente porcion anatomica referenciada.
En algunas realizaciones, la grna glenoidea puede referirse (sustancialmente como negativa) a la cara glenoidea o de la cavidad glenoidea, evitando el borde glenoideo y cualquier parte del labrum. En otras realizaciones, la grna glenoidea puede referirse (sustancialmente como negativa) a la cara del glenoideo y a una porcion del borde glenoideo. La grna glenoidea puede ser disenada para quitar solamente una porcion del labrum (de 2-5 horas, por ejemplo) o el labrum entero. Cuando la grna glenoidea esta disenada para sentarse directamente sobre el hueso en lugar de tejido blando, entonces el labrum se retira. En otras realizaciones, la grna glenoidea puede hacer referencia al propio labrum, tal como cuando se utilizan exploraciones MRI para reconstruir detalles de la geometna del tejido blando y la grna glenoidea se disena haciendo referencia a los tejidos blandos. En otras realizaciones, la grna glenoidea puede hacer referencia a la cara glenoidea y una porcion del proceso coracoides o accesorio coracoides que se extiende desde la parte superior del glenoideo.
En algunas realizaciones, la grna glenoidea puede tener orificios, aberturas o ventanas incorporadas que permitan al cirujano marcar el hueso glenoideo o un modelo del hueso glenoideo con un rotulador, escariador, bistun, o cualquier otro dispositivo que pueda crear marcas para ser utilizado como puntos de referencia en o en el hueso glenoideo o modelo glenoideo. Estos puntos de referencia se pueden utilizar para la orientacion de una grna secundaria. La grna glenoidea puede proporcionar tambien una forma de marcar ffsicamente el hueso glenoideo para la orientacion apropiada de grnas glenoideas adicionales a traves de una pluralidad de ranuras para ser utilizadas para pasar herramientas de marcado.
Las diversas grnas glenoideas descritas en el presente documento pueden incluir una pluralidad de formaciones de grna de perforacion, agujeros u orificios para colocar varios alambres o pasadores de grna de alineacion o para perforacion. En algunas realizaciones, la grna glenoidea puede incluir una segunda grna de perforacion o alambre de grna, por ejemplo, con una inclinacion de 10 grados u otra inclinacion inferior (y posiblemente desplazada superior o inferiormente) para acomodar la colocacion apropiada de la placa base para su uso con una artroplastia de hombro inversa. Tambien se pueden incluir orificios de perforacion perifericos para usar con una placa base inversa. Por
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consiguiente, estas caractensticas de la grna glenoidea permiten que un cirujano utilice la grna glenoidea para una artroplastia anatomica o inversa del hombro. Como se describe a continuacion, los diferentes agujeros u orificios adicionales pueden orientar los orificios que se perforan antes de la implantacion de los tornillos de la placa base. Los orificios adicionales pueden orientarse para posicionar cada tornillo de la placa base en la mejor reserva osea disponible y pueden controlar la profundidad del orificio del tornillo. La profundidad sena controlada por protuberancias construidas sobre la grna. Un taladro de acoplamiento se puede utilizar con un tope ffsico incorporado en el. El tope hana referencia al saliente construido sobre la grna, por lo tanto, controlando con precision la profundidad del agujero del tornillo.
Haciendo referencia a las figuras 1 y 2, se ilustra un implante 100 inverso de hombro de la tecnica anterior. El implante 100 inverso de hombro incluye un vastago 102 humeral, una bandeja 107 humeral, un cojinete 110 humeral, una glenosfera 111 y una placa 124 base que tiene una porcion 126 de placa y un saliente 128 central. El vastago 102 humeral esta implantado en el hueso 70 humeral y tiene un extremo 104 proximal acoplado a traves de una conexion conica de Morse a un cono 108 macho que se extiende desde una placa 106 de la bandeja 107 humeral. La glenosfera 111 puede ser modular e incluir una cabeza 112 que se articula con el cojinete 110 y un componente 115 de doble conico desplazado. El componente 115 de doble conico tiene una primera porcion 114 conica acoplada a una abertura 113 conica correspondiente de la cabeza 112 y una segunda porcion 116 conica acoplada al saliente 128 central de la placa 124 de base glenoidea. Un tornillo 118 central pasa a traves de la placa 124 de base en la cara glenoidea 80 de la escapula del paciente. Los tornillos 120 perifericos se utilizan para bloquear la placa base 124 en la cara 80 glenoidea. La figura 3A ilustra el uso de un pasador 150 de grna para guiar el escariado de la cara 80 glenoidea en la artroplastia inversa de hombro usando un escariador 130. La figura 3B ilustra el pasador 150 de grna a traves de un orificio 90 perforado a traves de la cara 80 glenoidea. El pasador 150 de grna se usa para guiar la colocacion de un implante anatomico o inverso, como se discute a continuacion.
Haciendo referencia a la figura 4, se ilustra un implante 180 de hombro anatomico de la tecnica anterior. El implante de hombro 100 anatomico incluye un vastago 182 humeral, una glenosfera 184 y un cojinete 186 con clavijas 190 perifericas y una clavija 188 central extrafble o no extrafble.
Haciendo referencia a las figuras 5-8, se ilustra una grna 200 glenoidea espedfica para el paciente. La grna 200 glenoidea espedfica del paciente esta configurada para guiar un pasador de grna (tal como el pasador 150 de grna mostrado en las figuras 3A y 3B) y proporciona una orientacion de alineacion del implante para la artroplastia de hombro anatomica e inversa a discrecion del cirujano. La grna 200 glenoidea tiene una superficie 202 superior (o externa) y una superficie 204 inferior (o interna) o la superficie 204 espedfica del paciente y de la anatoirna que hace referencia (sustancialmente como negativa o inversa o espejo) a la cara 80 glenoidea y puede incluir toda o una porcion del labrum 82, es decir, la estructura cartilaginosa periferica que rodea y profundiza la cara 80 glenoidea. Alternativamente, el labrum 82 puede ser completamente removido de manera que la superficie 204 glenoidea espedfica del paciente haga referencia y refleje solamente la superficie osea de la cavidad glenoidea o la cara 80 glenoidea. Opcionalmente, la grna 200 glenoidea puede incluir una porcion periferica o labio 206 periferico con una superficie 205 periferica correspondiente espedfica del paciente que se acopla con una superficie periferica correspondiente o borde 84 glenoideo alrededor de la escapula del paciente. Una primera grna 216 tubular de perforacion (o anatomica) puede extenderse desde la superficie 202 superior de la grna 200 glenoidea en un lugar espedfico y a lo largo de un primer eje A que se determina y disena de acuerdo con el plan preoperatorio del paciente para definir un eje de alineacion anatomico espedfico del paciente y un punto de insercion para un pasador 150 de grna. Una segunda grna 214 de perforacion tubular alargada (o reversa) puede extenderse desde la superficie 202 superior de la grna glenoidea a lo largo de un segundo eje B que se determina y disena de acuerdo con el plan preoperatorio del paciente para definir un eje de alineacion inversa espedfico para el paciente y un punto de insercion para un pasador 150 de grna. El eje B de alineacion inversa puede tener una inclinacion inferior predeterminada con respecto al eje A de alineacion anatomico, tal como, por ejemplo, una inclinacion inferior de diez grados. Las grnas 216, 214 de perforacion primera y segunda definen orificios 224 y 222 alargados correspondientes para guiar una broca de perforacion y/o insertar un pasador de alineacion o pasador 150 de grna. Cada grna 216, 214 de perforacion puede incluir aberturas alargadas o ventanas 226 de vision a su traves. La grna 216 anatomica de perforacion y la grna 214 de perforacion inversa pueden incluir marcas 220, 218 visuales y/o tactiles correspondientes que indican sus funciones correspondientes para facilitar la identificacion y evitar confusiones. Las marcas pueden ser, por ejemplo, letras elevadas usando las palabras ANATOMICA para marcar 220 e INVERSA para marcar 218. Adicionalmente, la marca 219 puede proporcionarse con otra informacion espedfica del paciente, tal como, por ejemplo, identificacion del paciente, procedimiento, etc. Las grnas 216, 214 de perforacion anatomicas e inversas pueden estar conectadas con una banda o brida 230 para una estabilidad adicional y pueden acoplarse de forma removible (Por ejemplo, mediante un encaje a presion o una conexion roscada) a la grna 200 glenoidea o firmemente fijada a la grna 200 glenoidea.
Con referencia continua a las figuras 5-8, la grna 200 glenoidea espedfica para el paciente puede incluir una porcion 212 de superficie externa espedfica del paciente que puede referirse a una porcion 86 de superficie correspondiente del procedimiento 88 coracoides o la fijacion coracoides. La grna 200 glenoidea espedfica del paciente tambien puede incluir una ranura 208 a traves del labio 206 periferico para su visualizacion y opcionalmente marcado por el cirujano. El cirujano puede, por ejemplo, ajustar la grna 200 glenoidea espedfica del paciente sobre un modelo de hueso espedfico para el paciente y marcar el modelo de hueso a traves de la ranura 208. El modelo de hueso
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espedfico del paciente tambien se construye durante el mismo plan preoperatorio a partir de las imagenes tridimensionales de la articulacion a partir de la cual se disena y construye la gma 200 glenoidea espedfica para el paciente. El cirujano puede ver el modelo de hueso marcado y ser guiado para el posicionamiento aproximado de la gma glenoidea en el hueso del paciente. La gma 200 glenoidea, por supuesto, solo encaja en el hueso de forma unica (solo en una posicion, ajuste unico). El marcado acelerara la colocacion de la gma 200 glenoidea espedfica del paciente sin ensayos innecesarios para encontrar la ubicacion de ajuste unico. La gma 200 glenoidea espedfica del paciente tambien puede incluir un bloque (u otro soporte) 210 que se extiende por encima de la superficie 202 superior y configurado para permitir que el cirujano sostenga y estabilice la gma 200 glenoidea espedfica del paciente. El bloque 210 puede ser dimensionado y conformado para acomodar un pulgar o uno o mas dedos del cirujano.
Adicionalmente, la gma 200 glenoidea espedfica del paciente puede incluir una muesca 223 de alineacion periferica que se puede usar para marcar la superficie glenoidea. La marca realizada a traves de la muesca 223 puede usarse con un saliente 321 de una gma 320 de perforacion secundaria para el alineamiento rotacional de la gma 320 de perforacion secundaria, como se describe a continuacion en referencia a las figuras 10 y 11.
Con referencia a las figuras 3A, 3B, 4 y 7, la gma 200 glenoidea puede usarse para la artroplastia anatomica para perforar un orificio 90 en la cara 80 glenoidea a traves de la gma 216 anatomica de perforacion e insertar un pasador gma u otro alambre K 150. El pasador 150 de gma puede usarse para guiar la alineacion predeterminada del cojinete 186 en la cara 80 glenoidea para su implantacion en la artroplastia anatomica.
Con referencia a las figuras 2, 3A, 3B y 7, en la artroplastia inversa, la gma glenoidea 200 puede usarse para perforar un orificio 90 en la cara glenoidea 80 a traves de la gma de perforacion inversa 214 para insertar un pasador gma u otro alambre K 150. El pasador de guiado 150 puede utilizarse para guiar la alineacion predeterminada de la placa de base 124 mostrada en la figura 1 (o placa base 300 mostrada en la figura 9 y discutida mas adelante) en la cara glenoidea 80 para implantacion en artroplastia inversa.
Adicionalmente, y con referencia a las figuras 9-11, se puede usar una gma 320 de perforacion secundaria para perforar orificios de tornillo para fijacion de la placa de base. La gma 320 de perforacion secundaria se puede unir a una placa 300 de base de un implante de artroplastia inversa de hombro y proporcionar trayectorias de orificios de perforacion que posicionan los tornillos de fijacion a lo largo de trayectorias que se determinan preoperatoriamente para tener la mejor reserva de hueso, como hueso cortical sano, en terminos de fuerza, accesibilidad y otros factores. La gma 320 de perforacion secundaria puede montarse sobre la placa 300 de base despues de que la placa 300 de base haya sido impactada dentro del glenoideo. Alternativamente, la gma 320 de perforacion secundaria puede estar unida a la placa 300 de base durante la impactacion. La gma 320 de perforacion secundaria puede incluir un saliente 321 que esta alineado con la marca realizada a traves de la muesca 223 de alineacion periferica de la gma 200 acetabular espedfica del paciente para orientar la gma 320 de perforacion secundaria de acuerdo con el plan preoperatorio para el procedimiento.
La placa de base 300 puede incluir una cara 306 superior, un orificio 304 central que pasa a traves de una clavija 308 de fijacion central de la placa 300 de base y una pluralidad de orificios 302 de fijacion perifericos (se muestran cuatro orificios en la figura 9). La gma 320 de perforacion secundaria tiene una cara 322 superior y una cara opuesta que se acopla con la cara 306 superior de la placa 300 de base. Un poste central (o saliente) 326 con un orificio 325 de paso y una pluralidad de postes 324 perifericos con correspondientes orificios 323 de paso que se extienden desde la cara 322 superior de la gma 320 de perforacion secundaria y comunican con el agujero 304 central correspondiente y agujeros 302 de fijacion perifericos de la placa 300 de base.
La gma 320 de perforacion secundaria puede controlar la orientacion del taladro a traves de orificios que se perforan previamente a traves de los orificios 323 de la gma 320 de perforacion secundaria. La gma 320 de perforacion secundaria puede controlar la profundidad del taladro usando alturas de poste controladas para los postes 324, 326. Las alturas de los postes 324, 326 (su longitud por encima de la superficie 322 superior) y las orientaciones de taladro pueden determinarse y configurarse en la gma 320 de perforacion secundaria durante el plan preoperatorio del paciente sobre la base de las imagenes reconstruidas 3D de la articulacion del hombro del paciente. Un taladro 340 de acoplamiento con la broca 342 de perforacion puede tener un elemento 350 de tope ffsico, como se muestra en la figura 11. El elemento 350 de tope en el taladro 340 y las alturas de poste controladas espedficas del paciente en la gma 320 de perforacion secundaria pueden proporcionar control de profundidad. La gma 320 de perforacion secundaria puede estar disenada para asegurar que los tornillos de fijacion para la placa 300 de base alcancen suficiente soporte bicortical.
La gma 200 glenoidea de las presentes ensenanzas tambien puede proporcionar una parada ffsica para el escariado glenoideo. Por ejemplo, la profundidad de escariado se puede determinar preoperatoriamente y se puede insertar un alambre gma o pasador 150 de gma a la profundidad predeterminada, vease la figura 3A. El escariador 130 puede hacerse para hacer referencia al pasador de guiado 150 de manera que la profundidad de corte del escariador 130 se limite a la profundidad predeterminada para el escariado glenoideo anatomico y reverso.
Generalmente, la gma 200 glenoidea espedfica para el paciente de las presentes ensenanzas hace referencia a los puntos de referencia en el glenoideo para orientar la gma 200 glenoidea en una orientacion predeterminada de
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acuerdo con un plan preoperatorio para el paciente espedfico. Los puntos de referencia pueden incluir, por ejemplo, la cara 80 glenoidea con o sin ninguna parte del labrum 82, el proceso 88 coracoides (o partes de los mismos o la union coracoides), el borde 84 glenoideo y/u otros puntos de referencia de la escapula. La gma 200 glenoidea espedfica del paciente puede usarse para orientar correctamente un alambre de gma o pasador 150 de guiado que se usara en procedimientos de preparacion de glenoideas posteriores. La gma 200 glenoidea espedfica para el paciente puede incluir gmas 214, 216 de perforacion o elementos similares que permiten usar la gma 200 glenoidea para reemplazos anatomicos e inversos del hombro. La gma 200 glenoidea tambien se puede disenar de manera que pueda orientar una gma de perforacion glenoidea secundaria.
Resumiendo, la gma 200 glenoidea espedfica del paciente puede usarse para posicionar un alambre gma en una posicion y orientacion predeterminada (punto de insercion) para su uso en un reemplazo anatomico del hombro (eje A mostrado en la figura 7) o reemplazo del hombro inverso (eje B mostrado en la figura 7). La gma 200 glenoidea espedfica del paciente puede referenciar puntos de referencia en el glenoideo o la escapula para proporcionar una base segura para la gma 200 glenoidea espedfica del paciente. La orientacion predeterminada puede disenarse y configurarse en la gma 200 glenoidea espedfica del paciente para el posicionamiento del implante, el control de la version del implante y el control de la inclinacion del implante.
Se pueden incorporar varios metodos adicionales en el plan preoperatorio para la colocacion exacta de la gma 200 glenoidea y para posicionar un pasador 150 central a traves del glenoideo para propositos adicionales, tales como version, inclinacion, punto de insercion del pasador u otro control de alineacion y gma de los implantes glenoideos. Como se ha discutido anteriormente, estos metodos incluyen la identificacion de puntos de referencia y software (o algoritmos) usados para posicionar el pasador gma como parte de un plan preoperatorio para el paciente espedfico. El software y los puntos de referencia se pueden utilizar para crear la gma 200 espedfica del paciente u otras gmas similares para usar durante la cirugfa de hombro. Los algoritmos y las entradas del cirujano (que definen ligeros ajustes al algoritmo de inclinacion inferior/superior, control de versiones y posicion de los pines) se pueden incorporar en software preoperatorio espedfico que un cirujano puede usar interactivamente para crear una gma glenoidea virtual. La gma 200 glenoidea espedfica para el paciente ffsico se puede fabricar preoperatoriamente desde la gma glenoidea virtual con entrada del cirujano y se puede usar intraoperativamente para posicionar con precision el pasador 150 de guiado en la ubicacion/orientacion correcta a traves del glenoideo. Despues de que se coloca el pasador 150 de guiado, se puede usar otra instrumentacion de preparacion glenoidea con referencia a este pasador gma. El plan preoperatorio tambien puede proporcionar al cirujano los detalles de la cantidad y forma de un injerto de hueso o eliminacion de hueso que se puede utilizar para corregir la version natural. Ademas, el plan preoperatorio puede usarse para orientar y determinar adecuadamente la longitud de los tornillos de fijacion usados en una artroplastia inversa de hombro para asegurar que los tornillos esten anclados en la mejor reserva osea disponible para el paciente.
Como se ha descrito anteriormente, la gma 200 glenoidea espedfica del paciente puede encajar alrededor o sobre el borde glenoideo expuesto y sobre la superficie sustancialmente como un negativo de la anatoirna correspondiente del paciente e incluye formaciones de gma o gmas de perforacion para guiar la orientacion seleccionada/predeterminada del pasador de gma para la artroplastia anatomica e inversa. Ademas, la gma 200 glenoidea puede coincidir con defectos e imperfecciones en el glenoideo del paciente espedfico.
La gma 200 glenoidea espedfica para el paciente puede usarse tanto para la artroplastia anatomica como reversa y puede usarse incluida en cualquier kit de artroplastia anatomica e inversa con implantes correspondientes y otros instrumentos. Ademas, la gma 200 glenoidea espedfica para el paciente puede incluirse en un kit de cirujano completo junto con el implante 100 inverso de hombro, la gma 320 de perforacion secundaria, la placa 300 de base y el implante 180 de hombro anatomico para permitir al cirujano cambiar entre la artroplastia inversa y la anatomica durante el procedimiento.
Para procedimientos de hombro inverso, la gma 200 glenoidea espedfica del paciente puede incorporar a traves de la correspondiente gma 214 de perforacion tubular inversa una inclinacion inferior incorporada del pasador 150 de gma central para la orientacion del implante glenoideo. Un implante glenoideo inclinado inferiormente proporciona un rango apropiado de movimiento y reduccion de tensiones alrededor del implante. Ademas, el plan preoperatorio (es decir, el software o el conjunto de aplicaciones o datos o dibujos y modelos utilizados para preparar el plan preoperatorio) puede analizar la mejor reserva osea y apuntar los tornillos perifericos y centrales hacia la mejor reserva osea. El plan preoperatorio tambien se puede usar para determinar con precision la longitud apropiada del tornillo.
En algunas realizaciones, la gma glenoidea espedfica del paciente puede incluir un bloque elevado configurado para estabilizar la gma glenoidea utilizando uno o mas dedos, tales como el pulgar u otros dedos del cirujano.
En algunas realizaciones, el software interactivo puede usarse durante el plan preoperatorio para que el paciente pueda proporcionar al cirujano la cantidad de injerto oseo necesario para restaurar la version natural para un paciente espedfico. El software interactivo puede, por ejemplo, especificar el numero de milfmetros de injerto oseo a anadir en la parte gastada del glenoideo. El cirujano tambien puede planear escariar una porcion del glenoideo para restaurar la version y tener la cantidad de hueso que se eliminara proporcionada por el software interactivo.
La descripcion anterior de las realizaciones se ha proporcionado con fines de ilustracion y descripcion. No pretende ser exhaustiva ni limitar la divulgacion. Los elementos o caractensticas individuales de una realizacion particular no estan generalmente limitados a esa realizacion particular, pero, cuando sea aplicable, son intercambiables y pueden usarse en una realizacion seleccionada, incluso si no se muestra o describe espedficamente. Lo mismo puede 5 variar de muchas maneras. Tales variaciones no deben considerarse como un alejamiento de la divulgacion, y todas estas modificaciones estan destinadas a ser incluidas dentro del alcance de la descripcion.
Se proporcionan ejemplos de realizacion de manera que esta descripcion sera completa y transmitira completamente el alcance a los expertos en la tecnica. Numerosos detalles espedficos se exponen tales como ejemplos de componentes, dispositivos y metodos espedficos, para proporcionar una comprension completa de las 10 realizaciones de la presente descripcion. Sera evidente para los expertos en la tecnica que no es necesario emplear detalles espedficos, que las realizaciones de ejemplo pueden estar incorporadas en muchas formas diferentes y que ninguna de las dos debe interpretarse como limitativa del alcance de la presente invencion como se define en las reivindicaciones adjuntas.
En algunas realizaciones de ejemplo, no se describen en detalle procedimientos bien conocidos, estructuras de 15 dispositivo bien conocidas y tecnologfas bien conocidas.
Claims (13)
- 5101520253035404550REIVINDICACIONES1. Un dispositivo ortopedico para una articulacion de hombro de un paciente que comprende:Una grna (200) glenoidea que tiene una superficie (202) superior y una superficie (204) inferior, en la que la superficie inferior es una superficie espedfica del paciente, configurada como una superficie negativa de una cara (80) glenoidea basada en una imagen tridimensional de una articulacion de hombro de un paciente reconstruido preoperatoriamente a partir de exploraciones de imagen de la articulacion de hombro del paciente, incluyendo la grna glenoidea una primera grna (216) de perforacion, caracterizado porque dicha primera grna de perforacion es tubular y se extiende desde la superficie superior a lo largo de un primer eje (A) de alineacion configurado preoperativamente con una orientacion espedfica del paciente y un lugar de insercion para guiar un implante glenoideo en la cara glenoidea,en donde la grna glenoide incluye una segunda grna (214) de perforacion tubular que se extiende desde la superficie superior a lo largo de un segundo eje (B) de alineacion configurado preoperatoriamente con una orientacion y ubicacion espedfica del paciente para guiar un implante glenoideo en la cara glenoidea,y en donde la primera grna tubular y el primer eje de alineacion estan configurados para la artroplastia anatomica del hombro y en donde la segunda grna tubular de perforacion y el segundo eje de alineacion estan configurados para la artroplastia de hombro inversa.
- 2. El dispositivo ortopedico de la reivindicacion 1, en donde las grnas de perforacion tubular primera y segunda estan conectadas con una banda (230).
- 3. El dispositivo ortopedico de la reivindicacion 1, en donde cada una de las grnas de perforacion tubulares primera y segunda incluye orificios (226) de vision alargados correspondientes.
- 4. El dispositivo ortopedico de la reivindicacion 1, en donde la grna glenoidea incluye una superficie periferica espedfica del paciente que forma un labio (206) configurado como un negativo de un borde (84) glenoideo del paciente, en donde el labio incluye una ranura (208) de paso configurada para ver y marcar la cara glenoidea.
- 5. El dispositivo ortopedico de la reivindicacion 1, en donde la grna glenoidea incluye una porcion (212) de superficie periferica espedfica para el paciente, configurada como un negativo de una superficie (86) coracoides del paciente.
- 6. El dispositivo ortopedico de la reivindicacion 1, en donde la grna glenoidea incluye una muesca (223) de alineacion para marcar la cara glenoidea.
- 7. El dispositivo ortopedico de la reivindicacion 1, que comprende ademas una grna (320) de perforacion configurada para acoplarse con un implante (300) de placa base para artroplastia inversa, incluyendo la grna de perforacion un poste (324, 326) de perforacion tubular central que tiene un eje de perforacion espedfico del paciente orientado a lo largo del segundo eje de alineacion.
- 8. El dispositivo ortopedico de la reivindicacion 7, en donde el poste de perforacion tubular central esta configurado para tener una altura espedfica para el paciente para controlar la profundidad de perforacion a traves del mismo, comprendiendo ademas una perforacion (342) que tiene un tope (350) configurado para acoplar el poste de perforacion central para controlar la profundidad de la perforacion a traves del mismo.
- 9. El dispositivo ortopedico de la reivindicacion 8, en donde la grna de perforacion incluye una pluralidad de postes (324, 326) de perforacion tubulares perifericos que tienen la orientacion y altura espedfica del paciente.
- 10. El dispositivo ortopedico de la reivindicacion 6, que comprende ademas una grna (320) de perforacion configurada para acoplarse a un implante (300) de placa de base para artroplastia inversa, incluyendo la grna de perforacion un poste (324, 326) de perforacion tubular central que tiene un eje de perforacion espedfico del paciente orientado a lo largo del segundo eje de alineacion y un saliente (321) configurado para alinearse con la marca realizada por la muesca de alineacion.
- 11. El dispositivo ortopedico de la reivindicacion 1, que comprende ademas un bloque (210) que se extiende desde la superficie superior de la grna glenoidea y esta configurado para estabilizar la grna glenoidea utilizando al menos un dedo de un cirujano.
- 12. El dispositivo ortopedico de la reivindicacion 1, en donde el segundo eje de alineacion es un eje de alineacion inversa, y el primer eje de alineacion es un eje de alineacion anatomico.
- 13. El dispositivo ortopedico de la reivindicacion 1, en donde el segundo eje de alineacion comprende un eje de alineacion inversa, y en donde el eje de alineacion inversa esta inclinado inferiormente con respecto al primer eje de alineacion que es un eje de alineacion anatomica; y que comprende ademasun implante de artroplastia de hombro invertida que incluye una placa base;un implante anatomico de artroplastia de hombro; yuna gma de perforacion secundaria configurada para acoplarse al implante de placa de base para la artroplastia inversa, incluyendo la gma de perforacion secundaria un poste de perforacion tubular central que tiene un eje de perforacion espedfico del paciente orientado a lo largo del eje de alineacion inversa.5 14. El dispositivo ortopedico de la reivindicacion 13, en donde la gma glenoidea incluye una muesca periferica paramarcar la gma glenoidea y de perforacion secundaria que incluye un saliente configurado para alinearse con una muesca realizada a traves de la muesca periferica en el glenoideo.
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EP2770918B1 (en) | 2017-07-19 |
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WO2013062848A1 (en) | 2013-05-02 |
US20200046381A1 (en) | 2020-02-13 |
EP2770918A1 (en) | 2014-09-03 |
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