FR2652498A1 - Modular assembly for a shoulder prosthesis - Google Patents

Modular assembly for a shoulder prosthesis Download PDF

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Publication number
FR2652498A1
FR2652498A1 FR8913366A FR8913366A FR2652498A1 FR 2652498 A1 FR2652498 A1 FR 2652498A1 FR 8913366 A FR8913366 A FR 8913366A FR 8913366 A FR8913366 A FR 8913366A FR 2652498 A1 FR2652498 A1 FR 2652498A1
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FR
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Application
Patent type
Prior art keywords
shoulder
part
assembly
elements
prosthesis
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.)
Granted
Application number
FR8913366A
Other languages
French (fr)
Other versions
FR2652498B1 (en )
Inventor
Colombier Michel
Throuilloud Pierre
Marsan Cyprien
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MEDINOV
Original Assignee
MEDINOV
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Filing date
Publication date

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/40Joints for shoulders
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86Threaded wires, pins or screws; Nuts therefor
    • A61B17/8605Heads, i.e. proximal ends projecting from bone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/40Joints for shoulders
    • A61F2/4081Glenoid components, e.g. cups
    • AHUMAN NECESSITIES
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    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/40Joints for shoulders
    • A61F2/4059Humeral shafts
    • AHUMAN NECESSITIES
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    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
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    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331Connections 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
    • A61F2002/30332Conically- or frustoconically-shaped protrusion and recess
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2002/30354Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
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    • A61F2002/30331Connections 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
    • A61F2002/3038Connections 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 made by pushing a key or a peg into a mating slot or hole
    • AHUMAN NECESSITIES
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    • A61F2/00Filters 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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    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
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    • A61F2002/30329Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/305Snap connection
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    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604Special structural features of bone or joint prostheses not otherwise provided for modular
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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604Special structural features of bone or joint prostheses not otherwise provided for modular
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    • A61F2/30Joints
    • A61F2/40Joints for shoulders
    • A61F2/4081Glenoid components, e.g. cups
    • A61F2002/4085Glenoid components, e.g. cups having a convex shape, e.g. hemispherical heads
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/006Additional features; Implant or prostheses properties not otherwise provided for modular
    • A61F2250/0062Kits of prosthetic parts to be assembled in various combinations for forming different prostheses
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00017Iron- or Fe-based alloys, e.g. stainless steel
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00029Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00179Ceramics or ceramic-like structures

Abstract

The subject-matter of the invention relates to the technical sector concerning orthopaedic implants, in particular shoulder prostheses. The modular assembly for a shoulder prosthesis is distinguished by the fact that it comprises a combination of an element (1) which is capable of being implanted in the humeral shaft and whose head is designed to receive interchangeable elements (2-3) which are attached thereon and whose shapes and profiles are adapted to cooperate either directly with a part of the shoulder or with complementary elements (4-7) designed to be implanted in a part of the said shoulder, depending on the nature of the fracture or other condition to be treated. <IMAGE>

Description

L'invention se rattache au secteur technique des implants orthopédiques, notamment des prothèses d'épaules. The invention relates to the technical sector of orthopedic implants, including shoulder prostheses.

On connait différentes formes de réalisation de prothèses aptes å traiter les épaules détruites. We know different embodiments of suitable prosthetic å handle destroyed shoulders.

La plupart d'entre elles sont conformées pour reproduire les surfaces anatomiques de l'articulation, mais ne donnent pas satisfaction lorsque la coiffe des rotateurs est détruite. Most of them are shaped to replicate the anatomic joint surfaces, but not satisfactory when the rotator cuff is destroyed.

La prothèse d'épaule définie dans la demande de brevet français N. 3710495 tend a remédier a ces inconvénients. The shoulder prosthesis defined in the French patent application N. 3710495 tends to remedy these drawbacks.

Cette prothèse est du type de celle comprenant une pièce malte sphérique destinée à être fixée à la glène de l'omoplate en étant apte à coopérer avec un élément humoral sous forme d'une cupule sphérique solidaire d'une tige apte a être implantée dans la diaphyse humérale. This prosthesis is of the type comprising a spherical malt piece intended to be fixed to the glenoid cavity of the scapula being adapted to cooperate with a humoral component in the form of a spherical cup integral with a stem adapted to be implanted in the humeral shaft.

Cette forme de prothèse est plus particulièrement adaptée pour traiter les cas de rupture de coiffe susceptible de détruire complètement la stabilité de l'épaule. This type of prosthesis is particularly suited for treating cases of rotator cuff may completely destroy the stability of the shoulder. Son application est donc limitée et ne peut traiter tous les cas cliniques Its application is limited and can not treat all clinical cases
Le problème que se propose de résoudre l'invention est de pouvoir traiter la plupart des traumatismes de l'articulation de l'épaule, à partir d'un ensemble prothétique composé d'éléments modulaires interchangeables soit au moment de l'opération soit ultérieurement au cours de l'évolution du cas Datllologique du patient. The problem to be solved by the invention is able to treat most injuries to the shoulder joint, from a prosthetic assembly comprising interchangeable modular elements either at the time of the operation or subsequently to during the evolution of the case Datllologique patient.

Le problème posé est résolu en ce qu'il a été conçus et mis au point un ensemble modulaire pour prothèse de l'épaule, qui comprend, en combinaison, un#élément apte à être implanté dans le fut huméral et dont la tête est conformée pour recevoir, d'une manière rapportée, des éléments interchan geables dont les formes et profils sont adaptés pour coopérer soii directement avec une partie de l'épaule, soit avec des éléments complémentaires conformés pour être implantés dans une partie de ladite épaule, en fonction de la nature de la fracture ou autre a traiter. The problem posed is solved in that it has been designed and developed a modular assembly for shoulder prosthesis which comprises in combination, a # member adapted to be implanted in the humeral shaft and whose head is shaped for receiving, from an attached manner of interchan geable elements whose shapes and profiles are adapted to cooperate soii directly with a portion of the shoulder or with additional components configured to be implanted into a portion of said shoulder, depending the nature of the fracture or other treat.

En fonction du choix et de la sélection des éléments, il est possible de traiter les fractures comminutives de la tête humérale, les omarthroses avec destruction de la glène et les différents cas de rupture de coiffe Depending on the choice and selection of the elements, it is possible to treat comminuted fractures of the humeral head, omarthroses with destruction of the glenoid and the various cases of rotator cuff
Pour résoudre le problème posé du traitement des To solve the problem of the treatment of
Fractures communitîves de la tête humérale, les éléments interchangeables comprennent une sphère humérale apte à coopérer directement en appui sur la glène. communitîves fractures of the humeral head, the interchangeable elements comprise a humeral sphere adapted to cooperate directly in abutment on the glenoid.

Pour résoudre le problème posé du traitement des omarthroses avec destruction de la glène, les éléments interchangeables comprennent une sphère humérale apte a coopérer avec une cupule glênoidienne de forme complémentaire. To resolve the problem omarthroses of treatment with destruction of the glenoid, the interchangeable elements comprise a humeral sphere capable of cooperating with a glenoid cup complementary shape.

Pour résoudre le problème posé des cas de rupture de coiffe, les éléments interchangeables comprennent une cupule sphérique apte coopérer avec une pièce male sphérique faisant office d'organe glénoidien. To resolve the problem of the case of rotator cuff, the interchangeable elements comprise a spherical cup adapted to cooperate with a spherical male part acting as a glenoid element.

Un autre problème que se propose de résoudre l'invention est d'assurer une fixatIon sûre et efficace sans risque de descellement de la cupule glénoidienne et de l'organe glénoidien. Another problem to be solved by the invention is to provide a safe and effective fixing without the risk of loosening of the glenoid cup and glenoid body. Dans ce but, la cupule glénoidienne ou l'organe glénoidien sont conformés pour être fixés sur un support agencé pour être implantés dans la glène. To this end, the glenoid or glenoid cup member are shaped to be fixed to a support arranged to be implanted in the glenoid cavity.

Avantageusement, le problème posé est résolu en ce que le support est fixé dans la glène au moyen de vis divergentes disposées de manière à être en alignement ou ensiblement en alignement respectivement avec le pilier de l'omoplate, le pilier coracoidien et le pilier acromial. Advantageously, the object is achieved in that the support is fixed in the glenoid cavity by means of divergent screw arranged to be in alignment or ensiblement in alignment respectively with the pillar of the scapula, coracoid the pillar and the pillar acromial. Les is étant à pas différentiel. The differential is not being.

Dans une forme particulière de réalisation, le support présente un plateau circulaire recevant dans son épaisseur les vis, ledit plateau étant prolongé par une portée coaxiale creuse de centrage pour être engagée dans un trou formé dans la glène. In a particular embodiment, the support has a circular plate in its thickness receiving the screw, said plate being prolonged by a hollow coaxial centering bearing to be engaged in a hole formed in the glenoid.

Pour assurer la fixation de la cupule glénoidienne sur le support, cette dernière présente une portée interne circulaire agencée pour être fixée sur le plateau du support. To ensure the fixation of the glenoid cup on the support, the latter has a circular internal bearing surface arranged to be secured to the tray support.

Pour assurer la fixation de l'organe glénoidien sur le support1 ledit organe présente une portée interne circulaire agencée pour être fixée sur le plateau du support et, d'une zanière coaxiale, une tige destinée a être engagée dans l'alésage de la portée de centrage dudit support, de manière à avoir le centre d'application de la résultante des efforts à l'intérieur de la glène To ensure the fixation of the glenoid support1 member on the said member has a circular internal bearing surface arranged to be secured to the tray support and a zanière coaxial, for a rod to be engaged in the bore of the scope of centering said support, so as to have the center of application of the resultant of the forces within the glenoid
La tête sphérique de l'organe glénoidien peut, d'une manière connue, être exécutée en acier inoxydable, en céramique, en alliage a base de titane ou de cobalt ou autre produit biocompatible. The spherical head of the glenoid body may, in known manner, be carried out in stainless steel, ceramic, titanium alloy or cobalt or another biocompatible product. Le support sur lequel est vissé l'organe glènoYdien ou la cupule glenoïdienne est en acier traité.Les cupules humérales et glénoidienne sont en polyéthylène. The support on which is screwed the glènoYdien organ or glenoid cup is steel traité.Les wells humeral and glenoid are made of polyethylene.

L'Invention est exposée, ci-après, plus en détail, a l'aide des dessins annexés, dans lesquels The invention is exposed below in greater detail, has the accompanying drawings, wherein
La figure 1 est une vue en perspective montrant les principaux éléments de l'ensemble prothétique selon l'invention, lesdits éléments étant représentes avant montage. Figure 1 is a perspective view showing the main elements of the prosthetic assembly according to the invention, said elements being shown before assembly.

Les figures 2 à 4 sont des vues à caractère schématique montrant les principales utilisations des éléments de prothèse, en jonction des fractures à traiter, notamment Figures 2 to 4 are schematic views showing the main uses of prosthetic components, junction fractures treated, in particular
- la figure 2 montre l'application de l'ensemble prothètique pour le traitement d'une fracture communitive de la tête humérale - Figure 2 shows the application of the prosthetic assembly for the treatment of a comminuted fracture of the humeral head
- la figure 3 montre l'application de l'ensemble nothètique pour le traitement d'une omarthrose, avec destruction de la glène. - Figure 3 shows the application of all nothètique for the treatment of glenohumeral osteoarthritis, with destruction of the glenoid.

- la figure 4 montre l'application de l'ensemble prothètique dans le cas d'une rupture de coiffe. - Figure 4 shows the application of all prosthetic in the case of a rotator cuff tear.

La figure 5 est une vue en coupe longitudinale montrant l'ensemble prothètique adapté pour le traitement d'une fracture communîtive de la tète humérale. Figure 5 is a longitudinal sectional view showing the prosthetic assembly adapted for treating a comminuted fracture of the humeral head.

La figure 6 est une vue en coupe longitudinale montrant le traitement d'une omarthrose, avec destruction de la glène. Figure 6 is a longitudinal sectional view showing the treatment of a glenohumeral osteoarthritis, with destruction of the glenoid.

La figure 7 est une vue partielle en coupe longitudinale montrant l'application de l'ensemble pr#othètique dans le cas d'une rupture de coiffe. Figure 7 is a partial view in longitudinal section showing the application of all pr # othètique in the case of a rotator cuff tear.

Comme le montre plus particulièrement la figure 1, l'ensemble modulaire pour prothèse de l'épaule comprend un élément de base (1), conformé pour être implanté dans la diaphyse de l'humérus CE). As shown more particularly in Figure 1, for the modular shoulder prosthesis assembly includes a base member (1), configured to be implanted in the diaphysis of the humerus EC). D'une manière connue, l'élément (1) comprend une tige d'ancrage Cla) prolongée dans sa partie supérieure, par une tête (lb) présentant un évidemment (ic) agencé pour recevoir, d'une manière rapportée, différents types d'éléments interchangeables, comme il sera indiqué dans la suite de la description. In known manner, the element (1) comprises an anchor rod Cla) extended in its upper part by a head (lb) having a recess (ic) arranged for receiving, from an attached manner, various types interchangeable elements, as will be described in the following description.

Avantageusement, , la tête (1b) de l'élément huméral Cl) présente en débordement de sa périphérie externe, une ou plusieurs aspérités faisant office d'aileron (nid). Advantageously, the head (1b) of the humeral element Cl) has protruding from its outer periphery, one or more protrusions being fin office (nest). Le nombre de ces ailerons est fonction de la dimension de la tête (lb). The number of fins depends on the size of the head (lb). Dans l'exemple Illustré, l'élément huméral présente trois ailerons décalés angulalrement de 45 . In the illustrated example, the humeral element has three fins offset angulalrement 45. Ces ailerons, après mise en place de l'élément huméral sont ancrés dans la corticale, en constituant des éléments stabilisateurs anti-rotatoire pour une implantation sans ciment. These fins, after positioning of the humeral element are anchored in the cortical bone by forming anti-rotation stabilizing elements for implantation without cement. En outre# ces ailerons (ld) peuvent être percés de trous pour permettre au chirurgien d'y engager d'une manière connue, un fil de fixation. Furthermore # these fins (LD) may be pierced with holes to allow the surgeon to engage them in a known manner, a fastening wire.

D'une manière connue, la tige (ta) présente tout type d'agencement et/ou de profil pour permettre son ancrage dans le canal modulaire de l'humérus avec ou non l'apport d'un ciment. In known manner, the rod (ta) has any type of arrangement and / or profile to allow its anchorage in the modular canal of the humerus with or without the addition of a cement. De même, la tête (lob) est orientée angulairement par rapport a la tige pour être convenablement positionnée après résection de l'extrémité supérieure de l'humérus. Similarly, the head (lob) is angularly oriented with respect to the rod to be properly positioned after resection of the upper end of the humerus. Cet élément huméral (1) est en outre, exécuté en tout matériaux connu et approprié. The humeral component (1) is also executed in any known and appropriate materials.

Comme indiqué, la tête (lob) de l'élément Ci) est destinée à recevoir notamment d'une manière démontable, des éléments interchangeables, dont les formes et profils sont adaptés pour coopérer, soit directement avec une partie de l'épaule, soit avec des éléments complémentaires conformés pour être implantés dans une partie de ladite épaule. As shown, the head (lob) of the element Ci) is intended to receive in particular a removable manner interchangeable elements, whose profiles and shapes are adapted to co-operate either directly with a portion of the shoulder, or with additional components configured to be implanted into a portion of said shoulder. Le choix de ces éléments étant fonction de la nature de la fracture a traiter. The choice of these elements is a function of the nature of the fracture process.

Pour l'essentiel, ces éléments interchangeables comprennent une sphère humérale (2) ou une cupule sphérique (3). Essentially, these interchangeable elements comprise a humeral sphere (2) or a spherical cup (3).

La sphère humérale (2) est clipsée ou autrement centrée G l'intérieur de la tête (lb) de l'élément (1). The humeral sphere (2) is clipped or otherwise centered G inside the head (lb) of the element (1). Le rayon de courbure (2a) de cette sphère est déterminé pour correspondre, très sensiblement, au rayon de courbure de la glène, recevant normalement la tête humérale de l'os. The radius of curvature (2a) of this sphere is determined to correspond, significantly, in the glenoid cavity of radius of curvature, usually receiving the humeral head of the bone.

Dans le cas d'une fracture comminutive de la tête humérale, la sphère (2) coopère directement en appui avec la glène CG) (figures 2 et 5). In the case of a comminuted fracture of the humeral head, the ball (2) cooperates directly with the glenoid support CG) (Figures 2 and 5). Dans le cas d'un traitement d'une omarthrose avec destruction de la glène, la sphère (2) coopère en appui avec une cupule glénoïdienne C4) présentant un évidemment en forme de calotte sphérique dont le rayon de courbure correspond sensiblement à celui de la sphère humérale ( (figures s et 6)* In the case of a treatment of a glenohumeral osteoarthritis with destruction of the glenoid cavity, the sphere (2) cooperates in abutment with a glenoid C4) cup having a recess shaped like a spherical cap whose radius of curvature corresponds substantially to that of humeral sphere ((figures 6 and s) *
La cupule glénoïdienne (4) est agencée pour être solidaire d'un support (5), conformé pour être implanté au niveau de la glène de l'épaule. The glenoid cup (4) is arranged to be secured to a support (5) configured to be implanted in the glenoid cavity of the shoulder. Avantageusement, le support (5) est fixé dans la glène au moyen de vis divérgentes C6) disposées en combinaison avec des agencements dudit support, de manière a être en alignement ou sensiblement en alignement, respectivement avec le pilier de l'omoplate, le pilier coracoidien et le pilier acromial. Advantageously, the support (5) is fixed in the glenoid cavity by means of divergent screw C6) disposed in combination with said fittings carrier, so as to be in alignment or substantially in alignment respectively with the pillar of the scapula, the pillar coracoid and acromion pillar.

Dans ce but, le support C5) présente un plateau circulaire (Sa) recevant dans son épaisseur les vis (6). For this purpose, the carrier C5) has a circular tray (Sa) receiving in its thickness the screws (6). En outre, ce plateau est prolongé par une portée coaxiale creuse de centrage C5b) destinée à être engagée dans un logement complémentaire formé dans la glène. In addition, this plate is extended by a hollow coaxial scope of C5b centering) intended to be engaged in a complementary housing formed in the glenoid.

La fixation de la cupule glénoidienne (4) sur le support (5) peut s'effectuer par tout moyen connu et approprié, apte à rendre cette fixation démontable. Fixing the glenoid cup (4) on the support (5) can be effected by any known and appropriate means, able to make the releasable fastener. Par exemple, la cupule (4) présente une portée interne taraudée C4a) pour être vissée sur la périphérie du plateau circulaire (Sa) du support filetée à cet effet. For example, the cup (4) has a threaded internal scope C4a) to be screwed on the periphery of the circular plate (Sa) of the threaded carrier therefor.

Avantageusement, les vis C6) présentent d'une manière connue, un pas du type différentiel entre la tête de vis filetée et son corps, pour assurer une compression entre le support C5) et la glène. Advantageously, the screw C6) present in a known manner, a step of differential type between the threaded screw head and body, to provide compression between the carrier C5) and the glenoid.

Dans le cas d'une rupture de coiffe, la tête (1b) de l'élément huméral (1) reçoit la cupule sphérique (3). In the case of a rotator cuff tear, the head (1b) of the humeral element (1) receives the spherical cup (3).

Cette cupule (3) présente un évidemment C3a) en forme de calotte sphérique. This cup (3) has a recess C3a) in the form of a spherical cap. Avantageusement, la forme en calotte sphérique s'étend sur environ un tiers de sphère. Advantageously, the shaped spherical segment extends over approximately one third of a sphere. De la même façon que pour la sphère humérale, la cupule (3) est positionnée et centrée à l'intérieur dé la tête (1b) de l'élément Ci), par tout moyen connu et approprié. In the same way as the humeral sphere, the cup (3) is positioned and centered within the head (1b) of the element Ci), by any known and suitable means.

Comme le montre notamment la figure 7, la cupule (4) coopère avec une pièce male sphérique (7) faisant office d'organe glénoidien. As shown in particular in Figure 7, the cup (4) cooperates with a spherical male part (7) acting as a glenoid element. Cette pièce sphérique est conformée de la même manière que la cupule glénoidienne (4) pour être fiwée sur le support C5). This spherical part is shaped in the same manner as the glenoid cup (4) to be fiwée on C5 support). Par exemple, l'organe glénoidien (7) présente une portée circulaire interne C7a) agencée pour être fixée d'une manière démontable sur le support. For example, the glenoid element (7) has an inner circular bearing C7a) arranged to be secured in a detachable manner on the support. Comme indiqué précédemment, cet agencement peut être constitué par un taraudage.En outre, la portée circulaire interne (7a) présente une tige coaxiale C7b) destinée à être engagée dans l'alésage de la portée de centrage (5b) du support (5) (figure 6), pour améliorer le temps opératoîr de pose. As indicated above, this arrangement can be constituted by a taraudage.En addition, the inner circular surface (7a) has a coaxial rod C7b) intended to be engaged in the bore of the centering bearing (5b) of the support (5) (6) to improve the time opératoîr pose.

Le diamètre de la sphère de l'organe glénoidien est déterminé en combinaison avec la tige co=^iale (7b) pour que le centre d'application de la résultante des efforts soit situé à l'intérieur de la glène. The diameter of the sphere of the glenoid element is determined in combination with the rod co = ^ ial (7b) so that the efforts of the resulting application center lies within the glenoid. D'une manière connue, la tête sphérique de l'organe glénoidien (7) peut être exécuté en acier ino-yda'Dle, en céramique, en alliage à base de titane ou de cobalt ou tout produit 'oio-comptatible. In known manner, the spherical head of the glenoid element (7) can be executed steel ino-yda'Dle, ceramic, titanium-based alloy or cobalt or any product 'oio-comptatible. Le support (5) sur lequel peut être vissé soit l'organe glénoidien (7 > soit la cupule glénoidienne (4) est en acier traité. Les cupules humérale (2) et glénoidienne C3) sont en polyéthylène haute densité. The support (5) on which can be screwed either the glenoid element (7> is the glenoid cup (4) is in treated steel. The humeral cups (2) and glenoid C3) are in high density polyethylene.

Les avantages ressortent bien de la description, en particulier on souligne la possibilité de traiter la plupart des fractures de l'épaule a partir d'un même ensemble composé d'éléments modulaires interchangeables entre eus, soit au moment de l'opération, soit ultérieurement, en fonction de l'évolution du cas pathologique du patient On souligne également, la fixation sûre et efficace, de la cupule ou de l'organe glinoidien, en combinaison avec le support vissé dans la glène, évitant ainsi, l'emploi d'un ciment, avec les risques inhêrant à ce type de fixation. The advantages clearly appear from the description, in particular, highlights the possibility of treating most fractures of the shoulder from the same set consisting of interchangeable modular elements between had, at the time of the operation or subsequently , depending on the evolution of the patient's pathological condition was also noted, the safe and effective fixation of the cup or glinoidien member in combination with the screw holder in the glenoid cavity, thus avoiding the use of cement, with the risks inherant this type of attachment.

Claims (1)

  1. REVENDICATIONS
    -t- Ensemble modulaire pour prothèse de l'épaule comprenant en combinaison un élément Ci) apte à être implanté dans le fut huméral et dont la tête est conformée pour recevoir d'une manière rapportée, des éléments interchangeables (2-3) dont les forme et profils sont adaptés pour coopérer soit directement avec une partie de l'épaule, soit avec des éléments complémentaires ( -7) conformés pour être implantés dans une partie de ladite épaule, en fonction de la nature de la fracture ou autre a traiter. -t- modular assembly for the shoulder prosthesis comprising a combination element Ci) adapted to be implanted in the humeral shaft and whose head is shaped to receive an attached manner, exchangeable elements (2-3) whose shaped profiles and are adapted to cooperate directly with a portion of the shoulder or with complementary elements (-7) configured to be implanted into a portion of said shoulder, depending on the nature of the fracture, or other treated.
    -2- Ensemble selon la revendication 1 caractérisé en ce que les éléments interchangeables comprennent une sphère humérale (2) apte à coopérer directement en appui sur la glène ou avec une cupule glénoidienne (4) de forme complémentaire. -2- assembly according to claim 1 characterized in that the interchangeable elements comprise a humeral sphere (2) able to cooperate directly in abutment on the glenoid or with a glenoid cup (4) of complementary shape.
    -3- Ensemble selon la revendication 1 caractérisé en ce que les éléments interchangeables comprennent une cupule sphérique (3) apte à coopérer avec une pièce mile sphérique, faisant office d'organe glénoidien (7). -3- assembly according to claim 1 characterized in that the interchangeable elements comprise a spherical cup (3) adapted to cooperate with a spherical mile piece, acting as a glenoid element (7).
    - 4 - Ensemble selon l'une quelconque des revendications 2 et 3, caractérisé en ce que la cupule glénoidienne (4) au l'organe glénoidien (7) sont conformés pour être fixés sur un support - 4 - Assembly according to any one of claims 2 and 3, characterized in that the glenoid cup (4) to the glenoid element (7) are shaped to be fixed on a support
    C5) agencé pour être implantés dans la glène. C5) arranged to be implanted in the glenoid cavity.
    -S- Ensemble selon la revendication 4 caractérisé en ce que le support (5) est fixé dans la glène au moyen de vis divergentes (6) disposées de manière à être en alignement ou sensiblement en alignement, respectivement avec le pilier de l'omoplate, le pilier coracoidien et le pilier accromial. -S- assembly according to claim 4 characterized in that the support (5) is fixed in the glenoid cavity by means of divergent screw (6) arranged to be in alignment or substantially in alignment respectively with the pillar of the scapula the coracoid pillar and pillar accromial.
    -6- Ensemble selon l'une quelconque des revendications 4 et 5 caractérisé en ce que le support (5) présente un plateau circulaire (Sa) recevant dans son épaisseur les vis, ledit plateau étant prolongé par une portée coaxiale creuse de centrage C5b > pour être engagé dans un trou formé dans la glène. 6- An assembly according to any one of claims 4 and 5 characterized in that the support (5) has a circular tray (Sa) receiving in its thickness screws, said plate being extended by a coaxial hollow centering scope C5b> to be engaged in a hole formed in the glenoid.
    -7- Ensemble selon l'une quelconque des revendications 4 et 6, caractérisé en ce que la cupule. 7- An assembly according to any one of claims 4 and 6, characterized in that the cup. glénoidienne (4) présente une portée interne circulaire C4a) agencée pour être fixée sur le plateau du support (5). glenoid (4) has a circular internal bearing C4a) arranged to be fixed to the table support (5).
    -6- Ensemble selon l'une quelconque des revendications 4 et 6, caractérisé en ce que l'organe glénoidien (7) présente une portée interne circulaire C7a) agencée pour être fixée sur le plateau du support (5) et, d'une manière coaxiale, une tige (7b) destinée à être engagée dans l'alésage de la portée de centrage dudit support, de manière a avoir le centre d'application de la résultante des efforts à l'intérieur de la glène. -6- assembly according to any one of claims 4 and 6, characterized in that the glenoid element (7) has a circular internal bearing C7a) arranged to be fixed to the table support (5) and a coaxially a stem (7b) intended to be engaged in the bore of the centering bearing surface of said support so as to have the center of application of the resultant of the forces within the glenoid.
    -9- Ensemble selon la revendication 5, caractérisé en ce que les vis (6) sont a pas différentiel entre la tête filetée et le corps. -9- assembly according to claim 5, characterized in that the screws (6) are no differential between the threaded head and the body.
    -10- Ensemble selon l'une quelconque des revendications 1 à 9, caracterise en ce que la sphère humérale et le support sont en métal traité, tandis que la cupule glénoidienne et la cupule humérale sont en polyéthylène. -10- An assembly according to any one of claims 1 to 9, characterized in that the humeral sphere and the support are treated metal, while the cup glenoid and humeral cup are made of polyethylene.
FR8913366A 1989-10-04 1989-10-04 Modular kit for shoulder prosthesis. Expired - Lifetime FR2652498B1 (en)

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