JP2005512673A - 肩用人工関節 - Google Patents

肩用人工関節 Download PDF

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Publication number
JP2005512673A
JP2005512673A JP2003554041A JP2003554041A JP2005512673A JP 2005512673 A JP2005512673 A JP 2005512673A JP 2003554041 A JP2003554041 A JP 2003554041A JP 2003554041 A JP2003554041 A JP 2003554041A JP 2005512673 A JP2005512673 A JP 2005512673A
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stem
intermediate member
ball
shoulder
accessory
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JP2003554041A
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JP2005512673A5 (ja
JP4199120B2 (ja
Inventor
ブラッテル，ゲオルゲス
シュヴェ−ゲルル，ヴォルフガング
ツェンツ，ペーター
ダルマン，フランク
グリーン，ヴィルフリード
ザーロモン，ディルク
イルレンブッシュ，ウルリッヒ
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Mathys Orthopadie GmbH
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Mathys Orthopadie GmbH
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    • A61F2/4637—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
    • A61F2002/4638—Tools for performing screwing, e.g. nut or screwdrivers, or particular adaptations therefor
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    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections 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
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
    • A61F2250/0008—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting a position by translation along an axis or two perpendicular axes
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0026—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in surface structures
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0085—Identification means; Administration of patients
    • A61F2250/0089—Identification means; Administration of patients coded with symbols, e.g. dots, numbers, letters, words
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0097—Visible markings, e.g. indicia

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
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  • Heart & Thoracic Surgery (AREA)
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  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
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  • Materials For Medical Uses (AREA)
  • Forging (AREA)

Abstract

ステム(10)、ボール状ヘッド(50)および中継ぎ部材(30)を有する肩用人工関節であって、中継ぎ部材(30)は、ステム(10)の基部端部(12)に取付可能であり、且つボール状ヘッド(50)を取り付けることができる。中継ぎ部材(30)は、ステム(10)の基部端部(12)で第一方向に調節できる付属部品(20)にクランプで固定することができ、前記第一方向は切除面あるいはそれに平行に位置している。前記第一方向は、一般的にほぼ内外方向である。付属部品(20)は、蟻継ぎガイド(15)によってステム(10)上を移動することができ、あるいはステム(10)のガイド孔内に移動可能に取り付けることができる。中継ぎ部材は、付属部品(20)に対しクランプで固定することができ、これにより付属部品(20)と中継ぎ部材(30)を固定することができる。

Description

本発明は、ステムとボール状ヘッド、及び第一方向に沿って任意の位置でステムの基部端部に装着可能であり、且つボール状ヘッドに装着可能な中継ぎ部材を有する肩用人工関節に関する。
欧州特許公開公報第0 953 321号に記載された肩用人工関節においては、中継ぎ部材は、外側に突き出たリブを有し、これはステムの基部端部の凹部（外側内側に互い違いになるように設けられている）に挿入することができる。中継ぎ部材は圧入によってステムに接続される。そしてボール状ヘッドは、中継ぎ部材にフィットするように形成された断面を持つ凹部を有する。中継ぎ部材は屈曲可能であり、様々な傾斜および後傾角度にセットできる。
米国特許公報第5 961 555号に記載の肩用人工関節においては、中継ぎ部材はステム基部端部の円錐部上にフィットさせることができ、ボール状ヘッドは円錐状の蟻継ぎガイドで固定される。ボール状ヘッドは、中継ぎ部材にクランプで固定される際、前後方向に移動する以外は、ステムに対する調節ができない。
欧州特許公開公報第0 549 480号、欧州特許公開公報第 0 599 429号、仏国特許公開公報第2 721 200号および米国特許公報第 6 197 062号には、中継ぎ部材の両端が円錐状に形成され、これによりステム及びボール状ヘッドに接続可能な肩用人工関節が開示されている。双方の円錐状端部の軸は、お互いに角度がつき及び／又は互いに相殺されている。その結果、ボール状ヘッドを内外方向および前後方向に調節すること、およびステムに対する後傾角度を任意に調節することが可能になる。同様の肩用人工関節がドイツ特許公開公報第198 41 612号に開示されている。中継ぎ部材は円盤状の形状をもち、両サイドに、互いに相殺される軸ピンを有している。
ステム軸と平行の軸を有し、ステムの基部端部に回転位置を調節してクランプで固定可能な円筒形部位を持つ中継ぎ部材を備えた肩用人工関節が、欧州特許公開公報第0 679 375号に開示されている。この円筒形部位から、ボール状ヘッドとフィットする円錐状部分が突出している。
ボール-ソケット接合（ボール-ソケット接合の凹面はステムに設けられている）によってステムに対する調節が可能な肩用人工関節が、欧州特許公開公報第0 712 617号、米国特許公報第6 228 120号および米国特許公報第6 206 925号に開示されている。欧州特許公開公報第0 715 836号に開示された肩用人工関節の場合、ボール-ソケット接合の凹面は、ボール状ヘッドに設けられ、接合用の球部がステムの基部端部に設けられている。
中継ぎ部材を、ステムの基部端部でステム軸の方向に調節でき、その結果、人工関節のステムを効果的な長さに変更できる肩用人工関節が、独国特許公開公報第195 48 154号および独国実用新案公報第299 18 669号に開示されている。
ボール状ヘッドに軸方向あるいは軸と平行方向のねじ山部を設け、このねじ山部をステムの基部端部に設けられたねじ山付き孔の中に螺合することによって、ボール状ヘッドとステム間の距離を変更することができる肩用人工関節が、独国実用新案公報第93 12 218号に開示されている。ボール状ヘッドは、そこに横向きに螺合する安全ねじによって固定できる。
本発明の課題は、非常に簡単に構築することができ、ボール状ヘッドをステムに対し連続的に調節できる肩用人工関節を提供することである。
前記課題は、ステムの基部端部において第一方向に調節できる付属部品にクランプで固定できる中継ぎ部材を有する本発明によって解決される。ここで、第一方向は、切除面あるいはそれに平行な面に位置する。
上記付属部品は、ステムの基部端部でガイド内に、好ましくは内側-外側方向に（例えば、蟻継ぎガイドあるいは左右対称に回転するガイド）、直線的に調節できるものが好ましい。一般に、調節可能な方向は切除面あるいはそこからわずかに平行にずれた面に位置する。
切除面は通常、ステム軸に対し４０°〜５０°の角度に位置する。すなわち、切除面の法線はステム軸に対し１３０°〜１４０°の角度をなしている。関節置換手術は通常、インプラントの連結面が、できる限り正確に切除面と適合するように行われる。この場合、連結面はステムの基部端部表面であり、理想的なケースでは、ボール状ヘッドはこの面に置かれる。
中継ぎ部材は好ましくはねじ山付きボルトによって固定される。該ボルトは中継ぎ部材のショルダー孔を通り、付属部品内に螺合される。この結果、付属部品は同時にガイド内に固定される。
これらの手段を通じて、ボール状ヘッドをステムに対し第一方向に連続的に調節することができる。ボール状ヘッドをステムに対し二次元的に調節可能にするため、中継ぎ部材は付属部品に対し第二方向に連続的に調節できることが好ましい。第二方向は第一方向に対してある角度、好ましくは第一方向に対してほぼ直角をなす。
付属部品に対する中継ぎ部材の調節機能は、中継ぎ部材内のショルダー孔を前後方向向きのスロット状のショルダー孔とすることにより、実現できる。
結果として、ボール状ヘッドをステムに対し両方向に連続的に調節することができる。調節は手術中に行われ、修正できる。傾斜および逆ねじれの再現は、この場合、ステムに対してボール状ヘッドを位置合わせすることによって起こらないが、切除器具によって起こり、そしてそれゆえ本発明にかかる肩用人工関節の場合は、前もってセットされる。
本発明の特に好ましい実施形態では、ステムは基部端部に連結面を有し、該連結面はステム軸に対し約４０°の角度で位置し、一般的に切除面とぴったり合うか、切除面に平行にわずかな距離をおいて位置する。付属部品はプラグ形状のスライディング・ブロックであり、これは、連結面より僅かに下方に設けられ、連結面に近接したウィンドウを有するガイド孔内を移動できる。スライディング・ブロックにはねじ山の付いた横穴が設けられている。中継ぎ部材は、ねじ山付きボルトをスライディング・ブロックの横穴に螺合することによって連結面に対し固定される。連結面と、中継ぎ部材の底面（連結面に接する面である）は、ポジティブ・ロッキングの噛み合わせをつくるため、鋸歯状に形成されてもよい。鋸歯状とする代わりに、粗面としてもよい。原理的には、あらゆるポジティブ-及び／又はフォース-ロッキング接合を用いることができる。
中継ぎ部材は、僅かに円錐状の外観を有し、ボール状ヘッドはこれに対応する円錐状の凹部を有する。結果として、前記中継ぎ部材に前記凹部をフィットさせるだけで、ボール状ヘッドを中継ぎ部材に連結することができる。ポジティブ・ロッキング（例えば、爪部品による）、あるいはポジティブ・フォース・ロッキング（例えば、ねじ接続）によって連結してもよい。
これらの連結手段は中心にあってもよく、一方が偏心位にあってもよく（シングル・エキセントリック）、双方が偏心位にあってもよい（ダブル・エキセントリック）。中心にした場合、中継ぎ部材のショルダー孔は中継ぎ部材の外観に対して中心部に設けられ、凹部または他の接続手段もボール状ヘッドの中心部に設けられる。
シングル・エキセントリックの場合、中継ぎ部材のショルダー孔は中心部に位置し、円錐状の凹部あるいは他の接続手段はボール状ヘッドの中心部から外れた位置に設けられる。中継ぎ部材上でのボール状ヘッドの回転位置を変更することにより、ボール状ヘッドの中心をステム末端に対し、その偏心度と等しい軌道半径上にセットすることができる。中継ぎ部材を第一方向に沿ってセットすることと連動して、ボール状ヘッドをステム末端に対し二次元で連続的に調節することができる。
ボール状ヘッドを中心性にし、中継ぎ部材のショルダー孔が偏心に位置するように形成することも可能である。しかし、シングル・エキセントリックの場合、このようにすることも可能であるが、一般的には、ボール状ヘッドのみが偏心位に設定される。
ダブル・エキセントリックの場合、中継ぎ部材のショルダー孔が中継ぎ部材の外観に対し偏心位で配置され、凹部あるいは他の接続手段はボール状ヘッドの偏心位に設けられる。二つの偏心度により、ステム端部に対し、二つの偏心度の合計に対応する円形領域の半径内で、ボール状ヘッドを連続的に調節することが可能になる。更に、ボール状ヘッドを第一方向に連続的に調節することも可能である。
ステムの基部端部には、腱および骨断片が付着できる孔のある羽根状部材を１以上設けることが好ましい。
ボール状ヘッドは、解剖学的なコンディションに応じて、半球と非常に平らな球部分との間の形状に形成することができる。中心部における角度の一例は９０°である。
ステム人工関節の各部位は、内部人工関節に通常用いられる物質で形成することができる。例えば、セラミックス、チタン合金あるいはコバルト-クロム合金または非強化プラスチックあるいは繊維強化プラスチックである。
本発明の実施例を図面を用いて以下に説明する。
以下に示す実施例の肩用人工関節は全て、ステム10、付属部品であるスライディング・ブロック20、中継ぎ部材30、ねじ山付きボルト40、およびボール状ヘッド50から成る。ステム10は、その基部端部12側に向かって広がり、末端で連結面14を形成する。連結面は、ステム10の縦軸に対し約40°〜45°の角度をなす切除面と一致するように形成される。
第一の実施例の場合、スライディング・ブロック20は蟻継ぎガイド15内に誘導される。ガイド15は、連結面14に設けられた内側向きに広がる溝16として形成されている。全体としてほぼ正方形状をなすスライディング・ブロック20の２つのガイド側外側面22は、溝16に一致するように傾斜している（図３）。これにより、スライディング・ブロック20を、溝16内に沿って内外方向に移動させることができる。連結面には、溝16の両側にエッジ18が存在する。
中継ぎ部材30は、錐台形状の外側面３２および軸方向のスロット状ショルダー孔34を有し、ショルダー孔34は前後方向に開口している。ねじ山付きボルト40は、ショルダー孔34内に挿入され、スライディング・ブロック20のねじ山付き孔24内にねじで固定される。ねじ山付きボルト40は、六角形ソケット付きの頭部42およびねじ山付きステム44を有し、ねじ山付きボルト40の頭部は、ショルダー孔34内に完全に格納される。ねじ山付きボルト40を締め付けることによって、中継ぎ部材30は蟻継ぎガイド15の外側エッジ18に固定される。ねじ山付きボルト40の端部は蟻継ぎガイド15の底面に設けられた凹部19内に位置する。
ボール状ヘッド15の外部形状は、球体を切断した形状（中心の角度が約90°）にほぼ該当する。従って、ボール状ヘッドは、アーチ状の上面52と水平な底面54を有する。底面54には、円錐状に次第に細くなる凹部56が形成され、その結果、ボール状ヘッド50を中継ぎ部材30に圧入してフィットさせることが可能である。凹部56は、中継ぎ部材30を完全に収納できる深さに形成されている。図４に示すように、ボール状ヘッド50の底面54は、肩用人工関節を組み立てた状態では、実質的に連結面14上、すなわち切除面上に位置する。
図５は、図１〜４の肩用人工関節に類似し、ショルダー孔34が円形である肩用人工関節の第二の実施例を示す。中継ぎ部材30は、前後には調節できない。それにもかかわらず、二次元で継続的な調節機能を持たせるために、凹部56は、ボール状ヘッド50の底面54の偏心位に設けられている。ボール状ヘッド50の中心はそれゆえ、中継ぎ部材30の縦軸の輪状線上にある。それによって、ステム10の基部端部12における中継ぎ部材30の内外方向の調節機能と連動して、継続的な調節機能が得られる（個々のケースの解剖学的コンディションに適合できる表面積の範囲内で）
ステム10を上腕骨のチャネル内に挿入する前あるいは後に内部人工関節を組み立てることが可能である。ねじ山付きボルト40は、中継ぎ部材30を通してスライディング・ブロック20内にまずゆるくネジで締め付けられる。付属部品20はステム10の基部端部12の溝16内に最初に置かれていてもよい。また、スライディング・ブロック20は、溝16内にゆるく挿入されて中継ぎ部材30に接続されてもよい。その後、ステム10を適切な位置に置き、ボール状ヘッド50が解剖学的状況にできるだけ近くなるように中継ぎ部材30を固定する。
第３の実施例（図６〜１０）の場合、付属部品はプラグ形状のスライディング・ブロック20であり、スライディング・ブロック20を横断するねじ山付き孔24が設けられている。スライディング・ブロック20はステム10のガイド孔65内に誘導される。ガイド孔65は、内側部からステム10の内部に向かって設けられ、その軸はステム10の基部の連結面14に平行である。スライディング・ブロック20は、ガイド孔内を内外方向に移動可能である。
ウィンドウ66は、ステム10の基部の連結面内に設けられ、ガイド孔に至る。ねじ山付きボルト40は、第一の実施例と同様、中継ぎ部材30に挿通される。該第三の実施例においては、その後、ボルト40をウィンドウ66内に導入し、付属部品20のねじ山付き孔24内で回転させる。ねじ山付きボルト40によって、中継ぎ部材30がスライディング・ブロック20に対して固定され、これによりステム10の連結面14に対しても固定される。ウィンドウ66の長さは、ステム10に対する中継ぎ部材30の内外方向の移動路を決定する。
中継ぎ部材30は、錐台形状の外観と、同心の貫通孔34（基部側の上面あるいはカバー面から始まり端部が狭くなる孔）を有する。ねじ山付きボルト40は、上述のようにこの孔の中に挿入され、そしてあらかじめ内側部からガイド孔65の中に挿入しておいたスライディング・ブロック20のねじ山付き孔24の中に挿入される。ねじ山付きボルト40は、六角形のソケットが設けられたヘッドとねじ山付きのステムを有し、このヘッドは完全に中継ぎ部材30の端部が狭くなった孔の中に格納される。
ステム10の連結面14上及び中継ぎ部材30の底面上の溝構造は、緩みや微動に対して連結がさらに安全に維持されるよう、ポジティブ-/フォース-ロッキングによって締め付けを確実にする。溝70は、1mmのグリッドで構成されている。これによって内外方向へのボール状ヘッド50の調節を行うことが可能になる。ステム10のウインドウ66内にはめ込むことができるガイドラグ36が、中継ぎ部材30の底面から突出している。このように溝構造に係るステム10に対する中継ぎ部材30の固定と位置合わせが保証される。
ボール状ヘッド50は、第２実施例におけるものと類似している。円錐状の凹部56の軸は、ボール状ヘッド50の中心軸に対し3mm（偏心）補正されて位置する。ボール状ヘッド50はこれにより中継ぎ部材30の軸に対し決まった偏心軌道で回転する。
偏位を示すマーク74および印は、ボール状ヘッドの底面に設けられる。時計と同様１２区分になるようにマークをつけることが好ましい。ガイド孔65に至るエントランスはシールによって密閉することができる。
ヘッドの偏心度と内外方向への移動メカニズムの組み合わせによって、ボール状ヘッドをステムに対し、望ましい位置に調節して切除面上にセットすることができる（いわゆる内側外側オフセット）。調節範囲は各ケースで±3mmである。継続的な調節機能は、このように、個々のケースの解剖学的コンディションに適合できる表面積の範囲内で得られる。
中継ぎ部材及びヘッドの円錐ピッチは、インプラントの円錐部で用いられている1:10のピッチに対応する。
基部側のステム末端には、セットした器具を補強するために、先端が盲端になっているねじ山付き孔76が中央に設けられ、セットされた器具の回転を安全にするために、２つの先端が盲端になった孔も設けられる。
ステムは、回転の安全のために、羽根状部材80を基部側／外側に有する。セメントを用いないステム設計の場合、このような羽根状部材は、基部の外側面に前後方向に設けられてもよい。同様に、ステムの先端部位のセメントチャネル82は、セメントケーシング内における回転の安全に役立つ。このバージョンでは、セメントチャネルはステム軸の周囲の４箇所に設けられている。
ステム10、中継ぎ部材30、スライディング・ブロック20及びボルト40を構成するモジュールは、あらかじめ組み立てられているが、締め付けられていない状態で無菌パックに入れて提供される。スライディング・ブロック20が既にステム10の中にある場合は、ステムの移植後に、中継ぎ部材30をボルト40で取り付けること、及び検査により中継ぎ部材30を取り替えることも可能である。スライディング・ブロック20の端面に横溝84を設けて、ボルト40のねじ締めの際にスライディング・ブロック20を揃えることができるようにしてもよい。
図１〜４の実施例の場合、基部/外側位置からアクセスするのに対し、図６〜１０の実施例の特に有利な点は、内側位置からアクセスできることである。さらに、グリッド方式と関連するガイドラグ36を設けることによって、中継ぎ部材を非常に確実に固定することが可能になる。図６〜１０の実施例における中継ぎ部材の調節は、移植したステム上で同時に行うだけでなく、テスト・ラスプ（調節メカニズムを備えた石目やすり）およびインプラントへの調節パラメーターを外部へ移すことによっても可能である。
図１は、本発明にかかる肩用人工関節の第一の実施例を、３次元で示す分解組立図である。 図２は、図１に示す肩用人工関節を、正面あるいは背面から見た分解図である。 図３は、図２のＡ−Ｂ断面図である。 図４は、組み立てた状態の図１の肩用人工関節の縦断面図である。 図５は、第二の実施例にかかるものであって、中心性の中継ぎ部材と、偏心位に凹部を持つボール状ヘッドを３次元で示す図である。 図６は、本発明にかかる肩用人工関節の第三の実施例を、３次元で示す分解組立図である。 図７は、図６に示す肩用人工関節を、正面あるいは背面から見た状態を示す分解図である。 図８は、図７のＡ−Ａ断面図である。 図９は、組み立てた状態の図６の肩用人工関節の縦断面図である。 図１０は、図６の実施例によるものであって、中心性の中継ぎ部材と、偏心位に凹部を持つボール状ヘッドを３次元で示す図である。
符号の説明
10 ステム
12 基部端部
14 連結面
15 蟻継ぎガイド
16 溝
18 エッジ
19 凹部
20 スライディング・ブロック
22 ガイド面
24 ねじ山付き孔
30 中継ぎ部材
32 外側面
34 ショルダー孔
36 ガイドラグ
40 ねじ山付きボルト
42 ヘッド
44 ねじ山付きステム
50 ボール状ヘッド
52 上面
54 底面
56 凹部
65 ガイド孔
66 ウインドウ
70 溝
74 マーク
76 先端が盲端の孔
80 羽根状部材
82 セメントチャネル

Claims (10)

  1. ステム(10)、ボール状ヘッド(50)および中継ぎ部材(30)を有し、該中継ぎ部材(30)は、第一方向に沿って任意の位置で前記ステム(10)の基部端部(12)に取付けること、並びに前記ボール状ヘッド(50)に取り付けることができる肩用人工関節において、前記中継ぎ部材(30)は、前記ステム(10)の基部端部(12)で第一方向に調節できる付属部品(20)にクランプで固定することができ、前記第一方向は切除面あるいはそれに平行に位置することを特徴とする、肩用人工関節。
  2. 前記第一方向はほぼ内外方向となる、請求項１に記載の肩用人工関節。
  3. 前記付属部品(20)が蟻継ぎガイド(15)によってステム(10)上を移動可能であり、前記中継ぎ部材は該付属部品(20)に対しクランプで固定することができ、これにより付属部品(20)と中継ぎ部材(30)を固定することができる、請求項１あるいは２に記載の肩用人工関節。
  4. 前記付属部品(20)をステム(10)のガイド孔(65)内に移動可能に取り付けることができ、前記中継ぎ部材は、前記ガイド孔壁のウインドウ(66)を通じて該付属部品(20)に対しクランプで固定することができ、これにより付属部品(20)と中継ぎ部材(30)を固定することができる、請求項１あるいは２に記載の肩用人工関節。
  5. 前記中継ぎ部材(30)は、ねじ山付きボルト(40)によって前記付属部品(20)と連結することができ、前記ステム(10)の基部端部(12)に対して固定することができる、請求項３あるいは４に記載の肩用人工関節。
  6. 前記中継ぎ部材(30)が、前記付属部品(20)に対して第二方向に調節可能である、請求項１〜５のいずれか１項に記載の肩用人工関節。
  7. 前記第二方向が、前記第一方向に対しほぼ直角であり、好ましくはほぼ前後方向である、請求項６に記載の肩用人工関節。
  8. 前記ねじ山付きボルト(40)が前記中継ぎ部材(30)に設けられたスロット状のショルダー孔(34)を挿通する、請求項６あるいは７に記載の肩用人工関節。
  9. 前記ボール状ヘッド(50)を前記中継ぎ部材(30)に偏心位で取り付けることができる、請求項１〜８のいずれか１項に記載の肩用人工関節。
  10. 前記ボール状ヘッド(50)の底面(54)が、人工関節を組み立てた状態において、実質的に前記ステム(10)の基部端部(12)に位置する、請求項１〜９のいずれか１項に記載の肩用人工関節。
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JP4773523B2 (ja) * 2005-10-03 2011-09-14 ジンマー，インコーポレイティド 近位上腕骨用のグラフト・プロテーゼ組立体
JP2014515645A (ja) * 2011-03-16 2014-07-03 スミス アンド ネフュー インコーポレーテッド 合成角インプラント
WO2022030783A1 (ko) * 2020-08-04 2022-02-10 (주)보일랩스 의지 체결장치

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US20050033443A1 (en) 2005-02-10
AU2002364295B2 (en) 2007-02-15
WO2003053280A2 (de) 2003-07-03
WO2003053280A3 (de) 2004-03-04
ATE296072T1 (de) 2005-06-15
AU2002364295A1 (en) 2003-07-09
EP1467682A2 (de) 2004-10-20
DE20120703U1 (de) 2002-03-07
EP1467682B1 (de) 2005-05-25
US7238207B2 (en) 2007-07-03
JP4199120B2 (ja) 2008-12-17

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