JP2005536240A - 膝関節内部人工器官の脛骨構成要素とスライド板 - Google Patents

膝関節内部人工器官の脛骨構成要素とスライド板 Download PDF

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JP2005536240A
JP2005536240A JP2004502894A JP2004502894A JP2005536240A JP 2005536240 A JP2005536240 A JP 2005536240A JP 2004502894 A JP2004502894 A JP 2004502894A JP 2004502894 A JP2004502894 A JP 2004502894A JP 2005536240 A JP2005536240 A JP 2005536240A
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slide plate
component
tibial
tibial component
polyethylene
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JP4382655B2 (ja
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ブレーム ペーター
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ブレーム ペーター
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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)
  • Materials For Medical Uses (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)
  • Adjustable Resistors (AREA)

Abstract

【課題】
本発明の目的は、互いに適合し、様々な移動度を有するポリエチレンのスライド板を、同一の脛骨プラトーに位置させるモジュラー式の概念を具体化し、それで手術室で利用可能に保たなければならない脛骨のプラトー構成要素の数を実質的に減少させることである。
【解決手段】
骨に固定するためのアンカー部と、ポリエチレンのスライド板のためのトレーを有する脛骨構成要素において、脛骨構成要素は、湾曲した関節表面によりスライド板に当接する大腿構成要素と協働する。スライド板（１）は連結部（２）を有する。連結部は、脛骨プラトー構成要素（４）のアンカー部（５）の内部に延び、脛骨プラトー構成要素（４）の末端部に、嵌合によってアンカー部（５）に回転しないで接続している。

Description

本発明は、骨に固定されるアンカー部を有する脛骨構成要素と、ポリエチレンのスライド板のためのトレーに関する。脛骨構成要素は、湾曲した関節表面によりスライド板に当接する大腿構成要素と協働する。
一般タイプの膝関節内部人工器官は、例えば特許文献１に記述されている。
基本的に、内部人工器官によりできるだけ関節の機能を回復させることが、膝関節の交換の目的である。そうする際、運動力学、生体力学、及び滑る−転がる動きの原理が特別に考慮されなければならない。膝関節義肢はこのような動きをコピーし、骨のベアリングと関節包靭帯システムに対するダメージなしに、屈曲、伸長及び回転により歪みを吸収できなければならない。
この目的のために、脛骨プラトー構成要素と大腿構成要素が結合した内部義肢と、このような結合がない一般タイプの内部義肢が知られている。これら双顆関節義肢は、脛骨構成要素に対するポリエチレンのスライド構成要素の動きにおける様々な自由度を選択可能にするコンセプトを利用している。それは、固く固定されたスライド板、回転プラットフォーム、又は並進の自由度によって回転するプラットフォーム（前後）、及び自由に浮動するプラットフォームを含む。今日の手術室の条件があれば、実質的に競合する利点は少数の器具及びインプラントと、できるだけ自由な手術中の決定の変換可能性とにある。これらの決定は移動度と安定性の間で個々に最適な妥協点を含んでいる。固定したポリエチレンのスライド板は、最大の関節安定性を提供し、自由に浮動する板−好ましくは安定した靭帯が利用できる場所で用いられる−は最大の移動度を可能にする。
双顆関節の大腿スライド構成要素の成形は次の事実を考慮しなければならない。つまり、非常に適合した内側の側面の関節表面が、拡大したベアリング領域を提供することによりポリエチレンへの圧力負荷を減少させるが、軸の脛骨の回転の関節の自然な滑る−転がる動きの自由度を制限し、これが、固定したスライド構成要素において剪断力と捻り応力を引き起こす。望ましくない結果は、未熟なインプラントの緩み、大きな局所的歪み、変形、及びポリエチレンのスライド構成要素の磨耗にある。
P4102509A1
本発明の目的は、互いに適合し、様々な移動度を有するポリエチレンのスライド板を同一の脛骨プラトーに位置させるモジュラー式の概念を具体化し、それで手術室で利用可能に保たなければならない脛骨プラトー構成要素の数を実質的に減少させることである。さらに、大腿のスライド構成要素の形状に非常にかみ合う適合性の利点が利用されるが、この組み合わせにおいて起こる回転力の減少を伴う。
本発明によれば、この目的は、連結部を有する大腿構成要素と非常に適合するスライド板によって達成される。連結部は脛骨構成要素のアンカー部の内側に延び、脛骨構成要素の末端部で、回転せずに且つ嵌合（形状拘束）によりアンカー部に結合している。
脛骨構成要素などに直接固定する従来の回転運動の様式に比べて、本発明に従うデザインにより実現する、この末端部の数センチメートルの変位は、ポリエチレンの大きな磨耗に伴う局所的なピーク負荷が避けられるようにして、生じる回転運動をポリエチレンのスライド板に移行させる。それにもかかわらず、対応する様々な移動度の異なるスライド板を、手術中に同時に簡単に挿入できる。
これらスライド板が脛骨プラトー構成要素、特にトレー４とアンカー部５に適合する結果、本発明に従うデザインは、多数の利点を伴うモジュラー組み立ての可能性を提供する。
上で述べたように、膝関節システムの臨床的な承認は、少数のインプラントと器具に加えて、手術中の決定の自由と手術中のオプションの後退（フォールバック）とによって決定的に影響される。スライド板の選択と使用は、縫合の前の、手術過程の最後のステップに属する。膝関節全体の屈曲と伸長の機能が、とりわけ靭帯の状況によって与えられる関節安定性に関して試される。この段階で、本発明に従う実施形態により、固定したシステム、回転の移動度、前後の回転の移動度（多方向さえ）、また浮動の回転の移動度の間で様々に、関節のデザインが識別される。
例えば、以下の典型的な操作状況が考えられる。
大腿構成要素と脛骨構成要素は移植され、固定される（セメントにより又はセメントを用いず）。本発明に従う移植システムは、手術に、彼が移植したいタイプのスライド板を自由に決定する可能性を提供する。これは、本発明に従う回転運動固定メカニズムを末端部に変位させることにより保障される。別の利点は、手術時間の減少、インプラントの骨のベアリング及び骨の接触領域の優しい治療、さらにもはや使用できない脛骨構成要素の保存にある。これに比べて従来技術のシステムでは、脛骨構成要素は、可動から固定スライドプレートに切り替える際（逆もまた同じ）、交換されなければならない。
本発明による別な基本的な利点は、修正の際、固定した大腿構成要素と脛骨構成要素は骨の中に残され、スライド板だけがそれぞれの靭帯の状況に応じて取り替えられなければならない点にある。従来技術のシステムでは必要不可欠であった、内部で成長した固定した脛骨構成要素の除去は、かなりの健康な骨の喪失を伴う。
本発明の別な実施形態では、特に、非円形の断面の末端部の凹みを有するアンカー部と、対応する外形の端部を有するスライドプレートの連結部が設けられる。この端部は非円形の凹みと嵌合により係合する。
非円形の凹みは、丸い角を有するほぼ三角形の基本的形状を有するのが好ましい。これはピークの応力を排除し、信頼できる回転運動の固定を実現するのに役立つ。
別な実施形態では、脛骨構成要素のアンカー部が内部で非円形の正の表面輪郭を有する。表面輪郭は、スライド板の連結部の非円形の負の表面輪郭と係合する。
別な実施形態は、嵌合により回転しない接続部を提供する。ここでは、スライド板及び脛骨プラトー構成要素のそれぞれの正及び負の表面輪郭は、凹みと連結部から偏心している。この実施形態では、嵌合により円形及び非円形の係合を特徴とする表面輪郭が考えられる。
全ての実施形態で、スライド板の連結部の軸方向に延びる金属の補強部が設けられ、それによりポリエチレンの剪断が避けられる。金属の補強部は円形又は非円形の断面を有する。
本発明の詳細は、図面に則した好ましい実施形態の後続の記述から明らかであろう。
図１及び２に見られるポリエチレンのスライド板１は腎臓形の基本形状を有し、下方に延びる連結部２を備えている。連結部は、図１に見られるような丸い角を有する三角形の基本形状の端部３を有する。
図３〜５に見られるトレー４は下方に延びるアンカー部５を備え、スライド板１の連結部２の形状にかみ合う凹み６を有する。
凹み６の底部には小さめの直径の凹み７が設けられている。凹みは、丸い角を備えた三角形の基本形状を有し、端部３の外形に対応する外形を有する。
先ず図１及び２に見られるスライド板１がその連結部２により凹み６に挿入されると、端部３は嵌合により凹み７と係合し、それで回転しない接続部が作られる。
それに応じて、同一の脛骨プラトー構成要素４を用いて、様々な移動度のスライド板１を適用することが可能である。
ポリエチレンのスライド板とアンカー部の下からの図である。 スライド板とアンカー部の側面図である。 脛骨プラトー構成要素の側面図である。 脛骨プラトー構成要素の縦断面図である。 移植した状態の脛骨プラトー構成要素の平面図である。
符号の説明
１ スライド板
２ 連結部
４ 脛骨プラトー構成要素
５ アンカー部

Claims (4)

  1. 骨に固定するためのアンカー部とポリエチレンのスライド板のためのトレーを有する脛骨構成要素において、
    上記脛骨構成要素は、湾曲した関節表面により上記スライド板に当接する大腿構成要素と協働し、
    上記スライド板（１）は連結部（２）を有し、
    上記連結部は、脛骨プラトー構成要素（４）の上記アンカー部（５）の内部に延び、該脛骨プラトー構成要素（４）の末端部で嵌合によって上記アンカー部（５）に回転しないで接続している
    ことを特徴とする脛骨構成要素。
  2. 請求項１に記載の脛骨構成要素及びスライド板において、
    上記アンカー部（５）は非円形の断面の末端部の凹み（７）を有し、
    上記スライド板（１）の上記連結部（２）は、対応する外形の端部（３）を有し、
    この端部（３）は、嵌合により非円形の凹み（７）と係合する
    ことを特徴とする脛骨構成要素及びスライド板。
  3. 請求項２に記載の脛骨構成要素及びスライド板において、非円形の凹み（７）は、丸い角のほぼ三角形の基本的形状を有することを特徴とする脛骨構成要素及びスライド板。
  4. 請求項１に記載の脛骨構成要素及びスライド板において、上記スライド板（１）は、超高分子量のポリエチレン及び／又は架橋ポリエチレンから成ることを特徴とする脛骨構成要素及びスライド板。
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