JP2021072940A - 股関節装置および方法 - Google Patents
股関節装置および方法 Download PDFInfo
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- JP2021072940A JP2021072940A JP2021012945A JP2021012945A JP2021072940A JP 2021072940 A JP2021072940 A JP 2021072940A JP 2021012945 A JP2021012945 A JP 2021012945A JP 2021012945 A JP2021012945 A JP 2021012945A JP 2021072940 A JP2021072940 A JP 2021072940A
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- medical device
- prosthetic
- femur
- acetabulum
- equator
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
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- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
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- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
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- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
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- A61M5/142—Pressure infusion, e.g. using pumps
- A61M5/14244—Pressure infusion, e.g. using pumps adapted to be carried by the patient, e.g. portable on the body
- A61M5/14276—Pressure infusion, e.g. using pumps adapted to be carried by the patient, e.g. portable on the body specially adapted for implantation
- A61M2005/14284—Pressure infusion, e.g. using pumps adapted to be carried by the patient, e.g. portable on the body specially adapted for implantation with needle insertion means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
- A61M5/142—Pressure infusion, e.g. using pumps
- A61M5/14244—Pressure infusion, e.g. using pumps adapted to be carried by the patient, e.g. portable on the body
- A61M5/14276—Pressure infusion, e.g. using pumps adapted to be carried by the patient, e.g. portable on the body specially adapted for implantation
Abstract
Description
この軟骨も異常に着用することは、Synovial流体と呼ばれているジョイント潤滑流体の減少に結果としてなる。股関節Osteoarthritisが、多少重大な形で、65歳以上の全ての人々の80%に影響を及ぼすことは、推定される。
股関節の中央の方の凸面股関節面を有する大腿骨の骨の近位の部およびボウルが股関節の中央の方の凹股関節面を有する骨盤の一部として寛骨臼を成形したので、医療装置は、成る以下の通り。植設されるときに、股関節の中央、前記人工凸面頭大腿骨の補綴球状部分に接続していて、ヒト患者の骨盤に固定するために適応する細長い部分、大腿骨が適応する前記人工凸面頭の方へ凸面から成っている人工頭大腿骨が、骨盤に前記細長い部分固定によるヒト患者の骨盤に固定する、そして、前記補綴球状部分を握るために適応する少なくとも一つの伸びている部分から成って、患者の大腿骨の骨に固定する補綴人工の寛骨臼面との移動可能な関係においてある。そこにおいて、前記細長い部分は前記人工凸面頭大腿骨に関して人工寛骨臼の運動範囲を制限するために適応する制限している部分から成る、そして、前記細長い部分の前記制限している部分は前記人工寛骨臼に関して有利な運動範囲を可能にするために適応する。
分の横断面は、楕円である。
一実施例によれば、寛骨臼の前記補綴代わりは、そこにおいて、前記医療装置と関連してある前記球状部分を受けるために適応する。
線を延長すること、背面の冠状骨盤平面PXYに、そして、横骨盤PXZ平面に末梢部のベース・ポジションにおいてあること。
マリーブその他、Human Anatomy、2003、ベンジャミン・カミングズ、サンフランシスコ、ページ195−202、そして、ムーアその他で、Clinicallyは、anatomy,1999、リッピンコット、ウィリアムス及びウィルキンズ、ボルチモア、ページ501 ― 653(両方とも本願明細書に引用したものとする)
― を正しい位置に置いた。
例えば、日常的な動作は、成る:
歩くこと、座ること、循環など。
ある。
そして、圧力は、応力によって生じる変化の比率である。
は、位置Oを調べる』起源Oである』そして、より深い谷頭大腿骨5および結腸煙突大腿骨6(結腸煙突大腿骨6に合わせられる)の以下の内部の中で上部。8a.、寛骨臼ボウルの端によって定義される円によって定義される平面と平行して、寛骨臼ボウル8aの一番下において軸Y』は、軸Xに対して垂直である』そして、起源Oを通過する』。
固定している部材は、放射状に安定させるための外科的に切られた頭大腿骨の外側上を移動する固定している部分680と外科的に切られた頭大腿骨へのロック部材を固定させることとを備えている。人工の凸面股関節面112は、スレッド114から成っている細長い取付けロッド113および細長い部分2201に接続している球状部分112に関して寛骨臼110の補綴代わりのより深い変化を可能にするための凹部2203に固定する。
例によれば、細長い部分2201は、部分を延長することから成っている寛骨臼の補綴代わりに関して補綴部分の動きを容易にしているいかなる凹部または改作を有しない。
断面を示す。細長い部分の制限している部分の偏心の配置は、常軌を逸して配置されている狭い部分によってつくられる凹部の方向に、人工股関節の運動範囲を増加させる。この実施例は、図17bの模型的な側面図において開示される。
は部分に補綴球状部分45を握っている1823c,dをして回られる二つから成る。寛骨臼の補綴代わりの二つを延長している部分1823c,dは、細長い部分2201の対応する丸い凹部にマッチするために適応する丸い形状を有する。伸びている部分が補綴球状部分45を握って静まる間寛骨臼の補綴代わりが比較的大きい運動レンジを移動させることができるようにこうして、寛骨臼65の補綴代わりの形状は、適応する。
面の4分の1の細長い部分2201aの大部分を配置することは、より重要でない方法で必要とされる運動範囲を制限する。凹部から成っている細長い部分は、図17bおよび19bに関して更に開示される。
節のよりかなりの運動範囲をつくる第1および第2の伸びている部分1823a,bとのすきまに入ることを可能にする)でないこと、細長い部分2201の凹部2203は、伸びている部分の若干の部分が凹部2203に入るために適応する。
中立位置から、股関節の以下の動きは、通常可能である:
横方向であるか外部の回転、延長される腰を有する30°、撓曲する腰、内側であるか内部回転40°、拡張または後屈20°を有する50°、屈曲または前傾140°、延長される腰を有する外転50°、撓曲する腰を有する80°、延長される腰を有する引証30°、撓曲する腰を有する20°。通常の腰の運動範囲が股関節を囲んでいる筋肉、テノールおよび靭帯によって、通常機敏な人において、これらの運動において制限された時から、外転および引証の運動範囲において、寛骨臼ボウルおよびこのように伸びている部分の深さは重要な方法の運動範囲を制限しない。
日常的な動作に関して、このように非拘束性の方法の股関節の運動範囲を制限して、ベース・ポジションの離れられた寛骨臼(図示せず)の中で離れられた大腿骨の骨に置かれる寛骨臼のための補綴置換は、二つを延長している部分1823a,bから成る、両方とも配置される、背面の対応する垂直な寛骨臼平面PX’Y』。両方の左右の実施例において、1823が赤道に沿って不連続的にこのように細長い部分2201が、そして、離れられた実施例において、線および拡張が沿って並ぶ赤道の間に部分的に配置されることを可能にしている第1821行にする伸びている部分が、このように伸びている部分1823a,b.との間に空腔に入っている伸びている部分1823a,bの間に配置される
頭および結腸煙突センター軸に関して、右の股関節に植設される補綴細長い部分2201の凹部2203は、放射状に配置される補綴細長い部分2201の中で断面、細長い2201および球状45a部に関して更に補綴寛骨臼面65の運動範囲を増加させるための凹部を始まることができる。細長い2201および球状45b部に関して更に補綴寛骨臼面65の運動範囲を増加させるために、頭および結腸煙突センター軸に関して、離れられた股関節に植設される補綴細長い部分2201をカーブさせることは、放射状に配置される。
している第2は、閉鎖孔の方へ内側に伸びる、ベース・ポジションにおいてあること。
び拡張第1846行に沿って並ぶ。補綴細長い部分2201が伸びている部分1823a,bを係合する場合、図26に示される構造は第二部品1842が回転することを可能にする。そして、それはこの目的のために傾斜する。第2の第1842部が常に配置されるこの方法で、補綴細長い部分2201が赤道の間に部分的に配置されることができるように、第1845行および拡張は1846に線をひく。そして、第二部品が補綴球状部分45を握る間、それは運動の最適範囲をつくる、そして。このように、寛骨臼65の補綴代わりの第二部品1842の球状部分45を制限する。
この実施例に従って所で、補綴細長い部分の横断面は楕円形に形づくられた細長い部分の狭い方向の寛骨臼65のための補綴置換のより深い変化を可能にする、より狭い、楕円形に形づくられた横断面である。そして、寛骨臼がそうである人工装具の伸びている部分は配置した。寛骨臼65の補綴代わりおよび補綴細長い部分2201は寛骨臼に関して正しい位置に置かれる。そうすると、ベース・ポジションおよび2201がそうである細長い部分の主な部においてあることが正面の1812および背面の1814の4分の1において配置するときに、伸びている部分1823c,dは近位の1811および遠位1813の4分の1に置かれる。その一方で、軽微な部だけは近位の1811および遠位1813の4分の1に置かれる。この構成は、寛骨臼65のための補綴置換が部分に1823c,dをすることを有することを可能にする、そして、自然の股関節の制限を上回る股関節の運動範囲を制限することのない比較的大きい横断面を有する細長い部分(いかなる方向もの)。
寛骨臼65の補綴代わりの二つを延長している部分1823c,dは、細長い部分2201の対応する丸い凹部にマッチするために適応する丸い形状を有する。伸びている部分が補綴球状部分45を握って静まる間寛骨臼65の補綴代わりが比較的大きい運動レンジを移動させることができるようにこうして、寛骨臼65の補綴代わりの形状は、適応する。いかなる方向でも、この構成は、寛骨臼65の補綴代わりが部分に1823c,dおよび自然の股関節の制限を上回る股関節の運動範囲を制限することのない比較的大きい横断面を有する細長い部分をすることを有することを可能にする。
若干の実施例によれば、長形部材の制限している部分の横断面の1/10は、近位で遠位四半部に置かれるが、9/10は、正面で背面の4分の1(9/10が二つ4分の1の間に配布されて等しくありえた)に置かれる、または、大部分は、6/10のような背面の4分の1に置かれることができる、そして、4/10は、正面の4分の1に置かれることができる、しかしながら、それは反対に寛骨臼のための補綴置換の設計の中で場合によっていることは、等しく考えられる。深い凹部または改作から成っている実施例で、または、細長い部分の制限している部分が結腸煙突および頭センター軸に関して常軌を逸して配置される実施例で、細長い部分のわずか0/10は特定の4分の1に置かれることができる、そして、それから、全てのものは1/10から変動する−細長い部分の制限している部分の10/10は有利な運動範囲を得るために4分の1のいずれかに置かれることができる、大腿骨の骨および特に寛骨臼のための補綴置換の伸びている部分に関する寛骨臼のための補綴置換の配置に応じて全てはベース・ポジションにおいてある。
ポリテトラフルオロエチレン(PTFE)過フルオロ・アルコキシ(PFA)でフッ化エチレン・プロピレン(FEP)。
素材が金属合金(例えばコバルト−クロミウム−モリブデンまたはチタンまたはステンレス鋼)から成ることはさらに、考えられる、または、ポリエチレン、例えばクロスリンク・ポリエチレンまたはガスはポリエチレンを殺菌した。
接触表面または全ての医療装置(例えばジルコニウムまたは二酸化ジルコニウム・セラミックまたはアルミナ・セラミック)で、セラミック材料の使用は、考えられもする。
人体の骨に対する医療装置の固定のための人体の骨と接触する医療装置の部は、医療装置を固定させるための医療装置の人体の骨のgrowth−inを促進するために適応する多孔性マイクロまたはナノ構造でありえた救貧院構造から成ることができる。
多孔質構造体はヒドロキシアパタイト(HA)コーティングまたは粗くopen−poredされたチタン・コーティング(空気プラズマ噴霧によってできることができる)を適用することにより提供されることができる。そして、ラフから成っている組合せはチタン・コーティングをopen−poredした、そして、HA表層は考えられもする。
接触部は蝋様変性のポリマー(例えばPTFE、PFA、FEP、PEおよびUHMWPE)のような自己油をさされた素材または潤滑油を吹き込まれることができる粉末冶金素材でできていることがありえた。そして、それは好ましくは生物学的適合性の潤滑油(例えばHyaluronic酸派生物)である。
本願明細書において医療装置の部または表層を接触させる素材が常に、または、断続的に油をさされるために適応することは、考えられもする。
若干の実施例によれば、医療装置の部または部分は、金属素材および/または炭素繊維および/またはホウ素の組合せ、金属およびプラスチック材料の組合せ、金属およびカーボンを主成分とする素材の組合せ、カーボンおよびプラスチックを主成分とする素材の組合せ、可撓性で固い素材の組合せ、弾性でより少ない弾性体の組合せ、Corianまたはアクリル系ポリマから成ることができる。
Claims (11)
- 患者の股関節に移植するための医療器具であって、前記医療器具は患者の大腿骨に固定するよう適合され、前記医療器具は内側(1827)と外側(1828)の表面を有し、前記内側表面の接触部分はボウル形状であり、前記医療器具が移植されるときに、前記股関節の中心に面するよう適合され、前記医療器具は大腿骨頭の頭部分の補綴である補綴置換を受けるよう適合され、前記補綴置換は球状部分を有し、機能的股関節を作成するために、大腿骨の近位部分に配置される前記医療器具の前記ボウル形状の前記内側表面に受け入れられるように形成され、前記医療器具は前記内側表面を平等に二分する球体の均分円ライン(1821;1845)を備え、前記内側表面の円周は前記均分円ラインで最大になり、表面は前記大腿骨頭の頭部分の補綴である補綴置換に接触するよう適合され、前記医療器具は少なくとも1つの延長している部分(1823a;1823b)を備え、
前記少なくとも1つの延長している部分は前記大腿骨頭の頭部分の補綴の前記補綴置換の球状部分(45)を留めるよう、前記球状部分は前記ボウル形状の医療器具に拘束されるように、前記内側表面の前記接触部分を延長し、前記医療器具は、前記少なくとも1つの延長している部分は前記均分円ラインに沿って周方向に延び、定義されたベース・ポジションにあるとき、骨盤の左右方向の軸の背面に適合され、前記医療器具は、前記均分円ラインの円周を超えては延びない第2の部分を備え、前記第2の部分は前記均分円ラインの円周の少なくとも2分の1に沿って周方向に延びることを特徴とする医療器具。 - 前記医療器具は、前記大腿骨頭の補綴である前記補綴置換の前記球状部分を受取るよう適合され、前記大腿骨頭の前記補綴置換の前記球状部分に固定するよう適合された細長い部材(2201)経由の接続によって前記骨盤に固定され、
a)前記内側表面は赤道を備え、前記内側接触表面の最大の円周になり、表面は大腿骨頭または補綴置換に接触するよう適合され、
b)前記少なくとも1つの延長している部分は前記赤道を超え、前記内側表面の接触部分の端部は、均分円ラインより小さい円周を有する円形の拡張線を形成し、
c)前記少なくとも1つの延長している部分は前記均分円ラインに沿って不連続的に周方向に延び、前記医療器具が前記大腿骨頭のための前記補綴置換と共に移植されるとき、前記細長い部材の一部分は前記延長している部分のラインと前記均分円ラインの間に配置されることが出来る、
ことを特徴とする請求項1に記載の医療器具。 - 前記医療器具が移植されるとき、前記延長している部分のラインが前記均分円ラインの背面に位置づけられるよう適合されたことを特徴とする請求項1又は2に記載の医療器具。
- 前記医療器具は、下記の:
定義されたベース・ポジションにいるとき、冠状骨盤面PXYの背面および水平骨盤PXZ平面の近位、
定義されたベース・ポジションにいるとき、冠状骨盤面PXYの背面および水平骨盤PXZ平面の遠位、
定義されたベース・ポジションにいるとき、冠状骨盤面PXYの背面および水平骨盤PXZ平面の近位、そして1つの延長している部分は冠状骨盤面PXYの背面および横骨盤PXZ平面の遠位に延び、
定義されたベース・ポジションにいるとき、前記均分円ラインの近位4分の1(1811)、
定義されたベース・ポジションにいるとき、前記均分円ラインの遠位4分の1(1813)、
定義されたベース・ポジションにいるとき、近位および背面の4分の1(1814)、
定義されたベース・ポジションにいるとき、遠位および背面の4分の1、
定義されたベース・ポジションにいるとき、遠位、背面および近位4分の1、
の少なくとも1つのポジションで、前記少なくとも1つの延長している部分が前記均分円ラインに沿って周方向に延びるよう適合されることを特徴とする請求項1から3の少なくとも一項に記載の医療器具。 - 前記医療器具の少なくとも第1の部分は延長している部分であり、前記均分円ラインの円周を超えて延び、少なくとも第2の部分は前記均分円ラインの円周を超えては延びず、前記第1の部分は少なくとも1つの:
前記赤道の円周の少なくとも4分の1に沿って、
前記赤道の円周の少なくとも3分の1に沿って、
前記赤道の円周の少なくとも2分の1に沿って、
前記赤道の円周の少なくとも10分の1に沿って、
前記赤道の円周の少なくとも10分の1に沿って、そして前記第2の部分は前記赤道の円周の少なくとも4分の1に沿って、
周方向に延びることを特徴とする請求項1から4のいずれか一項に記載の医療器具。 - 前記医療器具の前記少なくとも2つの第1の部分は延長している部分であり、前記均分円ラインの円周を超えて延び、少なくとも1つの第2の部分は前記均分円ラインの円周を超えては延びず、前記第1の部分のそれぞれは、前記赤道の円周の少なくとも10分の1に沿って周方向に延び、前記第2の部分は前記赤道の円周の少なくとも4分の1に沿って周方向に延びることを特徴とする請求項1から5のいずれか一項に記載の医療器具。
- 前記2つの延長している部分は、定義されたベース・ポジションにいるとき、前記均分円ラインの遠位および近位4分の1で、前記均分円ラインに沿って周方向に延び、前記医療器具の少なくとも2つの第1の部分は延長している部分であり、少なくとも1つは:
前記均分円ラインの円周を超え、前記延長している部分の1つは他の延長している部分より先に延び、もしくは、
第2の部分を備えた前記医療器具によって、前記2つの延長している部分の間の均分円ラインに沿って周方向に延びる、
ことを特徴とする請求項1から6のいずれか一項に記載の医療器具。 - 前記医療器具は少なくとも1つの穴を備え、前記少なくとも1つの穴は、前記医療器具を前記大腿骨に固定するため、固定部材を受取るよう適合されることを特徴とする請求項1から7のいずれか一項に記載の医療器具。
- 前記穴は前記大腿骨に固定するため、ネジ(1830;1831)を受取るよう適合されることを特徴とする請求項8に記載の医療器具。
- 予め決められた負荷が前記医療器具にかかるとき、前記医療器具は、前記大腿骨頭または前記補綴の大腿骨頭を開放するよう適合されることを特徴とする請求項1から9のいずれか一項に記載の医療器具。
- 前記医療器具は、移植されているとき、前記延長している部分が大腿骨の運動範囲を制限するために配置されるよう適合されるように適合され、前記延長している部分は少なくとも1つの:
内転が屈曲より制限される、
外転が屈曲より制限される、
内転が拡張より制限される、
外転が拡張より制限される、
よう配置されるように適合されることを特徴とする請求項1から10のいずれか一項に記載の医療器具。
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JP2018000175A Pending JP2018051366A (ja) | 2009-07-10 | 2018-01-04 | 患者の股関節内への移植される医療器具 |
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