JP4223802B2 - 腰関節人工装具用のモジュラー式大腿骨軸部構成要素 - Google Patents

腰関節人工装具用のモジュラー式大腿骨軸部構成要素 Download PDF

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JP4223802B2
JP4223802B2 JP2002513391A JP2002513391A JP4223802B2 JP 4223802 B2 JP4223802 B2 JP 4223802B2 JP 2002513391 A JP2002513391 A JP 2002513391A JP 2002513391 A JP2002513391 A JP 2002513391A JP 4223802 B2 JP4223802 B2 JP 4223802B2
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connector
tapered portion
tapered
concentric wall
neck
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JP2004504101A (ja
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デスプレス，アルフレッド・エス，ザ・サード
ヘイズ，ダニエル・イー・イー，ジュニアー
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デピュイ・オーソピーディクス・インコーポレーテッド
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Description

【０００１】
【出願係属中の先の出願の参照】
本出願は次の出願の優先権を主張するものである。
（１）アルフレッド・Ｓ・デスプレスＩＩＩ（Ａｌｆｒｅｄ Ｓ Ｄｅｓｐｒｅｓ ＩＩＩ）らが２０００年７月２０日付けで出願した、モジュラー式整形外科的接続具（ＭＯＤＵＬＡＲ ＯＲＴＨＯＰＥＤＩＣ ＣＯＮＮＥＣＴＩＯＮ）という名称の出願係属中の先の米国仮特許出願第６０／２１９，９５５号（弁護士事件番号ＨＡＹＥＳ−１ ＰＲＯＶ）；
（２）アルフレッド・Ｓ・デスプレスＩＩＩらが２０００年７月２０日付けで出願した、強制的継手接続具（ＦＯＲＣＥ ＣＯＵＰＬＥ ＣＯＮＮＥＣＴＩＯＮ）という名称の出願係属中の先の米国仮特許出願第６０／２１９，９６３号（弁護士事件番号ＨＡＹＥＳ−２ ＰＲＯＶ）。
【０００２】
上記２つの特許出願の内容を本明細書に含めるものとする。
【０００３】
【発明の分野】
本発明は、全体として、外科装置及び方法、より具体的には、腰関節を修復する整形外科的人工装具に関する。
【０００４】
【発明の背景】
関節置換外科手術は、長時間の永続的な機能及び痛み無しの可動性を提供し得るように関節の一部分を人工装具構成要素にて置換しようとするものである。
【０００５】
例えば、人工装具的全腰関節の場合、大腿骨の頂部を人工装具的大腿骨軸部構成要素にて置換し、股臼窩を人工装具的股臼陥凹構成要素にて置換し、これにより、人工装具的全腰関節を提供する。
【０００６】
人工装具的全膝関節の場合、脛骨の頂部を人工装具的脛骨構成要素にて置換し、大腿骨底部を人工装具的大腿骨構成要素にて置換し、これにより、人工装具的全膝関節を提供する。
【０００７】
本発明は、腰関節を修復するための整形外科的人工装具、より具体的には、改良された人工装具的大腿骨軸部構成要素に関するものである。
人工装具的大腿骨軸部構成要素は、典型的に、切除した大腿骨の基端部分内に座し且つ股臼窩内に座すボールを提供する基端部分と、大腿骨の軸部に沿って伸び得るように大腿骨の骨髄管内に座す末端部分とを備えている。
【０００８】
勿論、人工装具的大腿骨軸部構成要素はその周囲の骨と適正に嵌まることが重要である。この目的のため、人工装具的大腿骨軸部構成要素は、典型的に、患者の身体部位の相違に対応しようとして異なる寸法範囲内で提供される。しかし、これにも拘らず、患者に対して正確な人工装具的大腿骨軸部構成要素を提供することは困難であることが分かっている。この理由は、患者の身体部位が著しく相違し、また、病院の在庫に実際上制限があるからである。一例として、切除した大腿骨の基端部分に合うように適正な寸法とした基端部分を有する大腿骨構成要素が選ばれるならば、人工装具の末端部分は大腿骨の末端部分内に適正に座し得るように適正な寸法とすることができない。このことは、関節の安定性及び痛みに関係する問題点を含む、患者に対する重大な問題点を招来する可能性がある。
【０００９】
上記のため、複数の別個の構成要素から人工装具的大腿骨軸部構成要素を形成し、構成要素の各々を患者の身体部位に最も正確に近似し得るように独立的に選ぶことができ、別個の要素をモジュラー式接続具（ｃｏｎｎｅｃｔｉｏｎ）を使用して所要位置に互いに組み立て、患者に対する最良の人工装具的大腿骨軸部を提供することに非常な関心が持たれている。
【００１０】
一度び患者の体内に配置されたならば、人口装具的大腿骨軸部構成要素、従って、別個の構成要素を互いに固着するモジュラー式接続具には、軸方向荷重、曲げ荷重及び捩れ荷重が加わる。当該技術分野にて異なる型式のモジュラー式接続具が既知であるが、これら３つの型式の荷重、すなわち軸方向荷重、曲げ荷重及び捩れ荷重の全てに対処するのに理想的なモジュラー式接続具は全く存在しない。一例として、テーパー付き接続具は全体として軸方向（すなわち、圧縮）荷重に十分に対応するが、これらのテーパー付き接続具は全体として曲げ荷重及び捩れ荷重に特に十分には対応しない。更なる例として、同心状のシリンダ接続具は、全体として曲げ荷重に十分に対応するが、これらの接続具は全体として軸方向荷重及び捩れ荷重に特に十分には対応しない。
【００１１】
【発明の概要】
その結果、本発明の１つの目的は、人工装具的大腿骨軸部構成要素を形成し得るように複数の別個の構成要素を共に接続する改良されたモジュラー式接続具を提供することである。
【００１２】
本発明の別の目的は、改良された人工装具的大腿骨軸部構成要素を提供することである。
本発明の別の目的は、改良された人工装具的全腰関節を提供することである。
【００１３】
本発明の更に別の目的は、腰関節を修復する改良された方法を提供することである。
上記及びその他の目的は、本発明を提供し且つ使用することで実現される。
【００１４】
本発明の１つの形態において、人工装具的大腿骨軸部構成要素を形成し得るように複数の別個の要素を共に接続する改良されたモジュラー式接続具であって、テーパー付き接続具と、係合嵌め式接続具とを組み合わせて備えるモジュラー式接続具が提供される。
【００１５】
本発明の別の形態において、本体要素と、首状要素と、軸部要素とを備え、本体要素、首状要素及び軸部要素がモジュラー式接続具により互いに固着され、モジュラー式接続具が、テーパー付き接続具と、係合嵌め式接続具とを組み合わせて備える改良された人工装具的大腿骨軸部構成要素が提供される。
【００１６】
本発明の別の形態において、人工装具的大腿骨軸部構成要素と、人工装具的股臼陥凹構成要素とを備え、大腿骨軸部構成要素が、本体要素と、首状要素と、軸部要素とを備え、本体要素、首状要素及び軸部要素がモジュラー式接続具により互いに固着され、モジュラー式接続具が、テーパー付き接続具と、係合嵌め式接続具とを組み合わせて備える、改良された人工装具的全腰関節が提供される。
【００１７】
本発明の別の形態において、腰関節を修復する改良された方法であって、大腿骨の頂部を切除するステップと、人工装具的大腿骨軸部構成要素を受け入れ得るように大腿骨の内部を処理するステップと、本体要素、首状要素及び軸部要素を備える人工装具的大腿骨軸部構成要素を適正な寸法とした要素を選び且つこれら要素をモジュラー式接続具により共に固着することにより組み立てるステップとを備え、モジュラー式接続具が、テーパー付き接続具と、係合嵌め式接続具とを組み合わせて備え、人工装具的大腿骨軸部構成要素を大腿骨内に着座させることを備える方法が提供される。
【００１８】
本発明の上記及びその他の目的並びに特徴は、同様の部品を同様の参照番号で表示する添付図面と共に検討されるべきである、本発明の好ましい実施の形態に関する以下の詳細な説明からより完全に開示され又は明らかになるであろう。
【００１９】
【好ましい実施の形態の詳細な説明】
先ず、図１を参照すると、本発明に従って形成された人工装具的大腿骨軸部構成要素５が図示されている。人工装具的大腿骨軸部構成要素５は、全体として、本体要素１０と、首状要素１５と、軸部要素２０とを備える。本体要素１０は、首状要素１５及び軸部要素２０の一部分がその内部に伸びる中央開口２２を備えている。本体要素１０は、その外面２５が切除した大腿骨の基端部分に着座するのに適正な寸法となるように選ばれる。首状要素１５は、大腿骨内に配置された人工装具的大腿骨軸部構成要素５の他の部分に取り付けられたとき、首状要素のボール３０が腰関節の相応する股臼陥凹内に適正に着座するように選ばれる。軸部２０は、その外面３５が大腿骨の骨髄管内に着座するのに適正な寸法となるように選ばれる。
【００２０】
本発明によれば、本体要素１０、首状要素１５及び軸部要素２０は、完全な人工装具的大腿骨軸部構成要素５を形成し得るように改良されたモジュラー式接続具４０を使用して互いに固着し得るようにされている。
【００２１】
より具体的には、モジュラー式接続具４０は、テーパー付き接続具４５及び係合嵌め式接続具５０という２つの荷重支承接続具を組み合わせて備えている。
次に、図１及び図２を参照すると、テーパー付き接続具４５は、第一のテーパー付き部分５５を相応する第二のテーパー付き部分６０と相互作用させることにより形成される。より具体的には、第一のテーパー付き部分５５は首状要素１５の軸部６５に形成される。第二のテーパー付き部分６０は、本体要素の中央開口２２を画成する側壁の一部分に沿って形成される。第一のテーパー付き部分５５及び第二のテーパー付き部分６０は、荷重支承テーパー付き接続具４５を共に形成し得るように互いに対して強固に着座する。
【００２２】
次に、図１及び図２を参照すると、第一の同心状壁７０が第二の同心状壁７５と相互作用することにより係合嵌め式接続具５０が形成される。より具体的には、第一の同心状壁７０は首状要素１５の軸部６５上に形成される。好ましくは、第一の同心状壁７０は第一のテーパー付き部分５５と同軸状に且つ該第一のテーパー付き部分５５の末端側にて軸部６５上に配置されている。第二の同心状壁７５は、本体要素の中央開口２２を画成する側壁の一部分に沿って形成される。好ましくは、第二の同心状壁７５が、第二のテーパー付き部分６０と同軸状に且つ該第二のテーパー付き部分６０の末端側にて本体要素１０上に配置されている。第一の同心状壁７０及び第二の同心状壁７５は、荷重支承係合嵌め式接続具５０を形成し得るように互いに対して強固に着座する。
【００２３】
一般に、係合嵌め式接続具５０は拘束する第二の部材に対して圧力係止されるように１つの部材の変形によって安定性を実現する機械的な接続具である。この変形は、拡張（例えば、テーパー付きの拡張コレットにおけるように）又は収縮（例えば、強制嵌めの場合におけるように）とすることができる。この変形はまた、熱膨張又は熱収縮（例えば、ニチノール（Ｎｉｔｉｎｏｌ）等のような形状記憶合金の場合のように）にて行うこともできる。変形が実現される仕方に関係なく、形成される機械的接続具はこの変形の結果として互いに強制的に係合し、これにより、係合嵌め式接続具を確立する表面を有する。
【００２４】
上述したように、荷重支承係合嵌め式接続具５０を形成し得るように第一の同心状壁７０及び第二の同心状壁７５を互いに強固に着座させることのできる多数の方法が存在する。
【００２５】
例えば、第一の同心状壁７０を第二の同心状壁７５に比して僅かに過大の寸法とし、第二の同心状壁７５の内側にて第一の同心状壁７０を強制嵌めする結果、係合嵌め式接続具５０が形成されるようにすることができる。
【００２６】
これと代替的に且つ本発明の１つの好ましい形態によれば、首状要素の軸部６５の末端には凹部８０を形成し、軸部要素２０の基端が凹部８０内に挿入される突起８５を備えるようにすることができる。
【００２７】
より具体的には、突起８５は、凹部８０に対して直径方向に過大な寸法とされており、突起８５を凹部８０内に挿入すると、第一の同心状壁７０が半径方向に拡張して第二の同心状壁７５と係合し、これにより係合嵌め式接続具５０を形成する。本発明の１つの好ましい形態において、凹部８０及び突起８５の双方にテーパーが付けられており、首状部分１５の末端は割り型コレットである。これと代替的に、首状部分１５の末端は、割らずに、第二の同心状壁７５に係合するのに十分弾性的な材料で形成することができる。所望であるならば、その後に、ねじ付きボルトにより軸部要素２０を首状要素１５に係止することができる。一例として、首状要素１５は穴８７及び端ぐり穴８８を含み、軸部要素２０はねじ穴８９を含むことができる。次に、頭部９１及び末端ねじ部９２を有するボルト９０を凹状の六角ドライバ９３により推進し、その末端のねじ部９２が軸部のねじ付き穴８９内に座し、その頭部９１が首状部分の端ぐり穴８８内に座し、これにより、軸部要素２０を首状要素１５に係止することができる。
【００２８】
モジュラー式接続具４０の独創的な構造のため、人工装具的大腿骨軸部構成要素５は、従来技術の装置よりも軸方向荷重、曲げ荷重及び捩れ荷重に良好に対応することができる。より具体的には、モジュラー式接続具４０は、テーパー付き接続具４５及び係合嵌め式接続具５０という、２つの荷重支承接続具を同時に提供する。テーパー付き接続具４５は軸方向（すなわち圧縮）荷重に極めて良好に対応する。これと同時に、係合嵌め式接続具５０は曲げ荷重及び捩れ荷重に極めて良好に対応する。更に、係合嵌め式接続具５０は曲げ荷重及び捩れ荷重に対してテーパー付き接続具４５を安定化させる。２つの荷重支承接続具は、共に、従来技術の装置よりも十分良好に軸方向荷重、曲げ荷重及び捩れ荷重を全体として取り扱う。
【００２９】
次に、図３を参照すると、人工装具的大腿骨軸部構成要素５は次のようにして使用されることが好ましい。
最初に、例えば、大腿骨の頂部を切除し且つ人工装具的大腿骨軸部構成要素を受け入れ得るように大腿骨の内部を取り除くことにより患者の大腿骨１００を準備する。
【００３０】
次に、本体要素の外面２５が切除した大腿骨の基端部分内に着座するのに適正な寸法となるように本体要素１０が選ばれる。次に、大腿骨内に配置された人工装具的大腿骨軸部要素のその他の部分に取り付けられたとき、首状要素のボール３０は腰関節の相応する股臼陥凹１０５内に適正に着座するように首状要素１５が選ばれる。その外面が大腿骨の骨髄管１１０内に着座するのに適正な寸法となるように軸部２０が選ばれる。
【００３１】
次に、本体要素１０、首状要素１５及び軸部要素２０を組み立てて人工装具的大腿骨軸部構成要素５にする。このことは、第一のテーパー付き部分５５が第二のテーパー付き部分６０に係合し、これにより、テーパー付き接続具４５（図１、図２）を形成する迄、首状要素の軸部６５の末端を本体要素の中央開口２２の下方に通し、次に、軸部要素の過大寸法の突起８５が凹部８０内に挿入される迄、軸部要素２０の基端を中央開口２２内に上方に通し、そのとき、第一の同心状壁７０が拡張して第二の同心状壁７５と係合し、これにより、係合嵌め式接続具５０（図１、図２）を形成するようにして行われることが好ましい。所望であるならば、装置の要素２０を首状要素１５に係止するためにねじ付きボルト９０を使用することができる。
【００３２】
次に、人工装具的大腿骨軸部構成要素５を切除した大腿骨内に配置し、関節の股臼側を処理し（すなわち、人工装具的股臼陥凹構成要素１０５を患者の股臼１１５内に配置する）、ボール３０を首状要素１５上に配置し、腰を縮小させる。
【００３３】
上述したように、ボルト９０を首状要素１５の穴８７に通し且つ軸部要素２０を首状要素１５に固着し得るように軸部要素２０を固着する。これと代替的に、その他の配置も利用可能である。このように、例えば、次に、図４及び図５を参照すると、軸部要素２０は、その突起８５の基端側に軸８５Ａを含み、軸８５Ａの基端がねじ部８５Ｂを含み、この軸８５Ａが首状要素１５の穴８７を通じて上方に通すことができる。ナット９０Ａはねじ部８５Ｂに係合し且つ首状要素の端ぐり穴８８内に着座し、軸部要素２０を首状要素１５に対して係止する。
【００３４】
本発明の性質を説明するために本明細書にて記載して且つ図示した詳細、材料、ステップ及び部品の配置の多数の追加的な変更が、本発明の原理及び範囲から逸脱せずに当該技術分野の当業者により実現可能であることが理解されよう。
【図面の簡単な説明】
【図１】 本発明に従って形成された人工装具的大腿骨軸部構成要素の概略図的な分解側面図である。
【図２】 図１に図示した人工装具的大腿骨軸部構成要素を形成するために使用されるモジュラー式接続具の概略図的な拡大分解側面図である。
【図３】 本発明に従って形成された人工装具的全腰関節の概略図的な側面図である。
【図４】 本発明に従って形成された人工装具的大腿骨軸部構成要素の別の形態を示す概略図的な側面図である。
【図５】 図４に図示した人工装具的大腿骨軸部構成要素を使用する人工装具的全腰関節の概略図的な側面図である。

Claims (3)

  1. 人工装具的大腿骨軸部構成要素を形成し得るように複数の別個の要素を共に接続するモジュラー式接続具において、テーパー付き接続具と、係合嵌め式接続具とを組み合わせて備え、
    前記テーパー付き接続具が、第一のテーパー付き部分が第二のテーパー付き部分と相互作用することにより形成され、前記第一のテーパー付き部分が首状要素の軸上に形成され、前記第二のテーパー付き部分が、本体要素を貫通して伸びる開口を画成する側壁の一部分に沿って形成され、
    前記係合嵌め式接続具が、第一の同心状壁が第二の同心状壁と相互作用することにより形成され、前記第一の同心状壁が首状要素の軸上に形成され、前記第二の同心状壁が、本体要素を貫通して伸びる開口を画成する側壁の一部分に沿って形成され、
    前記第一の同心状壁が、前記第一のテーパー付き部分と同軸状に且つ該第一のテーパー付き部分の末端側にて首状要素の軸上に配置される、モジュラー式接続具。
  2. 請求項１によるモジュラー式接続具において、前記第二の同心状壁が、前記第二のテーパー付き部分と同軸状に且つ第二のテーパー付き部分の末端側にて本体要素上に配置される、モジュラー式接続具。
  3. 本体要素と、首状要素と、軸部要素とを備え、前記本体要素、前記首状要素及び前記軸部要素が、モジュラー式接続具により互いに固着された人工装具的大腿骨軸部構成要素において、
    前記モジュラー式接続具が、テーパー付き接続具と、係合嵌め式接続具とを組み合わせて備え、
    前記テーパー付き接続具は、第一のテーパー付き部分が第二のテーパー付き部分と相互作用することにより形成され、
    前記第一のテーパー付き部分が前記首状要素の軸上に形成され、前記第二のテーパー付き部分が前記本体要素を貫通して伸びる開口を画成する側壁の一部分に沿って形成され、
    前記係合嵌め式接続具は、第一の同心状壁が第二の同心状壁と相互作用することにより形成され、
    前記第一の同心状壁が、前記首状要素の軸上に形成され、前記第二の同心状壁が、本体要素を貫通して伸びる開口を画成する側壁の一部分に沿って形成され、
    前記第一の同心状壁が、前記第一のテーパー付き部分と同軸状に且つ該第一のテーパー付き部分の末端側にて首状要素の軸上に配置される、人工装具的大腿骨軸部構成要素。
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