JP6921754B2 - 関節形成術用バランシング装置および使用法 - Google Patents
関節形成術用バランシング装置および使用法 Download PDFInfo
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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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4657—Measuring instruments used for implanting artificial joints
-
- 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2/461—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of knees
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
- A61B17/154—Guides therefor for preparing bone for knee prosthesis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
- A61B17/154—Guides therefor for preparing bone for knee prosthesis
- A61B17/155—Cutting femur
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
- A61B2017/0268—Joint distractors for the knee
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
- A61B2090/065—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring contact or contact pressure
-
- 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/38—Joints for elbows or knees
-
- 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4657—Measuring instruments used for implanting artificial joints
- A61F2002/4658—Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length
-
- 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4657—Measuring instruments used for implanting artificial joints
- A61F2002/4666—Measuring instruments used for implanting artificial joints for measuring force, pressure or mechanical tension
-
- 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4657—Measuring instruments used for implanting artificial joints
- A61F2002/4668—Measuring instruments used for implanting artificial joints for measuring angles
-
- 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
- A61F2/00—Filters 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
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2002/4688—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor having operating or control means
- A61F2002/4692—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor having operating or control means fluid
- A61F2002/4694—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor having operating or control means fluid pneumatic
Description
インサート100上または内に配置されるセンサは、関節のバランシングに関連する多数の様々なパラメータを測定し判定するように構成することができる。たとえば、センサは、アクチュエータに加えられる力または荷重と、その結果として上側プレートまたは下側プレートの様々な部分が隣接骨から受ける圧力を測定し判定するように構成することができる。これらのセンサの例は、荷重セル、歪みゲージ、圧力センサなどである。バネ式アクチュエータの場合、バネ力はたとえば既知のバネ剛性と、変位センサを用いて測定されるバネ長とを用いて間接的に算出することができる。センサは、運動の距離を、下側プレートと下側プレート間の総運動距離または個々のアクチュエータの運動距離のいずれかで監視するように構成することもできる。これらのセンサの例はたとえば、磁気センサ、光電センサ、アクチュエータ機構(たとえばネジ式アクチュエータ)のストロークの監視などである。センサは、加速度計、磁気計、ジャイロスコープを使用して、運動角度、さらには角度位置を測定することもできる。
いくつかの実施形態では、インサート100は空気圧や水圧などの流体動力によって始動することができる。空気、食塩水、またはゲルなどのより粘性の高い流体を、始動流体として使用することができる。図4〜7はインサート100の1実施形態を示しており、インサート100は空気圧式インサートである。図4は、空気圧式アクチュエータ180を有する図1の1実施形態を示す斜視図である。
いくつかの実施形態では、インサート100は、プレートと関節の隣接骨構造に荷重を加える一定または可変力バネなどの1以上の機械的アクチュエータ180を設けて構成される。アクチュエータ180の数と種類は、装置の意図する機能や始動プロセスに必要な制御量などの様々な要因に応じて変動させることができる。
インサート100は、当業者にとって既知な生体適合性または医療用のポリマーまたは合金の組み合わせで作成することができる。生体適合性材料は、接触が限定されるように格付けすることができる。構造上および機械上の仕様を満たすために要求される材料は圧力、温度、流体、インサートのその他のコンポーネントおよび隣接する骨表面、軟骨、靱帯、その他の組織との摩擦に耐える必要がある。上側プレート110、特に関節接触面139の材料は、大腿骨またはコンポーネントの関節面に損傷を及ぼさないような材料にすべきである。また、インサート100は、手術中の感染リスクを最小限にとどめるため、殺菌することのできる材料から成るべきである。材料要件は、アクチュエータにも適用され、いくつかの側面では、特に無菌および耐久性要件に関してセンサにも適用される。実施形態では、インサート100は、X線透視確認のために使用されるX線不透過マーカまたは材料を含むことができる。
コントローラ
図15および16は、インサート100と切断ガイドアセンブリ400とを含む関節バランシングシステムの1実施形態を示す。切断ガイドアセンブリ400はインサート100に接続されて、関節のバランシング中の骨および組織の切断をガイドするのに使用される。切断ガイドアセンブリ400はインサート100に搭載されて、関節のバランシング中に骨、軟骨、または靱帯の切断部についてのガイドを外科医に提供する。
Claims (14)
- 関節の修復中に前記関節のバランスをとるためのインサートであって、前記インサートが、
関節の第1の骨構造とのインタフェースとなるように構成される第1のプレートと、
前記第1のプレートに連結される第2のプレートであって、前記第2のプレートが、
前記第1のプレートから離れて配置され、前記関節の第2の骨構造とのインタフェースとなるように構成されるプレート部であって、前記第2の骨構造が前記第1の骨構造に対向する、プレート部と、
前記プレート部から延在し、前記第1のプレートの外周を超えて突出する移行部と、
前記移行部から、前記第1のプレートの前記プレート部に対して横断する方向に延在する搭載部と、
を含む、第2のプレートと、
少なくとも1つの搭載ガイドであって、前記少なくとも1つの搭載ガイドのそれぞれが、前記搭載部を通じて延在する穴を含む、搭載ガイドと、
前記第1のプレートと前記プレート部との間に位置し、前記第1のプレートおよび前記プレート部に力を加えるように構成されるアクチュエータと、
を備える、インサート。 - 前記第1のプレートと、前記第2のプレートのプレート部との間の空間関係を判定するように構成された少なくとも1つのセンサをさらに備える、請求項1に記載のインサート。
- 前記第1のプレートが、膝関節の修復中に前記膝関節の大腿骨と接触するように構成され、前記第2のプレートが、前記膝関節の修復中に前記膝関節の脛骨に接触するように構成される、請求項1に記載のインサート。
- 前記アクチュエータが、膨張可能な材料から成る蛇腹を含む空気圧式アクチュエータである、請求項1に記載のインサート。
- 前記搭載ガイドが、前記搭載部から突出するフランジを含み、前記穴が前記フランジを通じて延在する、請求項1に記載のインサート。
- 前記搭載部が、
第1の脚部と、
第2の脚部と、
をさらに備え、
前記第1の脚部と前記第2の脚部との間に凹部が形成される、請求項1に記載のインサート。 - 前記第1の脚部が、前記第2の脚部よりも遠くに延在する、請求項6に記載のインサート。
- 前記蛇腹が膨張し、それによって圧搾空気により前記第1のプレートおよび前記プレート部に力を加えるように構成される、請求項4に記載のインサート。
- 前記フランジが、前記搭載部から、前記プレート部から離れる方向に、前記プレート部に向かう方向に、またはそれら両方の何れかに突出する、請求項5に記載のインサート。
- 前記プレート部、前記移行部、および前記搭載部が一体形成される、請求項1に記載のインサート。
- 前記搭載部が、前記移行部から、前記第1のプレートに向かって横断する方向に延在する、請求項1に記載のインサート。
- 前記第1の脚部および前記第2の脚部が、前記少なくとも1つの搭載ガイドを越えて横断する方向に延在する、請求項6に記載のインサート。
- 請求項5に記載のインサートを含む、前記関節の修復中に前記関節のバランスをとるための関節バランシングシステムであって、前記関節バランシングシステムが、
前記関節の修復中に切断をガイドするように構成されるガイドスロットを含む切断ガイドと、
前記切断ガイドを前記搭載部に連結する搭載留め具であって、前記フランジへと延在する搭載留め具と、
をさらに備える、関節バランシングシステム。 - 前記搭載留め具がガイドピンであり、前記インサートが、前記搭載部に固定され、前記ガイドピンの配置を調節するように構成される調節装置を含む、請求項13に記載の関節バランシングシステム。
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Application Number | Priority Date | Filing Date | Title |
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US201562137661P | 2015-03-24 | 2015-03-24 | |
US62/137,661 | 2015-03-24 | ||
PCT/US2016/024105 WO2016154489A1 (en) | 2015-03-24 | 2016-03-24 | Balancing device for arthroplasty and methods of use |
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JP2018512928A JP2018512928A (ja) | 2018-05-24 |
JP6921754B2 true JP6921754B2 (ja) | 2021-08-18 |
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US (3) | US10206791B2 (ja) |
EP (2) | EP3682855A1 (ja) |
JP (1) | JP6921754B2 (ja) |
KR (1) | KR102531926B1 (ja) |
CN (1) | CN107530097A (ja) |
AU (1) | AU2016238323B2 (ja) |
ES (1) | ES2784884T3 (ja) |
WO (1) | WO2016154489A1 (ja) |
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US10869771B2 (en) | 2009-07-24 | 2020-12-22 | OrthAlign, Inc. | Systems and methods for joint replacement |
CN102688097B (zh) * | 2012-05-14 | 2014-11-26 | 清华大学 | 人工髋关节置换术中髋臼及股骨头姿态获取方法与系统 |
US9649160B2 (en) | 2012-08-14 | 2017-05-16 | OrthAlign, Inc. | Hip replacement navigation system and method |
US10136952B2 (en) * | 2016-06-16 | 2018-11-27 | Zimmer, Inc. | Soft tissue balancing in articular surgery |
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