JP7173999B2 - 患者の股関節内への移植される医療器具 - Google Patents
患者の股関節内への移植される医療器具 Download PDFInfo
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- JP7173999B2 JP7173999B2 JP2020016088A JP2020016088A JP7173999B2 JP 7173999 B2 JP7173999 B2 JP 7173999B2 JP 2020016088 A JP2020016088 A JP 2020016088A JP 2020016088 A JP2020016088 A JP 2020016088A JP 7173999 B2 JP7173999 B2 JP 7173999B2
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- medical device
- hip joint
- prosthetic
- state
- caput femur
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Description
この軟骨も異常に着用することは、骨膜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。
股関節骨関節炎が、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。
最も一般の方法は、大腿骨の金属人工器官を配置することと寛骨臼のプラスチック・ボウルとを具備している。この動作は、腰および上の大腿の切開によって、そして、大腿筋膜および大腿の横方向の筋肉によってされる。
股関節(カプセルが大腿骨に取り付けた、そして、骨盤のイリウムが突き通られるために必要である支持股関節)への接近を得るそれを作る手術の後、完全に機能ジョイントを得るために困難である。
大腿骨は、それから骨鋸を有する首で切られる、そして、人工器官は、骨を有するどちらでも結合する大腿骨に置かれる、または、寛骨臼はAcetabularリーマーを用いてわずかに拡大される、そして、プラスチック・ボウルはネジまたは骨セメントを用いて配置される。
より深い医療装置には、固定するのに適している第二ピースが設けられて、大腿骨の骨ように構成されている。植設されるときに、第二ピースは部分的に前記第1の部分の凸面接触表面を囲むために適応する凹接触表面から成る。より深い医療装置は、第1の部分が第二ピースに取り付けた保持に適応する解除している部材(第1の状態の)を有し、第1のものは第二ピースから接合するすぐにステート解放を備えている。予め定められた圧力が解除している部材に配置されるときに、解除している部材は第1の状態から第2の状態
に変化するために適応する。解除している部材を有する構造は、人体および補綴部との間に人体および/または相互接続のいかなる構造にも損害を与える危険を減らす。
よる医療装置の第1の部分は各々と接触してあるために適応する少なくとも2つの部から成ることができる。少なくとも2つの部が患者の骨盤の穴による股関節に導入されたあと、少なくとも2つの部のある者は少なくとも2つの部の第2まで機械的に固定するために適応することができる。
さらにもう一つの実施例によれば、第1の部分を弾性部材を用いている第二ピースに保持するステップは、第1の部分を輪ゴムを用いている第二ピースに保持することから成る。
置されることができて、破裂ピンから成ることができる。
内面および外面。
内面に、6つの異なる位置が設けられている。
第1の位置、第2の位置、第3の位置、第4の位置、第5の位置および第6の位置(内面の長さ軸に沿った異なる場所にある全ての位置)。
前記第1の位置から位置が前記第3の位置から前記第4の位置まで第2の直線と平行して達している前記2番まで手を伸ばして、最初の直線、それは、次々に、前記第5の位置から前記第6の位置まで手を伸ばしている3本目の直線と平行である。
さらにまた、第1で3本目の直線は前記第2の直線より短い、そして、前記第2の直線は前記第1で前記3本目の直線の間に位置する。
頭大腿骨は、股関節をつくっているボウル形の寛骨臼に置かれる。
ボウル形の寛骨臼は、開口部および寛骨臼ボウルの一番下の中心からの中心の軸および、開口部の方のボウルの中央および頭大腿骨後の、そこにおいて、寛骨臼を有する第2の軸配分に寛骨臼の第2の軸配分の中心の軸と実質的に直角をなす最大直径を有させる。
軸配分の中心の軸の延長は第2の軸配分の中心の軸と同一である。そのとき、頭大腿骨は寛骨臼ボウルの中央に置かれて対称形のポジションにおいてある。
医療装置は、二つ人工股関節面(部分が成る第一)から成る;人工股関節は成ることに表面をつける、表層が部分的に少なくとも適応させた人工頭大腿骨は置き換える、そして、結腸煙突大腿骨の反対側に、そして、適応して、頭大腿骨の共同の表層を置き換えて、ジョイントに取り付けられるときに、従って、寛骨臼ボウルまたは人工の置換に置かれる。
カバーするために適応する表層の部を越えて最初に少なくともある者から成っておよび/または前記頭大腿骨の最大直径を越えて少なくとも前記頭大腿骨の部上の前記頭大腿骨の骨に入って、ジョイントのその機能的なポジションの前記頭大腿骨に載置するときに前記結腸煙突大腿骨の方の前記寛骨臼ボウルから間隔をおいて配置されて、人工の頭大腿骨面。
部を越えた少なくとも一つの第一は、前記頭大腿骨の前記最大直径の周辺および前記中心の軸の間の距離より小さくて、前記中心の軸までの最も近い垂直な距離を有するために適応するこのように適応させる作成する、そして、前記機能的なポジションの前記頭大腿骨に載置するときに、前記人工の頭大腿骨面のより安定ポジションを作成する。
を越えて、部は、少なくとも解除している部材の部から成る。
頭大腿骨は、股関節をつくっているボウル形の寛骨臼に置かれる。
ボウル形の寛骨臼は、前記寛骨臼ボウルの一番下の中心から、そして、開口部の方の前記ボウルの中央および頭大腿骨後の開口部および中心の軸を有する第2の軸配分を有する。
寛骨臼は寛骨臼の前記第2の軸配分の中心の軸と実質的に直角をなす最大直径を有する、軸配分の中心の軸の延長は第2の軸配分の中心の軸と同一である。そのとき、頭大腿骨は寛骨臼ボウルの中央に置かれて対称形のポジションにおいてある。
医療装置は二つ人工股関節面から成る、人工股関節は成ることに表面をつける、表層が部分的に少なくとも適応させた人工寛骨臼は置き換える、そして、ジョイントを交換することは寛骨臼の中で浮上して、股関節に取り付けられるときに、頭大腿骨または従って、人工の置換上に配置されるために適応させた。
股関節のその機能的なポジションで、従って、頭大腿骨または人工代わりに載置するときに、人工の寛骨臼面は寛骨臼(結腸煙突大腿骨の方の寛骨臼ボウルから間隔をおいて配置される)の最大直径を越えて従って、少なくとも頭大腿骨または人工代わりの部をカバーするために適応する表層の部を越えて最初に少なくともある者から成る。
前記人工の寛骨臼面の前記最大直径の周辺および前記中心の軸の間の距離より小さくて、前記中心の軸までの最も近い垂直な距離を有するために適応する部を越えて最初に少なくとも一つであるこのように適応させる作成する、そして、頭大腿骨または従って、前記
股関節の前記機能的なポジションにおいて、人工の置換に載置するときに、人工の寛骨臼面のより安定ポジションを作成する。
部を越えて第1であるものに、解除している部材が設けられている。
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。
図面において、参照番号の様に、数桁の全体にわたって同一であるか対応する要素を示す。これらの図が例示目的のためにあって、本発明の範囲をいかなる形であれ制限していないことはいうまでもない。このように、方向のいかなる参照も、例えば「上へ」または、「下って」図に示される方向に関連しているだけである。また、いかなる寸法もなど。図において、目的は、説明のために示される。
股関節に、頭大腿骨5(または人工代わり従って)大腿骨の骨7の最上部である結腸煙突大腿骨6のまさしくその表面に配置されるてが設けられている。頭大腿骨5は、骨盤9のボウル形の部である寛骨臼8と関連してある。頭大腿骨面10および表層11がそうである寛骨臼は、股関節のクッションとして作用する関節軟骨13によってカバーした。
股関節骨関節炎患者において、この関節軟骨13は、軽度の炎症により異常に摺り減らされる。股関節は、サポートをジョイントに提供して、脱臼を遅らせる股関節カプセル12によって囲まれる。従来の股関節手術の後、股関節カプセル12を突き通って、カプセル12は、その靭帯組織の限られた治癒可能性のため、劇的に弱められる。股関節カプセル12に損害を与えることのない股関節手術を実行することによって、自然なある者に可能であるように、患者は完全に回復することができて、圧力の等しい量を人工関節に配置することができる。
しながら最高水準の技術の他の実施例によれば、全ての結腸煙突大腿骨6は骨鋸を用いて取り出される。そして、それの後、頭大腿骨から成っている補綴部は大腿骨の骨を用いている骨セメントまたは機械式固定している部材において固定する。股関節がその機能的なポジションの機能的な腰運動を実行するときに、ボウル形のカップはそれから、新しい人工頭大腿骨45に対する接触表面として作用するために寛骨臼8に置かれる。従来技術、人工の頭大腿骨面および人工寛骨臼によれば、表層は股関節カプセルによって一緒に保たれている。そして、カプセルが動作の間、突き通られるときに、それは劇的に弱められる。
より小さい穴は、医療装置が2つ以上の部分から載置されることを必要とすることが更に考えられるより少ない侵襲的技法を作成する。
若干の実施例において、医療装置は、ベース部分に機械的に接続しているために適応するいくつかの部分から山にされる。
ヒト患者の腹壁の14が患者の身体に腹腔鏡トロカール33a,b,cの挿入に与える小さい切開。
一つ以上のカメラ34、骨盤35の穴をつくるために適応する外科用器具または人工器官または補綴部を導入するか、配置するか、接続するか、取り付けるか、つくるかまたは満たすための器具36が前記腹腔鏡トロカール33a,b,c.による前記本体に嵌入されることができるその後、
股関節に、大腿骨の骨7の最上部である結腸煙突大腿骨6のまさしくその表面に配置される頭大腿骨5が設けられている。頭大腿骨5は、骨盤9のボウル形の部である寛骨臼8と関連してある。腹腔鏡トロカール33a,b,cは、一つ以上のカメラ34を有する股関節39、骨盤9の穴をつくるために適応する外科用器具35または人工器官または補綴部を導入するか、配置するか、接続するか、取り付けるか、つくるかまたは、満たすための器具36に達するために用いられている。
第2の状態において、解除している部材801は頭大腿骨5を解除するために適応する、または、人工代わりは従って、骨盤9に置かれる寛骨臼カップ65を人工のボウルから作り上げた。
予め定められた圧力が解除している部材801に配置されるときに、解除している部材801は第1の状態から第2の状態に変化するために適応する。
好ましくは股関節の異常な動きによって生じている圧力(例えば落下している患者の結果としての)。
図9の図示した実施例によれば、全ての解除している部材801であることを示される実施例で、解除している部材801は、弾性部分から成っている弾性体から成る。
解除している部材は非侵襲的に、第2の状態に対する第1の状態から、そして、第2の状態から第1の状態に変化することが可能であるために適応する。そのとき、予め定められた圧力は解除している部材801に配置される。
部材がそうである保持は従って、頭大腿骨5または人工代わりを保持に、第1の状態において、適応させた。そして、それは骨盤9に置かれる人工のボウル形の寛骨臼カップ6
5に股関節のポジションの結腸煙突大腿骨6に付着するボール形の部である。
第2の状態において、解除している部材801は頭大腿骨5を解除するために適応する、または、人工代わりは従って、骨盤9に置かれる寛骨臼カップ65を人工のボウルから作り上げた。
保持把手802a,bは、較正部材(較正ネジ804a,bであること)および保持把手802a,bの間に配置されているバネ803a,bで載せられるばねである。
803a,bが頭大腿骨5を保つために適応する春から保持把手802a,bに動作する力または人工の置換は、従って、通常の、機能的な腰の人工寛骨臼65において運動を接合するが、頭大腿骨5または従って、予め定められた圧力が好ましくは股関節の異常な動きによって生じている解除している部材に配置される人工寛骨臼65から、例えば落下している患者の結果として、人工の置換を解除する。
較正ネジ804a,bは、保持把手802a,bに第1の状態においてあることから第2の状態においてあることに変化させる圧力の予定を可能にする。
保持把手802a,bは人工の寛骨臼面65のスリーブ806に格納される。それによって、ばね803a,bを圧縮する。
保持把手802a,bの収縮によって従って、頭大腿骨5または人工代わりが生じる。そして、順序を乱されて/人工の寛骨臼面65のそのポジションからluxatedされる。そして、それは大きな圧力が股関節および大腿骨の骨7に配置されるときに、大腿骨の骨7または骨盤9を折っている患者の危険率を低下させる。
保持把手802a,bは非侵襲的に、第2の状態に対する第1の状態から、そして、第2の状態から第1の状態に変化することが可能であるために適応する。そのとき、予め定められた圧力は保持把手802a,bに配置される。
保持把手802a,bは非侵襲的に、第2の状態に対する第1の状態から、そして、第2の状態から第1の状態に変化することが可能であるために適応する。そのとき、予め定められた圧力は保持把手802a,bに配置される。そして、それは従って、頭大腿骨5または人工の置換を可能にする。そして、外科的手技のない人工寛骨臼65において置き換
えられる。
。しかしながら、前記溝は、援助されることができるかまたは接着剤または機械式固定部材と置き換えられることができる。
バンド813がそうでありえた破裂は、人工頭大腿骨812の固定部分814および/または人工寛骨臼65の固定している部分815に用いることを固定させた、最少のある者ネジ、少なくとも一つのピン、形部品、溶接、接着剤、ピン、導線、ボウルに取り付けられるボール、他の部の雌型部に取り付けられるある者部の雄型部分で、キーは、前記部、バンドまたは他の機械式接続部材の部分であることをロックに導入した。例えば落下している患者の結果として、破裂バンド813の欠点は、股関節の異常な動きによって、好ましくは生じる。
817がそうでありえた輪ゴムは、人工頭大腿骨812の固定部分814および/または人工寛骨臼65の固定している部分815に用いることを固定させた、最少のある者ネジ、少なくとも一つのピン、形部品、溶接、接着剤、ピン、導線、ボウルに取り付けられるボール、他の部の雌型部に取り付けられるある者部の雄型部分で、キーは、前記部、バンドまたは他の機械式接続部材の部分であることをロックに導入した。例えば落下している患者の結果として、破裂バンド813の欠点は、股関節の異常な動きによって、好ましくは生じる。好ましくは、輪ゴム817は弾力的な部または断面から成る。そして、それは全ての輪ゴム817(弾性体(例えば弾性ポリマー素材例えば)から作られる)でありえた、共重合体素材(例えばポリスチレン、ポリエステル繊維(エチレン-ブチレン)またはポリスチレン)。素材がエチレンおよび少なくとも一つのビニル単量体(例えばこの種のモノ・カルボン酸酸の酢酸ビニル、不飽和脂肪族モノ・カルボン酸酸およびエステル類)のポリウレタン・エラストマー材、ポリアミド・エラストマー材およびポリエステル・エラストマー材ゴム共重合体であることは、考えられもする。輪ゴム813は障壁被膜から成ることができる。そして、それは体細胞によって突き通られることができない。好ましくは、障壁被膜は、パリレン・コーティングまたは生物学的適合性の金属層(例えば金、銀またはチタン)から成る。他の実施例に輪ゴムを一致させることは、バネ・タイプ部材と、金属およびプラスチック材料の組合せと、金属およびカーボンを主成分とする素材の組合せまたはカーボンの組合せと、プラスチックを主成分とする素材とを備える。
を有する。しかしながら、向こう側が単に磁気材料から成ることを必要とするだけであるのに対して、側のある者だけが磁気ことを必要とすることは、技術に熟練しているものによって容易によく理解されている。南北末端および磁石/磁気材料のいかなる組合せも、それ故、考えられる。記載されている磁力は頭大腿骨5(または人工の置換従って)を保つために適応する標準の寛骨臼の、股関節が機能的な股関節運動を実行することを可能にして、用いる、そして、予め定められた圧力が上回られる人工寛骨臼65から、頭大腿骨5または従って、人工の置換を解除する。
第1のまっすぐな第910a行は第1の位置908aから第2の909aまで手を伸ばして、第4に対する908bが909bを示す3ポイントめから手を伸ばしている第2のまっすぐな910b線と平行である。そして、それは次々に3本目のまっすぐな910c
線と平行である。そして、第6に対する908cが909cを示す5ポイントめから手を伸ばす。
最初の910aおよび3本目の910c直線は第2の直線より短い、そして、第2の直線は第1で3本目の直線の間に位置する。
メンバ119とヒト患者の重量から医療装置に配置される負荷を担持する際の援助とを具備している。さらに、図34は取付けロッド113にナット120の固定を示す。そして、それは案内ロッドとして作用する長形部材206によって次々に導かれる。
素材がエチレンおよび少なくとも一つのビニル単量体(例えばこの種のモノ・カルボン酸酸の酢酸ビニル、不飽和脂肪族モノ・カルボン酸酸およびエステル類)のポリウレタン・エラストマー材、ポリアミド・エラストマー材およびポリエステル・エラストマー材ゴム共重合体であることは、考えられもする。
輪ゴム813は障壁被膜から成ることができる。そして、それは体細胞によって突き通られることができない。
好ましくは、障壁被膜は、パリレン・コーティングまたは生物学的適合性の金属層(例えば金、銀またはチタン)から成る。
他の実施例に輪ゴムを一致させることは、バネ・タイプ部材と、金属およびプラスチック材料の組合せと、金属およびカーボンを主成分とする素材の組合せまたはカーボンの組合せと、プラスチックを主成分とする素材とを備える。
Claims (10)
- 患者の股関節への移植のための医療器具(65)であって、前記医療器具は、前記患者の骨盤骨(9)に固定されるように適合され、および前記医療器具は、内側面を備え、前記内側面の接触部は、球状であり、および前記医療器具が移植されるときに、前記股関節の中心に対向するように適合され、および前記医療器具は、球状部を有する、大腿骨頭(5)、または、該大腿骨頭のための補綴置換を受け入れるように適合される医療器具であって、
前記医療器具(65)、および前記大腿骨頭(5)、または、そのための補綴置換の一方の一つは、複数の磁石(822;823)を備え、前記医療器具、および前記大腿骨頭、または、そのための補綴置換の他方の一つは、複数の協働磁石(823;822)または磁気材料を備え、
前記複数の磁石(822;823)および前記複数の協働磁石(823;822)または磁気材料のそれぞれにおいて、前記複数の磁石(822;823)および前記複数の協働磁石(823;822)または磁気材料は、一様に分散され、その結果、前記球状部は、磁力によって、前記複数の磁石(822;823)と前記複数の協働磁石(823;822)または磁気材料との間で、前記医療器具内に拘束され、
前記磁力は、所定の負荷応力を超えた場合に、前記大腿骨頭(5)または前記補綴置換を前記医療器具から解除するように構成され、前記所定の負荷応力は、人体、および/または、前記人体と前記医療器具との接続部を傷つけるリスクを低減するために設定されること
を特徴とする医療器具。 - 前記磁力は、通常の使用中に、前記医療器具内において、前記大腿骨頭(5)またはそのための補綴置換を保持するように適合されて、前記股関節が、機能的な股関節運動を実行することを可能にすることを特徴とする、請求項1に記載の医療器具。
- 前記所定の負荷応力のレベルは、前記股関節の異常な動きに相当することを特徴とする、請求項1または2に記載の医療器具。
- 前記所定の負荷応力のレベルは、前記患者が大腿骨の骨(7)または骨盤骨(9)を骨折するリスクを低くするために、前記患者の大腿骨の骨の負荷応力収容力よりも小さいレベルに相当することを特徴とする、請求項1~3のいずれか1項に記載の医療器具。
- 前記医療器具、および前記大腿骨頭(5)、または、そのための補綴置換の少なくとも1つは、少なくとも3つの磁石を備えることを特徴とする、請求項1に記載の医療器具。
- 前記医療器具または前記大腿骨頭(5)、または、そのための補綴置換内の前記磁石の各々は、そのN極またはS極を前記内側面に向けた状態で方向付けられることを特徴とする、請求項1または5に記載の医療器具。
- 前記磁石(822)は、前記医療器具内に配置され、前記協働磁石(823)は、前記大腿骨頭(5)内またはそのための補綴置換内に配置されることを特徴とする、請求項1~6のいずれか1項に記載の医療器具。
- 前記磁石(822)は、前記医療器具内に配置され、前記磁気材料は、前記大腿骨頭(5)内またはそのための補綴置換内に配置されることを特徴とする、請求項1~請求項7のいずれか1項に記載の医療器具。
- 前記磁石(823)は、前記医療器具内にカプセル化されることを特徴とする、請求項1~8のいずれか1項に記載の医療器具。
- 前記磁力によって前記大腿骨頭のための補綴置換を保持するようにさらに適合されることを特徴とする、請求項1~9のいずれか1項に記載の医療器具。
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AU2010269152B2 (en) * | 2009-07-10 | 2016-03-24 | Implantica Patent Ltd. | Hip joint device and method |
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JP2018064971A (ja) | 2018-04-26 |
ES2970219T3 (es) | 2024-05-27 |
CA3043393C (en) | 2022-02-22 |
PT3066996T (pt) | 2021-08-11 |
CA3043393A1 (en) | 2011-01-13 |
RU2020130866A (ru) | 2022-03-30 |
LT3066996T (lt) | 2021-09-27 |
CA3192404A1 (en) | 2011-01-13 |
ES2949284T3 (es) | 2023-09-27 |
ES2968158T3 (es) | 2024-05-08 |
JP2018187429A (ja) | 2018-11-29 |
HRP20211214T1 (hr) | 2021-12-24 |
ES2883148T3 (es) | 2021-12-07 |
JP2020037025A (ja) | 2020-03-12 |
CA3158964A1 (en) | 2011-01-13 |
ES2864177T3 (es) | 2021-10-13 |
JP2019055275A (ja) | 2019-04-11 |
JP2020075159A (ja) | 2020-05-21 |
MX2021007750A (es) | 2021-09-21 |
JP2022190125A (ja) | 2022-12-22 |
ES2899803T3 (es) | 2022-03-14 |
MX2021007788A (es) | 2021-09-21 |
JP2021072940A (ja) | 2021-05-13 |
US20220304810A1 (en) | 2022-09-29 |
MX2021007789A (es) | 2021-09-30 |
JP2018051366A (ja) | 2018-04-05 |
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