JP7197842B2 - 肩プロテーゼの構成要素及びアセンブリ - Google Patents
肩プロテーゼの構成要素及びアセンブリ Download PDFInfo
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- A61F2/02—Prostheses implantable into the body
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- 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
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- 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
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- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
- A61F2002/30011—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in porosity
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- 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
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- 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
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- A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
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- 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
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- A61F2002/30428—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by inserting a protrusion into a slot
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- 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
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- A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
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- A—HUMAN NECESSITIES
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- 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
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30884—Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
-
- 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
- A61F2/40—Joints for shoulders
- A61F2/4014—Humeral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic humeral shafts
- A61F2002/4018—Heads or epiphyseal parts of humerus
- A61F2002/4022—Heads or epiphyseal parts of humerus having a concave shape, e.g. hemispherical cups
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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
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- A61F2002/4085—Glenoid components, e.g. cups having a convex shape, e.g. hemispherical heads
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- Orthopedic Medicine & Surgery (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
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- Heart & Thoracic Surgery (AREA)
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Description
本明細書に開示される様々な実施形態は、例えば、患者の上腕骨から除去される骨の量を減らし、手術時間を短縮し、解剖学的プロテーゼとリバース型プロテーゼとの転換性を向上させ、ステム付きアンカーによる適合性を提供し、前記プロテーゼの信頼性を向上させることによって、患者の転帰の改善に有利な肩プロテーゼアセンブリに関する。一部、従来の肩甲骨関節形成術の技術において、上腕骨ステムアンカーは、患者の上腕骨に挿入され得、関節窩面に取り付けられた関節本体と係合するように構成され得る。かかるステム付きアンカーは、長期的な固定の問題だけでなく、放射線透過度、スポット溶接といった望ましくない放射線学的特徴が生じる可能性がある。従来のステム付きアンカーに関する固定の問題、放射線学的特徴、及び手術時間を減らすために、ステムレスアンカーが使用され得る。
図3~図4Eは、一実施形態による、ステムレスボウル状上腕骨アンカー108Bを含むステムレスアンカー103を示す。前記ボウル状上腕骨アンカー108Bは、外面の少なくとも一部が湾曲した(例えば、凸状の)プロファイルを有する遠位部を有し得る。前記ボウル状上腕骨アンカーの遠位部は、ひれ部付上腕骨アンカーの対応する遠位部よりも幅が広くなり得る。特に言及しない限り、図3~図4Eの参照番号は、参照番号に「B」の字が追加された以外は、図1A~図2Cに示すものと類似する構成要素を示す。図3は、上腕骨H内に固定されたステムレス上腕骨アンカー108Bの概略的な側面図であり、上腕骨Hは、説明を容易にするために半透明で示している。図3は、ステムレスアンカー108Bを示しているが、本明細書で説明される任意の別のステムレスアンカー103が図3に示すように上腕骨Hに同様に挿入され得ることを理解されたい。本明細書で説明するように、示された実施形態において、前記アンカー108Bは、上腕骨Hへ回転せずに直接挿入することにより、上腕骨Hに挿入され得る。他の再建システムにおいて、上腕骨アンカーは、回転運動を用いて、例えば、前記アンカーを螺入して、ねじ込んで、又は穿孔して上腕骨Hに挿入し得る。かかるシステムでは、前記アンカーを回転させる必要があるため、手術過程が複雑になり、臨床医はアンカーを手動で所定の位置に回転させるか、又は他の器具を用いて上腕骨Hへアンカーを回転させなければならない。従って、開示された実施形態は、上腕骨Hへ回転することなく直接挿入を可能とし、置換術を有利に単純化できる。
本明細書で説明されるステムレス上腕骨アンカー104、108、108B、108Cは、上腕骨切除面RSの下方の関節構成要素160、180の一部を収容できるように構成される。また、本明細書で説明されるアンカーは、外科医が多種多様な患者の軟組織を収容しつつ、肩の関節面をリバースできるように構成される。本明細書の他の部分で論じているように、上腕骨アンカー104、108、108B、108Cは、外科医が患者又は手術計画をステムレスアンカーからステム付きアンカーに適合させることを可能とする。前記ステム付きアンカーは、切除面RS下の海面骨と同一又はより大きな体積を占めるように適合することができる。以下の方法が上腕骨Hに関して論じられるが、本明細書に説明されているアンカー及びカプラーは、関節窩にグレノスフィアを、(例えば、尻又は膝の処置のために)大腿骨先端に大腿部関節本体を移植したり、関節処置のため脛骨先端に脛骨関節本体を移植する等、他の整形外科的用途に活用できる。
図11A~図11Cは、本明細書に開示されるステムレス上腕骨アンカーの処理能力及び製造品質を改善するための様々な構成要素を示す。
所定の実施形態が本明細書に説明されているが、本明細書に説明されるインプラント及び方法は、文脈によっては、任意の関節構成要素を交換可能に用いることができる。
Claims (15)
- 近位部と、前記近位部と結合した遠位部と、を有し、前記近位部は前記近位部の中に第1の凹部を規定するものであり、前記遠位部は前記遠位部の中に第2の凹部を規定するものであり、患者の上腕骨の骨幹端の少なくとも一部を埋めるように成形されたボウル状のアンカー本体と、
複数の第1ひれ部と、を含むステムレス上腕骨アンカーであって、
前記それぞれの第1ひれ部の少なくとも一部は、前記遠位部から前記ステムレス上腕骨アンカーの遠位端部に遠位方向に延び、前記複数の第1ひれ部は、前記ステムレス上腕骨アンカーに対する回転防止能力を提供し、
前記ステムレス上腕骨アンカーはさらに、
壁を含み、前記壁は、前記壁と前記ステムレス上腕骨アンカーの前記遠位端部との間に空洞を規定するように、前記ステムレス上腕骨アンカーの前記遠位端部に対して近位に設けられており、前記壁は、前記ボウル状のアンカー本体が前記上腕骨に移植された際に骨が前記遠位部の前記第2の凹部内に配置されないように、前記遠位部を囲んでおり、
前記ステムレス上腕骨アンカーはさらに、
複数の第2ひれ部を含み、前記複数の第2ひれ部は、前記ステムレス上腕骨アンカーの前記遠位端部の近位に設けられており、かつ、前記壁と前記ステムレス上腕骨アンカーの前記遠位端部との間に規定された前記空洞内に配置されており、
前記複数の第2ひれ部は、中央部から半径方向外側に配置され、前記空洞の内壁に向かって延びており、前記複数の第2ひれ部は、前記ステムレス上腕骨アンカーに対するさらなる回転防止能力を提供している、ステムレス上腕骨アンカー。 - 前記第2の凹部は、リバース型解剖学的上腕骨インプラントを解剖学的上腕骨インプラントに交換するためのカプラーを収容するように成形された、請求項1に記載のアンカー。
- 前記第1の凹部は、リバース型関節インサートを収容するように成形された、請求項1に記載のアンカー。
- 前記第1の凹部及び前記第2の凹部の少なくとも一つは、円筒形又はテーパ状の壁を含む、請求項1に記載のアンカー。
- 前記第1の凹部は、前記第2の凹部よりも広い、請求項1に記載のアンカー。
- 前記アンカーの外面に沿って半径方向外側に延びる複数のストラットをさらに含む、請求項1に記載のアンカー。
- 前記アンカーの外面の少なくとも一部に沿って多孔性表面をさらに含む、請求項1に記載のアンカー。
- 前記近位部及び前記遠位部の少なくとも一つは、内側に向かってテーパ状となる形状を有している、請求項1に記載のアンカー。
- 前記近位部及び前記遠位部の少なくとも一つは、円筒形である、請求項1に記載のアンカー。
- 前記アンカー本体の内面は、関節本体アセンブリのロックリングを収容するように構成された溝を含む、請求項1に記載のアンカー。
- 請求項1に記載のステムレス上腕骨アンカーと、骨幹端プロファイルを有する骨幹端部分及びステムを含む上腕骨アンカーと、を含むキット。
- 関節本体を含む関節アセンブリをさらに含む、請求項11に記載のキット。
- 前記関節本体は、リバース型解剖学的関節本体を含む、請求項12に記載のキット。
- 前記関節本体は、解剖学的関節本体及びその解剖学的関節本体を前記ステムレス上腕骨アンカーと結合するためのカプラーを含む、請求項12に記載のキット。
- 前記壁と前記ステムレス上腕骨アンカーの前記遠位端部との間の前記空洞は、隣接する前記複数の第2ひれ部の間に空間を提供し、前記複数の第2ひれ部の間における骨内部成長を可能にする、請求項1に記載のアンカー。
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PCT/US2019/054007 WO2020072454A2 (en) | 2018-10-02 | 2019-10-01 | Shoulder prosthesis components and assemblies |
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