WO2012103871A1 - Dispositif de simulation d'arthroscopie et élément tibia - Google Patents

Dispositif de simulation d'arthroscopie et élément tibia Download PDF

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Publication number
WO2012103871A1
WO2012103871A1 PCT/DE2012/000075 DE2012000075W WO2012103871A1 WO 2012103871 A1 WO2012103871 A1 WO 2012103871A1 DE 2012000075 W DE2012000075 W DE 2012000075W WO 2012103871 A1 WO2012103871 A1 WO 2012103871A1
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WO
WIPO (PCT)
Prior art keywords
joint
natural
artificial
partners
frame
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Application number
PCT/DE2012/000075
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German (de)
English (en)
Inventor
Stephan CASPERS
Ulrich CASPERS
Original Assignee
Zwo3Vier Ug In Gründung
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Application filed by Zwo3Vier Ug In Gründung filed Critical Zwo3Vier Ug In Gründung
Publication of WO2012103871A1 publication Critical patent/WO2012103871A1/fr

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Classifications

    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/285—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine for injections, endoscopy, bronchoscopy, sigmoidscopy, insertion of contraceptive devices or enemas
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/30—Anatomical models
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/30—Anatomical models
    • G09B23/32—Anatomical models with moving parts
    • G—PHYSICS
    • G09—EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09B—EDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28—Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/30—Anatomical models
    • G09B23/34—Anatomical models with removable parts

Definitions

  • the invention relates to a device for arthroscopy simulation with an artificial joint, which has at least two joint partners with joint power transmitting joint heads.
  • the invention further relates to a tibial element.
  • Such devices are used instead of expensive anatomical specimens for the simulation of arthroscopic surgery on human and / or animal joints.
  • Such interventions are becoming increasingly necessary, in particular in the case of joints subject to high mechanical stress, such as the human knee joint, the damage to the joint giving rise to this being extremely different.
  • the object of the invention is to provide a generic device for arthroscopy simulation by means of which arthroscopic interventions can be practiced in a realistic manner.
  • the stated object is achieved by the features of claim 1. Advantageous developments are described in the subclaims.
  • the stated object is already achieved in that the joint has a joint space into which the joint partners each protrude at least with an end region of the joint head transmitting the joint force, which can be filled with fluid and / or a gaseous medium, and which is outwardly sealed by means of a sealing device can be sealed fluid- and / or gas-tight.
  • the artificial joint may be formed as an animal or human joint.
  • a handling of these phenomena and / or a suction or removal of the tissue parts by means of a suction as part or by means of a gripping instrument, such as forceps, can also be practiced by means of the device according to the invention for arthroscopy simulation.
  • the filling of the device according to the invention can take place under overpressure.
  • the envelope joint space enlarging elastic or inflate.
  • the joint or joint space can be dilated or inflated under overpressure.
  • changes in geometric relationships or spacings, for example, of the joint partners and / or other elements of the joint within the same can thus be established.
  • a surgeon can operate better with arthroscopic instruments, such as probe hooks, pincers, shavers and optical camera, into the joint space between the joint partners in a joint space and / or between the sheath and joint partners.
  • the sealing device may comprise at least one tubular flexible sheath.
  • the sheath can be designed to be fixable on both sides sealingly on the joint partners. With regard to its position relative to the joint space, the sheath can be arranged such that it is positioned at least approximately equal to a joint capsule of a natural joint.
  • the space limited by the flexible shell joint space may be at least approximately equal to a joint cavity of a natural joint.
  • the shell can be adapted to the material side, in particular with regard to tightness, flexibility and / or strength of a corresponding natural joint capsule.
  • at least locally limited tissue deposits may be provided in a shell for generating a correspondingly locally increased strength.
  • the inner sheath is preferably fixed in position on the femur element in the case of an artificial joint with a femur element and a tibial element designed as a knee joint.
  • a corresponding joint cavity with, for example, upper, inner (medial), lateral (lateral), inner posterior (dorsomedial) and / or laterally posterior (dorsolateral) joint pockets (recess) .
  • a reference to the anatomy of the corresponding part of the natural joint to be imitated is to be understood as meaning the elements imitating the part in terms of topographical anatomy, ie external shape and / or relative position, and / or internal anatomy, ie a material quality and / or an internal structure to which the part to be imitated are at least approximately or largely adapted.
  • sheath can also pathological changes of a joint capsule, such as crack, marginal detachment and / or surface enlargement by villi formation (synovitis), presented and their removal practiced.
  • access to the joint space can be achieved by penetrating the sheath at specific sites or portals. These can be used for training purposes, for example
  • the portals may be formed as fixed, preferably closable inputs.
  • the sealing device can have two hose-like flexible sheaths.
  • one of the sheaths can be arranged as an inner sheath facing the joint space.
  • the other can be arranged as an outer shell facing away from the joint space.
  • the inner casing and / or the outer casing can each be designed to be sealingly fixable on both sides of the joint partners.
  • the outer shell preferably completely overlaps the inner shell.
  • the inner sheath can be positioned at least approximately equal to a joint capsule of a natural joint corresponding to the artificial joint and / or the outer sheath at least approximately equal to a natural body surface.
  • the inner sheath may be shaped and / or dimensioned at least approximately like a joint capsule of a natural joint corresponding to the artificial joint and / or the outer sheath at least approximately equal to a natural body surface.
  • the joint space can be positioned at least approximately equal to a joint cavity of a natural joint and dimensioned. be nier.
  • the outer shell can simultaneously form the outside of the device at least in the area of the artificial joint.
  • the inner shell and / or the outer shell are advantageously arranged exchangeably in the device.
  • Inner shell and outer shell may include a gap.
  • the intermediate space may have a filler, such as a gel, in particular an aqueous gel, and / or preferably small, advantageously spherical particles of a preferably hydrophobic material, in particular of polystyrene.
  • This filler is preferably designed to provide a mechanical resistance to movement of the artificial joint which is advantageously at least approximately equal to the resistance created by surrounding tissue in a natural joint.
  • the casings can be part of a set for equipping the device according to the invention.
  • the set may comprise a series of inner and / or outer sheaths, each of which may have different sizes and / or defects to represent pathological changes.
  • the casings may have mimicked materials or material combinations in imitation of the joint capsule or the outside of the body.
  • a preferably valve-controlled or regulated filling device can be provided for filling and for manipulating the fluid and / or gaseous medium. This may have an entrance and exit to or from the joint space and / or to or from a gap between the inner shell and the outer shell. Input and / or output can be channel-like introduced into at least one of the joint partners.
  • the input and / or the output can be arranged axially extending in at least one of the joint partners, at least with a main path component.
  • a flow direction for the gaseous medium or the fluid can be defined. It can also be provided that the flow direction can be changed. This can also happen in constant change.
  • the filling device may have a pressure control or regulation for an internal pressure in the joint space.
  • the filling device may alternatively or additionally have access to an arthroscopic insertable feeder.
  • the filling device may, for example, have a preferably operable from the outside suction device with a movable suction element, such as proboscis, for sucking suspended particles in the fluid.
  • the suction of suspended particles can be done at least within a certain tolerance range without pressure loss, so this can be done without affecting the expansion of the joint space.
  • the access and suction tube can be inserted arthroscopically through the inner sheath into the joint space. Both can be combined into one unit.
  • About the filling and pathological changes of synovial fluid, for example, in terms of their amount and / or their composition, can be displayed in the joint space.
  • the filling of the joint space can take place such that the fluid and / or the gaseous medium is introduced primarily or at least predominantly into the inner shell. This can inflate under pressure. Furthermore, this can flush the joint space.
  • the inner and / or the outer sheath as in an arthroscopy at the natural joint, for example, by means of a scalpel in a small section are opened.
  • the cut edges of the cut can rest against the arthroscope at least approximately sealingly due to the advantageous flexibility of the casings.
  • a preferably end-side sealing of the shell or the shells can advantageously be carried out simply according to the tongue and groove principle.
  • the inner sheath and / or the outer sheath may each have at both ends a circumferential thickening or bulge, which may engage sealingly in each case in one or together in an associated provided on the corresponding joint partner groove.
  • the sheaths may each have provided grooves, in particular provided on the joint partner particular bead-like thickening can intervene. The intervention of the thickening can be carried out under elastic expansion of the respective sheath, so that the thickenings can each engage under bias in the associated groove.
  • an external contact force can be exerted on the thickening, by means of which the thickening can be pressed into its associated groove and / or held.
  • an additional ring-like or sleeve-like clamping element can be clamped on the outside over a region of the sleeve with the respective bead.
  • the tensioning element can be tensioned elastically and / or by shortening its length.
  • the tensioning element may be a rubber ring or sleeve, a tension belt or a cable tie.
  • At least the rod ends of the joint partners can be shaped at least approximately equal to the outer anatomy of the joint partners of the natural joint corresponding to the artificial joint.
  • the Geienkpartner preferably only the condyle or condyle with an adjacent shaft portion, be molded from a natural specimen.
  • bone imitations of the device for arthroscopy simulation can be made of plastic, preferably hard plastic, such as hard foam or cast resin, preferably with a medium to high Shore hardness.
  • This measure makes it possible to practice realistically on the imitation bone also bores or abrasions, for example by means of milling.
  • It can only be a core of the bone imitation made of hard plastic, which may be coated to imitate a natural cartilage layer on the bone substance with a softer plastic material material has at least similar properties, in particular Shore hardness and toughness as the natural cartilage.
  • Useful are rubber-like materials or silicone.
  • at least the joint head may be made of plastic, preferably with a medium Shore hardness, in particular made of silicone.
  • the Shore hardness can be 60, for example.
  • the bones in the itate may be at least partially coated with silicone to imitate cartilage areas.
  • a plastic may be provided which has a much lower Shore hardness, in particular a Shore hardness of about 15 to 30 , may have.
  • Inner and outer sheath can be made of a flexible plastic, in particular of a rubber-like material or silicone.
  • Outer shell and / or inner shell can be designed in multiple layers, in particular in the area of valves and / or access, in particular in areas of inflow and / or outflow for the fluid or gaseous medium into the joint space. Over this higher strength can be achieved.
  • Foam material may be incorporated between the layers to improve the tightness of the outer cover. Alternatively, a blend technique with the help of silicone fins in question.
  • the cases can be formed so pliable that they can perform all necessary movements of the artificial joint with. If two shells, the inner and the outer sheath, are provided, then only the outer sheath can be at least almost fluid and gas tight.
  • the flexible plastic, in particular the inner shell can be used to imitate reinforcing structures in natural joints, as a matrix for incorporating fiber structures. These fiber structures can be partially stored at specific locations and / or aligned differently effective mechanical force.
  • the condyle or the condyle with an adjoining shaft section may be designed at least approximately corresponding to the anatomy as bone-like.
  • the shaft or the same with an area of the condyle adjacent to it can be designed such that it emerges. tende forces and moments at least biomechanically approximate and anatomically correct transmits.
  • the device may be modular. This has the advantage that on the one hand easily individual parts of the device can be replaced. Furthermore, the device can be easily disassembled and stowed as a simulation apparatus, for example, for storage and / or transport to certain training locations.
  • the geienkpartner can be counted as the first modules, the meniscus elements and / or the shells for this modular structure.
  • At least one end portion of the joint head with force-transmitting joint surfaces, the joint head as a whole, the shaft portion and / or the joint head with shaft portion may each be formed as a separate component, which is preferably exchangeable.
  • the replacement component may thus be part of the modular structure.
  • the separate component can be fixed to a provided first base of the joint partner at least axially shift resistant and rotationally fixed. Preferably, this is a releasable axial locking connection, in particular a so-called shuttle lock, is provided.
  • the first base may thus be part of the modular design of the arthroscopic simulation device.
  • the first base can be fixed in place, for example, on a table or a room wall as a second base for simulation.
  • a joint partner can be constructed of a first base and a separate component.
  • the separate component may preferably be fixable to the first base by means of a tongue and groove connection, in particular a dovetail connection.
  • tongue and groove may preferably extend perpendicular to a longitudinal direction of the respective associated Gelenkpartners.
  • the separate component can be fixed by means of lateral or with respect to the longitudinal radial pushing on the first base.
  • Locking of the first base and separate component to be provided in a certain position.
  • an adapter may be provided. This can be arranged as an intermediate piece between the separate component and the first base.
  • the component can be fixed to the adapter, for example, by sliding it laterally onto the adapter.
  • the above-described tongue and groove connection or dovetail connection can be provided for connecting the separate component to the adapter.
  • the adapter can be rotationally fixed to the first base.
  • Adapter be formed by means of an axial connector frontally fixable.
  • the connector may have two radially spaced pins. At least one of the plug pins can lock on the joint partner.
  • the adapter can taper in the installation position in the direction of the separate component.
  • the adapter may be plate-like.
  • the joint partners may be designed to match each other corresponding to those of the natural joint to be simulated. Thanks to the interchangeability of the joint partners or the separate components through pairings, the device according to the invention offers the possibility of representing corresponding malformations in the shape congruence of the joint partners, to deal with them or to practice their at least partial elimination.
  • the first base in a region facing the joint with respect to its radial extent dimensioned smaller than the associated joint partner of the natural Joint is.
  • the region can be, for example, rod, tube or truncated cone or at least approximately the same size as the bone in the region of the associated natural Joint partner be formed.
  • the area may be integrally disposed on the first base.
  • the adapter can be designed like the region of the first base facing the joint. This has the advantage that simplifying the production, the first base, for example, at least approximately equal to the outer shape of the corresponding natural joint partner can be produced.
  • the operation field and / or a length of the associated artificial joint partner can be set via the adapter, for example.
  • the first base may be formed at least approximately corresponding to the natural shape of the respective joint partner.
  • the first base in the tibial element as a joint partner may preferably comprise the part of the lower leg adjoining the separate component up to the ankle or at least parts of the foot corresponding to its outer geometric shapes.
  • the foot may be stiff, in particular in one piece, or possibly articulated connected to the lower leg.
  • the first base of the femoral element may comprise at least the part of the femur adjoining the component.
  • the weight of the respective joint partner is bez.
  • the lower leg may be designed with foot and thigh so that it is at least approximately equal to the weight of an associated natural joint partner.
  • the weight of the respective joint partner may preferably correspond approximately to that of an associated natural joint partner in which a cavity is provided in the relevant joint partner, which can be filled with material for weighting.
  • Anatomical variants of the leg-weight of a natural leg can be generated by a variable degree of filling and / or by a variable filling material of the cavities of the artificial joint partners.
  • An additional advantage of this design feature is that the transport weight of the entire device can be kept as low as possible by not filling the cavities.
  • the artificial joint is designed as a knee joint with a femoral element and a tibial element with meniscal elements as a joint partner.
  • the meniscal elements of the artificial joint can be fixed to a tibial-headed head of the tibial element in an advantageous proximity to a natural knee joint only in certain fixing areas.
  • the setting areas are preferably selected to correspond at least approximately to the setting ranges of natural menisci of a natural knee joint.
  • the meniscal elements may be arranged to extend over the tibial-headed head and, bounded by the attachment areas, to form pockets with the tibial-head, which, like a natural joint, are instrumentally accessible during arthroscopic surgery. This also allows the underside of the meniscal elements to be examined.
  • the femoral element may have a femoral head.
  • the hardness of the used engineering materials may be at least similar to those of the natural materials.
  • the natural tibial plateau there are essentially three areas to be distinguished with regard to the materials: bone substance, bone cartilage or periosteum as well as menisci.
  • the natural menisci are located in their hardness between those of the hard bone substance and the softer articular cartilage or periosteum. This can be represented technically by means of appropriate plastics. It is, as noted above, advantageous to use as material a silicone having a mean Shore hardness of, for example, about 5 to 25 as a material.
  • the meniscus elements for the artificial joint may, for example, by means of mechanical methods, such as clamping or sewn, and / or chemical methods, such as gluing or by means of chemical compounds, in particular bridge connections, with the tibial element get connected.
  • the tibial element and / or the femoral element can be made of hard plastic for imitation of a bone substance.
  • conventional bores for example for fixing a torn off ligament or tendon and / or milling bone substance, can be practiced on the artificial bone.
  • the tibial plateau is made of a plastic, in particular silicone, average Shore hardness of 50 to 70.
  • the technical imitation of the natural articular cartilage or the natural periosteum can be dispensed with in many applications.
  • the tibial element and / or the femoral element can be coated with a softer plastic or rubber, in particular with silicone, at least on the joint surfaces.
  • This coating serves, among other things, to imitate a cartilaginous layer over the hard bone substance in a natural joint.
  • This coating may have a location-dependent layer thickness corresponding to the natural cartilage layer.
  • the meniscus elements also made of silicone can be positioned against the tibial-head head in such a way that solid silicone compounds can form in the fixing areas with the hardening of the silicones between the meniscal elements and the condyle in a type of vulcanization process.
  • the tibial element or the replacement component can be made of silicone with a preferred Shore hardness of about 60, on which the meniscus elements are applied with lower Shore hardness.
  • the meniscus elements in the plastic or silicone can have fiber structures embedded as a matrix for imitating collagen fibers of natural menisci.
  • the meniscal elements may have a specific gravity that is greater than or equal to the specific gravity of a fluid intended for filling the joint space. In order to avoid floating of separated parts of the meniscal elements during training, so that these parts float floating in the fluid used or fall in the same.
  • the meniscal elements can be prefabricated for training purposes various malformations and / or pathological changes, such as various crack shapes have.
  • a set may be provided which, in each case as an exchange component, has at least two or more identically and / or differently dimensioned components and / or components with unnatural shapes for simulating damage and / or malformation.
  • the damage and / or malformation to be represented can ultimately affect every part of the joint.
  • the damage and / or malformation to be represented may affect the menisci.
  • functional elements may be provided which serve in the artificial joint as a substitute for joint and / or capsule ligaments or tendons of an anatomical joint and / or the anatomical joint over and / or spanning tendons and / or ligaments.
  • joint or capsular ligaments connect the joint partners or tendons and muscles, which have a powerful effect on the joint.
  • the functional elements may be designed to be fixable according to the anatomy and / or according to their force-mechanical effect on the anatomical joint, preferably at the joint partners of the artificial joint.
  • the functional elements can each be at least approximately adapted to the material side of the associated natural tendon or ligament.
  • At least one spring element can be provided as part of a spring device, which can act on the Geienk according to force mechanics.
  • the spring force is adjustable in terms of amount, direction and / or point or attack points.
  • the functional elements can also be any pathological and / or caused by accidents deviations from anatomically normal training, Arrangements and / or functions of the joint and / or capsular ligaments or tendons of an anatomical joint and / or the anatomical joint over and / or spanning tendons and / or ligaments are imitated and practiced on these arthroscopic examinations and / or interventions.
  • the device may be provided with a frame with a guide and / or receptacle for guiding and / or fixing of functional elements.
  • a frame may be an additional component of the artificial joint that is not part of the anatomical joint.
  • the frame for example, at least some of the functional elements can be added instead of or in addition to one of the Geienkpartner on a page or end.
  • the one joint partner can be arranged free of connecting functional elements in the artificial joint, so that at this point a solution of the joint can be done more easily.
  • the one joint partner can be easily removed as the first module of the device.
  • the frame may have an approximately hollow cylindrical shape with an interior for receiving the one joint partner.
  • the inner contour of the frame of the outer contour of a joint partner can be adapted in the region of the frame.
  • the frame is preferably connected to the one joint partner in such a way that this joint partner can be pulled off the frame with the solution of the compound in a direction pointing away from the other joint partner.
  • the frame and the joint partner are designed such that they have no undercuts with respect to a relative movement into or out of a connection position.
  • the frame can serve as a driver for one joint partner by being able to be moved against the other joint partner, preferably by means of the functional elements fixed to it.
  • the frame can provide a joint connection.
  • the frame is arranged circumferentially to the hinge.
  • the frame may be fixed to the one joint partner.
  • an elongate connecting element such as screw rod or a secured by splint rod, be arranged radially to the joint partner guided by a guided through the joint partner and the frame bore.
  • a form-fitting and / or non-positive connection can be established via the frame fixed to the one joint partner and via the functional elements fixed to it and to the other joint partner
  • Joint partners are produced.
  • the joint partners can rest relative to one another via a joint gap or be positioned at a distance.
  • the joint gap can be adjustable by means of the definition of the functional elements on the frame.
  • By adjusting the effective length of a functional element or lengths of severaljanselerfiente anatomical variations, pathological and / or malformed changes in this power flow between the joint partners as well as symmetrical or asymmetric spacing and / or concerns of the joint partners can be simulated.
  • an artificial joint as a knee joint with tibial element and femoral element and when fixing the frame to the tibial element, the tibial element can be removed from the knee joint, for example, to exchange its replacement component out of the frame.
  • the frame may preferably be fixed to the one joint partner, preferably exchangeable.
  • the frame fixed to the one joint partner can in this case be positioned such that it leaves at least the joint surfaces of this joint partner by preferably projecting beyond the frame in the direction of the other joint partner.
  • the frame can be designed, for example, at least in sections as a rod or grid component.
  • the frame has a hollow cylindrical wall with provisions, such as receptacles, openings and / or guides, for the functional elements.
  • the functional elements can be arranged at least approximately anatomically correctly guided over the joint and can advantageously be operated on a specific force-mechanically effective manner. same length. Thus, an arthroscopy simulation can be carried out even closer to reality.
  • the frame may be disposed between the outer shell and the inner shell. He can press the inner shell, in particular at its thickening or bead sealing at least against one of the two joint partners. Through openings designed as portals can be provided on the frame, which hold certain intervention fields uncovered for arthroscopic engagement in the artificial joint from the frame. This is particularly advantageous when the frame presses the inner shell to its holder and seal both sides against the joint partners and this axially overlaps the inner shell. For example, for surgery on meniscus elements of an artificial knee joint openings may be provided in the installation position in the amount of menisci, the arthroscopic observation and freedom of movement for handling arthroscopic or surgical devices, such as for sewing defective meniscal parts allow.
  • a force-mechanically effective length for artificial joint can be fixed. This length can be adjusted by their definition on the frame and / or on the one joint partner.
  • the effective length of the functional elements may be adjustable individually, in groups or in their entirety.
  • Individual or all functional elements can be designed modularly as individual components. These can each be cut to a required length, for example, from suitable prefabricated yard goods in the form of ribbons, ropes and the like.
  • the functional elements may be fixed in position on the frame, for example via clamping or crimping connections.
  • the crimp can have a sleeve for round functional elements or a flat, preferably reinforced on the inside guide channel for flat functional elements in the or in which at least one screw or an eccentric can be screwed in laterally for clamping the respective functional element.
  • the force-mechanically effective length of the respective functional element is possible.
  • the artificial joint may have as functional elements anterior and posterior cruciate ligament element, patellar tendon element or quadriceps tendon element with interposed patellar or patella element, medial and lateral sideband element and / or populus tendon element ,
  • These functional elements can each be fixed with a first end region on the tibial element or the femoral element and can be fixed to the frame with a second end region.
  • the attachment to the frame and femur element may preferably be such that the forces transmitted by the functional elements in magnitude and / or direction are at least approximately equal to those in a corresponding anatomical joint.
  • the tibial articular head ⁇ or femur head may be freely accessible, at least with respect to its articular surfaces, such that, for example, meniscal interventions are freely accessible. It will be understood that in reversal of the arrangement, the frame may be fixed to the femoral head.
  • the anterior cruciate ligamentous element and / or the cruciate ligamentous element may, similar to the anatomy, be formed as a roundish band and may be made, for example, from a synthetic, strong to high-strength rope, which may comprise carbon fiber, for example.
  • the diameter may be, for example, 8-10 mm each. They can be fixed to the frame and tibial element so that a functional anatomy is guaranteed dynamically in the range of motion from extension to flexion.
  • functional joint play can be simulated or adjusted for valgus stress and for anterior stability.
  • functional joint play may be practiced in valgus and varus stress and for dorsal stability.
  • the second end region of the anterior cruciate ligament or of the posterior cruciate ligament can be guided on the frame in a respectively assigned guide channel and can be adjustably fixed in position.
  • a front and / or posterior cruciate ligament insufficiency can be represented.
  • a defined gel kspaitbreite can be set over this, over which the joint partners rest on their joint heads and are spaced.
  • Medial sideband element and / or lateral sideband element can in each case be designed as a flat band made of advantageously tension-resistant, preferably synthetic material, such as, for example, a roller blind strip, in adaptation to anatomical sidebands.
  • the first end region of the medial sideband element can be arranged on the medial side of a medial femoral condyle of the femur element in such a way that the functional anatomy is ensured in both extension and flexion, and functional joint play is enhanced
  • Valgusstress can be practiced by means of the device.
  • the first end region of the lateral sideband element may be on a lateral side of a lateral
  • Femoral condyle of the femoral element can be placed so that the functional anatomy in both extension and flexion is ensured, and the functional joint play in varus stress (also the foursome position) can be practiced by means of the device.
  • the second end region of the medial side band element and / or the lateral side band can each be arranged to be fixable in an associated flat guide channel in the frame. Both side band elements can fix the frame position on the femoral element and / or prevent it from opening medially or laterally thereof.
  • the Popliteussehenelement may be similar to the anatomy designed as a round band.
  • the first end region of the politeus tendon element can be arranged similar to the anatomy on the lateral side of the lateral femoral condyle so that the functional anatomy is ensured both in extension and in flexion and the functional joint play can be practiced in varus stress (quad position) by means of the device.
  • the second end region of the politeus tendon element may be preferably be fixed in a threaded sleeve in an associated guide channel on the frame.
  • the attachment of the first end region of the popliteus tendon element can be effected in the vicinity of the attachment of the lateral sideband element to the femoral condyle.
  • the patellar tendon element and / or the quadriceps tendon element may also be cut to length from a strap material described in more detail above.
  • the above-mentioned spring device may act on the quadriceps tendon element to simulate a naturally existing tensile force on the natural quadriceps tendon.
  • the spring device may comprise a tension spring element which preferably directly biases the quadriceps tendon element.
  • the pulling mechanism may be disposed within the outer sheath ventral to the condyle of the femoral element and / or be forceful.
  • the tendon elements can each be made of a hard elastic band material.
  • Quadrizepssehenelement be made of a band.
  • the patella element can be fixed dorsally, ie on the side of the band facing the joint space, in anatomically correct position or, for the simulation of pathological changes, displaced from the anatomically correct position.
  • a determination can be made purely mechanically.
  • a screw can through the tape must be screwed into the patella element.
  • the inner shell may be arranged.
  • the inner sheath can be fixed in position or clamped on the patella element by means of the connection between the ligament and the patella element.
  • the kneecap or patella may be formed at least approximately according to the anatomy.
  • the patella acts as a flexion-deflecting sliding component ("hypomochlion of the extensor apparatus"), which transmits forces of the musculature, the extensor apparatus, from the thigh to the lower leg, with the patella being displaced to the femoral head
  • the patella is anatomically covered by a smooth, translucent (hyaline) cartilage tissue for friction reduction on its sliding surface, which can be mimicked in the device, for example, by means of a suitably smooth cap made of a plastic
  • the plastic can be a rubber-like material or silicone
  • the plastic can be the same as the plastic that is used to imitate cartilage tissue in the bone of the joint partners.
  • the silicone cap can under elastic expansion over a hard plastic core, such as rigid foam or casting resin as an imitation for an anatomically bony core of the patella, preferably exchangeably drawn and fixed under pretension to the core.
  • the silicone cap may be slipped around the core with a kind of annular bead.
  • the silicone cap can be exchangeable.
  • prefabricated defects and / or deformities on the silicone cap can be provided for the simulation. Thanks to the use of hard plastic, drilling and removal, in particular milling, can also be practiced here.
  • Hoffaschen fat body On the inside of the inner shell, in a ventral, i. with respect to the knee front region of the joint space as a substitute for a naturally present in an anatomical knee joint so-called Hoffaschen fat body be arranged a faux.
  • the extravasation fat body may be at a clinical condition
  • Arthroscopy very easily hinders access to the interior of the knee joint and can obstruct vision from time to time in the optical field of vision of the surgeon pushing.
  • this imitation anatomically correct place in the knee joint can be practiced by means of the device and this difficulty in arthroscopy.
  • a possible material can be porous plastic, in particular foam, serve.
  • the imitation is preferably interchangeable.
  • a compensation device for compensation of forces and moments of force acting on the joint in a corresponding natural joint and not directly on joint and / or capsule bands or tendons of an anatomical Be transmitted joint.
  • These forces and moments of force can be caused, for example, by muscles that overlap the natural joint or tendons that lead to muscles, or by tissues that generally surround the natural joint, which can manifest themselves, in particular, in a movement inhibition and / or limitation of movement.
  • an overstretching of a natural joint can be prevented. To simulate this effect on the natural joint is very meaningful for a realistic practice of arthroscopy.
  • Single or multiple, possibly force-mechanically interconnected functional elements can preferably simulate these forces summarily.
  • a single functional element can transmit forces with soft-elastic and / or hard-elastic parts over a certain range of motion of the artificial joint, wherein at least one force application point of the functional element is preferably arranged remotely to the joint surfaces on one of the joint partners.
  • the soft-elastic portion can be simulated by means of spring elements, for example.
  • the hard-elastic portion can be simulated in a structurally simple manner by means of suitably hard-elastic bands, such as a roller blind band.
  • joints are limited in their range of motion (extension and flexion, external and internal rotation as well as abduction and adduction) by overarching muscles and / or tendons.
  • a simple technical representation for the simulation of this movement limit would be possible, for example, by means of appropriate stops.
  • additional functional elements may be be provided elements between the joint partners. These can be designed, preferably spring-loaded and / or have a certain functional length, which is effective only from a certain angle of flexion and / or angle of rotation.
  • the connecting element may be formed, for example, as a band element which spans force-transmitting and thus movement-inhibiting with a certain flexion angle and / or angle of rotation.
  • the band member may be cut to length from a band material, such as roller shutter band.
  • a longitudinal band element may additionally be provided as a band element in the simulated knee joint, which dorsally extend beyond the knee joint to simulate the posterior thigh and / or lower leg muscles as the rear longitudinal band element can.
  • the longitudinal ligament element can be fixed with its first end region on the back or dorsal side of the femur head and with its second end region on the back or dorsal side of the tibial articular head If a frame is provided, it may be fixable with its first end region on the posterior or dorsal side of the femoral head and with its second end region on distal-dorsal to the outside of the frame at the level of the tibial-articular head
  • the rear longitudinal band element is preferably stable up to about 30 kp and advantageously hard-elastic, ie it has little or no extensibility, and can have a flat shape Ormalfall be sized so that the knee joint can be stretched up to a maximum of 180 degrees or according to a so-called neutral zero method up to 0 degrees.
  • the force-mechanically effective length of the rear longitudinal band element can be extended or shortened.
  • the device may be modular in an alternative embodiment.
  • at least one of the joint partners may be connected to at least one second module on a side remote from the artificial joint and / or facing away from it.
  • the second module with respect to the artificial joint force-mechanically at least about the same effective as a corresponding natural body part may be formed.
  • the second module may be formed as a second artificial joint connecting the first module to a third module.
  • the second module subsequent to the femoral element, be a hip joint module, which in turn is connected to a pelvic element as a third module.
  • the hip joint module can be a common artificial hip joint with head and socket.
  • a calf bone element and / or a foot element may adjoin the tibia element laterally (laterally) in a caudal manner in a region facing away from the joint.
  • the device may, for example, become a complete limb, i. Leg or arm, to be assembled.
  • This has the advantage that also the type of movements required in clinical arthroscopy in which the limb as a whole has to be moved in various ways (such as valgus stress) in order to widen certain interiors or pockets of the joint to be arthroscopically in order to reach them instrumentally, one can practice.
  • the device can be attached and / or fixed in position, for example, via a further module on the preferably static second base. This can be for example a screw clamp or vise.
  • the modular construction of the device optionally also includes all previously named and / or described individual components, such as sheaths, replacement component, adapters, ligaments, tendons, joint partners or parts thereof, such as tibial head or femoral head, and / or the above-mentioned modules.
  • This makes it possible, by means of the modular structure of the device, the artificial joint or parts thereof, in addition to represent the body parts adjacent to the joint or its joint partner as imitations and in addition to these body parts adjacent body parts as imitations.
  • the individual modules are preferably matched to one another in such a way that, in their entirety and / or individually, they have at least approximately the weight of equivalent parts of a corresponding natural joint or, for example, a corresponding natural limb.
  • a set can be put together that has all the individual modules of the limb for this purpose.
  • replacement parts of, in particular, wear parts such as the replacement part, the sheaths and / or the chordable tendon and / or ligament material, may be provided alone or in addition in a set.
  • embodiments may be included, for example, the replacement part with representation of damaged areas and / or with different dimensions.
  • at least one camera is permanently installed in the device and / or an optic is arranged in the device so that the movements can be documented and the simulation process remains unaffected.
  • the optic is advantageously flexible and / or designed as a bronchoscope.
  • the present invention is explained in more detail below with reference to an embodiment of the device with the artificial joint shown in a drawing.
  • the drawing shows diagrammatically and diagrammatically a longitudinal section view of a first embodiment of a device with an artificial joint in the extended position a longitudinal sectional view of a second embodiment of the device with a joint formed as a knee joint in the extended position or in flexed position, comprising femoral element, tibial, patella and inner sheath, a cross-sectional view of the first embodiment of the knee joint according to section line III - III in Figure 2a, a 2a, a side view of another embodiment of the femoral element, a detailed view according to the detail VII in FIG.
  • FIG. 2a a side view of a third embodiment of the device with a modular artificial leg a knee joint according to Figure 2, a longitudinal sectional view of a section IX in Figure 8, a detailed view according to the section X in Figure 8, a side view of the artificial leg of Figure 8 in the bent position of the knee joint with a one end it tibia articulated head tibial element as a separate component, a side view of the artificial leg according to Figure 11, but disassembled in the bent position of the knee joint, 12a: a side view of the disassembled separate component,
  • FIG. 13 is a detail view according to section XIII in Figure 8, but this ventral or from the front,
  • FIG. 15 is a longitudinal sectional view of the separate component according to FIG.
  • FIG. 16 is a plan view of one half of the separate component with an outer shell lying on the outside
  • FIG. 17 is a detail view according to detail XVII in FIG. 15;
  • Fig. 19 a cross-sectional view of the frame according to the sectional profile
  • FIG. 20 shows a detail view according to section XX in FIG. 18a with functional element
  • FIG. 21 shows a side view of femoral element and frame from FIG
  • FIG 22 shows a view of the cross-sectional profile XXII - XXII according to FIG 18b with a separate component and inner shell
  • FIG. 23 a plan view with partial section of a separate one arranged inside one another.
  • FIG. 24 a perspective top view of a section XXIV according to FIG. 23, but with a defective meniscus
  • FIG. 25 a longitudinal sectional view of the knee joint according to FIG
  • FIG. 26 is a longitudinal sectional view of the knee joint according to FIG. 25, but in the bent position, FIG.
  • FIG. 27 a longitudinal sectional view of the detail XXVII according to FIG. 25, but additionally with inner and outer sheaths
  • FIG. 28 a plan view of the frame according to FIG. 18a with additional one
  • FIG. 29 a side view of an adapter from FIG. 2a
  • FIG. 30 a side view of a first base from FIG. 8, FIG.
  • FIG. 31 is a plan view of the first base according to FIG. 30 and FIG.
  • FIG. 32 shows a longitudinal sectional view of a connection region of the first base according to FIG. 30.
  • FIGS. 2 to 32 relate to a joint G designed as an artificial knee joint 1, which is designed in each case as a joint partner P with a tibial element 3 having a tibial head 2 and a femoral element 5 having a femoral head 4.
  • the artificial knee joint 1 is designed here as a left knee joint.
  • a right knee joint has the same anatomy as a mirror-symmetrical structure.
  • the joint V or the joint G has a joint space R into which the joint partners P1 respectively project at least with a joint force transmitting end portion E of their respective joint head K.
  • the joint space R can be filled by means of a filling device B with fluid F and / or gaseous medium not shown here.
  • a sealing device A is provided by means of which the joint space R can be fluid-tight and / or gas-tight to the outside.
  • the sealing device A has a tubular flexible inner shell 6.1, which is fixed at both ends sealingly to the joint partners P. With regard to its position relative to the joint space R, the inner sheath 6.1 is arranged such that it is positioned approximately equal to a joint capsule, not shown here, of a natural joint. Thus, the joint space R shown here corresponds at least approximately to a natural joint cavity.
  • the inner shell 6.1 is mainly constructed of a flexible material and has reinforcements, not shown here, in the form of fibrous structures in some places.
  • the inner shell 6.1 is thus formed approximately equal to the joint capsule of a natural joint in terms of their position, shape and material properties.
  • the inner shell 6.1 is provided at both ends with a circumferential bead 7, which engages sealingly in an associated circumferential groove 8.
  • the filling device B has two accesses 9, one of which serves as an input and one as an output.
  • the bottom access 9 as an input 10 and the top access 9 as an exit 11 are used on the basis of a flow direction f of the fluid F, by way of example.
  • the entrances 9 are valve-controlled. This can be the Joint space R under inflation of the inner shell 6.1 be subjected to pressure. Furthermore, as described above, this rinses and possibly exhausts done.
  • the figures 1 and 2 by way of example by means of a
  • the device V for arthroscopy simulation according to Figure 1 is as a part of the filling device B in the joint partners P respectively a channel 9 introduced approximately axially guided by the joint partner P channel-like, which opens into the joint space R.
  • the joint partners P each have a circumferential groove 8, in which the inner shell 6.1 sealingly engages with its bead 7 on the upper side or underside under bias.
  • an access 9 is axially introduced into the femoral element 5 and an access 9 is axially introduced into the tibial element 3.
  • the joint partner P designed as a femur element 5 has a circumferential groove 8 (FIGS. 5 and 6) which is externally introduced into the femoral element 5 in a curved shape, in which the joint capsule grows together with the femur in the case of a natural knee joint is.
  • the course of the provided here in the upper part of the inner shell 6.1 bead 7 is formed accordingly.
  • the inner sheath 6 is formed accordingly.
  • FIG. 7 a detailed view in longitudinal section view, the inside-side engagement of the bead 7 in the groove 8 introduced in the femur element 5 is shown schematically.
  • the joint space has corresponding joint pockets, of which an upper joint pocket 12.1 or a rear joint pocket 12.2 are shown here by way of example in FIGS. 2a and 2b.
  • the entrances 9 of the filling device B open into the upper joint pocket 12. 1 or into the rear joint pocket.
  • FIG. 2 additionally has a sleeve-like frame 13, which is arranged circumferentially to the tibia head 2 in the insert position shown in FIG. 2 and the inner sleeve 6.1 sealingly engages against the tibial shaft head 2. stuck.
  • the frame 13 on the inside a groove 8, in which under reinforcement of a sealing effect in the here lower part of the inner shell 6.1 provided bead 7 is pressed under back pressure of the tibial head 2.
  • FIG. 8 shows a third embodiment of the device V for arthroscopy simulation, in which the sealing device A has two tube-like flexible sheaths, the inner sheath 6.1 and an outer sheath 6.2 facing away from the joint space R.
  • the inner shell 6.1 of the third embodiment is here, as the inner shell 6.1 of the second embodiment of the device V, set the end sealing.
  • the outer shell 6.2 has at both ends also in each case a circumferential bead 7, wherein here both are arranged inside and circumferentially and sealingly under expansion and thus materially under hard elastic bias in a designated annular groove 9 on the tibial 3 and the femoral element 5 sealingly engages. This is shown by way of example and at the same time very schematically in a longitudinal section in FIG.
  • the outer shell 6.2 has on the material side silicone and is provided in some places with reinforcements not shown here in the form of fiber structures.
  • the outer shell 6.2 is positioned and shaped with respect to their position at least approximately equal to a natural body surface. As in the case of clinical arthroscopy, access to the joint space R can be achieved by penetrating the inner sheath 6.1 or the outer sheath 6.2 and the inner sheath 6.1 at specific locations or portals.
  • the joint partners P have a core 14 made of hard plastic for imitation of a bone substance and a coating 15 of silicone for the imitation of natural cartilage substance.
  • the hard plastic allows practicing arthroscopic drillings in the respective joint partner for the definition of ligaments and / or tendons and / or milling of "bone substance”.
  • the joint partners P of the artificial joint 1 are made in the region of their heads 2, 4 from a cast of corresponding anatomical preparations. Thus, in the field of casting technology, they have exact natural-like external forms, such as the natural knee joint. Thus, the femur head 4 has a medial
  • Femoral condyle 16.1 and a lateral femoral condyle 16.2 (FIG. 6) and, corresponding to the shape, the tibial condyle 2 has a medial tibial plateau 17.1 and a lateral tibial plateau 17.2 with an elevation 18 arranged therebetween. Subsequent to the femur head 2, a femoral shaft 19 is arranged.
  • the second and the third embodiment of the device V is constructed modularly in each case with the two joint partners P as first modules 20.1.
  • the possible complete modular construction of the device V will be explained below with reference to the third embodiment of the device according to FIG.
  • the two joint partners P of the knee joint 1 each have a first base 21.1 and a fixable on the first base 21.1, as a replacement component 22adedfegtes separate component.
  • the replacement component 22 of the femur element 5 comprises a section 23 of the femoral shaft 19 with subsequent femur joint head 4.
  • the replacement component 22 can be secured against rotation and displacement on the first base 21.1 by means of a conventional shuttle lock 24.
  • the shuttle lock 24 has on the first base 21.1 for latching a latching opening 24.1 for receiving a latching pin 24.3 provided on the replacement component 22 and for preventing rotation a plug-in opening 24.2 spaced from the latching opening 24.1 for receiving a plug-in pin 24.4 provided on the replacement component 22 (FIGS 29 - 32).
  • the replacement component 22 of the tibial element 3 comprises only one end portion 25 (FIG. 13) of the tibial-articular head 2 with the tibial plateaus 17.1, 17.2.
  • the replacement component 22 of the tibial element 3 is connected to the first base via an adapter 26
  • the adapter 26 is for this purpose also by means of a shuttle lock 24 rotatably and non-displaceably fixed to the first base 21.1.
  • the replacement component 22 of the tibial element 3 is in turn by means of a here formed as a dovetail connection 27 with groove 27.1 and spring
  • the device 1 furthermore has functional elements 28 which serve as replacement for joint and / or capsular ligaments or tendons of the here anatomical knee joint or for the anatomical knee joint over and / or spanning tendons and / or ligaments in the artificial joint 1 ,
  • These functional elements 28 are each designed to be elongated with a first end region 29.1 and a second end region 29.2.
  • the functional elements 28 are fixed to the first end region 29.1 on the femur element 5 and to the second end region 29.2 on the frame 13.
  • an effective length w is determined by means of the fixing of the functional elements 28 at both ends, via which forces are transmitted from the femoral element 5 to the frame 13 by means of the functional elements 28.
  • the tibial element 3 or here the replacement part 22 with the tibial plateau 17.1, 17.2 can be detached from the knee joint 1, without specifically for this purpose the functional elements 28 in its second end portion 29.2 detached must be, with the frame 13 by means of the functional elements 28 against the Femurgeienkkopf 4 held on the same remains.
  • the frame 13 For transmitting the forces acting on the frame 13 by the functional elements 28 on the tibia element 3, the frame 13 is in turn force-effectively connected to the tibial element 3 by means of a screw connection 30 by, as Figures 28 and 29 removable, a screw 31 radially to the longitudinal direction. 1 by appropriate through holes 31.1 the adapter 26 and by the circumferentially thereto arranged frame 13 feasible and can be fixed by means of an associated nut 31.2. With loosening of the screw connection 30, the frame 13 is released from the tibial element 3, whereby at the same time the inner sheath 6.1 can be pulled off the tibial element 3.
  • the tibial element 3 is released from the joint 1 and can be withdrawn in the longitudinal direction 1 of the joint 1, wherein the frame 13 remains on the knee joint 1.
  • This process is reproduced in FIG. 12, wherein the illustration of the screw connection has been omitted for the sake of clarity, and FIG. 12 shows the joint 1 with the tibia element 3 removed.
  • the frame 13 is arranged in the third embodiment of the device V between the inner shell 6.1 and the outer shell 6.2.
  • the outer sheath 6.2 with its bead 7 must first be removed from the groove 8 provided on the first base 21.1 of the tibial element 3. Then, after loosening the screw 29, the tibial element 3 can be withdrawn from the knee joint (FIG. 12). Subsequently, the replacement part 22 can be withdrawn from the adapter 26 perpendicular to the longitudinal direction 1 (FIG. 12a) and exchanged.
  • the engagement of the bead 7 of the outer sheath 6.2 in the groove 8 provided on the first base 21.1 of the tibial element is shown schematically in FIG.
  • a groove 8 is also provided on the first base 21.1 of the femoral element 5 according to FIG. 10, into which the outer sheath 6.2 engages on the femoral side in the same way as on the tibial side with a bead, which, however, is not specifically shown here.
  • the first base 21.1 of the tibial element 3 has the dimensions of a corresponding lower leg section of a natural leg and is additionally provided with a foot element 32 which is firmly seated here and which also has the outer dimensions of a natural foot.
  • a second module 20.2 which is designed here as a conventional artificial hip joint 33 with head 33.1 and socket 33.2, according to the anatomy of the head 33.1 the first base 21.1 and the pan 33.2 are fixed to a pool element 34 as a third module 20.3.
  • the pelvic element 34 is set according to FIGS. 11 and 12 by way of example at a table T as the second base 21.2.
  • the functional elements 28 are, depending on the type to be imitated tendon or band, formed essentially lacing or band-like and are cut to a certain length of a cord or a band. On the material side, the functional elements 28 are largely aligned with the strengths and the expansion behavior of the corresponding anatomical tendons and ligaments.
  • a clamping connection 35 is provided with screw 31 and nut 35.1 cast in the frame 13, wherein the functional elements 28 are each guided on the frame 13 by a guide channel 26 and here by means of a screw 31 can be clamped in the guide channel 28.
  • a certain effective length of the respective functional element 28 can be defined, ie it can also pathological conditions, such as too short or too long or torn or dissolved or ligaments and / or tendons, presented and their treatment be practiced.
  • Femurelement be provided with offset fixed position functional elements and / or a correspondingly modified frame with one or more dislocated guide channels.
  • the artificial knee joint 1 has as function elements 28 a front cruciate ligament element 37.1 and posterior cruciate ligament element 37.2 (FIG. 13), a patellar tendon element 38.1 or quadhopeps tendon element 38.2 with an interposed patella element 38.3 (FIGS. 25-27), a medial sideband element 39.1 and lateral sideband element 39.2 (FIG. 21) and a poplitus tendon element 40 (FIG. 21).
  • a rear side band member 41 is provided which mimics the forces and the cohesion, which or which are transmitted dorsally by means of overarching muscles and tendons on the anatomical knee joint.
  • the anterior cruciate ligament element 37.1 and posterior cruciate ligament element 37.2 are similar to the anatomy designed as a round band and made of a synthetic, high-strength rope.
  • the first end region 29.1 of the anterior cruciate ligament 37.1 is arranged medially of the lateral femoral condyle 16.2, guided by a guide channel 36 introduced into the femoral element 5 and is fixed in position at an outer attachment point 42 on the femur element 5.
  • a functional anatomy is guaranteed in both extension and flexion, whereby a functional joint play in valgus stress and in terms of an anterior stability can be practiced.
  • the first end portion 29.1 of the posterior cruciate ligament 37.2 is guided by an associated guide channel 36 and laterally of the medial femoral condyle 16.1 in one Fixing point 42 is fixed in position that the functional anatomy in both extension and flexion is guaranteed and the functional joint play in valgus and varus stress and in terms of dorsal stability can be practiced.
  • the second end portion 29.2 of the anterior cruciate ligament 37.1 and the posterior cruciate ligament 37.2 are guided on the frame 13 in each case in an associated guide channel 36 and adjustably fixed in position in the same by means of a screw 31 ⁇ Figure 20).
  • an anterior and / or posterior cruciate ligament insufficiency may be displayed for training purposes.
  • a joint gap width g can be set via which the
  • Joint partner P abut their rod ends K or, as shown in Figure 3, are spaced.
  • the medial side band member 39.1 and the lateral side band member 39.2 are similar to the anatomy each cut to length as a flat band of tensile synthetic roller blind belt.
  • the first end region 29.1 of the medial lateral ligament element 39.1 is arranged medially to the medial femoral condyle 16.1 of the femoral element 5 in such a way that the functional anatomy is ensured both in extension and in flexion and the functional joint play in valgus stress by means of the device V can be practiced.
  • the second end region 29.2 of the medial side band element 39.1 and the lateral side band 39.2 is in each case adjustably fixed in an associated flat guide channel 36 in the frame 13 by means of the clamping connection 35 with nut 35.1 and screw 31 cast in the frame 13 (FIG. 19).
  • Both side band elements 39.1, 39.2 are thus fixed in position on the frame 13 and on the femur element 5, whereby a fixing of the frame 13 on the femur element 5 allows and a medial or lateral unfolding of the knee joint 1 is prevented.
  • Corresponding pathological changes, such as ligament tear or shortening, can accordingly with detachment of the position fixing or
  • the Popliteussehenelement 40 is formed as a roundish band.
  • the first end region 29. 1 of the poplite tendon element 40 is arranged laterally on the lateral femoral condyle 16. 2 in the same way as the anatomical anatomy is ensured both in extension and in flexion, and the functional joint play can be practiced with the device V in case of varus stress.
  • the second end region 29. 2 is fixed in position in an associated guide channel 36 in the frame 13.
  • the attachment of the first end portion 29.1 takes place in an associated attachment point 42 dorsal of the attachment point 42 of the lateral sideband element 39.2 on the lateral femoral condyle 16.2.
  • the course of the popliteus tendon element 40 takes place within the inner sheath 6.1 to form a dorso-lateral or posterior-lateral part of the frame 13 in a dorsal or posterior joint pocket 43 (recess) (FIG. 22) below meniscal elements 46.
  • the guide channel 36 for the popliteus tendon element 40 is reinforced by means of a cast-in metal sleeve 44.
  • the patellar tendon element 38. 1 and the quadriceps tendon element 38. 2 are produced in one piece with one another from a hard-elastic band material (FIGS. 27-29).
  • a spring device 45 is provided, which is shown here purely schematically inserted into the Quadrizepssehenelement 38.2.
  • the spring device 45 directly clamps the quadriceps tendon element 38.
  • the spring device 45 is arranged inside the outer sheath 6.2 ventrally of the femoral head 4 and is effective in terms of its force.
  • the patella element 38.3 can be screwed by means of a screw 31 to the patellar tendon element 38.1 and the quadriceps tendon element 38.2 (FIG. 27), wherein, to imitate an anatomical adhesion of the patella with the joint capsule, the inner sheath 6.1 between see patellar tendon element 38.1 or the quadriceps tendon element 38.2 and the patella element 38.1 is clamped.
  • the patella element 38.3 is formed approximately corresponding to the anatomy. It has a core 14 made of hard plastic, which is coated with a replaceable cap-like coating 15 made of silicone under prestress. Again, prefabricated defects and / or deformities on the coating 15 can be provided for training.
  • the rear longitudinal belt element 41 is flat as a belt and resistant to tension, i. Hard elastic or hardly stretchable, formed. It runs dorsally over the knee joint 1 away ( Figure 21).
  • the rear longitudinal band element 41 is fastened with its first end region 29.1 on the rear or dorsal side of the femur head 4 and with its second end region 29.2 distal-dorsally on the outside of the frame 3 in the installed position at the level of the tibial head 2, in each case by means of a screw 31, via the screw - Exercise his force-mechanically effective length w is adjustable.
  • the force-mechanically effective length w is dimensioned for the normal case so that the knee joint 1 can be stretched up to 180 degrees.
  • the force-mechanically effective length w of the rear longitudinal band element 41 can be lengthened or shortened.
  • FIGS. 14 to 17 different views and longitudinal sections are shown with individual representations of the exchange part 22 with the Endabschnttt 25 of the Tibiagelenkkopfs 2 and the groove 27.1 of the dovetail joint 27.
  • the tibial head 2 has the meniscus elements 46 at the end. These are formed in terms of their shape and extent similar to natural menisci. Further, according to the natural meniscuses, the meniscal elements 46 are fixed to the tibia head 2 only in certain fixing areas 47.
  • the fixing areas 47 which are marked by "x" in the longitudinal sectional views according to FIGS.
  • meniscus elements 46 extend laterally and circumferentially around the tibial-head 2 and in tip-end areas 48 of the upper-half crescent-like shapes of the meniscal elements 46 according to FIG. 16.
  • Meniscus elements 46 are made of silicone of low Shore hardness and the Tibiagelenkkopf 2 with a not shown here coating of silicone with a medium Shore hardness.
  • a recess 50 for the rear hinge pocket 43 for the popliteus tendon element 40 is provided laterally. Further recesses 50 are provided dorsally and ventrally for the posterior cruciate ligament element 37.2 or anterior cruciate ligament element 37.1 in the center of the tibia head 2. This is also clearly Figure 23 removed.
  • fibers 51 are embedded in the silicone of the meniscus elements 46 as a matrix.
  • the meniscus elements 46 furthermore have a specific weight which is approximately equal to the specific weight of the fluid F provided for filling the joint space R.
  • FIG. 24 shows a section of the end section 25 of the tibial plateau 2 with the adjoining frame 13 and inner shell 6.1 clamped therebetween in a perspective plan view.
  • a needle 53 is sketched, which is used by using the portal 52 for sewing a "cracked" meniscus element 46.

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Abstract

L'invention concerne un dispositif de simulation d'arthroscopie au moyen d'une articulation artificielle présentant au moins deux éléments d'articulation associés comportant des têtes d'articulation qui transmettent une force d'articulation. L'invention concerne en outre un élément tibia. L'objectif de l'invention est de permettre de pratiquer des interventions arthroscopiques qui soient proches de la réalité. A cet effet, l'articulation présente une chambre d'articulation dans laquelle les éléments d'articulation associés font saillie respectivement par au moins une partie terminale, transmettant la force d'articulation, de leur tête d'articulation, ladite chambre d'articulation pouvant être remplie de liquide et/ou d'une substance gazeuse et pouvant être rendue étanche aux liquides et/ou aux gaz par rapport à l'extérieur au moyen d'un dispositif d'étanchéification. En outre, les éléments ménisques sont fixés seulement à l'élément tibia dans des zones de fixation correspondant au moins approximativement aux zones de fixation de ménisques naturels d'un tibia naturel.
PCT/DE2012/000075 2011-02-03 2012-01-30 Dispositif de simulation d'arthroscopie et élément tibia WO2012103871A1 (fr)

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DE202011002311.7 2011-02-03
DE202011002311U DE202011002311U1 (de) 2011-02-03 2011-02-03 Vorrichtung zur Arthroskopiesimulation und Tibiaelement

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CN106710408A (zh) * 2016-12-29 2017-05-24 上海凯利泰医疗科技股份有限公司 一种关节镜手术环境模拟装置
CN109830158A (zh) * 2019-03-25 2019-05-31 北京大学第三医院 一种膝关节动态模拟装置
CN110074900A (zh) * 2019-02-01 2019-08-02 北京爱康宜诚医疗器材有限公司 关节垫片假体及具有其的关节假体
EP4163903A1 (fr) 2021-10-05 2023-04-12 Université de Strasbourg Simulateur d' articulation ligamentaire

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US10085738B2 (en) 2016-05-16 2018-10-02 Arthex, Inc. Knee joint capsular disruption and repair
CN108269476A (zh) * 2018-03-13 2018-07-10 医技通智能科技（珠海）有限公司 一种膝关节置换模拟手术的人体模型
RU205282U1 (ru) * 2020-04-15 2021-07-07 Андрей Алексеевич Прохоров Симуляционная тренировочная платформа для отработки артроскопических навыков, резекции, восстановления патологически измененных менисков коленного сустава многократного использования
RU2763643C1 (ru) * 2021-04-20 2021-12-30 Федеральное государственное бюджетное учреждение "Национальный медицинский исследовательский центр травматологии и ортопедии имени Р.Р. Вредена" Министерства здравоохранения Российской Федерации Устройство для определения оптимальных компоновок ортопедического гексапода, применяемого для разработки движений при контрактурах коленного сустава и способ его использования.

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CN110074900A (zh) * 2019-02-01 2019-08-02 北京爱康宜诚医疗器材有限公司 关节垫片假体及具有其的关节假体
CN110074900B (zh) * 2019-02-01 2024-04-02 北京爱康宜诚医疗器材有限公司 关节垫片假体及具有其的关节假体
CN109830158A (zh) * 2019-03-25 2019-05-31 北京大学第三医院 一种膝关节动态模拟装置
CN109830158B (zh) * 2019-03-25 2023-10-20 北京大学第三医院 一种膝关节动态模拟装置
EP4163903A1 (fr) 2021-10-05 2023-04-12 Université de Strasbourg Simulateur d' articulation ligamentaire
WO2023057418A1 (fr) 2021-10-05 2023-04-13 Université De Strasbourg Simulateur d'articulation ligamentaire

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