WO2020181608A1 - 一种mts内侧胫骨平台补片、组配式mts内侧胫骨平台补片及其微创置换方法 - Google Patents

一种mts内侧胫骨平台补片、组配式mts内侧胫骨平台补片及其微创置换方法 Download PDF

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Publication number
WO2020181608A1
WO2020181608A1 PCT/CN2019/082730 CN2019082730W WO2020181608A1 WO 2020181608 A1 WO2020181608 A1 WO 2020181608A1 CN 2019082730 W CN2019082730 W CN 2019082730W WO 2020181608 A1 WO2020181608 A1 WO 2020181608A1
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Prior art keywords
mts
tibial plateau
patch
medial tibial
medial
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PCT/CN2019/082730
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English (en)
French (fr)
Inventor
王岩
柴伟
Original Assignee
王岩
柴伟
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Publication date
Application filed by 王岩, 柴伟 filed Critical 王岩
Priority to JP2021505992A priority Critical patent/JP2022522557A/ja
Priority to KR1020217022241A priority patent/KR102649339B1/ko
Priority to US17/427,113 priority patent/US20220096242A1/en
Publication of WO2020181608A1 publication Critical patent/WO2020181608A1/zh

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    • 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
    • A61F2/30767—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
    • A61F2002/30904—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves serrated profile, i.e. saw-toothed
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2002/3092—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth having an open-celled or open-pored structure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees
    • A61F2002/3895—Joints for elbows or knees unicompartimental
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4632—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using computer-controlled surgery, e.g. robotic surgery
    • A61F2002/4633—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using computer-controlled surgery, e.g. robotic surgery for selection of endoprosthetic joints or for pre-operative planning
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4635—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using minimally invasive surgery

Definitions

  • the present invention relates to the field of artificial knee joint prosthesis replacement, in particular to an MTS medial tibial plateau patch and an assembled MTS medial for minimally invasive surgical replacement of patients with obvious wear on the tibial articular surface, cartilage loss or tibial deformity Tibial plateau patch and its minimally invasive replacement method.
  • TKA total knee arthroplasty
  • UZA unicondylar arthroplasty
  • HTO high tibial osteotomy
  • This operation only removes the unilateral articular surface of the tibia and femur, and implants the tibia, femur, and cushion prosthesis.
  • the proprioception is better; however, this operation has a limited lifespan, and the tibial plateau becomes loose and lining.
  • the incidence of cushion dislocation is relatively high, and there is too much osteotomy. It is difficult to revise as a total knee surgery. Additional auxiliary fixation such as cushions is required, which limits its promotion. 3.
  • High tibial osteotomy is only effective for knee arthritis patients with tibial deformity, and requires additional plate fixation, which is expensive and requires limited activities after surgery, which does not meet the concept and needs of rapid recovery for orthopedic patients. Studies have shown that the anatomical position of patients undergoing joint replacement after osteotomy changes, and the functional effect is not as good as that of patients undergoing joint replacement.
  • the purpose of the present invention is to provide a MTS medial tibial plateau patch, an assembled MTS medial tibial plateau patch and a minimally invasive replacement method thereof, which are used to solve the problem of large surgical trauma, difficulty, and limited service life in the prior art. Problems such as loose platform, high incidence of dislocation of liner, and excessive osteotomy.
  • An MTS medial tibial plateau patch comprising an articular surface and a bottom surface, the articulation surface is provided with an arc-shaped depression area, and the bottom surface is provided with 3 triangularly distributed uprights or 2 non-parallel distributed longitudinal keels Or 2 triangular keel wings.
  • the included angle between the column and the bottom surface is 20°-40°.
  • 3-4 arc-shaped grooves evenly distributed are provided on the column.
  • the longitudinal keel has a taper of 3°-7°.
  • the longitudinal keel is provided with 3-5 evenly distributed convex ridges.
  • the triangular keel wing has 2-4 anti-rotation arc grooves.
  • the shape of the bottom surface is one of a grid-shaped concave bone cement groove, a plurality of longitudinally distributed dovetail bone cement grooves, or a polished surface without grooves.
  • the cross section of the MTS medial tibial plateau patch is D-shaped, and the bionic design is carried out according to the anatomical shape of the Chinese knee tibial plateau.
  • the prosthesis is divided into 1-6 different sizes.
  • tibial plateau patches with different thickness specifications, the thickness of which is 3-14mm.
  • the thickness of the joint is equal in front and back.
  • the material of the MTS medial tibial plateau patch is VE high cross-linked polyethylene.
  • a combined MTS medial tibial plateau patch comprising a tibial tray and a pad, the tibial tray including an upper surface and a bottom surface, the upper surface is provided with a conical protrusion, and the bottom surface is provided with 3-4 Triangular columns or 2-3 longitudinal keels distributed non-parallel;
  • the liner includes an articulating surface and a lower surface, the articulating surface is provided with an arc-shaped depression area, and the lower surface is provided with a cone Shaped depression
  • the tibial tray and the liner are locked by the tapered protrusion of the tibial tray and the tapered recessed part of the liner.
  • the bottom surface of the tibial tray is provided with a porous trabecular bone structure layer with a thickness of 1-5 mm.
  • the material of the tibial tray is medical titanium alloy or cobalt chromium molybdenum alloy or polyether ether ketone (PEEK)
  • the material of the liner is VE highly cross-linked polyethylene.
  • a minimally invasive replacement method for replacing the MTS medial tibial plateau patch or the assembled MTS medial tibial plateau patch which uses a parapatella approach small incision minimally invasive surgical method to expose the patient’s affected limb or
  • the bone tissue of the diseased tibia is resected according to the preoperatively planned coronal varus and sagittal retrograde angles, and the MTS medial tibial plateau patch is implanted on the resected tibia.
  • the integrated MTS medial tibia The platform patch and the resected tibia are fixed by cement, and the assembled MTS medial tibial plateau patch and the resected tibia are biologically fixed.
  • the MTS medial tibial plateau patch and the combined MTS medial tibial plateau patch of the present invention have simple structures, good shape, and conform to the anatomical characteristics of the Chinese; the MTS medial tibial plateau patch and the combined MTS medial tibial plateau patch
  • the patch is easy to implant, simple in equipment, minimally invasive, and does not touch important soft tissues. The patient recovers quickly after surgery.
  • MTS medial tibial plateau patch is firmly fixed, strong in wear resistance, and biocompatible High; the minimally invasive replacement method of MTS medial tibial plateau patch or combined MTS medial tibial plateau patch has a small amount of osteotomy, simple revision surgery, and does not increase the difficulty of total knee replacement surgery; MTS medial tibial plateau patch can reduce metal Ion toxicity and allergic reactions do not affect MRI imaging.
  • Fig. 1 is the first three-dimensional structure diagram of the MTS medial tibial plateau patch of the present invention
  • FIG. 3 is a sagittal view of the first structure of the MTS medial tibial plateau patch of the present invention
  • Fig. 5 is a sagittal view of Fig. 3 of the structure of the MTS medial tibial plateau patch of the present invention
  • FIG. 6 is a three-dimensional structural diagram 4 of the MTS medial tibial plateau patch of the present invention.
  • Fig. 7 is a sagittal view of the structure of Fig. 4 of the MTS medial tibial plateau patch of the present invention.
  • Fig. 8 is a three-dimensional structural diagram of the assembled MTS medial tibial plateau patch of the present invention.
  • Figure 9 is a three-dimensional exploded view of the assembled MTS medial tibial plateau patch of the present invention.
  • Fig. 10 is a sagittal sectional view of the assembled MTS medial tibial plateau patch of the present invention.
  • Figure 11 is an effect diagram before replacing the MTS medial tibial plateau patch of the present invention.
  • Figure 12 is an effect diagram of the present invention after replacing the MTS medial tibial plateau patch.
  • the present invention aims at the problems of large trauma, high difficulty, short service life, loose tibial plateau, high incidence of dislocation of the liner and excessive osteotomy in the existing surgical operations, and provides an MTS medial tibial plateau patch and a combined MTS Medial tibial plateau patch and its minimally invasive replacement method.
  • an MTS medial tibial plateau patch includes an articular surface and a bottom surface 1.
  • an MTS medial tibial plateau patch includes an articular surface and a bottom surface 1.
  • the bottom surface 1 is provided with 2-3 longitudinal keels 4 that are non-parallel distributed, Two longitudinal keels 4 are preferred.
  • an MTS medial tibial plateau patch includes an articular surface and a bottom surface 1.
  • the bottom surface 1 is provided with 2-3 longitudinally distributed triangular keel wings 9, which are triangular There are 2-4 anti-rotation arc grooves on the keel wings. In this embodiment, two triangular keel wings 9 are preferred.
  • an MTS medial tibial plateau patch includes an articular surface and a bottom surface 1.
  • the bottom surface 1 is provided with 2-3 longitudinally distributed keels with a cylindrical cross section
  • the cylindrical keel wing 11 is provided with 2-4 anti-rotation arc grooves. In this embodiment, two cylindrical keel wings 11 are preferred.
  • the shape of the bottom surface is one of a grid-shaped concave bone cement groove, a plurality of longitudinally distributed dovetail bone cement grooves, or a polished surface without grooves.
  • the thickness of the MTS medial tibial plateau patch of the present invention is 3-14 mm. It can correct the deformity of the coronal force line within 0-15° and restore the original tension of joint ligaments and joint force line to relieve pain.
  • the material of the MTS medial tibial plateau patch is VE high cross-linked polyethylene, which reduces metal ion toxicity and allergic reactions. Does not affect MRI.
  • the wear resistance of the VE high crosslinked polyethylene is extremely high. Compared with the existing commonly used ultra-high molecular weight polyethylene materials, the VE high crosslinked polyethylene has good wear resistance, High flexural strength and high fatigue strength.
  • the elastic modulus of the VE high-crosslinked polyethylene is closer to that of the articular cartilage of the human body, so that the MTS medial tibial plateau patch forms an articular surface better with it .
  • the MTS medial tibial plateau patch of the present invention is fixed by cement, can be combined with free radicals after implantation, and reduces the oxidation rate of the material.
  • the material of the tibial tray is medical titanium alloy or cobalt-chromium-molybdenum alloy or polyether ether ketone (PEEK) or its derivatives, and the material of the liner is VE high cross-linked polyethylene.
  • the MTS medial tibial plateau patch of the present invention can be set into MTS medial tibial plateau patches of different thicknesses and sizes according to the bone shape of the human body.
  • the models of the MTS medial tibial plateau patch of the present invention are divided into 1-6 types, front and back. The diameter and the left and right diameters are well matched, which are used to correct different degrees of force line deformities of the patient.
  • the movement mechanics characteristics of the patient when using the MTS medial tibial plateau patch of the present invention are closer to natural joints.
  • the thickness of the MTS medial tibial plateau patch of the present invention is equal in the front and back of the joint, and the osteotomy angle is determined according to the original posterior inclination of the joint, so that the joint can roll back normally during flexion and extension activities and restore the original eccentricity of the joint.
  • the articular surface of the present invention is set according to the shape and size of the meniscus of the human knee joint, wherein the cross-section of the MTS medial tibial plateau patch is D-shaped, and the MTS medial tibia
  • the cross-section of the platform patch is D-shaped, and the bionic design is based on the anatomical shape of the Chinese knee tibial platform.
  • the prosthesis is divided into 1-6 different sizes.
  • the sagittal plane of the MTS medial tibial plateau patch has an arc-shaped depression, and the arc of the arc-shaped depression is small and flat.
  • tibial plateau patches with different thickness specifications, the thickness of which is 3-14mm.
  • the thickness of the joint is equal in front and back.
  • the embodiment of the present invention provides a modular MTS medial tibial plateau patch, which includes a tibial tray 8 and a pad 5.
  • the tibial tray 8 includes an upper surface and a bottom surface. The surface is provided with a tapered protrusion 6, and the bottom surface 1 is provided with 3-4 vertical posts distributed in a triangle shape or 2-3 vertical keels distributed in a non-parallel distribution;
  • the liner includes an articular surface and a lower surface, The articulated surface is provided with an arc-shaped recessed area, and the lower surface is provided with a tapered recess 7.
  • the tibial tray 8 and the liner 5 are locked by the tapered protrusion 6 of the tibial tray 8 and the tapered recess 7 of the liner 5, effectively preventing The loosening of the matching shin patch ensures the reliability of the combination of the two.
  • the lower surface of the pad 5 matches the upper surface of the tibial tray 8 platform.
  • the bottom surface of the tibial tray 8 is provided with a porous trabecular bone structure layer with a thickness of 2-3 mm.
  • the thickness of the cushion 5 is 4-12mm, which can correct the coronal deformity within 0-15°.
  • the trabecular metal tibial tray 8 with the best bone ingrowth performance is combined with the VE high cross-linked polyethylene liner 5.
  • the material of the liner 5 is made of highly wear-resistant VE high cross-linked polyethylene.
  • the prosthesis of this material can be combined with free radicals after implantation, reducing the oxidation rate of the material, and has the effect of absorbing shock and buffering , To avoid the problem of stress shielding after traditional surgery.
  • the column 3 of the present invention is optimized according to the stress condition, which is beneficial to decompose the stress and achieve an excellent positioning and fixing effect.
  • the included angle between the pillar 3 and the bottom surface 1 is 28°-31°, preferably 30°.
  • the column 3 is provided with three evenly distributed arc-shaped grooves. The arc-shaped grooves can enhance the stability of the MTS medial tibial plateau patch, while facilitating the installation of the MTS medial tibial plateau patch, reducing The destruction of normal tissues realizes the concept of minimally invasive surgery.
  • the longitudinal keel 4 of the present invention is optimized according to the stress condition, which is beneficial to resolve the stress and achieve an excellent positioning and fixing effect.
  • the longitudinal keel 4 has a taper of 3°-4°.
  • the longitudinal keel 4 is provided with 3-5 evenly distributed ridges, preferably 3 ridges.
  • the longitudinal keel 4 can strengthen the stability of the MTS medial tibial plateau patch, and at the same time facilitate the installation of the MTS medial tibial plateau patch, reduce damage to normal tissues, and realize the concept of minimally invasive surgery.
  • the bottom surface 1 of the present invention is also provided with grid-like protrusions 2. It facilitates the fixation of the MTS medial tibial plateau patch and prevents the MTS medial tibial plateau patch from loosening or falling off.
  • the bottom surface 1 of the present invention is provided with a plurality of longitudinally distributed dovetail-shaped bone cement grooves 10 to facilitate the fixation of the MTS medial tibial plateau patch and prevent the MTS medial tibial plateau patch from loosening or Fall off or move forward.
  • the embodiment of the present invention provides a minimally invasive replacement method for replacing the MTS medial tibial plateau patch or the assembled MTS medial tibial plateau patch, which uses a parapatellar approach small incision to expose the patient Resection of the bone tissue of the diseased tibia according to the preoperative plan for the coronal varus and valgus angle and the sagittal retroversion angle of the affected limb’s medial or lateral tibial plateau, the MTS medial tibial plateau patch or the combined MTS medial tibial plateau patch It is implanted on the resected tibia, the MTS medial tibial plateau patch and the resected tibia are fixed with cement, and the assembled MTS medial tibial plateau patch is biologically fixed to the resected tibia.
  • Figure 11 is an effect diagram of the tibia before replacement
  • Figure 12 is an effect diagram after replacement.
  • the effect diagram before replacement and the effect diagram after replacement are compared.
  • the minimally invasive replacement method of the present invention will The MTS medial tibial plateau patch or the assembled MTS medial tibial plateau patch of the present invention is implanted on the tibia, and can correct the coronal deformity within 0-15°, and the effect is remarkable.
  • the MTS medial tibial plateau patch and the combined MTS medial tibial plateau patch of the present invention have simple structure, convenient implantation, firm fixation, low revision frequency, minimally invasive surgery, small incision, and maximum capacity It retains bone mass and soft tissues, and allows patients to recover quickly after surgery. It can solve current thorny clinical problems and better serve patients. Its market prospects are broad.
  • the terms "equipped” and “connected” should be interpreted broadly.
  • it may be a fixed connection, a detachable connection, or an integral connection; it may be directly connected or indirectly connected through an intermediate medium.
  • the fixed connection can be common technical solutions such as welding, threaded connection and tightening.
  • welding threaded connection and tightening.

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  • Prostheses (AREA)

Abstract

一种MTS内侧胫骨平台补片和组配式MTS内侧胫骨平台补片。MTS内侧胫骨平台补片包括关节面和底面（1）。关节面上设有弧形凹陷区域，与股骨髁形成良好匹配和滑动配合。底面（1）上设有3个呈三角形分布的立柱（3）或者呈非平行分布的两条纵行龙骨（4）或者呈三角状的两条龙骨翼（9），以保证假体的稳定性。组配式MTS内侧胫骨平台补片包括骨小梁金属的胫骨托（8）和VE高交联聚乙烯的衬垫（5）。MTS内侧胫骨平台补片和组配式MTS内侧胫骨平台补片结构较简单，且形似度较好。

Description

一种MTS内侧胫骨平台补片、组配式MTS内侧胫骨平台补片及其微创置换方法 技术领域
本发明涉及人工膝关节假体置换领域，特别是指一种应用于胫骨关节面明显磨损，软骨缺失或胫骨畸形的患者进行微创手术置换用的MTS内侧胫骨平台补片、组配式MTS内侧胫骨平台补片及其微创置换方法。
背景技术
随着中国老龄化社会的到来和医疗卫生事业的迅猛发展，人均寿命逐渐延长，关节炎作为一种退行性变，已经成为当今社会困扰中老年人的重大医疗问题。膝关节作为主要的负重关节，关节炎的发生率尤其高。另外，日益严重的肥胖问题和各种原因的运动伤，也在膝关节骨关节炎发生发展中起到了推波助澜的作用。患病的膝关节面和软骨受到破坏，表面明显磨损和缺失造成膝关节活动范围受限、疼痛，严重影响患者的日常生活和工作。
目前国内外采用的手术方案有：全膝关节置换(TKA)、单髁关节置换(UKA)和胫骨高位截骨(HTO)。
现有的手术方案的缺点如下：1、全膝关节表面置换，手术将内外侧间室或(和)髌股间室及交叉韧带全部或部分切除，手术创伤大，对于只有单间室关节炎的患者来说，全膝关节置换无疑是削足适履，牺牲了正常的关节面和韧带，本体感觉不佳，全膝关节置换术后不满意率达20％。一旦手术发生感染、松动、磨损、脱位等并发症，翻修手术为破坏性手术、难度大且需要特殊的假体，花费非常高。2、单髁关节置换，该手术仅切除胫骨股骨的单侧间室关节面，植入胫骨、股骨、衬垫假体，本体感觉较好；但是，该手术使用年限有限，胫骨平台松动、衬垫脱位发生率较高，截骨过多，翻修为全膝手术时难度较大，需要垫块等额外辅助固定，限制了其推广。3、胫骨高位截骨仅对胫骨畸形的膝关节炎患者有效，且需要额外钢板固定，花费较高，手术后需要限制活动， 不符合骨科患者快速康复的理念和需求。研究表明截骨术后的患者行关节置换时解剖位置改变，功能效果不如初次关节置换的患者。
发明内容
本发明的目的在于提供一种MTS内侧胫骨平台补片、组配式MTS内侧胫骨平台补片及其微创置换方法，用于解决现有技术中手术创伤大、难度大、使用年限少、胫骨平台松动、衬垫脱位发生率较高和截骨过多等问题。
为实现上述目的，本发明提供以下技术方案：
一种MTS内侧胫骨平台补片，包括关节面和底面，所述关节面上设有弧形凹陷区域，所述底面上设置3个呈三角形分布的立柱或2个呈非平行分布的纵行龙骨或者2个呈三角形的龙骨翼。
其中，所述立柱与所述底面之间的夹角呈20°-40°。
其中，所述立柱上设有均匀分布的3-4个弧形凹槽。
其中，所述纵行龙骨带有3°-7°的锥度。
其中，所述纵行龙骨上设有3-5条均匀分布的凸脊。
其中，所述的三角形龙骨翼有2-4条防旋圆弧槽。其中，所述底面形态为带网格状凹形骨水泥槽、多条纵向分布的燕尾型骨水泥槽或无槽的抛光面的其中一种。
其中，所述MTS内侧胫骨平台补片的横截面呈D字型，按照国人膝关节胫骨平台的解剖形态进行仿生设计，假体分为1-6型不同大小的尺寸。
其中，还包括数个不同厚度规格的胫骨平台补片，其厚度为3-14mm。
其中，所述关节面前后厚度相等。
其中，所述MTS内侧胫骨平台补片的材料为VE高交联聚乙烯。
一种组配式MTS内侧胫骨平台补片，包括胫骨托和衬垫，所述胫骨托包括上表面和底面，所述上表面设置有锥形突出部，所述底面上设置有3-4个呈三角形分布的立柱或2-3个呈非平行分布的纵行龙骨；所述衬垫包括关节面和下表面，所述的关节面上设有弧形凹陷区域，所述下表面设置有锥形凹陷部；
所述胫骨托与所述衬垫之间通过所述胫骨托的锥形突出部与所述衬垫的锥形凹陷部锁紧。
其中，所述胫骨托的底面设有骨小梁多孔结构层，厚度为1-5mm。
其中，所述胫骨托的材料为医用钛合金或钴铬钼合金或聚醚醚酮(PEEK)
或其衍生物，所述衬垫的材料为VE高交联聚乙烯。
一种用于置换所述的MTS内侧胫骨平台补片或组配式MTS内侧胫骨平台补片的微创置换方法，采用髌旁入路小切口的微创手术方法暴露患者的患肢胫骨内侧或外侧平台，按照术前计划的冠状位内外翻角度及矢状位后倾角度切除病变胫骨的骨组织，将MTS内侧胫骨平台补片植入被切除的胫骨上，所述一体式的MTS内侧胫骨平台补片与所述被切除的胫骨采用水泥固定，所述组配式MTS内侧胫骨平台补片与所述被切除的胫骨采用生物固定。
本发明的上述技术方案的有益效果如下：
上述方案中，本发明的MTS内侧胫骨平台补片和组配式MTS内侧胫骨平台补片结构简单，形似度好、符合国人解剖特点；MTS内侧胫骨平台补片和组配式MTS内侧胫骨平台补片植入方便、器械简单、手术微创、不触及重要软组织，患者术后恢复快预期可进行门诊手术治疗，当天出院；MTS内侧胫骨平台补片固定牢靠、耐磨性强、生物相容度高；MTS内侧胫骨平台补片或组配式MTS内侧胫骨平台补片的微创置换方法截骨量小，翻修手术简单，不增加全膝关节置换手术难度；MTS内侧胫骨平台补片可以减少金属离子毒性及过敏反应，不影响核磁共振成像。
附图说明
图1为本发明的MTS内侧胫骨平台补片的立体结构图一；
图2为本发明的MTS内侧胫骨平台补片的立体结构图二；
图3为本发明的MTS内侧胫骨平台补片结构图一的矢状面视图；
图4为本发明的MTS内侧胫骨平台补片的立体结构图三；
图5为本发明的MTS内侧胫骨平台补片的结构图三的矢状面视图；
图6为本发明的MTS内侧胫骨平台补片的立体结构图四；
图7为本发明的MTS内侧胫骨平台补片的结构图四的矢状面视图；
图8为本发明的组配式MTS内侧胫骨平台补片的立体结构图；
图9为本发明的组配式MTS内侧胫骨平台补片的立体分解图；
图10为本发明的组配式MTS内侧胫骨平台补片的矢状面剖视图；
图11为本发明的置换MTS内侧胫骨平台补片前的效果图；
图12为本发明的置换MTS内侧胫骨平台补片后的效果图。
附图标记：
1、底面；2、凹状骨水泥槽；3、立柱；4、纵行龙骨；5、衬垫；6、突出部；7、凹陷部；8、胫骨托；9、三角形龙骨翼；10、燕尾型骨水泥槽；11、圆柱形龙骨翼。
具体实施方式
为使本发明要解决的技术问题、技术方案和优点更加清楚，下面将结合附图及具体实施例进行详细描述。
本发明针对现有的手术创伤大、难度大、使用年限少、胫骨平台松动、衬垫脱位发生率较高和截骨过多的问题，提供一种MTS内侧胫骨平台补片、组配式MTS内侧胫骨平台补片及其微创置换方法。
如图1所示的，本发明实施例提供了一种MTS内侧胫骨平台补片的第一个实施例，一种MTS内侧胫骨平台补片，包括关节面和底面1，所述关节面上设有弧形凹陷区域，所述弧形凹陷区域与股骨髁形成良好匹配和滑动配合，且不增加关节内撞击，所述底面1上设置有3-4个呈三角形分布的立柱3，优选3个立柱3。
如图2所示的，本发明实施例提供了一种MTS内侧胫骨平台补片的第二个实施例，一种MTS内侧胫骨平台补片，包括关节面和底面1，所述关节面上设有弧形凹陷区域，所述弧形凹陷区域与股骨髁形成良好匹配和滑动配合，且不增加关节内撞击，所述底面1上设置有2-3个呈非平行分布的纵行龙骨4，优选2个纵行龙骨4。
如图4所示的，本发明实施例提供了一种MTS内侧胫骨平台补片的第三个实施例，一种MTS内侧胫骨平台补片，包括关节面和底面1，所述关节面上设有弧形凹陷区域，所述弧形凹陷区域与股骨髁形成良好匹配和滑动配合，且不增加关节内撞击，所述底面1上设置有2-3个呈纵向分布的三角形龙骨翼9，三角形龙骨翼上设有2-4个防旋圆弧槽，本实施例优选2个三角形龙骨翼9。
如图6所示的，本发明实施例提供了一种MTS内侧胫骨平台补片的第四个实施例，一种MTS内侧胫骨平台补片，包括关节面和底面1，所述关节面上设有弧形凹陷区域，所述弧形凹陷区域与股骨髁形成良好匹配和滑动配合，且不增加关节内撞击，所述底面1上设置有2-3个呈纵向分布的截面呈圆柱状的龙骨翼11，圆柱状的龙骨翼11上设有2-4个防旋圆弧槽，本实施例优选2个圆柱状的龙骨翼11。
其中，所述底面形态为带网格状凹形骨水泥槽、多条纵向分布的燕尾型骨水泥槽或无槽的抛光面的其中一种。
本发明的所述MTS内侧胫骨平台补片的厚度均为3-14mm。可以纠正0-15°以内的冠状面力线畸形并恢复关节韧带原有张力及关节力线，缓解疼痛。所述MTS内侧胫骨平台补片的材料为VE高交联聚乙烯，减少金属离子毒性及过敏反应。不影响核磁共振成像。所述VE高交联聚乙烯的耐磨度极高，VE高交联聚乙烯与现有的常用的超高分子量聚乙烯材料相比较，所述VE高交联聚乙烯的耐磨性好、抗屈强度高和抗疲劳强度高，所述VE高交联聚乙烯的弹性模量更接近人体关节面软骨的弹性模量，使得所述MTS内侧胫骨平台补片与之形成关节面更好配合。本发明的MTS内侧胫骨平台补片采用水泥固定，植入后能与自由基结合，减低材料的氧化率。
其中，所述胫骨托的材料为医用钛合金或钴铬钼合金或聚醚醚酮(PEEK)或其衍生物，所述衬垫的材料为VE高交联聚乙烯。
本发明的MTS内侧胫骨平台补片可以根据人体的骨骼形状设置成不同厚度和不同大小规格的MTS内侧胫骨平台补片，本发明的MTS内侧胫骨平台补片的型号分为1-6型，前后径与左右径均有较好匹配，用以纠正患者不同程度的力线畸形，患者在使用本发明的MTS内侧胫骨平台补片时的运动力学特征更接近自然关节。
本发明中的MTS内侧胫骨平台补片的关节面前后厚度相等，根据关节原有后倾决定截骨角度，实现关节在屈伸活动中的正常后滚，恢复关节原有偏心距。
如图3所示的，本发明的关节面是根据仿人体膝关节半月板形状和尺寸而设定，其中，所述MTS内侧胫骨平台补片的横截面呈D字型，所述MTS内 侧胫骨平台补片的横截面呈D字型，按照国人膝关节胫骨平台的解剖形态进行仿生设计，假体分为1-6型不同大小的尺寸。所述MTS内侧胫骨平台补片的矢状面上带有弧形凹陷，所述弧形凹陷的弧度小而平。
其中，还包括数个不同厚度规格的胫骨平台补片，其厚度为3-14mm。
其中，所述关节面前后厚度相等。
如图8-9所示的，本发明实施例提供了一种组配式MTS内侧胫骨平台补片，包括胫骨托8和衬垫5，所述胫骨托8包括上表面和底面，所述上表面设置有锥形突出部6，所述底面1上设置有3-4个呈三角形分布的立柱或2-3个呈非平行分布的纵行龙骨；所述衬垫包括关节面和下表面，所述的关节面上设有弧形凹陷区域，所述下表面设置有锥形凹陷部7。如图10所示的，所述胫骨托8与所述衬垫5之间通过所述胫骨托8的锥形突出部6与所述衬垫5的锥形凹陷部7锁紧，有效防止组配式胫补片的松脱，保证两者结合的牢靠性。衬垫5的下表面与所述胫骨托8平台的上表面相匹配。
其中，所述胫骨托8的底面设有骨小梁多孔结构层，厚度为2-3mm。衬垫5厚度为4-12mm，可纠正0-15°以内的冠状面畸形。
本实施例中，由目前骨长入性能最好的骨小梁金属胫骨托8联合VE高交联聚乙烯衬垫5组成，其弹性模量及孔隙率接近正常骨骼组织，固定方式为生物固定，衬垫5的材料采用耐磨度极高的VE高交联聚乙烯制成，此材料的假体植入后能与自由基结合，减低材料的氧化率，并且具有吸收震荡和缓冲的作用，避免了传统手术术后应力遮挡问题。
如图1和图3所示的，本发明的立柱3是根据受力情况进行优化设计，有利于分解应力，达到极佳的定位固定效果。所述立柱3与所述底面1之间的夹角呈28°-31°，优选夹角为30°。所述立柱3上设有均匀分布的3个弧形凹槽，所述弧形凹槽可以加强所述MTS内侧胫骨平台补片的稳定性，同时方便所述MTS内侧胫骨平台补片安装，减少对正常组织的破坏，实现了微创手术的理念。
如图2所示的，本发明的纵行龙骨4是根据受力情况进行优化设计，有利于分解应力，达到极佳的定位固定效果。所述纵行龙骨4带有3°-4°的锥度。所述纵行龙骨4上设有3-5条均匀分布的凸脊，优选3条。所述纵行龙骨4可 以加强所述MTS内侧胫骨平台补片的稳定性，同时方便所述MTS内侧胫骨平台补片安装，减少对正常组织的破坏，实现了微创手术的理念。
如图1和图2所示的，本发明的所述底面1上还设有网格状凸起2。便于MTS内侧胫骨平台补片的固定，防止MTS内侧胫骨平台补片松动或脱落。
如图4-7所示的，本发明的所述底面1上设有多条纵向分布的燕尾型骨水泥槽10，便于MTS内侧胫骨平台补片的固定，防止MTS内侧胫骨平台补片松动或脱落或前移。
本发明实施例提供了一种用于置换所述的MTS内侧胫骨平台补片或组配式MTS内侧胫骨平台补片的微创置换方法，采用髌旁入路小切口的微创手术方法暴露患者的患肢胫骨内侧或外侧平台，按照术前计划的冠状位内外翻角度及矢状位后倾角度切除病变胫骨的骨组织，将MTS内侧胫骨平台补片或者组配式MTS内侧胫骨平台补片植入被切除的胫骨上，所述MTS内侧胫骨平台补片与所述被切除的胫骨采用水泥固定，所述组配式MTS内侧胫骨平台补片与所述被切除的胫骨采用生物固定。
如图11-12所示的，图11为置换前的胫骨效果图，图12为置换后的效果图，对比置换前的效果图和置换后的效果图，采用本发明的微创置换方法将本发明的MTS内侧胫骨平台补片或组配式MTS内侧胫骨平台补片植入到胫骨上，可以纠正0-15°以内的冠状面畸形，效果显著。
上述方案中，本发明的所述的MTS内侧胫骨平台补片和组配式MTS内侧胫骨平台补片结构简单，植入方便、固定牢靠、翻修频率低，手术微创，切口小、能最大限度的保留骨量及软组织，患者术后恢复快，能解决目前棘手的临床难题、更好的服务于患者，其市场前景广阔。
本说明书中的各个实施例均采用递进的方式描述，每个实施例重点说明的都是与其他实施例的不同之处，各个实施例之间相同相似的部分互相参见即可。
在本发明的描述中，需要理解的是，术语“上”、“一端”等指示的方位或位置关系为基于附图所示的方位或位置关系，仅是为了便于描述本发明和简化描述，而不是指示或暗示所指的装置或元件必须具有特定的方位、以特定的方位构造和操作，因此不能理解为对本发明的限制。
在本发明的描述中，需要说明的是，除非另有明确的规定和限定，术语“设 有”、“连接”应做广义理解。例如，可以是固定连接，也可以是可拆卸连接，或一体地连接；可以是直接相连，也可以通过中间媒介间接相连。固定连接可以为焊接、螺纹连接和加紧等常见技术方案。对于本领域的普通技术人员而言，可以具体情况理解上述术语在本发明中的具体含义。
以上所述是本发明的优选实施方式，应当指出，对于本技术领域的普通技术人员来说，在不脱离本发明所述原理的前提下，还可以做出若干改进和润饰，这些改进和润饰也应视为本发明的保护范围。

Claims (15)

  1. 一种MTS内侧胫骨平台补片，其特征在于，包括关节面和底面，所述关节面上设有弧形凹陷区域，所述底面上设置有3个呈三角形分布的立柱或2个呈非平行分布的纵行龙骨或者2个呈三角形的龙骨翼。
  2. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述立柱与所述底面之间的夹角呈20°-40°。
  3. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述立柱上设有均匀分布的3-4个弧形凹槽。
  4. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述纵行龙骨带有3°-7°的锥度。
  5. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述纵行龙骨上设有3-5条均匀分布的凸脊。
  6. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述三角形的龙骨翼上设有2-4条防旋圆弧槽。
  7. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述底面形态为带网格状凹形骨水泥槽、多条纵向分布的燕尾型骨水泥槽或无槽的抛光面的其中一种。
  8. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述MTS内侧胫骨平台补片的横截面呈D字型，按照国人膝关节胫骨平台的解剖形态进行仿生设计，假体分为1-6型不同大小的尺寸。
  9. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，包括数个不同厚度规格的胫骨平台补片，其厚度为3-14mm。
  10. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，其关节面前后厚度相等。
  11. 如权利要求1所述的MTS内侧胫骨平台补片，其特征在于，所述MTS内侧胫骨平台补片的材料为VE高交联聚乙烯。
  12. 一种组配式MTS内侧胫骨平台补片，包括胫骨托和衬垫，其特征在于，所述胫骨托包括上表面和底面，所述上表面设置有锥形突出部，所述底面 上设置有3-4个呈三角形分布的立柱或2-3个呈非平行分布的纵行龙骨；所述衬垫包括关节面和下表面，所述的关节面上设有弧形凹陷区域，所述下表面设置有锥形凹陷部；所述胫骨托与所述衬垫之间通过所述胫骨托的锥形突出部与所述衬垫的锥形凹陷部锁紧。
  13. 如权利要求11所述组配式MTS内侧胫骨平台补片，其特征在于，所述胫骨托的底面设有骨小梁多孔结构层，厚度为1-5mm。
  14. 如权利要求11所述组配式MTS内侧胫骨平台补片，其特征在于，所述胫骨托的材料为医用钛合金或钴铬钼合金或聚醚醚酮(PEEK)或其衍生物，所述衬垫的材料为VE高交联聚乙烯。
  15. 一种用于置换所述的MTS内侧胫骨平台补片或组配式MTS内侧胫骨平台补片的微创置换方法，其特征在于，采用髌旁入路小切口的微创手术方法暴露患者的患肢胫骨内侧或外侧平台，按照术前计划的冠状位内外翻角度及矢状位后倾角度切除病变胫骨的骨组织，将MTS内侧胫骨平台补片植入被切除的胫骨上，所述一体式的MTS内侧胫骨平台补片与所述被切除的胫骨采用水泥固定，所述组配式MTS内侧胫骨平台补片与所述被切除的胫骨采用生物固定。
PCT/CN2019/082730 2019-03-11 2019-04-15 一种mts内侧胫骨平台补片、组配式mts内侧胫骨平台补片及其微创置换方法 WO2020181608A1 (zh)

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