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CN1533262A - 模块假肢关节窝 - Google Patents

模块假肢关节窝 Download PDF

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Publication number
CN1533262A
CN1533262A CNA028146123A CN02814612A CN1533262A CN 1533262 A CN1533262 A CN 1533262A CN A028146123 A CNA028146123 A CN A028146123A CN 02814612 A CN02814612 A CN 02814612A CN 1533262 A CN1533262 A CN 1533262A
Authority
CN
China
Prior art keywords
screw
ring
support plate
fixing
metal cup
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
CNA028146123A
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English (en)
Inventor
�ˡ����˶�������˹
弗雷德里克·马卡拉
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Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
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Publication of CN1533262A publication Critical patent/CN1533262A/zh
Pending legal-status Critical Current

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    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A61B17/8066—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for pelvic reconstruction
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    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
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Abstract

本发明涉及一种在全面修理髋部假器的情况下用于整复髋部关节的外科处理的模块假肢关节窝，并涉及一种用于对假肢关节窝一类的假肢植入件进行固定的锚固螺钉。假肢关节窝既包括设置在髋臼腔内用锚固螺钉(4)进行固定的支撑板(1)，所述锚固螺钉具有能够保证对所述支撑板(1)进行位置调节和固定其深度的设备(48)，还有一个依靠锥形胫骨组合系统(16，21)固定在该支撑板上的定向撑杆(2)，而且还有一个利用锥形胫骨组合系统(24，33)组装到所述定向撑杆(2)上的金属杯(3)。

Description

模块假肢关节窝
本发明涉及一种在全面修理髋部假器的情况下以及在发育不良的情况下用于整复髋部关节的外科处理的模块假肢关节窝，所述髋部假器带有(或没有丢失)骨质，本发明还涉及一种用于固定假器植入物，例如关节窝的锚固螺钉。
本发明的关节窝的目的在于利用其模块性单独对各基本元件进行处理，恢复关节窝的生物机械的标准协调性，这些基本元件用于植入物的固定和定位。
这种原理可以满足所碰到的各种情况的需要，并适应其要求，这样就可以快速给病人安装。
现有的用于整复髋臼窝外科处理技术表明，目前的假肢装置不论是在骨内的锚固高度，还是它们的机械定位处都是不够的。
这是因为，开始固定时限定的锚固当时会有一个对整个植入物不利的影响，与强加给植入物的压力和扭力相比，这可能导致所放材料的拔出和/或断裂。
植入物的定位通常依赖于需要处理的骨关节窝的状态，它不可能在任何平面中自由定向，这种自由定向可以修复与关节垂直的生物机械，因此会使关节的稳定性受到损失，常常使植入物脱臼或被拔出。
本发明的模块假肢关节窝可以克服这些缺陷，因考虑了机械、解剖以及生物要求，所以整体上满足整复髋部关节的外科处理。
本发明的模块假肢关节窝的特征主要在于它既包括设置在髋臼腔内用锚固螺钉进行固定的支撑板，所述锚固螺钉具有能够保证对所述支撑板进行位置调节和固定其深度的设备，还有一个依靠莫尔斯锥形组合系统固定在该支撑板上的定向撑杆，而且还有一个利用莫尔斯锥形组合系统被组装到所述定向撑杆上的金属杯。
这种模块假肢关节窝主要因为有锚固螺钉的特征，因此可以分别进行一次固定和二次固定的处理，而且由于其具有很大的模块性，因此可以对植入物进行解剖定向，因而利用构成模块假肢关节窝的各个元件的莫尔斯锥形组合系统，使稳定性更加可靠。
事实上，模块假肢关节窝的一次固定利用锚固螺钉通过支撑板得到保证，不需要定向应力，通过利用任何自由支撑，所述锚固螺钉就可以锚固在骨区。
根据本发明模块假肢关节窝的一个附加特征，所述支撑板包括至少一个带有环的髋臼内支撑爪，利用所述锚固螺钉，所述环可以将所述支撑板锚固在髋臼内。
根据本发明模块假肢关节窝的另一个附加特征，所述支撑板包括至少一个具有环的在髋臼上面的外爪，所述环用于接收多孔形或皮层状的固定杆，以及一个能够保证钩住髋臼下面的闭塞钩。
由于髋臼上面的爪产生的周边区域以及由于髋臼爪产生的内部区域上增加了许多支撑板的锚固点和支撑点，因此就可以使所述支撑板达到最大的稳定性，从而使植入物达到最大稳定性。
应注意的是，如果骨头的损伤很厉害，则髋臼上面的固定爪还可以通过锚固螺钉固定，这种锚固螺钉与固定髋臼爪的锚固螺钉相同。
锚固螺钉和支撑板的这种连接体现出了真正的接骨术，其初次机械稳定性只靠一个持久的主要整复元件，而且可以迅速给病人安装。
根据本发明模块假肢关节窝的另一个附加特征，它有一个接骨导体涂层，该涂层为钛和羟基磷灰石的双层涂层。
这种模块假肢关节窝的二次固定一方面由于髋臼腔填满了参与整复遗留损伤骨的移植骨和/或替代骨而得到最佳化，另一方面由于两层接骨导体涂层而得到最佳化，这种涂层主要粘到支撑板的髋臼爪的后面，以及粘到金属杯的后面，通过定向撑杆将该金属杯装在所述支撑板中。
根据本发明模块假肢关节窝的另一个附加特征，所述定向撑杆一方面在其底部包括一个被固定到支撑板所含的阴锥体上的阳锥体；另一方面该定向撑杆在其上部包括一个阴锥体，该阴锥体使定向撑杆接收金属杯所含的阳锥体，因而不论所述支撑板的位置如何，都可以根据需要对该金属杯定向。
这样，所述定向撑杆在所有平面中都可以定向，从而在支撑板和金属杯之间起到界面作用，并可以在所述金属杯内重新调整解剖学的垂直支撑点，这样也就增加了支撑面的相合性和尺寸。
与支撑板在骨关节窝中的固定无关，利用可以在后面垂直平面上转向180°的金属杯以及可以在垂直平面和水平平面中变向的定向撑杆来确保对假肢关节窝的定向调节，所述定向撑杆插在支撑板和金属杯之间。
这两个元件可以很灵巧地调节关节的解剖轴。
含有本发明的假肢关节窝的不同元件的莫尔斯锥形组合件确保组装件的固定，并长期可靠地保持其稳定性。
根据本发明模块假肢关节窝的另一个附加特征，所述定向撑杆在其外部，在其最宽部分的中心，并且在一半以上的周边设有一个固定圈，该固定圈的不同部位包括可以让螺钉通过的环，这些螺钉被拧在支撑板所含的周边台肩上的螺孔中，所述固定圈在所述的各个环的高度上有一个与所述螺钉配合的合适凹型，螺钉的头部为半球形支撑面，以便使所述螺钉根据若干轴定向。
根据一个变型，金属杯在其外赤道区，在一半以上的周边，并且在其阳锥体上面有-个可以对支撑板、定向撑杆和金属杯进行附加固定的固定圈，为此，该固定圈的不同部位包括一些可以让螺钉通过的环，这些螺钉被拧在支撑板所含的周边台肩上的螺孔中，所述固定圈在所述的各个环的高度上有一个与所述螺钉配合的合适凹型，螺钉的头部为半球形支撑面，以便使所述螺钉根据若干轴定向。
根据本发明的模块假肢关节窝的第一个具体实施方式，所述金属杯具有镜像式的完全不通的内部，这种内部可以使其里面接收的聚合插入镜头自由活动，所述插入镜头有一个用于接收假肢股骨元件的球形头的半球形腔。
这种构造有利于关节进行大幅度运动。
根据本发明的模块假肢关节窝的第二个具体实施方式，所述金属杯包括一个具有阴件的完全不通的内部，这种内部可以接收一个陶瓷插入镜头，所述插入镜头有一个阳锥形件，从而构成一个莫尔斯锥形组合系统，该插入镜头有一个用于接收假肢股骨元件的球形头的半球形腔。
这种使插入镜头相对于金属杯进行固定的构造对于年轻病人和/或很健康的病人来讲满足一些专门规定。
本发明的模块假肢关节窝的这些不同特征确保进行正常的生物机械修复，保证新假器的长期使用，并可以使病人进行操练治疗，很快恢复健康。
本发明还有一个目的在于一种用于对上述假肢关节窝一类的假肢植入件进行固定的锚固螺钉，该锚固螺钉的特征主要在于它包括能够保证对所述植入物支撑面的高度进行精细调节的设备，通过保证对各压力的平衡调节，使植入物确保锚固在骨组织中。
根据本发明的锚固螺钉的一个附加特征，该锚固螺钉包括一个本体，本体有一个从尖形末端部分延伸的柱形近端部分，并有一个能够自动钻入的多孔形螺杆，有一个钻有丝扣的管道沿轴向穿过所述远端部分，所述管道用于接收一个带丝扣的柱塞，柱塞本身有一个头部，而且被一个攻有螺纹的穴穿过，该穴用于接受一个固定的反向螺钉。
就如机力起重器一样，带丝扣的柱塞根据其深度可以深入到所述钻有丝扣的管道中，该管道调节假肢植入物的支撑面的高度，而反向螺钉保证拧紧所述植入物。
根据下面结合附图的描述将会更加清楚地理解本发明装置的这些优点和特征，附图表示的是几种非限定性的实施方式。
在附图中：
图1是本发明假肢关节窝的局部分解示意图；
图2是同一假肢关节窝的变型的沿正中剖开的局部示意图；
图3是图2的部分关节窝变型的透视图；
图4是该关节窝另一部分变型的透视图；
图5是该关节窝另一部分变型的透视图；和
图6是本发明锚固螺钉的沿纵平面进行局部剖开的分解示意图。
现在参见图1可以看到本发明的假肢关节窝。它包括一个用于植入在髋臼腔内的支撑板1，该支撑板接收一个由定向撑杆2安装的金属杯3。
所述支撑板1最好由不锈钢或铬—钴制成，可以涂覆双层微孔钛和羟基磷灰石，该支撑板构成假肢关节窝的底座。
该支撑板可以满足髋关节的解剖和机械要求。
该支撑板基本为支座环10的形状，该支座环用于局部安放定向撑杆2和金属杯3，支座环上带有一些可以让圆形环12穿过的内爪11，该环可以让下面将要详细介绍的锚固螺钉4通过。应注意的是，这些内爪11可以包括若干环12，这些环也可以为椭圆形。
众所周知，支撑板1还包括两个在髋臼上的外爪13，环14就在外爪中，以便让固定在骼三角上的未示出的螺钉通过，以及一个可以在座骨(Ischiopubienne)缺口中作外支撑的钩15。
撑杆2为指环20的形状，指环20的外面包括一个锥形远端区域21，以便可以与支座环10组装成莫尔氏锥体形式，该支座环的外面有一个互补形状的近端区域16。在基本为正中的区域，该定向撑杆的外部还包括一个周边环圈22，该环圈上穿过多个环23，将该环圈与支撑板1开口边上所含的一个环圈17连接，该环圈17上钻有与环23相对的以便接收螺钉5的螺纹口18，这样，一方面在选择了方向以后，不让定向撑杆2在支撑板1上转动，另一方面可以固定该组装件。
撑杆2总的形状为楔形，也就是说它分别与支撑板1和金属杯3的结合面为会聚面，以便通过选择其特征进行角度定向，角度定向能够调整金属杯3内的垂直解剖支撑点的中心，因而可以增加支撑面的相合面积和尺寸。
金属杯3总的形状为半球形，它有一个鸭舌帽形状的细边30，该金属杯包括一个用于接收图1中未示出但在图2中可以看到的插入件6，该插入件本身包括一个用于接收假肢股骨元件球形头的半球形腔60。
利用一个莫尔斯锥体式系统对杯3进行组装，这样，定向撑杆2内就包括一个锥形区24，而杯3的外面包括一个锥形区33。此外，杯3的外面有一个赤道细边32，该细边构成一个可以将其取出的莫尔斯锥体解锁元件。
本发明的假肢关节窝可以有许多变型，现在请参见图2和图3，4和5，可以看到本发明的另一种假肢关节窝，该假肢关节窝也是由支撑板1、撑杆2和杯3组合而成，这些不同的元件均有不同的结构。
在图2和3中可以注意到，支撑板1具有一些其他形状的内爪11，特别是这些内爪要更长些。
在图2和4中可以发现撑杆2没有环圈。
在图2和5中可以发现杯3的外面有一个由若干环35穿过的环圈34。
现在参见图6，可以发现一个锚固螺钉4，该锚固螺钉可以对骨腔中的支撑板1进行位置调节。
这种锚固螺钉4最好不容易定位，它包括一个带有丝扣的远端部分40，该近端部分有一个尖部41和多孔式螺纹42，该锚固螺钉还包括一个圆柱形的近端部分43，该近端部分沿轴向有攻了丝扣的管道44穿过，带有丝扣的柱塞45可以拧到该管道中，所述柱塞本身带有一个头部46，柱塞中有攻了丝扣的穴47穿过，该穴用于接收一个反向固定螺钉48。
带有丝扣的柱塞45根据其在攻了丝扣的管道44中的深度可以调节支撑板1的支撑面的高度，而反向固定螺钉48保证维持住所述支撑板1。
应注意的是，不同的丝扣最好有不同的螺距。
在将所述远端部分锚固到骨质中以后，柱塞45的固定或解固可以调节头部46的高度，该头部支撑在支撑板1上，确切地说，被支承在髋臼爪11上。确定了柱塞45插在管道44中的合适深度以后，利用拧到穴47中的反向固定螺钉48对支撑板1进行固定。
当然，近端部分43、柱塞45和反向固定螺钉48均带有轴向中空标记的槽作标记。
应注意的是，螺钉5，反向固定螺钉48以及其他未示出的用于固定髋臼上面的外爪13的螺钉均有头部，头部的支撑面为半球形的弯曲形状，而在其中分别制成有各个环23，35，12和14的各个元件22，34，11和13与环对应的高度具有互补形状，这种形状适合于将这些螺钉相对于元件22，34，11和13根据所要求的轴进行定向。
此外应注意的是，近端部分43的底部，也就是说与远端部分40连接的区域最好是截锥形，使螺纹42在该截锥形上延伸，以便保证可靠地进行锚固。
当骨头受到严重损伤时，在髋假肢的所有恢复过程中，以及在运动困难时，本发明的模块假肢关节窝主要用于重整髋关节的外科处理。
应注意的是，锚固螺钉4不只用于本发明的模块假肢关节窝，而且还可用于其它矫正。

Claims (13)

1.一种在全面修理髋部假器的情况下用于整复髋部关节的外科处理的模块假肢关节窝，其特征在于它既包括设置在髋臼腔内用锚固螺钉(4)进行固定的支撑板(1)，所述锚固螺钉具有能够保证对所述支撑板(1)进行位置调节和固定其深度的设备(44，45，48)，还有一个依靠莫尔斯锥形组合系统(16，21)固定在该支撑板上的定向撑杆(2)，而且还有一个利用莫尔斯锥形组合系统(24，33)组装到所述定向撑杆(2)上的金属杯(3)。
2.根据权利要求1的模块假肢关节窝，其特征在于所述支撑板(1)包括至少一个带有环(12)的髋臼内部支撑爪(11)，利用所述锚固螺钉(4)，所述环可以将所述支撑板(1)锚固在髋臼内。
3.根据权利要求1或2的模块假肢关节窝，其特征在于所述支撑板(1)包括至少一个具有环(14)的在髋臼上的外爪(13)，所述环用于接收多孔形或皮层状的固定杆，以及一个能够保证钩住髋臼下面的闭塞钩(15)。
4.根据权利要求2或3的模块假肢关节窝，其特征在于所述爪(11，13)在其所含的各个环(12，14)的高度上有一个与所述螺钉(4)配合的合适凹型，螺钉的头部为半球形支撑面，以便使所述螺钉(4)根据若干轴定向。
5.根据上述任一权利要求的模块假肢关节窝，其特征在于它有一个接骨导体涂层，该涂层为钛和羟基磷灰石的双层涂层。
6.根据上述任一权利要求的模块假肢关节窝，其特征在于所述定向撑杆为楔形，一方面在其底部包括一个被固定到支撑板(1)所含的阴锥体(6)上的阳锥体(21)；另一方面该定向撑杆在其上部包括一个阴锥体(24)，该阴锥体使定向撑杆接收金属杯(3)所含的阳锥体(33)，因而不论所述支撑板(1)的位置如何，都可以根据需要对该金属杯定向。
7.根据权利要求6的模块假肢关节窝，其特征在于所述定向撑杆(2)在其外部，在其最宽部分的中心，并且在一半以上的周边设有一个固定环圈(22)，该固定环圈的不同部位包括可以让螺钉(5)通过的环(23)，这些螺钉被拧在支撑板(1)所含的周边台肩(17)上的螺孔(18)中，所述固定圈(22)在所述的各个环(23)的高度上有一个与所述螺钉(5)配合的合适凹型，螺钉的头部为半球形支撑面，以便使所述螺钉(5)根据若干轴定向。
8.根据权利要求6的模块假肢关节窝，其特征在于所述金属杯(3)在其外赤道区，在一半以上的周边，并且在其阳锥体上面有一个可以附加固定支撑板(1)、定向撑杆(2)和金属杯(3)的固定环圈(34)，为此，该固定环圈(34)的不同部位包括一些可以让螺钉(5)通过的环(35)，这些螺钉被拧在支撑板(1)所含的周边台肩(17)上的螺孔(18)中，所述固定环圈(34)在所述的各个环(35)的高度上有一个与所述螺钉(5)配合的合适凹型，螺钉的头部为半球形支撑面，以便使所述螺钉(5)根据若干轴定向。
9.根据上述任一权利要求的模块假肢关节窝，其特征在于所述金属杯(3)具有镜像式的完全不通的内部(31)，这样可以使其里面接收的聚合插入镜头(6)自由活动，所述插入镜头(6)有一个用于接收假肢股骨元件的球形头的半球形腔(60)。
10.根据权利要求1-8之一的模块假肢关节窝，其特征在于所述金属杯(3)包括一个具有阴件的完全不通的内部，这种内部可以接收一个陶瓷插入镜头，所述插入镜头有一个阳锥形件，从而构成一个莫尔斯锥形组合系统，所述插入镜头有一个用于接收假肢股骨元件的球形头的半球形腔。
11.一种用于对上述任一权利要求的假肢关节窝一类的假肢植入件进行固定的锚固螺钉，其特征在于它包括能够保证对所述植入物支撑面的高度进行精细调节的设备(44，45，48)，通过保证对各压力的平衡调节，使植入物确保锚固在骨组织中。
12.根据权利要求11的锚固螺钉，其特征在于该锚固螺钉包括一个本体，本体有一个从尖形末端部分(40)延伸的柱形近端部分(43)，并有一个能够自动钻入的多孔形螺杆(42)，有一个钻有丝扣的管道(44)沿轴向穿过所述近端部分，所述管道用于接收一个带丝扣的柱塞(45)，柱塞本身有一个头部(46)，而且被一个攻有螺纹的穴(47)穿过，该穴用于接收一个固定的反向螺钉(48)。
13.根据权利要求12的锚固螺钉，其特征在于反向固定螺钉(48)有一个头部，头部的支撑面为半球形的弯曲形状，这种形状与用于固定的元件(22，34，11，13)配合，所述固定元件在用于接收所述反向螺钉(48)的环(23，35，12，14)的高度具有与环互补的形状，这种形状适合于将螺钉(48)相对于元件(22，34，11，13)根据所要求的轴进行定向。
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WO2003013397A2 (fr) 2003-02-20
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FR2827503B1 (fr) 2003-10-24
DE60218686T2 (de) 2007-11-08
ES2283597T3 (es) 2007-11-01
CA2454672A1 (fr) 2003-02-20
EP1408886B1 (fr) 2007-03-07
JP2004537371A (ja) 2004-12-16
US20040199258A1 (en) 2004-10-07
DK1408886T3 (da) 2007-07-09
EP1408886A2 (fr) 2004-04-21
AU2002336155B2 (en) 2006-11-30
WO2003013397A3 (fr) 2003-11-27
PT1408886E (pt) 2007-06-12
HK1067293A1 (en) 2005-04-08
FR2827503A1 (fr) 2003-01-24

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