CN105055049A - Endoprosthesis for reestablishment of knee joint cruciate ligaments under full arthroscope - Google Patents
Endoprosthesis for reestablishment of knee joint cruciate ligaments under full arthroscope Download PDFInfo
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- CN105055049A CN105055049A CN201510603001.XA CN201510603001A CN105055049A CN 105055049 A CN105055049 A CN 105055049A CN 201510603001 A CN201510603001 A CN 201510603001A CN 105055049 A CN105055049 A CN 105055049A
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Abstract
The invention discloses an endoprosthesis for reestablishment of knee joint cruciate ligaments under a full arthroscope. The endoprosthesis comprises a first bolt prosthesis and a second bolt prosthesis which are connected to a thighbone and a shinbone respectively, wherein an artificial tendon prosthesis is connected between the first bolt prosthesis and the second bolt prosthesis; each of the first bolt prosthesis and the second bolt prosthesis comprises a bolt prosthesis front section and a bolt prosthesis back section, and the bolt prosthesis front section and the bolt prosthesis back section are in detachable connection with each other; the bolt prosthesis front section is provided with a self-tapping external thread capable of tapping into the thighbone and the shinbone; the outer surface of the bolt prosthesis back section is provided with an external thread continuously butted with the self-tapping external thread of the bolt prosthesis front section, and adopts a material capable of growing together with bones; and muscle tendon fixation forcing screws are arranged between the first bolt prosthesis and the artificial tendon prosthesis and between the second bolt prosthesis and the artificial tendon prosthesis. Physical fixation and biological fixation are combined to realize the reestablishment of the knee joint cruciate ligaments without establishing a bone channel penetrating through the thighbone, a knee joint cavity and the shinbone, so that operation difficulty is obviously reduced, various complications are avoided, the tensile force of the reestablished artificial ligaments can be adjusted, the operation accuracy is improved and the operation curative effect is promoted.
Description
Technical field
The present invention relates to a kind of cruciate ligaments of knee joint prosthese, particularly relate to a kind of built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror.
Background technology
Along with increasing of vehicle accident now and extensively carrying out of sports, human knee joint cruciate ligament has become one of modal damage of motor system.[the Anteriorcruciateligamentinjuries.In:OrthopaedicKnowledge UpdateSportsMedicineIII such as GordonMD, GarrickJG. (Ed), AmericanAcademyofOrthopaedicSurgeons, Rosemont2004.p.169.] report: in the U.S., only cross ligament damage just has every year more than 200,000 person-time of generation.In China, at present without definite statistical data, but contrast labor intensity and population base, add the patient of posterior cruciate ligament injuries, its quantity is certainly on the U.S..Injury of cruciate ligament of knee joint, as can not get correct treatment, will have a strong impact on the stability in joint, cause traumatic arthritis, occur serious joint function disturbance.Due to himself structure, can not be treated after cruciate ligament by the method for suture repair, recovering the successional unique method of its organizational structure is exactly " rebuilding a ligament ".Desirable Cruciate ligament reconstruction method need reach good function and permanent life cycle, and ligament substitute character, fixing means and operating difficulty are its determiners.The Cruciate ligament reconstruction method of current application, owing to there is the defect of various aspects, does not reach desirable effect far away.
Ligament substitute is selected to be limited to four aspects: healing ability, intensity, source and safety.Graft substitute-knitting is the core concept when reconstruction of anterior cruciate ligament, reaches permanent ligament life cycle by healing.But ligament substitute lacks blood fortune, and and bone be two kinds of different tissues, healing is between the two more difficult, and this is the most obvious defect of current all ligament substitutes.Even apply autologous tendon transplantation, because tendon often lacks blood vessel network, and belong to heterotopic transplantation, reach the probability healed completely also not high.If use treated tendon allograft or artificial tendon, it heals into power and will decline further.In other respects, various ligament substitute has obvious defect, can not meet the demand of patient: such as autologous tendon graft belongs to " robbing Peter to pay Paul ", must leave sequela, and source is extremely limited; Tendon allograft thing is through process, and intensity and healing ability decline, limited source, and late period easily ruptures, and has spreading disease simultaneously, the risk of immunologic rejection occurs; Artificial tendon graft and host bone are difficult to heal, and very easily occur to loosen and wear and rupture late period, thus cause operative failure.
The fixing means aspect of ligament substitute is also faced with predicament.Cruciate ligaments of knee joint is antagonism knee joint over-travel and the primary structure ensureing normal arthrokinematics, at every moment needs the distraction force bearing 300-2200N.The starting point of ligament, the accuracy of dead-centre position and tough belt tension are most important to its function of performance.The method of fixing ligament needs when to ensureing when tension stress that substitute can not move until itself and bone reach the healing of sufficient intensity.The Cruciate ligament reconstruction fixing means (no matter being that extruding is fixing or suspension is fixing) of current application has weak point in this regard.Extruding is fixing mainly refers to that interference screw is fixed, a kind of eccentric fixing, bone road can be pressed on one side by screw when ligament substitute is fixed, it not the center point being positioned at osseous tunnel, the terminal of ligament can produce unmanageable " displacement effect ", and screw produces irreversible cutting damage to ligament substitute in fixation procedure; Although up-to-date Intrafix swell fixture can make the beam splitting of ligament substitute press to osseous tunnel wall, the arm of force often restrainted is different, and anti-stretching ability is uneven, also has unmanageable ligament to rotate and cutting effect, and only can be used for tibial side.It is that constant intensity is inadequate that another large defect is fixed in extruding, the osseous tunnel running through femur-knee joint cavity-tibia certainly existed makes Knee Joint Fluid be infiltrated between ligament and sclerotin, producing " rain brush effect ", affect constant intensity, making ligament produce displacement when resisting distraction force.Hang and fixedly comprise deadman method, cross that nail is fixed, Endbutton steel plate etc.This mode has insoluble defect in maintenance ligament tension force.The osseous tunnel running through femur-knee joint cavity-tibia and the ligament greatly extended easily produce " bungee jumping effect " when antagonism distraction force, cause displacement and the tensile failure of ligament, affect the usefulness of ligament.
Cruciate ligament reconstruction surgery process is also the key factor affecting ligament function and permanent life cycle.Be limited to ligament substitute kind and fixing means, current cruciate ligament reconstruction surgery difficulty is large, and process is loaded down with trivial details, and influence factor is numerous.Current modus operandi all needs to set up the osseous tunnel running through femur-knee joint cavity-tibia.The existence of osseous tunnel, makes Knee Joint Fluid be infiltrated between ligament and sclerotin on the one hand, produces " rain brush effect ", greatly increases the possibility of ligament displacement, reduces and heals into power; On the other hand, in operation, ligament substitute is loaded down with trivial details through the process of osseous tunnel, and the surface of bone of osseous tunnel often produces larger damage to ligament substitute; In addition, " killing and wounding corner effect " and " corner effect " between ligament and bone also makes the ligament of reconstruction easily rupture, and reduces long term survival rate.Another important intraoperative factors affecting ligament function is tension adjustment difficulty.Be limited to ligament substitute fixing means and spongy bone feature, ligament substitute need be fixed when maintaining ligament tension force in operation process, the tension force regulating ligament is just difficult to once fixing, otherwise easily cause fixing loosening, which greatly increases operating difficulty, reduce the accuracy of ligament position and tension force.
Therefore, for guaranteeing ligament-knitting success and obtaining good function, there is the strict rehabilitative exercise programme reaching 1 year after current cruciate ligament reconstruction surgery, bring great inconvenience to patient.And very long convalescent period also has all unexpected generations.The rebuilding body displacement caused because of above-mentioned various defect, tension force decline and disunion has had a strong impact on the curative effect of cruciate ligament reconstruction surgery.[the AmJSportsMed.2005Mar such as FithianDC; The long term follow-up research display of 33 (3): 335-346] announcing: only have the joint motion ability of the Cruciate ligament reconstruction postoperative patient close to 50% can return to preoperative level.
For solving the problem, domestic and international researcher all seeks new method in exploration.US2012/0078369 american documentation literature discloses a kind of method of grappling homology or artificial tendon, but its essence remains a kind of dependence and sets up the suspension running through femur-knee joint cavity-tibial bone tunnel and fix, this device comprises hollow screw and the porose plug-in type screw of afterbody, hollow screw surface is regular screw threads surfaces, can not produce with bone and heal, hollow screw screws in osseous tunnel, tendon is through the hole of plug-in type screw, again plug-in type screw is inserted in hollow screw, the feature of this device fixes the screw thread form relying on hollow screw completely, rely on the osseous tunnel set up and run through femur-knee joint cavity-tibia, screw is inserted darker, tendon is relied on to obtain long-term stability together with osteogenesis, namely ligament and knitting is reached., there is " bungee jumping effect " and " rain brush effect " simultaneously, cause ligament displacement and tensile failure, affect healing ability, affect ligament usefulness in device obvious Shortcomings in anti-tractive tension force of the fastening ligament of this plug-in type.Visible, the design of this technical scheme does not improve the defect easily producing relative displacement and healing ability deficiency between graft and bone; Its structural design does not improve the more weak problem of the ability of interference screw countertraction power yet, is difficult to ligament displacement when avoiding countertraction power; Still exist and be difficult to the defect regulating tough belt tension; Its healing process at a specified future date is also the same with current Cruciate ligament reconstruction method, does not provide the healing stabilizes at a specified future date being better than current application process.CN102614036A Chinese patent literature discloses and retains anterior cruciate ligament artificial knee joint prosthesis, which includes the ligamentaum cruciatum parts be anchored on knee-joint prosthesis, but it is in fact a kind of extruding fixed form being only applicable to knee-joint prosthesis, can not separately for cruciate ligament reconstruction surgery under total joint mirror, these parts are not better than the place of existing Cruciate ligament reconstruction method separately.
Application number be 201180051302.6 Chinese patent disclose a kind of fixture for fastening tendon or ligament, comprise hollow screw, attachment screw, the tendon suspension arrangement that tail end is porose, and regulate the aligning tool a of hollow screw penetration depth and remove the aligning tool b of fixture; This device remain in fact a kind of rely on to set up run through the fixing of femur-knee joint cavity-tibial bone tunnel, rely on aligning tool a fixture towing to be rotated in osseous tunnel and regulate tough belt tension, rely on the screw thread form of hollow screw to obtain the stability between fixture and bone completely; Insert in order to aligning tool can be made, away from the femur of articular cavity and tibia sclerotin, need to set up the osseous tunnel larger than usual ligamentaum cruciatum transplant operation, larger damage is produced to sclerotin and soft tissue, consequent " rain brush effect " is even more serious, easily causes fixture to loosen or disunion; Hollow screw distal opening, inserting attachment screw from the osseous tunnel mouth away from articular cavity through hollow screw has great defect, once attachment screw comes off in muscular soft tissues or marrow cavity of femur, will be difficult to take out, its consequence is catastrophic; If bone bits come off and enter in hollow screw in osseous tunnel, aligning tool a or attachment screw cannot be inserted, and also can cause the failure of operation.Visible, the design of this technical scheme does not improve the defect easily producing relative displacement and healing ability deficiency between graft and bone; Its structural design does not improve the more weak problem of the ability of interference screw countertraction power yet, is difficult to ligament displacement when avoiding countertraction power; Its healing process at a specified future date is also the same with current Cruciate ligament reconstruction method, does not provide the healing stabilizes at a specified future date being better than current application process; Although this technical scheme adds the design regulating tough belt tension, bring new defect, add operating difficulty and risk, increased the weight of sclerotin injury, it is little that global design is applied to clinical feasibility.
Generally speaking, current cruciate ligaments of knee joint method for reconstructing, the accuracy of ligament and stability are difficult to ensure, the function variation of ligament is comparatively large, and the overall long term survival rate of ligament is not high, add operation complicated, post-operative recovery time is long, can not reach gratifying curative effect, and once reconstruction operations failure, also can damage knee joint function further, bring further misery to patient.
Summary of the invention
In order to overcome the deficiency and defect mentioned in above background technology, providing a kind of and not needing to set up osseous tunnel, healing into the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror that power is high, reconstruction degree of accuracy is high, operation wound is little, post-operative complication is few, convalescence is short.
For solving the problems of the technologies described above, the technical scheme that the present invention proposes is:
For the built-in prothesis that cruciate ligaments of knee joint under total joint mirror is rebuild, comprise the first screw prosthese and the second screw prosthese that are connected to femur and tibia respectively, between described first screw prosthese and described second screw prosthese, be connected with artificial tendon; Described first screw prosthese and the second screw prosthese include screw prosthese leading portion and screw prosthese back segment, described screw prosthese leading portion is connected with described screw prosthese back segment is detachable, described screw prosthese leading portion is with the self-taped type external screw thread can shot in femur and tibia, described screw prosthese back segment outer surface has the external screw thread docked continuously with the self-taped type external screw thread of described screw prosthese leading portion, described screw prosthese back segment outer surface adopt can with the material of knitting; Described first screw prosthese and be also provided with tendon between the second screw prosthese and described artificial tendon and fix forcing screw, described tendon is fixed forcing screw and is provided with the outer end and detachable the inner being fixed in described screw prosthese back segment that are connected to described artificial tendon turnably, the afterbody of described screw prosthese back segment is provided with the tendon fixing forcing screw the inner for fastening described tendon and fixes forcing screw hole, and what described artificial tendon two ends were free to rotate is connected to the outer end that described tendon fixes forcing screw.Technical scheme of the present invention adopts stagewise, detachable design first innovatively, make screw prosthese leading portion and back segment by different structures, shape and draw materials to realize different functions, and form the complementation of screw prosthese leading portion and rear section structure function, fixing and the biological fixation of physics is combined, and then is expected to realize to ensure under the prerequisite without the need to setting up osseous tunnel reach more excellent for the device of repair deficiency and symphysis effect; Tendon is fixed forcing screw and is rotatably connected with artificial tendon, can be good at realizing regulating to artificial ligament tension force, and can not reverse and affect the constant intensity of screw prosthese by generation artificial tendon when regulating, and can repeatedly regulate, avoid the shortcoming of usual cruciate ligament reconstruction surgery " once fixing i.e. unadjustable tension force ", improve operation precision.
Further, the profile of described screw prosthese leading portion is the pyramidal structure with self tapping blade tip end, and the outer wall of described screw prosthese leading portion is provided with the sharp keen dark wide external screw thread of curved increase.The pyramidal structure having self tapping blade tip end makes built-in prothesis of the present invention can accurately locate the terminal needing ligament or tendon, the feature of the curved increase of sharp keen dark wide external screw thread can ensure that any skew can not occur fixed center point further, make it firmly to be fixed in spongy bone, the distraction force that enough intensity antagonism motion of knee joint produce after fixing, can be obtained.Sharp keen dark wide externally threaded making it firmly is fixed in spongy bone, can obtain the distraction force that enough intensity antagonism motion of knee joint produce after fixing.The outer wall of described screw prosthese back segment is provided with level and smooth shallow close external screw thread, and the external diameter of described screw prosthese back segment is slightly less than the maximum outside diameter of described screw prosthese leading portion.Level and smooth shallow close external screw thread is less than sharp keen dark wide externally threaded setting can make screw prosthese back segment and spongy bone realize more fully contacting and healing.
Further, the afterbody of described screw prosthese leading portion is provided with front and back section connecting axle, screwed hole is offered in the section connecting axle of described front and back, described screw prosthese back segment is hollow structure, described screw prosthese back segment front portion offers the front and back section connecting hole be socketed on the section connecting axle of described front and back, and described screw prosthese back segment wears section connecting hole before and after it by one and the attachment screw be fixed in screwed hole forms detachable connection with described screw prosthese leading portion.Detachable connected mode so not only structure is simple, easy to make, and can realize modularity processing, is also convenient to the later stage dismantle the building block of device and replace when running into fortuitous event.
Further, the rear that after described screw prosthese, intrasegmental part is close to described front and back section connecting hole offers the inner position hole for built-in rotation screwdriver, and the internal diameter in described inner position hole is slightly larger than the internal diameter of described front and back section connecting hole.This inner position hole can be used for trip bolt prosthese back segment, after screw prosthese front and rear sections links into an integrated entity, then by this inner position hole together rotary screw prosthese leading portion and screw prosthese back segment.
Further, described tendon is fixed forcing screw and is comprised the rotary connector cooperatively interacted and the drive division driving described rotary connector to rotate; The adjustment acting on and can realize described artificial tendon Tensity size that cooperatively interacts of this rotary connector and drive division.
Preferred, described rotary connector is that the tendon of a hollow form fixes forcing screw nut, its outer surface offers the tendon screw external screw thread fixing forcing screw hole for being fastened to described tendon, and described tendon is fixed forcing screw nut tail end and is provided with nut hook tooth; Described drive division is a riveted joint pressurization ratchet cover plate, the described riveted joint pressurization ratchet cover plate is hollow structure, the described riveted joint pressurization ratchet cover plate comprises riveted joint bar and is connected to ratchet coiled hair and the stopper section at described riveted joint bar two ends, described ratchet coiled hair is provided with ratchet cover plate hook tooth towards the one side of described riveted joint bar, described tendon is fixed forcing screw spiro cap and is connected on the periphery of described riveted joint bar and is stuck between described ratchet coiled hair and described stopper section, and described ratchet cover plate hook tooth matches with described nut hook tooth.
Further, described tendon fix forcing screw nut tail end have for rotate described tendon fix forcing screw nut in criss-cross cap rotation groove, the described riveted joint pressurization ratchet cover plate have for rotate the described riveted joint pressurization ratchet cover plate in criss-cross ratchet cover plate rotated trench.
Further, described artificial tendon is two hemispherical head artificial tendons, described pair of hemispherical head artificial tendon comprises hemispherical head, tendon body and tendon shrinkage part, described tendon shrinkage part is connected between described hemispherical head and tendon body, it is hollow structure that described tendon fixes forcing screw, the external diameter of described tendon shrinkage part is less than the internal diameter that described tendon fixes forcing screw, the basal diameter of described hemispherical head is greater than the internal diameter that described tendon fixes forcing screw, described tendon is fixed forcing screw and is socketed in described tendon shrinkage part periphery and is stuck between described hemispherical head and tendon body, preferred, described artificial tendon is made up of polyester fiber or elastic metallic yarn.This pair of hemispherical head artificial tendon and tendon are fixed can to produce between forcing screw and are moved radially and rotary motion, realize " tendon center is fixed ", extrusion screw in current cruciate ligament reconstruction surgery is avoided tendon to be pressed to bone road shortcoming on one side, realize the fine motion between tendon and bone simultaneously, avoid the shortcoming of " tendon is combined with bone rigidity " at present;
Further, this built-in prothesis also comprises being arranged on and prevents from the anti-tendon producing friction between the two from rubbing between described screw prosthese back segment and described artificial tendon protecting snap ring; This anti-tendon friction protection snap ring is set; avoid artificial tendon directly to contact with screw prosthese back segment, avoid friction, " kill and wound corner effect " after reducing current cruciate ligament reconstruction surgery, " corner effect "; and the situation causing operative failure brought thus, extend prosthese life span.Preferred; described anti-tendon friction protection snap ring is for being socketed in described tendon outside and elastic C shape structure; a handle hole is provided with at two ends of its C shape structure; closing up described anti-tendon friction protection snap ring by blocking described handle hole, being provided with the snap ring groove placing described anti-tendon friction protection snap ring at the tail end of described screw prosthese back segment.
Further preferably, described screw prosthese leading portion is made up of metal, absorbable material or ceramic material; Described can be metal bone trabecula material containing Osteoinductive Factor with the material of knitting.
Compared to repair at present the source existed in ligament or Tendon Defection operation method not enough, take from that body tendon causes secondary damage, application tendon allograft causes immunologic rejection and the defect such as pathophoresis, the tension force being difficult to adjust ligament or the tendon repaired, graft substitute and bone healing ability deficiency at a specified future date, technical scheme of the present invention has following significant advantage:
(1) global design is the screw profile of segmentation, can be directly implanted in sclerotin by articular cavity and form reliable constant intensity, do not need to set up the osseous tunnel running through femur-knee joint cavity-tibia that current all cruciate ligament reconstruction surgeries all produce, reduce patient trauma, thoroughly avoid the concurrent effect that " rain brush effect ", " bungee jumping effect " etc. cause cruciate ligament reconstruction surgery failure;
(2) be designed to the sharp keen dark wide externally threaded screw prosthese leading portion of taper and can directly shoot femur and tibia, darker and sharp keen dark wide external screw thread can reach enough early stage constant intensities, the outer screw prosthese back segment be made up of the metal bone trabecula material containing Osteoinductive Factor can be long by healing time, restriction is many, the tendon that success rate is on the low side and knitting are converted to that to heal into power high and can carry out the bone that maintains throughout one's life and the bone trabecular healing of metal, avoid cruciate ligament reconstruction surgery and heal into the not high shortcoming of power, the curative effect of significant increase cruciate ligament reconstruction surgery,
(3) fix forcing screw by arranging tendon, the tough belt tension of axial mediator's work under arthroscope can be realized, and can repeatedly regulate, avoid the shortcoming of usual cruciate ligament reconstruction surgery " once fixing i.e. unadjustable tension force ", improve operation precision; Tendon fixes forcing screw and two hemispherical head artificial tendon combines, the conical design of attachment screw prosthese leading portion, realize real " tendon centralized positioning, center are fixed ", avoid extrusion screw in current cruciate ligament reconstruction surgery tendon to be pressed to bone road shortcoming on one side, improve operation precision, realize the fine motion between tendon and bone simultaneously, avoid the shortcoming of " tendon is combined with bone rigidity " at present, meet biomechanics characteristic, avoid stress to concentrate, extend prosthese life span;
(4) anti-tendon friction protection snap ring prevents artificial tendon and bone attachment screw from rubbing, and " kills and wounds corner effect ", " corner effect " cause the situation of operative failure, prolongation prosthese life span after greatly reducing cruciate ligament reconstruction surgery.
Apply built-in prothesis of the present invention and supporting operation method cruciate ligament reconstruction, without the need to setting up the osseous tunnel running through femur-knee joint cavity-tibia, the direction scope that built-in prothesis of the present invention is implanted is larger, osseous tunnel process is passed through without complicated tendon, screw prosthese can be screwed into from the central point of location to the firmest or the most maneuverable bone parts, greatly reduce patient's sclerotin injury, reduce amount of bleeding, the more existing operation method of operating process is more simple, operation precision is higher, decrease wound, shorten operating time; The segment design of built-in prothesis of the present invention, " mechanics is fixed " and " biotic elictor is fixed " two kinds of fixing theories are combined, continue the constant intensity of remaining valid, get final product freely movable and motion in early days, convalescent period very long after avoiding current cruciate ligament reconstruction surgery and loaded down with trivial details method of rehabilitation; Built-in prothesis of the present invention avoids artificial tendon and bone in cruciate ligaments of knee joint reconstruction operations to be difficult to heal, the source of the ligamentaum cruciatum substitution material that increased, avoid applying the damage of autologous tendon transplantation to patient, avoid the shortcomings such as application tendon allograft immunological rejection, pathophoresis, and the segment design of built-in prothesis uniqueness of the present invention significantly can reduce the difficulty of the postoperative revision procedure of Cruciate ligament reconstruction.
Accompanying drawing explanation
In order to be illustrated more clearly in the embodiment of the present invention or technical scheme of the prior art, be briefly described to the accompanying drawing used required in embodiment or description of the prior art below, apparently, accompanying drawing in the following describes is some embodiments of the present invention, for those of ordinary skill in the art, under the prerequisite not paying creative work, other accompanying drawing can also be obtained according to these accompanying drawings.
Fig. 1 is the front view of screw prosthese leading portion in the embodiment of the present invention;
Fig. 2 is the sectional view of screw prosthese leading portion in the embodiment of the present invention;
Fig. 3 is the upward view of screw prosthese leading portion in the embodiment of the present invention;
Fig. 4 is the structural representation axonometric chart of screw prosthese leading portion in the embodiment of the present invention;
Fig. 5 is the front view of screw prosthese back segment in the embodiment of the present invention;
Fig. 6 is the sectional view of screw prosthese back segment in the embodiment of the present invention;
Fig. 7 is the upward view of screw prosthese back segment in the embodiment of the present invention;
Fig. 8 is attachment screw front view in the embodiment of the present invention;
Fig. 9 is attachment screw top view in the embodiment of the present invention;
Figure 10 is screw prosthese leading portion and screw prosthese back segment assembled front view in the embodiment of the present invention;
Figure 11 is screw prosthese leading portion and screw prosthese back segment sectional arrangement drawing in the embodiment of the present invention;
Figure 12 is two hemispherical head artificial tendon structural representation in the embodiment of the present invention;
Figure 13 is that in the embodiment of the present invention, tendon fixes forcing screw nut structure schematic isometric;
Figure 14 is riveted joint pressurization ratchet cover plate structural representation axonometric chart in the embodiment of the present invention;
Figure 15 is that in the embodiment of the present invention, tendon fixes forcing screw structural representation axonometric chart;
Figure 16 is that in the embodiment of the present invention, two hemispherical head artificial tendon and tendon fix forcing screw assembly structure schematic diagram;
Figure 17 is anti-tendon friction protection card ring structure schematic diagram in the embodiment of the present invention;
Figure 18 is built-in prothesis one end assembly structure schematic diagram in the embodiment of the present invention;
Figure 19 be in the embodiment of the present invention built-in prothesis one end assembled after structural representation;
Figure 20 is built-in prothesis assembly structure schematic diagram in the embodiment of the present invention;
Figure 21 is that in the embodiment of the present invention, built-in prothesis has assembled rear structural representation;
Figure 22 is the sectional view that in the embodiment of the present invention, built-in prothesis implants knee joint rebuilding anterior cruciate ligament;
Figure 23 is that in the embodiment of the present invention, built-in prothesis implants the sectional view that knee joint rebuilds posterior cruciate ligament.
Wherein 1, sharp keen dark wide external screw thread; 2, front and back section connecting axle; 3, screwed hole; 4, sharp keen dark wide external screw thread maximum diameter; 5, screw prosthese leading portion; 6, level and smooth shallow close external screw thread; 7, level and smooth shallow close external screw thread maximum diameter; 8, front and back section connecting hole; 9, inner position hole; 10, tendon fixes forcing screw hole; 11, snap ring groove; 12, tendon outlet; 13, attachment screw nut; 14, attachment screw screw rod; 15, attachment screw nut crisscross grooves; 16, screw prosthese back segment; 17, attachment screw; 18, hemispherical head; 19, tendon shrinkage part; 20, tendon body; 21, tendon screw external screw thread; 22, nut hook tooth; 23, cap rotation groove; 24, bar is riveted; 25, ratchet cover plate hook tooth; 26, ratchet cover plate rotated trench; 27, the riveted joint pressurization ratchet cover plate; 28, tendon fixes forcing screw nut; 29, artificial tendon; 30, tendon fixes forcing screw; 31, handle hole; 32, C shape snap ring; 33, anti-tendon friction protection snap ring; 34, distal femur; 35, proximal tibia.
Detailed description of the invention
For the ease of understanding the present invention, hereafter will do to describe more comprehensively, meticulously to the present invention in conjunction with Figure of description and preferred embodiment, but protection scope of the present invention is not limited to following specific embodiment.
It should be noted that, when a certain element is described on " be fixed on, be fixed in, be connected to or be communicated in " another element, it can be directly fixing, affixed, connect or be communicated with on another element, also can be by other intermediate connectors indirectly fixing, affixed, connection or connection on another element.
Unless otherwise defined, hereinafter used all technical term is identical with the implication that those skilled in the art understand usually.The object of technical term used herein just in order to describe specific embodiment is not be intended to limit the scope of the invention.
Unless otherwise specified, the various raw materials, reagent, instrument and equipment etc. used in the present invention are all bought by market and are obtained or prepare by existing method.
Embodiment:
As shown in Figure 18 ~ Figure 21, the invention provides a kind of built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror, comprise the first screw prosthese and the second screw prosthese that are connected to femur and tibia respectively, between the first screw prosthese and the second screw prosthese, be connected with artificial tendon 29; First screw prosthese and the second screw prosthese include comprise screw prosthese leading portion 5, screw prosthese back segment 16, attachment screw 17, tendon fix forcing screw 30 and anti-tendon friction protection snap ring 33, assembled rear structural representation as Figure 19, Figure 21 are depicted as each parts.
As shown in Figure 1 to Figure 4 and shown in Figure 10, Figure 11, Figure 18, Figure 19, firm fixing in early days for obtaining, the screw prosthese leading portion 5 applied in the present embodiment is made of metal (also can be made up of absorbable material or ceramic material), screw prosthese leading portion 5 can deeply in implantable bone metaphysis spongy bone, it is the pyramidal structure having self tapping blade tip end, and screw prosthese leading portion 5 outer wall is provided with and moves towards along spiral the sharp keen dark wide external screw thread 1 that increases gradually.The cone point having a self tapping sword accurately can locate the terminal needing tendon after ligament, along the feature that spiral moves towards to increase gradually, sharp keen dark wide external screw thread 1 ensures that any skew can not occur fixed center point, sharp keen dark wide external screw thread 1 can make screw prosthese leading portion 5 firmly be fixed in spongy bone, can obtain the distraction force that enough intensity produces to bear joint motions after fixing.Screw prosthese leading portion 5 is removably connected by attachment screw 17 with screw prosthese back segment 16, the afterbody of screw prosthese leading portion 5 is provided with front and back section connecting axle 2 for attachment screw prosthese back segment 16, has the screwed hole 3 for being fixedly connected with screw 17 in front and back section connecting axle 2.
As shown in Fig. 5 to Fig. 7 and Figure 10, Figure 11, Figure 18, Figure 19, screw prosthese back segment 16 fixes forcing screw 30 for the tendon of the screw prosthese leading portion 5 and its rear that connect its front.Screw prosthese back segment 16 in the present embodiment is hollow structure, be preferably hollow cylindrical structure, screw prosthese back segment 16 outer surface has the level and smooth shallow close external screw thread 6 docked continuously with the sharp keen dark wide external screw thread 1 of screw prosthese leading portion 5, and the external diameter of screw prosthese back segment 16 is slightly less than the maximum outside diameter of screw prosthese leading portion 5.The sharper keen dark wide external screw thread 1 of level and smooth shallow close external screw thread 6 is shallow and smooth, and level and smooth shallow close external screw thread maximum diameter 7 is slightly smaller than sharp keen dark wide external screw thread maximum diameter 4, and screw prosthese back segment 16 can be made like this to have comprehensive contact with sclerotin.Screw prosthese back segment 16 inside offers front and back section connecting hole 8 successively, inner position hole 9, screwed tendon fix forcing screw hole 10, snap ring groove 11 and tendon outlet 12.Front and back section connecting axle 2 can insert in front and back section connecting hole 8, and attachment screw 17 is fixed on front and back section connecting axle 2 through after front and back section connecting hole 8.In operation, when screw prosthese back segment 16 is fixedly connected with by attachment screw 17 with screw prosthese leading portion 5, the docking point adjusting sharp keen dark wide external screw thread 1 and level and smooth shallow close external screw thread 6 makes the two docking continuously.Inner position hole 9 internal diameter, slightly larger than the internal diameter of front and back section connecting hole 8, connects screwdriver in can being convenient to, for rotary screw prosthese back segment 16; After screw prosthese leading portion 5 is connected with screw prosthese back segment 16, can simultaneously rotary screw prosthese leading portion 5 and screw prosthese back segment 16 by rotating inner position hole 9.
As shown in Fig. 8, Fig. 9, Figure 11, Figure 18, Figure 19, the attachment screw 17 of the present embodiment is for being fixedly connected with screw prosthese leading portion 5 and screw prosthese back segment 16, it comprises attachment screw nut 13 and attachment screw screw rod 14, has attachment screw nut crisscross grooves 15 bottom attachment screw nut 13.
In the present embodiment, the snap ring groove 11 in screw prosthese back segment 16 is cylindrical, and its diameter is greater than tendon and fixes forcing screw hole 10 and tendon outlet 12, for holding anti-tendon friction protection snap ring 33.Tendon outlet 12 is cylindrical, and its diameter is greater than tendon to be fixed forcing screw hole 10 and is less than snap ring groove 11, and tendon body 20 is exported in 12 by tendon and stretches out.
The outer surface of the screw prosthese back segment 16 in the present embodiment adopts and can make it to reach biological healing with bone with the material of knitting (such as metal bone trabecula material), to obtain intensity firm for a long time.In addition, containing the short skeletal growth factor usually applied, as bone formation generation albumen (BMP) etc., other similar factors can be may also be in the outer surface metal bone trabecula material of screw prosthese back segment 16.
As shown in Figure 13, Figure 14, Figure 15, Figure 16, Figure 18, be that centrality is fixed in order to make the ligamentaum cruciatum of reconstruction, simultaneously in order to regulate its tension force after fixing ligament, reach optimum ligament function, the tendon that the present invention devises hollow type band ratchet pressurization disk fixes forcing screw 30.Tendon of the present invention fixes forcing screw 30 for hollow cylindrical, comprises the rotary connector cooperatively interacted and the drive division driving rotary connector to rotate.Rotary connector is that the tendon of a hollow form fixes forcing screw nut 28, and its outer surface is provided with tendon screw external screw thread 21, and tail end is provided with nut hook tooth 22 and is criss-cross cap rotation groove 23 (see Figure 13).Drive division is the riveted joint pressurization ratchet cover plate 27 of a hollow structure, and comprise riveted joint bar 24, be connected to ratchet coiled hair and stopper section (see the Figure 14) at riveted joint bar 24 two ends, the riveted joint pressurization ratchet cover plate 27 offers in criss-cross ratchet cover plate rotated trench 26.Tendon screw external screw thread 21 and the tendon of above-mentioned screw prosthese back segment 16 are fixed forcing screw hole 10 and are mated that (tendon fixes forcing screw hole 10 for cylindrical, the tendon screw external screw thread 21 that tendon shown in itself and Figure 15 fixes forcing screw nut 28 matches), the screw thread axial length that tendon fixes forcing screw hole 10 is greater than the length that tendon fixes forcing screw nut 28, and fixing forcing screw nut 28 to make tendon has certain distance adjustment space within it.Riveted joint bar 24 is hollow circular cylinder, tendon is fixed forcing screw nut 28 and is socketed in the periphery of riveted joint bar 24 and is stuck in (see Figure 15) between ratchet coiled hair and stopper section, ratchet coiled hair is provided with ratchet cover plate hook tooth 25 towards the one side of riveted joint bar 24, and nut hook tooth 22 and ratchet cover plate hook tooth 25 match each other.
As shown in Figure 12, Figure 16, Figure 18 ~ Figure 21, artificial tendon 29 of the present invention is two bulb artificial tendons, comprise hemispherical head 18, tendon shrinkage part 19 and tendon body 20, two tendon shrinkage parts 19 of being positioned at stage casing of being positioned at two ends to be connected between two hemispherical head 18 and the tendon body 20 in stage casing.The external diameter of tendon shrinkage part 19 is less than the internal diameter that tendon fixes forcing screw 30, the basal diameter of hemispherical head 18 is greater than the internal diameter that tendon fixes forcing screw 30, and tendon is fixed forcing screw 30 and is socketed in tendon shrinkage part 19 periphery and is stuck between hemispherical head 18 and tendon body 20.It is round and smooth that tendon fixes forcing screw 30 inner surface, can block artificial tendon hemispherical head 18, and can rotate freely on tendon shrinkage part 19.Artificial tendon 29 and tendon are fixed can to produce between forcing screw 30 and are moved radially and rotary motion.The artificial tendon 29 of the present embodiment can be polyester fiber braiding and forms, and may also be other similar biomechanics materials, as braiding elastic metallic yarn etc.Tendon fixes the conical design of forcing screw 30 attachment screw prosthese leading portion 5, can realize real " tendon centralized positioning, center are fixed ", screw in current ligament (or tendon) prosthesis is avoided tendon to be pressed to bone road defect on one side, operation precision can be improved, meet biomechanics characteristic, avoid stress to concentrate, extend the life span of ligament (or tendon) substitute.
As shown in Figure 17 ~ Figure 21; the anti-tendon friction protection snap ring 33 of the present embodiment is arranged between screw prosthese back segment 16 and artificial tendon 29; anti-tendon friction protection snap ring 33 is for being socketed in artificial tendon 29 outside and elastic C shape snap ring 32; respectively there is a handle hole 31 at two ends of its C shape structure, C shape snap ring 32 can be closed up by blocking handle hole 31.C shape snap ring 32 is inserted in snap ring groove 11 by the tendon outlet 12 of screw prosthese back segment 16, and behind loosening operation hole 31, C shape snap ring 32 can reinstatement.Anti-tendon friction protection snap ring 33 can avoid screw prosthese back segment 16 directly to contact with artificial tendon 29, reduces friction, reduces the angulation friction effect of the postoperative ligament of current ligament defect repair and bone, avoid ligament wear and rupture.
As shown in figure 20, respectively the first screw prosthese of built-in prothesis of the present invention is fixedly connected with by attachment screw 17 with screw prosthese back segment 16 with the screw prosthese leading portion 5 of the second screw prosthese, again two tendons of tendon shrinkage part 19 periphery being socketed in artificial tendon 29 two ends being fixed forcing screw 30 is rotatably connected in the screw prosthese back segment 16 of the first screw prosthese and the second screw prosthese respectively, finally two anti-tendon friction protection snap rings 33 are inserted respectively the snap ring groove 11 of the screw prosthese back segment 16 of the first screw prosthese and the second screw prosthese, built-in prothesis of the present invention after having assembled as shown in figure 21.
The present invention does not set up the osseous tunnel and accurate reconstruction cruciate ligaments of knee joint that run through femur-knee joint cavity-tibia under being mainly applicable to total joint mirror.
For knee-joint cross ligament damage, apply built-in prothesis Anterior cruciate ligament reconstruction surgical procedure of the present invention, as follows:
1, set up the front inner side of knee arthroscope, Anteroposterior aproach, remove the remaining broken ends of fractured bone of damage anterior cruciate ligament under arthroscope, respectively at ligament origin center point and ligament top dead center point location labelling, during measurement normal position, origin center point is to top dead center point distance.
2, select suitable large Screw prosthese leading portion 5, screw prosthese back segment 16 and attachment screw 17 according to femur, tibia size, select the tendon of appropriate length to fix the group ligand of forcing screw 30 and artificial tendon 29 according to ligamentaum cruciatum terminal central point distance.
3, bore in femoral lateral condyle medial surface anterior cruciate ligament top dead center point place the cortex that opens seam, to spongy bone, abundant place pierces 1cm; Application attachment screw 17 is fixedly connected with screw prosthese leading portion 5 and screw prosthese back segment 16, guarantees that between the section of front and back, screw thread is continuous; Screw prosthese is slowly screwed into until the concordant surface of bone of tail end along boring direction.
4, open cartilage in tibial plateau anterior cruciate ligament origin center point place brill, to spongy bone, abundant place pierces 1cm; Application attachment screw 17 is fixedly connected with screw prosthese leading portion 5 and screw prosthese back segment 16, and guarantees that the screw thread between the section of front and back is continuous; Then make screw prosthese leading portion 5 tip aim at ligament terminal central point, be slowly screwed into trip bolt along boring direction, until the concordant surface of bone of end of screw prosthese back segment 16.If old people with osteoporosis, first can insert bone cement around screw prosthese back segment 16, and then implant trip bolt, thus obtain more firm fixing.
5, group ligand tendon being fixed forcing screw 30 and two hemispherical head artificial tendon sends into articular cavity, under arthroscope direct-view, one end tendon being fixed forcing screw 30 is screwed in femoral lateral condyle place screw prosthese, other end tendon is fixed forcing screw 30 to be screwed in tibial plateau place screw prosthese, until artificial tendon 29 is tightened and produced certain tension force.Drawer Experimental comparison before the two knee joint of external work, the situation that experimentally contrasts determines to increase or lower ligament tension force, until completely the same with strong side.
In clinical operation, the stop of ligament and torsion are the difficult points of impact operation.When ligament fixture centrality fixes ligament, due to the stop of ligament, rotate each half-twist at most of flesh fixture with screwdriver, just need to unclamp screwdriver, reinsert screwdriver groove again to rotate, so repeatedly just may realize the rotation of fixture; When being in this narrow space situation of articular cavity, this operation can very complicated difficult to realize.This difficulty causes two results: centrality fixes ligament can only adopt the mode hanging and fix; Tough belt tension cannot be regulated after fixing ligament.Built-in prothesis of the present invention adopts hook tooth and this mode of the ratchet cover plate just can well address this problem.During use, apply radial pressure with the ratchet cover plate rotated trench 26 of hollow " one " word screwdriver to the riveted joint pressurization ratchet cover plate 27 and turn clockwise 90 °, ratchet cover plate hook tooth 25 drives nut hook tooth 22, make tendon fix forcing screw nut 28 generation to turn clockwise, tendon being fixed forcing screw 30 screws in screw prosthese back segment 16, loosen the radial pressure that screwdriver applies ratchet cover plate rotated trench 26, be rotated counterclockwise the riveted joint pressurization ratchet cover plate 27 half-twist, between ratchet cover plate hook tooth 25 and nut hook tooth 22, gearing effects disappears, tendon is fixed forcing screw 30 and can't be produced and be rotated counterclockwise, hollow " one " word screwdriver is again used to apply radial pressure to ratchet cover plate rotated trench 26 and turn clockwise 90 °, can continue tendon to be fixed forcing screw 30 to be screwed in screw prosthese back segment 16.And in above process without the need to hollow " one " word screwdriver being repeated insert in ratchet cover plate rotated trench 26, only need apply pressure when turning clockwise, the loose pressure when being rotated counterclockwise, even if when being in this narrow space situation of articular cavity, also operate very well.Repeat above-mentioned steps, each anglec of rotation is about 90 °, the stop of artificial tendon 29 pairs of screwdrivers (its principle changes continuous print 360 ° of circular motion into reciprocal 90 ° of motions) can be avoided, tendon can be fixed forcing screw 30 screws in screw prosthese back segment 16 simultaneously, fixes forcing screw 30 thus the tension force of increase artificial tendon 29 by tightening tendon.When needing the tension force adjusting loose artificial tendon 29, hollow " one " word screwdriver can be used simultaneously to insert cap rotation groove 23 that the riveted joint pressurization ratchet cover plate rotated trench 26 of the ratchet cover plate 27 and tendon fix forcing screw nut 28, the inverse time rotary riveting pressurization ratchet cover plate 27 and tendon fix forcing screw nut 28 simultaneously, and tendon is fixed forcing screw nut 28 and rotated to back-out direction.When two ends are fixing, continue to tighten tendon and fix the tension force that forcing screw 30 can increase artificial tendon 29, loosen tendon and fix the tension force that forcing screw 30 can reduce artificial tendon 29, avoid the shortcoming of usual cruciate ligament reconstruction surgery " once fixing i.e. unadjustable tension force ".When Clinical practice, the riveted joint pressurization ratchet cover plate 27 effectively can also stop that tendon fixes the effect of forcing screw 30 reverse rotation, artificial tendon 29 and tendon are fixed forcing screw nut 28 and are not directly contacted, the tractive tension force of artificial tendon 29 directly acts on the stopper section of the riveted joint pressurization ratchet cover plate 27, and the riveted joint pressurization ratchet cover plate 27 is fixed forcing screw nut 28 relative to tendon and can be rotated freely, the tractive tension force that avoiding problems artificial tendon 29 is converted to the power making tendon fix the generation counter-rotating of forcing screw 30, avoid the tensile failure of artificial tendon 29.
6, suitable size anti-tendon friction protection snap ring 33 is selected according to screw prosthese size; knee joint is implemented rear drawer experiment and is loosened ligament; C shape snap ring 32 is closed up by blocking handle hole 31; insert in snap ring groove 11 by tendon outlet; C shape snap ring 32 can reinstatement behind loosening operation hole 31, is stuck in two between hemispherical head artificial tendon and screw prosthese back segment 16.Rotate anti-tendon friction protection snap ring 33, loosen knee joint, guarantee two contactless between hemispherical head artificial tendon and screw prosthese back segment 16.
7, the anterior cruciate ligament of knee joint after rebuilding as shown in figure 22.
The above-mentioned technical solutions of this embodiment achieves effective reconstruction of ligamentaum cruciatum under running through the osseous tunnel condition of femur-knee joint cavity-tibia without the need to foundation, avoids multiple complications, decreases operation wound, improve curative effect.Screw prosthese back segment skin in the present invention is manufactured by metal bone trabecula material, it heals into power close to 100% in distal femur 34 and proximal tibia 35 spongy bone, changing the situation of tendon and knitting difficulty in cruciate ligament reconstruction surgery, is the key point that acquisition ligament is survived for a long time.In the present embodiment, tendon is fixed forcing screw and ligament repair can be allowed to have rebuild to regulate ligament tension force afterwards, by the test comparison of external bilateral knee articular ligament function, the tough belt tension of fine adjustment, this is that existing Cruciate ligament reconstruction method or device can not complete, and is also the important improvement ensureing the excellent function of ligament.
In addition, we are for posterior cruciate ligament of knee joint damage, apply built-in prothesis reconstruction of knee posterior cruciate ligament surgical procedure of the present invention, as follows:
1, the front inner side of knee arthroscope, front outside, rear inner side, posterolateral approach is set up, the remaining broken ends of fractured bone of damage posterior cruciate ligament is removed under arthroscope, respectively at ligament origin center point and ligament top dead center point location labelling, during measurement normal position, origin center point is to top dead center point distance.
2, select suitable large Screw prosthese leading portion 5, screw prosthese back segment 16 and attachment screw 17 according to femur, tibia size, select the tendon of appropriate length to fix the group ligand of forcing screw 30 and artificial tendon 29 according to ligamentaum cruciatum terminal central point distance.
3, in femur, the cortex that opens seam is bored at condyle lateral surface posterior cruciate ligament origin center point place, and to spongy bone, abundant place pierces 1cm; Application attachment screw 17 is fixedly connected with screw prosthese leading portion 5 and screw prosthese back segment 16, guarantees that between the section of front and back, screw thread is continuous; Screw prosthese is slowly screwed into until the concordant surface of bone of tail end along boring direction.
4, open cortical bone in tibial plateau posterior cruciate ligament top dead center point place brill, to spongy bone, abundant place pierces 1cm; Application attachment screw 17 is fixedly connected with screw prosthese leading portion 5 and screw prosthese back segment 16, guarantees that between the section of front and back, screw thread is continuous; Screw prosthese is slowly screwed into until the concordant surface of bone of tail end along boring direction.
5, group ligand tendon being fixed forcing screw 30 and two hemispherical head artificial tendon sends into articular cavity, under arthroscope direct-view one end tendon being fixed forcing screw 30 to be screwed in femur in condyle place screw prosthese, other end tendon is fixed forcing screw 30 to be screwed in tibial plateau place screw prosthese, until artificial tendon is tightened and produced certain tension force.Drawer Experimental comparison after the two knee joint of external work, the situation that experimentally contrasts determines to increase or lower ligament tension force (operation of adjustment of tonicity is see the operation of above-mentioned knee-joint cross ligament damage), until completely the same with strong side.
6, suitable size anti-tendon friction protection snap ring 33 is selected according to screw prosthese size; knee joint is implemented front drawer experiment and is loosened ligament; C shape ring is closed up by blocking handle hole 31; insert in snap ring groove 11 by tendon outlet; behind loosening operation hole, C shape ring can reinstatement, is stuck in two between hemispherical head artificial tendon and screw prosthese back segment 16.Rotate anti-tendon friction protection snap ring 33, loosen knee joint, guarantee two contactless between hemispherical head artificial tendon and screw prosthese back segment 16.
7, the posterior cruciate ligament of knee joint after rebuilding as shown in figure 23.
Patient is after application the present invention rebuilds ligamentaum cruciatum, screw prosthese leading portion 5 is fixed among spongy bone deeply, enough early stage stability (generally having about 1 year) can be obtained, screw prosthese back segment 16 is connected with screw prosthese leading portion 5 by attachment screw 17, can not produce any displacement.After 3 ~ 6 months, the metal bone trabecula material of screw prosthese back segment 16 surface containing porous, and with promoting skeletal growth factor, make it well can heal with spongy bone, healing probability close to 100%, thus reaches good stablizing effect.Application the present invention rebuilds ligamentaum cruciatum, and the position that the terminal of ligament and patient's ligament biology dissect attachment point is basically identical, and the tension force of ligament is also adjusted to consistent with strong side.Therefore, function and the Normal Knee ligament function of ligament are the most approximate, and can recover somesthetic sensibility to greatest extent.
Therefore, apply built-in prothesis of the present invention, without the need to setting up the osseous tunnel running through femur-knee joint cavity-tibia, the direction scope of screw Using prosthesis is larger, pass through osseous tunnel process without complicated tendon, the more current operation method of operating process is more simple, and operation precision is higher, decrease wound, shorten operating time; The segment design of screw prosthese, " mechanics is fixed " and " biotic elictor is fixed " two kinds of fixing theories are combined, continue the constant intensity of remaining valid, get final product freely movable and motion in early days, the convalescent period avoiding current ligamentaum cruciatum reconstruction Post operation very long and loaded down with trivial details method of rehabilitation, and significantly can reduce the difficulty of the postoperative revision procedure of Cruciate ligament reconstruction.After existing cruciate ligament reconstruction surgery, patient in early days (in 3 months) needs to wear brace and carries out rehabilitation, the restorative reconditioning of daily routines could be started in 3 months to 6 months, just sports ground can be got back to after 1 year, great inconvenience is brought to patient, also need to spend suitable rehabilitation expense, and use built-in prothesis of the present invention to implement the patient of cruciate ligament reconstruction surgery, the constant intensity of the ligamentaum cruciatum rebuild early stage and late period is after surgery very high, reconditioning mode is also fairly simple, expection rehabilitation duration is no more than 6 months, rehabilitation duration can be greatly reduced, reduce rehabilitation expense.Present invention also avoids the defect that artificial tendon and bone in cruciate ligament reconstruction surgery are difficult to heal, extend the source of ligamentaum cruciatum substitution material, avoid applying the damage of autologous tendon transplantation to patient, avoid the shortcomings such as application tendon allograft immunological rejection, pathophoresis.
Technical scheme of the present invention is disclosed as above by preferred embodiment.The change that those skilled in the art do when should recognize the scope and spirit of the present invention disclosed in the claim do not departed from appended by the present invention and retouching, within the protection domain all belonging to claim of the present invention.
Claims (10)
1. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror, it is characterized in that: comprise the first screw prosthese and the second screw prosthese that are connected to femur and tibia respectively, between described first screw prosthese and described second screw prosthese, be connected with artificial tendon (29), described first screw prosthese and the second screw prosthese include screw prosthese leading portion (5) and screw prosthese back segment (16), described screw prosthese leading portion (5) is connected with described screw prosthese back segment (16) is detachable, described screw prosthese leading portion (5) is with the self-taped type external screw thread can shot in femur or tibia, described screw prosthese back segment (16) outer surface has the external screw thread docked continuously with the self-taped type external screw thread of described screw prosthese leading portion (5), described screw prosthese back segment (16) outer surface adopt can with the material of knitting, described first screw prosthese and be also provided with tendon between the second screw prosthese and described artificial tendon (29) and fix forcing screw (30), described tendon is fixed forcing screw (30) and is provided with the outer end and detachable the inner being fixed in described screw prosthese back segment (16) that are connected to described artificial tendon (29) turnably, the afterbody of described screw prosthese back segment (16) is provided with the tendon fixing forcing screw (30) inner for fastening described tendon and fixes forcing screw hole (10), what described artificial tendon (29) two ends were free to rotate is connected to the outer end that described tendon fixes forcing screw (30).
2. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 1, it is characterized in that: the profile of described screw prosthese leading portion (5) is the pyramidal structure with self tapping blade tip end, the outer wall of described screw prosthese leading portion (5) is provided with the sharp keen dark wide external screw thread (1) of curved increase; The outer wall of described screw prosthese back segment (16) is provided with level and smooth shallow close external screw thread (6), and the external diameter of described screw prosthese back segment (16) is slightly less than the maximum outside diameter of described screw prosthese leading portion (5).
3. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 1, it is characterized in that: the afterbody of described screw prosthese leading portion (5) is provided with front and back section connecting axle (2), screwed hole (3) is offered in described front and back section connecting axle (2), described screw prosthese back segment (16) is hollow structure, described screw prosthese back segment (16) front portion offers front and back section connecting hole (8) be socketed on described front and back section connecting axle (2), described screw prosthese back segment (16) wears section connecting hole (8) before and after it by one and the attachment screw (17) be fixed in screwed hole (3) forms detachable connection with described screw prosthese leading portion (5).
4. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 3, it is characterized in that: the rear of described front and back section connecting hole (8) of described screw prosthese back segment (16) inside next-door neighbour offers the inner position hole (9) for built-in rotation screwdriver, the internal diameter of described inner position hole (9) is slightly larger than the internal diameter of described front and back section connecting hole (8).
5. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 1, is characterized in that: described tendon is fixed forcing screw (30) and comprised the rotary connector cooperatively interacted and the drive division driving described rotary connector to rotate.
6. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 5, it is characterized in that: described rotary connector is that the tendon of a hollow form fixes forcing screw nut (28), its outer surface offers the tendon screw external screw thread (21) fixing forcing screw hole (10) for being fastened to described tendon, and described tendon is fixed forcing screw nut (28) tail end and is provided with nut hook tooth (22), described drive division is the riveted joint pressurization ratchet cover plate (27), the described riveted joint pressurization ratchet cover plate (27) is hollow structure, the described riveted joint pressurization ratchet cover plate (27) comprises riveted joint bar (24) and is connected to ratchet coiled hair and the stopper section at described riveted joint bar (24) two ends, described ratchet coiled hair is provided with ratchet cover plate hook tooth (25) towards the one side of described riveted joint bar (24), described tendon is fixed forcing screw nut (28) and is socketed in the periphery of described riveted joint bar (24) and is stuck between described ratchet coiled hair and described stopper section, described ratchet cover plate hook tooth (25) is matched with described nut hook tooth (22).
7. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 6, it is characterized in that: described tendon fix forcing screw nut (28) tail end have for rotate described tendon fix forcing screw nut (28) in criss-cross cap rotation groove (23), the described riveted joint pressurization ratchet cover plate (27) have for rotate the described riveted joint pressurization ratchet cover plate (27) in criss-cross ratchet cover plate rotated trench (26).
8. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 1, it is characterized in that: described artificial tendon (29) is two hemispherical head artificial tendon, described pair of hemispherical head artificial tendon comprises hemispherical head (18), tendon body (20) and tendon shrinkage part (19), described tendon shrinkage part (19) is connected between described hemispherical head (18) and tendon body (20), it is hollow structure that described tendon fixes forcing screw (30), the external diameter of described tendon shrinkage part (19) is less than the internal diameter that described tendon fixes forcing screw (30), the basal diameter of described hemispherical head (18) is greater than the internal diameter that described tendon fixes forcing screw (30), described tendon is fixed forcing screw (30) and is socketed in described tendon shrinkage part (19) periphery and is stuck between described hemispherical head (18) and tendon body (20).
9. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to any one of claim 1 to 8, is characterized in that: this built-in prothesis also comprises being arranged on and prevents from the anti-tendon producing friction between the two from rubbing between described screw prosthese back segment (16) and described artificial tendon (29) protecting snap ring (33);
Described anti-tendon friction protection snap ring (33) is for being socketed in described tendon outside and elastic C shape structure; a handle hole (31) is provided with at two ends of its C shape structure; closing up described anti-tendon friction protection snap ring (33) by blocking described handle hole (31), being provided with the snap ring groove (11) placing described anti-tendon friction protection snap ring (33) at the tail end of described screw prosthese back segment (16).
10. the built-in prothesis rebuild for cruciate ligaments of knee joint under total joint mirror according to claim 1, is characterized in that: described screw prosthese leading portion (5) is made up of metal, absorbable material or ceramic material; Described can be metal bone trabecula material containing Osteoinductive Factor with the material of knitting.
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| CN201510603001.XA CN105055049B (en) | 2015-09-21 | 2015-09-21 | Endoprosthesis for reestablishment of knee joint cruciate ligaments under full arthroscope |
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| CN201510603001.XA CN105055049B (en) | 2015-09-21 | 2015-09-21 | Endoprosthesis for reestablishment of knee joint cruciate ligaments under full arthroscope |
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| CN106361466A (en) * | 2016-11-10 | 2017-02-01 | 杨广华 | Knee-joint posterior cruciate ligament anatomical-reconstruction system used in department of orthopaedics |
| CN106510908A (en) * | 2016-12-01 | 2017-03-22 | 周大勇 | Inner implantation device used for reconstructing knee joint cruciate ligament |
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