CN1236738C - 膝假体 - Google Patents

膝假体 Download PDF

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CN1236738C
CN1236738C CNB021078610A CN02107861A CN1236738C CN 1236738 C CN1236738 C CN 1236738C CN B021078610 A CNB021078610 A CN B021078610A CN 02107861 A CN02107861 A CN 02107861A CN 1236738 C CN1236738 C CN 1236738C
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knee prostheses
angle
contact surface
condyle
prostheses
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CN1376450A (zh
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V·勒克莱尔
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Zimmer GmbH
Zimmer Inc
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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
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    • A61F2/3859—Femoral components
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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Abstract

本发明所示的膝假体的股骨部分具有一个中心部分(2)和一个髁部分(3)，它们具有相应于切除的股骨残肢(1)的接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)，其中中心部分(2)具有用于髌骨(19)的导向面和相互成锐角α≤90°的外接触表面(4a、5a)，同时，髁部分(3)具有用于关节运动的跑合面(27、28)和相互成锐角β≤90°的外接触表面(6b、7b)。中心部分(2)和髁部分(3)可以被相互独立地在相互枢转的推动方向上推到股骨残肢上，以允许较大的弯曲，而角β的中心线相对于角α的中心线枢转过一个角度15°≤γ≤60°。

Description

膝假体
技术领域
本发明涉及一种具有一个股骨部分的膝假体，所述股骨部分具有用于髌骨的导向面和至少一个髁，所述髁具有呈α≤90°锐角的外接触表面并且其接触表面可以沿一条在角α枢转范围内的直线被推到股骨残肢的切除表面上。
背景技术
过去，推动髁并将髁固定到一个预处理好的向上开口的“U”形股骨中，这在膝假体中是常见的。为了这一目的，股骨残肢在自然髁的区域中形成人造髁部分的接触表面的形状，以便随后对其进行固定。实际的固定可以通过将接触表面上的突起销头楔入外部对向接触表面和/或通过用骨粘合剂对接触表面固定来进行。髁与一个半月形部分或一个平台接触，并且可以在膝关节的铰接过程中在它们的支撑表面上分别相对于平台或胫骨枢转过一个弯曲角δ。
EP-A-0519873中所示的人造膝关节，还可以在铰接过程中根据韧带的状态对髁或多或少地进行有效地侧导向。
假体的上半部分具有用于先前安排好的髌骨的导向面，并且所述相对于平台偏转90°的髌骨在弯曲过程中在假体上半部分上在其自己的导向面上滑动。假体的上半部分接触表面形成一个向上的“U”形开口，髌骨与前肢接触且平台在延伸部分与“U”的底部接触，同时，在弯曲过程中底部在髌骨下面旋转并且后肢相对于平台旋转。在弯曲过程中，由从前、后而来的髌骨的压力均产生于股骨残肢上，并且由相对的切除表面所吸收，所述相对的切除表面大体相互垂直。在假体的最上部，相关的外接触表面相互具有一个小的角度，从而通过推压时的楔入作用紧密地装配到假体残肢上。这种假体可获得的弯曲角度对于许多亚洲国家的人们是不够的，因为他们自然地在生活中采用较大的弯曲角度并且使膝假体弯曲到其不适于做到的弯曲角度。
发明内容
本发明的目的是提供一种设计形式，其允许用一个开口接头实现大弯曲角度。
为了实现上述目的，提供一种具有股骨部分的膝假体，所述股骨部分具有用于一个髌骨的导向面和至少一个髁，其具有成一个锐角α≤90°的外接触表面并且它们的接触表面可以在股骨的残肢处沿一条在角α的范围内枢转的直线被推到切除区域上，其中，该股骨部分具有一个带有用于髌骨的导向面的中心部分和一个可被单独推起的髁部分，其具有成锐角β≤90°的外接触表面并且其可以在股骨残肢处沿一条在角β的范围内枢转的直线被推到该切除区域上，而在该髁部分处的角β的中心线相对于在该中心部分处的角α的中心线被枢转过一个角度15°≤γ≤60°，以便允许较大的弯曲。
本发明的优点在于以下事实，即由假体上部传给假体残肢的力即使在弯曲大的情况下也是压缩力。在接触表面和与推动方向相对的切除表面之间没有剪应力产生。由于假体的上部被分成一个中心部分和一个髁部分，其分开的关节延展开以便用于髌骨的导向面被设置于中心部分上，并且由于支撑面相对平台设置在髁部分上，所以这些表面可以相互独立地制造并相互独立地沿相互独立枢转的推动方向被推压到股骨残肢上。尽管推动方向不同，中心部分的接触表面和髁部分可以共同与一个切除表面接触。所述推动方向被转过例如一个在15°至60°之间的角度γ，以允许一个大的弯曲角度δ。实现大于120°的弯曲角度δ例如160°是可能的。所述髁可以被一个轭连接起来或单独地形成。当推动时，所述髁通过股骨残肢被切除表面相对于中心部分对准。另外，中心部分和髁部分可以在一个径向平面中被相互可动地引导，以便在股骨残肢处获得与自然的膝关节类似的髌骨和平台的施力点。然而，在推起状态下通过一个连接件连接中心部分和髁的可能性仍然存在。
独立的接触面可以具有用于引入量最少的骨粘接剂的凹坑，以便用骨粘接剂进行固定。独立的接触区域且特别是外接触区域可以具有一个用于主锚固的锯齿形锚固结构。同样地，在推动方向上延伸且用于设置在推动方向中的孔的独立的销头可以改进主锚定。不被骨粘接剂浸湿的接触表面可以用一层促进骨生长的层覆盖。
被骨粘接剂浸湿的接触表面可以用粘接促进剂覆盖。这样的层例如可以由烃氧基钛和烷氧基硅烷制成。
在弯曲过程中，髁的啮合曲率半径可以连续或者分阶段地减小，以便在弯曲增加时允许髁横向偏转。
此外，所述角γ最好在40°-50°之间。而且，所述角α或角β优选小于10°并且最好是小于5°。髁部分可以具有两个髁，分别相对于该中心部分设置在外部并通过一个轭连接起来。该中心部分和该髁部分在推起状态下被一个连接件相互连接起来，此时，所述连接件包括一个横向插入穿过分界表面的销或一个横向贯穿的螺纹连接件。而且各所述接触表面最好由一个促进骨生长或增强骨粘接剂的粘附力的覆层所覆盖。另外，在接触区内的髁的曲率半径在从伸展至全弯的过渡期内至少缩小一次。销头最好沿推动方向被安装到接触表面上，以利于对中和主锚固。
附图说明
下面以实施例的形式说明本发明。其中
图1是带有预先加工好的切除表面的股骨残肢的示意图；
图2是表示中心部分可以沿一条中心线被推动的示意图；
图3是髁部分可以沿一条枢转过一个角度γ的中心线被推动的示意图；
图4是中心部分的另一个例子的示意图；
图5是与图4相匹配的具有轭的髁部分的示意图；
图6是图4的侧视图；
图7是图5的侧视图；
图8是推起之前的图4和5的仰视图；
图9是推起之后的图8的前部和髁部分的示意图；
图10是推起之前的具有两个相互分开的髁的中心部分的示意图；
图11是从一个不同的角度观察图10的部分在推起之后的情况的示意图；
图12是用于主锚固的带有锯齿形形状的外接触表面的局部放大示意图。
具体实施方式
如图所示的膝假体的股骨部分具有一个中心部分2和一个髁部分3，它们具有与切除的股骨残肢1相对应的接触表面4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b，其中，中心部分2具有用于髌骨19的导向面20和相互成一个锐角α≤90°的外接触面4a、5a，而髁部分3具有用于关节运动的跑合面27、28和相互成一锐角β≤90°的外接触表面6b、7b。中心部分2和髁部分3可以沿相互枢转的推动方向被相互分别地推到股骨残肢上，以便允许较大的弯曲，其中角β的中心线相对于角α的中心线转动的角度为15°≤γ≤60°。
下面，相同的参考标号用于表示相同的功能部件。
在图1、2和3所示的例子中，切除区域4、6、11、12、12、13、7设置在髁的区域中，而切除区域4、8、9、10、5在髁之间的区域中。切除区域4、5和中心部分2的与它们接触的外接触表面4a、5a成一个锐角，从而几乎是平行的。中心部分的接触表面8a、9a、10a被支撑在髁之间，并且其另外几个接触表面6a、11a、12a被支撑在自然髁的前部区域中的切除区上，这些切除区还被髁部分3的接触表面6b、11b、12b所占据，以便实现在髁之间的槽中的对中且在完全弯曲时对用于髌骨19的导向面20进行支撑。
中心部分可以从下面沿角α的中心线15推起，而推动方向和角β的中心线16转过一个45°角γ，从而即使在一个弯曲角度δ较大时如在δ＞120°的情况下，也能产生一个外接触表面7b，在这样的δ角度下，接触力将区域7b压入残肢中或至多垂直于区域7b地施压。如图3所示，髁部分3的跑合面27和半月形部分18的跑合面18具有相同的曲率半径R1。
图4、5、6、7、8、9表示另一个例子。由于延伸的弯曲角的缘故，用于髌骨19的导向面20和跑合面27、28还必须在弯曲方向上延伸。中心部分2具有接触表面4a、6a、8a、11a、5a和侧对中表面31。髁部分3具有一个连接实际的髁的轭14。中心部分2和髁部分3之间的分离接头25被设置成(图8、9)使得用于髌骨19的导向面20和髁的跑合面27、28相互不会干扰。设置有一个用于十字韧带的凹槽24。接触表面4a、6a、8a、11a的一部分具有凹坑17，在推动过程中该凹坑17中填充有骨粘接剂，以便允许在特定区域中具有最小层厚的骨粘接剂。凹坑17和接触表面可以用粘合剂和骨粘接剂薄层预粘接起来。
根据图6中的锐角α，中心部分2的推动必须大致在中心线15的方向上进行，而髁部分则具有较小的锐角β，推动方向与角β的中心线之间有可能存在较大的偏离。必须在角度β之内的推动方向是由销头23的方向确定的。在图5、7中，一条母线用于表示髁的跑合面27、28的轮廓。当弯曲增加时，跑合面27、28的曲率半径R1变成一个较小的曲率半径R2。
中心部分2和髁部分3具有孔22，以便它们在被推到股骨残肢上之后可以被连接到一个销32式的连接件上。由于其被接触表面以大于180°包角所围绕，所以股骨残肢同时被该连接所捕获。
接触表面4a在图12中的部分表示其可以是非常有意义的，结果，形成了相互成非常小的锐角的外接触表面如图6中的表面4a、5a，在该表面上设有锯齿，所述锯齿可提供良好的主锚固并且固定中心部分2，直到髁部分3已经被推起为止。
图10、11示出了一种设计，其中两个分立的具有跑合面27、28的髁部分3可以被推起并且可以被一个连接件如一个销或螺栓通过孔22连接到中心部分2上。如果膝部的十字韧带允许，则这两个髁部分3还可以从侧部引入，这是因为它们没有被牢固地连接到一个轭上，以便根据销头23的长度找到销头在推动方向上的锚固位置。一旦髁部分3被连接到中心部分2上，股骨残肢也就被以一个大于180°的包角包围起来并且可以没有风险地获得一个大于120°的弯曲角度。

Claims (54)

1、一种具有股骨部分的膝假体，所述股骨部分具有用于一个髌骨(19)的导向面(20)和至少一个髁(18)，其具有成一个锐角α≤90°的外接触表面(4a、5a)并且它们的接触表面可以在股骨(1)的残肢处沿一条在角α的范围内枢转的直线被推到切除区域(4、5、6、8、9、10、11、12)上，其特征在于，该股骨部分具有一个带有用于髌骨(19)的导向面(20)的中心部分(2)和一个可被单独推起的髁部分(3)，其具有成锐角β≤90°的外接触表面(6b、7b)并且其可以在股骨残肢处沿一条在角β的范围内枢转的直线被推到该切除区域(6、7、11、12、13)上，而在该髁部分(3)处的角β的中心线(16)相对于在该中心部分(2)处的角α的中心线(15)被枢转过一个角度15°≤γ≤60°，以便允许较大的弯曲。
2、如权利要求1所述的膝假体，其特征在于，该髁部分(3)具有一个大于120°的弯曲角δ。
3、如权利要求1所述的膝假体，其特征在于，该髁部分(3)具有两个髁，分别相对于该中心部分(2)设置在外部并通过一个轭(14)连接起来。
4、如权利要求2所述的膝假体，其特征在于，该髁部分(3)具有两个髁，分别相对于该中心部分(2)设置在外部并通过一个轭(14)连接起来。
5、如权利要求1-4之一所述的膝假体，其特征在于，该中心部分(2)和该髁部分(3)可在推起状态下被一个连接件(32)相互连接起来。
6、如权利要求5所述的膝假体，其特征在于，所述连接件(32)包括一个横向插入穿过分界表面的销或一个横向贯穿的螺纹连接件。
7、如权利要求1-4之一所述的膝假体，其特征在于，所述角γ在40°-50°之间。
8、如权利要求5所述的膝假体，其特征在于，所述角γ在40°-50°之间。
9、如权利要求6所述的膝假体，其特征在于，所述角γ在40°-50°之间。
10、如权利要求1-4之一所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有凹坑(17)，以便引入最小量的骨粘接剂，用于以骨粘接剂进行固定。
11、如权利要求5所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有凹坑(17)，以便引入最小量的骨粘接剂，用于以骨粘接剂进行固定。
12、如权利要求7所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有凹坑(17)，以便引入最小量的骨粘接剂，用于以骨粘接剂进行固定。
13、如权利要求6、8或者9所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有凹坑(17)，以便引入最小量的骨粘接剂，用于以骨粘接剂进行固定。
14、如权利要求1-4之一所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有一个用于主锚固的锯齿形锚固结构(30)。
15、如权利要求5所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有一个用于主锚固的锯齿形锚固结构(30)。
16、如权利要求7所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有一个用于主锚固的锯齿形锚固结构(30)。
17、如权利要求6、8或者9所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)具有一个用于主锚固的锯齿形锚固结构(30)。
18、如权利要求1-4之一所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)由一个促进骨生长或增强骨粘接剂的粘附力的覆层所覆盖。
19、如权利要求5所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)由一个促进骨生长或增强骨粘接剂的粘附力的覆层所覆盖。
20、如权利要求7所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)由一个促进骨生长或增强骨粘接剂的粘附力的覆层所覆盖。
21、如权利要求6、8或者9所述的膝假体，其特征在于，各所述接触表面(4a、5a、6a、6b、7b、8a、9a、10a、11a、11b、12a、12b、13b)由一个促进骨生长或增强骨粘接剂的粘附力的覆层所覆盖。
22、如权利要求18所述的膝假体，其特征在于，所述覆层包含羟基磷灰石或者由烃氧基钛和烷氧基硅烷制成。
23、如权利要求19或者20所述的膝假体，其特征在于，所述覆层包含羟基磷灰石或者由烃氧基钛和烷氧基硅烷制成。
24、如权利要求21所述的膝假体，其特征在于，所述覆层包含羟基磷灰石或者由烃氧基钛和烷氧基硅烷制成。
25、如权利要求1-4之一所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
26、如权利要求5所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
27、如权利要求7所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
28、如权利要求6、8或者9所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
29、如权利要求10所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
30、如权利要求14所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
31、如权利要求18所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
32、如权利要求11、12、15、16、19、20、22或者24所述的膝假体，其特征在于，在接触区内的髁的曲率半径R1在从伸展至全弯的过渡期内至少缩小一次。
33、如权利要求1-4之一所述的膝假体，其特征在于，所述角α或角β小于10°。
34、如权利要求5所述的膝假体，其特征在于，所述角α或角β小于10°。
35、如权利要求7所述的膝假体，其特征在于，所述角α或角β小于10°。
36、如权利要求6、8或者9所述的膝假体，其特征在于，所述角α或角β小于10°。
37、如权利要求10所述的膝假体，其特征在于，所述角α或角β小于10°。
38、如权利要求14所述的膝假体，其特征在于，所述角α或角β小于10°。
39、如权利要求18所述的膝假体，其特征在于，所述角α或角β小于10°。
40、如权利要求25所述的膝假体，其特征在于，所述角α或角β小于10°。
41、如权利要求11、12、15、16、19、20、22、24、26、27、29、30或者31所述的膝假体，其特征在于，所述角α或角β小于10°。
42、如权利要求33所述的膝假体，其特征在于，所述角α或角β小于5°。
43、如权利要求34、35、37、38、39或者40所述的膝假体，其特征在于，所述角α或角β小于5°。
44、如权利要求36所述的膝假体，其特征在于，所述角α或角β小于5°。
45、如权利要求41所述的膝假体，其特征在于，所述角α或角β小于5°。
46、如权利要求1-4之一所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
47、如权利要求5所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
48、如权利要求7所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
49、如权利要求10所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
50、如权利要求14所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
51、如权利要求18所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
52、如权利要求25所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
53、如权利要求33所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
54、如权利要求6、8、9、11、12、15、16、19、20、22、24、26、27、29、30、31、34、35、37、38、39、40、42、44或者45所述的膝假体，其特征在于，销头(23)沿推动方向被安装到接触表面(12b)上，以利于对中和主锚固。
CNB021078610A 2001-03-26 2002-03-25 膝假体 Expired - Fee Related CN1236738C (zh)

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ATE353200T1 (de) 2007-02-15
JP3738221B2 (ja) 2006-01-25
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