WO2016116571A1

WO2016116571A1 - Templates, prostheses and orthoses

Info

Publication number: WO2016116571A1
Application number: PCT/EP2016/051252
Authority: WO
Inventors: Luis Schuster
Original assignee: Luis Schuster
Priority date: 2015-01-22
Filing date: 2016-01-21
Publication date: 2016-07-28
Also published as: DE102015201029A1; EP3247313A1

Abstract

The invention relates to a resection template (10) for the resection of a bone (200), comprising at least one support device (20) for support on the bone (200) and at least one tool guide (30) for guiding a tool for machining, in particular resection, of the bone (200), characterized in that the resection template (10) has a clamping mechanism, locking mechanism and/or snap-action mechanism for fixing it to the bone (200), or in that the resection template (10) is an at least two-part structure and has a first template part (11) for carrying out a first resection and a second template part (12) for carrying out a second resection, the first template part (11) being particularly designed as an individual template, preferably for distal resection, and the second template part (12) being particularly designed as a standardized template part for multiple use and preferably for multiple resection, or in that the resection template (10) has a drill guide (35), in particular parallel to the tool guide (30) and designed as a saw guide, in particular for producing a groove in a resection surface of the bone (200), and/or is precisely and stably fixable to the bone by means of locking or snap-action mechanisms, and in particular allowing the exact implantation of an individually adapted endoprosthesis (100) whose size has been reduced as much as possible. The invention further relates to an exo-template or exoprosthesis or knee-joint orthosis for the, for example, post-operative stabilization of the knee joint and relief of the strain thereon, comprising a hinge, which permits a physiological movement of the knee joint, wherein, in particular, on the model of individual knee-joint prostheses, sliding hinges are attached to the outside of the exoprosthesis to ligament insertion points corresponding to the Burmester curve and held in place by braces.

Description

Stencils, prostheses and orthoses

The present invention relates to templates, in particular resection templates, as well as prostheses and orthoses for the endoprosthetic treatment of knee joints.

Here, innovations are described above all with regard to the templates and the prostheses, which describe a substantial improvement of the entire endoprosthetic procedure, in particular through a more reliable and precise fit of the templates. While the individual endoprosthetic knee joint replacement not only allows a much better postoperative knee joint function, but also moves in terms of production technology or cost technically realistic dimensions, the required relative to the conventional ready-made implants relatively accurate positioning of these individual implants is a certain requirement, which however, can be ensured by the optimization of the template design listed below. The use of these optimized templates also causes the use thereof for conventional confection endoprostheses also here a considerable additional simplification, a higher level of security and a shortened operation time during implantation.

Furthermore, new prosthesis designs for both the femoral and the tibial endoprosthetic knee joint replacement are presented, which are not only intended for use in individual endoprosthetic care but generally to a maximum protection of the bone substance or to a minimum required bone resection. Especially since the contact surfaces of the endoprosthetic joint partners are relatively low, in particular the breaking strength of these minimally reduced endoprosthesis components represents the limitation for the greatest extent. By the design shown below with additionally introduced reinforcing structures or shape design, which can be realized without significant manufacturing technology and implantation effort, can be achieved in these significantly reduced endoprosthetic bodies sufficient load stability.

Since the anterior cruciate ligament is often preserved in the case of individual endoprosthetic replacement, and thus the joint space offers only little space for the preparation of the implant site even after resection of the joint surfaces to be replaced, an implantation instrument, a so-called flat milling machine, for producing the implant site on the tibial bone is also used illustrated tibial minimal endoprosthesis shown.

The invention ultimately represents the endoprosthetic treatment of the "next generation" of endoprostheses, which will be used significantly reduced in size from conventional materials and in the long term only as "temporaries" until the final restoration with a true biological endoprosthesis.

To safeguard the success of the operation, a stabilizing knee joint orthosis is also shown for the post-treatment, which allows a stable and physiological movement due to its special hinge concept.

With regard to the current state of the art, reference is made to the preceding patent EP 1 074 229 A2.

1. template with clip construction and / or snap mechanism

The well-known in the art individual templates sit in spite of a relatively accurate and flush seat not really firmly on the bone and can be changed by slight wobbly movements in their position. The well-known standard templates for the implantation of conventional confectionary endoprostheses have also proved to be unsuitable for the implantation of individually adapted implants. Furthermore, it has hitherto been customary to make the templates on the basis of a nuclear spin tomographic image, since magnetic resonance tomography better represents cartilaginous structures than computed tomography. However, this requires complex and time-consuming recording procedures and means an increased risk of movement artifacts. Furthermore, are the disadvantages typical of magnetic resonance imaging, such as the limitation on the presence of a metal implant and the high costs.

According to a further embodiment, it is therefore provided that the resection template has a clamping mechanism, a latching mechanism and / or a snap mechanism for fixing to the bone (FIGS. 1 to 4).

For this purpose, it is preferably provided that the resection template for fixing to the bone has an undercut and is preferably designed to be elastic in order to receive a bone area or joint area in the undercut or to introduce it into the undercut. In this way, the template can be attached very securely to joint structures, so that wobbling movements are largely avoided.

According to the invention, it is therefore preferable to use anatomical conditions for attachment and to take them into account already during the shaping (production) of the template. The stapling mechanism, locking mechanism or snap mechanism is in this case arranged in particular such that it can embrace bony structures which can be represented by computed tomography.

Since at least predominantly osseous reference points and / or defined cartilaginous structures which can be unambiguously represented by computed tomography, so-called landmarks, are used for the construction and attachment of the template, the resection template according to the invention thus makes it possible to obtain data by means of computed tomography. As an alternative to computed tomography, of course, the more complex magnetic resonance tomography for data generation is also possible.

Due to the self-locking effect, a much more accurate and stable positioning of the template can be achieved. In addition, anchoring with so-called Kirschner wires can be reduced or even avoided. This achieves significant manual energy and time savings. This can also easily compensate for the extra expense of using an additional four-in-one stencil as opposed to the five-in-one stencil (see EP 1 074 229 A2) as described below. Another aspect is the engagement during insertion of the template after overcoming a resistance or the undercut. By briefly vibrating the template, accompanied if necessary by a tactile and audible snap sound, the surgeon receives confirmation of the correct fit of the template. This signal after placement of the template gives the surgeon or the surgical team confidence in the system and supports a concentrated and rapid termination of the surgical procedure. If appropriate, the locking mechanism according to the invention can also be used in combination with adaptable metal or similar multiple-use templates and also in the implantation of standard prostheses and also in revision endoprosthetics.

2. Multipart femur template

A further improvement of a resection template, in particular a femoral template, can be achieved by dividing the femoral template into a distal resection template and a so-called "four-in-one template", preferably with femoral anchoring posts.

According to a further embodiment of the invention it is provided in particular that the resection template has at least two parts and a first template part for performing a first resection and a second template part for performing a second resection, wherein the first template part in particular as a template individual, preferably for a distal template, and wherein the second template part is in particular a standardized template part for multiple use and is preferably designed for a multiple resection (resections along different resection planes).

Compared to the prior art, a significant improvement of the method is to be achieved in that the usual five resection steps on the femur are not performed with a single template, but with a first template only the so-called distal resection, which in the horizontal plane by the distal body Thighbone runs, is performed. This cutting plane is of crucial importance for the implantation of the prosthesis in that the adjustment of the knee joint Doprosthesis in the so-called coronary plane, that is set for the so-called varus and valgus tilting. These tilts are crucial for the correct biomechanical loading of the prosthesis. (Fig. 3)

Since in the five-in-one stencil known from the patent EP 1 074 229 A2 the resection shafts for the further cutting planes would cross the support and support devices several times, in particular also the intercondental hooks running into the facies poplitea, this would mean that Stable contact of these support and support devices impaired, or it would be larger support and support surfaces required to position the template sufficiently stable, which would significantly increase the volume of the template and would complicate the implantation in situ.

In order to precisely define the very important orientation, the rotation about the vertical axis, the first template with only one cutting plane can have drill guides for pre-drilling channels for anchoring pins of the femoral prosthesis. (Fig. 4)

The four further cuts still required are then, similar to the conventional methods, made possible by a second template, preferably a so-called "four-in-one template", which, however, additionally by anchoring pins corresponding to those on the femoral to be implanted Prosthetic component on the already established distal resection surface of the femur, can be precisely aligned. Further measurements for positioning and further fixations are therefore not required (FIG. 5). The "four-in-one template" reproduces the four standardized further resection surfaces of the femoral prosthesis pad, as in the conventional methods. The second template may therefore be reusable and may be made of durable material such as stainless steel or the like.

Dividing the femoral resection into two steps, using a second resection template, the "four-in-one" template, adds minor material, manual, and temporal overhead during surgery, but this overhead is made possible by the much more precise positioning of the template the first distal resection step, which facilitated Resection and the resulting savings in the construction of the smaller, individual disposable template with less volume or material compensated. 3. Endoprosthesis with reinforcement strut and template with drill guide for creating a channel-shaped bore in the implant bed

According to a further development of the resection template according to the invention, the latter comprises at least one drill guide for a groove-shaped bore of the, for example, femoral implant bed for a femoral prosthesis component with, for example, a semi-cylindrical reinforcing strut, for example at a predetermined breaking point of the prosthesis or prosthesis component. In this case, the resection template may in particular be designed as a "four-in-one template" for the femur.

According to one embodiment, it is provided that the resection template has a drill guide, in particular parallel to a tool guide designed as a saw guide, in particular for producing a groove or a channel-shaped bore on a resection surface of the bone (implant bearing).

The endoprosthesis according to the invention according to the second aspect of the invention is intended in particular for the femur. In particular, it has a plurality of bearing surfaces or bearing surfaces which are aligned at an angle to one another in abutment with correspondingly angularly aligned resection surfaces of a bone, in particular of the femur. According to a first embodiment, it is provided that at least one reinforcement is present, which extends over an edge formed between the support planes and, in particular, protrudes from the support planes aligned at an angle to one another.

In the manufacture of individual endoprostheses, it is possible to adapt the resection surfaces individually to the surface curvatures of the bone, in particular the femoral condyles, and the geometric conditions of the particular femoral plain bearing. This will be a maximum

Sparing or a minimum of resection of the bony substance achieved. This makes it possible to produce very thin prostheses which only barely exceed the cartilaginous bone boundaries or which replace supporting joint surfaces and thus actually represent only a surface replacement of the joint or the replacement of the cartilaginous surface.

With such minimal endoprostheses, the cutting lines of the resection surfaces or the support planes of the prosthesis are subject to comparatively low material thicknesses, which under biomechanical loading represent a so-called predetermined breaking point. To eliminate this predetermined breaking point, for example, according to the invention, semi-cylindrical reinforcements can be applied to the prosthesis via the edges of these cutting lines. The strength of the reinforcement can be determined for each individual load, taking into account the height and weight of the patient. Thus, a sufficient resistance to fracture can be ensured at these locations. In addition, the preferably semi-cylindrical reinforcements or reinforcing elements ensure further anchoring stability, in particular with respect to lateral shear forces. (Fig. 6)

To produce an implant bearing on the bone with at least one semicylindrical groove, the resection template preferably has at least one drill guide which runs along the corresponding resection plane or the resection shaft (sowing shaft). By means of this drill guide can bring a corresponding hole with drill bits of the same radius in the implant bearing. The template to be used may be, for example, a "four-in-one stencil". (Fig. 8).

These reinforcements on the femoral prostheses are particularly useful in the production and implantation of the real bioprostheses described below, since even with these increased stability of the implant facilitates handling and safer and also the trough-shaped gobbling of the implant bearing additionally the contact to something deeper allows and better perfused bone layers. Thus, the usual (vertical) tapping of the implant bearing can be dispensed with at least in part.

4. Femoral prosthesis and template for separate replacement of the medial and / or lateral articular surface and / or the patella sliding bearing A further aspect of the invention consists in a prosthesis and template for the femur in order to replace or resect, alone or in combination, the medial and / or lateral articular surface of the femur and / or the patella sliding bearing.

With regard to the endoprosthesis according to the invention in accordance with the second aspect of the invention, according to a further embodiment it is provided in particular that the endoprosthesis consists of several, preferably at least three, individual parts, wherein the individual parts each have at least one support plane for attachment to at least one resection surface of a cooking, in particular of the femur, wherein the individual bearing planes are preferably aligned at an angle to each other.

In principle, it is also possible to use the items separately. It is particularly preferred, however, for a replacement of at least two sliding surfaces of the knee joint (medial articular surface, lateral articular surface, patellar sliding bearing) to use separate prosthesis components for this purpose.

By dividing the originally tricompartimental femoral prosthesis components into three separate parts, a further reduction of the femoral bone resection, in particular in the case of genuine resurfacing, can be achieved. In particular, it is provided to separate or separate the two so-called distal femoral articular surfaces and the femoropatellar sliding bearing at the level of the so-called sulcus terminalis or sulcus femorotibialis at the respective medial or lateral femoral condyle. (Figure 9). In particular, the dorsodistal femoral sleeve bearing and the patellar sleeve bearing are preferably formed by separate (and spaced apart) prosthesis components. Preferably, the dorsodistal lateral sleeve bearing and the dorsodistal medial sleeve bearing are also formed by separate (and spaced apart) prosthetic components.

Further bone savings can be achieved by providing more than three resection planes for the prosthesis bearing at the dorsal and distal bends of the femoral sliding bearing. Particularly in the case of the conventional prosthesis bearing designs, several, in particular more than three, resection planes can also be provided on the ventral bends. A subdivision of the articular surfaces in the tricompartmental primary care makes sense, as this further reduction of the required bone resection and in addition to the femoral prosthesis component eliminates the predetermined breaking points at the transition between patellar sleeve bearing and distal femoral equal area. In addition, if one of the three femoral prosthesis components or components is loosened or damaged, it may also be necessary to replace it in isolation.

The division of the classical tricompartmental total endoprostheses is preferably carried out on linear or band-shaped areas, corresponding to the so-called border groove, sulcus femorotibialis or also sulcus terminalis, in each case medial and lateral. At these points, the kneecap performs a special load redistribution on the articular surfaces, whereby it is subjected to particularly low mechanical loads.

For the optimal solution of this biomechanical challenge, an adaptation in the sense of an individual production of the endoprosthetic knee replacement is thus unavoidable in the long term. By appropriate planning and arrangement of the resection shafts, for example by means of the "four-in-one stencil", these transitional areas of the articular surface or the partitions of the prosthetic joint surfaces can also be hit well enough or the endoprostheses can be positioned sufficiently accurately.

5. Vertical division of the ventral femoral bearing surface of a femoral prosthesis

Another aspect of the invention consists in a vertical distribution of the ventral femoral bone-side bearing surface of a femoral prosthesis (or femoral component of a prosthesis) in two bearing surfaces, which, preferably with a slight V-shape, are tilted towards each other. In order to produce a corresponding implant bearing, the corresponding resection shafts in the resection template for the femur, for example a "four-in-one stencil", are correspondingly applied or aligned. The endoprosthesis according to the invention preferably has a plurality of contact areas oriented at an angle to each other for abutment with correspondingly angularly aligned resection areas of a bone, in particular of the femur. In accordance with a further embodiment of the endoprosthesis according to the invention, it is provided that at least one of the support regions has an unfold, in particular V-shaped, whose at least one crest line runs transversely to an edge formed between the support regions. In particular, a ventral femoral bearing surface or plane of the endoprosthesis has a central graduation, this division preferably extending in the direction of the distal bearing surface or towards the distal bearing surface.

With regard to the first aspect of the invention (resection template), it is preferably provided that this is set up for the resection of the femur. The resection template preferably has at least one support device for support on the bone and a plurality of tool guides for guiding a tool for processing, in particular resection, of the bone or femur. According to a preferred embodiment, it is provided that the tool guides are aligned with one another in such a way that a plurality of angularly aligned resection areas can be produced by resection of the bone, wherein an at least one of the resection areas is able to produce a fold, in particular a V-shaped, whose at least one The crest line extends transversely to an edge formed between the resection areas.

The central division of the ventral femoral bone-side support surface of the femoral prosthesis and the V-shaped placement of these surfaces with appropriate resection of the implant bed in bone allows not only a significant bone savings in the ventral femur but also a stabilization of the femoral prosthesis in the lateral direction, even without the use of anchoring pin. (Figure 10).

The omission of the anchoring pegs on the femoral component of the knee joint endoprosthesis also facilitates, in particular, a possible replacement operation since, in particular in the case of prostheses implanted without cement, the contact surfaces, which are often considerably entwined with the bone, intermesh with the oscillating Saw can be separated without encountering an obstacle or the anchoring pins.

The V-shaped arrangement of the resection surfaces on the bone can be achieved by a corresponding arrangement of the saw slots, for example in the four-in-one resection block.

6. Rotary hook

According to a further embodiment, it is provided that the resection template, which is provided in particular for the resection of the tibia, has a contact area adapted to an approximately right-angled shin edge, preferably curved approximately at right angles, for abutment with the shin bone edge in order to achieve rotational stability.

By anchoring the template on an outside shin bone edge, a particularly good rotational stability of the tibial template can be achieved. On the outside of the shin bone, the tibia has a nearly right-angled edge slightly above and lateral to the so-called tibial tubercle and about 3-4 cm below the ventral anterolateral tibial margin in a slightly different shape. This extends to the tibial head just above the so-called tibial tubercle on the outside below the so-called tubercle Gerdii to the fibular head. By means of a hook-shaped, in particular rectangular, structure on the template which simulates the edge described, the edge can be precisely defined on the tibial template about the vertical axis , (Fig. 1 1, 18)

The rotary hook represents an optional additional stabilization aid, which, if necessary, can also later be attached or attached to the template already placed in the situs. 7. Division of a tibial prosthesis

In the prior art, when replacing both the medial and the lateral sliding bearing of the tibia, the tibial plateau is completely separated in a horizontal and possibly slightly inclined backward plane. The medial and the lateral tibial plateau are then treated endoprosthesis together. In the case of the so-called hemiprostheses, on the other hand, only the inner or, more rarely, only the outer knee joint compartment is supplied with an endoprosthetic replacement. It has been found that even less than half covered tibial plateau provides sufficient stability for an introduced joint replacement. Against this background, it is an object of the invention to obtain the anterior cruciate ligament in an individual knee joint arthroplasty and to keep the so-called inter-condyle hump, the anchorage site for the anterior cruciate ligament on the tibia, as stable as possible.

Attempting to lengthen the incision known from conventional endoprosthesis models with retention of only the posterior cruciate ligament, in the posterior portion of the tibial plateau of the endoprostheses to the extent that the Interkondylenhöcker to accommodate the distal anterior cruciate attachment provides sufficient space, leading to a narrow web formation the front of the tibial plateau component, which is exposed to a considerable risk of breakage. The connection of the prostheses of these two compartments through a bridge, however thin it may be, leads to loosening of one side by a leverage effect over the connecting bridge and a loosening of the opposite side, if not a rupture of the bridge.

In addition, in the case of the one-piece prostheses in the prior art, it is also not possible, in the case of a unilateral medial or lateral loosening of the femoral component, to obtain the non-loosened side or the femoral plain bearing and to carry out exclusively a revision of the affected compartment.

With regard to the second aspect of the invention (endoprosthesis), therefore, it is preferably provided that the endoprosthesis consists of at least two separate prosthesis bodies (parts), wherein a first prosthesis body for placement on a first side, in particular medial, the tibial intercondial tuberosity and a second prosthesis bodies is designed to be arranged on a second side, in particular laterally, of the intercondylar tuberosity of the tibia. Particularly in the case of the tibial component of an individual knee joint endoprosthesis, a division into two parts has proved to be advantageous. In this case, in particular, two separate tibial versions may be provided, which serve for receiving the respective prosthesis onlays, which are usually made of polyethylene, but in principle also of other similar or modified, suitable plastics or other materials may serve.

The unconnected (separate or separate) portions of the prosthesis facilitate easier bone resection. For example, the templates may be pre-drilled for one or more anchoring pegs, screws, or other fixation devices for the socket of the tibial prosthesis components on the resected bone separated and successively set up, aligned and if necessary corrected.

This allows a more accurate fit with optimal support of the prostate margins on the cortical bone, especially when using medial and lateral different slopes (so-called "slopes") of the resection surfaces on the tibia in the anteroposterior direction. By adapting the inclinations to the different inclinations of the tibial plateaus, further bone savings are possible.

The associated division of the prosthesis onlays or polyethylene enkomponenten (eg the polyethylene onlays) also offers the possibility, by the selection of onlays of different heights on one or the other side, for example in millimeter steps, a particularly accurate balance to achieve the belt tension taking into account a required axis alignment.

The division of the tibial component in the treatment of the knee joint with a total endoprosthesis is useful both when using individual knee joint endoprostheses and in the conventional standard prostheses. (Fig. 12)

8 Maintenance or restoration of the menisci The menisci in the knee joints of older people, especially those who are due to endoprosthetic care, especially in the arthrotic compartments due to their involvement in the degenerative process with corresponding structural damage and volume loss usually little more than a significant buffer function for between Femoral and tibial compression forces.

However, in advanced arthritic knee joints, as well as the bursae and fat pads, they often play an important role as filling material and lubricator for the joint space in the various joint positions and thus for maintaining the most important passive stabilizer of the knee joint, namely the intra-articular negative pressure.

A further stabilizing function mainly takes place in conjunction with the periarticular ligament apparatus, which undergoes a more flush and direct contact, in particular with the femoral condyles, through the menisci and thus supports the stabilization in the horizontal plane.

Just as with the conventional standard endoprostheses, this additional stabilization by the menisci is also missing in the case of the individual knee joint endoprosthesis. Although the more precise reconstruction of the surface geometry in the individually adapted endoprosthesis improves stability in different positions, it lacks the above-mentioned stabilization mechanisms compared to a healthy and also arthritic knee joint.

In principle, two approaches are available for obtaining these stabilization mechanisms. On the one hand, it is possible to attempt to preserve the existing menisci within the framework of a submil- aleter area-specific, exact individual reconstruction of the original tibial joint surface. If a definitive restoration with a true bioprosthesis is envisaged, this form of meniscus preservation would be essential.

On the other hand, the second approach would be to try to replace the menisci with the utmost precision and individually with a suitable plastic, for example rubber or the like, whereby these meniscal prostheses must be fastened at their edges analogously to the natural menisci. It would be conceivable that at least the fixed, passive fixation, for example, of the The anterior and inferior veins of the anterior and distal meniscus could be restored in sufficient form by fixation on the endoprostheses.

Much more problematic, however, is the restoration of the connection to the dynamic partially actively strained meniscal fixations, such as the lateral collateral ligament, the meniscal outlines of the semimembranosus tendon to the medial meniscus, the meniscal outlines of the popliteus tendon to the lateral meniscus, and the insertions of the wrist ligament on the outer meniscus rear horn.

To what extent alternative measures, for example improvement of the lubricity, consistency and modification of the shape of the meniscal prostheses, may possibly completely or partially dispense with a dynamic fixation, or alternative attachment possibilities can be found, requires experimental clarification.

As the development of the technical surgical possibilities progresses, such a procedure is conceivable in the manner described for the maintenance of the menisci for the optimal reconstruction of an arthritic joint.

A preferred embodiment of the invention thus relates to a method for maintaining the meniscus function, in particular in the case of an endoprosthetic restoration of the tibia, by preserving the original meniscus or replacing the original menisci with a meniscal prosthesis which is produced in particular from rubber and fixed on a tibial prosthesis component.

9. Template for a hemispheric tibial platelet site for minimal tibial prosthesis components

With regard to the first aspect of the invention (Resektionsschablone) is preferably provided that the tool guide is formed as a milling opening, in particular with an at least partially arcuate boundary for guiding a milling head or a plurality of milling heads. The support means may be designed here in particular as a preferably flat (flat) support surface. By using a second tibial template (FIG. 13), after a minimal height resection of the tibial plateau, for example, by the first tibial template described above, the tibial plateau can be removed in a second step. milled out to introduce into the tibial plateau a recess which forms an implant site for a prosthesis. The introduction of the depression is preferably carried out by a milling head, for example a hemispherical milling head, which is guided in the second template. This makes it possible, for example, to mill out a sufficiently deep implant bed, which ensures the introduction of the minimally required denture or polyethylene thickness in the respective loading zone. For example, the implant bed can be hemispherical. It is also possible to introduce several implant beds or depressions into the tibial plateau. The introduction of an optimally adapted indentation as an implant bed into the tibial plateau allows a further, considerable reduction of the bone resection and an optimized anchoring of a maximally reduced prosthesis component.

10. Tool for a Circular and / or Hemispherical Cutout In a preferred embodiment of the invention, a milling device for milling a bone, in particular a tibial implant bed, preferably the tibial condylar plateau, is provided, which comprises a milling unit, a handling part for manual handling and in particular a support surface for supporting on an opposing anatomical structure, in particular the femur. The support surface may be formed in particular on the handling part.

The milling unit preferably has a circular disk-shaped, dome-shaped and / or spherical or hemispherical milling head.

Furthermore, it is preferred that the handling part is pivotally arranged relative to the milling head or the milling unit or a Fräskopfführung and that by a repulsion on an opposing anatomical structure pressure on the bone for milling the bone is exercisable. The handling part or lever can be pressed by a pivoting movement against an opposing anatomical structure and thereby exert pressure on the milling unit or the milling head. The opposing anatomical structure may be, for example, the femoral condyle opposite, for example resected, the tibia. The pressure can be exerted in particular on a Fräskopfführung, for Example over the location defined by the tibial template. This makes it possible to press the milling head in confined spaces in depth. (Figures 14 and 15). Milling, according to experience, usually requires an extremely high contact pressure, in particular since the subchondral tibial bone often has considerable sclerosis in this area. If these compressive forces in the axial direction due to the narrow spatial conditions of ventral, ie about a 90 ° angle, exerted on the milling guide, there is usually a bending of this Fräskopfführung, which is critical in so far as this drive mechanism for the Rotation of the milling head is running. In principle, a sufficiently powerful milling head guide could be provided for the high contact pressure. In this case, however, compromises in the handiness of the instrument should be made or it would be slightly more complex bracing constructions for the material and a very specific design of the milling head guide device required to be able to handle the tight operation Situs or joint space. This applies in particular in the case of a two-stage surgical procedure, for example in the procedure according to patent number DE 44 34 539 C2, here again especially in hemiprosthetic procedures, in which first an implant bearing is milled via the smallest possible surgical access and the endoprostheses subsequently in accordance with the subtraction image of the pre- and postoperative CT image or corresponding to the CT image of the joint before and after the implant bearing milling.

11. Optimized shinstopper

In a further preferred refinement of the resection template, it is provided that the resection template has a cantilever at the end of which a contact surface for abutment with the tibia is formed, the abutment surface being at least 10 cm, preferably at least 13 cm, from a support surface for the proximal end of the abutment Tibia is removed.

According to the invention, it has been recognized that it is advantageous to construct the rest of the tibias sufficiently long and with a support zone far enough away from the hinge line. The boom, the actual tibial template (stencil body with support and Tool guide) to the tibial stopper (abutment member), may additionally include a drill channel as a guide for an alignment rod for checking the position of the resection plane for the tibial prosthesis component with respect to the tibial anatomical axis (Figure 22). By using a metal rotation-stable alignment rod, for example a square bar, stencil material can additionally be saved by using only the metal square alignment rod as a connection between the actual base body of the template and the support element on the shin edge. In this case, locking devices for template base body and support element would have to be attached to precisely determinable points of the alignment rod. Similar to the support element on the shin bone edge, such can also be made for the region of the ankle and, alternatively or together with the support element on the shin bone edge, be used for positioning the alignment rod, as described above. Furthermore, the invention relates to a method for determining a contact surface for a resection template with a boom and a contact surface for abutment with the tibia, in which a preferably three-dimensional image of at least a portion of the tibia is recorded, wherein during the recording of the three-dimensional image of a mass the tibia is modeled, which delimits itself on the three-dimensional picture against bones as well as against soft parts on the bone.

By placing a modulatable mass, which can be sufficiently delimited against bones and soft tissues on the shin bone edge (for example, a cooling pack), the contact surface or support surface for the shinstopper or for the contact surface of the resection template on the shin bone edge, which on the inside with a relatively thin skin and periosteum layer and externally covered with a displaceable, differently thick muscle layer, during a CT or NMR recording are shown more accurately (Fig. 18).

12. Exosch template and exoprosthesis

Another aspect of the invention relates to a method for producing a template, prosthesis or orthosis, in particular a limb or Geis Steering rail, which is formed at least partially to rest against an outer, for example skin-covered, body surface of the human or animal body, in particular a limb, wherein a three-dimensional image data set at least a portion of the body or the extra- is picked, wherein during recording of three-dimensional image data set, a preferably filled with a fluid, cuff around the outer contour of the body or the extremity is arranged, which is defined in the three-dimensional image data set against both bones and soft tissue, and wherein at least one mold portion of the template, prosthesis or Orthosis is formed based on the three-dimensional image. The attachment to the body surface can also take the form of an at least partial enclosure of a limb.

According to a further aspect, the invention relates to a template, prosthesis or orthosis, in particular produced by the method according to the invention, wherein the template is designed to bear on an outer, for example, skin-covered body surface and sleeve, shell, cuff, ring and / or is clamp-shaped to substantially encompass a limb of the body.

It is preferably provided that the template, prosthesis or orthosis has a joint.

The template is applied to the bone aligning the bearing surfaces with the intact, usually skin-covered body surface (based on the tibial template tibial stencil technique or the patellar template outer component technique).

With regard to the shaping of the template, prosthesis or orthosis adapted to the respective patient, a plastic cuff is applied to the leg of the patient, for example during the computed tomography recording. The plastic sleeve can be filled, for example, pneumatically or with liquid. As a plastic cuff, for example, such as is known to be used for the emergency immobilization of extremity fractures can be used. As a result, an excellent representation of the limb surface can be achieved by computed tomography. The bearing surface of the Exoprothese or Exoschablone to rest on the outer Extremity surface (for example leg) can then be shaped individually based on this recording.

Alternatively, the recording can be made by means of magnetic resonance imaging.

By liquid filling of the cuff, for example by water, due to the weight of the liquid additionally immobilization of the patient, in particular the extremity, can be achieved. This is advantageous both for a computed tomography and, if necessary, for a nuclear spin tomographic image.

By means of this procedure, an Exoschablone invention or

Exoprosthesis be formed. The exo-template or exoprosthesis can be, for example, a sleeve-shaped shell and / or a clamp construction, for example for a limb. The preparation may possibly be carried out analogously to the preparation of the endoprostheses, for example also using a suitable 3-D printing process. The Exoschablone or Exoprothese can be made of a suitable material, for example plastic, especially hard plastic, carbon fiber or the like.

Mechanisms, for example, for opening and closing, tightening and / or pressure padding may also be provided based on the conventional techniques for the production of prostheses. Air cushioning may be achieved, for example, by air chambers and / or by the proper choice of material or material texture. It is essential that the construction can be optimally attached to the body part, for example the extremity. The simultaneous presentation of limb surface and bony structures in the depth of the soft tissues also offers the possibility of constructing orthoses or splints in the sense of exoprostheses, which, for example, at the knee joint allow a significantly differentiated orientation on a bony or cartilaginous joint geometry. This concerns in particular the knee joint geometry. The orthosis or splint can therefore be adapted much more accurately to the individual knee joint kinematics, for example for the construction of the joint of a knee splint splint. For example, it is possible to position the fulcrum or the axis of rotation of a joint splint or exoprosthesis more precisely. For example, the epicondylar line may be applied much more precisely as an approximate anatomical center of rotation of the knee joint using, for example, conventional monocentric, bicentric or polycentric joints (with and without limiting movement of the respective joint) for extension and flexion.

Furthermore, the uniform representation of the soft tissue on the surface (surface contour) and the bone in the interior can realize much more complex joint kinematics. For example, by modeling a hinge construction adapted to the femoral condyle contour or a sliding bearing on the side of the exoprosthesis shell or the exoprosthesis, an individually adapted and significantly improved kinematics, possibly with rolling, sliding and rotation possibility for the knee joint movement can be realized. This may, for example, with a sliding metal / polyethylene, similar to the endoprostheses but possibly also by a roller construction or ball bearing construction along the contact surfaces of this hinge construction, for example, each inside and outside done. The hinge construction may possibly also be housed in a protective housing for protection against contamination and also for preventing the escape of lubricant. In this case, for example, the exoprosthesis (for example, a shell construction) can be widened in this area. The improved kinematics improves the physiological movement of the joint and thus the desired healing process as well as the wearing comfort.

A stabilization of the Exoschablone or Exoprothese (for example, shell construction) or the sliding bearing can be made for example by structures whose anchorages are given by the Burmester curve. These structures can be strip-like and / or strip-like and / or stable (dimensionally stable) and / or elastic. They can each be provided on the sides, possibly also dorsally and ventrally, of the joint. Structures preferably run laterally corresponding to the band structures or band insertions and / or ventrally of the extensor apparatus and / or dorsally corresponding to the dorsal capsular ligament structures of the knee joint. The constructions can be made with and without limiting the movement of the respective joint (for example, the knee joint) for the extension and flexion, for example, by wedge-like stopper devices or other types of joint locks. (Figures 19 and 20).

For example, a functional orthosis for stabilizing the knee joint can be produced. The orthosis can for example be used after an injury, for example a ligament structure, for example of the anterior cruciate ligament. The orthosis can also be used for relief, for example in unilateral medial or lateral gonathrosis, or for postoperative relief, for example, by additional support in the sole area and / or in the hip area. This can be done for example by a suitable boot construction and / or in the area of the pelvis, for example by a suitable support on the ischial tuberosity and / or a thigh adjustment corresponding to the prosthetic shafts, which in the prosthetic care of upper and lower leg amputations for the treatment of injuries, diseases and Postoperative conditions of other regions, for example, the lower limb are used.

The method according to the invention can also be used in the construction of other exoprostheses, for example the upper extremities, but also of trunk buttocks and orthoses for stabilizing the cervical spine.

Last but not least, the method can also be used in modern mechanized orthopedic care, in particular in the production of so-called external skeletons in neurorobotics, and in the treatment of neurological diseases and injuries, for example paraplegia.

In summary, in particular, an exo-template or exoprosthesis or knee-joint splint for, for example, post-operative stabilization and relief of the knee joint is provided which is provided with a hinge which allows a physiological movement of the knee joint, wherein, in particular based on the individual knee joint endoprosthesis , Sliding hinges on the outside of the exoprosthesis with braces fixed at the belt insertion points corresponding to the Burmester curve are attached. The invention will be further described below with reference to the accompanying figures. In the figures: shows a coronal section through the human femur and a femur template;

a sagittal section through the femur and a femoral template; a femoral template for an exclusively distal resection;

a template for the femur with drill guides for femoral prosthesis cones;

a resection block with anchoring pins;

a femoral bearing surface with reinforcements in the form of semi-cylindrical struts;

a femoral minimal endoprosthesis;

a "four-in-one template" for the femur with additional drill guides for a trough-shaped bore of the femoral implant bed;

a femoral minimum endoprosthesis in which dorsodistal femoral sleeve bearing and patellar sleeve bearing are separated; a femoral prosthesis with a V-shaped fold of the support surface for the femoral sleeve bearing;

a resection template, in particular a tibial template, with a rotary hook;

a tibial prosthesis with separate components;

a resection template (tibial template) with a milling guide for eating out a prosthesis bearing, in particular for a minimal endoprosthesis ventral;

a milling device for milling out a prosthesis bearing, in particular on the tibia dorsally;

a milling device for erosion of a prosthetic bearing on the tibia dorsal;

a tibial minimal endoprosthesis; FIG. 17: a tibial minimal endoprosthesis in a further view; FIG.

FIG. 18 shows a resection template with a rotary hook and a support surface for resting on the tibia (shinstopper); FIG.

Fig. 19: a prosthesis as a knee brace;

FIG. 20 shows a three-dimensional view of the exoprosthesis according to FIG. 19; FIG.

Figures 1, 2 and 4 show a fixed to a bone 200 and the femur 210 (femur) of a human resection template 10 with a stapling mechanism or snap mechanism for fixing. The resection template 10 comprises a support device 20 for supporting on the bone 200 and a tool guide 30, in particular a saw slit or sowing shaft or a saw guide, for resecting the bone 200 along a defined plane. A base body in which the tool guide 30 is formed forms a clasp-like clasp 40 of the bone 200. The clasp 40 includes an undercut to receive the bone 200 therein. The clasp 40 surrounds the bone 200 by more than 180 degrees, so that it can be securely fixed in the Umgriffsbereich formed by the clasp 40. The clasps of the clasp 40 are flexible, so that the resection template 10 can be placed on the bone 200 by latching.

A close examination of the anatomy of the knee joint reveals that at approximately 120 ° of flexed knee joint and vertical alignment of the tibia, predominantly bony, partially cartilaginous surface structures are present on both the femoral and tibial platelets. In the horizontal plane to the rear, when the operation is open, there is a rejuvenation in the depth of the surgical site on the femoral rolls and also on the tibialis. This posterior taper is located on the femoral rollers in the above-mentioned orientation just behind the lateral edges of the articular surface, which in the patients to be treated with knee joint endoprostheses by so-called arthrotic remodeling processes (predominantly with bony, but also cartilaginous-connective tissue bulges - so-called Osteophytes) are often additionally broadened. After overcoming this Gelenkrandverbreiterung follows a taper of the diameter of the thigh rollers in the horizontal plane (especially pronounced on the outer side of the outer thigh roller, also clearly on the inner side of the outer thigh roller and on the outer side of the inner thigh roller and depending on the arthrotic change also sufficiently pronounced on the inner side of the inner thigh roller). After this rejuvenation or diminution of the bony structure, a widening of the bone diameter follows again, due to the elevation of the so-called epicondylar stools, on which the outer bands each insert on the outer side of the outer thigh roller and the inner side of the inner thigh roller. In the so-called intercondylar notch on the inside of the outer femoral roll and the outside of the inner femoral roll, the bone diameter increases again to close the arch for the roof of the intercondylar notch, cf. Fig. 1.

An in-depth examination of the knee joint anatomy in the depth of the so-called notch reveals that between the anterior and posterior cruciate ligaments on the insides of the intercondylar notch, under the so-called roof of the latter or the posterior femur away from the back, up to the so-called "planum popliteum". Although, in particular in the arthritic knee joint, hyper-trophic synovial connective tissue and osteophytes also largely displace the lumen, they are adequately pushed aside by a sufficiently resistant, slightly chack-shaped structure, such as, for example, a pfriem or a raspartorium pierced to allow access to the back of the distal femur to the planum popliteum without injuring critical structures, particularly vessels, nerves, or tissues of importance for stability or function. This planum popliteum, similar to the femoral bone above the patella sliding bearing, is a computertomographically reliable and reproducible bony structure which, connected by a line extending vertically, or sagittally over the patella sliding condyle and through the intercondylar notch, forms an upwardly tapering clasp, cf. , Fig. 2. Above all, the template 10 in the area of the femur 210 makes use of the circumstance that in the knee joint endoprosthesis the bone 200 to be resected, above all on the femoral side, can be peeled out of the surrounding soft tissue without any other joint of the body leads to relevant soft tissue damage.

FIGS. 3 and 4 show a resection template 10 as a first template or a first template part 1 1 for an exclusive distal resection of the femur 210. The resection template 10 comprises only a single tool guide 30 in order to resect the condyles 212 of the femur 120. The resection template 10 further comprises drill guides 34 for pre-drilling canals for anchoring pegs of a femoral prosthesis to be inserted. The resection template 10 also includes a clip or clasp 40, as previously described, which clasps the femur 210 between the condyles 212 in the proximal direction.

FIG. 5 shows a resection template 10 as a second template part 12 in the form of a 4-in-1 template for further resection following the distal resection (FIGS. 1-4). The resection template 10 can also be referred to as a resection block and comprises a plurality of tool guides 30. The resection template 10 comprises a flat support surface 28 for resting on an already prepared resection surface (distal resection) of the bone 200. Anchoring pins 36 are provided for fixation on the resection surface. The resection template 10 is provided in particular for the femur 210 and comprises corresponding tool guides 30 (saw guides) for the resection of the condyles 212.

FIGS. 6 and 7 show two embodiments of an endoprosthesis 100. The endoprosthesis 100 for the femur has a plurality of contact planes 102 aligned at an angle to each other for abutment with corresponding resection surfaces of the resected femur 210. At the transition edges between the support planes 102, a reinforcement 104 is arranged, which connects the support planes 102 and reduces the risk of breakage in the region of the edges between the support planes 102. The particular strut-shaped and / or halbzylin- derförmige reinforcement 104 extends transversely to that between the support planes 102nd formed edge. The endoprosthesis 100 includes a first dorsal disc medial prosthesis portion 122, a second dorsodiscidal lateral prosthesis portion 124, and a third patellar sleeve bearing prosthetic portion 126. At the first prosthesis section 122, a first support region 106 having at least two support planes 102 is formed. At the second prosthesis section 124, a second support region 107 with at least two support planes 102 is formed. At the third prosthesis section 126, a third support region 108 with at least two support planes 102 is formed.

FIG. 8 shows a resection template 10 for producing an implant support for an endoprosthesis 100 according to FIG. 6. In order to penetrate groove-shaped depressions in the area of the resection surfaces, drill guides 35 are present in the resection template 10, which bore holes parallel to the corresponding guide (tool guide 30) ). FIG. 9 shows an endoprosthesis 100 for the femur 210 in the form of a minimal arthroplasty. In the endoprosthesis 100 for the femur 210, the prosthesis parts of the dorsodistal sliding bearing and the pattelaren sliding bearing are designed as separate elements (prosthesis parts). The parts of the prosthesis are separated in the area of the so-called sulcus terminal.

The endoprosthesis 100 comprises a first prosthetic part 130 for the medial dorsodistal sliding bearing, a second prosthetic part 132 for the lateral dorsodistal sliding bearing and a third prosthesis part 134 for the patellar sliding bearing.

FIGS. 6 and 10 show an endoprosthesis 100 in the form of a prosthesis for the femur 210 with a V-shaped fold of one of the bearing surfaces or bearing planes 102. The endoprosthesis 100 comprises a first bearing region 106 for the medial dorsodistal sliding bearing, a second bearing region 107 for the lateral dorsodistal sliding bearing and a third support region 108 for the patellar plain bearing. The third support region 108 comprises a V-shaped unfolding which is directed to the correspondingly folded resection plane of the bone (femur). The apex edge 109 extends transversely to the edges between the support planes 102 and in the direction of the dorsodistal sliding bearings or the support regions 106, 107. FIG. 11 shows an embodiment of a resection template 10 with a so-called rotation hook. The tibia 220 has an almost rectangular edge 228 on the outside tibial edge or side 226. For attachment to this right-angled edge 228, the resection template 10 has a hook-shaped abutment region 46. The hook-shaped, in particular bent at right angles abutment portion 46 feels the edge 228 on the outer tibial side and is preferably designed tongue-shaped. As a result of the abutment of the abutment region 46 against the edge 228, in particular a determination of the resection template 10 about a vertical axis is achieved. The hook-shaped abutment region 46 can be detachably connected to the main body of the resection template 10, so that it can also be attached later, for example, in the resection template 10 already applied in the situs.

An endoprosthesis 100 in a preferred embodiment of the invention is shown in FIG. The endoprosthesis 100 consists of at least two separate and spaced apart prosthesis parts 1 10, 1 12, in particular for placement on the two condyles 222 of the tibia 220. The two separate prosthesis parts 1 10, 1 12 of the endoprosthesis 100 are in the inserted state by the Intercondylen cusps of the tibia (intercondylärer area 224) separated or spaced apart.

According to the invention, in particular, it is provided that for the respective condyles 222 there is in each case provided a separate socket 1 14, 16, which in each case receives a prosthesis unit 1 18, 120 which has the condylar surface to be replaced. The endoprosthesis 100 thus consists of a first prosthesis part 110 and a second prosthesis part 112, which are arranged separately and spaced from one another on the tibia 220 and in each case one mount 1 14, 16 for placement on a resection surface and one on the mount 1 14, 1 16 attached Prostesenonlay 1 18, 120 have.

A particular aspect therefore consists in the provision of two separate sockets 1 14, 16 of an endoprosthesis 100, in particular for the tibia 220. The sockets 1 14, 16 are provided in particular for the medial and the lateral tibial plateau 222, respectively. FIG. 13 shows a resection template 10, in particular a second resection template for use after a previously performed height resection, in particular of the tibial plateau. For this purpose, the resection template 10 has a support device 20 for support on the flat resection surface of the tibia 220. The resection template 10 is designed like a frame with a circumferential frame 14 and a limited by the frame 14 milling opening 16. The milling opening 16 includes arcuate boundary walls for guiding a particular circular milling unit or a particular circular milling head. The milling opening 16 is preferably shaped such that it can guide a milling unit 92 or a milling head 94 in several, preferably at least two or at least three positions. For this purpose, a plurality of milling guides, in particular circular-arc milling guides provided accordingly. FIG. 13 shows an embodiment of a milling device 90 for milling out a bone, in particular the tibia 220, in particular an already resected tibial plateau. The milling device 90 comprises a milling unit 92, which is pivotally mounted on a handling part 96 and comprises a rotatable milling tool (milling head). The milling unit 92 with the rotatable Fräswerk- stuff is particularly designed dome-shaped and / or spherical or hemispherical to introduce a dome-shaped or spherical recess in the implant bearing.

The milling device 90 is further illustrated in FIG. 14 and FIG. 15 and shows, in particular, a milling operation on the knee joint between the femur 210 and the tibia 220. The resection template 10 according to FIG. 13 is placed on the already resected tibial plate. The handling part 96, which is designed in particular as a lever, is pivoted relative to the axis of rotation of the milling unit 92, in particular by about 80 to 1 10 degrees. To apply a pressure for milling out the implant bed, the lever can be supported on the opposite femur 210. For this purpose, a support surface is formed on the handling part 96, so that the contact pressure can be varied by pivoting the handling part 96 relative to the milling unit 92. For this purpose, the handling part 96 comprises at least two lever parts which can be pivoted relative to one another, wherein a first lever part is connected to the milling head and a second lever part has the support surface. By pivoting the two lever parts, the milling head or the milling unit is pushed away from the abutment surface.

16 shows a minimal tibial endoprosthesis 100, comprising a socket 1 14 and a prosthesis body 1 18 as a unilateral prosthesis for the lateral or medial femoral condyle 212. The socket 1 14 has a flat support area, in particular on the edge, for resting on a resection plane , In the flat support area a plurality of projecting, in particular hemispherical storage areas are formed which are inserted into corresponding recesses in the implant bed. As a result, such a minimal endoprosthesis 100 can be fixed more reliably. The prosthesis body 1 18 includes one or more pins, which engage in corresponding holes in the socket 1 14.

The tibial minimal endoprosthesis 100 according to FIG. 16 is shown in FIG. 17 in a lateral and partially sectioned view.

FIG. 18 shows a resection template 10 in the form of a so-called tibial stopper. The resection template 10 comprises a support device 20 for supporting at the upper end of the tibia and a tool guide 30 for guiding a tool, in particular a saw, for resection of the tibia. The resection template 10 further comprises a hook-shaped abutment region 46, as described in connection with FIG. 11.

An exo-template or exoprosthesis is shown in FIGS. 19, 20. In the embodiment illustrated in FIGS. 26 and 26a, the template 10 or prosthesis 100 comprises a joint and is designed in two parts. The preparation of the template 10 or prosthesis 100 is preferably carried out based on a computed tomographic image after modeling a mass on the outside of the extremity, which can be displayed well on the computer tomographic image. In particular, the invention can also be described as follows: 1. Devices for drilling and resecting bones, hereinafter referred to as templates, for introducing knee joint endoprostheses, methods for producing such a device, endoprostheses suitable for this and methods for carrying out such endoprosthesis implantations ( with reference to DE 102009028503 A1) and tools for implanting the same for use in conventional partial or full dentures, partial or fully individual partial or full dentures and in "real resurfacing".

Resection template for the resection of a bone, with at least one support device for support on the bone and at least one tool guide for guiding a tool for processing, in particular resection, of the bone, characterized in that the support means by means of latching or snap mechanisms on the bone exactly is stable fixable, the resection template in particular allows the exact implantation of a customized minimal endoprosthesis. 2. Template for the femur, division of the femoral template in a distal resection template and a so-called "four-in-one template" with femoral anchoring pin: for example, also called "four-in-one template", which as a second template at Resection of the femoral prosthesis bearing is used with femoral anchoring pins for anchoring the template in the drilling channels provided for the femoral prosthesis anchorage (FIGS. 1-4 and FIGS.

3. Template, for example by so-called "four-in-one template" for the femur with additional drill guides for a trough-shaped bore of the example femoral implant bed for femoral prosthesis components with, for example, semi-cylindrical reinforcing struts, for example, at the predetermined breaking points. 8th) 4. Femoral prosthesis component with, for example, semi-cylindrical reinforcing struts, for example, at the predetermined breaking points, especially when used in real complete or divided resurfacing or even in the real bioprosthesis. (Fig. 7)

5. Femoral prosthesis component in the sense of a true resurfacing, in which the cutting planes are adjusted individually to the respective femur of the patient with minimal bone / cartilage resection. (Figure 7) 6. Template for the femur, for example as a "four-in-one template", so that with this alone or in any combination, the medial and / or lateral articular surfaces of the femur and / or the patella sliding bearing (7) 7. Femoral prosthesis components as a true resurfacing, in which the incision planes are individually adapted to the respective femur with minimal bone resection In addition, the primary tricompartmental femoral prosthesis components can be divided into three parts, namely two femoral components and the femoropatellar plain bearing, by separating these individual parts at the level of the so-called sulcus terminalis or sulcus femorotibialis at the respective medial or lateral femoral condyles.Perhaps several resection levels for the implant bed at the femoral condyles to further bone savings. (Fig 8. Template for the femur for example as "Vie r-in-one template "so that a vertical division and unfolding of the bearing surface on the femoral implant bearing for the back of the femoral sleeve bearing of the endoprostheses in the slight V-shape of a corresponding femoral component of the endoprostheses arises. 9. Femoral prosthesis component with modification of the rear side of the femoral sliding bearing so that it is divided vertically according to the implant bearing described above and unfolded in a slight V position, in order to produce an additional lateral displacement stability of the prosthesis and reduction of the required bone resection. (Fig. 6)

A method of obtaining meniscal function by obtaining the original menisci or replacing it with a meniscal prosthesis made of a suitable material, for example rubber, and fixed to the tibial prosthesis component.

1 1. Resection template for the tibia, which by attaching a rotary hook, for example on the tibial template, allows a rotational stability of the same when placed on the tibia. (Fig. 1 1, 18)

12. tibial prosthesis component, which is a two-part prosthesis with a medial and lateral tibial component corresponding to a so-called tibial soapy bilateral slide, especially in tricompartmental articular surface replacement on the femur, to simplify the procedure in the so-called total endoprosthetic individual knee joint endoprosthesis, Improvement of precision and stability in the positioning of the prosthesis components as well as reduction of the required bone resection. In addition, appropriate modification to the tibial templates. (Fig. 12)

13. template for the tibia, so that after a minimum height resection on the same a milling head can be inserted into the template and the milling of a sufficiently deep, e.g. Hemispherical, individually optimally adapted implant bearing, which ensures the minimum necessary polyethylene thickness in the respective loading zone, can take place. (Fig. 13)

14. Tool for the hemispheric individually optimally adapted cutout of, for example, a tibial implant bed by means of a hemispherical milling head on soft by a lever mechanism, for example, on the milling head guide pressure exerted by repulsion of the opposing anatomical structure, for example, the resected femoral condyle will and under cramped space the milling head can be pressed into the depth. (FIGS. 15 and 16)

15. A tibial template, or method of making such a template, in which an optimized so-called tibial stop on the tibial margin contributes to more precise and stable positioning of the tibial template, and possibly includes a channel for a guide rod for axis alignment. (16) Exoschablone and Exoprothese after computer tomographic representation of the surface, for example, a limb by the application of a pneumatic or liquid-fillable Kunststoffmanschet- th, for example, the respective limb to better contrasting for this surface, so that For example, for the alignment of, for example, drill guides, for example, in the operative ligament surgery of the knee joint and, for example, also for the alignment of drill guides, for example, the respective extremity can be made and accurately oriented to the lying in the depth of the soft tissue bone geometry Production of splints in the sense of exoprostheses with optimized joint mechanics, for example also for use in neurorobotics. (FIGS. 19, 20)

Another option for assisting a cruciate ligament replacement plastic by means of an open or arthroscopic procedure is the use of so-called exo-templates, based on the technique used to produce the tibial stencil of a tibial template or the outer component of a patella template. (Fig. 26b)

17. The additional use of markers may be used in any combination or alternation in the template implantation procedures described above, to optionally achieve a further additional increase in precision and efficiency when using the stenotic technique or the endoprosthetic procedure, respectively.

Claims

claims

Resection template (10) for the resection of a bone (200), in particular for attachment of an endoprosthesis (100), with at least one support device (20) for support on the bone (200) and at least one tool guide (30) for guiding a tool for machining , in particular resection, of the bone (200), characterized in that the resection template (10) comprises a stapling mechanism, latching mechanism and / or snap mechanism for fixing to the bone (200).

Resection template (10) according to claim 1, characterized in that the resection template (10) for fixing to the bone (200) has an undercut and is preferably designed to receive a bone area in the undercut elastic.

Resection template (10), in particular according to one of the preceding claims, for the resection of a bone (200), in particular for attachment of an endoprosthesis (100), with at least one support device (20) for support on the bone (200) and at least one tool guide ( 30) for guiding a tool for processing, in particular resection, of the bone (200), characterized

the resection template (10) is constructed in at least two parts and has a first template part (1 1) for performing a first resection and a second template part (12) for performing a second resection, wherein the first template part (1 1) is designed in particular as indi - Vidualschablone, preferably for a distal resection, is formed and wherein the second template part (12) is in particular a standardized template part for multiple use and is preferably designed for a multiple resection.

4. resection template (10), in particular according to one of the preceding claims, for the resection of a bone (200), in particular for attachment of an endoprosthesis (100), with at least one support means (20) for support on the bone (200) and at least one Tool guide (30) for guiding a tool for machining, in particular

Resection of the bone (200), characterized

in that the resection template (10) has a drill guide (35), in particular parallel to a tool guide (30) designed as a saw guide, in particular for producing a groove on a resection surface of the bone (200).

5. resection template (10), in particular according to one of the preceding claims, for the resection of a bone (200), in particular of the femur (210), in particular for attachment of an endoprosthesis (100), with at least one support means (20) for supporting on the bone

(200) and a plurality of tool guides (30) for guiding a tool for machining, in particular resection, of the bone (200), characterized

in that the tool guides (30) are aligned with one another in such a manner that a plurality of angularly aligned resection regions can be produced by resection of the bone (200), wherein at least one of the resection regions can be produced, in particular a V-shaped fold, whose at least one apex line is transverse to an edge formed between the resection areas extends.

6. resection template (10), in particular according to one of the preceding claims, for the resection of a bone (200), in particular for attachment of an endoprosthesis (100), with at least one support means (20) for support on the bone (200) and at least one Tool guide (30) for guiding a tool for machining, in particular

Resection of the bone (200), characterized

that the resection template (10) is adapted to an approximately right-angled tibial margin in order to achieve rotational stability. has, preferably approximately at right angles curved contact area for engagement with the shin bone edge.

in that the tool guide (30) is designed as a milling opening (16), in particular with an at least partially arcuate boundary, for guiding a milling head (94) or a plurality of milling heads (94).

Resection template (10), in particular according to one of the preceding claims, for the resection of a bone (200), in particular for the attachment of an endoprosthesis (100), with

at least one supporting device (20) for supporting on the bone (200) and

at least one tool guide (30) for guiding a tool for machining, in particular resection, of the bone (200),

characterized,

in that the resection template (10) has a cantilever (50), at the end of which a contact surface (52) for abutment with the tibia is formed, the abutment surface (52) being at least 10 cm, preferably at least 13 cm, from a support surface of the resection template (52). 10) for a proximal end of the tibia (220).

Endoprosthesis (100), in particular for the femur (210), with a plurality of bearing surfaces (102) aligned at an angle to abutment with correspondingly angularly aligned resection surfaces of a bone (200), in particular of the femur (210), characterized in that at least one reinforcement is present, which runs over an edge formed between the support planes (102) and in particular protrudes from the contact planes (102) aligned at an angle to one another. 10. endoprosthesis (100), in particular according to claim 9, in particular for the femur (210), characterized

in that the endoprosthesis (100) consists of several, preferably at least three, individual parts (130, 132, 134), wherein the individual parts (130, 132, 134) each have at least one support plane (102) for engaging at least one resection surface of a cooking, in particular of the femur (210) are formed, wherein the individual bearing planes (102) are preferably aligned at an angle to each other.

1 1. Endoprosthesis (100), in particular according to claim 9 or 10, in particular for the femur (210), with a plurality of angularly aligned support areas (106, 107, 108) for abutment with correspondingly angularly aligned resection areas of a bone (200), in particular of the femur (210), characterized

in that at least one of the support regions (106, 107, 108) has an unfolded shape, in particular V-shaped, whose at least one crest line extends transversely to an edge formed between the support regions (106, 107, 108).

Endoprosthesis (100), in particular according to one of the preceding claims, in particular for the tibia (220), characterized

in that the endoprosthesis (100) consists of at least two separate prosthesis parts (1 10, 1 12), wherein a first prosthesis part (1 10) for placement on a first side, in particular medial, of the intercondylar tubercle of the tibia (220) and a second prosthesis part (10). 1 12) is designed to be arranged on a second side, in particular laterally, of the intercondylar tubercle of the tibia (220).

13. Milling device (90) for milling a bone (200), in particular a tibial implant bed, preferably the tibial condylar plateau, with a milling unit (92), a handling part (96) for manual handling and in particular a support surface for supporting on a opposite anatomical structure, especially the femur (210).

14. Milling device (90) according to claim 13, characterized in that

the milling unit (92) has a dome-shaped and / or spherical milling head (94).

15. Milling device (90) according to claim 13 or 14, characterized in that the handling part (96) is pivotally mounted relative to the milling head (94) and that by a repulsion of an opposing anatomical structure pressure on the auszufräsenden bone (200) for Milling the bone (200) is exercisable.

16. A method for determining a bearing surface for a resection template (10) with a boom (50) and a contact surface (52) for engagement with the tibia, in which a preferably three-dimensional image of at least a portion of the tibia is recorded, characterized in that during the image of the three-dimensional image is modeled on a mass of the tibia, which is delimited on the three-dimensional image both against bone (200) and against soft tissue on the bone (200).

17. A method for producing a template, prosthesis or orthosis, in particular a limb or joint splint, which is at least partially formed for engagement with an outer, for example skin-covered, body surface of the human or animal body, in particular a limb, wherein a three-dimensional image data set at least a portion of the body or extremity is recorded, wherein, during the acquisition of the three-dimensional image data set, a cuff, preferably filled with a fluid, is arranged around the outer contour of the body or extremity, which delineates both bones and soft tissues in the three-dimensional image data set, and wherein at least one mold section of the template .

Denture or orthosis is formed based on the three-dimensional image.

18. Stencil, prosthesis or orthosis, in particular produced by a method according to claim 17, wherein the template, prosthesis or orthosis is adapted to bear on an outer, such as skin-covered body surface and sleeve, cup, cuff, clamp and / or is clamp-shaped to substantially encompass a limb of the body.

19. A template, prosthesis or orthosis according to claim 18, characterized in that the template, prosthesis or orthosis has a joint, which preferably, in particular based on an individual knee joint endoprosthesis, a sliding hinge, which rigid, partially elastic or elastic struts in accordance with the Bandinsertionen or Burmesterkurve on the knee joint of the natural knee joint movement approximate movement of the template, prosthesis or orthosis permits. 20. A method for maintaining meniscus function by obtaining the original Menisci or replacement of the original Menisci by a meniscus prosthesis, which is in particular made of rubber and fixed to a tibial prosthesis component.