CN111447891A - 带有旋转部件的模块化的内置假体-杆轴*** - Google Patents
带有旋转部件的模块化的内置假体-杆轴*** Download PDFInfo
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Abstract
用于长形骨骼的内置假体‑杆轴***,包括锚固部分(10)和杆轴(1),该杆轴由通过插塞连接部(45)可耦接的各模块部件构成,其中,各部件沿所述杆轴(1)的相对旋转是可调节的,并通过旋转固定件来固定。为了调节旋转,设置了旋转件(5)作为另一模块部件,该旋转件自身独立地具有旋转调节机构(6)和作为旋转的固定件的紧固机构(7)。所述旋转件(5)包括用于所述插塞连接部(45)的两个端侧和外壳(77)。本发明利用旋转件提供了一种用于杆轴的特殊的模块部件,该模块部件作为结构单元在自身独立的单元中既能实现旋转调节,又能实现固定以防非希望的旋转。
Description
技术领域
本发明涉及一种用于长形骨骼的带有模块化杆轴***的内置假体。模块化的杆轴***包括多个待借助插销连接部来耦接的部件。为了调节各部件彼此间的相对旋转,设置了旋转部件,其中,由此调得的位置借助形状配合地作用的旋转固定件来固定。
背景技术
内置假体借助锚固部分保持在骨骼中,且具有杆轴,用于承载关节组件或者代替缺陷的骨骼部分。相应的杆轴可以根据应用情况实现明显的长度。为了在此能够使用易管理(überschaubar)数量的不同的部件来覆盖不同的长度,模块化的***已表明是适宜的。这些***包括多个可插塞在一起的部件,其中,作为插塞连接部,大多设置锥形耦接部。这些锥形耦接部分别包括锥形销和锥形套筒,锥形销和锥形套筒在插塞到一起的状态下通常足够牢固地保持在彼此处,以便能够可靠地且没有移动地传递轴向作用的力以及旋转力。
在植入这种内置假体时,有时产生如下需求:把杆轴转向一定的在解剖上有利的定向。这可以需要用来把布置在杆轴的一端处的假肢顶头带到有利的方向上。对于已知的模块化的杆轴***(例如由汉堡的Link公司提供的Megasystem C),由于任意旋转定向的大的插塞连接部,杆轴的各个组件虽然能够相互连接,但在连接之后难以矫正各个组件之间的相对旋转。此外已知一种模块化的假肢***(例如由Buxtehude(布克斯特胡德)的implantcast公司提供的***MUTARS),其中,沿着杆轴轴线居中地实施用来固定的旋拧部。通过松开这种旋拧部,各个部件可以相对旋转,且在拧紧该旋拧部之后,通过利用齿的配合而连接的各部件被旋转固定。但操纵的前提是,杆轴的上端和下端能够触及。在植入之后这恰恰往往不再是这种情况。
发明内容
本发明的目的是,提供一种用于内置假体的改善的杆轴***,其避免了这些缺点。
根据本发明的解决方案在于独立权利要求的特征。有利的改进方案是从属权利要求的对象。
在一种用于长形骨骼的内置假体-杆轴***的情形中,包括锚固部分和杆轴,该杆轴由通过插塞连接部可耦接的各模块部件构成,其中,各部件沿杆轴的相对旋转是可调节的,并通过旋转固定件来固定,根据本发明设置,为了调节旋转,设置了旋转件作为另一模块部件,该旋转件自身独立地(in sich abgeschlossen)具有旋转调节机构和作为旋转的固定件的紧固机构,其中,旋转件具有用于插塞连接部的两个端侧且具有外壳。
本发明利用旋转件提供了一种用于杆轴的特殊的模块部件,该模块部件作为结构单元在自身独立的单元中既能实现旋转调节,又能实现固定以防非希望的旋转。通过实施成杆轴处的中间件,因而可以在如下这种位置处嵌入在杆轴中:该杆轴适宜地在植入期间和之后可顺畅地触及(其通常是中间的位置)。由此保证即使在植入之后也可调节。尤其在内置假体的情形中,其端部无法触及,或者其定位通过布置在那里的假肢关节来进行(例如对于用于股骨的杆轴:在上方髋部假肢的顶头和在下方膝盖假肢的骨节),因而始终都保证在旋转方向上的取向。但如同能够旋转一样,固定以防不经意的进一步旋转也同样重要。本发明把这两种功能结合在一个部件中,且因而能实现在空间上紧凑地且从触及方面有利地把作为一方面的轻易的可调节性和作为另一方面的明显的固定组合起来。
实施成在模块化的杆轴***中的模块化部件允许本发明也把根据本发明的旋转部件用作已有杆轴***的改装件。应用范围由此显著地拓宽。
从患者的角度来看,本发明提供了对个体解剖学状况的更好的可调节性,且如有可能也可事后实现这一点。由此可以避免麻烦的修复手术。
适宜地,旋转件被如此实施成使其相应于模块化的杆轴***的延长模块部件。通过这种方式可以轻易地用根据本发明的旋转件来更换传统的延长部件。旋转件由此良好地嵌入到已有的模块化的杆轴***中。
适宜地,紧固机构如此实施,从而它具有用于操纵构件的中间作用部(Mittelzugriff,有时称为中间操作部),用来固定(Setzen)和/或松开固定件。中间作用部在此理解为一种用于操纵构件的耦接机构,该耦接机构并非布置在杆轴的起始端或末端处。由于这种中间作用部,即使在植入状态下也可以在杆轴处进行旋转调节,即通过从侧面作用。恰恰对于带有长杆轴的假肢,这种侧面触及通常在解剖学上明显更有利。
优选设置紧固螺母,其在***状态下限定了旋转件的内腔。这种紧固螺母一方面能够实现固定,且另一方面利用其内腔提供了受保护的区域。因而在那里形成了一个腔,该腔适合于容纳敏感的支座组件,如下面还将进一步详述。
另外,紧固螺母适宜地以其外侧面形成了旋转件的外壳的一部分。由此可以实现具有小的直径的紧凑的构造方式,从而根据本发明的内置假体也适合于应用在较细的骨骼处。优选地,紧固螺母具有光滑的(glattflächig)、进一步优选圆的外壳,在该外壳处适宜地构造了用于紧固工具的耦接部件。光滑的外壳提供了最小刺激周围组织的优点。这尤其当外壳圆形地实施时才适用。适宜地,用于紧固工具的耦接部件集成在外壳中。通过这种方式可以在进一步最小刺激周围组织的情况下实现对紧固工具的可靠耦接。有利地,各耦接部件沿周缘方向错开地布置。这能实现在操纵时将紧固工具简单地转移到下一个耦接部件中,且因而最小化对触及距离的要求。
此外,紧固螺母优选具有中央的通孔,插塞连接部的部件引导穿过该通孔。优选地,该部件直接与旋转调节机构的支座插件连接。因而可以由于中央通孔而将力从插塞连接部直接引导至支座,从而紧固螺母本身位于实际力路径之外。支座插件和插塞连接部的部件优选组合地实施,确切地说,尤其是一体地实施。这能实现特别直接的、可靠的且无间隙的力传递。
有利地设置,旋转调节机构的旋转支座完全布置在旋转件中,确切地说,优选包纳(gekammert)在旋转件的内腔中。如前已述,所述内腔能够适宜地通过紧固螺母的内部区域来提供。由此形成用于旋转支座的受保护的区域。因而以有效的方式保护以免污物或脏污。旋转支座适宜地包括支座销和互补的支座套,其中,支座销优选为柱形。柱形设计提供了实际优点:在保持旋转支座的功能性的情况下保证了轴向的可移动性。可以说,还有移动关节集成到旋转支座中。支座销和支座套因而优选形成无间隙的且不会卡死的配合。通过这种方式,保证了高的且可靠的力传递,且尽管如此实现了良好的可旋转性。
适宜地,在内腔中布置了固定机构的作用到旋转支座上的锁定圈。该锁定圈适宜地实施成多齿圈。多齿圈接合到旋转支座中,并且阻止进一步的旋转。适宜地,锁定圈布置在支座箱的基底处。锁定圈于是可以作用到支座销的端面上。优选地,为此在支座销的端面处布置互补的齿,锁定圈在锁定状态下形状配合地与该齿共同作用。
为此目的,紧固螺母优选如此实施,从而它在第一紧固位置中将锁定圈压到旋转支座上,且因此将其卡住,而在第二打开位置中使得锁定圈离开旋转支座,从而旋转支座可活动。因而可以通过操纵紧固螺母,尤其是通过旋拧,将旋转支座固定或松开。
在一种适宜的实施方式中,旋转件两部分地实施,带有旋转部分和间隔部分。旋转部分包括真正的旋转调节机构和紧固机构。间隔部分基本上用作优选可更换的延长部件。适宜地,间隔部分在其一端处抗扭地与旋转件连接,且在其另一端处具有插塞连接部的配合部件。优选地,间隔部分和/或支座插件实施成可分别用带有不同插塞连接器的其它件来更换。因此可以通过更换这两个组件来使得根据本发明的旋转件适配于其它的插塞连接部。由此实现明显更宽的可应用性。
附图说明
下面参照附图借助有利的实施例进一步介绍本发明。其中:
图1a-c示出用于股骨的带有旋转件的模块化杆轴***在不同阶段的侧视图;
图2示出该旋转件的侧视图以及剖视图;
图3示出该旋转件的剖视分解图;
图4示出模块化的杆轴的俯视图,其带有用于紧固和调节旋转的工具;
图5a、b示出模块化的杆轴的在旋转之前和之后的状态图。
具体实施方式
在这些图中示出了一种模块化的杆轴***,其应用在股骨处且部分地替代股骨。
该模块化的杆轴***具有杆轴1,该杆轴带有膝关节-内置假体的髁关节组件2,该关节组件布置在杆轴的下端处。在上端,在股骨头中设置有锚固件3,其中,锚固件3在当前构造成松质骨钉。
杆轴1在构造方式上由多个模块部件构成。该杆轴在上部区域中包括锚固部分10,以及在下部区域中包括模块化的延长部分4,该锚固部分用于锚固在股骨骼的上部分的髓管中。关节组件2作为其它模块部件布置到延长部分4上。模块化的延长部分4是各种不同的延长件的套装件(Baukasten,有时称为组合部件)的一部分,这些延长件可以具有不同的长度。
在锚固部分10与延长部分4之间布置根据本发明的旋转件5的一个实施例。该旋转件通过插塞连接部45既与延长部分4又与锚固部分10承载地连接。可以在延长部分4与关节组件2之间布置另一插塞连接部。
在装配假肢时,必须相对于股骨骼9保持一定的角度位置。该角度位置在上部区域中通过锚固件3的取向来限定,且在下部区域中通过关节组件2的定向来限定,该关节组件形成了膝关节假肢的上部部分。首先把锚固部分10***到股骨骼9的骨髓洞中,并且在股骨骼9的顶头区域中钻出用于锚固部件3的接纳通道93。然后装配带有旋转部件5、延长部分4以及关节组件2的假肢。在接下来的步骤中,***锚固部件3,且由此使得假肢在其角度位置方面相对于股骨骼9固定。在随后的手术过程中,于是需要将关节组件2取向,用来使其按规定用作膝关节假肢的部件。为此必须适配其旋转位置。这按如下方式来进行:使用合适的工具8来引起旋转件5的旋转,并将其固定在旋转后的位置中。
接下来介绍旋转件5的构造和工作方式。旋转件5包括用来调节旋转的旋转调节机构6以及用来固定所调好的旋转的紧固机构7。在这里,旋转件5的上部区域和下部区域相对旋转,从而结果使得关节组件2相对于锚固部分10旋转。通过这种旋转调得的位置也称为“旋转-位置”。进行这种旋转所经过的角度称为旋转角度α(参见图5b)。
旋转调节机构6包括旋转支座60,该旋转支座由支座销62和支座套63构成。支座销62布置在基体54处,而支座套63布置在支座插件61处。支座销62柱形地构造,且支座套63相应地实施成用于支座销62的配合套筒,从而该支座销无间隙地且不会卡死地安置在该支座套中。在此,支座销62在轴向方向上不同于支座插件61。在基体54处,在与支座销62相对的一侧处,构造了插销连接部45的锥形套筒52。基体54因而形成了旋转调节机构6的上部区域。
支座插件61在其与支座套63相对的一侧处具有插销连接部45的锥形销51。支座插件61因而形成了旋转调节机构6的下部区域。通过支座插件61相对于基体54的相对旋转,可以在杆轴1中引起所希望的旋转。为了简化这一点,在基体54处构造了平坦部66,这些平坦部用作工具扳手81的接纳部。由此可以旋转基体54。通过这种方式可以调得所希望的旋转角度α。
为了固定由此调得的旋转位置,设置了固定机构7。该固定机构包括带有中央通孔71的锁紧螺母(Hutmutter,有时称为盖形螺母)70。该固定机构在其内部具有内腔74,在该内腔的内壁处,在与通孔71相对的一端处,设置了内螺纹76,在***状态下,该内螺纹与设置在基体54处的互补的外螺纹56接合。在锁紧螺母70的内部形成了与通孔71连通的腔74。在***状态下,锁紧螺母70利用其通孔71被推动经过支座插件61的锥形销51,确切地说,被推动如此远,直至内螺纹76接合到外螺纹56中。通过旋转,因而可以将锁紧螺母拧紧,由此操纵紧固机构7(或者通过反向旋转而松开)。在此,在通孔71的区域中构造了凸肩75,该凸肩作用到支座插件61处的凸缘65上。通过将锁紧螺母70拧紧,该锁紧螺母进一步拧到螺纹56、76上,并由此朝向基体54移动,从而凸肩75作用到支座插件61的凸缘65上并带动该凸缘。该凸缘因而同样朝向基体54移动,确切地说,移动如此远,直至抗扭地布置在支座套63的基底处的采用多齿设计的锁定圈73接合到相应地互补成形的配合圈72中,该配合圈抗扭地布置在支座销62的尖端处。因此,通过将锁紧螺母70拧紧,多齿圈73和配合圈72相互接合,从而防止支座套63相对于支座销62进一步旋转。由此操纵紧固机构7,并且将旋转支座60固定,以防非希望的旋转。通过旋转松开锁紧螺母70,可以相应地将紧固机构7松开,以便由此又可以实现旋转支座60的旋转。
锁紧螺母70在此利用其内腔74形成了用于旋转支座60的腔室。由此保护旋转支座,以防否则会危及顺畅的(einwandfrei,有时称为无问题的)支座功能的异物和污物进入。
此外,锁紧螺母70在其外壳77处具有多个在周缘方向上错开的径向开口,这些径向开口用作操纵工具80的耦接部件55。该操纵工具在其顶头处具有相应的突出部(未示出),这些突出部形状配合地接合到耦接部件55中,并由此能够实现通过旋转来操纵锁紧螺母70。借助附接到基体54的平坦部66处的工具80,可以在需要时反向保持(gegenhalten),以便由此还使得杆轴保持无力。
两个工具80、81的该附接过程在图4中示出,以便由此松开紧固机构7,并且可以实现使得关节组件2相对于带有锚固部件3的上面的杆轴部分相对旋转。围绕旋转角度α的这种旋转在图5a和5b中示出。
自身闭合的带有布置于其中的旋转部件6以及紧固机构7的旋转件5因而能以紧凑的方式一方面实现杆轴的旋转,且另一方面实现有效的固定,以防非希望的调节(Verstellung,有时称为移位),其中,通过从一侧经由外壳77进行的操纵,可以实现在操作技术上更有利的作用(Zugriff,有时称为操作)。这在当前称为间接作用,与通过杆轴端部进行的作用相反。
此外,在本发明的一种变型中,能够设置一种两部分式的实施方案,其中,在本来的旋转件5处固定地布置间隔部分。该间隔部分如同短的延长件那样实施,在其各端侧处带有销连接部,也就是在其一侧处带有销锥部,且在相对的端侧处带有销套管。该间隔部分以其销锥部***到旋转件5的销套管52中。通过如此提供的插塞连接部45,以及通过用作附加的固定件的埋头螺钉57,使得间隔部分牢固地与旋转件5连接。采用这种方式,仅仅通过更换间隔部分就能改变长度,而不必对旋转件5本身进行结构上的改变;旋转件5本身可以保持不变。由此明显便于使得旋转件5与不同的套装件***适配。
Claims (15)
1.用于长形骨骼的内置假体-杆轴***,包括锚固部分(10)和杆轴(1),该杆轴由通过插塞连接部(45)可耦接的各模块部件构成,其中,各部件沿所述杆轴(1)的相对旋转是可调节的,并通过旋转固定件来固定,
其特征在于,
为了调节旋转,设置旋转件(5)作为另一模块部件,该旋转件自身独立地具有旋转调节机构(6)和作为旋转的固定件的紧固机构(7),其中,所述旋转件(5)具有用于所述插塞连接部(45)的两个端侧且具有外壳(77)。
2.根据权利要求1所述的带有模块化杆轴***的内置假体-杆轴***,其特征在于,所述旋转件(5)用作延长模块部件。
3.根据权利要求1或2所述的内置假体-杆轴***,其特征在于,所述紧固机构(7)具有用于操纵构件(81)的中间作用部,用来固定和/或松开所述固定件。
4.根据前述权利要求中任一项所述的内置假体-杆轴***,其特征在于,在外壳侧在所述旋转件(5)处设置用于调节所述旋转固定件(7)的触及部。
5.根据前述权利要求中任一项所述的内置假体-杆轴***,其特征在于,设置有紧固螺母(70),该紧固螺母在***状态下限定所述旋转件(5)的内腔(74),其中,所述紧固螺母(70)优选以其外侧面形成所述旋转件(5)的外壳(77)的一部分。
6.根据权利要求5所述的内置假体-杆轴***,其特征在于,所述紧固螺母(70)具有光滑的、优选圆的外壳(77),在该外壳处构造用于紧固工具(81)的耦接部件(55),所述耦接部件优选地沿周缘方向错开地布置。
7.根据权利要求5或6中任一项所述的内置假体-杆轴***,其特征在于,所述紧固螺母(70)具有中央的通孔(71),插塞连接部的部件引导穿过该通孔,其优选地直接与所述旋转调节机构(6)的支座插件(61)连接。
8.根据权利要求7所述的内置假体-杆轴***,其特征在于,所述支座插件(61)和插塞连接部(51)的部件组合地、优选一体地实施。
9.根据前述权利要求中任一项所述的内置假体-杆轴***,其特征在于,所述旋转调节机构(6)的旋转支座(60)完全布置在所述旋转件(5)中,确切地说,优选包纳在内腔(74)中。
10.根据权利要求9所述的内置假体-杆轴***,其特征在于,所述旋转支座(60)包括优选柱形的支座销(62)和互补的支座套(63),其中,所述支座销(62)和所述支座套(63)优选形成无间隙的且不会卡死的配合。
11.根据权利要求9或10所述的内置假体-杆轴***,其特征在于,在所述内腔(74)中,优选在所述支座套(63)的基底处,布置有所述固定机构的作用到所述旋转支座(60)上的锁定圈(73)。
12.根据权利要求11所述的内置假体-杆轴***,其特征在于,所述紧固螺母(70)在第一紧固位置中将所述锁定圈(73)压到所述旋转支座(60)上,且因此将其卡住,而在第二打开位置中使得所述锁定圈(73)离开所述旋转支座(60),从而所述旋转支座(60)可活动。
13.根据前述权利要求中任一项所述的内置假体-杆轴***,其特征在于,所述旋转件(5)两部分地实施,带有附接的间隔部分。
14.根据权利要求13所述的内置假体-杆轴***,其特征在于,所述间隔部分在一端处抗扭地与所述旋转件(5)连接,且在其另一端处承载有所述插塞连接部(45)的配合部件。
15.根据权利要求14所述的内置假体-杆轴***,其特征在于,所述间隔部分和/或所述支座插件(60)可分别用带有不同插塞连接器的其它件来更换。
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2017
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- 2017-12-15 EP EP17207776.0A patent/EP3498230B1/de active Active
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2018
- 2018-12-11 RU RU2020123102A patent/RU2020123102A/ru unknown
- 2018-12-11 US US16/772,766 patent/US11654029B2/en active Active
- 2018-12-11 JP JP2020531987A patent/JP2021511096A/ja active Pending
- 2018-12-11 AU AU2018385372A patent/AU2018385372A1/en not_active Abandoned
- 2018-12-11 MX MX2020006203A patent/MX2020006203A/es unknown
- 2018-12-11 CN CN201880081005.8A patent/CN111447891A/zh active Pending
- 2018-12-11 BR BR112020011085-0A patent/BR112020011085A2/pt not_active Application Discontinuation
- 2018-12-11 WO PCT/EP2018/084335 patent/WO2019115515A1/de active Application Filing
-
2020
- 2020-06-07 IL IL275176A patent/IL275176A/en unknown
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2023
- 2023-04-17 US US18/301,873 patent/US20230285157A1/en active Pending
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Also Published As
Publication number | Publication date |
---|---|
WO2019115515A1 (de) | 2019-06-20 |
US20230285157A1 (en) | 2023-09-14 |
ES2833873T3 (es) | 2021-06-15 |
AU2018385372A1 (en) | 2020-07-02 |
JP2021511096A (ja) | 2021-05-06 |
US20200306049A1 (en) | 2020-10-01 |
EP3498230B1 (de) | 2020-10-28 |
IL275176A (en) | 2020-07-30 |
BR112020011085A2 (pt) | 2020-11-17 |
RU2020123102A3 (zh) | 2022-01-13 |
US11654029B2 (en) | 2023-05-23 |
EP3498230A1 (de) | 2019-06-19 |
RU2020123102A (ru) | 2022-01-13 |
MX2020006203A (es) | 2020-08-27 |
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