CN112165918A - 髋关节或肩关节假体及其放置装置 - Google Patents

髋关节或肩关节假体及其放置装置 Download PDF

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Publication number
CN112165918A
CN112165918A CN201980034741.2A CN201980034741A CN112165918A CN 112165918 A CN112165918 A CN 112165918A CN 201980034741 A CN201980034741 A CN 201980034741A CN 112165918 A CN112165918 A CN 112165918A
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component
tubular
diaphyseal
kirschner wire
handle
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CN201980034741.2A
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Inventor
哈维尔·科尔特斯·库韦罗
卡洛斯·M.·阿蒂恩扎·维森特
安德烈斯·皮埃拉斯·赫拉伊斯
费尔南多·加西亚·托雷斯
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Biomaterial Innovation And Development Co
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Biomaterial Innovation And Development Co
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Publication of CN112165918A publication Critical patent/CN112165918A/zh
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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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    • A61F2002/4677—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using a guide wire
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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

假体包括基本上呈半球形形状的球形部件(1)，其由干骺端部件(2)支撑；所述干骺端部件(2)与用于骨干钉(3)通过的横向开孔(21)对齐，其设置用于***到股骨管或肱骨管中。干骺端部件(2)，通过纵向互锁结构(24)结合骨干钉(3)，纵向互锁结构穿过骨干钉(3)。所述装置包括部件(100)，用于定心K‑导线，其能够将K‑导线(102、102’)合适定位，和管状提取器(200)用于股骨头或肱骨头，和用于假体元件的各自的引入件(300、400、500)。

Description

髋关节或肩关节假体及其放置装置
技术领域
本发明涉及髋关节或肩关节假体(或关节置换术)以用于在所要求的任何情况下可以替换股骨头或肱骨头，并且能够通过对于病人相对平和的方法安装。
本发明也涉及用于放置所述假体的装置，均能够以微创方式。
背景技术
在正常医学实践中，有时需要进行髋关节或肩关节替换，换句话说，以去除股骨头或肱骨头并且放置能够恢复关节功能的装置，称为髋关节或肩关节假体或关节置换术。这可能由于不同的原因，例如骨折、关节炎、瘤形成等。
然而，假体放置方法，不管用于髋关节或肩关节，具有非常的侵犯性并且此手术过程包含非常严重的危险。
任何替换髋关节或肩关节假体(或关节置换术)的方法，在所要求的任何情况下，用于减少外科手术侵犯性的影响，必须克服两个重要的问题：
1.如何以最小侵入的方式去除股骨头/肱骨头，以减少对患者的损害？
2.取下股骨头/肱骨头后，哪种类型的设备可以轻松植入并且侵犯性更小。
关于第二个问题，在髋关节的示例中，已知有专利US2003060889，US2016256281和US2002095214的假体。这些专利中，每个包括用于髋臼或股骨头的替换假体，其由更小的元件组成并且原位相互连接。
在肩关节的示例中，尽管由于关节和其组件的大小原因，或多或少存在不同问题，但是肱骨头的移出存在相似。
申请人不知道任何为解决这两个初始问题的发明方案相似的任何假体或工具。
发明内容
本发明包括：
根据权利要求，髋关节或肩关节假体，由在人体内相互组装的多个部分组成。
根据所对应的权利要求，用于放置这个假体的装置。
在其不同实施例中描述的髋关节或肩关节假体以及其装置，克服现有技术的问题。
在整个说明书中，形容词“上”和“下”应当认为以非限制性的方式使用。它们的使用为了让本发明更加容易理解，并且不需要复杂的解释。具体地，“上部”可以理解为在实际使用时，该元件最靠近患者头部非区域。相反地，“下部”是指距患者头部最远的部位。
髋关节或肩关节假体的目的是为了在放置是必需的任何情况下，减少进行所要求的髋关节或肩关节置换手术引起的并发症。由于这个原因，假体的设计优选考虑如下方面，其放置要求外科手术技术，即在植入时，该技术相对地就不易受到生物力学的要求。
假体和其装置的设计能够让其以微创的方式进行经皮定位，与通常的假体手术相比，可以最大程度地减少手术的侵害。
在髋关节的示例中，针对假体置换，股骨近端髓内钉形成相同的切口，例如Stryker制造的Gamma钉或Synthes制造的PFNA钉。这假体可以通过两个切口放置在肩关节。
髋关节或肩关节假体用于更换股骨头或肱骨头，其包括如下组件：
1.基本上呈半球形形状的球形部件(在髋关节假体的示例中替换股骨头，在肩关节假体的示例中代替肱骨头)。所述部件具有背面，此背面具有孔和其中形成的凹槽，以便于将其***到患者体内。
2.干骺端部件附接到形成大致直型的元件的孔，该大致直型的元件具有横向的、近似中心的孔。所述干骺端部件具有附接到球形组件的孔的杆。所述部件具有穿过孔的纵向孔，所述孔的开头放置在与柄相对的一侧。
3.第三，所述假体包括骨干钉，其可以***到股骨管或肱骨管中。所述的钉具有第一部分，在此第一部分中，设置一个或多个固定孔，用于一个或多个螺钉以用于固定到股骨或肱骨，螺钉可以穿过干骺端部件的孔。其也具有第二部分，其部分地安置在干骺端部件的孔中。
4.最后，所述假体具有锁定装置，配置成在孔内被接受并且穿过骨干钉的第二部分。
在第一优选实施例中，所述干骺端部件在其整个表面具有凹槽。
优选地，所述锁定装置完全穿过骨干钉并且在其端部呈螺纹的。
更优选地，所述钉在第二部分内具有支架，其放置在干骺端部件上并且依靠在所述杆的相对侧。
本发明也涉及多个装置，其协助放置假体。
首先，这涉及用于股骨头或肱骨头的管状提取器，其包括管状部分。所述管状部分的一端具有把手，另一端具有钻头。所述钻头可以是圆锥形或圆柱形的，以能够让第一Kirschner导线紧紧地穿过其端部或中心。因此，管状提取器可以引导至股骨头或肱骨头，而通道的公差不影响结果。为了让Kirschner导线穿过，把手必须具有相应的孔。
在优选的实施例中，所述钻头由多种聚集的并且稍微柔性的元件组成。在此实施例中，管状部分的内径大于第一Kirschner导线的内径，以使得如果可以，可以***钻头的扩展器，其分离聚集的元件并且帮助所述钻头锁定在股骨头或肱骨头内。
本发明也涉及位于股骨头或肱骨头干骺端、颈和头内的Kirschner导线定心装置，其具有基本上倒“U”型形状。此倒“U”型形状具有两个元件组成：一端的定心钉和相对端的手柄引导件。
定心钉用于***股骨管或肱骨管内，并且在其下端部具有垂直开口；
在定心钉***到股骨或肱骨内时，手柄引导件保持在体外，同时在其下端部具有垂直开口；所述垂直开口的上边缘与定心钉的垂直开口的上边缘对齐。这种对齐方式可以通过布置在手柄引导件的垂直开口的套筒装置实现。这个套筒具有上通道，用于第一Kirschner导线，与定心钉的垂直开口的上边缘对齐。
因此，垂直开口可以是直型的或者具有与套筒互补的形状。所述套筒可以具有用于第二Kirschner导线的另外通道。
本发明也涉及球形部件***装置，其也具有倒“U”型形状，具有手柄，此手柄具有通过下边缘的打开凹槽，和具有上边缘，此上边缘定向于安装于***装置的球形部件。针对此安装，球形部件***装置具有支撑，其与球形部件的凹槽互补，并且可以利用从外部使用的致动器释放(例如，使用手柄)。
另外地，本发明包括用于干骺端部件***的装置，其包括直型的空心杆，其在一端具有用于干骺端部件的可释放钳子，和在相对端具有抓手。
优选地，其包括两个管状同轴主体，并且钳子在外部管状主体上的卡扣闭合的突起组成，用于干骺端部件相对应的夹子，其也具有靠近抓手的螺纹，用于锁定两个管状主体的相互运动。
最后地，本发明也涉及用于骨干钉的***装置，其与所述钉共同使用，其具有倒“U”型形状，具有手柄，此手柄具有凹槽，此凹槽朝向在第一端朝向下部和在相对端用于骨干钉的可移动连接。设置此凹槽用于固定干骺端部件的***装置。所述手柄可以为Kirschner导线定心装置的手柄引导件相同的元件，通过可移动连接仅改变定心钉。再者，其可以为球形部件***装置的手柄，用于定位球形部件的支撑。
所述定心装置的手柄引导件，球形部件***装置的手柄和骨干钉***装置的手柄可以均具有一组标记，这标记对于X射线的透明度不同于所述定心装置的其余部分，具有不同的展开角，换话句话说，其具有以不同展开角度定向的横向深度。
如下显示其他假体和不同装置的变型。
附图说明
为了更好的理解本发明，参照如下非限定实施例的附图。
图1是位于合适的球形部件的***装置内的球形部件实施例的透视图；
图2是靠近球形部件的干骺端部件实施例的透视图；
图3是根据图1和图2实施例安装的骨干钉和假体的透视图；
图4是前球形部件***装置的透视图；
图5是Kirschner导线定心装置(定心钉和手柄引导件)的透视图；
图6是具有放置在患者身体上(本例子为髋关节)套筒的实施例的Kirschner导线定心装置的透视图，显示切口。
图7是股骨头或肱骨头提取器的第一形式的透视图；
图8是干骺端部件的***装置的透视图；
图9显示干骺端部件的***装置的细节图；
图10为球形部件和干骺端部件***装置耦连的透视图；
图11为骨干钉和骨干钉***装置实施例的透视图；
图12为定向标记的详细视图；
图13为锁定装置的示意图；
图14为股骨头或肱骨头提取器的第二实施例的示意图；
图15为图14所示的股骨头或肱骨头提取器的纵向剖视图。
具体实施方式
本发明的实施例以非限制性示例的形式简单描述。针对髋关节假体的描述，尽管正如所说明的，也可以适用于肩关节假体。
根据本发明的假体，由三个独立主体组成，它们在图中所示的实施例中，对应于：
球形部件1，基本上呈半球形形状，其可以为双极/双关节或单极。
干骺端部件2，用于支撑球形部件1，在患者体内与球形部件连接。它具有不同长度以控制股骨偏移。
骨干钉3，其穿过干骺端部件2的孔21，以为了固定在合适位置。骨干钉具有不同直径和长度。
在图1中，显示球形部件1，其具有球形面11，其可以形成基本上半个球形，尽管其可以可选地形成为稍微大于半个球形，或者稍微小于半个球形。它也具有背面12，用于固定干骺端部件2，并且因此包括孔13，示例中其为有螺纹的。理想情况下，螺纹是圆锥形的。球形部件1的背面12具有凹槽14，其用于第一装置，即球形部件***装置300。球形部件1具有不同大小，由此外科医生可以选择最合适的部件。
图2显示的干骺端部件2通过杆22连接球形部件1，其可以为螺纹的或者包括其他类型固定器，以与孔13保持一致。所述部件也具有横向孔21，通过此横向孔，骨干钉3***其中，所述骨干钉3放置在股骨管中并且能够同时固定部件1和2。所述部件在杆22的相反侧也包括纵向孔23，其中***锁定装置24以将干骺端部件2刚性连接到骨干钉3。所述锁定装置24通常呈螺纹的，其端部整体通过或部分通过骨干钉3。在所示的实施例中，干骺端部件2在其整个面上具有凹槽以改善在股骨内的支撑。同时存在其他类型的表面处理。
最后，骨干钉3配置用于***到股骨管中，具有横截面增大的第一部分31，其中一个或多个固定孔32配置为一个或多个用于固定到股骨的螺纹。骨干钉3的第二部分33配置成结合在横向孔2内，其上部分向上突出。所述骨干钉3用于接受锁定装置24。在图3中，所述骨干钉3在干骺端部件2的孔21的边缘处具有支撑架34，其可以在骨干钉3***时形成止动并且在患者将腿靠在手术腿上时有助于传递关节运动和行走负荷产生的力矩。
形成在干骺端部件2和骨干钉3之间的角(颈部-骨干角)接近125°(其可以更大或更小，例如120°或130°之间)。
接下来，描述了放置髋关节假体的优选方法，并且描述必要装置。这些装置作为本发明的部分，其最适于放置假体元件的方式。
假体放置方式要求两个或三个切口(图6)：
上切口(IS)，稍微靠近大粗隆；
中切口(IM)，其由Kirschner导线根据Kirschner导线定心装置而进入的位置确定；
下切口(未显示)，其由远端螺纹的位置确定。下切口不是必需的，是因为可以与中切口(IM)一致。
首先，去除股骨头。这可以使用管状股骨头或肱骨头提取器200实施，其***到中切口中(IM)。为了去除股骨头，管状股骨头提取器200必须以最可能垂直和居中的方式***到股骨头的松质骨内。
相应地，第一Kirschner导线102作为引导，沿中切口(IM)***。第二Kirschner导线102’也可以沿中切口(IM)施加，如下所示。
所述Kirschner导线，作为管状股骨头提取器200的导件，其定心在股骨头骨干、颈和头。Kirschner导线102、102’通过具有基本倒“U”型形状的Kirschner导线定心装置100锁定到正确位置。
所述Kirschner导线定心装置100在一端具有Kirschner导线定心钉101，和手柄引导件104，其形成Kirschner导线定心装置100的其余部分。定心钉101用于穿过上切口IS***到股骨管中，同时手柄引导件104安置在患者体外。
定心钉101***之前，利用合适直径的钻头完成进入到大粗隆的端部内上切口IS，在髋关节的关节囊的上部区域中形成一个开口，所述开口能够让股骨头通过此开口通过管状股骨头提取器200移除。
定心钉101和手柄引导件104在其下部上具有垂直开口105、105’，以能够在放置Kirschner导线102、102’时，去除Kirschner导线定心装置100。此两个开口的上边缘可以对齐。
所述第一Kirschner导线102的定心位置是重要的，并且外科医生必须使用在手术室内可用的图像增强器或利用其他类似方法检查其位置。
图5和图6显示Kirschner导线定心装置100，其安置在使用位置，利用放置的Kirschner导线102和102’。可以使用套筒103对齐两个Kirschner导线102和102’，其能够从手柄导轨104上去除。在使用套筒103时，所述套筒具有用于第一Kirschner导线102的上通道，其可以实际上与定心钉101的垂直开口105的上边缘对齐。所述套筒103具有用于多个Kirschner导线102、102’的多个通道。
Kirschner导线102、102’定位之后，去除Kirschner导线定心装置100和套筒103(如果使用)。
图7所示的管状提取器的优选实施例，其包括管状部分201，换句话说，管状的，在一端具有抓手202和另一端具有钻头203，其为圆锥形或圆柱形。钻头203能够让第一Kirschner导线102紧紧穿过其中心。因此，管状提取器200可以引导至股骨头，并且通道的公差不影响结果。
在一个实施例中，钻头203可以形成多个内部聚集并且稍微柔性的元件。在此实施例中，所述管状部分201的内径大于第一Kirschner导线102的直径，由此，钻头203的扩展器(未显示)可以***，其能够分离聚集元件并且有助于将钻头203锁定到股骨头内。
第二Kirschner导线102’可以用于将股骨头锚定以能够在管状股骨头提取器200***到股骨头内时防止转动。因此，这是可选地。图6所示，第二Kirschner导线位于第一Kirschner导线102下方，但是准确位置可变。
图14显示管状提取器200的第二示例，其也包括管状部分201，抓手202和钻头203。另外地，该技术方案具有保持器204，其作用在伸缩爪205上，此伸缩爪205靠近钻头203伸出或缩回。在所示的实施例中，保持器204为管状部分201内部的螺钉206上的螺母(nut)，该螺母也可以为管道状以能够Kirschner导线102穿过。如图15所示，在所述螺纹连接到其上时，内部螺纹206可以伸出或缩回伸缩爪205。
所述伸缩爪205的端可以布置成在穿过孔时靠近或位于钻头203内而打开，所述孔为此目的而设置。例如，如图所示，所述端可以具有弯曲内部部分(朝向钻头定向)以形成倾斜面，其起始有助于所述管状部分201伸出。
因此，在钻头锁定在其上时，外科医生可以增加在股骨头或肱骨头的抓取力，以防止相对旋转。
在将管状股骨头提取器200***穿过中间切口IM之前，股骨的外侧皮质骨必须是被从相同中间切口利用足够直径的钻头钻孔，以使得管状提取器200穿过其制成的孔。空心钻头，使用相同Kirschner导线作为引导，用于此类钻孔。
下一步骤是将管状股骨头提取器200从中间切口MI***到股骨头。当到达股骨头的松质骨时，同时所述骨在接近软骨下骨时，骨头变得更硬，利用管状提取器200的旋转获得更大的抓取。当***管状提取器200时，第二导线防止所述骨头在臼内旋转。
但股沟头固定到提取器，Kirschner导线102、102’可以移除并且患肢内收。然后，利用管状股骨头提取器200，股骨头可以通过关节上部分错位(通过已经在关节囊上部区域形成的开口)用于通过上切口IS提取。在提取时，管状提取器200能够通过中间切口IM去除。
利用此股骨头去除技术，关节囊的整体性和髋臼唇得到保持。这意味着，髋关节保持器自身稳定元件，提供正确稳定性的装置并且防止错位。与其他假体方法(髋关节关节置换术)相比，这也需要更小的切口并且更小软组织分离，因此能减少手术过程中的流血。
进一步地，使用球形部件***装置300，球形部件1安装在其上。在图1和图4所示的实施例中，所述***装置稍微类似于Kirschner导线定心装置100，其中所述***装置具有弯曲手柄301和用于球形组件1的支撑件302。这支撑件302足够刚性连接到球形组件1的凹槽14，并且凹槽14可以按照需要利用外部致动器303释放，在此示例中，外部致动器为螺纹，其分离支撑件302的臂。
正如所示，球形部件***装置300的手柄301具有凹槽304，其定向球形部件1的孔13。换句话说，***凹槽304内的任何直向装置都可以接触孔13，而不需要进一步操作。所述凹槽304的下部分可以开口以能够让手柄301提取，而不管凹槽304内放置的元件。
因此，使用干骺端部件***装置400，其包括两个空心、细长的同轴杆401、402。外部管状杆401包括钳子403用于一端的干骺端部件2，并且所述内部杆402在相对端具有抓手404。外部杆401具有合适的外径，用于在放置在凹槽304内(图10)时完美地与孔13对齐。外科医生可以将干骺端部件2***穿过中间切口IM，并且将所述部件以合适方式固定到孔13，例如利用螺纹。干骺端部件***装置400上的指示可以向外科医生说明，当所述部件对于孔21位于正确位置以完美地接受骨干钉3。
图9显示优选干骺端部件***装置400的两个详细实施例。两个杆401、402之间的相对移动可以让钳子403释放或固定。可以看到的是，钳子403由外部管状主体上的卡口式闭合的突起406组成，用于对应干骺端部件2的钳子。再者，两个突起405安置在内杆402上，其必须进入干骺端部件2的对应切口25。如果杆401、402相互旋转，突起405确保干骺端部件2螺纹接到孔13内。如果所述杆独立旋转，突起405可以引起钳子403以卡口结构不连接。靠近抓手404的螺纹407，刚性连接同轴杆401、401之间的移动(紧靠外杆401和凸缘408)，其可以相对于杆401、402滑动，但不能相对于内杆402转动。齿形，或其他方法，能够确保凸缘408的关闭，并且防止外杆401旋转。
当球形部件1固定到干骺端部件2时，可以去除球形部件***装置300，通过致动器303释放凹槽14。
下一步地，骨干钉3可以使用骨干钉***装置500放置，如图11所示。所述骨干钉***装置500具有手柄501，其与球形部件***装置300的手柄301一致。在其下部分具有凹槽503，用于保持干骺端部件***装置400。骨干钉3以可移除的方式安置在骨干钉***装置500的另一端。所述骨干钉***装置500具有骨干钉3的释放机构504，其可以从外部操作，例如，保持或释放骨干钉3的螺钉。
骨干钉***装置500可以形成有用于远端螺钉或相应工具通过的孔口(506)。如图6所示，中间切口IM由此用于放置。
骨干钉3通过上切口IS***，直至所述钉穿过干骺端部件2的孔21。在骨干钉3锁定时，其第二部分33的大小与孔21的大小关联，尤其是在骨干钉3具有支架34时。
当骨干钉3处于位置时，锁定装置24***穿过干骺端部件***装置400的内杆402内，并且适合地拧紧或紧固。优选地，锁定装置24终止于螺纹区域。锁定装置24可以预先安装在干骺端部件2内，或者干骺端部件***装置400内，以使得此固定仅需要使用固定或拧紧工具。
在锁定工具24放置时，干骺端部件与干骺端部件***装置断开连接。此时，选择髋关节假体装置相对于股骨前倾。
在附图中，尤其是图12中，可以看出，手柄301、手柄501和手柄引导件104具有一系列的定向标记505，其能够让外科医生确定球形部件***装置300或Kirschner导线定心装置100的角度定向(前倾)。所述一系列标记包括物体(例如孔、***物等)，其相对于X射线的透明性不同于装置的其余部分。每个物体具有不同角度(“0°，8°和16°”，“0°，10°和20°”，“0°，5°，10°和15°”等)。
因此，当外科医生使用图像增强器，标记505，不会变形，以显示相对于股骨的前倾角度。图12显示，相对于第一标记505的角度，因此所述标记为不会变形但其他会。
手柄301，手柄引导件104或手柄501可以一致或可以为相同部件。
在选择前倾时，骨干钉3可以通过放置远端螺钉来固定到股骨。在骨干钉3的下部分处，一个或多个远端螺钉布置在每个固定孔32。这种***方式可以为现有技术的任何已知方法，是否通过下切口或通过中切口IM，这依赖于固定孔32的位置或定向。
当此操作之后，撤回骨干钉***装置500，让髋关节假体装置放置在其最终位置。
因此，除了假体之外，本发明包括整系列的优选装置，其设计成有助于其放置和去除股骨头：
Kirschner导线定心装置100；
管状股骨头或肱骨头提取器200；
球形部件***装置300；
干骺端部件***装置400；
骨干钉***装置500。
可以看出的是，两个第一***装置300，400作为下一个***装置的***过程的引导件。换句话说，球形部件***装置300作为用于***干骺端部件***装置400的引导件，并且其反过来会作为***骨干钉500的引导件(图10)，因此，减少误差和便于外科医生操作。
然而，可以使用其他不同装置，以能够让假体在使用位置组装，但不便于外科医生操作，例如，一直使用直型***装置。
再者，从假体到股骨的负荷传递可以分布到多个点：干骺端部件2将负荷传递到骨距，而骨干钉3通过相应的固定孔32将其负荷传递到骨干和每个远端螺钉。所有这些提供足够的稳定性并且因此粘结固定不是强制的，这可以避免粘结髋关节假体的并发症。
然而，如果粘结固定是优选的，干骺端2和/或骨干钉3可以具有通道，以能够在位置时让粘结剂从外部引入，例如通过插管、注射器等，以为了增加假体和股骨不同部分的接触。
所有材料必须为生物兼容的，尤其是保持在体内的部分。

Claims (18)

1.髋关节或肩关节假体，用于替换股骨头或肱骨头，包括：
基本上呈半球形形状的球形部件(1)，具有背面(12)、孔(13)和凹槽(14)；
干骺端部件(2)，由直型元件组成，具有横向、大致中心的孔(21)、附接到所述头部件(1)的孔(13)的杆(22)、纵向孔(23)，所述纵向孔穿过孔(21)和所述纵向孔的开口位于所述杆(22)相反侧；
骨干钉(3)，用于***到股骨管或肱骨管中，具有第一部分(31)和第二部分(33)；在所述第一部分(31)处，设置一个或多个固定孔(32)用于远端螺钉以固定到股骨，所述第二部分(33)部分地安置在干骺端部件(2)的孔(21)内；和
锁定装置(24)，安置在孔(23)内并且穿过所述骨干钉(3)的第二部分(33)。
2.根据权利要求1所述的假体，所述干骺端部件(2)在其整个面上具有凹槽。
3.根据权利要求1所述的假体，所述锁定装置(24)完全穿过所述骨干钉(3)并且在其端部呈螺纹的。
4.根据权利要求1所述的假体，所述骨干钉(3)在其第二部分(33)内具有支架(34)，其位于所述干骺端部件(2)之上并且靠于所述杆(22)的相反侧。
5.用于股骨头或肱骨头的管状提取器，其能够用于放置权利要求1所述的假体，其特征在于，其在一端具有带有手柄(202)的管状部分(201)，和在相对端具有圆锥形或圆柱形钻头(203)，所述钻头(203)在其端部具有通道，配置用于让Kirschner导线(102，102’)紧紧地通过，并且所述手柄(202)具有与管状部分(201)内的孔对齐的管道开口。
6.根据权利要求5所述的用于股骨头或肱骨头的管状提取器，所述钻头(203)有多种内部聚集并且柔性的元件组成，并且所述管状部分(201)的内径大于钻头(203)内制成的通道。
7.根据权利要求5所述的股骨头或肱骨头的管状提取器，具有保持器(204)，用于控制伸缩爪(205)靠近所述钻头(203)。
8.根据权利要求7所述的股骨头或肱骨头的管状提取器，其中保持器(204)为管状部分(201)内部的螺钉(206)上的螺母，所述螺钉为管道状以能够Kirschner导线102穿过，并且连接伸缩爪(205)。
9.Kirschner导线定心装置，其用于放置权利要求1所述的假体，其特征在于，其具有基本上倒“U”型形状，具有：
定心钉(101)，其位于一端，用于***到股骨管或肱骨管中，在其下端具有垂直开口(105)；和，
手柄引导件(104)，其位于相对端，在其下部分具有垂直开口(105’)，所述手柄引导件的上边缘与所述定心针(101)的垂直开口的上边缘对齐。
10.根据权利要求9所述的Kirschner导线定心装置(100)，其在手柄引导件(104)的垂直开口(105’)中具有套筒(103)，所述套筒具有用于第一Kirschner导线(102)的上通道，其与定心钉(101)的所述垂直开口(105)的上边缘对齐。
11.根据权利要求10所述的Kirschner导线定心装置(100)，所述套筒(103)具有用于第二Kirschner导线(102’)的其他通道。
12.根据权利要求9所述的Kirschner导线定心装置(100)，所述手柄引导件(104)具有标记(505)，其标记对于X射线的透明度不同于所述Kirschner导线定心装置(100)的其余部分，具有不同的展开角。
13.球形部件***装置(300)，其能够与权利要求1所述的球形部件(1)共同使用，其特征在于，其呈倒“U”型形状，其具有：
带有凹槽(304)的手柄(301)，所述凹槽开在下边缘，和所述手柄具有定向朝向球形部件(1)的孔(13)的上边缘；和，
支撑件(302)，其与球形部件(1)的凹槽(14)兼容，并且能够使用致动器(303)释放。
14.根据权利要求13所述的球形部件***装置(300)，所述套筒(301)具有标记(505)，所述标记对于X射线的透明度不同于所述球形部件***装置(300)的其余部分，具有不同的展开角。
15.干骺端部件***装置(400)，其与权利要求1所述的干骺端部件(2)共同使用，其特征在于，其包括直型、空心杆，并且具有用于一端的干骺端组件(2)的钳子(403)和在相反端的抓手(404)。
16.根据权利要求15所述的干骺端部件***装置，其包括两个管状、同轴主体，和所述钳子(403)由外部管状主体内的卡口式闭合的突起(406)组成，用于对应干骺端部件(2)的钳子，并且也包括靠近所述抓手(404)的螺纹(407)，用于锁定两个管状主体的相对移动。
17.骨干钉***装置(500)，其与权利要求1所述的骨干钉(3)共同使用，其特征在于，其具有倒“U”型形状，其具有手柄(501)，所述手柄具有凹槽(503)和在相反端用于骨干钉(3)的可移动连接；所述凹槽开向在第一端的下部分。
18.根据权利要求17的骨干钉***装置(500)，所述手柄(501)具有标记(505)，所述标记对于X射线的透明度不同于所述定心装置(500)的其余部分，具有不同的展开角。
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