CN112826640A - 用于植入髋关节假体的球和杯撞击器 - Google Patents

用于植入髋关节假体的球和杯撞击器 Download PDF

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CN112826640A
CN112826640A CN202110140228.0A CN202110140228A CN112826640A CN 112826640 A CN112826640 A CN 112826640A CN 202110140228 A CN202110140228 A CN 202110140228A CN 112826640 A CN112826640 A CN 112826640A
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femoral
cup
impactor
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扎菲尔·特曼尼尼
布莱恩·万黑尔
柯克·查尔斯
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Hip Innovation Technology LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/4609—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of acetabular cups
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
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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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    • A61F2/4607—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of hip femoral endoprostheses
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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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    • A61F2/4637—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for connecting or disconnecting two parts of a prosthesis
    • A—HUMAN NECESSITIES
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    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A61F2/34—Acetabular cups
    • A61F2002/348—Additional features
    • A61F2002/3483—Additional features having a convex shape, e.g. hemispherical heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/36—Femoral heads ; Femoral endoprostheses
    • A61F2/3609—Femoral heads or necks; Connections of endoprosthetic heads or necks to endoprosthetic femoral shafts
    • A61F2002/3611—Heads or epiphyseal parts of femur
    • A61F2002/3615—Heads or epiphyseal parts of femur having a concave shape, e.g. hemispherical cups
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4627—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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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
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/4681—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor by applying mechanical shocks, e.g. by hammering

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Abstract

描述了用于在病人体内植入反向髋关节假体元件的、新的手术器械和方法。所述器械是撞击器，在使用该器械将植入物元件定位在病人体内后，在其近端处用锤子敲击。髋臼杯撞击器具有倾斜棒和前倾棒，用于将髋臼杯最佳地定位在髋臼中。髋臼球撞击器将髋臼球以莫氏锥度的方式附接至髋臼杯。以及股骨杯撞击器将股骨杯以莫氏锥度的方式附接到股骨柄。

Description

用于植入髋关节假体的球和杯撞击器
分案声明
本申请是申请日为2016年7月15日、申请号为201680044079.5的中国专利申请的分案申请。
技术领域
本发明涉及与将反向髋关节假体植入病人体内有关的手术器械。更具体地，本发明涉及用于植入髋臼杯、髋臼球和股骨杯的撞击器。
相关技术
美国专利第8,313,531B2号和第8,540,779B2号中描述了一种反向髋关节假体。美国专利第8,992,627B2号中还描述了假体与翻修手术方法。这三项专利的公开内容通过引用方式以其整体并入本文。
发明内容
如上述引用的专利中所描述的，通过将髋臼杯撞击在髋臼中而将髋臼杯附接在髋臼中，然后，如果有需要则使用螺钉将其进一步附接。髋臼球借助于莫氏锥度(Morsetaper)附接至从髋臼杯的凹面的底部延伸的柄上，并且股骨杯借助于莫氏锥度附接至股骨植入物(或股骨柄)上。本发明的手术器械，在本文中有时被称为手术工具，使外科医生能够以髋臼杯的最佳位置撞击假体的这些部件中的每一个，并确保髋臼球和股骨杯的附接。
附图说明
图1是本发明的髋臼杯撞击器组件的立体图。
图2是髋臼杯撞击器组件的正视图。
图3是示出了部分髋臼骨元件的图2的剖视图。
图4是髋臼杯撞击器组件的分解图。
图5是用于髋臼杯撞击器组件的髋臼杯手柄的正视图。
图6是用于髋臼杯撞击器组件的内杆的正视图。
图7是用于髋臼杯撞击器组件的倾斜-前倾导向棒的正视图。
图8是用于髋臼杯撞击器组件的夹头的正视图。
图9是用于髋臼球撞击器组件和股骨杯撞击器组件的通用手柄的正视图。
图10是髋臼球撞击器组件、髋臼球和髋臼杯的立体图。
图11是图10的正视图。
图12是带有附加的髋臼骨元件的图11的剖视图。
图13是髋臼球撞击器的正视图。
图13A是图13的髋臼球撞击器的剖视图。
图14是股骨杯撞击器组件的正视图。
图15是股骨杯撞击器的立体图。
图16是图15的侧视图。
图17是图16的俯视图。
图18是图16的仰视图。
图19是股骨杯撞击器组件和定位在股骨植入物中的股骨杯的正视图，股骨植入物以剖面的形式示出。
图20是图19的剖视图。
具体实施方式
本发明的撞击器用于在病人体内植入反向髋关节假体的三个元件。所述元件是髋臼杯、髋臼球和股骨杯。
在制备的髋臼接纳髋臼杯之后，将髋臼杯定位在髋臼中，并使用图1至图4中所示的髋臼杯撞击器组件1在髋臼中撞击髋臼杯。图5至图8示出了髋臼杯撞击器组件1的元件。图1至图3示出了与组件1相关的髋臼杯2，且图3包括髋臼3的一部分。
髋臼杯撞击器组件1包括髋臼杯手柄4、内杆5、倾斜-前倾导向棒7和夹头8，其中，髋臼杯手柄4具有沿其长度方向环状延伸的通道，该通道在手柄4的近端和远端处开口，内杆5在其近端处具有把手6。导向棒7在其远端处是带有螺纹的。髋臼杯手柄4具有柄杆9和旋转安装在柄杆9上的倾斜-前倾导向套环10。倾斜-前倾导向套环10，在本文中有时被称为可旋转导向10，具有表示为前倾孔15和倾斜孔16的螺纹孔(见图4)。取决于被更换的是右侧髋关节或是左侧髋关节，将棒7拧入孔16和孔15中的一个中。在手术期间，当棒7被最佳地定位时，将翼型螺钉11拧紧以防止导向套环10的旋转。手柄元件12附接至杆9的近端，且套筒13附接至杆9的远端。套筒13具有锥形的环状内部，锥形沿近端方向变窄，套筒13的锥形环状内部的尺寸被设计为当夹头8沿近端方向移入套筒13中时，使得夹头8的远端收缩。图4示出了三个夹头8，每个夹头具有用于不同尺寸髋臼杯2的不同尺寸。髋臼杯2具有从其凹面的底部突出的柄14。夹头8的尺寸是指其环状内部部分，其尺寸设计成可释放地夹持柄14的近端部。在夹头8收缩时，夹头8夹持柄14，在夹头8打开(即，没有收缩)时，释放柄14。
在本发明的手术方法中，制备的髋臼3以接纳适当尺寸的髋臼杯2，并选择尺寸适合于该杯的夹头8。内杆5***至髋臼杯手柄4的远端，然后将夹头8附接至内杆5的远端。然后推动夹头8至髋臼杯2的柄14上，并将夹头8拉入套筒13中，使得夹头8牢固地夹持柄14。这导致杆5向近端移动，使得在把手6与手柄元件12的近端之间留有空间。将倾斜-前倾导向棒7拧入倾斜-前倾导向套环10的孔16中，将另一个倾斜-前倾导向棒7拧入孔15中(见图4)，并将髋臼杯2放置在髋臼3中。然后，将杯2中的螺孔在髋臼中适当地对齐，以使用螺钉将杯最终固定到髋臼。然后旋转倾斜-前倾导向套环10，直至棒7被适当地定位，然后拧紧翼型螺钉11。应注意的是，以相对于杆9成45度的角度和相对于彼此成20度的角度来设置导向棒。外科医生使用拧入孔16中的棒，通过保持棒与地面平行并将其指向病人的肩部来设置倾斜。如果正被替换的是左髋关节，则将其指向左肩部，而如果正被替换的是右髋关节，则将其指向右肩部。在设置倾斜的同时，外科医生随后使用拧入孔15中的棒7来设置前倾。根据正被替换的是右髋关节还是左髋关节来决定使用任一个孔15，这基于本文的公开内容对本领域普通技术人员来说是显而易见的。通过将前倾棒朝向相同的肩部定向，而使前倾棒与倾斜棒形成20度的前倾。棒以这种方式与后面的手术方式一起使用，并且这适当地将杯2的定向设置为倾斜45度和前倾20度的复合角度。当用锤子敲击把手6的近端从而撞击髋臼中髋臼杯时，通过保持手柄元件12来将该组件保持在适当的位置。然后将组件1从操作位置移除。
图10至图12中示出了髋臼球撞击器组件，并且图13中以正面的形式示出了髋臼球撞击器20。髋臼球撞击器组件13包括髋臼球撞击器20和通用手柄40(还见图9)。通用手柄40包括杆41，杆41在其远端处具有螺纹部分42并且在其近端处具有手柄元件43。髋臼球撞击器20具有近端和远端。如图13A中所示，髋臼球撞击器20的近端具有螺纹22，并且远端具有凹面部分23。凹面部分呈球体截面的形状。将螺纹部分42拧入髋臼球撞击器20的螺纹22中。
髋臼球撞击器20被制成与不同尺寸的髋臼球21匹配的尺寸。当选择球21时，将其放置在髋臼杯2的柄14上。将合适尺寸的髋臼球撞击器20拧入至通用手柄40上，并且将髋臼球撞击器20的凹面放置在球上，允许球被接纳在凹面中。这种情况下，合适的尺寸意味着髋臼球撞击器的凹面部分的尺寸被设计成接纳髋臼球。因此，凹面具有球体截面的形状，且其尺寸与待接纳在其中的髋臼球的球体尺寸相同或近似相同。当通用手柄40保持在适当的位置，其中，柄14的中心轴线与杆41的中心轴线处于相同或大致相同的直线(如图11和图12所示)时，用锤子敲击手柄元件43的近端，以使得髋臼球21借助于莫氏锥度而被牢固地附接到柄14。
在图15至图18中示出了股骨杯撞击器30。股骨杯撞击器30包括在其远端处的凸面部分(在本文中被称为撞击器尖端31)和在其近端处的螺纹部分32。凸面部分呈球形。螺纹部分32用于附接撞击器至通用手柄40。在股骨杯撞击器30被附接到通用手柄40时，本文中将该元件组合称为股骨杯撞击器组件。
图19和图20进一步示出了股骨杯撞击器、股骨杯50和股骨植入物51。股骨杯50具有柄52，该柄52的尺寸设计成以莫氏锥度关系配合在股骨柄51的凹处53中。
股骨杯撞击器30被制成与不同尺寸股骨杯50匹配的尺寸。股骨杯50具有球体截面形状的、其尺寸被设计成在髋臼球21上咬合的凹面部分。当选择股骨杯50时，将柄52放置在凹处53中。将合适尺寸的髋臼杯撞击器拧到通用手柄40上，并将凸出的撞击器尖端31放置在股骨杯50的凹部中。这种情况下，合适的尺寸意味着股骨杯撞击器的凸面的尺寸被设计成接纳股骨杯的凹面部分。因此，凸面具有球体截面的形状，且其尺寸与股骨杯的凹面部分相同或近似相同。因此，凸面具有球体截面的形状，且其尺寸与股骨杯的凹面部分相同或近似相同。当通用手柄40保持在适当的位置，其中，柄52的中心轴线与杆41的中心轴线处于相同或大致相同的直线(如图19和图20所示)时，用锤子敲击手柄元件43的近端，以使得股骨杯50借助于莫氏锥度而被牢固地附接到股骨植入物51。
本发明的手术器械可包括在手术套件的一部分。该套件可包括本发明的一个或多个手术器械以及其它手术器械和/或植入物。

Claims (9)

1.一种股骨杯撞击器组件，配置成将股骨杯撞击到股骨植入物的凹处中，以使所述股骨杯附接到所述股骨植入物，所述股骨杯在其近端处具有呈球形截面形状的凹面部分，并且所述股骨杯具有从所述股骨杯延伸并具有中心轴线的柄，并且所述股骨植入物的凹处的尺寸设计成容纳所述柄，所述股骨植入物已经被植入病人的股骨，所述股骨杯撞击器组件包括：
通用手柄，可附接到股骨杯撞击器，所述通用手柄包括杆，所述杆具有在其近端处的手柄和在其远端处的螺纹部分，以及
股骨杯撞击器，具有设置在其近端处的螺纹、设置在其远端处呈球形截面形状的凸面部分以及大致圆柱形的中间主体部分，所述螺纹的尺寸设计成接收在所述通用手柄的杆的远端处的螺纹部分，并且所述凸面部分的尺寸设计成被容纳在所述股骨杯的凹面部分中，以及其中，所述股骨杯在撞击期间的物理接触受限于与所述凸面部分的表面、所述大致圆柱形的中间主体部分的一部分以及所述股骨植入物的接触。
2.根据权利要求1所述的股骨杯撞击器组件，其中：
所述股骨杯撞击器还包括在所述股骨杯撞击器的近端与远端之间的大致圆柱形的中间主体部分，以及其中，所述大致圆柱形的中间主体部分的半径大于设置在所述股骨杯撞击器的远端处的凸面部分的最大半径。
3.根据权利要求1所述的股骨杯撞击器组件，其中，所述柄具有莫氏锥度。
4.一种套件，包括根据权利要求1所述的股骨杯撞击器组件，并且还包括：
至少第二股骨杯撞击器，具有设置在其远端处的、具有不同尺寸的呈球形截面形状的凸面部分。
5.一种使用根据权利要求1所述的股骨杯撞击器组件的方法，所述方法包括：
将柄放置在股骨植入物的凹处中，
仅通过将所述股骨杯撞击器的凸面部分仅定位到所述股骨杯的凹面部分中而使所述股骨杯与所述股骨撞击器接合，
将所述杆与所述股骨杯的柄的中心轴线对准或近似对准，然后用锤子敲击所述通用手柄的近端以将所述柄接合到所述凹处中。
6.一种套件，包括根据权利要求1所述的股骨杯撞击器组件，并且所述套件还包括配置成将髋臼杯撞击到病人的髋臼中的手术器械，其中，所述髋臼杯具有从其凹入内表面的底部延伸的、具有莫氏锥度的中心柄，所述手术器械包括：
手柄，具有近端和远端以及中心轴线、套筒和环状通道，所述套筒与所述手术器械的手柄同心地设置在所述手术器械的手柄的远端上，并且所述环状通道延伸贯穿所述手术器械的手柄，所述环状通道在所述手术器械的手柄的近端和远端处开口，
杆，具有近端和远端以及附接到所述手术器械的杆的近端的把手，所述手术器械的杆可滑动地设置在所述环状通道中，
夹头，可移除地附接至所述手术器械的杆的远端并且靠近所述套筒，其中，所述套筒具有锥形环状内部，所述锥形环状内部沿近端方向变窄，所述套筒的锥形环状内部的尺寸设计为当所述夹头沿近端方向移入所述套筒时，使得所述夹头的远端收缩并夹持所述髋臼杯的中心柄，并从而仅通过所述中心柄夹持所述髋臼杯，
可旋转导向套环，安装在所述手术器械的手柄的外部上并且能够绕所述手术器械的手柄的中心轴线旋转，并配置成将多个导向棒附接至所述可旋转导向套环，其中，每个导向棒具有可移除地附接至所述可旋转导向套环的近端，并且从附接至所述可旋转导向套环的近端处相对于所述中心轴线成角度向外延伸，其中，所述多个导向棒中的至少两个导向棒在附接至可旋转导向套环上时分别相对于所述手术器械的杆成45度角定位，并且相对于彼此成20度角定位，以及所述至少两个导向棒的方向定向成从所述可旋转导向套环沿远端方向延伸，以及
翼型螺钉，具有从所述可旋转导向套环延伸的部分，其中，所述翼型螺钉的旋转防止所述可旋转导向套环和附接至所述可旋转导向套环的任何导向棒相对于所述手术器械的手柄的运动。
7.根据权利要求6所述的套件，其中，所述夹头具有夹头内部，所述夹头内部的尺寸设计成可释放地夹持所述中心柄的近端部，在所述夹头收缩时夹持所述中心柄，并在所述夹头未收缩时释放所述中心柄。
8.根据权利要求6所述的套件，包括多个夹头。
9.根据权利要求8所述的套件，其中，所述多个夹头中的至少两个夹头具有不同的尺寸。
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