CN1738580A - 带有锚定在股骨骨髓管内的轴的髋部假肢 - Google Patents

带有锚定在股骨骨髓管内的轴的髋部假肢 Download PDF

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Publication number
CN1738580A
CN1738580A CNA2004800022768A CN200480002276A CN1738580A CN 1738580 A CN1738580 A CN 1738580A CN A2004800022768 A CNA2004800022768 A CN A2004800022768A CN 200480002276 A CN200480002276 A CN 200480002276A CN 1738580 A CN1738580 A CN 1738580A
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China
Prior art keywords
rib
artificial limb
cross
section
axle
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Granted
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CNA2004800022768A
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CN100479787C (zh
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A·凯勒
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Waldemar Link GmbH and Co KG
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Waldemar Link GmbH and Co KG
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Abstract

带有锚定在股骨骨髓管内的轴(1)的髋部假肢，所述轴的要锚定在骨干内的远体部分(7)具有向端部方向逐渐变细的轴芯横截面(12)，该轴芯横截面至少在外侧(19)和内侧(20)上具有纵向肋棱(16)，肋棱的高度从近端向远端增加。

Description

带有锚定在股骨骨髓管内的轴的髋部假肢
股骨的骨干，也就是骨的细长部份，起始于小转子，有一较厚且强壮的骨外壳(厚皮物质)，因此特别适合锚定假肢轴。已知这样利用该条件的假肢，即其***股骨骨干的轴的轴横横截面适应骨髓管大小，并有几乎不变的横截面(US-A-4,549,319，DE-A-2839092)。也确有一些假肢，其轴横截面在远体部分向端部方向逐渐缩小(EP-A-135755，US-A-2,719,522，US-A-3,067,740)。但在此或者涉及用粘合剂锚定并从而其相对骨髓管的横截面差别不再重要的假肢(Schneider：Die Totalprothese der Huefte，第120页)，或者涉及轴应基于其楔形楔入到骨髓腔内的假肢(Müller，出处同上，第214页及以后几页)。后者的缺点是，楔入导至在楔入部位力高度集中。但希望的是大面积的、无粘合剂的传力，但根据现有知识，这要求使假肢轴单独适应骨髓管形状，因成本太高一般对此不予考虑。它们对抵抗扭动也不够安全。
因此，本发明的目标是提供一种髋部假肢，在无粘合剂植入情况下，它的轴能在骨干区域进行大面积的传力，同时安全抗扭。
根据本发明的解决方案在于权利要求1的特征及特别从属权利要求的特征。
相应地，要锚定在骨干中的轴的远体部分具有向端部方向缩小的轴芯横截面，该轴芯横截面至少在外侧和内侧有纵向肋棱，这些肋棱在轴芯表面上方的高度从近端向远端增加。所需大面积的力传递由此实现，即当轴被推入骨髓管中时，由轴芯构成的、在肋棱间楔形扩展的表面使该处的板状骨质被压实，在此骨质被固定在肋棱之间。一种带有封闭无肋棱表面的已知轴在其形状与骨髓管符合得较差的情况下，即使楔形变厚，也只有很少和很小的可传力接触面积，因为轴可侧向偏离。与此相反，根据本发明的轴在***时由肋棱导向，因此不能侧向偏离，并且通过将肋棱之间的骨质推在一起并且压缩，获得了额外的传力区域。尽管被挤压的骨材料量和其局部的安排在不同情况下可能不同，但由此在各种情况局部都获得从轴通过被压紧的骨质向硬骨外壳的良好的力传递。这不仅产生良好的初始强度，而且也提供了以后向留出的空隙中长入新骨质的可能性，并由此提供了使假肢长期良好配合的良好的前提条件。
这不排除假肢也设计成在其近体区域传力。根据本发明的远体造型甚至特别适合于也带有近体传力装置的假肢的情况。
只要已知的轴备有肋棱，它们就不允许根据本发明的压缩效应。在带有周向肋棱的已知假肢情况下(US-A-2,719,522)，这些板状骨质被从骨髓腔表面刮去，而不被压缩。在另一已知假肢情况下(US-A-3,067,740)，轴间隔地带有凸出环状物，其任务是当被推入骨中时，从骨髓腔表面刮下骨质并将其围绕轴的肋棱压紧。由此促使骨痂形成。但由于锋利的环状物比肋棱伸出远得多，所以在它们公知地向骨传力情况下，它们更确切地说具有这样的作用，即切入骨并由此对其造成损害。在另一已知假肢情况下(DE-U-29907259；DE-C-4315143；EP-B-677281；EP-B-821923)，轴纵向有肋棱。轴在肋棱之间不变细(即轴芯表面与肋棱间的高度差并不从近端向远端增加)，并因此不能提供足够的挤压。这还适用于另一已知假肢的轴(EP-B-682924)，其中轴芯横截面表面之上的肋棱高度阶段递减。
为很好地将锥状轴芯挤压的骨质固定在肋棱之间，在轴芯的外侧或内侧表面部分上应至少各有三条肋棱。此外，在前侧和后侧有纵向肋棱也是适宜的。
为有效挤压骨质，轴芯横截面向其端部方向逐渐缩小已证明是有效的，在至少4厘米的长度上，平均至少缩小8毫米2/厘米长度，最好缩小超过10毫米2/厘米。但不应超过20毫米2/厘米，最好平均低于16毫米2/厘米。
在外内平面中，轴芯尺寸在4厘米的长度上应缩小至少0.5毫米/厘米，最好约1毫米/厘米。
肋高不必很大。应平均低于2毫米。平均肋高为1毫米和更低一般就足够了。肋高从远体部分的近端向其远端从0毫米增加到0.5至1.5毫米，最好约1毫米的轴设计是合适的。
因轴芯横截面主要负责挤压骨质，并且肋棱只有固定和导向作用，所以肋棱的横截面大小应小些。它们的横截面在周向上的平均尺寸应不大于其中心距的30％，并且例如在20％的数量级。在此基于轴芯横截面表面与肋棱尖顶间的肋棱高度确定肋棱的横截面。在轴的带肋棱部分中，除肋棱外不应有其它凸起物。但假如有些其它的凸起物，那么这些凸起物不应凸起到超越肋棱。
带肋棱的远体轴部分的长度适宜地约至少为4厘米，最好约5到8厘米。在此假定远体轴部分的近端起始位置位于关节头高度下方约7到9厘米。
在肋棱达到最大高度处，肋棱侧面与通过肋棱中心的半径间夹角不宜大于30°。更好的是该角度小于20°。如果轴在制造时必须垂直于其纵向脱模，则可允许该规则的例外情况。相对脱模方向-该方向一般为与假肢主长度所处平面垂直的方向-肋棱在此情况下不应侧凹。
在上部和中部区域，即还在远体带肋棱的轴部分的近端，轴适宜地有椭园形或细长的横截面，横截面的长轴位于外内平面内。在远端，远体部分的轴芯适宜地在横截面内限定圆形，使得轴芯在其长度上从椭圆形过渡到圆形横截面。在其近端的轴长比应至少是1∶2。
在另一实施形式中，轴的带肋棱部分在横截面中为细长的矩形，矩形的长轴位于外内方向，其中轴长比至少为1∶4。在远端，考虑到可能存在的端部倒圆从距离端部1厘米处测量横截面，轴长比至少为1∶5。在此至少在两个外侧棱边应各有一个肋棱，因为在这些位置分配给肋棱的导向任务是特别重要的。为确保轴的其它凸出部分不会妨碍这些棱边中的任一个与骨髓管边界导向接触，位于外侧棱边上的两个肋棱之间的轴芯横截面的边界不应比肋棱更向外侧凸出。如果外侧棱边上的两个肋棱之间还有另一个外侧肋棱，则该肋棱比所述两个肋棱向外侧多伸出的距离不应超过2毫米，最好不超过1毫米。
在内侧棱边也可各有一个肋棱。在此适宜的是，在轴横截面的腹侧和背侧上，肋棱之间的轴芯横截面向腹侧或背侧伸出超过肋棱的距离不超过1毫米，其中所述肋棱是分配给限定该侧面的外侧和内侧棱边的。如果在该侧面上在棱边之间还布置了一个或多个肋棱，则这些肋棱向腹侧或背侧伸出超过棱边上的肋棱的距离应不大于2毫米，最好不大于1毫米。
为使肋棱能更容易地实现其引导任务，根据本发明的另一个特点，它们应制造得粗糙些，以能够更容易地切入硬骨外壳。为避免不希望的过份损伤骨头，粗糙度不应过大。相邻颗粒或尖齿的中心距离不应超过0.5毫米，且适宜地平均在0.1毫米数量级上。
下面参考附图进一步解释本发明，其中附图示出了假肢的有利实施例。图中：
图1为前视图，
图2为内侧视图，
图3为俯视图，
图4到6为在轴的不同高度穿过轴的剖面，
图7和8为对应图5和6的、带有矩形轴芯横截面的实施形式的剖面。
假肢由轴1，颈部2和用于套装关节头4的圆锥体3组成，其中关节头周边用点划线表示，并且关节头具有中心点5。这里涉及所谓的直轴假肢。在该已知假肢类型情况下，轴总体基本构造为直的。与轴在近体区域弯曲为其方向适合颈部2方向的假肢不同，该轴只沿一个方向导入到在骨中制出的接收轴的空腔内。轴由近体部分6及远体部分7组成。近体部分可备有特别的装置以更好地向在股骨的骨骺区域包围轴的骨质传力。为此具体地使用了肋条对8。如图4和5或7所示，在该区域，轴横截面在外内方向上是细长的。
轴近体和远体部分之间的过渡位置9这样安排，即在植入状态，其稍稍低于小转子，并且远体轴部分7因此位于骨髓腔区，在该区域远体轴部分7被强壮的骨外壳包围，一些板状骨质从骨外壳骨髓管内延伸。不必在假肢上特别标出过渡位置。可以这样识别出过渡位置，即在植入状态其位于大约小转子或者更确切地是小转子下棱边所处的位置。按照轴方向上的箭头10测量，过渡位置比关节头5中心点低约7到9厘米。
在过渡位置9下方，远体轴部分7长约4到8，最好约为6到7厘米。其轴芯12从其近端9向其远端11方向按约10到15毫米2/厘米的比例逐渐变细。变细主要发生在外侧和内侧。在远体部分上端9的外内-尺寸13在根据图5的第一实例中约为17毫米，该尺寸到根据图6的远端11时减少到10毫米的直径，而前后-方向的尺寸15只减少约2至3毫米。在根据图7与8的实例中，外内-尺寸由约18减至约14毫米。
轴芯表面在远体部分具有肋棱16，这些肋棱在其间包围了轴芯表面的条状面17。肋棱16在过渡区域9零高度地过渡到轴表面，并在远端11达到比轴芯表面高约1毫米的高度。由于轴芯横截面从近端向远端缩小，所以肋棱间的条状面起到楔形面作用，当轴进入骨髓管时，该楔形面将那里存在的、特别是板状的骨质向轴芯表面和外皮骨髓腔边界之间的间隙内挤压。骨质不能被侧向挤出并偏移，因为其被肋棱16固定。由此还在没有该挤压不能到达骨髓腔的外皮边界并从而不能参与传力的轴横截面区域，获得了假肢轴和外皮骨髓腔边界之间的压实的、紧密的传力桥。因为轴横截面尺寸在外内方向比在前后方向上减少得更多，所以最强的挤压发生在轴外侧面和内侧面上。因此这里也通过压缩骨质产生最有效的传力桥。因此这是有利的，因为在假肢轴和骨之间要在该方向上传递绝大部分的力。但在轴的前侧和后侧也有一个楔形，该楔形在那里可产生相应的作用。
规定根据图6的假肢在铸造或锻造后在方向18上脱模。因此肋棱16关于该方向不应侧凹。
如果要准备其中***假肢轴的骨腔，则使用粗锉或此类工具，其横截面尺寸在其与假肢轴带肋棱部分对应的部分不应大于假肢轴轴芯的横截面尺寸，以便保留骨质，该骨质能在轴芯表面与硬骨外壳的内表面之间被挤压。
图7与8示出了带有矩形轴横截面的实施形式。除非下面另有说明，否则上面关于图5图6的说明在此也适用。与椭圆形横截面的实施形式相比的主要区别是，位于纵向棱边上的肋棱21由于其位置起着更强的导向作用。即使某一轴部分在骨髓管中向腹侧或背侧偏心偏移，也能可靠地预期在远体部分位于外侧棱边上的肋棱与骨髓腔表面嵌接。为了在特别不利的轴位置情况下或者特别不利的骨髓腔横截面形状情况下也能如此，如上所述，根据本发明，在外侧棱边上设置的肋棱应该也比轴横截面的其余外侧表面更凸出。这也适用于外侧棱边肋棱与轴腹侧或背侧表面部分的关系。

Claims (21)

1、带有锚定在股骨骨髓管内的轴(1)的髋部假肢，所述轴的要锚定在骨干内的远体部分(7)具有向端部方向逐渐变细的轴芯横截面(12)，该轴芯横截面至少在外侧(19)和内侧(20)上具有纵向肋棱(16)，肋棱的高度从近端向远端增加。
2、根据权利要求1的假肢，其特征在于，分配给外侧(19)或内侧(20)的轴芯区域的肋棱(16)的数量至少各三个。
3、根据权利要求1或2的假肢，其特征在于，在远体部分的前侧和后侧也有纵向肋棱(16)。
4、根据权利要求1至3之一的假肢，其特征在于，在至少4厘米的长度上，轴芯横截面平均至少缩小8毫米2/厘米长度，最好缩小超过10毫米2/厘米长度。
5、根据权利要求1至4之一的假肢，其特征在于，在至少4厘米的长度上，在远体轴部分外内方向上的横截面尺寸平均至少缩小0.5毫米/厘米长度，最好大于0.8毫米/厘米。
6、根据权利要求1至4之一的假肢，其特征在于，肋棱高度平均小于2毫米。
7、根据权利要求6的假肢，其特征在于，肋棱高度从远体部分(7)的近端(9)向其远端(11)从小于0.5毫米增加到0.5至1.5毫米。
8、根据权利要求1至7之一的假肢，其特征在于，在周向上，肋棱的平均横截面尺寸不大于其中心距的30％。
9、根据权利要求1至8之一的假肢，其特征在于，肋棱(16)侧面与通过肋棱中心的半径间夹角不大于30°。
10、根据权利要求9的假肢，其特征在于，肋棱(16)的侧面在脱模方向(18)上不侧凹。
11、根据权利要求1至10之一的假肢，其特征在于，远端、带肋棱轴部分(7)的近端(9)上的轴横截面限定为椭圆形，其轴长比至少为1∶2。
12、根据权利要求11的假肢，其特征在于，轴(1)的远端(11)上的轴芯横截面限定为圆形。
13、根据权利要求1至10之一的假肢，其特征在于，在近端(9)上的轴芯横截面基本限定为矩形，其轴长比至少为1∶4。
14、根据权利要求13的假肢，其特征在于，与远端(11)距离1厘米的轴芯横截面基本限定为矩形，轴长比至少为1∶5。
15、根据权利要求13或14的假肢，其特征在于，轴芯横截面至少在其远端附近在其两个外侧棱边上各有一个肋棱(21)。
16、根据权利要求15的假肢，其特征在于，外侧棱边上的两个肋棱(21)之间的轴芯横截面的边界不比肋棱更向外侧凸出。
17、根据权利要求16的假肢，其特征在于，外侧棱边上的两个肋棱(21)之间设置的肋棱比所述两个肋棱向外侧多伸出的距离不超过2毫米。
18、根据权利要求15的假肢，其特征在于，在内侧棱边上也各有一个肋棱。
19、根据权利要求18的假肢，其特征在于，外侧棱边和内侧棱边上布置的肋棱之间的轴芯横截面边界向腹侧或背侧伸出的距离不超过1毫米。
20、根据权利要求19的假肢，其特征在于，外侧棱边上布置的肋棱(21)和内侧棱边上布置的肋棱之间的肋棱比在所述棱边上布置的肋棱向腹侧或背侧多伸出的距离不超过2毫米。
21、根据权利要求1至20之一的假肢，其特征在于，肋棱构造为粗糙的。
CNB2004800022768A 2003-01-17 2004-01-14 带有锚定在股骨骨髓管内的轴的髋部假肢 Expired - Fee Related CN100479787C (zh)

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CN102871777A (zh) * 2012-09-26 2013-01-16 无锡市诚信洗选设备有限公司 防旋转下沉髋关节假柄
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