PT92740B - Protese de joelho modular - Google Patents

Protese de joelho modular Download PDF

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Publication number
PT92740B
PT92740B PT92740A PT9274089A PT92740B PT 92740 B PT92740 B PT 92740B PT 92740 A PT92740 A PT 92740A PT 9274089 A PT9274089 A PT 9274089A PT 92740 B PT92740 B PT 92740B
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femoral
stem
pins
connector
component
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PT92740A
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PT92740A (pt
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John Edward Slamin
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Johnson & Johnson Orthopaedics
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    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01L—SEMICONDUCTOR DEVICES NOT COVERED BY CLASS H10
    • H01L29/00—Semiconductor devices specially adapted for rectifying, amplifying, oscillating or switching and having potential barriers; Capacitors or resistors having potential barriers, e.g. a PN-junction depletion layer or carrier concentration layer; Details of semiconductor bodies or of electrodes thereof ; Multistep manufacturing processes therefor
    • H01L29/66—Types of semiconductor device ; Multistep manufacturing processes therefor
    • H01L29/68—Types of semiconductor device ; Multistep manufacturing processes therefor controllable by only the electric current supplied, or only the electric potential applied, to an electrode which does not carry the current to be rectified, amplified or switched
    • H01L29/76—Unipolar devices, e.g. field effect transistors
    • H01L29/772—Field effect transistors
    • H01L29/78—Field effect transistors with field effect produced by an insulated gate
    • H01L29/7801—DMOS transistors, i.e. MISFETs with a channel accommodating body or base region adjoining a drain drift region
    • H01L29/7802—Vertical DMOS transistors, i.e. VDMOS transistors
    • H01L29/7813—Vertical DMOS transistors, i.e. VDMOS transistors with trench gate electrode, e.g. UMOS transistors
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01L—SEMICONDUCTOR DEVICES NOT COVERED BY CLASS H10
    • H01L29/00—Semiconductor devices specially adapted for rectifying, amplifying, oscillating or switching and having potential barriers; Capacitors or resistors having potential barriers, e.g. a PN-junction depletion layer or carrier concentration layer; Details of semiconductor bodies or of electrodes thereof ; Multistep manufacturing processes therefor
    • H01L29/02—Semiconductor bodies ; Multistep manufacturing processes therefor
    • H01L29/06—Semiconductor bodies ; Multistep manufacturing processes therefor characterised by their shape; characterised by the shapes, relative sizes, or dispositions of the semiconductor regions ; characterised by the concentration or distribution of impurities within semiconductor regions
    • H01L29/0684—Semiconductor bodies ; Multistep manufacturing processes therefor characterised by their shape; characterised by the shapes, relative sizes, or dispositions of the semiconductor regions ; characterised by the concentration or distribution of impurities within semiconductor regions characterised by the shape, relative sizes or dispositions of the semiconductor regions or junctions between the regions
    • H01L29/0692—Surface layout
    • H01L29/0696—Surface layout of cellular field-effect devices, e.g. multicellular DMOS transistors or IGBTs
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01L—SEMICONDUCTOR DEVICES NOT COVERED BY CLASS H10
    • H01L29/00—Semiconductor devices specially adapted for rectifying, amplifying, oscillating or switching and having potential barriers; Capacitors or resistors having potential barriers, e.g. a PN-junction depletion layer or carrier concentration layer; Details of semiconductor bodies or of electrodes thereof ; Multistep manufacturing processes therefor
    • H01L29/02—Semiconductor bodies ; Multistep manufacturing processes therefor
    • H01L29/06—Semiconductor bodies ; Multistep manufacturing processes therefor characterised by their shape; characterised by the shapes, relative sizes, or dispositions of the semiconductor regions ; characterised by the concentration or distribution of impurities within semiconductor regions
    • H01L29/10—Semiconductor bodies ; Multistep manufacturing processes therefor characterised by their shape; characterised by the shapes, relative sizes, or dispositions of the semiconductor regions ; characterised by the concentration or distribution of impurities within semiconductor regions with semiconductor regions connected to an electrode not carrying current to be rectified, amplified or switched and such electrode being part of a semiconductor device which comprises three or more electrodes
    • H01L29/1095—Body region, i.e. base region, of DMOS transistors or IGBTs
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01L—SEMICONDUCTOR DEVICES NOT COVERED BY CLASS H10
    • H01L29/00—Semiconductor devices specially adapted for rectifying, amplifying, oscillating or switching and having potential barriers; Capacitors or resistors having potential barriers, e.g. a PN-junction depletion layer or carrier concentration layer; Details of semiconductor bodies or of electrodes thereof ; Multistep manufacturing processes therefor
    • H01L29/40—Electrodes ; Multistep manufacturing processes therefor
    • H01L29/41—Electrodes ; Multistep manufacturing processes therefor characterised by their shape, relative sizes or dispositions
    • H01L29/423—Electrodes ; Multistep manufacturing processes therefor characterised by their shape, relative sizes or dispositions not carrying the current to be rectified, amplified or switched
    • H01L29/42312—Gate electrodes for field effect devices
    • H01L29/42316—Gate electrodes for field effect devices for field-effect transistors
    • H01L29/4232—Gate electrodes for field effect devices for field-effect transistors with insulated gate
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01L—SEMICONDUCTOR DEVICES NOT COVERED BY CLASS H10
    • H01L29/00—Semiconductor devices specially adapted for rectifying, amplifying, oscillating or switching and having potential barriers; Capacitors or resistors having potential barriers, e.g. a PN-junction depletion layer or carrier concentration layer; Details of semiconductor bodies or of electrodes thereof ; Multistep manufacturing processes therefor
    • H01L29/66—Types of semiconductor device ; Multistep manufacturing processes therefor
    • H01L29/68—Types of semiconductor device ; Multistep manufacturing processes therefor controllable by only the electric current supplied, or only the electric potential applied, to an electrode which does not carry the current to be rectified, amplified or switched
    • H01L29/76—Unipolar devices, e.g. field effect transistors
    • H01L29/772—Field effect transistors
    • H01L29/78—Field effect transistors with field effect produced by an insulated gate
    • H01L29/7801—DMOS transistors, i.e. MISFETs with a channel accommodating body or base region adjoining a drain drift region
    • H01L29/7802—Vertical DMOS transistors, i.e. VDMOS transistors
    • H01L29/7811—Vertical DMOS transistors, i.e. VDMOS transistors with an edge termination structure
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01L—SEMICONDUCTOR DEVICES NOT COVERED BY CLASS H10
    • H01L29/00—Semiconductor devices specially adapted for rectifying, amplifying, oscillating or switching and having potential barriers; Capacitors or resistors having potential barriers, e.g. a PN-junction depletion layer or carrier concentration layer; Details of semiconductor bodies or of electrodes thereof ; Multistep manufacturing processes therefor
    • H01L29/40—Electrodes ; Multistep manufacturing processes therefor
    • H01L29/402—Field plates
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01L—SEMICONDUCTOR DEVICES NOT COVERED BY CLASS H10
    • H01L29/00—Semiconductor devices specially adapted for rectifying, amplifying, oscillating or switching and having potential barriers; Capacitors or resistors having potential barriers, e.g. a PN-junction depletion layer or carrier concentration layer; Details of semiconductor bodies or of electrodes thereof ; Multistep manufacturing processes therefor
    • H01L29/40—Electrodes ; Multistep manufacturing processes therefor
    • H01L29/41—Electrodes ; Multistep manufacturing processes therefor characterised by their shape, relative sizes or dispositions
    • H01L29/423—Electrodes ; Multistep manufacturing processes therefor characterised by their shape, relative sizes or dispositions not carrying the current to be rectified, amplified or switched
    • H01L29/42312—Gate electrodes for field effect devices
    • H01L29/42316—Gate electrodes for field effect devices for field-effect transistors
    • H01L29/4232—Gate electrodes for field effect devices for field-effect transistors with insulated gate
    • H01L29/42372—Gate electrodes for field effect devices for field-effect transistors with insulated gate characterised by the conducting layer, e.g. the length, the sectional shape or the lay-out
    • H01L29/4238—Gate electrodes for field effect devices for field-effect transistors with insulated gate characterised by the conducting layer, e.g. the length, the sectional shape or the lay-out characterised by the surface lay-out
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S148/00—Metal treatment
    • Y10S148/126—Power FETs

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  • Engineering & Computer Science (AREA)
  • Microelectronics & Electronic Packaging (AREA)
  • Power Engineering (AREA)
  • Physics & Mathematics (AREA)
  • Ceramic Engineering (AREA)
  • Condensed Matter Physics & Semiconductors (AREA)
  • General Physics & Mathematics (AREA)
  • Computer Hardware Design (AREA)
  • Insulated Gate Type Field-Effect Transistor (AREA)
  • Prostheses (AREA)

Description

DESCRIÇÃO
ANTECEDENTES DA INVENÇÃO
APLICAÇÃO DA INVENÇÃO
A presente invenção refere-se a um siste^ ma de prótese modular do joelho, que é um sistema de prótese implantãvel usado para substituir um joelho natural e que é composto por uma série de hastes intramedulares com comprimentos diferentes e ângulos Valgus diferentes. O ângulo de Valgus e o comprimento da haste podem ser ajustados pelo cirurgião imediatamente antes da implantação do dispositivo, o que permite maior flexibilidade cirúrgica na implantação da prótese do joelho total.
ANTECEDENTES
As próteses de joelho total estiveram em uso durante algum tempo. Essas próteses são geralmente compos^ tas por um componente tibial, um componente femural e com componente da rótula. 0 componente femural da prótese é geralmen te constituído por uma porção cóndilar afastada independentemente e um conector, que liga as porções cóndilares. 0 comp£ nente tibial da prótese é construído para encaixar as porções cândilares do componente femural, isto é, as porções cõndilaree da prótese em contacto directo e são suportadas pelo componente tibial. A superfície de contacto femural do componen te tibial é constituído por um material plástico biocompatível, tal como o polietileno de peso molecular ultra elevado.
A porção da rótula da prótese é geralmente um botão de polietileno de peso molecular ultra elevado, que pode ser apoiada ou reforçada por metal e que ê fixada à rótula natural e assen ta sobre uma superfície metálica numa depressão do componente femural. Exemplo desta prótese é a que é apresentada na paten te norte americana N2 4 298 992.
As próteses do tipo apresentado na patente acima mencionada estão geralmente disponíveis com ou sem uma haste intramedular. A haste intramedular é usada para con ferir estabilidade lateral à prótese e é inserida no canal intramedular do fémur. As hastes são fixas segundo um ângulo relativamente à vertical, o que duplica o ângulo de Valgus” na anatomia humana. 0 ângulo de ”Valgus” é o ângulo entre a linha central do fémur e a linha imaginária vertical, que se estende desde o fémur distai até ao centro da cabeça fémural. Esse ângulo estã geralmente compreendido entre 5 e 99.
Na selecção de uma prótese para implantação o cirurgião não precisa necessariamente de conhecer precisamente o ângulo de Valgus e pode ou não saber se a prótese com ou sem uma haste intramedular deve ser a desejada para um paciente em particular. Segundo a regra geral de manuseio, a prótese escolhida para ser implantada, deve ser a menos complicada e a que necessita de menos remoção de ossos do pacien te.
Têm sido propostas próteses modulares como as que, são mostradas nas patentes norte americanas n2s 4 404 691 e 4 578 081. As próteses descritas nessas patentes têm hastes ou talas, que podem ser estendidos em comprimento, mas não proporcionam próteses sem hastes ou a variação do ângulo de Valgus da haste.
DESCRIÇÃO RESUMIDA DA INVENÇÃO
As próteses da presente invenção proporcionam, ao cirurgião ortopédico, uma flexibilidade na prepara ção de um componente fémural simples de uma prótese de joelho total. Esse componente femural é idêntico para os joelhos direito ou esquerdo e pode variar para admitir hastes de diâmetros diferentes, comprimentos diferentes e fixar segundo ângulos de Valgus diferentes para o uso nos joelhos direito ou esquerdo. 0 sistema da presente invenção permite uma maior flexibilidade cirúrgica na implantação de próteses e proporcio na um número de componentes relativamente não dispendiosos, pa ra serem disponíveis e prontos a implantar durante o procedimento cirúrgico. Esse custo dos componentes simplifica os sis temas de controle de inventário, tanto ao fabricante como ao hospital e assim reduz os custos de tal procedimento.
DESCRIÇÃO DOS DESENHOS
No8 desenhos;
figura 1 é uma vista isométrica da prótese da presente invenção completamente montada.
figura 2 é uma vista de frente da prótese da presente invenção.
figura 3 é uma vista lateral, parcialmente em corte da prótese da presente invenção.
figura 4 é uma vista explodida de uma porção de próteses da presente invenção.
figura 5 é uma vista explodida das próteses da presente invenção.
- 3 DESCRIÇÃO PORMENORIZADA DA INVENÇÃO
As próteses da presente invenção são com postas por um componente femural, que tem duas superfícies condilares 10, ligadas por um conector intercondilar 11, tal como mostram as figuras 1-3. As superfícies condilares têm uma depressão de rótula 12 entre as superfícies condilares, o que permite que a porção da rótula da prótese total do jorlho assente na depressão 12, quando o joelho é dobrado. Para os objectivos de orientação, a superfície interior 25 da prótese ê referida como superfície inferior e a superfície exterior é referida como superfície superior. 0 lado da prótese com a depressão da rótula 12 ê o lado anterior da prótese e o lado oposto é o lado posterior. A porção de prótese que inclui as superfícies condilares e o conector intercondilar podem ter construção semelhante ã das próteses, que são apresentadas na patente norte-americana n2 4 298 992. Nas presentes próteses há um orifício 13, que é mostrado nos desenhos como sendo um orifício circular. Quando desejado, este orifício pode ter uma forma diferente. A orla posterior do orifício tem uma pequena abertura ou ranhura 16, cujo objectivo será descrito subsequentemente. A presente prótese contem um para fuso 17, que tem a mesma configuração da secção transversal do orifício e que deve ser montado através do orifício e estender -se através de um anel da haste 18 e dentro da porção roscada da haste 19. 0 interior da haste tem uma porção de rosca fêmea, que pode ser enroscada na porção roscada do parafuso fémural 17, quando o dispositivo é montado. 0 parafuso deve ser mantido em posição no orifício, para o que a cabeça 14 do para fuso é mais largo do que o orifício 13. Quando a haste sobre o parafuso é apertada, o anel 18 da haste e a cabeça 14 do parafuso arrastam-se uma à outra até que a cabeça 14 do parafuso e o anel 18 da haste estão em contacto firme com a superfície intercondilar e mantêm a haste segundo o ângulo de Valgus” apropriado. 0 anel da haste tem uma fenda periférica 21 próximo do extremo do anel, que pode receber um grampo circular 22 para tratar a haste contra o anel da haste. A haste tem uma depressão ou ranhura correspondente.
- 4 Como mostra a figura 4, o grampo 22 encaixa parcialmente na ranhura 21 do anel da haste e parcialmente na haste para tra var a haste contra o anel da haste. 0 parafuso femural tem uma cabeça 14, que é dimensionada para encaixar adequadamente num rebaixo 15 sobre a superfície superior do conector inter condilar.
parafuso fémural 17 é construído de tal forma, que o eixo geométrico do eixo mecânico faz um ângulo com a cabeça 14 do parafuso, o que pode ser visto na figura 14. A cabeça de parafuso também é angulada, pelo que a superfície da cabeça é relativamente nivelada com o rebaixo na base da caixa intercondilar. A haste forma um ângulo, de 52, 72 ou 92 o ângulo Valgus, com a base da caixa. Estes ângulos, são os ângulos de “Valgus” geralmente usados nas construções de próte ses de baste. Quando o parafuso estã completamente assente na base da caixa intercondilar, forma o ângulo de “Valgus”.
Para se poder ajustar com firmeza em tomo do parafuso, o anel da haste faz um ângulo com a horizontal, que corresponde ao ân guio de “Valgus. No sistema modular da presente invenção, os parafusos são providenciados nas configurações direita e esquerda e segundo ângulos de 52, 72 e 92. Para cada parafuso existe um anel de haste correspondente. As hastes são providenciadas com diâmetros diferentes, normalmente 13 milímetros e 15 milímetros e com comprimentos diferentes tal como 90 e 130 milímetros. Os aneis de baste são dimensionados de modo a corresponderem ao diâmetro da baste. Para cada joelho, isto é, direito ou esquerdo, há 12 modificações possíveis; três ângulos de Valgus diferentes, cada um com dois diâmetros de baste possíveis e dois comprimentos de baste possíveis.
Deve ser compreendido que o modelo do com ponente femural básico no presente sistema tanto pode ser usado para o joelho direito como para o esquerdo, quer a haste seja usada quer não. Quando a haste é usada, é necessário ter parafusos, que são inclinados para a esquerda ou direita, dependendo do joelho em que podem ser envolvidas. Os parafusos também devem ter ângulos de “Valgus diferentes. Quando se desejar ter a capacidade de implantação de uma prótese tanto no joelho direito como no esquerdo segundo os ângulos de Valgus de
- 5 52, 72 ou 92, com os diâmetros de haste de 13 ou 15 milímetros e com comprimentos de haste de 90 ou 130 milímetros, normalmente deve ser necessário ter disponíveis doze próteses diferentes para o joelho direito e doze próteses diferentes para o joelho esquerdo. No presente sistema modular, só há necessidade de um componente femural simples e de preferência deve-se ter doze conjuntos de haste do joelho esquerdo e doze conjuntos de haste do joelho direito disponíveis para implantação. Apesar de o actual componente fémural ser o componente mais dispendioso, não é necessário guardar uma colecçao de custos elevados deste componente, já que a maior parte de opções de implantação podem ser feitas com a troca de materiais relativa mente não dispendiosos, tais como o parafuso fémural, a haste intermedular e os anéis da haste. Quando uma prótese da presente invenção é seleccionada, por um cirurgião ortopédico para implantação, o cirurgião deve ter disponível a dimensão correcta do componente femural e um conjunto de parafusos femurais, hastes e anéis de haste. Quando durante o procedimento operativo, se verificar que a haste não deve ser necessária para um determinado paciente, então não devem ser usados a haste, o parafuso femural e o anel da haste. Quando se decide que a haste deve ser usada, então devem ser seleccionados o parafuso femural de ângulo de Vagus e a montagem de diâmetro e comprimento correctos. 0 parafuso femural deve então ser ajustado à base do componente femural e a montagem da haste inserida com o perno anti-rotacional do anel da haste na ranhu ra 16. 0 perno anti-rotacional encaixado na ranhura 16 deve prevenir a rotação do anel da haste, quando a haste é apertada ao parafuso femural. Depois de a haste ter sido apertada ao parafuso, a prótese deve estar pronta para implantar.
As hastes e os anéis da haste podem ser pré-montadas numa oficina, numa montagem de haste, se for des£ jado. Cada montagem de haste deve incluir uma haste e um anel de haste com o mesmo diâmetro da haste, conectados com um grampo circular. A pré-montagem da haste e do anel da haste é da conveniência do cirurgião. Durante o procedimento cirúrgico, o cirurgião deve decidir qual é a haste desejada, deve
seleccionar o parafuso apropriado e a montagem da haste, inserir o parafuso através do orifício 16 e adaptar a montagem da haste do parafuso, assegurando-se de que o perno 20 está posicionado na ranhura 21.

Claims (1)

  1. REIVINDICAÇÕES
    - lâ Sistema de prótese de joelho modular cons tituído por um componente femoral, um componente tibial, e um componente patelar, caracterizado por proporcionar um componen te femoral com pelo menos duas cavilhas femorais, cada una das quais está ligada e adaptada a um ligador intercondilar entre porções con dilares da componente femoral, pelo menos um aro de haste de suporte adaptado a ajustar em torno da cavilha e em contacto com a porção inferior do ligador intercondilar, sendo esse aro de haste de suporte e a cavilha femoral fixáveis ao ligador in tercondilar segundo ângulos correspondentes ao ângulo de valgus desejado na prótese implantada, uma seria de pelo menos duas hastes de comprimentos diferentes, estando cada uma dessas hajj tes adaptado para ser fixada à cavilha femoral para formar uma componente femoral completa.
    - 2s Sistema de acordo com a reivindicação 1, caracterizado por pelo menos uma das cavilhas possuir uma configuração angular que lhe permite ser implantada num joelho es_ querdo e pelo menos uma das cavilhas possuir uma configuração angular para ser implantada num joelho direito.
    - 3s Sistema de acordo com a reivindicação 1, caracterizado por a série de hastes incluir pelo menos quatro hastes possuindo pelo menos diâmetros diferentes.
    - Sistema de acordo com a reivindicação 1, caracterizado por possuir pelo menos três cavilhas femorais, desenvolvendo-se cada uma dessas cavilhas, quando totalmente instaladas no ligador intercondilar, segundo um ângulo que difere do ângulo segundo o qual as outras cavilhas se desenvolvem quando completamente instaladas no ligador intercondilar.
    - 5ã Sistema de acordo com a reivindicação 1, caracterizado por cada haste ser constituída por uma componente de aro de haste de suporte, uma porção de haste e um ligador para ligar o aro à haste.
    - 6ê Sistema de acordo com a reivindicação 5, caracterizado por um plano que passa ao longo da superfície inferior do aro da haste de suporte formar um ângulo com um plano que passa ao longo da superfície superior do aro da ha_s te de suporte e o qual corresponde ao ângulo de Valgus.
    - 7ã Sistema de acordo com a reivindicação 5, caracterizado por a porção de haste ser enfiada na cavilha para manter a haste em posição.
    - 8â Sistema de acordo com a reivindicação 5, caracterizado por a cavilha femoral se desenvolver a partir da superfície superior da componente femoral através de um orifício que possui uma ranhura na sua face posterior e uma cabeça na face inferior do aro da haste de suporte por ajuste no interior da ranhura para evitar a rotação do aro da haste de suporte.
    - 9ê Sistema de acordo com a reivindicação 4, caracterizado por ser constituído ainda por hastes possuindo pelo menos dois diâmetros diferentes.
    - lOê Sistema de acordo com a reivindicação 9, caracterizado por pelo menos uma das referidas cavilhas possuir uma configuração angular para ser implantada num joelho esquerdo e pelo menos uma das referidas cavilhas possuir configuração angular para ser implantada num joelho direito.
    A requerente reivindica a prioridade do pedido norte-americano apresentado em 27 de Dezembro de 1988, sob o número de série 290,540.
PT92740A 1988-12-27 1989-12-27 Protese de joelho modular PT92740B (pt)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
US07/290,546 US5072266A (en) 1988-12-27 1988-12-27 Trench DMOS power transistor with field-shaping body profile and three-dimensional geometry

Publications (2)

Publication Number Publication Date
PT92740A PT92740A (pt) 1990-06-29
PT92740B true PT92740B (pt) 1995-12-29

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US5298442A (en) 1994-03-29
US6627950B1 (en) 2003-09-30
US5072266A (en) 1991-12-10

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