CN1132067A - 用于矫形外科手术的器械 - Google Patents
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- 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
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4657—Measuring instruments used for implanting artificial joints
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
- A61B17/154—Guides therefor for preparing bone for knee prosthesis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
- A61B17/154—Guides therefor for preparing bone for knee prosthesis
- A61B17/155—Cutting femur
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
- A61B2017/0268—Joint distractors for the knee
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/2833—Locking means
- A61B2017/2837—Locking means with a locking ratchet
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
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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
- A61F2/30—Joints
- A61F2/38—Joints for elbows or knees
Abstract
一种器械组合用以在全膝部复位术中协助外科医生选择适当的埋植假体元件。该器械组合包括各种对准和校验的装置,其中一个转动对准导子包括用以导向切除该股骨的后侧髁骨的锯片的槽沟;该器械组合还包括一个伸张器,其由扭力旋钳起动并于其上承载可滑动的测量杆,测量杆上有相关于股骨与股骨和胫骨间距的尺寸大小的标记。
Description
本发明涉及用在矫形外科的器械,该器械在全膝部复位手术操作中用以测定股骨和聚乙烯元件以及提供正确的对准指示并能协助外科医生以对该关节提供适当的软组织平衡。
在对损伤的膝部进行复位的全膝部关节成形术手术过程中,矫形外科医生在确保膝关节的接合结果得到平衡方面往往需要化很长的时间。平衡的膝关节会显示该关节在整个运动范围内以及在该膝部的机械轴线线和该膝部的解剖轴线线之间的预定角度的正确韧带张力。这提供一种更自然有效的关节假体和改进该假体的磨损特性。正确地造反该假体部件的尺寸是一个重要的因素,该因素会影响手术过程的成败。如果选择了错误的部件,则其各腱可能会太紧或太松,造成该膝部的性能很差。
本发明的器械组合,在选择各植入元件的尺寸上、在确定切割远侧骨头的量上、在提供正确的软组织平衡上及在用以切割该骨头的器械的对准上,可对外科医生提供辅助作用。该器械组合对外科医生提供多种用以校验的系统,以便该医生能在切割该股骨之前,先校验是否已经正确地调整好该器械及正确地平衡好该关节。
该器械组合包括一个转动对准导子,该导子协助外科医生确定正确的膝部转动对准,这种正确的膝部转动对准是通过参照诸如后侧髁骨和上髁等标准的股骨界标而确定的。该转动对准导子包括一个用以导引一个锯片的槽沟,而该锯片则用以移除该股骨的后侧髁骨。
该器械组合还包括一个用以在该膝关节弯曲和伸展时张紧或松弛该膝关节的伸张器。该伸张器由一个扭力旋钳起动,使得可在该关节上施加一个已测定大小的张紧力。该伸张器构造成可滑动地承载测量杆,该测量杆与该股骨接触并具有多个与该股骨的尺寸大小及该股骨和胫骨之间的间距的尺寸大小相关的标志。外科医生可利用这些信息选择股骨和胫骨的关节联接表面部件的正确尺寸。当膝关节弯曲和伸展时,该测量杆连接到该伸张器,该测量杆便会相关外科医生指示出待被切割的骨头所需改变的量的大小。
因此,本发明的一个目的是提供一种用以张紧和测量膝关节的新颖器械组合。
本发明的另一个目的是提供一种新颖的伸张器,膝关节能以弯曲或伸展状态下放置于该伸张器中。
本发明的又另一个目的是提供用以测量膝关节的新颖系统,其包括测量胫骨和股骨之间的间距和测量该股骨的尺寸大小的器械。
本发明还有另一个目的是提供能相对于一个标准切割用以确定待切割的骨头的量的器械组合。
在阅读下述说明书及其附图之后,便可对本发明其他目有清楚的认识。
图1至13(包括图10A)说明在膝部复位外科手术过程中,使用本发明的器械组合的步骤序列以及其操作方式。
图14是本发明的转动对准导子的透视图。
图15是图14中所示的转动对准导子的侧视图。
图16是从图15所示的转动对准导子左方观察的该转动对准导子的视图。
图17是本发明的伸张器的分解透视图。
图18是图17中所示的伸张器的侧视图。
图19是从图18所示的伸张器右方观察的该伸张器的视图。
图20是本发明的股骨测量器和钻头导子的正视图。
图21是图20中所示的股骨测量器和钻头导子的侧视图。
图22是图20中所示的股骨测量器和钻头导子的顶部部分的顶视图。
图23是本发明的角度指示器的正视图。
图24是从图23所示的角度指示器左方观察的该角度指示器的视图。
图25是从图24所示的角度指示器的左(或右)侧方观察的该角度指示器的视图。
本文此处所叙述的优选实施例并不作为本发明的完全精确的形式而公开,也不作为对本发明的限制。相反,选择该实施例只作为对本发明的更好的说明,以使本领域的普通技术人员能运用本发明的教导。
图1至13(包括图10A)示出本发明的器械组合在进行外科手术时使用各单独器械的情况。各附图以这样一种方式安排,各器械以其在实际的膝部复位手术中的先后次序出现在各附图中。因此,本发明的说明书将如示于图1至13那样以各器械的用途作起点进行一般的叙述。下文将更详细地叙述每一个器械。
为了给予读者以本发明的各器械的正确指引并协助使其能对各器械的结构有更全面的认识,在多个附图中提供以小的方向图。该方向图指示出一般的方向,诸如前侧、后侧、内侧、外侧以及远侧和近侧。这些术语与股骨的定向相关,并将之用以与各个器械的公知医疗用途相一致地叙述该器械。
术前,外科医生需先获得病人腿部的各种有关X-光照片。该外科医生便利用该X-光照片确定该膝关节的解剖轴线和机械轴线之间的角度。该外科医生还可利用该X-光照片确定由该股骨远侧髁形成的横轴和平面之间的角度。
手术过程中,将该膝关节暴露,并将该胫骨T的远侧端切割,以便形成一种平坦的胫骨坪,该胫骨坪基本上垂直于该膝关节的机械轴线。利用一种标准的锯片和导子或通过研磨来完成该切割手术。美国专利第5,344,423号叙述了一种用以研磨该远侧胫骨表面的装置。该外科医生便以公知的方式形成有关进入该股骨F的髓管的开口。
此时,该外科医生需确定该股骨的转动对准。为此,如图1和2所示,将该转动对准导子10的支承导子26的髓内杆插入该股骨之内。将该导子10一直插入该股骨中,直到该导子的主体18与该远侧股骨相接触为止。在插入该导子的过程中,该外科医生须调整该导子10的主体18相对于该股骨的位置,使得该导子的参照脚部24如图1所示与后侧髁骨PC接触。该参照脚部24和该主体18之间的角度可固定或可调整,以便对该膝部提供正确的转动对准。如果该参照脚部24相对于该主体18的角度是固定时,该器械将提供以一组参照脚部,每个参照脚部设定在一个预定的角度对准上。以该器械如示于图1中的情况正确定位后,该导子10的主体18的后表面便平行于该胫骨坪。这样便可对该外科医生提供有关器械的正确对准的快速直观指示。为了对器械的正确对准进一步进行校验,该外科医生可将该转动对准导子直观地与公知的解剖界标对准,该解剖界标可诸如为后侧髁骨、上髁骨或前侧股骨。一旦该外科医生对该转动对准导子的对准感到满意后,便将一个销子插入管20两侧边上支承导子26的至少一个通孔30之中,在该股骨上形成一个标志,以便其后使用。类似地,将该主体支承到该远侧股骨上。再用锯片(未示出)移除该后侧髁骨,该锯片则由该转动对准导子主体中的导向槽沟导向。然后移除该转动对准导子。
接着,如图3所示,该外科医生通过插置在该胫骨和该股骨之间的该伸张器40将该弯曲的膝关节张紧。如示于图3和4中,该伸张器包括:一个第一桨片44,该桨片44接触已切割的该近侧胫骨;和第二桨片组58、92,该桨片组58、92与已切割的该后侧股骨的髁骨接触。该第二桨片组连接到独立的棘轮传动器72、88,该棘轮传动器伸展该桨片组58、92和桨片44之间的间距。一个扭力驱动器TD用以将该第二桨片和该第一桨片分隔开,直至将一预定的力施加在该股骨和该胫骨之间。该伸张器包括多个用以防止该第二桨片组无意当中朝该第一桨片移动的棘轮爪。将弯曲的膝关节张紧使该外科医生能平衡并微调该软组织。平衡软组织的操作可通过多种公知的方法进行,该方法诸如为在该多个韧带中的一个韧带切开一个很小的切口,以使该多个韧带得以“松弛”或稍许伸展。如果软组织的平衡需要更明显的调整,该外科医生可在再调整该器械或再切割该胫骨二个方法中选择其一。
以该膝关节弯曲并张紧的情况下(图3和4),将该股骨测量器滑入该伸张器40的T形槽沟48中,直至该测量器的测量臂104接触该股骨的前侧表面为止(图5和6)。接着,该外科医生将一个弯曲聚合物厚度导子130滑入该伸张器40中,该弯曲聚合物厚度导子与该伸张器40的槽沟48中的该股骨测量器成重叠关系(参见图7)。如图7所示,该弯曲聚合物厚度导子包括一个横臂132,该横臂132与该伸张器40的第二桨片组之一的第二桨片58上的杆49相接触。该测量器导子100包括位于其上的多个标记101,该标记101与该股骨所需的该股骨元件的尺寸相关。该弯曲聚合物厚度导子130包括多个标记131,该标记131与在弯曲时所需的聚合物元件的厚度相关并间接地指示待切割的该近侧股骨的尺寸大小。为正确确定该股骨元件的尺寸大小,该外科医生可读出在该股骨测量器导子上最高位置处所显示的字母。举例而言,在图8中所设定的状态下,显示该股骨需要一种E尺寸的股骨元件。接着,该外科医生须确定该胫骨联接表面(聚合物)所需的厚度,该厚度可通过读出与一个在该伸张器40的表面上制成的刻纹41对准的该弯曲聚合物厚度导子130上的该标记131而得出。请再参照图8,在所设定的状态下,显示病人的膝关节在弯曲时需要一个17毫米的聚合物元件。如下文将要叙述的那样,从该弯曲聚合物厚度导子读出的读数,也用以确定相对于一个标准切割量待切割的远侧股骨的切割量。
然后,该外科医生让该伸张器解锁,将膝部放置在伸展状态,并以上文叙述的相同方式在将该膝部张紧。以该膝部处于伸展状态,简单地将该测量器100的臂部104转动到毗邻该股骨且不阻碍该外科医生进行手术的位置上。如图9和10所示,将角度对准指示器110放置在该股骨测量器100上,并将之沿该测量器的转轴102滑动,直至该指示器100的主体112的腿部114接触该伸张器40的桨片58和92的杆49和59为止。该指示器100包括C形托架118,该托架镶嵌在该测量器100的转轴102上。该托架118连接到一个指针120。该指针120和托架118可相对于该主体112转动。如图10中所示,如此放置指针或放置指示器时,该指针或指示器显示出现在设定的膝部大略有3°的角偏差。该外科医生利用该角度对准指示器110,以保证可按照其在术前预先确定的适当的角偏差的量,正确地定位和平衡该膝关节。这便允许该外科医生微调该膝关节的软组织平衡,使得该膝部假体有适当的角偏差。一旦该外科医生对该角偏差的量感到满意时,便可将该角度对准指示器110移除,并将一对销子101插入该股骨测量器100的支承导子103的开口中(参见图10A)。接着,如图11所示,该外科医生将该伸展聚合物厚度导子140以重叠的方式放置在该伸张器40的槽沟48内的该股骨测量器100上。该伸展聚合物厚度导子140包括一个横臂142,并以与前文叙述的定位该弯曲聚合物厚度导子的相同方式前文该伸展聚合物厚度导子。该伸展聚合物厚度导子包括多个标记144。该外科医生读出与该伸张器40的表面上的刻纹41对准的标记读数。如图12中所示,该伸展聚合物厚度导子指示出一个数字“14”。
该外科医生将该弯曲聚合物厚度导子130读出的读数减去该伸展聚合物厚度导子140读出的读数,以便相对于一个标准切割量待切割的骨头的切割量。继续参看图12中所示的实例,弯曲度的读数是“17”;减去该伸展聚合物厚度导子的读数“14”;余数便是“3”。因此,该器械向该外科医生报告,为得到该膝关节的正确的软组织平衡及韧带张紧程度,必须相对于标准的切割量再额外地切割3毫米的骨头。如果计算结果是一个“负”的数时,该外科医生须如下文所述调整该器械,以便相对于标准切割量少切割3毫米。
该外科医生可选择一个相应于上述计算结果的垫片148,并如图13所示将该垫片连接到一个髓内对准导子150。如图13所示的该髓内对准导子150已详细地记载在1994年6月17日申请的、申请号为08/265,884的共同待决的美国专利申请案,该专利申请案通过引用而结合到本发明中。该髓内对准导子的调整于该结合到本发明中的该美国专利申请中已经详细说明,在调整时,该垫片148相对于IM杆的角度设定在有该外科医生于术前预先确定的外翻角度。该髓内对准导子包括穿过该垫片的一对槽沟和底部,该外科医生将该底板与在图1中所示的形成在该股骨的多个转动参照标志对准。该外科医生可选择性地在一对参照标志上插入销子,以便协助对准该髓内对准导子。再将该对准导子插入到该股骨中,直至该垫片与该远侧股骨牢固地接触为止。作为对外翻对准的最后直观检查,该外科医生将一个外翻对准导子160插入在该对准导子150之上(参见图13)。该外翻对准导子160包括一个由其主体164可滑动承载的T形手柄162。该T形手柄由该股骨测量器100导向而朝放置在该股骨内的参照销子101滑动。如果该T形手柄的头部接触该两个销子101时,该对准导子150便设定在适当的外翻角度上,在伸展状态下的该股骨和该胫骨之间形成一个矩形的关节间隙。如果没有接触其中一个销子,该外科医生便有四个选择:1)当该不配合性相差甚微时,接受这种不配合性;2)调整该对准导子上的外翻角度,直至与该两个销子接触为止;3)调整该软组织直至该两个销子与该外翻对准导子接触为止;或4)再切割该骨头并再对准该关节。该外科医生的选择依赖于该不配合性的大小和该外科医生的喜好而定。一旦该外科医生对该对准导子的放置感到满意,他便可以移除该外翻对准导子160并在该处以骨头研磨器械代替之,其有关的操作已经在1993年2月17日申请的、申请号为08/169459共同待决的美国专利申请案说明和叙述,该专利申请案通过引用而结合到本发明中。
此说明书的下面剩余部分将对上文所述的各器械的结构和功能详细地进行说明。
图14至16中所示的该转动对准导子10包括一个大致为矩形的主体12,该主体12具有一对相对的槽缝18,该槽缝18如图16所示伸展穿过该主体12。该主体12包括穿过其上的多个通孔14,该通孔14接收用以在切割该后侧髁骨的过程中稳定该主体的销子。从该主体12的前侧伸展有一个管子20,该管子20包含一个手柄22。一对参照脚部24与该主体12相互连接,该对参照脚部从该主体的近侧伸展。举例而言,该对参照脚部24通过一个螺丝钉(未示出)可拆卸地安装在该主体12上。该参照脚部24可在使其于预定的角度范围之间转动的方式连接到该主体12上。另一方面,该参照脚部24也可制成相对于该主体12有一个固定的角度。一个支承导子26可移动地由该管子20承载,该支承导子26大致上与该主体12平行。一个髓内杆28从该支承导子26的近侧伸展。如从图14和15可清楚地看到的那样,该支承导子26包括一对穿过该支承导子26的多个通孔30,该各通孔30相对于该管子20定位在该支承导子26的内侧和侧边部位。一个臂27从该支承导子26的内侧和侧边伸展,并提供给该外科医生用以直观地将该导子10与公知的解剖界标对准的瞄准装置。
该伸张器40示于图17至19中,其包括一个壳体42,该壳体限定一个用以接触该胫骨的第一桨片44。该壳体42还包括棘轮壳体46、47,该棘轮壳体46和棘轮壳体47被一个T形槽沟所隔开。该棘轮壳体46承载一个棘轮机构,该棘轮机构由一个爪件50和一个连接到该爪件50的释开装置52构成。一个爪件弹簧54由该释开装置承载并定位在该棘轮壳体和该爪件之间,该爪件弹簧54偏置该爪件,使该爪件与第二桨片58的棘轮转轴56上的棘轮齿60形成棘轮啮合。如图中所示,该棘轮转轴56可移动地接纳在一个贯穿该棘轮壳体46的开口,该棘轮转轴沿其纵向侧边有棘轮齿60。
该释开装置52包括一个释开转轴62,该释开装置可转动地连接到该爪件和一个释开钮64。该释开钮的内表面包括一对凸件66(图17中只见到一个),该对凸件彼此分隔在该释开转轴62的两侧。该凸件66接纳在该棘轮壳体46的一个槽沟68中。为了释开该爪件50与该棘轮齿60的啮合,从而允许该第二桨片朝向该第一桨片44移动,需将该释开钮转动,导致该凸件66从该棘轮壳体46中退出并与该棘轮壳体46的外表面接触,于是将该释开转轴62和中间的该爪件50移动,直至将该爪件与该棘轮齿分隔开为止。一个棘轮壳体盖70用螺丝钉旋紧在该棘轮壳体46之上。该棘轮转轴56包括驱动齿71,该驱动齿71沿该转轴上该棘轮齿60一侧的另一侧边纵向伸展。一个细长的驱动齿轮72承载在该棘轮壳体46中形成的开口之内,该驱动齿轮72与该棘轮转轴56的驱动齿71啮合。一个螺丝钉74将该驱动齿轮72固定在该棘轮壳体之内。
该棘轮壳体47承载一个爪件76,该爪件76可绕摆动销子77而在该棘轮壳体47内摆动。一个摆动臂78连接到该爪件78的前侧端部,并连接到释开装置86的释开转轴。一个爪件弹簧80定位在该棘轮壳体47和该爪件的侧向远侧端部,以便推动该爪件76与该棘轮转轴84的棘轮齿82啮合。该释开装置86设计成在结构和功能上与上文所述的释开装置52相同,故不拟在此多加赘述。在响应其凸件和该壳体47之间的接触后,该释开装置86便侧向地移动,该摆动臂则拉动该爪件76的前侧端部,以使其后侧端部摆动而释开其与该棘轮转轴84的啮合。该棘轮壳体47承载的一个驱动齿轮88,该驱动齿轮88由一个螺丝钉(未示出)保持与棘轮转轴84的啮合。该棘轮转轴84包括驱动齿85,该驱动齿85与该驱动齿88相啮合。一个棘轮壳体盖90通过螺丝钉连接到该棘轮壳体上。另一个第二桨片92则连接到该棘轮转轴84上。如图17至18所示,各个第二桨片58和92分别包括一个杆49和59,该各杆从该各桨片朝前侧方向伸展。该杆49和59大致上与其相应的桨片在同一平面内,并形成用以作与前述的该聚合物厚度导子接触的参照平面。该驱动齿轮72和88各包含在其上形成的六角形开口,该开口用以接纳一个扭力驱动器的工具头。该扭力驱动器的工具头插入到该驱动齿轮的开口,并将之顺时针方向转动以将该第二桨片58或92在离开该第一桨片44的方向上移动。直至使用该释开机构释开该爪件与该棘轮齿的啮合之前,该棘轮机构可以防止该第二桨片58和92朝该第一桨片44的方向上移动。
股骨测量器导子100(参见图20至22)包括一个转轴102,该转轴102具有一个T形截面,使得该转轴102可滑动地接纳在该伸张器40的T形槽沟48中。一个支承导子103连接到该转轴102上。该导子100还包括一个臂104,该臂104具有如图所示的头部。该臂104可转动地连接到该转轴102上。该转轴102的前向表面上包括多个标记,该标记与待该外科医生植入的各种尺寸的股骨假体元件相关,而这种假体元件可于受让人的齐默尔有限公司(Zimmer,Inc.)购得。
该角度对准指示器110示于图23至25中,其包括一个主体112,该主体具有一对伸展方向相反的腿部114和一个指示面板116。该面板116包括于其上的标记,该标记与该两个桨片之间相对于该股骨测量器导子的转轴的相对角度有关。该指示器110还包括一个C形支架118,该支架118通过该主体112连接到一个指示针120上。支架118和该指示针120彼此相对地固定,并相对于该壳体可转动。使用时,该支架118接合该股骨测量器导子100,而该腿部接触各该桨片的各杆49和59。
应当理解到,本发明并不限制在上述公开的精确形式,而可在附上的权利要求书的范畴内作出各种改型。
Claims (18)
1.一种用以在膝部复位术中的器械组合,其特征在于,该器械组合包括:一个用以在膝关节的远侧股骨和近侧胫骨之间施加张紧力的伸张器;和连接到该伸张器的、用以在该膝关节处于伸展或弯曲状态时测量该远侧股骨和该近侧胫骨之间的间距的测量装置。
2.如权利要求1所述的器械组合,其特征在于,该伸张器包括:一个用以接触该近侧胫骨的第一桨片,和用以接触该远侧股骨的第二桨片组,该第一桨片和第二桨片组包括一个用以将第一桨片和第二桨片组分隔开的齿轮驱动装置;用以防止该第一桨片和第二桨片组无意当中彼此朝向对方移动的棘轮装置,该棘轮装置由该伸张器承载并啮合该齿轮驱动装置;和用以释开该棘轮装置和该驱动装置的啮合并允许该第一桨片和该第二桨片组彼此朝向对方移动的释开装置,该释开装置由该伸张器承载。
3.如权利要求2所述的器械组合,其特征在于,该释开装置包括一个释开转轴,该释开转轴的一个端部连接到该棘轮装置的一个爪件,而其另一个端部连接到一个释开钮,该释开钮具有至少一个在该释开转轴的方向上从该释开钮伸出的凸件,当该棘轮装置与该齿轮驱动装置啮合时,该凸件接纳在该伸张器的一个槽缝中,在该释开钮转动时该凸件由该槽缝中退出并与该伸张器的侧壁接触,以便移动该棘轮装置而脱开其与该齿轮驱动装置的啮合。
4.如权利要求1所述的器械组合,其特征在于,该测量装置包括一个第一测量器,当该膝关节处于弯曲状态时,该第一测量器在该伸张器上滑动并接触该股骨的远侧前侧部分,该第一测量器包括在其上的第一标记,该标记与该远侧股骨所需的一个股骨元件的尺寸大小相关。
5.如权利要求4所述的器械组合,其特征在于,该测量装置包括一个第二测量器,该第二测量器以相对于该第一测量器部分地重叠的关系在该伸张器上滑动,该第二测量器以该股骨所需的假体元件的大小为准且与该第二测量器的一个端部对准的方式而接触该伸张器。
6.如权利要求5所述的器械组合,其特征在于,该第二测量器包括在其上的标记,该标记与该股骨和该胫骨之间的间距的尺寸大小相关。
7.如权利要求6所述的器械组合,其特征在于,该测量装置还包括一个第三测量器,当该膝关节处于伸展状态时,该第三测量器在该伸张器上滑动,该第三测量器包括在其上的标记,该标记指示出该膝关节处于盛装状态时该股骨和该胫骨之间的间距的尺寸大小。
8.如权利要求7所述的器械组合,其特征在于,将从第二测量器读出的读数减去从第三测量器读出的读数所产生的一个差数,该差数给外科医生有关相对于标准的切割量该待切割的股骨所需切割的骨头的量的指示。
9.一种器械组合,该器械组合在全膝部成形术手术过程中,用以建立和校验一个膝关节的转动对准角度和预定外翻角度;且该器械组合在切割远侧股骨之前,用以协助一个外科医生为该膝关节选择适当的假体元件以保证适当的软组织平衡;该膝关节包括与软组织互相连接的一个股骨和一个胫骨;该器械组合包括:
一个用以在该股骨的远侧端部上建立转动对准导子标记的角度对准导子,该导子标记与一个膝关节的该优选的转动角度有关;
一个放置在该膝关节的股骨和胫骨之间的伸展器,该伸张器用以张紧互连该股骨和该胫骨的软组织;及
可连接到该伸张器的测量装置,该测量装置用以给外科医生指示出有关适配于该膝关节的假体的适当尺寸大小,并用以给该外科医生指示出有关该胫骨和该股骨张紧的间距的尺寸大小。
10.如权利要求9所述的器械组合,其特征在于,该器械组合还包括一个用以校验该膝关节已定位在该外科医生预先设定的外翻角度上的校验装置。
11.如权利要求9所述的器械组合,其特征在于,该器械组合还包括一个支承导子,该支承导子用以在该股骨内放置一对对准销子。
12.如权利要求9所述的器械组合,其特征在于,该测量装置包括一个股骨测量导子,该股骨测量导子可滑动地接纳在该伸张器中,并包括一个当该膝关节处在弯曲状态时用以接触该股骨的前侧表面,该测量装置还包括一个弯曲聚合物厚度导子,该弯曲聚合物厚度导子成重叠关系地定位在该股骨测量导子上,该弯曲聚合物厚度导子包括在其上的标记,该标记与该膝关节处在弯曲状态下该股骨和该胫骨之间的间距的尺寸大小相关。
13.如权利要求12所述的器械组合,其特征在于,该测量装置还包括一个伸展聚合物厚度导子,该伸展聚合物厚度导子在该膝关节处在伸展状态时由该伸张器承载,且该伸展聚合物厚度导子还包括在其上的标记,该标记与该膝关节处在伸展状态下该股骨和该胫骨之间的间距的尺寸大小相关。
14.一种在全膝部成形术手术过程中用以建立和校验一个膝关节的转动对准角度和一个预定的外翻角度、且在切割远侧股骨之前,用以协助外科医生为该膝关节选择适当的假体元件以保证适当的软组织平衡的方法,该膝关节包括有软组织互相连接的一个股骨和一个胫骨;该方法包括如下的步骤:
(a)用手术暴露该膝关节并将该膝关节放置在弯曲状态,该膝关节包括一个近侧胫骨和一个远侧股骨,该远侧股骨包括前侧髁骨;
(b)将一个转动对准导子插入该股骨之中,并将该转动对准导子与各公知的解剖界标对准,
(c)将一个一个用以切割该前侧髁骨的锯片导向在该转动对准导子中形成的槽沟内,使得切割后,在该髁骨上形成的表面平行于该胫骨;
(d)在该胫骨和该股骨之间插入一个伸张器,并操作该伸张器,直至将一个预定大小的力施加在该伸张器上,使得该股骨和该胫骨分隔开;
(e)将一个股骨测量导子放置在该伸张器上,直至该股骨测量导子的一个部分接触该股骨,该股骨测量导子包括在其上的多个标记,该标记用以指示该股骨所需的一个股骨元件的尺寸大小;
(f)将一个弯曲聚合物厚度导子放置在该伸张器上,该弯曲聚合物厚度导子包括在其上的标记,该标记用以指示当该膝关节处在弯曲状态下该股骨和该胫骨之间的间距的尺寸大小;
(g)读出在该股骨测量导子上的读数;
(h)读出在该弯曲聚合物厚度导子上的读数。
15.如权利要求14所述的方法,其特征在于,该方法还包括如下步骤:
(a)将该膝关节定位成伸展状态;
(b)将该伸张器插入到该胫骨和该股骨之间,并操作该伸张器,直至将一个预定大小的力施加在该伸张器上,使得该股骨和该胫骨分隔开;
(c)将一个伸展聚合物厚度导子放置在该伸张器上,该伸展聚合物厚度导子包括在其上的标记,该标记用以指示当该膝关节处于伸展状态下该股骨和该胫骨之间的间距的尺寸大小;
(d)读出在该伸展聚合物厚度导子上的读数;
(e)将从该弯曲聚合物厚度导子读出的读数减去从该伸展聚合物厚度导子读出的读数以取得二者之差值,该差值指示出待切割的股骨的切割量以便接纳一个假体元件而要加以考虑的变化量。
16.如权利要求15所述的方法,其特征在于,该方法还包括如下步骤:
(a)当该膝关节处在伸展状态下,将一个角度对准指示器连接到该伸张器,以便指示出该膝关节的角偏离的量,该角度对准指示器包括在其上的标记,该标记与该膝关节的角偏离相关。
17.如权利要求14所述的方法,其特征在于,该步骤(e)中包括将一对销子提供在该股骨测量导子上形成的销子开口插入该股骨中。
18.如权利要求17所述的方法,其特征在于,该方法还包括如下的步骤:
(a)将一个对准导子连接到该远侧股骨上,该对准导子包括一个用以接触该销子的滑动手柄件;
(b)将该手柄朝向该销子滑动,直至至少有一个销子与该手柄接触。
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US08/369,226 US5540696A (en) | 1995-01-06 | 1995-01-06 | Instrumentation for use in orthopaedic surgery |
US369,226 | 1995-01-06 |
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Also Published As
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---|---|
AU4075195A (en) | 1996-07-18 |
CA2165933A1 (en) | 1996-07-07 |
EP0720834B1 (en) | 1999-06-02 |
US5688280A (en) | 1997-11-18 |
EP0720834A2 (en) | 1996-07-10 |
EP0720834A3 (en) | 1996-07-17 |
AU699893B2 (en) | 1998-12-17 |
US5540696A (en) | 1996-07-30 |
JPH08229058A (ja) | 1996-09-10 |
JP3822273B2 (ja) | 2006-09-13 |
DE69602624D1 (de) | 1999-07-08 |
KR960028883A (ko) | 1996-08-17 |
CA2165933C (en) | 2008-04-29 |
DE69602624T2 (de) | 1999-10-21 |
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