CN1738581A - 带有插入股骨中的轴的髋部假肢 - Google Patents

带有插入股骨中的轴的髋部假肢 Download PDF

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Publication number
CN1738581A
CN1738581A CNA2004800022772A CN200480002277A CN1738581A CN 1738581 A CN1738581 A CN 1738581A CN A2004800022772 A CNA2004800022772 A CN A2004800022772A CN 200480002277 A CN200480002277 A CN 200480002277A CN 1738581 A CN1738581 A CN 1738581A
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CN
China
Prior art keywords
rib
axle
artificial limb
shaft
height
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CNA2004800022772A
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English (en)
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CN100479788C (zh
Inventor
A·凯勒
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Waldemar Link GmbH and Co KG
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Waldemar Link GmbH and Co KG
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Publication of CN1738581A publication Critical patent/CN1738581A/zh
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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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017—Angular shapes
    • A61F2230/0023—Angular shapes triangular
    • 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
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017—Angular shapes
    • A61F2230/0026—Angular shapes trapezoidal
    • 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
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0026—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in surface structures

Abstract

带有要插入到股骨中的直轴(1)的假肢，其中轴的近体部分(6)插入到股骨的干骺区域内，并在前侧和后侧分别具有至少一个带内侧陡侧面(23)的凸出的肋条(8)。肋条(8)至少在其长度的一部分偏离轴(1)的纵向(27)、向上向股骨颈部(2)方向倾斜。因此当轴推入骨内时，包围肋条(8)的骨质被压缩并能传递更大的力。肋条(8)的高度从其内侧侧面(23)向其外侧侧面(25)降低。

Description

带有插入股骨中的轴的髋部假肢
对于在股骨中锚定假肢轴，骨骺区的情况与骨干区不同。在骨骺区，也就是基本在股骨小转子上方区域，疏松的骨头填充了多孔骨质，在骨质内必须做出人工接收管道以接收假肢轴。因多孔骨质松软，所以限制了在该区域传力的可能性。在股骨小转子下方，强壮的骨外壳限定了较窄的骨髓腔，该骨外壳为传力提供了好得多的前提条件。为此，发展的假肢轴特别适合锚定或楔入在骨的该股骨干区(Schneider：Die Totalprothese der Huefte，第214页及以后几页)。其可靠地锚定在在骨的骨干导至骨的骨骺区不受力。如果骨质不受力，它将逐渐萎缩。这是不希望发生的。
在最初锚定在骨的干骺区假肢情况下，已知的是(EP-B-761183；EP-A-780106；EP-A-1070490；EP-B-159462；EP-B-821923；EP-B-112435；DE-C-4428099)通过从假肢基体腹侧或背侧凸出的肋条和边缘改善在干骺区的锚定。如果规定用于锚定在骨粘合剂或形状相同的铣出的腔内，则这些肋条允许在内外侧方向上有相当大的延伸范围(EP-A-780106；EP-A-1070490；DE-C-4428099)。当使用了肋条，该肋条在无粘合剂植入情况下切入骨质并将其压缩，则在无粘合剂植入情况下，术后假肢非常牢固地配合在骨中(EP-B-761183)。因此在将假肢轴插入骨中之前准备的腔的大小限定为轴基体的体积。为在压入轴时肋条不将骨胀破，将肋条设计为狭长形并带有倾斜向下的内侧和外侧侧面(EP-B-159462；EP-B-821923；EP-B-761183)。这限制了其传力能力。
本发明涉及这种假肢类型，其中特别要实现在骨的骨干区进行锚定。本发明的任务是克服负荷减轻造成的干骺区萎缩。
根据本发明的解决方案在于，根据权利要求1，在干骺区使用了由肋条构成的附加传力装置。这些肋条具有带指向内侧的陡侧面的特别形状。由此与带有倾斜向下的内外和外侧侧面的已知狭长肋条相比，肋条向前或向后指向的表面相应地更宽了。为使得在将轴压入骨中时仍然不会产生可能将骨胀破的力，还规定，肋条从限定内侧侧面的棱边向外侧减少高度。传统的转向外侧的肋条侧面因此消失或减少到比较低的高度，该高度最高等于内侧侧面高度的一半。这是容许的，因为由肋条向外侧传递的力比向内侧方向的力小。
内侧侧面陡的特征表明，其与内外侧轴平面几乎构成直角。与该角度的偏差最好不要大于25°，更好的是不要大于15°。
内侧侧面至少在其长度的一部分偏离轴的纵向、向上向股骨颈部方向倾斜。这种形状的优点是，当推入假肢时，如果推入方向与假肢的纵向相符，肋条的内侧侧面象楔子一样压缩在推入方向上位于其前方的多孔骨质，使得骨质能够具有更强的传力能力。特别当该肋条侧面与轴纵向包围的角度在5和15°之间，优选的是约10°时，就会产生这种作用。
根据本发明，相应地压缩肋条的前面和后面由此实现，即各个轴基体表面上方的肋条高度从下向上增加。因此肋条是双向楔形，即首先是向内侧侧面方向，其次是向前侧或后侧方向。在外侧方向上，即在背离陡侧面的侧面上，肋条高度可逐渐降低。
通过肋条压缩多孔骨质的先决条件是，在植入后肋条所位于的位置上事先存在骨质。如果在将假肢插入骨的干骺区之前，人工构成假肢轴的接收管道，那么接收管道应该只对应假肢轴基体的横截面并且因此还不构成以后接收肋条的凸面。如果使用粗锉刀形成该接收管道，那么粗锉刀的形状也应该只对应轴基体，不带有去除肋条区域物质的装置。作为另外一种选择，还存在粗锉刀备有肋条的方案，该肋条与假肢轴的肋条对应并且设计为压缩骨质而不去除物质。因此上述在肋条传力区域压缩骨质就已经可通过粗锉刀实现或部分地由其准备。
下面参考示出有利实施例的附图更详细地解释本发明。其中；
图1为从前方看到的视图；
图2为从内侧看到的视图；
图3为从上面看到的视图；
图4至6为在轴的相应高度穿过轴的截面。
假肢由轴1，颈部2，用于套装铰链头部4的锥体3组成，其中铰链头部的周边用虚线表示。轴由远体部分6和近体部分7装配而成。在内外侧方向上，远体部分横截面为细长的，如图4和5所示。该部分备有一对肋条8以向上股骨骨骺区域中包围轴的多孔骨质传力。可明显看出轴1是直轴。这意味着轴直线构成，并因而必须在其纵向上和在上股骨的骨干纵向上推入骨干。
轴近体部分和远体部分之间的过渡位置9这样设置，即在植入的状态其约位于小转子附近，优选的是稍稍位于其下方，并且远体的轴部分7因而位于骨髓管道区域，在该区域轴部分7被强壮的骨外壳限定。不需要在假肢上特别标明过渡位置。它是这样确定的，即其位于小转子或者优选的是小转子下边缘在植入状态所处位置。按轴方向上的箭头10测量，其通常位于比铰链头部4的中心5低7至9厘米的位置。
远体的轴部分这样设计，即其适合锚定在上股骨的骨干区。为配合得牢固，其轴芯稍稍为圆锥形并具有纵向肋条。由此位于轴芯15表面和皮层骨髓腔边界之间的间隙内的骨质被压缩，其中这些骨质被肋条固定。远体的部分还可按其它方式这样设计，即其适合将轴初步锚定在骨的骨干中。
肋条8从轴基体22的前后表面21凸起。其具有指向内侧的陡侧面23和前侧或后侧的表面部分24，其中后者由边缘25限定。如图3和4所示，随着与侧面23距离的增加，表面24向表面21方向倾斜，使得肋条具有约三角形或梯形的横截面形状。其在基体22表面21上方的高度在内侧边缘23上至少为在外侧边缘上的两倍。肋条8起始于轴近体部分和远体部分之间的过渡区域9，高度为零并且宽度较窄。肋条向上均匀地增加到其在上端26达到的其最大高度和宽度。侧面23与轴的纵轴线27包围角α，在实施例中该角约为8°。侧面23的高度在轴上端26在2和4厘米之间，最好约为3厘米。侧面25的高度在零和侧面23高度的一半之间。在侧视图中，侧面25与纵轴线27重合或者平行或者与纵轴线成非常小的角度。
肋条横截面从下向上成楔形双向增加，即向侧面23方向和前或后侧面24方向增加。如果为将假肢轴接收在上股骨的干骺、多孔区而形成的腔在横截面上与轴的基体22相等，则在推入轴时肋条8挤出并压缩存在的多孔物质。由此使其更适合传力。肋条从内侧边缘向外侧边缘倾斜具有额外的优点，即在骨的干骺端中可用的空间可更好地用于体积大的轴设计。
实施例示出了肋条8的直线走向。但其楔形形状也可具有非直线的走向。
虽然规定假肢初步锚定在骨干中，但和假肢轴其它的指向内侧的表面28一样，侧面23同样有助于在干骺区传力。由此骨的干骺也参与了传力。由此避免了其萎缩的危险。可更好地将假肢长期可靠地固定在骨内。

Claims (5)

1、带有插入上股骨内的轴(1)的髋部假肢，所述轴的在上股骨干骺区中插入的近体部分(6)在前侧和后侧分别具有一个凸出的肋条(8)，肋条的内侧侧面(23)偏离所述轴(1)纵轴线(27)、向上向股骨颈部(2)方向倾斜，其特征在于，内侧侧面(23)是陡的，并且肋条(8)的高度从限定陡侧面的边缘向外侧减少。
2、根据权利要求1的假肢，其特征在于，肋条(8)相对所述轴(1)的纵轴线(27)以5到15°的角度(α)直线延伸。
3、根据权利要求1或2的假肢，其特征在于，肋条(8)在轴基体(22)的表面(21)上方的高度从下向上增加。
4、根据权利要求1至3之一的假肢，其特征在于，肋条(8)的外侧边缘(27)的高度不大于内侧边缘(23)高度的一半。
5、根据权利要求1至4之一的假肢，其特征在于，具有骨干的锚定装置。
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