CN86107059A - 韧带的手术替换的改进 - Google Patents
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- A61F2/02—Prostheses implantable into the body
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Abstract
一种用于在至少两块骨5、6之间移植的替换韧带1,韧带形状为由柔韧物质编织而成的管状体,移植后组织可经其向内生长,系在韧带1一端的带3a穿过骨内的管道,并拉动韧带通过该管道。当韧带被拉过管道后,保护性的、系在韧带上以便于韧带移植的可分离的鞘膜2马上脱离韧带。使用骨栓导引器(8到12)把骨栓嵌入骨管道内的韧带的一端,由此固定韧带末端,使其处于适当位置。
Description
本发明涉及一种韧带手术替换的移植器、方法和手术器械的改进,特别是把替换的韧带移入到人体中的方法的改进。
欧州专利申请第85300931.4号(出版号为0153831 A)描述了一种关于替换膝盖前部十字形韧带的手术方法,该方法介绍了一种管状聚脂纤维人造韧带的使用,管状聚脂纤维韧带的每端都有一个纵向切口,切口之一延伸到韧带的一端。而在韧带的另一端,在远离韧带中心的那个切口的末端上,形成封闭管子的闭合体,这样就提供了一种能容纳骨栓的凹陷结构。
该方法还涉及一套手术器械的使用以便于把韧带植入膝盖内,这套器械包括:一个用来沿预定轴引导筒形铰孔器的夹紧装置,以便利用宿主的骨头制造一个可作替换品的骨栓,圆筒状的铰孔器适于提供由宿主骨制成的骨栓。推杆帮助推动骨栓离开铰孔器,并帮助骨栓再次插入宿主骨。同时,圆柱钻的钻孔导向用来在待移入骨栓的关节窝底部钻一个孔径小一些的孔直通骨的另一侧。
该方法包括把导向夹紧装置设置在第一根骨的一侧上,如股骨。从股骨中取出圆柱状骨栓,并从关节窝底部钻一较小孔径的孔直至股骨的另一侧,然后在胫骨上重复同样的过程。
接着,把用一细带系在凹陷末端的韧带穿过由胫骨和股骨里的关节窝和孔形成的管道,直到暴露凹陷。然后,把预先从股骨中取出的骨栓装入凹陷,一挨骨栓设置在凹陷内,韧带就被反方向拉回,从而迫使骨栓靠在股骨的关节窝和孔之间的肩形凸出部分上。然后,把从胫骨中移出的骨栓推入另一切口,该切口在带有推杆辅助器的韧带的另一末端,所以韧带能被股骨和胫骨内的骨栓固定。
使用该方法存在的问题之一是,由于在骨管粗糙内表面上的网状物的残技,因此当韧带从胫骨和股骨的管中拔出时,可能造成韧带较疏松结构的变形。另外,韧带可能沿管道拉动骨头碎片使其进入关节腔内,从而损害关节腔内的软骨组织。当韧带从管中拔出时,由于韧带的变形还给外科医师进行手术带来不便。
同样,胫骨骨栓的替换有时是困难的,因为它可能扯动韧带的疏松结构。由于是沿韧带张力的相反方面把骨栓插入胫骨管道,所以,后者可能在手术的最后过程中,在关节内松驰关节内沿韧带方向的足够的张力的缺乏会使韧带冗余。
因此,本发明的目的在于提供一种经改进的韧带和能够克服上述不利因素的器械。
本发明的第一方面是提供一种替换的韧带,该韧带包括一适合在至少二根骨之间移植的柔韧的拉长体,系在拉长体一端上的用于将韧带穿过在骨骼中形成的管道并拉动韧带通过该管道的牵引设备及用柔韧材料制作的可分开的一个鞘膜,该鞘膜沿韧带体的整个长度方向延伸。所述的鞘膜是套在韧带上的,与韧带一起运动通过骨内管道。此后,鞘膜被从韧带上分离,以使鞘膜可以移去。
这样,带有鞘膜的韧带能被容易地拉过两根骨例如胫骨和股骨内的管道而不受韧带材料的影响,并能防止韧带被损坏和变形。
易于使用的牵引设备包括:系在韧带一端的一根带子。
特别需要指出的是鞘膜在带子与韧带体的结点之外延伸一小段距离,并且,在鞘膜内,带子被打了第一个结。
另外,带子可以在离开韧带系着点比第一个结更远的地方围绕着鞘膜打第二个结,第二个结的作用是保证鞘膜固定,并在它被拉过管道时防止其绕韧带滑动。
也可采用另一方法把带固定在鞘膜上,例如,应用金属卷住带子和鞘膜。
鞘膜可以在韧带的另一端延长一小段距离提供一夹持部分。
鞘膜可以呈管状(最好用聚乙稀制成),但也可以是多于一件的分离的材料,如覆盖韧带每个侧面的带状材料。
本发明的另一个方面在于进一步提供一种在至少两根骨之间移植一根替换韧带的方法,该韧带具有一柔韧的延长体和一连接在韧带体一端上的工具。从而,韧带可穿过骨中的管道,并随后被拉着通过该管道。该方法还包括用一沿韧带体的整个长度方向延伸的柔韧材料制作的鞘膜围住欲移植的韧带的四周,把鞘膜固定在韧带的一端上,以防止鞘膜和韧带之间的相对运动,在每根骨里钻一个如前所述的管道,将带有鞘膜的韧带穿过该管道,随后拉动其通过管道,在牵引工具与韧带体附着点的邻近位置处切断鞘膜,致使鞘膜能相对于韧带自由滑动,相应地将鞘膜从韧带上拔出,然后用如上所述的骨栓取代。
在执行上述方法时,正好在第一个结点的上部切断鞘膜和带子是有利的。
本发明的再一个方面在于提供一骨栓导引器,该导引器在如上所述类型的韧带的移植过程中使用。所述的骨栓导引器包括一中空的圆柱体,该圆柱作具有至少一个开口端和一个侧面开口孔,以便骨栓插入。中空圆柱体的内径比骨栓的直径稍大,以便于骨栓在圆柱体内自由地滑动,圆柱体内安置有一柱塞,该柱塞安置在第一缩回位置和第二延伸位置之间,并能在其内滑动,因为导引器是设计好的,所以,由于柱塞从所述的第一位置运动到所述的第二位置,预先装在圆柱体内的骨栓就会被推出导引器的开口端。
还需指出的是,骨栓导引器包括一邻近开口端的第一薄壁部分和邻近另一端的第二厚壁部分,侧面的孔设置在这两部分之间,在厚壁部分的内表面上有一螺纹部分,该部分正好能与导引器上的螺纹部分啮合,以保证导引器固定在圆柱体内第二延长部分内。
骨栓导引器可以用金属制造,或者用塑料制造,并且后者可随意使用。
这样,本发明的骨栓导引器可以把骨栓准确地装入宿主的骨骼内,防止由骨栓的粗糙表面引起的韧带变形,便于保持被移植韧带的足够的张力。
图1所示的是韧带的一实施方案的闭合末端,该韧带带有固定的鞘膜;
图2所示的是韧带的开口端,该韧带的四周被鞘膜环绕着;
如图2所示,带有鞘膜的韧带被穿过胫骨和股骨内的管道;
如图4所示,鞘膜和带子被切断;
如图5所示,韧带被拉紧,同时鞘膜被拔离韧带;
如图6所示,骨栓被安置在韧带的凹陷内;
如图7所示,韧带被拉,以便固定股骨的骨栓;使其处于股骨内的适当位置;
如图8所示,被移植的韧带与鞘膜完全脱离;
如图9所示的是带有柱塞的骨栓导引器;其中,柱塞处于其伸长的位置;
图10所示的是带有柱塞的骨栓导引器,其中,柱塞处于其部分缩回位置;
如图11所示,骨栓导引器被插入韧带的开口端。
如图12所示,骨栓导引器被推入骨内的关节窝的底部;
如图13所示,柱塞缩回以便容纳骨栓;
图14所示的是内部带有骨栓的骨栓导引器;
如图15所示,柱塞被推动以便把关节窝内的骨栓嵌入宿主骨;
如图16所示,骨栓导引器被撤离骨栓,骨栓处于其正确位置。
参见图1,本发明的韧带1采用把开口的编织聚脂纤维制成管状的长带形式,该韧带1的一个可能结构的例子详细地记载在已公开的欧州专利第0153831A号上,该结构的一端形成穿孔管的开口,在其相反端上有一凹陷。
韧带1设有由聚乙烯板制作的呈管状的鞘膜2,鞘膜2沿韧带1的整个长度方向将韧带的四周全部围住,并借助于系在韧带的闭合端上的带子3a里的结3使其固定在韧带的闭合端。结3是被绕着鞘膜2的外部打的,以便固定鞘膜2,使其处于适当位置,并防止鞘膜2相对于韧带1滑动。带3a还在鞘膜的内部打了一个结4。
参见图2,鞘膜的相反的末端见开口的,并在韧带的开口端之处延伸一小段距离。
参见图3,在从股骨5和胫骨6中取出骨栓并在关节窝的每个底部钻孔直通各自骨的相对一侧的外科手术进行以后,将带有鞘膜的韧带穿过所钻的孔,拉动带3a,首先使韧带穿过胫骨,然后穿过股骨。鞘膜2适宜于在韧带被拉着通过骨中的管道时保护韧带1,还使韧带能容易地穿过骨骼而不受韧带材料的影响。
参见图4,一挨韧带穿过骨孔,位于结4上部的鞘膜2和带3a就被切断,从而使鞘膜能相对于韧带自由滑动。
现在参见图5,韧带通过夹住带3a而被拉紧,同时,在韧带的开口端处继续拉鞘膜2。
参见图6,鞘膜被部分拔离韧带,暴露凹陷,股骨的骨栓被安置在韧带的闭合端凹陷内。
参见图7,然后,将韧带拉至开口端处,从而导致凹陷里的骨栓被拉进股骨关节窝的凹陷内。
如图8所示,韧带原有的鞘膜完全被拔离韧带,同时,股骨的骨栓复位。
参见图9和10,本发明的骨栓导引器包括一设置在柱塞12内的中空的圆柱体8,该圆柱体8包括一带有开口的薄壁围住部分9,和其相反末端的较厚的壁的围住部分10,限制在这两部分9和10之间的空间11允许骨栓被嵌在中空体内。柱塞12有两个端部13和14,在端部13上可以设置一螺纹部分15,该部分与圆柱体的厚壁围住部分10内部的螺纹部分啮合,骨栓导引器可由金属制造,或者由可随意使用的塑料制造。
参见图11,骨栓导引器被安置在韧带开口端的内部,柱塞处于其伸长位置。
参见图12,薄壁部分9在控制韧带张力的同时被压向胫骨里的关节窝。
参见图13,然后,柱塞缩回到以后放置胫骨骨栓的空间内。参见图14,柱塞被推向胫骨的关节窝,同时,骨栓被从导引器体内挤出进入关节窝。
参见图15和16,只要骨栓被放置在胫骨里,当骨栓导引器撤离时,韧带张力便能保留以制止活塞推进。这样,就本发明的骨栓导引器而言,当韧带残留有足够的应力时,由于残留应力的阻碍,所以,胫骨的骨栓能被置于胫骨的关节窝内而不会导致韧带的变形。
Claims (14)
1、一种替换韧带,其特征在于所述的韧带包括适用于在至少两块骨5、6之间移植的柔韧的拉长体1,该拉长体的牵引工具3a被系在拉长体1一端以将韧带穿过骨内管道并拉动韧带通过该管道,和沿韧带体的整个长度延伸的,用柔韧材料制造的、可分开的鞘膜2,所述的鞘膜2包附在韧带上,并与韧带一起运动,通过骨内的管道,然后与韧带分开,使鞘膜在韧带移植后可马上被除去。
2、根据权利要求1所述的替换韧带,其特征在于所述的牵引设备包括一根带子3a。
3、根据权利要求2所述的替换韧带,其特征在于所述的鞘膜2在带子3a与韧带体1的系结点之外延伸。
4、根据权利要求2所述的替换韧带,其特征在于所述的带子3a在鞘膜内打了第一个结4。
5、根据权利要求4所述的替换韧带,其特征在于所述的带3a通过第二个结3与鞘膜2连结,所述的第二个结被安置在比第一个结离开韧带体与带子的系结点更远的地方。
6、根据权利要求1所述的替换韧带,其特征在于所述的鞘膜2在远离牵引设备3a的韧带的末端处延长,以提供一夹紧部分。
7、根据权利要求1所述的替换韧带,其特征在于所述的鞘膜2是呈管状的,或者由许多单块的材料组成。
8、根据权利要求1所述的替换韧带,其特征在于所述的鞘膜由聚乙烯制成。
9、一种在至少两块骨5、6之间移植一替换韧带1的方法,其特征在于,在移植之前的韧带1四周环绕有由柔韧材料制作的鞘膜2,该鞘膜2实际上沿韧带体的整个长度方向延伸,把鞘膜2固定在韧带1的一端,由此防止鞘膜与韧带之间的相对运动,在骨5、6内各钻一管道,将带有鞘膜的韧带穿过该管道,随后,拉动韧带通过该管道,在牵引工具3a与韧带体系结点4的邻近位置处切断鞘膜,因此,鞘膜2能相对韧带自由滑动,将鞘膜从韧带上拔出,然后用骨栓取代。
10、一种在韧带的移植过程中使用的骨栓导引器,其特征在于所述的骨栓导引器包括一中空的圆柱体8,该圆柱体8有至少一个开口的末端和一侧面允许骨栓插入其内的开口孔,中空的圆柱体的内径比骨栓的直径稍大,骨栓能在圆柱体内自由滑动,把柱塞12设置在圆柱体8内并安排其在第一缩回位置和第二延伸位置间滑动,因此,由于柱塞的从所述的第一位置至所述的第二位置的运动,预先放置在圆柱体内的骨栓可被推离开口的末端。
11、根据权利要求1所述的骨栓导引器,其特征在于,所述的导引器包括一靠近开口端第一薄壁部分9和靠近另一端的第二厚壁部分10。
12、根据权利要求11所述的骨栓导引器,其特征在于,所述的侧面上的开口孔是设置在薄壁围住部分和厚壁围住部分之间。
13、根据权利要求11所述的骨栓导引器,其特征在于,所述的厚壁围住部分的内表面上有一螺纹部分,该部分与柱塞上的螺纹部分啮合,保证柱塞固定在圆柱体内,并处于其第二延伸位置。
14、根据权利要求10所述的骨栓导引器,其特征在于,所述的导引器用金属制成,或者用塑料制成。
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GB8525565 | 1985-10-17 | ||
GB858525565A GB8525565D0 (en) | 1985-10-17 | 1985-10-17 | Surgical replacement of ligaments |
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CN1010657B CN1010657B (zh) | 1990-12-05 |
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CN86107059A Expired CN1010657B (zh) | 1985-10-17 | 1986-10-19 | 韧带的手术替换的改进 |
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EP (1) | EP0223370B1 (zh) |
JP (1) | JPH08118B2 (zh) |
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AU (1) | AU597275B2 (zh) |
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US3545008A (en) * | 1968-05-27 | 1970-12-08 | Karl F Bader Jr | Tendon prosthesis |
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DE2747568C2 (de) * | 1977-10-24 | 1985-10-24 | Eckhard Dr.Med. 8191 Attenhausen Schmidt-Ramsin | Chirurgische Bohrvorrichtung für die Implantation einer Kreuzbandplastik am Kniegelenk |
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-
1985
- 1985-10-17 GB GB858525565A patent/GB8525565D0/en active Pending
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- 1986-09-29 GB GB8623345A patent/GB2181653B/en not_active Expired - Lifetime
- 1986-10-02 AT AT86307590T patent/ATE63050T1/de not_active IP Right Cessation
- 1986-10-02 AU AU63513/86A patent/AU597275B2/en not_active Ceased
- 1986-10-02 ES ES86307590T patent/ES2021591B3/es not_active Expired - Lifetime
- 1986-10-02 DE DE8686307590T patent/DE3679034D1/de not_active Expired - Lifetime
- 1986-10-02 EP EP86307590A patent/EP0223370B1/en not_active Expired - Lifetime
- 1986-10-16 US US06/919,669 patent/US4775380A/en not_active Expired - Lifetime
- 1986-10-17 JP JP61248260A patent/JPH08118B2/ja not_active Expired - Lifetime
- 1986-10-19 CN CN86107059A patent/CN1010657B/zh not_active Expired
Cited By (4)
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WO2012095868A2 (en) * | 2011-01-11 | 2012-07-19 | Padmakar Shinde | Bridge button for ligament reconstruction |
WO2012095868A3 (en) * | 2011-01-11 | 2012-10-04 | Padmakar Shinde | Bridge button for ligament reconstruction |
CN103830020A (zh) * | 2014-03-07 | 2014-06-04 | 复旦大学附属华山医院 | 中空管带状可折叠悬吊式人工韧带 |
CN103830020B (zh) * | 2014-03-07 | 2017-05-17 | 复旦大学附属华山医院 | 中空管带状可折叠悬吊式人工韧带 |
Also Published As
Publication number | Publication date |
---|---|
JPS62161359A (ja) | 1987-07-17 |
ES2021591B3 (es) | 1991-11-16 |
GB2181653B (en) | 1990-01-10 |
GB2181653A (en) | 1987-04-29 |
GB8623345D0 (en) | 1986-11-05 |
EP0223370A3 (en) | 1987-10-28 |
GB8525565D0 (en) | 1985-11-20 |
EP0223370A2 (en) | 1987-05-27 |
US4775380A (en) | 1988-10-04 |
ATE63050T1 (de) | 1991-05-15 |
CN1010657B (zh) | 1990-12-05 |
DE3679034D1 (en) | 1991-06-06 |
JPH08118B2 (ja) | 1996-01-10 |
EP0223370B1 (en) | 1991-05-02 |
AU6351386A (en) | 1987-04-30 |
AU597275B2 (en) | 1990-05-31 |
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