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CN101646403A - 用于移植的膝关节假体系统和方法 - Google Patents

用于移植的膝关节假体系统和方法 Download PDF

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CN101646403A
CN101646403A CN200880007770A CN200880007770A CN101646403A CN 101646403 A CN101646403 A CN 101646403A CN 200880007770 A CN200880007770 A CN 200880007770A CN 200880007770 A CN200880007770 A CN 200880007770A CN 101646403 A CN101646403 A CN 101646403A
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joint
limits
refilling
stem
component
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CN101646403B (zh
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罗伯特·梅茨格
奥德拉·沃森
布赖恩·M·马伊
杜克·A·福克斯
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Biomet Manufacturing LLC
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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
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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
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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
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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
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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
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    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
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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
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
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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
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
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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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30604—Special structural features of bone or joint prostheses not otherwise provided for modular
    • A61F2002/30616—Sets comprising a plurality of prosthetic parts of different sizes or orientations
    • 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
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A61F2002/30736—Augments or augmentation pieces, e.g. wedges or blocks for bridging a bone defect
    • A—HUMAN NECESSITIES
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
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  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Prostheses (AREA)

Abstract

模块化膝假体能够包括股骨部件(112)，其具有上延伸部分(130)、第一股骨支承表面(114)和第二股骨支承表面(116)。上延伸部分能够限定第一锥形补充件接收表面(132)。胫骨部件(12)能够具有下延伸部分(28)和胫骨支承表面。下延伸部分能够限定第二锥形补充件接收表面(30)。第一补充件(400)能够限定第一接收钻孔和第一台阶状表面。第二补充件(402)能够限定第二接收钻孔和第二台阶状表面。在股骨部件的第一锥形补充件接收表面的第一部分中和在胫骨部件的第二锥形补充件接收表面的第二部分中，第一和第二补充件适于在第一和第二台阶状表面处配合。

Description

用于移植的膝关节假体系统和方法
相关申请的交叉引用
本申请要求申请日为2007年1月10日的美国临时申请No.60/879,733和申请日为2007年10月10日的美国临时申请No.60/978,949的利益。上述申请的公开内容通过参引而结合在本申请中。
技术领域
本发明总体上涉及膝关节假体，更具体地，涉及各种胫骨和股骨部件和用于与所述胫骨和股骨部件协作的模块化补充件。
背景技术
膝关节假体一般包括股骨部件和胫骨部件。股骨部件和胫骨部件设计成在外科手术中分别附接于股骨远端和胫骨近端。股骨部件进一步设计成在模拟解剖结构膝关节的铰接运动中与胫骨部件协作。这种膝关节假体一般称为初级膝假体。
与韧带和肌肉组合的膝关节假体旨在复制自然的膝运动并且吸收和控制在屈曲过程中产生的力。然而，在某些情况下，必需更换现有的假体。这种更换假体一般称为修复膝假体。然而，根据膝腱、韧带和初级膝假体的退化或损坏程度，需要修复膝关节假体以取消这些运动中的一个或多个以便提供足够的稳定性。由此，所需要的是提供例如十字保持(CR)修复膝、完全束缚修复膝、后部稳定(PS)修复膝或铰接修复膝。此外，某些情况下，有可能需要考虑与这种膝关节假体相邻的区域中的骨损失。
发明内容
膝关节假体系统和用于在手术中组装所述膝关节假体系统的方法能够包括：具有第一附接部分的第一膝假体部件和限定茎接合部分的至少第一茎。第一接头能够具有限定第一轴线的第一接头接合部分和限定第二轴线的第二接头接合部分。第一和第二轴线能够平行并偏移错开。第一附接部分能够操作而在手术中与茎接合部分或第一接头接合部分联接。
根据附加特征，不同于第一膝假体部件的第二膝假体部件能够具有第二附接部分。第二附接部分能够操作而与茎接合部分或第一接头接合部分联接。第一膝假体部件可以是股骨部件，而第二膝假体部件可以是胫骨部件。股骨部件中的至少一个和胫骨部件中的至少一个能够协作而以形成十字保持(CR)膝假体、后部稳定(PS)膝假体、完全束缚膝假体和铰链膝假体中的每一个。
根据其他特征，茎接合部分能够操作而与第二接头接合部分联接。能够提供多个茎，每一个茎具有茎接合部分并限定不同的长度或直径。每一个茎接合部分能够操作而与膝假体部件的第一附接部分或接头的第二接头接合部分联接。
根据其他特征，第一附接部分能够限定雌性锥形接收部分。茎接合部分和第一接头接合部分能够各自限定雄性锥形插入部分。借助莫氏型锥体配合，雌性锥形接收部分能够协同地接合雄性锥形插入部分。第一锁定构件能够穿过在第一接头中限定的接头钻孔。第一锁定构件能够操作而将第一茎锁定至该第一接头。接头钻孔能够形成有螺纹。第一锁定构件能够在非紧固位置与紧固位置之间沿着接头钻孔以旋拧方式前进。插入部能够紧固至茎。在紧固位置中第一锁定构件能够在界面区域处接合插入部。第一锁定构件能够由比插入部硬的材料形成，使得插入部在第一锁定构件前进到紧固位置后在界面区域处变形。
根据其他特征，能够提供多个限定各种不同形状和尺寸的补充件。每一个补充件能够限定具有圆锥形接合表面的通道。多个补充件中的每一个能够操作而与股骨部件的上延伸部分或胫骨部件的下延伸部分联接。
附图说明
从具体实施方式部分和附图部分，本发明将得到更全面地理解，在所述附图中：
图1是根据本发明的膝关节假体的前视图，所述膝关节假体包括模块化胫骨部件、具有用于提供第一预定偏移的第一接头组件；
图2是图1的模块化胫骨部件的分解图；
图3A是图1的胫骨部件的前视图；
图3B是根据附加特征的胫骨部件的前视图；
图3C是根据附加特征的胫骨部件的透视图；
图3D是根据附加特征的胫骨部件的透视图；
图4是根据本发明的第一接头体的视图；
图5是根据附加特征的另一个接头体的视图；
图6是示例性茎和紧固件插入部的视图；
图7A是沿穿过图1的接头的上/下线的剖视图；
图7B是示出各种不同偏移的膝关节假体的视图；
图7C是图7A所示的锁定组件的分解图；
图8是根据本发明的示例性股骨部件的前视图，图中示出为具有图1的接头组件；
图9是根据附加特征的胫骨托架和支承件的透视图；
图10是图9的胫骨托架的透视图；
图11是图9的支承件的下表面的透视图；
图12是图9的支承件的上表面的透视图；
图13是图9的胫骨支架和支承件的顶视图；
图14是沿图13的14-14线剖取的剖视图；
图15是根据附加特征的铰链膝关节假体的透视图；
图16A是沿图15的16-16线剖取的剖视图，图中示出股骨部件旋转；
图16B是根据附加特征的铰链膝假体的剖视图；
图17-20示出组装图15的膝关节假体的示例性顺序；
图21是根据本发明的第一补充件的透视图；
图22是根据本发明的第二补充件的透视图；
图23A是图21和22的第一和第二补充件的平面图；
图23B是处于配合或互锁位置的第一和第二补充件的侧视图；
图24是根据本发明的第三补充件的透视图；
图25是图24的第三补充件的顶视图；
图26是图8的股骨部件的前视图，图中示出第一补充件组装在上延伸部分上；
图27是图8的股骨部件前视图，图中示出第一和第二补充件组装在上延伸部分上；
图28是图27的股骨部件的顶视图，图中示出图24的补充件紧固至下延伸部分；
图29是图1的胫骨部件的前视图，图中示出第一和第二补充件组装在下延伸部分上且不具有接头组件；
图30是图1的胫骨部件的前视图，图中示出第三补充件组装在下延伸部分上；
图31是根据附加特征的模块化胫骨部件的分解图；
图32是根据附加特征的补充件的透视图；
图33是根据本发明的另一个补充件的透视图；
图34是根据附加特征的接头组件的分解透视图，图中示出示例性胫骨部件和茎；
图35是图34所示的假体的前视图；
图36A是图34所示的胫骨托架和接头的详细分解图；
图36B是沿图36A的36B-36B线剖取的局部剖视图；
图36C是根据附加特征的与胫骨部件协作的接头组件的详细分解图；
图36D是沿图36C的36D-36D线剖取的局部剖视图；
图37是具有第一偏移的示例性接头的剖视图；
图38是具有第二偏移的另一个示例性接头的剖视图；
图39A是接头组件的紧固构件和插入部的分解图；
图39B是接头组件的局部分解图；
图40A是根据本发明的一个示例的胫骨部件、接头组件和茎的组装图；
图40B是沿图40A的40B-40B线剖取的剖视图；
图41A是根据本发明的一个示例的示例性胫骨部件、接头组件和茎的组装图；
图41B是根据本发明的一个示例的一对互锁的补充件、接头组件和股骨部件的组装前视透视图；
图42-45是以与骨养护铰链膝协作的方式使用的各种不同胫骨部件和支承件的透视图；
图46是组装的铰接膝的顶视图；
图47是沿图46的47-47线剖取的剖视图；
图48A和48B是根据本发明的一个示例的铰链膝假体的分解透视图；
图49是示出为处于组装状态的图48A和48B的铰链膝假体的剖视图；
图50-54是根据本发明的各种不同补充件的透视图；
图55A和55B示出根据本发明的一套植入件；并且
图56-60示出在组装阶段中的各种不同补充件。
具体实施方式
首先，本发明提供一种具有各种不同膝关节假体的膝关节假体系统，其可以适于在修复膝假体手术中使用。各种不同的胫骨和股骨部件被描述，其可以单独使用或者作为十字保持(CR)膝修复、后部稳定(PS)膝修复、完全束缚膝修复和铰链膝修复的一部分而使用。如将要描述，本发明进一步提供各种不同的模块化接头、茎和补充件，其可以在与在此公开的胫骨和股骨部件中的任一者的任意组合中使用。换言之，在关节线以上和以下的所公开的所有部件，例如茎、接头、补充件等，能够可互换地与任何在此公开的、位于胫骨或股骨侧的膝假体结合使用。而且，膝关节假体系统的相关部件和膝假体中的任一者的选择可以由执行手术的外科医生在手术中进行选择。
首先参考图1，根据本发明构造的膝关节假体得以示出并以附图标记10总体表示。膝关节假体10通常示出为包括支撑接合股骨部件(未示出)的铰接表面的支承件14的胫骨部件12。在本发明的范围内，可以理解胫骨托架12和支承件14能够适于与任何合适的股骨部件结合使用。例如，第一十字保持(CR)支承件14被示出，其设计成与CR股骨部件铰接。然而，可以采用固定PS支承件，其设计成与PS股骨部件铰接。
图1所示的胫骨部件12将被理解为在构造上为模块化，并且通常包括茎20、托架22和第一接头组件24。以下文将更全面讨论的方式，接头组件24能够连接托架22和茎20以便使茎20在横向或冠状平面中或者在任何其他平面中偏移。进一步解释地，当茎20通过第一接头组件24附接于托架22时，茎20的中心轴线25能够偏离托架22的下延伸部分的中心轴线27。在所示实施例中，第一接头组件24能够提供大约5mm的第一偏移量。可以理解偏移量能够为0至大约5mm或更大的范围，并且偏移能够相对于中心轴线27处于任意旋转方向。作为选择，茎20能够直接附接至托架22(图29)。也就是说，偏移轴线25能够相对于中心轴线27旋转360度以提供给外科医生各种不同的根据病人需要而进行选择的手术中选择。作为选择，能够对接头组件24或茎20进行旋转键锁，以仅提供有限的调整范围，例如仅提供单个偏移或者两个偏移位置。
参考图2和3A，胫骨托架22的下延伸部分28能够限定雌性锥形接收部分30。雌性锥形接收部分30能够随着其延伸进入下延伸部分28而略微地渐缩。中心孔32能够形成为穿过托架22和下延伸部分28而进入雌性锥形接收部分30。下延伸部分28也可以限定外部锥形补充件接收表面34。保持轨36(图2)能够从托架22的后边缘向上延伸。胫骨托架22能够进一步包括一对在其前边缘处一体形成在上表面上的柱38。柱38和轨36能够协作以将模块化支承件14保持在托架22上的固定位置中。可替代的胫骨托架22′示出于图3B中。
模块化支承件14可以由超高分子量聚乙烯(UHMWPE)形成，带有前和后凹部(未具体示出)以分别接收柱38和轨36，并在其踝间和中间/侧向部分上带有用于与托架22的上表面直接接触的均匀平坦的下表面。模块化支承件14能够设计成利用横向滑入锁定杆或夹子40而锁定在位，横向滑入锁定杆或夹子40以设置在其中的用于该目的的相对凹槽而楔进柱38和支承件14之间。关于锁定杆如何与柱和支承件协作的更详细的讨论可以在共同所有的名称为″带有可互换部件的膝关节假体(Knee Joint Prosthesis With Interchangeable Components)″的美国专利No.5,330,534中得到，该专利通过参引而结合在本申请中。如上所大体描述的模块化胫骨托架和支承件可从生迈公司(Biomet Inc.)---本发明的受让人---商业上获得，作为
Figure G2008800077701D00071
全膝系统的部件，其包括各种不同尺寸和构形的用于不同病人需求的托架、支承件和其他膝部件。模块化支承件14的铰接表面可以基本上与
Figure G2008800077701D00072
全膝系统所提供的相同。
现转到图2、4和5，接头组件24通常能够包括接头体44和锁定构件或元件46(图2)。接头组件24的接头体44能够限定具有穿过其形成的通道50的雄性锥形插入部分48。雌性锥形接收部分52能够形成在接头体44的、用于接收茎20的雄性锥形插入部分58的偏移体部分53中。在一个示例中，雌性锥形接收部分52可以是大体圆筒形。裙部54能够限定于雄性锥形插入部分48和偏移体部分53之间的过渡处。
参考图4，接头体44的雄性锥形插入部分48限定第一轴线A1，雌性锥形接收部分52限定第二轴线A2。进一步地，在所示实施例中，第一轴线A1和第二轴线A2彼此平行并间隔开以提供所需要的偏移。在这一点上，多个接头各自具有不同的偏移量以提供给外科医生取决于病人需要的手术中选择。在接头体44提供5mm的偏移量的情况下，第一和第二中心轴线A1和A2间隔开5mm。接头体44′能够限定具有可替代构形的裙部54′。对于裙部54、54′，可以设想到其他几何构形。
雄性锥形插入部分48能够随着其离开接头体44延伸而略微地渐缩。雌性锥形接收部分52类似地随着其从接头体44的端部延伸进入接头体44而略微地渐缩。如从以下讨论将变得清楚，各种不同的雄性锥形插入部分(例如部分48)能够插在各种不同的雌性锥形接收部分(例如部分52)中，以形成锁定锥体或者莫氏(Morse)锥体。接头体44示出为进一步限定侧向延伸的通路60，其与孔50和雌性锥形接收部分52相交。以下文进一步描述的方式，锁定元件46能够延伸进入侧向延伸的通路60，在该处锁定元件46最终将托架22联接至茎20。
如图2和图6所示，茎20能够包括协作地与锁定元件46接合的上部分64。在所示实施例中，茎20的上部分64能够包括紧固件插入部66。作为选择，茎20的紧固件插入部66可以一体形成以与锁定元件46协作。
紧固件插入部66能够包括远侧部分70，其能够形成有外螺纹，以便接合茎20的雄性锥形插入部分58的内螺纹孔72。紧固件插入部66能够进一步包括具有六角形的或者其他合适的横截面的中央部分74，其能够被工具(未示出)接合，以便将紧固件插入部66旋转进入茎20。进一步地，紧固件插入部66能够包括近端78，其包括加大直径的头部80。
锁定元件46能够被尺寸设计和构造成插入而穿过接头体44的侧壁中的开口81并进入通路60以便联接茎20和托架22。锁定元件46能够包括具有内螺纹孔86的上表面84(见图2)。内螺纹孔86能够螺纹地接收紧固件90，紧固件90能够延伸穿过设置在托架22中的中心孔32。紧固件90能够与托架22的下部分28的中心纵向轴线27对齐。
附加地参考图7C，锁定元件46能够附加地包括开口端94和具有槽口96的底表面。槽口96能够与开口端94相交。当锁定元件46穿过开口60而插入时，开口端94能够接收茎插入部66的头部80。槽口96能够容纳减小直径的、紧固件插入部66的中央部分100。紧固件插入部66的头部80能够具有大于槽口94的宽度的直径，以便联接紧固件插入部66与锁定元件46。
锁定元件46能够进一步包括封闭端104。封闭端104能够呈凸出弯曲状。当锁定元件46完全插入通道60中时，封闭端104能够与接头体44的侧壁齐平。
在使用中，能够将紧固件插入部66拧入茎20中。接下来，能够将接头体44放置于茎20的雄性插入部分64上，使得雄性插入部分64以压配合被接收在接头体44的雌性锥形接收部分52内，并且紧固件插入部66的上端78延伸进入侧向延伸的通道60。
现在，能够将接头44的雄性锥形延伸部48压配合到托架12的雌性锥形接收部分30上，使得接头体44定向成提供沿期望方向的偏移。如图7B所示，可以在紧固之前使接头体44绕轴线A1旋转，以针对特定病人以期望偏移对茎20进行定向。因此，茎20可以绕着由轴线A1和A2限定的半径在多个位置处延伸。作为选择，茎20可以与接头体进行键锁，从而阻碍旋转。另外，可以提供具有适合于不同病人的各种不同长度的一系列茎。同样，可以提供一系列接头体以提供各种不同的偏移。
在该点，锁定元件46能够通过开口81而插入侧向延伸的通道60。完全插入后，锁定元件46能够接合紧固件插入部66。托架22能够通过螺纹紧固件90紧固至接头体44，螺纹紧固件90延伸穿过托架22的中心孔32并螺纹地接合锁定元件46的内螺纹孔86。关于各种不同的胫骨和股骨部件的偏移茎及其应用的进一步讨论可以在共同所有的于2004年9月3日提交的名称为″膝关节假体(Knee Joint Prosthesis)″的美国专利申请No.10/934,282中得到，该专利申请通过参引而结合在本申请中。在该共同所有的申请中，胫骨托架限定下延伸雄性部分，而在本申请中，胫骨托架22限定下延伸雌性接收部分30。另外，尽管未具体示出，但是可替代地，接头体44可以限定轴线A2，该轴线A2相对于轴线A1限定出一定角度。
在另一个示例中，雄性插入部分58可以直接插入托架22的雌性接收部分30中。在该示例中，可以使用另一个螺纹紧固件90′，其具有用于生成适当距离以直接与茎20的螺纹孔72配合的更短的轴。如图3A-3D所示，图中示出了其他胫骨托架22A、22B、22C和22D，用于容纳紧固件90、90′，接头44、44′和茎20的各种不同组合。
现在转到图8，根据另一个示例的膝关节假体被示出并以附图标记110总体表示。膝关节假体110包括股骨部件112。股骨部件112可以用作后部稳定(PS)膝关节假体的一部分。在膝的中度退化或者失稳的情况下，PS膝关节假体能够提供足够的稳定性。这种情况最为通常地发生在前和后十字韧带损坏或功能障碍并且中间和侧向副韧带保持功能完整时。股骨部件112能够包括第一髁部分114和第二髁部分116，其分别提供第一股骨支承表面118和第二股骨支承表面120。股骨部件112的第一和第二髁部分114和116能够通过限定髁间凹部124的内髁部分122而互连。上延伸部分130可以形成在股骨部件112之上。上延伸部分130能够包括呈大体锥形的外体以接收文中所描述的补充件并限定雌性锥形接收部分132。
根据本发明，股骨部件112的雌性锥形接收部分132可以构造成接纳上述的接头体44、44′中的一者。由此，接头体44的雄性锥形插入部分48能够适于插入和压配合到股骨部件112的雌性锥形接收部分132中。如所能够理解的，第一轴线A1和第二轴线A2彼此平行并间隔开。同样，示例性接头组件24已被描述为具有5mm的偏移量，然而，其他接头体可以设置成具有各种不同的偏移量。根据上文的描述，可以使用锁定元件46和茎20。
现在转到图9-14，根据另一个示例的膝关节假体被示出并以附图标记210总体表示。膝关节假体210被大体示出为包括支撑旋转束缚支承件214的胫骨部件212。胫骨部件212通常能够包括呈基本平面状的平台状胫骨托架216(图10)和下延伸部分218。下延伸部分218能够限定锥形雌性接收部分220和外锥形体，用于接收本文所公开的补充件。
胫骨托架216能够进一步包括上延伸柱224。胫骨托架216和上延伸柱224之间的过渡部能够由变化的半径R限定，或者更具体地，由半径为大约0.50英寸的半径R1和半径为大约1.50英寸的半径R3之间的过渡部限定。中间半径R2能够具有大约0.38英寸的半径。可以理解，半径R可以限定其他尺寸。变化的半径R的过渡部能够最小化作用在上延伸柱224上的应力。限定成穿过柱224的轴线A3(图14)能够相对于限定成穿过下延伸部分218的轴线A4沿后部方向侧向偏移。螺纹孔228能够形成为穿过胫骨托架216的前部分。螺纹孔228能够大体垂直于轴线A4延伸。
下延伸部分218能够限定锥形补充件接收表面230。胫骨托架216能够由钴-铬-钼或者任何其他合适的生物相容材料形成。胫骨托架216的顶部232(图10)能够是高度抛光的、以提供基本平滑的胫骨支承表面234。
旋转支承件214能够具有呈基本平面状的下支承表面238(图11)，其能够相对于高度抛光的胫骨支承表面234旋转地移动。旋转支承件212能够进一步包括第一上铰接或支承表面240和第二上铰接或支承表面242。支承表面240和242能够从中心上延伸部分244形成在前部和侧部。第一支承表面240和第二支承表面242能够与相应的束缚股骨部件(未示出)的第一和第二髁的支承表面铰接。旋转支承件212能够由外科级别、低摩擦、低磨损的塑料形成，例如UHMWPE或其他合适的材料。如图13所示，胫骨托架216的后边缘246能够限定一表面，其相对于支承件214的后边缘250限定角度247。角度247可以是大约8度。可以设想到其他角度。
现在转到图14，茎20示出为直接接收于托架216的雌性锥形接收部分220中。同样，代替直接将茎20插入托架216的雌性锥形接收部分220中的情况，可以使用接头体44或者44′。茎20能够包括紧固件插入部66′。紧固件插入部66′能够包括远侧部分70′，其形成有外螺纹，以便接合茎20的雄性锥形插入部分64的内螺纹孔72。紧固件插入部66′能够进一步包括具有六角形的或者其他合适的横截面的中央部分74′，其能够被工具(未示出)接合，以便将紧固件插入部66′旋转进入茎20。进一步地，紧固件插入部66′能够包括具有圆锥形接合头部80′的上端78′。紧定螺钉252能够穿过胫骨托架216的螺纹孔228前进以接合圆锥形接合头部80′。这样，紧定螺钉252的前进能够将紧固件插入部66′进而茎20紧固在紧固位置。可以理解，当采用接头体44时，可替代地，可以使用例如紧固件插入部66′的但是具有更长的轴的紧固件，以对于锁定元件46螺纹地紧固。
现在转到图15-20，根据本发明构造的铰链膝关节假体被示出并以附图标记310总体表示。膝关节假体310被大体示出为包括支撑接合股骨部件316的铰接表面的支承件314的胫骨部件312。胫骨部件312通常能够包括呈基本平面状的平台状胫骨托架318和下延伸部分320。下延伸部分320能够限定锥形雌性接收部分322。
附加地参考图16A，胫骨托架318能够进一步包括上延伸柱324。如将要描述，盖326能够紧固地插入限定在上延伸柱324的终端开口处的长钻孔328中。螺纹孔330能够形成为穿过胫骨托架318。螺纹孔330能够大体垂直于由上延伸柱324限定的轴线延伸。胫骨托架318能够由钴-铬-钼或者任何其他合适的生物相容材料形成。紧定螺钉(未示出)能够穿过胫骨托架318的螺纹孔330前进以接合紧固件插入部的圆锥形接合头部(如上文针对图14所详细描述)。这样，紧定螺钉的前进能够将紧固件插入部进而接头体44或者茎20紧固在紧固位置。胫骨托架318的顶部能够是高度抛光的、以提供基本平滑的胫骨支承表面331。
旋转支承件314能够具有呈基本平面状的下支承表面332，其能够相对于高度抛光的胫骨支承表面331旋转地移动。旋转支承件314能够进一步包括第一上铰接或支承表面336和第二上铰接或支承表面338。第一支承表面336和第二支承表面338能够分别与股骨部件316的第一和第二髁340和342的相应的支承表面铰接。同样，如上所述，支承表面可以类似于在
Figure G2008800077701D00121
全膝系统中所提供的支承表面。为适应股骨部件316的引导运动，支承件314能够包括稳定柱350，其能够从支承表面向上突出。稳定柱350能够包括具有凸起的后部分354和降低的前部分356的鳍状本体352。本体350能够限定第一和第二侧向间隔开的侧部360和362(图17)。稳定柱350的第一和第二侧部360和362能够定位成延伸进入股骨部件316的髁间凹部366(图15)。稳定柱孔370能够沿穿过本体350的上/下方向形成。
通道372能够形成为穿过本体350的凸起的后部分354。通道372能够沿大体垂直于稳定柱孔370的方向延伸成大体穿过稳定柱350的第一和第二侧部360和362。旋转支承件314能够由外科级别、低摩擦、低磨损的塑料形成，例如UHMWPE或者其他合适的材料。
可替代的稳定柱350′示出在图16B中，其接纳盖或者紧固件326′。
股骨部件316的第一和第二髁部分340和342能够通过限定髁间凹部366的内髁部分380而互连。髁间部分380能够包括第一侧向侧壁382和第二侧相侧壁384(图17)，其可以是平面状并基本上彼此平行。第一和第二侧向侧壁382和384能够进一步限定分别穿过其而形成的铰链通道388。
第一和第二侧向侧壁382和384的前部分能够通过髁间部分380的前表面390(图15)而连接。在一个示例中，髁间部分380的前表面390能够相对于髁间部分380的上表面沿下部方向以大约60度成角度倾斜。上延伸部分392可以形成在股骨部件316上并大体从上表面394(图16A)延伸。上延伸部分392能够包括呈大体圆筒形的本体并限定雌性锥形接收部分394。
链铰柱396能够紧固地延伸穿过股骨部件316的第一和第二侧向侧壁382和384的相应的铰链通道388并穿过支承件314中的通道372。显然，股骨部件316的侧向侧壁382和384能够定位成接近相应的第一和第二髁340和342的内侧部分。这样，主骨无需在侧向侧壁382和384的外侧区域中损坏。如所能够理解，在使用期间，股骨部件316能够绕铰链销396旋转。
参考图17-20，图中示出了组装股骨部件和支承件的示例性顺序。图17示出相应的股骨部件310、铰链销396和支承件314的分解图。如图18所示，将股骨部件310放置到支承件314上，使得相应的通道372和388对齐。图19-20示出插入通道372和388中的铰链销296。
现在参考图21-25，将详细解释与如上所述的任何膝关节假体结合使用的多个示例性补充件。图21-23B示出第一对补充件400和402。第一补充件400能够大体限定具有第一端406和第二端408的本体404。本体404能够进一步在第二端408处限定一致半径部分410和在靠近第一端406处限定向外锥形径向延伸部分412。一致半径部分410能够限定穿过其形成的锥形接收钻孔416。接收钻孔416能够从第一端406至第二端408渐缩。分别地，第一台阶420可以形成在本体404中、位于一致半径部分410和径向延伸部分412之间。如所能够理解，可以提供一系列具有适合于特定病人的各种不同尺寸和构形的第一补充件。
第二补充件402能够大体限定具有第一端426和第二端428的本体424。本体424能够进一步在第一端426处限定一致半径部分430和在靠近第二端428处限定向外锥形径向延伸部分432。一致半径部分430能够限定穿过其形成的锥形接收钻孔436。接收钻孔436能够从第一端426至第二端428渐缩。分别地，第二台阶440可以形成在第二端428处、位于一致半径部分430和径向延伸部分432之间。如所能够理解，可以提供一系列具有适合于特定病人的各种不同尺寸和构形的第一补充件。
如后面将详细描述的，第一和第二补充件400和402可以独自使用或者作为组合使用。如图23B所示，当与上述的胫骨和股骨部件中的任一者共同使用时，第一和第二补充件400和402能够在第一和第二台阶420和440处互锁或配合。
现在参考图24和25，图中示出第三补充件450。第三补充件450能够大体限定具有第一端454和第二端456的本体452。本体452能够进一步限定一对从其径向延伸的翼状部分460以对股骨部件或者胫骨部件提供旋转稳定性。在一个示例中，翼状部分460可以朝向第一端454偏移。本体452能够限定穿过其形成的锥形接收钻孔464。接收钻孔464能够从第二端456至第一端454渐缩。
根据本公开的教导，每一个补充件400、402和450的接收钻孔416、436和464能够滑动地压配合到上述的胫骨托架的任何下延伸部上。更具体地，接收钻孔能够与胫骨托架的下延伸部的锥形补充件接收表面限定锥形互锁。同样，任何相同补充件还能够滑动地压配合到上述的股骨部件的任何上延伸部上。更具体地，接收钻孔能够与股骨部件的上延伸部的锥形补充件接收表面限定锥形互锁。如此，相应的锥形表面能够协作而形成莫氏锥体。
为示出该兼容性，第二补充件402示出为紧固至股骨部件112的上延伸部130(图26)。如果外科医生想要考虑附加的骨损失，也可以将第一补充件400推进到股骨部件112的上延伸部130上(图27和29)。如所示，相应的第一和第二台阶420和440协作从而配合或者形成互锁。
参考图29，第一和第二补充件400和402示出为紧固至胫骨托架22的下延伸部28。显然，第一和第二补充件400和402可以与或者可以不与接头结合使用。可以理解，任何补充件可以与或者可以不与上述的接头组件结合使用。图30示出紧固至胫骨托架22的下延伸部28的第三补充件450。
现在转到图31和32，图中示出另一个胫骨部件522。胫骨部件522能够限定形成在下表面上的至少一个开口526和一个或多个(例如一对)盲孔524。任选地，凹进部分例如凹处530也可以形成在胫骨部件522的下表面上。补充件540能够限定一个或多个(例如一对)互补定位栓542和至少一个互补开口544。补充件540能够适于紧固到胫骨部件522的下表面上以补偿骨损失。如所能够理解的，补充件可以设置在胫骨部件522的侧向或者中间部分中的任一者上，或设置在两者上。在组装期间，定位栓542可以嵌套在盲孔524内。紧固件(未示出)可以穿过相应的开口526和544而插入。具有至少一个栓542′的另一个补充件540′能够设置用于胫骨部件522的下表面的中间和侧向侧部的相对处。在另一个示例中(图32)，提供了适合于连接至中间和侧向侧部中的任一者的补充件540″。在此示例中，不需要提供栓(例如栓542，图31)。如所能够理解的，能够提供具有各种不同厚度的多个补充件540，使得外科医生能够组装适合于指定病人的特定补充件。茎20能够固定地接纳到托架的雌性锥形延伸部分560中。
图33示出限定穿过其形成的锥形接收钻孔592的另一个补充件590。锥形接收钻孔592能够滑动地压配合到上述的胫骨托架的下延伸部和/或股骨部件的上延伸部中的任一者上。补充件590的一部分能够任选地由多孔金属594形成。多孔金属594能够包括例如多孔钛合金。补充件590能够限定内实心金属套筒部分和外多孔金属套筒部分594。同样，根据本发明，相应的股骨部件、胫骨部件、支承件和/或补充件可以是套件的一部分，其中外科医生可以在手术中选择特定病人所需的期望的一个或多个部件。
现在转到图34-36B，图中示出与根据附加特征的接头组件600协作的模块化胫骨部件22(如上文针对图1-3A所描述)。接头组件600能够与茎20协作。以下文将更全面讨论的方式，接头组件600能够连接托架22和茎20以便为茎20提供在横向或冠状平面中或者在任何其他平面中的偏移。进一步说明地，当茎20通过第一接头组件600附接于托架22时，茎20的中心轴线25能够偏离托架22的下延伸部分28的中心轴线27。在所示实施例中，接头组件600能够提供大约5mm的第一偏移量。可以理解偏移量能够为0mm至大约5mm或更大的范围，并且偏移能够相对于中心轴线27处于任意旋转方向。换言之，偏移轴线25能够相对于中心轴线27旋转360度以提供给外科医生各种不同的根据病人需要而进行选择的手术中选择。作为选择，能够对接头组件600或茎20进行旋转键锁，以仅提供有限的调整范围，例如仅提供单个偏移或者两个偏移位置。
继续参考图34-36D并附加地参考图37-39B，接头组件600通常能够包括接头体604和锁定构件或元件606。接头组件600的接头体604能够限定雄性锥形插入部分608和雌性锥形接收部分610。雄性锥形插入部分608能够限定螺纹钻孔611。雌性锥形接收部分610能够形成在接头体604的偏移体部分612中，以便接收茎20的雄性锥形插入部分58。接头体604能够在外表面上限定平坦部614，用于夹持和便于进行对齐，如将作描述。裙部(未示出)---类似于形成在图2中所示的接头体44上的裙部54---能够限定在雄性锥形插入部分608和偏移体部分612之间的过渡处。可替代地，也能够形成如这里所示的非裙部状过渡部。钻孔614能够限定成从接头体604的外表面至雌性锥形接收部分610。钻孔614能够限定螺纹地接收锁定构件606的螺纹616。
参考图37，接头体604的雄性锥形插入部分608限定第一轴线A5，而雌性锥形接收部分610限定第二轴线A6。进一步地，在所示实施例中，第一轴线A5和第二轴线A6彼此平行并间隔开以提供期望的偏移。在这一点上，能够提供各自具有不同的偏移的多个接头，以给外科医生提供根据病人需要的手术中选择。在接头体604提供5mm的偏移量的情况下，第一和第二中心轴线A5和A6间隔开5mm。同样，接头体604能够限定具有可替代的偏移量的轴线。在一个这样的可替代构形中，接头体604′(图38)包括限定第一轴线A7的雄性锥形插入部分608′和限定第二轴线A8的雌性锥形接收部分610′。接头体604′能够限定2.5mm的偏移量。
雄性锥形插入部分608能够随着其延伸离开接头体604而略微地渐缩。雌性锥形接收部分610类似地随着其从接头体604的端部延伸进入接头体604而略微地渐缩。如从以下讨论将变得清楚，各种不同的雄性锥形插入部分(例如部分608)能够插在各种不同的雌性锥形接收部分(例如部分610)中，以形成锁定锥体或者莫氏锥体。以下文进一步描述的方式，锁定构件606能够延伸进入钻孔614，在该处锁定构件606最终接合紧固件插入部620。
紧固件插入部620能够包括形成有外螺纹的远侧部分622，以便接合茎20的雄性锥形插入部分58的内螺纹孔72。紧固件插入部620能够进一步包括中央部分624和近侧部分626。近侧部分626能够限定圆锥形接合头部630。夹持零件632(例如但是不局限于用于接收六角扳手(Allen wrench)的六角钻孔)能够形成在近侧部分626的上表面。如将作更详细地描述，紧固件插入部620，或者更具体地说是圆锥形接合头部630，能够由第一生物相容材料形成而锁定构件606则能够由第二生物相容材料形成。第二生物相容材料可以是比第一生物相容材料硬度值更高(更硬)的材料。
现在转到图36C和36D，图中示出根据附加特征的胫骨托架636。如文中将作更全面描述，胫骨托架636可以是骨养护铰链膝假体(图48A)的一部分。胫骨托架636能够限定上延伸立柱637和下延伸部分638，下延伸部分638限定雌性锥形接收部分640。下延伸部分638能够限定外部锥形补充件接收表面642。胫骨托架636能够限定穿过胫骨托架636的托架部分而形成的螺纹通道646。螺纹通道646能够适于螺纹地接纳锁定构件606。不同于提供中心孔32以便沿上/下方向接收紧固件90′的十字保持胫骨托架22(图34)，胫骨托架636能够提供螺纹通道646，以便沿前/后方向接收锁定构件606。
现在参考图39A-40B，将描述组装胫骨托架636、接头体604和茎20的示例性顺序。首先，能够将紧固件插入部620旋入螺纹钻孔611中。在一个示例中，能够旋拧紧固件插入部620直到中央部分624接合接头体604的雄性锥形插入部分608的终端表面650。此时，能够将茎20联接至接头体，或者能够将接头体604联接至胫骨托架636。尽管次序能够颠倒，但是接头体604能够通过将接头体604的雄性锥形插入部分608插入胫骨托架636的雌性锥形接收部分640而联接至胫骨托架636。然后，外科医生能够在雌性锥形接收部分640内旋转雄性锥形插入部分608以获得所期望的定向。如后面将作描述，本发明提供用于在相对于胫骨托架636将接头体604紧固在固定位置之前检验接头体604的正确定向的各种不同工具。一旦已获得所期望的定向，则能够从未紧固位置(图36C)将锁定构件606旋拧成与圆锥形接合头部630接合从而旋拧至紧固位置(图36D)。
如上所述，锁定构件606能够由比紧固件插入部620硬的生物相容材料形成。因此，锁定构件606的远端654能够使圆锥形接合头部630的界面区域变形(例如在该处形成凹陷)。变形区域以附图标记656表示(图39A和40B)。通过使紧固件插入部620的区域656变形，锁定构件606的锁定功能能够通过提供更大的分离阻力而得以改进。进一步解释地，所形成的凹陷能够抑制锁定构件606和紧固件插入部620之间的滑动、旋转或其他相对运动。
接下来，茎20能够通过将锁定构件606(即另一个相同的锁定构件606)钉入紧固件插入部620(即另一个相同的紧固件插入部620)中而连接至接头体604。
根据另一个特征，由钻孔614限定的螺纹616能够限定出与由锁定构件606限定的螺纹662相比略微不同的螺纹轮廓(即螺距)。作为选择，螺纹616或者662中的一者能够最初变形。这样的关系能够允许锁定构件606在外科医生的最初操纵后被保持在钻孔614内。换言之，能够早先将锁定构件606定位在钻孔内，使得外科医生将不需要将锁定构件606的远侧顶端654置入钻孔616中(即，使两个分离的部件配合)。可以理解，在紧固期间，这样的螺纹构形不会阻碍锁定构件606在钻孔616内的旋转。
现在转到图41A，包括有接头体604和锁定构件606的接头组件600被示出为与股骨部件112′组装。股骨部件112′基本上类似于股骨部件112(图8)，但是能够限定形成在股骨盒670中的螺纹钻孔668。如所能够理解，螺纹钻孔668能够提供类似于接头体604的钻孔614的螺纹616的功能。因此，锁定构件606能够被钉入从而接合紧固件插入部620的圆锥形接合头部630。
如图41B所示，图中示出接头体604上的裙部54″。裙部54″大体限定了能够在补充件402的向外锥形径向延伸部分432(也可参见图21)上提供大体平滑的几何过渡的喇叭状轮廓部分。裙部54″和补充件402之间的几何过渡能够减小否则植入部件之间将会出现的尖锐过渡，从而在植入位置中提供与周围骨的有利的适配构形。更具体解释地，接头604的雄性锥形插入部分608能够限定附接轴线671。本体424的向外锥形径向延伸部分432能够限定平面673。裙部54″的喇叭状轮廓部分能够在植入位置中大体地沿着平面673渐缩。裙部54″能够因此而与补充件402协作从而有效地充填骨空隙。
如现在所能够理解，本发明提供一组简化的可互换部件，其中接头组件600能够用在关节线的任一侧上(例如，如针对图35所述的与胫骨部件结合使用，还有如针对图41所述的与股骨部件结合使用)。而且，锁定构件606和紧固件插入部620的组合能够被用在如上所述的若干不同的区域中。另外，例如在图21-25中公开的补充件能够以与股骨部件的上延伸部分(例如图8中的部分130)或者胫骨部件的下延伸部分(例如图36C中的部分638)协作的方式使用。
现在转到图42-49，将更详细地描述可以以与胫骨托架636协作的方式使用的附加部件。如所解释，胫骨托架636能够用作骨养护铰链膝假体的一部分。胫骨托架636能够与支承件672协作。龙骨680能够限定用于接收上延伸立柱637的第一钻孔682、以及用于接收轴杆686的第二钻孔684。一对毂688能够接合轴杆686的相对端。在一个示例中，偏置构件687能够顶着龙骨680上的外表面偏置，以将轴杆686向外偏置。
通过沿向内的方向按压轴杆686并且将龙骨680大体置入股骨部件692的股骨盒696中直到轴杆686与形成在股骨盒中的通道695和697对齐，龙骨680能够在手术中联接至股骨部件692。毂688能够在轴杆686的相对端上嵌套在通道695和697中。轴杆686能够向外偏置，从而促使毂688座落在通道695和697中。如所能够理解，在使用期间，毂688能够提供用于支撑轴杆686的旋转表面。毂688可以由任何合适的轴承材料例如PEEK(聚醚醚酮)、聚乙烯、碳加强PEEK形成。然后，销700能够插入龙骨680中以抑制轴杆686的向内压缩。
承座690能够布置在龙骨680和股骨部件692中间。股骨部件692能够限定穿过盒696的螺纹钻孔694。上延伸部分698能够接收接头体604的雄性锥形插入部分608。锁定构件606能够如上所述地用来接合从雄性插入部分608凸伸出的紧固件插入部620(未具体示出)。作为选择，紧固件能够向上延伸而穿过股骨部件692，从而紧固地与接头体604配合(如图8所示)。马蹄状夹子702能够紧固地嵌套在限定在立柱637上的环形凹处704中。
现在参考图50-54，图中示出附加的补充件。补充件710能够限定用于紧固至胫骨托架(即，例如图3D中的胫骨托架22D)的中间或侧下侧的基本上对称的轮廓。通道712能够形成为穿过补充件710，以便在组装位置中接收紧固件(未示出)。补充件716和718能够限定通道720和722，分别用于接收股骨部件730(见图58)的上延伸部分724。补充件716和718能够限定特别用于与股骨盒732的中间或侧向侧协作的轮廓。补充件716能够被植入以占据股骨部件730的中间侧的骨损失区域。补充件718能够被植入以占据股骨部件的侧向侧的骨损失区域。补充件734和736能够分别限定通道738和740(图59)。补充件734和736可以单独地或者以组合方式使用。相应的通道720、722、738和740与股骨部件730的上延伸部分724能够限定圆锥形接合表面，其适于提供按照莫氏型锥体而形成的摩擦配合。补充件734和736能够限定不同于补充件716和718的轮廓。
现在转到图53，图中示出了另一个补充件744。补充件744能够限定通道746。在一个示例中，补充件744可以是对称的，用于联接至股骨部件730的中间或侧向表面。螺纹盲孔750和752能够限定在股骨部件730上，以便接纳用于紧固补充件744的紧固件(未示出)。能够提供另一个补充件744′(其能够呈相对于补充件744的镜像轮廓)，以便与股骨部件的唯一的中间(或侧向)侧相匹配。
参考图54和57，图中示出了具有中心通道756的鞍囊状补充件754。中心通道756能够接收股骨部件730的上延伸部分724。如同本文所提供的其他补充件，中心通道756与上延伸部分724能够限定适于提供按照莫氏型锥体而形成的摩擦配合的圆锥形接合表面。图60示出了具有紧固至上延伸部分724的翼状补充件450(图24)的股骨部件730。
本文所公开的每一个补充件能够由生物相容材料例如实心金属、多孔金属或者实心金属和多孔金属的组合形成。在一个示例中，实心金属或者多孔金属能够包括不锈钢、钛、钛合金、钴-铬合金及其他适合于在生物相容环境中使用的材料。如在本领域中众所周知，多孔金属能够提供合适的表面面积，用于促进自然骨和/或软组织的向内生长。制造这种多孔金属的各种不同成分和方法可以在以下共同未决的申请中得到：2005年4月21日提交的美国系列号11/111,123；2005年12月5日提交的美国系列号11/294,692；2006年2月17日提交的美国系列号11/357,868，以上申请的名称均为″用于多孔移植的方法和装置(Methodand Apparatus for Use of Porous Implants)″；2006年10月11日提交的、名称为″用于多孔移植的方法(Method for Use of Porous Implants)″的美国系列号11/546,500；2007年2月22日提交的、名称为″带有钴支承表面的多孔金属杯(Porous Metal Cup with Cobalt Bearing Surface)″的美国系列号11/709,549；以及2006年2月17日提交的、名称为″用于形成多孔金属移植物的方法和装置(Method and Apparatus for FormingPorous Metal Implants)″的美国系列号11/357,929，所有这些申请也被转让给印第安纳州Warsaw的生迈公司，这些申请通过参引而结合在本申请中。
图55A示出一套部件760。该套部件能够如本文所述地可互换地使用。茎能够限定各种不同的长度和直径。接头能够限定各种不同的偏移。图55B示出了这种可互换性。例如，外科医生能够在手术中选择所需要的股骨部件A、胫骨部件B、支承件C、补充件D以及偏移接头E。尽管未示出，但是合适的茎(例如茎20)也能够如本文所述地联接至偏移接头E。
如本文所述，锥形雌性接收部分已被描述为借助压配合接收锥形雄性插入部分。进一步解释地，雌性接收部分和雄性插入部分都限定适于提供按照莫氏型锥体而形成的摩擦配合的圆锥形接合表面。
尽管已参考优选实施例在说明书中描述和在附图中示出了本发明，但是本领域技术人员可以理解，在不脱离如权利要求中所限定的本发明的范围的情况下，可以进行多种不同的变化并且可以用等同物来替代其元件。另外，在不脱离本发明的实质范围的情况下，可以针对本公开的教导进行多种改型以适应特定的情形或材料。因此，本发明并未局限于通过附图示出和在说明书中描述的、作为目前可想象得到的实施本发明的最佳方式的特定实施例，而是，本发明将包括任何落入所附权利要求的描述中的任何实施例。

Claims (51)

1.一种膝关节假体系统，包括：
第一膝假体部件，其具有形成于其上的第一附接部分；
至少第一茎，其限定茎接合部分；以及
第一接头，其具有限定第一轴线的第一接头接合部分和限定第二轴线的第二接头接合部分，所述第一轴线和所述第二轴线平行并偏移；
其中，所述第一附接部分能够操作而在手术中与所述茎接合部分或所述第一接头接合部分联接。
2.如权利要求1所述的系统，进一步包括第二膝假体部件，所述第二膝假体部件不同于所述第一膝假体部件并且具有第二附接部分，其中，所述第二附接部分能够操作而与所述茎接合部分或所述第一接头接合部分联接。
3.如权利要求2所述的系统，其中，所述第一膝假体部件是股骨部件而所述第二膝假体部件是胫骨部件。
4.如权利要求3所述的系统，其中，所述第一膝假体部件包括多个股骨部件而所述第二膝假体部件包括多个胫骨部件。
5.如权利要求4所述的系统，其中，所述股骨部件中的至少一个和所述胫骨部件中的至少一个协作而形成十字保持(CR)膝假体、后部稳定(PS)膝假体、完全束缚膝假体和铰链膝假体中的每一个。
6.如权利要求5所述的系统，进一步包括胫骨支承件，所述胫骨支承件从由固定支承件、浮动支承件和旋转支承件构成的组中选择。
7.如权利要求1所述的系统，其中，所述茎接合部分能够操作而与所述第二接头接合部分联接。
8.如权利要求1所述的系统，进一步包括多个茎，每一个茎都具有茎接合部分并限定不同的长度或直径，其中，每一个茎接合部分能够操作而与所述膝假体部件的第一附接部分或所述接头的第二接头接合部分联接。
9.如权利要求1所述的系统，进一步包括多个接头，每一个接头都通过第一接头接合部分限定第一轴线并通过第二接头接合部分限定第二轴线，其中，所述第一接头的第一轴线与第二轴线之间限定的偏移不同于所述多个接头中的另一个接头的第一轴线与第二轴线之间限定的偏移。
10.如权利要求1所述的系统，其中，所述第一附接部分限定雌性锥形接收部分，而所述茎接合部分和所述第一接头接合部分各自限定雄性锥形插入部分，并且，借助莫氏型锥体配合，所述雌性锥形接收部分协同地接合所述雄性锥形插入部分。
11.如权利要求1所述的系统，进一步包括第一锁定构件，所述第一锁定构件穿过在所述第一接头中限定的接头钻孔，所述第一锁定构件能够操作而将所述第一茎锁定至所述第一接头。
12.如权利要求11所述的系统，其中，所述接头钻孔形成有螺纹，并且，所述第一锁定构件在未紧固位置与紧固位置之间沿所述接头钻孔以旋拧方式前进。
13.如权利要求12所述的系统，进一步包括紧固至所述茎的插入部，其中，在所述紧固位置中所述第一锁定构件在界面区域处接合所述插入部。
14.如权利要求13所述的系统，其中，所述第一锁定构件由比所述插入部硬的材料形成，使得所述插入部在所述第一锁定构件前进到所述紧固位置后在界面区域处变形。
15.如权利要求14所述的系统，其中，所述插入部限定圆锥形头部，并且，在所述紧固位置中所述第一锁定构件接合所述圆锥形头部。
16.如权利要求12所述的系统，进一步包括第二锁定构件，所述第二锁定构件穿过在所述第一假体中限定的假体钻孔，所述第二锁定构件能够操作而将所述第一假体锁定至所述第一接头，其中，所述第一锁定构件和所述第二锁定构件基本相同。
17.如权利要求16所述的系统，其中，所述假体钻孔限定成穿过股骨部件中的股骨盒。
18.如权利要求16所述的系统，其中，所述假体钻孔限定成穿过胫骨托架的托架部分。
19.如权利要求4所述的系统，进一步包括多个补充件，每一个补充件限定具有圆锥形接合表面的通道，其中，所述多个补充件中的每一个都能够操作而与所述股骨部件的上延伸部分或所述胫骨部件的下延伸部分联接。
20.如权利要求19所述的系统，其中，所述补充件中的一个限定向外锥形径向延伸部分。
21.如权利要求20所述的系统，其中，所述补充件的圆锥形接合表面限定附接轴线，所述补充件进一步包括径向延伸体，所述径向延伸体沿着与所述附接轴线相交的平面渐缩，并且，所述接头限定在植入位置中沿着所述平面渐缩的喇叭状轮廓部分。
22.如权利要求19所述的系统，其中，所述多个补充件各自限定出限定有附接轴线的圆锥形接合表面，所述多个补充件包括限定第一台阶的第一补充件和限定第二台阶的第二补充件，并且，所述第一补充件和所述第二补充件能够操作而绕着所述附接轴线旋转以相对于所述股骨部件或所述胫骨部件定位于所需的位置。
23.如权利要求22所述的系统，其中，所述第一补充件和所述第二补充件能够单独地或以组合方式使用，并且，所述第一台阶和所述第二台阶在所述第一补充件和所述第二补充件以组合方式使用时配合。
24.如权利要求4所述的系统，进一步包括第一补充件和第二补充件，所述第一补充件和所述第二补充件各自具有圆锥形接合表面并能够操作而单独地或以组合方式与所述股骨部件的上延伸部分联接，其中，所述第一补充件限定占据股骨盒的中间侧上的解剖结构空间的第一体，而所述第二补充件限定占据所述股骨盒的侧向侧上的解剖结构空间的第二体。
25.如权利要求3所述的系统，其中，所述股骨部件和所述胫骨部件通过铰链协同地联接，并且，所述铰接限定具有轴杆的龙骨，所述轴杆沿着其长度方向向外偏置，所述轴杆在植入位置中接合布置在所述股骨部件的股骨盒上的毂。
26.一种膝关节假体系统，包括：
股骨部件，其具有形成于其上的第一附接部分；
胫骨部件，其具有形成于其上的第二附接部分；以及
第一接头，其具有限定第一轴线的第一接头接合部分和限定第二轴线的第二接头接合部分，所述第一轴线和所述第二轴线平行并偏移；
其中，所述第一接头接合部分能够操作而在手术中与所述第一附接部分或所述第二附接部分联接。
27.如权利要求26所述的系统，进一步包括多个茎，每一个茎具有茎接合部分并限定不同的长度，其中，每一个茎接合部分能够操作而与所述膝假体部件的第一附接部分或所述接头的第二接头接合部分联接。
28.如权利要求26所述的系统，进一步包括多个接头，每一个接头都通过第一接头接合部分限定第一轴线并通过第二接头接合部分限定第二轴线，其中，所述第一接头的第一轴线与第二轴线之间限定的偏移不同于所述多个接头中的另一个接头的第一轴线与第二轴线之间限定的偏移。
29.如权利要求27所述的系统，其中，所述第一附接部分限定雌性锥形接收部分，而所述茎接合部分和所述第一接头接合部分各自限定雄性锥形插入部分，并且，借助莫氏型锥体配合，所述雌性锥形接收部分协同地接合所述雄性锥形插入部分。
30.如权利要求27所述的系统，进一步包括锁定构件，所述锁定构件在未紧固位置与紧固位置之间沿着限定在所述第一接头中的螺纹钻孔以旋拧方式前进，所述锁定构件接合与所述第一茎相联的结构并在所述紧固位置中将所述第一茎锁定至所述第一接头。
31.如权利要求30所述的系统，其中，所述结构包括紧固至所述茎的插入部，其中，在所述紧固位置中所述锁定构件在界面区域处接合所述插入部。
32.如权利要求31所述的系统，其中，所述锁定构件由比所述插入部硬的材料形成，使得所述插入部在所述锁定构件前进到所述紧固位置后在界面区域处变形，并且，所述插入部限定圆锥形头部，在所述紧固位置中所述锁定构件接合所述圆锥形头部。
33.如权利要求32所述的系统，进一步包括多个补充件，每一个补充件限定出限定有圆锥形接合表面的通道，其中，所述多个补充件中的每一个都能够操作而与所述股骨部件的上延伸部分或所述胫骨部件的下延伸部分联接。
34.一种执行膝外科手术的方法，所述方法包括：
提供多个股骨部件，每一个股骨部件具有形成于其上的第一附接部分，并且提供多个胫骨部件，每一个胫骨部件具有形成于其上的第二附接部分；
提供多个接头，每一个接头具有限定第一轴线的第一接头接合部分和限定第二轴线的第二接头接合部分，所述第一轴线和所述第二轴线偏移，其中，所述多个接头中的一个接头具有不同于所述多个接头中的另一个接头的偏移，并且所述多个接头的每一个的第一接头接合部分能够操作而与所述第一附接部分或所述第二附接部分联接；
提供多个茎，所述茎具有不同长度或直径，所述多个茎中的每一个都限定茎接合部分，所述茎接合部分能够操作而与所述第一附接部分、所述第二附接部分或所述第二接头接合部分联接；
从所述股骨部件、胫骨部件、多个接头和多个茎中确定所需的植入配置；并且
在手术中对所需的配置进行联接。
35.如权利要求34所述的方法，其中，在手术中对所需的配置进行联接包括形成十字保持(CR)膝假体、后部稳定(PS)膝假体、完全束缚膝假体或铰链膝假体。
36.如权利要求35所述的方法，进一步包括提供胫骨支承件，所述胫骨支承件从由固定支承件、浮动支承件和旋转支承件构成的组中选择。
37.如权利要求34所述的方法，其中，在手术中对所需的配置进行联接包括将限定于第一接头的所述第一接头接合部分的雄性锥形插入部分插入限定于所述第一附接部分或所述第二附接部分的雌性锥形接收部分中，从而形成莫氏型锥体配合。
38.如权利要求37所述的方法，其中，在手术中对所需的配置进行联接包括使锁定构件前进穿过限定于所述第一接头的接头钻孔。
39.如权利要求38的方法，其中，使所述锁定构件前进的步骤包括使所述锁定构件以旋拧方式前进穿过限定于所述第一接头的螺纹钻孔。
40.如权利要求39所述的方法，其中，使所述锁定构件前进的步骤包括在界面区域处接合与所述多个茎中的一个茎相联的插入部，其中，所述插入部在所述锁定构件前进至紧固位置后在界面区域处变形。
41.如权利要求38所述的方法，其中，所述锁定构件将所述多个茎中所需的茎锁定至所述第一接头。
42.如权利要求38所述的方法，其中，所述锁定构件将所述多个股骨部件中所需的股骨部件锁定至所述第一接头。
43.如权利要求37所述的方法，其中，在手术中对所需的配置进行联接包括使所述锁定构件前进穿过钻孔，所述钻孔限定成穿过所述多个胫骨部件中的一个胫骨部件的平台部分。
44.如权利要求34所述的方法，进一步包括提供多个补充件，每一个补充件限定具有圆锥形接合表面的通道，所述圆锥形接合表面限定附接轴线，其中，所述多个补充件中的每一个都能够操作而与所述多个股骨部件中的每一个股骨部件的上延伸部分或所述多个胫骨部件中的每一个胫骨部件的下延伸部分联接；并且
在手术中对所需的配置进行联接包括滑动地将所述多个补充件中的第一补充件附接到所述上延伸部分或所述下延伸部分上，从而形成莫氏型锥体配合。
45.如权利要求44所述的方法，其中，滑动地对所述第一补充件进行附接的步骤包括相对于所述上延伸部分或所述下延伸部分绕着所述附接轴线旋转所述第一补充件以获得所需的定向。
46.如权利要求45所述的方法，进一步包括滑动地将所述多个补充件中的第二补充件附接到所述上延伸部分或所述下延伸部分上从而形成莫氏型锥体配合，其中，所述第一补充件和所述第二补充件各自限定在植入位置中协同地配合的台阶状部分。
47.一种膝关节假体系统，包括：
股骨部件，其具有形成于其上的上延伸部分；
胫骨部件，其具有形成于其上的下延伸部分；以及
多个补充件，每一个补充件限定具有圆锥形接合表面的通道，其中，所述多个补充件中的每一个都能够操作而与所述股骨部件的上延伸部分或所述胫骨部件的下延伸部分联接。
48.如权利要求47所述的系统，其中，所述圆锥形接合表面与所述上延伸部分或所述下延伸部分协作，从而在组装位置中形成莫氏型锥体配合。
49.如权利要求48所述的系统，其中，所述多个补充件各自通过所述圆锥形接合表面限定附接轴线，所述多个补充件包括限定第一台阶的第一补充件和限定第二台阶的第二补充件，并且，所述第一补充件和所述第二补充件能够操作而绕着所述附接轴线旋转以相对于所述股骨部件或所述胫骨部件定位于所需的位置。
50.如权利要求47所述的系统，其中，所述第一补充件和所述第二补充件能够单独地或以组合方式使用，并且，所述第一台阶和所述第二台阶在所述第一补充件和所述第二补充件以组合方式使用时配合。
51.如权利要求48所述的系统，进一步包括多个茎，每一个茎具有茎接合部分并限定不同的长度，其中，每一个茎接合部分能够操作而与形成于所述上延伸部分的第一雌性锥形接收部分或形成于所述下延伸部分的第二雌性锥形接收部分联接。
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