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CN102006841A - 边缘匹配的关节植入物 - Google Patents

边缘匹配的关节植入物 Download PDF

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CN102006841A
CN102006841A CN2009801138088A CN200980113808A CN102006841A CN 102006841 A CN102006841 A CN 102006841A CN 2009801138088 A CN2009801138088 A CN 2009801138088A CN 200980113808 A CN200980113808 A CN 200980113808A CN 102006841 A CN102006841 A CN 102006841A
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implant
tibial plateau
tibia
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P·郎
D·斯泰内斯
W·费茨
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Conformis Inc
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    • G06—COMPUTING; CALCULATING OR COUNTING
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Abstract

一种关节成形术的方法，包括获得所述胫骨平台的至少一部分的图像。至少部分基于图像获取胫骨平台的至少一部分的外周界。提供用于所述胫骨平台的植入物，所述植入物具有包括外部边缘的周界，所述外部边缘基本上与取得的所述胫骨平台的外周界匹配。

Description

边缘匹配的关节植入物
相关申请的交叉引用
本申请要求2008年3月5日提交的美国临时申请第61/034,014的优先权，该申请以参见的方式纳入本文。
本申请涉及2004年11月24日提交的美国专利申请第10/997,407号，该申请以参见的方式纳入本文。
技术领域
本文所述的实施例涉及整形外科系统、方法和装置。更具体地说，提供用于膝、髋、踝、足、肩、肘、腰和手关节的系统、方法和装置。
背景技术
通常在例如单隔室膝关节成形术(且也可以是双隔室和总膝关节成形术)期间切除上部胫骨，并插入胫骨植入物。通常，胫骨植入物选自有限的、固定数量的尺寸，从而防止植入物伸出切除的胫骨平台。为此，胫骨植入物通常选择成使得植入物的周界比胫骨平台的外周小。或者，在选择情况下，植入物可能悬伸，可能与相邻的软组织和韧带干涉。于是，植入物搁置在内部松质骨上而不是位于胫骨平台的外周处的较硬外部骨皮质上。由于松质骨是海绵状的，所以胫骨植入物趋于过段时间之后移动位置。
发明内容
植入物的一实施例构造成配合在患者的骨的切割部分内。该植入物可包括大致平坦或大致盘形或穹顶形本体，该本体具有下表面、上表面以及在上表面与下表面之间延伸的外周边缘。周向边缘的至少一部分可构造成基本上与骨的切割部分的周界的至少相应部分匹配，使得植入物基本上由骨皮质支承。
另一实施例是胫骨盘，该胫骨盘构造成配合在患者的胫骨平台内。该盘可包括大致平坦或大致盘形或穹顶形本体，该本体具有下表面、上表面以及在上表面与下表面之间延伸的外周边缘。周向边缘的至少一部分可构造成当胫骨盘移植到胫骨平台上时，基本上与胫骨平台的周界的至少相应部分匹配。
该实施例可包括用于固定胫骨盘的锚固件。周向边缘的整个外部可构造成当胫骨盘移植到胫骨平台上时基本上与胫骨平台的相应周界匹配，且周向边缘的整个内部基本上任选地毗邻胫骨平台内的垂向切口。或者，周界边缘的至少一部分可构造成从胫骨平台的相应周界凹进，并可进一步构造成当胫骨盘移植到胫骨平台上时邻近骨皮质。在又一实施例中，当胫骨盘移植到胫骨平台上时，周界边缘的至少第一外部可构造成邻近骨皮质，且周界边缘的至少第二外部可构造成邻近松质骨。
另外，盘的上表面可至少部分从股骨骨节的患者具体数据中获取。患者具体数据可从股骨骨节的图像、胫骨或胫骨平台或植入物形状的图像获得。上表面可包括从患者具体数据获取的至少一个曲线。该上表面可由超高分子量聚乙烯(UHMWPE)以及交联聚乙烯制成。
周界边缘的轮廓可从患者具体数据获取，患者具体数据可从例如胫骨的近端的图像获取。当移植到胫骨平台上时，胫骨盘的周界边缘可构造成搁置在骨皮质上。该盘可具有从下表面到上表面的约3至15mm的厚度。
根据另一实施例，关节成形术的方法包括获得胫骨平台的至少一部分的图像。至少部分基于该图像获取胫骨平台的至少一部分的外周界。提供一种用于胫骨平台的植入物，该植入物具有包括外部边缘的周界，该外部边缘基本上至少与获取的胫骨平台的外周界的各部分匹配。
在某些实施例中，植入物的周界包括内部边缘，该内部边缘跨越胫骨平台伸展。获取胫骨平台的外周界可包括获取三维表示。胫骨平台的图像可包括软骨下骨、骨皮质、正常关节软骨和/或疾患关节软骨。植入物还可包括用于固定植入物的锚固件。该锚固件可以是龙骨、钉桩、结块和/或杆。该植入物可包括聚合物、陶瓷、金属和/或陶瓷金属复合物。该植入物还可包括面向胫骨平台的下表面和面向股骨的上表面，且其中上表面包括陶瓷、金属、聚合物和陶瓷-金属复合物中的至少一个。该植入物还可包括面向胫骨平台的下表面和面向股骨的上表面，该方法还包括从股骨骨节的患者具体数据至少部分地获取上表面。可从股骨骨节的图像获得患者具体数据。外部边缘可适于大致搁置在胫骨平台上的骨皮质上。该方法还可包括将植入物固定到胫骨平台，其中植入物的外部边缘基本上搁置在骨皮质上。该植入物可具有约3至15mm的厚度。可割除胫骨平台的至少一部分。
在其它实施例中，形成胫骨平台植入物的方法可包括获得包括胫骨平台的膝关节的图像。从该图像获取胫骨平台的外部胫骨边缘的表示。提供植入物本体，其具有承载表面、胫骨界面、内部边缘和基本上与外胫骨边缘的轮廓匹配的外部边缘。
在相关方法中，外部边缘可适于大致搁置在胫骨平台上的骨皮质上。该方法还可包括将植入物固定到胫骨平台，其中植入物的外部边缘基本上搁置在骨皮质上。
在其他有些实施方式中，关节成形术的方法可包括提供用于胫骨平台的植物体，该植入物包括本体，其具有承载表面、胫骨界面、内部边缘和基本上与患者胫骨平台的外部边缘的轮廓匹配的外部边缘。胫骨平台可制备成接纳植入物。植入物可固定到制备好的植入物位置，其中胫骨界面的外周界的至少各部分基本上搁置在骨皮质上。
在相关实施例中，植入物可包含锚固件。该锚固件可以是龙骨、龙骨、钉桩、结块和/或杆。植入物可包括用于接纳股骨骨节的承载表面部件。承载表面部件可包括陶瓷、金属、聚合物和/或陶瓷金属复合物。该聚合物可包括UHMWPE。该承载表面可至少部分从包括软骨下骨、骨皮质、正常和/或疾患软骨的胫骨平台，包括软骨下骨、骨皮质、正常和/或疾患软骨的一个或多个股骨骨节的患者具体数据获取。可从股骨骨节或胫骨平台或第一或相对的第二关节表面的图像获得患者具体数据。该本体可包括聚合物、金属、金属和/或陶瓷-金属复合物。外部边缘的轮廓可从患者具体数据获取。可从胫骨近端的图像获得患者具体数据。该植入物可具有约3至15mm的厚度。该方法还可包括获得胫骨平台的至少一部分的图像，并至少部分基于该图像获取植入物的外部边缘。该植入物的内部边缘可适于跨越胫骨平台伸展。该植入物的下表面可以是平坦的或弯曲的。植入物的该下表面和/或顶表面可相对于胫骨的纵向或冠状轴线或生物力学轴线成不为90度的角。
根据另一实施例，植入物可包括本体，其具有承载表面、胫骨界面、内部边缘和基本上与患者胫骨平台的外部边缘的轮廓匹配的外部边缘。
例如膝关节、髋关节、肩关节或其它关节内的任何植入物可由例如聚乙烯的单一材料制成。该植入物也可使用两种材料，例如金属背衬和聚乙烯插入件。该聚乙烯插入件可使用本领域已知的标准锁定机构锁定在金属背衬内。
根据相关实施例，植入物可包括用于固定植入物的锚固件。该锚固件可以是龙骨、龙骨、钉桩、结块和/或杆。植入物的各部分，例如桩钉或龙骨，或面对骨的表面的各部分可以有多孔涂层。该植入物的下表面可包括以是胶合凹腔。使用时，胶合凹腔可在植入物的外边缘处开口以与切割的胫骨平台的骨内膜骨接界或沿可能的垂直切口与切割表面接界。该植入物还可包括用于接纳股骨骨节的承载表面部件。该承载表面部件可包括陶瓷、金属、聚合物和/或陶瓷金属复合物。该聚合物可包括UHMWPE。承载表面可至少部分从股骨骨节或胫骨平台的患者具体数据获取，或者其可反映股骨承载表面的外部几何尺寸的各方面的形状或镜像形状，例如以不同的弯曲或延伸角。可从股骨骨节或胫骨平台的图像获得患者具体数据。该本体可包括聚合物、金属、金属和/或陶瓷-金属复合物。外部边缘的轮廓可从患者具体数据获取。可从胫骨近端的图像获得患者具体数据。胫骨界面的外周界可适于大致搁置在骨皮质上。该植入物可具有约3至15mm的厚度。
根据另一实施例，植入物的外部边缘的轮廓可从患者具体数据获取。可从胫骨近端的图像获得患者具体数据。该植入物的外部边缘的轮廓可从近侧胫骨的轴向或近轴向横截面图像、纵向或近纵向横截面图像、冠状或近冠状横截面图像、或任何其它横截面图像获取。或者，该植入物的外部边缘的轮廓可通过形成近侧胫骨的虚拟模型和在模型上进行虚拟切割来确定。在该虚拟模型上进行的虚拟切割可考虑膝盖的一个或多个机械或解剖学轴线。
由于该植入物是边缘匹配的，所以植入物的外部轮廓可以是凸出的，但其也可包括凹陷部分。例如，在髋关节内，凹陷形状可整合在装置的外部轮廓内以实现与髋臼缘边的形状的几乎100％一致。
附图说明
根据附图并参考以下详细描述将更容易地理解上述特征，在附图中：
图1是切除的胫骨平台的侧视立体图；
图2是插入在图1的切除的胫骨平台上的胫骨植入物的侧视立体图；
图3是关节成形术的方法的示意图；
图4是胫骨的近端的虚拟模型的侧视立体图，具有虚拟的胫骨切口；
图5是两个部件分别插入在两个切除的胫骨平台上的胫骨植入物的替代实施例的侧视立体图；
图6是插入在图1的切除的胫骨平台上的胫骨植入物的替代实施例的侧视立体图；
图7是插入在图1的切除的胫骨平台上的胫骨植入物的替代实施例的侧视立体图；
图8是插入切除的胫骨平台上的胫骨植入物的替代实施例的侧视立体图；
图9是插入在延伸穿过胫骨的整个近端的切除的胫骨平台上的胫骨植入物的替代实施例的侧视立体图。
具体实施方式
描述用于关节成形术的各种方法、系统和装置以提供用于胫骨平台的植入物，该植入物具有基本上与胫骨平台的外周、或整个外周或外周的至少一部分匹配或对应的外部边缘。较佳的是，植入物的外部边缘整个搁置在胫骨上以提供对植入物的支承。但是，在某些实施例中，仅装置的外部边缘的一部分搁置在胫骨上。
参照图1，示出胫骨10的上(近)端的切除部分。左胫骨10的中间胫骨平台被切除，且胫骨10的包括弯月面13的侧隔室是完整的。在替代实施例中，可替代地切除胫骨10的侧部分，或可切除胫骨10的两侧或中间部分。此外，植入物并不限于胫骨，且可应用于有利地使植入物搁置在骨的外周上的其它关节表面。
胫骨10的切除的侧隔室可例如沿纵切平面切割以形成侧壁15。该切口与水平切口组合形成大致平坦、切除的胫骨表面，在该表面上可放置胫骨植入物20，如图2所示，且如下所述。
如图1所示，切除的胫骨表面包括由骨皮质17构成的外周界19。在切除的胫骨表面的外周界内有松质骨18，该松质骨与硬质骨皮质17相比是海绵状的。
参照图2，植入物20是用于相应的关节股骨表面再造或更换植入物的胫骨植入物。植入物20具有基本上与胫骨平台的外周界匹配的外周边缘21。匹配的边缘确保植入物20的外部搁置在骨皮质17上，这提供比松质骨18更好的支承。与搁置在海绵状松质骨18上相反，植入物20的外部边缘21由骨皮质17完全支承。应当理解，植入物20的内周边缘25可跨越胫骨平台(包括松质骨)伸展，并可与胫骨平台接触或不接触。
植入物20包括下表面(图2中未示出)和上表面22，该下表面面向胫骨平台，且上表面22面向股骨。上表面22的至少一部分是负载承载件。上表面22可由例如陶瓷、金属、聚合物和/或陶瓷金属复合物制成。下表面和上表面可至少部分来自患者股骨骨节的具体数据，和/或可与相应股骨植入物部件的曲率匹配或由该曲率限定。患者具体数据可从股骨骨节的图像获得。植入物在上表面与下表面之间的厚度可为约3至15mm。其它结构也是可能的。例如，胫骨盘的侧壁可以是圆的、锥形的、凹陷的、突出的或相对于胫骨平台的周向边缘平齐。
图3示出根据一实施例的关节成形术的方法。该方法在步骤302处开始，在该步骤中获得胫骨平台的至少一部分的图像。所获得的图像可以是MRI、CT、螺旋CT、x射线、超声波、数字层析X射线照相组合和/或光学相干X线断层摄影术的结果但不限于此。胫骨平台的图像可包括软骨下骨、骨皮质、正常关节软骨和/或疾患的关节软骨。
该方法继续到步骤304，其中基于图像获取胫骨平台的至少一部分的外周界。这可通过电子方式进行。
例如，该获取可通过处理器(例如微处理器、微控制器、数字信号处理器或通用计算机)、用于可编程逻辑装置的可编程逻辑电路(例如现场可编程门阵列(FPGA)或其它PLD)、分离元件、集成电路(例如专用集成电路(ASIC))、存储器或包括其任何组合的其它装置进行。存储器可包括例如软盘、硬盘、光盘(CD)、只读存储器(ROM)、可擦除可编程只读存储器(EPROM)和/或随机存取存储器(RAM)。执行本文先前所述全部或一部分功能的计算机编程逻辑电路可体现为各种形式，包括但不限于源编码形式、计算机可执行形式和各种中间形式(例如由汇编程序、编译程序、连接程序或定位程序产生的形式)。源代码可包括以用于各种操作系统或操作环境的各种编程语言(例如目标代码、汇编语言或诸如Fortran、C、C++、C#、JAVA或脚本语言的高级语言)中的任何语言执行的一系列计算机程序指令。该源代码可定义和使用各种数据结构和通信信息。该源代码可以是计算机可执行形式(例如通过编译器)，或源代码可以转换(例如通过翻译程序、汇编程序或编译程序)成计算机可执行形式。
获取外周界可包括获取近向胫骨的横截面(例如轴向或近轴向、纵向或近纵向、冠状或近冠状截面)、两维或三维表示。可将各种扫描平面组合以形成三维表示。还可包括在一系列两维显示上或在三维表示上模拟胫骨切口，例如图4所示。模拟的胫骨切口的方向可基于膝盖的一个或多个机械或解剖学轴线。这些一个或多个轴线可从同一图像获取或从登记到与胫骨图像相同的坐标系内的一个或多个分开的图像获取。模拟的切口的高度可根据图像中的胫骨或股骨上的一个或多个参考点或标记确定。由于胫骨具有锥度，所以胫骨平台的外周界沿向上至向下方向越来越小。在较佳实施例中，因此在所要求的切割高度确定虚拟获取的胫骨平台的外周界。
然后该方法继续到步骤306，其中为胫骨平台提供植入物。植入物的周界包括外部边缘，该外部边缘基本上与获取的胫骨平台的外周界相匹配。在较佳实施例中，胫骨植入物的外部边缘因此有利地搁置在骨皮质上，如上所述。该植入物可由陶瓷、金属、聚合物和/或陶瓷金属复合物制成，但不限于此。
然后该方法可包括将植入物固定到胫骨平台。胫骨平台可例如图1所示切除。所提供的植入物可包括将植入物固定到胫骨平台的锚固件。该锚固件可以是但不限于龙骨、钉桩、结块和/或杆。
很多其它的实施例也是可能的。参照图5，一种替代实施例是具有两个分开的胫骨部件20和30的植入物。植入时，每个部件搁置在分开的胫骨平台32和34上。胫骨部件20和30结构上类似且由相同材料制成(但在其它实施例中可以是不同结构和/或材料)。但是，每个尺寸做成对应于胫骨平台32和34的匹配的外周界。因此，胫骨部件30包括基本上对应于胫骨平台34的外周界38的外侧壁36。胫骨部件20和30例如用于双隔室表面再造装置(诸如ConforMISiDuo)、完整膝盖表面再造装置(诸如ConforMISiTotal)、或完整膝更换装置。
在另一实施例中，如图6所示，胫骨盘40是与植入物20类似的形状、结构和材料。胫骨盘40的上表面42由UHWMPE制成并具有设计成在冠状平面内与相应股骨植入物部件的曲率匹配的凹腔。该曲率较佳地是冠状平面内股骨植入物的曲率半径的5倍，但也可能有很多其它实施例。胫骨盘40的外部边缘44不完全延伸到胫骨平台的外部边缘46，但外部边缘44搁置在骨皮质上。在又一些实施例中，胫骨植入物的边缘的一部分可与骨的周界平齐，而其他部分从周界凹进但仍位于骨皮质上。在其它实施例中，胫骨植入物的边缘的一个或多个部分可与骨的周界平齐，一个或多个其它部分可从周界凹进但仍位于骨皮质上，且一个或多个其它部分从周界凹进并位于松质骨上。在位于松质骨上的部分的情况下，周界的某些或全部可与骨接触或从骨突出。
参照图7，另一实施例包括较窄的胫骨盘50，该胫骨盘具有仅在端部54和56与患者的骨皮质的周界58匹配的周界，而侧部52跨越松质骨和骨皮质延伸。植入物50的远侧毗邻垂向胫骨切口60。
参照图8，另一实施例包括胫骨盘50，但胫骨盘50插入替代的胫骨平台62，该胫骨平台包括凹陷部分64和未切割部分66。在该实施例中，上部周界边缘68与未切割的软骨下骨或替代地与未切割的软骨匹配。
参照图9，另一实施例包括搁置在胫骨平台72上的胫骨盘70。胫骨平台72被切割并跨越胫骨近端的整个部分延伸。胫骨盘70具有与患者的骨皮质的周界76匹配的周界侧74。
另一实施例是用于肩关节的植入物。在肩关节中，关节窝缘边可基本上支承植入物。可使用诸如CT扫描或MRI扫描来定形或选择该植入物以基本上配合到关节窝缘边上。
在另一实施例中，在髋关节中，髋臼缘边可大致支承植入物。可使用诸如CT扫描或MRI扫描来定形或选择该植入物以基本上配装到髋臼缘边上。该植入可通过例如形成围绕植入物外部边缘的唇部而固定到髋臼缘边，该唇部直接搁置在髋臼缘边上或围绕髋臼缘边切割的骨上，其在插入时暴露于与植入物的唇部配合的平坦骨表面。这些实施例可提供用于这些关节中植入物的改进的结构支承。这种改进的结构支承可改进植入物的磨损和寿命。例如，髋关节内植入物失效的主要原因是植入物的变松。提供改进的结构支承是有利的。
其它实施例可应用于用于其它关节和骨的整形外科植入物，其中植入物的一部分的尺寸做成对应于患者的骨的未切割或切割部分的周界。在这些植入物中，骨皮质可在骨-植入物界面处支承放置在植入物上的大部分或所有负载。周向边缘的至少一部分可构造成基本上与骨的切割或未切割部分周界的至少相应部分匹配，使得植入物基本上由骨皮质或关节结构的缘边支承。很多其它的实施例也是可能的。
上述实施例仅是示例性的；还可能有包括上述构件或其它附加构件和/或附加实施例的各种组合的很多其它实施例。所有这些改型和更改都在本发明的各实施例的范围内。

Claims (49)

1.一种胫骨盘植入物，构造成配装在患者的胫骨平台内，所述胫骨盘植入物包括：
大致盘形的本体，所述本体具有下表面、上表面以及在所述下表面与上表面之间延伸的外周边缘；
其中所述周向边缘的至少一部分构造成当所述胫骨盘移植到所述胫骨平台上时至少与所述胫骨平台的周界的相应部分大致匹配。
2.如权利要求1所述的植入物，其特征在于，还包括用于固定所述植入物的锚固件。
3.如权利要求1所述的植入物，其特征在于，所述周向边缘的整个外部被构造成当所述胫骨盘移植到所述胫骨平台上且所述周向边缘的整个内部基本上邻靠所述胫骨平台内的垂向切口时与所述胫骨平台的相应周界大致匹配。
4.如权利要求1所述的植入物，其特征在于，所述周向边缘的至少一部分被构造成当所述胫骨盘移植到所述胫骨平台上时从所述胫骨平台的相应周界凹进并且还被构造成与骨皮质相邻。
5.如权利要求1所述的植入物，其特征在于，所述周向边缘的至少第一外部被构造成当所述胫骨盘移植到所述胫骨平台上时与骨皮质相邻且所述周向边缘的第二外部被构造成与松质骨相邻。
6.如权利要求1所述的植入物，其特征在于，所述胫骨盘的所述上表面至少部分源自股骨骨节的患者具体数据。
7.如权利要求6所述的植入物，其特征在于，所述患者具体数据从股骨骨节的图像获得。
8.如权利要求1所述的植入物，其特征在于，所述上表面包括源自患者具体数据的至少一个曲线。
9.如权利要求1所述的植入物，其特征在于，所述上表面包括超高分子量聚乙烯。
10.如权利要求1所述的植入物，其特征在于，所述周向边缘的轮廓源自患者具体数据。
11.如权利要求10所述的植入物，其特征在于，所述患者具体数据从胫骨近端的图像获得。
12.如权利要求1所述的植入物，其特征在于，所述胫骨盘的所述周向边缘被构造成当移植到所述胫骨平台上时搁置在骨皮质上。
13.如权利要求1所述的植入物，其特征在于，所述胫骨盘具有从所述下表面到所述上表面的约3至15mm的厚度。
14.一种关节成形术的方法，所述方法包括：
获得所述胫骨平台的至少一部分的图像；
至少部分基于所述图像得出所述胫骨平台的至少一部分的外周界；以及
提供用于所述胫骨平台的植入物，所述植入物具有包括外部边缘的周界，所述外部边缘基本上与得出的所述胫骨平台的外周界匹配。
15.如权利要求14所述的方法，其特征在于，所述植入物的所述周界包括内部边缘，所述内部边缘跨越所述胫骨平台伸展。
16.如权利要求14所述的方法，其特征在于，得出所述胫骨平台的至少一部分的所述外周界包括得出所述近侧胫骨的至少一部分的三维表示。
17.如权利要求16所述的方法，其特征在于，得出所述胫骨平台的至少一部分的所述外周界包括模拟所述三维表示上的所述胫骨切口。
18.如权利要求17所述的方法，其特征在于，所述模拟的胫骨切口基于机械或解剖学轴线或解剖学标志中的至少一个。
19.如权利要求14所述的方法，其特征在于，所述胫骨平台的所述图像包括软骨下骨、正常关节软骨和疾患关节软骨中的至少一个。
20.如权利要求14所述的方法，其特征在于，所述植入物还包括用于固定所述植入物的锚固件。
21.如权利要求20所述的方法，其特征在于，所述锚固件选自龙骨、钉桩、结块和杆。
22.如权利要求14所述的方法，其特征在于，所述植入物包括聚合物、陶瓷、金属和/或陶瓷金属复合物中的至少一个。
23.如权利要求14所述的方法，其特征在于，所述植入物还包括面向所述胫骨平台的下表面和面向所述股骨的上表面，其中所述上表面包括陶瓷、金属、聚合物和陶瓷-金属复合物中的至少一个。
24.如权利要求14所述的方法，其特征在于，所述植入物还包括面向所述胫骨平台的下表面和面向所述股骨的上表面，所述方法还包括至少部分地从股骨骨节的患者具体数据得出所述上表面。
25.如权利要求24所述的方法，其特征在于，所述患者具体数据从股骨骨节的图像获得。
26.如权利要求14所述的方法，所述外部边缘适于大致搁置在所述胫骨平台上的骨皮质上。
27.如权利要求14所述的方法，其特征在于，还包括：
将所述植入物固定到所述胫骨平台，其中所述植入物的外部边缘基本上搁置在骨皮质上。
28.如权利要求14所述的方法，其特征在于，所述植入物具有约3至15mm的厚度。
29.如权利要求14所述的方法，其特征在于，还包括切除所述胫骨平台的至少一部分。
30.一种制造胫骨平台植入物的方法，所述方法包括：
获得包括胫骨平台的膝关节的图像；
从所述图像得出所述胫骨平台的外部胫骨边缘的表示；以及
提供植入物本体，所述植入物本体具有承载表面、胫骨界面、内部边缘和基本上与外胫骨边缘的轮廓匹配的外部边缘。
31.如权利要求30所述的方法，所述外部边缘适于大致搁置在所述胫骨平台的骨皮质上。
32.如权利要求30所述的方法，其特征在于，还包括：
将所述植入物固定到所述胫骨平台，其中所述植入物的外部边缘基本上搁置在骨皮质上。
33.一种关节成形术的方法，所述方法包括：
提供用于胫骨平台的植入物，所述植入物包括本体，其具有承载表面、胫骨界面、内部边缘和基本上与患者胫骨平台的外部边缘的轮廓匹配的外部边缘；
制备所述胫骨平台以接纳所述植入物；以及
将所述植入物固定到所述制备好的植入物位置，其中所述胫骨界面的所述外周基本上搁置在骨皮质上。
34.如权利要求33所述的植入物，其特征在于，所述植入物还包括锚固件。
35.如权利要求34所述的方法，其特征在于，所述锚固件选自龙骨、钉桩、结块和杆。
36.如权利要求34所述的方法，其特征在于，所述植入物还包括用于接纳股骨骨节的承载表面部件。
37.如权利要求36所述的方法，其特征在于，所述承载表面部件可包括陶瓷、金属、聚合物和/或陶瓷金属复合物。
38.如权利要求36所述的方法，其特征在于，所述承载表面至少部分从股骨骨节的患者具体数据得出。
39.如权利要求38所述的方法，其特征在于，所述患者具体数据从股骨骨节的图像获得。
40.如权利要求34所述的方法，其特征在于，所述本体包括聚合物、陶瓷、金属和/或陶瓷金属复合物。
41.如权利要求40所述的方法，其特征在于，所述聚合物包括超高分子量聚乙烯。
42.如权利要求34所述的方法，其特征在于，所述外部边缘的轮廓从患者具体数据得出。
43.如权利要求42所述的方法，其特征在于，所述患者具体数据从胫骨近端的图像获得。
44.如权利要求34所述的方法，其特征在于，所述植入物具有约3至15mm的厚度。
45.如权利要求34所述的方法，其特征在于，还包括：
获得所述胫骨平台的至少一部分的图像；以及
至少部分基于所述图像得出所述植入物的所述外部边缘。
46.如权利要求34所述的方法，其特征在于，所述植入物的内部边缘适于跨越所述胫骨平台伸展。
47.一种用于胫骨平台的植入物，所述植入物包括：
本体，所述本体具有承载表面、胫骨界面、内部边缘和基本上与患者胫骨的外部边缘的轮廓匹配的外部边缘。
48.如权利要求47所述的植入物，其特征在于，所述胫骨平台包括对应于膝关节的两个隔室的两部分，所述本体对应于第一部分，所述第一部分对应于第一隔室，并还包括第二本体，所述第二本体对应于第二部分，所述第二部分对应于第二隔室。
49.一种用于体内的植入物，包括：
大致盘形的本体，所述本体具有下表面、上表面以及在所述下表面与上表面之间延伸的外周边缘；
其中所述周向边缘的至少一部分构造成至少与所述骨的切口部分的周界的相应部分大致匹配，使得所述植入物基本上由骨皮质支承。
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