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CN1032189C - 用于支撑手指的或其它的修复关节的关节机构的固定元件 - Google Patents

用于支撑手指的或其它的修复关节的关节机构的固定元件 Download PDF

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Publication number
CN1032189C
CN1032189C CN90103610A CN90103610A CN1032189C CN 1032189 C CN1032189 C CN 1032189C CN 90103610 A CN90103610 A CN 90103610A CN 90103610 A CN90103610 A CN 90103610A CN 1032189 C CN1032189 C CN 1032189C
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CN
China
Prior art keywords
fixed component
bone
joint
articulation mechanism
fixation member
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Expired - Fee Related
Application number
CN90103610A
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English (en)
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CN1047025A (zh
Inventor
佩-英格瓦·布兰尼马克
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Individual
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Individual
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Priority claimed from SE8901508A external-priority patent/SE466936B/sv
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Publication of CN1047025A publication Critical patent/CN1047025A/zh
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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Abstract

一种用于支撑关节机构的固定构件。该固定构件基本上是旋转对称的，至少是部分中空的，并且包括与组织相容的材料。该固定构件具有一个能至少部分地与组织骨整合的表面，以沿骨骼纵轴线实现了永久性的骨内固定。将该固定构件安置到骨内的步骤是：切开靠近关节的骨骼以露出骨髓腔；在靠近关节的骨髓腔内形成一个空间；在该空间内放置一导引套筒；以及在使用引套筒对中并固定固定构件的同时把固定构件拧入骨髓腔。

Description

用于支撑手指的或其它的修复关节的关节机构的固定构件
本发明涉及一种用于支撑关节机构的固定构件、一种在骨骼内安置固定构件的方法、以及一种修复关节。
本发明的一个优选实施例将在下面参照手指关节的修复进行详细描述。但本发明并不局限于此。本发明可用于其它类似的关节、诸如脚趾关节、肘关节、等等。本发明还可用于截断术后的修复或其它损伤的修复。
要带假体的手指关节修复主要是在那些已经产生风湿性病变的MCP(掌指骨)关节上进行。已知的用于此目的假体包括Swanson硅橡胶手指关节。这样一些关节由类似于硅的材料组成，呈细长形状，并具有横截面基本上呈圆形的端部。端部可以装入并固定到每个骨骼的骨髓腔内。假体的中心部份可弹性变形，因此就构成了实际的关节机构。
用于手指关节的修复的St.George假体-一种粘接的假体-也是众所周知的。
这些常规的假体存在的一个问题是，支撑实际假体机构的固定构件由于假体在负荷方向产生不期望的移动而出现松动和/或损伤周围的组织。
因此，近年来一直在尝试使用钛固定物固定在骨的骨髓腔中以形成骨整合，如在1986年斯堪的纳维亚整形修复外科期刊第20期第207至208页所登载的、Hagert等人发表的：“用骨整合的内假体的掌指骨关节置换”。(“Metacarpophalangeal Joint Rep1acement withOsseo-integrated Endoprostheses”)。在口腔及口腔以外的骨组织中永久性地固定假体是众所周知的。Br_nemark教授及他的同事们近25年来一直在研究用于牙科的骨整合技术，并且在将固定物放置在颌骨中以保持牙齿或弓连接件方面取得了极好的结果。然而，由Hagert进行的将该技术应用于手指关节修复的试验却未达到预期的效果。这个不令人满意的结果显然是由于在手指关节假体修复中使用“牙科技术”时遇到了全然不同的情况。例如，按公知的技术，固定物相对于骨骼的纵轴线成直角固定。在手指关节中，固定物沿骨骼的轴线放置。这当然就要对固定构件产生完全不同的负荷和应力。
目前，在假体矫形外科手术中的主要问题仍旧是骨骼固定构件的松动问题。但是，由于20多年来牙科植入术的成功率高于90％，至今一直没有必要考虑的一系列其它问题现在也出现了。这些主要问题之一是关节机构上增大的磨损。如果采用骨整合法，则需要设计一种和现行使用的假体类型不同的假体。为使关节机构能够被更换而又不妨碍骨固定，假体装置必须被分成几个组成件，使关节机构能够从现行的骨固定构件中分离出来。更进一步，如果采用两步骤法，而病人或至少是病人的被修复的关节不要保持不活动状态的话，则在第二步中必须能够把关节机构连接上。因此，必须考虑以下两个因素：首先，关节易发生磨损，因此必须是可更换的；其次，为了采用两步骤法，关节机构必须是可更换的。
我们出乎意料地发现，本发明能够消除上述技术存在的问题。
本发明是基于对骨骼组织磨损或炎性解体之后的缺损状态或疾病期间的关节的结构及功能的广泛的试验性的生物学分析，并且基本对骨髓供血的广泛研究。已经确定，在受损伤的关节的软骨和韧带的综合替换中，必须把骨骼与骨髓组织作为一个结构和功能单元来处理。如果这种硬组织作为一个支撑构件起作用的话，考虑骨骼和骨髓组织之间的协同作用是绝对必要的，尤其是在一个长时期内的上述相互作用更要考虑。
因此，本发明基于这种认识，即当在邻近关节的部分骨骼中固定一个假体来代替一个关节表面和韧带时，必须考虑骨髓与骨组织之间的相互作用。这就是说，必须通过尽可能沿固定构件的整个长度方向可沟通骨骼和骨组织的机械构件来固定长骨髓腔中的固定构件，尤其要注意骨髓腔壁上的骨髓和致密骨骼之间的边界层。
因此，本发明涉及一种用于支撑关节机构的固定构件，在关节机构中固定构件基本上是旋转对称的，至少是部份中空的，并且包括与骨组织相容的材料。该固定构件有一个至少能够部份地与组织发生骨整合的表面，从而可在骨骼的纵轴线方向实现永久性的骨内固定。本发明还涉及一种修复关节。
本发明还涉及一种在骨骼内安置固定构件的方法，它包括：切开靠近其关节的骨骼以露出骨髓腔；在靠近该关节的骨髓腔内形成一个空间；在该空间内安置一个导引套筒；在使用导引套筒对中该固定构件的同时将固定构件拧入骨髓腔内。
从下面参照除附图对本发明的一个优选实施例的描述，本发明的其它特点和优点将变得更加清楚。在附图中，
图1是带有按发明的固定构件的一个被修复的手指关节的部份剖面图；
图2表示一个完全修复的手指关节；
图3表示固定构件是如何在长骨中就位的；
图4是固定构件的透视图；
图5是沿图4的线5-5取的剖面图；
图6是沿图4的线6-6取的部份剖面图，表示按本发明的关节机构的一部份；以及
图7表示按本发明的关节机构和固定构件的装配；
图3至10表示另外一些实施例，表示如何能实现和/或改进固定构件与导引套筒之间的不可旋转的楔固效应。
图1中，分别用2和3代表在手指关节机构1每一侧的长骨部份。旋转对称的固定构件4由基本上是套筒状的中空主体5形成，它带有外螺纹6并且壁厚逐渐减小。主体5的开口插入端7逐渐变细并且设有从开口端开始的切槽8和9。
最靠近关节机构1的固定构件4的端部13(见图6)放置在导引套筒11内。图中所示的套筒11基本上呈圆柱形，沿其径向外表面设有纵向波纹。这些波纹可能和牙科中使用的旋转对称的带孔固定物的轴向部份大致相同。导引套筒11围绕着关节端13。因此当主体5拧入骨组织足够深时，通过楔固效应就把主体5的关节端13锁紧到导引套筒11的内表面14上。关节端13可拆卸地接纳关节机构1的连接部份15。连接部份15可以是从关节机构1上凸出出来的对中销钉(图7)。这样的销钉与固定构件4中的对应的凹陷16协同工作，或者与在导引套筒11与关节机构1之间适当安置的连接(未示出)协同工作。
可以让一个或多个孔直接与固定构件4的径向外表面相接，让孔的边缘朝向表面形成切割刃口。这样，当主体5拧入骨骼2时就实现了自攻丝作用。如图5所示，切下的骨髓17落入固定构件4内。
由于固定构件4的壁厚向插入端7逐渐变薄，和/或由于固定构件4有纵向切槽8和9，从而达到了对良好变形的要求，这就极大地降低了应力集中的风险，应力集中在现有技术的设计中能引起特殊的问题。图1中的箭头B-B表示出开口端7的柔性，即它具有能调节以适应周围组织的能力。箭头A-A表示同样的情况。
可适当地为切槽8和9提供切割刃口，并且由于图5所示该中空腔接纳了碎屑17，固定构件4本身就是它自己的预备工具。与此同时保证了正常解剖和生理状态的最佳条件，从而将对剩下的生物组织、即骨髓和骨组织的干扰减至最小。
图2表示由就位的固定构件4实现的关节修复。
图3表示固定构件4是如何在骨骼2中就位的。在使用时，将固定构件4定位在骨髓与骨组织之间的边界区。套筒状主体5的厚度朝带切槽的插入端7逐渐减小，形成一个锥形切割刃口12。纵向切槽8的边缘也可以成切割刃口的形式。在将固定构件4拧入骨髓腔时产生的碎屑17落入到主体5中的中空空间内，如图5所示。
在手术中，将长骨2的靠近关节的部份切开，从而露出骨髓腔。然后，将一个探头(未示出)插入骨髓腔内，以便为插入固定构件4定出一个合适的纵向轴线。该探头被用作方向探向器以便能根据需要对中固定构件4。然后在露出的骨髓腔中仔细地钻出一个用于导引套筒11的凹陷。在安置了导引套筒11后，将套筒状主体5通过导引套筒11拧入骨髓腔内。当然要事先取走探头。如在18处所示，固定构件4的关节端13向外并且向上略微增大，使它的直径略大于导引套筒11的上部开口。这样，最终就在关节端13与导引套筒11之间产生了楔固效应(当将套筒11移动到图6中虚线所示位置时)，因此导引套筒11和套筒状主体5这两者都根据需要就位了。
固定构件4和导引套筒11含有钛，或由钛制造，或由钛包复。钛表面的结构、至少是部份相关表面上，要能对整合有促进作用。最好该表面具有凸凹不平构造，包括有微坑，如瑞典专利7902035-0所述，坑的直径在10与1000nm之间，最好为10-300nm。也可以使钛表面层的化学成份能有某种确定的组织反应，例如如瑞典专利8505158-9所述。
图8表示如何为套筒11的面对固定构件4的凸缘20的上端19设置凸出的边缘21，使之与所述凸缘20上的纹线22协同作用。这样，当主体5拧入骨组织足够深时就将固定构件4与套筒11不可转动地锁住。
通过图9所示的结构，在套筒11与固定构件4之间实现了另外一种锁紧效果，其中轴向设置的波纹跟套筒11的内表面协同作用。
通过图10所示的结构可实现进一步的锁定效果，通过在构件4的上部边缘设置特殊齿形构形24来实现，这些齿将拧入组织中。
尽管上面就一个优选实施例对本发明作了描述，但有许多其它的变化和改进以及其它的用途对于本领域的普通技术人员来说是显而易见的。为此愿意指出，本发明并不限于本文公开的特定内容，而仅由所附的权利要求书所限定。

Claims (12)

1.一种用于支撑一个关节机构的固定构件，其中所述固定构件基本上是旋转对称的，至少部份是中空的，并且包括与骨组织相容的材料，所述固定构件具有一个至少能部份地与组织发生骨整合从而沿骨骼的纵向轴线实现永久性的骨内固定的表面，其特征在于，所述固定构件的所述材料是钛。
2.如权利要求1所述的固定构件，其特征在于所述固定构件的所述表面用钛包复。
3.如权利要求1所述的固定构件，其特征在于关节机构是一个被修复手指关节的一个构件。
4.如权利要求1所述的固定构件，其特征在于所述固定构件的所述表面是一个径向外表面，并且至少部份地带有微坑，坑的直径在10-300nm之间。
5.如权利要求1所述的固定构件，其特征在于所述固定构件含有一个套筒状主体，它具有带有用以将所述固定构件拧入骨骼内的外螺纹的径向外表面。
6.如权利要求5所述的固定构件，其特征在于还包含有直接连接到所述径向外表面的一个或多个孔，所述的孔在所述径向表面上具有切割刃口。
7.如权利要求6所述的固定构件，其特征在于所述套筒状主体是可变形的。
8.如权利要求7所述的固定构件，其特征在于所述套筒状主体具有一个壁和一个开口的插入端，所述壁的厚度朝向所述插入端逐渐变小。
9.如权利要求8所述的固定构件，其特征在于还包含有穿过所述壁的纵向切槽，所述切槽从所述插入端朝向关节机构伸展。
10.如权利要求19所述的固定构件，其特征在于所述切槽具有切割刃口。
11.如权利要求10所述的固定构件，其特征在于所述套筒状主体包括一个靠近关节机构设置的关节端和一个导引套筒，所述关节端放置在所述导引套筒中并且不可旋转地固定到所说导引套筒上，从而使所述导引套筒包围着所述关节端。
12.如权利要求11所述的固定构件，其特征在于所述关节端形成一个面对关节机构的开口端以便可拆卸地把关节机构安置到所述固定构件上。
CN90103610A 1989-04-25 1990-04-24 用于支撑手指的或其它的修复关节的关节机构的固定元件 Expired - Fee Related CN1032189C (zh)

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RU2069548C1 (ru) 1996-11-27
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HU213427B (en) 1997-06-30
AR242708A1 (es) 1993-05-31
ES2018769T3 (es) 1994-06-16
FI902050A0 (fi) 1990-04-24
ES2018769A4 (es) 1991-05-16
ATE101330T1 (de) 1994-02-15
FI103865B1 (fi) 1999-10-15
FI103865B (fi) 1999-10-15
DK0396519T3 (da) 1994-06-13
CS9002008A2 (en) 1991-08-13
NO901808D0 (no) 1990-04-24
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BR9001906A (pt) 1991-07-30
DE59004539D1 (de) 1994-03-24
AU630183B2 (en) 1992-10-22
AU5329790A (en) 1990-11-01
JPH031854A (ja) 1991-01-08
NO901808L (no) 1990-10-26
JP2552752B2 (ja) 1996-11-13
AU2073892A (en) 1992-10-01
HU902544D0 (en) 1990-08-28
DD301734A9 (de) 1993-09-02
NO176344C (no) 1995-03-22
EP0396519B1 (de) 1994-02-09
EP0396519A1 (de) 1990-11-07

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