CN104207863B - Introduce the total joint replacement prosthese of torque - Google Patents
Introduce the total joint replacement prosthese of torque Download PDFInfo
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- CN104207863B CN104207863B CN201410410460.1A CN201410410460A CN104207863B CN 104207863 B CN104207863 B CN 104207863B CN 201410410460 A CN201410410460 A CN 201410410460A CN 104207863 B CN104207863 B CN 104207863B
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- 239000007943 implant Substances 0.000 claims description 60
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- 210000000629 knee joint Anatomy 0.000 description 17
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- 238000005452 bending Methods 0.000 description 11
- 230000007246 mechanism Effects 0.000 description 9
- 230000009471 action Effects 0.000 description 8
- 238000002513 implantation Methods 0.000 description 8
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- 230000008569 process Effects 0.000 description 5
- 238000013150 knee replacement Methods 0.000 description 4
- 238000010008 shearing Methods 0.000 description 4
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Classifications
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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
- A61F2/38—Joints for elbows or knees
-
- 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
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Physical Education & Sports Medicine (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Abstract
Introduce the total joint replacement prosthese of torque.Tibial prosthetic insert includes tibial tray insert, and wherein tibial tray insert includes stability column, and the wherein center line of stability column is from least one of the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert disalignment.So that the method for axial rotation, it include the axial-rotation axis offset made by following at least one modes between tibial prosthesis and femoral prosthesis, i.e. by making stability column be deviated about tibia insert, so that the radius of the tibia insert medial condyle receivers of tibial prosthesis increases, and increase the adaptability between the medial condyle receivers and entocondyle of tibia insert.
Description
The application is application number 200680054475.2,21 days March 2006 applying date, denomination of invention " introducing torque
The divisional application of the Chinese invention patent application of total joint replacement prosthese ".
Technical field
The present invention relates to implanting prosthetic devices, and relate more specifically to imitate the natural biological in native mammalian joint
The implantation prosthetic joint of mechanics.The invention also includes the method for introducing torque in implantation prosthetic joint and containing introducing torque
Implanting prosthetic device.
Background technology
Previous research has shown that, in the amount of spin walked and highly occurred in knee in the active procedure of bending in natural knee
Lid (not doing operation previously and without the history of clinical deformity) and operation correct knee and are such as subjected to total knee replacement
It is big different between those of art (TKA) knee.During natural knee bends, axial stock shin of the femur relative to shin bone
Rotation pattern leads to inward turning of the shin bone relative to femur, and leads to outward turning of the shin bone relative to femur when knee extension.It should
Inward turning mechanism is part by the length and tension and intermediate and lateral femur and tibial condyle ruler in ligamentum cruciatum and collaterial ligament
Caused by anatomical variations on very little.
Real axial stock shin rotation pattern after KTA is still not clear, but has been shown and largely become
Change.Some assume the axial rotation after TKA reduce may with the removal or change of ligamentum cruciatum and/or cannot accurately answer
Make inside and outside femur is related with the geometry of tibial condyle, but most people assumes the movement of the reduction by not reproducible
Correct condyle geometry causes.
Polycentric load-bearing kinematics analysis in vivo proves to live with opposite heavy burden in the fixed TKA prostheses that bear a heavy burden
Average axial rotation value in dynamic TKA prostheses is similar.But about the accurate of axial rotation in the movable TKA prostheses that bear a heavy burden
There is dispute in position (the higher or opposite tibia insert of tibia insert is relatively low).Some fixed and movable TKA that bear a heavy burden
Prosthese proves that axial rotation significantly reduces, and other, proves that TKA patient is often subject to opposite rotation pattern, in this mode
Shin bone surrounds femur and rotates on the outside, and wherein knee bends degree increases.
Invention content
The present invention relates to the implanting prosthetic devices for imitating native mammalian joint natural biological mechanics.Described herein
Invention exemplary embodiment includes implantable prosthetic component, the component introduce torque in implantable prosthetic joint so that
Obtain the rotational motion between joint component.The invention also includes the implantable prosthesis containing the Exemplary prosthesis component for introducing torque
Joint, and for introducing torque so that being rotated between implantable intra-articular complementary prosthetic component.
The first aspect of the present invention provides tibial prosthetic insert comprising the inside for accommodating a pair of of femoral prosthesis condyle
And lateral receiver, prosthetic tibial tray insert further include stability column, wherein the center line of stability column is inserted into from prosthetic tibial tray
At least one of the front-rear center line of object and the medial-lateral centerline of prosthetic tibial tray insert disalignment.
In the more detailed embodiment of first aspect, stability column from the medial-lateral centerline of prosthetic tibial tray insert inwardly
Offset.Also in another more detailed embodiment, stability column deviates outward from the medial-lateral centerline of prosthetic tibial tray insert.
In another detailed embodiment, front-rear center line biased forwards of the stability column from prosthetic tibial tray insert.However another
In specific embodiment, stability column deviates backward from the front-rear center line of prosthetic tibial tray insert.In more detailed embodiment,
Prosthetic tibial tray insert includes the recess for being suitable for accommodating projection, and the projection is protruded from prosthetic tibial tray implant,
Prosthetic tibial tray insert can be rotated around it relative to prosthetic tibial tray implant.In a more detailed embodiment, prosthese
Tibial tray insert includes the projection for being suitable for being accommodated in prosthetic tibial tray implant recess, prosthetic tibial tray insert
It can be rotated relative to prosthetic tibial tray implant around it.In another more detailed embodiment, prosthetic tibial is relative to vacation
Body tibial tray implant is rotated along the first rotation in the first plane, and prosthetic tibial tray insert is relative to femoral prosthesis
Along the second rotation axis rotation in the first plane, and first rotation and the second rotation axis be not coaxial.Also another
In one more detailed embodiment, stability column is circular in rear side.
The second aspect of the present invention provides tibial prosthetic insert comprising the interval for accommodating a pair of of femoral prosthesis condyle
The inner side and outer side container opened, prosthetic tibial tray insert further include stability column, and wherein stability column is inserted along prosthetic tibial tray
Enter at least one of the front-rear center line of object and the medial-lateral centerline of prosthetic tibial tray insert center line orientation, wherein prosthese
The prosthetic tibial tray implant that tibial tray insert is adapted to immobilized patients shin bone is surrounded perpendicular to prosthetic tibial tray insertion
The rotation axis of object rotates, wherein rotation axis from the front-rear center line and medial-lateral centerline of prosthetic tibial tray insert to
A few disalignment.
In the more detailed embodiment of second aspect, the medial-lateral centerline of rotation axis from prosthetic tibial tray insert is inside
Side deviates.Also in another more detailed embodiment, rotation axis from the medial-lateral centerline of prosthetic tibial tray insert outward
Offset.In another detailed embodiment, front-rear center line biased forwards of the rotation axis from prosthetic tibial tray insert.However
In another specific embodiment, rotation axis deviates backward from the front-rear center line of prosthetic tibial tray insert.More detailed
In embodiment, prosthetic tibial tray insert includes the recess for being suitable for accommodating projection, and the projection is planted from prosthetic tibial tray
Enter object protrusion, prosthetic tibial tray insert can be rotated around it relative to prosthetic tibial tray implant.In a more detailed implementation
In example, prosthetic tibial tray insert includes the projection for being suitable for being accommodated in prosthetic tibial tray implant recess, prosthese shin
Basin insert can be rotated around it relative to prosthetic tibial tray implant.In another more detailed embodiment, prosthese shin bone
Disk insert is rotated relative to prosthetic tibial tray implant along the first rotation in the first plane, and prosthetic tibial tray is inserted into
Object is rotated relative to femoral prosthesis along the second rotation axis in the first plane, and first rotation and the second rotary shaft
Line is not coaxial.Also in another more detailed embodiment, stability column is circular in rear side.
In the third aspect of the present invention, tibial prosthetic insert includes outside for accommodating a pair of of femoral prosthesis condyle and interior
Side container, it is convex shape or the past that prosthetic tibial tray insert, which has lateral condyle receiver, the shape which has,
To at least one of rear-inclined shape shape, also there is prosthetic tibial tray insert medial condyle, the entocondyle to accommodate
Utensil is useful for accommodating the concave shape of the protrusion entocondyle of femoral prosthesis, the combination of lateral condyle receiver and medial condyle
The torque around rotation axis is generated, so that carrying out horizontal turn between prosthetic tibial tray insert and femoral prosthesis condyle
It is dynamic.
In third aspect more detailed embodiment, prosthetic tibial tray insert includes being suitable for accommodating being recessed for projection
Place, the projection are protruded from prosthetic tibial tray implant, and prosthetic tibial tray insert can be relative to prosthetic tibial tray around it
Implantation material rotates.In a more detailed embodiment, prosthetic tibial tray insert includes being suitable for being accommodated in prosthetic tibial tray plant
Enter the projection in object recess, prosthetic tibial tray insert can be rotated around it relative to prosthetic tibial tray implant.Another
In one more detailed embodiment, prosthetic tibial tray insert is relative to prosthetic tibial tray implant along first in the first plane
Rotation axis rotates, and prosthetic tibial tray insert is rotated relative to femoral prosthesis along the second rotation axis in the first plane,
And first rotation and the second rotation axis be not coaxial.Also in another more detailed embodiment, rotation axis is from prosthese
The medial-lateral centerline of tibial tray insert deviates.In another specific embodiment, rotation axis is from prosthetic tibial tray insert
Front-rear center line skew.
In the fourth aspect of the present invention, knee prostheses are provided, including：(a) femoral prosthesis；And (b) include prosthese shin bone
The prosthetic tibial of disk insert, the prosthetic tibial tray insert include spaced apart for accommodating a pair of of femoral prosthesis joint
Inner side and outer side container, prosthetic tibial tray insert further include stability column, and the wherein center line of stability column is from prosthetic tibial tray
At least one of the front-rear center line of insert and the medial-lateral centerline of prosthetic tibial tray insert disalignment.
In the more detailed embodiment of fourth aspect, stability column from the medial-lateral centerline of prosthetic tibial tray insert inwardly
Offset.Also in another more detailed embodiment, stability column deviates outward from the medial-lateral centerline of prosthetic tibial tray insert.
In another detailed embodiment, stability column deviates backward from the front-rear center line of prosthetic tibial tray insert.However another
In specific embodiment, front-rear center line biased forwards of the stability column from prosthetic tibial tray insert.In more detailed embodiment,
Prosthetic tibial tray insert includes the recess for being suitable for accommodating projection, and the projection is protruded from prosthetic tibial, prosthese shin
Basin insert can be rotated around it relative to prosthetic tibial.In a more detailed embodiment, prosthetic tibial tray insert
Include the projection suitable for being accommodated in prosthetic tibial recess, prosthetic tibial tray insert can be relative to shin bone around it
Disc prosthesis rotates.In another more detailed embodiment, prosthetic tibial tray is relative to prosthetic tibial along in the first plane
First rotation rotates, and prosthetic tibial tray insert turns relative to femoral prosthesis along the second rotation axis in the first plane
It is dynamic, and first rotation and the second rotation axis be not coaxial.Also in another more detailed embodiment, stability column is in rear side
It is circular, and femoral prosthesis includes the cam being supported on stability column, wherein cam offset is so as to the offset with stability column
Matching.
The fifth aspect of the present invention provides knee prostheses comprising：(a) femur for being adapted to be mounted to patient's natural femur is false
Body；(b) it is adapted to be mounted to the prosthetic tibial of patient's natural tibia；And (c) prosthetic tibial tray insert, prosthetic tibial tray are inserted
Enter the inner side and outer side container for accommodating a pair of of femoral prosthesis joint that object includes spaced apart, prosthetic tibial tray insert is also
Including stability column, wherein stability column along the front-rear center line and prosthetic tibial tray insert of prosthetic tibial tray insert inside and outside
At least one of center line center line is orientated, and wherein prosthetic tibial tray insert is adapted to prosthetic tibial around vertical
Rotated in the rotation axis of prosthetic tibial tray insert, wherein rotation axis from the front-rear center line of prosthetic tibial tray insert and
At least one of medial-lateral centerline disalignment.
In the more detailed embodiment of the 5th aspect, the medial-lateral centerline of rotation axis from prosthetic tibial tray insert is inside
Side deviates.Also in another more detailed embodiment, rotation axis from the medial-lateral centerline of prosthetic tibial tray insert outward
Offset.In another detailed embodiment, front-rear center line biased forwards of the rotation axis from prosthetic tibial tray insert.However
In another specific embodiment, rotation axis deviates backward from the front-rear center line of prosthetic tibial tray insert.More detailed
In embodiment, prosthetic tibial tray insert includes the recess for being suitable for accommodating projection, and the projection is convex from prosthetic tibial
Go out, prosthetic tibial tray insert can be rotated around it relative to prosthetic tibial.In a more detailed embodiment, prosthese shin bone
Disk insert includes the projection for being suitable for being accommodated in prosthetic tibial recess, and prosthetic tibial tray insert can phase around it
Prosthetic tibial is rotated.In another more detailed embodiment, prosthetic tibial tray insert is relative to prosthetic tibial edge
The first rotation rotation in the first plane, prosthetic tibial tray insert is relative to femoral prosthesis along in the first plane
Second rotation axis rotates, and first rotation and the second rotation axis be not coaxial.Also in another more detailed embodiment
In, stability column is circular in rear side, and femoral prosthesis includes the cam being supported on stability column, wherein cam offset so as to
It is matched with the offset of stability column.
The sixth aspect of the present invention provides knee prostheses comprising：(a) it is adapted to be mounted to the femur portion of patient's natural femur
Part；(b) it is adapted to be mounted to the tibial component of patient's natural tibia, tibial component includes for accommodating the outer of a pair of of femoral prosthesis condyle
Side and medial condyle receivers, the shape that lateral condyle receiver has at least one of tilted shape for convex shape or from front to back
Shape, medial condyle have the concave shape of the protrusion entocondyle for accommodating femoral prosthesis, lateral condyle receiver and interior
The combination of side condyle container generates the torque around rotation axis, so that in prosthetic tibial tray insert and femoral prosthesis condyle
Between horizontally rotate.
In the more detailed embodiment of the 6th aspect, tibial component includes prosthetic tibial tray insert, the prosthetic tibial tray
Insert includes cam face, and prosthetic tibial tray insert includes the recess for being suitable for accommodating projection, the projection
It is protruded from the prosthetic tibial tray implant of tibial component, prosthetic tibial tray insert can turn around it relative to tibial tray implant
It is dynamic.In a more detailed embodiment, tibial component includes prosthetic tibial tray insert, and prosthetic tibial tray insert includes cam
Surface, and prosthetic tibial tray insert includes being suitable for being accommodated in the prosthetic tibial tray implant recess of tibial component
Projection, prosthetic tibial tray insert can be rotated around it relative to prosthetic tibial tray implant.In another more detailed implementation
In example, prosthetic tibial tray insert is rotated relative to prosthetic tibial tray implant along the first rotation in the first plane,
Prosthetic tibial tray insert is rotated relative to femoral prosthesis along the second rotation axis in the first plane, and the first rotary shaft
Line and the second rotation axis be not coaxial.Also in another more detailed embodiment, rotation axis is from prosthetic tibial tray insert
Medial-lateral centerline deviates.In a more detailed embodiment, at least one of first rotation and the second rotation axis from
The medial-lateral centerline of prosthetic tibial tray insert deviates.
The seventh aspect of the present invention provides mobilizable knee prostheses that bear a heavy burden comprising：(a) for implantation into receptor shin bone
Interior tibial prosthesis, tibial prosthesis include tibial tray and the tibia insert fixed to tibial tray, and tibia insert is relative to shin
The rotatable repositioning of basin, so that the run-on point deviated with the medial-lateral centerline of tibial tray around tibial tray introduces torque,
Tibial tray includes medial condyle receivers and tibial receiver；And (b) for implantation into the femoral component in receptor femur, femur portion
Part includes the entocondyle being contained in the medial condyle receivers of tibial tray, and the outside being contained in tibial tray lateral receiver
Condyle, wherein at least one of tibial tray and femoral component include stability column, to prevent femoral component relative to tibial prosthesis
It is more than vertical rotation, the wherein medial-lateral centerline offset of stability column and tibial tray.
In the more detailed embodiment of the 7th aspect, tibial tray includes the stabilization deviated with the medial-lateral centerline of tibial tray
Column.Also in another more detailed embodiment, offset inboard of the stability column towards tibial tray.In another detailed embodiment,
Stability column is towards between about 0.1 millimeter to about 20 millimeters of the offset inboard of tibial tray.Also in another detailed embodiment,
Being followed by for stability column is circular.In more detailed embodiment, femoral component includes being suitable for being rotatably supported on behind stability column
On cam, the surface shape of wherein cam is the spill of bending, to accommodate the circular rear face of stability column.
The eighth aspect of the present invention provides the fixed knee prostheses that bear a heavy burden comprising：(a) for implantation into receptor shin bone
Tibial prosthesis, tibial prosthesis includes medial condyle receivers and tibial receiver, and (b) for implantation into the stock in receptor femur
Bone prosthese, femoral prosthesis include the entocondyle being contained in the medial condyle receivers of tibial tray, and are contained on the outside of tibial tray and hold
The external condyle received in device, wherein at least one of tibial prosthesis and femoral prosthesis include column, to prevent femoral prosthesis opposite
In tibial prosthesis be more than vertical rotation, wherein the medial-lateral centerline of the column and femoral prosthesis deviate.
In eighth aspect more detailed embodiment, tibial prosthesis includes that tibial tray and the shin bone fixed to tibial tray are inserted into
Object.Also in another more detailed embodiment, tibial tray includes cam member, and the inside and outside midpoint of the cam member and tibial tray is inclined
It moves.In another detailed embodiment, lateral offset of the cam member towards tibial tray.Also in another detailed embodiment,
Cam member is towards between about 2 millimeters to about 20 millimeters of the lateral offset of tibial tray.In another detailed embodiment, surely
Being followed by for fixed column is circular.In a more detailed embodiment, femoral component includes being suitable for being rotatably supported on behind stability column
On cam, the surface shape of wherein cam is the spill of bending, to accommodate the circular rear face of stability column.
The ninth aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes surrounding prosthese to close
Rotation axis generates torque between two main bodys of section so that carries out axial rotation between two main bodys, generates the action of torque
If including making the dry interface between two main bodys be opened with different distance intervals from anterior posterior midline, such rotation axis with it is inside and outside
Center line is misaligned.
The tenth aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes by under offer
It states at least one mode and makes axial-rotation axis offset between the tibial prosthesis of prosthetic knee joints and femoral prosthesis, that is, pass through
So that stability column is deviated about the anterior posterior midline of the tibia insert of tibial prosthesis so that on the inside of the tibia insert of tibial prosthesis
The radius of container increases to the degree bigger than femoral prosthesis entocondyle radius, and increase the tibia insert of tibial prosthesis
Adaptability (conformity) between medial condyle receivers and entocondyle.
In the more detailed embodiment of the tenth aspect, the invention also includes the tibial prosthesis and femur that make prosthetic knee joints
Axial-rotation axis offset between prosthese, so as to including posterior stabilization column about in inside and outside the tibia insert of tibial prosthesis
The offset of line, and wherein stability column deviates outward from the anterior posterior midline of the tibia insert of tibial prosthesis.Also it is another more
In detailed embodiment, the invention also includes the rotational axial shafts made between the tibial prosthesis of prosthetic knee joints and femoral prosthesis
Line skew includes offset of the posterior stabilization column about the anterior posterior midline of the tibia insert of tibial prosthesis, and stability column is from shin bone
The anterior posterior midline of the tibia insert of prosthese deviates inwardly.In more detailed embodiment, the invention also includes by making
The anterior posterior midline of rotation axis and tibia insert between the tibia insert and tibia implant of tibial prosthesis deviates and makes
Obtain the axis offset of the axial-rotation between the tibial prosthesis and femoral prosthesis of prosthetic knee joints.
The eleventh aspect of the present invention provides the method so that implantable prosthetic joint axial rotation, the method includes
Rotation axis between two main bodys of prosthetic joint generates torque so that carries out axial rotation between two main bodys, produces
If the action of raw torque includes that the dry interface between two main bodys is made to be opened with different distance intervals from anterior posterior midline, revolve in this way
Shaft axis is misaligned with anterior posterior midline.
The twelveth aspect of the present invention provides the method so that prosthetic joint axial rotation, the method includes：(a) pass through
Following at least one modes are provided and make axial-rotation axis offset between the tibial prosthesis of prosthetic knee joints and femoral prosthesis,
I.e. by making stability column be deviated about the anterior posterior midline of the tibia insert of tibial prosthesis so that stability column is about tibial prosthesis
Tibia insert front and back midline shift so that the radius of the tibia insert medial condyle receivers of tibial prosthesis increases to than stock
The big degree of bone prosthese entocondyle radius so that be rounded behind stability column associated with the tibia insert of tibial prosthesis；Make
It obtains and is rounded before cam associated with femoral prosthesis；And (b) increase the medial condyle receivers of the tibia insert of tibial prosthesis
Adaptability between entocondyle.
The thirteenth aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes surrounding shin bone
Rotation axis between the stability column of prosthese and the cam of femoral prosthesis generates torque, so that axially being revolved between two prostheses
Turn, the action for generating torque includes at least one following, i.e., so that femur is rounded and made behind tibial prosthesis stability column
The cam of prosthese becomes recessed.
The fourteenth aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes surrounding shin bone
Rotation axis between the stability column of prosthese and the cam of femoral prosthesis generates torque, so that axially being revolved between two prostheses
Turn, the action for generating torque includes at least one following, that is, makes the stability column of tibial prosthesis tibia insert and about shin bone
The medial-lateral centerline of insert deviates so that the stability column of tibial prosthesis tibia insert with about in before and after tibia insert
Heart line skew so that cam is from the medial-lateral centerline offset about femoral prosthesis, and makes cam from about femoral prosthesis
Front-rear center line skew.
The fifteenth aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes surrounding shin bone
Rotation axis between prosthese and femoral prosthesis generates torque, so that axial-rotation between two prostheses, generates torque
Action includes so that the entocondyle of femoral prosthesis is effectively fixed to the medial condyle receivers of tibial prosthesis, and prepares femoral prosthesis
External condyle, so as to the surface with substantially flat, the substantially flat of the lateral bearing surface of the surface and tibial prosthesis or basic
Protrusion surface interfacial contact.
The sixteenth aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes surrounding shin bone
Rotation axis between disc prosthesis and tibial prosthetic insert generates torque, and the action for generating torque includes so that prosthetic tibial
Run-on point offset between tibial prosthetic insert, wherein the offset of the run-on point is from medial-lateral centerline and front-rear center line
At least one of generate.
The seventeenth aspect of the present invention provides knee prostheses, including：(a) have the femur of a pair of of condyle (being separated by cam) false
At least one of the medial-lateral centerline of body, cam and femoral prosthesis and the front-rear center line of femoral prosthesis disalignment；With
And (b) include prosthetic tibial tray insert prosthetic tibial, prosthetic tibial tray insert includes spaced apart for accommodating one
To the inner side and outer side container of femoral prosthesis condyle, prosthetic tibial tray insert further includes the stability column for having circular rear face,
The center line of middle stability column is from the front-rear center line of prosthetic tibial tray insert and the medial-lateral centerline of prosthetic tibial tray insert
At least one of disalignment.
The eighteenth aspect of the present invention provides knee prostheses, including：(a) have the femur of a pair of of condyle (being separated by cam) false
Body；And (b) include prosthetic tibial tray insert prosthetic tibial, prosthetic tibial tray insert includes spaced apart for holding
Receive the inner side and outer side container of a pair of of femoral prosthesis condyle, prosthetic tibial tray insert further includes the stabilization for having circular rear face
Column, the circular rear face are suitable for contacting with the cam interface of femoral prosthesis.
The nineteenth aspect of the present invention provides knee prostheses, including：(a) have a pair of of condyle (by the concave cam that is bent every
Open) femoral prosthesis；And (b) include prosthetic tibial tray insert prosthetic tibial, between prosthetic tibial tray insert includes
The inner side and outer side container for accommodating a pair of of femoral prosthesis condyle separated, prosthetic tibial tray insert further include having circle
Subsequent stability column, the circular rear face are suitable for contacting with the cam interface of the bending spill of femoral prosthesis.
The twentieth aspect of the present invention provides tibial prosthetic insert comprising prosthetic tibial tray insert,
Prosthetic tibial tray insert includes the inner side and outer side container for accommodating a pair of of femoral prosthesis condyle spaced apart,
Prosthetic tibial tray insert further includes the stability column for having circular rear face, which is suitable for pushing the rotation of femoral prosthesis,
The wherein center line of stability column is from the front-rear center line of prosthetic tibial tray insert and the inside and outside center of prosthetic tibial tray insert
At least one of line disalignment.
On the one hand the 20th of the present invention provides tibial prosthetic insert comprising prosthetic tibial tray insert, prosthese shin
Basin insert includes the inner side and outer side container for accommodating a pair of of femoral prosthesis condyle spaced apart, and prosthetic tibial tray is inserted into
Object further includes stability column, and wherein the center line of stability column is inserted from the front-rear center line and prosthetic tibial tray of prosthetic tibial tray insert
Enter between about 0.1 millimeter to about 20 millimeters of at least one of the medial-lateral centerline of object disalignment.
In the more detailed embodiment of the 20th one side, the medial-lateral centerline of stability column from prosthetic tibial tray insert is inclined
It moves between about 0.1 millimeter to about 5 millimeters.
The 22nd aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes surrounding shin
Rotation axis between basin prosthese and tibial prosthetic insert generates torque, and the action for generating torque includes so that tibial tray is false
Run-on point offset between body and tibial prosthetic insert, wherein from the medial-lateral centerline and front-rear center of tibial prosthetic insert
Between the offset of at least one of line center line is about 0.1 millimeter to about 20 millimeters.
The 23rd aspect of the present invention provides the method so that prosthetic joint axial rotation, and the method includes surrounding stock
Rotation axis between bone prosthese and tibial prosthetic insert generates torque, the action for generating torque include so that femoral prosthesis and
Run-on point offset between tibial prosthetic insert, wherein from the medial-lateral centerline and front-rear center line of tibial prosthetic insert
At least one center line the offset be about 0.1 millimeter to about 20 millimeters between.
Description of the drawings
Fig. 1 is the free body diagram for the cylinder B for contacting platform A；
Fig. 2 is the figure for showing condyle of femur and being bent as linear segment, and shows accordingly to connect during knee joint bending
Touch the amount of linear segment；
Fig. 3 is the vertical view of the mobilizable full knee joint transposing prosthesis insert of heavy burden of the posterior stabilization of the prior art,
The insert has the polyethylene column being aligned on rotation center；
Fig. 4 is the vertical view of the full knee joint transposing prosthesis insert of the fixed posterior stabilization of heavy burden of the prior art, should
Insert has the polyethylene column that the anterior posterior midline along polyethylene insert positions；
Fig. 5 is the vertical view that prior art posterior cruciate ligament retains full knee joint transposing prosthesis insert；
Fig. 6 is that the full knee joint transposing prosthesis first of the heavy burden movable posterior stabilization according to the present invention for introducing torque shows
The rear side figure of example；
Fig. 7 is the full knee joint transposing prosthesis insert of the heavy burden movable posterior stabilization according to the present invention for introducing torque
First exemplary vertical view；
Fig. 8 is the figure that the polyethylene tibia insert of the prior art is rotated relative to the time, the polyethylene shin bone
Insert has column and the run-on point at polyethylene tibia insert center, and the mobilizable total knee of heavy burden of posterior stabilization is closed
The rotation for the new torque basic display bigger that joint replacement prosthesis insert introduces；
Fig. 9 is the full knee joint transposing prosthesis insert that the heavy burden fixed rear portion according to the present invention for introducing torque is stablized
One exemplary back side view；
Figure 10 is the full knee joint transposing prosthesis insert that the heavy burden fixed rear portion according to the present invention for introducing torque is stablized
First exemplary vertical view；
Figure 11 be for according to exemplary prosthetic insert of the present invention entocondyle adaptability and increase external condyle after
The inner side and outer side side view of exemplary variations in portion's gradient；
Figure 12 (a) is the figure for the lateral femur condyle PCRTKA prostheses with round convex shape for representing the prior art；
Figure 12 (b) and 12 (c) are the figures of representative example MITKAPCR prostheses, the prosthese have be suitable for it is more flat outer
The femoral radius of side condyle, the external condyle are in contact with convex surface downward in tibial component rear direction or inclined-plane；
Figure 13 is that the full knee joint transposing prosthesis of the heavy burden movable posterior stabilization according to the present invention for introducing torque is inserted into
The first exemplary vertical view of object；
Figure 14 (a) and (b) are the diagram profiles that representative example MITKA posterior cruciate ligaments retain TKA, are had in difference
Increased adaptability between the knee flexion entocondyle and tibia insert medial condyle receivers of degree；
Figure 14 (c) and (d) are the diagram profiles that representative example MITKA posterior cruciate ligaments retain TKA, are had in difference
Increase gradient between the knee flexion external condyle and tibia insert of degree；
Figure 14 (e) and (f) are the diagram profiles that representative example MITKA posterior cruciate ligaments retain TKA, convex with outside
Shape shape is supported on the different degrees of place of knee bends along the outside convex shape external condyle；
Figure 15 is the three dimensional top perspective view of TKA prostheses cam/column mechanism with flat guiding surface of the prior art；
Figure 16 is the elevational perspective view of exemplary MITKA posterior stabilized prosthetics insert；And
Figure 17 is the elevational perspective view of exemplary MITKA posterior stabilized prosthetics device.
Specific implementation mode
It is described below and illustrates exemplary embodiment of the present invention, to include being introduced in the prosthetic joint of implantation
The method of torque, and contain the implantable prosthesis joint for introducing torque.Certainly, for those skilled in the art
Preferred embodiment described below is exemplary in itself, and is weighed without departing from the scope and spirit of the present invention
Newly reequiped.But in order to clear and accurate, exemplary embodiments discussed below may include that those skilled in the art answers
This thinks optional step, method and the feature that whether must fall within the scope of the present invention.
The law of basic main control machinery comes from Newton's law：(A) each object under at the uniform velocity state tends to protect
The motion state is held, unless external force is applied to thereon；(B) relationship between the quality m of object, its acceleration a and exerted forces F
For F=ma；And (C) there are equal and opposite effect power for each active force.The machinery law is suitable for applying
It is added to the external force of system, still, when the power in plane is applied on the object moved with ability, and if is applied
When power is bigger than resistance (gravity, frictional force etc.), object will start to move.In total knee lid bending process, either walking
In paces or in depth bending, the ligamentum cruciatum of natural knee forces shin bone in inward turning, and femur is propped relative to shin bone.
Verified missing ligamentum cruciatum causes axial rotation to reduce.
For total knee replacement (TKA) prosthese, three main power can be applied on it：(1) power applied,
The power across kneed muscle by generating；(2) between the femur and shin bone at contact point and the femur at contact point
The bearing surface contact power generated between knee cap；And the restraining force that (3) are generated by the ligament of resistance active force.But
The generation of knee prostheses generally axially rotated and magnitude mode are controlled by introducing moment arm, and only can by introduce relative to
Power leads to the moment arm of rotation to introduce rotation.In exemplary system, vectorial V has distance D, wherein position
Pass through the starting point P of vectorial V.Vectorial V has the feature of following equatioies about the torque M of point P：Equation #1：M=RxV；Wherein R
It is from point P to the position vector of the second point along vectorial V.
Before carrying out torque analysis for arbitrary TKA prostheses, it should be clear that determine and understand to acting on knee
The understanding of magnitude and direction.It is to pass through mathematical model for deriving the most effectual way of muscle, supporting surface and ligament forces simultaneously
Technology.It has confirmed, under correct understanding knee mechanism, may derive the equation for determining intravital power.It is applied although knowing
The strength grade for being added to knee is important, but is to determine that the direction of these applied forces is of equal importance.Act on strand shin and plate-like
The correct direction of contact force at bone interface will ensure that the torque around institute's reconnaissance is correctly summed.Accordingly, it is determined that on femur with
The directional velocity of the point (point FT) of tibia contact is important, described to allow to determine the bearing table occurred between point FT and TF
The direction of face contact force, point TF are the points contacted with femur on shin bone.
It is such to the arbitrary mechanical system with any two object in contact, it may occur that three in natural knee
A possible situation leads to the big different situation at contact point between two objects.These three situations are：(1) pure
It rolls；(2) simple sliding；And the combination of (3) rotation and sliding.
Referring to Fig.1, illustrative free body diagram 100 includes the cylinder (main body A) 102 for having radius R, the cylinder
Body 102 is moved relative to the platform (main body B) 104 being fixed in Newtonian reference system being generally flat.In the simply example,
Two referentials are limited for each object 102,104, wherein the direction " A ＞ " and " B ＞ " is the negative direction of gravity.Object 102,
Contact point between 104 is mutually limited by two points：Point BA on point AB and cylinder 102 on platform 104.Three other points
P1, P2, P3 surround the circumferential surface spaced at equal intervals of cylinder 102, and wherein longitudinal center is limited by point BO.Point P1 on the directions A1 ＞ with
And on the directions A2 ＞ with point BA spacing distances R.Point P2 on the directions-A1 ＞ and on the directions-A2 ＞ with point BA interval distances
From R.Point P3 on the directions A2 ＞ with point BA spacing distances 2R.
Under the conditions of pure rolling, we can assume that velocity vector V_BO_A=A1 ＞, wherein：Radius R=1；And circle
Angular velocity omega of the cylinder relative to platform referential around A3 ＞ axis is equal to-A3 ＞.It can so be determined using equation #2-#5
The speed of point P1, P2, P3 and BO：
Equation #2：V_P1_A ＞=V_BO_A ＞+ω _ B_A ＞ xP_BO_P1 ＞
V_P1_A ＞=A1 ＞+- A3 ＞ xA1 ＞
V_P1_A ＞=A1 ＞+- A2 ＞
Equation #3：V_BA_A ＞=V_BO_A ＞+ω _ B_A ＞ xP_BO_BA ＞
V_BA_A ＞=A1 ＞+- A3 ＞ x-A2 ＞
V_BA_A ＞=A1 ＞-A1 ＞=0 ＞
Equation #4：V_P2_A ＞=A1 ＞+A2 ＞
Equation #5：V_P3_A ＞=2A1 ＞
Therefore, under pure rolling state, the speed of point BA is necessarily equal to the speed of point AB.Since platform 104 is " fixed
" and do not moved in Newtonian reference system, all the points on platform have null speed.The simple analysis is shown pure
The speed of point BA is equal to zero on cylinder 102 under rolling condition.
Under the conditions of simple sliding, the speed suitable for the same system shown in Fig. 1 is for along the every of cylinder 102
Any is different.The practical ways for describing to slide merely are automobiles on ice.If friction coefficient is equal to zero, tire will revolve
Turn, but automobile will keep stablizing.Therefore, in knee, under simple sliding state, V_BO_A=0 ＞, and be similar to and scheming
Example shown in 1, radius R=1, ω=- A3 ＞.So point P1, P2 and P3 can be determined to determine using equation #6-#9
Speed：
Equation #6：V_P1_A ＞=V_BO_A ＞+ω _ B_A ＞ xP_BO_P1 ＞
The ＞ of V_P1_A ＞=0+- A3 ＞ xA1 ＞
V_P1_A ＞=- A2 ＞
Equation #7：V_BA_A ＞=V_BO_A ＞+ω _ B_A ＞ xP_BO_BA ＞
The ＞ of V_BA_A ＞=0+- A3 ＞ x-A2 ＞
V_BA_A ＞=- A1 ＞
Equation #8：V_P2_A ＞=A2 ＞
Equation #9：V_P3_A ＞=A1 ＞
Therefore, under simple sliding state, the speed of point BA is equal to-A1 ＞ and directional velocity and condyle of femur in knee
The direction of rear portion femoral rollback is opposite.Although having assumed that the velocity vector of contact point between condyle of femur and shin bone highland simple
In sliding process will in a rearward direction, but the correct direction of velocity vector in bending process forwardly direction and
Backward directions are in stretching process.Although it have been described that pure rolling and simple sliding, it can be assumed that in vivo
In the case of, " only having " pure rolling or " only having " simple sliding state are impossible to occur.
With reference to Fig. 2, the circumferential surface distance 200 of femoral prosthesis condyle 202 can be indicated by flat line 204.Under pure rolling state,
Femoral prosthesis condyle 202 is advanced only along the path of flat line 204, and the distance in the path is than tibial prosthetic insert (not shown)
Front/rear size is big.Pervious analysis confirms that the amount of moving forward and backward can arrive for external condyle 10 for natural knee
Between 25 millimeters, and for TKA prostheses, which can be in forward direction 10 millimeters or 15 milli backward
Rice.In this way, in TKA prostheses, the movement at first occurred at the contact point between condyle of femur 202 and tibia insert is sliding
It is dynamic.
Referring again to Fig. 1, it can be analyzed and propped up on cylinder 102 with determining when existing simultaneously sliding and rotation
Hold the speed at surface interface BA, AB.In this analysis, we can assume that V_BO_A=A1 ＞, radius R=1 and cylinder
The angular velocity omega of body=- 2A3 ＞.Therefore the speed of point P1, P2, P3 and BA can be determined using equation #10-#13：
Equation #10：V_P1_A ＞=V_BO_A ＞+ω _ B_A ＞ xP_BO_P1 ＞
V_P1_A ＞=A1 ＞+- 2A3 ＞ xA1 ＞
V_P1_A ＞=A1 ＞ -2A2 ＞
Equation #11：V_BA_A ＞=V_BO_A ＞+ω _ B_A ＞ xP_BO_BA ＞
V_BA_A ＞=A1 ＞+- 2A3 ＞ x-A2 ＞
V_BA_A ＞=A1 ＞ -2A1 ＞=- A1 ＞
Equation #12：V_P2_A ＞=A1 ＞+2A2 ＞
Equation #13：V_P3_A ＞=A1 ＞+2A2 ＞=3A2 ＞
In all three kinds of situations (sliding, rotation or combination), an important information is the speed of point BA.In pure rolling
During dynamic, the speed of point BA is equal to zero, still, in our example, in the feelings of simple sliding and rotation and sliding combination
Under condition, which is not equal to zero.In simple sliding, the direction of speed BA is on the direction of-A1 ＞, the rear portion stock with condyle of femur
Bone reversion direction on the contrary, rotate and slide combination in the case of, in our example, velocity vector V_BA_N ＞'s
Direction is on the direction of-A1 ＞, and the direction of the V_BA_N ＞ is equally opposite with the direction of contact point BA on AB.V_BA_N ＞
Magnitude can change with the speed of BO in Newtonian reference system and the angular speed of main body B, but the magnitude is always in-A1 ＞
Direction on.Therefore it is presumed that acting on power at the BA points on AB during knee bends in the side of A1 ＞ (backward directions)
It is unfavorable that full knee joint transposing prosthesis is designed on.On the contrary, should design during knee bends on the directions-A1 ＞
Applied force and during knee extension on the directions A1 ＞ applied force full knee joint transposing prosthesis, similar to acting on this
Velocity vector direction at point.In addition, it should also be noted that in the speed of pure rolling contact point BA in bending process
Equal to zero, and in the case that simple sliding contact point BA speed in forward direction (- A1 ＞).Therefore, in knee bends mistake
Cheng Zhong, V_BA_N ＞ is not in backward directions.
Current, all known TKA prostheses are disposed at the contact point between femoral component and tibial component
Impartial distribution is carried out to power.Therefore, these TKA prostheses do not introduce the torque for generating axial rotation.In surgical procedures
In, the purpose of surgeon is to generate the gap with isostension between condyle of femur and tibia insert/highland.If
The strength acted between entocondyle and tibia insert is equal to the power acted between external condyle and tibia insert, it is contemplated that
Distance due to entocondyle and external condyle apart from tibia insert center is also identical, then femoral component will not obtain phase
For the axial rotation of tibia insert.If two force effects are in system, and two power are identical in magnitude, and from
The moment arm that fixed point is applied in these power is equal, then the torque of the system will be equal to zero.
With reference to Fig. 3, the mobilizable TKA prostheses 300 of heavy burden of common posterior stabilization provide five main contact forces：
(1) in vertical direction (FN M) on entocondyle power 302；(2) (F in forward/backward directionT M) on entocondyle power 304；(3) vertical
Direction (FN L) on external condyle power 306；(2) (F in forward/backward directionT L) on external condyle power 308；And (5) are applied by cam
The power 310 (Fp) being added on column.Point O represents run-on point of the polyethylene insert 312 relative to tibia implant (not shown), encloses
It sums to torque around it.Further include point O to the distance between entocondyle contact force r1And point O to the distance between external condyle r2。
If carrying out power to the movable TKA prostheses 300 that bear a heavy burden around point O on T3 ＞ (perpendicular to the directions T1 ＞ and T2 ＞)
Square is summed, and torque equation is indicated by equation #14：
Equation #14：The ∑ MoT3 α T3 of ＞=1 ＞
We can assume that angular acceleration of the polyethylene insert 312 on the directions T3 ＞ relative to tibial implant components
(α) can ignore, and may be set to be equal to zero.Therefore, which is substituted into, equation #14 is simplified to equation #15：
Equation #15：The ∑ Mo=0 on the directions T3 ＞.
∑ MoT3 ＞=- r1T2 ＞ xFT MT1 ＞+r2T2 ＞ xFT LT1 ＞
Wherein know following information, distance r1=r2=r and power FM=FL=F, equation #15 can be further simplified into
Formula #16：
Equation #16：∑ MoT3 ＞=- rF (- T3 ＞)+rF (- T3 ＞),
＞=0 ∑ MoT3.
As shown in equation #16, if from the run-on point O for the movable TKA prostheses 300 that bear a heavy burden to inner side and outer side condyle away from
From r1、r2It is identical, torque and be equal to zero.It is rotated in this way, polyethylene insert 312 does not surround tibial component.Bear a heavy burden movable TKA
The object of the internal analytical proof 7/9 of prosthese 300 is subjected to the axial rotation less than 2.0 degree.
With reference to Fig. 4, the common fixed TKA prostheses 400 that bear a heavy burden include being fixed to tibial implant components (usually metal shin
It is not shown in basin) tibia insert 402 (be usually polyethylene).Unlike the TKA of the movable posterior stabilization of heavy burden of Fig. 3
Prosthese 300, tibia insert 402 are fixed to tibial implant components, are thus inserted into object and are not rotated relative to tibial implant components.Make
With the TKA prostheses for being similar to the movable posterior stabilization of heavy burden to Fig. 3 in the power on fixed posterior stabilization insert 402 of bearing a heavy burden
Those of 300 restrictions power.
It can be to summing around the torque on fixed polyethylene insert 402 of bearing a heavy burden that acts on for limiting point O.Fig. 4 points O
Main difference between Fig. 3 points O is that selected point O does not represent run-on point in Fig. 4, but at the directions the T2 ＞ centers Shang Zhu
Tibia insert 402 on fixed physical point.Indicate that the torque around point O is summed by equation #14：
Equation #14：∑ MoT3 ＞=I α T3 ＞
Similar to the movable TKA prostheses 300 of heavy burden of Fig. 3, we can assume that femur on the directions T3 ＞ relative to shin
The angular acceleration (α) of bone insert 402 is small, and may be set to be equal to zero.Therefore, which is substituted into, equation #14 letters
It is melted into equation #15：
Equation #15：The ∑ Mo=0 on the directions T3 ＞.
∑ MoT3 ＞=- r1T2 ＞ xFT MT1 ＞+r2T2 ＞ xFT LT1 ＞
Wherein know following information, distance r1=r2=r and power FM=FL=F, equation #15 can be further simplified into
Formula #16：
Equation #16：∑ MoT3 ＞=- rF (- T3 ＞)+rF (- T3 ＞)
＞=0 ∑ MoT3.
If fruit polyethylene column 404 is located at tibia insert 402 at the center on the directions T1 ＞ and T2 ＞, then for by
Femoral component is applied to for the contact force on tibia insert, torque on the directions T3 ＞ and is equal to zero.TKA prostheses in the past
Analysis in vivo determines that all TKA prostheses obtain the axial rotation fewer than natural knee, and most of TKA are by physical efficiency
It is enough to obtain the final kneed axial rotation less than two degrees, and about 1/3 these receptors be subjected to it is opposite with natural knee
Axial rotation pattern.
With reference to Fig. 5, rear cross keeps TKA prostheses 500 (either bear a heavy burden movable or bear a heavy burden fixation) to allow rear portion ten
Word ligament is kept, and the cam present in the TKA prostheses 400 of the posterior stabilization of Fig. 4/column mechanism 404 may be not present.In rear cross
Keep lacking in TKA prostheses 500 cam/column mechanism cause to be very similar to it is described to those of the TKA prostheses of posterior stabilization
Analysis.Since cam/column mechanism of the TKA prostheses suitable for current posterior stabilization is in the center of tibia insert, cam/column power
Do not apply torque.Therefore, when cam/column mechanism does not introduce rotation, other than the resistance of posterior cruciate ligament, for bearing a heavy burden
The torque analysis of movable posterior cruciate TKA500 will be similar to that the torque point of movable posterior stabilization TKA prostheses 300 (see Fig. 3)
Analysis, and for the torque analysis of heavy burden fixed rear portion cross TKA500 will be similar to that fixed rear portion stablize TKA prostheses 400 (see
Torque analysis Fig. 4).In other words, for these posterior cruciate ligaments retain TKA prostheses 500, for being applied by femoral component
For contact force on to tibia insert torque and be equal to zero.
With reference to Fig. 6, exemplary posterior stabilization movable total knee replacement (MITKA) prosthese for introducing torque that bears a heavy burden is inserted
Enter object 600 and be fixed to prosthese tibial post 606, which is preferably implanted in patient's shin bone (not shown).Insert
600 are included the column 602 deviated from the anterior posterior midline 608 of insert 600 in side direction, provide insert and femoral component
The rotation axis 604 between rotation axis 605 and tibial post 606 and insert 600 between (not shown), rotation axis
604 deviate from anterior posterior midline 608 in outer side direction.
With reference to Fig. 7, the torque analysis of exemplary MITKA prosthetic inserts 600 includes to surrounding run-on point O in the directions T3 ＞
On torque summation.Torque equation is indicated by equation #17：
Equation #17：∑ MoT3 ＞=- r1T2 ＞ xFT MT1 ＞-r3T2 ＞ xFPT1 ＞+r2T2 ＞ xFT L·
T1 ＞
Wherein know following information, distance r1=2r, r2=r3=r and power FT M=FT L=F, equation #17 can be further
It is simplified to equation #18：
Equation #18：∑ MoT3 ＞=- 2rF (- T3 ＞)-rF (- T3 ＞)+rF (- T3 ＞)
∑ MoT3 ＞=2rFT3 ＞+rFT3 ＞-rFT3 ＞
∑ MoT3 ＞=2rFT3 ＞
In the exemplary torque summation, 2rF is equal to by the torque that exemplary MITKA prosthetic inserts 600 introduce,
The generally axially rotation for causing tibia insert (to be looked down) in the clockwise direction.
Unlike the TKA prostheses 300 (such as seeing Fig. 3) for movable posterior stabilization of bearing a heavy burden at present, it is suitable for as following results
The tibia insert 600 of MITKA (looking down) will rotate in the clockwise direction, that is, generate run-on point O to tibia insert 600
Distance (by r3The distance of expression), increase from run-on point O to entocondyle contact force FT M(by r1The distance of expression) distance, with
And it reduces from run-on point O to external condyle contact force FT L(by r2The distance of expression) distance, allow external condyle be similar to natural knee
Lid sample more moves backward.
The offset generated between column 602 and the run-on point O of MITKA prosthetic inserts 600 leads to tibia insert phase
Axial rotation on tibial implant components (not shown) in the clockwise direction (directions T3 ＞) is increased.Depending on patient's weight
Amount, knee balanced degree and the strength (see Fig. 8) on column is applied to by cam, exemplary mathematical model determine column 602 from
Center line in inward-outward direction deviates 3 millimeters and run-on point O from the center line in inward-outward direction outside in the inward direction
Side offsets up 3 millimeters of generally axially rotations for leading to 5 to 13 degree.The second analysis is carried out using exemplary mathematical model,
Center pillar 602 deviates 6 millimeters and run-on point O and deviates 6 millimeters in an outward direction in the inward direction.It is similarly dependent on patient
Weight, knee balanced degree and the strength on column is applied to by cam, which shows the usual of polyethylene insert
Axial rotation increases to the range of 10 to 22 degree.Third is analyzed, and center pillar 602 deviates 10 millimeters and rotation in the inward direction
Point O deviates 10 millimeters in an outward direction causes polyethylene insert usual in 20 to 35 degree ranges in the clockwise direction
Axial rotation.On inwardly or outwardly direction bigger offset it is also within the scope of the invention, such as it is unrestricted inwardly or
0.01 to 20 millimeters are deviated outward.
With reference to Fig. 9, demonstration posterior stabilization according to the present invention is born a heavy burden the fixed total knee replacement for introducing torque
(MITKA) prosthetic insert 900 includes the cam/column machine deviated in an outward direction from the inside and outside center 904 of tibia insert
Structure 902.It is appreciated that the respective cams of femoral component can be also deviated in an outward direction to coordinate the tibial post of offset.
Referring to Fig.1 0, the bear a heavy burden torque analysis of fixed PSMITKA prostheses 900 of demonstration includes to surrounding on the directions T3 ＞
The torque of run-on point O is summed.Torque equation is indicated by equation #19：
Equation #19：∑ MoT3 ＞=- r1T2 ＞ xFT MT1 ＞+r2T2 ＞ xFT LT1 ＞
Wherein know following information, distance r1=2r, r2=r and power FT M=FT L=F, equation #19 can further letters
It is melted into equation #20：
Equation #20：∑ MoT3 ＞=- 2rF (- T3 ＞)+rF (- T3 ＞)
∑ MoT3 ＞=2rFT3 ＞-rFT3 ＞
∑ MoT3 ＞=rFT3 ＞
In the exemplary torque summation, 2rF is equal to by the torque that exemplary MITKA prosthetic inserts 900 introduce,
The generally axially rotation for causing femur (to be looked down) in the clockwise direction relative to tibia insert.
The offset generated between column 902 and the run-on point O of MITKA prosthetic inserts 900 leads to tibia insert phase
Axial rotation on tibial implant components (not shown) in the clockwise direction (directions T3 ＞) is increased.Depending on patient's weight
Amount and is applied to the strength on column at knee balanced degree by cam, and exemplary mathematical model determines column 902 from inward-outward direction
On center line deviate in the inward direction 3 millimeters cause femoral component 2 to 8 degree ranges in rotation.If column 902 to
Foreign side offsets up 6 millimeters, and femoral component amount of spin increases to the ranges of 5 to 13 degree, and if column 902 in an outward direction
10 millimeters of offset, axial rotation amount are increased again to the range of 9 to 25 degree.Bigger offset on inwardly or outwardly direction also exists
In the scope of the present invention, such as unrestricted outwardly or inwardly side deviates 0.01 to 20 millimeters.
As described above, cam/column mechanism can be used in the TKA prostheses of posterior stabilization, generated from rotation with will pass through
The moment arm of point to the movable TKA columns that bear a heavy burden generates rotation, or is deviated outward by making column, and increase is cut from column to entocondyle
The moment arm of shear force generates rotation, mainly by deviate run-on point and establish femoral radius and spill tibia insert radius it
Between adaptability and introduce torque.
Referring to Fig.1 1, demonstration MITKA posterior cruciate ligaments according to the present invention retain (PCR) heavy burden fixed fae body insert
1100 include being suitable for accommodating the entocondyle of femoral prosthesis (not shown) and the medial condyle receivers 1104 of external condyle and outside appearance respectively
Receive device 1106.In order to enable (looking down) rotation, insert 1100 are included in tibia insert to tibia insert 1100 clockwise
Bigger adaptability between entocondyle on inside and medial condyle receivers 1104.In the exemplary embodiment 1100, inside holds
Receive device 1104 radius ratio entocondyle radius it is big, permission front/rear translation occurs between entocondyle and medial condyle receivers.Especially
It is if the upper surface in 1100 outside of tibia insert is medial condyle receivers 1104 and entocondyle in the case of flat or convex shape
Between increase adaptability lead to the increased shearing force being applied to by entocondyle on the medial condyle receivers of polyethylene insert, lead
Clockwise torque is caused to generate, described flat or convex shape and the more even shape of the external condyle suitable for femoral prosthesis coordinate.
2 and Figure 13 referring to Fig.1, exemplary MITKA bear a heavy burden movable PCR prosthetic inserts 1200 including the use of insert
Contour line between 1200 and condyle of femur 1206,1208 is implanted into the center of substrate (not shown) relative to shin bone in an outward direction
The run-on point 1202 (and rotation axis) of 1204 movements.On on the outside, lateral femur condyle 1206 is more flat (to be similar to dugout canoe
Shape) and tibia insert lateral receiver 1208 either tilt down in the longitudinal direction (see Figure 12 (b)) or
It protrudes (see Figure 12 (c)).On inside, medial femoral condyle has and the medial condyle receivers 1210 on 1200 inside of tibia insert
The adaptability of bigger.Therefore, when the shearing force between condyle of femur and tibia insert increases, shearing strength will be on inside more
Greatly and rotating clockwise for tibia insert is introduced, reason is：(1) increase adaptability；And (2) from run-on point to inside
The moment arm of shearing force is than the moment arm bigger from run-on point to external condyle power.
For total knee arthroplasty, a main purpose for obtaining increase load-bearing bending is can be backward
The ability of mobile external condyle on direction.It is described to be realized by the axial rotation or translation of two condyles in normal knee.
But it is no more than 10 millimeters since in normal knee, entocondyle is averagely mobile in backward directions, and the amount is less than 5 millis
Rice, external condyle obtain back contacts by stock shin axial rotation.Torque is introduced in MITKA, and normal axial direction can occur in this way
Rotation, and external condyle can get with the bigger back contacts for increasing knee bends.The TKA of the torque introducing posterior stabilization
It more easily realizes, wherein cam/column power can be used to drive rotation clockwise or prop entocondyle relative to column
Power.It is more relevant with the ability of introducing torque in posterior cruciate ligament keeps TKA.MITKA posterior cruciate ligaments keep knee profit
With the increase adaptability between entocondyle and the medial condyle receivers of polyethylene insert.In addition, being suitable for external condyle (canoe shape
Shape) increased bending radius allow external condyle contact point to be moved in the one 30 the degree of knee bends in backward directions.Cause
This, is obtained with the purpose of external condyle back contacts with increased knee bends by introducing torque and by changing condyle of femur
Geometry can be kept realizing in TKA in MITKA posterior cruciate ligaments.In this manner, MITKA bears a heavy burden, movable PCR prostheses are inserted
Entering rotation axis between object 1200 and femoral prosthesis can be from the medial-lateral centerline of insert 1200 (and also from front-rear center
Line) offset, while MITKA bears a heavy burden the rotary shaft between movable PCR prosthetic inserts 1200 and prosthetic tibial tray (not shown)
Line can be deviated from the medial-lateral centerline (and also from the front-rear center line of insert 1200) of insert 1200.
Although on the inner face of shin bone polyethylene insert and more flat external condyle, between entocondyle and container
Increase adaptability, the rear portion inclination for touching polyethylene insert or convex are being docked before this for posterior cruciate frame keeps TKA
It is described outside shape, these configuration features can be used in arbitrary TKA prosthesis types.It can be used in PSTKA types
The configuration variation can be used in front and posterior cruciate ligament reservation TKA types to increase axial rotation to ensure
Normal axial rotation.
The present invention Exemplary prosthesis insert in, entocondyle relative to tibia insert medial condyle receivers it is effective
Amount can play an important role.It can play an important role in axial rotation, the increasing of axial rotation amount described herein is caused to add deduct
Few additive factor is the condyle balance in surgical operation.It is appreciated that during the ligament balance that inside operates, aforementioned
The mathematical model referred in discussion, which combines equal inner side and outer side condyle curved slot, causes entocondyle contact force to be equal to outside
Condyle contact force.If entocondyle contact force is more than external condyle contact force, normal axial amount of spin will increase more than by the reference
Those of mathematical model prediction value.On the contrary, if external condyle contact force be more than entocondyle contact force, axial rotation amount will by
Those of model prediction value is following.
Referring to Fig.1 4, it includes that entocondyle and tibia insert are (poly- that exemplary MITKA posterior cruciate ligaments, which retain TKA prostheses,
Ethylene) medial condyle receivers between increase adaptability, to introduce clockwise moment (normal axis of the femur relative to shin bone
To rotation) (see Figure 14 (a) and (b)).Further, since the more flat condyle geometry at full extension causes from full extension
Contact position to 30 degree of knee bends quickly changes, and external condyle will obtain the rear motion of bigger.Contact suitable for external condyle
The rear portion variation of position can be by the increase rear portion gradient (see Figure 14 (c) and (d)) or polyethylene insert of polyethylene insert
Convex shape (see Figure 14 (e) and (f)) further assist.
Referring to Fig.1 5, all cams/column mechanism in TKA prostheses 1400 includes flat surfaces at present.These flat surfaces
Cause to assume that contact area can be larger, smaller stress on column 1404 is applied to from there through cam 1402.Unfortunately, if
Femoral component (cam) 1402, which is generated relative to tibia insert (column) 1404 in the TKA prostheses that heavy burden fixed rear portion is stablized, to be turned
It is dynamic, it is reversely correct, and the contact area 1406 between femoral cam and tibial post becomes very small.It mainly influences flat
The factor that contact area reduces between flat cam 1402 on column 1404 is edge loading, leads to high stress, the high stress
The tibia insert at column is caused to break down too early.
The TKA prosthetic appliances 1500 of 6 and Figure 17 referring to Fig.1, demonstration MITKA posterior stabilizations according to the present invention include tool
There are the tibia insert 1502 of tibial post 1504, tibial post 1504 that there is circular posterior face 1506.The circle of the column 1502
Posterior face 1506 is suitable for interacting with the round femoral cam 1508 of femoral prosthesis component 1510.Circle suitable for column 1504
The radius R of posterior face 1506 is similar with circular cam 1508, but is adapted for the prosthetic appliance of MITKA heavy burden fixed rear portions stabilization
1500 selected radius R will depend on desirable amount of spin.If the prosthetic appliance 1500 of MITKA posterior stabilizations is configured to wrap
Minimum stock shin axial rotation is included, if then the prosthetic appliance 1500 than MITKA posterior stabilizations is arranged to fit by the value suitable for R
In the value higher suitable for R of the axial rotation of bigger.
Although aforementioned utilized the shin section with integral post (suitable for being contacted with the cam interface of femoral prosthesis component)
Part illustrates the prosthese of exemplary MITKA posterior stabilizations, but column is incorporated into femoral component and combines cam
Enter tibia insert to also fall into the scope of the present invention.Although aforementioned utilized (is suitable for and tibia insert with integral post
Interior cavity interfacial contact) tibial component illustrate exemplary prosthese, but column is incorporated into tibia insert
It falls within the scope of the present invention, wherein the column will be correspondingly contained in the cavity in tibia implant.
Although illustrating preceding example MITKA by the offset pillars between insert and tibial component and run-on point
Bear a heavy burden movable POR prostheses, it should be appreciated that those skilled in the art can be only so that column deviates or only so that run-on point is inclined
It moves to generate torque described herein.Although the run-on point between insert and tibial component (disk) will be inclined with anterior posterior midline
It moves, but exemplary embodiment will include POR prosthetic appliances, which has the column being aligned along anterior posterior midline.On the contrary,
Although column will be deviated with anterior posterior midline, exemplary POR prosthetic appliances can have the run-on point being aligned along anterior posterior midline.
It is also fallen into the scope of the present invention in addition, the contact point of column or run-on point are deviated forward or backward.The prior art
The movable knee prostheses insert of heavy burden always have along anterior posterior midline and the run-on point to center along front and back center line.
By the contact point or run-on point of the Centre position deviation column from the prior art, if the contact point of column and run-on point be not coaxial,
Then introduce torque.
Those skilled in the art will readily appreciate that the exemplary inserts of the present invention are suitable for including shin bone and stock
The prosthetic knee joints of osteogenic section.The exemplary embodiment of the present invention can contain or replaceable many tibia implants and femur are planted
Entering object can not possibly all list.
From it is described description and invention summarize, although those skilled in the art should be understood that method described here and
Device constitute the present invention exemplary embodiment, but be included in this present invention is not limited to the exact embodiments, and
The embodiment can be changed without departing from the present invention, wherein invention scope is limited by claim
It is fixed.Further, it will be understood that the present invention is defined by the claims and is not intended to that description demonstration implementation will be incorporated as herein herein
Example propose so as to explain it is arbitrary require component it is arbitrary limitation or component, unless to it is this limit or component clearly explained
It states.It will additionally be appreciated that even if the advantage is not discussed clearly herein, but since the present invention is limited by claim
It is fixed, and since the intrinsic and/or unforeseen advantage of the present invention can exist, It is not necessary to meet it is disclosed herein so as to
Fall into the clear advantage or purpose of the invention in arbitrary right.
Claims (24)
1. a kind of knee prostheses implant system, including:
Femoral component, the femoral component include entocondyle and external condyle；
Bear a heavy burden mobilizable tibial tray insert, and mobilizable tibial tray insert that bears a heavy burden includes between lateral condyle receiver
The medial condyle separated;
It is operatively adapted for being connected to the tibial tray of mobilizable tibial tray insert that bears a heavy burden;
Mobilizable tibial tray insert that bears a heavy burden further includes stability column, and mobilizable tibial tray insert that bears a heavy burden has
Interior-outer center line, wherein mobilizable tibial tray insert that bears a heavy burden is rotated relative to the tibial tray around vertical first
Axis rotates, the first rotation from it is described bear a heavy burden in mobilizable tibial tray insert-outer center line deviates outward,
Mobilizable tibial tray insert that bears a heavy burden is rotated relative to the femoral component around the second vertical rotation axis, this second
Rotation axis deviates inwardly from the first rotation.
2. knee prostheses implant system according to claim 1, wherein:
Anterior-posterior center line biased forwards of the first rotation from mobilizable tibial tray insert that bears a heavy burden.
3. knee prostheses implant system according to claim 1, wherein:
The first rotation deviates backward from the anterior-posterior center line for bearing a heavy burden mobilizable tibial tray insert.
4. knee prostheses implant system according to claim 1, wherein:
The stability column from it is described bear a heavy burden in mobilizable tibial tray insert-outer center line deviate inwardly 0.1 millimeter to
20 millimeters.
5. knee prostheses implant system according to claim 1, wherein:
The stability column deviates 0.01 millimeter to 20 millimeters inwardly relative to the vertical first rotation.
6. knee prostheses implant system according to claim 1, wherein:
The lateral condyle receiver includes convex shape or at least one of continuous tilt shape shape from front to back;And institute
State the concave shape for the protrusion entocondyle that medial condyle has for accommodating femoral prosthesis.
7. knee prostheses implant system according to claim 1, wherein:
The rear of the stability column is circular.
8. knee prostheses implant system according to claim 1, wherein:
Anterior-posterior center line biased forwards of the stability column from mobilizable tibial tray insert that bears a heavy burden.
9. knee prostheses implant system according to claim 1, wherein:
The stability column deviates backward from the anterior-posterior center line for bearing a heavy burden mobilizable tibial tray insert.
10. knee prostheses implant system according to claim 1, wherein:
Mobilizable tibial tray insert that bears a heavy burden includes being suitable for accommodating the projection protruded from prosthetic tibial tray implant
Recess, mobilizable tibial tray insert that bears a heavy burden can be rotated around it relative to prosthetic tibial tray implant.
11. knee prostheses implant system according to claim 1, wherein:
Mobilizable tibial tray insert that bears a heavy burden includes being suitable for being accommodated by the recess of the prosthetic tibial tray implant
Projection, mobilizable tibial tray insert that bears a heavy burden can be rotated around it relative to prosthetic tibial tray implant.
12. knee prostheses implant system according to claim 1, wherein:
Second rotation axis from it is described bear a heavy burden in mobilizable tibial tray insert-outer center line deviates inwardly.
13. knee prostheses implant system according to claim 12, wherein:
The lateral condyle receiver includes convex shape or at least one of inclined in two-way shape shape from front to back;And
The medial condyle includes the concave shape of the convex interior condyle for accommodating femoral prosthesis.
14. knee prostheses implant system according to claim 12, wherein:
The femoral component includes the cam being placed on the stability column, wherein cam movement is with the shifting with the stability column
Dynamic matching;And
Rear by the stability column of the cam contact is circular.
15. knee prostheses implant system according to claim 12, wherein:
Mobilizable tibial tray insert that bears a heavy burden includes being suitable for accommodating the projection protruded from prosthetic tibial tray implant
Recess, mobilizable tibial tray insert that bears a heavy burden can be rotated around it relative to prosthetic tibial tray implant.
16. knee prostheses implant system according to claim 12, wherein:
Mobilizable tibial tray insert that bears a heavy burden includes being suitable for being accommodated by the recess of the prosthetic tibial tray implant
Projection, mobilizable tibial tray insert that bears a heavy burden can be rotated around it relative to prosthetic tibial tray implant.
17. knee prostheses implant system according to claim 12, wherein:
Anterior-posterior center line biased forwards of the first rotation from mobilizable tibial tray insert that bears a heavy burden.
18. knee prostheses implant system according to claim 12, wherein:
The first rotation deviates backward from the anterior-posterior center line for bearing a heavy burden mobilizable tibial tray insert.
19. knee prostheses implant system according to claim 12, wherein:
The stability column from it is described bear a heavy burden in mobilizable tibial tray insert-outer center line deviate inwardly 0.1 millimeter to
20 millimeters.
20. knee prostheses implant system according to claim 12, wherein:
The stability column deviates 0.01 millimeter to 20 millimeters inwardly relative to the first rotation.
21. knee prostheses implant system according to claim 12, wherein:
The lateral condyle receiver includes convex shape or at least one of continuous tilt shape shape from front to back;And
The medial condyle includes the concave shape of the protrusion entocondyle for accommodating femoral prosthesis.
22. knee prostheses implant system according to claim 12, wherein:
The rear of the stability column is circular.
23. knee prostheses implant system according to claim 12, wherein:
Anterior-posterior center line biased forwards of the stability column from mobilizable tibial tray insert that bears a heavy burden.
24. knee prostheses implant system according to claim 12, wherein:
The stability column deviates backward from the anterior-posterior center line for bearing a heavy burden mobilizable tibial tray insert.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201410410460.1A CN104207863B (en) | 2006-03-21 | 2006-03-21 | Introduce the total joint replacement prosthese of torque |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201410410460.1A CN104207863B (en) | 2006-03-21 | 2006-03-21 | Introduce the total joint replacement prosthese of torque |
| CNA2006800544752A CN101431967A (en) | 2006-03-21 | 2006-03-21 | Torque-introducing total joint replacement prosthesis |
Related Parent Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CNA2006800544752A Division CN101431967A (en) | 2006-03-21 | 2006-03-21 | Torque-introducing total joint replacement prosthesis |
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| CN104207863A CN104207863A (en) | 2014-12-17 |
| CN104207863B true CN104207863B (en) | 2018-09-07 |
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| CN201410410460.1A Active CN104207863B (en) | 2006-03-21 | 2006-03-21 | Introduce the total joint replacement prosthese of torque |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN104814815B (en) * | 2015-05-22 | 2016-10-05 | 北京爱康宜诚医疗器材股份有限公司 | Joint prosthesis |
Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5413604A (en) * | 1992-12-24 | 1995-05-09 | Osteonics Corp. | Prosthetic knee implant for an anterior cruciate ligament deficient total knee replacement |
| US5639279A (en) * | 1995-02-09 | 1997-06-17 | Intermedics Orthopedics, Inc. | Posteriorly-stabilized prosthetic knee |
| US6039764A (en) * | 1997-08-18 | 2000-03-21 | Arch Development Corporation | Prosthetic knee with adjusted center of internal/external rotation |
| US6299646B1 (en) * | 1997-09-23 | 2001-10-09 | Tornier Sa | Knee prosthesis with a rotational plate |
Family Cites Families (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DE202004003133U1 (en) * | 2004-02-26 | 2004-07-29 | Aap Implantate Ag | Joint replacement tibial plateau |
-
2006
- 2006-03-21 CN CN201410410460.1A patent/CN104207863B/en active Active
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5413604A (en) * | 1992-12-24 | 1995-05-09 | Osteonics Corp. | Prosthetic knee implant for an anterior cruciate ligament deficient total knee replacement |
| US5639279A (en) * | 1995-02-09 | 1997-06-17 | Intermedics Orthopedics, Inc. | Posteriorly-stabilized prosthetic knee |
| US6039764A (en) * | 1997-08-18 | 2000-03-21 | Arch Development Corporation | Prosthetic knee with adjusted center of internal/external rotation |
| US6299646B1 (en) * | 1997-09-23 | 2001-10-09 | Tornier Sa | Knee prosthesis with a rotational plate |
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| CN104207863A (en) | 2014-12-17 |
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