CN110191691B - 模块化扩充部件 - Google Patents
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30721—Accessories
- A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
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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
- A61F2/40—Joints for shoulders
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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
- A61F2/40—Joints for shoulders
- A61F2/4081—Glenoid components, e.g. cups
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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
- A61F2/30721—Accessories
- A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
- A61F2002/30736—Augments or augmentation pieces, e.g. wedges or blocks for bridging a bone defect
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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
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
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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
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30879—Ribs
- A61F2002/30881—Circumferential ribs, flanges or fins
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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
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2002/3092—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth having an open-celled or open-pored structure
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Abstract
公开了一种中央扩充件。所述中央扩充件可包括主体和突出部。该主体可包括第一弯曲表面和第二表面,所述第一弯曲表面被设定形状以与骨骼的中央部分接合,所述第二表面与所述第一弯曲表面相反并限定被设定尺寸以接收假体部件的一部分的凹部。所述突出部可以在所述凹部内从所述第二表面延伸。
Description
优先权要求
本申请要求于2017年1月20日提交的美国临时申请62/448,547的优先权,其内容通过引用全部结合于此。
技术领域
本公开涉及外科植入物系统,其包括植入物、器械和用于安装植入物的方法。具体而言,本公开涉及用于将关节盂植入物固定至关节盂的系统和方法。
背景技术
用于修复或重建关节的外科手术可能需要将外科植入物牢固地紧固到骨骼上。例如,肩关节重建可能需要将关节盂植入物固定至肩胛骨以在肩胛骨上重现或复制关节盂腔。外科植入物可以以各种方式(包括机械紧固件和粘合剂)牢固地紧固至骨骼。
发明内容
为了更好地说明本文公开的系统,在此提供了非限制性的示例列表:
示例1是在肩部更换手术中使用的中央扩充件,该中央扩充件包括:主体,所述主体包括关节盂接合表面和第二表面,所述关节盂接合表面被设定形状以与铰削关节盂的中央部分接合(交界),所述第二表面与所述第一弯曲表面相反并限定被设定尺寸以接收关节盂部件的凸台的凹部;在所述凹部内从所述第二表面延伸的突出部,所述突出部被设定尺寸以被接收在由所述关节盂部件的所述凸台限定的孔眼内;以及从所述关节盂接合表面延伸的支柱,所述支柱被设定尺寸以被接收在形成于所述关节盂的所述中央部分中的孔眼中,其中所述主体和所述支柱中的至少一个包括多孔金属涂层。
在示例2中,示例1的主题可选地包括,其中所述第一弯曲表面具有球根形形状。
在示例3中,示例1-2中的任何一个或多个的主题可选地包括,其中所述第一弯曲表面具有球形形状。
在示例4中,示例1-3中的任何一个或多个的主题可选地包括,其中所述第一弯曲表面针对特定患者成形。
在示例5中,示例1-4中的任何一个或多个的主题可选地包括,其中所述支柱包括带螺纹的部分。
在示例6中,示例1-5中的任何一个或多个的主题可选地包括,其中所述支柱包括带倒钩的部分。
在示例7中,示例1-6中的任何一个或多个的主题可选地包括,其中所述支柱是带沟棱(凹槽)的楔钉。
在示例8中,示例1-7中的任何一个或多个的主题可选地包括,其中所述凹部包括与所述关节盂部件的所述部分互补的锥形轮廓。
在示例9中,示例1-8中的任何一个或多个的主题可选地包括,其中所述突出部包括一个或多个外螺纹,所述一个或多个外螺纹被构造成与设置在所述关节盂部件的所述凸台内的一个或多个内螺纹配合。
在示例10中,示例1-9中的任何一个或多个的主题可选地包括,其中所述主体和所述支柱中的至少一个包括多孔金属涂层。
示例11是在肩部更换手术中使用的模块化关节盂系统,所述模块化关节盂系统包括:关节盂部件,所述关节盂部件包括:关节表面、与所述关节表面相反的关节盂接合表面和从所述关节盂接合表面延伸的凸台;以及模块化扩充件,所述模块化扩充件包括:第一外表面、与所述第一外表面相反并限定被设定尺寸以接收所述凸台的凹部的第二内表面、支柱,所述第一外表面形成圆顶并被设定形状以与关节盂的铰削部分接合(交界),所述支柱从所述第一外表面延伸并被设定尺寸以被接收在产生于所述关节盂中的孔眼中;以及突出部,所述突出部从所述第二内表面延伸并被设定尺寸以被接收在所述凸台中的孔眼内。
在示例12中,示例11的主题可选地包括,其中所述突出部包括阳螺纹部分,并且所述孔眼包括用于接收所述阳螺纹部分的阴螺纹部分。
在示例13中,示例11-12中的任何一个或多个的主题可选地包括,其中所述关节盂部件包括围绕所述凸台间隔开的多个楔钉。
在示例14中,示例11-13中的任一个或多个的主题可选地包括,其中所述模块化扩充件选自多个模块化扩充件,所述多个模块化扩充件中的每一个模块化扩充件被设定尺寸以填补不同尺寸的中央缺陷。
示例15是一种用于更换关节盂部件的方法,所述方法包括:铰削关节盂的中央部分;将模块化扩充件植入关节盂的中央部分中,所述模块化扩充件包括第一弯曲表面、与所述第一弯曲表面相反并限定被设定尺寸以接收从关节盂部件的扩充件接合表面延伸的凸台的凹部的第二弯曲表面,所述第一弯曲表面包括从其延伸的支柱,所述支柱被设定尺寸以被接收在产生于所述关节盂部件的所述凸台中的孔眼中;以及将所述关节盂部件植入所述关节盂中,所述关节盂部件经由所述支柱和在所述凸台中产生的所述孔眼耦接至所述模块化扩充件。
在示例16中,示例15的主题可选地包括,从多个模块化扩充件中选择所述模块化扩充件,所述多个模块化扩充件中的每一个模块化扩充件被设定尺寸以填补不同尺寸的中央缺陷。
在示例17中,示例15-16中的任何一个或多个的主题可选地包括,其中所述模块化扩充件是患者特异性的。
在示例18中,示例15-17中的任何一个或多个的主题可选地包括,其中植入所述模块化扩充件和所述关节盂部件同时发生。
在示例19中,示例18的主题可选地包括,将所述支柱旋拧至所述关节盂部件的所述凸台的所述孔眼中。
在示例20中,示例15-19中的任何一个或多个的主题可选地包括,其中所述模块化扩充件与所述关节盂部件压配合。
在示例21中,示例1-20中的任何一个或任何组合的模块化扩充件或模块化关节盂系统可选地被构造成使得,所述的所有元件或选项可用于使用或从中选择。
附图说明
通过参考以下结合附图对实施例的描述,本公开的上述和其它特征和优点以及实现它们的方式将变得更加清楚,并且本公开自身将被更好地理解,其中:
图1示出了关节盂中的中央缺陷。
图2示出了根据本公开的至少一个示例的模块化关节盂系统的立体图。
图3示出了根据本公开的至少一个示例的模块化关节盂系统的侧视图。
图4示出了根据本公开的至少一个示例的模块化关节盂系统的剖视图。
图5示出了根据本公开的至少一个示例的用于关节盂置换手术的示例性方法。
在所有的几个视图中,相应的附图标记表示相应的部件。这里阐述的范例示出了本公开的示例性实施例,并且这种范例不应被解释为以任何方式限制本公开的范围。
具体实施方式
如在此所使用的,应用以下方向性定义。前侧和后侧分别表示更靠近身体的前部或更靠近身体的后部,近侧和远侧分别表示更靠近或更远离结构的根部,并且内侧和外侧分别表示更靠近矢状面或更远离矢状面。矢状面是通过身体的中间的假想的竖直面,其将身体分成左右两半。此外,术语植入物和假体及其变型可以互换使用。
由于受伤、创伤、老化或其它退化状况,关节(例如肩部)可能被损伤或以其它方式减少活动性。此外,受伤、创伤、老化或其它状况可能引起反复受伤。例如,肩部的受伤可导致关节盂窝的中央缺陷或其它损伤。中央缺陷或其它损伤可导致肱骨头更容易从关节盂窝脱位。例如,人可能遭受关节盂软骨缺陷,其可能导致盂肱脱位或由盂肱脱位引起。
如本文所公开的,模块化扩充件可用于修复中央缺陷。模块化扩充件可包括主体和从主体延伸的支柱。支柱和主体部分可植入关节盂窝的中央部分中以帮助修复中央缺陷。用模块化扩充件解决中央缺陷可允许关节盂的中央部分周围的现有骨骼在外科手术期间被保留或以其它方式保持不受干扰。
中央缺陷可能在任何骨骼解剖学结构中。例如,中央缺陷可能在肩关节、髋关节或手或腕关节中。例如,在肩关节中,中央缺陷可能在关节盂中。在髋关节中,中央缺陷可能在髋臼窝中。在手中,中央缺陷可能在掌骨或指骨的基部中。
图1示出了骨骼102中的中央缺陷100。骨骼102可以是关节盂、髋臼窝等。中央缺陷100可以是具有或不具有下方骨损伤的窝(例如关节窝)上的裸斑或其它中央软骨缺失区域。其它类型的中央缺陷可包括但不限于盂肱关节的软骨病变,例如Hill-Sachs病变或关节软骨病变。如图1所示,中央缺陷100可影响头部106(例如肱骨头部)的骨表面104(例如肱骨表面)与骨骼102相互作用的方式。
参考图2-4,示出了根据本公开的一些方面的模块化关节盂系统200。模块化关节盂系统200可包括关节盂部件202和模块化扩充件204。如本文所公开的,模块化扩充件204可在最小程度地切除关节盂的情况下插入关节盂(例如骨骼102)中。例如,关节盂的中央部分可被铰削或以其它方式准备,以接收模块化扩充件204,而关节盂腔的关节盂下结节或其他部分或肩胛骨可保持在自然状态或其它未被干扰的状态。虽然图2-4示出了关于关节盂描述的且处于解剖学构造中的系统,但本文公开的系统和方法可应用于诸如翻转式肩关节置换术的反向手术中,也可应用于诸如髋关节等的其它关节中。
模块化扩充件204可包括主体206和从主体206延伸的支柱208。如图4所示,主体206和支柱208可包括在其至少一部分上的多孔金属层210。此外,在各种示例中,仅支柱208可以包括多孔金属层210。此外,在各种示例中,仅主体206可以包括多孔金属层210。此外,在各种示例中,支柱208和/或主体206可形成为多孔部件,而不是具有形成于其上的多孔层。
多孔金属层210(或多孔部件)可允许骨骼长入其中以进一步将模块化扩充件204固定到关节盂上。多孔金属层210可以是高度多孔的三维金属结构,其可以结合多种生物相容性金属中的一种或多种生物相容性金属,例如但不限于钛、钛合金、钴铬、钴铬钼、钽、钽合金、铌、或钽和铌彼此或与其它金属的合金。这样的结构特别适于接触骨骼和/或软组织,并且因此,可以用作骨骼替代物和其它植入物和植入物部件,其例如通过允许骨组织或其它组织随着时间生长到所述多孔结构中来接受细胞和组织长入其中以增强所述结构和周围身体结构之间的固定(例如,骨结合)。根据本文公开的示例,开放多孔金属结构或其一部分可具有低至55%、65%或75%或高至80%、85%或90%的体积(整体)孔隙率,或在任何一对前述数值之间限定的任何范围内的体积孔隙率,并且因此,这种结构可提供轻质但坚固的多孔植入物。某些多孔金属结构尽管具有如此高的孔隙率但仍然能够在植入时和在长时间内承受极端的机械载荷,例如,在高度多孔的三维金属结构其自身或与另一个植入物一起被强有力地压紧并压配合到骨骼中的情况下承受极端的机械载荷,并且在压紧期间和在身体中使用数月或数年之后保持其形状。这种结构可以根据任何合适的技术或工艺制造。开放多孔金属结构的一个示例使用可从Indiana、Warsaw的Zimmer公司获得的技术生产。是Zimmer公司的商标。这种材料可以由网状玻璃碳泡沫基底形成,该网状玻璃碳泡沫基底通过化学气相沉积(“CVD”)工艺、以在美国专利5,282,861和Levine,B.R.等人的“Experimental and Clinical Performance ofPorous Tantalum in Orthopedic Surgery”,Biomaterials 27(2006)4671-4681中详细公开的方式渗透并涂覆以生物相容性金属,上述文献的公开内容通过引用明确地结合到本文中。
在一些情况下,高度多孔的三维金属结构可以使用选择性激光烧结(SLS)或其它增材制造型工艺例如直接金属激光烧结或电子束熔化来制造。在一个示例中,三维多孔制品可以以逐层的方式由激光可熔性粉末例如单组分金属粉末制成,所述激光可熔性粉末可以一次沉积一层。通过施加激光能量,该粉末可以被熔化、再熔化或烧结,该激光能量被引导至粉末层的与该制品的横截面相对应的部分。在每层中的粉末熔化之后,可以沉积另外的粉末层,并且可以进行进一步的熔化步骤,其中熔化过的部分或外侧层熔化,以便熔化先前铺设的层的一部分,直到完成三维制品。在某些示例中,激光可通过扫描由所述制品的3-D数字描述(例如,来自CAD文件或扫描数据)产生的横截面来在粉末床的表面上选择性地熔化粉末材料。使用这种技术可以产生复杂的几何形状,并且在一些情况下,可以构造网形和近网形植入物。在一些示例中,无孔或基本上无孔的基底可提供基础,可使用选择性激光烧结(SLS)或其它增材制造型工艺来将三维多孔结构构建到并熔合到所述基础上。这种基底可结合多种生物相容性金属中的一种或多种生物相容性金属,例如本文公开的那些生物相容性金属中的任何一种生物相容性金属。
通常,高度多孔的三维金属结构将包括大量丝线(连杆),所述大量丝线在它们之间限定开放空隙(例如,孔)或通道。所述丝线之间的开放空间形成具有很少死端或没有死端的连续通道矩阵(基质),以使得软组织和/或骨骼穿过所述开放多孔金属的生长基本上不受抑制。根据本公开的一些方面,开放多孔金属结构的外表面可以以上述丝线的终止端为特征。这种终止端可以被称为支杆,并且它们可以沿着暴露的多孔金属表面产生高摩擦系数。这些特征可以向暴露的多孔金属表面赋予增强的固定能力,以便粘附到骨骼和软组织上。而且,当这种高度多孔的金属结构被耦接至下面的基底时,小百分比的基底可以与高度多孔结构的丝线直接接触,例如,基底表面积的大约15%、20%或25%可以与高度多孔结构的丝线直接接触。
高度多孔的三维金属结构可被制造成包括多种密度,以便例如通过将该结构与周围的天然组织匹配以便提供用于使组织长入其中并矿化的改进的矩阵来选择性地调整该结构以用于特定的矫形应用。这种结构可以是各向同性或各向异性的。在这点上,根据某些示例,开放多孔金属结构可被制造成整个具有基本上均匀的孔隙率、密度、空隙(孔)尺寸、孔形状和/或孔取向,或者具有例如孔隙率、密度、空隙(孔)尺寸、孔形状和/或孔取向在所述结构内或所述结构的一部分内变化的一个或多个特征。例如,开放多孔金属结构在所述结构的不同区域、不同层和不同表面处可具有不同的孔尺寸、孔形状和/或孔隙率。选择性地调整开放多孔金属的结构特性的能力使得能够例如调整所述结构以便将应力载荷分布到整个周围组织中并且促进特定组织长入所述开放多孔金属内。在一些情况下,高度多孔的三维金属结构一旦形成,就可以渗透并涂覆以一种或多种涂覆材料,例如生物相容性金属,例如本文公开的那些生物相容性金属中的任何一种生物相容性金属。
除了多孔金属以外,支柱208或多孔金属层210还可形成螺纹、倒钩或其它突出部,其可允许模块化扩充件204被旋拧至关节盂中或以其它方式固定到关节盂上。此外,支柱208可以是锥形的,并且可以包括一个或多个沟棱(凹槽)、翅片、肋条或其它从其延伸的突起。螺纹、倒钩、沟棱、翅片、肋条或其它突出部可提供用于骨骼接触的表面,并且可形成锚定结构以帮助固定模块化扩充件204。例如,在恢复期间,骨骼可在螺纹、倒钩、沟棱、翅片、肋条或其它突出部之间生长,以帮助将模块扩充件204固定到关节盂上。
主体206可包括弯曲表面212和关节盂部件接合表面214。弯曲表面212可与关节盂的铰削部分的轮廓相匹配。例如,铰削器可以具有半球形轮廓或其他球根形形状,其对应于弯曲表面212的半球形或球根形形状。另外,弯曲表面212可以是患者特异性的。例如,外科医生可使用患者关节盂的图像并指定弯曲表面212的形状以匹配患者的解剖学结构。然后,模块化扩充件204可制造成具有与特定患者的特定轮廓(铰削的或自然的)相匹配的弯曲表面212。
关节盂部件接合表面214可匹配关节盂部件202的轮廓。例如,关节盂部件202可包括从关节盂接合表面216突出的凸台402。换句话说,关节盂部件接合表面214可限定凹部,该凹部被设定尺寸以接收关节盂部件202(例如,凸台402)的一部分或如图4所示接收整个关节盂部件202(例如,凸台402),并且关节盂部件接合表面214以圆顶状方式围绕关节盂部件202延伸。凸台402可以如图2所示居中地定位,或者根据患者的需要而偏移。关节盂部件接合表面214可允许模块化扩充件204通过任何合适的连接、例如螺纹连接、卡扣配合连接或压配合连接来接合关节盂部件202。凸台402可限定孔眼404,该孔眼404可接收从关节盂部件接合表面214延伸的突出部406。弯曲表面212可以形成圆顶状结构并且封装突出部406,以使得突出部406远离所述圆顶状结构的顶部朝向所述圆顶状结构的基部延伸。在一个示例中,突出部406可以包括一个或多个外螺纹,所述一个或多个外螺纹被构造成接合在孔眼404内形成的一个或多个内螺纹。另外,关节盂部件接合表面214和弯曲表面212可形成薄壁结构,该薄壁结构可允许主体206是柔性的。因此,主体206可以伸展以容纳不同尺寸的凸台。此外,关节盂部件接合表面214可形成一凹部,所述凹部包括与关节盂部件204的一部分(例如,凸台402)互补的锥形轮廓。
通过使模块化扩充件204和关节盂部件202作为模块化关节盂系统200的单独部件,关节盂部件202可在不干扰模块化扩充件204的情况下进行调节或更换。例如,在模块化关节盂系统200植入之后,可能在稍后需要修正。由于关节盂系统200的模块化性质,关节盂部件202可在不移除模块化扩充件204的情况下移除。
另外,模块化扩充件204可与具有不同尺寸和构造的关节盂部件202一起使用。例如,模块化扩充件204和关节盂部件202可以是包括多个模块化扩充件和关节盂部件的系统的部件。在外科手术期间,外科医生可选择最佳地顺应中央缺陷的尺寸、形状或其它方面的模块化扩充件204。各种模块化扩充件的突出部406和关节盂部件接合表面214可以是标准尺寸的,并且各种关节盂部件的凸台402和孔眼404可以是标准尺寸的,以使得模块化扩充件和关节盂部件可以混合和匹配以产生更适合患者的植入物。
例如,患者的中央缺陷可能是小的。因此,外科医生可选择与该中央缺陷具有相似的尺寸和形状的模块化扩充件204。通过能够选择适当尺寸的模块化扩充件204,可使在铰削过程期间需要移除的骨骼量或对关节盂的其它干扰最小化。这可以改善愈合时间以及使患者的疼痛和不适最小化。
模块化扩充件204可由聚合物、陶瓷、金属材料或其任何组合制成。例如,模块化扩充件204可由聚合物(例如维生素E稳定聚合物)注射模制而成,并且涂覆以多孔金属层210,如上文所述。另外,多孔金属层210可仅涂覆支柱208、弯曲表面212或其任何部分。
模块化扩充件204可使用任何数量的制造技术或技术的组合来制造。例如,主体206可以是注射成型的聚合物,其可以附接至形成支柱208和突出部406的金属部分,该金属部分可以由坯料材料加工而成。
关节盂部件202可包括一个或多个楔钉218。楔钉218可从关节盂接合表面216延伸。例如,楔钉218可从关节盂接合表面216延伸,以使得楔钉218中的一个或多个平行于支柱208。另外,楔钉218中的一个或多个可从关节盂接合表面216延伸,以使得楔钉218中的一个或多个不平行于支柱208。
楔钉218可以与关节盂部件202形成一体,或者可以是可移除地耦接至关节盂部件202的单独部件。例如,关节盂部件202的主体222可包括一个或多个孔洞,所述一个或多个孔洞可接收楔钉218。楔钉218可以螺纹连接、压配合、卡扣配合等至所述一个或多个孔洞中。另外,关节盂部件202的主体222和楔钉218可由连续材料形成(即,成一体)。例如,主体222和楔钉218可以由聚合物形成并且在诸如注射成型或直接压缩成型的单个操作期间形成。
楔钉218可以围绕模块化扩充件204以任何构造间隔开,并且可提供任何数量的楔钉218。如图2所示,楔钉218可以布置成三角形图案,例如等腰、等边、不等边或其它三角形图案。除了三角形图案以外,当存在四个或更多个楔钉时,楔钉218可以以正方形或矩形图案布置。
楔钉218可以包括翅片或沟棱224。沟棱224的数量可以在楔钉之间变化。例如,一个楔钉可具有三个沟棱,而另一个楔钉可具有两个沟棱。楔钉218和沟棱225可以由如本文所公开的多孔金属制成或涂覆以如本文所公开的多孔金属。楔钉218可以全部是相同长度的,或者楔钉218中的一个可以具有与至少一个其它的楔钉218不同的长度。
关节盂部件202可包括关节表面226。关节表面226可以允许肱骨头(自然骨骼或假体)关节连接并允许肱骨的一定范围的运动。关节表面226的轮廓可以是患者特异性的。例如,外科医生可使用患者关节盂的图像来指定关节盂部件202和关节表面226的形状和轮廓。关节盂部件于是可被制造成具有适于患者的关节表面226。
如本文所公开的,关节盂部件202可在外科手术期间从多个关节盂部件中选出。例如,一旦患者的关节盂和肱骨头被暴露,外科医生就可检查关节盂和肱骨头并选择多个关节盂部件中最紧密地匹配患者关节盂的几何形状的一个关节盂部件作为关节盂部件。例如,外科医生可选择其关节盂关节连接表面的曲率与患者的关节盂关节连接表面的曲率相似的关节盂部件。
图5示出了根据本文公开的至少一个示例的用于关节盂置换手术的方法500的流程图。方法500开始于阶段502,在阶段502中,可以对骨骼进行铰削。例如,如本文所公开的,关节盂的中央部分可被铰削。在铰削过程期间,围绕关节盂的中央部分的骨骼可保持不被铰削。例如,关节盂上结节或关节盂下结节中的一个或二者可在铰削过程期间保持不受干扰,从而保留自然骨骼。如本文所述,在铰削过程中所使用的铰削器可与模块化扩充件的弯曲表面的形状相匹配。另外,对骨骼进行铰削可包括在关节盂中钻出用于支柱和/或楔钉的孔洞。例如,铰削器可以包括导向钻头,所述导向钻头可以在关节盂中钻孔以接受楔钉。备选地,外科医生可根据需要钻出导向孔和用于楔钉的孔洞。
方法500可从阶段502前进至阶段504,在阶段504中,可组装模块化扩充件。在一个示例中,在植入之前,可从具有不同大小、形状、尺寸等的多个模块化扩充件中选择提供最佳解剖学配合的模块化扩充件。如本文所公开的,关节盂部件可压配合至模块化扩充件或旋拧至模块化扩充件中。
方法500可从阶段504前进到阶段506,在阶段506中,可植入组装的植入物。如本文所公开的,模块化扩充件可压配合、卡扣配合、旋拧或以其它方式紧固到关节盂的铰削部分。在植入期间,模块化扩充件的支柱可插入关节盂中以将模块化扩充件锚定到关节盂。植入关节盂部件可包括将关节盂部件固定到模块化扩充件。此外,关节盂部件的各种楔钉可在植入过程期间嵌入关节盂中。
备选地,模块化扩充件和关节盂部件可彼此独立地植入。例如,模块化植入物可在植入关节盂部件之前植入。一旦模块化扩充件被植入,关节盂部件就可被植入并附接至关节盂和模块化扩充件两者上。
模块化扩充件和关节盂部件可以是患者特异性的或者是植入系统的一部分。例如,在外科手术期间,外科医生可基于外科手术期间对患者关节盂的观察和测量从多个模块化扩充件和多个关节盂部件中选择模块化扩充件、关节盂部件或它们两者。
本领域技术人员将容易理解,在不偏离如所附权利要求中所表达的本发明主题的原理和范围的情况下,可以对为了解释本发明主题的性质而描述和示出的部件和方法阶段的细节、材料和布置进行各种其他改变。
Claims (13)
1.一种在肩部更换手术中使用的中央扩充件,该中央扩充件包括:
主体,所述主体包括第一弯曲表面和第二表面,所述第一弯曲表面被设定形状以与被铰削的关节盂的中央部分接合,所述第二表面与所述第一弯曲表面相反并限定被设定尺寸以接收关节盂部件的凸台的凹部;
在所述凹部内从所述第二表面延伸的突出部,所述突出部被设定尺寸以被接收在由所述关节盂部件的所述凸台限定的孔眼内;以及
从所述第一弯曲表面延伸的支柱,所述支柱被设定尺寸以被接收在形成于所述关节盂的所述中央部分中的孔眼中,
其中所述主体、所述突出部以及所述支柱是一体的,并且
其中所述主体和所述支柱中的至少一个包括多孔金属涂层。
2.根据权利要求1所述的中央扩充件,其中所述第一弯曲表面具有球根形形状。
3.根据权利要求1所述的中央扩充件,其中所述第一弯曲表面具有球形形状。
4.根据权利要求1所述的中央扩充件,其中所述第一弯曲表面针对特定患者成形。
5.根据权利要求1所述的中央扩充件,其中所述支柱包括带螺纹的部分。
6.根据权利要求1所述的中央扩充件,其中所述支柱包括带倒钩的部分。
7.根据权利要求1所述的中央扩充件,其中所述支柱是带沟棱的楔钉。
8.根据权利要求1所述的中央扩充件,其中所述凹部包括与所述关节盂部件的所述凸台互补的锥形轮廓。
9.根据权利要求1所述的中央扩充件,其中所述突出部包括一个或多个外螺纹,所述一个或多个外螺纹被构造成与设置在所述关节盂部件的所述凸台内的一个或多个内螺纹配合。
10.一种在肩部更换手术中使用的模块化关节盂系统,所述模块化关节盂系统包括:
关节盂部件,所述关节盂部件包括:
关节表面,
与所述关节表面相反的关节盂接合表面,和
从所述关节盂接合表面延伸的凸台;以及
模块化扩充件,所述模块化扩充件包括:
第一外表面,
与所述第一外表面相反并限定被设定尺寸以接收所述凸台的凹部的第二内表面,
支柱,所述第一外表面形成圆顶并被设定形状以与关节盂的铰削部分接合,所述支柱从所述第一外表面延伸并被设定尺寸以被接收在产生于所述关节盂中的孔眼中;以及
突出部,所述突出部从所述第二内表面延伸并被设定尺寸以被接收在所述凸台中的孔眼内,
其中所述突出部以及所述支柱是所述模块化扩充件的一体部分。
11.根据权利要求10所述的模块化关节盂系统,其中所述突出部包括阳螺纹部分,并且所述凸台中的孔眼包括用于接收所述阳螺纹部分的阴螺纹部分。
12.根据权利要求10所述的模块化关节盂系统,其中所述关节盂部件包括围绕所述凸台间隔开的多个楔钉。
13.根据权利要求10所述的模块化关节盂系统,其中所述模块化扩充件选自多个模块化扩充件,所述多个模块化扩充件中的每一个模块化扩充件被设定尺寸以填补不同尺寸的中央缺陷。
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