CZ309950B6 - Distraction device for implants - Google Patents

Abstract

The distraction device for implants, in particular for the replacement of major joints with the patients with not yet finished development of upper and lower limbs, consisting of an outside body, formed by an outside plastic protective shell (3) with an inside plastic insert (6) in which there is an inside body (2) inserted from one its end, on the head part (2.1) of which inside the outside body (1) there is a collar (2.1.1) created from its face (2.5), protruding into its anchoring groove (6.1) in the inside plastic insert (6), and there is a cavity (2.4) created inside the inside body, in which there is a pretensioned compression spring (10) arranged with its one end to cause a gradual extension of the inside body (2) from the outside body (1) after a transient at least partial fusing of the material of the inside plastic insert (6) in the area of the anchoring groove (6.1). In order to develop the required heat, the inside body (2) is provided at the collar (2.1.1) of its head part (2.1) with at least one ferromagnetic ring (12) to generate swirling currents in its material from the outside space using an inducer inducing the concentrated electromagnetic field and the outside body (1), connected with its other end directly with the metal part (4) of the implant, is before the exit of the inside body (2) from its inside space provided with an anti-rotation plug (8) against the rotation of the inside body (2) and an insulation seal (7), whereas the inside space of the outside body (1) is closed around the exit of the inside body (2) with a swivel nut (5). In order to eliminate the formation of induced currents there is at least one outside groove (4.1) and/or at least one inside groove (4.2) created in the metal part (4) of the implant and a lateral incision (5.1) in the swivel nut (5).

Description

Distraction device for implants

Field of technology

The invention relates to a distraction device for implants, intended in particular for lengthwise adjustable replacements of large joints in patients with the development of the upper and lower limbs that has not yet been completed and enabling their non-invasive and non-contact controlled lengthening.

Current state of the art

Currently, there are already a number of types of so-called "growing" endoprostheses for pediatric patients, for example with a total knee joint endoprosthesis, allowing their length to be adjusted, depending on the course of their continued growth. Length adjustment is usually done by mechanical means such as various threaded spindles, ratchet mechanisms and the like.

A significant disadvantage of all the above-mentioned endoprosthesis solutions, as well as other similar solutions, is in particular the necessity of repeated and often quite extensive surgical intervention to enable access to their setting mechanism, and this with every change in the length setting of the prosthesis, which places additional demands on the patient and a high risk of infection.

This disadvantage is to a certain extent eliminated, for example, by the solution according to patent file US 2004/0193266, the subject of which is a prosthesis for children and adolescents, the length of which is adjusted by a magnetic field generated outside the previously operated limb. Also known is the solution according to file EP 1642550, the subject of which is an adjustable remote-controlled orthopedic prosthesis with telescopic segments and linear electric drives.

In addition to these examples of non-invasive electrically, magnetically or electromagnetically adjustable prostheses, a solution according to US 5626581 is also known. and extension mechanism. However, in most of these cases, these are rather complex and expensive solutions, which can limit their applicability.

To a certain extent, simpler solutions are known from documents US 5071435 and US 5466261. The subject of document US 5071435 is a hydraulically extendable bone prosthesis, consisting of a cylinder closed on one side, equipped with a retractable piston, under which a bag is placed in the cylinder, filled with liquid as needed, or . according to the required displacement of the piston by the filling valve in the cylinder wall from its outer space. The subject of file US 5466261 is a non-invasively extendable prosthesis for children with incomplete physical growth, created on a similar principle, in which a hydrogel is used in the cylinder instead of a bag, changing its volume according to the amount of physiological solution contained in it and thus determining the size of the piston extension. The disadvantage of these solutions may be the limited adjustability of such prostheses, given the size of the bag used or the amount of hydrogel used and its absorption capacity, and the increased risk of their failure.

A separate device, suitable for these longitudinally adjustable implants and enabling the mutual movement of two bodies relative to each other, is then known, for example, from the document US 5720746. The essence of this device is that it contains two members, each of which is combined with one of these two bodies, and a means of deriving the necessary force to produce this motion. One of these members is provided with a collar projection and the other member with a cavity, which at least partly corresponds to at least part of this projection. Both of these members are movably mounted relative to each other such that the projection engages the cavity, the cavity member being made of a material which can be changed by induction heating from a non-deformable hard solid state to a deformable soft pasty state, while

- 1 CZ 309950 B6 member with a protrusion is made of essentially hard material. The device is also provided with means for controlling the change of at least one part of the material surrounding the cavity from the first state to the second state and vice versa. Similar devices are further described in documents US 2003/0032958 or WO 2019/227859. The disadvantage of these devices, however, is that the mutual movement of the two bodies relative to each other is very difficult to control and predict with these devices due to the undefinable contact between the collar protrusion and the material of the magnetic core used in them, while when they are used with length-adjustable implants there is a risk of readjustment due to the transfer of a significant amount of heat from these devices to the metal parts of the implants as well as the risk of burning patients.

The task of the present invention is to further expand the assortment of these length-adjustable replacements, or their distraction devices and especially the removal of their hitherto existing disadvantages.

The essence of the invention

This task is largely solved by a distraction device for implants, especially for replacements of large joints in patients with incomplete development of the upper and lower limbs, comprising an external body, formed by an external plastic protective box with an internal plastic insert, in which one of its ends is inserted an inner body, on the head part of which inside the outer body, a collar is formed from its face, protruding into its anchoring notch in the inner plastic insert, and a cavity is formed inside the inner body, in which a pre-tensioned compression spring is arranged at one end to derive the gradual extension of the inner body body from the outer body after temporary at least partial melting of the material of the inner plastic insert in the area of the anchoring notch, according to the present invention.

The essence of the invention is that the inner body is equipped with at least one ferromagnetic ring at the collar of its head part to generate the necessary heat, in the material of which eddy currents are generated with the help of a concentrated electromagnetic field derived from the inductor, and the outer body, which is adapted at its other end for connection directly to the metal part of the implant, before the internal body exits its internal space, it is equipped with an anti-rotation plug against the rotation of the internal body and an insulating seal to create a barrier against the spontaneous ingress of body fluids into the internal space of the external body, which could otherwise occur in the event of pressure gradient, caused by the extension of the inner body and the drop in pressure inside the outer body. The inner space of the outer body is closed around the outlet of the inner body with a slip nut, ensuring the static storage of all these components when the inner body is pushed out, while in order to eliminate the occurrence of induced currents, at least one outer groove and/or at least one inner groove is created in the metal part of the implant, and in cover nut side cut. The part of the inner body protruding from the outer body can then serve, for example, directly as an intramedullary stem or can be adapted as needed for connection with any other components of subsequent joint or other replacements.

The essence of the invention further consists in the fact that the inner body is advantageously provided with three ferromagnetic rings in its cylindrical head part for better transfer of heat to its collar, which are arranged one behind the other and pressed into its inner space while overlapping, namely the first ferromagnetic ring with a flange, abutting on the collar from the face of the inner body, and the second and third ferromagnetic ring located behind it. At the same time, opposing grooves are created in the head part of the inner body. All ferromagnetic rings are integral in this case.

However, ferromagnetic rings can in some cases, e.g. when using a distraction device for intramedullary nails, be placed on the outer shell of the cylindrical head part of the inner body close to its collar, and in these cases they can also be composed of individual segments.

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The pre-tensioned compression spring, which rests with its one end on the bottom of the cavity formed in the inner body, is also advantageously placed with its other end in the metal part of the implant, however, it can rest with these ends on other parts of the structure to create its sufficient preload. In the axis of the pre-tensioned compression spring, its guide rod is then advantageously arranged, preventing the unintended deflection of the pre-tensioned compression spring when it is compressed. To eliminate unwanted induced currents, this guide rod of the pre-tensioned compression spring can be at least partly hollow and provided with one longitudinal cut.

The inner body is behind its head part in the area below the anti-rotation plug, corresponding in length to the maximum extension of the inner body, also advantageously formed by an octagonal part and an end part further connected to it, while the head part is cylindrical. The head part with ferromagnetic rings essentially has a melting function, the octagonal part in combination with an anti-rotation plug has an anti-rotation function, and the end part has a fixation function.

The essence of the invention further consists in the fact that the metal part of the implant is advantageously provided with a heat-insulating ring at its end inside the outer body, preventing the transfer of heat to its material.

Compared to previously known similar devices, which work on the principle of melting the plastic material inside the outer body in the place of anchoring of the inner body placed in it and re-anchoring it after the inner body has been partially extended, the distraction device according to the invention enables the accurate dosing of heat to the anchoring of the inner body in the outer body and thus and reliable control of its gradual extension according to the immediate need, with a length deviation of max. ±1 mm. At the same time, the danger of burning soft tissues in the places of the implant during its extension is completely eliminated.

Clarification of drawings

The invention is further explained in more detail by the drawings of an exemplary embodiment of the distraction device for implants according to the invention, which shows:

Fig. 1 - distraction device in elevation;

Fig. 2 - distraction device in section B - B from Fig. 1;

Fig. 3 - distraction device in section A - A from Fig. 1;

Fig. 4 - internal body of the distraction device in elevation and partial section;

Fig. 5 - distraction device in section C - C from Fig. 2.

An example of the implementation of the invention

The distraction device in the shown exemplary implementation of the invention is intended for replacement of large joints in pediatric patients with oncological findings and, as can be seen from Fig. 1 and Fig. 2, includes an outer body 1, replacing the removed tumorous tissue, and an inner body partially inserted into it 2, the outer end of which serves as a stem, implanted into the medullary cavity of the remaining preserved part of the long bone. The outer body 1 consists of an outer plastic protective box 3, which is firmly connected by a threaded connection to the metal part 4 of the implant, equipped with an insulating ring 11 and performing the function of a joint end, into which a hollow guide rod 9 is inserted together with a pre-tensioned compression spring 10. The other end of the compression spring 10 rests on the bottom 2,4,1 of the cavity 2,4. formed in the inner body 2. During assembly, a plastic insert 6 is gradually pushed onto the inner body 2, followed by an insulating seal 7, an anti-rotation plug 8 and finally a slip nut 5. Geometry

-3 CZ 309950 B6 of the inner space of the outer body 1 is designed in such a way that any negative pressure inside the outer body 1 does not represent a significant reduction in the effectiveness of the pre-tensioned compression spring 10.

The internal body 2 is, from the external view, as can be seen more closely from Fig. 4, divided into three main areas, namely a cylindrical head part 2.1 with a collar 2.1.1. protruding into its anchoring notch 6,1, formed in the inner plastic insert 6, and two opposite grooves 2,1,2, to the octagonal part 2,2 and to the end part 2,3, which in this case the inner body 2 directly interacts with bone tissue.

The cavity 2,4, located inside the inner body 2, also serves to store three ferromagnetic rings 12 pressed while hot with an overlap. The first ferromagnetic ring 12,1 is equipped with a flange 12,1,1 that fits from the face 2,5 of the inner body 2 to the collar 2,1,1 and its length extends beyond the opposite grooves 2,1,2 on the head part 2,1 of the inner body 2. The second ferromagnetic ring 12,2 and the third ferromagnetic ring 12,3 already have only a tubular shape.

Since both the metal part 4 of the implant, as well as the hollow guide rod 9 and the cover nut 5 are components made of metal materials, in order to eliminate the occurrence of unwanted induced currents inside their material, as can be seen more closely from Fig. 3 and Fig. 5, the hollow guide rod 9 provided along its entire length with one longitudinal section 9.1. the cover nut 5 with a side cut 5.1 and the metal part 4 of the implant with two types of grooves 4.1 and 4.2, The outer groove 4.1 interrupts the otherwise closed current loop on the outer surface to maintain the rigidity of the structure only once, the inner grooves 4.2 interrupt this closed current loop under the threaded connection with the outer plastic box 3 of the outer body 1 twice.

Such essentially cutting of the metal part 4 of the implant, the guide rod 9 and the cover nut 5 allows, with a specific setting of working frequencies, to transpose the occurrence of induced currents to the center of the distraction device towards the ferromagnetic rings 12. The heat generated in the closed loop areas, i.e. in the areas between the grooves 4.1 and 4.2. is thus cooled by thermal conduction to the metal part 4 of the implant after the disappearance of the electromagnetic field in the vicinity of the ferromagnet. During the initial assembly of the distraction device, the compression spring 10 is compressed and pre-tensioned by inserting the inner body 2 together with the plastic insert 6, the anti-rotation plug 8 and the insulating seal 7 into the outer body 1, while at the moment when the flanges 12,1,1 of the first ferromagnetic ring come into contact 12,1 and the insulating ring 11, the plastic insert 6 together with the anti-rotation plug 8 is secured by the union nut 5. The whole solution is thus characterized by the force action of the protruding collar 2,1,1 of the inner body 2 on the plastic insert 6 when the compression spring 10 is compressed.

The distraction device works in two states, namely in the working state, when the inner body 2 is allowed to move in the direction of the B-B section axis, i.e. in the direction of the force of the compressed spring 10, and in the rest state, when this movement is not allowed. The first state is used to lengthen the distraction device and thus the entire restoration, and the second state is used to maintain the extended length. The transition between the two states is conditioned by the presence of an electromagnetic field with specific parameters, respecting the depth of penetration of the induced eddy currents, concentrated in the direct vicinity of the ferromagnetic rings 12.1, 12.2, 12.3. Such parameters can be obtained using a frequency in the range of 8 to 20 kHz.

The electromagnetic field generates eddy currents both inside the ferromagnetic rings 12.1, 12.2 and 12.3, as well as in all other metal parts. However, the electromagnetic field is several times concentrated in the ferromagnetic parts, which is the key to the proper functioning of the entire system. The ferromagnetic rings 12.1, 12.2, 12.3 then, thanks to the external full-surface contact with the inner surface of the cavity 2.4 of the inner body 2 in the region of its head part 2.1 and partially its octagonal part 2.2, transfer the generated heat into the protruding collars 2.1.1. Opposite grooves 2,1,2 in the head part 2,1 of the inner body 2 ensure the transformation of the induced eddy currents directly into the material of the first ferromagnetic ring 12,1 with the flange 12,1,1. From this point of view, the first ferromagnetic ring 12.1 has both a "concentrating" and above all a "heating" function.

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The remaining second and third ferromagnetic rings 12.2. 12.3 has a primarily "concentration" function.

The contact pressure between the collar 2,1,1 on the head part 2,1 of the inner body 2 and the plastic insert 6 causes heat to be transferred to the material of the plastic insert 6 and its gradual softening. Due to the action of the force of the pre-tensioned compression spring 10 on the bottom 2,4,1 of the cavity 2,4 of the inner body 2, this softening will enable the release of the protruding collar 2,1,1 from its original anchoring notch 6,1 in the plastic insert 6 and the desired movement of the inner body 2 away from the outer body L This movement is associated with the gradual flow around the protruding collar 2,1,1 of the melted material of the plastic insert 6, while as soon as the electromagnetic field disappears from the surroundings of the ferromagnet or of ferromagnetic rings 12.1. 12.2. 12.3. the generated heat is gradually removed to its surroundings and the material of the plastic insert 6 gradually solidifies again, whereby in it, or in the newly created anchoring notch 6,1, the collar 2,1,1 and thus the entire inner body 2 is anchored in a new, more extended position, and the entire distraction device goes into a state of rest until the implant needs to be extended again. Places of transitions of the head part 2.1 and the octagonal part 2.2. as well as the edges of the opposite grooves 2, 1, 2 in the head part 2, 1 of the inner body 2 are smoothed and all sharp points that could cause the plastic insert 6 to tear off unintentionally are removed.

The outer protective plastic box 3 of the outer body 1 is made of PEEK plastic material with the trade name Optima and its plastic insert 6 of UHMWPE material with lower temperature and mechanical resistance. The inner surface of the ferromagnetic rings 12.1, 12.2, 12.3 is provided with a NiT alloy coating or a DLC layer. Both variants ensure the creation of biocompatible and heat-resistant ferromagnetic material insulation. The wall thickness of the ferromagnetic rings 12.1, 12.2, 12.3 is 0.5 mm, their inner diameter is 8.7 mm and the length is 10 mm. The metal part 4 of the implant is made of titanium alloy TÍ6AL4V ELI, with its outer groove 4.1 and inner groove 4.2. as well as the opposing grooves 2,1,2 of the cylindrical part 2,1 of the inner body 2 of the distraction device are insulated with silicone glue.

Industrial applicability

The distraction device according to the invention can be widely used as a universal construction module both for length-adjustable replacements of e.g. hip, knee or shoulder joints and, if necessary, for other length-adjustable implants, such as intramedullary nails, especially for pediatric patients with oncological disease.

Claims (6)

1. Distraction device for implants, especially for large joint replacements in patients with incomplete development of the upper and lower limbs, comprising an outer body (1), consisting of an outer plastic protective box (3) with an inner plastic insert (6), in which the an inner body (2) is inserted into one of its ends, the head part (2.1) of which inside the outer body (1) has a collar (2.1.1) formed from its face (2.5), protruding into its anchoring notch (6.1) in the inner plastic insert ( 6), and inside the inner body (2) a cavity (2.4) is formed, in which a pre-tensioned compression spring (10) is arranged at one end for inducing the gradual extension of the inner body (2) from the outer body (1) after temporary at least partial melting of the material of the inner plastic insert (6) in the area of the anchoring notch (6.1), characterized by the fact that the inner body (2) is provided with at least with one ferromagnetic ring (12), and the outer body (1), which is connected by its other end directly to the metal part (4) of the implant, is equipped with an anti-rotation plug (8) against rotation before the inner body (2) exits its interior of the inner body (2) and an insulating seal (7), while the inner space of the outer body (1) is closed around the outlet of the inner body (2) with a cover nut (5) and to eliminate the occurrence of induced currents, at least one outer groove (4.1) and/or at least one inner groove (4.2) and a side cut (5.1) in the cover nut (5). 2. Distraction device according to claim 1, characterized in that the inner body (2) is provided in its head part (2.1) with three ferromagnetic rings (12) arranged one behind the other and pressed into its inner space while hot with an overlap, namely the first a ferromagnetic ring (12.1) with a flange (12.1.1), abutting from the face (2.5) of the inner body (2) to the collar (2.1.1) of its head part (2.1.1) and a second ferromagnetic ring (12.2) located behind it, and by the third ring (12.1), while opposite grooves (2.1.2) are formed in the head part (2.1) of the inner body (2). 3. Distraction device according to claims 1 and 2, characterized in that the inner body (2) is formed behind its head part (2.1) in the area under the anti-rotation plug (8) by an octagonal part (2.2) and an end part (2.3) connected to it ), while the head part (2.1) is cylindrical. 4. Distraction device according to claims 1 to 3, characterized in that one end of the pre-tensioned compression spring (10) is placed in the metal part (4) of the implant and the other end rests against the bottom (2.4.1) of the cavity (2.4) formed in inner body (2), while its guide rod (9) is arranged in the axis of the pre-tensioned compression spring (10). 5. Distraction device according to claims 3 and 4, characterized in that the guide rod (9) is hollow and is provided with a longitudinal section (9.1) in at least one of its parts. 6. Distraction device according to at least one of the preceding claims 1 to 4, characterized in that the metal part (4) of the implant is provided with a thermally insulating ring (11) at its outer end.