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CN1348344A - 人工髋关节的股骨颈内假体 - Google Patents

人工髋关节的股骨颈内假体 Download PDF

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Publication number
CN1348344A
CN1348344A CN99810909A CN99810909A CN1348344A CN 1348344 A CN1348344 A CN 1348344A CN 99810909 A CN99810909 A CN 99810909A CN 99810909 A CN99810909 A CN 99810909A CN 1348344 A CN1348344 A CN 1348344A
Authority
CN
China
Prior art keywords
adapter
femur
support
bearing
femoral neck
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CN99810909A
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English (en)
Other versions
CN1205901C (zh
Inventor
贾迈尔·巴鲁德
克劳斯·布莱梅尔
赖讷·克莱西格
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Aap Implantate AG
Original Assignee
Aap Implantate AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
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Publication of CN1348344A publication Critical patent/CN1348344A/zh
Application granted granted Critical
Publication of CN1205901C publication Critical patent/CN1205901C/zh
Anticipated expiration legal-status Critical
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    • A61B17/74—Devices for the head or neck or trochanter of the femur
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Abstract

本发明涉及一种用于人工髋关节的股骨颈内假体,包括用于安装动关节(20)的转接器(2)、在股骨(1)近中侧导引转接器(2)的支承环(3)、以及在股骨(1)的旁侧导引转接器(2)的端支承(5)。本发明的目的是延长用于假体的骨组织的承载能力。为此将假体设计为,转接器(2)设有支承肩(21)和杆(22),杆大体沿大腿骨颈的延伸轴线(15)插入股骨(1);支承环(3)以其支承面(33)仅支承在股骨(1)的近中侧;在用于导引转接器(2)的支承环(3)上制有支承肩(21)的轴向止挡(31)和相对于支承面(33)向旁侧错移用于杆(22)的孔(32);端支承(5)仅仅固定在股骨的旁侧,以及,用于杆(22)的导引孔(52)可与转接器(2)的轴线(15)对齐。

Description

人工髋关节的股骨颈内假体
本发明涉及一种用于人工髋关节的股骨颈内假体，包括用于安装动关节的转接器、在股骨近中侧轴向和径向导引转接器的支承环、以及在股骨的旁侧导引转接器的端支承。
这种股骨颈内假体已知有不同的形式。
例如DE2724234A1公开了一种这样的假体。安装动关节的转接器设有支承肩以及一根杆深插入股骨内。大体锥形的支承肩座落在一支承环上，支承环通过其外边缘的形状固定在大腿骨颈上。端支承大面积地从外部用螺钉固定在股骨的旁侧上。
通过此端支承，一个带穿过股骨的长杆的长螺钉借助螺纹固定在转接器上。螺钉有一个长的导引段，它形封闭地与在转接器杆内的一个相应的长孔相配。此长螺钉一方面将转接器与端支承夹紧，另一方面将转接器与支承环夹紧。没有这种轴向夹紧，转接器便没有能力将大的负载可靠地传入股骨内。
这种假体有许多缺点。皮质被假体的一些部分大面积包围的地方在安装好假体后便不再得到充分的保养。皮质这些部分的质地发生不利的变化。皮质不再能承受通常出现的力。因此这种假体的工作能力维持的时间有限。
在端支承与支承环之间持续存在的股骨夹紧导致骨头永久变形并因而使假体松动。由于夹紧使骨头持续受载尤其导致在加压面上的皮质受损。降低了它的抵抗力。假体的工作能力经过较短的时间便不再能够保证。
EP207985B1也介绍了一种类似的假体。在这里为转接器配设的支承体设计为棱柱形体，它形封闭地装在股骨内的一个预先准备好的相应的槽中。这种棱柱形支承体用来将通常经动关节作用在假体上的力，以一个较大的面积和按一个最佳的传输角，传入皮质的一些大体垂直的部分中。
然而在这里也有缺点，此棱柱形的支承体只有当它在股骨的另一个旁侧借助于螺钉连接装置朝端支承夹紧时才能履行其功能。
前面已指出的一些缺点在这种设计中同样存在。在本方案的情况下，除此之外造成的骨头上大的骨质损失也是严重的缺点。在普通的负载以及必要的夹紧力的作用下，这种锥形的支承体导致股骨附加的变形。
端支承与转接器通过一个长的相配衬套刚性连接引起股骨附加地受损。因此，这种假体的持续工作时间同样是很有限的。
Gamal Baroud先生在Chemnitz工业大学的博士论文(97年12月12日答辩)中建议了另一种设计方案。在这里，转接器同样制有一支承肩。支承肩在其外端过渡为一根一直延伸到股骨另一侧并优选地有有限弹性的杆。
如此设计的转接器置入一个围绕着杆和支承肩的导套内。此导套的组成部分包括支承环、端支承和在这两个支承部分之间的衬套状弹性连接装置。
支承环在一个旋转对称的槽内有一个用于支承肩的轴向止挡和有一个转接器杆用的孔。在导套的另一端设所谓的端支承，它沿径向形封闭地固定在旁侧皮质内一个相应的孔中。支承环和端支承通过直径较大的密绕的套筒状螺旋弹簧有有限弹性地互相连接起来。
如此组成的导套从近中侧装入股骨的一个较大的孔中。与此同时，支承环沿径向的凸缘横向于导套的轴线方向贴靠在皮质的一个经加工的对应的支承面上。
随后安装的转接器在此导套内以其支承肩支持在支承环内的止挡上并沿径向导引。
采用这种导套的结构和转接器杆有限的弹性设计以及必要时可插入转接器与导套之间的弹簧垫圈，可以吸收在假体内部的运动以及可能出现的峰值负载并大面积地传入股骨。
业已证明的严重缺点是，在一定的条件下横向于转接器轴线作用的力的较大部分，至少在愈合前，传入股骨较软的海绵状结构中。由此限制了假体的初始稳定性。
另一个缺点是较高的生产成本以及比较大量的必须插入股骨内的异体材料。必须去除比较多的股骨部分也是不利的。然而决定性的缺点在于支承环与端支承之间必要的连接装置。
在这种设计方案中端支承在旁侧皮质内开始时的压配合和此端支承以后的愈合，也会导致在股骨内和在股骨与假体之间接触部位夹紧。
这些应力虽然比前面已说明的假体程度上要小得多，但仍然会造成骨组织受损并因而降低了假体的使用寿命。
因此本发明的目的是建议一种股骨颈内假体，它为了固定假体构件和当受一般的负荷时避免夹紧股骨。本发明应创造一些前提条件，借此可以降低在假体内部的局部峰值负荷。
在假体与皮质支承部分之间的接触面应这样设计，亦即应能保证在假体必要的持续工作期间骨组织的自然保养。
本发明的此目的通过权利要求1的构件以出人意料的方式达到。
通过在支承环与端支承之间最终有效的非刚性连接，如同处于自然的条件下那样，将负荷传入近中侧的皮质内。完全避免股骨横向于其纵轴线的夹紧。力主要传入稳定的近中侧皮质。即使处于不利的负荷状况，也不会在假体与股骨之间的接触部位产生任何令人担忧的拉力。这种狭窄的接触面始终可被所供应的体液达到。因此能在长得多的时间内避免破坏骨组织。
由于取消了在近中侧和旁侧皮质之间的机械连接装置，所以股骨在其总体上可以按自然的方式变形。这对于维持骨组织的功能有显著的贡献。
附加地转接器在支承环和端支承内防止沿轴向朝近中侧方向的运动，由于在人体内在那里存在肌腱和肌肉因而并不需要。
此假体能方便地制造，而且可以没有什么困难地适应不同大小和形状的股骨。
此假体有必要的初始稳定性。
采用转接器和支承环的支承面具有一个适当的中央锥角的设计(按权利要求2)，保证通常经动关节传入的负荷能在最佳条件下传入支承的皮质内。当过载时通过支承环内的孔保证附加地保险。
支承环在近中侧皮质上的支承面(按权利要求3)允许将正常的负荷沿股骨纵向最佳地导入。支承环本身(按权利要求4)在转接器支承肩与支承面之间的区域内朝皮质方向是弹性的。从而也可以降低其不可避免的峰值负荷。
权利要求5说明了支承环有利的弹性设计。通过选择缝的深度可以使弹性适应于患者的体格。
按权利要求6所述的支承环，保证除了期望的弹性特性外，在将力传入股骨内时还能对峰值负荷有一定的缓冲。
按权利要求7和8所述的端支承的设计形式，允许在端支承与支承的皮质之间接触面积最小的情况下端支承是一种质量小的结构。皮质一直到支承面的中央能得到充分保养。导引转接器杆的孔的轴线在这种情况下可以从一开始就按期望的角度延伸。孔的球形(按 8)允许在当地进行一定量的修正。
按权利要求9所述的端支承结构，允许孔在较大的范围内适应于杆可在孔内最佳地运动。
采用按权利要求10所述的端轴承的结构以及其按权利要求11所述的设计，可以做到即使在最极端的条件下也能保持假体的工作能力。然而在这方面重要的是，在衬套的轴向止挡与端支承之间始终存在足够的间隙以及衬套不会自行与杆脱开。
下面应借助实施例进一步说明本发明。在附图中表示：
图1通过带已置入的股骨颈内假体的股骨头部的剖面；
图2沿支承环轴线看它的视图；
图3股骨颈内假体的第二种方案；
图4支承环弹性设计的改型；
图5设计为摆动滑动轴承的端支承；以及
图6转接器支承肩和支承环另一种有利的设计。
在图1中，按与大腿骨纵轴线14成一角度16装入股骨颈内假体。股骨颈内假体的轴线15大体与健康的大腿骨颈的轴线一致。在这里角度16(图1)的大小在40°与50°之间。
股骨颈内假体包括一个转接器2，它在其头部区内的一个略有锥形的部分上安装一动关节20。在此动关节20的下方附近，在转接器2上设计一支承肩21。
转接器2直接在支承肩21之后过渡为杆22。杆22与转接器2头部区相比直径小得多。值得追求的是，此杆22在最大应力区能有限量地弹性弯曲。
在本例中，在杆22下端制有螺纹段，螺纹衬套23可旋在此螺纹段上。衬套23优选地有与杆22相同的外径。此外，螺纹衬套23在其头部有一个起轴向止挡231作用的凸缘231。相应的型面(槽232)用来借助于工具旋转衬套23。
衬套23主要用于允许在一定范围内改变杆22的长度，使杆22不会过多地在股骨旁侧伸出。衬套23也可以用一种滑动性特别好的材料制造，使端支承5尽可能无须受任何轴向力。
作为将转接器2置入股骨1头部中的准备，首先加工一个用于杆22的孔。通过此孔确定转接器2的轴线15相对于股骨1纵向中心线14的角度16。
加工好此孔之后，在股骨1近中的一侧加工一个与支承环3相配的优选地大体锥形的与轴线15同心的槽。此槽的锥角30在槽的区域内可以是不同的。在近中的皮质11区内，亦即在支承环3以其支承面33贴靠在表面111上的地方，这一角度30优选地选择为大于120°。
通过制备此锥形槽，在近中的皮质11上形成一个支承面111，它既可以承受平行于轴线15的力，也可以承受横向于此轴线15的力。决定性的主要是支承面111的下部，它可以承受沿股骨1纵向作用的力。
在此锥形槽内装入一个弹性有限的并因此壁较薄(取决于预想的负荷)的锥形支承环3。此支承环3相对于支承面111有一个向外和向下亦即朝大腿骨纵轴线14方向错移的凸缘状止挡31，转接器2的支承肩贴靠在此止挡31上。
在止挡31邻近的孔32或支承环3中另一个内部的环形槽，保证转接器2在支承环3内的径向定心。在支承环3内朝旁侧方向错移的孔32，保证在出现大的径向负荷时支承环3始终到处贴靠在皮质11的表面111上。
在靠外的或旁侧的皮质12处，同心于轴线15地再加工一个更大的孔，它安装端支承5。此孔恰当的是与在此区域内皮质12中央的外轮廓垂直地定向，以便端支承5的平凸缘53尽可能最佳地支靠在皮质12上。
在最简单的情况下端支承5以压配合置入孔中。若端支承5与旁侧皮质12的接触面设计为略凹，则在端支承5有高度的位置稳定性的情况下可以减小在安装状态与皮质12的接触力。
端支承5在中央区有一孔52，它的轴线与杆22的轴线15对齐。
业已证实有利的是，此孔52或设计为球形，或在此部位设一种类型的万向球接头(图5中61、62)，以便能补偿在外侧皮质12中的孔的轴线与转接器2轴线15之间通常不可避免的角度51或63。
孔52可以直接形封闭地导引杆22，或通过一个固定在杆22上的螺纹衬套23形封闭地导引杆22。
在股骨1配备有支承环3和端支承5(6)的头部内，现在可将转接器2从近中侧那里装入，以及，如果需要可通过从外侧装上螺纹衬套23并沿轴向保险(不是夹紧！！！)。
通常作用在动关节20上的力F(力的方向可在一定范围内变化)，通过支承肩21和在皮质11上与轴线15成锥形的支承面111由股骨1的一些有最强支承能力的部分承受，亦即由皮质11承受。完全避免在股骨内部的应力。
为了避免尤其在支承环3与支承面111之间极端的峰值负荷，恰当的是可在动关节20与上述支承面111之间设弹性元件。
在这里壁较薄的支承环3已经提供了一定的弹性。必要时还可以使挠性的大小与具体患者的体格相匹配，为此，如图2所示，在支承环3内加工径向缝34。这些缝34允许尤其在支承面33的区域内相对于在支承肩21的310处的止挡有或大或小的弹性。
附加的弹性还通过在转接器2上的杆22比较小的直径来保证。通过用箭头F表示的正常的负荷经由动关节20的轴线和由于端支承5的阻力，从下方作用在支承肩21上的力，使得转接器2绕在支承肩21附近的孔32内径向支承的作用点略有弯曲。采用上述这些设计为弹性的构件，使股骨颈内假体在其总体上获得类似于健康股骨1的弹性。
此股骨颈内假体的另一个优点在于，皮质11、12一律狭窄的、力在其中传入股骨1的区域，或从内部经海绵状结构13或从外部均可通过体液供应获得机能的物质。在这些有限的负荷区内即使假体经长期使用也完全不用担心皮质11、12的衰退。
图3表示了股骨颈内假体另一种实施例。此假体的结构在支承环3的区域和在端支承5的区域，类似或相同于借助于图1已说明的举例。
在这里，转接器2的杆22′直至其最外端有相同的直径以及没有螺纹。它直接在端支承5的孔52内滑动。在这里，孔52设计成略呈球状，所以可以修正小的角度偏差51。
在此方案中，杆22′在置入前准备好较大的长度。它的长度在安装转接器2的准备工作结束后确定，并设计为使它在股骨1旁侧的自由伸出量是有限的。
图4表示支承环3′弹性设计的另一种方案。在这里，转接器2′的支承肩21′朝近中侧方向错移。在此支承肩21′与支承环3′之间插入一个弹簧环4，弹簧环可制有一个缝。通过弹簧环4支承在支承环3′的内锥体内，弹簧环可以与一个有有限弹性的支承环3′配合作用，从而获得沿轴向以及横向于此轴线15的附加的弹性。转接器2′略有加长的杆22″保证得到附加的弹性。
图5表示了端支承6的一种实施方案，它可以代替端支承5使用。在这里置入外侧皮质12中的端支承6由导环61和滑环62组成。导环61借助紧配合压入或卡固在皮质12内。导环在其内侧设计有凹的球形表面，滑环62可摆动地在其中导引。滑环62有一个中心孔64，它与杆22′、22″的直径或与衬套23的直径一致。滑环允许调整在一定范围内的任意角度63。
端支承6这种设计的优点在于，假体的杆22′始终可无应力地导引。与通常差别很大的股骨1外轮廓的匹配以及与股骨1内用于转接器2的孔可能的偏差角的匹配，可以始终保证具有高的精度。
图6表示本发明的一种特别有趣的设计。支承环3″贴靠在皮质11平的表面111′上。转接器2″的支承肩21″设计为扁平的锥形环，并支承在支承环3″的凸缘上同样设计为锥形的表面31″上。
孔32″具有一个略大的间隙地导引转接器2″的杆22，所以转接器2″的定心在正常的条件下通过锥形的支承肩21″并结合支承环3″的锥形止挡面31″实现。
只有在过载时孔32″才起转接器2″径向导引的作用。从支承环向股骨沿径向的传力，在这种情况下得到去支承环3″的毂的过渡区的支持。

Claims (11)

1.用于人工髋关节的股骨颈内假体，包括用于安装动关节(20)的转接器(2)、在股骨(1)近中侧轴向和径向导引转接器(2)的支承环(3)、以及在股骨(1)的旁侧导引转接器(2)的端支承(5)，其特征为：转接器(2、2′、2″)设有一个面朝股骨(1)的支承肩(21)和一根大体沿大腿骨颈的延伸轴线(15)插入股骨(1)的杆(22、22′、22″)；支承环(3)仅仅支承在股骨(1)的近中侧，为此它以其凸缘(支承面33)支承在近中侧皮质(11)经加工的支承面(111)上和以其盘毂支承在股骨(1)内部；在用于导引转接器(2)的支承环(3)上制有转接器(2)支承肩(21)的轴向止挡(31)，以及相对于支承面(33)向旁侧错移用于转接器(2)杆(22)的孔(32)；端支承(5)仅仅在股骨(1)旁侧主要在旁侧皮质(12)上固定，以及在端支承(5，6)中用于转接器(2)的导引孔(52、64)有效的轴线可与转接器(2)的轴线(15)对齐。
2.按照权利要求1所述的股骨颈内假体，其特征为：转接器(2)设有一锥形支承肩(21″)，它与支承环3″凸缘上的一个设计成内锥体的止挡面(311)相配，转接器的杆(22)有间隙地插入支承环(3″)的孔(32″)中。
3.按照权利要求1或2所述的股骨颈内假体，其特征为：支承环(3、3′)的支承面(33)相对于转接器(2)的轴线(15)有一个在120°与160°之间朝近中侧方向张开的中央锥角(30)。
4.按照权利要求1所述的股骨颈内假体，其特征为：支承环(3、3′)在支承肩(21、21′)的定位面与支承面(33)之间设计为朝支承面(111)方向有有限弹性。
5.按照权利要求1至4之一所述的股骨颈内假体，其特征为：支承环(3、3′)的凸缘在其圆周区上有至少一个优选地径向的缝(34)。
6.按照权利要求1所述的股骨颈内假体，其特征为：支承环(3′)制有一个基本上非弹性的内锥形凸缘；以及，在转接器(2)的支承肩(21′)与此锥形凸缘的内锥体之间装有一个至少轴向弹性的弹簧环(4)。
7.按照权利要求1至6之一所述的股骨颈内假体，其特征为：端支承(5、5′、6)大体垂直于股骨(1)表面形封闭地穿过股骨(1)旁侧的皮质(12)；以及端支承(5、5′、6)有一个导引转接器(2)杆的孔(52)，它的轴线(15)相对于端支承(5、5′、6)的轴线倾斜一个在5°与30°之间的角(51；63)。
8.按照权利要求1至7之一所述的股骨颈内假体，其特征为：端支承(5、5′)配备有用于端支承(5、5′)在皮质(12)内转动的型面；以及，孔(52)定向在转接器(22)杆的轴线(15)可能的位置上并设计成球形。
9.按照权利要求1所述的股骨颈内假体，其特征为：端支承(6)由具有内部球形导引面的外导环(61)和可装入导环(61)并有一个用于转接器(2)杆(22)的孔的球形滑环(62)组成。
10.按照权利要求1至6所述的股骨颈内假体，其特征为：为杆(22)的外端配设一个可拆的端轴承(螺纹衬套23)。
11.按照权利要求10所述的股骨颈内假体，其特征为：端轴承是一个螺纹衬套(23)，它的外径有间隙地穿过端支承(5、5′；6)中的孔(52；64)；螺纹衬套(23)有沿轴向定向的外止挡，以及，可借助螺旋连接沿轴向在杆(22)的端部调整并可固定在调整好的位置上。
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CN107223040B (zh) * 2014-05-09 2020-11-24 萨维奇医疗设计有限责任公司 用在髋骨和股骨骨折手术中的髓内固定装置和系统
WO2022077192A1 (zh) * 2020-10-12 2022-04-21 董谢平 一种保留股骨颈的人工髋关节股骨侧假体

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DE19834277C2 (de) 2000-08-10
AU6187599A (en) 2000-02-21
WO2000006054A3 (de) 2000-07-13
DE19834277A1 (de) 2000-02-17
WO2000006054A2 (de) 2000-02-10
JP2002521128A (ja) 2002-07-16
EP1100414A2 (de) 2001-05-23
US6383227B1 (en) 2002-05-07

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