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CN101321507A - 肩关节假体中的肱骨部件 - Google Patents

肩关节假体中的肱骨部件 Download PDF

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Publication number
CN101321507A
CN101321507A CNA2006800365220A CN200680036522A CN101321507A CN 101321507 A CN101321507 A CN 101321507A CN A2006800365220 A CNA2006800365220 A CN A2006800365220A CN 200680036522 A CN200680036522 A CN 200680036522A CN 101321507 A CN101321507 A CN 101321507A
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CN
China
Prior art keywords
epiphyseal
axis
humeral component
section
segment
Prior art date
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Granted
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CNA2006800365220A
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English (en)
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CN101321507B (zh
Inventor
塞西尔·尼罗特
迪戴尔·卡彭
路德维希·泽鲍尔
安德斯·埃克隆德
利文·德维尔德
迈克尔·沃思
大卫·科林斯
劳伦特·拉福斯
D·庞塞特
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DePuy Ireland ULC
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DePuy Ireland ULC
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Publication of CN101321507A publication Critical patent/CN101321507A/zh
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Abstract

一种反转式肩部假体中的肱骨部件(2)包括用于设置在肱骨的髓内腔内的细长杆部部段(4)和具有用于与关节窝部件的凸出承载表面进行关节联接的凹进承载表面(12)的骨骺部段(8)。所述细长杆部部段(4)限定出杆部轴线且所述骨骺部段的所述凹进承载表面(12)限定出骨骺轴线。所述骨骺轴线相对于所述杆部轴线向后部偏移。

Description

肩关节假体中的肱骨部件
技术领域
本发明涉及一种反转式(reverse)肩关节假体中的肱骨部件。
背景技术
肩关节假体包括具有可被装配在肱骨的髓内腔内的杆部部段的肱骨部件以及关节窝部段。在自然关节中，肱骨部件提供了凸出头部，所述凸出头部被关节联接在关节窝上的凹进承载表面上。这种结构在所谓“解剖学”肩关节假体中被再造，在所述假体中，肱骨部件包括杆部部段和具有凸出承载表面的头部部段，且关节窝部件提供了凹进承载表面。杆部部段被植入肱骨内。头部部段被装配到杆部部段上(通常利用套管和承窝(spigot and socket)的布置实现所述装配)，从而使得所述头部部段置于肱骨的切除平面之上。解剖学假体适用于植入其中的关节组织已经发生劣化(所述劣化例如是由于关节炎导致的)的病人中。
利用模块化部件来形成肩关节假体中的肱骨部件是已公知的做法，特别是与解剖学肩关节假体相关时更是如此。例如，在US-5314479和US-5358526中披露了这种模块化部件。解剖学肩关节假体中的杆部部段与头部部段之间的连接可在两个部段之间提供可变的偏移，以便适应特定病人的解剖学组织构造。
在所谓“反转式”肩关节假体中，解剖学关节的结构被反转过来，其中关节窝部件提供了凸出头部，且肱骨部件具有位于骨骺中的凹进凹部，关节窝部件上的头部可被接收并关节联接在所述凹进凹部中。与解剖学肩关节假体相对地，包括提供了承载表面的骨骺部段的反转式关节假体中的肱骨部件几乎被全部植入肱骨内。
当反转式肩关节假体被植入时，由于假体导致关节的旋转中心向中间移置，因此使得病人关节的生物机械学性质发生了改变。反转式肩关节假体适用于植入袖肌组织(cuff muscle tissue)受损的病人中。旋转中心的移置由于导致获得了改进的机械优点而使得允许利用三角肌来操控手臂。
就植入的设计特征和技术而言，在解剖学肩关节假体与反转式肩关节假体之间存在显著的不同。在解剖学肩关节假体中，肱骨头部的轴线(所述轴线是该头部的对称轴线，所述对称轴线通常会通过球体的极点，头部的承载表面形成了所述球体的一部分)与杆部轴线之间的角度为约135°。在反转式肩关节假体中，相应的角度通常更大，例如为约155°。此外，在反转式肩关节假体中，已公知的做法是将在骨骺与杆部部段之间引入达约40°，例如为约20°，的前倾角度偏移。该角度偏移可增加植入后关节的移动范围，特别是增加了内旋转的范围。这一点可在包括模块化杆部部段和骨骺部段的肱骨部件中通过使骨骺部段相对于杆部部段围绕杆部轴线进行旋转而得以实现。
在解剖学肩部假体中的肱骨部件的杆部轴线与骨骺轴线之间提供偏移是已公知的做法。提供该偏移的目的在于以尽可能接近病人自然关节构型的方式来再造该部件的构型，所述构型包括肱骨头部的位置和取向。这当然不适用于例如上面讨论的反转式肩部假体的使用。
发明内容
根据本发明，已经发现：可通过使肱骨部件的骨骺轴线相对于杆部轴线在后部偏移而进一步增加反转式肩关节假体中的关节联接范围。
因此，在一方面中，本发明提供了一种反转式肩部假体中的肱骨部件，所述肱骨部件包括用于设置在肱骨的髓内腔内的细长杆部部段和具有用于与关节窝部件的凸出承载表面进行关节联接的凹进承载表面的骨骺部段，其中所述细长杆部部段限定出杆部轴线且所述骨骺部段的所述凹进承载表面限定出骨骺轴线，且其中使所述骨骺轴线相对于所述杆部轴线在后部偏移。
本发明的所述肱骨部件具有允许增加关节联接(特别是内旋转)的范围等优点。这是通过形成用于肩胛下肌(所述肩胛下肌有助于限定内旋转的范围)的杠杆臂来实现的。
本发明的所述肱骨部件进一步的显著优点在于：减轻了在骨骺部段的缘边(所述缘边被植入切除的肱骨中而不是突出地竖立在所述切除肱骨上方)与肱骨的皮层组织之间产生撞击的风险，特别是当在杆部部段与骨骺部段之间存在前倾角度偏移时更是如此。这种撞击可能由于可能需要去除皮层骨组织来使得能够植入肱骨部件而成为严重的缺点。这可能导致病人的组织受到所不希望的弱化。该问题由于肱骨部件中的骨骺部段在肱骨内所处的位置而成为反转式肩关节假体特有的问题。
减轻或避免在肱骨部件中的骨骺部段与皮层组织之间产生的撞击可允许植入更大的骨骺部段，这在载荷转移方面可提供优点。这可使得肱骨部件更好地装配在病人的肱骨中且可允许该部件被更紧固地固定。
大体上面对远离关节窝的方向且朝向骨头组织的方向的肱骨部件中的骨骺部段的表面优选适于与该组织接触，所述表面限定出肱骨腔的内表面。例如，由于骨头在所述部件的所述表面内的方向性相互作用(例如骨头的向内生长)而使得所述表面可适于连结至所述骨头组织，或所述表面可适于通过骨接合剂材料被连结至所述组织。这种适配性被广泛地用于整形外科假体的植入中。
介于所述杆部轴线与所述骨骺轴线之间的距离优选为至少约1.0mm，更优选为至少约1.5mm，例如为至少约2.0mm。
介于所述杆部轴线与所述骨骺轴线之间的距离优选不超过约7mm，更优选不超过约5mm，例如不超过约3.0mm。
通常情况下，所述杆部部段和所述骨骺部段将作为独立部段被提供，每个独立部段具有允许所述部段被组装以便使用的连接特征。例如，位于所述杆部部段和所述骨骺部段中的一种上面的连接特征可以是承窝，且位于所述杆部部段的另一种上面的连接特征则将为可被接收在所述承窝中的套管。所述套管和所述承窝优选具有圆形剖面且具有匹配的锥度，以使得它们在被压在一起时可锁定在一起。正如已公知地，适当的锥角可介于6°与8°之间。
由于所述骨骺部段上的连接特征(例如为朝向其封闭端部向内渐细的承窝)相对于所述骨骺轴线产生了偏移，因此优选可导致所述骨骺轴线可相对于所述杆部轴线产生后部偏移。
所述肱骨部件中的所述骨骺部段优选包括限定出凹部的壳体部段和可被接收在所述壳体部段中且提供了用于与关节窝部件进行关节联接的承载表面的承载部段。所述壳体部段和所述承载部段可由不同材料制成。特别地，所述承载部段可由提供了与所述关节窝部件的所述凸出承载表面形成低摩擦关节联接的材料制成。适当的聚合物材料包括超高分子量聚乙烯。陶瓷和金属材料也可提供所述肱骨部件的所述承载表面。
所述肱骨部件中的所述杆部部段以及所述骨骺部段的至少部分骨骺部段将通常由金属材料制成。用于整形外科关节假体中的适当金属材料是已公知的，且包括钴-铬-钼合金、某些不锈钢、钛及某些其合金。
所述壳体部段的所述缘边优选大致呈圆形。所述壳体部段的所述缘边优选大致呈平面。当被植入时，由所述壳体部段的所述缘边限定出的所述平面将被布置成与所述肱骨切除平面大致平行，且介于两个平面之间的距离优选至少为约1.0mm，且优选不超过约4.0mm，更优选不超过约2.5mm。
当所述壳体部段的所述缘边呈平面时，由所述壳体部段的所述缘边限定出的平面优选与所述骨骺轴线大致垂直。然而，在所述缘边呈非平面(例如由于所设置的用来减轻错位风险的局部唇缘而导致所述缘边呈非平面)的实施例中，所述轴线被视为通过了球体的极点，所述承载表面形成了所述球体的一部分，所述承载表面围绕所述极点被对称布置(除了所述局部唇缘或相似特征以外)。
当沿前部-后部轴线进行观察时，介于所述杆部轴线与所述骨骺轴线之间的角度优选至少为约20°。所述角度优选不超过约35°，例如为约25°。
本发明的所述肱骨部件可与反转式肩关节假体中的关节窝部件一起使用，所述反转式肩关节假体具有从现有的关节假体中已公知的特征，所述现有的关节假体例如为由DePuy Products Inc出售的商标为DELTA的关节假体。这种关节窝部件包括通过固定螺钉被紧固到关节窝上的metaglene部件。glenosphere部件随后被安装在metaglene部件上，且通过相互接合的套管和承窝布置被紧固到所述metaglene部件上。
在另一方面中，本发明提供了一种肩关节假体，所述肩关节假体包括如上所述的肱骨部件以及关节窝部件，所述关节窝部件包括可被接收在所述肱骨部件中的所述骨骺部段中且与所述骨骺部段的凹进承载表面进行关节联接的凸出头部部段。
附图说明
下面将通过实例并结合附图对本发明的实施例进行描述，其中：
图1是根据本发明的肩关节假体中的肱骨部件的侧视图；
图2是根据本发明的肱骨部件中的杆部部段和骨骺部段的分解等距视图；
图3是图2所示的肱骨部件中的杆部部段和骨骺部段的另一等距视图；
图4是根据本发明的肱骨部件的侧视图；
图5是图4所示的肱骨部件的剖视图；
图6是被植入病人肱骨中的根据本发明的肱骨部件的部分切去的侧视图；和
图7是大体上沿肩关节的中间横轴的视图，图中示出了在植入了根据本发明的肩关节假体之后的肩胛骨和肱骨。
具体实施方式
参见附图，图1至图6示出了反转式肩部假体中的肱骨部件2。该肱骨部件包括用于设置在肱骨6的髓内腔内的细长杆部部段4。骨骺部段8限定出用于承载部段10的凹部。承载部段具有用于与关节窝部件(未示出)的凸出承载表面进行关节联接的凹进承载表面12。
杆部部段4、骨骺部段8和承载部段10作为独立的模块化部段被提供，所述独立的模块化部段在植入之前被组装在一起以便形成肱骨部件。被包括在模块化整形外科关节假体尤其是肩关节假体内的特征例如从由DePuy Products Inc制造和出售的DELTA和GLOBAL假体中并且从由Tornier S A制造和出售的AEQUALIS假体中是已公知的，所述特征适用于本发明的假体中。图2至图5示出了肱骨部件的一个实施例的细部。
在图2至图5所示的肱骨部件的实施例中，杆部部段4具有平面近极面102，所述平面近极面具有在其中形成的轴向孔口104，所述轴向孔与该近极面相垂直地且大体上沿该部段的轴线进行延伸。直立突部106被设置在近极面上。杆部部段在其近端处具有两个肩部108以便在植入后提供杆部部段在肱骨中的旋转稳定性。
轴向孔口104被形成为两个部段，即近侧的大直径普通孔口部分110和远侧的直径更小的螺纹孔口部分112，所述螺纹孔口部分被构造成与用于骨骺部段8的固定螺钉113形成螺纹接合。
骨骺部段8具有平面远极面114，所述平面远极面具有从其中延伸出来的与远极面114的平面垂直的短套管116。该套管具有延伸通过其中的孔口117，所述孔口被构造成使得固定螺钉113的轴杆可延伸通过其中。
骨骺部段8的远极面114具有在其中形成的7个非贯穿凹部116，肱骨部段的近极面上的突部106可被接收在所述非贯穿凹部中。
突部和系列的非贯穿凹部允许对骨骺部段相对于杆部部段的角度取向进行调节。这是通过将骨骺部段上的套管松散地设置在杆部部段上的孔口中来实现的。骨骺部段可相对于杆部部段围绕杆部部段的轴线进行转动。突部被设置在凹部116中的大致定位的一个凹部中以便锁定骨骺部段防止其产生旋转。骨骺部段随后通过固定螺钉113被锁定到杆部部段上，所述固定螺钉与杆部部段中的孔口的直径更小的部分112中的螺纹进行接合。
此外，图4和图5示出了肱骨部件中的承载部段10。该承载部段和骨骺部段具有在其中形成的周向沟槽118、120，所述周向沟槽118和120在部段被适当地组装在一起时彼此对齐。以被成形为大致圆环的z字形金属丝的形式存在的弹性弹簧可被用于将聚合物承载部段紧固在关节窝部件中的杆部部段内。弹簧可在被组装之前被设置在沟槽中的一条沟槽中，所述弹簧在组装过程中产生变形，且在组装所述部段时允许所述弹簧松弛进入沟槽中的其它沟槽内。利用这种弹簧来将聚合物承载部段紧固在整形外科关节假体中的杆部部段内的方式是众所周知的。
杆部部段4由适用于整形外科关节假体部件的合金如钛合金或不锈钢制成。适当的材料是已公知的。杆部部段的构型正如已公知的肩关节假体中的杆部部段那样。杆部部段的特征可包括(a)朝向远侧尖端渐细的锥度、(b)在朝向远侧尖端的部分中的侧壁中的轴向凹槽、(c)在骨接合表面(特别是在近侧区域中)的至少部分上设置的由促进了植入物在髓内腔中的固定的材料制成的涂层等。正如已公知地，杆部部件的构型应该被优化以便确保其可被固定地紧固在病人的肱骨腔中。
部件中的骨骺部段8将通常由与杆部部段相同的材料形成，或由至少相似的材料形成(例如杆部部段和骨骺部段可都由金属尤其是相同的金属形成)。
部件中的承载部段将通常由聚合物材料如超高分子量的聚乙烯(UHMWPE)形成。这些材料已公知地被用于整形外科关节假体中以便与由硬质材料提供的其它部件的承载表面进行关节联接，所述硬质材料包括金属材料和陶瓷材料。肱骨部件的承载表面可由除了聚合物材料以外的材料提供，例如由金属材料或陶瓷材料提供。例如当骨骺部段提供承载表面时，则不需要在肱骨部件中包括承载部段。当肱骨部件的承载表面由硬质材料如金属材料或陶瓷材料提供时，这可能是特别适当的。
部件中的杆部部段4限定出杆部轴线13，当部件被植入时，所述杆部轴线旨在与病人的肱骨轴线对齐。
肱骨部件的承载表面应该根据关节窝部件的凸出承载表面的形状被成形，所述肱骨部件的承载表面与所述凸出承载表面进行关节联接。肱骨部件的承载表面将通常是大约旋转对称的，例如以球体的一部分或卵形体的一部分的形式存在。(然而，当沿对称轴线观察时，承载表面不需要是圆形的)。承载表面的对称轴线限定出肱骨部件的骨骺轴线。
在本发明的肱骨部件中，杆部轴线和骨骺轴线并不重合。它们优选是大致平行的。然而，如图1所示，骨骺轴线相对于杆部轴线在后部偏移约2.5mm。
图6示出了在被植入病人的肱骨6中之后的上面结合图1所示的肱骨部件。如图6所示，正如通常已公知地，通过切除对肱骨进行制备以便植入关节假体。骨头沿相对于肱骨轴线被倾斜的切除平面14被切除。
本发明的优点在于：肱骨部件中的骨骺部段8在被植入肱骨中时，可被布置成全部位于切除平面14上的肱骨的皮层组织内。这可能在不必损害肱骨部件尺寸的情况下得以实现(这对于为了保持假体的关节联接表面上的最优化载荷转移面积而言是一个优点)。在不破坏肱骨的皮层组织的情况下植入肱骨部件的能力提供了使得由于植入肱骨部件而引入骨头组织的弱化被最小化的优点。
图7示出了肩关节，所述肩关节中植入了根据本发明的肩关节假体。关节窝部件20被植入肩胛骨22中，关节窝部件具有凸出的关节联接表面24。关节窝部件可具有由DePuy Products Inc制造并出售的DELTA肩关节假体中的相应部件的特征。具有上面结合图1所示的肱骨部件的特征的肱骨部件26被植入肱骨28中。
由肩胛下肌腱(所述肩胛下肌腱是由虚线30示意性地示出的)部分地提供了对肩关节的内旋转的控制。该肌腱被附接到肱骨上的相对于肱骨轴向位于后部的更大的粗隆32上。
与肩关节上的肩胛下肌肉的作用相关联的机械优点取决于介于肩胛下肌腱被附接至肱骨的附接点与关节的旋转中心之间的距离。本发明的肱骨部件的优点在于：由于关节的旋转中心相对于肱骨轴线产生了后部偏移而因此改进了该机械优点。

Claims (13)

1、一种反转式肩部假体中的肱骨部件，所述肱骨部件包括用于设置在肱骨的髓内腔内的细长杆部部段和具有用于与关节窝部件的凸出承载表面进行关节联接的凹进承载表面的骨骺部段，其中所述细长杆部部段限定出杆部轴线且所述骨骺部段的所述凹进承载表面限定出骨骺轴线，且其中使所述骨骺轴线相对于所述杆部轴线向后部偏移。
2、根据权利要求1所述的肱骨部件，其中介于所述杆部轴线与所述骨骺轴线之间的距离为至少约1.5mm。
3、根据权利要求1所述的肱骨部件，其中介于所述杆部轴线与所述骨骺轴线之间的距离不超过约7mm。
4、根据权利要求1所述的肱骨部件，其中所述杆部部段和所述骨骺部段作为独立部段被提供，每个独立部段具有允许所述部段被组装以便使用的连接特征。
5、根据权利要求4所述的肱骨部件，其中位于所述杆部部段和所述骨骺部段中的一种上面的连接特征是承窝，且位于所述杆部部段的另一种上面的连接特征是可被接收在所述承窝中的套管。
6、根据权利要求4所述的肱骨部件，其中所述骨骺部段上的连接特征相对于所述骨骺轴线产生了偏移。
7、根据权利要求1所述的肱骨部件，其中所述骨骺部段包括限定出凹部的壳体部段和可被接收在所述壳体部段中且提供了用于与关节窝部件进行关节联接的承载表面的承载部段。
8、根据权利要求7所述的肱骨部件，其中所述壳体部段的缘边大致呈圆形。
9、根据权利要求7所述的肱骨部件，其中所述壳体部段的缘边大致呈平面。
10、根据权利要求9所述的肱骨部件，其中由所述壳体部段的所述缘边限定出的所述平面大致垂直于所述骨骺轴线。
11、根据权利要求1所述的肱骨部件，其中当沿前部-后部轴线进行观察时，介于所述杆部轴线与所述骨骺轴线之间的角度为至少约20°。
12、根据权利要求1所述的肱骨部件，其中当沿前部-后部轴线进行观察时，介于所述杆部轴线与所述骨骺轴线之间的角度不超过约35°。
13、一种肩关节假体，所述肩关节假体包括根据权利要求1所述的肱骨部件以及关节窝部件，所述关节窝部件包括可被接收在所述肱骨部件中的所述骨骺部段中且与所述骨骺部段的凹进承载表面进行关节联接的凸出头部部段。
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C06 Publication
PB01 Publication
CI01 Publication of corrected invention patent application

Correction item: Applicant

Correct: Collins David|Laurent La Force

False: David Collinslaurent Rufus

Number: 50

Page: 947

Volume: 24

CI02 Correction of invention patent application

Correction item: Applicant

Correct: Collins David|Laurent La Force

False: David Collinslaurent Rufus

Number: 50

Page: The title page

Volume: 24

C10 Entry into substantive examination
SE01 Entry into force of request for substantive examination
ERR Gazette correction

Free format text: CORRECT: APPLICANT; FROM: DAVID COLIN LA FORCE TO: DAVID COLLINS - LAURENT LA FORCE

C14 Grant of patent or utility model
GR01 Patent grant