CN102014802A - 肩关节假体的肩胛部件 - Google Patents

肩关节假体的肩胛部件 Download PDF

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CN102014802A
CN102014802A CN2009801151133A CN200980115113A CN102014802A CN 102014802 A CN102014802 A CN 102014802A CN 2009801151133 A CN2009801151133 A CN 2009801151133A CN 200980115113 A CN200980115113 A CN 200980115113A CN 102014802 A CN102014802 A CN 102014802A
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base plate
articular surface
scapular
anchoring
tenon
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H-K·施维泽
M·A·赖纳
E·凯尔里
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Smith and Nephew Orthopaedics AG
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Plus Orthopedics AG
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Abstract

一种肩关节假体的肩胛部件，包括能锚定在肩胛骨上的基板(11)和能固定在基板上的关节面部件(12)，该关节面部件限定解剖学的(凹陷的，13)或逆反的(突起的，33)关节面。在基板(11)的、在植入状态中朝向肩胛骨的背面(14)上设置至少一个锚定榫(15、16、17)，所述锚定榫大致在前外侧的方向上倾斜于基板(11)延伸。

Description

肩关节假体的肩胛部件
技术领域
本发明涉及一种肩关节假体的肩胛部件，包括能锚定在肩胛骨上的基板和能固定在基板上的关节面部件，该关节面部件限定解剖学的(凹陷的)关节面或逆反的(突起的)关节面。
背景技术
这种肩胛部件是普遍公知的。对此作为例子仅举出EP 1520561A1。
在肩胛骨侧的盂肱关节的关节面置换时的主要难点首先在于在通常应用的从胸三角接近时很好地显示原来的关节窝。在为肱骨安装表面置换假体时，还将额外加大这种接近的难度，这是因为解剖学的肱骨头并没有如在杆状假体(Shaftprothese)的情况下那样被切除，而只是准备其表面。这就是表面置换假体几乎仅作为半关节置换术实施的主要原因。
在常规的关节盂系统中，从解剖学的肩系统到逆反的(invers)肩系统的翻修需要移出存在的关节盂植入物，其结果是关节盂骨高的损伤。
假如有必要置换关节盂的关节面，则出于上述原因必须选择杆状假体，尽管在肱骨对于表面置换假体有适应症，其结果是肱骨上高的骨损失，这会在将来可能的翻修中对于锚定翻修植入物产生不利的影响。
发明内容
从引用的现有技术出发，本发明基于这样的任务，即提供一种关节盂系统(Glenoidsystem)，其使得从前外侧植入成为可能，从而便于接近肩胛骨侧盂肱关节的关节面。同时，应可以有选择地使用具有解剖学的或者说凹陷的作用面的关节面部件或具有逆反的或者说突起的作用面的关节面部件，使得在翻修时可根据需要从解剖学的系统换成逆反的系统，而无需移出已经锚定在骨头中的基板。
该任务根据本发明通过权利要求1的特征部分特征解决，从属权利要求描述进一步的细节和优选的实施方式。
本发明的特征在于：即在基板的在植入状态中朝向肩胛骨的背面上设置至少一个锚定榫，所述锚定榫大致在前外侧上倾斜于基板延伸。
优选在基板的背面设置两个、尤其是三个倾斜于基板延伸的锚定榫。它们相对于基板在预定的角度范围内、尤其是在30°～70°的角度范围内延伸。因此从前外侧植入是可能的。基板的基本形状是大致圆形的盘，但尤其是椭圆形或梨形的盘。上述锚定榫可彼此平行地或至少部分发散地延伸，但始终大致在前外侧的方向上。这种方案允许无接合剂的手术技术。优选基板本身由钛合金构成，出于改善骨整合的目的，基板可设有多孔的钛/羟基磷灰石涂层或者类似的生物活性涂层。在正面、即在植入状态中背离肩胛骨的一侧固定有已经提过的关节面部件，它在按解剖学安装时优选由聚乙烯或者说PE构成。在逆反安装时，该关节面部件由陶瓷或由植入物用钢构成。由于用于这种关节部件的材料本身已公知，所以也就不需进一步说明。
在一种优选的实施方式中，在按解剖学安装时限定真正的关节面的PE嵌件通过卡扣机构与基板在原位或在体外装配到一起。
优选规定借助至少一个、优选是两个骨螺钉进行所谓的初次锚定，其穿过基板中相应的孔。骨螺钉应在该孔中在基板和锚定榫之间的角度范围内、尤其是在基板和锚定榫之间的角平分线的范围内延伸。在多于一个骨螺钉的情况下，这些骨螺钉彼此平行地延伸或在0°到45°之间的范围内发散。
在翻修时，借助移出工具将所提到的PE嵌件拆卸掉并且用半球形的关节面部件或者说所谓的盂球
Figure BPA00001250902000021
代替。盂球相对于基板的几何中轴线可居中地或偏心地安置。在结构上，盂球和基板之间的锚定是这样的，即盂球可从前外侧锚定在基板上。为了这个目的，优选在基板的正面上构造至少一个、尤其是两个在植入状态中大致从前至后延伸的导槽或导肋，其与盂球底侧的互补的导向元件相对应。导槽在横截面上可构造成燕尾形的。优选如此构造的导槽在从前至后的方向上锥形地缩小，使得盂球在固定在基板上时不会越过基板向前移动。盂球在基板上的固定是借助与大致居中地设置在基板底侧上的锚定榫中的内螺纹相对应的紧固螺钉来实现的。
手术技术规定，借助由自由的手所持的锉工具来准备植入床，该锉工具由钻机或类似物驱动。
然后，借助钻模在骨头中钻出与上述基板底侧的锚定榫相对应的、倾斜的锚定孔。通过安装工具将基板导入准备好的腔中。紧接着通过所提到的被构造成自钻和自攻的骨螺钉进行固定。
基板的背面可构造成平的或平坦球形的、即略微拱曲的。
已经指出，锚定螺钉可以彼此发散地安装，而且彼此发散在0°到45°之间的范围。
可以规定骨螺钉单向地或多向地固定在基板上。当然在这两种情况下都必须实现必要的角度稳定性。但这些涉及公知技术。
可考虑使用常规的骨螺钉。作为替换方案也可考虑使用非角度稳定的、自钻和自攻的骨螺钉。
从前外侧接近允许对肩胛骨侧盂肱关节安装与肱骨侧表面置换假体相结合的关节盂植入物。此外，还可能在将来将解剖学的系统换成逆反系统。这种初次安装和翻修安装都比常规的植入物系统的创伤要小。因此患者的负担更小且恢复得更快。
附图说明
下面借助附图进一步说明根据本发明的、具有解剖学的和有选择地为逆反的关节面部件的肩胛部件的优选的实施例。
图1用于从前外侧接近的、具有解剖学的关节面部件的关节盂的从斜上方观察的透视图；
图2根据图1的关节盂的从斜下方观察的透视图；
图3根据图1和图2的关节盂的从下方观察的视图；
图4根据图1至3的关节盂的透视的分解图；
图5用于从前外侧接近的、居中地安置在基板上的盂球的从斜上方观察的透视图；
图6根据图5的盂球的从斜下方观察的透视图；
图7根据图5和6的盂球的从前方观察的视图；
图8相对于基板偏心地锚定的盂球的从前方观察的视图；
图9根据图5至7的盂球的从斜上方观察的分解图；
图10根据图5至7的盂球的从斜下方观察的分解图；
图11根据图1至4的盂球和肩胛骨；
图12根据图5至7的居中锚定的盂球和肩胛骨；
图13根据图8的偏心锚定的盂球和肩胛骨。
具体实施方式
图1至图4示出了肩关节假体的肩胛部件，确切地说是所谓的关节盂，具有能锚定在肩胛骨10(参见图11至13)上的基板11和能固定在基板上的关节面部件，其限定解剖学的或者说凹形的关节面13。在基板11的、在植入状态中朝向肩胛骨10的背面14上设置三个锚定榫15、16和17，它们各自大致在前外侧的方向上倾斜于基板11延伸，该背面可构成为平的或者如此处略微拱曲的。具体地说，所有三个锚定榫都在预定的角度范围内彼此平行地延伸，尤其是在相对于基板30°至70°的角度范围内延伸，在此相对于基板11大致45°。
两个锚定榫即锚定榫15和16被设置在基板11的背面的边缘侧，而第三个锚定榫17大致居中地连接在基板11的背面14。大致居中地设置的锚定榫17限定可从基板11的正面18(参见图4)接近的螺纹孔19，在正面上可连接关节面部件，在此优选为PE嵌件12。紧固螺钉可被旋拧入螺纹孔19中，关节面部件通过该紧固螺钉可固定在基板上。借助图5至10进一步说明此点。
为了基板11的初次锚定，在所示出的实施方式中基板11具有用于接收骨螺钉22、23的两个孔20、21，确切地说是使骨螺钉在基板和锚定榫15、16之间的角度范围内延伸，尤其是在基板11和上述锚定榫15、16的角平分线的范围内延伸。就这点而言，从前外侧固定骨螺钉22、23是可能的或者说被确保了。
骨螺钉22、23可以单向地或多向地固定在基板11上所属的孔20、21中。在此涉及无需在这里进一步说明的公知技术。已经指出的是：在两个或更多骨螺钉22、23的情况下，它们或者如此处彼此平行地延伸，或者作为替换方案彼此发散地延伸，其中，在后一种情况中发散在0°到45°之间的范围内。
在当前的情况中，各自被构造成自攻的骨螺钉22、23以相对于基板11大致20°至25°的角度延伸。
在所示出的实施方式中，关节面部件，优选是PE嵌件，可卡扣到基板11的正面18上。为了该目的，基板11的正面18具有两个在边缘侧设置的卡扣突起(尤其参见图4)，其与关节盂或者说PE嵌件12中的互补的卡扣开口相对应。当然也可以相反地设置卡扣突起和卡扣开口。
卡扣突起可借助移出工具被带入到脱开卡扣位置中，以便可在翻修的情况下移除PE嵌件或者说关节盂12。
由于在基板11的正面18上还设置有用于锚定所谓的盂球的——这点在下面还将进一步被说明——从前至后圆锥形缩小的燕尾形导向部26、27，关节盂12在其底侧具有对应的或者说互补的突起，其填满上述燕尾形导向部。但首先应通过上述卡扣机构来实现关节盂12的固定。假如放弃该卡扣机构，则关节盂12必须通过紧固螺钉来固定，这点在下面将会通过盂球在基板上的固定来说明。优选该固定通过卡扣机构结合燕尾形导向部来实现，如此就可以放弃紧固螺钉。
正如已经提到过的，在翻修的情况下，关节盂12可通过逆反的关节面部件或者说所谓的盂球28被替换。该关节面部件或者说盂球借助穿过关节面延伸的紧固螺钉29(参见附图9、10或12、13)固定在基板11上。如借助附图1至4的说明那样来构造基板11。紧固螺钉29可被拧进构造在所述大致在居中地设置的锚定榫中的螺纹孔19中，确切地说也是从前外侧。正如已经提到过的，在基板11的正面18上构造两个在植入状态中大致从前到后延伸的、以燕尾形导向部26、27形式的导槽，其在从前至后的方向上锥形地缩小。所述燕尾形导向部26、27与互补的导向元件即在各自所属盂球28的底侧上的导向条30、31相对应。
盂球可相对于基板11或如图5至7居中地或者如图8偏心地定位。
还应指出的是：出于将盂球28固定在基板11上的目的，紧固螺钉29穿过盂球28中的孔32。
还应指出的是：盂球的逆反的关节面在附图5至10及12、13中各自用附图标记33来表示。
所有在申请文件中被公开的特征都作为对本发明重要的特征要求保护，只要它们单独或者结合起来是创新的。
附图标记列表
10肩胛骨
11基板
12解剖学的关节面部件
13解剖学的关节面
14背面
15锚定榫
16锚定榫
17锚定榫
18正面
19螺纹孔
20孔
21孔
22骨螺钉
23骨螺钉
24卡扣突起
25卡扣突起
26燕尾形导向部(导槽)
27燕尾形导向部(导槽)
28逆反的关节面部件或者说盂球
29紧固螺钉
30导向条
31导向条
32用于紧固螺钉的孔
33逆反的关节面

Claims (14)

1.肩关节假体的肩胛部件，其包括能锚定在肩胛骨(10)上的基板(11)和能固定在基板上的关节面部件(12、28)，所述关节面部件限定解剖学的(凹陷的，13)或逆反的(突起的，33)关节面，其特征在于，在所述基板(11)的在植入状态中朝向肩胛骨(10)的背面(14)上设置至少一个锚定榫(15、16、17)，所述锚定榫大致在前外侧的方向上倾斜于所述基板(11)延伸。
2.根据权利要求1的肩胛部件，其特征在于，在所述基板(11)的背面(14)上设置两个、尤其是三个倾斜于所述基板(11)延伸的锚定榫(15、16、17)。
3.根据权利要求2的肩胛部件，其特征在于，所述锚定榫(15、16、17)相对于所述基板(11)在预定的角度范围内、尤其是在30°至70°的角度范围内彼此平行地延伸，或至少部分彼此发散地、但始终大致在前外侧的方向上延伸。
4.根据权利要求1至3之一的肩胛部件，其特征在于，所述至少一个锚定榫(17)大致居中地连接在所述基板(11)的背面(14)上。
5.根据权利要求4的肩胛部件，其特征在于，大致居中地设置的锚定榫(17)限定能从所述基板(11)的正面(18)接近的螺纹孔(19)，在所述正面上能连接所述关节面部件(12)。
6.根据权利要求1至5之一的肩胛部件，其特征在于，为了初次锚定所述基板(11)，基板具有至少一个用于接收骨螺钉(22、23)的孔(20、21)，使得骨螺钉在基板(11)和锚定榫(15、16)之间的角度范围内、尤其是在基板(11)和锚定榫(15、16)之间的角平分线的范围内延伸。
7.根据权利要求6的肩胛部件，其特征在于，所述骨螺钉(22、23)在基板(11)上所属的孔(20、21)中单向地或多向地、优选各自角稳定地固定。
8.根据权利要求6或7的肩胛部件，其特征在于，在两个或更多个骨螺钉(22、23)的情况下，这些骨螺钉彼此平行地或彼此发散地延伸，在后一种情况发散在0°到45°之间的范围内、尤其是在15°到25°度之间的范围内。
9.根据权利要求1至8之一的肩胛部件，其特征在于，所述关节面部件(12、28)能推到和/或卡扣到所述基板(11)的正面(18)上，并且因此也是能被更换的。
10.根据权利要求9的肩胛部件，其特征在于，所述关节面部件(28)能借助穿过关节面(33)的紧固螺钉(29)固定在基板(11)上。
11.根据权利要求10的肩胛部件，其特征在于，所述紧固螺钉(29)能旋拧入构造在大致居中地设置的锚定榫(17)中的螺纹孔(19)中。
12.根据权利要求9至11之一的肩胛部件，其特征在于，在所述基板(11)的正面(18)上构造有至少一个、尤其是两个在植入状态中大致从前到后延伸的导槽(26、27)或导肋，所述导槽或导肋各自与所属的关节面部件(28)的底侧上互补的导向元件(30、31)相对应。
13.根据权利要求9至12之一的肩胛部件，其特征在于，所述基板(11)的正面(18)具有至少一个卡扣突起(24、25)，所述卡扣突起尤其是设置在边缘侧并且与所述关节面部件(12)中的互补的卡扣开口相对应，或者所述卡扣突起和卡扣开口相反地设置。
14.根据权利要求1至13之一的肩胛部件，其特征在于，所述关节面部件(28)，尤其是在其逆反的结构中，能相对于所述基板(11)的几何中轴线居中地或偏心地锚定在基板上。
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EP2282701A1 (de) 2011-02-16

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