ES2278028T3 - Endoprotesis de articulacion tibiotarsiana. - Google Patents

Endoprotesis de articulacion tibiotarsiana. Download PDF

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Publication number
ES2278028T3
ES2278028T3 ES02732467T ES02732467T ES2278028T3 ES 2278028 T3 ES2278028 T3 ES 2278028T3 ES 02732467 T ES02732467 T ES 02732467T ES 02732467 T ES02732467 T ES 02732467T ES 2278028 T3 ES2278028 T3 ES 2278028T3
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ES
Spain
Prior art keywords
component
forms
intermediate piece
tibia
sliding surfaces
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.)
Expired - Lifetime
Application number
ES02732467T
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English (en)
Inventor
Hakon Kofoed
Arnold Keller
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.)
Waldemar Link GmbH and Co KG
Original Assignee
Waldemar Link GmbH and Co KG
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Filing date
Publication date
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Publication of ES2278028T3 publication Critical patent/ES2278028T3/es
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

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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
    • A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
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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
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    • A61F2/4202—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for ankles
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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
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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
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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
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
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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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
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    • A61F2310/00011—Metals or alloys
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005—The prosthesis being constructed from a particular material
    • A61F2310/00179—Ceramics or ceramic-like structures

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Abstract

Endoprótesis de sustitución de la articulación tibiotarsiana, que está constituida por un componente (4) que se ha de unir con el astrágalo (2) y que forma una superficie de deslizamiento cilíndrica (10) del lado superior, un componente (3) que se ha de unir con la tibia (1) y que forma una superficie de deslizamiento (7) del lado inferior, y una pieza intermedia (5) que forma dos superficies de deslizamiento (15, 16) que cooperan con las superficies de deslizamiento (7, 10) de los componentes antes citados de tal manera que queda fijada su dirección frontal, caracterizada porque la pieza intermedia (5) es de forma de cuña en el plano frontal.

Description

Endoprótesis de articulación tibiotarsiana.
Se conoce como sustitutivo de la articulación tibiotarsiana una endoprótesis que está constituida por un componente que se ha de unir con el astrágalo, un componente que se ha de unir con la tibia y una pieza intermedia (documento DE-U-8812806; folleto ``LINK S.T.A.R. Totale Sprunggelenkprothese [H. Kofoed] de la compañía Waldemar Link (GmbH & Co.), Hamburgo). El componente de astrágalo y la pieza intermedia cooperan a través de superficies de deslizamiento cilíndricas que facilitan la flexión y la extensión en el plano sagital. El componente de tibia y la pieza intermedia forman superficies de deslizamiento cooperantes que permiten una rotación alrededor del eje vertical. Pueden ser de construcción plana para hacer posibles movimientos de compensación en dirección AP y LM. La estabilización se efectúa por medio del ligamento natural.
En la prótesis conocida las superficies de deslizamiento de los lados superior e inferior de la pieza intermedia están orientadas paralelas una a otra en el plano frontal. Esto es consecuente debido a que las superficies de deslizamiento naturales del astrágalo y de la tibia deberán ser sustituidas por las superficies de deslizamiento protésicas, sin que esté ligada a esto una variación direccional. Sin embargo, se ha visto que no es raro que los ligamentos laterales y mediales de la articulación presenten una tensión diferente después de la operación, de lo que pueden resultar molestias.
La invención hace posible evitar esta falta de equilibrio proporcionando una pieza intermedia que está configurada en forma de cuña en el plano frontal. Los ejes de dirección de las superficies de deslizamiento situados en el plano frontal no corren paralelos uno a otro, sino bajo un ángulo que está comprendido normalmente entre 1º y 12º. Según las condiciones previamente encontradas, el médico puede determinar si y qué ángulo desea prever entre los ejes de articulación mediante una selección de la pieza intermedia adecuada. Esto puede efectuarse eventualmente también por vía intraoperativa.
Se conoce ciertamente una endoprótesis de articulación tibiotarsiana (documento EP-A-1097680) en la que las superficies de deslizamiento situadas entre el componente de astrágalo y la pieza intermedia forman partes de una superficie cónica. Sin embargo, no se desprende de esto el modo en que están colocadas estas superficies de deslizamiento en el plano frontal.
Para que la pieza intermedia permanezca correctamente orientada con respecto a su forma de cuña, se fija su orientación convenientemente de manera forzosa desde el astrágalo o desde la tibia haciendo que los pares de superficies de deslizamiento cooperantes estén construidos correspondientemente de manera que determinen la dirección. Es adecuada para ello especialmente la articulación entre el astrágalo y la pieza intermedia.
La patente FR-A-2676917 revela una endoprótesis de articulación tibiotarsiana con piezas intermedias diferentes.
Se explica seguidamente la invención con más detalle haciendo referencia al dibujo, que ilustra un ejemplo de realización ventajoso. Muestran:
La figura 1, una sección sagital a través de la articulación equipada con la prótesis,
La figura 2, la prótesis desplegada en abanico y vista en perspectiva,
La figura 3, una sección frontal a través de la pieza intermedia y
La figura 4, una vista en perspectiva de la disposición de los huesos y partes de prótesis correspondientes antes de la instalación de la pieza intermedia.
Entre la tibia 1 y el astrágalo 2 hay que disponer la prótesis, la cual está constituida por el componente de tibia 3, el componente de astrágalo 4 y la pieza intermedia 5. El componente de tibia 3 presenta una parte 6 de forma de placa cuyo lado inferior 7 forma una superficie de deslizamiento plana. Unos salientes 8 sirven para la fijación en rebajos de resección correspondientes 9 de la tibia 1.
El componente de astrágalo 4 forma una superficie de deslizamiento 10 abombada en forma convexa, la cual es de configuración cilíndrica. Lleva un nervio 11 que está situado en la dirección del movimiento relativo de la pieza intermedia durante los movimientos de flexión y extensión. Asimismo, el componente de astrágalo presenta unas facetas laterales 12 destinadas a cooperar con superficies de deslizamiento correspondientes de la tibia 1 y del peroné 13.
La pieza intermedia 5 posee un lado superior plano 15 conjugado de la superficie de deslizamiento 7 y una superficie de deslizamiento 16 del lado inferior que está formada de manera congruente con la superficie de deslizamiento 10 del componente de astrágalo 4. Contiene una ranura 17 destinada a recibir el nervio 11. La pieza intermedia 5 es guiada así lateralmente con relación al componente de astrágalo 4. Le son permitidos solamente movimientos de flexión y extensión.
\newpage
Los componentes 3 y 4 están constituidos convenientemente por metal y la pieza intermedia 5 es de un plástico favorable para el deslizamiento, tal como polietileno. Sin embargo, se pueden emplear también otros materiales con resistencia y capacidad de deslizamiento suficientes, por ejemplo cerámica.
Como consecuencia de la forma congruente de las superficies de deslizamiento 10 y 16, y debido también al nervio 11 en cooperación con la ranura 17, la pieza intermedia 5 no puede girar alrededor del eje vertical con respecto al componente de astrágalo 4. Por tanto, su orientación está fijada por la del componente de astrágalo. Aunque la forma de realización mostrada excluye por completo tales movimientos de rotación, son imaginables también realizaciones en las que estos son inhibidos únicamente por la configuración de las superficies de deslizamiento, para lo cual éstas están configuradas, por ejemplo, en forma elipsoidal.
En la sección frontal según la Figura 3 la pieza intermedia está configurada en forma de cuña. Su superficie de deslizamiento superior 15 encierra con la dirección de la superficie de deslizamiento inferior 16 un ángulo de cuña 18 que está comprendido preferiblemente entre 1º y 12º. En la mayoría de los casos, este ángulo está entre 3º y 8º.
Tan pronto como el cirujano, según se muestra en la figura 4, ha implantado el componente de tibia 3 y el componente de astrágalo 4, puede determinar por medio de instrumentos adecuados si sus superficies de deslizamiento 7 y 10, respectivamente, en dirección LM discurren paralelas o en ángulo una con otra cuando están tensados los ligamentos laterales. En correspondencia con esto, el cirujano selecciona una pieza intermedia adecuada 5.

Claims (5)

1. Endoprótesis de sustitución de la articulación tibiotarsiana, que está constituida por un componente (4) que se ha de unir con el astrágalo (2) y que forma una superficie de deslizamiento cilíndrica (10) del lado superior, un componente (3) que se ha de unir con la tibia (1) y que forma una superficie de deslizamiento (7) del lado inferior, y una pieza intermedia (5) que forma dos superficies de deslizamiento (15, 16) que cooperan con las superficies de deslizamiento (7, 10) de los componentes antes citados de tal manera que queda fijada su dirección frontal, caracterizada porque la pieza intermedia (5) es de forma de cuña en el plano frontal.
2. Endoprótesis de sustitución de la articulación tibiotarsiana según la reivindicación 1, caracterizada porque las superficies de deslizamiento (10, 16) cooperantes en el componente de astrágalo (4) y en la pieza intermedia (5) cooperan sustancialmente de forma no rotativa con respecto al eje vertical.
3. Endoprótesis según la reivindicación 1, caracterizada porque las superficies de deslizamiento (7, 15) cooperantes en el componente de tibia (4) y en la pieza intermedia (5) cooperan de forma rotativa con respecto al eje vertical.
4. Endoprótesis según una de las reivindicaciones 1 a 3, caracterizada porque el ángulo de cuña (18) está comprendido entre 1º y 12º.
5. Sistema de endoprótesis de sustitución de la articulación tibiotarsiana que están constituidas por un componente (4) que se ha de unir con el astrágalo (2) y que forma una superficie de deslizamiento (10) del lado superior, un componente (3) que se ha de unir con la tibia (1) y que forma una superficie de deslizamiento (7) del lado inferior, y una pieza intermedia (5) que forma dos superficies de deslizamiento (15, 16) que cooperan con las superficies de deslizamiento de los componentes antes citados de tal manera que queda fijada su dirección frontal, caracterizado porque están disponibles piezas intermedias diferentes que presentan en sección frontal ángulos de cuña diferentes entre la superficie de deslizamiento superior (15) y la superficie de deslizamiento inferior (16).
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