ES2340926T3 - Protesis de la cavidad glenoidea de la escapula. - Google Patents

Protesis de la cavidad glenoidea de la escapula. Download PDF

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Publication number
ES2340926T3
ES2340926T3 ES04300619T ES04300619T ES2340926T3 ES 2340926 T3 ES2340926 T3 ES 2340926T3 ES 04300619 T ES04300619 T ES 04300619T ES 04300619 T ES04300619 T ES 04300619T ES 2340926 T3 ES2340926 T3 ES 2340926T3
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ES
Spain
Prior art keywords
glenoid cavity
seat
intended
scapula
prosthetics
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
ES04300619T
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English (en)
Inventor
Laurent Beguin
Yann Brunnarius
Denis Bouttens
Charles Cohn
Geert Declercq
Jean Grimberg
Dominique Huguet
Eric Lesprit
Pierre Massart
Bruno Rio
Jacques Teissier
Bruno Toussaint
Bruno Zipoli
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Biomet France SARL
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Biomet France SARL
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Filing date
Publication date
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Publication of ES2340926T3 publication Critical patent/ES2340926T3/es
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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
    • A61F2/40—Joints for shoulders
    • A61F2/4081—Glenoid components, e.g. cups
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8047—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers wherein the additional element surrounds the screw head in the plate hole
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    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
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Abstract

Prótesis de la cavidad glenoidea de la escápula, que comprende un asiento (1), destinado a ser fijado sobre la cavidad glenoidea del paciente en el que se coloca la prótesis por medio de tornillos de anclaje (5), comprendiendo dicho asiento (1) una placa apta para recibir un inserto macho (17) y dicho asiento es apto para recibir un inserto hembra (10), estando destinados dichos insertos (10, 17) para cooperar con la cabeza humeral de la articulación de la espalda considerada o un implante humera colocado al nivel de dicha articulación, caracterizada: - porque la cara externa del reborde periférico (3), del que está dotado el asiento (1), está conformada en tronco de cono, apta para cooperar con un inserto macho (17) provisto con un tramo de forma complementaria, - y porque la placa (2) del asiento (1) está provista con medios (22) destinados a cooperar con un inserto hembra (10) con el fin de asegurar su fijación por encaje elástico en su seno.

Description

Prótesis de la cavidad glenoidea de la escápula.
La invención se refiere a una prótesis de la cavidad glenoidea de la escápula, y se refiere de manera general a las prótesis de espalda.
En función de la naturaleza de la patología, que puede ser objeto de la espalde de un paciente (dolores, artrosis, poli artritis, problemas de tendones o musculares, traumatismos, etc.), algunas veces se requiere, principalmente cuando la cavidad glenoidea ha sido destruida parcialmente o en su totalidad, pero igualmente cuando se observa una rotura de la funda de los rotadores, la necesidad de la aplicación de tal prótesis de la cavidad glenoidea.
Tradicionalmente, esta prótesis se presenta en forma de un asiento que se fija al nivel de dicha cavidad glenoidea de la escápula, al menos de lo que queda de ella. Tal cavidad glenoidea se describe, por ejemplo, en el documento FR-A-2 683 143.
Las prótesis de cavidad glenoidea conocidos hasta ahora están destinados a recibir un inserto destinado a cooperar con la cabeza humeral o con un implante humeral y, por lo tanto, se presentan bajo la forma de una concavidad de forma sensiblemente complementaria generalmente no congruente con dicha cabeza humeral o con dicho implante humeral. En otros términos, el inserto es generalmente una pieza hembra.
No obstante, puede ser que algunas veces se requiera, en función de la patología observada, no emplean una pieza hembra, sino una pieza macho que se presenta entonces en forma de una cabeza esférica o sensiblemente esférica sobre el asiento de la prótesis de la cavidad glenoidea. En esta hipótesis, es generalmente necesario recurrir a otra prótesis de cavidad glenoidea para permitir la aplicación de tal inserto macho.
En otros términos, la prótesis en cuestión no presenta el carácter modular deseable para los practicantes, ni tampoco en el plano económico.
Se ha descrito en el documento FR-A-2 652 498 una prótesis total de espalda que presenta un cierto carácter de modularidad. En este documento, tanto el implante humeral como la prótesis de la cavidad glenoidea comprenden elementos complementarios que confieren carácter modulable. Tratándose de la prótesis de la cavidad glenoidea, estos elementos están fijados en la periferia del asiento, principalmente por cooperación de una rosca, respectivamente interna para el inserto y externa para el asiento. Sin embargo, este modo de fijación se revela no suficiente en el uso, debido a los riesgos de micro-desplazamientos susceptibles de intervenir, induciendo, de hecho, riesgos de desencaje de la cavidad glenoidea. Paralelamente, durante los movimientos de la articulación considerada, se observa un desgaste del hueso de la cavidad glenoidea al nivel de la cual está implantada dicha prótesis inherente al implante y se traduce por una ruptura de los medios de fijación del asiento constitutivo del implante.
El objeto de la presente invención es proponer una prótesis de cavidad glenoidea de la escápula que presenta igualmente carácter modular y que soluciona los inconvenientes mencionados anteriormente.
Esta prótesis de la cavidad glenoidea de la escápula comprende un asiento, destinado a ser fijado sobre la cavidad glenoidea del paciente en la que se instala la prótesis por medio de tornillo de anclaje, comprendiendo dicho soporte una placa apta para recibir un inserto hembra, y dicho asiento es apto para recibir un inserto macho, estando destinados dichos insertos para cooperar con la cabeza humeral de la articulación de la espalda considerada o con un implante humeral aplicado al nivel de dicha articulación.
Esta prótesis de caracteriza:
-
porque la cara externa del reborde periférico, del que está dotado el asiento, está conformada en tronco de cono, apta para cooperar con un inserto macho provisto con un tramo de forma complementaria,
-
y porque la placa del asiento está provista con medios destinados a cooperar con un inserto hembra con el fin de asegurar su fijación por encaje elástico en su seno.
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Según la invención, el asiento está provisto con dos taladros transversales, cada uno de los cuales está inclinado un valor angular comprendido entre 20º y 35º con relación al plano general de la placa, y destinados a permitir el paso de tornillos de anclaje en el seno de la cavidad glenoidea.
Según la invención, la cara del asiento destinada a entrar en contacto con el hueso de la cavidad glenoidea está abombada, y está provista con una quilla destinada a ser implantada en el seno de dicha cavidad glenoidea.
Además, de manera ventajosa, esta misma cara presenta dos zonas planas situadas en posiciones extremas con relación a la parte abombada y, por lo tanto, situadas a uno y otro lado de la zona abombada, destinadas a apoyarse, después del fresado adecuado, en el seno de la cavidad glenoidea. Actuando de esta manera, estos planos aseguran una función de estabilización de la prótesis, evitando los fenómenos de basculamiento inherentes al funcionamiento anatómico de la articulación y reforzando la estabilidad primaria de dicha prótesis.
Además, y según otra característica de la invención, la quilla que prolonga la cara del asiento destinada a entrar en contacto con el hueso de la cavidad glenoidea está perforada de tal forma que favorece la fijación secundaria de la prótesis para crecimiento o migración ósea.
Según la invención, los medios que aseguran la cooperación y la fijación del inserto hembra con la placa del asiento están constituidos por orificios no pasantes apropiados para cooperar con peones de diámetro apropiado que resultan de la parte inferior del inserto hembra, o por cavidades realizadas en la periferia interna y en el interior del asiento, apropiados para cooperar con salientes de dimensiones correspondientes que resultan desde la base del inserto
hembra.
De acuerdo con otra característica de la invención, cada uno de los taladros pasantes de la placa están provistos con una rótula de expansión, susceptible de cooperar con los tornillos de anclaje, y destinada a asegurar el bloqueo de dicho tornillo según la orientación elegida por el practicante. Esta rótula está provista ella misma con relación a su envoltura externa, estado destinados dichos pivotes para ser recibidos en cavidades correspondientes, realizadas en el seno de un anillo soldado en el seno de dichos taladros.
La manera de realizar la invención y las ventajas que se derivan de ella se deducirán mejor a partir del ejemplo de realización siguiente, dado a título indicativo y no limitativo con la ayuda de las figuras anexas.
La figura 1 es una representación esquemática en perspectiva del asiento de la prótesis de la cavidad glenoidea conforme a la invención, provista con sus tornillos de anclaje.
La figura 2 es una representación en vista lateral del asiento de la figura 1.
La figura 3 es una representación esquemática en sección del asiento de la figura 1.
La figura 4 es una representación esquemática en perspectiva del asiento conforme a la invención en versión esquemática y vista desde arriba.
La figura 5 es una representación esquemática en perspectiva del asiento de la figura 4 vista desde abajo.
La figura 6 es una vista de detalle de la figura 5.
La figura 7 es una representación esquemática en perspectiva de una rótula de expansión, conforme a la invención.
La figura 8 es una representación esquemática en perspectiva de un anillo conforme a la invención, destinado a cooperar con la rótula de la figura 7, y cuya figura 9 es una vista en planta.
La figura 10 es una representación esquemática en perspectiva del asiento de la prótesis de la cavidad glenoidea conforme a la invención, provista con un inserto hembra.
La figura 11 es una representación en vista lateral de la figura 10.
La figura 12 es una representación esquemática en perspectiva de una vista desde abajo del inserto hembra conforme a la invención.
La figura 13 es una representación esquemática en perspectiva del asiento de la cavidad glenoidea conforme a la invención, provista con un inserto macho conforme a la invención.
La figura 14 es una vista lateral de la figura 13.
La figura 15 es una representación esquemática en perspectiva de una vista desde abajo del inserto macho conforme a la invención.
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Por lo tanto, se ha representado con relación a las figuras 1 a 6 la prótesis de la cavidad glenoidea de la escápula conforme a la presente invención. Fundamentalmente, esta prótesis está constituida por un asiento (1), que comprende una placa (2) destinada a ser fijada por anclaje en el seno de la cavidad glenoidea ósea del paciente en el que se coloca la prótesis, después de la preparación y principalmente después del fresado por el practicante.
Este asiento (1) presenta, por lo tanto, una cara delantera o superior sensiblemente plana, denominada placa (2) y una cara inferior destinada a entrar en contacto con el hueso. Según otra característica de la invención, esta cara inferior está abombada (9), tal como se puede observar en las figuras 2 y 5. Además, la cara inferior presenta dos zonas planas (23), situadas a una y otra parte de la bomba abombada (9). Esta forma particular contribuye a conferir una cierta estabilidad a la prótesis durante su instalación en posición. En efecto, la asociación de forma abombada (9) con las zonas planas que cooperan con zonas fresadas previamente realizadas en el seno de la cavidad glenoidea ósea, permite en primer lugar optimizar el contacto entre hueso e implante y, además, evitar los fenómenos de basculamiento del asiento y, por lo tanto, de la prótesis, fenómenos inherentes al funcionamiento mismo de la articulación de la espalda.
Esta estabilidad está optimizada, además, por la presencia de una quilla (6), orientada sensiblemente perpendicular con relación al asiento (1) y que prolonga dicha parte abombada (9). Esta quilla (6) está destinada a posicionarse en un alisado previamente realizado por el practicante en el seno de la cavidad glenoidea ósea.
De acuerdo con otra característica de la invención, esta quilla está perforada por orificios pasantes (9) respectivamente a lo largo de su generatriz y (8) al nivel de su extremo inferior. Estos orificios pasantes están destinados a favorecen la retención de la prótesis por fijación secundaria (migración 8 crecimiento óseos).
Este asiento permite por su estructura conservar en la mayor medida posible el capital óseo de la cavidad glenoidea.
Adicionalmente, el anclaje del asiento (1) en el seno de la cavidad glenoidea se realiza por medio de dos tornillos de anclaje (5). A este efecto, la placa (2) del asiento está perforada por dos orificios pasantes inclinados (4) para favorecer el paso de los tornillos (5) alrededor de un sistema de bloqueo descrito a continuación con más detalle.
Estos tornillos son orientables más o menos 12º con relación al eje de los orificios (4), con el fin de permitir al practicante colocarlos en el tubérculo supra e infra glenoideo.
Los orificios (4) están inclinados en un valor angular próximo a 30º con relación al plano que contiene la cara superior de la placa (2) del asiento. Los tornillos, realizados de manera ventajosa en aleación de titanio o de acero inoxidable, son auto-perforantes, auto-roscadores o retrocortantes. El alma cónica de las barras y la rosca cilíndrica de la que están provistas favorecen el anclaje en el hueso, y principalmente en la cavidad glenoidea considerada.
La cabeza del tornillo es cónica y posee una rosca cuádruple destinada a cooperar con el sistema de bloqueo. Más precisamente, la cabeza de los tornillos está provista con cuatro roscas paralelas, que desembocan al nivel de la base inferior de la cabeza según un ángulo de 90º entre dos roscas consecutivas. Estas cuatro roscas están destinadas a cooperar con un roscado cuádruple correspondiente, realizado al nivel de la pared interna del sistema de bloqueo, descrito con más detalle a continuación. Por este roscado cuádruple, se facilita la tarea del practicante durante la operación de roscado, en la medida en que el número de posibilidades de hacer agarrar el tornillo con el sistema de bloqueo se multiplica por dieciséis.
El sistema de bloqueo, al que se ha hecho referencia anteriormente, está constituido por una rótula de expansión (24) y un anillo (25). Está rótula está hendida (26) a lo largo de una de sus generatrices, de tal manera que se permite su expansión. Posee un roscado cuádruple (27) interno destinado a cooperar con el roscado cuádruple de las cabezas de los tornillos (5). Actuando de esta manera, el roscado del tornillo en la rótula (24) distancia esta última, que se bloquea entonces al nivel del anillo (25) soldado al nivel de cada uno de los orificios (4) situados en el seno del asiento según la orientación deseada por el practicante. Además, la base de la rótula (24) está provista con tres pivotes (28), formando un saliente con relación a la envolvente de la rótula, periódicamente distribuidos, y destinados a ser recibidos en alojamientos correspondientes (29) de dicho anillo (25). Actuando de esta manera, por cooperación entre los pivotes (28) y los alojamientos (29), la rótula (24) no puede girar entonces durante la colocación de los tornillos (5) por el practicante.
De acuerdo con la invención, la placa (2) del asiento (1) está provista en su periferia con un reborde (3) de forma particular, puesto que está en forma de cono cortante o, más exactamente, de un tronco de cono cortante. Está destinado a cooperar con el inserto macho descrito anteriormente en detalle.
Se ha representado con relación a las figuras 10 a 12 el inserto hembra (10) conforme a la invención. Éste está destinado a cooperar con el asiento descrito anteriormente. Este inserto está realizado principalmente en polietileno. Presenta un espesor mínimo de 5 mm al nivel de su zona más fina. Está provisto al nivel de su cara inferior (13), con dos peones (12) de posicionamiento y de fijación destinados a cooperar por encaje elástico con orificios no pasantes (22) realizados en el seno del plato (1) del asiento.
Este inserto hembra (10) se encaja elásticamente sobre dicho asiento, por una parte, por la cooperación de los eones (12) con los orificios (22) y, por otra parte, por la cooperación entre el borde periférico interno (14) del inserto sobre la pared interna (15) del reborde periférico (3) del asiento. Además, las zonas antero-posteriores (30) del inserto poseen un incremento de material, que permite aumentar la duración de vida útil del implante. En efecto, teniendo en cuenta la solicitación del inserto a este nivel inherente al modo de funcionamiento de la articulación, se observa generalmente un desgaste mayor a este nivel. Por último, la cara inferior (13) del inserto está provista con salidas (1) que garantizan el paso de las cabezas de los tornillos (5).
La cara superior (16) del inserto es de forma cóncava y principalmente anatómica, adecuada para cooperar con la cabeza humeral o con un implante humeral en el marco de la aplicación de una prótesis total de espalda.
\newpage
Se ha representado con relación a las figuras 13 a 15, la aplicación de un inserto macho con relación al asiento conforme a la invención. Este inserto macho (17) es de forma hemisférica, cuyo polo (18) está perforado por un orificio (19) destinado a permitir su colocación por un elemento auxiliar apropiado sobre el asiento (1) o su ablación.
Este inserto macho (17) está realizado, por ejemplo, de acero inoxidable. Su fijación sobre el asiento se realiza por manguito cónico sobre el cono cortante realizado en la periferia del reborde (3) de dicho asiento. Más precisamente, el manguito se realiza al nivel de su pared interna inferior (20), como se observa en la figura 15. Está fijación está asegurada, además, por medio de un tornillo que pasa por el orificio (19) y que se atornilla en un orificio roscado (31) realizado sobre la placa (2) de asiento (1).
Se concibe todo el interés de la prótesis conforma a la invención, principalmente por su carácter modular, que permite al practicante, a partir de un asiento estándar, la aplicación de un inserto adaptado al traumatismo o a la patología, pudiendo colocarse dicho inserto de manera fácil y segura evitado los inconvenientes ligados a los fenómenos de migración y de inestabilidad, tanto del asiento como de los insertos.

Claims (12)

1. Prótesis de la cavidad glenoidea de la escápula, que comprende un asiento (1), destinado a ser fijado sobre la cavidad glenoidea del paciente en el que se coloca la prótesis por medio de tornillos de anclaje (5), comprendiendo dicho asiento (1) una placa apta para recibir un inserto macho (17) y dicho asiento es apto para recibir un inserto hembra (10), estando destinados dichos insertos (10, 17) para cooperar con la cabeza humeral de la articulación de la espalda considerada o un implante humera colocado al nivel de dicha articulación, caracterizada:
-
porque la cara externa del reborde periférico (3), del que está dotado el asiento (1), está conformada en tronco de cono, apta para cooperar con un inserto macho (17) provisto con un tramo de forma complementaria,
-
y porque la placa (2) del asiento (1) está provista con medios (22) destinados a cooperar con un inserto hembra (10) con el fin de asegurar su fijación por encaje elástico en su seno.
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2. Prótesis de la cavidad glenoidea de la escápula de acuerdo con la reivindicación 1, caracterizada porque la placa (2) está provista con dos taladros (4) transversales, cada uno de los cuales está inclinado un valor angular comprendido entre 20º y 35º con relación al plano general de la placa, y destinados a permitir el paso de tornillos de anclaje (5) en el seno de la cavidad glenoidea.
3. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 1 y 2, caracterizada porque la cara trasera asiento destinada a cooperar con la cavidad glenoidea está abombada (9), y está provista con una quilla (6) destinada a ser implantada en el seno de dicha cavidad glenoidea.
4. Prótesis de la cavidad glenoidea de la escápula de acuerdo con la reivindicación 3, caracterizada porque la cara trasera del asiento (1), destinada a cooperar con la cavidad glenoidea presenta dos áreas planas situadas en posiciones extremas con relación a la parte abombada (9) y, por lo tanto, situadas a uno y otro lado de la zona abombada, destinadas a apoyarse en el seno de la cavidad glenoidea.
5. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 3 y 4, caracterizada porque la quilla (6) que prolonga la cara trasera del asiento está perforada (7, 8) de tal forma que favorece la fijación secundaria de la prótesis para crecimiento o migración ósea.
6. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 1 a 5, caracterizada porque los medios que aseguran la cooperación y la fijación del inserto hembra (10) con la placa (2) del asiento (1) están constituidos por orificios no pasantes (22) apropiados para cooperar con peones (12) de diámetro apropiado que resultan de la parte inferior del inserto hembra (10), o por cavidades realizadas en la periferia interna y en el interior del asiento, apropiadas para cooperar con salientes de dimensiones correspondientes que resultan desde la base del inserto hembra.
7. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 1 a 6 caracterizada porque cada uno de los taladros (4) de la placa (2) están provistos con una rótula de expansión (24), susceptible de cooperar con los tornillos de anclaje (5), y destinada a asegurar el bloqueo de dicho tornillo según la orientación seleccionada por el practicante.
8. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 1 a 7, caracterizada porque los tornillos de anclaje (5) son auto-perforadores, auto-roscadores o retrocortantes.
9. Prótesis de la cavidad glenoidea de la escápula de acuerdo con la reivindicación 7, caracterizada porque la rótula (24) está provista con pivotes periféricos (28) que forman saliente con relación a su envolvente externa, estando destinados dichos pivotes (28) para ser recibidos en cavidades o alojamientos (29) correspondientes, realizados en el seno de un anillo (25) soldado en dichos taladros (4).
10. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 6 a 9, caracterizada porque el inserto hembra (10) está provisto con dos peones de fijación (12), destinados a encajar elásticamente en el seno de los taladros (22) realizados en el seno de la placa del asiento (1), y porque su cara inferior está provista con salidas (11), destinadas a liberar el paso de las cabezas de los tornillos de anclaje (5).
11. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 6 a 10, caracterizada porque el inserto hembra (10) presenta un sobre espesor al nivel de sus zonas antero-posteriores (30).
12. Prótesis de la cavidad glenoidea de la escápula de acuerdo con una de las reivindicaciones 1 a 11, caracterizada porque los tornillos de anclaje (5) son orientables en un valor angular de más o menos 12º en el seno de los orificios pasantes (4) de la placa (2).
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FR2860426B1 (fr) 2006-05-26

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