FR2805152A1 - Prothese trapezo-metacarpienne a mobilite amelioree - Google Patents

Prothese trapezo-metacarpienne a mobilite amelioree Download PDF

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Publication number
FR2805152A1
FR2805152A1 FR0009402A FR0009402A FR2805152A1 FR 2805152 A1 FR2805152 A1 FR 2805152A1 FR 0009402 A FR0009402 A FR 0009402A FR 0009402 A FR0009402 A FR 0009402A FR 2805152 A1 FR2805152 A1 FR 2805152A1
Authority
FR
France
Prior art keywords
metacarpal
prosthesis
component
trapezium
hand
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
FR0009402A
Other languages
English (en)
Other versions
FR2805152B1 (fr
Inventor
Yves Allieu
Philippe Escare
Robert Gomis
Jean Luc Roux
Henri Connes
Jean Pierre Pequignot
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.)
CREMASCOLLI ORTHO S A
Original Assignee
CREMASCOLLI ORTHO S A
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
Priority to FR0002099A priority Critical patent/FR2805151B1/fr
Application filed by CREMASCOLLI ORTHO S A filed Critical CREMASCOLLI ORTHO S A
Priority to FR0009402A priority patent/FR2805152B1/fr
Publication of FR2805152A1 publication Critical patent/FR2805152A1/fr
Application granted granted Critical
Publication of FR2805152B1 publication Critical patent/FR2805152B1/fr
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • 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
    • 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
    • A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
    • A—HUMAN NECESSITIES
    • 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
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • 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
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30205—Three-dimensional shapes conical
    • A61F2002/3021—Three-dimensional shapes conical frustoconical
    • 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
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • 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
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
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    • A61F2002/30224—Three-dimensional shapes cylindrical
    • A61F2002/30233—Stepped cylinders, i.e. having discrete diameter changes
    • A—HUMAN NECESSITIES
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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
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    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
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    • A—HUMAN NECESSITIES
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    • 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
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30332—Conically- or frustoconically-shaped protrusion and recess
    • 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
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/30364—Rotation about the common longitudinal axis
    • 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
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30331—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
    • A61F2002/30362—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit with possibility of relative movement between the protrusion and the recess
    • A61F2002/30369—Limited lateral translation of the protrusion within a larger recess
    • 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
    • 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
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A—HUMAN NECESSITIES
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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
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    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30383—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
    • A61F2002/3039—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove with possibility of relative movement of the rib within the groove
    • A61F2002/30398—Sliding
    • A61F2002/30401—Sliding with additional means for preventing or locking said sliding
    • A—HUMAN NECESSITIES
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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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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • A—HUMAN NECESSITIES
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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
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30487—Circumferential cooperating grooves and beads on cooperating lateral surfaces of a mainly longitudinal connection
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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
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/30495—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism using a locking ring
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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
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30574—Special structural features of bone or joint prostheses not otherwise provided for with an integral complete or partial collar or flange
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    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
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Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

La présente invention est relative à une prothèse trapézo-métacarpienne, comprenant un premier élément (2) destiné à être inséré dans le métacarpe de la main d'un patient. Elle comprend un élément (24) substitutif du trapèze de la main, apte à être relié au premier élément par un élément d'articulation (20) relié solidairement au premier élément et, en pivotant, à l'élément substitutif du trapèze.

Description

La présente invention concerne une prothèse trapézo-métacarpienne à mobilité - liorée. Plus précisément, l'invention concerne une prothèse trapézo-métacarpienne permet de récupérer presque totalement les fonctions de l'articulation trapezo métacarpienne patient.
Comme sait, suite à des pathologies arthrosiques affectant la main, les fonctions du pouce, c'est ' dire de l'articulation entre le trapèze et le métacarpe de la main, peuvent être fortement compromises au point que le patient, en plus de souffrir de douleurs inten ses, ne dispose plus des fonctions optimales du pouce et que, par conséquent, lors même tentatives de préhension tout à fait normales il ne peut réussir à achever cette opération.
Pour faire face à une situation du type susmentionné, existent actuellement différen tes techniques ont pour objectif de récupérer les fonctions du trapèze et du métacarpe. Une premiere technique, connue, consiste à souder le trapèze et le métacarpe entre eux, avec pour résultat que le patient ne souffre plus, mais avec l'inconvénient de perdre les fonctions de la main.
Une seconde technique, également de type chirurgical, prévoit de prélever des liga ments d'une région du corps différente de la main et d'implanter ces ligaments entre le trapèze et le métacarpe pour pouvoir en récupérer les fonctions. Toutefois, cette seconde technique n'a la faveur des spécialistes car on obtient des résultats non satisfaisants.
Une troisieme technique opératoire prévoit d'insérer entre le trapèze et le métacarpe une prothèse appropriée. L'insertion de la prothèse doit avoir lieu en réséquant des portions des deux os de façon à pouvoir définir des logements pour la prothèse.
Les prothèses de type connu prévoient une tige destinée à être insérée dans le méta carpe, un col est inséré d'un côté dans la tige et se termine à l'extrémité opposée avec une tête sphérique qui s'engage dans un logement complémentaire défini dans une cotyle qui est elle-meme bloquée dans le trapèze de la main.
L'emploi du type de prothèse décrit pâtit toutefois de certains inconvénients, princi palement dus au fait que l'alignement entre la tige insérée dans le métacarpe et la cotyle insérée dans le trapèze, n'est pas toujours optimal, soit en raison d'une différence congé nitale entre trapèze et métacarpe de patient à patient, soit parce que la définition des placements dans le métacarpe et dans le trapèze peut ne pas être suffisamment précise pour permettre un alignement parfait entre la tige et la cotyle correspondante.
En outre, l'opération de flexion du pouce en opposition à la paume de la main provo que un effet de rotation de la cotyle dans le logement correspondant qui peut conduire à un déboîtement de la cotyle hors du logement, compromettant ainsi l'implantation prothéti que.
La fonction principale de la présente invention est de réaliser une prothèse trapézo métacarpienne qui permette d'éliminer la nécessité d'un alignement parfait entre la portion de prothèse insérée dans le métacarpe et la portion de prothèse destinée à être insérée dans le trapèze.
Dans le cadre de cette fonction, l'un des buts de la présente invention est de réaliser une prothèse trapézo-métacarpienne qui permette d'avoir un certain jeu entre la portion prothèse insérée dans le métacarpe et la portion de prothèse insérée dans le trapèze.
Un autre but de la présente invention est celui de réaliser une prothèse trapézo métacarpienne qui permette une flexion optimale du pouce en opposition à la paume de main.
Un autre but de la présente invention est de réaliser une prothèse trapézo métacarpienne qui permette une mobilité, aussi bien dans le sens rotatoire que dans un sens radial entre la portion de prothèse insérée dans le métacarpe et la portion de prothèse insé rée dans le trapeze.
Un autre , qui n'est pas le dernier, de la présente invention est de réaliser une prothèse trapézo métacarpienne qui soit d'une grande fiabilité, de réalisation relativement facile et à des coûts compétitifs.
Cette fonction, ainsi que ces buts et d'autres qui apparaîtront mieux par la suite, sont obtenus grâce à une prothèse trapézo-métacarpienne comprenant un premier élément des tiné à être inséré dans le métacarpe de la main d'un patient, un second élément destiné à relier ce premier élément à un troisième élément prothétique destiné à être inséré dans le trapèze de la main du patient, ladite prothèse étant caractérisée par le fait que l'accouplement entre ce second élément et le premier élément permet un jeu radial entre le premier élément et le second élément. D'autres caractéristiques et avantages de l'invention ressortiront mieux de des cription d'un mode de réalisation adopté, mais non exclusif, de la prothèse selon l'invention, illustré titre indicatif et non limitatif, dans les dessins en annexe, où la figure 1 une vue en perspective, éclatée, de la prothèse trapézo-métacarpienne selon la présente invention ; la figure 2 est une vue en section transversale illustrant l'accouplement entre pre mier et un second élément de la prothèse selon la présente invention ; la figure 3 est une vue en section transversale illustrant le premier et le second élé ment de la prothèse selon l'invention en position d'accouplement<B>;</B> la figure 4 une vue en perspective du troisième élément de la prothèse selon la présente invention la figure 5 est une vue en section de la composante substitutive du trapèze en de révision.
En référence aux figures susmentionnées, la prothèse selon l'invention, globalement indiquée par le chiffre de référence 1, comprend un premier élément 2, de forme essentiel lement tronconique, destiné à être implanté dans le métacarpe de la main d'un patient. Le premier élément 2 à dessein doté, à l'extrémité opposée à celle qui est destinée à etre insérée dans le métacarpe du patient, d'un élément à collet 3, circulaire, sur lequel est fixé un élément annulaire surélevé par rapport à la surface de l'élément 3, de façon à définir une cavité 5 d'accouplement pour un second élément de la prothèse, indiqué par le chiffre de référence 6.
Dans le détail, second élément 6 de la prothèse, par exemple réalisé en polyéthy lène, constitue un élément intermédiaire d'accouplement entre le premier élément 2 et un troisième élément 7 de la prothèse qui est destiné à être implanté dans le trapèze de la main du patient.
En observant la figure 1, et plus spécialement les figures 2 et 3, on note que le second élément 6 est de forme essentiellement cylindrique, avec une surface destinée à s'accoupler avec le troisième élément de la prothèse profilée en selle, et indiquée par le chiffre de réfé rence 8. La figure et la figure 3 illustrent l'accouplement entre le second élément 6 de la prothèse et le premier élément 2 et plus particulièrement l'accouplement entre l'élément annulaire 4 du premier élément 2 et sa cavité 5, avec un logement annulaire adéquat 10 défini sur la surface du second élément 6 qui est destinée à s'accoupler avec l'élément an nulaire 4.
En détail, l'élément annulaire 4 est doté de bords arrondis avec un plan incliné 11 s'accouple avec plan incliné 12 défini en correspondance sur la paroi latérale du loge ment 10 du second élément 6.
Le bord du logement 10 a un diamètre inférieur à celui de l'élément annulaire 4 de façon que l'élément 6 puisse être monté de force sur l'élément 2.
Le logement 10 du second élément 6 a une dimension supérieure à celle de la portion d'élément annulaire 4 qui est destinée à s'accoupler dans ce logement.
Cela permet, comme le montre l'illustration de la figure 3, d'avoir un accouplement avec jeu entre le second élément 6 et le premier élément 2.
L'accouplement avec jeu, dans lequel on peut donc avoir un mouvement radial entre le second élément 6 et le premier élément 2, permet d'éviter la nécessité d'avoir un ali gnement parfait entre le premier élément prothétique 2 inséré dans le métacarpe de la main et le troisième élément prothétique solidaire du trapèze.
En outre, le second élément prothétique 6 peut effectuer une rotation de 360 autour de l'élément annulaire 4 du premier élément prothétique 2.
Cela permet aussi d'améliorer les fonctions du pouce du patient, car la prothèse selon l'invention, en permettant un mouvement aussi bien radial entre le premier 2 et le troisième 7 élément de la prothèse, que rotatoire entre les deux, permet de pourvoir à l'absence de mobilité qui est un inconvénient typique affectant les prothèses de type connu.
En outre, le troisième élément prothétique 7 présente, sur sa surface destinée à s'accoupler avec la surface en selle 8 de l'élément prothétique 6, une surface profilée elle aussi en selle, 15, complémentaire de la surface en selle 8, de façon à ne pas permettre de rotation entre le second élément 6 et le troisième élément 7. Ce choix d'une surface d'accouplement entre le second élément 6 et le troisième élément 7 réalisée en selle est dicté par le fait que l'on entend ainsi copier la forme natu relle présentent le métacarpe et le trapèze dans leur accouplement.
troisième élément prothétique est doté, sur la face opposée à la face 15 d'accouplement avec la surface en selle 8 du second élément prothétique d'une paire de pivots saillants 16, 17 destinés à permettre l'accouplement du troisième élément prothéti que 7 avec le trapèze de la main du patient. A dessein, le troisième élément prothétique 7 est en outre doté d'au moins une ailette 18 sur laquelle est défini au moins trou 19 pour l'insertion d'une vis de fixation du troisième élément prothétique 7 au trapèze de la main du patient.
La figure 5 illustre, avec une vue en section, la composante substitutive trapèze en cas révision ou bien quand le trapèze est irrémédiablement abîmé.
ce cas, un élément d'articulation 20, à tête sphérique et à zone intermédiaire filetée est fixé à l'élément annulaire 4 de l'élément 2 par une frette 21 munie d'une ouver ture latérale 22 pour son introduction sur l'élément annulaire 4. En serrant la frette 21, l'élément d'articulation 20 se bloque sur l'élément 2 grâce à une surface d'accouplement conique 23. Sur la tête sphérique de l'élément d'articulation 20 est articulé un trapèze substitutif 24 qui peut tourner par rapport à la tête sphérique de l'élément 20 et est réalisé de préférence en polyéthylène contenu dans une coquille métallique.
On a, dans la pratique, constaté que la prothèse selon l'invention remplit pleinement le rôle fixé car elle permet d'obtenir une articulation optimale du pouce du patient, à savoir entre métacarpe et trapèze de la main, en reproduisant essentiellement l'articulation exis tant naturellement entre ces deux os.
La prothèse ainsi conçue est susceptible de nombreuses modifications et variantes, qui entrent toutes dans le cadre du concept de l'invention ; en outre tous les éléments de détail pourront être remplacés par d'autres éléments techniquement équivalents.
En pratique, les matériaux employés, pourvu qu'ils soient compatibles avec l'usage spécifique, ainsi que les dimensions, pourront être de quelque nature que ce soit selon les besoins et l'état de la technique.

Claims (5)

REVENDICATIONS
1. Prothèse trapézo-métacarpienne, comprenant un premier élément (2) destiné être inséré dans le métacarpe de la main d'un patient, caractérisée par le fait qu'elle comprend un 'lément (24) substitutif du trapèze de la main, apte à être relié au premier élément par un élément d'articulation (20) relié solidairement au premier élément et, en pivotant, à l'élément substitutif du trapèze.
2. Prothèse selon la revendication 1, caractérisée par le fait que l'élément d'articulation (20) est doté, sur l'extrémité apte à être insérée dans cet élément substitutif du trapèze d'une tête sphérique.
3. Prothèse selon la revendication 2, caractérisée par le fait que l'élément d'articulation (20) a, à l'extrémité opposée à cette tête sphérique, une portion terminale conique (23) apte à s'engager dans une portion profilée complémentaire du premier élé ment.
4. Prothèse selon la revendication 1, caractérisée par le fait que l'élément d'articulation (20) est doté d'une zone intermédiaire filetée, un élément à frette (21) pou- être vissé sur cette zone filetée pour bloquer l'élément d'articulation contre le premier élément.
5. Prothèse selon la revendication 4, caractérisée par le fait que l'élément (24) subs titutif du trapèze réalisé en polyéthylène est contenu dans une coquille métallique.
FR0009402A 2000-02-21 2000-07-18 Prothese trapezo-metacarpienne a mobilite amelioree Expired - Fee Related FR2805152B1 (fr)

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