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WO2016116571A1 - Gabarits, prothèses et orthèses - Google Patents

Gabarits, prothèses et orthèses Download PDF

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Publication number
WO2016116571A1
WO2016116571A1 PCT/EP2016/051252 EP2016051252W WO2016116571A1 WO 2016116571 A1 WO2016116571 A1 WO 2016116571A1 EP 2016051252 W EP2016051252 W EP 2016051252W WO 2016116571 A1 WO2016116571 A1 WO 2016116571A1
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WO
WIPO (PCT)
Prior art keywords
resection
template
bone
prosthesis
endoprosthesis
Prior art date
Application number
PCT/EP2016/051252
Other languages
German (de)
English (en)
Inventor
Luis Schuster
Original Assignee
Luis Schuster
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
Application filed by Luis Schuster filed Critical Luis Schuster
Priority to EP16701166.7A priority Critical patent/EP3247313A1/fr
Publication of WO2016116571A1 publication Critical patent/WO2016116571A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/14—Surgical saws
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/155—Cutting femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/14—Surgical saws
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/157—Cutting tibia
    • 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
    • A61F2/38—Joints for elbows or knees
    • A61F2/3859—Femoral components
    • 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
    • A61F2/38—Joints for elbows or knees
    • A61F2/3872—Meniscus for implantation between the natural bone surfaces
    • 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
    • A61F2/38—Joints for elbows or knees
    • A61F2/389—Tibial components

Definitions

  • the present invention relates to templates, in particular resection templates, as well as prostheses and orthoses for the endoprosthetic treatment of knee joints.
  • an implantation instrument a so-called flat milling machine, for producing the implant site on the tibial bone is also used illustrated tibial minimal endoprosthesis shown.
  • the invention ultimately represents the endoprosthetic treatment of the "next generation" of endoprostheses, which will be used significantly reduced in size from conventional materials and in the long term only as “temporaries” until the final restoration with a true biological endoprosthesis.
  • a stabilizing knee joint orthosis is also shown for the post-treatment, which allows a stable and physiological movement due to its special hinge concept.
  • the resection template has a clamping mechanism, a latching mechanism and / or a snap mechanism for fixing to the bone (FIGS. 1 to 4).
  • the resection template for fixing to the bone has an undercut and is preferably designed to be elastic in order to receive a bone area or joint area in the undercut or to introduce it into the undercut.
  • the template can be attached very securely to joint structures, so that wobbling movements are largely avoided.
  • anatomical conditions for attachment it is therefore preferable to use anatomical conditions for attachment and to take them into account already during the shaping (production) of the template.
  • the stapling mechanism, locking mechanism or snap mechanism is in this case arranged in particular such that it can embrace bony structures which can be represented by computed tomography.
  • the resection template according to the invention thus makes it possible to obtain data by means of computed tomography.
  • computed tomography of course, the more complex magnetic resonance tomography for data generation is also possible.
  • a further improvement of a resection template, in particular a femoral template can be achieved by dividing the femoral template into a distal resection template and a so-called “four-in-one template", preferably with femoral anchoring posts.
  • the resection template has at least two parts and a first template part for performing a first resection and a second template part for performing a second resection, wherein the first template part in particular as a template individual, preferably for a distal template, and wherein the second template part is in particular a standardized template part for multiple use and is preferably designed for a multiple resection (resections along different resection planes).
  • a significant improvement of the method is to be achieved in that the usual five resection steps on the femur are not performed with a single template, but with a first template only the so-called distal resection, which in the horizontal plane by the distal body Thighbone runs, is performed.
  • This cutting plane is of crucial importance for the implantation of the prosthesis in that the adjustment of the knee joint Doprosthesis in the so-called coronary plane, that is set for the so-called varus and valgus tilting. These tilts are crucial for the correct biomechanical loading of the prosthesis. (Fig. 3)
  • the first template with only one cutting plane can have drill guides for pre-drilling channels for anchoring pins of the femoral prosthesis. (Fig. 4)
  • the four further cuts still required are then, similar to the conventional methods, made possible by a second template, preferably a so-called “four-in-one template", which, however, additionally by anchoring pins corresponding to those on the femoral to be implanted Prosthetic component on the already established distal resection surface of the femur, can be precisely aligned. Further measurements for positioning and further fixations are therefore not required (FIG. 5).
  • the "four-in-one template” reproduces the four standardized further resection surfaces of the femoral prosthesis pad, as in the conventional methods.
  • the second template may therefore be reusable and may be made of durable material such as stainless steel or the like.
  • the resection template comprises at least one drill guide for a groove-shaped bore of the, for example, femoral implant bed for a femoral prosthesis component with, for example, a semi-cylindrical reinforcing strut, for example at a predetermined breaking point of the prosthesis or prosthesis component.
  • the resection template may in particular be designed as a "four-in-one template" for the femur.
  • the resection template has a drill guide, in particular parallel to a tool guide designed as a saw guide, in particular for producing a groove or a channel-shaped bore on a resection surface of the bone (implant bearing).
  • the endoprosthesis according to the invention according to the second aspect of the invention is intended in particular for the femur.
  • it has a plurality of bearing surfaces or bearing surfaces which are aligned at an angle to one another in abutment with correspondingly angularly aligned resection surfaces of a bone, in particular of the femur.
  • at least one reinforcement is present, which extends over an edge formed between the support planes and, in particular, protrudes from the support planes aligned at an angle to one another.
  • the cutting lines of the resection surfaces or the support planes of the prosthesis are subject to comparatively low material thicknesses, which under biomechanical loading represent a so-called predetermined breaking point.
  • predetermined breaking point for example, according to the invention, semi-cylindrical reinforcements can be applied to the prosthesis via the edges of these cutting lines. The strength of the reinforcement can be determined for each individual load, taking into account the height and weight of the patient. Thus, a sufficient resistance to fracture can be ensured at these locations.
  • the preferably semi-cylindrical reinforcements or reinforcing elements ensure further anchoring stability, in particular with respect to lateral shear forces. (Fig. 6)
  • the resection template preferably has at least one drill guide which runs along the corresponding resection plane or the resection shaft (sowing shaft). By means of this drill guide can bring a corresponding hole with drill bits of the same radius in the implant bearing.
  • the template to be used may be, for example, a "four-in-one stencil”. (Fig. 8).
  • a further aspect of the invention consists in a prosthesis and template for the femur in order to replace or resect, alone or in combination, the medial and / or lateral articular surface of the femur and / or the patella sliding bearing.
  • the endoprosthesis in accordance with the second aspect of the invention, according to a further embodiment it is provided in particular that the endoprosthesis consists of several, preferably at least three, individual parts, wherein the individual parts each have at least one support plane for attachment to at least one resection surface of a cooking, in particular of the femur, wherein the individual bearing planes are preferably aligned at an angle to each other.
  • the dorsodistal femoral sleeve bearing and the patellar sleeve bearing are preferably formed by separate (and spaced apart) prosthesis components.
  • the dorsodistal lateral sleeve bearing and the dorsodistal medial sleeve bearing are also formed by separate (and spaced apart) prosthetic components.
  • the division of the classical tricompartmental total endoprostheses is preferably carried out on linear or band-shaped areas, corresponding to the so-called border groove, sulcus femorotibialis or also sulcus terminalis, in each case medial and lateral.
  • the kneecap performs a special load redistribution on the articular surfaces, whereby it is subjected to particularly low mechanical loads.
  • Another aspect of the invention consists in a vertical distribution of the ventral femoral bone-side bearing surface of a femoral prosthesis (or femoral component of a prosthesis) in two bearing surfaces, which, preferably with a slight V-shape, are tilted towards each other.
  • the corresponding resection shafts in the resection template for the femur for example a "four-in-one stencil", are correspondingly applied or aligned.
  • the endoprosthesis according to the invention preferably has a plurality of contact areas oriented at an angle to each other for abutment with correspondingly angularly aligned resection areas of a bone, in particular of the femur.
  • At least one of the support regions has an unfold, in particular V-shaped, whose at least one crest line runs transversely to an edge formed between the support regions.
  • a ventral femoral bearing surface or plane of the endoprosthesis has a central graduation, this division preferably extending in the direction of the distal bearing surface or towards the distal bearing surface.
  • the resection template preferably has at least one support device for support on the bone and a plurality of tool guides for guiding a tool for processing, in particular resection, of the bone or femur.
  • the tool guides are aligned with one another in such a way that a plurality of angularly aligned resection areas can be produced by resection of the bone, wherein an at least one of the resection areas is able to produce a fold, in particular a V-shaped, whose at least one The crest line extends transversely to an edge formed between the resection areas.
  • the omission of the anchoring pegs on the femoral component of the knee joint endoprosthesis also facilitates, in particular, a possible replacement operation since, in particular in the case of prostheses implanted without cement, the contact surfaces, which are often considerably entwined with the bone, intermesh with the oscillating Saw can be separated without encountering an obstacle or the anchoring pins.
  • the V-shaped arrangement of the resection surfaces on the bone can be achieved by a corresponding arrangement of the saw slots, for example in the four-in-one resection block.
  • the resection template which is provided in particular for the resection of the tibia, has a contact area adapted to an approximately right-angled shin edge, preferably curved approximately at right angles, for abutment with the shin bone edge in order to achieve rotational stability.
  • the tibia On the outside of the shin bone, the tibia has a nearly right-angled edge slightly above and lateral to the so-called tibial tubercle and about 3-4 cm below the ventral anterolateral tibial margin in a slightly different shape. This extends to the tibial head just above the so-called tibial tubercle on the outside below the so-called tubercle Gerdii to the fibular head.
  • a hook-shaped, in particular rectangular, structure on the template which simulates the edge described, the edge can be precisely defined on the tibial template about the vertical axis , (Fig. 1 1, 18)
  • the rotary hook represents an optional additional stabilization aid, which, if necessary, can also later be attached or attached to the template already placed in the situs. 7. Division of a tibial prosthesis
  • the endoprosthesis consists of at least two separate prosthesis bodies (parts), wherein a first prosthesis body for placement on a first side, in particular medial, the tibial intercondial tuberosity and a second prosthesis bodies is designed to be arranged on a second side, in particular laterally, of the intercondylar tuberosity of the tibia.
  • a first prosthesis body for placement on a first side, in particular medial, the tibial intercondial tuberosity and a second prosthesis bodies is designed to be arranged on a second side, in particular laterally, of the intercondylar tuberosity of the tibia.
  • a division into two parts has proved to be advantageous.
  • two separate tibial versions may be provided, which serve for receiving the respective prosthesis onlays, which are usually made of polyethylene, but in principle also of other similar or modified, suitable plastics or other materials may serve.
  • the unconnected (separate or separate) portions of the prosthesis facilitate easier bone resection.
  • the templates may be pre-drilled for one or more anchoring pegs, screws, or other fixation devices for the socket of the tibial prosthesis components on the resected bone separated and successively set up, aligned and if necessary corrected.
  • the associated division of the prosthesis onlays or polyethylene enkomponenten (eg the polyethylene onlays) also offers the possibility, by the selection of onlays of different heights on one or the other side, for example in millimeter steps, a particularly accurate balance to achieve the belt tension taking into account a required axis alignment.
  • menisci Maintenance or restoration of the menisci
  • a further stabilizing function mainly takes place in conjunction with the periarticular ligament apparatus, which undergoes a more flush and direct contact, in particular with the femoral condyles, through the menisci and thus supports the stabilization in the horizontal plane.
  • the second approach would be to try to replace the menisci with the utmost precision and individually with a suitable plastic, for example rubber or the like, whereby these meniscal prostheses must be fastened at their edges analogously to the natural menisci. It would be conceivable that at least the fixed, passive fixation, for example, of the The anterior and inferior veins of the anterior and distal meniscus could be restored in sufficient form by fixation on the endoprostheses.
  • a preferred embodiment of the invention thus relates to a method for maintaining the meniscus function, in particular in the case of an endoprosthetic restoration of the tibia, by preserving the original meniscus or replacing the original menisci with a meniscal prosthesis which is produced in particular from rubber and fixed on a tibial prosthesis component.
  • the tool guide is formed as a milling opening, in particular with an at least partially arcuate boundary for guiding a milling head or a plurality of milling heads.
  • the support means may be designed here in particular as a preferably flat (flat) support surface.
  • the introduction of the depression is preferably carried out by a milling head, for example a hemispherical milling head, which is guided in the second template.
  • a milling head for example a hemispherical milling head
  • This makes it possible, for example, to mill out a sufficiently deep implant bed, which ensures the introduction of the minimally required denture or polyethylene thickness in the respective loading zone.
  • the implant bed can be hemispherical.
  • a milling device for milling a bone in particular a tibial implant bed, preferably the tibial condylar plateau, is provided, which comprises a milling unit, a handling part for manual handling and in particular a support surface for supporting on an opposing anatomical structure, in particular the femur.
  • the support surface may be formed in particular on the handling part.
  • the milling unit preferably has a circular disk-shaped, dome-shaped and / or spherical or hemispherical milling head.
  • the handling part is pivotally arranged relative to the milling head or the milling unit or a Fräskopf entry and that by a repulsion on an opposing anatomical structure pressure on the bone for milling the bone is exercisable.
  • the handling part or lever can be pressed by a pivoting movement against an opposing anatomical structure and thereby exert pressure on the milling unit or the milling head.
  • the opposing anatomical structure may be, for example, the femoral condyle opposite, for example resected, the tibia.
  • the pressure can be exerted in particular on a Fräskopf Insert, for Example over the location defined by the tibial template. This makes it possible to press the milling head in confined spaces in depth.
  • the resection template has a cantilever at the end of which a contact surface for abutment with the tibia is formed, the abutment surface being at least 10 cm, preferably at least 13 cm, from a support surface for the proximal end of the abutment Tibia is removed.
  • the boom, the actual tibial template (stencil body with support and Tool guide) to the tibial stopper (abutment member), may additionally include a drill channel as a guide for an alignment rod for checking the position of the resection plane for the tibial prosthesis component with respect to the tibial anatomical axis ( Figure 22).
  • a metal rotation-stable alignment rod for example a square bar
  • stencil material can additionally be saved by using only the metal square alignment rod as a connection between the actual base body of the template and the support element on the shin edge.
  • locking devices for template base body and support element would have to be attached to precisely determinable points of the alignment rod. Similar to the support element on the shin bone edge, such can also be made for the region of the ankle and, alternatively or together with the support element on the shin bone edge, be used for positioning the alignment rod, as described above.
  • the invention relates to a method for determining a contact surface for a resection template with a boom and a contact surface for abutment with the tibia, in which a preferably three-dimensional image of at least a portion of the tibia is recorded, wherein during the recording of the three-dimensional image of a mass the tibia is modeled, which delimits itself on the three-dimensional picture against bones as well as against soft parts on the bone.
  • a modulatable mass which can be sufficiently delimited against bones and soft tissues on the shin bone edge (for example, a cooling pack)
  • the contact surface or support surface for the shinstopper or for the contact surface of the resection template on the shin bone edge which on the inside with a relatively thin skin and periosteum layer and externally covered with a displaceable, differently thick muscle layer, during a CT or NMR recording are shown more accurately (Fig. 18).
  • Another aspect of the invention relates to a method for producing a template, prosthesis or orthosis, in particular a limb or Geis Steering rail, which is formed at least partially to rest against an outer, for example skin-covered, body surface of the human or animal body, in particular a limb, wherein a three-dimensional image data set at least a portion of the body or the extra- is picked, wherein during recording of three-dimensional image data set, a preferably filled with a fluid, cuff around the outer contour of the body or the extremity is arranged, which is defined in the three-dimensional image data set against both bones and soft tissue, and wherein at least one mold portion of the template, prosthesis or Orthosis is formed based on the three-dimensional image.
  • the attachment to the body surface can also take the form of an at least partial enclosure of a limb.
  • the invention relates to a template, prosthesis or orthosis, in particular produced by the method according to the invention, wherein the template is designed to bear on an outer, for example, skin-covered body surface and sleeve, shell, cuff, ring and / or is clamp-shaped to substantially encompass a limb of the body.
  • the template, prosthesis or orthosis has a joint.
  • the template is applied to the bone aligning the bearing surfaces with the intact, usually skin-covered body surface (based on the tibial template tibial stencil technique or the patellar template outer component technique).
  • a plastic cuff is applied to the leg of the patient, for example during the computed tomography recording.
  • the plastic sleeve can be filled, for example, pneumatically or with liquid.
  • a plastic cuff for example, such as is known to be used for the emergency immobilization of extremity fractures can be used.
  • an excellent representation of the limb surface can be achieved by computed tomography.
  • the bearing surface of the Exoprothese or Exoschablone to rest on the outer Extremity surface (for example leg) can then be shaped individually based on this recording.
  • the recording can be made by means of magnetic resonance imaging.
  • liquid filling of the cuff for example by water, due to the weight of the liquid additionally immobilization of the patient, in particular the extremity, can be achieved. This is advantageous both for a computed tomography and, if necessary, for a nuclear spin tomographic image.
  • the exo-template or exoprosthesis can be, for example, a sleeve-shaped shell and / or a clamp construction, for example for a limb.
  • the preparation may possibly be carried out analogously to the preparation of the endoprostheses, for example also using a suitable 3-D printing process.
  • the Exoschablone or Exoprothese can be made of a suitable material, for example plastic, especially hard plastic, carbon fiber or the like.
  • Mechanisms for example, for opening and closing, tightening and / or pressure padding may also be provided based on the conventional techniques for the production of prostheses.
  • Air cushioning may be achieved, for example, by air chambers and / or by the proper choice of material or material texture. It is essential that the construction can be optimally attached to the body part, for example the extremity.
  • the simultaneous presentation of limb surface and bony structures in the depth of the soft tissues also offers the possibility of constructing orthoses or splints in the sense of exoprostheses, which, for example, at the knee joint allow a significantly differentiated orientation on a bony or cartilaginous joint geometry. This concerns in particular the knee joint geometry.
  • the orthosis or splint can therefore be adapted much more accurately to the individual knee joint kinematics, for example for the construction of the joint of a knee splint splint.
  • the epicondylar line may be applied much more precisely as an approximate anatomical center of rotation of the knee joint using, for example, conventional monocentric, bicentric or polycentric joints (with and without limiting movement of the respective joint) for extension and flexion.
  • the uniform representation of the soft tissue on the surface (surface contour) and the bone in the interior can realize much more complex joint kinematics.
  • a hinge construction adapted to the femoral condyle contour or a sliding bearing on the side of the exoprosthesis shell or the exoprosthesis
  • an individually adapted and significantly improved kinematics possibly with rolling, sliding and rotation possibility for the knee joint movement can be realized.
  • This may, for example, with a sliding metal / polyethylene, similar to the endoprostheses but possibly also by a roller construction or ball bearing construction along the contact surfaces of this hinge construction, for example, each inside and outside done.
  • the hinge construction may possibly also be housed in a protective housing for protection against contamination and also for preventing the escape of lubricant.
  • the exoprosthesis for example, a shell construction
  • the improved kinematics improves the physiological movement of the joint and thus the desired healing process as well as the wearing comfort.
  • a stabilization of the Exoschablone or Exoprothese (for example, shell construction) or the sliding bearing can be made for example by structures whose anchorages are given by the Burmester curve. These structures can be strip-like and / or strip-like and / or stable (dimensionally stable) and / or elastic. They can each be provided on the sides, possibly also dorsally and ventrally, of the joint. Structures preferably run laterally corresponding to the band structures or band insertions and / or ventrally of the extensor apparatus and / or dorsally corresponding to the dorsal capsular ligament structures of the knee joint.
  • the constructions can be made with and without limiting the movement of the respective joint (for example, the knee joint) for the extension and flexion, for example, by wedge-like stopper devices or other types of joint locks. ( Figures 19 and 20).
  • a functional orthosis for stabilizing the knee joint can be produced.
  • the orthosis can for example be used after an injury, for example a ligament structure, for example of the anterior cruciate ligament.
  • the orthosis can also be used for relief, for example in unilateral medial or lateral gonathrosis, or for postoperative relief, for example, by additional support in the sole area and / or in the hip area.
  • the method according to the invention can also be used in the construction of other exoprostheses, for example the upper extremities, but also of trunk buttocks and orthoses for stabilizing the cervical spine.
  • the method can also be used in modern mechanized orthopedic care, in particular in the production of so-called external skeletons in neurorobotics, and in the treatment of neurological diseases and injuries, for example paraplegia.
  • an exo-template or exoprosthesis or knee-joint splint for, for example, post-operative stabilization and relief of the knee joint is provided which is provided with a hinge which allows a physiological movement of the knee joint, wherein, in particular based on the individual knee joint endoprosthesis , Sliding hinges on the outside of the exoprosthesis with braces fixed at the belt insertion points corresponding to the Burmester curve are attached.
  • a femoral minimum endoprosthesis in which dorsodistal femoral sleeve bearing and patellar sleeve bearing are separated; a femoral prosthesis with a V-shaped fold of the support surface for the femoral sleeve bearing;
  • a resection template in particular a tibial template, with a rotary hook
  • a resection template (tibial template) with a milling guide for eating out a prosthesis bearing, in particular for a minimal endoprosthesis ventral;
  • a milling device for milling out a prosthesis bearing, in particular on the tibia dorsally;
  • FIG. 17 a tibial minimal endoprosthesis in a further view
  • FIG. 18 shows a resection template with a rotary hook and a support surface for resting on the tibia (shinstopper);
  • Fig. 19 a prosthesis as a knee brace
  • FIG. 20 shows a three-dimensional view of the exoprosthesis according to FIG. 19;
  • Figures 1, 2 and 4 show a fixed to a bone 200 and the femur 210 (femur) of a human resection template 10 with a stapling mechanism or snap mechanism for fixing.
  • the resection template 10 comprises a support device 20 for supporting on the bone 200 and a tool guide 30, in particular a saw slit or sowing shaft or a saw guide, for resecting the bone 200 along a defined plane.
  • a base body in which the tool guide 30 is formed forms a clasp-like clasp 40 of the bone 200.
  • the clasp 40 includes an undercut to receive the bone 200 therein.
  • the clasp 40 surrounds the bone 200 by more than 180 degrees, so that it can be securely fixed in the Umgriffs Suite formed by the clasp 40.
  • the clasps of the clasp 40 are flexible, so that the resection template 10 can be placed on the bone 200 by latching.
  • a close examination of the anatomy of the knee joint reveals that at approximately 120 ° of flexed knee joint and vertical alignment of the tibia, predominantly bony, partially cartilaginous surface structures are present on both the femoral and tibial platelets. In the horizontal plane to the rear, when the operation is open, there is a rejuvenation in the depth of the surgical site on the femoral rolls and also on the tibialis.
  • This posterior taper is located on the femoral rollers in the above-mentioned orientation just behind the lateral edges of the articular surface, which in the patients to be treated with knee joint endoprostheses by so-called arthrotic remodeling processes (predominantly with bony, but also cartilaginous-connective tissue bulges - so-called Osteophytes) are often additionally broadened.
  • hyper-trophic synovial connective tissue and osteophytes also largely displace the lumen, they are adequately pushed aside by a sufficiently resistant, slightly chack-shaped structure, such as, for example, a pfriem or a raspartorium pierced to allow access to the back of the distal femur to the planum popliteum without injuring critical structures, particularly vessels, nerves, or tissues of importance for stability or function.
  • a sufficiently resistant, slightly chack-shaped structure such as, for example, a pfriem or a raspartorium pierced to allow access to the back of the distal femur to the planum popliteum without injuring critical structures, particularly vessels, nerves, or tissues of importance for stability or function.
  • This planum popliteum similar to the femoral bone above the patella sliding bearing, is a computertomographically reliable and reproducible bony structure which, connected by a line extending vertically, or sagittally over the patella sliding condyle and through the intercondylar notch, forms an upwardly tapering clasp, cf. , Fig. 2.
  • the template 10 in the area of the femur 210 makes use of the circumstance that in the knee joint endoprosthesis the bone 200 to be resected, above all on the femoral side, can be peeled out of the surrounding soft tissue without any other joint of the body leads to relevant soft tissue damage.
  • FIGS. 3 and 4 show a resection template 10 as a first template or a first template part 1 1 for an exclusive distal resection of the femur 210.
  • the resection template 10 comprises only a single tool guide 30 in order to resect the condyles 212 of the femur 120.
  • the resection template 10 further comprises drill guides 34 for pre-drilling canals for anchoring pegs of a femoral prosthesis to be inserted.
  • the resection template 10 also includes a clip or clasp 40, as previously described, which clasps the femur 210 between the condyles 212 in the proximal direction.
  • FIG. 5 shows a resection template 10 as a second template part 12 in the form of a 4-in-1 template for further resection following the distal resection (FIGS. 1-4).
  • the resection template 10 can also be referred to as a resection block and comprises a plurality of tool guides 30.
  • the resection template 10 comprises a flat support surface 28 for resting on an already prepared resection surface (distal resection) of the bone 200.
  • Anchoring pins 36 are provided for fixation on the resection surface.
  • the resection template 10 is provided in particular for the femur 210 and comprises corresponding tool guides 30 (saw guides) for the resection of the condyles 212.
  • FIGS. 6 and 7 show two embodiments of an endoprosthesis 100.
  • the endoprosthesis 100 for the femur has a plurality of contact planes 102 aligned at an angle to each other for abutment with corresponding resection surfaces of the resected femur 210.
  • a reinforcement 104 is arranged, which connects the support planes 102 and reduces the risk of breakage in the region of the edges between the support planes 102.
  • the particular strut-shaped and / or schzylin- derförmige reinforcement 104 extends transversely to that between the support planes 102nd formed edge.
  • the endoprosthesis 100 includes a first dorsal disc medial prosthesis portion 122, a second dorsodiscidal lateral prosthesis portion 124, and a third patellar sleeve bearing prosthetic portion 126.
  • a first support region 106 having at least two support planes 102 is formed.
  • a second support region 107 with at least two support planes 102 is formed.
  • a third support region 108 with at least two support planes 102 is formed.
  • FIG. 8 shows a resection template 10 for producing an implant support for an endoprosthesis 100 according to FIG. 6.
  • drill guides 35 are present in the resection template 10, which bore holes parallel to the corresponding guide (tool guide 30) ).
  • FIG. 9 shows an endoprosthesis 100 for the femur 210 in the form of a minimal arthroplasty.
  • the prosthesis parts of the dorsodistal sliding bearing and the pattelaren sliding bearing are designed as separate elements (prosthesis parts). The parts of the prosthesis are separated in the area of the so-called sulcus terminal.
  • the endoprosthesis 100 comprises a first prosthetic part 130 for the medial dorsodistal sliding bearing, a second prosthetic part 132 for the lateral dorsodistal sliding bearing and a third prosthesis part 134 for the patellar sliding bearing.
  • FIGS. 6 and 10 show an endoprosthesis 100 in the form of a prosthesis for the femur 210 with a V-shaped fold of one of the bearing surfaces or bearing planes 102.
  • the endoprosthesis 100 comprises a first bearing region 106 for the medial dorsodistal sliding bearing, a second bearing region 107 for the lateral dorsodistal sliding bearing and a third support region 108 for the patellar plain bearing.
  • the third support region 108 comprises a V-shaped unfolding which is directed to the correspondingly folded resection plane of the bone (femur).
  • FIG. 11 shows an embodiment of a resection template 10 with a so-called rotation hook.
  • the tibia 220 has an almost rectangular edge 228 on the outside tibial edge or side 226.
  • the resection template 10 has a hook-shaped abutment region 46.
  • the hook-shaped, in particular bent at right angles abutment portion 46 feels the edge 228 on the outer tibial side and is preferably designed tongue-shaped.
  • the hook-shaped abutment region 46 can be detachably connected to the main body of the resection template 10, so that it can also be attached later, for example, in the resection template 10 already applied in the situs.
  • the endoprosthesis 100 in a preferred embodiment of the invention is shown in FIG.
  • the endoprosthesis 100 consists of at least two separate and spaced apart prosthesis parts 1 10, 1 12, in particular for placement on the two condyles 222 of the tibia 220.
  • the two separate prosthesis parts 1 10, 1 12 of the endoprosthesis 100 are in the inserted state by the Intercondylen cusps of the tibia (intercondylärer area 224) separated or spaced apart.
  • the endoprosthesis 100 thus consists of a first prosthesis part 110 and a second prosthesis part 112, which are arranged separately and spaced from one another on the tibia 220 and in each case one mount 1 14, 16 for placement on a resection surface and one on the mount 1 14, 1 16 attached Prostesenonlay 1 18, 120 have.
  • a particular aspect therefore consists in the provision of two separate sockets 1 14, 16 of an endoprosthesis 100, in particular for the tibia 220.
  • the sockets 1 14, 16 are provided in particular for the medial and the lateral tibial plateau 222, respectively.
  • FIG. 13 shows a resection template 10, in particular a second resection template for use after a previously performed height resection, in particular of the tibial plateau.
  • the resection template 10 has a support device 20 for support on the flat resection surface of the tibia 220.
  • the resection template 10 is designed like a frame with a circumferential frame 14 and a limited by the frame 14 milling opening 16.
  • the milling opening 16 includes arcuate boundary walls for guiding a particular circular milling unit or a particular circular milling head.
  • the milling opening 16 is preferably shaped such that it can guide a milling unit 92 or a milling head 94 in several, preferably at least two or at least three positions.
  • a plurality of milling guides, in particular circular-arc milling guides provided accordingly.
  • FIG. 13 shows an embodiment of a milling device 90 for milling out a bone, in particular the tibia 220, in particular an already resected tibial plateau.
  • the milling device 90 comprises a milling unit 92, which is pivotally mounted on a handling part 96 and comprises a rotatable milling tool (milling head).
  • the milling unit 92 with the rotatable Fräswerk- stuff is particularly designed dome-shaped and / or spherical or hemispherical to introduce a dome-shaped or spherical recess in the implant bearing.
  • the milling device 90 is further illustrated in FIG. 14 and FIG. 15 and shows, in particular, a milling operation on the knee joint between the femur 210 and the tibia 220.
  • the resection template 10 according to FIG. 13 is placed on the already resected tibial plate.
  • the handling part 96 which is designed in particular as a lever, is pivoted relative to the axis of rotation of the milling unit 92, in particular by about 80 to 1 10 degrees.
  • the lever can be supported on the opposite femur 210.
  • a support surface is formed on the handling part 96, so that the contact pressure can be varied by pivoting the handling part 96 relative to the milling unit 92.
  • the handling part 96 comprises at least two lever parts which can be pivoted relative to one another, wherein a first lever part is connected to the milling head and a second lever part has the support surface. By pivoting the two lever parts, the milling head or the milling unit is pushed away from the abutment surface.
  • the 16 shows a minimal tibial endoprosthesis 100, comprising a socket 1 14 and a prosthesis body 1 18 as a unilateral prosthesis for the lateral or medial femoral condyle 212.
  • the socket 1 14 has a flat support area, in particular on the edge, for resting on a resection plane , In the flat support area a plurality of projecting, in particular hemispherical storage areas are formed which are inserted into corresponding recesses in the implant bed. As a result, such a minimal endoprosthesis 100 can be fixed more reliably.
  • the prosthesis body 1 18 includes one or more pins, which engage in corresponding holes in the socket 1 14.
  • the tibial minimal endoprosthesis 100 according to FIG. 16 is shown in FIG. 17 in a lateral and partially sectioned view.
  • FIG. 18 shows a resection template 10 in the form of a so-called tibial stopper.
  • the resection template 10 comprises a support device 20 for supporting at the upper end of the tibia and a tool guide 30 for guiding a tool, in particular a saw, for resection of the tibia.
  • the resection template 10 further comprises a hook-shaped abutment region 46, as described in connection with FIG. 11.
  • FIGS. 19, 20 An exo-template or exoprosthesis is shown in FIGS. 19, 20.
  • the template 10 or prosthesis 100 comprises a joint and is designed in two parts.
  • the preparation of the template 10 or prosthesis 100 is preferably carried out based on a computed tomographic image after modeling a mass on the outside of the extremity, which can be displayed well on the computer tomographic image.
  • the invention can also be described as follows: 1.
  • Resection template for the resection of a bone, with at least one support device for support on the bone and at least one tool guide for guiding a tool for processing, in particular resection, of the bone, characterized in that the support means by means of latching or snap mechanisms on the bone exactly is stable fixable, the resection template in particular allows the exact implantation of a customized minimal endoprosthesis.
  • Template for the femur division of the femoral template in a distal resection template and a so-called “four-in-one template” with femoral anchoring pin: for example, also called “four-in-one template", which as a second template at Resection of the femoral prosthesis bearing is used with femoral anchoring pins for anchoring the template in the drilling channels provided for the femoral prosthesis anchorage (FIGS. 1-4 and FIGS.
  • Template for example by so-called “four-in-one template” for the femur with additional drill guides for a trough-shaped bore of the example femoral implant bed for femoral prosthesis components with, for example, semi-cylindrical reinforcing struts, for example, at the predetermined breaking points. 8th) 4. Femoral prosthesis component with, for example, semi-cylindrical reinforcing struts, for example, at the predetermined breaking points, especially when used in real complete or divided resurfacing or even in the real bioprosthesis. (Fig. 7)
  • Femoral prosthesis component in the sense of a true resurfacing, in which the cutting planes are adjusted individually to the respective femur of the patient with minimal bone / cartilage resection.
  • Figure 7 Template for the femur, for example as a "four-in-one template", so that with this alone or in any combination, the medial and / or lateral articular surfaces of the femur and / or the patella sliding bearing (7) 7.
  • Femoral prosthesis components as a true resurfacing, in which the incision planes are individually adapted to the respective femur with minimal bone resection
  • the primary tricompartmental femoral prosthesis components can be divided into three parts, namely two femoral components and the femoropatellar plain bearing, by separating these individual parts at the level of the so-called sulcus terminalis or sulcus femorotibialis at the respective medial or lateral femoral condyles.Perhaps several resection levels for the implant bed at the femoral condyles to further bone savings. (Fig 8.
  • Template for the femur for example as "Vie r-in-one template "so that a vertical division and unfolding of the bearing surface on the femoral implant bearing for the back of the femoral sleeve bearing of the endoprostheses in the slight V-shape of a corresponding femoral component of the endoprostheses arises.
  • a method of obtaining meniscal function by obtaining the original menisci or replacing it with a meniscal prosthesis made of a suitable material, for example rubber, and fixed to the tibial prosthesis component.
  • Resection template for the tibia which by attaching a rotary hook, for example on the tibial template, allows a rotational stability of the same when placed on the tibia. (Fig. 1 1, 18)
  • tibial prosthesis component which is a two-part prosthesis with a medial and lateral tibial component corresponding to a so-called tibial soapy bilateral slide, especially in tricompartmental articular surface replacement on the femur, to simplify the procedure in the so-called total endoprosthetic individual knee joint endoprosthesis, Improvement of precision and stability in the positioning of the prosthesis components as well as reduction of the required bone resection. In addition, appropriate modification to the tibial templates. (Fig. 12)
  • a lever mechanism for example, on the milling head guide pressure exerted by repulsion of the opposing anatomical structure, for example, the resected femoral condyle will and under cramped space the milling head can be pressed into the depth.
  • a tibial template, or method of making such a template in which an optimized so-called tibial stop on the tibial margin contributes to more precise and stable positioning of the tibial template, and possibly includes a channel for a guide rod for axis alignment.
  • markers may be used in any combination or alternation in the template implantation procedures described above, to optionally achieve a further additional increase in precision and efficiency when using the stenotic technique or the endoprosthetic procedure, respectively.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Transplantation (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Surgery (AREA)
  • Vascular Medicine (AREA)
  • Cardiology (AREA)
  • Dentistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un gabarit de résection (10) utilisé pour la résection d'un os (200), comportant au moins un dispositif d'appui (20) servant d'appui au niveau de l'os (200) et au moins un guide d'outil (30) guidant un outil pour un traitement de l'os (200), en particulier une résection. L'invention est caractérisée en ce que le gabarit de résection (10) présente un mécanisme à agrafe, un mécanisme à loquet et/ou un mécanisme à cliquet destiné à être fixé à l'os (200), ou en ce le que gabarit de résection (10) est conçu en au moins deux parties et présente une première partie de gabarit (11) servant à effectuer une première résection et une deuxième partie de gabarit (12) servant à effectuer une deuxième résection, la première partie de gabarit (11) étant en particulier réalisée sous la forme d'un gabarit individuel, de préférence pour une résection distale, et la deuxième partie de gabarit (12) étant en particulier réalisée sous la forme d'un gabarit normalisé pour une utilisation multiple et de préférence pour une résection multiple, ou en ce que le gabarit de résection (10) présente un guide de foret (35), en particulier parallèle au guide d'outil (10), réalisé sous la forme d'un guide-scie, en particulier pour produire une rainure au niveau d'une surface de résection de l'os (200), et/ou est fixé à l'os de manière précise et stable au moyen du mécanisme à loquet ou à cliquet, et permet en particulier une implantation précise d'une endoprothèse minimale individualisée et d'une dimension la plus réduite possible. L'invention concerne également un gabarit externe ou une prothèse externe ou une attelle de l'articulation du genou, par exemple pour la stabilisation et le délestage post-opératoires de l'articulation du genou, muni d'une charnière qui permet un mouvement physiologique de l'articulation du genou. À l'instar des endoprothèses individuelles de l'articulation du genou, des charnières coulissantes sont fixées à la prothèse externe par des entretoises sur le côté extérieur en des points d'insertion de bande correspondant à la courbe de Burmester.
PCT/EP2016/051252 2015-01-22 2016-01-21 Gabarits, prothèses et orthèses WO2016116571A1 (fr)

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US20140114320A1 (en) * 2012-10-21 2014-04-24 William B. Kurtz Patient specific soft tissue protectors and retractors
WO2014140808A1 (fr) * 2013-03-15 2014-09-18 Materialise Nv Appareil de guidage chirurgical de surface adaptatif et systèmes et procédés de fabrication d'un appareil de guidage chirurgical de surface adaptatif

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FR2722392A1 (fr) * 1994-07-12 1996-01-19 Biomicron Appareil de resection des condyles de genou pour la mise en place d'une prothese et procede de mise en place d'un tel appareil
DE4434539C2 (de) 1994-09-27 1998-06-04 Luis Dr Med Schuster Verfahren zur Herstellung einer Endoprothese als Gelenkersatz bei Kniegelenken
DE19747979C2 (de) * 1997-10-30 2002-10-24 Michael Wehmoeller Verfahren und Vorrichtung für die Herstellung eines individuellen Knochenersatzes sowie ein Verfahren für die Herstellung einer individuell angepaßten Resektionsschablone
DE19936682C1 (de) 1999-08-04 2001-05-10 Luis Schuster Verfahren zur Herstellung einer Endoprothese als Gelenkersatz bei Kniegelenken
DE102009031269B4 (de) * 2009-06-30 2013-07-25 Universität Rostock Vorrichtung zur In-situ-Fräsung von Gelenkflächen
DE102009028503B4 (de) 2009-08-13 2013-11-14 Biomet Manufacturing Corp. Resektionsschablone zur Resektion von Knochen, Verfahren zur Herstellung einer solchen Resektionsschablone und Operationsset zur Durchführung von Kniegelenk-Operationen
DE102010049886B4 (de) * 2010-11-01 2014-01-09 Ernst-Moritz-Arndt-Universität Greifswald Chirurgisches Werkzeug zur Durchführung einer Knochenresektion

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Publication number Priority date Publication date Assignee Title
WO2007092841A2 (fr) * 2006-02-06 2007-08-16 Conformis, Inc. Dispositifs d'arthroplastie articulaire et outils chirurgicaux sélectionnables par le patient
WO2009001083A1 (fr) * 2007-06-25 2008-12-31 Depuy International Ltd Instrument chirurgical
DE112010003901T5 (de) * 2009-10-01 2012-11-15 Biomet Manufacturing Corp. Patientenspezifische Ausrichtungsführung mit Schneidfläche und Laseranzeige
US20140114320A1 (en) * 2012-10-21 2014-04-24 William B. Kurtz Patient specific soft tissue protectors and retractors
WO2014140808A1 (fr) * 2013-03-15 2014-09-18 Materialise Nv Appareil de guidage chirurgical de surface adaptatif et systèmes et procédés de fabrication d'un appareil de guidage chirurgical de surface adaptatif

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