CN101102724A - 旋转对准股骨尺寸测量导向装置 - Google Patents
旋转对准股骨尺寸测量导向装置 Download PDFInfo
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Abstract
本发明的实施方式允许在用于使用解剖学标记进行对准的两个边界之间进行不受限制的旋转对准,同时还参照两个后髁用于股骨的A/P尺寸测量。在特定实施方式中,所述系统提供至少一个可移动桨状物,其提供来自髁的参考点,使得所述测量组件能够与上髁轴线平行对准。一旦所述测量组件被正确地确定角度,就能由适当的参考点对所述骨骼的A/P长度进行测量。
Description
本申请以2004年12月21日递交的序列号为No.60/638153、名称为“Rotational Alignment Femoral Sizing Guide(旋转对准股骨尺寸测量导向装置)”的美国临时专利申请为优先权,在此引入该美国临时专利申请的全部内容作为参考。
技术领域
本发明涉及用于确定股骨远端的前-后尺寸以便确定适当植入物尺寸的尺寸测量和旋转对准装置,并涉及使用这种装置的方法。
背景技术
在完全膝关节替换外科手术或关节造形术中,膝关节由人造植入物替代。所述植入物典型地包括胫骨部件、股骨部件和可动轴承插入物(膝盖骨部件)。
大多数股骨部件的内表面具有与手术中准备的远端股骨表面对接的相交平面。其外表面典型地具有朝向相应的连接到患者胫骨上的胫骨部件的曲面。股骨部件上两个弯曲的髁区域复制了自然的股骨髁。
确定远端股骨的正确前/后(A/P)尺寸是一个困难的过程。外科医生必须测量远端股骨的正确A/P尺寸,同时要设置与解剖学标记(例如,上髁轴线和A/P轴线)的旋转对准。所述A/P股骨尺寸通常来源于远端股骨的后髁和前皮层之间的距离。所述旋转对准(在股骨的远端面处的横向平面上的旋转)通常来源于解剖学标记。但是这种旋转对准与正确测量远端股骨尺寸所需的A/P测量平面通常并不成垂直/平行关系或者成固定角度。因此,从骨的后面至前面进行测量并从而选择植入物并不容易。
过去用于该尺寸测量的工具包括两个固定桨状物(paddle),该桨状物靠着一切割远端股骨的后表面而竖直放置。这些工具并不解决或测量两个边界(用于使用解剖学标记进行对准)之间的旋转对准,同时其仍参照两个后髁以确定远端股骨的正确A/P尺寸。固定桨状物也并不解决不同尺寸和形状的髁(例如,由于患者的不规则性或患病的组织而导致的一个髁比另外一个髁更加突出)。
但是,用于独立地获得每一个变量(旋转和尺寸)的工具增加了过程时间,并且更重要的是,其导致并不最佳的A/P测量。例如,使用两个不同的工具使得该尺寸测量不能关于所使用的旋转位置来进行测量。具体地,所述尺寸的测量并不垂直于所使用的旋转位置。
一些工具会同时对旋转对准和A/P尺寸这两者进行测量。但是这些工具缺乏调整,从而当他们相对于解剖学标记旋转时,他们只能涉及一个后髁。(此外,无法获得精确的测量,因为由于患者的不规则性或患病的组织或任何其他原因使得一个髁会比另外一个更加突出髁)。在其他情况下,这些工具具有附加的部件,这些部件可被添加到所述工具上以代替髁接触,但是这些附加部件的增加限制了适应性并且会增加外科手术时间,因为他们需要被交换以确定“最佳配合”情形。
因此,需要提供一种股骨尺寸测量导向装置,其测量并关联旋转对准(在股骨远端面处的旋转)和A/P尺寸测量。
发明内容
本发明的实施方式允许在用于使用解剖学标记进行对准的两个边界之间进行不受限制的旋转对准,同时还参照两个后髁用于股骨的A/P尺寸测量。在特定实施方式中,所述系统提供至少一个可移动桨状物,其提供来自髁的参考点,使得所述测量组件能够与上髁轴线平行对准。一旦所述测量组件被正确地确定角度,就能由适当的参考点对所述骨骼的A/P长度进行测量。
附图说明
图1显示根据本发明一个实施方式的组件的分解透视图。
图2显示处于装配位置的图1的实施方式。
图3显示根据本发明一个实施方式的组件的顶部平面图,其中所述组件位于患者的股骨上,该组件处于操纵该凸轮组件之前。
图4显示一旦凸轮被操纵并且处于测量过程中的位于适当位置的图3的组件。
图5显示用于测量股骨A/P长度的图3的组件。
图6显示图3-5的组件的侧视图。
具体实施方式
图1示出主体12、可移动的桨状物60和旋转致动器90,总体上称为组件10。主体12是具有上表面14、下表面16和前部18以及后部20的块体。(这些解剖学方向指的是当主体12在远端切除股骨上就位时的情况。)从后部伸出的是第一桨状物22。该桨状物22意在为主体12提供稳定的髁参考点。桨状物22还显示具有固定部分30,该固定部分意在接收固定销、螺丝或任何其他固定机构,以将桨状物22固定在位。(尽管在本发明的优选实施方式中提供了该第一桨状物22,但是对于组件10按照需要来工作来说,它并不是组件10所必需的。)
主体12的上表面14具有致动器元件24。致动器元件24朝向主体的后部定位并且基本上位于主体12两侧32中间。尽管元件24显示为突出销,但是应当理解,它可以是凹槽、凹窝或允许主体12与第二桨状物进行协作的具有任何形状和尺寸的其它任何特征,这将在下文更多地描述。
主体12还具有枢轴元件28。与致动器元件24一样,枢轴元件28也显示为突出的销,但是应当理解,它可以是凹槽、凹窝或允许在第二桨状物和主体12之间发生枢轴转动的具有任何形状和尺寸的其它任何特征。
主体12还显示具有尺寸测量标记34。在优选实施方式中,这些标记具有1mm的间隔,但是其他间隔也是可能的。
主体12还具有可移动测量元件110。在一些实施方式中,元件110位于与触针40相协作的轨道38上,如图6所示,但是它可与主体以任何其他方式进行协作。在特别优选的实施方式中,测量元件110是由元件120调节的独立部分,如图5所示。元件120可以是可旋转的凸轮部分,它可以是接收六角形驱动器的凹槽,它可以是可转动的凸出销,它可以是螺丝或导螺杆,或是适用于下文所述测量的任何其他类型的调节装置。如图2更详细所示的,元件110在其上表面112上优选具有标记114,该标记114指示出图3中所示的上髁轴线140。标记114优选与主体12的尺寸测量标记34的零标记36对准。
如下文将要详细描述的,一旦使用桨状物确定正确的旋转,以将主体12与该上髁轴线平行对准或至少基本上平行对准,所述测量元件110就被用于确定远端股骨的正确A/P尺寸。元件110可相对于主体12在向前和向后方向(由A/P轴线142示出,图3)上移动。
回头参照图1,第二桨状物60示出为L形元件,其适于通过致动器元件62与主体12进行协作。在使用时,致动器元件62意在与致动器元件24联合。尽管配合件62显示为开口、孔或槽,但是应当理解,它可以是突出销或允许元件60与主体12进行协作的具有任何形状和尺寸的任何其它特征。
第二桨状物60还具有枢轴元件68。枢轴元件68与主体12的枢轴元件28协同作用。尽管枢轴元件68显示为开口、孔或槽,但是应当理解,它可以是突出销或允许元件68与主体12进行协作的具有任何形状和尺寸的任何其它特征。
旋转致动器90具有凸轮元件92,该凸轮元件92与致动器元件24和致动器元件62相协作,以测量对髁(或任何其它所希望的解剖学参考点,在这一示例和描述中,所述髁是当前所使用的参考点,但是应当理解也可能使用其他的解剖学参考点)的旋转对准。
在使用时,通过将枢轴元件68和28对准在一起并将致动器元件24和致动器元件62对准在一起而将第二桨状物60安装在主体12上。然后安装该旋转致动器90,以便与该元件24和/或配合件62相协作。如果这些部分是开口或凹槽,可以使用螺丝来完成这种连接。若需要,当致动器元件24是销(如图所示),则该销可以与旋转致动器90中的开口相协作。所完成的装置是组件10,如图2中所示。
在这里值得注意的是,两个桨状物不是必需的,并且一个或多个桨状物并不必须要延伸到后髁。也就是说,可以使用一个桨状物而将另一个移除,尽管对于桨状物来说优选其是可旋转的。如果其中一个桨状物被移除,外科医生通常喜欢可以看见的后部参考,并且可以提供任何类型的参考。在一些例子中,桨状物可以从该主体元件上加工掉一个桨状物,而由留下的后边缘来形成视觉参考。在其他实施方式中,在静止桨状物所在的位置可能有箭头。总之,只要能通过触觉或视觉参考来确定两个后髁(或上髁,或两个其他平面点),则两个后桨状物不是必需的。
装置10还具有度数或角度标记50。这些标记50可设在桨状物60上,如图2所示,或他们可设在主体12、旋转致动器90或任何其它在致动器90启动之后允许标记50容易读数的位置上。标记50意在显示主体12若要与上髁轴线140平行所需旋转多少度数。
在使用时,组件10定位在切除的远端股骨上(这是优选的方法,尽管还可以在不切除股骨的情况下使用组件10)。主体12向前滑动或转动直到两个后部桨状物22、60与远端股骨的后髁接触。维持桨状物22、60与股骨后髁的接触,同时旋转该旋转致动器90直到获得所需的旋转对准。在旋转时,旋转致动器90使得凸轮92来移动该第二桨状物60,该第二桨状物的移动是围绕由枢轴元件28、68所限定的枢转轴线沿径向进行的移动。可选择地,致动器90可相对于桨状物60来移动该主体。
为了清楚地理解,现在详细描述一个具体的实施例,但是它并不意味着是对这里所限定的用途和结构的限制性描述。图3显示定位在患者的切除股骨上的组件10。桨状物22、60与患者的髁的后部接触。桨状物60与主体12通过枢轴元件28、68相协作。旋转致动器90固定在位。在图3中,所述组件显示为未定向在任何角度上,因为标记度数为“0”。
当转动该旋转致动器90时(在该实施例中,它被顺时针转动,但是应当理解可以使用任何转动方法或方向),主体12轻微转动,如图4中的箭头X所示。图4示出主体12被旋转3°的一个例子,如标记50所示并且由在桨状物60和主体12之间产生的间隔所指示。还可以看出,在该示例中,标记114与上髁轴线140齐平,于是达到了正确的旋转对准。在如图2所示的示例中,正确的旋转对准在6°处达到。标记114仅仅是可用于确定何时达到旋转对准的标记的一个例子,且应当理解其它选择也是可能的。
应当指出,这些标记50显示为3°的间隔仅仅是为了举例。它们可以以任何所需的增量来提供,诸如一度接一度地、半度半度地增加,等等。还应当理解,如果需要毫米或一些其它度量而不是度数,该选择也在本发明的范围之内。
如上所述,这种旋转调节允许主体12旋转对准患者的解剖学位置。可以设置任选的旋转固定孔42来接收固定销,以助于保持后桨状物/髁接触。一旦完成了旋转对准,可将固定销插入到该固定孔44中,以将组件10以正确的旋转对准位置固定至远端股骨。
然后,使用测量元件110执行A/P测量。如图5所示,测量元件110适于向前扩张组件10或是向后收缩组件10(如箭头“A”和“P”所示)。完成这样一种测量动作的一种方式是利用测量元件上的元件120,尽管多种其它选择也是可能的并且被认为落入本发明的不同实施方式的范围内。如果在测量元件110上提供有钻孔导向孔116,则该导向孔用于放置远端股骨切除导向装置(该装置的不同形式是本领域公知的,并且用作切割块以使得患者的股骨准备好接收植入物)。所述钻孔导向孔116提供了一个支架,钻孔机可以延伸通过该支架,并在远端股骨上的适当位置制备孔,以便为所使用的切割块提供定位参考标记。
在备选实施方式中,第一和第二桨状物都可以是可移动的和/或可旋转的。它们都是独立的部件并且与相匹配的枢轴柱连接,或者它们可以具有各自的匹配枢轴柱。
另外,尽管已经介绍所述桨状物优选通过凸轮机构致动,但是所述桨状物可通过许多方式致动,例如,它们可以是齿轮驱动的、通过具有锁的径向槽来驱动、螺丝或导螺杆致动、可变角度插块或模块,或通过任何其它适当的方法致动。
可对上文所述的和附图所示的结构和方法进行改变和修正、添加和删减,这些均不脱离本发明和随后的权利要求的范围和精神。
Claims (15)
1、一种旋转对准股骨尺寸测量导向组件,包括:
(a)包括上表面、下表面和前部、后部的主体,并且一致动器元件位于主体的上表面上;
(b)桨状物,该桨状物具有与主体上的致动器元件相协作的致动器元件;
(c)旋转致动器,其与主体上的致动器元件和桨状物上的致动器元件相协作,以提供该第二桨状物与主体之间不同的角度。
2、如权利要求1所述的组件,进一步包括从主体的后部伸出的另一桨状物。
3、如权利要求1所述的组件,进一步包括测量元件,其通过适于相对于所述主体移动所述测量元件的元件与所述主体相协作,以测量前/后距离。
4、如权利要求1所述的组件,其中,所述桨状物适于背离和朝着所述主体枢转。
5、如权利要求1所述的组件,其中,所述桨状物包括与所述主体上的枢轴元件相协作的枢轴元件。
6、如权利要求1所述的组件,进一步包括角度标记,该角度标记位于所述桨状物、主体或旋转致动器上,其中,所述旋转致动器适于将所述主体枢转至由所述角度标记标出的角度。
7、如权利要求1所述的组件,其中,所述主体在其上表面上具有尺寸测量标记。
8、如权利要求1所述的组件,其中,所述主体包括一个或多个固定孔。
9、如权利要求1所述的组件,进一步包括测量元件,该测量元件与所述主体相协作,并且适于朝着所述主体的前部或后部延伸以便确定应当使用什么尺寸的假体。
10、如权利要求9所述的组件,其中,所述测量元件包括指示一轴线的标记。
11、如权利要求9所述的组件,其中,所述测量元件包括一个或多个钻孔导向孔。
12、如权利要求1所述的组件,其中,所述桨状物具有一个或多个用于固定到骨骼上的固定部分。
13、一种用于测量骨骼区域的旋转和尺寸的方法,包括:
(a)提供一组件,该组件包括一个或多个可移动的桨状物,该桨状物适于通过致动器与主体相协作桨状物,其中,在所述主体、所述一个或多个可移动桨状物或所述致动器中的一个或多个上设有角度测量标记;
(b)将所述组件放置在需要测量的骨骼上;
(c)操纵该致动器,以使得所述主体相对于由所述一个或多个桨状物标记的参考点旋转;
(d)读取由所述角度测量标记所测量的角度。
14、如权利要求13所述的方法,其中,所述组件进一步包括适于与所述主体相协作的测量元件,所述方法进一步包括:
(e)调节所述测量元件的位置以测量所需要测量的骨骼区域的宽度、长度或深度。
15、如权利要求14所述的方法,进一步包括:
(f)使植入体的尺寸与所得到的测量结果相关联。
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AU2005319025B2 (en) | 2012-04-19 |
US7451550B2 (en) | 2008-11-18 |
CA2591511A1 (en) | 2006-06-29 |
EP1827254A1 (en) | 2007-09-05 |
US20060142778A1 (en) | 2006-06-29 |
AU2005319025A1 (en) | 2006-06-29 |
WO2006069336A1 (en) | 2006-06-29 |
CN101102724B (zh) | 2010-09-01 |
CA2591511C (en) | 2014-04-01 |
JP5138382B2 (ja) | 2013-02-06 |
EP1827254B1 (en) | 2020-02-12 |
JP2008523964A (ja) | 2008-07-10 |
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