CN100396257C - 具有弯曲活动关节的膝部假肢 - Google Patents

具有弯曲活动关节的膝部假肢 Download PDF

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CN100396257C
CN100396257C CNB028088077A CN02808807A CN100396257C CN 100396257 C CN100396257 C CN 100396257C CN B028088077 A CNB028088077 A CN B028088077A CN 02808807 A CN02808807 A CN 02808807A CN 100396257 C CN100396257 C CN 100396257C
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butt joint
middleware
joint axle
artificial limb
joint
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CN1635859A (zh
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A·凯勒
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Waldemar Link GmbH and Co KG
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • 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
    • 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
    • A61F2/3836—Special connection between upper and lower leg, e.g. constrained
    • A61F2/384—Special connection between upper and lower leg, e.g. constrained hinged, i.e. with transverse axle restricting the movement
    • A61F2/385—Special connection between upper and lower leg, e.g. constrained hinged, i.e. with transverse axle restricting the movement also provided with condylar bearing 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
    • A61F2/3859—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
    • A61F2/389—Tibial 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
    • 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
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring elements
    • A61F2002/30566—Helical springs
    • 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
    • A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
    • A61F2002/30624—Hinged joint, e.g. with transverse axle restricting the movement
    • A61F2002/30632—Hinged joint, e.g. with transverse axle restricting the movement with rotation-limiting stops, e.g. projections or recesses
    • 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
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts

Abstract

具有一个弯曲活动关节的膝部假肢，该活动关节由一个具有两个相互对峙的脚(8)的关节托叉、一个要插入在关节托叉里横交于其弯曲轴线(19)的中间件(14)、和一个铰接轴构成，在将中间件(14)插入在关节托叉里之后铰接轴就通过在其纵向上的运动可以装入在关节托叉和中间件(14)的对齐的关节孔(11，20)里。为了使这轴不必从外侧推入假肢内，轴由两个对接轴端(12，13)构成，它们布置在中间件(14)里的装配位置上并在一个装配完的位置上部分地向外伸出。

Description

具有弯曲活动关节的膝部假肢
技术领域
本发明涉及具有一个用于确定弯曲运动的活动关节的膝部假肢。
背景技术
这种活动关节可以只是用于稳定作用(DE-C-3119841，EP-A-716839，EP-A-791343，EP-A-420460)或者传递全部负荷(GB-C-1305391，EP-A-278184，FR-C-2161588，US-A-3772709)。活动关节分别由一个关节托叉构成，该托叉通常与股骨相连接，还有一个关节中间件，它与胫骨相连。关节托叉的脚以及中间件里有对齐的孔，它们由一个铰接轴穿过。假肢的股骨和胫骨部件一般首先单独地植入并接着相互连接起来。在那些只是用铰接销轴将这些部件相互连接起来的情况下在把这些部件植入之后就将销轴从侧面推入相应的轴承孔里。这就需要在其中一个股髁里有一个相应的引入孔，这种孔不利地削弱了骨头并且在手术时要求附加的费用。若是那些在一个稳定的部分里含有这活动关节的假肢，该稳定部分与胫骨部件通过一个旋转轴承与一个胫骨平行的轴颈相连，此时这些部件大多用以下方法连接起来：将属于其中一个部件的轴颈装入另一个部件的轴承孔里。其缺点是膝部的韧带装置必须有大的伸长。
发明内容
通过本发明的特征而避免了这些缺点。即提出一种具有一个弯曲活动关节的膝部假肢，该活动关节由一个具有两个相互对峙的脚的关节托叉、一个要插入在关节托叉里横交于其弯曲轴线的中间件、和一个铰接轴构成，在将中间件插入在关节托叉里之后，这铰接轴就通过在铰接轴纵向上的运动可以装入在关节托叉和中间件的对齐关节孔里，其特征在于，这铰接轴由两个对接轴端构成，它们布置在中间件里的一个安装位置上并在一个装配完位置上部分地向外伸出。
根据本发明，用两个对接轴端来代替同一的铰接轴，这两个对接轴端可以有两个位置。在一个用于安装的位置上它们基本上完全装在这活动关节中间件里。它们缩回到此中间件里一定距离，从而使这中间件能够从侧边装入关节托叉里去。然后使对接轴端从中间件推出至它们在装配后状态下占有的位置，并且在此位置上它们一直伸出至在托叉脚里所包含的轴承孔里。
对接轴端在关节中间件里不需要大的支承长度，因为在中间件的端面和托叉脚之间的间距是很小的，而且由对接轴端所要承受的力矩也相应较小。尽管如此，有利的是对接轴端具有支承突起，这些支承突起支承贴靠在中间件的关节孔的壁上和/或在相应的另一个对接轴端上。具有突起的对接轴端的长度大于中间件里关节孔长度的一半，因而可以可靠地传递可能出现的力矩。在一种优选的实施形式中对接轴端的支承突起由一个轴颈构成，它在另一个对接轴端的设计成缸筒的支承突起里移动。但是也可以考虑另外的支承结构形式。例如每个对接轴端可以在圆周上装有一个梳形间隔开的突起的轮圈，在装配状态时这些突起布置在中间件孔的几乎整个长度上在另外一个对接轴端的反向指向的突起之间，而且分别支承在中间件轴承孔的圆周面上。
为了简化装配，对接轴端可以作用有一个弹簧的撑开力，它使这对接轴端撑开进到装配完的位置上，只要它们在到达托叉脚的轴承孔时能够进入。例如使关节中间件在装配开始时放在姆指和食指之间，从而将这两个对接轴端压入中间件里。中间件然后推入到托叉脚之间的空间里，从而使对接轴端由于其在托叉脚端面上的接触而留住在中间件里。只有当到达轴承孔时，对接轴端就在撑开弹簧的作用下运动相互分开至安装完的位置上。
但是为了使手术医生无需注意到装配开始时对接轴端的夹住，可以设有一个保持装置。这种装置至少应使得用于嵌入关节托叉里的一部分对接轴端端面是空着的，以便一旦这保持装置带着对接轴端至少局部地插入了关节托叉里，那就可以脱开这保持装置。
拆卸时必须又将对接轴端从关节托叉的轴承孔里退拉出来。为此目的在中间件的圆周面上在一个手术时可以接近的位置处设有一个孔，通过此孔就可以接近对接轴端的适合用于工具的作用面。这个孔是一个长孔或者是两个分别配属于一个对接轴端的长孔。工具也可以用来支持这撑开过程，如果弹簧力不足以撑开，或者如果医生想确认这些对接轴端已到达它们装好的终端位置的话。
不需要确保这些对接轴端在装好位置上，因为不必考虑那些能够使它们压回到装配位置上的力。但若要想保险起见，可以设有一个这样的保险装置。
以下根据附图对本发明进行详细叙述，这附图表示了一种优选的实施例。所示为：
附图说明
图1：伸开状态时假肢的主要部件的一个背视图；
图2：股骨部件的侧面倾斜视图；
图3：胫骨部件的侧面倾斜视图；
图4：在装配时这些部件的侧面倾斜视图；
图5：关节中间件带有对接轴端在装配完的位置上的一个剖视图；
图6：活动关节带有对接轴端在装配完的位置上的一个剖视图；
图7：带有通过一个保持装置保持于装配位置上的对接轴端的中间件的一个局部视图；
图8：保持装置的一个立体视图；
图9：带有通过工具撑开的对接轴端的一个对应于图7的位置。
具体实施方式
假肢包括有一个胫骨部件1，其芯棒2可以插入在股骨里，还有一个股骨部件3，其芯棒4可以插入在胫骨里。胫骨部件1上面终止于一个板5里，该板托有一个聚乙烯高台6，其上面形成了一个用于股骨部件的滑座7的滑动面。在这些部件上传递有垂直负荷。
为了稳定部件1和3设有一个稳定装置，它构成了一个允许在部件1和3之间有弯曲运动的活动关节以及构成了一个旋转轴承。股骨部件3以箱形相互平行布置的板8的形式构成了一个带有轴承孔9的关节托叉，这些孔由盖帽状的聚乙烯轴承部件10覆盖住，这些部件构成了一个空心圆柱体轴承面11。其中支承了对接轴部件12，13，它们的另一端布置在这关节中间件14里，这中间件14整体地位于一个轴颈15的上端，该轴颈15可旋转地支承在一个轴承孔16里，该轴承孔规定大致平行于胫骨部件1里的芯棒2。这种稳定装置用于在股骨部件和胫骨部件之间可以产生相对运动，只是作为围绕对接轴端12的轴线19的弯曲运动或者只是围绕这由孔16所规定的旋转轴线的旋转运动。
活动关节中间件14在关节托叉的脚8之间几乎没有间隙，其中聚乙烯部件10的帽边17避免了不希望的金属与金属接触。
如图5所示，对接轴端12，13可以退出或者压入这关节中间件14的孔20里，以便占据装配位置。其端面21则大致与关节中间件14的端面对齐并且总是加在一起不宽于可用于装配的位于托叉脚8之间的中间腔。在圆周上每个对接轴端12，13的轴向外形尺寸大致为活动关节中间件14的相应外形尺寸的一半那样大小。通过一个压力弹簧22使它们以这装配位置挤到装配完状态所占有的位置。按图7所示通过一个保持装置23使它们固定在装配位置上，从而使上述不会提前发生。这个单独由图9所表示的保持装置具有一个处于一定的不可改变的间距的销钉24，它们通过关节中间件14里的长孔25插入对接轴端12，13的孔26里。该保持装置23可以在这保险位置上借助于螺钉27临时可靠地固定在关节中间件14上。
只要这稳定装置处于这装配状态，胫骨部件1的股骨部件3就可以接合起来，如图4所表示的那样。一旦带有对接轴端12，13的关节中间件14处于托叉部件8之间，那就可以脱开和去除这保持装置23。一旦这些部件已经达到了那个在托叉脚8里和关节中间件14里的孔相互对齐的相对位置，那么对接轴端12，13就在弹簧22的作用下运动分开并进入轴承孔11里。借助于工具23’，其中在图8里只是表示了销钉24’，若对接轴端12，13在弹簧22的作用下并未达到其终端位置的话，那就可以使它们继续撑开。接着医生可以借助一个螺钉30将对接轴端12，13锁定在这装配完的位置上，该螺钉以图6所示的方式拧入支承突起31，34的孔35，36里，这些支承突起31，34设置在对接轴端12，13上。
为了在穿过这长孔25后总能到达这些孔26，而且不会由于对接轴端12，13的转动而失去，设置了一个防转动装置，也就是在孔20里设有一个纵向筋条28，它与对接轴12，13上相应的槽29共同作用。
若关节中间件如所希望的那样设计得比较窄，那么对接轴端12，13就只是在一个相对较小的轴向长度上与装纳这些对接轴端的关节中间件14的孔20共同作用。尽管它们不受或只是很少受到力矩的负荷，有利的是用作为一种附加的支承。在所示实例中这是这样实现的：对接轴端13具有一个支承轴颈31，其圆柱形圆周面32在对接轴端12的一个支承突起34的圆柱孔33里紧密导向移动。这些表面在装配完状态下也保持在一个相互支承和导向的状态下。
如果又要相互分离开这些假肢部件，那么就用图8所指明的工具再将这对接轴端12，13收缩紧。关节中间件就可以从关节托叉8上脱开。

Claims (7)

1.具有一个弯曲活动关节的膝部假肢，该活动关节由一个具有两个相互对峙的脚(8)的关节托叉、一个要插入在关节托叉里横交于其弯曲轴线的中间件(14)、和一个铰接轴构成，在将中间件(14)插入在关节托叉里之后，该铰接轴就通过在铰接轴纵向上的运动可以装入在关节托叉和中间件(14)的对齐关节孔(11，20)里，其特征在于，该铰接轴由两个对接轴端(12，13)构成，它们布置在中间件(14)里的一个安装位置上并在一个装配完位置上部分地向外伸出。
2.按权利要求1所述的膝部假肢，其特征在于，所述两个对接轴端(12，13)具有支承突起(31，34)，它们贴靠在中间件(14)的关节孔(20)的壁上和/或靠在相应另一个对接轴端(13，12)上，而且其长度超出了中间件(14)的关节孔(20)的一半的长度。
3.按权利要求2所述的膝部假肢，其特征在于，所述两个对接轴端中的一个对接轴端(13)的支承突起由一个轴颈(31)构成，该轴颈(31)在所述两个对接轴端中的另一个对接轴端(12)的设计成圆柱筒的支承突起(34)里导向移动。
4.按权利要求1至3中任意一项所述的膝部假肢，其特征在于，所述两个对接轴端(12，13)处于一个弹簧(22)的撑开力作用下。
5.按权利要求4所述的膝部假肢，其特征在于，设置了一个保持装置(23)，以将所述两个对接轴端(12，13)保持于装配位置上。
6.按权利要求5所述的膝部假肢，其特征在于，可以通过一个在中间件(14)圆周面上的孔(25)使用撑开工具和/或拉回工具(23’)，从而使得两个对接轴端(12，13)分离和/或接近。
7.按权利要求1至3中任意一项所述的膝部假肢，其特征在于，设置有一个装置(30，35，36)，用于使所述两个对接轴端(12，13)固定在装配完的位置上。
CNB028088077A 2001-04-25 2002-04-15 具有弯曲活动关节的膝部假肢 Expired - Lifetime CN100396257C (zh)

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