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WO2022040952A1 - Positionneur d'axe de mouvement pour remplacement de genou artificiel - Google Patents

Positionneur d'axe de mouvement pour remplacement de genou artificiel Download PDF

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Publication number
WO2022040952A1
WO2022040952A1 PCT/CN2020/111205 CN2020111205W WO2022040952A1 WO 2022040952 A1 WO2022040952 A1 WO 2022040952A1 CN 2020111205 W CN2020111205 W CN 2020111205W WO 2022040952 A1 WO2022040952 A1 WO 2022040952A1
Authority
WO
WIPO (PCT)
Prior art keywords
connecting body
spoon
arms
axis
artificial knee
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.)
Ceased
Application number
PCT/CN2020/111205
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English (en)
Chinese (zh)
Inventor
王志坚
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Individual
Original Assignee
Individual
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 Individual filed Critical Individual
Priority to PCT/CN2020/111205 priority Critical patent/WO2022040952A1/fr
Publication of WO2022040952A1 publication Critical patent/WO2022040952A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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
    • 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

Definitions

  • the present invention relates to an apparatus for artificial knee joint replacement, in particular to a motion axis locator for artificial knee joint replacement.
  • a current total knee arthroplasty (Total Knee Arthroplasty, TKA)
  • TKA Total Knee Arthroplasty
  • the surgical procedure is to firstly replace the proximal tibia (Proximal Tibial) and the distal femur (Distal Femur) for trimming, followed by re-implantation of the artificial joint and cushion.
  • the proximal tibia and distal femur cannot be recovered after surgical trimming and resection.
  • the artificial joint cannot cooperate with the patient's native skeleton after surgery and has good adaptability. Therefore, how to correct the proximal tibia and distal femur in a correct way?
  • the repair of the femur is one of the important topics in knee replacement surgery.
  • an existing method is the so-called Mechanical Alignment (MA).
  • MA Mechanical Alignment
  • the line is used as a reference axis, which can generally be obtained through X-ray fluoroscopy.
  • the proximal tibia and distal femur can be cut through the mechanical axis to cut out the vertical joint surface, and then implant the artificial joint and the pad to complete the artificial joint replacement.
  • the articular surfaces of the patient's original proximal tibia and distal femur are no longer perpendicular to the mechanical axis.
  • the articular surfaces that are perpendicular to the mechanical axis are obtained surgically through the aforementioned mechanical axis calibration for artificial joint replacement.
  • the articular surfaces can be restored after surgery It is perpendicular to the mechanical axis, but the collateral ligament on the narrow side before correction must be pulled apart during the operation so that the so-called "knee varus" or "knee valgus" deformity can be corrected. It causes relaxation, which leads to the instability of the knee joint and the sequelae of walking weakness and pain.
  • KA Kinematic Alignment
  • condyle femur is the reference axis that rolls relative to the Tibial Plateau as the lower extremity flexes.
  • the difference from the aforementioned mechanical axis-aligned knee replacement surgery is that if the knee replacement surgery is performed according to the motion axis alignment, the articular surfaces of the proximal tibia and distal femur after correction will almost overlap with the articular surfaces before the correction, that is, The original angle of the tibia and femur is still maintained after the operation, and the collateral ligaments on both sides of the knee do not need to be pulled apart during the operation. Therefore, compared with the knee replacement surgery with mechanical axis alignment, the collateral ligaments will not be loosened. Sequelae of knee joint weakness and pain.
  • the "movement axis" is a virtual imaginary axis rather than measurable with the naked eye.
  • One of the existing ways to find the motion axis is to measure the upper and lower positions of the patient's femur and tibia through images, and to use the dynamic motion of the lower limb to swing. The process is calculated and modeled, and a humanized surgical tool (Personal Specific Instrument, PSI), and finally apply this personalized surgical tool for knee replacement surgery with motion axis alignment.
  • PSI Personal Specific Instrument
  • the current practice is to perform image measurement and computational modeling, and then send the modeling-related data to Singapore for certification. It is produced by a mold factory in Belgium. This certification and production process takes two weeks to a month to complete, and the production cost is expensive, resulting in a time-consuming, labor-intensive and costly knee replacement surgery using motion axis alignment. high.
  • the present invention provides a motion axis locator for artificial knee joint replacement, which can assist the surgeon in positioning the motion axis before the articular surfaces of the proximal tibia and the distal femur are trimmed.
  • An embodiment of the present invention provides a motion axis locator for artificial knee joint replacement, which includes two spoon arms and a connecting body.
  • the two spoon arms of the guiding cutting member are symmetrically arranged on the connecting body of the guiding cutting member
  • the two spoon arms of the guiding cutting member are arc-shaped respectively to correspond to the curvature of the medial and lateral femoral condyles of the human body on the sagittal plane, the two spoon arms of the guiding cutting member can be placed along the sagittal axis into the proximal tibia and the proximal tibia.
  • the medial and lateral condyles are respectively clamped against the two spoon arms of the guiding cutting member on the tibial plateau with corresponding curvatures, and the guiding and cutting members are connected
  • the body naturally locates a reference axis according to the position where the two spoon arms of the guiding cutting member are clamped, and the reference axis of the guiding cutting member is parallel to the movement axis of the relative pivoting of the medial condyle and the lateral condyle on the tibial platform,
  • the articular surface between the proximal tibia and the distal femur is trimmed according to the reference axis of the guide cutter.
  • the connecting body is elongated and extends along a straight line
  • the two spoon arms include a fixed spoon arm and a movable spoon arm
  • the fixed spoon arm is integrally formed at one end of the connecting body;
  • the connecting body slides in the longitudinal direction, and is fixed to the connecting body after adjusting the distance between the movable arm and the fixed arm.
  • the movable spoon arm has one end, and the end has a chute, the inner contour of the chute corresponds to the cross-sectional contour of the connecting body, and the end is slidable along the length direction by the connecting body being sleeved on the chute.
  • the connecting body has a guide groove on the side away from the two spoon arms, the guide groove is opened along the length direction of the connecting body, and the end part has a convex part corresponding to the guide groove in the chute, and the end part is parallel to the guide groove.
  • a pressing piece is arranged on the side away from the convex portion.
  • the pressing member is a bolt
  • the end corresponding to the pressing member is provided with a screw hole
  • the pressing member is screwed in the screw hole, and can be screwed to abut against the connecting body and clamp the end portion of the convex portion in the connection. body.
  • the connecting body has a handle portion, the handle portion is extended and the extension direction is perpendicular to the linear extending direction of the connecting body, and the handle portion is opposite to the direction in which the two spoon arms extend from the connecting body, and the handle portion is located at the two ends.
  • the curvature radius of each spoon body is 17mm to 29mm.
  • the guide cutting member has a sleeve opening and a fixing portion, the sleeve opening is located above the fixing portion, and the guiding cutting member has a sleeve between the sleeve opening and the fixing portion.
  • Long slit when the connecting body is naturally positioned to the reference axis as described above, the handle is sleeved on the sleeve with a corresponding thickness, and is fixed to the proximal tibia at the location by the fixing part, and the length direction of the long slit is parallel to the reference axis , for the cutting tool to extend into the long slit and trim the tibial plateau along the reference axis.
  • the guiding cutting member has an installation groove between the sleeve opening and the fixing portion, and the side edge of the installation groove close to the guiding cutting member is open, the guiding cutting member has a piece, and the block has a long slit. and the open side of the block body is assembled in the installation groove and positioned in the installation groove.
  • the width direction of the long slit on the block is inclined from high to low from the side of the connecting body with the handle to the side of the two spoon arms.
  • the fixing part has a plurality of perforations, and a bone screw for surgery can be pierced through one of the perforations, and the fixing part is locked at an appropriate position of the proximal tibia.
  • the motion axis locator for artificial knee arthroplasty of the present invention is a simple-structured and easy-to-operate surgical aid.
  • the reference axis is compared, and then the articular surface modification of the proximal tibia and the distal femur can be carried out, and it has been clinically proven to be as accurate as the articular surface modification of the proximal tibia and the distal femur using a personalized surgical tool, and the operation is easy.
  • Simple and easy to implement to achieve the effect of saving time and money for computational model verification and mold opening.
  • FIG. 1 is a three-dimensional combined view of a motion axis positioner according to an embodiment of the present invention
  • FIG. 2 is an exploded configuration diagram of a motion axis positioner according to an embodiment of the present invention
  • Fig. 3 is the side sectional view of Fig. 1 as seen on the 3-3 section line;
  • FIG. 4 is a schematic side view of the motion axis locator according to the embodiment of the present invention with two spoon arms inserted into the knee joint along the sagittal axis;
  • FIG. 5 is a schematic front view of the motion axis locator according to the embodiment of the present invention, and two spoon arms are inserted into the knee joint along the sagittal axis;
  • FIG. 6 is a schematic front view of FIG. 5 after the guide cutting member is installed on the handle;
  • FIG. 7 is a schematic view of the guide cutting member of FIG. 6 being fixed to the proximal tibia with bone screws;
  • Figure 8 is a schematic view of the proximal tibia corrected to remove the tibial plateau.
  • Bone screw K motion axis
  • T proximal tibia
  • X reference axis
  • Y sagittal axis
  • the motion shaft positioner 100 mainly includes two spoon arms 10, 20 and a connecting body 30, and in a preferred embodiment, also includes a guiding cutting member 40, wherein:
  • the two spoon arms 10 and 20 are symmetrical in shape and are respectively curved and similar to the spoon shape.
  • the curved shapes of the two spoon arms 10 and 20 correspond to the curvature of the human femoral medial and lateral condyles on the sagittal plane.
  • each of the spoon arms 10 and 20 is flat and has a smooth surface, and each of the spoon arms 10 and 20 respectively has side walls 11 and 21 on both sides of the middle part, and the two side walls 11 of the spoon arm 10 are symmetrical.
  • the side walls 21 of the spoon arm 20 are also symmetrically arranged, and the top edges of the side walls 11 and 21 are flat.
  • the connecting body 30 is provided with two spoon arms 10 and 20 on the same side.
  • the connecting body 30 is elongated and extends along a straight line, and is a long rectangular block. The sides are respectively planar along the extending direction of the straight line.
  • the spoon arm 10 is a fixed spoon arm in this embodiment, and the other spoon arm 20 is a movable spoon arm in this embodiment.
  • the spoon arm 10 is integrally formed at one end of the connecting body 30;
  • the connecting body 30 can slide along the length direction of the connecting body 30 to adjust the distance between the spoon arm 20 and the spoon arm 10 , and then the spoon arm 20 can be fixed on the connecting body 30 .
  • the spoon arm 20 has one end 22 , and the end 22 has a chute 23 , the inner contour of the chute 23 corresponds to the cross-sectional profile of the connecting body 30 , and the end 22 of the spoon arm 20 is set through the chute 23 .
  • the connecting body 30 is provided so that the spoon arm 20 can slide along the length direction of the connecting body 30 .
  • the curved curvature radius R of the spoon arm 20 is 17mm to 29mm, so as to adapt to the different curvatures of the medial and lateral femoral condyles on the sagittal plane, and when the knee joint performs the straightening-bending movement, it naturally reflects the different curvatures.
  • the motion axis when the medial and lateral femoral condyles rotate like a sphere, and the radius of curvature R of the two spoon arms 20 in this embodiment is both 25mm.
  • the two spoon arms 20 of the present embodiment correspond to the positions of the curvature of the medial and lateral femoral condyles on the sagittal plane, and the thickness t thereof is both 1 mm.
  • the connecting body 30 of this embodiment has a guide groove 31 on the side away from the two spoon arms 10 and 20.
  • the guide groove 31 is also opened along the length direction of the connecting body 30, that is, the guide groove 31 penetrates the connecting body
  • the end 22 of the spoon arm 20 has a convex portion 24 in the chute 23, and the convex portion 24 is provided corresponding to the guide groove 31;
  • the end portion 22 has a protruding portion 24 to fit with the guide groove 31 of the connecting body 30 , which is only an implementation state of the present invention.
  • the guide grooves 31 can be arranged on the end portion 22 , and can also achieve a restricting effect when the end portion 22 slides on the connecting body 30 .
  • the pressing member 25 is a bolt in this embodiment
  • the end 22 is provided with a screw hole 221 corresponding to the pressing member 25, and the pressing member 25 is screwed into the screw hole 221 and can be screwed to the connecting body 30.
  • the pressing member 25 is linked with the convex portion 24 to clamp the end portion 22 to the connecting body 30 , so that the fixed spoon arm 20 is fixed on the connecting body 30 . fixed on.
  • the connecting body 30 has a handle portion 32, and the extension direction of the handle portion 32 is perpendicular to the linear extending direction of the connecting body 30 (that is, the handle portion 32 and the connecting body 30 are connected in a T shape), and the handle portion 32 Contrary to the direction in which the two spoon arms 10 and 20 extend from the connecting body 30 , the handle 32 in this embodiment extends from the side of the connecting body 30 with the guide groove 31 , and the handle 32 is located on the two spoon arms 10 and 20 . In between, the handle 32 can be held by the operator.
  • the motion axis locator 100 of the above-mentioned embodiment taking the left foot as an example, when the patient cuts the skin and flesh tissue at the knee joint, and the joint parts of the proximal tibia T and the distal femur F are visible, the two are moved together.
  • the spoon arms 10 and 20 are placed between the proximal tibia T and the distal femur F along the sagittal axis Y (as shown in FIG. 4 ).
  • the collateral ligament and cruciate ligament are restrained, the proximal tibia T and the distal femur F will maintain an opposite tensile force, and the two spoon arms 10, 20 can be maintained between the tibial plateau P and the medial condyle IC and lateral condyle OC of the femur contact, and make the medial condyle IC and lateral condyle OC clamp the two spoon arms 10, 20 against the tibial plateau P (as shown in FIG. 5) with corresponding curvatures, and as the two spoon arms 10, 20 are The horizontal direction is parallel or there is a difference in height.
  • the connecting body 30 will naturally locate a reference axis X according to the position where the two spoon arms 10 and 20 are clamped.
  • This reference axis X is related to the inner condyle IC and the outer condyle OC.
  • the relative pivoting motion axis K (see FIG. 8 ) of the tibial plateau P is nearly parallel, and the articular surface between the proximal tibia T and the distal femur F can be trimmed according to the reference axis X at this time.
  • the present invention further includes a guiding cutting member 40 to assist the tibia Trim of Platform P.
  • the guiding cutting member 40 has a sleeve opening 41 and a fixing portion 42 , the sleeve opening 41 is opposite to the position of the guiding cutting member 40 , and the fixing portion 42 is located at the position of the guiding cutting member 40 .
  • the guiding cutting member 40 has a long slit 43 between the sleeve opening 41 and the fixing portion 42 .
  • the guiding cutting member 40 has an installation groove 44 between the sleeve opening 41 and the fixing portion 42 , and one side of the installation groove 44 close to the guiding cutting member 40 is open.
  • the block 45 is provided with a long slit 43 .
  • the block 45 is assembled in the mounting groove 44 from the open side of the mounting groove 44 , so that the block 45 is positioned in the mounting groove 44 .
  • the fixing portion 42 has a plurality of through holes 421 , and each through hole 421 can be passed through by the bone screw 50 for surgery, so as to lock the fixing portion 42 in the proper position of the proximal tibia T.
  • the long slit 43 is provided on the block 45, which is inclined from high to low from the side with the handle 32 of the connecting body 30 to the side with the two spoon arms 10 and 20 (as shown in FIG. 3 ).
  • the blocks 45 can be separated and reassembled on the guide cutting member 40, the long slits 43 of the blocks 45 can be designed with different inclinations, and the blocks with different inclinations of the long slits 43 can be selected according to the actual situation. 45 is assembled on the guiding cutting member 40, which is beneficial to the smooth progress of artificial joint replacement.
  • the handle 32 corresponds to the position of the connecting body 30 .
  • the handle 32 can be sleeved in the sleeve 41 of the guide cutting member 40 with a corresponding thickness (as shown in FIG. 6 ), and the guide cutting member 40 can be inserted along the handle 32 And approach the proximal tibia T, and then use the bone screw 50 to select a suitable through hole 421 to pass through and lock it on the proximal tibia T (as shown in FIG.
  • the fixed portion 42 of the guiding cutting member 40 can be positioned at the location. It is fixed on the proximal tibia T, and the long slit 43 on the block 45 is parallel to the reference axis X in the length direction, and the cutting tool (not shown in the figure) can extend into the long slit 43 and along the reference axis X
  • the tibial plateau P is removed to complete the articular surface modification between the proximal tibia T and the distal femur F.
  • the proximal tibia T is corrected and the tibial plateau is removed, it can be obtained parallel to the motion axis K (ie the reference axis X). slice.
  • the motion axis locator 100 for artificial knee replacement of the present invention is only composed of two spoon arms 10, 20 and a connecting body 30, which is a simple and convenient structure. It is a simple and easy-to-operate surgical aid, and before the articular surface of the proximal tibia and the distal femur is trimmed, the two spoon arms 10 and 20 can be clamped against the tibial plateau P with the corresponding curvature through the medial condyle IC and the lateral condyle OC respectively.
  • a reference axis X which is compared with the motion axis, can be located, and the articular surface modification of the proximal tibia T and the distal femur F can be successively performed.
  • the result is as accurate as the articular surface trimming of the distal femur, and there is no problem of having to repeat the correction during the resection process to achieve balance. Even if the surgeon is not an experienced surgeon, it can be easily positioned by the motion axis locator 100 of the present invention.
  • the reference axis X of the motion axis is compared, thereby achieving the effect of saving time and money for computational model verification and mold opening.

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

Abstract

L'invention concerne un positionneur d'axe de mouvement (10) pour un remplacement de genou artificiel, comprenant deux bras en cuillère (10, 20) et un corps de liaison (30) ; les deux bras en cuillère (10, 20) peuvent être placés entre le tibia proximal (T) et le fémur distal (F) ; en outre, le tibia proximal (T) et le fémur distal (F) sont retenus par un ligament (L), de sorte que le condyle interne (IC) et le condyle externe (OC) de la pince de fémur sont contre les deux bras en cuillère (10, 20) sur le plateau tibial (P) aux courbures correspondantes ; le corps de liaison (30) positionne naturellement un axe de référence (X) en fonction des positions des deux bras en cuillère (10, 20) lorsqu'il est serré, l'axe de référence (X) est approximativement parallèle à un axe de mouvement (K) autour duquel le condyle interne (IC) et le condyle externe (OC) pivotent l'un par rapport à l'autre sur le plateau tibial (P), et un détourage de surface articulaire est réalisé entre le tibia proximal (T) et le fémur distal (F) selon l'axe de référence (X).
PCT/CN2020/111205 2020-08-26 2020-08-26 Positionneur d'axe de mouvement pour remplacement de genou artificiel Ceased WO2022040952A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/CN2020/111205 WO2022040952A1 (fr) 2020-08-26 2020-08-26 Positionneur d'axe de mouvement pour remplacement de genou artificiel

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/CN2020/111205 WO2022040952A1 (fr) 2020-08-26 2020-08-26 Positionneur d'axe de mouvement pour remplacement de genou artificiel

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WO2022040952A1 true WO2022040952A1 (fr) 2022-03-03

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114767208A (zh) * 2022-04-15 2022-07-22 北京市春立正达医疗器械股份有限公司 一种膝关节手术抱髁器

Citations (9)

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Publication number Priority date Publication date Assignee Title
US8900242B2 (en) * 2005-05-17 2014-12-02 Biomet Uk Limited Stylus assembly
US20160008143A1 (en) * 2014-04-14 2016-01-14 Mohamed R. Mahfouz Kinematic Alignment and Novel Femoral and Tibial Prosthetics
CN106037872A (zh) * 2007-12-06 2016-10-26 史密夫和内修有限公司 用于确定股骨的机械轴线的系统和方法
US10405871B1 (en) * 2015-09-29 2019-09-10 Stefano Bini Surgical tools and method for kinematic alignment
US20190290451A1 (en) * 2016-12-22 2019-09-26 Orthosensor Inc. Surgical Apparatus to Support Installation of a Prosthetic Component and Method Therefore
US20190336141A1 (en) * 2018-05-03 2019-11-07 Zimmer, Inc. Knee resection and gap balancing instruments and techniques for kinematic alignment
US20200015977A1 (en) * 2018-05-25 2020-01-16 MicroPort Orthopedics Inc. Soft Tissue Tension and Bone Resection Instruments and methods
US20200093502A1 (en) * 2016-03-24 2020-03-26 Zimmer, Inc. Tibial cut guide
US10709458B1 (en) * 2015-09-29 2020-07-14 Stefano Bini Surgical tools and method for kinematic alignment

Patent Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8900242B2 (en) * 2005-05-17 2014-12-02 Biomet Uk Limited Stylus assembly
CN106037872A (zh) * 2007-12-06 2016-10-26 史密夫和内修有限公司 用于确定股骨的机械轴线的系统和方法
US20160008143A1 (en) * 2014-04-14 2016-01-14 Mohamed R. Mahfouz Kinematic Alignment and Novel Femoral and Tibial Prosthetics
US10405871B1 (en) * 2015-09-29 2019-09-10 Stefano Bini Surgical tools and method for kinematic alignment
US10709458B1 (en) * 2015-09-29 2020-07-14 Stefano Bini Surgical tools and method for kinematic alignment
US20200093502A1 (en) * 2016-03-24 2020-03-26 Zimmer, Inc. Tibial cut guide
US20190290451A1 (en) * 2016-12-22 2019-09-26 Orthosensor Inc. Surgical Apparatus to Support Installation of a Prosthetic Component and Method Therefore
US20190336141A1 (en) * 2018-05-03 2019-11-07 Zimmer, Inc. Knee resection and gap balancing instruments and techniques for kinematic alignment
US20200015977A1 (en) * 2018-05-25 2020-01-16 MicroPort Orthopedics Inc. Soft Tissue Tension and Bone Resection Instruments and methods

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114767208A (zh) * 2022-04-15 2022-07-22 北京市春立正达医疗器械股份有限公司 一种膝关节手术抱髁器

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