本申请是申请日为2016年3月31日、申请号为201610196679.5的中国发明专利申请“股骨侧内侧、外侧单髁假体和股骨滑车假体”的分案申请。This application is a divisional application of the Chinese invention patent application "Femoral Side Medial and Lateral Unicondylar Prosthesis and Femoral Trochlear Prosthesis" with the filing date of March 31, 2016 and the application number 201610196679.5.
技术领域Technical field
本公开涉及人工膝关节假体，具体涉及应用于早期膝关节内侧间室、外侧间室和髌股关节骨性关节炎的单间室置换假体。The present disclosure relates to artificial knee joint prostheses, and specifically to single-compartment replacement prostheses used in early-stage knee joint medial compartment, lateral compartment, and patellofemoral joint osteoarthritis.
背景技术Background technique
膝关节分为三个间室，分别为内侧间室、外侧间室和髌股间室。早期的膝关节骨性关节炎(OA)可以累及任何一个间室，但尤其以累及膝关节内侧间室为主。此时膝关节的力线向内侧偏移(内翻畸形)，导致内侧间室磨损过多，引起股骨内髁和相对应的内侧胫骨平台软骨面变薄、剥脱。内侧间室OA典型症状是内翻畸形、疼痛伴关节交索、骨赘形成以及侧副韧带松弛。保守治疗或非手术治疗措施(如非甾体类抗炎镇痛药、关节软骨营养保护药物、关节内注射透明质酸、膝关节支具等)仅对轻度OA的患者有一定疗效。而当保守治疗无效时，膝关节内侧间室单髁置换术(Unicompartmental Knee Arthroplasty，UKA)是终极治疗方式。膝关节内侧间室UKA是指手术切除膝关节的内侧胫股关节面，即内侧股骨远端在屈伸活动时与内侧胫骨平台直接接触的那部分关节软骨面，以及与之相对应的胫骨平台关节软骨面。其手术目的是以最小的手术创伤去尽量保留正常关节结构，最终达到更好的功能恢复，同时为以后可能进行的全膝关节置换术保留足够的剩余骨量和操作余地。而且随着内植物材料和加工技术的改进，病例适应证的更适合的选择，以及手术技巧的提高，内侧间室UKA的疗效得到越来越多的认可。外侧间室和髌股间室OA发生率明显少于内侧间室OA，但治疗原则同内侧间室OA，必要时也需进行UKA假体置换。The knee joint is divided into three compartments, namely the medial compartment, the lateral compartment and the patellofemoral compartment. Early-stage knee osteoarthritis (OA) can affect any compartment, but it mainly affects the medial compartment of the knee joint. At this time, the line of force of the knee joint shifts medially (varus deformity), resulting in excessive wear of the medial compartment, causing thinning and detachment of the medial femoral condyle and the corresponding medial tibial plateau cartilage surface. Typical symptoms of medial compartment OA are varus deformity, pain with cross-joint joints, osteophyte formation, and collateral ligament laxity. Conservative treatment or non-surgical treatment measures (such as non-steroidal anti-inflammatory analgesics, articular cartilage nutritional protection drugs, intra-articular injection of hyaluronic acid, knee joint braces, etc.) only have certain effects on patients with mild OA. When conservative treatment fails, medial compartment unicondylar knee replacement (Unicompartmental Knee Arthroplasty, UKA) is the ultimate treatment. The medial compartment UKA of the knee joint refers to the surgical resection of the medial tibiofemoral articular surface of the knee joint, that is, the part of the articular cartilage surface where the distal end of the medial femur is in direct contact with the medial tibial plateau during flexion and extension, and the corresponding tibial plateau joint. Cartilaginous surface. The purpose of the surgery is to preserve the normal joint structure with minimal surgical trauma, ultimately achieving better functional recovery, while retaining sufficient remaining bone volume and room for possible future total knee replacement. Moreover, with the improvement of implant materials and processing technology, more suitable selection of case indications, and improvement of surgical skills, the efficacy of medial compartment UKA has been increasingly recognized. The incidence of OA in the lateral compartment and patellofemoral compartment is significantly less than that in the OA in the medial compartment, but the treatment principles are the same as those in the medial compartment OA, and UKA prosthesis replacement is also required when necessary.
内外侧间室UKA假体又可分为胫骨侧UKA假体(胫骨平台内外侧UKA假体)和股骨侧UKA假体(股骨内外髁UKA假体)；髌股间室UKA假体分为滑车(部)UKA假体和髌骨假体。相比于胫骨侧UKA假体，股骨侧UKA假体的设计更为重要，因为其直接影响了术后的膝关节功能。目前国内外一致认为：最接近正常人体股骨内外髁几何特征设计的股骨侧UKA假体，才能提供最接近正常膝关节的运动感觉。但股骨内外髁的几何形态特征异常复杂，并没有得到一致的公认。人们最初认为股骨内外髁是圆形，且围绕一个固定的轴旋转1。随后又有学者认为股骨内外髁是螺旋形，且旋转轴并不是固定的，而是存在一个瞬时的旋转中心2。上世纪90年代，学者们又重新支持股骨内外髁为圆形且旋转轴固定的观点3-5。尤其核磁矢状位扫描的应用，更使得这些研究者坚信股骨内外髁在矢状位是由两个圆形构成6-9。这些不同的理论，导致了不同的生物力学和运动学实验结果，并直接影响了股骨内外髁UKA假体的设计。例如依据股骨髁部为单一曲率圆形的理论，设计而出的牛津单髁假体；依据股骨髁部有两个或多个圆形组成的理论，设计而出的Miler-Galante假体，等等。然而目前的股骨内外髁UKA假体，都存在或多或少的缺点。例如牛津单髁假体(Oxford UKA)：虽然长期随访结果较好，但假体与股骨髁部形状并不匹配，导致假体与股骨髁部有一较深的被磨掉的凹槽；且由于其单一曲率圆形设计特点，牛津单髁假体并不能恢复患者已内翻畸形的下肢力线。其他类型的UKA假体的形状在术中与股骨内外髁部不匹配居多，这导致膝关节屈曲过程中髌骨与假体的撞击，极易引起疼痛和手术失败。股骨滑车几何形态是制造股骨滑车UKA假体的根本，但股骨滑车的几何特征更加复杂难释，所以人们把滑车UKA假体简化设计为具有外翻凹槽，并相应地把髌骨表面进行凸形置换。The medial and lateral compartment UKA prosthesis can be further divided into tibial side UKA prosthesis (tibial plateau medial and lateral UKA prosthesis) and femoral side UKA prosthesis (femoral and medial condyle UKA prosthesis); patellofemoral compartment UKA prosthesis is divided into pulleys. (Part)UKA prosthesis and patellar prosthesis. Compared with the tibial side UKA prosthesis, the design of the femoral side UKA prosthesis is more important because it directly affects the postoperative knee joint function. At present, it is unanimously agreed at home and abroad that the femoral UKA prosthesis designed closest to the geometric characteristics of the internal and external femoral condyle of the normal human body can provide the movement feeling closest to the normal knee joint. However, the geometric characteristics of the medial and lateral femoral condyle are extremely complex and have not been unanimously recognized. It was originally thought that the medial and lateral femoral condyle were round and rotated about a fixed axis1. Later, some scholars believed that the medial and lateral femoral condyles are spiral-shaped, and the axis of rotation is not fixed, but there is an instantaneous center of rotation2. In the 1990s, scholars again supported the view that the medial and lateral femoral condyles are round and have a fixed axis of rotation3-5. In particular, the application of magnetic sagittal scanning has convinced these researchers that the medial and lateral femoral condyles are composed of two circles in the sagittal position6-9. These different theories lead to different biomechanical and kinematic experimental results, and directly affect the design of the UKA prosthesis of the medial and lateral femoral condyle. For example, the Oxford unicondylar prosthesis was designed based on the theory that the femoral condyle is a round shape with a single curvature; the Miler-Galante prosthesis was designed based on the theory that the femoral condyle is composed of two or more circles, etc. wait. However, the current UKA prosthesis of the medial and lateral femoral condyle has more or less shortcomings. For example, the Oxford unicondylar prosthesis (Oxford UKA): Although the long-term follow-up results are good, the shape of the prosthesis and the femoral condyle does not match, resulting in a deep worn groove between the prosthesis and the femoral condyle; and due to Due to its single-curvature circular design, the Oxford unicondylar prosthesis cannot restore the alignment of the patient's lower limbs that have become varus deformed. The shape of other types of UKA prostheses often does not match the internal and external femoral condyle during surgery, which leads to the impact of the patella and the prosthesis during knee flexion, which can easily cause pain and surgical failure. The geometric shape of the femoral pulley is the basis for manufacturing the femoral pulley UKA prosthesis, but the geometric characteristics of the femoral pulley are more complex and difficult to explain, so people simplified the design of the UKA pulley prosthesis to have an eversion groove, and accordingly made the patellar surface convex. Displacement.
现有技术生产的股骨内外髁UKA假体、股骨滑车UKA假体没有和股骨内外髁、股骨滑车很好的形态匹配。这种形态不匹配导致膝关节屈曲过程中髌骨与假体的撞击，引起屈膝疼痛，假体松动，最终手术失败。即便如牛津单髁假体发生撞击几率略少，但它依据股骨内髁呈单一曲率的圆形设计而成。这样做的结果就是导致UKA假体前方与股骨内髁剩余骨质间存在一较深的凹槽。虽然这个凹槽并没有临床证据证明对膝关节运动学或假体使用寿命有影响，但事实上此凹槽就是股骨最远端所在，其高度无法恢复导致膝关节内翻畸形无法矫正。如果为了校正内翻畸形则必须使假体安放的高些，则这个时候就会导致屈曲过程中，髌骨与假体的撞击，而牛津单髁手术技术中不松解内侧副韧带的方法，其本身也是为了防止滑动垫片的脱位。The UKA prosthesis of the medial and lateral femoral condyle and the femoral pulley produced by the existing technology do not have a good morphological match with the internal and external femoral condyle and the femoral pulley. This morphological mismatch leads to the impact of the patella and the prosthesis during knee flexion, causing knee flexion pain, loosening of the prosthesis, and ultimately surgical failure. Even though the Oxford unicondylar prosthesis has a slightly lower chance of impact, it is designed based on the circular shape of the medial femoral condyle with a single curvature. The result of this is that there is a deep groove between the front of the UKA prosthesis and the remaining bone of the medial femoral condyle. Although there is no clinical evidence that this groove has an impact on the kinematics of the knee joint or the longevity of the prosthesis, in fact, this groove is where the most distal end of the femur is located, and its height cannot be restored, resulting in uncorrectable knee varus deformity. If the prosthesis must be placed higher in order to correct varus deformity, this will lead to impact between the patella and the prosthesis during flexion. However, the Oxford unicondylar surgery technique does not release the medial collateral ligament. It is also to prevent the sliding gasket from dislocating.
发明内容Contents of the invention
鉴于现有技术中的一个或多个问题，提出了一种膝关节单髁假体和滑车假体。In view of one or more problems in the prior art, a unicondylar knee prosthesis and a trochlear prosthesis are proposed.
根据本公开的一个方面，提出了一种股骨侧内侧单髁假体，包括：关节面，所述关节面为膝关节运动过程中与髌骨内侧和胫骨平台内侧相接触的表面，它在矢状位上表现为第一椭圆上的弧段，在冠状位上表现为第一圆形上的弧段；以及里侧面，所述内侧面为所述假体置入后邻接股骨髁部截骨面和骨水泥的部分，表现为直线截面的里侧面后髁处，以及与关节面弧段相一致的里侧面远端部。According to one aspect of the present disclosure, a medial femoral unicondylar prosthesis is proposed, including: an articular surface, which is a surface in contact with the medial side of the patella and the medial side of the tibial plateau during knee joint movement. It is located in the sagittal direction. It appears as an arc segment on the first ellipse in the coronal position, and appears as an arc segment on the first circle in the coronal position; and the inner side, the inner side is the osteotomy surface adjacent to the femoral condyle after the prosthesis is inserted. The part with bone cement is shown as the posterior condyle of the medial surface in a straight section, and the distal end of the medial surface that is consistent with the arc segment of the articular surface.
根据一些实施例，所述的股骨侧内侧单髁假体还包括：第一立柱，设置在所述里侧面上，对应于所述第一椭圆的圆心第二立柱，设置在所述里侧面上，对应于所述第一椭圆的焦点。According to some embodiments, the medial unicondylar prosthesis on the femoral side further includes: a first post, disposed on the inner side, and a second upright corresponding to the center of the first ellipse, disposed on the inner side. , corresponding to the focus of the first ellipse.
根据一些实施例，所述股骨侧内侧单髁假体的前侧的末端形成有锁定螺钉孔，所述锁定螺钉孔形成为插入其中的锁定螺钉的方向与第一立柱和第二立柱的方向不同。According to some embodiments, a locking screw hole is formed at the front end of the medial femoral unicondylar prosthesis, and the locking screw hole is formed such that the direction of the locking screw inserted therein is different from the direction of the first upright and the second upright. .
根据一些实施例，第一椭圆的长轴垂直于股骨机械轴，并且其圆心对应于股骨内髁内侧副韧带附着点。According to some embodiments, the long axis of the first ellipse is perpendicular to the mechanical axis of the femur, and its center corresponds to the medial collateral ligament attachment point of the medial femoral condyle.
根据一些实施例，在矢状位上表现为各个层面上的相应第一椭圆在三维空间上集合，它们构成完整的股骨内侧单髁假体形状，它们的圆心在矢状位上重合，且长短轴方向一致，全部圆心的连线重合于穿髁线(TEA)且垂直于Whiteside线。According to some embodiments, in the sagittal plane, the corresponding first ellipses at each level are gathered in a three-dimensional space. They form a complete medial femoral unicondylar prosthesis shape. Their centers coincide in the sagittal plane, and their lengths are The axis directions are consistent, and the line connecting the centers of all circles coincides with the transepodylar line (TEA) and is perpendicular to the Whiteside line.
根据一些实施例，在轴位视角上，所述假体放置方向为平行于Whiteside线且垂直于穿髁线(TEA)，并且假体外侧有一平直的边，平行于Whiteside线且垂直于TEA，而内侧弧边呈圆弧状，以适应股骨内髁远端外形，前方弧边的曲度对应于磨具圆形的参数，底部为冠状位第一圆形的曲率。According to some embodiments, in an axial view, the prosthesis placement direction is parallel to the Whiteside line and perpendicular to the transepodylar line (TEA), and there is a straight edge on the outside of the prosthesis, parallel to the Whiteside line and perpendicular to the TEA. , while the inner arc edge is arc-shaped to adapt to the shape of the distal end of the medial femoral condyle, the curvature of the front arc edge corresponds to the parameters of the circle of the grinding tool, and the bottom is the curvature of the first circle in the coronal position.
根据一些实施例，所述第一椭圆上的弧段的角度范围为150度至200度，所述第一圆形上的弧段的角度范围为50度至90度。According to some embodiments, the angle range of the arc segment on the first ellipse is 150 degrees to 200 degrees, and the angle range of the arc segment on the first circle is 50 degrees to 90 degrees.
根据本公开的另一方面，提出了一种股骨侧外侧单髁假体，包括：关节面，所述关节面为膝关节运动过程中与髌骨外侧和胫骨平台外侧相接触的表面，它在矢状位上表现为第二椭圆上的弧段，在冠状位上表现为第三椭圆上的弧段；以及里侧面，所述里侧面为所述假体置入后邻接股骨髁部截骨面和骨水泥的部分，表现为直线截面的里侧面后髁处，以及与关节面弧段一致的里侧面远端部。According to another aspect of the present disclosure, a femoral lateral unicondylar prosthesis is proposed, including: an articular surface, which is a surface in contact with the lateral side of the patella and the lateral side of the tibial plateau during knee joint movement. It appears as an arc segment on the second ellipse in the horizontal position, and appears as an arc segment on the third ellipse in the coronal position; and the inner side, which is the osteotomy surface adjacent to the femoral condyle after the prosthesis is inserted. The part with bone cement is shown as the posterior condyle of the medial surface in a straight section, and the distal end of the medial surface that is consistent with the arc segment of the articular surface.
根据一些实施例，所述的股骨侧外侧单髁假体还包括：第三立柱，设置在所述里侧面上，对应于所述第二椭圆的焦点。According to some embodiments, the lateral unicondylar prosthesis on the femoral side further includes: a third post, disposed on the inner side, corresponding to the focus of the second ellipse.
根据一些实施例，所述股骨侧外侧单髁假体的远侧的末端形成有锁定螺钉孔，所述锁定螺钉孔形成为插入其中的锁定螺钉的方向与第三立柱的方向不同。According to some embodiments, a locking screw hole is formed at a distal end of the femoral lateral unicondylar prosthesis, and the locking screw hole is formed so that the direction of the locking screw inserted therein is different from the direction of the third post.
根据一些实施例，在矢状位上表现为各个层面上的相应第二椭圆(78)在三维空间上集合，它们构成完整的股骨外侧单髁假体形状，它们的圆心矢状位上重合，且长短轴方向一致，全部圆心的连线重合于穿髁线(TEA)且垂直于Whiteside线。According to some embodiments, the corresponding second ellipses (78) appearing at each level in the sagittal plane are assembled in a three-dimensional space. They form a complete lateral femoral unicondylar prosthesis shape, and their centers coincide in the sagittal plane. The long and short axes are in the same direction, and the lines connecting the centers of all circles coincide with the transepodylar line (TEA) and are perpendicular to the Whiteside line.
根据一些实施例，在轴位视角，所述假体放置方向为平行于Whiteside线且垂直于穿髁线(TEA)，并且假体内侧有一平直的边，平行于Whiteside线且垂直于TEA，而外侧弧边呈圆弧状，以适应股骨外髁远端外形，前方弧边的曲度对应于圆形的曲率参数，底部为冠状位第三椭圆形的弧段的曲率。According to some embodiments, in an axial view, the prosthesis placement direction is parallel to the Whiteside line and perpendicular to the transepodylar line (TEA), and the inner side of the prosthesis has a straight edge, parallel to the Whiteside line and perpendicular to the TEA, The outer arc edge is arc-shaped to adapt to the shape of the distal end of the lateral femoral condyle, the curvature of the front arc edge corresponds to the curvature parameter of the circle, and the bottom is the curvature of the third elliptical arc segment in the coronal position.
根据一些实施例，所述第二椭圆上的弧段的角度范围为120度至160度，所述第三椭圆上的弧段的角度范围为50度至90度。According to some embodiments, the angle range of the arc segment on the second ellipse is 120 degrees to 160 degrees, and the angle range of the arc segment on the third ellipse is 50 degrees to 90 degrees.
根据本公开的再一方面，提出了一种股骨滑车假体，包括：关节面，所述关节面为膝关节运动过程中与髌骨关节面相接触的表面，它在矢状位上表现为第四椭圆或圆形上的弧段与第五椭圆或圆形上的段弧空间集合；以及里侧面，所述里侧面为所述假体置入后邻接股骨滑车部截骨面和骨水泥的部分，表现为与股骨滑车关节面形态相一致的里侧面。According to another aspect of the present disclosure, a femoral trochlear prosthesis is proposed, including: an articular surface, which is a surface in contact with the patella articular surface during knee joint movement, and which appears as the fourth joint surface in the sagittal position. The arc segments on the ellipse or circle are spaced together with the segment arcs on the fifth ellipse or circle; and the inner side, which is the part adjacent to the osteotomy surface and bone cement of the femoral trochlea after the prosthesis is inserted. , showing the medial surface consistent with the shape of the femoral trochlear articular surface.
根据一些实施例，所述第四椭圆或圆形和第五椭圆或圆形以同心排列，同心轴空间上平行于TEA，且垂直于Whiteside线。According to some embodiments, the fourth ellipse or circle and the fifth ellipse or circle are arranged concentrically, with the concentric axes spatially parallel to the TEA and perpendicular to the Whiteside line.
根据一些实施例，所述股骨滑车假体的中心处有一立柱，四周有四个锁定螺钉孔以安放锁定螺钉。According to some embodiments, the femoral trochlear prosthesis has a post in the center and four locking screw holes around it for placing locking screws.
利用本公开上述实施例的假体能够更为贴近正常人体股骨髁部的几何形态，并简化了各种不同型号股骨假体的设计参数值。The prosthesis using the above embodiments of the present disclosure can be closer to the geometric shape of the normal human femoral condyle, and simplify the design parameter values of various types of femoral prostheses.
附图说明Description of drawings
为了更清楚地说明本公开实施例或现有技术中的技术方案，下面将对实施例或现有技术描述中所需要使用的附图作简单地介绍，显而易见地，对于本领域普通技术人员而言，在不付出创造性劳动性的前提下，还可以根据这些附图获得其他的附图，在附图中：In order to more clearly illustrate the embodiments of the present disclosure or the technical solutions in the prior art, the drawings needed to be used in the description of the embodiments or the prior art will be briefly introduced below. Obviously, for those of ordinary skill in the art, In other words, without exerting any creative effort, other drawings can also be obtained based on these drawings, in which:
图1A是描述根据本公开实施例的假体的膝关节内髁矢状位剖面图，示意股骨内髁椭圆原理及特点；1A is a sagittal cross-sectional view of the medial condyle of the knee depicting a prosthesis according to an embodiment of the present disclosure, illustrating the principle and characteristics of the medial femoral condyle ellipse;
图1B是描述根据本公开实施例的假体的膝关节内侧滑车矢状位剖面图，示意股骨内侧滑车椭圆原理及特点，并与股骨内髁椭圆的关系；1B is a sagittal cross-sectional view of the medial trochlea of the knee joint depicting a prosthesis according to an embodiment of the present disclosure, illustrating the principle and characteristics of the medial femoral trochlear ellipse and its relationship with the medial femoral condyle ellipse;
图2是描述根据本公开实施例的假体的膝关节股骨滑车最凹处矢状位剖面图示意此处圆形的特点；Figure 2 is a sagittal cross-sectional view of the most concave part of the femoral pulley of the knee joint according to the prosthesis according to an embodiment of the present disclosure, illustrating the circular characteristics here;
图3是描述根据本公开实施例的假体的膝关节股骨外髁及股骨滑车矢状位剖面图示意股骨外髁椭圆原理及特点，并与此处股骨滑车圆形的关系；Figure 3 is a sagittal cross-sectional view of the lateral femoral condyle and femoral pulley of the knee joint according to an embodiment of the present disclosure, illustrating the elliptical principle and characteristics of the lateral femoral condyle and its relationship with the circular shape of the femoral pulley;
图4是描述根据本公开实施例的假体的膝关节矢状位股骨髁部椭圆形和圆形构造重叠示意图，示意股骨髁部是由椭圆形和圆形构成及其特点；Figure 4 is a schematic diagram depicting the overlapping oval and circular structures of the femoral condyle in the sagittal position of the knee joint according to the prosthesis according to an embodiment of the present disclosure, illustrating that the femoral condyle is composed of an oval and a circle and its characteristics;
图5是描述根据本公开实施例的假体的膝关节冠状位视图，示意股骨内外髁由圆形和椭圆形构成及特点；Figure 5 is a coronal view of the knee joint depicting a prosthesis according to an embodiment of the present disclosure, illustrating the composition and characteristics of the medial and lateral femoral condyle, which are circular and oval;
图6示出了根据本公开实施例的股骨内髁UKA假体的矢状位视图；Figure 6 illustrates a sagittal view of a medial femoral condyle UKA prosthesis in accordance with an embodiment of the present disclosure;
图7示出了根据本公开实施例的股骨内髁UKA假体的冠状位视图；Figure 7 illustrates a coronal view of a medial femoral condyle UKA prosthesis according to an embodiment of the present disclosure;
图8示出了根据本公开实施例的股骨内髁UKA假体的轴位视图；Figure 8 shows an axial view of a medial femoral condyle UKA prosthesis according to an embodiment of the present disclosure;
图9是描述本公开实施例的股骨内髁UKA假体的立体视图；Figure 9 is a perspective view of a medial femoral condyle UKA prosthesis depicting an embodiment of the present disclosure;
图10A是描述根据本公开实施例的股骨内髁UKA假体置入的操作和相应器械使用的示意图；Figure 10A is a schematic diagram describing the operation of medial femoral condyle UKA prosthesis implantation and the use of corresponding instruments according to an embodiment of the present disclosure;
图10B是描述根据本公开实施例的股骨内髁UKA假体置入的操作和相应器械使用的示意图；Figure 10B is a schematic diagram describing the operation of medial femoral condyle UKA prosthesis implantation and the use of corresponding instruments according to an embodiment of the present disclosure;
图11是描述根据本公开实施例的股骨外髁UKA假体的矢状位视图；Figure 11 is a sagittal view depicting a lateral femoral condyle UKA prosthesis according to an embodiment of the present disclosure;
图12是描述根据本公开实施例的股骨外髁UKA假体的冠状位视图；Figure 12 is a coronal view depicting a lateral femoral condyle UKA prosthesis in accordance with an embodiment of the present disclosure;
图13是描述根据本公开实施例的股骨外髁UKA假体的立体视图；Figure 13 is a perspective view depicting a lateral femoral condyle UKA prosthesis according to an embodiment of the present disclosure;
图14是描述根据本公开实施例的股骨滑车UKA假体的构造原理和立体视图。Figure 14 is a diagram illustrating the construction principle and perspective view of a femoral trochlear UKA prosthesis according to an embodiment of the present disclosure.
具体实施方式Detailed ways
下面将详细描述本公开的具体实施例，应当注意，这里描述的实施例只用于举例说明，并不用于限制本公开。在以下描述中，为了提供对本公开的透彻理解，阐述了大量特定细节。然而，对于本领域普通技术人员显而易见的是：不必采用这些特定细节来实行本公开。在其他实例中，为了避免混淆本公开，未具体描述公知的材料或方法。Specific embodiments of the present disclosure will be described in detail below. It should be noted that the embodiments described here are for illustration only and are not intended to limit the disclosure. In the following description, numerous specific details are set forth in order to provide a thorough understanding of the disclosure. However, it will be apparent to one of ordinary skill in the art that these specific details need not be employed to practice the present disclosure. In other instances, well-known materials or methods have not been described in detail in order to avoid obscuring the present disclosure.
根据本公开实施例的UKA假体(包括股骨内侧髁，股骨外侧髁和股骨滑车关节面)，其外形最贴近正常人体股骨髁部和滑车部的几何特征。如下的一个或多个实施例详述了此椭圆原理及应用于UKA的设计方法。一个或多个实施例将以图示形式表现。但这些图示及说明并不限制本公开申请想要保护的创新内容。每个图示及说明将关联于其他图示。The shape of the UKA prosthesis (including the medial femoral condyle, the lateral femoral condyle and the femoral trochlear articular surface) according to the embodiment of the present disclosure is closest to the geometric characteristics of the normal human femoral condyle and trochlea. The following one or more embodiments details this ellipse principle and the design method applied to UKA. One or more embodiments are presented in diagram form. However, these illustrations and descriptions do not limit the innovative content that this disclosure application wants to protect. Each illustration and description will be related to other illustrations.
根据一个或多个实施例，本公开提供的UKA假体元件包括：股骨内侧髁、股骨外侧髁和股骨滑车置换部件。它们可单独应用在特定的单间室骨性关节炎的情况，也可以联合应用于两个或三个间室的骨性关节炎的情况。具体来说，所述股骨内侧髁UKA假体元件是指膝关节运动时与胫骨内侧间室关节式联接部分；所述股骨外侧髁UKA假体元件是指膝关节运动时与胫骨外侧间室关节式联接部分；所述股骨滑车UKA假体元件是指膝关节运动时与髌骨相对应部分。其中任何UKA假体元件均包括假体关节面和假体里侧面。需要说明的是，这里使用的“前”是指朝向人体的腹侧；“后”是指朝向人体的背侧；“内”是指朝向人体躯干中轴；“外”是指远离人体躯干中轴；“近”是指朝向人体的头侧；“远”是指朝向人体的尾侧，等等。同样地，“矢状位”、“冠状位”和“轴位”的描述同解剖学平面定义。“水平轴”指向“前”“后”方向并平行于地面；“垂直轴”指向“远”“近”方向并垂直于地面。一般来讲，UKA假体元件的“最远点”是指膝关节完全伸直时与对应的胫骨支撑件建立的最远接触点；UKA假体元件的“最后点”是指与“最远点”相垂直的UKA假体后方偏心距最大值点。UKA假体元件的“最前点”是指与“最后点”相反的UKA假体前方偏心距最大值点。According to one or more embodiments, the UKA prosthetic component provided by the present disclosure includes: a medial femoral condyle, a lateral femoral condyle, and a femoral trochlear replacement component. They can be used alone in specific cases of unicompartmental osteoarthritis or in combination in cases of two or three compartments. Specifically, the medial femoral condyle UKA prosthetic component refers to the part that articulates with the medial tibial compartment when the knee joint moves; the lateral femoral condyle UKA prosthetic component refers to the part that articulates with the lateral tibial compartment when the knee joint moves. The femoral pulley UKA prosthetic component refers to the part corresponding to the patella when the knee joint moves. Any UKA prosthetic component includes the prosthetic articular surface and the prosthetic medial surface. It should be noted that the "front" used here refers to the ventral side of the human body; "posterior" refers to the dorsal side of the human body; "inside" refers to the central axis of the human body's trunk; and "outer" refers to away from the center of the human body's trunk. axis; "near" means toward the cranial side of the human body; "far" means toward the caudal side of the human body, etc. Likewise, the descriptions of “sagittal,” “coronal,” and “axial” are defined as anatomical planes. The "horizontal axis" points in the "front" and "back" directions and is parallel to the ground; the "vertical axis" points in the "far" and "near" directions and is perpendicular to the ground. Generally speaking, the "most distal point" of a UKA prosthetic component refers to the farthest point of contact with the corresponding tibial support when the knee joint is fully extended; the "rearmost point" of a UKA prosthetic component refers to the "farthest point" to the Point "is perpendicular to the point of maximum posterior eccentricity of the UKA prosthesis. The “anterior point” of the UKA prosthetic component refers to the point of maximum anterior eccentricity of the UKA prosthesis opposite to the “rearmost point”.
本公开描述的实施例显示为左侧股骨UKA假体元件。右侧股骨UKA假体元件和左侧股骨UKA假体元件呈矢状位镜像。因此，我们声明这里描述的股骨UKA假体的特征原理同等适用于左膝或右膝配置。需要注意的是，本公开的股骨滑车UKA假体设计包括“置换髌骨关节面”和“不置换髌骨关节面”两种情况的假体。其中“置换髌骨关节面”的股骨滑车UKA假体相对于“不置换髌骨关节面”假体，设计了髌骨相对应的滑车凹槽和角度。The embodiment described in this disclosure is shown as a left femoral UKA prosthetic element. The right femoral UKA prosthetic component and the left femoral UKA prosthetic component are sagittal mirror images. Therefore, we state that the characteristic principles of the femoral UKA prosthesis described here are equally applicable to left or right knee configurations. It should be noted that the femoral pulley UKA prosthesis design of the present disclosure includes prostheses in two situations: "replacing the patellar articular surface" and "not replacing the patellar articular surface". Among them, the femoral trochlear UKA prosthesis that "replaces the patellar articular surface" is designed with the corresponding trochlear groove and angle of the patella compared to the prosthesis that "does not replace the patellar articular surface".
根据本公开的一个或多个实施例，在矢状位上，股骨内外髁关节面外形由椭圆构成，内外滑车关节面外形由椭圆和/或圆构成，冠状位上，股骨内外髁关节面外形由椭圆形和圆形构成。According to one or more embodiments of the present disclosure, in the sagittal position, the shape of the articular surface of the medial and lateral femoral condyle is composed of an ellipse, and the shape of the internal and external trochlear articular surface is composed of an ellipse and/or a circle. In the coronal position, the shape of the articular surface of the medial and lateral femoral condyle is composed of an ellipse. Made of ovals and circles.
例如，股骨内髁UKA假体以矢状位椭圆和冠状位圆形的原理进行设计构造。在矢状位上，股骨内髁关节面各层面为椭圆形的集合，它们在三维空间上构成完整的股骨内髁部形状。其中股骨内髁关节软骨面的方向为垂直于穿髁线(TEA)且平行于Whiteside线的同心椭圆结构。在冠状位上，股骨内髁关节面表现为圆形的一段弧。For example, the medial femoral condyle UKA prosthesis is designed and constructed based on the principles of sagittal ellipse and coronal circular shape. In the sagittal position, all levels of the articular surface of the medial femoral condyle are an elliptical collection, which form a complete shape of the medial femoral condyle in three-dimensional space. The direction of the articular cartilage surface of the medial femoral condyle is a concentric elliptical structure perpendicular to the transecondylar line (TEA) and parallel to Whiteside's line. In the coronal view, the articular surface of the medial femoral condyle appears as a circular arc.
再如，股骨外髁UKA假体以矢状位椭圆和冠状位椭圆的原理进行设计构造。在矢状位上，股骨外髁关节面各层面为椭圆形的集合，它们在三维空间上构成完整的股骨外髁部形状。股骨外髁椭圆较股骨内髁椭圆稍小，其长轴方向参照于股骨内髁椭圆呈顺时针旋转一定角度。股骨外髁关节软骨面的方向为垂直于穿髁线(TEA)且平行于Whiteside线的同心椭圆结构。在冠状位上，股骨外髁关节面表现为椭圆形的一段弧。For another example, the lateral femoral condyle UKA prosthesis is designed and constructed based on the principles of sagittal ellipse and coronal ellipse. In the sagittal position, all levels of the articular surface of the lateral femoral condyle are an elliptical collection, which form a complete shape of the lateral femoral condyle in three-dimensional space. The ellipse of the lateral femoral condyle is slightly smaller than the ellipse of the medial femoral condyle, and its long axis rotates clockwise at a certain angle with reference to the ellipse of the medial femoral condyle. The direction of the articular cartilage surface of the lateral femoral condyle is a concentric elliptical structure perpendicular to the transecondylar line (TEA) and parallel to Whiteside's line. In the coronal view, the articular surface of the lateral femoral condyle appears as an elliptical arc.
根据本公开的实施例，股骨假体滑车UKA假体以椭圆和圆形原理进行设计构造。在矢状位上，全部股骨滑车各层面均可以椭圆形或圆形表现。它们在三维空间上构成完整的股骨滑车部结构。股骨内侧滑车关节软骨面矢状位各层面为椭圆形集合，且这些椭圆的长短轴方向相同，每个椭圆的圆心同心圆排列。但每个椭圆的离心率并不相同。这些椭圆的大小例如呈斐波那契数列排序。全部股骨外侧滑车层面均呈圆形表现，虽每个外侧滑车圆形的半径大小不同，但其圆心投影均重合。这条连接股骨滑车椭圆形和圆形圆心的直线垂直于穿髁线(TEA)且平行于Whiteside线。股骨内髁椭圆和股骨滑车最凹层面圆形的参数，决定了整个假体形状和长短径参数。According to an embodiment of the present disclosure, the femoral prosthesis pulley UKA prosthesis is designed and constructed based on the principles of ellipse and circle. In the sagittal view, all levels of the femoral trochlea can appear oval or circular. They form a complete femoral trochlear structure in three dimensions. The sagittal planes of the medial femoral trochlear articular cartilage surface are a collection of ellipses, and the major and minor axes of these ellipses are in the same direction, and the centers of each ellipse are arranged concentrically. But the eccentricity of each ellipse is not the same. The sizes of these ellipses are ordered, for example, in the Fibonacci sequence. All the lateral trochlear surfaces of the femur are circular. Although the radius of each lateral trochlea circle is different, the center projections of the circles coincide. This straight line connecting the centers of the oval and circular circles of the femoral trochlea is perpendicular to the transepodylar line (TEA) and parallel to Whiteside's line. The parameters of the ellipse of the medial femoral condyle and the circular shape of the most concave surface of the femoral trochlea determine the shape and length and diameter parameters of the entire prosthesis.
例如，核磁(MRI)矢状位扫描膝关节的最佳或最正确的位置方式：所扫描膝关节处于伸直0度位置时，膝关节轴位定位相设定为沿股骨内外髁最高点连线方向，膝关节冠状位定位相设定为沿正切胫骨平台关节面方向。股骨内髁几何特征可用椭圆形表示，属于此椭圆形上的一段弧。在一个实施例中，我们选取股骨内髁最后点偏心距(offset)最大值所在的矢状位层面，亦即股骨内髁中间层面，所示股骨内髁和椭圆形关系如图1A。自内侧半月板前角33伸直位时在股骨内髁42关节软骨面36形成的前切迹recess34开始，至内侧半月板后角43高屈曲位时在股骨内髁42形成的后切迹recess35结束，此段的股骨内髁42的关节软骨面36与一椭圆38完全重合。此椭圆38的长轴垂直于股骨机械轴，其圆心39在MRI轴位扫描上对应于股骨内髁内侧副韧带附着点123。在一个实施例中，此椭圆38的半长轴为31mm，半短轴为25mm，离心率为0.591。在另一个实施例中，此处椭圆的半长轴为27mm，半短轴为22mm，离心率为0.58。在多个实施例中，其半长轴在20mm至35mm之间，半短轴16mm至30mm之间，离心率在0.5至0.7之间。同时，通过测量椭圆圆心39与前后切迹34，35连线间的夹角α；椭圆圆心39和后切迹35连线与椭圆38长轴之间的夹角β，即可对此段关节软骨面36形状长度进行准确描述。在一个事实例中，夹角α为180度，夹角β为35度。在另一个实施例中，夹角α为190度，夹角β为40度。在多个实施例中，夹角α在170度至195度之间，夹角β在20度至45度之间。在绝大多数情况下，股骨内髁中间层面前方并无股骨内侧滑车关节面，即股骨内髁中间层面的椭圆38不对应于股骨内侧滑车最前点偏心距(offset)最大值层面，且这两个层面的椭圆并不一致。因此，我们将此股骨内髁椭圆38沿MRI矢状位扫描方向投射到股骨内侧滑车最前点偏心距(offset)最大值层面，如图1B。自此层面内侧半月板前角45伸直位时在股骨内髁42关节软骨面36形成的前切迹recess46开始，向前上至此层面股骨内侧滑车关节软骨面37结束，此段滑车关节软骨面37可用一椭圆形40的一段弧表示。虽一部分受试者此段关节面表现为圆形，但大多数受试者表现为椭圆形。此股骨内侧滑车关节软骨面椭圆40的长轴垂直于股骨内髁中间层面椭圆38的长轴。此椭圆40是以股骨滑车最凹层面(图2)上的圆形70为基准所做，所以此椭圆40的圆心41与股骨滑车最凹层面(图2)的圆形70的圆心41，在矢状位扫描的投影完全重合。在一个实施例中，此椭圆40的半长轴为29mm，半短轴为27mm，离心率为0.365。在多个实施例中，此椭圆40的半长轴在20mm至35mm之间，半短轴20mm至30mm之间。总体来说，此椭圆40半长轴与半短轴之差不大，例如1mm，2mm，或3mm。同时，通过测量圆心41与前切迹46及滑车软骨面结束点连线间的夹角γ，圆心41至滑车软骨面结束点连线与此椭圆40半短轴之间夹角γ’，即可对此段滑车关节软骨面的弧形37进行准确地描述。在多个实施例中，夹角γ在40度至80度之间，夹角γ’在-5度至40度之间。For example, the best or most correct position for MRI sagittal scanning of the knee joint is: when the scanned knee joint is in a straight 0-degree position, the axial positioning phase of the knee joint is set to connect the highest points of the medial and lateral femoral condyles. In the linear direction, the coronal positioning phase of the knee joint is set along the direction tangent to the tibial plateau articular surface. The geometric characteristics of the medial femoral condyle can be represented by an ellipse, which is an arc on this ellipse. In one embodiment, we select the sagittal plane where the maximum offset of the last point of the medial femoral condyle is located, that is, the middle plane of the medial femoral condyle. The relationship between the medial femoral condyle and the oval is shown in Figure 1A. It starts from the anterior notch recess34 formed on the articular cartilage surface 36 of the medial femoral condyle 42 when the anterior angle of the medial meniscus 33 is in the extended position, and ends at the posterior notch recess35 formed on the medial femoral condyle 42 when the posterior angle of the medial meniscus 43 is in the high flexion position. , the articular cartilage surface 36 of the femoral medial condyle 42 in this section completely coincides with an ellipse 38. The long axis of this ellipse 38 is perpendicular to the mechanical axis of the femur, and its center 39 corresponds to the medial collateral ligament attachment point 123 of the medial femoral condyle on the MRI axial scan. In one embodiment, the semi-major axis of the ellipse 38 is 31 mm, the semi-minor axis is 25 mm, and the eccentricity is 0.591. In another embodiment, the semi-major axis of the ellipse is 27 mm, the semi-minor axis is 22 mm, and the eccentricity is 0.58. In various embodiments, the semi-major axis is between 20 mm and 35 mm, the semi-minor axis is between 16 mm and 30 mm, and the eccentricity is between 0.5 and 0.7. At the same time, by measuring the angle α between the ellipse center 39 and the line connecting the anterior and posterior notches 34 and 35; the angle β between the ellipse center 39 and the posterior notch 35 and the long axis of the ellipse 38, the joint of this section can be determined The shape and length of the cartilage surface are accurately described. In a practical example, the included angle α is 180 degrees and the included angle β is 35 degrees. In another embodiment, the included angle α is 190 degrees and the included angle β is 40 degrees. In various embodiments, the included angle α is between 170 degrees and 195 degrees, and the included angle β is between 20 degrees and 45 degrees. In most cases, there is no medial femoral trochlear articular surface in front of the middle level of the medial femoral condyle, that is, the ellipse 38 at the middle level of the medial femoral condyle does not correspond to the level with the maximum offset of the most anterior point of the medial femoral trochlea, and these two The ellipses at each level are not consistent. Therefore, we project the medial femoral condyle ellipse 38 along the MRI sagittal scanning direction to the maximum offset level of the most anterior point of the medial femoral trochlea, as shown in Figure 1B. Starting from the anterior notch recess 46 formed on the articular cartilage surface 36 of the medial femoral condyle 42 when the anterior angle 45 of the medial meniscus at this level is extended, and ending with the medial femoral trochlear articular cartilage surface 37 at this level, this section of the trochlear articular cartilage surface 37 It can be represented by an arc of an ellipse 40. Although some subjects have a round joint surface, most subjects have an oval shape. The long axis of the ellipse 40 on the medial femoral trochlear articular cartilage surface is perpendicular to the long axis of the ellipse 38 on the medial femoral condyle surface. This ellipse 40 is made based on the circle 70 on the most concave surface of the femoral trochlea (Figure 2), so the center 41 of the ellipse 40 is the same as the center 41 of the circle 70 on the most concave surface of the femoral trochlea (Figure 2). The projections of the sagittal scans were completely coincident. In one embodiment, the semi-major axis of the ellipse 40 is 29 mm, the semi-minor axis is 27 mm, and the eccentricity is 0.365. In various embodiments, the semi-major axis of the ellipse 40 is between 20 mm and 35 mm, and the semi-minor axis is between 20 mm and 30 mm. Generally speaking, the difference between the semi-major axis and the semi-minor axis of this ellipse 40 is not big, such as 1mm, 2mm, or 3mm. At the same time, by measuring the angle γ between the center of the circle 41 and the line connecting the anterior notch 46 and the end point of the trochlear cartilage surface, the angle γ' between the line connecting the center 41 to the end point of the trochlear cartilage surface and the semi-minor axis of the ellipse 40 is The arc 37 of this section of the trochlear articular cartilage surface can be accurately described. In various embodiments, the included angle γ is between 40 degrees and 80 degrees, and the included angle γ' is between -5 degrees and 40 degrees.
根据一些实施例，股骨内髁椭圆38的圆心39与股骨内侧滑车椭圆40的圆心41的位置关系决定整个股骨髁部与股骨滑车部的空间位置关系，决定着股骨假体的外径里径的参数值。可以用股骨内髁椭圆38与股骨内侧滑车椭圆40的长短轴相交围成的矩形50来表述它们之间的关系。在一个实施例中，矩形50的长107为13mm，宽109为9mm。在另一个实施例中，矩形50的长107为12mm，宽109为7mm。在多个实施例中，矩形50的长107在8mm至16mm之间，宽109在4mm至12mm之间。这两个椭圆38，40圆心39，41连线与股骨内髁椭圆38长轴的夹角为θ。在一个实施例中，θ为32度。在另一个实施例中，θ为35度。在多个实施例中，θ角度范围在25度至35度之间。According to some embodiments, the positional relationship between the center 39 of the medial femoral condyle ellipse 38 and the center 41 of the medial femoral trochlear ellipse 40 determines the spatial positional relationship between the entire femoral condyle and the femoral trochlea, and determines the outer diameter and inner diameter of the femoral prosthesis. parameter value. The relationship between the medial femoral condyle ellipse 38 and the medial femoral trochlear ellipse 40 can be expressed as a rectangle 50 formed by the intersection of their long and short axes. In one embodiment, the length 107 of the rectangle 50 is 13 mm and the width 109 is 9 mm. In another embodiment, the rectangle 50 has a length 107 of 12 mm and a width 109 of 7 mm. In various embodiments, the length 107 of the rectangle 50 is between 8 mm and 16 mm, and the width 109 is between 4 mm and 12 mm. The angle between the line connecting the center points 39 and 41 of these two ellipses 38 and 40 and the long axis of the medial femoral condyle ellipse 38 is θ. In one embodiment, θ is 32 degrees. In another embodiment, θ is 35 degrees. In various embodiments, the theta angle ranges between 25 degrees and 35 degrees.
股骨滑车最凹层面62即为临床上Whiteside线所在的层面，如图2。此层面62是测定股骨内外滑车关节面几何形态的重要基础。能够最佳重合于此滑车层面62关节软骨面64的，且同时等比例缩小后仍能最佳重合于此层面62软骨下骨面65的圆形，有且只有一个70。此圆形70的圆心41在MRI矢状位扫描投影，与股骨内侧滑车椭圆40圆心及股骨外侧滑车圆形80圆心完全重合，故都用圆心41表示。临床上的Blumensaat线63被此圆形70囊括。类似于前面的表述，此层面62的滑车关节软骨面64是该圆形70的一段弧，并可用该圆形70的半径和角度表示。圆心41与滑车关节软骨面64前后界连线的夹角为ψ；圆心41与关节软骨面64前界的连线与水平轴夹角为ε。在一个实施例中，此圆形70的半径为24mm，ψ为100度，ε为0度。在另一个实施例中，此圆形70的半径为25mm，ψ为105度，ε为5度。在多个实施例中，此圆形70半径大小为16mm至30mm，ψ范围从90度至125度，ε范围从-20度至10度。且此圆形70的半径与股骨内髁椭圆38的半长轴长度呈特定比率关系，例如2/5，3/5或3/4。The most concave level 62 of the femoral trochlea is the level where the Whiteside line is clinically located, as shown in Figure 2. This level 62 is an important basis for determining the geometry of the articular surfaces of the inner and outer femoral pulleys. There is one and only one 70 that can best overlap the articular cartilage surface 64 of this trochlear layer 62, and at the same time can still best overlap the subchondral bone surface 65 of this layer 62 after being scaled down. The center 41 of the circle 70 in the MRI sagittal scanning projection completely coincides with the center of the medial femoral trochlear ellipse 40 and the center of the lateral femoral trochlea 80, so they are both represented by the center 41. The clinical Blumensaat line 63 is encompassed by this circle 70 . Similar to the previous description, the trochlear articular cartilage surface 64 of this layer 62 is an arc of the circle 70 and can be represented by the radius and angle of the circle 70 . The angle between the line connecting the center of the circle 41 and the anterior boundary of the trochlear articular cartilage surface 64 and the horizontal axis is ε. In one embodiment, the radius of the circle 70 is 24 mm, ψ is 100 degrees, and ε is 0 degrees. In another embodiment, the radius of the circle 70 is 25 mm, ψ is 105 degrees, and ε is 5 degrees. In various embodiments, the radius of the circle 70 ranges from 16 mm to 30 mm, ψ ranges from 90 degrees to 125 degrees, and ε ranges from -20 degrees to 10 degrees. And the radius of the circle 70 has a specific ratio relationship with the semi-major axis length of the medial femoral condyle ellipse 38, such as 2/5, 3/5 or 3/4.
根据本公开的实施例，股骨外髁几何形状可用椭圆形表示，属于此椭圆形的一段弧。在一个实施例中，我们选取股骨外髁最后点偏心距(offset)最大值所在的矢状位层面，亦即股骨外髁中间层面，此层面矢状位上同时也是股骨外侧滑车最前点偏心距(offset)最大值层面，所示各关系如图3。自外侧半月板前角73伸直位时在股骨外髁82关节软骨面76形成的前切迹recess74开始，至外侧半月板后角83高屈曲位时在股骨外髁82形成的后切迹recess75结束，此段的股骨外髁82的关节软骨面76与一椭圆78完全重合。此椭圆78的长轴相对于股骨内髁椭圆38长轴，呈顺时针旋转一定角度Ω，例如在一个实施例中为12度，另一实施例中为18度，在多个实施例中，Ω平均旋转5度至25度之间。其圆心79在矢状位投影完全重合于股骨内髁椭圆38的圆心39；在MRI轴位上对应于股骨外髁外侧副韧带附着点122。在一个实施例中，此椭圆78的半长轴为30mm，半短轴为26mm；在另一个实施例中，此椭圆78的半长轴为26mm，半短轴为23mm。在多个实施例中，此椭圆78的半长轴在21mm至33mm之间，半短轴16mm至30mm之间，离心率在0.5至0.7之间。同时，通过测量圆心79与前后切迹74，75连线间的夹角φ，圆心79和后切迹75连线与外髁椭圆78长轴之间的夹角ζ，即可对此段关节面76弧进行准确地描述。在一个实施例中，φ为130度，ξ为40度。在多个实施例中，夹角φ在120度至160度之间，夹角ζ在30度至70度之间。According to embodiments of the present disclosure, the femoral lateral condyle geometry may be represented by an ellipse and an arc belonging to this ellipse. In one embodiment, we select the sagittal plane where the maximum offset of the last point of the lateral femoral condyle is located, that is, the middle plane of the lateral femoral condyle. This plane is also the sagittal plane of the most anterior offset of the lateral femoral pulley. (offset) maximum value level, the relationships shown in Figure 3. It starts from the anterior notch recess74 formed on the articular cartilage surface 76 of the lateral femoral condyle 82 when the anterior angle of the lateral meniscus 73 is in the extended position, and ends at the posterior notch recess75 formed on the lateral femoral condyle 82 when the posterior angle of the lateral meniscus 83 is in the high flexion position. , the articular cartilage surface 76 of the femoral lateral condyle 82 in this section completely coincides with an ellipse 78. The long axis of this ellipse 78 is rotated clockwise by a certain angle Ω relative to the long axis of the medial femoral condyle ellipse 38, for example, 12 degrees in one embodiment, 18 degrees in another embodiment, and in many embodiments, The average rotation of Ω is between 5 degrees and 25 degrees. Its center 79 in sagittal projection completely coincides with the center 39 of the medial femoral condyle ellipse 38; in the MRI axis, it corresponds to the lateral collateral ligament attachment point 122 of the lateral femoral condyle. In one embodiment, the semi-major axis of the ellipse 78 is 30 mm, and the semi-minor axis is 26 mm; in another embodiment, the semi-major axis of the ellipse 78 is 26 mm, and the semi-minor axis is 23 mm. In various embodiments, the semi-major axis of the ellipse 78 is between 21 mm and 33 mm, the semi-minor axis is between 16 mm and 30 mm, and the eccentricity is between 0.5 and 0.7. At the same time, by measuring the angle φ between the center of the circle 79 and the line connecting the anterior and posterior notches 74 and 75, and the angle ζ between the line connecting the center 79 and the posterior notch 75 and the long axis of the lateral condyle ellipse 78, the joint can be measured Surface 76 arcs are accurately described. In one embodiment, φ is 130 degrees and ξ is 40 degrees. In various embodiments, the included angle φ is between 120 degrees and 160 degrees, and the included angle ζ is between 30 degrees and 70 degrees.
在此层面上，自前切迹recess74开始到股骨外侧滑车关节软骨面77结束，此段77可用圆形80表示。虽然一部分受试者表现为椭圆形，但大多数受试者表现仍为圆形。此股骨外侧滑车层面72圆形80的圆心41在MRI矢状位上与股骨内侧滑车椭圆40的圆心，以及股骨滑车最凹层面62的圆心完全重合。此圆形80的半径在25mm至35mm之间，例如28mm，或者26mm。圆形80圆心41与圆形80椭圆78下方交点的连线，圆形80的圆心41与股骨外侧滑车软骨关节面结束点连线，它们之间的夹角为ρ；圆形80的圆心41与股骨外侧滑车软骨面结束点的连线与水平轴之间的夹角为ρ’。夹角ρ在80度至120度之间，例如90度，100度或110度；夹角ρ’在-30度至20度之间，例如-10度，0度，或10度。At this level, starting from the anterior notch recess 74 and ending at the lateral femoral trochlear articular cartilage surface 77, this segment 77 can be represented by a circle 80. Although some subjects showed an oval shape, most subjects still showed a round shape. The center 41 of the circle 80 of the lateral femoral trochlea layer 72 completely coincides with the center of the circle 40 of the medial femoral trochlea ellipse 40 and the center of the most concave surface 62 of the femoral trochlea in the MRI sagittal position. The radius of the circle 80 is between 25mm and 35mm, such as 28mm, or 26mm. The line connecting the center 41 of the circle 80 and the intersection point below the ellipse 78 of the circle 80, the line connecting the center 41 of the circle 80 and the end point of the lateral femoral trochlear cartilage articular surface, the angle between them is ρ; the center 41 of the circle 80 The angle between the line connecting the end point of the lateral femoral trochlear cartilage surface and the horizontal axis is ρ'. The included angle ρ is between 80 degrees and 120 degrees, such as 90 degrees, 100 degrees or 110 degrees; the included angle ρ' is between -30 degrees and 20 degrees, such as -10 degrees, 0 degrees, or 10 degrees.
根据本公开的实施例，股骨髁部在MRI矢状位扫描方向上：股骨内外髁关节软骨面几乎均可用椭圆形表示，股骨内外滑车关节软骨面几乎均可用椭圆形和/或圆形表示，股骨滑车最凹处(即滑车沟中心)为圆形表示，如图4。According to embodiments of the present disclosure, in the sagittal MRI scanning direction of the femoral condyle: almost all the articular cartilage surfaces of the inner and outer femoral condyles can be represented by ovals, and almost all the articular cartilage surfaces of the inner and outer femoral trochlea can be represented by ellipses and/or circles, The most concave part of the femoral trochlea (i.e., the center of the trochlear groove) is represented by a circle, as shown in Figure 4.
股骨内髁关节软骨面矢状位各层面为同圆心椭圆形的集合92，其中每个椭圆的大小不同，长短轴方向一致且重合，每个椭圆有着近似的离心率，如图4。这代表着股骨外髁假体走行方向同矢状方向。所以股骨内髁关节软骨面真正方向为平行于Whiteside线，垂直于穿髁线TEA。股骨外髁关节软骨面矢状位各层面为椭圆形的集合93，如图4。其中每个椭圆的大小不同，长短轴方向一致且近似重合，即每个椭圆的圆心近似重合呈同心圆排列。这代表着股骨外髁假体走行方向同矢状方向。所以股骨外髁关节软骨面真正方向为平行于Whiteside线，垂直于穿髁线(TEA)。股骨内侧滑车关节软骨面矢状位各层面为椭圆形集合(图4)，且这些椭圆的长短轴方向相同，每个椭圆的圆心同心圆排列。但每个椭圆的离心率并不相同。这些椭圆的大小呈斐波那契数列排序。MRI矢状位扫描股骨髁部，全部股骨外侧滑车层面均呈圆形表现，虽每个外侧滑车圆形的半径大小不同，但其圆心41投影均重合(图4)。Each sagittal plane of the articular cartilage surface of the medial femoral condyle is a collection of concentric ellipses 92. Each ellipse is different in size, the long and short axes are consistent and coincident, and each ellipse has an approximate eccentricity, as shown in Figure 4. This means that the lateral femoral condylar component runs in the same sagittal direction. Therefore, the true direction of the articular cartilage surface of the medial femoral condyle is parallel to the Whiteside line and perpendicular to the transcondylar line TEA. The sagittal planes of the articular cartilage surface of the lateral femoral condyle are an elliptical collection 93, as shown in Figure 4. The sizes of each ellipse are different, and the directions of the long and short axes are consistent and approximately coincident. That is, the centers of each ellipse approximately coincide with each other and are arranged in concentric circles. This means that the lateral femoral condylar component runs in the same sagittal direction. Therefore, the true direction of the articular cartilage surface of the lateral femoral condyle is parallel to the Whiteside line and perpendicular to the transecondylar line (TEA). The sagittal planes of the medial femoral trochlear articular cartilage surface are a collection of ellipses (Figure 4), and the major and minor axes of these ellipses are in the same direction, and the centers of each ellipse are arranged in concentric circles. But the eccentricity of each ellipse is not the same. The sizes of these ellipses are ordered in the Fibonacci sequence. MRI sagittal scan of the femoral condyle shows that all lateral femoral trochlear planes appear circular. Although the radius of each lateral trochlear circle is different, the 41 projections of the center of the circle are all coincident (Figure 4).
在经过股骨内髁椭圆圆心39和股骨外髁椭圆圆心79的冠状面上，其股骨内外髁冠状位关节面95，97可用圆形和椭圆形表示，如图5。以股骨内髁椭圆圆心39为圆心，一圆形94可很好地重合于股骨内髁冠状位关节面95，其圆半径等于股骨内髁椭圆38的半短轴。此段关节面的弧度可用角度λ表示。垂线分λ为λ1和λ2，其中λ1和λ2可以相等，也可以不相等。在一个实施例中，λ角度为65度；在另一个实施例中，λ角度为70度。以股骨外髁椭圆圆心79为中心，一椭圆96顺时针旋转δ1度，且恰与内侧圆形94相切且重合于股骨外髁冠状位关节面97。此椭圆96的离心率等于0.618，即为完美椭圆。此段关节面的弧度可用角度δ表示。垂线分δ为δ1和δ2，其中δ1和δ2不相等。在一个实施例中，δ角度为70度；在另一个实施例中，δ角度为75度。On the coronal plane passing through the elliptical center 39 of the medial femoral condyle and the elliptical center 79 of the lateral femoral condyle, the coronal articular surfaces 95 and 97 of the medial and lateral femoral condyle can be represented by circles and ovals, as shown in Figure 5. Taking the center of the medial femoral condyle ellipse 39 as the center of the circle, a circle 94 can well overlap the coronal articular surface 95 of the medial femoral condyle, and the radius of the circle is equal to the semi-minor axis of the medial femoral condyle ellipse 38. The arc of this joint surface can be expressed by the angle λ. The vertical line divides λ into λ1 and λ2, where λ1 and λ2 may or may not be equal. In one embodiment, the lambda angle is 65 degrees; in another embodiment, the lambda angle is 70 degrees. Taking the elliptical center 79 of the lateral femoral condyle as the center, an ellipse 96 is rotated clockwise by δ1 degree, and is exactly tangent to the medial circle 94 and coincides with the coronal articular surface 97 of the lateral femoral condyle. The eccentricity of this ellipse 96 is equal to 0.618, which is a perfect ellipse. The arc of this joint surface can be expressed by the angle δ. The vertical line divides δ into δ1 and δ2, where δ1 and δ2 are not equal. In one embodiment, the delta angle is 70 degrees; in another embodiment, the delta angle is 75 degrees.
根据本公开实施例的股骨内髁UKA假体具有矢状位椭圆形几何形态和冠状位圆形几何形态。根据以上实施例，知道股骨内髁为同心椭圆的集合，且这些椭圆平面在空间上平行于滑车的Whiteside线。这些椭圆的圆心对应于股骨内髁内侧副韧带附着点处。所以股骨内髁UKA假体的几何形态为：矢状位上由同心椭圆构成，如图6；冠状位上由圆形构成，如图7。本公开的股骨内髁UKA假体201分为关节面部分，即在膝关节运动过程中与髌骨内侧和胫骨平台内侧相接触的假体外围表面；和里侧面部分，即股骨内髁UKA假体201置入后邻接股骨髁部截骨面和骨水泥的部分，表现为直线截面的里侧面后髁处，以及与关节面弧段相一致的里侧面远端部。The medial femoral condyle UKA prosthesis according to embodiments of the present disclosure has a sagittal oval geometry and a coronal circular geometry. According to the above embodiments, it is known that the medial femoral condyle is a collection of concentric ellipses, and the planes of these ellipses are spatially parallel to the Whiteside line of the pulley. The centers of these ellipses correspond to the attachment point of the medial collateral ligament at the medial femoral condyle. Therefore, the geometric shape of the medial femoral condyle UKA prosthesis is: it is composed of concentric ellipses in the sagittal position, as shown in Figure 6; it is composed of circles in the coronal position, as shown in Figure 7. The medial femoral condyle UKA prosthesis 201 of the present disclosure is divided into an articular surface part, that is, the peripheral surface of the prosthesis that contacts the medial side of the patella and the medial side of the tibial plateau during knee joint movement; and a medial surface part, that is, the medial femoral condyle UKA prosthesis. After 201 is implanted, the part adjacent to the osteotomy surface and bone cement of the femoral condyle is shown as the posterior condyle on the medial side of the linear section, and the distal end of the medial side that is consistent with the arc segment of the articular surface.
矢状位上，股骨内髁UKA假体201为一椭圆形38的一段弧203，如图6。这段弧203的前后点对应着半月板切迹recess，形成一个弧度范围，例如150度至200度，其中此弧度范围在一个实施例中为175度，另一个实施例中为185度，且在另一个实施例中为180度。其具体可表示为连接半月板前后切迹recess207，208且通过椭圆圆心39的直线与椭圆长轴的角度β。这个β角度在一个实施例中为30度，另一个实施例中为35度，且在另一个实施例中为40度。股骨内髁UKA假体里侧面后髁处202即为半月板后切迹recess208垂直于椭圆长轴的垂线，也即为后髁截骨位置所在。此位置随假体参数的变化而变化。股骨内髁UKA假体201的远端203呈椭圆弧形构造。其内侧面有两个立柱，分别是对应于椭圆圆心39的中心立柱204；和对应于椭圆焦点的后方立柱205。在此UKA假体的远端部件203的末端，还有一锁定螺钉的钉孔206，以对应一枚锁定螺钉206’。此位置在正常人体时接触与半月板，并不与胫骨平台关节面相接触；且也同时并不接触与髌骨，所以在此位置行螺钉固定并不影响关节面的接触。而且锁定固定螺钉206’的方向与中心立柱及后方立柱不同，可增强假体的稳定度。可以理解，本领域的技术人员可以根据需要设置更多数目的立柱。In the sagittal view, the UKA prosthesis 201 of the medial femoral condyle is an arc 203 of an oval 38, as shown in Figure 6. The front and back points of this arc 203 correspond to the meniscal notch recess, forming an arc range, such as 150 degrees to 200 degrees, where the arc range is 175 degrees in one embodiment and 185 degrees in another embodiment, and In another embodiment it is 180 degrees. Specifically, it can be expressed as the angle β between the straight line connecting the anterior and posterior notches of the meniscus 207 and 208 and passing through the center 39 of the ellipse and the long axis of the ellipse. This beta angle is 30 degrees in one embodiment, 35 degrees in another embodiment, and 40 degrees in another embodiment. The posterior condyle 202 on the medial side of the UKA prosthesis of the medial femoral condyle is the perpendicular line perpendicular to the long axis of the ellipse of the posterior notch recess 208 of the meniscus, which is also the location of the posterior condyle osteotomy. This position changes with changes in prosthesis parameters. The distal end 203 of the medial femoral condyle UKA prosthesis 201 has an elliptical arc shape. There are two uprights on its inner side, namely the central upright 204 corresponding to the center 39 of the ellipse; and the rear upright 205 corresponding to the focus of the ellipse. At the end of the distal component 203 of the UKA prosthesis, there is also a nail hole 206 for a locking screw, corresponding to a locking screw 206'. In a normal human body, this position contacts the meniscus and does not contact the tibial plateau articular surface. It also does not contact the patella, so screw fixation at this position does not affect the contact with the articular surface. Moreover, the direction of the locking fixing screw 206′ is different from that of the central column and the rear column, which can enhance the stability of the prosthesis. It can be understood that those skilled in the art can set up a greater number of columns as needed.
冠状位上，据图5我们已知股骨内髁冠状位关节面外形可用一圆形94的一段弧95表示，其弧度为λ，例如该弧度的范围为50度至90度，所以内髁UKA假体201的冠状位外形如图7所示。而矢状位上弧段203可看做与一圆形221近似重合，此圆形221的半径大于UKA假体201冠状位圆形94的半径。此圆形221的曲率和参数作为磨具参数以准备骨床面。In the coronal position, according to Figure 5, we know that the coronal articular surface shape of the medial femoral condyle can be represented by an arc 95 of a circle 94, and its arc is λ. For example, the range of this arc is 50 degrees to 90 degrees, so the medial condyle UKA The coronal shape of the prosthesis 201 is shown in Figure 7 . The sagittal arc segment 203 can be seen as approximately coincident with a circle 221, and the radius of this circle 221 is larger than the radius of the coronal circle 94 of the UKA prosthesis 201. The curvature and parameters of this circle 221 are used as grinding tool parameters to prepare the bone bed surface.
轴位视角上，股骨内髁UKA假体201的关节面呈不对称形，如图8。假体放置方向为平行于Whiteside线且垂直于穿髁线TEA。假体内外侧各有一平直的边243，245，平行于Whiteside线且垂直于TEA。而内侧弧边241呈圆弧状，以适应股骨内髁远端外形；前方弧边242的曲度对应于磨具圆形221的参数；底部244为冠状位圆形94的曲率。所以，股骨内髁UKA假体201的立体图示，如图9。除上述所说的各个位置，假体的里侧面具有相应凹陷槽痕以适应骨水泥。From an axial perspective, the articular surface of the medial femoral condyle UKA prosthesis 201 is asymmetrical, as shown in Figure 8. The prosthesis is placed parallel to the Whiteside line and perpendicular to the transcondylar line TEA. There is a straight edge 243, 245 on the inner and outer sides of the prosthesis, which is parallel to the Whiteside line and perpendicular to the TEA. The inner arc edge 241 is arc-shaped to adapt to the shape of the distal end of the medial femoral condyle; the curvature of the front arc edge 242 corresponds to the parameters of the grinding tool circle 221; and the bottom 244 is the curvature of the coronal circle 94. Therefore, the three-dimensional diagram of the UKA prosthesis 201 of the medial femoral condyle is as shown in Figure 9. In addition to the above-mentioned positions, the inner side of the prosthesis has corresponding concave grooves to accommodate bone cement.
以先前说明的股骨髁部MRI扫描方向，术前的MRI图像上即可计划出最佳的假体大小和位置。具体手术操作：显露后首先要确定滑车沟的Whiteside线，用电刀在内髁面上标记平行于Whiteside线的假体方向线。用一与股骨内髁椭圆最相适应的椭圆测量磨具251良好地贴合于关节面，如图10A。测量磨具251前端有一个抓钩254结构，能很好地把持住内后髁部。在测量磨具251的末端有两个钉孔255，用短钉进行固定以达到更大的稳定性。必须保证测量磨具的中空扶手257正对应着内侧副韧带附着点方向，即椭圆圆心39的方向。此中空扶手257可放入钻头，在股骨内髁上钻孔道258，以利于下一步放入磨钻中心固定桩。在测量磨具251的下端有一截骨槽256，其正对应着股骨内髁后方截骨线202。然后取下测量磨具251，在中心孔道258上放置固定桩259，用中空钻头271，其半径等于前面提及的圆形221。磨锉的深度由固定桩259限制，期间并不断用假体试模比较深度。Using the previously described MRI scanning direction of the femoral condyle, the optimal prosthesis size and position can be planned from the preoperative MRI images. Specific surgical operations: After exposure, the Whiteside line of the trochlear groove must first be determined, and an electrotome is used to mark the prosthesis direction line parallel to the Whiteside line on the medial condylar surface. Use an elliptical measuring tool 251 that is most suitable for the ellipse of the medial femoral condyle to fit well on the articular surface, as shown in Figure 10A. There is a grapple 254 structure at the front end of the measuring grinding tool 251, which can hold the medial and posterior condyle well. There are two nail holes 255 at the end of the measuring grinding tool 251, which are fixed with short nails to achieve greater stability. It must be ensured that the hollow armrest 257 of the measuring grinding tool corresponds to the direction of the attachment point of the medial collateral ligament, that is, the direction of the center 39 of the ellipse. A drill bit can be inserted into this hollow armrest 257 to drill a hole 258 on the medial condyle of the femur, so as to facilitate the subsequent insertion of a drilled central fixing post. There is an osteotomy groove 256 at the lower end of the measuring grinding tool 251, which corresponds to the osteotomy line 202 behind the medial femoral condyle. Then remove the measuring grinding tool 251, place a fixed pile 259 on the central hole 258, and use a hollow drill bit 271, the radius of which is equal to the circle 221 mentioned above. The depth of the grinding file is limited by the fixed pile 259. During this period, a prosthesis is used to test the depth continuously.
根据本公开实施例的股骨外髁UKA假体具有矢状位和冠状位皆为椭圆形几何形态。根据以上实施例，知道股骨外髁为同心椭圆的集合，且这些椭圆平面在空间上平行于滑车的Whiteside线。这些椭圆的圆心对应于股骨外髁外侧副韧带附着点处。所以股骨外髁UKA假体的几何形态为：矢状位上由同心椭圆构成；冠状位上由椭圆形构成，如图6。本公开的股骨内髁UKA假体201分为关节面部分，即在膝关节运动过程中与髌骨内侧和胫骨平台内侧相接触的假体外围表面；和里侧面部分，即股骨内髁UKA假体201置入后邻接股骨髁部截骨面和骨水泥的部分，表现为直线截面的里侧面后髁处，以及与关节面弧段一致的里侧面远端部。The femoral lateral condyle UKA prosthesis according to the embodiment of the present disclosure has an elliptical geometric shape in both the sagittal and coronal positions. According to the above embodiments, it is known that the lateral femoral condyle is a collection of concentric ellipses, and these elliptical planes are spatially parallel to the Whiteside line of the pulley. The centers of these ellipses correspond to the attachment point of the lateral collateral ligament of the lateral femoral condyle. Therefore, the geometric shape of the lateral femoral condyle UKA prosthesis is: it is composed of concentric ellipses in the sagittal position; it is composed of ellipses in the coronal position, as shown in Figure 6. The medial femoral condyle UKA prosthesis 201 of the present disclosure is divided into an articular surface part, that is, the peripheral surface of the prosthesis that contacts the medial side of the patella and the medial side of the tibial plateau during knee joint movement; and a medial surface part, that is, the medial femoral condyle UKA prosthesis. After 201 is implanted, the part adjacent to the osteotomy surface and bone cement of the femoral condyle is shown as the posterior condyle on the medial side of the linear section, and the distal end of the medial side that is consistent with the arc segment of the articular surface.
矢状位上，股骨外髁UKA假体301为一椭圆形78的一段弧，如图11。这段弧的前后点对应着半月板切迹recess307，308，它们形成一个角度范围，例如该弧度的范围为120度至160度，在一个实施例中，这个角度为145度，在另一个实施例中为150度。其具体可表示为半月板前后切迹recess307，308与椭圆圆心79围成的角度α。其中圆心79半月板后切迹308连线与水平轴呈角度β，此β角度在一个实施例中为35度，另一个实施例中为40度，在多个实施例中平均为35度。股骨外髁UKA假体301里侧面后髁截骨方向302垂直于水平轴。此位置随椭圆参数变化而变化。股骨外髁UKA假体301的远端303呈椭圆弧形构造。其内侧面有一个立柱，即对应于椭圆焦点的后方立柱305。在此UKA假体的远端部件303的末端，还有一锁定螺钉钉孔306，以对应一枚锁定螺钉306’。此位置在正常人体时接触与半月板，并不与胫骨平台关节面相接触；同时此螺钉孔位置偏外不接触于髌骨，所以在此位置行螺钉固定并不影响关节面的接触。而且锁定固定螺钉306’的方向与后方立柱不同，可增强假体的稳定度。In the sagittal view, the lateral femoral condyle UKA prosthesis 301 is an arc of an ellipse 78, as shown in Figure 11. The front and rear points of this arc correspond to the meniscal notch recess 307, 308, which form an angle range. For example, the range of the arc is 120 degrees to 160 degrees. In one embodiment, the angle is 145 degrees. In another embodiment, the angle is 145 degrees. In this example it is 150 degrees. Specifically, it can be expressed as the angle α formed by the meniscus anterior and posterior notches recess307,308 and the ellipse center 79. The line connecting the center 79 to the posterior meniscus notch 308 forms an angle β with the horizontal axis. This angle β is 35 degrees in one embodiment, 40 degrees in another embodiment, and is 35 degrees on average in multiple embodiments. The posterior condyle osteotomy direction 302 on the inner side of the UKA prosthesis 301 of the lateral femoral condyle is perpendicular to the horizontal axis. This position changes as the ellipse parameters change. The distal end 303 of the femoral lateral condyle UKA prosthesis 301 has an elliptical arc shape. There is a column on its inner side, namely the rear column 305 corresponding to the focus of the ellipse. There is also a locking screw hole 306 at the end of the distal component 303 of the UKA prosthesis to correspond to a locking screw 306'. In a normal human body, this position contacts the meniscus and does not contact the tibial plateau articular surface. At the same time, the screw hole is located outside and does not contact the patella, so screw fixation at this position does not affect the contact with the articular surface. Moreover, the direction of the locking fixation screw 306′ is different from that of the rear column, which can enhance the stability of the prosthesis.
冠状位上，据图5我们已知通过圆心79的股骨外髁冠状位关节面外形符合一椭圆形96的一段弧97表示，其弧度为δ，例如该弧度的范围为50度至90度，所以外髁UKA假体301的冠状位外形如图12所示，其相应的胫骨侧假体关节面冠状位形状为适应此椭圆的凹形325。这段弧97近似地可以重合于一个不经过圆心79的圆形321，其圆心位置为322，其圆半径可看做为椭圆96的半短轴长度。方向轴323不仅为后方立柱305的方向，也为磨锉钻及固定桩的方向，其与垂直轴的角度为15度，此圆形321的曲率和参数作为磨具参数以准备骨床面。冠状位上，锁定钉孔及锁定螺钉306方向与垂直轴呈角度15度。所以锁定螺钉306与后方立柱305呈角度30度，以达到假体的最大稳定性。In the coronal position, according to Figure 5, we know that the shape of the coronal joint surface of the lateral femoral condyle through the center 79 is represented by an arc 97 of an ellipse 96, and its arc is δ. For example, the range of this arc is 50 degrees to 90 degrees. Therefore, the coronal shape of the lateral condyle UKA prosthesis 301 is shown in Figure 12, and its corresponding coronal shape of the tibial side prosthesis articular surface is a concave shape 325 that adapts to this ellipse. This arc 97 can approximately coincide with a circle 321 that does not pass through the center 79 , the center of which is 322 , and the radius of which can be regarded as the semi-minor axis length of the ellipse 96 . The direction axis 323 is not only the direction of the rear column 305, but also the direction of the grinding drill and fixing pile. Its angle with the vertical axis is 15 degrees. The curvature and parameters of the circle 321 are used as grinding tool parameters to prepare the bone bed surface. In the coronal position, the direction of the locking nail hole and locking screw 306 forms an angle of 15 degrees with the vertical axis. Therefore, the locking screw 306 is at an angle of 30 degrees with the rear column 305 to achieve maximum stability of the prosthesis.
轴位视角上，股骨外髁UKA假体301的关节面呈不对称形，如图8。假体放置方向为平行于Whiteside线且垂直于穿髁线TEA。假体内外髁各有一平直的边343，345，平行于Whiteside线且垂直于TEA。而外侧弧边341呈圆弧状，以适应股骨外髁远端外形；前方弧边342的曲度对应于圆形321的曲率参数；底部344为冠状位椭圆形96的曲率。所以，股骨内髁UKA假体201的立体图示，如图13。除上述所说的各个位置，假体的里侧面具有相应凹陷槽沟以适应骨水泥。From the axial perspective, the articular surface of the lateral femoral condyle UKA prosthesis 301 is asymmetrical, as shown in Figure 8. The prosthesis is placed parallel to the Whiteside line and perpendicular to the transcondylar line TEA. The inner and outer condyles of the prosthesis each have a straight edge 343, 345, which is parallel to Whiteside's line and perpendicular to the TEA. The outer arc edge 341 is arc-shaped to adapt to the shape of the distal end of the lateral femoral condyle; the curvature of the front arc edge 342 corresponds to the curvature parameter of the circle 321; and the bottom 344 is the curvature of the coronal ellipse 96. Therefore, the three-dimensional diagram of the medial femoral condyle UKA prosthesis 201 is shown in Figure 13. In addition to the above-mentioned positions, the inner side of the prosthesis has corresponding concave grooves to accommodate bone cement.
股骨外髁UKA假体安放的操作步骤同内髁UKA假体安放步骤，有相应的特制的外形磨具，不再赘述。The steps for placing the UKA prosthesis on the lateral femoral condyle are the same as those for placing the UKA prosthesis on the medial condyle. There are corresponding special-shaped grinding tools, which will not be described again.
根据本公开的实施例的股骨滑车UKA假体具有矢状位内侧滑车椭圆形或圆形和外侧滑车圆形或椭圆形的几何形态，以及适用于非髌骨置换和髌骨置换的设计。例如，股骨滑车假体401包括：关节面，所述关节面为膝关节运动过程中与髌骨关节面相接触的表面，它在矢状位上表现为椭圆或圆形40上的弧段37与椭圆或圆形80上的段弧77空间集合；以及里侧面，所述里侧面为所述假体置入后邻接股骨滑车部截骨面和骨水泥的部分，表现为与股骨滑车关节面形态相一致的里侧面409。根据上述实施例，股骨内外滑车分别由椭圆形和圆形的一段弧以同心排列构成，如图4。所以本公开的股骨滑车UKA假体401设计为股骨内侧滑车的椭圆形和外侧滑车圆形几何形态构成，以同心排列。同心轴41’空间上平行于TEA，且垂直于Whiteside线。如图14的A所示，显示为内外侧滑车部分的同心椭圆及圆形构成，中心圆70即为经过Whiteside线的滑车最凹处圆形。股骨滑车UKA假体401的中心处有一立柱402，四周有四个锁定螺钉孔403，404，405，406以安放锁定螺钉，如图14的B所示。Femoral trochlear UKA prostheses according to embodiments of the present disclosure have sagittal medial trochlear oval or round and lateral trochlear round or oval geometries, as well as designs suitable for non-patellar replacement and patellar replacement. For example, the femoral trochlear prosthesis 401 includes: an articular surface, which is a surface in contact with the patellar articular surface during knee joint movement. It appears as an arc segment 37 and an ellipse on an ellipse or circle 40 in the sagittal position. Or the space collection of segment arcs 77 on the circle 80; and the inner side, which is the part adjacent to the osteotomy surface and bone cement of the femoral trochlea after the prosthesis is inserted, and is similar to the shape of the femoral trochlear articular surface. Consistent inner side 409. According to the above embodiment, the inner and outer pulleys of the femur are respectively composed of oval and circular arc sections arranged concentrically, as shown in Figure 4. Therefore, the femoral pulley UKA prosthesis 401 of the present disclosure is designed to be composed of an oval shape of the femoral medial pulley and a circular geometric shape of the lateral pulley, arranged concentrically. Concentric axis 41' is spatially parallel to the TEA and perpendicular to the Whiteside line. As shown in A in Figure 14 , the inner and outer pulley parts are composed of concentric ellipses and circles, and the central circle 70 is the circle at the most concave part of the pulley that passes through the Whiteside line. There is a post 402 in the center of the femoral pulley UKA prosthesis 401, and there are four locking screw holes 403, 404, 405, and 406 around it for placing the locking screws, as shown in B of Figure 14.
上述的实施例中，股骨外髁UKA假体设计基于股骨外髁椭圆结构形成的，股骨外髁椭圆是按照正常人体膝关节股骨外后髁关节软骨面形状进行设计的。股骨外髁的椭圆稍小于股骨内髁椭圆。其长轴方向参照于股骨内髁椭圆呈顺时针旋转一定角度。同时，股骨内外髁椭圆的圆心在股骨假体矢状位上呈重合表现。替代方案可将股骨外髁椭圆简化为长短轴方向与股骨内髁椭圆相一致，而取消顺时针旋转这个步骤，这可以更加简化股骨假体设计制作的过程。虽改变后的外形与正常人体肩关节股骨外后髁关节软骨面形状并不一致，但也无不可。辅以相匹配的胫骨平台侧假体垫片，也可以取到良好的关节运动学效果。In the above embodiments, the UKA prosthesis design of the lateral femoral condyle is based on the elliptical structure of the lateral femoral condyle, and the lateral femoral condyle ellipse is designed according to the shape of the articular cartilage surface of the posterior femoral condyle of the normal human knee joint. The ellipse of the lateral femoral condyle is slightly smaller than the ellipse of the medial femoral condyle. Its long axis direction rotates clockwise at a certain angle with reference to the ellipse of the medial femoral condyle. At the same time, the centers of the ellipses of the inner and outer femoral condyles overlap in the sagittal position of the femoral component. An alternative can be to simplify the lateral femoral condyle ellipse so that the long and short axis directions are consistent with the medial femoral condyle ellipse, and eliminate the step of clockwise rotation, which can further simplify the process of designing and manufacturing the femoral prosthesis. Although the changed shape is not consistent with the shape of the articular cartilage surface of the lateral femoral condyle of the normal human shoulder joint, it is acceptable. Supplemented by matching prosthetic spacers on the tibial plateau side, good joint kinematics effects can also be achieved.
此外，在滑车UKA假体设计中，将股骨内外侧滑车描述成由椭圆形或圆形构成。这个方案是最终统计学分析得出。虽然大部分实施例股骨内髁表现为椭圆形，但也有少部分实施例股骨内髁表现为圆形；虽然大部分实施例股骨外髁表现为圆形，但也有少部分实施例股骨外髁表现为椭圆形。且我们的具体实施方案是建立在分析中国人正常膝关节结构基础之上。如果将股骨内髁描述成圆形、股骨外髁描述成椭圆形；或者将股骨内外髁都描述成圆形、或者都描述成椭圆形，辅以相匹配的髌骨置换假体，也可以取得良好的关节运动学效果。Furthermore, in the trochlear UKA prosthesis design, the medial and lateral femoral trochlea is described as consisting of an ellipse or a circle. This solution is derived from final statistical analysis. Although the medial femoral condyle is oval in most embodiments, there are also a few embodiments where the medial femoral condyle is circular; although the lateral femoral condyle is circular in most embodiments, there are also a few embodiments where the lateral femoral condyle is circular. Is oval. And our specific implementation plan is based on the analysis of the normal knee joint structure of Chinese people. If the medial femoral condyle is described as round and the lateral femoral condyle is described as oval; or both the medial and lateral femoral condyle are described as round or both are described as oval, supplemented by a matching patella replacement prosthesis, good results can also be achieved. joint kinematics effects.
需要说明的是，本公开提出的假体，在非大批量生产时，如定制的个体化三维(3D)打印膝关节假体中，也将受到本专利保护。It should be noted that the prosthesis proposed in this disclosure will also be protected by this patent when it is not mass-produced, such as a customized individualized three-dimensional (3D) printed knee joint prosthesis.
这样，本公开实施例中提出的椭圆形、圆形原假体更为符合正常人体膝关节形态结构的。此椭圆形、圆形原理把复杂的、不可解读的膝关节结构简化为简单的、可有效重复的椭圆形、圆形的空间构成。In this way, the oval and circular original prostheses proposed in the embodiments of the present disclosure are more in line with the morphological structure of the normal human knee joint. This oval and circular principle simplifies the complex and uninterpretable knee joint structure into a simple, effectively repeatable oval and circular spatial composition.
此外，本公开实施例提出的椭圆形、圆形原理而制作的股骨假体，其各组件的参数都可以以椭圆形、圆形的、重要角度参数体现，且随着各参数的变化而相应出现变化，从而实现不同型号假体的精确制作。并且，各个单独的UKA假体可单独使用或联合组配应用。可实现关节力线的校正。In addition, the parameters of each component of the femoral prosthesis made based on the elliptical and circular principles proposed in the embodiments of the present disclosure can be reflected in elliptical, circular, and important angle parameters, and will change accordingly as each parameter changes. Changes occur, allowing for the precise production of different models of prostheses. Moreover, each individual UKA prosthesis can be used alone or in combination. Correction of joint force lines can be achieved.
虽然已参照几个典型实施例描述了本公开，但应当理解，所用的术语是说明和示例性、而非限制性的术语。由于本公开能够以多种形式具体实施而不脱离公开的精神或实质，所以应当理解，上述实施例不限于任何前述的细节，而应在随附权利要求所限定的精神和范围内广泛地解释，因此落入权利要求或其等效范围内的全部变化和改型都应为随附权利要求所涵盖。While the present disclosure has been described with reference to several exemplary embodiments, it is to be understood that the terms used are illustrative and exemplary rather than limiting. Since the present disclosure can be embodied in various forms without departing from the spirit or substance of the disclosure, it should be understood that the above-described embodiments are not limited to any foregoing details, but are to be construed broadly within the spirit and scope defined by the appended claims. , therefore all changes and modifications falling within the scope of the claims or their equivalents shall be covered by the appended claims.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202311160924.3ACN117224288A (en) | 2016-03-31 | 2016-03-31 | Femoral lateral medial and lateral unicondylar prosthesis and femoral trochlear prosthesis |
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201610196679.5ACN107280817B (en) | 2016-03-31 | 2016-03-31 | Femoral lateral medial and lateral unicondylar prosthesis and femoral trochlear prosthesis |
| CN202311160924.3ACN117224288A (en) | 2016-03-31 | 2016-03-31 | Femoral lateral medial and lateral unicondylar prosthesis and femoral trochlear prosthesis |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201610196679.5ADivisionCN107280817B (en) | 2016-03-31 | 2016-03-31 | Femoral lateral medial and lateral unicondylar prosthesis and femoral trochlear prosthesis |
| Publication Number | Publication Date |
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| CN117224288Atrue CN117224288A (en) | 2023-12-15 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN202311160924.3APendingCN117224288A (en) | 2016-03-31 | 2016-03-31 | Femoral lateral medial and lateral unicondylar prosthesis and femoral trochlear prosthesis |
| CN202311160979.4APendingCN118490423A (en) | 2016-03-31 | 2016-03-31 | Medial and lateral femoral unicompartmental prostheses and femoral trochlear prostheses |
| CN201610196679.5AActiveCN107280817B (en) | 2016-03-31 | 2016-03-31 | Femoral lateral medial and lateral unicondylar prosthesis and femoral trochlear prosthesis |
| Application Number | Title | Priority Date | Filing Date |
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| CN202311160979.4APendingCN118490423A (en) | 2016-03-31 | 2016-03-31 | Medial and lateral femoral unicompartmental prostheses and femoral trochlear prostheses |
| CN201610196679.5AActiveCN107280817B (en) | 2016-03-31 | 2016-03-31 | Femoral lateral medial and lateral unicondylar prosthesis and femoral trochlear prosthesis |
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