CN101155559B - 用于为开放楔形截骨术中在骨头中形成楔形开口的装置 - Google Patents

用于为开放楔形截骨术中在骨头中形成楔形开口的装置 Download PDF

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CN101155559B
CN101155559B CN2006800113018A CN200680011301A CN101155559B CN 101155559 B CN101155559 B CN 101155559B CN 2006800113018 A CN2006800113018 A CN 2006800113018A CN 200680011301 A CN200680011301 A CN 200680011301A CN 101155559 B CN101155559 B CN 101155559B
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osteotomy
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CN101155559A (zh
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V·P·诺瓦克
K·安曼
D·麦德维特
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Arthrex Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/151—Guides therefor for corrective osteotomy
    • A61B17/152—Guides therefor for corrective osteotomy for removing a wedge-shaped piece of bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1732—Guides or aligning means for drills, mills, pins or wires for bone breaking devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8095—Wedge osteotomy devices

Abstract

在本发明的一种形式中，提供有一种用于为开放楔形截骨术在骨头中形成楔形开口的装置，该装置包括：瞄准装置，该瞄准装置用于确定穿过骨头的切割面和确定用于终止沿着切割面做出的切口的边界线，其中，边界线被设置在骨头中；和用于沿着边界线布置的顶销，该顶销用于提供(i)在边界线处的用于限定沿着切割面的切割的有效障碍，和(ii)沿着边界线延伸的圆柱形开口，以便当切口任一侧上的骨头为了在骨头中形成楔形开口而被移走时减小骨头中应力集中的出现。在本发明的另一种形式中，提供有一种用于为开放楔形截骨术在骨头中形成楔形开口的方法，该方法包括：相对于骨头定位瞄准装置，以便确定穿过骨头的切割面和确定用于终止沿着切割面做出的切口的边界线，其中边界线被设置在骨头中；和沿着边界线定位顶销，以便提供(i)在边界线处的用于限定沿着切割面的切割的有效障碍，和(ii)沿着边界线延伸的圆柱形开口，以便当切口任一侧上的骨头为了在骨头中形成楔形开口而被移走时减小骨头中应力集中的出现；沿着切割面切割骨头，同时在边界线处终止切口；和将切口任一侧上的骨头移走，以便在骨头中形成楔形开口。

Description

用于为开放楔形截骨术中在骨头中形成楔形开口的装置 
对未决的在先专利申请的引用
本专利申请： 
(i)是未决的在先第11/047,159号美国专利中请的部分继续申请，Vincent P.Novak于2005年1月31日就开放楔形截骨术系统和外科方法提交了该在先申请(代理人档案号：NOVAK-010203I)； 
(ii)是未决的在先第11/047,551号美国专利申请的部分继续申请，Vincent P.Novak于2005年1月31日就开放楔形截骨术系统和外科方法提交了该在先申请(代理人档案号：NOVAK-010203SM)；和 
(iii)要求享有未决的在先第60/651,086号美国临时专利申请的权益，Vincent P.Novak等人于2005年2月8日就开放楔形截骨术系统和外科方法提交了该在先申请(代理人档案号：NOVAK-5 PROV)。 
上面确定的三个专利申请通过引用结合于本文中。 
技术领域
本发明通常涉及外科方法，并且更特别地涉及用于执行膝盖的开放楔形截骨术(open wedge osteotomy)的外科方法和装置。 
背景技术
膝盖截骨术对于治疗膝盖骨关节炎是重要的技术。本质上，膝盖截骨术调整了膝关节的几何形态，以便将重量支撑负载从关节的关节炎部分转移到了关节相对未受影响的部分上。 
大多数膝盖截骨术被设计用来修改上部胫骨的几何形态，以便调整胫骨接合股骨的方式，并且因此调整负载被转移穿过关节的位置。 
本质上，有两种方法来调整胫骨的方位：(i)闭合楔形技术；和(ii)开放楔形技术。 
在闭合楔形技术时，骨头的楔形物被从胫骨处移开，并且因而产生的缺口的任一侧上的部分被集合在一起，由此使胫骨顶台(tibialplateau)再定方位并且因此调整胫骨接合股骨的方式。 
在开放楔形技术时，切口被做到胫骨中，在切口任一侧上的部分被移走，以便在骨头中形成楔形开口，并且然后骨头被固定在这个位置上(比如，通过将金属板旋拧到骨头上或通过将楔形状植入物插入到骨头的开口中)，由此使胫骨顶台再定方位并且因此调整胫骨接合股骨的方式。 
尽管闭合楔形截骨术和开放楔形截骨术两者都为患者提供了相当多的益处，但是它们在程序上对外科医生而言是有挑战性的。在其它情况中，关于开放楔形截骨术，在骨头中以必要的精度形成楔形开口而又减小给周围组织带来的外伤这是困难的。 
本发明针对开放楔形截骨术，并且针对用于在胫骨中形成楔形开口的新的方法和装置。 
发明内容
本发明包括用于为开放楔形膝盖截骨术在胫骨中形成楔形开口的新颖的方法和装置。更特别地，本发明包括提供和使用为开放楔形膝盖截骨术在胫骨中使用前内侧通路(antero-medial approach)来形成楔形开口的新颖的方法和装置。 
在本发明的一种形式中，提供有一种用于为开放楔形截骨术在骨头中形成楔形开口的装置，该装置包括： 
瞄准装置(targeting apparatus)，该瞄准装置用于确定穿过骨头的切割面和用于确定终止沿着切割面做出的切口的边界线，其中边界线被设置在骨头中；和 
用于沿着边界线布置的顶销(apex pin)，该顶销用于提供(i)在边 界线处的用于限定沿着切割面的切割的有效障碍，和(ii)沿着边界线延伸的圆柱形开口，以便当切口任一侧上的骨头为了在骨头中形成楔形开口而被移走时减小骨头中应力集中的出现。 
在本发明的另一种形式中，提供有一种用于为开放楔形截骨术在骨头中形成楔形开口的方法，该方法包括： 
相对于骨头定位瞄准装置，以便确定穿过骨头的切割面和用于终止沿着切割面做出的切口的边界线，其中边界线被设置在骨头中；和 
沿着边界线定位顶销，以便提供(i)在边界线处的用于限定沿着切割面的切割的有效障碍，和(ii)沿着边界线延伸的圆柱形开口，以便当切口任一侧上的骨头为了在骨头中形成楔形开口而被移走时减小骨头中应力集中的出现； 
沿着切割面切割骨头，同时在边界线处终止切口；和 
将切口任一侧上的骨头移走，以便在骨头中形成楔形开口。 
在本发明的另一种形式中，提供有一种用于为开放楔形截骨术在胫骨中形成楔形开口的方法，该方法包括： 
在胫骨周围设置定位导向件，以便界定前后胫骨斜坡、穿过胫骨延伸的切割面和用于终止沿着切割面做出的切口的边界线，同时边界线界定骨头的铰合线； 
穿过定位导向件并且沿着边界线插入顶销； 
将切割导向件安装到定位导向件上，以便切割导向件中的切割狭槽与切割面共面对准； 
沿着切割面一直到边界线做出截骨术切口；和 
将切口任一侧上的骨头移走，以便在骨头中形成楔形开口。 
在本发明的另一种形式中，提供有一种用于为开放楔形截骨术在胫骨中形成楔形开口的方法，该方法包括： 
在胫骨的朝内侧周围设置定位导向件，以便围绕着部分胫骨，同时相对于胫骨顶台定位该定位导向件的上边缘； 
将第一圆柱销放置穿过定位导向件并且穿入到胫骨，以便将定位导向件可枢转地固定到胫骨； 
绕着第一销旋转定位导向件直到定位导向件的上边缘与前后胫骨斜坡平行； 
将第二圆柱销放置穿过定位导向件并且穿入到胫骨，以便将定位导向件固定到胫骨，同时定位导向件界定前后胫骨斜坡、穿过胫骨延伸的切割面和用于终止沿着切割面做出的切口的边界线，同时边界线界定骨头的铰合线； 
穿过定位导向件并且沿着边界线插入顶销； 
将切割导向件安装到定位导向件上，以便切割导向件中的切割狭槽与切割面共面对准； 
沿着切割面一直到边界线做出截骨术切口；和 
将切口任一侧上的骨头移走，以便在骨头中形成楔形开口。 
附图简要说明 
通过下面对发明优选实施例的详细说明(该说明被认为和附图结合在一起)，使本发明的这些和其它的目的与特征被更充分地公开或显而易见地呈现，在附图中相似的数字是指相似的部件，并且进一步地，其中： 
图1至图3所示是为开放楔形截骨术在胫骨中形成楔形开口，和将楔形状植入物定位到胫骨的楔形开口中的示意图； 
图4至图9所示是在胫骨高位截骨术中相关的平面； 
图10至图23所示是根据本发明的用于执行胫骨高位截骨术的一个优选方法和装置； 
图23A至图23C所示是形成在胫骨中的各种截骨术切口；和 
图24所示是本发明的备选形式。 
优选实施例的详细说明
概述
首先参看图1至图3，所示有将要在其上执行开放楔形截骨术的膝关节5。膝关节5通常包括胫骨10和股骨15。根据本发明，通过首先在上部胫骨中做出切口20(图1所示)，并且然后移走切口20任一侧上的部份骨头，以便在骨头中形成楔形开口25(图2所示)，同时楔形开口25被构造为使得胫骨顶台30相对于股骨15具有期望的方位，以此来实现开放楔形截骨术。切口20和楔形开口25可以本领域已共知的多种方式形成。 
本发明为使用前内侧通路来形成切口20和楔形开口25提供了新的和改进的方法与装置，这将在下面进行详细讨论。 
一旦期望的楔形开口25形成在胫骨10中，并且胫骨顶台30具有其期望的方位，骨头就可以本领域已共知的多种方式被固定在适当的位置上(比如，通过将金属板旋拧到骨头上或通过将楔形状植入物插入到骨头的开口中)，由此使胫骨顶台再定方位并且因此调整胫骨接合股骨的方式。作为示例，图3所示是被插入到形成在胫骨中的楔形开口中的楔形状植入物35。 
胫骨高位截骨术中相关平面的讨论
为了了解本发明的某些方面，对与执行胫骨高位截骨术相关的胫骨平面的彻底理解是有帮助的。因而，下面的讨论提出了相关于开放楔形胫骨高位截骨术的平面的几何说明。 
更特别地，并且现在参看图4，胫骨顶台30可被说明为与胫骨10的上方表面相交的水平(或横向)面。用于参考，还图示了矢状面32。如图5中所示，胫骨顶台30还垂直于正平面40。从前到后与胫骨的坡度表面相交的前后(A-P)坡度面45界定了前后(A-P)斜坡。公开的研究已论证了前后斜坡典型地与胫骨顶台30大约成7°到11°的角，然而，具体的角度可因个体而不同。 
接下来参看图6，典型地，在A-P坡度面45下方大约2cm处是 用于胫骨高位截骨术的。该偏移可用A-P偏移面50指代。 
如图7中所示，可用朝外侧面55和切深面60来界定朝外侧和切深，同时切深为从胫骨的朝外侧到内侧大约1cm。 
接下来参看图8，截骨术切割面65(当从直接正面视图看时)是由通过轴线旋转远离A-P偏移面50的平面形成的，该轴线由切深面60和A-P偏移面50相交形成。应该注意的是，当从直接正面视图看时平面是稍微“倾斜”的，因为它们顺着A-P坡度面45(图6所示)的倾斜。A-P偏移面50和切深面60在截骨术切口的末端处相交形成轴线70。换句话说，轴线70界定了穿过胫骨、与截骨术切割面65共面的直线，该直线界定了截骨术切口到胫骨中的最远程度。 
如图9中所示，截骨术面的直接A-P视图是符合截骨术的直接视图。该视图从直接正面视图处向下倾斜(也就是，大约成7°)。此外，向下倾斜的角度与A-P斜坡度相等。 
用于在胫骨中形成前内侧楔形开口的新颖的方法和装置
在本发明的一个优选实施例中，提供有新颖的截骨术系统100(图18所示)，该系统旨在为使用前内侧通路的胫骨高位截骨术做出精确而又可重复的截骨术切口。系统100通常包括定位导向件105、顶销110和切割导向件115，并且将在下文中做进一步详细的讨论。 
系统100旨在相对于胫骨的朝内侧被设置，并且平行于胫骨的前后(A-P)斜坡以及平行于胫骨顶台，同时顶销沿着轴线70延伸穿过胫骨，也就是，在将变成截骨术切口的底座或外侧铰链处，这将在下文中做进一步详细的讨论。 
接下来参看图10，定位导向件105在胫骨10的上部端面周围被定位，使得定位导向件卷绕着胫骨的朝内侧。应该了解的是定位导向件105并不是必然地需要与胫骨相接触。 
如图11中所示，定位导向件105可被调整，以便定位导向件的上边缘被设置在胫骨顶台的下方大约1-2cm处。然后，第一圆柱销120前移穿过定位导向件105中的第一钻孔125，同时定位导向件稍微伸 离胫骨，以便允许调节为与A-P斜坡平行。接下来，使用荧光镜显示A-P斜坡，定位导向件105旋转直到定位导向件的上边缘与A-P斜坡平行。 
一旦完成了这步，并且接下来参看图12，第二圆柱销130前移穿过定位导向件105中的第二钻孔135(图13所示)。该第二圆柱销130使定位导向件的位置相对于胫骨10稳定。可以了解的是，作为前述的结果，第一销120和第二销130的定位与布局使定位导向件105相对于胫骨10被固定了，以便定位导向件的上边缘与A-P胫骨斜坡平行。该过程确保了顶销钻孔140(图13所示)与轴线70(图8所示)对准，并且界定了轴线70，该轴线位于A-P偏移面50和切深面60的相交处，该顶销钻孔位于截骨术切口的远端处。 
接下来参看图14至图17，顶销110然后被前移穿过定位导向件的顶销钻孔140并且前移到胫骨10中。因此，顶销110沿着轴线70，也就是，在A-P偏移面50和切深面60的相交处延伸。因而，顶销110的轴线位于截骨术切口的远端处，与截骨术切口的面共面。 
此时，调节螺钉145(图14所示)前移穿过调节螺钉钻孔150并且前移抵住胫骨10，以便消除任何定位导向件105的位置相对于胫骨10的残余松动。在这方面，可以了解的是，在该操作中不要把调节螺钉145拧得过紧是重要的，以便避免反向影响到定位导向件相对于胫骨10的对准。 
接下来参看图18至图21，切割导向件115被安装到定位导向件105上。这是通过前移切割导向件115抵住定位导向件105使得定位导向件的置位销155被容纳穿过切割导向件的孔157来完成的。切割导向件115通过前移螺钉160穿过切割导向件中的孔165并且前移到定位导向件中的孔170中可被固定在这个位置上。该动作将切割导向件115中的切割狭槽175与截骨术的切割面65和顶销110对准，在某种意义上说它们是共面的。作为这种动作的结果，切割狭槽175与期望的截骨术切割的面相对准。 
此时，切割狭槽175的对准被核查以确保该狭槽是充分地位于胫骨根瘤180(图19所示)之上并且在胫骨顶台30之下。如果切割狭槽175没有充分地位于根瘤180之上或在胫骨顶台30之下，那么装置可被移开并且重复前述的操作。 
接下来参看图21至图23，摆锯(图未示)被前移穿过切割狭槽175并且前移到胫骨10中，以便形成期望的截骨术切口。在这方面，可以了解的是，顶销110将作为障碍以防止摆锯过多切割胫骨并由此损坏到胫骨外侧到截骨术切口的部分，这一点是重要的，因为当截骨术切口被打开以在骨头中形成楔形开口时这个未切割的骨头将作为底座或外侧铰链。而且，顶销还在胫骨中的截骨术切口的底座处形成了圆形开口，这将作为减少当截骨术切口被打开以在骨头中形成楔形开口时可能出现的应力集中。切深可用荧光镜来检验以确保胫骨充分地横穿过截骨术切口被切割。然后移开切割导向件115、顶销110和定位导向件105，并且用适当的骨凿(图未示)完成截骨术切口，使用荧光镜来检验切口位置。参看图23A，该附图所示是形成在胫骨10中的截骨术切口20。 
在一个优选的构造中，并且现在参看图23B，顶销被依尺寸制造以便形成在截骨术切口20的底座处的圆形开口20A的直径大于截骨术切口20的厚度20B。 
在另一种构造中，并且现在参看图23C，顶销被依尺寸制造以便形成在截骨术切口20的底座处的圆形开口20A的直径基本上与截骨术切口20的厚度20B相同。 
一旦截骨术切口被完成(图1所示)，在适当的情况下，截骨术切口任一侧上的部分骨头被移走，以便在骨头中形成期望的楔形开口25(图2所示)，由此使胫骨顶台30相对于股骨15具有了期望的方位。然后，比如通过将金属板旋拧到骨头上或通过将楔形植入物35(图3所示)插入到骨头的开口中将胫骨稳定在这个位置上。 
接下来参看图24，所示是另一个系统185，该系统旨在为使用 前内侧通路的胫骨高位截骨术做出精确而又可重复的截骨术切口。系统185包括定位导向件/切割导向件组合190，该定位导向件/切割导向件组合用于(i)在胫骨10中适当地定位顶销110，和(ii)将切口狭槽175与指定的切割面对准。这个的完成是通过，首先将定位销192穿过定位导向件/切割导向件组合190中的开口194，同时定位销192被布置为与指定的切割面共面。接下来，定位导向件/切割导向件组合190绕着定位销192旋转直到定位导向件/切割导向件组合的面与指定的切割面共面。然后，顶销110穿过定位导向件/切割导向件组合190中的第一开口196、穿过胫骨10，并且然后穿过形成在定位导向件/切割导向件组合190的远侧上的第二开口196。这就将定位导向件/切割导向件组合190相对于胫骨10固定在了合适的位置上，同时切割导向件狭槽175与指定的切割面对准，并且同时顶销110被布置在截骨术切口的远端处。然后，定位导向件/切割导向件组合190可被用于在胫骨10中形成期望的切口20(图1所示)，由此在骨头中形成楔形开口25(图2所示)。此外，顶销110将作为障碍以防止胫骨的过多切割，并且将在胫骨中的截骨术切口底座处形成圆形开口，这将作为减少当截骨术切口被打开以在骨头中形成楔形开口时可能出现的应力集中。 
发明的优势
通过本发明的提供和使用可获得许多的优势。 
作为示例而不是限制： 
(i)与定位导向件和切割导向件关联的顶销的提供和使用界定了与A-P胫骨斜坡有特定关系的骨头切口的外侧铰链或端点，这就提供了截骨术切口到楔形空间中的最终开口，以便不会扰乱或引起由于疏忽而造成的A-P胫骨斜坡的改变； 
(ii)顶销作为针对摆锯刀片或手动骨凿的有效障碍以防止外侧皮层的破裂； 
(iii)由顶销实现的在切割面端点处的圆形直径减少了应力集中， 在截骨术到楔形空间中的开口期间，该应力集中可能引起内部关节的骨折或外侧皮层的破裂； 
(iv)切割导向件为在近中心胫骨上使用前内侧通路结合了斜置的或成角的切割导向件狭槽，成角的切割导向件狭槽位于胫骨上的前内侧位置处，并且与期望的截骨术切割面对准； 
(v)斜置的狭槽设计获得了期望的切割面，这是从期望的偏移面处绕着由顶销轴线界定的轴线向下旋转而得的面； 
(vi)切割骨头的进程(也就是，制作截骨术的进程)是安全的并且从进程到进程之间是易于再现的；和 
(vii)进程不会反向影响胫骨的前后斜坡。 
变型
可以理解的是，为了解释发明的本质特性而在此说明和图解的部件的细节、材料、步骤和排列上的许多额外变化，都可由本领域中的那些技术人员在如附加权利要求中所表述的发明原理和范围中来实现。 

Claims (9)

1.一种用于为开放楔形截骨术在骨头中形成楔形开口的装置，所述装置包括：
瞄准装置，所述瞄准装置用于确定穿过所述骨头的切割面和确定用于终止沿着所述切割面做出的截骨术切口的边界线，其中，所述边界线被设置在所述骨头中；和
用于沿着所述边界线布置的顶销，所述顶销用于提供(i)在所述边界线处的用于限定沿着所述切割面的切割的有效障碍，和(ii)沿着所述边界线延伸的圆柱形开口，以便当所述截骨术切口任一侧上的所述骨头为了在所述骨头中形成所述楔形开口而被移走时减小所述骨头中应力集中的出现，
其中，所述顶销被如此构造，以便提供圆柱形开口，所述圆柱形开口的直径大于沿着所述切割面做出的所述截骨术切口的厚度。
2.根据权利要求1所述的装置，其特征在于，所述骨头是胫骨，并且进一步地，其中，所述瞄准装置被构造为使得切割通路通常沿着前内侧方向。
3.根据权利要求2所述的装置，其特征在于，所述瞄准装置被构造为使得所述边界线通常沿着前到后的方向延伸。
4.根据权利要求1所述的装置，其特征在于，所述骨头是胫骨，并且进一步地，其中，所述瞄准装置被构造为使得所述切割面和边界线是通过参照所述胫骨顶台来确定的。
5.根据权利要求4所述的装置，其特征在于，所述瞄准装置包括对准边缘，并且进一步地，其中，瞄准装置被构造为使得当所述对准边缘相对于前后斜坡被适当地定位时所述切割面和所述边界线被正确地设置。
6.根据权利要求5所述装置，其特征在于，所述对准边缘包括所述瞄准装置的上表面。
7.根据权利要求1所述的装置，其特征在于，所述瞄准装置包括定位导向件和切割导向件；
其中，所述定位导向件被构造成用于联接到所述骨头上，以便相对于所述骨头确定所述切割面和所述边界线；和
其中，所述切割导向件被构造成用于联接到所述定位导向件上，以便将切割狭槽与所述切割面对准。
8.根据权利要求7所述的装置，其特征在于，所述切割导向件被构造为使得所述切割通路通常沿着前内侧方向。
9.一种用于为开放楔形截骨术在骨头中形成楔形开口的装置，所述装置包括：
瞄准装置，所述瞄准装置用于确定穿过所述骨头的切割面和确定用于终止沿着所述切割面做出的截骨术切口的边界线，其中，所述边界线被设置在所述骨头中；和
用于沿着所述边界线布置的顶销，所述顶销用于提供(i)在所述边界线处的用于限定沿着所述切割面的切割的有效障碍，和(ii)沿着所述边界线延伸的圆柱形开口，以便当所述截骨术切口任一侧上的所述骨头为了在所述骨头中形成所述楔形开口而被移走时减小所述骨头中应力集中的出现，
其中，所述顶销被如此构造，以便提供圆柱形开口，所述圆柱形开口的直径基本上与沿着所述切割面做出的所述截骨术切口的厚度相等。
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CN101155559A (zh) 2008-04-02
JP2008529607A (ja) 2008-08-07
WO2006086476A3 (en) 2007-09-20
CA2597220A1 (en) 2006-08-17
EP1848384A4 (en) 2010-05-12
WO2006086476A2 (en) 2006-08-17
US8496662B2 (en) 2013-07-30

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