CN101835441A - 膝关节假体系统和植入方法 - Google Patents
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Abstract
一种用于在制备骨的过程中与细长IM构件协作来接纳假体的系统,其可包括脚手架、骨架或框架(1362)。对准组件(1364)可被选择性地连接到所述框架。所述对准组件可与所述IM构件协作以相对于所述骨定位所述框架。切割块(1366)可被选择性地连接到所述框架。根据其它特征,后稳定(PS)箱体引导组件(1470)可具有PS箱体引导附接部分,其选择性地与所述框架的第一附接部分连接。后底脚(1470)可选择性地与所述框架上的第二附接部分连接。所述后底脚可被定位为在安装位置占据关节线的空间。
Description
相关申请的交叉引用
本申请要求于2008年10月9日递交的美国申请12/248,509、于2008年10月9日递交的美国申请12/248,517的优先权,并为于2008年1月10日递交的美国系列11/972,359的部分连续,且要求于2007年10月10日递交的美国临时申请60/978,949的权益。以上申请的公开内容通过引用并入于此。
技术领域
本公开内容大体上涉及膝关节假体,更具体而言,涉及各种胫骨和股骨部件以及用于与这种胫骨和股骨部件协作的模块增强部。
背景技术
膝关节假体典型地包括股骨部件和胫骨部件。股骨部件和胫骨部件被设计为分别通过外科手术附接到股骨的远端和胫骨的近端。股骨部件被进一步设计为在模拟解剖膝关节的铰接运动时与胫骨部件协作。这种膝关节假体一般被称为主膝假体。
与韧带和肌肉结合的膝关节假体试图复制自然的膝运动,并吸收和控制在弯曲范围内产生的力。但是,在一些情况下,可能需要更换现存的假体。这种更换假体通常被称为置换膝假体。然而,根据主膝假体、膝腱和韧带的损坏或恶化程度,膝假体置换为了提供适当的稳定性可能需要排除一个或多个这些运动。通过这种方式,可能希望提供例如十字固定(CR)膝置换、完全约束膝置换、后稳定(PS)膝置换或铰链膝置换。而且,在某些情况下,可能需要在与这种膝关节假体相邻的区域内引起骨损失。
发明内容
一种用于在制备骨的过程中与细长IM构件协作来接纳假体的系统可包括脚手架、骨架或框架。对准组件可被选择性地连接到该框架。该对准组件可与所述IM构件协作以相对于所述骨定位所述框架。切割块可被选择性地连接到所述框架。
根据其它特征,后稳定(PS)箱体引导组件可具有PS箱体引导附接部分,其选择性地与所述框架的第一附接部分连接。后底脚可选择性地与所述框架上的第二附接部分连接。所述后底脚可被定位成在安装位置占据关节线的空间。
所述对准组件可包括对准构件,该对准构件具有接纳部分和由所述对准构件的所述接纳部分选择性接纳的衬套。所述衬套可限定纵向轴线和孔,该孔被构造为接受从中通过的所述IM构件。接合部分可形成在所述对准构件上。所述衬套可由所述对准构件的所述接纳部分选择性地接纳。所述接合部分可从分离位置移动到接合位置。在所述接合位置,所述接合部分基本阻止所述衬套沿所述纵向轴线的运动,而允许所述衬套围绕所述纵向轴线的旋转。
根据另外的特征,所述衬套可限定环形槽。所述接合部分可在所述接合位置嵌套在所述衬套的所述环形槽中。所述接合部分可包括连接到底脚的旋钮。所述旋钮能在所述分离位置与接合位置之间移动,从而使所述底脚从大致位于所述对准构件的所述主体内的位置移动到大致进入所述对准构件的所述接合部分的位置。
附图说明
本公开内容将根据详细描述和附图变得被更为全面地理解,其中:
图1为示出根据本教示的膝关节假体的前视图,其中该膝关节假体包括模块胫骨部件,其具有用于提供第一预定偏移的第一适配器组件;
图2为图1的模块胫骨部件的分解图;
图3A为图1的胫骨部件的前视图;
图3B为根据另外的特征的胫骨部件的前视图;
图3C为根据另外的特征的胫骨部件的透视图;
图3D为根据另外的特征的胫骨部件的透视图;
图4为根据本教示的第一适配器主体的视图;
图5为根据另外的特征的另一适配器主体的视图;
图6为示例性柄部和紧固插件的视图;
图7A为沿穿过图1的适配器的上/下线截取的剖视图;
图7B为示出各种偏移的图1的膝关节假体的视图;
图7C为图7A所示的锁定组件的分解图;
图8为根据本教示并与图1的适配器组件一起显示的示例性股骨部件的前视图;
图9为根据另外的特征的胫骨托盘和支承的透视图;
图10为图9的胫骨托盘的透视图;
图11为图9的支承的下表面的透视图;
图12为图9的支承的上表面的透视图;
图13为图9的胫骨托盘和支承的俯视图;
图14为沿图13的线14-14截取的剖视图;
图15为根据另外的特征的铰链膝关节假体的透视图;
图16A为沿图15的线16-16截取的剖视图,其中示出有旋转的股骨部件;
图16B为根据另外的特征的铰链膝假体的剖视图;
图17-20示出组装图15的膝关节假体的示例性顺序;
图21为根据本教示的第一增强部的透视图;
图22为根据本教示的第二增强部的透视图;
图23A为图21和22的第一和第二增强部的平面图;
图23B为处于配合或互锁位置的第一和第二增强部的侧视图;
图24为根据本教示的第三增强部的透视图;
图25为图24的第三增强部的俯视图;
图26为图8的股骨部件的前视图,其中示出有组装在向上延伸部分上的第一增强部;
图27为图8的股骨部件的前视图,其中示出有组装在向上延伸部分上的第一和第二增强部;
图28为图27的股骨部件的上部视图,其中示出有紧固到向下延伸部分的图24的增强部;
图29为图1的胫骨部件的前视图,其中示出有组装在向下延伸部分上且没有适配器组件的第一和第二增强部;
图30为图1的胫骨部件的前视图,其中示出有组装在向下延伸部分上的第三增强部;
图31为根据另外的特征的模块胫骨部件的分解图;
图32为根据另外的特征的增强部的透视图;
图33为根据本教示的另一增强部的透视图;
图34为根据另外的特征的适配器组件的分解透视图,其中示出有示例性胫骨部件和柄部;
图35为示于图34中的假体的前视图;
图36A为示于图34中的胫骨托盘和适配器的详细分解图;
图36B为沿图36A的线36B-36B截取的局部剖视图;
图36C为与根据另外的特征的胫骨部件协作的适配器组件的详细分解图;
图36D为沿图36C的线36D-36D截取的局部剖视图;
图37为具有第一偏移的示例性适配器的剖视图;
图38为具有第二偏移的另一示例性适配器的剖视图;
图39A为适配器组件的紧固构件和插件的分解图;
图39B为适配器组件的局部分解图;
图40A为根据本教示一个示例的胫骨部件、适配器组件和柄部的组装图;
图40B为沿图40A的线40B-40B截取的剖视图;
图41A为根据本教示一个示例的示例性股骨部件、适配器组件和柄部的组装图;
图41B为根据本教示一个示例的一对互锁增强部、适配器组件和股骨部件的组装后透视图;
图42-45为与储骨铰链膝协作使用的各种胫骨部件和支承的透视图;
图46为组装铰链膝的上部视图;
图47为沿图46的线47-47截取的剖视图;
图48A和48B为根据本教示一个示例的铰链膝假体的分解透视图;
图49为图示出为组装后的48A和48B的铰链膝假体的剖视图;
图50-54为根据本教示的各种增强部的透视图;
图55A和55B示出根据本教示的一套植入物;
图56-60示出在组装阶段期间示出的各种增强部;
图61-80B示出用于制备接纳在此公开的植入物的股骨和胫骨的各种装置;
图81-104示出使用图61-80B的装置的示例性顺序;
图105-107示出用于在将偏移适配器与预期股骨或胫骨部件结合之前将其对准在预期方位的各种装置;
图108-120示出用于制备接纳胫骨假体的胫骨的各种装置和相关顺序;
图121-140示出用于制备接纳股骨假体的股骨的各种装置和相关顺序;并且
图141和142示出用于在主膝手术中制备股骨的各种装置和相关顺序。
具体实施方式
首先,本公开内容提供一种膝关节假体系统,其具有可适于使用在膝置换手术中的各种膝关节假体。各种胫骨和股骨部件被描述为可单独使用或作为十字固定(CR)膝置换、后稳定(PS)膝置换、完全约束膝置换和铰链膝置换的一部分使用。如下文所述,本公开内容进一步提供可与在此公开的任何胫骨和股骨部件任意结合使用的各种模块适配器、柄部和增强部。换言之,所公开的在关节线上方和下方的所有部件(例如柄部、适配器、增强部等)可与在此公开的任何膝假体互换使用并在胫骨或股骨侧上。而且,从膝关节假体系统中选择任何膝假体和相关部件可由进行手术的外科医生在进行手术时选择。
首先参见图1,根据本教示构成的膝关节假体被示出并大体上由附图标记10表示。膝关节假体10被大体示出为包括支撑支承14的胫骨部件12,所述支承14接合股骨部件(未示出)的关节面。在本教示所涉及的范围内,可以理解的是,胫骨托盘12和支承14可适于与任何适当的股骨部件一同使用。例如,第一十字固定(CR)支承14被示出,其被设计为与CR股骨部件关节相连。然而,也可采用固定的PS支承,其被设计为与PS股骨部件关节相连。
图1所示的胫骨部件12将被理解为在结构上为模块式的,且大体上包括柄部20、托盘22和第一适配器组件24。按照以下将更为全面讨论的方式,适配器组件24可连接托盘22和柄部20,以在横平面或冠状平面或者任何其它平面中提供对柄部20的偏移。进一步解释的是,当柄部20通过第一适配器组件24附接到托盘22时,柄部20的中心轴线25可从托盘22的向下延伸部分28的中心轴线27偏移。在所示实施例中,第一适配器组件24可提供约5mm的第一偏移。可以理解的是,该偏移可从0mm至约5mm或更大,且能沿相对于中心轴线27的任何旋转方向。可替换地,柄部20可直接附接到托盘22(图29)。换言之,偏移轴线25可相对于中心轴线27旋转360度,以向外科医生提供各种进行外科手术时的选择,从而根据病人需求进行选择。可替换地,适配器组件24或柄部20可被旋转连接,以仅提供有限的调节范围,例如仅提供单一偏移或两个偏移位置。
参见图2和3A,胫骨托盘22的向下延伸部分28可限定凹形渐缩接纳部分30。凹形渐缩接纳部分30随其延伸至向下延伸部分28中而稍微渐缩。中心孔32可被形成通过托盘22和向下延伸部分28而至凹形渐缩接纳部分30中。向下延伸部分28还可限定外渐缩增强部接纳表面34。保持轨道36(图2)可从托盘22的后边缘向上延伸。胫骨托盘22可进一步包括整体式形成在其前边缘处的上表面上的一对立柱38。立柱38和轨道36可共同协作以将模块支承14保持在托盘22上的固定位置。可替换的胫骨托盘22’示于图3B中。
模块支承14可由超高分子量聚乙烯(UHMWPE)形成,其具有用于分别接纳立柱38和轨道36的前、后凹部(未具体示出),并在其髁间和内部/外部具有均匀的平坦下表面,以与托盘22的上表面直接接触。模块支承14可被设计为锁定在适当位置,在为此目的提供在其中的相对槽中,横向滑动锁定杆或夹具40楔入在立柱38与支承14之间。锁定杆如何与立柱和支承协作的更为详细的论述可在名称为“具有互换部件的膝关节假体”的共同所有人的美国专利5,330,534中找到,其通过引用并入于此。如以上大体所述的模块胫骨托盘和支承作为全膝系统的部件在商业上可从本公开内容的受让人Biomet公司获得,其包括针对不同病人需求的各种尺寸和结构的托盘、支承和其它膝部件。模块支承14的关节面可与全膝系统提供的关节面基本相同。
现在转到图2、4和5,适配器组件24可大体包括适配器主体44和锁定构件或元件46(图2)。适配器组件24的适配器主体44可限定凸形渐缩插入部分48,其具有贯穿其中形成的通道50。凹形渐缩接纳部分52可形成在适配器主体44的偏移主体部分53中,以接纳柄部20的凸形渐缩插入部分58。在一个示例中,凹形渐缩接纳部分52可为大致圆柱形。裙部54可被限定在凸形渐缩插入部分48与偏移主体部分53之间的过渡处。
参见图4,适配器主体44的凸形渐缩插入部分48限定第一轴线A1,凹形渐缩接纳部分52限定第二轴线A2。进一步,在所示实施例中,第一轴线A1和第二轴线A2彼此平行且分隔开以提供预期偏移。就此而言,可提供各自具有不同偏移的多个适配器,以根据病人需求向外科医生提供进行外科手术时的选择。在适配器主体44提供5mm偏移的范围内,第一和第二中心轴线A1和A2分隔开5mm。适配器主体44’可限定具有可替换结构的裙部54’。其它几何形状也可适用于裙部54、54’。
凸形渐缩插入部分48随其远离适配器主体44延伸而稍微渐缩。凹形渐缩接纳部分52类似地随其从适配器主体44的一端延伸至适配器主体44中而稍微渐缩。根据以下论述将理解的是,各种凸形渐缩插入部分(例如部分48)可插入到各种凹形渐缩接纳部分(例如部分52)中以形成锁定锥度或莫尔斯锥度。适配器主体44被示出为进一步限定与孔50和凹形渐缩接纳部分52相交的侧向延伸的槽道60。按照以下进一步所述的方式,锁定元件46可延伸至侧向延伸的槽道60中,在该位置最终将托盘22连接到柄部20。
如图2和6所示,柄部20可包括与锁定元件46协作地接合的上部64。在所示实施例中,柄部20的上部64可包括紧固插件66。可替换地,柄部20的紧固插件66可被整体式形成以与锁定元件46协作。
紧固插件66可包括远侧部分70,该远侧部分70可具有外螺纹以接合柄部20的凸形渐缩插入部分58的内螺纹孔72。紧固插件66可进一步包括中心部分74,该中心部分74具有可被用于将紧固插件66旋转至柄部20中的工具(未示出)接合的六边形截面或其它适当截面。进一步,紧固插件66可包括近端78,该近端78包括扩大的直径头部80。
锁定元件46可在尺寸和结构上被形成为适于插入通过适配器主体44的侧壁中的开口81,并插入至槽道60中,用于连接柄部20和托盘22。锁定元件46可包括具有内螺纹孔86的上表面80(见图2)。内螺纹孔86可螺纹地接纳紧固件90,该紧固件90能延伸通过提供在托盘22中的中心孔32。紧固件90可与托盘22的下部28的中心纵向轴线27对准。
另外参见图7C,锁定元件46可另外包括敞口端94和具有狭槽96的底表面。狭槽96可与敞口端94相交。当锁定元件46被插入通过开口60时,敞口端94可接纳柄部插件66的头部80。狭槽96可容纳紧固插件66的直径减小的中心部分100。紧固插件66的头部80的直径可大于狭槽94的宽度,以将紧固插件66与锁定元件46连接。
锁定元件46可进一步包括闭合端104。闭合端104可被凸起地弯曲。当锁定元件46被完全插入到槽道60中时,闭合端104可与适配器主体44的侧壁平齐。
在使用时,紧固插件66可被拧到柄部20上。接下来,适配器主体44可被放置在柄部20的凸形插入部分64上方,使得凸形插入部分64在压配合下被接纳在适配器主体44的凹形渐缩接纳部分52内,并且,紧固插件66的上端78延伸至侧向延伸的槽道60中。
适配器44的凸形渐锁延伸部48现在可被压配合到托盘12的凹形渐缩接纳部分30上,适配器主体44被定向为提供沿预期方向的偏移。如图7B所示,适配器主体44可在紧固之前围绕轴线A1旋转,以针对具体病人将柄部20定向在预期偏移处。结果,柄部20可围绕由轴线A1和A2限定的半径在多个位置延伸。可替换地,柄部20可与适配主体键合在一起,由此防止旋转。另外,可提供一组柄部,其具有适于各个病人的各种长度。类似地,可提供一组适配器主体来提供各种偏移。
就此而言,锁定元件46可通过开口81被插入到侧向延伸的槽道60中。在完全插入时,锁定元件46可接合紧固插件66。托盘22可通过螺纹紧固件90被紧固到适配器主体44,其中螺纹紧固件90延伸穿过托盘22的中心孔32并螺纹接合锁定元件46的内螺纹孔86。偏移柄部和其关于各种胫骨和股骨部件的应用的进一步论述可在于2004年9月3日递交、名称为“膝关节假体”的共同所有的美国专利申请10/934,282中找到,其通过引用并入于此。在该共同所有的申请中,胫骨托盘限定向下延伸的凸形部分,而在本申请中,胫骨托盘22限定向下延伸的凹形接纳部分30。另外,尽管未具体示出,但适配器主体44可替换地限定轴线A2,该轴线A2相对于轴线A1限定角度。
在另一示例中,凸形插入部分58可直接插入到托盘22的凹形接纳部分30中。在该示例中,可使用另一螺纹紧固件90’,其具有较短的轴,以横越适当距离从而与柄部20的螺纹孔72直接配合。如图3A-3D所示,其它胫骨托盘22A、22B、22C和22D被示出,以容纳紧固件90、90’、适配器44、44’和柄部20的各种组合。
现在转到图8,根据另一示例的膝关节假体被示出并大体上由附图标记110表示。膝关节假体110包括股骨部件112。股骨部件112可用作后稳定(PS)膝关节假体的一部分。在膝中等恶化或不稳定的情况下,PS膝关节假体可提供适当的稳定性。这最典型地发生在前后交叉韧带损耗或机能障碍且内部和外部的侧副韧带在功能上保持完好的情况。股骨部件112可包括第一髁部114和第二髁部116,其分别提供第一股骨支承面118和第二股骨支承面120。股骨部件112的第一和第二髁部114和116可由限定髁间凹部124的内髁部122互连。向上延伸部分130可形成在股骨部件112上。该向上延伸部分130可包括用于接纳在此所述的增强部的大致渐缩的外主体,并限定凹形渐缩接纳部分132。
根据本教示,股骨部件112的凹形渐缩接纳部分132可被配置为接受上述的适配器主体44、44’之一。通过这种方式,适配器主体44的凸形渐缩插入部分48可被适于插入并压配合到股骨部件112的凹形渐缩接纳部分132中。能理解的是,第一轴线A1和第二轴线A2彼此平行并分隔开。再次,示例性适配器组件24被描述为具有5mm的偏移,但是其它适配器主体可被提供为具有各种偏移。锁定元件46和柄部20可根据以上描述而使用。
现在转到图9-14,根据另一示例的膝关节假体被示出并大体上由附图标记210表示。膝关节假体210被大致示出为包括胫骨部件212,其支撑旋转约束支承214。胫骨部件212可大体上包括基本平坦的平台状胫骨托盘216(图10)和向下延伸部分218。向下延伸部分218可限定渐缩凹形接纳部分220和用于接纳在此公开的增强部的外渐缩主体。
胫骨托盘216可进一步包括向上延伸立柱224。胫骨托盘216与向上延伸立柱224之间的过渡可由不同半径R限定,或者更具体地,由具有约0.50英寸半径的半径R1与具有约1.50英寸半径的半径R2之间的过渡值限定。中间半径R2可具有约0.38英寸的半径。可以理解的是,半径R可限定其它尺寸。不同半径R的过渡可最小化承受在向上延伸立柱224上的应力。限定通过立柱224的轴线A3(图14)可相对于限定通过向下延伸部分218的轴线A4沿向后方向侧向偏移。螺纹孔228可形成通过胫骨托盘216的前部。该螺纹孔228可大致垂直于轴线A4延伸。
向下延伸部分218可限定渐缩增强部接纳表面230。胫骨托盘216可由钴铬钼或任何其它适当的生物兼容材料形成。胫骨托盘216的顶部232(图10)可被高度抛光,以提供基本光滑的胫骨支承面234。
旋转支承214可具有基本平坦的下支承面238(图11),该下支承面238可相对于高度抛光的胫骨支承面234旋转移动。旋转支承212可进一步包括第一上关节或支承面240和第二上关节或支承面242。支承面240和242可从中心向上延伸部分244前向和侧向形成。第一支承面240和第二支承面242可与约束股骨部件(未示出)的第一和第二髁的相应支承面关节相连。旋转支承212可由手术等级、低摩擦和低磨损塑性的例如UHMWPE或其它适当材料形成。如图13所示,胫骨托盘216的后边缘246可限定一表面,该表面相对于支承214的后边缘250限定角度247。角度247可为约8度。也可采用其它角度。
现在转到图14,柄部20被示出为直接接纳在托盘216的凹形渐缩接纳部分220中。再次,代替将柄部20直接插入到托盘216的凹形渐缩接纳部分220,可使用适配器主体44或44’。柄部20可包括紧固插件66’。紧固插件66’可包括远侧部分70’,该远侧部分70’具有外螺纹,以接合柄部20的凸形渐缩插入部分64的内螺纹孔72。紧固插件66’可进一步包括中心部分74’,该中心部分74’具有可被用于将紧固插件66’旋转至柄部20中的工具(未示出)接合的六边形截面或其它适当截面。进一步,紧固插件66’可包括上端78’,该上端78’包括锥形接合头部80’。定位螺钉252可通过胫骨托盘216的螺纹孔228被推进,以接合锥形接合头部80’。通过这种方式,定位螺钉252的推进可将紧固插件66’以及柄部20紧固在紧固位置。可以理解的是,当使用适配器主体44时,可使用诸如紧固插件66’但具有较长柄部部的紧固件,用于螺纹紧固到锁定元件46。
现在转到图15-20,根据本教示构造的铰链膝关节假体被示出并大体上由附图标记310表示。膝关节假体310被大致示出为包括胫骨部件312,其支撑支承314,该支承314接合股骨部件316的关节面。胫骨部件312可大体上包括基本平坦的平台状胫骨托盘318和向下延伸部分320。向下延伸部分320可限定渐缩凹形接纳部分322。
另外参见图16A,胫骨托盘318可进一步包括向上延伸立柱324。如下文所述,盖326可被紧固地插入限定在向上延伸立柱324的终端开口处的细长孔328中。螺纹孔330可形成通过胫骨托盘318。螺纹孔330可大致垂直于由向上延伸立柱324限定的轴线延伸。胫骨托盘318可由钴铬钼或任何其它适当的生物兼容材料形成。定位螺钉(未示出)可通过胫骨托盘318的螺纹孔330推进,以接合紧固插件的锥形接合头部(如以上关于图14的详细描述)。通过这种方式,定位螺钉的推进可将紧固插件以及适配器主体44或柄部20紧固在紧固位置。胫骨托盘318的顶部可被高度抛光,以提供基本光滑的胫骨支承面331。
旋转支承314可具有大致平坦的下支承面332,该下支承面332能相对于高度抛光的胫骨支承面331旋转移动。旋转支承314可进一步包括第一上关节或支承面336和第二上关节或支承面338。第一支承面336和第二支承面338可与股骨部件316的各自的第一和第二髁340和342的相应支承面关节相连。再次,如上所述,支承面可类似于在全膝系统中提供的支承面。为了容许股骨部件316的引导运动,支承314可包括稳定立柱350,其可从支承面向上伸出。稳定立柱350可包括鳍状主体352,其具有升高后部354和下降前部356。主体350可限定第一和第二侧向分隔开的侧部360和362(图17)。稳定立柱350的第一和第二侧部360和362可被定位为延伸至股骨部件316的髁间凹部366(图15)中。稳定立柱孔370可沿向上/向下方向形成通过主体350。
通道372可形成通过主体350的升高后部354。通道372可沿大致垂直于稳定立柱孔370的方向大致延伸通过稳定立柱350的第一和第二侧部360和362。旋转支承314可由手术等级、低摩擦和低磨损塑性的例如UHMWPE或其它适当材料形成。
可替换稳定立柱350’示于图16B中,其接受盖或紧固件326’。
股骨部件316的第一和第二髁部340和342可由限定髁间凹部366的内髁部380互连。髁间部380可包括可为平坦并基本平行于彼此的第一侧向侧壁382和第二侧向侧壁384(图17)。第一和第二侧向侧壁382和384可进一步限定分别形成为从中通过的铰链通道388。
第一和第二侧向侧壁382和382的前部可通过髁间部380的前表面390(图15)连接。在一个示例中,髁间部380的前表面390可相对于髁间部380的上表面沿向下方向向前倾斜约60度。向上延伸部分392可形成在股骨部件316上并从上表面394(图16A)大致延伸。向上延伸部分392可包括大致圆柱形主体并限定凹形渐缩接纳部分394。
铰链立柱396可紧固地延伸通过股骨部件316的第一和第二侧向侧壁382和384的相应的铰链通道388,并通过支承314中的通道372。值得注意的是,股骨部件316的侧向侧壁382和384可被定位为邻近相应的第一和第二髁340和342的内侧部分。通过这种方式,在侧向侧壁382和384的外侧区域不必损耗宿主骨。可以理解的是,在使用期间,股骨部件316可围绕铰链销396旋转。
参见图17-20,组装股骨部件和支承的示例性顺序被示出。图17示出相应的股骨部件310、铰链销396和支承314的分解视图。如图18所示,股骨部件310被放置到支承314上,以使相应的通道372和388对准。图19-20示出插入到通道372和388中的铰链销296。
现在参见图21-25,将详细阐释与上述任何膝关节假体一同使用的多个示例性增强部。图21-23B示出第一对增强部400和402。第一增强部400可大致限定具有第一端406和第二端408的主体404。主体404可进一步限定在第二端408的半径一致部分410和接近第一端406的向外渐缩径向延伸部分412。半径一致部分410可限定形成为贯穿其中的渐缩接纳孔416。接纳孔416可从第一端406向第二端408渐缩。第一台阶420可形成在主体404中分别在半径一致和径向延伸部分410和412之间。可以理解的是,可提供具有适于具体病人的各种尺寸和结构的第一增强部的集合。
第二增强部402大致限定具有第一端426和第二端428的主体424。主体424可进一步限定在第一端426的半径一致部分430和接近第二端428的向外渐缩径向延伸部分432。半径一致部分430可限定形成为贯穿其中的渐缩接纳孔436。接纳孔436可从第一端426向第二端428渐缩。第二台阶440可形成在第二端428处分别在半径一致和径向延伸部分430和432之间。可以理解的是,可提供具有适于具体病人的各种尺寸和结构的第一增强部的集合。
如下文将要详细所述,第一和第二增强部400和402可单独使用或组合使用。如图23B所示,当同时与上述任何胫骨和股骨部件使用时,第一和第二增强部400和402可在第一和第二台阶420和440处互锁或配合。
现在参见图24和25,第三增强部450被示出。第三增强部450可大致限定具有第一端454和第二端456的主体452。主体452可进一步限定从其径向延伸的一对翼部460,以向股骨部件或胫骨部件提供旋转稳定性。在一个示例中,翼部460可朝向第一端454偏移。主体452可限定形成为贯穿其中的渐缩接纳孔464。接纳孔464可从第二端456向第一端454渐缩。
根据本公开内容的教示,各个增强部400、402和450的接纳孔416、436和464可被滑动地压配合到上述任何胫骨托盘的下延伸部上。更具体地,接纳孔可限定与胫骨托盘的下延伸部的渐缩增强部接纳表面的渐缩互锁部。类似地,任何相同的增强部也可滑动地压配合到上述任何股骨部件的上延伸部上。更具体地,接纳孔可限定与股骨部件的上延伸部的渐缩增强部接纳表面的渐缩互锁部。这样,相应的渐缩表面可协作以形成莫尔斯锥度。
为了示出该兼容性,第二增强部402被示出为紧固到股骨部件112的上延伸部130(图26)。如果外科医生希望产生另外的骨损耗,则第一增强部400也可被推进到股骨部件112的上延伸部130上(图27和29)。如所示,相应的第一和第二台阶420和440协作以配合或形成互锁。
参见图29,第一和第二增强部400和402被示出为紧固到胫骨托盘22的下延伸部28。需注意的是,第一和第二增强部400和402可与或不与适配器一同使用。可以理解的是,任何增强部可与或不与上述适配器组件一同使用。
现在转到图31和32,另一胫骨部件522被示出。胫骨部件522可限定形成在下表面上的一个或多个(例如一对)盲孔524和至少一个开口526。诸如袋部530等凹部也可选择性地形成在胫骨部件522的下表面上。增强部540可限定一个或多个(例如一对)互补定位钉542和至少一个互补开口544。增强部540可适于紧固到胫骨部件522的下表面以抵偿骨损耗。可以理解的是,增强部可被提供在胫骨部件522的外部和内部之一或这二者上。在组装期间,定位钉542可套在盲孔524内。紧固件(未示出)可被插入通过相应的开口526和544。具有至少一个钉542’的另一增强部540’可被提供用于胫骨部件522的下表面的内部和外部的对面。在另一示例(图32)中,提供适于连接到内部或外部的增强部540”。在这种示例中,不必提供钉(例如钉542,图31)。可以理解的是,可提供具有各种厚度的多个增强部540,使得外科医生可组装适于特定病人的特定增强部。柄部20可被固定地接受到托盘的凹形渐缩延伸部分560中。
图33示出另一增强部590,其限定形成为贯穿其中的渐缩接纳孔592。渐缩接纳孔592可被滑动地压配合到以上所述的任何胫骨托盘的下延伸部和/或股骨部件的上延伸部。增强部590的一部分可选择性地由多孔金属594形成。多孔金属594可包括例如多孔钛合金。增强部590可限定内部固体金属套筒部分和外部多孔金属套筒部分594。再次,根据本教示,相应的股骨部件、胫骨部件、支承和/或增强部可为一套用具的一部分,其中外科医生可在进行外科手术时选择具体病人所需的预期部件或多个部件。
现在转到图34-36B,模块胫骨部件22(如以上参照图1-3A所述)被示出为与根据另外特征的适配器组件600协作。适配器组件600可与柄部20协作。根据将在以下更为全面详细论述的方式,适配器组件600可连接托盘22和柄部20,以在横平面或冠状平面中或者任何其它平面中提供对柄部20的偏移。进一步阐释的是,当柄部20通过第一适配器组件600附接到托盘22时,柄部20的中心轴线25可从托盘22的向下延伸部分28的中心轴线27偏移。在所示实施例中,适配器组件600可提供约5mm的第一偏移。可以理解的是,偏移可从0mm到约5mm或更大,且能沿相对于中心轴线27的任何旋转方向。换言之,偏移轴线25可相对于中心轴线27旋转360度,以向外科医生提供各种进行外科手术时的选择,从而根据病人需求进行选择。可替换地,适配器组件600或柄部20可被旋转连接,以仅提供有限的调节范围,例如仅提供单一偏移或两个偏移位置。
继续参见图34-36D并另外参见图37-39B,适配器组件600可大致包括适配器主体604和锁定构件或元件606。适配器组件600的适配器主体604可限定凸形渐缩插入部分608和凹形渐缩接纳部分610。凸形渐缩插入部分608可限定螺纹孔611。凹形渐缩接纳部分610可形成在适配器主体604的偏移主体部分612中,以接纳柄部20的凸形渐缩插入部分58。适配器主体604可限定位于外表面上的平坦部614以夹紧并便于对准,如下文所述。类似于形成在图2所示的适配器主体44上的裙部54的裙部(未示出)可被限定在凸形渐缩插入部分608与偏移主体部分612之间的过渡部。非裙部过渡不可替换地如在此所示地形成。孔614可被限定为从适配器主体604的外表面到凹形渐缩接纳部分610。孔614可限定螺纹616,该螺纹616螺纹接纳锁定构件606。
参见图37,适配器主体604的凸形渐缩插入部分608限定第一轴线A5,凹形渐缩接纳部分610限定第二轴线A6。进一步,在所示实施例中,第一轴线A5和第二轴线A6平行于彼此并分隔开以提供预期偏移。就此而言,可提供各自具有不同偏移的多个适配器,以根据病人需求向外科医生提供进行外科手术时的选择。在适配器主体604提供5mm偏移的范围内,第一和第二中心轴线A5和A6分隔开5mm。再次,适配器主体604可限定具有可替换偏移的轴线。在一个这种可替换结构中,适配器主体604’(图38)包括限定第一轴线A7的凸形渐缩插入部分608’和限定第二轴线A8的凹形渐缩接纳部分610’。适配器主体604’可限定2.5mm的偏移。
凸形渐缩插入部分608随其远离适配器主体604延伸而稍微渐缩。凹形渐缩接纳部分610类似地随其从适配器主体604的一端延伸到适配器主体604中而稍微渐缩。根据以下论述可以理解的是,各种凸形渐缩插入部分(例如部分608)可插入到各种凹形渐缩接纳部分(例如部分610)中以形成锁定锥度或莫尔斯锥度。按照以下进一步描述的方式,锁定构件606可延伸到孔614中,在该位置最终接合紧固插件620。
紧固插件620可包括远侧部分622,其可具有外螺纹以接合柄部20的凸形渐缩插入部分58的内螺纹孔72。紧固插件620可进一步包括中心部分624和近侧部分626。近侧部分626可限定锥形接合头部630。夹紧零件632(例如但不限于用于接纳方孔螺钉头用扳手的六角孔)可形成在近侧部分626的上表面中。如将更为详细所述,紧固插件620或更具体地锥形接合头部630可由第一生物兼容材料形成,而锁定构件606可由第二生物兼容材料形成。第二生物兼容材料可以是比第一生物兼容材料硬度更大(更硬)的材料。
现在转到图36C和36D,根据另外特征的胫骨托盘636被示出。如将更为全面在此所述,胫骨托盘636可为储骨铰链膝假体(图48A)的一部分。胫骨托盘636可限定向上延伸支脚637和向下延伸部分638,该向下延伸部分638限定凹形渐缩接纳部分640。向下延伸部分638可限定外渐缩增强部接纳表面642。胫骨托盘636可限定形成为通过胫骨托盘636的托盘部分的螺纹通道646。螺纹通道646可适于螺纹接受锁定构件606。不同于提供用于沿向上/向下方向接纳紧固件90’的中心孔32的十字固定胫骨托盘22(图34),胫骨托盘636可提供用于沿向前/向后方向接纳锁定构件606的螺纹通道646。
现在参见图39A-40B,将描述组装胫骨托盘636、适配器主体604和柄部20的示例性顺序。首先,紧固插件620可被拧到螺纹孔611中。在一个示例中,紧固插件620可被螺纹旋紧,直到中心部分624接合适配器主体604的凸形渐缩插入部分608的终端表面650。就此而言,柄部20可被连接到适配器主体,或者适配器主体604可被连接到胫骨托盘636。同时该顺序可被颠倒,通过将适配器主体604的凸形渐缩插入部分608插入到胫骨托盘636的凹形渐缩接纳部分640中,适配器主体604可被连接到胫骨托盘636。外科医生然后可在凹形渐缩接纳部分640内旋转凸形渐缩插入部分608以到达预期方位。如将稍后所述,本公开内容提供各种工具,用于在将适配器主体604相对于胫骨托盘636固定在固定位置之前验证适配器主体604的正确方位。一旦到达预期方位,锁定构件606可从非紧固位置(图36C)拧入而与锥形接合头部630接合到达紧固位置(图36D)。
如上所述,锁定构件606可由比紧固插件620更硬的生物兼容材料形成。结果,锁定构件606的远端654可使锥形接合头部630的分界区域变形(例如,在该处形成凹陷)。变形后的区域由附图标记656表示(图39A和40B)。通过使紧固插件620的区域656变形,锁定构件606的锁定功能可通过提供较大的抗分离性而提高。进一步阐释的是,由此形成的凹陷可阻止锁定构件606与紧固插件620之间的滑动、旋转或其它相对运动。
接下来,柄部20可通过驱使锁定构件606(即,另一相同的锁定构件606)至紧固插件620(即,另一相同的紧固插件620)中而连接到适配器主体604。
根据另一特征,由孔614限定的螺纹616可限定螺纹牙形,其略不同于(即,节距)由锁定构件606限定的螺纹662。可替换地,螺纹616或662之一可初始变形。这种关系可在外科医生初始处理时使锁定构件606保持在孔614内。换言之,锁定构件606能已经被定位在孔内而使得外科医生不必将锁定构件606的远侧末端654定位到孔616中(即,配合两个分立部件)。可以理解的是,这种螺纹结构不会防止锁定构件606在紧固期间在孔616内旋转。
现在转到图41A,包括适配器主体604和锁定构件606的适配器组件600被示出为与股骨部件112’组装在一起。股骨部件112’基本类似于股骨部件112(图8),但可限定形成在股骨箱体670中的螺纹孔668。可以理解的是,螺纹孔668可提供类似于适配器主体604的孔614的螺纹616的功能。结果,锁定构件606可被驱使为接合紧固插件620的锥形接合头部630。
如图41B所示,裙部54”被示出为位于适配器主体604上。裙部54”大致限定喇叭形轮廓部分,其可提供到增强部402的向外渐缩径向延伸部分432(也见图21)的大致平滑的几何过渡部。裙部54”与增强部402之间的几何过渡部可减少植入部件之间的尖锐过渡,以在植入位置向有利的嵌套结构提供环绕骨。更具体地阐释,适配器604的凸形渐缩插入部分608可限定附接轴线671。主体424的向外渐缩径向延伸部分432可限定平面673。裙部54”的喇叭形轮廓部分在植入位置可大致沿平面673渐缩。裙部54”因而与增强部402协作以有效填充骨隙。
现在可以理解的是,本公开内容提供一组简化的互换部件,其中适配器组件600可用在关节线的任一侧上(例如,与诸如关于图35描述的胫骨部件以及诸如关于图41描述的股骨部件一起)。而且,锁定构件606和紧固插件620的组合可使用在如上所述的许多不同区域中。另外,诸如图21-25公开的增强部可与股骨部件的向上延伸部分(例如部分130,图8)或胫骨部件的向下延伸部分(例如部分638,图36C)协作使用。
现在转到图42-49,将更为详细地描述可与胫骨托盘636协作使用的另外的部件。如所述,胫骨托盘636可用作储骨铰链膝假体的一部分。胫骨托盘636可与支承672协作。龙骨680可限定用于接纳向上延伸支脚637的第一孔682和用于接纳轮轴686的第二孔684。一对毂688可接合轮轴686的相对端部。在一个示例中,偏压构件687可偏压龙骨680上的外表面以向外偏压轮轴686。
通过沿向内方向压下轮轴686并将龙骨680大致定位到股骨部件692的股骨箱体696中,直到轮轴686与形成在股骨箱体中的通道695和697对准,龙骨680可在进行外科手术时被连接到股骨部件692。毂688可在轮轴686的相对端部套在通道695和697中。轮轴686可向外偏压,促使毂688位于通道695和697中。可以理解的是,在使用期间,毂688可提供用于支撑轮轴686的旋转表面。毂688可由任何适当的支承材料形成,例如PEEK、聚乙烯、碳增强PEEK。销700然后可被插入龙骨680以阻止轮轴686的向内压缩。
制动部690可被设置在龙骨680和股骨部件692的中间。股骨部件692可限定通过箱体696的螺纹孔694。向上延伸部分698可接纳适配器主体604的凸形渐缩插入部分608。锁定构件606可如上所述用于接合从凸形插入部分608凸出延伸的紧固插件620(未具体示出)。可替换地,紧固件可向上延伸通过股骨部件692,以与适配器主体604(例如如图8所示)紧固配合。马蹄形夹具702可紧固地套在限定在支脚637上的环形袋部704中。
现在参见图50-54,另外的增强部被示出。增强部710可限定基本对称的外形,以紧固到胫骨托盘(即,例如胫骨托盘22D,图3D)的内部或外下部。通道712可形成通过增强部710,用于在组装位置接纳紧固件(未示出)。增强部716和718可限定通道720和722,分别用于接纳股骨部件730(见图58)的向上延伸部分724。增强部716和718可限定与股骨箱体732的内部或外部协作的独特外形。增强部716可被植入以在股骨部件730的中侧占据骨损耗区域。增强部718可被植入以在股骨部件的侧部占据骨损耗区域。增强部734和736可分别限定通道738和740(图59)。增强部734和736可单独使用或组合使用。股骨部件730的相应通道720、722、738和740与向上延伸部分724可限定锥形接合表面,其适于提供由莫尔斯型锥度形成的摩擦配合。增强部734和736可限定不同于增强部716和718的外形。
现在回到图53,另一增强部744被示出。增强部744可限定通道746。在一个示例中,增强部744可为对称的,以连接到股骨部件730的内侧面或外侧面。螺纹盲孔750和752可被限定在股骨部件730上,以接受用于紧固增强部744的紧固件(未示出)。可提供另一增强部744’(其可具有相对于增强部744的镜像外形),以仅与股骨部件的内侧(或外侧)兼容。
参见图54和57,具有中心通道756的鞍囊形增强部754被示出。中心通道756可接纳股骨部件730的向上延伸部分724。与在此提供的其它增强部相同,中心通道756和向上延伸部分724可限定锥形接合表面,其被适于提供由莫尔斯型锥度形成的摩擦配合。图60示出股骨部件730,其具有紧固到向上延伸部分724的翼形增强部450(图24)。
本文公开的各个增强部可由诸如固体金属、多孔金属或固定金属和多孔金属的组合等生物兼容材料形成。在一个示例中,固体金属或多孔金属可包括不锈钢、钛、钛合金、钴铬合金和其它适于使用在生物兼容环境中的材料。本领域众所周知的是,多孔金属可提供促进天然骨和/或软组织向内生长的适当表面积。制备这种多孔金属的各种组分和方法可在以下共同未决申请中找到:于2005年4月21日递交的美国申请11/111,123、于2005年12月5日递交的美国申请11/294,692、于2006年2月17日递交的美国申请11/357,868,其名称均为“用于多孔植入物的方法和装置”;于2006年10月11日递交的名称为“用于多孔植入物的方法”的美国申请11/546,500;于2007年2月22日递交的名称为“具有钴支承面的多孔金属杯”的美国申请11/709,549;以及于2006年2月17日递交的名称为“用于形成多孔植入物的方法和装置”的美国申请11/357,929,所有这些申请也被转让给印第安纳州华沙省的Biomet公司,其通过引用并入于此。
图55A示出一套部件760。该套部件可如本文所述互换使用。柄部可限定各种长度和直径。适配器可限定各种偏移。图55B示出这种互换性。例如,外科医生可在进行外科手术时选择预期的股骨部件A、胫骨部件B、支承C以及增强部D和偏移适配器E。尽管未示出,但适当的柄部(例如柄部20)也可如本文所述被连接到偏移适配器E。
如本文所述,渐缩凹形接纳部分被描述为通过压配合接纳渐缩凸形插入部分。进一步阐释,凹形接纳部分和凸形插入部分都限定锥形接合表面,其适于提供由莫尔斯型锥度形成的摩擦配合。
现在参见图61-77,根据本教示的用于植入股骨部件和偏移适配器的示例性工具被示出。远侧切除切割导承800(图61)可包括远侧切除块802和可移除的支架部分804,该支架部分804具有一对表盘806、808以选择预期方位(即,外翻角等)。远侧切除块802可限定共同由附图标记810表示的+0、+4、+8和+12mm的切除狭槽以进行远侧切除。在一个示例中,+0狭槽作为清理切割可从最突出的髁切除。也可考虑其它结构。如果存在缺陷,则+4、+8或+12mm的狭槽可用于稍后与相应的4、8或12mm的远侧扩展块一同使用。
远测切割块812(图62A-62D)可限定侧向前、后狭槽822和824以及前、后倒角狭槽826和828。远侧切割块812在本文可被称为“切割”块。第一和第二部分重叠孔830和832可被限定通过远侧切割块812的中心部分834。可以理解的是,孔830和832之一可被对准供右股骨使用,而另一个可被对准供左股骨使用。标记836、837可被限定为与相应的孔830、832相邻。可旋转偏移衬套838(图66)可被选择性地接纳在重叠的孔830和832的任一个内。偏移衬套838可限定偏移通道840和记号842。偏移通道840可相对于偏移衬套838的纵向轴线侧向偏移。可提供多个偏移衬套(例如偏移衬套838’,图67),其提供适于病人需求范围内的各种偏移。在所示示例中,偏移衬套838可提供5mm的偏移,偏移衬套838’可提供2.5mm的偏移。衬套838”(图68)可具有零偏移。增强部试验部844(图63A)可被选择性地紧固到远侧切割块812的内侧面868(图62B)。增强部试验部844可限定一系列棘爪870,用于选择性地围绕紧固件872抓紧(图64A和64B)。该系列棘爪870可将增强部试验部844定位在预期位置。
股骨偏移样板876(图70A和70B)可限定多个孔880,用于将紧固件872和增强部试验部844定位在各个位置。在一个示例中,偏移样板可只有左股骨(例如,图70A和70B)或右股骨(例如,样板876’,图71)才有。通用修正对准构件882(图69)可限定用于接纳衬套838(或838’)的袋部884。标记886可被限定在袋部884上以与记号842对准。胫骨样板890(图78)可被提供为在胫骨制备期间使用。胫骨样板890的另外说明可在于2003年11月6日递交的名称为“胫骨制备装置和方法”的共同所有专利申请10/702,335中找到,其公开内容通过引用并入于此。胫骨样板890可与增强部切割块892协作。植入物凸台铰刀导向套896(图76)可被提供为接纳在对准构件882的袋部884中。值得注意的是,通用修正对准构件882、偏移衬套838和铰刀导向套896都可与股骨偏移样板876或胫骨样板890一同使用。
胫骨衬套止挡900(图77)可被提供为定位在铰刀导向套896与扩孔钻头904的轴环902(图65)之间。胫骨衬套止挡900可用于限制当铰除胫骨孔时在胫骨管中的铰孔深度。可以理解的是,铰孔胫骨管的深度可比铰孔股骨管的深度浅。偏移适配器锉刀衬套910(图74)可限定半月形通道912。半月形通道912可限定平坦部914。偏移适配器锉刀衬套910可与通用修正对准构件882的袋部884协作(在股骨或胫骨偏移孔的制备期间)。偏移适配器锉刀衬套910可限定记号918,用于与袋部884上的标记886对准。如下文所述,偏移适配器锉刀衬套910可被旋转为拨调到预期方位,该预期方位对应于适配器主体604(图34)的预期偏移方位。另一偏移适配器锉刀衬套710’(图75)可限定另一偏移。
锉刀922(图72A和72B)可限定位于远端926上的冲击部分924和位于近端932上的把手930。平坦表面934可沿冲击部分924限定。平坦表面934可与偏移适配器锉刀衬套910的平坦部914协作,以将锉刀922定位在预期方位。
后稳定箱体导承940或942(图80A和80B)可被提供用于制备后稳定股骨。狭槽944、946可被限定通过后稳定箱体导承940和942,分别用于在指定位置引导切割构件。后稳定箱体导承940可限定通道950,其采用以上所述的类似方式接受增强部试验部844。
现在将描述制备用于接受具有偏移适配器的股骨部件的股骨F的示例性顺序。首先,远侧股骨F可被露出,且股骨(髓内)管954可使用铰刀956铰除,直到实现皮层接触(图81)。接下来,远侧切割导承810可被紧固到远侧股骨F并使用表盘806、808被对准到预期方位。支架部分804然后可从块802上移除,从而将远侧切除块802留在前骨上。铰刀956可被留在骨F中。在避免铰刀956的同时,通过所选狭槽810的远侧切除可使用锯片960进行。远侧切割导承810可被移除并留在铰刀956(图83B)中。
如果需要远侧增强部切割,则增强部试验部844(或多个试验部)然后可扣到切割块812的后侧(图83C)。接下来,偏移衬套838可被插入到切割块812的适当的重叠孔830中。切割块812然后被插在铰刀轴956上方,使得铰刀轴956定位通过偏移衬套838的偏移孔840(图84)。偏移衬套838然后旋转(由此使切割块812围绕远侧股骨F平移),直到到达切割块812的预期位置。延伸通过切割块812中的前部通道960的螺栓(未示出)然后可被旋紧,以防止偏移衬套838的进一步运动。切割块812然后可例如通过将钉子962驱使通过提供在切割块812上的孔964而被紧固到远侧股骨F。对准号码(即,对应于标记836的记号842)被记录。偏移衬套838然后可被移除。前、后骨可使用锯片966(图85)切除,接着前、后倒角切割。
切割块812然后可从远侧股骨F上移除,并将铰刀956留在适当位置(图86)。增强部试验部844然后可使用希望的孔880被连接到股骨偏移样板876的后侧。接下来,通用修正对准构件882可被连接到股骨样板876的顶侧(图88)。偏移衬套838可被插入到袋部884中。扩孔钻头904可被插入通过偏移衬套838中的通道804,且组件可掉落到远侧股骨F上。偏移衬套838然后可被旋转到从上方记录的对准号码842。股骨偏移样板876可被紧固到远侧股骨F。偏移衬套838然后可从袋部884上移除。植入物凸台铰刀导向套896然后可被插入到袋部884中(图89)。扩孔钻头904可被引导通过植入物凸台铰刀导向套896,以铰除植入物凸台969(图90和92)。
植入物凸台铰刀导向套896然后可从袋部884上移除并转出偏移适配器锉刀衬套910。旋转方位可被验证(即,匹配以上记录的对准号码)。锉刀922可被穿过(即,重复地)偏移适配器锉刀衬套910的半月形通道912(以形成偏移孔部分970)。再次,偏移适配器锉刀衬套910对准锉刀922以在股骨孔内制备偏移通道。偏移通道可基本对应于偏移适配器(见叠加部件,图93)的外形(和旋转方位)。
如果希望,后稳定箱体导承740(图94A和94B)可用于在初始制备股骨时形成PS箱体,这是本领域众所周知的。
现在将描述制备用于接受具有偏移适配器的胫骨部件的胫骨T的示例性顺序。首先,近侧股骨T可被露出并切除。胫骨(髓内)管980可使用铰刀956被铰除。
接下来,通用修正对准构件882可被连接到胫骨样板890的顶侧。偏移衬套838可被插入到通用修正对准构件882的袋部884中。铰刀轴956可被插入通过偏移衬套838中的通道840,且组件可掉落到近侧股骨T上(图96)。偏移衬套838然后可旋转,从而使胫骨样板890围绕近侧胫骨T平移,直到实现最佳胫骨覆盖。胫骨样板890然后被紧固到近侧胫骨T。对准号码被记录。
如果需要近侧增强部切割,则具有增强部切割块892的胫骨样板890可被紧固到近侧胫骨T。近侧胫骨T然后可被切割,例如在近侧胫骨T上形成切口982(图98B)。试验部增强部984然后可被插到胫骨样板890的底表面上。
接下来,植入物凸台铰刀导向套896然后可被插入袋部884。胫骨衬套止挡900然后可被定位在扩孔钻头904的轴环902与植入物凸台铰刀导向套896之间(以限制切割深度)。扩孔钻头904可被引导通过植入物凸台铰刀导向套896以铰除植入物凸台(图101)。植入物凸台铰刀导向套896和胫骨衬套台阶900然后可从袋部884上移除并转出偏移适配器锉刀衬套910。旋转方位可被验证(即,以匹配以上记录的对准号码)。锉刀922可被穿过(即,重复地)偏移适配器锉刀衬套910的半月形通道912以形成偏移孔部分。再次,偏移适配器锉刀衬套910对准锉刀922以在胫骨孔内制备偏移通道(图104)。偏移通道可基本对应于偏移适配器主体604的外形(和旋转方位)。
参见图105,用于使偏移适配器主体604与植入物的接纳部分(即,胫骨部件或股骨部件的凹形渐缩接纳部分)旋转对准的装置1000被示出。在图105所示的示例中,装置1000被示出为紧固胫骨部件22,但可以理解的是,该装置也可紧固股骨部件(例如本文所公开的任何股骨部件)。装置1000可大致限定外框架1002,该外框架1002在其上限定刻度记号1004。多个臂1006可移除地紧固到外框架1002上。对应的多个指针1010可被限定在臂1006的远端上。一旦多个臂1006和指针1010被定位为紧固地保持植入物(即,托盘22),则臂1006和指针1010可被锁定在适当位置。在一个示例中,植入物(即,托盘22)可被紧固在已知位置。在所示示例中,已知位置可以使胫骨托盘22被定位为前部与记号1004对准(即,在记号号码“60”)。指示器1016可被安装为围绕外框架1002旋转。
记号1004相对于偏移衬套838上的记号842处于已知的位置。指示器然后可围绕表盘1004旋转,以对应于用偏移衬套838所拨取的记录号码。接下来,标记1020(见图106)可与指示器1016对准并落入胫骨托盘22的凹形渐缩接纳部分30。如详细所述的莫尔斯型锥度交界面可将适配器主体604相对于托盘22紧固,直到附加机械紧固(例如紧固件90’,图34,或锁定元件606,图36D)。
用于将偏移适配器主体604与植入物的接纳部分(即,胫骨部件或股骨部件的凹形渐缩接纳部分)旋转对准的另一装置1026示于图106中。装置1026可包括如上所述的表盘1002、臂1006和指针1010(或任何适当的紧固装置)。表盘1030可旋转地悬挂再胫骨托盘22上方。在一个示例中,表盘1030可在延伸在表盘1002上方的晕圈1032内旋转。表盘1030可限定标记1036和锁眼1040。该锁眼可对应于足印,该足印滑动地接受适配器主体604的平坦部613,使得适配器主体旋转地固定在锁眼1040中。表盘1030可被旋转,直到标记1036与用偏移衬套838所拨取的记录号码对准。适配器然后可掉落通过锁眼1040,并掉落到胫骨托盘22的凹形渐缩接纳部分30中。如详细所述的莫尔斯型锥度交界面可将适配器主体604相对于托盘22紧固,直到附加机械紧固(例如紧固件90’,图34,或锁定元件606,图36D)。
用于将偏移适配器主体604与植入物的接纳部分(即,胫骨部件或股骨部件的凹形渐缩接纳部分)旋转对准的另一装置1040示于图107中。该装置可包括泡罩包装(blister package)1042。泡罩包装1042可限定袋部1044,该袋部1044限定基本对应于植入物(例如本文所述的任何股骨或胫骨部件)足印的轮廓。在所示示例中,胫骨托盘22嵌套在袋部1044内的紧固位置。可丢弃表盘1048可松动地提供在泡罩包装1042内。可替换地,泡罩包装或可移除顶部的密封件可用作表盘1048并具有印刷在顶部内侧上的记号1052。可丢弃表盘1048或顶部可限定穿孔1050和刻度记号1052。可丢弃表盘1048可掉落到包装的植入物的渐缩延伸部分(胫骨托盘22的向下延伸部分28,如所示)上方,使得渐缩延伸部分穿过穿孔1050。表盘1048然后可旋转,直到标记1020与记号1052的号码对准,该号码与用偏移衬套838所拨取的记住的号码对应。适配器604然后可掉落到胫骨托盘22的凹形渐缩接纳部分30中。如详细所述的莫尔斯型锥度交界面可将适配器主体604相对于托盘22紧固,直到附加机械紧固(例如紧固件90’,图34,或锁定元件606,图36D)。
参见图108-119,将描述用于在置换外科手术期间制备胫骨的另一示例性方法。本领域技术人员可以理解的是,利用修正外科手术,现有的(即先前植入的)胫骨部件(例如,胫骨托盘、支承等)从胫骨上移除。工具1090的系统或套件示于图108中。如图109A所示,胫骨间隔器组件1000被示出。在图示示例中,胫骨间隔器1102a、1102b、1102c、1102d、1102e、1102f、1102g和1102h被提供。胫骨间隔器1102a具有10mm的厚度。其余的胫骨间隔器1102b-1102h各自具有2mm的厚度。胫骨间隔器组件1100可根据所需被堆叠以实现预期高度。给定堆叠的胫骨间隔器1102a-1102h(或者只是胫骨间隔器1102a单独使用)的厚度代表将被植入在近侧胫骨处的胫骨支承的预期厚度。在所提供的示例中,胫骨间隔器1102b可被堆叠到胫骨间隔器1102a上以共同限定12mm的厚度。可以理解的是,胫骨间隔器1102c-1102h可依次堆叠以实现另外的2mm的增量。胫骨间隔器1102c代表(例如,胫骨间隔器1102c、胫骨间隔器1102b和胫骨间隔器1102a的累计厚度)14mm的厚度。胫骨间隔器1102d代表16mm的厚度,胫骨间隔器1102e代表18mm的厚度。胫骨间隔器1102f代表20mm的厚度。间隔器1102g代表22mm的厚度。间隔器1102h代表24mm的厚度。在其它实施例中,可采用组件1100和各个间隔器1102a-1102h的其它厚度。如所示,相应的间隔器1102a-1102h可各自包括共同由附图标记1104表示的胫骨平台部分和共同由附图标记1106表示的把手部分。各个胫骨间隔器1102a-1102h通过紧固件1108被旋转地连接在终端。相应的胫骨间隔器1102a-1102h可各自围绕紧固件1108枢轴地旋转,以将预期胫骨间隔器1102a-1102h与间隔器1102a-1102h中的其余部分隔离。可以理解的是,尽管相应的胫骨间隔器1102a-1102h被示出为通过紧固件1108彼此附接,但它们可替换地为不附接的分立件。
胫骨间隔器组件1100可用于使用解剖界标找到胫骨T的关节线。更具体地,给定胫骨间隔器1102a-1102h的胫骨平台部分1104可放置在胫骨T的胫骨平台的顶上或者胫骨的切除近端的顶上。换言之,主胫骨被移除,且所选间隔器1102a-1102h被放置在先前切除的近侧胫骨上。在图示实施例中,间隔器1102a-1102h为通用的,且能适应左或右胫骨。适当的关节线将在合适厚度的间隔器1102a-1102h被放置在胫骨平台上并代表相对于解剖界标的预期高度(即,从胫骨平台向上)时被确认。此时,可确定选择的补充增强部(即,例如如图55A和55B所示的增强部)的厚度。可以理解的是,可能需要在胫骨的内侧和外侧的任何组合上提供补充增强部。一旦识别的间隔器1102a-1102h的预期厚度和增强部需求被确认和记录,则知晓相对于胫骨的关节线。间隔器组件1100然后从胫骨上移除。
一旦关节线相对于胫骨被确定,则髓内(IM)铰刀止挡1120(图110A)可被连接到铰刀1122。铰刀1122可与IM铰刀止挡1120协作以制备胫骨的IM管。在使用期间,铰刀122能够在IM管中铰除一定距离,直到铰刀止挡1120与近侧胫骨接触。
现在将参见图110A和110B更为详细地描述IM铰刀止挡1120和铰刀1122。IM铰刀止挡1120具有上表面1126、下表面1128,并限定从上表面1126延伸通过IM铰刀止挡1120到下表面1128的开口1130。指状支撑部1132可被支撑在IM铰刀止挡1120的上表面1126上。按钮1133可被连接到定位指1134。定位指1134可移动地固定到指状支撑部1132。在一个示例中,定位指1134可沿基本横切于由铰刀1122限定轴线的轴线移动(例如,通过按钮1133的下压)。在一个示例中,偏压构件1136(例如图示实施例中的弹簧)可将定位指1134偏压为与铰刀1122接合。
铰刀1122可限定铰刀轴1140,该铰刀轴1140具有形成在其上由附图标记1142共同表示的多个环形槽。可以理解的是,槽1142为定位指1134提供嵌套位置,以控制铰刀1122的铰除深度。根据一个示例,槽1142可用记号标记(未具体示出),该记号识别针对胫骨的各种铰除深度(从以下论述中可以理解的是,铰刀1122和IM铰刀止挡1120也可用于制备股骨中的IM管)。这样,槽1142也可对应于股骨中的各种铰除深度。出于示例目的,槽1142可对应于40mm、80mm、200mm和其它铰除深度,以对应于预期柄部长度。可以理解的是,各种切割深度可对应于胫骨柄部的各种深度,例如图29A所示的胫骨柄部20或图55A所示的任何胫骨柄部。还可以理解的是,在一些情况下,可能需要植入偏移适配器,例如图35所示的偏移适配器600或者任何其它本文所述的偏移适配器,例如图55A和55B所示的偏移适配器。在偏移适配器需要与柄部结合的示例中,槽1142将对应于不同柄部长度。例如,如果使用40mm的偏移适配器,则对应于80mm的胫骨柄部的槽将也对应于具有40mm的胫骨偏移适配器的40mm的胫骨柄部。本领域技术人员可以理解的是,本文所描述的尺寸仅仅是示例性的。通过这种方式,槽可沿铰刀1122被提供在任何结构的组合中,以识别能够适应本文所述的柄部和/或偏移适配器的任何组合的铰除深度。
在使用期间,例如图111所示的示例,具有不同直径的各种铰刀1122可被使用,直到在胫骨T中获得适当的皮层接触。可提供多个IM铰刀止挡1120,其各自被操作性地连接到具有不同直径的铰刀1122。通过这种方式,当转换到具有较大直径的铰刀时,外科医生可简单地移除铰刀1122和IM铰刀止挡1120的组合,并利用另一套组的铰刀和IM铰刀止挡。可以理解的是,这可将从IM铰刀止挡1120中的开口1130移除铰刀1122并将其更换为具有另一直径的铰刀可能需要的时间最小化。
一旦胫骨的IM管被充分制备,如图111所示,则IM铰刀止挡1120可从铰刀1122上移除。铰刀1122保留在IM管中。就此而言,铰刀1122由胫骨T的骨皮质紧固地保持在固定位置。接下来,如图112A所示,IM胫骨切除导承1144可滑动略过铰刀1122。IM胫骨切除导承1144可大致包括主体1146、调节臂1148、阻挡臂1150和触针或指部1152。主体1146可包括切除水平调节旋钮1156。调节臂1148包括毂1160,该毂1160具有贯穿其中的通道1162。如所示,通道1162可滑动地接纳铰刀1122的铰刀轴1140。联接器1164可调节地将调节臂1148紧固通过形成为穿过主体1146的狭槽1166。切除块1170然后可被紧固到阻挡臂1150。切除块1170可在内侧和外侧限定一系列狭槽1172。在各实施例中,拖柄部(未示出)可插入到髓内管中,以代替铰刀1122用作定位基准。
主体1146可沿调节臂1148调节,以使切除块1170紧靠胫骨T。切除水平调节旋钮1156可旋转,以将切除块1170放置在预期水平(即,相对于胫骨的近侧表面)。一旦到达切除块1170的预期位置,则切除块1170可被固定到胫骨(例如通过销1174)。其余的IM胫骨切除导承1144与铰刀1122一起可被移除。
现在将描述制备用于接纳5mm的内增强部和10mm的外增强部的近侧胫骨的示例性顺序。可以理解的是,可形成内、外切割,以容纳本文所述的任何胫骨增强部,例如但不限于增强部540和540’(图31)、增强部540”(图32)、增强部710(图50)或图55A和55B所示的任何其它增强部。IM胫骨切除导承1144的切除水平可通过将切除水平调节旋钮1156旋转到预期位置而设定。在一个示例中,切除水平调节旋钮1156的旋转可沿阻挡臂1150的纵向轴线在0到8mm的距离之间调节阻挡臂1150,这将切除块中的切割狭槽1172沿阻挡臂1150的纵向轴线方向从触针或指部1152的顶部移动特定距离。可以理解的是,切除水平调节旋钮1156可被配置为将阻挡臂1150调节到其它距离。进一步可以理解的是,可使用其它IM胫骨切除导承。一旦切除水平被设定,则清理切割在切除块1170的内侧上可通过狭槽1172的0狭槽形成。类似地,切割在切除块1170的外侧上可通过狭槽1172的5狭槽形成。在切割之后,同时使用切除块1170的示例性胫骨被示出在图113中。可以理解的是,以上所述的切割深度仅仅是示例性的。本领域技术人员可以理解的是,切割深度将形成为与上述的关节线一致,其可适应给定支承(即,例如本文所述的任何支承,包括14(图1)、214(图19)、314(图15)和672(图42))的厚度和给定增强部的厚度(如果需要的话)。一旦使用切除块1170制备了近侧胫骨,则切除块1170可从胫骨T上移除。铰刀1122然后可插入IM管。
现在将参见图108和114,铰刀1122的偏移位置将使用胫骨偏移定位组件1190确定。胫骨偏移定位组件1190可大致包括胫骨样板1192、胫骨对准构件1194和由附图标记1196共同表示的一系列定位套筒。胫骨样板1192可大致包括把手部分1200和胫骨外形部分1202(也见图108)。胫骨对准构件1194可大致包括主体1204,该主体1204限定孔1206(用于旋转地接纳定位套筒1196)和一对径向狭槽通道1210。主体1204可限定形成于其上的对准标志1212。定位套筒1196(图108)可包括中性定位套筒1198a(0偏移)、偏移套筒1198b(2.5mm的偏移)、偏移套筒1198c(5mm的偏移)和偏移套筒1198d(7.5mm的偏移)。定位套筒1196可各自限定通孔1220a、1220b、1220c和1220d,其分别从定位套筒1196的纵向轴线1222偏移一定距离。定位套筒1196包括由附图标记1124共同表示的记号。在图114所示的示例中,偏移套筒1198c被接纳在胫骨对准构件1194的孔1206中。胫骨对准构件1194可通过锁定机构1223被固定到胫骨样板1192。
就此而言,认识到只有铰刀1122相对于胫骨T固定是很重要的。定位套筒1196能够围绕其纵向轴线1222旋转,从而使胫骨对准构件1194(和胫骨样板1192)围绕近侧胫骨移动。定位套筒1196(例如由外科医生)围绕其纵向轴线1222旋转,直到获得胫骨外形部分1200在近侧胫骨T上方到达最佳覆盖的位置。在一些情况下,外科医生可能需要转出各种偏移套筒(例如其它定位套筒1196),以获得近侧胫骨的最佳可能覆盖。一旦预期近侧胫骨覆盖被验证,则胫骨样板1192例如通过销1199相对于胫骨T固定。就此而言,外科医生能够相对于胫骨对准构件1194上的标记1212记录记号1224。这将对应于胫骨偏移位置。在一些情况下,不需要偏移(即,最佳覆盖由0定位套筒1198a确认)。
一旦胫骨样板1192用销1198紧固到近侧胫骨T,则定位套筒1196可从对准构件1194上移除。铰刀1122也可在这里被移除。从由附图标记1230(图108)共同表示的组中选出的一个铰刀套筒然后可被定位到胫骨对准构件1194的孔1206中(图115)。集体铰刀套筒1230(图108)可包括中性铰刀套筒1232a(0mm偏移或中性偏移)、偏移铰刀套筒1232b(2.5mm的偏移)、偏移铰刀套筒1232c(5mm的偏移)和偏移铰刀套筒1232d(7.5mm的偏移)。铰刀套筒1230可各自分别限定通孔1233a、1233b、1233c和1233d。可以理解的是,每个偏移对应于从胫骨T的纵向轴线的径向偏移。每个铰刀套筒1230可对应于相应的定位套筒1196。通过这种方式,外科医生将选择具有与以上识别出的定位套筒1196类似偏移的偏移铰刀套筒1230。铰刀套筒1230可限定围绕其径向表面的记号1234和小面1235。外科医生然后旋转胫骨对准构件1194的孔1206内的偏移铰刀套筒1230,以将记号1234与胫骨对准构件1194的标记1212对准。辨别出外科医生旋转铰刀导向套1230以将铰刀导向套1230的共同记号1234与由定位套筒1196确定的相同记号1224(图114)对准是很重要的。一旦铰刀导向套1230被旋转到预期方位,则铰刀导向套1230可朝向胫骨对准构件1194前进,使得小面1235与一系列平坦部1238交界(在图108中只有一个平坦部被具体示为形成在胫骨对准构件1194上)。
现在转到图116A和116B,一旦偏移铰刀套筒1230被旋转到预期位置,铰刀1240被插入通过铰刀孔(即,1233c),且偏移空腔1242被铰除,以容纳植入物凸台(例如植入物凸台28,图34)和偏移适配器(例如适配器主体604,图34)。值得注意的是,如图116B所示,偏移铰刀套筒1230限定不平行的上平面1244和下平面1246。可以理解的是,可提供一系列偏移铰刀套筒1230,其具有以各种不同角度发散的各种上、下平面。可以理解的是,每个偏移铰刀导向套(例如1230)可对应于将容纳本文所公开的任何给定偏移适配器(例如适配器604,图35)的外形的铰除角度。如图117所示,空腔1242可容纳适配器主体。
在一些示例中,中性偏移衬套1232a可使用于不需要偏移适配器的情况。如最佳于图118A和118B中所示,中性偏移衬套1232a限定平行的上表面1252和下表面1254。铰刀1260可用于在近侧胫骨中铰除将容纳胫骨植入物凸台(例如附图标记28,图38)的开口。
在胫骨T必须被制备以接纳交叉增强部(例如图60所示的增强部450)的示例中,交叉增强部冲杆1262(图119)可穿过胫骨对准构件1194的孔1206。更具体地,冲杆1262可限定具有切割齿1264的翼形板,外科医生抓住带肋把手部分1266时,所述切割齿可穿过形成在胫骨对准构件1194上的狭槽通道1210。外科医生可重复地使冲杆1260轴向穿过胫骨对准构件1194,从而在近侧胫骨中形成互补通道,以接纳如图120所示的增强部450的翼形部分。
现在参见图121-140,将描述用于在修正外科手术中制备股骨的另一示例性方法。再次,可以理解的是,在修正外科手术中,可能需要以任何适当的方式移除先前植入的股骨部件。首先,IM铰刀止挡1120可在预期位置被连接到铰刀轴1140。铰刀1122可与IM铰刀止挡1120协作,以采用与以上关于制备胫骨的IM管(见图111和112)所述的类似方式制备股骨的IM管。同样,如上所述,槽1142可对应于股骨中的各种铰除深度。可以理解的是,各种铰除深度可对应于股骨柄部的各种长度,例如图26所示的股骨柄部20或图55A所示的任何股骨柄部。
与胫骨相同,在一些情况下,可能需要植入偏移适配器,例如图35的偏移适配器600或本文所公开的任何其它偏移适配器,例如图55A和55B所示的适配器。在需要偏移适配器与柄部结合的示例中,槽1142将对应于柄部的不同长度。例如,如果使用40mm的偏移适配器,则对应于80mm的股骨柄部(单独使用)的槽将对应于与40mm的股骨偏移适配器结合使用的40mm的股骨柄部。再次,槽可沿铰刀1122被提供在任何组合结构中,以识别能适应本文所公开的柄部和/或偏移适配器的任何组合的铰除深度。具有不同直径的各种铰刀1122可被使用,直到在股骨F(图121)中实现适当的皮层接触。如上所述,可提供多个IM铰刀止挡1120,其各自被操作性地连接到具有不同直径的铰刀1122。
现在转到图122A,股骨间隔器1300被示出。股骨间隔器1300大致包括上表面1302、下表面1304、内侧面1306、外侧面1308和凸台1310。内狭槽1314可沿内侧面1306形成。外狭槽1316可沿外侧面1308形成。一系列深度标记1320可形成在凸台1310上。将要描述的深度标记1320可表示为验证远侧股骨上的任何潜在增强部要求。如上所述,参见图26和27,在一些情况下,可能需要植入远侧股骨增强部,例如由附图标记400和402表示的增强部,或者任何其它本文标识的增强部,例如图24的增强部450、图33的增强部590、或者例如图55A和55B所示的任何其它本文标识的增强部。
一旦IM管被铰除,铰刀1122(与铰刀止挡1120一起)可从股骨F上移除。具有对应于先前使用的铰刀的直径的胫骨柄部1322可被附接到股骨间隔器的凸台。与胫骨柄部结合的股骨间隔器1300的凸台1310可被插入到股骨F的IM管(图122B和122C)。当制备胫骨时,关于胫骨的关节线可使用相同的胫骨间隔器110之一被重新显现。胫骨T和股骨F然后可被引入延伸部,同时将相应的股骨间隔器1300和胫骨间隔器1100分别放置在股骨和胫骨上。关节线由胫骨间隔器1100的胫骨平台部分1104表示,其基于解剖界标确定。此时,针对胫骨T和股骨F的远侧增强部需求可通过允许股骨间隔器1300的下表面1304与胫骨间隔器1100的胫骨平台部分1104相交来确定。一旦两个表面相交,在股骨的内侧或外侧可见多个深度标记1320,以表明需要对应的远侧增强部。类似地,支承(例如图3A的支承14或者本文标识的任何其它支承)的厚度可被重新验证。在一个示例中,股骨间隔器1300可适于为与左或右股骨一同使用。股骨间隔器1300可围绕凸台1310旋转180度以在左侧或右侧股骨之间使用。在其它示例中,可提供针对右或左股骨中每一个具体构造的专用股骨间隔器1300。
现在参见图123,股骨间隔器1300可与塔架1326协作配合。塔架1326可操作性地连接到远侧修正块1330。具体地,塔架1326可包括间隔器立柱1332,该间隔器立柱1332可沿限定在股骨间隔器1300上的相应的内和外狭槽1314和1316滑动地前进。阻挡立柱1334可滑动地前进到限定在远侧修正块1330中的孔1338中。在一个示例中,塔架1326和远侧修正块1330可被连接到股骨间隔器1300,而股骨间隔器1300的凸台1310保留在股骨F的IM管中。一旦塔架1326前进与股骨间隔器1300形成连接关系,且远侧修正块1330前进与塔架1326形成连接关系,则远侧修正块1330可被紧固到股骨F,且铰刀1122、塔架1326和股骨间隔器1300可从股骨F上移除(图124B)。远侧切割可使用限定在远侧修正块1330中的任何狭槽1340形成在股骨F上(见图125),以根据需要进行远侧切除或制备远侧增强部。
现在参见图126A和126B,股骨分级工具1350被示出。股骨分级工具1350可用于估计股骨部件(即,附图标记112,图8)和/或脚手架、骨架或框架1362(将在下文描述)的预期尺寸。股骨分级工具1350可大致包括把手部分1352、前指部1354和后指部1356。如图126B所示,股骨分级工具1350可用于估计远侧股骨F的前/后尺寸。股骨分级工具1350可朝向远侧股骨F前进,使得前指部1354和后指部1356邻近股骨F的相应的后表面和前表面。可提供多个股骨分级工具,其各自在相应的前、后指部1354、1356之间具有不同的跨度S。这样,如果所选取的股骨分级工具1350不能满意地配合紧靠股骨F(见图126B)的前、后侧,则可使用在相应的前、后指部1354、1356之间具有不同跨度S的另一股骨分级工具。
现在转到图127,其示出系统或套件1360,该系统或套件具有适用于制备根据本教示的一个示例的远侧股骨的大量部件。套件1360可包括多个不同尺寸的脚手架、骨架或框架1362、掩模或股骨对准构件1364、切割块1366、后稳定(PS)箱体引导组件1368、由附图标记1370共同表示的一系列定位衬套以及由附图标记1372共同表示的一组铰刀导向套。对准构件1364和该系列定位衬套1370以及该组铰刀导向套1372可共同限定对准组件。根据以下论述将可理解的是,本教示的套件1360允许外科医生选择性地且可替换地依次将对准构件1364、切割块1366和PS箱体引导组件1368附接到框架1362。总之,对准构件1364(与定位衬套1370和铰刀导向套1372组合)可被连接到框架1362,以制备在远侧股骨中铰除的孔。对准构件1364然后可从框架1362上移除。切割块1366然后可被连接到框架1362以制备远侧股骨切割。切割块1366然后可从框架1362上移除。PS箱体引导组件1368然后可被连接到框架1362,然后针对PS箱体所需的切割可在远侧股骨中完成。由以下论述将可理解的是,通过将框架1362用作固定基准,并简单地将套件1360的其它部件交换到框架1362中,精确且有效的系统被提供用于制备远侧股骨。
继续参见图127并另外参见图128,将更为详细地描述框架1362和对准构件1364。框架1362可大致包括前区段1380和远侧区段1382。远侧区段1382可包括内框架部分1384和外框架部分1386。内框架部分1384和外框架部分1386与前区段1380一起可共同限定入口1390。远侧区段1382可包括沿相应的内、外框架部分1384和1386形成的第一对相对的附接部分或引导狭槽1392。远侧区段1382可进一步包括沿内、外框架部分1384和1386形成的第二对相对的锁定狭槽1394。远侧区段1382可进一步包括分别在内、外框架部分1384和1386中形成的切割表面延伸部1396。远侧区段1382可进一步包括后切割狭槽1398。一对孔眼1400可形成在远侧区段1382上。前区段1380可限定支架1401和形成为贯穿其中的多个通道1402。
对准构件1364可包括主体1404。主体1404可大致包括一对侧向区段1406和上区段1408。侧向区段1406和上区段1408可协作以限定接纳部分或键槽1410,该接纳部分或键槽1410限定通过主体1404。轴向止挡1412可形成在侧向区段1406上。轴向止挡1412大致延伸到键槽1410中。一对侧向轨道1416可从相应的侧向区段1406延伸。锁定或横向轨道1420可从侧向区段1406之一延伸。偏压构件1422可沿从侧向部分1406大致向外的方向偏压横向轨道1420。横向轨道1420可凹陷到在侧向区段1406中限定的槽道1424中而抵抗偏压构件1422的偏压。旋钮1430可被旋转地固定到对准构件1364的上区段1408。旋钮1430可操作地围绕轴线1432旋转,并沿着由在对准构件1364的上区段1408中形成的狭槽1434限定的弓形路径。
现在将描述根据本教示的一个示例的对准构件1364与框架1362的组装。首先,外科医生可将横向轨道1420压到主体1404的槽道1424中。在一个示例中,横向轨道1420可与侧向区段1406的外表面平齐或基本平齐。接下来,外科医生可将对准构件1364前进到框架1362的入口1390中。更具体地,对准构件1364的侧向轨道1416可与框架1362的第一对引导狭槽1392对准。在横向轨道1420保持压下同时,对准构件1364的侧向轨道1416可沿框架1362的第一对引导狭槽1392前进。一旦横向轨道1420前进到超过前区段1380的位置,则侧向框架部分1386将横向轨道1420保持在压下位置,直到横向轨道1420与在侧向框架部分1386上形成的第二对相对的狭槽1394的相对狭槽1394对准。偏压构件1422然后将横向轨道1420推进至第二对相对狭槽的狭槽1394中的嵌套位置。对准构件1364现在被紧固到框架1362。沿两个方向(即,侧向轨道1416和横向轨道1420)紧固的对准构件1364提供安全、坚固的连接。可以理解的是,尽管第一对引导狭槽1392被示出在框架1362上,侧向和横向轨道1416和1420被示出在对准构件1364上,但它们可以被提供在相反部件上。换言之,引导狭槽1392可形成在对准构件1364上,而侧向和横向轨道1416和1420可形成在框架1362上。也可以想到其它结构。
现在参见图127,将更为详细地描述所述系列定位衬套1370。类似于与以上制备胫骨有关的定位套筒1196,所述系列定位衬套1370可包括中性定位衬套1440a(0偏移或“中性偏移”)、偏移定位衬套1440b(2.5mm的偏移)、偏移定位衬套1440c(5mm的偏移)和偏移定位衬套1440d(7.5mm的偏移)。孔1450a、1450b、1450c和1450d可分别形成通过各个定位衬套1370。记号标记1452可围绕各个定位衬套1370的前表面1454限定。环形槽1456可围绕各个定位衬套1370的圆周表面1460限定。定位衬套1370可选自所述系列定位衬套1370并前进到对准构件1364的键槽1410中直到接合轴向止挡1412。轴向止挡1412可防止定位衬套1370进一步轴向前进。接下来,旋钮1430可从图130所示的位置旋转到图131所示的位置。通过使旋钮1430围绕轴线1432旋转,扇形轴1462可延伸到键槽1410中,并由此延伸到围绕定位衬套1370的圆周壁1460形成的环形槽1456中的嵌套位置,而在使旋钮1430旋转之前,轴的扇形被定位成允许定位衬套的直径经过。随着旋钮1430旋转到图131所示的锁定位置,轴1462将防止定位衬套1370从键槽1410缩回。定位衬套1370仍然被允许围绕其轴线1451在键槽1410内旋转。
接下来,将更为详细地描述后底脚1470。后底脚1470可大致包括把手部分1472、鳍部1474和闭止部1476。后底脚1470可被选择性地连接到框架1362,如图131和132所示。具体地,在一个示例中,闭止部1476(图127)可被插入到框架1362上的远侧区段1382的后底脚狭槽1398中。后底脚1470可与胫骨间隔器1100一起使用,用于使如图132所示的挠曲间隔(即,挠曲放置的胫骨和股骨)和延伸间隔(如以上参照图122B和122C所述的延伸放置的胫骨和股骨)匹配。可以理解的是,如果挠曲和延伸间隔之间的差异不满足或类似地使用不同尺寸的偏移或不同偏移位置,可能需要将框架1362改变为不同尺寸的框架。
随着铰刀1122延伸通过定位衬套1370的偏移孔1450,定位衬套1370可围绕其纵向轴线1451(图129)旋转(例如,由外科医生),直到到达框架1362在远侧股骨上方实现最佳覆盖的位置。在一个示例中,在旋转定位衬套1370时,外科医生可将后底脚1470和胫骨间隔器1100的位置作为基准(图133)。在一些情况下,框架1362可在远侧股骨上占据满足适当骨覆盖的位置,但挠曲间隔不匹配延伸间隔。在该情况下,可能需要改变股骨尺寸(将框架1362改变为不同尺寸的框架)。可以理解的是,可能需要转出定位衬套1370,直到实现定位衬套1370具有对应于最佳远侧股骨覆盖的偏移(或中性偏移)。
一旦获得远侧股骨的最佳覆盖且挠曲间隔和延伸间隔匹配,则框架1362可相对于远侧股骨紧固在适当位置。在一个示例中,销或紧固件1480可被插入通过在框架1362上限定的孔眼1400。再次,重要的是记住,一旦框架1362充分紧固到远侧股骨,套件1360的其它部件(对准构件1364、切割块1366和PS箱体引导组件1368)可全部切断,而框架1362保持固定到远侧股骨。本领域技术人员将可理解的是,通过使用框架1362作为固定基准,在偏移孔、切割和PS箱体切割的形成期间可提高精确性。类似地,可以理解的是,通过提供共用基准点(框架1362),外科医生可需要较少的时间来完成远侧股骨的制备。
外科医生然后记录与对准构件1364的对准标志1425对准的记号标记1452。接下来,定位衬套1370从对准构件1364(图134)上移除。为了将定位衬套1370从对准构件1364上移除,外科医生可围绕轴线1432将旋钮1430旋转到非锁定位置(图134)。定位衬套1370然后可从键槽1410上缩回。铰刀1122也可通过键槽1410移除。在一些示例中,可能需要在将铰刀1120从键槽1410移除之前将对准构件1364从框架1362上移除。在这种示例中,外科医生可简单地将横向轨道1420压到槽道1424中,并通过滑动侧向轨道1416将对准构件1364从在框架1362中限定的第一对引导狭槽1392移除。
接下来,铰刀导向套1372可被插入对准构件1364的键槽1410。现在转到图127,铰刀导向套1372可包括中性铰刀导向套1520a(0mm偏移或“中性偏移”)、偏移铰刀导向套1520b(2.5mm的偏移)、偏移铰刀导向套1520c(5mm的偏移)和偏移铰刀导向套1520d(7.5mm的偏移)。各个铰刀导向套1372的前表面1524分别包括记号标记1522。环形槽1530可围绕各个铰刀导向套1372的圆周表面1532限定。偏移孔1536a、1536b、1536c和1536d可分别形成通过每个铰刀导向套1372。小面1538可形成在每个铰刀导向套1372上。铰刀导向套1372各自限定纵向轴线1540。所选的铰刀导向套1372可前进到对准构件1364的键槽1410中直到接合前表面1404(铰刀导向套具有凸缘以阻止其进一步轴向移动)。倾斜表面与铰刀导向套上的小面交界以将铰刀导向套锁定在预期位置。
外科医生然后在对准构件1364的键槽1410内旋转铰刀导向套1372,以将记号标记1522与记录的记号标记1452对准,该记号标记1452已与上述对准标志1425对准。铰刀导向套1372然后可进一步前进到键槽1410中而到达图136A所示的位置。旋钮1430然后可沿其轴线1432旋转,从而使轴1462嵌套在围绕圆周表面1532限定的环形槽1530中。与以上描述的定位衬套1370相同,轴1462可防止铰刀导向套1372从键槽1410缩回。当小面1538与在对准构件1364上形成的3个平坦部/轴向止挡交界时,因锁定到适当位置,铰刀导向套1372无法旋转。可以理解的是,每个铰刀导向套1372对应于相应的定位衬套1370。通过这种方式,外科医生将选择具有与以上标识的定位衬套1370类似偏移的铰刀导向套1372。如图136B所示,偏移铰刀导向套1520d限定不平行的第一平面1560和第二平面1562。可以理解的是,可提供一系列铰刀导向套1372,其具有以不同角度发散的不同第一和第二平面。可以理解的是,每个铰刀导向套1372可对应于铰除角度,该铰除角度将适应本文所公开的任何给定偏移适配器(例如适配器604,图41A)的外形。在一些示例中,中性铰刀导向套1520a可在不需要偏移适配器的情况下使用。
铰刀1570可用于在远侧股骨中铰除将容纳股骨植入物凸台(例如图8所示的附图标记130)以及根据需要容纳诸如604的偏移适配器的开口。铰刀1570通过铰刀导向套1372的偏移孔1536引导。
对准构件1364然后从框架1362上移除。为了将对准构件1364从框架1362上移除,在一个示例中,外科医生可压下横向轨道1420,使其从第二相对狭槽1394上缩回。然后,通过将对准构件1364的侧向轨道1416沿框架1362的第一对引导狭槽1392横移,对准构件1364可从入口1390缩回。
接下来,切割块1366被连接到框架1362。再次,可以理解的是,框架1362保持固定到远侧股骨。切割块1366采用与以上关于对准构件1364所述的相同方式附接到框架1362。切割块1366包括侧向轨道1602(图127)和横向轨道1604。在一个示例中,例如图137a和137b所示的示例,横向轨道1604可被包括在切割块的相对侧部上。横向轨道1604可各自由偏压构件1606沿从切割块1366大致向外的方向偏压。横向轨道1604可被压到相应的槽道1610中而抵抗切割块1366的偏压构件1606的偏压。切割块1366可进一步限定形成于其上的多个工具导承1614。工具导承1614可被构造为引导骨锯的刀片。
在一个示例中,根据本教示,外科医生可将横向轨道1604压到切割块1366的相应槽道1610中。横向轨道1604可与切割块1366的外表面平齐或基本平齐。接下来,外科医生可使切割块1366前进到框架1362的入口1390中。更具体地,切割块1366的侧向轨道1602可与框架1362的第一对引导狭槽1392对准。在横向轨道1604保持压下同时,切割块1366的侧向轨道1602可沿框架1362的第一对引导狭槽1392前进。一旦横向轨道1604前进到超过框架1362的外表面的位置,则横向轨道1604将保持在压下位置,直到它们与在框架1362的侧向框架部分1386上形成的第二对相对狭槽1394对准。偏压构件1606然后将相应的横向轨道1604推进到相应的相对狭槽1394中的嵌套位置。切割块1366现在被紧固到框架1362。接下来,外科医生可采用本领域已知的方式通过工具导承1614进行切割,例如倒角切割、后增强部切割。前表面切割也可在股骨上进行。后切割可通过框架1362中的后切割狭槽完成。
一旦远侧股骨已利用切割块1366制备,则切割块1366可从框架1362上移除。根据本教示的一个示例,为了将切割块1366从框架1362上移除,横向轨道1604可被压到其相应的槽道1610中。切割块1366然后可通过从在框架1362中限定的第一对轨道狭槽1392滑动侧向轨道1602而从框架1362上去除。
接下来,参见图138和139,PS箱体引导组件1368被连接到框架1362。再次,可以理解的是,框架1362保持固定到远侧股骨。PS箱体引导组件1368可大致包括第一PS箱体引导部件1360和第二PS箱体引导部件1632。第一PS箱体引导部件1360可大致包括U形主体1636,该主体1636具有沿其外侧限定的轨道1640。第二PS箱体引导部件1632可大致包括C形主体1644。C形主体1644可限定保持狭槽1648和闭止部1650。在一个示例中,第二PS箱体引导部件1632可被定位为抵靠框架1362的前区段1380,使得闭止部1650位于前区段1380的支架1401上。第一PS箱体引导部件1630的轨道1640然后可滑动地定位通过第二PS箱体引导部件1632的保持狭槽1648以及框架1362的第一对引导狭槽1392。PS箱体然后可采用本领域已知的方式被切除。接下来,PS箱体引导组件1368可从框架1362上移除,且框架1362可从远侧股骨上移除。跟踪部件然后可用于采用本领域已知的方式跟踪远侧股骨。如图140所示,具有例如本文所述的股骨凸台130、偏移适配器604和柄部20的股骨部件112然后可被植入到远侧股骨F中。
尽管以上论述大体上致力于进行膝置换外科手术的仪器和方法,但可类似地进行主膝更换外科手术。现在将更为详细地描述用于在主膝更换外科手术期间制备胫骨的一个方法。
首先,本领域众所周知,IM管可用启动器铰刀在胫骨中进行铰除。如上所述,铰刀1122然后可与铰刀止挡1120一起使用,以铰除胫骨的IM管,直到接触适当的骨皮质。应该注意到,近侧胫骨使用IM胫骨切除引导组件被切除。用于针对主膝更换外科手术制备胫骨的其余过程基本类似于以上有关在修正过程中制备胫骨所述的过程。
现在将更为详细地描述根据本教示的一个示例的用于在主膝更换外科手术期间制备股骨的一个方法。首先,本领域众所周知,IM管可用启动器铰刀在股骨中进行铰除。接下来,参见图141,AP分级器1660可用于确定远侧股骨的前/后尺寸。其它工具可用于确定股骨的前/后尺寸。
接下来,例如图61的导承800的远侧切除导承可用于进行远侧和/或增强部切割(即,例如5度),见图82和83。铰刀1122然后如上所述可与铰刀止挡1120一同使用,以铰除股骨的IM管,直到接触适当的骨皮质。对于主股骨手术可以理解的是,远侧切除将减小初始铰除的深度。
现在参见图142,前最终切割器1700可用于在远侧股骨上完成最终前切割。前最终切割器可包括主体1702、中心块1704、旋钮1706、指关节1708和指部1710。中心块1704可限定对应于右和左股骨的一对重叠孔1714。相应的孔1714可接纳铰刀轴1140。狭槽1718可形成在主体1702中,用于在切割前股骨期间接纳切割器。在使用期间,前最终切割器1700可在铰刀轴1140上前进(例如,通过标识的孔)。旋钮1706然后可被旋转,使主体1702沿相对于中心块1704的前/后方向移动。一旦股骨尺寸对应于由AP分级器确定的尺寸,则主体1702通过销1722在远侧股骨上固定到适当位置。前最终切割然后可通过狭槽1718完成。可以理解的是,框架的前区段1380可为远侧股骨上的前最终切割定位。
用于针对主膝更换外科手术制备股骨的其余过程基本类似于以上有关在修正过程中制备股骨所述的过程。
尽管参照优选实施例在说明书中描述了并在附图中示出了本公开内容,但本领域技术人员可以理解的是,在不背离权利要求中限定的公开范围的情况下,可进行各种变化且可用等同替换替代其元件。另外,根据本公开内容的教示,在不背离其本质范围的情况下,可进行许多修改以适应具体情况或材料。因此,本公开范围不限于在附图示出的和在说明书中描述的作为目前被认为实施本公开内容的最佳模式的具体实施例,而是本公开内容将包括落入所附权利要求的描述内的任何实施例。
Claims (36)
1.一种用于在制备骨的过程中与细长骨髓(IM)构件协作来接纳假体的系统,该系统包括:
框架;
选择性地连接到所述框架的对准组件,该对准组件与所述IM构件协作,以相对于所述骨定位所述框架;和
选择性地连接到所述框架的切割块。
2.根据权利要求1所述的系统,进一步包括后稳定(PS)箱体引导组件,该后稳定(PS)箱体引导组件具有选择性地与所述框架的第一附接部分连接的PS箱体引导附接部分。
3.根据权利要求1所述的系统,进一步包括后底脚,该后底脚选择性地与所述框架上的第二附接部分连接,该后底脚被定位为在安装位置占据关节线的空间。
4.根据权利要求1所述的系统,其中所述对准组件进一步包括对准构件,该对准构件具有接纳部分和由所述对准构件的所述接纳部分选择性接纳的衬套,该衬套限定纵向轴线和孔,该孔被构造成接受从中通过的所述IM构件。
5.根据权利要求4所述的系统,进一步包括形成在所述对准构件上的接合部分,其中所述衬套由所述对准构件的所述接纳部分选择性地接纳,并且,所述接合部分能从分离位置移动到接合位置,其中在所述接合位置,所述接合部分基本阻止所述衬套沿所述纵向轴线的运动,而允许所述衬套围绕所述纵向轴线的旋转。
6.根据权利要求5所述的系统,其中所述衬套限定环形槽,并且,所述接合部分在所述接合位置嵌套在所述衬套的所述环形槽中。
7.根据权利要求6所述的系统,其中所述接合部分包括与轴连接的旋钮,其中所述旋钮能在所述分离位置与接合位置之间移动,从而使所述轴从大致进入所述对准构件的所述接纳部分的位置移动到大致位于所述对准构件的主体内的位置。
8.根据权利要求7所述的系统,其中所述旋钮在所述分离位置与接合位置之间围绕轴线旋转。
9.根据权利要求5所述的系统,进一步包括多个衬套,每个衬套具有纵向轴线和形成为穿过所述衬套的孔,其中所述衬套中每一个的相应孔相对于对应的纵向轴线被限定在不同位置。
10.一种用于在制备至少第一骨的过程中与骨髓(IM)构件协作来接纳假体的系统,该系统包括:
框架,该框架具有形成在其上的附接部分;
对准构件,该对准构件具有限定接纳部分和对准构件附接部分的主体,其中所述对准构件附接部分在安装位置选择性地与所述框架的所述附接部分连接;
由所述对准构件的所述接纳部分选择性地接纳的衬套,该衬套限定孔,该孔被构造成接受从中通过的所述IM构件;
块,该块具有形成在其上的多个工具导承,所述多个工具导承被构造成引导骨锯的刀刃,所述块具有块附接部分,该块附接部分在安装位置选择性地与所述框架的所述附接部分连接;和
后稳定(PS)箱体引导组件,该后稳定(PS)箱体引导组件具有PS箱体引导附接部分,该PS箱体引导附接部分在安装位置选择性地与所述框架的所述附接部分连接;
其中所述对准构件、所述块和所述PS箱体引导组件中的每一个均在制备所述骨的过程中被选择性和可替换地连接到所述框架的所述附接部分。
11.根据权利要求10所述的系统,进一步包括形成在所述对准构件上的接合部分,其中所述衬套由所述对准构件的所述接纳部分选择性地接纳,并且,所述接合部分能从分离位置移动到接合位置,其中在所述接合位置,所述接合部分基本阻止所述衬套沿所述纵向轴线的运动,而允许所述衬套围绕所述纵向轴线的旋转。
12.根据权利要求10所述的系统,其中所述衬套限定小面,该小面选择性地与所述对准构件上的结构协作,以阻止围绕所述纵向轴线的旋转。
13.根据权利要求11所述的系统,其中所述衬套限定环形槽,并且,所述接合部分在所述接合位置嵌套在所述衬套的所述环形槽中。
14.根据权利要求13所述的系统,其中所述接合部分包括与轴连接的旋钮,其中所述旋钮能在所述分离位置与接合位置之间移动,从而使所述轴从大致位于所述对准构件的所述主体内的位置移动到大致进入所述对准构件的所述接纳部分的位置。
15.根据权利要求14所述的系统,其中所述旋钮在所述分离位置与接合位置之间围绕轴线旋转。
16.根据权利要求10所述的系统,其中所述附接部分限定轨道或狭槽之一,且所述对准构件附接部分、所述块附接部分和所述PS箱体引导附接部分都限定所述轨道或狭槽中的另一个,其中所述狭槽在所述安装位置能滑动地接受所述轨道。
17.根据权利要求16所述的系统,其中所述对准构件附接部分限定轨道,所述轨道具有在第一方向沿所述主体延伸的第一部分和在第二方向沿所述主体延伸的第二部分,所述第二方向不同于所述第一方向。
18.根据权利要求17所述的系统,其中所述附接部分限定狭槽,该狭槽具有滑动部分和锁定部分。
19.根据权利要求18所述的系统,其中所述第二部分能在组装位置与安装位置之间移动,其中在所述组装位置,所述第二部分与所述主体基本平齐,在所述安装位置,所述第二部分从所述主体向外延伸一距离并紧固地嵌套在所述狭槽的所述锁定部分中,其中在所述安装位置,所述轨道的所述第一部分沿所述狭槽的所述滑动部分的滑动运动被基本阻止。
20.根据权利要求19所述的系统,其中所述对准构件进一步包括偏压构件,该偏压构件将所述第二部分偏压向所述安装位置。
21.根据权利要求10所述的系统,其中所述对准构件包括大致延伸进入所述接纳部分中的止挡,其中所述衬套的轴向运动被所述止挡限制。
22.根据权利要求10所述的系统,进一步包括后底脚,该后底脚在安装位置选择性地连接到所述框架的远侧切除表面,该后底脚被定位为在所述安装位置占据关节线的空间。
23.一种用于在制备骨的过程中与骨髓(IM)构件协作来接纳假体的系统,该系统包括:
框架,该框架具有形成在其上的多个附接部分;
对准构件,该对准构件具有限定接纳部分、接合部分和对准构件附接部分的主体,所述对准构件附接部分在安装位置选择性地与所述框架的所述多个附接部分中的第一附接部分连接;
衬套,该衬套沿纵向轴线延伸,并具有:圆周表面,该圆周表面限定形成于其上的环形槽;和形成为穿过所述衬套的孔,该孔被构造成接受从中通过的所述IM构件;并且
其中所述衬套由所述对准构件的所述接纳部分选择性地接纳,并且,所述接合部分能从分离位置移动到接合位置,其中在所述接合位置,所述接合部分嵌套在所述衬套的所述环形槽中,由此基本阻止所述衬套沿所述纵向轴线的运动,而允许所述衬套围绕所述纵向轴线的旋转。
24.根据权利要求23所述的系统,其中所述第一附接部分限定轨道或狭槽之一,且所述对准构件附接部分限定所述轨道或狭槽中的另一个,其中所述狭槽在所述安装位置能滑动地接受所述轨道。
25.根据权利要求24所述的系统,其中所述对准构件附接部分限定轨道,所述轨道具有在第一方向沿所述主体延伸的第一部分和在第二方向沿所述主体延伸的第二部分,所述第二方向不同于所述第一方向。
26.根据权利要求25所述的系统,其中所述第一附接部分限定狭槽,该狭槽具有滑动部分和锁定部分。
27.根据权利要求26所述的系统,其中所述第二部分能在组装位置与安装位置之间移动,其中在所述组装位置,所述第二部分与所述主体基本平齐,在所述安装位置,所述第二部分从所述主体向外延伸一距离并紧固地嵌套在所述狭槽的所述锁定部分中,其中在所述安装位置,所述轨道的所述第一部分沿所述狭槽的所述滑动部分的滑动运动被基本阻止。
28.根据权利要求26所述的系统,其中所述对准构件进一步包括偏压构件,该偏压构件将所述第二部分偏压向所述安装位置。
29.根据权利要求23所述的系统,其中所述接合部分包括与底脚连接的旋钮,其中所述旋钮能在所述分离位置与接合位置之间移动,从而使所述底脚从大致位于所述对准构件的所述主体内的位置移动到大致进入所述对准构件的所述接纳部分的位置。
30.根据权利要求29所述的系统,其中所述旋钮在所述分离位置与接合位置之间围绕轴线旋转。
31.根据权利要求30所述的系统,其中所述对准构件包括大致延伸进入所述接纳部分中的止挡,其中所述衬套的轴向运动被所述止挡限制。
32.根据权利要求23所述的系统,进一步包括块,该块具有形成在其上的多个工具导承,所述多个工具导承被构造成引导骨锯的刀刃,所述块具有块附接部分,该块附接部分在安装位置选择性地与所述框架的所述多个附接部分中的所述第一附接部分连接。
33.根据权利要求32所述的系统,其中所述块附接部分包括轨道,所述轨道具有在第一方向沿所述主体延伸的第一部分和在第二方向沿所述主体延伸的第二部分,所述第二方向不同于所述第一方向。
34.根据权利要求33所述的系统,其中所述第二部分能在组装位置与安装位置之间移动,其中在所述组装位置,所述第二部分与所述主体基本平齐,在所述安装位置,所述第二部分从所述主体向外延伸一距离。
35.根据权利要求34所述的系统,其中所述块进一步包括偏压构件,该偏压构件将所述第二部分偏压向所述安装位置。
36.根据权利要求32所述的系统,进一步包括后稳定(PS)箱体引导组件,该后稳定(PS)箱体引导组件具有PS箱体引导附接部分,该PS箱体引导附接部分在安装位置选择性地与所述框架的所述多个附接部分中的所述第一附接部分连接。
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Publication number | Publication date |
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EP2222249A1 (en) | 2010-09-01 |
US8187280B2 (en) | 2012-05-29 |
US20090125114A1 (en) | 2009-05-14 |
WO2009049182A1 (en) | 2009-04-16 |
EP2222249B1 (en) | 2012-08-29 |
CN101835441B (zh) | 2013-09-18 |
JP2011500168A (ja) | 2011-01-06 |
JP5466647B2 (ja) | 2014-04-09 |
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