CN102727327A - Artificial knee joint prosthesis - Google Patents
Artificial knee joint prosthesis Download PDFInfo
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- CN102727327A CN102727327A CN2012101637944A CN201210163794A CN102727327A CN 102727327 A CN102727327 A CN 102727327A CN 2012101637944 A CN2012101637944 A CN 2012101637944A CN 201210163794 A CN201210163794 A CN 201210163794A CN 102727327 A CN102727327 A CN 102727327A
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- patella
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Abstract
The invention relates to an artificial knee joint prosthesis which comprises a patella prosthesis and a femur prosthesis, wherein the patella prosthesis is made of metal and is 3-4mm, preferably 3.5mm in thickness; the femur prosthesis is provided with a tackle part which is made of metal; a polyethylene joint surface is arranged on the surface of the tackle part; and the polyethylene joint surface is gradually thickened from a near end to a far end and no gap exists between the polyethylene joint surface and the tackle part. The artificial knee joint has the following advantages: the patella prosthesis is made of metal, so that the wear resisting property is good, the thickness is thin, the patella cut amount is decreased, then the application scope of the existing knee joint prosthesis is enlarged, the postoperative fracture occurrence rate is reduced, benefit is brought to overhauling and the problem of uneven patella stress distribution is solved at the same time; the tackle part of the femur prosthesis is covered by a layer of ultra-high molecular polyethylene joint surface, so that the abrasion is reduced and the 'soft landing' of femur quadriceps tendon is realized; and no gap exists between the polyethylene joint surface and the metal backing and the polyethylene joint surface and the metal backing are integrally pressed and shaped, so that a polyethylene/metal friction surface is not added.
Description
Technical field
The present invention relates to technical field of medical instruments, specifically, is a kind of artificial knee joint prosthesis.
Background technology
(Total knee arthroplasty TKA) is the effective means of treating at present that late period, gonarthrosis decreased to TKA.At present, the annual TKA example number of the U.S. has reached 500,000, expects the year two thousand thirty will increase to 3,000,000; The iconography of Chinese people knee osteoarthritis and clinical onset rate are all apparently higher than the west, and population base is huge, and the TKA technology just obtains fast development and popularizes in China.
The TKA operation of routine is to do an otch at the trouble knee joint, and the row tibial plateau is deep, DF is deep and patella is deep, excision pathological changes articular surface cartilage, and the special bone cement of reuse is fixed, tibial prosthesis, femoral prosthesis and the patella prosthese of correspondence in the displacement.Patella prosthese commonly used clinically at present is a ultra high molecular polyethylene patella prosthese; Femoral prosthesis is the prosthese that the all-metal of cochrome, rustless steel, titanium, titanium alloy or nickel cobalt (alloy) is made, and the traditional prosthese of this kind has following shortcoming: (1) narrow application range.Conventional polyethylene patella prosthese designs according to west human body anatomical features; Mostly thickness is the 8-10 millimeter, and deep back patella thickness need be greater than 15mm to guarantee certain bone strength, and this just requires the patella original depth just to be fit to displacement greater than 23mm; Female patient is the main crowd of knee prosthesis; But bibliographical information Korea S women patella thickness average out to 21.2mm, China's Human Patella average thickness is 21.8mm, is difficult to reach above-mentioned requirements; When therefore a lot of east capable TKA of female patient performed the operation, the doctor had to patella is done following processing: do not replace patella; Displacement patella but the bone bed is thin excessively; Displacement patella and reservation normal thickness bone bed, but the increase of patella gross thickness more than selects all can cause the unusual or patellofemoral joint complication of patella biomechanical property, influences postoperative function.(2) the postoperative fracture incidence rate is higher.The deep amount of tradition ultra high molecular polyethylene patella prosthese reaches 8-10mm; Subchondral bone is removed fully; The non-deformability of the inboard spongy bone surface of bone of patella is significantly less than the outside (Young's modulus of patella medial and lateral surface of bone is respectively 2.6GPa and 3.7GPa); Make inboard surface of bone deformation of patella and suffered tension force significantly greater than the outside, be prone to cause the preceding pain of Patella fracture and knee joint.(3) be unfavorable for overhauling.The patella prosthese occurs loosening and need overhaul during wearing and tearing; If use traditional patella polyethylene prosthese, excised approximately 1/3 when patella bone amount is replaced for the first time, overhaul and take away the part sclerotin when removing prosthese and bone cement again; The normal appearance of patella is damaged than DAGU; Even the thin bone shell of only surplus one deck, processing method commonly used has bone grafting, bone cement filling, uses the prosthese of band metal enhancing piece, patella excision etc., all is difficult to recover patella normal thickness and intensity; Be prone to the bad and severe complication of postoperative function, even operative failure.(4) the patella stress distribution is inhomogeneous, and poly patella is easy to wear.Tradition ultra high molecular polyethylene patella prosthese and femur coaster contact area are narrow and small; Bend and stretch lasting stressed in the process, friction in knee joint; And offside femur metal block surface range is wider, only receives moment stress at the position that contacts with patella, and the poly force intensity that receives of unit are is big; Fraction time is long, and the polyethylene patella is easy to wear.(5) " hard landing " of quadriceps femoris tendon.When normal knee sprung is spent above 70; Patella moves down along femur coaster ditch, and the quadriceps femoris tendon will be wrapped on the femur coaster cartilage surface, effectively share patellofemoral joint stress; And traditional metal femur is comparatively hard; Strong with the friction of quadriceps femoris tendon, be prone to cause that the joint is uncomfortable, be unfavorable for the curvature movement in joint.
Clinical data shows; The TKA postoperative often produces various patellofemoral joint problems because of the patella displacement; Like pain, patella ischemic necrosis, Patella fracture, prosthetic loosening, patellar ligament fracture, polyethylene wear etc. before the knee joint; Become the one of the main reasons of knee joint revision procedure, accounted for knee joint and overhaul 50% of several total amounts, and above complication is big with the deep amount of patella of using traditional patella prosthese to cause, polyethylene wear etc. has close ties.For avoiding the problems referred to above; Many scholars do not replace patella when TKA performs the operation; Keeping patella bone amount, to avoid polyethylene wear, but meta-analysis shows the TKA postoperative; Patella is not replaced patient's the preceding pain rate of kneecap and the operability again that causes because of the patellofemoral joint problem reaches 24.1% and 6.2% respectively, is significantly higher than patella displacement patient's 12.9% and 1.8%.In addition; Middle-aged and elderly people patellofemoral arthritis sickness rate is up to 11%-24%; Because simple patellofemoral replacement effect is reliable inadequately, it is master's knee osteoarthritis with the patellofemoral joint pathological changes that most of doctors still select the TKA operative treatment, if do not replace the value that patella then can not embody operation in the art.Equally, for the knee joint rheumatoid arthritis patients, the patella cartilage surface of excision pathological changes helps thoroughly removing the intraarticular inflammatory factor, improves clinical symptoms.The displacement of facies articularis patellae is vital for suffering from the knee joint rehabilitation, can not rely on the patellofemoral joint problem that patella is avoided the TKA postoperative of not replacing simply.
At present; Design improves multiple prosthese to the femur coaster; As strengthen the coaster trench depth, extend coaster ditch length, coaster moves outward etc., is referred to as " the friendly type of patella " prosthese (Pavlou G, Meyer C; Leonidou A; As-Sultany M, West R, Tsiridis E (2011) Patellar resurfacing in total knee arthroplasty:does design matter A meta-analysis of 7075 cases. J Bone Joint Surg Am. 93:1301-1309.); Rotary-type patella polyethylene prosthese (the Charalambous CP of band metab that also had prosthetic designs; Abiddin Z; Mills SP; Rogers S, Sutton P, Parkinson R (2011) The low contact stress patellofemoral replacement:high early failure rate. J Bone Joint Surg Br. 93:484-489.); But protection patella bone amount is all considered in above design, and clinical effectiveness is compared with traditional prosthese all not to have obviously and improved, and the deep amount of still unresolved patella greatly and the difficult problem of polyethylene wear.Therefore, need badly and a kind ofly can replace patella pathological changes articular surface, greatly degree keeps patella bone amount again, and few artificial knee joint prosthesis that weares and teares, but does not also appear in the newspapers about this type prosthese at present.
Summary of the invention
The objective of the invention is provides a kind of artificial knee joint prosthesis to deficiency of the prior art.
For realizing above-mentioned purpose, the technical scheme that the present invention takes is:
A kind of artificial knee joint prosthesis comprises patella prosthese and femoral prosthesis, and described patella prosthese is to be made of metal, and thickness is 3-4mm; Described femoral prosthesis is provided with metal coaster part, and the surface of described coaster part is provided with the polyethylene articular surface.
The thickness of described patella prosthese is 3.5mm.
Described patella prosthese is to be processed by vitallium, rustless steel, titanium, titanium alloy or nickel cobalt (alloy).
Described patella prosthese is to be processed by vitallium.
Described polyethylene articular surface is a progressive additive from near-end to far-end.
Described polyethylene articular surface is provided with guiding position and weight bearing area, and the thickness of described weight bearing area distal-most end is 6-10mm.
There is not the gap between described polyethylene articular surface and the coaster part.
The invention has the advantages that:
1, knee-joint prosthesis of the present invention, its patella prosthese adopt all-metal to process, and anti-wear performance is good; Thickness is little; Reduce the deep amount of patella, and then enlarged the scope of application of existing knee-joint prosthesis, reduced the postoperative fracture incidence rate; Be beneficial to and overhaul, solved the uneven problem of patella stress distribution simultaneously;
2, knee-joint prosthesis of the present invention, the coaster of its femoral prosthesis partly cover one deck ultra high molecular polyethylene articular surface, can reduce wear, and " soft landing " of realization quadriceps femoris tendon;
3, knee-joint prosthesis of the present invention, the polyethylene articular surface of its femoral prosthesis and metal-backed between seamless, the two is integrated pressing and forming, does not increase polyethylene/metal friction interface.
Description of drawings
Accompanying drawing 1 is a kind of artificial knee joint prosthesis patella prosthese sketch map of the present invention.
Accompanying drawing 2 is a kind of artificial knee joint prosthesis femoral prosthesis sketch maps of the present invention, and the position of point identification is the coaster part among the figure, also is the distributed areas of polyethylene articular surface.
Accompanying drawing 3 is polyethylene articular surface structural representations, and the position of point identification is the distributed areas of polyethylene articular surface among the figure.
The specific embodiment
Below in conjunction with accompanying drawing the specific embodiment provided by the invention is elaborated.
The Reference numeral and the ingredient that relate in the accompanying drawing are as follows:
11. 111. bottom surfaces, top
12. condyle in the patella joint pin 21.
22. ectocondyle 23. coaster parts
231. interior trochlear surface 232. outer trochlear surfaces
233. patella ditch 24. intercondylar fossas
25. femur joint pin 4. is metal-backed
6. polyethylene articular surface 8. guiding positions
10. weight bearing area
Embodiment 1 artificial knee joint prosthesis of the present invention ()
1, patella prosthese
Please with reference to Fig. 1, Fig. 1 is a kind of artificial knee joint prosthesis patella prosthese sketch map of the present invention.Described patella prosthese is provided with top 11.Described top 11 is to be processed by vitallium (Carpenter Technology Corporation, the U.S.), and top 11 is cheese; It is the sphere cone-shaped; Taper surface and circumferential edge are arc transition, and the thickness at top 11 is 3.5mm, and the diameter of the bottom surface 111 at top 1 is 28mm.Described bottom surface 111 is provided with three joint pins 12, and described three joint pins 12 are the equilateral triangle summit and distribute, and described joint pin 12 is cylindrical, high 5mm, diameter 3mm.
2, femoral prosthesis
Please with reference to Fig. 2, Fig. 2 is a kind of artificial knee joint prosthesis femoral prosthesis sketch map of the present invention.It is tabular that described femoral prosthesis is the two sleds of one, condyle 21, ectocondyle 22 and coaster part 23 in being provided with.Described coaster part 23 is the front end of condyle 21 and ectocondyle 22 in the bridge joints respectively, and interior condyle 21 and ectocondyle 22 be with relationship parallel to each other basically, and between them, is limited with intercondylar fossa 24.Described coaster part 23 is designed to flexibly connect with the patella prosthese of present embodiment; Coaster part 23 comprises interior trochlear surface 231, outer trochlear surface 232 and patella ditch 233; Trochlear surface 231 is positioned at patella ditch 233 both sides with outer trochlear surface 232 in described; Described coaster part 23 below broads, to hold the patella prosthese of present embodiment, interior trochlear surface 231 and 233 risings of outer trochlear surface and smooth excessiveness are in patella ditch 233.Described coaster part 23 also seamlessly transits with ectocondyle 22 with interior condyle 21.The back side of condyle 21 and ectocondyle 22 respectively is provided with a joint pin 25 in described.
Please with reference to Fig. 3, Fig. 3 is a polyethylene articular surface structural representation.Visible along the direction of frontal axis, described coaster part 23 be provided with metal-backed 4 with polyethylene articular surface 6, promptly described in trochlear surface 231, outer trochlear surface 232 and patella ditch 233 (three is not shown) all be to constitute with polyethylene articular surface 6 by metal-backed 4.Described metal-backed 4 is by vitallium (Carpenter Technology Corporation; The U.S.) process, described polyethylene articular surface is by ultra high molecular polyethylene (GUR1020 resin, molecular weight about 4,400,000; Purchase GmbH in Quadrant PHS Deutschland; Germany) process, described metal-backed 4 and polyethylene articular surface 6 between be gapless, adopt polyethylene/metal one pressing and forming technology to process; Do not increase polyethylene/metal friction interface, described polyethylene articular surface 6 is a progressive additive from near-end to far-end.To far-end, described coaster part 23 can be divided into guiding position 8 and weight bearing area 10 from near-end, and the thickness of described weight bearing area 10 distal-most end is 6mm, to guarantee polyethylene intensity, does not significantly increase the deep amount of femur side simultaneously.
Embodiment 2 artificial knee joint prosthesis of the present invention (two)
1, patella prosthese
Basically with embodiment 1 described patella prosthese, its difference only is: the thickness at top 11 is 3mm to the patella prosthese of present embodiment, and the diameter of the bottom surface 111 at top 1 is 32mm; Described joint pin 12 is cylindrical, high 6mm, diameter 3mm.
2, femoral prosthesis
Prosthese (the Zimmer NexGen LPS-Flex Knee that the form of described femoral prosthesis and Position Design are produced with U.S. Zimmer company; Cat No:00596401201) femoral prosthesis in; Difference only is: the coaster part 23 of described femoral prosthesis be provided with metal-backed 4 with polyethylene articular surface 6, promptly described in trochlear surface 231, outer trochlear surface 232 and patella ditch 233 all be by metal-backed 4 and polyethylene articular surface 6 constitute.Described metal-backed 4 is to be processed by vitallium (Carpenter Technology Corporation, the U.S.), and described polyethylene articular surface is by ultra high molecular polyethylene (GUR1020 resin; Molecular weight about 4,400,000; Purchase GmbH, Germany in Quadrant PHS Deutschland) process, described metal-backed 4 and polyethylene articular surface 6 between be gapless; Not increasing polyethylene/metal friction interface, is to adopt polyethylene/metal one pressing and forming technology to process.Described polyethylene articular surface 6 is a progressive additive from near-end to far-end.Described weight bearing area 10 terminal thickness are 8mm.
Embodiment 3 artificial knee joint prosthesis of the present invention (three)
1, patella prosthese
Basically with embodiment 1 described patella prosthese, its difference only is: the thickness at top 11 is 4mm to the patella prosthese of present embodiment, and the diameter of the bottom surface 111 at top 1 is 36mm; Described joint pin 12 is cylindrical, high 5mm, diameter 3mm.
2, femoral prosthesis
Prosthese (the P.F.C. Sigma RP System that the form of described femoral prosthesis and Position Design are produced with U.S. Depuy company; Cat No:9068-45-000) femoral prosthesis in; Difference only is: the coaster part 23 of described femoral prosthesis be provided with metal-backed 4 with polyethylene articular surface 6, promptly described in trochlear surface 231, outer trochlear surface 232 and patella ditch 233 all be by metal-backed 4 and polyethylene articular surface 6 constitute.Described metal-backed 4 is to be processed by vitallium (Carpenter Technology Corporation, the U.S.), and described polyethylene articular surface is by ultra high molecular polyethylene (GUR1020 resin; Molecular weight about 4,400,000; Purchase GmbH, Germany in Quadrant PHS Deutschland), described metal-backed 4 and polyethylene articular surface 6 between be gapless; Not increasing polyethylene/metal friction interface, is to adopt polyethylene/metal one pressing and forming technology to process.Described polyethylene articular surface 6 is a progressive additive from near-end to far-end.Described weight bearing area 10 terminal thickness are 10mm.
To the foregoing description 1-3, need to prove:
" far-end " described in this paper and " near-end " are conventional medical science/anatomical terms; Described " weight bearing area " when being meant knee joint bending, the position that the coaster part 23 of patella prosthese and femoral prosthesis contacts, described " guiding position " are meant that coaster part 23 plays the part that guides the patella prosthese to get into weight bearing area and do not make its dislocation; Described patella prosthese is not limited in vitallium, also can be that rustless steel, titanium, titanium alloy or nickel cobalt (alloy) are processed.
The deep thickness of metal patella prosthese of the present invention only needs 3-4mm, and reduced the deep amount of patella, thereby possessed following advantage: (1) is low to the patella thickness requirement, applicable to most patients, makes the patient no longer cross the thin patella that can't carry out because of patella and replaces; (2) the about 3mm of patella cartilage average thickness; If use metal patella prosthese of the present invention; Deep thickness is 3-4mm only, and hard subchondral bone can most ofly be kept, and can carry out the protectiveness stress shielding to the lower inboard surface of bone of bone strength; Make bone surface stress uniform distribution, reduce complication such as preceding pain of kneecap and fracture; (3) be beneficial to the patella revision procedure; (4) the patella prosthese processed of all-metal is compared with traditional polyethylene patella prosthese, can make the stress distribution of patella prosthese below surface of bone more even.
Corresponding with metal patella prosthese of the present invention, the coaster part 23 of femoral prosthesis of the present invention is designed to have metal-backed 4 polyethylene articular surface 6.Described polyethylene articular surface 6 is a progressive additive from near-end to far-end, its slope that thickens is not required, but be good with simulation articular surface radian progressive additive; Preparation polyethylene articular surface 6 employed ultra high molecular polyethylene materials are not limited in described in the embodiment, and the habitual ultra high molecular polyethylene material of medical instruments field all can; Described polyethylene articular surface 6 and metal-backed 4 integrated pressing and forming designs do not have the gap between the two, do not increase " metal/polyethylene " frictional interface; Simultaneously, the shape of described polyethylene articular surface 6 and scope and the simple metathetical femoral prosthesis of patellofemoral joint are same or similar, and the polyethylene thickness of the weight bearing area 10 of described coaster part 23 is greater than 6mm, to guarantee polyethylene intensity.The advantage of described polyethylene articular surface 6 is: (1) conventional polyethylene patella prosthese and all-metal femur coaster contact area are narrow and small; Bend and stretch lasting stressed in the process, friction [Ellison P in knee joint; Fisher J (2010) Assessment of the damage in retrieved patellar components. J Long Term Eff Med Implants. 20:57-72.], and metal block part 23 surface range of offside all-metal femoral prosthesis are wider, only receive moment stress at the position that contacts with patella; And the present invention selects opposite design; Be that the patella prosthese adopts metal material and the coaster part 23 use polyethylene articular surfaces of femoral prosthesis, then reduce the poly stressed and fraction time of unit are effectively, thereby reduce wear; A metaphor is; Patella is in the supratrochlear motion of femur, just as train driving on rail, wheel meets with stresses all the time and rubs in the train motion; And rail only bears weight and friction at position that contacts with train wheel and moment, thereby the former is more easy to wear; (2) make the quadriceps femoris tendon be wrapped in compliance polyethylene surface preferably, but not " soft landing " of quadriceps femoris tendon can be realized in hard metal surface, reduce the uncomfortable sensation in joint, be beneficial to the joint curvature movement.
Described patella joint pin 12 all is to be used to be connected sclerotin use with femur joint pin 25; The material of patella joint pin 12 and femur joint pin 25 is not limited in metal; Also can be other materials or adopt mature traditional design; But for ease of modeling and production, described patella joint pin 12 can use identical materials with the top 11 of patella prosthese; Described femur joint pin 25 can use identical materials with metal-backed 4 of femoral prosthesis.
Knee-joint prosthesis of the present invention can be applicable to the TKA operation, also can be used for simple patellofemoral joint displacement, and the tibial prosthesis that uses in the TKA operation then can be traditional tibial prosthesis or other novel prosthese, does not receive restriction of the present invention.
The above only is a preferred implementation of the present invention; Should be pointed out that for those skilled in the art, under the prerequisite that does not break away from the inventive method; Can also make some improvement and replenish, these improvement and replenish and also should be regarded as protection scope of the present invention.
Claims (7)
1. an artificial knee joint prosthesis comprises patella prosthese and femoral prosthesis, it is characterized in that, described patella prosthese is to be made of metal, and thickness is 3-4mm; Described femoral prosthesis is provided with metal coaster part, and described coaster partly is provided with the polyethylene articular surface.
2. artificial knee joint prosthesis according to claim 1 is characterized in that the thickness of described patella prosthese is 3.5mm.
3. artificial knee joint prosthesis according to claim 1 is characterized in that, described patella prosthese is to be processed by vitallium, rustless steel, titanium, titanium alloy or nickel cobalt (alloy).
4. artificial knee joint prosthesis according to claim 3 is characterized in that, described patella prosthese is to be processed by vitallium.
5. according to the arbitrary described artificial knee joint prosthesis of claim 1-4, it is characterized in that described polyethylene articular surface is a progressive additive from near-end to far-end.
6. artificial knee joint prosthesis according to claim 5 is characterized in that, described polyethylene articular surface is provided with guiding position and weight bearing area, and the thickness of described weight bearing area distal-most end is 6-10mm.
7. according to the arbitrary described artificial knee joint prosthesis of claim 1-4, it is characterized in that not having the gap between described polyethylene articular surface and the coaster part.
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| CN2012101637944A CN102727327A (en) | 2012-05-24 | 2012-05-24 | Artificial knee joint prosthesis |
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| CN2012101637944A CN102727327A (en) | 2012-05-24 | 2012-05-24 | Artificial knee joint prosthesis |
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Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN103598935A (en) * | 2013-11-08 | 2014-02-26 | 深圳先进技术研究院 | Patella prosthesis structure |
| CN104799979A (en) * | 2015-05-11 | 2015-07-29 | 北京爱康宜诚医疗器材股份有限公司 | Patellar prosthesis |
| CN104873308A (en) * | 2015-05-26 | 2015-09-02 | 北京爱康宜诚医疗器材股份有限公司 | Patella prosthesis |
| WO2016179727A1 (en) * | 2015-05-08 | 2016-11-17 | 江苏奥康尼医疗科技发展有限公司 | Orthopedic implant with polymer-wrapped metal prosthesis |
| CN109498220A (en) * | 2019-01-10 | 2019-03-22 | 上海交通大学医学院附属仁济医院 | A kind of artificial knee joint prosthesis of novel kneecap adaptation |
| CN110020494A (en) * | 2019-04-17 | 2019-07-16 | 徐州医科大学 | A kind of prosthetic designs method based on the articular morphology factor |
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| CN103598935A (en) * | 2013-11-08 | 2014-02-26 | 深圳先进技术研究院 | Patella prosthesis structure |
| WO2016179727A1 (en) * | 2015-05-08 | 2016-11-17 | 江苏奥康尼医疗科技发展有限公司 | Orthopedic implant with polymer-wrapped metal prosthesis |
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| CN109498220A (en) * | 2019-01-10 | 2019-03-22 | 上海交通大学医学院附属仁济医院 | A kind of artificial knee joint prosthesis of novel kneecap adaptation |
| CN110020494A (en) * | 2019-04-17 | 2019-07-16 | 徐州医科大学 | A kind of prosthetic designs method based on the articular morphology factor |
| CN110020494B (en) * | 2019-04-17 | 2022-12-30 | 徐州医科大学 | Prosthesis design method based on joint form factor |
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Application publication date: 20121017 |