Surgery device for performing surgery on the human knee
10856887 ยท 2020-12-08
Inventors
Cpc classification
A61B17/66
HUMAN NECESSITIES
International classification
A61B17/16
HUMAN NECESSITIES
A61B17/02
HUMAN NECESSITIES
Abstract
A surgery device for operating on the human knee. The surgery device comprises a guide component and a tensioning component. The guide component comprises a base body having a base surface for disposing on a tibial end face and comprises guide elements extending from the base surface. The tensioning component is set up for tensioning the guide component such that the ligaments of the knee are uniformly tensioned in the flexed state of the knee. A truing and drilling component for truing and drilling a femoral end face can be pushed onto the guide elements and fixed at various positions relative to the base surface. The risk of injury and misuse during the surgery on a human knee is reduced and the duration of surgery is shortened by means of the surgery device according to the invention.
Claims
1. A surgery device for operating on a human knee, the surgery device comprising: a guide component and a tensioning component, and a truing and drilling component for truing and drilling a femoral end face, wherein the guide component comprises a base body having a base surface for disposing on a tibial end face and guide elements extending from the base surface, wherein the tensioning component is configured to tension the guide component such that ligaments of the knee are uniformly tensioned in a flexed state of the knee, wherein the truing and drilling component is configured to be pushed onto the guide elements and fixed at various positions relative to the base surface, wherein the tensioning component comprises a tensioning cylinder and a tensioning lever, wherein the tensioning cylinder is guided by the guide elements along a longitudinal axis of the tensioning cylinder, and wherein the tensioning lever is configured to tension the tensioning cylinder relative to the base body.
2. The surgery device according to claim 1, wherein the tensioning cylinder comprises a cutout in a longitudinal direction.
3. The surgery device according to claim 2, wherein the cutout is a recess or a through hole.
4. The surgery device according to claim 1, wherein the tensioning lever comprises a first arm, a second arm, and a pivot point between said first and second arms, wherein the tensioning lever is configured such that the second arm is tensioned against the tensioning cylinder by a pretensioning of the first arm.
5. The surgery device according to claim 4, wherein the base body comprises an opening for actuating the tensioning lever on a lateral surface thereof.
6. The surgery device according to claim 1, wherein the base body comprises a cutout on the base surface for receiving the tensioning lever.
7. The surgery device according to claim 1, wherein the guide component comprises two guide elements spaced apart from each other by a distance and extending in a same direction as each other from the base body, wherein the two guide elements each comprise one inner lateral surface facing toward the other one of the guide elements of the two guide elements and one outer surface opposite the inner lateral surface.
8. The surgery device according to claim 7, wherein one of the outer surfaces of the two guide elements comprises a recess and the other one of the outer surfaces of the two guide elements comprises a protrusion in a direction of extent of the guide elements for guiding the truing and drilling component.
9. The surgery device according to claim 7, wherein the outer surfaces of the guide elements form a dovetail guide for guiding the truing and drilling component.
10. A surgery device for operating on a human knee, the surgery device comprising: a guide component and a tensioning component, and a truing and drilling component for truing and drilling a femoral end face, wherein the guide component comprises a base body having a base surface for disposing on a tibial end face and guide elements extending from the base surface, wherein the tensioning component is configured to tension the guide component such that ligaments of the knee are uniformly tensioned in a flexed state of the knee, wherein the truing and drilling component is configured to be pushed onto the guide elements and fixed at various positions relative to the base surface, and wherein the truing and drilling component comprises a gauge fixture, wherein the gauge fixture comprises at least one groove for an upper femoral cut.
11. The surgery device according to claim 10, wherein the gauge fixture comprises a plurality of pass-through openings and a guide element comprises a plurality of cutouts, wherein each of the pass-through openings is associated and has a same orientation with a corresponding one of the plurality of cutouts, and wherein the pass-through openings are different from each other and have orientations different from each other.
12. The surgery device according to claim 11, wherein the pass-through openings are disposed on a front side of the gauge fixture, wherein the front side of the gauge fixture is configured to face away from the femoral end face when the surgery device is in use.
13. The surgery device according to claim 12, wherein the gauge fixture comprises a millimeter scale on the front side thereof referenced by a marking on the guide component.
14. The surgery device according to claim 10, wherein the gauge fixture is configured to be set at a variable height position relative to the base surface by a setting element.
15. The surgery device according to claim 14, wherein the setting element is a clamping screw.
16. The surgery device according to claim 10, wherein the gauge fixture comprises two drill bushings configured to drill femoral prosthesis holes, wherein the two drill bushings are integrated in the gauge fixture or are drill bushing inserts.
17. A surgery device for operating on a human knee, the surgery device comprising: a guide component and a tensioning component, and a truing and drilling component for truing and drilling a femoral end face, wherein the guide component comprises a base body having a base surface for disposing on a tibial end face and guide elements extending from the base surface, wherein the tensioning component is configured to tension the guide component such that ligaments of the knee are uniformly tensioned in a flexed state of the knee, wherein the truing and drilling component is configured to be pushed onto the guide elements and fixed at various positions relative to the base surface, wherein the guide component comprises two guide elements spaced apart from each other by a distance and extending in a same direction as each other from the base body, wherein the two guide elements each comprise one inner lateral surface facing toward the other one of the guide elements of the two guide elements and one outer surface opposite the inner lateral surface, wherein each of the inner lateral surfaces comprises a concave cylindrical shape such that the two inner lateral surfaces define a cylindrical guide by the distance therebetween.
18. The surgery device according to claim 17, wherein one of the outer surfaces of the two guide elements comprises a recess and the other one of the outer surfaces of the two guide elements comprises a protrusion in a direction of extent of the guide elements for guiding the truing and drilling component.
19. The surgery device according to claim 17, wherein the outer surfaces of the guide elements form a dovetail guide for guiding the truing and drilling component.
Description
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
(1) Further embodiments and associated advantages are described below with reference to the attached figures.
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DETAILED DESCRIPTION
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(13) The surgery device 1 comprises a guide component 10, a tensioning component 20, and a truing and drilling component 30. The surgery device 1 is tensioned between the femur and tibia by the tensioning component 20 such that the ligaments (not shown) are uniformly tensioned. Malpositioning of the prosthesis and consequent malpositioning of the leg is thereby prevented.
(14) The guide component 10 comprises a base body 110 contacting the tibial base surface 5. The tensioning component 20 comprises a tensioning cylinder 210 tensioning the guide component 10 against the tensioning component 20. The tensioning cylinder 210 is fixed on the femoral end face 4 by means of a T-mount 250. Undesired displacing of the tensioning cylinder 210 relative to the femoral base surface 4 can thereby be prevented.
(15) The truing and drilling component 30 comprises a gauge fixture 300 for pushing onto the guide component 10. As can be seen in
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(17) The base body 110 comprises various openings set up for receiving various other components of the surgery device 1. The base body 110 has an opening for receiving a tensioning spring 230 on the base surface 111, and a further opening through which a tensioning lever 220 can be inserted through the base body 110 into the guide elements 120. A fastening screw 240 can be inserted through a fastening opening 114 provided on a front surface 112 of the base body 110, by means of which the tensioning lever 220 is rotatably fastened to the guide component 10.
(18) The truing and drilling component 30 comprises the gauge fixture 300 for being fixed at a desired position relative to the guide element 120 by means of an adjusting screw 350 and/or a locking pin 360. The locking pin 360 is inserted through openings 325 in the gauge fixture 300 and placed, for example latched, in corresponding openings 125 on the outer surfaces of the guide elements 120.
(19) The individual components and elements of the surgery device 1 are described below in detail and separately with reference to the further figures.
(20) The base body 110 shows a knob 118 on the front side comprising a groove 119 on the top side thereof (cf. e.g.
(21) The guide component 10 is shown in a view from above in
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(24) Finally,
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(26) The tensioning cylinder 210 further comprises a cutout in the longitudinal direction 214. The cutout 214 preferably extends completely through the cylindrical pin 211. The cylindrical pin 211 can thus be described as a hollow cylinder. The cutout 214, however, can also extend through only part of the length of the cylindrical pin 211. The cutout 214 is particularly set up for preventing jamming due to bodily tissues or fluids.
(27) The cylindrical pin 211 comprises a latching profile 216 on the cylindrical surface shown to the right in the image in
(28) The tensioning cylinder 210 further comprises the knob 218 on the front side thereof for tensioning, set up for tensioning relative to the corresponding knob 118 by means of a forceps, not shown. The knob 218 is thus a forceps protrusion.
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(31) In other examples of the gauge fixture 300, of course, other types and combinations of grooves 302 and size indications 306 are conceivable. The gauge fixture 300 further comprises a lower groove 304 in the lower region, set up for truing the lower femoral cut as well. The gauge fixture 300 further comprises one drill bushing 308 in each arm of the gauge fixture 300 for fastening the gauge fixture in the femur and defining the final drilling position or drilling the final prosthesis holes. The drill bushing 308 in the example is integral to the gauge fixture 300. The gauge fixture 300 thus comprises a material of sufficient hardness. In other examples, the drill bushing 308 can also be inserted, for example clamped, in the gauge fixture 300 in a known manner.
(32) In the illustrated embodiment, the gauge fixture 300 comprises a millimeter scale 307 on the front side thereof. The millimeter scale 307 is referenced by a marking on the guide component.
(33) In the side view shown in
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(39) The gauge fixture 300 comprises openings 325 on the front side. The openings 325 fulfill the identical functionality as the openings 325, but are disposed on the front side in order to better ensure usability for surgeries on both the left and right knee. A locking pin 360 can be placed in the openings 325, for example for fixing the truing and drilling component 30.
(40) The guides 326 and 328 on the inner side wall 324 of the gauge fixture 300 differ further. In the example shown in
(41) Finally, the labeling 307 differs, wherein in
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(43) Further advantages and improvements of the embodiment example of the device according to the invention in comparison with the prior art are described below.
(44) A plurality of operationally independent functions are combined in one surgery device 1 by the device. Uniform tensioning of the ligaments can be achieved, accompanied by correct rotation/alignment of the femur and reproducible determining of the individually required size of prosthesis in a combined surgery device 1. The surgery device 1 enables truing of the upper and lower cut locations of the femur in a flexed position during the surgery as well as drilling of the two fastening holes for fastening the prosthesis in the femoral end face 4.
(45) The angular displaceability of the tensioning cylinder 210 about the axis of rotation of the tensioning cylinder 210 is increased by the surgery device 1. By means of an installed force transmitting device, namely the T-mount 250, and by modifying the guiding of the tensioning cylinder 210 relative to the prior art, the angle of rotation of the tensioning cylinder 210 is increased.
(46) The tensioning device mechanism implementing a tensioning of the tensioning lever 220 and of the tensioning cylinder 210 enables complete removal of the tensioning lever 220. Disinfectability is thereby increased and buildup of bodily fluids and/or tissue residues is prevented. The arrangement and geometry of the guide components and the tensioning component 20 allows displaceable parts to be relocated in the guide component 10, whereby unintended actuation of the mechanism, such as the tensioning lever 220, due to protruding control elements, is prevented.
(47) The tensioning cylinder 210 is optimized in that a cutout 214 is provided in the longitudinal direction for receiving any foreign bodies, such as tissues, bones, cartilage, or the like in the tensioned state, and therefore jamming of the tensioning component 20 by material crushing/buildup is prevented.
(48) The surgery device 1 combines a plurality of gaging and drilling devices, such as a gauge for the upper and lower femoral cuts and a gaging and drilling template for femoral holes, for simplifying the surgical process, for simplifying the surgical sequences, for shortening the time of surgery, and for optimizing the quality of surgery, by means of mechanically predetermined process sequences implemented by a gauge fixture 300 for pushing on and grooves 302 of the gauge for the upper femoral cut labeled with numerical values for determining the size of the prosthesis. The gauge fixture 300 can be continuously variably displaced and clamped or locked at predefined locations.
(49) The gauge fixture 300 can be set by the adjusting screw 350. The setting device comprising the adjusting screw 350 further comprises a vernier scale for optimizing legibility, wherein the setting device is set up for setting the gauge fixture 300 in an analog manner. The setting mechanism is similar to that of a caliper gauge implemented having an adjusting screw 350, allowing implementation of continuously variable intermediate sizes depending on the surgical situation and the surgical anatomy of the patient.
(50) A locking device of the gauge fixture 300 by the locking pin 360 enables a plurality of potential locking heights for adjusting the gauge fixture 300. For example, special spacings such as 18, 20, 22, 24 mm, relative to dimensions such as 18, 20, 22, 24 mm also specially determined in preceding surgical steps, for example, allow a plurality of potential locking heights of the gauge fixture 300. The locking is performed by the locking pin 360, wherein incorrect setting is prevented by special locking pin geometry. Each of the locking openings 325 can be implemented as rectangular elongated holes. The locking pin geometry comprises elongated holes in the gauge fixture and the guide elements 120, each hole rotated by 360 divided by the number of elongated holes. Numerical values for indicating the selected position are preferably provided on the outer surface of the gauge fixture 300. Said locking pin geometry is designed according to the known method of poka yoke for preventing unintentional malpositioning using geometric devices in this case.
(51) The drill bushing 308 in the gauge fixture 300 is integrated in the gauge fixture 300 by means of sufficient base hardness of the material. Alternatively, the drill bushing can be implemented as a drill bushing insert and thereby clamped, pressed in, or otherwise fastened in the gauge fixture 300.
(52) The base surface 111 of the base body 110 is optimized to the benefit of the surgery sequence. The geometry of the base surface 111 of the base body 110 is thereby modified to the benefit of preventing intrasurgical collisions with the cruciate ligament and/or other tissues. The geometry of the base surface 111 of the base body 110 is concave, for example, and comprises general elimination of sharp edges (radius, chamfer, or the like) of the contour for preventing cutting and scraping of tissues and bone.
(53) In one example, the size of the base surface 111 of the base body 110 can be divided to the benefit of a surgery sequence and individual patient anatomy, that is, individual bone size. For example, the base body 110 can be divided into prosthesis sizes 1 through 6 and 8 through 12, possibly having overlapping sizes. The base surface 111 preferably makes plane-parallel and form-fit contact with the tibial end face 5.
(54) The surgery device 1 and all components and elements can be made of different materials and optionally having different surface properties or coatings. All individual elements can be implemented as metal, as plastic, or as hybrids, optionally also in combination and in composite designs. Not all individual parts must be made of the same material, and combinations of different materials between different elements are also possible.
(55) The surgery device 1 is conceived exclusively for optimizing the flexion gap occurring during the knee endoprosthesis surgery. Because uniform tensioning of the ligaments in a flexed position of the tibia to the femur is made possible, the femur can be aligned under balanced torque. If, in contrast, merely the parallelism of opposing tensioning surfaces in the flexed knee is used for aligning, then said essentially parallel forced position of the femur does not bring about uniform tensioning of the ligaments, but rather incorrect tensioning.
(56) The surgery device according to the invention thus has the advantage, in comparison with said ligament alignment tensioned in parallel, that the femur can be aligned under balanced torque without the entire surgery process being implemented by using the integrated device.
(57) Instead of the previous need for using individual device fixtures for the individual steps, the improvement over the prior art lies in recognizing the interrelation between the fixed hole spacing from the bottom edge of the device while simultaneously truing the size of the prosthesis by locking the size by means of a locking pin 360 or clamping screw 350 and integrating in a single device. In comparison with known device, the device 1 according to the invention having the single combined truing and drilling component 30 enables the steps of determining the size of the prosthesis and the drilled holes for the associated saw block to be implemented together in one unit when generating the flexion gap.