Set for constructing a transcutaneous implant

0001The invention relates to a kit for preparing a transcutaneous Implant.

0002It does so, of an adapter for a standard part exoprosthetic according to the DE-C-198 26 638th This adapter has a intracorporeal with its proximal stem portion in a femoral stump anchored adapter on a exoprosthetic standard part, the stem part at least partially with an open-meshed, three-dimensional Dimensional network structure is covered and at its distal end a coupling device for the exoprosthetic standard part is provided.

0003This adapter has proved for some time in practice. Of the Adapter gives in connection with a leg prosthesis coupled thereto, a thus treated patients an unexpected Osteoperzeption. Thus supplied patients show a virtually natural Motion picture, this is of course still dependent on the other parts of the prosthesis, ie, in particular the knee and the ankle.

0004Despite all the advantages, however, problems can occur. There is, for a potential contamination of the passage point of the adapter to call through the thigh stump. This problem is for example achieved by a subcutaneous, intramuscular bearing according to the unpublished DE-A-103 53 400. On the other hand to mention the risk of a fracture of the thigh stump once extracorporeally not a breaking point in at least one prosthesis part is provided, as proposed in DE-A-100 40 617 becomes. Also, a failure of a predetermined breaking point at an unfavorable Fall can have devastating consequences for the patient to be especially a fracture of the femur in the femoral neck region. A third Problem arises when the patient is indeed mentioned with a Adapter and a whole leg prosthesis is well supplied, but in Area of ​​the natural femoral head of the femur wear occur. A supply of the patients with conventional Hip stem endoprostheses ruled out because in the intramedullary Channel in the femur stump already the adapter is so the hip stem is available a sufficient space more. In front this background it is the object of the present invention, the To solve both problems mentioned above.

0005With regard to the issue of a femur fracture, the problem is solved by a set of the aforementioned type comprising the features of Claim 1. This is further developed by the subclaims 2 to 5. With regard to the problem of the patient's supply of a artificial joint ball, the object is achieved by a set with the Features of independent claim 6, which by the subclaims is 7 to 14 trained.

0006The first solution proposal in addition to the already mentioned Adapter as part of a set with the proximal end of the adapter connectable stick-shaped articles prior to fracture stabilization. This Implant attachment is particularly preferably a sleeve-shaped reinforcing body, the top, ie from cranial forth by the Cortex introduced opening near the greater trochanter in a is set appropriately reamed canal and the proximal is connected end of the adapter. The compound can for example and preferably by a conical clamping connection. For this purpose, for example, the sleeve has at its lower End a conical plug-in pin on while the adapter in its the proximal end having a conical receptacle. Socket and can plug pin in a known manner in a conical clamping connection to be brought. Additionally conceivable would be a backup by a screw.

0007In an alternative embodiment, the implant attachment be a tubular sheath body with a curved course and with such a length that it has received from the juncture the adapter in the femur through a bone channel in the femur neck can be inserted. This reinforcing body provides additional Reinforcement of the femoral neck.

0008Both aforementioned reinforcing body can particularly preferably consist of a shaped into a tube grid network, by which passed with increasing time of trabecular bone Cancellous bone ingrowth.

0009Alternatively, the reinforcing solid biocompatible Metal, and at least in sections a open-mesh, three-dimensional spatial network structure on its surface exhibit. In this network structure and through Trabecular bone in turn grow and a firm hold to care.

0010With the above set succeeds occurring fractures above to stabilize the proximal end of the adapter. The in Below we set described offers the possibility of replenishment the patient with a hip joint ball implant.

0011This set includes - in addition to the adapter already described - a with the proximal end of the adapter connected locking attachment to prepare the implant as a ball joint replacement implant on. The locking cap implant offers the possibility that large forces can be introduced into the total implant, as is also necessary when the locking attachment implant absorb the forces from the hip joint and the adapter who, when the locking cap implant with a artificial joint ball is fitted.

0012More preferably, the locking attachment of the implant one from above (ie from cranial ago) major alongside the trochanter insertable sleeve, with the proximal end of the adapter is connectable with a first through opening and a Locking handle, which in a bone canal of the femoral neck is of the femur can be used, wherein the locking handle by the first through opening in the sleeve engages. The bone tunnel in Femoral neck is made by laterally after the cortex in this area has been opened.

0013The locking between the sleeve and the locking handle can in a simple manner by a press fit. preferred contrast however, an embodiment of the set, wherein the first through hole the sleeve has an internal thread, with a External thread of the locking handle can be screwed.

0014Thus in the case of occurring wear of natural Femoral head an artificial hip joint ball with possible little effort can be applied, according to a preferred Embodiment provides that the distal end of the latch handle is designed as a conical plug-in pin. In case of a become necessary partial resection of the natural femoral head can after resection an artificial hip joint ball on the conical plug-in pin of the locking handle to be set. To this end, must the artificial hip joint ball a correspondingly formed have conical receptacle.

0015A conical clamping can particularly preferably also apply find between the insertable from cranial to the femoral stump Sleeve and the proximal end of the adapter.

0016The aforementioned conical clamping connection can additionally are secured by a screw connection between the Sleeve passing through bolt and a threaded hole in the Adapter. For this purpose, in the locking shaft, a second through hole provided by which then engages the screw. These Embodiment is naturally very stable.

0017The embodiments described below relate to the now Nature of the locking handle.

0018This can in accordance with one embodiment up to the second through hole, if present, be of solid construction. This embodiment provides at a basically be withdrawal the least resistance to the removal of the locking stem.

0019However, the locking handle can also at least partially as a hollow be reinforcing body formed of a grid network. It says the long-term stability of the locking stem in the femoral neck in Foreground. In the hollow reinforcing namely grows over the time a bone material, for which the long-term stability in situ makes.

0020Alternatively, the locking handle can at least locally with an open-meshed, three-dimensional network structure be provided. This embodiment provides the greatest safety a long-term fixation, as in the network structure and by this is einorganisiert through bone material.

0021The invention is described by means of embodiments explained in more detail. In the drawing:<dl tsize="6"><dt>Fig. 1</dt><dd>a set according to one embodiment, schematically shown as implanted in a femoral stump,</dd><dt>FIG. 2</dt><dd>the view of an implant created from this set seen in FIG. 1 from the lateral side,</dd><dt>Fig. 3</dt><dd>Three embodiments of the locking handle, and</dd><dt>Fig. 4</dt><dd>of cranial adjacent to the greater trochanter insertable Sleeve.</dd></dl>

0022Subsequently, the same reference numerals denote the same parts.

0023A first overview gives FIG. 1. This shows into a Femur stump 3 set adapter 1, the intracorporeal with his proximal stem portion is 2 anchored. The adapter 1 has at its distal end 5 a coupling device 6 for an indicated at 7 exoprosthetic standard part.

0024For long-term fixation of the adapter 4, the handle part 2 is at least partially covered with an open-meshed, three-dimensional network structure 4, in which einorganisiert to bone material.

0025The distal end 5 of the adapter 1, a bush 22 connects. This jack is also provided with an open-meshed, three-dimensional Dimensional network structure 23 is. This network structure is but already outside the Femurstumpfes 3 serves the spatial network structure 23 means that the after implantation of the sleeve 22 surrounding eingranuliert connective tissue so as to form a germ barrier (DE-A-103 53,400).

0026On the proximal end 8 of the adapter 2 is now present a Locking attachment 9 is placed, in the example shown a locking attachment 9 for a subsequent coupling of an artificial Joint ball.

0027The locking attachment 9 shown consists of one of the cranial, Thus in FIG. 1 from the top, next to the greater trochanter in the Femur stump 3 insertable sleeve. This is to the proximal end 8 the adapter 1 connected, namely present - as indicated - by means of a conical clamping seat. The sleeve 10 has a first Through opening on 11th

0028Furthermore, there is the locking attachment 9 of a locking handle 12. This locking handle 12 is to the lateral Opening of the cortex in a freely cleared bone tunnel 13 in Femoral neck 14 is set. His position is to be used by the of cranial Sleeve 10 is locked.

0029Operationally you go now before so that initially the sleeve 10 of cranial is set in a free-cleared bone canal and then by the lateral side of the locking handle 12 is set into the bone canal 13 is, the locking handle 12 while through the first through hole 11 engages in the sleeve 10th

0030In the illustrated embodiment, the first through hole 11 an internal thread. With this internal thread is a External thread 16 of the locking handle 12 screwed. To this end, , the locking handle 12 at its proximal end a Tool attachment (not shown).

0031The locking handle 12 has a designed as a plug-in cone distal to the end 17, with a corresponding seat is an artificial joint ball connected.

0032The seat of the sleeve 10 at the proximal end 8 of the adapter 1 present nor particularly secured by a screw 18. This Screw 18 reaches through the locking handle 12 by a fact provided second through opening 19th

0033In Fig. 3, three different embodiments for the Locking handle 12 is shown. In Fig. 3a, the locking handle is 12 solid except the second through opening 19th There is therefore virtually no ingrowth of bone material instead, so this Fixation is the most unstable, but in a revision surgery on easiest is to remove.

0034In Fig. 3b the locking handle 12 is in sections, with an open-mesh, three-dimensional network structure is 21, in which and through which bone trabeculae grow and so for stable long-term fixation worry.

0035In Fig. 3c, finally, the locking handle 12 is at least partially formed as a hollow reinforcing body of a mesh network 20, in which also einorganisiert bone material. The long-term stability this embodiment is between that of in Fig. 3a and FIG. 3b illustrated embodiments.

LIST OF REFERENCE NUMBERS

0036<dl tsize="2" compact="compact"><dt>1</dt><dd>adapter</dd><dt>2</dt><dd>stem part</dd><dt>3</dt><dd>femoral stump</dd><dt>4</dt><dd>Dimensional network structure</dd><dt>5</dt><dd>distal end v. 2</dd><dt>6</dt><dd>coupling device</dd><dt>7</dt><dd>exoprosthetic standard part</dd><dt>8th</dt><dd>proximal end v. 1</dd><dt>9</dt><dd>locking attachment</dd><dt>10</dt><dd>shell</dd><dt>11</dt><dd>first through hole</dd><dt>12</dt><dd>locking handle</dd><dt>13</dt><dd>bone canal</dd><dt>14</dt><dd>femoral neck</dd><dt>15</dt><dd>internal thread</dd><dt>16</dt><dd>external thread</dd><dt>17</dt><dd>distal end v. 12</dd><dt>18</dt><dd>screw</dd><dt>19</dt><dd>Through Hole</dd><dt>20</dt><dd>Grid Network</dd><dt>21</dt><dd>Dimensional network structure</dd><dt>22</dt><dd>socket</dd><dt>23</dt><dd>Dimensional network structure</dd></dl>