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    • 专利摘要:
    The present invention relates to runners for reamers for an acetabular cup, which allow a more accurate and accurate drilling out of the acetabular implantation zone. The invention further provides combinations of scrapers for an acetabular cup and conductors therefor and methods for their manufacture and use.
    公开号:BE1019679A3
    申请号:E2011/0341
    申请日:2011-06-01
    公开日:2012-09-04
    发明作者:Ben Geebelen
    申请人:Materialise Nv；
    IPC主号:
    专利说明:

    SPACIOUS FOR AN ACETABULAR CUP
    FIELD OF THE INVENTION
    The present invention relates to reamers for an acetabular cup reamers, combinations of reamers for an acetabular cup and runners therefor and methods for their manufacture and use.
    BACKGROUND
    In hip replacement surgery, the implantation area of an acetabular cup is prepared prior to placement of the implant to ensure a perfect fit thereof. This typically implies the removal of poor or affected bone surface, but also the excision of the opening to adjust it to the size of the implant to be applied. This is done using a reamer for an acetabular cup. This is typically a tool with a handle and a rotating head. Reaming head heads (optionally provided as removable heads of one device) are used to enlarge the acetabulum during the drilling process.
    Typically, drilling starts at a diameter of about 6 - 8 mm less than the size of the implant, and sequential drilling is done in 1-2 mm steps. However, the thickness of the acetabular wall must be taken into account. If the wall becomes too thin, the reamer should be pulled to the opposite wall to avoid generating an edge defect. To ensure correct orientation of the opening, the: position of the reamer should mimic the final position of the acetabular component. In the final acetabulum, the cotyloid bone should be removed and the acetabular edge should lie comfortably against the last larger.
    Accurate connection of the implant to the drilled-out acetabulum is critical since incorrect alignment of the implant can lead to an increased wear rate for the implant or improper placement of the implant, which can lead to limited leg movement and even hip dislocation.
    Accurate drilling is however hampered by three important factors: a) the variability of patient-specific properties, b) the limitation of manipulation of the reamer by the surgical window, c) the limited visual access of the target area and d) the fact that accurate manipulation of a rotating tool is difficult.
    US 2002/099288 describes a system that uses ultrasound imaging to guide the placement and orientation of the implant relative to the anatomical landmarks surrounding the aetabulum such as the foramen ischiadicum majus, the spina ischiadica, the gemellus superior, the obturator foramen , the spina inferior and others.
    US 2008/009874 discloses a reamer with a shaft to which a one-piece guide is attached and which includes a locator member that extends to a first portion of the bone and provides a reference point with respect to the reamer while the reamer a second portion of the reamer bone included during drilling. However, one reference point is not sufficient to limit all degrees of freedom.
    There is a need for reamers that can ensure accurate and accurate drilling to ensure optimum mounting of the acetabular cup implant.
    SUMMARY OF THE INVENTION
    The present invention provides guides for reamers for an acetabular cup that allow accurate drilling of the acetabular cup zone.
    Accordingly, a first aspect of the invention provides conductors for an acetabular cup reamer that includes one or more contact elements that fit on areas of the bone surrounding the acetabular cup implantation zone in at least three contact points and one or more connecting elements that have a reversible connection of allow the conductor with a broader. In particular embodiments, at least two of said one or more contact elements of the conductors of the invention form larger contact surfaces extending over specific areas of the bone surrounding the acetabular cup implantation zone in at least three contact points. Typically, these contact elements include patient-specific surfaces.
    In further particular embodiments, the one or more connecting elements allow a free rotation of the reamer about its longitudinal axis and restrict the movement of the reamer along its longitudinal axis, such as to prevent the reamer from penetrating the bone to an excessively large depth .
    In certain particular embodiments, the conductor is characterized by the presence of one or more locking elements, which restrict the movement of the reamer along its longitudinal axis, such as to prevent the reamer from penetrating the bone to an excessively large depth. In special embodiments, at least one of the one or more locking elements forms part of the guide. In certain embodiments, at least one of the one or more locking elements forms part of the one or more connecting elements. In special embodiments, the one or more locking elements form a separate device, which is removable from said conductor.
    In particular, the inventors provide combinations of conductors and reamers that can be securely placed on the bone surrounding the acetabulum. This is ensured by ensuring that the contact elements fit specifically on the bone.
    In particular embodiments, the one or more contact elements of the conductors according to the invention are designed such that the angle between the plane through the central axis of the circle formed by the acetabular edge and one contact point and the plane through the central axis of the circle which is formed by the acetabular edge and the adjacent contact point is never greater than 180 ° and, after contacting said specific areas of the bone surrounding the acetabulum, ensure a close connection of said conductor to said bone. More specifically, said contact elements comprise a patient-specific surface that uniquely fits a specific area of the bone, so that there is only one correct position of the conductor on the bone, that is, the position at which the contact elements are correctly positioned on their corresponding surface. In particular embodiments, conductors are provided in which the contact elements are designed such that when the conductor is placed on the bone, the conductor (and optionally the acetabular cup reamer connected thereto) is forced into a position so that the reamer has the desired orientation relative to the pelvis. In further particular embodiments, a rotation of the conductor around its central axis ensures that the conductor can be placed in the correct position.
    In special embodiments, the conductors according to the invention can comprise one or more fixing elements that allow the adhesion or connection of the conductor to the bone by means of one or more fixing means, such as pins or screws.
    In particular embodiments of the invention, the conductors are characterized by the fact that the connecting elements, which allow a reversible connection of the conductor to a reamer, form a separate device which can optionally be connected to the conductor. More in particular, the connecting elements are removable from the conductor.
    In particular embodiments, conductors are provided as described herein, further comprising a positioning element that allows passage of a positioning device that is placed in the bone surrounding the acetabulum.
    More specifically, the positioning device is a pin that is placed in the bone that surrounds the acetabulum.
    Most particularly, the conductors of the present invention are medical image-based patient-specific conductors.
    In particular embodiments, the conductors according to the invention are modular devices comprising elements with a standard shape that can be adapted to the shape of the bone.
    The conductors of the present invention are provided for use in combination with a reamer for an acetabular cup. It is contemplated that the conductor can be used with one or with a series of reamers.
    A further aspect of the present invention provides combinations of a reamer for an acetabular cup and a guide according to the invention, wherein the acetabular cup reamer comprises a handle and a hold member wherein the hold member is attached to the handle and has a roughly semicircular shape, and the conductor comprises one or more contact elements that fit on areas of the bone that surrounds the acetabular cup zone in at least three contact points, the one or more contact elements being designed such that the angle between the plane formed through the central axis of the circle through the acetabular edge and one contact point and the plane through the central axis and the adjacent contact point is never greater than 180 ° and, after contacting the specific areas of the bone surrounding the acetabulum, ensure a close connection of the conductor to the bone.
    In particular embodiments of the combinations according to the invention, at least two of said one or more contact elements of the conductors according to the invention form larger contact surfaces which extend over specific areas of the bone surrounding the acetabular cup implantation zone in at least three contact points. More specifically, as described in detail above, these contact elements comprise a patient-specific surface that uniquely fits a specific area of the bone, so that there is only one correct position of the conductor on the bone, i.e. the position wherein the contact elements are correctly positioned on their corresponding surface.
    In particular embodiments of the combinations according to the invention, the contact elements present on the conductor are designed such that, after placing the conductor on the bone, the conductor (and optionally the reamer for an acetabular cup connected thereto) in such a position it is forced that the reamer has the desired orientation relative to the pelvis.
    In further particular embodiments, a rotation of the conductor around its central axis ensures that the conductor can be placed in the correct position.
    The present inventors have further found that, in order to allow correct placement of the combination of the conductor and the reamer according to the invention, in particular within a limited surgical window, the reamer's stem optimally contains a hinge that the movement of the end of the handle in a different orientation with respect to the reaming element of the reamer; more in particular, such a hinge makes it possible to position the end of the shank at an angle with respect to the rest of the shank and the clearing element, such as, for example, during the placement of the combination of the guide and the reamer according to the invention within the surgical window. In this way, the presence of the hinge prevents a moment of force from developing on the conductor, i.e., a tendency to torch or rotate the conductor when the surgeon holds the reamer in a non-optimal or sub-optimal position; this prevents the conductor from being placed in an incorrect position. This can be interesting when the device is introduced within a limited surgical window. In special embodiments, the hinge is a cross-hinge coupling, also called a universal joint, a universal joint, a universal joint or a universal joint. In these embodiments, the cross-hinge coupling allows the end of the shank to bend or rotate in all directions with respect to the remaining portions of the shank and with respect to the reamer element, and thus to achieve an independent rotary movement of the end of the handle with respect to the other parts of the handle and with respect to the reamer element.
    In special embodiments, the hinge allows the rotary element to rotate relative to the end of the handle.
    In further particular embodiments, the hinge allows rotation of the reamer element relative to the end of the reamer stem, which is typically connected to a tool tool, to ensure correct placement of the reamer in the acetabular cup.
    As described in detail above, the combinations according to the invention provide one or more connecting elements.
    In further particular embodiments of the combinations according to the invention, one or more connecting elements are provided which reversibly connect the reamer to the conductor and allow a free rotation of the reamer about its longitudinal axis. In further particular embodiments, one or more locking elements are provided that prevent the reamer from moving along its longitudinal axis, such as to prevent the reamer from penetrating the bone to an excessively large depth. In special embodiments, at least one of the one or more locking elements forms part of the guide. In other special embodiments, at least one of the one or more locking elements forms part of the reamer. In certain embodiments, at least one of the one or more locking elements forms part of the one or more connecting elements. In special embodiments, the one or more locking elements form a separate device, which is removable from said reamer and / or guide.
    In special embodiments of the combinations according to the invention, at least one of the one or more connecting elements forms a part of the reamer. In special embodiments, at least one of the one or more connecting elements form part of the conductor.
    In special embodiments of the combinations of the invention, one or more connecting elements form a separate device, which is optionally removable from the reamer and / or the conductor. In still further specific embodiments, a combination of connecting elements is present on the reamer and on the conductor and can optionally be detached therefrom. Accordingly, in particular embodiments, the one or more connecting elements form a separate device, i.e., which is removable from the reamer and / or the conductor. In special embodiments, the connecting elements are a combination of elements that are reversibly present on the reamer and / or conductor, wherein each element and / or the combination of elements can be detached from the reamer and / or the conductor. Accordingly, in these embodiments, the connecting elements form a combination of elements that is removably present on the reamer and / or conductor.
    In special embodiments of the combinations according to the invention, the conductors comprise one or more fixing elements which allow the adhesion or the connection of the conductor to the bone by means of one or more fixing means, such as pins or screws.
    In particular embodiments of the combinations according to the invention, the conductor further comprises a positioning element that allows the passage of a positioning device that is placed in the bone surrounding the acetabulum. More specifically, the positioning device is a pin that is placed in the bone that surrounds the acetabulum.
    In particular embodiments of the combinations according to the invention, the conductor is a medical image-based patient-specific instrument.
    In particular embodiments of the combinations according to the invention, the conductor is a modular device comprising elements with a standard shape that can be adapted to the shape of the bone.
    Yet another aspect of the present invention provides methods for manufacturing the conductors of the invention.
    In particular embodiments, methods are provided to manufacture a guide for an acetabular cup reamer, which include (a) obtaining volume information of the pelvic bone and the acetabular implant to be placed therein, (b) identifying and selecting of parts of the bone surrounding the implantation zone suitable for use as a base for the contact elements of the conductor, and (c) designing and producing a conductor based on the information obtained in steps (a) and (b) ). More specifically, the information obtained in step (b) is used to design suitable contact elements.
    The devices for positioning and guiding a reamer for an acetabular cup, and the combinations thereof, allow, according to the present invention, a more accurate and precise drilling out of an acetabular implantation zone compared to the known surgical aids currently used in hip joint surgery. Moreover, the devices according to the invention can be more easily positioned and manipulated within a limited surgical window.
    BRIEF DESCRIPTION OF THE DRAWINGS
    The following description of the figures of specific embodiments of the invention is intended as an example only and is not intended to limit the current teaching, its application or use: Throughout the drawings, corresponding reference numerals indicate identical or corresponding parts and features.
    Figure 1 provides a top view of a conductor (5) according to a particular embodiment of the invention, which is positioned on the pelvis bone (11). The central axis (Y) corresponds to the central axis of the implant, the central axis of the reamer when positioned in the guide and the central axis of the circle formed by the acetabular edge.
    Figure 2A illustrates a side view of the combination of a reamer for an acetabular cup (1) and a guide (5), the reamer (1) comprising a handle (2), a clearing element (3), and a locking element (4); the conductor comprises contact elements (6) and a connecting element (7) which ensures the connection of the stem (2) to the conductor (5).
    Figure 2B illustrates a longitudinal section of a part of the combination of a reamer for an acetabular cup: (1) and a guide (5) according to a particular embodiment of the invention. That reamer (1) comprises a handle (2) and a hold element (3). Only a part of the conductor (5) is shown to which a connecting element (7) is attached. A locking element (4) is provided on the handle (2) of the reamer (1).
    Figure 3 provides a top view of a combination of a reamer for an acetabular cup (1) and a guide (5) according to a further particular embodiment of the invention, positioned on the pelvis bone (11). The conductor (5) comprises three contact elements (6). The guide (5) is shown with the connecting element (7) attached to it, which allows the passage of the reamer's stem (2). The handle comprises a locking element (4).
    Figure 4 provides a top view of a combination of a reamer for an acetabular cup (1) and a guide (5) according to a further particular embodiment of the invention, positioned on the pelvis bone (11). The conductor (5) comprises three contact elements (6). One of the contact elements (6) comprises a positioning element (8) that corresponds to a gap. A positioning device (9) is positioned through the positioning element (8) in the pelvis bone (11). The conductor (5) is shown with the connecting element (7) connected thereto, which allows the passage of the reamer's stem (2). The handle comprises a locking element (4).
    Figure 5 provides a view from below (A) and from above (B) of a combination of a reamer for an acetabular cup (1) and a guide (5) according to an embodiment of the invention. Facing from below (A), the reaming element (3) of the reamer (1) is substantially visible, as well as the patient-specific surfaces of the contact elements (6) of the conductor (5). In the face from above (B), conductor (5) is visible with its three contact elements (6). One contact element (6) contains a positioning element (8).
    Figure 6 provides a top view of a combination of a reamer for an acetabular cup (1) and a guide (5) according to a further particular embodiment of the invention, positioned on the pelvis bone (11). The reamer (1) comprises a handle (2) and a clearing element (3). The handle comprises a hinge (10) and a locking element (4). The conductor (5) is shown comprising three contact elements (6). A connecting element (7) is attached to the conductor.
    Figure 7A illustrates a side view of the combination of a reamer for an acetabular cup (1) and a guide (5), the reamer (1) comprising a stem (2) and a reaming element (3); the handle comprises a hinge (10) and a locking element (4); the conductor comprises contact elements (6) and a connecting element (7) is provided which ensures the connection of the stem (2) to the conductor (5).
    Figure 7B illustrates a longitudinal section of a portion of the combination of a reamer for an acetabular cup (1) and a guide (5) according to a particular embodiment of the invention. The reamer (1) comprises a handle (2) and a clearing element (3). The handle comprises a hinge (10) and a locking element (4). Only a part of the conductor (5) is shown to which a connecting element (7) is attached.
    List of reference numbers used in the Figures (1) Reamer for an acetabular cup (2) Stem (3) Ream element (4) Locking element (5) Guide (6) Contact element (7) Connection element (8) Positioning element (9) Positioning device ( 10) Hinge (11) Pelvic bone
    (Y) Central axis of the circle formed by the acetabular border DETAILED DESCRIPTION
    The present invention will be described with reference to particular embodiments, but the invention is not limited thereto but only by the claims. Any reference sign in the claims will not be understood as limiting the scope of protection.
    Where the term "comprising" is used in the present description and claims, it does not exclude other elements or steps. Where an indefinite or definite article is used when referring to a single noun eg "one" or "the", this includes a plural of that noun unless specifically meant otherwise.
    Furthermore, the terms first, second, third and the like in the description and in the claims are used to distinguish between similar elements and not necessarily for describing a sequential or chronological order unless otherwise specified. It is to be understood that the terms so used are interchangeable under appropriate circumstances and that the embodiments of the invention described herein are suitable for carrying them out in sequences other than those described or shown herein.
    The terms or definitions used herein are provided only as an aid in understanding the invention.
    The present invention relates to devices for performing computer-assisted surgical techniques and, more particularly, relates to medical image-based patient-specific surgical guides that provide the ability to accurately drill out a patient's acetabulum .
    The majority of acetabular implants are currently placed using the pressure-fit technique, which consists of the following procedure: • The patient's acetabulum is bored with a succession of semicircular reamers with increasing diameters, such that a semicircular cavity is created in which the implant should be placed. The last and largest reamer typically has a diameter smaller than that of the implant; • The implant is attached to an impactor; • The implant and the impactor are placed on the pelvis of the patient, such that the implant rests on the edge of the drilled out cavity and the orientation of the implant is anatomically appropriate; • The impactor is struck with a hammer until the implant is in the drilled cavity; • The implant is detached from the impactor.
    The acetabulum itself is a good point of reference for the placement of reamers. However, the surgeon has no means to control the depth to which the drilling was performed, except visual inspection. The surgical guides according to the present invention not only allow for optimum orientation of the reamer but also accurately control the depth of drilling.
    Accordingly, a first aspect of the invention provides guides for reamers for an acetabular cup. The conductors of the present invention can be securely placed in a specific position on the acetabulum. This is ensured by the presence of one or more contact elements.
    To ensure the stability of the conductor, the one or more contact elements of the conductors of the present invention fit, contact or coincide, in at least three contact points, with three or more regions on the patient-specific morphology of the pelvic bone that surround the implantation zone for an acetabular cup. In this way, the guides according to the present invention allow accurate and stable placement of the reamer for an acetabular cup during the drilling out of the acetabulum.
    In the context of the present invention, reference is made to a "central axis" corresponding to the central axis of the implant in its optimum position. This central axis corresponds to the central axis of the acetabular cup, or the central axis of the circle formed (at least approximately) by the acetabular edge. To ensure a cored acetabulum that allows the placement of the implant in the desired position, reamers should also cut the bone. Typically, a sequence of reamers is used, the latter being introduced into the bone by a downward movement along the same axis. Accordingly, the central axis will correspond to the central axis of the guide, which corresponds to the orientation and the axis of movement of the reamer during drilling. The central axis is illustrated in Figure 1 as "Y".
    In special embodiments, the contact elements of the conductors according to the invention are designed such that, after placing the conductor, rotational and / or translational movement is required from the conductor in one or more directions to obtain the desired orientation on the pelvis bone. In particular embodiments, this is ensured by the fact that the one or more contact elements fit, make contact, or coincide with surfaces that exhibit a patient-specific morphology on the bone surrounding the acetabulum. In further specific embodiments, the three-dimensional connection between the contact elements of the conductors and the specific regions of the pelvic bone of the patient ensures that the acetabular cup implantation zone surrounds the stability of the conductor through both translation and rotation (both unidirectional or bi-directional) along it and / or around a certain axis. Accordingly, in particular embodiments, the contact elements of the conductors according to the invention are designed such that, after placing the conductor, the conductor (and optionally the associated reamer for an acetabular cup) is moved in one or more (ie different) directions, including, for example, rotation and / or translation in one or more (ie different) directions, until the reamer has the desired orientation relative to the pelvis.
    To ensure the stability of the conductor, the contact points of the one or more contact elements are positioned such that the angle between the plane through the central axis of the circle formed by the acetabular edge and one contact point and the plane through the central axis and the adjacent contact point is less than or equal to 180 °. In special embodiments, this is ensured by the presence of at least three contact elements, wherein the angle between the plane through the central axis of the circle formed by the acetabular edge and one contact element and the plane through this central axis and the adjacent contact element is smaller is then or equal to 180 °. More specifically, it is contemplated that the conductors comprise three contact elements that include contact points that are separated by an angle of about 120 °. The contact elements typically span larger surfaces such that the distance between each of the different contact elements is less than 120 °. In special embodiments, contact elements are provided such that one contact element comprises a surface that spans more than one of these contact points.
    Thus, in particular embodiments, at least two of the one or more contact elements of the conductors, which span the bone in at least three contact points, form larger contact surfaces that extend over specific areas of the bone that surrounds the acetabular cup implantation zone. In particular embodiments, the one or more contact elements of the conductors extend over specific areas of the bone in at least one, such as at least two, or three or more different directions, to further enhance the stability of the conductors position on the conductors. to ensure pelvic bone. Indeed, in particular embodiments, the conductor is designed based on information from patient-specific medical images of the ischium, the ilium eri / or the pubis and uniquely fits the specific geometry of the bone of the ischium, the ilium and / or the pubis of the patient to which the conductor is applied, demonstrating the patient-specific nature of the conductor.
    In particular embodiments, the conductors of the present invention are modular instruments that include contact elements that can be adapted to closely match the patient specific morphology of the pelvic bone surrounding the acetabular cup zone. For example, in particular embodiments, the contact elements include individually controllable elements that are fitted either prior to or during attachment to the pelvic bone to ensure a tight fit with the acetabulum. More specifically, the contact elements are elements movably connected to a central support structure and which can be adjusted in height and / or moved, such as by rotation and / or translation, in order to provide the most accurate connection with the specific parts of the to ensure pelvic bone.
    In particular embodiments, one or more of the contact elements of the conductors of the present invention are attached and positioned to ensure correct connection with a corresponding pelvic bone structure.
    In particular embodiments, at least one of the contact elements of the conductors of the present invention comprises, at the contact point, a patient-specific surface on the side facing the pelvic bone, which is precisely and completely complementary, ie specifically fits on a specific anatomical region of the pelvic bone that surrounds the acetabular cup implant zone of the patient. This can be ensured by a pre-operative planning based on images of the (bored) acetabular cup zone. In further special embodiments, this specific connection may imply a clearance between the surface of the contact elements and the bone, such as, for example, a clearance between the surface of the contact elements and the bone of between 0.1 - 1.0 mm. When the patient-specific surfaces of the contact elements are contacted or placed against their corresponding complementary surfaces of the pelvic bone of the patient, they fit, fit and / or make contact with the surfaces, thereby fixing the conductor, and thus also the implant connected or attached to it in the correct and desired position.
    Typically, a patient-specific surface of a contact element is selected based on anatomical elements present on the pelvic bone that surrounds the implant zone. In particular embodiments, a patient-specific surface is selected that is based on anatomical elements present on one or more of the ilium part, the pubic part and the ischium part of the pelvic bone. However, it is also provided in particular embodiments that elements are introduced on the patient's bone to allow the generation of patient-specific surfaces on the contact elements based thereon.
    In particular embodiments as explained in detail above, the one or more contact elements of the conductors according to the invention are designed such that, after placing the conductor on the bone, ie a placement in which there is a close connection between the contact elements of the conductor and the corresponding anatomical areas of the pelvic bone of the patient, the conductor is forced into a position such that the reamer connected thereto has the desired orientation relative to the pelvis. In these embodiments, a (limited) movement, such as a rotation and / or translation of the conductor after placement, ensures that the one or more contact elements take their correct position, ie ensuring a connection or coupling between the (patient-specific) areas of the one or multiple contact elements of the conductors and the corresponding anatomical regions of the pelvic bone of a patient surrounding the acetabular cup implantation zone. In this way, the stability of the conductors is ensured by the prevention of both translation and rotation.
    In addition to the condition that they ensure a close connection to the pelvic bone, the size and shape of the contact elements of the conductors according to the present invention are not critical to the invention. Typically, the size and shape of the contact elements of the conductors of the present invention is determined by the three-dimensional surface of the pelvic bone surrounding the acetabular cup implant zone, more particularly from the pelvic bone surrounding the acetabular cup implant zone of the patient for whom it is designed, surrounds. In particular embodiments, the contact elements correspond to flanges, i.e. longitudinal structures extending from the support structure of the conductors of the invention in different directions and allowing a stable connection of the conductors to the pelvic bone. In further special embodiments, the flanges extend in the direction of the ilium, ischium and pubic, respectively. According to these embodiments, conductors with at least three, more particularly conductors with three flanges are considered.
    In certain embodiments, the conductors according to the invention can further comprise one or more positioning elements that allow the passage of or the connection to a positioning device. Typically, such a positioning device is introduced into the bone that surrounds the acetabulum in a planned position after positioning the conductor in its appropriate position on the pelvic bone. The conductor is then removed from the bone and leaves the positioning device in place, and connected to the reamer. The positioning device then facilitates the repositioning of the guide and wider combination. Optionally, the positioning device is further used in the remaining procedure, e.g. for orientation of the reamer and / or positioning of the implant. In particular embodiments, the positioning element is a hole, a cannula, a channel or a groove provided on one or more contact elements, which allows the passage of a positioning device such as a guide pin. In special embodiments, the element comprises at least one cylindrical hole. In addition or alternatively, the positioning device comprises a handle or other fastening element that allows a connection to a positioning device, such as a guide pin.
    More specifically, the nature of the one or more positioning elements of the conductors (i.e., actual height or distance with respect to the surface of the bone) is determined to ensure adequate conduction of the conductor by the positioning device or vice versa.
    As explained in detail above, in particular embodiments, the positioning element in the guide is designed for use in positioning the positioning device in the bone. In these embodiments, the one or more positioning elements may include a safety stop to prevent a positioning device from going beyond a planned depth in the bone.
    The location of a positioning element on the one or more contact elements of the conductors according to the present invention is determined based on anatomical characteristics of the bone, the desired position of the conductor on the pelvic bone and the structure of the conductor. The positioning element (s) is (are) located on. the guide such that the guide is in the desired position when the positioning device is locked in the one or more positioning elements.
    In special embodiments, the conductors according to the invention can comprise one or more fixing elements that allow the adhesion or connection of the conductor to the bone by means of one or more fixing means, such as pins or screws. According to these embodiments, one or more fasteners are used to fasten the conductor to the pelvic bone that surrounds the acetabulum after placing the conductor in its designated position. Typically, the location of such fasteners is planned during the manufacture of the conductor, based on anatomical characteristics of the bone and surrounding tissue, and taking into account the operation window.
    In special embodiments, the fixing element is a hole, a cannula, a channel or a groove provided on one or more contact elements, which allows the passage of a fixing device such as a fixing pin or screw. In special embodiments, the element comprises at least one cylindrical hole.
    The conductors according to the present invention are intended for use in combination with a reamer for an acetabular cup and for proper functioning, it is required that the conductor and the reamer are sufficiently, more particularly, reversibly connected. The "connection" between the conductor and a reamer is one that ensures that the position of the reamer is determined by the position of the conductor but that allows free rotation of the reamer along its axis. According to the present invention this is ensured by one or more connecting elements which can themselves be provided on the conductor and / or on the reamer. In special embodiments, the connecting elements ensure the passage of the reamer's stem through the opening that is part of, or connected to, the conductor. More in particular, the connecting elements are removable from the reamer and / or the conductor. In more particular embodiments, the connecting elements form a combination of elements which are reversibly present on the reamer and / or conductor, wherein each element can be separately and / or the combination of elements detached from the reamer and / or the conductor.
    As described above, typically more than one reamer head is used in the preparation of the implantation zone. The reamer heads can be supplied as separate reappers or can be provided as interchangeable reamer heads of one reamer instrument. Accordingly, the connecting elements of the conductors of the present invention are designed to connect the conductor to either one or a series of reamers. Prior to drilling, the conductor is attached to the reamer by means of the connecting element (s). The connecting elements ensure that there is a close connection such that the reamer can be held in position during drilling. The connecting element present on the conductors of the present invention allows rotation of the reamer about its longitudinal axis. In particular embodiments of the invention, the connecting element (s) themselves do not follow the rotation of the reamer stem. In particular embodiments, the one or more connecting elements present on the conductor according to the invention interact with one or more connecting elements on the reamer that allow the reamer to rotate about its longitudinal axis when the reamer is placed within the guide.
    The one or more connecting elements of the conductors according to the present invention can take different shapes and sizes. Typically, the conductors of the present invention comprise at least one aperture that allows the passage of the handle of a reamer. More specifically, the opening is a shaft designed to allow the passage of the handle of a broader. In special embodiments, the shaft is designed to engage precisely with the circumference of the handle of a reamer. In further special embodiments, one or more connecting elements form a separate device that can be connected to the conductor. The one or more connecting elements are optionally provided with locking elements that allow a tight locking with either the guide or the reamer's handle.
    In particular embodiments, the guides, the connecting elements and / or the reamers of the present invention are further designed such that, after placement of the reamer therein, the movement of the reamer along its longitudinal axis, more particularly, the movement of the handle downwards, ie to the pelvis bone. This prevents the reamer from penetrating the bone to an excessive depth. If the drilled out cavity is indeed too deep, the implant cannot be placed in the desired position.
    The element for preventing movement of the reamer along its longitudinal axis is ensured in special embodiments by one or more locking elements. These locking elements can be present on (or be reversibly attached to) the reamer and / or the conductor and / or the connecting element (s).
    In special embodiments, at least one of the one or more locking elements forms part of the reamer. For example, a locking element present on (or reversibly attached to) the reamer's stem is positioned such that it can interact with the conductor or a connecting element when the reamer is placed in the conductor. In special embodiments, at least one of the one or more locking elements forms an integral part of the reamer stem. More specifically, the locking element corresponds to an extension of the diameter of the stem or a protrusion present on the stem. The protrusion present on the handle of the reamer cannot pass through the shaft of the guide, but rather interacts with the edge of the shaft.
    In special embodiments, at least one of the one or more locking elements is present on (or removably attached to) the conductor. In further special embodiments, the one or more locking elements that are present on the conductor are included in a connecting element. In a more special embodiment, a locking element consists of the edge of the shaft of the guide which provides passage (but also limits the passage) of the handle of the reamer.
    In special embodiments, as explained in detail above, the one or more locking elements form a separate device, i.e. which is removable from the reamer and / or the conductor and / or the connecting element. More in particular, the one or more locking elements form a combination of elements that are reversibly present on the reamer and / or conductor, wherein each element separately and / or the combination of elements can be detached from the reamer and / or the conductor.
    The location of the locking element on the guides and / or the corresponding scrapers according to the present invention is determined by the depth to which the scraper should be able to move. This can be determined by pre-operative planning based on images of the acetabular cup zone prior to preparation and the projected position of the acetabular cup implant.
    As described in detail above, the conductors of the present invention are designed for use in combination with one or more reamers for an acetabular cup. Reamers for an acetabular cup comprising a handle and a reamer head are known to those skilled in the art and it can be considered that the guides according to the invention can be adapted to work with known reamers for an acetabular cup. In special embodiments, the conductors according to the invention are designed for use in combination with a reamer for an acetabular cup which is provided with one or more designated connecting element (s) and / or locking element (s) which, after placement of the reamer in the conductors according to the invention ensure a close connection of the reamer for an acetabular cup in the conductor, while allowing rotation of the reamer and the conductor along its longitudinal axis and central axis, respectively. In particular, it is intended that the handle of the reamer fit through an opening of the one or more connecting elements of the conductor.
    Accordingly, a further aspect of the invention provides combinations of a reamer for an acetabular cup and a conductor which, when interconnected, ensure a close connection of the reamer for an acetabular cup in the conductor, while rotation of the reamer along its longitudinal direction as is permitted.
    The combinations of a reamer for an acetabular cup and a guide according to the present invention are characterized by the fact that they comprise a reamer for an acetabular cup comprising a handle and a clearing element wherein the clearing element is optionally reversibly attached to the handle and typically roughly has a semicircular shape; and a guide for the reamer for an acetabular cup that includes one or more contact elements that fit on areas of the bone surrounding the acetabular cup implantation zone in at least three contact points.
    In particular embodiments of the combinations according to the invention, two or more of the one or more contact elements of the conductors of the invention form larger contact surfaces that extend over specific areas of the bone that surrounds the acetabular cup implantation zone in at least three contact points. Thus, in particular embodiments of the combinations according to the invention, the one or more contact elements of the conductors of the invention extend over specific areas of the bone in at least one, such as at least two, or three or more different directions, further ensure the stability of the position of the conductors on the pelvis bone. Indeed, in particular embodiments, the conductor is designed based on information from patient-specific medical images of the ischium, the ilium and / or the pubis and uniquely fits the specific geometry of the bone of the ischium, the ilium and / or the pubis of the patient to which the conductor is applied, demonstrating the patient-specific nature of the conductor.
    As described above, the contact elements of the conductors of the present invention are designed such that the angle between the plane through the central axis (Y) of the circle formed by the acetabular edge and one contact point and the plane through the central axis (Y) and the adjacent contact point is never greater than 180 ° and, after contacting said specific areas of the bone surrounding the acetabulum, a tight connection of said conductor to said bone is ensured.
    In special embodiments of the combinations according to the invention as described in detail above, the contact elements present on the conductor are designed such that, after placing the conductor on the bone, the conductor (optionally with the reamer attached for an acetabular cup ) after placement in a position such that the guide is in the desired orientation relative to the pelvis.
    In particular embodiments of the combinations according to the invention, this may imply movement of the conductor (and optionally the associated reamer for an acetabular cup) in one or more (ie different) directions, including, for example, rotation and / or translation movement of the conductor (and optionally the associated reamer for an acetabular cup) in one or more (ie different) directions, until the reamer has the desired orientation relative to the pelvis.
    The combinations of a reamer for an acetabular cup and a guide according to the present invention are further characterized by the fact that they comprise one or more connecting elements that reversibly lock the reamer with the guide, and that a free rotation of the reamer about its longitudinal axis allow. The one or more connecting elements are provided on the reamer for an acetabular cup and / or on the guide. In special embodiments the conductor comprises a connecting element which comprises at least one passage for the reamer, more in particular for the handle of the reamer. In addition, the reamer itself, more particularly the handle of the reamer, in special embodiments, comprises one or more connecting elements which cooperate with it. In further special embodiments, the one or more connecting elements form a separate device that can be connected to the conductor. In particular embodiments, the one or more connecting elements provided on the handle of the reamer ensure a close connection with the guide while allowing rotation of the hold element about the central axis of the handle. Typically, the one or more connecting elements present on the reamer comprise special elements that lock tightly with the connecting element of the conductor. In particular embodiments, the connecting element is a shaft that is stretched on the reamer stem, which fits tightly into a shaft that is stretched on the guide.
    In particular embodiments, the combinations of a reamer for an acetabular cup and a guide according to the present invention are further characterized by the fact that they comprise one or more locking elements that limit the movement of the reamer along its longitudinal axis, to prevent the penetrating into the bone to an excessively large depth. The locking elements according to the invention are provided on the guide and / or on the reamer and / or on the connecting element. The various embodiments contemplated above for the locking elements also apply to the combinations described herein.
    More specifically, the one or more locking elements of the guides of the present invention may consist of the edge of the shaft of the guide that provides the passage for the shank of the reamer.
    Also, as described above, in particular embodiments, one or more locking elements provided on (or reversibly secured to) the reamer's stem interact with (an element on) the guide such that the movement in at least one direction along the axis of the broker is limited. In particular embodiments, the locking elements prevent the reamer from moving along its longitudinal axis in both directions. For example, in particular embodiments, at least one of the one or more locking elements interacts with the reamer when it is placed in the guide, such as by interacting with (a locking element present on) the reamer stem. In particular embodiments, the locking element is a protrusion which is provided on the handle of the reamer, which cannot pass through the shaft of the guide and / or the connecting elements. In still further special embodiments, the one or more locking elements form a separate device, i.e. which is removable from the reamer and / or the guide. In special embodiments, the one or more locking elements form a combination of elements that are reversibly present on the reamer and / or on the conductor, wherein each element can be separately and / or the combination of elements detached from the reamer and / or the conductor .
    In one particular embodiment, the one or more locking elements that are optionally provided in the combination according to the present invention are provided as an integral part of the one or more connecting elements.
    In special embodiments of the combinations according to the invention, the conductors comprise one or more fixing elements which allow the attachment or the connection of the conductor to the bone by means of one or more fixing means, such as pins or screws. In special embodiments, the fixing element is a hole, a cannula, a channel or a groove provided on one or more contact elements, which allows the passage of a positioning device such as a guide pin.
    The reamers provided in the combinations according to the present invention typically include a handle and a ream element. Typically, the clearing element has a roughly semicircular shape and is provided on its outer surface with cutting or shaving elements that allow bone scraping away when rotating movement of the clearing element is performed. Reaming elements or reaming cups with different cutting elements are known to the skilled person. The clearing elements are typically removable or removable and optionally interchangeable from the handle such that the various clearing elements can be successively fitted to one wiper stem.
    The reamers provided in the combinations according to the present invention may further comprise a hinge in the handle of the reamer. As described in detail above, this hinge allows independent movement of the end of the handle (opposite to the reamer cup) and the reamer cup. Most particularly, the hinge can permit the movement of the end of the shank in a position where an angle is formed with the remaining portion of the shank. In this way, the presence of the hinge prevents a moment of force from arising on the conductor, i.e., a tendency to torch or rotate the conductor when the surgeon holds the reamer in a non-optimal or sub-optimal position; this prevents the conductor from being placed in an incorrect position. This can be interesting when the device is to be introduced within a limited surgical window. In special embodiments, the hinge 1 is a cross-hinge coupling, also called a universal joint, a universal joint, a universal joint or a universal joint. In these embodiments, the cross-hinge coupling allows the end of the stem to bend or rotate in all directions relative to the remaining portions of the stem and relative to the ratchet element, and thus to achieve an independent rotary movement of the end of the handle with respect to the other parts of the handle and with respect to the reamer element.
    In further particular embodiments, this hinge allows a rotation of the reamer element relative to the end of the reamer stem that is typically connected to a tool tool, to ensure correct placement of the reamer in the acetabular cup.
    A still further aspect of the present invention provides methods for manufacturing conductors according to the present invention.
    As explained in detail above, in particular embodiments, the conductors include contact elements designed to ensure a tight connection of the conductor to the bone surrounding the acetabulum. In particular embodiments, this is ensured by designing the conductor or at least the contact elements based on pre-operative images of the bone surrounding the acetabular implantation zone and the implant to be inserted therein. Accordingly, the methods of producing the (patient-specific) conductors of the invention typically include the step of (a) obtaining volume information of the pelvic bone and the acetabular implant to be placed therein, (b) identifying and selecting of parts of the bone surrounding the implantation zone suitable for use as a base for the contact elements of the conductor, and (c) producing a conductor based on the information obtained in steps (a) and (b). In particular embodiments, step (b) comprises identifying and selecting parts of the bone surrounding the implantation zone that contain sufficient elements such that the connection of the contact elements with the bone is patient-specific.
    Typically, the step of identifying and selecting parts of the bone that surrounds the implantation zone suitable for use as a base for the contact elements includes selecting a portion of the ilium, ischium and pubic bone of the pelvis suitable for use as a basis for a contact element.
    In particular embodiments, the methods of the present invention further include the step (b ') of identifying the depth to be bored with a particular reamer and the corresponding freedom of movement of the reamer to be allowed due to the presence of the locking element present on the guide and / or reamer for an acetabular cup. This can be ensured by pre-operative planning. Accordingly, in particular embodiments, the methods of the present invention include the step of producing a conductor, further taking into account the information obtained in this additional step (b '). In special embodiments, this implies that the conductor further comprises special elements which ensure that successive reamers can be moved to ascending depths.
    The method for manufacturing the conductors according to the invention may further comprise the step (b ") of identifying and selecting a suitable position for placing a positioning device and the corresponding positioning element in the conductor. Again, this can be ensured Thus, in particular embodiments, the methods of the present invention include the step of: producing a conductor, further taking into account the information obtained in this additional step (b ").
    In particular embodiments, the method for manufacturing the conductors of the invention includes the step (bm) of identifying and selecting a suitable position for the fasteners, ie, places where a fastener can be introduced into the pelvic bone around the conductor thereto to confirm. Thus, in particular embodiments, the methods of the present invention include the step of producing a conductor, further taking into account the information obtained in this step (b, M).
    It will be understood that the order of each of steps b, b ', b ", or b'", where applicable, is not critical in the methods of the invention.
    The step of obtaining volume information from the pelvic bone and the acetabular implant to be placed typically comprises obtaining digital patient-specific image information, which can be performed by any suitable means known in the art, such as, for example, a computed tomography (CT) scanner , a magnetic resonance imaging (MRI) scanner, an ultrasonic scanner, or a combination of X-rays. A summary of medical imaging is described in "Fundamentals of Medical Imaging", by P. Suetens, Cambridge University Press, 2002.
    In a particular embodiment, Additive Manufacturing (AM) techniques are used to manufacture the conductor according to the invention. Additive Manufacturing (AM) can be defined as a group of techniques used to produce a tangible model of an object, typically using three-dimensional data for (3-D) computer assisted design (CAD) of the object. A large amount of Additive Manufacturing techniques is currently available, including Stereolithography, Selective Laser Sintering, Fused Déposition Modeling, foil-based techniques, etc.
    Selëctive Laser sintering uses a high-power laser or other concentrated heat source to sinter or weld small particles of plastic, metal, or ceramic powder into a mass that represents the 3-dimensional object to be formed.
    Fused Déposition Modeling and related techniques use a temporary transition from a solid material to a liquid state, usually as a result of heating. The material is pressed through an extrusion nozzle in a controlled manner and deposited at the required location as described, inter alia, in U.S. Patent No. 5,141,680.
    Foil-based techniques attach layers to each other by gluing or photopolymerization or other techniques and cut the article from these layers or polymerize the article. Such a technique is described in US Patent No. 5,192,539.
    Typical AM techniques start from a digital representation of the 3-D object to be formed. In general, the digital representation is cut out as a series of cross-sectional layers that can be superimposed to form the object as a whole. The AM device uses this data to build the object on a layer-by-layer basis. The cross-sectional data representing the layer data of the 3-D object can be produced using a computer system and computer-assisted design and production software (CAD / CAM).
    The conductors according to the present invention can be made from different materials. Typically, only materials are considered that are biocompatible (eg USP class VI compatible) with the human body. Preferably, the surgical mold is formed from a material that can tolerate heat allowing it to tolerate high temperature sterilization. In the case that Selective Laser Sintering is used as an AM technique, the surgical mold can be made from a polyamide such as PA 2200, as can be supplied by EOS, Munich, Germany or another material known to those skilled in the art can also be used to become.
    A still further aspect of the present invention relates to the use of the conductors and / or combinations according to the present invention. More specifically, the invention provides methods for accurately drilling out an acetabular cup zone, which methods include the steps of placing the reamer for an acetabular cup in the guides of the present invention, positioning the guide on the pelvic bone, and ensure that the one or more contact elements are properly placed on the pelvis bone to ensure a unique connection of the conductor.
    In special embodiments where the conductor according to the present invention is provided with a positioning element, the methods according to the invention may comprise the steps of positioning the conductor on the pelvis bone and ensuring that the one or more contact elements are properly placed on the pelvis pelvic bone to ensure a unique connection of the conductor, fixing the positioning device in the pelvic bone based on the positioning element, removing the conductor from the pelvic bone, placing the reamer in the conductor and repositioning the conductor + reamer on the pelvic bone using the positioning device.
    The various aspects of the invention are illustrated herein by the following non-limiting embodiments.
    Embodiment 1
    According to particular embodiments, a combination of a reamer for an acetabular cup and a guide is provided as illustrated in Figure 2A. The combination comprises a reamer for an acetabular cup (1) and a guide (5). The reamer for an acetabular cup (1) comprises a handle (2) and a hold element (3), the hold element being firmly attached to the end of the handle and having a roughly semicircular shape.
    The conductor (5) comprises one or more contact elements (6) that fit on specific areas of the bone that surrounds the acetabular Cup implantation zone. The combination further comprises a connecting element (7) which is reversibly firmly attached to the guide (5) and which allows the passage of the shank (2) of the reamer (1), allowing free rotation of the reamer about its longitudinal axis .
    The reamer stem is provided with a locking element (4) that limits the movement of the reamer (1) along its longitudinal axis, such as to prevent the reamer from penetrating the bone to an excessively large depth.
    Figure 3 illustrates a side view of the combination of a reamer for an acetabular cup (1) and a guide (5) as described above, placed on the pelvis bone (11). The conductor (5) comprises three contact elements (6) which contact the pelvis bone in at least three contact points. The three contact elements are designed such that the angle between the plane through the central axis (Y) of the circle formed by the acetabular edge corresponding to the reamer's central axis, and one contact point and the plane through the central axis (Y) and the adjacent contact point does not exceed 180 °. The contact elements fit on specific areas of the bone surrounding the acetabulum, ensuring a close connection of the conductor to said bone; the conductor (5) is shown with the connecting element (7) attached to it, which allows the passage of the reamer's stem (2). The handle comprises a locking element (4).
    Figure 2B illustrates a longitudinal section of a part of the combination of a reamer for an acetabular cup (1) and a guide (5) as described above.
    The reamer (1) comprises a handle (2) and a clearing element (3) connected thereto. A part of the conductor (5) is shown to which a connecting element (7) is attached. A locking element (4) is provided on the handle (2) of the reamer (1).
    Embodiment 2
    Figure 4 illustrates a combination of a reamer for an acetabular cup (1) and a guide (5) according to a further embodiment of the invention that is placed on the pelvic bone (11). The conductor (5) comprises three contact elements (6) that fit on the pelvis bone in at least three contact points. One of the contact elements (6) comprises a positioning element (8) which corresponds to a gap. The positioning element is used for the placement of a positioning device (9) in the pelvis bone. The contact elements (6) of the conductor (5) connect to specific areas of the bone surrounding the acetabulum, thereby ensuring a close connection of the conductor to said bone. The conductor (5) is shown with the connecting element (7) connected thereto, which allows the passage of the reamer's stem (2). The handle comprises a locking element (4).
    Figure 5 illustrates a top and bottom view of a combination of a reamer for an acetabular cup (1) and a guide (5) according to this embodiment. Facing from below (A), the reaming element (3) of the reamer (1) is visible, as well as the patient-specific surfaces of the contact elements (6) of the conductor (5). Faced from above (B), the conductor (5) is visible with its three contact elements (6).
    Embodiment 3
    Figure 6 illustrates a combination of a reamer for an acetabular cup (1) and a guide (5) according to a further particular embodiment of the invention, which is positioned on the pelvis bone (11). The reamer (1) comprises a handle (2) and a clearing element (3). The shank comprises a hinge (10) that allows the rotation of the clearing element relative to the end of the shank that was inserted into a tool tool. In this embodiment, the hinge takes the form of a cross-hinge coupling, which is further clearly illustrated in Figure 7A.
    The handle of the reamer further comprises a locking element (4). The conductor (5) is shown comprising three contact elements (6). A connecting element (7) is attached to the conductor.
    权利要求:
    Claims (22)
    [1]
    A combination of a reamer for an acetabular cup (1) and a guide (5), comprising: - a reamer for an acetabular cup (1) comprising a handle (2) and a reaming element (3), wherein the reaming element (3 ) is securely attached to the end of the shank (2) and has a roughly semicircular shape and wherein the shank (2) comprises a hinge (10) that the movement of the end of the shank in an orientation different from the holds element (3); and - a conductor (5) comprising one or more contact elements (6), wherein two or more of said contact elements (6) form larger contact surfaces, extending over specific areas of the bone surrounding the acetabular cup implantation zone in at least three contact points , wherein the one or more contact elements (6) are designed such that the angle between the plane through the central axis (Y) of the circle formed by the acetabular edge and one contact point and the plane through the central axis (Y) and the adjacent contact point never exceeds 180 ° and which, after contacting said areas of the bone surrounding the acetabulum, ensure a close connection of said conductor (5) to the bone; and - one or more connecting elements (7) which reversibly connect the reamer (1) to the guide (5) and allow a free rotation of the reamer (1) about its longitudinal axis.
    [2]
    The combination according to claim 1, wherein at least one of the one or more connecting elements forms part of the reamer and / or forms part of the conductor.
    [3]
    The combination according to claim 1, wherein said one or more connecting elements form a combination of elements or a separate device that is removable from the reamer and / or the conductor.
    [4]
    The combination according to any of claims 1 to 3, wherein said contact elements are designed such that, after placing the conductor on the bone, said conductor and said reamer for an acetabular cup are forced into a position such that the reamer has the desired orientation to the pelvis.
    [5]
    The combination according to claim 4, wherein said guide, when placed on the bone, can be rotated to obtain the correct position on the bone.
    [6]
    The combination according to any of claims 1 to 5, wherein said conductor further comprises a positioning element that allows passage of a positioning device that is placed in the bone surrounding the acetabulum.
    [7]
    The combination of claim 6, wherein said positioning device is a pin that is placed in the bone that surrounds the acetabulum.
    [8]
    The combination according to any of claims 1 to 7, wherein the conductor is a medical image-based patient-specific instrument.
    [9]
    The combination according to any of claims 1 to 7, wherein the conductor is a modular device comprising elements with a standard shape that can be adapted to the shape of the bone.
    [10]
    The combination according to any of claims 1 to 9, comprising one or more locking elements that limits the movement of the reamer along its longitudinal axis, such as to prevent the reamer from penetrating the bone to an excessively large depth.
    [11]
    The combination according to claim 10, wherein at least one of the one or more locking elements forms part of the reamer, the conductor and / or the connecting elements.
    [12]
    The combination of claim 10, wherein said one or more locking elements form a separate device that is removable from the reamer and / or the guide.
    [13]
    A guide (5) for a reamer for an acetabular cup comprising: one or more contact elements (6), wherein two or more of said contact elements (6) form larger contact surfaces extending over specific areas of the bone that the acetabular cup implantation zone surrounds at least three points of contact, one or more connecting elements (7) allowing a reversible connection of the conductor (5) with a reamer (1) allowing a free rotation of the reamer about its longitudinal axis, and one or a plurality of locking elements that restrict the movement of the reamer along its longitudinal axis, such as to prevent the reamer from penetrating the bone to an excessively large depth, the one or more contact elements (6) being designed such that the angle between the plane through the central axis (Y) of the circle formed by the acetabular edge and one contact point and the plane through the central axis (Y) and the adjacent contact point is never greater than 180 ° and which, after contacting said specific areas of the bone surrounding the acetabulum, ensure a close connection of said conductor (5) to said bone.
    [14]
    The conductor of claim 13, wherein said connecting element is a separate device that can be connected to the conductor.
    [15]
    The conductor according to claim 13 or 14, wherein at least one of the one or more locking elements forms part of the one or more connecting elements.
    [16]
    The conductor of claim 14, wherein said one or more locking elements form a separate device that is removable from said conductor.
    [17]
    The conductor according to any of claims 13 to 16, wherein said contact elements are designed such that, after placing the conductor on the bone, said conductor and said reamer for an acetabular cup are forced into a position such that the reamer has the desired orientation to the pelvis.
    [18]
    The conductor of any one of claims 13 to 17, wherein said conductor further comprises a positioning element that allows passage of a positioning device that is placed in the bone surrounding the acetabulum.
    [19]
    The conductor of claim 18, wherein said positioning device is a pin that is placed in the bone that surrounds the acetabulum.
    [20]
    The conductor of any of claims 13 to 19, wherein the conductor is a medical image-based patient-specific instrument.
    [21]
    The conductor according to any of claims 13 to 20, wherein the conductor is a modular device comprising elements with a standard shape that can be adapted to the shape of the bone.
    [22]
    A method of manufacturing the combination according to any of claims 1 to 12 or the conductor according to any of claims 13 to 21, the method comprising: (a) obtaining volume information from the pelvic bone and the acetabular implant to be placed therein, (b) identifying and selecting parts of the bone surrounding the implantation zone suitable for use as a base for the contact elements of the conductor, and (c) designing and producing a conductor based on the information obtained in steps (à) and (b).
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    同族专利:
    公开号 | 公开日
    EP2575643A1|2013-04-10|
    US20130211407A1|2013-08-15|
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    法律状态:
    优先权:
    申请号 | 申请日 | 专利标题
    GB201009116|2010-06-01|
    GB201009116A|GB201009116D0|2010-06-01|2010-06-01|Acetabular cup reamer|
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