L-shaped side wing reinforcing block based on gluteus column structure and used for reconstruction around acetabulum
By designing an L-shaped lateral wing reinforcement block based on the gluteal column structure, and using point contact and bone cement cable to achieve a stable connection of the acetabular cup, the problem of unstable acetabular cup fixation in the prior art is solved, providing initial stability and long-term fixation effect.
Patent Information
- Application Number
- CN202510989691.0
- Authority / Receiving Office
- CN · China
- Patent Type
- Applications(China)
- Current Assignee / Owner
- Filing Date
- 2025-07-17
- Publication Date
- 2025-10-24
AI Technical Summary
Existing methods for periacetabular reconstruction are insufficient to achieve stable fixation of the acetabular cup. Traditional methods such as reinforcing blocks, buttress plates, and winged cages suffer from poor morphological adaptability, insufficient initial stability, and early failure.
The design incorporates an L-shaped lateral reinforcement block based on the gluteal column structure. The contact surface between the reinforcement block area and the acetabular cup is non-smooth, allowing for initial fixation through point contact. Secondary fixation is achieved using bone cement cable. The lateral region is fixed to the gluteal column with screws, providing initial stability and biological fixation.
It achieves a stable connection between the acetabular cup and the acetabulum, reduces longitudinal shear force, enhances the long-term fixation effect of the acetabular cup, and utilizes the abundant bone in the gluteal column region to provide core clamping action, ensuring the firm fixation of the acetabular cup.
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Figure CN120827458A_ABST
Abstract
Description
TECHNICAL FIELD
[0001] The present application relates to the technical field of medical devices, and particularly relates to an L-shaped side wing reinforcing block for periacetabular reconstruction based on the structure of the gluteal muscle column. BACKGROUND
[0002] Artificial hip joint revision is often accompanied by a large amount of osteolysis around the acetabulum, and firm reconstruction of the acetabular roof is crucial for achieving initial stability of the acetabular cup, but the reconstruction method is a great challenge for clinicians. The commonly used reconstruction methods include reinforcing blocks, Buttress plates, wing-shaped cages, etc., but all have corresponding defects and far from meet the needs of surgery: the reinforcing block has poor shape adaptability with the bone defect site, and it is difficult to achieve initial stability by screwing; the Buttress plate relies on iliac wing screws to achieve initial stability, but it is often insufficient to cope with the longitudinal shear force from the acetabular cup and leads to early failure; the shape adaptability of the wing-shaped cage is poor, it is difficult to achieve good initial stability, and it is difficult to achieve good biological fixation effect, and the early failure rate is high. Prior art also mentions two kinds of acetabular cup fixing blocks as shown in the accompanying Figure 4 The structure is fixedly connected with the acetabular cup through the side wing, and relies on the fixed side wing to generate tension on the acetabular cup to fix the acetabular cup, but the Journal of Clinical Orthopaedics and Trauma 54 (2024) 102488 clearly mentions that "to achieve good long-term fixation, the key is to carefully ream the acetabulum to the appropriate size and ensure that the entire edge of the prosthetic cup is in full contact with the bone to achieve a firm press fit." "In order to achieve the best clinical results, the initial stability provided by the press fit design or threads is necessary, and biological integration is the key factor to achieve good long-term results", from the above content, it is not difficult to know that the correct fixation of the acetabular cup should adopt the press fit method, so that the acetabular cup interferes with the acetabulum to achieve stability, rather than side wing tension fixation. And the inventor's previous biomechanical model experiment and pelvic specimen experiment confirmed that the gluteal muscle column extension area provides core mechanical support for the press fit and initial stability of the acetabular cup: As shown in the accompanying Figure 6Shown: Model experiment and process description: Column A: shows the pelvic model before the acetabular cup is hit. The upper part is the experimental group that retains the piriform muscle column, ischial branch and pubic branch. The lower part is the experimental group that removes the piriform muscle column and only retains the anterior inferior iliac spine, ischial branch and pubic branch. Column B: is a schematic diagram of the model state after the acetabular cup is implanted. The upper part is the experimental group that retains the piriform muscle column, ischial branch and pubic branch. The lower part is the experimental group that removes the piriform muscle column and only retains the anterior inferior iliac spine, ischial branch and pubic branch. Columns C and D: are photos of the tension test operation, showing the axial pull-out experiment (C) and the lateral pull-out experiment (D), respectively. The pull-out force of the acetabular cup is recorded in real time by a dynamometer. The upper part is the experimental group that retains the piriform muscle column, ischial branch and pubic branch. The lower part is the experimental group that removes the piriform muscle column and only retains the anterior inferior iliac spine, ischial branch and pubic branch.
[0003] As shown in Figure 7 : The bar chart shows the measurement results of the axial and lateral maximum pull-out force (N) under two different bone mass retention methods. The group that retains the piriform muscle column, ischial branch and pubic branch cannot pull out the acetabular cup in the axial pull-out test, showing significantly higher pull-out resistance. The group that removes the piriform muscle column and only retains the anterior inferior iliac spine, ischial branch and pubic branch has significantly lower pull-out force. The left column of each group is the axial pull-out, and the right column is the lateral pull-out. The data is represented by mean ± standard deviation, and the dots represent the results of each independent experiment.
[0004] As shown in Figure 8 : After implanting the acetabular cup in the pelvic specimen model according to the actual surgical procedure, the initial compression force provided by the piriform muscle column, ischial branch and pubic branch was measured respectively. The results show that the three have equal importance in the initial stability of the prosthesis.
[0005] The inventors confirmed that the piriform muscle column region is the thickest area of the iliac bone mass above the acetabular cup based on imaging measurements: As shown in Figure 9 : Column A: through three-dimensional reconstruction of hip CT data by Mimics software, the piriform muscle column (lighter color block, upper part) is clearly labeled, and its spatial anatomical position in the pelvis is intuitively displayed. Column B: is the pelvic anteroposterior and right obturator oblique X-ray films of the case, showing the postoperative prosthesis position and the overall structure of the pelvis. Column C: the CT three-dimensional reconstruction image is registered and projected with the corresponding X-ray image, showing the corresponding relationship between the position of the piriform muscle column region on the X-ray film, facilitating preoperative planning and intraoperative identification.
[0006] The inventors have previously used L-shaped side wings based on the piriform muscle column to reconstruct the bone defect around the acetabulum in clinical practice, and have accumulated more than 50 successful cases with an average follow-up time of more than 5 years, with a success rate of 100%.
[0007] As shown in Figure 10As shown: the figure shows the different manifestations of the proposed gluteal muscle column classification (I, IIA, IIB, III type) in three-dimensional reconstruction.
[0008] As shown: Figure 11 As shown: the figure shows the preoperative (A), postoperative X-ray (B) 3D printed half-pelvis model and custom reinforcement block, L-shaped side wing reinforcement block (C) of a representative actual application case. SUMMARY
[0009] The purpose of the present application is to solve the shortcomings in the prior art, and to provide an L-shaped side wing reinforcement block for periacetabular reconstruction based on the structure of the gluteal muscle column, comprising: The reinforcement block area is configured in the acetabular top bone defect area to bridge the host bone gluteal muscle column area and the acetabular cup, wherein the reinforcement block area includes a coronal plane with a first radius of curvature and a sagittal plane with a second radius of curvature; The side wing area bionically simulates the anatomical morphology of the natural acetabular iliac gluteal muscle column direction outer wall bone surface gluteal muscle column area, including a first arc-shaped surface that fits the iliac gluteal muscle column area bone surface, the bottom of the first arc-shaped surface of the side wing area is fixedly connected to one side of the reinforcement block area outside the acetabular top bone defect area, and the side of the side wing area away from the reinforcement block area is provided with a first mounting piece, and the side wing area is fixed to the iliac gluteal muscle column through the cooperation of the first mounting piece and the first fixing piece. Wherein, the arc-shaped surface of the lower end surface of the reinforcement block area near the side wing area abuts against the acetabular cup and exerts an abutting force on the acetabular cup towards the center area of the acetabular cup; and the lower end surface of the reinforcement block area and the upper end surface of the acetabular cup are fixedly connected through a second fixing piece.
[0010] Further, the first radius of curvature of the reinforcement block area in the coronal plane is greater than the radius of curvature corresponding to the maximum outer diameter of the acetabular cup in the coronal plane.
[0011] Further, the second radius of curvature of the reinforcement block area in the sagittal plane is greater than the radius of curvature corresponding to the maximum outer diameter of the acetabular cup in the sagittal plane.
[0012] Further, the reinforcement block area and the side wing area are 3D integrally printed.
[0013] Further, the lower end surface of the reinforcement block area in contact with the acetabular cup is a non-smooth surface.
[0014] Further, the lower end surface of the reinforcement block area and the acetabular cup are in point contact support to achieve preliminary fixation.
[0015] Further, the area where the lower end surface of the reinforcing block region is not in contact with the acetabular cup is a bone cement cable space, and bone cement is filled in the bone cement cable space to achieve secondary fixed connection of the reinforcing block region and the acetabular cup, and the bone cement is the second fixing member.
[0016] Further, the first mounting member is a plurality of through holes arranged in an arc shape uniformly on one side of the side wing region away from the reinforcing block region.
[0017] Further, the second fixing member is a screw.
[0018] Further, the side wing reinforcing block can be placed on the lateral side or the medial side of the ilium, and the thickness of the reinforcing block region matches the thickness of the acetabular roof bone defect area, or the sum of the thicknesses of the reinforcing block region and the filler matches the thickness of the acetabular roof bone defect area.
[0019] Compared with the prior art, the beneficial effects of the present application are: 1. The reinforcing block region of the L-shaped side wing reinforcing block for acetabular periprosthetic reconstruction based on the structure of the gluteal muscle column has a curvature radius on the coronal plane greater than that corresponding to the maximum outer diameter of the acetabular cup on the coronal plane. The curvature radius of the reinforcing block region on the sagittal plane is greater than that corresponding to the maximum outer diameter of the acetabular cup on the sagittal plane. Thus, the highest point of the acetabular cup can be in contact with the bottom point of the reinforcing block, i.e., the side wing reinforcing block always exerts a contact force on the acetabular cup towards the center of the acetabular cup, realizes press-fitting of the acetabular cup, causes the acetabular cup to interfere with the acetabulum, and thus ensures the stability of the acetabular cup.
[0020] 2. The reinforcing block region of the L-shaped side wing reinforcing block for acetabular periprosthetic reconstruction based on the structure of the gluteal muscle column is filled in the acetabular roof bone defect area, bridges the host bone gluteal muscle column region and the acetabular cup, and bears and conducts pressure stress; and the side wing region is fixed to the gluteal muscle column by means of a screw, which not only realizes initial stability of the reinforcing block region, but also reduces the longitudinal shear force of the traditional buttress plate.
[0021] 3. The applicant has confirmed through a large number of previous studies that the gluteal muscle column region has the most abundant bone mass and plays a core holding role on the acetabular cup. On this basis, an adaptive side wing reinforcing block is developed. The bone cortex in contact with the side wing part is the most abundant, and the use of a screw for fixation has the most secure fixing effect, which can achieve the most secure fixation.
[0022] 4. The applicant has confirmed through previous studies that the core point along the running direction of the gluteal muscle column plays a core clamping role on the acetabular cup, and based on this, a side wing reinforcing block is developed to reconstruct the gluteal muscle column defect position and function, and to play a core clamping role on the acetabular cup. BRIEF DESCRIPTION OF DRAWINGS
[0023] Various other advantages and benefits will become apparent to those of ordinary skill in the art upon reading the following detailed description of the preferred embodiments. The accompanying drawings are included to provide a further understanding of the application and are incorporated into and constitute a part of this specification, illustrate embodiments of the application and serve to explain the principles of the application, but are not limiting of the application. In the drawings: Figure 1 Lateral view of the L-shaped wing augment based on the structure of the gluteal muscle pillar for periacetabular reconstruction of the present application; Figure 2 Front view of the L-shaped wing augment based on the structure of the gluteal muscle pillar for periacetabular reconstruction of the present application; Figure 3 Structural schematic diagram of the L-shaped wing augment based on the structure of the gluteal muscle pillar for periacetabular reconstruction of the present application configured on the iliac mold Figure 4 Schematic diagram of two different acetabular cup fixation devices in the prior art; Figure 5 Schematic diagram of the curvature radius of the coronal and sagittal planes of the augment area; (a) and (b) are schematic diagrams of coronal fitting; (c) is a schematic diagram of sagittal fitting.
[0024] Figure 6 Schematic diagram of the model experiment and process of the present application; Figure 7 Bar chart of the experimental results on pull-out force; Figure 8 Bar chart of the experimental results on press-fit force; Figure 9 Schematic diagram of X-ray image; Figure 10 Schematic diagram of different manifestations of gluteal muscle pillar classification (type I, IIA, IIB, and III) in three-dimensional reconstruction; Figure 11 Schematic diagram of a representative actual application case. Reference signs 1: augment area; 2: wing area; 21: first arc surface; 22: first mounting member. DETAILED DESCRIPTION
[0025] In order to make the objectives, technical solutions and advantages of the present application clearer, further detailed description will be made to the present application in combination with the accompanying drawings and specific embodiments. It should be understood that the specific embodiments described herein are only used to explain the present application, and do not limit the present application.
[0026] For simplicity and brevity of the drawings, only parts related to the present application are shown in the drawings, which do not represent the actual structure of the product. In addition, in order to make the drawings simple and easy to understand, in some drawings, only one of the components with the same structure or function is shown schematically, or only one of them is marked. In this article, "one" not only means "only one", but also means "more than one".
[0027] First embodiment Please refer to Figures 1-11 The technical solution of the L-shaped side wing reinforcing block for periacetabular reconstruction based on the structure of the gluteal muscle column provided by the embodiment is as follows: The reinforcing block area 1 is configured in the acetabular top bone defect area (gluteal muscle column bone defect area) to bridge the host bone gluteal muscle column area and the acetabular cup, wherein the reinforcing block area 1 includes a coronal plane with a first radius of curvature and a sagittal plane with a second radius of curvature; The side wing area 2 simulates the anatomical morphology of the natural acetabular iliac gluteal muscle column direction outer wall bone surface gluteal muscle column area, including a first arc surface 21 that fits the iliac gluteal muscle column area bone surface, the bottom of the first arc surface 21 of the side wing area 2 is fixedly connected to one side of the reinforcing block area 1 outside the acetabular top bone defect area, the side away from the reinforcing block area 1 of the side wing area 2 is provided with a first mounting piece 22, and the side wing area 2 is fixed to the iliac gluteal muscle column through the cooperation of the first mounting piece 22 and the first fixing piece (screw); the first mounting piece 22 is a plurality of through holes arranged in an arc shape on the side of the side wing area 2 away from the reinforcing block area 1.
[0028] Wherein, the arc surface of the side wing area 2 close to the reinforcing block area 1 is in abutment with the acetabular cup, and exerts an abutment force on the acetabular cup towards the center area of the acetabular cup; the lower end surface of the reinforcing block area 1 and the upper end surface of the acetabular cup are fixedly connected through the second fixing piece (bone cement).
[0029] In specific implementation, in view of the defects of the existing periacetabular reconstruction means in the prior art and the clinical needs, it is proved from multiple dimensions such as anatomy, biomechanics and clinical cases that the core area of the reconstruction support above and above the acetabulum is the gluteal muscle column area, therefore, the side wing area 2 is fixed to the gluteal muscle column area, and the reinforcing block area 1 provided at the bottom of the side wing area 2 is configured in the bone defect area in the gluteal muscle column area as a filler, the thickness of the reinforcing block area 1 matches the thickness of the acetabular top bone defect area; when the defect area is large, a certain filler can also be filled in the gluteal muscle column bone defect area, and then the side wing reinforcing block is assembled, so that the upper arc surface of the side wing reinforcing block is in abutment with the filler, and in this case, the sum of the thickness of the reinforcing block area 1 and the filler matches the thickness of the acetabular top bone defect area.
[0030] In a specific implementation, to ensure that the highest point of the acetabular cup always maintains point contact with the lower arc surface of the reinforcement block region 1, the curvature radius of the reinforcement block region 1 in the coronal plane of the present invention is larger than the curvature radius corresponding to the maximum outer diameter of the acetabular cup in the coronal plane. The curvature radius of the reinforcement block region 1 in the sagittal plane is also larger than the curvature radius corresponding to the maximum outer diameter of the acetabular cup in the sagittal plane.
[0031] The principle of this design is as follows: Figure 5 As shown in (a) and (b) in the figure, if the first curvature radius of the coronal plane of the augmentation block region 1 is too small as shown in (b), when the acetabular cup is press-fitted, the cross-sectional outer diameter of the acetabular cup will contact the bottom surface of the augmentation block region 1 at two contact points, resulting in a gap between the highest point of the acetabular cup and the augmentation block region 1, making it impossible to achieve axial press-fitting, and thus prone to lack of stability; Figure 5 As shown in (c), when the second curvature radius of the enhancement block area 1 in the sagittal plane is larger, during the press-fitting process of the acetabular cup, the acetabular cup will be press-fitted along the lower end surface of the enhancement block area 2 to the middle of the lower end surface of the enhancement block area 1, that is, the highest point of the maximum cross-sectional radius of the acetabular cup contacts the middle of the lower end surface of the enhancement block area 1, forming initial stability. The interval formed between the lower end surface of the enhancement block area and the top of the acetabular cup can be filled with bone cement, and the enhancement block area and the acetabular cup are connected by a bone cement noose to achieve secondary fixation.
[0032] Specifically, the reinforcement block region 1 and the flank region 2 are integrally 3D printed. In practice, products of varying specifications can also be produced using traditional forging techniques. Specifically, the flank region 2 can be manufactured with varying widths, lengths, nail hole arrangements, thicknesses, and orientation angles. However, the curvature of the flank region 2 must be consistent with the morphology of the gluteal muscle column. The host bone surface of the flank region 2 can be manufactured with pores of varying diameters or a rough surface, allowing for bone ingrowth or bone growth. The reinforcement block region 1 can be manufactured with varying shapes, curvatures, thicknesses, and other properties depending on the volume of the acetabular bone defect.
[0033] Specifically, the lower end surface of the reinforcement block region 1 that contacts the acetabular cup is a non-smooth surface.
[0034] Specifically, the area where the lower end surface of the reinforcement block region 1 does not contact the acetabular cup is the bone cement noose space, and bone cement is filled in the bone cement noose space to achieve a secondary fixed connection between the reinforcement block region 1 and the acetabular cup. The host bone surface can be prepared as pores of different diameters or a rough surface, with biological properties of bone ingrowth or bone growth.
[0035] Finally, it should be noted that the above is only the preferred embodiment of the present application, and is not intended to limit the present application, although the foregoing embodiments of the present application are described in detail, for those skilled in the art, it still can be modified to the technical solution recorded in the foregoing embodiments, or equivalent replacement of some technical features. Any modification, equivalent replacement, improvement, etc. within the spirit and principles of the present application shall be included in the protection scope of the present application.
Claims
1. An L-shaped wing augmentation block for periacetabular reconstruction based on the structure of the gluteal muscle column, characterized in that, The application relates to a hip joint prosthesis, which comprises: a reinforcing block region configured to bridge a host bone gluteal muscle column region and a hip joint cup in a hip joint top bone defect area, wherein the reinforcing block region comprises a coronal plane with a first curvature radius and a sagittal plane with a second curvature radius; a side wing region, which is configured to simulate an anatomic shape of a natural hip joint iliac gluteal muscle column direction outer wall bone surface gluteal muscle column region, and comprises a first arc-shaped surface which is in contact with an iliac gluteal muscle column region bone surface, a bottom of the first arc-shaped surface of the side wing region is fixedly connected to one side of the reinforcing block region which is located outside the hip joint top bone defect area, and a side of the side wing region which is away from the reinforcing block region is provided with a first mounting piece, and the side wing region is fixed to the iliac gluteal muscle column through cooperation of the first mounting piece and a first fixing piece. The lower end surface of the reinforcing block region which is close to the arc-shaped surface of the side wing region is in abutment with the hip joint cup and exerts an abutment force on the center area of the hip joint cup, and the lower end surface of the reinforcing block region is fixedly connected to the upper end surface of the hip joint cup through a second fixing piece.
2. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 1, wherein: The first curvature radius of the reinforcing block region on the coronal plane is greater than the curvature radius corresponding to the maximum outer diameter of the hip joint cup on the coronal plane.
3. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 1, wherein: The second curvature radius of the reinforcing block region on the sagittal plane is greater than the curvature radius corresponding to the maximum outer diameter of the hip joint cup on the sagittal plane.
4. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 1, wherein: The reinforcing block region and the side wing region are integrally formed through 3D printing.
5. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 1, wherein: The lower end surface of the reinforcing block region which is in contact with the hip joint cup is a non-smooth surface.
6. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 1, wherein: The lower end surface of the reinforcing block region is in point contact with the hip joint cup to realize preliminary fixation.
7. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 6, wherein: The area of the lower end surface of the reinforcing block region which is not in contact with the hip joint cup is a bone cement cable space, and bone cement is filled in the bone cement cable space to realize secondary fixed connection of the reinforcing block region and the hip joint cup, and the bone cement is the second fixing piece.
8. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 1, wherein: The first mounting piece is a plurality of through holes which are uniformly arranged in an arc shape on the side of the side wing region which is away from the reinforcing block region.
9. The L-shaped wing augment based on the obturator pillar structure for periacetabular reconstruction of claim 1, wherein: The second fixing piece is a screw.
10. The L-shaped wing augment block for periacetabular reconstruction based on the structure of the gluteal-muscle column according to claim 1, characterized in that: The side wing reinforcing block can be placed on the lateral side or the medial side of the ilium. The thickness of the reinforcing block region is matched with the thickness of the hip joint top bone defect area, or the sum of the thickness of the reinforcing block region and the thickness of a filler is matched with the thickness of the hip joint top bone defect area.