DE102005027881B4 - Surgical tool and implantation set - Google Patents

Abstract

A surgical tool (16) for establishing a connection between a conduit (14) and a fillable implant (12), wherein the tool (16) has at least one tool portion defining a longitudinal direction (44), which has a conduit receptacle (46), and wherein the conduit receptacle (46) into which the conduit (14) is insertable extends parallel or coaxially or substantially parallel or coaxially to the longitudinal direction (44) of the tool section, characterized in that at the distal end (52) of the tool (16) a tool holder (54) is arranged for receiving a on the line (14) arranged Kupplungsseiements (40) for connection to the implant to be filled (12).

Description

The present invention relates to a surgical tool for establishing a connection between a conduit and a fillable implant, wherein the tool has at least one tool section defining a longitudinal direction which has a cable receptacle, and wherein the cable receptacle into which the cable can be introduced is parallel or coaxially or substantially parallel or coaxial with the longitudinal direction of the tool section.

Furthermore, the present invention relates to an implantation set comprising an implant, in particular in the form of a cavity-comprising intervertebral implant or vertebral body replacement, which can be inserted between two vertebral bodies of a spinal column.

It is known to use implants or instruments that can be filled with fluids in surgery. An implant is therefore understood below to mean both implants in the strict sense and instruments that can be temporarily inserted into a human or animal body and filled and / or emptied. As biocompatible fluids are often used air, water, contrast media or even before curing liquid bone cement. In order to fill the implant or instrument, it must, in particular after insertion into a human or animal body, be connected to a fluid source. As a line is advantageously a flexible hose, since it is possible with such even in a difficult to reach place to connect the fluid source with the implant.

From the DE 201 16 410 U1 is a surgical instrument for inserting a vertebral body, which comprises a fluid channel for filling a cavity having vertebral body replacement with a fluid known.

It is therefore an object of the present invention to connect a particularly flexible line in a simple manner with a fillable implant.

The object is achieved in that at the distal end of the tool a tool holder is arranged for receiving a arranged on the line coupling element for connection to the implant to be filled.

With such a surgical tool, it is possible to connect in a simple manner, in particular a flexible conduit with a refillable implant. If, for example, a hose is used as the flexible conduit and if it has to be twisted for the purpose of establishing a secure connection with the implant, in particular for screwing to the implant, this can lead to undesired twisting of the hose. In the worst case, the hose can thereby bend off and fluid supply from the fluid source to the fillable implant can be interrupted. Further, by the twisting of the lead, the operability thereof is deteriorated. These problems do not occur when using the surgical tool according to the invention, since the line can not twist in the line recording. This prevents the line from twisting inside the body during insertion or in the grip area of the tool. If the line is selected only slightly longer than the tool itself, virtually no twisting is possible. After connecting the implant to the conduit, it can then be connected to a source of fluid, such as a pressure vessel or cannula containing a fluid, so that the implant or instrument can be filled with the desired fluid. Characterized in that the line receiving coaxially or extends substantially coaxially to the longitudinal direction of the tool portion, the line when it must be rotated, coaxial or substantially coaxial with the tool with twisted, so that no relative twist between the line and the surgical tool occur can. In order to further simplify the handling of the tool, in particular to facilitate a connection of the line to the implant, it is advantageous that a tool holder is arranged at the distal end of the tool for receiving a coupling element arranged on the line for connection to the implant to be filled. By the tool holder, it is possible to take targeted the line in the region of the coupling element and apply, for example, for screwing the line with the implant with a torque. Moreover, the line can be held without force on the tool.

In order to prevent the line can twist relative to the tool in the region of the tool, ie in particular in the region in which the tool extends, it is advantageous if the tool portion from a proximal to a distal end of the tool over its entire length or substantially over its entire length extends. The line can thus safely guided in a portion corresponding to a length of the tool, held and introduced into a human or animal body, without the risk that the line is twisted in the region of the extension of the tool section. In addition, the structure of the tool is simplified when the tool section over the entire length or substantially over the entire length of the tool extends, since this can then be formed in particular rotationally symmetric or substantially rotationally symmetrical. However, it is not mandatory that the cable receiving extends over the entire length of the tool section. In particular, it can extend only over one or more subsections of the tool section.

The lead may be wholly or almost completely inserted into the lead receptacle of the tool when the lead receptacle extends from a proximal end to a distal end of the tool over its entire length or substantially the entire length thereof. By the introduced into the line receiving line, a twisting of the same can be prevented.

In order to introduce the line in a simple manner in the line recording, it is advantageous if an insertion opening is provided for introducing the line into the line receptacle and if the insertion opening is formed such that the line is transversely to the longitudinal direction of the line recording in this introduced. This makes it possible to bring the tool transversely to its longitudinal direction to the line and to introduce the line in the line recording. Thus, for example, the tool can be temporarily connected to the line and can be, in particular, even if both ends of the line are connected on the one hand to the implant and the other with a fluid source in a simple manner from the line.

Particularly simple is the structure of the tool when the cable receptacle has a slot extending parallel to the longitudinal direction and when the slot forms the insertion opening.

In order to prevent the introduced into the line receiving line can inadvertently escape from this, it is advantageous if an inner diameter of the line receptacle is greater than a width of the insertion opening. For example, by widening the insertion opening or by squeezing the line, the line can be introduced through the insertion opening into the line receptacle.

According to a preferred embodiment of the invention can be provided that a captive is provided to prevent the introduced into the line receiving line can emerge from the line receiving transversely to the longitudinal direction defined by the line recording. Such a captive facilitates the handling of the tool, as an operator, especially an operator, the line does not have to hold in the line recording by appropriate handling, as this is already held by the captive in this.

A particularly simple design of the tool results when the captive comprises a the insertion opening transversely to the longitudinal axis at least partially closing projection and / or when the line receptacle is at least partially undercut. In particular, a combination of the insertion opening at least partially occluding projections or a projection is conceivable with an undercut which extends only over a portion of the line receptacle in the longitudinal direction. It would of course also be conceivable to provide a closure element with which the insertion opening is at least partially closed and which is movable relative to the tool and / or can be removed therefrom. In particular, the captive can be designed such that a width of the insertion opening is at least partially smaller than a width of the line.

It is advantageous if the tool has substantially the shape of a rod and if the line receptacle is in the form of an opening or recess extending in the longitudinal direction of the rod.

In this way, both the structure of the tool and its production is particularly simple.

An opening or recess can be produced particularly easily if it is in the form of a bore or in the form of a longitudinal groove. In particular, the opening can also be formed by one or more holes in combination with one or more Längsnutabschnitten. A bore also has the advantage that it automatically forms a captive and does not allow leakage of the line from the line recording transversely to the longitudinal direction.

In order to simplify the structure of the instrument and its handling, it is advantageous if the tool holder is formed symmetrically with respect to a longitudinal axis of the line receptacle.

In order to additionally exert pressure forces from the tool on the line, it is advantageous if the tool holder is designed in the form of a frontally arranged, pointing in the distal direction depression. In addition, by such a configuration, a coupling between the coupling element and the tool holder by a displacement between the line and the tool be achieved parallel to the longitudinal direction of the tool.

In order to further simplify the structure of the tool and to increase the compatibility of the tool with conventional tools, it is expedient for the tool receptacle to be in the form of an inner polygon or an inner polygon. For example, the tool holder can be designed in the form of a hexagon socket.

Preferably, a torque limiting is provided, which is designed such that the coupling element slips when a predetermined torque in the tool holder is exceeded. This prevents that the coupling element is damaged by the tool holder. Furthermore, it is also prevented that the coupling element applied to the implant with a too large tightening torque and thereby possibly a connection, for example in the form of a connecting piece, can be damaged on the implant.

A particularly simple realization of the torque limiter is achieved if it comprises an expansion slot arranged on the tool holder and if the tool holder is made of a flexible material. If, for example, a tightening torque is exceeded, this construction of the tool allows the tool receptacle to widen and thus allow the coupling element to slip through in the tool receptacle.

To further simplify the structure of the tool, it is advantageous if the insertion opening forms the Aufweitschlitz. The insertion thus fulfills a dual function. On the one hand, it can be introduced through the line in the line recording, on the other hand, it forms the Aufweitschlitz, a component of the torque limiter.

Preferably, the tool is integrally formed. In this way, the stability of the tool is increased, moreover, it can also be easily produced, for example by injection molding, if it is made of plastic or metal.

In order to allow in particular a widening of the tool holder, it is advantageous if the tool is at least partially made of a flexible material.

The tool is particularly cost-effective to manufacture if the tool is wholly or partially made of a plastic.

Preferably, the plastic is polyetheretherketone (PEEK). The use of this material makes it possible in particular to sterilize the tool.

In order to simplify the handling of the tool even further, it is advantageous if the tool further comprises the line. As a result, for example, the tool can be sterilized together with the line and prepared for a surgical procedure. Of course, the tool and the line can be designed so that the line can be separated from the tool at any time. Furthermore, this embodiment has the advantage that the tool can be offered with the line as a unit, for example as a set.

In order to prevent that an undesirable deformation of the line can be effected by the tool, it is advantageous if the line has an outer cross section which corresponds to an inner cross section of the line receptacle or is slightly smaller.

In order to connect the line easily and safely with the implant to be filled, it is advantageous if the line has a coupling element for connection to the implant to be filled.

It would be conceivable to connect the coupling element with the implant or a connection thereof in the manner of a bayonet. However, the construction of the tool and the line becomes particularly simple when the coupling element of the line can be screwed to the implant.

Preferably, the coupling element has an internal thread. This makes it possible to form the tool in such a way that it terminates flush with the coupling element at the distal end or even projects beyond it.

The structure of the tool and the line is further simplified when the coupling element is in the form of a Außenvielkant or Außenvielrund. This also makes it possible to screw the coupling element with usually available in an operating room tools, such as a ring or a wrench, with a terminal of the implant to be filled.

In order to achieve a particularly secure screwing of the line with the implant to be filled, it is advantageous if the outer contour of the coupling element can be inserted in a form-fitting manner into the tool holder.

According to a preferred embodiment of the invention can be provided that an outer contour of the coupling element of a Inner contour of the tool holder similar and slightly smaller than this is that in a basic position in which no torque acts on the tool, the coupling element is rotatable relative to the tool holder only in an angular range about the longitudinal axis of the line recording, which is smaller than 180 °, and that in an overload position, in which a torque acts on the tool, which is greater than a predetermined limit torque, a rotation of the coupling element relative to the tool holder by any rotation angle is possible by elastic expansion of the inner contour of the tool holder. By this configuration can be prevented that the coupling element of the line can be acted upon by the tool with a too large tightening torque. In this way, a particularly simple torque limitation can be formed.

In order to realize an overload protection or a torque limitation in a simple manner, it is advantageous if a nominal diameter of the trained in the form of a polygonal coupling element is in a range of 0.95 times to 0.75 times a nominal diameter of the formed in the form of a polygonal tool holder equivalent. This configuration makes it possible that the coupling element can be rotated relative to the tool holder in a small angular range, but ensures that sufficient contact surfaces or edges are available to transmit a desired torque below a limit torque from the tool to the coupling element.

The object initially posed is further achieved according to the invention in an implantation set of the type described above in that a line is provided, that the implant has a connection for a line for filling the implant with a fluid and that a surgical tool for connecting the line with the Implant is provided.

Such an implantation set makes it possible to fill the implant with a preferably biocompatible fluid in a simple manner. Furthermore, such an implantation set ensures that all parts required for implantation and filling of the implant are available.

Particularly simple is the structure and operation of the Implantationsset when the surgical tool is one of the tools described above.

The implant is preferably a cavity-comprising intervertebral implant or a vertebral replacement body.

Advantageously, the above-described tools are used for establishing a connection between a conduit and a cavity-comprising intervertebral implant or vertebral replacement body for filling the same by means of the conduit with a biocompatible fluid.

Conveniently, a flexible line is used as the line.

The following description of a preferred embodiment of the invention serves in conjunction with the drawings for further explanation. Show it:

1 a schematic representation of a hose connection instrument when connecting a hose with a refillable implant;

2 a perspective view of a hose connector with a hose before merging the two parts;

3 a sectional view taken along line 3-3 in FIG 2 ; and

4 a sectional view through a distal end of the hose connector instrument with inserted tube.

In 1 is a total with the reference numeral 10 provided implantation set. It comprises a fillable implant comprising a cavity (not shown) 12 in the form of a vertebral body replacement, a conduit for filling the implant 12 in the form of a flexible hose 14 and a surgical tool for connecting the implant to the tube 14 in the form of a hose connection instrument 16 ,

The implant 12 includes two articulating surfaces 18 and 20 Applicable plates 22 and 24 and one between the plates 22 and 24 arranged and connecting these flexible cuff 26 surrounding the fillable cavity (not shown). The implant is used to replace a damaged, between vertebral bodies 28 and 30 two whirls 32 and 34 originally arranged vertebral body of a spine 35 , At the plate 24 is a cylindrical, transverse to a longitudinal axis of the implant 12 protruding connecting piece 36 arranged, which with an external thread 38 is provided.

At a distal end of the hose 14 is a coupler 40 in the form of a hexagon nut, which one to the external thread 38 corresponding internal thread 42 has arranged. The hose 14 and the coupling piece 40 are rotatably connected.

For connecting the hose 14 with the connecting piece 36 of the implant 12 serves the hose connection instrument 16 , which in the following in connection with the 2 to 4 will be described in more detail.

The hose connection instrument 16 has substantially the shape of an elongated cylindrical rod, which in its interior with a longitudinal axis 44 defining hole 46 is provided. The hole 46 forms a conduit or tube receptacle and extends from the proximal end, which is externally formed with a plurality of depressions 48 is provided for forming a grip portion, to the distal end. Likewise extends over the entire length of the hose instrument 16 a the bore 46 laterally opening longitudinal slot 50 which has a width which is smaller than a diameter of the bore 46 , The hole 46 and the longitudinal slot 50 together form such an undercut longitudinal groove into which the hose 14 transverse to the longitudinal axis 44 through the longitudinal slot forming an insertion opening 50 can be introduced. This is possible because the hose connector instrument is made of a flexible plastic, preferably polyetheretherketone (PEEK). Furthermore, it is preferably formed in one piece. The flexibility of the instrument allows the hose through the longitudinal slot 50 by widening it.

The distal end 52 the Schlauchanschlußinstruments facing with a distal direction, designed as a hexagon tool holder 54 Mistake. The tool holder 54 has an outer contour that the coupling piece 40 is similar. However, the dimensions of the coupling piece 40 and the tool holder 54 chosen so that just no positive engagement is possible. Rather, it is a nominal size 56 of the coupling piece 40 a little smaller than a nominal size 58 the tool holder 54 , This results in a certain clearance between the coupling piece 40 and the tool holder 54 which is a rotation about the longitudinal axis 44 of the coupling piece 40 relative to the tool holder 54 what is possible through the arrow 60 in 4 symbolized, by an angle 62 as he is also in 4 is drawn. The nominal diameter 56 corresponds to about 0.75 times to 0.95 times, preferably about 0.953 times the nominal size 58 , For example, the nominal diameter 56 6 mm, the nominal diameter 58 6.5 mm.

For connecting the hose 14 with the implant 12 First, the hose 14 through the longitudinal slot 50 inserted into the bore, taking care that the coupling piece 40 first in a distal direction over the end 52 protrudes. Then the hose can 14 be pulled in the proximal direction until the coupling piece 40 in the tool holder 54 dips. The hose connection instrument 16 can now with his distal end 52 progressing into a human or animal body in which the implant 12 is to be used, or already used, introduced and to the connecting piece 36 be introduced. The coupling piece 40 is done by means of the hose connection instrument 16 on the connecting piece 36 put on and by turning the connection instrument 16 around its longitudinal axis 44 over the coupling piece 40 on the connecting piece 36 screwed.

An operator tries with the hose connection instrument 16 a tightening torque on the coupling piece 40 to transfer, which is greater than a predetermined torque, then leads to the sliding of longitudinal edges 64 of the coupling piece 40 on inner surfaces 66 the tool holder 54 to one by arrows 68 and 70 symbolized widening of the longitudinal slot 50 so that the coupling piece 40 in the tool holder 54 slipped or twisted. By such a torque limiter can be prevented that both the coupling piece 40 as well as the connecting piece 36 of the implant 12 through the hose connection instrument 16 to be damaged. Damage is also prevented by the hose connection instrument 16 preferably made of a plastic, the coupling piece 40 In contrast, is made of a harder material, such as a biocompatible metal. The hose connection instrument 16 prevents the hose in the section between the coupling piece 40 and one from the proximal end of the tubing connector 16 can twist the protruding section. This will handle the hose 14 simplified, since neither a twisting of the hose 14 inside the body still in the area of a grip area 72 of hose connection instrument 16 is possible. Is one from the implant 12 pointing away free end of the hose 14 only after screwing the coupling piece 40 with the connecting piece 36 connected to a fluid reservoir, such as a bone cement syringe or a liquid container containing water or other biocompatible liquid, or with a compressed air source, then the hose 14 total twist-free connect the implant and the fluid reservoir together.

Claims (34)

Surgical tool ( 16 ) for establishing a connection between a line ( 14 ) and a fillable implant ( 12 ), the tool ( 16 ) at least one longitudinal direction ( 44 ) defining tool section, which a line recording ( 46 ), and wherein the line receptacle ( 46 ) into which the line ( 14 ) is insertable, parallel or coaxial or substantially parallel or koxial to the longitudinal direction ( 44 ) of the tool section, characterized in that at the distal end ( 52 ) of the tool ( 16 ) a tool holder ( 54 ) is arranged to receive one on the line ( 14 ) arranged Kupplungsseiements ( 40 ) for connection to the implant to be filled ( 12 ). Tool according to claim 1, characterized in that the tool portion from a proximal to the distal end ( 52 ) of the tool ( 16 ) extends over its entire length or over substantially its entire length. Tool according to one of the preceding claims, characterized in that the line receptacle ( 46 ) from a proximal end to the distal end ( 52 ) of the tool ( 16 ) extends over its entire length or over substantially its entire length. Tool according to one of the preceding claims, characterized in that an insertion opening ( 50 ) for introducing the line ( 14 ) in the line recording ( 46 ) is provided and that the insertion opening ( 50 ) is designed such that the line ( 14 ) transverse to the longitudinal direction ( 44 ) of the line intake ( 46 ) is in this einbringbar. Tool according to claim 4, characterized in that the line receptacle ( 46 ) one parallel to the longitudinal direction ( 44 ) extending slot ( 50 ) and that the slot ( 50 ) the insertion opening ( 50 ). Tool according to one of claims 4 or 5, characterized in that an inner diameter of the line receiving ( 46 ) is greater than a width of the insertion opening ( 50 ). Tool according to one of the preceding claims, characterized in that a captive is provided to prevent - that in the line receptacle ( 46 ) introduced line ( 14 ) from the line intake ( 46 ) across to the line receptacle ( 46 ) defined longitudinal direction ( 44 ) can escape. Tool according to claim 7, characterized in that the captive securing a the insertion ( 50 ) transverse to the longitudinal axis ( 44 ) comprises at least partially closing projection and / or that the line receptacle ( 46 ) is at least partially undercut. Tool according to one of the preceding claims, characterized in that the tool ( 16 ) has substantially the shape of a rod and that the line receptacle ( 46 ) in the form of a longitudinal ( 44 ) of the rod extending aperture ( 46 ) or recess is formed. Tool according to claim 9 , characterized in that the opening ( 46 ) in the form of a bore ( 46 ) and / or a longitudinal groove ( 46 . 50 ) is trained. Tool according to one of the preceding claims, characterized in that the tool holder ( 54 ) symmetrically with respect to a longitudinal axis ( 44 ) of the line intake ( 46 ) is trained. Tool according to one of the preceding claims, characterized in that the tool holder ( 54 ) in the form of a frontally arranged, pointing in the distal direction recess ( 54 ) is trained. Tool according to one of the preceding claims, characterized in that the tool holder ( 54 ) in the form of a Innenvielrund or a Innenvielkant ( 54 ) is trained. Tool according to one of the preceding claims, characterized in that a torque limiting is provided, which is designed such that the coupling element ( 40 ) when a predetermined tightening torque in the tool holder ( 54 ) slipped. Tool according to claim 14, characterized in that the torque limiting a on the tool holder ( 54 ) arranged expansion slot ( 50 ) and that the tool holder ( 54 ) is made of a flexible material. Tool according to claim 15, characterized in that the insertion opening ( 50 ) the expansion slot ( 50 ). Tool according to one of the preceding claims, characterized in that the tool ( 16 ) is integrally formed. Tool according to one of the preceding claims, characterized in that the tool ( 16 ) is at least partially made of a flexible material. Tool according to one of the preceding claims, characterized in that the tool ( 16 ) is wholly or partly made of a plastic. Tool according to claim 19, characterized in that the plastic is polyetheretherketone (PEEK). Tool according to one of the preceding claims, characterized in that the tool ( 16 ) the line ( 14 ). Tool according to claim 21, characterized in that the line ( 14 ) has an outer cross section, the an inner cross section of the line receiving ( 46 ) or slightly smaller. Tool according to one of claims 21 or 22, characterized in that the line ( 14 ) a coupling element ( 40 ) for connection to the implant to be filled ( 12 ) having. Tool according to claim 23, characterized in that the coupling element ( 40 ) of the line ( 14 ) with the implant ( 12 ) is screwed. Tool according to claim 24, characterized in that the coupling element ( 40 ) an internal thread ( 42 ) having. Tool according to one of claims 23 to 25, characterized in that the coupling element ( 40 ) in the form of an external polyhedron ( 40 ) or Außenvielrund is formed. Tool according to one of claims 23 to 26, characterized in that the outer contour of the coupling element ( 40 ) positively in the tool holder ( 54 ) is insertable. Tool according to one of claims 23 to 27, characterized in that an outer contour of the coupling element ( 40 ) an inner contour of the tool holder ( 54 ) is similar and slightly smaller than this - that in a normal position in which no torque on the tool ( 16 ), the coupling element ( 40 ) relative to the tool holder ( 54 ) only in an angular range ( 62 ) about the longitudinal axis ( 44 ) of the line intake ( 46 ) is rotatable, which is smaller than 180 °, and - that in an overload position in which a torque on the tool ( 16 ), which is greater than a predetermined limit torque, a rotation of the coupling element ( 40 ) relative to the tool holder ( 54 ) by any angle of rotation is possible by elastic expansion of the inner contour of the tool holder ( 54 ). Tool according to claim 28, characterized in that a nominal diameter ( 56 ) of the form of a polygonal coupling element ( 40 ) is within a range of 0.95 times to 0.75 times a nominal diameter ( 58 ) formed in the form of a polygonal tool holder ( 54 ) corresponds. Implantation set ( 10 ) comprising an implant ( 12 ), which lies between two vertebral bodies ( 28 . 30 ) a spinal column is used, wherein a line ( 14 ), the implant ( 12 ) a connection ( 36 ) for the line ( 14 ) for filling the implant ( 12 ) with a fluid and a surgical tool ( 16 ) for establishing a connection between the line ( 14 ) and the implant ( 12 ), characterized in that at the distal end ( 52 ) of the tool ( 16 ) a tool holder ( 54 ) is arranged to receive one on the line ( 14 ) arranged coupling element ( 40 ) for connection to the implant to be filled ( 12 ). Implantation set according to claim 30, characterized in that the surgical tool ( 16 ) a tool ( 16 ) according to any one of claims 2 to 29. Implantationsset according to claim 30 or 31, characterized in that the implant has a cavity-containing intervertebral implant or vertebral body replacement ( 12 ). Using a tool ( 16 ) according to one of claims 1 to 29 for establishing a connection between a line ( 14 ) and a cavity-containing intervertebral implant or vertebral body replacement ( 12 ) for filling it by means of the conduit ( 14 ) with a biocompatible fluid. Use according to claim 33, characterized in that as line ( 14 ) a flexible line is used.

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