DE202014011170U1 - Orbital lid with curved main body - Google Patents

Abstract

An orbital concealment grille (1) having a curved main body (2) having an outer end edge (3) and said main body (2) having a lower surface which, in the implanted state, faces the orbital bone (s) forming the main body (2) an upper side facing away from the underside (4), characterized in that on the upper side at least one optically recognizable channel (5, 6) for representing at least one insertion vector (18) is pronounced.

Description

The invention also relates to a patient-specific orbital masking grid for all four orbital walls, in particular in the form of a "three-dimensional orbita mesh", with a curved / S-shaped / multiply curved main body having an outer, normally circumferentially closed end edge / skirt, the main body has a bottom, which faces in the implanted state or the eye cavity forming bone and the main body has an upper side facing away from the underside.

Under a grid, an array of elongated parts is subsumed at regular or irregular intervals. It can have a netlike surface structure.

Augenhöhlenabdeckgitter are already known from the prior art, such as from the EP 1 965 735 B1 , There, an implant is used to replace an orbital floor. The implant is designed as an orbital masking grid, so it rests on the orbital floor. Such an implant, such as a "mesh" or grid, can also be used for the lateral orbital wall reconstruction. It can also be used self-supporting and does not necessarily rest on the ground. In said document, an implant for use as a replacement for an orbit and optionally also a medial and lateral orbital wall in the form of an integrally preformed plate comprising a first portion, a second portion and a third portion is presented, wherein the first portion according to an orbital base and the second portion are shaped according to a medial side wall and the first portion and the second portion abut a first predetermined line, the third portion for securing the implant being disposed at the anterior eye socket edge, wherein it is particularly noted that the first predetermined line in said document is defined as a break line along which a physician can easily remove a segment.

Grid-like plates are also known in a similar form for use on other parts of the body.

For example, the DE 197 46 396 A1 a grid for the fixation of bone parts or for the bridging of bone defects. Such a grid can also be used on the skull. Finally, in this German publication, a grille is proposed for use in the skull and jaw area, consisting of biocompatible materials with a net-like structure and with recesses for receiving bone screws, with which the grid can be attached to the bone. The webs form meandering, continuous, periodic web rows along the main axis of the grid.

The orbital masking grid, ie the device intended to be in contact with the orbital floor, must not interfere with eyeball picking when mounted on the bone. However, this eyeball image is not spherical, but extends oblong, in particular S-shaped.

Furthermore, the disclosure US 2012/010711 A1 a method of forming a patient-specific implant.

The US 2003/109784 A1 discloses a method of making shaped sheets as a prosthesis.

Finally, the US 2011/319745 a patient-adapted surgical guide and a method to use it.

In the known from the prior art post-processing of the implant is often necessary.

It is the object of the invention to make available to the surgeon the most optimal and patient-specific starting structure of an orbital masking grid, in particular such an orbital masking grid, which is not too large, already pre-adapted to the respective defect to be treated and is easily adaptable.

This object is achieved according to the invention with an orbital masking grid in which at least one optically recognizable channel for representing at least one insertion vector is pronounced on the upper side.

In this way, the orbital cover can be easily and precisely spent on or in the patient. The patient may be a mammal, especially a human or (mammal) animal. In this case, the Augenhöhlenabdeckgitter is to spend between a soft tissue filling the eye socket and the bone structure forming the actual eye socket. The Augenhöhlenabdeckgitter, is then an implant that rests on the bone structure, at least with as three points in contact there is located and is covered by soft tissue after implantation. Of course it is also possible to use less than three points of support. If the orbital masking grid is configured according to the invention, the insertion can be made more precisely, atraumatically and without injury / injury-free; In particular, objectivity exists for positional control in X-ray based Imaging. The compatibility of the orbital masking grid in the patient is significantly improved. The wearing comfort is increased.

Advantageous embodiments are claimed in the subclaims and are explained in more detail below.

Thus, it is advantageous if the primary model is a 3D model and / or the secondary model is a 2D model and / or the tertiary model is a 3D model.

It is expedient if generative methods, such as sintering methods, and / or CNC, milling and / or injection molding methods are used during production. Laser sintering processes, such as SLM processes, ie selective laser melting processes, have proved particularly successful. It is advantageous if the orbital grid consists only of one or more metal material (s) or only of plastic or a mixture of metal and plastic. In addition, ceramic components may be added. Also, the orbital grid can be made entirely of ceramic. Zirconium oxide or hydroxyapatite is suitable for this purpose.

It is also expedient if the secondary model is constructed / assembled from several layers.

An advantageous embodiment is also characterized in that when transferring or planning / laying out the primary or secondary model, a desired deviation from the 3D patient data is accepted / used to make the edge of the orbital grid optimized for the operator and / or optimized for the implantation process.

While preparing the tip portion of the eyelid lattice to contact the bone, it becomes curved, e.g., more curved than dictated by the 3D patient data, and / or the anterior edge of the eyelid lattice is prepared as a handle area for (manual) operator access, such as is curved, for example, more curved than specified by the 3D patient data, so a particularly safe manageable eyelet grid can be created.

It is advantageous if the perforations or passageways are deliberately orthogonal to a patient-specific vector, such as insertion vector, relevant to the deployment / implantation procedure.

Particularly good tuning can be achieved if a cord present at the terminal edge has a thickness of about 0.3 to about 0.7 mm, e.g. about 0.5 mm, and the surface of the main body inside thereof has a thickness of about 0.1 mm to about 0.5 mm, about 0.3 mm. The values are zigzags and may be subject to a deviation of 10% or 20%.

This also applies to a cord which is formed between about 0.1 to about 0.3 mm, about 0.2 mm thicker than the surface of the main body loaded therefor.

It is advantageous if an internal matrix is selectively / freely selected with regard to one or more factors of structure, geometry, pore size and biomechanical properties, for example in adaptation / imitation / improvement of the material to be replaced / supplemented of the respective anatomical region of the patient.

It is also advantageous if a patient-specific identification, such as in the manner of a barcode and / or a string of letters and / or numbers, is applied to the orbital grid, for example during the manufacturing step of that material which forms the eyelet grid, preferably in one (Laser) sintering process as sublimity, in particular for reproducing the patient name and / or the implantation position / position.

In this case, an inventive Augenhöhlenabdeckgitter can be created.

Thus, it is particularly advantageous if the channel connects two points linearly, that is, at least partially linearly configured, or better formed linearly in whole.

Thus, it is also advantageous if the main body is designed as a web-forming, perforated component. The adaptability to the example. Human body is thereby improved. In addition, the risk of forming a confined space is reduced, i. in the case of e.g. Bleeding allows the lattice openings to drain blood in adjacent paranasal sinuses.

When webs are arranged in the main body such that elongate through-slots extending through the main body in the area spanned by the main body, especially those extending from the bottom to the top of the main body, improve the compatibility of the orbital coverage grid with the patient Reducing weight, saving material, reducing costs and creating a drainage system.

It is also expedient if the slots are aligned (almost) orthogonally to the terminal edge / border and / or are distributed equidistant to each other. The insertion process is thus easier to control. Other advantages, such as obtaining a particularly rigid implant, can also be achieved.

If the channel has two raised from the top lifting and equally spaced extending channel walls, so a control instrument can be easily placed on the channel and act as a control when inserting. By the sublime designed channel walls leaving the control instrument to the outside of the channel is effectively prevented.

A structure weakening is avoided if the channel between the channel walls has a channel bottom, which is formed by the top of the main body or extends at least in the surface formed by the surface. Also, the production can then be carried out inexpensively.

It is also advantageous if the channel, which is preferably interrupted / continuous or sectionally interrupted, runs from a front edge, which is closest to an operator, to a tip region which, in the implanted state, is nearest or close to an optic nerve / visual canal. Placing the tip area on the bone is simplified while avoiding irritation or damage to the optic nerve / visual canal. Also, it becomes easier to bring the tip area into contact with a bone portion deep inside soft tissue. It is advantageous if the implant in the tip area is also over-arched to obtain a greater distance to the optic nerve.

The insertion process becomes even more precise feasible if a second channel for representing a further insertion vector is present. The second channel may then be similar or identical to the first channel and indicates the transition between the orbital floor and the lateral wall.

In particular, the first channel may be aligned transversely to the second channel, in particular at an angle α, which is in the range of 20 ° to 40 °, in particular 22.5 °, be angularly offset.

If the channel edges form a guide for an inserted and pushed along them control instrument, slippage of the control instrument is efficiently avoided.

So that the insertion of the orbital masking grid / implant can be interrupted and / or controlled in sections, it is advantageous if, between the canal walls and / or on / in the canal bottom, a navigation stop, preferably haptically or tactilely detectable by the control instrument, in the form of an elevation or recess is present / formed, and preferably a plurality of navigation stops per channel are formed, wherein in the channels equal to many or different numbers of navigation stops per channel are present, about in the second channel a navigation stop less than in the first channel. Navigation stops can be placed on the entire body of the implant, but preferably on the canal. The navigation stops are defined as landmarks to be controlled intraoperatively. Furthermore, a Trajoktorienplanung can be realized, which receives the inserted insertion vectors and can be administered.

It is also advantageous if the first channel is aligned parallel to a sagittal plane of the patient to be treated and / or the second or first channel is aligned parallel to an oblique-sagittal plane of the patient to be treated. An insertion movement that is curved in three-dimensional space can then be more easily controlled by the surgeon for precision.

If the tip region has a different curvature than the majority of the main body, in particular as the directly adjacent / adjacent region of the main body, is preferably convex, ie. For example, in the direction of the bone is increasingly curved / running, so injury-free handling of the eye socket lattice when implanting in the example. Human body is facilitated.

It is expedient if the first channel and the second channel meet in the tip region or nearly hit. Of course, it is possible that the point of intersection of the two channels is outside the implant, for example, by about 1 mm to about 4 mm, in particular about 1.3 mm outside the terminal edge of the eyelet lattice is present.

An advantageous exemplary embodiment is also characterized in that a length scale representative of the dimensions present on the main body is applied.

In this case, a further development is characterized in that the characters relevant for the length scale, such as numerals, are introduced / applied next to one of the channels, for example to the left or right next to the first or second channel, preferably in the manner of a (calibrated ) Rulers. In particular, the distance from Mark the tip area. The distances of approx. 15 mm, approx. 25 mm and approx. 35 mm as well as intermediate values such as approx. 10 mm, approx. 20 mm and / or approx. 30 mm can then be simply marked. The markings can be set at 5 mm intervals. In order to improve the adaptation to the patient, it is advantageous if the front edge has a convex curvature on the upper side and / or a concave curvature on the underside. Also, it can then facilitate the gripping for a surgeon. In particular, the manual holding the eyelet lattice at the front edge with the fingers of the surgeon is facilitated.

The attachment of the orbital grid to the bone becomes more precise if there is at least one through hole for receiving a screw securing the sacral bone to the bone, preferably a plurality of through holes for a plurality of screws and / or the through hole across the top and / or bottom of the main body (in the area of the through hole) is aligned to follow a Bohrvektor. Also slipping of the orbital grid relative to the bone is thereby effectively prevented. It has proven useful to calculate a bolt vector in the through hole in order to know beforehand where most of the bone supply is available and to use it meaningfully.

It is advantageous if a lacrimal region is physically predefined / formed.

It is also advantageous if the main body is designed as a plate, mesh and / or multi-layer component.

If the passageways or perforations are designed as a closure system, the compatibility of the orbit of the patient's orbit is improved, in particular in order to provide an outlet for possible rebleeding.

An advantageous embodiment is also characterized in that the end edge of thicker material than the (vast) rest of the main body is shaped in the manner of an atraumatic acting cord.

It has also proved to be advantageous for compatibility when the orbital grid is prepared and / or adapted to a specific patient.

If the passage slots are arranged so that an unintentional folding over of partial areas of the main body is impeded or precluded, a particularly resilient / rigid implant can be created. In particular, it is advantageous if a medial wall is only as high as patient-specific necessary, but designed as high as possible, if there is a need for it.

Patient compatibility is improved when the tip region is inverted to form a snow pusher-like curve to maintain a curvature away from the optic nerve.

The invention will be explained in more detail below with a drawing in which in the single figure, namely the 1 , A top view of an inventive Augenhöhlenabdeckgitter is reproduced. The drawing is merely schematic in nature and is only for understanding the invention.

It is also possible to install / implant several eye socket covers. The individual combined and at least partially covering Augenhöhlenabdeckgitter can also have different shapes per se. For example, a cylindrical or triangular shape may be favored.

In 1 is a first embodiment of a Augenhöhlenabdeckgitters invention 1 shown. The orbital cover grid is designed as an "orbita mesh". It has a multiply curved / curved / curved main body 2 on.

The main body 2 has on its outside a substantially circumferential / closed outer end edge / skirting 3 on. A bottom of the orbital cover grille 1 , in particular of the main body 2 and the finishing edge / border 3 is designed patient-specific. Thus, the internal and external structure is patient-specific. The internal matrix of the main body and the material used, for example a titanium alloy, is adapted to the adjoining patient-specific anatomical region in terms of bending stiffness and / or modulus of elasticity, preferably as closely as possible copied.

In this way, the orbital cover grid 1 specifically adapted to the bone (s) forming the orbit.

The top of the implant / orbital cover screen 1 is with the reference character 4 Mistake. On this top 4 are a first channel 5 and a second channel 6 educated. Both channels 5 and 6 are linear and visually and tactilely recognizable. Every channel 5 respectively. 6 defines an insertion vector. Every channel 5 respectively. 6 has two channel walls each 7 which are orthogonal to the top 4 stand out, being between the two channel walls 7 a channel 5 respectively. 6 a channel bottom 8th is defined.

In / on / on the canal floor 8th is a navigation stop 9 available. In the first channel 5 are two navigation stops 9 provided, whereas in the second channel 6 just a single navigation stop 9 is provided.

In the main body 2 are perforations or slots / passageways 10 held in the manner of through holes. They have an elongated form. They each run orthogonally to the end edge / border 3 through a drawstring 11 is formed, which has a nearly circular, elliptical or rounded cross-section. The cord therefore acts atraumatic.

It is also an anatomical limitation 12 available. An exact tear way area 13 is also physically trained and predefined.

There are four through holes 14 in a front edge 15 of the orbital masking grid 1 maintained. The through holes 14 define a drilling vector, or follow a predetermined Bohrvektor. The drilling vector is operator specific. The drilling vector is inclined on the top 4 and / or bottom of the main body 2 of the orbital masking grid 1 , Into the through holes 14 Screws are insertable, which can be anchored in the bone.

At the opposite end of the main body 2 is a top area 16 available. There, inside or outside of the main body meet 2 forming material, the insertion vectors.

One by numbers, like the number 15 , 25 and 35 formed length scale 17 is on the left side of the first channel 5 This one from the top area 16 starting / following educated. The length scale 17 is designed in the manner of a (calibrated) ruler.

The slots / passageways 10 form a drainage system. In the top section 16 is a critical area / area predefined in terms of the visual canal / optic nerve. The channels 5 and 6 underlying insertion vector is denoted by the reference numeral 18 Mistake.

The channels 5 and 6 are not only beneficial in implanting, so inserting the orbital masking grid 1 but also in the subsequent control of the implantation process. This enables a quality assurance procedure without injuring the patient. A reconciliation of the real position of the orbital masking grid 1 in the patient with a desired location on the computer is at any time easily feasible. Postoperative control of the situation is facilitated. Matching with the 3D dataset as planned was enabled. For this purpose, the patient can be provided with a reference point and read into the computer. In particular, there are three reference points. The channels 5 and 6 then act as a guide with intermediate points / depressions. The guide road is therefore the first channel 5 or the second channel 6 and the intermediate points / depressions are then the navigation stops 9 , The channels 5 and 6 So form a physical double contour / line for improved control of a control instrument.

The top section 16 may be formed in the manner of an inverted snow slide-like tip, ie form a protruding from the optic nerve curvature, so that a spitting of the eye muscle or a mechanical irritation / perforation of the optic nerve is excluded / avoided. Perforations, such as the slots / passageways 10 are also consciously orthogonal to a patient-specific vector, in particular to the insertion vector 18 aligned. The top section 16 is prepared for installation with the bone. The edge, in particular, formed by the finishing edge / mount 3 can be planned so that the implant forms a supernatant, which can be brought into contact with the bone and / or provides a handle for the surgeon.

It should be noted that after finishing the orbital masking grid 1 , a sterilization step can and should take place.

While so-called "mean value implants" have been created so far, ie are not patient-specific, a patient-specific training is now possible. For this purpose, similar to the application of a linen cloth to a rake, a secondary model can be applied to a primary model. The secondary model can be a conglomerate of different layers and shapes. Separating the implant from the 3D model is desirable. The implant can then be a model, for example in the form of a standardized 3D dataset form, for example in the form of an STL dataset. The secondary model can be a "BMP template", whereby JPEG, TIFF and similar formats are also possible. Of course, as a material of the orbital masking grid 1 also absorbable material can be used.

LIST OF REFERENCE NUMBERS

1

Augenhöhlenabdeckgitter

2

main body

3

Finishing edge / border

4

top

5

first channel

6

second channel

7

channel wall

8th

channel base

9

Navigation Stop

10

Slot / passage slot

11

Drawstring / smooth border

12

anatomical limitation

13

Tear duct area

14

Through Hole

15

front edge

16

tip area

17

length scale

18

insertion vector

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• EP 1965735 B1 [0003]
• DE 19746396 A1 [0005]
• US 2012010711 A1 [0007]
• US 2003109784 A1 [0008]
• US 2011319745 [0009]

Claims (5)

An orbital concealment grille (1) having a curved main body (2) having an outer end edge (3) and said main body (2) having a lower surface which, in the implanted state, faces the orbital bone (s) forming the main body (2) an upper side facing away from the underside (4), characterized in that on the upper side at least one optically recognizable channel (5, 6) for representing at least one insertion vector (18) is pronounced. Eye cup cover (1) after Claim 1 , characterized in that the main body is formed as a web forming, perforated component. Eye cup cover (1) after Claim 2 , characterized in that in the main body (2) webs are arranged so that through the main body (2) extend elongated, in the plane defined by the main body (2) surface extending through slots (10). Eye cup cover (1) after Claim 3 , characterized in that the slots / passageways (10) are aligned nearly orthogonal or orthogonal to the end edge / skirt (3) and / or are equidistant from each other. Augenhöhleabdeckgitter (1) after one of Claims 1 to 4 , characterized in that the channel (5, 6) has two raised from the top (4) lifting and equally spaced apart extending channel walls (7).

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