CN101141923A - 改进的骨凿 - Google Patents

改进的骨凿 Download PDF

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CN101141923A
CN101141923A CNA2005800465436A CN200580046543A CN101141923A CN 101141923 A CN101141923 A CN 101141923A CN A2005800465436 A CNA2005800465436 A CN A2005800465436A CN 200580046543 A CN200580046543 A CN 200580046543A CN 101141923 A CN101141923 A CN 101141923A
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cutter
cutting edge
blade
bone
distal tip
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M·J·R·扬
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Orthosonics Ltd
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/144—Surgical saws ; Accessories therefor with reciprocating saw blades, e.g. with cutting edges at the distal end of the saw blades with cutting edges at the side of the saw blades
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320072—Working tips with special features, e.g. extending parts
    • A61B2017/320074—Working tips with special features, e.g. extending parts blade
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Abstract

切割骨头的刀具(1，31)包括可与纵向模式超声振动发生器相连的细长刀片(7，37)。刀片(7，37)具有两个通过圆形远端梢部(8)相连的侧切割刃(9，10)。一排三角形齿(13)沿着每个切割刃(9，10)和远端梢部(8)延伸。刀片(37)可朝向每个切割刃(9，10)和远端梢部(8)成变细形状。刀具(21)的变化例包括可与扭振模式超声振动发生器相连的部分圆柱形的细长刀片(27)。刀片(27)在其远端梢部(28)处具有带多个三角形齿(23)的切割刃。刀具(1，21，31)的所有形式特别适合在修复关节过程中在要被去除的植入物周围切割松质骨。

Description

改进的骨凿
技术领域
本发明涉及一种用于(例如在整型外科手术中)切入或穿过骨头的刀具。尤其涉及(但不限于)一种切过皮质骨(cortical bone)或松质骨(cancellous bone)，从而例如将关节假体与周围骨头分开，其是修复过程的一部分。
背景技术
在整型外科手术中，如果植入的假体在其整个接合表面发生使人无法接受的破损或磨损，则经常需要对关节置换进行修复，例如置换髋关节的修复。本发明将描述其在髋关节修复方面的应用，但其也可用于其它关节，必要时术语“髋”、“骨盆”和“股骨”可互换。在很多情况下，植入假体被利用有机聚合物水泥(例如聚甲基丙烯酸甲酯，polymethylmethacylate)固定在骨头(例如股骨)内的一个腔中。已经发明了刀具去软化和去除这种水泥并允许方便地去除磨损或损坏的假体，然后更换植入物。
但是，近来压装假体的应用增多。在将这些假体放入股骨、骨盆等内时不使用水泥。而假体的植入部具有多孔表面或涂覆有羟基磷灰石的表面，羟基磷灰石有助于骨头生长，可使植入物稳固。松质骨也偶尔形成在水泥锚固的植入物中。由于没有股骨、骨盆或其它骨的壁的结构骨强壮，利用被设计用来修复水泥锚固的植入物的刀具不容易切割松质骨，其必须利用机械方式处理松质骨以修复这些植入物。
另外，为了去除假体，可能必须去除部分皮质骨，这不使用机械手段很难实现。
手工骨凿(osteotome)是有效的专用凿子，其纵向施力通过假体和假体周围的结构骨之间的骨头。所需要的力可以大到使该技术的方向精确性受到一些影响，并因此损坏周围的结构骨，尤其在如果其被骨质疏散等削弱的情况下。
另一方法是使用电钻钻开骨头。这也很难被精确地引导。旋转驱动轴在它们长度上的弯曲可导致在周围结构骨中产生不期望的间接损伤。这种方法还不利地产生大量骨屑，它们必须被去除以便看清楚钻头要钻切的关节。另外，高速钻导致明显的局部摩擦发热，这也会损伤相邻的骨头、组织和骨髓。
手动锯切骨头是非常慢且乏味的过程，也会导致局部发热和很多骨屑。不管在何种情况下，传统的骨锯不容易插入例如髋骨或其它关节假体与股骨的内壁之间或在它们之间操作，或不容易插入部分球形的髋臼壳体和骨盆骨之间或在它们之间操作。
发明内容
因此，本发明的一个目的是提供一种用于切割骨头(尤其是与关节植入物相邻的骨头)的刀具，其克服了上述缺点并可精确、快速和方便地去除这种植入物，这是修复过程的一部分。
根据本发明的第一方面，提供一种适于切割骨头的刀具，其包括产生超声波振动的产生装置和可操作连接到其上的细长刀片装置，刀片装置具有至少一个具有多个锯齿的切割刃，每个切割刃具有大致横向于所述超声波振动方向的第一切割面。
在第一实施例中，刀片适于被纵向模式超声波(例如方向大致平行于刀片装置的纵轴线)振动。
优选地，刀片装置包括具有两个大致相反的侧边的大致平的细长部件。
有利地，每个所述侧边大致平行于刀片装置的纵轴线延伸。
细长部件还可包括圆形远端梢部。
所述远端梢部可在第一所述侧边的远端和第二所述侧边的远端之间延伸。
优选地，切割刃或每个切割刃沿着对应的一个所述侧边的至少一部分延伸。
有利地，切割刃沿着每个所述侧边的至少一部分延伸。
连续切割刃可至少绕着每个侧边的远端部和在它们之间延伸的远端梢部延伸。
优选地，刀片装置的至少一部分具有朝向一个侧边或每个侧边变细的横截面形状。
有利地，刀片装置在靠近其远端梢部处具有朝向所述梢部变细的横截面形状。
所述变细型面可包括至少一个位于刀片装置的每个相反面上的倾斜面。
在每个所述面上，单倾斜面可在邻近每个侧边和远端梢部处延伸。
所述倾斜面可在它们相应的外周边处通过横向于刀片部件的主平面延伸的侧边面连接。
所述侧边面可大致比刀片装置的整个厚度窄。
优选地，所述变细型面至少与刀片装置的切割刃共同延伸。
优选地，切割刃或每个切割刃的每个锯齿大致为三角形。
每个锯齿具有与切割刃的局部准线大致垂直地延伸的第一切割面。
于是每个锯齿可具有相对于所述局部准线倾斜延伸的第二倾斜面。
每对相邻锯齿可相当对准，使得所述锯齿对中的一个锯齿的第一面与所述锯齿对中的另一锯齿的第二面相邻。
第一侧切割刃的每个第一面可面向刀片装置的远端梢部，相反的第二侧切割刃的每个第一面可面向刀片装置的近端根部。
优选地，每个锯齿从切割刃向外延伸，大致处于细长部件的平面内。
在第二实施例中，刀具适于通过扭振形式的超声波振动来振动。
于是，刀片装置优选包括细长部件，所述细长部件具有大致包括圆弧的弯曲横截面。
有利地，所述横截面沿着整个细长部件大致恒定。
刀具可适于绕穿过所述圆的中心的纵轴线扭振。
优选地，细长部件的远端梢部包括刀具的切割刃。
切割刃的锯齿可大致为三角形。
锯齿可从部件的梢部远端延伸。
细长部件靠近其梢部的部分可沿着纵向朝向所述梢部变细。
变细部可包括位于弯曲细长部件的凹入面上的倾斜面。
在每一实施例中，发生装置有利地适于产生频率在20至75千Hz范围内的超声波振动。
根据本发明的第二方面，提供一种切割骨头材料的方法，其包括以下步骤：提供如前述任一权利要求所述的刀具；将刀具的切割刃施加于要被切割的骨头的表面；使刀具以超声频率振动并使刀具的切割刃切过所述表面。
优选地，切割刃被往复通过所述表面。
有利地，骨头材料包括将外科植入物保持到活体的骨头上的松质骨和/或皮质骨，并且，所述方法包括上述切割骨头直到植入物被从其上分离的步骤。
附图说明
本发明的实施例将通过例子并参考附图更详细地描述。
图1是本发明的第一刀具实施例的透视图；
图2A是图1所示的刀具的远端部的平面图；
图2B是图2A所示的远端部的中间部分的示意性平面图；
图3A是本发明的第二刀具实施例的局部透视图；
图3B是图3A所示的刀具的远端部的正视图；
图4是本发明第三刀具实施例的透视图；
图5是图4所示的刀具的刀片沿直线V-V所取的剖视图；
图6是图4所示的刀具的刀片沿直线VI-VI所取的剖视图.
具体实施方式
下面参照附图，尤其是图1，第一切骨刀具1包括圆柱形的连接本体2，在本体2的近端处具有带螺纹突起3，通过所述带螺纹突起3，刀具1可装卸地连接至超声波振动发生器(未示出)。刀具1的细长刀片部4从连接本体2的远端伸出，并大致与其同轴对准。
刀片部4包括近端刀片根部5，根部5具有大致矩形横截面并通过变细部6连至薄的扁平细长刀片7，刀片7具有大致圆形的远端梢部8。刀片7的远端部具有两个相反的侧向切割刃9，10。每个侧向切割刃9，10和梢部8具有多个齿13，如图2A和2B所详细描述。刀片7的近端部是无齿的，尽管有齿部和无齿部的相对长度与所示出的相比可变化。
圆柱形连接本体2具有用于扳手的扁平部11以允许施加足够的紧固力矩以便使刀具1紧密接触超声波发生器，以及允许通过本体2的接触面12有效地振动耦接。刀具1优选由钛或不锈钢制成。
如图2A和2B所示，刀片7的齿13优选大致为传统的锯齿形状，具有与刀片7的纵轴线大致垂直的第一刃14和与其具有相对浅的浅滩角(shallow angle)处的第二刃15。在传统的锯中，第一刃14是锋利的，当在纵向拉(有时推)时锯进行切割，其中，第一刃14是齿13的前刃。在本发明中，没有必要使齿13锋利。
在所示的刀具1中，齿13沿着第一切割刃9、围绕稍端8以及沿着第二切割刃10以连续布置的方式延伸，齿13的第一和第二刃14，15的相对布置不变化。因此，第一切割刃9适于在箭头16所示的纵向拉动行程中切割，而第二切割刃10适于在箭头17所示的纵向推动行程中切割。
如果刀具1是传统的机械锯，这种结构不是很有效，推动切割尤其难以控制方向和力。对骨头(即使是松质骨)进行手动锯切产生很多的摩擦热，并且使用者需要费很大的力。
但是，当刀片7受到方向与刀具1的纵轴线18平行的纵向模式的超声波振动时，拉动行程16和推动行程17的有效性都大大提高。每个齿13的第一刃14接触骨头时的速度幅值比独自行程16，17的速度大很多。这使得可以非常快地切割过骨头，具有很小的摩擦，因而产生的热也很少。使用者不需要用力使刀具1通过骨头，这使得在切割中对于拉动行程和推动行程16，17都具有非常好的精确度和控制。稍端8可纵向沉入骨头中，刀具1只具有很小的横向运动。
刀具1被连接至在20-75Hz的频率范围内工作的超声波振动器。
因此，对于通过与松质骨的摩擦力或相互作用保持在股骨内的腔中的髋关节假体的置换以及所需要的修复，相对直接地将刀具1沉入假体主干和股骨本身之间，首先倾斜(tip first)，然后大致平行于所述主干延伸。然后刀具1可绕着主干横向运动，带有柔和的锯切运动，切过骨头并释放假体。
与可选的使用电钻的方法相比，超声波振动刀具1明显更精确，当其遇到增大的阻力时不弯曲，如果弯曲可能导致不期望的间接骨损伤。利用所示的刀具1产生的摩擦热低于使用电钻产生的摩擦热，并且产生的骨屑量明显少。
手动骨凿(类似凿子)需要很大的力在假体与股骨之间驱动，这会损伤被弱化的股骨壁，并常常会使该技术的方向精确性受到影响。
刀具1还可用于其它需要快速精确地切割骨头的外科手术，例如骨移植或骨切除。
图3A示出第二骨凿刀具21。第一骨凿刀具1包括圆柱形本体2，其具有在近端处安装的带螺纹突起3，通过所述带螺纹突起3，刀具1可连接至超声波振动发生器。但是，在本实例中，发生器产生扭振形式的超声波振动。对于纵向振动的第一刀具1，振动优选在20至75kHz的频率范围内。
第二刀具21具有大致半圆柱形刀片27，其沿着刀具21的纵轴线18与所连接的本体2同轴对准。半圆柱形刀片27的远端梢部28具有多个齿23。图示的齿23为对称的，尽管在任意情况或交替情况下第一刀具1的齿13可以是不对称的。因此，梢部28包括大致半圆形的切割刃，如图3B所示。
因此，通过连接本体2传输至刀片27的扭振形式的超声波振动使梢部28振动，如图中箭头26所示。使用者手动使第二刀具21绕着轴线18旋转，不需要施加非常大的纵向力，超声波振动使刀具21快速精确地切入其所施力的骨头中。
除了对在假体和长骨的凹入内壁之间切割有用外，第二刀具21还可用于切割圆形骨头标本或用在头盖骨手术中。尽管大致半圆柱形刀片27对于关节形成修复工作是最佳的，但是包括更大或更少比例的中空圆柱的刀片可能适合于其它场合。
第三骨凿刀具31(如图4所示)是图1所示的第一刀具1的优选变化例。对于第一刀具1，第三刀具31包括具有带螺纹突起3的连接本体2，通过所述带螺纹突起3，刀具31可连接至超声波振动发生器。细长刀片部4从连接本体2的远端以与其大致同轴对准的方式延伸出。
刀片部4包括近端刀片根部5，根部5具有大致矩形横截面并通过变细部6连至薄的扁平细长刀片7，刀片7具有大致圆形的远端梢部8。第一刀具1的刀片7包括具有两个相反的侧向切割刃9，10的远端。多个齿13沿着每个侧向切割刃9，10和与它们接合的圆形梢部8延伸。
第三刀具31的刀片37的横截面形状与第一刀具1的横截面形状不同。刀片7具有矩形的横截面，刀片37具有大致倾斜区域32，区域32沿着刀片37的纵向邻近每个边33并绕刀片的远端梢部8延伸。(在图4中可看到，相应的倾斜区域32被设置在刀片37的相反面上)
因此，如图5中清楚地显示，刀片37具有八边形横截面。刀片37的每个面上的相应的倾斜区域32限定了在它们之间延伸的窄边33。优选地，窄边33不被锋利化以便使其在刀具31没有被超声波致动时减小其意外切割的可能性。
如图6所示，在刀片37的齿13之间的缺口只部分地延伸过倾斜区域32。因此，它们在平面图中都是三角形(见图2和图3)并且型面也大致为三角形。
刀具1的刀片7的齿13具有大致矩形的横截面，很明显它们的外角容易被损坏。被致动的刀具1将在某时刻与要被去除的假体相接触，并且齿13的角部将可能撞到上面。结果，这些角部被撞掉、刻槽或破碎的可能性很大。平衡可超声波振动刀片很重要，齿13的材料的大量损失可能需要整个刀片7被再次平衡或甚至抛弃。而且，如果在刀片7的处于增大的应力区域处发生损坏，刀片7的疲劳破坏可能因这种损坏很快发生。
带倾斜区域32的刀片37很大程度上避免了这些问题。而刀片37的面在使用中可能接触假体，它的齿13(以及尤其是形成齿13梢部的窄边33)被设置在该面的背面并且接触假体的可能性小。即使这样，产生的型面意味着这种接触更随意且更易产生损坏。此外，在切过松质骨时，第三刀具31的刀片37的齿13的型面仅与第一刀具的效果相同。
还可绕着第二刀具21的切割远端梢部28产生类似的变细型面。

Claims (17)

1.一种适于切割骨头的刀具，其包括产生超声波振动的产生装置和可操作连接到其上的细长刀片装置，刀片装置具有至少一个具有多个锯齿的切割刃，每个切割刃具有大致横向于所述超声波振动方向的第一切割面。
2.如权利要求1所述的刀具，其特征在于，产生装置产生纵向模式超声波，例如方向大致平行于刀片装置的纵轴线。
3.如权利要求1或2所述的刀具，其特征在于，刀片装置包括具有两个大致相反的侧边的大致平的细长部件。
4.如权利要求3所述的刀具，其特征在于，每个所述侧边大致平行于刀片装置的纵轴线延伸。
5.如权利要求3或4所述的刀具，其特征在于，细长部件还包括在第一所述侧边的远端和第二所述侧边的远端之间延伸的圆形远端梢部。
6.如权利要求3至5中任一所述的刀具，其特征在于，切割刃或每个切割刃沿着对应的一个所述侧边的至少一部分延伸，有利地沿着每个所述侧边的至少一部分延伸。
7.如权利要求5所述的刀具，其特征在于，切割刃绕着圆形远端梢部的一部分或整体延伸。
8.如权利要求3至7中任一所述的刀具，其特征在于，刀片装置的至少一部分具有朝向一个侧边或每个侧边变细的横截面形状。
9.如权利要求5至8中任一所述的刀具，其特征在于，刀片装置在靠近其远端梢部处具有朝向所述梢部变细的横截面形状。
10.如前述任一权利要求所述的刀具，其特征在于，切割刃或每个切割刃的每个锯齿大致为三角形。
11.如前述任一权利要求所述的刀具，其特征在于，每个锯齿具有与切割刃的局部准线大致垂直地延伸的第一切割面。
12.如权利要求1所述的刀具，其特征在于，产生装置产生扭振形式的超声波振动。
13.如权利要求12所述的刀具，其特征在于，刀片装置包括细长部件，所述细长部件具有大致包括圆弧的弯曲横截面。
14.如权利要求13所述的刀具，其特征在于，其适于绕穿过所述圆的中心的纵轴线扭振。
15.如权利要求12至14中任一所述的刀具，其特征在于，细长部件的远端梢部包括刀具的切割刃。
16.大致如此处结合附图所描述的刀具。
17.一种切割骨头材料的方法，其包括以下步骤：提供如前述任一权利要求所述的刀具；将刀具的切割刃施加于要被切割的骨头的表面；使刀具以超声频率振动并使刀具的切割刃切过所述表面。
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CN113966199A (zh) * 2020-05-15 2022-01-21 美德克斯医疗器材有限公司 薄刃骨凿系统
CN113966199B (zh) * 2020-05-15 2024-02-27 美德克斯医疗器材有限公司 薄刃骨凿系统
WO2023142527A1 (zh) * 2022-01-27 2023-08-03 以诺康医疗科技（苏州）有限公司 超声刀刀头
WO2023142526A1 (zh) * 2022-01-27 2023-08-03 以诺康医疗科技（苏州）有限公司 超声手术刀刀头

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AU2005311113A1 (en) 2006-06-08
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AU2005311113B2 (en) 2011-07-14
WO2006059120A1 (en) 2006-06-08
GB0426503D0 (en) 2005-01-05
ES2583482T3 (es) 2016-09-21
EP2848214A1 (en) 2015-03-18
CA2590344C (en) 2017-10-31
EP2848214B1 (en) 2018-09-05
US8888783B2 (en) 2014-11-18
GB2420979A (en) 2006-06-14
CA2590344A1 (en) 2006-06-08
GB0524619D0 (en) 2006-01-11
US20080188878A1 (en) 2008-08-07
US20140316415A1 (en) 2014-10-23
EP1876978A1 (en) 2008-01-16
US9763673B2 (en) 2017-09-19

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