CN103841920B - 环钻 - Google Patents

环钻 Download PDF

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CN103841920B
CN103841920B CN201280022627.6A CN201280022627A CN103841920B CN 103841920 B CN103841920 B CN 103841920B CN 201280022627 A CN201280022627 A CN 201280022627A CN 103841920 B CN103841920 B CN 103841920B
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reamer
trepan
support rod
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bone
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W.L.范
伯纳德·J·布尔克
丽贝卡·安·布劳
本·金·格拉夫
威廉·R·戴维斯
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Smith and Nephew Inc
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1635—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for grafts, harvesting or transplants
    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1697—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans specially adapted for wire insertion
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
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    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4644—Preparation of bone graft, bone plugs or bone dowels, e.g. grinding or milling bone material
    • A61F2002/4645—Devices for grinding or milling bone material

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Abstract

本发明涉及用于重建韧带的医疗器械和手术。本发明提供了一种环钻(10)，其包括适配器(11)、联接到该适配器上的长形的扩孔器(12)以及扩孔器支承杆(13)，其中扩孔器支承杆共中心地安装在扩孔器和适配器之内，并且其中扩孔器支承杆的至少一部分可关于环钻的纵向轴线以可滑行的方式移动。

Description

环钻
技术领域
概括地说，本发明涉及医疗器械及手术，并且更具体而言，涉及用于重建韧带的医疗器械及手术。
背景技术
在诸多情况下，韧带由于事故而被撕裂或破裂。因此，已开发出多种手术来修补或替换此类已损坏的韧带。
例如，在人的膝盖中，前十字韧带和后十字韧带(即，“ACL”和“PCL”)在胫骨的顶部端和股骨的底部端之间延伸。通常，前十字韧带(即ACL)由于诸如运动相关的受伤而破裂或撕裂。因此，已开发出用于重建ACL的多种外科手术。
在诸多情况下，ACL可通过以移植韧带来替换破裂的ACL而被重建。更具体而言，在此类手术中，通常在胫骨的顶部和股骨的底部上都形成骨隧道(bone tunnel)，移植韧带的一端被定位在股骨隧道中并且该移植韧带的另一端被定位在胫骨隧道中，并且移植韧带的中间部分跨越股骨的底部和胫骨的顶部之间的距离。移植韧带的两端被以在现有技术中广为人知的多种方式固定在它们各自的骨隧道中，使得移植韧带以与原始的ACL基本相同的方式和基本相同的功能在股骨的底部端和胫骨的顶部端之间延伸。此移植韧带随后与周围的解剖结构协作，以便恢复膝盖的基本正常的功能。
用于将移植韧带的两端固定在股骨和胫骨的骨隧道中的多种方法是已知的。
在已知的手术中，移植韧带的端被放置在骨隧道中，并且随后使用无头骨科螺钉或干涉螺钉将该移植韧带固定在适当的位置上。通过此方法，移植韧带的端被放置在骨隧道中，并且随后干涉螺钉进入骨隧道，使得干涉螺钉平行于该骨隧道延伸并且同时该干涉螺钉与移植韧带及骨隧道的侧壁都接合。在此布置中，干涉螺钉实质上横向地将移植韧带推入与骨隧道的相对的侧壁的接合，由此以所谓“过盈配合”来将移植韧带固定到宿主骨(host bone)上。此后，经过一段时间(如，若干个月)，移植韧带和宿主骨在它们的接触点处生长到一起，以便提供在韧带和骨之间的强壮的、自然的连接。
干涉螺钉已被证明为用于将移植韧带固定在骨隧道中的有效手段。然而，干涉螺钉自身通常占据骨隧道之内的相当大量的空间，这可限制移植韧带和骨隧道之间的接触程度。这转而限制了骨至韧带向内生长的区域，并且因此可影响连接的强度。已经估算出的是，典型的干涉螺钉阻碍了大约50%的潜在的骨至韧带整合区域。
解决此问题的一种方法是用生物可吸收(bioabsorbable)材料制造干涉螺钉，使得干涉螺钉随着时间的流逝而被吸收，并且骨至韧带向内生长可在骨隧道的整个周边周围进行。一般地，该方法已被证明是临床上成功的。然而，这些可吸收的干涉螺钉仍然因若干缺点受损害。临床证据表明，骨至韧带向内生长的质量稍微不同于自然的骨至韧带向内生长，并且生物可吸收的聚合物趋向于被纤维块替换而非被秩序井然的组织基质替换。吸收可花费大约三年左右的相当长的时间，并且在这段时间期间，骨至韧带向内生长仍然受限于干涉螺钉的存在。另外，对于许多病人而言，吸收永远是不完全的，在体内留下了实质上的异质块(foreign mass)。此问题由于下列事实而稍微恶化：可吸收的干涉螺钉通常趋向于为相当大的，以便为它们提供足够的强度，如，常见的是干涉螺钉具有8mm至12mm的直径(即，外部直径)和20mm至25mm的长度。
一种备选方法在WO2008/021474中公开，其描述了一种用于将移植韧带附接到骨上的复合的干涉螺钉。该复合的干涉螺钉包括螺旋结构(screw frame)，当骨至韧带向内生长发生时，该螺旋结构用于提供将干涉螺钉设定在适当的位置上所需的以及将移植韧带保持在适当的位置上所需的短期强度；以及向内生长芯体，其用于促进优良的骨至韧带向内生长。该螺旋结构优选地由生物可吸收的聚合物形成，并且向内生长芯体是同样地由可再吸收的聚合物形成的骨支架结构，使得该复合的干涉螺钉经过一段时间后基本完全从手术位置消失。该骨支架结构也可为由去矿化的骨形成的同种异体移植物(allograft)。
螺旋结构包括在至少一些螺纹中间延伸的孔。这些孔促进了骨隧道的侧壁和向内生长芯体之间的接触。
期望的是利用由病人自己的骨材料形成的自体移植向内生长芯体。如上所述，十字韧带重建和其他相似类型的重建外科手术需要插入骨隧道的腱或移植物。隧道的位置优选地设在破裂的韧带或腱的原始附接点处，并且被称为是符合解剖学地安置。隧道必须具有足够的长度，以为适当的移植物接合提供硬度和强度。当骨隧道形成时，钻出物通常不会被收集，并且在钻孔过程中被冲洗掉。
在一个备选方法中，当骨隧道被钻出时，骨的芯体被收获(harvest)以用于未来的用途。典型地，外科医生将使用取芯环钻系统(coring trephine system)来从病人体内收获骨，并且该骨被用于填补产生的缺口以促进痊愈。在收获骨前，引导线沿计划的路径钻过骨，骨隧道将采用该路径。在沿引导线所跟随的路径进行覆盖钻孔(over-drill)之前，取芯环钻系统被插入并在引导线上滑行。
上述系统的特别的问题在于，难以使环钻取芯器维持为相对于引导线共中心。这可通过包括如在US5423823中描述的另外的手术步骤来克服，在引导销已钻过胫骨之后，该另外的手术步骤要求将该引导销移除。轴环引导销的引入，以及插入的芯体锯的随后的使用。其他系统在钻孔时需要另外的装置以使取芯扩孔器稳定。
然而，这些系统和方法需要另外的步骤(和装置)以在钻孔时控制环钻，并且因此增加了实施手术所需的复杂度和时间。
因此，存在对于更好的关节内窥(arthroscopic)方法的需求。
发明内容
本发明在其最广泛的意义上提供了一种环钻，其包括适配器、扩孔器和扩孔器支承杆。
根据本发明的一方面，提供了一种环钻，其包括适配器、联接到该适配器上的长形的扩孔器以及扩孔器支承杆，其中扩孔器支承杆被共中心地安装在扩孔器和适配器之内，并且其中扩孔器支承杆的至少一部分可关于环钻的纵向轴线以可滑行的方式移动。
优选地，扩孔器支承杆被插入。更优选地，扩孔器支承杆被插入并且允许引导线被容纳在其中。这允许环钻以可滑行的方式安装在已被钻入骨的引导线之上。结果，环钻可通过直接地与引导线接合而用于收获骨，并且无需另外的引导件。
优选地，扩孔器以可拆卸的方式联接到适配器上。
合适地，扩孔器支承杆和适配器包括用于将扩孔器支承杆联接到适配器上的互补的接合装置。优选地，当合适的轴向力被施加在扩孔器支承杆的末梢端处时，该互补的接合装置分离并且允许扩孔器支承杆邻近地滑行通过适配器。备选地，扩孔器支承杆和适配器通过摩擦配合来联接。优选地，扩孔器支承杆以可拆卸的方式与适配器联接。
备选地，扩孔器支承杆包括轴和可收缩式轴环(collapsible collar)。优选地，可收缩式轴环和轴包括用于将可收缩式轴环联接到轴上的互补的接合装置。优选地，当合适的轴向力被施加到可收缩式轴环的末梢端上时，互补的接合装置分离并且允许可收缩式轴环在轴上邻近地滑行。备选地，可收缩式轴环和轴通过摩擦配合来联接。优选地，可收缩式轴环以可拆卸的方式与轴联接。
用于形成骨隧道并收获骨材料的系统，其中该系统包括如上所述的环钻和引导线。
合适地，该系统包括一对压紧钳。优选地，这些压紧钳包括一对杠杆，这对杠杆在位于杠杆的末梢区域中的支点处枢轴地连接。优选地，这些压紧钳包括在杠杆的末梢端处的一组钳口以及邻近于支点的一对把手。优选地，钳口由一对相对的互补的成形板形成。
合适地，该系统还包括活塞。该活塞可用于从压紧钳的钳口移除压紧的骨。
一种用于在关节内窥韧带重建中形成骨隧道和收获骨材料的方法，该方法包括下列步骤：
i) 使引导线钻过骨；
ii) 使如上所述的环钻在引导金属线上滑行以与骨接合；以及
iii) 通过使环钻进入骨来扩大隧道。
上文所述的方法，其中韧带为前十字韧带，并且骨为胫骨。
附图说明
现将参考随后的附图来描述本发明的上述的和其他的方面，在其中：
图1是根据本发明的第一实施例的环钻的分解侧视图；
图2是图1的实施例的适配器和末梢端扩孔器支承杆的特写侧视图；
图3是在已组装的构造中的图1的实施例的适配器和扩孔器支承杆的特写侧视图；
图4是已部分地组装的环钻的侧视图；
图5是图1的已组装的环钻的侧视图；
图6A至图6C是图1的已组装的环钻的侧面、截面侧和特写截面视图；
图7是在图1已组装的环钻中的适配器的截面立体视图；
图8A至图8E是图示了图1的环钻的使用的立体视图；
图9A至图9C是用于与图1的环钻一起使用的一套压紧钳的立体视图；
图10A至图10B是图示了图9A的压紧钳的使用的立体视图；
图11是根据本发明的第二实施方式的环钻的从第一侧所见的分解立体视图；
图12图10的已组装的环钻的侧视图；
图13是图10的环钻的轴环组件的分解视图；
图14是图10的环钻的轴环组件和扩孔器的末梢端的特写侧视图；
图15是图10的环钻的适配器和扩孔器支承杆的邻近端的从第一侧所见的特写立体视图；
图16是图14的已组装的适配器和扩孔器支承杆的从第一侧所见的特写立体视图；
图17是图10的已组装的环钻的截面侧视图。
具体实施方式
参考图1至图5，示出了根据本发明的一个实施例的环钻10的分解视图。环钻10由各自包括内部导管的适配器11、扩孔器12和扩孔器支承杆13形成。
适配器11包括插入邻近的腿(leg)15和末梢头部分20之间的本体14。本体14包括通道21，该通道21在适配器的外部表面和其内部导管之间延伸。活塞22在通道21内是可移动的，并且活塞的至少一部分延伸入适配器的内部导管。一系列弹簧垫圈23作用来使活塞在已组装的构造中朝导管偏移，并且外部轴环或盖适配到本体14上。此布置将在下文中参考图6C更详细地描述。适配器腿15包括朝其邻近端的扁平区域25，该扁平区域25使环钻能够被连接到钻头(未示出)上。末梢头20包括一对相对的径向地延伸的销30。
扩孔器12由圆柱形管状构件形成，该构件具有比适配器11的末梢头20的外部直径更大的内部直径。如下文参考图4和图5所论述，这允许扩孔器12在已组装的构造中滑行到适配器头20上。扩孔器12在末梢端处包括一系列骨接合叶片或齿31，并且该扩孔器12在邻近端处包括一对相对的适配器销接合槽32。槽32通常是T形的，并且允许扩孔器以刺刀型(bayonet-type)布置锁定在适配器11上。尽管如此，销和槽布置被描述为一对相对的互补的销和槽，也可结合包括三个、四个或更多的互补的销和槽的其他合适的布置。
扩孔器支承杆13由圆柱形管状构件形成，并且具有比适配器11的末梢头20的内部直径更小的外部直径。这使支承杆13的邻近端能够滑入适配器11的末梢头20(图2和图3)。支承杆13的邻近端包括协助促进将其插入适配器11的渐缩形圆锥端。支承杆13的末梢端包括稍微地扩大的头34，该头34自身包括骨接合齿35。支承杆13的邻近区域包括在支承杆13的外表面和内部导管之间延伸的孔33。当支承杆滑入适配器11中时，延伸入适配器的内部导管的活塞22的一部分与支承杆13的孔33接合，并且延伸入支承杆13的孔33，以将适配器11和支承杆13锁定到一起。圆周标志40位于在孔33的邻近区域和远端中的支承杆13的外部表面中或外部表面上。
图2和图3示出了当环钻的两个元件彼此接合时适配器11和扩孔器支承杆13的末梢端的详细视图。为了帮助支承杆13的孔33与适配器11的活塞22的接合，设置了激光标志40，使得用户得以知晓还要将支承杆13插入多少。
在图4和图5中，示出了环钻10的组件的最终阶段(stage)。在此，将通常为一次性的扩孔器12滑行到支承杆13上。扩孔器12的末梢销接合槽与适配器11的销30对准，并且扩孔器通过小的旋转而被锁定在销30上的适当的位置上。
图6和图7更详细地图示了扩孔器支承杆和适配器11的接合的机构。如所示，活塞22通过弹簧垫片23而朝扩孔器支承杆13偏移，并与支承杆的孔33接合。在环钻的使用中，如将在下文中更详细地描述，当足够大的力被施加到支承杆的末梢端上时，这将克服活塞22与孔33的接合，并且导致支承杆相对于环钻的其余部分邻近地前进。将认识到的是，弹簧垫片可以以弹簧或其他合适的偏移装置替换。
现参考图8A至图8C，描述了根据本发明的环钻系统的使用。该环钻系统包括：钻出骨隧道的环钻；协助对被收获的骨进行切割和成形的压紧钳(参见图9和下文的相关描述)；以及帮助在干涉螺钉的中心中回填骨的仪器，该干涉螺钉为诸如在上文中参考WO2008/021474描述的干涉螺钉。环钻系统包括多种不同尺寸的扩孔器和扩孔器支承杆，以适应韧带重建手术所需的隧道尺寸的范围。
在手术中的第一步骤是将引导线插入胫骨，例如，将引导线沿着胫骨隧道将采用的路径(图8A)插入胫骨。这通过使用外部钻头引导装置(未示出)完成。在修补受损的前十字韧带的典型手术中，通常将使用具有2.4mm的直径的引导线。接着，外科医生将选择合适地定尺寸的环钻适配器、扩孔器支承杆和扩孔器，扩孔器与将使用的特定的移植物的直径相匹配。用于适配器、扩孔器支承杆和扩孔器的直径尺寸应当是相同的。扩孔器支承杆随后进入适配器，当在支承杆上的圆周激光标志与适配器的末梢端齐平并且活塞22已与孔33(图6C)接合时，扩孔器支承杆适当地座置在适配器中。扩孔器随后在支承杆之上滑行，并且在通过销30和槽32的锁定接合而固定在合适的位置上，并且已完全组装的环钻通过适配器腿(未示出)而附接到钻头上。
环钻组件随后在引导线上前进，直到在扩孔器支承杆的末梢端处的齿35在引导金属线41进入胫骨的点处与骨接合。环钻组件的进一步前进导致支承杆开始向骨钻入小的距离，直到扩孔器12的齿31与骨接合。在此之后，使扩孔器前进所需的力变为足够使位于适配器本体14之内的活塞22从孔33内移出，并且支承杆13邻近地移动通过适配器本体，并且当扩孔器前进通过胫骨时停止前进。扩孔器前进直到其末梢端完全突破在胫骨平台上的胫骨皮质和任何软组织残留物(图8D)。此步骤确保在环钻系统之内收获的骨可从胫骨隧道轻易地移除。
通过首先使适配器和扩孔器支承杆从引导线41分离，来自环钻系统的已收获的骨被移除骨。如图8E中所示，扩孔器随后从引导线41和骨栓42移除，使得已收获的骨栓42离开扩孔器的邻近的、未切割的端。已收获的骨可被用于填补例如在髌骨、胫骨和股骨收获点中的缺口，以促进痊愈。
在骨栓将与WO2008/021474的干涉螺钉一起使用的情况下，如将描述，将需要一套压紧钳以将骨从引导线上切割下并且形成合适的骨栓。现参考图9A至图9C，示出了一套用于切割和压紧骨的医疗钳50。钳50由在位于杠杆的末梢区域中的支点处枢轴地连接的一对杠杆51组成。一组钳口53被设在杠杆51的末梢端处，并且邻近支点52的区域限定了一对把手54。这种布置产生了机械上的优势，即允许用户的手紧握的力被放大并且集中在被夹持在钳口53之内的物体上。钳50可用于操作和切割过小而难以用手指处理的物体。
钳口53由一对相对的互补的成形板55形成。如在图9B中更清晰地示出，当成形板55通过用户紧握把手54而被带至一起时，形成了一系列圆柱形空间60。因此，例如当骨组织被放置在钳口53以及板55之间，并且压力被施加到把手54上时，骨组织被压入柱形空间60以形成骨组织的圆柱形塞。成形板55的边缘61可变得锋利，以帮助圆柱形骨栓的形成并且将它们从可残留在钳50的钳口53中的任何相关联的骨组织切除。在图示的实施方式中，成形板包括一系列的三个互补的槽，当钳口53聚合到一起时，这些互补的槽形成了三个圆柱形空间60。各个槽具有不同的半径，这将提供各自具有不同直径的三种圆柱形骨栓。在未示出的备选实施例中，各个槽具有相同的半径，这将提供三个相同的圆柱形骨栓。
把手54同样包括：以弹簧62的形式存在的偏移装置，在打开的构造中使把手54偏移并且因此使钳口53偏移；以及拇指操作的插销，以将把手和钳口锁定在期望的位置上。
如将在下文中更详细描述，同样提供了活塞工具64(图9C)，以便与钳50一起使用，以帮助移除圆柱形骨栓。活塞64包括扁平的邻近头65、长形的本体66和末梢销69。销69具有对应于至少一个圆柱形空间60的直径，这些柱形空间60由闭合的钳50的板55形成。
在图9A至图9C中图示并且在上文中描述的医疗钳可与本文中描述的环钻系统一起使用。在已收获的骨被从环钻系统移除骨但仍附接在引导线41(图8E)上的阶段处，医疗钳50可用于将已收获的骨从引导线41移除骨，如在图10A中所示。打开的钳口53被置于已收获的骨栓42周围，并且当该骨栓42滑行离开引导线41时，钳口53紧握该已收获的骨栓42。另外的压力随后被施加到钳把手54上，以使用成形板53的切割边缘来使骨栓成形，来使该骨栓的尺寸减小。在压紧状态的闭合的钳口53中的圆柱形空间60运作，以压缩已收获的骨并使该已收获的骨再成形。接下来，插销63被关闭以锁定具有闭合的钳口的钳，以便准备好在合适的时候且一旦所述螺钉在骨隧道中处于合适的位置上时将骨栓递送入前述的干涉螺钉。
参考图10B，在回填位于骨隧道71中的具有导管结构的干涉螺钉70时，通过使在钳口53上的合适尺寸的激光标志72与螺钉70的中心对准，钳50被直接定位在螺钉之上。活塞工具64(未示出)随后被插入钳口的相反端并且向前前进，以将骨栓递送入螺钉的中心。
通过防止扩孔器相对于引导线在钻孔期间行进，已描述的系统提供了骨材料的精确的同中心骨芯体。该系统同样允许使用较少的装置，并且通过允许更容易地执行收获步骤，最终节约了时间。如上文所论述，有竞争力的环钻系统及它们的使用方法包括另外的步骤或包括另外的引导装置，以获得合适的骨栓。已描述的系统可用于更高效地获得骨栓，而不需要另外的器械或需要另外的手术步骤。
根据本发明的环钻的一个备选实施例在图11至图17中示出。
根据图11，示出了根据本发明的第二实施例的环钻10'的分解视图。环钻10'由各自包括内部导管的适配器11'、扩孔器12'、可收缩式轴环75和扩孔器支承杆13'形成。
适配器11'包括插入邻近的腿15'和末梢头部分20'之间的本体14'。本体14'包括在适配器的外部表面及其内部导管之间延伸的通道21'(图17)。活塞或销(未示出) 可在通道21'内移动，并且活塞的至少一部分延伸入适配器的内部导管。活塞通过适配到本体14'上的外部轴环或盖而朝导管偏移。适配器腿15'包括朝向其邻近端的扁平区域25'，这使环钻能够被连接到钻头上(未示出)。末梢头20'包括用于在已装配的构造中与扩孔器12'接合的一系列径向槽。这将参考图16在下文中更详细地描述。
扩孔器12'由圆柱形管状构件形成，并且包括：在末梢端处的一系列骨接合叶片或齿31'以及在邻近端处的一对相对的适配器销接合槽32'(图16)。如将在下文参考图16描述，槽32'通常为T形，并且允许扩孔器以刺刀型布置锁定在适配器11'上。扩孔器12'的末梢区域包括在其侧壁上的一对相对的孔80。
扩孔器支承杆13'由圆柱形管状构件形成，并且具有比适配器11'的末梢头20'的内部直径更小的外部直径。这使支承杆13'的邻近端能够滑行入适配器11'的末梢头20'(图15)。支承杆13'的邻近端包括一个或更多扁平区域73，当被组装和在使用中时，这些扁平区域防止该支承杆13'独立于适配器11'旋转。支承杆13'的邻近区域同样包括圆周槽74。当支承杆被滑入适配器11'时，延伸入该适配器的内部导管的适配器活塞的一部分与圆周槽74接合以将适配器11'和支承杆13'锁定到一起。
可收缩式轴环75为圆柱形管状构件，其外部直径小于扩孔器12'的内部直径，并且其内部导管具有比扩孔器支承杆13'的外部直径更大的直径。以凸轮盘81的形式存在的用于接合扩孔器12'的装置朝可收缩式轴环75的邻近端定位。由此，轴环75可在扩孔器12'内滑行，并且可在支承杆13'上滑行。
图12示出了已完全组装的环钻10'。
图13示出了可收缩式轴环75的分解视图。轴环包括尖锐的末梢端82和在该轴环的邻近端处的一对折弯槽83。在折弯槽83之内容纳有通过一系列弹簧84而朝外偏移的凸轮81。末梢轴环盖85通过一对螺钉90固定到轴环75上，并且防止凸轮盘81远离折弯槽83地滑动。弹簧使凸轮盘81能够在槽83之内移动。
如在图14中所示，在环钻10'的装配期间，通过向凸轮盘81施加压力并且使轴环75进入扩孔器12'，可收缩式轴环75被装入扩孔器12'。通过凸轮盘81与在扩孔器12'的侧壁上的孔80接合、凸轮盘81咬合(click)到孔80之外的动作，轴环75在扩孔器12'之内锁定。可收缩式轴环75被设计为当环钻10'所附接至的钻头旋转以使该环钻10'进入骨时锁定，并且该可收缩式轴环75被设计为当钻头的旋转方向反转时收缩入扩孔器12'内。这允许扩孔器在收获骨组织时在轴环75之上行进。
在一种备选布置中，凸轮盘被通过弹簧(未示出)朝外径向地偏移的球轴承或球形杯(spherical cup)代替。在此类备选实施例中，可收缩式轴环以相似的方式被保持在扩孔器之内的适当的位置上，但不包括如上所述的方向锁定。因此，当环钻进入骨时，一旦可收缩式轴环经受足够大的力以克服其在扩孔器内的摩擦配合，可收缩式轴环将收缩并且在收获骨组织的同时允许扩孔器在轴环上行进。
在环钻10'的组件中，扩孔器支承杆13'能够滑入和滑出适配器11'，并且扁平区域73防止该扩孔器支承杆13'独立于适配器11'旋转(图15)。一个或更多活塞21'与槽74接合，并且防止该槽74从适配器11'掉出。另外，止动边缘91防止支承杆13'在切割期间移动通过适配器11'。
参考图16，适配器11'的头20'包括一对同中心的轴环92，在这些轴环92之间设有径向槽93。一对销94位于径向槽93内，并且在扩孔器12'的邻近端处的销接合槽32'滑行到这些销上滑行并互锁，以使扩孔器和适配器接合。在切割时，在适配器的槽的内部的锁定销使扩孔器稳定，并且也防止扩孔器掉出适配器。
在图17中示出了通过已组装的环钻10'的截面。

Claims (17)

1.一种环钻，其包括：适配器、联接到所述适配器上的长形的扩孔器以及扩孔器支承杆，其中所述扩孔器支承杆共中心地安装在所述扩孔器和所述适配器之内，并且其中所述扩孔器支承杆的至少一部分能够关于所述环钻的纵向轴线以可滑行的方式移动，扩孔器支承杆的末梢端包括扩大的头，该头自身包括骨接合齿。
2.根据权利要求1所述的环钻，其中所述扩孔器支承杆具有导管结构。
3.根据权利要求2所述的环钻，其中所述扩孔器支承杆具有导管结构，并且允许引导线被容纳在其中。
4.根据权利要求1所述的环钻，其中所述扩孔器以可拆卸的方式联接到所述适配器上。
5.根据权利要求1所述的环钻，其中所述扩孔器支承杆和所述适配器包括用于将所述扩孔器支承杆联接到所述适配器上的互补的接合装置。
6.根据权利要求5所述的环钻，其中当合适的轴向力被施加在所述扩孔器支承杆的末梢端处时，所述互补的接合装置分离并且允许所述扩孔器支承杆邻近地滑行通过所述适配器。
7.根据权利要求1所述的环钻，其中所述扩孔器支承杆和所述适配器通过摩擦配合而联接。
8.根据权利要求1所述的环钻，其中所述扩孔器支承杆包括轴和可收缩式轴环。
9.根据权利要求8所述的环钻，其中所述可收缩式轴环和轴包括用于将所述可收缩式轴环联接到所述轴上的互补的接合装置。
10.根据权利要求9所述的环钻，其中，当合适的轴向力被施加到所述可收缩式轴环的末梢端上时，所述互补的接合装置分离并且允许所述可收缩式轴环在所述轴上邻近地滑行。
11.根据权利要求8所述的环钻，其中所述可收缩式轴环和轴通过摩擦配合而联接。
12.一种用于形成骨隧道和收获骨材料的系统，其中所述系统包括根据前述权利要求的任一项所述的环钻以及引导线。
13.根据权利要求12所述的系统，其中所述系统进一步包括一对压紧钳。
14.根据权利要求13所述的系统，其中所述压紧钳包括一对杠杆，所述杠杆在位于所述杠杆的末梢区域中的支点处枢轴地连接。
15.根据权利要求14所述的系统，其中所述压紧钳包括在所述杠杆的末梢端处的一组钳口以及邻近于所述支点的一对把手。
16.根据权利要求15所述的系统，其中所述钳口由一对相对的互补的成形板形成。
17.根据权利要求12所述的系统，所述系统还包括活塞。
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