DE19634696C1 - Surgical device for alignment and temporary fixation of cap segment removed from skull capsule to remaining skull cap - Google Patents

Abstract

The T-shaped tractive component has a shaft (28) with two draw arms (30,31) extending from it and is rotatable around its longitudinal axis. The holding component (38) is adjustably held on the shaft along its longitudinal direction. The holding component may surround the shaft of the tractive component in a ring-shaped manner. The shaft may alternatively have an outer thread so that the holding component can be screwed onto it. The holding component may be displaceable against the effect of an elastic setback force in the proximal direction of the shaft. The holding component can be activated by a spring force directed to the draw arms by a spring component (36) supporting on an extension (32) of the shaft.

Description

The present invention relates to a surgical device device for aligning and temporarily fixing one of the shafts the capsule segment removed from the remaining capsule Skullcap.

In craniosurgery, it is necessary that the Operator to open access to the operating area in that of a patient's skull capsule a segment of a calotte is removed. For this purpose, there are usually several at first Trephination holes are drilled in the skull capsule then using craniotome sections to form a Cutting gap to be connected. The educated one Cutting gap surrounds the calotte segment, so that this is the Skull capsule can be removed and the surgeon one Access to the underlying brain. In connection to the surgery must put the calotte segment back into the skull capsule inserted and fi on the remaining skull cap be fixed.

To fix the calotte segment to the remaining peel delkalotte are usually wire loops, threads or also used metal micro-plates (textbook Neurological Surgery, edited by Youmans, W. B. Saunders Company, 1990, Pages 2084, 2087 and 2092; DE 41 11 856 C1). For use the wire loops and threads are in the edge areas of the Calotte segment and, adjacent to this, on the remaining Through holes were drilled through the the wire loops or threads are passed through. Will alternatively or in addition to the wire loops and threads  Cutting gap bridging micro-plates are used, so it is necessary for this, this one end with the Ka solder segment and on the other hand with the remaining skull skull plumbed to screw.

Both screwing and inserting additional ones Through holes are subject to a mechanical load on the Connected dome segments. As a result, the Calotte segment in many cases when it is fixed to the remaining skull cap so displaced that lengthways its circumference results in an unevenly wide cutting gap. In addition, the Ge Fahr given that the level of the Kalottensegments not with corresponds to that of the remaining skull cap.

The object of the present invention is a simple hand trainable surgical device with the help the calotte segment relative to the remaining skull cap aligned and permanent during attachment Connection element can be temporarily fixed.

This task is performed in a surgical device initially mentioned type solved according to the invention in that the device a tension element and with this verspannba res holding element, wherein the tension element essentially Is T-shaped, a shaft and two of this protruding pull arms and rotatable about its longitudinal axis is and wherein the holding element on the shaft in the longitudinal direction tion is held adjustable.

Due to its T-shaped design, the tension element can in the distal direction directly into the incision gap between the calotte segment and the remaining skull calotte  be performed. It is only necessary to do this by Shank projecting arms in the longitudinal direction of the cutting gap align. The width of the draw arms and the diameter of the Shafts are chosen to be smaller than that Width of the cutting gap. After insertion, the Zugele ment rotated by about 90 ° about its longitudinal axis, so that the from Shaft protruding arms that are adjacent to the cutting gap Bone tissue of the calotte segment and the remaining peel reach under delkalotte. The device also includes a Holding element that is adjustable on the shaft of the tension element hold is. The cut can be made by means of the holding element cover the gap so that the holding element on the outside the skull capsule on the calotte segment and the remaining one Skull comes to the plant. Traction element and holding element are clamped together, d. H. the cut gap adjacent bone areas of the calotte segment and the Remaining skullcap can between the tension element and Retaining element are clamped. As a result, the Calotte segment aligned with the remaining skull cap is tested. In addition, the tensioning of tension and hal teelement a fixation of the calotte segment to the remaining connected to the skull.

Are several surgical devices according to the invention distributed over the circumference of the calotte segment into the cut gap inserted and the pulling and holding elements together tense, this means that the level of the Ka solder segments to that of the remaining skull cap fits and the cut gap over the entire circumference of the calotte occupies substantially the same width. To the such aligned and temporarily fixed calotte segment can now be permanent fasteners for example the wire loops or threads mentioned at the beginning,  fasten. If permanent fixation is ensured, then the tension between tension and holding element is released and rotated the tension element again by about 90 °, so that the Draw arms again parallel to the longitudinal direction of the cutting gap are aligned and remove the tension element from the cutting gap men can be. The surgical device according to the invention device thus has a simple handling and enables off in a simple manner and in a short amount of time Direction and temporary fixation of the calotte segment.

To insert the tension element into the cutting gap between To facilitate calotte segment and remaining skull cap tern, it is advantageous if the shaft is in its distal Tapered end area. For example, vorese hen be that the shaft on his when inserting the calotte tensegment or the skull cap facing Sides is chamfered and thus related to the longitudinal axis of the Draw arms have a larger diameter than transverse to it.

It can also be provided that the distal end region of the Shaft is frustoconical and at its di stalen end at which the draw arms are held, a small ren diameter than at a distance from it.

It is particularly advantageous to pivot the draw arms on di stalen end of the shaft with transverse to the longitudinal axis of the Drawbar aligned swivel axis. This enables the Draw arms to compensate for any irregularities in the Align the skull cap diagonally to the longitudinal axis of the shaft ten.

It is advantageous here if the draw arms start from one Middle part aligned transversely to the longitudinal axis of the shaft  approximately 30 ° clockwise and counterclockwise Clockwise are pivotable.

It is advantageous if the holding element the shaft of the Tension element surrounds in a ring. Such a configuration has the advantage that for the holding element with respect to Draw arms in the circumferential direction no special orientation is required. Rather, the holding element comes independently from the orientation of the tension arms on the outside of the calotte tensegments and the remaining skull cap to the plant.

In an advantageous embodiment it is provided that the shaft carries an external thread and the holding element the shaft can be screwed on. The holding element can be designed as a lock nut, for example, so that the the incision adjacent bone areas of the calotte segments and the remaining skull cap between the Pull arms and the lock nut can be clamped.

In a particularly preferred embodiment of the invention Inventional surgical device is provided that the holding element is slidably held on the shaft. This enables a particularly easy handling by the Hal teelement for applying the surgical device immediately bar can be moved along the shaft.

The tensioning of the tension and holding element is in front partial embodiment achieved in that the holding element ment against the effect of an elastic restoring force proximal direction of the shaft is displaceable. So can for example, be provided that the holding element in the unbe loaded condition immediately on the protruding from the shaft Tension arms rests and for inserting the tension element into the  Cutting gap on the top of the cutting gap to the system comes and moved along the shaft in the proximal direction becomes. Moving takes place against the effect of an elasti rule restoring force, so that the holding element with a the tension arm directed clamping force is applied.

The elastic restoring force can advantageously be there can be achieved by the holding element from one itself a projection of the shaft supporting spring element with egg spring force applied to the tension arms is. For example, it can be provided that the shaft at a distance from the pulling arms, for example on the zu zu Garmen opposite end, carries a support flange on which the spring element is supported with its proximal end, while the distal end of the spring element on the Zugar men facing away from the top of the holding element comes to rest. With such a configuration, the holding element in proximal direction, it experiences because of the Spring element a spring force directed at the tension arms.

The spring element can advantageously as the shaft surrounding coil spring be formed.

In an advantageous embodiment it is provided that Holding element has a sleeve surrounding the shaft, which a proximal end protruding on the outside helps to lift the sleeve against the action of the elasti restoring force. The projection can be, for example, as end surrounding the sleeve along its entire outer circumference be formed flange, the Un facing the pull arms forms a contact surface for the surgeon, who the Reach in under the end flange with your index and middle fingers and thus  easily shift the sleeve in the proximal direction can.

It is particularly favorable if the shaft on the Tow end facing away from the handle carries a handle.

The handle can be designed, for example, as a crossbar be. Especially in combination with one end This has a particularly protruding sleeve fold handling of the surgical device according to the invention tion by giving the operator a handle det, from which he opposes the action of the ela tical restoring force can move by the front jump engages and in the direction of the ends Crossbar lifts. In the raised state, the sleeve takes egg NEN distance to the tension arms, so that the tension element immediately insertable and twisted into the cutting gap can, and then the surgeon releases the sleeve, so that these are on the outside of the calotte segment and the remaining skull cap creates and due to the by the Restoring force caused by the clamping force between the sleeve and Draw arms the calotte segment and the remaining skull calotte te are mutually aligned.

The following description of preferred embodiments the invention serves in connection with the drawing of the nä here explanation. Show it:

Figure 1 is a schematic representation of a human skull with aligned by means of the inventive surgical device tem and temporarily fixed calotte segment.

Figure 2 is a schematic, perspective presen- tation of a first embodiment of the surgical device according to the inven tion when inserting a pulling element in a cutting gap.

Fig. 3 is a schematic representation corresponding to Figure 2 after twisting the tension element.

Fig. 4 is a schematic, perspective presen- tation of a second embodiment of the inventive surgical device and

Fig. 5 is a schematic, perspective presen- tation of a third embodiment of the inventive surgical device.

In Fig. 1, a human skull 10 is shown with a skull capsule 12 , in which three trephine bores 13 , 14 , 15 have been made, which are then cut 16 , 17 and 18 together via craniotome. A cut gap 20 is formed by the craniotome cuts, which surrounds a calotte segment 22 , which can be removed from the skull capsule 12 in order to provide an operator with access to the underlying brain. After ope ration, the calotte segment 22 is again inserted into the skull cap sel 12 and on which the calotte segment 22 surrounds the remaining skull cap 24 , so that the calotte segment 22 can again grow together with the skull capsule 12 .

To promote the healing process, it is advantageous if the cutting gap 20 along the entire circumference of the spherical segment 22 has substantially the same width. In addition, it is desirable if the level of the calotte segment 22 corresponds to the level of the remaining skull cap 24 . The final fixation of the calotte segment 22 to the remaining skull cap 24 can be carried out, for example, using metal microplates or by means of wire loops and threads. In order to ensure in their application that the Kalottensegment 22 with respect to the remaining Schädelka Lotte 24 maintains an optimum orientation, the Ka is Lotte segment 22 rurgischen using the method described below chi device temporarily fixed, said dome segment is oriented 22 simultaneously Lotte relative to the remaining Schädelka 24 .

A first embodiment of the surgical device according to the invention is shown in FIGS . 2 and 3. Fig. 2 shows a surgical connecting element 26 with egg nem in the incision 20 between the calotte segment 22 and the remaining skull cap 24 insertable cylindrical shaft 28 , the distal end of which is T-shaped and two pull arms 30 and 31 projecting perpendicular to the shaft wearing. Where the tension arms 30, 31 facing away from proxima len end is held a this vice circumferentially surrounding support flange 32 on the shaft 28, and a vertically oriented to the shaft 28 transverse bar 34 which their longitudinal direction is centrally fixed to the proximal end face of the shaft 28 with respect to.

The shaft 28 is surrounded over its entire length in the circumferential direction by a helical spring 36 , the proximal end of which rests on the support flange 32 and which carries at its distal end a retaining ring 38 which is penetrated by the shaft 28 and by the helical spring 36 with one on the tension arms 30 and 31 directed spring force is applied.

The diameter of the shaft 28 and the width of the tension arms 30 and 31 are selected such that the shaft 28 and the tension arms 30 and 31 , provided that these are aligned parallel to the longitudinal direction of the cutting gap 20 - as shown in FIG. 2 - into the cutting gap 20 can be inserted while the diameter of the retaining ring 38 exceeds the width of the cutting gap 20 , so that it covers the cutting gap 20 . The crossbar 34 is aligned parallel to the pull arms 30 and 31 , so that the surgeon can orientate himself from the direction of the crossbar 34 when he introduces the pull arms 30 and 31 and the distal end region of the shaft 28 into the cutting gap 20 . Since the diameter of the retaining ring 38 is larger than the width of the cutting gap 20 , the retaining ring 38 comes to rest on the top of the calotte segment 22 and the remaining skull cap 24 when the tension arms 30 and 31 dip into the cutting gap 20 .

The shaft 28 is inserted into the cutting gap 20 until the tension arms 30 and 31 assume a position below the calotte segment 20 and the remaining skull cap 24 . After reaching this position, the shaft 28 is rotated by about 90 ° about its longitudinal axis, as shown in FIG. 3. The tension arms 30 and 31 now engage under the calotte segment 22 or the remaining skull calotte 24 in their regions adjacent to the cutting gap 20 . The retaining ring 38 is mechanically connected to the shaft 28 via the coil spring 36 and the support flange 32 , and the lowering of the distal end region of the shaft 28 has the result that the retaining ring 38 and the tension arms 30 and 31 due to the spring force of the coil spring 36 be braced together.

This in turn causes the tension arms 30 and 31 to be raised until the level of the calotte segment 22 matches the level of the remaining skull cap 24 , the retaining ring 38 serving as a counter ring and providing for level compensation. The distal end region of the shaft 28 which extends through the cutting gap 20 serves at the same time as a spacer between the calotte segment 22 and the remaining skull calotte 24 . In this manner, over the circumference of Kalot tensegments 22 distributes a plurality of connecting elements 26 appli ed, this has the consequence that on the one hand the level aligns te of Kalottensegments at the level of the remaining Schädelkalot and that on the other hand the cutting gap 20 along the entire circumference of the calotte segment 22 occupies approximately the same width. In addition, the calotte segment and the remaining skull cap 24 are mutually determined. After the application of a plurality of connecting elements 26 , the calotte segment 22 can be permanently fixed in the remaining skullcap 24 by means of known fastening elements without the risk that the calotte segment 22 assumes a misorientation.

A second embodiment of the surgical device according to the invention is shown in FIG. 4. This shows a surgical connecting element 40 , which essentially corresponds to the connecting element 26 described above and in which identical parts are designated with the same reference numerals as in FIGS. 1 to 3.

The connecting element 40 shown in FIG. 4 comprises, in addition to the retaining ring 38 which is subjected to an elastic restoring force in the distal direction by means of the helical spring 36, a sleeve 42 which is integrally connected to it and surrounds the helical spring 36 and on the proximal end face of which a sleeve 42 is aligned parallel to the retaining ring 38 End flange 44 is held. With the aid of the end flange 44 which is mechanically connected to the retaining ring 38 via the sleeve 42 , the handling of the connecting element 40 is simplified since the operator engages under the end flange 44 and can thereby raise the sleeve 42 and the retaining ring 38 against the action of the helical spring 36 , so that the distal end region of the shaft 28 and the two pull arms 30 and 31 stood from the holding ring 38 . The thus free-standing T-shaped end region of the connecting element 40 can thereby be inserted unhindered into the cutting gap 20 and then rotated through 90 °.

A third embodiment of the surgical device according to the invention is shown in FIG. 5. This shows a connecting element 46 with a shaft 47 which carries at its di stal end two transverse arms 48 , 49 aligned transversely to the shaft 47 and at its proximal end a parallel to the Zugar men 48 , 49 aligned crossbar 50 . Aligned parallel to the longitudinal direction of the cutting gap 20 , the tension arms 48 and 49 and the distal end region of the shaft 47 can be inserted directly into the cutting gap 20 and then rotated 90 ° around the longitudinal axis of the shaft 47 , so that the tension arms 48 and 49 form the calotte segment 22 or the remaining skull cap 24, according to the embodiments described above. In contrast to the previously described Verbindungselemen th 26 and 40 , the shaft 47 of the connecting element 46 carries an external thread 52 , onto which a lock nut 54 is screwed up, which has a plurality of longitudinal grooves 56 distributed over the circumference for better handling on its outer side . The length of the external thread 52 is selected such that the lock nut 54 can be screwed along the external thread 52 so far in the proximal direction that the distal end region of the shaft 47 can be inserted unhindered into the cutting gap 20 and rotated by approximately 90 °. After rotating the shaft 47 , the lock nut 54 is screwed so far in the stale direction until it comes to rest on the outside of the Ka segment 22 and the remaining skull cap 24 and the bone areas positioned between the pull arms 48 and 49 and the lock nut 54 aligns and braces each other.

In the embodiments shown in the drawing, the shaft 28 has the same diameter over its entire length. In order to facilitate the insertion of the distal end region of the shaft 28 into the incision gap 20 , it can be provided that the shaft 28 tapers conically in its distal end region. For this purpose, it can, for example, be frustoconical. Since when inserting le diglich the extension of the shaft transversely to the longitudinal axis of the pull arms 30 , 31 aligned parallel to the longitudinal direction of the cutting gap 20 is important, but not the expansion of the shaft parallel to the longitudinal axis of the pull arms 30 , 31 , can also be provided that the shaft on its side facing the calotte segment 22 or the remaining skull cap 24, which is oriented transversely to the longitudinal axis of the tension arms 30 , 31 , is conically chamfered.

It is also advantageous if the pull arms 30 and 31 are pivotally mounted on the distal end of the shaft 28 with a pivot axis oriented transversely to the longitudinal axis of the pull arms. This makes it possible to pull arms 30 and 31 to compensate for any irregularities in the skull capsule 12, starting from a center position oriented transversely to the longitudinal axis of the shaft 28 , that is, counterclockwise and clockwise, for example up to 30 ° swivel.

Claims (11)

1. Surgical device for aligning and temporarily fixing a cap segment taken from a skull capsule to the remaining skull cap, characterized in that the device has a pulling element and a holding element ( 38 ; 54 ) which can be releasably clamped thereto, the pulling element being essentially T-shaped is configured, has a shaft ( 28 ; 47 ) and two pull arms ( 30 , 31 ; 48 , 49 ) projecting therefrom and can be rotated about its longitudinal axis, and wherein the holding element ( 38 ; 54 ) on the shaft ( 28 or 47 ) is held adjustable in the longitudinal direction. 2. Surgical device according to claim 1, characterized in that the holding element ( 38 ; 54 ) surrounds the shaft ( 28 ; 47 ) of the tension element in a ring. 3. Surgical device according to claim 1 or 2, characterized in that the shaft ( 47 ) carries a Außenge thread ( 52 ) and the holding element ( 54 ) can be screwed onto the shaft ( 47 ). 4. Surgical device according to claim 1 or 2, characterized in that the holding element ( 38 ) is slidably held on the shaft ver. 5. Surgical device according to claim 4, characterized in that the holding element ( 38 ) can be displaced against the effect of an elastic restoring force in the proximal direction of the shaft ( 28 ). 6. Surgical device according to claim 5, characterized in that the holding element ( 38 ) from a on a projection ( 32 ) of the shaft ( 28 ) supporting spring element ( 36 ) with a spring force directed to the tension arms ( 30 , 31 ) can be acted upon is. 7. Surgical device according to claim 6, characterized in that the spring element as the shaft ( 28 ) surrounding helical spring ( 36 ) is formed. 8. Surgical device according to claim 5, 6 or 7, characterized in that the holding element has a sleeve ( 42 ) surrounding the shaft ( 28 ), which at its proximal end carries an externally projecting projection ( 44 ) for lifting the sleeve ( 42 ) counter to the effect of the elastic restoring force. 9. Surgical device according to one of the preceding claims, characterized in that the shaft ( 28 ; 47 ) at its end facing away from the pulling arms ( 30 , 31 ; 48 , 49 ) carries a handle ( 34 ; 50 ). 10. Surgical device according to claim 9, characterized in that the handle is designed as a crossbar ( 34 ; 50 ). 11. Surgical device according to claim 9 or 10, characterized in that the handle ( 34 ; 50 ) is aligned paral lel to the pull arms ( 30 , 31 ; 48 , 49 ).