DE202007017509U1 - Attachment device for a surgical device and surgical device for cutting through a bone - Google Patents

Abstract

attached device (10; 100; 200; 300) for a surgical device, wherein the attachment device (10; 100; 200; 300) has a cutting device (12) with at least one at least one cutting edge (26) forming cutting element (22) for producing at least one cutting line on a bone (88) comprises, characterized in that the attachment device (10, 100; 200; 300) has a feed device (34) which at least a feed member (62), which relative to at least one Cutting edge (26) is designed to be movable and thereby relatively can take a variable distance to this, as well as a Kraftbeaufschlagungseinrichtung (48), which is formed so that the at least one feed member (62) acted upon by a force acting in the distal direction is, at least if the distance exceeds a minimum distance.

Description

The The invention relates to an attachment device for a surgical device, wherein the attachment device comprises a cutting device with at least one at least one cutting edge forming cutting element for generating comprises at least one cutting line on a bone.

Furthermore The invention relates to a surgical device for cutting a bone with at least one attachment device, wherein the Attachment device a cutting device with at least one at least one cutting edge forming cutting element for generating comprises at least one cutting line on a bone.

A Attachment device of the type mentioned can as an accessory or supplementary device for the the latter surgical device for cutting through a Bone be used or a component, in particular a Building unit, the same form.

Under Use of a known attachment device may be a bone, for example the human skull, be cut through, for example, to create an opening in the Skull, over which a surgeon places surgical instruments inside the body of a patient introduce can. The following is simplified and non-limiting for applicability the attachment device and the surgical device are assumed that this on the human skull They are also used to cut other bones can be used. Accordingly, hereinafter refers to "body interior the patient "not only on the inside of the human skull, but generally on adjacent areas of the body to be cut through bone.

at Known attachment devices, it has a disadvantage for the handling proved that for the surgeon is often not recognizable when the bone cut through is. Because of this, the surgeon usually has to use slow Propulsion of the at least one cutting element and utmost care proceed during the cutting process to remove body tissue lying beyond the bone, for example soft tissue or a periosteum, when cutting through the bone not by means of at least one cutting element to hurt.

task The present invention is an attachment device and To provide a surgical device of the type mentioned, with the risk of injury to the patient is reducible.

These The object is achieved in a generic attachment device according to the invention that the attachment device has a feed device which at least a feed member which is relative to the at least one cutting edge is designed to be movable and thereby relative to this a variable Distance can take, as well as a Kraftbeaufschlagungseinrichtung, which is formed so that the at least one feed member with a acting in the distal direction force is acted upon, at least if the distance exceeds a minimum distance.

The at least one feed member of the feed device is relative designed to be movable at least one cutting edge. As a result, can the at least one feed member relative to the at least one cutting edge take a variable distance. For example, a relative movement the at least one feed member and the at least one cutting edge and an associated change in distance by a propulsion the at least one cutting element during the cutting process be achieved in the bones. That way the distance can be exceed a predetermined minimum distance, which is about predetermined by the thickness of the bone to be cut or can be determined by means of this.

Accordingly the at least one feed member can be relative to the at least one cutting edge then have the minimum distance when the bone is cut through is.

Further it is provided that at least when the distance exceeds a minimum distance, the at least one feed member by the Kraftbeaufschlagungseinrichtung can be acted upon by a force acting in the distal direction. "Distal" is present in Reference to the onset of the attachment device surgeon. Will the attachment device as usual with at least one hand, means "distal" present "in the hand of the Operators pioneering direction ".

By the application of force, the at least one advancing member can be moved in the distal direction. It is also made possible to act on the bone to be cut by means of the at least one feed member with a force and thereby also to move it in the distal direction, in particular into the interior of the patient. Beyond the bone lying tissue, such as a periosteum, can thereby also be moved in the distal direction and thus away from the at least one cutting element. This allows, with proper handling of the attachment device, a risk of injury to the underlying tissue behind the bone ver wrestlers. In addition, at the same time the handling of the attachment device is improved.

Around to determine if the distance of the at least one feed member of the at least one cutting edge exceeds the required minimum distance, the attachment device may comprise a detection device. This can be multifaceted Be formed manner, for example mechanically and / or optically. For example, it is possible that by means of the detection device, the resistance to the cutting through bones the at least one cutting element during the cutting process contrary, is detected. Its waste can be an indication that the bone is cut through.

alternative For example, the detection device may be a detection element include the bone already during the cutting process acted upon by a force, which by a counter force of the bone is compensated. If the bone is cut, its Counteracting force, since beyond the bone arranged tissue softer than the bone is formed. The elimination of the drag is detectable by means of the detection element and, for example, to Activation of Kraftbeaufschlagungseinrichtung used.

Cheap is it, if the force application device is designed such that the at least one feed member regardless of its distance from the at least one cutting edge with a distal direction Acting force can be acted upon. This allows the attachment device a simple and reliable To give functionality. The Kraftbeaufschlagungseinrichtung This can quickly lead to an overrun the minimum distance react, since the at least one feed member permanently acted upon by the force. In particular, it allows this embodiment, the at least one feed member than that described above Form detection member, which is the bone to be cut subjected to the force whose counterforce after cutting of the bone is eliminated. After the elimination of the opposing force of the bone, this can, for example under repression from beyond the bone arranged tissue, by means of at least a feed member to be moved in the distal direction.

From It is advantageous if the at least one feed member has a contact surface for Applying the at least one feed member to the bone. This gives the opportunity the bone over that at least one feed member with a distal direction acting Force to apply. Forms the at least one feed member the detection element described above, by means of the contact surface the Presence and elimination of a counter force of the bone detected become.

Prefers the at least one feed member comprises at least one in distal direction extending engagement element for engagement in the bones. This can be an intervention between the at least a feed member and the bone are ensured. At a Force application of the at least one feed member is thus the bone also reliable with force. It can be provided that the at least a feed link over the at least one engagement element addition to the one described above contact surface for application to the bone.

The Kraftbeaufschlagungseinrichtung may be formed in many ways. In particular, it may be directly or indirectly related to the at least act on a feed member. An example of an indirect on the at least a feed member acting Kraftbeaufschlagungseinrichtung is one which is used on the at least one feed member a medium such as a fluid acts. So can the Kraftbeaufschlagungseinrichtung comprise a nozzle, from the force application the at least one feed member, a fluid such as compressed air flows out when the distance of the at least one feed member of the at least a cutting edge exceeds the minimum distance.

A directly acting on the at least one feed member acting on Kraftbeaufschlagungseinrichtung Can on this in physical Interact with form. This is preferably done by the Kraftbeaufschlagungseinrichtung is applied to the at least one feed member. This indicates technical easy way the way the at least one feed member with the force in the distal direction to act on.

Cheap is it, when the Kraftbeaufschlagungseinrichtung an elastic element for applying force to the at least one feed member, because this allows a structurally simple embodiment of the attachment device. The elastic element, which advantageously on the at least for example, includes springs of any kind Type such as coil springs, gas springs, leaf springs, elastic rubber cuffs or similar.

The at least one feed member can be acted upon by the force applying device independently of its distance from the at least one cutting edge in a technically simple manner with a force acting in the distal direction, when the elastic element relative is biased to at least one feed member.

Preferably defines the attachment device an axis along which the at least a feed member relative to the at least one cutting edge movable is trained. This allows a defined movement of at least ensure a feed member and ensures reliable operation the attachment device.

Cheap is it, if the attachment device to a guide for the at least one feed member to having its movement relative to the at least one cutting edge. Leave it the movement of the at least one feed member relative to form at least one cutting edge even more reliable. For education the leadership For example, the attachment device may comprise a guide body arranged on the cutting device or the feed device is or is covered by this.

Around a movement of the at least one feed member relative to at least a cutting edge along an axis of the attachment device technically simple way to ensure that is at least one Feed member relative to the at least one cutting edge preferably slidably guided, for example, the above-mentioned guide body along.

From It is advantageous if the at least one feed member for limiting its movement relative to the at least one cutting edge at least a stop is assigned. By means of at least one stop, for example, be arranged on the cutting device and / or the feed direction can or can be included limit the range of motion of the at least one feed member.

It can be provided that the at least one stop for limiting the movement of the at least one feed member in the distal direction is trained. Will the movement of the at least one feed member limited in the distal direction, this gives the possibility, also a Movement of the bone, which by means of at least one feed member is energized to limit in the distal direction. Consequently The advance of the bone into the body of the patient can be limited become. This allows it to be located beyond the bone body tissues only so far from the cutting edge to remove that the risk of injury of the body tissue is reduced by the at least one cutting element and at the same time a risk of injury caused by compression of body tissue by advancing the bone could decrease. On constructive easy way lets the movement of the at least one feed member in the distal Limit direction, for example, by the fact that the at least one Feed member at least partially between the at least one Stop and the Kraftbeaufschlagungseinrichtung is arranged.

In similar It can be provided that the at least one stop for Limiting the movement of the at least one feed element in is formed proximal direction, wherein "proximal" in the present case opposite to "distal" is to be understood. For example, let this can be achieved in a structurally simple way that the Kraftbeaufschlagungseinrichtung at least partially between the Stop and the at least one feed member is arranged. In this case, the at least one feed member on the Kraftbeaufschlagungseinrichtung on the at least one stop support or attached to it.

From Advantage is when the cutting device is designed so that the at least one cut line is self-contained or substantially can be generated closed in itself. This allows for technically simple Way to cut out a bone segment from the bone, the one has self-contained edge line. After removing such Bone segment, the bone thus has an opening through which the surgeon Instruments inside the body introduce can. conveniently, the cutting line is round and still conveniently circular generated.

On structurally simple way the cut line described above thereby produce in that the cutting device has an at least partially sleeve-like cutting body includes and that the at least one cutting element at one of Ends is arranged. The cutting body can be, for example, hollow cylindrical be formed, so that the at least one cutting element during cutting the bone is a circular and self-contained cutting line can generate approximately when the cutter rotatably driven is. The cutting device may, for example, be driven at the end opposite the at least one cutting element of the cutting body Having means for connection to a drive device.

A compact design and a reliable Operation of the attachment device, in particular at last described embodiment, can be characterized achieve that the cutting device coaxial with the feed device is aligned.

A compact design of the attachment device can also be achieved in that the Cutting device, for example, with the cutting body described above, the feed device at least partially surrounds. Conveniently, then the cutting body is aligned coaxially with the feed device.

From It is advantageous if the feed device is rotatably movable relative to the cutting device is trained. If the cutting device as described above to produce a self-contained or substantially self-contained Cutting line driven on the bone rotating, can thereby for example the inertia reduce the attachment, since it is not necessary to drive the feed device also. The feed device can, for example by means of the above described at least one Engagement element of the at least one feed member, in the Bone intervene and be secured against rotation relative to this, while the Cutting device a rotational movement relative to the feed device and to the bone.

Preferably the at least one feed member is secured against rotation to the feed device trained, that is to the rest of the feed device, which the at least one feed member includes. That way a wear of the Avoid feed device, which could arise if the at least one feed member rotatable to the feed device would be trained. In the embodiment described last is thereby also given the opportunity the feed device as a whole, that is including the at least one feed member, rotatably to the cutting device train.

When Cheap it has been found, when the feed device relative to at least a cutting edge is linearly movable. This allows the feed device as a whole, to move linearly relative to the at least one cutting edge and in this way the distance between the at least one feed member and the at least one cutting edge to vary. Independently of can be provided that the at least one feed member for Rest of the feed device is designed to be linearly movable.

Prefers defines the attachment device an axis along which the feed device relative is designed to be linearly movable for at least one cutting edge. By doing so leaves a reliable one Ensure operation of the attachment device. The axis is advantageous identical to an axis along which the at least one feed member designed to be movable relative to the at least one cutting edge is.

Preferably the cutting device forms a screw connection with the feed device. By means of the screw connection, it is possible to use the cutting device and the feed device both rotatable with each other as also linearly movable to form each other, wherein the linear movement can be decoupled from the rotational movement. By means of the screw connection Furthermore, in particular a screw guide can be defined, for guide both the linear movement and the rotational movement of the feed device and the cutter relative to each other.

to structurally simple design of the screw it is as cheap proved when the cutter with the feed device engaged. In particular, it can be provided that the feed device an external thread having, which with an internal thread of the cutting device cooperates to form the screw and the definition the screw guide.

advantageously, is the cutting device from an operating position in which they is in engagement with the feed device, into a release position, in the engagement between the cutting device and the feed device is canceled and vice versa. This facilitates the handling of Attached device. For example, the engagement between the Cutting device and the feed device for moving the Feed device are lifted relative to the cutter, by the cutting device is transferred to the release position. After posting the feed device relative to the cutting device, the Cutting device are transferred back to the operating position.

Preferably the attachment device has a restoring device, with the cutting device can be transferred from the release position into the operating position. This causes further ease of handling the attachment device. It can be provided in particular that the transfer of the cutting device from the release position in the operating position is done without the intervention of a user.

A structurally simple embodiment of the last-mentioned embodiment can be achieved in that the return means an elastic Element comprises, against its bias, the cutter in the operating position with the feed device in engagement stands. The elastic element may be, for example Feathers of any kind act such as coil springs, leaf springs, Gas springs, rubber sleeves or the like.

Especially simply the attachment device is manageable when the cutter is designed so that it can be moved manually from the operating position to the release position and / or vice versa. The Cutting device may comprise, for example, an actuator, by its operation a user, the cutter from the release position to the operating position and / or vice versa.

A structurally simple design and compact design of the attachment device can be achieved by the feed device a the at least one feed member at least partially surrounding sleeve-like feed body which engages with the cutter. Of the feed body can in particular with the cutting device via a thread in engagement stand and train with this a screw connection. Furthermore can the feed body a guide for the at least one feed member for define its movement relative to at least one cutting edge.

A even more compact design of the attachment device can be achieved be that the feed body the Kraftbeaufschlagungseinrichtung at least partially surrounds.

Cheap is it, if the feed body at least a the at least one feed member for limiting its movement relative to the at least one cutting edge associated stop includes or trains. Preference, the feed body includes or forms two Attacks off, the movement of the at least one feed member both in Limit distal and in the proximal direction.

at a preferred embodiment the attachment device according to the invention it has to be cheap proven when the attachment device has a support means with at least one attachable to the bone support member. By means of the support device The surgeon can support the attachment device on the bone. This can especially in such a way that prevents it is that the surgeon the attachment device after cutting of the bone as a whole into the body of the patient. A risk of injury of being behind the to be cut Bone located body tissue let yourself thereby further reduce.

A structurally simple design and reliable operation of the attachment device can be achieved in that the support means at least one partially sleeve-like Having support body and that the at least one support member at one end thereof is arranged.

For one reliable Operation and a compact design of the attachment device has it proved to be advantageous if the support device coaxial with the cutting device and / or coaxially aligned with the feed device. Especially preferred is the support device coaxial to both the cutting device and the feed device aligned.

advantageously, surrounds the support device the cutting device and / or the feed device at least partially. It is particularly advantageous if the support device completely surrounds the cutting device and the feed device. This makes it possible to attach the attachment device to an area of the supporting bone that cuts outside the cutting line is arranged so that the attachment device on the bone effectively against penetration into the inside of the body Patients are supported can. In particular, the support device be supported on the bone by means of the supporting body described above, which preferably aligned coaxially with the cutting device and the feed device is.

Cheap, when the support rotates is formed to the cutting device. As explained above, can be by a rotational movement a closed or substantially closed Create cut line on the bone. Is the support rotatably to the cutting device, it can thus, for example, against rotation support the bone relative to the bone, the at least a support member is engaged with the bone.

From Advantage is when the support device is formed secured against rotation to the feed device. This is especially advantageous when the cutter rotating is driven and both relative to the feed device as well relative to the support device is designed to rotate. The latter can then each with the bone are engaged and secured against rotation relative to this formed be. This has proven to be particularly advantageous for the handling of the attachment device and for the reliability of their operation.

Advantageously, the support device is designed to be linearly movable relative to the at least one cutting edge. This makes it possible to move the support device as a whole relative to the at least one cutting edge. During the cutting of the bone, in which the attachment device with the support device is supported on the bone, the at least one cutting element can to penetrate the bones.

One reliable Operation of the attachment device can be ensured by that the support device along a defined axis of the attachment device relative is designed to be linearly movable for at least one cutting edge.

Preferably forms the support with the cutting device from a screw. This can be done make sure the support device relative to the cutter both linearly movable and is rotatably formed, wherein the linear movement of the Rotary movement can be decoupled. In particular, over the Screw connection further defined a screw, for guide both the linear movement and the rotational movement of the support device and the cutter relative to each other.

On structurally simple way, the screwing can be formed be when the support device engaged with the cutter, in particular via co-operating threads. For example, the support device have an internal thread, with an external thread of the cutting device cooperates to form the screw.

conveniently, the attachment device has one of the cutting device associated first coupling device with a with the at least one Cutting element operatively connected to the first coupling member and a drivable second coupling member connected to the first coupling member interacts. about the first coupling device may have a driving force on the at least a cutting element are transmitted, wherein the driving force may originate from a drive device, with which the attachment device can be coupled. For example, can the above-mentioned surgical device for cutting a bone having such a drive device. The first coupling member and the second coupling member can on the cutting device are arranged or covered by the cutting device but it is also possible in that they can be coupled to a gear mechanism that can be coupled to the cutting device are included or arranged thereon.

Preferably is the first coupling member with the second coupling member through Applying force to the at least one cutting element and / or the at least one feed member in the proximal direction in operative connection brought. This gives the opportunity the first and the second coupling member thereby in operative connection with each other to bring that attachment to the one to be cut Bone is placed. Practice the Operator while a force acting in the distal direction of the Bone out, its counterforce can be used to the first and bring the second coupling member in operative connection with each other. This favors the handling of the attachment device.

From It is advantageous if the attachment device has a restoring device comprises, against the action of the first coupling member with the second coupling member can be brought into operative connection. By the Reset device let yourself Make sure that the first and second coupling members are not permanently interact with each other, so that at least a cutting element not even with driven first coupling member is driven permanently. As a result, the attachment device is on safer way to handle.

Prefers the attachment device is designed so that the first coupling member acted upon by a pioneering force from the second coupling member is, at least if the distance of the at least one feed member of the at least one cutting edge exceeds a minimum distance. As explained above, can the passing a minimum distance is an indication that the bone by means of the cutting device has been cut through. In this embodiment is therefore allowed that the operative connection between the first coupling member and the lifted second coupling member after cutting the bone becomes. The cutting device is in this way after cutting of the bone automatically decoupled from any existing drive device becomes. By doing so leaves minimize the risk of injury to the patient and the handling the attachment device he lighter. To the force application can For example, the reset device described above used be in the form of a between the first coupling member and the second coupling member arranged elastic member can be trained.

at a structurally simple embodiment of the attachment device are the first coupling member and the second coupling member as interlocking tabs educated.

Advantageously, the attachment device has a second coupling device assigned to the support device with a third coupling element that is operatively connected to the at least one support element and a drivable fourth coupling element that interacts with the third coupling element. As in the case of the first coupling device described above, it is there by possible to transmit a driving force to the support means only when the third coupling member is in operative connection with the fourth coupling member. It can be provided that the third coupling member is only indirectly in operative connection with the support member. For example, the third coupling member may be arranged on the cutting device, which forms a screw connection with the support device. Driving of the third coupling member can then be used to effect, as explained above, a rotational movement of the cutting device relative to the support means.

Prefers is the third coupling member with the fourth coupling member through Applying force to the at least one support member in the proximal direction can be brought into operative connection. This can be done, for example, by that the attachment device from the surgeon with a distally acting force placed on the bone to be cut is, by its counterforce in the proximal direction of the third Coupling member with the fourth coupling member in operative connection can be brought. This facilitates the handling of the attachment device.

From It is advantageous if the attachment device has a restoring device comprises, against the action of the third coupling member with the fourth coupling member can be brought into operative connection. This is ensures that the third coupling member and the fourth coupling member not permanently in operative connection with each other.

Especially Cheap it is when the fourth coupling member with the first coupling device mechanically is coupled. This allows the fourth coupling member only then to drive when the first coupling member and the second coupling member with each other in operative connection.

On structurally simple way form the second coupling device when the third Coupling member and the fourth coupling member as interlocking projections are formed.

Preferably form the cutter and the feed device together at least partially a preassembled and replaceable unit. It may therefore be an assembly of the attachment device or also to a structural unit of the device according to the invention explained below to cut a bone. This improves the versatility the attachment device or the surgical device and also benefits a compact design of the same. For example, it may be provided that for creating openings different diameter at the bone to be cut different Building units are provided, each having a cutting device comprising adapted to it feed device.

Around to be able to drive the attachment device, it is advantageous if the attachment device a connection device for connecting the Attachment device has a drive device.

As already mentioned, The invention also relates to a surgical device for cutting through a bone with at least one attachment device.

at a generic surgical device The task initially posed according to the invention thereby solved, in that the attachment device has a feed device which comprises at least one feed member, which relative to at least a cutting edge is designed to be movable and thereby relatively can take a variable distance to this, and a Kraftbeaufschlagungseinrichtung, which is designed such that the at least one feed member is acted upon by a force acting in the distal direction, at least if the distance exceeds a minimum distance.

The inventive surgical Device thus has the already in connection with the explanation the attachment device according to the invention described advantages.

Especially It is advantageous if the at least one attachment device the inventive surgical Device as one of the attachment devices described above is trained. The surgical device then assigns the the explanation mentioned these attachment devices further advantages.

As already explained, Advantageously, the surgical device has one with the cutter coupled drive means for driving the cutting device on. For coupling the drive device with the cutting device The surgical device preferably comprises one to one Connecting device of the cutting device corresponding formed Connecting device. Alternatively or additionally, the surgical Device be designed so that the cutting device manually is drivable. The drive device is preferably as electrical Drive device formed, but this can also be to a pneumatic, hydraulic, using a fuel working or otherwise designed drive device act.

Prefers the drive device is designed such that the cutting device is driven in rotation. Under "rotating drivable "becomes present understood that a on the at least one cutting edge arranged reference point moves along a circular line, advantageously for producing a self-contained cutting line on the bone.

It can also be provided that the drive device is formed is that the cutting device is driven to oscillate. In this case leads a reference point arranged on the at least one cutting edge an oscillating movement. This may, depending on the design of the cutting device, a self-contained, essentially self-contained or not self-contained cut line on the bone result to have.

Furthermore can be provided that the drive device is formed is that the cutting device according to a pilgrim step method is drivable. A reference point located on the cutting edge leads through it a progressive forward / backward movement from, for example, the fact that a rotating Movement is superimposed on an oscillating motion.

The following description of preferred embodiments of the invention used in conjunction with the drawings, the detailed explanation of the invention. Show it:

1 a perspective view, partially in sectional view, of a first preferred embodiment of the attachment device according to the invention;

2 : Another perspective view of the attachment device 1 ;

3 a sectional view taken along the line 3-3 in 1 before cutting a skull bone;

4 : the tower device and the skull bone 3 during the cutting process;

5 : the tower device and the skull bone 3 after the cutting process;

6 a partial sectional view of a second preferred embodiment of the attachment device according to the invention with an operating position engaging cutting device;

7 : the tower device 6 whose cutting device has been transferred from the operating position to a release position;

8th a partial sectional view of a third preferred embodiment of the attachment device according to the invention before cutting a skull bone;

9 : the tower device and the skull bone 8th during the cutting process;

10 : the tower device and the skull bone 8th after the cutting process;

11 a partial sectional view of a fourth preferred embodiment of the attachment device according to the invention prior to the cutting of a skull bone;

12 : an enlarged view of detail A in 11 ;

13 : the tower device and the skull bone 11 at the beginning of the cutting process;

14 : an enlarged view of detail B in 13 ;

15 : the tower device and the skull bone 11 after the cutting process;

16 : an enlarged view of detail C in 15 ;

17 A first preferred embodiment of the surgical device according to the invention for cutting a bone comprising the attachment device 1 ;

18 A second preferred embodiment of the surgical device according to the invention comprising the attachment device 6 ;

19 A third preferred embodiment of the surgical device according to the invention comprising the attachment device 8th and

20 A fourth preferred embodiment of the surgical device according to the invention comprising the attachment device 11 ,

A first preferred embodiment of the attachment device according to the invention is in the 1 to 5 shown and there with a total of the reference numeral 10 busy. The attachment device 10 comes as an accessory or supplementary device for a surgical device for cutting a bone, in particular of the human skull, used or forms part of the same, in particular a structural unit. A first preferred embodiment of the surgical device according to the invention for cutting a bone is shown in FIG 17 represented there by the reference numeral 11 and will be explained below.

The attachment device 10 includes a cutter 12 which includes a first proximal end not shown in the drawing and a second distal end shown in the drawing 14 having. "Proximal" and "distal" is present not only for the attachment device 10 , but also for the other attachment devices described below 100 . 200 and 300 to understand that "proximal" and "distal" to the attachment device 10 are to be considered using the operator. This means that the proximal end of the attachment device 10 the surgeon and in particular his hands, with which he the attachment device 10 usually leads, is closer than the distal end 14 the attachment device 10 , In the drawing is the distal end 14 the attachment device 10 shown below, and the unillustrated proximal end of the attachment device 10 Accordingly, each would be at the top of the respective figures. This applies equally to the further preferred embodiments described below 100 . 200 and 300 the attachment device according to the invention.

Starting from the proximal end, the cutting device 12 a shaft 16 on, which widens funnel-shaped in the distal direction and in a sleeve-like cutting body 18 passes. The cutting body 18 is in particular formed as a hollow cylinder and comprises a plurality of openings for weight reduction 20 , At its distal end, the cutting body 18 a variety of cutting elements 22 on top of that from the cutting body 18 projecting cylinder jacket in the distal direction. The cutting elements 22 are in the form of sharp teeth 24 formed, which together form a circular cutting edge 26 the cutting device 12 form. The cutting device 12 is a total of rotationally symmetric with respect to an axis 28 designed, which is an axis of the attachment device 10 Are defined.

On an inside 30 includes the cutting body 18 distal to the openings 20 an internal thread 32 over which the cutting device 12 with a feed device 34 the attachment device 10 engaged, this is an external thread 36 having. The feed device 34 is from the cutting body 18 surrounded and coaxial with the cutting device 12 aligned. It comprises a sleeve-like and in a first approximation hollow cylindrical feed body 38 on the outside 40 the external thread 36 is arranged.

Near his proximal end 42 has the feed body 38 inside an annular groove 44 on, in which a spring washer 46 is clamped, at which one of the feed body 38 surrounded Kraftbeaufschlagungseinrichtung 48 in the form of a coil spring 50 designed elastic element 52 is applied.

At the distal end 54 of the feed body 38 is the cylindrical wall of the feed body 38 in the direction of the axis 28 bent inwards, forming an annular flange 56 , This is on the inside of an approximately hollow cylindrical section 58 one below as a stamp 60 designated feed member 62 the feed device 34 penetrated. To the hollow cylindrical section 58 closes in the proximal direction a ring section 64 of the stamp 60 at.

The ring section 64 lies at the distal end of the coil spring 50 on, thus between the spring ring 46 and the stamp 60 clamped and in particular biased to the punch 60 to apply a force in the distal direction. By concern of the ring section 64 of the stamp 60 on the ring flange 56 of the feed body 38 can prevent the stamp 60 through the coil spring 50 in the distal direction from the feed body 38 is pushed out.

At the distal end, the stamp includes 60 an approximately annular contact surface 66 , from the distally a plurality of engagement elements 68 in the form of sharp-edged strips 70 protrude.

Relative to the feed body 38 is the stamp 60 along the axis 28 movably formed, wherein the feed body 38 a guide body for the stamp 60 Are defined. To guide the stamp 60 can its ring section 64 on the inside of the feed body 38 abutment and its hollow cylindrical section 58 inside the ring flange 56 , Here are the hollow cylindrical section 58 such edge side two cylinder segments removed and has the annular flange 56 inside such two ring segments 72 and 74 on ( 2 ) that the stamp 60 Totally secured against rotation to the rest of the feed device 34 is designed.

The range of motion of the stamp 60 relative to the feed body 38 gets through two stops 76 such as 78 limited. The proximal stop 76 is through the spring ring 46 educated, where the coil spring 50 is present and indirectly via this the stamp 60 , The distal stop 78 is through the ring flange 56 formed, on which, as already mentioned, the ring section 64 of the stamp 60 can be present, provided the stamp 60 is not moved by force in the proximal direction of this.

Due to its mobility relative to the feed body 38 is the stamp 60 thus also relative to the teeth 24 and the cutting edge defined by it 26 movably formed, and it can relative to the cutting edge 26 take a variable distance.

Due to the existing engagement of the internal thread 32 the cutting device 12 and external thread 36 the feed device 34 form the cutting device 12 and the feed device 34 with each other from a screw, by which in particular a screw is defined to guide a relative movement of the cutter 12 and the feed device 34 , On the one hand, the screw connection causes a rotary movement of the cutting device 12 relative to the feed device 34 allows. In addition, it is also possible, the feed device 34 relative to the cutter 12 to move linearly along the axis 28 both in the distal and in the proximal direction.

As follows, in particular with reference to the 3 to 5 is described for cutting a bone by means of the cutting device 12 proceed as follows:
First, the cutting device 12 with a known per se, not shown in the drawing and arranged at its proximal end connecting device with a drive unit 80 ( 17 ) connect to. The drive unit 80 For this purpose, one has the connection unit of the cutting device 12 correspondingly formed connection device, which likewise can not be seen in the drawing, and with the connection device of the cutting device 12 can be connected in a known per se and therefore not explained in more detail way. Together with the drive unit 80 forms the cutting device 12 the already mentioned preferred embodiment of a surgical device 11 for cutting a bone.

For driving the cutting device 12 includes the drive unit 80 a drive device coupled to its connection device 82 , which is preferably designed as an electric drive device. However, this may also be a pneumatic, hydraulic, operating using a fuel or otherwise designed drive device.

The drive device 82 is formed so that the cutting device 12 both rotating and oscillating and can be driven according to a pilgrim step method. The term "rotationally drivable" is understood here to mean that a reference point on the cutting edge, for example one of the teeth 24 , performs a preferably continuous circular motion, "oscillating drivable" is understood in the present case that the reference performs a periodic reciprocating motion, and "according to a Pilgerschrittverfahren" is understood herein a superimposed rotating and oscillating movement of the reference point, so that this under Periodic forward and backward movement also performs a preferably continuous Kreisbe movement. For simplicity but not limitation, it is assumed below that the cutting device 12 by means of the drive device 82 is driven in rotation.

For cutting a bone, such as the human skull, as in the 3 to 5 . 8th to 11 such as 13 and 15 partially shown schematically and with the reference numeral 84 is occupied, is the cutting device 12 with the stamp 60 ahead on the outside 86 of the skull bone 88 set up ( 3 ). By applying force to the cutting device 12 by the surgeon in the distal direction is possible that the contact surface 66 of the stamp 60 on the outside 86 of the skull bone 88 is present and the strips 70 in engagement with the skull bone 88 devices. In addition, the stamp 60 relative to the feed body 38 and to the cutting edge 26 in the proximal direction against the spring force of the coil spring 50 shifted, with the spring ring 46 as a proximal stop 76 for the stamp 60 serves.

By existing engagement between the stamp 60 and the skull bone 88 is the stamp 60 and thus also the entire feed device 34 relative to the skull bone 88 against rotation. By activating the drive device 82 the drive unit 80 can then the cutting device 12 be put in a rotary motion. This causes the cutting device 12 relative to the feed device 34 moved linearly in the distal direction, due to the cutting device 12 and the feed device 34 defined screw connection by means of the internal thread 32 the cutting device 12 and external thread 36 the feed device 34 , By continuing rotational movement penetrate the teeth 24 and thus the cutting edge defined by them 26 in the skull bones 88 and thereby generate the skull bone 88 a circular self-contained and not shown in the drawing section line ( 4 ).

The hardness of the spiral spring 50 is such that the resistance that the skull bone 88 the cutting device 12 when cutting ent counterposed, by the existing engagement between the stamp 60 and the skull bone 88 by applying force to the stamp 60 by means of the spiral spring 50 can be compensated. Thus, the rotational mobility of the feed device 34 relative to the cutting motion 12 due to the rotation of the feed device 34 relative to the skull bone 88 be ensured.

With progressive propulsion of the cutting elements 22 in the skull bones 88 takes the distance of the punch 60 relative to the cutting edge 26 due to the relative movement of the feed device 34 and the cutter 12 to. Is the skull bone 88 completely cut, eliminates the counterforce of the skull bone 88 which of these the Kraftbeaufschlagung the stamp 60 through the coil spring 50 opposes. The thickness of the skull bone 88 is thus a measure of a minimum distance, which the punch 60 relative to the cutting edge 26 must take, thus the counterforce of the skull bone 88 eliminated. The Stamp 60 thus acts as a sort of detection element for the elimination of the counterforce of the cranial bone and thus as a detection element for when the skull bone 88 by means of the cutting device 12 is cut through.

One of the teeth 24 enclosed cut-out bone segment 90 becomes after cutting through the skull bone 88 due to the application of force by the spiral spring 50 and the lost counterforce of the skull bone 88 through the stamp 60 Stressed in the distal direction, because beyond the skull bone 88 arranged soft tissue 92 the stamp 60 can not provide sufficient resistance ( 5 ).

One inside the skull bone 88 adjoining periosteum 94 becomes due to the distally moving bone segment 90 from the teeth 24 the cutting device 26 moved away. In addition, something becomes soft tissue 92 displaced in the distal direction. When used as intended the attachment device 10 this gives the possibility of a risk of injury to the periosteum 94 and soft tissue 92 through the teeth 24 the cutting device 12 to reduce. This is made possible by the fact that the spiral spring 50 the stamp 60 at least when the distance of the punch 60 from the cutting edge 26 exceeds a minimum distance, inter alia, by the thickness of the skull bone 88 is given, acted upon by a force acting in the distal direction and thus the movement of the bone segment 90 effected in the distal direction.

The through the ring flange 56 defined distal stop 78 the feed device 34 ensures that the movement of the stamp 60 and thus the bone segment 90 is limited in the distal direction ( 5 ). As a result, the penetration depth of the bone segment is also 90 inside the skull 84 limited, leaving a risk of soft tissue injury 92 and the periosteum 94 through the bone segment 90 can be minimized.

Because the distal stop 78 due to the existing screw connection between the cutting device 12 and the feed device 34 during the cutting process also relative to the cutting edge 26 Moving in the proximal direction, moreover, the advance of the punch 60 after cutting through the skull bone 88 be minimized.

However, this is not a requirement for the function of the attachment device 10 , In a variant of the attachment device 10 could the feed body 38 For example, on the outside have a rib, which in an inside of the cutting body 18 arranged annular groove engages. In this case there would be no screw connection between the cutting device 12 and the feed device 34 , and linear movement of the cutter 12 relative to the feed device 34 would not be possible. Accordingly, the feed path of the punch fell 60 and thus the bone segment 90 after cutting through the skull bone 88 in the distal direction larger than in the attachment device 10 , Nevertheless, the periosteum can do so 94 and the soft tissue 92 from the teeth 24 the cutting device 12 be moved away.

In further modifications of the attachment device 10 can instead of the coil spring 50 a different type of elastic element 52 used, for example, a leaf spring, a gas spring or an elastic rubber sleeve.

In a variant of the attachment device 10 is the stamp 60 not during the cutting process on the skull bone 88 but only after the cutting of the cranial bone 88 through the coil spring 50 with force.

To determine if the skull bone 88 is cut through, the attachment device can 10 comprise a separate detection device, which for example functions mechanically and / or optically.

Instead of Kraftbeaufschlagungseinrich tung 48 that the elastic element 52 Also, a hydraulically and / or pneumatically and / or elastically operating force application device can be used.

It is also possible within the scope of the attached patent claims to use a force application device which is not directly like the spiral spring 50 on the stamp 60 but only indirectly. Such a force application device may, for example, comprise a nozzle from which to apply force to the stamp 60 then a fluid such as compressed air emanates when the skull bone 88 by means of the cutting device 12 is cut through.

The surgical device according to the invention for cutting a bone 11 can over the attachment device 10 In addition, further attachment devices include, for example, in terms of the diameter of the cutter body 18 and thus the diameter of the skull 84 he distinguishable witnessible cutting line. Such attachment devices come as well as the attachment device 10 form preassembled and interchangeable units, which in a simple and well-known manner to the drive unit 80 connect or disconnect from this.

A further preferred embodiment of the attachment device according to the invention is described below. She is in the 6 and 7 represented and there by the reference numeral 100 busy. The attachment device 100 can with the already mentioned drive unit 80 cooperate to form a second preferred embodiment of the inventive surgical device for cutting a bone, which in 18 represented and there by the reference numeral 101 is occupied. In addition, the attachment device 100 as well as the attachment device 10 be used as an accessory or supplementary device for other drive units and form with these further preferred embodiments of the surgical device according to the invention for cutting a bone.

The attachment device 100 is largely identical in construction with the attachment device 10 , why for identical and / or equivalent components of the attachment device 100 the same reference numerals are used as for the attachment device 10 , With respect to these components, reference is made to the above explanations to avoid repetition. The above-described advantages of the attachment device 10 can with the attachment device 100 also be achieved.

At the attachment device 100 has the cutting body 18 at its proximal end portion before the taper of the cutter 12 to the shaft 16 two wall segments 102 and 104 on. These are mutually related to the axis 28 , diametrically opposite and each extend over about one-eighth of the circumference of the cutter body 18 , Accordingly, the cutting body comprises 18 two further wall segments, of which in the drawing only a wall segment 106 can be seen, each about unge about three-eighths of the cutter body 18 extend. The wall segment 106 and the wall segment, not shown, are with a wall segment 108 of the cutting body 18 integrally connected, which the distal end portion of the cutting body 18 forms and on which the cutting elements 22 are arranged.

On the wall segment 106 and the wall segment, not shown, are the wall segments 102 and 104 movable and in particular pivotable about two perpendicular to the axis 28 aligned and perpendicular to the plane axes shown 110 respectively 112 stored. For pivotable mounting of the wall segments 102 and 104 has the attachment device 100 first bearing elements 114 as well as second bearing elements 116 on that with the first bearing elements 114 interact. The first bearing elements 114 are as breakthroughs 118 formed and the second bearing elements 116 as a bearing pin 130 , These are the openings 118 on the wall segments 102 and 104 and the bearing bolts 120 on the wall segment 106 and arranged on the wall segment, not shown.

The wall segments 102 and 104 have on their respective inside 30 the internal thread 32 the cutting device 12 on, so that the internal thread 32 over about a quarter of the circumference of the cutter body altogether 18 extends. As above in the case of the attachment device 10 explained, stands the cutter 12 over the internal thread 32 with the external thread 36 the feed device 34 engaged ( 6 ). A position in which the internal thread 32 with the external thread 36 is engaged, as the operating position of the cutting device 12 in which the attachment device 100 as above in the case of the attachment device 10 described can be used.

By applying force to their proximal ends 122 and 124 perpendicular to the axis 28 and present in the drawing plane, symbolized by the arrows in 7 , the wall segments can 102 and 104 relative to the rest of the cutter body 18 be pivoted. The direction of the application of force is present such that the proximal En the 122 and 124 to be moved towards each other, which allows the internal thread 32 the cutting device 12 out of engagement with the external thread 36 the feed device 34 bring to. This is called the release position of the cutting device 12 designated. In the release position of the cutting device 12 can the feed device 34 in a simple way relative to the cutting device 12 be offset. This is for example before or after use of the cutting device 12 useful to the feed device 34 for an imminent or re-use of the attachment device 100 relative to the cutting edge 26 suitable to arrange.

The cutting device 12 the attachment device 100 is in particular manually transferred from the operating position to the release position, what the attachment device 100 gives easy handling. In addition, the attachment device 100 a reset device 126 on which an elastic element 128 in the form of a spiral spring 130 includes. The spiral spring 130 is between the proximal ends 122 and 124 the wall segments 102 respectively 104 perpendicular to the axis 28 arranged and in particular in the operating position of the cutting device 12 between these biased. The transfer of the cutting device 12 from the operating position to the release position, therefore, takes place against the action of the coil spring 130 , by means of which the cutting device 12 is automatically transferred again from the release position in the operating position. In addition, it is of course possible, the cutting device 12 manually transferred from the release position to the operating position.

A third preferred embodiment of the attachment device according to the invention is described below, is in the 8th to 10 shown schematically and there with the reference numeral 200 busy. The attachment device 200 can with the already described drive unit 80 cooperate to form a third preferred embodiment of the surgical device for cutting a bone, which in 19 represented and there by the reference numeral 201 is occupied. The attachment device 200 can also be used as an accessory or supplemental device for other drive units and form with these further preferred embodiments of the device according to the invention for cutting a bone.

The attachment device 200 is largely identical in construction with the attachment device 10 , why for identical and / or equivalent components of the attachment device 200 the same reference numerals as for those of the attachment device 10 be used. With respect to these components, reference is made to the above explanations to avoid repetition. The above advantages of the attachment device 10 can with the attachment device 200 also be achieved.

The attachment device 200 has a support device 202 on, coaxial with the cutter 12 and to the feed device 34 is aligned and by means of a sleeve-like and in particular approximately hollow cylindrical support body 204 both the cutting device 12 as well as the feed device 34 surrounds. The distal end of the support body 204 forms an annular and in particular circular support member 206 in the form of a slightly tapered support edge in the distal direction 208 ,

The support body 204 Overall, it is largely rotationally symmetrical with respect to the axis 28 formed, wherein the rotational symmetry through a from the proximal end of the support body 204 in the proximal direction protruding fixation 210 will be annulled. The fixation member 210 runs parallel and at a distance to the shaft 16 the cutting device 12 and is as a flat strip of material 212 educated.

The drive unit 80 includes one with the fixing member 210 cooperating fixing device 216 ( 19 ), which is arranged on the outside and one parallel to the axis 28 extending recess 220 in which the proximal end of the fixing member 210 parallel to the axis 28 is guided when the attachment device 200 to the drive unit 80 connected.

On its inside 222 that the cutting body 18 facing, has the support body 204 an internal thread 224 on, with an external thread 226 engaged, which on an outside 228 of the cutting body 18 is arranged. The cutting device 12 and the support device 202 Form in this way a screw that defines a screw, so that the support device 202 relative to the cutter 12 is formed both rotatable and linearly movable, wherein the linear movement parallel to the axis 28 can be done both in the proximal and in the distal direction.

For the application of the attachment device 200 is this on the outside? 86 of the skull bone 88 put on that in addition to the stamp 60 the feed device 34 also the supporting edge 208 the support device 202 at the skull bone 88 is present ( 4 ). Upon application of force to the attachment device 200 in the distal direction, this causes the support body 204 in engagement with the skull bone 88 ,

Will the cutter 12 like the first described in rotation, remains with the skull bone 88 engaged support device 202 rotatable to the cutting device 12 because it is using the fixer 216 prevented, along with the cutting device 12 to rotate. Due to the existing screw connection between the cutting device 12 and the support device 202 the latter moves relative to the cutting edge 26 in the proximal direction, with the movement of the support device 202 through that in the recess 220 guided fixation member 210 to be led.

The external thread 36 the feed device 34 , the internal thread 32 and the external thread 226 the cutting device 12 as well as the internal thread 224 the support device 202 each have the same thread, so that the feed device 34 and the support device 202 relative to the cutting edge 26 move the same distance in the proximal direction. As a result, the cutter rotates 12 between the feed device 34 and the support device 202 , and the feed device 34 and the support device 202 are rotationally secured to each other ( 9 ).

During the cutting process, the support device serves 202 for supporting the entire attachment device 200 and thus also the surgical device 201 at the skull bone 88 , Is the skull bone 88 by means of the cutting device 12 cut across ( 10 ), this way may increase the risk that the attachment device 200 as a whole in the skull 84 invades and, as a result, soft tissue injuries 92 and the periosteum 94 be reduced.

A fourth preferred embodiment of the attachment device according to the invention described below is in the 11 to 16 represented and there with the reference numeral 300 busy. The attachment device 300 can together with the already mentioned drive unit 80 form a fourth preferred embodiment of the surgical device according to the invention for cutting a bone, which in 20 shown schematically and there by the reference numeral 301 is occupied. In addition, the attachment device 300 be used as an accessory or supplementary device for other drive units and form with these further preferred embodiments of the surgical device according to the invention for cutting a bone.

The attachment device 300 has a plurality of components that are identical and / or equivalent to the components of the attachment device 10 are formed and beyond a plurality of components that are identical and / or equivalent to components of the attachment device 200 are formed. Therefore, the components that are identical or equivalent to features of the attachment devices 10 or 200 are formed, with the same reference numerals as the corresponding components of the attachment devices 10 and 200 designated. With respect to these components, reference is made to the above explanations to avoid repetition.

The advantages of the attachment devices described above 10 and 200 can with the attachment device 300 also be achieved.

In the following, reference will be made in particular first to the 11 and 12 the structure of the cutting device 12 the attachment device 300 explained in more detail:
The shaft 16 the cutting device 12 is at the attachment device 300 not with the cutting body 18 but at least partially forms a housing for a transmission device 302 that of the cutting device 12 is included. Driving forces on the cutting device 12 become thereby at the attachment device 300 in contrast to the attachment devices 10 . 100 and 200 not over the shaft 16 but transmitted through within the shaft 16 arranged components of the transmission device 302 , which are described below.

The cutting body 18 the attachment device 312 has at its proximal end a ceiling wall 304 on, in which a connecting part 306 is used, that with a first gear part 308 in the form of a socket 310 rotatably connected, in this case by screwing, wherein the connection can be made in other ways. The socket 310 is annular from a second gear part 312 surrounded, which in turn from the shaft 16 is surrounded and firmly connected to this. The second transmission part 312 has an annular shoulder at its proximal end 314 on that one stop 316 for the socket 310 which forms along the axis 28 relative to the second gear part 312 and to the shaft 16 is displaceable.

The socket 310 is with a third gear part 318 acting as output shaft 320 is formed rotatably connected, in this case by screwing, wherein the connection can be made in other ways. At its proximal end is the output shaft 320 approximately hollow cylindrical and includes a central receptacle 322 in which a fourth gear part 324 in the form of a guide pin 326 engages with its distal end.

With its proximal end, the Füh approximately bolt 326 in a central recording 328 one, on a fifth gear part 330 , which as an approximately hollow cylindrical drive shaft 332 is designed, formed / is. A sixth gear part 356 surrounds the drive shaft 332 , in turn, is from the shaft 16 surrounded and connected with this.

The drive shaft 332 is in a known per se and therefore not shown in the drawing manner with a known per se and therefore not shown in the drawing connecting device of the attachment device 300 connected to their connection, for example, to the drive unit 80 ,

The output shaft 320 has a shoulder at its proximal end 334 on, on the guide pin 326 by means of a surrounding ring collar 336 is applied. In the proximal direction, an elastic element is supported on the ring collar 338 in the form of a spiral spring 340 off, the proximal end of which is on a shoulder 342 in the recording 328 the drive shaft 332 supports and a restoring device 344 the attachment device 300 forms what will be explained in more detail below.

In addition, the output shaft includes 320 at its proximal end a plurality of first coupling members 346 in the form of protruding teeth 348 provided with a plurality of second coupling members 350 can interact, which also as protruding teeth 352 are formed and at the distal end of the drive shaft 332 are arranged. The teeth 348 and 352 together form a first coupling device 354 the attachment device.

In her distal, that is the socket 310 facing area is the output shaft 320 from a seventh transmission part 358 in the form of an output sleeve 360 surround.

The output sleeve 360 indicates on its outside 362 the external thread 226 the cutting device 12 on. The external thread 226 stands with the internal thread 224 the support device 202 engaged, on an inside 364 a sleeve-shaped and in particular hollow cylindrical threaded body 370 is arranged. The threaded body 370 is from the support device 202 the attachment device 300 includes and is connected to the proximal end of the support body 204 rotatably connected. In addition, the threaded body lies 370 inside on the shaft 16 at, relative to which it is rotatably and slidably formed.

The cutting device 12 and the support device 202 the attachment device 300 form as in the case of the attachment device described above 200 a screw, so that the support device 202 relative to the cutter 12 both rotatably trained as well as linearly movable parallel to the axis 28 in both the proximal and distal directions.

Approximately at the level of the distal end of the picture 322 the drive shaft 320 has the output sleeve 360 one shoulder 372 on, on which an elastic element 374 in the form of a spiral spring 376 supported with its distal end. The proximal end of the coil spring 376 rests on one shoulder 378 the output shaft 320 starting at some distance from the proximal end of the output shaft 320 is arranged.

At its proximal end has the output sleeve 360 a plurality of third coupling members 380 on that as protruding teeth 382 are formed and having a plurality of fourth coupling members 384 can cooperate to form a second coupling device 386 the attachment device 300 , The fourth coupling members 384 be from an eighth gear part 387 in the form of a drive sleeve 388 includes and are also known as protruding teeth 390 educated. The drive sleeve 388 surrounds the distal end of the drive shaft 332 and the proximal end of the output shaft 320 and in turn is from the shaft 16 surround.

On an outside, the output shaft 320 between the teeth 348 and the shoulder 378 a recording 392 in the form of a long hole 394 into which a coupling element 396 in the form of a driving pin 398 engages, the other end in a receptacle 400 engages near the distal end of the drive sleeve 388 is formed. In the slot 394 is the driving stick 398 parallel to the axis 28 slidably, and over the Mitnehmerstift 398 exists between the output shaft 320 and the drive sleeve 388 a non-rotatable connection.

For cutting the skull bone 88 with the attachment device 300 proceed as follows:
First, the attachment device 300 as already mentioned, via its connection device arranged at the proximal end and not shown in the drawing, with a drive unit, for example the drive unit 80 , connect to the drive shaft 332 drive. To the cutting body 18 to put in a rotary motion, is the drive shaft 332 also to put in a rotary motion. Alternatively, it is of course also possible, the drive shaft 332 oscillating and / or driving according to a pilgrim step method as described above.

For cutting the skull bone 88 is the tower device 300 on the outside 86 of the skull bone 88 put on so that the contact surface 66 of the stamp 60 and the supporting edge 208 the support device 202 at the skull bone 88 issue. This is in the 11 shown, wherein the attachment device 300 only loose on the skull bone 88 shown adjacent, without being acted upon by the surgeon with a force acting in the distal direction.

As in 11 and in particular in 12 In this case, the teeth are visible 348 and 352 as well as the teeth 382 and 390 disengaged, that is, the first coupling means 354 and the second clutch device 386 are decoupled. This is due to the fact that in the case of the first coupling device 354 the spiral spring 340 between the drive shaft 332 and the output shaft 320 is biased; over the ring collar 336 becomes the output shaft 320 with one of the drive shaft 332 pioneering force. In the case of the second coupling device 386 the coil spring acts on the force 376 the output sleeve 360 with one of the drive sleeve 388 groundbreaking power.

By applying force to the attachment device 300 in the distal direction against the counterforce of the skull bone 88 ( 13 and 14 ) can both the first coupling device 354 as well as the second coupling device 386 be engaged with each other. In the case of the first coupling device 354 This is done by the cutting body 18 the counterforce of the skull bone 88 in the proximal direction, mediated either by the feed device 34 or the cutting elements 22 , The cutting body 18 transmits the counterforce of the skull bone 88 over the connecting part 306 and the socket 310 on the output shaft 320 to the teeth 348 with the teeth 352 to engage. This is done against the bias of the coil spring 340 , which is from the output shaft 320 mediated by the ring collar 336 can be compressed. The driving pin 398 is doing relative to the output shaft 320 in the distal direction in the slot 394 postponed.

In the manner described above, the first coupling device 354 coupled, and a rotational movement can from the drive shaft 332 on the cutting body 18 for cutting the skull bone 88 by means of the cutting elements 22 be transmitted.

The coupling of the second coupling device 386 takes place in that the support body 204 with the supporting edge 208 the counterforce of the skull bone 88 receives. Due to the solid connection of the support body 204 with the threaded body 370 becomes the output sleeve 360 that with the threaded body 370 is engaged, in the direction of the drive sleeve 388 postponed.

This is done until the teeth 382 with the teeth 390 in engagement, against the action of the coil spring 376 ,

About the driving pin 398 are the teeth 390 the second coupling device 386 mechanically with the first coupling device 354 coupled. In this way is possible, a rotational movement of the drive shaft 332 over the first coupling device 354 on the output shaft 320 and then via the driving pin 398 on the drive sleeve 388 to transmit, whereupon their rotational movement via the second coupling means 386 on the output sleeve 360 can be transferred.

Due to the existing screw connection between the output sleeve 360 and the threaded body 370 can the support device 202 parallel to the axis 28 relative to the cutter 12 move in the proximal direction, as already above in the case of the attachment device 200 has been described. The threads of the external thread 36 the feed device 34 , the internal thread 32 the cutting device 12 , the external thread 226 the cutting device 12 as well as the internal thread 224 the support device 202 are identically formed, so that when cutting through the skull bone 88 the feed device 34 and the support device 202 , each with the skull bone 88 are engaged, rotationally fixed to each other are formed. Between the feed device 34 and the support device 202 The skull bone is removed from the cutting body 18 the cutting device 12 intersected.

As already mentioned, forms the coil spring 340 a reset device 344 the attachment device 300 , After cutting the skull bone 88 ( 15 and 16 ) by then the skull bone 88 applied counterforce, so that the coil spring 340 due to its bias between the drive shaft 332 and the output shaft 320 the latter so from the drive shaft 332 can move away that teeth 348 and 352 disengaged. This means that after cutting through the skull bone 88 the first coupling device 354 automatically decoupled. Even if the drive shaft 332 after cutting through the skull bone 88 still performs a rotary motion, this is no longer on the cutting body 18 transfer. The risk of injury to the periosteum 94 and soft tissue 92 can be largely prevented. The stop 316 on the second transmission part 312 ensures that the cutting body 18 when decoupling the first coupling device 354 only so far in the skull 84 penetrates, as absolutely necessary.

Even after the decoupling of the first coupling device 354 remains the second coupling device 386 coupled in ( 15 and 16 ), as long as the attachment device 300 is acted upon by a force acting in the distal direction of the skull bone 88 can be compensated. After removing the attachment device 300 from the skull bone 88 get your teeth, too 382 and 390 due to the restoring force of the spiral spring 376 , which thus also a reset device 402 the attachment device 300 forms disengaged.

Claims (59)

Attachment device ( 10 ; 100 ; 200 ; 300 ) for a surgical device, wherein the attachment device ( 10 ; 100 ; 200 ; 300 ) a cutting device ( 12 ) with at least one at least one cutting edge ( 26 ) forming cutting element ( 22 ) for producing at least one cutting line on a bone ( 88 ), characterized in that the attachment device ( 10 ; 100 ; 200 ; 300 ) a feed device ( 34 ), the at least one feed member ( 62 ), which relative to at least one cutting edge ( 26 ) is movable and thereby can take a variable distance relative to this, and a Kraftbeaufschlagungseinrichtung ( 48 ), which is designed such that the at least one feed member ( 62 ) is acted upon by a force acting in the distal direction, at least if the distance exceeds a minimum distance. Attachment device according to claim 1, characterized in that the force application device ( 48 ) is formed so that the at least one feed member ( 62 ) regardless of its distance from the at least one cutting edge ( 26 ) is acted upon by a force acting in the distal direction. Attachment device according to claim 1 or 2, characterized in that the at least one feed member ( 62 ) a contact surface ( 66 ) for applying the at least one feed member ( 62 ) on the bones ( 88 ) having. Attachment device according to one of the preceding claims, characterized in that the at least one feed member ( 62 ) at least one engagement element extending in the distal direction ( 68 ) for intervention in the bone ( 88 ). Attachment device according to one of the preceding claims, characterized in that the force application device ( 48 ) indirectly or directly on the at least one feed member ( 62 ) acts. Attachment device according to one of the preceding claims, characterized in that the force application device ( 48 ) on the at least one feed member ( 62 ) is present. Attachment device according to one of the preceding claims, characterized in that the force application device ( 48 ) an elastic element ( 52 ) for applying force to the at least one feed member ( 62 ). Attachment device according to claim 7, characterized in that the elastic element ( 52 ) relative to the at least one feed member ( 62 ) is biased. Attachment device according to one of the preceding claims, characterized in that the attachment device ( 10 ; 100 ; 200 ; 300 ) an axis ( 28 ), along which the at least one feed member ( 62 ) relative to the at least one cutting edge ( 26 ) is designed to be movable. Attachment device according to one of the preceding claims, characterized in that the attachment device ( 10 ; 100 ; 200 ; 300 ) a guide for the at least one feed member ( 62 ) for moving it relative to the at least one cutting edge ( 26 ) having. Attachment device according to claim 10, characterized in that the at least one feed member ( 62 ) relative to the at least one cutting edge ( 26 ) is guided displaceably. Attachment device according to one of the preceding claims, characterized in that the at least one feed member ( 62 ) for limiting its movement relative to the at least one cutting edge ( 26 ) at least one stop ( 76 . 78 ) assigned. Attachment device according to claim 12, characterized in that the at least one stop ( 78 ) for limiting the movement of the at least one feed member ( 62 ) is formed in the distal direction. Attachment device according to claim 12 or 13, characterized in that the at least one stop ( 76 ) for limiting the movement of the at least one feed member ( 62 ) is formed in the proximal direction. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) is formed so that the at least one cutting line is self-contained or substantially self-contained can be generated. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) an at least partially sleeve-like cutting body ( 18 ) and that the at least one cutting element ( 22 ) is arranged at one end thereof. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) coaxial with the feed device ( 34 ) is aligned. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) the feed device ( 34 ) at least partially surrounds. Attachment device according to one of the preceding claims, characterized in that the feed device ( 34 ) rotatably to the cutting device ( 12 ) is trained. Attachment device according to one of the preceding claims, characterized in that the at least one feed member ( 62 ) against rotation to the feed device ( 34 ) is trained. Attachment device according to one of the preceding claims, characterized in that the feed device ( 34 ) relative to the at least one cutting edge ( 26 ) is formed linearly movable. Attachment device according to claim 21, characterized in that the attachment device ( 10 ; 100 ; 200 ; 300 ) an axis ( 28 ) along which the feed device ( 34 ) relative to the at least one cutting edge ( 26 ) is formed linearly movable. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) with the feed device ( 34 ) forms a screw connection. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) with the feed device ( 34 ) is engaged. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) from an operating position in which it is connected to the feed device ( 34 ) is engageable in a release position, in which the engagement between the cutting device ( 12 ) and the feed device ( 34 ) and vice versa. Attachment device according to claim 25, characterized in that the attachment device ( 100 ) a reset device ( 126 ), with which the cutting device ( 12 ) can be transferred from the release position to the operating position. Attachment device according to claim 26, characterized in that the restoring device ( 126 ) an elastic element ( 128 ), contrary to the bias of the cutting device ( 12 ) in the operating position with the feed device ( 34 ) is engaged. Attachment device according to one of claims 25 to 27, characterized in that the cutting device ( 12 ) is designed so that it can be manually transferred from the operating position to the release position and / or vice versa. Attachment device according to one of the preceding claims, characterized in that the feed device ( 34 ) one the at least one feed member ( 62 ) at least partially surrounding sleeve-like feed body ( 38 ) connected to the cutting device ( 12 ) is engaged. Attachment device according to claim 29, characterized in that the feed body ( 38 ) the force application device ( 48 ) at least partially surrounds. Attachment device according to claim 29 or 30, characterized in that the feed body ( 38 ) at least one of the at least one feed member ( 62 ) for limiting its movement relative to the at least one cutting edge ( 26 ) associated stop ( 76 . 78 ) or trains. Attachment device according to one of the preceding claims, characterized in that the attachment device ( 200 ; 300 ) a supporting device ( 202 ) has at least one of the bones ( 88 ) can be applied ( 206 ). Attachment device according to claim 32, characterized in that the support device ( 202 ) an at least partially sleeve-like support body ( 204 ) and that the at least one support member ( 206 ) is arranged at one end thereof. Attachment device according to claim 32 or 33, characterized in that the support device ( 202 ) coaxial with the cutting device ( 12 ) and / or coaxial with the feed device ( 34 ) out is directed. Attachment device according to one of claims 32 to 34, characterized in that the support device ( 202 ) the cutting device ( 12 ) and / or the feed device ( 34 ) at least partially surrounds. Attachment device according to one of claims 32 to 35, characterized in that the support device ( 202 ) rotatably to the cutting device ( 12 ) is trained. Attachment device according to one of claims 32 to 36, characterized in that the support device ( 202 ) against rotation to the feed device ( 34 ) is trained. Attachment device according to one of claims 32 to 37, characterized in that the support device ( 202 ) relative to the at least one cutting edge ( 26 ) is formed linearly movable. Attachment device according to claim 38, characterized in that the support device ( 202 ) along one of the attachment device ( 200 ; 300 ) defined axis ( 28 ) relative to the at least one cutting edge ( 26 ) is formed linearly movable. Attachment device according to one of claims 32 to 39, characterized in that the support device ( 202 ) with the cutting device ( 12 ) forms a screw connection. Attachment device according to one of claims 32 to 40, characterized in that the support device ( 202 ) with the cutting device ( 12 ) is engaged. Attachment device according to one of the preceding claims, characterized in that the attachment device ( 300 ) one of the cutting device ( 12 ) associated first coupling device ( 354 ) with one with the at least one cutting element ( 22 ) operatively connected to the first coupling member ( 346 ) and a drivable second coupling member ( 350 ) connected to the first coupling member ( 346 ) cooperates. Attachment device according to claim 42, characterized in that the first coupling member ( 346 ) with the second coupling member ( 350 ) by applying force to the at least one cutting element ( 22 ) and / or the at least one feed member ( 34 ) can be brought into operative connection in the proximal direction. Attachment device according to claim 42 or 43, characterized in that the attachment device ( 300 ) a reset device ( 344 ), contrary to the action of the first coupling member ( 346 ) with the second coupling member ( 350 ) can be brought into operative connection. Attachment device according to one of claims 42 to 44, characterized in that the attachment device ( 300 ) is formed so that the first coupling member ( 346 ) with one of the second coupling member ( 350 ) Wegweisenden force can be acted upon, at least if the distance of the at least one feed member ( 62 ) of the at least one cutting edge ( 26 ) exceeds a minimum distance. Attachment device according to one of claims 42 to 45, characterized in that the first coupling member ( 346 ) and the second coupling member ( 350 ) as interlocking protrusions ( 348 . 352 ) are formed. Attachment device according to one of claims 32 to 46, characterized in that the attachment device ( 300 ) one of the support means ( 202 ) associated second coupling device ( 386 ) with one with the at least one support member ( 206 ) in operative connection third coupling member ( 380 ) and a drivable fourth coupling member ( 384 ) connected to the third coupling member ( 380 ) cooperates. Attachment device according to claim 47, characterized in that the third coupling member ( 380 ) with the fourth coupling member ( 384 ) by applying force to the at least one support member ( 206 ) can be brought into operative connection in the proximal direction. Attachment device according to claim 47 or 48, characterized in that the attachment device ( 300 ) a reset device ( 402 ), contrary to the action of the third coupling member ( 380 ) with the fourth coupling member ( 384 ) can be brought into operative connection. Attachment device according to one of claims 47 to 49, characterized in that the fourth coupling member ( 384 ) with the first coupling device ( 354 ) is mechanically coupled. Attachment device according to one of claims 47 to 50, characterized in that the third coupling member ( 380 ) and the fourth coupling member ( 384 ) as interlocking protrusions ( 382 . 390 ) are formed. Attachment device according to one of the preceding claims, characterized in that the cutting device ( 12 ) and the feed device ( 34 ) together at least partially form assembled and exchangeable assembly. Attachment device according to one of the preceding claims, characterized in that the attachment device ( 10 ; 100 ; 200 ; 300 ) a connection device for connecting the attachment device ( 10 ; 100 ; 200 ; 300 ) to a drive device ( 82 ) having. Surgical device ( 11 ; 101 ; 201 ; 301 ) for cutting a bone with at least one attachment device ( 10 ; 100 ; 200 ; 300 ), the attachment device ( 10 ; 100 ; 200 ; 300 ) a cutting device ( 12 ) with at least one at least one cutting edge ( 26 ) forming cutting element ( 22 ) for producing at least one cutting line on a bone ( 88 ), characterized in that the attachment device ( 10 ; 100 ; 200 ; 300 ) a feed device ( 34 ), the at least one feed member ( 62 ), which relative to at least one cutting edge ( 26 ) is movable and thereby can take a variable distance relative to this, and a Kraftbeaufschlagungseinrichtung ( 48 ), which is designed such that the at least one feed member ( 62 ) is acted upon by a force acting in the distal direction bar, at least if the distance exceeds a minimum distance. Apparatus according to claim 54, characterized in that the at least one attachment device ( 10 ; 100 ; 200 ; 300 ) is formed according to one of claims 2 to 53. Device according to claim 54 or 55, characterized in that the device ( 11 ; 101 ; 201 ; 301 ) one with the cutting device ( 12 ) couplable drive device ( 82 ) for driving the cutting device ( 12 ) having. Apparatus according to claim 56, characterized in that the drive device ( 82 ) is formed so that the cutting device ( 12 ) is driven in rotation. Device according to claim 56 or 57, characterized in that the drive device ( 82 ) is formed so that the cutting device ( 12 ) is oscillatory drivable. Device according to one of claims 56 to 58, characterized in that the drive device ( 82 ) is formed so that the cutting device ( 12 ) is drivable according to a pilgrim step method.